Friday Fragments, inspired by gravity

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

Yeah, I got here three hours early.

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

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

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

Fr d ay fra ent s

Because I wasn't fragmented enough by the end of the week....
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Apparently there's a nationwide shortage of propofol. The company is blaming a manufacturing error, but personally? I had no idea Michael Jackson's habit was that bad...
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The end result of the above is that this morning in the ECT suite we had to use sevoflurane, an inhaled anesthetic. I...I can't stand that stuff. I've had it a couple of times when I was under the knife, and I had a hell of a time coming out of it, I was nauseated; it's good stuff for most people, but I'm just not a big fan. And I remember when I was in GYN, when we'd have a long day of cases, I'd occasionally be quite woozy and wacky from inhaling that stuff all day. So when I smelled that this morning, I was not super pleased to be standing at the head of the bed.

One of my inpatients, however, came back up to the floor after his morning ECT treatment all like, "wow, they used this different anesthesia today, and man, that stuff was great! I feel so much better!!" I relayed this to the team downstairs between cases, and they all cracked up. Apparently he was one of the few people that had a pretty profound activation reaction to the anesthetic, and got rather giggly and was flirting with the nurses.
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My dog is sleeping with her back feet up by her head. She is the cutest thing ever.
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Here's a funny story I'm stealing from my cousin Danielle - her daughter, who's 2, came up and told her that the dog had nipped her. Danielle asked, why did he do that? Her too-smart-for-her-own-good kid says, "Because I pissed him off."
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I'm watching this week's SVU while I write this. All the major players are bickering at each other. That kind of makes me queasy, like watching your friends' parents fight.
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I do appreciate that Alex Cabot is back - again - though. And when the hell did Dickie Stabler grow up and get adorable?
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So things get a little loose in the psychiatry department on Friday afternoons. This evening, Eva comes into my office and convinces me and Betty to accompany her down the ER for a brief little thing she had to do down there. So we're on our way down, and we were contemplating what you would call a group of psychiatrists? A herd? A gaggle? Eva says, nah, I'm pretty sure it would be a murder, like crows. A murder of psychiatrists. I said, hmm....do you think we're really a murder? Or just, like, a homicidal ideation? So we start giggling about this. And relate the story to Sparrow, who looks at us, deadpan, shakes her head and says, "Word salad." Which lead to a lot of cackling (shrink humor. Not to mention that at this point, Eva, Betty, Peng and I were sitting in an office that belonged to none of us) and Betty howling, "We're a homicidal word ideation salad!" I, of course, couldn't leave that alone, and finally caught enough breath to yelp, "We're a homicidal salad!!!"

Heh. And our patients think we're sane....

"Why do you think people would treat you worse if they knew the truth?"

I'm watching last night's episode of House.

(Don't worry, no spoilers.)

He's in the psych ward. Several of my patients today were really upset about this episode, and I'm trying to figure out why. My conclusion thusfar (I'm maybe halfway through) is that it's just the State Psych Hospital feel of the set. Which...I have a lot of trouble believing someone like House would be in a place like this. But, okay.

I really like the lead psychiatrist (or at least, I did until the boundary crossing). I identify with him, I'm not sure why. I wonder what it says about me (I'm kind of wondering why it's not House I identify with). Maybe it's the stubborn. Or the interpretations. I've had a lot of patient visits and family meetings over the past few days in which I've spent a lot of time being way more directive and interpretive than I normally tend to be. So far, it's worked out, although there's one case I'm a wee bit worried about.

Okay, that's not true. I'm worried about most of them. It's what I do.

I dunno, y'all. I'm tired. And my stomach hurts. And I don't feel so good in general. I'm unsettled, and I'm pensive, and...I...yeah, I dunno....

So, episode over, and my opinion of it is overall positive. Although I think the catatonia girl storyline was pushing dramatic license a bit.

And, there was one line in there (not the title line, which I also like) that I think very eloquently sums up my own ideas about therapy:

"You've got to make things better, you can't just keep talking and hope for the best."

Funny how many people don't get that.

Hallucinosis

So I'm watching last night's episode of House on the DVR (because, of course, last night was not a House call....if you will....sorry, I'm tired). And House has, over the last episode or two, developed this tag-along hallucination of his best friend's dead girlfriend. Whom, incidentally, I hated when she was on the show the first time, but I like her a lot more as a hallucination. So, she's this representation of his subconscious, but one he can talk to and interact with.

This is a totally fascinating construct to me.

I'm giving this talk tomorrow on dissociative identity disorder, right, to the first year residents, so I've been going over all this stuff and doing these slides and have a part in there where I talk about how the alters are (in object relations terms) split-off parts of the principle and typically have "jobs", or rather, parceled-out bits of emotion and affect which they're responsible for processing, containing, or decontaminating. It's interesting to look at the way the writers have set this up, in that context.

I know, that was mostly a lot of psychobabble.

Y'all, I'm really tired.

I do have to say, though, I'm SO COMPLETELY irritated with their medical advisers. ECT is safe. It's not for psychosis. And why couldn't he work if he was taking antipsychotics? Seriously. Call a psychiatrist. And pay attention to your social responsibility - do you know how many of my patients come in and talk about stupid things they saw on House?

Alright, fine. I give up. I'm going to bed.

Love/Hate Thursday

Such a day.

So I drove to the coast today, because someone more powerful in the university than I needed my plane. And I kinda like the drive anyway, and I REALLY like not being a mile above the ground in a tin can with wings. So I get there, and I notice some of the vans have this odd gold paint on the windows. And I think....well, now, THAT's weird...

Turns out someone (with think one of our patients clients consumers people we serve individuals, most likely) vandalized five of the eight cars in our fleet, as well as the door to the office. Had they stuck to spray painting just the glass, it would've been okay (that comes right off with paint thinner), but they painted the mirrors, the license plates, etc, and they broke one of the windshields and wrote "CUNT" on the hood of one of the cars (which, of the whole team, only the non-me doc is male, so that doesn't narrow down much who they were pissed at). But they were kind enough to leave the can of spray paint and several beer cans just lush with fingerprints and probably DNA. Brilliant career criminals I'm thinking they're not...

Still. When you work your ass off and really go out of your way to help people, which the members of my ACTT do on a daily basis, and at that a group of people who are already not the easiest people or the most accepting of help...something like this can be really discouraging. They spend every day tracking people down, getting them services, going into some unsavory places, taking them to do the things they need to do, and, again, not the easiest clientele to begin with! They pay for things out of pocket, they take phone calls in the middle of the night, and they frequently go beyond what they need to. They're a good bunch, who don't get paid nearly well enough, have crappy benefits, and often put themselves in potentially dangerous situations. So this really pisses me off, and makes me a little bit sad for humanity as a whole...

The day itself, though, wasn't bad. It was a gorgeous and glorious sunny, 73 degree, bluebird day on the coast. I made good time going in, the peer counselor and I had some good visits with people (AND she quit smoking - day 12. Go her!), and then I bugged out around 3. I went to the gym when I got back, lifted, got the machines I wanted, and had a good workout (although I'm wondering if I can impose a No Stinky People On The Machines On Either Side Of Me ban....). And then I came home, had some hummus, caught up on FB, and am going to bed now, which, that can't be bad. And I downloaded and listened to Incredibad, the newly released album from The Lonely Island (see several posts ago, when I linked the video for I'm on a Boat, which is Track 4, and still my favorite, I think). It was freakin' hysterical. A couple of the tracks...okay, well, several....are pretty juvenile or just outright weird, but, on the whole, damn funny stuff (and, what do you know? Carlos Santana does make a sparkling wine. And have a line of women's shoes. Who knew??).

Oh, and, fortunately, Peng called me tonight and reminded me that Dollhouse premiers tomorrow night (I'm having dinner at my Aunt and Uncle's, but, the DVR is standing by). It's got Faith (Eliza Dushku)! And Fred (Amy Acker)! And allegedly Wash (Alan Tudyk, whom I still adore from when he played Gerhardt in 28 Days)! And it's from Joss Whedon! If only Summer Glau weren't otherwise engaged, it would be the supernova of the Whedonverse...and maybe they could drop James Marsters in there (I always liked Spike WAY better than Angel, even though Angel was the one that got the spin-off. But David Boreanaz is doing much better for himself these days).

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:

"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...

I...um...oy.

My Facebook status reads, currently:

Kate is concomitantly over-caffeinated and deliriously tired.

I'm so bloody tired right now. And a little bedraggled. Last night was not awful, and Mike was on night float and took good care of me overnight (he didn't even make me see anybody after 1am. I wandered in to the workroom sometime around 3:30, and he was sitting at the computer, piles of paper surrounding him on the floor, each referencing a patient that somebody or another wanted to send us. I was like, "You need help?" He sort of looks around, looks back at me, and says, "Nope." Who am I to argue? I went back to bed. Well, I went back to my office. I dictated two clinic notes, checked my email, putzed and fussed, and then finally went to sleep around 5. I actually slept pretty darn well from 5-8, but from 1:30-3:30, I tossed and turned in this restless, shallow, inexplicably anxious sort of sleep, which I find is almost worse than just staying up.

There's cable in the intern lounge now. And a recliner. I should've just gone in there and dozed...

Sparrow's always reminding me that it's perfectly reasonable to be useless on your post-call day. Maybe if I would just quit fussing and lay in bed and watch House on these days, I wouldn't end up doing that on the weekends. But, nooo, I'm always trying to be "productive." Pah.

(Sparrow, by the way, so totally rocks. It was, to quote Peng, "ass-bitingly cold" this morning. So Sparrow calls me up and is like, I don't have to be at work until 10, and it's way too cold for you to walk, do you want me to give you a ride home? I almost cried. She also picked up dinner for us last night - which, apparently, Little Maxine got to come along for the trip, and thought the food was for her, and couldn't understand why Sparrow wouldn't let her eat it. Tyler - who met her downstairs - was very amused by Little Maxine. They - Maxine and Sparrow - also took good care of Ms. Mags overnight. Sparrow's so totally my hero today.)

I caught a little nap today. I tried to read. I saw my shrink and waxed philosophic about work for an hour. And I joined the gym. I liked the gym. They were very friendly. I have my complementary assessment and workout (read: sales pitch) with this large, bald, black wall of muscle named Joe on Friday night (I'm on call Saturday. Here's hoping I can still walk). There were old people working out (apparently they have three members over 90) and I got high-fived by the staff a lot. I also got a wicked (WICKED) deal because the manager was in a good mood and thought I was cute.

(One thing I've noticed about North Carolina, both today at the gym and in the context of various people I've met thusfar, is that personal trainers tend to be large black walls of muscle. Who tend to think ass-ful white girls are hot. A girl could get used to that.)

So I sign all the papers and pay - cash, since I don't want to be paying credit card interest on it and specifically took this out of my bonus money. But they had to ask the manager if they accepted cash for membership payments. I thought that was hysterical - and as she's handing me my change she says, "oh, by the way, about our cancellation policy..." And it took a good deal of restraint in my shriveled-up post-call brain to keep from laughing at her and saying, "I want to quit the gym!"

(Which, if you missed the reference, is not actually the case. Rather, it reiterates that there is a Friends analogy for every situation in life. Exhibit A:

)

So then I went to Starbucks and pretended to read for a while, and then I went to class. My first class was good, as it always is, but the second...I'm discovering I don't especially enjoy it, although I find the material interesting. And tonight, right, we get to talking about attachment, and this concept, which I think is huge giganamous gargantuan - the infantile attachment bond determines what "safety" feels like for a given individual. So if you're a baby surrounded by chaos, or inconsistent reinforcement, or a detached and unresponsive parent, this becomes your view of "normal" and "safe."

It's a simple, very reasonable statement. But the implications of that are just HUUUUUUGE.

I've really been pondering that hard. What I found disheartening, though, is that my leader/teacher/whatever I'm supposed to call him eventually pointed out that this gets strongly internalized and likely doesn't change, you know, ever.

Which, well, made me want to curl up in a corner and rock a little. Because if that's true (which, it is, to a degree, I think, but that degree, and the factors that modulate it, are important), then what I do is futile. Which is daunting, particularly for someone who wants to work with people repeatedly traumatized at an early age.

Anyhow....I have to be slept and dressed and showered and in my supervisor's office in 10 hours to learn how to practice my futile craft better, so I guess I'd better get to bed....

The best laid plans...

Maggie and I had such plans for today. We were going to sleep in (check). The movers were coming this morning to give us an estimate on packing, moving, and storing. They were very nice, and Maggie really liked the one guy. So I'm using this moving company, right, that's part of a comprehensive rehab program for substance abusers. So these two guys show up, all tattooed ex-badasses, in their ironed chinos and short hair, smelling pleasant and just as polite as can be. They were quick and efficient. And then I had all these great ideas about spending most of the day doing discharge summaries (I'm SOOOOOOO behind) and then starting to weed out stuff that's getting sent off to charity. Because, the house that I'm moving to is about half the square footage of the one I'm currently renting, so, lots has to go. And did I mention we're moving in LESS THAN TWO WEEKS, now?

Ahhhh, well.

I guess the working like 100 hours a week is finally catching up with me. Maggie and I spent the whole day watching Animal Planet and napping on the couch. Like, literally, it was suddenly 7pm and I had finished exactly one d/c summary.


We watched Animal Police, Houston. And Detroit. And, um, Miami (we love Animal Police. I really think Maggie just likes the barking. I like seeing the dogs in their new homes at the end. And Animal Police Miami always has alligators and horses and cool stuff like that). And we watched several episodes of this bizarre reality show, Groomer Has It.

Wow. Such ridiculous drama. But strangely addictive. And hosted by Jai, my absolute favorite Queer Eye guy. And next week they're going to the pound. We may have to watch.

So Jai is dealing with crazy dog groomers (at least he has a cute sidekick messenger dog), and Carson is telling fat girls they look good naked (of course they do). Ah, how the dynasty has...well...gone to the Crab People.


She really does get into some screwball poses to hang out and watch TV.

So now we're watching this very silly show called Showdog Moms and Dads. Which is another ridiculous reality show. Except it's not supposed to be so silly. But...ever see Best In Show? (If you haven't, you really need to.) It's exactly like that. Which...was supposed to be a parody. Oh, dear.

I guess we need to have a useless day every once in a while...

Hell's Pass Mental Hospital

(Double bonus points for anyone who gets that. Triple bonus points for anyone who gets that before reading the rest of the post).

I had something to say earlier.......although now I can't remember what. I was...somewhere, here, in the hospital (I'm on call again, big shocker)...and I thought, oh, that's so going on the blog....and now....no clue.

::sigh:: It sucks to be old and sleep deprived.

Oh. It was the EMTALA thing. Yeah, now that I'm not totally mad about it, it doesn't seem so interesting anymore.

Call's been frustrating, but not yet awful. We had a good medical student here during the day. I like my senior a lot, and I've not been on call with her before, but I'm enjoying it. We ordered Mexican food for dinner, and Mike was able to come join us (he's on for Neuro call tonight). He always has good stories. And this woman on the ED unit is having poop issues, which I keep getting paged about (She threw up! She can't poop! She pooped a little! It hurts to poop! She pooped three little hard rock things! Now the poop's like golf balls! Poop! Poop! Poop!), and so we made many inappropriate jokes and Mike whipped out this poop rating scale (no, it's a real diagnostic scale. Honest to God) that one of the medical students had put on a little card for him.

We've giggled way too much about poop tonight. It's like an episode of South Park over here...

Dogs, Drugs, and Dissociation

So, I made it through the week.

Hooray!

Today I haven't done much. Mags and I went to Starbucks this morning to read, but met some other people with a dog and talked to them for a while. Their dog was named Ally and she was this German Shepherd that was a little bit bigger than Mags. She wasn't well socialized, so we all stayed sort of wary, but she did pretty well with Mags. They were well socialized, though, and we had a very nice chat. After they left to go take Ally to the lake (apparently she likes the lake. Aww), they were replaced by a weird middle aged swarthy gentleman who was rattling along on is cell phone in what I can only guess was Lebanese. He was a little leery, and kind of creepy, so we left shortly after that. And I really haven't done a whole lot since we got home except nap, and read a little, and nap some more.

I still haven't started packing, although I think I did hire a mover. They haven't actually looked at the house yet, and we've mostly been playing phone tag, but they have availability the day I want to move, and I decided a few weeks ago that I wanted to use them. They're allegedly quite good and really cheap, but the more important thing (I think) is that they're an offshoot company of a treatment center for substance abusers. It's at least a two year commitment, I think, and you have to be clean - really clean - for the first year you're in residence before they'll let you work at any of their businesses. And the moment you slip up, you're out. But it's a fantastic second (or third, or eighth, or fiftieth) chance, a good honest living, and a great opportunity. For all parties involved.

Maybe if they're really as cheap as their rates on the website, I'll even let them pack me up. Because, let me tell you how quickly that's going over here.

I'm so tired. Physically, mentally, emotionally, metaphorically.

At least, as the week came to a close, I actually started to enjoy work a little bit. Like, I can at least appreciate how interesting this all is and think about how it might connect into adult pathology. The stuff that I find so fascinating in adulthood, it starts right here. The kids are interesting. Also still scary. But I've been able to separate the fact that I'm living in hell from the patients and the units. Not that the hell has really abated, just, it's not their fault. It's activating, what I'm doing, but it's activating my stuff. My stuff that's got to get dealt with eventually. So maybe the stimulation is good.

Which is unfortunate, because it feels like shit.

It's a hard feeling to articulate. It feels like I'm walking in one reality, and living in another. Another that no one else can see. It's very weird...and a little Joss Whedon, frankly.

Love Friday

Ohhh, so not feelin' the love today.

I wish I had the energy to tell you about the wackiness that's gone on this week on the unit. But I don't. So I tell you what I do love.


5. It's spring in North Carolina.

4. That Snoop Dogg is on Monk tonight.

3. That the new meat next year's intern class is identified in less than two weeks (it's like a light at the end of the tunnel, you know?)

2. I'm done (DONE!) with Crisis.

1. I'm on call tomorrow. Not normally a cause for joy, BUT, Daylight Savings Time starts Sunday morning. We spring forward! For the first three years that I was doing clinical medicine, I was on call for the fall back. Every year. This year, not only was I not on for that, I'm on call for the call that's a whole hour shorter! And, it turns out I'm on call with a resident I really like, instead of the one I thought I was on with, whom I don't really know but haven't really cared much for the limited times I've met her.

In less lovely news, ANOTHER ONE of our interns announced that he's leaving today. He's got good reasoning - he can't get his research funded here, and he's the one that's part time and spends the rest of his time doing research. But it's sad, because I really like him, and his partner.

Yet another perspective

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

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

But nonetheless. So Olivia says to her,

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

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

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

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

At least with this guy, I had a choice.

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

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

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

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

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

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

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

Him? That's my Jew.

That one made me giggle.

Of course, of course

First, though - what the hell is wrong with New Hampshire??!?!!!?! I mean, you'd think that a year of living there would be more than enough for me to stop asking this question, but, I mean...at least Obama took Iowa.

I voted in NH in the last presidential election. They gave me a legal-sized sheet of paper, and a pen. It's the only time in my very lengthy voting history (ahem) that I've voted straight ticket...because all six people I happened to want to vote for were democrats, and, um, there were only about six races on the ballot.

With a pen. Did I mention the pen? No hanging chads in New Hampshire. Freakin' ass-backwards state. I should've known to turn and run right then.

Then again....here's the end of my day today. I walked out of the hospital, called my folks, and when my dad picked up and asked me how I was, said very loudly "I AM SO FRIGGIN' GLAD TO BE OUT OF THIS GODDAM HOSPITAL." Then I sat in [long string of expletives] basketball traffic. Because, of course, the hospital sits in the middle of the college campus, literally. You know that scene in Renaissance Man where Danny Devito gets awakened by the Army boot camp recruits doing loud morning calisthenics at 5am, and runs around the grounds yelling "GO NAVY!"

I was thisclose to opening all my windows and yelling "Go Duke! Go Duke!"

But I did take advantage of the down time by texting my co-intern with the following message:

You're going to need to commit me soon for homicidality. Also, Betsy wants you to round on seven patients tomorrow morning because she can't write that many notes. (Maybe if we share a room on the inpatient unit, they'll give us a group rate?)

This was followed by a forty minute conversation with Mike and then an hour and a half phone conversation with my attending.

Today....I....oh my God.

Today was the first day of this new curriculum on the part of the Family Medicine department where they corral all their residents for learning on Wednesday mornings. Which meant the only residents left were me, Mike, and the Duke resident. Mike was postcall, and he'd had a rough night. So I made him sign all his work out to me and took his pager and then my attending (have I given her a pseudonym yet? I don't remember. Let's call her Sarah) and I sent him to go sleep for a while. And then we went off and tried to take care of some patients and get some stuff done and had some very manic and wacky walk rounds.

In the midst of this, by the way, we were awfully punchy, and I don't remember for the life of me what prompted this, but she started walking down the hall singing the Mr. Ed theme song. And she gets to the "famous Mr. Ed! Wil-bur!!" part, and...I'm so not kidding...someone in one of the patient room whinnied. Right on cue. It was the funniest damn thing I've heard in a long time.

We've conferred - we both heard it.

So then Betsy, our upper level, pages me. We'd both thought she was in clinic. Know why? Because this morning she told us that she had clinic. So she pages me, and is like, where are you? She's back from lecture (an hour and a half later than everyone else, by the way) and is all pissed off because you know, if I don't keep her informed she will never be able to run the service. And then we meet up with her (after we do some actual, you know, work), she sits us down and has this, like, 30 minute intervention. Which means basically she, a second year resident, berated Sarah, my attending physician, for a full half hour in front me, an intern from another department. About how Sarah was not respecting her and undermining her ability to do her job by - more or less - helping too much.

I....just....I...for.....what the fuck, woman?

What it boils down to, frankly, is she's making all of this all about her. It isn't about her. You know what? It's not about her at all. It's about taking care of patients. Something that needs to be done as a team. And you know what else? If she was doing her fucking job, Sarah and her co-attending, the, um, department chair, wouldn't need to interfere so much.

I really wanted to smack her. What I did, after about twenty minutes, was interrupt. And she says, "you're interrupting me."

I said, "Yes." And then I pointed out that I wasn't really involved, here, so, um, could I go take care of the page-long list of jobs I had to do?

She says, "No. This involves you."

How it involved me in any manner other than making me an audience to her histrionic, self-indulgent unprofessional behavior is totally beyond me.

Part of what she brought up was how poorly it reflected on her when the resident coming on call walked into the call room and found Mike asleep. Neither Mike, nor Sara, nor I can figure out why. It had nothing to do with her. It wasn't about her. It was a benevolent thing for us to do. And at one point she brought up the duty hours issue. I was like, oh, honey, don't even start. Because let me tell you, no one knows the ACGME duty hour rules better than I do. Not after life at the Emerald Palace.

Sarah slipped me her phone number on the way out and mouthed "call me." She felt really bad about me having to be involved in all this, she says. I was like, um, it wasn't you. Betsy wouldn't have let it go down any other way. ::sigh:: I don't understand people sometimes. I've really hit my limit with Betsy's behavior. I'm really not sure how I'm going to handle three more weeks of her without any hair-pulling. And of course next week Mike and I switch places and I stop taking Saturday call at State Hospital and start taking call with the Family Medicine team every fourth night. I'm a little concerned about this, because Mike's mantra over the past few weeks has become "I hate my life."

Fortunately, I have tomorrow off. Because, you know, I get one day off a week, and I'm on call on the weekends. Thank God. I think Maggie's excited about it, too.

"For someone who hates psychology, she sure has a lot of it."

It's one of my favorite quotes from the pilot episode of Bones, which is on tonight. And it's so true. I'd forgotten what a grumpy, cocky "cop" Booth was in the pilot. I'm glad he got over it. And I really like that Booth is all angsty, thoughtful, pining for a woman he can't have, again, except he has so much more depth in his thoughtful pining angst than Angel ever did. And Boreanaz is even cuter in the daylight.

Today was long again. Not quite as stressful, partly because I'd planned on going to SNB tonight at the local Borders, and the dog sitter came during the day. Needless to say, I didn't make it to knitting. I only left two patients of mine on our service, but, we're admitting tonight. I, truly, was done with my work at 2pm. But I left after 7. Because there was rounding and then this and then that and oyyy. And then one of my patients got sicker. So I stuck around for another hour fussing so Mike wouldn't have to. And I tied up his patient into a neat little package for discharge. It was a favor but you survive this life on favors-both the ones you get, and the ones you give. And no, I don't expect him to stay nearly this late when, starting next week, I'm the call girl du jour. Although....okay, maybe I will expect him to reciprocate on the post-call coffee I'm bringing him in the morning....

Because there is simply nothing better than a hot post-call beverage of choice from outside the hospital. It's that warm, little comforting cup of hope that the free world still exists somewhere outside the sterile and stagnant confines. Okay...there is one thing better...the post-call nap. Preferably a post-call nap with a warm dog or some other snuggly warm mammal.

I'm babbling again. I have a really sick patient I spent of a lot of today fussing over. I'm still really tired. Oy....I'm going to turn off House, which is now on because Bones got all solved and done with, and go to bed. But, after this:

"Treating illness is why we became doctors. Treating people is what makes most doctors miserable." It's a quite from tonight's House which more or less illustrates why I don't usually watch House. But....I will give him a tremendous amount of credit for this one:

"It's five o'clock. I'm going home."

Me siento en la necisitad por la velocidad

I'm watching Top Gun. On cable. In Spanish.

I don't so much speak Spanish.

That in and of itself isn't entirely peculiar - I occasionally watch some of my DVDs with the Spanish tracks on (and usually with the English subtitles). Because I do keep trying to learn Spanish. But this is cracking me the hell up. Like, things that aren't actually meant to be funny are making me cackle out loud. Part of it is the two hours of horrible, horrible sleep I got last night. Part of it is that I understand enough Spanish to understand how poorly some idioms translate on Telefutura (i.e., Goose says, when Charlie asks what they were doing un metre y medio from the MIG, "giving them the bird." Spanish Goose says something closer to "throwing a bird at them." How does one not crack up at that?). Part of it is how much I simultaneously love this movie and abhor Tom Cruise (no, I'm not entirely certain why that last piece contributes to all the giggling, but, it does). And he still looks like a rodent. Rick Rossovich looks equally delicious all oiled up with his shirt off in Spanish, though. And I never have been able to figure out why exactly Kelly McGillis is a "consultant" at Top Gun, in any language.

Does it surprise anyone else, as a total aside, that Katie Holmes has a new movie coming out? With Diane Keaton and Queen Latifah. It actually looks kind of funny in that over the top goofy, First Wives' Club kind of way. I'm just amazed he's letting her work. And all her hair seems to have grown back.

I'm so tired. Maybe I'll have something useful to say later...

Rainy Sunday

It's a rainy, rainy Sunday afternoon here in NC. Little Miss Delicate Puppy Dog is not pleased, neither by the giant puddle that is our back patio nor by the thunder that's rumbling around. I think maybe she's forgotten about her dislike for snow, though.

I'm feeling better. I'm not willing to go to "great" yet, still a little dizzy and nauseated but I'm significantly less achy and slept a little better last night. And my temp is down. I think the staying home yesterday was good for me (regardless of the fact that I would've been useless at the hospital). I even managed to go run some errands this morning. I was going to run to the Super Target, where, in theory, I could get everything I needed. But, of course, I totally forgot something that I didn't remember until after I'd left, which is my habit with Target. So I stopped at the Whole Foods to pick up milk. Which was better, anyway, because they always have local goods, and I'm always much happier to buy local. And while I was in the dairy section, I bought this:
Partly because I was running low on feta cheese (it's a staple around here). Partly because it cracked me up. Apparently this spelling is because the Greek government is cracking down on their proprietary right to call only cheese made in Greece "feta".

Pheta...

And as long as we're taking pictures of ridiculous things in my fridge, I also happen to think this is really funny. I have this package of polenta, right? And in the preparation instructions, is this:

Nine sixteenths? Really? They couldn't have just said half an inch?

Anyway. As I was saying.

Maggie and I spent pretty much the whole day hanging outdoing nothing yesterday (which, incidentally, is also my plan for this afternoon). Pretty much any time I got up, Mags stole my place on the couch.

We spent most of the time that we were awake watching movies on Lifetime. I got sucked in to the end of this really, really awful one called Criminal Intent. Wow, holy cow was it terrible. The acting was terrible. The plot was ludicrous. I'd watched about ten minutes of it and turned on something else, but then decided to turn it back on to catch the last fifteen minutes. Wow, it was so bad.


But by then I was sucked into the Lifetime vortex, and I ended up watching this movie about some Mormon woman in one of those extremist polygamist sects that escaped with her kids. It was formulaic, but entertaining. And then there was this movie called "Girl, posi+ive" with Kelly from 90210 (why can't I think of her name? Oh, Jennie Garth) about a girl that got HIV in high school. That one was actually fairly creative. And then I watched "The Waitress" on On Demand. I'd kind of wanted to see it back when it was in the little art film theaters, but never got around to it, and then yesterday they were advertising it and I discovered that it had Nathan Fillion in it, and well, I was sold (I adore him, even if he does have that weird hypertelorism thing going on). It was decent. Not as good as I was expecting after all the hype, and I didn't really like the relationship between Fillion's character and Keri Russell's (I think it's because I'm a doctor. There was a whole, medical ethics, makes-me-feel-kind-of-icky-inside thing to it that I probably wouldn't have responded to if I was, say, an accountant). But on the whole, worth the cheap rental.

So this afternoon I'm planning to do some knitting (I'm thisclose to having my sock finished. You know, the one I started in June) and nap through a marathon of Law and Order: SVU, which is one of my new favorite shows. Not because of the show itself all that much. I mean, it's well acted in general. The plotlines are usually fairly well written (although I occasionally find myself rolling my eyes when they blow right past the obvious solution and thinking, don't you people ever watch CSI??). And who doesn't love the irony of "Body Count" Ice-T as a cop? But really, what I love most is their liberal use of forensic psychiatrists, particularly the later episodes with B.D. Wong. That? Is the job I want. Right there. Profiling. Consulting to law enforcement. Doing actual criminology and forensics work, not prison psychiatry. Except maybe for the FBI. Really, I want to be Gordon Gordon.

Shut up, Katie, I do not watch too much TV.....

Insisting that the world keep turning our way

(If you missed the reference, click here. And be ashamed of yourself! That's, like, the ultimate road trip classic.)

So I'm in Charleston. The one in West Virginia. There's two out here, you know. Allegedly that confuses a lot of northerners, or so I'm told. I was hoping to get all the way to Beckley, WV, but, I got kind of a late start, and you know, that extra hour seemed like it was going to be a lot longer tonight than it will be tomorrow...and it's still a mere 5 hours to home, now, so hey.

I'm in the Hampton Inn. I've only stayed at this chain once before, when I went down to NC to look for apartments. On my way home, I was going to stop for the evening, and then decided, nah, I'll just keep going, but as long as I'm off the highway, I should get gas. And I started filling up my tank, and the nozzle promptly fell out of the gas tank and danced around a little until it shut off, soaking me with gasoline from about mid-thigh down in the process. Fortunately, I was travelling, so I had a spare pair of pants right on hand. I threw the old ones out in the gas station restroom, but figured I still ought to get to the nearest possible shower and decontaminate (did you ever see that episode of M*A*S*H where Klinger threatens to immolate himself, and then Colonel Potter realizes he just has water in the gas can, and so while he's inside "negotiating" with Max, Radar switches it out for a real gas can, and Max walks back out, all dramatic, and pours this gasoline over his head, and realizes the switch, and says, "Hey! Wait a minute! Somebody put gasoline in my gasoline!", and then runs flailing into the nurses' shower screaming "Stand back! Stay away from me with that cigarette! Nobody light a match!!"? I felt a little like that...). And, the Hampton Inn just happened to be behind the gas station. And it was one of the nicest places I've stayed, I have to say. The desk agent even upgraded me to a suite after I told her about the gasoline incident (I figured I ought to explain the smell as well as my immediate inquiry about laundry facilities). And the bed was insanely comfy. This room is equally nice.



Fancy. And under $100. If only there was room service, I might just move in.

The rooms across the hall, however, are still being renovated with the carpet all ripped up and the doors off their hinges and mattresses still in bags strewn all over. So it's a little bit of a war zone outside my door, and the place sort of smells like paint. But the rooms over here are, like, all new and shiny.

I'm really tired, in case you missed that. I'm not sure I actually have anything very profound to say tonight, actually. So maybe I'll go investigate the insane comfyness of that bed...