Saturday, March 29, 2008

Spring Cleaning


Enough of the endless winter ennui.

Enough of feeling sorry for myself for the lack of spring. And the persistance of grime. And mouse turds.


Enough of yet another week lost in work and illness. (Yes. The ninth bout of crud for this season. Not approaching that horrible season of '01, where I succumbed to 14 separate bouts of crud between November and June--the first year of same-day-caring and therefore abbreviated, no less, so stop whining.)


So, I arose with some semblance of energy and a bee in my butt. Well, a bee after a morning loafing with the small ones on the sofas, eating breakfast and doing nothing of value beyond the eating and getting breakfast for various and sundry beings. And that after sleeping in to the slothful hour of 7:04 AM CDT. ("Boy, mom sure sleeps late on weekends, doesn't she, Dad? Yes, son, she sure does, but some people like to sleep in a bit on the weekends.")


Well, enough after lunch and a rest. And the getting of lunch for the various and sundry. And the starting of seeds in small pots of peat under newly purchased grow lights. $100 spent to save $40 in new plants. If they live. But if one is going to claim to be a gardener, at some point one really does need to commit to growing more than sunflowers from seed. (And let's face it, the sunflowers have had less than a 50% success rate. More like 5%. Sunflowers. The things that grow where birds poop them.)

Enough. 1:30 pm and out you go. To the garage where you need to expell the garage floor of winter gravel and sand and dust on the floor of cement. And mouse doodies. Let's not forget the pounds of mouse doodies. Apparently the few field mice that did manage to get into the garage this winter found it to be the land of milk and honey and bags of garbage of partially eaten foodstuffs. And it was good. And cathartic. And they did eat much of it. And now, that they are no more with us (may their little beady-eyed souls rest in peace in the great garbage-filled garage in the sky), it is time to rid the garage of their evidence, the small black ovals blanketing the garage. (Let's try not to remember the symptoms of Hantavirus, shall we? Or the Hantavirus deaths.)

A full hour spent sweeping the detritus of the winter from the garage. And now to the garden. The first day of gardening. The first day of cleaning out two of the three parts of the front flower beds, each finally with noses of the bulbs of daffodils and tulips and the first flowers of the bravest of crocuses up, finally exposed to the sun, previously hidden by the rotting, frozen plant matter of last fall's fallen, now removed. New. Green. Forgotten. Remembered.

Oh, but wait.

I forgot the visitor.

Standing 100 meters (100 yards for those of us who still cling to the outmoded) from where I paced, sweeping, was the large, antler-free quadroped, gleaning the freshly plowed cornfield across the road and looking like chiseled Adonis. Molly-dog and I surreptitiously watched him from across the road for 10 minutes as he studiously ignored us, looking buff but aware of our admiration. And then the spell was broken.

Charles, sleepy from his afternoon nap (naps are important if you start your day at 5 am on the weekend for no better reason than habit), stepped out to investigate the dual sighting of a llama in the cornfield across the road.

("Dad! Dad! Wake up! There's a LLAMA across the road! Really! You've got to come and see!)

We decide that our children may not be as countrified as we thought, if they can't tell the difference between a llama and a deer at a distance of 100 m. (The 'llama' having bounded away in a distinctly un-llama-like fashion, flashing his white tale.)

Or maybe it's not that they aren't yet countrified, but it's in their genes to see llamas.

Happy springish.

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Tuesday, March 25, 2008

Call Of The Sirens (Part V)

The next installment of one person's faded reminiscences of medical training from the mid '80s to the mid '90s.

When last we left our heroine, there she was, having gotten all of the easier rotations out of her way, which, while not stress free, by any means, did enable her to go home to dinner and her own bed at night. She was able to see something of her friends of a weekend and even get a little exercise. Nothing helps sanity like a night's sleep in your own bed and having a beer with your friends on a Saturday night.

At this point in time, there were two specialties that I was seriously considering: Internal Medicine and Obstetrics/Gynecology. The internal medicine seemed a good match with my personality--it's for the plodders, the fiddlers, those with a fair amount of patience and attention to detail, who don't mind spending their days finding just the right cocktail of potentially lethal drugs to treat senile Aunt Mary's end stage congestive heart failure, complicated by brittle diabetes, labile hypertension, not to mention Aunt Mary's propensity to take a swing at anyone coming near her who somehow resembles Myrtle, her hated neighbor of 40 years ago. It's for someone who gets a gleam in their eye when being presented with a patient having 21 problems on their medical problem list, 22 drugs on their medication list, 14 drugs on their allergy list, symptoms of "I'm weak and dizzy all over" and a desire to talk about The War; yet who won't forget to make sure tetanus, influenza, and pneumonia vaccine status is always up to date. Oh, yeah! Bring it!

Ob/Gyn appealed to a slightly different part of me; the part that loved using scalpel and suture, the part that had a pull toward women's health issues, not to mention that whole miracle of birth stuff (sniff!).

With such heady decisions in mind, at the age of 24, I faced the next 18 weeks--a month and a half on ob/gyn, followed by 3 months of internal medicine, all in the depths of winter. Nothing like seeing your potential future at its bleakest.

You know, I figured that of all the areas of medicine, ob/gyn was likely to be the most joyous. I was so very wrong.

Ob/gyn was a bleak, living hell, peopled with exhausted, angry, bitter beings, whose only joy in life was spreading their bile and vitriol as far and wide as they could. At least that's what it was like on the University Hospital's obstetrics unit. There were, I believe, 6 of us students, one of whom was my good friend, Adam, who became my twisted rope of mental sanity. Without Adam, the bitter and cynical (emaciated and ever-pale, living on only coffee and the occasional stale cookie) soul that he was, and therefore only minimally affected by all the toxic atmosphere, I'd have shut myself into a cupboard to hide with the emesis basins and die. Adam, who cajoled me down the stairs, smelling of placenta and urine, after yet another sleepless night spent watching the scratchy patterns on the fetal monitor strips, checking cervices for dilatation. ("Um, 5 cm?" "NO! Idiot! 6 cm! Can't you feel the difference? And she's +1, not 0! Worthless scum!") Another night, following a day and being followed by yet another day, of getting literally pushed out of the way with a 1-2 combination of hip bump and elbow swing, deftly executed by one of the interns, who dashed in at the end to catch the baby, and cut and sew up the episiotomy. I did get a few deliveries myself over the weeks, but it wasn't the experience I'd wished for. Adam, who, no matter how angry my rantings, always topped my woeful grousings and made me smile ruefully, as we tromped off in the early morning hours, cups of bad coffee in hand, to check all the new moms on the MFBU (mother-fuckin'-baby unit), to make sure their C-section incisions were healing well, and cajole them to get up and walk around, dammit (the more you walk, the faster you fart, the faster you fart, the faster you poop, the faster you poop, the sooner you get the hell off our service and out of the hospital).

For a couple of weeks during the day, we were also farmed out to the inpatient gynecologic service, which was mostly ghastly bizarro tumors. The 'best' was the one the size of a beach ball in this very lovely woman. Fortunately, she had a good outcome, if a prolonged hospital course. The worst was the one with a horrific vulvar cancer that required not only the removal of her genitalia (external and internal) but half her pelvis and one of her legs. You don't forget that. No, you don't. She was youngish, in her 40s, I believe. We also spent time in the gyn clinic, doing lots and lots of pelvic exams, or at least the female students did. Poor Adam and the other guys seemed to spend a lot of time standing outside closed exam room doors. The women would let the guys in for the history taking part but were less than thrilled with them being there for the exam, which was understandable. The WWII vets in the urology clinic were a different matter. I only had one request that a male examine him. You can't beat a WWII vet for toughness. (Or maybe they were just being pervy.)

In speaking to my colleagues who drew their ob/gyn rotations at the private hospital across town, I heard that their experiences were completely different, with cheerful residents happy to teach and nurses happy to help and guide. None of us of the MFBU brigade believed such blatant bullshit.

Ob/gyn was pure, toxic evil.

So. That left me with only internal medicine on my now very short list, which, of course, put me into a state of extreme-freak. Nothing like knowing that you not only need to love it, but that you need to impress the socks off the attendings so you can get strong letters of reference for your applications for residency programs in a year. Don't want to end up as a house officer in the unheard of and uncared about residency program at St Mary's Hospital of the Long Forgotten in Blackhole, North Dakota, no-siree-bob. This is not to disparage North Dakota. I personally find North Dakota rather pretty, but it does have the reputation of being near the ends of the American earth, which is a bit odd as it's in the center of the continent. The vagaries of geography and extreme cold.

I think we'll take a break, here, as we next travel to the wonderful world of internal medicine, which in the true spirit of an internist, will be discussed in excruciating detail. (Bonus factoid: Why are internists called 'fleas'? Because they're the last thing off a dead body.)

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Thursday, March 20, 2008

Intersections Of Alternate Universes

Our scene: A medical exam room, Room # 2, that's quite a bit past its prime, but clean and reasonably well stocked with antique magazines proclaiming "At Home With Mamie Eisenhower" and "What Do Your Biorhythms Have In Store For You In 1977?" Seated is a young man, waiting to see the physician. He appears to be normal and sane. Enter our heroine with a pleasant "Hello" and an introduction. She sits and enquires of our young man how she can help, and listens politely.

Young Man: "I have a rash on my arm. It comes and goes and it won't go away."

Our Heroine: "I see. Does it hurt or itch? How long has it been like that?" (Etc, etc, many in-depth questions about the rash and the young man's life, career, and other assorted necessary questions.)

Our Heroine then proceeds to examine the rash, which looks like a classic spot of eczema (aka: atopic dermatitis). She is thorough in her exam and then sits down explaining eczema and its treatment and the expected time frame of outcome. She hands YM a prescription for the appropriate cream to treat it and discusses moisturizing. She then asks if there are any other concerns.

YM: "See, that's not it. I drank some hot tea from Fastfoodplace a few days ago and it didn't taste right. I got a bacterial infection from it and now it's in my blood and my body and coming out through my skin. I need a strong antibiotic for it."

OH: "Oh. OK. Let's talk about bacterial infections in the blood and skin and what you see with them." She then proceeds to briefly discuss this so YM can understand that the patch of eczema on his arm that waxes and wanes is in no way caused by bacteremia (bacteria in the blood) or its related conditions. She is not laughing nor joking.

YM (angrily): "Well, I see I will have to go all the way to Milwaukee to get competent medical care. This is from the bacterial infection I got from the tea. Just give me the antibiotic. I heard you were a good doctor and you clearly are not. I don't deserve to be laughed at. I deserve proper medical care."

OH (very calmly): "Well, it's certainly your right to go where you choose for your medical care and I'm sorry you feel that you are not being taken seriously. I take all the patients I see very seriously and give the best care I am able to. I realize that you disagree with me, but your rash does not require antibiotics."

YM (now frustrated and very angry): "How can you say that? You didn't even test me for infection. I want a urine test to show the bacterial infection in my body. You didn't even do a urine test! I want proper medical care, not some incompetent to sit there and laugh at me!"

OH (completely bewildered but trying to remain calm): "I can see that you're upset, but I can't treat you with something for which you have no medical indication. None of your symptoms fit with a urine or any other infection. Treating you with an antibiotic would not only not help you but would be potentially harmful and I'm not going to risk hurting you."

YM: "Well, I'm going to Chicago to see a real doctor, who'll treat me seriously!"

OH: "That's certainly your right. I'm sorry you feel that way. Good day."

Exit Our Heroine.

It is then that she realizes what has happened. It's the only explanation that fits. In that very small and unassuming exam room, there was an intersection of two alternate universes. In one were our two beings. In the other, were a person with necrotizing fasciitis or perhaps staph scalded skin syndrome appalled that the physician was trying to treat him with multiple broad spectrum antibiotics and possibly wide debridement (the cutting away of all potentially damaged tissue, to the point of removing healthy tissue so as not to miss any infection--very disfiguring in general) and hyperbaric oxygen therapy for what they felt was only a mild case of eczema. Horrifying, indeed. I hope the bad outcome is averted.

In my case, the only bad outcome was that YM stood at the desk and amazed our front and back office staff by first demanding and then filling out a complaint form about me and my substandard medical care. (An aside: Apparently the rules of grammar and spelling are only minimally similar to those of our reality.) After he left, I couldn't help chuckling a bit over the vagaries of the space-time continuum. After all, this was the first time that I knew of that a complaint was lodged against me for my personal care. For better or worse, I'm known as 'that nice doctor, who really listens'. I may not be that good, but, dammit, they can't accuse me of not seeming to care.

While I truly wish I'd been able to make the young man from the alternate universe understand what and why I was treating as I was, it was cool in a way.

Not every day this happens.


(Oh! And the next day, we found that he'd gone and filled the prescription for the cream. We knew this because the pharmacy called and said that his insurance wouldn't cover what I'd chosen and I needed to substitute a different cream. I'll take that to mean that the kink in our respective universes shook itself out and that the poor young man with the life threatening systemic bacterial illness is now recovering nicely with all the antibiotic therapy his reality can give, while the young man with the mild eczema, now back in his own plane, is rapidly improving under the appropriate cream, having avoided horrific and unnecessary therapies for his annoying but benign condition.)

Here's to all being right with the worlds and the universes being in their own spaces. I'll also be extra careful of where I stand in Exam Room #2. You never know when that may happen, again.

Note: Of course, most of the details of this tale were changed. I'm not a complete idiot, just a partial one. The substance remains unaltered.)

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Sunday, March 16, 2008

Sometimes, The Suitcase Has It Right

Chicago suburbs: Just so you know, you suck.

No really. You do. Now, I'm sure that there's lots of good things to be said about them and I'd be willing to bet they're filled with lots of lovely people and food and drinks and parks and what-not, but all that is cancelled out by the fact that each and every time you need to use a traffic ramp, to either enter or leave the freeway, you must pay a toll. And that's just so very wrong.

So, until you change this by, say, replacing it with a potato chip tax or a bottled water tax or a car tire tax, I'll continue to disparage your good name and assert that you do, indeed, suck.

Which leads us to how I spent my days off last week. No, it was not cleaning the house or reading a pleasant book or filling plastic eggs with Easter candy (all worthy things that I now need to do at the end of this week), it was spent in the glamorous Chicago suburb of Lisle, IL. (Motto: We're just an exit and another two tolls down from Naperville.)

I had my very first occupational medicine conference and, boy was I excited. Well, slightly excited. Somewhat.

The day I left, Wednesday, started rather dreadfully. In fact, if I believed in omens, I'd have faked appendicitis and never left the state. Being the anal soul I am, I had packed all I could the night before and made a list of all that still needed to be packed the next morning. As I'm ready to head out the door, I quite naturally go to zip the suitcase. It was full but not over packed. It had never been used, in fact I had to cut the tags off. It clearly had issues as within the space of 3 minutes, both of the zippers had broken off and I was cursing steadily under my breath as I jimmied the damn thing open, pulled my trusty duffel bag from the closet shelf and crammed what I could inside, adding a second small case for good measure. So, now we have me sweaty, cranky and leaving later than I wanted. And laden with an extra bag.

I staggered out to the minivan (because nothing says "cool" like a grey minivan) and heave the luggage in, pull out of the garage and reach for the remote to close the garage door. It's evaporated. What the hell? Who the hell drove the van last! Me. Being (all together, now) anal, I always return the remote to its place of repose, in the dash. Ah. Charles. Yes. He drove the little black Honda and must have taken MY remote to open the door as the Honda is missing its remote. OK, fine, I'll just take the one from the shameful SUV, that I hope we don't need to use until next November, when the snows start to lay deep. I hop out of the van with much vim and vigor and ......wait for it.......hit the solid sheet of ice that is the surface of the driveway. Slooooooooowly, I fall as a result of Somebody's law about a frictionless surface vs force and bodies in motion tending to stay in motion (damn Newton) and hit hard. During the approximately 5 hours it seemed to take to actually land, I was able to consider quite a lot of things:

  • That this was going to hurt like hell.
  • That it'd be a very good thing to avoid hitting my head.

  • That this was a really stupid way to start the day.

  • That this was a really stupid way to injure myself.

  • That if I lost consciousness, I'd likely lie there until Sara left for school after lunch, as there'd be no reason for anyone to look for me.

  • Oh! Wait! Work would probably miss me and I'd only lay here in sub-freezing temperatures for about 2 hours, and the cold would probably be a benefit to the head injury, slowing metabolism and retarding swelling (actually, they thought I was going to the conference that morning, like my partner, rather than working the morning, joke on me).

  • That this is really taking a long time to hit the ground, lets just get it over with, already, and remember to watch the head, shall we?

  • That this is really, really, really going to hurt.

There's something to be said for planning, as I did, indeed, not hit my head, just my wrist, back and butt, and nothing broke. So good. Oh, and the neck got a good whiplash-y sort of thing, but that's a small price to pay.

Got up, trotted (slid) gingerly to the house, where a large bottle of ibuprofen was sitting conveniently on the counter (Waiting for Colin, in the throes of the influenza, to need another dose.), swallowed 4 and poured a goodly amount in a sandwich baggie for later. I then drove like a nonagenarian, just waiting for the kamikaze deer to leap in front of the van to finish my day, but all was well.

After seeing the morning's patients, I hopped in the van and drove the 2 hours to where the conference was held, in a Hilton. Actually, that was harder than anticipated, as I kept taking every wrong turn possible (seems the area had grown up a bit since the directions were posted on the Hilton website), but after an additional hour and much paying of tolls for the use of the unavoidable on- and off-ramps (Chicago suburbs, you really suck), I did arrive, somewhat safely and more soundly than I deserved to be.

The good people at the Hilton were very welcoming and didn't even lose my reservation. And they keep a good bar (which my friend and colleague, J, and I availed ourselves of, for therapeutic reasons, of course; wine is a good muscle relaxant). And as I was feeling a bit shell-shocked, or freeway exit and ice shocked, we had no alternative but to avail ourselves of their rather good hotel restaurant. Salmon topped with crusted scallops has healing powers. As does chocolate-ginger creme brulee.

The conference itself had some good talks and a lot of meh talks. I am just not an occupational medicine doc at heart. I am an internist. I love my same day care clinic. But I know my job, as it currently exists, will be gone in a year or less, and I really love the people I work with. I had a group I loved once before and left them for my sanity. I don't want to do that, again. For me, the people I work with are even more important than the work I do. And it is still medicine. It's still doctoring. It's just from the work comp end, rather than the private end. And I am a good doc, I'll provide the best care I can, regardless.

I was also rather surprised to find that, if I wasn't the youngest one in the room of about 150, I wasn't far from it, at the ripe age of 42. Good lord, but we are a group of stodgy, old farts. I'll miss that about internal medicine conferences--the mix of ages and styles. I was one of the few not in a suit or at least a sport jacket (a suit? for a medical conference?), choosing to wear jeans and cotton shirts. Also annoying was that most of those in the audience who raised their hands were not actually asking questions or seeking clarification, but making statements trying to impress others with their methods. I hate that. Always makes me want to throw something squishy and smelly.

A few days later, I returned to home and hearth, husband and kids, laundry and dog hair, all in one piece, with a glimpse of my future and no closed head injury, so it's all pretty good, isn't it?

I'll take it.

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Friday, March 07, 2008

Call of the Sirens (Part IV)

I know I've bored you all stiff with the first two years (bored myself reliving it), but I wanted you to get the idea of what it really involved. But now, NOW!, we finally get to what most people think of as med school: Running around in short white lab coats, making egregious errors that nearly cost people their lives! Woot!

Oh, but wait just a minute there, Grasshopper, before you hit the wards, you must take your Medical Boards Exam Part I. A two full day fill-in-the-bubbles exam over the first two years of your basic science knowledge. You were given 2 weeks at the end of your second year's courses and the exam to 'refresh' your knowledge. We mostly sat on the grass and tried to re-learn biochemistry and the vagueries of spleen pathophysiology while wishing we were on a beach with a drink in each hand. The only thing I recall about the exam, aside from the length, was one question that made me start to laugh hysterically and mostly silently, sitting in my seat, shaking violently making those Eeeeep! Eeeeeep! sounds that wouldn't be suppressed from my glottis. The question? "What is the velocity of the axon of the giant squid?", which was followed by your 5 choices: A-E.

For me, that question pretty much summed up the whole damn thing. I mean, really! REALLY!! What the hell?

Somehow, I passed. Chalk another one up to a personal skill in taking standardized bubble-tests.

Ok. Off to the wards in our business casual clothes and short white lab coats!

Can we take a minute to examine the horror that is the short white med student lab coat? Can we? White--for starters--because it will show every blood, pus, iodine and ink splatter to greatest effect. Short--cuts across the broadest part of the butt. Unflattering on Victoria's Secret models, horrific on we of the German thighs. Large pockets from waist to hem-- the better to cram with pounds of pocket sized reference books (at the minimum a Sandford Guide, a Washington Manuel and a pocket pharmacopaea), computer print-outs of patient labs and radiology reports, journal articles, reflex hammer, peripheral brain (the small self-made notebooks of our collected wisdom not found in the published reference books) tongue blades, phlebotomy tourniquet, vacutainer holder (called the 'vacutainer' for short) for drawing blood, hemoccult cards and bottle of developer (you know, to check the smear of poop on the tip of your finger for blood, after you did the rectal exam), pen lights, fistfuls of drug-rep pens, calipers, cotton swabs, culture tubes, and a cookie or some other snack, as god knows when your next meal would be.

The vacutainer holder was a particularly prized item and when we had one, we guarded it with our lives. It's that little 2" / 5 cm plastic sheath that you screw a phlebotomy needle into one end and slip the vial for the blood in the other, so you can easily draw blood with just your one hand, leaving the other to position the vein, grab the cotton ball, or eat your cookie with at the same time. If you didn't have one, you needed to use two hands and a syringe, which was much more awkward and left you without your cookie lunch. The only way to get a vacutainer was to inherit one from a finishing 4th year student, steal one (not too cool, unless it was from a non-med student) or somehow get one of the phlebotomists to give you theirs. That's how I got mine. She will ever be in my nightly prayers. You knew who your very good friends were, as they were the ones who would lend you their vacutainer if asked.

Within a month or 3 (If the coat were particularly well-made) all the pockets on the white lab coats sported a large safety pin at each corner to hold them in place, as the pockets were actively ripping off the coats. Still and all, it was pretty amazing what could be carried around on one's person, thanks to those wretched short coats.

So, now you have us in your mind, a shuffling army of quasi-alert Quasimotos, bent and twisted with the sheer weight of our pocket-crap, off to learn how to actually become doctors.

Being of cautious nature, I requested, and got my first assignment as the easy-peasy ambulatory care rotation. Basically, you were farmed out to area family practice and internal medicine docs and mostly followed them around like little shadows that bulged at the midsection. It was there that I learned that a 28 year old sales rep who comes in with vaguely cardiac sounding symptoms deserves a stress test, which was done during lunch, which was positive, which led to the urgent call to the cardiologist, which led him to the balloon angioplasty, which saved his heart and possibly his life, all done before dinner. Don't ever doubt the worst-case scenario and proceed accordingly.

Then Surgery I, which was basically hanging out in ortho, urology and general surgery out patient clinics. If surgery can be said to be dull, than this was, indeed, dull. The only operating room stuff you got was the occasional joint replacement with the ortho folks, and those usually went to the students that wanted to go into surgery as a prime chance to brown-nose. Meh. But, not too taxing and no on-call, so sleep at night and regular meals.

Fall brought 6 weeks on psychiatry, which landed me at the VA (veteran's hospital), which mostly had WWII vets on the medical wards and Vietnam vets in the psych unit. As with most psych units, the nurses basically ran the show, the residents groused about the damn bossy nurses, and the attending hid in his office. I recall the attending as being nice, quiet and brown -- brown hair, brown beard, brown tweed jacket, brown pants. Soothing to the extreme. We students hung out, discussed the pros and cons of various nasty psych drugs (This was just before Prozac came into wide use, and so we were still using tricyclics for depression and worrying about tricyclic overdoses -- nasty, nasty arrhythmias that you couldn't do much about except watch the monitor and pray.), watch various interventions and what-all through the one-way mirror, talk to the inpatients (mostly a group of nice, if really fucked up, guys) and eat lunch. So far, this third year med student stuff was a piece of cake, yes?

We also had to do a long evaluation on one patient, so I chose this nice guy that I seemed to hit it off with, exchanging pleasantries and the occasional joke, to do the extensive interview on. I asked him and he agreed (I think he was really bored), and so, over a couple of days, I got his whole life story and wrote it up. I then got torn a new orifice by one of the nurses, as how the hell could I have talked to someone as fragile as he was? (This was after I'd asked who'd be good to interview and was told, "Eh, anyone.") He had been admitted, once again, for barricading himself in his house with a shot gun while having flashbacks of his Vietnam experience. Seems he was a butcher by trade, and while he was not working as one, for obvious reasons, he'd occasionally agree to butcher a deer carcass that a buddy needed to have done, which would set him off, etc, etc, and he'd finally land in the VA for a few weeks of med adjusting, group therapy, and calm talk about how maybe he should just tell his buddies to go find someone else to cut up their dead deer. Actually, he seemed better adjusted than most of the staff, and as I'd been completely up front with him about what I needed and what it involved, and he seemed perfectly fine with it all, I though he'd be a good subject. Fortunately, he backed me up, also, so I was out of the mud I had inadvertently stepped in. As a group, the med students were also accused of sneaking in and viewing someone through the one-way mirror without permission of the staff. We hadn't, actually, and had all been together in the office doing chart stuff, so that didn't stick, either. It was a very strange place: orange and brown and creepy, messed up staff.

So, from psych, I learned that they are all bat-shit crazy, the staff even more so than the poor patients, who at least had an excuse and were trying to get better, and were a decent set, at least at the VA. The ones at the university were a different matter. There the borderlines flourished and the severly schizophrenic wallowed and the 4-point restraints were used with necessity, but as I was only there for a Saturday on call (Woot! Only one whole day on call! With a nice, casual, non-abusive intern, who was polite to the patients and knew how to ferret out this and that.)

I think we'll leave it there, as after psych, we hit the harder stuff, where sleep is removed, stress is amped up, lives are on the line, and many, many meals are missed. Even the cookie-meals.

Gritty stuff, indeed.

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