What do I know?

Well, most of August's fun is over. I've worked four days, and man, I am not used to that. I'm used to Zumba classes and pool swims. But it was interesting and difficult and at times, upsetting. For whatever reasons, I drew the short straws on a couple of shifts and had very difficult days. I processed 6 discharges in one morning, and then the next day (of which I stupidly said out loud "this will be easy") actually had a worse day with no discharges. Hospital work is like that - very unpredictable. The part that continues to try me, and that is so very different from office work, is that many things can happen at once. A patient starts screaming and beating on the walls, another one slips in the hall and falls, the lab guy just walked in and needs you to unlock the door for the samples, the doctor was in mid-sentence to you, and you have a handful of narcotics to give to a patient down the hall. And guess what - you must deal with it all. Yes, ask for help, but eventually you must deal with it all. If a patient's assigned to you, you are the one who documents everything. And believe it or not, that's the soul of the floor nurse. Charting. So here's what happened that bugged me the most. One of the most challenging types of patients is those with the Axis II diagnosis (personality disorder) called Borderline. This is a bad name for the disorder - it's not like it straddles any borders - not sure what the origin is - but it's usually a female, very dramatic, has serious intimacy problems, lots of approach/avoidance and passive/aggressive (and real aggressive, too). High risk for suicide. And the worst part, as with other personality disorders, is that very few patients change, very few get better. Mostly because they don't want to. Not that they're exactly happy with their lives, but they are unwilling to do the hard work to change their behavior. And boy -- I'd like to hang this sign in my office: In psychiatry, only those that want to change will do it.

Anyway, I had a borderline patient. This was a young, 30 y.o. woman, many medical problems already from a life of living too large and extremely drug seeking. I was discharging her and she was apprehensive about that. But she'd been with us for a couple of weeks (a long time for this facility) and we had a solid out-patient plan for her. It was appropriate. I started working on the discharge process, reviewing her prescriptions with her, going over her valuables from the safe, having her sign off on instructions and commitments to attend meetings, etc. She fights it in various, frustrating ways. Takes hours to pack in her room. Gets tearful and has to rest in her room. Then the kicker is when she asks where her necklace is. There's no necklace documented in any of the forms. And we document it all, carefully, on admission. The tech that processed her admission, luckily, is there and remembers her well. There was no necklace. But the patient insists she was wearing it when admitted, even though she was so high at the time and off her psych meds, that she really remembers little else. She says it had sentimental value and screams and cries. I get the supervisor, who (excuse me, I must speak frankly) is a worthless sack of dirt that rarely does her job right and always complains about it. I ask her for the form the patient needs to fill out for a missing item. She shrugs - I dunno where the hell it is. So I have to ask some of the more seasoned nurses on the other floor to get me the form. I'm running around, this takes time, I have other patients standing at the desk that need me. It's starting to turn into a circus. She's still crying. I'm feeling a little overwhelmed when I look over and see that one of the docs just completed rounds and has put up 4 charts with orders for me to process. This is not atypical.

I finally get this woman out the door; it's really, really hard. She came in with a ridiculous amount of stuff, clothes and toiletries. And there are 4 big bags of prescription drugs, each contains about 10 pill bottles. Mostly highly abused things, like Xanax and Oxycodone. Many bottles are the same stuff from different docs. She had these in her bags when she was admitted, we just count them, seal them up and secure them, and return them when she leaves. Yes, seems crazy, does it not? And this is the capper -- as we're leaving in the elevator, I'm helping carry it all down to the car waiting for her (something I normally don't have to do, but whatever it takes to get her out at this point), I start giving her a little positive pep-talk about how she can get off on the right foot after discharge and she stops me. She says pointedly, "What the hell do you know about mental illness? You've never had a problem like me." And it stops me. Because (thank goodness) I am not jaded enough to ignore this and dismiss it out of hand. Yes, I definitely do not have a problem like her. Now, I haven't talked about this much on this blog, but I have had issues in my life and I have had treatment. I am doing great now. I am working towards a place where I can be completely open about that, I'm not there yet. Sometimes with certain patients especially, I will talk about it. When it's therapeutic and appropriate, and in a limited way (because it's not about me). But no way do I have any experience like her. And truly, can I know what that's like? No. So I get to think about that for a while. It will certainly inform some of my clinical experiences this semester.

On a lighter note, I'm reading an interesting book that a classmate recommended called Stumbling on Happiness. It talks a lot about the current research on what we humans do in pursuit of happiness and how we try to set up our lives and make choices to create a future of happiness. The main thesis is that we usually do that wrong -- because we assume that the way we feel now about things is the way we'll feel in the future. But research shows that's not true. I haven't finished the book yet, and haven't gotten to the part where he recommends what to do about that conundrum. Ha. But he does provide lots of good data to support his points.

I have more to say, but I'm tired. We leave in the morning to take Dani to NYU.

Ken and I went to Baton Rouge last weekend to see Karen and Jim and celebrate her retirement. She made boiled spicy peanuts for us! Oh my -- sitting on the patio, eating peanuts and drinking wine and laughing for hours. It was heaven. And here's the absolute best part - she loves retirement. Isn't it great? And yes, Karen's still good for a flash. Throw me something, mister.

Clever Title here....song lyric I think....

I should be studying, so of course it's a perfect time to blog. I also need to go to the grocery for cat food and put towels in the dryer. Yes, perfect.

I sometimes jot down little things to blog about on the back of an envelope when I'm in class or leaving yoga, whatever....I did that this week and then lost the envelope. And let me tell you, it was some clever bullshit this time. Including the weird title, which was some song lyric, I think from the new Shins album. (BTW, they are coming to ACL. I looked at the lineup a few days ago, and wow, it is really something this year.) I've been listening to their new album on my Nano at the gym, and I have to tell you James Mercer really is quite a lyricist. Some words he puts together truly take my breath away. I think the title I planned to use was something about bridges engulfed in flames....you know, burning your bridges....something about not getting what you expected. Anyway, imagine that I put it up there.

One of the things on my mind has been this Chick-fil-A controversy. I posted an invite to my Facebook female friends to meet up and kiss last Friday and one of my "friends", a long-ago coworker, a conservative guy that I haven't seen or talked to since 2005 (yes, not really a friend, huh?), posted this as a reply "Now that's classy." I wasn't sure how to take this -- but I'm pretty sure it was an insult to me, saying that my proposition was uncouth. Well, I read this right before I left to drive to school so I got to ruminate on it for my 30 minute drive. I came up with so many clever ripostes. I'm so good at thinking of snappy retorts after the fact, when it doesn't count. Here's some, I had at least 6 on the envelope.

• Oh, "Joe" (not his name) -- you can come too and watch. I know you like that. 
• Yes, being a doormat to bigots is much classier. 
• Why yes, Joe, you get it! It's a class session type thing -- look, Chick-fil-A, here is reality, same-sex couples exist and kiss in your store and deserve the same civil rights as other people. 
• Classy? Boy, if you are looking for class in my FB posts, you're on the wrong page. 
• I have lesbian friends. They are classy. You, Joe, are not. 

I was talking to a friend about the whole Chick-fil-A thing yesterday over lunch and he brought up an excellent point. This is all a manufactured controversy. The media is sticking it in our faces. The CEO is a known religious bigot, and he was speaking to a Southern Baptist group when he made his hateful remarks. That's nothing new. The media whipped it up. And look at all the profits the company gets now. Not OK. But I can tell you this, I won't ever purchase their products again. 

Nile has his black belt testing. This is the first stage, the provisionary or probationary, or something. But the belt is black and that's what counts. He was supposed to test Saturday but woke up sick. Drag. Now he has to wait for October. This is a huge deal. He's been taking Tae Kwon Do since fourth or fifth grade and has had to basically start over twice when we moved and he changed styles because the schools are all different in parts of the country. This last time has been the worst -- he was a senior red belt in NJ, and was six months away from black belt when we moved. It's taken him 2 years to catch back up. He had to re-learn every form. 

My class is still interesting. Our lecture this morning was on attraction and love. Some good socio-biology (and just plain ole biology too). Here's an interesting tidbit: there is a known phenomenon called misattribution of arousal. When we're physically aroused (by lots of things -- it can be fear, exercise), if we encounter a suitable partner (that is, someone within the framework of who we deem as acceptable in terms of age, gender, ethnicity, social status, etc), we are more likely to be attracted to them and pursue them. In fact, some theorize that we often mistake a good sex partner for love that way -- we're aroused and we start down the romantic path. When the truth is, we're just aroused. The professor suggested that we do active things on first dates - go jogging, for example. That is, if you want to activate that pathway and start down that road. I guess if you want a one-night stand (like Ryan Lochte's mom advocated), you should avoid that. Including no swimming. Ha.

I'm very much anticipating next semester, which will be the most challenging and most critical of grad school. I've applied for two clinical positions, one is at the University Counseling Center working with eating disordered clients (definitely an interest of mine), the other is working at a private therapy practice. They see a variety of clients and work on sliding-scale fees, but here's the kicker -- they are on Bee Caves Road, down the street. Yes, can you say "10 minute commute"? I'd be super happy with either of those. But before the circus starts back up, Ken and I go to Baton Rouge to see Karen and then up to New York to deliver Dani to NYU. Oh, and I'm working two days a week for the next two weeks. Some fun stories to come!

I'm going to close with two fun photos. One is Crabby, all tucked up in bed. Yes, I'm sorry you're jealous but I have the cutest cat in the world. The other is me at Vino Vino, our favorite little bar, Ken took this. I look tired, but that's because it was Friday night and I am tired by the end of the week. Hey, my life is hard! The other day I had to spend at least 10 minutes getting leaves out of the pool before I could swim laps after a hard day of attending my sexuality class that morning. The yard guys had come that morning and a few things ended up in the pool. And the pool guy only comes on Thursdays. It's rough.