And in the end

Valentine's Day weekend 2014 was a way-terrific experience. Ken and I went to Park City to see Duncan Sheik perform live and to try cross-country skiing. And both were top-notch. The skiing was good - it is much easier to get up and going than downhill. Of course, years of downhill experience I'm sure helped. The first day, we took a lesson in the morning and then went back in the afternoon and did our own thing for about 3 hours. It was a nice day, if anything too warm. Ah but the next day-- totally different deal. A storm was blowing in, dumping snow as we started. By the end of our second run, I couldn't even see the tracks and my face hurt from all the needles of snow the wind pushed in my face. But it was so beautiful. Gorgeous. And, yes, it's safer than downhill. It's not an adrenaline rush, it's more your body being one with the outdoors. It's such a steady-state cardio workout, I ended up just hearing my breath and feeling the snow. I like it.

My new job couldn't be better. Here's how great they support me -- every day I'm there, the office manager comes by and asks if I have any questions or need anything. I mentioned off-hand that I could use a clipboard. Oh, she says, I'll get you one tomorrow. What color? What style?  This after I opened my desk drawer on the second day and found it had a nice set of supplies arrayed. They asked if I'd like a painting to go over my couch, and then brought in an assortment for me to choose from. We have Starbucks K-cups, cream and milk, and La Croix water in the break room, all free. It's so first-class.

And then there's the stuff that really matters. My schedule is already as full as I want it. I have 7 appointments for Thursday. Already, folks. In two weeks. It's because I can see insurance patients right away. And get this, one of my contacts is a fellow NP that is closing her practice because she's pregnant with her third child. (She plans to resume but not for at least a year or two.) She has hooked me up with UT's employee assistance program, and now I'll get a bunch of those clients referred to me. I'm meeting with UT next week. The best part: I really like it. It's challenging, it's fascinating -- I mean, I'm the shrink, people tell me things that they have never spoken aloud before, and it's a puzzle and an art. Especially prescribing. Which medication to choose? So much less cut and dried than antibiotic or cholesterol meds. And much more critically, is medication even warranted? My supervising physician is so different on that front -- he's so non-meds oriented -- frankly, it's been a little hard to get used to. When I bring my cases in to review with him, he spends much more time on that question and always, always about the therapy. With my previous doctors, it was all about med selection. We got to that very quickly. It's nice to have the opposite, because I like to always be conservative with medication.

My sort-of last day at the old place was Friday. I'm returning on Tuesday to write up a bunch of discharge summaries that I got behind on. It was a typical day there - so busy I barely had time to pee. I had an intern with me all day, and they planned a little cake party for me, but of course, something came up and I had to see a patient and the party turned into a 5 minute deal. So no tears because there was no time. I did an exit interview with some suit up in St. Louis and it was just stupid and pointless. I don't need to bitch and moan to her, and I didn't. But this has been, oh god, such a stressful time. I'm not sleeping well, and my pants are all baggy because I've lost weight. Part of it is just the stimulation of the new job - when I wake up at 3:00 am, I'm running through all the decisions I made about my patients that day - did I pick the right antidepressant? Did I note in the chart that she had seizures as a kid? Did I remember to block my lunchtime meeting next week? Didn't help that my Doc at the old job took a day off this week AND our census popped up. It was a terrible week. And it's over. And I'm going to yoga three times this next week, because I can now. Hoo hah.

So Dani casually mentions to me she's going to the movies. Oh, I say, with who? She says "my boyfriend". My eyes pop out of my head - What boyfriend? Oh yes, she has one of those now. His name is Rakan. Computer Science major at UT. His parents are from Syria. Can't wait to meet him.

Quit

I had a brand-new experience on Friday. I got angry and quit my job. Well, yes, I did give two weeks notice - I mean, I'm trying to do what's responsible for my patients - but after sitting through the ridiculous meeting with the owner where she failed spectacularly to reassure us that the place isn't falling apart,  I said enough. But allow me to back up a few days - so Tuesday, the COO and the Clinical Director quit. The Administrative Head quit the week before. And I quit Friday. Maybe that tells you all you need to know. 

My life has changed considerably. I'll be able to focus much more on my new private practice and I'm full of good feelings about that. I had my first day on Thursday and saw two new patients for evaluations. Of course, both were very complex, what we call "special" populations. The second one I reviewed with my collaborating psychiatrist and agreed that even he didn't have the expertise for the case. But both of them wanted to continue seeing me, and I have two more scheduled for Monday already. This is growing quickly. And I am finding that the staff there are as good as I'd hoped - I am getting the orientation and support that I need. They are smart, capable people. As Ken says, they seem to realize that both process and environment are important. 

Here's a pic of my new office. Every item in it is new - how cool is that? It's so nice after my crummy previous office with the stained carpet, the holes in the walls, the broken handle on the desk, and no window. So obvious they were saving every nickel and dime. I like this so much better. It aligns more with my personality - frugal is not me. Since we only go around once, it better be good. 

Nile took his next step in black belting. This was the most assured that I ever saw him before a test. And he broke his board on the 2nd try. He is assisting with the little kids on Thursdays now, and surprise...he likes that. He's always grumbled about being around them before, but turns out being the teacher is OK. 

I'm looking forward to having a much calmer life. After last week, I was already quite worried about how to fit in both of my jobs. I worked very late on Tuesday, and then they were peppering me with questions from the new job (Did you read that email? Have you turned in this form to Blue Cross? When you check your schedule, you need to look at this.) I could see that it was going to be out of control soon. Now that won't happen. So right now, their expectation is for me to be there two days a week. As soon as I have enough clients, I'll add another day and then another....until I'm at all 5 days. But here's the sweet part: I don't have to work Friday afternoons. I can use that time to catch up on administrative tasks or I can leave. Totally up to me. 

Friday was a really intense day. I walked out of that awful meeting with the owner - and she insulted me personally by the way, implied that I wasn't running my CBT group properly (which I strongly disagree with; and I wasn't the only target of her insults) - went straight to my office and typed out my resignation letter. I think it was 2 sentences, just the facts with no emotions. I'm leaving on this day, thank you for my time here. Then I walked up to the Clinical Director and handed it to her. She read it quickly and said "I totally understand." Then I walked away. And you know what? The owner was there the whole rest of the day and she never said a word to me. Telling. I was in the front office about an hour later, and our PhD Psychologist said to me, "Hey, I just want you to know how completely inappropriately I thought you were treated in that meeting." and this is the only time that day I really allowed things to leak out, I just blurted out "I quit". There were three other people in the office, and their heads snapped around. Late in the day, an announcement went out. It was a difficult day, I had a full slate of patients to see, insurance companies to call. I even had two doc-to-doc calls that I had to do (which is what they call an insurance appeal. I have to talk to the insurance company doctor, instead of just the clerk.) And I lost both of those appeals. I have to say, that's usual. I had a good track record of usually winning. So I'm going to take that as a sign that it's time to move on. 

L'aissez les bons temps roulez

Two big things to talk about. First, I have a new job. I'll be working in private practice with a local psychiatrist. He has one NP and now he's adding me. It's a truly innovative office, they emphasize therapy as much as medication, and his primary technique is psychodynamic. That's right up my alley, with my love of Jung and appreciation for his philosophy. The psychiatrist's wife is also a key player in the office, and she has an ivy league MBA, and they are very focused on data and best practices. But the most remarkable aspect is basically there is no churn. Unlike most other practices, it's not how many billable hours can you cram in a day, it's more how can we do good and feel good about our work. Education and collaboration is a planned, scheduled weekly thing. And he really means all this -- here's proof: he expects 30 billable hours a week, which is lower than most other practices, and I can do 4-6 therapy-only clients a week. That's really different, and it happens to be what I want. I am so lucky. Maybe it will help me heal from the storm that ran through my life when things I loved so much left me. The signs are good. I start Thursday. There will be an overlap period with my other job, but only as long as I want that (per contract, up to a year). Ken is actually urging me to just quit, but a part of me isn't ready. (I have a great husband, just FYI.) It's going to be emotionally very difficult to leave, to admit that I can't fix this. But more proof seems to happen every day; just this week I found out that they've started a new, expensive initiative that basically is just moving deck chairs around. Can I tell you how angry I am that they have money for this ridiculousness, yet my position was cut in half? It's going to be quite a chore to hold my tongue in the two stupid special management meetings I've been asked to attend, never mind the fact that I'm not management anymore. I mean, hell, I'm PRN, how can that be management? I have to drum up some patient emergency that will require my attention.

The other thing to talk about is Carnaval. Www.sambaparty.com. We went last night and it was one of the most fun events I've been to in ages. It was like an indoor Mardi Gras parade, with the creme de la creme of dancers. I was blown away by the quality of the hour-long drum and dance show by Austin Samba School. (and you better believe I'm going to Zumba tomorrow night, ha) The costumes that the attendees wore were incredible -- I was so both over and under dressed. Dani did my makeup and said "Mom, you look like a hooker." False eyelashes are way fun. Well, that really wasn't enough, I had a mini skirt, fishnets and boots with a Lulu top, but man, I needed to show waaaaay more skin. I lost count of the topless women, the ass-less chaps, the thongs (male and female), the innovative body paint....what a feast for the eyes. I'll definitely be spending more time on my costume next year. It's not a time to be classy, let's just say.

One of the things I really liked about the experience, and you'll see this from my pics, was that people of all shapes and sizes were included among the performers (attendees, too -- all 5,000 of us). There were so many women who weren't rail-thin, just full of happiness and great dancing ability, and did they ever strut their stuff. It was impossible not to smile and feel amazing watching it. Made me wish I could have a field trip with my anxious little anorexic patients, so convinced that the scale determines their worth. Oh baby, it does not. All bodies are beautiful! Just watch and learn.