The Naked Eye

I got a little extra time, but it's being redeployed immediately to clinical time. We finished our psychopharmacology class, which is abbreviated (ridiculous -- it needs to be a full-semester course) so I can stay at ASH all day on Wednesday instead of running off to class at 4:00. Last night I stayed until 6:00, so this could work out well. Get even more hours in, then December won't be miserable. Anyway, last week I spent one day at a Psychopharm conference that UT put on - it was an utterly huge room of people interested in this stuff. Here's the sessions I attended - really fascinating: placebo response, bipolar in kids, new psych drugs, treating refractory schizophrenia, and alternative therapies in depression. The one I found most interesting was on new psych drugs, not because of the new drugs planned (there basically aren't any, which is a real disgrace), but because the man teaching it put up so many helpful charts on choosing the right drugs, particularly antipsychotics, from all the choices. And people - take your Vitamin D. Every day. 

Nile is a black belt now in Tae Kwon Do. He is technically a black belt candidate, which is the first level, but - hey - the belt is black. It counts. Dani blew into town for ACL, with her bright red ombre'd hair tips. She's back in NYC now. I barely got to see her, but my sister Holly and I did get to take her to dinner the last night. We talked about Holly's twitter guy - this is interesting. Holly had been following the tweets of a cool guy on twitter, she was in Vegas & discovered (via a tweet of course!) he was too - they met up, hit it off, and now they may have a thing going. He's coming to Austin to see her. It's just so fun to say "your twitter boyfriend", I hope it works out so I can keep saying it. Ah, the new rules of dating in our networked, social media, 24/7 age. 

So on my first exam in Advanced Psychiatric nursing, I think I was the only person that passed, and that was by 2 points. Really. Ridiculous, I was mad for days about that. Then she gave us all a monster curve, and everyone passed. Yes, all us morons had to be yanked by our heels to the "acceptable" line. I was under a silly illusion that things like that wouldn't happen in grad school. 

Now I'm going to comment on a couple of juicy news items that I can't resist. First is this fungal contaminated steroid injection problem. A compounding pharmacy sent out vials of injectable steroid solution that were so contaminated with a fungus that you could see particles with the naked eye, according to the NPR report I listened to. I have noticed that medical professionals that I've dealt with in general are very against these compounding pharmacies and what they are doing. In my class that covered supplemental hormone treatment for women (compounded "bio-identical" hormones are all the rage), the lecturer flat out said this stuff is bad, there are absolutely no standards and no monitoring, they can put whatever they want to in there, and there's no guarantee of purity or strength. Or apparently of safety.

The other thing that caught my attention is the Lance Armstrong story. It's not playing out like I expected. I really don't understand why, after all these years, they are doing this. Now you may think to yourself, "because it's true" -- well, maybe it is, I certainly have no way of knowing it, but Lance won seven Tour de France titles, the last being in 2005. That is seven years ago. I can't believe that they had investigators working on this for seven years. Just seems to me like there should be a statute of limitations for them taking your medals away. I have to add that I have tremendous respect for what Lance has done with his LiveStrong Foundation. Did you know he started that before he won his first Tour? How many celebrities do that before they hit the big time? Hell, how many do it after they hit? Anyway, I don't like how this went down. It's just wrong. But one thing makes me happy - donations are up at LiveStrong. 

My clinical days are intense. I am at two sites that couldn't be more different - the children's unit of the state psych hospital and then a private therapy office. I literally go from seeing the most challenging, saddest, difficult to treat cases of kids with profound mental illness to sitting in a quiet, comfy little office listening to a couple talk in quite tones about improving their communication. It's hard to keep perspective at times. And I find this tidbit interesting - the kids that I see at the state hospital, in my opinion, are getting better care than they would at a private hospital. I would even say much better. Mostly because they don't have the mad dog insurance company snarling and growling at them to hurry up and discharge the patient. Most patient stays are at least two weeks, I've seen many longer, sometimes months if there's significant placement problems. And let me add, these kids need that time. OMG, I had one really bad day in treatment team review where I listened to so many stories of troubled homes. Thank goodness that is not every day, and certainly not every family. So when you hear "state hospital", don't think snake pit or that Jack Nicholson movie. It's really a pretty good deal. And it helps us all, these are our friends, relatives and neighbors that need these services. We're all in this together. A child that's been properly treated, appropriately accommodated at school, and had the necessary social support applied will grow up to be a tax-paying citizen instead of the homeless guy on the corner, getting bucks so he can self-medicate at the liquor store. Speech over.

A Little Extra Time

I'm currently immersed in a social experiment, it is called how much can I take. My week Monday - Friday is wall to wall school and clinical. And when I'm at clinical, it is often late. Tonight I have a therapy group to co-facilitate for parents of seriously ill kids and I won't be home until 8:30. That is, if nobody needs a little extra time. I just tried to make an appointment for a haircut in October and failed.  The only times open on the weekend would have gobbled up my exercise time on Saturday -- and sorry, that is sacred. So is this really so bad - come on, right, I'm a full time student, not working? Well, a couple things are killing me, the first is that I have to drive all over for clinicals. And Austin traffic is terrible. I have to drive up to Dell Children's Hospital tonight, for just a one hour meeting. The second thing is my professor (for 3 of my 5 classes) is pathologically disorganized. She has many other good qualities -- she's smart and experienced, and not a hard-ass, but I'm so tired of things not being posted for class until a couple hours before, and things forgotten, and .... if I was not the opposite kind of person (you know, the one always early to the meeting), it would be easier. I hope that when I graduate my family doesn't have to visit me in jail. Because I so want to strangle her with my bare hands (please....just a little strangle....I'll stop....I promise). So since Mon - Fri is taken that means my weekends are all study, all the time. Ken and I make it point to go to Vino Vino (best wine bar ever) one night, but that's all the fun I get, folks.

Clinical is fantastic. It's humbling to be allowed into such personal interactions, where people reveal their innermost fears and tribulations. I'm at a private therapy office, I'm the only NP, everyone else is a social worker. But that's good -- they offer a different perspective, and frankly I have so much to learn. The range of issues is huge. From serious abuse and addiction to just learning better relationship skills. I can't wait to see patients on my own. That may not happen this semester, but I'm gratified that I want to get there. Soon. My other clinical site is the Austin State Hospital Child and Adolescent Unit. It's dramatically different, but the two psychiatrists I'm paired with have been very generous with me, treating me as a junior colleague. I'll have some stories for my next post, but they will be heavily disguised. I will make absolutely sure that no personal data gets transmitted. I guess the biggest surprises I've felt so far are these: it's amazing how hard parents have to work to cope with a mentally-ill child. Just the school accommodations require a great deal of discussion and involvement. These parents are incredible; and the other thing (in the therapy office) is that boy, we sure don't have perspective on ourselves. I've heard jaw-dropping things where I struggled to hide my reaction that the patient minimized (oh, I smoke pot every day, but I'm not an addict because everyone does that), and OTOH I've learned to discount it when a patient says "this session will really be a big deal." (the ex wants to reconcile, sorry....well within the realm of normal.)

Dani is busy making a list of famous people she sees in NYC. Here's it so far: Edward Norton, Carla Gugino, Alec Baldwin, Coconut Records guy, Louis CK, Pineapple Express actor, a Sprouse twin. Some of those mean nothing to me, but I'm not 18. Ha. Every interaction we have, it's "I'm so stressed because you mean parents have me on a budget." Yes, Dani, this is a task that most of us in life have to learn. Get cracking. She figured out, though, that she can go try on Herve Leger dresses for fun in SoHo. It was a revelation - hey mom! I don't have to buy them! I told her I'd buy her one if she gets straight A's. (Well, it would work for me. You should see those dresses.)

Grumble

I don't have time for this (blogging) but I'm going to do it anyway. Grumble. I seem to be doing a lot of that lately -- I think it's how I express my worries that I've bitten off more than I can chew. I'm taking 5 classes this semester, specifically because there's an instructor I really like who's only teaching (get the name of this course) "Nursing Phenomena of Concern" in the Fall. I want to take it from her. And I want to have a better attitude, but I have 240 clinical hours to complete by the first week of December, I'm supposed to start next week and I don't even know where I'll be for prescribing hours. ARRRGGG. For a planner, it's a disaster. I had my interview Wednesday for my therapy hour placement, it was at the private practice office that's close to home. Looks good, I'm waiting to hear back from them. (Yes, it's Friday and I need to start Monday and I've checked my email 50 times this morning!!!) I will be learning how to do individual, group and family therapy with them if I get the nod. The two directors interviewed me over their lunch hour, it was fine but they were obviously rushed. Nobody screamed and they only laughed when I expected, so I hope that means I passed. Some interesting little extras this semester: I will be observing family court, going to NAMI meetings, and going to Al-Anon meetings.

We got Dani ensconced in New York. She gets along with her roommate and seems to be OK. We went to the Cloisters while there, which was really quite nice. It's a building way up in North Manhattan where the Met houses their medieval European collection. It's an incredible scope of art, including the architecture. Beautiful. http://www.metmuseum.org/visit/visit-the-cloisters Two pictures below are from there. We stayed at Times Square, mostly because I wanted to get two queen beds in one room and choices were few, and here's a piece of advice: don't ever stay there. Any other part of Manhattan has to be better than that. It's like the dirtiest, nastiest Mardi Gras parade you've ever been to, but 24 hours a day.

I've done a little volunteering at AIDS Services, doing their TB tests and even some foodbank days. We ask clients to bring in reusable grocery bags and the guy next to me opened up someone's bags and roaches scurried out. Really. Oh well, that's the only time that's ever happened. I love doing that work, but I'm pretty sure it's going to take a backseat for the next three months. Nile and I are still taking care of kitties over at Austin Animal Center, and I think we'll be able to keep doing that, mostly because we can do it on Sunday evening.

I read a good essay in Newsweek by Ira Glass - isn't he great? And his show on NPR, This American Life, it's great too. His piece is about love and the way life sometimes presents it to you. Be open to it in all its forms, I think is the message. He hooked me from the first two lines: "I’ve definitely had a f--ked up life in a lot of ways, but not because of big turning points where I made the wrong choice. It’s more like character flaws that played out slowly over time."
http://www.thedailybeast.com/newsweek/2012/08/26/ira-glass-on-rescuing-a-pit-bull-dog-with-a-ridiculous-diet.html

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. 

Wag more

I have a lot to talk about, a lot rattling in my brain. First, important thing in my life: I ostensibly switched gyms. Gold's has an on-going problem with the employee scheduled to open at 4:00 not being on time. Well, about 3 weeks ago, they opened an hour and 20 minutes late. I was fed up. The problem is that the nearest alternative is 15 minutes away and it's thru a very bad Austin intersection (the "Y" as we call it). But I decided to give it a try after all - they have a great pool system, and I miss being able to swim in a nice long lane. This new place cost a lot more - and they purport to be the Taj Mala of gyms. Turns out they were more focused on style over substance; the locker rooms were beautiful, plush with lovely dark wood. The kicker for me was the uneven quality of instruction in spin, yoga, and zumba. People complain about the robotics of Les Mills programming -- but I'm here to tell you, it's not always good when you allow individuals creative control. I made a list of the objective problems I observed (no, I didn't say the yoga instructor on Friday at 11:30 sucked, but she did) and sent an email to the manager -- things like the spin bikes are in poor repair (even the instructors complained), the glute machine rails are damaged and the mechanism sticks, there's only 2 neck pads for the squat bars, etc. He thanked me and then did nothing. So a week later, we cancelled. I'm back at Gold's. Occasionally I will have to turn around and come home to work out. I accept it.

 This obviously mentally-ill shooter in the Colorado theatre has me thinking about schizophrenia and how widely it presents. I worked last week and had two schizophrenic young men assigned to me who couldn't have been more different. One was the classic negative-symptomatic guy: very silent, very low energy, dirty and unkempt, made no eye contact. His roommate, on the other hand, had many positive symptoms and although this is rare, his auditory hallucinations were positive. He giggled and laughed to himself at odd moments all day. But he also attended group activities and came out of his room. I had a conversation with him and he was fully lucid and had some grasp on his problems and his prospects (insight, as we say). Some of my classmates and I had lunch yesterday with a woman who's a PMHNP (Psych Mental Health Nurse Practitioner) already in practice (she's actually the mother of a classmate, and she's a professor at the Nursing school in UT-Arlington). I asked her two things: what were some of the hardest things when you first started practice, and what extra stuff should we be doing/focusing on now? In answer to the first item, she said, working with schizophrenics. Guess I already knew that - based on what some of the psychiatrists have said at work.

I went to a musical with Cathy, we saw Chess at the Austin Playhouse and really enjoyed it. Yes, it's that play with the song "One Night in Bangkok" that was a late-80's hit. It was well done and in quite an unusual setting - a big tent. In July in Austin. It was hot at first, but they did an excellent job of coping. Apparently they are building a new site.

I'm still attending my Human Sexuality class. It's quite interesting usually. I have been pretty silent because I'm uptight about being seen in a motherly role to my classmates - I mean, nobody wants to talk about sex with your mom around - but I decided that was kind of silly and when we covered the chapter on adolescents, I did talk about having "the talk" with my teens about contraceptives and STI's and handing over the big box of condoms. There's definitely some folks in there who have a streak of exhibitionism though. When we covered the unit on sexual orientation, one young woman (with a really impressive shoulder tattoo, I sit behind her) felt compelled to tell us that her lesbian lover has a thing for gay male porn -- because she just wishes she had a penis so badly. Yep. Really. You should have seen my professor's reaction. It's fun, I think I'm finally relaxing and enjoying the class. The topic of abortion and gender-selecting the fetus came up and I found that I was the only one in the room that knew some of the laws around that, so it was nice to offer a little education (I'm sure my pro-choice bias showed, but so be it). One of the guys grew up in boarding school and mentions some of his experiences. Sounds like it was a good place to learn bad information (ha).

The DeMouys came to visit from Baton Rouge and we bowled Wednesday at Dart Bowl and then had a pool party the next day. It turns out Laura is going to honors college at LSU - which is great for them, she actually went all over the country checking out music schools (this is a young woman who was in all-state band). In Louisiana they have something called TOPS, it's a program that pays in-state tuition for the very best students in an effort to keep the smarties in Louisiana, so Laura gets a free ride. Guess a Hawaii vacation's in their future - ha.

I learned this really cool manicure technique off Jezebel - my favorite web site next to NYTimes - it's distressed, shabby chic nails. Very cool, you just need fabric paint and regular nail polish. And since I can do it myself, I save $35 a week.

Bumper sticker seen on the way home from the Animal Shelter: Wag More, Bark Less. Indeed.

Semen

Dani had a party. Here's some pictures. She invited mostly 16 to 18 y.o. girls and it was a pretty good time. Her NJ BFF Idil was here (that's them - the two little white-bread suburban princesses doing a gansta pose). Only one tiny hiccup -- one of the girls had an older brother come along - who showed up with 3 friends and proceeded to hide a 2-quart bottle of vodka behind the pool. Ken observed this and rectified things. Problem averted.

I bathed Morris, our old kitty. I had bathed a cat at the shelter with a blind woman (a fellow volunteer - she did most of the work) so I felt like I could handle this. He smells much better.

Summer school is half-way done. I've started the second session and it's not exactly what I expected. I'm in a class with a bunch of really young ones (all undergrads) and it's a little painful. This is the human sexuality class. Today we did an exercise on the scripts that we have for how sexual relationships progress and it was obvious that none of the volunteers for the exercise have ever been married -- or maybe that was my interpretation, it is possible they were presenting the "ideal" to the class. But seems like they had this fairy-tale expectation. Once you've lived through a few marriages (and especially had a few teenagers), you feel much more relaxed and nobody needs to follow a bunch of rules. I guess it rubbed me the wrong way. Judge for yourself -- here's what the group of class volunteers (about 10 students) produced.

Meet and agree to a date
Date 1 - kiss
Date 2 - fondle
Date 3 - fondle more and start conversation about sex, including contraception
Date 4 - oral sex
Date 5 - intercourse
After Date 5+ - say "I love you"
After Love - meet the parents
After Parents - get engaged
After Engaged - marriage

You know, when I look at that now, I think to myself, that can't be what these kids are actually doing. One of the guys had the energy to suggest that intercourse be moved to date 2 -- he was voted down. Hey, at least he's being honest about what he wants, right? But the outcome is so....predictable. I bet if it was a bunch of 50 y.o. women up there, we would've come up with a little different answer. I couldn't rubberstamp any specific timeline to be honest. People aren't like that - we rebel against that.

I've worked a few days. Friday I got to work with my favorite two guys - Curtis and Gilbert. We had a woman on the PICU that was very manic. You know, I'd never seen someone truly manic before I started working here. It takes some getting used to, you need to grow a thick skin for one thing, because they usually are saying a lot of things, and much of it isn't nice. I actually wrote down a sequence of what she said, just one interaction that I had with her. It was how we started the day together at about 7:30 am, I came out of the medication room and she was at the dutch door. Here's what she said. "I need a shirt and toothbrush. I came in last night and I can't find them. And don't try to give me that toothbrush you guys have - I need my special brush that I use with my organic toothpaste. Oh, but you can't give me that, can you (makes a face and slaps her hands down loudly). The class-action lawsuit that I've filed will take care of that, you will just see (voice is rising). You're looking at me like I'm dumb, but I'm not, my IQ is 1000 so we have a communication problem and it's on you, bitch! (I start to turn away at this point). Hey, when you come back, you need to wipe semen off me."

That's really what she said. About 10 minutes later, in the med room, Gilbert asks me, "Hey, did you get that semen wiped off yet?" And I did look into getting her a warmer shirt and her toothbrush. Just because she's manic doesn't mean that she doesn't have legitimate needs.