That 4-Letter Word

First of all, time is very precious now. I have had lots of times I wanted to blog and very, very little opportunities. So this'll be short. Because, of course, I'm at work. Yep, I'm there all the time. I was there today (Sunday). I rarely leave before 7 pm, sometimes much later. No complaints - really - just I have a lot to learn, I love the work, and that's how it's going to be for a while. I'm cool with it. But I miss a few things - like yoga, and clean socks. Anyway, we have a new kitten. We named him Yeezus, which is the title of Kanye West's new album. We call him Yeezie, and he is very, very cute. Of course, I mean the two sweetest, cutest things on earth are kittens and puppies. Here he is as a scarf, worn by the international model Dani. He's so docile, he just falls asleep on your shoulder. And Crabby loves him. They wrestle and play, then she'll pause, mid-bite to lick his ear. It's a hoot.

So during my first week at work, I got to accompany the patients on an outing to the Blanton Museum at UT, which as it turns out, is terrific http://www.blantonmuseum.org/. The art therapist there had an exercise for us all - we each drew a card, had an assignment for about 20 minutes, then as a group we toured around as each of us explained our assignment's outcome. I took a couple pics of how mine turned out. And - did I mention I was lucky to get this job? My luck continues. Wait til you see the card I drew.

And the work that I chose was this massive thing, takes up an entire wall of the gallery, it's called Passage. It's gorgeous. But it's not what it appears to be from a distance. Here's what it looks like as you go up the gallery stairs and first look at it.

Some kind of weird Wright-brothers thing, right? That's what I thought. That strange modern art thing. Tsk tsk. Then I got closer and ... oh my goodness ... it's not what I thought. It's completely different. It's not some utilitarian, transportation thing. Well actually it is that, and more. So much more.

Yes, it's made of the most tiny, delicate soft butterflies. And to me, this just screams of love. The opposites. The soft and the hard, the utility and the ridiculous beauty, the big and the miniscule, and of course the deception. Love is not what you think at first. In fact, it's entirely different the closer you get.

It was a truly fun day at the museum. Can't wait to go back, actually. But I'm not sure when I'll find time, because, see, I'm carrying on this mad love affair. It consumes me. It's huge, and yet it can be so small and fragile. Just the tiniest moment with a patient. The tissue I hand someone after she's told me intimate details about her life, something she's locked inside for years. What a privilege.

Kickstart My Heart

It's been a packed couple of weeks. So here's the most riveting thing: I helped, in a small way, save a guy's life. Yes, I know that in my job as a psych NP I could actually say that every day -- and really, there are some days that I genuinely feel that (& let me say, it's a marvelous thing, something that gives my life great meaning) but this was a bit more tangible and immediate. In spin, there's a fellow rider named Jamie who is a regular, comes with his wife, they are always on front-row bikes in front of me. Nice people, he's actually the guy that suggested I use The Great Santini movie to write my family therapy paper (which I got an A on). He had fainted in spin a month ago, went to see his doctor, then cardiologist for tests. Nothing was found, he was cleared to return to class, and he'd been back regularly for at least two weeks.

So it's the Wednesday before July 4th, we are all at the 5:30 a.m. spin class, and Jamie leaves right before the last song. NBD, I think, he must need to go to work early. We finish up and exit the room. And Jamie is lying on the floor by the bench where we all put on our cleats. There's a Gold's trainer bent over him and about 5 others, wringing their hands. Yes, it's time to utter the magic words: "Please let me through, I'm a nurse." So I am thinking, he fainted again. I follow my little CPR protocol, I shake his shoulder and say his name loudly. No response. So I bend down and look, listen, feel for breathing. Holy f'ing god, he is not breathing. This is completely not what I expected. So I position his head and start doing rescue breaths and this is hard as hell, folks. Just getting his head positioned is hard. He's in a tangle of arms and legs on the floor, and I bark out "Help me straighten him out". This is funny -- I have gum in my mouth and I just throw it across the room as I bend down for the first breath. I got a breath in him after he's straightened, and he makes a few agonal gasps (not a good sign) and now I'm desperately feeling for a pulse on his neck. Yes: Holy f'ing god, he has no pulse.

And folks, here is where I screwed up: I should have applied the AED at that point. But I didn't, I was just about to get my hands in position for the compressions, and EMS walks up. Honestly, I think I've never been so happy to see anyone in my life. There's about 5 or 6 guys (and man, some of them need to pose for a calendar of manly firemen/EMS guys with their shirts off, let me tell you....um OK....back to the topic). They defibrillate him twice, which is harrowing. I'm watching this, standing with his wife. After he fails to respond to the first shock, my eyes are wide and I'm genuinely thinking what if he dies here, on the gym floor. But he does not. They get a line in him (probably gave him epi), apply O2, and then they are pacing his heart. This is painful and he's moaning and writhing, and one of the EMS guys explains that's actually a good sign. They take him away. I look at the clock: only 20 minutes have elapsed. Felt like hours.

He spent a few days in ICU, got a pacemaker implanted and he's fine. He had an existing arrhythmia and went into ventricular fibrillation I'm guessing, and then cardiac arrest. It couldn't have been a better outcome. I got to shake his hand and see him again at the gym. He's walking on the treadmill for now, but he'll be back on that bike in front of me.

I learned a couple of things, first is beware of your assumptions. My thinking that he'd fainted again was not helpful. And yell for the AED right away, do not wait, and start the damn compressions sooner. The other thing I learned is that performing CPR on the gym floor is a hell of a lot harder than in a hospital bed. And it is much, much more emotional when it's someone you know. I was tearful and trembly the rest of that morning. I've never reacted that way to a work situation, and I've seen much more terrible things at work.

What else can I say to follow up that drama? We went to Mississippi/Alabama and visited Ken's family and it was a great trip. We even got to see his daughter Jennifer and her four kids. Here's a pic of Dani clowning with her newest little cousin, Charlie (an extremely cute little guy).

Oh wait, I do have a big drama in my life to report. Ha. I quit my brand-new job 2 days ago. Yes, the one I just accepted as an NP in private practice with a local psychiatrist. Doesn't sound like me, does it? Well, back in March when I first started job hunting, I interviewed with a small, private specialized treatment center and I absolutely loved it. I liked the job description, I liked the people, I liked the fact it's 15 minutes away. And they liked me too, but timing was a problem. They needed to fill the position and couldn't wait for me to get credentialed. So, sadly, we parted ways. Last week, I get a call from the director of the treatment center. He simply asks if I would meet him for coffee. I don't ask why, I think for just a second and say yes. And as we sit down, he says, "Let me get down to it. Is there any way we can convince you to come work for us now?" Wow. That wasn't what I expected; I was thinking he wanted to see if I could work PRN for them, maybe fill in when their NP is on vaca or out at training. So he explains how we've arrived at this interesting juncture. I ask some questions, and we agree that I'll take a week to decide.

It was not an easy decision, mostly because I feel so badly about telling my brand-new job that I'm leaving now, like right away. But ultimately I decided that is indeed what I want. For many reasons, this particular job at the treatment center is just cosmically right for me. It's a specialty area that I've always been interested in and someone close to me killed herself while suffering from this disorder when I was in my 20's. I feel incredibly lucky, actually, to get this second chance. Once in a while in life, you get a second chance. It's wonderful that it's for something so important. And here's the cool thing: I have absolutely no doubt that I will love my job. I am so looking forward to learning and specializing and becoming capable. Getting to know fantastic, challenging patients. And maybe, just maybe, saving someone's life.

Duh DOMA

I passed my boards, who knows how close I came, because all they say is that you passed or failed. It was more difficult than I expected and I'm not allowed to talk about the exam content, but it had questions in areas of focus that I did not expect. Have to leave it at that. It was 175 questions, I took about 3 hours because I went over the entire test again after I completed it, and changed about five answers. I was an utter wet noodle when I finished. I left the little testing room and turned in my stuff, the woman clicked a couple of keys on the computer and then frowned as she stared at the screen. OMFG, did I FAIL? I start babbling, please, tell me I passed. She doesn't answer, still frowning, turns to the printer and then hands me a page that starts with "Congratulations". I should've punched her, but I actually hugged her. Really. Then I gave $20 to the homeless woman on the corner outside. I never have to take it again, as long as I pay my dues and keep up my CEUs. And let me tell you, I'm all over that. So now I'm in the process of getting my license and prescribing numbers. It's exciting.

I've used my dining room as study central since I first started all this grad school mess two years ago - and now I finally have to clean it up. Yes, it's really bad, see?

 

 

It's been a nice time for the last week, a great weight was lifted from me. I've been using this time to clean out the garage and get rid of old clothes, order a new dishwasher, and paint the house. Well, not really. Would like to do all that, but actually the only things I've done is lots of yoga with Dani and lots of Anthro trips. Ha. We had lunch at Hula Hut Monday, lovely sunny day on the lake. Perfect Austin activity.

 

Weird day yesterday. SCOTUS make me proud of my country and our ability to learn, grow, and change. Then the Texas Legislature made me embarrassed as they stupidly wasted our money on a special session to try to chip away (again) on a woman's right to choose. Can we please pick up Austin and whisk it away to sit in another state? I love this place, deeply, but I am so weary of the backward stupidity of the rest of this state. Yes, I'm a little opinionated about this. I've felt strongly about a woman's right to control her own body my whole adult life. I stood as a clinic defender when Operation Rescue tried to create havoc in Baton Rouge (in the early 90's) by targeting and picketing the clinic. And I'm a devoted mother. Anyway, I looooooove this tweet about the great smack-down of DOMA.

 

 

 

I went to a 34-year reunion for the Youth Conservation Corp summer work experience that I did in 1979 in San Angelo. Out of 100 high school kids from back then, only seven of us came back for the reunion. We revisited all the places where we lived and worked. Yes, everything was smaller. So much had changed - the dorm that I lived in had been torn down. Much of it was not familiar. And my boyfriend from that summer didn't go! Yes, my first love, Jeff, had recently moved to New Mexico and just couldn't swing a trip back. It's understandable - I mean, San Angelo doesn't exactly have an international airport - but awwwww, wouldn't that have been awesome? Ken was our photographer for the trip - he was great. It was a nice quick trip away together.

 

 

I meet with my doctor tomorrow to make the job agreement. I have a very important form that I need to fill out with a little blank for the Doctor's name. So I'm going to say, hey dude, does your name go here? ha. I've been told that he's trying to set up some TeleMedicine (as they call it) for me to do. This is when you have an office visit over a teleconference link, like a fancy Skype session. I'll find out more tomorrow, but the office manager said that it could be a way for me to "jump start" my practice. Sounds good to me. I am ready to roll up my sleeves. Update on that in the next blog.

 

ETA: I got the job! Now just hammering out the details. I'll be there every Tuesday in July, learning and absorbing while I get my license and prescribing authorization. I should be able to start seeing patients in about a month, maybe a little more. Exciting.



Center of the Sun

I know, I should be studying. But you know how that goes. I suddenly want to do everything else, even clean my house (and domestic does not equal me). I have two days left. I feel pretty fine about it, but not going to skip any prep these last few days.

I've been able to go to yoga almost daily, often with Dani which is a treat, and the routine that Erica is doing now (my fave teacher) starts off with this incredible song, very quiet with these disturbing lyrics about the awful things that can happen but the chorus says "and I cannot be hurt by anything this wicked world has done". That rings in my head long after yoga is over. Sometimes it's difficult to read what I'm studying. I go from a horrific chapter on intimate-partner violence (the new name for wife-beating) to schizophrenia (usually a death-sentence type of diagnosis) to suicide to post-traumatic stress disorder....I could go on and on. This is my profession, to help those who've seen the worst, been through the worst, and together we find a way out and up. My personal image of this has always been the experience of being in a pit - it's dark, you're at the bottom, the top looks so far up, you can't reach it. Now I'm the one with the rope. Anyway, if you're curious, here's a link to that song. Center of the Sun by Conjure One

Dani did not get into UT. Fine, on to ACC. The nice thing is I think I've convinced her to give nursing a chance, and a perfect route into that is ACC. As soon as my boards are over on Tuesday, we'll get busy researching her class schedule, pre-requ.s, etc. She was stung by a scorpion this week. It was midnight and I heard this scream. She was in the kitchen, barefoot, and got stung. We counted, and this is the 7th scorpion we've seen either in the house or porch/pool area since we got here, in 3 years. So yes, we need to wear shoes. All the time. The neat thing was, she did not have leg cramps and terrible pain after the sting. Either he didn't get her good, or he wasn't very venomous. Either way, great.

The kids both had their first day on-the-job last Wednesday. Nile did excellent, working in a hot warehouse all day. He was positive and enthused afterwards. We made the drive together (because I'm overprotective) and I studied at this little library branch in North Austin while he worked. Here's a pic of him after his first day. Oh, and it was his birthday. Monday he drives alone, in his new car. Here's something cool: my brother ordered a shipment of very special furniture from England (a container full); mid-century items in the Danish-modern style, which because of Mad Men is very popular right now. You should see the quality of these things. It was jaw-dropping. These are from the early 1960's and in beautiful shape - even some of the upholstery is still fine. This is a huge gamble for him, it was not cheap, and he luckily had an empty warehouse to store them in (yes, there is that much of it). Some of the pieces are custom, and Roy even knew the names of the furniture makers that had created them. He showed me one of those, a long credenza, that should go for $3000. Anyway, incredible.

And Dani basically got fired from her brand-new babysitting job by text yesterday. The woman said that for financial reasons, she was going to have a relative take over. Who knows if that's true - it seemed like everything was cool - but this woman had been a bit flaky from the beginning. Note to self: the way people behave and treat you at the beginning of a relationship is how they really are. They explain things away, and we want to believe them, but listen to your inner voice.

It's pool season, and it's fantastic. I'm in love with my pool. Perfect timing because I've had to give up running. God, I hate to say that, but my knee pain was becoming worse. It was even hurting in Spin, and that's just a no-go situation because I'm in Spin 6 mornings a week. And I couldn't do full Hindi Squat pose in yoga any more either. So I stopped running completely about 2 weeks ago and finally, finally yesterday it didn't hurt at all. Dani has taught me how to use the rowing machine instead - which actually is hard to do correctly. It's taken me a couple of weeks to get my form down, but yesterday we did it together and I got the thumbs-up from her. It's a super calorie-burner, and an advantage over running is that it uses your full body - upper as well as legs. And as Dani likes to note, it really works the glutes. Man, it hurt to sit down! Bring it on. Next up is rowing on Townlake.

Between rowing and swimming and all this time for yoga, summer could not be better. Hold that thought until Tuesday. Ha!

Oh, one more thing. On Friday at 11:00, I finally meet with the psychiatrist; we didn't do it last week because he's had to work so hard to catch up from his vacation (a good sign - very full practice). I'm going to flat-out ask for the job. I got a call from a headhunter Friday morning about a job up in North Austin at - get this - $150,000. It's a locums thing, but they need a permanent. The headhunter was asking if I could even do it for just a couple months, and depending on what the Doc says on Friday, I may do that. It's a treatment facility which means I don't have to be on the insurance panels just yet -- I can do everything under the psychiatrist's credentials. Which means I could start right after boards. I'm thinking about it.

I plan on sleeping in

That's another Deathcab lyric (actually it's Postal Service, since I was at that concert this week, but I lump them together). It accurately captures my state of mind but certainly not my actual activities. Ha. People that know me, know that I'm always up early at the gym when there's only a select handful of us regulars and almost all the machines are free. There's no weirdos to come up to you, in your face while you're in the middle of a leg press set, with your earbuds on, and stand there yelling excuse me until you remove one of them to (ick) hold a conversation. Which turns out to be some asinine question about the relative advantages of one leg machine versus another. Look buddy, I'm not your free personal trainer. You'd think I hated people, but look folks, I really don't. Just do not interfere with my gym time. I'm not there to socialize. Not one bit. This is exactly what happened to me when I had to be there during regular-person hours recently (oh, the horror). I had this surreal morning the Tuesday after Memorial Day. First, the doofus at my gym is not on time again. This happens a couple times a month, and I have blogged about it before (so no boring rant); I go to Plan B, which is drive to the Gold's on William Cannon. And even though it's a 24 hour place, it's locked up tight too. A woman and I stand there at 4:30 a.m., scratching our heads. Guess they have a doofus that works there too. She said that had never before happened to her, and she's been an early-bird there for years. Know how I got revenge? Oh, I'm so, so evil. Read all about it (sigh...like they even care). Yelp Review

I've been waiting to write this post until I had job news and I got some today. So, yes, folks, I have so much time on my hands that blogging is now something that I have time to do. Ha. I received "the note" from the Doc's office manager that he'd like me to come in for a meeting. I'm pretty sure that it's to discuss the terms of me working in the practice, and I'm ready to make a deal for that. I've done some more checking around, and I'm convinced that this is the best option for me. One of the checks was someone in the know (won't reveal sources) who said in confidence that their plan is to offer me the job. I'm pleased. I feel lucky to have found a private practice job in Austin as a new grad. I'm not going to reveal where I'm working or with whom so that I can continue to talk in my blog about my work, but only in terms that disguise patients completely.

I just read the most disturbing (in a great way) book. It's Gone Girl by Gillian Flynn and it's a psychological murder-mystery thriller. With some huge twists in the middle and end of the book that really threw me for a loop. I spent most of the day Monday reading it. I haven't had a can't-put-it-down day like that since I read Middlesex (another book I'd highly recommend). What an absolute luxury of a day, and in the evening Dani and I went to hot yoga at this little studio that opened just outside our neighborhood.

Anyway, the book paints an excellent picture of a person with borderline personality disorder, I would list it as chronic, severe, with psychotic features (fixed delusions) if I was writing it as a diagnosis. I am not going to reveal which character has this illness, because it won't be apparent for the first 60% of the book (yes, obviously I have a Kindle if I'm quoting percentages). Really sucked me in, I was completely taken in by this borderline. And the book as a whole is a truly excellent explanation for why clinicians dread working with these patients (in fact, the doc I'll be working with says that we should never have more than 2 borderlines as patients). It's almost impossible to sift through the lies and the truth, mostly because they believe their own lies (that's their version of a fixed delusion). Which is quite sad. And the havoc they wreak on the lives around them, in their desperate attempts to fill their wide, bottomless abyss of neediness is painful to watch. I think of the parents I've met of the frequent-flyer young-adult borderlines that I had as patients at the psych hospital. To a one, they looked tired and sad.

I have done basically nothing since I got back from New York, besides read, eat, and go to lots of yoga class. Well, then there's the Anthro trips with Dani. I found a fantastic black top marked down twice that was only $9.95 yesterday! And I'm not talking about some schlubby loose Splendid top, no it's got these nice little ruched shoulders with 3 tiny set-in buttons. What a find. Made up for the full-price items that I proceeded to buy for Dani.

Nile took another step in his black-belting this week, he had testing Saturday and passed to the next level. He'll get his new belt tonight. It's nice that he gets that before summer kicks off. He is going to work for my brother at his used furniture store, Modern Salvage (Store Link), driving his new car. We got him a dark blue Prius, at his request. Isn't my son smart? Dani is still looking for a job and still looking to see if UT accepted her for the fall. One of her NYU friends, a guy from L.A. whose dad is some big-time screenwriter, arrives tonight for a visit. I bet he loves Austin, what do you think? I loved it when I was 19. In fact, that's about the age when I first fell for her, from the Congress bridge bats to the ice cream at Udder Delight, to water skiing on Lake Travis, to concerts at Club Foot, to bowling in the UT Union basement and indie movies at Dobie Mall. OK, I better stop.

I guess I have to start studying for this board exam. It's kind of weird, when I get the Authorization To Test (ATT) from the credentialing organization, it better light a fire under me; there sure isn't a fire yet. Maybe this meeting about the job will do the trick. I seem to be waiting for some magic. So snap your fingers, say a little hocus-pocus for me (thx).

Here's a few pics of the summer fun.

ETA: Thanks for the chant! It worked! I got my ATT in my email this afternoon and scheduled my test for the 18th. Two weeks is enough to study for the most important test of my life, right?

Postal Service concert

Lakeway trails

Black belt time

Significant

I have graduated. It was a pretty decent day, not too hot and had that nice milestone feeling. I thought the speakers were thoughtful and (most important) not too long. This was just for the school of nursing so it was pretty specific, and I liked that. I must say, I was quite glad that I did not wear heels. Lots of walking, traffic was super awful. Apparently different schools had their convocation ceremonies at the Bass Concert Hall all day long, separated by 2 hours, so as people were leaving, we were arriving. I saw all my Psych NP classmates (all 9 of us).

I have to say, this would not have been possible without the support of my husband, Ken. It was quite a luxury to only work on the breaks (& even then, only because I wanted to). This was a successful joint project. I'm finally at the point of doing my life's work. BTW, here's a link to a story that eloquently explains why I feel that way. I want to be the one that makes a difference in someone's life in exactly this way. Modern Love Story

After graduation, Ken and I went to Kerbey Lane (yep, the original one). I've been going there since 1980, when I first came to UT. Yep, 33 years. Feels incredible. There was a loud table of young ones next to us with a few fellow graduates, drinking mimosas. Great way to spend a Texas afternoon. BTW, I just have to mention that I'm wearing two nursing pins on my gown, nurses go through this unique "pinning" ceremony when they first become nurses, one of them is my grandmother May's pin, who was a nurse in Arizona in the 1930's, the first surgical nurse in a small Arizona mining town. A pioneer. The second one is from my original graduation from Our Lady of the Lake College in Baton Rouge, in 2007. Another meaningful day. 

Then we flew to New York to go get our daughter. We had some fun, but it was a super quick trip (only there 4 days). We went to MOMA, wandered around Soho, and saw a Broadway show (Kinky Boots - fantastic, makes me want to be a drag queen for Halloween next year, ha!), and got her and her stuff back to Texas. We had six heavy suitcases and shipped two big boxes of clothes, but we did it. I ate the best Thai food I've ever had at a place called Peep in Soho, and of course, we had to try the vegan falafel sandwiches that Dani has been living on at Taim (it was as good as she said).

Here's some pics from what we did.

So now I'm just waiting for the authorization to take my boards, and I hope that will be soon although I haven't started studying yet. Not sweating it too much. 

This is an interesting time to be entering this profession. The DSM 5 just came out and is pretty controversial. I listened to an interview on NPR a few days ago with the new head of the American Psychiatric Assn. and I thought he explained/defended the viewpoint of the mental health professional community pretty well. NPR DSM-5  People are upset because we have much more detail in this volume - the first new edition since 1990, which is an eternity in science - but many people don't feel that upset about the fact that similar guidelines for physical diseases, such as heart disease, diabetes, etc. have had even more growth in their body of knowledge. We know more, shouldn't we inform more? And no, I don't agree that we are pathologizing normal (which seems to be the main criticism), it's still an individual clinician that is licensed to make an actual diagnosis - no just anyone can do that - and one of the most important things that the DSM stresses over and over is that if you have a mental disorder it should cause you significant distress and impairment in your daily functioning. If those two criteria aren't met, that it should call the diagnosis into question. 

Next up on the agenda: buy our son a car this weekend, and get each teenager a job. No small feat. Hopefully I'll have job news myself in the next post. I talked to the director of Shoal Creek and I've essentially crossed that off my list because they don't anticipate a start date until September. That tells me they really aren't interested in new grads. I'm certainly not going to wait that long.

Perched on the Handlebars

I took my last final exam this morning. As in "last in my whole entire life", unless I'm going to enter a new profession again. Which I guess is not too unreasonable, given that I've already done at least 5 different things. Those would be (in order): accountant/auditor, systems analyst (which includes many different types of jobs, from project leader to software developer), group exercise instructor, RN, and now....Nurse Practitioner. Yes, I know, I still have a pesky little thing called Boards to pass. NBD. I'll take it soon, but not before May 25th -- that's when UT will officially send my degree info to the credentialing organization.

It was the Pecan Street Festival last weekend, and it was perfect weather. It's been such a cool Spring here, makes it more pleasant to be outside. But of course, there's the grumbling I do as I run to my car in my sweat-soaked clothes before it's even light in the morning. Not digging the cool weather then. But that time appears to be over. Anyway, Pecan St. was a real shopping opportunity, which I did not waste. And half the fun of anything in Austin is the people watching. Great city for that!

I'm still figuring out where I'd like to work. Yes, to quote the Shins, it's like I'm perched on the handlebars of a blind man's bike. I am pretty sure that I'm going to work for a psychiatrist in central Austin in private practice. But I did get a call from a large local psychiatric hospital last week, and they are seem very interested because I have a variety of psych hospital experiences, both here and in NJ. There would be advantages to working there, but the biggest downside is the traffic. I would certainly have to be there for morning rounds - probably at 8:00 - and the traffic would be a nightmare. If I didn't want to be late, I'd need to leave an hour before. The advantage would be higher initial pay, full benefits, but mostly the variety of patients (including those serious mentally ill, which I love but won't see in this practice) and working collaboratively with a large team that includes psychiatric residents. And I'd be their first Psych NP, so it would be ground-breaking. But working in private practice, I can shift my work hours -- arrive at 9:00 or even 9:30 -- and voila, no traffic. Yes, the flexibility would be divine. I have spent 2 days with the Doctor and his existing two NP's and I like/respect all three of them - it feels like a good fit. And this morning, I got an email from his office manager basically asking if I was ready to start job negotiation. Still thinking about checking out the hospital.....urggg, but that traffic.....of course, that's only for two years. When Nile graduates, Ken and I plan to move closer in.

Anyway, that's all been on my mind. Here's something funny. Antipsychotic medication (things like Thorazine, Haldol, Risperdal, Zyprexa) are being found useful for more and more things. They work as mood stabilizers for bipolar disorder and work as an augmentation agent for treatment-resistant depression. But when you say the word "antipsychotic" to a patient, they just hear PSYCHOTIC and flip out. What? I'm not taking that drug! So my clever professor advised us to call them.....broad-spectrum psychotropic medication. Isn't that great? You also see that when you tell a bipolar patient their diagnosis - they envision the Hollywood mania and get pretty upset - WHAT? I'm not manically crazy! I haven't spent every penny and had sex with every man on the street!

I have an Ebel Beluga watch that I bought a couple of years ago on Overstock.com. I saved a few hundred dollars on it and figured that was great. The bracelet broke and I took it to be repaired, which the jeweler said that they could not do. All repairs have to be done by authorized Ebel jewelers or I can ship it to Ebel. I went online to get a repair order and ship it....and guess what...it's counterfeit. The serial number is invalid; it's not even the correct number of digits and letters. Now what? So I googled around and found someone that offers to repair any watch -- I sent it to them. But here's the fun part of this story. I dreamed that night about my watch, that I opened it up to see the inner workings and then I ate them. Yep, crunched up all those little delicate metal pieces. Yum. (note to you: don't buy luxury items from that web site)

Graduation is on the 17th. I'm excited but it will basically be a hellish day. Because of the Boston bombings, security will be super-tight and everything will take longer. Graduates cannot bring any bags or purses. Guess I'll stick my lip gloss in my bra. Spectators have been advised to only bring a bag/purse 12" or smaller, and warned that lines for those to be searched will be long. Better to just go through the metal detector and carry nothing. Oh boy. 

I had an interesting conversation with my hairdresser this week. It was the day that they discovered those three women held captive for 10 years. She wanted advice on whether to bring it up with her two young daughters. We talked about the risk of scaring them unnecessarily vs. letting them hear about it on the news, and talked about the relative risks of stranger danger vs. someone a kid knows (stranger is actually quite rare, most common is parents stealing kids in a bad divorce, but behind that is relative/acquaintance). And we talked about the nature of evil, which is the only thing I can call this. I'm an atheist, so I have no biblical beliefs about the devil and what caused such a thing. Is he mentally ill? Well, of course, it would actually be fascinating to do a psychiatric evaluation of him (if he would talk, surely his lawyer is putting the kibosh on that). Deep down in my bones, I know this man is just plain evil. Very few mentally ill people are violent or motivated to do something like this. And here's the thing - you can't really tell. When I worked at a state psychiatric facility in NJ, we had some of what you call "forensic" patients and a few of them had done absolutely terrible things. I can still remember that one of my patients needed to go off-site for some specialized medical test, and in big red letters inside his chart it said "must be accompanied by two mental health officers for any off-grounds appointments". I had seen orders to have one officer, but two? Then I read further in the chart that he had been a serial rapist. Great. (Rule on the first day: never let the patient get between you and the door.) But was there any clue when seeing this patient in the milieu with everyone else? Absolutely not. Just another guy. 

One more pic. These are my fellow UT Psychiatric Nurse Practitioner graduates, professor (far L) and program director (far R) for 2013. We are a small group, there are many more Family NPs and also about six Pediatric NPs.