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.

Up

Things are looking up. I don't have a lot of news, but I mostly just want to get that rant off my homepage. Ha. Felt good to do it, but now I am uncomfortable with it being the first thing seen. I had an interview, and it went really well (in my opinion). It's an innovative practice with a psychiatrist that really emphasizes therapy. Already has one NP and seeks another, so I won't have to break any new ground. Lots of experience to learn from. Excellently run, with an office manager that's been there 7 years. The office is simply gorgeous - in a lovely park-like setting, the building is quiet. Obviously been professionally decorated with no expense spared. I would have an office with a window. The only downside is the commute, but it's bearable. And he was amenable to working flexible hours. They asked the magic question near the end: How soon can you start? Anyway, I'm providing them with all my license numbers, diplomas, etc. It's definitely going on to the next step. We haven't talked money yet, but I've already heard that he's reasonable. I must confess, the idea of seeing a wider range of patients with a variety of issues does interest me. This practice only sees adults now, but perhaps I could broaden that - I'm so comfortable with adolescents at this point, as they've been the majority of my patients.

It's a snow day in Austin. A rare event. My gym opened about 45 minutes late, but I got over there and my wonderful spin instructor did two extra songs for the three of us there. Love her. And no work today! Of course, no pay today either! This part-time thing....not gonna work. I'm really trying to put on my big girl panties and smile and have a positive attitude there. There is only one person at work I've bitched to, and I'm going to keep it at that. But the signs continue to be quite negative. I was told that I need to start meeting in person (instead of calling) with parents of adolescents on admission day - which is great, I think it's a good idea, but I'm not there every day. Nobody thought of that. Another example: I had 4 insurance reviews to do today, which won't get done because of the snow. And I'm not there on Monday. Someone else will have to do them that day, or patients could get denied for coverage and we have to eat the cost. Hope that gets done (said in a bitchy voice). I asked how situations like that would be handled when we were discussing this part-time schedule, was told "we have a lot of things to work out" and that was it. Just like the contract I was supposed to sign on Tuesday. Never saw it.

Um, this is turning into a rant again. Damn.

So what else is going on? Running is going really well. My rule is that I run one song, walk one. I'm up to 40 minutes doing that, wearing a knee brace. No more pain than before I started this, so = success. My gym is strangely deserted for a January, and it's because the new location opened in Westlake. A lot of people are going to that one, it's brand new and has a pool. I'm going swimming today, for sure. And yoga, and oh my...it'll be a fantabulous workout day. It's nice not to have a jammed resolutioners crowd, but I'm also worried that they may cut some of the spin classes for poor attendance. And I must, I mean must, mainline my spin every morning or I go into withdrawal. Nothing else quite does it for me, I think it's the intervals. Working so hard you can't catch your breath, drenched in sweat, cranking it up to the nth degree, screaming inside when will this stop?! And then slow down, breathe, recover, and do it again! For 45 minutes! Yeah baby. This may completely be TMI, but it is a lot like sex. You're in a dark room, building up to the climax, breathing hard, focused, straining.... especially when we reach the top, folks sit down on the bike and everyone sighs and squeals. Sometimes I just have to laugh. Yes, it's a spin orgy.

My ham planet cat has learned how to open doors. We have hook door knobs, and he stands on his hind legs, reaches up and opens it. He really likes to do this to the bathroom and then destroy the toilet paper. His girth facilitates this - ha.

I just finished The Goldfinch by Donna Tartt. It's a novel about love, art theft, tragedy and PTSD, and the losses that all of us face in life; the unfinished nature of how things turn out, the missed connections and the way that love actually doesn't conquer all. But still... there remains beauty and meaning, if we are brave and face things. It takes place in New York, Las Vegas, and Amsterdam. It's hard to put in to words why it's so good. It's well written, it surprises, it is deep. And it's absolutely not trite. I guess that's what I value most in a novel. If you want to read more about it, here's a link. I can't recommend it enough. http://books.google.com/books/about/The_Goldfinch.html?id=T2CA83gbtM8C

OK, yoga in an hour.

I'm not crabby, I'm just really bitchy.

This is going to be a bitchy rant. If that's not your thing, walk on by.

As I've often mentioned, I love my job. I work at a small specialized treatment center that I feel really makes a difference in people's lives, especially those of girls and young women. Most of the clinicians there are so capable and there's this wonderful collaboration. It's a stimulating environment to work in, and when I look back on the 5 months I've been there, it's quite stunning how much I've learned.

Can you hear the "yes, but..." coming? Our break-even census number is 11 patients, and since about late summer, we have not consistently been at that number. I've still had plenty of work, at first it was because I was learning so much, but I've taken on other tasks. I am the liaison to all the insurance companies, so I have to interface with them for each patient about every 4 days and get authorizations for continued stay. It takes time to collect the data from everyone on our team and build the story of what that patient needs. I also do three therapy groups each week and work with two different interns on separate days. I revised all of our medication management policies, which basically was non-existent. I was busy in spite of the low census, and I definitely worked more than 40 hours a week. I went in every Sunday afternoon, and frequently I had to meet with patients who were struggling over the weekend since none of the therapists were there. Sometimes I left early because of that, but not lately. In spite of all that, I knew that the organization was worried about the low census. In the past month, they laid off our HR person and our PR person. And guess who was next? Well, I'm their third-highest dollar employee, right behind the COO and the clinical director. But here's the deal, they really can't lay me off. Nobody else can do what I do - they aren't licensed to diagnose, treat, and prescribe. Only the doctor can, and he works only 8 hours a week, and half of those are meetings. I was thinking that they might consider dropping me to work only 4 days a week, or expanding my role to take on more of the therapist tasks. But they had something else in mind. And it didn't go down well.

So the delightful day before my birthday, the director tells me that they are dropping me from a salaried employee to only 25 hours a week, and keeping all my duties intact. I would work 3 days a week, and they propose that I see patients in a private practice using my office on the other days, and use a 60/40 split for the money I make on those days. The only problem with this is they were "too busy" to get me credentialed with the insurance panels all this time, so I've been billing under the doctor's name. I can't take any insurance patients on my own. And that's a ridiculous split - I would never agree to it. The going split around town is between 20 and 30, and that's with providing billing and insurance processing. They want 40% of my money just for me to use an office that's empty anyway? They also asked me to propose an hourly rate. So  I went away and started thinking about this.

The next morning, I see the COO in the coffee room and say, oh by the way, I forgot to ask when you guys want to implement this. He says, next week. My mouth falls open. I can't stop myself. I say "you are kidding". He says, oh I'm under a lot of pressure from Dr. M (our "headquarters" organization is a treatment center in another city; the doctor there owns both facilities). That's just peachy. You expect 2 weeks notice from me, yet you give me 5 days. That's just great. Later, in the weekly leadership meeting (and that they nicely inform me, I'll no longer be attending) our administrative head tells us that she worked all weekend on a proposal to fix financial problems that have recently been uncovered at HQ. Seems that their census has been low for months too, and they had been very sloppy about billing and record keeping when times were flush. Now they're not, and discovering that they have huge problems. Hmmmm. Could there be a connection to their sudden decision to cut my job to the bone?

Anyway, I calculate a rate that basically turns my salary into an hourly rate, I don't add on anything for the lost benefits. I am generous. I tell them the next day what I want, and that I want a 70/30 split and want to be credentialed. I offer to help with that process, filling out forms, making calls, whatever. Reasonable, no? I do this without being pissy, either, in spite of how I feel. And then I wait. And wait. So it's Friday, and all of this is supposed to start on Monday and fucking finally, he meets with me and counters my hourly rate with one dollar below that and they won't compromise on the 60/40 split. I say nicely through clenched teeth, I decline your offer. I can stay for the 3 part-time days but at my original rate and I'll find something else to do on those 2 days off. And incredibly, he says Well I have to run that by the owner. Great. Let me know by the end of the day. I'm not showing up to work without us coming to terms.

And at 2:00, they come back and agree to that.

I'm incredibly sad about all this. I really was doing work that fed my soul. But I can't stay at a place that feels they need to humiliate me. One dollar less? What is wrong with you people? I've had uncomfortable, strong signals for a while that our COO isn't very competent, and this just confirms it. Throughout all this, he kept saying this was not his choice, it was all coming from HQ, it was out of his hands. You fucking ballless wonder. So what exactly do you do here then? And the serious financial mismanagement is not trivial. I don't believe these people are good businessmen and women. I see reaction, I don't see strategic thinking.

I have a job interview Thursday, at an office with a psychiatrist that I've heard wonderful things about. The only downside is the drive. He's up 360 on Spicewood Springs, but that's reverse traffic so I don't think it will be bad. And it avoids Mopac, which is about to become a disaster area for years when they start building the toll road. My plan is to start working there on the 2 days I'm off, he can start getting me credentialed, and then I'll quit and go over there once my practice on those 2 days fills up. Actually, a pretty good deal because many times the first 6 months of a private practice are pretty lean as you build your clientele.

And I'm closing with a picture from the hot sauce fest this past summer. It allows me to do what I wanted to do all week. I look pretty happy.

More Naps

I'm at work. Seems like I could just say that at any moment and it's correct. Not too big a whine, but seems like lots of parents thought that they could "cure" their teenage daughter of her eating disorder in the two week break for the holidays. Ridiculous, sad, so misinformed. And then they are angry at us when we don't pull that rabbit out of the hat. My doc has worked only a total of 4 hours over the last 2 weeks, and numerous people have been on vacation. What I'm trying to remember is that I can only do what I can do, and that all of this is a choice. And people covered for me when I took a week off (of course, they have a PRN NP that has to come in for me. Nobody but the doc can actually do what I do; unfortunately that's not true for me. I can step in and do the therapist work and I have been.) But honestly, I've had some fantasies about finding another job. That bothers me. My boss returns Tuesday and we will be having a chat. I've decided that I need to set some limits on the time I leave the office. The actual patient work is quite rewarding, it's worth it to make a big effort to fix the problems.

They opened a new Gold's gym less than a mile from my office. It's pretty sweet, all brand-new equipment and .... a POOL. I've swum laps there twice now and I have all the excitement for the beginning of a long term relationship. They have a nice sauna too. I suspect that will become attractive for me, stop there a few times a week after work. Swimming has always been such a meditation activity for me, it would be perfect after a long day to "process" as we say. Their spin room is big too, I'll have to try that out. Brand new bikes. I've started running again. My knee really felt better after that week in Holland with just walking for exercise. Took away all the weights, yoga, spinning and rowing. So I've started VERY slowly. I run one song, walk one. And I stop after a cycle of 3. After two weeks, I'll let myself increase. This is so NOT what I did last time. I think in less than a week, I was running 30 minutes straight. Through the knee pain. Don't do that.

Ken and Dani are in Taos. They skied yesterday, I'm waiting to hear a snow report. And it's supposed to be a super-chilly day here. I should have some great snowy pics for my next post. They ate at Tecalote Cafe in Santa Fe, one of our favorite places. Blue corn pancakes.

Ken and I are going to Carnaval Brasileiro www.sambaparty.com this year. I figured no Mardi Gras, this'll stand in. And I bought the VIP tickets, so we'll have a nice little area to chill when we get out of breath from dancing. And baby, I sure plan to do that. I'm working on my costume, so far I've settled on freaky stockings and boots. Maybe a Lululemon top, I need some extra support for all my jumping up and down. Ha. Can't wait. From what I read online, this is a real feast for the eyes as well as the legs.

The holidays are over and I'm so ready. Not my favorite time of year, and I think with the work issues it was particularly bad this year. It's funny, I spend much of my days being somewhat of a cheerleader to my patients -- "What skills could you have applied in that situation? What things work for you to improve your mood? What's standing in your way of making those choices?" and I catch myself thinking, maybe (just maybe) I should apply them to myself. Certainly it's easier to tell others than to do it yourself when you're blue. Or stuck in the black and white of it all, technicolor gone missing.

Over the holiday revelry, here's something interesting that came up in the dining table conversation this year. We were all sharing the most interesting thing from our year's work. My brother owns a vintage furniture store in Austin called Modern Salvage www.royt.com and as part of his inventory acquisition process, he buys foreclosed storage units. One of the units he bought was owned by a great-grandson of Jack and Rose from the Titanic story. Yes, the movie. Those were actually real people, although they weren't that young, and they had children that were not with them on the boat and survived. So yes, most of the movie's plot line was fiction. Anyway, this guy that owned the storage unit has had a difficult life. Lots of money handed to him (the family was wealthy) but he was a sucker for con men with schemes. Lots of detritus in that unit from failed deals that he was involved  in, and also lots of expensive, little-used things he bought (great for my brother). One of the items was this beautiful Movado pocket watch that you slide apart to see the lovely little clockface - pic below. And here's the real kicker - there were Krugerrands in the unit too. Why would you put such a thing in storage and then stop paying the rent? Isn't that an interesting question.

I've been reading some of my friends' New Year's resolutions on Facebook, and so far my favorite one is "take more naps". I kind of hate the whole idea of setting goals, usually not realistic, at some arbitrary point. Maybe it stems from my distaste with my ridiculous overcrowded gym for the month of January. Yesterday I had to place my yoga mat right smack at the front mirror so that people who only stayed for 3 songs could have the primo spots. I'm serious, Erika even remarked "where did everybody go?" ARRRGGG. Lots of people with no sense of gym etiquette - muddy shoes, doing their sets right in front of the rack, using F'ing cell phone on the machines..... But on the other hand with resolutions, few of us take the time to stop and take a breath and evaluate our lives. So yes, I've taken a few moments to do that, need to do it some more. I heard a great thing on NPR this week about this by Two Guys on Your Head. I love them. It's locally produced by KUT and exactly the kind of stuff I think about constantly anyway. Here's a link. http://kut.org/post/how-make-effective-changes-new-year-0 So what are your resolutions? I am toying with the idea of taking a drawing class but wrestling with the reality of having to drive through traffic at the worst time of day to make that happen. I think I would love it but the truth is that my time is limited and precious. If only I could find something close - I'd be all over that. (Austin friends  -- any art classes in the Westlake/Lakeway area?) The other thing is meditate more and get in at least 2 yoga classes a week. Odds just went up on that one with that delightful Westlake gym. 

XXX Amsterdam

I'm just back from Amsterdam. Yes, great opening line. Dani and I spent a week there. It's cold, but that's probably obvious. Some other obvious things: apparently, in a city where it's legal, it's never too early for a doobie. As we walked to the Rijks museum our second day, we passed many "coffee shops" along the way and the smell wafted out. https://www.rijksmuseum.nl (So why do they call them coffee shops? Don't know, but they seem to be just for tourists, or at least that's what it looked like to me.) I congratulated myself that morning as several shopkeepers spoke Dutch to me (I didn't wear sneakers, I'm not a sloppy American). The Dutch are very well-dressed. Lots of different languages here, many I can't even place, other than the continent. Dutch beer is great (Heineken, right?) and the drinking age is 16. Really. Totally different attitude about that over here.

So it was pretty fun. We went to a cheese shop and sampled, we looked at many paintings I've only seen in books, we have walked a lot along the canals. We found a Lebanese restaurant, of course. We went to the Anne Frank house and waited "in a queue" for less than an hour in the freezing rain. That was pretty intense -- seeing the actual marks on the walls where the Franks recorded the girls' heights as they grew. The Van Gogh museum www.vangoghmuseum.nl was breathtaking - but I felt like so much of his works are at other museums, such as MoMA. I was expecting to see more paintings from his time in Arles. Still an incredible museum, a once in a lifetime opportunity to see the span of his development, which they did an excellent job of articulating. Here's a few of my favorite Van Goghs.

When we arrived in Amsterdam, it was about 8 am on a Sunday as we walked from the train to our B and B, and we walked thru the Red Light District. Interesting. Saw people clearly coming off-shift. We made a tour of that later, and saw the sex workers in the windows. Kind of takes all the romance completely away, but that must be the idea. The bikes are everywhere and you better watch out. I haven't seen a single helmet, either, which scares me. Some of the taxis drive way too fast up these little cobblestone side streets beside the canals. And yes, everyone here is generally slimmer than Americans. Might be because they smoke, however. Getting tired of the butts everywhere (there I go, ugly American). The biggest difference is the Dutch men - quite attractive, no 10-year old baggy Dad jeans that wifey bought. I haven't seen a single boring Izod on them either.


We walked thru the Red Light District and arrived at Oude Kerk (Old Church), which the Dutch started building in 1250. This actually was my favorite place in Amsterdam. It was such incredible beauty, and we arrive pretty early so we were alone. The stones on the floor were grave stones. See one below. But the most interesting part was an art exhibit they had inside. It was an acoustical piece that sought to reflect all the souls that had passed through that church all these hundreds of years, but it was beautiful visually as well. A series of speakers in a lattice hung from the ceiling would activate as you walked under them, whispers and sighs and prayers and songs and arguments….it was incredible. I took a video, here it is, it's less than a minute. Just a taste.

Oude Kerk

We took a canal cruise and listened thru headphones to the tour. I counted, it was offered in 18 languages. Everyone on our boat was Asian except us and one other guy. The canals make quite a picturesque city, but it's still crowded and dirty. Much like New York.

Van Gogh land

It's nice to take a week off from work. I'm starting to see some of the ...I don't know.... issues or problems at work. I used to complain about working for large, impersonal organizations, like big hospitals or even when I was a corporate drone, but now I see that small organizations have problems too, but they're different. When there aren't a lot of rules, things happen. I still find my work fulfilling, and I definitely don't want to whine. What I'm trying to remind myself is basically, step up. If there's an issue, fix it or speak up. Be part of the solution. Haters, don't drag me down. But here's a really cool thing....none of my worries have anything to do with patients.

My favorite painting at
Rijks Museum 

Flower Market

We walked to a park several mornings, got a little lost the first time so the walk took 2 hours. Not utilizing a car is great exercise, it's funny because it seems everything here is a 30 minute walk away, whereas in Austin,  everything is a 30 minute drive away. Speaking of which, Austin traffic was deemed by NPR as third-worst in the nation. Really. I'm not kidding, they played the story last week. Trapped in shiny metal boxes.

I'm freezing. Take the picture already.

One of the weird things here is dealing with restaurants. The big differences are you seat yourself, you don't tip, and you head up to the register to pay. It's considered rude for the server to rush you out by handing you the check. But it's funny, we picked up on this after the 2nd meal, but it still feels awkward. There are lots of cats in Amsterdam - loved that - but our hosts explained that's because the buildings are so old that they are full of rats.

We visited the floating flower market, it was absolutely lovely. Incredible selection of bulbs, such choices, and some super-high prices. I doubt if these would do well in Austin - could the climate be more different? The weather here is ...you know... what it's like on this side of northern Europe. Cold, wet, and overcast. I was thinking today that I bet they sell a lot of SSRIs here (antidepressants). I'm finding that if I dress for the walk, I am a sweaty mess by the time I arrive at the destination, and then I'm hot in the over-heated buildings, plus I have a heavy coat to wrangle. So I'm just wearing a jacket and suffering a bit. I kept seeing all these people without gloves and I'm wondering, how do you do that?!

One of only 2 sunny days the whole week

Visiting Rembrandt's house

City at night

On our last day, we took that canal cruise. The captain explained that the "XXX" that you see frequently in Amsterdam has been used since the middle ages and has nothing to do with porn - it means fire, flood and plague and seems to have been used as a talisman to ward off those things, which were the things most feared by the Dutch back then. It's such an old city, so beyond anything in the States. We also found a way cool fetish shop right behind where we stayed -- and apparently straight jackets ("leathers" as we called them in the psych hospitals I've worked in) are fetish objects. For some people. Look.

Spice

I'm just back from Colorado Springs. Yes, what a lovely little town nestled in the mountains. I was at Steve Stahl's psychopharmacology conference. Tons and tons of psychiatrists and NPs in the house and a whole lotta learning to be had. The coolest seminars were on Impulsive and Compulsive Disorders, Assessment and Treatment of Inpatient Aggression: The Changing Face of Public Psychiatry (boy, did that bring back memories of my prior job), and Silent Epidemic: Consequences of Synthetic Drug Use on Psychiatric Outcomes.

The Impulsive/Compulsive talk proposes a new grouping of these disorders that recognizes the commonalities. The new DSM 5 diagnosis of Binge Eating Disorder (BED) fits in with this group, and he actually (yes, it was Stahl himself giving it, the rock star) spent half the talk on new obesity drugs that could be used off-label for BED. Of course, sitting in this talk, I'm seeing that the other primary eating disorders (anorexia and bulimia) really fit into this new paradigm too. It's an area receiving a lot of research and attention, which could help my patients.

A psychiatrist from the California Prison system talked about Inpatient Aggression. They had a staff member murdered by a patient last year, so they really overhauled their whole assessment system and it seems to have improved things. Two big points she made were that they found about 25% of their patients were antisocial, which is often termed "psychopath". These people had no other true mental illness (except maybe SUD - substance use disorder, yep, lots of alcohol and drugs) and they were incredibly predatory -- carefully planning and executing acts of aggression on the units. This percentage was higher than they expected, although honestly it didn't surprise me. It was consistent with what I saw working on a Psych ICU that had 1/3 indigent patients. Anyway, the other thing she said is that you never, never mix predator and prey. That is, you do not take those antisocial patients on a unit with the seriously mental ill - those hallucinating and delusional. And gee, that's exactly the scenario of the PICU I worked on. I mean, no wonder it was so dangerous.

 The third fun seminar was all about these new synthetic drugs - you know, Spice and Bath Salts. I used to get those mixed up, now I know that Spice is synthetic marijuana and Bath Salts is synthetic stimulant (speed or meth). These are drugs made in labs with ever-changing formulas to stay one step ahead of the laws that restrict them. And OMFG they are bad news. I already knew that, having seen it in my patients. In fact, it's rare to have a death on the PICU but we had one with a very young man who had wrecked his brain by smoking lots of Wet (marijuana dipped in formaldehyde) and Spice. He couldn't speak, in fact he drooled and wet his pants. He went into respiratory arrest on the unit - just went to bed and stopped breathing. So what are the long-term consequences of using these gee-whiz newfangled drugs? Hey, well, some great stuff there - for Spice, it's cognitive impairment (hence the drooling). For Bath Salts, it's depression/suicidality unresponsive to treatment, and sometimes permanent psychosis.

Tonight we are going to Ester's Follies. One of my co-workers is a dance teacher on the side, and she leads a group called the Tap-Dancing Grannies and they are performing. Ester's is an improv troupe on 6th Street that is a true-blue Austin tradition. I haven't seen one of their shows since the 1980's and it's just time to go back. I'll offer my report in the next post, expecting some great scandalous action. And in 3 weeks, Dani and I are going to Amsterdam for a week. She picked the place, and then I (oh so reluctantly...right, ha) agreed to go with her. She booked us at this bed and breakfast. And we'll see how that goes. Expecting good things, again. Maybe not quite so scandalous.

I had my 90 day review at work. Yes, I am off my probationary period and I DIDN'T GET FIRED. Yay! It's funny, but knowing that they fired the person right before you certainly does have an impact. Anyway, things are wonderful, I love my job, I am so fortunate. And my new doc is slammin'. He's great, very genuine and caring and seems to be able to answer all my questions. It's also kind of cool that I know some things he doesn't - like where the file cabinet is! Yes, I've learned something in 90 days! Even the patients like the new doc. And I thought that could be a slight problem, I mean he's around my age and he's a guy -- would adolescent girls and young women really connect with him? Well, I'm happy to say that he works that pretty well, and several patients have told me (when he's not around) that they like him. He does have some decidedly different preferences for meds, so I'm learning all of that.The owners of our center, who live in another state and run a treatment center there, are coming for a big week-long dog and pony in early December. Hoo boy. I already have 2 dinners planned and lots of time booked for yakking. I'm just waiting for the order to warm up PowerPoint.

Anyway, busy times. Great times. Can I say it again? I love my work. And we did half-moon pose in yoga this morning - my favorite. I think it's a good sign.

Licks

Things are better at work. My doctor has been back and I've gotten some good guidance about prescribing anti-psychotics, which frankly I'm a little nervous about, but I need to know how to do it. We meet every Wednesday for staffing, which is when all the professionals get in a room and we review each patient and discuss the treatment plan to make decisions about the future. It's terribly interesting, and this week we were reviewing a particularly tough case, one that I had to handle by myself when the doctor was out, and I said "I've put her on benzo's and anti-psychotics and haven't seen a bit of improvement. I'm not happy with this case at all." Those are the two classes of drugs I'm very, very cautious in using. Anti-depressants, sleepers, and the non-benzo anxiolytics however? Eh, here you go. (I'm kidding, of course. But I'm not terribly worried. The side effect profile for those just isn't very risky.)

So tomorrow morning I am meeting our new doctor for the first time, over breakfast. He suggested Kerbey Lane so he's already got a brownie point (a pancake point?) in my book. He's actually only agreed to be our interim doctor until we find a permanent and he'll be there only 2 afternoons a week - only 2/3 of the time that Dr. T was there - but hey, it's a start. (I'm wondering if it could actually turn more permanent.) Our census is terribly low right now, so it will work fine. And if it pops up, well, I think I remember where my sleeping bag is. Ha. And since things are so low, I don't need to go in to work this afternoon, which has been my routine. I think instead Dani and I are going to a dance performance. Of course, it's something that kind-of applies to my work anyway.... here's a link: Silence to Power. It's a collection of dances produced by local choreographers as a means to process psychological and emotional trauma and societal pressures, which includes eating disorders.

I've spent a lot of time with Dani, which is good for both of us. She's doing super great at school. Her sociology professor wrote such a nice note on her first exam, said that her essay responses were the best from all of students in all the classes she taught. I'm not surprised. My girl is smart. I'm so pleased that she now wants to be a nurse. I think it's where many of her talents naturally lie, and of course, it's such a worthwhile profession.

My back still hurts from the ACL Festival but it's probably because I'm still at the gym every day. Slow down? Are you kidding? It's all Phoenix's fault. I wanted to see them so badly, and they were on a smaller stage than they should've been -- they should've been on one of the big stages, I mean when their new album came out this summer, Rolling Stone headlined it. So we had a great spot an hour before they started, but we were so jammed together that nobody could sit down. Yes, it's oh so much fun to have completely stoned teenage strangers with their elbows in your ribs. So I stood there for an hour and then the concert was 90 minutes, so that's a loooooong time to be rooted to one spot. Worth it? mmmmmm not sure. I think if I could have gotten back far enough to sit as we waited, it would've still been pretty darn good. I did get kicked in the head by one of the crowd-surfers too, but just a glancing blow, didn't hurt. And I got chiggers. That's just part of ACL.

Last night Dani and I cooked fish and watched Miss Representation. It's about how the media has stolen the power of girls and young women by saturating them with images that only their sexiness matters. Yes, our culture is run by teenage boys with boners. Beavis and Butthead. It's an interesting thing to ponder, it's still fresh in my mind and I have more thinking to do. I'm against censorship and am a sex-positive person, I mean I hate slut-shaming and love Madonna, but OTOH I get furious when I hear stupid media reports about Hillary Clinton's hair. Miss Representation Documentary Trailer I see the consequences of this toxic, shaming, lowest-common-denominator culture every day at work. And it breaks my heart.

Lick on SoLa (South Lamar), on of our favorite Austin places, celebrated two years recently. We often go there for ice cream on a Friday or Saturday night. Lick has these wonderful, locally-sourced unique flavors. Here's part of the menu board from the last time I was there. You should go. It's near the Lucky Lounge, look for the big neon horseshoe.