Kids say the darndest things...

"He called me a slave. So I called him a Dorito head, because his head looked like a triangle."

About this time Dr. Luckyone completely lost his composure and started laughing. After he regained his composure, he apologized for laughing and clarified that he was not laughing about his patient being called a slave, which is never OK.

Blog storm...

I was perusing through my blog, and noticed that there were quite a few interesting posts that I had let pending for whatever reasons. So they may be coming in bursts!

Flaws and All?

I scribbled this out on a piece of scratch paper several years ago, on a day when I was very upset. It makes me very uncomfortable to read it, but a close friend of mine says I should leave it the way it is, and post it.


Things used to be different,
My mother always says.
Things used to be simple,
My mother always says.
Things are always simple for a child,
My mother forgets to say.
Her mother let the mountains
Run her life.
My mother never liked that.
My mother tries to run my life
in a passive-aggressive fashion.

Don't tell them your Daddy's sick,
My mother always said.
She was quite embarrassed by that,
But would never admit it.
The world can only be *this* big,
Otherwise I can't make it.
Reality is too complex.
Things must be black and white
Just because they are.
Don't ask me why, 
But that's how I want them to be.
I am the judge of universal right and wrong.
I get to decide the line between enough and too far.
I get to decide when everybody else has gone too far.

God hates me
Why else would my daddy be sick,
He didn't deserve that.
Why can't I have nice things,
just because my daddy's sick?
I feel inferior every time the neighbor gets a new car.
I get mad when I'm not skinny,
But I don't want to put the work in.
Someday when I have credit cards
I can screw myself up really good,
And lie to my husband about it
And make it hard for my son to trust other people.

Be who you are,
But make sure I like that person.
Be honest, 
But don't tell me inconvenient truths.
Be brave,
But don't scare me.
Be truthful,
But don't tell anybody about it.
Live my way, 
Because that's what I know.
Do what the preacher says,
Or he says you'll go to hell.
Everything depends on what somebody else says.
Ignore why they're saying it
Because it's better to be careful

My mother never taught me to cope.

My father was often too sick.
I overreact.
I assume the worst.

When angry I flail about like a 4 year-old

And want you to hurt more than me.

I must push your buttons to make that happen.

I will say the most hurtful things,

The most vicious things,

I will spew venom.
I'll try to make you feel guilty.
I'll try to make you feel sorry for me.
When that doesn't work

I must make you say something mean,
Because then you're the asshole,

Because that absolves my mistake.
And never move forward.

I want a fast solution,

To a problem I helped create.
I never can let things go.
I spend twenty years wishing people who did me wrong got theirs worse.
I let it fester and never make peace because I can't find closure,
And expect everybody else to be as confused.
And get mad when they're not.
Being happy is hard for me
Because I worry why I'm not happier.

I micromanage everybody's business.
I get mad when I don't know my son's business before he does.
Tell me what I don't know,
What I don't want to hear,
So I can overreact,
And get mad at you for telling me what made me mad,
That I forced you to tell me.
I get mad when people can't tell me things they don't know.
I become frustrated when I can't have information when I need it,
Because my plans are the best plans.

Don't do anything...
People might say you did something wrong.
Other people are more important.
We must not let that happen.
Why?
Because in a small town
things get around.
We've never lived in a small town.
I don't like people saying I'm not perfect.
I attach my identity to the GOP
Rush Limbaugh is my high priest.
He is never wrong
And if you suggest so I will likely raise my voice in frustration.
Romans 13:1, I've never read that.
I don't like what it means about Democrats.
Stop living and you'll never make a mistake.
I'm always scared of what other people say.
I listen to people that tell me what I've already heard.
Will & Grace can't be real.
But Mayberry is.

His father didn't care.

Wasn't ever there.

His mother was never wrong.

Do as I say
Not do as I do,
I always say.
I jest, but not really.
My rules and expectations only apply to you.
Take the shit from me that I won't accept from others.
I'm entitled to say what I want and you must respect that.
You do not have that privilege, especially if I'm wrong.
The world I grew up in
Was blinded by hate and bigotry,
Disguised in superfluous manners
And dressed in the Gospel for ritual,
Set to the tune of Dixie.

I don't want to go anywhere.
Nothing impresses me.
There are Yankees there. 
They're not as good as we.
Things are different there.
That makes me uncomfortable.
I don't want you to like things I don't.
That's not easy.
I don't know how to appreciate that.
Thankfully I have another son who won't disappoint me.
Let's live in 1974.
That's easy.
That's what I know.
I don't care
If it wasn't always right.
It's easy.
That's what I know.

Edicts banish problems.
Keep your feelings to yourself.
Please don't get upset,
Or I'll have to run
To the the basement and
Go to sleep to make it go away.
If you don't let me
I will throw a fit...
And maybe a glass.
I don't know how to handle emotions constructively.
So I'll drown mine in carbs,
Boxes of cereal
And gallons ice cream.
And teach you to do the same,
And make you watch me eat myself until I give myself diabetes,
Then refuse to take care of myself,
And make you pick up my slack.
Why does watching me eat myself to death make you mad?
You've no right to be mad.
So what if I'm too unhealthy to enjoy my grandchildren.

It's my way or the highway,

Even if you are pushing thirty.

Boys are easy,

Just threaten to kick their ass,

Then you always win. (I swear he actually did say that...)

Then you are always right.

I never stopped to think you might be paying attention,

That you might actually be listening to everything I say.

I never stopped to think you wouldn't always be seven.

I never wanted to hurt you, but I can't stop myself,

Even when you're right in front of me telling me that you're hurt.

I don't care if you're angry,

My anger is more important.

Make me not angry.

Apologize to me.

Your apology isn't good enough.

Do it again.

Seven times.

I can drag you up a flight of stairs.
I am your father.
I can threaten physical violence.
I am your father.
I can grind you into a fine powder
And humiliate you to get my way.
I am your father.
I will realize my mistake,
Then hide behind my money
And rationalize my behavior
So I don't have to say I was wrong.
I'm right.
You're wrong.
Always.
Stay a child so I can keep it that way.

I will only apologize to you once,
But never when you ask for it.
I don't care if you don't like it
You'll never actually convince me that I made a mistake.
I'll always be the man.
Just like my father taught me.
No, you rarely saw him before he died.

I can chew tobacco
Behind your mother's back
And hide it
And lie about it for over twenty years
And get made at you for catching me.
I am justified.
But don't you dare do what I've been told is Immoral.
I've never bothered to find out why.
You'll never call me a hypocrite.
You'll never make me listen.
I taught you to think,
But I don't like that you don't think like me.


Please me or I'll make you go away
To make it easier on me.
Do things the way I think you should,
Or I'll write you off.
Like my sister.
Like my aunt.
Like my cousins.
Like your aunt.
Like your uncle.
Like your cousins.
Like my friends.
Like my neighbors.
Like everybody...
There's not many left.
Never mind my sister did the same thing to me.
My reasons are actually right.
I want things my way.
I taught you and showed you
How to run from people who hurt you.
Why is there this distance between us?


So why am I the one acting like the adult?

Honesty...

...brings no regrets. But it can certainly make things more complicated" ~ Martina Navratilova.

People hate truth. People especially hate truths that make them feel wrong.

Psychobabble

41M. Extensive trauma. No meds. Bookoos of therapy. He's talking existentialist psychobabble so far over my head I don't even pretend I've ever heard of any of it. As is required, I call the attending in. She's also boarded in integrated medicine and does a lot of alternative stuff and huge into therapy and it's like watching Yoda and Mace Windu giving a lecture. Ok. I'll be the little psych resident over here when yall are done. Prozac??? Ok. I can do that.

Dr. Luckyone's Migraine

It started at Mariano's. I was looking at a bottle of wine (kosher if you care, thinking that it was a richer type of grape juice which should've been the first clue). I saw this greenish yellow wavy light, thinking that it was the reflection off the glass. My eyes were bugging me while we were at the checkout line. By the time I got home my head was pounding. While waiting for some friends I was watching Star Wars, and they kept saying "Jedi" and I kept repeating it like some stoner moment because even though I've seen Star Wars 8,000 times--I wasn't sure if I'd ever heard the term Jedi before. Then my hand started to tingle. I got a bit freaked out, but thankfully that passed after a few minutes. Two aspirins, and thirty minutes later I didn't feel like my head was in a cloud, but I still felt weird. Being a paranoid doctor, I was going through the differential in my mind (seizure, stroke, did somebody slip me something...).  At one point I was in the mirror testing my cranial nerves--anyone who happened to see that probably would've thought I was nuts. Thankfully the headache lifted after about three hours, but the whole evening was weird. 

A day or so later, I'm processing this, and I realize that I had a migraine. (I confirmed this with a few neurology friends, and friends who actually have migraines regularly). I've had one, maybe two migraines in my life, but they were both close together, and occurred about twenty years ago when I was a kid. It's very strange, the whole thing. 

Psychotherapy

As the title suggest, the subject is psychotherapy. What is it? Well...I'm not entirely sure, though I'm supposedly supposed to be well-trained in it come the end of residency. Doesn't that bode well...


I had a rather lengthy, and involved discussion with my psychotherapy supervisor this morning, about what exactly psychotherapy is supposed to be. Because again, I haven't the foggiest. We discussed my uncertainties about the modality and how I feel as though I'm not really doing anything concrete or useful. I think that I'm actually a very good listener, but perhaps it's ADHD, perhaps it's just personality, but I'm not overly fond of just listening for three hours at a stretch. Even more annoying is the fact that I often feel like whatever I suggest they don't want to hear, and they want to continue doing the same things that brought them into therapy in the first place---yes Dr. Luckyone that's the point, I'm sure you might be saying. Perhaps it is. But it's annoying. I feel constrained by how engaged I can be, and how much help I feel I can actually be. Perhaps it's inexperience. Perhaps it's having to sit down all day. Perhaps it's having to see a few patients over and over again, that I really do not like as people. Counter-transference is a big deal in therapy.

Kvetching

Dear Pharmacy: on what planet does "Invalid NPI" (itself not true, try google) for one medication equate with "Send Dr. Luckyone pre-authorization requests for every medication but the one where there's a problem"?????

Really...I mean really...

Walking (nay, speed walking) back to my office so I can scarf down some soup and a salad before my afternoon clinic begins I walk past three (or maybe four??) obviously not medical staff seated in a corner by the elevator in one of the nooks of the hospital. They were clearly important people. With a lot of important things to talk about...

"...I mean really, I think Rihanna is better than Beyonce."

Child Psych 101

One morning a week I see nothing but kids. It's never boring. But the best part of child clinic? Parents who defer giving their kids the sex talk...and just sit there and point and say "Listen to the man" after they ask you to do it

Grumpy Face...

Who doesn't love schlepping to work for an 8am appointment....only to find that said patient moved 1000 miles away...8 months ago....

Kvetch

Patient's mom complaining that (among other irrational things) that her son isn't sleeping: I didn't give him the sleeping medication because it made him drowsy and I didn't like that. 😠😠😠

Kvetching...Time flies when you're strung out

The last month or so has been a very stressful time for me. If I'm being completely forthcoming it's been longer than that, but I've been acutely aware of it for about a month. Quite a bit has contributed. I've been feeling in general unsettled and quite anxious for a few months now, much of which has to do with a personal situation--how ironic, no?? 

Professionally/academically it has also been challenging. During the course of the past six months, I have been in a different rotation every four weeks. And all but one of them was a new rotation. This meant that I had a constant back-and-forth with myself about feeling comfortable in the rotation and feeling like I've learned what is appropriate vs. taking vacation time and not getting admonished for not using my vacation days. Add to the mix Step 3, which was a month of studying following by two days of MCQ purgatory. Who wouldn't be excited?? Perhaps unique to me, I was annoyed about having to take the thing because more than 80% of the thing is related to medicine, and the management of medical patients...It may bear mentioning that I'm a psychiatrist. I haven't seen my stethoscope in months because I don't need it. I think it's buried in the trunk of my car. Yet I'm required for licensing purposes to be able to not only diagnose things like gallstones, but also recommend the appropriate intervention and treatment. For hell's sake...I'm a facking psychiatrist. I am not trained for surgery, much less licensed. Yes, in medical school a medical student has 8-12 weeks of required surgery rotation. What that ultimately means is you stand there and hold retractors in ergonomically unsound positions for three hours while an asshole surgeon (that may be redundant...) asks questions to which only he/she knows the answer. During intern year, I handled one, exactly one GI patient--and that, pardon the pun, was a shit show as soon after admission (on a senior-less Saturday morning, no less) Smuckers jam started exiting this poor man's rectum, and GI and the MICU experts assumed his care. So, fast-forward several years and the meshuganna psychiatry resident is taking Step 3 and being asked questions regarding patients he's never seen, and in reality would have deferred out to a consult service. But never mind. What is one to do about this? Could we have a separate board exam for each service? How fair would that be? Probably not very fair, or manageable. So, like many a psych resident before me, I did thousands of practice questions and faked my way through Step 3, which thank God I passed. Now, on to 3rd year and outpatient clinic!!

Grumpy face

Can anyone come up with a reason why an attending who is barely a year out of residency would page a resident at 9am...about a note they wrote while clearly on overnight call?? Call the damn service pager!!

But of course...

What does orientation include at the state NGRI facility...a screening of Shutter Island...what else.

Friday night I spent two hours on a patient who not only attempted to overdose on Xanax and gabapentin, but also required Narcan for heroin intoxication, which the ED missed. While it's easy for me to say...uh, you actually believed her when she said she hadn't used in months? there's so much going on in the ED and the patient wasn't obtunded until I was called that I can easily understand why they missed it. Now, having said that, the patient's spouse said that she had used heroin yesterday, so the key here is that drug users lie and collateral is key--SHOCK AND AWE!!  After having her opioid reversed, only then did the patient admit to snorting a bag of heroin. Still, she lied because her UDS showed cocaine and marijuana, which she had denied. So all-in-all, a very time consuming but simple consult. 

Derp

When you have that sneaking suspicion that your 1pm outpatient substance abuse patient isn't going to show...because he got drunk last night and developed pancreatitis and presented to the ED...