Wow.

i love OBGYN. i worked 14 hrs today, am just getting home at 10pm and still i'm skipping around in a cheery mood. i saw tons of prenatals and a few GYN issues in the office. then i helped w/ a vaginal delivery tonight at a local hospital and it was awesome and beautiful and gruesome and gross... in other words, a normal, healthy birth.

the office i'm in is pretty up-scale. the clients are all well-to-do and have babies with names like "moon" and "odysseus." to me, that's just one manolo blahnik away from "apple" and "suri." (i had to look up how to spell the aforementioned shoe company- i spell my preferred shoe company "s-k-e-c-h-e-r").

but this birth! so sweet. the dad cried...and the mom, in pain...paused...(sniff)...and looked up at him...(sniff)...and told him to go see their new daughter...and....(sniff)....he kissed her....it was very sweet. i got a little verklempt, i must admit.

so, again, i'm having a ball. OBGYN is great- there's office work, surgery, and deliveries. a bit of everything. and the huge majority of patients are healthy- either healthily pregnant or healthily coming for their annual exams. but because the female body requires maintenance and goes through so many big changes, even just regular office visits are interesting and offer opportunities for discussion and education with the patients.

another sweet moment- i saw a first time mom today (at something like 9 weeks) go into an almost shaky shock state when she saw the baby on ultrasound. it was pretty powerful for her to realize there was a real live being up in there. pretty amazing. pretty darn amazing.

Scooch Just a Little Further Down Again...That's Right.

i'm back in OBGYN for a few wks and i love it. i think i enjoy women's health so much because it's kind of like primary care plus. not only do you get all the heart, lung, kidney, brain stuff you get with men, but you ALSO get all the fascinating female organs, unique hormonal influences and processes, and the bun in the oven-ness. and i think women are piss-poorly educated on their bodies and its changes, birth control, diseases and treatments, and the whole bebe carrying/birthing/nursing process, so it affords me lots of opportunities to educate. which i love.

so as i search for jobs and get my resume out there, i'm really leaning toward OBGYN jobs. we'll see what i find. there are some limitations on PA's practicing in OBGYN, so i'm not yet entirely clear on what i can/would do. i'll know more soon, i'm sure. i've spent the last week re-writing, adding and removing bullets, hyphenating and un-hyphenating certain things on my resume. i'm about ready to scrap the whole thing and just trace my hand on a piece of paper, sign it and turn that in. then they would have my name and my glove size- what else could they possibly want?

between the way better weather and leaving psych and getting back into OBGYN and being with a cool doctor right now, i'm in a great mood. i have renewed energy to get stuff done and keep moving towards the finish line. one of my beloved classmates always says to us when we're feeling bogged down, "just keep swimming, just keep swimming" from "finding nemo." he's right. so now i'm going to swim back and add another hyphen. or maybe not. well, maybe. hmmm.

Mojo Lost and Stressin'

so i used to be really good at taking exams. i thought i had some sort of sixth test-passing sense and that i could "use my instinct" to get by on anything. not so much. last week i failed an ekg exam and have to re-take an annoying version of it. now this week i just took my psych exam and while i did ok, nothing to write home about. i just don't care much anymore. i sit there on questions i'm uncertain about and just randomly pick something because i'm too apathetic to give it much thought. and this is a problem, since i have several intense cumulative exams coming up, not to mention by boards. evidently employers request that you take AND PASS your certification exam and get a license before they'll let you practice under their license on their patients. drag. i just think i'm out of school mode.

but then, i'm not entirely in work mode, either. all my friends have their CV's and resumes out, are interviewing, and some even already have jobs and contracts and stuff. i've been so unmotivated to do anything...and i feel like i'm falling behind. we're lucky, PA's in this market are pretty much gold right now, so i don't think i'll have trouble finding a job, it's just that i might be slacking my way out of finding the right job. and i don't even know exactly what i want to be when i grow up...which discipline i am 'passionate' about enough to seek a 'challenging position in.' so far i've loved obgyn the most- and i start a few week elective in that next week- but is that too specialized? will i have wished that i went into more primary care? will i work with the type of patients i want to work with? have a good amount of autonomy while still being guided, taught? will i make enough money? will i be in a clinic and wish i was in a hospital or vice versa?

aaaaaaaahhhhh!!

i just want a job fairy to show up and land one in my lap. and i don't want to be like all the other new grad PA's who change jobs every 6 months for their first few years until they find the right fit. i want to find the perfect place for me. and i want to have a clue what that is. and since we're on the subject, i want to work only 15 hours/week but make tons of money and get chocolate cake bonuses when i'm especially productive. seems reasonable enough to me.

so i guess i'm feeling stressed out and kind of blah. i'm off this long weekend and am throwing a birthday party for my husband, so hopefully i'll be able to relax, have fun, and not worry about this stuff for a little while. and then come back next week refreshed and motivated to get after it.
sounds like a plan. thanks for listening to be gripe.

p.s. i am reading something for fun right now....it's the sequel to "house of god" by samual shem, called "mount misery" about his residency in psychiatry. it's accurate on the challenges of being a student and on the agony of working with psych patients. so it's depressing, of course. smartly written and wry, but maybe not the most relaxing piece of literature i could have chosen while going through my mental break down.

Things I've Learned About the Human Body

1- new parents are always worried about their babies having 10 fingers and 10 toes, but digit mutation is actually highly unusual. you should be more worried about the babies having fur patches on their backs (for real) or having both boy and girl parts and having to choose the sex (also for real). ok, to be fair, these things are also highly unusual, but aren't they WAY WORSE than a missing pinky?

2-everyone has back problems. we're not really meant to walk erect all the time like we do. but considering the alternative, i think i'll just find a better pair of shoes.

3- humans are animals, minerals, and vegetables, it seems, judging by the weird stuff we can grow on our skin. be glad i picked those pictures, it could have been so much worse.

4- if you're retaining water, the lowest point on the body will always be the most swollen. so if you're standing or sitting all day, it will be your legs. if you're in a hospital bed with the head and foot of the bed elevated and you're a dude, it will be your scrotum. That is something to see. You will never look at a red water balloon the same again, will you? :)

5-we all have different pain tolerances, responses to pain meds and anesthetics, and rates of recovery. it is impossible to accurately predict success/failure or unpleasantness of treatment from one patient to the next. "will this hurt?" is a common question patients ask- i just always say "we'll try to go quickly, but you might feel some pressure" for everything. so if you hear that from your practitioner, you've been warned.

6- most of us do not get better looking with age. things will sag and wrinkle. and this is normal. it seems like everyone thinks they are the oldest/fattest/baldest/most over the hill. but notice that while physically we may deteriorate as we get older just remember how much smarter we become every day. the only proof you need is to listen to a teenager talk for 30 seconds. (at which point you might WISH you had hearing loss).

7-it is absolutely miraculous what the body can survive. i've seen 600lb patients and people who smoked 2 packs/day of cigarettes for 50 years and though they're not the pictures of health, they're still alive into their 60's. and that is amazing. we are so extremely durable, and stretchable, and adaptable. BUT, we are also very fragile. i saw several motor cycle accidents during my ER rotation. those patients who walked away from them made me believe in guardian angels. but they were the minority.

8-much of health really is mind over matter. attitude literally makes all the difference. i've seen end-stage cancer patients offering support to other people, always smiling and full of hope, most definitely partially responsible for their own level of wellness. on the flip side, i've seen plenty of people give up and give in to the common cold.

9-most everyone is self-conscious about their bodies. occasionally i hear tell of a female PA student getting an eye-full from a voyeuristic male patient, but everyone else is really sensitive to being seen unclothed. and totally honestly, from behind-the-scenes, medical practitioners do not care what you look like. they've literally seen it all. so don't apologize to us for not shaving, don't worry that we're staring at your dimples and other unsight-lies- we're not.

10- what goes in must come out. patients with diarrhea are miserable, but those with constipation think they're dying. and if they're not, they request that you just kill them. this is still true.

Art Mimics Life Mimics Jesus's Life

so in my travels this weekend to celebrate mother's day w/ my mum and her entourage of female relatives, i watched/listened to several DVD's in my car as i drove. and it just so happened that several of them had themes of mental illness. one was "dream team," recommended to me by my brilliant second cousin. it was funny and sweet, interesting, and surprisingly poignant. it was set in a mental institution in the 1980's and hinted at turning trends, using psychotherapy without the aid of medications. it starred, among others, michael keaton who was a violent antisocial (think jack nickolson in "one flew over the cuckoo's nest" without the dire consequences), christopher lloyd with OCD and delusions of grandeur (he had a delusion of being a competent doctor...that one was a little too close for comfort for me), and peter boyle who drank and swore and walked around naked, but also believed he was the son of God. the other movie that i found interesting in its observations on mental health was "year of the dog" with molly shannon and john c. reilly. she was a socially awkward, but comparatively normal woman who after the death of her dog, lost all reason, her job, and her family in the pursuit of animal welfare.

it's interesting how fascinated we as a society are by psychiatric issues. i'm thinking of movies like "silence of the lambs," "taxi driver," "summer of sam," "fatal attraction," "a beautiful mind," "girl interrupted," "sybil" and "mrs. doubtfire." but issues of depression, mania, suicidality, psychosis, and gender identity are seen in many other films and TV shows. neurosis is funny, psychosis is scary, and characters with personality disorders reflect our friends and families. that's just good entertainment.

a common delusion i've seen a lot here is related to religious ideas. it was funny to see that peter boyle character, because just last week there was a patient here that considered himself "the only living Son of God." i see a lot of persecutory thoughts of devils and satan, sometimes commanding actions, sometimes criticizing. or thoughts of speaking directly to, being immediately directed by, or actually personifying God or Jesus. it's fascinating. we had an ethical debate about whether or not to commit a patient who was being told to move across the country by God. all seemed well when you met him, but the more you listened to the reasoning behind his actions, and the consequence (homelessness) the more he seemed unstable. but i have to say, it crossed my mind more than once- what about faith? you KNOW we would have locked up joan of arc ( i think they tried) if she'd presented today. and what about allowing people self-determination? it's a fine line between keeping people safe and maintaining too stringent a parameter on what is "normal."

anyway.

i'm finding psych interesting. i miss using my stethescope and actually touching patients to evaluate their wellness. i couldn't just dialogue all day like this, i need more contact and procedures. but this has been really good so far. and no matter what i end up going into- i'll see psych issues. regular ol' medical patients will present with depression, anxiety, insomnia, substance abuse, sexual issues, and others. the things i'm learning now will be good to have.

Nobody home.

it's been a weird week. my husband is away on a mission trip in exotic places, eating great food and reaching out to strangers in need. and i'm home with the dog and going to work, reaching out to crazy people. (not very PC of me, huh? how about "sanity challenged?" is that better?). the house is pretty quiet without him. but i've been working a lot- i was at the hospital over 12 hrs both the last 2 days, so i haven't done my usual things i do when he goes away....like lying in bed eating sushi and chocolate covered espresso beans while drinking red wine from the bottle and watching reruns of bad TV....or other such intellectual persuits. my poor dog has been very much alone all week since i'm not getting home until nearly 10pm every night. she can go outside, but doesn't eat or get human contact until i get home. and i think she is going into a funk. she often will kind of moan like an old house when she lies down, but late last night, she gave a sustained, contakerous, "meeeeeeeehhhhh" as she laid down discontentedly. i took it to mean, "you stinking stupid lady, are you trying to convince me to poop in your shoe? cuz you're doing a bang up job there, champ." hopefully that's not what she meant. i'll check my shoes and get back to you.

otherwise, things at the VA are going well. i've seen a few suicide attempts, some really bizarre psychosis, and a lot of PTSD. it's incredible the many ways that the brain can break. i have a new found respect for the relative mental health of my family and friends. their behaviors no longer seem quite as unreasonable after seeing people with major mental illnesses. (except for you. you know who you are).

and i haven't been blogging as much as i'd like to. i'm writing from the hospital now, but my laptop at home is broken. the "b" key doesn't work. it will include "b's" randomly into my typing but won't let me type them on my own volition. so i write sentenses like "it's een a lbong tibme sincbbe i aked ananba bbbbread." not good. i'll get a new keyboard soon and will be back at it.

"I Just Want to Forget"

war sucks.

and i'm not talking about whether or not we should be in iraq....i'm not talkin' politics. i kind of figure that every country/kingdom/domain has their moments of attacking and moments of getting attacked and that in the grand scheme of things, our country is average among them. i don't know what it takes to rule the country, i wouldn't want to try. i'm not sure what i would pick as America's goals or core competencies. i'm pretty glad i don't have to make the call whether or not we go to war, or have to have the burden of all those lives in my hands. so this isn't about a political perspective. but as a rule... war sucks.

i've seen only veteran psych patients for the past week. and they have a variety of conditions-schizophrenia, depression illnesses, bipolar disorder, anxieties, and some personality disorders. but something you see a whole lot more of in this population than others is post traumatic stress disorder.

i have heard a lot about ptsd on the news and on cop shows and stuff, but this is the first i've encountered it firsthand. and i have to say, it is very real and totally devastating. it stems from witnessing horrific terrors daily for months at a time, facing your own impending death, witnessing your friends and colleagues deaths, having to kill. these are things you don't just bounce back from. these people have daily and nightly nightmares, sometimes so intense that their spouses can't share a bed with them for fear of being smacked or strangled in the fit of a dream. they are tense all the time and tightly wound, so that every little noise and distraction can send them into a tailspin. one guy told me that he attacked a friend on the 4th of july because his friend was setting off firecrackers. many of them use alcohol or other drugs to try to control these phantom terrors. it leads to a lot of social isolation. a veteran told me that people he's around either ONLY want to talk to him about the war or NEVER want to talk to him about it, as if he didn't go through it and he can just get back to life as usual.

speaking of that- after the adrenaline, the insanity, the importance of what they did while in battle, finding "normal" again at home is really challenging. see the movie "plenty" with meryl streep for a good demonstration of the incongruence in expectations that veterans experience after returning home from battle.

and some of the descriptions i've heard from veterans returning from iraq on the things people are saying to them here in the states sound like accounts from returning vietnam soldiers. (maybe without the demonstrations and stones being thrown at them as they step off of planes). apparently everyone has an opinion. (and you know what they say about those). one veteran told me he feels like he's the only one he knows who thinks we SHOULD be in the war and that we are doing necessary and important work in iraq. he says he gets mocked and ridiculed for these thoughts. and so, again, he drinks 10 beers a night, avoids his friends, doesn't watch the news, and tries to forget.

ready for a soapbox? here goes...

i can't imagine anything more disrespectful than telling a returning soldier your negative opinions on the war. first of all, it's their job- they should be proud of the work they do. and they believe that they're doing it for a worthy cause- that things like freedom and the security of our country are on the line. so attacking them is criticizing their work, and likely appearing as an ingrate for the protection they provided us. second of all, they were there- they may have lost friends, they may have been shot at, they may have had to shoot at other humans. we can't even imagine what that's like. any of it. and third of all, a soldier is not responsible for this war. they are part of it, they are involved in a small piece of it, but they are not the ones making the decisions. it's like blaming a doctor for the crappy condition of our health care system. wrongly placed blame.

so i've seen some frustrated, destroyed men and women battling with PTSD. it's a lifetime struggle. with psychotherapy, group support, and multiple anti anxiety and antidepressant drugs, it can be controlled. but the terror can never be taken away.

and of course, the other psych conditions are amazing to see. like schizophrenia, where "successful treatment" means always staying 2 steps ahead of the voices. i've seen several suicide attempts and threats, where patients are so low that they can hardly lift their heads off their pillows and just can't think of anything worth fighting for.

it's been depressing to be around all this, as you can imagine. i actually had nightmares the first few nights. i kept waking up with violent images in my head, which is totally unusual for me. i think i was internalizing too much. that's a problem i tend to have. i feel people's pain and want to take it from them. i'm working on finding a compassionate but detached position. wish me luck.

and in conclusion...war sucks.