Mezzomedical

not so descriptive

2011-10-17T18:20:00.000-04:00

Not so sure what I want these days. Dropped physics. Again. Infidelity. Who knew my best friend could deliver a slap in the face like that. Just couldn't concentrate. Trying to move on. Work is busy. Really just want things to be better; the way they used to be.

Finding I like beer.

I really like beer.

Actually, all alcohol is pretty good. Chilled warm forgetfulness in a bottle.

wordless friday

2011-09-30T21:05:00.001-04:00

back

2011-08-10T12:59:00.000-04:00

Things have been perhaps more than ever, a combination of wonderful and terrible these past few months.

It seems this blog has done plenty of focusing on rough times, so for now, at least, I'm just going to keep my mouth shut. Or my fingers still. Or whatever it is you to be silent. Maybe some day I'll break things up into posts; I think there were enough ridiculously bad days to border on comedy.

Anyway, the job thing, while I didn't anticipate to be especially great, has turned out, oddly, to be kind -- of -- great.

I'm involved in an EMR conversion process, and my job is to meet with all the clinical departments in the hospital and go over their documentation. All of their documentation. Everyone in the hospital is currently using an EMR application from the early 90's that looks like DOS and leaves quite a lot to be desired, so it really hasn't been a matter of converting what was there, it's been more like rebuilding every nursing assessment and note template in the hospital. And, oddly, it's suited me. I like being exposed to so many different departments and their processes. It also seems like there's been a lot more flexibility in terms of working from home and scheduling once I stopped directly taking care of patients.

My boss is super flexible and this fall, I am (once again!) taking physics in a few weeks. This time I'll be taking it at a private college about a half an hour from where I live. My boss is allowing me to arrive to work between two and five hours late some days so I can go to class/lab in the morning. And, here's the real shocker: she's okay with me leaving and taking a class a semester until I finish my post-bac coursework.

Although this is slow (med school around age 30), there are a lot of benefits: my employer would cover most of the tuition costs (we have tuition reimbursement and scholarships with somewhat low caps, which are perfectly suited to taking about a course at a time), I would have summers and winters off for family time, I'd be able to get sleep, and there would be some stability (both in terms of a schedule, and financially).

By the time I went to medical school, MiniMan would be in school himself, which would further alleviate some of the scheduling woes. And, there are some opportunities for career advancement; my boss has encouraged me to apply for a position as an analyst which would double (perhaps more than double) what I am making now.

So, there's a lot to be said for that.

In other news, I weaned myself off of most of my meds about two months ago (taking half the dose of seroquel), and am generally feeling a lot better.

in retrospect

2011-06-20T21:34:00.002-04:00

Today I ate lunch with one of my friends, a cardiovascular tech who does the EKG and hemodynamic monitoring in the cath lab. Actually, she was the one person who took the time to teach me a lot about reading EKGs and how to use Holter monitoring software to make reports.

I don't remember how we got started on it, but I started rambling about some of the "cool stuff" that I had the chance to see in real time when I worked in the ICU: torsades de pointes, other ventricular tachycardias, ventricular fibrillation and other lethal arrhythmias that you hope you won't be encountering when you're reading outpatient Holter monitor recordings 48+ hours after you stuck your electrodes to your patient.

I paused for a minute, thinking about the last episode of torsades.

"The guy was actually dying," I told her. He was really sick: on a ventilator for weeks and weeks, feverish in septic shock (from a strain of VRE that seemed to take forever to find, after endless blood culture draws and procedures ending in -centesis). He was completely unresponsive by that point, and he was alone.

I remember sitting outside his room, looking at the monitor, watching in awe as the amplitude on his EKG twisted like crepe-paper party streamers. I had seen it books, but never in real life. He was a DNR, and so we sat there still, leaving the crash carts tucked against the nursing pods, as the torsades turned to coarse vfib that slowly grew finer until it was just a haphazard line.

I don't know why I didn't go in there and hold his hand, or even just sit with him. I don't know why any of us didn't. The idea of dying in the middle of the night, in a hospital bed, alone, just doesn't seem okay. Maybe we were feeling mildly inconvenienced by the idea of having to gown up to go into his contact precautions room or divert our eyes from the monitor or documentation. I don't even remember what I was thinking while I sat there doing nothing. Hopefully something besides "wow, cool EKG!"

I wonder, had death started to become so familiar that it had lost its significance? I really don't know. After he died, I cut up his strips, somewhat somberly affixed them to pages and pages of strip sheets, labeled them, and thought about how sad they were -- how they told a story all by themselves.

a sea of strawberries

2011-06-19T14:32:00.003-04:00

okay, so maybe the "sea" was more like four quarts

MiniMan and I went strawberry picking this morning. Well, maybe more accurately, I went picking and he went eating. It probably would have been fair to weigh him before and after (and pay the difference), but it seems like the unsaid rule of "u-pick" is: you eat. And so he did; he picked and shoved strawberry after strawberry in his little mouth, juices dripping off his already berry-stained chin. We had a good time.

Strawberry season, in the northeast, comes and goes alarmingly fast, sometimes lasting only around a week. It's worth the effort to get out of the house and pick these tender, lustrous berries; they really set themselves apart from under-ripened and bland grocery store varieties.

I think that with these, I'll probably hull and freeze half (smoothies), and eat the other half. I keep dreaming of picking more and saving them for the fall and the winter, in an effort to preserve a little bit of summer. I have the feeling even the ones that end up in the freezer won't last long. Oh well.

I also picked up some garlic scapes, which are available almost as fleetingly as the summer strawberries. The first time I got a few, I had received them as part of my vegetable CSA and I really didn't know what to do with them. If you gather enough, you are left with a medusa-like mass that you can turn into amazing pesto. Garlic scapes, by the way, are the little shoots that come off the top of the garlic plant. They are milder in flavor than garlic cloves. The recipe that I usually use is the one on Dorie Greenspan's blog. You should try it!

money matters

2011-06-06T19:41:00.002-04:00

I found myself seated at my laptop the other night asking my husband what his take-home pay was per week. It had been almost a year since I drafted a budget. Last time I did it, I don't remember it being so discouraging. We weren't paying a whole lot for daycare, and it was before our house got reassessed (at 250% of it's original value). Uugghckk..

After some brief number crunching, I realized that we have about $300 worth of leeway each month if we pay all the bills and never spend money on anything other than gas (40/week) and food (30/per person/week). I keep telling myself: it could be worse, it could be worse. Really, it's enough money to save for a class, I guess, if nothing goes wrong, if the cars don't break, if no one needs clothes or shoes or to go to the dentist.

I keep looking at jobs in other states. I keep dreaming of some way to get more cash. The Mayo Clinic pays their hospital aides no less than $14.80/hour because of union regulations. Is cost of living higher in Rochester, though? I have no idea. It's probably not enough of a justifiable pay increase to move, especially considering that we own a house and no one wants to move. I keep looking, anyway, though. I'm just not really sure what else to do. I feel a little trapped.

I've started to wonder if maybe I should apply to some kind of accelerated RN program (some of which take only a year), just to make enough money to go to school. There's some overlap with the premedical prerequisites, and I can't help but wonder if the financial aid situation is more encouraging. And, when I would be done, I would be able to make twice as much money per hour which would mean that I could work half as much, leaving more time for classes. I don't know. I don't know if it makes any sense. I guess it would totally depend on financial aid offers.

Probably most nursing programs would hate me if I admitted that I decided apply to nursing school so that I could shield my family from financial collapse and eventually go to medical school. At this point, I'm just really not sure what to do. If I save and manage to put aside money for a class, as soon as I stop working, we'll be screwed. The only thing that seems even remotely feasible would be working part time (which I'm not even sure is an option) and taking a class.

My husband and my parents keep telling me that I'm young, that I have lots of time. It just seems like they don't understand how deflating it feels to not have an even remotely promising plan.

I don't get how I am making this so complicated.

It seems like it shouldn't be so complicated. Really, though, things have changed a lot, especially how difficult it is to procure educational loans these days for more undergrad classes when you already have a bachelor's degree.

So, I just keep looking for better jobs, and going to work, day after day, which I guess is okay. I just don't get how so many people live this way. How are so many people are okay with their mediocre dead-end jobs? Are some of them honestly content, or is this just an illusion?

on procreation

2011-05-31T21:29:00.002-04:00

My office mate's stomach bulges a little now. She's pregnant with twins. Unlike me, she seems to have quietly thirsted for motherhood for years. It hasn't been easy for her: difficulty conceiving, two miscarriages, rounds of IVF. I wonder sometimes about people doing IVF, if they've reached some point of biological desperation bordering on insanity. The endless injections, the endless cost, it seems like people pour their entire savings into some bottomless pit just for the chance of a child. Just for a chance.

For her, it seemed to have worked. The little aliens are getting big. She came to the office elated today after news of an ultrasound that they were estimated to be growing slightly faster than predicted.

It really didn't seem right to me. It didn't seem right that although she is about my age, she had been through all this shit. It didn't seem right that there are so many struggling with infertility, yearning for a family and that meanwhile there is always a sea of fertile Myrtles who don't even want kids, but are unwittingly getting knocked up.

I didn't dare tell her about first ultrasound.

I didn't tell anyone about the day I left work early to go to my prenatal appointment, how I reluctantly got onto the table and adjusted my scrub top. The ultrasound tech chattered enthusiastically as the probe eventually centered on a little blob. She pointed to a flicker on the screen.

"There's the heartbeat," she exclaimed.

I didn't say a word. A tear rolled down across my temple and into my hair. I thought how I must seem like a terrible patient, to not be cooing and delighting in the fact I was housing this healthy fetus. She handed me a print out, a keepsake. I didn't want it, I didn't even want to look at it, but it seemed strange to refuse it.

I wadded it up the ultrasound paper, put it in my pocket. My husband walked me to the car. I sat in the passenger seat for a while, just crying. I hadn't decided if I was going to have this baby, but I had no idea that I was going to be so rattled by a fucking ultrasound.

My husband and I had endless discussions and probably some of the most stomach twisting arguments I can remember, about whether or not to keep this little organism, which I would jokingly refer to as "a parasite." Maybe referring to then barely-developed MiniMan as "Cletus the fetus" or "an alien" made the idea of having an abortion easier, but after the ultrasound it no longer seemed like something I could just distance myself from.

I had never wanted to have a kid in my early twenties. It really did not fit in with my goals. I was months away from starting a post-bac program in Vermont, and being preggo was not part of the plan.

Everything was falling down around me. I was going to lose this child and this guy who I hadn't meant to love, but had really fallen for. I was putting in eighty hour weeks washing eighty-year olds at the nursing home, watching the gradual breakdown of body and mind. Medicine, from that perspective, seemed so depressing, discouragingly palliative, and even as a caregiver, I didn't even have the time to offer these people the support they really needed. I remember initially being so intrigued by Korsakoff's syndrome, Alzheimer's disease and other dementias. What an asshole I was, I realized, to delight in the details of disease when those very illnesses were slowly destroying people, removing personalities, piece by piece, until nothing remained but an infantile shell. I worried an abortion, of all things, would push me over the edge, into some insurmountable depression.

I can't remember how many times I prayed that I would just have a miscarriage so I wouldn't have to decide what to do, that the universe would just take the reins and somehow work things out. And, somewhat reassuringly the universe did work things out, just not in the way I expected.

Eventually, I ran out of time. I had to decide.

So I chose happiness. I decided to choose love and silliness and unrefined Christmas cookies with too many sprinkles. Imagining my future that way, it wasn't actually so far off. My life is definitely goofier and droolier and toothier and at times undeniably more joyful. It's also more exhausting and slow, and financially drained, but, I guess you can't have everything, at least not all at once.

relative calm

2011-05-26T21:45:00.001-04:00

Things are getting a little better. I don't know if it's the job, or the lectures, or the new TCA, or going running, or all of the above, but I'm starting feel more like myself.

There continues to be plenty of ridiculous family shit, financial shit, legal shit, and literal shit, but for some reason it's starting to be less depressing and instead kind of funny. My husband and I set a "start medical school date" of age 30 for me (this is five years away), and although it seems slow, I think it's reasonable (and definitely doable). I'm in the process of setting up a class for the fall. It will be a relief to do something other than wait around and be miserable.

I'm starting to get more comfortable at my job. I'm working with a team to update our EMR software, which is really old (it looks like DOS). It is a huge project with (apparently, according to a recent article) a budget of 13+ million dollars. I can't figure out if this is completely insane (it's the 250-bed hospital with a good number of outpatient services), but it seems like a ton of money. Pretty much every form and assessment imaginable is being reevaluated and built electronically. It's been interesting to read this stuff. I recently came across a physician's order to "Plant Purified Pork Derivative (PPD)."

Seriously? Is that what PPD stands for? Anyway, in case you were wondering, I looked it up. These days, everybody uses a synthetic purified protein derivative (so vegans and folks with religious obligations, have no fear), but apparently the original PPD was pork-derived. Crazy.

this weekend

2011-05-23T06:58:00.000-04:00

I sat in a MiniMan with my parents, my husband, and MiniMan. We had decided to take a six-hour trip to visit my grandparents, my brother, and his fiance.

I didn't want to go, but my husband kept laying it on about how MiniMan deserved to meet his great grandparents (and he was right), so I decided to suck it up and smile.

The trip was fine. MiniMan did really well. I guess it was a success.

Everyone is doing so well: my grandparents (who are in their 90s and independent), my parents (who just bought a second house with four bathrooms), and my brother, who is wildly successful in his likely multimillion dollar business (he has it rough because he has to travel a lot and take red-eyes).

I probably should feel happy for them, but instead I'm just bitter.

Everything seems so bleak for us right now.

far away

2011-05-20T21:29:00.001-04:00

This week seemed impossible.

Somehow, though, it's over.

I don't understand why it is so easy to fall into a big hole. You'd think I'd just climb out, but I wanted to curl up for a while. When it was time to leave, though, I couldn't distinguish up from down. I seemed to have tunneled in.

Today I saw light.

no apology

2011-05-17T21:07:00.000-04:00

empty

nothing to say

tired

missing something

confused

not really sure about anything

these days

keep wondering if maybe I'm

losing my mind

seems awfully melodramatic...

tired

giving up

just want to give up

go to bed

and sleep tonight and tomorrow

and the next

in and out of weeks

sleep

apology: no energy

2011-05-16T18:55:00.004-04:00

i wonder

when's this going to be over

over over over

over over

over?

if life is going

to balance out, then

everything in store must be

wonderful.

at my hospital

2011-05-13T21:07:00.008-04:00

They hold a lecture series that meets every Friday morning. It's mostly geared towards the physicians so that they can obtain their CME credits, but it's open to all health care providers. I just asked my (awesome) boss a few days ago if it would be okay to attend (when I didn't have meetings) and she said yes! I've wanted to go to these lectures for years, but always had scheduled patient care stuff going on. I think I'll get to go on a regular basis, and hopefully be exposed to a lot of information.

This morning one of the gastroenterologists came and spoke about proton pump inhibitors (i.e. the class of drugs that are typically used to treat GERD like Prilosec and Nexium). A lot of the lecture went over my head, but here were two cool points that were mentioned:

-There can be a significant rebound when PPIs (proton pump inhibitors) are discontinued. Some practitioners argue that the withdrawal can actually create heartburn in patients who didn't have it.

-People taking PPIs are more likely to develop polyps in their stomach (specifically, gastric fundic gland polyps). This is kind of creepy, but apparently according to studies, these polyps don't seem to put people at risk for developing GI neoplasia. So far they appear to be silent.

(Gastric fundic gland polyps - images courtesy of Medscape)

therapy schmerapy

2011-05-11T19:45:00.000-04:00

Today I had probably one of the most even days I've had at work in the past year. I was actually busy and it wasn't all mind-numbingly boring. I was getting along with my coworkers and I wore a dress to work (I do not understand why, but find dresses both comfortable and oddly confidence-boosting).

Everything was really going well. The weather was beautiful. It was sunny, warm, all the flowers had popped and bowed down for a belated Easter salute.

I went to see my therapist after work. I thought it was going to be an upbeat session. For the first time in a while, I really felt pretty okay. Somehow, though, everything he said pissed me off. We talked about why I stopped singing. It pissed me off. We talked about post-bac stuff. It pissed me off. We talked about my husband. It pissed. Me. Off. He encouraged me to go to group therapy. No fucking way.

Sometimes I am really unsure if all this talking and focusing on how screwed up things are, if it's really useful in any capacity. Right now it feels like the minute things start to get back on an even keel, somebody has to rock the boat. Does therapy have to make you feel like shit to accomplish something? I'm just not sure if I buy into that logic.

Sometimes I wonder if maybe I need more of a mentor than a therapist, that I'd rather have someone cup me gently in their hands like a newborn chick and focus on the good.

I have nothing

2011-05-09T21:27:00.001-04:00

wise to say, so I will write a foul limerick:

There once was a sinus infection
That gave Peter Paul an erection.
He noodled around
With some trash on the ground
Using tissues he found as protection.

2011-05-08T14:07:00.001-04:00

It's been a profoundly difficult week.

I keep wondering if I am going out of my mind. What is real and what isn't? I've started seeing my therapist, the one who's moving away, two times a week now. I asked him if wanted to see me twice as often because he was "worried I was going to off myself."

He said "no." Knock on wood.

I can't help but wonder if all this talking is making things worse; if it is only drawing more attention to my suffering; if it is better to swallow and bury it, to laugh instead. He argues ironicalness is a coping mechanism, but not an ideal one, that it is better to feel.

I am not so sure.

I find myself driving into college town, pulling over less than a block away from that bridge. We've become so familiar to each other. I sit in my front seat writing goodbye notes on the backs of old pay stubs.

After long gazes, after considering the 9 foot fencing, I reevaluated my plan. To really simplify things, I would need a ladder, and I would need to do it when there wasn't nearly so much traffic. I would need to come back during the night or early, early morning.

Although I was tired and really just wanted to get it over with, I was okay with taking the time to do more planning. It wasn't worth dying if I wasn't going to do it right.

I drove home.

I went to bed early. I was exhausted; there was nothing I wanted to do. I couldn't sleep. I felt compelled to open the window, take of the screen and jump, but surely this wouldn't be nearly enough of a fall to guarantee death. I started planning: what about the fifth floor of the hospital? Is the entrance locked? I'd have to be careful, there was so much grass in some areas.

I didn't want to think this way, but it's difficult to turn thoughts around. I had reached a new level of desperation. Maybe I should stop taking drugs all together. I always used to be able to get back on track when I was at Oberlin, and I didn't take any drugs as a student. Something had to change.

I saw my PCP a few days ago. I sat there, flatly explaining that everything seemed pretty pointless. After a while she started suggesting alternatives, including ECT. I was disturbed and appalled. I know ECT has become comparatively less...barbaric, that the delivery is less prolonged and less intense, that they sedate people. Still, I had a friend who underwent ECT. I knew her before and after. It was like someone had replaced her head with a yellow balloon, bobbing happily in the breeze (but empty). She had a lot of retrograde (and probably anterograde) amnesia, too.

I started to wonder, what would it be like to forget all these memories, to forget memories of my son, his birthdays, my marriage. How is this living? After all this bullshit, you want to steal my memories, too? From what I'm read, I'm just not convinced of the efficacy of ECT and that the benefits outweigh the risks. From what I've read, it's not uncommon for people to have reduced IQs of 30-40 points (although many state they do not feel less intelligent). I might as well just get ECT, and go back to my job as an automaton. That's the kind of promise that I envision. Maybe I'm being overly protective of what memory and intelligence I do have. Still, getting robbed of all this is - calling it frightening seems like an understatement.

We talked about trying some of the old (and now comparatively more obsolete) tricyclic antidepressants. My husband took my script to the pharmacy (which apparently doesn't routinely stock it). I told him to just get it filled - that I didn't want to read about the side effects, that I was worried if I did I wouldn't bother taking it, that I was desperate.

I don't know. I just keep going through the motions. I keep trying to put on a brave face, but in this job, where I am grossly underutilized every day, I just have too much time to think. This thinking, it's not pretty: counting down the minutes, plotting my demise.

Everyone once in a while something real slips out. A narrow beam of light through a cracked doorway: excitement about xanthomas, about knowing something, about actually being useful in some capacity that is above that of a trained monkey. Every once in a while, something very real and very sad slips out, too. I find myself reduced to a puddle of goo, trying to hold back sobs as I sit in my car, driving down the road, listening to the radio. Sometimes I feel as though I am carrying around the entire weight of the world, that I just need to lay down and cry, that I am not capable of much beyond that.

I don't know what's happening. Things are changing, but I can't seem to discern if it's for better or for worse.

healed by a xanthoma

2011-05-06T06:50:00.002-04:00

I was really being a stinker yesterday until I went to the Emergency Department EMR upgrade meeting. We were running through a whole bunch of the nursing assessments, and at some point we got to a visual assessment.

The director and her staff were scanning the form, and someone asks "what the heck is a xanthelasma?"

No one seemed to know what it was.

I don't know why I remembered, but a couple years ago I had read about xanthelasmas when I was reading some cardiac stuff. So I told them it was a yellowish lipid deposit under the skin around the eye.

I don't know why, but this made me feel much better. Much more alive, anyway.

2011-05-05T06:35:00.000-04:00

Don't want to get dressed.

Don't want to go to work.

Everything feels bad.

still chugging along

2011-05-03T07:17:00.001-04:00

All of a sudden, it seems like the childcare options have started to multiply.

My parents offered a few days ago to watch MiniMan for us (as a substitute for daycare) for the entire summer. I'm sort of baffled. I'm actually really confused about my relationship with them. I'm used to them not being supportive at all or sort of passively being involved. Maybe my father feels guilty for banishing me for the last three years or something.

We also found another daycare that is about the same price as the other one. It was also pretty close to home, safe, clean, and the lady who ran it was not scary and seemed very competent and fun. The only downfall is it smelled like those artificial air fresheners and I had a headache by the time I left. My husband said he was concerned about "exposure to solvents" (from the air fresheners, or cleaning supplies, or wherever this scent was originating). I wonder if anyone was done studies on the adverse effects of "air fresheners." They seem like one of those things that would just piss mother nature off.

So, things are okay. I saw one of the day nurses from the ICU in the cafeteria yesterday. Apparently all the day people think that I'm still working nights, there. It seemed odd. Usually the nurse managers there are quick to send some kind of mass e-mail alerting the entire staff to someone leaving (followed by party or food/alcohol destination).

I can't help but wonder if the lack of communication was some kind of alienating gesture. I didn't expect a party or anything, but I thought that it might be worth mentioning that I was leaving. Probably I'm overanalyzing...

life in general

2011-04-30T19:56:00.002-04:00

MiniMan has learned how to harvest our wacky daffodils (note short stems)

I'm sorry for all the bitchy posts. I have really been feeling crummy, lately, or maybe more accurately, been more aware of it. I think this is good.

We managed to find daycare for MiniMan that would be $600/month, five days a week. We don't need five days a week, but maybe it would be good for my husband to actually (!) have some time to himself, or be able to pick up extra shifts at work. I'm going to check her out next week, but I have the feeling it will be okay. She's been in business for about twenty years, a friend referred us, and she has an opening. I've got my fingers crossed.

Work is okay. It is still kind of overwhelming being back in the hospital. I really thought that I had kind of made peace with my hospitalization and what happened in the fall, but I've started to realize that even though I don't want to and don't think I should, I still feel ashamed (for failing) and guilty (for being unreliable).

I still dread talking to anyone and have pretty much cloistered myself in my office (which has a door!). Actually, the workspace is comparatively good. It's really different from being in a clinical environment where I never had my own chair and was always searching for a free computer even when I was doing long-term projects like re-drafting policies. Now I have a large desk, two fucking file cabinets that are not filled with other peoples' junk, and my own chair. I do share my office with one of the new analysts, who seems cool. I am kind of relieved not to have a cubicle because that just seems too much like Dilbert.

I can't sleep

2011-04-28T23:56:00.000-04:00

Still haven't figured out the daycare situation yet. I wonder if I should quit the new job. Today was my second day at work. I like that I can hide in the corner of the hospital and not have to interact with very many people. On the other hand, I've been doing mostly data entry that is tedious and boring and generally reinforces my feelings of inadequacy.

I am really starting to hate work.

I can't even imagine wanting to have any kind of job. I don't know what's wrong with me. I don't want anything.

I haven't wanted to write about it, but I don't even want to take classes or go to medical school. I can't think of a single thing that I'd ever want to do. I just keep sort of tentatively planning to take a class in the fall hoping that eventually I'll feel more like myself. Right now, all I really want out of life is to sleep.

I don't know why I even have this blog anymore. Sometimes I think I should delete it. I don't really blog about the healthcare profession very much, anymore, instead just how much I've screwed up my life.

bankruptcy via daycare

2011-04-25T21:17:00.000-04:00

This is a disaster.

I guess it could be worse.

After spending the entire day calling local day care councils (apparently there is one in most counties), checking craigslist, and taking suggestions from everyone and my mother we have still not come up with a plan.

Almost everyone who I called was all filled up. One lady didn't have any openings until 2013! I did visit one woman who was running a daycare out of her home, and although I guess it could have been worse, it was just not right. When I got there I knocked on the dirty white door. An uncentered no-smoking sign hung from the door. The daycare woman was on the phone with DSS discussing one of her teenage sons. The daycare kids were only allowed in one room of the house which was probably about 15 by 20 feet. This room was also filled with cats (which I was told by one of the toddlers are NOT friendly), dogs, random knickknacks, random antiques that were on the floor but the kids were not allowed to touch, and random dolls that the kids were also not allowed to play with. Talk about NOT childproofing.

Thankfully, one of our friends, a stay at home mom who is stunningly smart and beautiful (but also leads this strikingly sparse life which includes not currently owning a functioning car) has offered to take MiniMan this week. This will buy us a little more time. Unfortunately, she lives like forty five minutes from our house in the opposite direction of where I work (which is about twenty-five minutes away from my house). This means I'll spend about four hours each day driving around to drop MiniMan off at her house, and then back through the area where I live and to the hospital, only to do it in reverse at the end of the day. At least it is only temporary.

I'm really starting to wonder if going back to work is futile. My mom sent me all these listings for students at the closest ivy-league who are interested in babysitting. It seems unreasonable to pay anyone significantly less than $10.00/hour, but when I add this up, just to do the three days a week, we'd be spending around $1200.00 for part-time daycare. That is more than my take home is working full-time, so essentially, I would be working only to a) pay taxes and b) procure benefits.

If I didn't work at all we'd qualify for the NYS health insurance for poor people. I don't know. I'm just wondering what the point of all this is. Right now, it seems like I'll mainly be going to work "for the experience" since likely, almost my entire paycheck will go to childcare. And right now, I really don't think I'm going to give a shit about the experience.

The whole thing is seriously bumming me out. Daycare sucks.

blog silence

2011-04-24T15:22:00.005-04:00

When I stop writing, it's usually because things are overwhelmingly good, or really, really, overwhelmingly bad. Right now, I'd have to choose the latter.

Unfortunately, too much marriage-stuff, which is off limits for this blog, will have to be saved for my memoir, which will either be published when I am dead or when my parents die. I can't decide which.

On Friday, our new daycare provider called me to let me know that she had given away MiniMan's spot to her cousin's child, who is having some kind of daycare emergency. Unbelievable. Guess who has the daycare emergency, now? I'm supposed to start work on Wednesday.

I don't typically find myself getting irate, but seriously, this woman screwed us over. So now, on a holiday, we're looking for someone (who does not cost more than I make) to watch MiniMan in a matter of days. I think my husband (a nurse) may end up trying to work evenings or overnights until we can get into a regular program. I guess it's great that he has that kind of scheduling flexibility, but I also know that he hates those hours and feel guilty. Ugh.

Stressors seemed to escalate and by Saturday my husband returned home unexpectedly early only to uncover my haphazard attempt at hiding the array of pharmaceuticals that I had collected and been gazing at. I don't know if I would have taken them or not. I was sitting there considering their prospective harm. Drowsiness. Dizziness. Seizures. Brain damage. Death.

Things aren't so bad, now.

pasta with spinach ricotta pesto

2011-04-22T14:11:00.001-04:00

I made this for dinner last night, and thought the recipe was worth sharing! It is not time-consuming to prepare, but does require a food processor.

Ingredients:
-9 ounces of spinach, halved (I used one of those pre-washed bags)
-About 1/4 cup of ricotta
-About 1/4 cup chevre (goat cheese), cream cheese, or yogurt cheese
-1 garlic clove, pressed
-1 box pasta (I used whole wheat penne)
-Salt and pepper to taste

Directions:
1) Heat a large pot of water on the stove for your pasta.

2) Meanwhile, put the ricotta, cheese, garlic, and half the spinach in your food processor. Pulse until you have a pesto-like paste. If you have a small food processor, you may have to add the spinach in two stages.

3) Coarsely chop the remaining spinach. Set aside.

4) When your water is boiling, add the pasta and cook to desired tenderness.

5) Drain pasta, return to pot. Mix in spinach-ricotta pesto and coarsely chopped spinach. The spinach will wilt from the heat of the pasta. Season to taste with salt and pepper. Serve immediately.

on Peeps

2011-04-21T16:02:00.001-04:00

I never thought I would stoop to this level of culinary offensiveness, but today I purchased...

Yes. Peeps. The quintessential all-American nutrient-free candy.

I have never liked Peeps, not even as a child, yet somehow today when I was at the grocery store, I felt oddly compelled to buy them and share them with my darling family.

I don't know if I bought them because (although they are not terribly delicious), they are kind of cute all nestled together in their little cardboard box. Note: I do think my cuteness threshold has decreased severely since having a child (be forewarned, future mamas).

Still, now I have the peeps, and I'm not sure what to do with them. Should I pull them apart and stuff them in those little plastic eggs (we are planning on hiding some this weekend)? Will this leave them looking injured and lonely? Maybe they are meant to be together; maybe it's like sending three siblings to different adoptive families. Still, is it worth caring? They'll all probably have the same cruel fate of getting masticated by some very small, very short, very new, very cute (here we go again) teeth.

Has anyone ever microwaved a Peep? That sounds like it has some entertainment potential.

Note: this post was not sponsored by "Just Born Inc.," the company that manufactures Peeps.

ugly

2011-04-20T14:45:00.001-04:00

My parents called earlier today to tell me that my brother had called them late last night: he got engaged. He didn't call me.

So what did I do? I immediately sent him a congratulatory e-mail.

They're so happy and excited for him. I'm not. I hate him for telling my parents, but not me. I hate my parents for being happy for him, but not me (when I got married my father refused to attend the wedding). I hate my mother for telling me to get an abortion when I was pregnant. I'm selfish and immature and I hate everyone.

It pisses me off so much I want to throw my laptop at the wall.

sometimes I think

2011-04-19T23:19:00.000-04:00

I'm coming a little unglued.

It's not that I'm unhappy; I'm jovial now.

I was just sitting here reading, my eyelids drooped, my body slumped. I only made it to page six. I took my pills, walked up the stairs.

The air was too warm. My pillow felt wrong. The moment I hit the mattress I thought of you, Bridge. I've dismissed and dismissed you again and again, but wouldn't tonight be so nice for a visit?

The pressure is constant to always say no, to reign myself in. It wears me out.

girl abandoned by shrink

2011-04-19T20:11:00.008-04:00

And by girl, I mean me. And by shrink, well, you probably can figure that part out. Okay. So maybe the post title is a little bit of an exaggeration, but on a more serious note, remember how I mentioned my psychologist was off visiting a far-away paradise? Well, I saw him today, and it turns out he's moving there. Soon.

Girl abandoned by shrink. Figures.

I'm fretting.

It seemed somewhat miraculous that I was finally actually able to find a therapist who was not a floppy fish, who did not just nod phlegmatically as I ran my mouth (or sat silent, squirming and fidgeting on their couch).

I know it's not so bad, but really, I'm feeling a little panicked. I feel like I'm going to have to resort to my last technique which is biased and I'm not sure if it actually works well, which involves consulting the local mental health agency's guide to therapists. Basically I go down the list, I cross off all the people who do not have Ph.D.s, and then I cross off all the people who don't accept my insurance. Then I pick up the phone and start going down the list.

I don't know if I've written about this before, or if I've been re-inspired by RS, but I'm a strong advocate for some kind of therapist speed dating program. And by speed "dating" I don't really mean dating; I don't want to date my therapist. But, to be able to talk to someone for three minutes and move on to the next, well, it might actually be enough of an interview to figure out if there's potential for a relationship that works.

Unfortunately, though, I doubt anyone will ever do speed-find-a-therapist, or whatever we should call it. It seems like everyone has a waiting list a mile high and two months long.

What to do? What to do... girl abandoned by shrink.

everything's fine

2011-04-18T11:08:00.005-04:00

I haven't had a doctor's appointment in weeks (overbooked and underpaid), and haven't seen my psychologist in a few weeks, either (vacation to a far-away paradise). And it's almost surprising, everything is really, so uneventful that I can't help but wonder what all the fuss is about all this talking and drug taking.

I remember as an undergrad I used to go through a similar process. I'd get partway through the semester, my credit load at the max or teetering over the limit, working, volunteering, cooking, tutoring, playing rugby (!), auditioning. I considered myself somewhat invincible and seemed to succeed at whatever I put my mind to. I'd finish my midterms in one last puff of exertion, and then, come that one week break, I'd have cloistered myself in my dorm room, slowly slitting away at my arms or my legs just to gain some temporary relief, meanwhile planning my demise.

I can remember talking to my brilliant and ridiculously hardworking close friend, how she insisted that I see a psychotherapist (after all, she does, and it helped her). I'd wonder if something was actually wrong. Something seemed cripplingly wrong. It would take all my energy just to look up a few therapists, leave a few messages. Most of the time I lost my courage by the time I listened to their voicemail messages.

By the time I heard back from anyone, everything was fine. Everything was absolutely fine. It really was. I had of course, wondered what had possessed me before, to feel the way that I did, but classes had resumed. It was over now, and I didn't need help. Maybe I was just one of those people who needed to be busy to be comfortable.

I think I went through this process (of seeking and then dismissing the need for psychotherapy) at least five times. When I think about it now, it's sort of stunning that I never noticed this sort of classic pattern, but here I am, once again craving some independence, feeling just fine.

the bread is taking over

2011-04-17T13:44:00.002-04:00

And I'm not sure what to do. I looked down at my cutting board. It was a mess of half-eaten and abandoned loaves (I counted seven).

Here's yesterdays latest experiment:

my attempt at epis (French: "stalks" of wheat) and some bloated baguettes

Today I made no bread. Instead, I started to recycle the remnants. I took two half-eaten loaves and stuck them in the freezer, and another, cubed and then froze. I made croutons and maple bread pudding, which was supposed to be saved for after dinner tonight with friends, but after MiniMan's repeated attacks and requests, now has a good-sized chunk missing. Oh well. I guess that means it tastes good (at least to a toddler).

on work, and being recognized as cuckoo

2011-04-15T22:02:00.003-04:00

It's so strange to think that in a week or two I'll be back at the hospital, working days, part of the 9-5 Monday-Friday, weekends off club. No patients, just meetings, typing, more typing, computers.

I'm trying to brace myself for it socially. When I was an EKG tech, I used to pretty much work the same schedule. Now I'm going to constantly be running into my old coworkers that are, of course, going to be asking how things are going, why I stopped working overnights in the ICU, why I'm not in school right now, etc.

I suppose the quick offhand answer that I can tell people is that a) I just couldn't tolerate the overnight schedule and needed to switch to a daytime job and b) it's summer (close enough), and I'm not taking any classes until the fall.

Still, though, I don't think there's much of a point in being really evasive about the fact that I pretty much crashed and burned (no doubt hastened by lack of sleep), and took about six months just to get a grip on my metal health. I don't really want to be an open book about it, but I also don't want to feel like I am hiding the truth.

I'm still on the ICU listserv so I get hoards of department e-mails, even though I won't be working there when I come back to work. One of the nurses recently injured her leg, and everyone is going all out. All the other nurses have a schedule posted for each day of the month and different people are signing up to deliver her meals. They are going all out to offer their support.

On one level, I think this is awesome, but it also really demonstrates how differently people react to a physical illness or injury, versus psychiatric illness. Even though I wasn't particularly secretive with my coworkers about what had been going on in my life, there was still this extreme hush-hush mentality which really lended itself to my general sense of social isolation. I don't know if my coworkers were worried that word would get out about my newly recognized flawed character, or what.

There seems to be this sort of uber-confidentiality thing going on with psych issues. Even at our hospital, whenever you go into someone's medical record who has been admitted to the behavioral health unit, you receive an electronic reminder (that you don't receive with non-psych patients) that the patient's medical record is confidential. What's up with that? I think it's sort of archaic.

I don't know where I'm going with this. There's some stigma with the psych stuff. I don't want to proliferate the stigma, but it's funny, it's like society is already geared to proliferate it for me.

delighting in dough

2011-04-14T19:46:00.002-04:00

From goo, to:

basic country bread

It seems logical that this process would get mundane after a while, but every time the metamorphosis still amazes me.

who is fermenting today?

2011-04-14T11:57:00.003-04:00

a budding ginger bug for ginger beer (no bubbles yet)

the beginnings of a SCOBY (symbiotic colony of bacteria and yeast) for kombucha

the wild yeast starter, nearly a month old now, working its magic on some dough

ode to Benadryl - a haiku

2011-04-13T20:44:00.005-04:00

My monster's sleeping

(thank you diphenhydramine)

I'll always love you

how much?

2011-04-13T06:36:00.004-04:00

I got my first statement in the mail for my hospitalization last month. I'm sure that it doesn't cover everything since there's no mention of the emergency department, which sadly, is the only way to get admitted (there are no direct admits).

Yup, that's right, $6401.81, which was for five days, I think. This is probably pretty cheap compared to almost any other reason to be in the hospital, I'd imagine. I am really grateful for my awesome health insurance right now, which so far, has covered everything from that visit.

Maybe there should be some kind of "psych cruise" industry. Instead of paying a thousand dollars a day to get locked up on a ward, get locked up on a boat instead. Get a little sun, a little water, and hopefully a lot of really high fencing.

New International MD Program in Milan

2011-04-12T10:56:00.017-04:00

I was recently asked to share the news about a new international MD program at Vita Salute San Raffaele University in Milan, Italy. Their MD program was launched in 2010 and is being taught in the English language.

Below is some additional information about the program:

Vita Salute San Raffaele University is part of the San Raffaele Foundation which includes hospitals, research centers and the Vita-Salute San Raffaele University. San Raffaele is well-known worldwide for its excellence: it is a highly specialized center for molecular medicine, diabetes and metabolic diseases, as well as biotechnology and bioimaging. The hospital channels many of its resources into cancer treatment, cardiovascular diseases and numerous acute and chronic-degenerative diseases, and a very efficient emergency department that serves a vast area.

The International MD Program builds on the institution's solid presence on the international scene: San Raffaele healthcare centers can be found in many countries of the world, including Brazil, India, Uganda, Poland, Chile, Israel, Mozambique and Algeria. This degree course provides medical-scientific education at the highest level, allowing students to improve their skills and to upgrade their knowledge. It also provides clinical and laboratory research opportunities and additional education in humanities and cultural sciences: philosophy, communication skills, cognitive neurosciences and psychology.

The International MD Program is designed to train a new kind of doctor: someone who possesses the necessary human, cultural and professional ablities to actively participate in healthcare and share ideas in today's globalized world. Unlike other medical programs in Italy where clinical courses are held in Italian, the International MD Program is fully in English, including classes, lectures, practicals and all clinical activities.

Students enrolled in the San Raffaele International MD Program have access to all the facilities of the Vita-Salute San Raffaele Institute and the San Raffaele Scientific Institute, including skill labs for practical training, a library with more than 20,000 books and several thousand scientific e-publications and resources, as well as to the clinical and research laboratories of the San Raffaele Scientific Institute, the largest private resarch institute in Italy, that further expanded with the inauguration of DIBIT, a scientific facility for basic, translational and clinical research. DIBIT is part of the largest biomedical science park in Italy, which includes the San Raffaele Hospital, Science Park Raf, created to support the foundation's development, and the Vita-Salute San Raffaele University.

Applicants who wish to enroll in the International MD Program are required to take an admission test. 64 places (32 for EU citizens, 32 for Non-EU citizens) are available for Academic Year 2011-2012.

The admission test will take place on April 28th, 2011 in the following locations:
Milan, (Italy)
New York, (USA)
Kuala Lumpur, (Malaysia)

Candidates who wish to take the admission test can visit this website for detailed information.

The application deadline is April 20th, 2011.
Here are the guidelines on the admission process for academic year 2011-2012.

For more information on the International MD program, please visit the following website: http://bit.ly/mdprogram

life is (actually) good

2011-04-11T20:10:00.007-04:00

For the first time in months, I feel like myself. I'm so looking forward to everything turning green, to the CSA starting again (photo: flowers from last summer from our CSA), to my neighbor's ridiculously cheap you-pick rhubarb operation reopening.

Things are looking like they're going to (s l o w l y) work out. The new job is getting arranged and seems comparatively flexible. My new boss is young, approachable, and seems really relaxed. We've got daycare set up for MiniMan. It's pretty close to our house, affordable, and will only be three days a week because my husband can stay home with him when he's not working.

I'm not exactly sure what's going to happen with the fall, but I am sure that I'll end up taking one class, that it will be at a campus closer to home, and this will take precedence over work. And, I know I'll get to sleep at night! Things are going to be okay.

everything I own is getting destroyed

2011-04-10T21:55:00.006-04:00

Someone (no names) has scribbled all over the door with sharpie, and at a later date, on the quilt on our bed with a green highlighter (which I am pleased to tell you, was later determined to be water soluble).

My laptop has been dropped on the floor so many times that a piece of the polycarbonate coating has cracked and fallen off. Someone (no names) so thoughtfully threw it on the floor one day after shoving two CDs into my disc drive.

Just moments ago, I was about to plug my camera into my computer only to learn that somehow the video/PC port on the camera has been pushed beyond the plastic of the camera and into some dark abyss. AAGHHHHH.

I think I might cry.

And so I tell myself what I seem to be telling myself increasingly more often:

It's just stuff. It's just money. It's just money. It's just money.

2011-04-10T13:40:00.009-04:00

When life

gets worrisome

I bake

the more anxious I become

the more the cakes

and the muffins

and the bread

and the cookies

and the bagels

seem to grow

grow

they

reproduce

they march

across the countertops

set up haphazard camps

so, when one day

my two-year-old

picked up a food magazine

and shouted:

"CAKE TOWER!"

in delight

as his plump finger

pointed to a tall wedding cake

I couldn't help but wonder--

is this carb compulsion hereditary?

Since then he has proudly declared

his third birthday cake desires:

super

chocolate

CAKE TOWER

(with dinosaurs on top)

spa day

2011-04-09T13:42:00.012-04:00

Yesterday I cooked the turkey

my husband captured

under fluorescent lights

between the frozen chicken cutlets

and cornish hens.

It rested in

my refrigerator for days

until one morning

I wrestled it out of its

plastic suit and

into the sink.

I sprayed it

and washed it

and patted it dry,

and gave it a little

sea salt and pepper

aromatherapy scrub.

The sauna was up to

temperature:

four-hundred and fifty degrees.

And so I laid down the turkey on that

minimalist

metal lawn chair

I usually reserve only for use

around Thanksgiving.

I opened the door

the heat blasting against my face

to pop it inside,

and dump a cup of water

in the basin

underneath.

the door.

Set

the timer.

I hope

you like it

steamy.

three and a half inches

2011-04-06T20:05:00.011-04:00

I have a graveyard of high heels in a suitcase upstairs. Almost none are expensive; most are disposable, almost. The red ones? On sale, $3.88 at Target, they boast. Bronze with scalloped edges and peep toes? I bought them in Cincinnati, and almost lost them after a night of corn hole, too much Guinness and too much...Wayne. You know there was some kind of judgement lapse when you end up in some guy named Wayne's apartment and can't find your shoes the next morning.

I first willed myself to walk in unsteady heels in college; it seemed like a rite of passage into womanhood, some tangible proof of sexual maturation. I strode bravely across slippery linoleum floors and uneven cement sidewalks, onto aging brick walkways, only to get a heel stuck between a few bricks and suddenly be traipsing around campus, half-barefoot. No one told me that I would need a sense of humor, too.

And so the heels, they sat in my cozy closet, giggling among each other, begging for sisters, for socialization. They multiplied. I needed a bigger closet.

I got a bigger closet. They went out and partied, brought new friends home. They travelled to Austria's snowy winter streets; they politely braved five hours in standing room during Parsifal on the floor beside my ankles. In Italy they modestly climbed narrow cobblestone sidewalks, paling among the other shoes, among a million brunettes dyed blonde and the eighty-year old Italian grandma riding her vespa in five-inch stilettos and a tight camouflage-print dress.

The heels flourished in Florence, but they had a rough time with the whole pre-med transition. It just wasn't as fun as opera, and suddenly, they were out of place. They weren't welcome in my neuroscience lab, and made me feel like a stereotypical diva in my calculus class. So, sadly, the heels were slowly tossed aside for a beaten pair of Salomon trail runners or my old Dansko clogs.

After I graduated, the heel neglect only worsened. I started working at a chichi nursing home and seemed to have residents accidentally urinating or spilling coffee on my feet on an almost daily basis. By the time I wandered into the parking lot at the end of each day, under the glow of street lamps swarmed by moths, my shoes became sloppy sweat receptacles after fourteen hours of running up and down the hardwood stairs, Oxycodone in hand, of that four-story mansion.

The heels figured their situation couldn't get any more awful, but, well, they were wrong. I moved out into the cabin in the woods. They had to venture across the gravel, not asphalt, driveway. They braved the puddle-luscious spring, only to occasionally become engulfed by the slurping mud. They calmly awaited their death on the kitchen floor next to our two-year old shepherd, who ultimately gnawed apart half a dozen pairs during her developmental "shoe fetish" period.

After I became pregnant, my feet became so flattened under the bulk of "Cletus the fetus" that the heels seemed to have reached an entirely new level of impracticality. I listlessly gathered the remaining survivors, threw them into a suitcase, and shoved it in the corner, where they sat undisturbed and forgotten for quite some time.

I look at it now, as I clean out the pile of junk in that corner, and wonder:

Who the hell am I?

(and what do I do with all these shoes?)

2011-04-04T09:28:00.003-04:00

I don't want to go back to work. I don't want to speak to anyone or be social. I want to sleep all day instead.

A few days ago I went for the my first jog in months, up the hill and to this alpine lake near my house. The next day I was driving around town with MiniMan and we got rear-ended. We're both okay, but I am seriously sore (the whimper yourself to sleep kind of sore). I don't know if it was the running or the car accident, probably both.

I've been thinking about trying Bikram yoga. This is a really unusual declaration for me to make, because I tend to be really uncoordinated. In college, I dreaded my dance classes more than calculus, and choreography scenes more than juries (everyone performs for a panel of faculty and they decide whether or not you can continue in the program). A friend of ours teaches Bikram yoga (and owns a yoga studio). He has been pressuring me to go for years. At my husband's insistence, he finally stopped asking/offering. Of course, now I want to go.

I don't know anything about yoga, but apparently what distinguishes Bikram yoga is a limited number of poses (26, which are repeated at every session -- phew!) and a (patented!) hot temperature (around 105 degrees Fahrenheit). Because it's so hot, people tend to sweat a lot (and detoxify their systems), and it's easier to stretch because the body becomes really warm. Since I am starting to feel like a stiff eighty-year old man when I wake up in the morning, I figure I probably can't make things worse by going to our friend's yoga class, right?

distracted

2011-04-02T07:49:00.005-04:00

This is what happens when I pay more attention to my laptop than my MiniMan:

Title: "Need make pancakes"

the winter that keeps on giving

2011-03-31T09:17:00.004-04:00

This was the view from our porch when I woke up this morning.

The paper lanterns are from last summer; I never seemed to have the chance to take them down in the fall and they ended up staying up all winter en lieu of Christmas lights or something. I can't believe that delicate paper survived. The lanterns must have been sheltered by just enough of an overhang from the roof.

I had been looking forward to spring: to streams overflowing after the thaw and a yard overrun by puddles, to the first smattering of green and our quirky daffodils. For whatever reason, though, it's still soothing to be shrouded in one of this winter's last attempts, and to watch the snow fall calmly in fat, slow clumps.

my pharmaceutical cornucopia

2011-03-30T00:01:00.004-04:00

I've become the noncompliant patient. I stopped taking most of my meds about two weeks ago.

"It's classic bipolar," my doctor said, "to just stop like that."

I pulled my hands inside the sleeves of my sweater, squirming. "It started as an accident. I was taking Seroquel and Klonopin at night, and Lexapro and Wellbutrin in the morning; I kept forgetting to take the morning meds, and I started to feel better."

I knew that it would be obedient to get back on track despite the missed doses, that I was putting myself at risk for some kind of depressive relapse or whatever -- by stopping without tapering, but I really didn't care. I felt so much better.

Anyway, if discontinuing some of my medications is viewed as being "bipolar" at least I kept taking the one that would actually be appropriate for that diagnosis (the Seroquel). I don't know. Maybe I am a nut.

Good thing I like nuts.

cheater's limoncello

2011-03-29T14:56:00.013-04:00

Beer making, sadly, is going to have to wait for the bills. There is a lone large bottle of cheap vodka that I bought in the fall to make infusions and a bag of organic lemons that I splurged on a few days ago, so I decided to make limoncello (or more accurately, a sweet lemon infusion, since I guess authentic limoncello is made with grain alcohol).

Limoncello is typically made with lemon rind, alcohol, and simple syrup (one part sugar, one part water). The vodka that I had was only 40% alcohol by volume (not nearly as strong as grain alcohol), but it's all I have, so I decided to make my limoncello without using a simple syrup (i.e. not dilute the already "too weak" alcohol with water from the simple syrup). I've done this before in the past with other infused alcohols, and eventually the sugar dissolves on its own.

So, here's my recipe:

INGREDIENTS

~4 cups cheap vodka

1 heaping cup sugar

5 lemons (organic unless you like to eat chemicals)

DIRECTIONS

1) Wash and dry lemons.

2) Remove the zest from of all the lemons. I used a microplane grater to do this, and grated the on top of a piece of parchment paper, since my wooden cutting board likes to share its garlic flavor with any host (you could use also foil or wax paper). Try to avoid grating any of the pith (white stuff). Alternatively, you can use a sharp vegetable peeler and peel off the rind in chunks.

3) Put zest and sugar in a quart-sized container (I used a mason jar). Cap and shake well.

4) Fill halfway with vodka. Cap and shake again.

5) Top with vodka. Shake some more.

6) Let the mixture sit in a cool, dark place. You can agitate it occasionally to help dissolve the sugar.

7) After 45 days, filter the mixture four times using a coffee filter (or a tea towel or clean t-shirt if you don't have coffee filters lying around). Stick it in your freezer. Enjoy.

ferment with me

2011-03-27T16:12:00.006-04:00

Okay. Maybe the post title is a little deceiving. Only two of these products are truly fermenting (from the left: our own maple syrup, lacto-fermented dilly carrots, sauerkraut with caraway and mustard seeds, pickled turnips and beets, pickled turnips with cumin and paprika).

For the past few years, my husband and I have been members at a nearby CSA. Our CSA has summer shares and winter shares, and we've done both for a while now. The winter shares for us are primarily preserved root crops (that were harvested in the fall and then put into cold storage), but also some greens that were still in the fields (did you know that you can harvest kale even when it covered with snow?) and some others (spinach, salad greens) in passive greenhouses. Anyway, the winter CSA just ended, but I had an abundance of gold ball turnips, daikon, beets, and celeriac.

This resulted in some uh, exciting projects including a batch of celeriac fries that boiled over and started a grease fire that reached past the hood over our stove. Surprisingly, nothing was damaged and no one was hurt (including the fries) thanks to some baking soda for the fire and a larger pot for the fries. The celeriac fries were surprisingly sweet and not dissimilar in texture from sweet potato fries.

As to why I picked up so many turnips at the CSA, I'm not really sure. I've never liked turnips very much, so I decided to grab a bunch and try pickling then to see if I would like them that way. So far I've only tasted the ones with the beets (which have taken on their vibrant pink hue), but they're pleasant, not oppressively turnipy, and taste, well, pickled.

Sort of at a standstill with the whole work thing. I need to get a doctor's note before I can come back yet again, so tomorrow I guess I'll figure that out. I've been thinking that if I really can't figure out a schedule that works in the fall (i.e. daytime job and a daytime class) that maybe I will just stop working. I think that if I stopped working but my husband didn't, we'd be just poor enough for state-subsidized family health insurance. Money would be tight, as it is now, but life would probably be more pleasant. Plus, I'd have more time to cook (and make beer).

berserk work

2011-03-24T12:01:00.004-04:00

I had yet another very exciting meeting with HR this morning. The prospect of it all wasn't quite as nauseating as it was the last time. I guess this means I must be making progress.

I think I might try to take a temp job which is mostly recording minutes for the IT department. They're implementing a new electronic medical record software change, and so there are meetings up the wazoo with every department in the hospital. I would be able to keep my benefits, but it would also buy me some time to figure out how to take classes in the fall, and I wouldn't have to buckle down for a long-term commitment.

As relieved as I am about not having to work overnights for the long-haul, and as nice as the prospect of having a paycheck again and breaking even with the bills, I still feel sort of like an idiot. After all this (my failed attempt at working overnights and taking classes, going nuts, etc), I'll probably be in basically the same situation I was in a year ago, except with a more idiotic, more useless job. In the fall, I'll be faced with exactly the same challenge I had before: how do I take my classes? I'll either have to a) not take my classes, b) switch to another job with a different schedule (i.e. work evenings, nights, etc.), or c) stop working.

Ugh.

back from the abyss

2011-03-22T11:08:00.003-04:00

I haven't been writing. It seemed like there wasn't much positive news to write about, so I just didn't bother. My husband read my last entry and uh, it didn't go over too well, and I started to wonder if posting in a public setting was not such a great idea.

Not a lot is going on over here. I'm supposed to meet with HR in a few days and look into working in another department. I have this creeping feeling that I am going to end up in accounting. I guess that would be okay.

Meanwhile I've been hanging out at home, slowly considering all things fermented. The wild yeast starter is happy and making some good bread, and recently I made some yogurt. I think next fermented item on the agenda may be beer. Hmm. Beer makes everything better.

everybody hurts

2011-03-09T08:11:00.004-05:00

The indigo sky is becoming black. I pull into my driveway after a long doctor's appointment. I can barely open my car door, the snow is so high. I manage to gain a few inches and plunge a sneakered foot into at least a foot of snow.

I open the door, remove my sloppy shoes. The house is dark, unusually quiet.

"Hi guys!" I set down a few groceries on the floor.

I hear MiniMan upstairs watching reruns of Dinosaur Train on Netflix. My husband eventually walks down the stairs. He wears huge weary circles under his eyes and a look of defeat.

"I was just about to grab MiniMan and start looking for you. I thought you were dead."

I take my husband into my arms and hold him awkwardly, stroking his head. I pull him closer, listening to ragged sobs. He doesn't collapse into my arms. Instead, he just stands there, stiff, alone. I don't know what to do. He almost never cries. I'm blank, empty, somewhere else. I should be more empathetic. He has every reason to lament but it makes me squirm. A better wife would know what to do.

It must be my turn to be the sane one, or at least the strong one, but instead I just want to bolt. How fucked up is that?

"It will be okay. I'll figure this stuff out. We'll figure it out. It will be okay." I say, unconvinced. I rub his back.

I don't know how to comfort him. I don't know if he'll ever stop worrying, if he'll ever trust me. Maybe he shouldn't. Sometimes I wonder if I'm like a contaminated water source, slowly introducing my filth to fester in him.

2011-03-08T14:32:00.003-05:00

I got discharged yesterday from the psych ward. I thought I wanted to get out, but now that I'm out, I feel worse. I had almost become comfortable locked in that cocoon, I guess.

You would think that something would have changed -- that I would change after spending a week in there; that maybe I'd feel better; that maybe I'd be more motivated to repair myself. I don't feel much differently at all. The gorge is still as tempting as ever. I still just want to sleep all day, all night, ad infinitum.

2011-03-06T20:43:00.009-05:00

I've been coping

with cocoa

"only 90 calories"

it boasts-

I wonder

what's really

in there?

my white

styrofoam cup

obliviously

insults the world

the tear

of a thin wrapper

reveals a heap of dark dust

transformed

by steaming hot water

from the mineral-crusted tap

chocolate powder

struggles to float

in the vortex

imposed by a flimsy

wooden stirrer

I pause

take a sip

of the chaos

reveling

in its warmth

my life exploded: the aftershock (part ii)

2011-03-06T14:37:00.002-05:00

6:45 p.m.

We walked through the emergency department doors. I followed Dr. D to the reception desk.

"This is the patient I called about earlier; she is suicidal and having an acute crisis."

I started at the floor. Some acute crisis, I thought. This has become a way of being. It is not a big deal. Hospitalization is overkill.

The receptionist asked me to take a seat.

"I need an insurance card, picture ID... is this still your address?"

I watched as she looked my name up in the computer and promptly slapped a green label on all of my paperwork with "CONTACT PRECAUTIONS" written in bold lettering. My wound with the MRSA that I had contracted in the fall had long ago healed, but according to our hospital policy, any time I entered the facility as a patient my coworkers would have to gown and glove, even if my cultures were now negative.

A nurse met me at the door. It was Meghan. We had taken an EKG class for nurses together when I had first started working at the hospital. We used to sit together, eat lunch together. She sat me down in the triage room and started taking vital signs.

"So, what brings you here?" She asked awkwardly.

"Umm. Nothing." I said. I was at a loss for words. I watched as she turned to the computer and typed in "Nothing."

Dr. D chimed in, "is it all right if I speak on her behalf?"

"Well, that's up to E," Meghan said.

"It's okay."

Dr. D started to present some kind of explanation for my admission that was a little more substantial than "nothing."

A few minutes later Dr. D said his goodbyes and told me that he would call in the morning. Meghan walked me over to a room.

I sat in a chair against the wall, silent, listening to the relaxed chatter of techs and nurses, people gently giving each other a hard time. A young guy in stolen green surgical scrubs, probably not older than twenty, sat outside my room by the nursing station watching me. It was strange, being the patient behind the glass doors in the bed, forbidden to close my curtain. I can't even count the number of times that I have floated to the emergency department and done the exact same thing; observe psych patients awaiting their assessments, one eye on the patient and the other perusing an issue of Fine Cooking.

A knock on the door. "Hi, I'm Beth, I'm your nurse tonight."

I looked at her. She must have just graduated from nursing school. I had never seen her before and she had a new grad kind of clumsiness and lack of confidence to her.

"So, first I'm going to need you to change into these scrubs."

She set a pair of blue disposable scrubs on the stretcher.

"No thanks," I replied.

"Um, okay." She walked out.

Beth walked back in a few minutes later. "About the scrubs, actually, it's our policy that you wear them."

"I'm sorry that I'm not following your policy, but I will be keeping my clothes on."

She walked out of the room.

A few minutes later the young tech came in.

"It would really help us if you would put on these scrubs. Could you do that for us?"

"No. Sorry." I offered an exasperated smile. He walked out.

Beth came back in.

"They're just scrubs. Couldn't you please just put them on for us?"

"No," I replied politely.

A few minutes later the charge nurse came in.

"These scrubs are for your safety. If you don't put them on, I will call safety and security, call the response team, and have you put in restraints."

I was baffled. Could they really put a nonviolent person in restraints? Should I just give up or exercise a little civil disobedience? The whole ordeal seemed so dehumanizing.

I decided to just fuck it and put on the stupid scrubs. What did they think I was going to do? Take the staples out of my Dansko clogs and eat them? Pull the underwire out of my bra and stab myself in the neck? Hang myself with my pants? Saw myself in half with the zipper from my fleece pullover? The possibilities were endless. Then again, I was in a room filled with other things I could harm myself with, cords and tubing, blunt objects, needles from the UA kits (which are not locked up), metal and electrical sockets. Hmm.

A while later, Beth came in to draw my blood. I told her she could do my hands if she wanted. I have pretty serious protruding veins on my hands and they are easy to see and an easy stick. She decided to go for my left AC. I told her that my AC was sometimes hard to see, but very bouncy. Tourniquet on. She probed for a while with her finger. She swabbed my skin with alcohol and followed quickly with a butterfly.

No flush on the butterfly. I had this overwhelming urge to grab the butterfly from her and do it myself, but I sat there passively, even relaxed while she prodded around. She pulled out the needle a few moments later.

"Let's try that hand."

Tourniquet on, alcohol prep, big fat juicy (but superficial) vein. She needle went in. I saw a flush. She continued to push the needle in. She popped a tube into the vacutainer. No blood.

"Pull the needle back a little," I gently prompted her.

I watched as a bluish lump started to form under my skin around the needle.

"I blew your vein, didn't I..."

"Yeah, it's okay." I popped the tourniquet.

"I'll go find someone else to draw your blood."

A few minutes later another nurse came in to draw my blood.

"I think I must have freaked her out," I said.

"Yeah, drawing blood on other healthcare providers never puts anyone at ease." The nurse quickly drew my blood, gathered and labeled the full tubes, and walked out.

I sat in the chair, alert, listening to the rhythms of the emergency department. A crying baby, a screaming psych patient, the scuffle of shoes and EMS radio giving report in the background. Time passed slowly.

my life exploded: the aftershock (part i)

2011-03-05T14:54:00.003-05:00

On Wednesday, I was out for a drive. I had to fill a script for Seroquel and was going to pick up some root vegetables at the farm where we're members. My husband offered to take care of our son while I was out, and there it was again, temptation.

I drove into town. Do I pick up the prescription or do I just drive to the bridge and get it over with? I felt calm, relaxed. It was no longer an option to just jump off the railing; someone had installed perhaps eight-foot high inverted fencing against the three or four foot railing. I had it all planned out, though. I could visualize myself climbing over the wrought-iron bars of the neighboring fraternity driveway and carefully hiking along the brittle frozen shrubbery to climb, from the outside, to the bridge railing. I would inch myself along until I was over the gorge, and then all I had to do was let go. It seemed so simple.

I was, I guess, a little bummed that I was giving into temptation, but my suicide was inevitable, right? I mean, if someone offered you a super-awesome brownie ten times a day for the rest of your life, don't you think sooner or later your willpower to decline it might falter? Most people take it for granted: this conscious choice to keep living, to keep plodding through perhaps mundane, unfulfilling, or despairing lives, day after day, after day.

For some reason, instead of driving up the hill to the gorge, I stopped at my psychologist's office first. I figured it would be like flipping a coin. If he weren't there, I would head to the gorge, and if he were, well, maybe he could help me figure this out.

His car was parked next to the back door. I opened the unlocked door and sat on the landing at the bottom of his stairs for a while. I rested my head against the wall, listened to the noises of energetic children, clanking pots and pans, dinnertime noises. I must have been up against someone's kitchen apartment. I sat there a long time. I watched the sun go down. Eventually it grew dark. The wind blew against the outside screen door. I was becoming cold, my butt getting numb from sitting on the floor so long.

I decided to walk up the stairs. Dr. D opened his office door, startled, and asked if he could help me, as if maybe I was some kind of invading burglar or a lost homeless person. He turned on the lights in his waiting room, his face softening when he recognized me.

"I know you said to call if I needed to, but I didn't have my phone."

"Sit down, sit down." He ushered me to a seat in his waiting room.

He retreated to his office for a moment, and then the door opened and the patient he had been seeing left.

"I'm sorry, I didn't mean to mess up your schedule." I muttered.

"We were just about done."

I sat on the floor. I don't so much remember what we talked about. I don't even remember if I told him where I was planning to go, what I intended to do. I must have told him something about these thoughts, these burrowing, insistent, relentless thoughts.

We talked, unhurried.

Eventually, he convinced me that I needed to go back to the hospital; that I needed to be admitted again as a psych patient if only to be safe, get some better medication management, take a break.

I hated the idea of all of it. We spent a while kind of passively arguing about it, but in the end, I realized I didn't have a choice. We walked outside and got into his car, and I sat in the front seat, my teeth chattering, as he drove to the hospital.

Running from myself

2011-03-02T13:56:00.004-05:00

I don't cry very much, anymore. It was becoming kind of pathetic to have these constant breakdowns. I'm glad they're going away.

I still find myself wanting to be dead, though. Not really in an emotional way, just in a constant detached way. It's starting to be all I can think about again.

I think about it during the day when I'm feeding my kid lunch; I dream about it; I wake up in the middle of the night and start planning. Sometimes I just want to get in my car right away, to drive somewhere and just get it over with. Funny how once you have a kid, you even have to find childcare just to kill yourself.

Most likely things are bound to change, they're bound to become better or something, but I really don't care.

I want to spend all of my days alone, but I don't feel safe with myself. We are not friends. I am out to get me.

empty

2011-02-27T00:26:00.004-05:00

Still can't sleep.

I find myself staring into the darkness next to my husband, feeling kind of numb. Instead I wish I were sad. I wish I were hysterically upset, sobbing, throwing things at the walls. Why would I want that? All these months I've spent trying to regain some kind of semblance of normalcy -- it doesn't make sense. Maybe I brought all this on myself. Maybe I have some kind of deep-rooted seed of self-sabotage.

Ten minutes later I'm rubbing my barely-awake husband's broad shoulders and crying, but I don't even know why. And then it's gone. Nothing. Back where I started. I want to turn the dial and stop being. Turn the radio off. No more static.

Can't sleep. Can't sleep.

I try to imagine being dead. Usually this is soothing and I can fall asleep, but this time it isn't. Now it's upsetting. I'm so confused. I feel like I'm floating away from the earth, alone in space. Profoundly alone. Just me, the stars, and the darkness.

on sleep

2011-02-26T22:02:00.006-05:00

Nearly every night I find myself in a vague state of dissatisfaction. Definitely not a crisis or anything near that, but always kind of in this place where I don't want to be awake but I don't want to go to bed. I'm tired but I can't fall asleep. I feel like I should be up doing something, because it's rare that I have much time to myself, but there isn't anything that I want to do.

I'm sort of lonely, but I don't want to be around anyone. I don't want anyone to touch me. I think somewhat longingly of my last bed in my last apartment in Oberlin. It was nice to have my own space; to be able to sleep diagonally across the mattress; to hog my pristine white covers; to not have someone next to me snoring or a toddler climbing in constantly during the middle of the night.

MiniMan has a lot of trouble falling asleep on his own. Most days I lie down with him before he takes a nap and when he goes to bed. It probably isn't a good parenting practice to do this, but it is so exhausting to walk him back to bed over, and over, and over again (sometimes for over an hour) that I've given up. Instead, I get into bed, hold him close, slow my breathing and close my eyes. I pretend to be asleep. It's probably as much of a comfort for me as it is for him.

Usually he falls asleep quickly, although sometimes just as I think he's begun to relax, I'll feel a tacky hand caress my face, then fingers on my brow line.

"Eyebrow," he says.

A finger gently presses against my closed eyelid: "Eye-yashes."

Then, a finger pries my eye open. "Shiny eyeball!"

I laugh.

Maybe I should just give up on sleep. Maybe I should adopt the toddler philosophy: it's more fun to stay up even if I get cranky. Somehow, I'm not really even sure about the fun part, though.

Is psychotherapy mental prostitution?

2011-02-25T06:55:00.005-05:00

One day when I was on my way home after seeing my psychologist, I started pondering how bizarre the patient-therapist relationship is. After only talking for a few hours, I felt like this person understood and accepted me more than my family or my friends. The whole thing struck me as kind of strange. And so I began to wonder: is psychotherapy some form of social prostitution?

Think about it: you're paying for a relationship where the terms are at least somewhat defined; you know that you'll be the chief subject of attention (instead of giving out the attention); you get to connect intimately with this person almost immediately, but you don't have to worry about any social obligations when you're not in a session. The terms are pretty clear cut. You are the sole subject of focus. Maybe you're not getting a blow job, but the playing field sure isn't equal.

Oh, but, let's stop talking about me.

Taking the focus off of yourself apparently crosses some kind of professional barrier, but the therapist is expected to at least objectively care about you. It's a fundamentally unbalanced relationship: one person's livelihood combined with another's personal life.

I wonder why it is so acceptable to have this mind mistress or sorts, when it's clearly not to spend some money to obtain a little sexual healing. Isn't prostitution one form of taking care of yourself on one of the most basic levels, uncomplicated by commitment? If someone were to ask me my opinion, I'd probably be an advocate for the decriminalization of prostitution. After all, with legalization comes some level of regulation. Regular STI screenings, more tax money (instead of illicit income), a decreased amount of workplace violence and significantly more comfort reporting it. Legalized prostitution sounds way less sketchy and scary. I wonder why we choose to make it so scandalous and culturally unacceptable.

Sex and psychotherapy - they're both trying to fulfill some pretty basic desires. A therapist will listen and maybe put you on a trajectory to becoming a more emotionally satisfied human being. That kind of relationship seems as (if not more) intimate than a strictly sexual one. Weird.

the bake fest continues

2011-02-23T14:22:00.005-05:00

I took MiniMan to the 'dinosaur museum' (paleontological museum) this morning. He was thrilled to see towering collections of bones; to sit at a station for kids and look for fossils; to play with and name the toy dinosaurs. After we left the museum, we drove into town and split a bagel for lunch. We had a nice time.

As we were driving home and he was starting to drift to sleep in his car seat, the sun was reflecting off the crusty snow. The edges of huge round hay bales were glowing. The snow was sparkling. I wanted to drive faster and faster, to accelerate until my car took off into the sky. I wanted to disintegrate into the air.

That's the thing about having a toddler in the back seat, though. Your car never really turns into a plane. At least not a real one.

I'm home now. MiniMan is sleeping. I should be cleaning the kitchen and bringing in wood, but instead I'm preheating the oven and waiting to slide in a second attempt at the perfect sunflower raisin bread.

The first one came out okay. It was crusty on the outside and moist on the inside. I was out of sunflower seeds so I used walnuts. They stained the inside dough a kind of brownish purple. This time I've added more whole wheat flour in hopes for a denser loaf, sunflower seeds instead of walnuts, and sultanas (golden raisins) instead of the more familiar deeply brown raisins. We'll see how it goes. There's something very transformative about bread...to take a slurry of ingredients that are so simple: flour, water, salt -- and turn them into fragrant, cracked golden mass.

another dreary post

2011-02-22T22:55:00.004-05:00

It's not that late, but I'm tired. I don't want to go to bed. Every time I lie in bed my mind starts to drift to everything I've been trying not to think about all day: unpaid bills, dread about what will happen with work, apathy towards the future, skepticism that I will ever be able to function the way I used to, disgust with my body and my constant state of frumpiness, death, death, and more death. Sometimes I just lie quietly and cry. Other nights I hope that I'll have an aneurysm in my sleep and die. It's funny, sometimes the only thing that brings me comfort is imagining that I'm dead.

I want to be sedated. Even just being able to fall asleep, to reboot, would be a comfort, but it always seems like when I really want to, I just can't.

I've been entertaining the idea of trying Seroquel. Some of the side effects, though, like brain damage and death were kind of a deterrent. Then again, maybe it would be great. Maybe I could walk around in a bathrobe like a zombie all day.

I don't want to feel anything.

the rambling path continues

2011-02-21T00:30:00.006-05:00

I haven't been blogging lately, or communicating with anyone really, because I am so much more content to ignore reality and draw pictures of cows with my toddler.

Last week I had a meeting with my boss and Mr. Slimy Schmoozer in human resources. I ended up agreeing to resign from my job.

Before all of this, I kept going to work. I had all this anxiety about it. I had to bake a cake (to bring to work) before every shift to convince myself to walk out the door. Despite the cakes, I usually only made it through the entire night about a third of the time without flipping out beyond the point of no return. The aftermath was worse. I felt so shitty for crying uncontrollably, for not being able to do this basic job, for not being able to pull myself together. It seemed to take a couple days just to rebuild my confidence to do it all over again.

So, I'm not working. I'm not totally divorced from the hospital. Part of all this talk with boss and Mr. S. Schmoozer was the offer to let me work in another department. Right now, any place that offers a little hermitage sounds good. Morgue? Yes. Histology? Yes. Sweeping the floors in the basement? Yes. Okay. I lied. Nothing sounds good. But I have to try to ignore my pessimism, right?

But, again, I'm not currently working (once again). Anything even remotely resembling plans for the future seems kind of bleak and just emphasizes what a loser I am, so instead, I continue to divert my attention with carbohydrates. The latest craze is bread. My current endeavor is to replicate this chewy, dense sunflower raisin bread that one of the local bakeries sells. I'm thinking that with all this free time, maybe I should try to grow my own sourdough starter, too. Then I can have a little fermenting gooey pet. It will be like having a second child (who is much pickier about what to eat). I will try to fall asleep tonight thinking of baby names for my sourdough starter. Suggestions are welcome.

Maybe I should just get a lobotomy and become a baker. Actually, there's a lot of food science behind baking, so perhaps the lobotomy isn't necessary.

All this bread has made life a little easier to tolerate. I mean, who can have a mental breakdown when the house is full of warm yeasty crustiness?

Am I a diagnosis?

2011-02-09T06:39:00.009-05:00

I know some people who define themselves by their illness(es). I guess you can spin it either way: it's a tolerably miserable parasite to live with, or you've somehow triumphed over evil and now you want to shout it from the rooftops.

I don't think I want to do either.

As for that whole bipolar thing, I did end up talking to my doctor and I did end up talking to not one, but TWO psychologists (I was getting a little frustrated with that whole finding the right person process, so I decided to get a little polygamous and improve my odds). After talking to my GP, she seemed utterly convinced that bipolar disorder was a more accurate diagnosis.

I'm not really sure how I feel about this. I think that as someone who works in healthcare, I enjoy labeling things. I find comfort in grouping symptoms together. It was kind of a relief to have a diagnosis that to me, made my life suddenly make a little more sense. I was equally saddened, though. Old MD Girl mentioned in a comment that she thought I knew I was bipolar, but that I didn't bring it up because of the associated stigma. She's right. Depression isn't much of a big deal anymore, but telling someone I'm bipolar?

"Well, I used to think I was just sort of whimsical. Turns out I'm actually seriously nuts."

I dread the day that I encounter another physician (who is treating me) or am filling out some kind of college health form and have to list my medical history. I almost wonder if the stigma is actually worse in healthcare. In the ICU, it seems like the patients with a noted history of mental health issues are always the ones who are suspected of not being credible, of not being compliant, and that they may be trying to manipulate us. I'm not gathering this from any personal experiences I've had with these patients, I'm gathering it from my coworkers attitudes (my generally really kind, not terribly judgmental coworkers).

What's up with that?

Is it just a social norm? I hate to admit it, but I can't deny that I've been uncomfortable around patients who are admitted with psychiatric diagnoses, or that I've sometimes viewed them as somehow less human, as if they were a departing subspecies.

And now, is it reasonable for me to expect everyone to treat me the same way? I really haven't changed; all I've done is let someone slap a new label on me. I really worry that that label is going to follow me around, though. That even when there comes a day when I can come to terms with it and peel it off, there's still going to be all this residue; that even after I go after it with a razor blade and some goo gone, it's still going to be apparent that something was there.

A visit with Death

2011-02-06T16:59:00.012-05:00

The comments from "anonymous" on my previous post prompted me to reread some things that I had written during my first healthcare job, before I had a blog, where I worked as a caregiver in a nursing home. I've been rereading my blog, and realize I do sound a lot less compassionate now than I used to. I can't decide if I'm bothered by this. I really don't think that I lack empathy, and I definitely don't act or think cruelly of towards the patients I work with. I used to wear my heart on my sleeve, though, and that was not sustainable for me. If being extremely compassionate meant that I was too distraught to do my job (or to get completely burnt out in a matter of months), then it also wasn't something that was good for my residents. I think it is extremely important to offer someone whatever kindness you have, to always give a person the benefit of the doubt, but I don't think it's usually practical to experience a person's troubles on a deeply emotional level. It would be an excessively painful existence, I think, to fully immerse oneself in the pain, suffering, and death that inevitably we are exposed to.

Here is something I wrote not too long after starting that first job as a caregiver:

Dr. Schechter stood no taller than five feet, a likely contributor to her height being the pillow of white wispy hair formed into a bun on top of her head. Permanently misplaced dentures lent to her immediately endearing incisor-framed toothless grin. She seemed like the present-day manifestation of the old-fashioned tiny, cackling witch from Hansel and Gretel (the cackling probably due to her asthma).

I used to bring Dr. Schechter a cup of tea and sit on her bed where we would have looping and nebulous philosophical conversations. I left her always feeling that we had spoken about something profound, but being unsure about exactly what it was. A retired Viennese psychotherapist, she was one of the more interesting and magnetic residents, but her loneliness made me sometimes avoid putting away the laundry in her room or bringing up her lunch because I hated to leave her.

She used to walk into the hallway hunched over and confused, thinking that she was reliving her time as a refugee during the holocaust. I would gently take her arm and walk her back to her room, where she would sit on her bed rocking and moaning. I once asked her why she moaned all the time. She told me she liked to listen to it. I never knew Dr. Schechter as the person who she used to be, and maybe for that reason it is not difficult to accept her as she was.

She eventually became so confused and maybe desperate for interaction, that she would smear her excrement onto herself, the walls, and onto the furniture in her room. I would clean her up and comfort her for forty-five minutes or an hour, but it was never really enough; she was never really peaceful when she was by herself.

Aging seems terrifyingly lonely. Sometimes I wonder if it isn't so lucky to live into old age -- to see everyone you love die; to either lose your independence and watch your body decay while you still understand what's going on, or to have your mind deteriorate as you struggle to recognize your own children.

We knew she was dying. When I sat beside her bed on her last night, it seemed out of character to see that charming little old gingerbread witch so silent. I brought her morphine every hour and lorazepam every two. She didn't open her eyes or moan anymore. She couldn't talk or swallow anymore, so I had to crush the pills and mix them with a little water and use a syringe to squirt them into her mouth.

I don't know if she could hear me that night. I read to her from a book of German poetry I found on her bookshelf. When I picked up the book to thumb through it and read her a little, it opened to Der Tod und das Maedchen: a poem that was immediately familiar to me because Schubert famously set it as a lied. The poem is dialogue between a young woman and Death: she begs him not to come for her, but Death tells her to be unafraid, that she will sleep softly in his arms.

I stopped reading after a while and just sat quietly by her. When she stopped breathing, I didn't believe that she was dead. I kept thinking that maybe I saw her chest rise a little bit. I insisted on listening for a heart beat again and again, but could only hear my own body. After the funeral home came to take her body, I went upstairs to her room.

Her bookshelves still held Beethoven symphonies, Mozart operas, Brahms songs: recordings that would have made me like her before I had even met her. I turned on her CD player, wondering what she had listened to last. I was rather proud of myself for staying so calm and composed throughout all of this. But as I bent to make her empty bed and the Strauss waltzes began to play, I realized that all day I had just been maintaing a facade.

One step forward, eight steps back

2011-02-04T22:32:00.011-05:00

I'm becoming perplexed about work.

Remember how I said everything went really well last weekend? Well, it was kind of an exaggeration. I came in the first night; it was great. The second day, for whatever reason, I just couldn't deal with it. About four hours before my shift, I couldn't pull myself together. I was crying and I didn't know how to calm down. I wanted to be dead. I just kept thinking that I'd rather be dead than go to work, and that if I had to drive to work, then I'd drive to meet death instead.

I kept trying to tell myself things that I thought would help: you just have to get through tonight; it's only twelve hours; you'll feel better when you get there; things are going to become less weird at work; we need the money, you need to suck it up a little; you're not going to be stuck doing this for the rest of your life; your patients will be great; you adore the nurses; you made a cake, you need to bring it in and share it. Instead I just cried more. I called in and fell asleep on the couch about ten minutes later. The third night I went back to work; it was like nothing had happened. I was fine again, in a warm and silly mood.

Well, now I'm on my next hump. The other night, I went to work. I waited for things to get more comfortable, but they just didn't. Some nights it would take me about four hours to start to feel comfortable, to stop feeling sad. I kept trying to stay busy. I kept trying not to think too much about anything besides my immediate tasks at hand, but I was just getting more and more worked up. I was cleaning IV pumps and restocking procedure carts and doing finger sticks and my eyes were brimming with tears. I kept trying not to blink so they wouldn't splatter anywhere. I didn't want to do this crying thing again; it was really beginning to annoy me, and also starting to scare me. All I could think was I need to get out of here. I felt like I couldn't talk to a single patient or coworker without losing my composure.

I was recording some vital signs and realized I was going to blow. It was sort of the brief warning someone might get before puking, only this time, it was sobbing. I rushed to the bathroom, locked the door, sat down, head in hands, apathetic about the germy floor. This time I couldn't stop, I really couldn't stop. Thick strings of mucus were dripping onto my scrub top. I didn't care and was too unsettled to move the three feet to reach for toilet paper. I was trying to keep quiet, but one of the nurses must have heard my ragged breathing through the door.

"E."

Muffled crying.

"E, it's Judy. Are you okay."

"Yup." More crying.

"Can I come in?"

I pressed down the handle on the door. It swung open a few inches. Judy came in and sat on the floor across from me. I continued to cry.

"Did something happen?"

"No."

She handed me some toilet paper. Other than my sniffles and honks as I furiously blew my nose, we sat there in silence.

"Is there anything I can do for you?"

"No."

I stood up, patted off my face, washed my hands, and walked back out into the nursing area. I continued to work, silently blinking away tears. I kept telling myself I have to stop this. I'm going to scare patients if I look like this. My coworkers are going to think I'm a nut. I'm never going to get anything done if I can't stop crying. I focused on another task, and by the time I was done, I couldn't hold it in anymore and returned to the bathroom. I cried for about ten more minutes and went back to work. Things seemed no better than before. I still couldn't stop.

After two hours of crying and little improvement, Judy told me I should go home and get some sleep. I left work about four hours before my shift was supposed to end. It was about 3:00a.m. Instead of going home, though, I drove the opposite direction. It was cold and snowy. I was wearing my warm and comforting down winter coat, just like in my fantasy. I watched the snowflakes flying into my windshield and imagined that I was flying away from them. This is just how it was supposed to be. This is the perfect night. My husband won't be expecting me so he won't be worried. There will be no one on the street; no one will see me; no one will try to call the police. I can become splattered on the rocks and I won't have to worry about anyone bringing my body to the hospital.

I drove through town and up the hill, closer to the bridge and the gorge. I sat in my car while my engine idled. I sat and thought about MiniMan and started sobbing violently. And then I thought, you really should be nicer to yourself. This really isn't very nice. You're tired. Go home and go to bed. Get some sleep.

So I turned around. I turned around and drove home, all the while continuing to cry.

* * *

Somehow this turned into a narrative, but still, I really don't know what to do. Sometimes I feel fine and sometimes I feel out of control. The day after that I couldn't hold myself together and called in again. I am becoming so unreliable I'm worried I'm going to get fired from my stupid job. I don't know how to manage these "bouts" any means except sleeping. I'm being honest with my doctor and my psychologist, but I still haven't found any good ways to cope. Everyone keeps telling me that things will improve over time, but I feel like (at least with my job) I'm running out of time.

As I'm getting dressed

2011-02-04T09:51:00.005-05:00

MiniMan comes over, pulls down my underwear and sticks his head against my crotch.

"Hey, get out of there!"

MiniMan continues to burrow his head against me.

"You know you came out of there, right? That's how you got into this world."

"Oh." Big pause. "Sorry, Mama."

Bipolar II? Early onset medstudentitis?

2011-02-02T11:54:00.005-05:00

hypomania hy·po·ma·ni·a (hī'pə-mā'nē-ə, -mān'yə)

n.
A mild form of mania, characterized by hyperactivity and euphoria.

The American Heritage Stedman's Medical Dictionary

I always assumed that if my mental health status had to be summarized by an ICD-9 code, that my diagnosis was major depressive disorder; after all, that's the conclusion that my healthcare providers always came to. Whenever bipolar disorder was considered (or maybe more accurately, bipolar I) it was always dismissed because I never had any kind of full-blown manic episode. I was just a high-functioning person who was depressed. The other night, though, I started reading about bipolar II disorder, which, by the DSM criteria, must include at least one major depressive episode and one episode of hypomania. I'm wondering if maybe bipolar II might be more accurate diagnostic framework to work from. After all, it opens the door to a lot of new medications that might be a hell of a lot more effective for me.

Based on what I've read, hypomania is mainly distinguished from mania by it's lack of psychotic features (hallucinations, delusions, etc.), and that the person experiencing the hypomania often maintains a high or improved level of functioning.

I don't know if I'm just being paranoid, but I started jotting down a list of hypomanic symptoms and personal examples that I could think of:

Decreased need for sleep; increased productivity: a huge chunk of my time as an undergrad consisted of never sleeping and working all the time. Then again, that can be normal, right? It's normal to be motivated and work hard for the things that you want. And it can be normal not to sleep if you're working hard. Then again, here is a post from the fall where at the end I describe my sleep deprived self as being "invincible." I'm also really not sure why I thought I would be able to pull off that insane schedule, other than the fact every time I had tried to stretch my limits in the past, it had worked. I was convinced that everything was just a battle of will.

Risky behavior: for no reason that I can really explain (clearly I knew better), I would repeatedly have unprotected sex (and eventually unintentionally became pregnant); I would regularly participate in an illicit activity that I won't go into detail about right now; I sometimes would spend significant amounts of money on an impulse; I would go joyriding (always alone).

Psychomotor agitation: there are a few things that I find myself doing but that I really have no desire to do: jigging my leg; scratching my scalp, sometimes until it bleeds; chewing on my hair. The hair thing is new, and equally disgusting, I think. I keep catching myself mid-act, stopping myself, and thinking: that's gross -- if I don't stop this I'm going to have to chop all my hair off.

It makes sense that bipolar II was never considered, because for the most part, I've never talked to anyone about this stuff. Why would I want to? It's all kind of odd, gross, stupid, or embarrassing.

A new perspective

2011-01-31T14:09:00.006-05:00

I really don't like to get all mushy in my blog, but take this as your warning: it's going to get mushier.

As you can probably gather, I went back to work and survived to write about it. I can't exactly describe it, but something about my attitude towards patients really changed over the weekend. I finally understood that it wasn't some kind of intellectual insult to help people on a basic level (to get some ginger ale, to help reposition an uncomfortable patient in bed for the tenth time, to give someone a bath). I realized that being a patient in the hospital really sucked (okay, I knew this before, but now had this entirely new level of empathy) and that I wanted to do whatever I could to take care of my patients and ease the misery of being trapped in the ICU. So there, that's my mushy revelation.

Now for the highlights:

-Inventoried and checked expiration dates on one adult crash cart and a Broselow crash cart. It was pretty tedious, but I liked that it familiarized me with supplies and that during a code I would know exactly where to look for something. I had never opened the Broselow before; my reaction was a combination of amazement and concern as I sorted through through teeny tiny ET tubes and their stylets, feeding tubes and Foley catheters. I didn't want to imagine this stuff ever being needed.

-Changed a bag on an FMS (first time). I will probably lose my sparkly enthusiasm for that pretty fast.

-Assisted Dr. Nolan with a central line (first time I had ever worked with him since I came in as a patient). It was a little weird, but okay.

-Saw an episode of torsade de pointes in realtime when a monitor was alarming. The patient was given magnesium sulfate and lived.

Mice

2011-01-31T01:46:00.002-05:00

Sweet little old lady: Could I have one more pillow for over here?

Me: Sure, do you just want some extra padding around the side rail?

Sweet little old lady: I want to keep out the mice.

Me: The mice?

Sweet little old lady: I want to keep them out of my bed.

Me: I can promise you won't have to worry about any mice crawling into your bed in the ICU.

Sweet little old lady: They're already in my butt.

Me: What's that?

Sweet little old lady: The mice -- they're up my butt.

Chicken or the egg?

2011-01-27T15:20:00.006-05:00

People (my husband, bloggers) keep telling me that I need to get in a better place, to get my head sorted out, or something along these lines.

Here's the part that I don't understand, though. I've been grappling with these same issues (depression, suicidal ideation, etc.) since I was a preteen. This is the first time that things have really come to a head and made me feel like my life is falling apart. The thing is, before I overdosed, I wasn't depressed. I wasn't thinking about suicide constantly. Although I was exhausted, I was usually happy.

Do I really need to eliminate stressors? Is that really going to make life better? I feel like it's just the opposite. Stressors are usually what motivate me to be productive. They make me feel useful and provide meaning in my life. I always thrived off of being challenged and being busy.

I only started feeling really content after I started going to Oberlin where I was surrounded by musicians, convinced they were all better than I was, and scared shitless half the time. It was intense, but it gave me a reason to live. I know that having a kid and a family should be a way more important reason to live, and I don't know why I don't feel the same way, but, as Kara mentioned to me, time does move in slow motion when you have a child.

I guess I always thought not that I was depressed, and that working really hard was my coping mechanism, but instead that working hard, being challenged, and learning were what brought meaning into my life and gave me control over my mood.

I just don't get it.

2011-01-26T20:06:00.003-05:00

I signed up for some shifts at work the other day. I'm supposed to work tomorrow night in Friday morning, Friday night into Saturday morning, and Saturday night into Sunday morning. This was usually how I'd try to schedule my overnights: all in a clump. It really doesn't make sense to space them far apart, because then you never get back on a daytime schedule and just become a useless zombie for the rest of the week.

Today I went through a big box of random paperwork that I had stowed in the corner upstairs. I spent half the time crying. Fat stacks of xeroxed opera scores; memos and travel itineraries from the recital series that I used to work for; letters to hospitals requesting to volunteer; notecards with praise from conductors and colleagues, binders and folders crammed with notes, assignments, and papers; my name on old concert posters and in programs. I don't know why I saved so much. I guess I figured maybe I would need it. Maybe the old me would have needed it. I slowly leafed through it all, and put almost everything in a pile to use as kindling for the wood stove. It was sort of devastating to review the things I used to do in my old life, versus everything I don't do now. I miss life as a student. I liked being sheltered from the real world -- from owning a house, from having a frustrating full-time job, from paying property taxes.

I need to go to work but all I can think about is how I'd rather be trapped under the ice on a frozen lake or browsing the aisles of Agway for rat poison. I keep telling myself not to indulge in thinking this way -- I mean, it really isn't me, right? They're just stupid thoughts. I don't really know anymore. Maybe it's exactly the opposite; maybe I'm irrevocably drawn to these patterns of thinking; maybe they define who I am.

Joining the masses

2011-01-24T14:32:00.017-05:00

I saw my doctor this morning and got a note to finally return to work. I told her I needed to work full-time, because our expenses are greatly outnumbering our income. My husband's paycheck covers the mortgage, the electrical bill, and maybe a little gas. That leaves groceries, the phone/DSL, diapers, car insurance, life insurance, health and dental insurance, and more gas for the cars. I recently had to explain to my toddler that he could not watch "Caillou" on Netflix because mommy's credit card is maxed out. Yeah. Not good.

So, I'm going back to work. This is good, right? No more eating rice and beans constantly (for a while, anyway). No more seemingly unending state of financial disaster looming over our heads. I know I need to do it, but when I lay down in bed and think about it I have to stifle the tears insisting their way out of my closed eyelids. I keep telling myself, it's really not that bad. I love the night nurses in the ICU. I love working with patients on vents. I love their complex situations and scrolling lists of comorbidities.

Still, I dread the idea of staying up all night and potentially doing this for years until I finish my pre-reqs. I'm tired of bringing people ginger ale and cleaning up their fecal incontinence. I'm tired of placating disgruntled patients, giving bed baths, and spending hours stocking random supplies in room, after room, after room.

I know. It really doesn't sound that bad. I'm sure tons of people aren't happy with their careers. Still, it's driving me apeshit. I hate that I can practically feel my brain start to atrophy when I go to work. I want to do something that isn't just a check mark on a list.

I don't know if I have ever written about my sequence of events after Oberlin, but during my last year there, I applied to masters programs in opera and post-bac pre-med programs. I got into both and ultimately decided to give up the singing to pursue medicine. I was supposed to start my post-bac program in the fall of 2007, but was terrified by the interest on the loans (by the time I finished med school, the interest would have quadrupled the cost of my post-bac program). My parents urged me to stay home and save some money, and this seemed like a reasonable idea to me, so I deferred from the program until the next year, lived at home with my parents, got a job as a caregiver at a nearby nursing home, and stowed away my earnings like a chipmunk.

Meanwhile, I'd been fooling around with this nurse at work. He was nice, real easygoing -- not really my type (loose definition of my type: bookish socially inept Caltech students who could ALWAYS help me with my calculus problem sets), but interesting. He had really amazing taste in music, but it was none of the stuff I normally listened to. Still, he was really not my type. He had a huge tattoo covering his entire back and he liked to wear camouflage pants on his days off. He was devilishly intelligent but had a complete disregard for the educational system and had dropped out of highschool as a teenager. He was really rustic. He lived in a cabin in the woods, he had a huge dog, and he used to have his own sawmill before he became a nurse. He wasn't my type, but he was hot and magnetic.

Historically, I had always put my education before guys. I highly valued my independence. I had convinced myself that I was my own star leading my way; that I was content with myself and my academic pursuits; that I didn't need a boyfriend or a husband to find happiness, and that I would never be blinded by love (or lust) and let a guy screw up my plans -- I had worked too hard for that.

So, what did I do? You guessed it. I became hopelessly enamored with this rustic man-nurse and let him screw up my plans. Idiot. Idiot. Idiot. Still, I don't really regret that part (most days, anyway). Then I got knocked up. When I found out, the idea was so ridiculous that I laughed. Me? Kids? What? I didn't like children; I didn't think they were cute; I'd never even babysat a kid.

I had always thought maybe I would have kids, but not until I was around forty or fifty...or sixty. Maybe I'd adopt. Pregnancy and childbirth seemed sort of overrated. I always thought that if for any reason I needed an abortion, that it would not be a difficult decision to make. Things were becoming complex, though. I had been working at this nursing home eighty hours a week wiping butts and playing scrabble, I was emotionally exhausted and confused about my interest in healthcare, and had all these weird pregnancy hormones surging through my body. I was depressed and was worried that if I aborted this little dude we had been calling "Cletus the Fetus," that I would crawl into a hole and never come out. My rustic-man nurse was about fifteen years older than me and ready to have a family. I knew he'd be an awesome dad. He was totally willing to play stay-at-home dad while I went to school. In some ways, it was like I had found the perfect guy. And so, even though kids have sticky fingers and dirty diapers and boogers and destroy everything, the idea of one seemed kind of happy. This is how I became a mother.

When I told my parents, the shame was pretty much equivalent to getting pregnant at age 12 by some five foot tall eighth-grader with a gameboy. My dad banished me from the family for three years.

I got over it and started taking my post-bac classes one at a time while working full-time as an EKG tech. The day that MiniMan was born, I went to work and I went to a class afterwards and took an exam. I was having contractions but just wanted to get the exam over with. I had studied well and I didn't want to have to study for it again (especially with a newborn). By the time I got home it was pretty much time to turn around and go back to the hospital. MiniMan was born about an hour and a half later. All the nurses said "if it were that easy for me, I'd have another one." All I knew was that it felt like squeezing a TV out of my nostril.

Things were okay at the hospital, but then I came home. I realized this crying, pooping, never sleeping torture device had taken over my life. I knew it would be bad, but it was worse. "What was I thinking," I asked a few days after he was born, bawling hysterically to my midwife. "I've given up my entire life." Somehow she was able to console me, and things did gradually get easier. Still, the snaillike pace of my coursework was driving me up the wall.

About a year later, I started applying to programs again. I applied to post-bac programs and for second bachelor's degrees. I looked into taking courses "a la carte" and just taking what I needed. I seemed to have researched every school within a 2-hour radius and how much it would cost. I got into a wad of programs. I could have done a post-bac program again and I could have gotten another degree with a full scholarship. I opted to take my courses at the big state school as a non-matriculated student. It seemed like the most practical use of my time (I wouldn't have to take two years worth of extra courses to fulfill a degree requirement), and it was still one of the less expensive options.

Anyway, you get the point. Then I went to school and went to work, and went back to school, and never slept and eventually flipped out. I guess my point is, I feel like I've been putting off the remainder of my post-bac courses forever. I'm becoming so impatient with and practically intolerant of my menial job (which pays less than half what I made singing with opera companies). I chose to be in this situation, but I never anticipated that this period would last so long.

I think I just need to suck it up, but really, I need to have some kind of end in sight. I have a really hard time dealing with the idea of being a hospital aide for the next five years. I'm not planning to take classes again until next fall. If I work and take one class at a time, though, it would take four years for me to finish these. It really horrifies me. I don't know what to do.

Picking up the pieces

2011-01-22T20:48:00.008-05:00

I've been on short-term disability for four months now. It's strange to consider myself "disabled." More and more, people are uncovering the neuroscience behind mental illness, but I can't help but wonder if this whole mess is just the manifestation of my flawed character.

I'm finally starting to feel okay again. I still have really off-days, but for the most part, I feel more like myself. I've been hanging close to home, mostly to avoid spending money (on groceries, on gas, at coffee and bookshops -- you get the point). I initially felt weird about taking the disability money, but honestly, I'd be so screwed if I didn't. I have no idea how I'd pay for my health insurance. After deductions I end up getting $54.00/week. My husband and I have started doing some seriously frugal living. I now shop almost exclusively at Aldi (although still have a huge weakness for the big bags of organic lemons at our co-op).

Lately our diet has been lots of variations on rice and beans (chickpea masala, moong dal, a north Indian style chili with kidney beans). Yay for soluble fiber! I've mostly stopped buying bread and instead bake our bread. Most of it is from this no-knead cookbook that I am really into (Kneadlessly Simple, by Nancy Baggett). Here's a ciabatta I made the other day:

I've been raiding my stores of slightly shriveled produce and the freezer, and canning a lot (at least for me): blueberry lemon jam, cranberry jam, orange marmalade, applesauce (just apples), and applesauce with crystallized ginger. I am not sure what is up with my jam binge, other than the fact that the other day I went to the store and wanted to buy jam, but did not have enough money. NOW I HAVE JAM. Lots of jam. I will eat it on my bread, and let my toddler smear it on his face, and on the table, and on the windows, and on the dog...

As if this level of cooking tedium were not enough, I decided to venture into the land of craftiness and whip up some homemade play-doh for MiniMan. He has really enjoyed creating little sculptures in the snow, but seemed uh, pretty unimpressed by the homemade play-doh. In the process, though, I found this tutorial on the same website for making lampshades out of parallelograms with little hooks at each corner. This required one template, and then cutting out and assembling what seemed like a gagillion pieces of paper with little hookies (which was oddly soothing). However, now I have this kind of cool lamp thingie:

I was e-mailing my mom and sent her some photos of MiniMan, and some of the lamp. My parents called me a few hours later, and my dad told me (in regards to said lamp) something along the lines of "you're so creative and talented, I hope that you actually apply it to something someday." Uhh. All I could do was laugh.

In the snow

2011-01-12T14:45:00.004-05:00

My totally awesome mother-in-law got us really, really fun Christmas presents this year: snowshoes for me, my husband, and MiniMan.

I had never been snowshoeing before and had always imagined the circumstances for snowshoeing something along the lines of being buried in rural northern Canada under three feet of snow and walking around with tennis rackets on your feet. I guess they still sell the traditional woven kind, but snowshoes seem to have become way more hardcore.

I had no idea how easy they are to walk in, or that a lot of models now have crampons on their undersides to give you traction in icy conditions (see photo, above, of my new snowshoes). Our snowshoes were easy to put on (they have bindings that you adjust around your everyday boots or shoes), and MiniMan did really well. I was a little skeptical about a two-year old traversing around in snowshoes, but he actually walked about a half a mile during his first time out. He was insanely excited and completely into it.

This morning, I was reading some stuff online and it turns out that some companies have developed snowshoes with spring-loaded suspension systems so that a person can actually go running in them. It seems like the perfect winter solution for any kind of trail runner. Our property borders public state land and I love to run on the dirt roads and trails, but in the winter, I'm pretty deterred because of the risk of falling on a patch of ice and taking out an ankle. Heading out on a trail to run in snowshoes instead of braving a road covered in slush seems fantastic, though.

Ridiculous

2011-01-03T20:22:00.011-05:00

"Mama, my turn."

2011-01-03T08:52:00.006-05:00

My two-year old climbs into my lap and squeezes himself between me and my laptop. He closes my computer and tries to walk away with it.

"Mama, share. Mama, share it."

My MacBook has patiently tolerated a considerable amount of toddler strife. It's been dropped on the floor; thrown on the floor; sat on; stepped on; colored on (both crayon and sharpie, to my horror); taken baths in milk, coffee, and tea; and had plenty of CDs and DVDs shoved in its disc drive, which is currently jammed because it has two CDs stuck in the space for one.

Now, maybe you're reading this, haven't had a child/children, and are thinking to yourself, well, if I had a kid, he probably wouldn't that. This kid sounds kind of like a terror. It's probably best to continue deluding yourself.

So, as you can probably gather, MiniMan is really curious about my laptop, although right now he uses it almost exclusively to stream Netflix. He likes to watch Dinosaur Train, along with some other kids shows. We don't have a TV hookup or cable, and it's okay with me if he uses the computer to watch TV sometimes. My husband calls it a lobotomy in a box, but this lobotomy has provided some much needed sanity for both of us.

I also currently share my laptop with my husband (who, when I met him, professed to be so technologically disinclined that he did not want to have high speed internet, wireless, or use a computer more than rarely). Let's just say this has changed.

I'm starting to think maybe it's time to introduce a new electronic member to the family. Should I start seeking something new, but cheap for the boys? Would a PC be more durable? Should I get a refurbished Mac? Should I wait a while and save for a new MacBook, keep it for myself, and let them inherit the damaged goods?

Visiting the nursing home

2011-01-02T22:16:00.014-05:00

I walk in with MiniMan, past plastic-coated couches, fake flowers and a large faded fish tank housing one lonely fish. MiniMan runs down the hall immune to the poor décor, eager to push the elevator button. He gives it a push as I wonder what kind of bacteria live on that button, and we walk inside the dingy elevator with its flickering fluorescent lights and chipping pale green paint.

The doors reluctantly open. The scent of urine permeates the stale air. MiniMan grabs my hand as we walk past a middle-aged woman slumped in a wheelchair and a tiny grey-haired woman holding a baby doll, her arms outstretched to us. I find my husband down the hall standing in front of what looks like a giant filing cabinet, unlocking drawers and popping pills out of plastic and foil. My husband works as a nurse at one of the largest nursing homes in the area.

I could never understand why he continued to work there. I always described it to friends and coworkers as “a shit hole,” because that was really my honest impression. In his unit (which houses about 60 patients) staffing ratios are disturbing:

-3 to 4 aides to do daily care, toilet, transport and/or help feed patients

-1 nurse to do the med pass

-1 nurse to do treatments

As someone who has worked in a nursing home as a caregiver, I couldn't even imagine bathing twenty people in an eight-hour shift. Probably the reason I couldn't imagine it was because it doesn't happen. Same with some of the medications. Oh, you're supposed to get eye drops? Definitely don't have any time for that. And this is just when things are going according to plan, not when Mr. Schneider wipes out in the hallway and is lying in a huge puddle of blood. The staff who work there are placed in hopeless situations. No matter how much they want to take care of everyone, it's almost impossible to do.

I sometimes ask my husband why he keeps working there. It doesn't seem like an enjoyable place to work, it doesn't pay especially well, and the staff never have their needs met, even on a basic level (like supplying pens, having a sterilization system for bandage scissors, etc.) My husband's reply is one of the reasons I love him. He tells me that he enjoys being around the residents, and that if someone needs to do this job, it might as well be someone who actually cares. I think he sort of sees it as his contribution to society, and admittedly, it's a noble cause. I still don't know how he does it, though; I don't think I could work there more than a week without ripping my hair out.

Probably one of the most nauseating aspects of being stuck in a nursing home is the bill. I am sure there must be some kind of at least slightly logical breakdown to explain where the money goes, but seriously, how can it cost $7,000/month to be trapped in a small room in a poorly maintained moldy building and receive suboptimal nutritional and medical care? Something seems really, really wrong with this picture. I think it might be cheaper to live on a cruise ship. The customer service is probably a lot better, too.

When there are residents literally dying of heat stroke during the summer in a poorly ventilated building, it makes me wonder why this local nursing home has no air conditioning, but the local prison has central air, free medical treatment, and probably better lunch. It is so sad and also really angering to see people wiping out their savings in a matter of months or years to live in, well, a shit hole.

Podunk Living

2010-12-30T12:19:00.010-05:00

It dawned on me today that we are really doing some backcountry living. This year, we have been heating our house entirely with wood. We have one monstrous wood stove and a chimney running straight through the middle of the cabin. Last year we bought a few cords of wood, but this year (at least in regard to heating) we've been living off the land. My husband selectively thins out trees on our 40 acre property, cuts and splits them to size, and lets them dry for firewood. We drive into the woods with an old pickup truck and bring the wood back to our house, where it sits in a long winding stack between the trees.

I went outside today to bring some wood into the house. The sunlight against the snow was a visual assault. After a few minutes, though, it became a welcome change to stand alone baking in the sun, surrounded by slowly melting snow.

I don't know when the switch flipped -- when this comparatively rural lifestyle stopped seeming foreign and became instinctive. Driving on dirt roads has become commonplace. Threadbare barns and towering oceans of corn have lost their novelty (although continue to charm me). A backyard dotted with bear scat, mystical-looking white goats emerging from a neighbor's tree line, and the occasional escaped holstein in the middle of the road are no longer totally crazy scenes.

A suitcase crammed with at least a dozen pairs of high heels now collects dust in a corner upstairs. I'm a serious klutz, and it took at least a year to master walking across the brick sidewalks in Oberlin. I don't wear them anymore, even at the very rare formal event. I can't even imagine tolerating heels again; I think I would have to relearn how to walk in them. I've traded pumps for galoshes, dresses for flannel-lined jeans, and delicate sweaters for free Molson Canadian t-shirts that came in 12-packs of beer.

Getting by

2010-12-28T19:37:00.003-05:00

I've re-read my previous posts, and to say I feel sheepish would be the understatement of the year. I can't really explain what was going on. Even when I was feeling at my worst, I understood that my life was not that bad; that my med school plans were salvageable; that MiniMan needed a mom, and my husband, his wife. Even though I could grasp those ideas, everything still seemed hopeless. I knew that my reaction wasn't rational, but it was completely overwhelming.

Not long after writing those posts, I ended up talking to my doctor (even though I was terrified that she would involuntarily hospitalize me). She didn't. We both agreed that it would make me feel worse. I agreed not to do anything until the next time I saw her. For a while I was seeing her practically every day. I don't know why she was willing to invest so much attention in me (it definitely would have been easier to send me off to the hospital), but I'm grateful for it.

Winter

2010-12-13T10:30:00.007-05:00

I've been living life in my not-so-favorite style, which (although it sounds cliche) is just trying to get through one day at a time. I don't know why it's so difficult. I really don't have any responsibilities other than keeping up with laundry, hanging out with MiniMan, cooking, and cleaning. Wow. I completely sound like a domestic housewife. It's funny how all of a sudden I'm living this life that I never could have even imagined for myself.

Last night my husband asked me what class I wanted to take this spring. I had originally planned to take some kind of science elective just to keep me engaged, since I'm pretty sure that the classes I want to take are not being offered out of the regular sequence (i.e. take ChemI in the spring, and ChemII in the fall). My reply instead was, "I don't really want to take anything." I wonder if I'll feel differently later. I hope so. Right now I can't even imagine leaving the house to buy groceries.

Instead, I've been planning. I set a deadline of being dead by the winter solstice. Part of me knows this is completely ridiculous and that I should just let it go, that it's disturbing, that of course I shouldn't do it, but the rest of me tells me that I have things to do: make sure that the Christmas presents are wrapped; that letters are written (I don't know how I'll ever explain my goodbye without being a completely hurtful and selfish asshole -- then again, it won't really matter, I'll be dead!); that I take most of my clothes to the Good Will; that bills are paid; that I make sure not to jump with my husband's engagement ring on (it was his grandmother's). I figure that if he gets married again, he should be able to have it without associating it with my shattered body.

I researched the bridge I chose. Apparently the university near me recently constructed some kind of net underneath the bridge, so now I have to navigate that, too. I think it's only enough to deter a drunk person from being impulsive, though, not someone who is really determined to die.

Just recently I started to feel guilty about destroying a perfectly healthy body when there are so many people who need organs. Maybe jumping is wrong. We had a student in her early twenties in the ICU who hung herself from a tree with a dog leash. Her family kept her on the vent long enough to donate her organs. Seems straightforward enough, but the timing would be kind of a crapshoot to coordinate. I hate the idea of my husband finding me in a tree, though, and I hate the idea of him seeing me brain dead in the hospital. The girl I took care of -- she looked terrible. Her entire head was swollen; her eyelids bulged out from her head like a frog's.

scratching the itch

2010-12-11T09:41:00.005-05:00

a calm drive

full of silent streets

and warm memories

soft blonde curls

my two-year old's maniacal grins and

uncontrolled giggles--

the huge hands of

my tickling husband

I keep driving

into my childhood neighborhood past

Christmas trees glowing though

living room windows

I park on the road near

the trails where

I used to run

and the bridge that overlooks

the gorge our small city has become

so famous for

under the street lamps

nestled in my long down coat

I savor this instant of comfort

I take

one great step

to tiptoe on the balance beam

before the lights of the town below me

all it takes is

a trusting collapse

to fall though the air

I gaze straight ahead

at the stars

a cold blast of air on my back

as I watch the snowflakes float

up into the sky

So this is my life

2010-12-10T13:37:00.005-05:00

After my night of flipping out at work, I later saw my family doctor (she goes by Molly) who suggested I take two weeks off. One morning, I came to her office with MiniMan to pick up paperwork. I sat in her waiting room while MiniMan played with toys. I couldn't stop silently crying.

One of the nurses pulled me into an exam room. She told me that Molly wanted to talk for a minute. I curled up on the floor in the corner. The office staff started playing with MiniMan. When Molly came in, I don't remember what she told me. All I remember is being in the corner of an exam room, crying all day while she checked in on me between patients, until she called my husband at work who picked me up later that afternoon.

I don't know why Molly let me stay. She told me a story about having a breakdown in the NICU during residency and crying relentlessly in a corner.

It's hard to write about this. It's difficult to describe what was going on, because I don't even remember what I was thinking. This psych stuff is especially frustrating because it was my choice to sit on the floor and cry all day. I don't know why I felt like I couldn't do anything else.

Since then, things haven't been great. I nearly got readmitted as an inpatient again, but instead stayed at home. My husband took family medical leave from work and took care of me while Molly quickly increased my dosages of antidepressants. I stopped going to work. I stopped taking classes.

I didn't feel like doing anything, but I would go for a run most mornings, cook quite a bit, hang out with MiniMan, force myself to get dressed. I was going through the motions, but I wasn't feeling significantly better. I was obsessively pondering my suicide, whether I felt sad or even when I felt mostly fine.

I don't know how my life went from looking so bright to becoming a wasteland so quickly. I went back to work last weekend. The night nurses were so nice. They brought in celebratory food and everything was really thoughtful.. but when I had to go back a few days later I just couldn't do it. Every time I drive to work I have a panic attack in my car. I never used to have panic attacks. I've gone from being driven and capable to being this unstable, totally useless person.

Just give up

2010-12-09T13:57:00.002-05:00

The next day, I decided to drop chemistry, too. I wasn't prepared for my lab. If I wasn't going to get near-perfect grades, it seemed like maybe it just wasn't worth bothering right now. Everything felt like an uphill battle at my big state school. My professors didn't appear to care about anything (other than their workload and trying to avoid contact with students). I felt completely isolated in all of my classes. I wasn't having fun. I gave up.

I drove back to my big state school one more time to fill out more forms, to pick up MiniMan's things from daycare, to attempt to tie up all the loose ends. MiniMan was beside himself about leaving daycare. I remember when I first started going he would cry when I left him in the morning to go to classes. That day, he instead cried when he couldn't stay. He still talks about his friends from daycare practically three months later. I feel guilty taking all that away from him, knowing he'll probably never see them again.

After I stopped going to classes, I felt even worse. I was able to get a lot more sleep, but half the time I would spend the greater part of the day curled up on the couch, crying, while MiniMan watched TV. My husband would come home from work and MiniMan would walk over to him and say "Mama sad." The first emotion he had learned was sad.

Since I'd been a teenager, I had always had issues with depression. Some years were more difficult than others, but I was always functional. I hadn't taken antidepressants for years until just recently. Things had been okay. I thought I knew how to keep my emotions under control. I thought I knew how to kick myself in the butt when I needed it, and get myself out of a funk.

This time I couldn't do it. I don't know exactly why. I stopped showering. I stopped eating. I wore my PJs all day long. The only thing I could muster up the motivation to do was feed MiniMan and change his diapers.

I fantasized about my death constantly. It just seemed like such a relief to turn off the switch. I imagined death as a comforting void. Black, silent, empty. Nothing to worry about, nothing to be happy about: no more thinking. Would I jump off a bridge? Poison myself with carbon monoxide? Slit my wrists? I have a weird anomaly: a superficial artery on my hand that I had always thought would be interesting to slice. But I don't have a bathtub, I thought. Do you need a bathtub? Does that interfere with clotting? I needed to research this... I definitely wouldn't be overdosing again -- what if someone found me, took me back to the hospital again? Should I get in a terrible car accident? No, seemed like too high a chance of just getting maimed and not dying. But I had a good life insurance policy. Maybe I could make it look like an accident, not a suicide.

In the end, the bridge seemed like the best option. Plus, it would be almost like sky diving. I wondered if I'd change my mind during free fall.

Somehow it became December

2010-12-08T22:25:00.007-05:00

I expected that I would have blogged more by now, but I never felt like writing. I still don't really feel like writing now, but somehow I persuaded myself to start typing.

I don't know where to start. It seems like so much has happened over the past few months yet I spend my days doing nothing at all, just wasting time, rotting.

As for the rest of the story, well... On a Friday, after two nights that seemed like an eternity, I left the hospital. My husband forgot to bring my shoes so I walked out in beige hospital socks, carrying my clothes in a brown paper bag. I prayed no one I knew would pass me in the hallway.

I took the weekend off, and then went back to classes on Monday. I decided to drop physics, because it seemed like between the lack of sleep and the hours spent commuting and the full-time job, there just weren't enough hours in the day (or night) to get everything done.

It took most of the morning just to drop physics. I was trekking all over campus from one end to the other to get my list of signatures that had to sign off on me dropping the class: first the grad school, then my professor, then the grad school again, then student accounts (not only would I not get any tuition refunded, I had to pay a fee to drop it (talk about adding insult to injury!), then the registrar...etc.

I had a problem set to finish for my chem class, a lab report to turn in, and the prelab for the next lab which was the next morning. I thought I would be able to get on top of things, but by late afternoon, I had only finished the problem set and my lab report. I was having chills and wondered if I was feverish again. I had a note from the hospital explaining that I was "ill" and excusing me from the lectures that I missed (both classes used iclickers for attendance monitoring, ugh). I decided to see if it was possible to get an extension: I had to pick up MiniMan from daycare to then drive home and work an overnight that night. There was just no way to get everything done by the next morning, and on top of being overwhelmed, I felt like shit.

I tried to contact the professor for my chem class, but I realized that he didn't list his e-mail or his office location in the syllabus (and also didn't offer office hours). I went to the chem help lab (run by TAs), but there were about twenty students in there and one TA milling around answering questions. I waited about half an hour, and then finally one of the TAs suggested that I contact a different professor who oversaw all the chem labs. When I finally talked to her, she said that it wouldn't be possible to have any kind of extension because it wouldn't be fair to the other students. I was fucking amazed.

I walked out, made it to my car, closed the door, and cried. I picked up MiniMan from daycare and we drove home. We made it home, and then I got dressed to go to the hospital and started driving to work. I felt nauseated. I started sweating in my car, crying the closer I got to the hospital. Part of me knew it was ridiculous to be consumed by dread, but it was hard to ignore such a visceral reaction. I made it work, pulled myself together, walked inside. My unit was so good about maintaining confidentiality, almost none of my coworkers knew that I had been admitted just a few days ago.

I muttered a few brief hellos and sequestered myself to the med room to stock supplies. I ripped open boxes and filled drawers with syringes; I just couldn't deal with patients. If a call bell went off, I would ignore it. I had never done that before. I just felt like I couldn't go into a room again, like I wasn't strong enough to take care of someone, to converse and be cheery. I looked out the med room window into the ICU room where I had stayed. Everything was still so raw. I faced the wall and unpacked bags of saline and silently started crying again.

Forty-five minutes later my charge nurse discovered me and sent me home. I drove home in the dark, trying to decide if it made more sense to drive home or to drive into a tree.

My life exploded (Part IV).

2010-11-01T15:01:00.008-04:00

Day 3

The night was mostly uneventful. It consisted of me waking up, feeling like crap, walking over to the nursing station, taking more Tylenol, going back to sleep, waking up feeling bad again, tossing and turning, putting my sheets back on, etc.

By the time it's morning, I no longer feel like sleeping so much and decide to acknowledge the pile of papers that I had been given upon arrival to the unit. I sift through them: some kind of form about being involuntarily committed to the mental health unit; a big packet full of information about their adult recovery program. I'm expected to participate in group sessions; shower, come to meals, keep my room clean, make my bed, wash my clothes. Visitors are allowed once a day. I may be granted to go outside if I obtain a special pass from my psychiatrist. The list went on..

7:30a.m.

I decide to take a shower and wash my hair. Bathing, that's compliant patient behavior, right? I scrub my torso until my skin becomes raw; it's impossible to get the adhesive off from the series of electrodes that I had worn. I towel off, put on the one remaining pair of clean underwear that I have, and finish getting dressed. I have no hairbrush, but eventually manage to get the flimspy hospital comb through my thick, knotted hair. I braid my wet hair. I make my bed. I sit down on my bed and read the one book I have with me: My Stroke of Insight.

8:00a.m.

One of the psych techs knocks on my door.

"I just wanted to let you know that you can get breakfast down the hall." She said.

I look up. It's Megan, one of the people I had oriented with when I first started working at the hospital. We had gone to high school together. Her expression changes when she realizes I'm me.

"Oh..man. Umm....I'm really sorry to see you here. What happened?"

"I overdosed."

There was an awkward silence.

"Well, I know this is kind of weird," she said "but let me know if you need anything."

I nod. She walks away.

8:05

I'm not hungry. I don't want to get breakfast. I don't want to sit with other people. I do want to get out of here, though, so I walk out into the hallway. I look at the other psych patients sitting around the table eating, and tell myself that I'm just an observer, I'm just a journalist doing an expose. I'm not like everyone else. This is the only way I know how to get through things.

I walk into the eating area and pour myself a cup of coffee. I take a piece of fruit.

"Do you want a bagel?" Asks one of the nurses.

"Okay."

"What kind?"

"Wheat."

"Do you want it toasted?"

"Um, okay." I reply.

She hands it back to me a few minutes later. I'm not allowed to use the toaster. I guess it would be too easy to strangle myself with the electric cord, or stick my hair in the toast slots and light myself on fire. I sit down across from an overweight, bearded man in his fifties who has a huge plate of eggs with American cheese melted on top and is incoherently talking to himself. I spread some cream cheese on my bagel with a plastic spoon. I open my book so I don't have to talk to anyone. I take a few bites of my apple.

At the other end of the table a (most likely) transgendered person who appears to identify as female sits and eats some bacon while talking to a young, withdrawn Latino girl next to her. It seems like both of them have been here for a while, they seem at ease around each other. The transgendered girl is dressed in a hot pink tube dress with black leggings. She looks like she isn't more than twenty. She twirls her shoulder-length brown hair and continues to chat.

I take a bite of my bagel, and then pick up the remnants of my lunch and throw them in the garbage. I walk back to my room in my slipper socks. I still have no shoes.

8:20a.m.

I look at the schedule posted outside my door: community meeting at 8:30, group therapy (DBT - Dialectical Behavioral Therapy) at 9:00. One of the nurses comes up behind me with a paper cup of water and some pills.

"Are you E?" He asked.

"Yes."

"Here's your Celexa and some more Tylenol, if you feel like you still need it."

I take the pills and go to my room.

The minutes tick by. Finally, it is about 8:30. I walk out into the lounge to attend the "community meeting." A lot of people are already sitting down, so I quickly grab a spot on a love seat next to a grey-haired woman who looks nervous and exhausted, but comparatively benign. Patients continue to filter in, and finally one of the nurses begins to speak.

"Hi everybody," she said cheerfully. "I'm Michelle, one of the nurses, and this is the community meeting. First off, I have a couple announcements. Our washing machine and dryer are currently broken, but if you are having a laundry emergency, then let me know, and we'll figure something out. If it's not an emergency, please wait, we should have it fixed in the next day or so..." She continued on about meetings during the day, the procedure for getting a "pass" to go outside (where to everyone's dismay, is a no-smoking area). "Now I'd like all of you to tell us your name and one goal that you'd like to accomplish today. E, let's start with you."

I force a smile and hear myself saying, "Hi, I'm E, and I'd like to become familiar with the routine on this unit." At least that's over.

I listen to the other peoples' goals:

"I'd like to color, today. And I'd like to see the male psychiatrist, not the female one. Do I have to see the female one?" The girl in the hot pink tube dress asked.

"I'd like to see my family," a young guy with a cane said.

"I'd like to change my sheets," someone else said.

9:00a.m.

Finally, the meeting comes to a close, and now it is time to go to DBT. I walk into the meeting room. A chipper recreational therapist comes into the room and tells us that the person who normally does the DBT won't be leading it, and that she's going to lead today's session. She starts to launch a conversation and asks each person to "name on thing that you are proud of that has happened in the last week." Here we go again.

"I was proud that my brother came to visit me."

"I was proud that I got to go outside."

"That I'm feeling better. I'm really proud of that."

"I was proud that I called my friend."

"I was proud that I got a perfect score on my chem exam." I say quietly. I hate this kind of stuff. I seriously hate this stuff.

The conversation takes a turn and then the recreational therapist asks us to talk about recreation and how mental illness has effected that.

"Well, I used to go roller skating a lot, but then I got a really bad spider bite and now I can't go at all and now I'm really fat."

"I used to make a lot of jewelry, but now I'm too depressed to get out of bed or even watch TV, so now I don't do that anymore."

Dr. Martin pokes his head in and asks me to exit with him. I never thought I would be glad to see him again, but at that moment, getting stuck with him seemed like the lesser of two evils.

9:45a.m.

Dr. Martin walks me out into the hallway.

"Can we talk for a while?" he asks.

"Sure," I say. We sit down in two chairs in the corner.

"So, how are you doing..?"

"I'm fine. How are you?"

"Great, thanks. And how are things going on the unit," he asks.

"I don't know what you want me to tell you. I don't feel like this is helpful for me, but if you would like me to stay, I will cooperate with your routine and do whatever you would like so that I can get out of here as quickly as possible," I reply.

He nods. "So you would like to go home."

"Yes."

He rubs his chin. "Do you still feel like harming yourself?"

"No."

"Any suicidal plans?"

"No."

"I'd like you agree to follow up with someone on an outpatient basis."

"Okay."

Eventually Dr. Martin agrees to let me go home, and not long after my husband arrives. I chat with my husband for a few minutes.

"We'll have to be careful around MiniMan with the MRSA." He says.

"What MRSA?" I reply.

"When they ran the cultures on your finger it was positive for MRSA."

"Dr. Nolan told me it was just plain old staph..."

"I don't think the cultures were back that early." My husband replies.

I get a sinking feeling in my stomach. Had I not washed my hands well-enough? Had I gotten this at the hospital (where I work closely with patients who have MRSA all the time); had I gotten it at the grocery the grocery store; had my husband brought it home from the nursing home where he works? I felt guilty, and so hugely screwed by healthcare. I take care of all these people who are sick and sometimes dying, and this is what I get, MRSA?

When I used to work in the hospital there were always clear boundaries that separated me from patients. I know that must sound strange or maybe insensitive, but I think it was one of the ways that I compartmentalized; patients were like a subspecies. My patients might have MRSA or VRE or some other form of nasty resistant bacteria, but I didn't; they were sick, but I was healthy; one patient was on a forty-eight hour psych hold, but I was stable; my patients wore hospital gowns, but I wore scrubs. I was finally forced to realize we weren't so different. It disturbed me.

My life exploded (Part III).

2010-10-26T16:55:00.003-04:00

Day 2

7:15a.m.

"E, I need you to wake up." I look up and Dr. Nolan is standing over my bed in green OR scrubs. "Did anyone from behavioral health come to evaluate you last night?"

"No." I reply.

"How are you feeling?"

"Okay."

"Do you still feel like hurting yourself?"

"No."

"Okay. Well, I think Dr. Martin, one of the psychiatrists, will be over soon for a consult later this morning. After that we'll go from there."

7:45a.m.

New nurse, Sarah. She comes in and explains that Dr. Nolan wants to run an IV antibiotic for the infection. I talk to her for a few minutes as she sets up the antibiotic, and then she leaves. I lay in bed for a minute, and then glance at the IV tubing hanging from the pump and realize that it was never connected to me and is creating a puddle on the floor. I laugh. I guess if anyone has shock-value and could distract a good nurse, it would be me.

Sarah walks back in sheepishly, and examines the bag which is now totally empty. A while later, a second bag arrives from pharmacy and she hangs a new bag of antibiotics.

I go back to sleep. I don't remember if I was tired by this point or if I just didn't want to deal with being awake.

11:30a.m.

I wake up to MiniMan and my husband standing in the doorway. MiniMan is scared. I didn't expect him to be. He's been to the ICU many, many times. He knows most of the nurses, who adore him and his curly blond hair. He knows where we keep the graham crackers and who will give him toys and stickers. I guess he knew something wasn't right when he saw me in bed instead of walking around, wearing scrubs.

I ask my husband to bring him over, let him sit in the bed, but MiniMan shakes his head and clings to my husband tightly. He starts to cry. He doesn't want anything to do with me.

"Has the psychiatrist come yet?" My husband asks.

"No."

"I talked to your nurse on the phone two hours ago and she told me he was on his way over."

"I don't know.. I haven't seen him, maybe something came up. I'm sure I'm not a very emergent patient."

My husband explains that he has to go, that he has to drop MiniMan off with his mom, that he would be back. I hug him, pull the covers up around my neck, and fall back asleep.

12:15p.m.

Dr. Martin knocks on the glass door.

"Hi, I'm Dr. Martin. I'm one of the psychiatrists."

"I know." I remember seeing you at the hospital coffee stand flirting with nurses and telling them that all women should really take the time to treat themselves to a facial more often. Probably not all women, however, have your salary.

"So.. can you tell me what happened?"

I sit up and try not to act upset. "I had been taking some classes at the big state university: physics and chemistry to complete my premedical prereqs. I was also working full time doing overnights here as an aide. It ended up being kind of tough because a lot of nights I just didn't get to sleep. I'd go to school all day and then work all night and go back to school. I recently learned from my physics professor that we were going to have three exams over the course of the semester (not finals) that were going to be at 9:00 p.m. on Monday nights (this wasn't in his syllabus). I had e-mailed the professor telling him that I had a conflict, that it would be insane for me to take my two-year old son to daycare there, then drive him home when the daycare ends at five, and then turn around and drive back to school (1.5 hours each way) and then drive home again. My only other option would be to hire a babysitter on campus (or nearby) to watch him until ten, who would have to put him to bed, and then I'd have to wake him up, put him in the car, and then wake him up and put him to bed again. This just didn't seem fair to my son.. Anyway, my professor e-mailed me back and told me that he was sorry, but that he couldn't help me and that it would be impossible for them to proctor three exams for me, that I'd have to figure out a way to make it work... When I got the e-mail I just sort of lost it. It was early in the morning, I was getting ready to go to class. I was so upset I just got back into bed and cried. My husband couldn't figure out what was wrong, he couldn't calm me down. I told him that I just wanted to sleep and he forced me to get up and I couldn't calm down so I took a lorazepam that my GP had prescribed PRN for anxiety. I barely ever take them. My husband wouldn't let me go back to sleep and I don't know. I just took the whole bottle. I didn't think about it, I just did it. I wanted to sleep.

"You work in this unit, right?"

I nod.

"Do you see a lot of patients who overdose?"

I pause. I guess we see a lot of patients who overdose, but if you think that I had some kind of scheme have a vacation in the hospital, let me tell you, having your coworkers undress you while you are unconscious is far from therapeutic. "Probably more than many other units in the hospital."

"Do you think you might harm yourself again?"

"No."

"Do you think you would benefit from spending some time on our unit?"

"I don't really think so. I've floated to the mental health unit before and I don't think I would really be very comfortable there. I don't really feel like this is still an acute situation and I'd like to get out of here as soon as possible to get back on top of my coursework."

"Okay.. Is your husband still here?"

"He had to drop off our son."

"All right. Well, when he gets back, have have your nurse call my unit. I'd like to talk to him as well."

1:00p.m.

My husband is back, minus MiniMan. He meets with Dr. Martin, who agrees that it would be okay for me to go home without getting locked in the psych unit. I silently rejoice. I would get getting out. Dr. Martin leaves, then my husband, who is going to stop at home and bring me some clothes and shoes. It will take a while to get the discharge paperwork together.

1:30p.m.

My legs are killing me. My nurse, Sarah stops in my room to take out my IVs.

"My legs are really achy."

"Might just be from staying in bed so long." She walks out to complete some paperwork.

1:50p.m.

I ring my call bell. One of the aides comes in. "I'm having these body aches. I really don't feel good." In retrospect, I probably should have been direct and just asked for Tylenol, but for whatever reason, it doesn't occur to me.

2:00p.m.

I'm lying in bed crying. The monitor is alarming because I'm tachypneic. Dr. Nolan walks in.

"Well, I didn't expect to see you like this." He remarks.

"My legs really ache. I don't know what's going on."

"I don't see how I can send you home like this. I'm going to talk to Dr. Martin again."

"I need to get out of here. I need to get back to school."

"No kind of school is worth dying for. Clearly you're not ready to go home."

2:45p.m.

Dr. Nolan comes back in, tells me that he's talked to Dr. Martin, that they have a bed for me in the psych ward. I start bawling hysterically, begging him to let me leave.

"I can't lose my license over you. I can't guarantee that you won't hurt yourself when you get out of here."

3:00p.m.

Sarah comes in with some Tylenol for the leg pain. My husband walks in behind her, tells me he's talked to Dr. Nolan, and reiterates that I won't be discharged -- that Dr. Nolan said my discomfort was "a cry for help."

"Have you had your Celexa?" My husband asks.

"Not since Monday."

My husband walks out of the room following my nurse.

"She hasn't had her antidepressant in three days," he says, following Sarah out to the nursing station.

"It wasn't ordered," she replied.

"Why?"

3:45p.m.

Sarah comes back in with the Celexa.

"Some nurses are going to be over from the mental health unit soon to walk you over," she says.

4:05p.m.

A male nurse and a pysch tech arrive. I walk through the halls of the hospital with them, hoping no one will see me.

4:10p.m.

My belongings are being checked by one of the nurses. "You'll have to have your husband take your sneakers home, they have laces." I now have no shoes. My pants have a drawstring and are also confiscated and replaced by faded elasticized scrub pants. I now am the stereotypical psych patient, I haven't showered in days and wander around in hospital pants and beige non-skid socks.

4:30p.m.

I am starting to feel really bad, again. My legs are aching and it's freezing in my room. I get under the covers but I just can't get warm. I finally get up and try to turn up my thermostat, but it can only be turned up with an allen wrench or something. I walk out to find one of the nurses, who comes back in and turns up the heat.

5:00p.m.

I still can't get warm. I wander out of my room and ask for another blanket. One of the nurses returns and throws it on my bed.

5:15p.m.

The blanket doesn't help. I decide to call my husband, see if he will bring me a sweatshirt and sweatpants. It's so cold here. I don't know how they can leave it like that. I wait in line to use the phone.

Some gaunt woman in black stretch pants is angrily gesticulating while she yells into the phone. She says some closing remarks, hangs up the phone, and then mutters "fuck you, you cunt," walking away.

6:00p.m.

I'm shivering. I ask one of the nurses for another blanket.

6:15p.m.

My husband arrives. I tell him how cold I've been. He puts his hand to my forehead.

"You're hot. Has anyone taken your temperature?"

"No."

He walks out, and comes back with one of the nurses who is carrying a thermometer. She takes my temperature. It's 103.2.

My life exploded (Part II).

2010-10-22T21:06:00.003-04:00

Night 1

My nurse, Sue, comes in. It's dark now, and the night shift staff has arrived. These are the people I normally work with.

The last time I worked with Sue I had been doing a 1:1 observation on one of her patients: a hyponatremic college student who had been admitted to our unit for the third time. He had intentionally been drinking water by the gallons and depriving himself of salt in his diet. I think he may have had some kind of psychogenic polydipsia going on but I don't know if that was an actual diagnosis. He was confused, hallucinating, and vomiting. I sat next to him all night, talked to him, cleaned the vomit off his body, changed his clothes, his sheets... Sue thanked me profusely for dealing with him and for being patient, revealing to me how much she hated working with psych patients. This isn't really unusual, a lot of nurses I know admit having little tolerance for "crazy patients," not to mention those who intentionally harm themselves.

So here I am, another psych patient. I wonder how many nurses and doctors I'm pissing off.

I have to pee. I ring my call bell; Sue comes over.

"Is it okay if I walk to the toilet?"

"Sure," she replies, untangling my IVs and monitor wires.

It is more effort to move around than I expected. I walk several steps and sit down on the toilet. Sue walks out of my room to give me some privacy.

I stare down at my blood-stained underwear. Awesome. I got my period. I sit there for a minute, wondering if there was such a thing as pre-menstrual insanity, and then ring my call bell again, this time requesting a pair of the disposable stretchy fishnet-type underwear that we give to OB/GYN patients. Sue returns with the (sort-of) underwear and some pads. The pads don't really stick to the underwear. This is going to be great. I have visions of me tossing and turning in bed, soiled maxi-pads stuck to my forehead and my bed becoming a bloodbath.

I stand up, empty my hat, flush the toilet, and report a 900ml void. It is too weird to have my coworkers dump and flush my pee.

I keep waking up to pee. I look up at a big bag of normal saline and realize that I have been receiving tons of fluids, which must explain my continued propensity to urinate. I feel guilty ringing the call bell, making someone come into my room. I'm probably fine to walk there myself.

I fall asleep, and wake up to some alarm going off on my monitor. Blood pressure, 68/41. I fall back asleep.

I wake up again, some other alarm on the monitor. I pulled off some of my EKG leads tossing and turning. I reconnect them and turn on my side, trying to get comfortable. One pops off again. I realize this is going to be an all-night affair.

Back in time

2010-10-08T14:03:00.008-04:00

I realize that I hadn't really posted anything in my blog about how school had been going. The reality of it was that things were okay, but pretty much any free time I had I was spending studying or with my family, and as a result wasn't really blogging.

It turned out that I had to commute to school five days a week (initially I thought it would only be three), and then work three days a week (12-hour shift overnights). MiniMan went to on-campus daycare three days a week with me, and those days were nice, because it meant that whenever I wasn't in class I could use the chunks of time to do homework and study.

Chemistry was going really well. My lecturer was good, and I was getting A's on my tests. Even though I was doing well, it was kind of maddening to be in a class with four-hundred other students. The professor was impossible to contact except after the class (he didn't even list his office location or e-mail in the syllabus) and we had to rely on TAs for everything. I was impressed that they had chem office hours 9-5, five days a week, but then I realized that the office hours were in fact, a room filled with twenty students looking for help, and one TA milling around helping one person at a time. Sometimes people would wait forty-five minutes before the TA even talked to them. It was really screwed up.

Physics was going okay. I think that math-intensive courses will always be more challenging for me. My homework assignments took up huge amounts of time. I wasn't able to get everything done on campus and during the evenings, so I ended up hiring a baby sitter on the weekends so that I could spend more time on my problem sets.

When I wasn't in class, I was spending tons of time in the car. The commute was pleasant. It was a pretty drive, but when I realized how much time I was spending in the car (over fifteen hours a week), it started to drive me crazy. I could have been spending that time studying. As a result, I devised a sort of flash card study system which I brought with me in the car. I think this really disturbed my husband. He was convinced that I was going to crash my car through some combination of distraction and sleep deprivation.

Crash my car, I did not, but be sleep deprived, I'm sure I was. I was yearning to work only two nights a week instead of three, but if I did, I was guaranteed to lose my health insurance and other benefits. This resulted in a sort of bizarre schedule which went something along the lines of:

6:00a.m. Get up to get dressed.

6:45a.m. Start driving to school.

8:15a.m. Arrive at school.

8:30a.m. Go to my chem lab.

12:00 noon Drive home.

1:30p.m. Watch MiniMan, eat lunch, attempt to tackle laundry, make dinner.

5:45p.m. Get dressed for work.

6:00p.m. Leave for the hospital.

6:45p.m. Arrive at work.

1:00a.m. Eat "lunch" again.

7:15a.m. Leave work, pick up MiniMan, drive to school.

9:00a.m. Drop MiniMan off at daycare.

9:25a.m. Park, walk to class.

9:40a.m. Chem lecture.

10:40a.m. Study, eat lunch No. 3.

12:00 noon Physics lecture.

1:00p.m. Physics "discussion" with useless professor who constantly gets confused and gives quizzes during practically every class.

2:00p.m. Study.

4:15p.m. Physics lab with TA who talks way to fast and seems irritated by the prospect of having to teach us.

5:40p.m. Pick up MiniMan from daycare.

6:00p.m. Drive home.

7:30p.m. Get home, figure out some form of dinner.

8:30p.m. Fall asleep on the couch next to husband.

There were always a couple nights like this, days where I had to go to school and then work and then go back to school. Or nights where I had to work, couldn't sleep during the day, and then had to work another night. At first I wondered if I would be able to do it, and then I realized I could. I felt important and invincible. I had a purpose. I was more giddy than tired. It was like being drunk.

My life exploded.

2010-10-07T21:16:00.006-04:00

For over a week, I've been debating whether or not I should blog about what has been going on in my life. My first inclination was not to write -- after all, who wants to announce to the world (or more accurately, my small pool of readers) about how they've failed?

After talking to my husband, I had a change of heart. My blog is an anonymous outlet for me, and I've decided to share my story. It will probably come in installments as a narrative, because I just don't feel that motivated to write about everything all at once. I don't really feel motivated at all. Life sucks.

Day 1:

I'm in the emergency department of the hospital where I work, barefoot, lying on a stretcher. Familiar nurses are doing an EKG, putting IVs into my arm, hanging saline. My husband, somewhere.

“What did she take?” Someone asks.

I wake up in the ICU. I'm in room 8. My shirt is gone. My bra is gone. I'm wearing a gown. I don't remember taking my clothes off. I try to sit up. It doesn't really work. It's like the force of gravity has doubled. I succumb to my hospital bed, fading in and out of sleep.

My nurse (also one of my coworkers), Claire, comes in. I like Claire. She lives in the country, has a little farm with her husband. “Hi E.,” she says. “We're just going to monitor you for a while, make sure you're doing okay.” I close my eyes.

“E.? E, it's Dr. Nolan. Can you tell me what happened?” Dr. Nolan is one of the intensivists. I used to assist him with procedures when I still worked days, inserting central lines, doing lumbar punctures. He must think I'm such an asshole. I wish this bed could engulf me.

"I.. I.. took some pills. I was just really tired. I just wanted to sleep. I had gotten in an argument with my husband about the schedule for my physics class and I was just really tired and upset, and he refused to let me sleep, so I took the whole bottle. " It was stupid. It was stupid and impulsive. There are people here who are actually sick, unlike me. I'm just wasting your time, destroying any kind of once positive rapport we might have had, I thought to myself.

He continued to ask me questions for his history and physical in a detached manner.

"Past medical history?"

"Chronic sinusitis; aseptic meningitis."

"Surgeries?"

"Tonsillectomy."

"Anything else I should know?"

"I think my finger is infected. I had cut it a few days ago, and it's just been getting worse. I had been waiting to see if it would get better on its own." I held up my hot and puffy finger.

The rest was a blur.

I wake up again. Lauren, one of the aides, tells me she needs to draw blood cultures. I stick out my arm, barely aware of needles, of any kind of pain. I drift back to sleep.

Crayola Crayon Colors -- Medical Edition 2010

2010-08-31T19:13:00.004-04:00

The other night at work, some of the nurses and I were sifting through an old Avon catalog that someone had made behind and giggling over their products. After perusing the nail polish section, I admitted that I had always had a secret career ambition of being one of the people who comes up with the names for new Crayola crayon colors.

After some brainstorming, we decided that our hospital assortment might include:

-Cyanosis

-Meconium

-Last night's mac and cheese

-Jaundice

-Mahogany stool

-Bile

-Leukorrhea

-Turbid tea-pee

Feel free to contribute your own!

My husband rocks.

2010-08-30T14:54:00.004-04:00

Last night, I was getting everything ready classes and setting it all on the kitchen counter before I packed it up. Wallet, important forms, notepad, glasses, diapers, extra clothes for MiniMan, etc. Of course, it didn't take long for MiniMan to pull a stool over to the counter and have a seat. I didn't think much of it, until he picked up my glasses and in one swift motion, broke them apart at the hinge.

I was too late this time. My glasses were literally in two pieces. I made a joking remark to my husband about now how people could really make fun of me for being nerdy, as I looked around for some tape to do a makeshift repair.

When I woke up this morning after my husband had already left for work, I found my glasses sitting on the counter, the hinge reshaped, held together with some kind of tacky clear glue. I wouldn't have to wear taped-together geek glasses on the first day of school! It's been a good day.

Note: this post comes to you from the campus of my large state university. I have attended two lectures and a discussion section, and everything is going great. Yay!

The Saab Strikes Back

2010-08-29T14:29:00.002-04:00

I have been basking in this wonderful, sort of giddy feeling for the past few days about taking classes. I'm excited. It's hard to sleep. It's like Christmas Eve when you're five years old.

My husband just came home after borrowing my car and putting some gas in it. Turns out, it broke down AGAIN. I just don't get it. My car breaks down the day before classes start? You've got to be kidding me. I think this vehicle has bad karma or something. Our mechanic, who we have a super-friendly practically family relationship with has graciously offered to let me take one of his loaner cars to classes tomorrow. Meanwhile, though, financial disaster looms once again. Oh man.

The saga continues...

2010-08-25T15:16:00.007-04:00

Monday morning: I wake up and call admissions. "What's the quickest way to pay my [third!] application fee?" I ask. "Can I give you my credit card over the phone?"

"No, you may only pay by credit card online, but it will take a few days before you have the option of paying online." Don't ask me why this is. I talk to the admissions lady for a few more minutes and we decide that it makes the most sense for me to drive the hour and a half commute there to drop off my transcripts (for the third time) and a check. She also recommends meeting with the continuing education advisor, to see if she can help me sort this out.

I call the continuing education office to ask if my advisor will be there in the afternoon and if she'd be available to meet in person. Her secretary confirms she'll be around. I get my things together and start driving.

I arrive on campus. It's pouring outside and I'm wearing these bright orange mud-covered galoshes that probably make me look like I've just stepped off of a dairy farm. That's okay. My feet are dry, my hair is wet. I decide to head to continuing education first and look for my advisor. The secretary is gone. Everyone is at lunch. I'm told to come back in a half an hour.

I walk across campus to the building where the admissions office is. I drop off my check and my transcripts. I head back over to continuing education, but everyone is still gone, so I decide to do a miniature self-guided tour in the rain. Student union. Check. Campus bookstore. Check. Science library. Check.

I head back over to continuing education. It's been a good forty-five minutes, now. Everyone is still gone. I decide to wander through the building, get lost, and eventually find my way back over to their office. The secretary is back. I introduce myself. "Oh," she replies, "we wanted to call you, but I couldn't remember your name. It turns out that your advisor has a dentist's appointment today and won't be in until later this afternoon. You can wait for a few hours or just call her when you get home."

Rather than walk around in the rain for a few more hours, I decide to go home.

I call my advisor when I get home. She tells me that I should be registered by the next morning, and that if I'm not, that I should check in with admissions.

Tuesday morning: I still can't register. There are two more spots left in physics. I'm getting freaked out. I call admissions again and talk to the same unpleasant guy who I talked to last time.

"I'm calling to inquire about the status of my application," I tell him.

"Did you check online?" He asks with exasperation.

"Yes. It has been received but not processed. My advisor in continuing education suggested I call you and check in if I was not able to register by today."

"Can you hold?"

I hold for five minutes, literally. No joke.

"We've received your application online."

(Duh, I knew that).

"Have you submitted a payment?" He asks.

"Yes, I dropped off a check (and my transcripts) in person yesterday."

"It will take us a while to process the check. First it needs to be deposited, and then it needs to cleared. After it clears we can process your application. I doubt that we'll be able to process your application until after classes start, so I suggest you contact departments independently and see what their processes are for getting into classes that are closed."

I politely detail the nature of all the crap that I've been through already. "Is there any way that you might be able to expedite things considering these extenuating circumstances?"

"I'm sorry, you'll just have to be patient," he says unsympathetically.

"Okay. Thanks for your help." (Not).

I hang up the phone and start sobbing somewhat hysterically. MiniMan, my nearly two-year-old, is sitting at the kitchen table with me looking disturbed. I blow my nose. Then I cry some more.

"Mama. Sad." He says. He picks up the used tissue and wipes my nose.

I give him a hug and pick up the phone again to call admissions back.

"Admissions, can you hold?" I wait. And wait. And wait.

"Hello, admissions." Finally.

"If I drive up today and drop off cash instead of a check, will this speed up the processing of my application."

"We do not accept cash. You may pay online with a credit card, though."

Am I going out of my mind? I think I'm going out of my mind. I pay online with a credit card, and then call the chemistry department as recommended by the unpleasant guy in admissions.

"Chemistry department, this is the really nice secretary speaking."

"Hi, I'm E. Greene. I talked to you last week. The unpleasant guy from admissions who you suggested I call suggested I call you again."

"Oh dear."

"He told me that I couldn't be deferred and that I'd have to reapply. I reapplied but now I've been told that admissions won't be able to process my application until after classes start..." My voice wobbles as I try to hold back tears. I start crying again.

We talk for a few minutes. I must sound really pitiful, because she starts making jokes to try to cheer me up.

"Okay, I'm going to have to call some people, but in sum, you're looking to take undergraduate classes as an unaccepted, non-matriculated student, right?"

I laugh. "Exactly!"

Tuesday afternoon: Super-nice chemistry secretary calls me back.

"I talked to admissions and they're processing your application. You should be able to register this afternoon, or by tomorrow morning at the latest."

I gratefully thank her and wait expectantly at my computer.

About an hour later, I actually register. I get the last space left in my physics class, and a spot in the huge gigantic chemistry course, too. I am not sure how I ended up being so freakishly lucky, but I am forever indebted to the really nice secretary in the chemistry department. I wonder what she said to make admissions give me the time of day? I have noticed that sometimes only by breaking down and exhibiting signs of complete desperation, will people actually notice you. I'm not sure if that was the case in this instance or not. Anyway, how do I thank her? I want to write her a note and perhaps do something involving food. Chocolate cake with fresh raspberries? Wine? Both?!

Greetings from Grumpyland

2010-08-20T16:13:00.003-04:00

I am getting really, really, really frustrated with my huge state university. I had contacted continuing education early in the summer to make sure that everything was on the right track and I wouldn't have any problems with the registration process. I was assured that everything was in order.

About a week ago, I logged onto the campus student website (what people use to look at unofficial transcripts, pay bills, register, etc). I got some kind of weird message that I needed to reapply. So I called continuing education and asked what the deal was. Continuing education said, "we don't know, call the graduate school." I call the graduate school. "You need to reapply," I am told. I was annoyed to say the least. It's not like the application process is that bad, but this was the third time that I would be applying to the same school where I had repeatedly been accepted in the past year. Now I need to apply again? Apparently so.

I end up calling admissions again to ask them if I'm eligible for an application fee waiver. I talk to a student who puts me on hold, and then finally puts me through to an admissions counselor who never answers the phone and doesn't have voicemail. I call back, listen to their five minute automated message, and talk to another student. They put me through to the assoc. director's voicemail who is on vacation. The associate director calls me a few days later when he returns from his vacation, and says that I have to contact a different office. I call the other office and am told by a woman on their staff that I will have to reapply. She promptly hangs up. I call her back "what about the fee waiver?" I ask. She replies that that is not available and that I will have to reapply. I start explaining my situation to her and then she puts me on hold. She says that if I contact the department that I'm taking classes in (for ex. the chem. dept.) then they may be able to grant me a deferral and then I won't have to reapply. Okay, now we're getting somewhere.

I contact the chemistry department and repeat my story, once again. The woman who I talk to says that she's never heard of anything like that. She says that she will have to call some people and get back to me. She leaves me a voicemail today, saying that I need to contact someone in the office that referred me to her. I talk to this guy, and he says that I'll have to reapply, and that there are no fee waivers except for poor minority students who are in their poor minority student program (which is only for matriculated students).

I get online, repeat the application this afternoon, and then realize that unlike their other application, there is no way to pay the application fee online. So now I have to drive an hour and a half to the school on Monday to drop off another check, and more transcripts (which I've already given to them, twice).

To make matters worse, registration begins for students with my lowly status on Monday. So, I'm pretty much screwed. I feel like this is some kind of secret test of patience and endurance. If that's the case, bring it on.

SDCOD

2010-08-09T13:10:00.003-04:00

SDCOD (sleep-deprived comment of the day) should probably be changed to SDCOW (week) or SDCOM (month). I'll aim for SDCOW, and we'll see how that goes.

And now... an excerpt from doctor's orders for a patient in our unit:

0.4mg sublingual nitroglycerin for chest pain, every 5 minutes x 3 doses PRN. If chest pain unrelieved after 3rd dose, call 911.

Did I make the wrong choice?

2010-08-05T16:10:00.006-04:00

I just called the daycare center at the university where I'm taking classes in the fall. I learned I'm not eligible for their financial aid program because my husband and I make over $3500/year together. It's frustrating. I sometimes feel like some of these aid programs are practically an incentive to quit my job, because then if I did, I'd actually be poor enough (by their standards) to get assistance.

The cost of daycare plus the cost of gas to commute to school alone will eat all of my take home pay each month. I still haven't figured out how to pay tuition (or any other expenses like the utility bills, groceries, etc). After finally giving up on private loans (which were all variable interest rate and scary), I applied for a second credit card in an act of desperation. I can pay for tuition with a credit card, right? And after all of this, I still don't even know if I'll be able to get into the classes I needed to take because I'm non-matriculated.

I opted to take the "design my own post-bac program route" because I thought it was more direct and made more sense financially. But honestly, I don't even know how we'll pay the bills. The whole thing stresses me out so much I can't sleep.

Did I make the wrong choice? Last year I applied to the bioengineering program at the same school and was offered grants that covered the entire cost of tuition, plus ample money for cost of living in federal (not scary) loans. I would have had an advisor. I would have been able to get into classes. I would have been able to take voice lessons and get involved with research. It would have taken four years instead of two, but now I'm not even sure if I'll be able to figure out how to take classes this year. I would so much rather spend some extra time in school and be intellectually engaged then spend some extra time waiting to take classes and pulling my hair out.

Is it completely insane to call the director of the program (I met with her last spring) and tell her I changed my mind? Do you think they would actually let me back in?

Weighty Matters

2010-08-04T13:31:00.008-04:00

I've been called in with four other people to help hold up the panniculus of a fifty-year old woman in our emergency department so that one of the nurses can catheterize her. The big flap of abdominal tissue that nearly extends to her knees is firm and pocked, and almost scaly in areas with patches of dry skin flaking off under my gloved fingers. With the help of my coworkers, we grab the the heavy lump of tissue and pull it up so that Matt can prepare to insert the Foley.

"I can't find her vagina," he mutters in exasperation.

We all shift around a little bit, trying to pull the panniculus up a little higher and shift the position of her legs. After a few more minutes, Matt manages to find her vagina.

"Are you guys doing okay?" He asks. "How are your backs?"

"We're fine, don't worry," says one of the ED techs, her forehead damp with sweat.

Mike unwraps the catheter package, puts on his sterile gloves and prepares a sterile field, lubes up the tip of the tube, drapes her, swabs her, and gives it a go. The catheter is in. None of us thought it would be that easy.

"You're done?" Our patient asks. She smiles. "I've never had anyone put in a catheter that fast before!"

These kind of situations were initially really shocking to me, but more and more, I'm realizing that they are becoming commonplace. It is not all together unusual that I will come to work and we'll have a patient in the ICU who is so obese that she is unable to move her legs or even turn onto her side. I will later read histories and physicals, and see that some of these patients were not in nursing homes before they were admitted to the hospital. How do they live independently? How do they go to the bathroom, take a shower, clean their house and get groceries? Who takes care of them? It is terrifying to me that some peoples' obesity has become so out of control that they are nearly trapped within their own homes.

It is physically strenuous to care for these kinds of patients, even in the hospital setting. It sometimes takes four or more people to turn and clean up the patient in bed if she has a bowel movement. They seem predisposed to skin breakdown between the folds of their skin. We need to find special bariatric commodes, wheelchairs, and beds (in our hospital, there are a limited few) with special bariatric sheets, and use bariatric gowns because normal hospital gowns do not provide adequate coverage.

Many of these patients are in the hospital due to complications of their obesity (heart disease, hypertension, diabetes, sleep apnea), and some healthcare personnel are not terribly sympathetic, having an attitude something along the lines of it's your own fault that you let things get this out of hand.

I don't know exactly how I feel. As an aide, it's rare that I have the chance to get a very complete picture of any of our patients. I don't really know what the contributing factors are to their obesity, how they got there, what they tried to do to help themselves. What did their doctor try to do to help? Did they even have a doctor? There's a part of me that's always a little baffled. I always imagine if I were becoming seriously overweight, I would be alarmed at my weight gain and I would do something. If my attempts didn't help, I would seek help until I found a weight-loss strategy that worked.

At the same time, I feel like these patients who are so obese they can barely move are practically past the point of no return. How can they exercise if they can't stand up? Even just as a pregnant woman it was uncomfortable for me to exercise, so I can't even imagine what that would be like if I were 300+ pounds. By the time these patients are in the hospital, their prognosis is likely even more dismal, so in my book, these patients are deserving of any kindness and help they can get. After all, it's our job.

So I guess my big question is, how does a healthcare provider keep patients from getting apathetic about their weight? Do you think it's an issue of motivation, education, or something entirely different?

Where did I go?

2010-08-03T21:32:00.007-04:00

I've been really grumpy, lately. Everything seems like kind of a crapshoot. I delayed taking classes until the fall, but then I encountered an insane car bill and have now spent most of the money that I had been saving for tuition. I applied for several private loans but was rejected for all of them even with a cosigner (which surprised me, because my credit rating is in the 700s). I think it is really hard to get loans as a non-matriculated student taking 5th year undergrad courses. I'm feeling screwed.

Spending nearly four years exploring menial jobs to confirm my interest in medicine has proved to be overkill, and now I feel like I'm going to lose my shit. Working overnights sucks. I never get to sleep during the day as much as I would like to (between two and six hours) and I think the sleep deprivation is messing with me.

It's depressing not to be challenged, and I constantly feel torn between wanting to learn (one of my favorite activities is reading charts, and looking up terminology that is unfamiliar to me) and doing what needs to be done (emptying foleys and urinals, stocking supplies all over the unit etc.). Stocking is this endless task that no one wants to get stuck with. We stock about a hundred supplies in each room; it's mostly boring stuff: shampoo, toothbrushes, suction liners, tubing, yankauers, emesis basins, etc. Initially it was cool to familiarize myself with some unfamiliar equipment, but it's just banal repetition. Compelled to do my job as well as I can, I always do whatever needs to be done over what I enjoy doing. The thing is, I stand there filling these cabinets while I imagine my brain atrophying and grow more and more bitter. The nature of my job involves few puzzles, little problem solving. If I actively seek it out too much, I feel like I'm slacking off. I guess the good news is that it's not forever, but I just don't know if I'll really last two more years as an aide while I finish my pre-med requirements.

Despite this, we recently had a patient who was detoxing, but two weeks later, was still significantly confused. He came in reasonably oriented, and I was puzzled as to why he wasn't getting better. I asked one of the nurses if it was normal to have DTs for such a long period of time -- don't they usually subside by this point? Do you think the benzos are making him loopy? And then wide-eyed and excited, "maybe he has Korsakoff's Syndrome!" recalling tidbits from a human neurobiology class from undergrad. His nurse looked up at me, "what's Korsakoff's Syndrome?"

Tonight I was reading a progress note by one of the internists whom I really respect, and he too, was curious about the origins of this guy's encephalopathy. And what did he consider? Tail end of DTs, adverse reaction to benzodiazepines, and you guessed it, maybe Wernicke Korsakoff's syndrome. I was really surprised with myself. Usually I just laugh at myself and the ridiculousness of an aide throwing out ideas as a diagnostician. I think the thing that I have to remember is that I'm learning, even if only by osmosis, a lot the time. Hopefully some day some of that will actually be useful.

Penn or Wilson?

2010-06-14T20:18:00.004-04:00

In the mental health unit at the facility where my husband works as a nurse, one of the patients was complaining of rectal bleeding. After some investigation, one of the nurses learned that he had been using a tennis ball can as a dildo. She had to call the patient's attending, who wrote orders for a comparable sex toy and 1:1 observation by a staff member until a new, safe sex toy was procured.

My husband's coworker, Leanne, who is the manager for the unit, was somehow elected to buy the replacement dildo. She is notoriously polite and very slight in stature. All the staff members are harassing her to hurry up and buy something, so that they don't have to keep observing this guy. The patient threatens that the replacement dildo must be at least as wide and as long as his tennis ball can, or else he won't use it and will continue to insert random foreign objects up his butt.

All I can imagine is Leanne sheepishly bringing some huge dildo up to the register and trying to explain "really, this is for my job."

SDCOD

2010-06-13T21:53:00.002-04:00

Husband: Did you just fart?

Me: No.

Husband: What was that noise?

Me: I don't know.

Husband: You did fart, didn't you...

Me: Smell my butt; I did not fart.

Sleep Deprived Comment of the Day

2010-06-06T07:36:00.006-04:00

Inspired by the Medical RNinja and her cat of the day and Latin of the day series, I have decided to trial a sleep deprived comment of the day series (SDCOD, pronounced: sad cod).

So, here goes:

This morning, I walked into a patient's room to empty his Foley bag and noticed that his nasal cannula was way up on his forehead. I leaned over and said to him "I'm just going to readjust your Foley and put it in your nose, okay?"