Antisocial Personality Disorder

I just finished my week on the addictions unit. The best summary I can create is that, "People. Are. Crazy." And these aren't even the real crazy people. I'll meet them all in the ward next week.

At the same time, it was very humbling. I attended an AA meeting earlier this week, and I was astounded when I walked in the door at 6:25 am. There were so, so many people in that gym--I'd expected a small circle of about 15 people, mostly older broken men, in a small room somewhere. Instead, I encountered more than 70 people seated in a gym, and among them I saw fellow students, attendings, and nurses I recognized from the hospital--there as patients. Young people, professors, grandmothers. Guys in ripped shorts and guys in suits with stethoscopes around their necks. It was inspiring.

Also, I met my first Antisocial. This personality type is the most common "sociopath" identifier and is recognized in test questions as having childhoods involving prolonged bed-wetting, the habit of setting fires, and animal mutilation, all before the age of 15. Of course, as I was admitting this guy, nothing he told me had anything to do with urination or cutting up cats and setting his room on fire. Turns out that these guys (or girls), in reality, usually have pasts that include abuse and are currently extremely manipulative, with no qualms about hurting anybody and everybody to get what they want. I didn't realize that's what this dude was like until he started trying to strong-arm the staff into giving him privileges he didn't have, and after I heard him unabashedly lying to and manipulating someone he "loved" over the phone. Or maybe after he tells me he's abusive towards his pregnant girlfriend, or I find out that he requires sex from her much more often than she wants it (his average estimate was twice a day). Yeah, all of that.

Meeting him underscored for me that there will be patients I do NOT want to interact with. Patients that I may come to despise, even, and may see no worth or value in--but I need to figure out how to love these people. At least, how to interact with them in a way where they feel as valued as they would if they had spent time with Jesus. Which sounds ridiculous. I can't do that. Not even close. I'm not even sure I want to try, to be honest. But I think it's a worthwhile goal and I would like to learn how.

Shirley

Her name was Shirley, she was 76 years old, and the last thing she told me was that she was looking forward to drinking tea with me, but that she was going to go home and rest awhile. I hugged her granddaughter goodbye, went out to the elevator, and cried. She was so tiny, in that hospital bed, with great bruises on her arms from the blood thinners and a tear on her shoulder from a piece of tape that took the skin with it. Even when I held her hand, the skin turned dark under my thumb. Her eyes were still so blue, but she found it hard to talk to me much. She just smiled and called me "honey" as we got her ready to go home for the last time.

There were more tears, three days later, when Sherrie told me that her gran was dead. How odd, to be sincerely mourning the death of someone I've only spent a few hours with over the course of several months, but I do, regardless.

After they took her home, one of the last things she had them do was hang this picture. That's us, there in the middle--my mom, dad, and siblings. She always wanted to hear about my family, and one night I went to see her, late, and took a picture so she'd know what they looked like. When she went home, she added it to the family tree on her living room wall. It was one of the most profound gifts I have ever experienced, to be so welcomed into a family like that.

They tell us not to let people in, to leave work in the hospital and separate your life and emotion from the people you treat--that they will sap your strength and break your heart if you give them too much of yourself. And that is the truth of it. But every once in a while, you meet people who are worth it. Tears are such a small price to pay for being able to feel like I meant a great deal to that family, that I could actively make their lives better with just a little time and caring. Those are such small things, sometimes.

Anyway.

Reflection

Here I am. A little older, a little sadder, but...the world is still full of wonder. It is bright and brilliant and sharp, vague and colorful and made of movement and moments; and it buoys up my soul that I still have it in me to pull courage from somewhere deep, to take those moments and run with them. To ask the right questions. To dare to hope for new dreams. To forgive myself for what I couldn't change, and remember that the beautiful parts of human interaction are really quite simple. It actually feels strange, letting joy chase me again, but...man. So worth it.

Skin Deeper

It bemuses me how unlike myself I feel tonight, freshly showered at an unusual hour, with the unfamiliar scent of brand new shampoo and soap drifting around me. It's like being in the skin of a stranger, and I'm surprised every time I move and the air stirs. I catch myself breathing deeply and looking over my shoulder before I remember, again, that the unfamiliar feeling is nothing more than a trick of my senses.

I received a text from an unfamiliar number yesterday. My patient, the one who was in several weeks ago, is back in the hospital--I'd given my contact info to her granddaughter in case that happened, and so I went in to see her this afternoon. She is diagnosed with esophageal cancer, now. I sat and talked to her for half an hour, and she held my hand the whole time. She's so tiny...lost a great deal of weight. My heart breaks for her. It isn't very often that you meet people who just seem good, but she is like that. You can tell it in the way her family surrounds her and the way they interact. It's good, and strong and loving, and she's decided that I'm also just another one of her kids--told me that, today. And then she followed that I needed to make sure and remember to take care of myself. It put a warm spot in my heart. Of all the patients I see every day, everyone I interact with, she got under my skin and it looks like she's there to stay. I'm pretty happy about that.

We use that phrase, "getting under my skin", to describe something that slides past our defenses to the core of who we are underneath, where it matters. Much of the time it's a negative connotation and comes with a lot of pain attached. I know that in my more self-effacing moments I tend to wonder if mine is too thin, but in the end it just turns out that I'm no good at defending myself against people I love. I just won't do it. I carry them under my skin all the time, as close to my heart as I can, where the most damage could be inflicted if they so choose; but where, in turn, that love is a shield, a strong, warm, living guard against the pain that is a byproduct of living. I've got such a strong family, and such good friends. I feel quite loved tonight.

Also, I am lying in my bed smelling my hair because it is new and different and ridiculously soft. This new shampoo stuff...wow. I smell delicious.  What can I say? It's the little things.

Futures

It's hard to reclaim a blog once you've given it to someone. I used to blithely tell people about it, probably hoping they'd get to see a bit more of who I am and be intrigued enough to pursue a friendship, or at least to let them into my world enough to share a conversation about things that are important to us. I've discovered, though, that this is a double edged sword, and that I edit my thoughts according to who reads them. It entirely defeats my purpose.

I'm tired of that.

And right now I'm just tired. And done editing because my ex may happen across my thoughts. Because this is mine.

I have talked a great deal with trusted friends about the dynamics of breakups, in light of my own, and one asked me this question (or one very similar to it--I'm running on east coast time as my flight just landed, so it's 4 am for me and we know I don't function very well in the wee hours). The question was dual; who do you think will move on first, and if it's not you...how are you going to feel about that? How will you respond?

I got to test that theory tonight. It's been such a long day...somehow, my plane ticket landed me back in CA a full day early. I scrambled to find a ride and it was very late when I finally made it back here, to my cold and dark and frankly creepily deserted apartment (I suppose it would be more creepy if it wasn't deserted), super grateful for the friends I have. A quick and ferocious running of the wall heater to warm things up, a run and jump into my bed piled high with blankets...and a last-minute, sleepy scrolling through of facebook on my phone, because the city lights coming through my window take some getting used to after days of dark and quiet nights.

He's dating another girl. I didn't quite understand it at first--apparently he wasn't satisfied at just changing status...it required a post. Just in case we missed it earlier, as I had. That was...poorly done. Though it did finally prompt a blocking of all further updates that I had been considering, and should have done just one day sooner, it was still shocking. On multiple levels, as well, which was an unexpected and unwelcome development.

What a mess. There's a great deal of me that believes he has every right to be happy and move on, and hopes well for him. Being alone is a hard thing. I personally hate it. For all the time I need to be by myself, I don't do well without someone to love and be loved by. I got away with being alone in college because I wanted to wait for the real thing, and I didn't really know what I was missing--I suspected it, but I wasn't quite sure. Now I know. So if he can move past everything and be happy...how could I not want that for him?

But.

The shocked part, the raging part that will not let me sleep is not so easily persuaded. Her? Really? The same girl he told me was just a cool new friend, and then described his hours of conversation with, and how excited he was to find a "soul-twin like her," that now there were "two people who really understand me--you and Dani?" The one who sounds like all the good parts of me, but without the flaws? The one he connects with so effortlessly that it's almost like they can read each other's minds? I actually hope I'm wrong, and it's a different Dani. I hope so very selfishly because I wanted to believe him when he said that he could have other deep relationships with other girls; and, I had hoped, without conducting them in a way that would make slipping into a relationship with them this easy. Because four months. Seriously. You do not go from a ish-two-year relationship and start dating someone four months later unless you have that kind of base built, the kind you shouldn't be building if you're in a long-term relationship with someone else. And that was always a point of pain between us--his "base-building", per se. So I really hope it's a different Dani...although in the end it doesn't have anything to do with me. Which makes it easier, somehow. It was just a nasty surprise.

It just leaves me so tired. I think my dreams of finding a soul-mate broke when I realized that something vital was missing from the future I wanted so badly with him. Soul-mates--I don't think they exist anymore. You can't have everything. Like mom says, there are no Manicorns. And so I have to remind myself that it's very simple, now. I don't need much. Just someone to quietly and fiercely love me at the end of the day, unwavering, who is kind to me no matter what life throws at us. Someone I can trust with my heart unreservedly, without fear of the future. I've discovered that those are two things I cannot live without.

Driving the Differential Diagnosis Strugglebus

I have no idea what I could possibly write about tonight. But that title is just too good. I'll think of something.

...

Still haven't thought of anything. In other news. I went climbing on Friday night, and my fingers are only now slowly responding to mental commands. One of my patients has C. diff, and if you've never smelled that, well, consider yourself blessed among men. I just did a late-night run to Taco Bell, which is funny since it's not even 9 pm yet. I have the occasional awkwardness meter of a high-school nerd. My senior resident is making me work on Thanksgiving. I have a dream of me all fit and sexily defeating bad guys and whatnot and tried to start running against last night to make it come true...suffice to say that the dream died at about a mile when my lungs felt like they were icing over and caving in. Now I'm defeating test questions from the comfort of my own couch, in my tee shirt and sweats. I will try and be a superhero again tomorrow.

knotted

I'm not sure how I got pulled into it--heaven knows there are so many things I should be studying--but before I knew it, 40 minutes had passed and I was still lost in clips of various Disney movie ending scenes. It sounds ridiculous even in my head, being a grown woman and all, but somewhere halfway through the dance at the end of Enchanted, where Patrick Dempsey starts singing "So Close", I completely lost it.

Such stories just seem to set us all up for heartbreak, don't they? It's the sheer perfection of it. Both people always have, of course, obstacles that stand between them. They have to fight for each other, be the hand outstretched when everything is falling apart, and balance the other's weakness--and maybe they don't know how, at first, maybe they have to learn--but in the end, it works, because they are right for each other. At the core, they fit. They match. They learn how to love each other best. And because they do, it doesn't matter what life throws at them--they can handle it.

Nothing in any of these movies sets you up for the reality of two people who fall in love anyway before realizing that they don't fit in ways they must. Nothing in any of the stories I've ever heard gives any idea of the unbearable decisions that have to be made when this happens. They don't talk about hyperventilating in the shower or nights spent alone or the loss of futures and dreams. They don't prepare you for how difficult it is to find hope again. I don't think anything can.

The Fat Entitled Whiner

I was talking to dad today during a leisurely breakfast here at the hospital--both things are sadly far too rare, and so I was thoroughly enjoying myself as we talked about interesting cases I have seen here in LA. He works with other medical students as well, in his practice, and so I get to hear stories about interesting people he comes across.

He was telling me about a young female resident that reminded him of me, and her experience with a patient. A young illegal immigrant from Mexico was hit by a car and came into the hospital with bleeding in his brain, eventually requiring surgeries to place a mesh and several months in the hospital. The mesh became infected, but not all problems can be fixed, and the danger of him having it removed was greater than the danger if it stayed--and so he was placed on expensive antibiotics to control the chronic infection in his brain, and would have to be on them for the rest of his life.

But he was illegal--no citizenship, no insurance--and so the authorities contacted the mayor of the small mountain village where he came from to determine how to get him home. It turns out that the mayor had a burro, and so he would travel down to the city and collect the man from the airport when they shipped him back. All the resident could do was send the man to the airport with 6 months worth of antibiotics, and let him go home to die.

I was telling dad about the dichotomy that exists in my mind when I hear these stories. On one hand, the little girl in me wants to save everyone--on the other, I have paid thousands and thousands of dollars for the right and ability to save people, and in uninsured cases like this, the rest of the hundreds of thousands of dollars it takes to do so are also coming out of my pocket. That's not right, any way you look at it.

And then there are patients like the one upstairs, who has been here for almost a week for "chest pain," weakness, more chest pain, back pain, neck pain, nut pain, paralysis, brain pain, trouble breathing--you name it, he has it. Oh, and he's "allergic" to Tylenol and Motrin--only Dilaudid and morphine will work, Doc, I'm in so much pain, can we increase my dose? I just wanna feel better, Doc, I'll stay here as long as it takes. I'll do whatever it takes. Including eating on the days we schedule his testing, twice, so that we have to reschedule them for the next day. We all know he's full of crap; of course he wants to stay here. Here is where the medicines are, here is where the nurses are at his beck and call--here is a several-thousand-dollars-a-night hotel is his for the asking. So every day he comes up with new excuses, and threatens to sue us if we send him home with all the "symptoms" he's having--and policy being what it is, we're not allowed to tell him how easy it is to test if people are faking, and that he's failing miserably. If I had my choice, I'd've kick him out on his butt yesterday, with pleasure.

If money is just lying around to be wasted on lardy, unhealthy, duplicitous people like this man--and it's not, but for the sake of argument, let's assume--then I'd much rather spend it on the man who is going to die alone in his village while the man upstairs eats himself to death.

Arrhythmias and Surly Black Men

My resident was explaining EKGs to me tonight, taking advantage of the first slow on-call night we've had since I've been in LA. After several successive calls with over 12 patients admitted, today was a deep breath in the middle of a hectic week. The most exciting thing that happened was our first admit, a large and angry black man who (after questioning whether my residents did anything useful besides paperwork) answered most of our questions with surly and progressively louder "I don't know! It doesn't matter!" exclamations, and who also decided while in the ED that he was hungry, and promptly left against staff instructions, dragging his IV pole and his partially hospital-gown covered bare cheeks behind him to find the cafeteria. The last I heard, security was searching for him. Seriously. I have no idea where he is. I hope he eventually comes back and reclaims his underwear.

Anyway, I digress. I was learning EKGs in prelude to questions I know are coming, courtesy of my attending, who is ever so excited when I have at least one question to ask him about each patient. He likes to know that I am invested and curious, and he's also feeling out his teaching style for students and likes to have conversations stimulated by inquiries. He is very sweet and makes me laugh, like yesterday when he was telling me about a research project he did while in medical school. Apparently, there were large rats that he and his colleagues used for experiments, and he was frankly creeped out by them. "The rats, you see, the rats are very large and I do not like to handle them," he told me in his heavy spanish accent, "but you have to, you know. They are very smart, and so you must caress the rat, yes, caress it like this, and then, yah! You must grab it very quickly! So I got on my big leather gloves, and I was caressing, caressing the rat like so, and then I grabbed it (with a violent motion) and I grabbed it so hard that I damaged one of its lungs. We discovered that when we opened it up later." Horrifying, yes, but ridiculously funny to watch.

 The EKG session, though, was the highlight of my day. Compliments from residents are not a daily occurrence for me, and so they mean a great deal. While Ben, my senior, was explaining how to determine results from the strips, I answered one of his questions with clarification from something we'd discussed last week. He laughed, looked at me and exclaimed, "God, that's why I love you! You're just like a sponge. You remember every single thing I teach you." And that's what makes him such a good person to learn with--not only does he rock at teaching clearly and concisely, but he encourages and doesn't make a big deal out of my mistakes. He and Andie are about the best thing I could wish for on this rotation.

Heroic Nudity

She's called the Veiled Virgin by Giovanni Strazza. This is what I love about how marble flows.

Finally, after over a week, I have had an adventure in LA. Let me sum up for you the highlight of my evening at the Getty Villa Museum's college night. 

"In this funeral fresco, added white paint accents the figure's heroic nudity." 

I did a double take. Wait, what? Sure enough, the figure in the Greek and Roman museum exhibit fairly glowed moon-bright with all of his painted glory, he was certainly nude, and...I suppose if you looked out of the corner of your eye and squinted a bit, he did look potentially hero-esque. His abs were very chiseled, and he had a strong profile and wavy hair, but his languid reclining position sort of killed the strong hero-image for me...and I kept getting distracted by trying to imagine a situation where a naked stranger coming to my rescue wouldn't have overwhelmingly awkward overtones.

What if it really were that simple? What if all you had to do was slather yourself in white paint, run stark naked into the middle of the city and strike a pose, and passersby would stop, point, and scream, "Look! There goes a true hero!" Everybody would get all excited, and that was all it took--you and your accented heroic nudity were an instant big deal. Ross informs me that, if we replace the paint with gold, I've basically described the premise of Immortals. Nowadays, the pointing and screaming would end with a shiny pair of handcuff accenting your heroic wrists.

The Villa was an excellent adventure and very good for the beauty-loving part of my soul...although I can't think there's a part of my soul that doesn't crave lovely things. I wandered through the halls fairly in awe of the intricacy of artistry from all those thousands of years ago, some rivaling anything you could find today for their lifelike depictions of those long dead. I loved the gallery of full-sized statues--it's amazing how marble seems to flow and come alive, how the illusion of transparency comes from solid stone. There was a carved girl with a slight smile on her face, about my height, and it was easy to look at the marble and see the individual that the artist took such pains to replicate--how he delineated the individual strands and curls in her hair, curved the pattern on her drapes, and how he made the stone of her skin shine. It was lovely.

Also, we exited through the Herb Garden--130 feet of every herb known to man. I was so excited that I couldn't decide which way to go first. I assumed that the true enjoyment of such a place was through the olfactory senses, so I picked sprigs of almost everything and was perfectly happy.

LA

The city of angels isn't quite what I expected--probably to be expected, since I haven't seen much of it past the skyline from my temporary apartment. I'd like to go down into it, explore, talk to people before I make up my mind, but the chances aren't as readily available as I'd thought, and I don't quite feel up to the task of wandering solo and keeping myself in one piece.

White Memorial is proving to be enjoyable, for the most part. The most noticeable difference so far is how the residents interact with me. Back at LLUMC the species can, at best, be described as pleasant but detached and aloof. We address them as "Dr. White" and "Dr. Shuminahumina", and it's all very correct and such even though the only difference between us is sometimes barely a year and a half. Here, my residents quite emphatically told me that they are to be addressed as Ben and Andie, and that the abandoned wing they use as a clubhouse is now the "Ben, Andie, and Alyssa" hideout. They're encouraging and they laugh with me when I mess up and then tell me how they've done worse. The other residents I run across actually make it a point to introduce themselves, and they always use their first names. They assume me into their world. It takes a graceful spirit to do that, and I'm grateful.

There are more of us here than I thought there would be, as well. Last night was such fun! I wanted to cook, so with Ben acting as bodyguard we made our first foray out into the world to find a grocery store, a pot, and some cooking utensils. There ended up being seven of us in this small apartment...Debbie, who scared the bejeezus out of me when she stumbled into my room on the third night, after I'd gone to sleep, to take up residence in the other bed; Alicia, who I'd never really met before and who has the most lovely head of hair; Zach, who has fantastic taste in girlfriends; Ben, who warded off all the scary LA people; Jonathan, who has a kind spirit and great kitchen ethics; and Jessica, who just joined out class and whom I like very much. That's always so much fun for me, to be able to feed people and just be surrounded by goodness and contentment.

The only downside is that I have to work tomorrow...after this, I get my Sabbaths off, so I'm resigned to sucking it up and doing my best. But most everyone has gone back to LLU for the weekend, and this little apartment is very quiet. Not so, unfortunately, the street band playing outside. Oy vey. Sleeping will be difficult tonight!

Peanuts

So many times over the past few weeks I've thought, "I must write about this." Those moments have been frequent--not all happy, and some heartbreaking--and yet the nights have been late and evenings heavy with the loss of sleep and press of responsibility. Soon enough, I find that there are too many stories clogging up my veins and it's impossible to pick just one. I prefer a single event, really--I love bringing out the hilarious potential and learning how to recreate a moment so that I can share it as I saw it happen--and OB GYN is amazingly full of the ridiculous. If you like your awkward comments about vaginal fluids, Carrie will provide them. If you're a fan of "That's what she said!" moments, shoot, the OR is a never-ending source of entertainment. And the fun never stops on night float, which I was lucky enough to experience with Carrie and Lisa, who made the never-ending hours so entertaining.

I suppose the most important and joy-filled moments of my life in the past few weeks have been the babies I got to catch. Oh, I watched many deliveries, including several crash C-sections and one OR delivery of twins, but night float is an entirely different story than the daylight hours. Dr. Barrera is the resident in charge of us, and the very first thing he did on that very first night was to take me into a room, gown up, and show me exactly how to catch a baby, hands over mine. She was a beautiful mess, that little girl, and while everybody else was calling out phrases like, "Start the Pitocin" and "Hand me the clamps," I was just holding on to her and babbling like the most besotted moron--"Hello, precious. Aren't you the sweetest thing, just look how perfect you are. Hi, sweetie." It was one of the best moments of my life, followed at the end of the shift by another delivery in which Dr. B left me completely in charge of getting the baby out, plus one helping hand from the senior resident as she let me get used to the force necessary to move the baby where it has to go. All told, I caught four babies on those four nights, and each one was a new and beautiful thing.

It was during that week of night float, after days on end of 14 hour shifts and short nights, that I realized I was happy. Even with all of that, still excited to go in the next day and see what else would come along.  I went in today and discussed OB residencies with Dr. Hart, who I respect and enjoy very much. I think I've found the way my life is headed, and after several years here and most of my life in school, that's a very good feeling.