we remember

veteran's day

rut

so, i have been learning a lot about hunting. apparently in chillicothe everything revolves around hunting. we have several gentlemen who are resistant to having to miss out on (insert aspect of hunting here) due to pesky health care appointments. a few weeks ago it was explained to me by a man who only communicates by nodding and writing brief notes on a pad of paper he carries in his pocket that it was a severe inconvenience to schedule follow-up bloodwork. as an explanation, he offers this note: "it's rut". i look at him quizzically and tell him i don't know what that is. he starts to blush and kind of fumble around, and finally writes "makes deer run". suddenly, it clicks. all the male deer are out chasing after the ladies, which makes them easy pickings.

in a related story, we had to explain to one of our long term care dementia guys he can't ride through the halls in his wheelchair without any pants. it's offensive to other residents and visitors. he replied "i'm gonna get a tattoo on my ass that says 'property of dr. (name of attending)'".

gun season starts monday.

who's keeping score?

last night, i had a throwdown with a PA.

to summarize, i was staffing the inpatient pharmacy. the MOD (medical doctor on duty) entered a script for buprenorphine, or subutex (i couldn't find subutex.com, so here's suboxone, which contains buprenorphine). bottom line is only one MD in our hospital is allowed to prescribe it because special certification is required. guess what? the MOD was not that guy.

so after a frustrating discussion with the MOD, she hands the phone to some guy who starts berating me. i inquire, "i'm sorry, who is this?" to which the voice on the other end of the line replies, "i'm mr. ******, the PA in blah, blah, blah". voice continues to bully, saying how can i interrupt this patient's therapy, etc. etc. i say, "you don't need to get testy with me, we just need to figure out what we're going to do". after the telephone equivalent of a stare down, megalomaniac PA agrees to call MD who can prescribe the medication in question.

i must have really pissed him off when i told him not to get testy with me, cause what does PA do? calls the chief of pharmacy to tattle on me.

later i needed to confirm that PA really wanted to prescribe the same medication in 2 different forms to be given at the same time. when he returns my call, with an absolute lack of pleasantries, he just says "what do you want?" i explain, he says yes, he wants it as he wrote it. i confirm, and he says to just do what i want. what i wanted to do was walk down to the floor and punch him in the throat, but instead i paged the MOD and had the orders changed.

errgh.

choke

never choke if i'm around.

dr. heimlich would have been so disappointed in my skills at his manuever. today we had cpr certification and while i seem perfectly proficient at 100 compressions per minute, that tricky upward thrust to dislodge chokable niblets eludes me. the nurse teaching had to move the choking-hazard-on-a-string to the front of the dummy's mouth so i could satisfactorily pop it out with a well-placed, though very weak, thrust.

apparently one must have a degree of upper body strength i lack in order to execute the perfect heimlich manuever.

you've been warned.

i'm an expert!

i survived my first panel discussion as an "expert". it helped quell my rampaging butterflies that only about 10 people showed up. so i was effectively able to field the questions without sounding like too much of an idiot. at least i hope not.

i think it was because i accidentally wore my underwear inside out all day. i read a long time ago, when i was a kid, that if you serendipitously put an article of clothing on inside out, you will be graced with good luck the whole day through.

what i didn't want to do

i totally had no desire to make this blog about how i spend most of my time riddled with self-doubt and questioning my decision-making skills, both in life and pharmacy practice. i should have chosen a career my suitable to my anxiety issues, prehaps a trash collector or part of the division of abercrombie and fitch that distresses jeans for purchase by spoiled adolescents. it wouldn't matter if i messed up; destruction is part of the job process.

but, unfortunately, i had a particularly bad week two weeks ago and this coming week, i am expected to serve on an expert panel. the purpose of this expert panel is to do a q&a about suicide in celebration of suicide prevention week. i do not feel my knowledge of drugs and suicidality is adequate to qualify me as an "expert", so i have been spending the weekend cramming and making notes so i don't look like a total idiot. really i'm less concerned about looking like an idiot than providing bad information. one would expect those on an expert panel to have some inkling of what they are talking about, and it terrifies me to think i could say something that would in any way influence treatment decisions.

i guess in some respects my absolute lack of confidence is good. it compels me to always care about what i'm doing, to pay attention, and to keep learning.

my senior quote in high school was a few lines from a billy joel song, "shades of grey wherever i go/the more i find out, the less i know". i have always found this to be true.

northern exposure

ok, so i know i have been a terrible blogger and my contributions to this page have been minimal. reason being, i use a computer all day and the absolute last thing i feel like doing is picking up my laptop when i get home.
anyway, life in chillicothe is humming along. i joined a gym and started taking zumba to counteract the fried food so prevalent here. it's pretty awesome. i am off psychiatry and on to internal medicine. as much as i love psych, i didn't really feel like divulging tales from the psych ward. frankly, the month was pretty uneventful. lots of substance abuse, which is 1)boring, and 2) frustrating. frustrating because it's such a revolving door. i had some guys last month that i had last year at this time who were back again to go through detox and treatment. plus, i don't want to write about people who spend $700/day on cocaine or live under a bridge and are accosted by children throwing rocks because they're drunk and homeless (the vet, not the children). that shit's depressing. i'd rather be able to talk about how someone came in and was depressed and we fixed him up and made him better through a combination of appropriate medications and psychosocial rehabilitation. unfortunately i just didn't experience that satisfaction.
anyway, what i have been doing in my spare time (besides zumba) is watching dvd box sets of northern exposure. i love that show. the moose walking down mainstreet? classic! i've come to realize that this show was my basis for my whole impression of small town life. quirky, colorful inhabitants who debate the finer points of philosophy and native wisdom while drinking beer and/or hunting in beautiful alaskan wilderness. i feel a sort of communion with the displaced dr. fleischman. now, i know southern ohio is definitely NOT alaska and i am not a jewish new yorker, but where are my quirky, colorful inhabitants? the pensive disc jockey who waxes metaphysically? the ex-astronaut who has christened the area "the riviera of ohio"? why am i stuck in a town that is populated by a large percentage of people who think shirts and shoes are optional, and not in an endearing way?

this is just another example of how the media has done me a disservice. for another instance, we can talk about what jane austen has done to shape my unrealistic expectations for love and romance. but another time.

my point is...i really have no point. in closing, i just want say what i will be missing out on by heading home to cincy this weekend: the easy rider biker rally. it's supposedly like mardi gras in black leather. sorry to miss out on the debauchery at the fairgrounds, but luckily chillicothe is much closer than alaska and i can retreat home.