February 10th, 2004

Nescafe rabbit

More has happened, but I haven't the time to find the words.

daimones, don't ever stop telling me when I'm wrong. It makes me a little better every time.

I got the car.
Now I have to wait for everything to go through with the bank, which means I don't get to drive it again until the weekend.

I need a good name for it now. I'm thinking something Japanese, rather than French.

On call tonight; maybe an update unless I'm smart and go to bed - two days now of 5h sleeps are not good.

And I'm late.
  • Current Mood
White Coat

I went to the desert on a horse with no name...

So I needed a client, because updating via lynx was just not happening. So I found Charm. It's cute. It uses vi for its editor by default, and I don't really know how to use vi, so I crashed it once already. :P But I'll figure it out. Or I'll change it to emacs or I'll change it to pico or I'll give up in horror.

One thing I forgot to mention last night, as I was exhausted: Dad paged me yesterday morning to tell me my baby sister Erin had gone into labour. She delivered at 6:40 something, 7#3oz baby girl. I'm an aunt, O Best Beloved. I wanted to go see her yesterday but by the time I got done at the dealer's it was too late.

Rounds are in a few minutes, but Charm (if I can figure out how to get out of vi without losing my entry) means I'll be able to continue this later. My notes are alll done.

--- 14:00 ---
Notes are all done, discharge summaries are all tucked away, and I page my resident to find that the patient down in Detention who came in the other night with chest pain has decided he's not sticking around here any longer, just to get a stress echocardiogram.
So it's a good thing I finished his discharge summary - as now we're cool to get him gone. He doesn't really need to be here anyway - he can get a stress echo as an outpatient. And Nuclear Med said they might not get to him today, so why keep him and spend the county's money? No point at all.
My charming lady with the stroke is going to rehab as soon as we can make Cards and Vascular happy. She's gotten MRIs, MRAs, CTs and dopplers. She's a cute but nutty old woman with the personality gestalt of a child. And all she's concerned about is getting to go home.

I'm tired, now, and I have nothing to do. But I'm on call - so along with getting to wear comfy scrubs, I have to sit around and amuse myself for a while. O will page me when we start getting admits, around 1500. The goal is to fill up our quota of 9 in waves of 3 every 2 hours from 1500 on. Then we can sleep well. I think we admitted 2 already today, even better.
If this had happened yesterday, I might have gone on a self-deprecatory rant about how I feel like nobody trusts me enough to criticize me, and talked about the things that make me feel that way...the fact that Dash is the only person who will reliably tell me when I'm being stupid, the feeling that I could trample all over people with good intentions and never once be chided for it, the empty disconnect between the life I live here and the one I live at home - I miss everyone, so very much, and I don't think I ever spend enough time talking to them. When the only time you have to talk is so very very short, you don't spend it all bringing up the little problems. That I need to learn yet. I would have explained contritely that the overbearing sound of my comments about Quin was a case of bad construction rather than the arrogance I am so prone to - that my mother wanted me to know she felt I'd done well in letting Q live her life without mothering her, that I see her more confident and more willing to decide things on her own than she was when she came, that it feels good to see that and to feel like I've been in some way helpful. I would have explained all that, O Best Beloved, and it would have been through my tears because the criticism that had been alluded to came from someone I dearly love - and the people I love are the people I most want to hear these things from, but the people I take it most seriously from as well.
But today it's more in perspective - I have my father's cyclothymia, I think, a sort of very mild bipolar disorder. Angel bears the brunt of it in mercurial moods that can change in the blink of an eye from buoyant to hysterical, in duck-and-cover screaming fits that invariably end either in my breaking down in tears or my screaming obscenities at him and storming out of the house, later to break down in tears. Angel sees that - those who've lived with us or spent long times at our house have seen it - I'll go from cheerful and contented to borderline psychotic in moments. And I can swing just as quickly back the other way. It's worse when I'm stressed; when I'm not, when I'm on an even keel and enjoying what I'm doing, you'd never know.
He says he keeps waiting for me to flip out, I've been so happy and so upbeat this last week and a half. That worries me, that he's gotten so used to my mercurial temperament that he isn't completely willing to forget it's possible. But he has reason to.
This month is a good month; next month will be better because I'll be at home. Both months I'm doing what I love to do. I don't feel as stressed, as brittle and unstable. I can believe in my good moods, and given a little time I think Angel will get used to it. After all, he's known me long before medical school, from back in the days when the mood swings were far rarer and further between. I don't think they're gone. And today, it's in more perspective than yesterday, buoyed by the wild thrill of Erin's baby and the new car.
And it'll all work out.

Speaking of the car:
The bank won't let me sign the loan papers via fax. They're going to overnight them to S's, where I'll get them tomorrow after lectures. I'll then sign them, take them to UPS, and overnight them right back out to Angel at work. He should get them Thursday, will take them to the bank and get the check, go in Thursday evening and pick up the new car. Then Friday I'll drive up, ditch Michel-Ange at my mom's house, and meet Angel and my car. Then I can get down to the business of naming it.
Daddy says all stick-shift cars are male. But it's such an organic car that it just feels feminine. I'm leaning toward Misaki, as that name is fascinatingly pretty to me (yes I know, it's all over the place in my stuff right now, sort of like Alexandra was years ago), but I'm looking for good Japanese boys' names to compare. And no, piccolopixie, I'm not going to call it Rurouni or Kenshin. One of my residents was Akihiro, which is kind of pretty. Shininichiro was another, but now that I've got an NPC built with that name I can't dissociate it from the warrior figure he is, and this car is not a warrior car. So, to those out there who've made it this far and speak a hint of Japanese, any ideas? I'm trying to avoid blatant anime names, but subtle ones wouldn't be necessarily bad. Does anyone remember the names of the boys in Weiss Kreuz?

I've probably a few more things I should mention about the weekend and the last few days, but I've exhausted my mind and I'm thinking I'll walk down to the ED and see what the admit list looks like. Wish me luck for the evening, O Best Beloved.
  • Current Mood
    lonely lonely
White Coat

"It's Tuesday", he says. "Where are all the f*ing druggies coming from?"

I need to get to sleep before too long, O Best Beloved, and yet I have so much to say.
O paged me - "got one for ya." He's so cool. I love doing things for O because he never gets psycho. Even when he was berating the night shift for not drawing cardiac enzymes, he never raised his voice, just explained things in a this-is-ridiculous tone of voice, words carefully chosen and very fast. I wish I were like that.
Met him in the shock room in front of a mountain of flesh. The man is nearly 2 Hoosier Units - that's almost 400 pounds, for those of you not from the Midwest - and he smells bad. And he's on oxygen, staring blankly into space. We try to get a history. He's not cooperative, other than giving us his mother's name - doesn't tell us anything useful. It's not that he refuses to answer questions, it's that he doesn't. Just keeps talking about nothing.
I keep going, O calls mom. He told me a huge run-on story, with highlights like the following:
  • He used to be a police cadet before he got whacked and spent a long time in a coma.
  • When he was working, he used to mark where his truck was parked, and someone moved it every day. That same someone (he had names for all this, but I don't remember them) got a spare key to his house and beat him up and took all his money because he called the drug house over on (some street) in to the police.
  • He faxed the info to the Feds in Waco that let them bust the place.
  • Someone stole his van and chased him all over town with it.
  • The reason he's in the hospital is because (name) right over there (here he points to the ER nurse), who stole one of his police cadet uniforms and used it to pretend to be a cop, knew that he knew that he wasn't really a cop and found him on top of his mom's house and shot him. But our patient, being a canny fellow, had a camera on a pole to watch the roof of his mama's house and it's wired to a TV downtown, right to the Federal Government, and they sent the police.

O gets off the phone as I'm listening. I finally escape to find out that Mama says he does cocaine, and that he gets these spells like this...and there he is, still talking as long as he thinks I'm listening. He went on and on and on. This is a mid-forties gentleman who still lives with his parents and does cocaine, obviously with some kind of delusional thinking, and we don't know when he last drank - he says some kind of liquor-store wine, I'm thinking Red Rose type, three days ago.
We're scanning his head, his heart (oh, he's in atrial fib, and he has hypertension, and he has diabetes), and his blood. Tox is negative, alcohol is negative, so our guesses are some kind of stroke, DT's, or just plain crazy. Peeked at the labs and someone's ordered a syphilis screen. It's possible...

I'd barely finished with him when O sends me over to see the next girl. I have a Mage character who's a barely-legal child of a hippie, raised on peyote and pot, hooked on X and only avoiding hard drugs because she's too vain to stomach the idea of needle tracks marring her body. This girl was Jen gone wrong.
She's early-twenties, history of having showed up at the ER once for detox with a claim of shooting up heroin 10x a day, taking percocet 60-80mg, and about 150 other pills, and walking out before the paperwork was done. She's in now because her dad picked her up from a friend's and noticed she was absofriggin'lutely nuts. We got her because her creatinine is high.
Urine tox is positive for cocaine, amphetamines, and opiates. Interview consisted of us asking questions and her talking a hundred miles a minute about somethign completely else, then apologising and giving us a few semi-lucid seconds. She told us she'd been shooting up cocaine and heroin the previous night - not together, no, sequentially. "Wouldn't they just cancel each other out?" A asked me later. "Get nothing?" He was being facetious. She probably was doing something else - the girl was completely manic, absolutely out of her mind with drugs. It was an amazing experience. I could put my hand on her shoulder - the contact seemed to give her focus; she'd look at me and keep looking at me as long as I was touching her - and talk to her, she'd pay attention to my face, nod a bit, get teary. And then I'd ask a question and she'd give me a high-velocity stream of gibberish before looking all around. She was very concerned with under the bed, and with all the other patients.
We gave her enough Ativan to put her to sleep so the nurses could get fluids in her and draw labs. She later woke up, I was told, and they had taken her out of restraints, so she was dancing half-naked around her little isolation room. When we got there she was in restraints - one hand, one foot. ER nurse said "She's gotten out twice already - walks around popping into other people's cubicles and scaring them - I just use them to slow her down a bit. I don't want to lose her."

I wonder, O Best Beloved, what she'll be like tomorrow as she starts to go into withdrawal from the heroin and amphetamines...

It's half an hour past my self-assigned bedtime. We capped around 8 or so except for the shockroom patient, I have my two admits and my H&P work is done; I've been dismissed for the night. In the morning I have three patients - one druggie, one strange man, and the sweet old lady with the stroke and the childish gestalt. Nobody in their right mind today. Is it a full moon?

Friday I see my Angel. Friday I get my car. Fridayfridayfriday.
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    horny horny