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Destroyer of Nations

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catching up [Dec. 17th, 2010|05:09 pm]
Destroyer of Nations
it's been a while, old friend. and not much time to catch up now, either.

but just let me say. I'm a wizard of the stock market. No fucking shit, either. We're talking 30% return in the last year. Fuck yes.

Let me also clarify that this is probably what one might call luck. Ok. Tesla was a solid decision. But there were about 100 nanotech companies to choose from. And I chose right.

Future ideas: Rat. Octopus. Ummm, no time to write more.
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15 days [Oct. 13th, 2010|10:38 pm]
Destroyer of Nations
I have 15 days of actual work until the end of this rotation. This includes 2 nights of call.

I nearly wrote "I have 15 motherfucking days..." and then I nearly wrote "I have 15 fucking days..." and then I wrote what I did because I thought that it sounded too forced to say fuck.

I hate to sound recursive (like a psychiatrist talking about a patient), but I am beginning to feel dysphoric. Last month was brutal. This month has been brutal up until today. Today was the first bright day of the rotation, and there are some reasons for it.

Paul's laziness rivals my own. He will gladly take a new patient, so I don't mean that he'll dump work on me. But I think we both operate at the same pace, so it's really nice to work with him. We both sort of silently groan at how busy this rotation is, and then bitch about it in secret code. I'm not making this up.

What I'm about to write, I told to some of my classmates, and one of them in particular is a workaholic and rolled her eyes at me. I have 7 patients now. Three of them were there when I started this rotation. None of them will leave this week. These patients are all rocks to varying degrees. There's a good chance I'll still have most of these patients in 15 days. That's kind of my goal anyway. I think I might call it rock surfing.

Of course, what I want has nothing to do with what will actually happen. Because whether they stay or go has nothing to do with me, and has everything to do with their response to treatment. So in truth, my hope to still have the same rock garden at the end of the month is nothing more than superstition.

I am exceedingly superstitious these days.

I have one particular patient who is brilliant. I am speaking of this patient's intellect. This patient (to mask the gender, of course) is incredibly smart and knows how to work the system. I want to speak more clearly about this, but I can't right now. I'll talk about something else.

I have major qualms about keeping people on a locked psychiatric unit. Yes yes, danger to self and others, right, that's the reasoning we use to do what we do. But to what degree do we carry that argument? I have to go to bed. I'll write about this later.
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gol-den [Oct. 7th, 2010|10:21 pm]
Destroyer of Nations
My last call was unbelievable. It was golden. It was pure perfection. From 5pm until 8am, the entire duration of my call, the pager did not go off once. Not a single call. Fucking amazing.

It makes me wonder if the beeper was broken.

How am I so lucky?

And the next day, I played like I was up all night. I even carried around a Rock Star. I stumbled around and watched people through squinted eyes. I wore a confused scowl on my face.

I still had to stay all day. I wonder if the day would have gone differently if I was really post-call.

Oh. My. Fuck. I just remembered something.
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medicine. [Oct. 4th, 2010|10:34 pm]
Destroyer of Nations
I'm doing a month of internal medicine now. It's the fiery pit people unknowingly imagine when they think of residency. We're talking about the 80 hour week. More even. More if you count all the work you have to do at home. Not you, but me. All the work me have to do--I mean, all the work I have to do. That's better.

It's busy. Really busy. Unreally busy.

And I don't even want to get into the weird shit I think about when my brain is ground down to a mush stump after a 9 hour Satur-motherfucking-day. We're talking about 17 hours of work over a weekend. Are you fucking getting this? Those are light days. Those are the easy days of God's Rest. Today was a 12 hour day. That is 12 hours at the hospital. And 3 hours outside the hospital. 15 goddamn hours. This is normal.

I will bitch about this for years to come.

And I'll tell you, those long days on Neuro included at least 1 hour of fucking around with my friends down in the psych department offices. So they were long days, but they were easy and carefree (until I got little miss "I'm only 20 and I'm on the brink of death and no one knows what I have and you Mr. 4-months-out-of-med-school-and-now-I'm-a-doctor are her doctor and you are completely alone for the next 5 days").

But this month, this month is not easy. This month is multi-task out of necessity, stop accepting new work at 5pm and still be stuck at the hospital til 7pm and continue to work until 10:15pm. This month is busy like I've never known busy.

Then my chief jokingly says today, "Don't let them talk you into switching to med/pscyh!" And it's a "joke", but it's tantamount to saying, "Don't let them talk you into cock-and-ball torture!"

On the plus side I've been mistaken for a senior resident 3 times in the last couple days, so I kind of feel like a pimp. And by pimp, I mean purveyor of nasty skanks.

On call tomorrow. I was almost completely golden the last time I was on call. I think my luck will shine tomorrow. I will have the perfect (silent) call tomorrow. I will it.
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shit. [Sep. 18th, 2010|12:04 am]
Destroyer of Nations
shit got fucked up. I ended the day with 3 patients. i don't trust these neuro residents. They are not brick walls. I am a fucking brick wall. They are a sieves. They are perforated and inviting.

That's not entirely true.

But it feels like it.

shit got fucked up. That's what I was telling you about. shit got fucked up and I ended the day with, what, 3 patients? patient F, patient K, and patient B. I think that's all of them. One will probably go tomorrow. Another might go Sunday unless labs are fuct The third is with us indefinitely, but that one is a delight to talk to in the mornings. That one tells me about staying up all night drinking with a preacher. That one tells me the most fantastic stories. That one stays in bed all day.

The stories are confabulations.

It's a fantastic word. Fantastic.

I'm going to go read Dune Messiah until I fall asleep and then wake up slightly in pain due to hangover and then I'll take optimal care of my patients and then I might take a nap. One nap. A single nap.
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meth. [Sep. 17th, 2010|08:06 am]
Destroyer of Nations
"Why isn't our son going home on antibiotics?"

"Because whatever is causing his symptoms can't be treated with

"What's causing his symptoms?"

I want to tell her the truth, that her son smokes meth and that's why he's
fucked up. But I'm not going to tell her. He can tell her if he wants to.

So I make some shit up. Basically. It's not lying. It's deception. Maybe
it would be best to say, "I'm not legally allowed to tell you what is wrong
with your son. He will have to tell you himself unless he gives us written
permission to tell you." But that's not what I was instructed to say. I
was given a line of bullshit, and that's what I'm going to use.

After today I'll only have one (1) patient unless shit gets fucked up.
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briefly. [Sep. 15th, 2010|05:42 pm]
Destroyer of Nations
I heard some real inspirational shit today, made me realize that I want to do a fellowship. Can you do a fellowship in schizophrenia? I want to be an expert in some area of psych. Academics would be amazing.

This is a new sensation.

I'm exhausted from this rotation. It's work. Psych is challenging, but I love it. Neuro is challenging, and I do it because I have to do it. Just 6 more weeks and then I get to do psych again.

December: a couple days in Tucson. Maybe go to SC with Steve, but prob not.

March: Vegas for conference.

May: Paris.

Hoping to learn some more French. Will not likely happen.
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seizures [Sep. 3rd, 2010|04:12 pm]
Destroyer of Nations
This new rotation... it's kind of awesome. Lots of things are kind of
awesome. And this new rotation is one of them.

No patient cap, which potentially sucks. But my senior and attending
are aggressive at moving patients out who don't need to be here. So in a
few short minutes I'll be carrying 2 (two) patients. On a psych service, as
soon as a bed opens up, it gets filled, which makes discharging a patient
bittersweet, and it makes rocks your best friend. A rock is one less
patient to worry about, it costs you 15 minutes a day, but it saves you
hours. But a rock on this service costs you the 15 minutes, but it doesnt
save you any time, because there's no cap.

Dr. B asked a patient (who claimed to be a "writer") if he had ever
published anything. And the patient spoke a lot of bullshit which can be
summarized as "No, because I'm not really a writer." It was the question,
though, that betrayed an expectation that someone who claims to be a writer
should be measured by what they've published. This is not an unfair

So I need to write something, just for the hell of it, that might be
published. Oh that's a weak statement, isn't it?

I started Franny and Zooey by JD Salinger. It's amazing so far.
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decemberisms [Aug. 27th, 2010|11:53 am]
Destroyer of Nations
Week of vacation in December. What to do with it? Only a week, can't go
far. A beach would be nice. Maybe stay home, save money until I can get a
2 week vacation lined up. 2 weeks. Go to Thailand or Vietnam.

Friday is awesome. I don't nkow what I'll do tonight.

Steve's work has BBQ tomorrow afternoon. Definitely going to that.

A coworker pointed out that he accidentally types "Consluts" instead of
"Consults". Now we're the Conslut Team.
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secrets [Aug. 26th, 2010|04:12 pm]
Destroyer of Nations
It turns out none of the residents in any program get any help setting up VA remote access. I talked to some medicine residents today and when they learned that I knew the proper incantation and reagents for the dark ritual, they were like starving sharks in bloody water.

I am hesitant to help get all of the residents access. This new method is totally legal. Dave showed me how to use Sysprep to bundle the virtual machine as a new system that will require a Win XP Professional product key when you start it up the first time, and there's no pirated software in the setup. So that's important.

But I'm afraid that if I give this power to everyone that something terrible will happen--i.e. I'm afraid the VA will learn of this and make up some bullshit excuse to deny us remote access entirely. An example of a bullshit excuse would be that this software is run within VMWare Player, which could be construed as a security vulnerability. The University won't give a department a VMWare Workstation license if the virtual machine will be handling confidential data (and they specifically mention HIPAA protected patient information). I do not know why this is, perhaps because if the primary system is vulnerable, then the virtual system will be compromised as well.

So I'm in a difficult position. It's not really that great of power actually. It will just make the lives of these residents a little bit easier. Marginally easier. Psych residents are the ones who really need it, because it will keep us at home for everything but admissions and code greens.


It's tough. It really comes down to a sense of scarcity (although my concerns about VA bullshit are totally valid), because my own supply could be jeopardized if things go sideways. And perhaps more importantly, if there is some legal point that I am unaware of (e.g. it's illegal to distribute virtual machine images like this, maybe because 3rd party software has been installed on it), then that could jeopardize my entire life. Getting my shit confiscated would be a pain in the ass and potentially devastating financially.
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