Wednesday, April 11, 2007

On Being Connected


This is a post that's about me and my life and something that's important to me, and it's about psychiatry, even if it might not seem that way.

I am very lucky. I have some really wonderful people in my life--both family and friends. My husband and I met our freshman year of college-- we've been together our entire adult lives, we carry each others' histories, we've shared nearly every event (including and especially the Red Sox victory in the World Series in 2004, even if he was in a hotel room in Florida), he knows all the inside jokes, let me write chemistry equations all over his legs, listened to my pre-med then med school angst, has survived endless shrinky dinner parties (--newsflash: he's not a doc).

And then there's the Judge, along with her dog Tex (who vomited on my carpet this morning, thank you for that Tex), who makes her way over for coffee every morning, still in juice-can sized hair curlers and looking very lovely nonetheless. Every morning you say? Every morning. Occasionally, wine later in the day, once she called from her car to ask if I'd go out for soup with her (I did) and the Judge is always up for a movie, so my standing date to chick flicks. I like Carol (and doggy Prize) and Maria (and Nelly who jumped on my bed, tracked mud through the bathroom, & ate the garbage) too, but they're more sporadic and I often hear about their lives in snippets, not as a continuous episode.

Camel (see my post: Everyone needs a Camel) lives pretty far away, but we talk often, sometimes daily, always on the go, sometimes for pretty long. We talk about psychiatry, the hubbies, the kids, whatever. My first stop when I have a problem that needs solving. Camel has good ideas and another minor bonus about her: very good taste in food-- when we're in restaurants together, sometimes I just order whatever she's having because hers is always good.

ClinkShrink has ragged on me for 20 years now, she's in my life more since the blog (this is good). Mostly though, I remember that residency wasn't always the easiest time for me-- I was new to Baltimore, soon pregnant, missing my friends and feeling a bit isolated, as well as exhausted. There were times there I called Clink every night, for long periods of time. She talked about her cats (Spike, then Elavil and Prozac, I kid you not). It was nice. It's probably taken me 20 years to appreciate just how nice.
Linda from med school writes in frequent spurts, glimpses of her life as mother and shrink (in that order). She listens to some of the garbage that courses through my mind, stuff I'm happy to have someone a little bit at a distance to tell these things to.

And then there's ABF. Where do I begin? She sat in front of me in Mr. Wasserman's civics class in Junior High. We lost each other in college-- she sort of fell off the map right after she visited me during a break our sophomore year. I next heard from her 10 years later, and again, 10 years after that. And then came e-mail, and when ABF got email-- maybe 2 years ago?, we started sharing our lives. Again. We took off from somewhere new, it's not just where we left off, and we email, everyday, probably 3 times a day. We've caught up on the past, I think, shared our views on religion, child-raising, weight loss efforts, what we're having for dinner (yes, this is what psychiatrists talk about with their friends, it's a step beyond the endless junior high school discussions about pierced ears and shampoo). ABF has two children, a son with autism, she spent today helping her daughter with her Spanish class project, she knows what I did today and every day. She's getting over a cold, tea and chicken soup have helped, and the weather in Boston has been quite cold lately. I go through my days filtering my experiences with the thoughts that "Oh, I'll tell ABF that later." I've only seen ABF once in recent years, it's funny that this relationship of bits-and-pieces of the mostly mundane, is so important to me.

I forgot some others-- some of my email relationships have been very meaningful to me, but have petered out at least in their day-to-day investment. Cuz B used to write several times a week, I knew when she took a walk, when she had her hopes up about an audition, when a boy was on her mind. Now it's down to once a week, we skim over some of the little stuff, she's still huge in my heart. Victor has made his way in, and now has been dragged to hear a psychoanalyst speak on the most depressing of Russian films. Roy, of course, is special, a friend I connect with on perhaps a different level; I think he wants me to appreciate Monty Python and it may be a climb. Eight years of lunch with Lisa on Monday-- friendship contained in its own little box-- and I still miss her.

When my mother was alive, she cared about my life in the most detailed way. She lived a few hours away, I didn't see her often, but who else cared so much about the little things. If I bought a new shirt, who else would ever ask me to describe it in detail? After she died, I wished I'd had a digital camera so I could have photographed and e-mailed her the smallest of things, she liked to picture everything in her head.

The blog is like it's own little world-away-from-reality of connection. The same people visit and reliably post. I wonder how Foofoo5 is doing. Carrie, Midwife With a Knife, and Lily come daily, Sarebear wanders in and out, JCAT, Rach, and the assorted others who touch our bloglives at particular moments when something resonates.

So I said this would have something to do with psychiatry, not just my personal ramblings. Today my youngest turns 13, I think I'm feeling a little sentimental. My husband and I were talking about plans for the day, I referred to her "the baby" as I often do, and he said, "She's not a baby anymore." Oh, she still is.
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Obviously, psychotherapy is a way of being connected. Someone listens, they listen hard, they care about the details of your life, they remember them week to week or month to month, they want to know what happens in the next chapter, in a sense they collect you. Maybe it's love, in some funny sense of the word, certainly it's intimacy, sometimes it's simply a business affair. Hopefully some of it's about mutual caring.
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There, did I tie it together?

29 comments:

Rach said...

Dinah, what a wonderfully heartfelt post. It sounds like there are so many people in your life with whom you share your daily struggles and triumphs. I think it would be so cool to have coffee with the same person everyday. Does the judge always come over in hair-curlers?

The concept of a support network is one that I didn't quite understand until quite recently when my 3 closest friends went away to school for the year. It just isn't the same without them close by, even though we email, facebook, MSN, and phone each other quite frequently.

I really enjoy reading what you, Clink & Roy have to say. It's made me think about myself, my life, my relationships and my therapy in different and novel ways.

I only wish there was more time for you all to write and share with us, your readers. BTW, thanks for including me amongst your thoughts everyonce in a while... It feels comforting to be thought of.

Rach (who is watching the snow fall up here... we may get 5" tonight... I may have a nervous breakdown if that happens)

Midwife with a Knife said...

Dinah: I agree with rach. It was a very heartwarming post, and kind of a nice reminder to stay connected. I have a few friends from high school and college I frequently think about, but am on the verge of loosing touch with.

And then there's the friend that I talk with every day (often more than once, sometimes for more than an hour at a time). The first person I call when... well... when anything happens. Good... bad... whatever. I call her when I'm scared, when I'm happy, when I'm sad. We've been together through all of our collective medical school and residency and fellowship angst, and through each others personal turmoil.

I should call her and thank her for being my best friend. Thank you for reminding me. :)

Midwife with a Knife said...

Oh, and I forgot to add, Happy daughter's birthday to you! :)

Here Come The Judge said...

Dinah,
That is probably the nicest thing anyone has said about me in a long time (unless you consider "white haired honky bitch" to be a complement). But then again, it has never been the coffee that keeps me coming over evey morning. It dawned on me a long time ago that we need our time as much as, if not more than, Tex and Max. Make sure the coffee is hot in the AM

NeoNurseChic said...

Dinah - That was such a sweet post. :) Hope your daughter's birthday was enjoyable for all! :)

This one resonates with me as do just about all of your posts in some way! I had a very heartfelt conversation with my friend Tom tonight. Tom and I have known each other since high school, but he was 2 years older than me. We have only been best friends since my best friend Lindsay's wedding in November. We talk every day. I was very insecure and basically did not have many friends before Tom...Lindsay and I were best friends but before she got married, she was so busy that we didn't talk for like a year - now we talk a lot!! So all the sudden I went from no friends to 2 friends!!

I said a lot of things to Tom today including the fact that when I considered taking my own life (before he and I became best friends), so much of that was loneliness and even though this will sound rather insignificant, what sent me over the edge was that when I came home from one of the worst days of work ever, I walked into my apartment, looked at my phone and saw no missed calls.....same as every single day. I had no new emails. Nobody was trying to IM me. I felt like not only did nobody want to talk to me, but nobody even wanted to make sure I was doing okay, either.

When the headaches first started, my friends were very concerned. My music fraternity sent me cards when I was in the hospital. People called. They came by. They checked up on me. But as the headaches stayed and I continued to deal with all that, people started falling out of my life. They say that it's times like this that you learn who your true friends are. What I learned was that I had almost no true friends! What a concept... But I wasn't really a good friend either. I never wanted to go out. I didn't have the energy to make an effort, and a friendship shouldn't always be one way. Lindsay was my best friend and big sister in college, but she graduated 2 years ahead of me! So the last 2 years, I got to learn to like being by myself...I actually really became comfortable with staying home every night and watching late night tv on the WB....the tv "Friends" characters were more like friends than any human being in my life!

So, over the last 5 months, Tom and I have become best friends and Lindsay and I have started talking more and are now just the way we always were - like sisters - she's like the older sister I never had. One night, I had IMs on my computer the second I walked in the door from work - one from Tom, one from Lindsay, and one from another friend, and my mom was calling me on the phone. I said to my mom, "I actually have IMs from all these people! What a change! Nobody ever wants to talk to me!" My mom laughed...but you have no idea how good that made me feel that when I came home and signed on the computer, my friends would IM me and want to talk to me. It feels good to be wanted. lol... I told Tom today (and I've told him before) that he makes the things I don't like about myself actually seem like lovable qualities. And Tom and Lindsay don't treat me badly because of the health problems. They don't mind listening to them at all, so in fact I probably talk about my health a lot more around the 2 of them because they completely do not mind - they don't hassle me about it - but they still treat me like a normal person, too. Not like some damaged freak of nature. It means so much to me.... Tom said to me today, "You are not going to make me cry, so stop trying." LOL....

Don't know if you have read my latest post but in the last 4 days, I have suddenly gone to cloud 9.5. I can't remember the last time I was this happy. And it's all because I started talking to a guy who I really feel a spark with...and he sees that in me, too. I've never had a connection with someone so quickly. I just texted him a few minutes ago and said, "Doesn't it feel like we've known each other for more than 4 days already?" His response was, "Way more than 4 days! I'm enjoying it!" My entire post that I wrote earlier today basically sums it all up. All the times I was disappointed because things didn't work out - well, if I had gotten what I wanted at the time, then I wouldn't be able to have this now. I know it's only been 4 days and we actually have not even met in person yet (going to a greek restaurant in center city on Saturday night - his favorite restaurant..!), but I never thought that this kind of connection even existed, let alone that it was something that could happen to me. I've made a complete 180 in my mood and mindset in 48 hours. I'm almost afraid of being this happy....I talked to my psychiatrist about it today, and he said that it's amazing what the thought of happiness derived from a relationship can do. Totally man....I think I have a permanent smile frozen on my face! I've smiled for like 48 hours straight!

Your tying it into psychotherapy and talking about the psychiatrist's feelings for the patient and the patients life is so much appreciated. This is not really talked about much. There was one time back quite awhile ago that I came to an appt and I forget how much time had passed (couldn't have been that much! the longest I've gone without an appt was 3 weeks, and that's only happened twice...), and I had said before this break at my last appt that I had a lot of things I wanted to talk about..I might have even said I had 3 things I wanted to talk about, and we only talked about 1 of them. At the next appt after this, he brought this back up, and he said that he had been really wondering what the other 2 things were. The thought that he had been actually spending time thinking about what the other 2 things I wanted to talk about were outside my appt was a little strange to me at first. I think about my appts all the time in between appts - but I guess that perhaps he might also think about me or my life occasionally between appts too - I just don't think about it that way. Your post just touched me. :)

Today, I could tell that my psychiatrist was actually happy that I was happy. I was relaying what I put on my blog, and he seemed happy for me - both in what he was saying and his mannerisms. It's such an investment in somebody, and I guess I don't think about what toll it might take on him (or, in general, the therapist) for me to share really upsetting things 3 days a week - and then he's got a bunch of other patients (and he does a lot of inpatient stuff....so that's gotta be heavy) who he also sees - so that's a lot of heaviness. Not sure how y'all deal with that. I guess maybe that's why for some reason he seemed very excited for me today as I was telling this story and sharing how I truly felt happy and couldn't remember the last time I felt this happy. I said there's been times that I've thought I've been happy about stuff, but I wasn't really happy. Now I'm happy. It's so funny to feel this happy about something - and actually rather scary. Seriously.

And on that note, I need to go to bed, because in the last 2 days, I've slept a total of 6 hours between the both of them. Tomorrow, hopefully I will get vacation, but I still have to call at 6am to find out!

Oh and - I know nobody has asked me for this information, but I'd sent you that email the other night with the story in it. This morning was my appt at the neuro. I'm coming off the mexiletine (praise the Lord!) and he did agree to go up on the other. He had a med student with him when he called me back, and he asked if that was okay, and when I said sure, he then said, "You're a ham anyway, right?" LOL - I knew instantly that he was in a good mood. Thank goodness for large favors! It was actually a really good appointment and quite funny even! I love having med students sit in on my appts or come see me if I'm in the hospital. I eat up the chance to educate people on headaches - especially my weird types that nobody knows a lot about. This girl was writing a lot down today - some of what she was writing was when I would talk and some of what she was writing was when he would talk. I kinda want to know what she was writing! What did I say that was important enough for a med student to write down! Sort of made me feel special! Because I need good things to come out of all the bad things I've been through. And students learning is good. Well - off to bed finally. My brain is shutting down from sleep deprivation, but it's all been for a good cause! lol...

Take care,
Carrie :)

NeoNurseChic said...

P.S. Thank you very much for including me in the post. :) I forgot to say that - but I meant it!

word verif: imthpooe All I can say is lol...seems juvenile!

Anonymous said...

EEK, I love you abf

Midwife with a Knife said...

Weird (possibly dumb) psychotherapy question: If you've been seeing a patient for a while, and then, they get better, and eventually stop coming (because they're fine), do you miss that patient?

For example, even though I joke about liking the fact that pregnancy is only 9 months, I usually feel a little sad when people have their postpartum visit. I mean, it's usually a happy visit, you play with the baby, do a quick exam, make sure that mom and baby are doing well, and then that's the end. Even with patients who I've found to be frustrating or unpleasant to take care of, I usually feel a touch of sadness at the postpartum visit, because that relationship is over.

jcat said...

What a lovely post. I am really impressed by how many people you have time for in youre life - as well as jobs and books and blogs!
And have to confess...got excited to see me on your blogpeople list, seeing as the first thing I do over morning coffee is check on you guys, FD and Guinness Girl - time differences mean I quite often get "breakfast" mail!

NeoNurseChic said...

MWWAK - Funny you say that. My friend Sean is a 2nd year OB resident at the same hospital I'm at.

I used to ask him why he wanted to go into OB/Gyn. Face it, it's not really something that you hear a lot of mid-20 males saying they want to go into! I believe there were 2 his year. But anymore, it's rare to find young, male OB/Gyns! Maybe one might find them in gynecologic oncology or something like that - I have no idea, but I still suspect the field is mainly populated by women in the younger generations! So I was very curious why he wanted to go into that. (And endlessly teased by my friends - mostly my guy friends - when I said I was dating a guy OB/Gyn....I'm sure you can imagine the crude things they would say to me! And I get very very embarrassed about talk like that.... lol)

I would never go to a male OB/Gyn, personally. My mom has - but does not anymore...I was born in 1980, and I think at that time it was still more commonplace to go to a male, and women who today would say they'd never go to a male didn't used to say such things back then - although I'm sure some thought it was awful. Even when I do have a baby someday (I'm going to go out on a limb and say "when" although I usually say "if" but I really really really really want to have kids!), I don't want any males there - and a lot of people will say that I won't care when I'm actually having a baby, but that's not true. I will. And I have a slew of reasons that I won't list here as to why I KNOW that I will unless something seriously major changes in my personality between now and then! The only thing about me is that it is almost certain I will have to go to a high risk group because I've had blood clots, am on drugs like methotrexate for an undeclared autoimmune disease (either RA or lupus, depending on whether or not you ask my rheumy or my internal med doc!), and have had weakly positive antiphospholipid antibodies (actually they were equivocal) and lupus anticoagulant (one of 2 were positive...). There are other reasons, but those are some of the bigger ones that have led my docs to say I will need to go to a high risk. My rheumatologist says that "well...the ob's tend to flip over stuff like this and want you to go to high risk, but you should go to the hematologist before you ever get pregnant so maybe they will say that none of this is even worth worrying about..." Dunno...not at that point in my life yet!

And - (get to the point, Carrie!) - the answer Sean gave me is that he loves the ability to do surgery AND have continuity with the patients. He's totally right, although he does say that this isn't as possible during residency as he hopes it will be when he is finished his training. If you are a surgeon in most fields, you only see the patient when they get sick (unless it's elective cosmetic surgery just because you want to make some changes, I guess!), and then there's the surgical eval, surgery, immediate post-op, and then some small period of follow up. And unless the patient is sick again, that's the end of it. Just yesterday, I was telling my neuro that at my 3 month post-op from my bilateral knee surgery, my orthopod declared my surgery a failure because I was still having knee pain. However, then several months later, after ending up in the ER for severe back pain based on the way I was walking, and then spending like 5 months in very intense physical therapy, I now walk without a limp the majority of the time (or at least it's a lot less noticeable - just a slightly uneven gait but almost looks like a kinda cool intentional swagger! heh..) and am not in knee pain very often at all! Not like the pain before - so I said that I sort of feel like writing my doctor a letter to say that the surgery was not a failure afterall - 3 months follow up just wasn't enough time to determine that in my case. My neuro was like, "You totally should!" And I'm saying this because of the fact that most surgeons have no further contact with the patient after the last follow up, which all too often falls before the end of the 90 day period where insurance stops paying for follow up related to that surgery unless something new happens.

But OB/Gyn is totally different. You can be the doctor for the mom that has 5 babies. You really can get to know her on an intimate level. In some cases, some women only go to the Ob/Gyn and don't even go to a regular doc. (Although some women just go to a family doc and not an OB/Gyn, too!) Say you have a patient who loses a baby or has a baby that requires extensive NICU care - and then the next time, she has a totally healthy term infant. Lots of times, the OBs (especially attendings) will stop by the NICU from time to time to see how a baby is doing that they delivered, and they'll chat with the mom a bit if she is there. It seems exciting to me to be a part of these times in the patient's life - her greatest sorrow and her greatest joy. One of the major highs for me as a NICU nurse is being able to be a part of the largest extreme of emotions ever....emotions are always charged, even in cases where the baby is just a r/o sepsis. And I very strongly have feelings about my patients and their families although I tend to be a very calm person as far as keeping even keel as a nurse, no matter what the situation, but I always express in words what I feel, even if I'm not crying over something sad or something like that. I think my coworkers might disagree that I am calm, because really I am animated and tend to really be active at work and jump up to help others often, but what I mean is that if something goes wrong, in spite of the activity, my emotional state remains calm most of the time. I really enjoy being a part of their lives during their darkest hours and happiest moments. It's not that I want people to have bad times, sick and dying babies. However, people do have bad times and they do sometimes have sick and/or dying babies. And since that's always going to be the case, I am very honored to be able to be there for them during these times. Even though the OB does more of the pregnancy period - if someone does both OB and Gyn, they still have enough continuity with the patient to be with them through all of these extremes - and through perhaps multiple pregnancies (err...multiple singleton pregnancies - not multiple multiple pregnancies! although I know people that have gone through multiple multiples! lol)

So at least that is what Sean and I have said about our collective feelings on NICU and OB/Gyn. One thing that is very difficult for me is to have my patients leave the NICU, so I understand that. When the ones that I get close to leave, I'm ecstatic that they are going home, but I'm so sad that I won't be a part of their lives anymore. I won't get to hear their daily stories and see their setbacks and triumphs. When I connect with a new family that has a micropreemie, while I may not know the exact course or set of problems that family has, a lot of times, I know what they are going to experience long before they do and by that I mean emotionally and physically (know what they are going to experience does not mean the same as understand what they feel because I cannot understand, I can only imagine....having not been there as the mother of a NICU baby, but I understand as a nurse who loves her patients, which is kinda similar in a small way!) - at least on some level.

When a preemie starts to feed from the bottle for the first time after a few months of being on a ventilator and trying to get through the critical period, it's almost like the families suddenly "forget" how much they worried over the crtiical times and suddenly they are obsessing and worrying over why the baby is only taking 5 cc today, and needs the rest through the tube. (Part of this is simply because they see the end of the tunnel finally and want the baby home!) I always tell them that the feeding process at that point is frustrating - it'll seem like it will take forever for the baby to "get it" - sometimes the first time they PO feed, they down like the entire bottle - and that makes parents then ask what happened because after that very first feed, they never do that again for weeks! Then they will take a few ccs once a day, then a few ccs twice a day or once a shift (8 hr), and then they will start taking an entire feed PO once a day, then twice, then three times. Then they will PO feed every other feed. THEN, they will attempt to PO a few times in a row, but they won't take the whole feed anymore because they get tired. So then the parents start to worry that something is wrong. If the O2 is coming off, then feeding skills sometimes suffer - and if they are trying to come out of the isolette and do feeds and wean off O2, the temp often becomes instable.

It is an art to be able to guide a baby through those changes that are all taking place at the same time...knowing when to wean here, when to push there. If you rush them, they end up suddenly back in the isolette, on more O2, and not PO feeding much at all. But if you allow them to slowly wean and are patient with them, they will let you know when they are ready on their terms, not ours. They are wise well beyond their years. And then one day, they just "get it" - they just suddenly take every single feed from the bottle. It's like the lightbulb finally came on, or else they said, "Holy crap....I don't want to be here until I'm 20! I better get my act together!" lol... (They say stuff like this all the time, don't ya know!) It happens every single time that the PO feeding development is slow and painful with lots of give and take and then one day the lightbulb comes on and they never look back. They won't all do this in the same amount of weeks (in other words, I cannot answer the question "how long will it be until they take all their feeds from the bottle?" My answer to that is, "it's up to the baby - they run the show!") At the start of learning to PO feed, the parents do not believe me, and I know they don't - when I tell them this is how it will go! And then at the end, I remind them that I said this way back at the start - and they're like, "Yeah...yeah you did!" I have seen it over and over, but they have never seen it before - it is hard to believe and trust what you have never experienced before, even when someone tells you it is so. This is especially true in an emotionally charged environment like the NICU.

And then sometimes when the parents have a bad day and get really upset about needing a bit more O2 or needing a few more NG feeds, if I feel that it is appropriate (and I will be helping, not hurting by doing this), I remind them that a few months ago, the baby was going up and down on the oscillator and fighting feeding intolerance, so that these things are really small matters compared to that - and it will be okay, even if they can't see that. Because I am very careful at what times I choose to say such things, I always get a positive response as they appreciate that refocus on perspective. And then they go home.

If they don't bring the baby back to visit or send us pictures and cards, then we do not ever know what happens to them. The ones that transfer to peds facilities either for PICU care, surgery, or rehab, sometimes the peds residents will tell us what happened to them when they rotate with us again because they run into them in other settings. If we send one of our special babies (they are all special) to another hospital for something, then often a nurse close to the baby/family will call to get an update on how they are doing. It isn't common that we do that - however, I have spoken to nurses and docs from referring hospitals many times to give an update as we receive babies for lots of different things from outlying hospitals.

The families that I am really really close to, I give my email or address or phone or all 3. They all promise to keep in touch. Very few do, but I value so much the ones that do. I don't give my info out to very many....but sometimes you just have that special connection. I have pictures in my email from a few of the families who stay in touch. And it means the world to me. I love that they consider me a part of their extended family and continue to share their lives with me.

It is very hard to be a part of their lives for such an important, critical part of time, and then that's it. Oh and we have had a few families since I've been here who have had babies in our NICU before - but I haven't been here long enough to have had repeaters yet! lol...

May I ask what your plans are as far as what you would like to do in OB/Gyn? Do you know yet, or are you testing the waters? Maybe you've said on your blog, in which case sorry to ask again here! I do read your blog from time to time but haven't stopped by in the past few weeks I don't think!

Shrink rappers - sorry to hijack with a very long comment on what MWWAK said, but she touched on something that is a really cool topic. One worthy of posts by all 3 of you, her, me, and anyone else who works with patients in a very vulnerable setting and either gets to continue working with them over the years, or loses touch and wonders what became of them. I miss my patients a lot of the time - I don't know if everyone misses their patients when they are finished working with them, but I suspect that most do - it's a caring field, and most of us are softies at heart, no matter how tough we are on the outside! ;)

Take care,
Carrie :)

Midwife with a Knife said...

Carrie: Thanks for your response. I'm a bit of a freak in my field. I'm much more into the medicine part than the surgery. (I frequently joke that a c-section is my favorite surgery because it only lasts an hour, and that's about the length of my attention span! :) ).

But seriously, I don't get the kind of continuity that general ob/gyn's get because I'm a perinatologist. Um.. pre-perinatologist, actually. So I don't see anybody for gyn care between pregnancies. Although some of my patients end up being repeat patients (or could be, I haven't been here long enough to have any repeats yet), mostly they have to plan their pregnancies and space them, and since I have yet to live anywhere for longer than 4 years at a time, I don't get a ton of continuity. (Although I loved my continuity clinic in residency!)

Gerbil said...

Dinah, your post has somehow implanted the Beatles' "In My Life" in my head...

My sweetie once commented that my friendships are for keeps. (One of my dearest friends was a nursery school classmate of mine!) She wanted to know how I do it. I guess I'm just drawn to people who want that same kind of relationship.

A little over a year ago I was struck by how lucky I was that my college pals didn't abandon me when I was ill. In fact, just the opposite happened. They piled into a car and drove 45 minutes to visit me in the hospital; sat with me many psychotic nights; convinced me to go to parties to have a little fun; et cetera. I wanted to send everyone a thank-you note, but I couldn't think of how to say "thanks for not dumping me when I went crazy" without sounding weird.

Coincidentally, around the time I was debating this, my best friend (whom I met in college) said, apropos of really nothing, "You know, we totally could have abandoned you freshman year, but I guess we all knew it was just temporary stuff. Plus, you were still cool even when you were having problems." Aww...

Gerbil said...

MWWAK, on missing clients: There are a few clients whom I miss. Mostly I just wonder how they're doing; but sometimes I also genuinely miss them and the connection we shared. I don't think it has anything to do with how long I saw them--most I saw only for a couple of months, and one for almost a year. (Then again, as a graduate student therapist, I only had a year at each site anyway!)

There are also two providers whom I miss terribly. I saw each for four years. I've visited with each since (one took me out to breakfast!) and yes, they both said they'd missed me... even before I said I missed them.

Incidentally, that psychiatrist took me to breakfast at a little cafe where he is a regular. The waitress studied me for a moment, then asked him, "All right, who's this one then?" His reply: "An old friend."

Anonymous said...

Dear Shrinkrap,

(slightly unrelated comment. Just had to ram it in somewhere)

I would like to announce that this week I am very thankful for psychiatrists, particularly mine, and I think you lot seem to share a lot of the same qualities that I value in how he treats his patients.

It's the connection that makes it such a special clinical relationship. I used to worry that I had turned into a therapy junkie (which seems unlikely with monthly 30 minute visits (that tend to stretch to 45...)), but I think having someone whose job it is to listen and give objective feedback but with my best interests in mind, is a great thing and I have grown so much through the process.

I am now in my second year of med school (and practising as another type of health professional - I had to tick the "other" box on the survey) and I was initially worried about discrimination on the basis of having a psychiatric history. But I know that my psychiatrist is behind me all the way and that the stuff I do with him is already making a huge difference to the way I connect with my patients.

I'm not sure what sort of doctor I want to be. Psych is not off the cards, although I'm not sure if it would be frowned upon to be a psychiatrist who regularly sees a psychiatrist (I suspect not as psychiatrists like people to see psychiatrists - do you lot have any thoughts on this?), but whatever I end up as, the input my nut doctor has had on me, will definitely influence how I work.

The End.

(being anonymous for today :) )

NeoNurseChic said...

Anon - Happy for you, and that is a cool story, and how I feel about my psychiatrist, too. Therapy junky? Now you've given me something else to worry about! haha.... j/k

Are you from England? Or if not, some other English-speaking country outside the US? Just noted that you said "tick the box" and "I suspect not" and have some spelling differences. But the reason I'm asking is because if you are from England, you'd be one of the first that I've heard who has a good relationship with a psychiatrist and see the same psychiatrist every month. I'm sure this might happen there more often than I am led to believe, but I get the impression that needing a psychiatrist over there is generally much more difficult than needing a psychiatrist over here!

I'm planning to become a pediatric neurology nurse practitioner. (Umm...if you are from England, all I can say is please note that nurse practitioner in the United States is an entirely different thing from nurse practitioner in the UK - I'm getting an advanced degree and have a lot of training before I can do this...I can't just call myself a nurse specialist cuz I woke up one day and felt like it! hehe...) However, the other day I was in our university bookstore. I bought a general peds neuro book, and I really really wanted to buy this "child neurology" textbook (that had a really nice chapter on birth trauma, which would be very useful to me at present since I am working on an inservice on hypoxic ischemic encephalopathy and will also be teaching about this topic for our critical care course for new neonatal nurses in the spring), but it was $150! No thanks. But what I'm getting at is that they also had a pediatric psychiatry book, and I also considered purchasing that one - it was written by authors at my university, I believe! I know that neuro and psych often go together (and I know a lot of doctors who are board certified in both), and I thought maybe it would be cool if I did both pediatric neuro and psychiatry. I would really like that. But I worry that maybe this would be a bad idea for me....however, I do imagine that probably many psychiatrists have had some personal experience with psychiatry in some way....but who knows. Not sure if there has been a study done. In the headache world, they did a survey of neurologists who are headache specialists, and a very large (like >70%) percentage of those they surveyed had a significant personal history of headache. My neurologist had bad migraine, and the director of the center (who is one of the top researchers in the world on headache) also suffered very bad migraine when he was younger - don't know if either of them do now. My former neuro who is still a good friend said that he just gets tension headaches, and I never really got out of him why he wanted to go into headache. I think in this field, it's very common to go into it because you've interacted personally. When I first got the headaches, I wondered why anyone would want to specialise in just that, but now I know!

When I did my psychiatry rotation as a nursing student (undergraduate), I actually had a really bad rotation.... My clinical instructor, during the evaluation, ripped my entire being to pieces and the things she was criticising had nothing to do with how I was as a nurse or how I interacted with patients during the rotation (we were scattered all over the facility, and I don't think she ever actually saw me interact with a patient at all...), but had to do with my personality and how I was when she saw me on break or at lunch. BUT the only thing I really enjoyed a lot about it was the day I spent in the pediatric ward. I had one view of the kids when I spent time with them, and then when I read the charts and I read what these kids were like outside the hospital, I was shocked. And actually frightened. And also felt that while they were actually normal children while in the hospital, they went back to the same environment where they'd kill their neighbor's dog with scissors or put their cat in the oven, and then they'd end back in the hospital, where they behaved like normal children. I felt sad for them because I felt like they'd spend their entire lives bouncing from troubling outside environments to the hospital, only to get better, only to go out and get worse, and so on. I know I was seeing the extreme. I didn't get any outpatient psychiatry experience as a nurse. But this is something I am truly interested in, and I'm not taking it off the table! I know I want to do pediatric neurology but especially in headache, if you do both neuro and psych, you're actually able to encompass an even bigger picture for headache patients since so many of them have comorbid psychiatric disorders. And since I want to be an acute/chronic pediatric nurse practitioner, well - I think kids who have chronic health problems may not have psych disorders just because of that, but I think all of them should be eyeballed from time to time just to make sure they aren't developing a problem simply based on the stress of having a chronic health problem and being a kid. It wouldn't hurt to have a background in psych, too.

OK - gotta go watch Grey's Anatomy! It started 10 minutes ago! eek!

Take care,
Carrie :)

dinah said...

To everyone who said something nice: thank you. Nice to feel appreciated and nice to think I've touched someone in some small way.
And thanks to everyone who's wished the kid a happy one!

Carrie-Wow, those were really long comments. Please send all cat comments on to the Caroline Reads The Blog post at this point, and it's way too late for me to try to link it with html stuff.

Rach: stay warm.

Do I miss my patients when they finish? Generally I feel kind of emotional at any planned final sessions. I can't say I actually pine for patients after the fact. People often just drift out of therapy rather than terminate in a premeditated way, and I wonder about them, sometimes I call. I do often think about patients between sessions. I may do a post on ending therapy.

Someone asked how often I see patients: usually weekly at first unless there is a reason to meet less often (patient can't afford it, patient was seeing last psychiatrist monthly and wants to continue that and is stable...). At some point, most people taper down to every other week then monthly. Some people just come when they feel the need....

This is my brain on overdrive... said...

LOL sorry - something happened to my brain the last 24-48 hours. I'm not diagnosed bipolar, but sometimes I seriously wonder because my brain goes into manic phases where the race of ideas is ridiculous, and I end up not sleeping much for several days on end because I can't stop my mind from racing - and that's when I get like 100s of ideas of things that I will never carry out when I come down off this. Happens once in awhile, and it started Monday night this week. Earlier today, my friend made fun of me for sending a ridiculously long email where I described the room I was working in for like more than a paragraph. He told me I need to write a book and that he will never open a word document from me because it will be at least 14 pages long.

I think I need help. LOL

And all week I've had to take sleeping pills just to sleep like 3 hours. I think I may shut off the computer tonight, but I doubt it - I can't stop checking websites that I always read, and I must've checked them all 1000 times today at least. I thought of something earlier today that I really want to discuss with my psychiatrist, and unfortunately I have to wait until Monday to try to deal with...um...some of this.

Sorry again!
Not even putting my name on this one - you know who I am! Oy....what's funny is that I have almost no headache right now - and haven't had much of one all night. Not sure what that says, but this isn't exactly a fun trade off.

Sarebear said...

Carrie, I feel for you! Since I'm not a doc, I CAN offer my advice (lol). That one comment there, this last one where you talk about it, take that to therapy with you and describe the way you describe there what's going on.

Not that I'm saying you have anything necessarily (goodness knows, you have so much already to deal with!) but this issue is extremely important and needs addressed.

Said from she who should take her own advice, as I've only attempted to find a new iatristi n fits and starts (and keep landing on ones w/so many addresses and they end up working for the county mental health system, which won't see me because I don't have "a certain kin d of funding" in their words. I'm sick and afraid of all the addresses I see for the iatrists on my insurance list . . . I hate getting rejected over and over.

Woops, went on there. Anyway, I need to take my own advice. Easier said than done, lol.

Thanks Dinah for the mention; I started being a bit more sporadic when I was hurt by something Roy said. Now it's not that really anymore, so much as some days I feel no one gives a damn anyway, and my existence means nothing and is completely POINTLESS so why foist it on y'all. Or anyone, really.

Thanks for giving a darn.

Sarebear said...

Gerbil, I am SO jealous.

Despite all my attempts, I have nothing and no one for friends.

I had one best friend (who only sporadically considered me her best friend, when she had no one cool-er) whom I was there for in any way she needed, I wasn't clingy or anything, but if she called and I was home, I could and would just drop whatever and we'd go do something or even I'd sleep over where she was living at the time (especially during her parents' divorce). I was that friend who stays with you through thick and thin, who supports you, listens, has fun, goes shopping and isn't afraid to tell you how it really looks, but will also spot the most perfect thing that you might not have thought to try on but turns out to be something that looks stellar on you. That friend who accepts you as you unconditionally, even though she hurt me and used me from time to time, and dropped me when someone cool-er was around.

Now, there were some good times or a couple of years in all that, where I wasn't used or dropped, but eventually she moved away.

So I know I'm capable, in here somewhere. But God hasn't seen fit to send anyone across my path who sees any merit in my existence.

I have no support network, no support system. I'm rather NOT connected, though I'd dearly like to be. Life is cruel, and life doesn't care, and these illnesses have robbed me of so much I may as well let them take it ALL. There isn't much to take. If I had a way, I would. Facing a lifetime of this hell, alone, is more than I can bear. But, there is no way. I fail at failing, which is ironic given my last name.

Sarebear said...

Gerbil, I don't intend to make you feel bad. My "life" shouldn't decrease the happiness and satisfaction you take in your friendships.

Anyway, I wanted to clarify that.

DrivingMissMolly said...

What a sweet and heartfelt post. Thank you.

It is nice to hear you talk about normal interactions with people or at least, what I consider to be "normal."

When you grow up in a home chaotic enough to cause you to develop a personality disorder, you're talking about a lot of dysfunctionality. This means that it is difficult to know what is normal or not and what other people do in life.

I have always isolated myself because I've always felt deficient. Thus, I don't have a lot of friends. I am hoping that my work in therapy and with my psychiatrist will result in someday having friends like you do.

Dinah, you are definitely a person I'd aspire to be like. You are intelligent and have a career, but you also have a family and friends. You seem adept at achieving that elusive balance so many strive for.

You are lucky to have friends and they, in turn, are lucky to have you.

Lily

Violet said...

Sarebear: I feel the same way. I have one person who I like to consider my friend, but we only talk a few times a year, when I call her. She doesn't have time to call me, and I can't tell her anything about me. She's as close to a friend as I've ever had though. I told her I was lonely once, but I'm sure she already knew that, because she knows I don't have any other friends.

I want to be friends with people at work, but they don't want to be friends with me. They all have enough friends.

Gerbil said...

Sarebear: you did not make me feel bad at all. I'm sorry that you don't have the support system that you want; I hope that someday you are able to find that magical connection with someone.

FWIW, I had maybe 5 friends until I reached high school... and one of them was the quintessential girl bully. If she'd had her way, I'd have had exactly 1 "friend" (i.e., her). For a long time, I thought friendship was about manipulation and possessiveness. To this day I still sometimes doubt that people truly like me, believing instead that they are just humoring me while I'm in the room.

But true friends appreciate you for who you are--not for what you can do for them. And I know far too well that trust is tough when your early experiences say "trust no one."

NeoNurseChic said...

Sara,

Thank you. Last night I slept 14 hours - the whole thing ended, and I feel better today. I don't feel tired, but my brain is only having one thought per minute as opposed to trying to have 1000 thoughts per minute. I'm literally only thinking about one thing at a time, and it's wonderful. For me, I know at least one trigger is talking on the phone for an extended period of time after a certain hour - and the Monday evening call that started at 10 and ended at 11:15 did this. That's what started the entire week worth of "mania". I'm lucky that it ends.

You are a great person, and I may not be there and we may not talk all that much, but I think I'm your friend! :O)

Hugz,
Carrie :)

Sarebear said...

Thanks Carrie, That means alot. Sorry I've not been to your passworded blog as much as I've meant to. My blogreader doesn't know what to make of it. Poor excuse, but I'll get there.

Rach said...
This comment has been removed by the author.
Rach said...


Here
is a link to a post I did based on your post.

Rach said...

Dinah, here's the link regarding NW:

http://rblsc2006.blogspot.com/2006/09/bitching-and-complaining.html

Dinah said...

Rach, That's funny, I laughed out loud. And then I wondered if my patients think of me as NitWit, but some things I just don't control. I don't answer the phone during sessions. I'm sure I do do other nitwitty things. At least I threw out the totally dead plants.