Notes on everything!
Hooray for Labor Day!
One thing I like about psychiatry is that the nurses and social workers in charge of the program are really good at their jobs. They set boundaries but also have great rapport with the kids; they have lots of insights about life; and they can make suggestions to the parents without being threatening.
Not much more to report for now.
There is a certain degree of scriptedness to a patient-provider interaction. I say, “What’s bothering you today?” The patient tells me one or two things. I ask some follow up questions and then do an exam, then write a note with a presumptive diagnosis and labs/follow-up.
But there is one type of patient who doesn’t follow these conventions: it’s the Positive Review of Systems patient.
They are the ones who, when we do a review of systems (a rapid rundown of various symptoms), answer “yes” to most of our questions. Yes, I had some chest pain a week ago. Yes, I get migraines frequently. Dizziness, abnormal menses, shortness of breath, back pain, depressed mood, blurry vision, insomnia — yes, yes, yes, excruciating, yes, yes, and all the time.
I still get hung up when I meet these people. I want to be directed and move things along, yet somehow I can never fully steer the conversation to keep it on track. And I have to be thorough: chest pain requires further questioning. So does abnormal menses. So does depression. And yet, the questions don’t make anything clearer — no diagnosis emerges.
Over an hour passes. Other patients are waiting. My resident is wondering what’s taking so long.
I don’t know if I’ll ever develop a good strategy for the Positive RoS patient. I feel terrible for them — they have a slew of problems and it’s not their fault, although most likely a number of these trace back to the depression or anxiety. And they remind me of my mother and her complex medical history.
But the fact is, time is precious, and I’m not as good when I am off-script like this.
Smart, good-looking, well-adjusted people. Sometimes I am in the company of several of these. It’s exhilarating, depressing, and anxiety-provoking all at the same time. Will they like me? Why can’t I be more like them? With their impeccable sense of style, cool taste in music, library of worldly knowledge, and natural ease and confidence.
And sometimes I find myself with people who are (to my judgment) dumb, socially inept, and emotionally immature. In them I see all of the things I want to cut off from myself, all of the parts of me that embarrass me–and I am repulsed. I want to purge whatever is like them from inside of me.
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It’s not a secret that I don’t believe in God, and I have mentioned before that this happened only a couple of years ago. Since then, I’ve been writing and re-writing the story of my deconversion, revisiting journal entries and re-examining my emotions from different perspectives to discover my true reasons. Here’s the current version.
Up until my final year of college, I was (or wanted to be) very much a believer. I wasn’t exactly the model Christian, but I did often think about, talk to, and recommit my life to God, and I was disappointed at many of my failings. Being too scared to share the gospel to strangers, for instance. Allowing family concerns to interfere with my walk with God. Sexual impurity*.
(*Although I never considered being gay itself a sin — just the dirty thoughts I would have.)
In college I became heavily involved in a small, tightly-knit fellowship group on campus. Overall, they are not bad people, and my experiences with them were almost all good ones. We ate together a lot, and the leaders often had us over in their homes.
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I’ve got dozens of unfinished drafts that I’ll be trying to wrap up and get up here in the next few days/weeks.
I just don’t care anymore.
This was a story I caught while listening to NPR this summer, and it really disturbed me: Part 1, Part 2.
Did you know that sexual assault occurs every 2.5 minutes in this country? And if you are a Native American woman, your chances of being sexually assaulted are two and a half times higher than other women. The legal system is useless to capture and convict these felons because of complicated legal rules and bureaucratic inertia concerning tribal land and who has jurisdiction. So Native American women who are raped by white men are basically ignored.
One day recently at the Chickasaw police headquarters, a call came in from a Native American woman who said she had been raped and didn’t know where she was….
If the woman is Indian on Indian land with an Indian attacker, he can help her. If not, there’s often little he can do – and he says that’s usually the case. According to a Justice Department report, 80 percent of Indian victims describe their attackers at non-native.
“Many of the criminals know Indian lands are almost a lawless community, where they can do whatever they want,” O’Neal said.
In this case on this day, the woman turns up outside of tribal land, which means he cannot intervene and won’t know what happened to her.
What’s the deal? Can’t we do better?
