Tuesday, April 24, 2007

On Call...

So, I didn't actually die, just abandoned my blog for a while. A long, long while. It just wasn't fitting into life for a while.

I don't know if it will keep fitting in or not. I've started work on a new project...with any luck, we'll be finished by early November or so. But there will be more info to come in future weeks.

Tonight I am on call. We have a night float system at our program, and we do nights for two weeks. Additionally, we have a PA come in from midnight to 8 am, so we end up doing only 8 hours a night (from 4 to midnight). This resulted from some RRC issues about too much service and not enough teaching...golly, those crazy RRC people. (RRC = Residency Review Committee, the folks in charge of credentialing residency programs and making sure they do everything they are supposed to, including teaching us lots of stuff AND not abusing us too much.) So most night float stretches are pretty good, and even if it's super busy, you usually get to go home at a reasonable hour.

However, when the PA goes on vacation, another resident comes in from 4-10 pm, and then the night float person comes in from 10 pm-8 am. And...the PA was on vacation on Wednesday, and Thursday, and Sunday! And currently, overnights have not been good for me. It's been much better for me to be IN BED rather than roaming around the unit tucking the elderly into bed, or sitting in the ER listening to the next story of tragedy and horror. This has all resulted in my sleep-wake schedule becoming very altered, which caused me to have insomnia when I got home at midnight last night and could FINALLY sleep. There I was, with a cat under each arm and a husband next to me and....nope. Nothing. At all. *sigh*

I'm not quite sure what to say about the Virginia Tech thing. My brother went to school at Richmond, and one of my friends is in med school in Richmond, so I've probably at least BEEN to Virginia a few more times than some people. And being a budding shrink, it seems like the kind of issue I'd be thinking about. I did end up seeing a few patients the night after it happened who'd been destabilized by it. One had an intensification of his psychosis and ended up lying on the floor of his parents' living room, sobbing hysterically in front of CNN. Another approached staff at the homeless shelter and told them they needed to send him to the hospital, because he couldn't see what was stopping him from taking a cop's gun and doing the same thing as Cho. So it did affect our community.

But I've been intrigued to see the number of forensic social workers and psychologists willing to discuss the man's issues on TV. Without examining the person, but by what small history we have, and by the evidence of his disturbing behavior in classes, people are willing to offer all kinds of diagnoses. Psychosis, schizophrenia, depression, paranoid personality disorder, antisocial personality disorder...we're trying to label this, to put it in a box, to make it "other." This makes the case safe. In effect, we're labeling and extruding him from the community. By labeling him with some kind of named illness (although he is clearly very broken), we both feel we've explained the unexplainable, and insulated ourselves from the possibility that it could ever happen to someone "normal." It is possible that a person could make a horrible choice. People do this all the time. They lie, steal, murder, cheat, sleep around, hurt themselves, and hurt others--all without having a diagnosis of mental illness. In fact, there are people in Iraq who are planning the injury and murder of many more people than died in the VTech assault, and we don't call them mentally ill...but we call them radicals, or extremists, and we ignore the numbers of innocent people who die there every day. But people have their reasons for doing things, even inexplicable things.

And the point of something inexplicable is that you CAN'T explain it. There's no doctor on earth who can really explain why this happened. Trying just seems so...pointless.

Anyhow. This is what happens when a shrink is short of sleep. More info on the project...later.

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