Just a moment

That first day in July

With what I can only accurately describe as an absolutely miraculous white coat, I entered blazing, sunny court besides the garage. Patients, physicians, and nurses seemed to slowly vibrate and swirl around me as my walk to the building seemed imperceptibly slow; like mountains or childhood. The wind flickered the heavy fabric that would be my shield (the shield is a reference to our white coat ceremony speech given by an amazing pedi surgeon).

...as for the ides?

My shield, it wears the scent of veterans, evening travails, 2am tears, and my favorite and very carefully chosen indefatigable micro ballpoint pens. It protects my path as I glide through the Commons, down the halls, and through daily allegory. Its tightly woven cotton paradoxically shines to the deepest corners of my new sense of profession and warms my clumsily honed practice of empathy.

Though at the end of the day, when I exit the building and take the same path through the court, my miraculous white coat scrubs away any (for now, gossamer or forgotten) frustration and makes indelible those reasons I deftly and delicately placed in the interior of my heart. It oddly, but perhaps appropriately, reminds me of those ubiquitous intensely sweet and glowing countenances emblazoned on new mothers that betrayed even the most pain-replete and exhausting births. Though these two weeks are but a moment, a few grains of sand in the glass, I certainly hope I can always revisit this place in time. Its bliss, its mine to share, and we're just getting started.

Non Sequitur

My favorite Houston haunt, La Carafe, with some friends. David and Kiran are pictured, but sheepish Ina declined the photo (by declined I mean repeatedly put her hand on the lens). A very recent pre-residency Tuesday night.

Anxiolytic Calls

"I've got a suicidal patient on the line, would you mind if I merged the call?"

Yeup. I was to manage a suicidal call into the hospital. Compared to the fake Code Green of earlier today, I must say that my heart rate went astronomical. How was I, a novice intern on his first night of call, going to talk someone out of lethal action and get them to the hospital? Huh. Quite the formidible challenge. Thankfully, again for training call, I had my now favorite Atlantan by my side to coach me through with rapidly written questions on some loose leaf.

We'll call the guy Mr. Sad.

"Mr. Sad this is Dr. Webster, can you tell me what's going on right now? Alot of people are worried about you."
"Well. I just want to end it all. Its too much."

Thus began our talk. I clearly donned my most calming, empathetic voice and prayed my anxiety would not bleed through the line. Think, midnight slow jams DJs on R&B stations.

Mr. Sad talked of his recent failure out of college, his loss of a job, loss of financial security, and the threat of being kicked out of the house by his mother. Apparently, he had been experiencing a debilitating depression since his December despite taking his medications.

"I just feel like everything makes me snap...I just...feel low and stuck."

Well, as for the latter half of his sentence I must admit that he was not the only one that felt a bit low and stuck. All I could think about is just keeping the guy on the phone and trying to organize a way for him to get to the hospital.

We spent about 20 minutes chatting while we (the nurse on the phone and I) located his brother to get him to our ER (he declined an ambulance or police officer ride). He seemed to finally be letting off some of his steam and simmering down a bit. Similarly the newness of the situation melted off a bit and I found a warm compassionate place to come from. It worried me that there were firearms in the home (as so many vets have), but I was comforted by the arrival of his brother to his house and hearing his mother in the background.

"Alright. Its absolutely important that you come to the ER as soon as possible. We'll all waiting for you so we can help you through this difficult time. I'll be waiting for you at the ER."

Those were a long 30 minutes. Mr. Sad lived far from the city and although my sense was he would definitely be arriving there is always that fear. We eventually saw in the ER and admitted him to the ward. He seemed deeply thankful for our visit. The nature of psychiatry is such that you never really have control. It becomes painfully more clear when your twiddling your thumb on the cord as you stare at a computer screen tens of miles away from a very acute situation.

My Atlantan training wheels put my mind to ease and congratulated me on a fine job.

"Your voice. You'd be a great psychotherapist. Its just so relaxing. It just makes me want to go to sleep."

Let's hope so. Speaking of which I hope I can pack in some sleep. The blood pressures on the floor have cropping up again. Let's hope the night staff is resilient and my drug choices adequate.

One life saved.

Code Green

"Code Green Unit 5A, Code Green Unit 5A"

Thus began my first Code Green (i.e. psychiatric emergency). As this is my first call, I've got a set of beautiful training wheels, a very capable and calming third year resident. As I was, ahem, updating the blog (after a looong break courtesy of orientation week), the words above dispassionately filled the room from the intercom and drowned out Venus Williams' vocal serves on the waiting room television. We briskly exited the clinic.

"Is your heart rate up yet?"

Yup. Certainly was. Remarkably though I was still grasping calm. I was desperately trying to clear the clouds of our orientations to think of exactly what to do. Thankfully, I had the fast-walking Atlantan by my side to elucidate the details. What level of Haldol? How much Ativan? I'm not supposed to use Benadryl, right?

This was quickly replaced images of what awaited us on internal medicine's fifth floor. Images of a charging half-naked, obese, gray-haired veteran came to mind. Then there was the thought of a feces-flinging new schizophrenic break. By the time I had psyched myself out (no pun intended), we arrived to hear an exasperated :

"Yeah, no problem now. He was just trying to leave AMA (against medical advice) and with his IV still in his arm (a big no no). His doctor told him that he can't be discharged right now; he's in an emergency surgery."

That's it? Huh. So, we enter this patient's room to find a IV-less ornary old man with an incredibly appropriate hat that read, "Dysfunctional Veteran, Leave Me Alone." Will do. After some coaxing, and of course the arrival of half a dozen police officers, he calmed down a bit and was allowed to leave donning a scruffy disposition with his physician's new blessing ten minutes later.

Apparently the threshold for calling for a Code Green on the internal medicine ward is a bit lower than I expected. The rush melted away, and I've retreated to the clinic.

Chuy Margaritas

A whirlwind. This is how I can best describe my transition between Cecil Webster, Medical Student to Cecil Webster, MD.

We might as well start at the beginning. As you may know last week was the official start of orientation. Five days of orientation. Nine fresh new interns, two second year residents and myself were to arrive at the formidable MEDVAMC (Michael E. DeBakey Veteran Affairs Medical Center) a hospital as large as its name. While some love the VA with its design-by-committee color scheme and federal-government-mauve tile, I admittedly was a bit reticent about beginning my psychiatry career here. So, after finding some parking I walked past a river of muddy flag-adorned trucks, Buicks, and of course the gaggle of valets that attended to them.

I got lost of course somewhere on the cavernous sixth floor, but I did bump into Leroy, a fellow intern. With a bit of walking, and my apologies for not being better oriented to the building, we made our way to the bright, albeit windowless, orientation room. After a steady stream of smiling faces, and introductions we got down to business. As anyone that has worked for the federal government knows, there was a deafening bureaucracy to wade through. Patience and enthusiasm was still fresh so we tolerated this 10 hour imposition. This was followed by the public hospital's orientation, BCM's orientation, the Department's orientation, and of course the orientation for psychiatry specifically at each of those hospitals. Sprinkle on some Compliance training (still think of that as an odd choice of words) and voilà. Orientationed out.

Thankfully, my fellow green colleagues are really cool. We're quite the motley crew. There are New Jerseyans, Tennesseans, Floridians, Marylanders (I suppose I can still count myself as one)and of course Texans near and far. The program director, at an evening party at her house, described us "quite a fun group" hopefully not euphemistically as we stayed about 45 minutes past the scheduled party's end. One of the very things that attracted me to the department was the sense of togetherness (not a stuffy remoteness that I experienced frequently although not invariably in the Northeast), and it seems like we'll have no problem with that. Already we've had a casual happy hour at Amazon Grill and an inaugural round of margaritas at Chuy's. We learned a little more about eachother. Jenn is uber-eager to buy a house, Alauna is hilarious as all hell, and Ben flushes at a quarter of a margarita. Nice.

Besides this there are other tidbits. There are former Nepal Peace-Corps members, siblings of spellers featured in Spellbound, and well-worn passport porters.

After a mercifully restful Sunday (my patients were seen by the soon-to-be-offservice second years), coupled with the arrival of my roomate back in town, and a visit from my mother, all was well. I pressed my gorgeous white coat...and its quite the handsome medi-cape. Laid out my best I-promise-I'm-older-than-I-look shirt, tie, and slacks. Tucked myself in to my newly cleaned bedroom and blissfully dreamed of sunny days with fanciful well-managed, compliant, schizophrenics. While I do not doubt that may I come up a bit short in regards to my career-eve dream, I do think that I will don a drowsy smile for the next four years. C'est commencé. Wish me luck.