Clinic duty

I'm really thankful its Friday. I have to stay late tonight at work, but at 8:00 I'm going home, and crawling into bed. Peace and lights, both out.

This week presented a number of challenges and new experiences, and begun with my first encounter with the cranial/facial clinic at MCV. I staffed their cleft palate clinic that runs from 8:30 til 11:00 and met with the kids who were scheduled to be reevaluated by their surgeons, orthodontists, ENTs, etc. I was told that usually the patient list spans anywhere from 6 to 15 kids depending on the day, but we ended up only seeing four. The follow up advice was, "well, be prepared, because next week's clinic is going to be swamped." My job is to do a mental health well check, basically, and ferret out any psychological problems that may (or even may not) be related to the cleft palate, lip or other cranial facial surgeries/problems. The easiest patient I saw was a 5 week old newborn who slept the entire time. Her parents looked exhausted, though! I make any necessary recommendations, and then after I've seen all the patients, I dictate my reports. Dictation isn't as easy for me as I thought it would be...there was a lot of ummms, silences and "scratch thats" on my tape. All of the docs, speech pathology, audiology, and I convene for rounds and lunch was served. I'm better in person than on tape, that's for sure. Psychology led off rounds, and so I gave my synopsis of the first child, and then everyone else contributed their parts. The clinic coordinator took notes and presumably follows up with the families prior to the report being signed and mailed to them. I found the morning to be really fun, and challenging in a way that is different than my challenges on the unit at VTCC. I will definitely have to get loads of rest before next Monday's clinic. Apparently this clinic only happens twice a month so I will have some Mondays off from the merry go round.

Some really great stuff happened in therapy this week with my one and only patient. It's hard to quantify progress given her particular diagnosis and challenges, and then relate it in a blog. But I'm really pleased with the progress so far. While its not at all hard to maintain the positive regard (this kid is so likeable to me), it did become increasingly draining this week to maintain the high level of nurturance that she requires. It's like we're making up for the lost nurturance from childhood, and when you dump nurturance into the void, its hard to see the level rise.

I planned an assessment for my outpatient kiddo who is coming in at the end of the month, and did the requisite summer reading on an acute admission who is arriving Monday. I'm assigned to do a 15 day evaluation on him...supervision next week will reveal more about what that all entails. Usually it means testing, interviewing and observation to do a differential diagnosis. Sometimes I have to find things to do around here, and then sometimes its been seven hours and I realize that I never made it to the bathroom to pee. Wednesday afforded us a particularly slow afternoon, so 2.5 hours into lunch, several of my fellow interns and I were like shit, we need to be doing something related to our jobs. We reconvened at the Cheesecake Factory at 6:30 pm to partake in the anniversary celebration that made the cheesecake $1.50 a slice. The whole of the Richmond suburbs descended on Short Pump mall that night. I was lucky enough to be approached by a woman leaving, who gave me her pager for a party of 4, as I was in a long ass line just to get my name on the wait list.

Tonight I have my very first family therapy session, complete with a Spanish interpreter. I have no idea what to expect, but I'm pretty sure that I will walk away feeling like I didn't do a great job. I already exercised multicultural incompetency this week in the form of making hospitality house reservations for a woman who usually shares a room with two of her children at home. This bright idea of mine was fostered by my assumption that sleeping in a real hotel bed would be preferable to a cot on the unit. And of course, I was completely wrong and should've asked in the first place. I believe the woman's response was "why would I want to be apart from my child?" Duh. So, we worked that out :)

The background issue to my last two weeks of work has been the news that one of my best friends has been diagnosed with breast cancer. The truth is, I don't really know how to feel about it yet as I've been wavering between all-business/information mode and chronic anxiety/wallowing. The obvious corollary issue that gets brought up for me is my mom's own health, which has been great and not concerning thank goodness. It also occurred to me that I might have to worry about my own health at some point, as my friend's age isn't that far away from my own. That one remains more fleeting, maybe because I karate kick it away. But regardless, I feel like I'm carrying a backpack that I can't set down, and I'm looking over my shoulder a little more than I used to.

This weekend holds some good distraction, and opportunity for rest. Like a 35 year old hanging out a college bar, I'm going to Kings Dominion with some of my VTCC friends. I plan to be thrill seeking and have reckless abandon for screaming on the rollercoasters. Sunday is completely reserved for errands, a manicure, and reading. I am three chapters into a sociological/historical investigation of the development of Nancy Drew as a figure in literature and girl culture. And I'm promised good explanation on who Carolyn Keene really is.