Flow Rider and the Baker Act

I made it to Florida! And besides the weather in the 80s, the sweet park across the street that runs through tons of golf courses and

During our orientation today we learned that much of our work in inpatient psychiatry will be related to Florida's "Baker Act" - the Mental Health Act of 1971 that allows physicians to involuntarily hold someone for psychiatric examination if they:

A) have a mental illness,

B) indicate any reason to suspect that they will harm themselves or someone else

After someone is "Baker Act-ed", as they say in our world right now, they are sent to our inpatient psych institute where a psychiatrist must evaluate them within 24 hours to see if they A) are competent to make decisions about their own treatment and B) need psychiatric or any other type of medical treatment.

After this, there are a few things that can happen. The first assessment is to determine if the person is competent to make decisions. The word "competent" carries a lot of weight in the medical (and legal) world, so it's a very important assessment. It's hard to be deemed competent if you are having a psychotic episode and think aliens are coming to get you - but you can be determined to be competent and suicidal.

If someone is determined to be incompetent, a surrogate decision maker is found - this can be a family member, close friend, or in the worst case scenario, a court-appointed surrogate decision maker.

If someone is determined to be competent they have some more decisions to make. They can decide to voluntarily consent to treatment and stay temporarily on an inpatient psychiatric floor for evaluation and treatment. This means the system accepts them as a patient and will either place them back at home, find them a home if they didn't have one when they came, or find them long-term psychiatric care, if it's determined that that's what they need.

If someone is determined to be competent but does not consent to treatment, practitioners can petition for involuntary placement either in an inpatient facility or an outpatient (community) placement. This language was only added in 2005. We'll see how it all goes tomorrow - we start with admitting at 9 and go from there.

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"diseases of the soul are more numerous - and more dangerous - than diseases of the body"

-Cicero

to give a name to the problem

Q: Who is your best critic? What makes a good critic?

When I was home (post-boards) last week, I attended a lecture by author Tracy Kidder where he talked about the dynamics of his relationship with his editor (and now friend) and the qualities one needs, as a writer, in a critical eye.

He had some really profound thoughts, including:

"you become what you pretend to be" (said to Kidder in reference to becoming a writer by another writer who was an alcoholic at the Iowa's writer conference; during the lecture, Kidder remarked that he's found that it's easier to become an alcoholic than a writer...)

he also said that the most important role of an editor is "to find out what is wrong, and to give a name to the problem"; this obviously made me think of the role of a physician, and how often times even when the medical world can offer no help, giving a problem a name legitimizes it as real, and also gives you something tangible to either accept or fight against (whichever seems more productive at a given time).

especially as I am about to start my first rotation in psychiatry, one of the more frustrating (?) areas of medicine because there's so little we understand about mental health and even less that we can do to help (though there is more and more!), I like the idea of the NAMING of a problem being a goal or a service unto itself.

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I love this quote, and while I don't feel in the middle of my life,

I definitely feel RIGHT in the middle of medical school -

between being a knowledgeable student in a classroom and

a clueless physician-in-training in a clinical setting:

"this is where I have always been coming to. Since time began. And when I go from here, this will be the mid-point, to which everything ran, before, and from which everything will run. But now, my love, we are here, and we are now, and those other times are running elsewhere"

-A.S. Byatt, Possesion

chase to the cut

Q: what do you do to mark a new start?

A: get a haircut

In one of my many talks with my favorite stylist (M salon in Cambridge, MA), he told me that women often cut their hair after a break-up or at the start of a new job or after graduating from college - as a sort of symbolic "starting anew" and shedding of the past.

since I'm headed to FLORRRRRIDA this weekend (eek!) I decided to shed my winter hair along with all boards stress and get a suuuper short haircut -- as the locks fell onto the ground I actually felt like the stress was leaving me too. It also may have had something to do with the awesome head massage the stylist gave me when I told her I had just finished a huge test in medical school.

stylist: so what was your test on?
me: ohhhh just all of the first two years of medical school.
(massage, massage, massage) yessss...

check out my cut:

because I think this is the shortest my hair has ever been since birth and I'm soon to be wearing a bikini, I'm stealing parts of a quotation from my rockstar friend Anna's blog by Joan Juliet Buck, former editor of french vogue:

Hair is time.
Women with short hair always look as if they have somewhere else to go. Women with long hair tend to look as if they belong where they are, especially in California. Short hair takes a short time. Long hair takes a long time. Long hair moves faster than short hair. Long hair tells men that you are all woman, or a real woman, or at the very least a girl. Short hair always makes them wonder. When you cut your hair you lose a nose and gain a neck. A neck is generally better than a nose. It does not need to be powdered, except on extreme occasions. It does, however, need to be washed more often.

With short hair you suddenly dislike the month of March, when the wind blows down the back of your neck. With short hair you begin to crave pearl necklaces, long earrings, and a variety of sunglasses. Short hair removes obvious femininity and replaces it with style. Short hair makes you aware of subtraction as style. What else can you take away? You can't hide behind short hair. Your nape is exposed. Men put their hands around your neck instead of stroking your long locks. You can only pray they have friendly intentions. The backs of your ears show, your jaw line is clear to anyone watching, and you realize --perhaps for the first time-- how wide the expanse of skin is between cheekbone and ear.

You may look a little androgynous, a little unfinished, a little bare. You will look elegant, as short hair requires you to keep your weight slightly below acceptable levels. However, the first time you wear a bathing suit with short hair, you will feel exceptionally naked. People who used to look straight at you will love you in profile. Short hair makes others think you have good bones, determination, and an agenda. The shape of your skull is commented on, so are its contents. They can pick you out in a crowd, and you can be recognized from behind, which can be good or bad. But your face is no longer a flat screen surrounded by a curtain: the world sees you in three dimensions.

Chase to the cut.

surround yourself with comfort

Question: what makes you feel suuuper comfortable?

Or better, what do you seek out when you need a little (or big) dose of comfort?

Since I'm about to become a medical student nomad and basically live out of my backpack in various apartments around the country for the next (2?) years, I decided I should use my post-boards, pre-nomad time to come up with a few things that I can try to bring with me or create everywhere I go to give myself some semblance of comfort along this journey. Also, sometimes when I have these things written somewhere, in moments of exasperation or almost-meltdown I'm able to glance at this list and take a deep breath and put at least one (but usually more than one) into motion to give me a dose of comfort.

1. my parents

(especially for total breakdowns AND the while-I'm-walking-places phone conversations)

2. my sister

(maybe the only person in the world who can actually say ANYTHING to me and I'll listen)

3. my tribe

(with visits, phone calls, letters, and emails, you rock my whole world)

4. chocolate milk

(the perfect post-workout/anytime snack)

5. spanicopita

(my favorite food - with spinach, eggs, cheese, all wrapped up in phyllo dough, what's not to love?)

6. leather bound journal

(thank you moleskin for making a no line versions. I kinda hate lines - no room for REALLY BIG WORDS and/or doodles)

7. good (escapist?) books

(reading novels that take me faraway places or bring me to new perspectives has become even more important as I get deeper into this medical perspective; I'm always on the lookout for new ones, so hit me up with recommendations!)

8. running shoes

(because it's my favorite way to explore new places, get to know new friends, and zone out with my own thoughts after a crazy, crazy day)

9. yoga podcasts

(this may seem crazy, but because you can do them at any hour, in any weather, wearing anything, having a 90 minute workout that not only makes you sweat, but makes you BREATHE in your backpocket is pretty awesome)

10. my favorite bag

(cause I gotta put it all somewhere so it can come with me, right? this one takes me from work to the gym to a weekend trip and packs up as small as a pair of socks when I'm not using it)

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"the dog days are over,

the dog days are gone

can you hear the horses

because here they come"

-florence and the machine

wishes

"Dear eyelashes, wishbones, dandelions, pennies,

shooting stars, 11:11, and birthday candles,

DO YOUR JOB (please)."

-unknown

Question: What kinds of wishes do you make on birthday candles?

I thought this quote was fitting both for valentine's day and the week that I take the Boards (and for all my wonderful friends who also take the boards in the next week or so). I had a conversation with a friend on probably my eighth birthday where she told me that when she blew out the candles at her birthday, she made 2 wishes - one that was so big that she felt like she needed to just send it out into the world as often as possible, and one that was about something that she could almost entirely do on her own, she just needed a little itsy bitsy push of luck to top it off and make it great. I thought that sounded like an awesome idea and since then, every time I get to make a wish - I make two. which is totally against the genie-in-a-magic-lamp rules, but since it's pretty rare that I get to wish to genies, it's become a tradition.

AND it goes right along with a piece of advice from my dad's "backgammon theory of life" (more on that in a future blogpost):

"just put yourself in a position to be lucky"

because that's all you can do, right? the rest is up to wherever those wishes on candles, pennies, and shooting stars go...

a life of love

Question: what does love look like to you right now?

last night= me + chocolate chip cookies + milk + fireplace (+ ... yup, qbank and books). but still... it was pretty warm and cosy feeling nonetheless.

and as valentines day approaches, for a little reminder of how big love gets, (and because I love montages) a photo montage about what love means to me right now:

UPS truck photo source

"you don't have a soul. you ARE a soul. you have a body." -cs lewis

lub. dub.

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And the ultimate love quote from When Harry Met Sally

(the ultimate because it's about loving all the thing that make you you)

"I love that you get cold when it's 71 degrees out. I love that it takes you an hour and a half to order a sandwich. I love that you get a little crinkle above your nose when you're looking at me like I'm nuts. I love that after I spend the day with you, I can still smell your perfume on my clothes. And I love that you are the last person I want to talk to before I go to sleep at night. And it's not because I'm lonely, and it's not because it's New Year's Eve. I came here tonight because when you realize you want to spend the rest of your life with somebody, you want the rest of your life to start as soon as possible"

On Waking

Question: what prayer or saying do you feel resonates with you right now?

so I have a complicated relationship with religion and spirituality, which I think can be said for most people - especially most people around my age who are far enough from the traditions of their parents and close enough to figuring out what traditions they will want to have for their own children to be thoughtful about what moves them.

that said, there are a few prayers that really resonate with me, that I find myself filing away for other times in my life and to share with my friends and family. the poetry and prayers written by John O'Donahue are particularly special. here's one of my current favorites that's short enough to say every morning to welcome the possibilities a new day brings; enjoy:

On Waking

by John O'Donohue

I give thanks for arriving

Safely in a new dawn,

For the gift of eyes

To see the world,

The gift of mind

To feel at home

In my life,

The waves of possibility

Breaking on the shore of dawn,

The harvest of the past

That awaits my hunger,

And all the furtherings

This new day will bring.

getting un-stuck

Question: In what situation, relationship, moment are you stuck right now?

the latest of my mom's wisdom: so you know when you see a stick caught in between some rocks in a too-low creek or a tide pool, how the urge is to kick the rocks or kick the stick to free it, but really all it needs to get unstuck is more water, higher tides.

she said that how this metephor translates to real life is that sometimes when you feel stuck, you have to think about what you could pour in excess over the situation to just let it flow. Sometimes this means pouring a huge amount of generosity

, understanding, kindness, or faith towards a situation, another person, or even yourself in order to get "un-stuck".

lately I've been feeling stuck in lots of things and with plenty of people, and definitely with repeating thoughts in my own head of not being ______

enough (fill in the blank with whatever it feels like that moment). and so I'm going to try to pour some understanding and good intentions on myself, this pre-boards situation, and everyone around me who's trying just as hard to be _____ enough.

that's me - stuck in the snow, which is one thing I finally know how to get through.

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"be kind, for everyone is fighting a hard battle"

-Plato