This burnout

Is your medical provider seeming snippy? Impatient? Cranky?  Do they have a faraway look in their eye that looks like they may be wishing they were gouging their eyes out rather than talking to you?  Do you feel like they have checked out and aren't listening?  Follow this simple checklist to see if you are the reason your psychiatric prescriber has compassion fatigue!

Do you regularly make appts and then simply forget about them and no show, so the provider gets yelled at by their boss for reduced productivity?

Do you regularly wander in 15 mins late for appointments and then loudly demand to be seen, completely uncaring of the 15 clients whose appts are after yours who your provider now has to run to catch up with because they will yell at them for making them wait in the lobby?

Do you show up late and then complain at your provider for making you wait in the lobby for 10 mins because of the other 5 people who didn't bother to show up on time?

Do you demand controlled substances by name and then when your provider agrees but has to give you a urine drug screen because our bosses require it, do you yell indignantly at them about how this is unfair before peeing a stream of pure molly and Jack?

Do you come in to your appointment dressed in pajamas you have been wearing for 3 days straight without having showered or used deodorant while chain smoking tobacco and cannabis so that when you leave the office the miasma of your body odor perseveres?

Do you insist on giving your provider a hug as if we're friends rather than understanding that this is a job they are being paid to do?

Do you try to find and friend your provider on social media and then get mad when they decline?

Do you track down your provider's home address or number and contact them to ask for refills?

Do you refuse to take simple advice like engaging in therapy but at the same time say hyperbolic things like "My anxiety is through the roof off the charts out of control" when you actually mean "I get tense sometimes at work" and then insist that the only thing that works is controlled substances?

Do you insist you need sleeping pills and then argue with your provider when they say that perhaps instead you should cut back the 3 energy drinks you have every day because you think that could not possibly be the problem?

Do you insist on getting benzos and then argue that you have no need for therapy "because I've done it all before" and thus it can't possibly help because of course two different therapists could not possibly have different approaches?

Do you whine to your provider about how the only reason you got a domestic violence charge is because you're a subjugated cishet white male and if you were female you would have been treated better by the courts for giving your partner a black eye?

Do you insist on interrogating your provider about their gender presentation and then make a big deal of how annoying you find gender neutral pronouns, and then insist that they engage in that conversation with you rather than let them focus on their actual job of medication management?

Do you change your med dosages on the fly without consulting your provider first and then yell at them for not releasing early refills when you increase your dose on your own?

Do you miss appts and then request early refills of controlled substances via email?

Do you complain about how hard it is to manage your trust fund/inheritance, while not having to work or go to school, and having no real social responsibilities while being a cishet white male?

If you answered yes to any of the above, yes, you are part of the problem and yes you are part of why we burn out and seem calloused and uncaring.  Don't take it wrong or personally, it's just that we are burnt out because of you specifically and how you are and the things you do and say, that's all.  Thanks for listening.

This Gender Affirming Surgery Letter

For the sake of allowing folks to have a copy of a generalized, boilerplate psychiatric gender affirming surgery recommendation letter, here then, in all it's gatekeepy glory, is a blank copy of the letter I have used and curated for years successfully. Feel free to use, share, copy, give helpful feedback, etc etc. 

Date: today

Re: John Q Lastname (the Q stands for queer)

DOB: 26 June 2019 

To Whom It May Concern:

I am writing this letter of support on behalf of John Q Lastname in his pursuit of medical treatment and evaluation for gender reassignment and affirmation surgery.  He is a 28 year old Black trans male, assigned female at birth.  He first met with this clinician on your mom’s birthday for a comprehensive psychosocial assessment that included an evaluation of gender dysphoria history, support network, awareness of risks and benefits related to said procedure, and for an assessment of his ability to give informed consent.

After the comprehensive psychosocial assessment detailing past experiences and gender identity, it became evident that John Q Lastname meets the criteria for Gender Dysphoria, as set forth by the World Professional Association for Transgender Health in the seventh edition of the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, and as defined by the American Psychiatric Association in the DSM 5.

The goal of the psychosocial assessment is to provide a holistic client portrait, gauge the client’s readiness for medical treatment, and to inform a treatment plan from a behavioral health perspective.  The purpose of the psychosocial assessment includes the following six factors:

1. To facilitate the wellbeing, empowerment, and support of the client;
2. To highlight the diagnostic criteria for Gender Identity Disorder, that is met by the client, as defined by the DSM IV-TR or for Gender Dysphoria, as defined by the DSM-V;
3. To facilitate appropriate referrals for mental health, psychiatric, medical and/or surgical interventions as indicated, and if client is seeking medical intervention, to make assessment of the client’s mental health and readiness for these interventions;
4. To rule out the presence of psychiatric or psychosocial stressors which could interfere with the client’s ability to engage in treatment, or be able to describe how these are controlled;
5. To assess the client’s ability to make informed decisions about her/her/their care; and
6. To identify with the client any issues which could be addressed in on-going behavioral health treatment.

The assessment process generally includes, but is not limited to: childhood development, gender identity, sexual orientation, trauma history, prior mental health treatment and/or hormone replacement treatment, social support and finances, substance abuse history, and the client’s understanding of medical intervention as part of the transition process.

John Q Lastname has a long history of cross-gender identification and gender dysphoria. This has impacted work, school, and social functionality historically.  He has been living socially under his preferred name of John Q Lastname for approximately 5 years, which also has contributed to reduction in gender dysphoria.

This clinician believes that he is able to provide informed consent in pursuing or engaging in any prescribed medical treatment to alleviate gender dysphoria.  He has a more than adequate social support network in place to support him during the recovery process as well.

John Q Lastname has been undergoing hormone replacement therapy for 4 years under the supervision of Dr Jacob Feelgoode at this clinic.  John Q Lastname has been living fulltime as his identified gender for over 5 years.  He has been binding his chest off and on to reduce feeling of dysphoria as well as wearing oversized clothing to obfuscate his figure.  Avoids binders only due to the discomfort they cause and the exacerbation of feelings of claustrophobia and difficulty respirating.  Further medical/surgical gender affirming intervention, including chest reconstruction surgery, would seem to be the logical next step in relieving any remaining gender dysphoria symptoms.

John Q Lastname is both able to assess and is aware of risks and benefits associated with medical intervention to relieve gender dysphoria including surgical procedures.  Judgment and insight have remained intact and unimpaired consistently as have mental status exams overall.

In all, I am confident that John Q Lastname understands the implications of surgical treatment.  It is my clinical opinion that pursuing further reduction in feelings of dysphoria will greatly improve his quality of life.  I support his decision to pursue medical intervention related to gender identity/dysphoria.  If you have any further questions, please contact my office at 503-460-0405. I would be happy to discuss the matter further, with the client’s written consent.

Sincerely,

Jacob Balinky, PMHNP-BC 

This corpus horror

In which I recount the Epic Saga of the last month. Here's the thing, intellectually you always know that you can become really sick, or even disabled, but on some level you never really believe it until it throat punches you.

Diabetes runs all through my family, so I always knew that it was coming for me, slowly but surely, like a fucked-up vampire sloth. A couple of months ago I noticed that I wasn't able to read the item descriptions in my inventory on Mass Effect, and had to have my partner read them for me even though he was just about as far from the screen as I was. So I went to the eye doctor and found that I needed glasses despite the fact that I only had LASIK surgery a few years ago, and quite successfully too. As an afterthought we decided to go ahead and test my blood sugars just to be certain that I wasn't running high, because that's a thing that can sometimes drive reductions in vision.

Turns out my sugars were through the roof, cue metformin. A rare side effect of Metformin turns out to be something called lactic acidosis. I was one of the lucky ones.

Cue Glipizide. This was not bringing my sugars down however, even at top doses, cue insulin. For those of you unfamiliar, this is not the way this usually goes. Typically you have a lot of time before you have to start insulin, and usually diabetes doesn't slam into you like a freeway truck. However even with this cocktail, my sugars were uncontrolled and I wasn't really able to eat much, for some reason I couldn't deduce at the time. I also was having trouble with dizziness, stumbling around like I was drunk despite painful sobriety, and general weakness and fatigue, and not the Monday morning after a late Sunday kind.

As it turns out, my liver was attempting to jump out of my navel. This was uncovered after a blood test revealed that my liver enzymes were just about on level with someone who had Advanced hepatitis. To be clear, I don't have hepatitis. I know because that's the first thing we tested for. By this point I was on Zofran, a medication to keep me from Technicolor yawning all over the house. It wasn't really working, but it was trying hard. We took my blood again and found that my liver was continuing to be pissed off and so we did an ultrasound. This didn't show anything except for, surprise, a liver with anger management issues. This type of thing drives up blood sugars a lot, so mystery solved there at least.

You know, you can go your whole day and not really think about what your liver is up to. That is, of course, until it starts getting an attitude.

My doctor's verdict? I had some mysterious virus that was pissing off my internal organs and was going to run its course and then I would magically start feeling better? I hadn't much hope by then. By this point it had been about 2 weeks since I'd been able to work, thank all the deities for Aflac.

Eventually, the universe took pity on me and my liver just started to chill out as this unnamed mystery virus got bored and wandered off. My doc doesn't believe that we'll ever know what infectious process was slapping my liver around, and frankly I don't care as long as it doesn't take an interest in me ever again.

I've never been truly disabled since I started working as an adult. I mean, aside from the occasional respiratory infection, however those have a really well defined course and you know roughly how long they're going to last. The worst I'd experienced as an adult was bronchitis taking me out for a week or two, or the odd surgery that took me out for a week or two. But here it was three weeks in and I still wasn't sure how much longer this was going to last. The biggest stressor for me was the nebulousness of it all. How much longer was I going to have to miss work? How much longer was I going to have to sit in this recliner? Just how long before I could eat something besides dry toast before I kill someone? I haven't even gone into the details of what liver dysfunction does to your bowel movements, but trust me, it ain't pretty. I'm fairly certain we're going to need a rabbi to bless my bathroom before it can be safely used by humans again. But I digress.

Today marks the fourth week of my being off of work, and it looks like I'll be fit to be re-released into the work force next Monday. This has been without a doubt the most terrifying, most uncomfortable period physically and emotionally of my adult life. I was sick a lot as a kid, but when you're young, you don't really have a sense of mortality, or at least I didn't. All I know is that there's no amount of emotional preparation that I could have done that would have made this any easier to process. When you're that sick, the most simple cognitive processes become intense uphill struggles. The next time one of my clients comes in telling me that they have trouble thinking or concentrating because of pain or nausea or any physical problem really, I'll have a whole new understanding of what they're talking about.

I cried every day of this ordeal. Every. Day. And now, the simplest of physical victories, like leaving the house for something other than another blood test or eating something other than toast and not throwing it up make me feel like Rocky Balboa beating a Russian twice his size.

Yesterday, I went out wearing real clothes, and got 2 oz of sugar free frozen yogurt, and sat like a person eating it with my family at a table and watched random humans go by. After weeks of going to Kaiser an average of 4-5 times a week, it felt like going to Disney World.

The point of all this, if indeed I have one other than to record this experience as a means of upload to external memory, is as a reminder. Both to appreciate any moment of good health that you have, and to be as kind and patient as possible to those who have less of it than you do. Because that, I assure you, will be you someday, and you will not be ready, and you'll need all the kindness and patience you can get.

Meanwhile, that thing that you were really wanting to do but were putting off until you had a little bit more money? Go do it. Because you might not have the spoons to do it tomorrow.

Dat fourth reich tho

Chuck Wendig recently, and super no-scopedly, called this the epoch of syphilitic dipshittery. (I had to spell check syphilitic omg am I a nurse?)  And it got me Thinking About Stuff. Specifically, it made me think about why I keep having sweat-and-pee soaked dreams about all the body politic.  I'd been questioning my reactions to the persistent, hyperspeed onslaught of news, each byte more freaky than its predecessors.   Was I being melodramatic? Was I just losing my teflon-coated Daedric armor of positivity?  The news kept calling me a snowflake, were they right??? Holy shit, it's June, snowflakes don't historically last long in these kind of heatwaves... I better figure this socio-political angsty shiz out, and that right quick.

I'm quite stereotypically Ashkenazi. Like so many of my peers at my heeb school growing up, lots of my family branches had been burned during WWII.  (Yes, literally.)  My great Aunt told me stories about growing up in the Warsaw ghetto while her sister, my grandmother, got gently drunk on white Franzia and turned off her hearing aid so that she couldn't hear my mom squawk at her to put the box down.  I hadn't dredged those stories to mind in a long time, but recently, they started fluttering limply back from the 'ol hippocampus like Exxon Valdez birds. 

So many of my aunt's stories sound vein-chillingly familiar to some of the news stories of the last 6 months.  Stories of the gestapo being helped by local militant groups, or just conservative randos who were nearby, to herd and incarcerate the Jews of the area when they were moved to the ghetto, or, more specifically, when they resisted being moved. Jews being shot by law enforcement just for talking back or walking down the street.  My aunt hated telling me these stories, though my dad and I always pressed her to.  She was beaten pretty badly once as she was on her way to school when she was 8 by some older teens while being called (screamed) the equivalent of kike, just before her family moved.  That particular story she never told me, my grandmother recounted it because, as she put it, "it's too hard for her to talk about, but it's important you never forget it, where we were, and what we did, and why we're here instead.  Now eat some ruggelach, you're too skinny."  

Baked crumbly Jewish delicacies aside, she was right, it was.  I think, looking back on it now, she meant that this moment right here is why it was important to remember.  It was important to remember what impact the news can have on a populace, and how that populace can feel empowered to be monumental prolapsed anuses to any group they don't like if those in power encourage it.  It was important to remember how to identify the warning signs of an impending autocracy. It was important to remember how it looked and felt as empathies, and rights, were degraded by centimeters and eventually parsecs.  They tried to trust the law, the government, their non-Jewish neighbors, wanting to keep to the high road and assuming it would all work out because, c'mon, these were their neighbors.  But, eventually it all exploded in a long, heavy shit shower, and the country eventually disappeared entirely up it's own asshole and then imploded.  And that's how I ended up here.  Blogging at your face. About how this all feels way too familiar.  My aunt and her family didn't march or protest, they feared, and they ran.  To be vodka transparent, I ain't mad at them for self preservation.  BUT.  I can't help but wonder what my aunt's stories would have sounded like if she, and all of the other amcha and righteous (or just middle of the road) gentiles at the time, would have loudly taken to the streets.  

My point, if indeed I even have one in all of this fappery, is this: TAKE TO THE GAWDSDAMNED STREETS.  I'm tired of despairing, I'm tired of feeling like there's a heavy inevitability to all this syphilitic dipshittery.  Cussing a lot helps, so cuss up a fucking storm.  Yeah, I'm still sad, it's unavoidable.  But I'm rapidly finding that the best tonic for sad is RIGHTEOUSLY FUCKING PISSED OFF.  It's important you never forget it, it helps when you're where we are, doing what we're doing, here instead of someplace better. Now go eat some muthafucking resistance ruggelach. 

This pain

WHY YOUR PAIN IS NOT BEING TREATED

Hi. I'm your friendly neighborhood NP, here to talk to you about how THE WORLD IS GOING TO END  ARG ARG ARG RUN RUN RUN THE OPIOIDS ARE COMING FOR US ALL.

At least, that's apparently what this, er, let's call it "measured and thoughtful" letter from our US Surgeon General, Vivek H Murthy, is trying to tell us.  By us, I mean every practitioner with a prescription pad or, more to the point, a DEA number.  Yesterday I walked into my office and saw this little number waiting for me on my desk, enjoy. My opinions follow.  No, there will be no jumpcut. Read it.

"August 2016
Dear Colleague, I am asking for your help to solve an urgent health crisis facing America: the opioid epidemic. Everywhere I travel, I see communities devastated by opioid overdoses. I meet families too ashamed to seek treatment for addiction. And I will never forget my own patient whose opioid use disorder began with a course of morphine after a routine procedure. It is important to recognize that we arrived at this place on a path paved with good intentions. Nearly two decades ago, we were encouraged to be more aggressive about treating pain, often without enough training and support to do so safely. Tis coincided with heavy marketing of opioids to doctors. Many of us were even taught – incorrectly – that opioids are not addictive when prescribed for legitimate pain. Te results have been devastating. Since 1999, opioid overdose deaths have quadrupled and opioid prescriptions have increased markedly – almost enough for every adult in America to have a bottle of pills. Yet the amount of pain reported by Americans has not changed. Now, nearly two million people in America have a prescription opioid use disorder, contributing to increased heroin use and the spread of HIV and hepatitis C. I know solving this problem will not be easy. We often struggle to balance reducing our patients’ pain with increasing their risk of opioid addiction. But, as clinicians, we have the unique power to help end this epidemic. As cynical as times may seem, the public still looks to our profession for hope during difficult moments. Tis is one of those times. Tat is why I am asking you to pledge your commitment to turn the tide on the opioid crisis. Please take the pledge at www.TurnTeTideRx.org. Together, we will build a national movement of clinicians to do three things. First, we will educate ourselves to treat pain safely and effectively. A good place to start is the enclosed pocket card with the CDC Opioid Prescribing Guideline. Second, we will screen our patients for opioid use disorder and provide or connect them with evidence-based treatment. Third, we can shape how the rest of the country sees addiction by talking about and treating it as a chronic illness, not a moral failing. Years from now, I want us to look back and know that, in the face of a crisis that threatened our nation, it was our profession that stepped up and led the way. I know we can succeed because health care is more than an occupation to us. It is a calling rooted in empathy, science, and service to humanity. These values unite us. They remain our greatest strength.
Thank you for your leadership."


Well then.  And thank you, Vivek, Vivvy, may I call you Viv? Viv. Thank you, for alerting me to this "urgent health crisis that threatened our nation."  Naturally, as a conscientious practitioner, I wish to be up on the latest data and, hey, if prescription opiates like Norco and Vicodin are killing people in droves, quadruple the deaths since 1999 sounds super scary after all, I better take your advice and make sure I'm as educated as I can be, right? Of course right.  So, off I surf to CDC.gov, to fill up on data, omnomnom delicious data.  I mean, the last thing we'd expect is to find is that this kind of vague, inflammatory language isn't... *reads opioid overdose stats page* isn't based on actual facts that... *reads some more* facts that.... *re-reads*....
....
*re-reads again*
....
Gawddamnit, Viv.
Turns out, according to the CDC, "Changing the way deaths are analyzed seems to result in a decrease in deaths involving prescription opioids."  Huh. What does "changing the way deaths are analyzed" mean, I ponder. Turns out, this means that while deaths from opioid overdoses have indeed increased over the last several years, this means deaths related to ANY opioid, including such best selling titles as frakking heroin (which is NOT a prescribed opiate, just to be painfully clear) and bootleg Fentanyl cooked in a bathtub and cut with who knows what.   Apparently, overdoses from NON prescription sources, specifically heroin alone, accounts for most of this uptick.  Also, given that Oxycontin wasn't even INVENTED until 1996, it makes sense that the deaths from this medication have, you know, increased, since before it existed.

Viv, from the bottom of my prescription pad and from the bottom of my heart which belongs to two amazing partners who struggle with chronic pain every damn day, please go fuck yourself vigorously with a cheese grater. And do it, obvis, without pain meds.  Because years from now, I want us to look back and know that, in the face of reactionary ableist tripe, it was our profession that stepped up and looked critically at said tripe and led the way to ripping it to shreds.

This paradigm

Hey there.  I'm Jake.  I have a lot of discomfort related to neuralgia in my left femoral area, due to nerve root impingement.  In English, I gots pains, yo. Pins and needles that shoot pretty constantly from my left hip down to the knee.  High doses of turmeric help. I'm a PMHNP so I can't take anything that might intoxicate me or hinder my judgement while I'm prescribing, though to be fair, pain can hinder your judgement pretty profoundly too, so, yeah.  (and no, don't @me about that unless you have some fucking experiencing being in consistent, cringing discomfort for months on end while having to make important day to day decisions which significantly impact other people's wellbeing all the while just wanting to punch a baby square in the cutes)  I only have one functional kidney, so I can't take NSAIDS on the reg, gotta baby that thang.  Which brings me to the point of all dis glorious tmi:  HOW DO I TREAT DIS SHIZ BEFORE I KILL SOMMUN????  Glad you asked.  Since I live in Portland, I know what you're gonna ask, and no, I don't smoke weed.  I vape cannabis.  SEE WUT I DID THAR? Here's the thing, I get my curls in a twist when I see the dominant thoughts about cannabis being amplified by, well, most platforms.  Even the platforms that are pro-cannabis are hit and miss when it comes down to it, because eventually at least 50% of the sites I go to for information degrade into the all-to-familiar tropes most associated with cannabis.  Yeah yeah, that joke about Chong was hilarious, sure sure lacing that article about anti-inflammatory effects of cannabidiol with stoner-talk euphemisms is super cute, and original af too, never seen it done before, now please just render unto me my relevant medical information. *disappears in a puff of vapor*

This muphu right here

Please enjoy this copypasta of an actual chat I had with customer service, trying to find the missing tech who was supposed to repair my internet line which had been cut by the FD after the ice storm. The snark is real.  Note: My name. Is not. Jennifer. However, that's how they had it on my account so that's what showed.  Note the last line, I imagine he was rubbing his nips while moaning as he typed that line.

Jennifer : at 11:05:19

he was supposed to be here today between 8 and noon I think

no luck yet

Albert: at 11:05:43

I see. Let me check the technician. 

Jennifer: at 11:05:50

repair reference number is VP217129

Albert: at 11:06:21

Thank you

Jennifer: at 11:07:20

I appreciate the help?

Any luck?

Albert: at 11:10:13

Thank you for waiting. I'm, reaching out to the technician assigned to the job right now.

What's your best callback number?

Jennifer: at 11:10:35

503-867-5309

So do we have an ETA for the tech's arrival?

Albert: at 11:13:59

Thank you for waiting. I've sent an immediate message to the technician to update you since he is been running late on the schedule appointment visit. Base on his status that I can see here, he is still working a job before your location.

Jennifer: at 11:14:41

uh huh.

soooooo, he's going to be at my place when?

Albert: at 11:16:05

My apologies, there is no Estimated time of arrival, however, he should be updating you any time soon about the appointment.

Jennifer: at 11:17:52

so, to sum up, he's running late, not sure how late, he should be updating me about when he may be showing up, but that definitely won't be within the pre-arranged 4 hour window, is that right? And I should expect him to call me in how long?

Albert: at 11:20:05

Unfortunately, that is right Jennifer, the update from him should be within an hour or within the day.

Jennifer: at 11:21:35

uh huh. you know, I'm curious why we bother scheduling 4 hr windows days in advance if they're not something the techs can honor. Just saying.

Jennifer: at 11:23:08

So to also sum up, I'll need an adult at the house for the rest of the day if we want the wire repaired. I can't authorize the repair here?

Albert: at 11:23:09

I understand your frustration Jennifer, rest assured your feedback about this scheduled appointment will be escalated.

Jennifer: at 11:23:41

Also, before I forget, I've changed my name and I'd like to do that officially.

In your records.

Albert: at 11:24:29

You want to update the account holders name is that right?

Jennifer: at 11:24:37

Correct

Jennifer: at 11:25:52

Can we do that?

Albert: at 11:27:32

As much as I wanted to do it for you, only Care department can update the information for you as we are in charge of technical concerns.

Here is their direct number: 800-244-1111 They are open from Monday to Friday 8AM-6PM. Saturday CLOSED.

Jennifer: at 11:30:06

Ah ok. Thanks.

Albert: at 11:30:54

Again, I'm really sorry you are having these issues but for the mean time, is there anything else that I may assist you with?

Jennifer: at 11:31:37

else? you haven't really been able to do anything at all, so, no, I guess not.

Thanks for trying.

Albert: at 11:32:31

Your welcome Jennifer, Thank you for choosing CenturyLink, have a good day!

Bots of our lives

Fun with idiots

Fun with grindr bots

This cat

Liked to yowl and bring us things she killed. Like socks, and napkins, and sweaters. We called them Isis babies.

Liked to sit above me on a sofa back and groom my hair. FOREVER. Yeah it got creepy.

Liked to scream in the middle of the night in a manner that sounded exactly like someone howling  my man's name. First night he slept over, nearly made him piss himself.

Really really hated the cone of shame. No really. A lot.

Liked when she was the least bit hungry to chase any and all creatures within bitch slapping distance. Her pimp paw would lash like a hurricane and the other cats fled from her while she chased them around and around our house. This continued until a continuous feeder was offered. The bloodshed lessened after that.

She was amazing and graceful and proud and loving. And she would kick your ass. And you'd thank her after. I've seen it happen. She even pimp slapped my bear once when she got mouthy, right upside the head. How many cats can you depend on for that, seriously.

I knew her 14 years. Smallest cat in the house, with the footfalls of an African elephant whom all the other animals respected and feared. Including us.

Requiem in terra pax. You gorgeous little evil.

Insert this trite overused pithy comment about sex change here

Getting a hysterectomy by accident: Check. It ain't exactly "Bottom surgery" but, check anyhow.

Changing name legally to one the world would generally consider a boy's: Check.

Changing DMV designation to reflect "M": Check. (well, soon as name change is done)

Next: Call IRS to see what is entailed in filing jointly because jeebiz after supporting my wife for years as the breadwinner but not being able to file jointly, I ask you: What has two thumbs and is tired of paying upwards of 6k extra in income tax because it looks like I'm single every damn year: this guy, good to meet you.

IRS Guy on phone: "Um, interesting question, I think that if you are legally married as a legal male and legal female, and the state recognizes the marriage, it's ok, but, um, let me send you to the Complicated Tax Problem team."  (No I'm not making that last bit up, they're really called that)

Me: "Um, thanks?"

So... umm... check?

This temptation

Not ten minutes after I wrote that previous post, my very very favorite cake showed up in the staff room. Strawberry, angel food, and whipped cream frosting. Poked my finger into the frosting a bit and had a tiny taste and walked on by. TESTED. PASSED.

This Relapse

So things got hard. I went into foreclosure, got out again. Lost my bear to various types of illness for a while, got her back again. I got sick myself, with a bad cold, still am.  And in the midst of all of that, like so many other addicts, I said Fuck It.  I said everything to myself that I've heard from the other side of my desk a thousand and one times: It was just too much. I couldn't keep it all together and stay straight at the same time.  Etc. I made all the excuses and gave myself all kinds of permissions.  I haven't even bothered to weigh myself in weeks, though I know the damage is likely not as bad as I fear it is.  I'm still in between a size 40 and 42. I can still turn back before I fall further.  I tell my clients that relapse is a part of recovery, that you shouldn't punish yourself for it, you should just learn from it and move forward, move on, let it be part of yesterday rather than today. Just live in today as best you can, and say that just for now, just for this meal, just for today, you'll stay on your program.  My dad never could do that.  He never could forgive himself, for anything really, ever.  If I learned about being hard on myself from anyone, it wasn't just from my mom who drip fed (and drip feeds, current tense, whenever I let her) the ammo, it was from my dad, who fed me the habit of self flagellation through food, all by example.  He didn't mean to, any more than I think my mom means to be, well, mean.  He taught me to be forgiving for everyone, for everything, to a fault even, except when it came down to where the buck stops.  He taught me about responsibility, but never about how to put it down carefully without breaking it or give it to someone else when I was tired.  Responsibility was not something to be proud of or to celebrate, it was something like a hair shirt, but worse than that, because you were supposed to want it, because you deserved it.  As in, thank you sir may I have another kind of deserving.  He had a very Catholic way of looking at responsibility and guilt, see, Jews  usually just live with it in an almost cheerful way, they love their guilt, they cherish it. But dad, he carried it like a big damn cross, always living in effervescent fear that he wouldn't live up to his own expectations or those of his wife or kid.  He did so many things he didn't want to to assuage that fear, and I know he never wanted that for me.  When I felt like I failed at supporting my family, I started punishing myself in the only way I knew how, which brings me to today.  This is not, by the way, a testimony about a diet that'll "start tomorrow and for reals this time."  This is not a promise of abstinence and sobriety forever and ever amen.  This is just an assertion that for now, for the rest of today, I look at what I eat and I count my points. Just for today. As for tomorrow, well, fucked if I know, I'll have to see what I end up writing here then.

This parody: Gay Pride Day Song

With apologies to Adam Sandler, please sing the following lyrics to the tune of "The Channukah Song" loudly, while at your office, preferably in a cubicle so everyone can enjoy it. Thank you.

(Chorus)
Put on your ondoms-kay
Here comes Gay Pride Day
Break out the good lube, ok?
Cuz it's time to celebrate Gay Pride Day
Down some X and dance the night away
It's national Gay Pride Day
Put on your leather and gold lame
To celebrate Gay Pride Day
Listen to your Indigo Girls C-Dai
For Big Gay Pride Day
Don't forget to practice sodomay
On this National Gay Pride Day

(Bridge)
Gay pride day is the festival of feys
Instead of just one type o'sex, we're all over the damn place
So when you feel you're the only kid in town
Who's not a heteroo
Here's some folks who're also queer
Just like me and you:

(Verse)
Doogie Howser smokes the pole
Zack Quinto also loves getting stuffed in his hole

Greta Garbo, Joan Baez, they loved to lick carpet
So does Cheney's daughter Mary, he can't stand it

Green Day's Billie-Jo, does the sweaty hulu
And you know else does? Oh my, Mr Sulu!

Saddam Hussein. Not a gay.
Despite the opinions of Matt and Trey.

But Gaddafi had his beefcake porn, and David Geffen too
I however imply no connection between the two

Tilda Swinton. Only in our fondest wishes.
But sometimes, in the right mood, Ellen's ex Anne Heche is.

Alexander the Great buggered lads, so did Cole Porter           .
And Maurice Sendak always knew where those wild things were

Angie Jolie and Drew Barrymore, bat for each side
Put them together, what a fine looking dyke

Being a queer isn't magic, but I'm just sayin,
Dumbledore AND Gandalf were played by Sir Ian Mckellen

Kathy Griffin wishes she was as gay as Margaret Cho.
But the guy who wrote Fight Club was a HUGE friggin 'mo.

David Bowie and Micheal Stipe love to hatch balls.
And do you know whose? Wham's George Michael's!

The Oakland A's Glenn Burke batted for our team they say
And you know I've always wondered about Andrew Dice Clay.

Ricky Martin broke the closet door when he exeunted
You know who else? (sit on my)Facebook cofounder Chris Hughes did.

Lady Gaga often visits Sappho's island
And Rock Hudson took his packages through the back end

John Cameron Mitchell: Here I will simply reference "Hedvig"
And best believe B-52's Fred Schneider tossed him some salad

James Carroll, William Burroughs, & Truman Capote.
I hope they're all in heaven, enjoying a lemon party

So many people getting humped so many ways
So fuck it, go ahead make 'em all queer pride days!

This phisher

I recently received a phishing spam, as one does, and out of boredom and devilment I responded.  The results are below with the spam first. Please note: I used an anonymous email address unconnected to anything else on gmail to respond. I highly recommend against responding to sack-cheeses like this with your actual email address.  You could get some on you. Enjoy.

Royal Dutch Shell Group
Shell headquarters
Carel van Bylandtlaan 16, 2596 HR The Hague, The Netherlands

Postal address:
PO box 162, 2501 AN  The Hague, The Netherlands

WINNING NOTIFICATION,

We happily announce to you the Lotto Winning of the Royal Dutch Shell
Lottery, online promo held in March 2012. Your email address match
with Ticket Numbers: 7673899373ST with Serial Number: 779937/SN which
subsequently won you in the Lottery promo.

You have therefore been approved to claim a total sum of $5,000,000.00
(Five Million USD) in cash.

All participants for the online version were selected randomly from
Royal Dutch Shell Database worldwide, Royal Dutch Shell must have had
your contact from the purchase you have made or the entry of your data
on the masterlist relating to Shell or it's Petroleum/Gas Products.

PLEASE NOTE!

To file for your claims, please contact the Fiduciary Agent:
Zonal Co-ordinator
E-mail: 1952204889@qq.com

Provide her with the below details for payment processing:
FULL NAMES:....................
ADDRESS:.........COUNTRY:......
GENDER:...........AGE:.........
OCCUPATION:....................
TELEPHONE/CELL NUMBER:.........
AMOUNT WON:....................

Your Sincerely,
MR. LESTER JOHN STOVER
Online Co-ordinator ROYAL DUTCH SHELL LOTTERY International Sweepstakes

My response follows:

I am happily going with the Winning of the Royal Dutch Shell Lottery, with luck balls in!  On online held winnings I will be have of the promotion and I strongly wish that my email address matches with claim numbers that are generated from the promotion of the masterlist.  The elephant flies with a cigar, I'm sure, and so I'm worried that the matching with the claiming numbers might be not with the correct fiduciary appeasement of same.  Can you provide me with the correct widget, so that we can entry together with this process before the petroleum catches inflation? Thank you!

Sincerely, 

Pringle Frito, Esq.

Age 94

Occupation: State Panty inspector, #69

Telephone: 248-434-5508

```````````````````````````````````````````

Bonus Note:  That number? It's a Rick Roll. That is all. -JB

This idea

If I were a superhero, I would be a wonderous badass with a scrip pad. My nom de hero would be Psych Man and I would have the power to manipulate every neurotransmitter and receptor within 100 feet.  My tag line would be "I just psyched you out."  I would use it whenever I crushed evildoers by upping their guilt transmitters.  They would crumble into tears and beg their victims for forgiveness and the judges to convict them.  And the victims would have all their narsty PTSD chemicals erased and I could make people super smart and reverse brain damage. I probably wouldn't even need the scrip pad.  Somebody get on this.

Born this way

Recently I found myself in a conversation with my boyfriend regarding some of My Issues. Apparently I have a tendency towards more than just John Cusack-esque self deprecatory witticisms.  No, I have a tendency towards full on bad-poetry-by-black-candles type self abasement.  Who knew.  So the boyfriend asserts that this is not in fact hard to comprehend, because each instance of said abasement can be traced back to- oh come on sing it with me you know the words- my mother.

Yes we understand, Mr Freud, siddown. In fact, as it turns out, I can indeed recall such sterling gems as "oh my gawd don't brush your hair back your forehead is showing it looks ridiculous" and "holycrap do you have big saddlebags" and of course who could forget the iconic "what are you wearing?"  I've recently been made aware that this is not in fact the way all parents speak to their pre-adolescent offspring. This is fascinating information.  Further, it has been revealed that when you do talk to your pre-adolescent of choice like that, it can, and stay with me here I know this is a complex equation, affect them.  It seems that when you're constantly ragged about your appearance as a youngster you tend to integrate that kind of thinking as an adult. Again, who knew. Certainly not myself, a trained psychiatric specialist. No really, it never occurred to me to connect these two facts.  It just goes to show you. What it shows you or where it goes I am not entirely certain and I hate that saying but there you have it.  I'm guessing it goes to therapy.

In any case. Herein I have compiled a completely non-exhaustive list of things I was gifted with at birth and would love to return rather than regift to anyone else.  I figure, I'd better start liking some of this stuff in order to  better recognize the hot melted butter that I apparently am according to the two experts I live with and regularly get to sleep nekkid next to:

A huge shnozz, like whoa.  Also it's been broken twice so it meanders. Check the silhouette before it wrecks you.
A hairline almost as high as Garfunkel's. When I'm sweaty you can check your makeup.
Lumpy thighs. Which taper so fast on the way to Ankletown that when I look down at my legs when I'm sitting at my desk it looks like an M typed in Comic Sans.
An appendix scar that has puckered to the point of being able to hide things in there. I could fool drug dogs.
I have muscular forearms, but once again, the taper in my upper arms is so extreme I bork BP cuffs.
I have feet that are about as wide as they are long and they don't make shoes shaped like squares.
I have no torso or neck. These are facts.
Ever since my sweaterpuppy redux surgery my shirtfruit are strangely pyramid shaped. I think my black cat Isis feels at home sleeping on my chest as it recalls her to her native land where she was properly worshiped.

I think that's all that comes to mind plus I should probably like, work to help underserved people achieve mental wellness or something.

This admission

I don't think I've told this to anybody.  You see, there are two kinds of people in this world: Those who clean their ears daily with q-tips, and those who do not.  I am the former of the two. Every day, without fail, a cotton swab and I go at it and it's a pleasurable experience for all involved. Or so I assume. But how does one begin such a lifetime of auricle servitude? I know just the moment when it happened. Perhaps you've seen the quintessential 80's teen love ski movie Better Off Dead with the ever deadpan John Cusack.  Perhaps you haven't, and if that's the case, go rectify that shit right now.  He battles wills and wits with Blond Popular Hunk  Who We Swear Is 17 But Looks About 30 Because That's How We Rolled In Those Days on the slopes of some nameless midwestern town costarring an actress with the most hysterically horrendous French accent you've ever freaking heard.  In this movie, there's a fabulous bathroom scene wherein John starts stuffing q-tips in every orifice he has above the waist. I've used them ever since. My name is Jake, and I'm a swabber.

This job

For the love of Xanax, people, please, I beg you on my knees, take. Your damn. Medications. As ordered. Look, I know, you feel like you've gotten comfortable with that med I prescribed, you think, "hey, this is amazeballs! I shall take more!"  Because more is always better, as any crackhead will tell you.  And then you run out early. And then there are no refills left. And then you call me because suddenly you're not feeling so hot because you either a) overdosed yourself or b) ran out early and are going through withdrawals. And I gotta swoop in and pick up the pieces. Usually at 4:45 on a Friday, because I'm the only clinician fool-headed enough to actually work till 5 on Fridays.  

Allow me to make this as vodka-for-my-splitting-stress-headache-clear as I can: That shit written on the bottle? Those are called "orders" for a fucking reason and I didn't put them there just so that my stock in label-printer-ink would go up.  No, betchiz, I wrote those just for you and only you and they are not suggestions.  They are not meant for your buddy who is having "a rough day and just needs a little something to help him calm down."  No.  I decided on that dose based on your weight, physical health and health history, allergy history, possibly also on family history as well as on the severity of the symptoms I'm treating your I-didn't-go-to-3-years-of-psychopharmacology-classes-but-I-still-know-better-than-my-NP ass for.  I don't fucking know your buddy. I didn't spend an hour pounding his history into my keyboard for later reference. No. I did that for YOU.  Thus, that shit on that bottle, if I may be so bold as to reiterate, IS FOR YOU.  

If I tell you to take one of those every day and they work well and you end up having a fight with your baby daddy at the Burger Barn and then decide to power down 5 of those bad boys with your Mountain Dew to "take the edge off" and also as it happens your ability to be conscious, well that's just Darwin proving himself right one more damn time. You may think that calling me after the fact and saying "Now I didn't want to lie about it so here's what I did what do I do now?" is going to make us all good. No, idjit.  Wanna know how to make me happy? It's easy. Take your damn meds as I damned well prescribe them, and then tell me all about how they did or did not work and then fucking well wait for further fucking advice. That simple.

I'm not trying to go all Jack "I won't take criticism from a person who rises and sleeps under the very umbrella of protection I provide and then questions the manner in which I provide it" Nicholson on you, really I'm not, I work for you, you pay me to give you options and you pay me to be sure the options you get are safe ones tailored to your needs.  You're welcome. Now go take your meds.