Well, I moonlighted this past weekend. Friday evening, my family drove with me to my second job. I work two weekends in a month in a town fifty miles to the south.

I was happy to find this position because it enables me to be with my family. Instead of traveling several hours away to do in-house call (my old moonlight), it is only an hour away. Since it is only admissions, we can stay with relatives and we can enjoy the city.

This weekend was unusual in that I wasn't scheduled for Sunday. For the other two days though, it was busy. I saw more patients in those two days than I typically do in three.

A fair number of people came in for various combinations of chemical dependence, which is always the case. One interesting patient was a young man in the early stages of Huntington's disease. He didn't have many abnormal movements yet. I was glad his family was visiting.

Another interesting patient was an older teenager with anger management problems. I had the satisfaction of gaining his trust, but it wasn’t easy or quick. He denied use of drugs or alcohol on the nursing intake form. Not using would be unusual for a young person experiencing the problems in life that he was. I led him “around the back door” to disclosure by looking with him at many aspects of his life which were not on the nursing intake form. I think that helped him to feel at least a little comfortable telling about himself to a stranger like me. He needed to know that a psychiatrist does not often divulge information to police. He needed to know that I was not in a hurry. He needed to feel that I knew what I was doing. This was clear: “You’re good at your job, huh?” Somewhat taken aback and trying not to appear defensive, I replied “Well, I sure love it, and I always do the best I can for folks. I try to keep learning.” I explained how drugs and alcohol impair judgment, allowing people to act out their anger, and how they simulate other mental problems. Finally, one of my invitations to trust was accepted and we established a foundation of mutual honesty to begin his treatment, starting with revising his account of his drug use. He was not unusual in that his drug use was an attempt to assuage negative feelings. He probably has a depression which is being masked oftentimes by the drugs and alcohol, and which sometimes makes it easier for him to lose his temper. I felt satisfied with the visit, feeling I had done more than just admitting a patient to the partial program. I had introduced confidentiality, beneficence, and truthfulness to him as qualities of the doctor-patient relationship.

On Saturday, my husband, Mark, went to a neat toy shop with the boys and found a new board game to play with our four-year-old. Enjoying a few hours away from the hospital, we were all set to play it when my phone rang. At that moment I would have gladly given $500 for a chance to play that game.

Well, it's Sunday night when I'm writing this, and we've had another chance with the board game. Dylan seemed to get a bigger kick out of showing us how he could "be a duck" by sticking two slices of polenta between his lips and flapping them around. We watched a Veggie Tales video with them and them We all played a yoga-inspired game of Twister that Mark picked up at a garage sale. It was hilarious.

Tonight totally made up for working hard Friday and Saturday, even if the kids were exhausted at the end.

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