May 2040. Upon graduating from Tulane with honors, and a BA+MHA, and getting a job at a psychiatric hospital on the Kansas side of the Kansas City, she returns to her family, with her loan balance on hand. I think it's better if I stayed at my parents for a bit, while I get my finances under control. It's not the most crushing debt load in the world but still... I'm grateful for getting a job with a 401k.

And another grim realization that, even with a job she'll start soon, there's something amiss: In my life up to this point, I always had ready access to intellectual peers, if only a handful, which made my social life much more comfortable. In a sense, I am lucky enough to have my professional life in order. Other new grads may not have that chance. However, it was due to happen at some point! And the outside world doesn't seem to value intellect, socially speaking: it appears that intellect is valued mostly in the professional arena. Yet, a person is more than just a professional. Also I can't play quiz bowl as I used to. Graduation was supposed to be a happy moment in a college graduate's life. 5 years of hard work paid off but I know what kind of world I am leaving behind, Patricia ruminates, while she feels the fog forming in her mind. Dazed and confused about what to expect out of life after graduation. And she dreads what comes next.

What taste she does have of the working world, obtained by internships, might be representative of the day-to-day work, but not of what happens in the long run. Patricia's parents come to her and finds her crying in her bedroom:

"What's wrong, honey?" Patricia's mother asks her daughter.

"Now I have the impression that I will be the freaky genius again..." Patricia sobs. "In college, okay, socializing came much more easily than I expect. At work I am not so sure"

"Honey, just focus on doing the best job you can" her mother tells her about her feelings of dread about the future.

"In healthcare administration, what constitutes a good job goes beyond key performance indicators. There's a social aspect to consider, too. How you get along with your colleagues is important. But I have a pretty good idea of what to expect for me to perform best at work"

So I will need to familiarize myself with the IT systems, the bureaucratic procedures, as well as the clinical realities of outpatient mental health services. And, more specifically, addictions. Of course, I also need to familiarize myself with the challenges faced by each stakeholder, Patricia muses about what to expect in the coming weeks at work. It almost feels like I will be learning how to become an addictions counselor on top of the job I am hired for.

"You said freaky genius? Wouldn't that fit the therapists and physicians, too?"

"Not that they aren't smart, I just don't think the same way they do. Might be a blessing in some situations, a curse in others. I have a lot to learn about, IT systems, bureaucracy, provision of mental healthcare services for both patient and provider..." Patricia keeps crying, unsure of what to use as a starting point.

"If only there were more healthcare administrators like you..." Patricia's mother comments while listening to her roadmap.

"If you could please excuse me, I must learn more about what addictions are and a basic overview of how to treat them. And maybe go into the specifics of abusing each drug" Patricia tells her mother before she leaves the scene.

Yet there is so much to learn about addiction and recovery; I'm not sure I picked the right starting point. Let's start with the summary... Patricia then sighs, not in the best of moods to study what addictions are, what causes them, and what happens in and to addicts. I have a vague idea that not knowing, on a medical level, what the patients are in outpatient care for would hurt me in doing what I'm ultimately hired for, and whether I'm doing a good job or not is going to be much fuzzier than even essay writing in college. But there's only so much I can learn about addictions by reading about causes, symptoms, prognosis, treatment, prevention and the like until I shadow the people actually doing these things, at least not in a way that helps me do my job, these thoughts keep preying on Patricia as she learns more about the biological bases of addiction.

And then she moves on to other factors she feels could affect addiction treatment in an outpatient setting, such as enablers and triggers. Then who would be better served in an inpatient vs outpatient setting. (Suspicions of triggers and enablers are often key) But all of this remained very shallow to her eyes.

This manic pace of reading material about the medical aspect of addictions reminds her of quiz bowl practicing, especially as the World Cup came around the corner when she competed in it as a freshman in its inaugural edition. When she takes a break from reading about the medical aspect of addictions, her focus shifts on to the latest issue of FTPFTC. The HSNCT special.

From reading the latest issue of FTPFTC, she peruses which countries are, outside of the US, expected to go furthest, and which countries are playing. Over the years, the field started to feature more countries, and this year Ukraine participates at the HSNCT for the first time. Among FTPFTC's watchlist by country, you have Bryansk #3, Voronezh #12, Moscow #263 for Russia, Kyiv #189 for Ukraine, Perse for the UK, and that's only part of it, Patricia muses while her mind seems to slow down, and her eyelids seem to feel heavier by the second. And her intensifying headaches are not helping. I may as well go to sleep as soon as I can do so... this feels so tiresome.

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Around the dinner table that night, Patricia's father asks her about a topic she knows is sensitive:

"I think we're due for a discussion about finances!" Patricia's father warns her.

"Yes, I know, this is why I stay here until I have more wiggle room to move out and/or get married" Patricia answers her.

"Your student debt is the elephant in the financial room. Do you have any idea how did this decision of going for the BA+MHA, even on a sixty-five percent scholarship, impact your student debt?" Patricia's father asks her.

"I'd say the combined degree was, for me, a redemption from a poor choice of a major"

"What do you mean?"

Patricia then draws a blank. She starts thinking about what made her choice of a major a poor choice, but her train of thought turns to the debt load and how it was incurred. Tulane offers a variety of accelerated master's degrees. Accepted students do so on a 65% tuition scholarship for the graduate portion. Now I'm saddled with $86k in debt, and pursuing the MHA (masters of health administration) made this debt balloon. But even a MHA on a 65% scholarship at Tulane was still ca. $25k just for one year of tuition. The net cost of attendance nearly doubled for the final year, and my debt along with it. My parents were willing to pay $15k per year. But what do I have to show for this World Cup run, other than souvenirs from Moscow and an appearance on VGTRK? (Russian state TV) The World Cup didn't affect my debt in any way... Patricia ruminates, weighed down by the budgeting process.

"Let's say that it has to do with the jobs I expected to obtain at graduation. With my major alone, I didn't expect to be earning a whole lot. You will tell me, yes, Tulane might have a presence on Wall Street but it's mostly finance and IT, not much for humanities. And teaching? Low-paying, too. With the MHA, on the other hand, I could be earning a lot more, especially in the long run" Patricia explains, in a monotonous voice, before she starts crying again. "I don't want a repeat of these discussions about why pursue the MHA!"

"You're deep in debt! Do you have any ideas for how you can keep your expenses and debt under control?" Patricia's mother asks her.

"Unlike some of my classmates in college, I have never been a spendthrift. I am not the kind to indulge in fashion, accessories, or to engage in expensive hobbies. I also know also that house brand groceries are mostly end of series of brand name products. And I don't plan on taking expensive vacations"

Thank goodness for the School of Public Health and Tropical Medicine allowing to enroll in the BA/BSc+MHA dual degree with any major provided that you earned credit for single-variable calculus! (And for tropical medicine or environmental health, a year each of biology and chemistry) Restrictions on undergraduate majors for the dual degree were newly lifted when I arrived at Tulane, she keeps reflecting on what even made this move possible. Then again, she had a pretty good idea of what expenses to limit.

"Before you ask, I am not eligible for any kind of loan forgiveness plan. So I know I must avoid the temptation to "keep up with the Joneses" if you will" Patricia keeps talking, feeling that she would need to pre-empt parental questions.

"Honey, if you already feel... unwell at this point, when you seem to have your finances and professional life under control, maybe giving you some autonomy would smooth out the transition" Patricia's father tells her daughter.

"My main request is that I have complete control over when I eat and do chores. I can already see my work schedule not being fixed. It's not like law or accounting in that you're expected to eat the big hours early in a career, however. Nor is it like emergency medicine, where you have no control whatsoever over when your work day ends" Patricia then states the other component of her request. I want to make sure I have no curfew, too.

"That's a lot to ask for, but you understand what you need to do at home. You also seem to understand that you might not be able to adhere to a fixed schedule I guess, better this than failing to take any responsibility at home" Patricia's father realizes that, especially early in a career, his daughter might live through too much at once if she undertakes too many changes in her personal life at once.

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During the Memorial Day weekend, she moves on to learning more about how the patients and their loved ones live through addictions and the recovery process. However, she feels something crucial is missing. More specifically, how the providers experience their patients' recovery process. While I won't be hitting the ground running, at least I will have a better idea of what outpatient drug and addiction is for, what is the meaning of each KPI. And then finding solutions to the challenges I will be facing at work will make that much more sense. Also, addiction and mental health conditions are kind of like a chicken and egg situation. If an addict is found to have underlying health issues, any treatment plan will be affected, Patricia muses, while taking a break from reading stories from addicts in recovery and their loved ones. About what made them realize they need help, and often at very advanced stages.

When she feels that too much is too much, on Saturday night, she starts scrolling NAQT for news regarding the HSNCT, as well as liveblogs from several sources. The most interesting to her seems to be, well, the liveblog of the game of Kyiv #189 vs Bryansk #3. Which led to a flame war between the fans of the two teams, especially since the game was close and tightly contested. Experience won out, I guess; Bryansk #3 wins, 310-285, Patricia thinks, feeling some inexplicable urge to react:

"Kakogo cherta? (What the hell?)" Patricia shouts at the screen.

"What do you mean, kakogo cherta?" Patricia's mother overhears her daughter shout from a room away, not understanding anything in Russian.

"It's about the lengths enablers can go to enable their loved ones faced with addictions" Patricia answers, while her mother doesn't suspect the real reason why Patricia was even shouting in Russian in the first place. Often enablers will lie by covering for the addict, and they don't realize the damage they are causing to their loved ones by enabling.

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After Memorial Day weekend ends, her first day at work begins with a meeting with the outpatient addiction team, including addiction counselors and other personnel attached to it.

"Good day everyone, please welcome our new assistant director, Patricia Halpern! For her first few weeks here, she will shadow both drug addiction counselors and behavioral addiction counselors, so please treat her with respect. If you or your patients have any objections to her shadowing you, please tell me as soon as possible" Patricia's boss tell the rest of the team.

Her boss then introduces the counselors and what they specialize in, but leaves them free to resume their respective activities. He then shows her around the major areas within the hospital she needs to familiarize herself with. The scribes' office, the triage area, the staff dining room, the cashier, and so on, so forth. Then he takes her to his office, laying down a road map for her first few weeks.

"Our last assistant director was fired because he acted like a manager in the manufacturing sector. He was a very good counselor though. I trust you understand how running an outpatient treatment ward differs from running even a medication manufacturing plant" the director of outpatient drug services harangues her.

"Yes. The human factor is so important that it cannot be overlooked, nor what people are addicted to" Patricia tells him, not telling him about the gaps in her knowledge of providing outpatient drug services.

"Exactly: while shadowing counselors, please ask what their main problems are. But today you need to get familiar with the paperwork and the regulations around it, because it's going to be part of your work from now on" his boss then calls in IT to set up Patricia's credentials in the system.

"Thank you"

It's too early to write off the job. However, I knew that, in mental health, so many people wanted to provide the care, but not many were willing to handle the bureaucracy of it. However, what glimpse I do have makes me feel like being a mental healthcare provider wouldn't be for me. Maybe, during lunch time, I will get a better idea of what needs to be done for the providers and patients, Patricia sighs, while turning to links given to her via intranet. Regulations, procedures, what forms to file when, who processes what forms, etc.

When comes the time to get to know some of the counselors, later that day...

"Have you seen some of these patients? One of mine started getting drunk by gorging on cooking wine as a teenager!" Ainslee, an alcoholism counselor, starts telling Patricia at lunch.

"Cooking wine?" A surprised Patricia shouts, whose only reason for even suspecting a teenager to drink cooking wine is because of how the local law treats cooking wine as being unusable as a beverage for human consumption. "Is that patient a good cook?"

"She got expelled from culinary school because of her addiction to alcohol! That's what led her here" Ainslee then answers Patricia's question. "I am sure that, if given the opportunity to cook for the patients in inpatient care she would be fantastic. But, as much as I would have loved to push her case to the hospital management to work as a chef here, she is too early in recovery"