Sunday, June 27, 2004

The things you learn watching TV...

I rarely watch TV. Therefore, on the days when I work out in the weight room, I make it a point to find the baddest TV possible and really immerse myself in it.

Today it was three miles' worth of treadmilling to a movie on the Sci-Fi channel called "Arachnid." Arachnid is apparently Latin for "movie so bad it'll make you giggle and almost sprain your ankle."

Here's What I Learned

Spiders large enough to kill people are bulletproof.

They therefore must be killed by a man with a machete.

Not just *any* man with a machete, however. The machetes of Loyal Amazonian Natives Who Guide The White Folks Through The Jungle are apparently not good enough.

Further, spiders large enough to kill people spit poison and have nasty screams and icky bitey parts.

The poison, however, has no apparent effect on Our Hero. Even though a loogieful of poison is enough to knock a Loyal Native Guide and The Friendly Acceptable Black Guy In Fatigues out of the action for twenty minutes, it does not affect the hero.

Nor do the icky bitey parts. A love tap on the throat with said parts is enough to kill the Learned Spanish-Accented Entemologist but the same bitey bits won't penetrate Our Hero's neck.

A Learned Spanish-Accented Entemologist can produce a surprising variety of agonized cries even after a Big Spider has eaten eaten his throat out.

The Cute, Busty Curly-Haired Nurse will get it first (after all the natives have been eradicated, that is, and just before the Acceptable Black Guy bites the dust). This makes me wonder about my idea of doing medical missions.

Saturday, June 26, 2004

A public service announcement from your friendly neighborhood nurse

Several years ago, while chatting with my sister on the phone, I learned that she didn't have a first-aid kit at home. I was shocked. Even though I don't have one myself, I strongly believe that everybody *else* should have one, just so they don't call me at 3 am for advice on what to do with a bleeding finger.

Here's a list of what I keep in the ol' casa, even if it's not all in the same place:

The Ideal First-Aid Kit

1. Band-Aids of various sizes, including a box of those hideously-expensive clear ones that you can leave on through a shower or two. I don't use any sort of Band-Aid very often, but the minute I run out you can guarantee that I'll slice a finger wide open somehow.

2. An elastic bandage, two inches across. You only need one. If you sprain an ankle falling over the cat, it's nice not to have to hop down three flights of stairs, hop into the car, and try to drive a standard transmission vehicle to the store to pick up something with which to wrap said ankle.

3. A bag of frozen peas or corn, for ice-packing.

4. Gatorade powder, Dramamine or Bonine, and maybe some Pedialyte frozen popsicles. Nothing's better to combat a case of the stomach flu or a really toxic hangover than Bonine/Dramamine and Gatorade or Pedialye. Mix the Gatorade half-strength; drink the Pedialyte or eat the pops straight. This will help you not get too dehydrated when you're garking up every meal you've eaten in the last two weeks.

You might notice that there's no Immodium or similar anti-diarrheal there. That's because, if I have the runs, I'm not going anywhere anyhow. Besides that, if there's something irritating your intestines to the point that your body's trying to expel it, you really *need* to get rid of it, not let whatever-it-is sit around in your gut doing more damage.

5. Aspirin. I don't take Tylenol or acetaminophen-containing things because I challenge my liver quite enough as it is, thank you. If you have more than two drinks a week, you probably shouldn't take acetaminophen, either. It's tough on your liver, and you need your liver.

6. Sharp-pointed tweezers, a pair of bandage scissors, and strong medical tape. You can fix almost any problem with those things.

7. A hot-water bottle. Champion for cramps and muscle strains.

8. Hydrogen peroxide and alcohol, bought in bitty bottles and replaced every few months (the peroxide, that is; the alcohol will keep forever). Buy 70% rubbing alcohol--stronger is not better when it comes to topically-applied alcohol. In a pinch, you can use at least forty-proof liquor for disinfecting cuts, though I'd personally stay away from rum or anything flavored.

9. Double- or triple-antibiotic ointment. Yes, you really ought to have some of this lying around, just in case.

10. A bottle of el-cheapo saline solution, the sort used for contact lenses. I'm not talking about the protein-removing no-rub solution, but the plain old 0.9% saline. It's handy-dandy for washing out cuts or open blisters. Back when I had dogs who were clumsy and/or enthusiastic about running into sharp things, I went through a big bottle every month. It's only 99 cents at the drugstore, if you get the store brand, and when you have a cut that has ook embedded in it, nothing's better for getting the ook out.

There you go. Aside from the Gatorade, hot water bottle, and frozen peas, you can stick all of this stuff on one shelf in your bathroom or kitchen and be prepared in case you end up as ungraceful as I am.

Friday, June 25, 2004

This is how it goes.

The pediatric patient I wrote about a couple of days ago? She smiled at me today.

Made my entire *week*.

I also had a great conversation with an 88-year-old woman who'd left college when her mom died to raise her two younger brothers...just before WWII started. Amazing.

And a third patient, a woman whom I'd admitted a few days ago, said "Don't tell any of the other nurses, but I think you're better than any of them. I like you."

Some days are just great, and then there's the gravy....

Like pulling up to the local drive-in burger place and seeing a woman who used to be an old patient of mine from Planned Parenthood, some six years ago. She has three kids now and is about to go back to school and looks happy and well and healthy.

Thursday, June 24, 2004

Good things about being single

1. You can clean the entire place and an hour later, it will still be as you left it.

2. You can clean the entire place in an hour, since you don't have to have a place big enough to house multiple people.

3. Ordering pizza with what you like on it, not what somebody else likes on it.

4. Two beers is enough.

5. Never finding your toothbrush inexplicably wet.

6. The seat *stays* down.

7. Laundry. Not as much of it, that is.

8. Walking around naked in your place without having somebody else grabbing you, snickering at your butt, or commenting on your cellulite.

9. Dates. (this might also go on a "bad things about being single" list)

10. Not having to wake up next to anybody unless you want to.

Oh, my freaking God.

This is going to be another one of those hard things to talk about. I will, however, provide happy snippets for those willing to slog through the difficult stuff. They'll be down at the bottom, so be patient.


We are not an all-purpose hospital. There is no obstetrical or labor and delivery unit, there is no dedicated cardiology unit, there's no pediatric unit. We work with several other fine hospitals within spitting distance with those things, so we don't do 'em. We do neurology and plastic surgery and tricky cancer treatments. Specialization means quality care in some cases.

However, once in a while we get a pediatric patient with something that the kid-doctors across the street don't feel comfortable treating. That was the case this week, when I got a teenager from the ICU.

She has a fairly rare blood disorder that can cause problems with clotting and hemoglobin levels and so on. She'd stroked out once as a child, and we'd done some stuff in concert with the child specialists to try to keep her from stroking again.

Unfortunately, the things we did didn't work. Worse, they screwed her up royally. This happens once in a while; you can't predict if or when a coil or clip or stent is going to come loose or migrate. You can't tell which patient is going to bleed suddenly and require emergency surgery. She ended up in the operating room getting a frontal lobectomy (chopping out a piece of brain to save the rest) after a major bleed and uncontrollable swelling put her life in danger.


She came back to me two days ago. A month before she had left our floor on her way to the OR talking, laughing, walking, and with a wicked sense of humor. She returned with a dent in her skull, eyes that won't go to the right, and no use of most of her body. She's got a tube in her stomach, a tube to breathe through, a tube in her bladder, and a vacant expression. She knows what's going on, to a large extent, but is trapped behind the wall that repeated brain injury puts up.

They'd kept her in the ICU for a month to make sure she was stable. During that time, her hair matted and her skin got ashy and yeasty, nobody really talked to sounds horrible, but it's the way of intensive care: you're more concerned with keeping your dying patient alive than with making sure they're clean and stimulated.

Still. I scrubbed her down yesterday and the washcloths came out black. Not the usual caramel-brown coloring that you see when a dark-skinned patient sheds skin cells, but black. With dirt. And sweat. And old shed skin. I cut the mats out of her hair and noticed that in some places she was bald--the matting had gotten bad enough that the hair had been pulled out by the roots. I rubbed her down with cocoa butter from head to foot in an attempt to soften some of the dead skin on her scalp, her back, her arms. I used a pick on her hair until I got the worst of the tangles out. During the entire process, she didn't grimace or fight me; she just laid there, occasionally closing her eyes and moving slightly into my hands as I rubbed her down.

Her mother was amazed at the change. Her pediatrician and I were furious at the state she'd gotten into. Most of the nurses at our hospital are white, and this kid was black. It's not that nobody took care of her *because* she was black, just that white folks don't generally know what sort of special care black skin and hair requires. Frankly, at a certain point, you have to get over your own fear of looking like some sort of ignorant cracker and *ask* how to take care of hair and skin that's different from your own. If you don't, your patient will end up with bedsores and broken skin and compromised health.

It wasn't just that she was dirty. It was that nobody had thought for a minute that she might need different care than they would, if they were lying intubated for a month in a bed.

A rare occurance

I almost broke down, talking over her case with the pediatrician. We ranged over social issues to personal issues to family issues, and I just got more and more frustrated with how my patient and her family had been treated. There was much more to it than her cleanliness, believe me. It was like her family, because they're quiet and shy, had just been forgotten.

But dammit, things will be different now. They *will* be. This girl will be clean and comfortable and happy. And someday, if I do a good enough job, she'll recognize me and smile at me like she does at her doctors and her mother.

Happy moments from the past week

1. A charming older man calling me an angel simply because I brought him a cup of coffee.

2. Hugs from the biker couple who'd dreaded coming in to our facility, thinking that nobody would respect them or treat them well because they both have multiple tattoos and leather vests.

3. The response from my patient's pediatrician when she saw the care I had given her patient.

4. Seeing some of our residents circulating back in after a rotation at a different hospital.

5. Flirting madly with an 89-year-old patient with myasthenia gravis and seeing him smile.

Saturday, June 19, 2004

Unscheduled non-job fluff

Today's Phone Conversation From Weirdland

*ring* *ring*

Me: Hello?

Voice: Diane?

Me: Beg pardon?

Voice: Is this Diane Wilson?

Me: Nope, sorry. Wrong number.

Voice: But your name is Wilson, right?

Me: Yep, but I'm not Diane.

Voice: Oh. you happen to *know* Diane, or where I could get in touch with her?

A Stupid Thing To Say

At the convenience store this morning I was faced with a thin young man with dark wavy hair brushed ever-so-slightly forward and a pair of wide clear grey eyes. Heavy eyebrows, well-shaped lips. Slight gap between his front teeth. Entirely too young to be away from his mama, but cute as a collie pup.

He let me buy Certain Restricted Items after I rattled off my birthdate (my ID was in the car) and assured him that I wasn't the ABC in disguise.

Then I asked, "D'you ever get sick of people telling you you look just like Frodo?"

"After I did that nice thing for you!" he protested.

"No, no," I said, "I meant it in a commiserating, I-look-like-Molly-Ringwald way. Really."

He said, "Yeah, I do, kinda."

Fuck this shit, man.

After three weeks of diet and exercise, watching my fat intake and cutting out alcohol, running on the treadmill, lifting until my shoulders groan, and generally being miserably hungry and sore all the time, I discovered this morning that I am now too large to fit into the clothing that fit three weeks ago.

From here on out I'm going to live on Whoppers and Bud.

Pity my poor sister

My sister and her boyfriend just adopted a new dog. He's an American Bull Terrier cross (that's Pit Bull to all you non-technical readers) who is dignified, calm, affectionate, and watchful. He has only one apparent fault so far, and that's a certain exuberance around pups of the opposite sex. This wouldn't be a problem, except that he weighs sixty-five pounds and is solid muscle. Exuberant muscle is hard to deal with.

Beloved Sis and Lucky Man have decided to give him a few weeks to make sure that he's trainable--or rather, that they can train him out of lunging, enthusiastically and affectionately, at female dogs. If they can't, they'll return him to the adoption service. I have no doubt that he'll do fine.

So I'm going to sally out tomorrow and buy them a selection of the finest noisemaking dog toys available on the market today. Beloved Sis sent my old Greyhound a Screaming Monkey toy (bite it and it screams "ayaaaa ayaaaa ayaaa aiiiiii aiiii aiiii aiiiii") that the dog loved. Her dog is getting two. And some Kongs with holes for treats. And squeaky things. And jingly things. And, if I can find it, something noisy that glows in the dark.

I owe my sister a lot.

Wednesday, June 16, 2004

Pity my poor downstairs neighbor.

Last night I stayed up until well past midnight, cleaning and lecturing myself on not being a dickhead (see previous post). At about midnight-thirty, I opened the door to the porch, intending to let in some fresh air.

Instead, I disturbed a sizable red wasp that had been perching there.

Cue thumps, bumps, and "EUGH! BLAR!" noises as I knocked it off my shoulder onto my foot, off my foot onto my shirt, and off my shirt onto the wall.

Quick cut to me panting, retreating across the suddenly-very-small apartment, searching for something with which to whack the wasp.

I ended up killing it with a rolled-up copy of my Advanced Cardiac Life Support review text. It took a lot of whacking and much dancing around to avoid the dying, drunken, broken wasp as it attempted to take its revenge.

Eugh. Blar. Yuck. |||shudder|||

Tuesday, June 15, 2004

Land Mines

Just after I got divorced (well, actually about five months afterwards), friend Juliet told me that I should watch for land mines. "Land Mines" being defined as "canalized ways of thinking that worked for you in the past but now will throw a monkey wrench into your life."


The man I was married to had a crazy mother. I don't mean Collected Precious Moments Figurines crazy; I mean Threatened to Shoot Us On Our Wedding Day And Never Really Improved crazy. I was probably the only bride in recent local history who chose her wedding dress with an eye to how well it would hide a flak vest.

Looking back, I think that probably should've been a clue.


TMIWMT went crazy, slowly, over the nine years of our marriage. Part of that was very likely my fault--I made demands on him that, had he had fewer stresses or a less-nutso family, he could've probably handled. I couldn't see that, though, and so kept pushing and pulling and yelling and generally making his life harder and harder until he couldn't see any way out besides fucking around on me. For him to do that means that he must've been miserable beyond expressing. I know I was.

So. Crazy mother who makes crazy demands, like "come over this very minute and clean my house, which means taking a shovel to the piles of rotten food all over and the dead rats and so on". Crazy schedule trying to start a variety of small businesses over the years and keep them going. Craziness in that he went to California and ended up working for another crazy person and staying away for better than a year.

Given that this was the first significant relationship of my adult life, and given that it lasted twelve years, you can see what I'm up against in the Land Mine department.


Pal Keith can probably attest to the fact that when somebody gradually goes nuts, you don't notice right away. Instead, if you love them, you try to make them saner by changing your behavior and your reactions. (Parenthetical note: this is why the saying, "You can't change a person, but you can change your reaction to them" is so damning. It ought to be "You can't change a person, so run the hell away if they're nuts.")

Everything will eventually, if you're involved with a real nutcase, become your fault. Note here that I'm not talking about abusive relationships; that's a whole different kettle of fish. Abuse, be it emotional or physical or both, involves one person purposefully destroying another person's sense of self in order to gain and maintain control of them.

Being involved with a nutcase involves a person pushing aside their own ideas of what's sane and second-guessing their reactions in order to try to make things normal. Eventually this becomes second nature. Then you're really screwed.

Where I am now is screwed

Man A. and I reconciled a couple of weeks ago. I like him. A lot.

Tonight he's over at his mother's house, fixing some stuff she can't fix and doing a couple of quickie remodeling jobs. I'd like to see him Friday, but he's not sure how work is going to be, so I might not get to.

Work. Mother. Work. Mother. Work. Mother.

You can see the land mines here, right? Thought you could.

A normal person would say, "Gosh, what a nice guy Man A. is. He's helping his mom out, his nice, sane, normal, charming mom..." (I've met her and know this for the truth) "...and isn't that responsible and caring of him? Isn't it nice that he comes from such a close-knit family?" A normal person would understand that occasionally work is crazy-making, especially when you cook for a living.

Unfortunately, I am not normal. I am canalized to believe that Mother and Work equal Abuse and Desertion.

So I've been cleaning the apartment for the last two hours, talking out loud to myself in an attempt to defuse these particular land mines.

1. I get frightened when Man A. doesn't want to see me right now or can't drop everything to do so. This is totally unreasonable on my part. For God's sake, he's a grown man with a family and so on. Besides that, if he were clingy and remora-like, I would be flipped out by *that*.

2. But there's still a little, irritating part of me that curls up into a ball and rocks back and forth when he says we might not see each other this week. That's the part of me that spent fifteen months asking her husband when he would come home, and another seven years keeping dinner warm for him when he worked late.

3. If I could cut that whimpering part of me out and throw it away, I would. In a second. Because that's the part of me that's scared of everything, and being afraid makes me treat people unfairly and illogically.

4. Unfortunately, you can't cut tumors out of your soul as easily as you can cut them out of your body. So that whimpering bit is staying for now, and I'm not really sure how to deal with it, other than by making very sure that I treat Man A. well, without the whimpering bit's influence. Or with as little of it as I can manage, at any rate.

These are land mines. Clearing a field of land mines, especially when it's your entire life, pretty much, is hard.

Do they sell special boots for this?

Surly to bed, surly to rise...

It has been a Vaguely Grumpy Day. Maybe it's the heat. Maybe it's the humidity. Maybe it's lack of sex. Maybe it's lack of beer. Maybe it's lack of calories.

Yesterday, however, kicked ass. I went to a nice little scrub shop in the next town over that was packed *full* of interesting scrubs. I have a reputation at work to maintain, being the only nurse there with sushi scrubs, scrubs with cowboys on 'em, and scrubs showing Stepfordesque women who obviously love their appliances. Thanks to Beloved Sister for those.

The Haul yesterday was as follows:

One pair royal blue scrubs with multicolored embroidery around the neck and sleeves. The top made me think of saris.

One top with chickens on it. Chickens. I ask you, what less-likely pattern could you find for a scrub top?

One top from French Kitty, with winking Mod cat-faces on it.

One set of scrubs in a bluish lavender, which will undoubtedly freak out my coworkers, since I hate pastels.

One set of Dickies dark denim scrubs.

Two pairs each of navy and black pants.

And, when I got home, my white Dansko clogs had arrived. And, on the way up to my apartment, the nice man from the building across the lot gave me several fresh-caught sea trout filets. Not that I know what sea trout is, or what I ought to do with it, but I'm going to experiment tonight.

The marine life around here ranges from the inadvisable (gar, anyone?) to the bizarre ($10-per-pound scallops) to the acquired taste (squid and catfish and other things too strange to mention). I'm thinking that "sea trout" might actually be a name for something you don't really want to know much about. Like "monkfish". I saw a monkfish in a seafood shop once, still wholly corporate, and had nightmares for weeks.

Anyway, back to the scrubs. I think I might just be grumpy today because I have all these amazingly nifty things to wear to work, and I still have today and tomorrow off. The feeling of being cheated will stop abruptly at 4:20 Thursday morning, but for now it seems as good an explanation as any other.

Hell Cat said I should eat, nap, and get up again in a better mood. She said it works for her. She and I had salmon for lunch (her portion plain, mine with pesto) and now we will nap.

Later I will clean the oven and mop and vacuum and then sail out in the evening for a nice little drink at the local bar.

And perhaps I will be less surly tomorrow.

Monday, June 14, 2004

This is why I was grumpy.

This is hard to talk about

I work with a nurse's aide who is a very sweet person. Not the sharpest tool in the shed, unfortunately, but very sweet.

We've been having problems with vital signs being made up or not taken, input and output numbers being very, very wrong (this is a problem on a unit where I&O is a huge part of watching for trouble), baths not getting done for days...

...and, a couple of weeks ago, a situation that happened with a patient of mine that put them in danger. The aide did something that I had talked to her about a number of times before that's absolutely inexcusable. And this time, it hurt somebody, and I had to pick up the pieces.

We talked about it yesterday. I had finally snapped and sat down and vented about the problem with my coworkers over lunch. One of the other aides offered to speak to this particular person, and did, but (I suspect) did it in a not-very-graceful way.

So she came to me and we talked about what had happened.

She protested that a) she'd found the personal sitter with the patient doing the same thing, and b) that this wasn't something that was worth getting upset about.

My response, with my voice soaring higher and higher and my temper becoming evident, was that a) I don't give a damn what an untrained sitter does, *you* don't do the same thing, b) I'd talked to you about this very thing multiple times before, and even taken it to the supervisor, and c) if a patient nearly coding wasn't enough to get upset about, then what was?

I want to cry out of frustration and anger and disbelief every time I review that conversation in my head. This is not the first time we've had this talk, nor is it the first time that some of this stuff has been brought to her attention. I've talked to the supervisor about it, and our supervisor has said, "Well...I'll talk to her. We'll work on that."

Unfortunately, talking doesn't seem to be working. And it's gotten to the point now that I don't feel I can trust her--after comparing notes with the other nurses--to even take vitals or write down proper intake and output.

Not that I'm perfect by any means. Paperwork is my thorn bush, and sometimes I forget to put things down, too...but at least I don't make shit up.

And I simply don't have time most days to either do this stuff myself or to check her every move.

So I don't know what to do. Aside from keeping a written record of every time I notice something wrong or off and presenting it to the supe, I mean. And like every other person in a tight working environment, I don't want to look like a troublemaker.

Actually, I wouldn't mind looking like a troublemaker or like I'm targeting this person (because, frankly, I am) *if it meant that something would get done about her.* The problem is that I don't trust the supervisor to make a tough call. That would mean that I'd launched some sort of Safety Jihad with no real results.


This will require much thought and a lot of fast footwork to keep up with her for the next several months.

Grumpy Nurse.

Grumpy Nurse would like to make the following public service announcements. Sit down, read, and shut the heck up.

Things not to do in the hospital

If your children do not know how to stay in your room, instead preferring to run up and down the halls, playing on the equipment and entering other patient's rooms, please do not invite them to visit you on a Sunday afternoon.

If you have a particularly obnoxious child who tries to grab charts to read them, asks personal questions of the nurses and patients, and screams when it doesn't get its way, that child will be bound, gagged, and sold to Kurdish yak herders at our first opportunity. I'm not joking.

Please do not invite twenty of your closest friends to have a party in your room, complete with alcohol and loud music. Yes, this has actually happened.

Please do not complain to us about the food service. We have an excellent chef. You get a menu each day, with the option of substituting *anything you want* on that menu. If you want lobster and steak, some poor schmo will have to drive out and get it for you, but we'll do it.

If, however, you don't bother to fill out the menu, don't bother to call the food service number on your patient information card, and don't bother to let the visiting dietician know your food preferences, you cannot bitch. Unless you tell us, we have no way of knowing that you're allergic to lettuce, tomatoes, and bran. Unless you say something, we can't know that you don't like salmon. Unless you say something, you might just end up with a big plate of shut-the-fuck-up rather than the macrobiotic diet you're whining for.

Back to children: Do not allow your children, no matter how cute they are, to play with the call bell. If they pull it out of the wall, your nurse (me) will respond as though there's an emergency. You won't like that.

Do not pat, stroke, or attempt to kiss your caregivers. I would've thought that this was obvious. I don't care who you are or how many planes you own; if you grab my breast, there will be a confrontation that only you will regret.

Things not to say to a nurse

Grumpy Nurse thought we'd already covered this, but apparently some of you are slow learners. Therefore, here's another round:

"You must make a lot of money."

Um, not really. Today, however, after taking care of *you* for ten hours, with two hours still left on my shift, I am definitely in this for the money rather than any feeling of satisfaction I get.

"Are you married? Do you have a boyfriend? Would you like to meet my son?"

I'm not even going to get started on how inappropriate these questions are. Perhaps the only one worse is:

"How about you come home with me and be my personal nurse?"

Yes, I have gotten that question. Not, as you might think, from nasty men, but from elderly women with more money than sense. They're generally the same people who try to tip me (more on that in a moment). For some reason, really rich people seem to get the idea that they can purchase or squeeze anything out of anybody else.

"Here. Take this and buy yourself something nice." (Usually said as the patient is trying to hand me a twenty-dollar bill.)

Let's get one minor point straight right now:

I am a professional. I may be funny and cute and cuddly and make you feel better, but I am not your friend. I am a nurse who is paid to keep you alive, help you get better, and take care of your complex and dangerous problems.

Do not even attempt to tip me. In doing so, you're insulting me and demeaning my profession. I know what nursing was like in the 1940's and 50's; I can read history books. Things are not like that now, however...and I doubt that any nurse who took pride in her profession, at any point in time, would ever have been flattered by a tip.

Besides that, everything nice that I want costs way more than twenty bucks.

"Bitch. Cunt. Motherfucker."

It is always inappropriate to curse at the person who has control of the catheter, the needle, the IV drip, or the medications with narrow therapeutic indices.

I've never yet been sadistic--but it's been a temptation. It's a little-discussed fact of nursing that, when faced with an openly abusive patient, we tend to fantasize about pulling on Foleys or leaving wrinkles in the sheets. Those of us who are sadistic are sociopaths who rightly end up in court, but we all have those moments.

Do not abuse your nurses. We are doing the best we can. We cannot be six places at once, or do more than three things at once.

If you're very unlucky, you'll be like the man who cussed me out last Tuesday. I leaned down next to his ear and whispered, "You have the choice of being nice and getting help, or being mean and being alone. If you say those things again, I will walk out of here and not come back."

Have I made things a little clearer?

I certainly hope so. If you have any doubts that what you're about to say or do is appropriate, nice, kind, or necessary, please don't say or do that thing. Thank you.

I would really hate to subject you to a lecture about how to be decent.

And, if after all of this, you still persist in being an ass, there's always the county hospital (aka Bedlam) down the street. I'd be happy to transfer you there.

Wednesday, June 09, 2004

Never give in to a craving for cookies.

I suppose I should've known on Sunday night

Sunday night, as I was getting ready for bed, the water pressure dropped significantly. In this town, that means that somewhere there's a broken water main, and you'd better get cracking on filling up jugs and bowls with what water there is. So I was. Then the tornado sirens went off.

The man I was married to is a HAM radio operator. He helped work out the protocol for blowing the sirens. I knew, therefore, that this was serious business. I'll skip the excitement of listening to the weather radio and waiting for the all-clear and just say that I didn't, between the thunder and the sirens, get a lot of sleep.

what was going to happen on Monday

Monday was busy, busy. I had three patients who were of major concern: the first had had a large meningioma removed from her frontal lobe. The second was dying. The third had intractable pain.

But damn, they were stable. Pain Woman had gotten a new cassette for her PCA pump (that's that patient-controlled painkiller with the little button you push). Phred, the beloved night nurse from Vietnam, had put it up for me at shift change. Phred always takes care of me. Dying Woman was, well, dying. There's not a lot you can do when somebody's doing that. She was still talking and responsive at the time, so the main job was to keep her comfortable. A Do Not Resuscitate order doens't mean you leave the person to rot; you just don't burden them with life support. Meningioma Girl had no drift, pupils were equal and reactive; not even a headache.

Then Dying Woman was taken off DNR status and put on a full-code status. Why this happened, I'm still not clear. I'm not certain she knew what she was asking for, but it's better to be safe than sorry.

Then Pain Woman started having problems.

Then, just as I'd gotten the problems with PW resolved and the politics surrounding DW dealt with, I got a craving for cookie. Everybody was taken care of, my other two non-scary patients were bopping along just fine, and I figured a trip to the lobby for a cookie would not go amiss.

I'll never do that again

I was downstairs when Meningioma Girl had a generalized tonic-clonic ('grand mal') seizure.

Not gonna go into that, no sir. All I know was that I had a feeling of impending doom that I shook off. When I returned to the floor, they told me she had seized. Two of my colleagues were in the room, taking blood pressures and so on (the patient was post-ictal by this point and very sleepy). I moved fast.

As I was headed down the hall to get a milligram of Ativan, the respiratory therapist came out of Dying Woman's room to tell me that she had suddenly become nonresponsive. With a DNR patient, that's not a real big deal. It's simply another step in a natural process. With a code patient, it means a lot more.

"Ben," I said, "you have to deal with this. I can't. I've got a seizure down the hall."

Ben did, thank God. And the patient was fine.

I would not have gotten through the rest of that afternoon, what with stat CT scans and Cerebyx needing to be run and so on, had it not been for my coworkers. Three of them picked up so much slack that they were as busy as I was.

And the moral is....

This is why I love working where I do. If one person is snowed, everyone else pitches in to the best of their ability to make life easier. They don't just get patients up to the bathroom or take pain medications in to them; they draw blood, put nasogastric tubes down, take phone orders, set up BiPAP machines. I've done it for other people, and on Monday they did it for me.

I was so touched I nearly cried. Well, touched *and* tired.

And I will deny myself cookies now. There's nothing worse than being downstairs, or worse, at the McDonald's next door, and having a stat page come over your beeper.

Saturday, June 05, 2004

A perfect day.

Today started with a long, lazy morning in bed and out of it as I tried to recover from the effects of not-even-a-pint of dark beer last night. Ugly, ugly. I now remember why I don't drink dark beer.

Several gallons of water, a backrub, three aspirin, four cups of coffee, and some scrambled eggs later, I took a shower. I found a bar of heather soap I thought was gone and used that.

Then I dressed in my favorite elderly and quite filthy jeans, a tank top, and a linen shirt. I grabbed a straw hat that makes me look like one of the dancing mushrooms from "Fantasia", loaded on all the big amber jewelry I own, and went out to the town square.

One day a year our town becomes "Dogton." The central square is given over to the Dog Days Festival. Businesses around the square, including restaurants, allow dogs inside. There are booths of pet goods, dog-themed jewelry, single-breed adoption agencies, the SPCA, you name it. The name of the city is officially changed for this one Saturday in June and anything goes--if you're quadripedal.

I petted six Greyhounds, a 156-lb. bloodhound who told me in no uncertain terms that he loved me, an Irish wolfhound named Ranger, several Boxers and Bulldogs and Beagles, and a couple of 57-flavor mutts with bicolored eyes. Oh, and the Great Danes (three, including one all-white with blue eyes) and the chocolate-colored Shar-Pei.

Then I bought a large, heavy amber pendant from the beautiful Indian woman who runs a shop out of her house. I said hi to my Pakistani friend who displays glass bracelets on beds of red lentils. I stopped in the Irish imports store to say hello to Liam (Irish), Dawn (not Irish), and Pudge (canine) and hear Liam talk. I was bought a beer and given a tour of the new wine store downtown by the very handsome owner of said store. Then I went and had a blackened cheeseburger and fries at a patio restaurant and shared some of my fries with another Great Dane.

Then over to the used bookstore for Laurie King books, then to the coffee shop for a breve, then into the blessed air-conditioning of my car to come home to more blessed air-conditioning.

I'm now slightly woozy and very happy. It was cloudy all day, so I didn't even have to wear sunscreen. I'm crusted with salt from sweating and festooned with dried ribbons of spit from the bloodhounds. I'm covered with sixty breeds of dog hair. I wonder if I should just give up and shower now, taking the chance of falling asleep with my head under the running water, or nap first and then change the sheets.

It's rare that a day this good all around comes along.

Friday, June 04, 2004

"Shit oh dear," said the Countess...

Part One

Arlene emailed tonight and mentioned that she'd really like to be able to comment on what shows up here. I could, I suppose, enable the "comments" section, but for two things:

1. With my luck, I'd end up getting stalked by some guy with a nurse fetish.

2. Nobody reads this blog anyhow, so why bother?

The thought of somebody else commenting on my writing, even someone as nice and kind and sensitive and marvelous and with a great sense of style (okay, I'll stop now) as Arlene terrifies me. I'm not a writer the way my sister and father are. I've had exactly one thing published: A letter to "Ms." magazine. I don't show this blog to just anybody. Mention the names "Eurotrash" or "Belle" and I quail.

Even linking terrifies me.

Sure, it'd be nice to be linked. Link me! I'm cute and friendly and I use lots of punctuation! The trouble is that with linking comes weirdos, and I deal with enough of them in work, outside of work, and in the mirror as it is.

Part Two

I do NOT need a vintage silk-satin olive-green circle skirt with a black velvet waistband and black velvet polka dots all over it. Even if it is amazingly cheap on Ebay, even if it is my size, and even if I can think of eight places to wear it. Charge card, get thee behind me!

Nor do I need any Pierre Hardy shoes. Even if they do come in a black-velvet rounded toe style that would, come to think of it, look lovely with the skirt.

...or maybe I do.

Part Three

The orthopedics department is moving all of its large joint surgeries out of our hospital. More to the point, they're moving off of our floor. I don't know if it's going to be every surgeon, or just a few, or if they're going to keep complex cases, or what. Suffice to say that this is the beginning of what feels like a long slow slide into hell.

Part Four

A potato exploded in the oven today. I was in the shower, humming some little song, when I heard a bang. I figured it was the woman downstairs hanging up pictures. When I checked my tater, it had exploded.

Or not so much exploded as decloaked. The potato was intact. The skin of said potato was in one piece, mostly, but on the other side of the oven. I've never seen that before.

It was yummy anyhow.

Part Five

The Cute Goateed Greek Neurologist shaved off his goatee. This makes him look like somebody's Greek grandmother. Or maybe about ten years younger; I can't decide. Unfortunately, there's no good way to tell a resident that he looks like Doogie Houser anyhow and any more youngification will not inspire confidence in his patients.

Thankfully for my fingers, Cute Grandmotherly Greek Neurologist has the same initials as Cute Goateed Greek Neurologist, so I won't have to be clever again.

Sometimes I just have to wonder.

I've been having what I call "brain static" dreams lately. You know the ones--they're the dreams in which nothing really makes sense. Things happen faster than the cuts in a music video. You're wandering around in your pajamas, looking for a snowcone stand, and then suddenly there's a giraffe right there, telling you jokes.

The cool thing about dreams--both the brain static sort and the intricately plotted, sense-making sort--is that nobody really knows why they happen. I have my own pet theory on dreaming, which goes like this:

Brain static dreams happen just before you wake up. They're the last-gasp attempt of your temporal and frontal lobes to discharge all the detritus of your last several days so that you can concentrate on being awake. They "mean" nothing. They don't symbolize anything except that you're a bit stressed out. They are, in short, your brain's way of cleaning out your huge mental refrigerator.

The intricately-plotted sort are a bit different. Those dreams tend to have bits in them that make you wonder if maybe your subconscious isn't trying to get something out of its system. These are the dreams that your brain makes up when you're ignoring something important. They mostly happen in the middle of the night and are longer.

I just had a really cool one of the second sort, even though it devolved into brain static by the end. I could play guitar in my dream--something I've never even seriously attempted--and sang two songs of my own composition that were really, really good. Nice harmonies, nice key changes, the whole shooting match.

Given that I ended that dream wandering down the service road of the highway naked, I'm not sure that I want to know What It Meant. I don't really care. Let the psychologists and neuropsychologists worry about why we do what we do inside our own heads. I'm just happy that my mind has such an incredible imagination independent of my consciousness.

Wednesday, June 02, 2004

Obligatory trivia

I have a wisdom tooth that is lying sideways in my upper jawbone. It will never erupt, which is a good thing, considering that if it did I'd have a tooth in my ear. Yes, its cutting surface is toward my ear.

I drive an old Honda Civic hatchback named Nash. I love him. He has gotten me through horrible weather, moved my house more than once, and never been unreparably sick.

"A Case of You" is, IMO, the most perfect love song ever written.

I wear a size 9 shoe and a size 7 1/2 glove. Given that I'm 5' 2" on a tall day, this means my hands and feet must've been recycled from someone else.

I base my fashion taste on what doesn't itch. (credit to Gilda Radner)

Sometimes I get an illogical craving for black-eyed peas.

I have red hair. Real red, yes.

Nursing was not my first career choice. I thought for years that I would be a musician until I discovered that I wasn't any good.

My favorite dog ever was a wolf-hybrid named Elsie. It took her years to really like me, and we didn't truly bond until she got very sick and I took care of her. I miss her, and she's been dead almost three years.

Most of my clothes are black. This is not because I'm grumpy but because I lack any sort of taste in clothing.

I will drive a long way for decent barbecue.

Thunderstorms terrify me.

I can take or leave chocolate, ice cream, cake, and other sweets. I don't crave sugar when I'm premenstrual. Show me a bag of Chee-tos and a bottle of Sierra Nevada Pale Ale, though, and I'm your gal.

The best taco I've ever eaten came from a Mexican restaurant in Winfield, Kansas.

I'm still searching for the perfect salsa.

I like Brussels sprouts.

Despite my horrible lifestyle habits, I am still one of the strongest and fittest people I know. Those who live well get very frustrated when a boozing, overworked nurse can still kick their asses during a 10K walk.

My first boyfriend now sings with a band called "Your Mother" and looks like William Shatner--post-toupee. How the mighty have fallen!

Brown and green and hazel eyes knock me out.

I keep my hair really, really short. For a while I kept it long but it was a pain in the ass.

I write bad rhyming doggerel sometimes, but I never know when the Muse will strike.

I sing songs to my cat about how wonderful she is. She hates that.

Love a nurse. She might save your life.

Today, children, I will introduce a new character in the life of your typical nurse: The Pompous, Ignorant, Condescending Asshole Doctor.

This particular subspecies of MD can be any age, but is usually of the generation that doesn't like nurses and wishes that they still wore caps and cleavage. Generally speaking, the PICA doctor is tall, dignified, homey, and wears a tie to work. It might even be a bow-tie, if you have a specimen of the more gentlemanly sort.

The PICA doc is the one who breezes through the nurse's station on his way to the elevator and informs you that your patient is in "respiratory distress." This will be news to you, since your patient had a normal pulse and respirations ten minutes before, when you last checked on him. When you get through the cloud of dust left by the PICA doc's passing and check on your patient again, you will find him gurgling and wheezing, unable to cough or breathe well, and will have to get things like electrocardiograms and chest X-rays done on an emergent basis.

You'll wonder why this happened. It won't become clear to you until the next day, after multiple nebulizer treatments and suctionings, when the Cynical and Harried Respiratory Therapist starts suctioning out something that looks suspiciously like coffee from your patient's trachea. It'll occur to you that this patient, who is NPO (nothing by mouth) and who has a tube going into his stomach, has been being fed liquids by his family.

His family will confirm this. They'll tell you that PICA doc, who washed his hands of this patient and moved him to another service, told them that it would be a good idea if the patient got liquids by mouth. The PICA doc, in doing so, will have ignored the recommendations of other people--not MDs, but highly qualified--who have said that this patient lacks both the cognitive skills and level of consciousness to swallow.

Let's review the bidding: You have a patient who is just now beginning to come out of the effects of a nasty bleed on the brain. He's being fed through a tube to make sure he doesn't get aspiration pneumonia. He's being followed by the neurologists, not the PICA doc. Yet Mister Doctor Man, without writing official orders, says that it's a fine thing for this patient to be able to breathe in coffee, apple juice, and soda. When your patient begins to have trouble breathing, the PICA doc *leaves the floor* in a blaze of glory.

Think of this. A doctor leaves the area where a patient who has been in his care is in distress. He leaves it up to the nurses and his resident to manage things. In retrospect, I'm glad he did--he might've fucked things up even more if he'd stayed.

There's an unwritten code of conduct in the medical world that bars nurses from screaming down hallways with a claymore in hand to bash stupid people in the head. Thankfully, the service that my patient is now on is populated by humorous, approachable doctors (including the Goateed Greek Neurologist, who promises to teach me to curse in Greek). I know all of their phone numbers now, after that little "respiratory distress" incident and a couple more, and I'm on a first-name basis with some of the residents. Hell, all I have to do with one of the residents is say, "Hey" on the phone and he knows who I am.

I'm trying to decide if I want to file an incident report on this one. I doubt it would do much good in the long run--after all, a fairly new nurse writing up an MD with thirty years' experience is like a gnat buzzing around an elephant--but it sure would be satisfying. It would be more satisfying because I know I'm right. The two neurologists with whom I had to discuss the case were flummoxed by the PICA doc's behavior. One of them called it "horseshit." I don't think that's too strong a word.

At least I know whom to avoid on the floor. If ever I get another one of this guy's patients, I'll know that it'll be a battle to keep the person from being hurt by his doctor's stupidity.

Which reminds me. I need to warn the residents on the next service this guy'll be transferred to to *watch out*.