Saturday, October 30, 2004

I'll get to it, I swear.

Sorry, kids. I just don't have the energy today to deal with The Types of Nursing Student. Maybe next week.

Beekeeping, or odds and ends cleared up

GruntDoc has noticed that I don't have a description of ED docs in my guide to specialists. As I told him, I'm depraved on account of I'm deprived--our hospital, being referral-only, has no ED.

However, I'm sure that ED guys and gals are uniformly the most attractive, most talented, most charming, and most tasteful doctors of them all.

I've not written lately because my arm is acting up. I have an old case of ulnar neuropathy that doesn't take kindly to typing, though it'll handle cooking just fine. The result is that I've made a huge salad to last the week and baked some apples today.

The rash is better, thanks for asking. Not gone, but not as leprous as it was.

Head Nurse: Now With More Poop

I got a request via email for more poop and mucus stories. (You know who you are.) Therefore, I present to you the Worst Poop Story of Them All:

A young man with a high cervical injury was admitted to our floor by the PM&R doc that sees him most often. His diagnosis was fecal impaction: not unusual in spinal-cord-injury patients, as nothing below the level of the injury really works as it ought to. Even daily bowel programs don't always do the trick.

This kid was scheduled for a colostomy to reduce the need for occasional admissions for disimpaction. Problem was, he hadn't had a normal bowel movement in something like six weeks. He'd been having *daily* bowel movements, but not enough to keep him from....well, from backing up.

On assessment, the guy had a distended belly. Let me rephrase that: He looked like he was ten months gone with quadruplets. Bowel sounds were almost normal all over except in the lower-left quadrant. He complained of a lack of appetite and difficulty breathing; not surprising considering what he was dealing with. His belly was tympanic to percussion. (In English, that means it went "bomp bomp bomp" like a drum when I whacked it gently.)

His doc decided to try the gentle stuff first: a couple of doses of Sennakot over a few hours, digital stimulation, and see what happened.


So she went to two bottles of magnesium citrate and digital stim.


Enemas. Nothing. More mag citrate. Nothing. Further doses of laxative. Nothing.

Finally, I called her just before shift change and asked permission to coordinate with another nurse who worked nights and simply do our worst.

So James and I went to work in tandem, him on nights and me on days. Our poor distended patient got a couple of Triple-H enemas (high, hot, and a hell of a lot) and a gallon of Go-Lytely, given in a dose of fifty cc's every ten minutes. (In a case like this, you want to work from both ends and not dose the person too hard with Go-Lytely, lest something bust open.) In the morning, he got yet another enema and some more mag citrate, drunk slowly and carefully.

About two o'clock in the afternoon things started to happen. By four his belly was soft and nontender, its normal size, and we'd all had three changes of clothes. It ended up being easiest simply to hold him up while he sat on the regular toilet--not the bedside commode--and flush every thirty seconds or so as he sat.

Some medications dissolve through their capsule, leaving their shells--the actual tablet or capsule part that you see--intact. He had literally hundreds of those backed up in his colon. That should give you some idea of what our day was like.

If the government is ever looking for a cheap, easy way to put people into low-earth orbit without a spacecraft, I recommend magnesium citrate and a hose.

Thursday, October 28, 2004

Taking care of business

A few updates:

1. My rash is slowly improving. On the offchance that this could be pellagra, the plague, or alien invasion, I'm upping my vitamins and doubling up the Clarinex. Maybe I'll see the doctor; maybe not.

2. Faithful reader Mark has suggested that I do something called an RSS feed on this blog. Watch this space for technical foul-ups and broken links as I attempt that very thing.

3. You may soonish be seeing an ad on this very blog. Please attend:

It was my original intention to make this site something that maybe one or two people would read three or four times a year, after heavy doses of antiemetics and Immodium. Unfortunately, as with so many other things in my life, I failed miserably in the attempt. So much so that some very nice but probably not-too-bright person in Cyberland wants to link a site he manages to this one.

I didn't want to go commercial (as it were) at first, but damn, I can really get behind the site in question. I like the writing, I like the premise, and the folks there seem to be doing good work. When the link goes up, you'll see what I mean. I've no idea when that might happen; the person in charge of such things is just as laissez-faire about deadlines as I am.

Tuesday, October 26, 2004

I really wish I felt inspired.

Sorry, folks. The guide to nursing students will have to wait. Right now I feel rather like an old car that suddenly has things going wrong with it all over.

The count so far is:

1. One left ankle that's still complaining when I try to put weight on it in a certain way

2. One right arm that's having a flare-up of ulnar neuropathy

3. One left deltoid that's developed an odd, itchy reaction to the flu shot I (miraculously) managed to get yesterday

4. Several square feet of skin that's now covered, not just with an itchy bumpy rash, but also with hives in weird spots (back of one thigh, front of one shoulder).

The plan for today, therefore, is to stick my check in the bank, swing by the early-voting place and vote, and then hit the drug store for things I avoid, like Benadryl. I wouldn't normally touch that stuff, but being goofy and sleepy and weird for twelve hours, even with the attendant hallucinations, beats looking like something that ought to be sitting in rags, bowl held out beseechingly, on the street of a medieval walled city.

Once many years ago, when I still worked in a large college bookstore, I had an interesting Benadryl reaction. Actually, all of us had interesting Benadryl reactions.

It was during the fall rush, the busiest time of year for textbook departments. Those of us who normally worked in the front office placing orders were drafted to help unpack wholesale order after wholesale order of used textbooks. Those damned things come in by the freightload and are in all sorts of shape--from soaked in perfume and god-knows-what to pristine and lovely.

Fall here is bad for allergies. Fall in a dusty warehouse with only fans to cool the place is worse. Fall in a dusty, fan-cooled warehouse with several tons of textbooks is one circle of Hell.

So we all--eight of us--had been pumping the Benadryl for several days as we cleaned books, priced 'em, and tried to get 'em into the hands of the students. If 25 milligrams of diphenhydramine works well, 50 must work better...and if you've built up such a tolerance that 50 will still let you sniffle and sneeze, go on up to 75. At which point you'll begin hallucinating.

And if you're working with seven other people who've also been snacking on antihistamines, you'll soon find that *all* of you are hallucinating. What's more, you're all hallucinating roughly the same things. For us, this meant ten- and twelve-hour days lifting literally two tons apiece while small fuzzy black things scuttled at the edge of our vision.

Lather and rinse that bad boy for ten days, no time off, and see how you're doing at the end. You lose your ability to gibber on about day 5 and become irretrievably punchy on day 8.

And *that*, my chickens, is why I'm going to hide all the sharp things, make sure there's plenty of farina in the house, and lock all the doors before I take my first antihistamine today. If I start dreaming I'm back at the bookstore, at least I won't be moving other peoples' books around.

Sunday, October 24, 2004


How many nurses does it take to change a lightbulb?
ONE, to call the intern!

Oh, fuck you.

In case you hadn't noticed, I'm the person that calls you to let you know when you've fucked something up. If your patient has a critically-high potassium level because you've been supplementing them out the wazoo without requesting more levels, I am the person who catches it.

I'm the person who wakes you up, sweetie, before your attending walks into the station and justifiably fries your ass.

I'm the person who holds your patient's hand while she dies, then spends thirty minutes trying to locate you because your department can't get the call schedules right. When you do finally show up, I'm the person who shows you how to fill out the paperwork you should've been familliar with months ago.

I'm the person your attending yells at when *you* fuck up. If you write an order that doesn't comply with our chemo protocol, and forget to have your attending clarify it and cosign it, I am the one who will have to endure thirty seconds of blasting in the nurses' station from your overfed, undercivilized boss.

I'm the person who, just last week, paged you a total of forty-eight times over the course of eight hours about a patient who was hemorrhaging from an incision. I had, of course, already contacted your attending and had the problem dealt with by somebody else...because you had slept through your beeper on your on-call weekend.

I do an amazing amount of scutwork, from running to get you lumbar drain kits to holding your hand when you're doing a procedure you've never done before. I'm the one who keeps that patient with the undiagnosed tremors and dyskinsesia still in my arms while you do a lumbar puncture. I catch your errors more than once a day, thus saving both your license and mine. I change your dressings for you when you don't have time and correct your orders when you don't know that a) Xanax doesn't come IV or b) the dosage of phenytoin for a loading dose. Your patients weep and vent and rage to me so that they can keep a calm face to you, and maybe you won't then think less of them.

I am, in short, a nurse.

I may need you to change a lightbulb, but you apparently need somebody else to wipe your ass.

So why do it?

For starters, it's better than being shot at.

Seriously, if I get my back up at a stupid-nurse joke, why do what I do? Why not take one of those six-week miracle courses that will turn me into a legal nurse expert, or work in case management, or become an NP?

Here are some reasons:

The time I called Mario, one of the neurology residents, with what was an idiotic question. I realized that before he called back and apologized for paging him, remarking that I'd been hired for my looks, not my brains. Mario, with a total lack of irony and his usual sweetness, said, "Jo, I've been trying to tell you that for months, but was afraid it would land me a charge of sexual harassment." (To get the full effect, you need a heavy Brazillian accent on that last bit.)

Hearing a patient or a patient's family member say that they've never been in a hospital with such caring staff or such good care.

Improving one patient's mood or symptoms, or just leaving them better/cleaner/more comfortable than I found them.

The time that the Ice Queen, a brilliant and unapproachable internal med specialist, broke down and confided her worries about her elderly and ill dog. I teared up too; we ended by drinking cups of very hot and very strong tea in the family room.

Watching a total dickhead of a resident turn into a real human being and begin to be good for his patients. Sometimes this takes a while.

Being able to translate what a patient needs into language even the most inhuman doctor will understand, and being able to translate back into English what he says for even the most overwhelmed patient.

The science of neurology and neurosurgery. The joy of learning something new and incredibly neat. The fun of trading jokes with the orthopedics staff or setting aside brownies for the constantly-hungry hem/onc fellow. Seeing the aforementioned dickhead resident melt and grin and stammer when I ask him about his newborn son.

Knowing that somebody was with that person who died. If a patient doesn't have family around, we arrange assignments so somebody can be with him or her when he or she dies. Nobody should have to die alone, without another human being's smells and sounds in the room. Once in a while, I'm that other human being. That's a privilege and an important job.

I'm better at this than I've been at anything else in my entire life. Nursing is a calling, as much as medicine is, or more so--we're belittled and underpaid in a way that doctors aren't once they leave residency. "Just a nurse" is a common refrain among patients and doctors and even some nurses. (Yes, I've said it. Once. And kicked myself silly afterward.)

We don't do this because we want to lean on other people or depend on them for answers. The majority of us have a passion for the science and a fierce pride in our work. We appreciate being given room to practice and independence to make our own decisions. If we fuck up, we admit it and fix it (well...most of us do, at least).

I get cynical. I get angry. There are days when I come home exhausted, sore, covered in puke and shit and blood and less-savory substances, and fall into bed too tired to cry. There are times when I've lost a patient or had to deliver bad news or made a stupid mistake when I berate myself endlessly.

But if you offered me any other job in the world, I wouldn't take it. If I won the lottery tomorrow, I'd keep working. And there's never a morning that I don't secretly look forward to going in to work, no matter how much I might grumble over that first cup of coffee.

Blog O' The Mornin' to Ye!

Michelle Au

Be sure to check out the "Scutmonkey" cartoons. They're among the funniest things I've ever read.

Resident Wife

Love it, love it. *AND* she uses the word "schadenfreude" (spelled correctly, of course) as part of her subtitle.

Jasper Dog

James Lileks, the guy who did The Gallery of Regrettable Food, takes pictures of his dog. Many of them. Many of them are beautiful. It's your dog-fix for the week.

Saturday, October 23, 2004

Damn, my ankle hurts.

I was leaving a patient's room today and somehow torqued my left ankle in such a way that it made a little teeeeeny "pop" noise and started to hurt. This was at 0900, of course, so I hobbled around on the ankle for the rest of the day, too busy to ice it or wrap it.

It wouldn't be considered a work injury, ironically enough, because though I was in a patient's room, I wasn't actually *doing anything with the patient* when the injury happened. I guess if you sprain a wrist while holding a pillow over a patient's face, that's workmen's comp for you.

It ain't broken, it's not bleeding, and it's not much swollen. Tonight I'll ice it and elevate it and compress it and all that and see if it's better by Monday.

Dark dread and horror

Monday is the rassumfrassum EKG test I've been simultaneously dreading and not studying for. I can recognize a lethal rhythm on a strip and I know what drugs to give, but some of the trickier, non-lethal rhythms are gone out of my brain. They need to git up on in here by Monday morning so I can keep my job until the next round of testing.

A lack of med blogs?

I read somewhere that medical types are less likely to blog than English majors or law folks. A Chance To Cut Is A Chance To Cure gives the lie to that.

There are some excellent nursing student blogs in there, which surprises me. I don't remember having a lot of time to breathe in nursing school, let alone write funny and perceptive blog entries. These people may well be smarter than me, though. That's usually a safe bet.

And finally, it is officially fall.

I say that because I have my Annual Weird Rash again this year. I get this same Weird Rash every year during the fall, about the same time that other people are being socked with cases of hay fever. My personal opinion is that my body can only produce so much mucus. After attempts to break the Mucus Record, my immune system gives up and focuses on rashes. Itchy ones. Itchy, bumpy ones.

Please send nail clippers and back scratchers. And a three-inch ACE bandage, if you have one. Thanks.

Friday, October 22, 2004

"Use of alcohol on call may merit expulsion!"

(Noah Wyle sighs heavily; cut to Ford commercial.)

Probably a good thing I wasn't on call tonight, then.

Tonight I went to get a nice, peaceful burger at the local bar. It was, instead of a nice, peaceful burger, Pariahs of The Medical World Night.

There was Karen, the woman who trained me at the abortion clinic. There was Julie, who used to escort there. Lisa, who did HIV outreach for the local health department and later moved to the capital city to do the same thing, was dining with Julie.

Goodness. All that the night lacked was a couple of old patients from my Planned Parenthood days.

All went well until Julie, who worked with a woman who worked with my ex-husband, brought up the ex-hub thing. Then everybody got very quiet as I struggled to put into words what the last year has taught me:

1. My marriage sucked from day one.

2. We were both too dumb to notice.

3. Regardless, I'm glad I was married to the man, and retain many happy memories of that decade.

4. He's better off now with the woman he's with, and I'm happy for them both; nay, thrilled, that they could be this content.

5. I'd rather not talk about it any more, thanks.

Perhaps I need to move to a bigger--0r a smaller--town. One where either nobody knows me and my history, or one where *everybody* knows it, but the town's so small nobody wants to talk about it.

If I stay here, my liver is going to cut out the middleman. It's going to hop out of my body, a la Lenny's brother on the "X-files," and go looking for a bar on its own.


This is funny...

Completely off-topic

I finished Christmas shopping today

I can't talk about what I got my sister or David, since they both read this blog. But Mom and Dad have nifty things coming: alpaca sweater, horned lizard jewelry, many fine pieces of duck-shaped things for the bathroom. We have a long-running duck joke in our family, and I've used that to best advantage.

What did you say?

David made the comment yesterday that if the funding comes through for his B & B (he wants to buy one south of here, in a touristy area known for its wine) he'll get me a MINI for Christmas. Not likely, but I can dream.

Extremely touching

One of the nurse techs at work told us how he proposed to his wife. She was flying to LA, at the other end of the state, and he had the gate attendant wipe all the flight information off one of the boards and replace it with the words, "Maria, will you marry me?" The gate attendant then announced the proposal over the airport intercom, and everybody around them applauded. Cynical me got a tear in her eye over that one.

Straw what?

I've recently developed a fascination with straw-bale construction. It's termite- and rodent-proof, earthquake- and tornado-proof, damned near fireproof, and cheap cheap cheap to build. A per-square-foot cost of $10 is about all I'll probably be able to afford, ever, and most existing houses are far too big for me. I'm looking at two bedrooms, two baths, and right at 1,000 square feet. Preferably passively-solar-heated, with in-floor hot water heating in the bathrooms (I found I loved that in Denmark) and solar panels on the roof. I don't want to go totally off-grid or sell back energy to the utility folks, but it would be nice to have a system that would make things cheaper, as well as act as a backup.

The neatest thing about straw-bale construction is, for me, the "truth window". That's a little bit of un-plastered wall you leave in the interior part of the house, covered with glass, to show the structure of the house.

They say that hemp bale construction is even better than straw in terms of insulation (straw has an R-50 value on its own), but I hear that hemp dulls chainsaw blades, is a bitch to work with, and is hard to pierce with the rebar that allows it to be load-bearing. Plus, you can't get it anywhere but Canada.

Wednesday, October 20, 2004

The Nurse's Guide To Specialists

Internal Medicine:

Fit, well-dressed, with a cholesterol of 130 and the oddest prescribing habits you've ever seen. If you need electrolytes repleted or your INR brought to its proper level (that's a measure of clotting time that's influenced by coumadin), the internal med specialist is your gal. Or guy. If you're a nurse, having an internal med consult means that you'll be cutting tablets into quarters and giving 7.5 milligrams of something that comes in a 25-mg dosage, but only on alternate Thursdays during the dark of the moon.


Brilliant, with a necessary arrogance. Would you want somebody suffering pangs of self-doubt while their fingers are in your brain? Didn't think so. Usually underfed and underslept. Will eat anything that's moving slowly or standing still. Very nice people, overall, since they have to deal with people who can't talk, walk, or make a lot of sense. (Those are the nurses, not the patients.)


Sweet, but from Mars. Odd senses of humor. Usually strange facial hair (on the men, not the women). Sometimes they have a fascination with Bach or zebras or rowing. Older neurologists tend to be courtly in the extreme and wear bow ties.


The jocks of the medical world. They are carpenters and craftsmen--and I mean that as praise. A good orthopedist working on your hip will leave you with the equivalent of really good Art Deco woodwork: functional and beautiful, with nothing extra added. If you see a muscular young man or woman of few words striding down the hallway with a tiny box containing magnifying eyeglasses in his or her hand, that's your orthopedist.

They also have very strange senses of humor. A few months ago the C group at our facility had "Talk Like A Pirate Day." "Shiver me timbers! Swab the deck with that dressing, matey! AAARRR!"

Cardiothoracic Surgeons:

I do not work with any of those folks and so have no clue what they're like.

Plastic Surgery:

Artistic, with the emotional lability that comes with artistry. I'm personally uncomfortable with plastic surgeons, as I wonder if they're casting a covetous eye on my double chin.


How much does that suck? Proctologists are probably the only people with a more-misunderstood specialty. Urologists, however, have the benefit of access to the scariest-looking pieces of medical equipment in the entire hospital.

General Surgeons:

If you see a resident asleep in a chair at the nurses' station, chances are it's a general surgery resident. They're horribly underslept but have a solid working knowledge of where everything ought to go in the body. If you're a general surgeon, you can take people apart and put them back together with no bits left over. I've gotten speech of a few of them that's beyond "mmmmrrrppphhhh" as I wake them up, but not many.


Your average endocrinologist has a second brain somewhere in his body, in which he stores minute bits of important information that came from some obscure study in Backobeyondistan five years ago. They will speak to you as equals, even if their conversation about a complex patient eventually sounds to you like "Grobble grobblescrink mmmmREEEE! ppphhhhbt!"


Well-dressed, with a fondness for expensive shoes and dangling pendants (men and women respectively). Pleasant but strange. Psych nurses are nice as well, but strange. You *have* to be a little odd to work psych and be good at it.

The best illustration of a typical non-psych-nurse and psych-nurse exchange I can come up with is this:

Me: (trying to reach a med on a high shelf) "Sometimes I wish I were taller, dammit!"

Psych nurse: " you have body image issues?"

Next week: The Nurse's Guide to Nursing Students

Saturday, October 16, 2004

A cool circle of Hell, with nice silverware.

Today I had lunch with my boyfriend's family.

They are really very nice people. His brother wasn't there, having had car trouble on the way, but his sister was, with her husband and their three kids. His mom was there as well--the reason for the lunch was her birthday.

Let me preface this tale by repeating that I like these people. They're intelligent, polite, funny, pleasant folks.

The trouble was not them; nor was it their children. It was the lunch itself, or maybe the way events conspired against the lunch.

Background: Boyfriend runs the kitchen at an exclusive little lunch-and-dinner place that's attached to a bed-and-breakfast. Fifty-five people is about as many as get served on a typical night; reservations are strongly recommended for dinner. We went to that restaurant for lunch. David came out wearing his chef gear, taking a break from preparing food for a wedding, and ate with us.

"Us" being a four year old, a two year old, a seven week old baby, Mom and Dad, Grandmother, and me.

I'm childfree for a reason. I have little to no interest in children. They don't bug or delight me; they just don't register. Mostly. Unfortunately, one of the things that I hate is adults bringing small children to exclusive eateries that have nothing to entertain kids.

I was one of those people I hate today. The poor kids were trying their best to amuse themselves quietly and politely, but the bread-basket is only going to last so long and forks hold only so much interest. Babies tend to get fussy and have to be fed. Adults tend to try to have conversations that don't have much to do with kids' interests. And no matter how you try, any meal that involves children is going to revolve around those children. Adult conversation is impossible while you're trying to keep one child or another from amputating bits of itself with a knife or tipping over backwards in a chair.

Add to that Hayseed and Hayseedette, our two "servers". I put "server" in quotes because it took us four tries to get teaspoons and three requests to get lemons for tea. "Serve from the left, remove from the right" apparently means (at least to Hayseedette) "Reach across the person who's eating to drop a spoon with a clank on the table in front of the person to her right." Water refills took two or three requests. Coffee got cold. It was bad enough that David sat vibrating with rage next to me, getting more and more humiliated by the minute. As executive chef, he's not responsible for training the wait staff, but's his kitchen and his pidgin.

At least the food was good. Though I did manage to dip my breast into some red pepper puree (a common problem for the busty, Beloved Sister assures me). Nobody noticed. I think.

The brother-in-law faced the menu with trepidation: Unfussy Foodie greets Schwanky Menu. He ordered a beer with a quiet desperation that made me love him and want to take him down the street for a burger. Sister was busy with Baby, whom I tried to calm down at one point but signally failed to un-fuss, beings as I didn't smell like family. And through it all sat Grandmother, being calm and gracious and keeping the two year old from killing herself with cutlery.

All in all, it wasn't bad--except for Hayseed and Hayseedette. I want to train Hayseedette, since she looks like there might be enough synapses in her vacuous eighteen-year-old head to someday make a half-decent waitress. Hayseed I want to kick in the face. Had I known I'd see him today, I'd've worn heavier boots.

This day started with David and me bent over a power snake, unclogging his sewer line. I would've gladly done that all day.

Wednesday, October 13, 2004

Fat and a quarter tit*

Yesterday was Holy Mary Mother of Gawd Revelation Day. Out of curiosity, I measured myself and typed the numbers into the website for bra fitting I provided the other day, only to find that I'd moved from Cute Lacy Numbers to Three Hooks and Minimizer Size. I am now, judging from the numbers, fully a quarter tit.

John in Phoenix is a snookum-wookum who has complimentary things to say about this blog. In response, since he's a nursing student, I've decided to edit and publish my Ten Rules For Nursing Students, originally compiled some time during my third semester. To wit:

1. Type everything. Instructors prefer typed documents.

It's easier, of course, to jimmy handwriting so that you take up the requisite five pages, which is why instructors prefer typing. It's also nice to be able to read what somebody wrote without having to decipher hieroglyphics for hours. Contrary to popular belief, most nurses have handwriting just as bad as that of most doctors.

2. Handwrite everything. Instructors prefer to see your handwriting.

Or, as one particularly flaky instructor told me, "I like to get a *feeeeel* for what you're doing."

3. Concentrate on textbook learning; you'll learn skills in your graduate internship.

Not a bad piece of advice, especially if you have an internship like mine: heavy on tests for the first three weeks.

4. Concentrate on skills; you won't have time to learn them at your first job.

Foleys and IVs are all you really need to know. A trained monkey can do a dressing change. Really.

5. You will always have one instructor who is totally, completely, inarguably from Mars. Deal with it.

My From Mars moment came in a classroom discussion of ethics and the nursing shortage in our last semester, when one of the instructors on the team told us that the reason for the nursing shortage was that "we've aborted a third of our population since 1973." Everybody, for some reason, turned and looked right at me. I said nothing, preferring to marvel at the clear transmission she achieved even while orbiting somewhere outside the Van Allen Belt.

6. One in ten of your female classmates is looking to meet a doctor. One in ten of your male classmates might be, too. Deal with it.

Not much you can do about that one, unfortunately. The most you can hope for is that she'll leave the plum job she gets as soon as she meets a likely resident, leaving the position open for you.

Before anybody accuses me of stereotyping or downing young female nurses, may I present the following evidence? Out of 19 female classmates, one was in nursing school so her husband would "get off her back" about getting a job. She was pregnant at the beginning of our last semester. Another two were self-professed doctor-hunters. A fourth was admittedly in it for the money, and took a job at a pediatric clinic with the expectation that it would be low work/high pay (heh). A fifth was "drifting", in her own words, and didn't know if she'd actually use the degree or take up crystal healing.

Is it any wonder I was valedictorian of my class?

7. You will have no life for two to four years. Don't worry. It'll still be there when you get back.

I swear. Really. Honest. You'll be able to sleep and get haircuts and go dancing and everything.

8. Everybody thinks they flunked the NCLEX. Few people actually do. Go ahead and get blasted anyhow.

9. Yes, you do look dorky in those whites.

10. No matter how bad things are now, they will end. You will eventually be a nurse, subject to redefining hell. Of course, you'll also redefine happiness.

I can't tell you how much weight I lost the last six weeks of nursing school. The speculation on class ranking had really ramped up, and as immune as I tried to stay, I still felt the pressure to come in first. I think the under on me was something like 10 points.

But it ended. Valedictorian means shit in the world, except that older nurses will expect you to be able to recite the latest information on Disease X without pausing, like a computer.

And you know what? Being a nurse is infinitely easier than being a student. For one thing, being pushed out of the nest means not only the freedom to screw up, it means the freedom to make judgements. You're not really allowed to do that as a student. For another, you're finally done with those fucking care plans. For a third, you're able to sleep without dreaming that you've missed a test or three. Instead, you dream of beeping IV pumps.

To all those poor sots out there who have three, or two, or just one semester to go before the NCLEX, I raise a toast. Nursing is *not* the hardest job in the world. Being a nursing student is.

Oh, I forgot one thing:

11. Comfortable shoes. Comfortable shoes. Comfortable shoes. Comfortable shoes. Comfortable shoes, fer Godssake!!


*Carl Bennett, quoted by Oliver Sacks in An Anthropologist on Mars

Monday, October 11, 2004

Looks like it's time to call in the professionals.

Fair warning: girlyness ahead.

One thing nobody ever tells you when you enter nursing school is this: your hands and feet, after four years of schooling and practice, will be practically unrecognizable.

It's not just washing your hands every ten minutes or less or using alcohol foams on them. It's not just wearing heavy protective leather clogs all day long or running from place to place like a chicken. It's a combination of those things and lifting heavy patients and equipment, as well as not having the time or energy most days to fuss with cuticle remover or foot files.

My feet have grown a half-size since I started school. What was once a nice average 8 1/2 medium pair of feet is now a 9 wide. David said, as gently as possible the other night, "When did you decide to try to grow hooves?" I have calluses between my toes; that's how bad it is.

So I'm thinking that it may be time to enlist the services of a professional pedicurist and manicurist twice a month or so. Pal Joey took me for my first pedicure last summer. My shoes fit differently after the poor woman had finished sanding down my calluses. Not that I'm obsessed with my calluses, or that I'm afraid I'll injure my bed partner (although one callus, on my left small toe, left a scratch on his shin), I'm just sayin'.

Taking care of one's hands--which I do actually do--is a matter of self-interest in the nursing profession. A torn cuticle or a hangnail opens up an avenue for infection, no matter how careful you are with gloves. Long nails (ie, anything past the end of your finger) tear gloves and are a perfect habitat for bugs. I am therefore aggressive about keeping my nails short-short, using a good cuticle remover every other night, and slathering on lotion when I get home from work. As a result, my paws look workmanlike but not abused. It's my feet that resemble something from the Russian Ballet.

I guess I'll call my hairdresser, a patient woman who cuts my hair twice a month, tomorrow. I'll see if her partner has any openings on Wednesday. Her partner has horses and a fascination with straw-bale construction, as I do, so will be open to not putting pink nailpolish on my toes.

We'll see.

What's that blue stuff on the weather map?

Oh. It's a flood warning. Lovely.

Chuckleheads on Parade, Part Two

The chucklehead situation I wrote about the other day became so bad on Saturday that I could only sit back and stare with my mouth slightly open. Not only did the patient who got screwed as an inpatient get screwed as an outpatient, but I had another one of Doctor Chucklehead's patients who's going to be in just as bad of shape this morning. Thank God I'm not there to see the rivets pop out of the case manager's skull.

One quick tip for any medico who might be reading: If you write an order at 1700 on Sunday for rehab placement on Monday morning, it's *probably not going to happen*. Case managers have weekends, you know.

I don't want to go into details on the Previous Chucklehead Victim. Suffice to say that the level of arrogance, laziness, and outright disrespect I've seen from The Chucklehead Twins (attending and resident) is unmatched in my experience. Except maybe by the protesters who used to work outside the clinic where I worked. They walked the sidewalk with a baby every day for five years and got paid $38,000 a year by a local anti-choice group for their efforts.

Anyway. The case manager, a slender woman who drinks more coffee than I do, and I will have to figure out a way to do end-runs around Dr. Chucklehead and Friends. The normal routine of explaining, very patiently, why X and Y and Z orders won't work, or why one actually has to *write* an order for what one wants, rather than expecting it to be transmitted telepathically to one or more colleagues, is not going to be enough here. Punishment won't work. A good dope slap would probably be really satisfying, but it won't accomplish much in the long run.

In other news

It's been raining off and on for a week and a half now. This is wonderful for the crops and the grass and all the little birdies, but bad for the people who (like me) have to commute through construction areas. Remind me sometime to tell you what it's like to be slogging along in a Honda Civic when allofasudden the world goes away and you're covered with water.

My car also needs new tires. *sigh*

A Handy Site for Women

More than likely, you're wearing the wrong size bra. I know I am. Check this
out and learn how to fit a bra. As soon as I'm done here I'm getting out the tape measure.

Testing, testing

This week we have a series of tests at work to requalify us for whatever work we're doing. It's a hospital-based version of the ACLS or BLS or COC or whatever tests are national. In other words, we test three times a year for what normally only gets tested once. The biggie for me will be EKG stuff; I'm not a cardiac nurse for a reason. EKG strips have never made the slightest lick of sense to me. I passed that part of nursing school by taxing my short-term memory to the fullest and then promptly forgot everything I'd learned. Since David will be at a food show tonight and tomorrow, that'll be my time to cram QT intervals and P waves back into my noggin.

And so to bed

It's back to beddy-bye for me. The one drawback of working three days in a row (aside from the punchiness that hits on day 3) is that your body wants to get going at 3 am on day 4. I've been up long enough to get sleepy again. The cat will teach me how to nap.

Thursday, October 07, 2004

It's schaDENfreude, asshole!

Confidential to Denise: I really, really do know how to spell 'schadenfreude'. It's just that I can barely type in English most of the time, let alone German.

Some nice person sent me an email asking "What's a typical day like for you?" Herewith, A Typical Day In The Life:

0420: Awaken to the dulcet tones of a BBC announcer soothingly reporting the latest casualties from the Gaza Strip.

0423: Pour first cup of coffee.

0424-0440: Mindless circumambulation with said cup of coffee gripped tightly in paws.

0440-0520: Shower, try to apply eye makeup without ending up in traction, dress, decide on lunch. Leave for work.

0610: Arrive at work. Eat yogurt while sitting in car, listening to the dulcet tones of Carl Kasell totalling up the latest casualties in Iraq.

0625: Stumble in to the breakroom with another cup of coffee, prepare for report.

0640: Report until 0700. Pee if possible.

0700: Start waking up patients. Most of them are grumpy, since they've been awakened every two to four hours for days on end. Check lab results from earlier in the morning. Inform the neurosurgery nurse liason if there's anything amiss. Send people to surgery, CT scan, and echo.

0800: Start charting. Morning assessments are done; all that remains is putting them on paper and hoping that I haven't charted Patient X's assessment on Patient Y's chart.

0803: Think longingly of eggs and bacon in the cafeteria downstairs, then remember latest scale numbers and cholesterol results.

0825: Five minutes for bran muffin.

0830: Begin passing morning medications. Deal with, at a minimum, six new orders and four new crises. Receive patient from ICU.

0915: Finish passing medications. Start calling residents, consults, specialists, the housekeeping people, the guest services staff, family members, and wound care/ostomy care/urology people for help or with information.

1006: Morning routine of physical therapy, bowel programs, and incoming phone calls begins. Take time to pee if possible. Change dressings, check ins and outs, empty drains. Retrieve six new orders from box. Discharge two patients home. Charting.

1128: Begin passing noon medications, hanging antibiotics, giving Decadron, and checking blood sugars and every-six-hour lab reports. Do noon assessments on neurology/neurosurgery patients. Call report on patient going to rehabilitation unit. Chart.

1230: Finish above. Begin to think longingly about sandwich. Retrieve six new orders from box. Send patient to rehab.

1240-1315: Various crises, lunch preparations, and phone calls.

1315: Sit down with sandwich. Take first lustful bite, be called away for lift help or because Patient Y has just had explosive diarrhea that covers the entire back wall of the bathroom.

1330: Return to lunch, if fortunate. If *extremely fortunate*, have time for another cup of coffee and a quick pee break.

1400: IV flushes, any dressings I didn't get to in the morning, afternoon rounds of tests start. Assess non-neurology patients again. Catch up with respiratory therapists for progress reports. Check box for new orders. Find new order written by chucklehead from any one of several services and call for clarifications. Hang new bags of tube feeding. Check ins and outs, empty drains, calculate total IV drips for the last seven hours. Check box for new orders. Hang potassium, magnesium, or calcium drips. Chart.

(Optional: four new crises.)

1530: Look at clock, realize there are only three-and-a-half more hours in the day. Fail to mourn this realization. Start 1600 assessments on neurology/neurosurgery patients. Get two new admits from surgery. Discharge late-home patient. Plow through group of new residents taking tour of unit. Be almost rude to hospital administrator taking group of investors through unit and thus blocking the entire damn hallway so I can't get a bed through. Field call bells from patients with problems ranging from inability to breathe to their fruit basket not containing enough grapes.

1700: Neurosurgery rounds start. Stare dully at wall, wishing I worked a ten-hour shift rather than a twelve-hour. Wonder what to have for dinner.

1745: Neuro rounds end. Reassess patients. Retrieve six new orders from box. Direct men who are impersonating Birnam Wood to various rooms for flowers/potted plant deliveries.

1800: Last push of the day. Hang evening medications, pass evening medications, check IV bags. Long for strong drink. Fill out report sheets. Do quick rounds of rooms, picking up dirty linens and trash, changing water in vases (yes, we really still do that). Check to see that evening labs have been sent. Sometimes, if very fortunate, practice French with Cajun patient or discuss politics with Political Heavyweight Patient over dinner. Chart.

1845: Report to night shift. Give up beeper. Hope I haven't forgotten anything.

1908: Punch out. Go home. Fall over.

Wednesday, October 06, 2004

Chuckleheads on Parade

I was not going to blog about what happened yesterday at work. As I told friend Arlene, it made me sick to my stomach to even think about. Then, as I was sitting outside with my coffee this morning, I started getting angry.

I have the feeling that what I did yesterday is about to blow up in my face.

Here's the situation: a young HIV positive patient came in for an emergency joint replacement. He has a condition that makes the bone in his large joints die off--it's a side effect of the medication he's been on. He had the surgery Thursday and should've gone for rehabilitation Saturday or Sunday, but he was still at the hospital yesterday. The Chucklehead Brigade from the orthopedic service had decided at the last minute that blood transfusions and more cultures were necessary. He almost left AMA (against medical advice, without formal discharge), but the lead doc on the team talked him out of it.

This kid didn't understand that the fluid a doctor had drawn out of his hip was going to be used for cultures. He didn't understand what the word "culture" meant. He didn't know why they'd transfused two units of blood into him and didn't understand that he'd given consent for the transfusion when he consented to surgery. The lead doc's explanation consisted of "I'm really busy and have a lot of patients in clinic right now, so I don't have time to talk to you."

In short, he didn't understand what was going on, and nobody had bothered to explain it to him.

I had this guy in my care for *four hours* yesterday. Of that four hours--and keep in mind I had three other patients as well, including a new admit--I spent probably two hours with him. That's a huge amount of time for any hospital nurse. This kid needed it, though.

He's poor. He's non-white. He's HIV-poz. His family has limited transportation. He needs to get home, but for some reason he can't conceive, the doctors aren't letting him go. At five yesterday afternoon, as I was filling out his discharge paperwork--because we'd both been told that everything was ready for him to leave--the ortho resident swanned in and said he'd have to stay for an internal medicine consult.

This is when Nurse Jo takes off her cute nurse mask and becomes Ratched.

Long story short, I made a lot of people very unhappy yesterday, including the attending doc who'd done the surgery and then blown off his patient. The patient, however, is going to go home today with pretty much everything he needs, including a long-term venous access for antibiotics. I told him I'd call today at ten to make sure he was on his way home and that if he wasn't, I'd raise hell.

This is what really pisses me off:

For several years, I worked as a paraprofessional with mostly-poor women, some of whom didn't speak English. I managed to make clear the consents that they signed even if they were Chinese-speaking immigrants, even if they were deaf, even if they were illiterate. Literally. I took the time in a busy clinic to do such cutting-edge things as answer questions in plain English. The place I worked didn't have a lot of money, didn't have readily-accessible doctors (the care was provided by nurse practitioners), didn't have a lot of clout politically in the community. And yet I managed to do my job, not only to *minimum standards*, but to what I think were pretty damn good standards.

Why can't a fully-staffed, cutting-edge hospital do the same thing? Why did I have a patient who was ignorant of almost everything that had happened to him in the last three days? Why had nobody informed the doctors that his pain control was bad? Why had nobody talked to him and his family about what was actually going on in his hip joint? Why was *I* the one who had to get angry and motivated in the last four hours of the day and make things happen for this guy?

I swear to God: If one person wants to give me trouble about what I said, did, promised, or acted on yesterday, all everloving hell is going to break loose. The political implications of some of my reactions and actions yesterday might lose me my job--seriously, as it's never a good idea to be insulting to an attending physician--but at this point, they can fucking have it. Any place that spends more effort on getting fruit baskets for some VIP than on making sure a run-of-the-mill patient understands why we're cutting on him is not a place that deserves me.

Some days I really, really wish I lived in the country and worked at some tiny hospital where I'd have the chance to do *happy* things, like helping babies be born or taking care of people who aren't getting jacked around.


Sunday, October 03, 2004

Shit, oh dear, part two.

Note: avoid this entry if you have a problem with the requisite female blogger's musings on weight and body image.

So, today, I was wandering around the apartment, wondering what that funny stiff feeling was in my lower back. I couldn't bend backwards easily and felt, well, stiff.

I figured it was muscle pain. Then I put my hands on the small of my back and realized that it was my hips keeping me from bending over backwards.


At 117 pounds, the recommended weight for my height, I am skeletal. At 130, I'm just fine. At 150-something, where I am now, I am not as motile as I'd like to be. Not entirely sessile, mind you, but not terribly flexible.

Plus, I'm getting winded walking up the three flights of stairs to my apartment.

Plus plus, the two male nurses on the floor who are close to me in height weigh eight and eighteen pounds less than me respectively.

Time to start shutting the pie-hole and getting back on the treadmill.


This is a depressing prospect. For most of my life, the trouble's been to keep weight on. In times of stress I simply burned off anything I might've gained in happy times and kept a fairly even balance the rest of the time. Now it's looking like the Dreaded Mid-Thirties Metabolic Slowdown has hit. The fact that it's hard not to eat late at night when I don't get home until eight and that it's hard to get to the gym most nights doesn't help.

I thought it was bad six months ago. I was wrong. It's worse now.


Requisite musings on weight and body image might become as much of a routine here as Blog O' The Morning! is. Don't worry. I'll warn you before I mope.

Friday, October 01, 2004

Friday Fluff

Blog O' The Evening! (Blog of the Evening, Beautiful Blog...)

Incurable Hippie

Site of the Evening....

Regrettable Food

Girly Product Reviews, Inspired by the latest Allure Magazine Issue

Olay Complete Body Wash, Sensitive Skin Formula
, is totally free of icky perfumes. It's also good for people with really, *really* dry skin, like me.

L'Oreal Lash Architect super-duper weirdo lash-curling waterproof formula will stand up to mineral baths in odd, out-of-the-way places, but the sensation of feeling your lashes curl is very odd. I'm sure there's some sort of polymer technology at work here, but I'd prefer to remain ignorant and simply throw the tube away. I have enough to deal with at 0500 four days a week without the sensation of various body parts being manipulated by colored liquid.

It also makes me look a whole lot like Carol Channing.

Dove products: buy them. All of them. Soap, lotion, scrub, whatever.

Dove Bars with almonds are the quintessential PMS food.

Toad Hollow chardonnay
is good for a crowd. Not too expensive, not oddly metallic and oily, with a pronounced oaky flavor that dissipates if you let it breathe.

Things I have discovered I am expert at:

1. Picking all the Oreo pieces out of a pint of cookies & cream ice cream.

2. Bandage changing.

3. Driving irresponsibly fast in construction zones.

4. Timing french fries in the oven so that they come out exactly as crispy as you want them to.

5. Avoiding political topics in my online life, though I'm feminist and liberal enough in the meat world to glow in the dark.

This last is why you won't see any dissection of the war or the debates or the Presidential campaign or any of the stupid things Governor Hair has done recently here. If you want a feminist political blog, check out whatshesaid.