Sometimes there are no words.

Sometimes there are no excuses, no rationalizations.

Ingrid came to us with brain tumors. We didn't know the origin until one of our doctors found a breast mass less than two inches wide. After that, it was fairly clear that what she was dealing with was nasty.

She had ten rounds of radiation with no functional improvement and decided against further treatment. She had her feeding tube removed and died with Teresa at her side at 7:47 am on the 13th of this month.

I like Teresa. I liked Ingrid. But I didn't call much after they left the hospital. First, because I got lazy. Second, because I got busy. And third because after so much time goes by, you feel weird calling.

I called today. Tomorrow I'll go see Teresa at the house she and Ingrid shared and learn about Ingrid, what she was like when she wasn't sick.

Maybe next time I won't not call.

You know it was a good vacation when....

...Pal Joey sends you many, many pictures of your time on vacation, and you don't remember some of them.

At all.

I'm fairly sure a few of the pictures came from Poutine Night #1, and I know who the other person in the picture is (the wonderful Magda), but I don't quite remember how I ended up in the poutine place eating poutine and having pictures taken. Also, the fact that I have the *exact same facial expression* in every picture leads me to believe that I might've been a bit tipsy at that point.

Maybe Joey can help me out, here. Joey? Joey? (*crickets*)

Okay. We'll let my sins die a quiet death.

In other news, it's been a quiet week at work. This means that next week will suck dead rats, but I'm grateful for a slow week. Slow enough, in fact, that I got cancelled yesterday. Instead of transfusing blood and titrating intrathecal medications, I spent the day eating baba ganouj and hanging out with the cat.

Today it was back to transfusions and titrations.

But everybody's been reasonable; we didn't have the influx of absolutely insane people this week that we had last. Nobody, thank God, coded. Nobody needed emergency anything, which made for a nice, steady day. And nobody had enormous infections that required constant care.

So off to bed.

What fucking planet are you fuckers fucking from, anyhow?

Or, Performance Improvement, Management-Style

We had a MANDATORY SEMINAR this week on performance improvement. The PI guidelines were written up by management (read: those with little or no patient contact) and presented to us in PowerPoint form (read: we had the handout read to us) or in skit form.

One of the best parts was this: (bear with me...)

A very short, morbidly obese patient had come in for some treatment or other and had had problems with the bed in the room being too high even when it was lowered as far as it would go. He'd also had problems with the toilet seat being too high for him to sit on, as it had a riser. A riser, for those who don't work in hospitals, is a large plastic device used to raise the seat of the toilet high enough so that hip-replacement patients don't have to squat to poop.

These problems had apparently gone unfixed for several days, leading to aggravation and frustration on the part of the patient. I get this, and sympathize, having dealt with it myself in the past. However, management's solutions were to a) take the riser off of the toilet, and b) provide a stool for the patient to stand on so he could get into bed unassisted.

There're only two problems with this approach: a) The toilet risers are permanently installed on toilets in a percentage of rooms and cannot be removed and replaced with a regular seat. Nobody seems to have thought of this and moved the guy to another room. B) Stools for patient use are strictly forbidden under hospital policy. We on the neuro/ortho unit have to sneak them into patients' rooms in order to provide people with extra inches. As far as I know, there is *one* stool in the entire hospital, hidden in our supply room.

The PI skit focused on how to validate the patient's feelings and solve his problems. It was performed by two people who apparently operated in total ignorance of hospital policy and technical reality.

Need I mention that the MANDATORY SEMINAR was held at 0730? For half an hour? And that was the only time of day it was offered? So that day-shift nurses had to leave the floor at the busiest time of day, and night-shifters had to lose an hour of sleep?

So I left my patients in the capable hands of my overworked charge nurse for 30 minutes in order to prove that I was committed to patient care.

Teamwork, by the way, is an essential part of this PI initiative. In order to facilitate teamwork, each floor manager is going to post a list of people who've gotten props from the patients on a monthly basis.

Uh. It doesn't matter if I pray with a patient, talk to her for forty-five minutes, or get many compliments from family members. All of those things, by the by, have happened in the last seven shifts. What matters to management is if those patients fill out a piece of paper. I feel idiotic saying to a woman who's just cried on my shoulder, "Hey, I know you're in a rough spot, but would you mind filling out this questionnaire to let my boss know I'm doing a good job?"

I'm not (and I'm sure this is shocking) good at self-promotion. Guess it's time to go back to work with the attitude of loving the job for its own sake.

In other news

It really sucks when you tell a friend that you have to lose 25 pounds, on doctor's orders, and she doesn't say, "Oh, you look great as you are. That doctor's blowing smoke."

Guess it's time to go do some situps.

Goal: size 8 by April 24th. We'll see how this goes.

Welcome to the other side of the stethoscope.

I now have two chronic health problems.

I am too fat. And my blood pressure is too high.

It's a sure bet that my cholesterol numbers, if my doctor knew them, would cause his eyes to bulge out like Large Marge's from "Peewee's Big Adventure." However, neither he nor I know them, because I haven't had my cholesterol tested in...far too long.

So now I'm on the other side of the stethoscope, with a stern lecture from my doctor on my weight (which is about 25 pounds too much) and my BP (about 15 points too high on both numbers) and my lifestyle (cheeseburgers are a food group, right?) and my stress level (contact dermatitis that worsens whenever I go to work).

It doesn't help that my doctor is normally the non-lecturing type. Some of these guys lecture as a way of life when they're not out climbing Everest or keeping their cholesterol at 133. This doctor doesn't lecture. Instead, he cheerleads.

Not today, though. So here I am, beginning a new phase of my life: close contact with my primary-care physician.

This week I'm not eating anything bigger than I am (cow, pig, sturgeon). Next week I'll cut out animals that pair-bond. I'm sure I have some vegetables somewhere, and I seem to remember a treadmill in the workout room. In a month I'll have a follow-up exam, and by God, he'd better see some results.

Oh, dear.

Grand Rounds!

Are at The Well-Timed Period this week.

Dadratit, I need to add her page to my link list.

Link o' the mornin' to ye!

Dogblog

Rampaging PMS

Controversy Roundup

In which Jo comments on controversial issues in the news.

1. Terry Schiavo: get your power of attorney and living will done, people. That's the lesson to take away from this.

2. The supposed lack of women bloggers, as bemoaned by male bloggers: I'm a woman blogger. We exist. Get over it.

3. Steroids in baseball: Yeah, whatever.

4. Abortion clinic records subpoena'd by legislators in an attempt to research child sexual abuse: Why is anybody buying that argument?

5. Lindsey Lohan's and Paris Hilton's behavior: zzzzzzz*snurk*zzzzzz.

That's a new one on me.

Just when you think you've seen everything, your patient brings a homeless person back to the hospital to share her room.

There are a number of things wrong with that sentence. See if you can list them. I'll give you a few minutes.

In other news, management is apparently still concerned with our customer service skills. In addition to initiating formal charge nurse rounds (not the sort you think, hang on), we have a new script to follow and a new set of guidelines on how to provide good customer service. The new formal charge nurse rounds, rather than being the usual CN rounds, are focused on customer service. Instead of rounding on each patient to make sure the CN knows what's going on and what sorts of issues the patients have, CNs now have to round to make sure that the patients know their nurse's name and that they're happy with their interpersonal interactions with the nurse.

Never mind that we're dealing primarily with people who have pretty massive brain injuries. Only two of my five patients could possibly remember my name; the others think they're either in Paris or being held hostage by the FBI. Or they're faking neurological problems in order to get more drugs and so won't cooperate anyhow. I forsee a number of problems with this new customer service focus.

Okay, pencils down. What's wrong with a patient bringing a homeless person back to her room?

Well, first thing, you really ought not to be leaving the floor right after brain surgery. You ought not to be going outside to smoke, that's for sure. Probably striking up a conversation with a random person in this neighborhood isn't the best idea, nor is bumming a cigarette off of them. You just don't know what you're getting. Finally, bringing said random person back to your room will present problems for both the nurses and (when they get involved) the security staff.

Of course, this was the same patient who tried to fake neurological deficits in order to get both more attention and more hydromorphone (Dilaudid). My morning started like this:

*ring ring ring*

Doctor: "Yes, this is Doctor Unpronounceable."

Jo: "Doc? That patient in 33? She's complaining of new numbness and pain. And speaking like Yoda, she is."

Doctor: *slightly hysterical laughter* "Okay. I'll be up in a sec."

It's amazing how fast those embellished neurological symptoms disappear when you tell the patient that the surgeon is coming up to tap her shunt, after which she'll be going for a long and probably uncomfortable series of tests. I dunno, they're probably going to have to do a lumbar puncture too, so I'd better start about four more IVs.

Yes, this is sadistic and manipulative. However, the sort of behavior that woman exhibited is a prime example of Shit I Don't Have Time For. I have actual, real, live, *sick* people to take care of; don't waste my time because you like your narcotics a little too much. Besides, if you start faking new symptoms, we'll figure it out--you simply don't know that much about neurology. And if we're unsure, we'll take you off the narcotics completely to see if the symptoms resolve.

So there, too. I'm fairly sure my customer service rating will dip on that one.

Oh, my goodness gracious.

My feet hurt.

My ankles won't bend.

My lower back hurts.

So does one little muscle that runs from my lower back to my right buttock.

My hamstrings are stiff.

And my shoulders hurt.

And I have to do it all again tomorrow.

I'm glad somebody is braver than I am.

I ran across a link at Bitch, PhD's site called "Abortion Clinic Days". The stories she tells and the way she tells them took me straight back to the days when I worked at an abortion clinic.

Prior to that I'd been a paraprofessional at a Planned Parenthood clinic that did general and women's health care. When I started school, I needed a part-time job a few days a week; one of the clinic's aftercare people was leaving, so I took that job. And it was an experience.

An overwhelmingly *positive* experience. Let me emphasize that. Aside from the times that protesters tried to follow me home to get my address, or the time that I had to body-block a protester who started to get violent with a post-procedure patient, it was an amazing time. We were all women there, and all of us had had abortions. Two of us had had abortions pre-Roe, and one of them had been botched. I had my own abortion at that same clinic, with the same doc. That was the whole reason I ever considered working there--the women I met were so kind, so supportive, and so positive about what they were doing that I wanted to be a part of it.

Writing about those days makes my palms sweat. At the same time I was working at the clinic, I was also doing post-abortion counselling both online and in real life. But doing post-AB counselling and working at a clinic will bring two very different reactions in public. Neither are something that you'd necessarily want to announce at a cocktail party--or even in a blog--but the first, at least, won't get you harrassed.

The thing I remember most about those years is this: everywhere I went, from grocery stores to restaurants, women approached me to thank me and the people I worked with for the job we did. Once it was a woman in her 50's whose breast cancer had been discovered by a mammogram that PP paid for. Once it was a woman whose 13-year-old daughter I'd counselled about delaying sex. The daughter had quit hanging out with boys and had made the varsity volleyball team that semester. (That story made me cry; it also made me glad I'd refused a subpoena, but that's a different story.) Once it was a woman who just wanted to thank me for speaking openly and honestly about the circumstances surrounding the abortion I'd had.

It strikes me as strange indeed that one in three of us will have had an abortion by the time we hit menopause, yet talking about it is something nobody wants to do. Or, at least, we don't want to start the conversation. Even typing "I had an abortion" brings up the fear of the sort of comments I hate to see being left here. Women don't write them down on their medical histories. They don't tell their doctors or NPs about their abortions. They've even tried, in the past, to lie about why they were getting aftercare at the clinic. (Um...we saw you last week, okay?)

The reasons we don't talk are shame and fear. The fear is real, and protective: I've been followed in public, followed around the store, gotten nasty postcards from people who claim to be praying for me. Nobody wants to let themselves in for that. The shame is equally real, but comes from a different place: the straw-man idea that women who have abortions are automatically bad and wrong.

We might have been stupid at one point, or forgetful, or had some health problem that only cropped up later. But we're not bad and wrong.

And here is this anonymous woman who's writing about an experience that few of us will have. A third of us will have abortions; many fewer of us will ever talk professionally about the decision or help other women weigh it. Most of us who have done it or do it now don't talk about the work we do, except to other people in the same business. I'd bet that only a fraction of us actually come out in any public way and open the discussion ourselves.

Damn, I'm glad somebody is braver than I am. Whoever the hell she is, I wish her the strength not to fear the people outside the clinic, the ability to keep listening, and the stamina to continue her work.

Addendum: I've decided to leave comments enabled on this post.

Political discussions, if they go on too long, will be closed. As will any sort of debating. Flames of any sort will be returned to sender with a heapin' helpin' of rebound kharma attached.

Don't be stupid, friends.

From Izzle Pfaff

Clicky

Sylvia Bath

I have done it again.
One day in every ten
I manage it--

A sort of caulking miracle, my tub.
The sour mildew
Will vanish in a day.

I have suffered the atrocity of toilets.
Munge in the bowl
My brush filaments scrub and burn, a hand of ick.

Now I churn up soapstuffs that fly about the tub.
A film of such indolence
Will accompany my bystanding: I must shriek.

Cleaning
Is an art, like everything else.
I do it not terribly well.

I do it so it does not smell.
I do it so it feels clean.
I guess you could say I bought some gel.

Does not my sponge astound you. And my rag.
All by myself I am a schmutz Godzilla
Scrubbing and powdering and brow-dering, flush on flush.

I think I am cleaning up,
I think I may sanitize--
The motes of green Comet fly, and I, toilet, I

Am a pure ammonia
Virgin
Attended by noses,

By hisses, by effluvium,
By whatever these pink fingers clean.
Dead hands, dead astringents.

There were stains on your white parts
And we tenants never liked you.
We are dancing and showering in you.
We always noticed your goo.
Bathroom, bathroom, you bastard, I'm through.

A week of frustration.

Every nurse has Those Weeks once in a while: you work your three, or four, or five days, and each day has three, or four, or five little frustrations that make you wonder why you're doing this job rather than working at McDonald's.

The uniforms, after all, aren't as cool at McDonald's, but the hours are better.

Speaking of uniforms, two of my scrub jackets have come down with some sort of stain that even soaks in bleach and hot water can't remove. This in itself isn't an unusual occurance--I've had everything from antibiotics to Dead Guy Bile end up on my shirt--but the thing is, I can't remember how on earth something pink got up on my shoulder two days in a row. And scrub jackets are intensely personal. Everybody who wears one has a favorite, a second favorite, and one they wear only when everything else is filthy. These two are two of my favorites and have to be replaced.

Speaking of replacing things, I now need a new stethoscope. I lent mine to a nurse's aide who lost it within 15 minutes of putting her paws on it. We searched the entire floor and couldn't find it. It wasn't a particularly nice one, but it's still irritating.

Speaking of irritating, a tip for future patients: if I discharge you with a list of medications and how to take them, and spend forty-five minutes teaching your family how to administer said medications to control your pain and inflammation, *please* follow my instructions. I'm not doing this for the exercise, after all. If you don't follow my instructions (which come from the doctor and not my fevered brain), please don't get readmitted on the evening of the day you're discharged for a headache. Really and truly, this will not make me disposed to like you. Especially if it turns out that no, you didn't take any of the pills that I so laboriously educated you about.

In short, prayer might make you feel better and speed your healing, but God expects you to take advantage of pharmaceuticals as well. Heaven helps those and all that.

And finally, speaking of Heaven, that's where you might find yourself if you air your Neanderthal views about nurses to me.

This, people, is a biggie. There aren't too many folks around any longer who express surprise that I'm not wearing a cap or a white dress or whatever fantasy of nurse that Playboy has taught them, but there are a few. Most of those folks know enough to keep their mouths shut and not treat nurses like a combination of waitress and stripper, which only makes the person who doesn't keep his or her (yes, there are both sexes involved here) mouth shut that much more surprising.

I have had people try to tip me. I've had serious job offers from rich old ladies who want companions. I've had more offers of young sons and nephews than I can count. I have never, though, had a critique of my scrubs that included the opinion that they're a) too baggy and b) not low-cut enough until last night. Especially not tagged with the word "Darlin'".

"Darlin'" coming from an old cowboy is charming. Coming from a World War II vet covered with tattoos, it's appropriate. Coming from a lecherous man who dates women half his age, it makes me wish for a large-gauge needle.

It's frustrating weeks like this past one that make me wonder if maybe I shouldn't start working in the OR, where everybody's asleep, or in labor and delivery, where everybody's female.

I hear Wendy's is offering nine bucks an hour to start. And their uniforms aren't bad.

"Isn't there somebody who can get it all?"

No. Not when the "it" in question is a glioblastoma that's reached its tentacles into parts of your brain that you actually might need later.

As I told his wife, "there's no getting better with this, but there's often 'staying good'."

Then I went into another patient's room to say goodnight. He and his family ribbed me unmercifully and joked around as they'd done all day, with him leading the pack. All 160 pounds of him, cramped up in an odd position because multiple sclerosis had left his muscles too weak to support his body weight.

Last year he was playing football in high school and cruising with his friends.

And I wonder why I have dreams about missing an algebra test, trying to write an English paper, meeting my boyfriend's parents, and my car breaking down--all at once.

I am the luckiest girl in the world.

And not just because I ate poutine twice in one week and lived to tell the tale, and not just because Sheezlebub has made me Minister of Whacking Stupid People On The Head. I'm the luckiest girl ever because I got to hang out in Montreal with people that I love and whom presumably love me back.

Montreal is, at first glance, all balconies. That's what I remember--balconies on every apartment, and spiral staircases so steep that your head clears the second curve before your feet clear the first. Balconies and windows painted different colors on every building: purple and pink, yellow and green, black and richly stained wood. "Pas de circulaire" signs on all the doors of all the apartments, not color-coordinated with the balconies. That's probably a bit too much to ask.

We went up a horridly steep spiral staircase to Magda's one afternoon and into her long, narrow, utterly beautiful apartment. We consumed bread from the Polish bakery down the street and spinach pastries from the Pakistani restaurant and rabbit pate. I played with her cat, Kropka, who has a tiny spot on her chin (hence the name, which means "little dot" in Polish). All the time we were there, from the first bite of bread to the last bit of coffee and cherry tart, the sun shone through her kitchen windows. I was in the room with three of my favorite people and one person I was beginning to like very much.

Then, Friday, we met up with jhave totally by chance--an email had been misdirected or had gone unread, so he wasn't sure what I was doing or when I was leaving. Thanks to synchronicity and a bad lecture on temporal modalities in art, we got to hang out at the cinq-a-sept for a Chinese artist and talk neurology and productivity and romance. So there was Close Pal Number Four, just dropped into my lap.

Afterwards, we all (save jhave, who had a hot date with his girlfriend) went to Pied de Cochon and ate pork bits. Except for me, who had venison bits. Jacques and Arek and Justina and Joey were in rare form, the waiter teased me about being from Texas and shooting him, and then we went home to bed. Can't do better than that.

Now I've got a pot of spaghetti sauce bubbling on the stove. When I look out the window, I don't see Parc La Fontaine covered with snow; I see boring plain balconies. Spring is coming, the pear trees are trying to bloom.

I can't paint my balcony pink, but I think I'll get some window boxes this week.

In which Jo eats her way across Montreal

The best part of travelling anywhere is the food. It's also the worst part, but we'll get to that in a bit. For the moment, let's concentrate on the positive.

Joey and Arek live in a high-ceilinged old apartment across from Parc La Fontaine. It's got those cool old windows that are five feet high and a foot wide and push out rather than lifting up, though nobody's doing any window-opening when it's twelve below. There is the requisite exposed brick wall on one side, and Joey's painted most of the rest of the place in shades of cream, sage green, and light turquoise. It's a sunny place, filled with African masks and Polish ceramics and Joey's paintings and Arek's books. It's also filled with about forty different kinds of cheeses, so that when you open the refrigerator door, you get whacked across the snout with CHEESE.

Cheese here is made from unpasteurized milk. Pasteurization is a marvelous thing; it keeps various nasty bugs from growing in an otherwise wholesome beverage. Unfortunately, the process of pasteurization (as I understand it) also reduces the number of cultures which can grow in milk to make cheese. So the cheese that you get in the States, even some of the best stuff, is a pale approximation of the wonderful creamy, nutty goodness you can find here.

Junk Food

There's a restaurant just 'round the corner that sells practically nothing but poutine. Poutine, for the uninitiated, is French fries with cheese curds and brown gravy.

I'll just wait over here while y'all recover yourselves.

Anyway, the specialty of this place is poutine, and they're proud of it--for good reason. Poutine is one of those things in which wildly disparate ingredients combine to make something that the angels eat in Heaven. If there's a National Food You Can't Believe You Ever Tried But Now Crave for Quebec, poutine is it. Nothin' like it, friends, when you've downed a couple too many Maudites and now need a sponge for the alcohol. I credit poutine with getting me where I am today, which is mostly vertical and with some basic neural functioning.

Good Food

Another fun thing I tried the other day was tendons. Yep, tendons. See, the pho restaurants at home don't offer tendons (hard or soft, your choice) for good reason: people run screaming from the mention of connective tissue in the US. But the brave folks at Ho Pho or Yo' Pho or Go Pho or wherever it was we ate proudly offer tendons (hard or soft)...and they're pretty damned good. As in, I took a bite expecting to be able to swallow, but not expecting to eat the rest by choice. I ate the rest.

Odd Food

Did I mention the peculiar Quebecois humor of putting small amounts of maple syrup on everything edible? Well, practically. There wasn't any on my poutine, but then, I wouldn't have been shocked to find it there.

I'm spoilt. I've been here, what? three days? and I already have a craving for hash browns and barbecue. And a good burrito. First place I'm stopping when I get off the plane is at some hole-in-the-wall barbecue place with good old vinegar sauce.

In the meantime, more coffee is in order. And maybe a little cheese.