How to make summer chili
It's just like winter chili, but everything's fresh.
Get the best vine-ripened tomatoes you can find. If you have a farmer's market nearby, so much the better. Avoid the stall run by the woman with the flower-print dress and big sunglasses, whose tomatoes are all packed head-down in little plastic baskets. Those will be cracked and still green. Go for the fat old guy in overalls with various-sized tomatoes laid out casually on a folding table.
While you're there, pick out an onion. Yellow or white or red doesn't matter.
And some beans. If you can find black beans, fresh, still in their pods, get those. And a couple of ears of corn.
Maybe a pepper or two, if you're feeling adventurous.
Be sure to talk to all of the people selling patty-pan squash, even if it has no place in your chili. Complement them on their produce. Good cooking kharma will follow.
Snag a pint of blackberries or raspberries to snack on while you cook.
When you get home, dig through the freezer for the vegetable or chicken broth you put up last month (or was it the month before?) . Dice the onions, shell the beans, chop the tomatoes. Cut the corn off the ears. Don latex gloves and chop the pepper, leaving as many seeds as you dare.
Throw it all into a huge pot. Add a little cumin; maybe a little extra chili powder too.
Simmer.
Now, then. The important part of this entire process is the music you use to cook by. I recommend Alison Krauss, Emmylou, Cathie Ryan, The Chieftans, early Indigo Girls, and Joni Mitchell. You want women's voices for this--high ones, sweet ones, gravelly ones, all kinds. The Chieftans are in there to bring out the heat of the peppers and to keep you from adding too much salt. Singing along is mandatory.
Midway through the simmering process, which should take at least an hour but can stretch as long as you like, go outside. Making summer chili is the perfect time to talk to the rosy finches who land on your porch railing to tease your cat. They won't fly away when you open the porch door; instead, they'll cock their heads at you, shift their feet, and trill cooking tips.
Winter chili is best made when the wind is awful and the sky is gray. That way, when the smell of the beans takes over the entire house, you can bundle up, go outside, and take counsel with the crows. Summer chili is best made when everything is so ripe it's about to pop.
Turn the heat off under the chili. Whip up some hot-water cornbread right quick and find that hunk of fresh cheese you got from the friend with the goats last week. Have a bowl of chili, sprinkled with mild goat cheese and crumbled cornbread. Sweat.
Sunday, July 31, 2005
Saturday, July 30, 2005
My day on the boogie board, and all info revealed
You know that cartoon where the guy paddles out into the ocean, catches a wave, stands up and surfs....only to find a shark behind him, taking huge bites out of his surfboard?
That would be my day yesterday. Fridays are always a little on the wacko side, but yesterday was four days rolled into one.
It started on the highway, when I had to slam on my brakes as the guy ahead of me slammed on his brakes. It soon became apparent that there was a mile-long backup on the highway just south of a suicidal merge between the road I was on and another four-lane highway.
After I counted three firetrucks, four MICUs, two helicopters, and eight cop cars going past, I decided that EMS was simply having a little teaparty in the middle of the road ahead.
Good call. The car had apparently tried to merge underneath a flatbed eighteen-wheeler. Its top was torn off, the airbag had deployed, and the highway was covered with patches of what looked a whole lot like blood. No question of what was covering the airbag, the inside of the car, and the emergency workers. I drove past, shaking a bit (I really don't like trauma scenes) and arrived at work only ten minutes late.
To find, to my dismay, that Spleen Guy (see below) was having a stroke. That's a real bummer, don't you know. Add to that his anxiety levels, which are becoming high enough to both constitute something that need a psych referral and are also interfering with his treatment. That lovely nursing-school canard about "contracting" with your patients? Where you tell them you'll be in their room at the top of the hour for ten minutes, and don't call you in between? That only works on sane people, and it's the crazies who need it.
The folks that work in MRI and CT really hate me now. I had to stat both, and they had to deal with a person who was alternately yelling, praying, crying, and generally making their lives difficult.
So I called the chaplain to come talk to Spleen Guy. When he arrived, he mentioned in an off-hand, oh-by-the-by tone that one of our colleagues had been found dead at home the previous morning, having apparently just dropped over and kicked off without warning. A healthy person of 43. Lovely.
Something else happened after that, but I don't remember what it was. Maybe it was lunch, as it was past two o'clock by that time.
Then my encounter with Arrogant Attending. Then home. During the drive I saw nothing, thank God, that would require a closed-casket funeral.
I will say this about my job: difficult it might be, but there's rarely a time when I have to return all recoverable bits of a patient in something the size of a shoebox.
All information, all the time
Seems some of you fine folks are wondering who I am and where I live. In an attempt to answer all email questions at once, here's a list (in descending order of recent-ness):
1. No, I don't work at Parkland in Dallas.
2. A medium-sized city on a major Southern bird-migration route. That's all the more I'm sayin'.
3. No, I probably didn't take care of your brother Bob after his pancreatic resection. I do brains, remember?
4. Yes, the red hair is real.
5. No, I don't make this stuff up. (I feel a bit like Belle de Jour here; next thing you know, somebody's going to be accusing me of being the Valerie Plame leak.) You *can't* make this stuff up.
6. No, sorry, I don't give medical advice over email.
7. Yes, I have an Amazon want list, but I'm not making it public. And no, I don't accept donations (hence the lack of the PayPal button), but thank you anyhow.
8. Yes, I do get paid for hosting Ivo's ad. The money he sends goes straight into either animal rescue or Planned Parenthood. After all, hosting his ad is no skin off my schnozz.
9. An ADN, two-year program. And sorry, but I can't recommend a good program in your state.
10. Yes, you may have that gazpacho recipe. I'll post it later. Unless I've already posted it; I have to go back and check.
That would be my day yesterday. Fridays are always a little on the wacko side, but yesterday was four days rolled into one.
It started on the highway, when I had to slam on my brakes as the guy ahead of me slammed on his brakes. It soon became apparent that there was a mile-long backup on the highway just south of a suicidal merge between the road I was on and another four-lane highway.
After I counted three firetrucks, four MICUs, two helicopters, and eight cop cars going past, I decided that EMS was simply having a little teaparty in the middle of the road ahead.
Good call. The car had apparently tried to merge underneath a flatbed eighteen-wheeler. Its top was torn off, the airbag had deployed, and the highway was covered with patches of what looked a whole lot like blood. No question of what was covering the airbag, the inside of the car, and the emergency workers. I drove past, shaking a bit (I really don't like trauma scenes) and arrived at work only ten minutes late.
To find, to my dismay, that Spleen Guy (see below) was having a stroke. That's a real bummer, don't you know. Add to that his anxiety levels, which are becoming high enough to both constitute something that need a psych referral and are also interfering with his treatment. That lovely nursing-school canard about "contracting" with your patients? Where you tell them you'll be in their room at the top of the hour for ten minutes, and don't call you in between? That only works on sane people, and it's the crazies who need it.
The folks that work in MRI and CT really hate me now. I had to stat both, and they had to deal with a person who was alternately yelling, praying, crying, and generally making their lives difficult.
So I called the chaplain to come talk to Spleen Guy. When he arrived, he mentioned in an off-hand, oh-by-the-by tone that one of our colleagues had been found dead at home the previous morning, having apparently just dropped over and kicked off without warning. A healthy person of 43. Lovely.
Something else happened after that, but I don't remember what it was. Maybe it was lunch, as it was past two o'clock by that time.
Then my encounter with Arrogant Attending. Then home. During the drive I saw nothing, thank God, that would require a closed-casket funeral.
I will say this about my job: difficult it might be, but there's rarely a time when I have to return all recoverable bits of a patient in something the size of a shoebox.
All information, all the time
Seems some of you fine folks are wondering who I am and where I live. In an attempt to answer all email questions at once, here's a list (in descending order of recent-ness):
1. No, I don't work at Parkland in Dallas.
2. A medium-sized city on a major Southern bird-migration route. That's all the more I'm sayin'.
3. No, I probably didn't take care of your brother Bob after his pancreatic resection. I do brains, remember?
4. Yes, the red hair is real.
5. No, I don't make this stuff up. (I feel a bit like Belle de Jour here; next thing you know, somebody's going to be accusing me of being the Valerie Plame leak.) You *can't* make this stuff up.
6. No, sorry, I don't give medical advice over email.
7. Yes, I have an Amazon want list, but I'm not making it public. And no, I don't accept donations (hence the lack of the PayPal button), but thank you anyhow.
8. Yes, I do get paid for hosting Ivo's ad. The money he sends goes straight into either animal rescue or Planned Parenthood. After all, hosting his ad is no skin off my schnozz.
9. An ADN, two-year program. And sorry, but I can't recommend a good program in your state.
10. Yes, you may have that gazpacho recipe. I'll post it later. Unless I've already posted it; I have to go back and check.
Friday, July 29, 2005
There need to be four of me.
That way, I wouldn't have to keep repeating myself.
Today, I had an encounter with an attending physician who'd never been on our unit before. His resident came up to me and asked, "How do I get in touch with the person who's covering for Doctor So-and-So this weekend?"
My answer was this: "Call the neuro rotating pager number (pointing at the board where it's written) and ask the person who calls you back."
Two minutes later the attending came up and asked me the same question.
Forty-five minutes later, I saw the attending wandering around the nurses' station, muttering things like "I hope I never get sick on this unit" and "This is no way to run a service" and "What the hell are they playing at, anyway?"
So I asked him. "Is there a problem?"
"Yes. I can't get hold of the person who's covering for Dr. So-and-So."
"Did you call the neuro rotating pager number?"
"No. I called (list of numbers picked, apparently at random, here). Nobody can tell me what's going on."
So I picked up the phone. I called the rotating pager. Dave called me back, pointed me to Sharma, and I called her pager number.
The attending kept hovering at my back, asking, "Is that an *attending*? Is that an *attending*??"
Sharma called back, had a short conversation with the *attending*, and answered all of his questions.
He hung up, then told me that this is no way to run a unit, he didn't understand what was going on, he hoped he never ended up with us, and he was amazed that people didn't die every day up here.
The Nurse Jo Bag of Snippy Replies was suddenly and annoyingly empty. I stood, staring at him like a calf at a new gate, with my mouth open and my hand frozen on the telephone receiver.
Whereupon he smiled pleasantly, patted me on the shoulder, and thanked me for my help.
I really should get that gun turret installed on the charge nurse's desk.
Today, I had an encounter with an attending physician who'd never been on our unit before. His resident came up to me and asked, "How do I get in touch with the person who's covering for Doctor So-and-So this weekend?"
My answer was this: "Call the neuro rotating pager number (pointing at the board where it's written) and ask the person who calls you back."
Two minutes later the attending came up and asked me the same question.
Forty-five minutes later, I saw the attending wandering around the nurses' station, muttering things like "I hope I never get sick on this unit" and "This is no way to run a service" and "What the hell are they playing at, anyway?"
So I asked him. "Is there a problem?"
"Yes. I can't get hold of the person who's covering for Dr. So-and-So."
"Did you call the neuro rotating pager number?"
"No. I called (list of numbers picked, apparently at random, here). Nobody can tell me what's going on."
So I picked up the phone. I called the rotating pager. Dave called me back, pointed me to Sharma, and I called her pager number.
The attending kept hovering at my back, asking, "Is that an *attending*? Is that an *attending*??"
Sharma called back, had a short conversation with the *attending*, and answered all of his questions.
He hung up, then told me that this is no way to run a unit, he didn't understand what was going on, he hoped he never ended up with us, and he was amazed that people didn't die every day up here.
The Nurse Jo Bag of Snippy Replies was suddenly and annoyingly empty. I stood, staring at him like a calf at a new gate, with my mouth open and my hand frozen on the telephone receiver.
Whereupon he smiled pleasantly, patted me on the shoulder, and thanked me for my help.
I really should get that gun turret installed on the charge nurse's desk.
Monday, July 25, 2005
An old story
With the grace of God, an open window, and a good couple of fans, I managed to keep the fire alarm from going off.
They'd come, the three of them, laden with turquoise, from three states away. They'd come to chant and burn sage and pray for the recovery of the man I was caring for. It wasn't the chants I was worried about; it was the fire department.
The aneurysm wasn't unusual of itself. It was the bleed that happened during surgery that had threatened him, and the resulting rise in his intracranial pressure. Still, he'd pulled through. Now he sat regally in his bed, with one side of his hair long--and matted--and the other side of his head shaved to the scalp.
The three men stayed for a few hours, exchanging gossip and news about what was happening on the reservation. Then they went, leaving smoke from the sage and amulets to speed healing behind.
And the man's wife and I went to work on his hair. We couldn't cut it off; he didn't have the wherewithal to consent to that. And it was a mess--tangled into the sort of dreadlocks that only Southwestern Native American hair can achieve after weeks in ICU.
It took three hours to untangle. He let me braid it, one single braid on one side of his head.
Later, he came back. Much later: his hair had grown out to almost its original length, and was braided in almost-matching braids.
He barely remembered me. What he did remember was the white girl who had forbidden anyone to cut his hair, and who had braided it herself.
They'd come, the three of them, laden with turquoise, from three states away. They'd come to chant and burn sage and pray for the recovery of the man I was caring for. It wasn't the chants I was worried about; it was the fire department.
The aneurysm wasn't unusual of itself. It was the bleed that happened during surgery that had threatened him, and the resulting rise in his intracranial pressure. Still, he'd pulled through. Now he sat regally in his bed, with one side of his hair long--and matted--and the other side of his head shaved to the scalp.
The three men stayed for a few hours, exchanging gossip and news about what was happening on the reservation. Then they went, leaving smoke from the sage and amulets to speed healing behind.
And the man's wife and I went to work on his hair. We couldn't cut it off; he didn't have the wherewithal to consent to that. And it was a mess--tangled into the sort of dreadlocks that only Southwestern Native American hair can achieve after weeks in ICU.
It took three hours to untangle. He let me braid it, one single braid on one side of his head.
Later, he came back. Much later: his hair had grown out to almost its original length, and was braided in almost-matching braids.
He barely remembered me. What he did remember was the white girl who had forbidden anyone to cut his hair, and who had braided it herself.
Look, I'm sorry,
...but your IV pump is not talking to you.
...but I can't get you a bigger room for free. There are no bigger rooms. Put that money away; I can't be bribed.
...but I simply won't give you a hundred of Phenergan to go with your 75 of Demerol.
...but the doctor won't be in today. It's nineteen on a Sunday.
...but we can't put your husband's head back just as it was. It's going to have to have plastic in it now.
...but I can't sleep with your son, no matter how badly you want him not to be gay.
...but she is just not going to get better. Not after a bleed like that.
...but I can't let your heroin dealer spend the night.
...but your twelve-week-old fetus is not telling you what to do.
...but that Chihuahua will have to go.
...but I can't give you that information. Yelling won't help.
...but there is no Playboy channel here.
I love my job. I love my job. I love my job. I love my job.
...but I can't get you a bigger room for free. There are no bigger rooms. Put that money away; I can't be bribed.
...but I simply won't give you a hundred of Phenergan to go with your 75 of Demerol.
...but the doctor won't be in today. It's nineteen on a Sunday.
...but we can't put your husband's head back just as it was. It's going to have to have plastic in it now.
...but I can't sleep with your son, no matter how badly you want him not to be gay.
...but she is just not going to get better. Not after a bleed like that.
...but I can't let your heroin dealer spend the night.
...but your twelve-week-old fetus is not telling you what to do.
...but that Chihuahua will have to go.
...but I can't give you that information. Yelling won't help.
...but there is no Playboy channel here.
I love my job. I love my job. I love my job. I love my job.
Saturday, July 23, 2005
Memo to Stupid People:
Before I forget: the Fashion Edition
To that nice nurse in the recovery room:
Isn't it lovely to be young? Isn't it lovely to have a flat stomach with a rhinestone belly-button piercing and a sacral tattoo of a Celtic knot?
Yes, it is. It is lovely to be and to have all those things.
But it is not lovely at work. If you persist in wearing hipster scrub pants and shirts that are a fraction too short, thus allowing all and sundry to see your rhinestones and tattoos, I will be forced to point and laugh.
To the pleasant nurse who works next to me three days a week:
I understand that your nails are brittle and delicate. I understand that you place a high value on your personal appearance. But I don't understand why, given those things, you continue to wear acrylic nails.
Not just acrylics (which, by the way, aren't really allowed in patient-care settings), but acrylics that have grown out, leaving a big gap between the cuticle and the fake part of the nail. That just screams bacteria to me.
Please. Take them off. Wear your nails short and neat, like the rest of us do. Or, if you must keep the acrylics, have them filled once in a while.
And, for the love of God, stop painting them green.
To the gorgeous belly surgeon I know:
Love your 'do. Really. I love the French twist in the back and how it comes down into little stair-stepping teacups on the left side. I love the braids in the front and the tiny curlicues that outline your forehead and cover your ears. But it's been three weeks now, and you don't sleep good. Things are starting to sprout out of your French twist, and the teacups are starting to look more like styrofoam cups.
Maybe something a little more low-maintenance would be good.
To the pleasant, if unkempt, neurosurgeon who put a lumbar drain in my patient the other day:
You've made progress. Thank you. I notice that you're keeping your hair neat and your nails short, which is huge. Honest. I appreciate that you're shaving at least weekly. Nobody likes the "House" look on a resident, and you're cleaning up nicely.
But there's one remaining issue we have to discuss, my friend. It's scrubs.
Surgical scrubs are thin. They're baggy. They tend to ride up in odd spots.
Do you see what I'm getting at, here?
Underwear. Buy it. Wear it. Save the rest of us some trauma.
To that nice nurse in the recovery room:
Isn't it lovely to be young? Isn't it lovely to have a flat stomach with a rhinestone belly-button piercing and a sacral tattoo of a Celtic knot?
Yes, it is. It is lovely to be and to have all those things.
But it is not lovely at work. If you persist in wearing hipster scrub pants and shirts that are a fraction too short, thus allowing all and sundry to see your rhinestones and tattoos, I will be forced to point and laugh.
To the pleasant nurse who works next to me three days a week:
I understand that your nails are brittle and delicate. I understand that you place a high value on your personal appearance. But I don't understand why, given those things, you continue to wear acrylic nails.
Not just acrylics (which, by the way, aren't really allowed in patient-care settings), but acrylics that have grown out, leaving a big gap between the cuticle and the fake part of the nail. That just screams bacteria to me.
Please. Take them off. Wear your nails short and neat, like the rest of us do. Or, if you must keep the acrylics, have them filled once in a while.
And, for the love of God, stop painting them green.
To the gorgeous belly surgeon I know:
Love your 'do. Really. I love the French twist in the back and how it comes down into little stair-stepping teacups on the left side. I love the braids in the front and the tiny curlicues that outline your forehead and cover your ears. But it's been three weeks now, and you don't sleep good. Things are starting to sprout out of your French twist, and the teacups are starting to look more like styrofoam cups.
Maybe something a little more low-maintenance would be good.
To the pleasant, if unkempt, neurosurgeon who put a lumbar drain in my patient the other day:
You've made progress. Thank you. I notice that you're keeping your hair neat and your nails short, which is huge. Honest. I appreciate that you're shaving at least weekly. Nobody likes the "House" look on a resident, and you're cleaning up nicely.
But there's one remaining issue we have to discuss, my friend. It's scrubs.
Surgical scrubs are thin. They're baggy. They tend to ride up in odd spots.
Do you see what I'm getting at, here?
Underwear. Buy it. Wear it. Save the rest of us some trauma.
Step away from the spleen.
He's a nice man. Intensely religious, charming, friendly. He's got a wife and three kids at home, and an AVM that's taken up a significant portion of his spinal column.
An AVM (arteriovenous malformation) is a collection of blood vessels that have developed wrong. We don't know what causes 'em, and most of the time, they don't cause any problems. You can have one anywhere (I've seen 'em in the tongue, belly, arms and legs, and brains and spines). Essentially, the pattern of blood vessels that feeds the tissues normally gets all kerfuffled, and you end up with a huge mass of unproductive arteries and veins that only connect to each other.
Anyway, nice guy. Came in with MRI films taken back in March that showed a small-but-significant AVM in his spine at the junction of his cervical and thoracic vertebrae (that lump on the back of your neck). It had caused a few problems at that point: numbness and painful tingling of his arms, some pain in his chest musculature.
He'd tried to treat it with prayer, herbs, and dessicated spleen tablets. Why the spleen? I have no clue.
[Now, then: I don't mean to give prayer, herbs, and supplements short shrift. In some cases, like repetitive strain injuries, vitamins can help, as can massage. Acupuncture can help some things. Prayer has done some things that make my eyes all slitty and make me say "Hmmmm."]
But an AVM is a surgical problem. And, for all you know, God might intend for you to put the spleen back in the cabinet and contact a good neurosurgeon, so you perhaps had better not delay getting treatment.
Our MRI showed that the AVM had grown. It now stretches from the middle of the back of his neck to where his bra strap would be if he wore a bra. He's lost the use of his legs completely, lacks sensation below the waist, and is rapidly losing the use of his hands.
We hope to embolize and remove the AVM--a process that will take months, more'n likely--and at least save his diaphragm.
The one question I haven't yet asked him is "Why the hell the spleen?" I think I'm a little afraid of the answer.
Knees, knees, knees.
It's that time of year again: every orthopedic surgeon we have has gone on vacation except one. And the one who's left specializes in knee replacements in morbidly obese women.
Last year at this time we had another of his patients. Normally, a person who weighs 200 or even close to 300 pounds has some good muscle in their legs. Depending on comorbidities, folks that large can get around and move a bit, so their thighs and (especially) calves bulk up from moving that weight around.
This patient, who thankfully has not been back, was not one of those people.
She was big. Not just fat, but tall. Big, heavy bones. Broad shoulders. And had apparently spent the last thirty years in bed, stepping out only when absolutely necessary. And had screwed up both of her knees in the process.
Women's knees are particularly vulnerable to damage because of the angle at which our thighbones leave our pelvises. Men's thighbones drop more or less vertically from their more-or-less vertical pelvises, while women, with a flared, wider pelvis, have thighbones that drop down at an angle. Men's legbones line up better, therefore, with all the musculature and ligaments and kneecaps and so on, while women are at an increased risk of ACL tears and cartilage wear and other problems. This could all have been avoided had our original parts list contained more than one style of knee, but we were apparently built, as a species, by the lowest bidder, on spec.
Anyway. Back to our patient. Both legs had the large, stapled incisions that mean "total knee replacement." Both were encased in continuous passive motion machines. Both legs were the size of tree trunks with no perceivable muscle.
And she had Issues. You know what I mean. She didn't have the strength, either of body or will, to lift herself up with the trapeze above her bed. She wouldn't call for a bedpan. (Try changing a bed under a totally inert, 388-pound woman sometime.) She couldn't manage to get two steps from bed to chair, and so had to be pulled from the bed to the cardiac chair to sit up.
Which makes me wonder, why the new knees in the first place? She had no plans to slim down to a more reasonable 300 pounds. She didn't want to move, particularly, and by her own admission had had very little pain with the old knees. She'd gone through a difficult, painful surgery with all its attendant risks and didn't really need the outcome.
I think that particular orthopod has a boat payment due in August.
An AVM (arteriovenous malformation) is a collection of blood vessels that have developed wrong. We don't know what causes 'em, and most of the time, they don't cause any problems. You can have one anywhere (I've seen 'em in the tongue, belly, arms and legs, and brains and spines). Essentially, the pattern of blood vessels that feeds the tissues normally gets all kerfuffled, and you end up with a huge mass of unproductive arteries and veins that only connect to each other.
Anyway, nice guy. Came in with MRI films taken back in March that showed a small-but-significant AVM in his spine at the junction of his cervical and thoracic vertebrae (that lump on the back of your neck). It had caused a few problems at that point: numbness and painful tingling of his arms, some pain in his chest musculature.
He'd tried to treat it with prayer, herbs, and dessicated spleen tablets. Why the spleen? I have no clue.
[Now, then: I don't mean to give prayer, herbs, and supplements short shrift. In some cases, like repetitive strain injuries, vitamins can help, as can massage. Acupuncture can help some things. Prayer has done some things that make my eyes all slitty and make me say "Hmmmm."]
But an AVM is a surgical problem. And, for all you know, God might intend for you to put the spleen back in the cabinet and contact a good neurosurgeon, so you perhaps had better not delay getting treatment.
Our MRI showed that the AVM had grown. It now stretches from the middle of the back of his neck to where his bra strap would be if he wore a bra. He's lost the use of his legs completely, lacks sensation below the waist, and is rapidly losing the use of his hands.
We hope to embolize and remove the AVM--a process that will take months, more'n likely--and at least save his diaphragm.
The one question I haven't yet asked him is "Why the hell the spleen?" I think I'm a little afraid of the answer.
Knees, knees, knees.
It's that time of year again: every orthopedic surgeon we have has gone on vacation except one. And the one who's left specializes in knee replacements in morbidly obese women.
Last year at this time we had another of his patients. Normally, a person who weighs 200 or even close to 300 pounds has some good muscle in their legs. Depending on comorbidities, folks that large can get around and move a bit, so their thighs and (especially) calves bulk up from moving that weight around.
This patient, who thankfully has not been back, was not one of those people.
She was big. Not just fat, but tall. Big, heavy bones. Broad shoulders. And had apparently spent the last thirty years in bed, stepping out only when absolutely necessary. And had screwed up both of her knees in the process.
Women's knees are particularly vulnerable to damage because of the angle at which our thighbones leave our pelvises. Men's thighbones drop more or less vertically from their more-or-less vertical pelvises, while women, with a flared, wider pelvis, have thighbones that drop down at an angle. Men's legbones line up better, therefore, with all the musculature and ligaments and kneecaps and so on, while women are at an increased risk of ACL tears and cartilage wear and other problems. This could all have been avoided had our original parts list contained more than one style of knee, but we were apparently built, as a species, by the lowest bidder, on spec.
Anyway. Back to our patient. Both legs had the large, stapled incisions that mean "total knee replacement." Both were encased in continuous passive motion machines. Both legs were the size of tree trunks with no perceivable muscle.
And she had Issues. You know what I mean. She didn't have the strength, either of body or will, to lift herself up with the trapeze above her bed. She wouldn't call for a bedpan. (Try changing a bed under a totally inert, 388-pound woman sometime.) She couldn't manage to get two steps from bed to chair, and so had to be pulled from the bed to the cardiac chair to sit up.
Which makes me wonder, why the new knees in the first place? She had no plans to slim down to a more reasonable 300 pounds. She didn't want to move, particularly, and by her own admission had had very little pain with the old knees. She'd gone through a difficult, painful surgery with all its attendant risks and didn't really need the outcome.
I think that particular orthopod has a boat payment due in August.
Thursday, July 21, 2005
An awards show of sorts....
What a week.
In honor of the week just past, I present: The 2005 Nursing Weirdness Awards.
Best Line Used In The Context of Patient Care:
"Time to disimpact the midget."
Best New Use of An Old Standby Drug:
"I need a Uroject (lidocaine jelly) to help with this disimpaction."
(No, there's no theme here.)
Best Use of Medical Equipment:
The use of an IV pole by one of our security guys to fend off a violent, confused patient who was attacking nurses.
Best Use of Food Items:
Stacking two bags of white rice and a bottle of molasses from the kitchen around a free-standing drainage bag in order to keep it from tipping over. No, you don't want to know what was in the drainage bag, or even how big it was. And no, I don't know why we had two ten-pound bags of white rice in the clean utility room.
Best Line from an Attending Physician:
(On observing a widespread rash on a patient's back) "Oh, no. I don't know anything about *that*" (while backing away).
Best Line from a Resident:
"Next thing you know, they'll be expecting me to follow up with this guy in clinic."
In honor of the week just past, I present: The 2005 Nursing Weirdness Awards.
Best Line Used In The Context of Patient Care:
"Time to disimpact the midget."
Best New Use of An Old Standby Drug:
"I need a Uroject (lidocaine jelly) to help with this disimpaction."
(No, there's no theme here.)
Best Use of Medical Equipment:
The use of an IV pole by one of our security guys to fend off a violent, confused patient who was attacking nurses.
Best Use of Food Items:
Stacking two bags of white rice and a bottle of molasses from the kitchen around a free-standing drainage bag in order to keep it from tipping over. No, you don't want to know what was in the drainage bag, or even how big it was. And no, I don't know why we had two ten-pound bags of white rice in the clean utility room.
Best Line from an Attending Physician:
(On observing a widespread rash on a patient's back) "Oh, no. I don't know anything about *that*" (while backing away).
Best Line from a Resident:
"Next thing you know, they'll be expecting me to follow up with this guy in clinic."
Monday, July 18, 2005
So Mom and I were talking the other night....
She has, since she is my mother, flattering things to say about this blog.
Goodness me. At least she and I are agreed in our conspiracy to Keep Things On the Q.T. Where Dad Is Concerned. Mom said, when I mentioned that I was just a little freaked out about her reading stuff, "I am sixty-seven years old. Whatever you've done, I've either done or imagined. Relax."
Then she said, "You've been getting some rain lately, huh?"
Yes. Yes, we have, as a matter of fact. Hurricanes are good for that. She made sure that I could get a change of scrubs at the hospital (the neighborhood around the hospital flooded horribly the other day; people weren't able to get to the highway), and then asked:
"And you have a clean pair of underwear with you, right?"
My jaw dropped. Mom actually did a Momlike thing, asking me if I had clean undies. After all, she pointed out, what would happen if I were to be in an accident?
I think Mom's tongue will have to be surgically removed from her cheek.
Goodness me. At least she and I are agreed in our conspiracy to Keep Things On the Q.T. Where Dad Is Concerned. Mom said, when I mentioned that I was just a little freaked out about her reading stuff, "I am sixty-seven years old. Whatever you've done, I've either done or imagined. Relax."
Then she said, "You've been getting some rain lately, huh?"
Yes. Yes, we have, as a matter of fact. Hurricanes are good for that. She made sure that I could get a change of scrubs at the hospital (the neighborhood around the hospital flooded horribly the other day; people weren't able to get to the highway), and then asked:
"And you have a clean pair of underwear with you, right?"
My jaw dropped. Mom actually did a Momlike thing, asking me if I had clean undies. After all, she pointed out, what would happen if I were to be in an accident?
I think Mom's tongue will have to be surgically removed from her cheek.
No blogging for a couple of days.
I've just bought the newest Harry Potter.
Oh, yeah? And what are *you* reading?
Edited to add:
Damn. Damn, man. Read the whole thing in one sitting, with quick breaks to drag scrubs out of the dryer and load the dishwasher.
No spoilers here, but I feel as though my insides have been run over a cheese grater.
And I have the almost-irresistable urge to eat pork potstickers, the ultimate comfort food.
Goodness.
Damn.
Wow.
Oh, yeah? And what are *you* reading?
Edited to add:
Damn. Damn, man. Read the whole thing in one sitting, with quick breaks to drag scrubs out of the dryer and load the dishwasher.
No spoilers here, but I feel as though my insides have been run over a cheese grater.
And I have the almost-irresistable urge to eat pork potstickers, the ultimate comfort food.
Goodness.
Damn.
Wow.
Sunday, July 17, 2005
Why we have protocols.
I've said it before, and I'll say it again: "A policy does not exist to inconvenience you. There is a reason for it."
That was brought home to me last week in a big way.
A patient had come in, had a bad surgical outcome, and had spent the better part of eight weeks bouncing from unit to unit. At one point, some bright person had noticed that the patient was coughing up a lot of junk (sorry for the technical term) and decided to do an acid-fast smear and culture on that junk.
Acid-fast bacteria are a big family. Most of 'em you don't really need to worry about, but one you do: tuberculosis. Our hospital policy says this: if a patient has an acid-fast bacillus positive smear or culture, that person is put into respiratory isolation in a negative-pressure room until it can be determined that they do or do not have TB. It sounds draconian to do that, but it's really quite sensible; the treatment for TB is nasty beyond description and takes a very long time.
So this patient had a negative AFB smear and a positive AFB culture. The micro lab called the floor where the patient was at the time and gave the results to a physician's assistant who had been following the case.
Here's where the system breaks down. The PA, being a Quasi-Important Person with an inflated sense of his own authority, decided that the culture didn't matter, that the patient didn't have TB. How he determined that without psychic abilities escapes me, but the point remains: he didn't notify the infection control folks or put the patient into isolation. In other words, he carefully ignored the protocol that the hospital has put into place for the protection of everyone.
Micro also screwed up. They're supposed to call report, with a read-back, to two people: the resident in charge of the case and the nurse caring for the patient. They didn't. They ignored the protocol that was put into place for the protection of everyone.
So. Fast-forward four weeks. The patient's been on our floor for two weeks. Another bright person, this one from the pulmonology staff, takes a walk through the patient's chart and finds the old AFB positive culture result. The patient is slapped into isolation, where I find them after I come back from a three-day weekend.
I'd taken care of that patient for two weeks solid. Several times I had gotten coughed on and sprayed with mucus (no matter how careful you are, this will sometimes happen). I was told that an AFB-positive culture had *just come back* from micro, hence the sudden isolation.
Which struck me as fine, until I read the chart and noticed that the AFB culture had actually been done back at the end of May. And that it had been positive. And that the patient had been un-isolated and coughing on yours truly, as well as other nurses, techs, support staff, and doctors all that time.
My hair caught fire. I started making phone calls. I found the record of an order for a PPD (purified protein derivative test for tuberculosis), but no record of its having been done on the patient. (Protocol again, this time a failure of a nurse to chart properly.) I wandered into the room and inspected both arms--yep, there's the permanent-marker circle that defines a PPD placement. Okay. It's negative. Back on the phone, I paged the infection control team leader and told her about what had just happened. She paged the PA in question and the chief attending physician of that service. The attending called me, so I had to tell her the same story I'd told everybody from IC to ICU.
The upshot of all of this drama? The patient got some super-duper DNA screening widget test that involves turning urine into gold, or some such, which determined that there was no tuberculosis bacillus present. Period.
(Of course, we'll all have to be tested again in twelve weeks, just to be sure.)
The test costs not-a-little-money. It has to be sent out, and the results in this case were statted, which costs more. The hospital is going to eat that cost. There were also a number of us who'd cared for this patient who'd had to go home and inform our families that we might've been exposed to a particularly icky bacillus. (That was a fun one; Chef Boy was coming down off of having his smoker explode when I told him.)
Yes, TB is hard to catch. Yes, it's treatable. Yes, the chances of my having caught it, even with direct exposure to infective goop, were quite slim.
But the point remains: at least two people in this little drama didn't follow protocol. One didn't follow it because he just knew he was right; the other didn't follow it because they were just plain lazy. As it turns out, everything was fine--and the PA in question really *was* right this time.
Still, it cost us 24 hours of worry and cost me quite a lot of time to clear up.
The worst bit? The PA, since he doesn't work for the hospital itself, can't be written up or otherwise go through our disciplinary--sorry, "counselling"-- process. And the lime pit in my back yard is already full.
That was brought home to me last week in a big way.
A patient had come in, had a bad surgical outcome, and had spent the better part of eight weeks bouncing from unit to unit. At one point, some bright person had noticed that the patient was coughing up a lot of junk (sorry for the technical term) and decided to do an acid-fast smear and culture on that junk.
Acid-fast bacteria are a big family. Most of 'em you don't really need to worry about, but one you do: tuberculosis. Our hospital policy says this: if a patient has an acid-fast bacillus positive smear or culture, that person is put into respiratory isolation in a negative-pressure room until it can be determined that they do or do not have TB. It sounds draconian to do that, but it's really quite sensible; the treatment for TB is nasty beyond description and takes a very long time.
So this patient had a negative AFB smear and a positive AFB culture. The micro lab called the floor where the patient was at the time and gave the results to a physician's assistant who had been following the case.
Here's where the system breaks down. The PA, being a Quasi-Important Person with an inflated sense of his own authority, decided that the culture didn't matter, that the patient didn't have TB. How he determined that without psychic abilities escapes me, but the point remains: he didn't notify the infection control folks or put the patient into isolation. In other words, he carefully ignored the protocol that the hospital has put into place for the protection of everyone.
Micro also screwed up. They're supposed to call report, with a read-back, to two people: the resident in charge of the case and the nurse caring for the patient. They didn't. They ignored the protocol that was put into place for the protection of everyone.
So. Fast-forward four weeks. The patient's been on our floor for two weeks. Another bright person, this one from the pulmonology staff, takes a walk through the patient's chart and finds the old AFB positive culture result. The patient is slapped into isolation, where I find them after I come back from a three-day weekend.
I'd taken care of that patient for two weeks solid. Several times I had gotten coughed on and sprayed with mucus (no matter how careful you are, this will sometimes happen). I was told that an AFB-positive culture had *just come back* from micro, hence the sudden isolation.
Which struck me as fine, until I read the chart and noticed that the AFB culture had actually been done back at the end of May. And that it had been positive. And that the patient had been un-isolated and coughing on yours truly, as well as other nurses, techs, support staff, and doctors all that time.
My hair caught fire. I started making phone calls. I found the record of an order for a PPD (purified protein derivative test for tuberculosis), but no record of its having been done on the patient. (Protocol again, this time a failure of a nurse to chart properly.) I wandered into the room and inspected both arms--yep, there's the permanent-marker circle that defines a PPD placement. Okay. It's negative. Back on the phone, I paged the infection control team leader and told her about what had just happened. She paged the PA in question and the chief attending physician of that service. The attending called me, so I had to tell her the same story I'd told everybody from IC to ICU.
The upshot of all of this drama? The patient got some super-duper DNA screening widget test that involves turning urine into gold, or some such, which determined that there was no tuberculosis bacillus present. Period.
(Of course, we'll all have to be tested again in twelve weeks, just to be sure.)
The test costs not-a-little-money. It has to be sent out, and the results in this case were statted, which costs more. The hospital is going to eat that cost. There were also a number of us who'd cared for this patient who'd had to go home and inform our families that we might've been exposed to a particularly icky bacillus. (That was a fun one; Chef Boy was coming down off of having his smoker explode when I told him.)
Yes, TB is hard to catch. Yes, it's treatable. Yes, the chances of my having caught it, even with direct exposure to infective goop, were quite slim.
But the point remains: at least two people in this little drama didn't follow protocol. One didn't follow it because he just knew he was right; the other didn't follow it because they were just plain lazy. As it turns out, everything was fine--and the PA in question really *was* right this time.
Still, it cost us 24 hours of worry and cost me quite a lot of time to clear up.
The worst bit? The PA, since he doesn't work for the hospital itself, can't be written up or otherwise go through our disciplinary--sorry, "counselling"-- process. And the lime pit in my back yard is already full.
Wednesday, July 13, 2005
Well, that was nice.
I got a very sweet piece of fanmail the other week, from a guy who says that my blog is the "blog by which other nursing blogs should be measured."
Which is a lot like saying that mayonnaise is the condiment by which other condiments should be measured. It gives you a solid median, but there's plenty of room for improvement.
Still. Whether or not I agree, it's nice to get props.
In other news, Kelly (She Who Rocks The Night Shift) is dropping her blog, Time to Lean. I've replaced that link in the list with Shrimplate's blog. No, I'm not a disloyal bitch, just too lazy at the moment to re-figure-out the whole HTML thing. At some point in the future I'll add a list of Gone But Not Forgotten links--blogs that aren't updated any more but which still are worth reading.
Given that it's about to start raining again and that power this week has been spotty at best, I'm going to go eat a bowl of panzanella and hope my refrigerator stays on.
Which is a lot like saying that mayonnaise is the condiment by which other condiments should be measured. It gives you a solid median, but there's plenty of room for improvement.
Still. Whether or not I agree, it's nice to get props.
In other news, Kelly (She Who Rocks The Night Shift) is dropping her blog, Time to Lean. I've replaced that link in the list with Shrimplate's blog. No, I'm not a disloyal bitch, just too lazy at the moment to re-figure-out the whole HTML thing. At some point in the future I'll add a list of Gone But Not Forgotten links--blogs that aren't updated any more but which still are worth reading.
Given that it's about to start raining again and that power this week has been spotty at best, I'm going to go eat a bowl of panzanella and hope my refrigerator stays on.
Tuesday, July 12, 2005
Write an order, dance a jig, beat up your fellow nurses.
"I don't understand why you people are so incompetent."
That's a bad way to begin any conversation. Unless, of course, it's me saying the words, in which case it's perfectly acceptable.
But it's not a good way to begin a conversation with me.
Especially when you're a resident who just started on this unit on the first of the month.
Perhaps especially especially when you're not the sharpest tool in the shed yourself.
Universally Competent and Marvelous Resident (UCMR) was upset that his patient hadn't gotten a number of treatments and medications that UCMR had discussed with one of the nurses. When I say "discussed" I mean *discussed*, as in "Do you think we ought to keep this guy on the high dose pressors he's on, or cut 'em back for a while?" and "Does the wound care service take care of ingrown toenails?" and "What's the procedure for calling a pharm consult for vanc dosing?"
Never mind that these are Very Simple Questions, the answers to which UCMR should've already known. Never mind that the nurse he discussed them with wasn't even the patient's nurse; UCMR had just pulled the poor guy aside during the middle of the night to pepper him with questions.
UCMR lit into me because none of his brilliant ideas had translated into action on anybody else's part.
"You know," I said, trying my best to be gentle, "we can't do anything without an order from you. Just talking about it isn't the same as ordering it, since we don't know exactly what you want."
"Well, you *should*" he protested. "And isn't writing down verbal orders your job anyhow? I don't have time for that shit."
"A verbal order," I replied through my fangs, "should be given as such, not as a series of increasingly idiotic questions. Preferably, it should be given to the nurse caring for the patient. And as for shit, I don't have time for yours. Write your orders and get out of my chair."
Poor UCMR. He really should go into plastics, or some other specialty where people are nicey-nice.
TEAM players
Management has come up with another marvelous idea. This time it's TEAM, a laboring acronym that stands for something like "Teamwork, Enthusiam, Attitude, Managing problems". Here's how it works:
Patients and family members are supposed to fill out little cards the hospital sends 'em a couple weeks after discharge, then mail 'em back, prepaid, with their glowing review of staff members. Each staff member mentioned by name gets a gold star (no, I'm not making this up) next to their name in a file somewhere. When the staff member compiles enough brownie points, they get a nifty T-shirt to wear that proclaims them as a TEAM Player.
Management has its collective crinoline in an uproar. Our unit has gotten the fewest TEAM mentions of any unit since this whole thing started. The assumption on Management's part is that this makes us a bunch of hard-drinkin', dirty-talkin' malcontents without professionalism or caring attitudes.
The reality, of course, is that we have the largest proportion of patients who are totally gorked. Many of 'em either die shortly after they leave us or go to some sort of inpatient rehabilitation. None of those factors make it likely that the patient will suddenly sit up/return from the grave/begin to speak rationally and commend the care he or she got with us. Never mind that the families are dealing with a different set of issues than family members of patients who just had a facelift or breast reduction.
Let's face it, people: Creutzfeld-Jakob disease is not a condition that makes anybody want to fill out a postage-paid postcard six weeks after diagnosis.
So those of us on the Pariah Unit have come up with a plan. We're gonna have white vinyl jackets made up, in the style of 1950's Broadway musical gang members, and have "TEAM PLAYA" embroidered on the backs. We're going to get matching tattoos, set up a wet bar in the nurses' station, and take to dandling Lucky Strikes out of the corners of our mouths. Then we'll mug any nurse we see wearing a TEAM Player T-shirt.
In a few weeks, our reign of terror will be complete. We'll have the hospital under our thumbs. Ice cream sundaes for everybody in OR 7!
That's a bad way to begin any conversation. Unless, of course, it's me saying the words, in which case it's perfectly acceptable.
But it's not a good way to begin a conversation with me.
Especially when you're a resident who just started on this unit on the first of the month.
Perhaps especially especially when you're not the sharpest tool in the shed yourself.
Universally Competent and Marvelous Resident (UCMR) was upset that his patient hadn't gotten a number of treatments and medications that UCMR had discussed with one of the nurses. When I say "discussed" I mean *discussed*, as in "Do you think we ought to keep this guy on the high dose pressors he's on, or cut 'em back for a while?" and "Does the wound care service take care of ingrown toenails?" and "What's the procedure for calling a pharm consult for vanc dosing?"
Never mind that these are Very Simple Questions, the answers to which UCMR should've already known. Never mind that the nurse he discussed them with wasn't even the patient's nurse; UCMR had just pulled the poor guy aside during the middle of the night to pepper him with questions.
UCMR lit into me because none of his brilliant ideas had translated into action on anybody else's part.
"You know," I said, trying my best to be gentle, "we can't do anything without an order from you. Just talking about it isn't the same as ordering it, since we don't know exactly what you want."
"Well, you *should*" he protested. "And isn't writing down verbal orders your job anyhow? I don't have time for that shit."
"A verbal order," I replied through my fangs, "should be given as such, not as a series of increasingly idiotic questions. Preferably, it should be given to the nurse caring for the patient. And as for shit, I don't have time for yours. Write your orders and get out of my chair."
Poor UCMR. He really should go into plastics, or some other specialty where people are nicey-nice.
TEAM players
Management has come up with another marvelous idea. This time it's TEAM, a laboring acronym that stands for something like "Teamwork, Enthusiam, Attitude, Managing problems". Here's how it works:
Patients and family members are supposed to fill out little cards the hospital sends 'em a couple weeks after discharge, then mail 'em back, prepaid, with their glowing review of staff members. Each staff member mentioned by name gets a gold star (no, I'm not making this up) next to their name in a file somewhere. When the staff member compiles enough brownie points, they get a nifty T-shirt to wear that proclaims them as a TEAM Player.
Management has its collective crinoline in an uproar. Our unit has gotten the fewest TEAM mentions of any unit since this whole thing started. The assumption on Management's part is that this makes us a bunch of hard-drinkin', dirty-talkin' malcontents without professionalism or caring attitudes.
The reality, of course, is that we have the largest proportion of patients who are totally gorked. Many of 'em either die shortly after they leave us or go to some sort of inpatient rehabilitation. None of those factors make it likely that the patient will suddenly sit up/return from the grave/begin to speak rationally and commend the care he or she got with us. Never mind that the families are dealing with a different set of issues than family members of patients who just had a facelift or breast reduction.
Let's face it, people: Creutzfeld-Jakob disease is not a condition that makes anybody want to fill out a postage-paid postcard six weeks after diagnosis.
So those of us on the Pariah Unit have come up with a plan. We're gonna have white vinyl jackets made up, in the style of 1950's Broadway musical gang members, and have "TEAM PLAYA" embroidered on the backs. We're going to get matching tattoos, set up a wet bar in the nurses' station, and take to dandling Lucky Strikes out of the corners of our mouths. Then we'll mug any nurse we see wearing a TEAM Player T-shirt.
In a few weeks, our reign of terror will be complete. We'll have the hospital under our thumbs. Ice cream sundaes for everybody in OR 7!
Saturday, July 09, 2005
Things I do not understand.
1. Why are the French considered cheese-eating surrender monkeys? They mobilized eight million some-odd people for World War I. Over a million of those got killed in combat alone. That's not counting the three-quarters of a million folks dead of disease or badly injured, or the civilian casualties. Yet they were able to contribute another five million bodies for WW II and run a fairly efficient sabotage operation even while being occupied by the Nazis. That doesn't say "run away, run away" to me.
2. How come people in Lexuses (Lexi?) drive so badly? 60 in the fast lane, signalling for MILES without turning and turning abruptly without signalling, cutting people off, playing with their hair. What's up with that? Does owning a Lexus make you stupid?
3. Why won't that guy in 108 get it that I cannot get him a bigger room, no matter how much cash he offers me or how much he cusses? Can I please please please tell him tomorrow that I'm not his nurse because he's so personally unpleasant?
4. What *up* with the pharmacy, dawg? Why can I not get a timed vancomycin dose that only comes every thirty-six hours? Is that not enough lead time for you guys?
5. What's the appeal of those little batter-boogers that seafood fast-food restaurants put under your fried fishlike substances?
6. What *up* with you residents, dawgs? Like, your patient is sick. Do not come to me and tell me that and then stand there like I ought to be able to wave a wand. Write an order. Call a code. Dance a jig; I don't care. Just effing *do* something, okay? Okay.
And that, again, is all.
2. How come people in Lexuses (Lexi?) drive so badly? 60 in the fast lane, signalling for MILES without turning and turning abruptly without signalling, cutting people off, playing with their hair. What's up with that? Does owning a Lexus make you stupid?
3. Why won't that guy in 108 get it that I cannot get him a bigger room, no matter how much cash he offers me or how much he cusses? Can I please please please tell him tomorrow that I'm not his nurse because he's so personally unpleasant?
4. What *up* with the pharmacy, dawg? Why can I not get a timed vancomycin dose that only comes every thirty-six hours? Is that not enough lead time for you guys?
5. What's the appeal of those little batter-boogers that seafood fast-food restaurants put under your fried fishlike substances?
6. What *up* with you residents, dawgs? Like, your patient is sick. Do not come to me and tell me that and then stand there like I ought to be able to wave a wand. Write an order. Call a code. Dance a jig; I don't care. Just effing *do* something, okay? Okay.
And that, again, is all.
Friday, July 08, 2005
A Guide to Getting Along With Me, by Nurse Jo.
1. If you are a doctor, please sign the orders you write. What's easier--signing the orders while you write them, or signing them all when I present you with a big stack of incomplete charts and an evil smile, when you're already late for dinner with your wife?
2. If you are a patient with six different diagnoses, all of which must be reached by exclusion, all of which are obscure, and four of which require narcotics to control, you might consider that you're a whackjob.
3. If you're a night nurse, please don't bitch that I "left" you a single piece of not-very-challenging paperwork to fill out during your shift. I had five discharges and six admits today, and your head explodes with one of each, so shut the hell up and fill out the paperwork.
4. If you're a patient's family member, please understand that I don't have the power to get you a "bigger room". There are no "bigger rooms" in the hospital. Yours is as big as it gets. The fact that you're inviting twenty people to witness your being wheeled away for minor surgery is not my problem.
5. If you're a floating nurse on my shift, can the twenty-minute report. We write reports for a reason. You really, really, really don't need to go through every normal system in detail. Hit the high points. We all want to go home.
And home is where I am, with a plate of nachos and a beer.
And I get to do it all again tomorrow.
2. If you are a patient with six different diagnoses, all of which must be reached by exclusion, all of which are obscure, and four of which require narcotics to control, you might consider that you're a whackjob.
3. If you're a night nurse, please don't bitch that I "left" you a single piece of not-very-challenging paperwork to fill out during your shift. I had five discharges and six admits today, and your head explodes with one of each, so shut the hell up and fill out the paperwork.
4. If you're a patient's family member, please understand that I don't have the power to get you a "bigger room". There are no "bigger rooms" in the hospital. Yours is as big as it gets. The fact that you're inviting twenty people to witness your being wheeled away for minor surgery is not my problem.
5. If you're a floating nurse on my shift, can the twenty-minute report. We write reports for a reason. You really, really, really don't need to go through every normal system in detail. Hit the high points. We all want to go home.
And home is where I am, with a plate of nachos and a beer.
And I get to do it all again tomorrow.
Thursday, July 07, 2005
Wednesday, July 06, 2005
You know you've worked too hard when
You have a dream that Gregory House is leading a tour you're on through Cape Verde, and that you've forgotten your sun hat back at the hotel.
However, I did manage both to avoid dysentery and to earn his praise by figuring out how to manufacture pure oxygen using only a match, a tablespoon of mayonnaise, and a bowl of spinach.
However, I did manage both to avoid dysentery and to earn his praise by figuring out how to manufacture pure oxygen using only a match, a tablespoon of mayonnaise, and a bowl of spinach.
Tuesday, July 05, 2005
I am *so* done with you.
Just a tip:
If you plan to seize eight times in four hours, please seize at least once during the five hours that you're in the EEG lab. That will save a lot of trouble.
If you're not going to seize in that five hours, please don't seize twice in the five minutes it takes to transport you from the lab to your room.
And, for God's sake, if you do *that*, seize just one goddamned time after I've set up the incredibly complex and nasty portable EEG monitor and glued things to your head. Okay? Okay.
And one more thing, this for another patient:
If I tell you to hold still, it means *hold still*. As in, STOP MOVING. As in stop fucking wriggling around, or this line that's in your artery, or going into your heart, or just in the wrong damn place, will puncture something that I won't be able to put pressure on.
And, while I'm at it, don't tell me how much more money I could be making as a fucking medical equipment sales rep, because that would mean I have to give up this incredibly rewarding and satisfying job, holding you down so you don't kill your own money-grubbing, shallow, awful self.
Um.
Anybody wanna buy a DynaMap?
If you plan to seize eight times in four hours, please seize at least once during the five hours that you're in the EEG lab. That will save a lot of trouble.
If you're not going to seize in that five hours, please don't seize twice in the five minutes it takes to transport you from the lab to your room.
And, for God's sake, if you do *that*, seize just one goddamned time after I've set up the incredibly complex and nasty portable EEG monitor and glued things to your head. Okay? Okay.
And one more thing, this for another patient:
If I tell you to hold still, it means *hold still*. As in, STOP MOVING. As in stop fucking wriggling around, or this line that's in your artery, or going into your heart, or just in the wrong damn place, will puncture something that I won't be able to put pressure on.
And, while I'm at it, don't tell me how much more money I could be making as a fucking medical equipment sales rep, because that would mean I have to give up this incredibly rewarding and satisfying job, holding you down so you don't kill your own money-grubbing, shallow, awful self.
Um.
Anybody wanna buy a DynaMap?
Quick housekeeping
No, I don't know why Netscape is inconsistent with Blogger's commenting. I can't even fix my own HTML without a handful of Xanax and somebody standing over my shoulder.
Sorry if I haven't replied to your email. It's been rather busy here. Don't take my lack of response for a lack of interest, unless you're calling me a baby-killer or a bad woman, in which case you may. Everybody else, I've got two days starting tomorrow and will run through the inbox then.
General advice: It is a bad idea to eat half a Virginia ham by yourself, no matter how lovingly prepared and wonderful it is. You'll be up all night slugging water.
I'll be back tonight or tomorrow. Salut!
Sorry if I haven't replied to your email. It's been rather busy here. Don't take my lack of response for a lack of interest, unless you're calling me a baby-killer or a bad woman, in which case you may. Everybody else, I've got two days starting tomorrow and will run through the inbox then.
General advice: It is a bad idea to eat half a Virginia ham by yourself, no matter how lovingly prepared and wonderful it is. You'll be up all night slugging water.
I'll be back tonight or tomorrow. Salut!
Saturday, July 02, 2005
Unusually political post....
Fuck you, so-called "liberals".
Let me lay two things out for all of you right here and now.
1. Abortion is not a "devisive" or "minority" issue. It is a normative fact of women's lives. Forty percent of women under the age of 45 have had abortions. It is *routine* for women in this country to terminate pregnancies. It is a basic part of women's health care.
Whether or not you agree with whether a woman has an abortion is not the issue. This is the issue: Would you support criminalizing, in what's likely to be 21 or 22 states, a procedure that many women have during their lifetimes? Would you be willing to accept the morbidity and mortality that would certainly result from women too poor or too desperate to travel to a different state for a legal procedure?
Which brings me to the second point:
2. Criminalizing abortion criminalizes all aspects of pregnancy loss. If a woman in a non-choice state has a late miscarriage, chances are she will be quizzed prior to or during the delivery of services to determine whether or not she had help in ending the pregnancy. Those people who wish to help women terminate pregnancies safely will be prosecuted, and will likely lose whatever licenses they have. Those who don't care--the kitchen-table idiots--don't have anything to lose.
Consider for a moment what your life would be like if you, or your partner or wife, had a miscarriage and needed medical help. Would you be willing to have that pregnancy loss investigated as a possible crime?
Think it can't happen? One of the women I worked with at PP got into women's health after watching her first patient ever die. Of tetanus. From an illegal abortion. In 1980. She lived in a place where abortion services weren't available.
After the institution of parental consent laws in my home state several years ago, I saw two young women during my emergency department rotations, a year apart, who had both tried to self-abort. One is now sterile. Both were afraid to tell their parents.
I met a woman who, in 1968 in Texas, was denied emergency care during a hemorrhagic miscarriage until she provided the name of her abortionist. The fact that she hadn't *had* an abortion didn't matter to the cops. Her hematocrit got to 15 before a doctor intervened and saved her life. She ended up in the septic ward anyhow, and lost a kidney.
Probably things won't be as bad now as they were from the 1930's onward, when women had to go to literal back alleys to terminate pregnancies. The advent of cheap airfare and better medical technology, along with a generation of medical providers who grew up with legal abortion, will probably prevent too many horror stories. Probably there will be a new Jane Collective, dedicated to helping women get safe illegal abortions. Probably we won't see the return of septic wards, thanks to better antibiotics and better practice.
But I am not willing to rely on probably.
Edited to add this addendum, which I only just remembered:
Several years ago, I was cleaning out the cabinets at our local Planned Parenthood. I came across a file box full of index cards that had come from the women's health clinic that PP had taken over. On one of those cards was the name and phone number of a doctor who performed illegal and safe abortions in the town's only hospital prior to 1973. The police apparently gave him a pass, given that this is a liberal college city.
The doc was my mom's obstetrician. He would've delivered me back in 1970, but he was going under for an emergency root canal at the time. I asked Mom if she knew then that her doctor did illegal abortions. She said she knew. I asked why she chose him.
"Because I knew my life would be important to him, just as my pregnancy was important to him."
Let me lay two things out for all of you right here and now.
1. Abortion is not a "devisive" or "minority" issue. It is a normative fact of women's lives. Forty percent of women under the age of 45 have had abortions. It is *routine* for women in this country to terminate pregnancies. It is a basic part of women's health care.
Whether or not you agree with whether a woman has an abortion is not the issue. This is the issue: Would you support criminalizing, in what's likely to be 21 or 22 states, a procedure that many women have during their lifetimes? Would you be willing to accept the morbidity and mortality that would certainly result from women too poor or too desperate to travel to a different state for a legal procedure?
Which brings me to the second point:
2. Criminalizing abortion criminalizes all aspects of pregnancy loss. If a woman in a non-choice state has a late miscarriage, chances are she will be quizzed prior to or during the delivery of services to determine whether or not she had help in ending the pregnancy. Those people who wish to help women terminate pregnancies safely will be prosecuted, and will likely lose whatever licenses they have. Those who don't care--the kitchen-table idiots--don't have anything to lose.
Consider for a moment what your life would be like if you, or your partner or wife, had a miscarriage and needed medical help. Would you be willing to have that pregnancy loss investigated as a possible crime?
Think it can't happen? One of the women I worked with at PP got into women's health after watching her first patient ever die. Of tetanus. From an illegal abortion. In 1980. She lived in a place where abortion services weren't available.
After the institution of parental consent laws in my home state several years ago, I saw two young women during my emergency department rotations, a year apart, who had both tried to self-abort. One is now sterile. Both were afraid to tell their parents.
I met a woman who, in 1968 in Texas, was denied emergency care during a hemorrhagic miscarriage until she provided the name of her abortionist. The fact that she hadn't *had* an abortion didn't matter to the cops. Her hematocrit got to 15 before a doctor intervened and saved her life. She ended up in the septic ward anyhow, and lost a kidney.
Probably things won't be as bad now as they were from the 1930's onward, when women had to go to literal back alleys to terminate pregnancies. The advent of cheap airfare and better medical technology, along with a generation of medical providers who grew up with legal abortion, will probably prevent too many horror stories. Probably there will be a new Jane Collective, dedicated to helping women get safe illegal abortions. Probably we won't see the return of septic wards, thanks to better antibiotics and better practice.
But I am not willing to rely on probably.
Edited to add this addendum, which I only just remembered:
Several years ago, I was cleaning out the cabinets at our local Planned Parenthood. I came across a file box full of index cards that had come from the women's health clinic that PP had taken over. On one of those cards was the name and phone number of a doctor who performed illegal and safe abortions in the town's only hospital prior to 1973. The police apparently gave him a pass, given that this is a liberal college city.
The doc was my mom's obstetrician. He would've delivered me back in 1970, but he was going under for an emergency root canal at the time. I asked Mom if she knew then that her doctor did illegal abortions. She said she knew. I asked why she chose him.
"Because I knew my life would be important to him, just as my pregnancy was important to him."
My right hand really hurts.
It's stiff, too.
That's because I spent twenty minutes with a hell of a lot of weight on it, leaning into that nice man's groin last night, trying to keep him from either bleeding to death or getting the world's nastiest bruise after that post-A-gram bleed.
That's the bad news. The good news is that, not only did he not bleed, he doesn't even have a hematoma there today. Nurse Jo with the magic fist!
It's not often that you can come home from work and pat yourself on the back for something you did really, really right. So I'm wearing out my other arm, patting away. It didn't hurt that the poor post-surgical nurse is brand new and so stood there gaping like a trout, thus making me look good. She was scared to death, poor thing, having done mother-and-baby for the past fifteen years.
In other news, it poured rain today for umpteen hours (actually about two) just at the time I was at the farmer's market. I stood in the rain and talked organic gardening with the thin, intense guy with tomatoes, okra and peppers with the old fat farmer guy, and blackberries with the blackberry guys.
Then I came home, napped, and made this:
Stuffed Zucchini, Jo-Style
Get you two "Eight-Ball" zucchinis. No, these are not zucchinis that have been mulched with heroin; they're round and about the size of baseballs.
Cut off the tops and scrape out the insides with a spoon, leaving about a half-inch border of flesh on the inside.
Chop that scooped-out zucchini gut stuff up.
Chop up about three tablespoons of onion and a handful of small mushrooms, too, while you're at it.
Heat a pat of butter in a non-stick skillet. Add a handful of chopped pecans and saute them until they start to smell really good. Then dump in the rest of the vegetables. Salt and pepper them once they turn soft, then add a tiny bit of dried thyme or oregano. Garlic is optional.
Just when you think the veggies might be done, when they're looking mushy and slightly browned and marvelous, add a chopped-up Roma tomato or two that you got from the organic gardening guy. Heat the whole kit and caboodle through, then take it off the heat.
When it's cooled a bit, stuff the zucchinis with the veggie and pecan mixture.
Put 'em in a pan, add an inch or so of water to keep 'em from burning, and bake 'em at, oh, about 350 until the sides of the zucchini wonderfulness cups can be pierced easily with a knife. Parmesan cheese, grated over the top during the last few minutes of baking, is really good.
Serve to general applause.
Now, can anybody give me some really good recipes for the umpteen gazillion crookneck yellow squash that Thin Intense Organic Gardening Guy gave me as a bonus?
That's because I spent twenty minutes with a hell of a lot of weight on it, leaning into that nice man's groin last night, trying to keep him from either bleeding to death or getting the world's nastiest bruise after that post-A-gram bleed.
That's the bad news. The good news is that, not only did he not bleed, he doesn't even have a hematoma there today. Nurse Jo with the magic fist!
It's not often that you can come home from work and pat yourself on the back for something you did really, really right. So I'm wearing out my other arm, patting away. It didn't hurt that the poor post-surgical nurse is brand new and so stood there gaping like a trout, thus making me look good. She was scared to death, poor thing, having done mother-and-baby for the past fifteen years.
In other news, it poured rain today for umpteen hours (actually about two) just at the time I was at the farmer's market. I stood in the rain and talked organic gardening with the thin, intense guy with tomatoes, okra and peppers with the old fat farmer guy, and blackberries with the blackberry guys.
Then I came home, napped, and made this:
Stuffed Zucchini, Jo-Style
Get you two "Eight-Ball" zucchinis. No, these are not zucchinis that have been mulched with heroin; they're round and about the size of baseballs.
Cut off the tops and scrape out the insides with a spoon, leaving about a half-inch border of flesh on the inside.
Chop that scooped-out zucchini gut stuff up.
Chop up about three tablespoons of onion and a handful of small mushrooms, too, while you're at it.
Heat a pat of butter in a non-stick skillet. Add a handful of chopped pecans and saute them until they start to smell really good. Then dump in the rest of the vegetables. Salt and pepper them once they turn soft, then add a tiny bit of dried thyme or oregano. Garlic is optional.
Just when you think the veggies might be done, when they're looking mushy and slightly browned and marvelous, add a chopped-up Roma tomato or two that you got from the organic gardening guy. Heat the whole kit and caboodle through, then take it off the heat.
When it's cooled a bit, stuff the zucchinis with the veggie and pecan mixture.
Put 'em in a pan, add an inch or so of water to keep 'em from burning, and bake 'em at, oh, about 350 until the sides of the zucchini wonderfulness cups can be pierced easily with a knife. Parmesan cheese, grated over the top during the last few minutes of baking, is really good.
Serve to general applause.
Now, can anybody give me some really good recipes for the umpteen gazillion crookneck yellow squash that Thin Intense Organic Gardening Guy gave me as a bonus?
Friday, July 01, 2005
So I had planned to
Come home today and lift weights. After all, if Georgia can live on 1200 calories a day and exercise like a madwoman, so can I. Right? Right.
But instead, after an alligator-to-the-eyeballs day with an arterial bleed at 1830, I went and had two beers and a grilled portabello mushroom.
With cheese.
NCLEX question: How much blood can one lose from a femoral artery bleed following an arteriogram?
Answer: Not as much as you'd expect, but God it looks like a fucking lot when it's spread around.
But instead, after an alligator-to-the-eyeballs day with an arterial bleed at 1830, I went and had two beers and a grilled portabello mushroom.
With cheese.
NCLEX question: How much blood can one lose from a femoral artery bleed following an arteriogram?
Answer: Not as much as you'd expect, but God it looks like a fucking lot when it's spread around.
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