Happy New Year, everybody!

Chef Boy and I got home this afternoon, and after I ate, I was so tired I went to bed and napped for a while.

Christmas was lovely, unsullied by things having to do with work. Chef Boy and I met Brooke of odious woman at a place called Pike Pub for dinner and a beer. She's funnier and more charming in person than in her blog, even, and has really great glasses. She gave us great tips for living in Seattle ("Get a light box, some antidepressants, and be prepared to pay through the nose for housing") and showed us a good time. Thanks, Brooke! I had what I thought was going to be a funny post about our meeting worked out in my head, but I'm just too damned tired.

Beloved Sister's boyfriend announced their upcoming nup-shulls by giving her a gorgeous diamond. Now, I am not a fan of diamonds, generally, but this one was really cool--it was set like a little flying saucer about to land. The big joke for the next three days was getting blinded by The Ring. Yes, we're lame jokesters in my family.

Mom and Dad's cat, Astro (a Maine Coon cross) decided he didn't loathe me as much as he thought he might. Beloved Sister's dog, Bones (a Staffordshire Terrier mix) decided my lap was a good place to sit in the car. It was highly animalistic, as Mom would say.

Beloved Sis and CB and I also made the biennial pilgrimage to Archie McPhee. Everything I loved was on sale, which I take as evidence that maybe I didn't burn down that orphanage in a past life. Or, at least, that I didn't lock the doors first.

Seattle itself was beautiful, with frequent sun breaks and only one day of pouring all-day rain--the last day we were there. We got to see Heather and Will, friends of mine and purveyors of wonderful IBS remedies, in their new setup, a warehouse at Pioneer Square. I'm so pleased for and proud of them I can hardly stand it, and I can testify: if you have IBS, Crohn's, or colitis, you'd do well to visit Heather's website.

We saw the new baby otter at the Aquarium (cute overload!) and an entire family group of gorillas hanging out at the zoo. Also a tapir, looking disgruntled, and an elephant having a bath/snack/rubdown all at once in the elephant barn. That last was worth the price of admission; who knew a several-ton elephant would lie down on her side and stretch like a cat while being hosed off by her keepers?

Recommendations after this trip: the Wallingford Pub on 35th really does have the best bacon cheeseburger in town. Anthony's, whether it's the Home Port or the fish-and-chips stand on the pier, has excellent fish. The local beer is marvelous, no matter what you get: I had no bad beer for five days. Take the 522 express bus if you're leaving downtown for Wallingford; the other routes are milk runs. Archie McPhee continues its tradition of being the world's best source for rubber rats and cool Hindu-themed snackboxes. Sully's near the zoo (Phinney and about 60th, I think) was having technical problems the day we went (the women's bathroom ceiling had fallen in) but Sully himself was gracious and poured me a pint of really good IPA. Take his suggestions on what to drink. And be sure you hit the Space Needle if you're a first-timer. Really. It's cheesy and touristy and pricey, but it really is cool to see all of Seattle spread out underneath you.

And now I am sleepy again and will ring in the new year with a snooze.

Hallelujah, Noel, be it Heaven or Hell...

A 2005 retrospective, done now because I expect to be too zonked from travelling on New Year's Eve to do it then, and because I'm avoiding the laundry.

For another year, I've avoided being hauled in by the IRS, FBI, BON, or DON. The NSA and the CIA don't want me, either.

I did not get married this year. w00t!

Nothing burned down and I didn't kill anybody, either accidentally or on purpose.

My cat doesn't hate me any more than she did last year.

I have a new car, the same (wonderful) apartment, and a few new friends. Chef Boy and I will have been dating for two (!!) years in January. No wedding bells are in the picture, so keep your toasters.

I put on a few pounds, but those'll come off eventually.

We lost a few patients, one attending, and one resident. The patients leave little-bitty holes, not because they don't matter but because you lose so damned many that unless you prioritize, your soul will look like Swiss cheese inside of a week. The attending left a big hole. The resident left a great yawning chasm, horrible, since she was younger than me and infinitely more deserving of life.

Hal, Stacy, Bill, Doreen, Mark, Marie...say hi to everybody up there, okay?

Our beloved friend John failed for the second year in a row (speaking of dead people) to quit calling in dead and come in to work again. We're getting pretty fucking sick of covering for him.

Kristen had a baby and has a new kitten. Lydia has a new granddaughter. T-bird got married. No marriages failed, and one was saved by the skin of its teeth.

Emmy's husband does not have cancer, thank God. Amy's baby lived her first year with very few problems; not bad for a 26-week preemie. My oldest goddaughter from my first marriage graduated high school this year. The world keeps turning.

Bonnie the Drama Dachshund adopted me as her human.

I got a really, really kick-ass pair of boots. And I got interviewed for a Major National Publication on blogging. That was fun.

And, in hopes that some of her good kharma will rub off on me, I'll be buying Brooke from Odious Woman a drink this week (excited squealing).

I'll catch up with you guys later; perhaps from Seattle, where I will be hanging out with the family, or perhaps from an undisclosed location after I return from the Pacific Northwet.

Let us all sing praises....

To the Best Boyfiend Ever (Chef Boy)...

...who took my antisocial, biting cat to the vet today to be kennelled for the Christmas holiday. She hates everybody but him. I think this is a very good sign.

To Amazing Nurses' Aides...

...who meet the doctor you've paged STAT when your patient goes into anaphylactic shock and are able to tell her exactly what time things started going south and what you've done so far, including dosages.

...and who deal, without complaint, with a paraplegic patient who I've just fed lots of laxatives to because he hasn't had a bowel movement in a week...

...and who manage, even when things are going to Absolute Hell, to make one patient after another laugh.

To The Talented Young Doctor Mike...

...who always manages something snarkier than I could ever have thought up on the spur of the moment...

To Doctor Bob...

...who brings me pictures of his Siamese cat unwrapping Christmas presents and thus turns a horrible day into a funny, bearable one...

To Glenda from the lab...

...who understands that STAT means STAT and who always, always gets her blood on the first try...

To my fellow nurses...

...who wipe butt when I have no time, who handle crises when I have no brain, and who remind me what on earth I got into this business for when I have no hope.

Happy Christmas, everybody.

So, just after I went to sleep,

I ended up with the same nightmare-situation, I can't believe this is happening patient that I had over the weekend. Only with more tubes and wires and with a worse blood pressure, if such a thing were possible.

Then somehow I got a NICU patient as well. Now, I don't do newborns; never have. But they had to overflow the NICU somewhere, and so up I ended with some five-pound, very sick little kid. RSV, or something. Anyway, kid couldn't breathe. Bad deal.

Then I got *another* patient, who just sort of left the room and disappeared. Guess I should've been happy that one could walk, but I would've liked to have seen her before she left the floor.

Just about that time, Mom called with the news that Dad had left her for some 50-year-old ER nurse. She looked a proper chippie, too. Mom decided to move in with me.

And then I had to find some obscure diagnosis in some obscure book that kept changing titles every time I put it down, while trying to figure out why there was an obese, bloated, bald teenager sitting on a stool on the other side of the counter.

I woke up just after the OR called and some surgeon was talking to me like I was Central Sterile.

No more combinations of "House", loaded baked potato, and Dogfish Head IPA right before bed.

You know it's One Of Those Days when...

I first had an inkling of trouble when the call bell rang and all we heard from the intercom was a scuffling noise. One of the physical therapists and I went into the room as quickly as we could, hustling our little butts, and found fists, and nurses dancing and feinting like Ali, and general chaos.

He'd been a rancher all his life. We don't grow people like this any longer: well over six feet tall even in his seventies, never drank or smoked, never sick a day in his life until his aneurysm bled. The bleed had unfortunately affected only his personality and not his body; he was standing, bleeding from where he'd tried to remove the second Foley catheter, screaming, "GODDAMMIT! I'll KILL you! Let GO OF ME!!"

He's a strong sonofabitch, I'll tell you that. Two nurses got his arms--staying well away from his hands, as he'd already tried to break one nurse's wrist and another one's finger--and I put a shoulder into his belly and shoved him onto the bed. Once we got him into restraints, one on each limb, and a vest, he continued to fight. The bed shook and creaked and groaned until his nurse got some Ativan into him.

The irony is that we knew him from before, when his wife came in for surgery. He was (before the bleed) the sweetest man you'd ever hope to meet. Polite, courtly, took good care of his family. Now he's trying to get out of the hospital, pulling out multiple lines, and punching security guards in the face.

Later, one of the nurses asked me about the amount of force that's acceptable when you're subduing a combative patient. She was in there with one other person when he started to go berzerk, and was merely staying out of his way as best she could, dodging his punches and kicks.

"I was afraid to grab his arm or put him on the floor, because I was afraid I might hurt him" she said. Now, this is a tiny woman--smaller than me--who spent the first half of her life in very rough neighborhoods. She's taken punches from patients before with no more than a blink.

"Lou," I said, "whatever amount of force is necessary, without breaking bones, you use. If somebody is trying to hurt you, the objective is to get them tied down and sedated before they can manage to break something of yours." Hence my shoulder-in-the-solar-plexus trick: I've found it works well with a distracted, combative patient.

It doesn't work so well with the oriented, mean patient. One of our nurses is out following surgery for a broken neck that a patient broke on purpose.

The woman weighed close to five hundred pounds and was, put simply, meaner than Satan. When the nurse taking care of her got close enough one day, she simply reached out, grabbed the nurse's head, and pulled. Score: nurse with cervical fractures, patient refused services forever.

Luckily, the nurse will be fine. The patient? I don't give a damn.

I woke up this morning sore and exhausted and couldn't remember why I was so achy. Then it hit me--I'd spent several minutes riding a bucking bronco of a man down onto a bed, then holding his legs down.

Nursing. It's glamorous! It's exciting! It's the toughest job you'll ever lay in stores of Advil for.

Just a quick update...

I have now eaten five times and have not yorked (credit: Dr. V) once.

I think tomorrow will be ducky. Just lovely.

Tonight I actually ate half a burger and three french fries. Yay me.

Chef Boy looked concerned earlier and said "Six pounds in five days? You're going to waste away to nothing!" Considering that I still outweigh him by almost 25 pounds, can you not see why I love the man?

If it *is* my appendix, it'll just have to wait until Tuesday to come out. That's my final offer.

From the *duh* files...

Nurses face sexual harrassment

Really? You don't say. Grunt Doc, DB's Medical Rants, and Code: The Web Socket have all taken stabs at this; Alwin at C:TWS has a particularly funny experience to recount.

I regularly get sexually harrassed at work by patients; whether it's sweetie or honey pie, or let me fix you up with my son, or even (once) a man trying to pull me into the bed with him for a kiss. It comes with the territory when you're working with brain-injured people. When you're missing part of your frontal lobes, or they've been otherwise damaged, you're not going to have the same control and pay the same attention to social norms that other people do. At any road, it happens at least twice a month.

It also happens to the female residents and doctors. There have been times when I've had to knock on a patient's door and say something like, "Doctor X, there's an urgent phone call for you at the desk" in order to get Doctor X away from the patient who's *sure* that her nephew's business partner's son, who sells used cars in Atlanta, is just the man for her.

The worst is when you're standing over a patient, assisting a (male) doctor with a procedure, when the patient pipes up with "Don't you think Doctor Y is cute?" My answer from the start has always been a puzzled look and "When?"

I have some theories as to why this happens so often. First, it's because some of our patients are brain-damaged. There's not much you can do about that, really. Second, a lot of patients (especially the older gentlemen) seem to think that when one social norm goes away (like I'm wiping your ass for the fortieth time today), the others go away too, and they can say or do whatever they want acceptably. This misconception also explains the amazingly bigoted stuff I hear from patients on a weekly basis.

And, finally, let's face it: a lot of patients grew up in the 1930's through 1950's, a time when nurses were seen as passive, accomodating helpmates. The popular image of the Sexy Nurse hasn't died yet (Google "Head Nurse" sometime and see what you come up with, oi!), but it was infinitely more popular in the days of Cherry Ames and her ilk. (And yes, I know WWII was a different matter, but it was statistically a blip.)

So you've got brain damage, combined with a lack of societal norms, combined with the idea that nurses will do anyone...er, I mean any*thing* for another person.

The funny thing is this: our facility spends hours and hours teaching young interns how to avoid sexual harrassment by nurses.

I'll wait until you're done laughing.

They don't brief the female residents on how to handle dirty old men or nosy old women. They don't brief the male residents on how to deflect the sorts of questions that make men blush and stammer. And they're certainly not briefing *either group* on how not to make yourself look like an idiot by intimating that certain female colleages get more OR time because they have pretty hair (yes, I heard that one two weeks ago. From a *female* PA, who lost pretty much all the professional respect I had for her).

The point here is that nurses can't win. On the one hand we're being exposed to lecherous weirdos and weirdettes, while on the other, our future colleagues are getting the idea that we're rapacious, predatory, sex-crazed fiends. Our female MD colleagues don't have much more luck. And pity the poor male nurse, who's automatically seen as prissy, if not outright gay. (And anybody who assumes all male nurses are gay is the sort of person who's going to have a problem with gay guys. I guarantee.)

So, okay, what do we do about it?

Well, first of all, nurses' training programs and doctors' training programs can be realistic about the problem. Where I work, there are a lot of young nurses and a whole lot of young residents. Yes, sometimes they do end up dating, but the problem isn't so widespread that it causes problems in the professional arena. So we could probably drop the insistence to the interns that it's the nurses they'll have problems with and save some time and trouble there.

Second, hospitals and other facilities need to be realistic about the problem. The first line of defense is the nurse's own reaction, true, but if the behavior continues, she or he needs to be certain that there will be somebody to back her or him up in her refusal to countenance the behavior. If your charge nurse or nurse-manager falls down on the job, you're left to "solve" the problem on your own, which usually means either getting somebody to go into the room with you every time, or foisting the assignment off on another nurse. Raising conciousness rarely works in such a short period of time.

Finally, families need to be realistic about the problem. Yep, you heard me: I said "families". I've had patients' family members egg the patient on as they were harrassing me or another nurse. That kind of thing usually stops as soon as I get my mouth open. But the point remains that a lot of people seem to think it's cute that Grampa's a tit-grabber or that Papa is a bigot.

It's a weird job we do, nursing. I'm just glad that nobody's tried to get me up against a wall--yet--or done anything really violent. Yet.

I'm getting tired of this.

Mostly because it's become predictable.

Get up. Feel okay. Think, "I can go to work today. Good deal."

Drink a little coffee. Drink a little water.

Stumble to bathroom either to a) lose coffee and water immediately, or b) lie on the floor in a cold sweat with the room spinning, then lose coffee and water.

Fall prey to a number of nasty intestinal symptoms.

Return to floor. Sweat some more. Feel the beginning of a pounding headache.

Haul self, on hands and knees if necessary, to phone. Phone in sick.

Answer various questions about degree and type of symptoms. Why on earth do they want to know this? *I* don't want to know this about *myself*.

Stumble back to bathroom. Stick thermometer in mouth, note return of fever. Note intensification of pounding headache. Note rumblings of a sort that bode ill for the health of my GI tract.

Stumble, several minutes and one more cold sweat later, back to bed. Lie there panting.

Wake up several hours later feeling borderline normal. Eat half a boiled potato. Meditate on the gastrocolic reflex almost immediately thereafter.

Back to bed, panting. Wonder what everybody's doing at work. Wonder if I'll live long enough to return. Wonder when this is going to stop.

Remember what happened on Wednesday morning. Haul self to kitchen and drink a little ginger ale. Haul self to bathroom to retrieve thermometer.

After ten minutes in bed, take temperature. Fever is unchanged. Head still hurts.

Fall asleep. Wake up. Post bitchy whiny blog entry on illness.

Lather, rinse, repeat.

**For those of you who are thinking that there might be a Little Jo at the end of this, please don't worry. As far as I know, pregnancy occurs most often in people not contracepting and is generally not accompanied by a fever, gut cramps, and other GI symptoms. But thanks for your concern.

Gar.

Yesterday I called in sick.

I called in sick because, for the first time in my life, I actually *lost conciousness* as a result of a combination of nausea, standing up too fast, and general ookiness.

Passing out is an interesting experience. First come the black spots in front of the eyes and a feeling like the world is moving in new and strange ways. Then comes the feeling that it's absolutely necessary that you get horizontal *right now*. When you do, there's nothing at all for a few seconds (I wasn't out for very long), then a return to the floor moving unpleasantly, compounded with a nasty stinky cold sweat. And retching. And the shakes.

As I shoved the chair behind me and sagged to the floor, I remember thinking quite clearly two things simultaneously: "This is how my patients feel" and "I don't want to fall over like my sister did and hit my head on something."

Twenty minutes later, I was feeling fine, if a bit tired. So I went back to bed and slept for four hours. Then I went out and got some Sprite and Gatorade, rehydrated, ate a little something that stayed down (wonder of wonders!), and went back to bed.

In four days I've lost four pounds. No, the skin on my hands isn't tenting any longer, and my eyes aren't sunken.

The strangest thing is this: in between bouts of nausea, I have cravings for tomatoes, asparagus, corn, and honeydew melon. That's all. The normal sick foods like crackers and toast have no appeal.

Later I'll go out to the grocery store and stock up on cravings foods. Maybe I'll get a couple of cans of vegetarian vegetable soup. At this rate, my cholesterol will be down to 130 and I'll weigh that much by March.

God, what a nasty bug.

Back to bed now.

Everybody's doin' it...

One of the links at Grand Rounds this week has a focus on a suggested code of ethics for medbloggers and a list of questions we should all be able to answer.

So, because everybody's doin' it....


1. Who runs this site?

Jo. I'm an RN (ADN) with a bachelor's degree in music and one in sociology. I've got almost four years' experience in neuroscience and ten years as a women's health advocate and paraprofessional.

2. Who pays for the site?

Blogger. The ad to your right for Ivo Drury's site generates as much income as Ivo finds fair, which is then donated by me to either Planned Parenthood (to provide exams and Pap smears for women who can't afford 'em) or to local animal charities.

3. What is the purpose of the site?

Yarking and complaining, with the occasional burst of decent information.

4. Where does the information come from?

Mostly from my own experience. If it's something that's useful or interesting, you can bet I've stolen it from another site somewhere.

5. What is the basis of the information?

Huh? Didn't you just ask that?

6. How is the information selected?

It's selected based on what I figure will be interesting to those few poor unfortunates who read the blog. There's going to be an emphasis on neuroscience, women's health (especially reproductive health issues), and feminism, mostly because I'm a feminist neuroscience nurse with background in happy hootchie care.

Oh, and food. I like writing about food. Matter of fact, I have some salsa in the fridge that you guys have just got to try.

7. How current is the information?

I try to keep anything that's seriously scientific current to within the last month or so. For reasons of privacy protection, most of the stories I post about my own experiences on the floor are not only changed detail-wise, they're put into a different time-frame. Therefore, the things that I write about happening "last week" might actually have happened six months ago, or vice versa.

8. How does the site choose links to other sites?

I link to what I like. Generally speaking, I like sites to have some sort of track record before I link to them. I'm also extremely lazy, so link-swapping takes weeks for me to accomplish.

9. What information about you does the site collect, and why?

I was unaware that I could collect any information at all, actually. I'm not technically savvy.

10. How does the site manage interactions with visitors?

Comments are welcome; obnoxious comments get deleted. Deal. (credit Bitch, PhD.) Personal emails are welcome if somebody has a question that they feel uncomfortable posting, or that they think requires a longer answer.

***

On a different note, I don't know that these questions go far enough for the average personal-experience blogger. I feel very strongly that nobody's confidentiality should ever be compromised for my own convenience or anybody else's amusement or edification; if there's one thing I take very seriously, it's that.

If somebody emails me with a personal story about something that happened to them in the hospital, I'm not going to post it here without prior permission. Excerpts from personal emails, if I get permission to use them, get changed around in such a way that it's not going to compromise anyone.

Hell, I've even changed what I've said about where I live, so that the area isn't immediately recognizable. It's not worth some wacko figuring out that Jo is actually Becky Smith, who works at Podunk Memorial Research Facility and Rib Shack in Lolitaville, Texas. That compromises both me and my patients.

Those of us who write based on personal experience cannot take this issue seriously enough. I'd like to see a code of ethics drafted for the personal-experience blogger. Who wants to start?

Your regular blogger, now with viruses!

A follow-on to yesterday's incoherence: Shakespeare's Sister takes a look at the Oslo post-abortion study from a statistical angle, along with stuff that wasn't published in the BBC article and that I didn't think to look up. Thank God there are people out there doing my work for me. They think so I don't have to!

Unless my reactions to chlorpheniramine maleate (the stuff in Advil Sinus/Allergy) have changed drastically overnight, I seem to have picked up a simultaneous belly and head bug. Blogging will be light for the next couple of days as I rush between the bathroom and the Kleenex factory.

Disinfect your computer screens, people. I am not playing around.

Back into the fray....

This pissed me off.

*deep breath*

*several deep breaths*

As I've mentioned before, I worked at an abortion clinic. I also was a volunteer post-abortion counsellor, and moderated an Internet message board for women who were having emotional problems post-abortion. I'd like to think that the years of doing those things have given me a fairly good handle on the years of pain and suffering and guilt that some women feel after an abortion.

There are a couple of angles I'd like to pursue, here. The first one is the easier one to dissect: that, if you're living in the U.S. and you've had an abortion, you're *expected* to feel guilt, shame, and regret. I don't know what it's like in the U.K. or in Scandanavia, but here there's a constant subtext that women who have abortions regret them, that they wish they could go back and change things, that somehow the procedure has damaged them.

Which isn't true. It's simply not true.

Let's get one thing straight: women whose lives are going fine and dandy generally don't have abortions. Often an unintended pregnancy is the last thing on top of a lot of *other* things, like being broke or in an unstable relationship or immature, that breaks the proverbial camel's back. Having an abortion is not just a response to a crisis pregnancy; it's a response to a whole set of other crises that a pregnancy compounds.

What I saw time and time again was this: women without guilt, women without shame, put their abortion into proper perspective. They took responsibility for the decision and understood the context of the action. They did not (and this is important, so remember it) feel coerced into having an abortion; it was their own choice from the get-go.

Yet they had doubts about themselves because they didn't feel guilty. A friend of mine expressed it well: "I spent two years feeling guilty because I didn't feel guilty."

How much of that guilt and shame that women feel is being brought on by being told, over and over, that there's something shameful and wrong with them for having had an abortion? How many times can a woman see a bumpersticker that says "Real Mothers Don't Have Abortions" or hear someone dismiss women who terminate pregnancies as "sluts" before it starts to take a toll?

The second angle is nastier, darker, and more complex.

There were some women I saw at the clinic--a small minority, maybe one in twenty--who were being browbeaten into terminating their pregnancy. Those women didn't get services. Instead, we called the shelter or the cops (in the case of "my boyfriend/father said he'd hurt me if I didn't do this") and let people who were qualified to deal with the situation handle it.

There were a number of women I encountered in post-abortion counselling, both in the meat world and online, who had guilt. Lots of it. And they had one thing in common: they had had an abortion not because they felt it was best for them, but to please somebody else.

The line that sticks in my head is one from an online correspondent who said this: "My partner wasn't ready for fatherhood and left me when he found out I was pregnant. I had an abortion, but he didn't come back. Now I'm alone, and I don't even have a baby to look forward to."

Some of those women were really, really young when they got pregnant, and their parents basically made the decision for them. Hard enough to be fourteen and pregnant (with all the weirdness that that situation must've come from in the first place) and then have yet another piece of bodily control wrested away from you. If somebody says, "it's for your own good", look at them with slitty eyes...but a girl in that situation has no option.

Just as abortions don't happen in a vacuum, they don't fix everything. I reckon that the majority of women who had real problems dealing with their abortions had the idea going in that somehow life would be roses and cherries afterward; as though solving this one, monumental problem would solve all the others. And, of course, it doesn't work that way. You're still broke, your lover is still gone, you still live in a crappy apartment, your parents are still the sort of wackjobs that would enable your having sex at the age of ten.

I think that, as a culture, we need a reality check. Let me start here:

Even with perfect use, most contraceptive methods have at least a one-percent failure rate. In the U.S., the average failure rate for the most popular birth control method (the Pill) approaches 12%. That means that even with consistent contracepting, some women are going to get pregnant. Some of those women are going to terminate those pregnancies.

Even the most conservative estimates of abortion rates show that more women have abortions than get breast cancer. It's anywhere from one in three (WHO numbers) to one in five (AGI numbers) versus one in seven or eight.

Therefore, abortion is a common experience.

Therefore, we need better systems in place to help women deal with abortion. And not just the procedure itself and the aftereffects, but the whole complex web of situations that lead up to the decision to terminate. At my clinic, the number-one reason for having an abortion was not using birth control. We dealt with that by making contraception cheap and easy to get, even giving a year's worth of pills away to women after they'd had a follow-up exam and their Pap results had come back.

But that's only barely pricking the surface of the problem of unintended pregnancy.

It would be nice if women weren't stuck in situations where they felt that abortion was their only reasonable option. Affordable child-care and decent health programs for children and mothers would go a long way toward solving that particular difficulty. So would wider availability of job-training programs. So would better health care in general for women.

I'll say it again: abortions don't happen in a vacuum. Sometimes it's a simple choice, but it's not ever an *easy* choice--remember the difference. If we as a society deal with the issues that complicate unintended pregnancy rather than sweeping them under the rug, we'll lower the number of abortions performed. If we deal with the issue of abortion openly and honestly and without shame, we'll lower the proportion of women who feel damaged and wounded.

This is not just about the fetuses and women. This is not just about terminating pregnancies. Our societal response to unintended pregnancy is evidence in microcosm of how much or how little we value women, pregnant or not.

And it's not just about guilt, shame, and regret. Getting past those emotions, looking realistically at the whole of a person's life, and finding resources to deal with crises of every sort is what we ought to be doing.

Squid.

Today I went for breakfast at Rosa's. Rosa is a friend of mine who is mother to two charming and intelligent pre-teenage boys, wife to a charming and intelligent man, and mistress to three of the largest dogs I've ever met. Rosa is also from the Phillipines, so breakfast with her consists of rice, eggs, and some sort of dried marine life.

Today it was a combination of squid and fish, dried and then deep-fried. Normally, I'm game for almost anything edible and a number of things that are dubious, but I've got a skeevish reaction to eating anything that stares at me while I'm consuming it. Hence I stayed away from the dried fish and concentrated on the squid.

"Try the baby ones," Rosa said, "they're crunchier."

I eat them, as does her husband, Americano style: in small bites, with bits of garlic rice on the same fork. And they're delicious, especially the baby ones. The fish was a bit too salty for my taste, but the squid were just right.

As I wolfed down squid and rice and eggs and vegetables, three dogs crouched at my feet, not out of affection but because there was room at my end of the table.

The smallest dog, Dallas, is a shiny spaniel cross who weighs about 60 pounds. She's intelligent and suspicious and has decided after repeated exposure to me to delay ripping out my throat until some later, as yet undetermined, time.

The next larger dog is Sam. He's elderly and has had a rough life. If you pet him, he'll follow you everywhere, begging more affection with rolling eyes and a grin.

The chief of the household is named Soldier. He's either a Great Dane and Akita cross, or perhaps Great Dane and Catahoula hound cross; nobody is quite sure. He could be half flying flapdoodle and half Shetland pony for all I know; he weighs more than the other two dogs combined. Unfortunately, unlike the Brontosaur that he resembles, he has no second brain halfway down his spine. He is, however, a sweet-tempered (if dumb) animal with a soft spot for me. We sit on the floor and have a little mutual admiration session every time I go over there.

Which I desperately needed after this last couple of days.

When "they" say that doctors make the worst patients, "they" are discounting those patients whose family members are doctors.

I don't know why it is that everybody who wants to fake something ends up faking neurological disorders. Maybe it's that there are no sure, definitive tests for most neuro problems, barring tumors and abcesses and such. Maybe it's that they think neurologists are too flaky to catch the frauds. Maybe it's that the vast majority of people, even health-care professionals, look at neurology and neurosurgery as some sort of weird half-science practiced in the dark of the moon.

Whatever the reason, the wackos always fake neuro problems. Well, not *always*; sometimes they fake obscure autoimmune disorders with neurological components. Either way, there's Xanax and Valium and Dilaudid involved.

The wackos I can handle. They're generally undemanding, provided they get their needs (for drugs) met, they're normally pretty stable medically. It's the wackos' family members that drive me over the edge. And nothing is worse than a wacko with two close family members who are doctors.

Why? Because those family members will monopolize the lightboxes in the nurses' station as though they were their own personal property. They'll wander off for hours with the chart, ignoring the new orders that need to be posted. They'll call from their cell phones, demanding that you change medications on *their* say-so, even if they're not the primary physician. They'll medicate those family members with stuff they haul in from the office, then forget to mention it to you. They might even start sitting in wheelchairs, having discussions about their family member's case in the hallway, and then leave their detritus and the wheelchairs scattered for you to clean up.

Thankfully, this was not my patient. If it had been, there would've been fireworks. Unfortunately, the antics of the Family Doctors made life miserable for all of us--it's difficult to do your job in a confined space when there are people lurking, answering the phones because it might just be the person they paged, and monopolizing your time.

The last straw came, for me, when one of the Family Doctors opened one of my patients' charts. Note that this patient was not that doctor's family member; it was a patient with the same attending physician. Apparently, Family Doctor #1 wanted to "get a feel for" that doctor's "style" and the way that he comes to a diagnosis.

I learned yesterday that an icy "I. beg. your. pardon." and an equally icy "How *dare* you?" have the same effect on a doctor, even a wacko doctor, that they do on anyone else. Unfortunately, I didn't get an apology from said wacko, but I did extract a promise that the Family Doctors wouldn't be going near the chart rack again.

I fixed them, though. They'd left their family member's MRI and CT films all over the back of the nurses' station, so I just tidied 'em up. The resident and the attending both know where they are, but I doubt that the Family Doctors will be able to find them again.

The sad thing is that all of this hoohaw could've been avoided if somebody in a position to do so (like the charge nurse, or the manager, or the attending physician) had set some limits at the outset.

Maybe I should bring Dallas in on a nice, long chain. Those of us who want to get past her to the station can carry dried squid in our pockets.

Random musings

The benefit of a liberal education

The following scene is why everyone should get at least a couple of years of liberal arts education before doing anything related to their profession:

Me: That's a really nice pendant.

Snooty, more-cultured-than-thou coworker: (archly) Thanks, it's a Mackintosh.

Me: Charles Rennie Mackintosh?

SMCTTC: (looking confused) Er...yes.

Me: (peering closer) Hm. Looks like the motif from the organ screen at Holy Trinity.

SMCTTC: (spluttering)

I was nice enough not to pump my arm and whisper "YES!!" soundlessly until I got into an empty room.

The basics of nursing

It strikes me that the three things that I've said most often in the last almost-four years have been "That's perfectly normal; don't worry", "I'll call the doctor", and "Don't pick."

A lot of nursing involves reassuring patients and their families that yes, everybody gets symptom X after situation Y happens. Especially in surgical situations, people get understandably nervous about things that we nurses see every day.

Yes, it's normal to hear that slooshing sound in your head; we filled the space where the meningioma was with sterile saline solution.

Yes, Mom will be kind of out of it for a few days; she's eighty, and that's what anesthesia does to eighty-year-olds.

Yes, that swelling will go down in a couple of days, but your eyes will stay black for a while.

There's also the occasional situation in which you really want a resident or PA there. Those are the times when it's essential to keep a straight face, show no signs of panic, and say something like "Let me give the resident a buzz and we'll let her clamp lamps on that there."

One of the nurses I work with who's done neuro for years tells the story of the patient she took care of in a neuro ICU whose wound dehisced (split open) and whose brain began to crawl out of said wound. When she saw the shiny grey-and-pink hallmarks of a cerebral cortex out of its natural environment, she calmly said, "Let me put some wet gauze on that; I'll give the doc a ring, eh?"

I always tell my patients this: If my hair catches fire, *then* you can worry. Otherwise, you're paying me an immense amount of money to worry for you; it's ridiculous for you to do it for free.

And, of course, every nurse knows the words "Don't pick."

Don't pick at those staples. Yes, I know it itches, but don't scratch that. Keep your hands away from there. Mister Jones, you'll need to keep your hand out of that, okay? Leave that stitch alone, dear, it's holding the tube in your brain. And so on.

The words "don't pick" might be just as essential to the profession as the words "drink this."

"It's more important to know whether there will be weather than what the weather will be." (The Whether Man, The Phantom Tollbooth)

I got to watch the latest cold front roll in this morning as I sat out on the porch. My porch is sheltered, thank heavens, so even 27* F is relatively bearable if you bundle up and put on slippers. The Cat has to see what the world is like every morning, which is why I was out there.

It's supposed to get nasty today. I can hear my Yankee friends laughing at the idea of a high of 30 and forcasted "wintry mix", but let me tell you: "wintry mix" this far south means one thing--ice.

By this time tomorrow, we're supposed to have three inches of ice on everything. Provided the power lines don't come down, I think we'll be okay. I'll be at Chef Boy's; I'm cooking a celebratory dinner for him tonight and don't plan to get back out in the middle of the storm. No sane person expects to be able to drive on ice, so my plan is to stay put until the insane people get out and clear the roads a bit.

Unfortunately, the reason for the celebratory dinner and the weather are comingled. Chef Boy has to start a forty-mile round-trip with an audition dinner in the middle of it just when the weather gets nasty. He's applied for a job at an Extremely Schwanko Restaurant that just happens to lie at the end of a not-well-travelled road, off a quiet spur of a not-well-travelled highway.

I think I'll make plenty of appetizers and not start roasting the chicken until he makes it back.

A PSA of sorts

You know what's good? What's good is when you have enough empenada dough left over for one more empenada, but not enough filling, so you roll up the dough with brown sugar and butter and nuts. That's good.

On to the serious stuff.

A poster over at LiveJournal has posted the experience of a friend of his whose prescription for Valtrex was refused, confiscated by the pharmacist, and not returned to her. I don't know whether or not it's a true story, and I don't think the LJ community would appreciate me linking to it, but you can check it out over at Pandagon.

If this should happen to you, here's what to do, in order:

1. Get the name of the pharmacist. The *full* name of the pharmacist. Make a note of it, along with the time that he or she was working, and the date.

2. Get the name of his or her superior, if he or she has one.

3. Get the name of the store manager for the pharmacy in question.

If anybody tries to block you at any point, make a fuss. Seriously. Refusing to fill a prescription might not be illegal in most states, but *confiscating* one is. Even if your prescription is returned to you, the pharmacist who refuses to fill it should face public scrutiny for his/her actions.

4. As soon as you get home, call the doc or clinic that prescribed the drug for you. If it's emergency contraception you need, go here to find a list of every-day oral contraceptives that can be used as EC, and their doses. Most doctor's offices will carry at least one of these brands in samples. Demand one.

The doc's office also needs to know the name of the pharmacy and pharmacist that refused your prescription, so that they can steer their patients away from them in the future.

5. Next, call the manager of the pharmacy/drugstore, or, if that person is not available, the consumer help-line for national chains. That can be found on the websites that the national chains run. Give the time, place, and date of the incident, as well as the names of the people involved. Be calm, but remind the person or people that you speak to that this is something that *will* be followed up on, and that *will* be acted upon.

Follow that up with both an email and a paper letter to the folks you've talked to. Keep copies of both. It's time-consuming, but worth it. If you get a response at any point, get names and phone numbers from everyone involved.

Most of the time, you'll get sufficient action from those first five steps to make you calmer, if not happier.

If you're still angry, or if the people you've dealt with up to this point have been a herd of bleating dickwads, do the following:

If there's a university within fifty miles of you, find out if they have a women's right's group. Or look online for the nearest chapter of the National Organization for Women or the ACLU. Call any or all of those folks and tell *them* (time, date, names, places) what happened to you and who you talked to. Ask them if they have any pointers about what you should do next. With luck, you'll get plenty of pointers, ammo, and hell--they might even stage a demonstration.

Then call your local paper. Even *my* local birdcage liner, as in-pocket as it is with the wingnuts, ran a front-page article on women being denied EC and OC at a local drugstore. Can't hurt to try.

All of this requires a lot of effort and that you become a spokesperson of sorts for Women For Whom The Condom Broke. That sucks; you ought to be able to get prescriptions for legal drugs filled with a minimum of hassle and wasted time.

Unfortunately, there is a small (but growing) cadre of people who work as pharmacists who believe that it is their right to make judgements about the people they serve, and judgements about whether or not those people ought to have one drug or another. The only way they'll ever do their jobs fairly--by either filling *every* prescription, or handing them off to someone who will--is if they're called out publicly on their bigotry.

Yes, it's bigotry to deny women oral contraceptives. It's bigotry to deny people with herpes drugs that reduce the frequency and severity of outbreaks on the grounds that they somehow deserve to suffer. You'll notice that all of these things have to do with *other people* making judgements on the validity of *your* sexuality, and that those judgements are necessarily on a case-by-case basis.

I was with a woman who was refused an EC scrip once. I wish I'd made more of a fuss over it; luckily, the wall-eyed bastard who refused the scrip later lost his job after doing the same thing to a rape victim.

Unless we want to have to go through some sort of pseudo-underground machinations *as women*, to get our health-care needs filled, we have to speak out.

Edited to add: Holy shit, lookee here. Seems some pharmacists are now refusing to dispense pain meds and psychotropics (like antidepressants). How far does this bullshit have to go before people start getting angry en masse?

Well, well, well.

I got my second "TEAM Player" T-shirt the other day (you don't remember the TEAM Playa post?), which seems to indicate that I'm doing my job. Which is a good thing, since sometimes I'm not so sure. Bad days like the one last week really make me wonder if I'm competent (because I catch problems like couplets and triplets before they send a patient to the ICU) or incompetent (which is silly, because even on Dilantin, people sometimes seize).

Luckily for me, the two best nurses I work with had Signally Bad Days this past week, too. One of 'em walked into a patient's room, and the patient...died.

Just like that. Brady'ed down from 70 to 6 and stopped breathing, just like that. Wow. And the patient's wife, thankfully keeping her head on straight, refused a code on him. They'd coded him twice already, and it was time for him to go home.

However, it's unusual to have your first death, or rather, your first unexpected death, at 0715. Lou-Who was shook, but professional, and dealt with the whole baggin'/taggin' thing, then took a break with a nice hot cup of tea. When the floor manager walked in with paperwork Lou-Who had to sign, she (Lou) looked up and asked, "So. Do I get a TEAM T-shirt for this?"

Luz's bad day started with the death of a patient she loved. She walked in to the room at 0845, and the patient just...died. (Holy crap. Two in one morning?) He just quit breathing. He was a DNR, thankfully, so there was no need to start working on him. Instead, Luz comforted his wife, then I helped her bad & tag and made her a cup of tea.

We've drunk a lot of tea on our floor in the last couple of weeks.

Luz's day would've improved had not another patient *tried* to die on her. Luz, however, is determined, and disinclined to let anybody go who hasn't given the whole living thing a good shot, so that patient went to the ICU. It was, ironically, the same guy who seized on me and who left me with a feeling of not having done something vital.

'Tis the season, I guess. Each hospital has its own rhythms. Most of the folks on our floor like to die right before Christmas, perhaps because they're so damned *tired*. The people two floors up on chemo wait until after the holidays, then head out. Either way, we have a ragged time between Thanksgiving and New Year's.

We're having a potluck lunch next week to try to make up for the Bad Days everybody has had lately. I think I'll be taking mac & cheese and maybe a couple of other things, too. There's a need for comfort food.

Considering.

Why is it so difficult to have certainty?

I'm a big fan of Ellis Peters's Brother Cadfael novels. For the uninitiated, Brother Cadfael is a Welsh-born English monk who lives in the 12th century and who solves the mysterious crimes that are rampant in the town beyond his monastery walls.

Br. Cadfael came to the monastery after forty years as a Crusader, soldier, and sailor. He's conversus rather than oblatus, which makes for some interesting perspectives (his) on the nature of the Benedictine order to which he belongs, the nature of Divine justice, and the vagaries of humanity.

One thing Cadfael has is certainty. He's certain about the existence of God, the fact that His justice will eventually prevail, and that sometimes humans have to act as God's hands in daily life. He's certain that he can heal the sick (Br. Cadfael is the herbalist and assists the infirmarian in his duties) and bring wrong-doers to justice. Most of all, he's certain of his place.

"We do what we must, and we pay for it. So in the end, all things are simple."

That's a line from the last Brother Cadfael novel, in which he goes recusate in order to rescue his son (conceived during the Crusades) from death.

Being in this business has made me aware that most things are far from simple, far from certain. I envy the certainty that my pal the chaplain has, that all things are for the best. I envy the simplicity that allows a person to see that their life has reached its effective conclusion and thus refuse further care.

I'm thinking of spending a week or so at a convent somewhere. I'm not sure whether it'll be Benedictine or Buddhist, but I think the silence would be useful. Not as a way to reaffirm vocation; as Opus Dei advocates, the vocation I've chosen sanctifies itself every day. Perhaps as a way to settle doubts; whether or not there's some Universal Being up there, it makes sense to decide whether to believe or not, once and for all.

"Agnosticism as a belief system is akin to immobility as a form of transportation."--Life of Pi

For some reason the thought of a week of silence, discipline, and thought is sounding better and better every day. Not as a retreat, mind you, in the typical sense of the word, but as a regathering.

Observations

1. Moxie Fruvous might be the best band to cook to. Better than Indigo Girls, better than Joni Mitchell, even, though I prefer Joni Mitchell when I'm baking bread. There's something about "King of Spain" and the little shimmy-dance you can do to it that makes chicken pot pie come out really well.

2. The attitude of any given employee of a medical facility is inversely proportional to their skill. That observation includes me.

3. Every child should be taught touch-typing at a young age.

4. Sr. Cathleen and Sr. Mary Catherine of the Benedictine convent in Clyde, Missouri, make great lotion bars and soap. Green Tea scent is my favorite.

5. Brushing the top of your biscuit dough with a mixture of milk and melted butter (sorry, no exact proportions) will make the biscuits stay crunchy even in the microwave.

6. It is good to spend at least one afternoon of your days off in pajamas.

7. Honor Harrington (On Basilisk Station, A Short and Victorious War) undoes all the damage that years of Heinlein and Asimov females have done to me.

8. My boyfriend's sister-in-law is pretty cool for lending me her treasured copy of the first Honor Harrington story.

9. Anybody who feels that an IV-start certification will get them anywhere is probably sadly mistaken.

10. My cat is extremely strange. I have had nothing whatsoever to do with this.

Recipe for a bad day

For the first time in more than a year, I have had a bona fide bad day at work.

It's rare to have a truly bad day. I mean, the day the medication dispenser went down and I couldn't get antibiotics for a patient with fulminant meningitis was pretty bad. The day a patient's family member assaulted me was pretty bad. And yesterday was pretty bad. Three in three years, though, is a good ratio.

Start with a pimple. Put it somewhere sensitive, like between your upper lip and your nose, and make sure that it's painful. It doesn't have to be big, or noticeable, or ugly, but it does have to be painful.

Then, when you wake up, make sure you're not feeling up to snuff. Something must've blown in on the wind night before last, because when I woke up yesterday, every cell in my body was poisonous to every other cell. It felt like a hangover without the alcohol.

Add one patient who seemed determined to seize, code, and die. Before 8 am.

He'd come in with a particularly nasty aneurysm that was snuggling up against his brainstem. Three hospitals had told him the thing was inoperable, but we figured we could either go in through his basilar or femoral artery and at least coil the thing. Turns out that genetic roulette had cursed him with arteries so torturous that we couldn't get to where we needed to be remotely; we had to go in and clip the damned aneurysm in an open surgery.

Which was a success, and not just in the "the operation was a success, but the patient is now trached and tubed and gorked" sense. It was a success in that he could move everything better when he came back than when he left, he knew where he was, and things were looking up.

Until that seizure. I didn't see it; the aide was feeding him breakfast and, for a split second, thought he was choking. She wisely yanked the emergency cord out of the wall and we all converged on the room. By the time I got there, the patient was already post-ictal and nonresponsive even to pain, but with a blood pressure in the high 200's.

And respirations of less than eight a minute. And a number of other little quirks that made the aide roll the cart down to the room, just in case.

I'll spare you the details of labetalol, large-bore IVs, and external pacing.

His daughter, when I called her, immediately asked me if the seizure was a result of her not coming to visit the day before. Yes, she's one of *those*. I went with the resident when she went in to see Daughter and tell her what was up with Dad; I figured somebody had better be there to stem the tide of hysteria and keep the resident from getting stuck in the family room. And yes, it was just as bad as you might imagine. Thanks for asking.

Shortly after I got him to the ICU, I got sent to another floor. Not because of my skill in keeping other people from going to the light prematurely, but because of staffing issues.

I was immediately presented with two patients fresh out of the unit after inguinal lymph node dissections and assorted other things. One guy had had a penectomy (yes, that is exactly what you think it is) for cancer; the other had had his bladder removed for the same reason. Urology is okay, it's interesting and fun, but I hate cardiology.

So when Mister No-Bladder Person started throwing PVC's (this is a very bad thing) in couplets and triplets and generally making the monitor sing pretty songs, I started hating things. A dose of IV metoprolol regulated his rhythm and made me hate things less...until his blood pressure started rising. And rising. And rising some more.

It came down after forty milligrams of hydralazine. To 185/100. An improvement, but not enough of one. So here we go again with the bleeping labetalol and the monitor going nuts and now the patient is sundowning and trying to get out of bed, uncapping drains and yanking catheters and generally being difficult.

At some point in the middle of all of this, Chef Boy called with the news that his gate had blown open and his Dachshund was somewhere in the city, wandering. Somehow this was my fault, he implied in a snarky voice mail message, even though *he's* the one with the house and the gate.

Did I mention the particularly painful and distracting pimple? I thought so.

Finally things calmed down. Mister No-Bladder Guy got his Haldol and went to sleep. Mister Penectomy Guy quit sending his obnoxious wife out to the station with demands for more pillows (you have eight in the room; how many more do you need?) and I got his potassium running and his blood sugar (480) dealt with.

Just then somebody asked me when my baby was due.

I'm not pregnant.

Yesterday was an actual, real-life, nonstop Bad Day.

So you're working Thanksgiving...

Warning: heavy accent ahead.

Well, so am I.

Even though we get a good lunch--and dinner, if we want it--for free, I still prefer to take my own breakfast to work on holidays.

Herein is Jo's Diner Breakfast, gleaned from the days when I was a Dinette at Jim's ("You don't need no teeth/to eat the beef/At Jim's Diner"; "If you got it, share it; don't smoke it in the bathroom, man."):

One raw potato, peeled and cubed
Two eggs, beaten
A few shreds of onion
A handful of shredded ham
Whatever cheese is to your liking

Set your biscuit dough up and cut it out. Stick it in the oven to bake.

(There are numerous recipes for biscuits; even Bisquick makes a decent biscuit if you eat it hot. Try Brother Juniper's Fluffy Biscuit recipe for a Yankee version or search "angel biscuit" on Google for a Suthun version.)

Fry up your ham and onion until the ham begins to brown.

Scrape it out of the pan and dump the eggs in. When they're settin' nicely, put your sliced or shredded cheese on 'em and dump said ham and onions back on top.

Fold it all over and wrap it up into an omelette when things look good and ready. Don't ask for more specific instructions or Terry the Drunken Cook will go after you with a spatula.

When that's done cookin', stick it into a Tupperware and put it into the fridge.

Parboil your cubed potatoes until they're almost done, then season 'em with seasoned salt (or paprika, salt, garlic powder, and cayenne, in that order).

Slide a quarter-cup of oil into that hot pan you cooked your omelette in. (Yes, I know that's a lot by today's standards, but this is *diner* cooking.)

Dump in your seasoned potatoes. I hope you have a good exhaust fan over your stove.

Cook until they're crispy on the outside, mealy on the inside.

Drain on paper towels. If you're in the diner, you can skip that step.

If you're really hurtin' for gravy, now's the time to make it, with sausage grease and flour in a roux, milk, and more flour to thicken. (You do keep sausage grease on hand, right? In an old coffee can? What are you, some kinda hippie?)

Take the biscuits out of the oven. Let them cool on the counter, then wrap two up in foil. Put your putative gravy in another Tupper, and your now-cooled and drained potatoes in yet another.

Pack the whole caboodle into your bag to be assembled in the morning. Don't forget the jelly.

That kind of cooking shouldn't be eaten every day. Fo' sho'. But for charming Rainbow Children who are hitching from Austin to Portland, Maine for the blueberry harvest, or satisfying old truck drivers or cement layers from the South, nothing can compare.

This year we're having turkey, cornbread stuffing, greens, and pumpkin pie. In homage to the recently displaced Louisianians we've got working with us, those same N'Awlinians have agreed to come in to cook crawfish etouffe, dirty rice, and bread pudding for us.

Happy Thanksgivin', y'all. I have a beer in my belly, a cat in my bed, and Jim's Diner cooking in my fridge for tomorrow.

I had no idea. Wow.

The Death Post has inspired some excellent comments.

Tell me your stories. Tell me what sticks with you after twenty years, or what shocked you your first year out. Tell me why you do what you do, why you stick with it, why you continue to give a damn.

Post in the comments below, or send your stories to me using the email link. I'll read them all (promise!) and I might ask persimmons to republish a few up here, where everyone can read them.

I am amazed. I am amazed and honored to be called a nurse, and to share that title with the people who've posted below. Thank you.

Jo

It's time for another round of....

PRODUCT REVIEWS!

After that last post, I feel the need to reassure everybody that I'm not some sort of deep-thinking, intelligent person. Therefore, I present this week's product reviews:

Gray's Anatomy

Really. Who watches this? I mean, who watches it *seriously*, without laughing at the unintentionally funny moments, like when the surgical intern breaks sterility while working on his dad's butt? Or when the neurologist suddenly performs brain surgery? Or when that same neurologist/neurosurgeon/whatever tells a patient that he has a fifty-fifty chance of surviving surgery to evacuate an epidural hematoma?

Note: This is why you don't have actors performing neurosurgery.

Plus, all the surgical interns on that show look older than I do. I mean, come *on*, casting directors--the residents I work with look about eighteen, the interns even younger. Why have a rode-hard, put-up-wet bunch of young actors who are supposed to be looking young and idealistic?

Judgement: avoid.

Mr. Clean Magic Eraser cleaning sponges

I'm probably going to lose my crunchy-granola badge for this, but these things rock my world. I have no idea what's in 'em, probably PCBs and DDT and fiberglass, but they really do work well. You know those smudges on the wall around the light switch? They take those off. Ditto soap scum of undetermined age on Chef Boy's bathtub.

The only problem is that they're meant to be disposed of. Seems wasteful to toss 'em out after only five or six uses.

But damn if they don't clean well.

Judgement: good, but in small quantities.

Ryka walking shoes (women's only)

Get the wide if your feet are at all normal. If they're really skinny, get the regular. Expensive, but comfortable on the track and at work, though not as nice as the Columbia light-hikers I got on sale a couple of years ago.

Judgement: nice, but pricey. Do not purchase through mail order.

Faux Frog Chardonnay, 2001

The only Chardonnay I've ever tasted that has an aspartame-like finish.

Judgement: run away, run away.

Harry Potter and the Goblet of Fire

Shortened considerably from the book, naturally, but still a good ride. Hardly any Malfoy. Lots of Hermione. Moaning Myrtle makes an appearance, and I think they used a body double in the bathroom scene. The costumes are wonderful. Ralph Fiennes is balletic in his evilness.

Judgement: see, preferably at one of those movie places that will serve you a nice glass of Blue Paddle or two.

I have seen people die.

In that sentence, in that thought, the plural form is the strangest part.

I've been doing the death-in-the-headspace thing a lot lately, partly because of my patients and partly because of my aunt.

A side note: the previous entry, the one that Jodi responded to, had a long section about the decision my aunt made earlier this week to die. After I'd posted it, I got an email from Mom saying that she had indeed died, early this morning, and so I edited that portion out. It seemed inappropriate, somehow. She'd made her decision and followed through, and I didn't want to dissect it after the fact.

Anyway, back to the death-in-the-head thing.

The most sobering thing about doing what I do for a living is this: it means that I have done something that, as far as I know, the rest of my immediate family has not. I've done it enough that it's become, at least in the outlines, fairly routine.

I've hugged family members. I've answered the call bell or the person who comes out into the hall with *that tone of voice* or *that look* that means that the person in the bed has quit breathing. I've caught up another nurse on the way to the room to verify the lack of a heartbeat. I've called more residents than I care to think about to verify our verification and chart time of death. I've walked them through the paperwork and told them where to sign.

And, more than that, I've been alone with a number of dead people. The dead are peaceful; they don't ask for cups of coffee when they're NPO or talk politics. I've bathed bodies, removed tubes and wires and IVs, wiped off things I couldn't identify and would rather not think about. I've talked to those people as I've done it, hoping that maybe my persistence in treating them as a living person would speed their souls on to wherever souls go.

I always leave the window open when I do this, no matter the weather. If I have a soul, and if it leaves my body after I die, I do not want to have to work to get outside and fly away. No elevators for me; give me an open window. Supersitious, yes, but part of the private ritual I have.

None of this is stuff my parents have done. My folks, who have a wider experience of life and a much greater understanding both of how stupid and how wonderful people can be, have not (to my knowledge) been around when somebody's died and then taken care of the body. I know my sister hasn't, or I would've heard about it already.

More than that, I've done it *multiple times*. Which is a stunner, when you think about it.

It opens an experiential gulf that I'd not thought about before today. Those of us who midwife the dying are a weird group; we're not generally skeeved out or frightened by the thing that is most taboo in our culture. Most of us have dissected at least portions of bodies; all of us have talked to those still living about the process of dying. It's hard work, as hard as having a baby, and with much the same rhythm as birthing.

The people who understand that, who don't get flipped out by the thought of a person not being immediately available in the body, tend to get chosen for the palliative care assignments on our floor. Oh, yeah, we always give the newest nurse a couple of DNRs who are about to go, just to make sure they can handle it, but after that, there's a cadre of us who seem to get assigned the dying and soon-to-be-dead over and over.

We self-select through our attitudes and our actions. The folks who make the assignments recognize that.

There's still a part of me that wonders, every time one of my patients dies, what on earth those idiots at the nursing school were thinking when they gave me my degree. What made them think that I could do this well? Why am *I* the one that has to be the shoulder and comfort for the living? I ask that not because it's a burden but because I feel so unqualified. The person who takes care of your dying father should be unflappable. Calm. Sympathetic but not overwhelmed by emotion. Distant enough to give you privacy, but not appear cold. I feel too imperfect, too undeserving, to do that job.

And every time, that gulf that lies between my and my folks and my sister, between me and Chef Boy, between me and the other average Janes on the street, grows a little wider. It gets a little deeper.

But I don't worry. I have the gut feeling that this is a gulf that will eventually grow wide enough that I'm back on the same side as everybody else. It'll be more like a discarded orange peel and less like an enforced distance. It'll be interesting to watch that process happen.

Just because you can doesn't mean you should, part II

He came to us four weeks ago with a tumor in his cervical spine. The surgeons resected as much as they could, placed hardware in his spine to keep his head erect, and arranged for him to start radiation therapy.

He came back last week, unable to hold his head up. An MRI showed that the tumor had returned, aggressively, covering and wrapping around the hardware we'd placed recently enough that his scars were still pink.

He's in his forties, with two kids. His wife had to make the decision to withdraw care, and had stayed with him since then. He was breathing near-pure oxygen last night through a mask, in short gasps, his ribs and intercostal muscles showing with every breath. The place in his skull where we'd taken out a bone flap after a brain biopsy was sunken. His wife curled against his chest and talked to him, telling him it was okay to relax, to go, to let go. For her, there was nobody else in the room.

I thought about that as I stood looking at the syringe of morphine I was holding. I'd just drawn it up; his wife had come to me saying that he looked as if he was about to go, and like it was hard work. Could he, she asked, have a little more morphine to ease his breathing?

He was already on a drip--not a lot, but enough to calm the demands his heart was making for oxygen.

You're taught early on that it's not unethical to give pain medication to people in palliative care, even if the amount of medication they receive might hasten their deaths. It's a decision about quality of life rather than quantity, and it's acceptable: no one wants to deny pain medication to a cancer patient in fear that they might either die sooner or become addicted. By the time you hear the word "palliative", it's too late to worry about addiction.

It's a different animal, though, when you're standing in the med room five minutes before shift change (a fact you note with only a part of your attention; at times like this, punching out doesn't matter) with a possibly-lethal dose of morphine in your hand.

If I give him this morphine and he stops breathing, how will I handle it?

He knew what he wanted; his wife knew what he wanted. There would be no problem for him. Not breathing for a few hours more would be no skin off his nose. Knowing the patient, he'd probably--if he were still aware--thank me for the favor.

But his mom and dad? His kids, standing at the bedside? His wife? Me?

There's a big difference between knowing something is ethically clean when you read it in a textbook and pondering the reprecussions when it's you that has to make that decision.

I gave him the full dose of morphine; he kept on breathing. The reprecussions were delayed for a bit in that case.

I wasn't comfortable with the morphine for a number of reasons, mostly because it seemed that I had the potential to cut short some sort of necessary process. Who knows what's happening to somebody else, what sort of transition they're undergoing, as they die? The old-fashioned pillow-on-the-face trick might leave them unprepared to do whatever the hell it is we do after we stop breathing. Either way, why is it my decision? Why is it my responsibility?

And there in black and white is the hardest thing about being a nurse: not accepting that a beloved, brilliant person has decided not to go on living, but realizing that at some point, you may have the task of helping them out, incidentally and unintentionally.

Time for another "humorous diatribe"

Helpful tips for hospital patients, drawn from life...

1. If your nurse is trying to get a history from you, it's not the time to answer your cell phone, order a pizza, start manicuring your nails, try to set up your 'Net connection, or take calls from your constituents.

2. Likewise, if you're the family member of a patient who has global aphasia (think: unable to speak, write, or comprehend; limited only to pleasant smiles and gestures), now is not the time to book it toward the exit door. Stick around. Knowing what Mom is allergic to is really nice in these situations.

3. If you are one of those people lucky enough to have an entourage, whether privately or publicly funded, they're going to have to leave the room during the exam. The gentleman with the expensive suit, earpiece, and suspicious lump in the armpit of his suit will not tell me more about your neurological status than I can find out on my own.

4. A special note for elderly Yankees, or those who have moved to Florida: I don't know what kind of nurses they have in your universe, but I am not "the girl." I am not a waitress, maid, personal secretary, dogsbody, factotum, or whore. I have a particular job to do, and you're not making it much easier. Plus, the amount of money you donated to the hospital makes little or no difference to me. You're still gonna get stuck.

5. Speaking of needles, I don't care who you are. You don't get to refuse the urinalysis, the IV start, the fluids, getting weighed, the CT scan, or the bloodwork. You are ill enough to be in the hospital; this is what we do in the hospital. I won't argue with you, either; I'll simply tell your surgeon that you're refusing treatment, and you can go home, enormous bleed/fulminating meningitis/giant tumor and all.

6. Please bring your medications, or a reliable list of them, with you to the hospital. This helps me in two ways: I don't have to butt heads with my beloved pharmacists about what sort of small, blue pill you might be taking for your sugars, and (more importantly) it lets me know what sort of person you are. If I see that you have a mostly-full bottle of Cipro with you that your doctor prescribed for you to take "when I'm not feeling well", and I see the name of a tough-as-nails, take-no-prisoners internist on the label, I will immediately know that you're the sort of obnoxious bully who's worth risking a resistant infection for rather than arguing with.

7. Please don't bring anybody else's medication with you. I don't care what Papa takes, only what you do.

8. And for God's sake, don't hide stuff in your bed. I *will* find it and you *will* have it taken away from you. There are doctors who will write orders for a Scotch and soda before bed. Find one.

9. Don't abuse your privilege. I'm talking here about the patients who threaten to call the president of the hospital if there's something they don't like (the food, the resident, the fact that they have to get fingersticks to check their blood sugar). I'm also talking about patients who call out on the call bell and say things like "Goddammit, you idiot, I need you in here RIGHT NOW to adjust my bed!!" (verbatim quote.)

10. And finally, be nice to the support staff. The woman who cleans your room is not (verbatim) "that cute little nigger." The people who transport you from place to place don't lack brains or ears. The person who brings your tray, sets it up for you, and helps you get started on your meal deserves at least a "thank you" for her trouble.

The sad thing is that none of the people referenced above were demented. None of 'em had troubles that would have affected their thought processes. They were just *like* that.

There are dozens of people, of course, who are genuinely sweet and pleasant; the sort of folks that you grow to love in the week that they're with you. Unfortunately for everybody, the assholes of the world are louder and more persistent.

Oh, well. The meek might not inherit the earth, but as long as they're not on a restricted diet, they'll inherit whatever treats and tidbits the nursing staff brings them to tempt their appetites.

A bad idea.

It is a signally bad idea to eat four slices of artichoke-heart pizza and drink a pint of Winter Ale, no matter how hungry you are, then sleep for two hours with a Dachshund perched on your butt, no matter how sleepy you are after your pizza orgy. Waking up in a hot bedroom with a snoozy Dachshund draped over your hip will make you groggy, grumpy, and unlikely to be cheerful when your boyfriend suggests going swimming.

So I'm blogwhoring instead, having cleaned my house and drunk a pot of coffee and generally worked back up to feeling half-human.

Twisty gets bald

In which Twisty Faster preempts the hair loss occasioned by chemo and shows off one of the most elegant heads I've ever seen.

Germans get weird

In which the Shakes share a story that makes me wonder.

Things get scarier

In which Michael Brown suddenly, by contrast, looks like an expert.

The Playpus gets dead. Maybe.

It may be too early to tell.

Kim gets an award.

In which it should be obvious to everyone why Emergiblog won the October NurseBlog Award. (Thanks to whomever it was that nominated me, too.)

Health blogs get listed

I had not known of Globe Of Blogs until tonight. Check it out. Mia's blog Death Maiden is listed, as well as some other interesting nurseblogs. There's at least one interesting-looking single-focus patient blog, as well.

Because I am not cool

Several years ago, there was a meme floating around the WorldWideInternetsBlogosphere called "One Hundred Things About Me."

Because I am a slowpoke, not inclined to do memes, and still wearing straight-legged jeans without a cool wash on them, I present:

As Many Things As I Can Think Of That You Might Find Mildly Interesting And Might Not Have Known Before:

1. I am a nurse (okay, okay. But it's a definition.) who works mainly with neurosurgery and neurology patients.

2. As a result of that, I'm extremely uncomfortable taking care of heart patients. Brain, easy. Heart? Scary.

3. My mother and I had the same mole on our right hips for years, until I had mine removed.

4. Other than that, and the shape of our foreheads, there's nothing in the way we look to indicate we're related.

5. I don't look much like my dad, either, but I did when I was younger.

6. I have one sister. She's eight years older than me, or nine, depending on what time of year it is. I don't look like her. Which makes me wonder.

7. I also have a cat. She's insane. Not unlike the rest of my family.

8. I like single-malt Scotch. A lot.

9. But I like a good chicken biryani or vegetable biryani more.

10. In fact, the quickest way to my heart is through homemade Indian or Pakistani food.

11. So I weigh about 30 pounds more than I should.

12. But I don't feel any larger than I did when I was a size six.

13. I can walk two and a quarter miles in 30 minutes, not bad for a fat chick.

14. My boyfriend weighs 22 pounds less than me.

15. My cat weighs eleven pounds, two ounces...

16. ....which is what my miniature Dachshund (staying with Chef Boy) weighs, as well.

17. I'm actually a big-dog person, not a small-dog person.

18. I vote Democratic.

19. I'm screamingly liberal on most issues.

20. I hate George Carlin and love Robin Williams.

21. If I were to die tomorrow, I'd want a NOLA jazz band on the way back from the cemetery...

22. ...and a polka band at the wake.

23. I have one ex-husband.

24. Which is fine with me. I'm gleeful, in fact.

25. Although once in a while, when I see his girlfriend riding around town on her scooter, I want to run her down.

26. Which I wouldn't do, because I have a NEW CAR!!!

27. I drive like a fucking maniac. Sorry, Mom.

28. I routinely denigrate residents and nursing students in this blog, but the reality is that I love them all to varying extents and try to be as helpful as I can be at work.

29. Because I was there once, too.

30. I was crap, in fact, in clinicals, but managed with classwork to pull it out in time to graduate.

31. I have a BA in music and sociology (double major) and an ADN in nursing.

32. Which makes me pretty much useless outside the hospital, except I can quote a lot of CS Lewis and Marx.

33. Sometimes I get homesick for Montreal or Banff.

34. But I rarely get homesick for Denmark, unless it's 108* here.

35. I have friends all over the damn world, mostly through the WorldWideInternets.

36. I used to moderate a board on housecleaning and organization (!!!) at iVillage (!!!!!).

37. I am compulsively organized everywhere except the trunk of my car.

38. I'm also compulsively crunchy and granola, letting critters live in my house and share my space peacefully, dude, unless they're like, silverfish or those huge fucking horrible flying roaches, that, like, really squick me out.

39. I make the best scrambled eggs Chef Boy has ever tasted.

40. I also make really good, really dense cakes that melt in your mouth.

41. I don't like chocolate all that much.

42. I use the word "fucking" a lot.

43. I can also cuss in Greek (thanks, Christos!), Russian (thanks, Urev!) and Portugese (thanks, Dario!).

44. I can speak a little French, get myself into trouble in Danish, and read German.

45. I understand enough medical Spanish to follow along.

46. My new favorite snack food is roasted corn with chili powder, lime, and salt (hence the Spanish reference).

47. I had an Internet stalker once, but the FBI was very helpful.

48. I do not want children.

49. But I get along with them fine, and babies crying for hours on end doesn't bother me.

50. Most people strike me as basically good-hearted but a little silly.

51. Which is fine, because I'm way silly myself.

52. I sing along with "Walk Like An Egyptian" every time it comes on the radio...

53. ...which doesn't happen often, since I mostly listen to NPR.

54. I make up silly songs about my cat.

55. I also give animals I know nicknames like "Schnozzhound" or "Grumplemuffin."

56. This causes my coworkers to look at me with some suspicion.

57. I hung a miniature disco ball in the break room, but nobody knows it was me. Heh.

58. I really, really like playing practical jokes on people.

59. But I hate surprise parties or practical jokes played on me.

60. I can quote huge chunks of Donne and Elliot, mostly because I wasted a lot of time taking English classes in college.

61. I once wrote a parody of Gerard Manley Hopkins's "Pied Beauty" that earned me an "A".

62. I like reading Ellis Peters's and Dorothy Sayers's mystery novels in the dead of winter....

63. ...but I never wanted to marry Peter Wimsey.

And that seems to be a good place to stop. "She never wanted to marry Peter Wimsey" would look equally well on a tombstone or a resume.

What I want for Christmas

If I were to make up the Ultimate Christmas Want List, this would be on it.

I would put it into one of these

And then, if Santa figured I'd been very, very good, I'd get one of these, too.

I'd also ask for a new pair of these.

I don't wanna do your dirty work no more...

So I'll just do my own.

Anonymous comments are back. Both Mom and Vi had trouble commenting without 'em. The trouble occasioned by the rare anon troll is worth having their comments here. Mom, try the names I made up for you, okay? Okay.

Trolls: If you show up here, I will find you out. I will then put you on 180 mailing lists for sex toys that will follow you until the day you die. Alternatively, I will figure out which way you voted in your last local election and put you on 180 mailing lists for the opposite political camp. Be warned. I ain't doin' no Bitch, PhD thang here. I go straight for the jugular.

If you've sent me email in the last few days, I've not answered because (again) my Internets have been down. I've added Geek Nurse to the sidebar, more in appreciation of the Camera Whose Name Shall Not Be Spoken than because the Geek himself asked. Check it out. It's worthwhile. And it's the only Peds-related link I have.

My Samhain resolution was to post Grand Rounds links here, but I failed miserably the first week (see above complaining about Nonrobusto Mister Roboto 'Net access). Grand Round linkage will commence later.

That's all.

Just because you can doesn't mean you should, and other lessons

If Mama is 87 years old, demented, obese, with long-standing heart troubles and CAD, a less-than-ideal immune system, and unable to make sense of what's going on, it might not be such a good idea to have her hip replaced.

Especially if the outcome--a six-day stay in the ICU, a raging infection, and general misery for all--is one you've been warned about beforehand.

I'm just sayin'. Mama is going to be lying in bed for the rest of her life anyhow, not knowing where she is, alternately screaming and cursing, Foley and O2 mask and rectal tube and permacath in place, regardless of what you do. Quality of life here is an issue. Would you rather Mama be in pain with a huge fever, in a strange place, with invasive things done to her, or in *controllable* pain in a familliar place, with less likelihood of dying in fear?

If anybody ever does that to me, I will make it a point to die on the table and then haunt them for the rest of their lousy lives.

What a Young Nurse Should Know

Strokes do not necessarily change a person's personality. If Papa is a racist now, after one of his frontal lobes got bludgeoned by a big ol' clot, it's likely that he always had those attitudes, but also had the socialization to keep them to himself.

Likewise, if Auntie is dreadfully unpleasant now that she's lost her right parietal lobe and part of her frontal lobes, it's very likely that deep down, waaaay hidden away, she was pretty unpleasant to begin with.

The trick is to accept the family's apology for Papa's or Auntie's behavior without pointing out to them that you took care of Papa or Auntie last year, prior to this stroke, and not much has really changed.

Nobody told me there'd be days like this...

It has been a hellishly long six days. The two days I've had off in the last eight, the 'Net was down here at Las Casas Del Nonrobust Connection, so I've not been able to blog. That's probably just as well, because any writing I'd be able to produce would sound a whole lot like a drunk running into a wall at 3 a.m.

There are days in nursing when everything goes smoothly, you get your charts opened by nine, you have a chance to eat and even maybe drink a mid-afternoon cup of coffee, and you feel good when you leave the floor. There are other days, when nothing specifically horrible happens, but everything gets all wadded up in a huge ball that takes you hours to untangle. The last six days have pretty much been the latter sort.

It's not that the work recently has been particularly demanding in a physical or mental sense. After all, I'm not the one who has to localize somebody's stroke on the basis of symptoms or read their EEG. There have been no six-hundred pound patients falling out of bed lately (thank God and knock wood). It's just that little, simple things, like accessing a Mediport, took on a new and complicated dimension this week.

The Mediport (a permanent, implanted catheter under the skin of the chest through which one can infuse medications and draw blood) would flush, but not draw. This necessitated my trying to unclog it with TPA and failing, then ordering a chest X-ray, as per hospital protocol. Meanwhile, the patient whose Mediport it was was getting itchier and itchier (liver failure will do that to you) and more and more anemic. All of the falderal about TPA and chest X-rays was necessary, as I didn't want to run a couple of pints of blood into somebody's chest wall unless I was ordered to do so.

Then the one respiratory isolation room on our floor got bolloxed up somehow, so that the exhaust wasn't going to the outside air, but instead to the floor in general. Which would not have been a big deal had somebody discovered it *before* we'd put a possible TB case in the room. Again, not a big deal from a health standpoint, since it'd take a person about a million years of overtime to catch TB from the diluted particles that were exhausted into the air, but a cluster-fuck from a logistics standpoint.

Then the post-op unit sent me the wrong patient. I was waiting for an angiogram and got a belly surgery. Oops. More Three Stooging ensued, with the patient going to another floor, everybody smiling in a rictus of horror and trying to make like we'd planned it that way, and my promising, in a tense whisper, to skin the PACU nurse who'd messed up.

It seems the Universe knew I'd bought a fresh bottle of Bruichladdich.

...Most peculiar, Mama.

The differential diagnosis crew will be hard at work for the rest of the week.

MS behaves differently in different people, that we know. Sometimes you see the characteristic plaques in the brain on MRIs, sometimes you don't. Sometimes there are exacerbations and remissions, sometimes there aren't.

But MS does not behave like this:

An eighteen-year-old male presents with a six-month history of pain in the legs and decreasing coordination, especially truncal control.

Fast forward a year, to the latest exacerbation of what's been diagnosed as MS, despite no clinical evidence: the patient shows a persistent left-going gaze, still complains of intolerable pain in his legs and arms, the use of one side of his body. He never got better, not for one single day, in the intervening year. His family is now reporting personality changes, aggression, fearfulness, and aphasia.

His MRI signal is abnormal in the hippocampus. His EEG is insane.

We're all being very quiet on the floor, waiting for the neurologists to take a brain biopsy (not very useful, as you'd have to get very lucky to get what you need in a single cut), get the results back from his lymph node biopsies, and make a diagnosis.

My Favorite Martian (aka one of the best, most pleasant, least weird neurologists on staff) looked at me with a very solemn expression the other day, after he left my patient's room. He said nothing. I said nothing. Then we went down to the station and, together, ordered all the biopsies and reserved all the ORs that he would need for the next week.

We think we know what it is, and we really hope we're wrong.

Ending on a hopefully-more-cheerful note

The fact of the matter is, I'm not dead. The flu shot I got might've caused me to be sore and grumpy for the last two days, but grumpy and sore are my usual personality traits, so nobody much cared.

I'm off for three days, on for one, then off for two. On the last day of my mini-vacation, I'll be attending a monstrously wonderful pre-Thanksgiving potluck for the third year straight. We get such marvels as biriani and tabbouleh, enchiladas and that weird corn/mayonnaise/chili powder/lime concoction so beloved in Mexico, spring rolls and squid and dried fish. Somebody always fries a turkey, as a concession to the Suthun way of doing Thanksgiving, but we can eat barbecue instead if we like.

(I'll be taking Chef Boy's rolls and my own Danish rice pudding, thanks.)

The New Car continues to be amazing. I fill it up once every couple of weeks, drive it around while I play with all the nifty automatic settings for this and that, and consider my $380 per month well spent.

They charged me the price of a ten-year Scotch the other night when I picked up the Bruich. It's actually a 14-year. And, because I am the original cheap drunk, I can expect that it'll last me at least three more months.

Needs Meme

Stolen from Badgerings :

Google a first name, in quotes, with the word "needs"

To wit:

Jo needs head.
Thanks, I have plenty of those at work.

Jo needs a 17" PowerBook.
Ergh.

Jo needs surgery.
Lord, I hope not.

Jo needs 2b funky.
Sing it, sister.

Jo needs some room to be used powerfully.
You betcha.

Jo needs help with dressing and washing and still wets the bed occasionally, though she is reliable during the day.
Which one of you has been watching me??

Jo needs a heart and lung transplant.
Well, they're all black and shrivelled up, so...

Jo needs to update her page.

I promise I won't foam at the mouth.

Not one word about Alito. I swear. Just go read PinkoFeministHellcat on the subject that's attracting the most attention. Oft thought, but ne'er so well expressed.

And please, please don't get me started on civil rights, disability rights and access, and gender equality.

We all knew Miers would be a sacrificial lamb, and that once she withdrew or failed to be confirmed, Bush would come out with his *real* candidate. Now he has, and now things will get interesting.

A word on judicial bypass

The state in which I live requires parental notification for minors seeking abortions. In the years I worked in women's health, I only saw a handful of cases in which young women who had to notify their parents were unwilling to do so, for very good reason.

One case involved a young woman whose father and stepmother had looked the other way while she was raped repeatedly by a cousin. Another involved a girl whose father would've killed her, literally, for bringing shame on his family. Those were the two worst; there were four or five more that, while not as horrible, certainly presented food for thought and caused me to call the equal-access folks for help.

Now, then. Judicial bypass is an option for young women in this state...but there is not one judge in my county who will hear a judicial-bypass request. Not one. They've all decided that judicial bypass takes the rights of parents away. Unfortunately, it's difficult to get a bypass ruling from a judge not in one's home county, even with competent legal help.

It's accepted that parents have a certain amount of dominion over their minor children; that's how parental consent and notification laws have passed in so many states. The spousal notification and consent laws that have been struck down assume that men have the same dominion over their spouses.

Which is a silly assumption, especially considering it doesn't go both ways.

Imagine what it would be like to be living in a county with no judicial bypass option, as a married woman with an abusive spouse, or one who's simply disappeared, or one who's locked up somewhere, and trying, as an adult woman, to get basic, common health care.

Imagine how it feels to be told this: even if you're in a good relationship, even if you and your spouse have made the decision not to continue a pregnancy together, you still don't have the ability to make that decision on your own, simply because you are the one carrying the pregnancy.

This is just like pharmacists refusing to dispense the morning-after pill, people. The onus falls on women in every case. When you show me the cases involving pharmacists refusing to dispense Lipitor or Levadopa to men, or the cases in which men are required to notify their wives before undergoing a radical prostatectomy, then I will believe that all this is about moral repugnance or equalizing voices within a relationship.

Until and unless that happens, I will continue to think that perhaps, just maybe, just a little bit, these sorts of things are about not allowing women full power over their bodies and their lives.

In other news

I got the closest thing yet to an invitation for a date the other night from a resident. Bless his heart, he got all kerfuffled when I started laughing hysterically, right in his face.

Nurses don't date residents. Not, at least, residents that they have to work with. They're residents, after all, and the work-with-this-person-for-years angle doesn't make it any more attractive.

We still have two screamers on the floor. I'm too tired to even consider writing about their latest antics.

The scary nursing student has been booted, not because she's gum on anybody's shoe or because she refused to do maid work, but because she ignored a tonic-clonic seizure one of her patients had and failed to inform the nurse about it.

And that's all the news for now.