When it absolutely, positively cannot be about work.

I go back to work tomorrow after five days off, the first three of which I spent incredibly tired and feeling as though someone had scrubbed my left maxillary sinus with Brillo. The last two days I've spent running around doing errands, getting my teeth cleaned and my eyes checked, and doing laundry.

Fun times.

This evening I'm drinking Scotch (thanks, Beloved Soon-to-be-Brother-In-Law!) and watching, to my faintly bemused horror, "Dancing with the Stars". And trying to plan what to do for my 36th birthday and reading the latest issue of "Mental Floss" during the commercial breaks.

Oh, mercy. George Hamilton's tan is doing a slowed-down samba to a live version of "Do the Samba" or whatever that awful Miami Sound Machine song is, and I'm worried it might fall and break a hip. If tans have hips.

Anyway, I'm waiting to go to bed before work. Michelle has, as usual, an intelligent take on one of the most common problems that nurses and invisible doctors like anesthesiologists have: we know before the patient does what's going on. And that sucks.

I've been wondering over this week if it's maybe not time to get back into non-hospital nursing, more because of the commute time (40 minutes each way is long, especially on the 3rd of 3 days) than because of the emotional stress, though that stress is playing a role. I've had some really difficult cases this past fall and winter, and I'm getting stress-related illnesses as a result. For me, that means tummy trouble and sinus infections and possibly an aneurysm down the line, as well as trouble sleeping the night before I go back to work.

Don't get me wrong: I love what I do. Neurology and neurosurgery are ripe with opportunities to educate, amusing in the variety of problems we see, and incredibly elegant. I never knew how damned elegant the human nervous system could be; it fills me with awe and joy every time I see a manifestation of a tiny problem writ subtly on a patient's behavior or body.

But it's getting tiring, seeing people who will probably not get much better. Say what you want about working with pregnant teenagers, women in their 30's with unsuspected STDs, and women needing abortions: at least it opened up avenues to the future. Those folks had an entire future opened up to them that was multifaceted and unbounded; the patient with a massive bleed or thalamic stroke often doesn't have that option.

Ha. This was going to supposed to be an essay on the various options I have for spending my 36th birthday, which unfortunately coincides with Chef Boy's prep day for The Biggest Holiday Of The Year (Valentine's). Instead of pondering flying out to The Palms of Dubai or getting a mani-pedi, I'm missing working public health.

I don't know. I decided, the day the 27-year-old mother of a pregnant 13-year-old came in with her daughter, that I needed a new job. I had, in fact, just told the 13-year-old, who was in methadone treatment, that she was pregnant. Her mother looked at me and said, "What do you expect? Do you want me to cry? 'Cause I'm not gonna cry."

I wanted to shout, Yes, I want you to cry, because your daughter has somehow repeated the awful life that you lived. Your daughter has made her future that much more difficult and that much more bleak by deciding that her mama did it, so she can too. I want you to cry for whatever failure of yours it is that allowed your otherwise bright and engaging daughter to start shooting up heroin and sleep with God knows how many men.

Instead I went to the bar and stared at the wall for hours, hoping that I could down enough alcohol to make it possible for me to sleep without making it impossible for me to drive.

I'd take Lunesta, but Miss Cat would flip out over the glowing butterfly.

Planned Parenthood needs a recovery room nurse for a clinic. It's part-time, and it's forty miles away (again), but...well.

Every nurse has the chance to make a difference every day she works. Even if you have five vent-dependent, gorked-out patients, you have the ability to make a difference. Somebody, somewhere, if you're doing your job right, will end the day feeling better than they did when the day started.

I suppose it's a difference in type of heartbreak. The same heartbreak over and over gets old; eventually, trading 32-year-olds with gliomas for 13-year-olds with unplanned pregnancies (Query: Can a 13-year-old plan a pregnancy?) begins to sound like an option. Again.