Sunday, December 31, 2006

Getting next to beauty.

We had three patients die last week.

One had bounced back and forth from the unit, getting better and then worse in ways nobody could diagnose, and steadily losing weight. Her breasts hung on her chest, her ribs showed through her shirt. She wasn't convinced we weren't consipiring to confuse her about where she was.

Eventually, finally, after eight months in hospital, she died.

She was my age. To the day.

The second was much too old for his diagnosis. You'd expect a patient with his problem to be thirty years younger; instead, he had lived long enough to have married the woman who nursed him back from a war wound. He died with her holding one hand, me holding the other. It was two days after his diagnosis was confirmed. He simply decided to die.

The third sacrificed everything for her kids. When the tornado hit seven years ago, she laid down over her children and covered them so they wouldn't be hurt. She spent the next seven years as a quadriplegic with horrible bone infections from dirt that was driven with the shards of wood into her wounds. She had lived as long as she could with the pain, the skin grafts, the constant infusions of this-that-and-the-other.

Eventually in this job your soul gets shredded. Weeks like last week can do it; losing one person who you thought might make it can do it.

At times like this, you need beauty. Doesn't matter if it's a sunset or Body Worlds or a good bottle of wine; you need beauty.

And getting next to it can be enough. Getting to hear fetal heart tones coming from the belly of a woman who's had successful emergency surgery can be enough. Seeing one person walk that you never thought would is enough. Having a patient who's well enough to eat the food his family brought in for Eid ul-Adha is enough.

We throw stones at the Devil, and he retreats, for a while. He leaves us enough space to slide in next to Beauty and strike up a conversation.

Tonight I have a bottle of shockingly expensive Champagne open in front of me. I have a cat who tolerates me rubbing against my legs. I spent an evening with friends, drinking gently and eating very good food. Getting next to beauty is enough.

Saturday, December 30, 2006

A couple of days late; a couple of dollars short.

First of all, the new Change of Shift has been up since Thursday at NeoNurseChic. Go there and read.

Second, it's time for a year-end round-up or two. Of sorts.

Round-up the First: The Most Memorable Moments and Patients of 2006

1. Biggest Eeewww Moment: A patient with an infection in the ventricles of her brain has to have a ventriculostomy (that's a tube that drains fluid directly from the brain, and that can be used to instill antibiotics and other drugs). The doc drills a hole in her skull, inserts the small plastic straw into her ventricle, and pus shoots out and hits the opposite wall of the room.

2. Heaviest-Person Moment: The heaviest person I've ever seen came in this year for bariatric surgery. He weighed something in excess of 800 pounds.

He survived the surgery but died later of complications.

3. Funniest Non-Medical Moment: I walked around a corner earlier this year and found a bunch of residents all doing the Electric Slide in a back hallway.

4. Most Embarrassing Non-Medical Moment: My own hip-shakin' Happy Dance in the hallway, witnessed by the chief of neurosurgery, the chief resident, and the medical director. They were nice enough to applaud.

5. Best Moment: when a patient who had been told he'd never walk again unaided walked unaided up to the floor to thank us for caring for him.

6. Funniest Moment: watching a colleague leap over a counter to try to save a bottle of incredibly expensive and hard-to-find medicine that had fallen off of said counter. She made it.

7. Most Memorable Patient: the one who was allergic to water. *sigh*

8. Most Memorable Injury Sustained In The Course of The Day: A bite wound and bruise from a detoxing methamphetamine addict. (She didn't bite me.)

9. Best Wacko Statement: From a woman suffering from a subarachnoid hemorrhage, which makes people a bit weird: "Yer goin' to the pen-i-ten-shurry. And Ah'm gonna *laugh*."

10. Best Awwwww Moment: All the therapy animals coming to the hospital just before Christmas, dressed in wreaths and antlers and cute Christmas hats, and handing out dog-biscuit-shaped brownies to the staff.

Round-Up The Second: Some of The Best Stuff of The Year

1. Dermabond surgical adhesive in the little plastic crush applicator. Steal some from the OR for the next split knuckle or glass cut you get. It can't be beat. Dermabond forms a flexible, nearly-permanent, impenetrable barrier that doesn't sting.

2. Christian Dior Diorshow Mascara. Yes, it costs twenty-three bucks. No, it doesn't seem all that different from drugstore mascara until you realize that it doesn't smudge, doesn't run, doesn't clump, lasts forever, and comes off easily with soap and water.

3. Sid Schwab's Surgeonsblog. The best writing around.

4. Pharyngula, for the Best Friday Cephalopod.

5. VitaliaDerma skin-care products. I've thrown out everything else that I used to use. Non-drying cleansers and glycolic acid treatments, non-greasy moisturizers, and it clears up your zits. Pricey, but worth every penny.

Happy End of the Year!

Friday, December 22, 2006

Well, I got that day off.

And it's restored my faith in....wait. No, it hasn't. Manglement is still as mangly as ever, but at least I didn't have to be there to deal with it today.

There's spaghetti sauce (Italian sausage, tomatoes, lots of garlic, oregano) simmering on the stove, bread proofing in the bread bowl, and Dermabond on my split knuckle, so I feel like I can pass along a meme a non-blogging friend sent to me. To wit:

I Believe...(you fill this bit in yourself)

In hot coffee. And really cold beer.

In young guys and old furniture.

In high heels and low levels of debt.

In great big windows and itty-bitty house payments.

In old jokes and new discoveries.

In not judging your worth by the size of your waist.

In a really, really good bra.

In swinging heavy weights around at least three times a week. It teaches you that you can accomplish more than you ever thought you could...

...but I also strongly believe in asking for help to move heavy people.

That a management position takes twenty points off a person's IQ.

That occasionally you have to humiliate yourself to make a point or move things forward.

That humiliation isn't that bad, overall.

That collecting facts and figures won't give you the whole picture.

That personality tests ought to be outlawed.

In big, big dogs and warm, purring cats.

That checking Cute Overload once a day has made me a better person.

That doctors aren't all assholes.

Thursday, December 21, 2006

Why I want a day off.

I'm frustrated. I'm worn out. I'm a little bit angry. And a little bit country and a little bit rock and roll, but that's a subject for a different post.

I'm learning that, in the absence of competent managers and anybody who gives a damn about staffing, good time management skills can be a bad thing. They'll land you with extra work when other people are drowning, and you'll have to help the drowning folks as well. Not that I mind doing that, generally, but it's a bit of a stretch to expect that one person can carry six or seven high-acuity patients while still starting IVs and putting NG tubes down other people's patients. Something has to suffer, and it's usually the care of the least-acute patients.

Or it's the nurse. As it is in this case.

See, we're having staffing problems. We're having problems with management, in that management simply doesn't give a damn. We're having problems getting supplies. We're having problems getting answers.

And what that means, for us on the ground, is this: there is no guarantee that the person who manages the floor or the poor sod who's been tapped to charge will be around when you need them. More likely one or both of them will be stuck on the phone, trying to put out fires somewhere. That leaves the most experienced nurses, the ones with the best time-management skills and the broadest clinical knowledge, to juggle things like signing off orders and implementing bizarre drips and titrations, all the while trying to take care of their own patients and clean up messes left by people in other departments who are so overworked they can't see straight.

This is why I want a day off.

The last three weeks have been hellish. We've all run our bohunkeses off, trying to keep it together, and nobody seems to notice. Nobody in charge, that is. A group of five of us got called in to the Big Mangler's Office last week to get quizzed on why we haven't earned enough Customer Service Points to get the nifty T-shirts that proclaim us TEAM players.

We all stared at each other for a few seconds, glassy-eyed, before another nurse said, "Um...well, we've been too busy doing our jobs."

And that, my friends, is the root of the problem. If your manglement cares more about the external signs of Good Customer Service than the basics (which translates to "being able to provide good care to your patients"), you'll get screwed...and then dinged for walking bow-legged.

I want a few simple things for Christmas this year:

Enough staff to do a decentish job keeping people from coding.

Support staff that knows what they're doing.

Enough supplies to do my job. We don't need hinty-quintillion thoracentesis kits on a neuro unit; we need enough urinals and suture kits.

Managers that aren't too busy with customer service issues to notice what's going on in patient care.

Ten extra minutes in a day. That's all. Just ten minutes.

Wednesday, December 20, 2006

Nip, Tuck, Dead.

That's the name of the book I agreed to review. A very pleasant marketing person named Nancy offered me a free book (read: crack) and the opportunity to review the thing here. How could I say no? I like to read, free books are best, and I like to hear myself type. It was the trifecta of goodness.

When I first got the email from Very Pleasant Nancy, I wasn't sure what to expect. See, I'm a mystery novel snob of the worst sort. I prefer the younger Peter Wimsey to the older one, I like the early Sherlock Holmes much, *much* better than the later stories (especially that horrible one that was supposedly written by Holmes himself), and parts of Laurie King's Holmesiana books make me howl with rage.

Here was a popular mystery novel written for a general audience, that contained no verbose descriptions of London streets at the turn of the century or bizarre Latin quotes. What would I do?

Well, honestly, I hurled the book across the room the first time I read it. It was not at all what I was expecting.

Then I read it a second time, because I felt like I had to, in order to give a decent review. Then I read it a third time because I wanted to.

The story concerns one Pauline Sokol, an ex-nurse turned private investigator. To reinforce that this is a fictional character, Sokol both runs everywhere ("Think I'll go for a jog") and cannot hold her liquor. Hello, she's a *former nurse*.

Sokol gets chivvied into yet another medical insurance fraud investigation (haven't read the books leading up to this one, sorry) and has to take her best pal off so that he can have a nose job and she can play private nurse while carrying out her Sherlocking and skullduggery.

The best friend is a flamingly gay man named Goldie. Of course he's six foot six, and of *course* he's a cross-dresser. And of *course* she lives with both him and his boyfriend, a man capable of whipping up bruschetta after giving Our Fair Heroine a foot rub.

See, I told you this was fiction.

But, dammit, this is a cute book. It's a book you'd want to read on the beach, or on a cruise, or waiting in the doctor's office. Okay, maybe not that last, given the propensities of some of the doctors in the story. Some of the dialogue is a little rough, and sometimes it reads like a travel guide to Newport, but it's fun, fast-paced, and surprisingly funny in parts.

If you like books that star nurses in which the word "fabulous" is used seven times by page 113, and the word "pus" isn't used once, this is the book for you.*

Quick plot summary: Pauline runs a lot. People fall off cliffs. There's a ghost (this bit is really well-done) and a couple of guys who make Pauline's pulse race. We meet Pauline's mom and dad and uncle--again, for those of you who've read the other books in the series--and Pauline's mom, in one hilarious scene, replaces all of Pauline's sensible undies with thongs from Victoria's secret. Pauline does eventually come close to solving the mystery, but the evildoer confesses at the end, thus saving her a lot of time. Not a lot of medical detail, thank God. Plenty of attention paid to clothes and food.

In short, the Insufferable Mystery Story Snob gives this book a C. The Ordinary Girl gives it an A-minus, with extra points because I didn't figure out who the murderer was until page 155.

Want a literary comedy of manners with a corpse in the drawing room? Stick with Murder Must Advertise or The Nine Tailors. Want something you can giggle over while you have another glass of wine? Nip, Tuck, Dead by Lori Avocato is your book.

*Thanks to Beloved Sister for pointing that out.

Sunday, December 17, 2006

Nobody cares what you eat for lunch, but sometimes they care what you cook.

It has been the cookingest weekend I've had in a very long time. The tally as of tonight is carrot cake and mashed potatoes for the annual Christmas potluck, panzanella and mac & chee for me (no, that's not all I'm eating; I have protein, too) and four loads of laundry, all folded and put away.

I've also made a new cover for my down comforter of fabric Beloved Sis sent me. It's white with gray elephants and green palm trees on it. Some of the elephants are carrying fruit (pineapple and cherries) or flowers, and others have pink toenails. They're all smiling.

Mom and Dad say that all is well where they are. They live in a protected valley in Seattle and so didn't get the brunt of the wind this past week. They also cut down all the trees that might've caused problems when they moved in, so that's all good. I hear that my favorite two bars (Wedgwood Ale House and Fiddler's Inn, both on 35th) sustained no damage, so we can all relax.

It's been a swell weekend. I was tired to death of sick people, so it was good to have three days off in a row. I'll pay for it next week and over Christmas, of course, but that's how these things work. For New Year's Eve, Chef Boy will be visiting a friend of his down south, so I'll have to find something to do other than dressing changes and cake-baking.

Perhaps I'll order the rest of the books on my Amazon list. And a pizza. And grab a six-pack of Celebration Ale. Mmmm. Nurse vacation.

Friday, December 15, 2006

In which Jo contemplates the destruction of nursing

I think Nurse Ratched and I work at the same place. I would've thought her last CoS entry was over the top had practically the same thing not happened to me a couple of years ago.

The story is here. Read it first, then come back.

I got assaulted by a patient's nutso family member a couple of years ago. Not punched, thank God, and nobody was waiting for me after work, but I did get grabbed and shaken. The family member wasn't removed from the hospital until after he'd assaulted two other nurses, forged a letter on stolen hospital letterhead giving him permission to sleep in the ICU waiting area, and punched a security guard.

The reason it took so long for him to get booted was that management was afraid of getting the patient's family upset. Customer Service is key, you know, coming before good patient care or even employee safety.

I remember reading once that the profession most likely to suffer on-the-job assault or murder is nursing. I understand why. The emphasis on "customer service" is going to ruin nursing. Seriously. You can get pretty-much-adequate care anywhere for whatever ails you, so the focus now is on making a patient's stay as pleasant as possible. Unfortunately, in the rush to focus on the patient's happiness, things like staff safety are being ignored.

We once got a letter, post-discharge, from a patient suffering from dementia. The letter was six single-spaced, typed pages and ran the gamut from accusations of starvation to physical abuse to white-slave trading (I kid you not; I thought that went out in the 1920's) and kidnapping. Copies ended up on the desk of the medical director, the director of nursing, the president of the hospital system, and every member of the board of directors.

And we got pulled in for a Very Important Meeting on Customer Service. After forty minutes of lectures on how we could've been more sensitive and improved this patient's stay in the facility, I finally asked, "Has it occurred to anyone else that this patient is demented and probably not in touch with reality?"

Instead of giving a long, rambling, incoherent series of complaints about kidnapping and slave trading the attention it deserved (nil to none), we had a Meeting. And we got Lectured by Management about how we had fallen down on the job.

Managers, listen up: There are some people who will never be happy. It is not my job to be abused (twice), have things thrown at me (twice), be threatened with physical harm (once), rape (once), or cussed at (still counting) in order to make them happy.

Your responsibility as a management team is to make sure that nurses have the resources and ability to do their jobs well. This means, first and foremost, that we must be physically safe when we're doing our jobs.

I don't know how to put it more clearly than that.

I worked for years in women's health care, longer than I've worked at this hospital. That environment was ripe for assault and threats, but I only ever got touched by an angry person once. That's because the people who run women's health care clinics and abortion clinics take staff safety and dignity very seriously. If a patient even came close to crossing the line of appropriate behavior, they were booted. Period. No questions, no meetings, no focus on customer service.

The understanding was that I have a duty to provide care, and you have the obligation to be civilized. The management of La Schwank has forgotten that last bit, as have managements all over the hospital map.

We're going to lose nurses over this. Nurses are gonna decide that it's not worth the effort to go in to work, only to be screamed at and grabbed, and they'll go cheerfully off and get a job at an insurance company.

It's pretty damned depressing when working at an abortion clinic in the Red-State, Anti-Choice South is safer than working at a specialty hospital.

Thursday, December 14, 2006

New Change of Shift!

At Protect the Airway. This is the best CoS I've read in a very long time.

Wednesday, December 13, 2006

Yah ow ow ow ow.

Inspired by a headache I had on Monday, which continued despite Excedrin on Tuesday, and was still with me when I woke up this morning:

Things that Hurt:

Getting your kneecap kicked around to the back of your leg by an angry mare. Luckily, he was in midair at the time, having been thrown by the horse. If he'd been standing on his leg, he likely would've lost the bottom half of it.

Having a piece of debris on the trash truck in front of you come off the truck, fly through your windshield, and hit you in the eye. At 75 mph. Especially when that debris is roughly round and weighs about two pounds.

Seizing, falling down, and waking up with a kitchen knife stuck partway into the back of your skull. Then getting to the ER.

Getting out of bed several days after a major abdominal surgery and having your wound suddenly open up. Whoops! Intestines!

Getting run over (technically, it's run *under*) by a car. If you're short, it'll damage your lower body. If you're tall, it'll probably take out at least one lobe of your brain, as your head will hit the metal edge of the car's roof. This is another good reason to be short.

Leaping off the fourth-story balcony of a dorm. Actually, the leaping doesn't hurt, probably. It would be the landing that would suck. Especially if you lived, which this guy did...after a fashion.

Getting shot in the back of the head with a kid's pellet rifle. The pellets didn't penetrate the skull, and the docs at Podunk Memorial didn't feel like taking them out, so my patient had some interesting lumps in his skull.

A punji stick through your foot. I'd heard of punji sticks from Vietnam vets but had never seen the effects of one until I had a veteran come in who had a small scar on the bottom of his left food--and a huge mass of scar tissue and old skin grafts on the top. Wowee.

Your parachute malfunctioning when you're still a hundred feet or so from the ground, meaning you land going about 45 mph. Especially when you're in Germany, for God's sake, in World War II. (My favorite old guys are the old guys who fought in that war. They have the best stories to tell. And they're dying off, which makes me sad.)

Being bled, being fed concoctions of woodlice and mercury, having tinctures of snails put on your smallpox lesions, having a black rooster cut open while still alive and laid on your abdomen, having a pan with a few ounces of molten lead in it placed on the top of your head. These are not things that have happened at La Schwank lately; rather, I've been reading about Elizabethan and Restoration medicine. That last, the pan with molten lead? Is a sure cure, or so the promoter said, for chronic headache.

He was right. I feel better now.

Monday, December 11, 2006

Personal, not professional.

For various reasons, I've become reacquainted with Felix the Cat lately.

Felix was my favorite cartoon when I was a kid. As I recall, Felix came on either just before or just after my afternoon nap. Either way, I was in a receptive state for his Bag Of Tricks, the antics of Master Cylinder, and Poindexter. It wasn't until later, in college, that I discovered Felix's roots in 1920's silent films and fell totally in love with the weird, surreal cartoons from that time. "Felix In Hollywood", where our hero dances with Charlie Chaplin, is a classic.

Anyway. Felix has an online presence, including a Felix store. I'm thinking I may have to get me a couple o' Felix T-shirts or some Felix Christmas ornaments. The Bag of Tricks is so far not available for retail sale.

In other cat news, the Hello Kitty phone, while a nice shade of pink and a cute imitation of those old Princess phones GE used to rent (and which I coveted for several months when I was nine), is a total loss in the operation department. Not only are the buttons on the outside of the receiver, which means I dial 911 by mistake while I'm on the phone and chopping vegetables, but the sound quality sucks rocks. There's also one huge button right in the middle of the phone, which on any other phone would be the pick-up/hang-up button, but which on this phone does nothing much. The pick-up/hang-up button is a small button to the right of that one. It's impossible to find in the dark.

I'm thinking the Hello Kitty phone may have to be consigned to the Goodwill pile.

The Happy Fitness Person was quite kind to me today, making me do only about fifty minutes of hideous exercises instead of my usual fifty-eight, because I had to make a diving catch on Saturday to keep a patient from falling on the floor. The upside to the stiff back and sore neck I have today is this: had I not spent the last umpty-ump months lifting weights, I would've been actually, no-joke injured. And so would the patient. As it is, I'm stiff and wanting a massage and some Flexeril, but I'm unhurt. As is the patient.

Speaking of which, I can now see my lats if I flex them.

Yes, I occasionally flex in front of the mirror. Along with pulling at the corners of my eyes to see how I'd look if I were Fu Manchu, dancing in front of said mirror while singing into my toothbrush (I do a legendary "My Sharona"), and lip-synching along with the NPR station breaks as I put on eyeliner.

Plus, I've lost five pounds in two weeks by following the No-Crap Diet. That's a tough one for a nurse, as it precludes such vending machine delicacies as White Castle Burgers (which are the same whether you buy them in the restaurant, from a vending machine, or unearth them in a pyramid), Butterfingers, and fries. Chef Boy asked if "no crap" included "no beer" and I said no, because I don't drink crappy beer. Besides which, beer is--and here I can see Shrimplate nodding--one of the four basic food groups, up there with poutine, homegrown tomatoes, and good dark chocolate.

I will not be appearing at the AANN conference in a burgundy bikini, though.

When Acronyms Attack!

I heard a new acronym the other day.

Acronyms are common in medicine and nursing. We have "ETOH", shorthand for "alcohol" (it's the chemical formula for drinkable alcohol, not the rubbing sort), which is also often used as a shorthand for alcohol abuse.

There's "SOB", which isn't a description of the patient's personality, but instead stands for "Shortness Of Breath".

And "TURP". TURP means Trans-Urethral Resection of the Prostate, a method of removing part or all of the prostate gland.

"BRCA" is one everybody knows about, thanks to recent news stories about the breast- and ovarian-cancer gene BRCA1. BRCA is, of course, BReast CAncer.

"GBM" is one I use a lot--it stands for GlioBlastoma Multiforme, the number-one brain tumor you don't want to get.

The new one? "TUD".

"TUD...." I thought. "TUD. I wonder what TUD means., that's not it."

Finally, I started asking everybody else on the floor if they'd heard the acronym before. Nobody had. And nothing makes a group of nurses feel dumber than an acronym they can't figure out, so we were an unhappy bunch. I finally caught up with the doctor who'd written the history and asked what on earth TUD meant, and she said:

"Tobacco Use Disorder."

Tobacco use disorder. The patient is a smoker. No, wait, not a smoker, but a person with tobacco use disorder. I rolled the term "tobacco use disorder" around in my brain for a while, wondering when we'd get hit with "Dietary Fat Disorder" or "Inactivity Syndrome" or "Fewer Teeth Than A Chicken."

Most of the time I'm in favor of medical language. It's hung on for years for a reason: it's exacting and precise, it's descriptive, and it's relatively easy to translate for the lay person if you take a little time. I'm not a huge fan of the idea that we need to write in plain English rather than use medical terminology, partly because most of the doctors and nurses I run into can't write plainly, but can manage medical terminology.

But this time? I'm in favor of ditching the acronym TUD and going back to "smoker", with a quick comment or two on PPD (pack-per-day) and when the person quit, if they already have.

Tobacco Use Disorder, if it catches on, is going to cause Exploding Head Syndrome.

Friday, December 08, 2006

Apparently I'm falling down on the job...

...because the Focus On Patient Care hasn't been what it could be lately.

Patient Care, people! That's what it's all about! Unless, of course, you work for La Schwank Hospital, in which case it's about Customer Service. But I'll get to that in a minute.

So. Boys and girls, let's go over this one more time:


If you have a resident to admit and discharge patients, please make sure that resident knows that he or she is to admit and discharge patients. That way I won't have four patients waiting in their rooms, twiddling their thumbs, while I wait for orders. And call six residents in round-robin fashion, looking for somebody, anybody, to write diet and activity orders.

If I have a patient who's just been admitted to the unit with bleeding from hinty-bazillion places, and I call you because the orders say to call you when the patient arrives (bleeding from hinty-bazillion places, oh, and now there's some weird swelling going on, too), please don't lecture me about "turfing". Not only do I not know what "turfing" is (it seems to have something to do with the perceived size of your genitalia relative to how many calls you get in a day), I don't care. Take it up with the other attending, who's been working this case with you for weeks.

I know you have a rule that I'm not supposed to call you before seven in the morning. Occasionally, I break rules. Like the other day, when your patient had a massive stroke and had to be moved to the ICU and placed on a vent. Sure, I called you at 0655 (and no, I do not kid), but was that really a reason to scream and holler for a minute and a half? I would've called your resident, but you don't have one.

Finally, if you're an attending I've never seen before in my life, from a service I've never seen in nearly five years of working at La Schwank, please don't be offended if I ask your name. Especially please don't be offended if I ask your name after you've walked up to me and started spouting off verbal orders without preliminaries. You may be considered God wherever it is you came from, but here you're just another damn thing I have to deal with.


Don't put that vacuum container filled with strangely-colored body fluids down on the desk and tell me to "take care of this" without telling me where it came from, who it came from, and what the bloody hell I'm supposed to do with it. If you omit those minor details, that Evac bottle will sit on the corner of the desk until you're out of surgery. At least label the damn thing with the patient's name so I can divine your intentions from your badly written, detail-free note.

Do not--and this I am saying for the last time, before I come hunt you down--put an unstamped, un-labelled loose order sheet on the desk. Ever. There are charts for a reason, there are stampers and labellers for a reason, and you have a pen in your hand. If I don't know who those orders are for, none of them will get done.

Stay the fuck away from my pencil case. Next time I see you riffling through my stuff looking for something like a penlight, you're gonna lose digits. "MD" does not mean "My Domain."

While I'm at it, where were you raised, that you think using *my cellphone* without permission is acceptable? If you and your pencil-case-riffling colleague don't stop this, Patient Care will suffer because I'll be out back, shoving your bodies into the incinerator.

PAs, NPs, and other and sundry people:

I'm calling you at the office because you submitted the wrong damn set of order sheets to the PACU. That means that your patients have meds ordered that we don't have, and you're referring to protocols that we don't follow. Don't snark at me because I called you to inform you of this fact. Just get me the correct order sheets and I'll figure it out on my own.

Read the allergy list prior to prescribing meds to which the patient is allergic. Please. This is only the forty-millionth time I've pointed this out to you.

Please know the protocols for the hospital at which you've been practicing for ten years. Thank you.

Customer Service People:

I know the patient's daughter called you, angry because I wouldn't order a food tray for the patient. Hear me out: the patient cannot swallow and is a silent aspirator. Do not make my job harder by sending a food tray up to make the daughter happy.

The time to come in, cheerfully dropping off a basket of fruit and a newspaper, is *not* when I'm involved in an unpleasant and potentially embarrassing bedside procedure. Knock first.

Things like isolation rules cannot be relaxed just because somebody's stepfather twice-removed gave a load of dough to the hospital eight years ago. No matter how important the patient, they cannot bring their own furniture to the hospital. Don't tell them they can.

I've been too nice lately. It's time to get out the whip and Bettie Page-style nursing outfit and start cracking down on folks.

Tuesday, December 05, 2006

Pity the pretty.

No, seriously.

Lightning strikes are like...well, like lightning strikes. They're mostly predictable, in that you know one might be coming if the sky gets stormy, but also strangely random, in that you can be a perfectly happy, outgoing sixteen-year-old in a lake at one moment, and then the next and forever a person in a high-backed wheelchair, gorked out.

One hole to shit through, another to breathe through, and an indwelling catheter so that your urine doesn't eat through the skin on your legs and buttocks. The high-backed chair is there so that your natural tendency to torque backwards is controlled. Splints for your hands and feet complement the chair; there'll be no decorticate positioning going on, not while your parents are alive.

Your hands and feet are smooth. You never use them. Your toes and fingers are perfectly manicured, colors changing depending on the season. Your hair is styled every morning by your older sister, who gave up a college scholarship to help take care of you, and to tell you how pretty you are. So very pretty.

Pretty is all you were ever known for. Being born pretty is a curse; the pretty girl never gets the chance to develop any other talents.

Dead John was nice-looking, in a sort of retired-hippy, craggy, fiftyish guy sort of way. He couldn't be trusted to not wear black boxers with red print on them under white scrubs, but mostly he cleaned up all right.

What I remember him for, though, was the way he used to barricade himself inside the one-hole bathroom on the floor and chart. We'd page him, and he'd call us on his cell phone: "I'm in the bathroom, dammit!"

Or the way he'd answer any question that rephrased "How are you?" "Lovin' life" or "Workin' for the maaaan", he'd say, and it seemed so odd coming out of him that I'd always laugh. I would laugh at his enormous white-framed, mid-eighties sunglasses, too, and the way his cell phone played "Ride of the Valkyries" every time his wife called.

And the time he wore the tuxedo shirt and bow tie to work on New Year's. And the way he'd flutter around the med room, delaying everybody else.

Point is, I loved him and I remember him for more than being pretty, though he was easy on the eyes.

Pity, then, the poor bartender at my usual watering hole. Through no fault of his own, he was born with a perfect nose. Through hard work, he's developed the sort of build that makes random women at the bar cheer when he bends over to grab a tapped-out keg.

Still, I didn't look forward to seeing him until the night that I made some offhanded joke and he responded with something lightning-quick and funny. The man somehow overcame the hell of being pretty and managed to develop a brain and a wit besides, though how many people actually see that is debatable.

Should he (Frog in his Spaghettiness forbid) be struck by lightning, or pasted by a bus, or develop some nasty brain tumor, I promise I'll remember the brain and the wit. The pretty is easy-come, easy-go, plus I hear it gets harder to maintain as you age.

Pity the pretty ones. Cherish those with seams in their heads or warts on their noses, who might have something more interesting to give.

Oh, no you didn't.

Let's say you're a manager in a hospital. Let's say that you have excess staff because nobody's doing surgery, much, during this inter-holiday period. Let's say, specifically, that you have extra staff in two departments: Neurosurgery and Transplant.

Now, then. Neurosurgery will need staffing this morning, while Transplant will need staffing this afternoon, when ICU transfers start to come in. You have three extra nurses on each unit to cancel.

Do you:

a) Staff Neuro with a neuro nurse, waving off the transplant nurses until the afternoon, or:

b) Send a transplant nurse to Neuro, then call a neuro nurse to go to Transplant in the afternoon?

If you answered "a", you obviously do not work for La Schwankienne Hospital Du Monde. I, unfortunately, do, which is how I found myself in the midst of Transplant and asking questions like, "Now, where did they put that kidney, again?"

In other news, I grabbed The Work Pal Who's Been Sworn To Secrecy because she knows about my blog and told her, "Hey! I have exciting news!" (Meaning that I'd had that interview, y'know?)

Her response? "Oh! Chef Boy bought you something with a diamond in it!!"

My head did not explode then. It exploded later, when I told a non-work pal that I had exciting news, and she said the Exact Same Damned Thing.

Let's take as read my howling objections that marriage shouldn't be considered the pinnacle of a woman's life. Let's ignore for the moment the fact that I don't wear diamonds and haven't since I started learning about the diamond trade and the human rights abuses inherent therein. Let's pass over both my general and specific objection to marriage both as an institution and as a thing that I would want to do again on my own.

Let's instead take the next thing that came out of Work Pal's mouth, after I told her that no, I wasn't getting be-diamonded and betrothed.

"Well," she said confidentially, "you might want to think about it anyhow. I mean, you're not getting any younger [yes, she actually said that] and the time's going to come that you might want somebody, but nobody will want you."

Hm. The time might come, eh? Which means that I, of course, ought to hook up with the first charitable soul that comes along (since I am, as she pointed out, not immune to the Inexorable Maaaaarch of Tiiiiime), just in case the time comes at some future date that I might want somebody to kill bugs or lift heavy things.

I'd better get cracking, eh? I mean, hell, at 36 I'm already twenty years past my use-by date, am I not? Well, eighteen, at least. Because we all know women get all dried up and flaky and ooky after twenty-five, thirty at the latest.

Wait a minute. Nobody would want me *now*, right, since I'm like, all wrinkly and stuff. So I guess my time has passed. I suppose I'll either have to marry Chef Boy posthaste, just in case, or find somebody with even lower standards than he has. To take on a woman who's past her prime and not getting any younger. You know. Wrinkly and stuff. It'd have to be a nice man, a kind man, involved in charity work and able to look past ook. A monk. That's it. I need to meet and marry a monk. Right.

I would like to say that if I hadn't already been on edge, her comments wouldn't have bothered me...but they would've. That whole third-wave feminist thing comes to the fore whenever I hear obdurate stupidity, and it comes *screaming* to the fore whenever I hear that particular sort of obdurate stupidity. Yeah, I was primed to be pissed, but I probably would've gotten equally as pissed if I'd spent the day napping. (Us old folks need a lot of sleep.)

What I don't get is that she's not that much older than I am. I mean, she's right at the right age to remember her mom having consciousness-raising sessions in the living room. She grew up in a fairly liberal political climate and is, in practice, a walk-the-talk feminist. And she wasn't just making fun; no, she was serious. Which boggles my exploding head.

Many, many moons ago I was involved with the birth of a women's political group at one of the colleges here. It was great while it lasted; that is, it was fantastic until everybody that was running it left.

To get married.


Monday, December 04, 2006

Omigawd just what I needed after a long day...

Check this bad boy out.

Note: you will need a good pipe to the Internetweb.

Note: This is why I have always loved and will always love octopi. Even when I'm eating their babies with endive and artichokes and pink wine in Montreal.

Edited to add: Did you know that there's such a thing as an octopus's garden?

No, really.

My friend Lou, a master diver, told me about it. In addition to being nominally famous and good at not getting himself killed under water, he tells really good stories.

Anyway, he was out diving off the coast of Oregon or Northern California once, somewhere where there are lots of octopudlians.

He noticed that one octopus had scooted into his cave (octopi like little caves to live in) and that he had put an arrangement of rocks and shells and bits of detritus in a semicircle around the entrance to his cave. That's the "octopus's garden" that Ringo wrote about. They have eyes like ours, and brains that recognize patterns, so it makes sense.

Lou moved a few things out of place in the octopus's arrangement, then moved back and tried to look as much like a lump of seaweed as he could.

After five minutes or so, a looong arm came snaking out from the cave and the octopus put everything back where it was before.

Although they'd never make it on Cute Overload, I still rank the octopus as my favorite animal. The pangolin comes in a close second.

Interview with a vampire...

...the vampire being me, since I've gotten into this habit of getting up unreasonably early even on my days off. Future nurses, be warned: Your circadian clock will be an early career casualty. Right after your social life and waistline.

Anyhow. I had a fun interview with a writer for Nurse Week/Nursing Spectrum yesterday. We went over the whole "how to get started as a nurse blogger", "how to protect privacy", and "tips for new bloggers" thing, and then she asked a tough question:

Why start a blog?

Not only that, but she asked it three times, in three different ways. This, by the way, is one of the cardinal signs of a good interviewer: restating a question in order to get a slightly different perspective each time.

So why blog? Why write, for that matter?

I subscribe to the theory proposed by Isaac Asimov: that every writer is, at heart, a cheerful monster of ego. You *have* to be, to write anything; your assumption is at the outset that somebody will read what you're putting out. More than that, you assume (if you're published) that they'll pay to read what you're putting out. If you blog, the assumption is that they'll ignore the rest of the World Wide InterWebWonderNet and click over to your site to read what you say.

Sure, you start blogging to vent steam about work, or to share stories you think are important. Or you start out as a person who gathers nifty links from hither and yon and puts them into rational order, but before you know it, you're commenting on those links, and then on others, and then you're actually writing.

So the thing that starts a person blogging is usually specific. For me, it was Beloved Sister (who is actually a *writer*, as in, that's what she does and she's been published, and stuff) saying, "You know, you really ought to write some of this stuff down."

But what keeps me writing is my own cheerful self-regard.

Would I write if nobody ever commented? Probably. I went for a year with no comments enabled on the blog. I'm not looking forward to the day when people quit reading, though; it's valuable to have feedback in comments and in email.

Would I write if what I was putting down turned out to be absolute dreck? Oh, hell yeah. Because, you see, (and this was part of what we discussed in that interview) nine times out of ten, the stuff I dash off without thinking that I later regard as absolute slop is the stuff that rings the loudest bells with other people. It's the stuff that people comment on, that they email me about, that they say touches them.

(This is not because people who read this blog like junk. It's because my mental editor is turned off when I dash something off, so maybe the voice is different. More honest, less contrived.)

At the end of the day, the answer to the question "Why write?" is "Well, 'cause I gotta." On some level, life is better now that you're writing, be it in a journal or on a blog or for a Major National Publication. Things may not have turned overnight into Caramel Apples and Puppies For Everybody, but they're *better*. When you don't write, things aren't as good. You end up with a lot of things to say, all backed up in your head, and your thoughts get all tangled and weird.

Writing, be it on a blog or on paper, is the mental equivalent of a nice hard workout. You do it at first because you feel like you ought to, that there's something you ought to be saying. Later, once the endorphins take hold, you do it because you have to.

Saturday, December 02, 2006


I've spent a nice portion of the last two days cleaning munge out of my own house and out of Chef Boy's. That is what happens when you're in a profession that deals with cleanliness and service; you find it necessary to be clean and serviceable when you're not working.

Which I'm not. CB and I were supposed to travel way south and east this weekend, to the place where the Wild Things are and Spanish moss grows, but we decided against it. So instead, I cleaned. And as I cleaned, I thought back to the last few weeks...

I was cleaning a patient's room. Sometimes we do this, especially if things have gotten disorganized and messy. I do this a lot if things in my "work area" (ie, anywhere I say) have gotten kerfuffled.

He's a frequent flyer, through no fault of his own. Neurofibromatosis has left him, for lack of better words, lumpy and blind, with crippled feet and hands. He has a bad case of NF. It's not just pigmented spots here and there; it's large aprons of skin with huge tumors on them. Three years ago his father, in an excess of concern, offered me money to "make sure (my son) don't turn gay." Despite that, the patient and I are still friendly. The fact that his dad is mad as pants has nothing to do with him.

He's young. "I'm almost twenty-four," he said from the cardiac chair, "and I haven't ever been on a date."

"I'm almost thirty-seven and I haven't either," I replied, rather tartly.

"Yeah, but you're not covered with tumors," he said.

"How do you know? You're blind, man!"

He shot back, "You don't sound lumpy."

"You don't sound lumpy" will go down for posterity along with "You don't sweat much for a fat chick" as Weird Compliments to Pay Somebody.

*** *** *** *** ***

Okay, so we've established that eventually, after you watch enough people die, your soul gets to be like that Baby Swiss cheese, full of itty-bitty holes.

My pal Carolita brought up a person we'd both taken care of some months ago; a person who'd died on my shift. In my care. And I'd bathed his body and comforted his mother and wife and bagged & tagged him and sent him to the morgue.

I had forgotten about him.

Not just his name; his entire existence.

I had promised myself when my first patient died that I would never, ever forget a person who died under my hands. Midwifing a soul out of a body is the most honorable and sacred thing I do. I can't allow the frailties of memory to screw that up.

And yet, here was one I'd forgotten. Other people had died more tragically and more unexpectedly and more horribly in the intervening year, so this guy had gone on to be one of those people you only remember if they're brought to your attention.

I still feel bad about that. As long as somebody somewhere remembers a person, they're not really, truly dead...and who better to remember them than the person who was with them when they died? What makes it worse is that I was actually in the room when this patient died. That doesn't happen often; it's a matter of chance that you're there.

So my soul is full of little bitty Swiss cheese holes. And apparently my brain is, too. The only thing now, I guess, is to write about people as they die, to make sure they stay alive in electrons if not in neurotransmitters.

*** *** *** *** ***

Success Story:

The woman in the doorway looked at me and said, "You don't remember me, do you?" I had to admit that while I had forgotten her name, I remembered that she had a big bear of a husband and a huge, weird, dysfunctional family, and that her husband had been diagnosed with a brain tumor about six months ago.

She had brought her husband back. He was having seizures, a natural consequence of having a glioma invading your brain.

"I want you to see one of your success stories" she said.

She told me that he had been given a prognosis of six weeks at the most, but that steroids and chemo had allowed him to live that many months. Yeah, he wasn't himself most of the time, but he was still here, and that was all that mattered, right?


I was confronted with a bloated, vacant man who had none of the charm and spice of the man I'd cared for. He sat uncomprehending, staring at nothing, until I touched his arm and said, "Hey. Big guy. What's up?"

Then he looked at me without remembering who I was, or where he was, and made some sort of reply that didn't make sense.

But he's there. In body, at least.

I was reminded that "success" differs for each person and in each situation, and that I can't always be the arbiter of what defines a good outcome.

*** *** *** *** ***

In other news, I have an interview tomorrow, by phone, for a nursing magazine. Part of the interview will be about mistakes new bloggers make. God knows I've made 'em all, so I'm well-qualified to speak.

I will be doing the interview on my brand-new Hello Kitty telephone.

How good is that?

Change of Shift!

Over at Fat Doctor.