Tuesday, May 29, 2007

Freddy Mercury: Still Dead.

This has been one of those weeks in which you could look at the glass half-full or half-empty. Or half-empty or half-empty, unless it was filled with a good single-malt, in which case it'd be gone before you could tell.

Bad: La Schwankienne is cutting staff, cutting beds, but not cutting the number of surgeries its surgeons perform. This has led to understaffing and stressful bed crunches.

Good: La Schwankienne Hospital has announced its new program: Facilitating Patient Independence. Cardiac patients will now be taught to monitor their own rhythms, since there are no more monitor supervisors to do so. Orthopedic patients will perform their own physical therapy with the help of colorful instructional materials, since there aren't enough physical therapists. And patients with brain injuries will learn self-sufficiency by administering their own medications in the proper doses at the proper times, as there are no longer enough nurses. Those patients who are well enough to take care of other patients will receive an additional loaf of brown bread and an extra measure of gin with dinner.

Bad: I've tried to get in to two houses in the last two days, only to find that purchase contracts were signed on them Friday afternoon and this morning, respectively.

Good: My interest spells good luck for someone else.

Bad: We've had flooding here recently.

Good: It gives me an excuse other than seasonal writer's block for not blogging, as it's difficult to write with a snorkle on. Additionally, the rising waters are driving away the obnoxious Californians who moved in to the area five years ago and pushed real estate prices to an amazing level.

Bad: Holy Kamole, our sister hospital, had a nasty power surge that cut off the oxygen generators for an afternoon.

Good: We got to get rid of all those silly oxygen cylinders that were cluttering up the hallway. And some of those silly patients as well, as there won't be oxygen enough to get them down to the ICU if they code.

Bad: It just started to rain again.

Good: West Nile Virus-carrying mosquitoes are practically nonexistent this season, as they like to breed in stagnant water. There's been so much rain that they, like the Californians, have fled to less-turbulent climes.

Bad: Freddy Mercury is still dead.

Good: Someone, somewhere, is building a time machine that will allow me to go back to 1975 and warn him about GRID or HLTV-II before it becomes AIDS.

I can dream, can't I?

Monday, May 21, 2007

I can't decide...I can't decide....

So I have to move this summer.

I have a choice: house or apartment?

House comes with the possibility of a big, happy dog, like a Cane Corso or a lurcher or a big ol' Anatolian (my favorite breed, next to Greyhounds, which of course I'd have one of as well) and a place to plant herbs.

Apartment comes with less responsibility, free weight room, pool, somebody else to do the maintenance. But I can't paint, I can't plant herbs, and I certainly couldn't have a Molosser.

House I could do things to. Apartment I wouldn't have to.

House I could play around with. Apartment I couldn't...but there'd be somebody there to fix the faucets.


The thing that's swaying me is the dog issue. It's been *so* long since I had a dog.


Saturday, May 19, 2007

Things that make the needle on the Baffleometer swing to the red, part 386

Why is it that the neurology residents, after ordering twelve tubes of blood drawn on one patient (yes, literally twelve tubes) for various obscure tests, return to the floor or call with a telephone order for one more test? And why is it always the test that can't be run from any of the tubes already drawn?

Why do tacos come in threes? Twinkies come in pairs. So did Noah's animals. So do senators. Are tacos like celebrity deaths and plane crashes? And if so, should I be eating them?

Why on earth is that resident wearing both bi-colored wingtip shoes *and* a bow tie?

Why do people think tan looks better?

Why did Louis Farrakhan record "Zombie Jamboree" as a young man? Did he really think it would be his ticket to fame? (Speaking of bow ties.)

Why do our urologists have such huge fucking egos? Would it kill them to be polite once in a while?

Why isn't there a decent Ethiopian restaurant in this town?

Thursday, May 17, 2007

For Chef Boy

It's Change of Shift time!


Be sure to check the video "(I'm bringing) Patients Back". Hee!

Sunday, May 13, 2007

Product Reviews: Mother's Day Edition

It's time again for non-professional product reviews. If you schlubs want me to review your book or your product or your salted pistachios, you gotta email me. Until that time, I review what I got.

Cutting Remarks: Insights and Recollections of a Surgeon, by Sidney M. Schwab, MD.

Sid is known to most of us as Dr. Sid, the proprietor and author of Surgeonsblog. Here he collects stories and cautionary tales from his training as a general surgeon (1970-76, UCSF). I have three words for you:

Buy this book.

More accessible than Oliver Sacks, funnier by far than Atul Gawande, totally devoid of snarky ego, and a fascinating insight into how surgeons are made and how they evolve. Buy this book. Read it. If you work with surgeons, read it again. Stick little bits of torn-up paper in between the pages you find particularly interesting, as I did. Keep it by the bedside.

I once reviewed a book here and had hellish trouble finding anything nice to say about it. I am now having hellish trouble not fawning over Cutting Remarks. Sid neither suggested I review this book, nor did he send me boxes full of cheese curds and poutine gravy. I'm doing it on my own.

Verdict: Buy the damned book already. If we're lucky, he'll write another one.

Everybody's Nuts Roasted and Salted Pistachios

The back of every Everybody's Nuts box contains a vignette about pistachios. They are less interesting than the nuts themselves. The nuts are big, as advertised; open, as advertised; crunchy and salty and easy to eat. I have a bag of them next to me right now.

Verdict: Recommended.

Land's End Women's Sleeveless Super-T

Extremely soft. The sleeve-less-es are wide enough that your bra straps don't hang out, and the neck is low enough that you avoid the Enormo Neck Problem (especially if you're me and have more trapezoids than neck). No show-through, even with the white ones. I'm five-foot-two, a size 12/14, and the large fits perfectly. It falls to the bottom of my butt while covering the sides of my bra at the arm holes.

Verdict: Why get anything else? Volume discounts so you can show off your guns in different brilliant colors.

How To Cook A Wolf, M.F.K. Fisher

This is the cookbook Fisher wrote (and later revised) for World War II shortages and rationing. You won't want to attempt most of the recipes here, but she does have excellent advice on how to deal when you got no money, no cheese, no butter.

Her best advice? Carry a (filled) flask with you at all times in case the air-raid sirens go off. That way you'll be set for several hours if you end up in a dark basement with strangers. I would follow this advice daily, since I deal with the dark-basement-and-strangers thing routinely, but I'd get fired.

Verdict: A good read, but optional.

Mirena intrauterine contraceptive

Not A Cramp In A Carload!

I had this bad boy installed on Wednesday. I won't lie: the insertion hurt like a sonofabitch, because I haven't had kids. I have not, however, had any trouble since. Days 1 and 2 I took ibuprofen to control the cramps and have not taken any since then.

It's good for five years and is for both multiparous and nulliparous women. It does *not* protect against STDs and can, in fact, raise the chances of a woman getting PID if she has multiple partners. The Mirena releases hormones that thin the uterine lining, making it a good choice for women who have heavy periods or lots of cramps.

My Mom

The best in the bunch. If you haven't had the opportunity to hang out with My Mom, you're missing out. My Mom is the finest-quality Mom available on the market currently; she uses less electricity than other Moms to accomplish the same tasks. She can also be left by herself for long periods in used bookstores without adverse consequences. My Mom should not be submersed in water for long periods of time. Hand wash with mild soap and hang to dry.

Verdict: You who don't have My Mom are big ol' losers.

Happy Mother's Day, Mom!

Saturday, May 12, 2007

Things Jo Hates Today. And Loves. And Can Tolerate.

Jo hates it when a kit she puts together for a lumbar drain just...disappears, five minutes before the drain is due to be put in.

Jo hates it when the day is so confused and chaotic that she forgets to hang an antibiotic until 1800, at which time the patient has been discharged for six hours.

Jo hates it when all the cafeteria has for lunch is pulled pork sandwiches and chicken adobo.

Jo hates failed procedures.

Jo loves it when she's passed all her medications and opened all her charts by nine a.m.

Jo loves chicken salad with pecans and red grapes.

Jo loves it when a patient tells her, "Thank you for answering all my questions. I was scared before, but I feel better now."

Jo loves it when she can peg a neurology resident from twenty feet away with a thrown ball of paper.

Jo can tolerate delays in MRIs getting read, but she's not happy about it.

Jo can tolerate a twisted sock for almost twelve hours.

Jo can tolerate a two-mile run.

Jo can tolerate it when people just...disappear, sort of like that lumbar drain kit, be it through death or dismissal or Personal Journeying, but that doesn't mean she likes it.

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

I have ended up on somebody else's blog. Not *me* me, but my Mild-Mannered Alter Ego. One of my patient's fathers started a blog to document her brain surgery and had me pose with her for a few pictures. Those pictures are now up (or so they tell me) on the blog, with appropriate captions ("We don't know which ward this one escaped from, but she doesn't seem dangerous").

I just hope the Nurse Jo Cape didn't make telltale wrinkles under my scrub jacket.

Thursday, May 03, 2007

CoS/Gracious, I'm tired.

Change of shift is up here. I'm an asshole and missed it last week. Sorry, Kim.

Goodness. I'm tired.

Something about hundred-mile-an-hour wind gusts and bits of the hospital flying off and having to drive through four-inch-an-hour rain will really take it out of a girl. (We're all fine, by the way.)

Something about medical service patients who are, in a word, all batshit crazy will take it out of a girl.

And there's something about learning entirely new protocols and care plans and how to take care of totally unfamilliar patients that will take it out of a girl, too. This week it's been urology patients; the specialty has moved to our unit to partner with neurology. And if you think that causes problems when we page people, because of the sound-alike qualities of "urology" and "neurology", you'd be right. We've started referring to them as "brains" and "bladders" to make things easier.

Guys who've had their prostates out will talk about *anything*. One gentleman compared his prostate exam to labor and childbirth. I did not laugh. Another regaled me with tales of where one finds blood after a prostate biopsy. I did not run out of the room screaming.

(And that crazy patient? The one I said no to? Was fired by her surgeon shortly thereafter. Sweet, sweet justification of my actions. Sweet.)

Don't get me wrong: I'm not complaining. I'm liking having to learn new things on the fly, and there's a lot of interesting stuff coming in with the medicine and surgery folks. Like Whipple procedures--I'd not heard of that since nursing school. I'm doing a lot of research between patient rounds and boning up on drugs I'm not familliar with. But it's exhausting.

How exhausting? It's 15:45 and I just got out of bed. Cancelled my workout with the trainer today, skipped eating, and slept. This is how tired I am: a box from Sephora arrived and I didn't open it right away. I laid back down on the couch and dozed off instead.

General surgery patients are heavy, primarily because they're not routine for me. Neurosurgery and neurology I could do in my sleep because, well, that's all I've done for nearly five years now. But surgery and medicine have all these new orders and care tracks and protocols and I'm just blown. Plus, they tend to get better faster, so instead of six high-acuity admissions in a day, we have seventeen low-acuity admissions and just as many discharges in the twelve hours.

Overall, though, it's fun. The surgery guys have great senses of humor and are good to work with: intelligent, humane, and good at returning pages. The urology guys are just as all-around good, plus they have a stable of nurses who are helping us out as we get comfortable with their patients.

I just wish I could take a nap in the middle of the shift. After a day when I start with five patients (usually one or two high-acuity neurosurgeries in there), discharge three, get three, discharge two of those, get two more, and pick up one last one at 1815, I'm *so* done.

I wonder what's in that box from Sephora.