Tuesday, July 31, 2007

Product Reviews: Lovely Lady Lumps Edition

Here it is again! Reviews of products you might could use, wish you didn't have to, and ones you would rather avoid!

1. Title Nine "Because She Said So" sports bra:

I got sick of wrapping my boobs in two or three compression bras, so I bought two of these. They make me resemble a lingerie model from the late 1950's, but that's okay: I don't bounce. At all. Ever. Even at a dead run, or hopping on and off of a step during some new torture routine Attilla the Trainer has devised. The nice thing about looking like I'm All Boob, All The Time is that there's not as much squish to the side, so I can still do things like bench presses without running into the sides of my own breasts.

Verdict: I will only trade these in when I find another Title Nine bra I like better. I bought mine a cup size smaller, just FYI.

2. Rimmel "Volume Flash" mascara in brown:

Due to the fact that I had to give up a pile o' cash for home renovations, I'm not shopping at Sephora for things like Christian Dior mascara any more. Instead, I prowl the aisles at the local Target. And I came up with this mascara, which (dare I say it) works better, stays on longer, and clumps less than even my beloved Dior. Plus, it has one of those really skinny, ineffective-looking brushes that lets you get to every single lash.

The brown is a nice light brown, suitable for somebody with very fair skin and lashes. The only downside is that it's a bit difficult to remove: I find that my usual face-wash stuff put on without water takes it off. Any dilution results in my looking like a football player or a boxer, post-eight-rounds.

Verdict: Rocks my socks, and for only $7.99!

3. Joe's Frozen Chitterlings, pre-cleaned:

No, I did not buy these. I mention them only because I stood before the freezer case in my neighborhood grocer's, amazed that there was such a thing as frozen chitterlings. And that "chitterlings" was spelled the proper (rather than the more charming phonetic) way. "Chitterlings", for you who've never eaten them, is pronounced "chitlins" and are intestines.

Anyway, they're available frozen in some parts of the country.

Verdict: I'm not eating *anything* in the way of pre-cleaned, pre-packaged soul food unless it's Glory Greens and I'm in a hurry.

Speaking of food:

4. Balance 100-calorie Caramel-Vanilla snack bars; Soy Joy Almond-Raisin snack bars:

I mention these together because, together and separately, they are nearly the nastiest things I've ever eaten. I got 'em because they're both small enough to fit in the breast pocket of my scrub jacket. They taste horrible. The Balance bar is 100 calories of oversweetened, cardboard-like stickiness; the Soy Joy bar tastes like almond extract gone bad with an undertone of sawdust. I'd rather drink retsina than eat another one of these ever again.

Verdict: Yeah, they're expensive, big, and calorie-laden, but cut a couple of Odwalla Banana-Nut bars in half, and they fit in your pocket. They actually taste good, too.

Verdictal postscript: I'm trying to think of anything nastier than Soy Joy that I've eaten more than once, and I really can't. I tried the second Soy Joy in the conviction that nothing could taste that bad; that I must've been imagining things. I wasn't. Avoid.

5. Med-Prime suture removal kits:

I hate these fucking things with the burning hatred of a thousand suns going supernova. Med-Prime, my ass. Try Cheap-Shit Medical Supplies That Will Drive You to Drink. The "iris scissors" included in the suture "removal" kit are loose-joined, dull things that simultaneously pierce your patient's skin and refuse to gnaw through the suture in question. Some dickweed bought these for the hospital. In response, we're all hoarding the decent suture clippers; the sort that look a bit like bypass pruners in miniature.

Verdict: Anyone who orders these for hospital use should be condemned to having one thousand #2 silk sutures removed from some ticklish part of his anatomy with the scissors. God, I loathe them.

6. Dansko "Calla" clogs:

The winner, and still, after two years, champeen of the clog wars. Mine are wearing out only now. I plan to buy two more pairs with my next paycheck, because, at $115 a pop, they are Not Cheap. However, they hold up well. You can roll a bed over your foot in 'em and your toes won't break. And, unlike other Dansko clogs, the heels are nice and wide so you won't fall off of 'em.

Verdict: Trade in the Professionals, if you're the clumsy sort, and try these.

7. Target Boxed Wine:

Of all the damn things. Target actually carries wine! (Well, mine does. Along with those cute Pommey POP champagne bottles that come with a package of straws and are bottled by the same people who make Veuve Cliquot, so it's actually pretty good, but anyway.) Target boxed wine comes in White: Pinot Grigiot, White: Chardonnay, Red: Merlot, and Red: Something Else. They're drinkable, but not outstanding.

Verdict: Good for a big party, where nobody's going to be discriminating. Plus, the technology is kind of cool. Plus, at $11 for the equivalent of four bottles, how can you lose?

8. Jezebel dot com:

A great website for celebrity gossip, makeup tips, and girly things in general. Unfortunately, going to the website caused my computer to be infected with Brave Sentry, a malware program of a particularly nasty sort. In fact, now that I've upgraded my firewall, installed malware detection software, and regained access to my computer's registry, I can see that I get an average of 128 attempted downloads *each time* I visit Jezebel. Try Too Fat For Fashion or Faking Good Breeding instead.

Verdict: Unless you want to spend four hours fixing your computer, avoid.

Saturday, July 28, 2007

House Blog.

They say that some things sound the same in any language. I can attest to "Shake it, don't break it" and "Hey, baby, give me a piece of that" sounding the same in gutter French or Swedish. It seems that "What the hell are you doing?" and "Stop, dammit!" sound the same in Spanish as they do in English.

The Foundation Fairies* are at work on the New House.

I could swear that I heard a guy say (translated badly from gutter Spanish), "You call that level? My *grandmother* could level better than that! Where are your eyes??"

I also heard, quite clearly, one of the Foundation Minions tell another, "That crazy (female) gringo doesn't know shit. Go turn the power on, willya?"

Things have progressed markedly since the days of hammering on the floor with one's fist and shouting. Now the Foundation Guys have laser levels that beep repeatedly when "level" has been reached. There's a limited amount of shouting and insulting that the Head Foundation Guy can do, but this HFG puts his all into it. There was an interesting call-and-response pattern I heard this morning as I was painting, all of it in Spanish; most of it I couldn't understand unless I concentrated.

(from under the floor) "Hey!"
"Bring this up two more!"
(under floor) "Bring it up two more?"
"Two more! Two more!"
(under floor) "Like this?"
"Like that!"
(under floor) "Like this?"
"Just a little! Just a little!"
(under floor) "Like this?"
(A flood of descriptive and abusive Spanish that, while interesting, lost me about a third of the way through.)

It was all done in the most gorgeous (and here I'm dropping all snark) sing-song, with a sort of heave-ho mentality issuing from the depths of the foundation.

These guys work *hard*. As I told my Sainted Father that one time, it's the Illegal Immigrant Work Ethic that has made this country great.

The electricity is done, thank Frogs, and the work was passed by the city inspector. I kinda wonder who the Electrical Fairies bribed, since I didn't have the smoke-detectoring up to snuff. The living room is totally painted, and Penny The Lotion Slut's guestroom is painted the most gorgeous color of pale sunset peachy-pink you can imagine. I would've done the rest of the painting today, but I got the feeling I was really in the way of the Foundation Brownies.

In a few days I will start, with Chef Boy, on the Great Bathroom Remodeling. We'll see how many wine boxes from Target it takes for me to retain my sanity during that process.

*I call them "Fairies" not because they're fabulous (oh, snap!) but because they come after I leave and are gone before I come back, accomplishing immense amounts of work out of my sight.

*** *** ***

In other news, I once told the story of a patient who'd had five (five!!) spinal cord AVM embolizations. I am pleased to report that that patient, who was paralyzed from the chest down the last time I saw them, walked back up to the floor on Wednesday to say hi.

Occasionally this job has benefits.

Thursday, July 26, 2007

Wednesday, July 25, 2007

My cat is aloof. What's it mean when she curls up with me?


The Weirdness of Id

How much must this suck?

You're walking around fine and dandy one day when suddenly your brain bleeds. Intraventricular hemorrhage, subarachnoid hemorrhage, whatever: suddenly, you've lost your inhibitions, your ability to form coherent sentences, and your will to do anything. You are, in short, a perfect candidate for employment on our unit.

The one thing that's better than it was before is your brain's ability to get into a groove. That would be okay if your brain were focused on ponies and butterflies, but it's usually not. In fact, I've only met one person in five years who grooved on positive things. The rest of the brain-bleed population lives nightmares over and over and over.

One patient, born in America of Iranian parents, was stuck in Paris on September 11th, trying to get home. Over and over. Another was in the middle of divorcing her abusive husband and on the run, something that had happened forty years ago. A third was trying to get the ambulance for her horribly injured youngest child. Over and over.

Mostly, people who groove on nightmares are quiet. Anxious and confused, but quiet. They can't be reoriented (sometimes trying just makes it worse) but usually they can be calmed. And, eventually, the brain heals itself to the point that they can break out of that nightmare box. Until then, they talk constantly about the nightmare they're in.

Sometimes, though, Horrible is happening in somebody's brain and there's no telling what it is. We had a patient like that last week: perfectly fine one minute, he'd suddenly sit bolt upright in bed, eyes wide and face pale, and scream.

Something was coming after him, that's for damn sure. And whatever it was, neither he nor I wanted to see it again. I had a choice. He didn't.

I had no clue what he was seeing. He couldn't articulate it. I got the feeling from watching him, though, that it wasn't as simple as watching a buddy step on a land mine planted by the Viet Cong, or seeing his house destroyed by fire with his family inside. Whatever it was that came out of the walls at him came from his own mind. I don't scare easy, but seeing his face as Horrible came at him, just before he screamed, made it hard for me to sleep for a couple of nights.

Tuesday, July 17, 2007

I feel like a sicko. I saw "Harry Potter" tonight...

...and in one of the first scenes, Daniel Radcliffe is in a T-shirt.

A *snug* T-shirt.

My first thought?

"Damn. Look at that vein in his bicep. I could slide an 18-gauge in that, easy."

Monday, July 16, 2007


I picked seven cherry tomatoes, two bell peppers, and one cucumber.

The cantaloupe I inherited with the new house and garden is coming along well. Please send anti-bug and anti-bird vibes its way so it will actually get a chance to ripen. Thank you.

Sunday, July 15, 2007

Everybody's doin' it...

Dr. Sid is doin' it. Dr. Rob is doin' it. And now I'm hopping in, with my own simple rules and few for you physicians out there who want your patients to end up in my ample lap.

How To Have Things End Up As You Would Like Them To: A guide for physicians in our hospital

1. Please be aware that, as you've been told since your first day as a resident, nurses cannot call for consults. If you write an order for a consult, you're the one who has to call the doc. Wandering vaguely away from the chart rack will not accomplish your consult; neither will being mad at me for not calling. No matter how much you yell, this will not change.

2. If you are sending a patient from your office for a consult, please note that our surgeons have office hours. You, as the referring doc, can't just send a person up to the hospital floor with no warning and expect them a) to be admitted, or b) to be seen in a timely fashion. The doc you wanted is probably up to her elbows in somebody's brain and won't be available for at least six more hours.

3. Don't lie to me. Don't call me with the news that you've got a critically ill patient on his way via ambulance for immediate admission. Not only can I not *do* anything about that (you really should call the bed-board people for admissions), but I will be supremely pissed at you when, after a two-hour scramble to get an acute-care room opened up, your critically ill patient shows up walking under his own power, having driven himself to the hospital.

4. Understand that certain things are not our specialty. Let's say that you have a patient who's post-heart/lung transplant and who is having problems. I will do my best to send them to our sister facility, Holy Kamole, because *they* took over all the heart/lung transplants four years ago. It really doesn't matter how much you want them to be at La Schwankienne; we do neuroscience. We don't know a damned thing about transplants. It's not a personal slight; you don't have to holler. It's about the best care for the patient.

5. Having the admitting physician write a consult request for a particular specialist is, I guess, okay. It's not okay when it was your idea, when you're the one who'll be consulted, and when the patient is your mother.

6. And finally--listen up, guys--when you write a consult for an inpatient, be aware that the patient will be seen first by the resident or fellow, and later by the attending (once the attending finishes office hours or surgery or whatever she's doing). This is how it works in *your very own service*. Do not--I repeat, do *not*--get snippy with the charge nurse when the senior resident or a second-year fellow is the first to have contact with your patient. (You know who you are.) I have nothing to do with it; I can't help you; perhaps you should think back over your last ten years here and see if it's ever been different.

Thank you. You may all return to your regularly scheduled rounds. Please do not rack charts with new orders. Thank you. Thank you.

Friday, July 13, 2007

Head Nurse: The Lazar-House Edition

Take One Tablet Daily. May Cause Dizziness.

It's been wet here lately.

Wet and warm. And things are blooming. And beginning to mildew and mold.

Things are, in fact, so bad that condensation is beginning to form on the air-conditioner ducts in the ceilings of the hospital. That condensation drips on to the ceiling tiles and makes everybody panic, thinking there's an undiscovered leak somewhere. Which is a possibility, as bits of the hospital roof keep getting blown off or washed away by storms.

The immediate effect of all of this is that everyone is sick. We're used to living in a desert this time of year, so the effect of a decent climate sends us all for a collective loop. As you walk down the hallway in our unit, you can hear burbling coughs, the honking of noses being blown, and the sound of the percussion devices that Respiratory uses for pneumonia patients.

And that's just the nurses.

The patients, poor things, are in even worse shape. Bad enough you should have a meningioma or a herniated disk that needs repair--imagine having a condition like that in combination with a chesty cold or a zinging sinus infection. One poor woman came in with such a bad case of sinusitis that we just kept her on a morphine PCA for a week. ENT was finally able to drain her posterior sinuses after she'd healed sufficiently from her meningioma removal.

All we need is for the lights to go out for a while so we can get some nice pitch torches. That and a few rags and a couple of clappers to knock together would set us all up as a group for crying "Unclean! Unclean!"

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

Extreme Whateverover

In Head Nurse House News, do you have any idea how much it costs to rewire a relatively small house?

A lot, that's how much. As in, somewhere north of a good pair of Manolos, yet south of a drawer full of mink. However, it has to be done, given that the electrician suggested I sleep with a fire extinguisher if I didn't want to replace the breaker box.

I've got the dining room mostly painted (this was before I was felled by the same Creeping Crud that's infected my coworkers) in a pleasant pinkish white above the chair rail and an extremely estrogenic rose color below. I'm now having pleasant dreams that involve inveigling good-natured friends into painting the woodwork while I scrub other walls. When it's done, I'll hang bottle-green velvet curtains over the window with a net curtain underneath. This will be, when it's done, a dining room that Lily Allen would be happy to eat in, foofy skirts and all.

The Foundation Guy is supposed to call me on Monday to set up a time to get under the foundation and add joists, replace joists, build new piers, and generally get things back to plumb as much as possible. I'm on call for the Plumbing Elves so that they can run new piping into what used to be a garage for the washer and dryer. With any luck they'll all show up at the same time, and my new refrigerator will be delivered, so I'll find a nicely rewired, replumbed, releveled house with the fridge already set up and plugged in.

And then Lily Allen will come to dinner.

Sunday, July 01, 2007

About a hundred posts per year.

This week is the fifth anniversary of my passing the NCLEX and being a newly minted, official RN.

If I had to break things down, I'd say this: the last four years have been the absolute best of my life. The fifth year, the first year I was a nurse, was tough--but still good.

When you're brand-new, you're still in that headspace from school--the one that makes you not want to make a mistake, ever. Ever. It's the mindset that tells you that no learning curve is too steep, no responsibility too big for you--you just have to get in there and do it. It's the same mindset that led me to be certain that I couldn't cut it as a nurse, that I'd surely kill somebody before the shift was out, that sent me (the dubious agnostic) into the chapel every morning before my shift to pray please God please, if you're up there, let me do well today.

After that first year (listen up, new nurses!) things don't exactly get easier, but you develop a routine and a flow. Bobbles that might throw you off for an hour or two get easier to handle. You develop a sixth sense for IV bags, so you can change them before they're empty. You develop the same feeling for fevers, so you can tell when somebody's actually sick or when they just haven't been walking as much as they should. You make up your own shortcuts--and I don't mean that in a bad way--that work better than formalized routines.

After the first year, your feet hurt less, because you've discovered good shoes. You know that going without lunch won't kill you. You've figured out how to manage a fluid rotation (peeing and drinking water) in thirty seconds or less.

During the second year, you find that other nurses will sometimes ask you questions. Certain things get to be routine, like starting IVs or managing minor crises. Bad things bother you less. You redefine "good outcome".

During the third year, you hit your stride in other areas. People calling you "nurse" no longer feels weird. The crazies don't seem to seek you out like they used to. You can see problems developing a long way away, and you finally have the wherewithal to avert crises. Care plans, those things you struggled with in school, finally make sense. More than that, you're making them up in your own head without any problem.

During the fourth year, things really seem to start coming together. You've got your routine down to where it feels natural. Your reports are short, sweet, and hit the high points. You know the guys in Radiology by name. You're finally good at making a bed with a person in it. You can see a patient in a holistic way, rather than as a bunch of problems and potential problems in isolation. You know which size of filter mask fits you. You know what size sterile gloves all your residents wear.

Now I'm in my fifth year. I find that people call me for tough IV starts (zut alors!) and for tough catheter and NG tube insertions. (Everybody has a schtick; mine is catheters and NGs.) Newer nurses ask me for advice. Older nurses bounce ideas and problems off of me. I've learned that leaning on other people and asking questions is a good and honorable thing. The residents and attendings respect me, and I've learned not to be afraid of them.

I've learned the value of teamwork and of occasionally staying late. I know how to fix, jimmy, or jury-rig almost every piece of equipment on the floor. I know where we keep the molasses, and I know where the bodies are buried.

A whole bunch of people I cared for are dead now, most of 'em from what they came in for, some of 'em from other things. More are still alive and doing well. Some have come back to visit. A few people I've worked with are dead for various reasons. Most are fine. We've been short-staffed, overstaffed, bizarrely staffed, staffed with floaters, agencies, and nurses so old they walk around with oxygen backpacks on. We've won awards as a floor. I've won a couple on my own merits, a fact which still baffles me.

I am five years older. I have grey hair now. I'm thirty pounds heavier. My feet hurt sometimes, and I've developed some odd varicosities in my ankles. I used to be intimidated and awed by those no-bullshit nurses who would get straight to the point and tell you something *once*; now I'm one of them. I can change a dressing, calm a fever, stop bleeding, resucitate a dying person. My sleep habits have completely changed. I can and will eat food from vending machines without complaint or adverse effects.

And after five years, when the nice man from the mortgage company asked me what I did for a living, I said, "I'm a nurse." And grinned.

Several days late, uncountable dollars short...

Here's the latest Change of Shirt.