Take *that*, work frustrations.

This post was going to be titled "When Morons Attack".

But I ran a mile.

Then I lifted weights.

Then I stretched. And did some yoga.

And now I'm cheerful and warm and relaxed and no longer concerned with morons. Instead, I think I'll go buy some doggie nail-clippers and then hang out with Max for the rest of the day.

Spring. Sprang. Sprung.

This is the time of year when it's hard to go to work. The weather is beautiful, the birds are singing (did you know male mockingbirds will sing all night long in search of a mate? They will. Especially the ones in my back yard), Max is wanting belly-rubs, there are music festivals and art shows outside in the sun, and I'm stuck inside with patients with disseminated vasculitis and brain stem tumors and stupid, stupid families.

The past few weeks have been a sojurn in the Land of the Tiny-Brained.

For instance, if you have a family member with a fistula that communicates between esophagus and trachea, and that person is unable to swallow in the first place, and has a tracheostomy to make it possible for them to breathe without choking, and the nurse has said six times in the last three hours that you are NOT to FEED that person, why on earth would you try to make them eat oatmeal?

I spent ten minutes deep-suctioning oatmeal out of the guy's lung.

Likewise, if you have the nastiest chest wound in the history of ever, and you're going for your fifth surgery to debride it, and you've been told over and over not to eat or drink anything preparatory to surgery, why would you tell the anesthesiology resident who comes to consent you that, by damn, you *are* going to drink this Dr. Pepper, and he's not going to be around if and when you get aspiration pneumonia, so he shouldn't worry his pretty head?

 Just because you had an LPN license for six months twenty-five years ago does not mean you necessarily know more about anesthesia than the guy who does it for a living.

And, finally, if you have the nastiest stomach wound in the history of ever, one so bad that you had to stuff washcloths in it to keep the pus from pouring out and getting all over your clothing, why would you undo the work of two surgeons, a wound-care nurse, and an hour of OR time to undo your wound-vac dressing and stuff the wound with washcloths again?

"It needs air to heal" is not an acceptable explanation.

I'm not even going to tell you about the disseminated vasculitis patient who screamed. Constantly. And cried and whined and hollered. Not their fault; vasculitis in the brain makes you completely crazy. But still, it's difficult (note ironic use of understatement!) to deal with a screaming, crying, whining, abusive patient for twelve hours straight when the other three people you're caring for hit the call bell Every. Twenty. Minutes. Without. Fail. All. Shift. Long.

And this was, comparatively, a good assignment. The other patients on the floor were worse.

Nobody wants to go to the hospital. No sane person wants to spend any more time than necessary indoors during the six weeks of the year when the weather here isn't actively trying to kill you. That, unfortunately, means that the only people in the hospital right now are both very, very sick and completely nuts. And, according to a newly-delineated Universal Law, the amount of shit you get from a family is inversely proportional to the total number of teeth in the room.

I was considering throwing up my hands and becoming a bank robber yesterday. Or a train robber. On a pink Vespa scooter. With pink leathers and a white full-coverage Bell helmet with a reflective faceplate. And saddlebags with fringes. 

The pharmacist on call looked at me thoughtfully and said, "I'm a little concerned that you seem to have thought this out so thoroughly."

Well, yeah. The one thing that's stopping me is the knowledge that if you get caught robbing trains, your time inside doesn't end at 7 pm. 

A Day In The Life

Getting Better All The Time

There's been an outbreak of what I'm convinced is norovirus at work. Norovirus is That Nasty Stomach Bug family of viruses--the sort of bug that incubates in a day or so and takes a day or two to resolve. Since all nurses work some degree of sick most or all of the time, it makes sense that something that could only be eradicated by bleach and scrubbing might be lurking in the viral soup that is our hospital.

My turn was yesterday. I was pretty damned puny, but Chef Boy brought over bread and ginger ale, and I ate soup and laid on the couch, making noises like the cartoon woman in the introduction to "Mystery!" Today I am better, though not enough better to, say, climb the Matterhorn or work out. I shall (she says, determinedly) finish the laundry and nap.

Sky of Blue, and Brain of Green

What makes your brain the color and consistency of pea soup in about three days?

I wish that were a riddle. Instead, it's something that happened to one of my patients (now dead). Mayo took their sweet time over the biopsies and sent back a detailed pathology report that said, in essence, "We have no fucking clue. Try Hopkins."

It's been about five years since we had a patient who had a true God Only Knows diagnosis. That last one garnered laurels for a couple of fellows in neurology who presented a paper on the patient's decline. What it did not get anybody was a name for that person's condition, a cause, or a cure. 

Dr. Dink, the psychiatrist who writes my prescriptions for Happy Brain Pills, said, "Well, those are the interesting cases, you know." Yeah. Interesting. Because it's never any fun at all when somebody gets better. That gave me an insight into the shrink personality.

Fixing A Hole

Finally, a non-neuroscience happy ending. 

A couple years ago we had a patient with a big hole. I mean a *big* hole, the sort of thing you could easily put your head in. Mediastinitis, it's called, and it's an infection in your chest that's usually caused by rupture of one of the organs there. In this person's case, it was the result of surgical infection. The hole went from the middle of the breastbone down into the belly and tunnelled every which way. It was so badly infected, necrotic, and generally nasty that it took weeks and weeks to heal, and we had to repaint the room after the patient was gone--it smelled that bad.

He's fine. Two weeks ago, he came breezing in, more than a hundred pounds lighter and quite fit, totally recovered, and with only a half-dollar-sized, puckered white scar on his chest to show for his ten weeks of hell. That was nice.

Run For Your Life If You Can, Little Girl

In non-nursey news, I bought a treadmill. I am totally, totally in love with my treadmill, to the extent that I get up a bit earlier every day than I used to and hurple along for a few minutes before I get ready for work. It's quite fine. The cat has no opinion on it, while the dog looks at it with deep suspicion and loathing, but does not actually run off when I start it up. 

The damned thing weighs 300 pounds and has a control panel that looks like it belongs on the bridge of the Enterprise. I haven't yet discovered how to make it do laundry, but it does nearly everything else. It took two guys with experience in the process an hour and much multilingual cursing to put it together and get it working. Man, I love my treadmill.

You Like Me Too Much

I've finally had--and gotten rid of--my first patient-stalker.

It happens to everybody at some point: you take care of a patient who decides for some reason that you're the be-all, end-all, and that (to add to the weirdness) they simply must hang out with you outside of work and be your babydoll. This probably happens much more often to people in the brain business (be it psych or neuro), but hadn't as yet happened to me. 

Well, now it has. A traumatic brain injury will make a person think anything's possible. Thankfully, a combination of carefully-timed hiding in utility rooms and non-diplomatic "go aways" has made that patient, well, go *away*. 

If this ever happens to you, be aware: It's not always something you can predict or prevent. Especially with brain-injured patients, there's not going to be a way to control their reactions to your actions. The simple act of changing a dressing can, for them, become a declaration of your undying devotion. The best way to handle it is the way you'd handle a recalcitrant child: with firm repetition and without panic.

The End.