Teh Kyoot: I Haz It.

No more Cheezfriends-Speak; I promise. 

These are the boys, napping in the green velvet chair right next to my desk. They spooned all the way from Kansas to Texas with minimal complaining. They're good kitties, and have already met Max. Flashes (grey tabby in the front) rubbed right up against an astounded Max, while Notamus (blue in the back) looked at him worriedly. I think Notamus will come around, though.

These guys are both lovers and demolition experts. Flashes has already figured out the physics of the rocking chair and Notamus has explored all the cubbies in my desk. Notamus also almost met an unpleasant fate when he made a leap for the toilet lid I had *just* raised--he did it with more speed than grace and had to be caught before he fell in head-first. 

They're absolute loves. Notamus is cuddlier, but both will accept paw-pad-touches and belly-rubs with pleasure. Both have thunderous purrs. 

I haven't had kittens in a while (like thirteen years), so this will be interesting. I imagine I'll know by tomorrow evening what I should've already kitten-proofed.

Drive-by posting....

First, from Faithful Correspondent and Lotion Slut Pens, a link for those of you who can't figure out how to pronounce all those new words in your science texts (note that this will probably only be useful for those folks in the US, as everybody else in the world talks weird):

Pronounciation Dictionary for Medical Terms

Pens points out that "clicking on the handy-dandy little speaker icon is a beautiful thing."

Second, posting will be really light for a couple of days to a week. I'm off to see Faithful Correspondent and Mid-Century Doyenne E and do the Great Kitten Retrieval 2009. It should've been this past weekend, but Mister Cold Miser made that impossible, as the roads were impassible. The Great Kitten Handoff 2009 didn't work out either, for the same reason.

Anyway, if all goes well, I should have this by the end of the weekend:

Sans babysitting Siamese and socks.

So. If the constant "Mew! Mew! Mew! Mew! Mew! Mew!" doesn't drive me mad after ten hours on the road, I'll be back later this week.

I can't believe I'm having to go over this again.

*sigh*

You would think, after however many years I've been doing this, that I would cease to be surprised by people. Or at least that I would become inured to their behavior. Sadly, people continue both to surprise and irritate me. 

My patients, generally, surprise me but don't irritate me. My patients, generally, are quite unwell. Therefore, they do crazy-ass shit now and again, but it's rarely something they mean to do. Their families and visitors, on the other hand....

1. It's a hospital, not a drag-racing track.

If your darling children (all of whom seem old enough to know better) continue to play dodgem and drag-race in our wheelchairs, you and I will have words.

2. Smoking is not permitted. Really and truly.

If you go into the bathroom and turn on the shower, then open the window in the room, then attempt to smoke, I will know about it. And I will be unhappy.

3. Please, for the love of all that is holy, do not take out Mama's drains. Even if you are a physician.

Considering that Mama's surgery was on her neck, and that there's a lot of important stuff in the neck that doesn't do well when it's compressed by fluid accumulation, it would probably be wise to leave those drains in place for more than twelve hours.

Especially do not remove Mama's drains (even if you're a physician) by grabbing them and pulling. They're probably, you know, *stitched in*.

4. Likewise, please, for the love of all that's holy, do not remove Papa's trach tube.

He needs it to breathe. Yes, he's acting like it bothers him. It does bother him. Having a tracheostomy tube sucks rocks. However, it beats the alternative, which is not breathing.

5. Now is neither the time nor place to attempt to rebuild your stable of hookers.

You heard me, Big Pimpin'.

6. Nor is it the time or place to attempt to buy large quantities of illicit substances.

We allow pretty much anybody to come visit. I draw the line, though, at a steady parade of shady characters (unless they're residents) who are looking to exchange their fun pills for your money.

7. Come to think of it, why don't you just let me take those narcotics for you and lock 'em up?

I know Mama doesn't feel well. Mama had a grade 3 brain bleed and is lucky to be alive. The consequence of having had a chunk of your skull removed is a headache, but again, it sure beats the alternative. However, if you insist upon crushing Brother's Oxycontin and putting it under Mama's tongue, the alternative will be what you get.

8. No, I will not marry your son and give you grandbabies before it's too late.

Neither will any one of the more than dozen hospital employees to whom you've posed the same question.

9. You may not ride your Segway up and down the hall. 

I can't believe I had to point this out.

10. The hospital is not the best place to have a bench-clearing brawl over who gets what out of Grandma's attic. 

If you're going to brawl, at least do it where you have a little more space, and where all the members of the family can be present at once. That way, I won't have to waste time answering the phone when those family members who weren't invited to Inheritance Cage Fight MCLXVII: The Reckoning call up to know what the hell happened yesterday.

And they wonder why I do beer reviews.

Oh, good Lord.

This was a blast from the past:

Yoiks.

A correction

My Brother In Beer* has informed me that I'm a dope. 

He put it much more nicely than that, but in response to my post about Boulevard's pale ale not being what I really wanted, he basically said, "You dope, Belgian-y is what we *do*, duh."

So, I take it all back. If you want a well-balanced, not-for-the-hophead PA, go for Boulevard's Double-Wide. It'll get you where you need to go.

If you're still a hophead, try Brooklyn Brewery's East India Pale Ale. That, too, will work fine.

*Dear man, I love you like I love my own gallbladder, but your hair is cut much, much too short. You look like a Midwesterner.

Brother Bruce's Big Bargain Brain Bleed Bazaar

Sunnydale General has turned into the place to be if you've had a brain bleed. No matter the type--subdural, epidural (what killed Natasha Richardson), subarachnoid--if your brain has bled, you're in like Flynn.

Which means, of course, that I've had an average of five patients a day for the last week, four of whom can walk, and all of whom are confused/delusional/generally disoriented.

Which means I've been running my rapidly-widening ass off, trying to keep my patients from (variously) finding a policeman to report some crime that they can't articulate, going downstairs alone in a bad neighborhood to smoke, getting on a bus that isn't there, delivering twins that don't exist, and going to the movies.

When blood gets somewhere it shouldn't inside your brainbox, weird things start to happen. The most obvious is that blood isn't supposed to leave its conduits, so your brain tissue gets really irritated. It's like meningitis, with the attendant pain and sensitivity to light and sound. Then you have the issue of what happened immediately after the bleed: some people end up with ischemic areas of the brain because their vessels clamped down right after the one vessel burst--it's the body's attempt to minimize the problem, but often it makes things worse. And, finally, all of that's compounded with ICU psychosis, because all of these folks have been in the ICU, with its constant noise, light, and disturbance, for a period of days to weeks.

To put it bluntly, you get very, very weird after a brain bleed. Initiative disappears (unless it's the initiative to do something like wander out of the hospital and into traffic), you get easily distracted, your balance suffers, and you hallucinate. 

All of that makes it fun for the nurse who's taking care of you. (I have no idea what it's like to be inside the braincase of somebody who's had a recent bleed, but it can't be a picnic.) I'd say that the distractability is the hardest thing to deal with: it's difficult to get a person to do something as simple as take a pill. Just the steps involved: grasp pill cup, bring to mouth, open mouth, etc. are too difficult for the post-bleed brain to handle. So the person sits there, meditating on God knows what, pill cup in hand, while the family tries to help by repeating the same instructions over and over. You can imagine what that does: sets up a feedback loop inside the injured brain, until the person in posession of the brain gets agitated, flipped out, and very worried.

I still like taking care of people who've had bleeds. It's fun. (No, really.) Something as simple as a two-hour nap can make a confused, agitated person into someone who's just a little stranger than baseline. It's also nice in that, unlike things like concentric sclerosis and optic neuritis, you can see people get better over the course of a week or so. There are drawbacks, naturally--the primary one being that, as people get better and stronger physically, the brain lags behind.

Which is why I've run my ass off. Sometimes the only thing you can do for someone who's delusional, agitated, and insomniac is exhaust them. I walked four people around in circles yesterday until I felt like my own feet would fall off. Three of them ended up napping heavily afterwards, while the fourth had to be restrained by Security and prevented from going out to buy some drugs. Three out of four isn't bad.

Oh, and that fifth patient? Once we figure out what's causing the encephalomalacia (brain softening; my new favorite term), we'll talk about that.

Here's a Before photo for you!

After coming later.

Okay, okay, okay.

I promise to post pictures. Sometime after this weekend, when I'm done working three days in a row. 

Right now, though, I'm going to continue to cook potstickers and make crackers.

There goes the oven timer!

PS: Leaf-Nosed Bat in the comments is my cousin Dan, who doubtless has plenty of incriminating "before" pictures--from when I was three years old.

Obligatory Occasional Girly Floof

I may have mentioned in the past that I have curly hair. 

For years, I thought my hair was just wavy, not curly. Then, after living for a short time in California without benefit of hairbrush or hair dryer, I discovered it was curly. Not *curly*-curly, but at least more than wavy. 

Since then I've been fighting a losing battle against Pyramid Head* and frizz and hair-in-face syndrome. Even at the best of times I've looked more like Roseanne Roseannadanna than like Nicole Kidman--which is not a bad thing, necessarily, but wasn't what I was going for. So after doing some research and dithering about and avoiding the phone, I finally made an appointment for what's called an Ouidad Carve And Slice haircut.

Ouidad, for those of you who don't know, is a woman who a) goes by one name and b) has developed a technique for cutting curly hair that rocks socks. A "carve and slice" is a proprietary haircut--there are only twelve or so salons in the country that have Ouidad-trained stylists--and it's meant to regularize curl patterns and keep curly hair from looking like a bush, pyramid, or big blocky mass.

It's not a regular haircut, that's for sure. I'm not certain if it was the haircut itself or the fact that my stylist was a little weird, in a good way, but it didn't seem like she had any real pattern or plan for That Which Ruled My Head. Instead, she'd grab bits of hair, seemingly at random, and run down them with the edge of a pair of very sharp scissors, planing off bits of hair. That's the "carve and slice" bit of the cut. 

What this does, according to the theory, is allow the curls to sit inside one another with near-mathematical regularity. Thus, rather than having a mass of curls that just sort of...pile up on each other, you get nice, well-behaved ringlets (in my case) that have the extra poofiness planed off. 

You would think this would make your hair thinner. It does not. True, my hair sits closer to my head, but only because it is actually in defined curls, rather than in a large mass that extends past my shoulders in every direction. You would think this would make your hair shorter. It does not. (No shit! Really!) Because I'm no longer carrying tons of poof around, my hair is now at my collarbone rather than just barely brushing my shoulders.

After I baked under a dryer for ten minutes with gel (this Ouidad stylist doesn't make you leave the salon with dripping-wet hair, thank Frogs), said stylist ran some sort of anti-crunch anti-frizz stuff through my hair and then made me shake it out gently. I am not shitting you in the least when I tell you that every single person in the very full salon turned to look. Several conversations stopped dead, and I heard at least two "Oooooo"s. I went from having a mass of impressive, unruly red hair to having beautifully behaved, shiny red ringlets in about an hour and a half. 

This haircut was miraculous. Seriously. I'm never going to be more than three hours away from an Ouidad-certified stylist again. And I am not generally a vain woman. I do not put on makeup to leave the house, and I don't much care what I'm wearing at any moment. This, though, was such a good haircut that if the woman who cut my hair were abducted tomorrow by aliens, I might consider shaving my head.

So: curly-haired people: consider a Ouidad cut. It cost me a hundred bucks, but The Miracle Worker tells me I only have to have it done every four to six months or so, when the poof returns. That's not such a bad deal--especially when you consider that the whole process took 90 minutes and did not involve any hard-selling of Ouidad-brand products. 

*This would be an excellent name for a beer. Get on it, brewers.

Because I am feeling a little blue today, music:

Jo's Fun List Of Medical Terms Nobody Can Pronounce!

It's that time again, kiddies! Sit yourselves down and get ready for a wild ride through medical terminology. Today we'll be covering Things Nobody Can Pronounce. Ready? Go! (Please keep your hands and feet inside the vehicle.)

La belle indifference: This is a symptom of conversion disorder. It's what happens when a person shows utter unconcern about whatever symptoms they've got, regardless of how scary things get. 

Homonymous hemianopsia: I still get tangled up halfway through this one. It's a complex, yet quick way of saying that a person has lost the same field of vision in both eyes.

Prader-Willi Syndrome: My personal definition of hell. It's a spectrum of disorders caused by a deletion or doubling on chromosome 15, resulting in a person's never, ever, ever feeling like they've had enough to eat. There are related problems (including a lack of muscle mass and sometimes mild mental retardation), but the feeling of overwhelming and constant hunger is the hallmark of Prader-Willi.

Glioblastoma multiforme: Look in the dictionary under Do Not Want and you'll find this particular brain tumor. It's the most common, most lethal, and least-treatable brain tumor out there.

Hemiasomatognosia: aka "neglect". A person who's had a stroke or other brain injury forgets about half of their body. In severe cases, they lose all concept of one side of the universe, so that "left" or "right" no longer exists. 

Apneustic breathing: It happens when you get a bonk or a tumor in your lower pons (v. important part of brain): you breathe in deeply, pause, breathe out...(wait about a minute)...repeat. 

Astasia-abasia: A person tries to walk, lurches around, weaves, and finally falls over--but only falls when there's something soft to land on.

Flocculonodular lobe: It's a part of your cerebellum. I learned this term once and have never used it again.

Aphonia: The inability to speak.

Blue Rubber Bleb Nevus Syndrome: Yeah, this one's easy to pronounce, but I included it just because I love the name. Unfortunately for people with Blue Rubber Bleb Nevus Syndrome, the condition isn't as fun as its moniker: it's a problem of venous malformation in which the person ends up with extremely painful, constantly-bleeding lesions all over the inside and outside of the body. 

Oligodendroglioma: A brain tumor that arises from the cells that insulate the electrical wiring of your brain.

Aaaaand that's it! Everybody okay? Good! Unbuckle your seat belts. You may now return to your normal life with some fun bits of knowledge that will serve you well at the next party you go to.

A simple request....

I have both Lyle Lovett and Boulevard's Double-Wide IPA floating around in my head tonight.

Boulevard Double-Wide IPA: (stealth product review!) It's okay. It's good, even. Not a genie in a bottle, and I would've preferred less Belgian-style head and darkness and more clean, aggressive hoppiness, but that's just me. The label admonished me to drink it out of one of those roundish glasses that stands on a little pedestal, but I haven't got those, so jelly jar it was. 

Lyle Lovett: Always good.

A simple request for all of my patients:

Please understand. Please don't be angry or snippy with me. Please don't make me hand your head to you after you're a jerk.

It's just that, you know, when there's one patient coding and another whose leg has suddenly turned a dusky blue and gotten cold, and a third who's bleeding uncontrollably out of her rectum and a fourth who is seizing, *your* particular request--that the IV fluids Mama's getting be turned down because "she's peeing too much"--might come fourth or fifth on my To-Do list.

I will turn down Mama's fluids from 70 to 30, but only after I make sure everybody else on the floor is breathing. As the oldest/most experienced/best at starting IVs nurse here, it's kind of my responsibility. Kind of like interrogating that drain to make sure there isn't a split in the tubing that leads from the brain to the bag is my responsibility.

Please, please, *please* do not overburden the already-overburdened charge nurse with your request. It only makes you look like a twit. And please, for the love of all that's country & western, do not be snarky when I show up to ("Finally! [eyeroll]") turn down the fluids, because that might make me morph from Nurse Jo to Take No Bullshit Abortion-Clinic Jo. And that's ugly.

Thank you.

In Which Jo Goes to the Opthamologist and Gets All Steampunk On Your Ass....

...and reviews a beer. A really mediocre beer. A sex-in-a-canoe beer. In a word, Dundee: Avoid.

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

So I went to the eye doc today. This is a fraught event for many reasons, least of which being that, when my eyes get dilated, they *stay* dilated for 24 hours or more. I was dreading the dilation and the feeling of being totally bat-blind while in public and then of having no close vision while at work in the morning. (And no, I don't know why my eyes stay dilated. I stayed stoned for 72 hours the only time I tried smoking weed, and I can't tolerate narcotics. Must be something inside.)

Technology, thankfully, has caught up with us bat-blind people. My doc has this new thing called an OPTO-MAP (ACQUIRING TARGET: RANGING: HIYA BABY) that requires no dilation to read a 200-degree map of your retina. It takes about thirty seconds and totally rocks out: there's a bright green light that blinds you for a brief moment, and then look! it's your photogenic retinas on the computer screen!

I must say that I have very cute retinas. My optic nerve is darling, as well.

Anyway. The ratio of my optic disc to optic nerve is five-point-nine when it ought to be five or less, but it's the same in both eyes and hasn't changed lately, so I've not got glaucoma. Yet. Likewise, my vessels aren't tortuous, and that little freckle in my left eye disappears with different color screens, so it's not melanoma. I was absolutely certain that missing an eye appointment last year would land me in the "horrible incurable eye disease we'd better just take that out right now hold still" camp, so this is good news.

However, my eyes are still bad. As in, really bad.

As in, the lenses for my new glasses (which I have not replaced in a decade at least) cost somewhere north of shocking and somewhere south of a mortgage payment.

It's bad news when the therapeutic optometrist who's in charge of fitting you with glasses ixnays all your choices for frames on the grounds that they would be too large. Not because you would look matronly, but because your vision would be impaired with the type of lenses you need.

So I have itty-bitty constipated librarian glasses with a mustard-yellow and turtle-green Pucci print on the frames, and horrifyingly expensive toric prismed carbon-fiber super-thin technologically magnificent lenses that will do everything but my laundry for a good three to four years.

Which means that they'll only cost me between one-and-a-half and two bills a year to wear.

*sigh*

You will be pleased to hear that Practical Nurse Jo refused the thick-templed glasses, the glasses with jewels on the sides, and even an adorable pair of frames with orange-red miniature rhinestones on them which rocked her world, just so she could look professional in case she has to wear glasses at work.

Pictures forthcoming. On my old cruddy digital camera, as I now have no money to buy a new one.

*sigh*

Whaaaa?

Allergies are common. Everybody's allergic to something, be it pollen, the resins used to keep no-iron cloth no-iron, narcotics, cedar, dogs, cats, tomatoes, strawberries, wheat, milk, Republicans, whatever. Everybody has a tendency to have that ol' immune system get out of control once in a while and serve up a course of rash and hives and "whelps", which are what the rest of us call "welts".

(Conversation: Patient: "Whenever I take penicillin, I break out in whelps all over." Me: imagining patient covered with puppies.)

You get used to handling allergies at a hospital. Sometimes a patient has some sort of infection that can only be dealt with using an antibiotic that has cross-reactions with something they're allergic to. Sometimes a patient will have an unexpected reaction to something that they've never had a problem with before, which is how allergies work. You get the Decadron and the Benadryl IV and have the respiratory guys on the pager and you deal.

How-sum-ever, I have now seen something that had me literally scratching my head as I tried to figure out how the patient in question managed to survive in the outside world.

Four typed single-spaced pages of allergies. 

Four. Pages.

With additional editorial comments on the nature of the reactions to said allergens. The reactions weren't the run-of-the-mill "I itch when I take narcotics" variety. Nor did this patient have hallucinations when exposed to morphine--which is not technically an allergy, but will sure stop us from giving you more morphine. 

No, these were things like (and here I am giving a representative, fictionalized example) "Percocet: Causes unbalanced energy fields." "Beef: Candidiasis and sluggish bowels." "Latex: anaphylaxis." That last is sometimes a real deal, and it means you either have to be in a positive-pressure room or take your chances, as latex ends up in the air ducts and can be all over the hospital. Somehow, though, he managed okay with the (latex) balloons in his room.

Dude was allergic to non-ionized water. 

I. . .I. . .I for once am without words. Four pages of allergies. Four pages of things that you have gone to the trouble to decide you aren't tolerant of, can't have in your body or around it, can't deal with. Four bloody, be-damned pages of allergies, any of which might unbalance your Chi, slow down your lymph recirculation, or cause you to become a horrible wheezing swollen mass of welts.

Listen, I am not an ogre. There are some folks who have multiple drug allergies; usually they've undergone some sort of unpleasant treatment for, say, an intractable infection or chemo. There are people who can't tolerate some foods. I myself live on generic Claritin year-round and have to scrub after I touch a dog or cat. There are allergies out there that can make your life difficult and dangerous. We'll take that as read.

But four pages? Including non-ionized water? (How on earth do you ionize water, anyway?)

Have you thought about maybe focusing less on yourself and more on the outside world? It's entirely possible that some of those allergies would go away if you'd just relax and get out of your own head. 

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

In other news: People, don't do meth. I had a patient this week who is a full twenty years younger than me (in other words, not quite past her sell-by date, according to the fashion industry) who had no teeth. Full set of dentures, upper and lower. No. Teeth.

Do yourself a favor: develop a permanent allergy to methamphetamine.