I need some friends in Japan.

Seriously.

I've adjusted well to this night-shift thing, but it's frustrating to be awake at 3:30 in the morning and not be able to interact with anybody else. Normally, I'd spend days off at the used bookstore or the coffeeshop or at the dog park, but all of those places are closed overnight (except the coffeeshop, and who wants to be in a small room with hookahs going at oh-dark-thirty?).

So I've worked up a couple of projects to keep me from going stir-crazy. Nothing like painting the kitchen cabinets (sadly) or mowing the yard (more on that in a minute), but projects. To wit:

First, a review of basic A&P. I've been doing brains and spines so long that I've forgotten what happens in the belly and kidneys. The review we got during internship classes was nice, but not enough. If anybody has any good A&P books to recommend, please leave them in the comments.

Second, physics. I was reminded tonight of the fact that subatomic particles that have begun to dance with one another will continue that dance, even if they're separated by the length of the universe. That fact blew my mind the first time I heard it and charmed me this time; I've decided to start on basic physics. And re-read Bill Bryson's book on Everything while I'm at it. (I only got three-quarters of the way through the last time.) Please do recommend physics-for-the-general-reader books in the comments as well.

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The funny thing about working nights is that you discover how many people have done it, and how many people are willing to give you advice about it. Pastor Paul next door did an overnight shift a year ago on a crisis line run by his church; as a result, he has lots of tips on how to get through hours of boredom punctuated by moments of intense activity. He offered to lend me his miner's helmet-with-light so that I can mow the lawn in the middle of the night come summer. He did it last year; we both have Neuton mowers, which sound like nothing more than a large box fan on "high", so it's not going to annoy anybody.

The Brother In Beer is working nights these days, too. It's harder on him than it is on me; he's got a crazy schedule that alternates short shifts with long ones. The nice thing about that is that when I get home at 0730 and crack open a pale ale, he's got his chat window open and is doing the same thing.

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If you need a giggle, check this out: Medical Acronyms and Doctors' Slang. I snickered most of the way through the page, then came out with things I plan to use at the first opportunity, like "acute lead poisoning" and "foreverectomy".

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In non-nursing-related news, I have birthday plans thanks to my pals in BFE. The way I spent Thanksgiving will be the way I spend my 40th, huzzah, with the addition of a space heater and a down comforter. The cabins out at La Ranchita Skankola are unheated, and it gets cold at night way out west of here. There will be a barbecued goat, some tiramisu, probably plenty of tequila, and possibly some dancing. I plan to stay up late, sleep late in the morning, and drink boiled coffee. The Brilliant Friend has promised much fun; her boyfriend cherishes hopes of setting me up with his brother. It should be a good weekend.

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Finally, finally, one of my patients was allowed to die this week.

I understand that families have a hard time letting go--that is, I understand in an intellectual way, not having been there myself yet--but this time was horrifying. When you develop a syndrome that barely has a name and that has only been recorded four times previously, all four of which have been fatal, the assumption should be that we 1) won't know much about what's going on, and 2) won't be able to stop it.

It's bad at any time to not be able to help, but it's worse when the person who's sick is eighteen and full of promise.

We ran every drip we could think of to keep her pressures up, coded her seven times in one shift, reset her vent every two hours or so to keep her tidal volumes up, and finally were allowed to extubate her. She died in less than three minutes.

I heard a poet say tonight on the Beeb: "It's difficult to write about a cataclysm and be convincing." The same handicap applies when you're trying to tell the story of somebody young and brilliant and vivacious, who's hit by an unfortunate over-reaction of her own body to an infection that she got when she was a child. I could tell you about how her sense of humor disappeared as she got sicker, or how she got more and more worried about her mother coming to visit, or even how her father and mother--estranged for a decade--sat together on the couch in her room, but it wouldn't be convincing.

At the end, when she was still able to talk (before she was intubated), she was earnest. Everything she said was without unnecessary verbiage or drama; every word counted. Movement was a luxury, so even lifting a hand took on a significance it wouldn't have in the Well World. Yet she still thanked us for little things, like fluffing a pillow or turning her when she couldn't do it herself. She still had the strength to be concerned about her mother seeing her this sick. She still said, "Goodnight" and "Have a good nap" when I went home in the morning.

Sometimes the smalltalk, the passing remarks, become so important. They're the things that keep you connected to a world you no longer live in.

Goodnight, child. Have a good nap.