Why I hate working with Indian nurses

Because Indian nurses will, once they find out you like Indian food, start bringing you little tasty tidbits to try, including these crispy fried bits of rice flour and sesame and cumin that they press out of a gun into oil and bring still warm from the stove, and they'll shove the bag at you and say, Here, Try This, I Know You'll Like It, and then you'll be tasting something that's garlic and cumin and sesame and apparently dusted with crack, and no matter how much you protest that no, you're really back on your diet, you will find an entire quart-sized baggie of them in your purse when you go to reach for your car keys.

And then there will be nothing to do but eat them in the car, and that means you'll have to have a glass of wine when you get home.

And that is why I hate working with Indian nurses.

(But not really.)

Please bring more of the crispy little snackitudes of doom. Thank you.

Sunday night wrap-up:

It's a pygmy jerboa, but it looks like something out of The Phantom Tollbooth.

In which Jo goes all Martha Stewart on yer ass and has success!

OMG PONIES!!!

There's this design blog called Little Green Notebook. I'm not totally wild about some of her style choices, particularly with regard to animal print, but most of the stuff she puts up is gorgeous. I'm just more of a minimalist these days.

As a result of this new minimalist approach--which I think has a lot to do with the fact that it got so freaking hot so fast--I'm redoing the living room. The mint-green walls and black-and-white curtains have gotten oppressive. I'm painting everything white and buying a new couch (from here; check this out and get off the floor--is it cool or what?) and changing what's on the windows.

So. Roman shades. I like 'em. They're not frilly-girly, they're good at blocking the light, and they don't require dusting. Most importantly, they're not curtains. But damnation are they ever expensive--the cheapest I could find started at US$179 for my little-bitty single window. Given that I eventually have to cover six windows (living and dining room, plus the four in the study), that was simply untenable.

Therefore, behold the $3.99 roman shade!

Yes, the slats show through. I plan to remedy that next time, by backing the fabric with blackout fabric (for the study, which faces southeast and gets early morning sun). I may go ahead and mess with this shade, so that the slats aren't too obvious.

For some reason, my math wasn't right, and I ended up with some extra slats left over. That wasn't a problem; the way it turned out is just fine with me. Considering this shade was made with the assistance of two cats and a glass of wine (or two) (or three?), I think it turned out pretty well.

The worst of it was that I still can't raise my left arm higher than my shoulder, so screwing the brackets into the window frame was... ... ...well, let's just say that I considered asking the neighbors for help, bursting into tears, rehanging the curtains, and moving out of this house, in that order. I eventually managed it one-handed. That's my 18-volt NiCad powered power drill on the couch, next to Notty.

Cost breakdown:

Curtain, cut down to make the shade: Free, as it had hung in myriad houses over the years.

Spray adhesive, to attach fabric to blinds: Approximately fifteen cents.

Vinyl mini-blind, from Wal-Mart (and going there was the second most painful part of this whole project): $3.99 plus tax.

If you use a patterned fabric, or one that's a little thicker than the loose cotton weave of the former tab-top curtains (God, how I've grown to hate tab-tops, and curtains in general, given that the boys climb them), you won't have the problem of the slats showing through. Likewise, you could always line the shades with blackout fabric (NOT the stuff you buy at the store; that's been cut in half and only measures 23" or so across). You could also, if you're less lazy than I am, actually *hem* the dadratted things rather than just turning them under and gluing them to the slats.

I have a buddy (Hi, Rob!) who has offered to help me hang a ceiling fan; he's good with a power drill; I might have him come down in his copious free time and hang Roman shades instead. Rob is handy not only because he offers to help with stuff like this, but in that he's 6'5", so he doesn't need a stepstool. (Plus, he's known me since we were both eight years old, so we have plenty to talk about. Plus-plus, his boyfriend is a freaking doll.)

Oh. Speaking of ceiling fans, I'm strongly considering this, which comes with a 3-inch downrod. It's silly, but I love it for that reason: it reminds me of the Ork from the OZ books.

Yeah, so. The success of my first non-carpentry DIY project has inspired me. Watch this space for updates involving scatter pillows that have elephants! and sequins! and beads! on them.

The cats' thought processes, two a.m. edition:

"It's a mouse."

"Dude. You sure that's a mouse?"

"Yep. It's a mouse. Look at the way it's moving."

"What's a mouse doing in the bed?"

"I don't know, but that, right there? Is definitely a mouse. Watch. (swipes at lump under the sheets with one paw) See? It moved. Mouse."

"Hm. (swipes at other side of lump-under-sheets with paw) You may be right."

(Both cats sit for a moment and meditate)

"So what do we do about it?"

"Well, we're supposed to be killing those things. You know. Grabbing them with teeth and paws and biting their little heads and killing them."

"Oh. Okay. How do we do that?"

"You hit it from that side with your teeth, and I'll grab it from this side with my claws and kick it really hard with my back legs. It's a big mouse."

"Yeah. It is a big mouse. We'd better get it right the first time."

(Lump under sheets moves slightly)

"You ready?"

"I'm ready."

"Okay... ... ... ... ...GO!!"

(Both cats attack Nuclear Mutant Bed-Mouse simultaneously)

"Holy SHIT! Who knew that mouse was attached to the Human?!"

"Who knew humans could levitate?"

"Why is she making those noises? She's awfully loud."

"Dude. We'd better get out of here. She's got the squirt bottle."

(Both cats beat it for the door)

(Finis)

A Conversation in the CCU

"Lortab. I can't imagine why anybody would choose Lortab."

"Maybe it was the only thing he had around."

"Still....if it doesn't work the first time out, it seems like an awfully messy situation."

We're talking about suicide.

Everybody does it. Everybody, that is, who sees the aftermath of the incompletely-resected glioma, or the failed aneurysm clipping, or the treatment for whatever neuromuscular disease that simply didn't work, or the outcome of a bone-marrow transplant that didn't take.

"Valium," someone says. "Valium and insulin."

That's my preferred way to go: several cc's of regular insulin on an empty stomach, injected IV with many dozen milligrams of mixed benzodiazapenes. I've talked about it with one of the surgeons here: he's agreed to help me out when the aneurysm I'm surely cooking in my head blows. Another nurse has promised to be right behind him with a pillow. My friends at work say, jokingly, that if they both fail, they'll pluck my chin hairs until I'm extubated.

There's something about working with people who have gone through their days just fine until something either blows or blocks up in their heads, or goes out in their abdomens, or simply quits, like a heart, that makes you much more thoughtful. I leave the house neat and the cats' and dog's water dishes full every morning before I go to work, just in case I don't come back. I don't leave incriminating evidence around, or keep my changes of scrubs in the dryer.

Still, we wonder about the people who try to kill themselves, and who fail. It's not as foreign as you might think--probably every one of us has thought carefully and concretely about suicide, and not in a depressed way, more in an I-don't-want-to-end-up-like-them way.

But if you don't have that experience, if you don't have that knowledge, what is it like?

Is it the certainty that nobody's going to call to check up on you on this particular night that pushes you over the edge? Is it the fact that you turned down the invitation to the party that turned out to be a rocking good time? Is it that you never got over that one rejection? Or is it simply an accumulation of exhaustion and disappointment, a desire to rest, that leads you to chew and swallow and wash down with gin a handful of hydrocodone/acetaminophen 10/650?

I can easily understand how things can get that dark. After my husband and I separated, after a few other disappointments, the feeling of not-enough had gotten deep into my brain, so that I considered what the easiest, least-messy, least-traumatic way to go out might be. It's always run up against practical considerations, though: who else knows how much Max depends on belly-rubs at exactly the right time? Who could I count on to leave a specific size of water glass out for the cats? What on earth would my patients say? And who would call my parents and sister, and give them the news?

In the end, there is a gulf there as deep as the one that separates us from normal human beings. One one side, there are the people for whom practical considerations were no barrier; on the other, those of us who worry about details. On the one side, there is us: the people who touch the dead and dying and keep going; on the other, everybody else.

We think about it. We talk about it. We joke about it, even, but we know that a thread of serious business runs under the joking: if ever I am to end up in that bed, there, without the ability to swallow or breathe or toilet on my own, please kick the plug out of the wall. If ever I lose X amount of use of Y amount of my body, please bring me the ten-cc syringe full of insulin and the twenty-cc syringe full of benzos; here's my password so you don't get in trouble.

I don't particularly want to die. I don't look forward to it, as I think I would miss being alive. At the same time, it doesn't hold any particular fear for me. I've seen it enough to know that at some point you pass beyond pain and caring and simply get on with the business at hand. Being dead is a neutral state; dying is something I'm happy to avoid.

I wonder, though. I wonder about the people that decide that liver failure, of all things, is preferable to living. Christ, what a messy, awful, painful way to go. Same with gunshot wounds to the head: a gunshot wound to the chest is much less reparable and much less likely to go wrong. The guy in 23 who decided to take the handful of Lortab on its own, without the help of gin or Ambien, didn't know what he was doing. He's paying the price now, and we all wonder what on earth was so bad that smelling like ammonia and being on a ventilator seemed better.

No matter how bad it gets, I know I can count on Flashes lying belly-up on my lap and stretching out to his full length, purring and asking for belly-rubs. I know I can count on Max being excited to see me, and bringing me his bones for exclamation and approval. I know my neighbors will need a cup of sugar, or a biscuit recipe, or a bottle of wine. Notamus will always want to knead my bare shoulder as I'm falling asleep, leaving me with scratch-marks worthy of the most avant-garde body art shop in Bigtown. My friends will always call to check up on me and see how I'm doing.

I wonder--we all wonder--what it takes to go through with the Lortab without thinking it out thoroughly beforehand.

Edited to add: Anybody who can listen to A Prairie Home Companion's sound effects guy doing a skit involving juggling a chihuahua, a chicken, a chainsaw, a chuckroast, and a child and can still not feel slightly lighter gets my services for free. Seriously: how can you not be assured that humanity won't destroy itself after that?

Also edited to add, for Brad and for others who might be worried: Gracious, no, I'm not considering offing myself. I can *almost* understand why it might feel like a good idea to somebody, but... ... ...no. Being dead seems like too big a step to take. I wonder what separates the "almost" from the "did", you know?

Friday Night "Oh, What The Hell."

Abilene Rob's head is exploding just about... ... ...now.

Here's a good idea:

If you have a patient without IV access and with a blood glucose of twelve, who is having a prolonged seizure because of that hypoglycemia, do not call casually down to the NCCU and ask me to mosey on up "when I have a minute" and put in an IV for you.

Call the response team instead.

I arrived to find a patient who'd been burned over about 40% of her body when her meth lab took a wrong turn, with a nurse and doctor standing at the bedside like calves at a new gate. The doctor was beseeching the patient to breathe slowly and deeply as her eyes rolled back in her head and she seized. The nurse was doing something, I don't recall what, but it wasn't what needed to be done.

So I grabbed a start kit off the cart and found the only place I could without fresh grafts: her left ankle. Her daughter started protesting that she'd "had tumors in that leg" and trying to stop me from inserting the IV. The daughter got told to get out of my way. As I found one decent vein and stuck it, I asked, "What's her CBG?"

"Uh....low" said the doc.

"How low?" I pressed.

"Twelve."

I looked up from the blood flash I'd gotten and turned to the nurse. "Call the response team" I said, low and forcefully.

"What?" she said.

"Call the fucking response team. Dial ninety-nine and tell them you need a response team stat."

Back to the IV. I heard the call go out. The catheter hit something and wouldn't budge any more, so I tried floating it in. No go, and I lost blood return. I eased the catheter out about a quarter inch (about half of the length it was actually in) and got blood.

"Give me the D50" I said.

The nurse fumbled around for a minute and managed to give me an amp of D50 with the needle guard removed. At that point, thank God, the response team showed up and included a nurse I'll call Stoya because, well, she looks like Stoya. She got the needle guard back on the dextrose and managed to push the amp through a 22-gauge that was only about an eighth of an inch in the vein. It blew as she finished off the amp.

The response team chief was looking at the doctor, expecting some sort of explanation and perhaps a brief history of what was going on. Doctor Moo stared back, speechless. "Forty-five-year-old female, brittle type I," I said to the chief, "who was given 125 units of NPH this morning and hasn't eaten since. CBG of twelve, no access. Why the hell doesn't this patient have a central line?" That last was to the doc.

Meanwhile, somebody showed up with Glucagon, and that got into a muscle somehow, and Stoya handed me a 20g to start another IV. A couple of CCU nurses were working on the other leg, but nobody was getting anything. After several minutes of this (it felt longer), Stoya said, "Oh, fuck yeah" under her breath and turned the woman's leg to the side.

A huge vein had popped up out of nowhere on her ankle. I slid my right hand under Stoya's arm and, with her stabilizing the vein for me with one thumb, watched the entire universe collapse down to this one scene: right hand with a needle, blood on my ungloved left hand (I'd taken off the glove to try to feel something; don't tell me you don't do that too), a single vein popping out of a bony ankle. Stick, flash, fumble for a flush, yank the cap off the flush with my teeth. Get the access flushed and taped. Push another amp of D50.

The patient's blood sugar had come up by this time to the point that she was no longer seizing, but instead was actively fighting. She took a swing at one of the nurses and began to scream. Her daughter, at the head of the bed, started screaming back. "Get her out of here" I said to the biggest respiratory tech we have, and he did. A patient care aide who weighs somewhere around 220 laid down across the patient to keep her from coming out of the bed.

"I need a milligram of Ativan, stat" I said, to one of the dozen people clustered around the door. "Uh...I don't know if we have that on the floor..." she started to reply. "Then get it out of the code cart. A milligram of Ativan. MOVE!"

Working with those nurses was like working with a group of sedated turtles in Jell-O. I'm proud that the only time I raised my voice was when I said "move" to the nurse who was impersonating one of the more languid varieties of rock.

Through the whole response (twenty minutes, total) the doctor at the bedside never said a damn word. He simply had no clue at all what to do. The nurse was new, so I'll excuse her for not knowing: knowing what to do in the classroom and doing it automatically in a crisis are worlds apart.

The pharmacist came to visit me the next day. "I liked the way you handled that response the other day" he told me. "Nice work."

There is no better feeling

Than coming home after work on a hot day with a fresh six-pack and taking off all your clothes and putting on a bathrobe.

Unless it's wandering into the kitchen to scrub out all the little plastic containers you use to take your lunch in, and finding them already clean and filled with dhosa and potatoes and lumpia and roast chicken and vegetables, because your coworkers were feeling kind.

Melodic Monday:

Can't do much better than this.

Nix and Hydra, and other things.

It's the solstice. This is always sort of a sad day for me, as it marks the time when the days begin to get shorter. There are plenty of blackberries still to be had, and apples and Brussels sprouts still to come...but. One begins to feel like Robinson Crusoe, rescuing spars and detritus from a wreck that's long since gone down.

Nix and Hydra, Pluto's two moons, were disovered on this day in 2006. Were they demoted, too?

The Battle of Okinawa ended, in 1945.

Bats are particularly active at this time of year.

Things that happened today:

1. A six-foot-three, two-hundred-twenty-pound patient with a subarachnoid hemorrhage decided to get all dicey on my ass while I was drawing blood from his arterial line. What a mess.

2. My cat got all obsessed with a) going outside, and b) removing the measuring tape from its casing. It is alternately funny and really loud in here.

3. The coworker who's been on light duty for the last six weeks finally started having regular contractions. While we were taking a patient to MRI. We timed them faithfully throughout the entire procedure.

4. Max shed four new puffballs in the house within ten minutes of coming in. The house is now covered with equal parts munge, dog-hair, and substances too nasty to think about, even on a nursing blog.

5. I took my antidepressant with beer.

Auntie Jo's Agony Corner: How Do I Care For The VIP?

From the mailbag:

Dear Auntie Jo,

I work in a hospital that depends on donations for a large part of its funding. Every once in a while, we get a donor in as a patient. Those people are given VIP status, which means they get free parking and real silverware with their meals and soft towels, stuff like that. A lot of them take "VIP Status" to mean "I can abuse anybody and direct my own care." What's a poor nurse to do?

Signed,

Frustrated in Fargo

Dear Frustrated,

Auntie Jo read your cri de coeur with a sardonic smile. For most of her career, she has worked for a hospital owned by EnormoGiganto Research and Education, Incorporated, which also depends on handouts--alors!--for a fair portion of its overall operating budget. She, too, has had the noiseless tenor of her way interrupted by those misguided souls who believe that donating a paltry one hundred million smackers to EGRE Inc. would buy them uninterrupted sleep and unpunctured veins, if only they whined loudly enough.

Take heart! Auntie Jo's motto is, If You're Sick Enough To Be In The Hospital, You Will Be Treated Like Somebody Who's In The Hospital (and no amount of chump change will make that go away, sucker!)

Auntie Jo approaches this in a very specific way: the Limited Choices Approach.

Instead of asking, "Do you mind if the laboratory technician, that vixen of venipuncture, that Bodecia of bloodletting, takes a teeny-weeny sample of blood?" Auntie Jo announces brightly as she walks in the room, "Lab's here! Right or left arm?"

Instead of asking, "Madame Secretary, I have some pills here. Would you like to take them?" Auntie Jo announces, "Time for your morning medicines, Mister President! Would you like to take them with milk or water?"

This is a well-known tactic to any parent of a three-year-old. Since most people, especially the rich or privileged, turn into three-year-olds when they're hospitalized, it crosses over.

Auntie Jo is also fond of what she terms the "Celebrities: They're Just Like Us!" approach. Most very rich people are surrounded by syncophants and yes-men. The arrival of someone, like you or (if you are very lucky indeed) like Auntie Jo, who is the slightest bit of a smartass, makes them brighten up and look alive. You are not afraid or awed by them, no matter how many deals they've brokered or innocuous third-world countries they've invaded. It's a refreshing change of pace.

Two noti bene for Auntie Jo's less perceptive readers: The smartass approach should be undertaken with great caution. It should also never reference political views, religious practice, or sexual tendencies (even if those tendencies are well-known as a result of pending or resolved litigation). What you want is a sort of insouciant, devil-may-care tone, not all-out debate.

Finally, Auntie Jo recognizes that sometimes the chief difficulty in caring for a patient springs not from that patient, but from the hordes of money- and recognition-seekers in the hospital administration or management who wish to a) pay their respects, or b) make things illogically hard for the nurse.

A perfect illustration of this happened *just* the other day to Auntie Jo herself. Rather than being able to place a lunch order for her patient (who was demented and unsure of even the year, but frankly stuffed to the gills with money and with a very short life expectancy), Auntie Jo had to run a gauntlet of people who thought they could do it better and with more style than she herself could. (Longtime readers will laugh hollowly at the futility of that belief.)

Auntie Jo did what she terms the Timesaving End-Run around the six people who believed, with all their hearts, that it would take all of them to place and deliver a lunch order. She merely called the kitchen, asked to speak to a long-time friend of hers, and had lunch delivered in record time as the gauntlet was still working out how best to take the order.

On a more serious note: Remember that you are in ultimate charge of what happens to your patient. If the president, CEO, CFO, and COO of your hospital show up while you are bathing your patient, the correct thing to say is, "His Highness is engaged. Please return at one p.m." If a patient consistently refuses such things as scans and blood draws, let the attending physician handle it--he's paid much more than even Auntie Jo.

Dignity, poise, and a particular carriage of the head goes a long way in dealing with a VIP.

If all else fails, though, Auntie Jo keeps a special gold-plated mallet in the nurses' station for tough cases.

A question for my fellow vampires:

I have a blood draw coming up in the next week. Normally, I have veins you could hit with a harpoon from a door three blocks down. This, however, will be a fasting blood draw, and my veins disappear when I fast, no matter how much water I drink.

Would it be a breach of manners to show the phlebotomy guy my left radial vein and say, "This one, right here, with an eighteen-gauge butterfly"? It's at my wrist, which is an odd place, but then, I have odd anatomy (thanks, Mom!). Or is that considered sub-fusc?

Comments welcome. Last time, he had to stick me six times before getting enough blood for two vials.

Our friend died yesterday.

She was three years older than me. She has two kids, one in his twenties and one just a teenager.

She had breast cancer. It was a rare, awful, aggressive kind that went into remission for long enough for her to talk about coming back to work, then exploded in her liver and bones and lungs and pancreas.

She was a good, good person. I never heard her say a word against anyone, or saw her be depressed or negative. The worst thing she ever said to me was this: just after her diagnosis, but before her first surgery, I asked her how she was doing. "I'm makin' it" was her answer.

"Makin' it" was as bad as it got for her.

She was unfailingly kind. She was unfailingly helpful. She never seemed to get tired. She never made excuses, or flew off the handle, or gossiped. Seriously: in a hospital as tiny as ours, nobody that I talked to could remember a time when she was less than *good*.

I worry about her sister. Let other people worry about her kids and her husband; her sister is also a friend of mine, and oh Lord how I worry. They were tight in the way that it takes most of us years to achieve, past the hurdles of adolescence and into adulthood. Five years apart, they were inseparable since forever. Now her sister has to live the rest of her life without the one person to whom she could've talked about all of this.

She'd worked in health care long enough to know what she did not want. No tubes, she said; no intubation, or compression, or drugs. Just give me enough morphine that I don't hurt too much, but let me be awake enough to see my babies. Every baby was her baby; the baby boom in the CCU made her so happy.

We'd all planned to go see her last night. She died yesterday at ten-thirty in the morning. She went smoothly and peacefully, bradying down into the 30's, with a blood pressure that was barely palpable, before things just stopped. Never any true agonal breathing, never any fighting; she just went to sleep. It was appropriate and right that the night shift nurses who'd worked with her were the last to visit, just before she went to sleep.

It was as good a death as you can have. It was as good a life as you could wish for.

It is as large a hole as you can imagine for the rest of us.

I would say "rest in peace", but it would be redundant. She believed, strongly, in a God more good than I can conceive of. She believed she would go to a Heaven I can't wrap my head around. She believed in an eternal, painless life after death, when everyone would be reunited and happy forever.

Who am I to say she was wrong? The strength of her faith makes me believe that she was right.

Unintentional hilarity of the week:

Six neurologists.

One from Romania, one from Puerto Rico. Two from Africa (Ethiopia and Ghana). Two from the U.S.

All of them standing in the hall, arguing about the World Cup. In English. With accents getting heavier and heavier as they get more and more impassioned.

It got to the point that all of them were dropping into their native languages at times to make their respective points (including the guy from Georgia, who has a Southern drawl that would make your eyes glaze over), and yet they still all understood one another. Mostly.

For my friend James, the best tech on the planet...

....who has an unfortunate fondness for refurbing El Caminos.

How the fuck do you people do this?

I mean "you people with chronic pain."

Srsly? You rock.

I ask this because I have what started as a cold and is turning into a sinus/upper respiratory infection that will probably require antibiotics. And, when my doc gives out antibiotics, he throws in a scrip for that stuff that's liquid hydrocodone and promethazine combined, which, while providing a pleasant night's sleep, leaves me unable to do much more than blink for 48 hours after one-half of the recommended dose.

Yet I have friends and coworkers who live on narcotics. I mean, they're unable, due to chronic pain or unresolved injuries, to function without, say, a couple of Lortab in the morning with their coffee. That blows my mind.

We went over this in Pharmacology, and I understand that some of the side effects do go away, with time; yet I can't imagine actually *caring* about stuff with a Lortab or two in my system. I can barely imagine breathing with a couple of Lortab in my system.

And yet people do it. One of my most productive coworkers, the kind of nurse you'd want for yourself if you ended up in the ICU, the woman who catches complications before they're complications, takes four or six Oxycontin during a shift. She does that because she's had two failed back surgeries in ten years and is currently grinding bone-on-bone through at least three vertebral pairs. Meanwhile, I'm sitting in a chair, head lolling loosely, barely maintaining my own basal metabolism, on five hundred milligrams of Robaxin.

Beloved Sister takes Tylenol 3 now and again for migraines and general female troubles. And she does fine on it. Tylenol 3 will make me fall over in a little heap that does nothing but groan, vomit, and sleep--in that order--for sixteen hours.

Narcotics are weird. I remember in high school trying to get stoned (Hi, Mom!) and ending up paranoid and shaky. I remember later, attempting to take some drug or another that would make me mellow and love everyone, and merely being insomniac and organizing my sock drawer compulsively. This is why I no longer follow the Rainbow Trail or hit Burning Man in the summer. It's not the heat; it's the drugs. I am a big walking FAIL sign for anything that's supposed to relax a body or make you feel cool. You want me to be happy and mellow? Give me coffee. You want me to veer wildly between comatose and compulsive? Give me a narcotic.

All joking aside, it makes me wonder about my brain chemistry. Dr. Dink (my shrink) explained patiently to me during my last visit that I would probably never get the answers I seek to the (fascinating to me) questions I have about brain chemistry, simply because they would involve depriving people of/stuffing people full of various chemicals that might harm them. I wonder sometimes if my brain chemistry is just that off.

There are benefits, of course. Too much caffeine rarely makes me shaky; instead, I fall asleep. And I can get a commendable high from non-controlled substances. If I'm given a controlled substance, like Valium or hydrocodone, I can manage a dose or two (or at most three) before I start itching all over and having hallucinations. Tylenol works on my migraines. I'm a cheap date; half a bottle of wine will make me goofy; five glasses of same will make me no more goofy than two, but will effectively erase my memory.

I'm really, really thankful that my shoulder is getting better with massage. I'm really hopeful that I don't have to be on NSAIDs for months on end (because they make me stoned). And I'm amazed by people who can take codeine and go to work on the stuff.

The downside to being single

I was thinking about this last night, as I was cooking hashbrowns to go with my breakfast-for-dinner entree of Boca Burger and Muenster omelette (don't knock it; it's quite tasty). There was nobody around to say to, hey would you mind scooping the cat boxes because I forgot to do it before I started cooking and now I have to make sure the onions don't burn.

I thought of it again today, after hauling myself out of bed at 10:53 ack emma (in my defense, I did get up and stay up in the middle of the night) and trotting out to the grocery store. I have a sore throat--not the kind that comes on suddenly and necessitates antibiotics, but the viral sort that just lingers on and on. And I needed soup and juice. And beer. And guaifenesin. And there was nobody to send for it.

So, yes. While being single rocks overall, there are parts of it which, situationally, suck.

I suppose I could put an ad up, maybe on Craigslist. The thought of actually joining something like Match dot Com is entirely too frightening; besides, have you seen what's on there? Guys who either work out twice a day, or list the requirement of liking NASCAR. As my personal ad would probably be titled "WOMAN WITH PULSE SEEKS MAN WITH SAME", I don't think I'd get too much of a response. Especially as I would be tempted to use a picture of a velociraptor as my profile picture.

So. Let's assume that I put up an ad. I don't really *want* a boyfriend, but I don't want to advertise for somebody to come 'round and get me soup and make me tea when I'm not feeling well, and to scoop the cat box when I'm busy. For one thing, putting the words "cat box" in a personal ad would attract two kinds of attention, both of them the wrong sort: the first from men who think that "cat box" is a coded phrase for Something Else Entirely; the second from men who would be willing to scoop said box (the more I say that, the awfuller it sounds) and take out the trash and make a cup of tea, but who would insist on wearing a leather harness and calling me "Mistress" while doing it. The former is too much trouble to explain away; the latter is too much work.

Therefore, I suppose I would have to advertise for a boyfriend. Unfortunately, I don't have a lot of personal qualities that translate well to personal-ad-format. For instance, I can make up bad song lyrics at a moment's notice and have a gift for limericks. I'm a hella good cook, but mentioning "hella good cooking" brings to mind women in aprons with immobile hair and a rictus of joyous fulfillment at the thought of a new vacuum cleaner. Besides, my grooming is inconsistent at best. Somehow,

SQUATTY WOMAN WITH INCONSISTENT PERSONAL GROOMING SEEKS MODERN-DAY ADONIS FOR LIMERICK RECITAL, TRASH REMOVAL, AND CAT-BOX SCOOPING. MUST BE FINANCIALLY SOLVENT AND NOT INTO WEARING BONDAGE GEAR OUTSIDE THE BEDROOM. PLEASE HAVE EQUAL FACILITY IN QUOTING SAYERS AND PEELING GRAPES

doesn't seem like a formula for success. Especially not when paired with a velociraptor snap.

Oh, I could hire people to do it for me, I suppose, but there's the problem: it would take multiple people to do what I need done. The drunken man who pounds on my door twice a week offering to mow my lawn is not the person I'd trust to feed my animals. Nor is a cleaning service likely to take kindly to the suggestion that their already-overworked employees trim back the bushes along the fence line. (You'll note that I did not include bush-trimming in the example above. Combined with a mention of personal grooming, that too raises unpleasant associations.)

Is there such a thing as husband-rental, and does it come by the hour, and without the need to nag? Because that's truly what I need. I'm not, however, willing to put up with either the expense of getting married or the irritation of picking up 1500 socks every day, none of which the owner of said socks will claim. And divorce is just a flaming pain in the ass.

Any newly-minted nurses need letters of recommendation? Because I'd be happy to write some. If you'll come scoop the cat box and trim back the bushes and mow the lawn.

In honor of Dr. Grumpy....

The good doc posted a story about a patient getting hit over the head with a poodle.

So, in honor of Grumpy, and to show that weird shit really does happen, and to distract myself from a very sore throat, here are...

The Five Weirdest Cases I've Seen So Far

5. A suburban homeowner, after mowing his lawn, comes down with a rare fungal infection in both eyes. The fungus in question is found in the soil, but only rarely in *our* soil.

4. Worms in your brain, worms in your brain. Actin' like a fool with those worms in your brain.

3. That kid who had the drill bit from the oil rig land on him.

2. The poor bastard who had somebody else's trailer hitch fly off their truck and crash through the window of the car in which he was riding (back seat; not driving), pegging him smack in the frontal lobes.

And the number one weirdest case I've seen so far?

This happened so long ago that I'd forgotten about it until I saw Ibee Grumpy's story (I posted a very short version in the comments there):

We admitted a very sweet, quiet young man who'd had some pretty extensive reconstructive surgery and scar revision on his face, neck, chest, arms, and hands.

He'd been driving one morning on a rural road Deep In The Heart. We got a whole lot o' nothin' out here, and where there's a whole lot o' nothin', there's a plethora of roadkill. And where there's roadkill, there are vultures.

Poor guy was zipping along at 70 or 80, humming a happy tune, when he sees a vulture on the road ahead of him. Normally vultures take flight when they see a car coming. This one was late in getting off the ground and so crashed through his windshield and into the guy's upper body and face. The damage came not from broken glass, but from the death throes of the injured vulture. Vultures have big, big claws and beaks.

(You'd think that would be unusual, but really? Not so much. Since then I've met two other people, one of them one of my neighbors, who've had windshields broken by vultures. The difference in this case was that the vulture was apparently heavy enough to break *through* the windshield rather than just sort of sliding off.)

Luckily, he was in a place with remote 911 service and not out of reach of a cell tower. Can you imagine having to explain that to the EMS folks who respond to your call? "No, really, dude. It was a vulture. Right here. See?"

I take it as credit to the unit as a whole that nobody laughed at this. We all just stood there with big, round eyes like saucers and said "....crap."

He told me a couple of days later that the insurance company was kind enough to total his car, given the damage not only to the glass but also to the upholstery and dashboard. "What do you remember about the accident?" I asked. He said, "I remember somehow getting the car to the side of the road, and a lot of blood, and some awful noises. And feathers. In my mouth. Vulture feathers. They don't taste good."

Really and truly. It's very simple.

(The return of the grouchy nurse vent!)

Nurses do not have "cred". This "cred" of which you speak can be found in the ICU, on fixed-wing and whirly aircraft, and in the trauma ED. I do not have "cred", I do not need "cred"; in a pinch, I am a neuro nurse and I know where to hit you.

If you capitalize "Me" and "Myself" in your Facebook entries, you will not get friended by lower-case me. You are from Oklahoma, not Dusseldorf.

You are the resident on call. As such, I expect you to know something, no matter how minimal, about the patient you're about to see. Do not confuse Mrs. Westheimer, who is 88 and female and here from a LTC facility, with Mr. Gonzales, who is male and 50 and speaks no English.

If you tell me I have the freedom to move back and forth between the various steps of a protocol depending on lab results, please do not write me up when I do so. I've already entered your verbal order as, well, a verbal order.

Likewise, if you tell me to call you with any change, understand that I will call you with any change that warrants calling you. A blood sugar over five fucking hundred is one of those. Don't shout; the telephone reception is fine.

And really: I hate to pull rank, and I hardly ever do it, but understand this: Your attending has worked with me for eight years. We have pulled each others' asses out of so many fires you'd never believe. Therefore, if there's a question of practice, he's probably going to side with me first. This is no reflection on your brilliance; he's only worked with you for three weeks and has no idea how you think. Muttering "cunt" on your way out the door effectively seals your fate.

I do not want to date your grandson. I don't care how cute he is. Because he is 28 and your grandson, and I am 40, no matter how young I look.

If I ask you to please take a moment when you're not busy and refill the paper towels, please take a moment and refill the fucking paper towels.

Doctor Dracul, this one is for you: don't order six tests that are send-outs to Mayo and JH three days in a row, then come in on day four and yell at me, messing up my 'do, for not having test results back yet. I will respond in a pleasant, calm, straightforward manner and make you feel like a donkey's ass. No offers of coffee and cream cakes will make your shame go away.

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

We need real monitors; the sort that don't shut off when you unplug them for travel.

We need beds with scales that work.

We need important paperwork to be translated into Spanish, Chinese, Korean, and Arabic.

We need a list of send-out tests for which results take a minimum of 96 hours (I'm starting on that on Tuesday; don't worry).

We need an updated call list, a list of acceptable protocols (do we use the insulin protocol for critical care or the one for acute care, or the one you just made up?).

We need enough pumps.

We need dedicated vents, so if a patient has to be intubated, I don't have to beg a vent from the guys down in the basement (that was a very near thing indeed).

We need propofol in the machines.

We need.... ..... .....damn. We need so much on this stupid unit, with only four beds and two nurses and a floater. I'm having to spend so much time on the absolutely critical that I no longer have time for the merely urgent.

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

I remember once in the last eight years when I said something akin to "I have been here for X amount of time, therefore you need to listen to ME".

I'm hoping that I've built up some credit with everybody else in the hospital, because I'm about to start using that line a LOT. As in, throwing my weight around, pulling rank, calling in favors. The only way I was able to get a working travel monitor today was by reminding the dude in central supply about the time......well. That doesn't bear mentioning here.

The trouble is this: Manglement is hoping they can vamp 'till ready on this unit, and then somehow have it spring fully-fledged from somebody's (my?) forehead in January. That's not going to happen, but try to convince a bunch of desk-bound paper-shufflers of the need for, oh, equipment that won't actually kill people, and you fight a losing battle.

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

That said, D0c Dracul is kind of cute, in an underfed, Eastern-European, I've-gotta-look-that-country-up-on-Wikipedia sort of way. His offer of cream puffs and chocolate, though, left me unmoved. Show me the Cheetos and Scotch, boy!

It's Friday Night!

For those of you who don't work over the weekend.....

Look at this fucking cat, courtesy of The Daily What:

When you're done laughing, a groovable tune from my favorite impossibly small, impossibly big-voiced singer:

Her ballads are fantastic, too.

Have I mentioned lately how much I love xkcd?

Okay, I'm finally forming an opinion on the MN nurses' strike.

For those of you who don't know, I work in a non-union shop. Texas as a whole has not been friendly to unions; we're considered at work-at-will state (though whose will that is is sometimes in contention). The whole union/nonunion thing is therefore a little bit of a closed book to me.

I've stated in the past that I will not scab for the management of a union shop during a strike. I've gotten a couple of emails and one comment in the past week or so asking why that is. First, it's because I believe strongly in what unions have accomplished in the past and what they continue to do now. The value of unions in certain industries is debatable, as are the actions of certain union leadership, but let's be clear: the forty-hour work week, safety standards in industries like construction and mining, and fair pay and benefits did not come out of the goodness of business leaders' hearts.

Second, the key to an effective strike is that management feels some discomfort. If people are willing to break a strike, that means the discomfort doesn't happen. Yeah, management will feel the pain in paying those people a C-note per hour, but it's not as uncomfortable as seeing and feeling the effects of other workers refusing to break the strike.

And now you all can picture me in my red T-shirt, fist in the air, singing "Solidarity Forever".

As for the nurses' strike in Minnesota (and the concurrent one in California): I've read the proposal from the Minnesota Nurses' Association (PDF can be found here) and am flummoxed.

It's not any different from the staffing guidelines we have at Sunnydale and in the Ginormo Research And Education System, Incorporated as a whole. Right down to the ten percent wiggle room in beds for OB and ER patients, it's what we do. Yes, there are times we go on divert and have to reschedule elective surgeries, though it's not common. Yes, there are times that ICU nurses have to work overtime (though there are guidelines in place for that, as well: I can't work more than four days without a break, for instance). Yes, there are times that managers have to come in and work at the bedside, though that's *exceedingly* rare. Overall, though, it seems to work pretty well.

We have some flexibility in how we staff, not just according to patient numbers, but also according to patient acuity. People on continuous dialysis, for instance, always are one-to-one, as are complex kiddos in the NICU. If a charge nurse decides that a patient needs to be one-to-one or two-to-one for some reason, that happens. (Don't ask me how; I'm not a critical-care charge nurse, thank Frogs.)

Though we float from place to place, we do so within reason. A neuro-critical-care nurse like myself is not going to float to a transplant unit or to OB. Likewise, a med-surg nurse from an oncology floor isn't going to end up in a neuro or orthopedic unit. We have a pool of float nurses who are trained eight ways from Sunday to handle damn near everything, and the OB and baby-people have their own float staffs.

Is it expensive? You bet your ass it is. Is it labor-intensive in terms of training and scheduling all those people? Yep. Does it result in some of the best patient outcomes in the country? As my six-year-old neighbor would say, "Well, DUR."

We have had no--I repeat, no--cases of hospital-acquired pneumonia, central line infections, or UTIs in the past three quarters in our critical care units.

So. Given my own experience with what seem to be very reasonable demands on the part of the Minnesota nurses, I have to say: my primary opinion on this strike is that it was warranted. I support their demands. I support their right to strike. I hope like hell they get the staffing levels they want and need.

But then, I'm a pink-socked Marxist with a poster of Che above her bed.

Oh, shit, I forgot: An update on those creepy guys I had to deal with.

One of them is gone. He was asked for his resignation back in March. This was the dude who showed me the picture that left me gobsmacked and nauseated for days. From what I hear, he's having a not-too-successful career in home health care. Good riddance for us; bad news for his patients.

The other two guys....

Well, one of 'em bought a house, and his wife got pregnant. That gave him something to complain about besides feminists and brown people, which was a relief. Given that his bigotry seemed shallow and reactionary, I decided not to do anything official about him.

The third guy? The one with the pictures of redheads in compromising positions?

Somebody else filed a complaint, and mentioned me as a supporting witness. I was called in to a Very Official Meeting a few weeks ago and asked about my experiences; thankfully, I had my little black book of notes with me in my bag. HR took a very solemn view of all that had transpired, and ended up officially reprimanding said dude, tossing him into sensitivity training (yeah, right), and putting him on six months' probation. I think he'd do better with Keeping Your Damn Mouth Shut training, but who am I to legislate punishment?

In other news, I simply must stop chasing married men.

I call them. Constantly. They either don't return my calls, or they return them, but are obviously annoyed that I've interrupted their dinner. They won't talk to me at work--none of them will--because they all claim they're not interested in my problems. They come and go and acknowledge me only when it's convenient; when it's not, even shouting won't get their attention.

Yes, my friends, it is time to get a decent, updated call list for the NCCU. I feel like a Nursing Whore Of Babylon for calling resident after resident looking for the orders and answers I need.

And finally, No, I don't have an opinion. Yet.

The first I heard about the Minnesota nurses' strike was when I got a Facebook message from a coworker, asking me if I'd like to earn $1600 for a 16-hour day in Minneapolis. Smelling scab, I turned her down. (My two non-negotiables when I started this were these: I will not assist in infant circumcision, and I will not scab.) I don't have an opinion--yet--because the strike hasn't been carried in The Stars At Night Are Big And Bright's newspapers, and I've been too drugged (frankly) to look it up online. Expect something after this weekend.

Notamus is apparently deeply distressed with the state of the world. He's yowling like his Siamese mama did. I must go see what has upset him so. He probably needs cuddles and skin-to-skin contact so he can make new track marks on my shoulder.

Well, gosh. Being injured sure is boring.

At least it's gotten to "boring" rather than "dear Frog what did I do to deserve this??"

The massage therapist I visited today for a placeholder chair massage put her hands on the left side of my back and said, "Ooooooo. I like a challenge." As a result of her leaning on me with her entire body weight concentrated behind her elbow, which was on a knot in my rhomboids, I can now move mostly without pain.

I'm still weak on that one side, though. Which sucks, because I keep thinking of things I could be doing. "Maybe I'll go wash the car," I think, then realize that no, washing the car takes two good arms. "Oh! I could put up those shelves," I muse, before remembering that putting up shelves, especially overhead, requires two good arms. Then, before I know it, I'm halfway out to the shed for a pair of secateurs so I can trim back the sage, but....I can't bend over for another week or so.

Thank God for the beloved Plumcake. Her line in this week's Monday Hotness (on page two, and good Lord, why am I not surrounded by a rugby side from New Zealand, all doing my heavy lifting and shelf-hanging and sage-trimming for me??) about a Methodist from Lubbock getting a tribal tattoo that suits him had me laughing so hard I scared the cats.

Design*Sponge has also saved me from frustration this week, as they've posted a DIY tutorial on making your own custom roller shades. I had been talking about this earlier this week with a pal at work, but neither one of us could find a good source on how not to screw it up.

The fine folks at the farmer's market had gobs and oodles of fryable green tomatoes this morning. They're not normally a beginning-of-season treat, but with as hot as it got as fast as it got, a lot of local tomato plants are giving up the ghost. Fried green tomatoes got me thinking about shrimp and grits, one of my favorite eats of all time. I would make a cream sauce with a few bits of chopped fresh tomatoes, mix in the bacon, and serve that over the shrimp (piled atop the grits, please, and not stirred in), or do it like a local restaurant does: Bake the grits as though they're polenta cakes, then add shrimp and tomato/cream/bacon sauce. NOM.

Speaking of how hot it's gotten, it's weeks like this one, where 88* is a relief, that get me remembering cooler days spent in other places. Although I've never been as hot as I was two (or three?) summers ago in Montreal, it's much more fun to be hot in a place where everybody speaks French and there are cute film-makers to flirt with under a tent. And then there was the Labor Day weekend in Kentucky, on a houseboat, with Friend Pens the Lotion Slut, the Marvelous E. and her hubby, and one more couple who shall not be named. Anyway, despite the drama of a planned meltdown, that was one of the best--and coolest--late summer weekends I've ever had. Hence my current lust for ditching the house and living on a houseboat.

And finally, to cut the drudgery of one-handed counter-wiping and laundry-folding, I've been listening to a new radio station online. It's out of Dallas, it's public, and it's called KKXT. You can listen online for free, but I hope that if you find yourself doing a lot of that, you'll make a donation. Damn fine indie radio right there, folks.

Thursday morning sauropod

from lefthandedtoons

The Crip Files: Well, At Least It's Not Broken edition, Plus: Musings.

Got a call from the happy doctor people yesterday. Doc Pedro reviewed my X-rays and determined that I have degenerative changes in my spine, specifically in the areas C5, C6, C7 (what a shocker that was), but no obvious subluxation or fractures or aliens.

At least no aliens that are radio-opaque.

That was good to know, especially as my assigned light duty turned into heavy duty quite quickly yesterday afternoon. There's something about having three stat CT scans and no transporters that makes "light duty" into "take this immensely heavy bed on which the drive has gone out down this stretch of carpet, down seven floors, and oh, by the way, you'll have to push the damn thing aaaaalllll the way down here, to where we've built the new radiology department."

I hate not having enough bodies around to do the work. I've been training heavier so that I could do more on my own, and that, combined with the fact that I have to do more on my own, is what led to this injury. I'm backing off the heavy weight. My new goal is to look like Christina Hendricks, but with definition.

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

As a follow-up to my last post, I have to point out: I had a patient have multiple TIAs during my shift the other day. The nurse practitioner came in and immediately dropped the head of his bed and raised his legs.

I've worked so long with *hemorrhagic* strokes that that didn't even occur to me. With hemorrhages, you keep the head of the bed 30 degrees or *more*. With occlusive strokes, it's 30 degrees or *less*.

This is going to be a really steep learning curve.

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

What I want, she thinks, is to be outside on the deck, drinking a dry sparkling wine and eating stinky cheese and fruit. Instead, it's been raining off and on all day (more like HOLY SHIT THE WORLD IS COMING TO AN END pouring off and on all day; so much for the dusty plains of central Texas) and it's just humid enough to require gills for breathing. Plus, the flies and mosquitoes are out in force. So I'm sitting indoors, eating Auntie Jo's Special Refried Leftover Ramen Concoction and drinking the Scotch that Nurse Ames brought me from the duty-free.

Perhaps I will hit the farmers' market tomorrow and buy blueberries blackberries strawberries buffalo mozzarella cheese tiny ornate vegetables home-made whole-grain crackers and a bottle of something drinkable from Becker. Then I will sit out, rain or shine, and watch the bats and the satellites.

Okay, so you've been a nurse for a year or so....now what?

Julie and I were sitting in the monitoring room the other morning before report, just enjoying the glamorous and exciting life of the nurse, when she made a comment that I remember making:

"I've been a nurse for a year, and I am so burned out. I can't wait until I actually know something."

(Now, before any of you older nurses snicker over the "burned out" part, think back: remember how it felt to be overwhelmed all the time? Yeah. Like that.)

I think everybody feels that way after the first year, and then again after the second. Not to give you false hope, or anything, but after the second year of practice, nursing gets a whole lot easier. The question of *why* it's so hard the first two years, though, is something that it might help to understand. Heck, it might keep you from flinging yourself in front of a fast-moving laundry cart, even.

The first year of nursing is a combination of one part sheer terror and two parts cluelessness. It doesn't matter how well you did in class with pathophysiology or nursing diagnosis; things are much, much different when seen in 3D. Looking at a lab report with wonky numbers and figuring out what's going on in the classroom is miles away from looking at the same numbers at the nurses' station as call bells are going off, doctors are rounding, and your patient has sixteen other things going on that distract you from those numbers. I like the simile that another colleague of mine came up with: Nursing school is like learning to put together a jigsaw puzzle of a cathedral, while practice is like being handed a bunch of stone blocks and being told to build that church.

"Burned out" isn't really the right term for it. Most of us still want to come to work, and most of us aren't especially depressed by our choice of career. It's more like your brain feels full all the time, and you never really get a chance to integrate things. You *know* you're learning stuff, but it's either not really sticking (even though it is), or things are happening so fast that you have a hard time with recall (even though you don't).

Plus, you keep feeling like you're totally ignorant. (You're not.) Again, it's that jigsaw puzzle versus cathedral-building thing: you have all the information you need, but it's hard to put it together on the fly.

And, if all of that weren't enough, you're refining your routine and your time management and the way you deal with people and doctors and other staff members and learning who to call in the pharmacy when the dadratted drug machine won't dispense and what to eat and what to stay away from in the cafeteria and where the best bathrooms are and.....*whew*.

The good news is that the feeling of being constantly overwhelmed goes away. The bad news is that it's replaced, during the second year, with "is this all there is?"

There's a good reason for *that*, too. During the second year of practice--and keep in mind that these timetables are fairly arbitrary and mostly based on my own experience--you've got the basics covered. You can make a bed with a person in it, you can lever a body up off the floor without hurting yourself or them. A crazy-low potassium or calcium level won't make you panic, and you know who to call at 3 am for those problems.

The trouble is that you're....well, you're kind of disappointed. Things seem a little dull.

That feeling passes, too. It's there because you've absorbed all the things you need to do your job *efficiently*, but you're not quite to the comprehensive detail-management, weird-complication-anticipating point. That comes during the middle or end of the second year, and things therefore suddenly get much more interesting.

The biggest change in my practice between years two and three was this: I began to be able to see, sometimes even days in advance, what might go wrong with a patient. My care up to that point had been competent, but shallow. After two-and-a-half years, it deepened, as everything that I knew and everything that I could imagine anticipating came together in a cohesive whole.

The human brain recognizes patterns. Part of the brain's development is the ability to recognize patterns *as part of a whole picture*. That's what happens during years two and three: the big stone blocks you've piled up begin to resemble a cathedral, because you're able to stand back and see the whole damn thing.

So hang in there. Don't feel like you're the Lone Ranger on this one--believe me, going from expert in one part of nursing to novice in another brings those feelings right back. If you're feeling overwhelmed still, remind yourself to look back in a year more and see how things have changed.

Because your brain will catch up and your practice *will* change. The stuff you need to avoid in the cafeteria, though? That stays the same.

Mellow Monday Music

She asked, "Are you cursed?"

He said, "I think that I'm cured."

Then he kissed her and hoped that she'd forget that question.

Sunday Night Link Roundup!

Endangered Ugly Things covers, as you might have surmised, endangered ugly things.

Albert Kahn's collection of color photographs--from the early 20th century.

Tavi blogs on fashion, photography, art, and....middle school? Dayum.

Enjoy!

And two late additions: Lost on the Floor and a link I snagged from his blog, on what makes a satisfied hospital "customer".

Dudes. It is so freaking hot.

I mean, like really really really freaking hot.

Like, dude, the low tonight is going to be in the mid-eighties. It's so hot that I put shadecloth up over my tomato plants and they're still losing leaves, even with daily watering.

And this gets me thinking about some of the things that people end up in the ER for this time of year. Like dehydration. And heat exhaustion. And various electrolyte imbalances.

So, a public service announcement: If you, like me, are unfortunate enough to live in a place where we treat summer like people in civilized places treat winter (never go out, huddle at home, get cabin fever), you need to be aware of the following things. Even if you're just visiting. Or maybe especially if you're just visiting.

1. Water is great, but it ain't *all* that.

Years ago I drove from Missouri to Texas in a car with no air-conditioning in June. Not only did I get badly sunburned, but I over-replaced fluids with plain water and ended up hypotonic as a result. I'd sweated out all my salts, and spent the next two days vomiting and craving potato chips and Gatorade in between.

If you're going to be outside, even for a little while, take care that you're not guzzling nothing but water. Consume some potassium and some salt as well. Coconut water, which contains all five of the important electrolytes in the human body, is great for rehydration. Gatorade is a distant second, but works if it's paired with a banana or an avocado.

2. Be aware of how sunny it is, not just how hot.

Even dark-haired, dark-skinned people can burn in a matter of minutes. Do yourself a favor and get some sweatproof, waterproof sunscreen and use it liberally before you go out. I've had many conversations about this with my African-American colleagues, and the general consensus is that even if you're blue-black, you should wear sunscreen.

3. Watch out for pets, vinyl car seats, and pavement.

NEVER EVER EVER EVER LEAVE A DOG IN A CAR, EVEN FOR A SECOND, ANYWHERE THAT IT'S WARM IN THE SUMMERTIME. I don't care if you leave all the windows wide open; the lack of shade and restricted air movement means your furry pal will get overheated in as little as five--yes, five--minutes. An overheated, dehydrated pooch is no fun to deal with.

(Max seconds this from his spot on the floor under the A/C vent. Although he's better equipped to deal with heat than short-coated dogs, he still gets to come in for several hours during the heat of the day.)

Vinyl car seats will get hot enough to blister the backs of your legs. I have scars on my thighs from forgetting this in the days when I drove a VW Beetle, circa CE1970.

Pavement will likewise get hot enough to blister the bottoms of your feet. (See "scars obtained through blatant stupidity during my teenage years", above.) Even if you're just stepping out onto your concrete porch for the mail, get some shoes.

4. Take care with that glass of gorgeous, crisp Prosecco, willya?

Alcohol, while marvelous when you're sitting outside a little cafe in Montreal's Little Italy, watching the people as the sun goes down, eating a salad composed of equal parts squidlets, raddichio, and genius, is dangerous in the South in the summer. You will get so blasted in such a short time in the heat that I can't even describe it. Check yourself before you literally wreck yourself: plenty of water, plenty of cool, refreshing food, and stop after two glasses.

5. Never underestimate the power of shade.

I have a work buddy who grew up in Alaska and moved here in his twenties. He's a great guy--the go-to man when you get your car stuck in slush or need help with rebuilding a cabinet--but he hasn't yet learned how to deal with heat. We were waiting for the med center bus the other day, and I noticed he was standing in full sunlight, while I had wriggled into the small patch of shade thrown by a wilting cypress. He doesn't think about the heat. You have to remind him that yes, shade is a good thing. The temperature under dense leaf cover can be as much as fifteen degrees Fahrenheit lower than the temperature out in the sun, and that can mean the difference between Uncomfortably Sweaty and Dead.

Likewise, you will not see me out in tank tops in the summertime. Long sleeves in light colors provide protection from sunburn, West Nile Virus-carrying mosquitoes, and their own shade. A neighbor of mine wrapped me in one of her chadors last summer to demonstrate conclusively that when it's 110* out, 98* or thereabouts under your clothes is positively chilly. Clothing provides shade. Wear more of it.

I am going to go off now and eat a couple of tortillas made fresh this morning, some black beans, guacamole, and two yellow pear tomatoes snagged from the garden before the woodpeckers got 'em.

Be careful out there. It's going to be like this through mid-September.

Can we get one thing straight, as it were? Please?

So I'm reading the comments on a New York Times editorial about how men have become more accepting of gay people than women over the last ten years, or something like that, and one comment strikes me:

"I don't know what I'd do without my gay boyfriend! Every gal needs at least one!"

Every gal. Needs. At least one.

Like a "gay boyfriend" is a pet, or an accessory.

Or a Lay's potato chip: betcha can't acquire just one!

Or a Chia Gay! Watch him grow *fabulous* bangs!

Watch me reduce this person to a cartoon!

Gay men are not, and I can't believe I'm having to say this, things to be acquired. They are not cute little one-dimensional objects of amusement or unrequited crush or lust; they don't necessarily care if you paint your living room pink or blue or green. They may have worse taste in clothing than *me*, even. They are not there to butt-slap and help you accessorize.

Nor are they there to help you recover from every damn broken heart you have, or go shopping with you, or dance with you at the bar, or take you out for brunch (or whatever the convention is these days--has it changed since the mid-eighties?).

You can have your own personal Jesus, straight people, but you can not have your own personal gay. They might have their own lives, their own interests, and be sick to death of you. Your patronage does not do anybody any favors.

Gay people are not a commodity. Correction: gay men are not a commodity. I rarely hear straight women talk about how they'd love to have their own personal pocket-dyke around, to help them with plumbing problems and talk about how much other women suck. Funny, that, eh? Dehumanizing somebody is so much easier when they're portrayed as cute and nonthreatening in the media. It's much harder when they're threatening or invisible.

Friend Pens the Lotion Slut talks about her Gay Boyfriend David in a sardonic, tongue-in-cheek way. They're both born-again Christians who have a lot in common besides their relationship with their Christ.....but the people with whom they go to church see their deep and abiding friendship as just another straight-woman-with-gay-man-as-pet thing. Pens's use of Gay Boyfriend, with caps, is a dig at the veiled intolerance that she's encountered among the very people who claim to love everybody.

Because veiled intolerance is what it's about, really. As long as straight people see gay men and lesbians (and bi, and trans, and otherwise queer folk) as people that can be pegged into the best-pal, motorcycle-mechanic, crazy-drama-Nelly-come-apart role, straight people can keep a comfortable distance and not have to treat gay people as fully human. We straights can recognize one part--a tiny, stereotyped part--of a whole bunch of folks, and not acknowledge the parts that are complex, or sometimes point up our own failings, or make us think.

It's sort of like those people who insist they're fine, fine with gay people, as long as the gay people don't flaunt it. You know, like straight people flaunt it by wearing wedding rings. Or hold hands in public without fearing getting rolled and beaten. Or get myriad civil rights just by going through what's a very simple ceremony at bottom. Saying that gay people flaunt their gayness by being who they are with the people that they love means that you don't recognize your own privileged status. Either way, whether by having one-to-a-customer gay boyfriends or insisting people keep things quiet, you're contributing to inequality. You're refusing to recognize that folks, frankly, is folks.

I'm thinking about this tonight because I had dinner with two friends, one old and one new. They've had a solid, committed relationship for eleven years--longer without serious troubles than almost any straight couple my age that I know. One of the guys said the wisest thing I think I've heard ever about relationships: that the key to getting along for a long period of time is that the relationship is not on the table unless it's explicitly on the table. In other words, fights about who left the freaking toothpaste cap off this time are limited to toothpaste caps. You should never haul the entirety of your relationship into every. single. fucking. fight.

That stopped me dead, even after two margaritas, and made me realize what I've been doing wrong.

And I would've missed that had I been concentrating only on Rob's facility with show tunes or Adam's beaux yeux, and wondering if I could've gotten them to see Sex In The City with me. (In which case, you'd've had to have called the ambulance, because there was something toxic in those margaritas.)

It makes me sad, watching my otherwise well-meaning straight sisters and brothers screw this up. I have learned the best relationship lessons from gay couples, primarily because me and my ilk have made it so hard for them for so long. I've learned a hell of a lot about my own unrecognized privilege from gay, gay and biracial, gay and Buddhist, and trans women. Not to say that Gay People exist primarily as Teaching Moments, because they don't--who'd have time to go grocery shopping and mow the lawn if you were always Acting As An Example--but because I've paid attention, I've learned.

I've learned that love is too rare to be legislated against. Nobody should have to go through this life alone, and we shouldn't put barriers in each others' ways.

I've learned that people are not accessories. We should not reduce each other to the status of "betcha can't have just one".

I've learned that the crappiest situations mostly make for weirdos, but sometimes you get a jewel. And that I've been lucky.

We are all too valuable, and too valuable as we are, as we stand, to be reduced.

Muh-muh-muh Molly and the Catssssssssss....

I don't understand. I brought him my chewy bone, and then my pig's ear, and he still didn't do anything but make that awful noise at me. Maybe if I get up here and wag my tail really, really hard, he'll understand that all I want to do is PLAYPLAYPLAYPLAY!

Hm. Well, *that* didn't work. He still hasn't moved. At least he hasn't broken out the pointy things on the ends of his paws.

No harm, no foul, Molly-Loo.

The Crip Files: Radiation Edition

I had X-rays taken today of my neck. Front, left side, 3/4 left, and odontoid, which entailed me standing in front of the camera with my mouth wide open for more seconds than were probably necessary. The results will be available in about 48 hours, at which point I hope they don't call me and say "Um....you need to get to the ER right now, please, as your neck is broken."

Although that would explain a lot.

Friendly Doctor Guy assured me yesterday that I had indeed not had a stroke (Me: "Oh. Good.") and that he, too, thinks that this is probably a muscular problem rather than a spinal problem. Still, the X-ray's a necessary part of diagnosis, as it wouldn't do to have a subluxated vertebra and no clue that it's there. For the next two weeks I'm to avoid lifting anything or anybody, stay away from housework and yardwork (like I need an excuse), and not lift weights--basically what I'd been told before, but with a longer timeframe. If, in two weeks, the muscle spasms haven't quit, then I'll visit Ye Olde MRI Hutte and lie quietly in a tube for an hour.

I am BORED out of my SKULL. And I'd like my brain back, please.

My routine looks something like this: Wake up, take anti-inflammatory. Have fifteen good minutes between the time the drugs kick in and the time they make me too dizzy and woozy to move. Use those 15 minutes to accomplish something like folding laundry one-handed.

Nap for four hours.

Get up out of bed, run errands one-handed. Get home with shoulder creeping up toward ear. Take muscle relaxant. Have thirty good minutes before I fall over in a spineless heap; use that time to eat. Sleep for four to six hours.

Wake up. Repeat. Somewhere in there, feed dogs and cats. Perhaps consider taking on a major project, like reading The Wizard of OZ, but give up due to lack of brain power.

Go to bed. Wake up in the middle of the night with spasms that necessitate both NSAIDs and relaxants. Know nothing more until about ten the next morning.

I can't wait to go back to work. What a picnic *that'll* be. I'm not quite as disoriented as my patients, but my physical NIHSS score is worse.

The crip files: Pure Comedy Gold Edition

I managed to bathe. Let all rejoice.

Here's how to bathe when your left arm doesn't work, but your hand does: bring everything into range of your hand, rather than bringing your hand into range.

In other words, to scrub your left armpit, you must first firmly grasp your left wrist in your right hand. Then you must lever your left arm into such a position that it stays propped behind your head. Then you scrub and rinse.

To wash your hair, you must lower your head to the level at which both hands can reach it. (Scrubbing one-handed is not an option. I have a lot of hair.) Similarly, if you wish to put your wet hair up in a clip to keep it from falling in your face and making you homicidal, you must bend over to the point that your arm won't fall down when you're trying to use your hand. This is especially important if the distal portion of your arm (ie, your hand and wrist) are unaffected by the weakness in your shoulder and tricep. If your arm starts to drop, you will instinctively tighten your grip on your own hair, demonstrating exactly how heavy your arm is. Owie.

Getting into a bra was a whole new kind of humbling experience. I did not know it was possible to simultaneously hold open the arm strap of a bra while using the same hand to lever my left elbow through said strap.

Now all I want to do is take a nap.

Two for Abilene Rob, who makes me laugh when my arm won't work:

I want to write papers for the Institute of Danzig Research.

Guaranteed to be an earworm. FOREVAH.

Update On Max And His Young Jedi

(No pictures, because it's dark out at the moment)

Molly is having much less separation-from-humans anxiety already, even after just 40 hours.

Max has taught her how to play Bite Head, how to bark at the postman in the Max-Approved Manner (bark as he's coming, bark as he's leaving; don't bark in between when you can't see him), how to play So's Your Mother with the dogs next door, and has started on Bones 101.

I think we'll get into Proper Hole-Digging and Advanced Lounging in the next two days or so. Max tends to dig himself large holes in the shady corners of the yard, then lounge in them. Molly has been trying to emulate him, but is still obviously an amateur in the hole-construction arts.

Last night's So's Your Mother episode was a classic example of an old dog teaching somebody new tricks. Max and his girlfriend next door did two rounds of So's Your Mother (racing along the fence, barking and snarling horribly, then face licking with wild tail-wagging), and then Max backed off to let Molly have a go. She did her best, but apparently got too distracted or wasn't turning around sharply enough, because Max went over and scooped her out of the way gently with one paw. He then looked at her for a couple of seconds, turned back to the fence, and showed her what was missing with her performance.

She watches him, ears cocked, and does everything he does. If she barks incessantly at something, or gets too excited, he gently takes her head in his mouth and calms her down. If he chews a bone, she'll find another and *watch* him chew, then do her best to emulate him.

It's amazing. Max is so happy, and Molly is over the moon. I have a feeling when she's gone, he'll sleep for a week.