Saturday Groaner: How come Soviet bees don't talk much?

Because they're CAGEY BEES!

*koff*

Crayola doesn't make a color for your eyes, and Hallmark doesn't make a card to fit.

Stoya asked today if I'd ever Googled my Erstwhile Hub and The Replacement. I looked at her, I'm afraid a bit quizzically.

"No," I said, "why on earth would I do that?"

"Uh....because you're curious?"

I sat and thought about it for a minute. No, I'm not curious. I'm not really interested at all.

Then Stoya insisted, so I Googled El Erstwhilo and TR. I found nothing at all about the woman who replaced me, and more than I wanted to know about EE. "See?" I said, "he has a huge web presence. Is that enough for you?"

I left Stoya to her Webinating and wandered downstairs for a cup of coffee and some think.

I thought about getting married, about how I wasn't sure it was the right thing to do at the time, but what did I know? being twenty-four. I thought about the hard times, and the really, really good times, and about waking up to somebody who asked me every day for three or four years, first thing, if I was mad at him. I thought about the "you'd be so much more beautiful if..." and the "why don't you ever come home on time?" and the stress and the family weirdness and the pressure of the house and the animals and Beloved Elsie and the grief.

It was like I went through the entire marriage and its breakup, standing there at a window, looking out at the dome and the river and wondering what the hell had happened, and all at once it didn't really matter.

Because I have friends who love me immensely. Going out with them tonight was like coming home after a long absence, even though we all just saw each other last week. Coming back to Max (who was the only thing I ever missed from my marriage) was wonderful. I have a house that's not too big, not too small. I have a job that is different every day and gives me immense satisfaction and intellectual stimulation. I have animals that, while they might pull the shades down and shed everywhere, also snuggle up against my side every morning at about three.

This has been the best seven years of my life. The anniversary of the breakup of the most important relationship I've had up to date is coming up, and I could not be happier. By letting me go (or forcing me out, depending on how you look at it), El Erst gave me a life better than I ever could've imagined.

I may not have aged well. I have debt, in the shape of a house, and I have wrinkles and about thirty extra pounds that I didn't have then, but look at the tradeoff: I'm not anxious, frightened, scrabbling to maintain a handhold on the most important thing in my life, when that importance wasn't reciprocated. I'm older and stronger and have the tattoos from a thousand living and dying patients on my soul. I am so thankful that he gave me the excuse to leave; the courage I found in that has been invaluable.

A good man loves me. Another good man calls me friend. A number of excellent women of all shapes, colors, and sizes are happy to see me when I show up and miss me when I'm not there. With luck, I'll be with the guy carrying the atoms mine were next to when the universe got its start; if not, there's always next time.

Miss him? No. And I'm a little sad about that. It seems as though that whole shebang should deserve its own holiday. Hallmark doesn't make a card that says, "Thank you for teaching me to be an autodidact, and thanks for fucking me over, and for going a little nuts there at the end, because everything since has been so much better than I ever could've imagined."

Dr. Teeth came up at the end of my meditation in the window and said, "I hope you don't take this wrong, but you are very, very pretty."

I turned to him with the feeling that I was roaring like the sun, and said, "Thanks, dude."

Sometimes I get very sad and have to drink lots because people are dumb.

Today, between snorgle-waffleonium 327 test draws (get it in that orange-topped tube that gets specially shipped from Kyurgistan! Don't rotate it counter-clockwise to mix! Don't refrigerate it! And for God's sake, don't feed it after midnight!) and helping a very nice, very old woman to the bathroom, I was reading one of those websites that I used to like but don't really any more.

I wonder why I do that. I really do.

Anyway, there was a complaint from the person in charge of this website I don't much like any more about how meeeeeaaaaannnn and anti-child and awful people in the hospital industry are, because somebody wouldn't let her special little snowflake onto a critical care floor to visit a family member. Her child is well-behaved, and attractive, and eloquent, and generally a good kid. I believe that wholeheartedly.

But I still agree with the evil hospital industry's stance on not letting your kid onto the CCU.

I dunno.....maybe it has something to do with the horror of watching two people die of a common, highly contagious, mostly harmless childhood illness because their immune systems were shot (because we'd recently transplanted new shit into 'em to replace the old shit that wasn't working no more). Maybe it has to do with the knowledge that neither death had to happen, had people simply followed the rules. Maybe it has to do with frustration at how everybody in the world--even me, yes--thinks that rules shouldn't apply to them in whatever circumstance.

I'm afraid I left a comment. In it, I described the last few days of one of my patients, who ended up hemorrhaging from a newly-transplanted organ. I talked about how the family of the person who'd died too soon and thus provided that organ were comforted by the thought that a new liver could make the difference for a stranger, then horrified beyond belief that the transplant recipient would die so soon. (Yeah, they stick around sometimes, the families, and find out things we'd rather they not know.) I wrote a little about what it's like to hold a nice, decent guy in your arms, who's bleeding out as you're doing that, and how the only clue you had to how sick he was--since his numbers looked okay early on--was that he didn't want his sheets changed.

I talked about the difference in deaths: the man who didn't want to be resuscitated, and the woman who did, and ended up being coded five times in twelve hours.

All because of a kid with the sniffles.

Your kid's inability to be inside the hospital is an inconvenience for you, yes. It means you have to drive X number of hours home and line up a baby-sitter, and may not get to see your mom this evening. But it is a matter of life and death for any number of people who come into contact with your kid, or things your kid has touched, or people who have done either.

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

Meanwhile, back at the ranch, I had a very nice patient (female, age 95) who couldn't understand why she'd been spared to live so long, albeit with weird chronic health problems, at the same time that I had a patient who was dying far, far too young.

His kids couldn't come in and see him, which was probably best. They'd moved him up to my unit from the surgical critical-care unit primarily because his family needed more quiet and more one-to-one attention than they were getting in a unit with twenty-nine other very sick people.

He'd bled. It always starts the same way, with a horrible headache. This one progressed as it always does with the young and healthy: nausea, vomiting, the decision to stay home from work with the predictable migraine. And half an hour later, his wife had found him unresponsive, breathing agonally, and called the ambulance.

He was my age; she was a little younger. Today was all about "what's going to happen" and "is he hurting" and "what can you do for this or that minor problem", with me being as competent and calm as I could be while I looked at a patient who could've been a friend or a colleague or even an old lover.

It's hard when they're your age. It's hard when they're young, but at least then I have the luxury of fighting with God over the unfairness of it. This? Not so much. Had we been able to do something about the bleed that crushed his brain up against his skull, he would've been a vegetable, even if his organs had survived the massive doses of pressors we'd had him on for two days.

He went to sleep, and quit breathing, when she left the room to get a cup of coffee. I had warned her that that might happen; that people who looked like he looked had, in my experience, merely been waiting for their loved ones to leave the room. She came back in as I was waiting for the last rattling breath to be followed by another.

When it wasn't, I shot her a quick glance and took my stethoscope off my neck, then put the bell against his chest. She didn't break eye contact with me. I had to say, "He's dead" to a woman who already knew what was going on.

(I never say, "He's gone" or "She's passed" to a family. The person in question is not "gone"; they're still watching and waiting--as far as I know--to see what happens next. And "passed"? Passed what? The test of life?)

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

My other patient saw the gurney leave the room opposite hers, and knew what had happened. When I came back into the room, professional expression firmly in place, she did exactly what people in books do, and stretched out one hand from her bed.

"Honey? Do you want to talk?"

We sat for about an hour and a half, just talking about why life seems so unfair, and how it seems less so as you get older. I'm trusting her nearly-hundred-years of perspective over mine. As she put it, "The people who die too young are the ones who miss all the inconveniences of getting old. My husband had the chance, twenty years ago, to say 'C'est la guerre' and let me go, but he didn't. Now that I'm past ninety, it doesn't seem so unjust that I would've died at seventy-three."

She's funny. She's sharp as a damn tack, and aside from needing the occasional tune-up at the geriatrician's office, she's in pretty good shape. She'll probably go on, with her Kindle and her iPhone and her water aerobics class, for another five years.

I'm not sure if I want the peace that her perspective would give me. I talk about death a lot here, because midwifing a death is an honorable, amazing, incredible thing to be a part of. Once I know more and have more experience, I might go into hospice. I feel the same way about my dying patients--protective and gentle and more human--that I once did about my very poor, very scared teenaged patients.

But at the same time....being able to look back over a life that spans all but a bit of a century might not be such a good thing. I'm not sure I'm capable of the peace she's managed to achieve. I think I might keep fighting and cussing and being pissed off into my nineties.

That's it. I'm moving to Iceland.

Courtesy of The Daily What:

A slow day, or: Online Dating In Four Words:

The horror! The horror!

Kiva and I were in the unit yesterday. Both patients had gone off to have obscure tests of one sort or another done, and things were slow. She asked how my love life was.

"Dismal."

"Have you thought about finding a man here at work?"

When I recovered sufficiently, I pointed out that, as a nurse, you are not around men most of the time, unless they're not neurologically intact, and that's sort of a requirement for me, thanks.

"What about online dating?" she asked.

Now, Kiva's not from here. Her marriage, as is usual where she's from, was arranged. Over the last twenty years and two kids, it's grown into the sort of partnership that gives arranged marriage a good name. But, as you might expect, she's a little clueless when it comes to the reality of being a forty-year-old woman in the online dating world.

Without a word, I punched up Match dot com.

Kiva watched me enter my pertinent information, then peered over my shoulder excitedly.

"Gracious, there are a lot of pictures of tongues."

I scrolled down the page.

"Oooo! This one looks good! He's thirty-seven, and....wait. No, he works at Wal-Mart. And he's married? And looking for a slave girl?"

I continued scrolling.

"What about....oh, no. You aren't part of a couple."

Still scrolling.

"What on earth does that mean?" she asked at one point. I wasn't brave enough to tell her.

"He looks nice" she said, "Really strange, but nice."

Except, at fifty, he wanted a woman no older than twenty-three.

Finally, Kiva found somebody she figured was perfect for me. He could punctuate, knew the difference between "they're" and "their" and "your" and "you're", and was single, looking for a single woman, and wasn't possessed of any of the stranger fetishes.

"Except he's nineteen," I said, "and looking for a cougar."

"Perhaps you can tell him that two of your cats equals one big one" Kiva said.

I didn't have the heart to tell her what "cougar" really meant.

No time, sore shoulder, but good news!

The Zoater's bloodwork came back normal. The only thing weird was an elevated level of monocytes which, Dr. Google reminds me, peak eight to fourteen days after inflammation or infection sets in (or something like that).

The vet sounded surprised: "It's really unusual that a dog his age would have such great numbers. But he's a good boy."

I think Max isn't sure what his name is any more. He went to a party the other night (I was invited but wasn't up to it) and got praises and belly-rubs and little bits of shrimp and perhaps a tiny sip of dark beer or two. When I wandered out back, he was surrounded by a bevy of beautiful babes, all telling him what a good, what a beautiful, what a sweet boy he is. I think he thinks his name is "Handsome" or "Gorgeous" or "Oh, hi there."

It bothers me not at all that my dog is invited to parties which I choose not to attend. He came back strutting, if dogs can strut, and slept like a log all night.

Don't stop with the good vibes, folks. If you can stand to add one more to your list in addition to the Zib-Nose Scronkle-Hound, there is a certain kitten in Colorado who needs a good home, having almost been left in a dumpster at a local Petco.

And thanks. People sometimes suck, but you guys certainly don't.

Again: Amen, bow-wow.

Where was I? Oh, yes: NSTEMI and clotting. That's right.

Ah, yes. The promised on-subject post.

A couple of definitions for those of you who aren't well-versed in Medicalese: NSTEMI (pronounced "enstemee") stands for Non-ST Elevation Myocardial Infarction, which means basically that it's a heart attack that lacks a hallmark of heart attacks when they're found on an EKG (that wiggly line that goes boop-boop-boop in the ER shows).

And platelets, which we'll be looking into later, are critical to making your blood clot. I've forgotten by now what a normal platelet count is, since I haven't seen one in a year or more (Dr. Google says it's 150,000 to 450,000; thanks!), but the important thing to remember is this: Sunnydale has a policy that says, due to the general shortage of platelets for transfusion, ain't nobody getting a platelet bag unless their plates are under 10 grand.

So I get this patient. Brilliant, funny, cynical, hilarious: the sort of person you would want to drink your gin with the very second the sun crosses the yardarm. He showed up at Sunnydale's clinic that morning--wearing, and here I shit you not, an ascot--for his usual platelet transfusion (because he has a bevy of weird clotting disorders that I won't go into here) and mentioned casually that his left leg just went dead the night before.

They ran him over to the ED, where it was discovered that he did not have a brain bleed, he was not any more sick than usual according to the bloodwork, and that he was having an NSTEMI right there in the ED.

Whereupon they transferred him to me.

Now, the interesting thing about this case is this: the MRIs we did showed no stroke. Neither did the CTs of the brain that he had over at the ED. I imagine they've gotten a CT of his spine by now; I certainly hope so, since it's likely that he had a clot or some sort of weirdness going on in his spine.

Except for that whole platelet thing. People who develop clots normally have a risk factor that's incredibly common: a normal platelet count. His was not normal. In fact, it was the worst I've ever seen: less than a thousand. Why he wasn't just sort of seeping blood out from every orifice is beyond me; his platelet count was so low that our lab just sort of shrugged, ran the test a couple more times, and said, "Walp, here 'tis, have fun."

I suppose he could've had a spontaneous spinal hematoma, which would explain his symptoms, but he had no pain. Pain is the hallmark symptom of a spinal hematoma. Of course, he had no pain with the heart attack, either, so maybe that's not the best thing to go on (hence my hope they've done a spinal CT by now).

In short, this is how his exam by Dr. Heron, the neurologist who reminds me of a wading bird, went:

Dr. Heron: "So, how did you feel just before your leg went dead?"

Patient: "It was the best day I'd had in years! I felt just fine. No worries, no pain; just got up from the couch and fell over."

Dr. Heron (while doing complex neurologist-stuff with pokey things and feathers and such): "Okay, do you feel this? This? How about this? Oh, you feel that?"

Patient: "Yes, I feel that. It's sharp."

Dr. Heron, standing back and gazing adoringly at the patient, as though he's a new form of insect never before described by science: "Fascinating!"

When Dr. Heron says "Fascinating!" in that tone of voice, and with that charming smile, I expect two things: a bevy of the most obscure lab tests I've ever seen, and a very strange diagnosis at the end.

My conversation with him later went something like this:

Me: "Um....did they tell you that this patient was in the middle of an MI when he came in?"

Dr. Heron, busily looking up obscure tests to order: "Yes, they mentioned that."

Me: "Do we want to do anything about it?"

Dr. Heron, distractedly: "Do we? I mean, can we do anything about it?"

Me, totally out of my depth with anything below the neck: "Er....well, we can't stop it, if that's what you mean. But it might be a good idea to, you know, try to prevent any more damage to the myocardium. With medication. Er."

Dr. Heron, still more distractedly: "This is why we hired that physician's assistant with the specialty in cardiology. What was his name again? Call him. Oh, and how long will it take to get a beta-three gronkorcium scan with trilateral snorfle screening back from the lab?"

I called the PA and let him handle it.

Max went to the vet today.

While he was there he caused such a stir (being a beautiful, well-behaved boy) that one of the office staff said that he should come with his own caption, to wit:

"Heeellllloooo, Ladies. Look at your dog. Now back at me. Now back at your dog. Now back at me."

He's on a horse!

Well, not really. I don't know what Max would do if confronted by a horse. He'd either decide it was a really, really big dog that he could play with (being apparently half pony himself), or ignore it.

He went to the vet because he had a weird blood-blister looking thingie on the right side of his neck, covered by his collar. It started scabbing over the other day, so I figured maybe it was time to get it looked at, as things like that are hardly ever good.

The vet was solemn. (She also, interestingly, had bilateral cochlear implants.) She trimmed the hair away from it and recommended a harness (so it wouldn't get rubbed) and warm compresses (just in case it's an abscess, the best-case scenario), but admitted that things like this are normally not pleasant. The next step would be a chest and belly X-ray, given that stuff that shows up on the skin looking like this particular thingie does are usually skin mets from an inside source.

Max is nine. He's a big guy, a GSD cross, and so is prone both genetically and age-wise to things like hemangiosarcoma.

He has a new harness, the biggest one Petsmart sells, let out to its absolute maximum for his forty-two-inch chest. He also has a bully stick waiting for him once he gets up from his nap.

The harness has his new rabies tag on it. I went ahead and bought a six-month supply of heartworm meds for him. I hope we'll get to use them.

Prayers would be gratefully accepted. He's a very good boy.

And Thursday night Sarah, too:

Communicating only through song, that's me!

Thursday Night Before The Friday Vet Appointment Patsy:

Reasons why I love this blog, by the author of same

One: When things really, really suck, I get emails from people who say things like, "Y'know what? Things sucked for me recently, too, but I'm okay, and you will be as well."

Two: When I fuck up, I get emails and comments that point out that I'm a moron. Which is nice, because there's nothing worse than being a moron and being clueless.

Three: When I say something that, to different ears, might sound a little strange ("black bitch of a morning"), people like 'Drea email me and say, "Um? Like, really?" Whereupon I can reflect and come to the realization that when I say something like "black bitch", other people do not automatically visualize a snarling black metaphorical shaggy female dog draped across my shoulders, which is what that phrase references. Whereupon I feel like a total douche but am grateful for somebody pointing out my idiocy. (FWIW, I have a good mental picture of the Black Bitch in question: she looks just like The Man of God's dog, Sophie, but with a nastier personality and, of course, black fur.)

Four: I get the occasional feedback (okay, more than occasional) that makes me feel like I'm actually doing a decent job at this nursing/blogging thing.

Five: I am the recipient of the most insane troll emails ever. I got one yesterday from somebody claiming to represent a group of people that protests things, claiming that they were going to protest my blog online, because I am a harlot (wahoo!) and anti-Jesus and generally going to Hell. Dad'll be proud; he never thought this blogging thing would amount to much.

Six, and most importantly:

On a blog, a person who has a difficult, draining job can be honest.

There have been times I have felt like tearing my hair out, and being able to vent about it here has meant the difference between my keeping my job and having to find a new one. There have been times I've felt like I'm the only person in the world to feel a certain way, and twenty-eight comments in two hours have helped immensely. There have been times when I've wondered if the picture of nursing I've painted here has been honest, or if it's been unreasonably colored, and then I've gotten an email from somebody who says, "I'm the only new nurse on my floor, and reading back over your posts has made me feel less alone."

One of my most valued friendships came to be as a result of this here blog. My Sainted Parents and Beloved Sister have gotten insights into my life that I'd never have given them in person or over the phone through reading. People I haven't talked to in a year (hi, Joey! Call me!) read what I write here and know what's going on.

And the folks who read and comment here stick with me through nursing, through having siding put on, through Max having weird lumps and The Boys driving their claws into my shoulders, and don't complain about any of it unless I'm an idiot.

So, thank you. For reading, for emailing, for commenting, for pointing out when I'm dumber than normal.

Good stories will return this week. I have some doozies for you over the next couple of days, including the NSTEMI Saga, in which the neurologist said, "You expect me to do something about his heart?" and the Clotting Drama, which I will fill you in on later.

In an attempt to look on the bright side

(whistling on the cross)

Even though Manglement scheduled NO relief for me today, and even though it was a black bitch of a morning, I did have one good happen: A doc I've known since he was a PGY1 showed up unexpectedly on the floor...

....to tell me his wife's having a baby.

Now, he and I have a history. He's a conservative at best and a libertarian at worst, while I'm a card-carrying member of the Pinko Bleeding Hearts Club Band. We discovered this early on, so since then it's been nothing but jokes: I see him coming and duck the boot that's heading for my face; he sees me coming and grabs his wallet.

I asked him once, when he was accompanied by a med student, why he'd come back so quickly from County General. His answer? "The smell of entitlement just got to be too much." The med student's eyes got really round.

For his birthday last year, I gave him a dozen Kool-Aid packets with Obama's picture on them. So we understand each other.

And his wife is having a baby. Not only is he going to make a kick-ass dad, he's going to make a kick-ass dad to a daughter, which is what she's having in November.

I'm going to get him a copy of "Fifty Dangerous Things (You Should Let Your Child Do)" and a sawed-off shotgun for baby shower presents. It's just so nice to see somebody who's freaking over the moon about having a kid.

And yeah, I can survive as long as I have people to share inside jokes with.

Somebody in the comments below opined that perhaps I was being set up for a fall by Manglement. I could believe that if they were just a little more organized: they didn't realize I was scheduled today until about noon, when I showed up in the break room to eat lunch. The fact that I was in the CCU all morning, under the mangler's nose, didn't make a difference.

*sigh*

Think baby. Think baby. Think Che Guevara onesie.

Yeah, so, not a lot of posting about nursing lately.

Because, frankly, it's just too damn frustrating.

I'm frustrated with having to MacGyver everything from monitors which I've been assured are fixed, to the wheels on the laundry cart (which we finally got and which keeps getting stolen, and let me tell you, if I find it down the hall one more time I am going to start removing people's digits, I swear), to the plumbing. The fucking PLUMBING. Because, the other day, one of the toilets just....blew up. As in fountained water up to the ceiling.

I'm just glad there wasn't a patient sitting on it.

Add to that that there's some sort of budget bitching going on between departments over who pays for what in the NCCU. The CCU claims part of the budget ought to be taken care of by the float department, who claims that some of it's the responsibility of the ninth floor, who complains because they're not allowed to have any say in how the rooms and monitors are used, and I'm sitting there, listening to all this, and thinking, "What the hell does this have to do with *me*? I have no control over anything."

Except, apparently, though I'm not allowed control over things like staffing, I'm supposed to take responsibility for things like staffing. As in, it's now my problem if somebody calls in sick or doesn't show up or leaves early. Yet I'm not allowed any input into the staffing grid, and we have nobody on-call for our unit. In fact, if the CCU needs nurses, they'll pull the other nurse from the NCCU, leaving me on my lonesome with three patients who range from okay to actually critical.

So, yeah. That's why I've been posting things about Max, and the cats, and the really fun time I had the other night when I threw a totally spur-of-the-moment party with the express purpose of getting rid of five pounds of strawberries. We had strawberry shortcake, and somebody I hadn't seen a quarter of a century brought two bottles of very good wine, and a bubble machine, and a night-vision video recorder.

Except that I can't post too much about stuff other than nursing, because that's fucking frustrating as well. Like, my shoulder/neck/whatever seems to have gotten about as good as it's going to get without major intervention.

Most of the time, I don't hurt. Sometimes I hurt a lot. That's not the bad part; the bad part is not being able to lift stuff with my left arm. Everything in my house, from sheets to dishes to animal chow, is migrating from higher shelves to lower shelves. I can move against gravity, but any amount of weight makes my shoulder just....well, it just quits working. Which is why I have interesting bruises on my forehead, as I haven't (it seems) learned not to try to make it work. It stops unexpectedly, and whatever I'm boosting up goes ka-thunk into my face.

And the cats, as cute as they are, are beasts. And Max is a love and a half and has done absolutely nothing wrong or frustrating lately, but he's got this lump on his neck. It looks like the tail-end of a blood blister, but of course I'm imagining hemangiosarcoma (what got the greyhound) or mast cell carcinoma (what got the hybrid) or alien abduction (what got my optomism, by the sound of it).

Yeah, so. Not a lot of posting about nursing lately, and nothing about recipes, because dammit, it's still like a zillion degrees here and even heating shit up in the microwave seems insane. And no fashion or beauty tips, because I don't really care at the moment how anybody looks; getting to work clean and on time is enough for me. And no product reviews, because I simply don't have the energy. Though I can tell you not to buy the sort of monitor we have in the NCCU, or at least don't unplug it without waving a chicken over it first.

And now, if you'll excuse me, I'm going to go find a pair of big-girl panties and yank 'em up as high as necessary.

Saturday Off-Topic, but really, *really* fun:

Zenyatta is a six-year-old, unbeaten Thoroughbred that I'd never heard of until today. She has a signature dance and an unusual racing style. Watch this: you can see her using that great. Big. Butt to get speed right near the end. She's an enormous horse with a lot of power, and seems to completely enjoy what she's doing.

I'm not a huge fan of horse or dog-racing, but damn if it's not fun to watch the good ones really get into what they're doing.

How hot is a hundred and ten, really?

Make that a heat index of a hundred and ten.

Or, if you're from these parts, a hunnert 'n' taeyn*.

A heat index is the measure of heat plus humidity plus wind plus the number of demons released from the Hellmouth at this time of year. Anything over a hunnert means that you're in real physical danger if you try to do anything remotely active outside. This, of course, does not stop the hipsters from riding their fixies or the poor bastards at the roofing companies from getting a paycheck, but those types are a different breed.

A hunnert 'n' taeyn heat index means that dogs don't so much pant as become enormous tongues with vestigial furry bodies attached. Max, who refuses to come inside unless it's actively thundering and hailing out, will scratch desperately at the door starting at about 1 p.m. and will stay inside despite being sniffed by The Horrible Kittehs all afternoon.

A hunnert 'n' taeyn means that you drive with your fingertips on the steering wheel.

It means that all your errand-running had best be done by nine a.m.

It means that you can hang out your scrubs on the line, and by the time you've finished hanging the last pair, the first pair is ready to bring in. It also means that swimming is pointless, as the water in the pool/river/lake is blood temperature. And that everything including bread has to be refrigerated lest it mold. You can't eat enough salt, you can't undress enough to be comfortable, and even flip-flops seem unreasonably restrictive. You actually start longing for El Paso, where at least it's a dry heat.

A hunnert 'n' taeyn means that even breathing outside is work. I feel for the transplanted Californians here. Even though they ran up housing prices to Silicon Valley levels and made keeping things weird a bumper-sticker campaign, they've still not learned that we don't complain about the heat; we simply acknowledge it.

Sample Conversation Between Native Texan and Transplanted Californian:

TC: "Sure is hot today."

NT: "yep."

TC: "My ice cream all melted on the way from the store."

NT: "yep."

TC: "It's, like, a three-block drive, man! This is nuts!"

NT: "yep."

TC: "And I can't find a decent gelato stand anywhere around here. I'm drowning in sweat! I'm going to die! My neighbors on the southwest side of the property have goats! How do you stand it? The Bay Area is much nicer than this! I wish I'd never moved here!"

NT: "yep." (*wipes brow*)

I walked into the Bindi-Mart today to pick up some beer (the only approved cold beverage when it's this miserable) and the guy behind the counter said tensely, with the whites of his eyes showing, "IT WASN'T EVEN THIS HOT IN PAKISTAN."

What he means is that it wasn't this humid. Money can't buy you love, but it can buy you the ability to keep your thermostat on 73* all day. As Christine Lavin observed, "You need an air-conditioner/And you are the man for me."

Only two more months, roughly, of this to go. I am not complaining; going outside in the heat for short periods has taken on the exciting, dangerous quality of going outside during a West Texas snowstorm without a compass. By Hallowe'en it'll be bearable again.

Or not. Maybe if it stays hotter longer, the Californians will all go back to the Bay Area.

*Nota Bene: I remember when I was eight or ten, the temperature was really-and-truly in the mid-hundreds for days on end. Longhorns died during that heatwave, which is unheard of. Birds dropped from the sky--and I wish I were making that up--from heat exhaustion. Anything less warm is an excuse to stay indoors; nothing more.

Gaudy Night.

I woke up after my massage (mmmmm) and wanted some meat.

So I went to The Usual Place, where I was confronted by a whole bunch of fifty-ish people with bad hair, being loud. It was a class reunion of some sort.

I was fascinated. And scared.

I think everybody there graduated in about 1977, because all the women had some version of 1977 Hair. The men were either bald with goatees or mulleted with goatees. Everybody had thick Texas accents (another clue; by 1987, when I graduated, *nobody* had an accent, even the ropers) and was smoking insanely long, thin cigarettes and drinking weird martinis with, like, chocolate in them.

I had planned to sit and read Gaudy Night and eat too much, but I ended up getting my order to go and having an irresponsible amount of Talisker while I waited. It wasn't the smell of Stetson that got to me, but the looks on their faces.

Dorothy Sayers said in that very book (and here I'm paraphrasing) that the young, when reunited with their classmates, talk soberly about life and its responsibilities. The old go to bed wondering if they've worn as badly as their contemporaries. The middle-aged are the loud ones, because they're trying to recapture their youth and keep fear at bay.

Every person who walked through the door scanned the crowd of people standing at the bar, perhaps hoping to see somebody who wasn't cruel to them in high school. They all greeted each other with the same hearty handshake for the men, high-pitched squealing for the women. Everyone looked brittle and hopeful and a little bit frightened, as if they were afraid that time hadn't changed who they were at fifteen, and that people there would see through the house, the kids, the car, the job, and shut them up in the 2010 equivalent of a locker again.

A few weeks ago, a woman I'd idolized in high school put up a post on Facebook, that reanimator of teenaged angst, about how weird it was to have people friending her who were nasty to her when we all went to Littleton High. Given that she was about the smartest, most stylish, most cutting-edge person I'd met up to that point, I was amazed that anyone could have bullied her or been nasty. Just before that, another pal of mine had written about his own high-school reunion, "I couldn't have gotten drunk if I'd tried; my nerves were too frazzled."

I don't think most of us ever really age past fourteen or sixteen or eighteen. I'm lucky; I don't remember much of those years (anxiety and depression have a benefit!), so I just regressed to being an eight-year-old boy. Bugs are way cool, poop is hilarious, and if you say "Bloody Mary" enough times into a mirror, a headless bartender will appear and take your order.

I really hope, when I'm fifty-five, that I have something other to talk about than having visited every Harrah's (is that the name?) casino in the world, except for the one in Saint Louis. I hope my hair isn't the same as it is now, though it wouldn't be so bad to have my 1987 flattop. I hope like hell that I'm never in a room with people who smelled like they did in high school--with one notable exception--and who haven't really done much since then.

It would really suck to be mulleted and smell like bad, sweet roper cologne. Though me with a bright-red goatee would be okay. It would save on tweezing.

Requisite Female Blogger's Post on Body Image

My coworker came in to relieve me last night. She's from Puerto Rico.

She's also five feet tall on a tall day, wearing heels, and eighty-five pounds soaking wet.

She has the perfect American body: tiny waist, long legs, no hips, big boobs.

And she came in walking funny. Because she'd been at the gym the day before, in an attempt to gain weight.

"My God!" she said, "I've been doing squats and lunges and sit-ups! All I want is a buttocks, can you imagine?" (I wish I could say that this was funny; instead, it's transcribed as she said it.) "I want a butt! I want a body like yours, right? With a belly, and boobs, and a butt! I am so sore, I should be walking down the hall, saying 'BRAINS' because I am walking like a zombie!"

Her husband thinks she is too damn skinny. She looks great, not underfed; she's just one of those women, like the Immortal Elizabeth, who will never be fully-human-sized.

And yet she wants *my* body. Because her husband complains that there's nothing to grab hold of. She says that he says that she's too bony; that her rib and hip bones aren't padded by enough belly fat. He wants a woman who's more voluptuous. She would love not to look in the mirror and see herself; instead, she would like to see my belly and boobs and hips.

And I would love *her* body, because of her tiny flat stomach and her lack of hips.

I told my massage therapist about this today. "I hate it that people think I'm undisciplined or not fit because I'm fat" I said. "Tell me about it," she replied, "I've lost some weight in the last couple of months, I don't know how much, but I'll be damned if people aren't treating me differently. Better."

We exchanged knowing looks.

My butt and belly and I might move to Puerto Rico.

Johnny Dooit, come to me/I need you bad as bad can be*

Ah, the forgotten joys of bundle service.

So, yeah: my washer is broken. And the new one won't be delivered until sometime the first week of August, because that's how all the appliance stores in the area roll, except for the one that has washers *starting* at a thousand smackers. I love that store, primarily because there is an ageless woman who sits at a desk, remembers my name, asks about my sister, and remembers when my parents bought their washer from her (!!!) just before I was born (!!!!!!), but I can't afford their stuff.

So I took everything to Mike and Audelia's Super-Clean Qwiki-Wash last night and dropped it off for bundle service. Forty-nine cents a pound is nothing to sneeze at, especially when everything comes back free of stains (even the ones Max left the last time I wiped mud off of him) and neatly folded or hung.

I had forgotten how nice it was to have bundle service. Seriously? The worst parts of the laundry--the drying and folding--are done. Nothing's shrunk, nothing's stained, and the only T-shirt they hung was the LOLObama one I have, which has forty-something cat heads on it, with the last one a black cat.

It took me a moment to think--*hard*--before I realized that, cost-wise, not cancelling the washer delivery and selling the dryer was a bad idea. It was that nice to come home to a basket full of clean laundry, all folded the way I like it. I hate folding.

And meanwhile, in the back yard....

My neighbor's tree fell over.

That doesn't really express what happened. In the last two weeks, we got as much rain as we normally get in a year. The neighbor's tree is--or I should say, *was*--a seventy-foot-tall pecan tree that had mostly grown sideways in the way that pecans have.

It fell over by degrees, onto the garage that belongs to the house behind me. It just pulled out of the saturated ground and fell over slowly, not doing much damage.

Today, driven by a combination of further-saturated ground and high winds, it just sort of rolled off the garage and landed in my back yard. So now I have seventy feet of tree across an eighty-foot-wide lot (the shed is undamaged), and I have to wait until the already-overburdened tree company can find space in its schedule for a non-emergency tree removal.

It's not inconvenient--Max can and does walk under the bulk of the trunk easily--and it's not really damaging the fence, since the fence was installed by Army guys a zillion years ago and won't come down short of a direct meteor strike, but it is weird to look at.

And meanwhile, back at Sunnydale,

I got a third broken monitor fixed, got the second broken door fixed, reassigned two computers to a different printer, and took care of a patient in between. The guys from Engineering and Computer Services are my pals; they're my own personal Johnny Dooits. (And I don't even have a Love Magnet, and please no comments from the peanut gallery on that.) They show up, they fix the problem, and with a smile and a wink, they disappear.

The patient, meanwhile, was one of those ones that makes you glad to be in nursing. She had a clot in her left MCA, which is an artery that perfuses pretty much everything that's important in your head, while still letting you live.

Her friends got her to the hospital within fifteen minutes of her falling over, and could actually provide a good history for her once she got to our ED. We couldn't give her TPA, because her clot factors were all out of whack (she has a fake heart valve), but we were able to go in and yank that big ol' clot out of her head.

This morning she could barely stand. This evening she was walking with a normal gait. This morning she could say "yes" and "no" if you gave her time; this evening she was speaking in two- and three-word phrases. We got the clot out last night.

This is hugely exciting. She might have some residual difficulty with word finding, or maybe a bit of a limp, but the option prior to the MERCI procedure was a life lived trapped in her own head, without the use of the right side of her body. If she hadn't shown up at our hospital, where we're part of an ongoing study of MERCI retrievers (I always think of a shaggy dog with a French accent), she would've languished in long-term care for the rest of her life.

As it is, she's getting her speech back. She never lost her sense of humor. She's aware enough of the left side of her face to try to make it match the right when she smiles. And, most important of all, she's bilingual and didn't lose either language, which means her language centers fared okay.

I burst into tears when I asked her, "What do you want to drink with dinner? Coke or Dr. Pepper?" and she replied, "Iced tea."

*A big Head Nurse prize to the first person outside my immediate family who can identify the source of those lines and give me context. Google will not save you now, young Padawan.

Everybody needs a hobby.

The new neurology intensivist fellow came up to me in the hallway. "I hear you have a way with whackjobs," he said.

"Uh....they seem to like me?"

"Good. Come with me. I'm having problems and I need some help."

So off I went with the New Dude to see what, exactly, problems he was having. I was expecting somebody who really needed a psych consult rather than the run-of-the-mill patient I was introduced to.

It was the same old story: four pages, single-spaced in a small font, obviously drawn up over years and years, listing a couple hundred drug allergies. A list of surgeries, complete with editorial commentary ("Not necessary" and "Surgeon cut in wrong place" and "anesthesia overdose, nearly died")(you'd think, after having something like twenty surgeries, if *everybody* kept fucking up, you'd just quit having surgery). Two additional pages of complaints and demands, including that plastic anything was unacceptable because of chemical transfer and only organic food should be offered.

Behind all of that sat a vaguely plump, vaguely pale, vaguely average-looking middle-aged woman without much facial expression. She had an electric widget in her hand, which I had seen before: it's sold, at great cost, by one of our local guys, who claims it'll prevent everything from poisoning to anaphylaxis. She held the widget protectively, no doubt ready to press it to her temple at a moment's notice, should I whiff of perfume or dioxin.

We had to get a history. Some sort of usable history, sans editorializing and without extraneous detail about what houses Jupiter and Vulcan were in at the time of her last gut surgery.

It took an hour. One solid hour from start to finish, with Dude noting things down on his little pad of paper, and me practicing the most therapeutic forms of redirection and point-keeping-to-ing that I could. Turns out there's not a lot wrong with her: no hypertension or hyperlipidemia, no diabeetus, no chronic anything except a general malaise and dissatisfaction with her life. Nobody died in her family of anything but old age, and she'd never really been sick to speak of, at least not sick enough to be in the ICU or anything, but there were those multiple chemical sensitivities and all the allergies and....

And, and, and, and. And fucking and.

At the end of it, I didn't think to ask what she came in for. Probably something with a name like "generalized pain syndrome" or "rule out lupus" or just "boredom".

As we walked down the hallway to get some coffee, the New Dude thanked me profusely. "I'm going to start calling you my Mental Health Nurse," he said, in an attempt at Neurologist Humor.

"Don't even," I said. "I am so not making a habit of this for you."

"D'you think it's just boredom, that makes people do that?"

"Dude, I don't know. All I know is that every time I see somebody like that, it reminds me of what I do not want to grow up to be."

What I do on my (damp, muggy, hot, thundery) day off.

I got up at four because I'd forgotten to turn off the alarm. That, and my bladder was full.

I cleaned out the fridge. Notamus got so excited by the smell of spilled catnip in the freezer that he attempted to climb into the undefrosted freezer, turning back only after he discovered it was wet and nasty.

Then I vacuumed. This is not something I would do normally during two weeks of almost nonstop rain, but Max had been in a few times and had left mud all over the house. Say what you will about central Texas; we have mud and muck unlike any I've seen anywhere else in the world.

Then Max and I cuddled for a bit. This was messier than it sounds, as he's been mostly damp for the better part of two weeks, as I mentioned.

And then I went grocery shopping. My neighbors, the poor unfortunate dears, are going to have to spend a horrific two weeks on a fifty-foot catamaran in the British Virgin Islands (seems like everybody's going there this year) with a cook and a captain and nothing to do but lounge on the deck. They leave tomorrow, so they have no food in the house, so they're coming for dinner. Stuffed chicken breasts (andouille sausage, feta cheese, and roasted poblano peppers), oven-baked parboiled potatoes, grilled asparagus, wine.

By this time, it had not rained for a whole six hours, so I got out the mower. The grass in the front yard is nearly knee-high in spots. Just as I was getting started, a huge crack of thunder happened, and it started to fucking pour. I came in, abandoning the Neuton in the back yard, and let in a very soggy Max. I'll have to vacuum again.

And, eventually, shower. It's disheartening to shower, only to be as damp after you've dried off as you were while you were actually under the water. Actually, it's disheartening just to be breathing at this time of year, since the air you're breathing in is more humid than the stuff left over in your lungs. And warmer.

It would be easier to stand this weather if I were at L'Express or Pied de Cochon, drinking wine and eating that bizarre, tasty broccoli aspic, or maybe a pied de cochon with truffle poutine. It would be nice if things actually cooled off at night, as they do in Seattle or Missouri or Provincetown or Colorado. It would be fantastic if this summer would end early, with a few scattered thunderstorms and a bevy of bright, crisp days, rather than lingering into early October as is usual. It would be perfect to be on the beach in Denmark just now, with a bonfire and herring and tiny glasses of ice-cold akavit and large glasses of beer, and watch the sun barely touch the horizon at ten o'clock.

Later this month I have four days off in the middle of the week. Don't ask me how I did that; just assume that they'll think I'm working and notice I'm not there at about three p.m. I might drive west-southwest and hit the river, or I might drive north and stay overnight in Oklahoma, in the mountains and next to the waterfall.

This is the hardest part of the year here. You're already sick of the heat, and you know it'll keep on coming--and get worse--until Hallowe'en, when it always freezes. The possibility of being comfortable seems so far away it's not worth waiting for. Our summer is like winter in places like Minneapolis: people don't go out, they have to steel themselves to be outside at all, and everything shuts down. The rare outdoor music festival is attended only by the toughest tourists; all the locals are at home under a fan with a glass of tea.

Spring is marvelous, aside from the tornadoes. Fall is sheer unadultrated relief. Winter isn't too bad; there are exciting things like snowstorms interspersed with sixty-degree days, and things stay mostly green. Summer is hard: you know that it has to end, it always does, but it's just a beat-down while it's going on.

Promises, promises. Summer contains the promise of fall contains the promise of snow contains the promise of blooms all over your rosebush come April. The trick is to be patient, and let time pass, and hope you live long enough to see the promises come true.

It's not easy being green.

I feel for the new residents this summer. I really, *really* feel for them.

In addition to working in the NCCU, which isn't really very critical yet, I'm picking up days in the CCU. I've only been there six months, so I'm still a total newbie, and my newbieness is compounded by the fact that I'm not there all the time. I have to really think about things like pressors and vent settings and boluses, rather than just having them come natural-like.

So I'm not that different from a new resident. All of the residents at Sunnydale start out in the CCU; it's a trial-by-fire sort of thing. They do their first year at El Giganto, working trauma units and medical CCU, then come over to us to handle surgical critical care and Shit You Won't See Anywhere Else, It's So Weird. By the time they get to us, they're totally competent in things like coding patients and following protocols, but at sea when it comes to dealing with stuff like your average everyday demented crani patient with a potassium of six.

I'm totally competent in management of stroke, hemorrhage, and spinal injury, and totally incompetent when caring for a patient whose middle name is Crump and who's on three pressors, CRRT, and racemic epi. With an open belly. And cardiomyopathy.

We're makin' it so far. So far, nobody's tried to bolus a patient with potassium (yes, that happened once, and yes, the dude grew up to be an excellent intensivist). Nobody's tried to push fluids on somebody with flash pulmonary edema and kidney failure. The acute pancreatitis and general-shutdown dude with the coup/contrecoup injury is doing okay. Two folks got off the Prisma and one person came off the vent. I've managed not to mistake norepi for dopamine.

And we're all *so careful*. We walk softly, talk softly, round carefully, ask lots of questions, and have facial expressions like surprised mice. The new intensivist fellow sat with me during lunch, and we talked about what's been going on in our lives with the determination of people who wanted to take a mental break. He gave me a nickname, I gave him a nickname. I explained the concept of the "dope slap" to him. He gave me a recipe for potato curry.

It's gonna be okay. I know that. By the end of August we'll all be comfortable in our roles. We'll have exchanged cell phone numbers. We'll know who tends to sleep through her beeper. But for now, we are all in the same leaky-seeming boat, unsure if anybody's going to grab us when we're about to fall over the side.

Get an oar, you guys. Start rowing. That frog in the middle of the swamp warned you about aaalll-eeee-gaaay-torrrs for a reason.

Sometimes it's really not worth it to get out of bed.

My washer broke today. It'll make noises like it's spinning, but it won't spin. The trouble is the clutch drive on the spin widget; apparently, when there are teeth broken off, this is what happens.

Since I bought an off-brand washer from Friendly Fred's Washer Emporium, it'll take two weeks for the replacement widget to arrive (from Albania, maybe?) and the damn thing'll cost about three hundred bucks. Apparently there's one place on the planet that makes this particular widget, and they only make about three of them a year, and they're gold-plated. Or something.

So, for two hundred bucks more, I bought a new washer. I expect the nice folks from Sears to be calling any time with a delivery date. I figure it's a good use of two hundred extra dollars, since I won't have to wait two weeks for delivery (geez, I hope not), I won't have to take the dadratted washer apart myself, and I won't have to worry about any parts left over when I put it back together. Plus, it's a Kenmore, so the parts will be manufactured for the forseeable future.

And that el fantastico Roman shade I made is...well, it's coming down. The glue I used to stick everything together apparently couldn't handle both cats climbing on it and horrendous heat coming through the window.

And I'm just generally grumpy. I shouldn't be; I worked out this morning for the first time since May 29th, and did okay. I have air conditioning and money in the bank. It rained like the dickens here earlier, complete with huge thunderations that brought Max in like a shot for belly rubs. My scrubs are clean, if soaking wet. The cats were especially sweet and cuddly during their nap today.

Maybe it really will be okay after all.

Good and Bad, Bad and Good

I got a call today, just before five pm, from the house charge at work.

"Why aren't you answering your Interlinx phone?" he asked.

"Because the Interlinx is in the unit, and I'm at home."

"Why aren't you here?" he asked.

"Because I wasn't scheduled to work," I replied.

I'm not sure whether to be worried that they didn't notice I wasn't there, or worried because I'm apparently expected to be psychic and show up when I'm not scheduled and the unit is short.

Because, you know, in the way of all things corporate, the rules suddenly changed to match somebody's level of irritation. Whereas before we were staffed by the critical care unit, now neurocritical care is apparently expected to have their own staffing and do their own thing. This is news to both me and my opposite number on nights.

At least something good came out of it. When I mentioned that working at Sunnydale was a lot like being written by Pratchett, she replied that it sucked that we didn't even have a Crowley to help us out.

"You know," she said, "like, the unit's on fire, but he's here holding it together with gritted teeth, through sheer force of will."

"Excuse me, Sir," I responded, "your unit seems to be on fire."

We giggled.

It's nice to work with somebody as nerdy as I am.

The Problem with Holidays; or, Big Titties Ahoy.

People who are in the hospital over July 4th, Christmas, or Thanksgiving generally don't want to be there. They're usually quite sick. Sometimes, they're so sick that they need to be in the CCU, with the attendant machines (Ping!), wires, tubes, and medicines.

Which means that at a time when staffing is less-than-ideal, the people you're taking care of are usually a) on a vent, b) extremely heavy medically, with multiple problems, c) extremely heavy physically, or d) all of the above.

Most of them have diarrhea as well. I do not know why this is; it seems to be a constant of nursing care that the volume of poop a person produces is inversely proportional to his level of consciousness.

Still, there are benefits to working holidays. Everybody that's there on staff, from the guy who pushes the linen carts to your charge nurse, has a cheerful, "okay, Peeps, let's get it done" attitude. There's usually a party somewhere in the hospital. Residents, if you feed them, are in a better mood. And people who work holidays routinely are a bit loopier than the rest of us, so you end up laughing your ass off at odd times during the day.

Carrie was talking about how much she hates the Owl City song "Fireflies". That, of course, got it going through her head, so she was walking around singing, "I'd rather gouge out my eyes/Than hear about fireflies". Nurse Ames had one of those continuous-dialysis machines to monitor (Ping!) and so had plenty to say about that. Sherry and Cindy both had patients who were practically nothing but poop factories, so I was in there a lot this weekend, helping them turn people who were twelve liters up with ventriculostomies and major lines everywhere. And, frankly, there's a lot of humor to be had from poop.

And from people who are what we call "frontal." If you have a frontal brain injury, it tends to knock out all your filters, with interesting results. The Interesting Result of this weekend came when we asked a healthy young guy with a frontal bleed to turn over in bed toward me. He said, quite enthusiastically, "Oh, yeah--toward the one with the big titties!" All I could say, amidst Ames's and Stoya's and Sherry's hysterical laughter, was "Yes. Yes, that's right."

We all went out for drinks after work. If you were next to a table of women, all in pale blue scrubs, all laughing hysterically about big titties and poop, I apologize.

Friday night wrap-up

A Conversation With Jo's Sainted Mother*. And other things.

My Sainted Mother called the other night, to update me on her trip (with my Beloved Father) to somewhere north of Seattle, for their fiftieth wedding anniversary.

She also mentioned their trip to Alaska, during which they saw some longtime friends and met the friend's son.

Now, then: Sainted Mom has never once expressed any concern over her spinster daughter's love life, or lack thereof. Therefore, it was a little weird to hear her talk about this guy.

"He's a genius," she said, "a carpenter, who does beautiful work. He built the front door of the house, and it's gorgeous. Plus, he just got out of a long-term relationship."

Then she delivered what I'm sure she thought would be the chef d'oeuvre, the coup d'amour, the end-all and be-all recommendation for this unseen person with a Russian name:

"He bonded with one of the chickens before they were slaughtered during the fall" she revealed. "So he saved it. It was the first one to come running when he threw bugs to them. Now this chicken comes when he's called, and rides to work with Son in his pickup truck, and sits with him all day, and goes to lunch with him. He's really formed a relationship with this chicken."

"Mom." I said, "Are you trying to set me up with a chicken-wielding Alaskan carpenter? I mean, really?"

"Oh, no," she protested, "He's really boring. I mean, aside from the chicken thing."

I said, "Great. Now he's boring? And with a chicken? No matter the depths of your desperation, mine have not gone that low."

I told this story to the kids at work, and one of them pointed out what was, to her, the principal problem with this story: that the guy in question was a zillion miles away, in Alaska. I responded that the principal problem was actually the chicken.

*Mom, you know I tease because I love.

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

The monitors are fixed. The doors are fixed. The computers work, and all of them have been assigned to a printer. The plumbing once again works as well as plumbing at Sunnydale General has ever worked, and the call schedule is getting straightened out.

The trouble with being both Manglement and Working Nurse is that my brain doesn't function well in either sphere. Even as I'm doing a stroke-scale assessment, I'm worrying over whether we have enough batteries for the flashlights and enough paper for the monitors. As I'm dealing with the central supply people's requests for a new inventory list, I'm wondering about my patient with the weird growth in his cerebellum. It's distracting all the way around.

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

Some people question why I don't work at one of the myriad very small hospitals that are between here and Sunnydale General. The following story illustrates why:

A patient with a four-year history of weird rashes, joint pain, mouth ulcers, and unexplained fevers shows up. The patient's been told recently that a seizure she had after having The Worst Headache of Her Life was due to withdrawal from pain medication (one Norco every eight hours for no more than two weeks) and discharged from Teeny-Weeny Hospital's ED without so much as a non-contrast CT.

Turns out she has lupus, no matter what Dr. House says, and has had a brain bleed. This is why I don't work at Teeny-Weeny Hospital, or its fifty-five bed sister facility, Eensy-Weensy Health Care Center.

Anybody who shows up in an ED in a post-ictal state, complaining of the worst headache they've ever had, with focal deficits, needs to be scanned. It's really very simple.

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

It's been a rainy week here in Littleton. Bigtown has also gotten its share of precipitation, thanks to Hurricaine/Tropical Storm/Depression Alex. As a result, the skies of Bigtown and Littleton alike have had some unusual visitors.

We don't often get pelicans too far away from Lake Giganto, but this week I've seen several. They fly over the highway, looking like prehistoric critters, and land to take their bearings in the open spaces near where I live. They're incredibly clumsy on the ground, but I don't think there's a prettier bird in the air.

The clouds have also been gorgeous. Driving north from Bigtown these days involves going through some really, really heavy rain, but once you get close to Littleton, the clouds start breaking in a particularly Seussian way, with shafts of late sunlight hitting the ground. Living in the middle of the state means that the stuff that hits the Gulf moves up here in bands, and the terrain is such that you can actually see the storms move across the sky in strips. It's amazing.

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

The cats are well. Max is consistently and vaguely damp. It's raining again, and I am off to bed.