Does anybody else have the urge to do the routine they learned as part of Strutter tryouts in high school? I hear this song, and "Let's Hear It For The Boy" and I'm transported to that two weeks in June of 1984, before I realized I. Can't. DANCE.
Tuesday, August 31, 2010
Posted by Jo at 6:02 PM
Walp, I learned something today.
We have two Chinese intensivists at work. I had always wondered why, when they ate lunch with the nurses, things like "Pass the salt" were said as "Pass the salt", while things they said on the unit were prefaced with "please" and "thank you". Turns out, thanks, NPR! that "pleases" and "thank yous" are considered a more formal sort of address in Chinese, and that using them in a social situation (which lunch is, given that The Manhandler is showing us what she learned in pole-dancing class) is considered offensive. It's sort of the difference between "Dear John" and "My Dear John" for those of us who read Victorian lit.
This helps explain why they're so formal on the unit and so abrupt off of it. Especially when we're all at Joe's having a beer, and things....devolve.
All of which helps me not at all when it comes to the relationships between Eastern European or Indian doctors. One of the things I love most about working at Sunnydale is that I work with people from all over the world. One of the things I hate most is not knowing jack about the cultures that these folks come from. With the folks from Eastern Europe and India it's especially hard, as customs vary from city to city and even neighborhood to neighborhood, depending on where you're hailing from. When two of the Indian docs are apparently in the middle of a shouting match and about to go hand-to-hand over something, it's a little disconcerting.
It's even more disconcerting to find out that they're merely discussing where to go to lunch, say, or who's got the better cricket team.
Likewise, when one of the docs from Moldova or Chechnya or Bjorkistan starts frowning and talking through her teeth, I'm concerned that something must be Very Wrong about something I've done. It rarely is; mostly, it means that the doc in question is merely concentrating, or thinking (again) about lunch, or is working differential equations in her head.
Noti bene for my fellow nurses in this situation: accept any food offered you; it will be uniformly delicious. Do not attempt to guess where somebody is from. If you guess "Russia" and it's actually some tiny offshoot of the Soviet Union's breakup that you've never heard of, and that only came into being in 1997, you will be in the doghouse.
Also, never, ever, ever drink with Russians. You will be sorry.
*** *** *** *** ***
I've had three days off of work, which has given me plenty of time to think about these things (if I had actually been thinking about them, which I wasn't). It's also give me plenty of time to stand, chin on hand, and consider how exactly I'm going to hang the typewriters from the wall. This has become my new Holy Grail: hang the typewriters in such a way that they're both interesting-looking and accessible. Given that I have 24" on-center, sorta, wall studs, this is going to be a challenge.
Oooo. Maybe I could hang them in a straight line, right down the middle of the wall to the side of the arch going into the dining room.
*** *** *** *** ***
I did squats yesterday and ran for the second time in months. Today I ran again. I am sad and sorry today; I will be sadder and sorrier on Friday.
*** *** *** *** ***
My massage therapist, when I walked in yesterday, didn't even say hello. All she said was, "Who's Adam?"
I told her that Adam is the husband of Friend Rob (not Abilene Rob; he's not been holding out on you) and a friend of mine. She'd heard that I'd gone to dinner with some Adam guy the other night, and was hopeful. I hated to disappoint her, so I told her instead that both Adam and I had come to the conclusion that we could be brother and sister: both stocky, redheaded, freckled, and short.
We wandered around the shopping area where he works and then went to a teeny restaurant for dinner. I waited until after we'd consumed chicken and cheese and greens to hit him with the dessert selection. His eyes bugged out. It was marvelous to see somebody with an actual sweet tooth enjoying little tiny hazelnut cookies and caramel and berries.
*** *** *** *** ***
I need a stud-finder-finder. Mine is somewhere buried in the shed, and I need it to hang those typewriters. Except it's too hot to go out and paw through the shed.
Posted by Jo at 2:29 PM
Saturday, August 28, 2010
....really *bad* cancer, as in "you don't want this sort of cancer, ever" cancer, and I've just wasted about a half a milligram of hydromorphone more than was ordered in the tubing, so he's feeling pretty good.
So I lean over him, and I remind him that he should let me know if he's uncomfortable--because, what the hell, he's gonna die anyhow; the graft's fighting his body--and I'll bring him more meds. Even if it's not time. He doesn't need to know that; he just needs to know that once his pain hits a four on a one to ten scale, I'll be there with the happy drugs.
And he says to me, "How many counselling classes did you need to take before you learned how a person feels?"
I said, "None. It's all experience." I didn't tell him that grimacing and guarding and short, gasping breaths are indicators of pain, universally, that don't need a lot of training to recognize.
"Trial and error," he said, "that's bullshit."
"I've been doing this longer than I'm willing to admit" I said, "and you wouldn't believe the number of patients I killed before I got to you."
That brought a smile.
I'm sure there was some point, maybe working at Planned Parenthood or the abortion clinic, when I realized that what was coming out of the person's mouth didn't match what was on their face, or in their body language. I can't remember that particular moment, but looking back, I'm sure it happened like a lightning strike.
Ever since then, I've been much more conscious of what the person isn't telling me. I had one nursing instructor who bothered to touch her patients with an un-gloved hand, and I've followed her example ever since. Sometimes a simple skin-to-skin touch makes all the difference in letting somebody know that you're not just some sort of health-care-providing automaton; you're a person like them who actually gives a damn what they're feeling.
If I have to hurt somebody by starting an IV or a catheter, I try to touch them just afterwards without gloves on, just to make sure that their last memory of the whatever-it-was isn't plastic and pain. Sometimes I even hug my patients without a gown on, zut alors! despite the rules.
By the same token, sometimes it's best to just shut the hell up. The dude I was working with was worried that his insurance wouldn't cover his return to the ICU. I let him vent for about ten minutes about how stupid his insurance company was, and it helped. His heart rate went down, his blood pressure dropped. Shutting up and being a body in the room who's attentive is a therapeutic intervention just as much as a Cardene drip is.
And as much as I hate to admit it, a lot of nursing has to do with intuition and gut feelings. We don't get trained in intuition, but we all use it. You have to develop the skill, and so you do.
Posted by Jo at 6:18 PM
Wednesday, August 25, 2010
And I thought the acute-care floor I used to work on was bad.
I've been pulling shifts in critical care the past couple of weeks, because the patients we've gotten have been critical enough to need easy access to things like Femostops and ventilators. I had forgotten how nutso these girls could be.
I say "girls" because we're all female and I'm usually the granny of the bunch, except for Kemal, who's Muslim, so we're trying to go easy on him this month. He gets a little punchy anyhow at the end of the day after not eating or drinking anything, and it's harder to resist the temptation to be highly inappropriate when you're hungry or thirsty. When Kemal's there, we're kind and gentle helpmeets and angels. When he's not, things like this happen:
Cap'n Obvious, the critical-care med fellow, had asked why, after being raised by fine upstanding churchgoers and having gone to a religious college, I no longer went to church.
I said, "Well, the last time I went, the whole place spontaneously combusted the minute I walked through the door. The pastor got a little annoyed."
The look on the devoutly-Catholic unit secretary's face was enough to make Cap'n O. burst into laughter. He kept laughing until his attending showed up, at which point he turned a delicate shade of purple in an attempt to keep from busting a gut.
Or the conversation between The Bomber, Kitty-Kat, Cap'n Obvious, and me on the subject of what one does in an ocean-view cabin in Oregon for a vacation. Cap'n Obvious, true to his internal med roots, prefers doing active things on vacation, like climbing mountains. Or ziplining. Or, and I wish I were kidding, swimming with whales.
"So what do you do?" Cap'n Obvious asked.
"Drink." said The Bomber.
"Have sex?" suggested Kitty-Kat.
"Go out for a hike and take a picnic lunch," I said, thus proving how old I really am.
"And then come back and drink." The Bomber said.
"And have more sex. Kinky sex" added K-K.
"Yeah, like when I imagine I'm Ben Bernanke and the guy is a Keynesian economist." That was me.
And again, Cap'n Obvious turned a little red and a little purple and bent over and puffed out his cheeks. The neurosurgery team was rounding at that point, and it wasn't quite appropriate for a fellow to be seen peeing his shorts.
Then we did a little forks-in-a-blender, and Manhandler made fart noises with her armpit, and then we all went home.
Posted by Jo at 5:17 PM
Sunday, August 22, 2010
just like you all to know:
I have a monster knot in my left calf.
As in, so bad it made me think I have a DVT. Nope, just a monster knot.
Atilla made me do one hunnert-n-twenny (three sets of forty) calf raises on a step yesterday. With twenty pounds in each hand.
And then more lifting.
If I were Hyperbole&1/2, I would be drawing pictures of screaming people with really, *really* muscular calves right now.
Posted by Jo at 12:44 PM
Saturday, August 21, 2010
Friend, are you feeling bored? Dissatisfied with your life? Vaguely disappointed by everyone and everything? Do you think you ought to be getting more attention from your family and from strangers than you do currently? Do you need a vacation from responsibility for a few days? How about your meals brought to you in bed? Does that sound good?
Well, Friend, do I have an offer for you! In a few easy steps, you can waste tens of thousands of dollars of resources, undergo unnecessary and sometimes unpleasant testing, and contribute to the inefficiency of the American health care system! You'll get all the attention you want and then some! You'll have people waiting on you hand and foot! You'll get visits daily from attractive young men and women! Just read this first:
Auntie Jo's Guide to Faking Neurological (and other) Disorders:
1. Remember to be consistent. If you present to the emergency room with a pronator drift, be sure that that pronator drift either stays the same or improves very slowly over time. Pronator drift testing is a cornerstone of the neurological exam, and drifts don't get better suddenly, only to worsen in a few moments, then improve again.
2. The same goes for unilateral weakness. Keep track of where, exactly, you're supposed to be weak. Having your leg give way and land you on the floor is an excellent dramatic touch, but only if it's the same leg every time. Again: consistency is key!
3. Retrograde amnesia rarely shows up in the absence of head trauma (internal or external) or really, really good drugs. It also rarely presents in a person with no other deficits. Try not to bring out the big gun of amnesia unless you're in danger of being discharged.
4. Beware the CT scan and MRI! They might just show that you have, indeed, no basis for your extremely interesting neurological exam. Watch out for the MRI especially: it's best to avoid being scanned by telling the tech at the last possible minute that you have a pacemaker, artificial joint, or bullet fragments in your body. It doesn't matter if you forgot to include that on your medical history before; you won't have to get scanned for now!
5. Don't forget: Migraines and somatic pain are for amateurs. There are too many non-narcotic options for treatment these days, and too many neurologists who are themselves migraneurs. Go with something more exotic, like the classic ipsilateral/contralateral/whateverlateral "falling out" syndrome.
A quick couple of notes on other disorders:
1. Rheumatoid arthritis generally affects more than one side of the body. Although a good-quality deformity can be achieved in one hand with time and self-harm, it's best to create problems on *both* sides of the body.
2. Blood tests and X-ray results have no place in your concept of reality. Even if radiology reports and test results come back normal time after time, keep insisting that a test you had at some hospital (the name of which you've conveniently forgotten) at some undefined time in the past was indeed positive. It'll create doubt and the need for even more exciting testing.
3. Never, ever admit to having any psychiatric diagnosis. It makes diagnosing your current illness that much easier. Instead, insist that you're fine, just fine: your hospitalization will be dragged out for days (or weeks) that way!
Friday, August 20, 2010
Thursday, August 19, 2010
Danish rabbit agility trials. They leave me in awe. Because, first of all, they're Danish. And who else would've thought up something as silly as rabbit agility trials, only to have it turn out so damn well?
Swear to God the Danes will profit from global warming when nobody else can, and it'll be in a fun, sort of silly, extremely comforting way that none of us can imagine at this point. With tongue clicks.
Posted by Jo at 6:57 PM
Wednesday, August 18, 2010
(Because this is totally random and just came to me as I was trying to compose a very frustrated blog post about the bugnuts patients I've had lately. I decided to do cute instead.)
Dr. Dink has a dog. His dog is a laborador mix who's been trained as a therapy dog and wears his cute little yellow vest every day. He's black, with big brown soulful eyes.
I see Dr. Dink once a year, long enough to tell him Yeah The Meds Are Working Everything's Great.
This time, Snooger (dog) came back into the office with us and curled up on the couch with me. I reflexively started patting Snooger's head and belly. He ended up on his back with his head on my lap, sound asleep from belly rubs.
Dr. Dink glanced up from my chart and at his watch. "Well, that's taken us exactly five minutes, but I hate to disturb the dog. Tell me, then: how did you learn to hang wallboard?"
We chatted about house renovations for fifteen minutes, until Snooger woke up.
Posted by Jo at 6:39 PM
Tuesday, August 17, 2010
The olfactory center of the brain is right next to the place where you process and store memories. That's why the smell of a pot roast, or the scent of somebody's perfume can take you back to 1959, when you were at that jazz club with the skinny guy named Frankie who had the bad bow tie.
Today I smelled two things: pine needles in the middle of a very hot day, and the combination of my dad's mother's perfume and chlorine on a woman who'd just gotten out of the pool.
The first took me back to weeks at Mom's parents' house in Saint Jo. We had tomatoes for dinner that had had their finishing on the kitchen windowsill. Granny's kitchen was all steel; I still lust after solid-steel countertops and steel cabinets.
We'd eat dinner, and then I'd have a very small demitasse cup ("demitasse" pronounced in the French way by my grandmother, who'd learned her French both at school and from the maids at the place where they spent their winters in Bermuda) of coffee, while watching my grandfather pour cream into his iced coffee. The Coffee Fairies would make the cream hit the bottom of the glass and swirl up into amazing patterns.
In the morning (after I'd laid awake, thanks to that demitasse of boiled percolator coffee) we'd go walking, because the doctor had recommended that Granddad walk for his heart. We'd feed biscuits to the various dogs on the route, who knew when we were coming. I knew them all, from Molly the enormous mop-like sheepdog to Sheriff, my favorite, a giant Schnauzer with a star on his chest and a lovely curly black vest on his back. Then home, for tiny bowls of cereal with cream and strawberries, and eggs and toast (endless toast, warmed with the butter melting in the toaster), and my grandmother asking if I'd like more "wipie kweepies"--my toddler name for Rice Krispies.
Then, finally, the smell of pine needles: that came after Granny parked the Mercedes convertible (I was relegated to the nonexistent back seat, which I savored--the smell of dust and leather and the fabric liner of the hard-top) at the country club and we walked up the path between the pine trees to the pool, where we swam--always a careful hour after lunch.
The country club pool wasn't as cold as the one that Dad's mother took us to. Dad's father was a Shriner, complete with fez, and the Moila Shrine in Saint Jo had a pool that had been built out of post-World War Two surplus steel. Even at two or three in the afternoon, it was cold. It lost heat quickly at night (when the mourning doves and cicaidas would sing) and wouldn't gain it back until sometime in August, long after we'd gone.
The Moila pool had, in addition to the iciest water this side of the Comal, a high dive. I remember quite vividly being eight years old and standing on the high-dive board, wondering if I would die if I jumped. It was a detached, impersonal wondering: the other kids visiting their grandparents had already gone, and I knew I wouldn't last long at the pool if I didn't jump too. The next summer, thanks to the experience of beating Eric Burch up during a soccer practice and thus exorcising all my childhood fears, I went off head-first. The sensation of my hair parting as I hit the water was memorable, to say the least--there was no bubbler for that three-meter high dive.
Granny II would lie on a chaise longue (not a "lounge", thankyouverymuch) with her silver rings and bangles and occasionally let me get a disappointing ice cream bar from the cart at the edge of the pool. She'd then make me sit for ten minutes before I was allowed to swim again.
The baby pool was always warm. The real pool, the one my sister and I were allowed in because we knew how to swim, was always ice freaking cold and required some getting used to.
And I always smelled my grandmother's perfume along with chlorine and hot pavement and the burnt-cotton smell of the towels we used. I know she didn't use the same scent every day, but it's always the same in my head.
So when I was gravely sorting through cucumbers today at the local Indie Mart, it hit me like a sledgehammer, to smell chlorine and pool water and maybe Youth Dew or Chanel #5 or whatever it was she wore, and to turn around, expecting to see a short woman with white hair in a bun, wearing white linen and silver. Instead, I saw a tall, slender woman who must've been a well-preserved seventy, with wet hair and workout clothes.
Sometimes I go to Michael's, the craft store, just to walk through the aisles where they keep the dried flowers. Sometimes I tempt fate and pull off the road to cut cat-tails in the fall, in order to dry them and keep them in a big floor-standing vase in my kitchen, near the back door. Sometimes I make myself toast out of Pepperidge Farm bread (very-thin sliced, please) and keep it warm in the oven for breakfast, when I drink tiny cups of boiled coffee.
Barton Springs, while lovely, doesn't match the Moila. And the Comal, as nice as it is to tube down, doesn't match the quiet calm of the country club swimming pool: the smell of chlorine, and hot dogs, and pine needles, and the hot, hot Missouri afternoons.
Posted by Jo at 6:10 PM
Posted by Jo at 2:57 AM
Monday, August 16, 2010
She's English, with the requisite plummy accent, a grey braid over one shoulder, a hand-knitted afghan she packed to come to the hospital, and her favo(u)rite tea mug on the bedside table.
She lives in Tinyton, a very small town north of Littleton, in a three-story Victorian that she and her late husband bought nearly sixty years ago. She's in her mid-eighties. She has a large grey cat and a small fluffy white dog and a garden, so of course we talked about dogs and cats and gardening.
"I'll need to be home this week," she said, after we suctioned the clot out of her head, "because nobody knows to water my peas."
I goggled. "You have peas?" I gasped. "Nobody has peas this time of year."
It's true. Three weeks of temperatures in the high 90's and low 100's and little to no rain has turned Bigtown, Littleton, and surrounding locales into a mesquite-flavored dustbowl. The only rivers worth swimming in are the ones that are spring-fed and have a mostly constant water level. My tomatoes gave up the ghost the second week of July, and I'm waiting for less-severe heat to plant fall crops of soft greens and crucifers.
But this woman? Has a Garden, capital G. A friend (the same age and equally as vibrant) brought pictures she'd taken with her new 4G phone, to prove to my patient that things hadn't withered and died. There in the pictures were sweet pea blossoms climbing up her fence, broccoli in the garden (note for northern gardeners: broccoli here bolts in the heat before you can pick it), a dozen pea plants on trellises, zinnias and rose bushes in full bloom, and an entire herb garden laid out like a Celtic cross. Between the patches of vegetables and the beds of flowers were the sort of grass paths you can't make without about a hundred years and a herd of sheep. In the back I could barely make out the edges of her property, which looked to be covered with wildflowers and the remains of spring bulbs. The little fluffy white dog was in some of the snapshots; in others, the big grey cat prowled along the edges of the flowerbeds.
Reader, I was gobsmacked. Her garden looked like nothing else on earth, and certainly like nothing you'd find in central Texas in the middle of August. She'd been completely aphasic when the volunteer firefighters from Tinyton brought her in, but had obviously trying to communicate something. Turns out she wanted to make sure that someone knew to water the honeydew melons.
I gave up and worshipped her when she showed me the two lemon trees, with fruit on them, that she'd smuggled from California in the trunk of her car in the mid-sixties.
She adjusted her bed jacket (do you have to wear bed jackets to be English? I mean, is it some sort of citizenship requirement?) and settled herself more comfortably on the pillows. "Well, dear," she said, "It has rained rather a lot in Tinyton this year."
The only explanation I have is that she carries the weather from Merrie Olde England with her wherever she goes.
Posted by Jo at 6:33 PM
1. Stand at the side of the bed facing your Human.
2. Breathe heavily.
3. If your Human doesn't budge, check the clock. If it's after two a.m., you may continue. If it's before two a.m., go back to bed and try again later.
4. (Assuming it's after two a.m.) Wag tail.
5. Breathe heavily.
6. Stare hard at your sleeping Human. The intensity of your stare should wake your Human. If it doesn't, then
7. Jitter your jaw so that your teeth click together. This is best done at a distance of no more than 3.75 cm from your sleeping Human's nose.
8. Breathe heavily.
9. Wag. The velocity of air from the movement of your tail should approximate that of the wash of a small plane on takeoff.
10. Breathe heavily.
By now your sleeping Human should be awake and fumbling for her glasses. Express your happiness at her returning conciousness by doing a subdued tap-dance. Extra points if you step on an Evil Cat during the tap-dance.
Once your Human is vertical (or some approximation thereof), jitter your jaw again to express your delight. Then turn and galumph toward the door. Be certain to hump your back so that the tags on your harness jingle. This will allow your recently-sleeping Human to approximate your position by sound.
When you reach the door, stand with your head down and nose against it, breathing heavily and wagging your tail.
Human's note: I would've strangled him, but Max never wakes me up in the middle of the night or the early hours. Usually he sleeps right through my shower and only goes outside when I'm ready to leave, or after the sun comes up.
And aside from the jaw-jittering (which I think he learned from the greyhound; it's not a habit I've ever seen in another shepherd- or LSG-type dog), it's not a bad way to wake up. A pair of melting brown eyes and a shiny black nose and a grin is a helluva lot better than the way the greyhound used to greet me, which was by running at me full speed on his hind legs, front paws out velociraptor-style, mouth open, tongue flying out to the side.
The fact that he woke me early also meant that I was awake when work called, begging me to come in for the seventh shift in eight days. Had Max not gotten me up and out of bed, I would've been too tired to laugh hollowly at the person on the other end of the line.
Posted by Jo at 2:36 AM
Sunday, August 15, 2010
1. This new woman I'm training? Way too sweet and way too friendly and way too skilled to be working with us. We'll teach her to be cynical and nasty-minded, but I'm afraid laziness is beyond her.
2. Indian food! New Girl On The Block brought a variation of biriyani unlike any I'd had before. It had red and yellow rice in it! We all traded food, so I had a combination of homemade Mexican, Chinese, Indian, and Thai and take-out American for lunch.
3. My next dog will probably be three rescued pit crosses, a bull terrier, two Kangal mixes like the Zoaters, and a herd of goats with a couple of Strider-clones to watch over them. I think I might need a farm.
4. And on that note, I have a long-term goal: by the time I'm sixty (ie; in 20 years) I want to be one of those husky-voiced, stocky Texan women who can run a baler and fire a shotgun and who owns her own land. Mine might have a super-efficient earthship on it, true, but that won't stop me from exercising my second-amendment rights to fire shots in the air to scare off coyotes. (Seriously? I couldn't shoot a predator, even, unless it was coming after me. But using dogs and donkeys and llamas to kill them/scare them off? Cool.)
5. I've finally figured out how residents do it: First, you work until you're exhausted. Then you work until you get that brittle, cheerful, hyped feeling. Then you work through that. Then you fall over and sleep. Then lather, rinse, repeat.
I am feeling distinctly harsh and unforgiving tonight, along with being cheerfully brittle. I feel like I've had six cups of coffee today, when it's only been two, and I doubt I can sleep.
The folks who do this repeatedly for up to seven years (shout-out to Beloved Cousin Claire!) have mad props from me. When people ask my why I didn't go to med school, I tell them that *this* feeling is why.
6. Good fucking night.
Posted by Jo at 6:52 PM
I am not sure what day it is or where "up" might be. Near as I can tell, I'm still vertical, but it's a struggle. I have worked six days out of seven this week and am wondering how people who do this all the time manage it.
Such is life when you're a delicate flower who needs regular baths in the blood of virgins to stay at your best.
Today I train a new person for the NCCU. Let's hope I don't make any really stupid mistakes. Moderately stupid would be acceptable, but not really stupid.
More Sunnydale funtime stories to come in the coming week, once my sleep deficit is repaired.
Saturday, August 14, 2010
Friday, August 13, 2010
People, listen up:
This shit, right here? Is copyrighted.
Just because it doesn't have a copyright notice at the bottom of the page doesn't mean it's not copyrighted. Just because I don't have a widget that says I have a Creative Commons license doesn't mean that I don't. And just because you can repost my shit--this shit, right here--and maybe have two or three days or a month before I find it does not mean that I won't find it.
I can use Google as well as anybody else. Plus, I have minions all over the Interwebs. Plus-plus, there are ways of finding out if somebody's snagged this shit right here and reposted it without credit.
I don't mind sharing this shit if you just ask me. Credit me as Jo, or credit the shit as having come from Head Nurse, and I'm cool. Send me an after-the-fact heads-up saying, "Yo, bitch, I reposted your shit on Name Of Blog" and we're all good. Just don't post my shit like it's your shit. Even if it's in company with other really cool shit, like stuff from H&1/2 or Whoopee.
What the hell can I do, you ask? Well, honestly, not much. I suppose I could hit you with a C&D snowball, but what the hell: the Internet is a wild place, and it's best that way, and really, there's nothing much legally I could do to your lousy ass that would stick. Copyright-infringement lawsuits are generally not bumped to the top of anybody's docket ahead of, you know, gruesome murders of multiple small animals, or anything.
Kharma, however, will bite you in the ass. You will develop the Internet version of psoriasis, or end up with hemorrhoids large enough to qualify for their own ZIP code, and/or develop a nasty rash that will be public enough and weepy enough to prevent you from ever getting laid again. Ever. Your dick will shrink to the diameter and length of my little finger at the same time that your thighs suddenly grow thick, dark, wiry hair unlike any hair on the rest of your body.
You will have really, really bad breath. That's how serious Kharma takes this stuff.
So cut it out. Don't repost my shit without permission. I'm easy, I swear, and there are plenty of guys out there who'll swear it along with me.
In short: ask, and we're cool. Don't ask, and be prepared for termites, locusts, hemorrhoids, and total lack of sexual stimulation for the rest of your life.
Leave the blog. Take the cannoli.
"How'd you feel when you finished your internship?" the new girl asked, a little cautiously.
"Like a complete moron," I said. "Like I didn't know shit and I was a danger to myself and others."
It's true: no matter how experienced you are at Thing One, when you start doing Thing Two, you go from being a light in the field to being a mud-covered, vaguely clumsy, not-terribly-smart lump of nurse-goo. There are some things you can do well because you've been doing them for years, but everything's all mixed up in your head, and suddenly you can't remember how to start an IV.
It's an interesting sensation, when your brain starts to slot new information in with the older stuff. You realize not only how much you've forgotten, but how much *stuff* is in there in the first place. The sheer complexity of what's in your brain-box becomes more apparent. It's a little disconcerting.
We've all been doing that a lot lately, that genius-to-lump transformation. Because of that bugaboo, Staffing Issues, everybody's been going everywhere and doing everything. Why on earth any Mangler thinks it's a good idea to send a neuro nurse to a heart transplant unit is beyond me, but it's happening now, to fill gaps in the CVCCU's staffing. (I haven't gone--yet--thank God.)
I've been working for the last five days in both the neuro CCU and the surgical CCU. The latter is much more fast-paced, being an established unit, and you really have to be sharp to keep up. I had forgotten how much *stuff* I had to fit into my head in the course of a day there. Just remembering the drips I have to remember is challenging. Esmolol? Er, okay. Vec? Sure....let me just, uh, get this quick-reference sheet over here.
At the same time, I've been watching my colleagues who are used to dealing with people who are immediately post-craniotomy feel off-balance when they deal with an acute embolic stroke, because the protocols are completely opposite. If you bleed into your brain, we'll keep your head high and your blood pressure low. If you've clotted off a distribution of your MCA, we'll do the exact opposite. (I remember the first time I saw another nurse drop the head and raise the legs of a patient who was having TIA symptoms. It was as though I was in a different universe, and I felt like an idiot.)
Perhaps the biggest difference in my unit is that you can't rely on machines to tell you how a patient's doing. If you have a post-op patient who's intubated, paralyzed, sedated, and on a vent, you spend a lot of time titrating this or that drip to keep their heart rate and blood pressure within defined limits. A CT scan will tell you that X or Y is healing well and that there's no acute bleeding into the neck/abdomen/brain. An arterial line and a CVP line and a Swan will let you know if something is going wonky before the patient even feels it.
In my unit? You have to use your eyes, and your ears, and your hands. CT scans won't tell you much about a clot-ridden brain, except that there's no free blood in there. MRIs will, but nine of ten of our patients can't tolerate an MRI. Subtle changes in hand and foot strength, differences in the level of ataxia, new speech changes--those are what you look for when you're on my territory.
A machine won't tell you if a Star hasn't held closure, or if an angio site's gone bad and has put the patient's leg in danger, but you can look and touch (with ungloved hands, even, to get a sense of temperature) and ask and observe.
My shrink, Doctor Dink, once said that he went into neurology and later psychiatry because it was the closest he could get to Ye Olde-Tyme Doctoring. Well, it's the same with nursing.
And moving from Let Me See You Do This Ataxia Test and Repeat After Me to Titrate That Drip and Level This Line, Willya is like trading your horse-and-buggy for a racecar.
It's fun, and I'm certainly not bored or tired, but I have three more days of this to go this week and I'm not sure how much more moronic I can feel.
*You'll note that the title of this post has nothing to do with the content. I've just always really, really wanted to use those words as a title, is all.
Posted by Jo at 2:20 AM
Monday, August 09, 2010
And that was almost pointless, because one of the patients we were expecting didn't show up, and the other showed up at shift change...
...I love Maru. So, so much.
He's almost as fuzzy as my boys.
Posted by Jo at 7:09 PM
Sunday, August 08, 2010
Yeah, so. I have a two-inch slice on my ankle now, thanks to the super-duper retraction speed of the cord on the Miele. Don't get near the vacuum when you're retracting the cord, is all I can say. The plug'll whip around and slice the shit out of you.
The house is mostly put back together now after the Painting Party. I'm trying to figure out how to best arrange the typewriters on various walls. I'd planned to put them all on one wall, but the nice man at ACE told me that that wouldn't work, as the wallboard wouldn't hold 'em.
The rug (which was always too big and too rough) is out of the house now, and has gone to the neighbor's. Now I need something to put on the floor before winter comes, so my tootsies don't freeze.
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It struck me today that it's a sign that things are going better than I had expected with the new NCCU that they keep calling me on my days off, asking if I want to work. That means we have patients galore. Given that we're still working with crapped-out equipment and borrowed space, that's pretty impressive.
I just wish we had the wherewithal to handle vents on our unit. There's some obscure hospital policy that says we can't have vented patients, probably because things are, well, cobbled together and borrowed. Eventually, though....maybe in ten years? Or in five, if we can get the space from the surgical CCU?
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Max has finally figured out that it's really too hot to be outdoors during the middle of the afternoon, and has taken to scratching at the back door. The other day, when I didn't let him in (since I was forty miles away), he simply walked through the fence to the neighbors' house and went through their dog door. We're not going to bother to repair the fence; we're just putting in an extra gate that I'd been saving for the occasion.
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Friend Joy revealed on Facebook today that she and her Lovely Husband are now caretakers to two stock guard dogs--Anatolian/Pyr mixes--who are meant to supervise the goats that are to show up in a week. Remembering Strider makes me hope two things: first, that both dogs have plenty to do in the meantime, and also that Joy and Lovely Husband have plenty-plenty food around for the one who's still growing. Strider, according to his forever-home person (who still emails me twice a year or so) topped out at about 170 lbs and eats everything in sight.
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My cuticles are a mess.
Posted by Jo at 3:47 PM
Saturday, August 07, 2010
Friends Rob and Ed and Anne came over today and helped me paint my living room. This was an act of pure-dee charity on their collective part, as my living room is panelled in ancient faux-wood (well, I mean, it's real wood; it's not like salami panelling or very-quiet-peacock panelling) that takes up paint like a sponge, plus it used to be chartreuse and now it's white.
Anyway, the three of them came over and we painted and painted and painted. At one point, late in the day, we all got punchy. Ed started asking plaintively, "Paint ALL the things?" and we kept replying, "Paint ALL the things!"
Which got me thinking about how I found Hyperbole and a Half. I had been unaware of the blog until I got an email from somebody (I don't remember who, and I'm sorry, and you rock) warning me about somebody *else* putting shit up that they were passing off as their own work. As well as my stuff, I saw some of Allie's from H&1/2, and some things Sark wrote years ago for Tomato Nation, and a whole load of things from other very well-known bloggers.
Anyway, that's how I found H&1/2. The person who'd put up our work as her own apparently had been doing it for some time on different blogging platforms; Allie mentions the same situation on a Blogger page (the one I was clued into was on WP). Some people need fucking hobbies, man. Better fucking hobbies.
But it was nice to see HN posts up there among the rarified works of people I really admire. I'll admit to getting quite a charge out of that.
Speaking of hobbies, as I mentioned above, the living room is painted. I had hoped to get the dining room painted too, but then I realized that a) eight hours is about four and a half hours too long to spend painting in one day, and b) there was nowhere to put the stuff in the dining room, as I'd piled all the stuff from the living room in there.
This is a natural consequence of my addiction to dwell blogs. I read them all day long if I'm not careful, and I come up with great ideas on how to make my own bead curtains from waxed paper and embroidery thread, or why decoupaging your refrigerator is a good thing, or which exact shade of white you should use with which decor. (For the record, I used Behr UPW all over the living room. It reflects colors nicely.) I could talk about the difference between midcentury modernism and Brutalism now.
Unfortunately, I have ten thumbs and no natural decorating talent, so my attempts at warm-and-cozy, midcentury cottage style came out looking like somebody's crazy Aunt Bossie had camped out in the living room. And had gotten into the cooking sherry and the paint, in that order.
Hence the change from chartreuse to white.
I'm also getting a new couch delivered sometime (I hope) soon. This will be a real couch, though condo-sized, because it struck me the other day that I have several friends who are on the enormous end of the size scale. They're all guys, and they're all very sizy, rangy, tall people. There's something kind of pathetic about watching poor Rob, who stands about six-five, trying to wedge himself onto my loveseat, with his knees up around his ears, and still make charming conversation. Friend Ed isn't much shorter, and Beloved Dmitri is big enough that he has to keep swatting the small planets that circle him away as though they're mosquitoes.
So, yeah. New walls, new couch. I gave the jute rug to the sweet hippies across the street, rescued a tail-less gecko from Notamus, and scrubbed the floor. Tomorrow I will continue to clean ALL the things.
I will post pictures when everything's a little closer to done. Right now you'd get a lovely tableau of the new shiny gorgeous walls, the empty bookshelves I just moved back into the room, and a floor buffer, vacuum, and all their attendant cords. Oh, and both cats sitting on the back of my grandfather's chair on their hind legs, chirping at something near the ceiling.
Posted by Jo at 7:47 PM
Friday, August 06, 2010
Because, really, nobody cares what I ate for lunch (hot dogs) and work has been blessedly boring lately, I thought I would share some interesting personal information with the entire world.
(Here I had meant to put some cute pictures of Max, but my memory card was full, so none of them transferred. Take it as read that you're seeing Max with his new harness, lying on the dining room floor, paws up in the air as he asks for belly rubs.)
Ten Odd Anatomical Quirks Jo Has:
10. I have no antecubital vein on my right arm. This has been verified by my doc, who says it's not all that unusual. Apparently, some people just don't develop AC veins in utero, so you have to go kind of off to the side in order to get blood. The left arm is fine.
9. I am missing one thoracic vertebra and the corresponding pair of ribs. Thanks, Mom; I get this particular anatomical weirdness from her.
8. My appendix is apparently quite small. I discovered this during the Great Belly Workup of 2010. I have a vestigial appendix! Now if I only had no foreskin and could see in ultraviolet, I could be like Lazarus Long!
7. According to the orthopod I saw after I hurt my knee, my shinbones are out of proportion to the rest of my leg. They ought to be shorter. Given that I'm already short enough thanks to the missing vertebra, I'm thankful I have long shins.
6. My molars are backwards: no shit. This was discovered initially by the orthodontist who put braces on my teeth when I was thirteen and has been confirmed since by innumerable dental hygenists who, when I open my mouth, say "What the hell?"
5. My optic nerves are too large for their discs. Nobody knows what this means but my opthamologist, a nice guy who wears very bad ties. He mentions it every time he sees me. Even in social situations. He's a little strange. (He also told me I have stretch marks on my retinas. I'm not sure what to think about that.)
4. I have a third nipple. Make of that what you will. I lived for thirty-eight years with a third nipple, in blissful ignorance, until the dermatologist I see (to make sure I don't die prematurely of melanoma) pointed it out excitedly. Given that it's closer to my navel than to my breast, it makes me feel more like a pig (anatomically speaking) than a Bond villain (again, anatomically speaking). For future reference, it's on the right.
3. According to the last set of X-rays I got, the bottom set of floating ribs I've got sits inside my pelvic girdle. Again, Thanks, Mom! There's short-waisted, and then there's short-waisted.
2. I can lock the distal joints of every finger, a talent that most people apparently don't have. I have a buddy who can roll her shoulder and hip joints out of place on request and can simultaneously push her hands back to the point that her knuckles touch her forearms (Madelung syndrome), so being able to lock joints never seemed like such a big deal to me, but it apparently is.
And the number one weird anatomical quirk I've got, and the one I've considered putting on Christmas cards:
1. I have a wisdom tooth in my right cheekbone.
No shit. This was such a cool revelation that I demanded copies of the X-rays showing it. I had one wisdom tooth removed from my lower jaw about....gosh, was it twelve years ago? It must have been. During the workup, the dentist did one of those 180-degree X-rays and found a wisdom tooth, lying horizontally, in my right cheekbone. It's not going anywhere, obviously, but it's kind of neat. If it ever decides to go against all human development theory and grow, it'll come out in the middle of my ear.
This is all to illustrate what an amazing thing the human body is. I have met one person with a cerebral vascular setup like unto a cow's, and another who, after a head CT for sinus problems, found out he has about an inch of brain tissue surrounding enormous ventricles. The neurosurgeon said, in that second case, Well, it hasn't been bugging you, so we'll let it be.
And, with that, my bed is calling me. Imagine a picture of Max, lying on the floor, ears up in airplane-position, right here.
Posted by Jo at 6:49 PM
That's our new go-to phrase in the NCCU when dealing with any other service. Those of you who don't know where it came from, watch this, and then read on. (Note: the video will only take three minutes and twenty-two seconds of your life, and you won't regret it.)
The new patient came in late in the evening, after I'd left, from an outside ED. The folks at the ED had done everything right, from a stat CT to offering TPA for his stroke symptoms (which he and his family refused) to doing a 12-lead EKG. It was the 12-lead EKG that caused the trouble: without TPA, there was nothing our services could do but watch and wait to be sure his stroke symptoms didn't get worse, but he was also having a heart attack.
Oops. Well, crud. That's below the clavicle.
So we transferred him to cardiology, because, well, you don't want neurologists and neurosurgeons managing your myocardium. I mean, I'll happily give you all the oxygen and aspirin you can suck down, but I'm really not a heart kind of gal.
A few hours after he'd left my unit and gone to the CVCCU, I got a call from the resident.
Heart Gal: Hey, I'm the resident in the CVCCU, and I had a question about Mr. Jones. How do you know he had a stroke?Me: Beg pardon?Heart Gal: Well, you know, he never got an MRI. How do you know he had an acute infarct?Me: Symptoms.Heart Gal: But he never had an MRI. How do you know he had a stroke?Me: His left side went weak and his speech got slurred and his palate wasn't elevating equally. His stroke scale score was 5.Heart Gal: But...but...without an MRI, how do you know there was an infarct? I mean, how can you tell that there was a stroke without an MRI?Me: One quick question for you: have his symptoms resolved, or is he still weak and ataxic on that left side?Heart Gal: He's still weak and ataxic, yeah. But I don't see what that has to do with it. He didn't have an MRI, so you can't tell if he had a stroke, right?Me: Um. (thinking hard, trying to figure out how to explain this to HG, who's a very nice person as well as an excellent cardiologist) Well, y'know, we don't generally *do* MRIs on people who present with symptoms of an embolic stroke. They take a long time, so we go by symptoms so we don't lose any time in treating with TPA. And Mr. Jones and his family didn't want TPA, so we figured we'd do an MRI once he was stablized. How's his heart, by the way?Heart Gal: His heart?Me: Yeah, his heart. We sent him over there with a troponin of 3; how's his heart?Heart Gal: Oh, it's fine. I'm just trying to figure out how you knew he had a stroke.et finis
Posted by Jo at 3:16 AM
Sunday, August 01, 2010
This is the mirror that hung in the house where I grew up.
This is the mirror, with chipping gilt paint, that hung in the house where I grew up.
This is the mirror, with chipping gilt paint, that I'm going to paint, that hung in the house where I grew up.
This is the cat who scared me to death when he jumped on the mirror, with chipping gilt paint, that hung in the house where I grew up.
This is the mirror, with one coat of paint, that will hang in the dining room of the house that I bought after I moved out of the house where I grew up.
Posted by Jo at 5:47 PM