What you should never, ever do.

You should never buy a five-bill German vacuum, no matter how much disposable income or desire for Teutonic clean you have. Never, ever.

Because if you do, you'll end up with a cute little blue vacuum that has all the personality of a milkmaid and all the determination of a Dalek. And you will vacuum. And you'll find, as you vacuum, that there are things that you maybe might have missed vacuuming for the last four years.

Like your walls. Your walls.

Your walls, that have dog hair and cobwebs up near the ceiling. And wolf spiders as big as your thumb lurking in the baseboards. Yes, I screeched like a girl. Then I complimented Ms. Wolf Spider on her coloring and put her gently outside. But anyway.

Your Blue Teutonic Charming Vacuum will enable you to vacuum those walls, and the doors, and the tops of things that have dust on them, and then maybe the kitchen cabinets, because boyo, don't those have some dust on them? And then you'll get to the baseboards and suddenly realize that all the little delicate moldings on the mirror in the dining room probably trap dust too, so you'll vacuum that.

At this point, Max will get annoyed. You'll pull out the TV/DVD player to watch a movie, but you'll realize that those are both covered with dust, so you'll vacuum them. And then you'll think about your office, and how your desk hasn't had any glass in the windows for ages, and you'll open a bottle of wine and go vacuum the office.

Which will lead to vacuuming the bathroom walls and the storage drawer under the stove and the cabinet where you keep the rice and the utility room.

Max will have long since gone outside to get away from the eternal, infernal vacuuming, and your toenails will not be Tiffany-metallic blue, and you will have drunk a half bottle of wine without realizing it.

And then it will come to you that, in order to get the kitchen walls really clean, you must scrub them with Method spray soap and white melamine scrubby things from Target.

Which is why you should never buy a five-bill German vacuum, no matter how cute it is.

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

Excuse me. I just realized I forgot to vacuum the back side of the guest room door.

Gracious!

After most of a week without 'Net (due to a horrible thunderstorm that produced lightning that hit and split in half a tree in my neighbor's back yard, sending one half of the tree into *my* back yard, but more on that later if at all, because it really sucked and I don't want to go into it) and most of a week with really heavy patients, including one sweet, charming gentleman who insisted on leaping from his bed like a gazelle though he had no use of his right side, and most of a week during which I've been grousing about not being able to take NSAIDs (see charming gentleman, above) for my back, I'm back.

My massage therapist is very unhappy with me. She will continue to be unhappy with me tomorrow, when we meet for another session of elbows-on-back, yank-the-leg-into-weird-positions massaging and stretching. I did yoga this week, and refrained from lifting heavy things over and over, and I was still flat on my back on the floor for most of the day today thanks to that sweet guy in the surgical CCU. He was very apologetic about making me grab him around the waist and swing him into a chair at the very last second.

Uh....updates. Yes. IbidKitty is coming around nightly to eat her chow, though I rarely see her now, as it's getting dark later and later. Max is lovely, thanks to my brother-in-law's suggestion that what I thought was a seizure was maybe old-dog farting-with-bonuses, and perhaps lentils would help. The Boys are dangerous and deadly, and would like all of you to be very, very afraid. And then give them belly-rubs and head skritches. Attila is in California at a yoga class and will be gone until after I have surgery.

I still have not been able to watch any of the Dr. Who episodes involving the Weeping Angels after the first one ("Blink"), which means I'm missing a lot of River Song history, which is frustrating. But the Angels are scary.

The Powers that Be have implemented three new daily audits that must be done on every patient every day, adding to the two that we already did ibid opcit, and making our lives that much harder.

The house is still standing despite the baseball-sized hail that fried my Interwebs connection and dented the siding (all but one dent popped out the next day). Surprisingly, I didn't have any roof damage. I think that was primarily due to the fact that the fucking hail was coming down at a 35-degree angle thanks to the 70-mph straight-line winds. After the power went out, Max went to the Disaster Closet, opened the door, and went straight in. He knows what's right.

I have a new bottle of metallic robin's-egg blue nail polish. It's posh, rathah.

And that is all.

People make me so MAD.

There was a little kitty out in the front yard the other night when I got home from work. She seemed unafraid but cautious, so I talked to her a bit and got some meows in response. I forgot about her until last night, when she showed up in the back yard--and any cat who does that is either ballsy or desperate, given that that's Max's territory--and meow-meow-meowed until I came outside.

(I should mention here that I live in a part of town heavily populated by what my marvelous pal E. calls "stupidents." Everybody moved out about a month ago. Some of them apparently left a cat behind. It happens every year; some folks think animals are disposable.)

Poor little cat was skin. And. Fucking. BONES. Her spine and tail were sharp through her skin, she was covered with scabs, and there were big patches of fur gone from her back legs and belly. At one point, she was a floofy, long-haired cat: now she's a bristly, skinny, patchy-haired cat with her ribs showing.

What could I do? I fed her. When I went outside later, she was as ravenous for affection as she had been for food. We sat for a bit and I petted her--carefully, since I'm nervous around strange cats--and then she ate some more. She did the head-bump, pet-beg, eat, head-bump thing for about a half hour, by which time I was fairly sure that she wasn't pregnant and wasn't sick. I got my hands around her and picked her up briefly; she might weigh four pounds. The boys watched it all from the window, interested but not pissed off.

If she sticks around, I'll feed her up and then take her to the vet to get her spayed (or, on the off-chance it's a him, neutered), because I'm sure whatever moron left her behind didn't bother to get her altered; get her shots and so on, and then I'll probably have another cat.

I've seen dogs with their ribs showing. I've never seen a cat with its ribs showing. I've also never seen a cat so thin that you could see each individual joint of its tail through its fur.

Poor baby. There is a special place in Hell for the people who abandoned her.

What I did today (a paraphrase of an earlier email)

Woke up late. Ate breakfast. Read Kelly's The Great Mortality. Napped. Woke up. Ate lunch. Texted Abilene Rob to see how his NCLEX went and got encouraging news. Napped again, this time under a pile of cats. Considered doing laundry, cleaning the bathroom, buying a new Weed-Eater (the last one caught fire the last time I used it), or dyeing my eyelashes. Rejected all options as being too labor-intensive. Started Jeffrey Steingarten's It Must Have Been Something I Ate. Let Max in out of the heat. Rubbed his belleh. Went out and picked up a six-pack, and on the way in to the house, picked a tomato off the plant in the front beds. It's now ripening on the windowsill.

What I most emphatically did not do today:

Answer phone calls, frantic or otherwise, from any hospital, clinic, coworker, or doctor. Get tested for anything. Have anything plastic refitted. Slide into any tubes, magnetized or otherwise. Suction, rinse, or wipe snot out of my enlarged oral cavity. Think about what I could or could not eat. Be exposed, therapeutically or not, to radioactivity. Think about having cancer. Take pain medications. Research anything. Worry about whether I'll have enough energy tomorrow or the next day to do what I want to do.

In short, it was a beautiful, ordinary, lazy golden day: the first one I've had since August of last year. Even if things go to shit tomorrow, I'm going to treasure this twenty-four hour period. Thank God for ordinary days.

A Burma-Shave-worthy offering from my sister:

"When you're sick

Here's how you know:

Even doctors

Mutter 'Whoa.'"

I learned today what you do not want to hear when you open up your trap for the prosthodontist. What you do not want to hear is one tiny syllable, uttered in a quiet voice and with force:

woo

That noise means there's bone exposed on the backside of what used to be your palate, before your palate was removed by a nice man who resembles a wading bird, and it's exposed because the prosthetic palate that the pleasant prosthodontist fit to your trap has rubbed the flesh away from the bone.

Note that I did not actually feel this happening. I thought the prosthetic was irritating one of my adenoids, or a softer bit of tissue further back in my throat. I was completely unprepared for the

woo

However, the prosthetic now fits like a dream. I no longer sound nasal, my hard k's and esses have improved, and I don't have to rinse the thing every ten minutes to remove built-up spit.

Aside from the whole bone-showing, owie-zowie thing, it's great. With a couple of tiny modifications, this will probably be the palate that I end up wearing from here on out.

I still want glitter, or rainbows, in the final version.

Thank God I'm a nurse.

My father once wondered aloud what it was that made me the only nurse in a family of academics. He answered his own question to his own satisfaction with the observation that I'm the only one who was ever good at math (my 9th grade algebra teacher is staring in disbelief) and has let the subject lie since then.

I had dinner with the Sainted Mother and Honored Father tonight. I was once again reminded, during the course of the meal, how very glad I am that I'm a nurse.

See, Dad was talking about academic politics and who gets what professorship and what one's ranking in the department was dependent on, and how that was affecting this, that, and the other thing. And I was sitting there, alternately casting my eyes Heavenward and thinking, "Y'know, if some jackass tried *that* shit around me, they'd never set foot in my unit again."

Even though there's politics involved in my job, it's not the sort that touches your average floor nurse. Even though there's the little matter of the state budget, or the little matter of the performance improvement scores, or the tiny issue of staffing, I'm generally immune to everything besides the delta between Patients Alive At 0700 and Patients Alive at 1900. Less than one is good. One or more needs explanation.

I grew up in academia. I was the world's best paper-writer in college, having been inducted early into the world of poundage of production equalling quality of execution. Becoming a nurse, with its no-bullshit, no-slack way of looking at the world, was a shock. People told you things once and expected you to remember them! There were immediate consequences to your actions! Fucking up was not something you could put in an errata notice in the next edition!

It's very comforting. You're either breathing or you're not. You either have the chops or you don't. Mediocrity is not something that can be hidden, and crazy-pants behavior doesn't last long on the unit. Every problem, no matter how complex, becomes simple once you break it down into its component parts. You cannot argue with an arterial blood gas result.

Thank God I'm a nurse. Maybe the academic world needs more of us, running around like badgers with chainsaws.

So there's this new doc....

....who's missing an arm. Nice guy. Just happens to be missing an arm.

Joanna and I were watching him walk down the hall when she turned to me and said, "I wonder if he ever does The Fugitive as a one-man show?"

Max got a bath today.

And boy is he unhappy about it. He's lying on the floor near the doorway between the dining room and the kitchen, alternately shooting me mournful looks and licking his delicate paws.

He also got his toenails clipped. For his reaction, see the previous sentences.

He's a big dog with a whole lot of fur and huge claws. His claws look like parrots' beaks and are just about as hard. Even with the racheted kind of nail clippers, it takes me both hands and a lot of sweating and cursing to clip one nail.

All of this happened today because I think he had a seizure overnight. I woke up to find him lying in a puddle of urine and feces, but unaware that he had soiled the floor. Normally if he has to go out, he's all up in my grill no matter the time of day (or night). He got up and walked fine after, though his back legs are chronically weak, and his reflexes were fine when I Furminated him this morning. If it had been a spine thing or a loss-of-control thing, he wouldn't have been as strong as usual, and he would've been extremely embarassed about soiling in the house. He has standards. If, however, he seized and then slept through the post-ictal period, he wouldn't be aware of what had happened.

So I'm thinking, hoping, praying seizure. Seizures I can handle. Spine problems or joint problems, or, God forbid if You love dogs and I know You do, a tumor, I don't know that I could handle.

Anyway, he got a bath. It was time for his annual bath anyhow; the ecosystem that grows during the fall, winter, and summer in his undercoat has to get evicted yearly to make room for new inhabitants. I'll take him to the vet on Tuesday to have an X-ray and make sure there's nothing screwed up in his lumbar spine.

Much as I hate to say it, I think this might be his last summer. The heat has gotten harder for him to handle as he's gotten older, and now he's a very old dog. His heart was damaged early on by heartworms, so there's that. And now this whole spine/tumor (no, God, please)/seizure thing. . .he's been put down, pushed around, apprehended, and put up wet, and every critter has its limits.

He is, however, the best boy ever. Even if he takes the varnish off the floors because he wants to come in when he's soaking wet. He's a good boy.

I met somebody today.

I am so excited.

Just over the freaking MOON.

Today, I met somebody--introduced by my uncle, no less--who had her palate removed, same as I did eight months ago. She's three weeks out of surgery.

She sounds just like I did three weeks out of surgery. I don't know that I ever subjected you guys to the absolute depths of suckiness that I was feeling then; I don't remember. The first paragraph of her email, though, was exactly what I was thinking then, so much so that I sucked in my breath and said "Oh, my GOD."

There is somebody like me out there. Better than that, there's somebody like I was all that time ago, when things were really, really bad. She can hear from one person, at least, that things get better. It'll remind me that that's true every time I say it.

She's gonna be *fine*. Fine as freshly-fluffed froghair. Just like I am.

Wow.

See, here's the thing:

If you're working on some massive project or presentation for work and you suddenly get a dull headache and lose half your visual field, it's not normal. The dull headache might be, but the loss of half of your eyesight isn't.

If you wake up in the middle of the night totally blind and without the use of one side of your body, that's not quite right either.

And when you're sitting at breakfast and can't talk, well, that's out of the ordinary. Especially if you've already had a cup of coffee, and doubly-especially if one side of your face quits working, causing you to drool.

All of these situations would warrant, at the very least, a call to your doctor. I mean, it's conceivable that you might, in the first scenario, be having some sort of atypical migraine...but wouldn't it be better to know? If something is going wrong with your sight or coordination or speech, wouldn't that freak you out just a little bit?

I would think it would. Yet all of the people who experienced those symptoms above either went back to bed to sleep them off or kept on chugging along with their respective days. By the time they got to me, all three of them had had massive embolic strokes. They'd delayed long enough that there was nothing we could do except start 'em on aspirin and do rehab. One dude kept cutting hay until his entire back forty was done, then dragged his no-longer-working left side up to the barn and called his wife.

This puzzles me. I know that getting the hay in is important, especially with rain in the forecast. But isn't...I dunno, the fact that you can't feel one side of your body a little more important? Don't you think that being able to lift your arm should have priority here?

If you have a seizure, you go to the hospital or somebody calls 911. Same deal with losing the function in your legs, or losing control of your bladder: you'll go to the doctor if you think you've got MS. What is it about strokes that makes people not start worrying? Don't tell me that it's a function of the stroke itself, because it happens no matter where the stroke is.

It makes me wish that strokes came with some sort of awful green discharge or a rash, or something. Maybe if people could see that something's wrong, they'd be a bit more panicky.

>shakes head<

Sometimes nothing works.

Bad is having a patient with no IV access who is currently critical, and on whom starting an IV is like sticking a rock.

I'm not a bad IV start, really. I manage to get crazy shit on veins in the thumb, for Christ's sake, when nobody else can get anything. You give me a coding patient with a foot that's unburnt and relatively perfused (for a foot) and I can start a 20 gauge.

Really bad is not being able to advance a catheter, and having to give meds through the sixteenth of an inch that you've managed to float into a vein with prayer and incantations and maybe a chicken waved over the patient.

Worse is the situation where they've been okay, then not okay, then sort of okay while the labs say they're not okay, and the clinical signs say they're really touchy, but you still sort of think they're okay, maybe, but suddenly they crump.

Worst is when you acknowledge that they've crumped. You've got eight channels running in the CCU and they're not getting any better, but you keep playing with the Levophed to try to keep their BP within range.

Oh shit is when you realize it's all over. You can't do anything more; you've used up all the tricks in your particular bag o', and it hasn't been enough. All you can do is watch this thing, this person, go down the drain. Slowly. Despite all interventions.

No matter what you do, sometimes it isn't enough. Sometimes, in the face of all your training and all the things you've picked up over the years and even all the little crazy tricks you've tried that might not be in the protocols and might even be a bad idea, it isn't enough and the person, the life you've tried to save, the thing you've invested so much time and emotion in, they die.

It started out fine. She weathered a few bumps in the road, what with electrolytes and pressures going nuts, and she did okay. Then she fell over and there was not a damned thing I could do. I'd known her for two years, with her pulmonary hypertension and her crazy blood sugars and her dialysis, and I knew what had to be done.

None of it worked. None of it *worked*. Something, somewhere, ought to work in cases like this. Nothing does.

I guess, once you have enough experience, that you shrug and go on and say, "It just wasn't meant to happen." You deal with the next thing that has to be done and you put that last thing behind you, no matter how big it was.

I can't do that yet. I don't know that I'll ever be able to. This is where I feel most alone: I can't call Beloved Sister or Sainted Mother and say "I lost somebody tonight," because, for one thing, it's not something they could understand. For another, it was less a failure of things I did or didn't do, but more a recognition that nothing at all was working.

Sometimes nothing at all works. You do the debriefing and the root cause analysis and you go back over your charting and your actions, and everything is right, but nothing worked. You know it's not you, specifically--that the human body has tricks up its sleeve that we can't even imagine--but you still feel like you weren't enough.

Sometimes nothing works. Those are the times you remember when stuff that you did *did* work, and you wait and hope for the next time that that might happen.

The times that you fuck up through comission or omission are better. The times when there is nothing at all in the world to be done are the ones that keep you up.

Ignore the ad at the beginning. I think this might be a good song for Fall.

Ooo! The ad didn't come up for me the second time. Huzzah!