I missed Christmas Day, but. . .

May you all have the Humor of Donna

The Heart of Rose

The Patience of Rory

The Balls of Amy

The Bravery of Martha

The Belief of River

The Courage of Clara

And the Love of Tashi

http://images2.fanpop.com/images/photos//Tardis-in-Space-tardis-6289810-1280-768.jpg

To welcome in this new year.

"But you. . .

. . .you were fantastic."

Arizona north of Phoenix is, as Beloved Pens says, fucking lousy with vistas. Coming up over a series of hills you weren't aware you were climbing, the whole earth opens up to reveal hills the size of small mountains, creekbeds that probably haven't had water in them in years, and is that a mesa out there in the distance?

I trundled along in my speed-governed econo-box, and my mouth dropped open as I topped that last hill on 17. All I could think to say was "Holy. Shit."

Arizona is a weird place. I hadn't been through there in years--the last time was in 1996 or so, and we bypassed Phoenix for Flagstaff--and I had forgotten how you see places in the desert.

The first way is in the details: the grinding sameness of saguaro cactus, which at first is incredible and then just blends in to the sagegrass and the sand. The second way is in a car, where everything moves fast enough that you're taken by surprise by the whole picture when a vista opens right up in front of you. The third way is from a plane. Nothing's human-scale any more; it's a glorious, perspective-less panorama of mountains and dry washes. You wonder, looking at it from the air, if anybody who'd settled the area would've kept going if they'd known what was ahead of them.

I wondered that same thing about Tashi before Kevin's memorial service this weekend. If she'd known what was going to happen, what she'd have to go through, would she have stuck with him? The grinding sameness of the day-to-day chores of dealing with somebody whose brain is altered, when vistas don't open up with the regularity that they do on the highway; what would she have done?

The answer came when Tashi said this: "Even though I only knew him for about a year before the cancer started changing him, he was so amazing that the love he gave me made it worthwhile to stick around."

And, "The cancer never got *him.* He was never his cancer. He was always himself."

Speaking literally, Kevin lost. He died of brain cancer. It won.

Speaking in every way that matters, he won. He owned that cancer, and beat the hell out of it. The proof is in how all of his friends remembered him: a silly, loving, incredible, creative, goofy, loyal man who cared more about other people than he did himself, and loved everybody. Those things that made Kevin Kevin didn't change just because he had a tumor.

I've never laughed so hard at a party in my life, even one where the guest of honor wasn't dead.

Kevin's friends told stories and provided details. Tashi told us what it was like to take care of him when he was sick. The two combined opened up a big, detailed portrait of a person I wish desperately that I'd known. I was honored and lucky to hear all about him, though, and for that I'm grateful.

Tashi said at one point that Kevin was the kind of guy who made other people want to be better people.  I had been thinking that exact same thing just seconds before.

Thank you, Tashi, for introducing me to Kevin. He was fantastic.

RAAAAAAAAAN-dom

I just painted my fingernails a dark, elegant grey. My toenails are a sparkly dark red, except for the nail on the fourth toe on my right foot, which is grey. Tomorrow, when the polish is totally dry, I will decorate the nail on my left fourth finger with bright pink stripes.

This is all for Kevin's memorial service, which is Saturday in Arizona. I will be wearing, per his wishes, bright-colored comfortable clothing (ink blue baggy pants, grape-purple artist's smock with a green t-shirt underneath, Converse and a saffron-dyed scarf from India). There will be, if my Interwebs research is correct, pie available at the service. I am all about pie. Hence the baggy pants.

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The Boy and I are texting. I say he should check out Baker Seeds; he says I should check out Forestry Supply. Little does he know that I already have a wishlist from FS that's as long as your arm.

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Best salad ever: greens, including baby kale (NOM), bell peppers, tomatoes, cucumbers, corn, black-eyed peas, cheese, FRIED OKRA, little bits of carrot and olive. I'm kind of on a kale kick at the moment, which is good, as the hippies across the street have approximately eight gazillion tons of the stuff to give away. They're desperate. I eat the teeny new kale plants in salad, since it doesn't have to be cooked or massaged or whatever, and the older leaves chopped up for tabbouli.

The folks at Baker Seeds say that kale will grow whenever there's even a hint of warmth in the air or soil. That doesn't really express how kale will take over your garden, your yard, your life, if the air temperature isn't below thirty degrees. It was eighty degrees here today (what the fuck global warming stop it STOP IT) and, sure enough, there were bitty kale sprouts coming up from the ground.

Some say the world will end in fire, some say in ice. I say the world will end in kale and cucumber vines.

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Speaking of cucumber vines, have I told you guys the story of Mom's killer melons and pumpkins?

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Or the time she planted luffa gourds and zucchini in the same garden, and they cross-polinated? I noticed that nine of ten blurbs for luffa gourds I saw in gardening catalogs this year noted that they would not cross-pollinate with other squashes. Technology: saving us from weird stir-fried squash.

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Don't tell The Boy, but I'm thinking of redecorating the bedroom, to make it more Boy-friendly.

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

Attila made me do some weird new back exercise today. Given that I dealt with hemiparetic and tetraplegic patients last week, all weighing over three hundred pounds, I am sore as hell this evening.

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And that is all for this evening. I'm off to make stripes of Scotch tape and pink nail polish.

So we have this new computer system.

The whole damn thing's been reworked, top to bottom, and it's rumored to be the best, most efficient, most amazing computer system in the history of EVAH. Lab tests and MD notes and medication administration and tiny bits of lint from the dryer are all linked together; all that's linked to some magical whoozit that records when a nurse enters a room, what equipment s/he uses while there, and when s/he leaves. It's rumored, in short, to be the best. damn. thing. since SLICED FUCKING BREAD, MAAAN.

Except, well, it doesn't work.

And I mean, all joking and superlatives aside, it doesn't work.

For instance: let's say you have a patient who wants only one Lortab, rather than the two that were ordered. Instead of pulling two out and wasting one, or just doing an RN override on the Diebold that holds the meds, you have to now call the doctor and get an order for only one Lortab. And then wait for that to be entered and linked and so on.

Yeah.

Let's say you have to waste a partial dose of a medication, like when a patient gets two milligrams of morphine but the morphine comes in four-milligram ampules. The old way to do it was pull, waste at the machine, chart. The new way is pull, have two people scan the med at the bedside, waste at the bedside, do an override to administer 2mg of an ordered medication, then go back and enter the waste at the machine.

And, because everything is now coordinated, Les Machines keep track of how long it takes you to get *back* to the Diebold and waste. If it's more than about a half hour, your administration will get flagged for investigation, because you might be huffing morphine. Which is fine and dandy unless you have five (or six, or eight) patients to deal with. Nurses with huge patient loads often waste everything at the end of the shift.

Let's say you have a person on a heparin drip. Even if you only want to enter the same drip rate hour after hour after hour, you still have to scan the person's armband, scan the bag, and get a witness. This is the new rule for every titrate-able drip in the system. For us, it's not a big deal: we might have one or two drips running in the NCCU on a person. In the med-surg CCU or in the neurosurgical CCU, though, it's a big deal: imagine having to scan-scan-witness-verify for eight drips on each of two patients. Every hour. On the hour.

And, finally, let's say you go into a room that holds a person who's been admitted for a TIA. They're neurologically intact, fine and dandy, and on only aspirin and an antacid. If you leave the room before a certain number of minutes have elapsed when you're giving those meds, you get flagged for not doing sufficient patient teaching on the Tums and Bayer you just administered. If you take too long--that is, if your patient is on six different meds, five of which are new, and the person has questions--you get flagged for inefficiency.

THIS IS WHERE I GET ALL CAPSLOCKY. The trouble with setting up difficult failsafes in a time-crunch-prone profession like nursing is this: once the new checks are set up, all the older ones get scrapped. We no longer have the pop-up windows on our med records that alert us to possible double-dosing. Instead, we have a huge, long, convoluted process to go through that guarantees nothing, as most of our peers are too time-crunched to double-check us.

We learned, less than four hours after the system was implemented, how to get around it. By the end of day shift on Monday, most nurses had copied the scan-codes from med labels and stuck them to the back of their ID cards. We'd also figured out how to copy the med-admin codes from the patients' armbands and stick them to the charts. We worked around the new, cumbersome failsafes. . . .

. . .but we didn't have any other checks or warnings to alert us when we'd fucked up. In other words, our system now has only one point of warning for each patient, and that point has already been sabotaged in the name of saving time.

So we have this new computer system. It reminds me a lot of a story I heard from one of my colleagues. He and his wife bought a gorgeous, brand-new house where everything, from the computer to the thermostat to the hot-water heater, was controlled through the Internet. Their online service provider suffered an outage that lasted three days (he's in the boondocks). During that time, they had no heat. Or hot water. Or air-conditioning. Or TV, phone, Internet, or burglar alarm service. Reprogramming things manually wasn't an option. Why should it be, with this shiny new system?

No system should ever have only one point of failure. Even muskrats and beavers have a back door out of their homes. Manglement's reduced a perfectly workable checks-and-balances system to something with one point of failure, in the name of Patient Safety, and we've already figured out workarounds.

In other news, the hospital-wide campaign to leave our badges in the bathrooms for extended periods of time seems to be working. Manglement might be monitoring our pee-breaks, but we'll work around that, too. (I wonder what they'll say when they see that four of us were in the public men's restroom on the ground floor for six hours on Tuesday?)

Tips for Everybody:

There's nothing like coming in to work, feelin' all efficient and enthusiastic, to find that you're two nurses short in a three-nurse unit. Unless it's finding out that a different department expects your unit to staff theirs for some undetermined amount of time in the morning and again in the afternoon.

Dear Doctors: Please don't wear your ID tags on your belts. Especially please don't do this if you're an observant Muslim, a conservative Coptic Christian, or a member of some other staunchly upright religious group. See, if you've got both a name with eighteen syllables and a strong moral sense, it's gonna be embarassing for both of us if it looks like I'm starin' at your junk while trying to read your ID.

Tip for myself: Next time it seems like a patient is globally aphasic, shaking her head and smiling gently whenever you try to get her to do something, make sure it's not because she speaks only Romanian.

A gentle note to Manglement: top-down initiatives, like locator chips in ID cards, timers in employee bathrooms, and noise-and-motion sensors in nurses' stations and common areas, can and will be hacked.

Many, many thanks to the elevator inspector who sang loudly in the elevator shaft as he was doing a routine inspection of that elevator's braking system.

Also many thanks to whoever it was that joked up a pile of mattresses sitting in a storage room by sticking a can of peas in there, so it peeked out one side.

Best Line of the Night

We've been having some trouble with our sheets lately. We get one size of sheet, but have three sizes of bed. In the past, the sheets fit the largest beds but were a little loose on the other two types. Recently, Manglement decided that knit sheets were better than woven, and so dumped sheets on us that, until they're washed the second or third time, fit every bed beautifully. After the second or third washing, though, you'll hurt yourself trying to get them on to the bed. (I wish I were exaggerating, but one of my coworkers is out with a torn rotator cuff right now. It went when she was trying to change a bed.)

Anyway, Deepa and I were changing a bed under one of our patients, a guy whose stroke had left him both paralyzed on one side and unable to speak easily. Deepa, struggling with the corner of the sheet and unwilling to lift the mattress to force the sheet on to it, exclaimed, "It is so small that we can't get it on!"

Our hemiparetic, expressively-aphasic patient said, clear as a bell:

"That's what *she* said."

Y'all, I am blessed in friends.

Tashi just emailed me. She's starting her own fundraising efforts for Mary.

Tashi.

Who, by all rights, should be allowed to recover and rest and be quiet for a year or more, is fundraising for Mary.

Which proves again what I already knew: I have the best friends ever, and Tashi is the most amazing one of the bunch.

Peeps, we got a job to do here.

Some of you know Mary Osheskie, or read her blog The Bright Optimist.

Mary was one of the first people to contact me privately after I got my cancer diagnosis. She was also the only other oral cancer patient who was a woman and about my age. Her story makes mine look like a walk in the proverbial park:

Mary's a lifelong nonsmoker and nondrinker, so when she was diagnosed with stage III squamous cell carcinoma of her tongue (at an age about forty years younger than is typical, no less) it was a huge shock. She had a partial glossectomy--in other words, the docs took out half her tongue and replaced it with muscle from her arm.

Then she had head-and-neck radiation. Y'all remember how scared I was of radiation. Everything that terrified me, from a tracheostomy to losing every tooth and a bunch of bone, happened to Mary. All of her teeth are gone, her jawbone is jacked beyond recognition in several places, and--as if all that weren't enough--she had a recurrance of the cancer recently and had to have *more* tongue cut out. Luckily, she's fine now, but she still ain't got no teeth.

Now, for your average toothless person, that isn't a problem. You go to the dentist or prosthodontist, you get some implants or some dentures, and you're back to eating apples in a couple of weeks.

Mary's got a different set of troubles. She's got to have posts put into her jaw to hold specially-made dentures in place, because her jawbone alone won't take the stress of the dentures. Plus, most of the bone that's left (after surgeries to remove the dead stuff) is really, really freaking fragile. And of course, after radiation, she's not capable of healing as well as somebody who hasn't been fried.

In short, she has to have an oral surgeon do both the preliminary post-setting and the molding of the dentures, as well as follow her afterwards to make sure there's not further tissue death or infection. It's a big fucking deal.

It's such a big fucking deal that the surgery alone was going to cost $45,000 (US) and not be covered by Medicaid. Mary's on Medicaid because, after having a feeding tube and a trach and a zillion rounds of radiation and hyperbaric dives, she was indigent and disabled.

BUT!! Mary got the news today that her state Medicaid board is going to cover her surgery. She's going to be able to get the posts put in and things ready for a set of dentures. They're even going to cover anesthetic--which, if you read her blog, was not the case for having ALL OF HER TEETH EXTRACTED HOLY SHIT.

So Mary's getting her bone spicules filed down and her posts put in. But she still needs dentures.

She's a thirty-something woman with no teeth right now, and I'd like to help her make that not be the case.

Let me remind you of what you've done in the past: You gave more than eight hundred dollars to the Oral Cancer Foundation, which is run out of the founder's living room, for research and awareness. You gave Tashi Pratt-King a thousand bucks when it looked like she and Kevin (Wash) would lose their home--you guys got her over the hump, and allowed her to keep taking care of Wash until his death this past September. You also bought two Therabites for people with oral cancer who couldn't have afforded them on their own--devices that allowed people to regain the ability to open their mouths more than a few millimeters. Those Therabites, by the way, are still being sanitized and passed around.

And you made me very, very proud and grateful in the process.

Mary needs twenty thousand dollars for dentures. Medicaid won't cover them. Let's do this thing.

Let's commence Operation: Choppers.

Give Forward Fundraiser

Indiegogo Fundraiser

There is also a PayPal link on Mary's blog, linked above.

Thank you, guys.

Happy Coming-Out Day!

I had this whole long post about little old men going septic in my head, but then I just lost the will to type it all out. Instead, let me leave you with a Wayback Machine comparison of what things were like when I was sixteen, versus now, twenty-five years later (as a starting point). . . .

*woo-woo sounds of a time machine ramping up*

Twenty-five years ago, WHAM! put out a video that implied that George Michael was straight. Come to think of it, they also released a single ("Work") that pretty much declared right out that he was straight. (George, George, how little we teenaged girls knew ye.)

This year, a tweener pop star with a devastating hook ("Call Me Maybe") produced a video in which it became apparent that the boy she liked was gay, and the joke was on her.

Twenty-five years ago, I was two years away from making about a dozen friends in Chicago, all of them gay men.

This year, I have one close gay male friend who survived the AIDS epidemic. One.

Twenty-five years ago, as a matter of fact, "AIDS" came into being as a name. The other candidates were LAV and HTLV-III. The name(s) replaced what it had been called, either GRID (gay-related immune disorder) or "gay cancer."

This year, the majority of HIV positive people will be straight women of color, although the rate of HIV infection is again increasing in young gay men, who now see the disease as a manageable chronic condition, rather than the nine-month diagnosis-to-death thing it was in 1986.

Twenty-five years ago, my oldest friend was raped by some guys in our high school. He was targeted because he was gay.

This year, there was a special flag team composed of GLTBQ high-school students in a gay-pride parade in Bigton.

Twenty-three years ago, I saw posters in the windows of restaurants and bars in Chicago that showed the photographs of men suspected of having AIDS. They were put up as a public service to other gay men, so they knew who to avoid. The practice started in San Francisco in the early 1980's, when there was no test for HIV, and people's first symptoms were either Kaposi's sarcoma or PCP pneumonia.

Last week I had to explain Kaposi's sarcoma to a much-younger nurse who'd never heard of it, and who'd never realized that the AIDS epidemic was a big thing.

Fifteen years ago, Ellen DeGeneres came out on television, on the Oprah Winfrey show. That led some obnoxious so-called Christian minister to refer to her as "Ellen Degenerate." (Her response? "I heard that one in the fourth grade.")

Six years ago, Neil Patrick Harris coming out prompted a collective yawn from the public and, as far as I can tell, failed to incense any obnoxious so-called Christians.

Twenty-five years ago, I knew no gay people who were married. This year my friends Joe and George will get married. Deena and Deb have been married for five years and have a second baby on the way, and Sid and Sam are celebrating their tenth anniversary.

Happy CODay to all my gay and genderqueer buddies. Even though all of you are so far out that the closet's now lost beyond the curve of the earth, you all had tough times. Here's to real equality, the valuation of all people on the strength of their character, and the freedom to love whomever you love. Let's work to make it happen in a fraction of the time it took us to get this far.

I need laundry advice.

I can get anything except benzoin stains out of scrubs, but I need help on a non-stain-related issue.

Recently, I got four sets of Wink scrubs. They fit better than Urbane, though they're cut along the same lines: Wink seems to be made with women with hips in mind, while Urbane assumes you're young and athletic and built like The Mankiller, who looks like a boy with boobs.

Anyway, these scrubs. 65% polyester, 35% cotton, tons of pockets. Love 'em.

But even after two wash/dry cycles on Boil and Broil, they are stiff and rustly, and they still have the creases from packaging. How do I get those out?

Do not say "fabric softener." That shit is of the devil and gives me rashes.

Ideas?

Culture clashes and advice for Yankees

For those of you wondering about Tashi, she's doing as well as can be expected. She has good moments and bad ones, but that's par for the course.

We've had an influx of Northerners this summer, so I feel like I can share a little advice with them:

This is central Texas. Things move much more slowly here. Nevertheless, we have been known, while driving, to pass on the right.

Speaking of driving: going the speed limit, unless you're near a known speed-trap, is Not Done here. We have places to be and miles to go, so we generally drive like bats out of hell. Just keep up with traffic and you'll be fine. Don't go the speed limit in the passing lane; you'll likely get killed or yelled at.

I understand that things work differently in Chicago or New York or wherever it is you're from, but here you *can't* be abrasive and expect to get things done. If the movers tell you they'll be there between twelve and three, but you need them to be there right at twelve because you've got the freight elevator reserved from two to four, explain that. Don't, as I heard one person say, snap back, "You will not be there between twelve and three! You'll be there at twelve!" She later wondered why the movers came late and moved slowly. Just be polite. It costs nothing and greases the wheels.

If you have to ask how to "style" "cowboy boots" (they're called just "boots") then you probably shouldn't be wearing them. As Lyle says, buy your jeans a little longer.

The heaviness of the accent does not always indicate the education level, general intelligence, or personal wealth of the speaker.

Women of a certain age are always referred to with "Miz" preceding their first names, and only then if you've been invited to call them by their Christian name. This holds true in most small towns (it does in mine) and some large cities. In fact, it's best not to call anyone by their first name unless you're sure it's okay.

"Ma'am," "Sir," "Please," and "Thank You" are not optional. And don't, unless you want a reputation for being difficult, walk straight up to somebody and tell 'em to do something without first asking how they are and being pleasant.

Bless their hearts, they don't know any better.

Speaking of culture clashes, I was listening to an NPR interview a few weeks ago with a guy who says that culture influences perception of color; in other words, the context in which you're raised determines to a large extent how many colors you see and what you call them. He said, for instance, that the ancient Greeks had so few delineations between colors that they essentially saw in black, white, and bronze.

I snorted mentally at that until the other day, when Friend Deepa, who can't believe my hair, was touching it gently and cooing, "Golden hair, golden hair." Now, my hurr is red--at the most, it could be called strawberry-blonde when I've been out in the sun. When I corrected her, she said positively, "No, your hair is golden." I said, No, my hair is red.

She then pushed back her own hair to show me the earrings that she wears which, like those of most of the Indian women here, are twenty-four carat gold, so pure it's brassy. "Your hair," she pointed out, "is the same color as my earrings. So it's golden."

Point to Deepa. I stand corrected.

GERONIMO!!

Tashi brought Wash's ashes home today in his Tardis urn. This completes this stage of his journey. Next stop: Wherever, Whenever.

Regularly scheduled blogging will resume whenever this localized weather system gets off my face.

Allons-Y, Wash! Good journeys.

Kevin Pratt-King

1985-2012

Prayers for Tashi and Wash, please. . .

Wash is in Hospice right now. He told Tashi on Sunday that he thought he was about to die, watched an episode of Dr. Who, and was unconscious before the end of it.

Please keep them both in your thoughts, but especially Tashi. She proved every day what love is.

Thank you.

In which Jo gets a little pissy about language.

Gifting.

Gifted (passive voice).

Skirting.

When did "gift" become a verb? When did it become acceptable to say that your mother-in-law gifted you with a Precious Moments figurine? How is it okay to say that something is good for gifting or is giftable?

And when did skirting start describing pieces of fabric with buttons at the top? Skirting is either something one does around an issue, or vinyl sold by the linear (not lineal) foot at the mobile-home dealership. One buys a skirt. One does not purchase skirting to wear on one's body, unless one is suiting up for a particularly bizarre costume party. (Halloween costumation ideas, right here on Headly Nursingtons!)

A million years ago, my parents would sit around the breakfast table in their bathrobes, reading out loud from the Wretched-Comical, our local newspaper. Dad went into fits one day over the headline "GIFTABLE SWEATERING," then read the accompanying ad copy out loud with hoots and snorts. I think it might've been 1980 or thereabouts; my sister was home for Christmas break from college. She, being the English major in the house, had lots to say about giftable sweatering.

Then, about a month ago, somebody on my beloved Hairpin used the term "for gifting." The somebody in question was an actual contributor, not a commenter, and nobody called her out on it. Nobody. "Gifting" was okay.

I felt a little like I'd been dropped into a reality I wasn't familliar with. With which I wasn't familliar; whatever. I'm not opposed to splitting the infinitive if it makes reading easier.

I am, however, opposed to gifting and skirting.

(Before anybody asks, yes, I'm poncy about "nursing" as a job description as well. "Nursing" feels like it ought to be limited to breasts and babies. "Being a Nurse is My Bag" doesn't flow, though, and looks crappy on a reusable grocery sack. Yeah, I'm weird.

At least I'll never turn "surgeon" or "patient care aide" into verbs. That's my promisation.)

Well, *that's* never happened before.

Friends and neighbors, I got my ass kicked on Monday.

And when I say I got my ass kicked, I mean I got my ass kicked.

Let me explain: there are a number of unfortunate things that can happen to make a normally nice, cheerful person batshit insane. Things like drug abuse, encephalopathy, encephalitis, vasculits, meningitis, strokes in unusual places, tumors--you get the idea. There's a lot of stuff out there that can hit your brain in such a way that your personality does a one-eighty, but most of those things are very, very rare indeed.

When they hit you, though. . .wow.

Granddaddy came in with a few personality changes and some increased sleepiness (note for new neuro people: your A-number-one sign that there's a problem is irritability and decreased consciousness in tandem) and steadily got worse. He was transferred to us with a Posey vest on, keeping him in his wheelchair as he cussed and ranted.

At some point in the proceedings, he tried to stand up and tip the wheelchair over backwards in order to get out of it. Gweneth, the steadiest and most sensible of patient care aides, was there in a second, keeping Granddaddy from overbalancing, and Stoya went around to his front to see if she could calm him down. I was close behind her. Too close, as it turned out.

Granddaddy threw a punch. Stoya did some sort of Matrix move to avoid it (thank goodness, as it would've messed up her face), and the punch landed squarely in my solar plexus.

Well! I wasn't expecting that at all.

I made a noise like a duck and went down. I'm not ashamed to admit it: have you ever been punched in the gut? I hadn't. I've been hit in the face, which only makes me angry. I've been whacked about the head and shoulders, which is disorienting and painful, but not too handicapping. Being hit in the stomach, though, right in the breadbasket, so hard that the breath gets knocked out of you? You fold up like a sack of potatoes, which I did.

Unfortunately, I folded up right where Granddaddy, still Posey'd in to his chair, could get to me with both fists and feet.

In retrospect, it's funny. It must've looked like something out of a comedy film, or that clip on YouTube where the dude in the Darth Vader costume gets attacked by a playful dog. At the time, though, all I knew was that I was getting wailed on by an angry person with what felt like superhuman strength. Oh, and I couldn't breathe.

Gweneth managed somehow to get the wheelchair unlocked in the middle of all of this and get Granddad out of range. Stoya got his arms, I got the Haldol, and things quickly got better from there.

Y'know, IV Haldol is strongly not recommended, because it tends to cause heart arrhythmias, but at that point, we didn't care. In a few minutes, things calmed down to the point that Grandpa could go back to bed.

The bruises are fading now. He didn't actually hurt me, but he sure woke me up. This is not something you think about when you're taking the NCLEX.

ERMEHGERD SCHNERZZLES

Stolen from CuteOverload. CRANK UP THE VOLUME, PEEPS.

I have the letter!

Yes, my friends, the letter from the OEB that tells me that I am getting Moneys from the insurance people is here in my hot little paw. As I said to La Belle Dame, though, I ain't chillaxin' until that check's cleared.

With my luck, BCBS will skim 90% of it off for processing costs. Which will, of course, lead to the recently-repaired Hell Bolts being sheared again.

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I have made a new friend.

A few days ago we got one of those patients in: you know the sort, that come without CDs of scans and with minimal information from the transferring hospital. Luckily, this nice little old lady had no medical history, and not because she'd never been to the doctor. She was, at eighty-something, simply that healthy. A lifelong non-drinking, non-smoking vegetarian, she'd had a TIA as a result of a brief dip in her already-low blood pressure.

So, upon her arrival to the NCCU, I paged the dude on call. And paged and paged. Finally, I sent a text page reading "Are you alive? If so, call Jo at XXXX. Minimum three minute rates apply."

The dude on call called me back immediately and apologized. Turns out that between consults and admits at Holy Kamole, he had more than fifteen patients to see. I said I just wanted him to know that I'd gone ahead and entered orders under his name, using the NCCU order protocol, to which he said, "Oh, are *you* the one who entered all those brilliant orders? You clever little thing, you."

"Yes, darling," I said, "I did enter those orders. Now, you'll have to swing by and work your magic on our sweet LOL, but the rest is taken care of for now. Just decide whether you want heparin and let me know, okay?"

"Brilliant!" he replied. "I'll be there as soon as she gets to sleep and the nurses have relaxed for the evening."

He greeted me the next morning, after no sleep, with a muffin. He thanked me for saving him a half-hour's work and making his life easier.

I may have to reassess my attitude toward new fellows.

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

It dawned on me yesterday that when my boss is not around, stupid shit happens much less often.

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

The Apocalypse is nigh: it is August in Central Texas, and I have all the windows open. We've gotten some rain in the last couple of days, and it's now a balmy 70* at just past 0800. All the fans are on, the a/c fan is whirring away, and the cats are napping on the north-facing windowsills.

After two years of really weird weather, this is a relief. This is how it's supposed to be here: daytime highs in the 90's, occasional rains that flood the highways, and brisk mornings. Ever since everydamnthing burned down last year, I've been watching the skies and the winds. Normal is a little disturbing, but I'll take it.

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

Three big things are going to be happening here in the next few months:

1. A template and step-by-step instructions on how to fight insurance companies. Once the template and instructions are up, I'll put permalinks in the sidebar for anybody who wants to use them. Not everybody has the resources and time I do; it's a no-brainer to distill everything I've learned in the last two years, and all the expert help I've had, into something you can fill in, print out, and send off in order to get your money back.

2. HN might be migrating to a new platform. I haven't decided yet. If HN does move, it'll have the same look & feel and the same layout as before, or as nearly as possible.

3. I am dog-hunting. More to come on that as things develop.

Well, well, well.

That appeal? The one that got lost, then found, then didn't have enough paperwork attached?

JUST GOT APPROVED FOR EIGHTY PERCENT REIMBURSEMENT.

They just called.

You may commence celebrating.

Hi. My name is Jo, and I am totally demoralized.

Or not. It's been a rough week.

I talked to the friendly folks at the employee benefits office on Tuesday about the Ongoing Drama Of The Obturator. (For those of you coming in late, the prosthetic I wear to replace my palate/protect my airway/allow me to eat, drink and talk was not paid for by insurance. Given that the whole process cost as much as a new car [Hyundai, not Mercedes], I was a little peeved by that, especially given that the insurance company [Blue Cross/Blue Shield of Texas] first denied that it was medically necessary, then failed to follow their own rules on covering prosthetics.)

So I appealed, all the way to the Office of Employee Benefits. Beloved Sister and I worked up and sent a multi-page appeal letter complete with charts, diagrams, copies of reciepts, photographs of my mouth post-Harrowing, and ninety other things. The nice folks from the OEB asked me to send them a couple of additional pieces of paperwork, which I did. . .and I waited. They told me the whole kit and kaboodle had gone to some doctor who reviews things like this for them, so I waited.

And waited. I had no idea how long it would take for said doctor, who probably has a desk full of appeals, to get his head around mine.

So, when I called on Tuesday, I was expecting that things might not be fresh in the OEB's hivemind, given that the submission date for my appeal was back in March. I was not expecting them to tell me that the case had been closed for lack of documentation.

Well, to be more exact, first they told me that there wasn't anything there. Then they told me that yes, they'd found the file, but it'd been closed for lack of documentation.

Now: given the eight-page letter (with charts, diagrams, and circles and Xes on the back) and the two times I faxed the same information to my contact at the OEB, this was not what I was expecting. The nice contact at the OEB told me it would take her a couple of days to get everything together (right after she told me that everything was printed out and gathered up) for her boss to look at, so he could decide what was going on. So I told her I'd be calling her first thing Friday morning.

I am, to be nice about it, gob-fucking-smacked at this whole thing. I mean, I understand if they deny the appeal. Even though BCBSTX claims to reimburse non-network providers of prosthetics at 60% of cost, and even though they claim to reimburse at standard market rates (manifestly untrue; they actually reimburse less than Medicare or any other provider), I can see that they could finagle a way to deny my claim. That is, after all, their business.

Let me be a little more clear for you: The purpose of an insurance company is not to leverage your premiums into providing efficient, quality care for you. The purpose of an insurance company is to make money for their shareholders.

However, going back to the OEB: the University of Texas is a huge system, with many, many employees. The Office of Employee Benefits is, by necessity, the sort of bureaucracy that can handle that volume of employees. You would think that they could, at some point, have sent me a letter--not a certified letter or a wax-sealed scroll via elephant, just a letter--to tell me that they'd closed my file because I hadn't submitted some document or another.

Or, alternatively, they could've contacted me at the address, two telephone numbers, or email address that they had to let me know they needed more paperwork.

But they didn't.

Somewhere, somebody fucked up. I intend to find out who it was, and make them figure out how to fix it.

At first I was coldly enraged. I told Beloved Sis that the noise she was hearing was the sound of the bolts that hold Hell down shearing loose. Then I spent two days feeling horribly sick and depressed and stressed out. It's amazing how canalized anxiety becomes in the body.

Now I'm just peevish and determined.

Peevish. And determined. Very determined.

Odds, Ends, Updates

OEU the first:

I saw Dr. Crane today and had my tongue yanked around and both of his hands in my mouth at the same time. The exam was clean, the MRI looked "great" (his words; he's not given to superlatives) and I don't have to see him again until February. I won't have any scans then, either.

I said, "No scans?" He told me that at two years, in his experience, it's safe to begin backing off the surveillance scans and just go with eyes-on exams. It's simultaneously exciting and weird to know that my interior doesn't have to be irradiated for everybody's psychological comfort. I worried before every scan; now I'll worry that I'm not *having* scans.

"Nearly cured" is a strange place to be.

OEU the second:

Now that I've told Mom, it's time to tell you guys: I'm dating somebody. Seriously. As in, Talking Marriage Serious. He's marvelous beyond description, with just enough of the annoying human things that everybody has to keep him normal, and I've known him since we were both teenagers. His name is Brother In Beer (yes, the one who sent the lovely flowers after surgery). He's intelligent and funny and sweet and writes beautifully and routinely throws himself down rocky hillsides while perched on a bike. (Yes, he wears a helmet.)

I'm pretty stoked.

OEU the third:

Work sucks. We're staffed for twelve in the surgical CCU and have eighteen to twenty patients every day--even our code bed is full--which means that the staffing in the neuro CCU has been short. If everybody in the SCCU is tripled, they can't exactly send two people to help us out in the NCCU with our six or seven patients.

Plus, we've been having a rash of codes lately.

OEU the fourth: 

Aside from the staffing thing at work, things are going really well around here. I've not been *here* as much as I'd like; there's a lot of writing I've been doing for money that cuts into my blog time. As soon as I get this month's stack of articles sent off, though, I'll tell you funny stories about the Guy With No Memory At All and touching stories about bunnies.

Basically, this summer can be summed up in one well-known phrase: Two out of three ain't bad.

Semi-demi-hemi-annual MRI today!

And no, I don't have the results yet. I won't for several more days.

This was how it went:

http://www.marriedtothesea.com/072412/

This was me this morning. . . .

...when I'd discovered I've been drinking decaffeinated coffee for the last ten days.



GIFSoup

This was in my back yard an hour ago.

Yes, they really are that big. That's a tarantula hawk. It's a critter that eats nectar and pollen, but lays its eggs in tarantulas.

And no, that is not my hand. I've seen a lot, and even held a hissing cockroach, but I'm not that butch.

At first, I was terrified. Then I came around to the idea that this incredibly large critter, which kinda hops around in flight, is pretty cool. I just don't go outside when she's around. Luckily for me, they're not a communal species.

So, yeah. Tarantula hawk in my back yard. Friend La Belle Dame Sans Merci posted to my Facebook page, "This means you either have lots of tarantulas in your back yard, or a lot of tarantulas with hatching T-Hawk eggs in them."

I thanked her for being such a fucking comfort in my time of distress.

Good Lord, it is hot. And humid.

I've just done all my cooking for the week, except for assembling salads, which are best assembled at the fifty-ninth minute of the eleventh hour. Protip for those of you too hot to eat real food: cut up a shitload of vegetables all at once and put them into little containers. Assemble your nommable salad before work out of the little containers. Seriously, this is the best thing I ever learned from Serious Salad Eaters.

We got a doohickey to fill out this week from our Big Boss, about how our Lesser Bosses are doing. Instead of boring you with the boxes I checked, I figured I would put down the letter I wrote in my head while assessing my bosses for a dozen things which do not matter to anybody but management:

Dear Big Boss,

You want my opinion on my other two bosses. You even sent me a survey form to fill out at a third-party website, with the assurance that my replies will be completely anonymous and confidential and not be prejudicial to my continued employment with Sunnydale General.

Instead of filling out yet another useless survey (because, really, whether or not I'm being given positive feedback on how I'm doing my job is not a major issue around here), and because I know as well as you do that surveys are neither anonymous nor non-prejudicial, I've decided to tell you what I really want in a boss.

For starters, I'd like fewer of you. I have four at last count: Small Boss, Bigger Boss, you, and your Horizontally-Equal On The Org Chart Colleague. Of those people, I see Small Boss the most, with Bigger Boss coming in a very, very distant second. I've seen you exactly four times in the last two years, and your Horizontal Equal not at all. The way I figure it, it's ridiculous for me to submit memos about how I plan to hang educational posters in the family room for Horizontal Equal's approval, since she's never, to my knowledge, seen the family room I'm talking about. Maybe we could take her out of our org chart's hierarchy? While we're at it, could you either show up regularly or just stay away?

Because, really, your visits here contribute nothing to the smooth running or the "culture" (whatever that is) of the CCU. You've shown up once to bitch about the placement of warning signs, once to introduce me to somebody I'll never see again, once to warn me about a VIP showing up, and once because, I dunno, somebody in Manglement complained that you weren't showing up enough. Honestly, your visits take time away from my patients and fuck up my train of thought. If I had the chance to get used to you, or didn't see you at all, things would be much, much better.

While we're on the subject of bosses, it sure would be nice if my Bigger Boss had an inkling of what happens in a critical-care unit or on a stroke unit. See, he has about six months of CCU experience, and that was years and years ago. Our old boss, whom you chased off, used to lead codes. Our current boss stands around looking impotent and gets in the way. Maybe he could be retrained to work in a critical-care setting, then work a shift or two a month to keep his skills up. That way, we could at least use him as a charge nurse when there are four nurses, all of whom are tripled, and not enough support staff to make a dent in our patient loads.

It would also kick ass if Bigger Boss and Small Boss made sure that people who work in my NCCU actually have the certifications you claim to require for employment here. So far, I'm the only person who works here who has all of them. We've been open three years (in August), and that seems like plenty of time for folks to do the online NIH course and the other required stuff. It'd be awfully nice if I could give report to another nurse and not have them go jaw-sagging blank when I say something like "hemiparesis" or "gaze preference" or "NIH score of 16."

Finally, if you're really dedicated to a complete reworking of the Culture of the Institution, hire some more damn people. If need be, hire unqualified people with a modicum of brains; I'll happily train them. Just get me some bodies up in here, so I'm not forced to work day in and day out with nurses who are floated here from the CVICU. It's not fair to them, and it's not fair to our patients. They can spot a-fib from a mile away, but they're not used to doing neuro assessments and don't understand our BP parameters. Have mercy on the nurses who are more comfortable with a Swan-Ganz than a ventriculostomy, and Get Me Some Damn Staff.

Oh, wait: that wasn't my final point. My final point is this: if you're going to hold me responsible for stuff, and yell at me when it doesn't get done, or pass things off to me, and expect me to work extra and train new people, the title of "Mangler" would be peachy fucking keen. I have to admit that it's not the title I'm after so much as the pay grade. In any event, since we're speaking of Bosses, you're making me a FIFTH layer of boss-ness between the people I work with and the real world, and I'd like to be compesnated for it.

Much love and many happy capybara kisses,
The one who makes sure the plumbing gets fixed,

Jo

In which Auntie Jo lays down the law.

I love my job I love my job I love my job I love my job.

However.

People: Please research the symptoms of whatever disease or disorder you're going to try to mimic. Most physical troubles, including neurological ones, have a certain expected set of symptoms. Even conversion disorder has an expected course: while the physical manifestations of psychological stress might be weird and unexpected and unexplainable by other means, they're consistent.

A stutter that goes away with opiates is not a disease. It's an attempt to get drugs.

Likewise, there's a name for what you're doing: it's "abasia-astasia," and it means "No, she won't fall over and hurt herself; she'll only fall if I'm there to catch her or she's near something soft."

And frankly? If your weakness is distractable to the point that you yourself cannot remember which side you're weak on, I will call bullshit on your shenanigans and send you out the door tout suite.

I don't just have the population of Greater Sunnydale to thank for this; I have the combined Great Minds at Holy Kamole's emergency department. Therefore, I have some law to lay on them:

If you call and ask me to accept a stroke patient, you'd sure as shootin' better have done an NIH stroke assessment on that patient and be able to tell me his score. If you haven't, I'll tell you to call me back once you've assessed the patient, then hang up the phone gently.

Same deal if you call me with a patient who has a constellation of symptoms and you don't know his history. Same deal if you call me and say, "Well, we're not really sure what's going on, but we'd like to send him over to your NCCU."

Same fucking deal, dear doctors, if you call with a ninety-year-old, demented patient who has a temp of 38.2, whose labs show that he's dehydrated and has a UTI, and who is experiencing the same symptoms he had when he had his stroke two years ago. Incidentally, he's therapeutic on coumadin.

And, just as a reminder, if I accept this patient because I want to put a stop to your whining, but specify that he is to go to the regular neurology floor, do not under any circumstances then tell the bed board that I'd cleared him for a bed in the NCCU. The Wrath of Jo will be visited, not upon your grandchildren's grandchildren, but upon you, comprehensively and cheerfully.

This is because, as might be expected in a critical care unit, I actually have sick people to take care of. I got one on a Cardene drip, one with the most labile blood pressure I've ever seen, good Lord what is she doing going from 220 systolic to 77, maybe an abdominal binder would help, and one who is, sadly, getting ready to go home to Jesus due to a combination of factors, not least of which is an infection with some bacterium that only two people have ever gotten before. I got problems, in other words, because I got patients with problems.

Joe-Bob looking for a hit of dilly is not a problem. At least, he's not *my* problem. He's *your* problem. If you try to make him my problem, you'll have another problem, and probably a whole set of problems of varying, interesting types, right after that.

Thank you, as Katniss said, for your consideration.

Good God I love both of these people, whoever they are.

Here

and

Here.

This is what happens when I try to live like a normal person. . .

Neighbor Beth is here. She's wiping down the kitchen as I slowly, slooowly type this, for reasons which will become clear in a minute.

Those of you who follow me on Facebook will know that I had a cheerful afternoon of productve semi-drunkeness with Neighbor Beth (who is Not Good With Blood). After the prosecco had worn off, and with a liter of water and tea under my belt, I mandolined my right ring finger.

There was a sudden spray of blood. Then there was a heartfelt "Oh, SHIT" from me, as I realized that the suddenly-numb sensation in my right paw was due to my having halfway cut off my right ring finger. I tried everything: direct pressure, flour, glue: nothing worked for longer than I care to think about. Poor Beth, who hates her own blood and has a tenuous relationship with other people's blood, mopped up mine for the 40 minutes it took for shit to stop happenin'.

I'm more than a little annoyed that this happened while I was sober. Beth is more than a little annoyed that she had to scrub blood off my spice shelves. AND I had to throw away a perfectly good, blood-soaked tea towel.

None of the zucchini was affected, though. Which is good: we have a Pickle Party coming up in two weeks.

I kind of wish I'd accepted Beth's offer of another bottle of wine. My finger hurts.

Good Frogs. Has it been that long?

I see I haven't posted since the middle of last month. My apologies.

I've been working a lot, which means new stories for you! but I'm also between keyboards at the moment.

More later this week, I promise. Nothing horrible has happened; I've just been busy.

I'm all right; don't nobody worry 'bout me.

Well, not really.

This week we had a party for Neuroscience Nurse's Day, or Week, or Something Along Those Lines. I was interested to see that the woman who holds herself out as the Director of Neuroscience Nursing (a few years' experience as an ortho rehab nurse, followed by a decade in manglement) wasn't there. Ironic, fitting, all that stuff.

I was more bitter than usual these days. *Everything* pissed me off, even stuff that could've worked to my advantage. Good things pissed me off just as much as bad things, and wishy-washy things pissed me off most of all.

For instance, I work with two mid-levels. One is fantastic. The other is a clueless tinpot tyrant with an ego problem. Fantastic Midlevel and Fantastic Case Manager and I had been working on med-surg to rehab placement for a patient under a return agreement with another hospital (his case is complex) since the patient was admitted almost a month ago. It had been arranged that Sweet Complex Guy would go back to his original hospital, since he's a resident of that particular county and can therefore get services for which bill collectors won't hound him. (Some counties in Texas do it right.)

At the absolutely last possible second--and I mean after the ambulance had been arranged (difficult, because he required vasoactives while en route)--Clueless Tinpot stopped Sweet Complex Guy's transfer. The reason? He was afraid that "SCG would end up rotting in a med-surg bed and his family wouldn't be taught what they need to know." Clueless Tinpot decided to try for a "charity bed" in our facility.

As Fantastic Rehab Manager said, "No bed here is a charity bed. I have explained this to Clueless Tinpot Tyrant over and over. Even if that patient meets all of our specifications for discount services, he'll still have people calling him constantly, and his credit will be ruined by the bills."

None of this, I just realized, will make any sense to you unless you're one of the medical club, so let me put it in English:

We had a patient transferred to us by a county facility. That hospital paid all of the patient's bills while he was with us, with the understanding that he would be sent back once we were done with our peculiarly specialized care. The sending facility has systems in place to provide free, quality care to this dude, provided that we sent him back needing specific things.

And Tinpot Tyrant fucked it up. Not only will my nice, sweet, complex-but-promising dude be two hours from his family, he'll have to deal with the demands of our billing department (not fun; I can testify that they screw things up fairly regularly) for the next two years or so.

And I have to deal with this guy daily. Between making sure that he actually writes orders that he's going to yell at us later for not carrying out and being certain that his orders don't suck, I'm already tired. He's slated for a manglement and marketing job soon, and I hope his transition is smooth and speedy.

Seriously: If you have somebody on a high-sodium diet and six additional grams of sodium tablets a day, and they drop their sodium from 139 to 135 after you lower their hot-salt drip for six hours, would *you* write an order discontinuing that drip immediately?

I thought not. Especially if you want to keep their sodium between 140 and 150 to keep their brain from swelling. Three-percent and 23% saline are useful in limited amounts, but they're useful.

Okay. Enough with the overmedical jive.

I miss my dog. He wasn't my baby, or my furbaby; he was my buddy. We were intellectual equals, no question. He was a stubborn asshole at times, but I never knew his judgement to be off. It's very weird, being here without him snoring and shedding and licking Flashes all over. I step over a body that isn't there, in the middle of the night, when I have to pee. My brain twitches toward the back door every day at dinnertime.

I haven't had the vadge yet to go out to the back yard. Yesterday, I thought maybe I could do it today. Now I'm thinking I could maybe manage it tomorrow.

Thank you all for your kind thoughts. They're a huge, huge comfort, even if I can't respond to everybody individually.

Now Flashes wants 'tentions. I'm going to give him some skritches and heat up beans for dinner.

Max.

When I met Max, he was still a puppy. He might've been nine or ten months old, with those perfect white adult teeth that hadn't seen any wear, except where one was exposed to the roots, where his gums had been stripped away.

The Erstwhile Hub saw him on his way to work and called me, saying, "There's a dog trying to die in the empty lot two doors down." My response was, "Not on my watch."

I went and lured him to our front yard and tried to feed and water him, but he didn't eat or drink much. He was emaciated, his eyes and cheeks sunken, and he looked exhausted. I loaded him into the Honda hatchback I had at the time and drove him to a vet I'd not been to before because my usual vet was closed on Wednesdays.

They told me he was probably very old and probably wouldn't make it, and showed me the X-ray of his gut, full of rocks and sticks. For some reason, I said "do what you have to do to save him." They ran two liters of fluid into him over a couple of days, keeping him sedated so he wouldn't chew the IV out of his arm. I went to see him both days, kneeling down by his cage and saying, "You must not die, you must not die."


He had a cracked hip and two cracked ribs and heartworms from hell and torn-up pads. The vets figured he must've been thrown or fallen from the back of a pickup, and walked all the way from the highway to my neighborhood.

When El Erstwhilo and I divorced, I left Max behind. I was moving into a 600-square-foot apartment and working sixteen hour days, and I couldn't take him. Later, when Erstwhilo thought he might be moving to Ireland and couldn't handle the thought of quarantine, I took Max back. I had just bought a house. Having him made everything better; he was the only thing I missed from my marriage.

Max died Saturday. I was out of town, visiting The Boy in Kansas City. My neighbor called to say that he'd gotten up and boofed around the yard that morning, then had lain down to have a nap and had simply not woken up. I got home this afternoon and found him lying where they'd tucked a sheet over him, looking exactly as though he'd just gone to sleep with his head between his front paws.

There were no signs of distress. He'd gone to sleep in his own back yard and woke up on the other side of the Bridge, where there are dozens of mail carriers on crutches and an ice-cream truck with a flat tire.

This is what I'd been praying for. Whatever Thing is there, out there in the Universe, watching over deserving dogs, gave Max a death in keeping with his life: quiet, gentle, without fuss or pain.

He was my Zoater-Bloater Max-Nose Spoon-Hound, and I'll miss him. I'm thankful, though, that his last days didn't involve vets and needles and fear.

Happy Trails, buddy. May many kitty-bellies present themselves for snorgling on the other side. I'll see you in a little while, okay? :)

Y'know how you feel when a friend does something really great?

That's how I feel right now. My pal Nikki, late of "CatsNotCancer," is doing THIS.

Nikki, although you wouldn't know it to look at her, has ovaries of titanium and shoots laser beams out of her eyes. On vacation, she goes to Australia and rubs Great White Sharks on the belly, to which they respond by rolling over and purring. If she meets a rattlesnake while she's out hiking, the rattlesnake bows politely and gets out of the way. Bees fear her. Butterflies worship her. She's dressed by a posse of bluebirds and little woodland creatures every morning, after which she distributes semiautomatic weapons and shoulder-mounted grenade launchers of Truth to all of them, the better to fight for justice.

Because, you know, this lawsuit isn't all she's done. She's also been a hell of a pal to me.

And if BCBSTX doesn't see reason as regards the Obturator of Doom, you can bet I'll be channelling Nikki when I go see them. With a smiiiiiile.

I really need to stop yelling at my boss.

But honestly, when somebody calls me when I've got two phones already ringing off the hook, a patient who's about to code, six people lined up to ask questions about random neuro stuff, a housekeeper with a query about whether or not something obscure needs to be done today or can wait until tomorrow, and four people leaping out of bed in their usual confused way, it is NOT the time to tell me that I have to check the crash cart this month, myself, alone, today.

I *will* snap at you. And, if you're a condescending asshole (sorry, Bossman! But you were!) and point out to me that ICU nurses have a lot to do, too, I will respond by noting that your average ICU nurse has patient care aides, a secretary, a charge nurse, and a manager to do what I am just that moment doing all by my lonesome. I might even respond at a higher-than-normal volume.

It's a good thing that Bossman had me check the cart, as it turns out. Even though it meant that I missed an assessment on one patient (not a big deal; he was stable as a rock) and didn't get lunch until 1430, it was a good thing. Because I found that the crash cart, ostensibly checked by other people on the unit each month for several months, was full of stuff that was expired. As in, expired in 2009.

Now we have a nice, spandy-fresh cart with magnets in their proper places, salem sump tubes that aren't in packaging so old that both it and the tube have become discolored and brittle (holy crap you would not BELIEVE), and the proper number of needles, large and small, and medications, unexpired. It only took me three hours, between answering phones, helping turn patients, resetting monitors, taking delivery of a cartload of supplies, and fixing the computer that decided suddenly to regress to its roots.

I keep reminding myself that I have a mini-vacation coming up next week, and another one a couple of months after that. They don't keep crash carts on planes, do they? . . .*Do* they?

Big Drama at Sunnydale.

Phiddipus audax, the Daring Jumping Spider (how much do you love that name?) is making its summer home in my house. We do this every year: I see a cute black spider with white spots and bluish-green what-d'ye-call-em (those things that the fangs come off of. Not pedipalps, the one that starts with "c") and catch it and put it outside. This year I missed the Mother of All Audax, and she spun a nest at the corner of the wall and ceiling in the kitchen.

After some research, I decided that the thought of several hundred, maybe as many as a thousand, spiderlings was more than I could stomach, and sucked her into the Miele. I feel awful about it, but we need the rain. (Bonus points for the first Minion who understands that last sentence without using Google.)

Sunnydale's NCCU is in the grip of Big Drama these days. A particularly difficult doctor and a couple of grouchy colleagues of mine have made it their mission in life to submit incident reports for everything, and I mean *everything.* Unfortunately, the doctor writes up nurses for things that she, the doc, should've done (like writing orders) rather than get in trouble with *her* boss, and the grouchy colleagues are sending off irate and insulted emails about things like the lack of housekeeping standards 'round those parts.

I got written up for three things, two of which my boss and I agreed weren't really relevant. The third was not only totally justified, but pulled me up short. I've gotten careless about making sure orders get written, so it looks like I've been haring off on my own, making treatment decisions. This is obviously bad. Nurse Jo is going to spend more time checking orders prior to punching out, and probably doing a lot more last-minute running around to fix things as a consequence.

So yeah, I fucked up. I got called on it. Though I'm not crazy about the *way* I got called on it, it's a good reminder that you have to behave like a brand-new nurse all the time in order to make sure you're not getting careless.

The whole shebang also pulled me up short because it made me realize how scatterbrained I've become in the last few weeks. It made me analyze, thoroughly, *why* I might've gotten scatterbrained and careless, and I came up with what I think's a pretty good reason: I'm overburdened.

When I'm primary nurse in the NCCU (we usually have three nurses, with one taking three patients, another taking two or three, and a third helping out in the absence of a patient care aide), I have a patient load of three. These are acutely ill people who are generally leaping out of bed or desatting or doing some combination of the two, sometimes with a third fun thing thrown in.

I'm also charge nurse, dealing with staffing and bed assignments and crises. I'm also acting as secretary, breaking down charts and answering the phones and entering orders. The facilities management and biomedical repair staff deal only with me: they ignore the other day-shift nurses and hold on to their questions or problems until I'm on staff. I'm also the only person who's allowed to do certain tests (with hyperagitated goo and saline), so I do all of the ones in the entire hospital, as well as the clinic next door. Plus, I do around a hundred chart audits a month to make sure we're in compliance with whatever brilliant idea the Joint Commission's come up with this week.

Some of this stuff has *got* to be delegated. The most obvious solution is to delegate the chart audits, probably to the night staff (which will, I'm sure, make me their most favorite person ever). The other stuff, I'm not so sure about. We've got to get more people trained in the more obscure test protocols; the obvious solution is to train the charge nurses for the other CCUs. I'm not sure how well that'd go over, though, as they're just as overwhelmed as I am.

My first step is to chart exactly how much time I spend doing things other than direct patient care. Given that I round three times a day with residents, midlevels, and attendings, then implement whatever they want implemented, I think that charting'll show I'm really busy. Add in all the other stuff, and. . .well, it'll make a good argument for me getting some relief.

And hopefully, if I get some of this crap off of my to-do list, I'll be able to concentrate on what I'm there for: you know, taking care of sick people and not screwing up.

While you're waiting for a real post. . .

For The Boy.

0:04 at Casa Del Snotbags

I'm strung out on pseudoephedrine (that beautiful demon) and researching plants from exotic nurseries. These are not, as you might think, nurseries that have dancing poles and topless women all over the place; they're nurseries from whom you can get things like amorphophallus* and elephant ear.

Notamus is out in the Kitty Koop, watching the bats with envy. He's convinced he can become a bat by his next birthday if he only tries hard enough. The best thing about being a bat, he thinks, is that he'll be able to fly to chase craneflies rather than just jump. (Sometimes I hold him up so he can reach one that's particularly high on the wall. Yes, I spoil my cats.)

Flashes is sitting on the kitchen windowsill, playing Bonk That Junebug. The junebug lands on the kitchen window screen and sits there. Flashes noses it, and it goes *bonk* onto the outside sill. Then it climbs back up and sits. Flashes paws it, and it goes *bonk* again. Lather, rinse, repeat. Infinitely.

They have both taken to leaving half-chewed junebug corpses in my shoes. This is better, believe it or not, than cranefly legs *everywhere*, including my pillows. It's like a battalion of drag queens with bad eyelash adhesive came over when they do that. "I love you; have a piece of bug" seems to be the new cat-speak.

Max's ears are coated with triple antibiotic and the rest of him is coated with citronella spray. He has a pleasant, lemony scent, like an enormous mobile air freshener. I really should've groomed him today, but the logic of headcolds is that you can't move during the day and have tons of energy at night. He's sleeping in the kitchen, alternately snoring and boofing very quietly as his paws twitch. I think he's finally catching the ice cream truck.

My cold is, strangely, better. I still can't produce anything more than a squeak when I talk ("I'd not mind that he speaks/In gibbers and squeaks/But for seventeen years, he's been dead") and my throat is kind of sore, but I feel almost okay. I sneezed something truly horrifying out of the operative side of my sinuses this morning; it almost made me re-think the wisdom of daily antihistamines for allergies. There's such a thing as stuff getting too dry up in there.

Still, I managed to make it out to the store for real Sudafed and soup and tater tots. As I went through the checkout line, the sixty-ish woman who was checking remarked on my lack of voice. I whispered apologetically, "Yeah, I have a cold."

"Honey," she said, "You go home and make yourself a toddy and feel better. Don't mind if all you want is your mamma. I get a cold, all *I* want is *my* mamma."

That made me feel better. Plus, The Lovely Diana gave me a recipe for a hot toddy that consists of honey, heated up, and double that amount of rum. She says it won't bring my voice back, but I won't care. It's apparently an old Cuban recipe, used far and wide on everybody from children to ancient grandfathers, and she swears it's safe as houses. Given her propensity for being attacked by wildlife on vacation, I'm not sure I trust her, but I'm willing to try anything.

Tomorrow's to do list: Nap, Rum, Nap.

*Okay, that's almost as bad as topless nurserypeople.

My poor Max!

I got home tonight to discover that The Best Boy had a bloody head. Not specks or splotches of blood, but patches of bright red rubbed-off blood that had come from somewhere else. When I looked closely at his ears, I discovered that they were covered with the awful, horrible, nasty, icky biting flies that drink blood and come around in the spring.

Vampire flies. On my boy.

So I brushed them off and let him in and anointed him with antibiotic ointment. Then Flashes sat down and groomed his head, so that the blood wouldn't make him any less handsome. You could see where he'd shaken, hard, trying to get the flies off, and where he'd rubbed his face with his paws to discourage them.

Poor guy. I have no idea where the flies came from. It's war, though: tomorrow, rain or shine, I am putting out freaking fly traps and laying down cedar granules and nematodes.

And I have a cold. This is the first time I've been head-sick (as opposed to tummy-sick) since surgery. Eighteen months and no clinging head cold; this one could not be dislodged with zinc and Emergen-C. It is, of course, the Worst Cold Ever, and I Need My Mommy. I have completely utterly totally lost my voice and there are interesting poppings going on in the neighborhood of my right ear.

But I'm much more worried about Max. I, after all, have bourbon. Max only has ointment. He's sprawled out on his bed right now, sound asleep. I wish I could give him some Maker's.

I also wish I had a toaster that didn't have two settings: Raw and Burnt.

I also wish I had a gallon of Mom's Mexican chicken soup.

I guess this is what those damned swollen nodes in my chest were trying to tell me.

Clean CT!

No nasties in my chest.

There were a couple of swollen lymph nodes, one borderline, but once Dr. Crane looked at the back of my sinuses (conveniently exposed for his perusal) he said, "Oh my gosh! You have a lot of goop in there, for sure. Y'know what'll fix that up, is a Solumedrol Dose-Pak. . . "

(glances over at my face)

". . . . or not. Um. . .you don't like Medrol?"

"It makes me want to hug people."

"It makes you want to hug people. . . .?"

"Until they stop breathing."

The swollen lymph nodes are a reaction, apparently, to the horrid allergy season that's hit us this year.

My next scan is an MRI in four months. Wahoo!

Tap, tap, tap. Drum, drum, drum. Twiddle, twiddle, twiddle.

There's a lot going on at work, but I'm too distracted to write about it right now.

I had my first follow up chest CT today, with and without contrast, wahoo. Stevie was very kind and put a 22g IV into my 18g-worthy hand vein, so I have only a minor bruise on the back of my paw. Given that I bled for forty freaking minutes after I scraped my knuckle the other day, a minor bruise is a good thing. Maybe my aspirin dose needs adjustment.

Tap, tap, tap. Twiddle, twiddle, twiddle.

I'm obsessively checking my work email. Last time I had a scan, Dr. Crane sent the results to me there. I don't know how long it took, though, because I hadn't checked my email in days and days. Now I'm trying to remind myself that no news is good news, and trying *not* to read into Tracy's expression as she was helping me off the CT sled. Her usual expression is no expression and that's what I got today so that's got to be good, right?

Drum, drum, drum. Pace, pace, pace.

Surely it's going to be fine. Right? Right. Negative CT. Negative CT. Think negatively. Even if there is something there, it means that whatever-it-is was found quickly, so it'll be relatively easier to treat. Right? Right. But it'll still be negative. My goal for this year is to not have surgery.

Twiddle, twiddle, twiddle. Check email. Nothing.

I have to make lunch for work tomorrow, but I have no appetite and am therefore uninspired.

I'm going to go steam some asparagus. It beats pacing and twiddling.

WAHOOO! More than a thousand followers!

I wish I had something to give as a prize for Follower One Thousand and Follower One Thousand One. You're Minions; that'll have to do.

Welcome, Minions! Await my orders.

Thanks to all you knitters! And odds and ends.

The Project is well underway at this point. Thanks a thousand times to all of you who responded; the person who ended up getting the assignment emailed me this morning and said, "Well, it's actually done now. I had some yarn left over."

Sooooomebody (singsong voice) had toooo much coffeeeeee!

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

Apropos of nothing, have I mentioned lately how much I hate Large Music Festivals? It's not like Bigton can't survive for another decade on the backs of the musicians who've flocked here like roaches to a trash can. Still, they have their Damn Music and Technology and Whatever Festival every damn year about this time, and every damn year about this time, traffic is worse, people are stupider, and I get grouchier than usual. Thank Frogs the weather sucked the first weekend, or I'd've never gotten to work at all. I think next year I'll take the weekend of the time change through the end of Big Stupid Festival off entirely and go hide somewhere like Prince Edward Island. Or someplace with penguins. Penguins would be nice. They don't consider day-drinking an Olympic sport.

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

Max has a new friend. Man of God and His Lovely Wife sold their house and moved to Bigton after he got The Call from a small church looking for a fighting young priest who could talk to the young. Max and I miss them terribly; they were excellent neighbors with a very sweet dog, but the new neighbors are promising. They have a rescued French bulldog and a cross-eyed Bengal cat (first one I've ever seen--he was surrendered to the pound because of his cross-eyed-ness), and Max is busily making friends with both of them. The cat only goes outside on a lead. This is a good thing, as he's the biggest damn feline I've ever seen outside of a zoo and I am not kidding. He's fucking terrifying.

New Neighbor Husband seemed a bit frat-boyish at first, but he's beginning to relax. He's gotten the vibe of the neighborhood (nobody uses poison on their lawns, we all compost) and has quit mowing the yard in a button-down shirt and loafers. New Neighbor Wife is kind and funny, and was quite sympathetic to my locking myself out of the house the other morning.

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

Oh, that? Yeah. . .well. We had some really severe storms here the other day: there were tornadoes not too far away (tornadoely speaking) and hail and all sorts of scariness. The Beardman, my other neighbor, came over to let Max out a couple of times during the day and make sure he was all right. In doing so, he locked the doorknobs of both front and back doors. I never lock the doorknobs, just the deadbolts.

So when Attila showed up the other day for our training session, I was standing on the front porch (it was 0630, and raining) with a cup of coffee. I turned to let us both in to find the door was locked. No problem; the back door's unlocked! Except it wasn't. And the key that normally lives on Max's collar was in Beardman's pocket.

So I borrowed Attila's car key and slashed the screen in my bedroom window. New Neighbor Wife walked out to her car in the middle of all of this and, to give her credit, merely looked at me questioningly. I explained the situation, and she said Oh, How Awful and offered Husband's assistance in re-screening the window. Then Attila levered herself up over the windowsill and unlocked the door, and life went on as normal.

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

All thing considered, I think the neighborhood got lucky when this couple decided to ditch the lights of Bigton and commute instead. Now if only their cute! cute! cyooooot! little Frenchy would decide I'm trustworthy and play-with-able. I almost had him liking me yesterday, but then he got all watchdoggy again.

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

In Attila news, I am now not only squatting, deadlifting, and good-morning-ing more than she can lift (being built like a gazelle), I now *bench* more than she can lift. This is going to require either a reworking of our training sessions or the purchase of the weightlifter's equivalent of a Hoyer.

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

And that is all for now. Eventually I'll work up an interesting (in the sense of the Chinese curse) day I had recently for public consumption. Right now I'm going to go vacuum all the cobwebs off the ceilings and chase the geckos back outside.

One of those days.

Once in a while, something happens at work that is so traumatic, so difficult to talk about, that I don't even want to post it on the blog. One of those things happened this week.

The minute I turned away from the cauldron on the cafeteria line that held "Fresh Seafood Gumbo," though, everything got better.

Ba-donk-ksssshhh!

But seriously, folks: this was One Of Those Weeks. I got a lecture from the director of nursing about being on my Best Behavior (Best Beloveds) when it came to taking care of the family member of a VIP. "We're going to give him, of course, the same standard of care that everybody gets," said the DON, "but we might need you to expedite some of the testing, like the MRI, for him."

"Soooo," I said, unaware of what my mouth was actually doing, "We're *not* actually giving him the same standard of care as anybody else." 'Cause if you're on Medicare, that MRI's gonna take thirty-six hours.

It's a wonder I haven't been fired thirty times over. I called the bed board to report the arrival of Le Petit Prince with the words, "The Eagle has landed. Repeat, the Eagle has landed. With his diamond chariot and his staff."

Let's face it: If you work in practically any non-profit healthcare facility these days, especially one in the state where Guvnuh Goodhair has yanked funding for various things you used to do, you are dependent on donors to do things like fix the a/c and make sure you have enough money to buy IV fluids. I live in Texas; therefore, I am used to whoring for money to make sure my less-fortunate patients get the private funding they need to get treated. Ever since I watched a guy die of a treatable brain tumor because of lack of indigent-care funding, I have whored more cheerfully and fluffed-and-puffed in a more dedicated fashion than you would ever believe.

LPP hopped the line in the emergency department with a problem that had been going on since sometime in September and which had recently, despite not changing, gotten insupportable. Therefore, our Prince presented hisself at the ER with vague complaints of. . .something.

I admitted him and his Something ahead of two actually emergent patients with actually emergent problems--though, thankfully, they'd gotten good care at their local EDs in the meantime. They just kind of had to wait around for a bit, one on the helipad, the other in a buggy (ambulance, for you civilians), until we'd gotten His Highness settled in.

(Just now Max put his head in my lap, bad breath and shedding ear-puffs and all, reminding me that no matter how stupid we humans are, there are still dogs who love us.)

HRHLPP will be fine. There's nothing wrong with him that six weeks drying out and a few B vitamins won't cure. My other two patients will be fine: one got TPA in a timely fashion, administered correctly by an on-point ED MD (shout out to all the ED docs!) who'd never actually done it, but who read up on it on the Internet from his tiny, six-bed ER; the other got a nifty new experimental drug we're testing and seems to be getting over her aphasia even as we (ahem) speak.

It's not his fault his daddy's rich. He was a nice guy: said "Please" and "Thank you" and was admirably brief and succinct in the description of his symptoms. Daddy is currently funding a study on the benefits of various anticoagulants in the acute phase of stroke (the beneficiary of which was in the next room over), so I had little trouble being nice to him. We even had a few things in common: birdwatching, politics, and music.

Even if your client is nice, it doesn't make it any easier to whore, though.

Question for the minions: anybody here know how to knit?

If so, please shoot me an email at johannebertha at gmail you know the rest.

Thankee. I may have a commission for you.

For Tashi and Wash, on the occasion of their third anniversary, belatedly.

Peeps, a request:

That you send your best wishes to Nurse Ames, who has spent thousands of minutes waiting for me to get done with yet another damn scan and driving me back and forth to said damn scans, tomorrow. She's having her stapes replaced with a titanium replica and her eardrum repaired in some way that I don't understand, starting about 2:30 pip emma central time.

What the hell do I know? I do strokes. All I know is that she's a little anxious, and so am I.

Prayers, hip-shakingks, om-sayings, and capybara-snuffles would all be appreciated.

As for me, I'm getting started on soup right now.

I don't tell anyone about the things we have planned. . .

Your voice is my favorite sound.

You know what ammolite is, right?

It's the fossilized shell of a squidesque beastie that lived in the late Cretaceous (IIRC) period and which died out with the dinosaurs. The shells of those guys were apparently made of something very much like the stuff that makes pearls, but the fossilizing of their shells makes them all opalescent and gorgeous and rainbow-glittery.

Imagine the darkest, reddest amber you can, and then shoot green and yellow through it. That's ammolite. It's amazing. It's also found only in a very few places, from Utah to Saskatchewan, and around my neck.

Yes, friends and neighbors, this is mine. (Dry-washes hands, cackles.) It's a craptastic picture, but I was shooting and shooing a cat away at the same time.

Der Alter Jo and I were looking at this piece at a street fair, and I walked away.

Then I doubled back, with DAJ giggling with glee, and handed over my bank card. I knew that if I didn't get it, I would think about it forever, just like I do with a necklace I passed over in Alberta lo these many years ago.

In other news, things at the new NCCU are. . . . .well. Exciting? Thrilling? Slap-yo-mama-type fun? Sure: let's just call it that and leave it alone. I'll tell you: if it's not a stroke that takes out one entire side of your body, or a brain problem that leaves you face-blind (I passed over "prosopagnosia" and then typed "face-bling," which is what I've got around my neck, yo), or a previously-undescribed demyelinating disorder, we ain't got it. It's been one of those weeks where residents and nurses high-five one another over lab results, in other words.

Best moment of the week, and possibly of my entire life ever, came when one of my coworkers, who teaches jazz and ballet on the side, spun around in her chair to answer an intern's question. The thing was, she had her left ankle behind her head at the time, as she was trying to stretch out a cramp in her glutes. I had just put an empty accordian folder on my head as a hat and was humming to myself, and one of the midlevels was playing Bejeweled on her phone. It was Anything Can Happen Day in the NCCU.

I really think that shows like "Scrubs" and "House" are/were great for hospital staff. People get used to seeing craziness on TV, and it doesn't bother them nearly as much when they encounter it in real life. Unless, like that intern, they're just looking for the nearest vending machine.

What to do on your day off.

Wake up to a cat licking your knuckles. Roll out of bed, stopping mid-roll to rub the doggy belleh presented to you. Start the coffeemaker, then pee.

Check your messages. Notice that your trainer has cancelled your training session for the day. Hope that she doesn't have the violent stomach ailment that's been going around.

Leave the house an hour after waking up, having spent more time than is necessary in the shower with mounds of scented soapsuds and lots of implements. Make your way to Target.

Find that everything you need--boring stuff, like dish soap and lotion--is on sale. Grab a bag of work socks as an impulse buy. Think of how nice it'll be to have a dozen pairs of the same socks.

On the way home, decide to visit the strange little nursery on the edge of town. (NB: One of my few unbreakable life rules is never to shop at a nursery that doesn't have resident cats.)

Roll on into that nursery and greet the Domestic Orange Jumbo who patrols the perimeter. Meander slowly down the rows of trees (Japanese maples are big this year) and hardy annuals until you get to the greenhouse. Push aside the plastic sheeting that covers the door, walk into the greenhouse, and take a deep breath of warm, humid, growing-things-scented air.

Take a few more deep breaths.

Dodging craneflies, examine the offerings. Consider buying four-inch pots of catmint. Discard this idea when you remember how prolific and invasive catmint is. Sniff hard when you bend down to look at the Carolina jessamine and Asian jasmine in teeny pots. Admire the Meyer lemons and wish you could remember to bring such a thing inside when it gets cold.

Walk out of the greenhouse and enjoy the change from warm and humid to cool and slightly muggy.

Walk to the next greenhouse. Stop along the way to pet an argumentative calico cat and a black-and-white cat with long whiskers. Realize that the combination of greenhouse and relative outside humidity has made your hair go native in a big, bushy way.

Enter the second greenhouse. Breathe deeply. Realize that this one is mostly roses, but don't go back out, even though you don't want roses. Stroll the aisles of rose plants, reading every card and smelling every bloom. About halfway through, pick up the calico cat who's followed you in and carry her so she'll stop complaining.

Leave the second greenhouse. Stop to commiserate with the nursery's owner, who thanks you for paying attention to the bitchy calico (now curled up with her head on your shoulder). Discuss the drought, the invasiveness of artemisia, how Home Depot has ruined foundation plantings, and whether you can divide buddelia by whacking at it with a shovel.

On the way home, stop to pick up tacos from the taco truck.

Eat your tacos. Update your blog. Take a nap.

My head, let me show you it.

We had a patient recently who had something I've never seen before (for that matter, neither had the physician). He'd infarcted his corpus callosum.

Now: If you're not a brains person, this won't mean jack to you. It's a very big deal, though, for a couple of reasons: first, the corpus callosum has a huge blood supply coming from (if memory serves) three different arteries. Second, infarcting (cutting off the blood supply) it means that you end up with something called split-brain syndrome.

See, the C.C. is the part of your brain that ties everything together. It's a big ropy mass of white matter--the stuff that has the thinking bits of your brain in it--that acts as a communication corridor between the right and left sides of your brain. It allows you, for instance, to be able to recognize a chicken, describe that chicken, name that chicken (sounds like a bad game show title), and talk about what sorts of implements you'd need to take care of said chicken. Besides a knife and fork, I mean.

Occasionally we'll cut the corpus callosum as a last-ditch attempt to stop a really horrible case of epilepsy. That's usually done on children who simply can't stop seizing, no matter what we do pharmacologically, and it's usually done at a very young age, because the ability to overcome that callosotomy, as it's known, decreases as you get older. If it's done too late, or if it happens later in life as the result of a stroke or other injury, you end up with split-brain syndrome.

I'll bring back the chicken and let Wikipedia explain what split-brain syndrome does:

A patient with a split brain, when shown an image in his or her left visual field (the left half of what both eyes take in, see optic tract), will be unable to vocally name what he or she has seen. This is because the speech-control center is in the left side of the brain in most people, and the image from the left visual field is sent only to the right side of the brain (those with the speech control center in the right side will experience similar symptoms when an image is presented in the right visual field). Since communication between the two sides of the brain is inhibited, the patient cannot name what the right side of the brain is seeing. The person can, however, pick up and show recognition of an object (one within the left overall visual field) with their left hand, since that hand is controlled by the right side of the brain.

The same effect occurs for visual pairs and reasoning. For example, a patient with split brain is shown a picture of a chicken and a snowy field in separate visual fields and asked to choose from a list of words the best association with the pictures. The patient would choose a chicken foot to associate with the chicken and a shovel to associate with the snow; however, when asked to reason why the patient chose the shovel, the response would relate to the chicken (e.g. "the shovel is for cleaning out the chicken coop").

Obviously, it's going to be a drag if your C.C. gets all jacked up. It's hard, given the other problems this dude has (like an almost total lack of white matter, thanks to diabetes and hypertension and a bunch of other stuff), to get a really clear read on how it's affecting him and whether or not he even notices. We thought that he had some left-sided neglect (more on that, per Pens's request, in a later post) combined with a major psychiatric overlay (given his history). It wasn't until we saw the MRI, with the corpus callosum lighting up like Christmas, that we realized what, exactly, the problem was. Golly!

(Yes, I actually said "Golly!" upon seeing the guy's MRI. Sometimes I say "Gee whiz!" as well. Ironically, of course. Because I'm hip.)

Now I'm left with a wet, cold chicken who's been in a snowy field and has to be returned to her cozy coop over at Wiki.