Wednesday, October 30, 2013

Let's talk about cancer.

Three years ago at this time I was lying on the couch, watching St. Elmo's Fire with Friend Pens The Lotion Slut, feeling rather giddy from a combination of red wine and Vicodin. I had just had the majority of my hard palate and all of my soft palate removed due to a case of oral cancer. If you want to read the whole story, go back to September of 2010 in the archives.

(St. Elmo's Fire is a good movie filled with terrible people. Skip it; that way, you won't have to wish for that two hours of your Vicodin- and red-wine-soaked life back.)

Let's talk about oral cancers. There are a lot of them, some of them frightening, some of them less so. All of them are on, as they say, the rise, due to a number of factors. Here are some interesting things about OC that you may not know:

1. A large number of oral cancers are due to the human papilloma virus. In different forms, HPV can cause warts on your fingers, genital warts, cervical dysplasia and cancer, or lumps in your mouth, or oral cancer. There are innumerable strains of HPV. Most of them are harmless. Some are really a bitch to get and to treat.

2. Oral cancer, which used to be the province of men over the age of 60, is increasing in young women. Part of this has to do with the near-ubiquity of HPV in the population. A lot of it has to do with the fact that young women now smoke more and drink more than young men. Alcohol or smoking predisposes you to oral cancer; doing both at once is a great way to lose chunks of your tongue or jaw.

3. Oral cancer is underdiagnosed in young people. Part of this has to do with the fact that the thinking on OC hasn't caught up with the reality. Part of it has to do with how often young people visit the dentist. I go to the dentist twice a year; my OC was found by The Fantastic Hygienist at my dentist's office. It had grown from nothing to a two-centimeter lump that I had not noticed in half a year.

4. Oral cancer has a huge impact on your life, no matter how minor it is. I got lucky: all I have to do for the rest of my life is wear a metal-and-plastic prosthetic that protects my airway and allows me to speak, and get yearly checkups (complete with MRI and CT scans and all the associated radiation) to make sure that I still have no evidence of disease. Some people, like my pal Mary, have lost much, much more than that to this disease, and the consequences are ongoing.

5. Oral cancer can hit you even if you don't smoke, or drink, or have sex. Mary, for instance, had a stage III squamous cell carcinoma of the tongue that was HPV negative. She is a lifelong nonsmoker and nondrinker. OC doesn't play favorites.

6. Which leads me to THE MOST IMPORTANT POINT OF ALL: If you see or feel a weird bump in your mouth, get it checked out. If you've got a gut feeling about it, don't stop asking for answers until you know what's really going on. OC is still one of those things that docs don't expect to see in people my age (forties) without other risk factors. I was incredibly lucky in that I had a dentist who was paranoid as fuck about the thing on my palate. Other people have not been so fortunate; as a result, they've had to undergo things like feeding tube placements and the loss of all of their teeth.

My cancer, polymorphous adenocarcinoma, doesn't have known risk factors. The article in Wikipedia on it is still only a stub. It's rare, it's non-invasive (usually), and can normally be treated with what's called "wide excision," also known as "taking out most of your mouth and changing your life forever." The type of cancer I had was indolent, meaning that it didn't spread or grow very quickly. It could happen to anybody. It happened to me.

So, on this third, give or take, anniversary, I have this one request: think about oral cancer. Go to the fucking dentist. It doesn't matter if you haven't been in fifteen years; they get off on that stuff. Get your mouth checked out. Avoid what I went through.

Friday, October 25, 2013

Of plumbium and bidets, of subway tile and new nurses, of cabbages and kings.

This week was long. People, I tell you: wearing leads for seven hours a day, five days a week, will wear. you. the fuck. out.

Let me back up.

Sunday last I stepped through my bathroom floor. Yes, that bathroom floor. The bathroom floor that the Ex Chefboy and I spent something like six weeks demolishing and redoing. I stepped through the floor. Because it had rotted. From something. I don't know what. Don't ask me. La la la la laaaa.

Monday I started cross-training for angiography/interventional radiology/that weird place waaaaay down the hall in the basement next to the operating rooms where they make you wear hairnets, like, 24/7.

Tuesday I felt my hip joints grind in a way that I hadn't felt before.

Wednesday I was fairly confident with the charting, but still hating the leads. You try wearing ten or so poundses of lead on your top and bottom (ten pounds each, my friends) for several hours at a stretch and see how you like it.

Thursday I realized that they'd given me a male lead-vest with double shielding over the chest because nothing else would fit over my bazooms. And *that,* best-beloveds, is why aformentioned bazooms will be permanently droopy from here on out.

Today I discovered that, starting this coming week, I will be precepting a new nurse for twelve weeks. She's coming into the NCCU as a new hire. I have never, ever precepted a new person for that long. Not that I'll be doing it all by myself, but I'll be doing the majority of her  Hey Lookit This Ain't This Cool edumacation.

And at some point during this week I realized that what I want, deep in my heart of hearts, more than happiness or a living wage or a fuzzy kitten, is a bidet.

Let me back up again.

It looks like at least one of the walls and most of the floor in the bathroom is/are a total loss. That means sledgehammering and chiseling and generally demolitioning the tile out and laying new Hardi-Board and waterproof stuff. Waterproof cement board is great, and it generally works, but it's not meant to withstand the bursting of a pipe that carries Unimaginable PSI of water under said waterproof board. I had, apparently, the one situation for which RedGard and Hardi-Board are not rated.

We don't have to do everything right now. Most of the demo and reconstruction can wait over the winter, thank Frogs. I can use that time to save up my pennies and decide what I really, really want in the bathroom. Which is kind of a story in itself. . .

Seven-nearly-eight years ago, subway tile was the exclusive province of Brooklyn hipsters. Seriously: they hadn't even moved out to Williamsburg yet, and subway tile was available only by special order through the big-box stores here. It's what I wanted, but couldn't afford, so I went with Pelican 1 x 1's all over the floor and up the walls and have kind of dealt with it ever since.

Now I'm looking at subway tile. And console corner sinks. And a BIDET.

I was introduced to the miracle that is the bidet in Denmark twenty-something years ago (also: that was the last time I rode a bike. Coincidence? Maaaybe.) and reintroduced to it while visiting Pal Joey in Quebec. Bidets, People, are the shizz. Nit. I swore that my Forever Home would include a bidet in every bathroom when I had a bathroom all to myself, complete with bidet, lo those many years ago.

But putting a bidet--a real one, not one of those toilet-seat make-do's, in the bathroom would require a smaller sink. Which I'm good with. I mean, what do you use a sink for? Washing your hands, taking off makeup, brushing your teefies. That's it. Corner sink = perfectly functional situation, if it means getting a bidet.


Mmmmm. You see?

I have had fucking MOUTH CANSUH, and I will have my bidet now, thank you.

But back to the leads: I learned a whole, whole lot this week. Most of it was charting in a totally unfamilliar system, but some of it was fun stuff about how the hell G-tubes get put in, and what you have to worry about with patients who have aneurysms coiled, and how some doctors who are fine in the unit are assholes in the OR.

Most of what I learned can be boiled down to two things: If you have shoulder problems, like I do, get an apron instead of a vest. That way, the bulk of the weight can be carried around your waist rather than on your delicate bursal nerve plexus. Also, radiology techs are the coolest guys in the hospital. I worked with The Daves (two guys named Dave who are indistinguishable when in full sterile gear), and they were *so amazing.* The nurse who was training me was great, yes, but she didn't always catch all the stuff I was screwing up as I was doing it, and so couldn't correct me with a quiet word from under a mask. I brought The Daves cookies today. It was not enough.

Another thing I learned: if you really, really like your job and find interesting things in it every day, you will communicate that enthusiasm to the person you're helping out who's new. That's what The Daves and My New Pal Sherri (the nurse who trained me) and My Old Pal Andrea (the other nurse in the department) did. It was fun. And educational. And my shoulders hurt.

And one final thing I learned: If you give a woman a bidet once, she will not stop thinking about it for two decades.

Sunday, October 20, 2013

An Illustration of How Nursing Shapes One's Thinking

This morning I stepped through the bathroom floor.

Yes, that bathroom floor. The one an ex-boyfriend of mine and I spent six weeks working on. I was turning on the shower when *crunch* went my right foot, right through some tile.

BN (Before Nursing), I would've panicked. AN (After Nursing), here's my thought process.

1. Is it a problem?


2. Is it a problem that will prevent me from showering?


(Get into shower.)

3. Is this a problem that will require me to wake up Boyfiend for his opinion?

No. It can wait.

4. What are the best-case and worst-case scenarios when it comes to fixing this problem?

Best: Replace a few squares of floor tile

Worst: Rip out entire bathroom and replace everything; live with Boyfiend while bathroom is being dealt with

Median: Rip out part of the bathroom and replace, bathe in kitchen sink

5. What is likely to have caused this problem?

In descending order of likelihood:

a) Wonky plumbing in the wall that we didn't notice the first time
b) Rot from bad grout lines in the floor
c) Leftover damage from pipe breaking under house
d) Ants or termites or some other bug
e) Aliens have decided to use my bathroom floor as a portal to another universe

6. What does this mean for the problem as it stands?

Ask for Home Depot gift cards for Christmas. Wait until Boyfiend to drink coffee before examining the floor. Make popovers.

(Get out of shower, make popovers.)

Saturday, October 05, 2013

Ohai. September was sort of busy.

A few folks have asked for updates on our Fantastic Integrated Computer System and about the woman who went to the non-accredited nursing school. Herewith:

The FICS is. . . .well, most of the functionality has been turned off. Which is nice, as it doesn't feel like Big Brother is right over your shoulder all the time. Basically, none of the tracking features worked right. Hell, the call lights and information boards in the rooms didn't even work right, so away they went, to be replaced with the old setups. Nobody is crying.

As for the tech who went to the wrong school: Somebody asked why accreditation makes a difference, if her grades were good and she'd had previous floor experience. It makes a difference because accreditation is the way that hospitals and clinics know that a particular school is teaching material that's up-to-date and useful. It's based, as far as I know, on things like NCLEX passing rates and the qualifications of the teaching staff as well as the course requirements. Whether or not it's one more bit of Press-Ganeyesque BS I don't know; all I know is that you simply won't get hired if you don't have a degree from a school with accreditation.

And yeah, she and I talked about it; she's going to work where she can until she gets enough experience that it won't matter where she went to school. I don't know if that'll work or not, but here's luck to her.

In other news, it's been a while since I gave y'all a good, old-fashioned, gross nursing story. Here you go:

The patient was a woman in her fifties or early sixties. She was obese, had alcohol and opiate dependency, and was diabetic. She was in the preop area of another hospital, prior to getting some toes snipped off, when she started complaining of a headache and then fell over and seized.

Big aneurysm. Big, big blown aneurysm. The hospital, having no flies on its collective self, transferred her to Sunnydale to have that aneurysm clipped, even though it wouldn't make much of a difference to her functionality. So she showed up at Sunnydale NCCU intubated and sedated, got her clipping done, and stayed intubated and sedated for about twenty-four hours (the usual routine).

Except that about six hours after surgery, both of her legs got all swollen and funky. Oops. That's not a part of the usual routine. Turns out she'd somehow clotted off her IVC filter. That's a doohickey that looks a little like a miniature colander--you get one in your inferior vena cava if you have large or repeated clots in your leg veins. It's supposed to strain out any clots that might go to your lungs or head and hurt you. Anyhow, hers got all full of clots, which basically means you lose the blood flow back to your heart from your lower body. If you're thinking that's not good, you'd be right.

Out comes the heparin drip. More clots, more problems. Eventually, she managed to sustain pretty substantial damage to both kidneys, which required pressor support (drugs that go through your IV line to help your body maintain a livable blood pressure) and continuous renal dialysis (which is a big blood-scrubbing machine that we only use when things are Indeed Dire). We cut off the heparin and started using leech spit (yes, really) to anti-coagulate her, but the damage was done. She had some clotting disorder that's rare enough in women (why do we always seem to find those?) that nobody had tested her for it until she came to us.

Here's where things get interesting. Patient had two sons, one of whom was beyond batshit on the crazy scale. Mama made one good decision in a rare moment of sobriety and made Sane Son her power of attorney and medical liason. He was all for stopping the heroic measures. Beyond Batshit Son, however, was still part of the family, and used his time in the NCCU to cause problems, raise hell, and generally put up such a fuss about continuing life support that the docs felt hogtied by family drama.

Meanwhile, the patient had infarcted her bowels, meaning she had a belly full of dead intestine. She'd put on about forty pounds of water weight and looked like an enormous balloon person in the bed. Her skin was weeping excess fluid all the time, to the point that we put super-absorbent pads all over the bed and hoped for the best. The only things keeping her alive at that point were nine different drips (I counted), a ventilator, a dialysis machine, and sheer dumb bad luck. Her hands and feet were gangrenous. She no longer responded even to pain. Her reflexes were gone.

Beyond Batshit Son, despite being told that her chances for recovery were nil, continued to insist that Mama be kept on life support. He even called Adult Protective Services to tell them that his brother was abusing Mama--imagine APS's surprise when they investigated and found a Mama-Lump in a bed in a critical-care unit. This continued for a couple of weeks, until I degloved one of Mama's legs by accident.

"Degloving" is a nice word for what happens when you're so sick, or so burned, or so generally unlucky that your skin simply comes off. We were turning her, using the pads we'd put under her to absorb fluid, when I felt something mushy in the pad under her thigh. I figured it was just the super-absorbent gel in the thing and shifted my grip. . .which was when the nurse across from me blanched and shuddered.

The skin on the back of Mama's left thigh had sloughed off her leg. You could see layers of fascia and muscle underneath, and the lump of shed skin and fat was hanging off in a flap. There wasn't any blood; even with multiple drugs to keep her blood pressure up, she wasn't pushing enough of the red stuff to bleed when that happened. She leaked clear fluid.


With that, the docs on the case sat down in a meeting, collectively sacked up, and turned off the ventilator. The patient, grateful for the relief, died without fuss four minutes later. Given that the accidental skinning happened over a weekend, it took 'em all a couple of days to get together, but they did it. Beyond Batshit Son was never on board with the decision and had to be escorted off the premises by a couple of no-nonsense cops.

And that, my friends, is your Requisite Gross Nursing Story for the month. Sweet dreams!