Friday, July 31, 2015

If I see one more preachy Facebook post about air conditioning. . . .

Look: I know air conditioning costs money. I know it's bad for the environment, it makes people fat, it destroys the great plan that the universe has for us, and that it's one small step from central a/c to us telling our children and our children's children what it was like in America when men were free.

But I live in Texas. Central fucking Texas, where even the Native Americans didn't hang out in the summer, unless they could do so while standing up to their necks in spring-fed rivers.

So when I get tagged by well-meaning friends who live in Michigan and Wisconsin and Maine, where sure it gets hot during the day but it cools down to less than 80* at night, I get homicidal. They send me fun little articles about how people lived "before the age of air-conditioning." There's then this competition, with Europeans chiming in (bless their hearts), talking about how *they* don't use a/c until mid-July, and only then if their aged Aunt Maude is visiting. Hot? Just open a window, they say. That's what people used to do.

Yes, people had fourteen-foot ceilings and transom windows and heavy draperies they could pull to keep out the sun. They had cross-ventilation and attic fans and houses built on pier-and-beam foundations that allowed cool air to circulate. They had strategies for allowing cooler air in at night. They had huge ice blocks with fans blowing across them.

And you know what? They still left this part of the country and went to cooler places if they could possibly afford to. Whether it was a few miles away, to the Comal and Guadalupe and Frio, or down to the coast, or back East or to the mountains, they got the hell out of Dodge while things were baking. If they didn't, they either were miserable or they died.

Next time those friends get buried in snow, I'm going to post articles about how shoveling snow is bad for the planet and makes you a lesser person.

Yes, I'm a little grumpy. It's the heat.

Sunday, July 26, 2015

If you've not yet listened to RadioLab's broadcast "Telltale Hearts," you should.

It has (you can find it here) not only a great story about a heart, but an appreciation of Oliver Sacks by Robert Krulwich.

Dr. Sacks has liver cancer. As these things go, his prognosis varies depending on whether a given treatment has worked, or whether he has new metastases (the original one came from a melanoma that was eliminated from his eye nine years ago). Robert Krulwich, who's been friends with Dr. Sacks for thirty-five years, took a possibly-last opportunity to talk with him about his life.

It's an amazing, heartbreaking, heart-healing interview.

If I have one regret, it's that I'll probably never get to sit at Oliver Sacks' feet and listen to him talk, or take a look at his collection of elements from the periodic table, or be there when he makes some remarkable connection between the way things are ordinarily and the way they can be in the strange land of the human brain. It was Dr. Sacks who awakened my love for the human brain and the way it intersects with and informs the mind. Before I was ever a neuro nurse, back when I was a music major, I read one of his books and knew that *this* was what I wanted to learn about, forever.

If you want to skip the cardiology part, though I recommend that you *not,* his part of the show starts roughly halfway through. Don't miss the story of his philosophical conversation with the spider.

Dr. Sacks, I hope you get nothing but indigo from here on out.

Tuesday, July 21, 2015

Heads-up and queries:

I. . .I noticed the other day that, um, my blog design is like, you know, ten years old? And a lot of the links are broken or outdated? And I got really embarrassed? But I didn't actually do anything about it because I am a curb-crawling, lazy SOB blogger with a mind on Higher Things.

So now I wanna give all y'all Minions a heads-up: In the next week or so, maybe, I might kinda be re-doing some of the links and maybe the text size and so on, so if the blog goes down totally, that's why.


How does the text of the main body resolve for y'all? It's really small for me.

How does this bad boy look on mobile or tablet?

Should I ditch the full-text thing and go for "more below the break" formatting? I know I talk a lot, and I'm wondering if that would make for easier scrolling or if, as it does to me, it would drive people insane.

How does the Garnier Nutrisse Warm Copper compare to L'Oreal Preference 7LA Lightest Auburn? Good match, or Bonzo Orange?

Wednesday, July 08, 2015

Well. A whole lot just happened all at once.


To recap: I work in a critical-care unit that's embedded on a floor that is not critical-care. My immediate managers, the Assistant Manglers,  are not critical-care nurses. They don't have neurological or neurosurgical backgrounds. There are two of them, and both of them have shown a positive disinclination to be trained in the way we take care of critical or acute patients, despite having been told to get that done fourteen months ago. As a result, we folks in the NCCU deal mostly with our Head Big Mangler, who is a critical-care nurse.

(I should mention here that we are the only unit in the wide swath of hospitals that Ginormo Research, Inc. owns that does exactly what we do. If you're in reach of a Ginormo ED, and you have a specific problem, you will end up on my unit.

Four months ago, give or take, Keith showed up. Keith has been nothing but badly-groomed, unhygienic trouble since he showed up. He makes decisions on a weekly basis that, if he were working for Planned Parenthood, would get him fired the same day. . .but because this is a big corporate bureaucracy, have been allowed to accumulate in his file. He endangers patients and makes bone-headed mistakes that are simply inexcusable in somebody who has as many certifications as he does.

I bypassed the Assistant Manglers last week to report a particularly dangerous Keithism, and was written up. I discussed it yesterday with the Head Big Manager, and today got called into her office. Here's what happened:

I presented her with the rebuttal I wrote to the quote-unquote verbal warning I got. She read it, and then cross-referenced it with the writeup that the Assistant Mangler had submitted. I watched as her eyebrows climbed and she made little snorting noises.

Then she said, "I hope you understand that I can't, unilaterally, take this off your file. . . .but I am going to talk to Assistant Mangler about removing it."

I didn't know that using gentle terms like "misunderstanding" rather than the more accurate "I checked this out and it's a baldfaced lie," or "lower-acuity skillset" rather than "this person refused to complete mandated training" would be so effective. But they were.

Head Big Mangler agreed that I had done the right thing by going to the unit coordinator. She agreed that I had done the only thing that was logical, in light of various issues I didn't expand on here. She asked me to pass the word that any future Keithishness be brought to her attention, immediately, even if she weren't physically there.

I heard a distant hum, like large machinery.

And then she said, "So. . . how do we deal with our weakest link?"

The hum grew louder and more distinct, and all I could think of was

But unfortunately that would leave us short-staffed. I said, "Well, we're already manipulating the assignments so that we can keep an eye on Keith's patients as well as our own. . . ." and Manager cut me off. "No," she said, "you guys have enough going on with your own assignments. We need a way to keep an eye on him without burdening you further."

The hum resolved into the singing of a choir of angels, bursting through the Keith-colored clouds that have made my life a misery since March.

End result, TL;DR, was that Manager will be auditing charts and being much more present. She won't delegate this, since there aren't any sub-Manglers that can make good decisions about critical-care patients. And she promised to keep us in the loop. She told me, "I've noticed that people have been calling in rather than work with Keith, and I don't want to lose strong nurses because of one person."

So damn if I didn't get all validated and shit.

And, much more importantly, the entire unit, working as a group, got validated. We saw a problem, we followed the rules in so far as we could follow them rationally, I broke a couple because what the hell am I here for otherwise, and it's all slowly working out.

Now--whether this actually happens is a different deal. Having seen Head Big Manager's face today, though, and learned the meaning of the words "her lips narrowed into a grim line" as she was reading my write-up, I feel a bit more hopeful.

Sunday, July 05, 2015

Once in a while, I am reminded that I am no longer young.

Most of the time, I'd say I feel about. . .oh, twenty-seven? Mentally, at least. When I'm not being an eight-year-old boy.

Sometimes I am reminded that this is only a lovely fiction, a way that my brain has of denying the inevitable decay and death that attends every one of us.

Like when I tried to get into and then out of Kitty's car.

We had a strategic meeting, Kitty and Marcie and Marcie's husband and their dogs and I. Kitty drove the five minutes to Marcie's house--believe me, this is not a place you want to walk when it's numpty-bumpty degrees outside--so we took her car.

Kitty has a Japanese rocket of some sort. It has letters and numbers after its name. It's low to the ground and feels like an old sports-version Mercedes to ride in: you can feel every bump, and it's very, very tight and heavy. And getting into it is like getting into a bucket.

I folded in half and sort of fell in with a "GNMPH" noise and managed to buckle my seatbelt. Getting out? Well.

Have you ever watched a bullrider in the chute before the bull's released? He'll grab the harness with one hand, put the other up above his head, and then do this back-and-forth rocking three or four times. Then the chute's opened, and a huge mass of fat and muscle, enraged at its captivity, bolts forth with unpredictable and probably disastrous results.

That was me.

ANYway. We got there in one piece and met dog #1, dog #2, and husband, in that order, as well as Marcie's sister, who was there visiting. And we talked.

About Keith. And about us.

See, nothing's been done, as far as anybody knew as of Monday of last week, about Keith. I'd been assured by our mangler that Keith would be retrained in the areas where he showed deficiencies. . .but nothing's happened. And he's still doing totally unnecessary, stupid things, like not giving blood pressure medicine to people who need it. Because they've had brain bleeds. And their systolic pressure is in the 230's. When the top limit for them is 140. But I digress.

Because things are not moving along as we would've liked, and for a number of other reasons, I contacted the person who coordinates the neurocritical care unit. It was just a "hey, how you doin', we've got this moron here, how's the baby" sort of casual thing, bringing her up to speed on what's been and not been happening. Because, you know, I figured that, as the coordinator of the whole fucking unit, somebody might've mentioned this stuff to her.

Well, nobody had. And my calling her led to a number of people suddenly waking up to the fact that a) other people above them in the org. chart had been made aware of this running disaster by the coordinator; b) something had to be done, and; c) everybody's hair was on fire. It escalated, even though I didn't mean it to. Now everyone from the CNO on down's been made privy to every single write-up and suchlike.

And Marcie and I have been disciplined. Marcie for "falsifying" charting that she didn't actually falsify--in fact, the whole reason she got a black mark is because an assistant manager who's had nothing to do with this whole situation can't understand how our machines work*--and me, for going "outside the chain of command." Which means that that same manager is upset that she got called out for not doing more to help us with Keith.

In her defense, she never knew about Keith. Because we never told her. Because she showed a positive, proactive disinclination to learn or understand anything about the NCCU, not being a critical-care nurse herself. Because she's declined to be oriented, she's shoved off responsibility for us on to other people, and she's thrown mini-tantrums about us calling on her for help.

Tomorrow I get to walk back into a forest of people taller than me, all with smouldering hair. I'll probably be pressured to sign the write-up that's on my file, and once again, I'll have to refuse. Hell, I might have to write a rebuttal, or take it to HR.

I might have to quit nursing altogether, change my name, get plastic surgery, and move to Brazil.

That might be okay.

Unless all they have is cars like Kitty's.

---   ---   ---   ---   ---

*LSS, our machines time-and-initial-stamp vitals when they're verified by a nurse. Our assistant mangler (Ass Mangler? Mmmmaybe) doesn't understand that, and so thinks that differing initials on one chart mean that somebody's lying. It's stupid, but it's what I've come to expect from Sunnydale.