Head Nurse

Why I love my job, part umpty-umpty-ump:

2012-01-26T19:21:00.000-08:00

1. Standing around on rounds with the chairman of the department and the United Nations of Neurology (aka the residents), trying to figure out what the hell is wrong with a particular person. "He can't read out loud, but he can read silently and give you a good summary of what he's read." "Do you suppose that guy has edge-sensing and blindsight? That would be really cool. I've never seen a case of blindsight before." "How the heck are we supposed to get her to eat all of her food if she has total extinction of the left side?" (Me, having read Oliver Sacks: "Just tell her to turn her plate to the right until more food appears." Neurologists, not having read Oliver Sacks: *gaping in amazement*) "What about that one dude who sees only in black-and-white? Is that any better?"

2. Seeing function come back after TPA administration. Normally we don't do MRIs prior to TPA, just CTs. The MRI suite is always so busy that holding TPA until we have a solid MR image would push most of our patients out of the window (in terms of time, not literal defenestration). That means it's always kind of a crapshoot in terms of what we'll see, depending on whether the embolus was a clot or plaque or whatever.

3. Learning even tinier details of brain anatomy every single day. Just when I think I've got a good handle on things, some genius comes up with a theory that a patient's symptoms are due to a minor derangement of Whargarrbl's Foci of Bolognese's Range of the Straits of Inglewhazzit. It all starts to sound like Terry Pratchett, and I'm off to the textbooks again.

4. Learning really gross things about gross anatomy. Turns out there's a nasty situation that can happen inside an artery that causes a big snotlike glob of fat and plaque to detach partway and hang there in the blood streaming from the artery. Except that it's attached at one end to the wall of the artery, so it just goes "hrrbl hrrbl hrrbl" and blops around, occasionally causing TIAs. I can't remember the name of it, but if I see it again, I'll know it.

5. Knowing enough to explain what's going on when somebody in a different department starts freaking out about the YouTube video with that octopus? That's dead, and in soup, but then somebody pours vinegar over it? And I can explain how the acid in the vinegar stimulates the sodium channels and makes the octopus-food-corpse-guy want to crawl out of the bowl. That's really cool. I like that part.

In which Nurse Jo performs an assessment:

2012-01-25T18:31:00.000-08:00

Nobody died over the last four days: good.

TPA given to two people who needed it: good.

TPA given to one person who has a factitious/psychological disorder: well, no harm done.

Intubation of one patient: very, very good call.

Extubation of another patient: good. I'm glad her daughters got to be there.

Lotioning of a patient: Jeebus grits, why did this woman have to use Johnson's Baby Lotion? I hadn't smelled that smell in better than twenty years. It took me back to watching my grandmother get ready in the morning, in her alcove lined with mirrored closets, and her vanity mirror with Johnson's on the table.

I think I might have to go buy some Johnson's Baby Lotion just for the helluvit.

Self:

Oh, dear.

Noticeable right nasolabial flattening. Left neck musculature overcompensates for right on swallow. Left and right shoulder shrug equal. Right facial and neck dermatomes non-compensatory; total extinction of buccal and mandibular distributions. Compensation adequate.

Crooked smile: my new trademark.

So, yeah. Hey. How you doin'?

2012-01-17T04:31:00.001-08:00

Well, we're moved.

We have a spandy clean new unit with seven (!!!) beds, monitors, a central monitoring station, computers that work, (oh, crap, I just realized I have to call them about the call light system) and beds and so on that actually function and don't have bits broken off of them.

So that's what I've been doing for the last couple of weeks. That, and the usual keeping people from falling out of their chairs or having larger strokes or otherwise having complications that would keep them in the hospital for weeks and weeks.

The first thing I did in the Spandy New Unit was stretch my arms out from my sides and turn in a complete circle. That did not used to be possible. The second thing I did was walk from one end of the floor to the other, giggling, and saying "wahoo!" softly. Then I got my poop in a group and got the patient we had to move to her new room.

It feels a bit like a shakedown cruise. There's still a lot of stuff that doesn't work, and things that could be neater or more convenient, but we'll work those out in time. Right now, I'm just grateful to have a place to put people where I can be relatively sure that the walls won't catch fire and I can get them into and out of the rooms through doors wide enough to admit hospital beds.

While you're waiting for a real new post, kd lang.

2012-01-11T17:32:00.000-08:00

Things They never tell you about having had cancer:

2011-12-29T16:47:00.000-08:00

1. While cancer might be simultaneously boring and terrifying, it beats waiting for the surveillance scans. There's an up-and-down rhythm to getting your lymph nodes biopsied (ow!) that just isn't matched by the four-month drag that is waiting for your first chest CT.

2. Growing your hair out after having had cancer sucks just as much as it does when you're well. You still have weird flippy pieces and flat bits, and you still look like hell, but at least nobody says anything snarky. They just look at you and say, "You lookin' good. Whassup with yo' 'fro?" (credit: Friend Lisa from work.)

3. Every beer, every french fry, every night out on the town is larded with guilt that This Might Be The Thing that tips you over the edge into another horrible diagnosis.

4. Your blood pressure will always be a source of concern for the nurses at your surgeon's office, and they'll waste lots of paperwork on you before you say, through gritted teeth, "MY PRESSURES ARE HIGH BECAUSE I DON'T WANT ANOTHER BIT CUT OUT OF MY HEAD, THANK YOU VERY MUCH."

5. Your foresight in putting all your favorite colognes at the back of the closet during the first week of treatment will be rewarded when a patient in the chemotherapy unit says you smell good.

Redemption rips through the surface of time

2011-12-24T12:49:00.000-08:00

(Bruce Cockburn, Lou Reed, and Roseanne Cash)

"...and guess what? I felt the baby kick today."

Merry Christmas, y'all.

Question From A Young Nurse: But What About The Feelings?

2011-12-20T16:08:00.000-08:00

A Young Nurse asked Auntie Jo for advice this week. Poor, deluded Young Nurse.

Our correspondent asked this: "What do I do when a doctor or older nurse snickers at an answer I give to a question, or takes me aside later and tells me that I should've done something different? I have six patients, and I'm new to the night shift. I can't keep everything straight all the time. I want to kill them. What should I do?"

Dear Young Nurse,

We were all there, once. Those of us who got over it became the sort of nurse that your Auntie Jo is. Right now, I have a cat rubbing on my shoulder, a cold beer to the right of the keyboard, a happy dog frolicking in the back yard, and a list of men who want to be seen with me.

Those of us who didn't get over it became the doctor and nurse you're working with.

Practically, what you can do is this: Do what residents do. At the start of your shift, make out index cards that have each patient's name on them in big, bold lettering, so you can't miss it. On those cards, write the essential lab results and neuro/cardio/gastric/renal changes the patients have during the shift. Update them as you need to. That way, if you're ever caught out by a question, you can yank your index cards out of your pocket (be sure to wear scrubs with pockets at the waist) and answer the question quickly.

Doctors *love* it when you do things that they did as residents. It makes them feel very smart, and they will treat you better as a result.

As for the nurse: be humble. Shrug things off with a "Well, I'm still learning. Someday I'll have all that stuff on the tip of my tongue, like you do!" Make sure your back is turned when you roll your eyes. Mean nurses love that sort of thing, even as it makes them wonder if they're really *that* decent of people (answer: No, you're not, and you're going straight to a flaming-hot Hell when you die).

But what about the feelings?

It is hard, and I acknowledge that it's hard, not to reach out gently and wrap your scrawny little hands around somebody's neck. As The Bloggess once said, "A hug is just a strangle you haven't finished yet." I would suggest that you find a nice, private place to feel those feelings.

Feeling something like rage or disappointment doesn't mean you have to act on it. It just means that you've opened the door marked "RAGE" or "DISAPPOINTMENT" and have gone in and browsed through the goods on offer. It's best to do it in private so you're not interrupted. Rage, rage, against the asshole nurse or doctor who decided to get his or her rocks off by humiliating you. Then set it aside.

Resolve that next time you'll be so bulletproof that you'll embarrass them without meaning to. Resolve that next time you'll have the perfect l'esprit d'escalier and won't forget to say something like "up yours, motherfucker" when it's warranted.

Resolve--and this is both the most difficult and most important thing--that you won't let this make you think less of yourself or your practice. Some people are just assholes. Instead of bundling the urge to finish the hug up inside yourself, practice letting it out in the car.

All you can do is the best you can do. Be prepared, be on point, and if things don't go your way, don't fret: you've done your best. Believe it or not, your best doesn't have to be perfect. This is a twenty-four hour a day job. Self-doubt is a killer, because the minute you doubt yourself, you start doubting that little voice in your gut that tells you something ain't right.

If all else fails, Talisker. It's a good Scotch for beginners.

Am I old yet?

2011-12-14T15:32:00.001-08:00

A coworker of mine reminded me recently that 2012 will mark my tenth year at Sunnydale General (Healthcare for the Hellmouth). Reader's Digest called me a "long-time" nurse. Doctors refer to me as "experienced."

So am I an Old Nurse?

I would argue not, and this is why: Old Nurses are people who still know how to work stuff you only heard about in nursing school, and who remember techniques and tricks (and are willing to teach them to you!) that you've never even considered.

Take Wendy, one of the nurses I work with. She's not an old nurse, having been a nurse for only slightly longer than I have--but she's an Old Nurse. She can count drip rates and work them out to milliliters per hour, having worked in rural hospitals. She can make a mean hot pack. She knows how to access the really bizarre permanent catheters that we sometimes see. She doesn't remember the days when pneumocephalus was induced as a diagnostic tool, but she's done stuff--like reducing dislocated shoulders--that I've only read about. In fiction.

On the opposite side of the coin, I was a New Nurse with eight years' experience under my belt when I went to the CCU. No matter how good you are at one thing, if you move to another, you're automatically a novice. That's not a particularly comfortable role to inhabit, but it does do wonders for an overblown ego and a sense of entitlement. At the same time you're being humbled, however, you're being encouraged to ask "Why?" (That is, if you don't work in a bad environment.) "Why?" is one of the most important questions we can ask on a daily basis; it's the only one that leads to changes and improvements in care.

So, no, I'm not an Old Nurse. Not yet. At this rate, I may never *be* an Old Nurse. Although, I will say--my willingness to get post-op patients up out of bed without waiting for physical therapy has gotten shocked, admiring reactions from CCU nurses.

If I ever do get to Old Nurse status, I want to be asking "Why?" still. Those are the best sort of Old Nurses to have around.

HA.

2011-12-13T17:56:00.000-08:00

And a Huge Shock:

2011-12-12T17:05:00.000-08:00

Teddy Bear the Fretful Porpentine is from My Home Town!

I might have to ask to meet him (and bring him erk-erk-eeenh-eeenh-gitback! noms) next time I'm up there.

Updates, of a sort.

2011-12-12T14:50:00.001-08:00

I saw Dr. Elf today for the last time until April. The New Bug is performing beautifully; I'm even able to lie on my stomach for a massage without any nasal regurgitation (aka saliva running out my nose). He thanked me for being such a happy patient; I thanked *him* for being kind on the days when I was not happy. There were plenty of those.

So, April: I go for a chest CT. That's scary as hell. Apparently, polymorphous adenocarcinoma rarely metastasizes, but when it does, two things happen: it goes to the lung or brain, and it's incredibly virulent. My brain, so far, is clear. (My coworkers would say that it's not just clear of cancer, it's clear of thought and reason as well.) My neck is clear. I'm very happy that the lymph nodes in my neck are clear, by the way: the radiologist who read this last CT was the same dude who read the last one, and he said something like, "I note that the lymph node in the right neck, swollen in the pre-surgery CT scan, has returned to a normal diameter and density." I'm hoping nothing nasty shows up in April.

ANYway, the same day I see the CT guys and Dr. Crane, I see Dr. Elf for a follow-up. As he said, this is a dynamic process. As I age, as I lose or gain weight, as I sing more or less, the prosthetic will need to be modified. We'll let it float until April unless something major happens.

Speaking of major, two things happened this past week: BCBSTX denied my appeal and simultaneously refunded me about a tenth of the money that they ought to admit they owe me. What this means in real terms is that I now have to appeal to the Office of Employee Benefits at Giganto Research and Education Corp. Beloved Sister is helping me set up the most impressive packet of information ever, including slightly nauseating pictures of The Deficit, in order to do that. So, more of that.

Enough about me. In work news. . .

It's getting harder and harder to get one of the cross-covers to call me back. She's a nice girl, if a bit scatterbrained and inclined to panic. I'm thinking that I ought to just page her in haiku:

Your patient's IC

P is rising. Perhaps

You should come see him.

Wind through falling leaves

Like gas in patient's bowels.

Please order senna.

In sadder news, one of my coworkers simply didn't wake up last week. He was thirty. As is usual for this sort of unexpected death, there'll be an autopsy; likely he had sudden cardiac arrest or a PE. And, as is usual for this sort of death, nobody had a bad thing to say about the man. He was, as a friend of his said, a "good hand"--coming from a deep East Texas country boy, that's high praise.

I know I'm not supposed to wish death on anybody, but wasn't there somebody out there who set kittens afire that could've died, rather than the nice young guy with four kids? I liked working with him, knew I could trust him, was glad to see him in the mornings. Greater praise no nurse hath for any man.

Aaaand in less-sad news, we have a new place for the NCCU: we're taking over a unit on the floor above where we currently are. We'll have real doors that close or not, as we choose, and real monitors, and real beds, and real pumps! Just the luxury of more than four square feet of desk space (and half of that taken up with a sink) is more than I can think about without giggling. We should be there by the end of next month.

Finally, read this by Xeni Jardin. She captures better than I ever could the feeling of being out there, beyond reach of the people you depend on most, stuck in a new place.

"When I finally got through, someone else's voice was coming out of my mouth, and it was taking forever for the stuttery radio transmissions to beam through space, from the cold planet I was lost on, way out here, far from home."

Two and a half minutes of nomming Teddy Bear.

2011-12-07T08:53:00.001-08:00

This is. . .amazing.

Real posts a bit later, after I get back from buying new blades for my reciprocating saw.

In case you've had an especially bad day. . .

2011-11-29T17:48:00.000-08:00

I present the Strontium-90 of cute animal videos.

This is not a title I bestow lightly. Until today, the best-ever cute animal video was that of a porcupine who thought he was a puppy. He's been dethroned by a greedy porcupine. At least they kept it in the species.

Behold: Teddy the Selfish Porcupine!

Man. That is one fretful porpentine.

The Evolution of a Bug.

2011-11-29T11:51:00.000-08:00

The scans were clear. I have a flowery turbinate that bears watching, but that apparently can be a normal variation. Next flip-out comes in April, with CTs of my chest and belleh.

I also got the new obturator fitted yesterday. It works. It works wonderfully, in fact. So, in honor of the New Bug, a retrospective:

The obturator on the far left is the first one I had, the surgical one. The speech bulb was added later, and they had to change the position of the wire on its right side, hence the weird plastic outpouching. I broke off the wire on the top right by biting on it.

The obturator in the middle is the interim one. Note the thumb-sized snot channel, meant to drain away what doctors euphemistically call "secretions." You'll notice that it's narrower and longer than the surgical bug, as a result of my head healing and changing shape.

The obturator on the far right is the one I'm currently wearing. It's made of chromium nanowhatsit, some nonferrous material that's only found in conjunction with unobtanium. It's hollow to cut down on weight, and no, that hollow doesn't fill up with crap. I was amazed.

See how the shapes have changed as I've healed? You can't really tell from this picture, but the first Bug is so large I can't close my hand over it, and I wear a size 7 glove. The newest one is so petite and light that it feels like nothing. Plus, since it doesn't cover the backs of my front upper teeth, I can do things like bite into an apple.

Notamus loves the fabric I laid out as a background. He started milk-treading it just after I took this picture. Weirdo.

First obturator, alone. Damn, that was huge.

Second obturator, alone. That loop of metal inside the plastic speech bulb is meant to stabilize things. Look how tiny the obturator part is, and how fat the speech bulb is in contrast to the first one!

It's like I'm watching my own baby grow up, she says, clasping her hands to her breast.

Well. Enough of that. I've got sausage and potatoes and sauerkraut to eat. With my new obturator.

BIG DRAMA today at Bigton's Scanning Centre!

2011-11-28T17:11:00.000-08:00

Call out the Marines! Get the helicopters going! Phone the Prezznit!

Or, at least, call the security guys and have them come and scratch their heads.

There was an Opossum (from the Proto-Algonquin aposum, or white beast) in one of the trash bins this morning at Scanning Central. The security guys, the maintenance guys, the housekeeping folks, and the animal control peeps were all alerted. Everybody ran about and waved their hands.

Until one of the valet parking dudes rolled the trash bin (with aposum inside) carefully over to a landscaped bit of ground with plenty of bushes and tipped it over. The white beast made its way (trundle trundle trundle, wide-butt-ily) to the far side of the landscaping and disappeared.

Possums got big teefs.

And so do I. Scans were today; results of scans and possibly an Evolution of the Bug, tomorrow.

Black Friday Relief. (not that I went anywhere, mind)

2011-11-25T16:44:00.000-08:00

It's like I put a quarter in the scumball machine.

2011-11-25T05:55:00.000-08:00

No, I will not hide you from the cops who have come to investigate your lousy ass for leaving the scene of an accident in which you hit a pedestrian while cracked off your noodle.

No, that minor forearm injury will not qualify you for disability.

No, you may not leave the critical care unit to smoke one with your buddies.

Yes, I do intend to start this IV on you. You can threaten to hit me all you want; it's still going in.

Yes, we enforce visiting rules. No, conjugal visits are not an option.

Get your child out of the CCU. Now. I have already explained this to you twice. You cannot smuggle a toddler in under your coat and not get found out.

You do indeed have gonorrhea. Sorry. Now roll over and take this shot.

And you do indeed have syphillis. All the shouting in the world won't change that; besides, it's annoying the Clampetts on the other side of the curtain.

You may not see your "clients" in my unit.

Telling me that you'll sue me if I do one thing you don't like is not the way to build a therapeutic relationship. Neither is having your lawyer call me to demand details of your care. There is such a thing as confidentiality.

Yes, I am a fat bitch. Pointing that out neither hurts my fee-fees nor makes me more inclined to be cheerful.

Thank God for little grannies who come in with their unfailingly polite, helpful family ranged around them. Grandma can hold court from her bed as long as she likes, and you guys can stay as long as you like, bandanas and weird droopy-ass pants and all. You may be scary looking, but you're obviously good to her. You're also very nice to me. Thanks for the chicken pot pie.

Had a bad day? Have some ducks and a cop.

2011-11-20T14:19:00.001-08:00

Here.

H/t to Friend Pens for this!

One thing about being single

2011-11-19T18:05:00.000-08:00

. . .is that you learn how to do things on your own. You get used to doing things on your own, and even begin to like it.

Today, for example, I hung wallboard and panelling (not that I like panelling, but I had to match the stuff that was already on the walls). Last weekend, I took down an eight-by-eight-by-two built-out closet that was messin' with the feng shui of the bedroom where I type. Tomorrow I'll bake a couple of pies (home-made crust, thanks) and tape and mud the wallboard in the utility room. I did all of this on my own, except for loading the stuff into the bed of my neighbor's truck today. I'm used to doing stuff on my own. I'm good at it.

Which is how I came to be lying atop a fighting, screaming, thrashing man, holding his wrists with one hand to keep him from punching me and threading an NG tube down his nose with the other hand. I figured I could do it on my own.

After all, I reasoned, with six of Ativan and God only knows how much of Haldol already in his system, he's well sedated. He withdrew to pain thirty seconds before I busted out the KY and the NG tube, so I figured I was good to go.

I was wrong.

As he felt the bed starting to rise, both of his legs went over the bedrail and he started screaming. It was a full-blown, woman-like scream that went on and on and on. Dude could've made a killing in opera, I tell you. I figured that he, like most patients with encephalitis, would stick to the screaming and maybe make a small gesture here and there with one arm.

Again, I was wrong.

He scooted all the way to the end of the bed, got his legs out, and proceeded to try to buck his way out of the situation. Which is why I laid atop a person who had a history of projectile-vomiting blood and punching unsuspecting phlebotomists.

I was very glad to see Figgy, the stocky and strong intensivist, come through the door at a run. Figgy and I managed to get the guy back into the bed and tied down, then ran him down to CT.

It was a long day. I'd give my kingdom (with new wallboard!) for a thousand milligrams of methocarbomol right now.

What we talk about on slow days.

2011-11-16T17:53:00.000-08:00

Is there an animal which, in its baby form, is not cute?

I assert that there is, though I don't know which one(s) that might be. The Mankiller swears that all baby animals are adorabubbles. We went on a Google search to see what might, in the baby-critter world, be uncute.

Llamas are cute as babies. So are goats. So are Tasmanian devils. Even Chinese Crested puppies are cute, which I was not expecting. Baby parrots are about the furthest thing from cute ever made, but even they, with their oversized beaks and button eyes, have a certain charm. Baby reptiles are cute because something scary in a large form is cute when it's wee.

We are still looking for the baby animal that won't make us squee and want to snuggle it.

The Mankiller and I also discussed the concept of Intrinsic Funniness, which I mentioned here a couple of days ago. Elephants, pennyfarthing bicycles, large moustaches, tweed blazers with leather elbow patches, and half-grown puppies are intrinsically funny. We agreed on those things. Possibly intrinsically funny things (those things which need more study) are mice, any consumable good that has a name like "Ho-Ho" or "Ding-Dong," certain shoes (white bucks and those loafers with tasseled tongues), balloons (opinion is divided between funny and scary), people in drum circles (funny or tiresome?), and bologna. Personally, I incline to the idea that bologna is funny. The Mankiller isn't so sure. She thinks bowling shoes are funny, but I find them overdone. I find pit bulls hilarious, especially when you rub their bellies and make them banjo, and she says they're too politicized.

We agree that although they are the butt of many jokes, the following things are not intrinsically funny: Jews/Poles/Irishmen/Your Best Friend (whatever ethnicity he is), the Wicked Witch of the West, the suburbs (more depressing than funny), anything Scots, garbage disposals, utility companies, and the Works Progress Administration. That last came out of a conversation with Richard the Respiratory Guy, who asked, "What can you never imagine anybody telling a joke about?" I came up with "the WPA;" The Mankiller came up with something I can't talk about on a family blog.

Suggestions? Disputations? We can't spend all day hacking our coworkers' Facebook pages; we need some help.

Best voicemail ever.

2011-11-15T18:30:00.000-08:00

"Hi, this is Dr. So-and-so from Littleton Animal Hospital. I have Max's blood test results here, and they all look great. Wonderful. Take care; 'bye."

Max has been on Rimadyl for three months, and it's like we've knocked five years off of his age. He had blood tests run today, and a nail clipping (HORRORS IT'S A PAWDICURE HORRORS), and all is well.

Elsie-Mo got hit by the doggy equivalent of an incoming asteroid. I think it might, *might* just take that much to take Max out. For a dog who's half German Shep and half Huge Enormous What The Hell, he's doing well.

I love my Flying Flapdoodle Snacktracker. It was a good voicemail.

Dear Blue Cross and Blue Shield of Texas,

2011-11-14T16:43:00.000-08:00

You have pissed off the wrong fat bitch.

I was moderately pissed off before now, when I discovered that you reimburse my prosthodontist one-hundred and fifteen percent of Medicare reimbursement, or approximately a thousand bucks for each prosthetic. You don't allow appeals, and you've ignored letters from my surgeon and the prosthodontist.

Now I'm *really* pissed, because this is what I found out today:

The lowest reimbursement for an oral prosthetic offered by any of the insurance companies with which Dr. Elf deals is fifty percent.

BCBS in other states covers between 60% and 90% of prosthetic costs. Even BCBS Oklahoma.

BCBS Texas covers close to all of the cost for limb prostheses.

BCBS TX, you are in deep, deep shit. See, when all this started, with me running up bills that I will never, ever be able to pay off (even at the competitive rates offered by the pleasant people at the credit card company, when they found out all these charges were for medical expenses), I was determined to blow into your offices like a bulldozer and make something change. If it didn't change for me, I reasoned, I could change it for the next poor bastard who lost part of a palate to cancer.

Now, a year on, I've lost energy for the bulldozer approach. Instead, I've decided to take the poppy-seed-under-the-prosthetic approach. A poppy seed doesn't do much, at first, but then it becomes annoying. As it digs into the mucosa left behind by a palatectomy, it gets painful. After a few hours, you're dealing with outright pain, runny eyes, a swollen set of sinuses, and--worst of all--the tissue around the poppy seed has become irritated enough that you have to use commando tactics to get it dislodged.

My finding out about differing reimbursement rates coincided with your sending me the same polite form letter you sent me a year ago: "Since we have not been successful in reaching you by phone" (even though the first letter had my diagnosis, Subtotal Palatectomy, right there in the header) "we invite you to call us to help us resolve any issues you have in your care. . . ."

Oh, Blue Cross, *never* ask me what you can do to make my life better. I'll tell you. I'll give you printouts, even, with diagrams and charts with circles and X-es on the back.

Strangely, darling BCBSTX, something very interesting has started to happen in the media, as well: Bigton's local paper has started doing an expose series on practices within Giganto Research and Development's operations. This follows a comparable expose done by Local Paper's sister paper north of here. Given that Giganto Inc owns Sunnydale, and that Giganto is the subscriber to your insurance, and that I am a paying member of BCBSTX's insurance pool, wouldn't it be interesting to have things like your reimbursement rates made public? I mean, things like oral prosthetics aren't even covered in your brochures' fine print. It might be nice, what with oral cancer rates on the rise, for the general public to know exactly what you cover and what it means for the people who pay for your service if you don't cover something they need.

Don't get me wrong, Blue Cross: I'm grateful that you covered the majority of the cost of my surgeries and follow-up. Without you, I'd be declaring bankruptcy. Still, it seems a little unfair that you'd cover the prosthetics necessary for a person to, say, walk, yet not cover the prosthetics necessary for her to maintain her own airway. If I needed an AFO or a hook-hand, you'd be at the plate. Now that I need something that lets me talk and not choke when I drink, you're bowing out.

And that sucks. More specifically, it's sucks for you. I may not be able to keep bulldozing, but I can sustain the level of annoyance required to feel like a poppy seed forever.

It is ON, bitches.

Odds and Ends after a few days off

2011-11-04T16:15:00.001-07:00

A couple of mornings ago, a big, BIG owl launched itself from the mulberry tree in the back yard and went flying off west. I think it was a Great Horned Owl; I'd heard its call enough times to recognize it when I Googled it. The sunrise colored it cream and pink and erased any bars on its wings. It returns to the mulberry tree late at night after it hunts and spends the early-morning hours calling.

A Cooper's hawk nearly got a dove yesterday in the neighbor's back yard. I heard screaming and ran to the kitchen window, just in time to see a dove fight its way out of the hawk's talons and see the hawk soar up, screeching. I hope the dove's okay. The same hawk has made at least one sortie against The Boys while they're in their Kitty-Coop; I've found her feathers hanging off the wire mesh ceiling of the coop. At least it's not a red-tailed hawk; Cooper's are big enough to hurt an eight-pound cat, but the red-tails we grow around here could kill one of the boys, easy.

The low last night was about 35 degrees F. Max came in this morning puffed up, feeling ten years younger, and doing his hurpling puppy-dance, so I gave him an egg yolk and a tiny amount of bacon grease in his kibble. One thing about having a sense of smell about a billion times better than ours: it means you don't need much bacon grease to have a good time.

One of the sweet hippies across the street and I got to talking. Turns out he let everything die in his garden this summer. That made me feel much better about not watering the yard-long beans or worrying about the tomatoes after the tree fell on them. Strangely, both his globe basil and mine have come back from the drought and horrible temperatures and are leafing out as good as new. Note to self: make spicy-globe basil my new groundcover.

Man of God's child is pulling up and cruising the house with the help of convenient, ten-month-old-child-height handholds. He has blond hair like his father and dark eyes like his mother and already looks to turn out taller than either one of them. He smiles and reaches out to me when I say hi, even though I've been the one to examine the various rashes he's gotten so far and set his parents' minds at rest.

I put together an elliptical trainer today. The reviews on Amazon said it would take me about two hours, and it did, from the time I cut the first strap on the shipping carton to the time I tested it out. Then I fixed a couple of wonky drawers in the pantry and eyeballed what it would take to demolish the built-in closet in this office. All of this has left me with the smug feeling of accomplishment that presages an email from a Fulbright scholar taking me to task for my grammar. Bring it, boys! *I* can put together an *elliptical*.

One last wildlife note: I went out this morning, way early, before sunrise, to take some things out to the recycling bin. It's one of those heavy-duty plastic things on wheels that stands about three and a half feet high. I opened it and--there in the glow of the streetlights--saw a pair of eyes looking back at me. So I closed it again, abruptly, and wheeled it to where the light was better. Inside was an adolescent raccoon, looking very apologetic and perhaps a bit ashamed at having caroused on black-bean cans and empty beer bottles all night. He scrabbled pleadingly on the inside wall of the bin, so I laid it down on its side and let him get out before I dumped cardboard into it.

Raccoons are, I have decided, intrinsically funny, like elephants. Or turnips, or pennyfarthing bicycles, Jell-O, forgetful professors, sex, any number of bodily functions (come to that), peacocks, getting caught in the rain, religious authorities, people in hats, or umbrellas.

I'm tired of this body. Can I trade it in?

2011-11-01T16:10:00.001-07:00

First it was six months of constant sinus infections. Then it was cancer, and not even a cool kind of cancer with pretty ribbons. Oral cancer comes with a maroon-and-white ribbon, which is not a good color combination for me. In between all that, I screwed up my neck and threw out a knee, then the other knee. Then I got an abscess. In my groin.

Of all the things I've subjected myself since I started writing this blog, getting a doctor to take a gander at the egg-sized, painful lump in my right groin was the most humiliating. Lying in an exam chair, with my right leg out at an angle, pointing to the problem while modestly covered by several sterile drapes is not going to go into my personal-best album.

The doctor, who was wearing a pink button-down shirt and a bow tie, was pleased. He called it a classic presentation, and pointed out the various identifiers of an abscess to the nurse standing next to him. I was busy trying to be someplace else, at least mentally, and didn't pay attention until he hit the thing with freezing spray and incised it.

I'll spare you guys the details. Suffice it to say that the nurse said admiringly, "This ought to be on YouTube." The bow-tied doctor took cultures, irrigated the area with sterile saline, gave me aftercare instructions and a prescription for Bactrim DS, and left the room. The nurse dressed my groin with sterile gauze and antibiotic ointment and a cubic yard of tape. I went to the pharmacy for drugs and then came home, figuring that that would be it.

Until yesterday morning, when the kindly doctor called me himself to tell me that he'd decided, on the basis of the cultures, to add another antibiotic to the regimen. I'm now on both Bactrim DS and Augmentin, eight hundred and seventy-freaking-five milligrams of the latter, both twice a day.

Turns out that it's nothing I did: I quizzed him quite thoroughly on that. It seems that there are bacteria that live normally on your skin and keep it healthy (that I knew) and are quite peaceful in their proper places. When they get inside your skin, though--and this can be through a small abrasion or cut or just by chance--they turn into the sorts of bacteria you don't want anywhere. That's what made me end up with a kiwi-fruit-shaped mass of crap in Area 51: normal skin flora and fauna.

I'll say this for Doctor Bow-Tie: he's human. He told me the story of his own abscess, which he got while a resident, and how it was a tossup whether to have a fellow resident deal with it or go to an outside doctor. He praised my wisdom in not tackling the thing myself, given the proximity of various blood vessels and lymph nodes, some of which were already badly swollen and tender. Apparently he sees several of these a week: who knew the human body was such a soup of potential horror?

The most painful part of the whole ordeal was calling in to work. I was told, solemnly, not to work the day after, to monitor my temp every four hours, and to call the doctor's office if I developed a fever or chills. Trying to tell your boss that you've had an alien removed from the house next door to The Queen of All She Surveys is not easy. Telling a blog audience of a couple thousand is cake by comparison.

So, People: watch yourselves. No amount of personal cleanliness, good diet, or virtuous living can save you from the horror that is quad antibiotic coverage. A one-to-ten solution of bleach to water might help, but I'm not going to bathe in that.

Remember back when I had CANSUH? Back when I was in a good mood?

2011-10-23T15:37:00.000-07:00

Yeah. Been that sort of week up in here.

Something I should've told the "Reader's Digest" folks: If you're going to admit Junior to the NCCU after he's smoked/snorted/stuck into his body whatever the hell the kids are doing these days, you should not then expect me to police his friends and extended family.

It is not my job to be a policeman.

My job is to make sure that Junior, who's currently taching along at about 130, since he hasn't had his God-knows-how-much methadone in the last week, doesn't pull the tube out of his skull. It's also to make sure that he doesn't stroke out again as the result of three of your darling relatives getting into an all-out fistfight in his room. Additionally, I'd kind of like to be able to keep the arterial line he has in his wrist in place, and the ventilator tube in his throat, and the Foley in his bladder. Those, you see, have specific purposes. They can't accomplish their specific purpose if you're getting your nasty paws all over 'em and wondering if he could do without them.

Yes, yes, I know he's mouthing words around the tube, but *he cannot protect his airway without it.* I don't know why this is so hard to understand: just because you can talk doesn't mean you won't inhale your own spit and get pneumonia (yours truly being a case in point; see, Obturator: Fitting).

So after the Bigton Police showed up--you know, the ones who don't take silliness lightly--and led the majority of the family away in zipties, I got to thinking: This is the second time in a month that this has happened, with two different patients.

What the hell is wrong with you people? Do you not understand that a hospital is not the place to slug out your deep-seated familial resentments? We do not have time for this.

It is not about you.

It is about the person in the bed.

Speaking of which, I have thoughts on The Person In The Bed for next time. Meanwhile, I'm going to go try to find the Cooper's hawk that's calling "squeeee! squeeee!" in the back yard and rub some Max Belleh.

Happy Anniversary.

2011-10-19T17:35:00.000-07:00

A year ago, I was here.

This morning, Dr. Elf put the new Bug in my mouth (thanks, Der Alter Jo, for that name!) with some tracing material, a nasty-tasting greenish-black mix of wax and diatomaceous earth, on it, in my mouth.

My speech was normal.

My tongue hit the back of my front upper teeth the way it did before this whole obturator thing started. I sounded funny to myself, like I had a lisp. It's gonna mean learning to talk normally all over again.

I wish Maudie, who was there at my first appointment, had been there for this one. She was off helping another patient, though. Still, she'll be there when I get the wax tracing and all that stuff.

On the third of next month, I'll spend five hours doing. . .something, I don't know what, with the Bug in place, with a firmer tracing wax atop it. That's to get a mold of the inside of my mouth in action, as it were. After that, the molded form will be cast in acrylic and then I'll have a permanent speech bulb and obturator. Permanent as in "I won't have to have it re-fitted every few weeks," not permanent as in not-taking-it-out. Once I get it, we'll have a Photographic Retrospective, right here on this very blog, of the Evolution of Bug.

At the end of November I'll have a CT scan and an MRI, then an appointment with Dr. Crane to see how things are going. I don't expect any new tumor or weirdness. Still, I'm a little nervous.

I can't read over the past year's entries without bursting into tears. What they don't tell you about surgery and cancer and treatment and all that shit is that the physical memory remains even after you think you've gotten over the psychological stuff. Reading what I wrote about my lymph node biopsy makes my neck hurt. Reading the stuff I wrote about downer days makes me cry harder. It was so lonely-feeling and bleak at some points, you guys.

But I'm here. I am *here*. I didn't die, I didn't have to be irradiated, or have more huge chunks removed from my head, and I've done okay. Tonight's dinner is cheese enchilada and Scotch; I might make myself something special tomorrow.

Tomorrow is the anniversary of the day--even though I didn't know it then--that I was free of cancer. In a way, this whole year has been vamp-till-ready.

Thank you for sticking with me through it.

If there were a word that combined the feeling of watching the first snowflakes fall in a place where snow is uncommon, taking your first shower at home after a long trip away, the feeling of the pillow when it's smushed just right under your head, seeing your dog chasing a squirrel you know he's never going to catch, the cat on your lap falling asleep, and waking up with your back pleasantly cold on the first day of Fall, I would use it to describe how you all made me feel during this past year of weird unpleasantness.

All I have is "thanks."

Thanks.

Here's the real fatitude. Fatty fatty fat fat ground squirrel ahoy!

2011-10-17T16:41:00.001-07:00

This might be the fattest ground squirrel west of the Mississippi. Seriously: I have a picture of her where she's stuffing her cheek pouches that is just unbelievable. This is what we sallied out to every morning, just after we'd had tasty muffinage and coffee in our room.

Since when are plumbers hot?

2011-10-17T16:24:00.000-07:00

First, I'd like to welcome all the Minions who found me through "Reader's Digest." Welcome! This blog might not be at all what you're expecting.

Today I had to stay home from work for a doctor's appointment. Thankfully, Rosie-Posie-the-schedule-maker took me off three weeks ago, so there was no showing-up necessary. Which was good, because I might've strangled the person I took care of over the weekend if I'd had to see him again. Pro Tip for those who've had strokes: Just because you can make it ten feet walking with two physical therapists, a nurse, and a walker all holding you up does NOT mean you're fit to return to your truck-driving job.

Anyhow, today was a Scheduled Obturator Day. Fortunately for me, the dude at the gas station looked out of the window and said, "Uh. . .do you have a low tire?" That's Polite Gas-Station Dude-Speak for "Holy crap, your tire is, like, totally flat." So I aired it up and headed home, figuring it was a slow leak.

Aaaand by the time I was home (three blocks), it was flat. So I bopped off to the tire fixit guys and got the thing repaired, but that necessitated cancelling my New Mouth appointment. Dr. Elf is probably glad; he barely gets time to eat as it is, and has been taking lots of new fit-in appointments. Oral cancer's on the rise, people. See your dentist twice a year.

Since I was going to have to be home anyhow, I called the plumber. My kitchen faucet, a no-name brand that's been here since I moved in and which seems to have been installed with glue and staples, quit working. The plumbers, plural, just left. The upshot of their visit is that they agree that the thing doesn't work and that I'll probably just have to replace it.

That's not the weird thing. The thing that has me scanning the horizon, listening for four sets of hoofbeats, is that both the plumber and his trainee were cute. For embryos, I mean; neither one of 'em was within spittin' distance of thirty. Still, cute plumbers? When did that happen?

Next thing you know, there'll be cute neurologists rounding on my patients. If that happens I'll just be in the crawlspace, with my canned food and bottled water. You heard it here first.

Okay, try this.

2011-10-16T03:54:00.000-07:00

Can you see us now?

Interesting question via the comments.

2011-10-15T01:51:00.000-07:00

I got this the other day in the comments and decided to repost it for everybody to take a swing at:

Dear head nurse,
I am currently interning at a heart institute in Texas .
All (except one )the RNs here treat me like trash and also are slave drivers , Not exaggerating here.They get paid for the crap i am doing for them .
I would truly love to hear your thoughts on this.
And heres the best thing , they dont let me learn anything , or watch procedure s , as their filing and copying is of utmost importance to them more than my learning phase. What do you think?

First things first: If you're in a situation where you're supposed to be watching procedures and helping care for patients and you're not able to do that because you're getting saddled with copying, filing, whatever--it's time to talk to the person in charge of overseeing your internship. The primary purpose of a nursing intern- or externship is to learn the theory and skills you'd use in the unit where you're placed.

When you approach your internship coordinator, take in a list of times when you've not been present for procedures because you've been tasked with something clerical. If you've been assigned a job that's not patient-care-related and told that because of that task, you can't practice a particular skill you're meant to master, take that (or those) specific examples in with you as well. You don't have to name the people who've assigned you those jobs, but *make sure you have documented times when it's happened.* Be specific and timed and all that stuff.

("Specific, timed, and measurable" works for more than care plans. Who knew?)

Second things second: When you say the RNs treat you "like trash," what exactly do you mean? Is there a fundamental lack of respect, trash-talking, or lateral bullying? If so, again provide concrete examples--and in this case, you might be asked to name names--to your coordinator. It will help if you can keep a written list of times Person X has said something belittling or bullying to you. This is standard practice in situations when somebody feels discriminated against or harrassed, and it's a *good* standard practice: building a list of incidents helps you build a case.

While you're doing those things, do two more: take a look at your expectations for the internship versus the facility's expectations for the internship. If there's a basic disconnect--in other words, if you wanted nursing experience and they put you into a position where you're learning to be a unit secretary--you'll need to talk to the coordinator about that as well.

Examine the culture of the place where you're interning, too. There are some places that are great, some that suck, and a whole bunch stuck in the middle. If you're in a place that just outright sucks--where there's a lot of what they call "lateral violence," like bullying or back-stabbing--you might need to go somewhere else. If you're in a place that's great but just isn't a good fit for you, again, you might need to find a different position somewhere that's a better match. If you're in one of those facilities that's in the middle, you can work with the people who treat you well in order to carve out a better learning experience.

Can you talk to the RN you mentioned and ask him or her to act as your advocate? That RN might have some insight as to what's happened with previous interns. She or he could tell you if the way you're being treated is something that's habitual, or if there's a better place within the facility to get the experience you want.

When you present all this stuff to the person in charge, be as unemotional as possible. Avoid the terms "slave-drivers" and "crap" at all costs. There's a certain amount of drudgery and general-factotum-ness in every job, and some of that's going to spill over into an unpaid position. (By the way, yeah, those RNs are getting paid for what you're doing. . .but that's kinda the nature of the beast.) Focus on how the stated goals of the internship aren't getting met, and be sure to present possible solutions. You can't just go in with a list of problems; you'll get a much better reception if you can come up with ideas for fixing them.

And good luck. This is a tricky spot to be in.

Had a bad day? Have an otter having its morning bath.

2011-10-12T17:48:00.000-07:00

With a shoutout to Friend Johnny, who is Portuguese, like this otter! (I don't know if she bathes like this, though.)

I'd have fun nursing stories for you, except I haven't got any.

2011-10-11T17:38:00.000-07:00

I've had nine patients in the last week or so. One of them had a stroke. The others were referred to us, for reasons I don't understand, for everything from constipation to heartburn to a torn rotator cuff.

If an emergency room doc can't tell the difference between constipation and a stroke. . . .Oh, dear.

Just Oh, dear.

So instead I'll talk about Dia de los Muertos and the costume I've worked up for this year's street party. I didn't make last year's party, due to that little altercation with a bone saw, so this year I'm going as. . .

a nurse.

Yep. A nurse. With a white dress (Barco still makes 'em: double-breasted, button-down nurse dresses with knee-length skirts and long sleeves) and cap (White Swan makes those, out of cotton, with a button in the back) and black-and-white sugar skull makeup, excepting the big red cross in the middle of my forehead and the drop of blood on my chin.

Basically I'll be my own calavera, complete with bottle of tequila and black-and-white flowers in my hair (small ones, so as not to compete with the cap).

The cap I'm going to trim out with black grosgrain ribbon, ditto the sleeves of the dress, and find a wide-enough piece of grosgrain for a belt. White stockings and black heeled oxfords, and all I'll need is some dude dressed as a calavera Navy guy to recreate The VJ Day of the Dead.

Dad was all excited that I was returning to a gentler, more modest past until I told him that the dress was for DdlM.

Pictures to follow, provided the makeup turns out and I don't end up in a white dress with some dude with a faltering grip on reality and a harpoon following me around.

Oh, yeah. I was reminded that I hadn't posted details about that date.

2011-10-05T17:33:00.000-07:00

Uh. . .maybe I need to start another blog. Just for the comedic effect.

He ordered tacos at a Salvadoran restaurant, requested that they be brought without lettuce or tomatoes, made a face at the fried plantains, didn't touch the black beans, picked the cheese off of his tacos, and then left a dollar tip.

I came home and watched cute animal videos for a while.

I love the "artist" in the beret.

2011-10-03T07:47:00.000-07:00

Letters! I get letters!

2011-10-03T03:28:00.001-07:00

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

Note: This post is Not Safe For Work, Mom, or Life. If you are faint of heart, scroll on past.

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

Every blogger out there gets the occasional nutso comment or email. There's a dedicated group of trolls that reads HN and occasionally submits comments. I hear from the "ALL FEMALE NURSES ARE PERVERTS AND UNPROFESSIONAL" guy, the anti-vaccination folks, and the dude who claims to be an MD and says nurses don't know anything about anything, on a fairly regular basis. Sometimes I get somebody new up in this grill, and I always watch to see if they come back. It's exciting. I love my regulars, but it's nice to see a new face.

I got a comment on the post about the State Fair and the dude with an autoimmune disease the other day. I've sat on it because I couldn't decide what to do: ignore it, put it up and watch the fur fly, ask for contact info so I could excoriate the sender privately, or turn it into a post and let it rip?

Nice didn't win. Here's what somebody submitted:

Jo,

You know what, it really sounds like you need to be serviced. I'm going to go out on a limb, here. I'm young (well, relatively so), hung, and I'll bang you. I'll make things right in your world, guaranteed. I know writing is a sort of release for you, but I'll give you a release that'll make you forget about writing for a good while....
You just name the time and place.

Sincerely,
Anonymous

Ain't that something?

I have tried to take this point-by-point and be funny about it, but I really can't. I do admire the dude's grasp of basic grammar--unusual among trolls--but that's it.

Anonymous Commenting Dude, you need to cut back on the booze and the self-esteem. Only somebody drunk enough to be stupid and stupid enough to be mistakenly confident would ever submit something like this. Seriously, what were you thinking?

I mean, has this sort of approach worked for you in the past? Have women you've catcalled out of your car actually come running, hopped into the back seat while removing their clothing, and said, "Okay, baby, let's go"? Do the fifteen-year-olds you creep when they babysit for the neighbor's kids find your descriptions of yourself cute? Have you ever had an actual interaction with an adult female? I would think not, given what you seem to believe is appropriate for a conversation-starter.

I have less than no interest in getting "banged" or "serviced" by you. In fact, I've found that if a person, male or female, talks up their talents in any area, it's highly likely that they have no talents to speak of. (This is an oblique way of calling you a needle-dicked bug-fucker who couldn't find a woman's crotch with both hands and a candle.)

Plus, you're an asshole.

You probably got some sort of naughty thrill out of imagining me opening your email and sitting there, shocked expression and all. While you were typing one-handed, did you fantasize about how fast I would be posting a note asking for your contact info?

Did you have a vision of me laughing out loud, then showing your comment to everybody in the immediate area, emailing it to several more people, and collecting their extremely amused reactions? Because that's what happened. I wasn't creeped out or freaked out or turned on; rather, it was the funniest damn thing I've gotten in the HN inbox in years.

So why spend the energy to respond to this in public? Because guys who think like you do deserve to be mocked. (You really deserve to be humiliated, but given that I don't know who you are, I'll settle for mocked.) If I'd had the inclination, I would've found out your name and put it up here for the world to see, but you know what? Not worth it. It'd be too much energy expended for too little return.

Much like, I expect, being serviced by you would be.

Okay, this is ridiculous. And it doesn't change my view on having WILD FUCKING ANIMALS as pets. . .but.

2011-09-29T17:42:00.000-07:00

When I watch this, even though they're two different species, I know what he means, because I live in this place with Max every day:

Max was feral when we found him. He was skeletal at 37 kilos/81 lbs and was perfectly able and willing to attack anything that looked like food. For months he would not come near me, no matter how non-aggressive I tried to be when I approached him. He would either shy or snarl; neither option was comfortable.

Yeah, he's not a half-ton grizzly bear, but he's certainly able to kill the cats. He won't do that, though, because he recognizes that cats have Sharp Pointy Bits at the end of their paws. He respects the cats, and the cats respect him.

He's also capable of killing *me*. You don't ever live with a hundred-pound animal without having that somewhere in the back of your mind. The reason he doesn't get obnoxious when we're irritated with each other, I think, is that he understands that I respect him and recognize his autonomy. I never give him a command without reason, but at the same time, if he disobeys the command (like "sit/stay"), he knows I'll take a second look at the situation. One hundred percent of the time, so far, I've deferred to his judgement.

Yeah, no. He's not a bear. But I kind of understand what this is like, to rearrange your life a bit so that a critter can have Thanksgivings in your house (although Max doesn't care for turkey; instead, he gets his own plate of pumpkin pie).

He's a good boy. A good boy. And he eats birthday cake just like the grizzly does.

*shiver*

Had a bad day? Have a cub-'n-bucket.

2011-09-29T16:36:00.001-07:00

Gar. GAR. GAAAAAARRRRRRR!!!

Tomorrow, the State Fair starts in Yeehawton.

2011-09-29T15:21:00.000-07:00

And dammit, I am going to drive and drive and drive sometime in the next twenty-four days and go to the State Fair. Because two years ago, I was too busy being heartbroken and stood up to go, and last year, I was too busy bein' all cancery and shit. I want me some fried food.

In the meantime, I have advice for the Minions: Don't get an autoimmune disease that affects your nervous system.

The patient in question is a normal, boring guy who went on his normal, boring, noiseless way until the day when he suddenly seized. Multiple times, in the presence of his family, and then multiple times in the presence of the emergency department peeps.

Then, while he was hospitalized, he got confused and combative. Then he got really weird and stopped breathing on his own. Then he ended up with us and did nothing but twitch and seize for four months.

Six months after he first had a headache that turned into Hell, this dude is waking up. Turns out he has a weird autoimmune situation going on: nearly all the people who get his particular syndrome are female; the ones who aren't have tumors on their thymus gland. Less than a tenth of a percent of folks develop this thing with the hard-to-pronounce name on their own, in the absence of triggering factors.

This guy is, of course, one of those perfectly inoffensive, perfectly boring people who had nothing at all wrong with them, who went on to develop an autoimmune disorder so rare that even Wikipedia doesn't have more than a stub on it. It's the autoimmune fuckup version of my cancer, basically, but without the good drugs and the pleasant outcome.

HOWEVER! He has, statistically speaking, a good chance of recovering. From what we can tell, if you wake up at all, you're pretty much guaranteed a happy ending. It just takes a while.

In the meantime--and this is why I would advise against getting any weird, obscure disease--we've tested him for everything from viral infection of the central nervous system to heavy metal poisoning to parasitic infestation. He's had so much blood drawn over the last four months that he's required two transfusions. For a while, we had a drain in his back to draw off CSF, just because it was easier than doing repeated lumbar punctures.

Now that he's kind of sometimes a little bit following some commands, I'm sending him off tomorrow to a long-term intensive rehab program. There, he'll learn how to swallow and talk and walk and tie his shoes again. If he's lucky he won't remember a damn thing about the last half-year. If he's really lucky, he can hit the State Fair along with the rest of us next year.

And if I see him there, you can be sure I will buy that man a Shiner and a corndog.

Whiskey-soaked donuts, Tornado Taters, unicycle, eight small rubber balls.

2011-09-28T15:19:00.000-07:00

Or, the title of this post has nothing to do with the post itself.

I got the Definitive Obturator fitted today. There was no speech bulb attached; that'll come on October 6th, after Dr. Elf has a chance to mold the thing off of this current obturator, which works great both in terms of speech and of snot drainage.

You guys, I am *so* excited.

Remember how much I hated the first obturator? Remember how I got used to the second obturator, but kind of didn't like it because it fell down in the back and was heavy and made it harder to talk?

This one is. . .well.

It's shiny, shiny silver metal. I have no clue what the metal is; it looks like that cheap stuff they make adjustable rings out of--the kind you get out of the gumball machine. It's got integrated tooth hooks, which means they're much less likely to break off. And it's got this loop on the back which'll hold the speech bulb, and *that* means that the shape and size of the bulb can be changed as needed without as much effort.

I'll post comparison pictures after I get the D.O., but for now, imagine a retainer. You know how retainers have that plastic part that covers up your entire palate? That's what I've got now. The D.O.'s palatal widget is about a third the thickness of the plastic one, and it doesn't cover the area just behind my front teeth. That means that not only is it lighter and easier to put in, but it also doesn't change the way I talk. I've learned that the speech bulb is only part of the equation: good enunciation requires tongue contact with the backs of your front teeth.

(This is especially important for singing, for reasons I don't completely understand but have experienced. I talk fine but I lisp when I sing.)

When Dr. Elf put the D.O. in, it was like wearing nothing. I'm not kidding: the feeling was as close to having a normal mouth as I've experienced in nearly a year. It was. . .comfortable. Not just comfortable, it was unnoticeable. I could tell the difference even without the speech bulb.

There are two pieces of bad news: first, I will no longer be fully protected from Dorito Abrasions and Pizza Burns. I'll have to re-learn how to eat like a normal person. The second bit of bad news is that Dr. Elf had to grind down several teeth to get the occlusion right; there's only so much grinding you can do on tiny metal hooks before you weaken them. My tooth enamel had to be slightly sacrificed in two places to get my bite correct. Tooth enamel ain't no thang, y'all; it's totally worth it to have this new widget work.

The upside to the tooth grinding is this: When the first obturator was being fitted, Dr. E. had to grind off bits of the posterior edge of the anterior side of my eyeteeth. Given that *this* grinding of teeth involved the anterior edge of whatever tooth is behind the eyetooth, I now have even more prominent fangs than I used to. When I smile a certain way, I look like a vampire. This is a look I really, really dig: it's body mods with a medical excuse.

In sum, this new obturator/speech bulb combo is going to be bad-ASS. It's gonna be Terminator Mouth from here on out. I think that this might actually be an improvement on the normal human mouth, in fact: it'll cover most of the area of my palate that used to get burned from too-enthusiastic hot-food consumption, yet not impede my speech.

Okay, enough of that. Thank you, all of you who sent reassuring emails and posted reassuring comments after The Twerpacle (the minor debacle involving That Guy I Was Dating). In a surprising demonstration of Good Timing, the Universe decided to make my pal and coworker Dame Hammet (points for those who got the Brother Cadfael reference) want to introduce me to her cute friend who's tall and skinny and funny. Pray for me this Sunday, around 7:30 pm Central time.

***I should mention here that TGIWD isn't actually a twerp. His behavior was twerpy (and so was mine), but he's a hell of a person, and any woman who is able to sort through his various issues is getting a massive catch. (Feed him up, girl. Them elbows is sharp.)***

And yes, I've already picked out my outfit. And my shoes. And my eyeliner. Not that I'm nervous, or excited, or anything.

This "dating" stuff is fun. Who knew? Now that I've gotten over the Fear Of The Obturator Causing Uncomfortable Conversations (take it or leave it, buddy), I'm kinda enjoying myself.

Coming Up: Why you should try to avoid autoimmune diseases!

Nursing stuff later this week. For now, sigh.

2011-09-25T17:51:00.000-07:00

That Guy I'm Dating is now That Guy I Was Dating.

Because, after six weeks, he still hadn't figured out whether or not he liked me. I mean, really? All the signs were there, dude: You brought me an LED mod for my mini-Maglite, you wanted to hang out whenever, all that other stuff, and you weren't sure whether. . .you. . .liked. . .me?

Getting upset over this would be like getting upset because I can't communicate with somebody who speaks only Russian. Abilene Rob, being the sort of stand-up guy he is, and a very good friend besides, was exasperated on my behalf. I think he said something like, "He had your boobs right there and he didn't know what to do with them? What kind of idiot is he?"

Ah, Rob. Always there to pick up a girl's self-esteem.

Anyway, this has led to my re-reading the profiles of those poor fools deluded enough to check me out on A Famous Online Dating Site. From my perusal, I have determined the following:

1. Every man in Central Texas describes himself as laid-back. This explains the droves of horizontal men lining the streets.

2. Few men in Central Texas can spell, punctuate, or put together a sentence. There were at least half-a-dozen guys whose profiles left me all, "What? What?"

3. If a man is six-three and three hundred pounds with a bad goatee, he wants somebody at least ten years younger with a slim or athletic build.

4. I am too old for forty-one-year-old men. (Yes, one of them actually *told* me this after I'd emailed him, my rockin' profile notwithstanding.)

5. Every guy around here is looking for a mother for his children. Most also have few to no teeth, and one in six admits freely that his mother thinks he's gay and that he's looking to change that.

I could have the problems Stoya has, though: Within 24 hours of getting an account on A Famous Online Dating Site, she had over fourteen hundred "winks." That's one thousand four hundred, or a one followed by a four and two zeros. There is such a thing as having too many choices. Stoya is about to just pull the plug and spend the rest of her life in her apartment, cowering under the bed.

I, on the other hand, would like to dissect That Guy I Was Dating, and find out what he uses in place of a brain.

Please, nobody suggest I start dating musicians. This place is as full of musicians as a fleabag hotel is of fleas, and you know the old joke: What do you call a musician without a girlfriend?

Homeless.

See? I have a sense of humor! Call me!

Home again, home again, etcetera.

2011-09-25T12:00:00.000-07:00

I could happily live the rest of my life in central California, near the coast, provided I didn't have to do anything to earn a living. Could somebody please invent a time machine so that I could invest in Microsoft stock early? Thank you.

Pens the Lotion Slut and I keep emailing and texting each other with the words "Best Vacation EVER" and "CONDORS."

We ("we" being Pens and me) arrived late in the morning Sunday at San Jose and were whisked, as much as a bus can whisk, off to the CalTran station near the airport. There's some wonky stuff going on with construction there that would've made it impossible for Beloved Sis to pick us up, so we just rode the bus through town, with Pens asking things like "What's that vine?" and "Is it always so gorgeous here?" (Answers: Bougainvellia and Yes.)

Beloved Sister and Brother-In-Law have a little place in Monterey--and by little, I mean little--with a guest house/studio out back. Pens and Beloved Sis and I installed ourselves there and proceeded to eat lots of bread and hummus and snackages, complete with thyme-infused olive oil. Then B.S. and B.I.L. made us ravioli and butternut squash puree with sage butter and perfectly sauteed zucchini with the sweetest bell peppers ever. I should've known at that very moment that it's nearly impossible to get a bad meal in central California.

Seriously? Had I posted during the past week, this would be the Head Food and Condor blog. Because we saw CONDORS. But before that, I saw HUMPBACKED WHALES. And before that, I sprained my knee.

On Monday, Pens and I went to see whales on the Monterey Bay Whale Watch tour. We took the Sea Wolf II from the wharf at 0900 sharp. It was during the boarding (boarding? Embarking? Getting-on-the-boat?) that the boat went *wibble* and my left knee went *gronk* and I stumbled, practically into the arms of the handsome man who was charged with getting my landlubber ass onto and off of the boat in one piece. Sadly, I caught myself and sadly, my knee swelled to the size of a small grapefruit during the trip.

But I saw three humpbacked whales: a mother and calf and a big male lazily doing the flipper-slap on the surface. And dozens of Risso's dolphins pacing the boat and breaching, and several sea lions (distinguishable from harbor seals by their longer flippers) scamming for scraps. Penny ended up belowdecks in the cabin, green and sweaty from seasickness. At least I won the genetic lottery *somehow*: Penny could be mistaken for a European fashion model, but *I* got the steady cerebellum that allowed me to stand at the bow of the boat and go whooping over the waves while eating a sandwich and ignoring the groans of the dying.

It was, truly, one of the best moments of my life.

Then we went to Cambria. If you ever have to go to Cambria, stay at the White Water Inn. They have cookies! And, if you go straight across the street, dozens of ground squirrels will meet you on the boardwalk and beg for food. I have pictures; they are forthcoming.

Also, if you ever have to go to Cambria (and poor you, having to go to one of the most gorgeous spots on this earth), you should eat at JJ's Pizza. I'm not sure why it got only three and a half stars on Yelp; it's seriously the best pizza I have ever eaten, and close to if not the best hamburger. Plus, the dude who couldn't work the bottle opener for my Sierra Nevada IPA was both charming and handsome.

When you go to Cambria, you have to do two things: See the Hearst Castle and eat at Indigo Moon. The tours at the Castle have been cut to 45 minutes, which is just enough that your head doesn't *quite* explode from the beauty of the place. I kept walking past medieval tapestries and triptychs and saying, "Wait. . .I saw that in a book."

Indigo Moon is that sort of experience, but in food form. Beloved Sis had a risotto that made me determined to learn how to make risotto, with a cheese that I will be ordering in bulk. Pens had a tomato-basil soup that (and I will not lie, here) I was unreasonably proud of already having the recipe for. I had seafood fettucine that will live forever in my memory. Get the Harmony Wineries Riesling: it's the only Riesling I have ever liked. It's superb.

I've been so caught up in the food that I haven't even mentioned the condors. So, CONDORS: As we were driving along Highway 1, a route that is fucking lousy with vistas, we passed a low stone wall with two large, ugly birds sitting on it. One had a nasty pink head; the other had a less-nasty grey-feathered head. The dialogue in the car went something like this:

Pens: Vultures?

Me: Too big.

Beloved Sis: TAGS.

Beloved Sis and Me, together: HOLY SHIT CONDORS.

So we screeched to a halt and walked back to get within ten feet of two California Condors in all their impressive, irrepressable ugliness, and take pictures. Other people were hopping out of their cars and grinning maniacally at us.

Penny mentioned, being the bird-person that she is, that number four looked like she was getting a bit agitated, and what happened? Everybody moved back and let the birds calm down.

Then we saw two more condors soaring over a cliff. Protip: They look a lot like vultures, but marked differently and WAY bigger than vultures.

AND I spotted a purple-freckled starfish and several anemones and a hermit crab in a tidepool, AND Beloved Sis has great pictures of a bright-orange starfish in another tidepool, AND we saw a sunfish at the aquarium, AND Pens is Beloved Sis-and-Brother-In-Law's favorite person ever, AND there were many cuddles with my pit-bull nephew sweetums snuggums Bones, and we all slept eight hours a night at least without nightmares or insomnia.

I'm so glad I took a vacation I could not afford to a place I had left, the last time I was there, with loathing and disgust. I want to do this every week. Tell me, those of you who live in California: do you ever get tired of being surrounded by Nature that isn't trying to kill you?

Say nice things about me, 'cause I'm gone. . .

2011-09-17T18:23:00.000-07:00

Tomorrow I leave for California, where I will be spending a week in the lap of near-luxury, if not outright dissipation, in the company of Beloved Sister and Friend Pens The Lotion Slut.

Beloved Sis has been emailing all week with details about the tiny goats'-milk soap she's wrapped in Japanese printed paper and arranged lovingly in tiny straw baskets in the guest-house bathroom. Pens said today on the phone, "It just makes me feel bad to think that we're going to be using up all her toothpaste and stuff, you know?" To which I replied, "Beloved Sis will be like a pig in a wallow, knowing that she can go out and buy new Vetiver soaps and wrap them in delicate paper with flower-petal inclusions. GET OVER IT ALREADY."

There is whale-watching scheduled. And wine-tasting. And pedicures and facials and a B & B in Cambria after the tour of the Hearst Castle. I am taking a pair of leggings on this trip, bought special today at Target: that's how you know I'm serious about being in Northern California.

What this means for you, the devoted minions of Head Nurse: I will not, unless circumstances permit, which I certainly hope they don't, be posting. I'll update you on the Hospital Follies du jour when I get back. You're on your own.

There may be pictures, too.

PS: Thanks for the good wishes and prayers; my house is on the other side of Bigton from the fires, which are now mostly-contained. If y'all want to donate money or clothing or household goods to the folks in Central Texas who lost fucking everything, please talk to your local Red Cross chapter. We need animal chow, too--everything from cat food to horse feed. Thank you.

This made me laugh right out loud.

2011-09-10T14:51:00.001-07:00

From Buzzfeed.

Pens The Lotion Slut emailed me this morning

2011-09-09T14:42:00.001-07:00

To point out that it's been a year.

I hadn't even thought about it until I got her email. I wasn't sure what to feel or think this morning, and I'm still not this afternoon. I had to go back and check the blog entries for this time last year to be sure.

A year ago I had, though I didn't know it for sure yet, cancer. Not a nasty sort of cancer, not an invasive sort, but cancer. Amanda The Amazing had found it during my routine tooth cleaning and had looked very solemn about it. So had the dentist, and the receptionist, and everybody else.

I remember feeling as though I'd been walking along on a treadmill that had suddenly sped up. I was barely keeping up, keeping my feet under me, as other people made phone calls and tried to find an oral surgeon that would accept an emergency appointment within a few days.

The next few weeks were like that all the time. I went from one oral surgeon to another to an ENT to CT and MRI and PET scans and had a lymph node biopsy (just thinking about it makes the right side of my neck hurt again) without really being aware of what was going on. I remember eating lunch with Nurse Ames, high on Valium, after the PET scan. I remember Abilene Rob coming to town the day that the biopsy came back positive, and trying to eat dinner with him. I watched him clean his plate--you have never met anybody who can eat like Rob can--while still feeling like I was in a film that had been speeded-up.

I remember it was the most beautiful fall I'd seen in years.

Today is a beautiful day, too. The quality of the light's the same, and the trees--those of them that are still green--are up against a perfect blue sky the same way that they were last year. Things have quit burning down to the extent that it's eerily familiar outside.

Max is still here. Pens and my Beloved Sister and Parents are still here, Rob is still here, my Brother In Beer is still here. The cats are still here. I yelled at Notamus today for stabbing me with one of his claws, a thing he knows he's not supposed to do, then felt bad for yelling at him, then felt incredibly grateful that things are normal enough that I can yell at him.

Part of my mouth is gone forever. It got cut out with a bone saw and ended up on a pathologist's counter, cut into frozen sections and analyzed. Somewhere at Dr. Elf's there's a mold of what used to be in my mouth, including a dent that marks the mirror image of where the tumor used to be. ("That's the tumor," he said, showing me the hollow on the alginate mold.)

I have three new friends, all "cancer buddies"--Lara, whose general pissed-offed-ness at the whole Cancer Mess made it okay for me to be pissed off too; Tashi, who provided comfort and love and concern even in the middle of her own hell; and Nikki, who didn't come along until after everything was over, but who provides some of the best on-going one-liners ever.

I have a lot more patience than I used to. I have a better understanding of what it means to be on the other side of my job--how little you remember from moment to moment when you're terrified, how huge even simple things seem, how hard it can be to get the hell out of bed. I missed a lot of work between diagnosis and surgery because, most days, it was just too damn hard to get out of bed.

Now, if something is going to hurt, I can tell my patients that honestly. I can also recommend Dilaudid wholeheartedly and without reservation. I know firsthand where to put an IV, how it feels to get up the first time after surgery, and what "tired" really means. I never want to see pureed anything ever again.

I have a lot of debts I can never pay. Lola and T-Bird, Carolita and James, Nick and Aud, Nurse Ames and Stoya and The Manhandler--all the nurses who took care of me inside the hospital and out--I want to buy them all dinner every night for a year. Beloved Sister made me a communication board because we didn't know if I'd be able to talk after surgery, and some of the magnets from it are still on my fridge, because they're hilarious. My folks were about as non-strange as it's possible for parents to be in that situation. My Uncle Jon came down and played housewife for a week, making it possible for me to go back to work. The Man of God and His Lovely Wife fed me, Beth and Matt buzzed my hair. . .I'd have to start a whole new blog just to say thanks.

And you guys: When I needed information, you sent me loads. When I doubled back and asked you please not to any more, you sent pictures of kittens instead. I got prayers and outpourings of love and good, solid ass-kicks when it was appropriate.

Some things have changed. Some things haven't. Some things changed for a while, then went back to the way they'd always been. It's been--and it seems weird to say this--a good year.

This picture is copyrighted by Deanna Roy

2011-09-07T14:40:00.000-07:00

Austin skyline today.

I get all excited about the weather, and then everything catches fire.

2011-09-07T09:20:00.000-07:00

I may be rather scarce for the next couple of days. The fires aren't near Casa Jo, but the air is horrible--smoky, hazy, awful--and I'm staying glued to the fire maps on the Innerwebs.

Pray for rain, Peeps. We need it, bad. It was enough that every stock tank was dry; now they're dry and ON FIRE.

OMG. It's supposed to be 80 here tomorrow.

2011-09-04T03:05:00.001-07:00

And the low?

In the fifties.

I might just live long enough to go to California with Pens The Lotion Slut and see Beloved Sister.

In the meantime, the Universe reminded me that there's something worse than having a chunk gone out of your head: Joint Commission survey prep.

For those of you who are lucky enough never to have heard of the Joint Commission (the Joint Commission on Accreditation of Healthcare Organizations, aka "TJC," aka "JCAHO," aka "Our Benevolent Overlords"), it's a not-for-profit organization that sends out "Surveyors" every so often to your local hospital to determine whether or not people are charting, washing their hands, sterilizing instruments and changing lightbulbs--all the stuff that goes into running a hospital.

Surveys are usually unannounced. You can be sure that the middle manglement of every hospital in every city across this great land is on speed-dial to every other hospital the minute TJC shows up, to warn everybody that The Beast Is In The House. You don't want to be caught unprepared, without liners in your trashcans or with mops in the corners of the utility closets.

Accreditation is bullshit. When a survey's expected, the management of a hospital decrees that every chart will be audited for errors and omissions. Every bit of equipment that normally languishes in the hallways between uses gets taken away and stored somewhere. Things that are normally unlocked, like syringe drawers and storage room doors, are locked by the housekeeping staff, who usually have the only keys. Nurses are subject to surprise searches to be sure nobody's carrying meds in their pockets. Floors get polished and bathrooms get cleaned.

And then, once TJC has either not come or has come and gone, things go back to their usual comfortable, vaguely disorganized state. About the only thing that Joint Commission accreditation tells you is whether or not the management of a facility can handle having a bag of rabid weasels thrown into their midst unexpectedly, because that's what it looks like.

Prep is horrible. Everybody who shows more intelligence than your average turnip is handed a stack of charts to audit--in other words, you go back from day one of a patient's stay and look at everything everybody has written--and correct. Correction means hunting down the folks who made an error and sitting on them until they fix the error (or omission). Given that we move patients between Sunnydale and Holy Kamole all the time, chart prep means hours and hours of soul-destroying fiddly work, followed by the opportunity to have doctors and nurses from two hospitals and all the associated clinics pissed off at you, the auditor.

My job this week was auditing, along with precepting a new experienced nurse for the unit. Thankfully the nurse was sharp and with-it, or else I would've leapt out the window by nine ack emma. Chart audits are the worst thing I can think of to do at work.

But we're prepared! For the survey! And it'll be great!

Never mind that another hospital in Bigton got surveyed a couple of years ago and won accolades from the JC folks, only to return to having potato chips show up in supposedly-sterilized surgical kits. I'll bet their trash bin liners looked fantastic.

Two Stupid Things in two days: a new record?

2011-08-29T22:31:00.000-07:00

As I was leaving the doctor's office after my annual how-you-doin' checkup, he said, as a sort of by-the-by, "You've gained six pounds in the last year. You'll need to watch that."

This after a long discussion of what sort of cancer I'd had and how I'd recovered and what my further treatment would be like, if I had to have any. This after he'd asked how the psychosocial aspects of recovery had been, by querying "How's your social life*?" in his Muppety voice.

I turned around in the hallway after the weight warning and looked at him levelly. "I've been busy" I said, and walked out.

Because, really? The last thing on my mind since just about eleven months ago has been Weight Fucking Watchers and not eating too many calories.

The first Stupid Thing had come the day before, so maybe I was a little over-reactive.

A woman I work with very occasionally--maybe twice in three years--asked why I'd cut my hair. Before I could respond with something neutral and funny, another nurse said, grimly, "She had cancer and was afraid she'd lose her hair to radiation." Leaving aside whether or not it's quite sporting to scoop somebody on something like that, things got a bit uncomfortable.

Nice Lady I Barely Know had a lot of questions. I don't mind answering questions about what happened to me; very few people, after all, even think that head-and-neck cancer is A Thing, let alone that you can lose part of your palate to it. I answered as best I could, and then she said this:

"Well, at least you don't have anything to worry about any more!"

Nice Lady I Barely Know put her foot straight fucking into it with that comment. I *know* it was meant to be reassuring and optomistic, and I treated it that way, but really? I have more to worry about now than I know what to do with.

I have, for starters, a very much increased risk of developing another, different sort of oral or oropharyngeal cancer. Call it two to three times the risk of your average person: my mucus membranes have shown that they'll react badly to HPV infection, and that reaction won't go away unless my DNA gets reworked in the manner of a Time Lord's.

I also have, not to put too fine a point on it, a couple of surgical sites that will never heal any more than they've already done. That means that inhaling my food, wearing a big plastic or plastic-and-metal thing, and having to explain shit to people will never go away. I can't emphasize how much that's affected things up to this point: I wear a MedicAlert bracelet, I don't go out to eat as much (because I can never tell when something might decide to exit my schnozz rather than head toward my gut), I have to tell *every* medical person I deal with about the prosthetic. And then I have to explain. Again.

Which brings us to the Social Life aspect of the whole deal. I hadn't realized, until I'd talked to other young and young-ish cancer survivors, how much that can factor in to starting--or ending--a relationship. I've been on a couple of dates with a new guy, and now I wonder, every time he doesn't email or call, if he's flipped out either by my lack of anatomy or by the idea that he might be buying into something that could end Very Badly Indeed. I used to worry about my belly or my cellulite or that huge zit on my chin; now I worry about the fact that I have this thing in my past and this plastic thing in my present and future.

And, finally, I have something that normal people don't: An every-six-months reminder of what pure gutwrenching fear is like.

I have to get scanned in November. I'm dreading that, almost as much as I'm dreading the dentist visit I have in September, a year to the freaking *day* that Amanda the Hygienist found Lt. Lumpy. I'm dreading the chest CT I have to have next year, to make sure that the tumor didn't seed into my lungs. Every six months for the next couple of years I get to go back to the CT center, drink the barium, take the Valium, wobble out of the room after the scan, and go on to the MRI.

These things are just part of the deal, I guess. They don't make me any more special or tragic or brave or stalwart than any other person who had rogue cells cut out of her body. I actually had it easy by comparison to my pals like Lara and Nikki.

But. When my tongue, out of habit, traces the curve where Dr. Crane cut out my palate, or when I have to run for my prosthetic when the phone rings, or when somebody acts relieved because I only took a few days off and wasn't out for some health crisis, I remember.

I used to have a favorite dress. It was a double-layered thing from Gudrun Sjoden, a Scandanavian store, and it had tiny lines of ornate embroidery around the cuffs and hem and neckline. It's the dress I wore when I went to the dentist last year. It's still hanging in my closet. I haven't had the balls to put it on again. Maybe I will this year, when I go see Amanda.

It would be the first step in not worrying so much.

*"Social Life" meaning "sex life" to my doctor. Which, to give him props, was the first time I'd been asked about it by any medical perp involved in my care. But still: DO NOT WANT to discuss that with Dr. Muppet.

pant pant pant

2011-08-29T03:09:00.000-07:00

I'm twisting my spine at a worrisome angle, checking behind me to make sure I still have a butt. I had thought I had run it off this weekend, but no, it's still there.

Something happened last week that I forgot about until yesterday, one of those once-in-a-lifetime moments that nurses hear about happening to other people but don't believe will ever happen to them:

I had a sensible, intelligent, well-informed patient leave AMA and I totally agreed with his decision.

This particular patient had some pretty complex, chronic problems that had been exacerbated by a combination of dehydration and missed medications, and he ended up in the emergency room at Holy Kamole with weird symptoms. The fine folks at HK sent him to us for definitive diagnosis and treatment. Turns out he had missed some meds and gotten dehydrated.

So we ran a few liters into him and titrated his meds back up to therapeutic levels and were getting ready to get him on out when one of the new attendings on service decided we needed to do a much more thorough workup for stroke, something that did not actually happen to this patient. That would've required he spend several more days in the hospital, according to the doc, even though everything could be done as an outpatient.

So he asked about checking out AMA. The attending covering for Doctor Overreactive is a rational sort, but was worried about officially discharging somebody else's patient. So we did everything we'd normally do for a discharge except fill out the official paperwork, and off he went with a smile.

I'm still not entirely sure that this doesn't signal the End Times. Usually, if a patient checks out of our facility against medical advice, it's because they're either angry about the treatment they've gotten or are peevish because they're out of drugs. People who leave in the middle of treatment for whatever landed 'em in the hospital are not in the best of headspaces. This guy? Totally fine.

In other news, the appointment with Dr. Crane went fine. I got poked and squoze and told to make appointments for scans in November. Nothing's swollen in my neck, thank God, but he still wants a CT and an MRI to make sure I'm good on a radiological level. He dithered for a couple of minutes about whether to do both a with-and-without contrast CT *and* an MRI this time, saying he didn't want to "scan me to death," until I said "Dooood. I had CANSUH. Scan me all you want, okay? Just make sure it hasn't come back." So: scans in November, chest and abdominal CTs sometime next year, and then on to regular follow-up in perpetuity.

Next time I'll tell you about the Stupid Thing somebody said to me regarding having had my mouth hacked on. For now, I'm due another cup of coffee.

Bizzy Backson.

2011-08-26T04:20:00.001-07:00

(Does anybody else remember that bit from "The Tao of Pooh"? I can't believe parts of that book are still taking up space in my memory.)

Today I have an appointment with Dr. Crane. I'm not sure what, exactly, is going to happen, except that I'll get my sinuses scoped (ohboy) and probably get an appointment set for yet another MRI and PET scan later on in the fall. No matter how big a pain in the ass being a CANSUH patient is, the follow-up is a bigger pain in the neck.

Speaking of pains in the neck, Dr. Elf started the molding process for The Final Bug yesterday. Here's what happens when you're having a Bug molded to the Giant Hole in your head:

First, the doctor will inspect your teeth and decide that, like a large farm animal, you need to have bits ground off of some of them. This will make it easier to hitch the wires on the prosthetic to your teeth later. If you're like me, with a relatively good set of teeth, the doc will have to grind quite a bit (WHEEEEEEZZZZ goes the dremel tool) to make the wire grooves. It doesn't hurt, but it is annoying, and leaves you feeling like you have bits of things stuck in your teeth. It also takes a surprisingly long time to do, as he's going micrometer by micrometer.

After that, as you're still in the comfy dentist's chair, you relax--until you hear the doctor say "We're going to need rope. Lots of rope." You wonder what "rope" is, and why they'd need a lot of it, and are relieved to find out that it's wax rope, meant to take impressions of your teeth for the obturator mold.

The rope goes into a metal widget that's shaped like a horseshoe, but hollow. That gets shoved into your trap and held there for a few seconds, so that your teeth can make a good impression.

Then comes the alginate molding. This is the truly annoying part of the process. Alginate is this pink stuff that's made, I think, of seaweed. It's sticky as hell, has to be very, very cold when it goes in (in order to hold a clean impression), gets *everywhere*, and tastes foul. Seriously: I had it in my ears before they were done.

The doctor cranks the chair back until you're lying feet up, head down at about a 25-degree angle, then instructs you to tip your head back as far as possible. Then he goops alginate all over the front and back sides of your teeth (mmph) and shoves another horseshoe thing into your mouth, full of a shockingly huge amount of alginate. This is meant to take an impression of The Defect.

The effect is like being gagged with Play-Doh. Luckily, the surgery left me without much of a gag reflex, so I was able to lie there without panicking and meditate on the wonders of medical technology. Once Dr. Elf waggledwiggledyanked the the mold out of my mouth, I was much happier.

Dr. Elf showed me on a plaster mold what he wants to do with the final, definitive obturator. In order to cut down on the bulk, he wants to make the front of the thing metal, and smallify it by about two thirds. He'll do that by leaving the area immediately behind my front teeth free of obturator: I'll have a sort of hourglass-on-its-side bit of metal that hooks to my back teeth with the speech bulb attached.

This is good for three reasons: First and most importantly, the whole contraption will be lighter. It won't fall down on the back of my tongue and make me sound like a retainer-wearing kid with a bad cold. Secondly, it'll take up less space and thus theoretically be more comfortable to wear for long periods of time. And third--and more important to him than to me--it'll be hooked to teeth further back, so nobody will be able to see the wires unless they're really looking. I don't mind the wires, but he wants a good aesthetic result as well as a good functional one. *shrug* Whatever, dude. You're the perfectionist.

Dr. Elf also sprang what could be a fun thing or a wearing thing on me: He's giving a talk to some otolaryngologists later this fall and wants me to come be a show-and-tell for people without palates. I told him I'd be happy to sit up straight, mind my manners, and let doctors shine lights into my mouth. He said he'd let me know when and where this thing is happening.

So! Three weeks until the TerminatorMouth comes back from the molding company, then more fittings and filings and grindings of plastic. I was a little disappointed that I won't get a glittery My Little Pony Palate, but TerminatorMouth is a good second choice.

Had a bad day? Have some sleeping leopard cubs.

2011-08-24T18:29:00.000-07:00

First they play a two-step, then a Cajun waltz. If you don't dance, then it's your fault.

2011-08-21T17:04:00.000-07:00

La Belle Dame Sans Merci, Der Alter Jo, and Heidi The Goat-Girl and I (along with respective spouses) went down to the river this weekend. We stayed in an elderly farmhouse with wavy floors and an entire batallion of mice, ate tons of smoked sausages and bratwurst and potato salad, and floated the Comal for a record five hours. The Comal wasn't much lower than I'd ever seen it (and I've seen it once about four feet higher, which is a story in itself); we just hung out in the shade under a bridge for about an hour.

It was a good weekend. There was plenty of food, plenty of beer and tea and coffee and bottled water, plenty of cold spring-fed river to tube down, and I only lost a couple of things in the chutes.

For the uninitiated, the "chutes" are places where the city fathers and various engineers have decided that the river is too dangerous (second chute) or the bridges too low (first chute) to be safely navigated by crowds of semi-drunk people in big rubber innertubes. Years ago, you had to haul out of the river and walk around one particular bridge, but the more moronic segments of the population didn't, and got stuck under the bridge and drowned horribly. Hence, the chutes were put in--one at the low bridge, and one just above a small waterfall that's much more treacherous than it looks. I nearly drowned going over Stinky Falls once.

Anyway, here's how it works: you're sitting in an innertube, thoughtfully provided with a drink holder and handles, and probably tied on to other innertubes containing either people or coolers or both. Right before you get to the chute, you untie from everything except your cooler tube and manuver yourself into position so that you're (ideally) going down the chute feet-first.

As you enter the chute, you're going slowly. Then things begin to go very wrong indeed, as you spin around, lose sight of your companions, and eventually get spat out of the chute going remarkably quickly, into a surprisingly strong whirlpool-like current. That was where Der Alter Jo rescued the tiny baby snapping turtle, who was as dizzy and confused as she was.

The second chute is a bitch. It doesn't help that the signs above the river warn you that a "Tube Shoot" is coming up--it makes it sound like rednecks with guns will be taking potshots at your sunburnt self. It was at Stinky Falls that I managed to get the cooler tube (with water, not beer, in it) and my own tube safely over the edge and down into a companion's hands, then fell over the edge of the falls and lost my hat and the bottle of sunscreen.

The River Gods got a full set of clothing from us that day: La Belle Dame's shoes went first, followed by two T-shirts and a cute little cover-up, and then my hat. Nobody lost their sunglasses, their mind, or consciousness. We all got vaguely, patchily sunburned in weird places. We all stayed well-hydrated.

And then we finished Saturday night at the best damn dive bar I've ever been to. A band called The Chubby Knuckle Choir played, we ate cheeseburgers and drank Maker's Mark, and wrote our names on the wall behind the table. It's the only dive bar I've ever been to with a haunted flush outhouse.

Back to work this week, with a follow-up with Dr. Crane and His Band of Merry Sinus-Scopers and a remolding appointment with Dr. Elf. I wish I could move the river to my front yard.

Y'know what's depressing?

2011-08-18T18:51:00.000-07:00

This is what's depressing: I've been through breakups, job changes, CANSUH, failed romances, and all manner of crises, large and small, and the biggest load of squee-ing, fan-girl email I get is occasioned by my father's comment on this blog.

My Sainted Father makes *one* comment (about mailing his liver to Abyssinia) and I'm innundated by emails saying things like, "OMG! Was that really your dad? You sound just like him!! Is he cute??"

Dad and I used to play a game at dinner to drive Mom wild. We called it the "New Mommy Material" game. Dad would posit theories like "Pia Zadora would make a good New Mommy" and I would shoot them down or offer alternatives. If Sainted Father ever wants a New Mommy with medical training, can I offer him all your email addresses?

Good God, has it been that long since I posted?

2011-08-18T02:42:00.001-07:00

Sorry, you guys. It's been busy around here. (In the same way that the ocean is moist or the Pope occasionally attends religious services.)

Hey, kids! Drugs are bad! Because if you do drugs, you might find that your drugs have been cut with something that contains strychnine, and you'll find yourself rolling around on the floor with your heels touching your head. As if that didn't suck enough, you'll then find yourself intubated and sedated in a hospital somewhere so that you don't twitch and jerk yourself out of the bed. And you'll stay that way for three weeks and counting.

And, while we're at it, intravenous injections of hydrogen peroxide aren't great either! I don't care if the self-styled guru who does your colonics says they'll keep you young. They won't. All you'll get is some nasty shit cutting loose into your brain. Please, please do not ask me, as I'm discharging you, when it'll be safe for you to go back to doing whatever woo treatment brought you in here in the first place, because it'll be very hard for me not to get snarky right then and there.

Only about thirty percent of the people exposed to syphillis will, if untreated, go on to develop the tertiary stage of the disease. It's still a good idea to finish your treatments if you've been diagnosed with the pox, so as not to end up with neurosyphillis thirty years after the fact.

Also, weird demyelinating diseases: Please do try to avoid them, especially if you're offered one which we can't identify.

And don't get your aneurysm clipped by a general surgeon in Backobeyondville. Really.

These last two weeks have left me and everyone else at Sunnydale with our jaws hanging open and our eyes wide. Weird isn't weird where I work, but this much weird, and this severity of weird, is.

I was watching Notamus eat my guacamole last night

2011-08-07T17:53:00.000-07:00

...before taking it away from him in a hurry, because aren't avocados really bad for cats? Johnny?

Then I looked over my shoulder to see Max carefully licking his right paw and washing behind his ear with it. He then did the same thing with his left paw.

Something is broken in the space-time continuum.

Yo! Smart people! You are not disabusing me of my stereotypes.

2011-08-06T08:38:00.000-07:00

Got up yesterday morning, set the makeup gun to "Slut" and checked my email. (This is my usual routine for work, and no, I'm not trying to catch a doctor. If I don't layer on whore paint with a trowel, people ask me if I'm sick. This is Texas.)

In the email was a note from a Faithful Minion who told me that somebody had quoted something on HN out of context. When I followed the link, I found that not only had HN been quoted out of context, the person who'd quoted me had gotten the quote wrong, and drawn completely wrong conclusions about what they'd misquoted.

On a professional website. A, like, *big* professional website.

So I sent the person in question a very nice email, correcting and expanding.

Once I got to work, I was told by a patient's family member that that patient was "very important and, actually, famous." This did not stop me from looking blankly at the patient and saying, "So. They let you cross the street by yourself" after he'd asked me one of those questions that just defies belief. ("They're gonna put me under for this surgery, right?" "Oh, no, we think the suffering of surgical patients brightens up the joint. NEXT!" Even worse than that. Swearsies.)

Then, about lunchtime, I checked my email again. In it was a snotty note from the person I very nicely corrected and a confused note from a Minion who read something wrong.

Reading comprehension: The Lost Art Of The Covenant.

I've long believed--since before I ever met the first Nobel Laureate I ever met--that truly brilliant people ought to be given minders. There should be somebody following every Genius Grant recipient around, making sure they don't leave their car keys in the freezer or put their shoes on the wrong feet. If you've won a prize for anything intellectual, you would automatically be issued some nice, boring, sensible person who'd tell you not to wear those shoes with that pair of pants and who'd make sure you didn't leave your head in the taxi.

My Sainted Father is one of those folks who'd misplace limbs if they weren't glued on. My Beloved Mother has spent the last fifty years making sure he doesn't wander out under a bus or absentmindedly mail his own liver to Abyssinia. She deserves a medal.

I deserve, after limiting my snark to the words "You're welcome, Doofus" more than once, a drink.

Please, smart people. Get it together. Or at least present a semblance of togetherness when you're around me.

Had a bad day? Have a beluga whale and a mariachi band.

2011-08-03T12:52:00.001-07:00

Nothin' like blood up to your elbows.

2011-08-02T13:28:00.000-07:00

The neuro CCU didn't have any patients, so I took myself down to the surgical CCU to be a general dogsbody and bottle-washer. And got my ass run off for three days straight.

It wasn't so much the lack of staffing as it was the acuity of the patients. And it wasn't so much the acuity of the patients as it was the cluelessness of the residents. And it wasn't so much the cluelessness of the residents as it was that every single damn thing that could go wrong, *did*, usually all at the same time, which was of course right around lunch.

Elizabeth called me into one of her rooms to ask if the leaking from around a JP drain was normal. Yeah, sometimes it is. . .but that drain site was leaking a little more than I would strictly consider okay. So, as Deidre packed Surgi-Cel around the area, trying to stanch the worst of the leaking, and Elizabeth called the resident, I tried to figure out where the blood was coming from. No go. There were enough holes in the poor patient to make any of them a contender, and no obvious source of blood.

Which means that the blood was coming from *inside* the patient, not from the hole the drain came out of. This is always bad, because it means that you have to re-open the surgical site and see what the heck is going on.

In came the resident. He looked at the drain site and said, "Walp, looks like the bleeding's stopped for now." I looked at him from across the bed and said, "On the outside, maybe."

And just then the patient turned his head and coughed out a fountain of bright red arterial blood from his trache.

Which is how I got blood up to my elbows. The patient is fine, by the way: a quick re-exploration of the area showed a small artery hadn't been properly dealt with during the surgery and had reopened--nothing that a few stitches, or something, and about six units of blood couldn't fix. When I saw him the next day he was relatively pink-cheeked and cheery.

What I've not mentioned until now is that, as all of that was going on in the room (and you know how it is, with Get me a suture kit please and Can somebody please call the fellow and Hold this there and tape that here), there was a person just next door whose head suddenly blew up like a beach ball for no apparent reason, and a person down the hall whose MAP (mean arterial pressure, a measure of how well you're perfusing) dropped into the 20's (bad), and another person who leapt out of bed over the bedrails despite having a dense right hemiparesis, and the fire alarm went off.

Just then the helicopter crew showed up, bagging a person who'd fallen off of something tall and hit his head and been transferred to us.

Run that tape back and play it over and over for two more shifts. This is why I took a five-hour nap today and will order a pizza tonight.

Odds & Ends

2011-07-29T16:15:00.000-07:00

Man, Rimadyl works FAST.

Max woke up this morning and trotted (trotted!!) outside, with scarcely a trace of stiffness, then spent about ten minutes barking at something I couldn't see with a vigor I haven't heard in three years, at least. Then I let him in, because five ack emma barking is not a thing in this neighborhood. Although it might become a thing, because Max is groovin' back to his badass self.

No weird memory issues the last few days, either.

Now, of course, I feel like shit because all of this must've been related to the pain his back was causing him. And I didn't notice. But he's stoic, so how would I have noticed? Anyway, I think he might keep going for a few more years, now that he's able to boink around the yard going BAROOOF at things.

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

Turns out that Bossman had a meeting with The Big Evil Bossman and one of the BEB's Minions, a woman I used to like and respect until she got too close to the BEB and started acting more like him than like herself. What is it about Evil Bosses? How do they corrupt the minds of the innocent? And, more than that, what was Minion doing at a meeting about the NCCU with our Bossman? WTF? She has zero CCU experience and doesn't even run a floor that has to do with our specialty.

All these questions will have to wait until Monday to be answered. The upshot of the last meeting was that BEB can't understand why (because he too has exactly zero critical-care experience) we would want heart monitors on our patients in the NCCU.

.... ..... .... .... ....Yeah.

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

I have finally figured out liquid/gel eyeliner. This is a huge deal for me. Back in the day, I wore the shit out of that stuff, but as I've gotten more mature (read: as I've gotten lines around my eyes) the mid-Eighties Rococo Raccoon Look is less and less appropriate for work.

Last night I took some time and figured out a better way to do liquid eyeliner, which involves lining the inside of my upper eyelid, and will try this bad boy out with the green-and-black rhinestone-encrusted glasses which Abilene Rob said made me look hot. I'm thinking it'll be a sort of Nutso Cat Lady Librarian Meets Studious Nurse Thang, and I'm all over that.

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

Why I love The Hairpin, part three gazillion: because they introduce me to websites like this.

'Zhausted.

2011-07-28T14:39:00.000-07:00

Max has arthritis in his spine. His bloodwork was perfect, his right hip is fine, his left hip is all jacked up with arthritis, and his spine--especially the lower back--is a mess.

He now has the tippy-top super-duper prescription glucosamine supplements from Hades, a bottle of generic Rimadyl, and a bad sedative hangover. Luckily, he's a meditative drunk rather than the pacing, panting sort.

That's him, passed out with his head on the nice cool bathroom tile. Poor guy.

Had a bad day?

2011-07-28T02:46:00.001-07:00

Have a baby hippo.

Max news!

2011-07-25T13:32:00.000-07:00

Thank you, first of all, to all the folks who sent/commented with tips and tricks for old, arthritic dogs.

The vet says two things:

1. It's probable that the trouble with Max's hind legs is arthritis in his hips. HOWEVER. There is a rare degenerative spinal disease that tends to hit German Shepherds, so he's going in for X-rays on Thursday to make sure that it's actually arthritis.

2. The memory loss doesn't concern her yet, because it's recent, sporadic, and correlates with the horrible heatwave here. I am to keep a journal of when he goes blank and, if I get more than five or six instances in the next couple of months, to bring it back to her. My marvelously intuitive brother-in-law might be right: this might be Max saying "I hate the heat and there are ants biting my butt."

Also, he has Old Dog Teeth and Old Dog Skin Weirdnesses, but we're not going to put him under to deal with them. His heart's fine, his bloodwork is pending, but honestly? I don't see the point in putting a 107-lb, eleven-year-old dog under general anesthetic to have a couple of minor, benign skin-things removed and his teeth cleaned. They're not *that* bad.

I learned today that the fastest way to get a reaction out of people is to take your very large old dog into a liquor store on the wrong side of the tracks. There's a store here that sells 471, a pale ale I particularly like, and so I ran past there on the way home from the vet's, with Max in tow. I took him in because, in 100-degree heat, you don't leave any animal in any car for any length of time.

We walked past Mexican roofers with cases of Corona Light in their arms, gang-banger wannabes with saggy shorts and gold teeth and bandannas, and scary-skinny blonde white women with prison tattoos, and all of them were totally silent. Max was prick-eared and perky; he likes going new places. Not one person said one damn thing to me, the chunky chick in the empire-waisted flowy hippie-dress. Except one guy, who came in, stopped dead in the doorway, and said, "Woah." I reassured him that Max was friendly, so he came closer, scratched Max behind the ears, and said, "He's a big man, ain't he?" I replied that yes, he got that way through drinking all my beer, and the guy chuckled while Max drooled on his shoes.

Max is now lying on the dining room floor, and taking up most of it, because he has had a Very Big Day.

Oh, well.

2011-07-24T18:11:00.000-07:00

I have had One Of Those Days.

Worry about work kept me up late last night; the heat kept me in today. I did some basic grocery shopping, but forgot to get coffee. Max seems better--of course, because he has a vet appointment tomorrow.

Today, a friend of mine whom I love and respect was bitching about how the development of cellulite has kept her from buying shorts. It was dramatic enough that I nearly said something like, "What a coincidence! I've been looking for months for shorts that'll coordinate with the huge hole in my head, the sores I get on my tongue from the prosthetic, and the wires that poke my gums."

Anger from work is obviously spilling over.

Tonight I'm going to read All Creatures Great And Small and eat a pile of toast. Tomorrow I'll see the Prosthodontic Fairy, then take the Zoaters to see the doctor he once tried unsuccessfully to bite, then come home and make salads and lunch for the rest of the week. It'll be a productive day, which is better than a day spent worrying and pacing.

Something is going to happen soon, I know that. I just wish I knew what it *is*.

pace pace bang bang pace pace

2011-07-24T12:06:00.000-07:00

I do not know what to do.

DAJ and I have been chatting prior to her leaving on vacation. She's got worries about the NCCU, and so do I. She's the best formal, businessy-type letter-writer I've ever met, and I'm good at editing, so we're going to work together--after she gets back--on a formal letter of complaint about what's been going on. Meanwhile, all of us are going to keep on filling out incident reports and yelling and pointing out problems and inadequacies, and I'm going to ask for a meeting with the person who's the head of education for the chemotherapy nurses. I'm going to throw myself on her mercy and ask her if she thinks it's a good idea that we, the NCCU nurses, take over chemo administration after our chemo unit moves across the street.

I'm also going to chat with the director of the unit.

But, after that, then what?

Here's the deal: we're moving the unit sometime later this year into a designated space. Rather than carving out space in underused rooms with borrowed beds and semi-working monitors and pumps, we're going to have an actual six-bed unit, with *stuff* that works. I'm holding out hard for central monitoring (the patients could be monitored remotely in the surgical CCU, but I don't like that idea for a number of reasons) and in-room recording monitors. Frankly, not having those two things would be a dealbreaker for me.

I'm also holding out (dealbreaker again) for actual written policies as concern staffing and duties, not a make-it-up-as-we-go approach, which is what we've got. The Big Boss of the Block told me a few weeks ago that the reason we don't have formal policies yet, after ten months of being open, is that we don't *officially* open for business until this coming fall.

Which makes me wonder what we've been doing since September.

All of this is making me very thoughtful.

The Big Boss is a bully and a terror. I've known this since I started working under him five years ago, and he and I have gone head-to-head on a number of issues ranging from his harassment of other nurses to the way he treats people on committees. He doesn't like me; I don't like him. We can work together, just barely, provided our interests don't conflict too much. We both realize this.

I'm not sure I can outlast him. He's older than me, and much fatter, and in rather poor health. Unfortunately, given that he's a lump of Concentrated Evil, he's likely to last in his current position for a very long time. Evil don't die easy.

Should I leave now? Should I wait, since this unit has become my baby, and leave after we transition to a workable space? (Just the space we were given is nearly impossible, given how it's laid out. I mean, really--you guys wouldn't believe it if I told you.) Should I stick it out, hope to outlast the Big Boss, and continue to fight the good fight?

I don't think I can stick it out. I'm convinced that part of the reason I got cancer was the amount of stress I was under during the year before I was diagnosed. I don't want a second malignancy.

At the same time, how easy would it be for me to get another job within Giganto Research & Education, Inc, parent company of Sunnydale, with Big Boss still in the picture? Leaving the GREI fold isn't workable right now for a number of reasons I don't want to go into.

Will an infusion clinic hire a nurse they have to train? Is there a way I can make myself more or less bulletproof as regards Big Boss? If I'm not naturally very diplomatic, how do I learn those skills, and will they actually do me any good? Should I try to get another job here in the state, or just up and move to Missoula? Should I stick it out for a year while DAJ finishes her degree, then move with her to Seattle so we can split rent?

I tossed and turned last night and had to do deep meditative breathing to keep from getting so angry I couldn't sleep. I simply am at a loss.

I think I'll go make a coffee cake.

Let's get one thing straight right the hell now.

2011-07-23T09:57:00.000-07:00

I am not a fan of small dogs.

If you give me the choice between a stubborn, grouchy big dog of unknown origin and a cute little white fluffy eager to please purebred that weighs less than 20 pounds, I'll take my chances with the grouch.

However: my old vet, the one with the overalls and the goats in the waiting room and the six rescued Greyhounds on her land, once told me this:

In a fight between any dog and a Chihuahua, she would bet on the Chihuahua, unless the other dog was a Greyhound.

Give it up for Paco, the crime-fighting, bad-ass good-boy of the day!

Eeeyep. Yep, yep, yep. Juuuuust about quit my job today.

2011-07-22T18:04:00.001-07:00

For two reasons:

1. My boss is a moron.

2. My boss is a fucking moron.

Seriously: You should have more than six months' experience as a working nurse before anybody gives you a managerial job, no matter how brilliant an organizer or genuinely nice a person you are.

Because, if you have some experience on the floor or in the unit or in a clinic, you would not:

1. Double the number of patients in my unit without warning and without giving me any extra resources.

2. Look at me like a calf at a new gate when I suggest that those of us who might be administering chemo (there is no policy as yet) will have to get and maintain competency, and, given that chemo is an entirely different specialty, that this might be a big deal.

I walked in today to find eight patients and two nurses, which doesn't seem like a big deal, until you remember that these patients are in a critical-care setting, we are doing total care on people who are hemiplegic, altered as hell, and tend to have rapid neuro changes, and there weren't even enough monitors for the patients we had. One of them was on a not-centrally-monitored ancient thing somebody dug out of a basement storage room.

This is, as of yesterday at noon, the new policy: fill all the beds imaginable with all the patients we can get, until something breaks. We were damned, damned lucky today that nothing broke. The guy who lingered on the edge of crumping managed not to crump, the woman who has a violent history with us and was actually labelled as a "Do Not Return" (she was admitted by mistake) managed not to punch anyone, and we got through the day.

Then in the middle of the day, Bossman comes to me to chat about the whole deal, and I bring up the "Oh, by the way, you're also going to be giving chemo" thing. He truly did not understand why maintaining competency would be a big deal. "There are protocols and regimens in books this thick," I said, holding my thumb and forefinger about three inches apart. He had no idea. I am not a chemo nurse, and *I* knew that shit, just from being around it.

Now I am going to drink. Maybe not a lot, and maybe not hard liquor, but I am going to drink. With any luck, it'll mellow me out enough that I don't end up staying up late and writing letters to the medical director, the state board of nursing, the state board of morons, and the paper.

Holy. Crapping. MONKEYS.

Y'know what's great about being a nurse?

2011-07-21T16:50:00.000-07:00

What's great is this: when your worried neighbor texts you just before dinner because her seven-month-old has a weird rash just spring up, and you can go over there and see him and her and reassure her that yes, it's just heat-rash, he'll be fine.

Because--and this is what gets me--her pediatrician told her the same thing, but she and her husband wanted to talk to a nurse, because nurses really know what's going on.

(Never mind that I know next to zilch about pediatrics, and that heat-rash is pretty easy to diagnose.)

It gives you the warm fuzzies.

(Plus, I got to play with a baby for a few minutes which, if you are a fan of babies for a few minutes at a time, as I am, is not a bad thing.)

And then this afternoon, Max.

2011-07-20T18:34:00.000-07:00

I'd noticed he hasn't been barking at the mailman recently. And he needs encouragement to get up from the slippery wood floor; his back legs don't work as well as they did even six weeks ago.

Today I found him standing in the living room with a "what the hell did I come in here for?" look on his face. The last week, he's been standing stock-still and just staring at random times.

He's wuffing at the cats more often, but also staying still and licking their backs and heads more often, which confuses them. When he rolls over for belleh-rubs now, it's an even chance that I'll get a look that says fear and confusion versus a look that says rub mah belleh.

My boy is old. He didn't *get* old; he just suddenly *is* old. One day he was fine; the next he woke up in a puddle and couldn't get up easily and started forgetting stuff. His ears still twitch reflexively when I call his name; it's just now he can't remember his name every time. About one time out of three it's just a sound, not something to respond to.

Just now he's barking at the dogs walking past the house with their humans. If I didn't look outside, I'd think he was only a couple of years old, except that the barking stops too soon.

All I want is for him to have a good Fall and maybe half the winter. I want him to be mobile and happy without all this horrible heat that forces him indoors for most of the day. If he has to go down, I'd prefer he go down all at once, like he was hit by a meteorite. God knows he lived through enough to kill most dogs in his first nine months. I remember how apologetic he looked after he got the Huge Nasty Injections in his back muscles to kill heartworms, just after we rescued him: he kept moving from couch to floor to chair to floor and finally back to chair, just trying to get comfortable.

I will never, ever be ready to say goodbye to my friend, but I at least want him to be able to enjoy one last cool season, with fog and rain and being Braveheart, before he goes.

Shit shit shit shit shit. bangs head on knees

2011-07-20T04:46:00.000-07:00

As I told Der Alter Jo on Monday, it's a rare morning that I wake up and think to myself, "Y'know, I really should've drunk *more* last night."

Call this a rare morning. Also, please butter my ass and call me a biscuit; I'm feeling peckish.

The Fearsome Foursome (that's us in the Neuro Critical Care Unit) have finished our chemotherapy certification course. That means that, after several hours of hanging chemo under supervision, we'll be okay to be "chemotherapy resource nurses" at Sunnydale. Our chemo unit is moving over to Holy Kamole sometime this year, which means all our chemo nurses will be unavailable without major advance notice.

So Sunnydale will need resource nurses. Which is understandable, but. . . .

There are real questions as to what our scope of practice will be. Will we act as actual chemo nurses, hanging chemo on those very, very rare occasions when somebody needs it? If so, how will we maintain our skills? What about the safety issues surrounding patient care in our unit if we're somewhere else, monitoring a chemotherapy infusion? If we're both certified and competent (two totally different things; the latter has to do with practice, the former with book-larnin'), will we be expected to pull shifts in the new cancer unit at Holy Kamole? Or are we merely meant as a "resource" in the most basic sense--somebody to call if a patient has a delayed reaction or a bad IV?

The other nurses in the unit are very upset. Der Alter Jo, who is an intensivist and neuro specialist, is understandably bothered that the specialized unit she signed up for is getting diluted in terms of duties and resources. "If you're gonna have an intensive neuro care unit, have an intensive neuro care unit" is how I'll paraphrase it. She has worked so hard to make certain that the CCU's been utilized appropriately and has gotten adequate staffing, and that the other nurses have all been treated with respect and given resources. I can see why she's frustrated and angry. The other two nurses we work with are worried about safety and whether or not we're going to screw things up, plus they're understandably upset about having to learn an entirely new specialty--jack of all trades means master of none.

*sigh*

I volunteered to take these worries to Manglement, provided DAJ put 'em all into some sort of coherent formal letter. I guess we'll have a meeting soon about it. (Meetings: BAH.)

Something tells me that Manglement and the neurology folks are not on the same page about what's going on. I only thought I was worried before.

Tuesday night mellow

2011-07-19T19:15:00.000-07:00

You've got tombs in your eyes

But the songs you've punched are dreams

July Moneygrubbin':

2011-07-18T14:54:00.000-07:00

Mary is a friend of my pal Lara's friend Nikki. Mary is 38, and was diagnosed two years ago with stage 3B tongue cancer. For those of you who aren't fluent in solid-tumor staging, that's not good at all.

Mary has been in remission since March of this year. She recently started hyperbaric treatment to help rebuild the bone in her jaw. A word (or many) about hyperbarics:

When you have chemo, and more especially when you have radiation, to kill off a cancer in your head or neck, everything suffers. All the structures in your head and neck are affected, especially cells that replace themselves quickly, like those in your salivary glands and in the lining of your mouth and throat.

Because the treatment is really fucking intensive, and because it kills off your salivary glands, and keeps new blood vessels from forming, things happen after radiation that are decidedly not cool. For one thing, your bone? Doesn't heal if it's injured. It just sits there and rots. Hyperbaric oxygen therapy, or "diving" is supposed to fix that. You sit in a big, huge can, usually with pure oxygen pumped in under enormous pressure (at least ten times the atmospheric pressure you'd feel at sea level), and that forces pure oxygen into your bloodstream and thus into other tissues. That in turn causes what we in the biz call "angiogenesis," which is Fancy-Pants Medicalese for Growing New Blood Vessels All Over.

"Well, Jo, that's fanfuckingtastic," you're saying to yourself. "What does this have to do with anything?"

Let me tell you: Mary had radiation to her neck and face. She lost her salivary glands. As a result, her teeth are breaking off at the roots. She can't have them pulled unless she undergoes this hyperbaric oxygen treatment, because the lack of blood vessels in her jaws mean that her face will, and I am not joking here, simply fall apart. I have seen it happen, and it is about the ugliest thing you can think of.

Mary's going to need dentures after this tooth-yanking and hyperbaric treatment is done. She probably has the same insurance company as I do: it'll cover her hyperbarics, and the tooth-pulling, but won't cover the anesthetic for her tooth-pulling (for the love of God) and won't cover her dentures. Which means, tra la, that she'd do this all without sedation and then not be able to eat.

So you should, if you're looking for a place to drop a dime or two, give her your money.

Her blog is here, the fundraising page is here, and here's a video interview she shot recently:

Shoulda listened to the doctor when she said "No Heavy Lifting."

2011-07-17T05:49:00.000-07:00

Unfortunately, her definition of "heavy lifting" and mine differ. Apparently they differ substantially.

Before anybody panics, no, I did not herniate through my incisions (near as I can tell). I didn't tear anything or pull anything loose; I just did a little too much yesterday. Specifically, I went grocery shopping.

See, I shop at this place where the sackers are paranoiacally careful about how they bag up your food. I did *not* take my nice reusable bags with me, specifically to avoid the sort of weight that can be put in those bags. So I got umpteen bazillion bags of groceries, some with one package of rolls or one carton of eggs in them.

Also see, I do twenty-pound bicep curls on a fairly regular basis--sixty of 'em at a time. Plus, I lift more weight than I really want to talk about with my back and legs. I figured that I'd be golden for lifting umpteen bazillion very light bags of groceries. After all, I can straight-arm a 17-pound bag of dog food with no problem, right? Right.

Loading a dozen one- and two-pound bags of groceries into the car and then unloading them into the house undid me. I had actual pain for the first time since day two post-surgery: a feeling like I'd been repeatedly punched in the right side of my gut. I can still tell that it's there, though it's not actually hurting this morning.

I cannot freaking believe that *groceries* did me in. I mean, yeah, if I had been doing hot naked unassisted power ultimate yoga, or running miles at a time, or trying my usual lifting workout, I could see that there would be a problem. And I understand that the belly muscles are connected to the everything-else muscles. But, really: groceries? Rotisserie-seasoned, deli-thin-sliced chicken breast? Eggs? A carton of milk?

The deep frustrated grumbling you hear is me.

Let's drop that last title below the lead, shall we?

2011-07-15T16:06:00.000-07:00

Notamus is gonna get his comeuppance tonight. I have on the stove spaghetti sauce--pasta is one of his favorites, the little weirdo--with fake meatballs (soyballs?)(wheatballs?) and artichoke hearts.

Knowing him, he's gonna try to snatch a fakeball. I'm gonna let him. And boy will he be surprised when he realizes that it's not the sort I usually make, with the egg and the breadcrumbs and the veal and the pork and so on. If I'm lucky he'll have a facial expression worth capturing on camera.

*nod nod nod*

As to why I'm eating spaghetti and fakeballs when it's approximately a zillion degrees outside, it's because I can't bestir myself to go to the grocery store. When the low is 89F/almost 32C, the idea of hunting and gathering at the local market loses its glow.

Things are bad here this summer. Summers in the middle of Texas are always dry, but I've not seen a summer this dry in my life. Really and truly: there's not a crop in Central Texas that's survived this long, and most ranchers in the area and north of here are selling off all their stock in order to pay their bills. They can't afford to feed 'em, because nothing is freaking growing.

The upside is that there are fewer mosquitos than I remember there ever being. The downside is that everything in my yard is dead or dying. The upside to *that* is less maintenance later on, especially when you consider that those of us here in Littleton's Hippie Quarter aren't saddled with the demands of homeowners' associations.

Yeah, so: No rain means no grass, no herbs, no grain. No grain means no cattle going to feedlots means hugely high beef prices in about a year and a half, as there will be no mature cattle to slaughter then. No rain and temperatures of over 100F for the foreseeable future also means a dimunition in the number of fleas and ticks and mosquitoes, but also huge grass fires.

I am constantly amazed, especially when it comes to summers here and winters in the western part of the state, how people could've settled here in the first place. I mean, where I live isn't so bad: there's water, natural springs and the like--but west of here? Northwest of here? Those first settlers were BAMFs of the first degree. There is one natural lake in Texas. One. The rest are manmade.

I listened to an interview once with a guy who did water management or crop management or was a fire chief or something, out west of Midland. He said (and you'll have to supply the drawl for yourself), "You take a map of Texas, you draw a line down the middle. To the left of that line, it don't rain." Precipitation comes in the form of snow, ice, hail, sleet, and a horrifyingly heavy sort of drench that washes away roadbeds, but it doesn't rain like it does in Columbus or Boston or Seattle.

Every year about this time I begin to get rain-hungry.

And fake-meatball hungry. Time to mind-fuck the cat.

My pussy smells like fish.

2011-07-14T21:47:00.000-07:00

Which wouldn't be a problem, except the fish (she says, with emphasis, giving Notamus the side-eye) was meant for my dinner.

This afternoon I told Der Alter Jo the charming story of how Notamus had once intercepted a piece of pepperoni, mushroom, and black olive pizza while it was on its way to my mouth. He got a healthy shark-bite out of it before he bounced off the wall.

What? You try eating pizza when something with teeth is going after it and see what you do.

So, tonight, I had made myself a lovely tuna salad with chopped cornichons and shredded cucumber and grated onion and a delicate lashing of mayo. I had planned on eating it with pita bits and maybe itty shreds of veggies.

I mixed up the tuna with the mayo (home-made, by the by, with lemons I squeezed myself and olive oil carefully dribbled into the blender) and the onion and the cornichons and then turned my back to assemble the other bits of dinner.

When I turned around, I found one Notamus eating MY TUNA.

*cue frustrated troll noises*

So: Notty got two-point-six ounces of tuna. With fixin's. I got pistachios and wine.

HAT is only one letter different from CAT.

(And, post-scriptally and parenthetically, how weird is it that my cat likes sour French pickles? Because the underlying aroma of his breath is cornichons, overlaid with TUNA. Bastard.)

Twiddling thumbs

2011-07-13T14:46:00.000-07:00

No news is good news, right?

Right.

My incisions itch. I wore pants today, for a short time; long enough to head to Target to pick up a new water bucket and rug for Max. He's ignoring them both, being resistant to change. Eventually he'll cop to the fact that Old Dog Hips are more easily levered from the floor when the feet below them have something to grab hold of, and that Old Dog Mouths like water from nice, fresh buckets rather than two-year-old, scuzzy things, but for now? he's ignoring both with glacierlike calm.

Two things that shock me today: how swollen Mah Belly actually is and how stupid people can be.

I put on a dress that fit fine the day before surgery and was surprised that it wouldn't zip up past my waist. I figured the belly-swelling was a two-to-three-day thing, at the absolute outside, and that I'd be back to normal by day five (which this is). Sadly, no.

I also figured that, given that we're getting more and more patients with strokes in the CCU, there would be--at some point--a drop-off in the number of people admitted under stroke protocol who later turned out to have such conditions as, say, a torn rotator cuff.

Sadly, no.

Going over the recent chart audit submissions from here at Casa Del Piles of Sleeping Mammals, I was distressed but unsurprised to see that the guy whose job it is to compile all the charts to audit had, as has been his habit, included a bunch of people without strokes and missed a number of folks with them.

A little explanation: chart auditing is one of those things which the Accrediting Agencies require hospitals to do for the accreditation. Because Sunnydale and Holy Kamole are both now stroke centers, it falls on us to audit the charts of people who come in with stroke symptoms to make sure that we're doing things like telling them to quit smoking, getting them head CTs in a reasonable time, and doing NIH scales. I got volunteered for the job of doing chart audits because I don't spend enough time already either taking care of patients or making sure people don't suddenly leap out of bed like so many gazelles, eating utensils in hand, ready to attack other nurses.

For whatever reason, the guy who makes up lists of charts for me to audit has about a fifty percent success rate in actually picking out the folks who have had strokes or strokelike symptoms. Fifty percent. That means that half my time is spent picking through charts, reading notes, and looking desperately for something that says "stroke," only to find that the person I'm reading about had, say, a bad reaction to chemotherapy (not making this up), a case of food poisoning (not making this up), or a fecal impaction (o how I wish I had made that up).

The other half of my time is spent--and I kid you not, it's probably close to 40% of the remaining time I spend on audit-related stuff--looking through the charts of everybody that Sunnydale or Holy Kamole has discharged in the past three days, and usually finding stuff that Chart Guy has missed.

Ten percent of that time is spent actually auditing the charts of stroke patients. Since most of them come to me, it's quick and easy: I can and do do it from memory, mostly.

So, yeah. The TL;DR of the preceeding complaint is that I'll have twenty or so (at last count) charts to transcribe to paper and a couple hundred to slog through on the hunt for missed strokes. I don't know what Chart Guy's problem is, honestly, except that he's probably as overworked and understaffed as the rest of us.

In other news, uh. . . .I got nothin'. Der Alter Jo has damaged her knee in some unique and painful way, so we're both lying up on our respective couches feeling like extras from "Spirit of '76." I finished Bill Bryson's book At Home with the result that I now have a list of six more books that I really ought to read. I'm getting into the first season of "Torchwood" and now want to buy a Roomba vacuum for the sole purpose of naming it Ianto.

Off to turn the a/c down some more, and maybe pour myself a glass of something intoxicating, before I get back into chart audits. Hospital administration would be so much more pleasant--and probably more productive--if we were allowed to tipple at our desks.

Owling; because planking is so yesterday.

2011-07-12T20:02:00.000-07:00

I just saw the first example of Owling I'd seen on the 'Webs.

You have to perch in a crouched position like a bird on something unlikely.

I think this might be a new trend at Sunnydale.

F'rinstance, I could Owl on the person who went after Kari with silverware the other day. You do not go after my colleagues with sharp things; how many times do I have to tell you this?

Number of people who have tried to stab, punch, kick, or bite Jo or her colleagues: 11.

Number who have succeeded: 1.

That leaves ten who have failed. You are not the exception.

*beat* *beat*

So, yeah. Owling. It doesn't look as though it's particularly physically challenging, and I wouldn't have to lie on my stomach. I could, you know, crouch on the staircase leading to the roof access just above the 9th floor stairwell. Or Owl on the unit secretary, provided she's in a good mood and not hung over. Or Owl on an empty bed. Or, hell, a full bed, provided the person in the bed isn't noticing much.

Propofol + Jo = Owling Deluxe.

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

In other news, Friend Penny tells me that *everything* weighs more than five pounds and *everything* is below waist height. I am not allowed to lift anything heavier than the first or lower than the second. Even so, I have scooped Notamus up from the floor (12 lbs) (lower than my waist) and snuggled him, and the only side-effect I have had is a buzzing kitty on my shoulder. Still, I won't be moving heavy boxes full of Stuff any time soon. It's truly astounding what you can feel from just three small puncture marks.

The one in the depths of my belly button itches terribly. The one to the right of my belly button, where they did all the actual pulling & tugging, does not--but there's an area about the size of a half-dollar, two inches down, that's about to drive me NUTS. And, of course, I move faster than light when the boys decide (either singly or together) that they need to hop up into my lap/belleh.

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

I am waiting for my post-op pictures to show up on Facebook.

I hope I photograph, slackjawed and roll-eyed, well.

0215 Sunday:

2011-07-10T12:26:00.000-07:00

*bleeerrrrt?*

MROOoooooOOOW.

(rattle rattle rattle THUD)

Mmmmrrrr?

Mmmmrrrr.

(pat pat pat pat THUD pat pat pat pat)

Meeeeeeh? THUD

MRROOOWWW.

(silence)

*creeeeaaaaaak*

Bllllrrrrt?

CRASHBANGTHUDCRASHBANGCRASH

*tinkle*

*tink*

Mrrrroooooow?

BORED. blam BOOOORED. blam BOOOOOORED!! blam

2011-07-08T18:17:00.000-07:00

(A little "Sherlock" humor there, special for Der Alter Jo.)

I do this Recovery Thing very badly.

First of all, I hate pain medicine. Dilaudid makes me woozy and dizzy, hydrocodone makes me itch, it's too early to take naproxen or ibuprofen, and whiskey is ten miles away and thus totally out of the question. But I *hurt*, so I end up taking the Lortab as it's been prescribed, especially after Notamus decides that his fourteen pounds needs to be on my lap right the hell now. And I itch, and it doesn't help much, and I'm still stuck with this cat on my tum.

Secondly, I have entirely too much energy of entirely the wrong sort. I can't lift anything that weighs more than five pounds. That makes laundry difficult and taking out the trash impossible, and made folding up the futon today something that I considered, then rejected. Don't even ask about the gymnastics it took to get Max's food bowl off the porch and into the house.

I suppose I could edit the stuff I've written for Scrubs, but if there's anything worse than my writing when I'm on painkillers, it's my editing when I'm on painkillers. All of a sudden, major arguments go away and subject-verb agreement seems not to matter in the least. I become one of those people who insert's apostrophe's rand'omly into word's. Worst of all, I start adding things that, to my sleep-deprived and drug-addled brain, sound funny. It's like SNL in the mid-nineties.

Thirdly, I am very, very, very grumpy after surgery. Maybe it's the constant itch; maybe it's the inability to *do* much, or maybe it's the cat walking on the keyboard, but I get foul-tempered and out of sorts. I've been reminding both the boys today that "cat" is only one letter away from "hat" and that it won't stay too hot for fur headcoverings forever. It's unfair; they're actually being very sweet, if a bit clingy, but I'm taking my temper out on everything from bran muffins to ceiling fans that need to be dusted.

(Speaking of cats, Ibid showed up this evening earlier than usual and wearing a cute little pink collar with a bell on. She has a new home, hurrah! She acted quite pleased with herself and declined food, but accepted pets.)

And, finally, *you* try to be serene and relaxed when your belly is so bloated you can't breathe deeply. I have some remarkable bruising that's only just now starting to show up, as well as some fantastic marks from the tape they used on the operating drapes: I'm allergic to adhesives, apparently. My right shoulder is sore, even though they obviously worked hard to press all the CO2 out of me prior to closing me up.

It's a good thing I own ten empire-waisted dresses. Der Alter Jo asked hopefully if I'd be able to make Marcus Wallaby, MD's birthday party this weekend, and I had to respond, "Dear, I can't even wear pants. Only sluts run around without drawers, so the answer is no."

I guess it's a good thing my social life is in shambles. I'm in no shape to be pretty, popular, or charming just now. I can go to bed, sleep three hours at a stretch, and then get up and surf Craigslist for project cars and nobody'll be the wiser.

Bah. Lortab. Bah. *blam*

What Fresh Hell Was That? or, My Day At Holy Kamole.

2011-07-08T05:05:00.001-07:00

My doctor doesn't do surgery at Sunnydale, because apparently they don't have the right sort of laparascopes, or the walls aren't sufficiently lined with gold, or something. So Der Alter Jo and I were at Holy Kamole at oh-dear-thirty yesterday, her limping on a busted knee and me casting the side-eye at everything, for Animal's eviction.

Preop nurse, resident, attending, preop nurse again. More urine, more blood. Cute little backless dress. A fond farewell to being able to bend over easily for a while.

A brand-new nurse intern started my IV and did a slammin' job. I have veins like hoses in the backs of both hands, so when she hesitated between an 18-gauge and a 20-gauge 1.5 inch IV, I told her to go big or go home. One stick, flawless placement, and she only needed help on taping the thing up. Not so on my other hand, where some Einstein in the OR tried three times on the back of my paw, blew one vein and missed two, and finally did the med-student start on my wrist just below my thumb. Brand New RN Whose Name I've Forgotten, you rock.

Then EKG leads and a KVO rate bag of fluids, then two CNAs came in to introduce themselves and one brought Versed. Then down the hall on a surprisingly comfortable gurney (why can't Sunnydale get some of those?), into the OR, which was smaller and more crowded than I expected, and another shot of something into my IV. Aaaaaaand goodnight.

The disturbing thing about general anesthetic is the complete lack of a sense of time passing. Your brain tries to rationalize it later, but at the time, you go to sleep in the OR and wake up simultaneously in post-op. I do vaguely remember being extubated and hearing somebody ask if the doc wanted the Foley out, but that moment collapsed into the going to sleep/waking up moment. All I know is that I went into a controlled coma with one set of friendly people and woke up to another set, including Friend T-Bird, who is liberal with the Diluadid. Somebody handed me my prosthetic, which I tried earnestly several times to put in backwards until I figured it out.

I precepted T-Bird when she was a new nurse. She's now an experienced post-op nurse and a new mother, and both seem to agree with her. She was blooming. It's so nice to watch frightened, shy people really get into their groove. Plus, I don't think I know anybody prettier, which is nice to wake up to.

Back up to the post-op recovery room. Der Alter Jo at the bedside, giggling over my inability to move and my drunken philosophizing. A sudden brain-stem-level urge to get the HELL out of there, and so ice chips. And Sprite. And getting up on my own (woooooooo....*listing heavily to one side*) and peeing and getting discharge paperwork. Into a wheelchair, which, thinking back, Der Alter Jo could probably have used better than me, what with her knee.

Car. Highway. DAJ is another one of those conservative looking types who can push a Prius up to 90 and keep it there, so I just shut my eyes and replayed Disney cartoons in my head.

As of right now, I'm surprisingly comfortable. If I had a wide-angle lens I'd take a picture of my stomach. Never flat, even at the best of times, it's now assumed some really weird contours and bruises. The trochar punches form an equilateral triangle with my belly button at the top, about four inches on a side. I have a hard time getting up or down quickly, but once I'm one way or the other, I'm good. I have bowel sounds and can pee on my own. Eating is no problem. I do the splinted-deep-breathing-and-coughing thing once an hour, because coughing and laughing hurt.

The most uncomfortable part of my body is my throat, from the intubation. The anesthetists were very excited at seeing what they called an "A-one-plus-plus airway." I guess that's anesthetist humor.

The Boys are playing with all my ID bands. The folks at Scrubs Magazine sent a lovely bunch of flowers. I have a full refrigerator. I can't complain, unless I drop something on the floor that I really need.

Oh, and the doc said that Animal had chips of calcium (unformed teeth), hair, and sebaceous pockets. That last is medicalese for "that stuff that makes up zits." I feel like I've had a teenaged boy removed from my reproductive system. I feel twenty years younger. (ba-dump KSSSH.)

I'm home; all is well.

2011-07-07T10:43:00.000-07:00

Bloated belly, three band-aids, and a disinclination to move quickly. That's what I've got.

Oh, and one less unwanted tenant.

Can this be all for a while? Thank you.

Uh....yeah. I have no idea how to do this.

2011-07-06T06:38:00.000-07:00

I'm sitting here staring at two little packets of Hibiclens scrub. I have to SCRUB MAH BELLEH with one tonight and one tomorrow morning, prior to Animal's eviction.

The nurse at the presurgical testing hootenanny didn't tell me anything specific, and I was too flummoxed to ask anything specific. She just handed me the little packets and said, "Scrub once the night before, and once before you come in, and prepare to be ashy." She then looked at me more closely and corrected herself: "Dry. You'll be dry. You're already ashy."

So, um. . .what do I do? I mean, I assume I should pay some extra attention to my navel, since one of the trochars will be stuck through it, and that I should scrub gently, without trying to take the skin off. But should I leave the suds on for two minutes, or something? Use a black rooster rather than a washcloth to apply the stuff? Put my right foot in, then out, then shake it all about? Is there something special I need to know?

Searching "preoperative chlorhexadine scrub" leads me to interesting studies of iodine versus chlorhexadine and a stunning PDF, with illustrations, of how to scrub your horse prior to surgery. Since I don't own a large scrub brush, I can't follow those instructions.

Ideas?

The weirdest thing about this surgery bidness?

2011-07-05T14:51:00.001-07:00

Is this: Dr. Crane didn't type and cross me prior to removing El Lumpacito, because there was little chance of his running into any major vessels during surgery. Dr. T decided to do a T&C because, as she put it, there's a lot of *stuff* in the belly, and better safe than sorry.

So, when the type & cross results came up in my email, I opened them expecting to see a blood type of O-positive, which is what I'd always thought I was.

I'm A-positive. Without, as it turns out, antigens to anything. Given that I've never had a transplant or a transfusion of any sort, that wasn't a surprise. The A+ part was, though.

I had to check in the mirror to make sure my eyes are actually blue.

Ah, the first week of July....

2011-07-05T02:50:00.000-07:00

I'd like to know what Einstein decided that the first of July would be a good time to introduce new residents to their units. I mean, it's right before a holiday (this year's been especially bad, what with the three-day weekend), people are going on vacation, and patients always crump on holidays.

Always. It's one of those immutable laws of the medical Universe: if you have a person who's had, say, a minor bladder-scoping procedure, that person will choose a holiday (preferably one with a three-day weekend involved) to have something completely nuts happen that lands him or her on six drips and a vent. We once had a patient who came in to have a couple of teeth removed prior to some other surgical procedure who coded on the table: it was the day before Thanksgiving.

I mean, *really*? (Side-eye at Murphy and his laws.)

One good thing about having residencies that last at least five years, which is all of the ones that I work with regularly, is that you don't get too many bright-eyed, idealistic young medicos on July first. Most of the docs who rotate in and out of the units have been there before and have just been out doing research, or something. They're the same exhausted, cynical people we've worked with forever.

We do have one rather dashing new fellow ("fellow" in the academic sense, though he's also got XY chromosomes) with a Spanish accent and Italian shoes. He glided in yesterday, did a very thorough exam on one of my patients, then discharged her home without any fuss or muss. It's nice to see efficiency. I doubt the Italian shoes and silk tie will last through August. I hope the lack of drama does.

July is also the beginning of the yearly fiscal crunch for State-funded agencies here Deep In The Heart. Some of my colleagues have simply gone missing, laid off in the face of gazillions of dollars of shortfalls. Others are walking around looking tense about the possibility of losing their jobs. It's all Manglement positions that are being cut, no front-line staff, but that doesn't make it any easier. Nobody's hiring, either. What that means at the end of the day is that if you're working in research, you now have thirty more cats/pigs/rats to deal with in addition to the ones you were already taking care of. If you're a mid-level Mangler, you've got six more pages of audits and quality-improvement surveys to do every week, and no help.

Maybe they could get the residents to help with the audits. It'd at least give 'em a chance to sit down once in a while.

Self-Portrait Sunday

2011-07-03T11:08:00.001-07:00

What you should never, ever do.

2011-06-28T17:02:00.000-07:00

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

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

Like your walls. Your walls.

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

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

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

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

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

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

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

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

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

Gracious!

2011-06-27T18:58:00.000-07:00

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

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

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

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

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

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

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

And that is all.

People make me so MAD.

2011-06-20T02:29:00.000-07:00

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

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

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

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

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

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

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

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

2011-06-17T14:23:00.000-07:00

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

What I most emphatically did not do today:

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

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

A Burma-Shave-worthy offering from my sister:

2011-06-14T18:35:00.000-07:00

"When you're sick

Here's how you know:

Even doctors

Mutter 'Whoa.'"

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

woo

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

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

woo

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

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

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

Thank God I'm a nurse.

2011-06-13T19:38:00.000-07:00

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

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

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

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

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

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

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

So there's this new doc....

2011-06-12T17:50:00.000-07:00

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

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

Max got a bath today.

2011-06-11T12:23:00.000-07:00

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

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

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

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

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

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

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

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

I met somebody today.

2011-06-07T14:41:00.000-07:00

I am so excited.

Just over the freaking MOON.

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

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

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

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

Wow.

See, here's the thing:

2011-06-07T03:18:00.000-07:00

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

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

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

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

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

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

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

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

>shakes head<

Sometimes nothing works.

2011-06-04T20:36:00.000-07:00

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

2011-06-04T18:28:00.000-07:00

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

Congratulations, new graduates! You'll be fine.

2011-05-31T16:21:00.000-07:00

Really.

You won't kill anybody.

No, I mean it. Seriously. Just remember Jo's First Rule of Nursing:

If you have to fuck with it, it's wrong.

This was brought home to me in a big way just yesterday, when I had a patient with one of those don't-stop-it-or-they'll-die drips. The pharmacy sent a bag with a certain concentration of drug, and that matched the doctor's order, but the pump....was fucked. I couldn't make the drug dosage on the order match the drip rate in the pump's library, no matter how much I fucked with it.

So I stopped. Because fucking with it until you can't remember exactly how you got to where you are means it's wrong. I got another pump, with a different drug library, and I reprogrammed that pump, and everything was fine and dandy.

Advice for the new nurse, graduate nurse, or intern, gleaned from five minutes' worth of actually paying attention over the last decade:

1. Do not freak the fuck out.

There will be time to learn everything you need to know. There will be people who are willing to answer your questions, and people who will have your back (even if you don't know it at the time) and people on whom you can call when things hit the fan. You are not doing this on your own. Everybody has been where you are; sometimes we feel like we're right there with you once again.

2. Actually killing somebody means that a lot of things have gone wrong.

Therefore, it's extremely difficult. With any medication or procedure or what-have-you, there is a string of quality-assurance checks that happen that are meant to ensure that you, New Nurse, will not make a mistake. Trust the procedure, but verify. Which brings us to:

3. Be sure to ask for help or advice when you're not feeling confident.

I ask for help every damn day, and I have been doing one thing for eight years. How many of you have done one thing for eight years? Show of hands?

Yeah. That's what I thought.

The point here is that the human body, even independent of doctors' orders, can do crazy shit with very little warning. Don't bully on through if you don't feel good about it. It's worth it to look like an idiot, or to take the extra five minutes to verify a policy or drug dosage.

4. This ain't no party; this ain't no disco; this sure as hell ain't no fucking Grey's Anatomy.

Don't sleep with your coworkers.

I don't care how cute that nurse is: you're asking for trouble if you have a horizontal relationship. Ditto the resident, the intern, the attending, the other nurse's boyfriend. Just don't. If you must have a relationship with another nurse--a decision which might lead to endless arguments about who had the worse code that day--make it a nurse you don't work with directly.

I, and your other coworkers, thank you.

For this one, Rob, I'm looking at you:

5. Don't work too hard.

There is time. Coco Chanel said that there was time for love and time for work, and no time for anything else. If you adhere to that philosophy, you'll be a crappy, burnt-out nurse in no time. I know you have loans to pay off and an electricity bill that's two months overdue, but you can't kill yourself the first six months out of school. Any knowledge or insight you gain will be overwhelmed by stress hormones.

Take some time to rediscover what you loved before you started drinking from the firehose that is nursing school. Remember what it's like to wake up in the morning (or evening) with nothing to do all day (or night). Read for pleasure. Go catch a movie. Spend a couple of hours doing nothing but daydreaming and petting the dog. It'll not only help you stay healthy, it'll make your brain more able to retain information, true fact!

You're done. You've walked the stage, you're about to take the NCLEX (and you'll pass, I swear), you're getting ready to start a hell of an adventure.

Congratulations! And I look forward to working with you.

I'm really looking forward to a week off.

2011-05-31T04:54:00.000-07:00

It will come as no surprise to anybody that people can be stupid.

I wonder why it still surprises me sometimes. The level of inexcusable, inexplicable, unbelievable stoopid I've encountered lately has left me looking forward to having holes punched in my belly. At least I'll get a nap, and at least I'll be at home for a week.

People, please:

If we tell you Papa mustn't drive after his stroke, that means Papa must not drive. Not "not drive long distances" or "not drive a Toyota" or "not drive to the store." It means that Papa now lacks decision-making ability, part of his visual field, and most of the use of one side of his body, and Must Not Drive. Even a big car, even for short distances, even in town.

This is a hospital. It's in the inner city, on a busy street. People come in and out and through on a regular basis. Some of them have business here, while some are merely cutting through our lobby in order to shorten the trip from point A to point B. We can't predict who's going to be coming in and out. Therefore, it's a very bad idea to leave your computer, your iThingy, your purse (no, I am not kidding), your children, *whatever*, unsupervised for long periods of time in the ground-floor lobby.

Likewise, if you choose not to reveal that you have valuables on your person (which means I can't inventory them and lock them in the safe), I am not responsible if your aunt, cousin, ex-husband, or daughter takes those valuables away while you're laid up in the bed. It says so right there on the admission sheet.

No matter how long ago you had that reaction to that drug, it's still an allergy. If penicillin made your face swell up and your breathing get funny six months ago, it's likely to do the same again. Please tell me these things. While we're at it, tell me if you have a food allergy. Some things I can predict, like that the guy whose rabbi visits twice a day might not want bacon on his breakfast plate. Other things, like that you're allergic to nuts, are not immediately obvious.

If Mama is ninety-plus years old with multiple medical problems and occludes the big arteries in her brain, then converts to a hemorrhagic stroke, it might be time to let her go. I do understand that this is a horrible shock to you and that it's tremendously difficult, but please: you are not doing her any favors by leaving her on a ventilator and pressors and a tube feed for three weeks. There is no Mama in there any more.

Check a blood sugar before you give insulin to your patient. That way I won't be trying desperately to start an IV in a stenosed, disappearing vein that belongs to the person with a blood glucose of 20. (Jesus H. Creeping Roosevelt: how many times do I have to say this?)

And, finally: I know I am strong. I know there's a certain amount of noblesse oblige that comes with being stocky and squat and able to lift heavy things. That doesn't mean, however, that if you ask me to "help" move your patient from the bed to the chair, you can stand by quietly as I lift your patient bodily, pivot him (with only toe-touch to the floor on his part), and place him in the chair by myself. Although I am so feminist that I glow in the dark and kill noxious weeds at twenty paces with only a glance, I will be doubly pissed off if you're a man and bigger and stronger than I am. Help means help. Picking up a person and slinging him over my shoulder means my back hurts today.

Do you suppose, if I stay under general anesthesia long enough, that the collective IQ of the planet will have gone up a few points by the time I wake up?

I just won five bucks.

2011-05-28T10:03:00.000-07:00

Although I doubt Laura-Loo will pay, because she wasn't all that keen on the bet in the first place.

We had a patient with symptoms of psychogenic origin (English: crazy as a pet raccoon) discharge home the other day. I bet her that the patient would call within forty-eight hours with either a problem or a claim that we had failed to return some of their (controlled substance, held in a lockbox) prescriptions.

I returned all of the prescriptions on discharge, and made sure I saw the patient put them into their suitcase. I even noted that in the chart.

They called today, claiming we'd lost a bottle of controlled-substance drugs.

We're never accused of failing to return antibiotics or hormones or other non-formulary drugs without a significant street value or abuse potential. It's always the amphetamines, Oxycontin, and Fentanyl lollipops we lose.

Of course.

Random, and updates.

2011-05-25T14:50:00.001-07:00

Dr. Crane emailed me on Tuesday with a single line: "MRI looks good. No tumor."

That was fucking amazing, guys. I wasn't aware that anybody was even looking for a tumor. I just thought they were, you know, getting a baseline for my new skull configuration.

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

If you wake up from your afternoon nap totally blind, it's probably not a good idea to wait a full twenty-four hours before you go to the emergency room.

On the upside, though, it gives me a chance to see a really nice case of cortical blindness in action, along with temporal lobe edge-sensing and a lack of confabulation. The patient's hypothalamus got hit in the stroke as well, with the effect that they seem to be unable to regulate body temperature.

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

Likewise, if your spouse has had a stroke, it is not a good idea to allow them to drive. Home. From the hospital. Just. Sayin'.

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

And finally, let me make this perfectly clear:

We Can Tell If You Are Cray-to-the-Cray.

If you insist (par example) that you have to have an MRI because of some whacked-out set of symptoms that correspond to no possible hit in your brain to me, then insist that you *can't* have that MRI because of some whacked-out implant that nobody has ever heard of to the doctor, we will treat your case with what's known as a "high level of suspicion."

I still do not know, nearly ten years later, why people think faking neurological symptoms will somehow fool neurologists and neuroscience nurses. We have seen it all before, including things that hadn't been described before we saw them. I, personally, me, Little Jo The Neuro Nerd, have seen two things that weren't named before the patients showed up on our doorstep, and one additional thing that our most experienced neurologist had never seen, but only read about. He told me I could retire happy after that one.

You can't get past us. We are the Cerebrus of the medical system. Just give up, already.

Please note that here I am not describing conversion syndrome, which is a positively hellish disorder in which your body basically takes over your brain. I am talking about hydromorphone-craving malingerers. Dilaudid's a great trip; I'll give you that. But it's not worth four days in a CCU, with me standing over you like an angel of Hell.

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

In other, more personal news, my GYN thanked me today for being the easiest, least emotional, most logical and productive surgery consult she'd ever had.

Yes, Animal is being evicted. On July 7th. I have yet to tell my boss.

My GYN, whom I'd thought was seven feet tall and as impressive as Michelle Obama, actually turned out to be a rather short, fragile-looking woman with huge eyes and a ready grin. It's amazing how one's perspective changes when there's no speculum involved.

Animal is roughly the size of, oh, I dunno, a starling's egg? A robin's egg? Say, four cee-em one way and three cee-em the other? And, thankfully, there was no indication of malignancy on this super-de-duper microsonic amazo-sonogram. Teeth and hair and possibly some waxy substance (me thinking "WAXY BUILDUP" from the commercials), yes, but not anything scary.

So not big, but big enough to torque, which would be a fucking emergency. So we're going to take it out. Not that there was any question, mind you: as long as I'm still relatively young and healthy, and have met my deductible, why not go in for another $13,000 nap?

It'll be laparoscopic and will involve four band-aids to my belly. Worst-case scenario, which neither Dr. Impressive nor I think is likely, would involve the ONC/GYN staff coming in to do a lavage of my belly and take out both uterus and tubes. More'n likely I'll get out in under an hour.

My recovery nurse, whom I've already lined up, is named Tiffany. So is my surgeon. All I need now is a gashog with the same name and we'll be set.

Remember when we all were kids, and we were told "Girls can do anything they want!"? That time is now. I'm a middle-aged woman going under the knife with a female, black surgeon and a female recovery nurse, and probably a female anesthesiologist.

Wow. Things sure have changed since the 70's.

Head Nurse

Why I love my job, part umpty-umpty-ump:

In which Nurse Jo performs an assessment:

So, yeah. Hey. How you doin'?

While you're waiting for a real new post, kd lang.

Things They never tell you about having had cancer:

Redemption rips through the surface of time

Question From A Young Nurse: But What About The Feelings?

Am I old yet?

HA.

And a Huge Shock:

Updates, of a sort.

Two and a half minutes of nomming Teddy Bear.

In case you've had an especially bad day. . .

The Evolution of a Bug.

BIG DRAMA today at Bigton's Scanning Centre!

Black Friday Relief. (not that I went anywhere, mind)

It's like I put a quarter in the scumball machine.

Had a bad day? Have some ducks and a cop.

One thing about being single

What we talk about on slow days.

Best voicemail ever.

Dear Blue Cross and Blue Shield of Texas,

Odds and Ends after a few days off

I'm tired of this body. Can I trade it in?

Remember back when I had CANSUH? Back when I was in a good mood?

Happy Anniversary.

Here's the real fatitude. Fatty fatty fat fat ground squirrel ahoy!

Since when are plumbers hot?

Okay, try *this*.

Interesting question via the comments.

Had a bad day? Have an otter having its morning bath.

I'd have fun nursing stories for you, except I haven't got any.

Oh, yeah. I was reminded that I hadn't posted details about that date.

I love the "artist" in the beret.

Letters! I get letters!

Okay, this is ridiculous. And it doesn't change my view on having WILD FUCKING ANIMALS as pets. . .but.

Had a bad day? Have a cub-'n-bucket.

Tomorrow, the State Fair starts in Yeehawton.

Whiskey-soaked donuts, Tornado Taters, unicycle, eight small rubber balls.

Nursing stuff later this week. For now, *sigh*.

Home again, home again, etcetera.

Say nice things about me, 'cause I'm gone. . .

This made me laugh right out loud.

Pens The Lotion Slut emailed me this morning

This picture is copyrighted by Deanna Roy

I get all excited about the weather, and then everything catches fire.

OMG. It's supposed to be 80 here tomorrow.

Two Stupid Things in two days: a new record?

*pant* *pant* *pant*

Bizzy Backson.

Had a bad day? Have some sleeping leopard cubs.

First they play a two-step, then a Cajun waltz. If you don't dance, then it's your fault.

Y'know what's depressing?

Good God, has it been that long since I posted?

I was watching Notamus eat my guacamole last night

Yo! Smart people! You are not disabusing me of my stereotypes.

Had a bad day? Have a beluga whale and a mariachi band.

Nothin' like blood up to your elbows.

Odds & Ends

'Zhausted.

Had a bad day?

Max news!

Oh, well.

*pace* *pace* *bang* *bang* *pace* *pace*

Let's get one thing straight right the hell now.

Eeeyep. Yep, yep, yep. Juuuuust about quit my job today.

Y'know what's great about being a nurse?

And then this afternoon, Max.

Shit shit shit shit shit. *bangs head on knees*

Tuesday night mellow

July Moneygrubbin':

Shoulda listened to the doctor when she said "No Heavy Lifting."

Let's drop that last title below the lead, shall we?

My pussy smells like fish.

*Twiddling thumbs*

Owling; because planking is so yesterday.

0215 Sunday:

BORED. *blam* BOOOORED. *blam* BOOOOOORED!! *blam*

What Fresh Hell Was That? or, My Day At Holy Kamole.

Okay, try this.

Nursing stuff later this week. For now, sigh.

pant pant pant

pace pace bang bang pace pace

Shit shit shit shit shit. bangs head on knees

Twiddling thumbs

BORED. blam BOOOORED. blam BOOOOOORED!! blam