The morning after the nights before.

Holy crapping monkeys, as my coworker Kathy would say, it's been a week. Working four nights in a row leaves you in much better shape than, say, working two nights, being off for a day, and then working two more....but HCM, what a mess I was this morning.

I'm finding that I really like becoming a generalist. Though Sunnydale is primarily a neuroscience facility, we also see what are called "complex" patients. Those are folks with massive, complex medical histories that wouldn't normally be able to get the sort of surgical or medical care that we provide in the itty-bitty towns where they live. As a result, this week I've taken care of a patient with a neobladder (so freaking cool--hey! Let's make a new bladder out of this piece of intestine! How about it?), one poor dude with some whacked-out chest surgery, a woman with an incredibly complex breast reconstruction that involves moving some bits here and other bits there, and a couple of people with your average, every day, run-of the mill stuff like aneurysms and infiltrating sinusitus, who also have X, Y, Z, and Z to the X wrong with 'em.

My eyes still glaze over when I see an EKG rhythm other than normal sinus, but I *really* dig seeing fresh post-op patients and their various problems.

Sometimes those problems require more of a light touch than at other times.

I was settling in a fresh post-op last night whose angiogram had run later than we'd expected. They'd managed to coil the dude's aneurysm, but one of the coils had gotten loose and had had to be retrieved, which took a little longer than usual. He was fine--grumpy about having to lie down flat for six hours, but otherwise okay--so I was able to take some time between hourly neuro exams and chat with him.

He started talking politics. Now, regular readers of this blog know that I don't talk politics or religion with my patients. If they ask, I'm a Democrat, a conservative Republican, a Christian, or a Blorgian yak herder--whatever gets me out of the room and doesn't raise either of our blood pressures. So this time, as in the past, I kept my eyes down, my hands busy, and my mouth shut while Aneurysm Dood bloviated.

Health care, as it turns out, is not a human right. Nope, no sirree. Health care of any sort is one of those things that the deserving work for, by God, and no socializt preznit is going to tell *him* any different. Why, if you need something, you should just go to the emergency room, right? (I didn't say a word. I swear.) Nobody should get what they haven't earned; if they take something for free, like health care, they're nothing but a drain on the system.

(Parenthetical note: why did this guy assume that I would agree with him that health care isn't something that everybody ought to get? I mean, did he not realize that I see the effects of untreated hypertension and diabetes every day? I know, I know; rhetorical question.)

In fact, that's what *he* did. He had a terrible headache, and some vision changes, and drove himself to the hospital--no socializt ambulance for him!--where it was discovered that he had an aneurysm that was just about to go nucular, if you'll excuse the term.

Whereupon he was airlifted, on a two-hour whirlybird flight, to our fine facility. We called in the neuroradiology fellow, a couple of CNAs, the radiology techs, a nurse or three, and promptly coiled his aneurysm. We then moved him to the CCU, where I was busy dealing with his incredibly labile blood pressure.

Where, glory be to the Great Watchmaker and technology, he was well enough to bitch about socialized medicine and the takeover of our good, clean American society by left-wing radicals interested in running our lives to the nth degree. He'll spend the morning in the CCU tomorrow, then be ambulanced home to Teensyville, where he'll return to normal life, except for a checkup in six months.

I was glad we were able to help him out, even if his particular views were odious to me personally. I was even more glad when I saw his face sheet, with the code next to the financial number that means his care was paid for by the hospital as a charity case. Everything, from the airlift to his breakfast in the morning, will be financed by Sunnydale; it's part of our commitment to provide free care to one in five patients.

Those damn socializts. By which I mean us.

Sometimes the strangest things strike me as hilarious.

The following communication will not be therapeutic.

If you have a patient-controlled pain relief pump that is giving you thirty micrograms of fentanyl every five minutes with an optional bolus of one hundred micrograms of the same drug every hour, and you've been taking advantage of that bolus every hour on the hour for the past twelve hours, and you've also been taking more than one hundred milligrams of baclofen and more than one hundred and twenty milligrams of oxycontin and various other milligrammage of narcotics twice or three times daily, please do not try to get me to believe that you are going into withdrawal because I have removed your fentanyl patch, which expired three days ago.

Because I will look at you and say, "Really?"

Then, when you do not respond, I will say, "Really?"

And when you tell me that you're feeling queasy and you want Phenergan, because ondansetron doesn't work for you, I will say, "Of course it doesn't."

It has been a long week.

I can't believe I'm having to go over this again.

*sigh*

You would think, after however many years I've been doing this, that I would cease to be surprised by people. Or at least that I would become inured to their behavior. Sadly, people continue both to surprise and irritate me. 

My patients, generally, surprise me but don't irritate me. My patients, generally, are quite unwell. Therefore, they do crazy-ass shit now and again, but it's rarely something they mean to do. Their families and visitors, on the other hand....

1. It's a hospital, not a drag-racing track.

If your darling children (all of whom seem old enough to know better) continue to play dodgem and drag-race in our wheelchairs, you and I will have words.

2. Smoking is not permitted. Really and truly.

If you go into the bathroom and turn on the shower, then open the window in the room, then attempt to smoke, I will know about it. And I will be unhappy.

3. Please, for the love of all that is holy, do not take out Mama's drains. Even if you are a physician.

Considering that Mama's surgery was on her neck, and that there's a lot of important stuff in the neck that doesn't do well when it's compressed by fluid accumulation, it would probably be wise to leave those drains in place for more than twelve hours.

Especially do not remove Mama's drains (even if you're a physician) by grabbing them and pulling. They're probably, you know, *stitched in*.

4. Likewise, please, for the love of all that's holy, do not remove Papa's trach tube.

He needs it to breathe. Yes, he's acting like it bothers him. It does bother him. Having a tracheostomy tube sucks rocks. However, it beats the alternative, which is not breathing.

5. Now is neither the time nor place to attempt to rebuild your stable of hookers.

You heard me, Big Pimpin'.

6. Nor is it the time or place to attempt to buy large quantities of illicit substances.

We allow pretty much anybody to come visit. I draw the line, though, at a steady parade of shady characters (unless they're residents) who are looking to exchange their fun pills for your money.

7. Come to think of it, why don't you just let me take those narcotics for you and lock 'em up?

I know Mama doesn't feel well. Mama had a grade 3 brain bleed and is lucky to be alive. The consequence of having had a chunk of your skull removed is a headache, but again, it sure beats the alternative. However, if you insist upon crushing Brother's Oxycontin and putting it under Mama's tongue, the alternative will be what you get.

8. No, I will not marry your son and give you grandbabies before it's too late.

Neither will any one of the more than dozen hospital employees to whom you've posed the same question.

9. You may not ride your Segway up and down the hall. 

I can't believe I had to point this out.

10. The hospital is not the best place to have a bench-clearing brawl over who gets what out of Grandma's attic. 

If you're going to brawl, at least do it where you have a little more space, and where all the members of the family can be present at once. That way, I won't have to waste time answering the phone when those family members who weren't invited to Inheritance Cage Fight MCLXVII: The Reckoning call up to know what the hell happened yesterday.

And they wonder why I do beer reviews.

Valentine's Day Special: A Long-Overdue Love Letter.

I remember when we first met. I was so young; I didn't know what I was doing. All I knew at the time was that this was something special, something rare.

There were months, later, when I didn't even think about you. Whole years could go by, and I wouldn't wonder about you--wonder when I'd see you again, if you were still the same as I remembered, if it could be as good again as when I was young.

The last time I saw you was years ago. A good friend brought you over after dinner. I didn't realize then that that would be the last time for a long time that we would meet. Had I known then what I know now, I would've made more of an effort to make our time together last.

I saw you again yesterday, and all those feelings came back. My heart beat a little faster; I felt kind of nervous, just being in the same car with you. And, later that evening, when we finally got the chance to be alone together, it was just as good as I'd remembered.

Tiramisu, tiramisu! How could I have neglected you all these years?

Let's talk about compassion.

I've gotten a couple of comments in the last week that I haven't published. Both of 'em came from women (or a woman, posting as two) who claim to have kid(s) with AVMs on their faces; both of 'em took me to task for a lack of compassion. Apparently, I'm supposed to have compassion when I'm posting here, about my patients, and the doctors, and my nutso coworkers. (I should mention that both comments were personally abusive and name-calling, which triggers the auto-dump feature on the Nurse Jo Robot. That's why they're not here.)

Normally, criticism doesn't bother me. Blame it on the codeine, 'cause I'm gonna answer my critics:

Lady (or Ladies), you don't want me to have compassion on this blog.

Why not? Because, if I'm compassionate here, it means one of two things:

1. I've not used up all my compassion on my patients.

2. I'm drunk.

Let's be real, People: You don't come here for compassion and warm fuzzies. It's like the man said--come for the stories, stay for the snark. And, honestly, who wants to read me tear my heart out over patients that've torn my heart out?

I could talk about walking down the hall with Darlene, her arm around my waist, as we discussed the best way to tell her eight-year-old daughter that Mom wasn't going to live much longer. I could talk about Velma, and how she cried about having to go to hospice, because her mind was still there though her body wasn't. Or I could tell you about Ben, who told me frankly over dinner that he was damned ready to die, but was holding on for the good of his wife and kids, who weren't ready to let him go yet.

But you don't want to hear about that. Nor do you want to hear about the 13-year-old girl with the horrendous congenital AVM that would likely kill her, whose toenails I painted the night before she went into surgery (all but one, so they could put a pulse ox on in the OR), so they'd be pretty for the surgeons. You don't particularly care about the fifteen-year-old boy whose Moya Moya had so screwed up his brain that I was the only one who could get him to consent to surgery, and only then after coming in early and rocking him on his bed like a baby. And I'm certain, as the mother of an eleven-year-old with an AVM, that you don't care about the time I summoned up all the crappy, rusty Danish I could muster to help comfort a dying woman who couldn't remember that she wasn't at home, in Copenhagen.

You'd rather hear the snark, and read the snappy lines. I don't blame you. If my working life were snappy lines and snark, it'd be something for ABC or FOX to run in a half-hour between family comedies. It wouldn't be what I live every day, where real people hurt, and die, and sometimes don't die...and those of us who are living are left to pick up the pieces.

This is an important point for those of us who blog, and those of us who nurse: People will criticize you for not being the constant comforting angel that they think you ought to be. To hell with them. The important thing is that you do what you are meant to do for those people who find themselves in your care. 

That means you won't always be unsnarky when somebody wants you to be. You may not always want to talk about work when you get home. Sometimes, if you're a bit under the weather or a little too far into your cups, you might surprise your drinking companion with some heartbreaking story. The important thing is that when it counts, where it counts--with your patients--you aren't holding back.

I spend enough time questioning whether or not I did what was best for my patients. I spend hours after every work day going over every. damn. thing. I did. and trying to figure out if there were a way to say it better, do it more gently. In the middle of my day, I am a nurse. When I come home, I am a blogger. If the nurse part bleeds into the blogger part, it means I'm not doing my job--either job--well enough.

And so, critics, up yours. It's a shame you didn't read farther or dig deeper. I'm sorry for you, and I'm sorry for your kid--but I'm not sorry for my patients. What they get is the absolute best of what I have to give. What the blog gets is the cynical, tired leftovers.

Would you rather it be the other way 'round?

Quick Tips:

1. If there is no mail delivered in The Most Important City in The Most Important State Of This Here Union, Yee-Haw, you know that the weather was bad that day.

2. Similarly, if you roll down your car's window and the quarter-inch-thick sheet of ice on said window sits there, and you are then able to punch a perfect cartoon hole through it with your weakened fist, you know there was a lot of ice last night.

3. Codeine cough syrup, while not as blindingly effective as Tussionex, is quite the bomb. 

4. It also makes all the keys on your keyboard be in the wrong places.

5. If your hair hurts, you have the flu (this is the official word from the NP I saw today).

6. My temp is down to 101.2. This is better than 102.6 or 103.1. I am tired of sounding like a radio station.

Hot Air Vent

Every year at Sunnydale, we have a big Christmas party. I mean *big*. Our floor feeds all our employees, the employees from various other departments, and sundry patients and family members. We plan the thing for weeks in advance and everybody chips in.

There are rules. If you don't bring enough food to feed a minimum of twelve folks (or one hungry resident), you have to pony up cash. There's no set amount, but whatever is given should be given without our having to pester you or your whining about it. Likewise, if you didn't bring something or pay money, you don't get to take any leftovers home. And, finally, we leave the vast majority of food for the night shift and residents, who reciprocate throughout the year.

Sounds reasonable, right? And you know where this is going, right?

I have two coworkers: The Thiever and The Bitcher. 

The Thiever steals anything and everything that isn't tied down: potted plants, toilet paper, items left unclaimed in the lost and found, people's empty totebags that are left a moment too long, clean Tupperware from the kitchen.  I understand that two kids and a deadbeat husband can make things tight, but c'mon. There is a limit.

Plus, she hates giving money for parties and doesn't cook.

The Bitcher has not--and here I do not exaggerate, for once--ever eaten anything besides meat and starch in my presence. Everyone else's food is fair game for her wrinkled nose and expressions of disgust. Vegetables are a foreign concept, as is any cheese that is not processed. She lacks even the most basic dinnertime manners. She would give my mom a heart attack.

Plus, she hates giving money for parties and doesn't cook.

I know you can see the end of this tale, like the steeple of a church rising up from the Alberta horizon, but bear with me. My blood pressure is insanely high.

Friday was the annual Xmas Do. Those of us who cook spent hours preparing food (and a good chunk of our own change), setting up the tables, and making sure things were hot. There was a turkey. There was a ham. There were various side dishes including, but not limited to: greens, macaroni and cheese, scalloped potatoes, mashed potatoes, dinner rolls, bean casserole, an enormous green salad with walnuts....you get the idea. I made four pies and a cake for the dessert course. We rocked out. 

Come afternoon, The Thiever arrived with--and again, here I am not exaggerating--a stack of plasticware and a couple of trash bags, and proceeded to scrape, pile, dump, and ladle all of the leftovers she could fit into the plastic containers. This after not giving any money or time to the party fund or even bothering to show up for the damn thing.

The Bitcher joined her in the kitchen and offered a running commentary on what was good, what was bad, and what was just plain too weird to eat. 

I was washing dishes and so got to see and hear the whole thing. After hearing my beautiful Potatoes Savoyarde denigrated as being "funny-tasting" (that would be the Gruyere, thanks), I lost it. I put down the sponge and grabbed the plastic container with the half of an apple pie in it.

And I snarled, "Get OUT." Like a pink-eyed pig on a fire escape, I was.

I was met with expressions of disbelief.

"Neither one of you," I hissed, "Did one fucking thing for this party. You" (stabbing finger at The Bitcher) "refused to eat anything without complaining about it. And you" (ditto at The Thiever) "didn't bother to show up, pay even five bucks, or cook anything. You do not get leftovers. Bitcher, you do not get any more food from me."

"I am not done cooking, but I am done cooking for you two damn fools."

And with that, my beloved, blessed, wonderful coworkers, who had heard the whole thing, all stood up silently and began to unload the various plastic tubs and boxes from The Thiever's bags and return them to the fridge for the night shift. The Bitcher stood there flummoxed and protesting that she was only joking, but everybody ignored her.

And on Christmas Day? When we're all working together again and a few of us are bringing breakfast? 

My two worthless colleagues will have to brown-bag it or buy something from the vending machines. I am *through*.

Things that make me go * blink *

Nurses can, as I illustrated in my last post, be jerkwads who jump to conclusions.

Every once in a while, though, somebody goes above and beyond and says something that makes me go *blink*.

About a young, gay, HIV+ guy I was taking care of: "You have to watch out. Those people will try to spit on you or bite you and give you the AIDS."

Me: *blink*

About a young female sex worker with a galloping case of CNS cancer: "What do you expect, with a lifestyle like that?"

Me: "Tell that to the chick in the next room." (A young female Evangelical Christian missionary with, you guessed it, a galloping case of CNS cancer.)

About a woman who topped 400 pounds and had recently had gastric bypass: "Jesus Christ, woman! Go for a walk!"

Me: After we all rolled our eyes at that nurse, I started thinking about how we wouldn't tell people with heroin addiction to just say no--after all, Nancy Reagan was rightly criticized for a simplistic approach to drug addiction. Yet we expect people with chemical imbalances just as serious as those in drug addictions to...what? Push away from the table? Just say "no" to a slice of pie? Why aren't food addictions treated as carefully and aggressively as drug and alcohol addictions?

About a man with a history of clinical depression: "Oh, great. Another whining drama queen."

Me: "Excuse me? EXCUSE ME? What the FUCK??" (Yeah, the Effexor makes me a little aggressive sometimes. Wanna make something of it?)

About a recent African immigrant who had lots of family in the room: "You can't tell those people anything. They're just animals."

Me: *blink* *blink* *gape*

My Ghanian coworker: "Excuse me? Excuse me? What the FUCK??"

About a female bodybuilder who'd come in for back surgery: "That sort of muscle on a woman is just so dykey."

My bodybuilding coworker: (leaning her muscular upper body over the table) "What? I can't hear you. Could you repeat that, please?"

Yeah. So we have some winners in our ranks, for sure. Sheesh.

The only thing to do, when faced with a bigot or a jerk, is to call them out on it. Sometimes you have to call them out repeatedly and loudly, as in the case of the nurse (now thankfully gone) who'd expound on the sinfulness and horribleness of various lifestyles other than her own. Sometimes a raised eyebrow is all it takes. And sometimes, in the case of the nurse who warned me that my patient would "try to give me the AIDS", all you can do is blink and walk away.