A Public Apology.

Today, young Padawan Jo learned that the Snark has a light side and a dark side, and that, unlike the folks on the dark side of the Force, amateur practitioners of the Snark's dark power are unlikely to get cookies.

About a month ago, I compiled a list of blog crushes, including a blog called Door Sixteen in the mix. In the blurb about D16, I said quite honestly that any time my friends and I or Beloved Sister have to reference something that would require skill, artistic vision, and perfectionist tendencies, we call it a "D16" for short. That's as in "I couldn't manage that, dammit, because I'd screw it up and have to throw it away, but jeebus grits, what nice work."

Well, then I threw out a one-off about how Anna probably wipes her ass with hundred-dollar bills.

Anna read that as hurtful, and rightly called me out on it.

See, normally I assume (what's that they say about assuming? Oh, yeah. That's why I have these long grey ears) that when I'm snarky, it'll be broad enough that it's obviously parodying or self-parodying. This time it wasn't. It came across as bitchy and mean-spirited, which was the last thing I intended.

So, in trying to be clever, I hurt somebody else's feelings.

It might surprise long-time readers of HN that I care about other people's feelings. I do; that's why I try to make sarcasm as broad and obvious as it can be, and that's why I anonymize patients, doctors, and coworkers to the point that *I* don't even recognize them a month or so later.

This time, though, I judged badly and was way off. Anna, I am really sorry. I do admire both your blog and the work you've put in to your house and design projects. I didn't ever intend to imply that you're an over-funded dilettante (dammit, even when I'm being sincere, I come off as snarky. Shit) who spends frivolously rather than working hard or who's wasteful with resources. You were completely right in slapping me on the back of the head.

I'm going to go off now and chew over this lesson. The President was right when he said the word "jackass"; he just got the names mixed up.

Sunday Prior-to-the-start-of-things Silliness:

From A. Rob:

"Kylie was so *earnest* about the chiggy-wiggy thing."

YAAAARRRR, Mateys!

Just a heads-up: International Talk Like A Pirate Day is tomorrow (Saturday, 9/19). AAAAaaaarrr! (Accent on the first syllable is crucial.)

Whatcha thinkin', Mrs. Lincoln?

I think I may not be smart enough.

I think I might not be young enough, or energetic enough, to keep up.

I think I might make a huge, irretrievable fool of myself.

I think I might just lie down and take a nap.

I think I will have to be tougher than I've been in a while.

I think my idealism could take a beating.

I think what I've learned up to now will do me no good at all.

Oh, my blessed, I am anxious. I am frightened. I am doubting myself and my good sense and my gut, which has so far never steered me wrong (when I've actually chosen to listen to it; the low point being a day that involved a big white dress and a minister that mispronounced my name): I mistrust myself.

My strengths lie in talking to people who are conscious. They're in the personal-relations side of nursing, the "caring" side.

I'm not going to be doing that much any more.

I am sore afraid. What if it's all a huge mistake? Can I go back to acute care without looking like an idiot? What if I decide this isn't right, eight weeks into the fourteen? What if they hate me? What if I can't get Swan-Ganz catheters right?

Four days until the day I start, and this is worse than beginning the first time, because I *know* what's at stake now.

The Rat Wrangler showed me the Best. Video. EVAR.

In answer to queries via email: The Dorothy Parker Edition

On writing:

"I hate writing; I love having written."

On drinking:

"Martinis are like breasts: one is not enough, three is too many."

On breakups, then and now:

(Then):




(And now):





"In youth, it was a way I had,
To do my best to please.
And change, with every passing lad
To suit his theories.

But now I know the things I know
And do the things I do,
And if you do not like me so,
To hell, my love, with you."

For the Lotion Slut and Rat Wrangler:

Finally! Something that made me go "Aaaawwww! Eees CYOOT!"

Thanks to Sunflower, RN, for this link!

The Doctor Is In

Funny, informative, and yes, weird.

I'm not sure how I did this the *first* time.

I'll say this for Sunnydale General and our sister hospital, Holy Kamole: the peeps are serious about the internships.

Even as a seven-years-under-the-belt nurse, in the speciality in which our CCU specializes, I still have to go through the entire fourteen week internship: everything from new employee orientation to the final days of evaluation.

(I asked, by the way, why they wanted to pay me my current inflated hourly rate to show up for something I've already done, and the internship director said, "Because we think you can be a leader."

Dude.

You've spent the last seven years trying to chain this particular loose cannon down. I'm from the unit which is widely acknowledged to be the weirdest, rule-breakingest, fuck-you-ing-est unit in the whole damn system, and all of a sudden I'm supposed to be a leader? Are you drunk? AGAIN?)

Anyway. I remember dimly that my first internship was challenging. This one doesn't look like it's gonna be any easier. The first week will be a comparative breeze: only five twelve-hour days in a row, doing things like learning computer systems and filling out Gubmint paperwork. After that, though, we start on the real meat: two or three classroom days a week, combined with two or three clinical practice days. Tests. We're having TESTS. As in, one now, one in three weeks, and one at the end of the internship.

I haven't studied for a test in...well. It's been a while.

So. This morning I showed up, bright and early after getting my teeth scaled like a horse does, to the Sunnydale General Investiture Meeting, and met the leader of the particular group I'll be in.

I am not making this up: his name is Dante.

What it took Alighieri seven days to accomplish will take us fourteen weeks.

I am, quite frankly, more than a little concerned by all of this. I don't know that I have the stamina to make like a new nurse again. I mean, a whole lot of it will be (presumably) easier, since I already know the routine and where they keep the tubes and stuff, but still. I don't know the charting. I've not worked with a ventriculostomy in years. I'm not sure which end of the stethoscope goes up the resident's ass. I'm not sure where the bathrooms are. I'm afraid I'll get just plain tired and worn out and have to take a little mental break right when somebody needs me.

Remind me why I wanted to do this, again?

It probably would've been easier for me to deal with had I had a proper night's sleep and hadn't spent an hour getting sharp things poked into my piehole by a nice woman with a cheery attitude. As it was, I stumbled in to the conference room, grabbed a colleague by the lapels, and groaned "COFFEE. I NEED COFFEE." She got me some, and it was all almost okay.

Still. It concerns me, this schedule. When nine hundred years old I am, feel this energetic I will not, hmm?

I kinda like it.

All this discussion below re: political freedoms and intersexed individuals? Is fun.

Just wanted to say that. I'm underslept and over-product-ed (thanks to the haircut I just got), so my brain isn't working as well as it usually does.

Carry on.

Ouch.

Holla.

A few quick requests:

If you cannot use the terms "Nazi", "Stalinism", "socialism" and "communism" in a sentence correctly, or cannot differentiate one from the other, please do not engage in political discourse.

There is no mercury in flu shots. The flu shot is bits of a dead virus and will not give you the flu. Nor will it give your unborn child birth defects. If you cannot internalize these simple bits of scientific fact, please do not engage in discussion of how evil flu shots are.

It's not "hermaphrodite." It's "intersexed." That's the correct, accepted, professional term. If you can't bring yourself to be correct, please don't talk about South African runners to me.

Your opinion on medical issues is automatically downgraded in my eyes if you are a young-Earth creationist.

Your opinion on *everything* is automatically downgraded if you cannot accurately define "theory," "hypothesis," and explain briefly what the differences between the two are.

If you begin a sentence with the words "All women..." and if that sentence ends with anything other than "are fantastic", don't be surprised if I end that sentence for you with a heel to your instep.

Thank you, and good night.

Submitted with chortling.

Musings from the surgical floor.

It's probably best, if you have to get a lovely case of necrotizing fasciitis, not to get one severe enough that it requires three separate wound-vacs on three separate parts of your body.

Likewise, if you're going to have surgery to connect a large flap of belly skin and flesh to somewhere around your collarbone, try not to have that flap die and fall off so that your collarbone, ribs, and chest musculature are exposed. Yow.

And while we're at it, if you're going to travel to a third-world country where medical care is iffy at best, do make sure you're not going to go tumbling off a roof and onto the street where you'll be run over by various conveyances both gas- and animal-powered.

Finally, please do wear a helmet when you ride your motorcycle. That way, if you happen to go sliding across the highway after popping an extremely ill-advised wheelie, the back of your head won't simply just... ... ...go away. There are skull defects, and then there are skull defects.

Now: to wash the proceeding images out of your brain (and I am so glad I found this), clamp lamps on this article on one-hundred-year-old color photographs by a Russian:

Here.

I just don't know. I just...shit. I don't know.

James Pouillon was shot to death today.

James Pouillon was an anti-abortion protester who frequented the sidewalk across the street from Ossowo High School in Michigan. He was, according to FOX news (ha) "well-known" in the community; Randall Terry claims to have known him personally.

Nobody knows yet if he was shot because of his beliefs. The nutjob who shot him (equally as nutty a job as Scott Roeder; anybody who shoots other people without the reason of self-defense is crazy) shot one other man and was planning to kill a third when he was arrested.

I admit: When I read the news, I had a brief moment of "Ha. Chickens. Roost."

Then the human side of me took over, and I thought about this guy, confined to a wheelchair and on oxygen, doing the same thing he'd done every day, trying to make people see his side of a contentious argument.

Then the vicious side of me remembered how a colleague's wedding was disrupted by protesters carrying bloody-fetus signs.

I thought about his wife, if he had one, and his kids, if he had them.

I thought about the woman I worked with whose kids were targeted by anti-choice protesters.

I thought about his friends.

I thought about how I'd been followed home from work by protesters and how, nearly ten years after I worked at the clinic, I still occasionally get postcards calling me a baby killer. I've moved three times since I worked there.

I thought about what it must be like to feel the bullets hit, and I wondered if he even knew what had happened to him.

I thought about what George Tiller's wife must've thought when she saw her husband's body on the floor of the church, or what Barnett Slepian's kids must've felt when their dad was shot in the kitchen of their house in front of them.

I wondered if the anti-choice movement would make this man a martyr, regardless of why he was shot.

I thought about how pro-choicers have dealt with the acts of violence at abortion clinics in the last twenty years.

I wondered how many Internet shrines would be created for James Pouillon.

I thought about how it's the doctors who perform abortions, and the staff at the clinics, that show up on websites that call them murderers and say that they have to be stopped by any means necessary.

The vicious part of me, the part that wants to kill people who abuse children or women or old people, the part of me that wants to torture to death men that rape, is happy. It's exultant, in fact, that maybe--just maybe--the people who fucked with me every single day might now feel a tiny shred of the fear that I felt in doing a job I knew was necessary.

That vicious part of me feels like this is payback for the screaming protesters outside the clinic, the shouting people outside my church, the posters that got put up in my neighborhood, the times people from the anti-choice side knocked on my door on Sunday morning, the fact that it's really hard to put the name of the place where I worked--or even the doctor's name--on a resume, for fear of what people will think.

The human side of me wants to weep. Whatever the motivation, this is a waste of a life. It's the waste of a person who believed strongly in what he was doing. Even if we're on opposite sides of the fence on this one issue, I have to respect him for walking the talk. The human side of me grieves that maybe, just maybe, the disagreement over abortion has come to this on both sides. Prior to this, the pro-choicers had the high ground; we'd never killed anybody or perpetrated acid attacks on crisis pregnancy centers or put doctors' home addresses up on the 'Net for crazies to find.

The evil part of me--and don't fool yourself, because every human being has the capacity for evil--is dancing. It's laughing. It's saying "See? See what you sowed? See what you're reaping? Suck on this, motherfuckers! See what we live every day!" It's very, very happy. It's very, very pushy.

The human part of me is so horribly disappointed in humanity. It wants to believe that the proportion of good to evil in the world is always 51% to 48%, with one percent undecided, but it's not sure now. It wants to grieve the loss of another person, but the evil side gets louder and louder.

I am ashamed to admit all this. It makes me feel less humane. Not less human, you understand; if an undergraduate degree in sociology taught me anything, it's that humans, generally, suck pretty hard.

This death, this conflict between my good and evil sides, shows me one thing: I have a huge, deep, dark reservoir of anger and resentment from my year at the clinic and my years at Planned Parenthood. That frightens me. It shows up what I fear I might be capable of.

God help me if Randall Terry is ever one of my patients. I...shit. I just won't know.

My deepest apologies.

I had intended this to be a post on my new Littman Cardiology Master stethoscope. I bought it because I realized that I'll actually be expected to *use* the damn thing in the CCU, rather than just wearing it around my neck as decoration. Let's face it: on a neuro floor, you can mostly get away with a 'scope from Fred's Friendly Discount Stethoscope Emporium. You can borrow a good one when you need it.

This post was also supposed to talk about how I've made the best yogurt blueberry muffins on the planet, and would have probably included a recipe as well, except for Jezebel.

See, Jezebel posted this new music video that Kylie Minogue has up, promoting the Bollywood movie "Blue". "Blue" also stars Akshay Kumar, who is really pretty damned good, but the video in question is all about Ms. Minogue. She sings a song called, sadly, "Chiggy Wiggy."

It has the lyric "I wanna chiggy wiggy wit' you, boy" repeated over and over. Now, in Texas, "chiggy wiggy" means a condition that you only see in non-natives who sit on the grass in the summer. It requires liberal applications of clear nailpolish to the bites and plenty of Benadryl PO so they don't scratch themselves silly. In Bollywood, though, "Chiggy Wiggy" apparently translates to "awful song that will drill itself into your right temporal lobe and run on repeat until you want to kill yourself. Oh and by the way? The lyrics aren't the worst of it."

More disturbing than the lyrics are the backup dancers in their black fedoras, black leather ties, and gold lame pants.

More disturbing than that, even, is how Akshay comes riding in on a chandelier. Actually, that's pretty cool. I would've liked a flaming chariot, but a flaming chariot wouldn't have gone with the whole Bombay Night Club theme, so a chandelier will do. Don't ask me what the other guy is doing there, or where the chicks in bikinis came from.

See, Jez posted this damn thing with the embed code that makes it start up as soon as you open the site. I am not doing that to you, because I love you (each and every one of you, readers, truly!) just that much. That said, click on the video below at your peril--especially if you are my father. Dad, I know you love Kylie Minogue, but if you walk around humming "Chiggy Wiggy" over and over, Mom is going to kill you.

So, without further ado, the thing that has distracted me from my lovely new stethoscope and my lovely blueberry muffins and damned me to a life of chiggy-wiggy-ness:

O Fortuna

Best. Music. EVER.

It's been a lovely evening.

It's sad when 77 degrees F (25 C for those of you north of the border and overseas) is cool enough to open all the windows in the house, but that's what I did about an hour ago. Max and I sat out on the deck with a beer (for me) and some chow (for him) and the latest Urban Outfitters catalog (for both of us) and mourned the resurgence of the 1980's. Max expressed his opinion of the fashions available either by curiously licking the pictures--the suede offset heels got his approval--or by sneezing.

Someone nearby was frying onions. Someone else on the other side of the house was baking bread. As the wind shifted and the clouds changed, I got onions....bread.....onions......bread. The cats busily knocked things off of the kitchen windowsill and counter, and it was breezy enough that the mosquitoes didn't bite.

It was a good evening. Now the sun's gone down, and thunderstorms are rolling through, and I'm going to go shut the windows and read The Phantom Tollbooth for the nine-hundredth time. And maybe eat some of the Moo-Lennium Crunch Rachel left behind this past weekend.

*snork* Part II

*snork*

Holes, part two.

They don't tell you these things when you're in school. They don't tell you these things when you start out. You have to find them out for yourself, the hard way.

Two deaths this week: an old patient and a young coworker.

The old patient was the first person I'd ever put Buck's traction on. She and her partner had been together for something like 70 years and were both doctors. They were doctors at a time when women either weren't doctors at all, or were doctors in something nonthreatening, like pediatrics. Not these women; they went into internal medicine and orthopedics and proceeded to kick ass in the research and practice departments.

They showed up after my patient broke her hip in a fall. They stayed for a week after her hip replacement, then went to a rehab closer to home. They sent Christmas cards every year, thanking the nurses for their work. I was a brand-new nurse when I cared for her, and I learned a lot: like how Buck's should be put on, what output on a CHF patient looks like, how to prevent shear injuries in moving orthopedic patients. Every time I get a CHF patient, I think of her, still, seven years later. That is her life-after-death, and I think she'd like it.

The young coworker?

He was younger than I am. Most of 'em are, these days, but it doesn't lessen the shock. He'd gotten bloated over the last few months and had seen a doctor about it, only to be--finally--diagnosed with by-then-far-advanced liver cancer. He died barely two months after diagnosis, sadly compos mentis to the end and well aware of what was happening. Rumor has it that he was giving tips to the nurses' aides that took care of him up until the end.

This is what they don't tell you: That, if you have nobody at home who's willing to listen, or nobody at home at all, you'll walk around feeling the hole.

Remembering people to somebody else keeps them alive. It does what we fail to do all too often. When you can't remember somebody in person, you either drink, or take Vicodin to the detriment of your liver, or you blog. Of the three, blogging might be the least harmful but is certainly the most annoying.

Eventually, it gets to you. I put my hair up this morning in its usual bun and wondered whose obituary I'd read today, rather than wondering what's in store in the marvelous healing and miraculous recovery department. That's temporary, of course; I'll wake up next week optomistic and energetic again, and forget what it's like to wait at the elevator for somebody who's not going to show up.

The bitch of it is--the truly real bitch--is that so few people share your experience. "Someone died," you say, and they say, "Oh, so sorry". It's not the same as saying "someone died" and having the other person say, "was it under your hands? 'Cause that sucks." You realize, the longer you do this job, that you live on the other side of a vast gulf of experience, separated even from your best friends and your parents and your lover.

Well-meaning people try to cheer you up, when what you need is to sit out on the porch and pour one out for the homie who's no longer there. They want to listen, but you find yourself explaining things in too much detail, too carefully, and somehow the sheer raw power of life and death gets lost. It's not the same as it is on TV: it's not pretty, it's not accompanied by a feeling of closure and two thirty-second commercial breaks, and it's sure as hell not done in company of a bunch of good-looking residents.

This, friends and students and neighbors, is the hard part. This is the time when what we do, no matter how much we love it, gets lonely and empty and strange. This is the point at which we survey groups of people and wonder who's going to be alive in a year, simply because we've seen so many young, healthy, old, intelligent, marvelous, funny, grouchy people die.

They all leave holes in your soul. Some of them are big holes, some of them are small. Some people you see die and feel nothing but relief and thankfulness. Others, you wonder why the hell the good not only die young, but die young of horrible things. Eventually, you look at your own self, not with shock that your essential person-ness could've survived so many leavings, but with wonder, at how long it seems to be taking to disappear.

The human brain is an awesome thing: I mean that in the original sense of "awesome". It is also a terrible thing: ditto. The human soul? Is equally as awesome, equally as terrible, equally as deserving of respect. And it is, thankfully, infinitely more elastic than the brain.

If what happened to my self had happened to my brain this week, there would be no way I could've gone to work today.

Those who are not here any more eventually, and irreversibly, define what I am.

Auntie Jo's Rules For Decent Behavior, Inside The Hospital Or Out.

1. Bathe.

I don't care if you paint your toenails, shave off every last bit of your body hair, or are covered with tattoos (am I the only person in America without tattoos? Sometimes I think so). If you're not clean, I care. I care deeply. As long as you bathe regularly, like at least once a week, I'm happy. If you stink the stink of the deeply, chronically unwashed, I am bothered.

2. Don't threaten violence unless it's absolutely necessary.

There is no need to tell me that you'll "fuck me up" if I don't do something right. I'm going to do it right without your threat, because I'm ethically obliged to, and besides, your grandma is a much nicer person than you are. If you were my patient, there might be a few instances of fuckupery on my part; as it is, there will be none. So STHD and STFU.

3. Please don't ask me if I want to date your cousin/grandson/uncle's sister's stepchild.

It's not exactly a welcome question at the bar; when I'm doing a tricky dressing change or assisting with a bedside procedure, it's even less welcome and more distracting. Subsets of this behavior include: stalking (you're not going to be able to stalk me very efficiently if you're ataxic, so don't try), giving me your number on a piece of hospital stationery, or trying to pull me into bed with you for a little kiss. I don't care if you're eighteen or eighty; knock it off.

4. Do not, ever, press me for my opinion on political matters. You won't like it.

I'm a big ol' flamin' feminist socialist. And, since I can actually define "socialist" correctly and use it in a sentence, I get annoyed by those of you who can't (and who further equate socialism with Communism, Stalinism, Nazism, and Glenn Beck's Flavor Of The Week). Please don't ask me what I think of health care reform, universal sufferage, the plight of immigrants (legal or il-), or whether women's shelters ought to be defunded. I might tell you, and then your aneurysm would grow, and you'd have to go to the ICU and would be deprived of the pleasure of my company.

5. If you're a racist bastard, come right out and say it.

I had a guy do that once, and it made things much easier. I was able to reassign nurses and nurses' aides and read the guy the riot act in the meantime. If I'm forced to interpret your Birther mumbles through the tiny hole in the sheet that you're wearing, it's going to waste a lot of my time. If you're an asshole, own up to it. We'll get along fine once you understand that it's my way or the quick ambulance back to Hicktown highway.

6. Tell me about your animals. Or ask me about mine, though I'll probably tell you anyhow.

I want to hear all about your critters. I may disagree that your Corgi, Chihuahua mix, or Siamese is the best animal ever, since my critters have the top three spots and my nephew the fourth, but I'm interested anyhow. We can discuss grooming aids and kibble while I'm resiting your IV, and I'll take you down in a wheelchair so that you can see Spot or Fluffy. You might even be the person to hook me up with the nonaggressive, big dog I've been looking for to be pals with the Max-Zoats.

7. Don't pretend that that dude on the couch is your wink-wink "friend". It's cool.

I'm just glad you have somebody here with you. I don't really care if you're straight or gay; the important thing is that somebody loves you, and that you love them. Likewise, it's not really necessary to show me your POA or living will; I'd happily break the law to allow a life partner into the room, and damn the consequences. It's a hard enough world out there; love like that is something to cherish, not block.

8. Ask questions. Really.

I'm not going to be threatened by you asking questions, double-checking the bed angle, or otherwise sticking up for the patient. In fact, I'll welcome it: I make mistakes, especially toward the end of a long run of work days. Two heads are definitely better than one in this business, and I'm just grateful that you're paying attention. Besides, education is my all-time favorite part of being a nurse, and I like to hear myself talk, so you're golden. If you're considering emailing me for advice on being a student/nurse, feel free! I'm always looking for excuses not to do the dishes. Likewise, if you just want to hang out, that's good too.

9. If you really, really like the care I've given you, tell the boss.

A couple of times, people have left me money (donated to Sunnydale's Christmas Angels program) and once, a bottle of really good single-malt Scotch (hidden under my voluminous lab coat and taken home in defiance of hospital policy). I'd much rather you tell my boss, though, as it helps temper the image of me as some sort of lunatic loose cannon let fly on the medical world.

10. Finally, let me know if there's something wrong.

Again, this goes for both friends and patients. I am not psychic. I can't tell automatically if there's something I'm either doing wrong or not doing at all; you have to tell me. My fee-fees aren't going to get hurt; instead, I'll take the check and use it the best way I know how. And be grateful if, in future, I have reason to recall the lesson and use it again.

See? It's easy. All you have to do is do things my way and the world is a better place.

It's Genius Week at Sunnydale General!

Listen up, all you captains of industry out there:

If you're going to run somebody over with your truck, or with your motorcycle, or with your mid-eighties Impala, please try to be sure that you do the job right. I'm getting very tired of patients with a promising, bright future, who were run over in the course of a mugging/robbery/kidnapping attempt. It gets old. Either kill them, or give them a miraculous escape. Thank you.

Likewise, Baby Einsteins, if you're going to go after somebody with a tire iron--and what is it with tire irons these days? Back in *my* day, we were lucky to have chains! Get offa my lawn, you rotten kids!--be sure you do the job correctly, so that they can't identify you to their various family members and friends. That way, I won't have to take care of your sorry ass when you get rolled and sustain a subdural hematoma of truly awe-inspiring proportions.

And if you're here on my floor from over at County, leg irons intact, because you got fucked up by your cellmate when he found out you're a rapist and child molester, do not try to flirt with me. I can't state this strongly enough: My oath says that I'm to relieve pain and ease suffering and facilitate the transition back to health regardless of whom I'm working with, and I take that seriously. I will, however, walk *real slow* on the way to your room when I'm carrying morphine. That oath says nothing about returning you to health in a timely fashion. Suck it up.

Last but not least, if you're gonna ride your crotchrocket 120 miles an hour without leathers or a helmet, at least try not to pop a wheelie just north of Waco during rush hour. The fact that your reflexes were fast enough that you avoided death is no comfort to your parents, who get to watch you drool on yourself, or to me, who has to change the umpteen dressings occasioned by your nearly-full-body skin grafts.

It's been one of those weeks. I'm going off to eat salt now, and drink some of the beer Friend Suz was nice enough to leave in the fridge.

Morons.

Lighter (?) News:

I was standing at the counter yesterday afternoon and noticed the date: 9-3-9. I turned to the charge nurse and said, "Hey! John! If you take that first number, and its square root, and then square that second number, you get today's date! Isn't that cool?"

My good friend Maria, the craziest girl on the block, looked at me solemnly and said "You will never, ever find a man as weird as you are."

Today we were discussing one of the docs whose wife is having twins, fairly late--she's a little older than I am. I said, musingly, "I don't know; maybe twins wouldn't be so bad. I could have twins."

Without looking up from her charting, one of my coworkers said, "You'd eat them. Like a gerbil. You'd have them in the middle of the night, and bury them in wood shavings, and then eat them before dawn."

I have to admit she's right.

And now, for an email I sent my uncle at Sainted Mother's request, detailing something interesting that happened on my street this spring and summer: The Buzzard Tale.

(Actually, it's the Black Vulture Tale)

Black vultures are much more common here in town than turkey buzzards are. They're smaller, more adapted to quick dives and quick escapes, and they're easier to get along with than their more aggressive cousins.

The folks down the street--and you have to understand that I am like the Den Mother to every other house on the street, all full of hippies--decided to start putting dog food out for the black vultures that nested in their liveoak. Now, why a pair of black vultures would nest in a spreading tree that never gets very tall is beyond me, but they did. And they had an egg. And, sure enough, the egg hatched this past spring.

The hippies down the street decided to keep putting dog food out and to try to get the vultures acclimated to human activity. Given that they (the people, not the vultures) are constantly outside, playing hackey-sack or horseshoes or just sitting smoking weed, this was not difficult. Pretty soon the vultures had learned to associate any human with food.

Which led to the inevitable: every person walking past the house gets to within fifteen feet of the cross-street (the house is on the corner) when Plop! Plop! Plop! and Braaak! Braaaak! BRAAAAAAK! (that last is the baby), here come the vultures out of the tree, looking for treats.

They're not aggressive. The baby, who is now half-grown, is tame enough to take food from the hand without biting. They just really want to hang out with humans.

Which is fine. I don't have a problem with vultures, per se. They do, after all, perform an important function (in our neighborhood, that extends to cleaning up the occasional electrocuted squirrel and the blown garbage that escapes the truck) and are social, intelligent animals. Max, however, has a serious problem with them. They're not dogs, and they're not humans, so he's not sure whether or not to protect me from them. At the same time, they're obviously assertive, which weirds him out no end. He has what my old sociology professor would call "total role conflict, maaaan" every time he sees them.

I've taken to taking him the other way on walks, just so he doesn't ruminate on the Vulture Issue for hours after we get home.

That, courtesy of your big sister, was the Vulture Tale.

Sometimes you cry.

77-yo WM, found down in bathroom at 1347. Last FTF thirty seconds before, RN assist to ambulate to bathroom. On discovery, pt had 0 pulse, 0 resps, 0 response. Code team called; multiple att. to revive pt failed. Called 1442. A.M., MD, pronounced.

This is what charting does not tell you:

A new nurse, only a few months on the job, helps his patient to the bathroom. The patient had undergone a simple, very minor surgery the day before and was ready for discharge. As the nurse walked him to the bathroom, he joked that he had a long drive ahead of him and didn't want his kids telling him that they'd asked him if he needed to go ten minutes before and that he'd just have to hold it.

The nurse heard him fall off the toilet. When he got into the bathroom, a matter of five steps (if that), the patient was unresponsive, not breathing, and did not have a pulse. The nurse ran the three steps to the door and shouted for a code cart and to call the code (which I did), then went back to start compressions.

Because he was literally seconds away from discharge, the patient had no IV. Three of us dug around in his arms before I was able to start two large-bore IVs in his ankles. We started fluids, continued compressions and artificial breaths with an Ambu-Bag, and pushed as many drugs as we could in a vain attempt to get his heart started again.

At some point in the proceedings, someone realized that his kids were downstairs with the car, waiting for him to be wheeled down to leave. That brave person went with the chaplain to tell the kids that something had happened, we didn't know what, but that the doctors were with Dad.

But he's not doing well. At all. You need to know that now.

We coded him for just short of an hour. At the end of it, we left the nasal trumpet and the tube in place, left the IVs where they were, turned off the useless fluids, and called for the coroner. The docs wanted an autopsy. It'll probably show either a massive pulmonary embolus, or a massive bleed, or a massive cascade of clots in the brain, but they want to know.

And I walked into the breakroom and found my colleague in tears.

I don't do well with tears. Especially not from people that I know and respect and care for. All I could do was hug him, and cuddle his head in my shoulder, and tell him that he did the right thing, that he acted fast enough, that sometimes there are things that nobody can predict, that sometimes shit just happens, without any warning from vital signs or behavior or a change in the level of consciousness.

All of those things are true. All of those things were true in this case. All of the residents, and the people on the code team, and the attending physician told him the same things I did. But true or not, real or not, sometimes those things make no difference at all to how you feel.

I should've been there faster. I shouldn't have turned my back to give him privacy. I should've left that IV in thirty seconds longer. These are the things that run through your head.

Three nice people lost their dad today. One very nice woman lost her husband of fifty-two years. My colleague lost...I don't know what. It's certainly not innocence, because that's gone within the first five minutes after you step on the floor. Something, though: maybe a certainty that we *can* win 'em all, that what you do can make a difference, that caring enough will pull people through.

He'll be thinking about his patient tonight. I hope to God that his partner rubs his feet and feeds him something strong and comforting for dinner. I'll be thinking about him, and wondering if he'll feel like I felt the first time I lost somebody.

We all do our jobs with the belief that we are invincible. That is not true, of course, but being shown our inability to save every life hits hard. Eventually the belief in invincibility comes back, because how on earth could you do this job without it?

But between now, when you pull the sheet up over your--*your*--patient's face, and the day that you forget what it's like when you can't bring one back, is a very long time.

To work off the carrot cake:

The best song ever. In the history of the world. Period. No argument. All you Flogging Molly and Gentle Giant and Celine Dion fans can just go home now.

My Baby Loves A Bunch Of Authors

Well you should see my story-reading baby, you should hear things that she says
She says "Hon, drop dead, I'd rather go to bed with Gabriel Garcia Marquez"
Cuddle up with William S. Burroughs, leave on the light for bell hooks
I been flirtin' with Pierre Burton 'cause he's so smart in his books
       I like to go out dancing
       My baby loves a bunch of authors
       My heart's so broke and bleedin'
       Baby's just sittin' there doin' some readin'
So I started watching some TV, played my new CD player too
She said "Turn it off or I'll call the cops, and I'll throw the book at you"
All this arguing made me get dizzy, called my doctor to came have a look
I said "Doctor, hurry!" He said: "Don't worry, I'll be over when I finish
       my book"
       I like to go out dancing
       My baby loves a bunch of authors
       We've been livin' in hovels
       Spendin' all our money on brand new novels
So I got myself on the streetcar and it drove right into someone
The driver said: "I was looking straight ahead!" but he was reading the
       Toronto Sun
So my honey and me go to a counsellor to help figure out what we need
She said: "We'll get your love growin', but before we get goin' here's some
       books I'd like you to read"
       I like to go out dancing
       My baby loves a bunch of authors
       Lately we've had some friction
       'Cause my baby's hooked on short works of fiction
So we split and went to a party, some friends my girl said she knew
But what a sight 'cause it's authors night and the place looks like a who's who
Now I'm poundin' the Ouzo - with Mario Puzo
Who's a funny fella? - W.P. Kinsella
Who brought the cat? - would Margaret Atwood?
Who needs a shave? - he's Robertson Davies!
Ondartje started a food fight, salmon mousse all over the scene
Spilled some dressing on Doris Lessing these writer types are a scream!
       I like to go out dancing
       My baby loves a bunch of authors
       We'll be together for ages
       Eatin' and sleepin' and turnin' pages

Come on. You know you want it.

Auntie Jo's Most Kick-Ass Carrot Cake

(adapted from The Tassajara Bread Book by Edward Espe Brown)

Preheat oven to 350* and grease and flour two 8" cake pans.

1 cup white sugar

1 cup brown sugar (light is better than dark)

4 eggs

1/3 cup neutral-flavored vegetable oil

1 cup melted butter

Mix all of these ingredients together.

2 cups unbleached white flour, or wheat flour, or a combination

1 teaspoon baking soda

1 teaspoon baking powder

1 teaspoon salt

1 tablespoon cinnamon

1/4 teaspoon ground ginger

2 teaspoons nutmeg

Mix all of these ingredients together in a different bowl.

4 cups shredded carrots (don't use preshredded carrots. You want them moist.)

2 cups chopped walnuts (if you're chopping them yourself, try for a nice variation in texture, from almost-powder to big chunks)

A cup of raisins or pineapple if your tastes run that way, which mine don't, which means that you're a commie pinko who can't appreciate good carrot cake.

Mix the flour and spice mixture into the egg/sugar/oil mixture. Fold in the carrots and nuts. Pour the resulting batter into your greased, floured pans, trying hard to make sure the same amount gets into each pan.

Bake for at least 35 minutes. The cakes are done when a knife or toothpick inserted in the center comes out clean.

Cool for ten minutes on top of the stove, or on racks, then turn the cakes out onto a wire rack.

Allow to cool completely, and frost with

Totally Yowza Italian Cream-Cheese Frosting, courtesy of my pal from Italy

Allow to stand at room temperature until just barely soft

2 sticks of butter

Cream in a mixer with

2 cartons of cream cheese (full-fat, please; none of this fat-free crap)

Add two teaspoons, or more, of vanilla. I prefer more. Usually I just stand there and stare into space while pouring in the vanilla, but then, I'm a balls-out kind of girl.

Pour in powdered sugar until the frosting reaches the desired sweetness and spreading consistency. This will probably amount to most of a bag of sugar, but then, my coworkers like a lot of frosting with their carrot cake.

Frost the cake, using tons between the layers. The cake is naturally pretty crumbly and only borderline sweet, so don't be afraid to go heavy on the frosting. It also weighs a ton once it's finished. Be sure you have a good cake carrier to tote it around in.

Apply, as Nigella Lawson says, to face. Fall over in a food coma. Pretend you just got a serving of vegetables.

Quick request (blog bidness)

Lower-case d. with the comment on disrespectful doctors on "Saturday Seriousness", would you please email me? Address is to the right. You don't seem to have a Blogger account, so I can't contact you that way.

Thanks!

Oh, speaking of bellies....

One of the guys from the cafeteria brought in his first grandson the other day. Grandson is something like a month old (whatever age it is that they first begin to look like somebody's home) and quite adorable. He's got a shock of black hair and perfectly round eyes and one of those boneless baby Filipino faces, and a lovely toothless grin.

That said, my first reaction to babies is still, "It's cute, but what does it *do*?"

So anyway, baby comes in, we all ooh and ah over him, I get out as soon as is polite and go about my work, and a few hours later, one of the janitorial staff comes over and says to me, "So you're a grandmother!"

I stared at her. I wasn't sure whether she was joking. "Uh, no." I said. "I don't have kids."

"Oh, I thought that baby was your grandbaby," she said. "When's your baby due, then?"

I am not a grandmother. I am most certainly not pregnant. And yet one clueless individual had managed to assume I was both, and within 30 seconds of each other.

I ran down to the OR, where a friend of mine who's ageless and beautiful works, and asked her what wrinkle cream she uses. Oil of Olay ahoy!

And I'm also going to be very, very good about Weight Watchers.

That did not work out at all as I had planned.

I went out back to feed Max-Zoats and ended up in a conversation about justice with Pastor Paul.

Then one of the hippies from across the street showed up with her dog, and the conversation turned more general.

Now I have a vegan chocolate cake baking, and I'm preparing to go watch other people eat marinated portabello mushrooms and vegan risotto and salad, and probably devour said vegan chocolate cake.

Variety is not the spice of life. It is the meat and bread of life.

I'm twenty years older than most of the trust-fund hippies. This doesn't imbue me with any particular wisdom, unless it's wisdom about which cookbooks suck and which don't. It does, though, give me a certain gravitas (can you use that word with hippies?) when I show up with a loaf of fresh-baked bread or a bowl of freshly-picked, steamed garden veggies.

"You're Mother Earth!" said the young man who's been doing naked-but-for-a-loincloth yoga in the front yard.

"Oh, god!" exclaimed a random girl, "I love chile peppers!"

"How do you do that?" asked the primary TFH, on being told that the marinade was one I made out of my own basil (organically grown, 'cause that's how I was raised, thanks, Mom), natural vinegar, and sea salt.

At last: boys who appreciate my belly. I was over there earlier, before I came back to wash off the bug spray and put the cake in the oven, and they were rubbing my midsection like I was a lucky Buddha, and talking about how marvelously round and fecund I looked. They seem to appreciate excesses of flesh after being around sprout-eating dancer types all day. I am, apparently, the embodiment of the full moon. Make of that what you will.

I managed not to be snarky. The people who deal with me regularly in real life will be proud of me. I also managed not to feel like a pedophile, though it's difficult when you're surrounded by 23-year-old guys who are in awe of your ability to, you know, ovulate.

Even though they're hippies, and not-having-to-work hippies at that (though they all have odd jobs), they do show some modern sensibilities. This week begins the remodeling of the band bus, an ancient Bluebird without electricity, into a liveable space, complete with chemical toilet and storage cubbies, thanks to yours truly. I'm going to supervise to make sure they don't attach the neutral to the red, but the rest of the scutwork is theirs to do. The Bluebird of Hippiness will be outfitted with things from the IKEA as-is section, hammocks, and swings: all the things I wanted as a teenager/young adult to prove how cool I was.

It's my first job as designer. I'm thinking I might need a blog just for that.

In the meantime, the timer just went off for the cake. And I need to find an ankle-length skirt and tank-top to wear over there, in honor of the days when Sam used to draw on the sidewalk and Jim's used to be a real diner.

Oh my God I am so tired.

Jeebus grits, people. I am the conjugation of exhausted.

Six--count 'em--six patients last week, all of whom had neuromuscular disorders (myasthenia gravis, CIDP, MS) and all of whom, every single last one, was well north of three hundred pounds.

In fact, the lightest patient we had in the group was 166 kilos (365 pounds, more or less) at four foot eleven inches tall. She was Pickwickian to the point of near-sphericality.

Now, then: I am not of the opinion that "fat" automatically equals "unhealthy". I'm much more concerned with your mobility, your lab values, your ability to manage your daily activities, and what it is you eat. A skinny person who eats nothing but the value menu from McDonald's is going to be a much bigger pain in my ass, medically speaking, than a 300-lb guy who takes good care of himself and simply has fat genes.

However. When you're my height (five-two on a tall day, with an inch of MBTs underneath) and weigh enough that you literally cannot walk across the room without getting winded, something is very, very wrong. Add a demyelinating disorder to whatever it is that's wrong, and things will go from very, very wrong to severely jacked up in short order.

And when things do go to severely jacked up, and you're unable to move at all, the person who's going to be lifting--or, more accurately, helping to lift--you is me.

Which means, at the end of a four-day run, that I will be tireder than I can even express. Attila came over this morning and I panted through a workout, unable to curl 20 pounds more than about eighteen times. That barbell was so. damn. heavy.

Then I ate some eggs, fell over into bed, and slept until 1530. I have bean tostadas in the oven now, and plan to fall over and sleep some more after I apply them to my face. No, I have not showered. Yes, I have brushed my teeth. I think.

We have one Hoyer for the entire hospital, so every lift we did last week was a dead-man, six person affair with doubled drawsheets. The only person who got the Hoyer was the dude who weighed 800 lbs, and he only got that when it was time for him to go to the unit because his FVC was dropping fast.

Reader, I am going back to bed.

Saturday Seriousness: for nursing students.

It's not often that I'm really, really serious, but today I think I might as well go 'head and be.

I got to thinking today about what five things I could tell nursing students that would make them feel better--or at least a little less bad--about clinical rotations and classes. Here, then, with a special shout out to my fellow Texan Rob, currently kickin' ass and diggin' shallow graves (see his blog in the listing to the right!), is my list of Five Things You Must Know About Nursing School:

1. Nobody Wants You To Fail. They Just Want You Not To Be Stupid.

Even the toughest professor I had (Pediatrics, booyah!) would forgive stupidity if it was followed by a fast "Oh, duh, I wasn't thinking." Trust me. I had plenty of those moments and still graduated. The professors who seem most intent on weeding out students are those who are also excited and stimulated by people who want to be challenged.

2. The Nurses You're Paired With During Rotations Don't Hate You; They're Just Nurses.

We say things once and expect you to get them. We want you to conform your schedule to ours; after all, you're usually leaving halfway through the shift, and we're there all day. We double- and triple-check everything that you do not just because you're newbies, but because we care about you not learning something wrong. But we (well, most of us; there are some toxic weirdos out there) really like nursing students. We want you to do well, and we like teaching.

3. That Said, Someday You Will Be Just Like Us.

I used to swear that I would never be the brash, outspoken, cynical, irreverent, bitter person that I saw over and over and over during rotations. I'm not as bitter as a lot of those nurses, but everything else, I am. I have become incredibly tough-minded and efficient, with a short-term and mid-term memory that would put most Mensa members to shame. You will be that person, too--it's part of becoming a nurse. Just make sure the bitterness comes last in the list rather than first and you'll do fine.

4. Doctors Don't Hate You Either; They're Just Busy.

Learn to say it in the fewest words possible. Never apologize for paging someone, or forget to thank them for returning your call. Have the chart with you before they call back. If you must interrupt rounds, be sure it's for something major, like the patient's stopped breathing and you can't intubate them. Doctors like efficiency, and they love nurses who are one step ahead of them.

If these skills don't come immediately, don't fret. They take practice.

5. Eventually, This Will Be Over.

Everybody has a breakdown in nursing school, and everybody has a crisis when they're a new nurse. It's okay. You're riding the steepest learning curve known to man. In time, it'll smooth out and you'll feel finally like you're swimming with the current rather than fighting to stay afloat.

In the meantime: sharp pencils, extra pens, and notecards never hurt anybody. And have some fun learning this stuff, okay? It's actually really, really cool to be a nurse.

Further Friday Foof. With Fluffitude.

This is Flashes. He's very proud of having unmade a corner of the bed.

I fear Notamus is under the bed, plotting my demise.

I got tired of having the same ol', same ol' fire extinguisher.

This is the dresser I painted white (from a weird light-pine color) and put green knobs on. It makes me very happy, like I'm living in an Anthropologie catalog but without the underfed stringy-haired people in ill-fitting clothing.

Friday Foof.

I loved these guys when I was a kid. I love them now. I'm considering making a blue Martian costume for Halloween.

Edited to add that the orange singing "Carmen" always scared the shit out of me when I was younger. I don't know why.

And speaking of dermatology,

I have an eight millimeter by eleven millimeter gouge in my face today. It took off a third of my left eyebrow and left behind an oddly colored (secondary to iodine) divot in my normally-lovely visage.

Such is the joy of being a freckled, fair-skinned redhead. You could trace the veins on my chest to their source and would be amazed at the transparency of the skin on my calves. And I'm prone to actinic keratoses, the precoursor of skin cancer, thanks to Dad. Thanks, Dad.

I got sunburned (true story!) in Copenhagen, Denmark. in JANUARY. It was sunny that day, between 9 am (when the sun got up) and 3 pm (when it went back to bed), and I got sunburned.

In Copenhagen. In Nyhavn, actually. In January. Which made my dermatologist crack up.

All told, getting a precancerous lesion cut off my face was better than what happened in Nyhavn that day, which involved a statue of Birgit and a drunken Swede and a lot of promiscuous kissing (not on my part) and beer horns you can't put down because they're curved or have big balls on the end, and isn't that a fun trick to play on the Americans? It was less painful to get lidocaine infused into my skin and a lesion scraped off than to deal with the fallout of getting Gammel Dansk'ed on a college field trip.

Which tells you something about my experience with dermatologists. It's a good thing when I'm told that whatever bump has popped up will probably take care of itself, unless I really, really want it cut off.

The best bit of the visit was when the dermatologist apologised for taking off a third of my eyebrow. I pointed out that a) my eyebrows are so fair I have to draw them in with a pencil; and b) that I'd already hacked off a portion of my right eyebrow with a pair of tweezers, so what was the problem? and she replied, "Well, at least you'll be even."

So now I look like Divine. With a divot. Which might be something I could parlay into a second job, so I'm not complaining.

Oh My God, You Fucking Idiots.

Neurology has three different subspecialties: stroke, general, and some other name that's been blasted out of my head by the Dalwhinnie.

If you call the Neurology rotating pager, your chances are good (ten out of ten) that you'll end up with a resident not on your patient's particular service, and with no clue what to do with that patient.

If you have a patient go bad at 1830, it's a sure bet that it's a Neurology patient.

So that's what happened to me the other night. And it's why I'm typing with one eye squinched shut and a half-empty (make that 3/4 empty) bottle of Scotch next to me.

Okay, not really. But still. It should not take me nine pages to find a resident willing to write the orders I need, and that resident willing only because I wrapped my bony paws around his scrawny neck. And squeezed.

WHY can you not have rotating residents on-call for more than a week? WHY must you keep the on-call pager a Deep National Secret? WHY on earth can you not brief the resident on call on the patients she or he is likely to encounter after 5 pip emma?

It's like the Neuro guys think they're Dermatology. Or that they actually get to sleep, post-call. In any event, the usual way of doing things brought me closer to actual physical violence, as in strangling the resident who decided to be a dick about things, than I've been in better than half a decade.

The best thing about moving to the CC unit? Is that neuro patients rarely get admitted to the intensive care service. And, if they do, it's the intensivist caring for them; not some jerk from the stroke service who knows nothing about myesthenia gravis.

PS: You're a moron.

Part I

Dr X: "Why hasn't the Argle-Bargle T380A test been run on my patient yet?"

Nurse Jo: "Because it's a timed test that has to be done by the lab. It can't be drawn through a central line."

Dr. X: "Why haven't you drawn it yet?"

NJ: "Because...it's...timed. As in, it shouldn't be drawn until a...specific time."

Dr. X, growing upset: "But you could draw it right now! Out of the central line!"

NJ: "No. I can't. It can't be drawn through a central line. The heparin lock we use will screw up the test results, and besides, it's a timed test. It's not due to be drawn until 1630."

Dr. X: (incoherent ranting about incompetence of nursing staff.)

NJ: (finds herself on the opposite end of the hall, unsure of how that bruise got on her forehead. Oh, wait. It was Head-Meet-Wall again.)

Part II

Dr. Y: "Why did you change my patient from calcium gluconate to a calcium citrate and magnesium supplement?"

Nurse Jo: "Because that's our protocol for people who have had gastric bypass surgery."

Dr. Y: "But this patient didn't have a gastric bypass! She had a parathyroidectomy!"

Nurse Jo: "Yes, I know. However, the patient's history shows that she had a bypass six years ago, and her blood calcium levels have been low enough to warrant IV repletion. Therefore, according to protocol, we changed her over to citrate and mag, and her calcium levels have come up."

Dr. Y: "Are you a doctor? I didn't write that order!"

NJ: "It's the standard hospital nutritional protocol for patients who have had bypass surgery. Here it is on the computer (clicks twice)."

Dr. Y: "I didn't write that order! You had no right to change that patient's medication!"

NJ: "Her calcium has been stable at 9.2 for three days, after being between 2 and 3.5 for the proceeding week. Is there a problem?"

Part III

Dr. Z: "Why didn't you replete this patient's magnesium and transfuse blood?"

Nurse Jo, looking worried: "Because I didn't see an order for it."

Dr. Z: "Her hemoglobin is ten! TEN!! Why didn't you transfuse her??"

NJ: "Um... ... ...because her hemoglobin is ten. And has been ten for the last four days. And her magnesium is 2.0 and has been for the last four days."

Dr. Z: "But I always transfuse patients with a hemoglobin less than twelve!"

NJ, taking chart in hand: "See this preprinted sheet? You filled out this preprinted sheet. It says right here that if hemoglobin is less than nine or crit is less than 25, we transfuse. It says we replete magnesium for mag levels of less than 1.7. Her crit and hemoglobin and mag have all been above those levels for four. days."

Dr. Z: "But that's not how I do it!"

NJ: Considers banging head on desk, then decides that the bruise that's already there is enough, and wonders why on EARTH the new docs in rotation aren't briefed on our protocols.

Super freak. (Composed Saturday night; posted Sunday morning.)

Oh God, oh God, oh God.

I start the CC internship in a month. A month. What was I thinking? What the hell am I doing, leaving what I'm used to? What happens if I hate it?

What happens if I can't do EKGs? I've never been good at EKGs. And all that other CV stuff; I haven't done that in years. I can't remember what Vfib looks like. Blocks...blocks...I can't remember blocks. What's the normal for mag? I can't remember. I've been off work for too long. I'm only back for a few weeks, and then I start the internship.

Holy crap. What if I hate it? What if they hate me? I'm going to have to work nights. I've never worked a night in my life. What if I can't stay awake? What if I can't sleep the day before my first night? Oh, God, oh, God. Nights. What am I going to do about feeding the dog? How long will I have to work nights? When will I start? What if I hate it?

Seven years. I've worked on the same unit for seven years. Why did I have to go and make a change now? I wonder if it's too late to back out. It probably is. What if I hate it? I'm going to feel like a complete idiot for at least a month, and pretty stupid for at least six months after that. Ventrics. I haven't dealt with a ventric in...what? Four years? Five? I've forgotten how to level them. I mean, I know this is what an internship is for, but they'll expect me to remember this stuff.

Oh, geez, and ventilators. I wonder how much ventilator stuff we'll have to do. RT is right there, but will I have to troubleshoot? What about extubation? What about intubation? What about code team? When do you use bicarb, again? Isn't bicarb, like, your last resort? Shit. And open bellies. Open. Bellies. Covered with plastic wrap. That's insane. What am I doing, changing units?

We're gonna see a lot of flu cases this year. Probably some of 'em'll be on vents. I hope I don't get the flu. What'll I do about vents? What if I have to go to Holy Kamole and work on vents there? And what about all that damn CV stuff? Geez, I hate counting out rhythms. I need to get a better stethoscope. I need a set of calipers. My feet hurt. It's the last night of my vacation, and my fucking feet hurt. I can't sleep. What about EKGs? I wonder when they'll have flu shots for us. I wonder *if* they'll have flu shots for us. Maybe I can tell 'em I'm pregnant, and get a flu shot that way. But then I'd have to produce a baby.

Which would probably be easier than starting this damn internship.

*toss*

*turn*

Eternal Questions: Friday at 4:30 a.m. edition:

1. Why is it so hard to plug in equipment with batteries that have to recharge? Is there some anti-plug-in gene that only I am missing? It's frustrating to have every. single. pump. start screaming "LOW BATT" the minute you turn your back.

2. What the heck are they using now to mop the floors? Superglue? 'Cause that's what it feels like.

3. Why does my sweet curly lamb of a resident insist on writing floor orders on preprinted critical care order sheets? It doesn't work like that, dear. For the fifth time.

4. How is it that a hospital can make such uniformly bad vegetables? Is there a special pre-over-cooked form of veggies that are only available to large institutions?

5. Why are there six boxes of gloves in this room, but none of them are my size?

6. How many family members does it take to see one person off to surgery? My record so far is 35, all in one small room. It was...humid. And crowded.

7. Do I have a sign over my head that says "Crazies: Talk to Me! I Like It!"?

8. Where do all these college students keep getting all this Adderall? And Ritalin? And Abilify?

9. Why do I have so many pockets and so little memory?

10. Why do my patients keep bringing up health care reform to me? I don't talk politics to patients, and you won't like what I have to say anyhow.

Yeah, I love this. I'm a nerd.

"The discovery of the gastroliths associated with this plesiosaur specimen were particularly exciting because most plesiosaur gastroliths are found associated with the long-neck morphotype", Dr. Schmeisser explained.

(Long-neck morphotype shown.)

You gotta know when to hold 'em.

Back in the saddle again!

A conversation I had over vacation brought to mind a patient I had a couple years ago. He told me, quite seriously, that he tended to throw punches when he got a shot.

"You won't this time" I said calmly.

"You don't understand!" he insisted. "It's like, this reaction I can't control. You gotta get a couple big guys to hold me down before you give me that shot!"

I went on filling the syringe (I can't recall what, exactly, I had to give him, but it was one of those drugs that requires a glute shot and a Z-track) and said, again, "You won't this time."

(Query: Why is it always young, healthy guys in the military who tell me this? Dude, you spend your days *getting shot at by bad men with big guns*.)

He looked at me. I said, "Roll over onto your stomach."

He did. I said, "Okay, now grab your crotch with both hands."

A sidelong glance over the shoulder. "Why?"

"Because if you try to make a fist, your balls are in the way. And by the time you get your arms out from under you, I'll be across the room."

I did not need two big guys to hold him down.

More recently, I had another patient like that. Only this guy told me that he'd kick me in the gut if I tried to start an IV on him.

"Not this time you won't," I said, calmly unpacking the IV supplies.

"No, seriously!" he insisted. I sensed a trend. "You gotta get a couple..."

"Big guys to hold you down?" I asked. "Yeah, except this time, I won't."

"Why not?" he asked, chin jutting out.

"Because I'm going to stick you once with two hands. If you kick at me, I'll stick you the second time with one hand." I tied the tourniquet around his upper arm.

"What'll you be doing with the other hand?" he asked.

"It'll be wrapped around your balls, ready to squeeze." I smiled sweetly.

One stick, no kick.

Monday Mush

Sunday Meditation

...And if it was all to do again, would I do otherwise than I have done? No, I would do the same. A thousand times over, I would do the same. And it would still be sin.

In our various degrees, we are all sinners. To acknowledge and accept that load is good. Perhaps even to acknowledge and accept it and not entertain either shame or regret may also be required of us. If we find we must still say: Yes, I would do the same again, we are making a judgement others may condemn. But how do we know that God will condemn us? His judgements are inscrutable....In the end there is nothing to be done but to state clearly what has been done, without shame or regret, and say: Here I am, and this is what I am. Now deal with me as you see fit. That is your right. Mine is to stand by the act, and pay the price.

You do what you must do, and pay for it. So in the end all things are simple.

--Ellis Peters, Brother Cadfael's Penance

I wanna party with these guys.

Extreme Pool Jump - Click here for more home videos

I am bummed.

Severely, severely bummed.

Intolerably bummed.

Listening-to-Sugarland-and-sobbing-even-at-the-happy-songs bummed.

Friend Pens the Lotion Slut will not be joining me for a week of debauchery after all.

Friend Pens has the worst boss in the world. The day before she's supposed to come see me for a week of champagne, IKEA, and swimming in spring-fed pools, he swanned into town without warning. Worse, his minions passed out a pre-arranged itinerary that had entries on it that said, in burning letters that would do J.K. Rowlings proud, "LOTION SLUT'S PRESENCE REQUIRED OR SHE WILL BE FED TO THE WOMBATS."

Pens, being an intelligent woman with a good grasp of the essentials, decided that not being fed to wombats trumped champagne and strawberry trifle. I don't blame her; I believe wombats are vegetarian (or, at the very least, have kind of dull teeth), so being nommed repeatedly by a cage-ful of them would certainly suck.

*sigh*

On the upside, it's still the week during which my pal Suz the Rat Wrangler will be liberated from the crazy man she had the bad fortune to marry lo those many years ago. So the champagne and strawberry trifle will still happen; it'll just happen without the L.S.

And, as a result, I am bummed.

Stolen from Shakespeare's Sister

Yeah I know that you wanna be Canadian, please
Even if in winter things tend to freeze
We've got the world monopoly on trees
And our country's bordered by three different seas

Yeah I know that you wanna be Canadian, please
We invented the zipper, we've got expertise
We made insulin to combat disease
Yeah I know that you wanna be Canadian, please

CHORUS
Brits have got the monarchy
The US has the money
But I know that you wanna be Canadian

The French have got the wine and cheese
Koalas chill with the Aussies
But I know that you wanna be Canadian

Et si ce n'était pas assez
On a deux langues officielles:
L'anglais et le français
Ooh la la

Yeah I know that you wanna be Canadian, please
Where else do you find mounted police
Or go to the hospital and not pay fees
Yeah I know that you wanna be Canadian, please

And when freshwater is in high demand
We've got the world's largest supply on hand
So you know that we could make a pretty good friend
But it's even better if you can be...

CHORUS

So you're thinking to yourself,
"How do I live in this beautiful country?"
Well we've got some steps for you to follow...

STEP 1: Lose the gun
STEP 2: Buy a canoe
STEP 3: Live multiculturally
STEP 4: You're ready, there is no more!

We got beavers, cariboo and moose
We got buffalos, bears, and Canadian goose
And we're sorry about Celine Dion
But she did do that good song for James Cameron...

CHORUS
Brits have got the monarchy
The US has the money
But I know that you wanna be Canadian

The French have got the wine and cheese
Koalas chill with the Aussies
But I know that you wanna be Canadian

The Greek chilled out with Socrates
Can't build a wall like the Chinese
But I know that you wanna be Canadian

In Kenya they have safaris
We've missed lots of other countries
But I know that you wanna be Canadian

Live, from the dusty plains of Central Texas, it's Head Nurse!

I had no idea my eyes slant downward like that.

Sunday Sweetness

This blog is lovely; one little girl is lucky to have the mother she does.

You undoubtedly heard about this on NPR. It's still a good read.

Something tells me my nephew might be getting a really cool Christmas present this year.

Drive-by vacation posting

ONE:

Please. I have told you and your coworkers four times this week that Maria Wenschel does not live at this number. I have had this number for (counting on fingers) uh...five? No, *six* years now. Maria Wenschel has never lived here. Neither has Joyce Ngabe or Matthew Watkins or any of those other folks who owe you money.

TWO:

Bra. Buy one. Wear it. Please. Unless you are the adorable, bone-thin, dancer-bodied hippie chick from across the street, you need one. And she has no boobs anyhow, so she's good.

THREE:

Leash. Buy one. Put it on your dog. Otherwise, my dog will get very upset when your bait canine* comes over to the fence and starts acting all tough, because Max won't know whether to bark or be calm or run away. This is sort of an existential crisis for him, because he believes in protecting the small and weak, and your particular small and weak is begging for a beat-down.

FOUR:

Call. Before you come over. Unless you are the UPS man with new shoes, in which case you can come over any time you like without calling first. Especially if the shoes are free.

FIVE:

Bad: The idea you had to come knock-knock-a-knockin' on my door this morning at four a.m. Not only am I awake then, but I am awake with an anodized pink practice bat filled with Quikcrete** in one hand and my very large dog's collar in the other. And I do not know you, so either the bat or the dog is going to move toward you fairly soon. No, you may not use my phone.***

*"Bait Canine": any dog under six pounds who has no other obvious function than to act as bait for real dogs.

**For a while I considered buying a shotgun, because the sound of a round being chambered in a sawed-off double-barrelled shotgun is the single best deterrent to violent crime ever. However, I've now discovered that the sound of a concrete-filled bat tapping against a doorframe combined with the subterranean rumble of a Good Boy (yes, he's a good boy! Yes, yes he is!) is almost as good.

***And no, I would not have normally opened the door at all, but the knocking was getting insistent and distracting me from Go Fug Yourself.

In Which Jo Reveals Her Blog-Crushes (aka link roundup)

Since I don't have anybody in the meatworld to crush on, here are a list of my current blog crushes:

Design/Homewrecking

Door Sixteen. In my social group, "D16" has become shorthand for "anything you obsess about and work on with perfectionistic tendencies showing, because you know it'll be gorgeous in the end". This woman probably wipes her ass with $100 bills, and has more patience than I do, but it's a crush....so it's aspirational, right? Right?

The Daily Danny. Yes, it's all about consumption, which doesn't seem very green to me, but he does find some pretty things. And, when you really need to replace your coffee mug collection/end tables/whatever, he undoubtedly has a post about whatever it is you need a new one of. (What a sentence.)

Screamprinting. You've seen those "Keep Calm And Carry On" repro posters? Well, these folks have some that say "Bloody Hell, We're Buggered Now." I'm thinking of getting one of each and gluing them together, then hanging them on the wall so I can turn them whichever way I'm feeling that day.

News You Can Use

The New York Times. The original and still the best.

Jezebel. Not only do the brave souls of Jezebel offer commentary on this week's "Big Brother" episode, they do thoughtful analysis of news stories you won't get anywhere else.

Advertising For Love. The project of a woman doing her dissertation on old personal ads. Maybe it's not "news", but it sure is interesting, and it shows us plus ca la change, plus ca la meme chose, or wevs.

Girly Shit, Like Lipstick and Shopping

Apocalypstick Now. Not only does she have the best blog name ever, she's hilarious.

Outblush. I must admit that I read this blog only to see what the authors consider to be reasonable purchases. The average price of a dress exceeds my mortgage payment.

The Beauty Brains. Science and beauty in one tidy package! Don't buy a new shampoo without checking here first.

Esteemed Colleagues

Grunt Doc. Right up there with Sid Schwab, in my opinion (who's no longer medblogging, and what a loss that is), I always find something interesting going on with The Grunter.

March of the Platypi. Still one of my favorites, lo these many years later. It was the Platypus who showed me both that it could be done and how to do it.

Your Pharmacist May Hate You. Total blog-crush material: he likes Scotch, he's grouchy, he's overworked. What more could a woman with her own tools ask for? Plus, he writes amusingly and is politically active.

WANT.

All the way down at the bottom of the page. 1940's girl's bike.

It's blue. It has a headlight. It looks cool. I wonder if it's fixupable?

I wonder if Friend E. would mind a houseguest while I go browse?

HA!!!