I fought the blah and the blah won.

I spent the entire day in bed.

Which is not as fun as it sounds, because not only was I alone, I was getting up every half-hour to evacuate one or another storage unit that the human body has. In abundance.

Yeah, I called in sick. They can take it out of my hide later; the way I see it, if I'd had to sit for thirteen hours with limited chances to hit the bathroom, not only would I have come up with a bladder infection for reals, but anybody nearby would've been very unhappy with me. Because that tummy bug? The one that all the interns are getting? I got.

You would THINK (she says, grouchily, looking back at all the people who told her that "nurses never get sick after the first year") that working on a high-acuity med-surg unit with a fucking PRESSURE ROOM and dealing with people who have VISA and VRSA and all those great diseases that are known only by their initials would've PROTECTED ME from some bullshit stomach virus that somebody's kid brought home from school. I *mean*. But no, no; if it's possible to catch it, whatever "it" is, I'll catch it.

I'm half-convinced that the horrible cough/insanely high fever/body aches I had last Spring was H1N1, and devoutly, wholly hoping that it was. Because damn I do not want to do that again.

So, yeah. The entire day in bed, wishing for a dipstick (quit snickering)(you know who you are) to tell me whether or not I was really sickening for cystitis and wondering if Heinlein and Ben & Jerry's have curative powers.* Apparently, they did; I feel better now than I've felt in a week. The Rat Wrangler came by to offer a hug and moral support; thanks to all of you who offered the same. The hug was delivered in person.

Oh, and Molly? I've read differing opinions about cranberry juice and extract, and have come up with only two solid things: first, that you should not take cranberries of any sort with Bactrim, as the cranberry binds to the Bactrim somehow and renders it less effective. Second, that cranberry extract can *prevent* UTIs, but only prevent--once you've got honest-to-Frog symptoms, it won't cure you. (Don't ask where I got that first bit of information; it probably came from Ken the Pharmacist at some point over a bottle of tequila. Speaking of Ken the Pharmacist, he said something weird the other day: "Of course I knew you were transferring to the CCU! You have a whole blog dedicated to the subject!" Which made me look at him narrowly, but if anybody can keep my secrets, Ken can. I still don't know how he found it, though.)

Anyway, yeah. Cranberry capsules, water, and EKGs and Friday**. That was my day. I feel like I have a better handle on EKGs than I ever realized before; I can recognize all of the lethal rhythms and know mostly how to treat them, and I can recognize a number of the nonlethal ones as well. The rhythms that still give me trouble are the blocks. Those will get woodshedded into my brain in the morning.

Meanwhile, Max is outside going ba-roo ba-roo, incredibly happy because it's not only raining, it's appropriately chilly, so he can act like the big furry Northern, kilt-wearing Protecto-Pooch that he is. It's going to be raining again tomorrow, so I'll be up early for bacon and waffles and a big cup of coffee and some....sigh....cranberry capsules.

Thanks for all the well-wishes and encouragement. My mood is much better now that I'm successfully, rather than half-assedly, fighting off this bug.

*So I guess, in retrospect, that I spent the day in bed with three men. Hi, Mom!

**Don't hate me. I tried Before The Golden Age and Ender's Game, and they were both too dense. So was Eating Right In The Renaissance (all of his footnotes are in Latin and Old French) and We Band Of Angels.

I mentioned I don't like you either, right?

You know that phrase "wheels off"?

I'm coining a new one: "wheels still sort of on, but making really funny noises, and gosh, it kind of worries me." Okay, maybe that's a little long. It still describes my day.

How is it, I ask you, that I can perfectly understand the structure and function of the heart, the way EKGs work, and whether or not a missed QRS complex means you have a block on Wednesday, then find it all impossibly dense on Friday? How is it that I can identify rhythms on one day, and not manage it two days later?

How is it, for that matter, that my grass can go four fucking weeks without needing to be mowed, then suddenly, it needs to be mowed twice in one week? It's not getting mowed today, and thus won't be mowed for the forseeable future, because it's supposed to rain from now until the Four Horsemen show up on their My Little Pony-style steeds. I fully expect to see Max slinking through the waist-high grass by this time next week. He'll have fun pretending he's a big lion on the veldt; I'll have fun trying to mow the back yard on just two Neuton batteries.

And cat hair. I had cat hair everywhere today; yesterday, there was none in evidence.

I'm beginning to sound like Andy Rooney.

Honestly, though? It's all beginning to hit, what I've done. I'm basically starting over in my career, and I miss my friends from the neuro acute care unit. We were family for nearly eight years; they got me through divorce, trauma, happiness, my sister getting married...and I just plain miss them. There are inside jokes my new colleagues just can't get, and quirks I have that they're not used to, and that makes the transition hard.

The guy who changes my oil went from being a sweet, kind of clueless nerdy type last month to having fresh tattoos of zombies on his arm and rivets in his ears today. *That* was a shock.

Max is getting grey around the muzzle. There's no other evidence that he's getting old; in fact, he's more active now than he was two years ago. But I still notice, and I wonder how much longer he'll be around.

And I'm fighting off, simultaneously, whatever bug is going around at Holy Kamole (fever, chills, nausea, diarrhea; not the H1N1 flu) and a bladder infection (hooray for cranberry capsules!). In an attempt to give my body what it needs, I've bought sour-cream-and-onion chips and Ben & Jerry's.

Frankly? I could use a hug. I wish my long-lost Polish buddy Arek were here; he gave the best damn hugs on the planet (partly because he was, like, seven feet tall and three hundred pounds, with an enormous curly red beard). I could use a couple of glasses of wine with Friend Pens. I could use a really, really good dinner with little deep-fried squidlians and endive and all those things I don't normally eat, then a walk in cool weather along a river I'm not familliar with.

*sigh* Potato chips and soprasetta for me, kids. And artichokes and clarified butter. And another beer, and another week, and maybe things will improve.

He doesn't like you. I don't like you either.

Max went batshit insane today, just as there was a nice big storm blowing in. Normally, Max does not go batshit insane with storms; he instead scratches apologetically at the door and asks to be let in.

Not today, though. Today was growling, snarling, barking, howling insanity in the back yard.

Now, I have to set this up for you:

Imagine the biggest German Shepherd you've ever seen.

Cross that with something that's mostly blonde, much stockier than a G.Shep, and equally as furry.

Add a healthy dose of Mellow.

Toss in some love for kitty-cats.

Slap on a couple of pounds of happy, add a schmear of totally unflappable, and take out all the ditzy, weird, spooky behavior that overbred dogs can have.

You'll end up with a mutt who, like Max, is normally the calmest, most Zen being on the planet. He barks, yes, but it's understood that he's not really barking at the postman; it's a formality on both their parts. The postman regularly comes over to the fence to scratch Max's ears. Likewise, he'll bark at dogs wandering past (and bay at his girlfriend the basset hound), but he would never growl at or bite your average dog that comes right up in his grill. He's mellow, you see. He's kind of a Southern-California type dog, taking each day as it comes and chilling out.

So, when he went absofrigginglutely batshit insane, I let him in. I figured there was something out there that I needed to be aware of, and better he's in the house than out of it.

Sure enough, the doorbell rang.

Max went straight to the door, ignoring my "back" and "sit-stay". He stood at the door, looking interested. This is normal. Ignoring "back" and "sit-stay" is not. I opened the door.

On the doorstep stood a clean-cut young man who was obviously there to sell me an alarm system, or offer one for free for a limited time only! or beg me to put his company's sign up in my front window.

Max stalked forward, ears up, hackles rising, legs stiff, normally-curly tail straight out behind him. There was a low, almost-sub-audible growl that I could feel but not quite hear coming out of his chest. The guy on the porch said nervously, "Uh...nevermindseeyoulatersorrytodisturbyou" and left as quickly as I've ever seen a person leave who was not actively being pursued by an unholy combination of fire ants, cicaida killers, and door-to-door evangelicals.

Max got some cheese. ("Cheese? I LOVE cheese! How 'bout some bay-cun too?") He's now lying calmly under a tree in the back yard, grooming his hind feet. All the doors and windows are locked.

Let it never be said that I don't know how to take a hint.

Product Review: Alan, I Am Saddened Edition.

Based on some fabulous reviews, I bought a bottle of Alan Cumming's cologne, Cumming. (Yes, yes, he makes all the jokes you'd associate. Now stop giggling.)

Now, I am not normally a cologne girl. I am especially not a celebrity cologne girl, but I was tempted for two reasons: First, because I love Alan Cumming. Second, because every single review I read lauded the peat, the whiskey, the cigar smoke, the deep notes of sandalwood.

And I am *not* a cologne girl. When I go out, no scent. When I go to work, no scent. Occasionally--*very* occasionally--I'll wear a single squirt of that Amazing Grace stuff Philosophy makes that smells a little like Mister Bubble, or a single squirt of Demeter's Gin & Tonic or Sandalwood. Hell, when I went to meet That Guy I Like the first time, I didn't even wear cologne. Don't like the way I smell? Cut yer damn nose off and eff you.

But, y'know, once in a while, a girl needs some options.

Let me tell you: This shit is da bomb. It smells like whiskey, smoke, rubber, peat, sandalwood, musk, and old library books.

For about five minutes.

At which point my weird body chemistry turns it into something you might've smelled back in 1987 on that dude from your bio class, the one that had the souped-up El Camino and the mullet, but who was somehow, inexplicably, still hot.

I do not want to smell like that guy. (I think his name was Robert; I do know he dated an absolutely gorgeous girl named Diana.) I don't want to think of that guy. I certainly don't want to be that guy, but now I have two bottles of cologne (they sent me an extra because shipping took so long) that will turn me *into* that guy if I'm not careful.

After a workout and a shower, the single squirt of it on my forearms smells vaguely like my paternal grandfather's study...which is nice, but I'm not willing to go through a workout and shower just to smell like Poppy's old law books. So I've offered it to an online acquaintance who loves it, and maybe she'll get some use out of it.

This feels a little like when I found out Alan Cumming is gay, and all the dreams I had of re-enacting "Posh Nosh" and scenes from "Spice World" flew out the window.

Alan, I still love you. Call me; we'll tie on some aprons sometime. No pressure.

Nurse Jo, a fitness blogger? Zut alors! (BIG ANNOUNCEMENT)

Heads up, peeps!

As of tomorrow at oh-dear-thirty, I will be blogging with Crabby McSlacker at Cranky Fitness.

I know, I know. Me, a fitness blogger? Sheesh. My posts will probably be along the lines of "heaviest beers to lift" and "throwing a fit and running in circles: effective exercise?"

Crabby wrote me a very sweet email, talking up my talent and asking me to come on board, and I was so shocked I said yes before I thought twice. I've still not thought twice: The Crab is a fantastic writer, and her blog (though fitness-focused) is general-interest enough even for slugs like me.

Check it out! I can't promise I'll have anything up early-early tomorrow, but I'm'a do my best.

Blogging here will, of course, continue uninterrupted.

Why, yes, I've been there....

Good news, bad news.

The bad news: The exit I take to Sunnydale is closed for the forseeable future.

The good news: I discovered this in time to get stuck in a huge traffic jam, make a highly illegal U-turn on a side street, and head back toward Sunnydale.

The bad news: The U-turn was highly, highly illegal. As in, almost as illegal as the turn I made into my dentist's parking lot two weeks ago, which I did on two wheels.

The good news: The cop behind me didn't care; he was too busy making the same highly illegal U-turn. If a cop flashes you a grin and a thumbs-up from his squad car in the middle of rush hour, things can't be so bad.

The bad news: I had to buy new scrubs.

The good news: They're a size smaller! And they're not even tight!

The bad news: They're not exactly the color that the Manglement at Sunnydale wants for its nurses.

The good news: Nobody cares! Everybody else in my critical care pod wears the same wrong color! Plus, I don't have to haul in the drawstring hand-over-hand to get them to fit!

The bad news: The Hello Kitty lunchbox was not big enough to hold my bulky-yet-non-caloric lunches.

The good news: The next size up, Transformers (classic style) was just right. I am now the only nurse at Sunnydale in posession of a Classic Transformers lunchbox. Flyin' the Nerd Flag high, I am.

The bad news: The Transformers thermos was too big to fit into the Transformers lunch box. Why they do this, I do not know.

The good news: The Hello Kitty thermos was *just* the right size, and was on sale!

The bad news: Sexy underwears are uncomfortable.

The good news: Sexy underwears come in cotton.

The bad news: I am very, very sore. A leg/core/glute workout yesterday combined with a massive, huge, horrible, worse-than-IUD-insertion upper body workout on Saturday (and no, ladies, I am not joking about that at all) has left me unable to do much of anything.

The good news: I have nothing to do tonight and there are grilled cheese sandwiches on the stove.

Monday Morning Remedy: Spice-y Edition

Focus. Focus.

Shout-out to UnsinkableMB: I have your avatar on the back of my hospital ID! Back when The Hair was still growing out--before it had become its own separate lifeform with its own desires and demands--I looked something like the woman with the coffee cup. It gave my patients pause.

*sigh*

Tomorrow starts class. The first couple of days will be cardiovascular stuff. If what I remember is what's going to happen tomorrow, it'll be horrendously dense, full of all sorts of things I probably ought to remember from school (how long ago was that, exactly?) and all sorts of things I never learned properly in the first place.

I have a confession to make: I never learned exactly how many chambers the heart has, how it repolarizes, and why exactly it beats. I'm not even sure any more how blood goes from one place to another. Seriously. Might be the pull of the moon, might be the contraction of one of those "ventricle" thingies that people are always talking about, might be the will of Jello Biafra. I don't know.

This fits in with my hypothesis, not yet disproved, that people who really get CV stuff rarely really get neuro stuff, and vice versa.

Anyway, my CV knowledge is built on an extremely shaky foundation. I know that there's something pumping away in the left-center of my chest; I can feel it. I know that there's a similar something in other people's chests; I've felt it there, too, going at various speeds. I know that that something that's bonking away in there has a lot to do with whether or not you keep blinking and breathing and scratching the eight hundred mosquito bites you got yesterday while mowing the lawn even though you were wearing Deep Woods Off and what the hell is that all about, anyway, did they import mosquitoes from Alaska? but I'm not real clear on anything beyond that.

Plus, after two days of CV Hell, we start intensive Neuro Hell. The internship group will be splitting up for that, with the CVCCU folks going off to learn more about that mysterious bonking thing in the chest, and those of us in Neuro CCU staying to learn more than we ever wanted to know about neuro anatomy, infections, tubes, machines that go beep, and complications. There are two of us going into the Neuro CCU; I do not expect to be able to hide in class.

But oh, my blessed (prize to the first person besides Beloved Sister who can identify where that phrase comes from), I am distracted.

It is cool out, finally. Although it hasn't rained enough to relieve the worst drought in central Texas in my lifetime, it's rained enough to make things resprout and turn green. The Hill Country is almost, almost pretty. North of the Hill Country, the weird mesa-like outcrops are covered with oak trees that, from a distance, look kind of healthy. It's cooling off. (Note to self: take next year's vacation in late September.) The days are beautiful and clear, and the nights have just enough chill to them to make me thankful for two cats at my feet.

My nose is waking up after a summer of air-conditioning and dust. This can be inconvenient, as smells that have nothing to do with critical care tend to lodge in there. I want to make soup, go to Central Market and buy marinated roasted long-stemmed artichoke hearts, and make a pilgrimage to Fort Worth to feed the koi in the botanical gardens.

And to top it all off? I'm sure this is news to nobody but me, but guys? Rock.

Focus. Focus. Calcium channels and independent wiring and aorta here and ventricle there and atria on top somewhere and somehow blood gets reoxygenated through the lungs. Yep. Lungs. Heart. Lungs. Heart.

Focus.

Things learned: week one.

1. Slow down and pay attention.

It doesn't matter if you've done it a million times one particular way before. If you hurry through it, there's a chance you'll miss something important.

2. If it hasn't worked every time you've done it before, the problem is you.

This is not a time for pride: if you're not good at something in particular (with me, it's tricky IVs), you should examine how it is that you've been doing it all these years and fix the problem. If you don't know what the problem is, ask somebody else. Another person will certainly have either advice or insight that will do you good.

3. Play to your strengths, but know when to give 'em a rest, too.

My big strength is education. I can teach almost anybody almost anything that I understand myself. In a way, that's good: patients and family members who are getting ready to go home have lots of questions about aftercare. In a way, that's bad: patients and family members in the ICU don't necessarily need to know exactly what every single piece of tubing means. There is such a thing as too much information.

4. Let other people take the lead.

People will generally tell you what they want, if you just give them the chance. Fall back and allow that to happen. In that same vein...

5. Nonverbal cues are very important, whether or not they're subtle.

What's *not* happening is as important as what is. If you have a family member who won't ask questions, or who sits in a chair with their arms crossed and looks stony, there is something Very Big going on there. Those are nonsubtle nonverbal cues. The subtle ones are things like the little flicker of the eyelid that means that the person didn't understand what you were just saying, or the small pause before a question. They're just as important as the big ones, if not more so.

I'm limiting this to five. If I listed 'em all, I'd blow Blogger up for sure.

Yeah, so. Maybe it's not all so bad.

I got a really, really good night's sleep last night--the sort of sleep where you roll over, consider trying to stay awake for a minute to follow the interesting train of thought that just developed, and then fall asleep, only to dream about people who become vampire zombies if you don't give them sunscreen--and woke up to coffee.

I love coffee.

Then I drove through Big City construction (will it never end? No.) and sat for six hours in what should've been a ten-hour computer training course. The instructor began the course by listing out in detail what he would and wouldn't be covering. Given that I'd seen it all before--literally, as I've been using this system for a year (but we're all getting re-trained), that was a relief.

Halfway through the six-hour course, we got an hour and ten minutes for lunch. Do you have any idea how long it's been since I've been given an hour and ten minutes for lunch? Holy cow. We all went down the street to some tiny little hole-in-the-wall place with a name like "101 SNAX" simply because we saw a line of other people headed there.

Inside was your typical Korean, Vietnamese, and Filipino grocery section. In the back were several long steam tables offering everything from chicken fingers to pre-breaded shrimp to some sort of soup I'd never had before that involved kimchi. I ended up having soup, a salad with vegetables that were beautifully peeled and cut into different shapes, something that I think might've been cold pickled tripe, some roasted vegetables that were so fresh they tried to cop a feel, and a really interesting mix of rice, more vegetables (including bitter melon, which I try to love), and shrimp. I skipped the pre-made cheesecake and lonely slice of chocolate cake and went instead for melon bits carved into fun animals. Oh, and some pineapple in the shape of a swan. Couldn't pass *that* up. All for less than ten bucks, including drink. Don't tell me that the 'hood don't have good food.

Now I have to figure out how to submit my hours for the week while simultaneously feeling sorry for a fellow intern who wouldn't even go into the restaurant because it "smelled funny." Granted, she's from the land of corn and wheat, but I think she'll have a hard time here if she won't eat anything that smells funny. The Big City is a diverse place; you're as likely to find menudo as you are meatloaf, and foods that might be animal or vegetable (sea cucumber?) are common.

So, yeah. It's not all so bad. I have intelligent colleagues who like to talk about cooking and dogs. I had a very satisfying phone conversation that made me laugh like a hyena more than once, followed by a good night's sleep. And coffee.

When it gets bad--when I'm trying to remember how to level an A-line, or when somebody pulls out their ventric tubing--I will remember today.

Which won't be hard, 'cause I'll probably still be burping kimchi soup in July.

Mad props to all you nursing students out there.

Dayum.

I remember school being hard. I remember being stressed a lot, and getting through on a combination of adrenaline and coffee, and weighing something like seventy pounds less than I do right now at the end of it, and not having any muscle mass and looking and feeling like a concentration camp victim, patchy baldness and all. I remember being so mentally exhausted that I didn't want to read anything, even the simplest bad science fiction. I remember being so emotionally spent that I couldn't go to the last two days of a very expensive NCLEX review course.

But I do not remember being this damn tired. And it's only been one week. The hard stuff hasn't even started yet.

Part of this is probably that I've been getting up early every day and staying up, with no opportunity for the naps which I've become accustomed to. Part of it, I'm sure, is the endless driving back and forth, back and forth. Part of it is sheer frustration with how slowly some things move and how much paperwork there is.

But Jeebus Grits. Internship was hard when I was 32. I've a feeling it'll be impossible seven years later.

I cannot IMAGINE starting nursing school at nearly- or past forty. Yet I had classmates then, and have co-interns now, who were in their fifties and doing fine. Is there some reserve of stamina I'm missing? Is there a Delicate Flower chip, and did Mom and Dad saddle me with two?

So: All you nursing students out there, especially the ones of you that are past, say, fifteen years old? You rock. Those of you over forty rock double. Those of you over *fifty* deserve both a medal and a mountaintop retreat at the end of things.

I'm going to go lift heavy things now and then fall over into bed. If I get a shower in before bed, it'll be because I'm feeling almost human.

Color-coded cords? I can do that.

I can also empty pee out of a Foley and total up ins and outs. I can turn a patient, I can run your errands, and I can stare blankly at the readout of a monitor measuring something obscure.

Critical care will kick my ass. There are thirteen weeks (and a couple of days) to go, and I'm going to need every single one of them.

Holy crap. I know *nothing*. Everything I thought I knew isn't going to be enough. My brain hurts already. Holy crap.

But I'm jazzed. Seriously excited, wanting to figure out more, wanting *not* to have to do any more mimblemumble administrative stuff, wanting to get back out on the floor.

Special bonus post: Cooking with Auntie Jo

Now that I'm in an internship, I've been cut back in hours. Being unwilling to eat things like ramen and generic Cheerios, I've decided to cook what I can from what's lying around (with the occasional foraging trip). It's Live Like A Student Time, but not really, because my college cafeteria had pretty good food, and it was all paid for, so maybe it's not at all like that.


Auntie Jo's What's On Sale Pretty Damn Good Black Bean Chili

three cans plain black beans (3/$1, sitting in cabinet)
one 28-oz can whole tomatoes (99 cents; the diced ones were 30 cents more)
about a half a bag of frozen corn I just had lying around
one medium onion, ditto
two poblano peppers (the big budget breaker at $1.29)
an appropriate amount of both cumin and chili pepper (at least two tablespoons of each. I have no idea what this costs per use, because I buy both in bulk from the Indian grocery)
however much cayenne pepper you want, if you want it.

Chop the onion and poblano pepper coarsely. Heat up a little oil in a pan large enough to hold two half-grown cats. Toss onion and peppers into the oil.

Saute over low heat until the onions are softening and the poblanos are an unnaturally bright green. (Do not be alarmed. They will not stay this color.)

Drain the tomato juice into a suitable container and chop up the tomatoes. Or use diced ones. Or just dump the whole can into the pan (once the onions have softened a bit) and use a potato masher or big fork or knife to squish them around and break them up.

Drain the beans into a colander and rinse them under cold running water until all the soaplike bubbles are gone. (This is an important step, as it will prevent you from making a huge pot of Auntie Jo's Gas Giant Black Bean Chili.) Dump said beans into the pot.

Dump in a half bag of corn, or maybe some carrots you've chopped up, or perhaps even a little squash (ew).

Dump in the appropriate amounts of chili and cumin. I tend to use about a two-part chili to three-part cumin ratio (Beloved Sis is garking right now), but then, I like lots of cumin.

Sprinkle on, or toss on, or shovel in, cayenne. Here again I am in the shovel-in school. Your mileage may vary.

Bring the whole kaboodle to a simmer and allow to continue to simmer for anywhere from 45 minutes (the absolute minimum) to five hours (about as long as you can go without scorching the mix or turning it into a solid). If you're simmering longer, add a little extra water now and then, and stir to keep from sticking.

Serve with cheese if you have it, sour cream if you've got that, or nothing. See? Pretty! And tasty! And filling and cheap!

Makes enough to serve one hungry nurse three meals and two hungry liberal Christians one meal each.

Testing... ... ...testing... ... ...

Today I kicked ass and took names. We had tests. I love tests. I especially love tests that have to do with little scenarios you read and analyze, then try to figure out what to do first, when to call the doc, and when to tell the patient to calm the heck down, everything's really and truly fine.

Of course, these were critical care scenarios. I am a med-surg nurse by training, so there was a certain amount of thinking that had to go into things. And, as a Minion heard recently, you can't always put down real-life solutions to test questions, because what the accepted nursing practice says is different.

For instance, take this scenario: a patient has a heart rhythm that's consistent with having too much potassium in their blood. What would I do in the real world? Why, I would draw a stat serum potassium. Then I'd call the resident. While waiting for the lab results, I would get a stat 12-lead EKG in order to get a clearer read on what was actually going on. I would check IV access and stop any potassium-containing fluids that were running, then call the pharmacy and give 'em the heads-up that I'd be needing Kayexalate soon. (Kayexalate is an oral suspension or enema that pulls potassium into the large bowel where it can be excreted.) By that time, the resident would've called me back and I could present her with all the necessary information.

Sounds pretty good, huh? I thought so. Unfortunately, I was totally, utterly, completely, unequivocably wrong. The first thing I should've done was page the resident. Paging the resident comes first in the book world, because in the book world, nurses aren't given as much autonomy as I've had for the last mmumphm years. In the book world, nurses do not act autonomously. They wait for residents--even if the resident is horribly underslept or doesn't know much about the patient--to make the call. The most we as nurses can do is make gentle suggestions as to courses of action.

If you've read this blog for more than five minutes, you know that is not the way Jo rolls. If I can save a resident from multiple phone calls, regardless of the hour, I will do so. Part of my job is making *their* jobs easier.

Anyway, I mostly kicked ass on the four-and-a-half hours of testing. The one thing I really quibbled about was when I was docked points for checking the output of a patient who'd recently had a neobladder created and who was complaining of intractable pain. The book answer was to treat the pain first (Pain Takes Precedent, another lesson I forgot) and then worry about output. My feeling is that if you've got a brand-new neobladder (that's a bladder that's made from a section of small intestine), you ought to be worried about output first, because the damn things can tear open if the catheter in them is occluded by mucus (a common neobladder problem), and then you've got a bellyful of hot piss, and then where are you?

But no. Tylenol first (TYLENOL? WHAT PLANET ARE YOU PEOPLE FROM??), then check output, then page the doc.

*sigh*

So I came home and opened all the windows. Now I have a pot of black bean chili on the stove and a happy Max-dog nuzzling my rib cage. Later I will eat large amounts of veggie black bean chili and take the rest to Pastor Paul next door, then fall into bed. Tomorrow, after all, I'll be back on the floor bright and early.

Kickin' ass, takin' names, and... ... ...filling out paperwork?

We all filed into Employee Orientation this morning bright and early at 9 am, faces shining with enthusiasm.

Okay, *my* face wasn't shining with enthusiasm, but I'd just spent an hour and ten minutes in Big City Traffic, going through a part of the Big City that Google Maps doesn't even bother to update, the construction is so bad. Leave early, kiddies!

The nice lady from HR was calling names and handing out badges. I already had a badge, so I didn't worry when my name wasn't called. I didn't worry when I didn't have a package from HR; after all, I'd filled out all that paperwork years ago when I was first hired.

Nor did I worry when all of the stuff the nice lady from HR was going over seemed familliar. After all, I'd done yearly refreshers on this stuff for seven years.

It wasn't until I went up to the nice lady from HR to ask a question over the lunch break that I got concerned. "Why are you here?" she asked. "You're not supposed to be here. We called you and told you not to come."

"Yeah, I know," I replied, "but the education department called me that same afternoon, after you did, and told me to disregard and to show up anyhow."

She looked puzzled. Eventually, we figured out between us that there had been a misreading of something somewhere, and that the folks in Ed thought that I was actually new, while the folks in HR knew I wasn't, and therefore, I got to go home early. It was kind of a pain to have to get there, but the trade-off is that I start clinical rotations a week early now, in order to make up hours. WAHOO!

I can actually get back on the floor. (Can you believe I'm saying that? No, I can't either. That's why I was asking you.) I can actually get back to dealing with people with bits missing. I'm excited about that, strangely.

The important work-related lesson I learned today was this: Even the best of institutions sometimes screws up. I have a fairly common, unremarkable name, and with something like eighteen bazillion employees in the system already, and another hinty garillion coming in every month, I was bound, eventually, to be mixed up with another person with the same name. I'm honestly a little surprised that it took this long to happen; after all, there are three of me at my dermatologist's office, for cryin' out loud, and two of us have the same birthday.

For now, I'm going to use this extra time to do normal, every-day things like mow the lawn and pet the dog. At least Max never gets me mixed up with anybody else.

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.