What we talk about on slow days.

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

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

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

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

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

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

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

Best voicemail ever.

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

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

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

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

Dear Blue Cross and Blue Shield of Texas,

You have pissed off the wrong fat bitch.

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

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

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

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

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

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

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

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

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

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

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

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

It is ON, bitches.

Odds and Ends after a few days off

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Yeah. Been that sort of week up in here.

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

It is not my job to be a policeman.

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

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

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

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

It is not about you.

It is about the person in the bed.

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

Happy Anniversary.

A year ago, I was here.

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

My speech was normal.

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

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

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

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

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

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

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

Thank you for sticking with me through it.

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

All I have is "thanks."

Thanks.

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

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

Since when are plumbers hot?

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

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

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

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

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

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

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

Okay, try *this*.

Can you see us now?

Interesting question via the comments.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Just Oh, dear.

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

a nurse.

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

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

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

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

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

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

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

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

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

I love the "artist" in the beret.

Letters! I get letters!

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

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

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

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

Jo,

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

Sincerely,
Anonymous

Ain't that something?

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

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

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

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

Plus, you're an asshole.

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

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

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

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

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

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

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

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

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

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

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

*shiver*

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

Gar. GAR. GAAAAAARRRRRRR!!!

Tomorrow, the State Fair starts in Yeehawton.

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

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

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

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

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

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

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

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

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

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

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

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

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

You guys, I am *so* excited.

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

This one is. . .well.

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

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

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

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

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

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

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

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

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

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

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

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

Nursing stuff later this week. For now, *sigh*.

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

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

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

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

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

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

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

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

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

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

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

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

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

Homeless.

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

Home again, home again, etcetera.

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

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

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

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

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

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

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

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

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

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

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

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

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

Pens: Vultures?

Me: Too big.

Beloved Sis: TAGS.

Beloved Sis and Me, together: HOLY SHIT CONDORS.

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

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

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

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

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

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

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

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

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

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

There may be pictures, too.

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

This made me laugh right out loud.

From Buzzfeed.

Pens The Lotion Slut emailed me this morning

To point out that it's been a year.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This picture is copyrighted by Deanna Roy

Austin skyline today.

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

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

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

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

And the low?

In the fifties.

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

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

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

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

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

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

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

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

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

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

Two Stupid Things in two days: a new record?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

*pant* *pant* *pant*

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

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

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

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

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

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

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

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

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

Bizzy Backson.

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

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

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

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

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

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

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

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

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

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

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

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

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

Had a bad day? Have some sleeping leopard cubs.

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

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

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

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

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

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

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

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

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

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

Y'know what's depressing?

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

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

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

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

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

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

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

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

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

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

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

I was watching Notamus eat my guacamole last night

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

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

Something is broken in the space-time continuum.

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

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

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

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

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

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

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

Reading comprehension: The Lost Art Of The Covenant.

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

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

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

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

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

Nothin' like blood up to your elbows.

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

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

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

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

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

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

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

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

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

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