North, northwest, the stones of Faroe*

Some days do not suck.

Those are the days when, against all odds, everything goes right. The meds you need are there on time, without you having to call the pharmacy four times. The equipment you need somehow magically appears on the shelf in the clean utility room, despite nobody having needed that particular machine in four months.

And those are the days when your demented patient, who has advanced Alzheimer's, remembers only one person, and remembers them well: the man she's been married to for sixty years.

For a few hours, as long as he's at her bedside, she's completely oriented and alert. She understands that she's in the hospital, that she's not well at the moment and that she needs the antibiotics you're putting into her PICC line, that she's not to pull out whatever lines and leads you have attached to her. She doesn't fight you, she doesn't try to get out of bed. She just stays in bed or up in the chair, talking to her husband, perfectly happy.

You see a lot of things as a nurse. I've seen people die, and seen people born, and seen people end up trapped somewhere between the two states, with no way of resolving the issue. I've seen people forget everything they were, and people come back from what we all thought were insurmountable injuries. The best thing ever? Was watching my confused, distressed, combative patient become the person she was before she was admitted--all due to the man she'd spent two-thirds of her life with.

Would to God we should all have somebody like that.

Things They Don't Tell You In Nursing School, Part Four Hundred Seventy-Two:

Some days suck.

They're not the days with three codes and a couple near-misses. They're not the days when some idiot resident decides now is the time to scream at you in the nurses' station. They're not the days when big things go wrong; they're the days when a multitude of tiny things don't go quite right.

Mostly, it's because of people. Not patients--people. Patients are, though we tend to forget it, basically people just like we are; they just happen to feel like shit and need good drugs. 

There's the patient who has a dozen excuses for why he simply can't walk right now. There's the patient who is inexplicably rude to you, or the one who's offensively rude about you in front of a doctor or family member. There's the patient who, for some reason, you just can't do anything right for, no matter how hard you try. They're all people, and most of 'em aren't as big of assholes as they seem while they're in your hospital.

Some days it's easy to channel your inner Cherry Ames and just keep on plugging. Other days, the sorts of days I'm talking about, you get frustrated and have to stop yourself from running screaming out into the night (or dawn) as soon as your shift ends.

I once had a patient who had a big, nasty brain tumor in her frontal lobes. It turned her from a bearable, if brusque, person into the sort of alkaline bitch you wouldn't want your worst enemy to meet. For a week, I had no problems at all dealing with her, and could even sweeten her mood a bit--all while getting charts open on time and handling five other patients with varied (and more pressing) needs.

This has not been one of those weeks. When a patient was insulting about a resident to me, I snapped back, "Keep a civil tongue in your head" and handed her off to my (angelic) charge nurse without a backward glance. When a patient gave me yet another reason why she simply couldn't turn over in bed just now, I growled "You're turning, and that's final" and then hauled her over on her side before she could protest. When one other patient said to me, after I finished starting a particularly tricky IV, "I bet you don't have a boyfriend; it hurts to hold your hand," I had to get out of the room quickly in order to hide the ridiculous tears that started in my eyes.

That's what they don't tell you in nursing school: that dealing with people is hard. It's rewarding and satisfying, yes, but it's also really, really hard at times. You get lessons on how to handle the really difficult, insane people, but nobody prepares you for the exhausting, grinding, disillusioning work that makes up some days. 

What's worst about those days is how lonely you feel during and after them. It feels like, no matter how much your coworkers sympathize, you're the only person who's ever had a day this bad in the history of nursing. You feel inadequate, you wonder what the hell is wrong with you that you can't manage to take care of four or five sick people without nearly losing your mind by noon, you think seriously about applying at Starbucks. 

The good news is that those days, those weeks don't last forever. Eventually something turns around: the surgeon who's known as a stickler compliments you spontaneously, or the raving bitch in room 9 decides you hung the moon. Sometimes it's as simple as having all your meds and equipment there when you need them, and avoiding the running-around that characterizes so much of the average nurse's day.

So: If you're a new nurse, or a more experienced nurse, or an old, old, old nurse (and, believe me, after a week like the one I've had, you feel old-old-old), don't lose heart. Eventually the moon will move out of Klutz and things will stop sucking as much as they do now.

In the meantime, you still have the end of the shift to look forward to.

The following communication will not be therapeutic.

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

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

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

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

It has been a long week.

This has been running through my head all day long...

...as I dealt with five people who all had interesting, obscure things wrong.

Yes, I know there's nothing to look at. Just listen. 

Lyrics here.

I heard this song first on a Weekend Edition broadcast; Case said she'd often heard love referred to metaphorically as a force of nature, and wondered what would happen if an actual force of nature fell in love with a person.

It would make even *my* most Crazypants McStalkerson of boyfriends look sane, that's what.

Random 0557 musings, or, how having kittens means never having to say...

"Honey, let's sleep in in the morning."

Kittens love to play at night. Kittens love to play in the morning. In fact, kittens (these kittens, at least) play all the time, with short breaks for naps and eating and using the litterbox. It's mostly playtime at all times, though. Which means, between kittens and Max waking me up ("It's four a.m.! C'mon! Time to get up!") I've gotten about....oh, nine hours of sleep in the last two days.

I got an email the other day from a patient's family member. Yes, I do occasionally--very occasionally--give out my email address when I've been taking care of somebody for a really long time and have gotten close to the patient or family. Anyway, the patient's brother wanted me to know that the patient had died.

Just like that. And it was somebody that we all had expected to get better.

Sometimes inexplicable things happen, and you're left holding the various bits of the story, wondering what the hell went wrong. It's hard when it's somebody you've cared for who's been really, really sick and nobody expects them to live, but it's not as shocking and kick-in-the-gut as it is when it's somebody who, two weeks ago, was doing relatively fine.

I mean, they come in sick as a dog, you pop 'em into the ICU, spend a month or so balancing electrolytes and stabilizing them to the point that they won't croak during surgery. Then you do the surgery, and it goes well, and you transfer 'em to acute care. And, in acute care, you spend a couple of weeks (or more) getting 'em up, making them eat on their own, rebalancing their electrolytes, making sure they pee, walking 'em around the hall...and finally discharge them to rehab.

Where they suddenly drop dead. Not the rehab's fault, by the way. Sometimes things happen.

It makes you really good at dealing with loss in a healthy way, I'll say that. If you don't figure out how to handle things well, you won't be working/alive very long. 

If you're me, you lift very heavy things and run in between sets until you're about ready to barf. Then you do lots of heavy yardwork. Then you have a nice dinner with your favorite chef and then play with kittens, and finally go to bed and hope to sleep. When you wake up, it might be three seconds before you remember why you've got that lump in your gut.

And then you pick up the bits and look them over again, wondering what the hell went wrong.

Sometimes people just decide to die. I've seen it happen--where a person makes a conscious decision to kick off, and a day or two later, they're dead. There's not enough time to get them into hospice or even transition to comfort care: they've made up their mind, and that's it. Maybe that's what happened here. Could be.

What to Expect When You're Expecting A Ventriculostomy!

Back to work, kids! Today, we'll learn about (cue music) Tubes In Your Brain!

(I really wish I could hire James Earl Jones to say "tubes in your brain". That would be cool.)

What's a ventriculostomy, anyway?

Simply put, a ventriculostomy is a tube that goes into a ventricle in your brain to drain off CSF.

Simply put into English, it's a tube that a surgeon runs through your skull and into one of the big, fluid-filled spaces on the inside of your brain (yes, your brain has big fluid-filled spaces on the inside) in order to drain off what's called cerebrospinal fluid. Cerebrospinal fluid surrounds your brain, penetrates it...oh, sorry. *ahem* It does surround your brain, though, and it cushions it and provides a number of different benefits.

So why the hell would I need a tube in my brain?

The reasons aren't good reasons. That is, you're obviously not doing all that well if we're needing to stick a tube in your brain.

The three big reasons to get a ventriculostomy (or "ventric", for those who sling the lingo) are head trauma, including brain bleeds; hydrocephalus that happens really fast, or an infection inside the brain itself that needs to be dosed directly with drugs. We also sometimes put them in during or before surgery, or use them for chemotherapy, though those are less common, at least that I've seen.

Okay, great. What's in this for me?

Well, if you remember your anatomy, you'll remember that there's only room for your brain inside your skull. If you should add more stuff there, like extra CSF or extra blood, your brain gets squished. A ventric can help your brain not get squished by giving it more elbow room. Not that your brain has elbows, mind you.

If you stayed awake during the second hour of anatomy, you might remember that there's something called the blood-brain barrier. Normally, this nifty anatomical trick keeps your brain safe by filtering out all the harmful stuff that could get into your bloodstream, thus keeping it away from the delicate and mostly-defenseless brain. Unfortunately for us, the blood-brain barrier also keeps things like chemotherapy drugs and antibiotics out of the brain. We occasionally have to stick 'em into the brain directly to see an effect.

How do you get one of those ventriculowhatevers?

Sit down. You're gonna love this.

A neurosurgeon drills a hole in your skull at the crown of your head (roughly speaking) and sticks a tube in, aiming for your nose.

Best part? At our facility, it's done at the bedside. With a nurse holding your head and speaking soothing words of comfort (unless it's me, in which case the nurse is humming a little tune and trying to block out what's happening). It's done with a hand drill, usually, unless it's in the operating room, in which case it's done with a power drill. Oh, and lidocaine. Lots of lidocaine.

Yikes. What happens next?

Well, a ventriculostomy, unlike a lumbar drain, is open all the time. It's connected (as with a lumbar drain) to a sterile, closed system. It's also connected to a leveling apparatus that in some cases is kind of fancy and in others involves, like, an old radio antenna* and a marked pole. 

What happens next is "not a lot, really". In other words, if you're the recipient of a ventric, you should begin to feel better fairly quickly (if you're in a state to feel much of anything at all). You might have a dull headache for a while, given that somebody's punched a hole in your brainbox, but that's it. 

Your nurse will watch you like a hawk, making sure that the ventriculostomy drain stays at a particular level, ordered by the doctor, and that there's not too much or too little fluid draining out. If you need drugs administered through the ventric, you'll get those administered by a doctor, through a syringe connected to the tube setup.

What can go wrong?

The biggest threats are infection and overdraining.

See, whenever you penetrate into the brain, you're opening that box of troubles right up. Ventriculostomies are done in a sterile field, of course, and we're paranoid about making sure nothing horrible gets in to the hole. Sometimes, though, things can happen that mean you end up with an infection in the ventricle. In that case, we treat it with stuff instilled--you guessed it--through that ventric.

If your brain is overdrained of CSF, it sags. Sometimes it can herniate (bulge through) the hole in the bottom of your skull. This normally leads to death. That's why the nurse who'll be taking care of you is hopped up on caffeine and hovering over you like a hen with one chick: it's her responsibility to make sure nothing happens (like a sudden position change) that could cause you to overdrain CSF.

The whole infection threat is why she's drawing blood and constantly checking your temperature and asking if your neck is stiff, too. 

What happens when you guys are done with tubes in my brain?

Well, we take it out. The ventric tubing gets pulled out by a doctor, and that's it.

No, really. Sometimes you might get a stitch to close the hole in your scalp, but usually we just slap a piece of sterile gauze or a bandaid on there and let it be.

Holy shit! You're kidding, right?

Nope. Not in the least. The skull itself might take a while to heal, but your scalp heals really quickly--and your brain just sort of squooshes shut around where the tubing used to be.

Uh...so...then what?

Well, presumably, if we've taken out the tube, we've solved the problem.

If your problem is hydrocephalus, we've probably put a shunt in (more about that in a week or so) to help keep your CSF pressures normal. If the problem is an infection, we're done with instilling drugs into your brain. If the problem is a tumor in your brain, we've installed something called an Ommaya reservoir to pump little doses of chemo toward that tumor on a continuous basis. Whatever it is, we're done with tubes in your brain.

That's all, folks! Now you can be happy you've never had to have a ventriculostomy!

*No, really. I had a confused patient once who kept fiddling with and breaking off the leveling arms on his ventric setup, so I had to replace the leveling arm with an old radio antenna I scavenged from the surgeon's lounge. Just call me MacGyver.

Teh Kyoot: I Haz It.

No more Cheezfriends-Speak; I promise. 

These are the boys, napping in the green velvet chair right next to my desk. They spooned all the way from Kansas to Texas with minimal complaining. They're good kitties, and have already met Max. Flashes (grey tabby in the front) rubbed right up against an astounded Max, while Notamus (blue in the back) looked at him worriedly. I think Notamus will come around, though.

These guys are both lovers and demolition experts. Flashes has already figured out the physics of the rocking chair and Notamus has explored all the cubbies in my desk. Notamus also almost met an unpleasant fate when he made a leap for the toilet lid I had *just* raised--he did it with more speed than grace and had to be caught before he fell in head-first. 

They're absolute loves. Notamus is cuddlier, but both will accept paw-pad-touches and belly-rubs with pleasure. Both have thunderous purrs. 

I haven't had kittens in a while (like thirteen years), so this will be interesting. I imagine I'll know by tomorrow evening what I should've already kitten-proofed.

Drive-by posting....

First, from Faithful Correspondent and Lotion Slut Pens, a link for those of you who can't figure out how to pronounce all those new words in your science texts (note that this will probably only be useful for those folks in the US, as everybody else in the world talks weird):

Pronounciation Dictionary for Medical Terms

Pens points out that "clicking on the handy-dandy little speaker icon is a beautiful thing."

Second, posting will be really light for a couple of days to a week. I'm off to see Faithful Correspondent and Mid-Century Doyenne E and do the Great Kitten Retrieval 2009. It should've been this past weekend, but Mister Cold Miser made that impossible, as the roads were impassible. The Great Kitten Handoff 2009 didn't work out either, for the same reason.

Anyway, if all goes well, I should have this by the end of the weekend:

Sans babysitting Siamese and socks.

So. If the constant "Mew! Mew! Mew! Mew! Mew! Mew!" doesn't drive me mad after ten hours on the road, I'll be back later this week.

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

*sigh*

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

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

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

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

2. Smoking is not permitted. Really and truly.

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

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

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

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

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

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

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

You heard me, Big Pimpin'.

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

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

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

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

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

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

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

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

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

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

And they wonder why I do beer reviews.

Oh, good Lord.

This was a blast from the past:

Yoiks.

A correction

My Brother In Beer* has informed me that I'm a dope. 

He put it much more nicely than that, but in response to my post about Boulevard's pale ale not being what I really wanted, he basically said, "You dope, Belgian-y is what we *do*, duh."

So, I take it all back. If you want a well-balanced, not-for-the-hophead PA, go for Boulevard's Double-Wide. It'll get you where you need to go.

If you're still a hophead, try Brooklyn Brewery's East India Pale Ale. That, too, will work fine.

*Dear man, I love you like I love my own gallbladder, but your hair is cut much, much too short. You look like a Midwesterner.

Brother Bruce's Big Bargain Brain Bleed Bazaar

Sunnydale General has turned into the place to be if you've had a brain bleed. No matter the type--subdural, epidural (what killed Natasha Richardson), subarachnoid--if your brain has bled, you're in like Flynn.

Which means, of course, that I've had an average of five patients a day for the last week, four of whom can walk, and all of whom are confused/delusional/generally disoriented.

Which means I've been running my rapidly-widening ass off, trying to keep my patients from (variously) finding a policeman to report some crime that they can't articulate, going downstairs alone in a bad neighborhood to smoke, getting on a bus that isn't there, delivering twins that don't exist, and going to the movies.

When blood gets somewhere it shouldn't inside your brainbox, weird things start to happen. The most obvious is that blood isn't supposed to leave its conduits, so your brain tissue gets really irritated. It's like meningitis, with the attendant pain and sensitivity to light and sound. Then you have the issue of what happened immediately after the bleed: some people end up with ischemic areas of the brain because their vessels clamped down right after the one vessel burst--it's the body's attempt to minimize the problem, but often it makes things worse. And, finally, all of that's compounded with ICU psychosis, because all of these folks have been in the ICU, with its constant noise, light, and disturbance, for a period of days to weeks.

To put it bluntly, you get very, very weird after a brain bleed. Initiative disappears (unless it's the initiative to do something like wander out of the hospital and into traffic), you get easily distracted, your balance suffers, and you hallucinate. 

All of that makes it fun for the nurse who's taking care of you. (I have no idea what it's like to be inside the braincase of somebody who's had a recent bleed, but it can't be a picnic.) I'd say that the distractability is the hardest thing to deal with: it's difficult to get a person to do something as simple as take a pill. Just the steps involved: grasp pill cup, bring to mouth, open mouth, etc. are too difficult for the post-bleed brain to handle. So the person sits there, meditating on God knows what, pill cup in hand, while the family tries to help by repeating the same instructions over and over. You can imagine what that does: sets up a feedback loop inside the injured brain, until the person in posession of the brain gets agitated, flipped out, and very worried.

I still like taking care of people who've had bleeds. It's fun. (No, really.) Something as simple as a two-hour nap can make a confused, agitated person into someone who's just a little stranger than baseline. It's also nice in that, unlike things like concentric sclerosis and optic neuritis, you can see people get better over the course of a week or so. There are drawbacks, naturally--the primary one being that, as people get better and stronger physically, the brain lags behind.

Which is why I've run my ass off. Sometimes the only thing you can do for someone who's delusional, agitated, and insomniac is exhaust them. I walked four people around in circles yesterday until I felt like my own feet would fall off. Three of them ended up napping heavily afterwards, while the fourth had to be restrained by Security and prevented from going out to buy some drugs. Three out of four isn't bad.

Oh, and that fifth patient? Once we figure out what's causing the encephalomalacia (brain softening; my new favorite term), we'll talk about that.

Here's a Before photo for you!

After coming later.

Okay, okay, okay.

I promise to post pictures. Sometime after this weekend, when I'm done working three days in a row. 

Right now, though, I'm going to continue to cook potstickers and make crackers.

There goes the oven timer!

PS: Leaf-Nosed Bat in the comments is my cousin Dan, who doubtless has plenty of incriminating "before" pictures--from when I was three years old.

Obligatory Occasional Girly Floof

I may have mentioned in the past that I have curly hair. 

For years, I thought my hair was just wavy, not curly. Then, after living for a short time in California without benefit of hairbrush or hair dryer, I discovered it was curly. Not *curly*-curly, but at least more than wavy. 

Since then I've been fighting a losing battle against Pyramid Head* and frizz and hair-in-face syndrome. Even at the best of times I've looked more like Roseanne Roseannadanna than like Nicole Kidman--which is not a bad thing, necessarily, but wasn't what I was going for. So after doing some research and dithering about and avoiding the phone, I finally made an appointment for what's called an Ouidad Carve And Slice haircut.

Ouidad, for those of you who don't know, is a woman who a) goes by one name and b) has developed a technique for cutting curly hair that rocks socks. A "carve and slice" is a proprietary haircut--there are only twelve or so salons in the country that have Ouidad-trained stylists--and it's meant to regularize curl patterns and keep curly hair from looking like a bush, pyramid, or big blocky mass.

It's not a regular haircut, that's for sure. I'm not certain if it was the haircut itself or the fact that my stylist was a little weird, in a good way, but it didn't seem like she had any real pattern or plan for That Which Ruled My Head. Instead, she'd grab bits of hair, seemingly at random, and run down them with the edge of a pair of very sharp scissors, planing off bits of hair. That's the "carve and slice" bit of the cut. 

What this does, according to the theory, is allow the curls to sit inside one another with near-mathematical regularity. Thus, rather than having a mass of curls that just sort of...pile up on each other, you get nice, well-behaved ringlets (in my case) that have the extra poofiness planed off. 

You would think this would make your hair thinner. It does not. True, my hair sits closer to my head, but only because it is actually in defined curls, rather than in a large mass that extends past my shoulders in every direction. You would think this would make your hair shorter. It does not. (No shit! Really!) Because I'm no longer carrying tons of poof around, my hair is now at my collarbone rather than just barely brushing my shoulders.

After I baked under a dryer for ten minutes with gel (this Ouidad stylist doesn't make you leave the salon with dripping-wet hair, thank Frogs), said stylist ran some sort of anti-crunch anti-frizz stuff through my hair and then made me shake it out gently. I am not shitting you in the least when I tell you that every single person in the very full salon turned to look. Several conversations stopped dead, and I heard at least two "Oooooo"s. I went from having a mass of impressive, unruly red hair to having beautifully behaved, shiny red ringlets in about an hour and a half. 

This haircut was miraculous. Seriously. I'm never going to be more than three hours away from an Ouidad-certified stylist again. And I am not generally a vain woman. I do not put on makeup to leave the house, and I don't much care what I'm wearing at any moment. This, though, was such a good haircut that if the woman who cut my hair were abducted tomorrow by aliens, I might consider shaving my head.

So: curly-haired people: consider a Ouidad cut. It cost me a hundred bucks, but The Miracle Worker tells me I only have to have it done every four to six months or so, when the poof returns. That's not such a bad deal--especially when you consider that the whole process took 90 minutes and did not involve any hard-selling of Ouidad-brand products. 

*This would be an excellent name for a beer. Get on it, brewers.

Because I am feeling a little blue today, music:

Jo's Fun List Of Medical Terms Nobody Can Pronounce!

It's that time again, kiddies! Sit yourselves down and get ready for a wild ride through medical terminology. Today we'll be covering Things Nobody Can Pronounce. Ready? Go! (Please keep your hands and feet inside the vehicle.)

La belle indifference: This is a symptom of conversion disorder. It's what happens when a person shows utter unconcern about whatever symptoms they've got, regardless of how scary things get. 

Homonymous hemianopsia: I still get tangled up halfway through this one. It's a complex, yet quick way of saying that a person has lost the same field of vision in both eyes.

Prader-Willi Syndrome: My personal definition of hell. It's a spectrum of disorders caused by a deletion or doubling on chromosome 15, resulting in a person's never, ever, ever feeling like they've had enough to eat. There are related problems (including a lack of muscle mass and sometimes mild mental retardation), but the feeling of overwhelming and constant hunger is the hallmark of Prader-Willi.

Glioblastoma multiforme: Look in the dictionary under Do Not Want and you'll find this particular brain tumor. It's the most common, most lethal, and least-treatable brain tumor out there.

Hemiasomatognosia: aka "neglect". A person who's had a stroke or other brain injury forgets about half of their body. In severe cases, they lose all concept of one side of the universe, so that "left" or "right" no longer exists. 

Apneustic breathing: It happens when you get a bonk or a tumor in your lower pons (v. important part of brain): you breathe in deeply, pause, breathe out...(wait about a minute)...repeat. 

Astasia-abasia: A person tries to walk, lurches around, weaves, and finally falls over--but only falls when there's something soft to land on.

Flocculonodular lobe: It's a part of your cerebellum. I learned this term once and have never used it again.

Aphonia: The inability to speak.

Blue Rubber Bleb Nevus Syndrome: Yeah, this one's easy to pronounce, but I included it just because I love the name. Unfortunately for people with Blue Rubber Bleb Nevus Syndrome, the condition isn't as fun as its moniker: it's a problem of venous malformation in which the person ends up with extremely painful, constantly-bleeding lesions all over the inside and outside of the body. 

Oligodendroglioma: A brain tumor that arises from the cells that insulate the electrical wiring of your brain.

Aaaaand that's it! Everybody okay? Good! Unbuckle your seat belts. You may now return to your normal life with some fun bits of knowledge that will serve you well at the next party you go to.

A simple request....

I have both Lyle Lovett and Boulevard's Double-Wide IPA floating around in my head tonight.

Boulevard Double-Wide IPA: (stealth product review!) It's okay. It's good, even. Not a genie in a bottle, and I would've preferred less Belgian-style head and darkness and more clean, aggressive hoppiness, but that's just me. The label admonished me to drink it out of one of those roundish glasses that stands on a little pedestal, but I haven't got those, so jelly jar it was. 

Lyle Lovett: Always good.

A simple request for all of my patients:

Please understand. Please don't be angry or snippy with me. Please don't make me hand your head to you after you're a jerk.

It's just that, you know, when there's one patient coding and another whose leg has suddenly turned a dusky blue and gotten cold, and a third who's bleeding uncontrollably out of her rectum and a fourth who is seizing, *your* particular request--that the IV fluids Mama's getting be turned down because "she's peeing too much"--might come fourth or fifth on my To-Do list.

I will turn down Mama's fluids from 70 to 30, but only after I make sure everybody else on the floor is breathing. As the oldest/most experienced/best at starting IVs nurse here, it's kind of my responsibility. Kind of like interrogating that drain to make sure there isn't a split in the tubing that leads from the brain to the bag is my responsibility.

Please, please, *please* do not overburden the already-overburdened charge nurse with your request. It only makes you look like a twit. And please, for the love of all that's country & western, do not be snarky when I show up to ("Finally! [eyeroll]") turn down the fluids, because that might make me morph from Nurse Jo to Take No Bullshit Abortion-Clinic Jo. And that's ugly.

Thank you.

In Which Jo Goes to the Opthamologist and Gets All Steampunk On Your Ass....

...and reviews a beer. A really mediocre beer. A sex-in-a-canoe beer. In a word, Dundee: Avoid.

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So I went to the eye doc today. This is a fraught event for many reasons, least of which being that, when my eyes get dilated, they *stay* dilated for 24 hours or more. I was dreading the dilation and the feeling of being totally bat-blind while in public and then of having no close vision while at work in the morning. (And no, I don't know why my eyes stay dilated. I stayed stoned for 72 hours the only time I tried smoking weed, and I can't tolerate narcotics. Must be something inside.)

Technology, thankfully, has caught up with us bat-blind people. My doc has this new thing called an OPTO-MAP (ACQUIRING TARGET: RANGING: HIYA BABY) that requires no dilation to read a 200-degree map of your retina. It takes about thirty seconds and totally rocks out: there's a bright green light that blinds you for a brief moment, and then look! it's your photogenic retinas on the computer screen!

I must say that I have very cute retinas. My optic nerve is darling, as well.

Anyway. The ratio of my optic disc to optic nerve is five-point-nine when it ought to be five or less, but it's the same in both eyes and hasn't changed lately, so I've not got glaucoma. Yet. Likewise, my vessels aren't tortuous, and that little freckle in my left eye disappears with different color screens, so it's not melanoma. I was absolutely certain that missing an eye appointment last year would land me in the "horrible incurable eye disease we'd better just take that out right now hold still" camp, so this is good news.

However, my eyes are still bad. As in, really bad.

As in, the lenses for my new glasses (which I have not replaced in a decade at least) cost somewhere north of shocking and somewhere south of a mortgage payment.

It's bad news when the therapeutic optometrist who's in charge of fitting you with glasses ixnays all your choices for frames on the grounds that they would be too large. Not because you would look matronly, but because your vision would be impaired with the type of lenses you need.

So I have itty-bitty constipated librarian glasses with a mustard-yellow and turtle-green Pucci print on the frames, and horrifyingly expensive toric prismed carbon-fiber super-thin technologically magnificent lenses that will do everything but my laundry for a good three to four years.

Which means that they'll only cost me between one-and-a-half and two bills a year to wear.

*sigh*

You will be pleased to hear that Practical Nurse Jo refused the thick-templed glasses, the glasses with jewels on the sides, and even an adorable pair of frames with orange-red miniature rhinestones on them which rocked her world, just so she could look professional in case she has to wear glasses at work.

Pictures forthcoming. On my old cruddy digital camera, as I now have no money to buy a new one.

*sigh*

Whaaaa?

Allergies are common. Everybody's allergic to something, be it pollen, the resins used to keep no-iron cloth no-iron, narcotics, cedar, dogs, cats, tomatoes, strawberries, wheat, milk, Republicans, whatever. Everybody has a tendency to have that ol' immune system get out of control once in a while and serve up a course of rash and hives and "whelps", which are what the rest of us call "welts".

(Conversation: Patient: "Whenever I take penicillin, I break out in whelps all over." Me: imagining patient covered with puppies.)

You get used to handling allergies at a hospital. Sometimes a patient has some sort of infection that can only be dealt with using an antibiotic that has cross-reactions with something they're allergic to. Sometimes a patient will have an unexpected reaction to something that they've never had a problem with before, which is how allergies work. You get the Decadron and the Benadryl IV and have the respiratory guys on the pager and you deal.

How-sum-ever, I have now seen something that had me literally scratching my head as I tried to figure out how the patient in question managed to survive in the outside world.

Four typed single-spaced pages of allergies. 

Four. Pages.

With additional editorial comments on the nature of the reactions to said allergens. The reactions weren't the run-of-the-mill "I itch when I take narcotics" variety. Nor did this patient have hallucinations when exposed to morphine--which is not technically an allergy, but will sure stop us from giving you more morphine. 

No, these were things like (and here I am giving a representative, fictionalized example) "Percocet: Causes unbalanced energy fields." "Beef: Candidiasis and sluggish bowels." "Latex: anaphylaxis." That last is sometimes a real deal, and it means you either have to be in a positive-pressure room or take your chances, as latex ends up in the air ducts and can be all over the hospital. Somehow, though, he managed okay with the (latex) balloons in his room.

Dude was allergic to non-ionized water. 

I. . .I. . .I for once am without words. Four pages of allergies. Four pages of things that you have gone to the trouble to decide you aren't tolerant of, can't have in your body or around it, can't deal with. Four bloody, be-damned pages of allergies, any of which might unbalance your Chi, slow down your lymph recirculation, or cause you to become a horrible wheezing swollen mass of welts.

Listen, I am not an ogre. There are some folks who have multiple drug allergies; usually they've undergone some sort of unpleasant treatment for, say, an intractable infection or chemo. There are people who can't tolerate some foods. I myself live on generic Claritin year-round and have to scrub after I touch a dog or cat. There are allergies out there that can make your life difficult and dangerous. We'll take that as read.

But four pages? Including non-ionized water? (How on earth do you ionize water, anyway?)

Have you thought about maybe focusing less on yourself and more on the outside world? It's entirely possible that some of those allergies would go away if you'd just relax and get out of your own head. 

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In other news: People, don't do meth. I had a patient this week who is a full twenty years younger than me (in other words, not quite past her sell-by date, according to the fashion industry) who had no teeth. Full set of dentures, upper and lower. No. Teeth.

Do yourself a favor: develop a permanent allergy to methamphetamine.