Culture clashes and advice for Yankees

For those of you wondering about Tashi, she's doing as well as can be expected. She has good moments and bad ones, but that's par for the course.

We've had an influx of Northerners this summer, so I feel like I can share a little advice with them:

This is central Texas. Things move much more slowly here. Nevertheless, we have been known, while driving, to pass on the right.

Speaking of driving: going the speed limit, unless you're near a known speed-trap, is Not Done here. We have places to be and miles to go, so we generally drive like bats out of hell. Just keep up with traffic and you'll be fine. Don't go the speed limit in the passing lane; you'll likely get killed or yelled at.

I understand that things work differently in Chicago or New York or wherever it is you're from, but here you *can't* be abrasive and expect to get things done. If the movers tell you they'll be there between twelve and three, but you need them to be there right at twelve because you've got the freight elevator reserved from two to four, explain that. Don't, as I heard one person say, snap back, "You will not be there between twelve and three! You'll be there at twelve!" She later wondered why the movers came late and moved slowly. Just be polite. It costs nothing and greases the wheels.

If you have to ask how to "style" "cowboy boots" (they're called just "boots") then you probably shouldn't be wearing them. As Lyle says, buy your jeans a little longer.

The heaviness of the accent does not always indicate the education level, general intelligence, or personal wealth of the speaker.

Women of a certain age are always referred to with "Miz" preceding their first names, and only then if you've been invited to call them by their Christian name. This holds true in most small towns (it does in mine) and some large cities. In fact, it's best not to call anyone by their first name unless you're sure it's okay.

"Ma'am," "Sir," "Please," and "Thank You" are not optional. And don't, unless you want a reputation for being difficult, walk straight up to somebody and tell 'em to do something without first asking how they are and being pleasant.

Bless their hearts, they don't know any better.

Speaking of culture clashes, I was listening to an NPR interview a few weeks ago with a guy who says that culture influences perception of color; in other words, the context in which you're raised determines to a large extent how many colors you see and what you call them. He said, for instance, that the ancient Greeks had so few delineations between colors that they essentially saw in black, white, and bronze.

I snorted mentally at that until the other day, when Friend Deepa, who can't believe my hair, was touching it gently and cooing, "Golden hair, golden hair." Now, my hurr is red--at the most, it could be called strawberry-blonde when I've been out in the sun. When I corrected her, she said positively, "No, your hair is golden." I said, No, my hair is red.

She then pushed back her own hair to show me the earrings that she wears which, like those of most of the Indian women here, are twenty-four carat gold, so pure it's brassy. "Your hair," she pointed out, "is the same color as my earrings. So it's golden."

Point to Deepa. I stand corrected.

GERONIMO!!

Tashi brought Wash's ashes home today in his Tardis urn. This completes this stage of his journey. Next stop: Wherever, Whenever.

Regularly scheduled blogging will resume whenever this localized weather system gets off my face.

Allons-Y, Wash! Good journeys.

Kevin Pratt-King

1985-2012

Prayers for Tashi and Wash, please. . .

Wash is in Hospice right now. He told Tashi on Sunday that he thought he was about to die, watched an episode of Dr. Who, and was unconscious before the end of it.

Please keep them both in your thoughts, but especially Tashi. She proved every day what love is.

Thank you.

In which Jo gets a little pissy about language.

Gifting.

Gifted (passive voice).

Skirting.

When did "gift" become a verb? When did it become acceptable to say that your mother-in-law gifted you with a Precious Moments figurine? How is it okay to say that something is good for gifting or is giftable?

And when did skirting start describing pieces of fabric with buttons at the top? Skirting is either something one does around an issue, or vinyl sold by the linear (not lineal) foot at the mobile-home dealership. One buys a skirt. One does not purchase skirting to wear on one's body, unless one is suiting up for a particularly bizarre costume party. (Halloween costumation ideas, right here on Headly Nursingtons!)

A million years ago, my parents would sit around the breakfast table in their bathrobes, reading out loud from the Wretched-Comical, our local newspaper. Dad went into fits one day over the headline "GIFTABLE SWEATERING," then read the accompanying ad copy out loud with hoots and snorts. I think it might've been 1980 or thereabouts; my sister was home for Christmas break from college. She, being the English major in the house, had lots to say about giftable sweatering.

Then, about a month ago, somebody on my beloved Hairpin used the term "for gifting." The somebody in question was an actual contributor, not a commenter, and nobody called her out on it. Nobody. "Gifting" was okay.

I felt a little like I'd been dropped into a reality I wasn't familliar with. With which I wasn't familliar; whatever. I'm not opposed to splitting the infinitive if it makes reading easier.

I am, however, opposed to gifting and skirting.

(Before anybody asks, yes, I'm poncy about "nursing" as a job description as well. "Nursing" feels like it ought to be limited to breasts and babies. "Being a Nurse is My Bag" doesn't flow, though, and looks crappy on a reusable grocery sack. Yeah, I'm weird.

At least I'll never turn "surgeon" or "patient care aide" into verbs. That's my promisation.)

Well, *that's* never happened before.

Friends and neighbors, I got my ass kicked on Monday.

And when I say I got my ass kicked, I mean I got my ass kicked.

Let me explain: there are a number of unfortunate things that can happen to make a normally nice, cheerful person batshit insane. Things like drug abuse, encephalopathy, encephalitis, vasculits, meningitis, strokes in unusual places, tumors--you get the idea. There's a lot of stuff out there that can hit your brain in such a way that your personality does a one-eighty, but most of those things are very, very rare indeed.

When they hit you, though. . .wow.

Granddaddy came in with a few personality changes and some increased sleepiness (note for new neuro people: your A-number-one sign that there's a problem is irritability and decreased consciousness in tandem) and steadily got worse. He was transferred to us with a Posey vest on, keeping him in his wheelchair as he cussed and ranted.

At some point in the proceedings, he tried to stand up and tip the wheelchair over backwards in order to get out of it. Gweneth, the steadiest and most sensible of patient care aides, was there in a second, keeping Granddaddy from overbalancing, and Stoya went around to his front to see if she could calm him down. I was close behind her. Too close, as it turned out.

Granddaddy threw a punch. Stoya did some sort of Matrix move to avoid it (thank goodness, as it would've messed up her face), and the punch landed squarely in my solar plexus.

Well! I wasn't expecting that at all.

I made a noise like a duck and went down. I'm not ashamed to admit it: have you ever been punched in the gut? I hadn't. I've been hit in the face, which only makes me angry. I've been whacked about the head and shoulders, which is disorienting and painful, but not too handicapping. Being hit in the stomach, though, right in the breadbasket, so hard that the breath gets knocked out of you? You fold up like a sack of potatoes, which I did.

Unfortunately, I folded up right where Granddaddy, still Posey'd in to his chair, could get to me with both fists and feet.

In retrospect, it's funny. It must've looked like something out of a comedy film, or that clip on YouTube where the dude in the Darth Vader costume gets attacked by a playful dog. At the time, though, all I knew was that I was getting wailed on by an angry person with what felt like superhuman strength. Oh, and I couldn't breathe.

Gweneth managed somehow to get the wheelchair unlocked in the middle of all of this and get Granddad out of range. Stoya got his arms, I got the Haldol, and things quickly got better from there.

Y'know, IV Haldol is strongly not recommended, because it tends to cause heart arrhythmias, but at that point, we didn't care. In a few minutes, things calmed down to the point that Grandpa could go back to bed.

The bruises are fading now. He didn't actually hurt me, but he sure woke me up. This is not something you think about when you're taking the NCLEX.

ERMEHGERD SCHNERZZLES

Stolen from CuteOverload. CRANK UP THE VOLUME, PEEPS.

I have the letter!

Yes, my friends, the letter from the OEB that tells me that I am getting Moneys from the insurance people is here in my hot little paw. As I said to La Belle Dame, though, I ain't chillaxin' until that check's cleared.

With my luck, BCBS will skim 90% of it off for processing costs. Which will, of course, lead to the recently-repaired Hell Bolts being sheared again.

*** *** *** *** ***

I have made a new friend.

A few days ago we got one of those patients in: you know the sort, that come without CDs of scans and with minimal information from the transferring hospital. Luckily, this nice little old lady had no medical history, and not because she'd never been to the doctor. She was, at eighty-something, simply that healthy. A lifelong non-drinking, non-smoking vegetarian, she'd had a TIA as a result of a brief dip in her already-low blood pressure.

So, upon her arrival to the NCCU, I paged the dude on call. And paged and paged. Finally, I sent a text page reading "Are you alive? If so, call Jo at XXXX. Minimum three minute rates apply."

The dude on call called me back immediately and apologized. Turns out that between consults and admits at Holy Kamole, he had more than fifteen patients to see. I said I just wanted him to know that I'd gone ahead and entered orders under his name, using the NCCU order protocol, to which he said, "Oh, are *you* the one who entered all those brilliant orders? You clever little thing, you."

"Yes, darling," I said, "I did enter those orders. Now, you'll have to swing by and work your magic on our sweet LOL, but the rest is taken care of for now. Just decide whether you want heparin and let me know, okay?"

"Brilliant!" he replied. "I'll be there as soon as she gets to sleep and the nurses have relaxed for the evening."

He greeted me the next morning, after no sleep, with a muffin. He thanked me for saving him a half-hour's work and making his life easier.

I may have to reassess my attitude toward new fellows.

*** *** *** *** ***

It dawned on me yesterday that when my boss is not around, stupid shit happens much less often.

*** *** *** *** ***

The Apocalypse is nigh: it is August in Central Texas, and I have all the windows open. We've gotten some rain in the last couple of days, and it's now a balmy 70* at just past 0800. All the fans are on, the a/c fan is whirring away, and the cats are napping on the north-facing windowsills.

After two years of really weird weather, this is a relief. This is how it's supposed to be here: daytime highs in the 90's, occasional rains that flood the highways, and brisk mornings. Ever since everydamnthing burned down last year, I've been watching the skies and the winds. Normal is a little disturbing, but I'll take it.

*** *** *** *** ***

Three big things are going to be happening here in the next few months:

1. A template and step-by-step instructions on how to fight insurance companies. Once the template and instructions are up, I'll put permalinks in the sidebar for anybody who wants to use them. Not everybody has the resources and time I do; it's a no-brainer to distill everything I've learned in the last two years, and all the expert help I've had, into something you can fill in, print out, and send off in order to get your money back.

2. HN might be migrating to a new platform. I haven't decided yet. If HN does move, it'll have the same look & feel and the same layout as before, or as nearly as possible.

3. I am dog-hunting. More to come on that as things develop.

Well, well, well.

That appeal? The one that got lost, then found, then didn't have enough paperwork attached?

JUST GOT APPROVED FOR EIGHTY PERCENT REIMBURSEMENT.

They just called.

You may commence celebrating.

Hi. My name is Jo, and I am totally demoralized.

Or not. It's been a rough week.

I talked to the friendly folks at the employee benefits office on Tuesday about the Ongoing Drama Of The Obturator. (For those of you coming in late, the prosthetic I wear to replace my palate/protect my airway/allow me to eat, drink and talk was not paid for by insurance. Given that the whole process cost as much as a new car [Hyundai, not Mercedes], I was a little peeved by that, especially given that the insurance company [Blue Cross/Blue Shield of Texas] first denied that it was medically necessary, then failed to follow their own rules on covering prosthetics.)

So I appealed, all the way to the Office of Employee Benefits. Beloved Sister and I worked up and sent a multi-page appeal letter complete with charts, diagrams, copies of reciepts, photographs of my mouth post-Harrowing, and ninety other things. The nice folks from the OEB asked me to send them a couple of additional pieces of paperwork, which I did. . .and I waited. They told me the whole kit and kaboodle had gone to some doctor who reviews things like this for them, so I waited.

And waited. I had no idea how long it would take for said doctor, who probably has a desk full of appeals, to get his head around mine.

So, when I called on Tuesday, I was expecting that things might not be fresh in the OEB's hivemind, given that the submission date for my appeal was back in March. I was not expecting them to tell me that the case had been closed for lack of documentation.

Well, to be more exact, first they told me that there wasn't anything there. Then they told me that yes, they'd found the file, but it'd been closed for lack of documentation.

Now: given the eight-page letter (with charts, diagrams, and circles and Xes on the back) and the two times I faxed the same information to my contact at the OEB, this was not what I was expecting. The nice contact at the OEB told me it would take her a couple of days to get everything together (right after she told me that everything was printed out and gathered up) for her boss to look at, so he could decide what was going on. So I told her I'd be calling her first thing Friday morning.

I am, to be nice about it, gob-fucking-smacked at this whole thing. I mean, I understand if they deny the appeal. Even though BCBSTX claims to reimburse non-network providers of prosthetics at 60% of cost, and even though they claim to reimburse at standard market rates (manifestly untrue; they actually reimburse less than Medicare or any other provider), I can see that they could finagle a way to deny my claim. That is, after all, their business.

Let me be a little more clear for you: The purpose of an insurance company is not to leverage your premiums into providing efficient, quality care for you. The purpose of an insurance company is to make money for their shareholders.

However, going back to the OEB: the University of Texas is a huge system, with many, many employees. The Office of Employee Benefits is, by necessity, the sort of bureaucracy that can handle that volume of employees. You would think that they could, at some point, have sent me a letter--not a certified letter or a wax-sealed scroll via elephant, just a letter--to tell me that they'd closed my file because I hadn't submitted some document or another.

Or, alternatively, they could've contacted me at the address, two telephone numbers, or email address that they had to let me know they needed more paperwork.

But they didn't.

Somewhere, somebody fucked up. I intend to find out who it was, and make them figure out how to fix it.

At first I was coldly enraged. I told Beloved Sis that the noise she was hearing was the sound of the bolts that hold Hell down shearing loose. Then I spent two days feeling horribly sick and depressed and stressed out. It's amazing how canalized anxiety becomes in the body.

Now I'm just peevish and determined.

Peevish. And determined. Very determined.

Odds, Ends, Updates

OEU the first:

I saw Dr. Crane today and had my tongue yanked around and both of his hands in my mouth at the same time. The exam was clean, the MRI looked "great" (his words; he's not given to superlatives) and I don't have to see him again until February. I won't have any scans then, either.

I said, "No scans?" He told me that at two years, in his experience, it's safe to begin backing off the surveillance scans and just go with eyes-on exams. It's simultaneously exciting and weird to know that my interior doesn't have to be irradiated for everybody's psychological comfort. I worried before every scan; now I'll worry that I'm not *having* scans.

"Nearly cured" is a strange place to be.

OEU the second:

Now that I've told Mom, it's time to tell you guys: I'm dating somebody. Seriously. As in, Talking Marriage Serious. He's marvelous beyond description, with just enough of the annoying human things that everybody has to keep him normal, and I've known him since we were both teenagers. His name is Brother In Beer (yes, the one who sent the lovely flowers after surgery). He's intelligent and funny and sweet and writes beautifully and routinely throws himself down rocky hillsides while perched on a bike. (Yes, he wears a helmet.)

I'm pretty stoked.

OEU the third:

Work sucks. We're staffed for twelve in the surgical CCU and have eighteen to twenty patients every day--even our code bed is full--which means that the staffing in the neuro CCU has been short. If everybody in the SCCU is tripled, they can't exactly send two people to help us out in the NCCU with our six or seven patients.

Plus, we've been having a rash of codes lately.

OEU the fourth: 

Aside from the staffing thing at work, things are going really well around here. I've not been *here* as much as I'd like; there's a lot of writing I've been doing for money that cuts into my blog time. As soon as I get this month's stack of articles sent off, though, I'll tell you funny stories about the Guy With No Memory At All and touching stories about bunnies.

Basically, this summer can be summed up in one well-known phrase: Two out of three ain't bad.

Semi-demi-hemi-annual MRI today!

And no, I don't have the results yet. I won't for several more days.

This was how it went:

http://www.marriedtothesea.com/072412/

This was me this morning. . . .

...when I'd discovered I've been drinking decaffeinated coffee for the last ten days.



GIFSoup

This was in my back yard an hour ago.

Yes, they really are that big. That's a tarantula hawk. It's a critter that eats nectar and pollen, but lays its eggs in tarantulas.

And no, that is not my hand. I've seen a lot, and even held a hissing cockroach, but I'm not that butch.

At first, I was terrified. Then I came around to the idea that this incredibly large critter, which kinda hops around in flight, is pretty cool. I just don't go outside when she's around. Luckily for me, they're not a communal species.

So, yeah. Tarantula hawk in my back yard. Friend La Belle Dame Sans Merci posted to my Facebook page, "This means you either have lots of tarantulas in your back yard, or a lot of tarantulas with hatching T-Hawk eggs in them."

I thanked her for being such a fucking comfort in my time of distress.

Good Lord, it is hot. And humid.

I've just done all my cooking for the week, except for assembling salads, which are best assembled at the fifty-ninth minute of the eleventh hour. Protip for those of you too hot to eat real food: cut up a shitload of vegetables all at once and put them into little containers. Assemble your nommable salad before work out of the little containers. Seriously, this is the best thing I ever learned from Serious Salad Eaters.

We got a doohickey to fill out this week from our Big Boss, about how our Lesser Bosses are doing. Instead of boring you with the boxes I checked, I figured I would put down the letter I wrote in my head while assessing my bosses for a dozen things which do not matter to anybody but management:

Dear Big Boss,

You want my opinion on my other two bosses. You even sent me a survey form to fill out at a third-party website, with the assurance that my replies will be completely anonymous and confidential and not be prejudicial to my continued employment with Sunnydale General.

Instead of filling out yet another useless survey (because, really, whether or not I'm being given positive feedback on how I'm doing my job is not a major issue around here), and because I know as well as you do that surveys are neither anonymous nor non-prejudicial, I've decided to tell you what I really want in a boss.

For starters, I'd like fewer of you. I have four at last count: Small Boss, Bigger Boss, you, and your Horizontally-Equal On The Org Chart Colleague. Of those people, I see Small Boss the most, with Bigger Boss coming in a very, very distant second. I've seen you exactly four times in the last two years, and your Horizontal Equal not at all. The way I figure it, it's ridiculous for me to submit memos about how I plan to hang educational posters in the family room for Horizontal Equal's approval, since she's never, to my knowledge, seen the family room I'm talking about. Maybe we could take her out of our org chart's hierarchy? While we're at it, could you either show up regularly or just stay away?

Because, really, your visits here contribute nothing to the smooth running or the "culture" (whatever that is) of the CCU. You've shown up once to bitch about the placement of warning signs, once to introduce me to somebody I'll never see again, once to warn me about a VIP showing up, and once because, I dunno, somebody in Manglement complained that you weren't showing up enough. Honestly, your visits take time away from my patients and fuck up my train of thought. If I had the chance to get used to you, or didn't see you at all, things would be much, much better.

While we're on the subject of bosses, it sure would be nice if my Bigger Boss had an inkling of what happens in a critical-care unit or on a stroke unit. See, he has about six months of CCU experience, and that was years and years ago. Our old boss, whom you chased off, used to lead codes. Our current boss stands around looking impotent and gets in the way. Maybe he could be retrained to work in a critical-care setting, then work a shift or two a month to keep his skills up. That way, we could at least use him as a charge nurse when there are four nurses, all of whom are tripled, and not enough support staff to make a dent in our patient loads.

It would also kick ass if Bigger Boss and Small Boss made sure that people who work in my NCCU actually have the certifications you claim to require for employment here. So far, I'm the only person who works here who has all of them. We've been open three years (in August), and that seems like plenty of time for folks to do the online NIH course and the other required stuff. It'd be awfully nice if I could give report to another nurse and not have them go jaw-sagging blank when I say something like "hemiparesis" or "gaze preference" or "NIH score of 16."

Finally, if you're really dedicated to a complete reworking of the Culture of the Institution, hire some more damn people. If need be, hire unqualified people with a modicum of brains; I'll happily train them. Just get me some bodies up in here, so I'm not forced to work day in and day out with nurses who are floated here from the CVICU. It's not fair to them, and it's not fair to our patients. They can spot a-fib from a mile away, but they're not used to doing neuro assessments and don't understand our BP parameters. Have mercy on the nurses who are more comfortable with a Swan-Ganz than a ventriculostomy, and Get Me Some Damn Staff.

Oh, wait: that wasn't my final point. My final point is this: if you're going to hold me responsible for stuff, and yell at me when it doesn't get done, or pass things off to me, and expect me to work extra and train new people, the title of "Mangler" would be peachy fucking keen. I have to admit that it's not the title I'm after so much as the pay grade. In any event, since we're speaking of Bosses, you're making me a FIFTH layer of boss-ness between the people I work with and the real world, and I'd like to be compesnated for it.

Much love and many happy capybara kisses,
The one who makes sure the plumbing gets fixed,

Jo

In which Auntie Jo lays down the law.

I love my job I love my job I love my job I love my job.

However.

People: Please research the symptoms of whatever disease or disorder you're going to try to mimic. Most physical troubles, including neurological ones, have a certain expected set of symptoms. Even conversion disorder has an expected course: while the physical manifestations of psychological stress might be weird and unexpected and unexplainable by other means, they're consistent.

A stutter that goes away with opiates is not a disease. It's an attempt to get drugs.

Likewise, there's a name for what you're doing: it's "abasia-astasia," and it means "No, she won't fall over and hurt herself; she'll only fall if I'm there to catch her or she's near something soft."

And frankly? If your weakness is distractable to the point that you yourself cannot remember which side you're weak on, I will call bullshit on your shenanigans and send you out the door tout suite.

I don't just have the population of Greater Sunnydale to thank for this; I have the combined Great Minds at Holy Kamole's emergency department. Therefore, I have some law to lay on them:

If you call and ask me to accept a stroke patient, you'd sure as shootin' better have done an NIH stroke assessment on that patient and be able to tell me his score. If you haven't, I'll tell you to call me back once you've assessed the patient, then hang up the phone gently.

Same deal if you call me with a patient who has a constellation of symptoms and you don't know his history. Same deal if you call me and say, "Well, we're not really sure what's going on, but we'd like to send him over to your NCCU."

Same fucking deal, dear doctors, if you call with a ninety-year-old, demented patient who has a temp of 38.2, whose labs show that he's dehydrated and has a UTI, and who is experiencing the same symptoms he had when he had his stroke two years ago. Incidentally, he's therapeutic on coumadin.

And, just as a reminder, if I accept this patient because I want to put a stop to your whining, but specify that he is to go to the regular neurology floor, do not under any circumstances then tell the bed board that I'd cleared him for a bed in the NCCU. The Wrath of Jo will be visited, not upon your grandchildren's grandchildren, but upon you, comprehensively and cheerfully.

This is because, as might be expected in a critical care unit, I actually have sick people to take care of. I got one on a Cardene drip, one with the most labile blood pressure I've ever seen, good Lord what is she doing going from 220 systolic to 77, maybe an abdominal binder would help, and one who is, sadly, getting ready to go home to Jesus due to a combination of factors, not least of which is an infection with some bacterium that only two people have ever gotten before. I got problems, in other words, because I got patients with problems.

Joe-Bob looking for a hit of dilly is not a problem. At least, he's not *my* problem. He's *your* problem. If you try to make him my problem, you'll have another problem, and probably a whole set of problems of varying, interesting types, right after that.

Thank you, as Katniss said, for your consideration.

Good God I love both of these people, whoever they are.

Here

and

Here.

This is what happens when I try to live like a normal person. . .

Neighbor Beth is here. She's wiping down the kitchen as I slowly, slooowly type this, for reasons which will become clear in a minute.

Those of you who follow me on Facebook will know that I had a cheerful afternoon of productve semi-drunkeness with Neighbor Beth (who is Not Good With Blood). After the prosecco had worn off, and with a liter of water and tea under my belt, I mandolined my right ring finger.

There was a sudden spray of blood. Then there was a heartfelt "Oh, SHIT" from me, as I realized that the suddenly-numb sensation in my right paw was due to my having halfway cut off my right ring finger. I tried everything: direct pressure, flour, glue: nothing worked for longer than I care to think about. Poor Beth, who hates her own blood and has a tenuous relationship with other people's blood, mopped up mine for the 40 minutes it took for shit to stop happenin'.

I'm more than a little annoyed that this happened while I was sober. Beth is more than a little annoyed that she had to scrub blood off my spice shelves. AND I had to throw away a perfectly good, blood-soaked tea towel.

None of the zucchini was affected, though. Which is good: we have a Pickle Party coming up in two weeks.

I kind of wish I'd accepted Beth's offer of another bottle of wine. My finger hurts.

Good Frogs. Has it been that long?

I see I haven't posted since the middle of last month. My apologies.

I've been working a lot, which means new stories for you! but I'm also between keyboards at the moment.

More later this week, I promise. Nothing horrible has happened; I've just been busy.

I'm all right; don't nobody worry 'bout me.

Well, not really.

This week we had a party for Neuroscience Nurse's Day, or Week, or Something Along Those Lines. I was interested to see that the woman who holds herself out as the Director of Neuroscience Nursing (a few years' experience as an ortho rehab nurse, followed by a decade in manglement) wasn't there. Ironic, fitting, all that stuff.

I was more bitter than usual these days. *Everything* pissed me off, even stuff that could've worked to my advantage. Good things pissed me off just as much as bad things, and wishy-washy things pissed me off most of all.

For instance, I work with two mid-levels. One is fantastic. The other is a clueless tinpot tyrant with an ego problem. Fantastic Midlevel and Fantastic Case Manager and I had been working on med-surg to rehab placement for a patient under a return agreement with another hospital (his case is complex) since the patient was admitted almost a month ago. It had been arranged that Sweet Complex Guy would go back to his original hospital, since he's a resident of that particular county and can therefore get services for which bill collectors won't hound him. (Some counties in Texas do it right.)

At the absolutely last possible second--and I mean after the ambulance had been arranged (difficult, because he required vasoactives while en route)--Clueless Tinpot stopped Sweet Complex Guy's transfer. The reason? He was afraid that "SCG would end up rotting in a med-surg bed and his family wouldn't be taught what they need to know." Clueless Tinpot decided to try for a "charity bed" in our facility.

As Fantastic Rehab Manager said, "No bed here is a charity bed. I have explained this to Clueless Tinpot Tyrant over and over. Even if that patient meets all of our specifications for discount services, he'll still have people calling him constantly, and his credit will be ruined by the bills."

None of this, I just realized, will make any sense to you unless you're one of the medical club, so let me put it in English:

We had a patient transferred to us by a county facility. That hospital paid all of the patient's bills while he was with us, with the understanding that he would be sent back once we were done with our peculiarly specialized care. The sending facility has systems in place to provide free, quality care to this dude, provided that we sent him back needing specific things.

And Tinpot Tyrant fucked it up. Not only will my nice, sweet, complex-but-promising dude be two hours from his family, he'll have to deal with the demands of our billing department (not fun; I can testify that they screw things up fairly regularly) for the next two years or so.

And I have to deal with this guy daily. Between making sure that he actually writes orders that he's going to yell at us later for not carrying out and being certain that his orders don't suck, I'm already tired. He's slated for a manglement and marketing job soon, and I hope his transition is smooth and speedy.

Seriously: If you have somebody on a high-sodium diet and six additional grams of sodium tablets a day, and they drop their sodium from 139 to 135 after you lower their hot-salt drip for six hours, would *you* write an order discontinuing that drip immediately?

I thought not. Especially if you want to keep their sodium between 140 and 150 to keep their brain from swelling. Three-percent and 23% saline are useful in limited amounts, but they're useful.

Okay. Enough with the overmedical jive.

I miss my dog. He wasn't my baby, or my furbaby; he was my buddy. We were intellectual equals, no question. He was a stubborn asshole at times, but I never knew his judgement to be off. It's very weird, being here without him snoring and shedding and licking Flashes all over. I step over a body that isn't there, in the middle of the night, when I have to pee. My brain twitches toward the back door every day at dinnertime.

I haven't had the vadge yet to go out to the back yard. Yesterday, I thought maybe I could do it today. Now I'm thinking I could maybe manage it tomorrow.

Thank you all for your kind thoughts. They're a huge, huge comfort, even if I can't respond to everybody individually.

Now Flashes wants 'tentions. I'm going to give him some skritches and heat up beans for dinner.