Tuesday, May 31, 2005

If this is "ER", I want my makeup artist.

We had one of those Sundays that happens only on medical dramas: nurses chugging down the hall at a dead run, stethoscopes flying, scissors bouncing out of pockets, yelling things like "I need OXYGEN!" and "TWO MILLIGRAMS ATIVAN! STAT!" We sent three people to CT for emergent scans--one person twice--which led me to point out to the neurosurgery resident on call that, with two more scans, we'd get a free eggroll.

Therefore, I present

What I Cook On My Day Off

A really great layered sandwich:

Chop up a bottle of pitted kalamata olives. Mix these little guys, all chopped up, with enough mayonnaise to make a semi-creamy glop. Then add some good mustard and a clove of crushed garlic.

Slice the top off of and yank the innards out of a round loaf of bread. Spread the olive mixture on the bottom and up the sides. Schmear some more on the cut side of the top.

Layer salami, prosciutto, and pastrami into the cavity in the bread, alternating with chopped seeded tomato and provelone and fresh mozzerella cheese. If you're feeling adventurous, toss a few chopped-up basil leaves in there occasionally. Red pepper or thinly sliced red onion is good, too.

Keep layering and packing the sandwich goodies in there tightly until you've reached the top. Now slap the top of the loaf on, squash it all down, and bake for forty-five minutes or so, wrapped in foil, at about 400 degrees.

Yank it out and slice into wedges. Serve with salad or potato salad or strawberries with cream.

Just now my hands are stained yellow-green and smell strongly of dill. In Mom and Dad's neighborhood, dill grows wild in vacant lots. Here I have to buy it in plastic packages at the store, then toss it in the blender with black pepper and yogurt. I still serve it over cucumbers or with chicken breast, though.

Friday, May 27, 2005

More than two hundred days

Ali was making coffee, the thick black cardomom-scented stuff that Kuwatis drink by the gallon, when I mentioned to Mahmoud that I was reading "A Hundred and One Days", a book by a Norwegian journalist about the second Iraqi war and the occupation of Baghdad.

I wonder, I said half to myself, what it would be like to live in a country that's occupied.

Not easy, said Mahmoud. Ali had his back to us, still swirling the coffee in the tiny silver pot, but I could hear him muttering to himself in the Kuwaiti dialect they speak.

Mahmoud is my age. In 1991, when Saddam occupied Mahmoud's country, I was in college. When the American bombs started to fall, I was in Scandanavia. Ali was in California with his family.

Mahmoud was in Kuwait for all of it, the sole support for eight other people, all too pregnant or sick or old to leave.

We had no water, he told me. Every day I would go out and get cans of water from wherever I could, sometimes from the ditches by the side of the road. My brothers and sisters and my parents had left for Jordan and I stayed behind. Someone had to take care of my grandfather and my aunts and the babies.

We would line up for hours for bread, he continued. Sometimes in the bread lines the Iraqi soldiers would come and take some people away. We never knew why or where they went. I walked everywhere, passing through Iraqi checkpoints several times a day.

All you could do was keep your head down. Some of them, you could make them laugh, and that was all right. Others thought we were trash.

Ali poured coffee into tiny glasses. Iraqi soldiers, he said conversationally, are like the Chinese. Dirty. Not all of them, but most of them. Dirty.

Mahmoud and Ali broke into something faced-paced and gutteral I couldn't follow, my Arabic being so far limited to compliments, thank-yous, and requests for basic food items and water.

It was not easy, Mahmoud repeated. After the war I felt I had to do something for my country, so I volunteered at the hospital where they sent people who had been frightened by the shelling. All I had to do was sit and listen to them talk, the men, but after three days I could not go back. The men frightened me too much. The stories were too frightening. I could not do more for my country than I had done. I had helped keep my family alive until the end of the occupation.

Then he looked at me, full on, for the first time since he'd started speaking. Don't tell anyone, he said. Not even David. I don't want anyone to know what I did.

Why not? I asked.

Because they will ask me questions, he answered.

Wednesday, May 25, 2005

Star Wars: A Guide For The Newbie.

Yesterday I met two people who'd never seen a single "Star Wars" movie. Tragic. Having just seen Ep.3, I hereby present my own capsule versions of the movie, to bring other Tragic Teens up to speed.

Episode Four: A New Hope...for about ten minutes.

Despite its name, the first in the series. Whiny kid plugging womp rats hooks up with mysterious monk-type, wild-and-crazy spaceman and his giant ape companion, and cute princess. Mayhem in the form of cantina scenes and space war ensues. (Note: Pay attention to the cantina scene. At the time, it was the best special effect bit most of us had ever seen.) Happy ending complete with medals and Wookie hollering.

Episode Five: What the Hell Am I Doing On This Swamp-Planet?

Whiny kid, now no longer a kid, gets frozen. Then he thaws out on a swamp planet with a wise monk-type Muppet. Meanwhile, crazy space-cowboy turns into HanSicle, much to Princess's distress. Wookies. Pseudo-Oriental philosophy. A large sluglike creature. Space wars.

Episode Six: In Which Billy Dee Proves He Has No Rhythm

Carrie Fisher in scary hair extensions! Luke, I am your father! Dead Yoda! Happy Han and Leia! Ewoks, most of whom sadly survive! Chases on rocket sleds through Northern California! Bad ending with Billy Dee Williams clapping off-beat!

Okay. We've gotten through the first three. Now for the prequels....

Episode One: In Which We Encounter Anakin, Savior of the World

Small child with incredible powers. Two monk-types, one of whom is much younger than the last time we saw him. A guy in scary face paint and horns. Chariot races. Space wars. Yoda, but younger. We meet the Princess, mother of the Later Princess.

Episode Two: The One I Don't Remember Very Well

Er....lessee. Princess falls in love with Whiny Teenaged Anakin. Politics. Clones. Politics. Space wars. Er...Politics. Something about a secret marriage. A REALLY REALLY IRRITATING GUY WITH LONG EARS.

Episode Three: In Which All Is Revealed

Pregnant Princess. Pushy Palpatine. Arrogant Anakin. Observant Obi-Wan. More Wookies. Better bad guys. Tragic ending with half-burnt half-corpse on the bank of a lava river. The best opening sequence since the first movie. Samuel L. Jackson looking oddly out of place. Yoda, kicking ass.

And now the cat (my very own quadripedal Sith Lord) is drinking out of my water glass, a signal that it's time for bed.

Tuesday, May 24, 2005

What not to do.

Don't, when you're standing in a group of people including nurses, nurses' aides, transport people, flight nurses, unit secretaries, and one attending physician, respond to the physician's snarky comment with the words, "Oh, gosh! Dr. House, it's so nice to finally meet you in person!!"

Everyone but the attending will laugh.


Sunday, May 22, 2005

Nice things other nurses have done for me lately

Listen up: If you're in nursing school or a new-new nurse, you're going to learn a lot of really, really cool stuff and have a lot of folks doing you favors. At least, you will if you live in *my* universe, where nurses don't eat their young.

And if you're a not-so-new nurse (I refuse to call myself a New Nurse after three years, thanks), you'll still be learning/on the receiving end of nifty stuff. To wit:

1. A while ago, I had a patient come in through our triage center who the nurse downstairs thought might could use a blood transfusion (given that his hematocrit was something like 20, I could see that). So the nurse, in addition to starting an IV for me and hooking the patient up to normal saline, *hung that fluid with blood tubing* to save me a little time. Bless his head.

2. If you've got a person who's a really, really hard stick and you manage to get an IV on 'em, you can usually draw blood from that peripheral IV if you slap a tourniquet on the arm above it. I learned that just two days ago. For some reason, I'd never thought of the tourniquet.

3. Clearing feeding tubes is a constant bugaboo. If flat Coke doesn't work (and don't waste your time with other sodas; they're not acidic enough), magnesium citrate will. Strangely, this saline laxative, given time to dwell in a clogged feeding tube, will dissolve almost anything. Of course, you then have to deal with having fed your patient a laxative, but it's better than replacing a tube.

4. Chlorhexadine will get iodine stains out of clothing if the stains are fresh.

5. If you have a triple- or double-lumen central line with one lumen clotted off, it'll take you only thirty minutes with TPA to unclot it. If you wait until the whole thing's verklempt, you'll spend an hour mucking with TPA and saline. A stitch in time saves nine, you know.

6. Another nice thing somebody did for me: a workaholic patient came in with suspected meningitis. By the time he came up from admitting, his cell phone and Blackberry were already in Security, locked up away from him. (Meningitis patients do better with very little stimulation and stress in the early days.) Bless the admitting nurse who saved me the stress of getting his technology away from him.

7. If you're having a hard time starting a Foley on a woman, make your last pass with your iodine swab *up*. The urethral meatus in most women has a down-facing lip, and you can usually tell where the meatus is if you wipe up with iodine--it opens up a bit. Likewise, if you hit the vagina on your first try, *leave the catheter in there as a landmark* while you start the next one.

8. And finally, if your female patient has a very full bladder and you're trying to start a Foley, in-and-out catheterize her first with a tiny little catheter. For some reason I don't understand, that'll loosen things up enough that you can get a larger-bore Foley in there easily. I found that one out by accident, in desperation, and it's worked every time since.

Now that all the medical folks are nodding their heads, half are saying "She didn't know *that*??" and the non-medical folks have all crossed their legs and said "Oooooooooooo", I'm going off to iron.

Link o' the mornin' to ye!

I love this one:

Food Whore

Monday, May 16, 2005

Why, yes, I *do* live in a novel.

The Flailing Patient had just cold-cocked me in the kidney during a fit of frustration. I was getting a bit tired of a person who lashed out--physically and verbally--without the slightest qualm, so I took myself into another room where there was an alarm sounding.

I fixed the alarming pump and glanced at the patient in the bed. Something about him seemed familliar. Then I glanced at his armband: "Schlomo Fishnugget."

Schlomo Fishnugget???

"Uh, sir?" I ventured, "Are you the same Schlomo Fishnugget that invented the Ding-Dang Freakywidget and postulated the Creakynut Energy Conversion Theory?"

"Why, yes, I am" he replied, with a boyish grin.

"The same Fishnugget who won the Nobel Prize for applications of the Ding-Dang Freakywidget?"


I was standing in the presence of one of my heroes. It was as though Bucky Fuller had knocked on the door and offered to sell me some Girl Scout Cookies (now with less waste!).

I gaped. I've taken care of politicians, minor members of royal families from all over the globe, heads of small states, rodeo clowns, circus performers, musicians of all stripes, investors, and interesting normal people, but here was Schlomo Fishnugget. And I was clearing an alarm on his IV pump.

So, after the requisite I'm-Your-Biggest-Fan business, we talked about dogs. And how to make the perfect potroast.

Thursday, May 12, 2005

On the record, off the leash

I spent a pleasant hour yesterday chatting with a very nice woman named Janet Wells, who's doing an article on nursing blogs for Nurseweek magazine. Why on earth *I* seemed like a candidate for an interview I don't know; there are plenty of other nursing blogs both more sane and more nursey than mine.

There was only one point at which I had to say, "Wait! Wait! No! Don't write that down! That's off the record!" Given that I was simultaneously talking to her, knocking cobwebs off the ceiling with a broom, trying to unpack two boxes of books, keep the cat from going completely schizoid, and drink a beer, I'd be surprised if what she prints is comprehensible. The quotes from Jo will probably end up looking like this: "Urgh. Dammit. Ow! Silly cat! Nursing. OW!!"

That's me, the only undiagnosed Touretter ADD nursing blogger out there.

I guess I really ought to subscribe now, or at least find a copy, so I can tell if I translate well to print.

Oh, for those who were wondering (like anybody was), there will be no picture. I haven't got a digital camera, so Janet is on her own looking for a representation of a Typical Blogger.

Sunday, May 08, 2005

Cooking and those who don't.

I can bring home the bacon and fuckin' fry it up, man.

Today, before one o'clock, I had made two chicken pot pies (the real sort, with mushrooms and carrots and peas and cream sauce and biscuit dough) and a brisket and put together my crazy Kuwaiti friend Mahmoud's desk.

Mahmoud bought, on a whim, one of those melamine desks with forty umpteen holes and numerous little odd screw-things that are supposed to attach the various bits together. He had no clue how to start with the thing, so I went over to his place and had it together in fifty minutes.

Let me tell you how to reduce a crazy gay Muslim to rapture: bring a chicken pot pie into his house. I'd fed him once before on the stuff and he kept asking, "Is this something Americans eat all the time? Or do you keep it for special occasions?" Every once in a while he'd mention it with a sigh and a woeful look. So I thought I'd take him a pan. He ate half of it while I put his desk together.

Then, as I was leaving the house to get gas, I ran into a neighbor. She doesn't cook either.

(A quick aside: When I say "doesn't cook", I mean *DOESN'T COOK*. Mahmoud keeps Tupperware in his oven. Stephanie occasionally heats things in the microwave.)

Anyway, she's doing spring cleaning at the moment and wanted to give me three pans: all Calphalon. One's a medium-sized skillet, the twin of which I already have, but there are two true finds: a very small omelette pan, just perfect for one person, and a straight sided skillet that I've been looking for in thrift shops for years. Neither of them is made any longer and haven't been for some time.

So I came back and made her a cake. Chocolate, with chocolate frosting, because she likes that sort of thing.

The top looked a little rough-and-ready, so I grated some white chocolate over it. Then I noticed that the middle of the top was sagging a bit (it was still warm), so I just piled on some of the tiny sweet strawberries I got earlier today at the store.

I just took it downstairs. Stephanie looked like I'd handed her an Oscar. She got very flustered, round-eyed and stammering, and finally put it on the counter and stood staring at it for a few moments.

This is what I love about people who don't cook. What for me is a fun hobby and for Chef-Boy is a way of making money is some sort of arcane alchemy to them. The simplest things, like making stock from scratch, fill them with awe and appreciation. Tell people who don't cook "Sure, come on over, I'm just about to pull the bread out of the oven" and you'll hear sonic booms preceeding their entry into the driveway.

Therefore, in honor of those who don't cook, I present the best recipe ever for those who do or don't.

Kick-Ass Mac and Chee

Melt four tablespoons of butter in a very big saucepan. Use medium heat; you don't want to burn the butter.

Add five tablespoons of flour. Whisk the butter and flour together until it's marginally smooth.

Pour in four cups of milk. Whisk like a madman until all the lumps are gone. If you can't get 'em all out, don't sweat it.

Add a teaspoon each of dry mustard and garlic powder, along with a couple of shakes of cayenne pepper. Keep heating the milk mixture, stirring, until it thickens up a bit.

Now add eight ounces of grated or chopped-up sharp cheddar, five ounces of mild cheddar, and five ounces of mozzarella cheese. Don't add 'em all at once; let the previous cheese melt a bit before you add the next.

Let it melt all together, stirring constantly, until it's creamy.

Pour over twelve ounces of cooked pasta. Devour.

Things about which I do not care, Sunday, 5:53 am edition:

1. Michael Jackson.

2. Any of the celebrities who slept in Michael Jackson's bed.

3. Ultra-super-duper long-lived mice with healthier hearts.

4. The men's rights movement.

5. Anything much going on in Kansas. I promise I'll care about that later.
(Apropos of which, I met somebody the other day, about my age, who actually believes the world is only 4,000-some years old. Given that almost nobody believed that idea *when it was postulated*, I think we should put her in a glass case. Amazing.)

6. Cholesterol. It's just too damn early.

7. Florida.

8. What David Beckham is doing these days.

9. Laura Bush's comedy routine.

10. Merck Pharmaceuticals.

Why am I up this morning this early? On a day off, no less? Because Beloved Chef-Boy has to cook a Mother's Day brunch (plated, limited menu, special selections) and so has to be at work at 7 am. This is early for a chef, especially when he worked dinner the night before.

Wish your mom a happy Mom's Day. And reserve a few good wishes for those long-suffering members of kitchen crews who were up late last night and will be up early this morning.

Saturday, May 07, 2005

Listen up, Fashionistas.

Sonic Nurse (love that title) complains that scrubs for guys suck. Most scrubs for women suck, too, but I have a solution to that little problem.

It's called Ladybutton Fabrics.

Yes, yes, I know. The fabrics there are nine-fiddy a yard. You'd have to find somebody to make you the tops once you do have the fabric. But honestly, come on: where else you gonna find scrub toppable fabric with sushi on it? "Futurella" pinup girls? Women who love their appliances? Beloved sister had a sushi scrub top made for me two years ago that looks fantastic still and gets many compliments. Soon I will have *more* crazy scrubs, since it looks like LBF just got some new stuff in.

There's no excuse for being boring in your nursey suit. If your facility allows you choice in scrubs, join me. Rainbow-colored poison dart frogs are only the beginning.

Not-smart things to do

For a pretty smart chick, I sometimes do some pretty dumb stuff. Managed it again last night, when I went to a local dive with some friends. Now, no matter how good and greasy dive-bar food is, no matter how nice it is to sit next to a biker named Skillet and his dog Nanook, sometimes you need to exercise a little restraint when it comes to adventurous eating and drinking.

Those words are shocking my friends, who remember me saying things like, "Oh, look! A guy selling tamales out of his car! Let's get some!" Or stopping at every boudin shack within a hundred-mile radius. Or eating way-undercooked turkey legs proferred by toothless inbreds at VW Fests. Whatever. I'm learning slowly, in part due to Skunked Beer.

I do not know, nor do I want to know, what makes beer skunked. All I know is that I got one last night, had enough of it to realize that it was off somehow, and then thirty minutes later came down with the second- or third-worst headache I'd ever had. It's an odd sensation, sort of like having the stomach flu but without any stomach symptoms.

I'm better today thanks to liberal applications of water and ibuprofen, but I'm still feeling a little peaked.

Which leads me to a book review.

I'm reading Bill Bryson's A Short History of Nearly Everything and making slow progress, not because he's a bad writer (near as I can tell he writes on every conceivable subject and makes it all understandable and fun), but because the book is so damned dense.

Still, it rates a Highly Recommended on the Nurse Jo Nonfiction Scale. He makes string theory comprehensible. I can't wait to see what he does with quasars.

Friday, May 06, 2005

Well, that was interesting.

It's crunch time at the hospital. Every patient in the ICU is on a vent--no kidding--so we're getting a lot of really...er...marginal patients up on the floor and into our ICU overflow. Makes for an interesting day, as we discharge everybody that is ready for discharge, move people hither and yon to open up rooms, and then wonder what fresh hell is coming up from downstairs.

One of my guys this week was in after a major stroke to one of the big arteries in his brain (posterior basilar, if you're interested. Also, writing the word "basilar" over and over makes you wonder if you've spelled it right). He's lost all function except for voluntary eye movement, and that with a fairly significant delay. Ask him to open his eyes wide and he will, but only with what seems a lot of work and after a couple of seconds.

The report I got gave a diagnosis of "locked-in syndrome", a nightmarish situation in which a brain injury or other problem robs a person of all voluntary movement except those of the eyes. Given that that diagnosis was postulated by a pulmonology resident and not a neuroscience resident, I was a little weirded out. Anyhow, my poor patient had all the prerequisites for a rotten diagnosis: fulfilling life, happy family, loving friends, beautiful kids. At this rate, I'll live forever.

Another patient (beautiful children, loving family, loyal friends) came up to us after two weeks in a phenobarbital coma for status epilepticus.

In English, that means this:

You know when you have an epileptic seizure, and the electrical activity in your brain goes completely haywire? Imagine that without end. Status epilepticus equals completely wacked-out electrical signals. A phenobarbital coma is a fun little medical tool we use to calm peoples' brains and bodies down long enough to give them a rest and us some breathing room to figure out what the hell to do next. (By the way, we still have no clue as to what caused the problem, so please don't ask me.)

This poor patient had been in an almost-constant seizure state for *three weeks*. The seizures had calmed down to the point that facial twitching was her only symptom (well, probably also because she really couldn't move anything else, given the amount of damage she'd had), so they handed her off to me.

Nobody told me that the seizures would occasionally stop for a few minutes at a time, leaving my trached/g-tubed/paralyzed patient aware of what was going on. Unable to speak or move, but aware.

At which point she would sob silently, tears flooding down her cheeks.

Then, maybe mercifully, she'd start to seize again and would become unaware.

Makes you long for a tumor. At least those, you can get out of the hospital in a week or two.

Monday, May 02, 2005

In which Jo meets Satan and Satan wins

You know it's going to be bad when one of your patients is complaining about another patient he met in the emergency room.

You know it's going to be worse when you can hear the complaining patient all the way down the hall, being wheeled up in a stretcher, bitching about how, Goddammit, he pays fourteen hundred dollars a month for insurance and ought to be in a private room.

You know it's going to be unbelievably horrible when you try to explain to the patient that the reason he's in a semi-private room is that this is ICU overflow and he's got an expanding hematoma, and all he does is say, "That's a good line, cunt" and then ask you if your hair is *really* red.

Of course, he came in positive for benzodiazapenes, cocaine, cannabinoids, alcohol (BAC 1.2), and opiates. He's morbidly obese, has diabetes, has had five heart catheterizations, multiple gut surgeries, and is hypertensive. He's noncompliant with all of his medications, but still complained about the food and the pills I had to give him.

The black eye he had from getting drunk and falling over improved neither his appearance nor his mood. His family doctor, who showed up and humored him, didn't improve my mood.

You can talk all you want to about being assertive, setting boundaries with your patients, and laying down the law. Sometimes it just doesn't work. Sometimes you have to get out of the room before you either say something unforgivable or actually hurt the person in a red fog of rage.

But we showed him. Yesterday we assigned him a nurse who'd been the charge nurse of a busy county emergency room. By ten o'clock he was behaving.

Call me a wuss, but I really hope I never have a patient like him again. If I do, I hope I have a good supply of morphine and a ball gag.