Wednesday, September 28, 2005

So then she asked me...

"Where's the lumbar dressing?"

"On his lumbar spine, over his lumbar drain" I replied.

"But where's the lumbar area?" she persisted.

This from a fourth-year, last-semester, about-to-be-released-on-the-world student nurse.

At that point I sat her down with a stack of reading material and told her to research the patient's diagnosis, come up with a care plan, and know what his damned medications are so she wouldn't tell me again that Tessalon Perles were an antibiotic, and to have it done by today. That way, she'd be able to actually take care of and interact with the patient.

Which would've been fine, had she not kept wandering around, asking if she could *do* stuff. As in, "Can I watch you admit this patient?" "Can I open that lumbar drain for you?" (NO!!) "Can I ride this unicycle down the hall while singing 'Tosca'?"

Finally I wheeled around in the hallway as she followed me like a puppy, levelled my finger at her, and, reverting to Theater Geek/Abortion Clinic Jo, said, "You do not have the chops to be following me around. You need to do what I told you to do two hours ago so that you can be productive and safe tomorrow. Right now, you are neither safe nor productive, and you need to fix that."

So she, predictably, took herself into the bathroom and cried. She's afraid I'm going to fire her and she won't graduate.

She's right to be afraid. Very afraid.

Frankly, if you're in your fifties, dedicated enough to get a BSN, dedicated enough to go through all the crap that comes with being a "nontraditional" student, then you're old enough and tough enough to do what you're told by somebody who wants you not to screw up irretrievably.

All of which paled in comparison to the question asked by another of the students.

I'd asked her to catch a set of vitals on a patient, a fresh post-op, who'd had a right arm and shoulder amputation. This is a beautiful girl in her early twenties with an advanced and atypical case of chondrosarcoma.

So there's nothing to the east, shall we say, of her right collarbone. Nothing, that is, but a big slanty white gauze dressing with three Jackson-Pratt drains hanging out of it. No arm, no shoulder, no nothin'. There. Is. Nothing. There. Except an obviously fresh postop dressing.

Nursing student first tried to take a blood pressure on the patient's non-existent right arm. I had to redirect her to the left.

Then she asked me, as we left the room, "So...what did she have done, anyway?"

There. Is. No. Arm. There. What the hell do you *think* she had done? Rhinoplasty?

Sweet Christ on a pogo stick, I need a drink just retelling it.

Sunday, September 25, 2005

This has been bugging me for a while.

I once heard a story about some researchers in the Amazon, or someplace where there are sloths, who put pie pans on sloths' heads. They came back 24 hours later to find that the pie pans hadn't been disturbed.

Or maybe it was the sloths' bellies that held the pie pans. I don't recall.

Chef Boy woke me last night with a phone call to ask, "What good are sloths?"

I replied, half-asleep, that sloths are where you store your pie pans.

Has anybody else heard that story? Or is it a product of my fevered imagination?

What really sucks

What really sucks is reaching into the oven for a baked potato, and misjudging the amount of space between the oven racks, and pressing the delicate skin of your forearm against the searingly hot metal of the upper rack. That sucks. I have a nice inch-and-a-half-long burn now that will take forever to heal.

What else really sucks

Is having a very small kitchen. I can make a clean kitchen into a disaster area in a matter of seconds if the kitchen is very small.

My kitchen is very, very small.

Which means I have to go clean it now. Including scrubbing bits of my own seared forearm out of the oven.

Saturday, September 24, 2005

Let's get one thing straight right the hell now.

Oh, holy hell.

Can I just say this? I've figured out over the course of a short and misspent life that if a doctor is an asshole to you, she or he would be an asshole whether he was holding a stethoscope or a plumber's wrench. Some people are just plain assholes, and they end up in careers that allow them to make the most of their assholishness.

Same for nurses. If you work at a hospital (whether as a resident or nurse) where the nurses resent female residents, or residents of either sex as a group, then I feel sorry for you. That's known as a combination of assholery on the nurses' parts and a bad work environment.

I do not resent residents as a group. I resent the hell out of certain residents; namely, those who tell me that they're sick of reading X-rays on a particular patient, or that I should ignore the fact that said patient is breathing 32 times a minute and satting 76% on ten liters with a nonrebreather mask.

It's a focused, specific resentment.

And it's a resentment that's easily dealt with; namely, you have to be straight with the assholes you work with. If Doctor Assholian tells me he's tired of dealing with the above patient, I say to him (as I've said before), "Look, Fred, part of my job is to make your job easier. Would you rather write for Mucomyst now or code this patient later?"

If you're a nurse who gets peevish when an attending or resident goes against your recommendations, think of this: they might just know more than you. I'm not talking, of course, about times when somebody who's too tired or too frazzled orders something ridiculous, but about times when there's a judgement call to be made on a *medical* basis. We can't call all the medical stuff; there's simply too much that we don't know, okay? Okay.

If you're a resident who dislikes being called "Nurse" by mistake, suck it up. Mistaken identity is part of the business of dealing with people who are not all there. If you've got nurses who woo you in the station and diss you in the breakroom, you might examine your own behavior. If your behavior comes out clean--and I'm saying here, loud and clear, that there are lots of times when it will--you might have to chalk the whole backstabbing thing up to assholishness.

And for the residents who pull the "ten years of training" card, think of this:

Three hundred years ago, or even less, medical school was a short-term thing. Doctors had a few years of courses, followed (sometimes) by informal apprenticeships.

Nursing is where doctoring was in its infancy. As a profession--not just a dumping ground for retired whores and drunks--we're less than two hundred years old. We've still got the relatively-short-formal-education thing followed by what's essentially a working apprenticeship. Nurses who have been practicing in high-acuity settings for three to five years are referred to as "new" nurses. The idea of nursing diagnoses is less than fifty years old, and the reality of nurses as people who synthesize a large amount of scientific data and decide on treatments based on that data is even younger.

You're an expert in your field. Do me the credit of assuming (until I pull one of my spectacularly original fuckups) that I'm an expert, or at least an expert-in-training, in mine.

I will bust ass to make sure that your job is as easy as possible. If you let me round with you, you'll know all your patients' lab values for the last thirty-six hours without having to refer to an index card. If you let me make a suggestion, I will keep your patient from having to have a wound-vac installed on the stage IV decub. on their butt.

Likewise, I know that you will bust ass to make sure that my patients are as healthy as possible; that they don't end up getting conflicting medications or unnecessary treatments. I know that you won't cuss at me if I call you at 2 a.m. because something is *just not right*.

And let's drop the whole notion of whether scrub jackets or print scrubs make you look more or less like a nurse, shall we? I already have enough trouble with residents who don't wear undies.

Whore sauce, or what I aspire to on my day off

A recipe from a real Italian

This is for puttanesca sauce, the pasta sauce made famous by the hookers in some Italian city or other. It's strong and rich and should be reserved for those evenings when you can cook it, eat it, and fall over in a heap. A good red wine is essential.

Do Not Be Afraid Of The Anchovies. Really. Anchovies are good as a condiment, and that's what they are here.

3 cloves garlic (Lydia's recipe didn't say whether to chop them, so I did)

6 tablespoons of olive oil

1 pound of ripe Roma tomatoes, cored, or a 28-ounce can of tomatoes (I used Hunt's Petite Diced because the Romas aren't so good just now)

3 tablespoons capers, rinsed and drained (they're weird green things you find in jars in the olive and pickle section)

2/3 cup small black olives, pitted and chopped up slightly (Nicoise would be good, but they're a bitch to pit. I used Kalamata, rinsed and drained.)

a couple of shakes of red pepper flakes

a couple of teaspoons of chopped *fresh* oregano. The fresh part is important.

3 ounces salt-packed anchovies, rinsed and drained (Or oil-packed, but be sure in either case to rinse them well, then drain and chop them coarsely.)

2/3 cup fresh Italian parsley, chopped

salt to taste, though I sure didn't need any

A whole mess of thick spaghetti or linguine to serve this over

In a medium saucepan, heat the olive oil, then add the garlic. When it begins to color, add the tomatoes, capers, olives, red pepper flakes, and oregano.

Cook this at a bare simmer for about ten minutes, or until it begins to thicken. I left the sauce simmering for nigh on a half hour and it worked fine.

Add your anchovies and parsley, mix it all up very well, and leave to simmer, again, for as long as it takes you to cook up the pasta.

Taste to adjust seasonings and add salt if you're crazy. *ahem* That is, add salt if you think the sauce needs it, which it wouldn't unless you're the Salt Vampire from the original Star Trek, but anyway.

Top with Parmesan cheese (the freshly-grated stuff, please, just this once, as the garp in the can ruins the sauce). Eat. Collapse.

Friday, September 23, 2005

Her: "Boy, you're mean." Me: "Boy, you're perceptive."

The students are back.

It's not the medical students and nursing students that bug me. It's the nursing instructors.

Or, rather, it's the nursing instructors from one particular four-year institution that uses us as a teaching facility. Years ago, the university's nursing program was rated one of the best in the nation; lately, it's kinda fallen off. But those dadratted instructors...oy. They think that once the best, always the best is the rule, and so refuse to listen to reason.

It doesn't help that the woman I'm working with now hasn't practiced in seven years. She's kept her licensure current, and she works as a "nurse expert" in legal cases, but she hasn't laid a hand on a patient in seven years.

That makes it difficult to explain why, if an order is written to run potassium as a piggyback (English: as a secondary IV that feeds into the main IV, thus running very, very slowly), it is not a good idea to run that potassium bolus as a primary IV line. You know, potassium can stop your heart and all. No, really. See? The order is specifically written as a piggyback order, and it gives the rate and everything. Maybe you shouldn't try to run it by gravity, as fast as you can, into this elderly and debilitated patient.

No, you may not take your student in to give medications without me there. I already caught you drawing up one medication into a syringe that should NEVER be given IV; I don't intend to let you poison anybody I'm responsible for.

(And yes, we've already taken this to the DON.)

Anyway, that's one issue. The other is that last-semester four-year nursing students don't know where the pons is. And one of them didn't know the difference between veins and arteries. Like this: "The carotid artery? That's, um, the jugular vein, right?" No, not right. They have different names, like different people have different names. Sam and Bob, artery and vein.

Jesus H. Leapfrogging Christ on a stick.

The Big Issue is this:

You do not get to have an attitude as bad as mine until you pay your dues. I will not eat you for lunch; I will not call you out in front of other people; I will not make you feel small. But if you try for as crappy and cynical an attitude as I have and you're not even out of your externship yet, I will shoot you down. Nicely.

Example: Nursing extern starts discussing the case of a patient who had a pontine mural stroke (English: very, very bad) in front of said patient. Now, this guy is totally mentally there; he just lacks the ability to speak clearly. I took her out of the room before I reminded her, as nicely as I could, that it's considered bad form to talk about a patient in the third person in front of that patient, especially if he or she can contribute to the conversation.

Her response? "Well, the resident was doing it."

Me: "It's still rude."

End of discussion.

I know she's fifteen years older than me. I know she's been a high-powered something-or-other in a law firm for the last ten years. But here, your job means shit unless you can *actively apply the principles you learned* there. And I, frankly, am seeing little active application in terms of tact or motivation.

My last job motivated me to go to nursing school. After all, the prospect of being shot at or followed home by wackos will make you want something less stressful. But I recognized early that the only thing I could take away from the prior job was the ability to tell the wackos from the sane people. I didn't feel I had the privilege of pulling a House until I'd been doing this a while. I got students now who out-House House, and it's getting a little irritating.

Plus, they get all the good comebacks. That's the root of the problem.

Monday, September 19, 2005

Deconstructing scrubs

Poor Dr. Au. I say that without any sarcasm at all (rare for me, I know), because she's on the horns of a dilemma: freeze to death in the OR, or be taken for an RN?

No, Michelle, (may I call you Michelle?) you're not prejudiced against nurses. You're not trying to remind people that you are a Big Doctor Person. You're just trying to stay warm while not confusing people about your role.

I don't know what it's like in your facility, but in mine we can wear pretty much whatever we want (the RNs, that is) under our white lab coats or scrub jackets. I tend toward scrub tops with sushi prints. Some folks like, yick, teddy bears. One woman wears tops with glow-in-the-dark alien faces on them--she works nights. The docs wear OR-distributed scrubs or street clothes under their lab coats or, yes, scrub jackets.

Sometimes it's hard to tell us apart, pity the poor patients. I get called "Doctor" at least three times a week, more because I'm a little older than the other nurses and hence have a few more dark circles under my eyes. I look more like an exhausted resident to a gorked-out patient, I guess. One of my male resident colleagues gets called "Nurse" at about the same rate, probably because he looks well-rested and doesn't have pockets full of *stuff*.

It *is* all about truth in advertising. Clothes make the person in the hospital.

Get you some of those silk long undies and a scrub jacket, then have the scrub jacket embroidered with "Dr. Michelle Au". You'll stay warm and there won't be any questions, at least not from the observant.

Sunday, September 18, 2005


Being a nurse means

...that you have callouses between your toes...

...that, speaking of callouses, you know where those callouses on the tip of your thumb and between the first and second finger of your right hand came from.

...that you know exactly how much time you have left if your fluids are running at 120ccs/hour with 83 ccs left in the bag...

...and that you show up one minute before the pump starts beeping with a new bag.

...that you know when "breathing weird" is normal and when "breathing weird" means "grab the code cart"

...that your feet never really stop hurting

...that you can measure three or five or twenty minutes without looking at your watch

...that you never have time to do your hair just right

...that you always know exactly where your curved hemostats, straight hemostats, and penlights are in your scrub pockets

...that you don't need a "cell-phone pocket" in those scrubs, because you don't have time to take personal calls at work

...that a balanced meal is coffee with your donut

...that you can debate the merits of various McDonald's chicken sandwiches with your coworkers...

...and do this while discussing the consistency, quantity, and frequency of your patients' bowel movements in the lunchroom

...that a crisis requires only a grasp of the essentials...

...but that the essentials might be different from crisis to crisis

...that knowing that "airway" isn't *always* your first concern

...that listening to the flight crew is a really, really good idea

...that residents sometimes do actually know something

...that calls should be screened on every day off, no exceptions

...that four days in a row can make or break you in terms of rational thought

...that a nap might be the most valuable thing on the planet

...that "Well, *he's* gonna die" isn't necessarily an unfeeling statement; sometimes it's more whistling in the dark...

...and that "circling the drain" and "on vulture precautions" are nice ways of facing that which none of us want to face

...that 1912 or 0712 is the most beautiful time on the clock face

...that sometimes you forget the names of those who have died...

...but never, ever the faces.

Saturday, September 17, 2005

While waiting for news, distractions.

This is so very cool.

Chef Boy's new stove/oven has a Sabbath setting.

He said, when I mentioned that it had a Sabbath setting, "Yeah, I read that in the instruction book. Seems kind of weird."

I pointed out that the laws of the Jewish Sabbath prohibit, as far as I know, lighting cooking fires or lighting lights, so having an oven that would stay on with its light on for 72 hours straight might be a pretty cool work-around.

His question was, "What if I want to make a stir-fry?" I guess you'd have to wait until sunup to start that.

This is what happens when you live in a culture where Judaism and Mormonism are practically unknown, Southern Baptists build a church on every corner, and you know more about the Hindu pantheon than you do the Torah.

Another cool thing, this one rather scary.

As of when I get the phone call later tonight, Chef Boy will be unemployed. Probably. Most probably. And about damn time, too.

If any of you nurses think nursing is an insular, codependent, strange world filled with people who would be better off with minders, you haven't worked in a kitchen yet. The people who open small restaurants are often totally ignorant of what it takes to run a business. They're the sort of folks who will spend $38,000 on a new sportscar while cutting the hours of their staff back so that they can save money. They're weird folk.

Kitchen folk are weird, too, but they're pretty straight-up for the most part. Your average chef might have an ego the size of Alaska when it comes to his cooking, but he's not going to screw you around or lie to you when he's in the kitchen. (Out of the kitchen, approach at your own risk.) These are folk who work with knives, fire, and corpses, think it's okay to take whatever drugs they've found on the floor after closing time, and find humor in somebody cutting off the end of her thumb in a slicer. But they are honest, they do tell the truth, and they understand the Darwinism of the kitchen: either you make it as a line cook and go up from there, or you wash out and go back to the nine-to-five.

So Chef Boy is leaving his peculiarly pathological kitchen and looking for something else to do. He's gotten tired of being undermined and having his hours cut.

Let's have some kharma for the Boy, shall we, that he doesn't end up someplace even worse than Il Ristorante Schwankienne? Thankee.

Meanwhile, I'm sitting here at the computer, staring at the phone, wondering what in hell is taking him so long to call with the news. With every passing minute, my mental image of the proceedings worsens.

Still more coolness

Ever heard of Eaton-Lambert syndrome? I had, but I'd never seen it until yesterday. It's an autoimmune disorder, most commonly brought on by small cell lung cancer, that mimics myasthenia gravis, except in one particular: where people with MG get weaker the more they use their muscles, people with ELS get *stronger* with repetition of motion.

The treatment for both is the same: plasmapheresis.

I'll let you know how the ELS patient does after the first three pheresis treatments. I'm back at work on Tuesday. Until then, I'll bite my nails while waiting for Chef Boy to call and work on killing the dust bunny armies that have invaded my house.

Thursday, September 15, 2005

Just a tip...

If you call me at home, and I return your call from work, and tell you that I'm calling from work on my cell phone, and you have both my cell phone and work numbers, don't sound annoyed if you later leave two messages on my home answering machine when you can't get in touch with me there.

I'm just sayin'.

Oh, and another thing...(edit)

If the op report says "glioma" and the residents' notes say "glioma" and the attending's note says "glioma", do not get snarky with me when I give a physician from another service the rundown on gliomas (nasty, fatal) rather than pilocytic astrocytomas (minor, totally curable) when she asks me.

Especially not if you dictated the report that called it a glioma.

If you do, I'll have to do one of two things:

1. Pull the chart and show you your error, which you will not like, or
2. Dump your bludgeoned and charred corpse out of the window.

A further note to the commenter of the other day: we've spoken to the nursing supervisor, the chief resident, and Doctor Assholian's attending about Doctor Assholian's behavior. So far, it hasn't made any difference.

Option #2 is starting to sound good. And totally, totally workable.

Tuesday, September 13, 2005

Not just in name only

Close encounters of the LDS kind

A group of about five of us started stocking and furnishing the apartment "our" evacuees will be moving into. Just as we were getting started, a couple of the missionaries who live downstairs asked if we needed help. I tasked them with moving a big, heavy couch up two flights of stairs, around three tight corners, and into a living room. And they did. Then they stayed and kept helping, and refused offers of pizza.

I didn't realize one of the women helping out was also a Saint until I started unpacking box after box of Number 10 cans of macaroni, flour, sugar, rice, beans, baking mixes, oatmeal...basically everything you'd need to cook for a month, she'd brought. Everything you'd need to wash your clothes, yourself, or your dishes for a month, she'd brought. She had all of this stuff stocked as extra, even though she's been living off of it since losing her job last year.

All that and a first-aid kit, too. It was a wonder to see. Every time one of us said, "Do we have X?" she'd answer "Hang on, got one right here" and yank some new thing out of her bag. When I asked her about it, she shrugged and said, "Hey. It's what we do."

So the folks coming in have a pantry crammed full of food, a closet crammed full of clothes (in the right sizes!) and a bathroom so stocked they won't have to buy toilet paper or shampoo for, like, six months. Either that or they'll be *very* clean.

We also have a wad of cash for gas cards, gift cards, grocery shopping, deposits to get the electricity turned over to their name, phone service, odds and ends, you-name-its, and a nice dinner out.

Everybody contributed according to their ability, I guess. It was a shock, though, to see a woman who's been unemployed since December who was still able to give so much, simply through storing this stuff since God Knows When. And the two missionaries who helped haul heavy things? Did it with smiles on their faces and in their dress clothes in the 100* heat.

Saints? You betcha.



Shampoo. Hydrating or not? I suppose it doesn't matter.

shaving cream and razors

two toothbrushes and some toothpaste

towels. Two. No, better get four.

knives. The block set, or the three? Three. They can build around that.


kitchen towels

silverware. They'll need silverware.

trash bags

dish detergent




tampons and pads

a small lamp for the bedside

"Do we have dishes?" Yes, we have dishes. "How about a coffeemaker?" Yep, got that.

coffee. And filters. Don't forget the filters.

"How about toilet paper?" I don't think anybody thought of that. "Okay, then. I'll get some."

"Oh--wait. Any pets?" No, no pets. (a small sigh of relief here, that they didn't have to abandon their critters)

Paper. Pens. A phone book. A list of decent businesses to buy things from. A gift card for anything else we might've forgotten.

A couch. A bed. A dining room table and a rug. Later, someone will go out and buy a shower curtain.

Pillows. Blankets. Two sets of sheets that will be a little bit big, but should work.

The washing machine churning away at the towels, so that they can use them right away. The dishwasher churning away at the dishes, so that they can use them right away.

Food. More food than you could shake a stick at, stocking the pantry.

Some barstools.

A green plant.

Something to read.

A radio.

They lost everything. They were lucky enough to have the means and the ability to leave everything, but their business and house are now gone. No trace of 'em, *gone*.

They've driven ten, twelve, finally sixteen hours to come here. The management doesn't care that they don't have a housing voucher. "Go ahead and move in; no bills or rent for three months." The rest of us are giving whatever we can cull or buy or do without to furnish the apartment.

Triage means deciding what's important, what you have to do or have or deal with first. When you're looking at somebody who has nothing but what they could stuff in their Civic, that's hard to figure out.

Saturday, September 10, 2005

Playing hooky and practice issues...

I need reassurance that what I did was the right thing to do.

It took me over five hours to get home last night from work. What would normally be a 45-minute commute turned into a hell of gridlock thanks to highway construction, people running out of gas, and some genius who miscalculated both the speed of the cement truck next to him and how fast the highway would run out.

Suffice it to say that for five hours I was stuck on a highway in a spot without exits or turnarounds for fifteen miles.

I got home after midnight and called in to work for today. Normally I'd attempt a day on four hours' sleep, with a few naps, but that's not an option at La Schwankola Hospital. You can't nap when you have lumbar drains open.

The Guilt Chip that was installed in my head midway through school is firing full-strength. It's not that we're short-staffed--we've got plenty of people to cover--or that I doubt that I wouldn't be safe, showing up way underslept.

It's that I feel like I ought to be SuperNurse, able to work with *no* sleep (which is better than short sleep), even though I'm sick, even if I've got a broken leg.

My practice would be unsafe were I at work today. That's a given. So I called in. Please, somebody, reassure me that nurses working short of sleep is just as bad as doctors doing it. Reassure me that if I have the choice not to practice if I'll be dangerous, the right thing is to make that choice.

Back to bed.

Thursday, September 08, 2005

Read this

This is what my colleagues, bless them, are going through.

Welcome to my universe....

In which a discussion of the radical Marxist feminism of 30 years ago turns into a discussion of whether or not lesbian sex is used as a metaphor for death on "Buffy", and everybody gets very upset 'cept me, who's never seen an episode of "Buffy"...

In which the best list of links for Hurricane Katrina relief was put up by the gals at Go Fug Yourself...

In which a friend of mine loses her job and is made to go through counselling and Narcotics Anonymous meetings even *after* her tox test came back negative for alcohol or drugs, lest she be reported to the State nursing board...

In which the city government of Our Fair Burg has decided that housing Katrina evacuees would be "bad for business"--even though a neighboring town of half our size has turned an old grocery store into a shelter...

And an online pal sent me a picture from her local (Dallas) paper of an evacuee's dog who had been smuggled in a backpack all the way from NOLA, sticking his cute little doggy schnozz out to get some fresh air (I giggled until I cried, and then I cried some more)...

In which a "snack" is corn on the cob, roasted asparagus, and half an artichoke (next week I'll be back to Cheetos and beer, never you mind)...

In which avacados are suddenly something ridiculous like 4/$1, even though gas prices at some stations in my 'hood still hover at *over* four dollars, leaving me to make a huge bowl of guacamole and stay home...

And in which a snack-sized Greyhound (also known as a miniature Dachshund) named Bonnie has decided that I am Her Human, even *after* I took her to the vet for Various Undignified Tests.

Wednesday, September 07, 2005

Let's get a few things straight

Or, there ain't no "benign" or "malignant" when it comes to your brain

The first thing that most patients ask when they find out they have a brain tumor is "is it malignant?" They want to know if we can take it out, sew them up, and send them home in four days with no need for further treatment.

The first thing most patients ask when their MRIs show white matter lesions is "is that benign?" They want to know if the changes in their brains will lead to them sitting in a chair, reminiscing about something that never happened.

I have a philosophy on that whole question of benign or malignant, and it's this: when it comes to what's happening in your brain-box, all bets are off.

F'rinstance, there's only one brain tumor most of us should lose sleep over: glioblastoma multiforme. Unfortunately, it has the dual distinction of being both the most common type of tumor and the most lethal. You don't get better after a glio, and we can't cure it. It's an extremely aggressive type of tumor that grows fast and interleaves normal tissue with tumor tissue, meaning we can't get it all out.

There are other types of "malignant" brain tumors (meaning they're likely to come back): astrocytomas, metastatic tumors, low-grade gliomas.

There are also plenty of "benign" tumors out there, the most common being the meningioma, which grows on the coverings of the brain rather than in the brain itself.

The problem is this: there is limited space in your skull. Generally speaking, there is only room in there for your brain. If you have a small, easily resectable glioma in a place that's not too valuable, you're likely to live longer and better than somebody with a large meningioma that's compressed tissue in a sensitive spot and done its damage.

It's the same with the various brain lesions that show up on scans.

Most of us, unless we've lived a life free of alcohol, fat, tobacco, caffeine, hypertension, stress, depression, exultation, sadness, and thought, will have white matter lesions in our brains by the time we're 30. Mostly they're not a problem. The only time they start to cause trouble is when they're widespread (like in Alzheimer's) or if they're in sensitive spots. Sometimes they can be a symptom of other things, like hydrocephalus in older folks, which can be more-or-less easily fixed.

Point being, your brain is much like your skin: it shows changes as you get older, but those changes don't generally affect its ability to do its job.

My advice, then, is this: if you're diganosed with tissue changes or a tumor, don't think in terms of benign or malignant. Get a name for the tumor or the changes first, then find out where it is.

If cutting it out will lead to the loss of something that's valuable to you, like your balance or your sense of humor, then it's a bad tumor, no matter what type it is. If cutting it out will allow you to have a good quality of life with minor or no loss of those things that are important to you, then it's a good tumor, no matter what type it is.

If your scan shows changes that are a surprise to you, don't lose sleep over them. If something in your life changed that prompted you to submit to an MRI, then find out if that something could be related to those changes. If it is, find out what the treatments are, and go from there.

"Benign" and "malignant", when it comes to the brain, have more to do with where something is and how it will affect you than *what* it is.

Sunday, September 04, 2005

What has happened down here is the winds have changed

Clouds roll in from the north and it started to rain
Rained real hard and rained for a real long time
Six feet of water in the streets of Evangeline


The river rose all day
The river rose all night
Some people got lost in the flood
Some people got away alright
The river have busted through clear down to Plaquemines
Six feet of water in the streets of Evangeline


Louisiana, Louisiana
They're tryin' to wash us away
They're tryin' to wash us away
Louisiana, Louisiana
They're tryin' to wash us away
They're tryin' to wash us away


President Coolidge came down in a railroad train
With a little fat man with a note-pad in his hand
The President say, "Little fat man isn't it a shame what the river has done
To this poor cracker's land."


Saturday, September 03, 2005


"In a state of emergency, you are creative, you figure out ways to get stuff done. They told me they went overnight and they built 17 concrete structures and the pulleys on them and were going to drop them, I flew over that thing yesterday and it's in the same shape that it was after the storm hit. There is nothing happening, and they're feeding the public a line of bull, and they're spinning, and people are dying down here."--Ray Nagin, mayor of New Orleans

We've been on disaster standby all week. The facility where I work is part of a regional disaster relief network, so when Katrina hit, we assumed we'd be getting a load of folks from University Hospital and Charity, the two hardest-hit hospitals in New Orleans. Tulane has the only working helipad, so we kind of figured that everybody would be boated or crawler-ed over to Tulane, then airlifted out.

So we waited. And waited. And nobody came. Not a trickle, much less a flood. One of the other hospitals in town got six patients rather than the 80 they were expecting. Which struck me as strange, until I heard an interview with a doctor at University on NPR yesterday.

There is very little food and potable water left at any of the hospitals. There has been no power for four or five days, and no flush toilets. They've taken to storing corpses in the stairwells. They're out of medications--not just code meds, but things like insulin and pressors.

And the doctor said he had been watching National Guard crawlers and boats go past all week. They're half a mile or so from the NG staging center, but there has been no concerted effort to evacuate the hundreds of patients in the two hospitals. Volunteers are taking people with critical injuries and so on in their own fishing boats to Tulane, but that's it.

Cell phones have finally started working again--if your batteries haven't gone dead. The administrators of our disaster planning group have been getting really scary phone calls and text messages from the people still stuck in hospitals in NOLA. There are nurses and doctors getting sick with E. coli and Giardia. They're out of alcohol. People are simply up and dying without medications to save their lives.

The National Guard has shifted its focus from search and rescue to shooting to kill when they find looters. The crawlers are passing the hospitals on the way to restore law and order.