Saturday, December 31, 2005

Happy New Year, everybody!

Chef Boy and I got home this afternoon, and after I ate, I was so tired I went to bed and napped for a while.

Christmas was lovely, unsullied by things having to do with work. Chef Boy and I met Brooke of odious woman at a place called Pike Pub for dinner and a beer. She's funnier and more charming in person than in her blog, even, and has really great glasses. She gave us great tips for living in Seattle ("Get a light box, some antidepressants, and be prepared to pay through the nose for housing") and showed us a good time. Thanks, Brooke! I had what I thought was going to be a funny post about our meeting worked out in my head, but I'm just too damned tired.

Beloved Sister's boyfriend announced their upcoming nup-shulls by giving her a gorgeous diamond. Now, I am not a fan of diamonds, generally, but this one was really cool--it was set like a little flying saucer about to land. The big joke for the next three days was getting blinded by The Ring. Yes, we're lame jokesters in my family.

Mom and Dad's cat, Astro (a Maine Coon cross) decided he didn't loathe me as much as he thought he might. Beloved Sister's dog, Bones (a Staffordshire Terrier mix) decided my lap was a good place to sit in the car. It was highly animalistic, as Mom would say.

Beloved Sis and CB and I also made the biennial pilgrimage to Archie McPhee. Everything I loved was on sale, which I take as evidence that maybe I didn't burn down that orphanage in a past life. Or, at least, that I didn't lock the doors first.

Seattle itself was beautiful, with frequent sun breaks and only one day of pouring all-day rain--the last day we were there. We got to see Heather and Will, friends of mine and purveyors of wonderful IBS remedies, in their new setup, a warehouse at Pioneer Square. I'm so pleased for and proud of them I can hardly stand it, and I can testify: if you have IBS, Crohn's, or colitis, you'd do well to visit Heather's website.

We saw the new baby otter at the Aquarium (cute overload!) and an entire family group of gorillas hanging out at the zoo. Also a tapir, looking disgruntled, and an elephant having a bath/snack/rubdown all at once in the elephant barn. That last was worth the price of admission; who knew a several-ton elephant would lie down on her side and stretch like a cat while being hosed off by her keepers?

Recommendations after this trip: the Wallingford Pub on 35th really does have the best bacon cheeseburger in town. Anthony's, whether it's the Home Port or the fish-and-chips stand on the pier, has excellent fish. The local beer is marvelous, no matter what you get: I had no bad beer for five days. Take the 522 express bus if you're leaving downtown for Wallingford; the other routes are milk runs. Archie McPhee continues its tradition of being the world's best source for rubber rats and cool Hindu-themed snackboxes. Sully's near the zoo (Phinney and about 60th, I think) was having technical problems the day we went (the women's bathroom ceiling had fallen in) but Sully himself was gracious and poured me a pint of really good IPA. Take his suggestions on what to drink. And be sure you hit the Space Needle if you're a first-timer. Really. It's cheesy and touristy and pricey, but it really is cool to see all of Seattle spread out underneath you.

And now I am sleepy again and will ring in the new year with a snooze.

Saturday, December 24, 2005

Hallelujah, Noel, be it Heaven or Hell...

A 2005 retrospective, done now because I expect to be too zonked from travelling on New Year's Eve to do it then, and because I'm avoiding the laundry.

For another year, I've avoided being hauled in by the IRS, FBI, BON, or DON. The NSA and the CIA don't want me, either.

I did not get married this year. w00t!

Nothing burned down and I didn't kill anybody, either accidentally or on purpose.

My cat doesn't hate me any more than she did last year.

I have a new car, the same (wonderful) apartment, and a few new friends. Chef Boy and I will have been dating for two (!!) years in January. No wedding bells are in the picture, so keep your toasters.

I put on a few pounds, but those'll come off eventually.

We lost a few patients, one attending, and one resident. The patients leave little-bitty holes, not because they don't matter but because you lose so damned many that unless you prioritize, your soul will look like Swiss cheese inside of a week. The attending left a big hole. The resident left a great yawning chasm, horrible, since she was younger than me and infinitely more deserving of life.

Hal, Stacy, Bill, Doreen, Mark, Marie...say hi to everybody up there, okay?

Our beloved friend John failed for the second year in a row (speaking of dead people) to quit calling in dead and come in to work again. We're getting pretty fucking sick of covering for him.

Kristen had a baby and has a new kitten. Lydia has a new granddaughter. T-bird got married. No marriages failed, and one was saved by the skin of its teeth.

Emmy's husband does not have cancer, thank God. Amy's baby lived her first year with very few problems; not bad for a 26-week preemie. My oldest goddaughter from my first marriage graduated high school this year. The world keeps turning.

Bonnie the Drama Dachshund adopted me as her human.

I got a really, really kick-ass pair of boots. And I got interviewed for a Major National Publication on blogging. That was fun.

And, in hopes that some of her good kharma will rub off on me, I'll be buying Brooke from Odious Woman a drink this week (excited squealing).

I'll catch up with you guys later; perhaps from Seattle, where I will be hanging out with the family, or perhaps from an undisclosed location after I return from the Pacific Northwet.

Friday, December 23, 2005

Let us all sing praises....

To the Best Boyfiend Ever (Chef Boy)...

...who took my antisocial, biting cat to the vet today to be kennelled for the Christmas holiday. She hates everybody but him. I think this is a very good sign.

To Amazing Nurses' Aides...

...who meet the doctor you've paged STAT when your patient goes into anaphylactic shock and are able to tell her exactly what time things started going south and what you've done so far, including dosages.

...and who deal, without complaint, with a paraplegic patient who I've just fed lots of laxatives to because he hasn't had a bowel movement in a week...

...and who manage, even when things are going to Absolute Hell, to make one patient after another laugh.

To The Talented Young Doctor Mike...

...who always manages something snarkier than I could ever have thought up on the spur of the moment...

To Doctor Bob...

...who brings me pictures of his Siamese cat unwrapping Christmas presents and thus turns a horrible day into a funny, bearable one...

To Glenda from the lab...

...who understands that STAT means STAT and who always, always gets her blood on the first try...

To my fellow nurses...

...who wipe butt when I have no time, who handle crises when I have no brain, and who remind me what on earth I got into this business for when I have no hope.

Happy Christmas, everybody.

Wednesday, December 21, 2005

So, just after I went to sleep,

I ended up with the same nightmare-situation, I can't believe this is happening patient that I had over the weekend. Only with more tubes and wires and with a worse blood pressure, if such a thing were possible.

Then somehow I got a NICU patient as well. Now, I don't do newborns; never have. But they had to overflow the NICU somewhere, and so up I ended with some five-pound, very sick little kid. RSV, or something. Anyway, kid couldn't breathe. Bad deal.

Then I got *another* patient, who just sort of left the room and disappeared. Guess I should've been happy that one could walk, but I would've liked to have seen her before she left the floor.

Just about that time, Mom called with the news that Dad had left her for some 50-year-old ER nurse. She looked a proper chippie, too. Mom decided to move in with me.

And then I had to find some obscure diagnosis in some obscure book that kept changing titles every time I put it down, while trying to figure out why there was an obese, bloated, bald teenager sitting on a stool on the other side of the counter.

I woke up just after the OR called and some surgeon was talking to me like I was Central Sterile.

No more combinations of "House", loaded baked potato, and Dogfish Head IPA right before bed.

Tuesday, December 20, 2005

You know it's One Of Those Days when...

I first had an inkling of trouble when the call bell rang and all we heard from the intercom was a scuffling noise. One of the physical therapists and I went into the room as quickly as we could, hustling our little butts, and found fists, and nurses dancing and feinting like Ali, and general chaos.

He'd been a rancher all his life. We don't grow people like this any longer: well over six feet tall even in his seventies, never drank or smoked, never sick a day in his life until his aneurysm bled. The bleed had unfortunately affected only his personality and not his body; he was standing, bleeding from where he'd tried to remove the second Foley catheter, screaming, "GODDAMMIT! I'll KILL you! Let GO OF ME!!"

He's a strong sonofabitch, I'll tell you that. Two nurses got his arms--staying well away from his hands, as he'd already tried to break one nurse's wrist and another one's finger--and I put a shoulder into his belly and shoved him onto the bed. Once we got him into restraints, one on each limb, and a vest, he continued to fight. The bed shook and creaked and groaned until his nurse got some Ativan into him.

The irony is that we knew him from before, when his wife came in for surgery. He was (before the bleed) the sweetest man you'd ever hope to meet. Polite, courtly, took good care of his family. Now he's trying to get out of the hospital, pulling out multiple lines, and punching security guards in the face.

Later, one of the nurses asked me about the amount of force that's acceptable when you're subduing a combative patient. She was in there with one other person when he started to go berzerk, and was merely staying out of his way as best she could, dodging his punches and kicks.

"I was afraid to grab his arm or put him on the floor, because I was afraid I might hurt him" she said. Now, this is a tiny woman--smaller than me--who spent the first half of her life in very rough neighborhoods. She's taken punches from patients before with no more than a blink.

"Lou," I said, "whatever amount of force is necessary, without breaking bones, you use. If somebody is trying to hurt you, the objective is to get them tied down and sedated before they can manage to break something of yours." Hence my shoulder-in-the-solar-plexus trick: I've found it works well with a distracted, combative patient.

It doesn't work so well with the oriented, mean patient. One of our nurses is out following surgery for a broken neck that a patient broke on purpose.

The woman weighed close to five hundred pounds and was, put simply, meaner than Satan. When the nurse taking care of her got close enough one day, she simply reached out, grabbed the nurse's head, and pulled. Score: nurse with cervical fractures, patient refused services forever.

Luckily, the nurse will be fine. The patient? I don't give a damn.

I woke up this morning sore and exhausted and couldn't remember why I was so achy. Then it hit me--I'd spent several minutes riding a bucking bronco of a man down onto a bed, then holding his legs down.

Nursing. It's glamorous! It's exciting! It's the toughest job you'll ever lay in stores of Advil for.

Saturday, December 17, 2005

Just a quick update...

I have now eaten five times and have not yorked (credit: Dr. V) once.

I think tomorrow will be ducky. Just lovely.

Tonight I actually ate half a burger and three french fries. Yay me.

Chef Boy looked concerned earlier and said "Six pounds in five days? You're going to waste away to nothing!" Considering that I still outweigh him by almost 25 pounds, can you not see why I love the man?

If it *is* my appendix, it'll just have to wait until Tuesday to come out. That's my final offer.

From the *duh* files...

Nurses face sexual harrassment

Really? You don't say. Grunt Doc, DB's Medical Rants, and Code: The Web Socket have all taken stabs at this; Alwin at C:TWS has a particularly funny experience to recount.

I regularly get sexually harrassed at work by patients; whether it's sweetie or honey pie, or let me fix you up with my son, or even (once) a man trying to pull me into the bed with him for a kiss. It comes with the territory when you're working with brain-injured people. When you're missing part of your frontal lobes, or they've been otherwise damaged, you're not going to have the same control and pay the same attention to social norms that other people do. At any road, it happens at least twice a month.

It also happens to the female residents and doctors. There have been times when I've had to knock on a patient's door and say something like, "Doctor X, there's an urgent phone call for you at the desk" in order to get Doctor X away from the patient who's *sure* that her nephew's business partner's son, who sells used cars in Atlanta, is just the man for her.

The worst is when you're standing over a patient, assisting a (male) doctor with a procedure, when the patient pipes up with "Don't you think Doctor Y is cute?" My answer from the start has always been a puzzled look and "When?"

I have some theories as to why this happens so often. First, it's because some of our patients are brain-damaged. There's not much you can do about that, really. Second, a lot of patients (especially the older gentlemen) seem to think that when one social norm goes away (like I'm wiping your ass for the fortieth time today), the others go away too, and they can say or do whatever they want acceptably. This misconception also explains the amazingly bigoted stuff I hear from patients on a weekly basis.

And, finally, let's face it: a lot of patients grew up in the 1930's through 1950's, a time when nurses were seen as passive, accomodating helpmates. The popular image of the Sexy Nurse hasn't died yet (Google "Head Nurse" sometime and see what you come up with, oi!), but it was infinitely more popular in the days of Cherry Ames and her ilk. (And yes, I know WWII was a different matter, but it was statistically a blip.)

So you've got brain damage, combined with a lack of societal norms, combined with the idea that nurses will do, I mean any*thing* for another person.

The funny thing is this: our facility spends hours and hours teaching young interns how to avoid sexual harrassment by nurses.

I'll wait until you're done laughing.

They don't brief the female residents on how to handle dirty old men or nosy old women. They don't brief the male residents on how to deflect the sorts of questions that make men blush and stammer. And they're certainly not briefing *either group* on how not to make yourself look like an idiot by intimating that certain female colleages get more OR time because they have pretty hair (yes, I heard that one two weeks ago. From a *female* PA, who lost pretty much all the professional respect I had for her).

The point here is that nurses can't win. On the one hand we're being exposed to lecherous weirdos and weirdettes, while on the other, our future colleagues are getting the idea that we're rapacious, predatory, sex-crazed fiends. Our female MD colleagues don't have much more luck. And pity the poor male nurse, who's automatically seen as prissy, if not outright gay. (And anybody who assumes all male nurses are gay is the sort of person who's going to have a problem with gay guys. I guarantee.)

So, okay, what do we do about it?

Well, first of all, nurses' training programs and doctors' training programs can be realistic about the problem. Where I work, there are a lot of young nurses and a whole lot of young residents. Yes, sometimes they do end up dating, but the problem isn't so widespread that it causes problems in the professional arena. So we could probably drop the insistence to the interns that it's the nurses they'll have problems with and save some time and trouble there.

Second, hospitals and other facilities need to be realistic about the problem. The first line of defense is the nurse's own reaction, true, but if the behavior continues, she or he needs to be certain that there will be somebody to back her or him up in her refusal to countenance the behavior. If your charge nurse or nurse-manager falls down on the job, you're left to "solve" the problem on your own, which usually means either getting somebody to go into the room with you every time, or foisting the assignment off on another nurse. Raising conciousness rarely works in such a short period of time.

Finally, families need to be realistic about the problem. Yep, you heard me: I said "families". I've had patients' family members egg the patient on as they were harrassing me or another nurse. That kind of thing usually stops as soon as I get my mouth open. But the point remains that a lot of people seem to think it's cute that Grampa's a tit-grabber or that Papa is a bigot.

It's a weird job we do, nursing. I'm just glad that nobody's tried to get me up against a wall--yet--or done anything really violent. Yet.

Friday, December 16, 2005

I'm getting tired of this.

Mostly because it's become predictable.

Get up. Feel okay. Think, "I can go to work today. Good deal."

Drink a little coffee. Drink a little water.

Stumble to bathroom either to a) lose coffee and water immediately, or b) lie on the floor in a cold sweat with the room spinning, then lose coffee and water.

Fall prey to a number of nasty intestinal symptoms.

Return to floor. Sweat some more. Feel the beginning of a pounding headache.

Haul self, on hands and knees if necessary, to phone. Phone in sick.

Answer various questions about degree and type of symptoms. Why on earth do they want to know this? *I* don't want to know this about *myself*.

Stumble back to bathroom. Stick thermometer in mouth, note return of fever. Note intensification of pounding headache. Note rumblings of a sort that bode ill for the health of my GI tract.

Stumble, several minutes and one more cold sweat later, back to bed. Lie there panting.

Wake up several hours later feeling borderline normal. Eat half a boiled potato. Meditate on the gastrocolic reflex almost immediately thereafter.

Back to bed, panting. Wonder what everybody's doing at work. Wonder if I'll live long enough to return. Wonder when this is going to stop.

Remember what happened on Wednesday morning. Haul self to kitchen and drink a little ginger ale. Haul self to bathroom to retrieve thermometer.

After ten minutes in bed, take temperature. Fever is unchanged. Head still hurts.

Fall asleep. Wake up. Post bitchy whiny blog entry on illness.

Lather, rinse, repeat.

**For those of you who are thinking that there might be a Little Jo at the end of this, please don't worry. As far as I know, pregnancy occurs most often in people not contracepting and is generally not accompanied by a fever, gut cramps, and other GI symptoms. But thanks for your concern.

Thursday, December 15, 2005


Yesterday I called in sick.

I called in sick because, for the first time in my life, I actually *lost conciousness* as a result of a combination of nausea, standing up too fast, and general ookiness.

Passing out is an interesting experience. First come the black spots in front of the eyes and a feeling like the world is moving in new and strange ways. Then comes the feeling that it's absolutely necessary that you get horizontal *right now*. When you do, there's nothing at all for a few seconds (I wasn't out for very long), then a return to the floor moving unpleasantly, compounded with a nasty stinky cold sweat. And retching. And the shakes.

As I shoved the chair behind me and sagged to the floor, I remember thinking quite clearly two things simultaneously: "This is how my patients feel" and "I don't want to fall over like my sister did and hit my head on something."

Twenty minutes later, I was feeling fine, if a bit tired. So I went back to bed and slept for four hours. Then I went out and got some Sprite and Gatorade, rehydrated, ate a little something that stayed down (wonder of wonders!), and went back to bed.

In four days I've lost four pounds. No, the skin on my hands isn't tenting any longer, and my eyes aren't sunken.

The strangest thing is this: in between bouts of nausea, I have cravings for tomatoes, asparagus, corn, and honeydew melon. That's all. The normal sick foods like crackers and toast have no appeal.

Later I'll go out to the grocery store and stock up on cravings foods. Maybe I'll get a couple of cans of vegetarian vegetable soup. At this rate, my cholesterol will be down to 130 and I'll weigh that much by March.

God, what a nasty bug.

Back to bed now.

Tuesday, December 13, 2005

Everybody's doin' it...

One of the links at Grand Rounds this week has a focus on a suggested code of ethics for medbloggers and a list of questions we should all be able to answer.

So, because everybody's doin' it....

1. Who runs this site?

Jo. I'm an RN (ADN) with a bachelor's degree in music and one in sociology. I've got almost four years' experience in neuroscience and ten years as a women's health advocate and paraprofessional.

2. Who pays for the site?

Blogger. The ad to your right for Ivo Drury's site generates as much income as Ivo finds fair, which is then donated by me to either Planned Parenthood (to provide exams and Pap smears for women who can't afford 'em) or to local animal charities.

3. What is the purpose of the site?

Yarking and complaining, with the occasional burst of decent information.

4. Where does the information come from?

Mostly from my own experience. If it's something that's useful or interesting, you can bet I've stolen it from another site somewhere.

5. What is the basis of the information?

Huh? Didn't you just ask that?

6. How is the information selected?

It's selected based on what I figure will be interesting to those few poor unfortunates who read the blog. There's going to be an emphasis on neuroscience, women's health (especially reproductive health issues), and feminism, mostly because I'm a feminist neuroscience nurse with background in happy hootchie care.

Oh, and food. I like writing about food. Matter of fact, I have some salsa in the fridge that you guys have just got to try.

7. How current is the information?

I try to keep anything that's seriously scientific current to within the last month or so. For reasons of privacy protection, most of the stories I post about my own experiences on the floor are not only changed detail-wise, they're put into a different time-frame. Therefore, the things that I write about happening "last week" might actually have happened six months ago, or vice versa.

8. How does the site choose links to other sites?

I link to what I like. Generally speaking, I like sites to have some sort of track record before I link to them. I'm also extremely lazy, so link-swapping takes weeks for me to accomplish.

9. What information about you does the site collect, and why?

I was unaware that I could collect any information at all, actually. I'm not technically savvy.

10. How does the site manage interactions with visitors?

Comments are welcome; obnoxious comments get deleted. Deal. (credit Bitch, PhD.) Personal emails are welcome if somebody has a question that they feel uncomfortable posting, or that they think requires a longer answer.


On a different note, I don't know that these questions go far enough for the average personal-experience blogger. I feel very strongly that nobody's confidentiality should ever be compromised for my own convenience or anybody else's amusement or edification; if there's one thing I take very seriously, it's that.

If somebody emails me with a personal story about something that happened to them in the hospital, I'm not going to post it here without prior permission. Excerpts from personal emails, if I get permission to use them, get changed around in such a way that it's not going to compromise anyone.

Hell, I've even changed what I've said about where I live, so that the area isn't immediately recognizable. It's not worth some wacko figuring out that Jo is actually Becky Smith, who works at Podunk Memorial Research Facility and Rib Shack in Lolitaville, Texas. That compromises both me and my patients.

Those of us who write based on personal experience cannot take this issue seriously enough. I'd like to see a code of ethics drafted for the personal-experience blogger. Who wants to start?

Your regular blogger, now with viruses!

A follow-on to yesterday's incoherence: Shakespeare's Sister takes a look at the Oslo post-abortion study from a statistical angle, along with stuff that wasn't published in the BBC article and that I didn't think to look up. Thank God there are people out there doing my work for me. They think so I don't have to!

Unless my reactions to chlorpheniramine maleate (the stuff in Advil Sinus/Allergy) have changed drastically overnight, I seem to have picked up a simultaneous belly and head bug. Blogging will be light for the next couple of days as I rush between the bathroom and the Kleenex factory.

Disinfect your computer screens, people. I am not playing around.

Monday, December 12, 2005

Back into the fray....

This pissed me off.

*deep breath*

*several deep breaths*

As I've mentioned before, I worked at an abortion clinic. I also was a volunteer post-abortion counsellor, and moderated an Internet message board for women who were having emotional problems post-abortion. I'd like to think that the years of doing those things have given me a fairly good handle on the years of pain and suffering and guilt that some women feel after an abortion.

There are a couple of angles I'd like to pursue, here. The first one is the easier one to dissect: that, if you're living in the U.S. and you've had an abortion, you're *expected* to feel guilt, shame, and regret. I don't know what it's like in the U.K. or in Scandanavia, but here there's a constant subtext that women who have abortions regret them, that they wish they could go back and change things, that somehow the procedure has damaged them.

Which isn't true. It's simply not true.

Let's get one thing straight: women whose lives are going fine and dandy generally don't have abortions. Often an unintended pregnancy is the last thing on top of a lot of *other* things, like being broke or in an unstable relationship or immature, that breaks the proverbial camel's back. Having an abortion is not just a response to a crisis pregnancy; it's a response to a whole set of other crises that a pregnancy compounds.

What I saw time and time again was this: women without guilt, women without shame, put their abortion into proper perspective. They took responsibility for the decision and understood the context of the action. They did not (and this is important, so remember it) feel coerced into having an abortion; it was their own choice from the get-go.

Yet they had doubts about themselves because they didn't feel guilty. A friend of mine expressed it well: "I spent two years feeling guilty because I didn't feel guilty."

How much of that guilt and shame that women feel is being brought on by being told, over and over, that there's something shameful and wrong with them for having had an abortion? How many times can a woman see a bumpersticker that says "Real Mothers Don't Have Abortions" or hear someone dismiss women who terminate pregnancies as "sluts" before it starts to take a toll?

The second angle is nastier, darker, and more complex.

There were some women I saw at the clinic--a small minority, maybe one in twenty--who were being browbeaten into terminating their pregnancy. Those women didn't get services. Instead, we called the shelter or the cops (in the case of "my boyfriend/father said he'd hurt me if I didn't do this") and let people who were qualified to deal with the situation handle it.

There were a number of women I encountered in post-abortion counselling, both in the meat world and online, who had guilt. Lots of it. And they had one thing in common: they had had an abortion not because they felt it was best for them, but to please somebody else.

The line that sticks in my head is one from an online correspondent who said this: "My partner wasn't ready for fatherhood and left me when he found out I was pregnant. I had an abortion, but he didn't come back. Now I'm alone, and I don't even have a baby to look forward to."

Some of those women were really, really young when they got pregnant, and their parents basically made the decision for them. Hard enough to be fourteen and pregnant (with all the weirdness that that situation must've come from in the first place) and then have yet another piece of bodily control wrested away from you. If somebody says, "it's for your own good", look at them with slitty eyes...but a girl in that situation has no option.

Just as abortions don't happen in a vacuum, they don't fix everything. I reckon that the majority of women who had real problems dealing with their abortions had the idea going in that somehow life would be roses and cherries afterward; as though solving this one, monumental problem would solve all the others. And, of course, it doesn't work that way. You're still broke, your lover is still gone, you still live in a crappy apartment, your parents are still the sort of wackjobs that would enable your having sex at the age of ten.

I think that, as a culture, we need a reality check. Let me start here:

Even with perfect use, most contraceptive methods have at least a one-percent failure rate. In the U.S., the average failure rate for the most popular birth control method (the Pill) approaches 12%. That means that even with consistent contracepting, some women are going to get pregnant. Some of those women are going to terminate those pregnancies.

Even the most conservative estimates of abortion rates show that more women have abortions than get breast cancer. It's anywhere from one in three (WHO numbers) to one in five (AGI numbers) versus one in seven or eight.

Therefore, abortion is a common experience.

Therefore, we need better systems in place to help women deal with abortion. And not just the procedure itself and the aftereffects, but the whole complex web of situations that lead up to the decision to terminate. At my clinic, the number-one reason for having an abortion was not using birth control. We dealt with that by making contraception cheap and easy to get, even giving a year's worth of pills away to women after they'd had a follow-up exam and their Pap results had come back.

But that's only barely pricking the surface of the problem of unintended pregnancy.

It would be nice if women weren't stuck in situations where they felt that abortion was their only reasonable option. Affordable child-care and decent health programs for children and mothers would go a long way toward solving that particular difficulty. So would wider availability of job-training programs. So would better health care in general for women.

I'll say it again: abortions don't happen in a vacuum. Sometimes it's a simple choice, but it's not ever an *easy* choice--remember the difference. If we as a society deal with the issues that complicate unintended pregnancy rather than sweeping them under the rug, we'll lower the number of abortions performed. If we deal with the issue of abortion openly and honestly and without shame, we'll lower the proportion of women who feel damaged and wounded.

This is not just about the fetuses and women. This is not just about terminating pregnancies. Our societal response to unintended pregnancy is evidence in microcosm of how much or how little we value women, pregnant or not.

And it's not just about guilt, shame, and regret. Getting past those emotions, looking realistically at the whole of a person's life, and finding resources to deal with crises of every sort is what we ought to be doing.

Sunday, December 11, 2005


Today I went for breakfast at Rosa's. Rosa is a friend of mine who is mother to two charming and intelligent pre-teenage boys, wife to a charming and intelligent man, and mistress to three of the largest dogs I've ever met. Rosa is also from the Phillipines, so breakfast with her consists of rice, eggs, and some sort of dried marine life.

Today it was a combination of squid and fish, dried and then deep-fried. Normally, I'm game for almost anything edible and a number of things that are dubious, but I've got a skeevish reaction to eating anything that stares at me while I'm consuming it. Hence I stayed away from the dried fish and concentrated on the squid.

"Try the baby ones," Rosa said, "they're crunchier."

I eat them, as does her husband, Americano style: in small bites, with bits of garlic rice on the same fork. And they're delicious, especially the baby ones. The fish was a bit too salty for my taste, but the squid were just right.

As I wolfed down squid and rice and eggs and vegetables, three dogs crouched at my feet, not out of affection but because there was room at my end of the table.

The smallest dog, Dallas, is a shiny spaniel cross who weighs about 60 pounds. She's intelligent and suspicious and has decided after repeated exposure to me to delay ripping out my throat until some later, as yet undetermined, time.

The next larger dog is Sam. He's elderly and has had a rough life. If you pet him, he'll follow you everywhere, begging more affection with rolling eyes and a grin.

The chief of the household is named Soldier. He's either a Great Dane and Akita cross, or perhaps Great Dane and Catahoula hound cross; nobody is quite sure. He could be half flying flapdoodle and half Shetland pony for all I know; he weighs more than the other two dogs combined. Unfortunately, unlike the Brontosaur that he resembles, he has no second brain halfway down his spine. He is, however, a sweet-tempered (if dumb) animal with a soft spot for me. We sit on the floor and have a little mutual admiration session every time I go over there.

Which I desperately needed after this last couple of days.

When "they" say that doctors make the worst patients, "they" are discounting those patients whose family members are doctors.

I don't know why it is that everybody who wants to fake something ends up faking neurological disorders. Maybe it's that there are no sure, definitive tests for most neuro problems, barring tumors and abcesses and such. Maybe it's that they think neurologists are too flaky to catch the frauds. Maybe it's that the vast majority of people, even health-care professionals, look at neurology and neurosurgery as some sort of weird half-science practiced in the dark of the moon.

Whatever the reason, the wackos always fake neuro problems. Well, not *always*; sometimes they fake obscure autoimmune disorders with neurological components. Either way, there's Xanax and Valium and Dilaudid involved.

The wackos I can handle. They're generally undemanding, provided they get their needs (for drugs) met, they're normally pretty stable medically. It's the wackos' family members that drive me over the edge. And nothing is worse than a wacko with two close family members who are doctors.

Why? Because those family members will monopolize the lightboxes in the nurses' station as though they were their own personal property. They'll wander off for hours with the chart, ignoring the new orders that need to be posted. They'll call from their cell phones, demanding that you change medications on *their* say-so, even if they're not the primary physician. They'll medicate those family members with stuff they haul in from the office, then forget to mention it to you. They might even start sitting in wheelchairs, having discussions about their family member's case in the hallway, and then leave their detritus and the wheelchairs scattered for you to clean up.

Thankfully, this was not my patient. If it had been, there would've been fireworks. Unfortunately, the antics of the Family Doctors made life miserable for all of us--it's difficult to do your job in a confined space when there are people lurking, answering the phones because it might just be the person they paged, and monopolizing your time.

The last straw came, for me, when one of the Family Doctors opened one of my patients' charts. Note that this patient was not that doctor's family member; it was a patient with the same attending physician. Apparently, Family Doctor #1 wanted to "get a feel for" that doctor's "style" and the way that he comes to a diagnosis.

I learned yesterday that an icy "I. beg. your. pardon." and an equally icy "How *dare* you?" have the same effect on a doctor, even a wacko doctor, that they do on anyone else. Unfortunately, I didn't get an apology from said wacko, but I did extract a promise that the Family Doctors wouldn't be going near the chart rack again.

I fixed them, though. They'd left their family member's MRI and CT films all over the back of the nurses' station, so I just tidied 'em up. The resident and the attending both know where they are, but I doubt that the Family Doctors will be able to find them again.

The sad thing is that all of this hoohaw could've been avoided if somebody in a position to do so (like the charge nurse, or the manager, or the attending physician) had set some limits at the outset.

Maybe I should bring Dallas in on a nice, long chain. Those of us who want to get past her to the station can carry dried squid in our pockets.

Wednesday, December 07, 2005

Random musings

The benefit of a liberal education

The following scene is why everyone should get at least a couple of years of liberal arts education before doing anything related to their profession:

Me: That's a really nice pendant.

Snooty, more-cultured-than-thou coworker: (archly) Thanks, it's a Mackintosh.

Me: Charles Rennie Mackintosh?

SMCTTC: (looking confused) Er...yes.

Me: (peering closer) Hm. Looks like the motif from the organ screen at Holy Trinity.

SMCTTC: (spluttering)

I was nice enough not to pump my arm and whisper "YES!!" soundlessly until I got into an empty room.

The basics of nursing

It strikes me that the three things that I've said most often in the last almost-four years have been "That's perfectly normal; don't worry", "I'll call the doctor", and "Don't pick."

A lot of nursing involves reassuring patients and their families that yes, everybody gets symptom X after situation Y happens. Especially in surgical situations, people get understandably nervous about things that we nurses see every day.

Yes, it's normal to hear that slooshing sound in your head; we filled the space where the meningioma was with sterile saline solution.

Yes, Mom will be kind of out of it for a few days; she's eighty, and that's what anesthesia does to eighty-year-olds.

Yes, that swelling will go down in a couple of days, but your eyes will stay black for a while.

There's also the occasional situation in which you really want a resident or PA there. Those are the times when it's essential to keep a straight face, show no signs of panic, and say something like "Let me give the resident a buzz and we'll let her clamp lamps on that there."

One of the nurses I work with who's done neuro for years tells the story of the patient she took care of in a neuro ICU whose wound dehisced (split open) and whose brain began to crawl out of said wound. When she saw the shiny grey-and-pink hallmarks of a cerebral cortex out of its natural environment, she calmly said, "Let me put some wet gauze on that; I'll give the doc a ring, eh?"

I always tell my patients this: If my hair catches fire, *then* you can worry. Otherwise, you're paying me an immense amount of money to worry for you; it's ridiculous for you to do it for free.

And, of course, every nurse knows the words "Don't pick."

Don't pick at those staples. Yes, I know it itches, but don't scratch that. Keep your hands away from there. Mister Jones, you'll need to keep your hand out of that, okay? Leave that stitch alone, dear, it's holding the tube in your brain. And so on.

The words "don't pick" might be just as essential to the profession as the words "drink this."

"It's more important to know whether there will be weather than what the weather will be." (The Whether Man, The Phantom Tollbooth)

I got to watch the latest cold front roll in this morning as I sat out on the porch. My porch is sheltered, thank heavens, so even 27* F is relatively bearable if you bundle up and put on slippers. The Cat has to see what the world is like every morning, which is why I was out there.

It's supposed to get nasty today. I can hear my Yankee friends laughing at the idea of a high of 30 and forcasted "wintry mix", but let me tell you: "wintry mix" this far south means one thing--ice.

By this time tomorrow, we're supposed to have three inches of ice on everything. Provided the power lines don't come down, I think we'll be okay. I'll be at Chef Boy's; I'm cooking a celebratory dinner for him tonight and don't plan to get back out in the middle of the storm. No sane person expects to be able to drive on ice, so my plan is to stay put until the insane people get out and clear the roads a bit.

Unfortunately, the reason for the celebratory dinner and the weather are comingled. Chef Boy has to start a forty-mile round-trip with an audition dinner in the middle of it just when the weather gets nasty. He's applied for a job at an Extremely Schwanko Restaurant that just happens to lie at the end of a not-well-travelled road, off a quiet spur of a not-well-travelled highway.

I think I'll make plenty of appetizers and not start roasting the chicken until he makes it back.

Sunday, December 04, 2005

A PSA of sorts

You know what's good? What's good is when you have enough empenada dough left over for one more empenada, but not enough filling, so you roll up the dough with brown sugar and butter and nuts. That's good.

On to the serious stuff.

A poster over at LiveJournal has posted the experience of a friend of his whose prescription for Valtrex was refused, confiscated by the pharmacist, and not returned to her. I don't know whether or not it's a true story, and I don't think the LJ community would appreciate me linking to it, but you can check it out over at Pandagon.

If this should happen to you, here's what to do, in order:

1. Get the name of the pharmacist. The *full* name of the pharmacist. Make a note of it, along with the time that he or she was working, and the date.

2. Get the name of his or her superior, if he or she has one.

3. Get the name of the store manager for the pharmacy in question.

If anybody tries to block you at any point, make a fuss. Seriously. Refusing to fill a prescription might not be illegal in most states, but *confiscating* one is. Even if your prescription is returned to you, the pharmacist who refuses to fill it should face public scrutiny for his/her actions.

4. As soon as you get home, call the doc or clinic that prescribed the drug for you. If it's emergency contraception you need, go here to find a list of every-day oral contraceptives that can be used as EC, and their doses. Most doctor's offices will carry at least one of these brands in samples. Demand one.

The doc's office also needs to know the name of the pharmacy and pharmacist that refused your prescription, so that they can steer their patients away from them in the future.

5. Next, call the manager of the pharmacy/drugstore, or, if that person is not available, the consumer help-line for national chains. That can be found on the websites that the national chains run. Give the time, place, and date of the incident, as well as the names of the people involved. Be calm, but remind the person or people that you speak to that this is something that *will* be followed up on, and that *will* be acted upon.

Follow that up with both an email and a paper letter to the folks you've talked to. Keep copies of both. It's time-consuming, but worth it. If you get a response at any point, get names and phone numbers from everyone involved.

Most of the time, you'll get sufficient action from those first five steps to make you calmer, if not happier.

If you're still angry, or if the people you've dealt with up to this point have been a herd of bleating dickwads, do the following:

If there's a university within fifty miles of you, find out if they have a women's right's group. Or look online for the nearest chapter of the National Organization for Women or the ACLU. Call any or all of those folks and tell *them* (time, date, names, places) what happened to you and who you talked to. Ask them if they have any pointers about what you should do next. With luck, you'll get plenty of pointers, ammo, and hell--they might even stage a demonstration.

Then call your local paper. Even *my* local birdcage liner, as in-pocket as it is with the wingnuts, ran a front-page article on women being denied EC and OC at a local drugstore. Can't hurt to try.

All of this requires a lot of effort and that you become a spokesperson of sorts for Women For Whom The Condom Broke. That sucks; you ought to be able to get prescriptions for legal drugs filled with a minimum of hassle and wasted time.

Unfortunately, there is a small (but growing) cadre of people who work as pharmacists who believe that it is their right to make judgements about the people they serve, and judgements about whether or not those people ought to have one drug or another. The only way they'll ever do their jobs fairly--by either filling *every* prescription, or handing them off to someone who will--is if they're called out publicly on their bigotry.

Yes, it's bigotry to deny women oral contraceptives. It's bigotry to deny people with herpes drugs that reduce the frequency and severity of outbreaks on the grounds that they somehow deserve to suffer. You'll notice that all of these things have to do with *other people* making judgements on the validity of *your* sexuality, and that those judgements are necessarily on a case-by-case basis.

I was with a woman who was refused an EC scrip once. I wish I'd made more of a fuss over it; luckily, the wall-eyed bastard who refused the scrip later lost his job after doing the same thing to a rape victim.

Unless we want to have to go through some sort of pseudo-underground machinations *as women*, to get our health-care needs filled, we have to speak out.

Edited to add: Holy shit, lookee here. Seems some pharmacists are now refusing to dispense pain meds and psychotropics (like antidepressants). How far does this bullshit have to go before people start getting angry en masse?

Friday, December 02, 2005

Well, well, well.

I got my second "TEAM Player" T-shirt the other day (you don't remember the TEAM Playa post?), which seems to indicate that I'm doing my job. Which is a good thing, since sometimes I'm not so sure. Bad days like the one last week really make me wonder if I'm competent (because I catch problems like couplets and triplets before they send a patient to the ICU) or incompetent (which is silly, because even on Dilantin, people sometimes seize).

Luckily for me, the two best nurses I work with had Signally Bad Days this past week, too. One of 'em walked into a patient's room, and the patient...died.

Just like that. Brady'ed down from 70 to 6 and stopped breathing, just like that. Wow. And the patient's wife, thankfully keeping her head on straight, refused a code on him. They'd coded him twice already, and it was time for him to go home.

However, it's unusual to have your first death, or rather, your first unexpected death, at 0715. Lou-Who was shook, but professional, and dealt with the whole baggin'/taggin' thing, then took a break with a nice hot cup of tea. When the floor manager walked in with paperwork Lou-Who had to sign, she (Lou) looked up and asked, "So. Do I get a TEAM T-shirt for this?"

Luz's bad day started with the death of a patient she loved. She walked in to the room at 0845, and the patient just...died. (Holy crap. Two in one morning?) He just quit breathing. He was a DNR, thankfully, so there was no need to start working on him. Instead, Luz comforted his wife, then I helped her bad & tag and made her a cup of tea.

We've drunk a lot of tea on our floor in the last couple of weeks.

Luz's day would've improved had not another patient *tried* to die on her. Luz, however, is determined, and disinclined to let anybody go who hasn't given the whole living thing a good shot, so that patient went to the ICU. It was, ironically, the same guy who seized on me and who left me with a feeling of not having done something vital.

'Tis the season, I guess. Each hospital has its own rhythms. Most of the folks on our floor like to die right before Christmas, perhaps because they're so damned *tired*. The people two floors up on chemo wait until after the holidays, then head out. Either way, we have a ragged time between Thanksgiving and New Year's.

We're having a potluck lunch next week to try to make up for the Bad Days everybody has had lately. I think I'll be taking mac & cheese and maybe a couple of other things, too. There's a need for comfort food.