Tuesday, January 31, 2006

The sky is indeed falling, just not very fast.

Okay, so Alito got confirmed. And it's likely that in the next decade or two, we'll see either states' laws become more restrictive of abortion, or we'll see Roe overturned completely.

A little background first: Roe V. Wade didn't legalize abortion across the board, without restrictions, in every state. All it said was this: in the first trimester, a woman's right to an abortion cannot be subject to unreasonable restrictions by the state. "Unreasonable restriction" is a broad term: one that's been brought to the courts when states have attempted to pass parental or spousal consent or notification laws, laws restricting minors' access to abortion, waiting periods, education, and so on.

In the second and third trimesters, abortions are subject to a variety of restrictions that vary from state to state.

So let's take a worst-case-scenario view and say that the Constitutional right to privacy that is accepted as part of the not-specifically-named rights therein is decided not to cover the right of a woman to terminate a pregnancy.

Two things would then happen: a legal challenge would likely be mounted on the basis of equal protection under law--an argument that I find more compelling than the right to privacy in this particular case, as well as one that I'll leave for non-fluff-brained commenters and bloggers to handle.

The other thing that would happen would be this: access to abortion would return to a pre-Roe patchwork. It would likely be illegal where I live and in several surrounding states. Travel to New York and California would become commonplace for middle-class women, while other women would be either screwed to the wall or forced to obtain illegal abortions.

And, by the way, don't assume that women aren't already forced to obtain illegal abortions. Only 13% of counties in the US have an abortion provider; most of those providers are in urban states like Washington, California, and New York. I saw my first patient with complications from an illegal abortion during nursing school and my second only about a month ago. The situation for women in states where there are already notification laws and waiting periods is grim; there's no reason that it wouldn't get grimmer if, say, the three abortion providers within a day's drive of me went away.

But that's not really what I'm wanting to address here. The thing that bothers me about the thought of returning to pre-Roe days is this: each state will, in accordance with its rights under the Constitution, be able to define the beginning of life.

Think about that for a minute in context of pharmacists (who are, or who should be, nominally scientists) refusing to refill birth control pills or fill emergency contraceptive prescriptions on the basis that they might "abort" an embryo. Think about it in the context of doctors who refuse to fit women with IUDs for contraception on the same principle, even though repeated studies have shown that IUDs prevent ovulation and destroy sperm rather than embryos. All the science in the world won't convince these soi-disant scientists; do you think there'd be better luck with politicians?

Although Griswold V. Connecticut, which legalized birth control for married couples (and, as a result, opened the door to the contraceptive freedoms that you and I enjoy) will likely stand, access to contraceptives will probably become more difficult. Some forms might be legislated away, or surrounded by the sorts of requirements and caveats that make doctors loathe to prescribe them. After all, if legislators can require that abortion clinics meet the same standards as ambulatory surgery centers (which perform more complex and demanding surgeries), why not require that doctors meet special standards for, say, inserting an IUD? After all, women have been known to vagal out and seize during the procedure before.

That's scary enough for me to look wall-eyed at my pals in Canada and make sure their addresses in my book are current. What's worse, though, is what's likely to happen to us as healthcare providers.

It was not unusual, back in the day, for doctors to be wary of providing even lifesaving treatment to women who were bleeding after an induced illegal abortion, for fear that they might be prosecuted for assisting in an illegal termination.

It was not unusual for the police to show up in the septic wards or the ED to question women who were suspected of trying to self-abort, or suspected of having seen an illegal practitioner.

It wasn't unusual for women to place themselves at the mercy of untrained abortion providers and suffer the consequences of abortion and sterility.

Many years ago, when I was still working at the clinic, I had the opportunity to talk to a woman who'd had an illegal abortion, and who was sterile as a result. The folks in the emergency room were so nervous about being questioned or prosecuted that she bled nearly to death before one doctor finally intervened...at which point he had to go before the hospital ethics committee and the police to explain his actions.

Moiv has a heartbreaking post on this. The thing that scares me most about her post is one little mention of an abortion provider being called to help set up a "septic ward"--the place where women who'd had illegal abortions and had had complications were cared for. There's at least one hospital near me that's contemplating the same thing.

So, as healthcare providers, we'll get a triple role if Roe is overturned:

If we live in a state where abortion is across-the-board illegal, we'll be seen as informants for the police, witnesses for women who claim they'll kill themselves if they don't have an abortion, and caregivers for women who don't get the lucky straw in the illegal-abortion lottery.

If we live in a state where abortion is legal, we'll see an influx of women, probably mostly middle-class, coming across state lines and choking clinics and hospitals. Some of those women will have complications, even from a relatively safe procedure: it happens. And, if the state that woman with complications came from criminalizes crossing state lines, we may be called upon to release medical records or otherwise testify to her situation and our care.

Caregiver, witness for the prosecution, witness for the defense.

This is what'll happen, people. Not all those women will end up in septic wards, by the way. Pennyroyal, an herb that causes intestinal cramping and pain and can occasionally dislodge a pregnancy, comes in an oil-extract form that is highly toxic to the liver. When a person tries to self-abort with pennyroyal oil, she'll likely end up on a floor that deals with livers, kidneys, or neuro issues as a result of hepatic encephalopathy.

If worse comes to worst, it's gonna be an interesting ride.

Saturday, January 28, 2006

I'm drunk. And I'll be having orgiastic sex tomorrow.

With a black guy.

A *gay* black guy.

A gay black Catholic clergyman.*

In a wheelchair.

No, that is not what I said.

It's what I wish I'd said, though.

I knew today that I was coming down with a sinus infection. In addition to the swimmy feeling and the pressure over my right cheekbone, I felt unreasonably aggressive and bitchy. (Chorus of my coworkers: "...aaaand this is different how?")

So, after running into something with my car (no injuries, just paint transfer off of the concrete barrier in front of the convenience store) and not feeling any better with Sudafed, I called in sick.

Whereupon the night mangler asked, "Do you mind if I ask what's wrong?"

Yes, I mind.

I mind immensely.

Not only am I doing you a favor by not double-dosing at least two patients tomorrow or coughing my crap onto their lumbar drains, I'm being nice enough to call you in time for you to find a sub.

And it's none of your business why I'm calling in. Okay? I could have a cold, or a stomach bug, or just be horribly hung-over; it's enough that I'm calling to say "I'm feeling peaked".

Perhaps you should ask the two other nurses who worked sick last week why they *didn't* call in. Those of us who worked with them for three days are feeling decidedly puny.

Unless I have smallpox, or bloody sputum, or avian flu, my reasons for calling in are my own business.

But I got her.

Instead of simply saying "I have a sinus infection; sorry" I described the multi-colored snot that my sinuses are producing, the pain, the lollygagging feeling, and the diarrhea.

Sweet dreams, night mangler.

*Or clergy-woman. Whatever works for you.

Wednesday, January 25, 2006

Okay, fine, whatever.

I love my boyfiend.

This is why: I called him an hour ago and said, "Look, I'm in a foul, foul mood that hasn't gone away since last night and I don't want to inflict this on anybody, I just want to listen to polka music and clean my closet out, so can we skip lunch and get together this afternoon instead?" and he said "Yes."

No "why are you in a foul mood?", no "aaawww, honey, it's not that bad", no bull about it. Just "Yes."

Because it *is* that bad.

I sent an email about a week ago to the Great Sub-Leader at work, pointing out some errors in ins-and-outs that one of our techs had made.

Ins-and-outs (I&O) are a big deal on a neuroscience floor. When your patients are at risk for things like diabetes insipidus or syndrome of inappropriate antidiuretic hormone, it's a good idea to keep an eye on how much they drink versus how much they pee, because that'll help you catch problems early.

Likewise, it's a good idea to have an accurate blood pressure and respiratory rate on these folks. The tech in question had falsified blood pressures and fucked up respirations before in charting--in one case, she had charted a patient with agonal, death-is-on-the-way breathing of about six a minute as having tachypnea. My patients always breathe in unison, at 16 a minute, every time she works. They all have BPs in the 130's over 80's.

In short, there is a problem here. It's not necessarily one of intelligence, since she routinely wears shoes with laces that she's tied herself; it's more one of indolence and not caring.

This is the same person, by the by, who inflicted a reverse Trendelenburg (head-down, feet-up) position on a patient who was being fed through a tube without stopping the feeding first, thus almost killing him. No joke.

So there's a history here that goes back about two years. This latest email was an attempt by yours truly to actually document some of the bullshit that's been going down lately.

The response from Subcommandante Merkin today was as follows:

"You have to give her the benefit of the doubt. There is no malice in her."

No malice? Benefit of the doubt? This tech has a list of write-ups and policy violations as long as my commute, yet management won't get rid of her, for fear she'll sue. News flash, kids: in a work-at-will state, suing is a near-impossibility unless the fired person can show proof of discrimination or malice (speaking of malice). Even then, it's not likely she'd win, or even tie up the case in court for years. Judges here, while weird in social matters, tend to look slitty-eyed at the rights of workers.

When I worked at Planned Parenthood, we had a family planning associate who faked blood pressures. These were healthy patients in for annual exams, undergoing no medical procedures, at no particular risk for anything. And that FPA got fired immediately, on the grounds that faking medical information is A Bad Thing.

My manager doesn't have the same standards. ....Hello?

So, okay, fine, whatever. I'll deal with the fact that I have a person who takes until 1530 to do baths on three patients. I'll handle having to do my own I&Os; I do that anyway for the most part. I'll recheck blood pressures every couple of hours, even though that cuts into time that I could spend doing things that only a nurse can do, like analyzing lab results and deciding on courses of action.

We need good techs. Our facility rewards good techs handsomely, and I work with some *excellent* ones. It's hard physical labor, and the techs are the first people to notice when a problem crops up. Three of four of our techs I trust to give hand-off report on complex patients to a doctor. Three of four of them I trust to handle the first stages of an emergency before they yank the call cord out of the wall. One of them recently saved my bacon during a code. These are smart people who understand that getting blood pressures and tracking ins-and-outs is not shitwork; it's valuable, basic to the patient's outcome, and not to be faked.

This fourth one, though, regardless of malice, is going to kill somebody one of these days. Being smart is not enough. Being thoughtful is not enough. Being paranoid is close to enough, but it doesn't get the job done on its own. You need a combination of all of those things, and she doesn't have any of them.

Which means I have to take time that I do not have in order to double-check every. Single. Damned. Thing. She. Does. to make sure that she hasn't "missed" anything.

I can't afford to give her the benefit of the doubt. My patients can't afford it.

Unfortunately, Subcommandante Merkin thinks that the only thing the facility can't afford is a suit.

Grouse: It's What's For Dinner

Cindy-Lou Who looked across the table at me just before report began. She widened her big brown eyes and said, "Y'know, this working-short shit is really starting to blow."

Yep. Can't put it better than that. This working-short shit is really starting to blow.

We're working short because a lot of us have been working sick, because working sick is the only way to avoid working short. (Note: that will make sense only if you're a nurse.) Now our manager's down with a cough so bad she can't eat, one of our nurses has been confined to bed by his doctor on the threat of hospital admission if he gets up, and the rest of us are sort of sniffly.

Never mind that Management did some sort of wonky air-filter cleaning thing that filled the entire hospital with the smell of burning rubber and diesel fumes. What up with that, dawg?

There's been a lot o'yakking over the last decade about our Terrible Nursing Shortage and What A Tragedy That Is and How On Earth We Can Fix It. Suggestions have ranged from higher pay and better bonuses (which might work, if nurses weren't so inculcated with the idea that big bonus = scarily understaffed facility), on-site daycare (huh? Who would want to expose their child to the bugs in a hospital?), more flexible hours (now, cutting out mandatory overtime might help), and fun little bonuses like on-site massage and cool totebags.

Can I inject a little dose of reality here?

Going back over the many books I've read on history, both general and specific to nursing, I've noticed one thing: Good nurses have always been hard to come by. During each World War, there was talk of drafting nurses; incentives were offered to civilian women who were willing to take shortened training courses and go off to serve as RNs in the military. In the 60's and 70's, there were efforts by folks who ran hospital-based programs (usually three-year courses that produced on-the-spot-trained nurses who then worked for the hospital for a time) to make their curricula more attractive to students. The only blip I remember that bucked the Terrible Tragic Nursing Shortage Trend came sometime in the 1980's, I think, and I have only anecdotal evidence for that: a nurse I knew vaguely went off to be a stock trader.

Hell, my antique medical books mourn the lack of decent nursing care in hospitals, and the difficulty of finding a nice, sober woman to come in by the day to the house.

So, basically, we're working now with the same formula we've always been working with: There are more sick people than there are folks willing to care for them. Even if we doubled the number of working nurses tomorrow, nothing would change; hospitals would simply build more wings and schedule more surgeries to take care of the endless lines of sickies outside their doors.

Let's assume that we can't change the Terrible Tragic Shortage. What could make life better for your average working nurse?

It ain't tote bags or pedicures. It's not even higher pay, though that might make a few people more cheerful.

It's people in other professions Getting A Clue.

A third-year internal med resident asked me yesterday how much break time we got during a shift. I said we got fifteen in the morning, half an hour for lunch, and fifteen during the afternoon, though we took what we could when we could.

"Can you skip all your breaks and leave an hour early?" she asked. I peered closely at her to make sure she wasn't joking. She wasn't. She simply had no clue, after years of working with and around nurses at various hospitals, what the job entails. I'm not sure what she thinks we do.

Upper management in hospitals is usually comprised of people who've either never worked in hospitals as nurses or doctors or who did so so long ago that "I walked sixteen miles uphill in the snow to get to the ward where I supervised 29 patients by myself" isn't too much of a stretch. They're management experts and efficiency experts and safety experts, but they have no real gut sense for how acuity affects staffing levels. Most of the patients that I took care of yesterday would've been dead even fifteen years ago, in ICU eight years ago; now they're on the floor in a high-acuity unit. The people in charge of budgeting for our unit have no idea what it's like to work with an open ventriculostomy or three. For them, "brain injury" means Poppa's a little forgetful these days.

I got snarked at by an attending the other day for "turfing" a patient wrong. Apparently, that means I asked for a consult from some service that I shouldn't have; there's some obscure way of going from specialty to subspecialty (for this guy, at least) that I'd not heard of before. The fact that the patient was showing worrisome signs of Some Very Severe, Life-Threatening Complications didn't faze him; he was more worried about his "turf" as regards the case.

I would love to have Dr. Turf, that internal med resident, and our Great Leader follow me for a week. Hell, even a *day*, if I could be sure that they'd actually have to work during that day. I would love for them to get a clue, in other words.

Let's be honest: nine-tenths of the cleanup work, the tidying up of loose ends that's done in a hospital is done by a nurse somewhere. Most of the emotional support a patient gets from non-family members is provided by a nurse. The nasty complications that get caught early are caught by a nurse. The wonky test results get re-draw orders written by a nurse. And those three patients with tubes draining brain juice are taken care of by a nurse who's trying to make sure they don't end up with fulminant meningitis while she's doing re-draws and fixing doctors' mistakes on paperwork.

I hereby propose National Get A Clue Week. One week out of the year, at a time of their choosing, every resident and management person, as well as attendings selected for their attitudes and indolence, would work on the floor with nurses. Full twelve-hour shift, they break when their nurse breaks, they stick to her or to him like glue.

It wouldn't solve the shortage; there's not a lot we can do about that. But maybe, just maybe, it would imbue those folks who think of us as starched white angels with a sense of what it is we do all the hell day long. And that, perhaps, would change their attitudes and actions and make our jobs a little less insane.

Friday, January 20, 2006

Good news, chilluns, good news!

My pal with ovarian cancer?

Doesn't have cancer at all, thanks be to Frog.

Turns out what she had is some sort of crazy rare benign growth that thankfully didn't contain hair and teeth but is related to that sort of germ cell tumor. She's good.

She's been off Ovarex for a few days now and is feeling much better.

Her family got a little snitty, calling this a "scare" and an "over-reaction", but my feeling is this: when the docs are united in putting a young patient on what's normally a salvage drug for ovarian CA, *they're* pretty damned scared.

She looks like a cross between one of the Desperate Housewives and Skeletor, ie, skinny and absolutely no ass, but is no longer sort of...flat. It's amazing what that 20% difference in "You might live five years" to "You will live five years" will do for a girl's mood. Plus, all her hair has not quite fallen out yet, so she's leaving it.

Thanks to all who sent good wishes and advice and email and hats. I think the general outpouring of goodness had a lot to do with this.

Thursday, January 19, 2006

This is what I do all day

(With apologies to Beloved Sister, who originated the title.)

0420: get up, get coffee, wonder again why I took a job that requires a forty-minute commute. Sit outside on the porch with the cat and a cup of that coffee.

0440: get into shower.

0620: walk into work, with (hopefully) unwrinkled scrubs, a professional mein, and artfully applied makeup. If it's a good week, my nails will be short and my cuticles tended.

0700-1900: take care of other people.

For the bored patient who's being converted from heparin to coumadin, try to think of a new metaphor that will explain the difference between PTT and INR and the actions of heparin and coumadin. "There's this herd of zebras, see, who all have terrible static cling...." Act out said metaphor to gales of laughter from previously-bored patient.

For the patient who's experiencing intractable pain secondary to anxiety following surgery, reassure him that he will indeed be able to play bad country music on his guitar again. Keep opinion of whether or not this is a good thing to myself. Draw many diagrams of nerve plexuses (plexi? Resolve to look that up) and explain why the pain is worse now than it was prior to surgery. Bite back snotty response when patient's wife makes the predictable "We're not going to let you go home tonight" comment.

Remind self that "we're not going to let you go home" is a huge compliment, and those folks don't know I've heard it five thousand times before.

Eat lunch.


Readjust a heparin drip and bitch at the poor hapless lab personnel who cross my path, because the PTT is two hours late.

Reposition one or two or more of any number of patients, my own and other people's.

Chart. (That should actually be a constant background noise, like a bunch of Gregorian monks with nothing better to do. "Chart. Chart. Chart. Chart.")

Pee. It might be the first time today, but probably not. Every nurse has his or her priorities; mine is peeing.

Discuss end-of-life care with a woman whose son is dying of an easily-treatable brain tumor. Treatable, that is, if you have insurance or if the indigent care department of the hospital hadn't cut you off two years ago.

Consider the possibility of taking up recreational drug use. Decide against it; all the good stuff is tracked.

Chart. (omni in microscopicae chaaaaaaaaartuuuuuuuuussssss....)



1920-2000: drive home.

post-2000: sit on porch with cat and drink. Could be lemonade, could be Scotch; the important thing is that it ends the day. Wonder how on earth my feet could possibly smell *so very bad*. Admire 0.5 cm dents in ankles from socks; consider, then reject, wearing supphose to work. Wonder if heparinizing patient has thrown herself out of the window through boredom yet. Pee. Note that cat is avoiding my feet. Marvel at the dents that my beeper and waistband have put into my waist.

Consider eating. Recall that the only things in the fridge are biryani rice and leftover nachos. Decide that those sound pretty good anyhow. Eat.


On a day that I have off, that last line is repeated at least twice the following day, along with "drink more coffee" "pee some more" and "poop".

Most nurses I know spend their days off pooping and sleeping, like babies.

I'm on to the latter right now.

Sunday, January 15, 2006

Hobbyists, part one zillion

This is the time of year when, if you work in the typical hospital, the patients who come to you are either very sick or very weird. Sick, because everybody who had a choice about having surgery came in before the end of the year, so as not to have to pay a huge deductible; weird, because the post-Christmas letdown brings in the folks who really, really love their narcotics.

We've got 'em all over the spectrum this time. The one who mixes up whatever liquids are left in the room, complete with pills he's cheeked, to simulate vomit. The one who's complained for so long of pain at 10 on a 1 to 10 scale that she's become addicted to strong painkillers, yet can wander outside, complete with IV pole full of stuff, to smoke during the worst pain crisis. The one who Munched himself into four unnecessary surgeries, years of heavy steroids, and finally, an almost-complete dehiscence of his gut.

I want to put the new Munchers into a room with the experienced Munchers so that they can see what they're getting into.

If you're a Hospital Hobbyist, there is a possibility that you will eventually make yourself sick. Since we deal with people who have diseases that have to be diagnosed by exclusion and that often have wierd and vague symptomatology, we get a fair number of hobbyists. We also get a fair number of folks who started out as hobbyists but have actually become ill. Whether they're injecting Dilaudid and Demerol through their own implanted port at home, or simply going from doctor to doctor to get Vicodin until their livers give out, they will come to us at some point.

Yes, yes, I know: another person cannot rate your pain for you. A nurse has to believe that a patient is really experiencing the pain they say they are. Pain is the fifth vital sign, and should be treated with effective drugs, not shots of saline.

Please. There's a limit.

If you're in pain, you generally don't wait until the nurse is in the room to act like it. (Same with seizures: if you're lying there watching TV while I'm spying on you from outside, only to seize when I walk in the room, I'm going to wonder.) If you're in pain, you generally don't have the energy to steal vials and ampules of goodness from other facilities and stash them in your room when you're with us. If you're in pain, you sure as hell won't have the energy or desire to hang out in the smoking court for four hours, bringing a wide variety of interesting individuals back with you for a little tete a tete.

Eventually, if you complain of severe and unremitting pain long enough, we're going to start using non-narcotic drugs to treat that pain. It could be steroids, which thin your skin and leave you moon-faced and irritable. It could be immunomodulators, which leave you open to lovely infections. It could even be surgery, rather than drugs, as a last-ditch effort to relieve that headache, gut pain, or back pain you've been complaining about for years. You might end up with a shunt here, a colostomy there, or a hunk of metal somewhere else. Is it worth it?

On the other side of the unit is the patient who's really, really fucking sick. She might've had an aneurysm diagnosed shortly before Katrina wiped out the CT scanner; maybe he woke up one morning with CSF pouring from his ear. Could be fulminant meningitis, could be a stroke. If you bite through the tubing leading to your PCA in an attempt to siphon off more painkiller, you take me away from those people that need me.

Some days I go to work with a light heart and a happy smile, knowing that I'll have a chance to actually help somebody feel better, maybe even help them heal a bit. Other days I go to work with a sense of duty, reminding myself of the hourly rate I earn. This week has been full of that second sort of day.

There are still compensations, don't get me wrong. I just worry on my day off about the sick, sick people that I might've missed something on, or might've not taken prime care of, because I was busy rooting under a patient's mattress for the ampules of Demerol stashed there.

Monday, January 09, 2006

Coming soon....

I have had a hell of a day. Can you say retroperitoneal hematoma and bleeding out of a kidney? I knew you could.

However, I am not yet so zonked on Chee-tos that I could let this slip by:

January 22nd is Blog For Choice day.

You can expect something foaming-at-the-mouth then.

Sunday, January 08, 2006

The jig is up; the gloves come off...

Beloved Sister sent me this email in response to the post below:

I have decided that every female who is blood-related to me, however
distantly, whether they attend this wedding or not, must on our wedding
day wear a dirndl, an apron, and one of those Dutch hats with the
earpoints that flip up. So you don't have to worry about looking like a
Russian peasant. You'll look like a Flemish peasant. Stay tuned for
color picks and mandatory accessories.

Something tells me I should go get a froofy pink dress with big puffy sleeves and a butt-bow. I just *should*. And a poodle on a leash. With a rhinestone collar. And Big Hair. Like something from Etiquette Hell. Just to teach her a lesson.

The jig is up.

WARNING: boring girly stuff ahead. Nursey stuff later.

Beloved Sister has actually set a date (well, she has to re-set it, because of the conflict of a football game that weekend) for The Wedding. Which means, apparently, that she's actually getting married.

Which means that I have to start trying to look less like a fuzzy-headed, rather plump, goggle-eyed mouthbreather and more like something she would want in her wedding pictures. I am not too proud to admit that I don't particularly look forward to resembling a Russian peasant in a bridesmaid's dress, either.

So I'm joining Brooke and Eileen in the Great Weight-Loss, Weight-Lift Hoo-Ha of 2006.

Lest you think I'm totally girly, I had a revelation the other day when I tried to lift a patient out of a chair with only one other person helping. I've gotten so out of shape that it left me panting. I am no longer strong enough to do my job well, hence the weight-lifting part. *sigh*

On to the nursey bits.

I got floated to another floor. This in itself is not unusual; we often float nurses between floors at 11 am or 3 pm depending on staffing.

What was unusual was that I got floated to a fully-staffed floor.

The nurses had gotten so far into the weeds in the morning that they needed a runner in the afternoon so they could finish their charting and so on. I started an IV, took a few blood pressures, sat with a one-on-one patient (well, he was sound asleep, so I watched "Animal Planet" for a while), and picked somebody up off the floor (more about that in a second).

They'd already gotten one floated nurse; she was the only one who had gotten everything done and didn't need a hand. Now, this floor isn't known for its general efficiency and poise, but I didn't realize things had been so bad in the morning that only the person used to being sharp would actually be on top of things.

To boil it down: the nurses on the floor I floated to have such poor time-management skills that they needed somebody to save their collective asses midway through the shift. That somebody was me. Staffing was happy to float a nurse, at $Outrageous/hour, to be a dogsbody and general factotum.

I was not thrilled. My floor has the highest patient-to-nurse ratio of the hospital on a regular basis, mostly due to short-staffing. We routinely float nurses to other floors so that somebody else can go home (overtime issues, usually). We complained when the first staffing grid came out and got cut by one patient per nurse, so we were each handling five high-acuity patients on day shift. After that, complaining didn't help, so we all got very, very fast and efficient. There is little screwing around on our floor. If you have a patient with an open ventriculostomy (ie, we're draining out brain juice on a continuous basis), one with a lumbar drain, one with seizures, and two knee replacements, you don't have time to chat.

There was nothing but screwing around on the other floor. If you haven't been able to complete paperwork you got at 10:30, and it's 17:00, and the paperwork consists mainly of vitals and allergies, there is a problem.

Things came to a head at ten 'till go-home. A woman came out of a room to inform us that her husband was sliding out of his wheelchair. Nobody moved but me and one attending, an extremely elegant and disciplined woman in very high heels.

We untied the Posey vest that was strangling him, manhandled him back to bed between us, and then left the room to go back to the nurses' station, where four nurses were still sitting, staring at us like calves at a new gate.

I almost said something snarky. Then I remembered earlier in the day, when I actually needed help with a combative patient who outweighed me by about 100 pounds. I had yanked the call bell out of the wall, setting off the emergency call. And I waited, trying to keep the patient from either doing himself or me an injury.

Ten minutes later, after I grew as many arms as an octopus and managed to get him restrained, I walked out to the nurses' station and turned the emergency call light off myself.

To say I'm bugged would be an understatement. I don't mind helping out when people have a truly bad day--I've been almost in tears myself a few times when coworkers have come to my rescue. But I do mind immensely getting stuck with the cleanup when a bunch of folks've been doing their nails all morning.

Tuesday, January 03, 2006

Today I cooked.

Today I cooked puttanesca casserole (puttanesca sauce over ziti with tiny crumbles of good cheeses throughout) and blueberry muffins and some Americano-style fried rice. I boiled pasta and crushed tomatoes and melted butter.

Because today a friend of mine called me. She's 27. For the last three months she's been steadily losing weight--attributing that to stress--and having dyspepsia, diarrhea, abdominal pain, and bloating. The onco nurses in the readership know, of course, where this is going.

She has stage I ovarian cancer. She's going in tomorrow for surgery to remove the ovary and the Fallopian tube; she's been on Ovarex for about three weeks now.

Thank God, I suppose, that it's stage I. Depending on what sort of cancer it is, she has between a sixty percent and an eighty percent chance of surviving to her 32nd birthday. It's weird to think of sixty to eighty as good news; with brain tumors, you generally die or you don't.

It's weird to think that there's a 20% to 40% chance--if all goes really well--that she won't live to be as old as I am.

I've ordered a pink wig. She's a "Sex In The City" fan; she'll get the reference. I'm also taking over some big earrings, since she's already losing her hair, so she can be one of those bald women who are all about earrings.

And mashed potatoes. She's down to a size 2; the woman is five-eight at least and looks healthily slender in an 8. And a mix CD for courage. And some macaroni and cheese, since she needs the calories.

I promised her that when she's ready, I'll shave her head for her with the same clippers I'll use to shave mine.

I'm proud of my reaction when she told me. Rather than freaking out, I said, "Well, shit. That sucks. But, you know, you can't die. You'll save your husband some paperwork (she's in the middle of a divorce), but dying is really not all it's cracked up to be." She laughed. She's looking for things to make her laugh, these days.

So today I cooked. There's a limited amount I can do to make my friend laugh, the night before her surgery, so I'll cook. At least it keeps me from crying.

Monday, January 02, 2006

Cat came back/The very next day...

So I went to pick up The Cat at the vet today.

The receptionist looked at me when I came in and said, "I'm here to ransom my cat" and replied, "The man-eating tortie with the bad attitude? I'll have our vet tech go get her."

The tech wouldn't touch her. Nobody would. I was about to go in there myself and haul her out of her boarding kennel when the guy who gets picked for the awful jobs volunteered, bless him.

My cat has the only chart at the office with a huge CAUTION sticker on it.

*sigh* My cat is Gregory House in a fur coat.

What I cook on my day off:

In other news, I've come across a close approximation of Buca di Beppo's canellini beans and arugula. Herewith:

1 can of canellini beans
about a half cup of petite-dice tomatoes and juice
five or six nice-sized cloves of garlic, chopped
a teaspoon or so of oregano
salt to taste

Dump all of that into a saucepan and let it simmer until the flavors blend and the beans get good and soft. It should be more stewy than liquidy.


A couple of big handfuls of baby spinach, whole, or a couple of big handfuls of arugula, chopped up.

Simmer (barely) until the greens are soft and wilted. This will not take very long at all.

This makes enough for two generous side dishes or one serving for a real beans-and-greens nut.


Product Reviews!

Bissell Quick Steamer Powerbrush

This is a miniature upright carpet shampooer, not really a steamer, that you can get at Lowe's for 84 bucks. You fill the back chamber with hot water and a cleaning solution, then turn the thing on and press the trigger. It sprays automatically, scrubs your carpet, and then suctions up the dirty (oooicky) water.

This damn thing works like a *champ*. The only drawback is with the dirty water collector: not only do you have to empty it three times for every full tank of cleaning solution, but it has some weird vent/opening arrangement that means you'll spill water all over the carpet if you're not paying attention. Other than that minor quibble, I am in love with this machine.

It's good for spaces 8'x8' or thereabouts. Since I don't have too much contiguous space in my wee apartment, it works fine. It even raised the trodden-down pile in the living room. You'll still have to pretreat things like cat pee stains, but on ordinary ucky tracked-in greasy yuck dirt it works great. And the carpet will dry in an hour or two if you turn on the ceiling fan.

Judgement: If you have crappy carpets, this is the widget you need.

L'oreal Volume Shocking Mascara

I have six skinny eyelashes. This product made me have two skinny eyelashes, like a Muppet. Furthermore, the eyelashes were bizarrely Tammy-Faye-esque in their clumpiness.

See, this mascara *ought* to work. There's a comb applicator on the color side (it's one of those two-sided deals with a colorless foundation prep), which is the greatest way ever to apply mascara. Unfortunately, they've done something funky to the comb so it's not actually a comb, per se; it's more a toothy V-shaped thingamajig that deposits approximately ten pounds of goop on each of your six skinny lashes, then sticks them together.

What a disappointment, especially for twelve fucking dollars. If you have six skinny lashes, stick with Maybelline Full & Soft.

Judgement: Run away, run away.

American Airlines Snack Box

In case you haven't noticed, there is no longer meal service on most domestic airline flights. Instead, for three bucks, American (and I assume other carriers) will sell you a "snack box" full of processed food that will presumably keep you from chewing off your seatmate's arm out of hunger or boredom.

We were offered the same snack box on two flights (same menu, I mean). The first flight, Chef Boy and I were curious and so got a couple. The second flight we smuggled on McDonald's and a flask of bourbon.

The snack box contains one chocolate biscotti, semi-stale; one one-ounce hunk of unidentifiable processed cheese in foil, two "water crackers", one pack of yogurt-covered raisins, and a breakfast bar from some manufacturer I don't remember.

I skipped the raisins and the breakfast bar. The cheese was...well, I'm sure I've run into something like it before; you could probably use it to close up holes in peoples' skulls. The water crackers, thank God, they didn't manage to mess up. The biscotti was semi-stale.

Judgement: Avoid. Get a bagel or something and carry it on.

I'm going to go eat an entire pan of greens & beans now.

Sunday, January 01, 2006

Santa's Oversights

I was having trouble sleeping. In lieu of slumber, I started making a list of things Santa apparently overlooked this year; I didn't find any of them under the tree. Listen up, Big Guy: I expect you and all ten reindeer to come through next year.

1. An instantaneous-travel device, with one portal here, one at work, and one at Green Lake in Seattle. It would, of course, have to be secured somehow so confused residents and joggers didn't end up blundering around my kitchen. It'd be so nice to be able to skip the commute and go jogging instead.

2. One of those automatic massage tables like Lazarus Long had on Tertius. That would really come in handy right now.

3. Failing that, the whole refresher.

4. A flying car. With radar and a cloaking device. Nothing fancy, really; just something to allow me to zip around doing errands a bit more efficiently.

5. Synthahol, like on the old Star Trek.

6. Antigeria. That could be fun for a while.

7. The sudden and simultaneous implosion of all Starbucks and McDonald's everywhere. Also any brewery that makes mass-market beer.

8. A plate of really good poutine. I feel like sending my pals in Montreal a telegram: AM STARVING STOP SEND POUTINE STOP SITUATION CRITICAL STOP PS DON'T FORGET THE BACON AND MUSHROOMS

9. A time-travel machine. With appropriate vaccination schedule.

10. One of two: a one-day cure for the common cold, or a one-day cure for athlete's foot. Either would probably promote human happiness and world peace; I'm not picky.