Wednesday, May 31, 2006

MBTs and me: a product review

So I got some new shoes the other week: Masai Barefoot Technology, they're called, and all I have to say about that is this: if the Masai have to spend the amount of money on their bare feet that I had to spend on these shoes, it's a wonder they can eat.

Anyway, I promised a review of the shoes.

They were recommended to me by a number of orthopods and physical therapists for plantar fasciitis. That's a condition in which the bottom of your foot stretches too much, or doesn't stretch enough, or something, and you end up with heel pain that makes it nearly impossible to walk after a day of work. So, taking a deep breath, I ordered a pair of these babies online.

Consider the MBT shoe: it is big. As in, it looks like a basketball's been cut in half and glued to the underside of the shoe. In addition, it has some sort of rocker action, the upshot of which is that when you stand normally, you actually have to balance your weight over the middle of the shoe. This led Chef Boy to ask, "Do they come with training wheels?" a reference to my fabled clumsiness. My sister remarked that that quip led her to consider Chef Boy her hero, and I said, "Shut up."

So you've put the things on and are balancing cheerfully in the middle of your foot. Or, alternatively, you've rocked back onto your heels so as to not have to waggle constantly to stand up. The first thing you notice when you start to walk is this: they're a very well-balanced shoe. As in, even *I* can't fall over in them. So snark away, Chef Boy and Beloved Sister, I'm doin' all right.

The second thing you notice is how heavy the damned things are. I don't know what sort of technology the engineers stuck into the oversized soles of these shoes, but it seems to be made of lead and gold. They're *heavy*.

That said, my heel hurts about the same after a day at work. But! On the morning after, it does not hurt *at all*, which means that I can pretty much walk to the bathroom rather than having to hobble and curse. Also, they do give my legs a good workout--not so much at work, since I'm used to walking around for twelve hours, but boy hidey! After a thirty-minute trot on the treadmill, I can feel muscles I only dimly remember from comparative anatomy class.

I can also run in them for several minutes at a stretch, having to stop only because my aerobic capacity is shit, not because my shins hurt. That is good. Very, very good.

And, strangely or not, the rocker-action of the shoe makes it easier to walk fast or trot than it does to walk slowly. That's nice, especially when you're trying to get as many miles in on the treadmill as you can. You have to walk with a shorter stride and in a more concentrated manner, or else your toes will brush the ground and you'll lose your rhythm. It's more like a forced march than a walk, but then, treadmilling is always more like a forced walk for me.

I'm sitting here contemplating the insertion points of my quadriceps--I can feel all of them, on both legs--after a thirty-six minute trot on the treadmill in the shoes. That's okay. My heel hurts a little, but not terribly, which is better than okay. And my bank account hurts a little more, but I'm dealing with that.

Bottom line: If you're happy with your Danskos, keep 'em. If, however, you spend the majority of the day wondering when the hell your heel will quit hurting, it's worth it to try a pair on to see if they work for you.

Sunday, May 28, 2006

No big surprise here...

You Are Wolverine

Small but fierce, you're a great fighter.
Watch out! You are often you're own greatest enemy.

Powers: Adamantium claws, keen senses, the ability to heal quickly

Friday, May 26, 2006

I need an intervention.

Tonight, after realizing that people really *don't* get any less annoying when you know them better, I had the following for dinner:

A large handful of cherry tomatoes. Okay, two large handsful.




In slightly more cheerful news, this is the way of eating that has sustained me for years: weird food at weird hours, heavy on the vegetables and complex carbs, light on the meat. (I don't consider bacon meat; it's more a condiment.) I went back to it after three weeks on South Bitch sent my blood pressure to 150/100, shock! My BP is now back in the basement where it belongs.

In even more cheerful news, Carolita handed me an antique ad from a medical journal that she'd culled from among the equally antique books at her mother's house. It begins with the line "Experience Is The Best Teacher", references Camillo Golgi (a famous 19th-century neuroscientist), and ends with the claim that "More Doctors Smoke Camels Than Any Other Cigarette." It's now framed and resting atop the bookshelf that holds my ancient medical books.

Beloved Sister had the unenviable experience of interviewing a candidate for a job today who'd put semi-naked pictures up on his website. Oooooh, nipples. Love 'em. I wonder if her head has actually exploded, or if her brain simply oozed out one ear and crawled away across the conference room.

Speaking of brains, the Seriously No Kidding Single Most Squicky Thing I've Seen Recently came home to roost the other day: a guy who hadn't bothered to wear his seatbelt and went through the windshield of his car...and then had his frontal lobes (well, most of 'em), his sinuses, and his frontal skull removed.

There's a divot in his skull that I could put my fist in. Eugh. And no, he's not doing much these days.

Nor am I, except going to bed.

Thursday, May 25, 2006

This had better be all for a while. Dammit.

The last two days at work have been...well.

Mister Annoying Screaming Man came back a*gain*. Mr. ASM is one of those frequent-flyers who has some dementia, though not enough to keep him quiet and compliant, and who does things like leave his walker across the room at home and take repeated face-plants into the linoleum. The first six or seven times he came back, it was cute. It's not cute any more.

I took his care over about an hour before my shift ended and went to start an IV. He's been in the hospital before. He's been stuck before. He knows the drill, remembers it, knows he has to have a saline lock in his arm. Why, then, when I pierced his skin with the needle, did he scream and dope-slap me on the back of my head?

I jerked, the IV start needle ripped upward through his skin, and blood splattered my face and scrubs. That made a nice contrast to the vomit, feces and urine I'd already been splattered with.

Earlier that day I'd had the sort of patient everybody dreads--a brittle type I diabetic who refuses to manage his blood sugar or stick to his diet. There's a certain type of person you know is going to be trouble, usually shortly before he goes in to DKA or his glucose dumps down into the teens, and this was that guy. After a hearty breakfast of five (!!!) glazed donuts, coffee with sugar, and some chocolate milk, he started feeling a little tetchy. He was kind enough to unload breakfast on my shoes--thank God I was wearing my old Danskos--and my scrubs. Lovely.

The vomit was joined a short time later by shit. And sweat. There's some Universal law somewhere that says that isolation patients with nasty intestinal bugs must a) weigh something on the wrong side of 400 pounds, and b) want their thermostat turned up to 85. You know those plastic isolation gowns? They don't protect worth a damn.

There was no isolation gown nearby when my seriously demented patient yanked out her Foley catheter and started waving it around, speckling everybody with pee. Of course, she was on pyridium.


Chef Boy floated the idea of moving to Brazil and running a B & B last night. You know, there are times when moving to the Southern Hemisphere, learning Portugese, and living in the middle of nowhere tending orchards and sheep seems like a really fine idea.

Oh, and I did get the IV started on the second try. A combination of barely-controlled rage on my part and several towels wrapped around his bleeding hand kept him quiet.

Sunday, May 21, 2006

The Glamorous Life of a Neuroscience Nurse

Hugh called *again* last night, sobbing, stumbling drunk, begging me to take him back. I've got to change my number; he just won't leave me alone.

It was fun in the beginning, when all we did was have quick dinners out, followed by long evenings of piano-playing, tap-dancing, and singing Judy's old songs. He loved my rendition of "The Man Who Got Away", especially when I did it as though I was half-smashed, wearing huge false eyelashes.

Then I made the mistake of telling him I liked his sideburns. After that, things began to go downhill. He was always so *serious*, talking about how we could move north, excavate a little den of our own, and raise a few litters of kits. He just couldn't understand that I wasn't ready to settle down, especially not with such a player. I mean, what about Kate? And don't tell me that that kiss with Meg was all acting.

So I told him as gently as I could that we'd have to go our separate ways. He took it hard. But really, what's a girl to do?

Plus, the claws were, frankly, a pain.

Saturday, May 20, 2006

Therapeutic Communication

"Roll over" I said.

"So you can see my incision?" he asked.

"No, so I can kick your no-good ass," I replied. "You've been giving me grief all day, and I've had it up to my moustache with your antics."

"Gobsmacked" would be the best word to describe his expression at that point.

The call bell system was dead. The cable was dead. The plumbing was under the control of some evil spirit. All of this had happened on the third day of his having to be flat on his back due to a low-pressure headache, and he was fed up. So he called the operator, the receptionist, the concierge, the assistant to the assistant to the President, and complained.

The one person he didn't call was me.

For two days he'd been cursing at nurses, throwing things, and generally making a pain of himself. The last nurse to take care of him had exited the room with some speed as the sound of smashing crockery came from behind her. This is a nurse whose dad was a Merchant Marine, so it's not like she couldn't handle it. But she couldn't handle it any more. So I went in to resite an IV that was giving him trouble, cussed right back at him, and got him for the full twelve hours the next day. Seems he liked my style.

I pointed out to him, at varying volumes and at some length, that he was paying me to make his life easier. Why, I asked, would he pay a lawyer to accomplish in two weeks what I could manage in two minutes if he simply gave me the chance? Why risk being branded a whiner when I could get him what he wanted (short of fixing the cable myself, which he seemed to expect) with a minimum of trouble and effort? Why, essentially, did he insist on being the most difficult of difficult patients--one with a legitimate complaint who says nothing until the pot boils over--rather than answering my questions honestly and letting me *make his life easier*? I'd tried to draw him out earlier, a number of times, and he'd simply waved me off.

Screw therapeutic communication. Sometimes it doesn't work. Sometimes it does, true; there are times when a patient simply needs a listening ear and somebody to say "Uh-huh, and then what?" over and over. But--and this is a big and delicate but--there are times when you have to throw it out the window and be blunt. Speak the language, as they say. Walk the talk.

He gave me cookies and a hug and an apology. I walked out with a smart remark and a toss of the head. We understand each other now; even if there's another crisis in the middle of the night tomorrow, I know he'll behave like a human being rather than the whistle on a teakettle.

*** *** ***

In other news, I'm rereading Bill Bryson's book on Australia. If you hear that I've cleared out my savings account and taken up a job travel nursing, you'll know what to expect: bulletins from the billabong.

*** *** ***

The Cat seems to love the Feliway Comfort Zone diffuser I got her. It's a pheremone-squirting widget that you plug into an electric outlet--supposedely, it combines "friendly pheremones" in such a way as to make cats happier and more relaxed. All I can say is this: after four hours of having the thing putting away, The Cat laid down in the middle of the floor and purred, allowing me to rub her belly. That hasn't happened in nine years. Maybe the neurologically-damaged Cat just needed some Happy Kitty Smellatrons; I dunno. I'm not questioning the results. (Mom: Try it for Astro.)

*** *** ***

The MBTs are, so far, a revelation. I'll let you know how they continue to work out.

Monday, May 15, 2006

Non-Work-Related, Part Deux

Girly Product Reviews, part Nine Gazillion

Amlactin Lotion

Friend Penny swears by this stuff for wrinkles. I haven't yet tried it on my face, but it works wonders on very dry legs and feet. It doesn't smell like anything, either, which is nice. And a little goes a long way; a lot will cause your skin to just sort of give up and peel off.

Flexitol Hand Balm

Another recommendation from Friend Pens, the Lotion Slut. She actually recommended the Heel Balm this way: "If there were something that worked on the rest of my life as well as Flexitol works on my heels, it would be called Dammitol."

The hand balm is petroleum-based, which means you can't use it during working hours, but it makes a nice overnight treatment for very rough, dry hands. It was originally developed for diabetics. It's easy to wash off and odorless, and again, a little goes a long way. Also good for feet.

Sally Hansen Beyond Perfect Nail Polish

I bought Whore Red (no, that's not the name, but it might as well be), painted my toenails with it, and they stayed unchipped and extremely shiny for three weeks. Plus, it came off with a minimum of strain. The only warning on this one I can come up with is, you'd better get a color you like. It'll be there for a while.

Old Navy Capri Pants, pickstitched, Just-Below-Waist

I found out after I bought two pairs of these that they were "Real Simple" magazine's pick for best capris for people under 5' 5" tall. Now, that's too much of a categorization for me, but I *did* buy two pairs of these pants. The waist is low, but not so low that you get that overgrown-teenager look. In fact, if you're short-waisted, the waist will hit *almost* at your natural waist, thus avoiding the Mom Jeans look and the muffin-top simultaneously. They wear like iron. I wash them on Boil and dry them on Broil and they don't shrink.

Gap (I know, I know) Flared Linen Skirt

At $68, this is a 'spensive piece of clothing...but I've already patterned two other skirts off of it and they're ready to hit the sewing machine. Good thick linen lined with cotton, eight gores, zip closure, French seams that should last forever. If you're short, do not mess around with the regular sizing; go for the petite.

This skirt hits at the natural waist and hangs almost to the ankle. It's perfect for people who live where the summers are sunny but who don't want to wear SPF 45 all over every damned day.

As soon as I get the MBTs in the mail, I'll review those too. Provided I don't fall off them and break my neck.

Sunday, May 14, 2006

Non-work related

Sometimes a girl just has to turn her back on the brainstem, you know?

We were talking at work the other day about beautiful words: words that have their own intrinsic value as sounds, like "sycamore". Or "glioblastoma". Or "brook". We came up with quite a few, but the best remark came from a foreign doctor who remarked that "pus" was the best English word he'd ever learned. "Sounds like what it is and what it looks like. There's no question, when you hear the word 'pus', what the other person is talking about."

Apropos of nothing, United Nude shoes has usurped the place that Irregular Choice used to have in my heart. Any company that puts out a pump based on the Eames chair gets my vote. Unfortunately, I have no excuse whatsoever to buy even the least-pricey of their designs, as I just dropped a couple bills on some MBTs. They come highly recommended by the orthopods and physical therapists at work. Chef Boy's reaction was, "Do they come with training wheels?" No, but they do come with an instructional DVD, which kinda scares me. Still, if they ease my plantar fasciitis, they're worth it.

Pal Joey has a wedding to go to in Quebec City while I'm in Montreal this July. Anybody know of anything I should see or do while I'm there? Keep in mind that my French is limited, rusty, and slow.

Tuesday, May 02, 2006

Simple rules.

1. If you have to jack with it, it's wrong.

This goes for everything from IV tubing to new shoes to long-standing romantic relationships. If you have to jack with the tube-feeding tubing to get it to go into the IV port, you've got it wrong. If you have to walk like a kangaroo in Earth Shoes in your new shoes, return them. If you have to jack with your responses in a long-time relationship, it's time to rethink.

2. If in doubt, give oxygen.

Again, this goes for everything from nonresponsive patients to relationships. Space is a good thing.

3. Sternal rubs cause bruising out of proportion to their usefulness.

This does not mean you should necessarily stop using them. After all, bringing one patient back from the brink of grokdom is worth a few bruises, right? Right. The trick is knowing when, by looking at your patient's sternum, one more mofoing sternal rub is not going to do the trick.

4. Always set two alarms in case of power failure.

That one's self-explanatory.

5. Less than a quarter-tank of gas is just asking for trouble.

Even when gas is $3.40 a gallon.

6. If you love, love, love a place, you should either buy it (if it's a condo or a house) or move there (if it's a city) without thinking too hard about the alternatives.

Another alternative may be better to the logical thinker, but will it make you happier? I think not. (Joey, listen up.)

7. Pate de fois gras always tastes better when you have several months of anticipation invested in it.

I'm going travelling in July, yes I am.

8. Cocaine and methamphetamine are the only scary drugs.

9. When you're eating faux-Mexican, just go 'head and get a to-go box right at the start.

That way, when the waitstaff brings you a four-part symphony in pseudo-burrito, you can put it away rather than munching on it all evening.

10. Support hose, no matter how good they feel at 0900, will always twist in some heretofore-unimagined way and cut off your circulation during a code.

You have been warned.

Monday, May 01, 2006


"You," she said grimly, through clenched teeth, "are gonna end up in the pen-i-ten-shurry for this. They're gonna come let me out tomorrow and you're gonna go to the pen and I'm gonna laugh when the cops come to get you."

It was three-and-a-half hours into a four-hour drama, and I was getting rather tired of the situation. I replied, as calmly as I could, that I was not going to the penitentiary or to jail or to hell, no matter how often she repeated those suggestions, and that she was not getting out of this place tomorrow.

Subarachnoid hemorrhages are weird things. They happen most often when an aneurysm, a weak area in an artery, cuts loose and bleeds. What happens next is confusing and fascinating; the patient ends up with what's essentially a sterile meningitis (inflammation of the coverings of the brain and spinal cord). The ability to speak clearly sometimes disappears temporarily, and the person tends to take long vacations from reality.

Combine a subarachnoid hemorrhage with a couple of other organic problems that have already caused substantial damage, then add on a subdural hematoma. That's bleeding under the toughest layer of meninges that cover the brain, and is most often caused by a blow or counter-blow injury to the head. Subdural hematomas fall under the category "walk, talk, and die", because they tend to expand rapidly, compressing the brain tissue under them and on the opposite side of the brain. We keep SDH patients under close observation for several days for that reason.

Even if those patients aren't wandering off the floor, attacking ICU nurses when said nurses don't come up with discharge paperwork, and begging to be left alone long enough to have a quiet cigarette outside.

Had I been able to, I would've ordered a toxicity screen, both blood and urine. Unfortunately, after she came back upstairs from the lobby of the ICU, I had been busy holding her down. For three and a half hours. That kind of energy--the sort of energy and strength that allows an 80-pound patient to break through soft restraints and a restraint vest and requires 160-pound me to kneel atop her--doesn't come only from a subarachnoid hemorrhage or subdural hematoma.

It started innocently enough, with a long-distance phone call to her elderly mother, asking Mom to come pick her up. When Mom arrived, having not checked with the nurses to determine whether she could take her daughter home, things went straight to hell. The patient, amazed and angry that she wasn't going home, became increasingly violent. We got Mom out of there pretty sharpish when it was obvious that we would have some serious work to do.

The end toll on the patient goes like this: ten milligrams of Haldol IM, three of Versed IV, eight of Ativan IV, and four-point soft restraints, Posey vest, and bruises on wrists and ankles where people had to hold her down. (Note for nonmedical types: that's enough sedative and antipsychotic medication to take down a 200-pound man and make it necessary to bag him. She just got calm.)

Oh, and I ran a fourteen-gauge (note for nonmedical types: a fucking huge) IV into her left ankle with one stick. She didn't like it, but I felt better.

The end toll on the staff is as follows: One black eye, one certainly sprained and possibly broken finger, one sore back (that's the only one that's mine, thank God), several puncture wounds from filthy fingernails, and one inch-wide bite wound on a forearm.

The bite wound happened to a very sweet, slightly slow nurses' aide who happened to look away at a critical moment. I feel terrible for her, not least because she had to get vaccinated for tetanus and all the various other things one can get from a human bite, and she hates needles. I will say this, though: she held on like a bulldog even with blood from the bite running down her wrist and hand.

I bought her a pair of heavy black rubber elbow-length gauntlets today at the hardware store. I'll wrap them in pretty pink paper with a girlish bow and give them to her the next time I work.