Tuesday, November 28, 2006

Busman's Honeymoon*

Okay, so more randomness....

I just watched "House" and "3 Lbs.".

Watching Stanley Tucci operating on a basilar artery aneurysm is more fun than watching Hugh Laurie go through simulated withdrawal, but not by much. As friend Lisa says, "HL could create a need for forearm porn in any woman." Tucci doesn't have that gift. Plus, he's too short to be a neurosurgeon.

Aside from that, and the whole "neurologist sleeping with her patient" thing, because everybody knows neurologists never get laid, and aside from the piano in the lobby (ripoff from "House", anyone?), and aside from the blue coats the residents wear...well, it's pretty much where I work.

So much so that when the patient said, "You're a terrible doctor" and the neurosurgeon replied, "Yeah, but I have steady hands, and that's all you should care about" I gasped in recognition.

More so at the lobby. That was really, really creepy. And the OR registrar.

They're following me. They are.

But neurosurgeons don't associate with neurologists. The surgeons are too arrogant, the -ologists are too flaky. Plus, they don't speak the same language.

Anyway. Fun show. Good for popcorn and entertainment value, and they're not trying to Deepen the Characters the way they are on "House".

*** *** *** *** ***

When are we gonna have a show in which nurses aren't invisible?

*** *** *** *** ***

Mom and Dad bought a house in Seattle. They discovered (on the cusp of the housing boom, their luck) that the house was too small to house all of Dad's books. So they bought another.

Then Dad remembered that the winters in the Pacific Northwet are really rainy. And dark.

So, instead of investing in a lightbox and some Wellbutrin, they found a place in Mexico, Land of Manana.

They've just gotten back from a couple of weeks of Manana. I'm wondering if they've regretted...wait, no. I'm wondering *how many times* they've regretted not getting a lightbox and some Wellbutrin.

Dad, always the optomist, said, "My Spanish sure got a workout."

*** *** *** *** ***

I hurpled along (yes, Virginia, "hurple" is actually a word) on the treadmill today for a half hour while watching ABC news and discovered deep within myself an urge to be a Roller Derby Queen.

Well she might be nasty
She might be fat
But I never met a person
Who would tell her that
She's my big blonde bomber
My heavy-handed Hackensack mama

Think of it: I could wear a black unitard with the spinal column on the back, and a helmet with a brain on it.

Well, she's five foot six
And two-fifteen
My bleached-blonde mama
With a streak of mean

It almost, *almost* works.

'Cept I gotta learn how to skate.

*Apologies both to D.L.S. and J.C.

Random Ruminations

Thanks to the holidays, I've not been at work much the last week or so. Our census is low enough that us full-timers get waved off for a shift at a time.

So this will be not so much about work.

Two requests for favors, first:

1. Who's using the new Blogger Beta, and how's it working for you? I'm not keeping up with the Blogger group on Google, so I'm looking elsewhere for advice and experiences.

2. Who's fairly fluent in German? I have an old Mercedes Selekta typewriter with the instruction manual, but the manual's all in a German I can't decipher. I'm curious to find out what it says. The pictures alone are great.

*** *** *** *** ***

Yes, I collect typewriters. I found a Corona model 3 yesterday at the Big Junk Barn, cheaply priced, so I snapped it up. The collection started with the Smith-Corona portable (1926) that my grandfather used in his business and expanded with a post-war Remington manual. That Remington doesn't look like much, but any burglar I hit on the head with it would be sad and sorry indeed. There must've been a glut of steel on the market in the late 1940's, 'cause this thing is built like...well, like a solid-steel manual typewriter.

A couple of years ago, when I should've been hunting for a desk, I found the Mercedes. I'm not sure how common they are in the US, though I've found a few eBay listings in French and German for them. It's quite a nifty little machine--the keyboard, rather than having "QWERTYUIOP" as the top line, has "QWERTZUIOP", with the Y where the Z normally is on an English keyboard. There's also an umlaut key, like a shift key on an English keyboard, and an eszett key. Plus, the nifty instruction manual, which features a nice-looking if heavily marcelled woman.

And then there's the new Corona. It's six inches high and eight wide at the front, and widens enough to accept a typical 8 1/2" sheet of paper over the roller. It's cute! It's bitty! I can't figure out where the locking mechanism is for the carriage! I'm going to need a whole new set of shelves to display these bastards soon!

*** *** *** *** ***

There's a doctor at work we've nicknamed "Stat Daddy". This is because he writes every order--*every* order, even those for, say, magnesium citrate or a Fleet's enema, as a stat order. Which makes it tricky to decipher what he actually wants. Did the patient perf a bowel? Are they having seizures? Is the doc just an asshole?

So, the other week, I get an order for "Dulcolax suppository PR x1 stat."


"Doctor Stat Daddy," I approached him, "Does the patient really need this suppository stat?"

"Well, he's cramping, and he says he's really uncomfortable," replied Stat Daddy.

What Stat Daddy didn't know was what I knew: that the patient was bowel-obsessed and had been taking literal handfuls of laxatives, stool softeners, and GI stimulants for four days. He was having pretty-much-constant diarrhea with the attendant gut cramping that six Sennokot pills three times a day will give you. Oh, that and I found an empty bottle of Milk of Magnesia, the super-value size, in his trash.

You could say we had issues there.

So I pointed out as gently as possible to Stat Daddy both the ins and outs the patient had had, as well as the previous nurses' charting, in which it was revealed in neat handwriting that said nurse had discovered the patient's laxative dependency.


No, I did not give the Dulcolax suppository.

*** *** *** *** ***

In other news, That Damned Cat has temporarily abandoned peeing on the rug for an equally annoying, if less smelly behavior: now that the days are getting short and she knows it'll be cold soon, she's taking up the exact geographic center of the bed every night. I'm doing yoga in my sleep to avoid crushing her head.

*** *** *** *** ***

Speaking of crushing heads, as well as doing fun things with them, I saw my first Liberace-ized patient two weeks ago. This guy was in his seventies and, I kid you not, had had so much plastic surgery that his eyes wouldn't close completely when he slept. That, and he'd had what I suspect was one of those Teflon implants in his upper lip, which meant he talked like Mushmouth from the old Fat Albert cartoon.

Note to the general public: If you're in for surgery to revise the scars from your previous plastic surgeries, you've had too much surgery.

Saturday, November 25, 2006

You're beautiful; you're beautiful....

I need to know if anybody else does this:

When I go to a restaurant, which I do fairly often, being possessed of both plenty of folding money and a boyfriend who's sick of cooking, I look at the other patrons.

When I go to the bar, my usual hangout, for a burger and a bump and a beer, I stare at the bartenders, male and female.

When I wander down the street near one of the local colleges, I gaze at the students. Obsessively.

Because they are, all of them, beautiful. No matter what might lurk within their bodies (a brain tumor, a broken bone, a deep vein clot just waiting to cause pain), they're *whole*. They're beautiful because they're whole.

They don't even have to be young. The eighty-year-old men helping their wives pick out groceries strike me as being as gorgeous as the twenty-year-old waitress at the pizza joint downtown. Because they're all whole.

One of the biggest current joys of my life is working out, simply because I *can*. I know I have a left side and a right side; I know which side is stronger (left, strangely; Mom, did you retrain me as a child?). I can lift heavy things and run on a treadmill without collapsing. I can do this.

Back in the day, during nursing school, I kept a journal during the psych ward part of our training. It wasn't by choice; it was assigned, and woe be to the poor instructor who had to read it. In that journal, I talked about my fear of being taken for an inmate of the hospital we went to. The only thing that separated *me* from *them* was the key that I had, that I could easily lose or have taken from me.

There's a different "me" and "them" in the hospital world. For now, I'm still in the camp of the whole. But I'm in contact with the un-whole, the grieving, those who've lost a part or a half of their bodies, enough that I'm reminded that it's a very small difference.

So. If you see me staring at you, it's not your beautiful forearms or your curly hair that's causing it. It might be, instead, the way you put your hand on the small of your wife's back, the way you have since 1946, even though she's now in a walker. It might be the way you use every finger to pour a drink, with the cork of the bottle between a ring finger and little finger you're still aware you have. It could be the way you break into a run to cross the street in front of my car, without even thinking of what you have to do to accomplish that.

If I had it in me, I would break in to Whiny English Singer-Songwriter mode and compose a little tune.

Be thankful that I don't, eh?

The Good Wife

Say what you will about Ginny, our chaplain: for being a Godly woman, she has the worst sense of timing in the world.

It had been an officially long day. From the time the 20-year-old started seizing to the point at which I finished holding pressure on an arterial puncture site that had broken open, it was the sort of shift you don't want to work, let alone be charge for. And there I was, charging.

I had wandered into the break room in search of something to eat--it was about six o'clock, just before the end of shift--and Ginny came in after me.

"Hey...you know that guy with the huge glioma? The young guy?" She gave me a few other details so I would remember exactly *which* young guy she was talking about. He was a typical glioblastoma patient: loving family, good job, healthy up to the point that he developed personality changes and seizures. Eight months before, we'd taken out as much of the tumor as we could manage and sent him off for experimental chemo.

He'd come back last month after failing treatment. (I love how we medical types say that: "The patient failed treatment." Not "the treatment failed the patient," which is how it actually works. No, the patient fails. Our treatment *never* fails, right? It's those damned patients who screw up.) We'd pumped him full of steroids, told his family that his brain was now officially mostly tumor, and recommended hospice.

Which his lovely young wife had agreed to. It was, after all, the best decision: stop cutting the poor man open, quit exposing him to nasty chemotherapy, and let him enjoy his kids while he could. He'd been at home for three weeks, doing about as well as you could expect--in other words, dying pretty peacefully. His wife had taken him home, despite the care he'd need, because she didn't want him to be alone. They'd barely been separated in fifteen years of marriage; she didn't want to start now.

"So," Ginny continued, "His wife dropped the kids off a couple of days ago with their grandmother, got into the car, drove out to the lake, and took a couple handsful of pills and drank a half a bottle of vodka before she passed out."

"She didn't" I replied. "Yeah, she sure did," came the response.

At which point I surprised everyone, myself most of all, by turning around and bursting into tears.

I guess it shouldn't have been such a shock. That I burst into tears, I mean. When you see enough people die, you start to grieve unexpectedly over peripherals--the dog they've left behind, who wonders where its human went off to, the kids who take the news that Mommy isn't going to be around anymore stoically, without really understanding. You can't grieve over every patient you lose, because if you did, your soul would be shredded into little bitty bits.

So you get into peripherals. The news that yet another person you cared for has ended up in the City section, under Obituaries, is met with a "Damn shame, that. Nice guy" and you go on.

What makes a person so indispensible to another person that their death would trigger an attempt at suicide? Is it grief that drives people to down Xanax and Valium and Skyy, or is it fear? Why do the weirdest, least-well-adjusted (at least on the outside) people manage to continue living after somebody dies, and the best-adjusted people with the best support systems just give up?

Those questions end up filed under the same heading as "Why do glioblastomas hit nice people?" and "How come mean people live forever?" There's a folder somewhere labelled "Damned if I Know".

So there's the peripheral for the week, or month, or season. The good wife, the one who didn't want her husband to be alone.

Thursday, November 16, 2006

In which Jo reaches new levels of self-absorption

One thing I have to say to all you back-aching nurses out there, you with plantar fasciitis and aching necks and the whole nine yards:

Hire a trainer, do.

I've had thirty-six sessions with Carol, the Cheerful Drill Sergeant, and I've signed up for seventy-two more. In thirty-six sessions, I have:

*gone from lifting five pounds on latissimus dorsii flyes to lifting ten;

*gone from lifting eight pounds for fifteen reps on bicep curls to lifting fifteen pounds for fifteen reps, or twenty pounds for twelve;

*put on ten pounds;

*lost a dress size;

*and have developed the sort of muscles in my back and legs that make me grin and hug myself.

Carol is about five-four and weighs a hundred and twenty pounds. You would think somebody like me could break her in half until you notice that you can see the muscles move under her clothes the way a jaguar's muscles move under its fur. She tells me happily, three times a week, that I only have to do fifteen more reps of whatever Evil Multi-Muscle Exercise she's brought with her from the depths of the torture chamber.

She reminds me to kick the punching bag higher and not to cheat on form with various weightlifting exercises. She looks grim when I complain about having to get on the stair-climbing machine. She asks me every week if I've stopped eating cheese yet. Occasionally, she tells me, "Good workout" in a sort of offhanded way that is better than trumpets and flags flying.

She doesn't laugh at me when, in an attempt to get a high lateral kick to land on the bag, I miss it completely and go stumbling across the weight room.

More than that, she's helped me get to the point where two things have happened: first, I haven't been sore after a day's lifting patients in weeks. Second, another coworker said something when she thought I couldn't hear her: "Get Jo to help lift this person. We'll need a lot of muscle."

My plantar fasciitis flared up yesterday for the first time in three months. It's better today. The GERD I suffered with is gone. I no longer hurt when I wake up on the third day of working. And I can lift patients safely, catch people when they fall without fear of injuring myself, and beat my boyfriend at arm-wrestling.

It's amazing. I used to be a pizza-and-beer girl. Now I eat lean protein and veggies or fruit five times a day. I used to think, as I was showering on a day off, "Gosh, I wonder what the bar has in the way of tapas tonight?" Now I think, "Y'know, I really need to work on my shoulders more."

I walk with the springy step of a weightlifter. My posture has improved to the point that other people notice. Thanks to weeks of pushups, my boobs now start at my nose: *that's* perky. And I look like I've lost fifteen pounds, even though I'm on track to be the first two-hundred-pound size eight in the history of women's clothing.

Hire a trainer, all you nurses. You'll no longer feel like strangling the nearest resident, much. You'll wake up refreshed at the time you normally wake up grumpy. You'll find a new appreciation for Boca Burgers and salad, though the whole turkey thing might take a little time. Even if you don't give up cheese, you'll feel so much better.

It's about time we recognized, as a group, that our profession demands muscle as well as brains.

I'm going to go off now and...maybe do a few pushups. I've gotten up to fifteen military-style (straight-legged) and would like to work on form.

Weekly Change of Shift is up....

Over at Life in the NHS.

Wednesday, November 15, 2006

In Which Nurse Jo Calls Bullshit.

Anybody who's worked in a hospital in any capacity can tell you that the nutjobs come out right before the holidays. Not *during* the holidays, mind you--that's when the really sick people stay at the hospital rather than heading home--but just before.

I had fourteen patients (counting admissions and discharges) in two days and only one of them was not a nutcase. Unfortunately, Non-Nutcase Guy went home the same day as his admission. He was that healthy. I wish he'd stayed; I could've used the company.

Every nutjob save one had a neurological condition of some sort that defied all manner of scans and testing. One was demonstrating both la belle indifference and arc-de-cercle, but the latter only if she knew someone was watching. Funny thing: the only thing that cured those compulsive backwards archings was repeated injections of Dilaudid.

Another had real problems with formal neurological testing but was functionally fine. Babydoll, if you're walking around in your room with no trace of the shuffles or the sways, you ain't gonna have that bizarre of a neuro exam five minutes later, when the doc walks into the room.

Why, *why* do people always try to fool neurologists? Why not cardiologists or orthopods or thoracic surgeons? Is it that we don't understand the brain the way we do joints and hearts? Or is it that some folks have a special place in their hearts for neurology and its adherents?

I have, in the last two days, been confronted with a patient who claims to be allergic to water. And every antibiotic known to man. *Every* one. They all cause laryngeal edema and laryngospasm, two things that can kill a person if we don't poke a hole into their trachea somewhere south of that swollen, closed-off larynx to allow them to breathe.

But no, I was told, there's no need to put a tracheostomy tray by the bedside. Because, you see, if the patient in question merely holds up this electrical widget to their temple, it will cause their brain to produce chemicals that will keep their laryngospasm from getting bad enough to kill them.

No, really.

I had a patient who claimed to have an anaphylactic reaction to tomatoes. And severe and constantly-changing food allergies that could kill at any moment. And who required a special diet so that their energy fields wouldn't undergo a conversion to a negative polarity.

No, really.

This was, of course, the same patient who managed to put away two Big Macs (which have no tomatoes but which do include Thousand Island dressing, the main component of which is...oh, never the hell mind) in ten minutes, when she thought I wasn't going to notice.

And the one who was allergic to cotton. This allergy was, according to the five-page list of allergies that accompanied the patient, diagnosed by spiral CT scan.

No, really.

And the one who had the rash and hives and difficulty breathing when given oral Dilaudid, but who could handle the IV form just fine. But only just before he went outside to smoke. Because the nicotine from the cigarettes helped calm down the anaphylactic reaction.

No, really.

When I admitted the patient with the oxygen saturation of 88 percent on room air, I tried to put oxygen on her. "Don't do that," she protested. "I'm allergic to oxygen."

I gave up. I left the room on some pretense I don't recall just now.

One of the orthopedic residents found me in an alcove, laughing until the tears ran down my cheeks.

Sunday, November 12, 2006

It's time...to impart wisdomses!

1. If you tell a resident that you'll take care of bowel management for them, not only will he or she sign anything you write, s/he'll love you forever.

2. Don't call at 0300 for a sleeping pill for a patient.

3. White is a magnet for ook of all sorts.

4. Your favorite clogs have just been discontinued, and your favorite pen is about to run out of ink.

5. The cutest bartender is always taken.

6. There is no substitute for dental floss.

7. The volume of ook that will splatter on you is directly proportionate to how much you like the scrubs you're wearing.

8. The doctor who yells at you is actually trying to make up for the size of his or her genitalia. Don't let it rattle you.

8a. Remember that you can go home at seven; they're on call. Smile.

9. The word "pomegranate" never looks like you've spelled it right.

10. If you're a student, don't fret: you'll never use care plans again.

Friday, November 10, 2006


I had a fast-food salad last night.

I've spent the last five hours being very sick.

I'm not taking the CNRN today, obviously.


Thursday, November 09, 2006


I'm taking a moment during one of the commercial breaks during "Grey's Anatomy".

I watched it last week a little goofy, with Chef Boy. He had a nice bottle of Bordeaux.

I'm watching it this week sober.

When I'm tipsy on good wine, I like the show. I mean, really like it. It's touching, even.

When I'm sober, I throw things at the TV. Like slippers. And packets of ranch dressing from Sonic.

That should tell every non-medical person something about "Grey's Anatomy."

Poetry and musings, like

An ode to my fucking cat, Evinrude the Neurologically Deranged:

Why do you pee on the rug?
My house has been filled with your fug.
You don't use your box,
Though it's not behind locks;
Why do you pee on the rug?

Why do you pee on the rug?
I've tried every potion and drug.
The Feliway spray
Only lasted a day;
Why do you pee on the rug?

Why do you pee on the rug?
A permanent frown's on my mug.
I can't have in guests
You small, furry pest;
Why do you pee on the rug?

Why do you pee on the rug?
You're a ten-inch-tall, fourteen-pound thug.
I can't find an answer
To this pee-staining cancer.
Why do you pee on the rug?

Why do you pee on the rug?
You're not a nice cat, you're a lug.
You're so down in my eyes
You might be euthanized;
Why do you pee on the rug?!!!

(Nota bene: I do not intend, under any circumstances except those merciful, to euthanize my cat. From the time she came to me soaked in insectide [Thanks, evil humans!] as a kitten to the day she recovered from distemper, she has been my best buddy. But this peeing on the rug thing is getting to me. I have ordered a carpet steamer.)

(I should note here that Evvie really is neurologically damaged, thanks to the early immersion in insecticide. Until the age of two, she had a disconjugate gaze, which still reappears when she's tired. And she bites. And freaks out for no reason. But I love her. Even though my house smells like a Crazy Old Cat Lady's house. Next time it's wood floors or nothing.)

Musings, like

I know an Irritating Californian who moved to The Great Stars At Night Are Shining Bright State a few years ago, just like the rest of the irritating people from California did. And like the rest of the Irritating Californians, he's helped drive up property values and destroy ranchland with his McMansion.

He recently moved away from the big city into a town that's easily mispronounced and is now complaining about 1) the outcome of the mid-term elections and 2) the weather. These two things are related in a tangential way; trust me.

His big bitch about the mid-term elections is Speaker Pelosi. "As a long-time resident of The Bay Area (tm), " he says, "I dread a Pelosi-led Congress." "I didn't see much of the consensus-building Pelosi you refer to during my time in The Bay Area (tm)." "The thought of Speaker Pelosi, since I lived in The Bay Area (tm), gives me the willies."

Okay. Fine. We know you lived in The Bay Area. You now live in a fully Red state, so you should be happy.

But no. It was 89 degrees deep in the heart today, and California Dreamer had to complain about that, too. "I just don't like waking up to 44* and having it be nearly 90* by the end of the day" he whined.

Look. This state has famously weird weather. It's mostly hot and dry. As the man said, if he owned both Hell and here, he'd live in Hell and rent out the state. This state is known for weather that kills the stupid and preserves their corpses at the side of the road. It's where even the most stoned of hippies knows not to camp under a pecan tree or in a dry ditch, as the one drops limbs without warning and the other fills up with water ditto.

I pointed out that The Bay Area is supposed to be nice this time of year. It did not earn me points.

That's okay. I'm not the one who moved to a small unpronounceable town in the middle of the state and is raving about how countrified it is.

This guy is actually happy that he has goats near him.

On the south side of his property.

I can't wait until August.


The Certified Neuroscience Registered Nurse exam is tomorrow. That is, it's tomorrow in a city far enough away that I have to get up at an even more horrifying time than my usual horrifying awake time in order to get there. Originally, a bunch of what-I-thought-were-my-friends and I had planned to carpool up to The Test, but I was the only one who registered in time, so I'll be making the drive by my lonesome.

And taking a four-hour, 250-question test about the brain and spine and all the marvelous things that can go wrong with them.

I've been studying. But I'm still shocked at how much I've forgotten since my internship. I guess I haven't really seen that much variety in my four years at La Schwankienne Boutique Hospital; perhaps (if I pass) I should parlay the CNRN designation into a job at the Cleveland Clinic. Or Johns Hopkins, where they have that guy who cures gliomas.

Speaking of gliomas, the young mother with a glioma is doing...much better. It's another case of withdrawing treatment to see the patient improve.

There's one thing that won't improve if you withdraw treatment, however: an eighteen-year-old cocaine overdose with attendant heart failure and anoxic brain damage. That was one of my patients yesterday.

I am going to go to every beautiful, healthy young person I know and ask them if they snort cocaine. If they do, a massive ass-kicking will commence without warning. I'm starting tomorrow night at the bar, as soon as I'm done driving back from That Test.

Wednesday, November 08, 2006


I'm sitting here repeating quietly and happily, 'First female Speaker of the House...first female Speaker of the House...first female Speaker of the House...'


First female Speaker?


What the Hell?

Go get 'em, Nancy.

Saturday, November 04, 2006

What's in *your* wallet?

I am looking for a pen. It is, I think, a Pilot G7 with black gel ink and a medium point. It is the pen I use to balance my checkbook. Without this pen, no checkbook-balancin' is a-gonna happen. So I have to find this pen.

It is not in the drawer where I keep the checkbook and check register. It is not next to the telephone. It is not in my purse. It is, most significantly, in the pencil bag I use to hold the detritus of my day as a nurse.

I did, however, find the following things:

1. One five-hundred milligram capsule of acetazolamide (Diamox). Why?

2. One dosepak blister card containing a multivitamin.

3. One each of those little plastic ampoules of albuterol and Atrovent that one uses to give nebulizer treatments. These I remember: Joe the Respiratory Therapist gave 'em to me when I had bronchitis. For a while, I also carried around my own nebs tubing.

4. Two Halls Menthol cough drops, still in wrapper.

5. Three sticks of peppermint Extra gum, not in outside wrapper. I know it's Extra because it's the last gum I bought.

6. A pair of straight forceps.

7. A pair of curved forceps. Why I have these, I don't know.

8. A pair of iris scissors. Ran my finger into the point of 'em just now, ow.

9. Fourteen alcohol wipes.

10. Twelve cotton 2-by-2s in various stages of decrepitude.

11. Three Introcan Safety-W 20 gauge, 32 mm long, 60 ml/min IV needles in their wrappers.

12. $1.26 in small change.

13. An empty acetaminophen blister pack. I took the acetaminophen.

14. Three partially-used rolls of tape, two of which come in those IV start kits.

15. One 14-french red rubber catheter. Unused. I think my coworkers stuck that in there as a joke.

16. Two highlighters, one Sharpie retractable marker courtesy of Lovenox, two Relpax ballpoints, one Viagra ballpoint (nice pen), one ancient Dr. Grip ballpoint, four red ballpoints, and one mechanical pencil.

17. Two penlights. Both work.

No checkbook-balancing pen. Dammit.

Friday, November 03, 2006

Weekend Reading....

I don't know how I missed Retrospectacle, a blog by a third-year PhD candidate in neuroscience.

And, of course, the weekly Change of Shirt is up at Disappearing John's place. He's done a stellar, stellar job with this week's edition--one of the best I've seen. Oh--the Winnah of the Wild Blog Name Contest? OB-GYN Kenobi.

Thursday, November 02, 2006

I stumbled into work on my last day

...and asked one of the patient care techs if "I'm too sexy for this party" was a valid reason for calling in, or if "I'm itching like a man on a fuzzy tree" would play better.

"Depends" he replied. "Do your friends say you're as white as a bug?"

Another nurse chipped in with, "What would the history look like for something like that?"

Somebody else said, "'I held my nose, I closed my eyes, I took a drink?'"

Then the case manager, going to get coffee, pointed out, "The social history would probably say, 'Mama's got a squeeze-box; Daddy never sleeps at night.'"

We all giggled.

"What about the discharge note from the doc?" Carolita mused.

The Accentless Egyptian Doctor (the AED) looked up from stirring his coffee and said, "'Grampa's done got rhythm; the old man throwed them crutches down.'"

*** *** *** *** *** *** *** *** ***

The AED and I have been working pretty closely on one of those cases you hate working closely with a doctor on: a young person who's perfectly healthy aside from the fact that her frontal lobes are eaten up with glioblastoma.

We took a chunk out of her left frontal lobe about a year ago. Earlier this week, just after her 28th birthday, she started vomiting and losing her balance. So her family, aware that there was a golf-ball-sized tumor in her right frontal lobe despite a year's worth of chemo, took her in for an exam.

She was admitted to us with dehydration and went through the MR scanner.

Which showed that, in just about three weeks, the golf-ball-sized tumor had grown to encompass her entire right frontal lobe, most of her right temporal lobe, and a good portion of her right parietal lobe as well.

Plus she's septic. It's a line infection from a central line put in so she could get chemo.

I spent most of Tuesday doing fun stuff like drawing blood samples, getting chest X-rays done, and talking to her family about what, exactly, septicemia means in the context of somebody who has about two weeks to live anyhow. Her dad, the main mover in terms of her care, is deeply in denial about his daughter's chances of either recovery (none) or survival (ditto) at this point. The attending physician had already told him that he (physician) would not order treatment for the sepsis, nor would he prescribe steroids for the edema in her brain. But Dad wanted serial blood cultures and chest X-rays and the like in hopes that they could find something, anything, to give them hope.

He finally asked me what it would be like if they treated the sepsis and she died from the brain tumor. I had the unenviable job of telling the man that first, his daughter would commence to seizing at odd times throughout the day, regardless of the doses of anti-seizure meds she was on. Then she'd probably (hopefully) lose consciousness, and finally, the edema in her brain would cause her brainstem to get squashed, stopping her breathing.

They're going to get hospice. Eventually. Maybe. Perhaps her husband would rather she stayed at the hospital. Maybe her dad will convince him that she needs to go to another facility for more chemo.

With any luck, she'll die of sepsis before the second set of cultures comes back. It would be kindest.

Sometimes I truly, deeply, madly hate my job.