Thursday, January 28, 2010

I want my mommy.

I woke up this morning to Max asking to be let out (lip flip, snuffle, show me his fangs, "Let me out! Let me OUT!") and a headache.

At about 1300, I woke to a huge crash of thunder, followed immediately by Max shouldering open the back door, and the realization that the headache had been joined by somebody who was scrubbing my sinuses and throat with Brillo, a nasty hacking cough, and the sort of body aches and chills that make you long for oblivion.

I have a cold. Not just any cold, but the cold that made the hardest-working patient care aide I know (shout out to PCAs here: you guys have the toughest job ever) leave early from work for the first time in his life. I have the cold that sent me out to the pharmacy in pajama pants and a sweatshirt, and made me wish for the first time that Littleton had package stores, so that I could pick up some whiskey for a hot toddy on the way home. I have the cold that even a hot-water bottle won't cure. I have the cold that makes the edges of your nostrils bleed from constant contact with a hankie.

Plus, I still have the damned headache.

So, if you've commented or emailed or called in the last nine hours, I apologize. I didn't get back to you right away, and I won't be getting back to you for several hours, if not days.

I'll just be over here in the corner, a cat on each side of me, Max looking Very Concerned, wanting my mommy, and snuggling my hot water bottle.

Monday, January 25, 2010

I need some friends in Japan.


I've adjusted well to this night-shift thing, but it's frustrating to be awake at 3:30 in the morning and not be able to interact with anybody else. Normally, I'd spend days off at the used bookstore or the coffeeshop or at the dog park, but all of those places are closed overnight (except the coffeeshop, and who wants to be in a small room with hookahs going at oh-dark-thirty?).

So I've worked up a couple of projects to keep me from going stir-crazy. Nothing like painting the kitchen cabinets (sadly) or mowing the yard (more on that in a minute), but projects. To wit:

First, a review of basic A&P. I've been doing brains and spines so long that I've forgotten what happens in the belly and kidneys. The review we got during internship classes was nice, but not enough. If anybody has any good A&P books to recommend, please leave them in the comments.

Second, physics. I was reminded tonight of the fact that subatomic particles that have begun to dance with one another will continue that dance, even if they're separated by the length of the universe. That fact blew my mind the first time I heard it and charmed me this time; I've decided to start on basic physics. And re-read Bill Bryson's book on Everything while I'm at it. (I only got three-quarters of the way through the last time.) Please do recommend physics-for-the-general-reader books in the comments as well.

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

The funny thing about working nights is that you discover how many people have done it, and how many people are willing to give you advice about it. Pastor Paul next door did an overnight shift a year ago on a crisis line run by his church; as a result, he has lots of tips on how to get through hours of boredom punctuated by moments of intense activity. He offered to lend me his miner's helmet-with-light so that I can mow the lawn in the middle of the night come summer. He did it last year; we both have Neuton mowers, which sound like nothing more than a large box fan on "high", so it's not going to annoy anybody.

The Brother In Beer is working nights these days, too. It's harder on him than it is on me; he's got a crazy schedule that alternates short shifts with long ones. The nice thing about that is that when I get home at 0730 and crack open a pale ale, he's got his chat window open and is doing the same thing.

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

If you need a giggle, check this out: Medical Acronyms and Doctors' Slang. I snickered most of the way through the page, then came out with things I plan to use at the first opportunity, like "acute lead poisoning" and "foreverectomy".

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

In non-nursing-related news, I have birthday plans thanks to my pals in BFE. The way I spent Thanksgiving will be the way I spend my 40th, huzzah, with the addition of a space heater and a down comforter. The cabins out at La Ranchita Skankola are unheated, and it gets cold at night way out west of here. There will be a barbecued goat, some tiramisu, probably plenty of tequila, and possibly some dancing. I plan to stay up late, sleep late in the morning, and drink boiled coffee. The Brilliant Friend has promised much fun; her boyfriend cherishes hopes of setting me up with his brother. It should be a good weekend.

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

Finally, finally, one of my patients was allowed to die this week.

I understand that families have a hard time letting go--that is, I understand in an intellectual way, not having been there myself yet--but this time was horrifying. When you develop a syndrome that barely has a name and that has only been recorded four times previously, all four of which have been fatal, the assumption should be that we 1) won't know much about what's going on, and 2) won't be able to stop it.

It's bad at any time to not be able to help, but it's worse when the person who's sick is eighteen and full of promise.

We ran every drip we could think of to keep her pressures up, coded her seven times in one shift, reset her vent every two hours or so to keep her tidal volumes up, and finally were allowed to extubate her. She died in less than three minutes.

I heard a poet say tonight on the Beeb: "It's difficult to write about a cataclysm and be convincing." The same handicap applies when you're trying to tell the story of somebody young and brilliant and vivacious, who's hit by an unfortunate over-reaction of her own body to an infection that she got when she was a child. I could tell you about how her sense of humor disappeared as she got sicker, or how she got more and more worried about her mother coming to visit, or even how her father and mother--estranged for a decade--sat together on the couch in her room, but it wouldn't be convincing.

At the end, when she was still able to talk (before she was intubated), she was earnest. Everything she said was without unnecessary verbiage or drama; every word counted. Movement was a luxury, so even lifting a hand took on a significance it wouldn't have in the Well World. Yet she still thanked us for little things, like fluffing a pillow or turning her when she couldn't do it herself. She still had the strength to be concerned about her mother seeing her this sick. She still said, "Goodnight" and "Have a good nap" when I went home in the morning.

Sometimes the smalltalk, the passing remarks, become so important. They're the things that keep you connected to a world you no longer live in.

Goodnight, child. Have a good nap.

Sunday, January 24, 2010

Sunday Sushimaking Soundtrack

Margaret Atwood

You Fit Into Me

You fit into me
like a hook into an eye

a fish hook
an open eye

Saturday, January 23, 2010

Hi! My name is Jo, and I'm a moron.

This cat looks suspiciously like Flashes.

Yeah, so. I'm grumbling my way to work on the night shift the other night, wondering why it is that I have to put in some undefined time on nights before I'm allowed to work days.

After all, I'm an experienced nurse, right? I have my routine down; I'm afraid that I'll lose that rhythm on nights, because they're so different from days. And it's not like I don't know the surgical patients in the CCU; I've worked with them now for years and years. Besides, other nurses got to go straight to days, and I know there are openings on days, so why the hell am I messing with my circadian clock?

Grumble, grumble, grumble.

About two-thirty, just as I was meditating on how odd it was to be eating tuna and cauliflower in the middle of the night, another nurse came over and asked the nurse sitting next to me a question about positioning a post-surgical patient.

I realized I did not know the answer.

*Blink* *blink* *blink*.

You can say what you want about me, call me every name in the book, but don't you ever dare imply that I'm a quick study.

After only three soul-crushing weeks on nights, it became apparent to me why they put new CCU nurses on the overnight shift: It's because we don't know jack shit.

There's time on the night shift to think. On days, when I felt like I was slaloming down that double-diamond slope, I didn't have time to think. All I could do was react to things and *maybe* anticipate problems if I had a minute to clear my head. Now I have time to read the charts, form something resembling a synthesis, and actually plan for disasters.

I also have time to, you know, learn the niceties of positioning people with big free flaps covering their whaddyacallits or their humunuhas. I have time to replace the pressure tubing for central venous and arterial lines, over and over, until it becomes routine--and more importantly, I get fast at it. I have time to jack with wound-vacs and figure out how to troubleshoot them. It's not a huge deal if labs get done at four rather than at three. The fiddly business of sterilizing reconnecting a ventriculostomy tubing is less loaded when nobody's breathing down your neck as you do it.

That morning, when the day shift came in, I asked one of the girls who'd gone straight from her internship to day shift if my theory held water. "Oh, shit" she replied, "Starting on days sucked. I was never out of here before eight-thirty or nine at night, I never had a chance to eat lunch or even pee, and I was totally out of my depth from the start. It's only in the last year or so that I feel even halfway confident." So, um, yeah.

If I had the chance to give the internship directors three pieces of advice, those would be these:

First, split the neuro group away from the CV and MS groups. It's a great idea in theory to give everybody an overview, and there's a time and place for that, but it doesn't work to have us all together at the same time. Us neuro babies learned about pressor drips (which we use occasionally, but only occasionally) and nothing about things like hot-salt and mannitol, which we use all the freaking time.

Second, (and this is a subset of item number one) give us more than two days on neuro review. Anatomy and physiology review is all well and good, but the internship as structured gives us very little preparation for what we'll actually see in the CCU on a day-to-day basis. I left that internship with the feeling that if I ever got a patient with a Swan-Ganz catheter, I'd do fine (four days on that), but that if I hadn't seen a neuro patient with a bleed before, I'd be screwed (one day on bleeds).

And third and most important, don't blow smoke about *why* we're placed on nights. I got as many stories about that as there were instructors in the internship, and not one of them was actually the truth: They put us on nights because it's the only place we'll have a chance to really learn stuff. That business about "setting your routine" and "learning the flow"? Is bullshit. The two shifts differ so radically that there's no translating one to the other.

So for now, I'm approaching this whole thing with a new attitude. It may not last through the end of this week, which is crazy as far as my schedule is concerned, but I'll try.

In the meantime, I'm going to make plenty of vegetarian sushi and little bento-box-esque munchies for the middle of the night. After all, I do get time to eat.

Tuesday, January 19, 2010

Eternal questions, 00:50 edition.

Why is it so difficult for you guys to write additional medication orders on the lines provided for that use on the preprinted protocol orders? You write 'em in the margins, you write 'em top and bottom; you will never learn. As a result, I have a hard time telling whether your prescription reads "Decadron 6 mg IV q 4 hrs ATC" or "Fuck you; I'm an ANTEATER."

Why do patients always wait until 0600 to suddenly become totally unresponsive? They then go for a stat CT (shout-out to the dudes who pull 96-hour shifts down in radiology: you guys rock!) which shows that they have no ventricles left, thanks to swelling, and everything has to be done RIGHT NOW.

Likewise, how come two patients always manage to break their restraints at the same time everybody's running around like chickens, dealing with the brain-swelling patient?

Why have you not learned yet, Skipper, that you need to write all the lab orders you want at once? Not that it matters; I learned from working with you on the floor that I just need to yank a rainbow and grab some pee. The lab'll hold onto it until you figure out what it is you want.

Also, I know you guys have a shower and a really nice, spacious, homelike bathroom in the call room. (I slept there once when three inches of ice coated the highways.) Why don't you use it? Remember: fifteen minutes of hot water poured over your head equals eight hours' sleep! And it makes the nurses who have to stand at your shoulder during rounds that much happier.

Why do the nicest patients have the weirdest family members? I don't mean unpleasant or demanding or obnoxious; just *strange*. Like, crystal-hangin', goji-berry-smoothie-funnelling-into-feeding-tube, wild-eyed strange.

And how is it that White Castle burgers taste the same whether you get them out of the freezer case, from the restaurant, or out of the vending machine at County? In the same vein, who the hell invented the coin-operated ice cream vending machine? I would like to kiss that person.

I would also like to kiss the person who invented evening primrose oil, which knocks me out. And so to bed.

Well, *this* is a downside.

I'm awake, and it's 0830 GMT (or 0230 Central Time). Which means that nobody else in the city is awake, except those other poor sots that work nights. And the cats, who are alternately playing Kill My Brother ("I lub my brudder. So I keel heem.") and Cuddle With Max, Thus Freaking Him The Fuck Out.

Thus, I must get sleepy. In order to get sleepy (so I can get my oil changed and my hair chopped and go to Home Depot tomorrow, like normal people do), I am doing the most relaxing things I know:

Did you know Willie Nelson wrote this? I heard an interview with him once in which the interviewer asked him how he'd come up with the "Crazy" lyric. He answered that "Stupid/I'm stupid for feeling so lonely" didn't work as well as "crazy".

Aggressively hopped? I'd say so. With an ABV of 9.2%, this is guaranteed to make you woozy. Plus, it uses Fuggles hops, which is the best reason to drink it. "Fuggles" sounds like the evil stepbrothers of the Wiggles.

And finally, I'm going to go off and read Tam Lin. It's comforting and not as fast-paced as The Phantom Tollbooth, which means it's a better bedtime read.

Monday, January 18, 2010

In Which....

...Jo becomes a sparkly vampire

I was resentful and nauseated at the beginning of last night, but as soon as things got moving, I did fine. The usual two-ack-emma to three-ack-emma slump wasn't even so bad. And I didn't nearly fall asleep on the way home, either.


Never thought I'd be able to say that I did okay on a night shift.

The secret seems to be snacking. I took a variety of weird vegetables marinated in odd substances, some lean protein, and a few complex carbs with me and just plain munched all night. It kept me away from the coffeemaker and awake and energetic.

By the way: Did you know that, in addition to their other good qualities, respiratory therapists make the best coffee? I love me some RTs anyhow, and discovering that they had a pot of coffee brewed from real coffee beans that they'd ground right there in their breakroom just made me love them even more. Especially when it transpired that they had real cream to put in it.

...A milestone's in spitting distance

HN is at (as of this post) nine hundred and fifty one entries. That's almost a thousand. It's within shooting distance of a thousand, at any rate. I feel like I ought to do something special for the thousandth post, but I have no idea what. Fireworks? Dancing girls? Hugh Jackman jumping out of a cake?

...Another milestone's also looming

In roughly a month, give or take, I'll be forty. The thought of turning forty fills me with much less trepidation than the thought of driving out to IKEA tomorrow to return some stuff, but again, I feel like I ought to do something to mark the occasion. I have that day and the day after off of work, so any suggestions as to on-your-own birthday celebrations are welcome.

Meanwhile, I have things to do. None of them, sadly, involving Wolverine covered in buttercream, but a girl can dream, right? Right?

Monday Mellow.

Sunday, January 17, 2010

Sunday Sonnet: Special Edition

Susan Palwick, over at Rickety Contrivances of Doing Good, writes the best blog I have ever read through tears. She makes me both want to write and stop writing.

Bed 5.1

Room five’s for criticals, and has four beds.
The only room that’s scarier is 2,
though many patients here go home instead
of being brought upstairs, to ICU.
This corner’s where I first saw someone dead.
We’d prayed; her voice had vanished, but I knew
from her expression what she would have said
could she have spoken: “Help me. Help me! Do
you understand?” A dying cat once stared
at me like that. I held her hands and prayed;
she struggled less. But later when I went
to check on her, the patient wasn’t there:
a cold corpse lay, eyes open and afraid,
fixed face a mute mask of abandonment.

Friday, January 15, 2010

Friday "Gracious!"


The first night was weird. My brain and my body disagreed vehemently on what time it was, and I felt very odd all night.

The second night was torture. I didn't know it was possible to feel that bad physically and still be vertical and productive.

Last night was...not so bad, actually.

I might just be able to do this working nights thing for a little while. I'll never be a natural night person, as my body-clock says "Wake up at 0400; go to bed at 2100", but I think I can, I think I can, at least until somebody goes on maternity leave, or something.

The possibility of having to work nights during the summer leaves me cold with fear. How anybody could ever work nights in a state with the hottest and brightest sunshine I have ever seen is beyond me. But for January, February, and probably a little of March, when it's rainy and cloudy most of the time anyhow? Count me in. I can doooo eeeeet!

Nights are weird, people. In a hospital, you're insulated from the rhythms of the outside world anyhow, but at night, it's even more pronounced. The morning rush starts at 0130 down at Big Brother Bruce's Bargain Brain Barn, with CT scans and MRI and morning labs and what-have-you. That means that the first hour of the shift is busy, the middle of the night is most definitely not, and the last six hours of the night vary from steady to downright insane. That's the opposite of how it works during day shifts in the Sunnydale CCU, and that's been the hardest thing to get used to.

Night people are weird, too. There's a certain breed of person who's meant to stay up all night and sleep all day. They don't do well on days (can you imagine? I can't) but are cheerful and helpful and ready for pizza at two ack emma. And they're all a little off. Intelligent, pleasant, good company....but a little weird. They don't see anything odd about listening to Morning Edition when they're on the way home from work, or buying beer at 0700. (That was my greatest discovery: at the end of my second night, when all I wanted was a beer and my bed, I discovered that you can buy beer here before sunrise on weekdays. Alors!)

The trick is going to be sticking on this schedule when I'm not working. Attila is coming over this evening, after which I plan to take myself out for a celebratory dinner. Tonight I'll sleep; tomorrow, I'll take a nap in the afternoon and stay up all night (thank God for 24-hour grocery stores), and Sunday I'll sleep all day. I work again Sunday night.

Oh--did you know (again, a revelation to me!) that there are BARS that open at SIX A.M. and serve BREAKFAST and have HAPPY HOUR?? I mean, I'd read about that in books, mostly books set in London near the docks, at the turn of the century, but I had no idea that the Green Door or Louie's served eggs-your-way and a vodka martini at eight in the morning. Monday morning, since Sunday is a one-off, I'm going to hit Bigtown's most venerable lesbian bar, which serves a breakfast buffet on weekday mornings, then go trolling salvage shops for 1/2" knobs for my desk.

It's like a vacation in a foreign country, but I'm getting paid. Very, very weird.

Monday, January 11, 2010

My plans for tomorrow night:

How Jo Plans To Stay Awake During Her First-Ever Night Shift; or, Disaster Comes On Little Cat Feet

1. Nerves. I figure nerves will carry me from 1900 until about 2200.

2. Coffee. I can drink a cup of coffee at 2230 and stay awake until well after 0200, at which point there are...

3. CT scans and MRIs to haul patients down for.

4. And when I get back from those, there are baths to do.

If all of the above fail, then....

1. Food. I've been warned by a number of people not to forget to eat while I'm on nights; apparently, this is a big problem for some folks. Not sure Mama's gonna have a problem with that, but I'm taking an omelette and a salad with me anyhow. (Actually, that sounds pretty good right now, too.)

2. Sports. Everybody on night shift is on some sort of fantasy football team. Even though I don't watch sports or follow them at all (except for Olympic curling, which I love because it's just so weird), their chatter will keep me awake.

Which brings me to the fact that our CCU is essentially oval. On the back wall is a single automatic-open door leading to the back hallway, which has things like the dialysis rooms and outpatient lab collection and the lab and so on on it. The front side of the oval, as it were, is the CCU. With an oval floor layout, you can have....

3. Curling. Steal a whisk broom and a push broom from Housekeeping, snag the tea kettle from the break room, and put some tape lines on the floor. Presto: your own indoor, ice-free curling arena! And if that's too north-of-the-border for my colleagues, an oval layout also lends itself to....

4. Roller Derby. This might be the opportunity I've been waiting for all my life. I'd make one hell of a blocker and might even work as a pivot, you know? Plus, I have a name all picked out: Miss Ann Dree. Get it? It might be a little work to get Steve, the six-foot-five ex-Ranger to play on a mostly-girls' team, but I think we could make it work. If all else fails, we could have two sides of three each and he could referee.

5. Boys! And girls! The nurses at night play "Which resident is least loathsome?" (answer: Not Dr. Dweebo) and "Which movie star makes you want to stab your eyes out the least?" Most of the day-shift CCU nurses are gay; most of the night-shift CCU nurses are straight. Do not ask me why this is, and don't ask if it's a common thing; I don't know. Anyway, going from one to the other should give me plenty of thought-provoking answers.

6. FORKS IN A DISPOSAL!! This is the favorite game of the nurses on days. Whenever things get too rough, too tough, too stressful, or too emotionally-charged, we all go into the back and do a quick run of Forks In A Disposal. Essentially, you hop up and down with your hands in the air, yelling "Tink-a-tink-a-tink-a-tink-a!" and going in circles until everybody falls down laughing. I look forward to introducing this concept to nights.

7. Tooth-Whitening and Cuticle Care. I once asked Friend James how his night was, and he replied, "Oh, great. I got to do my tooth strips and a manicure, see?"

8. Boomshine, Bubble Blaster, and Bejeweled. 'Nuff said.

9. Facebook. I mean, what was Facebook invented for, if not long night shifts when both of your patients are on floor orders and everybody else is intubated, including your coworkers?

10. ...aaaaand here is where I run out of ideas.

I'm really kind of nervous. I mean, on the one hand, it'll be nice to get to nap frequently and well tomorrow, with the excuse that I'll have to be up all night tomorrow night, but on the other...working nights is a different feel, a different schedule and rhythm. I'm not sure that my natural hyperactivity will work well with night shift.

I've never been happier than this past week at work, when I felt like a barely-adequate skiier confronted by a double-black-diamond slalom. I had everything just barely under control--with a whole, whole lot of help when the shit hit the fan--and was loving every second of it. Long stretches of not a lot to do is the primary reason I left the floor for the CCU.

Oh, well. Attila's been kind enough to give me a list of easy-to-do, no-equipment-necessary exercises that are guaranteed to wake me up and make me a laughingstock, so maybe I'll just do those in the middle of the night. Hell, maybe I'll haul in my twenty-pound bells so I can do oblique crunches and lower-back exercises at 1 am.

Wish me luck, Fearless Readers. I think I'll be needing it.

Sunday, January 10, 2010

Blessings, blessings

Girls in white dresses with blue satin panties;
Stock distributions from elderly aunties;
Wild Turkey, Jack, and CDs of the King
These are a few of my favorite things!

Wait...those aren't the lyrics?

Well, okay then. Try this:

A strange new olive-green bird in my pecan tree this morning, about the size of a titmouse. He (or she) had a mate (or friend) who looked exactly the same. Ruby-crowned kinglet? Maybe.

The cormorants, speaking of birds, are back. Even in sub-zero temperatures, they sun themselves, wings spread, around the ponds and stock tanks here.

Pecan-and-cinnamon sour cream coffeecake in the oven. Enough homemade refried beans to last a month. Coleslaw.

Clean laundry, happy dog, acrobatic cats. The small, less-acrobatic one got stuck atop my dresser this afternoon and mewed until I came and rescued him. His brother sat by, looking disdainful.

Good neighbors. Mine watched Max-Zoats when the high was eleven and the low was too low to bear thinking about.

Warm enough weather (42*) to open the windows and blow out whatever it is that's been making me sneeze lately.

I went to a funeral today. The woman whose funeral it was found Jesus in a big way, just before she was diagnosed with a right temporal glioblastoma. I'm glad her family doesn't know that the primary sign of a problem in the right temporal lobe is religious hallucinations.

Still, it was a good funeral: laughing, singing; I'm glad I wore shoes I could dance in. The little church on the bad side of Bigtown was rockin' like the church Dr. Teeth and The Electric Mayhem inhabited.

This was one of her favorite songs. I have a minor disagreement with my beloved Brother in BFE about worshipping the Eternal; he prefers formal, ritualized, (to me frankly cold) Anglican incense-burning. Church is one of two places I want to really let loose, so give me big voices, drum sets, and dancing.

When I die, have a gospel funeral, please, for the nerdy white chick who throws the "Live Long And Prosper" sign back to her black coworkers who hit her with the Westside.

Sunday Sonnet

Edna St. Vincent Millay


If I should learn, in some quite casual way,
That you were gone, not to return again --
Read from the back-page of a paper, say,
Held by a neighbor in a subway train,
How at the corner of this avenue
And such a street (so are the papers filled)
A hurrying man -- who happened to be you --
At noon to-day had happened to be killed,
I should not cry aloud -- I could not cry
Aloud, or wring my hands in such a place --
I should but watch the station lights rush by
With a more careful interest on my face,
Or raise my eyes and read with greater care
Where to store furs and how to treat the hair.

Saturday, January 09, 2010

And a bonus recipe! Auntie Jo's pick-a-little, drink-a-little, open-a-couple bags corn chowder!

Right. First you need to pour yourself a glass of something. Scotch is my preferred drink when the high (as it was today) is sevenfuckingteen degrees.

Dump a little olive oil in a big pot.

Open a bag of chopped, frozen onions-and-celery you got at the grocery store. (What?! They were three for a dollah!)

Dump it in there when the oil is warm and let it cook, covered, while you:

Chop up four Yukon Gold potatoes (peeled, if you're me and can't stand potato peels)
Chop up a container of smoked ham
Mince two cloves of garlic
Chop up four carrots, or open a bag of pre-sliced, frozen carrots, also three-for-a-dollah.

Dump all aforementioned veggies into the pot. Let them sizzle for about ten minutes, then add:

One half carton of unsalted chicken stock (this part is important. Salty chicken stock will make your finished product inedible.)

Allow to simmer until the potatoes are almost translucent all the way through.

Pour another glass. Savor.

Add two bags of frozen corn and about three cups of milk.

Drop in two bay leaves and a few grinds of black pepper.

Simmer. For two hours. While you talk on the phone to Pal Kelly and solve the problems of the world.

Eat. With the biscuits you made earlier.

Feel sorry for all the people who are weatherbound and who do not have this marvelous corn chowder to look forward to.

What to bake when it's seven freaking degrees outside.

You have two choices: biscuits or coffeecake. Either one is tasty and both will keep the oven on for a while.

Biscuits first (adapted from Mark Bittman's How To Cook Everything):

2 cups all-purpose flour
3 teaspoons baking powder
1 teaspoon baking soda
1 teaspoon salt

6 tablespoons cold butter, cut into small bits

about a cup of yogurt (I used nonfat and it was fine), maybe a little more.

Whisk the dry ingredients together. Cut the butter into that mixture until the whole mess becomes relatively uniform. Dump in the yogurt and mix until it all comes together in a nice, shreddy, soft ball.

Knead a couple of times--no, seriously, I mean a couple only--on a floured surface, then pat or roll out to about 3/4" thick.

Cut into 2" rounds with a biscuit cutter and bake in a preheated 450* oven until the tops are brown. Reroll and cut the scraps. I ended up with about sixteen biscuits.

(NB: Do not make these any larger than 2". They'll turn out all weird and spongy if you do. Also, handle the dough as little as possible. These are fantastic with strawberry jam.

And do not burn yourself as you take these out of the oven, like I just did.)

Coffeecake That Takes A While But Is Totally Worth It

Mix up:

1/2 cup brown sugar
1/2 cup all-purpose flour
3/4 teaspoon cinnamon
1/4 teaspoon salt
a sprinkle or six of nutmeg
1/2 stick unsalted butter, cut into chunks

Cut all these ingredients together until the whole mess looks sort of sandy. You can also melt the butter and mix it up that way. If you like, add some broken pecans or chopped walnuts, too.


2 cups all-porpoise flour
1 teaspoon baking powder
1 teaspoon baking soda
1/2 teaspoon salt

and set aside.

In a big bowl, with a mixer, cream

1 stick butter, softened, until it's fluffy.

Mix in

1 cup brown or white sugar, or a mixture
3 large eggs
1 cup sour cream or yogurt (or I use buttermilk; adjust it so the batter isn't too thick)
2 teaspoons vanilla

Now dump in the flour mixture and mix until it all just comes together. Pour half into a greased-and-floured 9" square pan (or a Bundt pan if you're feeling foncy) and sprinkle on half the streusel mixture. Top with the rest of the batter and the remaining struesel.

(I always make extra streusel 'cause I like it that much, yo.)

Bake at 350* for about an hour, or until the edges of the coffeecake just begin to pull away from the sides of the pan. Wrap it in plastic, avoiding evil midgets, to store. DO NOT use aluminum foil, as the acids in the sour cream/yogurt/buttermilk will eat through the foil.

Sometimes, instead of nuts in the streusel, I add a couple of apples that I've cut into eenbeeninesy pieces. Don't top the coffeecake with the apple mixture; just put 'em in the middle layer.

Or you could throw in some chocolate chips.

Or maybe a cup or so of blueberries.

Don't make any plans for the rest of the day if you make this coffeecake. It's good hot, it's good warm, it's good stored in the refrigerator and then toasted. You'll want to spend the whole day just nibbling on it.

Friday, January 08, 2010

Jo Makes A Public Announcement; or, Dude, I'm Baggin' It.

I am done.

Absolutely done.

Kat and Denise and Marcie and I were sitting around during down-time yesterday, talking about how difficult it is to date these days. Kat's recently engaged, Denise is happily single, Marcie is in a happy partnership with another woman, and I...well.

Dr. Dweebo walked past and cocked an ear. Later, he pulled me aside.

"Your problem," he began, "is that you seem too smart. That's intimidating."

*blink* *blink*

The person who is intimidated by me, in the words of a Jezebel commenter, is probably also intimidated by loud gusts of wind and squirrels. In high school, I was voted "Most Likely To Become A Muppet". I am clumsy, silly, and have big eyes that tend to google around in circles during serious moments. Most of the time I'm unaware of what my face is doing. I trip over things. I drop food down my front. If I'm intimidating, so is a teacup poodle puppy.

Besides that, Dr. Dweebo, *you,* the critical care attending, telling *me* that I "seem too smart" is making me want to prove to you just how smart I am.

For instance, you should pick one: expensive, fashion-forward Italian sunglasses, Velcro-fastened shoes my seventy-four-year-old father would not be caught dead in, or a badly-groomed moustache. You can't have all three and expect to be taken seriously. Oh, and wash your lab coat. It's grimy.

And "seem too smart"? Seem? Seem?

(Y'know, the more you type the word "seem", the less like a word it looks. But anyway.)

So I should "seem" dumb? I should let you make all the jokes, even when you lob a ball so gently over the plate that I can count the stitches as it glides past?

Looking around at myself today, after I rewired an outlet and fixed the toilet and dug up a couple of garden beds in the twenty degree weather, I decided to bag dating. Frankly, I'm not sure dating at nearly-forty is a good idea. I'm certain that if an accomplished, intelligent person who has a good grasp of one of the most complex subjects on the fucking planet thinks I "seem" too smart to land a man, I don't want a man.

The alternative is just too depressing. If I lose X amount of weight, grow my hair to Y length and keep the grays under control, wear Z brand of makeup and perfume, then I can land a man.

A man who, to be blunt, prefers childish bullshit and emotional back-and-forthing with somebody who *seems* feminine and delicate, but who's actually a passive-aggressive leech who will suck the joy out of life. Men in their late thirties and early forties seem to want women who either love Teh Dramz or who are glorified trophy wives. I don't need that. If you want somebody too weak to stand on her own two when presented with the perfect opportunity, then to hell with you.

People who are afraid of egalitarian, reciprocal, *intelligent* relationships need not apply, and they're not. So the subject is tabled until I hit my fifties, or until some miracle occurs and the Universe works a change in everybody involved, including me.

I can and do kill my own bugs and mice. I can and will rewire a lamp, put up a ceiling fan, and fix a hinky outlet. I can and will replace my own car battery. Although I've never changed a tire, I know who to call when the *^$&*( lugnuts are too tight for me to loosen by myself. I make my own money, am planning for my own retirement (with Airstream trailer, outfitted in the latest retro fabrics and cabinetry!), and pay my own bills. I use subjunctive case correctly. I have close friends of both sexes and all ages from fourteen to eighty. I think I'm doing okay.

Actually, I'm disappointed and bitter just at the moment. But that will change. And, at the end of the day, when I'm less disappointed and no longer bitter, I will still not be dating somebody like Dr. Dweebo, so it's a win all around.

Bad, Bad Choices.

Texas isn't exactly known for its mercy toward the poor. Medicaid is almost impossible to get onto here, food stamps are even tougher, and medical services for people too rich for Medicaid and too poor to afford a doc are practically nonexistent. As bad as my state's attitude is, though, there are states that are even worse--and those states send their neurosurgical patients straight to the Sunnydale CCU.

She was a great-grandmother and not even fifty. Three decades of poor nutrition, nonexistant dentistry, crappy medical care for her hepatitis, and cooking meth to feed her ever-growing number of kids had left her in quite a state. She came to us with three abscesses in her brain, a pseudoaneurysm in one carotid artery, and a mycotic aneurysm that had blown out in a spectacular manner, leaving her mostly unresponsive. We put her on three different antibiotics, two different drips to keep her blood pressure up, and clipped off what we could of the aneurysm.

Her family kept showing up, all of them living in one room of the short-rate motel two blocks from the hospital, all cranked out of their fucking minds. Not a one of them, except her youngest daughter, had the slightest idea that things might be really, really touchy and bad. Nobody seemed to understand that no, she wasn't in a coma, and she wasn't just going to wake up and ask for a Coke if they talked to her. Eventually, either because they ran out of money or ran out of meth, they all went back whence they came--except for her youngest daughter.

She'd taken care of Mama for the last three years, in between taking care of her own firstborn and getting pregnant with a second. When Mama didn't take her lactulose and her ammonia went up into the one-twenties, it was Youngest Daughter that called the meatwagon and got her to County. When Mama's meth lab blew up in her face a few years ago, it was Daughter who learned how to change the bandages on Mama's arms.

Daughter, contrary to what I expected, was incredibly sharp. Ignorant as hell, but by no means stupid. She had no clue as to what the basic anatomy or processes of the human body were, but once I explained things to her in fairly simple terms, she caught on immediately. More than that, she drew the correct conclusions about what was happening to Mama and what was going to happen, and was sensible about them.

I thought about her--the daughter--last night when I couldn't sleep. The odds are against you from the get-go if your mom had her first kid at fourteen and those kids have kids that are as old as you, her last child. Between the amphetamines, the men coming and going, the near-certainty of domestic violence, the lack of cash for groceries, it would've been easy for her to have had five kids by eighteen rather than just two, and that last with a guy who seemed pretty stable. Not one person in a hundred would be able to get past the handicap of being a poor, Midwestern, meth-cooking-trailer-trash-high-school-dropout statistic, but at least she had brains.

At one point, as we were talking about Mama's chances of survival (dismal) with her family, I wanted to grab Daughter and drag her out into the hall. "Ditch the weed until you can piss clean for a drug test," I wanted to say, "then get your GED and have somebody watch your kids while you do a two-year RN program. You can earn seventy grand a year, get out of that shithole you're living in, and send your kids to college. You're an extraordinarily smart woman. You can *do* this."

Maybe I will, if she's there when I get back.

Thursday, January 07, 2010

My proudest moment this week...

...did not come when I did a pre-emptive panculture on a patient whose temperature never hit the panculture protocol point (say that five times fast), but whose temp was rising fast, and whose pancultures showed positive results this morning,

...nor did it come when I caught a med error that would've resulted in certain disaster,

...nor did it come when I explained a complex neurosurgical problem in words a five-year-old could've understood (more on that later).

It came when three of the best neurosurgeons in the country were fumbling through the new computer system, trying to figure out how to get to a particular note in the chart. Dr. Teeth asked for my help, so with three clicks and a scroll, I showed them all how to access what they needed.

"How did you do that so easily?" demanded Dr. Teeth.

"Gentlemen," I replied, "This is not brain surgery."

Monday, January 04, 2010

In which Jo gets totally girly:

What Jo has in her hair right now:

What she's considering buying for the spring:

What astonishes her:

What makes her drool, drool (especially if worn with a simple white salwar kameez) (remind me of this if I ever decide to get married again, especially if it's in Texas in the summer):
And what she is wearing on her toes this very minute. It's considerably darker on than it is in the bottle.

That is all. I go back to work tomorrow; this girly-time is a necessary mental health moment.

Off the leash

Well, I'm done with my internship, off the chain, on my own, riding without training wheels, a danger to myself and society.

Six weeks ago, I felt like every day at work was like trying to climb up an escalator covered with bacon grease while somebody yanked on my shirt-tails at random moments. Now I feel like a barely-adequate skiier slaloming down a slope rated for Olympians. If I just go with what's happening, don't think about it, and don't try to look too far ahead, I do just fine. It's just a matter of not relaxing, of doing things right when I get the chance, and of being as efficient as possible.

Which is frustrating. It's hard to go from an area where you've been able to know without thinking what needs to be done, where the synthesis is second nature, to an environment where you have to stop, think, and double-check that you're even asking the right questions.

The head of the CCU internship program for Sunnydale and I had a conversation about that the other week. She wasn't exactly encouraging about my progress (though I thought I had done pretty well), and she expressed some serious doubts about my ability to form a comprehensive picture about my patients and anticipate/prevent problems. I left that interview feeling about three inches tall, until two things happened:

1. I realized that I cannot possibly be expected to think like an experienced CCU nurse yet. Fourteen weeks is barely enough time to review the things you have to review to keep from hurting somebody in the unit, let alone learn how to integrate all of those things into a cohesive whole. Everything right now is going to be task-based, and I'm going to feel like a complete idiot for a while, and that's just part of the learning curve.

2. The other interns in the program said that they'd had the exact same meeting with the head. The upshot of everybody's discussions with her was that she felt we're all safe nurses, but she's encouraging everyone to ask lots of questions and get help when they need to (collective "Duh"). In her defense, she's been a CCU nurse for about twenty years, so I think the thought processes involved have become so second-nature for her that she can't get into the headspace of a new nurse/new CCU nurse. Anyway, I felt better about the whole thing after we all got together and looked blankly at one another.

After the last couple of days on the floor, during which I had two not-really-critical patients who quickly turned critical, I feel more confident about my ability to at least keep people alive. Right now it's more a matter of being fast on my feet (as my Sainted Mother says) than of being a really good CCU nurse, but I'll settle for that for the moment. One patient yesterday shook off the propofol and Versed and tried to extubate herself in a particularly creative manner while shooting liquid stool all over the place, and the other had a fistula between an abscess and an artery break loose near the end of the shift, but I still got out on time and gave a good report.

As I was leaving work, passing the very last computer monitor on the very last computer cart near the furthest edge of the station, the monitor on that cart suddenly caught fire. I did not stop, I did not look back, I merely kept walking. That, my friends, is what the CCU is like.

Friday, January 01, 2010

And on a more optomistic note....(informal recipe roundup!)

I made the best damn blackeyed peas today. I swear. All vegetarian, low-salt, and nummy.


The leftovers of a can of low-salt tomatoes, diced
One and one-half bags of frozen blackeyed peas
Half a red onion, minced very finely
A handful of garlic cloves, chopped or not, depending on how garlicky you like your peas
About a teaspoonful of dried thyme, crumbled up in your hands
Enough water to make a soupy mix

...and combine in a large saucepan. Allow to simmer for forty minutes, minimum, and up to two hours (if you forget about it and start doing other things like I did). Eat. Nom!

I just realized that this is my last week on days. I work four days this week, then have four days off, then start nights with the remaining three shifts in *that* week. As a result, I've planned a number of things I can do right when the sun comes up (when I'll be getting home) and overnight, so I can adjust my body clock.

One is work out with Attila. That's a given.

One is yardwork. The stinkin' catalpa tree in the front yard lost all its leaves in one big whump, which means I have gobs of big, flat, nasty, non-decaying leaves all over the front beds. Plus, I have to cut back the butterfly bushes. Plus, I have to find something to put in the front pots. Bare pots with dead things in them are bad mojo on your front steps.

One is cooking*. All night long if necessary, interspersed with the books I plan to pick up on Monday from the used bookstore. If I need to, I can even refinish my dining room table over the course of a night, in order to stay awake.

I'm planning sausage-and-poblano-stuffed chicken breasts, Russian sour cream coffee cake, several different kinds of bread (not all for me, sadly), a lasagne to freeze, and maybe some of the trickier recipes from Cooks dot com, like tiramisu. If you have any time-consuming, niggly, detail-laden, and ultimately delicious, lunch-packable recipes to share, feel free to email me. Link is to the right.

I might even make biriyani without the spice mix: instead, mixing up my own spice mix.

Or not. I'm dedicated to resetting my circadian clock, but I'm not sure I'm *that* dedicated.

*January 8th through 11th! Come one, come all! I have a guest bed, a loveseat, and plenty of floor space. Bring your cooking utensils!