Thursday, September 30, 2010

Yeah, so. A little more detail, like you need it.

I need a moustache. Or a pair of those Groucho glasses, so I can wear them as they wheel me into the OR.

The surgeon I saw today--and I wish I hadn't already used the name "Dr. Heron"--reminds me of a large wading bird. He has a shock of untidy brown hair, a nose two sizes too large, and stands about six foot five. Most of his height is in his legs, and he stoops, so the general effect is that of a drab crane with bunions. He's sweet and shy and quiet, but then comes out with something dryly funny and a nice grin that makes his face all wrinkly. In other words, he's nothing like what he seems in the unit.

Dr. Crane stuck flexible tubes up my nose and into my sinuses, fiddled around and took some pictures, and gave me the following news:

1. The CT showed absolutely zilch. Given that the tumor isn't highly vascular, this comes as no surprise at all. Near as we can tell, it hasn't invaded the bone, though, which is good.

2. It takes up a surprising amount of my soft palate and is invading my sinus. Again, no shocker; that's pretty typical tumor behavior.

3. He's not certain that the lymph node he saw is nasty because of cancer, but better safe than sorry, so we're going ahead with the biopsy. Yee-haw.

4. It's weird that nobody noticed this last year during my exam.

5. He's seen enough of these tumors to know that some people die from them.

That last point is reassuring rather than otherwise. Most surgeons in most places--even ENTs--haven't seen that many minor salivary gland tumors. And most people don't die from 'em. To have seen enough to have had patients die is an excellent thing; it means that he'll be able to resect this little bastard totally and know what he's doing.

I might lose some teeth (minor concern). I will certainly have what Dr. Crane termed a "great big hole" in my head (moderate concern). I will certainly have to have wide external-beam radiation (major concern). All of that, though, is in the future--and it's a future that won't be determined until I get the MRI and PET scan.

The upside of all of this is that I got a prescription for one five-milligram tab of Valium to take before the PET. I'm not usually a huge fan of benzodiazapenes, but this one I'm looking very forward to.

Tired, so reprinting the mass email I just sent....

The good news is that my hearing is normal, my mouth is okay, though my uvula (that little dangly-down thing at the back) is purple for some reason, and my left sinus is clear. The not-fun news is not fun.

The tumor (heretofore known as Cap'n Lumpy) has vascular (blood vessel) and nerve involvement. In the doc's opinion, that means that it's likely a higher grade (read: nastier) and more likely to metastasize or recur than your average, every-day, extremely rare freaking tumor.

Plus, I have a lymph node that looks suspicious.

So. In addition to the MRI that I have to have (because my CT yesterday showed exactly nothing except a possibly suspicious lymph node), I will have to have an ultrasound-guided biopsy of the lymph node with a pathology read right then and there, and then have a PET scan. For you non-medical types, neither of these is as scary as they sound. An ultrasound-guided anything merely means that somebody will be sticking a little wand up to my neck and locating the lymph node by echolocation, like a bat does, so that the dude sticking the needle into my neck gets a sample of lymph node and not just some random tissue.

A PET scan is not what my animals do every morning to see if I'm indeed awake. Instead, it's a kinda-cool whole-body scan that uses radioactive sugar water to see if the cancer's spread. See, cancer cells multiply at a much higher rate than normal cells, so they use more sugar, which is the basic fuel of every cell in your body. I'll be injected with radioactive hummingbird food and scanned from head to foot. When you do a PET scan of cancerous tissue, it lights up like New York City on New Year's Eve. Normal tissue looks vaguely glow-y and drops into the background.

I'm no dummy: I know that a PET scan is not the usual MO when faced with this type of cancer.

Now, then: On to surgery.

Surgery is scheduled for October 20th.

It will take anywhere between two and four hours and will be, thank God, a transoral (through the mouth) approach. There is a chance I'll have to have my neck dissected, to get out the lymph nodes, but I won't have to have a breathing tube placed in my neck or a feeding tube placed in my stomach, thank God. I could've done all of this just fine, but a tracheostomy (breathing tube) would be freakin' pushing it.

I'll stay in the hospital for a couple of days, long enough to get good pain control and be able to take fluids. I'll be fitted with something called an obdurator, which will be placed during surgery and cover up the very big hole that the surgery will leave in the top of my mouth.

Now, then, as to the obdurator: (Medical folks can skip this; you already know all this stuff.) This surgery will take most of my soft palate and a portion of my hard palate on the right side. It might also take some teeth, but that's a minor concern.

The reason this is important is that your soft palate keeps you from either choking on food or squirting it out through your nose every time you swallow. With a big hole there, things tend to go wrong fairly quickly. Hence, the obdurator: it looks a bit like the top of a retainer, minus the wires, and covers up the big hole. Hi presto, and I won't have liquids squirting through my sinuses! I will wear the obdurator for a year, then have reconstructive surgery if I wish.

Meanwhile, there's the whole radiation angle. I won't lie to you: head and neck radiation is nasty. It's nastier than the surgery itself, and has a lot of really huge downsides. Unfortunately, tight-beam radiation or implants are not an option in this case, as there'll need to be a good "scatter"--in other words, I can't have targeted radiation because it might miss some cancerous cells. Instead, I'll have classical external-beam radiation that will screw me up for a good while--probably at least six to eight weeks.

Thankfully, I'm already forty pounds overweight. This means that any weight loss--and there'll be some, so don't be surprised if you see me looking skinny--won't be the desperate situation it would be in somebody of more normal weight. There will be lifelong side effects of the radiation to deal with, but that's a bridge I'll cross later.

So: October 20th, two to four hours, two-day stay in the hospital (probably on the fifth or seventh floors, my home turf at Sunnydale). Obdurator, which will be a pain in the tuckus and probably make me lisp, for one year after. Undetermined amounts of radiation to follow surgery. MRI, PET and lymph node biopsy between now and October 20th.

Wednesday, September 29, 2010

Me; My Sister:

Me: My cancer is a pussy-ass wimpy cancer.

My Sister: Your cancer is going to renaissance festivals.

Me: My cancer has a drawer full of twelve-sided dice.

My Sister: Your cancer watches QVC, and buys stuff off of it.

Me: My cancer lives in its parents' basement.

My Sister: Your cancer wears a three-wolf shirt unironically.

Me: My cancer forwards emails.

My Sister: You win.

New month, new *sigh* residents.

I feel for 'em, I really do. They've spent time over at County General before coming to Sunnydale, and the doin's at County are both much more severe and much more boring than the ones here in the Hellmouth. Whereas at County you might see fourteen TBIs a day in the trauma unit, at Sunnydale, you'll see two cases of God Only Knows What. Both of the GOKWs seem stable, but in reality, they're just as prone to crump as the donor-cycle riders next door.

It's an adjustment--for me and for them.

Case in point: I had a patient this week who came in fine and dandy, stable as the rock of Gibraltar, and then (about six hours after admission) began to decompensate in a truly spectacular way. Now, keep in mind that my CCU, being mostly neuro and not post-surgical, doesn't have a lot of the Machines That Go Beep ready to hand. Therefore, when somebody who was breathing twelve times a minute begins to breathe twenty, your Spidey-sense starts to tingle. When that respiratory rate goes up to thirty, your hair catches fire.

When it's up to forty, with the patient retracting all the accessory muscles they have, you intubate. End of story. Never mind about the urine (they're not making any) or the blood pressure (systolic palp; no reading on the machine) or the change in neuro status: it's the airway that I'm primarily concerned about, and this dude didn't really have one. As in, his ABG showed a CO2 in the 90's and a normal bicarb. (Note for non-medicals: that means you're suffocating in your own carbon dioxide, and your body hasn't started to fix the problem.)

It wasn't really his airway that was compromised, to be honest: he simply didn't have any muscular strength below his neck. Damned if I know what his problem will turn out to be; all I know is that he's no longer *my* problem, because the kindly anesthesiology guy came and intubated him and took him away to MSCCU.

Before this, of course, came the Dance of the Uninitiated Resident. Other Jo and I paged, and got no response, and paged again, 911 this time, only to have the resident call back in response to the first page. At which point I cheerily informed him that we were intubating his patient right then, with the cart at the bedside. He came rushing up (I will say this for this new class: they're much fitter physically than the last one. He ran all the way from County and wasn't even breathing hard.) and insisted that we assess the guy's respiratory effort before sticking a tube down his throat.

Other Jo and I looked at each other, looked at the anesthesiology resident, and said in unison, "Tube him." Then Jo handed him a bougie and I continued to insert the foley/start additional IVs/etcetera.

After we got Not-Breathing Man down on a vent, the resident protested the intubation. "He was fine when he came in, and he was fine when I saw him two hours ago! Don't you guys think you were a little hasty?"

Other Jo and I looked at each other, looked at the resident, and said in unison, "No."

Because, you see, shit happens with people who look stable as rocks. Neuromuscular disorders can rob you of your sight, your hearing, your ability to move or breathe in as much time as it takes to type up a post on your fantastically popular nursing blog. The tricky thing is that they look perfectly healthy--unlike the patient in Trauma Bay Six who has half her head gone.

It's a learning curve. I don't get annoyed with the residents; I'm still on the left side of a very steep learning curve myself. Honestly, if I hadn't been aware that the guy in the bed had something that was acting like Guillain-Barre, I wouldn't have been on guard for respiratory issues. And the only way that I *knew* he had something like GBS going on was that I had been able to assess him in a different way than the resident had. Every-hour assessments are much different than a one-time thing: a slight change in strength can clue you in to impending disaster. I wasn't a hero, I just had access to more data.

In any event, we all made up and are friends now. And I got one of the nicest compliments I've ever gotten from a doc: as the anesthesiologist was working away at something, I had to hand him a syringe of sterile saline. They come with screw caps. For some bizarre reason, I was able to summon the muscular control to hold four things in one hand and thumb the cap off of the syringe with my one free digit. The doc said, "You have good hands." How sweet is that?

Minion Andrea sent me this, and I busted a gut.

Andrea can be found here at Joyful Caffeination. And yes, the rest of her stuff is as good as that label.

Highly inappropriate doin's in the CT suite (Hi, Mom!)

So I walked in to the CT suite through the back door, and Steve-O looked up and said, "Hey, Steph! Guess who's here!"

Steph and Steve and I were all hired at the same time, so we have a shared history.

Steve checked my armbands while Steph did whatever mysterious thing it is that CT geniuses do to the machine before your scan. "You pregnant?" Steve asked.

"Geez, I hope not," I said, "as we'd either need a baby or a stable in Bethlehem at this point."

"How long's it been since you've had sex?" he persisted.

"Uh....a year?" I said, then added quickly, "I can't seem to get a date."

Steph chose that moment to get on the microphone into the scan room. "You gonna run her pee?" she asked.

"No," Steve said, "she hasn't had sex in a year."

Much hilarity.

Then I got up on the extremely narrow CT bed and had the contrast drip hooked up to my IV and laid there while they took slicey-dicey X-rays of my head. Steph warned me every time she injected dye. The dye makes any areas with high blood flow (like the perineum) feel quite warm; most women describe it as a feeling of having peed in their pants. That's about right.

In addition, Steph would occasionally say, "Okay....the dye's going in. Now: DON'T SWALLOW."

We finished in ten minutes or less. As I swung my legs off of the bed, Steph and Stevie both came into the room. I said, (and thank God for time to think of a good line) "Thanks, you guys! Between the dye injection and the warnings not to swallow, that was the most fun I've had in a year!"

Once in a very great while you get to leave the stage to applause.

Tuesday, September 28, 2010

Monday, September 27, 2010

Jo's Rules of Cancer, first incarnation

1. It is always to be referred to as CANCER, or CAAAAAANSUH, or "that fucking bullshit I need to get over."

2. It is never to be given any seriously frightened mindspace after the first week (unless circumstances warrant seriously frightened mindspace).

3. InkGrrrl's description of "steel-toothed brain ferrets" will be the baseline for all descriptions of CANCER/CAAAAANSUH-related anxiety.

4. "I have cancer" is only an excuse if you use it tongue-in-cheek. Or maybe to get more chocolate. I have plenty of chocolate; want some?

5. If you have to fuck with it, it's cancer.

What Not To Do, Volume Whatever (*waves hands*)

1. No matter how homelike the lobby of Sunnydale might seem, it's not acceptable to bring in and set up a grill in said lobby and then commence to cooking hotdogs.

2. If Grandma is sleeping in the back of your unairconditioned beater, don't roll up all the windows and lock all the doors and leave her there while you go in to the Wal-Mart for your weekly shopping. If you're going to do that, at least make sure it's not ninety-some-odd degrees out.

3. If I'm working on your wife, who's been trying to die for a good long while except that you keep insisting she be brought back, don't mumble (as I'm pushing succs and eto and versed) "They nearly killt her at Yeehawton General, they nearly killt her here..."

I might, in the stress of the moment, almost break out in giggles as I finish your sentence: "...they nearly killt her on the beaches; they nearly killt her in the streets; she shall NEVAH SURRENDAH!!" in my mind. That would be awkward.

4. The time to stick your head in the door and ask cheerfully if I want a flu shot is not as I'm busily coding the above person.

5. If your extremely aged long-term-care facility resident takes a sudden turn for the worse, please call report to me before she shows up. Or, failing that, at least check for a urinary tract infection before you transport her. It'd probably be obvious what the problem is once you do an in-and-out cath and are rewarded with urine the color and consistency of slightly thinned lemon yogurt. (Sorry, yogurt fans.) Or, failing *that*, make sure she's breathing when she leaves. It'll save the EMT guys a whole lot of trouble.

Thank you, and goodnight.

Saturday, September 25, 2010

Oh, and lest I forget:

I ran into my friend Willie outside the used bookstore today. He came up to me, looked at my chest carefully, and then said warily, "That's a funny shirt."

"Not really" I replied.

He stuck his hand out. "I got diagnosed with prostate cancer last Thursday."

"Welcome to the club!" I said.

Then he said this: "I don't know what it is, but I have just been exhausted since my diagnosis. I'm so tired all of the time, and so depressed. Even though my doctor says my cancer isn't any big deal, and I can put off surgery, I'm just so *tired*."

At that point, I just gave up and hugged him and said, Me Too, Oh Boy Holy Crap.

Today I had a good five hours of not thinking about cancer, cancer, cancer. And I was still exhausted by the end of it, though not as exhausted as I have been when people have been asking me to *talk* about it all the time.

They really ought to warn you. Seriously: If you get a diagnosis of cancer, the first thing the doctor ought to say is, "Listen: you're fine. You've not got anything wrong with you that's gonna kill you in the next week. That's not how you'll feel, though. So, if you feel like you have the flu, and you just want to sleep, that's okay. It's normal; it's just stress."

I feel so much better now. And Willie and Joann are fine, and Willie will be fine after his robotic whatchamacallit, and all will be well.

And you know what? It *is* a funny shirt. Especially with my boobs, considering it ain't boobinoma.

What I did on my day off:

Lunch with Rob and Adam at a semi-poncy but very good restaurant here in Littleton. They go to the trouble of making their own butter and bread, and the waiters are actually knowledgeable about the food.

I had a wedge salad (oh, the glories of iceberg lettuce! Once in a while, it's nice to let something be a foil for other ingredients) and fried grits with shrimp (bacon/tomato cream sauce) and part of Rob's white truffle fries with Parmesan, and a pale ale. It was a nice boozy lunch.

After which we went to the indoor flea market and tried on desert camo and funny hats, and I found a wedding dress I could actually see myself wearing, even though there is no wedding even remotely in my future. It was topped by a lavender hat with a big bow that I made the boys promise one of them would wear.

And my sister sent a gorgeous gold lame opera coat. I need a black silk v-neck sheath with a pencil skirt, STAT. The best part? This one fits. In this shot, it's lying on the dining room table.

Speaking of things that fit, I also got my two shirts from Cafepress today:

It reads: "My cancer is rarer than your cancer. Neener neener."
I think it'll go quite nicely with my hat:

Thursday, September 23, 2010

God, I love my commenters.

Example of mood swings: Luis, down below, is sweet and caring and incredibly comforting.

And then along comes Anon, who, with piercing logic, points out that yes, I *am* overthinking this too much, and thinking too much about the worst case, and yes, I might want to pull my head out of my own ass for a bit and look around at the world.

Both of which were exactly what I needed.

Where'd I put those sparkly disco panties? Because I need to pull. them. the hell. up.

Cancer is boring. It's also exhausting.

I am simultaneously bored and exhausted.

I'm bored because I have this damned diagnosis, and nobody wants to talk about anything but CANCER, and I can't think about anything but CANCER, even if it's not-that-big-a-deal CANCER that has an almost-guarantee of a complete cure, because it's scary. The thought of having my mouth reroofed is scary. It's scary to the point of being boring, just like contemplating perhaps having to have a PEG tube is terrifying until it becomes another source of ennui.

(That's the weird thing about this diagnosis: You go over and over and over it in your head, trying to file down the edges and fold it until it fits your concept of yourself, but somehow, you can't bring the concept of CANCER to a place where it actually makes sense in your body. It just doesn't fit.

You have something in your body that doesn't fit. It wants to take over, and that's terrifying, and at the same time, it's boring as hell, because you can't think about anything else, and nobody wants to talk about anything else, and, and, and.)

It makes me tired. All I want to do is lie on the couch and go to sleep, and wake up some time after surgery, or maybe after radiation.

Yes, yes, I know this is a symptom of depression. I understand that if it doesn't go away after four hours, I should seek emergency treatment. It's perfectly clear to me, in both a gut sense and an intellectual sense, that this is indeed normal for somebody to experience, especially at a time when they are facing possibly having their face replaced in large part with plastic.

Yet it wears me out and it pisses me off, because I'm used to doing things other than stopping by the Beer Hut once a day and getting a four of Brewdog's Hardcore, then sleeping for twelve or fourteen hours.

I'm working a whole slew of days coming up. If my throat isn't too sore and I'm not too emotional, maybe it'll help to work a whole slew of days.

Being diagnosed with cancer is terrifying. It's emotionally wrenching. It makes you worry about yourself, and about your family. It makes you make grandiose plans and promises for the future, and then take them back hurriedly out of fear that if you can't or don't fulfill the promises, something worse will come. It's boring. It's dull to repeat the same information over and over, and have people look at you the same way.

(So many people asked me yesterday "How do you feeeeeeel?" in that tone of voice that I started to reply, chirpily, "Fine! You don't look so good, though.")

Being diagnosed with cancer makes you feel guilty for all the things you've done, and all the things you've omitted doing. It makes you want to go back and change the past. It makes you sad, and excited, and wish that you could see this all as one great adventure. It makes you feel bad because you feel bad, yet so many other people have it so much worse than you, with much less of a chance for a cure or a happy ending. It makes me want to take a Lortab and drink a beer and sleep for twelve or fourteen hours. It makes me angry that I don't have the energy, thanks to the combination of boredom and exhaustion and terror, to contemplate much else.

Eventually this will wear off. I know that it will; everybody who has ever been diagnosed with cancer can't *stay* in this state, or else the world would quit turning.

It's just exhausting to be here. And boring.

So I walk into work, and everybody looks at me like they expect a beard and a robe.

It's like I've risen from the dead, or something. "You're back!"

Yeah, I'm back. I'm not sick; I just have cancer, okay? Seriously.

It reminds me of when my old, old (in duration and age) friend Cenobio got lymphoma and was still mackin' on the ladies in the middle of treatment. "It's just cancer," he'd tell them. "It's not like it's catching."

God, it was nice to get back to work. I've never been so glad to have to start difficult IVs or draw skrinch-knuckle Z48 whammalamma labs before. I've never been so glad to assess patients with various neurological infirmities. I even enjoyed doing chart audits.

Nobody had any crises. Only one thing got set on fire in the hospital yesterday, and nobody got hurt from it. No codes, only a couple of response-team calls, an interesting approach to decompressing a Chiari malformation, only one frontal-injury patient who kept getting out of bed, and he was sweet and charming. So a good day.

My throat was sore from explaining, over and over, how I was *not* going to have to will my shoe collection to anybody, and why I wasn't particularly worried about who would take care of the dog.

And today, a shout-out to my pal Cap'n Obvious, who's taking his boards THIS VERY MINUTE. Go get 'em, Cap'n! Show 'em what you know in whatever field it is you're expert in! Rah! Rah!

Tuesday, September 21, 2010

Okay, questions for *you*....

Who's the anon lurker with whom I used to post on the BB?

Where, exactly, are my European and Antipodean minions posting from? I plan, now that I have a reason to celebrate, to visit the other side of the planet, and sleep on all y'all's couches. (You don't have to be specific as to an area; I just want to know that nobody had their ceiling come down in Christchurch.)

Answers if you're comfortable with them being public in the comments, please, or email me at johannebertha at gmail dot com.

Hat tip to ThursdayNextGal....

Good News, good news!

It's still cancery, but it might not be as cancery as we all thought/feared.

I asked Dr. C. (who is the shizznit, by the way, and about my age) how terrified I should be.

Her reply: "Not terrified. See, this particular type of cancer is weird. We used to group it in with pleomorphic adenoma, which is totally benign--you take it out and that's it. Then we noticed that some types of pleomorphic adenoma would come back, so we started calling this sort polymorphic low-grade adenocarcinoma.

"The important thing about this tumor is that, when it gets bumped or irritated by food as you're swallowing, it can develop malignant bits, while the rest of it down deep stays normal. So the thing to do is to talk to it, tell it it's going to remain normal throughout the rest of its course, and we'll get it out.

"Either way, worst-case or best-case scenario, with your age and general health, this is not going to kill you."

So: best case scenario is a shallow lesion that does not intrude on my teeth or palate and which the oral surgeon could take out, and no radiation.

Worst-case scenario is a deep lesion that would require removal of teeth and a muscle graft to form part of the roof of my mouth, and radiation--but even that comes with a benefit, which is a cross-scalp incision that would tighten up my forehead.

I'll get a CT this week, an MRI next week, after the inflammation from the original cutting subsides, and we'll decide what to do after the oral surgeon and the ENT guy put their heads together.

Keep prayin', people. Eventually we'll get to the point where this blog can be about freaking NURSING again, and not being on the other side of the stethoscope.

Monday, September 20, 2010

How. Do. You. Feel.

(commence Geek Flag)

Remember that scene in, oh, Star Trek MCMVLXII or something, where Spock's come back from the dead on the Genesis planet, and he's doing this sort of rehabby thing on the Enterprise, and his mom slips a ringer into the computerized questions that are supposed to be judging his fitness?

And the computer says, flatly, "How. Do. You. Feel."

Spock looks quizzical and says the Vulcan equivalent of "Whut?" And the computer repeats "How. Do. You. Feel."

(end Geek Flag)

That's a hell of a question. Everybody's asking it, and it's so difficult to answer. Some people ask how I am both mentally and physically, and that's a little easier, but it's still tricky. Catch me during a good hour and I'm all "Dood, fine, nothing to see here, move along." Catch me fifteen minutes later and I might be a hysterically weeping wreck.

Which is all fine and normal, but it's really exhausting and inconvenient and it's pissing me off.

Physically? Simple: my throat hurts, the side of my face hurts sometimes, and I'm vaguely nauseated all the time, just from stress. The op site is healing well, and the stitches still feel like I've got a hair on the back of my tongue, especially when I drink something cold and they stiffen up. I sleep okay.

Emotionally? Like I said before, it depends on the moment.

I woke up this morning feeling incredibly peaceful and happy and grateful for everybody in the meat world and on the Innerwebs. Went to the doctor, had a good meeting with him, got the appointment with Dr. C, the oral surgeon at Consolidated Research and Education (operating at Sunnydale, thank God) all set up, got my scrips for MRI and CT and yadda yadda and the path report and everything. Shook his hand, told him I'd let him know how things go, and bopped out of the parking lot to Bachman Turner Overdrive.

Got back to Littleton and ran some errands. Managed not to get annoyed by the slowness of the grocery store clerk, got to Home Despot, picked up a big bucket for Max to drink out of, and bopped out of the parking lot to some indie song I'd not heard before.

And, totally without warning, at a stop light, started quiet tears at the thought of how lonely all of this is going to be. I cried the rest of the way home, had lunch, and took a nap. And now I'm fine. Not hungry, not particularly interested in eating, though I know I have to because I need Lortab.

I'll be all "Research ALL the things!" and get all ready, typing fingers poised, and then....I can't. I want somebody else to do this for me, to digest whether radiation is a good idea or not in the absence of cervical lymph node involvement. I want somebody else to crunch numbers on survival rates. I want somebody else to do all this for me and present me with a set of decisions that I can trust.

I get very excited over something simple, like laying out the rock-and-sand extension to the porch, and then this wave of exhaustion just rolls over me.

This is all normal. I know that, intellectually, but it's still hard to handle. The last three days have felt like sixteen years--sixteen *long* years--and I don't see that anything is going to smooth out any time soon.

Which is going to be important to remember in the future. I mean, yeah, I have cancer (and Imma flush its head six or eight or twenty-nine times in a junior high toilet, as I told Beloved Sis), but I'm not facing things like horrible bodily disfigurement or the loss of a secondary sex characteristic. In a lot of ways, because I *look* fine and mostly *feel* fine, other people are seeing this as a pain in the ass.

Which it is. It's also veers wildly between horrible terrifying monster and minor concern.

Imagine how much worse people with, say, laryngeal cancer must feel. Imagine how hard it would be to articulate your fears when you have no voice left. Imagine being the woman in a shaky marriage, or the man who's freshly divorced, who finds out she or he has breast, or prostate, or advanced cervical cancer: something that affects not only your body, but also your sense of yourself as a sexual, physical being and how you function.

I always wondered why people just coming out of surgery were so damn stable emotionally. I think now it's because you see the surgery as the worst thing that's going to happen to you: after they're done cutting on your ass, you can move along with scars and without the fear of the surgery itself. Even if that's not true, it's still a huge hurdle you've overcome, right?

We learn all this in school. Then we learn it again when we start dealing with patients. *Then*, if we're a statistic--and somebody's gotta be a statistic--we learn it a third time, first hand, and have to remember it for later.

How do you feel?

Hell of a question. Give me six or eight days of total oblivion and I'll try to answer that for you, okay?

Sunday, September 19, 2010

Well, would you looky thar...

Nothin' like a cancer diagnosis for getting a whole bunch of new followers, is there?

Were it not for the fact that you, you know, actually have to have cancer, I would recommend the technique to any young, struggling blogger.

Enough with the forced humor.

I have gotten more emails in the last week, especially since Friday afternoon, than I can count. Some of them came from people I know (Hi, Judy!); most of them came from complete strangers. They range from angry, to thoughtful, to much funnier than ought to be allowed in this situation, and every one of them is indescribably precious to me.

There are no other words to say except the ones that we say out of habit, so I'll say them:

Thank You.

There's no way I can answer even one email right now. I'm still too shocky, still too shaken by what's happened, but please know that I read everything that comes to me with immense gratitude. I haven't always been thoughful enough to be conscious of the advantages and blessings that I have, but this time? It's so obvious even I can figure it out.

I'm still terrified. There are moments when everything's fine, and then suddenly it all goes to hell and I'm left sobbing and shaking. The edges will get smoothed out as time goes on and I get used to Having Cancer, but right now I am just so *thankful* for all you guys' prayers and thoughts and emails and...just everything.

Things will get better. Just because (as Zenna Henderson pointed out) you've shut your eyes doesn't mean the sun's gone out. It's important to recognize the difference between the two. In the meantime, there are hundreds of people hoodwinked enough by gross stories and cheap humor to actually care about somebody they've never met. They--you--keep reminding me that I can indeed open my eyes, dammit! and that, at some point, all manner of things will be well.

It humbles me to read yet another email from somebody who read this blog through nursing school and the first few years of practice.

All I can say is "thank you, thank you" over and over.


Saturday, September 18, 2010

Two more favors (Jeez, they never end, do they?)

First, that you would send some prayers up for Naomi, a seven-year-old kid in Colorado who's having a hell of a time just now.

And second: Lurkette, could you please email me at the link to the right? Thankee.

So I was doing fine this morning...

...I woke up at my usual time (0400; don't say nursing doesn't change you) and made coffee and had some oatmeal. I had to take the oatmeal away from Notamus, who seems to like Irish steel-cut oats without butter or sugar.

Then I took a pain pill because my throat hurt. Then I got paranoid because, twenty minutes later, I got all dizzy.

So I sat down and had a nice little chat with myself, which made everything better.

Until the bed sneezed.

I had just finished making it, laying the American Heritage (made in China) quilt over the comforter and hunting up some pillows for the guests I'm having this weekend, and it sneezed.

I looked over my shoulder at the perfectly flat, perfectly even bed. I make my beds *perfectly*. It's a leftover from my anxiety-ridden, OCD past and nursing school: you could bounce a Humvee off the bottom sheet if you wanted.

Staring at bed. Bed perfectly flat. Corners perfectly even.

And it sneezed again. An audible, ordinary "a-CHOO!" came from somewhere in the bed.

So I stood there for a minute, wondering if Sneezing Bed was a symptom of something I should be concerned about. I pondered what, exactly, would make a bed sneeze, as I use hypoallergenic mattress covers and pillows. I wondered if the bed could perhaps be allergic to cotton.

The bed sneezed a third time.

I quit pondering and started stripping. Under the quilt, under the comforter, under the top sheet, where I had not noticed him, was Notamus. Flat. Dozing off. Under all the blankets. Sneezing himself awake.

He's now on the couch, where I can see him. His brother is on *top* of the bed, on the outside of the quilt, curled up. They're both adorable.

For two minutes this morning I wondered if hallucinations came along with everything else, and why on earth I would be hallucinating sneezes.

I have a favor to ask all you lovely readers:

This is a hard request to make, but I have to make it now:

Please don't send me any information about the type of cancer I've got.

TM, I send thanks to you for the links you provided, and I'm not singling you out by any means; I've gotten more information than I knew existed about PLGA. I'm not mad, I'm just overwhelmed.

Right now there is not a damned thing I can do with more information. I realize that this cancer tends to metastasize in rare cases, and that things can really suck when it does. I understand that it sometimes comes back years after treatment. I know that a minority of patients die from it (though I don't intend in the least to be in that minority). All these things are things that the current research re- and re- and re-iterates. This is stuff I knew going in.

And I just. simply. cannot. handle it. Not now. Not when I've got two days before I see the oral surgeon, and then an unknown number of days before I see an oncologist and a head-and-neck surgeon, and not when the future is wide open with a number of possibilities, some of which are only marginally less horrible than others to contemplate.

I can handle being frightened. What I can't handle is sheer, cold terror, and that's what links and papers and abstracts do to me. Even knowing they're out there makes me more upset.

The strangest thing about this whole situation is that it still feels like it's happening to somebody else, even though the first coherent thought in my head this morning was, "I have cancer." I would like to preserve that somebody-else feeling for as long as I can, even if it's only for a couple of days.

Every cancer is as individual as the person it attacks. Remember that if you read about PLGA and get freaked out. Remember that I've always done weird stuff, and that this is no exception. Focus on the positive things that can come out of this, please, for my sake. Send all the good thoughts and prayers and wishes and hip-shakes you can muster, but please, don't send me any more links to the same Institute of Rare Diseases paper.

I am frightened. I feel very alone, notwithstanding the dozens of messages and emails and comments I've gotten in the last sixteen hours. I am scared for my life, and scared for my family, and scared for my friends. I would honestly like nothing better than to wake up and have this all have been the worst dream ever.

Please: this blog is a place where I can come and maybe not be so frightened for a little bit. I'd like it to stay a safe place, and I need your help to do that.

Thank you.

Friday, September 17, 2010

Yeah, so. I've got cancer.

I look at that sentence and I giggle.

Beloved Pens, when I called her, was at the Salvation Army. She wandered around the store for an hour longer, feeling sort of blank, and then went home and drank gin and ate ice cream.

Beloved Sister was driving when I called. She went home and had a fight with Beloved Brother-In-Law about money.

I don't know what my Sainted Mother or Beloved Father did.

I think about all of that, about life going on around me just fine, and I giggle. I saw my neighbor, Pastor Paul (Man of God) and his Lovely Wife, planting trees out in their back yard, not fifteen minutes after he'd come over and prayed with and for me, and I giggle.

Because, you know, life does go on.

At some point, my hair will fall out. If I'm lucky, I'll end up with a big scar down the back of my throat. If I'm not lucky, I'll end up with a big scar where you can see it, down the side of my neck. I'll have radiation, and maybe chemo, and possibly hideous treatments that are only whispered about in the bowels of Sunnydale.

But life will go on, regardless of what happens to me. Unless I announce it in the middle of the grocery store, nobody there will know that I Have Cancer.

I'm saying those three words over and over and over, because it's important that I understand just how serious this is. So far, it's all happened in third-person, sort of the way the discovery of the lump did. I have a feeling that that third-person sensation will return at every juncture or every new discovery: I need chemo, so I'll go third-person. Radiation is done, so I'm in third-person. Surgery is tomorrow: I'm third-person. CT is clean: it's third-person.

I recognize that it'll all come down to first-person at some point, and I really hope I have the wherewithal to write about that. I would hate to abandon the blog for lack of material--and it looks like I won't have to, now, wahoo!--or because I'm just too tired or overwhelmed to write.

So I'm not going anywhere. That's the second thing we can all hold on to as fact.

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

I'm wearing my hair down tonight. After so many years of keeping it very short, I'm going to miss it when it goes. But then, I can be one of those women with the cool scarves and the huge earrings.

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

I tried to reassure my Brother in Beer and Pens tonight that I was not going anywhere, that I do not plan to die from this. It is, after all, a low-grade carcinoma, with or without vascular involvement (which, frankly, scares me because I don't know what it means). My BiB kept saying, "Oh, Honey, I am so sorry" and Pens kept reassuring me that she was there for me...but I feel like I need to be there for *them* right now. It's easier for me, in a way, because I'm living through this. I may not know what's coming, but at least I don't have to imagine it happening to anybody else.

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

Maybe radiation will clear up my acne.

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

I really hope there's a way that we can do all this that won't involve me being trached and PEGged.

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

This is the first night that I have cancer. By the time Rob shows up tomorrow evening, it will have been about twenty-four hours since I found out. I wonder what I'll do tomorrow to pass the time. Maybe I'll pay bills (needs to be done anyhow, and would be a nice normal thing to do). Maybe I'll research this further, though I don't know where else to look. Maybe I'll rage at God and shake my fist at the sky.

One thing I know for sure: God, whatever you conceive Him to be, has plans for me. I would not have gotten this diagnosis if it weren't part of some bigger, better plan.

I may have to work my ass off, but I'll deserve the second chance I get.

Well, fuck.

I have cancer.

I'm saying it, "CAN-SAAAAHHH", the way Tim Curry would if he were here, and in character as Dr. Frankenfurter.

It's polymorphous adenocarcinoma, a tumor of the minor salivary glands. Don't bother to Google it; it's rare enough that Wikipedia only has a stub on it. This particular type of cancer makes up one to two percent of all cancers diagnosed in a year in the U.S.

There are no risk factors. Treatment is surgery and radiation. Usually, PLGA (for polymorphous low-grade adenocarcinoma) is a slow-growing, non-aggressive tumor that has an excellent cure rate. That's the good news.

The bad news is that mine has both vascular and nerve involvement. Whatever surgery happens, I'll probably lose a facial nerve. And, if things go very wrong indeed, I'll find out that this damn thing has metastasized to other parts of my body. That would seriously, seriously piss me off.

But, for now, I'm pretending that all is well and that I'm not going to have any problems with treatment, or any sort of metastasis or recurrance.

I'm going back to the oral surgeon on Monday, to see how I'm healing (brilliantly). He'll make appointments for me at the cancer center that's associated with Sunnydale and Giganto Education And Research Inc, which is actually a very good thing. Not only will I be working with people who are used to weird-ass shit like this, but I'll be working with people I know.

I may lose a facial nerve. I will certainly lose all my hair. I might lose a salivary gland. I'll certainly have a big ol' ugly line of staples down my neck, or a bunch of sutures in my throat, when they take the rest of the tumor out.

It is no longer Cap'n Lumpy. I can't be cute about this any more: I have fucking cancer. I'm pissed off, and resentful as hell. It is NOT welcome here. There will be time for reflection and philosophizing and grieving later, but this is not it. I have cancer, and I am PISSED.

Great Googly-Moogly, this room is a mess.

It has not been the easiest morning.

After I posted that question from PhiloRN, I got hit by one of those awful dark hopeless moods that are bad enough when you don't have a thing in the back of your throat, and even worse when you do.

I'm really sick of being brave and cheerful, so all the brave-and-cheerful went down in a rush.

Then I went to bed. And got up again, and saw that my study/guestroom/cat-napping area looks like a tornado hit it. So I'm going to clean. ALL the things.

When I'm done, I'm sure the brave-and-cheerful will have come back. It better have.

Another excellent question from the comments section:

Nurse Philosopher sent this one in (which I tried to find after I'd hit "publish comment", but now cannot; thank heavens I saved the message):

What can you tell me about prejudice and lack of compassion among staff members? At Little Ol' County General we have staffers renowned for their competence, steadiness under fire, and breadth of knowledge. They'll call you sweetie and God Bless you all day long.

Yet these same members have been observed expressing a good deal of judgmentality about patients who are 1)LGBT, 2)of an unusual faith (i.e., not mainline Christian), who have 3)lifestyle-related diagnoses (alcoholism, HIV,) anyone with 4)a psych history, 5) are non-native speakers of English, OR 6)whose family members are assertive in their advocacy for the patient.

Speaking for myself, I enjoy the "different" patients & families. I find a little compassion and support goes a long way in many cases. I do spend more time listening to patient stories than most of my colleagues, because I enjoy them. I also find that informing & encouraging the strongest family member helps the patient and the family in general. It lowers their anxiety levels, which is all to the good.

So, why do so many of my fellow nurses accept a negative attitude? Why does it seem ok to them to denigrate and dismiss patients' genuine concerns because the pt has one or more of the Big Bad Five elements above? Is there anything I can do to encourage a more positive attitude toward disliked classes of patients?


I've seen these atittudes too, and toward the same groups of patients. I've also *had* these attitudes on bad days.

Sometimes we have good reasons for dreading an encounter with a particular patient, especially if that person's been a Hospital Hobbyist for years and we know them. Most of the time, though, our prejudices against certain patients or people with particular diagnoses are just that: prejudices. They're unfounded and unfair.

*scratches head*

Seems to me that we're dealing with two different issues here: one is bigotry and the other is an unwillingness to deal with "difficult" patients or families.

Bigotry you can't do jack about unless you're willing to say, over and over, "It's not always like that, you know." If someone says something offensive and you feel comfortable calling them out, then do so. You can do that in a way that's not rude or combative; just saying, "I find that remark really offensive" is enough in most cases. The best you can hope for is to shut people up while they're around you. I guess if you're really feeling tough one day, you could ask (in response to a bigoted statement), "Why do you say that?" or "Why do you feel that way?" and keep probing until the other person gets uncomfortable.

Difficult patients/family members is a different story. Most of the time, people are hard to work with or demanding because they're frightened, or they're trying to keep some sort of control over a situation that's spun totally out of hand. Nurses tend to dread them because they're control freaks (and so are we), or because they question everything (just like we do).

Those are folks I actually really enjoy working with. It's sort of a challenge, but you can build a respectful relationship in three ways: by being open and accessible, by setting boundaries, and by answering questions. *Not* giving the family short shrift over their concerns is the place to start. It's also one of the easier ways to model better behavior and foster better attitudes among coworkers.

Honestly, I don't know that you're going to be able to change deep-seated attitudes. I don't know that you'll be able to stop venting that's bigoted or otherwise short-sighted. Acting the way you'd like your coworkers to act and refusing to participate in the gay- or non-English-speaking- or Zoroastrian-bashing might be all you can do.

Suggestions, anybody? Nurse Philosopher has knocked upon the noggin something we all have to handle, every day.

Thursday, September 16, 2010

And a personal-questions post from the comments section....

One thing about having stitches in the back of your mouth: it makes it impossible to talk. Combine that with the totally stoned feeling one gets from Lortab, and the fact that I have to stay up for a while until the potatoes are done baking, and you get....

Answers, in no particular order.

Homemaker Man wanted to know about the worst hangover I've ever had, preferably on a work day.

I'm boring. I've had hangovers, and I've worked, but I've only done the two at once one time, and that was *years* ago. It was during the Divorce Debacle, and I'd gotten a little too frisky with the tequila. And because I'm a lightweight, "a little too frisky" meant two-and-a-half ounces of the stuff rather than two. The awful headache went away by nine o'clock, and I swore I'd never do it again, and I haven't.

Interesting side note: The Manhandler and Kitty-Kitty and a raft of other people were all sitting around the other day, trying to decide if they drank too much. I mentioned mildly that perhaps comparing one's own alcohol intake with that of other CCU nurses would lead to a skewed perception of what's normal. Nobody laughed; they all just looked thoughtful and nodded.

Crazed Nitwit asked for stories of when I was a brand-new nurse. Oh, Lord. How about the time I slipped as I came into the patient's room, bounced off several walls and a couple of pieces of equipment, and ended up in the doctor's lap?

Or the time I was wheeling a patient down a long, steep ramp on a stretcher and lost hold of the stretcher? I had to chase it madly down the hallway and grabbed it just before it went into a wall.

Or the day one of my patients got out of bed after his hip replacement, snuck downstairs with a friend, and went to McDonald's for a burger?

Or the infamous afternoon when I did the Happy-Nurse-Hip-Shake in the hallway, in a pair of ill-fitting drawstring scrubs, only to have my pants come down in front of a crowd of interviewing interns?

Do I *have* to talk about those days?

Messymimi wanted to know if I have any further plans for redecorating.

Not just now. I'd like to get the typewriters hung and a kitty-cube built so the cats can hang out outdoors, but that will have to wait until I've gotten over this hump. I refuse to plan redecorating projects when I'm altered, for fear of ending up with the room equivalent of an electric-blue harem-legged jumpsuit with studs and epaulets.

I really do need to do some gardening, though. Weeds are growing through the mulch in the front beds, the salvia needs to be cut back something fierce, and I need to prune the rose bush sooner rather than later. Plus, thanks to two solid weeks of horrible heat, I lost two butterfly bushes (though not the two I wouldn't have minded losing) and a Scotch broom.

Oooooo. The pain meds just kicked in, hard, so I need to go get horizontal for a bit.

Wednesday, September 15, 2010

And one final post as I wait for the Lortab and Benadryl to kick in

Lori asks, "How do you deal with difficult coworkers?"

Lori, there are entire books written on that subject by people much wiser than me. The only advice I can give you is threefold: find something you have in common with that person and stick with that thing as a topic of conversation; do not react to anything they do or say that's insulting; and finally, make sure your lime pit is deep enough.

Anonymous has this request:

Since you are smart and insightful, I'd like you to explain why piles of mail and assorted paper on the kitchen counter grow exponentially, and why scientists cannot harness the phenomenon to cure cancer.

Anon, it's funny you should ask. I've spent part of the last two decades examining this question, and I've come to the following conclusions:

Far from being able to harness the parthenogenetic power of paper to cure cancers, the phenomenon seems to be related to the uninhibited reproduction of malignant cells. There are further parallels in the asexual reproductive capabilities of wire hangers in dark closets and single socks.

Current research seems to suggest that a long, steady glare at piles of paper will, to some extent, inhibit reproduction on flat surfaces. Exposure of both sides of each piece of printed material to light is much more effective, however; this method seems also to work with wire hangers. Interestingly, these treatment methods have their antecedents in targeted light therapies for certain malignant growths.

Nothing seems to work yet, either systemically or as a targeted therapy, for single socks. My personal line of research at this point is whether or not the second sock of the pair will be electromagnetically attracted to the singleton if that singleton is coated with enough dust and lint to make it unrecognizable. My hypothesis right now is that singleton socks suffer from "mother rejection" syndrome, as is often seen in cute widdle baby lambs in James Herriot novels (cf "All Creatures Great and Small").

If I can't get the former pair of each singleton sock to accept the disguised singleton, I'm thinking of placing them in foster pairings with tights or pantyhose. This method has worked well in other species such as chipmunks (with cats) and tigers (with Dalmatians). See YouTube, ref. "Cute! *** adopts *** baby!" for further research.

I have the sneaking suspicion that all three things: socks, hangers, and cancer are related somehow to string theory and the secret recipe for Twinkies. If we can lick one, we've got 'em all licked.

Max pictures (with bonus kit-taynz!)

Max says he is very, very sleepy. Or maybe not. He can't tell.

Notamus says he'd happily go outside with Uncle Max and play....

But Flashes would rather stay inside and play tag! So they did.

I totally stole this from Jezebel, who stole it from F*yeahcuteanimals:

Gettin' to the comment-section questions....

First, a couple of nursing-related queries:

Katie asked, "Is it possible to be a good nurse-manager? If so, HOW?"

Yes. Yes, it is.

As to how to do it, I think--and keep in mind here that I'm totally talking out of my hat, because I've never been a nurse manager--you'd need to keep three things in mind: fairness, free flow of information, and what the nurses you're working with go through.

Fairness is a far-reaching concept. Every unit is going to have little niggling things, like the person who only works twice a week and yet wants to be first-cancelled *every time they work*, that are going to drive people on the unit crazy. I would bet that if something can be quantified and put into a rotation, it should be. Who worked last with the crazy-sick, heavy patient with the difficult doctor? Put a new nurse on that patient. Who took an extra shift last Christmas Eve? That person gets off this Christmas Eve.

Find the niggling things that drive your nurses crazy, then find a way to standardize the hell so it's evenly distributed. People will complain at first, but will later realize that fairness is good.

Free flow of information is essential. When we get another piece of paperwork (or another piece of computer-work, these days) or another audit we have to do, we get annoyed. If a manager explains to us why we're having to do these things, though, it helps keep the annoyance at bay and increases cooperation.

Likewise, rumors are bad. If a manager can be straight-up with their employees about why upper management isn't giving out raises, or is giving out promotions, or *whatever*, it stops rumors in their tracks and lessens the chances somebody will get grumpy.

And finally? Remember what it was like when you were on the floor. There will be personal disputes between nurses: keep an eye out for which nurse it is who *keeps coming back* to your office with interpersonal problems. Keep an eye out for the patients or patients' families who are likely to be trouble. If you're unfortunate enough to have an abusive family or patient, stand up for your nurse first. We're not stupid: we're not going to hurl bottles of drugs across the room or do any of the other things I've been accused of.

Elsie asked why I didn't want sedation during my dental work, and if propfol automatically equalled intubation.

No, it doesn't. Propofol is a fantastic sedative to use for intubated patients, but people can breathe on their own when given small amounts of it. The whole reason I didn't want to be sedated was that I thought this was going to be a quick in-and-out biopsy. The drama of having Cap'n Lumpy have to be removed on the fly was something neither I nor the doc expected.

NurseXY asks "How can a graduate nurse present themselves when interviewing for a job so that they'll actually be considered over an experienced candidate?" (paraphrased)

Emphasize stuff you've done outside of nursing school, for one. If you've got loads of experience being a project manager for GinormoCorp, LLC, then be sure to mention that on your resume. If you've got loads of experience managing people, mention that.

Emphasize particularly things that make you look responsible, accountable, and like a team player. (What a sentence; sorry, the drugs are kicking in.) Training a new nurse, while expensive, is the easy part. Finding a person who fits in with the existing culture on the floor is the hard part. You can have the best nurse in the world, but if she or he doesn't have a good fit with the other folks on the unit, he or she will never last.

Also, keep in mind that a lot of specialty areas (CCU, NICU, transplant) really like to train their nurses the way that they want them. Don't be afraid of specialty areas; nothing in the world says you have to work med-surg (now a specialty in itself) for X number of years before you specialize. In most cases, I would argue against that, in fact, because you'd lose knowledge without gaining specialized skills.

Oh! Elsie had a second part to her question that I missed before: Do redheads have a lower tolerance for pain?

Actually, no. We do, though, have a greater resistance both to local and general anesthetics. I remember reading that a couple of years ago in some journal and feeling vindicated. Natural blondes, by the way, also have the same resistance. Nobody knows why. The way to deal with this is to express clearly your dislike for pain and your desire for lots and lots and lots of local anesthetic and semi-sedation.

Oh, and Elsie? The minor-to-moderate pain I'm experiencing in my soft palate is way the hell better than what you'd experience if you let your gums recede further. Just sayin'.

Finally, Penny had a question that I'll just reprint here in its entirety. Please have at all of these questions, especially hers, in the comments:

It's getting to be crunch time for me, and I'm going to have to decide if I'm going to A.) stick with my tenuous career and pray I make it to retirement, or B.) cash out my 401(k) cry and cry for days over how much money I lost out of it and use the scant balance so that I can quit work and go to nursing school.

There are NO jobs for new grads in the Denver area. NONE. Are there jobs for new grads elsewhere? WILL there be jobs for new grads in two years?

Discuss. Please. I need all the input I can get.

Personal posts and info about the critters and redecorating will happen later!

Uh, yeah. So it looks like I'll be blasted out of my skull on Lortab for the rest of the week...

...and thus won't be doing any nursing to speak of. Unless you consider shoving ramen noodles and icee-pops down my gullet "nursing".

Therefore, it's once-in-a-blogtime offer time! You got any subjects you'd like me to cover? Any questions you want answered? Any arcane subjects on which you need tips? Leave suggestions in the comments, or email me, and I'll be happy to apply my wonked-out brain to 'em.

PS: Don't, please, ask me when I wrote a particular post. Honestly, I don't recall when I did things, and you'd probably be much more efficient than I am at browsing through the archives. Especially right now.

Tuesday, September 14, 2010

Oooo! Two things I learned today that I just remembered:

1. The person with the suction is occasionally the most important person in your life.

Visualize this: Your Intrepid Correspondent, lying in the Comfy Chair at the oral surgeon's office. I'm leaned back, neck hyperextended, and I'm just *barely* not tearing the arms off the chair because of the lidocaine injection. (Note to future doctors: the feeling of lidocaine being injected is not a "pinch". Quit using that word.)

Suddenly it strikes me that I have sixteen gazillion instruments in my mouth and I can't swallow. Worse, the spit is building up horribly at the back of my throat, but I have to keep my tongue out of the way, so I'm afraid that I'll choke.

And in swoops the assistant with the suction catheter. She was gentle, thorough, and seemed to suction me every time right *before* I needed it.

I am going to go over and over her technique in my head later, once it's not all swimmy, and try to improve my own suctioning skills. There really is a skill to it, and she was good. Very, very good.

2. Remind patients not to look at their own incision sites, especially when those sites are likely to look like somebody drove a coal-fired locomotive through a huge mass of charred Jello.

It's scary, and I knew what I was looking at, mostly. If I have to show a patient a horrible incision site, I am *so* gonna do it next when we have plenty of time and they have plenty of meds on board.

Now to figure out how in hell to brush my teeth. Hm.

Okay, now that I've had a Lortab and thus can function again....

Two things right off the bat: First, we don't know if the Cap'n will turn out to be benign or malignant. I'm still praying and focusing on benign, of course, and will let you all know via HN when we get path labs back.

Second, if you're one of those people with my phone number, please don't call me. Talking hurts way too much. Think of a case of strep plus tonsillitis and you'll come close.

Do not EVER refuse opiates after mouth surgery, no matter how much you hate them with the passionate flame of a thousand burning suns. I was a total idiot for doing so; thankfully, Nurse Ames had some Lortab stashed away at home and was willing to break the law on my behalf. Ain't no way Advil would be holding this pain even a little at bay.

So, the story:

Nurse Ames and I arrived bright and early at the clinic, having had a few interesting "hey, where the hell's the road we're supposed to turn on?" moments on the way. The Good Doc was gentle, thorough, and told me that I would not be able to look forward to evicting Cap'n Lumpy today, as he was way bigger than Good Doc wanted to take on in his office. "That is," he pointed out, "a rather vascular area."

He then took us into an adjacent office where I was presented with a bill for $Zillion and change. I signed all the consents and managed not to whack Ames when she leaned forward and said, "Hey....shouldn't that diploma have a date on it? And that one--is 'dentist' spelled wrong?" Ames is one of those people who looks, well, like Cherry Ames, yet who should not be trusted an inch. Not an inch.

Back into the comfy chair, mouth open, pleasant young woman explaining to me that they use propofol for sedation (how come they get propofol and my patients can't?) until I told her that I only wanted lidocaine. Which, actually, was the worst part of the whole thing: felt like I was being shot, slowly, in the roof of the mouth.

Then twenty minutes of cutting and scraping, then a couple of snapshots, then stitches.

The Good Doc explained afterward that whatever Cap'n Lumpy was, he peeled away in layers as he was being sliced into, so Doc just took him mostly out. He's still maintaining a much smaller presence in part of my soft palate, but I can already feel the difference. Lumpy was a not-vascular, granular, fatty tumor of a whitish-pink color, and God only knows what all that means.

I did have one very scary moment when Ames was out picking up drugs: either a small fresh hematoma had formed over the (seemingly enormous) incision site, or I popped a stitch while drinking broth, but all of a sudden my mouth started bleeding. A lot. As in, enough that I was leaning over the sink, just letting blood run out of my mouth, as I scrambled for a rag. After ten minutes of pressure, it let up (and felt much better almost immediately, which is why I'm thinking hematoma).

Ames walked in to find me scrubbing the blood off my elbows, with a blood-spattered shirt and a brow with lily moist and fever dew. She looked at me like I had all the brains God gave a turnip, and said, "Got any Afrin?"

I'd forgotten that the ENT guys use Afrin-soaked gauze for tonsillectomy bleeding. I'd also forgotten that I learned about that during an ED rotation in school.

Sometimes I wonder what the hell I went to school *for*, if I can't even deal with my own blood. Sheesh.

Anyhow. My throat looks like somebody set a freaking bomb off in there, and feels not too much better than if somebody had. Swallowing is a challenge; eating and drinking almost out of the question. Something tells me I'm going to be very, vewwy quiet for the next few days.

Keep up the good thoughts, prayers, and kharma deliveries, Peeps. We've got at least a week before we know which port the Cap'n hailed from.

Ow ow ow ow fuck


I have something on the order of nine stitches in my mouth. I hurt a lot.

Cap'n Lumpy has been mostly evicted. He was some sort of granular, fatty thing that didn't look like a lipoma, so we'll see in seven to ten days. The doc said he flat-out didn't know what it might be.

Ow ow ow ow.

Nurse Ames is bringing back antibiotics and Lortab.

More later.

Monday, September 13, 2010

So. Tomorrow.

Heidi (I think it was Heidi; my apologies if I've got that wrong) wanted to know what, exactly, the good doctor will be doing in the morning.

I haven't the foggiest idea.

I suspect there will be at least a biopsy involved, though perhaps more. The nice lady from the office who confirmed my appointment today reminded me not to eat or drink anything after midnight, just in case I wanted to be put to sleep for the procedure.

Ve haff vays off makingk you zleeeeep.

Which all makes me think that either the good doc is going to take this damned thing *out*, which would be more than okay with me, or that they offer sedated biopsies to people who are less afraid of not breathing than they are of needles.

Call me a nut, call me a crazy dreamer, call me one of those quirky do-it-yourselfers, but I really prefer to maintain my own airway.

So. After the biopsy/eviction, I suspect there will be a wait for pathology reports. The best-case scenario is that the good doctor will hit Cap'n Lumpy with his special patented Cancer Detecto-X Ma-cheen and say, "Oh, hell, why do those people at that dentist's office keep wasting my time?" and send me cheerfully (and sedatedly) on my way after excising a ginormously impacted salivary duct. The worst-case scenario is one I have firmly banished from my brain. The reality will probably be a week's wait or more. Again.

Either way, I'll post something as soon as I can sit up long enough to type.

Everything else here is going swimmingly. All I have to do in the morning is change the sheets (a long-time habit of mine: if I know I'm getting sick, or if I have to do something that involves more than a blood draw, I like to have clean sheets) and refill Max's water bowls. I have a fridge full of soft, bland food that doesn't take a lot of effort to swallow, and a line of people willing to do everything from clean the cat box to gas up my car if necessary. I have, speaking of the cats, food and litter galore for them and enough to last Max a week, plus enough coffee to get through. So I'm as prepared as I'm going to get.

Say your prayers, children. We'll see what happens.

Sunday, September 12, 2010

Best. Friends. EVAR.

Nurse Ames, when I called her to give her the news that Cap'n Lumpy had been discovered, said, "I'll take myself off of the schedule on Tuesday and take you to the doctor."

Friend Pens the Lotion Slut just ended the phone call we were having with "You'll call me tomorrow, right? And on Tuesday? Just as soon as you can coherently string words together? On my cell phone?"

I asked my bestie, the Russian Prince, for a chatty email and he sent me a thousand-word essay on rebuilt road bikes and broken toes.

I have the best friends ever. And the best family, too.

I am a very, very lucky woman.

Saturday, September 11, 2010

Submitted without comment:

Oh, and by the way....

If you haven't yet seen this, you should click on it.

Now, a Personal-Drama Free Post That's Actually About Nursing!


Crazed Nitwit wrote in with a link to her blog, in which she asks one of those important questions that they never address in school:

How do I respect the older nurses I work with, and yet keep using current techniques? (I paraphrased, CN, sorry.)

That's actually a stickier question than you'd think. My first response was to think, "Well, that's not that hard. You just keep washing your hands and not mixing your drugs and ignore what the other nurses are doing."

Here are a couple of real-world examples: I work with a nurse practitioner of the Old, Old, OLD School (meaning that she's been in practice for years, not that she's ancient). She's an expert in her field: kind, knowledgable, irreverent when it's called for, fantastic in the clutch.

And she never wears gloves.


Think about that for a minute. Her practice includes things like dealing with recently-Roto-Rooted prostates and crazy-ass bladder reconstructions, but she never wears gloves when she's seeing/treating/removing things from and sticking things into patients.

What to say about that? Well, you gotta notice that her patients never get infections. I mean, they just don't come back to the clinic or the hospital with infections, period, because she's a maniac about hand-scrubbing and teaching her patients to do the same. I'd wager that her fingernails are cleaner than the gloves in the box.

So, despite the fact that I shiver every time, still, even knowing what I know about her standards of care (insanely high) and her infection rate (nil), I do not say squat.

Because frankly, it wouldn't help. She would either not wear gloves, or wear them only around me and be annoyed, and nothing would change except our working relationship.

Real-World Example Number Two: Another nurse I work with is textbook perfect. She's also of the school that studied on engraved stone tablets.

The difference between the two nurses is stark, though, when you start to look at practice: even though Nurse Number Two knows all the latest research and parrots all the latest rules, her patient care sucks rocks. Unfortunately, she's also the person most likely to have a screaming fit at the station if a younger nurse (ie, all of the rest of us) questions her or corrects something she's done.

The trick we have, then, is to keep complex patients the hell away from her interventions. Dealing with her wackiness is not our job; it's Manglement's, and I wish them much luck in the endeavor. *Our* job is to look beyond the HIPPAA (sic), TJC, AJCCN-published bullshit and make sure that everybody who's on a ventilator gets mouth care every four hours. I guess if you look at it one way, we're respecting her skill level and autonomy and giving her patients she will mesh well with; looked at the other, we're keeping the people who are either really critical or who actually need some help out of her grasp.

At the end of the day, it all comes down to tact and people skills. I mean, if you see somebody doing something (or about to do something) that's really and truly dangerous, you ought to speak up. (" that IV push supposed to be crystalline white?")

If, though, upon thought and consideration, you can balance outcomes against practice and have outcomes come up the winner, it might be best to keep your mouth shut, listen, and learn. *I* have some unconventional ways of doing stuff, as do nurses that've been in practice twenty-five years longer, and nurses who've been in practice for two months.

Styles differ. Unless there's an imminent danger, keep on wit' yo' bad self and yo' bad self's way of doing things. And if you have to correct somebody, no matter if they're older or younger in nursing terms than you are, doing it respectfully and kindly will never, ever hurt.

Friday, September 10, 2010

Lessons to be put to use later:

In the past nearly thirty-six hours, I have learned:

1. That a terrible sense of inertia sets in when you're waiting.

I hadn't realized how hard it would be to even get out of bed in the morning when all there is to do all day is watch the clock and wait. That makes the reluctance of my patients to walk, or do physical therapy, or do anything but sleep much more understandable. If you sleep, the time goes by a little faster.

2. That people can be really marvelous.

If the prayers, hip-shakings, incense-burnings, and chants of my friends, readers, family, and complete strangers mean anything, I should be floating on a cloud of glory right now. And I am, and I'm thankful. I think about all the nice things people have said all day long, right before I go to sleep.

3. At the same time, though, you're always essentially alone.

Nobody else can get into your head after you've been diagnosed with X or Y, or while you're waiting for X or Y to happen. I had understood that intellectually before, but not on a gut level. As with so many things that you *have* to do when you're human, this you have to do alone. The best you can hope for is another person to watch with you.

4. Cheese is good.

Eating things that take very little effort but give big returns in the texture and taste department is important. I plan, tomorrow, to spend money on late-season tomatoes and green tomatoes and possibly a truffle or two, and have some potatoes as well. With butter. Dammit.

5. Fiction, or even familliar non-fiction, can be extremely comforting.

I'm re-reading the "Little House" series.

6. There is always, always something worse.

I've not yet seen the situation--well, no. I lie. I have seen situations that couldn't get worse, but mostly those people have been on so many pressors and so gorked out that they don't realize how badly they're being treated. Perhaps I should say: as long as you're conscious and functioning, things could always be worse.

F'rinstance, all the critters are healthy. There are no wildfires burning here, and no gas lines have blown up recently. More than that, I have water and power and clean food to eat, and I'm not living in a tent outside Peshawar.

I know I can call any one of a number of besties in the middle of the night, or my sister or parents, and they'll answer the phone. That alone puts me way ahead of a lot of people.

7. Humility often means asking for shit you need.

As I emailed a pal of mine tonight, "I need you to send me chatty emails about the bike you're building; I'm sick of explaining what's going on."

I'm not fearful right now of looking needy. I'm needy, okay? I'm scared, and I'm needy, and I'm owning the hell out of that. It's humbling, but being humbled, in this case, is a very good thing.

8. The human body has an immense reservoir of tears. At the same time, it also has the capability to come up with really bad jokes.

I was thinking today that "Cap'n Lumpy" was a fine name for this (benign, not dangerous, not scary, easily-removed) thing in my throat, but just in case he turns out not to be benign, and he turns out to have spread, I would rename him Benny.

As in "B-b-b-Benny and the metssssssssssssss."

9. Paranoia will destroy ya.

In the last almost-thirty-six hours, I've had cancer. In situ and metastatic. I've also had West Nile, a couple of salivaliths, a brain tumor, lymphoma, sarcoma, mesothelioma, and tacomaroma. I've been feeling lymph nodes and yanking my tongue out and generally exploring every inch of skin for weirdness. After I'd gone over every inch twice, it stopped. But still, it was an interesting fifteen minutes (I'm short).

10. Perspectives change.

To hell with going two-point-seven seconds on a bull named Blue Manchu. I would like to outlive my animals. I'd like to be able to contemplate putting the laundry into the washer without it seeming an insurmountable task. I would like to have a five-minute space, after coffee, when I'm not aware of this *thing* hanging out in my throat and thus over my head.

Still, it's not a bad set of problems to have. Given the alternatives, I'll take it.