Friday, July 29, 2011

Odds & Ends

Man, Rimadyl works FAST.

Max woke up this morning and trotted (trotted!!) outside, with scarcely a trace of stiffness, then spent about ten minutes barking at something I couldn't see with a vigor I haven't heard in three years, at least. Then I let him in, because five ack emma barking is not a thing in this neighborhood. Although it might become a thing, because Max is groovin' back to his badass self.

No weird memory issues the last few days, either.

Now, of course, I feel like shit because all of this must've been related to the pain his back was causing him. And I didn't notice. But he's stoic, so how would I have noticed? Anyway, I think he might keep going for a few more years, now that he's able to boink around the yard going BAROOOF at things.

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

Turns out that Bossman had a meeting with The Big Evil Bossman and one of the BEB's Minions, a woman I used to like and respect until she got too close to the BEB and started acting more like him than like herself. What is it about Evil Bosses? How do they corrupt the minds of the innocent? And, more than that, what was Minion doing at a meeting about the NCCU with our Bossman? WTF? She has zero CCU experience and doesn't even run a floor that has to do with our specialty.

All these questions will have to wait until Monday to be answered. The upshot of the last meeting was that BEB can't understand why (because he too has exactly zero critical-care experience) we would want heart monitors on our patients in the NCCU.

.... ..... .... .... ....Yeah.

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

I have finally figured out liquid/gel eyeliner. This is a huge deal for me. Back in the day, I wore the shit out of that stuff, but as I've gotten more mature (read: as I've gotten lines around my eyes) the mid-Eighties Rococo Raccoon Look is less and less appropriate for work.

Last night I took some time and figured out a better way to do liquid eyeliner, which involves lining the inside of my upper eyelid, and will try this bad boy out with the green-and-black rhinestone-encrusted glasses which Abilene Rob said made me look hot. I'm thinking it'll be a sort of Nutso Cat Lady Librarian Meets Studious Nurse Thang, and I'm all over that.

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

Why I love The Hairpin, part three gazillion: because they introduce me to websites like this.

Thursday, July 28, 2011


Max has arthritis in his spine. His bloodwork was perfect, his right hip is fine, his left hip is all jacked up with arthritis, and his spine--especially the lower back--is a mess.

He now has the tippy-top super-duper prescription glucosamine supplements from Hades, a bottle of generic Rimadyl, and a bad sedative hangover. Luckily, he's a meditative drunk rather than the pacing, panting sort.

That's him, passed out with his head on the nice cool bathroom tile. Poor guy.

Had a bad day?

Have a baby hippo.

Monday, July 25, 2011

Max news!

Thank you, first of all, to all the folks who sent/commented with tips and tricks for old, arthritic dogs.

The vet says two things:

1. It's probable that the trouble with Max's hind legs is arthritis in his hips. HOWEVER. There is a rare degenerative spinal disease that tends to hit German Shepherds, so he's going in for X-rays on Thursday to make sure that it's actually arthritis.

2. The memory loss doesn't concern her yet, because it's recent, sporadic, and correlates with the horrible heatwave here. I am to keep a journal of when he goes blank and, if I get more than five or six instances in the next couple of months, to bring it back to her. My marvelously intuitive brother-in-law might be right: this might be Max saying "I hate the heat and there are ants biting my butt."

Also, he has Old Dog Teeth and Old Dog Skin Weirdnesses, but we're not going to put him under to deal with them. His heart's fine, his bloodwork is pending, but honestly? I don't see the point in putting a 107-lb, eleven-year-old dog under general anesthetic to have a couple of minor, benign skin-things removed and his teeth cleaned. They're not *that* bad.

I learned today that the fastest way to get a reaction out of people is to take your very large old dog into a liquor store on the wrong side of the tracks. There's a store here that sells 471, a pale ale I particularly like, and so I ran past there on the way home from the vet's, with Max in tow. I took him in because, in 100-degree heat, you don't leave any animal in any car for any length of time.

We walked past Mexican roofers with cases of Corona Light in their arms, gang-banger wannabes with saggy shorts and gold teeth and bandannas, and scary-skinny blonde white women with prison tattoos, and all of them were totally silent. Max was prick-eared and perky; he likes going new places. Not one person said one damn thing to me, the chunky chick in the empire-waisted flowy hippie-dress. Except one guy, who came in, stopped dead in the doorway, and said, "Woah." I reassured him that Max was friendly, so he came closer, scratched Max behind the ears, and said, "He's a big man, ain't he?" I replied that yes, he got that way through drinking all my beer, and the guy chuckled while Max drooled on his shoes.

Max is now lying on the dining room floor, and taking up most of it, because he has had a Very Big Day.

Sunday, July 24, 2011

Oh, well.

I have had One Of Those Days.

Worry about work kept me up late last night; the heat kept me in today. I did some basic grocery shopping, but forgot to get coffee. Max seems better--of course, because he has a vet appointment tomorrow.

Today, a friend of mine whom I love and respect was bitching about how the development of cellulite has kept her from buying shorts. It was dramatic enough that I nearly said something like, "What a coincidence! I've been looking for months for shorts that'll coordinate with the huge hole in my head, the sores I get on my tongue from the prosthetic, and the wires that poke my gums."

Anger from work is obviously spilling over.

Tonight I'm going to read All Creatures Great And Small and eat a pile of toast. Tomorrow I'll see the Prosthodontic Fairy, then take the Zoaters to see the doctor he once tried unsuccessfully to bite, then come home and make salads and lunch for the rest of the week. It'll be a productive day, which is better than a day spent worrying and pacing.

Something is going to happen soon, I know that. I just wish I knew what it *is*.

*pace* *pace* *bang* *bang* *pace* *pace*

I do not know what to do.

DAJ and I have been chatting prior to her leaving on vacation. She's got worries about the NCCU, and so do I. She's the best formal, businessy-type letter-writer I've ever met, and I'm good at editing, so we're going to work together--after she gets back--on a formal letter of complaint about what's been going on. Meanwhile, all of us are going to keep on filling out incident reports and yelling and pointing out problems and inadequacies, and I'm going to ask for a meeting with the person who's the head of education for the chemotherapy nurses. I'm going to throw myself on her mercy and ask her if she thinks it's a good idea that we, the NCCU nurses, take over chemo administration after our chemo unit moves across the street.

I'm also going to chat with the director of the unit.

But, after that, then what?

Here's the deal: we're moving the unit sometime later this year into a designated space. Rather than carving out space in underused rooms with borrowed beds and semi-working monitors and pumps, we're going to have an actual six-bed unit, with *stuff* that works. I'm holding out hard for central monitoring (the patients could be monitored remotely in the surgical CCU, but I don't like that idea for a number of reasons) and in-room recording monitors. Frankly, not having those two things would be a dealbreaker for me.

I'm also holding out (dealbreaker again) for actual written policies as concern staffing and duties, not a make-it-up-as-we-go approach, which is what we've got. The Big Boss of the Block told me a few weeks ago that the reason we don't have formal policies yet, after ten months of being open, is that we don't *officially* open for business until this coming fall.

Which makes me wonder what we've been doing since September.

All of this is making me very thoughtful.

The Big Boss is a bully and a terror. I've known this since I started working under him five years ago, and he and I have gone head-to-head on a number of issues ranging from his harassment of other nurses to the way he treats people on committees. He doesn't like me; I don't like him. We can work together, just barely, provided our interests don't conflict too much. We both realize this.

I'm not sure I can outlast him. He's older than me, and much fatter, and in rather poor health. Unfortunately, given that he's a lump of Concentrated Evil, he's likely to last in his current position for a very long time. Evil don't die easy.

Should I leave now? Should I wait, since this unit has become my baby, and leave after we transition to a workable space? (Just the space we were given is nearly impossible, given how it's laid out. I mean, really--you guys wouldn't believe it if I told you.) Should I stick it out, hope to outlast the Big Boss, and continue to fight the good fight?

I don't think I can stick it out. I'm convinced that part of the reason I got cancer was the amount of stress I was under during the year before I was diagnosed. I don't want a second malignancy.

At the same time, how easy would it be for me to get another job within Giganto Research & Education, Inc, parent company of Sunnydale, with Big Boss still in the picture? Leaving the GREI fold isn't workable right now for a number of reasons I don't want to go into.

Will an infusion clinic hire a nurse they have to train? Is there a way I can make myself more or less bulletproof as regards Big Boss? If I'm not naturally very diplomatic, how do I learn those skills, and will they actually do me any good? Should I try to get another job here in the state, or just up and move to Missoula? Should I stick it out for a year while DAJ finishes her degree, then move with her to Seattle so we can split rent?

I tossed and turned last night and had to do deep meditative breathing to keep from getting so angry I couldn't sleep. I simply am at a loss.

I think I'll go make a coffee cake.

Saturday, July 23, 2011

Let's get one thing straight right the hell now.

I am not a fan of small dogs.

If you give me the choice between a stubborn, grouchy big dog of unknown origin and a cute little white fluffy eager to please purebred that weighs less than 20 pounds, I'll take my chances with the grouch.

However: my old vet, the one with the overalls and the goats in the waiting room and the six rescued Greyhounds on her land, once told me this:

In a fight between any dog and a Chihuahua, she would bet on the Chihuahua, unless the other dog was a Greyhound.

Give it up for Paco, the crime-fighting, bad-ass good-boy of the day!

Friday, July 22, 2011

Eeeyep. Yep, yep, yep. Juuuuust about quit my job today.

For two reasons:

1. My boss is a moron.

2. My boss is a fucking moron.

Seriously: You should have more than six months' experience as a working nurse before anybody gives you a managerial job, no matter how brilliant an organizer or genuinely nice a person you are.

Because, if you have some experience on the floor or in the unit or in a clinic, you would not:

1. Double the number of patients in my unit without warning and without giving me any extra resources.

2. Look at me like a calf at a new gate when I suggest that those of us who might be administering chemo (there is no policy as yet) will have to get and maintain competency, and, given that chemo is an entirely different specialty, that this might be a big deal.

I walked in today to find eight patients and two nurses, which doesn't seem like a big deal, until you remember that these patients are in a critical-care setting, we are doing total care on people who are hemiplegic, altered as hell, and tend to have rapid neuro changes, and there weren't even enough monitors for the patients we had. One of them was on a not-centrally-monitored ancient thing somebody dug out of a basement storage room.

This is, as of yesterday at noon, the new policy: fill all the beds imaginable with all the patients we can get, until something breaks. We were damned, damned lucky today that nothing broke. The guy who lingered on the edge of crumping managed not to crump, the woman who has a violent history with us and was actually labelled as a "Do Not Return" (she was admitted by mistake) managed not to punch anyone, and we got through the day.

Then in the middle of the day, Bossman comes to me to chat about the whole deal, and I bring up the "Oh, by the way, you're also going to be giving chemo" thing. He truly did not understand why maintaining competency would be a big deal. "There are protocols and regimens in books this thick," I said, holding my thumb and forefinger about three inches apart. He had no idea. I am not a chemo nurse, and *I* knew that shit, just from being around it.

Now I am going to drink. Maybe not a lot, and maybe not hard liquor, but I am going to drink. With any luck, it'll mellow me out enough that I don't end up staying up late and writing letters to the medical director, the state board of nursing, the state board of morons, and the paper.

Holy. Crapping. MONKEYS.

Thursday, July 21, 2011

Y'know what's great about being a nurse?

What's great is this: when your worried neighbor texts you just before dinner because her seven-month-old has a weird rash just spring up, and you can go over there and see him and her and reassure her that yes, it's just heat-rash, he'll be fine.

Because--and this is what gets me--her pediatrician told her the same thing, but she and her husband wanted to talk to a nurse, because nurses really know what's going on.

(Never mind that I know next to zilch about pediatrics, and that heat-rash is pretty easy to diagnose.)

It gives you the warm fuzzies.

(Plus, I got to play with a baby for a few minutes which, if you are a fan of babies for a few minutes at a time, as I am, is not a bad thing.)

Wednesday, July 20, 2011

And then this afternoon, Max.

I'd noticed he hasn't been barking at the mailman recently. And he needs encouragement to get up from the slippery wood floor; his back legs don't work as well as they did even six weeks ago.

Today I found him standing in the living room with a "what the hell did I come in here for?" look on his face. The last week, he's been standing stock-still and just staring at random times.

He's wuffing at the cats more often, but also staying still and licking their backs and heads more often, which confuses them. When he rolls over for belleh-rubs now, it's an even chance that I'll get a look that says fear and confusion versus a look that says rub mah belleh.

My boy is old. He didn't *get* old; he just suddenly *is* old. One day he was fine; the next he woke up in a puddle and couldn't get up easily and started forgetting stuff. His ears still twitch reflexively when I call his name; it's just now he can't remember his name every time. About one time out of three it's just a sound, not something to respond to.

Just now he's barking at the dogs walking past the house with their humans. If I didn't look outside, I'd think he was only a couple of years old, except that the barking stops too soon.

All I want is for him to have a good Fall and maybe half the winter. I want him to be mobile and happy without all this horrible heat that forces him indoors for most of the day. If he has to go down, I'd prefer he go down all at once, like he was hit by a meteorite. God knows he lived through enough to kill most dogs in his first nine months. I remember how apologetic he looked after he got the Huge Nasty Injections in his back muscles to kill heartworms, just after we rescued him: he kept moving from couch to floor to chair to floor and finally back to chair, just trying to get comfortable.

I will never, ever be ready to say goodbye to my friend, but I at least want him to be able to enjoy one last cool season, with fog and rain and being Braveheart, before he goes.

Shit shit shit shit shit. *bangs head on knees*

As I told Der Alter Jo on Monday, it's a rare morning that I wake up and think to myself, "Y'know, I really should've drunk *more* last night."

Call this a rare morning. Also, please butter my ass and call me a biscuit; I'm feeling peckish.

The Fearsome Foursome (that's us in the Neuro Critical Care Unit) have finished our chemotherapy certification course. That means that, after several hours of hanging chemo under supervision, we'll be okay to be "chemotherapy resource nurses" at Sunnydale. Our chemo unit is moving over to Holy Kamole sometime this year, which means all our chemo nurses will be unavailable without major advance notice.

So Sunnydale will need resource nurses. Which is understandable, but. . . .

There are real questions as to what our scope of practice will be. Will we act as actual chemo nurses, hanging chemo on those very, very rare occasions when somebody needs it? If so, how will we maintain our skills? What about the safety issues surrounding patient care in our unit if we're somewhere else, monitoring a chemotherapy infusion? If we're both certified and competent (two totally different things; the latter has to do with practice, the former with book-larnin'), will we be expected to pull shifts in the new cancer unit at Holy Kamole? Or are we merely meant as a "resource" in the most basic sense--somebody to call if a patient has a delayed reaction or a bad IV?

The other nurses in the unit are very upset. Der Alter Jo, who is an intensivist and neuro specialist, is understandably bothered that the specialized unit she signed up for is getting diluted in terms of duties and resources. "If you're gonna have an intensive neuro care unit, have an intensive neuro care unit" is how I'll paraphrase it. She has worked so hard to make certain that the CCU's been utilized appropriately and has gotten adequate staffing, and that the other nurses have all been treated with respect and given resources. I can see why she's frustrated and angry. The other two nurses we work with are worried about safety and whether or not we're going to screw things up, plus they're understandably upset about having to learn an entirely new specialty--jack of all trades means master of none.


I volunteered to take these worries to Manglement, provided DAJ put 'em all into some sort of coherent formal letter. I guess we'll have a meeting soon about it. (Meetings: BAH.)

Something tells me that Manglement and the neurology folks are not on the same page about what's going on. I only thought I was worried before.

Tuesday, July 19, 2011

Tuesday night mellow

You've got tombs in your eyes
But the songs you've punched are dreams

Monday, July 18, 2011

July Moneygrubbin':

Mary is a friend of my pal Lara's friend Nikki. Mary is 38, and was diagnosed two years ago with stage 3B tongue cancer. For those of you who aren't fluent in solid-tumor staging, that's not good at all.

Mary has been in remission since March of this year. She recently started hyperbaric treatment to help rebuild the bone in her jaw. A word (or many) about hyperbarics:

When you have chemo, and more especially when you have radiation, to kill off a cancer in your head or neck, everything suffers. All the structures in your head and neck are affected, especially cells that replace themselves quickly, like those in your salivary glands and in the lining of your mouth and throat.

Because the treatment is really fucking intensive, and because it kills off your salivary glands, and keeps new blood vessels from forming, things happen after radiation that are decidedly not cool. For one thing, your bone? Doesn't heal if it's injured. It just sits there and rots. Hyperbaric oxygen therapy, or "diving" is supposed to fix that. You sit in a big, huge can, usually with pure oxygen pumped in under enormous pressure (at least ten times the atmospheric pressure you'd feel at sea level), and that forces pure oxygen into your bloodstream and thus into other tissues. That in turn causes what we in the biz call "angiogenesis," which is Fancy-Pants Medicalese for Growing New Blood Vessels All Over.

"Well, Jo, that's fanfuckingtastic," you're saying to yourself. "What does this have to do with anything?"

Let me tell you: Mary had radiation to her neck and face. She lost her salivary glands. As a result, her teeth are breaking off at the roots. She can't have them pulled unless she undergoes this hyperbaric oxygen treatment, because the lack of blood vessels in her jaws mean that her face will, and I am not joking here, simply fall apart. I have seen it happen, and it is about the ugliest thing you can think of.

Mary's going to need dentures after this tooth-yanking and hyperbaric treatment is done. She probably has the same insurance company as I do: it'll cover her hyperbarics, and the tooth-pulling, but won't cover the anesthetic for her tooth-pulling (for the love of God) and won't cover her dentures. Which means, tra la, that she'd do this all without sedation and then not be able to eat.

So you should, if you're looking for a place to drop a dime or two, give her your money.

Her blog is here, the fundraising page is here, and here's a video interview she shot recently:

Sunday, July 17, 2011

Shoulda listened to the doctor when she said "No Heavy Lifting."

Unfortunately, her definition of "heavy lifting" and mine differ. Apparently they differ substantially.

Before anybody panics, no, I did not herniate through my incisions (near as I can tell). I didn't tear anything or pull anything loose; I just did a little too much yesterday. Specifically, I went grocery shopping.

See, I shop at this place where the sackers are paranoiacally careful about how they bag up your food. I did *not* take my nice reusable bags with me, specifically to avoid the sort of weight that can be put in those bags. So I got umpteen bazillion bags of groceries, some with one package of rolls or one carton of eggs in them.

Also see, I do twenty-pound bicep curls on a fairly regular basis--sixty of 'em at a time. Plus, I lift more weight than I really want to talk about with my back and legs. I figured that I'd be golden for lifting umpteen bazillion very light bags of groceries. After all, I can straight-arm a 17-pound bag of dog food with no problem, right? Right.

Loading a dozen one- and two-pound bags of groceries into the car and then unloading them into the house undid me. I had actual pain for the first time since day two post-surgery: a feeling like I'd been repeatedly punched in the right side of my gut. I can still tell that it's there, though it's not actually hurting this morning.

I cannot freaking believe that *groceries* did me in. I mean, yeah, if I had been doing hot naked unassisted power ultimate yoga, or running miles at a time, or trying my usual lifting workout, I could see that there would be a problem. And I understand that the belly muscles are connected to the everything-else muscles. But, really: groceries? Rotisserie-seasoned, deli-thin-sliced chicken breast? Eggs? A carton of milk?

The deep frustrated grumbling you hear is me.

Friday, July 15, 2011

Let's drop that last title below the lead, shall we?

Notamus is gonna get his comeuppance tonight. I have on the stove spaghetti sauce--pasta is one of his favorites, the little weirdo--with fake meatballs (soyballs?)(wheatballs?) and artichoke hearts.

Knowing him, he's gonna try to snatch a fakeball. I'm gonna let him. And boy will he be surprised when he realizes that it's not the sort I usually make, with the egg and the breadcrumbs and the veal and the pork and so on. If I'm lucky he'll have a facial expression worth capturing on camera.

*nod nod nod*

As to why I'm eating spaghetti and fakeballs when it's approximately a zillion degrees outside, it's because I can't bestir myself to go to the grocery store. When the low is 89F/almost 32C, the idea of hunting and gathering at the local market loses its glow.

Things are bad here this summer. Summers in the middle of Texas are always dry, but I've not seen a summer this dry in my life. Really and truly: there's not a crop in Central Texas that's survived this long, and most ranchers in the area and north of here are selling off all their stock in order to pay their bills. They can't afford to feed 'em, because nothing is freaking growing.

The upside is that there are fewer mosquitos than I remember there ever being. The downside is that everything in my yard is dead or dying. The upside to *that* is less maintenance later on, especially when you consider that those of us here in Littleton's Hippie Quarter aren't saddled with the demands of homeowners' associations.

Yeah, so: No rain means no grass, no herbs, no grain. No grain means no cattle going to feedlots means hugely high beef prices in about a year and a half, as there will be no mature cattle to slaughter then. No rain and temperatures of over 100F for the foreseeable future also means a dimunition in the number of fleas and ticks and mosquitoes, but also huge grass fires.

I am constantly amazed, especially when it comes to summers here and winters in the western part of the state, how people could've settled here in the first place. I mean, where I live isn't so bad: there's water, natural springs and the like--but west of here? Northwest of here? Those first settlers were BAMFs of the first degree. There is one natural lake in Texas. One. The rest are manmade.

I listened to an interview once with a guy who did water management or crop management or was a fire chief or something, out west of Midland. He said (and you'll have to supply the drawl for yourself), "You take a map of Texas, you draw a line down the middle. To the left of that line, it don't rain." Precipitation comes in the form of snow, ice, hail, sleet, and a horrifyingly heavy sort of drench that washes away roadbeds, but it doesn't rain like it does in Columbus or Boston or Seattle.

Every year about this time I begin to get rain-hungry.

And fake-meatball hungry. Time to mind-fuck the cat.

Thursday, July 14, 2011

My pussy smells like fish.

Which wouldn't be a problem, except the fish (she says, with emphasis, giving Notamus the side-eye) was meant for my dinner.

This afternoon I told Der Alter Jo the charming story of how Notamus had once intercepted a piece of pepperoni, mushroom, and black olive pizza while it was on its way to my mouth. He got a healthy shark-bite out of it before he bounced off the wall.

What? You try eating pizza when something with teeth is going after it and see what you do.

So, tonight, I had made myself a lovely tuna salad with chopped cornichons and shredded cucumber and grated onion and a delicate lashing of mayo. I had planned on eating it with pita bits and maybe itty shreds of veggies.

I mixed up the tuna with the mayo (home-made, by the by, with lemons I squeezed myself and olive oil carefully dribbled into the blender) and the onion and the cornichons and then turned my back to assemble the other bits of dinner.

When I turned around, I found one Notamus eating MY TUNA.

*cue frustrated troll noises*

So: Notty got two-point-six ounces of tuna. With fixin's. I got pistachios and wine.

HAT is only one letter different from CAT.

(And, post-scriptally and parenthetically, how weird is it that my cat likes sour French pickles? Because the underlying aroma of his breath is cornichons, overlaid with TUNA. Bastard.)

Wednesday, July 13, 2011

*Twiddling thumbs*

No news is good news, right?


My incisions itch. I wore pants today, for a short time; long enough to head to Target to pick up a new water bucket and rug for Max. He's ignoring them both, being resistant to change. Eventually he'll cop to the fact that Old Dog Hips are more easily levered from the floor when the feet below them have something to grab hold of, and that Old Dog Mouths like water from nice, fresh buckets rather than two-year-old, scuzzy things, but for now? he's ignoring both with glacierlike calm.

Two things that shock me today: how swollen Mah Belly actually is and how stupid people can be.

I put on a dress that fit fine the day before surgery and was surprised that it wouldn't zip up past my waist. I figured the belly-swelling was a two-to-three-day thing, at the absolute outside, and that I'd be back to normal by day five (which this is). Sadly, no.

I also figured that, given that we're getting more and more patients with strokes in the CCU, there would be--at some point--a drop-off in the number of people admitted under stroke protocol who later turned out to have such conditions as, say, a torn rotator cuff.

Sadly, no.

Going over the recent chart audit submissions from here at Casa Del Piles of Sleeping Mammals, I was distressed but unsurprised to see that the guy whose job it is to compile all the charts to audit had, as has been his habit, included a bunch of people without strokes and missed a number of folks with them.

A little explanation: chart auditing is one of those things which the Accrediting Agencies require hospitals to do for the accreditation. Because Sunnydale and Holy Kamole are both now stroke centers, it falls on us to audit the charts of people who come in with stroke symptoms to make sure that we're doing things like telling them to quit smoking, getting them head CTs in a reasonable time, and doing NIH scales. I got volunteered for the job of doing chart audits because I don't spend enough time already either taking care of patients or making sure people don't suddenly leap out of bed like so many gazelles, eating utensils in hand, ready to attack other nurses.

For whatever reason, the guy who makes up lists of charts for me to audit has about a fifty percent success rate in actually picking out the folks who have had strokes or strokelike symptoms. Fifty percent. That means that half my time is spent picking through charts, reading notes, and looking desperately for something that says "stroke," only to find that the person I'm reading about had, say, a bad reaction to chemotherapy (not making this up), a case of food poisoning (not making this up), or a fecal impaction (o how I wish I had made that up).

The other half of my time is spent--and I kid you not, it's probably close to 40% of the remaining time I spend on audit-related stuff--looking through the charts of everybody that Sunnydale or Holy Kamole has discharged in the past three days, and usually finding stuff that Chart Guy has missed.

Ten percent of that time is spent actually auditing the charts of stroke patients. Since most of them come to me, it's quick and easy: I can and do do it from memory, mostly.

So, yeah. The TL;DR of the preceeding complaint is that I'll have twenty or so (at last count) charts to transcribe to paper and a couple hundred to slog through on the hunt for missed strokes. I don't know what Chart Guy's problem is, honestly, except that he's probably as overworked and understaffed as the rest of us.

In other news, uh. . . .I got nothin'. Der Alter Jo has damaged her knee in some unique and painful way, so we're both lying up on our respective couches feeling like extras from "Spirit of '76." I finished Bill Bryson's book At Home with the result that I now have a list of six more books that I really ought to read. I'm getting into the first season of "Torchwood" and now want to buy a Roomba vacuum for the sole purpose of naming it Ianto.

Off to turn the a/c down some more, and maybe pour myself a glass of something intoxicating, before I get back into chart audits. Hospital administration would be so much more pleasant--and probably more productive--if we were allowed to tipple at our desks.

Tuesday, July 12, 2011

Owling; because planking is so yesterday.

I just saw the first example of Owling I'd seen on the 'Webs.

You have to perch in a crouched position like a bird on something unlikely.

I think this might be a new trend at Sunnydale.

F'rinstance, I could Owl on the person who went after Kari with silverware the other day. You do not go after my colleagues with sharp things; how many times do I have to tell you this?

Number of people who have tried to stab, punch, kick, or bite Jo or her colleagues: 11.

Number who have succeeded: 1.

That leaves ten who have failed. You are not the exception.

*beat* *beat*

So, yeah. Owling. It doesn't look as though it's particularly physically challenging, and I wouldn't have to lie on my stomach. I could, you know, crouch on the staircase leading to the roof access just above the 9th floor stairwell. Or Owl on the unit secretary, provided she's in a good mood and not hung over. Or Owl on an empty bed. Or, hell, a full bed, provided the person in the bed isn't noticing much.

Propofol + Jo = Owling Deluxe.

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

In other news, Friend Penny tells me that *everything* weighs more than five pounds and *everything* is below waist height. I am not allowed to lift anything heavier than the first or lower than the second. Even so, I have scooped Notamus up from the floor (12 lbs) (lower than my waist) and snuggled him, and the only side-effect I have had is a buzzing kitty on my shoulder. Still, I won't be moving heavy boxes full of Stuff any time soon. It's truly astounding what you can feel from just three small puncture marks.

The one in the depths of my belly button itches terribly. The one to the right of my belly button, where they did all the actual pulling & tugging, does not--but there's an area about the size of a half-dollar, two inches down, that's about to drive me NUTS. And, of course, I move faster than light when the boys decide (either singly or together) that they need to hop up into my lap/belleh.

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

I am waiting for my post-op pictures to show up on Facebook.

I hope I photograph, slackjawed and roll-eyed, well.

Sunday, July 10, 2011

0215 Sunday:



(rattle rattle rattle THUD)



(pat pat pat pat THUD pat pat pat pat)

Meeeeeeh? THUD










Friday, July 08, 2011

BORED. *blam* BOOOORED. *blam* BOOOOOORED!! *blam*

(A little "Sherlock" humor there, special for Der Alter Jo.)

I do this Recovery Thing very badly.

First of all, I hate pain medicine. Dilaudid makes me woozy and dizzy, hydrocodone makes me itch, it's too early to take naproxen or ibuprofen, and whiskey is ten miles away and thus totally out of the question. But I *hurt*, so I end up taking the Lortab as it's been prescribed, especially after Notamus decides that his fourteen pounds needs to be on my lap right the hell now. And I itch, and it doesn't help much, and I'm still stuck with this cat on my tum.

Secondly, I have entirely too much energy of entirely the wrong sort. I can't lift anything that weighs more than five pounds. That makes laundry difficult and taking out the trash impossible, and made folding up the futon today something that I considered, then rejected. Don't even ask about the gymnastics it took to get Max's food bowl off the porch and into the house.

I suppose I could edit the stuff I've written for Scrubs, but if there's anything worse than my writing when I'm on painkillers, it's my editing when I'm on painkillers. All of a sudden, major arguments go away and subject-verb agreement seems not to matter in the least. I become one of those people who insert's apostrophe's rand'omly into word's. Worst of all, I start adding things that, to my sleep-deprived and drug-addled brain, sound funny. It's like SNL in the mid-nineties.

Thirdly, I am very, very, very grumpy after surgery. Maybe it's the constant itch; maybe it's the inability to *do* much, or maybe it's the cat walking on the keyboard, but I get foul-tempered and out of sorts. I've been reminding both the boys today that "cat" is only one letter away from "hat" and that it won't stay too hot for fur headcoverings forever. It's unfair; they're actually being very sweet, if a bit clingy, but I'm taking my temper out on everything from bran muffins to ceiling fans that need to be dusted.

(Speaking of cats, Ibid showed up this evening earlier than usual and wearing a cute little pink collar with a bell on. She has a new home, hurrah! She acted quite pleased with herself and declined food, but accepted pets.)

And, finally, *you* try to be serene and relaxed when your belly is so bloated you can't breathe deeply. I have some remarkable bruising that's only just now starting to show up, as well as some fantastic marks from the tape they used on the operating drapes: I'm allergic to adhesives, apparently. My right shoulder is sore, even though they obviously worked hard to press all the CO2 out of me prior to closing me up.

It's a good thing I own ten empire-waisted dresses. Der Alter Jo asked hopefully if I'd be able to make Marcus Wallaby, MD's birthday party this weekend, and I had to respond, "Dear, I can't even wear pants. Only sluts run around without drawers, so the answer is no."

I guess it's a good thing my social life is in shambles. I'm in no shape to be pretty, popular, or charming just now. I can go to bed, sleep three hours at a stretch, and then get up and surf Craigslist for project cars and nobody'll be the wiser.

Bah. Lortab. Bah. *blam*

What Fresh Hell Was That? or, My Day At Holy Kamole.

My doctor doesn't do surgery at Sunnydale, because apparently they don't have the right sort of laparascopes, or the walls aren't sufficiently lined with gold, or something. So Der Alter Jo and I were at Holy Kamole at oh-dear-thirty yesterday, her limping on a busted knee and me casting the side-eye at everything, for Animal's eviction.

Preop nurse, resident, attending, preop nurse again. More urine, more blood. Cute little backless dress. A fond farewell to being able to bend over easily for a while.

A brand-new nurse intern started my IV and did a slammin' job. I have veins like hoses in the backs of both hands, so when she hesitated between an 18-gauge and a 20-gauge 1.5 inch IV, I told her to go big or go home. One stick, flawless placement, and she only needed help on taping the thing up. Not so on my other hand, where some Einstein in the OR tried three times on the back of my paw, blew one vein and missed two, and finally did the med-student start on my wrist just below my thumb. Brand New RN Whose Name I've Forgotten, you rock.

Then EKG leads and a KVO rate bag of fluids, then two CNAs came in to introduce themselves and one brought Versed. Then down the hall on a surprisingly comfortable gurney (why can't Sunnydale get some of those?), into the OR, which was smaller and more crowded than I expected, and another shot of something into my IV. Aaaaaaand goodnight.

The disturbing thing about general anesthetic is the complete lack of a sense of time passing. Your brain tries to rationalize it later, but at the time, you go to sleep in the OR and wake up simultaneously in post-op. I do vaguely remember being extubated and hearing somebody ask if the doc wanted the Foley out, but that moment collapsed into the going to sleep/waking up moment. All I know is that I went into a controlled coma with one set of friendly people and woke up to another set, including Friend T-Bird, who is liberal with the Diluadid. Somebody handed me my prosthetic, which I tried earnestly several times to put in backwards until I figured it out.

I precepted T-Bird when she was a new nurse. She's now an experienced post-op nurse and a new mother, and both seem to agree with her. She was blooming. It's so nice to watch frightened, shy people really get into their groove. Plus, I don't think I know anybody prettier, which is nice to wake up to.

Back up to the post-op recovery room. Der Alter Jo at the bedside, giggling over my inability to move and my drunken philosophizing. A sudden brain-stem-level urge to get the HELL out of there, and so ice chips. And Sprite. And getting up on my own (woooooooo....*listing heavily to one side*) and peeing and getting discharge paperwork. Into a wheelchair, which, thinking back, Der Alter Jo could probably have used better than me, what with her knee.

Car. Highway. DAJ is another one of those conservative looking types who can push a Prius up to 90 and keep it there, so I just shut my eyes and replayed Disney cartoons in my head.

As of right now, I'm surprisingly comfortable. If I had a wide-angle lens I'd take a picture of my stomach. Never flat, even at the best of times, it's now assumed some really weird contours and bruises. The trochar punches form an equilateral triangle with my belly button at the top, about four inches on a side. I have a hard time getting up or down quickly, but once I'm one way or the other, I'm good. I have bowel sounds and can pee on my own. Eating is no problem. I do the splinted-deep-breathing-and-coughing thing once an hour, because coughing and laughing hurt.

The most uncomfortable part of my body is my throat, from the intubation. The anesthetists were very excited at seeing what they called an "A-one-plus-plus airway." I guess that's anesthetist humor.

The Boys are playing with all my ID bands. The folks at Scrubs Magazine sent a lovely bunch of flowers. I have a full refrigerator. I can't complain, unless I drop something on the floor that I really need.

Oh, and the doc said that Animal had chips of calcium (unformed teeth), hair, and sebaceous pockets. That last is medicalese for "that stuff that makes up zits." I feel like I've had a teenaged boy removed from my reproductive system. I feel twenty years younger. (ba-dump KSSSH.)

Thursday, July 07, 2011

I'm home; all is well.

Bloated belly, three band-aids, and a disinclination to move quickly. That's what I've got.

Oh, and one less unwanted tenant.

Can this be all for a while? Thank you.

Wednesday, July 06, 2011

Uh....yeah. I have no idea how to do this.

I'm sitting here staring at two little packets of Hibiclens scrub. I have to SCRUB MAH BELLEH with one tonight and one tomorrow morning, prior to Animal's eviction.

The nurse at the presurgical testing hootenanny didn't tell me anything specific, and I was too flummoxed to ask anything specific. She just handed me the little packets and said, "Scrub once the night before, and once before you come in, and prepare to be ashy." She then looked at me more closely and corrected herself: "Dry. You'll be dry. You're already ashy."

So, um. . .what do I do? I mean, I assume I should pay some extra attention to my navel, since one of the trochars will be stuck through it, and that I should scrub gently, without trying to take the skin off. But should I leave the suds on for two minutes, or something? Use a black rooster rather than a washcloth to apply the stuff? Put my right foot in, then out, then shake it all about? Is there something special I need to know?

Searching "preoperative chlorhexadine scrub" leads me to interesting studies of iodine versus chlorhexadine and a stunning PDF, with illustrations, of how to scrub your horse prior to surgery. Since I don't own a large scrub brush, I can't follow those instructions.


Tuesday, July 05, 2011

The weirdest thing about this surgery bidness?

Is this: Dr. Crane didn't type and cross me prior to removing El Lumpacito, because there was little chance of his running into any major vessels during surgery. Dr. T decided to do a T&C because, as she put it, there's a lot of *stuff* in the belly, and better safe than sorry.

So, when the type & cross results came up in my email, I opened them expecting to see a blood type of O-positive, which is what I'd always thought I was.

I'm A-positive. Without, as it turns out, antigens to anything. Given that I've never had a transplant or a transfusion of any sort, that wasn't a surprise. The A+ part was, though.

I had to check in the mirror to make sure my eyes are actually blue.

Ah, the first week of July....

I'd like to know what Einstein decided that the first of July would be a good time to introduce new residents to their units. I mean, it's right before a holiday (this year's been especially bad, what with the three-day weekend), people are going on vacation, and patients always crump on holidays.

Always. It's one of those immutable laws of the medical Universe: if you have a person who's had, say, a minor bladder-scoping procedure, that person will choose a holiday (preferably one with a three-day weekend involved) to have something completely nuts happen that lands him or her on six drips and a vent. We once had a patient who came in to have a couple of teeth removed prior to some other surgical procedure who coded on the table: it was the day before Thanksgiving.

I mean, *really*? (Side-eye at Murphy and his laws.)

One good thing about having residencies that last at least five years, which is all of the ones that I work with regularly, is that you don't get too many bright-eyed, idealistic young medicos on July first. Most of the docs who rotate in and out of the units have been there before and have just been out doing research, or something. They're the same exhausted, cynical people we've worked with forever.

We do have one rather dashing new fellow ("fellow" in the academic sense, though he's also got XY chromosomes) with a Spanish accent and Italian shoes. He glided in yesterday, did a very thorough exam on one of my patients, then discharged her home without any fuss or muss. It's nice to see efficiency. I doubt the Italian shoes and silk tie will last through August. I hope the lack of drama does.

July is also the beginning of the yearly fiscal crunch for State-funded agencies here Deep In The Heart. Some of my colleagues have simply gone missing, laid off in the face of gazillions of dollars of shortfalls. Others are walking around looking tense about the possibility of losing their jobs. It's all Manglement positions that are being cut, no front-line staff, but that doesn't make it any easier. Nobody's hiring, either. What that means at the end of the day is that if you're working in research, you now have thirty more cats/pigs/rats to deal with in addition to the ones you were already taking care of. If you're a mid-level Mangler, you've got six more pages of audits and quality-improvement surveys to do every week, and no help.

Maybe they could get the residents to help with the audits. It'd at least give 'em a chance to sit down once in a while.

Sunday, July 03, 2011