Thursday, December 29, 2011

Things They never tell you about having had cancer:

1. While cancer might be simultaneously boring and terrifying, it beats waiting for the surveillance scans. There's an up-and-down rhythm to getting your lymph nodes biopsied (ow!) that just isn't matched by the four-month drag that is waiting for your first chest CT.

2. Growing your hair out after having had cancer sucks just as much as it does when you're well. You still have weird flippy pieces and flat bits, and you still look like hell, but at least nobody says anything snarky. They just look at you and say, "You lookin' good. Whassup with yo' 'fro?" (credit: Friend Lisa from work.)

3. Every beer, every french fry, every night out on the town is larded with guilt that This Might Be The Thing that tips you over the edge into another horrible diagnosis.

4. Your blood pressure will always be a source of concern for the nurses at your surgeon's office, and they'll waste lots of paperwork on you before you say, through gritted teeth, "MY PRESSURES ARE HIGH BECAUSE I DON'T WANT ANOTHER BIT CUT OUT OF MY HEAD, THANK YOU VERY MUCH."

5. Your foresight in putting all your favorite colognes at the back of the closet during the first week of treatment will be rewarded when a patient in the chemotherapy unit says you smell good.

Saturday, December 24, 2011

Redemption rips through the surface of time

(Bruce Cockburn, Lou Reed, and Roseanne Cash)

"...and guess what? I felt the baby kick today."

Merry Christmas, y'all.

Tuesday, December 20, 2011

Question From A Young Nurse: But What About The Feelings?

A Young Nurse asked Auntie Jo for advice this week. Poor, deluded Young Nurse.

Our correspondent asked this: "What do I do when a doctor or older nurse snickers at an answer I give to a question, or takes me aside later and tells me that I should've done something different? I have six patients, and I'm new to the night shift. I can't keep everything straight all the time. I want to kill them. What should I do?"

Dear Young Nurse,

We were all there, once. Those of us who got over it became the sort of nurse that your Auntie Jo is. Right now, I have a cat rubbing on my shoulder, a cold beer to the right of the keyboard, a happy dog frolicking in the back yard, and a list of men who want to be seen with me.

Those of us who didn't get over it became the doctor and nurse you're working with.

Practically, what you can do is this: Do what residents do. At the start of your shift, make out index cards that have each patient's name on them in big, bold lettering, so you can't miss it. On those cards, write the essential lab results and neuro/cardio/gastric/renal changes the patients have during the shift. Update them as you need to. That way, if you're ever caught out by a question, you can yank your index cards out of your pocket (be sure to wear scrubs with pockets at the waist) and answer the question quickly.

Doctors *love* it when you do things that they did as residents. It makes them feel very smart, and they will treat you better as a result.

As for the nurse: be humble. Shrug things off with a "Well, I'm still learning. Someday I'll have all that stuff on the tip of my tongue, like you do!" Make sure your back is turned when you roll your eyes. Mean nurses love that sort of thing, even as it makes them wonder if they're really *that* decent of people (answer: No, you're not, and you're going straight to a flaming-hot Hell when you die).

But what about the feelings?

It is hard, and I acknowledge that it's hard, not to reach out gently and wrap your scrawny little hands around somebody's neck. As The Bloggess once said, "A hug is just a strangle you haven't finished yet." I would suggest that you find a nice, private place to feel those feelings.

Feeling something like rage or disappointment doesn't mean you have to act on it. It just means that you've opened the door marked "RAGE" or "DISAPPOINTMENT" and have gone in and browsed through the goods on offer. It's best to do it in private so you're not interrupted. Rage, rage, against the asshole nurse or doctor who decided to get his or her rocks off by humiliating you. Then set it aside.

Resolve that next time you'll be so bulletproof that you'll embarrass them without meaning to. Resolve that next time you'll have the perfect l'esprit d'escalier and won't forget to say something like "up yours, motherfucker" when it's warranted.

Resolve--and this is both the most difficult and most important thing--that you won't let this make you think less of yourself or your practice. Some people are just assholes. Instead of bundling the urge to finish the hug up inside yourself, practice letting it out in the car.

All you can do is the best you can do. Be prepared, be on point, and if things don't go your way, don't fret: you've done your best. Believe it or not, your best doesn't have to be perfect. This is a twenty-four hour a day job. Self-doubt is a killer, because the minute you doubt yourself, you start doubting that little voice in your gut that tells you something ain't right.

If all else fails, Talisker. It's a good Scotch for beginners.

Wednesday, December 14, 2011

Am I old yet?

A coworker of mine reminded me recently that 2012 will mark my tenth year at Sunnydale General (Healthcare for the Hellmouth). Reader's Digest called me a "long-time" nurse. Doctors refer to me as "experienced."

So am I an Old Nurse?

I would argue not, and this is why: Old Nurses are people who still know how to work stuff you only heard about in nursing school, and who remember techniques and tricks (and are willing to teach them to you!) that you've never even considered.

Take Wendy, one of the nurses I work with. She's not an old nurse, having been a nurse for only slightly longer than I have--but she's an Old Nurse. She can count drip rates and work them out to milliliters per hour, having worked in rural hospitals. She can make a mean hot pack. She knows how to access the really bizarre permanent catheters that we sometimes see. She doesn't remember the days when pneumocephalus was induced as a diagnostic tool, but she's done stuff--like reducing dislocated shoulders--that I've only read about. In fiction.

On the opposite side of the coin, I was a New Nurse with eight years' experience under my belt when I went to the CCU. No matter how good you are at one thing, if you move to another, you're automatically a novice. That's not a particularly comfortable role to inhabit, but it does do wonders for an overblown ego and a sense of entitlement. At the same time you're being humbled, however, you're being encouraged to ask "Why?" (That is, if you don't work in a bad environment.) "Why?" is one of the most important questions we can ask on a daily basis; it's the only one that leads to changes and improvements in care.

So, no, I'm not an Old Nurse. Not yet. At this rate, I may never *be* an Old Nurse. Although, I will say--my willingness to get post-op patients up out of bed without waiting for physical therapy has gotten shocked, admiring reactions from CCU nurses.

If I ever do get to Old Nurse status, I want to be asking "Why?" still. Those are the best sort of Old Nurses to have around.

Tuesday, December 13, 2011


Monday, December 12, 2011

And a Huge Shock:

Teddy Bear the Fretful Porpentine is from My Home Town!

I might have to ask to meet him (and bring him erk-erk-eeenh-eeenh-gitback! noms) next time I'm up there.

Updates, of a sort.

I saw Dr. Elf today for the last time until April. The New Bug is performing beautifully; I'm even able to lie on my stomach for a massage without any nasal regurgitation (aka saliva running out my nose). He thanked me for being such a happy patient; I thanked *him* for being kind on the days when I was not happy. There were plenty of those.

So, April: I go for a chest CT. That's scary as hell. Apparently, polymorphous adenocarcinoma rarely metastasizes, but when it does, two things happen: it goes to the lung or brain, and it's incredibly virulent. My brain, so far, is clear. (My coworkers would say that it's not just clear of cancer, it's clear of thought and reason as well.) My neck is clear. I'm very happy that the lymph nodes in my neck are clear, by the way: the radiologist who read this last CT was the same dude who read the last one, and he said something like, "I note that the lymph node in the right neck, swollen in the pre-surgery CT scan, has returned to a normal diameter and density." I'm hoping nothing nasty shows up in April.

ANYway, the same day I see the CT guys and Dr. Crane, I see Dr. Elf for a follow-up. As he said, this is a dynamic process. As I age, as I lose or gain weight, as I sing more or less, the prosthetic will need to be modified. We'll let it float until April unless something major happens.

Speaking of major, two things happened this past week: BCBSTX denied my appeal and simultaneously refunded me about a tenth of the money that they ought to admit they owe me. What this means in real terms is that I now have to appeal to the Office of Employee Benefits at Giganto Research and Education Corp. Beloved Sister is helping me set up the most impressive packet of information ever, including slightly nauseating pictures of The Deficit, in order to do that. So, more of that.

Enough about me. In work news. . .

It's getting harder and harder to get one of the cross-covers to call me back. She's a nice girl, if a bit scatterbrained and inclined to panic. I'm thinking that I ought to just page her in haiku:

Your patient's IC
P is rising. Perhaps
You should come see him.


Wind through falling leaves
Like gas in patient's bowels.
Please order senna.

In sadder news, one of my coworkers simply didn't wake up last week. He was thirty. As is usual for this sort of unexpected death, there'll be an autopsy; likely he had sudden cardiac arrest or a PE. And, as is usual for this sort of death, nobody had a bad thing to say about the man. He was, as a friend of his said, a "good hand"--coming from a deep East Texas country boy, that's high praise.

I know I'm not supposed to wish death on anybody, but wasn't there somebody out there who set kittens afire that could've died, rather than the nice young guy with four kids? I liked working with him, knew I could trust him, was glad to see him in the mornings. Greater praise no nurse hath for any man.

Aaaand in less-sad news, we have a new place for the NCCU: we're taking over a unit on the floor above where we currently are. We'll have real doors that close or not, as we choose, and real monitors, and real beds, and real pumps! Just the luxury of more than four square feet of desk space (and half of that taken up with a sink) is more than I can think about without giggling. We should be there by the end of next month.

Finally, read this by Xeni Jardin. She captures better than I ever could the feeling of being out there, beyond reach of the people you depend on most, stuck in a new place.

"When I finally got through, someone else's voice was coming out of my mouth, and it was taking forever for the stuttery radio transmissions to beam through space, from the cold planet I was lost on, way out here, far from home."

Wednesday, December 07, 2011

Two and a half minutes of nomming Teddy Bear.

This is. . .amazing.

Real posts a bit later, after I get back from buying new blades for my reciprocating saw.