Monday, February 27, 2012

What to do on your day off.

Wake up to a cat licking your knuckles. Roll out of bed, stopping mid-roll to rub the doggy belleh presented to you. Start the coffeemaker, then pee.

Check your messages. Notice that your trainer has cancelled your training session for the day. Hope that she doesn't have the violent stomach ailment that's been going around.

Leave the house an hour after waking up, having spent more time than is necessary in the shower with mounds of scented soapsuds and lots of implements. Make your way to Target.

Find that everything you need--boring stuff, like dish soap and lotion--is on sale. Grab a bag of work socks as an impulse buy. Think of how nice it'll be to have a dozen pairs of the same socks.

On the way home, decide to visit the strange little nursery on the edge of town. (NB: One of my few unbreakable life rules is never to shop at a nursery that doesn't have resident cats.)

Roll on into that nursery and greet the Domestic Orange Jumbo who patrols the perimeter. Meander slowly down the rows of trees (Japanese maples are big this year) and hardy annuals until you get to the greenhouse. Push aside the plastic sheeting that covers the door, walk into the greenhouse, and take a deep breath of warm, humid, growing-things-scented air.

Take a few more deep breaths.

Dodging craneflies, examine the offerings. Consider buying four-inch pots of catmint. Discard this idea when you remember how prolific and invasive catmint is. Sniff hard when you bend down to look at the Carolina jessamine and Asian jasmine in teeny pots. Admire the Meyer lemons and wish you could remember to bring such a thing inside when it gets cold.

Walk out of the greenhouse and enjoy the change from warm and humid to cool and slightly muggy.

Walk to the next greenhouse. Stop along the way to pet an argumentative calico cat and a black-and-white cat with long whiskers. Realize that the combination of greenhouse and relative outside humidity has made your hair go native in a big, bushy way.

Enter the second greenhouse. Breathe deeply. Realize that this one is mostly roses, but don't go back out, even though you don't want roses. Stroll the aisles of rose plants, reading every card and smelling every bloom. About halfway through, pick up the calico cat who's followed you in and carry her so she'll stop complaining.

Leave the second greenhouse. Stop to commiserate with the nursery's owner, who thanks you for paying attention to the bitchy calico (now curled up with her head on your shoulder). Discuss the drought, the invasiveness of artemisia, how Home Depot has ruined foundation plantings, and whether you can divide buddelia by whacking at it with a shovel.

On the way home, stop to pick up tacos from the taco truck.

Eat your tacos. Update your blog. Take a nap.

Friday, February 24, 2012

My head, let me show you it.

We had a patient recently who had something I've never seen before (for that matter, neither had the physician). He'd infarcted his corpus callosum.

Now: If you're not a brains person, this won't mean jack to you. It's a very big deal, though, for a couple of reasons: first, the corpus callosum has a huge blood supply coming from (if memory serves) three different arteries. Second, infarcting (cutting off the blood supply) it means that you end up with something called split-brain syndrome.

See, the C.C. is the part of your brain that ties everything together. It's a big ropy mass of white matter--the stuff that has the thinking bits of your brain in it--that acts as a communication corridor between the right and left sides of your brain. It allows you, for instance, to be able to recognize a chicken, describe that chicken, name that chicken (sounds like a bad game show title), and talk about what sorts of implements you'd need to take care of said chicken. Besides a knife and fork, I mean.

Occasionally we'll cut the corpus callosum as a last-ditch attempt to stop a really horrible case of epilepsy. That's usually done on children who simply can't stop seizing, no matter what we do pharmacologically, and it's usually done at a very young age, because the ability to overcome that callosotomy, as it's known, decreases as you get older. If it's done too late, or if it happens later in life as the result of a stroke or other injury, you end up with split-brain syndrome.

I'll bring back the chicken and let Wikipedia explain what split-brain syndrome does:

A patient with a split brain, when shown an image in his or her left visual field (the left half of what both eyes take in, see optic tract), will be unable to vocally name what he or she has seen. This is because the speech-control center is in the left side of the brain in most people, and the image from the left visual field is sent only to the right side of the brain (those with the speech control center in the right side will experience similar symptoms when an image is presented in the right visual field). Since communication between the two sides of the brain is inhibited, the patient cannot name what the right side of the brain is seeing. The person can, however, pick up and show recognition of an object (one within the left overall visual field) with their left hand, since that hand is controlled by the right side of the brain.

The same effect occurs for visual pairs and reasoning. For example, a patient with split brain is shown a picture of a chicken and a snowy field in separate visual fields and asked to choose from a list of words the best association with the pictures. The patient would choose a chicken foot to associate with the chicken and a shovel to associate with the snow; however, when asked to reason why the patient chose the shovel, the response would relate to the chicken (e.g. "the shovel is for cleaning out the chicken coop").

Obviously, it's going to be a drag if your C.C. gets all jacked up. It's hard, given the other problems this dude has (like an almost total lack of white matter, thanks to diabetes and hypertension and a bunch of other stuff), to get a really clear read on how it's affecting him and whether or not he even notices. We thought that he had some left-sided neglect (more on that, per Pens's request, in a later post) combined with a major psychiatric overlay (given his history). It wasn't until we saw the MRI, with the corpus callosum lighting up like Christmas, that we realized what, exactly, the problem was. Golly!

(Yes, I actually said "Golly!" upon seeing the guy's MRI. Sometimes I say "Gee whiz!" as well. Ironically, of course. Because I'm hip.)

Now I'm left with a wet, cold chicken who's been in a snowy field and has to be returned to her cozy coop over at Wiki.

Thursday, February 23, 2012

Cross your extremities.

I'm waiting for a call back from the insurance peeps. They called earlier regarding my appeal, I called 'em back, got voice mail, and left a message.

Pray, chant, shake your booty, light incense, whatever.


Sunday, February 19, 2012

My week, by Jo.

This past week, I was stroke coordinator, advisor to the publications department, advisor to the computer guys who are installing new monitors, preceptor to two nurses, secretary, patient care aide, transporter, housekeeper, fire-putter-outer (figuratively, not literally, thank Frogs), chief inspector of electrical outlets, general dogsbody, and carrier of a full patient load.

I have this weekend off. Except work has called four times as of 0500 this morning to see if I'd like to work extra.

Extra work is not on my schedule. Last night I went to bed just after 5 pip emma, as the sun started to go down. I slept eleven and a half hours and feel almost human.

Things are bad at Sunnydale General: we've got a number of people out with work-related injuries or stress-related problems, our census has ballooned over the last six weeks, and we're all run to nubbins. On top of all of that, I've had such a sore butt over the last two weeks that I've been barely able to walk.

Conversation between me and Der Alter Jo at the Korean barbecue:

Me: My ass hurts.

DAJ: Cross your legs like this: (demonstrates).

Me: (crossing legs like that) scream

DAJ: That's piriformis syndrome.

Conversation with Dr. PMR:

Me: My ass hurts. Friend of mine says it's piriformis syndrome.

DPMR: Cross your legs like this: (demonstrates)

Me: Aw HELL to the no.

DPMR: You work out on an elliptical, right? And you run the stairs here?

Me: Yep.

DPMR: You're a moron. It's piriformis syndrome. Quit running the stairs. And do these stretches. And use a heating pad and NSAIDs.

Me: scream

If there were a Twitter tag for this entire month, it would be #tinyscream.

As the topper, I think one of the docs that I like best is leaving the stroke program. I'm not sure yet, having only heard the most whispered of rumors, but I'm worried.

Kentucky is gorgeous, though, as is Missoula. I could move, right? Right? Even with my sore butt and my worn-to-a-nubbin temper?

Thursday, February 09, 2012

Danish cooking: it's messy.

First you go to the local butcher and ask for a pound of ground pork, the leanest possible, run through the grinder four times. No more, no less. Four times.

Then you get a pound of veal, run through the grinder twice.

Run home, put that in the fridge, and run out again for the following:

1. White bread with which to make breadcrumbs
2. Sour cream, heavy cream, dill, and selzer
3. Cloves, pepper, and salt
4. Frozen red currants (you have NO IDEA how hard it is to find frozen red currants) and raspberries
5. Unsalted Danish butter, Lurpak brand.

When you get home with all that glory, you'll do the following:

Mix half a cup of flour, two eggs, half a cup of heavy cream, half a cup of selzer, and about a cup of breadcrumbs with the meats. Add a smidgen of salt, a buttload of pepper, and a couple of pinches of cloves. Knead it all together and stick it in the fridge.

Put your currants (two packages) and raspberries (ditto) into a nice, heavy stockpot with enough water to keep them from burning. Simmer until everything's soft. Blend the mess in your blender (being careful not to let it explode out of the top), and then strain it through a strainer lined with cheesecloth. Twice.

Return it to the rinsed stockpot with a quarter-cup of cornstarch mixed with water, and simmer until the mixture begins to look gelled. Then pour it into an appropriate container and refrigerate.

Look around your kitchen and marvel at the red splotches everywhere.

Now it's time for meatballs. Grab a golfball-sized hunk of meat mixture out of the bowl and shape it into something like a flattened egg. Repeat eleven times, then fry the meatballs in a third of the butter you bought. Repeat twice more. While you're doing that, you can plan out mincing up the dill and mixing it into the sour cream to make a dill sauce.

While those frikadeller are frying, why not try to clean up some of the fruit splash from your counter, backsplash, stove, table, and person? Well, why not? Because it'll never work. Just learn to live with red splashes every-damn-where.

Remember dimly how your Danish host mother managed to do both frikadeller and fresh ham and rodgrod med flode without making the kitchen a horrible mess, and without spilling stuff on herself. Gaze around your own kitchen and marvel at the number of sieves and pots you've used at this point, only halfway through. Load the dishwasher. Pour yourself some aquavit.

Consider pickling your own beets to go with the frikadeller and roasted potatoes, then dismiss the idea.

Consider repainting the kitchen walls in a glorious, vibrant shade of pink. Consider it twice.

Eat a hot dog, drink a beer, go to bed.