Saturday, May 19, 2012

I'm all right; don't nobody worry 'bout me.

Well, not really.

This week we had a party for Neuroscience Nurse's Day, or Week, or Something Along Those Lines. I was interested to see that the woman who holds herself out as the Director of Neuroscience Nursing (a few years' experience as an ortho rehab nurse, followed by a decade in manglement) wasn't there. Ironic, fitting, all that stuff.

I was more bitter than usual these days. *Everything* pissed me off, even stuff that could've worked to my advantage. Good things pissed me off just as much as bad things, and wishy-washy things pissed me off most of all.

For instance, I work with two mid-levels. One is fantastic. The other is a clueless tinpot tyrant with an ego problem. Fantastic Midlevel and Fantastic Case Manager and I had been working on med-surg to rehab placement for a patient under a return agreement with another hospital (his case is complex) since the patient was admitted almost a month ago. It had been arranged that Sweet Complex Guy would go back to his original hospital, since he's a resident of that particular county and can therefore get services for which bill collectors won't hound him. (Some counties in Texas do it right.)

At the absolutely last possible second--and I mean after the ambulance had been arranged (difficult, because he required vasoactives while en route)--Clueless Tinpot stopped Sweet Complex Guy's transfer. The reason? He was afraid that "SCG would end up rotting in a med-surg bed and his family wouldn't be taught what they need to know." Clueless Tinpot decided to try for a "charity bed" in our facility.

As Fantastic Rehab Manager said, "No bed here is a charity bed. I have explained this to Clueless Tinpot Tyrant over and over. Even if that patient meets all of our specifications for discount services, he'll still have people calling him constantly, and his credit will be ruined by the bills."

None of this, I just realized, will make any sense to you unless you're one of the medical club, so let me put it in English:

We had a patient transferred to us by a county facility. That hospital paid all of the patient's bills while he was with us, with the understanding that he would be sent back once we were done with our peculiarly specialized care. The sending facility has systems in place to provide free, quality care to this dude, provided that we sent him back needing specific things.

And Tinpot Tyrant fucked it up. Not only will my nice, sweet, complex-but-promising dude be two hours from his family, he'll have to deal with the demands of our billing department (not fun; I can testify that they screw things up fairly regularly) for the next two years or so.

And I have to deal with this guy daily. Between making sure that he actually writes orders that he's going to yell at us later for not carrying out and being certain that his orders don't suck, I'm already tired. He's slated for a manglement and marketing job soon, and I hope his transition is smooth and speedy.

Seriously: If you have somebody on a high-sodium diet and six additional grams of sodium tablets a day, and they drop their sodium from 139 to 135 after you lower their hot-salt drip for six hours, would *you* write an order discontinuing that drip immediately?

I thought not. Especially if you want to keep their sodium between 140 and 150 to keep their brain from swelling. Three-percent and 23% saline are useful in limited amounts, but they're useful.

Okay. Enough with the overmedical jive.

I miss my dog. He wasn't my baby, or my furbaby; he was my buddy. We were intellectual equals, no question. He was a stubborn asshole at times, but I never knew his judgement to be off. It's very weird, being here without him snoring and shedding and licking Flashes all over. I step over a body that isn't there, in the middle of the night, when I have to pee. My brain twitches toward the back door every day at dinnertime.

I haven't had the vadge yet to go out to the back yard. Yesterday, I thought maybe I could do it today. Now I'm thinking I could maybe manage it tomorrow.

Thank you all for your kind thoughts. They're a huge, huge comfort, even if I can't respond to everybody individually.

Now Flashes wants 'tentions. I'm going to give him some skritches and heat up beans for dinner.

Sunday, May 13, 2012


When I met Max, he was still a puppy. He might've been nine or ten months old, with those perfect white adult teeth that hadn't seen any wear, except where one was exposed to the roots, where his gums had been stripped away.

The Erstwhile Hub saw him on his way to work and called me, saying, "There's a dog trying to die in the empty lot two doors down." My response was, "Not on my watch."

I went and lured him to our front yard and tried to feed and water him, but he didn't eat or drink much. He was emaciated, his eyes and cheeks sunken, and he looked exhausted. I loaded him into the Honda hatchback I had at the time and drove him to a vet I'd not been to before because my usual vet was closed on Wednesdays.

They told me he was probably very old and probably wouldn't make it, and showed me the X-ray of his gut, full of rocks and sticks. For some reason, I said "do what you have to do to save him." They ran two liters of fluid into him over a couple of days, keeping him sedated so he wouldn't chew the IV out of his arm. I went to see him both days, kneeling down by his cage and saying, "You must not die, you must not die."

He had a cracked hip and two cracked ribs and heartworms from hell and torn-up pads. The vets figured he must've been thrown or fallen from the back of a pickup, and walked all the way from the highway to my neighborhood.

When El Erstwhilo and I divorced, I left Max behind. I was moving into a 600-square-foot apartment and working sixteen hour days, and I couldn't take him. Later, when Erstwhilo thought he might be moving to Ireland and couldn't handle the thought of quarantine, I took Max back. I had just bought a house. Having him made everything better; he was the only thing I missed from my marriage.

Max died Saturday. I was out of town, visiting The Boy in Kansas City. My neighbor called to say that he'd gotten up and boofed around the yard that morning, then had lain down to have a nap and had simply not woken up. I got home this afternoon and found him lying where they'd tucked a sheet over him, looking exactly as though he'd just gone to sleep with his head between his front paws.

There were no signs of distress. He'd gone to sleep in his own back yard and woke up on the other side of the Bridge, where there are dozens of mail carriers on crutches and an ice-cream truck with a flat tire.

This is what I'd been praying for. Whatever Thing is there, out there in the Universe, watching over deserving dogs, gave Max a death in keeping with his life: quiet, gentle, without fuss or pain.

He was my Zoater-Bloater Max-Nose Spoon-Hound, and I'll miss him. I'm thankful, though, that his last days didn't involve vets and needles and fear.

Happy Trails, buddy. May many kitty-bellies present themselves for snorgling on the other side. I'll see you in a little while, okay? :)

Thursday, May 03, 2012

Y'know how you feel when a friend does something really great?

That's how I feel right now. My pal Nikki, late of "CatsNotCancer," is doing THIS.

Nikki, although you wouldn't know it to look at her, has ovaries of titanium and shoots laser beams out of her eyes. On vacation, she goes to Australia and rubs Great White Sharks on the belly, to which they respond by rolling over and purring. If she meets a rattlesnake while she's out hiking, the rattlesnake bows politely and gets out of the way. Bees fear her. Butterflies worship her. She's dressed by a posse of bluebirds and little woodland creatures every morning, after which she distributes semiautomatic weapons and shoulder-mounted grenade launchers of Truth to all of them, the better to fight for justice.

Because, you know, this lawsuit isn't all she's done. She's also been a hell of a pal to me.

And if BCBSTX doesn't see reason as regards the Obturator of Doom, you can bet I'll be channelling Nikki when I go see them. With a smiiiiiile.

Wednesday, May 02, 2012

I really need to stop yelling at my boss.

But honestly, when somebody calls me when I've got two phones already ringing off the hook, a patient who's about to code, six people lined up to ask questions about random neuro stuff, a housekeeper with a query about whether or not something obscure needs to be done today or can wait until tomorrow, and four people leaping out of bed in their usual confused way, it is NOT the time to tell me that I have to check the crash cart this month, myself, alone, today.

I *will* snap at you. And, if you're a condescending asshole (sorry, Bossman! But you were!) and point out to me that ICU nurses have a lot to do, too, I will respond by noting that your average ICU nurse has patient care aides, a secretary, a charge nurse, and a manager to do what I am just that moment doing all by my lonesome. I might even respond at a higher-than-normal volume.

It's a good thing that Bossman had me check the cart, as it turns out. Even though it meant that I missed an assessment on one patient (not a big deal; he was stable as a rock) and didn't get lunch until 1430, it was a good thing. Because I found that the crash cart, ostensibly checked by other people on the unit each month for several months, was full of stuff that was expired. As in, expired in 2009.

Now we have a nice, spandy-fresh cart with magnets in their proper places, salem sump tubes that aren't in packaging so old that both it and the tube have become discolored and brittle (holy crap you would not BELIEVE), and the proper number of needles, large and small, and medications, unexpired. It only took me three hours, between answering phones, helping turn patients, resetting monitors, taking delivery of a cartload of supplies, and fixing the computer that decided suddenly to regress to its roots.

I keep reminding myself that I have a mini-vacation coming up next week, and another one a couple of months after that. They don't keep crash carts on planes, do they? . . .*Do* they?