It is, really, all about blood.

There was blood on my front door. There was blood on the pedestal of the toilet, from a cut on her leg. There was blood in the sink--less blood than you might expect, but enough to stain it. There was blood on a door frame, where she'd richocheted off in coming through to the bathroom, where I put cold cloths on her ruined face.

An old friend of mine went looking for a beating and got it. Or maybe not; maybe she was looking only for resolution of the awful telephone calls her ex-lover had been making, and she didn't think he'd actually get violent again.

He did, and she showed up on my doorstep late at night, her face a mass of bruises and blood and snot, all mixing with her tears and her inability to speak.

I had never seen the damage one person could do to another, not up close without warning or intermediary. I've always seen it a couple of days after the fact, or in the clean environment of a clinic or shelter. It's never invaded my house and my peace before, not like this.

There were phone calls after that, and a conversation with a very nice cop with a twisted sense of humor, then trips to the police station and the emergency room. I found myself at home at two o'clock in the morning, making unanswered phone calls in an attempt to decompress. Eventually, unable to sleep, I called Nurse Ames, who I knew was working, and met her for breakfast a few hours later. Nurse Ames is sweet, soft-voiced, unflappable, and the toughest bitch kitty I know.

I got home to an email message from Land's End. Apparently, Sane Me had taken over and ordered Freaked-Out Me an entirely new set of bathroom towels. I needed them anyhow; the old ones are ragged and literally coming to pieces, even if they hadn't been spotted with blood.

There wasn't a lot of blood, but it wasn't blood I was prepared for or shielded from. It was blood that was born of a series of really, truly, amazingly bad decisions on the part of somebody I'd hoped would be smarter. It was blood that I didn't want to have to deal with, that should never have dripped on my floor, gotten smeared on my wall. There were myriad better ways to handle this that would've never meant bloodshed, and all those myriad ways got ignored. That left me to deal with the aftermath and the consequences and the public records and the police statements.

I am angry, and I am sick. I'm sick because the person who did the damage was methodical, almost scientific in his application of fists. I'm angry because the person to whom it was done knew better. She crawled back to the tiger cage after the tiger had taken off her leg. Nobody, ever, anywhere, deserves a beating--but you have a responsibility to your own self not to place yourself willingly into that situation when the alternative is easier.

There was no need for this. From start to finish, there was absolutely no need. I've had trouble sleeping since that night, and I've had trouble finishing both meals and sentences. I don't know what happened to my old friend; my first reaction--and I think it's a good one--was to offer help, and when that help was refused, I cut off contact. I don't need that brand of crazy coming around. Willfully putting oneself in harm's way without a larger purpose is not something I can support. Especially not when everyone around you has been campaigning against it for a year or more.

Things tonight are quiet. The dew has already risen; it's humid out, and we'll have storms in a few days, but for now everything smells fresh and new and, most of all, clean. The salvia is getting ready to explode in that way that it does, out in the front beds. Tomorrow I'll buy tomato plants and lavender and basil, scrub the remaining blood off of the grout in the bathroom, and change the sheets. In the afternoon I'll mow and plant and then lift weights.

I used to be annoyed by the amount of hair that my boys shed. Between Max and Notamus and Flashes, there's a lot of hair balling up and rolling around my floors. Now, though, I'm grateful that I can turn on the vacuum and have it be out of sight, out of mind, and gone.

As Pens the Lotion Slut says, "I AM DRINKING BEER."

It has not been a beautiful day in Nurse Jo's neighborhood. Not at all.

Because the person who directs my Clinical Experience is a little.... .... ....well, she's weird, I had got to go to a two-part ACLS class this week, rather than renewing in April at the six-hour test-and-megacode extravaganza that I'd normally do. That meant two days of long classes covering things that I really don't ever want to have to deal with, and then a megacode at the end of the day today.

Followed by another megacode.

Yes, my friends, we tested *twice*. Once on a nice, boring, nonanimated dummy, and once on an animated dummy that costs a gazillion bucks and has no bones to speak of (the dude running the lab got really exercised when I bent the dummy's leg backward and said "Look! Osteomalacia!") and could speak and blink and breathe and all that happy shit. This was because the group I was in got selected randomly for a study on who did better in a code--a group with a nonanimated dummy, or a group without.

My hands and shoulders are sore as hell, because there were two very capable women in the group who were both unfortunately the size of my little finger, one guy, and me. Guess who got to do most of the compressions on both code tests? If I tell you that my private nickname for the guy is "Mister Lazy ThinksHe'sAmusing," will you guess right?

And if I tell you that I was, at one point, stuck for more than an hour and a freaking half in a room with Mister Lazy ThinksHe'sAmusing and another classmate whose nickname is HandsyMan, will you pity me? Will you hand me another beer? Please say yes.

Oh, never mind. I just got one on my own.

For some reason, since I've been single again, I've been attracting the sort of men one usually only sees in sitcoms and bad Craigslist ads. If he's got a girlfriend, he's hit on me. If he's an instructor in a nursing program and has a Marine Corps symbol (although if he's been any closer to the Marines than I've been, I'll eat my socks) dangling in his chest hairs, right above where his potbelly begins, he's said something inappropriate to me. If he's married but handsy, I've had to duck out from under unwanted shoulder-rubs, Angela-Merkel-style, more than once in the last month. And the topper came, as I was telling the Brother in BFE the other week, a couple weeks ago at my favorite bar.

My favorite bar is a class establishment that attracts only the finest folks--dames like myself. I was minding my own business, tucking into a poblano-stuffed chicken breast or some of the shrimp enchiladas that Antonio makes, or maybe it was a burger, when a drink appeared next to me.

I looked across the bar. There were three possible drink-senders, none of whom looked real promising. So I asked the bartender, Ray, who'd sent it. "The guy with the bad hair" she replied.

"Which one?" I asked.

"The one who doesn't look like he's bathed for a week."

Yes, fiends and neighbors, the dude with the bad greasy black hair, the corduroy Sansabelt-wannabes with the patch pockets on the front, and the reindeer sweater had sent me a drink.

He'd asked Ray what I was drinking. She'd told him single-malt Scotch, so he'd sent me Maker's Mark.

Oh, dear.

Ooooohhhhh, deeeeaaaaar.

I smiled, toasted him silently from across the bar, and returned firmly to my book. A few seconds later, somebody cleared his throat right next to me. Damn. Sansabelt Reindeer Man. So I thanked him politely and looked interested politely as he proceeded to try to make conversation. After all, they know me there: if anything untoward were to happen, Ray and her barback would throw the guy out on his ear. And he was really sweet, if kind of inert in a geeky way, until--and here you have to take a deep breath--he comingled the Star Wars and Star Trek universes in a way that showed me he was ignorant of both.

The way I figure, if you're living in Mom's basement, you have time to study these things, to work them out. Don't try to impress the girl who knows Yoda's middle name (it's Heironymous). Don't try to snow me with yammering about how we could go where no man has gone before if I'd just take hold of your lightsaber. Okay, it wasn't quite *that* bad, but it was close.

I've learned a lot of things in nearly forty years. I learn a lot of things from each guy I date, and I learn a lot when I'm single, too. And I've learned a lot--a lot--from this internship.

What I didn't expect to learn at any time was how to avoid weirdos in bars and how to avoid ass-pats while doing compressions.

*sigh*

That'll teach me to get all excited about my hair.

Sorry about the lack of hair pictures; I didn't even think of taking one before I unsnarled the bun and went to bed.

And, apparently, forgot to take my fucking Effexor.

That doesn't happen very often, but I can always tell when I've gotten distracted and forgotten the Anti-Brain-Scurvy meds. I had a dream that the entire ICU crew had to walk from Dallas to the Gaza Strip, climb 300-story skyscrapers, and be catapulted across huge crevasses in a sort of Survivor-meets-Amazing-Race-meets-Python challenge. (Just for the record, I've never seen either reality show, so I don't know how accurate the catapult thing is, but there you are.)

If the crazy-ass dreams aren't enough to clue me in, the electrical shocks up my neck and down my arms will remind me. And if *those* aren't enough, the feeling that my brain has the flu will be, for sure. (Note to those who are saying "brain flu? WTF?": Yes, it really is like my brain has the flu: mentally achy, exhausted, and foggy as hell. It's bizarre and unpleasant.)

Thankfully, my brain is jacked up enough that one dose of Effexor XR is enough to set me straight again in terms of norepi and serotonin within about eight hours, so now I feel fine.

Thus, a public service announcement: I've gotten six emails in the last two weeks from readers who are dealing with stress, anxiety, and depression. I've told all of them this individually, but I want to make it public: If you are having problems with mental fitness, *please* see a doctor. Specifically, see a psychiatrist rather than a family practitioner.

General practitioners are fantastic, but they don't have the intensive training that a shrink does when it comes to both the mind and the brain. I went to see a family guy, a generalist, when I discovered that I didn't want to get out of bed in the morning, and I ended up on a drug that is difficult to dose, hideous if not impossible to stop taking, and the psych drug equivalent of swatting a fly with an atom bomb.

My shrink, the first time I saw him, raised his eyebrows both at the drug I was taking (in light of my personal history) and the dose I was on. In his words, "If that other guy thought you were really depressed and possibly bipolar [see archives as to why the GP was mistaken], he did everything exactly wrong." Turns out Effexor is best used for people whose depression and anxiety has been refractive to other treatments.

This drug saved my life. Period. I would've either drunk myself to death like the women in my family did generations ago, or I would've simply died of lack of mental stimulation and ennui. That life-saving, though, came at the cost of knowing that if I miss a dose of my Brain Vitamins, I'm screwed for the next eight hours, *and* that there's a very good chance that I will never ever ever be able to stop taking this particular drug.

Which, as long as an asteroid doesn't hit and the zombies don't invade Medco, isn't too bad a future to contemplate......but it would've been nice to work up to the Strontium 90 of brain meds rather than start out on them, if you know what I mean.

Here endeth the Public Service Announcement. You may all go back to your homes, your beer, and your regularly-scheduled Nurse Blogging now.

Live, from the dusty plains of Central Texas, it's Head Nurse!

I had no idea my eyes slant downward like that.

The lunatic is in the hall. And, sadly, the break room.

One of the things that happens when the management of a place starts to break down is that the weirdos come out of the woodwork.

It doesn't happen immediately. Sometimes it takes a while, as the nice, normal, everyday people in the place get replaced by nutjobs. Eventually, though, when things get weird enough, the weird (as H.S.T. said) turn pro. And, oh my children, it has been the Masters' Tour of Wack on the unit lately.

The ontorexics and tanorexics I can handle. The woman with sixteen fluffy little dogs (I exaggerate; it's really only something like four) is no problem. The nurse who wears what is probably the entire stock of Sephora and jumps like a startled rabbit every time you speak to her doesn't bother me a bit. The golf-obsessed? I don't turn a hair. The Cultist, though, really threw me for a loop.

He doesn't wear white robes and Nike sneakers, at least not at work. I've never caught him offering any sort of sugary drink to anyone else. And, for a while, I thought he was okay, if a bit overbearing and loud. Well, and self-righteous. And strange. Until, that is, he started talking about religion.

(Rhetorical question: What *is* it about religion and politics? I mean, I get weird too, if I start talking politics. Anyway.)

We had a run of people who had just been diagnosed with HIV the other week. Two things about the epidemic are really fucking depressing: the fact that AIDS is the leading cause of death for African women, and the fact that HIV infection is beginning to increase again in the very young and the older-than-40. We were seeing a few of all of those groups. It's a shock to be transported back to the bad old days of the late 1980's when you see a 20-year-old who's just been diagnosed with full-blown AIDS and had no idea he's positive. It's depressing to have the second immigrant woman in a week come in who contracted HIV from her husband. And it's difficult to have to talk to a guy in his 60's about how, exactly, he managed to get this infection that "only" young/gay/Black/whatever people get.

So we're talking about this over lunch (because we know how to have fun) and The Cultist pipes up that HIV is a reason he's glad *his* wife was a virgin when they got married.

Pause for contemplation on the part of the rest of the crew.

Sweet Loretta asked, carefully, if he thought that lack of virginity was the issue with the two positive women on the floor. Well, of *course* it was, silly! Because everybody knows that only nasty, dirty strumpets (and, I guess, Godless pervs) end up with nasty, dirty diseases.

Longer pause as we all digested this.

The Cultist took the longer, more aghast silence as an invitation to explain why and how this was a fact, and how it was supported by Biblical texts, and how the truth of the matter (about the nasty, dirty strumpets, I mean) had been covered up for years by a secret cabal involving the Pope, the government, and the WHO.

It was like a combination of Monday morning at the health department and "The DaVinci Code". I think the Illuminati actually got mentioned once; I wasn't paying that much attention. I was too busy checking to make sure that the world was still on its axis and gravity was still working.

I'm still not sure how we all got out of there. By some miracle, beepers started going off and people started remembering meds they had to pass; within about five minutes, only The Cultist was left, eating his sandwich and muttering about the Four Horsemen. I've never been so grateful for patients who call every ten minutes, let me tell you.

That was, of course, before I walked 'round the corner and smack into The Bully....but that's a different post.

Updated: Jo's Rules For Living.

General:

1. Pick up after yourself.

2. Don't be an asshole.

3. Say "thank you."

On Work:

1. If you have to jack with it, it's wrong.

2. Every surface should be thought of as dirty until proven otherwise.

3. Have an extra pair of scrubs.

4. Always take extra supplies into the room with you.

5. Wear shoes you won't fall out of.

On Drinking and Eating:

1. If the ingredients list has words beginning with "para" or "quasi", don't eat it.

2. Cheese always helps.

3. Good bread is worth the money.

4. It's not worth getting drunk on fine wine; you won't remember how good it is, and your head will hurt just as much as with the cheap stuff.

5. Eat butter, not margarine or Promise.

On Partying:

1. If you drink, pace yourself.

2. Don't say it drunk if you wouldn't say it sober.

3. Remember: If you start something, *somebody* is going to have to finish it. It might not be you.

4. Always have an alternate plan in case your designated driver craps out on you.

5. No, that's not a good idea.

On Relationships:

1. Pick up after yourself.

2. Don't be an asshole.

3. Say "thank you."

Tessalon, Omnicef, and a heat index of 108.

According to Herr Doktor Babyface, I do indeed have a sinus infection; a bacterial superinfection after my summer cold. Which sucks, I must say, rocks. The bad news is that I'll feel rotten for a couple more days. The good news is that Herr Doktor Babyface believes me when I say I hate narcotics, and so hooked me up with some Tessalon for the cough. I'll sleep tonight, wake up in the morning (sadly), and not have to worry about itching and being dopey.

Which is good. With a heat index of 108*, I have enough to worry about. When it's this hot and humid (101*, 60%), the air conditioners at work tend to start getting overburdened and not working quite as well as they ought to. The temperature inside the building on the ground floor when I left today (early, to see HDB) was near 80. It was hotter upstairs. 

Patients don't like it when it's hot. Nurses don't like it when it's hot, but aside from sweating through scrubs and smelling worse than usual, there's not a lot about heat that's going to hurt us. People who've had large sections of their brains fingered, though, tend to have really crappy temperature-management systems internally: they get hot and cold quite easily. Add to that the usual number of people with high cervical spine injuries (who tend not to be able to regulate their own temperature either), and you're in for a fun day of ice bags and fans.

I'm thinking of moving, once my two years in the ICU is up, to somewhere with slightly less obnoxious summer weather. Spring here is such that you can go on a picnic during it, provided it doesn't happen while you're in the shower. Fall here is great, if you don't mind hay fever from hell. Winter is quite mild....but summer? Kills people. For reals.

Meanwhile, friends of mine a few hundred to a thousand miles north are talking cheerfully about camping and gardening and going for long walks in the balmy afternoon. If I went for a long walk in the balmy afternoon today, I'd be coming back in an ambulance with an IV of 3% saline. 

Y'know how people in Northern cities like Anchorage and Montreal and Toledo come out in droves in the springtime, squinting at the sun? And how all the great street festivals and so on are held in the summer? And how some people wear sweaters, even, after the sun goes down in the summer? 

Summer for us is like winter for them. We come out, squinting at the sun, in early October. Oktoberfests are huge here, partly because it's finally cool enough to dance again. We hang out all winter (with the exceptions of the two days it's really cold) and most of the spring, then go back inside in early June and stay there until the next cool front blows through on September 30th. 

Yow. I've grouched myself out. I have a sinus headache, four months of over-100* temperatures to look forward to, and I'll stop right here.

Meanwhile: does anybody have a house in, say, Portland that they'll be looking to sublet in late 2011?

Dear God, I hope this is the last time HN is a remodeling blog for a while.

I have eleven new windows and two new doors and a man who needs to get his ass in here, silicone-caulk a couple of things, and get the hell out.

Watching other people work hard is exhausting. Time to break out the LST.

Unusually political:

The Network has also received many requests from women who received care from Dr. Tiller and from activists in the reproductive justice community to set up a Fund in Dr. Tiller’s name. In response, we have established the George Tiller Memorial Abortion Fund to assist the women to whom George Tiller dedicated his life. The Fund will assist women in the second trimester to pay for abortion care, as well as pay for travel and lodging en route to providers. To donate to the Fund in Dr. Tiller’s name, please send contributions to:

George Tiller Memorial Abortion Fund
c/o National Network of Abortion Funds
42 Seaverns Ave.
Boston, MA 02130

You may also donate online at http://www.nnaf.org/tiller.html

Eight years after I worked at the local abortion clinic, I am still getting harassed. Please consider donating if you have the money, volunteering if you have the time, or speaking out if you have the balls.

My new bumper sticker will read: "I'M PRO-CHOICE AND I RETURN FIRE."

*sigh* >rubs forehead<

Very Simple Requests:

Please do not ride that stallion if you don't know for sure that he can be ridden. Stallions are not usually the first choice for riding. If the stallion can't be ridden, he will almost certainly either sweep you off his back by running under a low branch, or step on your head, or both.

Go to a bar with padded floors if you plan to fall off your barstool.

Do not--I repeat, do *not*--attempt to chew through the tubing that runs from your PCA pump to your IV line. PCAs have an anti-siphon device, which means that no matter how hard you suck on the tubing, you won't get extra medicine.

While we're at it, please don't try to hide Phenergan in your bed.

Or Oxycontin in your purse. I'll find it.

And don't steal the damn DVD player out of your room. I'll walk you down and find it when you're loading up your car. It'll be really embarrassing when I have to look you in the eye, smile brightly, and say, "I'll just take this back up to the room for you."

Helmets are a good idea if you're riding any sort of two-wheeled vehicle. This goes double for motorcycles and triple for bicycles, since the idiots riding bikes these days seem not to be able to stay upright. Or, for that matter, able to avoid running into large metal signs headfirst.

By the way: a 300-cc Vespa is not appropriate transportation on the interstate.

Graduation parties are nice. They're fun. They're not nice or fun, though, when they involve enough alcohol and cocaine to put you into an anoxic state for several minutes.

And speaking of cocaine, please don't try snorting it in your hospital room. I'll find out, and neither one of us will be happy.

If you really *want* to throw your IV pump across the room, go ahead. If you then want to protest to the police that you're ready to get the hell out of this dump, go ahead. We'll transfer you to County, where mama don't play. You'll discover the joys of five-point leather restraints. Have a nice day!

Live poultry is not allowed inside the hospital. Thank you for your cooperation.

Nobody ever said trying to dive from the second-story balcony into the pool was a good idea.

If you're trying to fake having had a stroke, please remember that one-sided weakness will always be present. It will not come and go depending on convenience. Also, please remember that everybody here knows who you are, so you might want to try slurring your words with everyone, not just with your nurse for the day and the doctors.

Likewise, if you're trying to fake a seizure, please be aware that seizures sometimes happen when there's nobody around. They don't happen suddenly, as you're reading a book, just when you hear me open the door. And they generally don't involve bending backwards in the bed and trying to touch your head with your heels. That's strychnine poisoning you're thinking of.

It's probably not wise to ask me out. Ever. My standards aren't brutally high, but "neurologically intact, mostly" is right there at the top of the list.

Sometimes I wonder who lets these people in.

Well, gosh. That's kind of a drag.

This is Cinco de Mayo, right? So there are gonna be fireworks, right? Right.

I just heard a few fireworks go off. 

Then a few more. This was happening, by the way, just down the street.

Then I heard a noise like a spark had hit a box of fireworks and they'd all gone off within seconds of one another.

Now I'm hearing sirens.

Sucks to be you, dude. At least we've had enough rain lately that you won't catch the grass on fire. 

Wonder if whoever-it-was kept his hands intact.

Five by Five

It's been a while since I've done a meme, so here's one:

1. Five posts from the blog which I particularly like:

This is the coin

Dear Joey

A Chrissolstikah Story

Nursing Students: A Love Letter

The Nurse's Guide To Specialists

2. Five things of which I am proud:

a. That I work out three to four times a week and thus can lift heavy things

b. That I started the prerequisites for nursing school at 30, despite feeling quite old

c. That of all my colleagues at the hospital, I only really have problems personally with one

d. That my dog likes me

e. That I can get pretty much anything to grow--outside.

3. Five things I'm a bit ashamed of:

a. My temper

b. My foul mouth

c. That I'm a beer snob

d. That I have a terrible weakness for beauty products

e. That every present I wrap looks like a mentally-deficient orangutan went at it with a chop saw.

4. Five things you'll never find in my house:

a. Miracle Whip

b. Far-right periodicals

c. Coors Light

d. A non-dusty surface

e. Anything you can't touch, use, or sit on.

5. Five things you'll always find in my house:

a. Coffee

b. Toilet paper (I have a morbid fear of running out)

c. Brain drugs (ibid)

d. Lots of books

e. Dog and cat hair

What're yours?

Whaaaa?

Allergies are common. Everybody's allergic to something, be it pollen, the resins used to keep no-iron cloth no-iron, narcotics, cedar, dogs, cats, tomatoes, strawberries, wheat, milk, Republicans, whatever. Everybody has a tendency to have that ol' immune system get out of control once in a while and serve up a course of rash and hives and "whelps", which are what the rest of us call "welts".

(Conversation: Patient: "Whenever I take penicillin, I break out in whelps all over." Me: imagining patient covered with puppies.)

You get used to handling allergies at a hospital. Sometimes a patient has some sort of infection that can only be dealt with using an antibiotic that has cross-reactions with something they're allergic to. Sometimes a patient will have an unexpected reaction to something that they've never had a problem with before, which is how allergies work. You get the Decadron and the Benadryl IV and have the respiratory guys on the pager and you deal.

How-sum-ever, I have now seen something that had me literally scratching my head as I tried to figure out how the patient in question managed to survive in the outside world.

Four typed single-spaced pages of allergies. 

Four. Pages.

With additional editorial comments on the nature of the reactions to said allergens. The reactions weren't the run-of-the-mill "I itch when I take narcotics" variety. Nor did this patient have hallucinations when exposed to morphine--which is not technically an allergy, but will sure stop us from giving you more morphine. 

No, these were things like (and here I am giving a representative, fictionalized example) "Percocet: Causes unbalanced energy fields." "Beef: Candidiasis and sluggish bowels." "Latex: anaphylaxis." That last is sometimes a real deal, and it means you either have to be in a positive-pressure room or take your chances, as latex ends up in the air ducts and can be all over the hospital. Somehow, though, he managed okay with the (latex) balloons in his room.

Dude was allergic to non-ionized water. 

I. . .I. . .I for once am without words. Four pages of allergies. Four pages of things that you have gone to the trouble to decide you aren't tolerant of, can't have in your body or around it, can't deal with. Four bloody, be-damned pages of allergies, any of which might unbalance your Chi, slow down your lymph recirculation, or cause you to become a horrible wheezing swollen mass of welts.

Listen, I am not an ogre. There are some folks who have multiple drug allergies; usually they've undergone some sort of unpleasant treatment for, say, an intractable infection or chemo. There are people who can't tolerate some foods. I myself live on generic Claritin year-round and have to scrub after I touch a dog or cat. There are allergies out there that can make your life difficult and dangerous. We'll take that as read.

But four pages? Including non-ionized water? (How on earth do you ionize water, anyway?)

Have you thought about maybe focusing less on yourself and more on the outside world? It's entirely possible that some of those allergies would go away if you'd just relax and get out of your own head. 

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

In other news: People, don't do meth. I had a patient this week who is a full twenty years younger than me (in other words, not quite past her sell-by date, according to the fashion industry) who had no teeth. Full set of dentures, upper and lower. No. Teeth.

Do yourself a favor: develop a permanent allergy to methamphetamine.