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.

What's In *Your* Wallet?

A quick rundown of the contents of my purse, before I go to bed. For entertainment purposes only; please do not attempt this at home.

1. My Work Pouch, which contains two small tubes of toothpaste, the caps of which have both come off, one small tube of triple antibiotic ointment, assorted pens, highlighters, dry-erase markers, alcohol swabs, blunt cannulas, needles, tape rolls in various stages of lintiness, and one tablet of...what is this? Orphenadrine CR. Whatever the hell that is.

2. Datebook. Cell phone, with three numbers in it. My Sunnydale ID, with angel pins (2) and horny toad pin (1) and TEAM Playa pin (1) on it. I look like an axe murderer in the picture. The back of the ID has a picture of a 1950's housewife holding a cup of coffee and the words "I haven't had my coffee yet; don't make me kill you" taped to it.

3. A compact of powder so old I don't remember when I bought it. I do not use powder. I'm not even sure it's mine.

4. Two lipsticks and one jar of Carmex.

5. Three hair clips, a barrette, a hair elastic, and a hairbrush. None of which I use during the typical day at work. Which is why I look like an axe murderer in my ID photo.

6. Wallet. Change purse containing one pound of quarters. (I ended up washing the car in the driveway.)

7. Bag of assorted prescription antidepressants and OTC pain medications. When other nurses need an aspirin, I point them to the bag with the warning "Don't take the pretty red ones."

8. A box of Sensa, part of my unending quest to get rid of this avoirdupois around my waist.

9. Max's new rabies tag.

10. A list of services my vet provides for kittens. No word on what services they provide for kangaroos. 

11. Four green tea bags. I hate green tea.

12. A book of coupons for products I don't use that I'm going to give to a coupon-clipping coworker.

13. The same damn red rubber catheter that's been riding around in this bag for what seems like forever.

14. A stopcock (wrapped) for a lumbar drain. What the hell?

15. Lint. And some old orders I need to shred.

16. FMLA paperwork.

17. Two paperclips and a book of matches from an Italian restaurant here in town that I haven't been to in 20 years.

What's in your wallet?

How to have a truly crappy week.

1. Go in for a minor surgical procedure that requires a regional nerve block. End up with an autoimmune demyelinating disease that nobody recognizes and can't seem to treat.

2. See your doctor about a week-long bout of back pain after you spend a weekend moving. Discover a golf-ball sized metastatic tumor in your spine.

3. Feel vaguely faint during your son's Bar Mitzvah. Find out you have a dandy case of cancer in your liver, lungs, and brain, and wonder where the origin is.

4. Get your lumbar spine pain dealt with, then bleed out on the table because some genius nicked an artery. Receive more than twenty units of various blood products. Be transferred to Sunnydale General and get more blood products. Feel like hell later.

5. Go from walking to not moving in a week's time because of another weird, rare demyelinating disease that doesn't respond to treatment.

6. Have all of those patients, each young and previously healthy and inescapably cheery and hopeful, as yours for several days in a row. Throw in a couple of long-time patients who have returned to your floor for palliative care. Add two enormous technological and management blunders. Stir well and pour over ice.

It's not often that I ditch Chef Boy at the end of a long week and come home and have a good howl, but last night was one of those nights. I am spent, emotionally and physically, and I don't want to go back to work tomorrow. My patients this week haven't been hard in the sense of having a lot going on--no tube feeds, no ventilator-dependent folks, no ten medications to hang and crush by 8 am--but they've been hard emotionally.

What you don't realize when you start being a nurse is how fiercely you're going to love some of your patients. They don't come around often, but when they do they're the type that you remember for years afterward, or forever. I had five of those this week, along with their families. When a kid asks you, looking dead in your eyes, if his mom is going to be okay and all you can say is, "We don't know", well, that's the definition of helpless.

The floor feels uneven under my feet, and it's not just because the house's foundation has shifted again. 

Back to bed, back to bed. Everything looks better after a nap.

It's only made of short stories

I still haven't found what I'm looking for

Y'learn something new every day, I guess. I've seen seizures that manifest as the good, old-fashioned generalized tonic-clonic (shaking, grunting, scary, traumatic for everybody) sort; I've seen seizures that manifest as anxiety attacks or giggling fits or simply staring off into space for a bit.

I had never seen a somebody seize where the only symptom was that they were looking for something they couldn't find. 

It took us a while to figure out what was going on. There weren't any acute neurological changes that I could see in the patient during these episodes--he stayed alert, oriented, aware. There weren't any acute changes that we could see in MRIs or repeated CT scans. We figured it was some weird anxiety thing going on--until the video EEG showed seizure activity concurrent with the patient's desire to find his wallet.

The residents and I were looking over the video record and saw the first telltale signs of a complex partial seizure corresponding to the patient's asking where his wallet was. 

Well, I will be damned. Okay, then. Load 'em up on Keppra. 

Short, sharp. Shocked.

Another nurse's patient had complained for the last hour or so of shooting, stabbing pain in one particular area of his shoulder. Given that he'd had a lumbar laminectomy, we couldn't figure out why his left shoulder would feel as though something was stinging it. Was it a problem with positioning during the surgery? Was it some unrelated problem in his cervical spine? Was it just one of those weird things that would go away on its own?

We rolled him and checked the shoulder. Nothing. We did range-of-motion. Nothing. Xrays showed nothing. Still that sharp pain. It wasn't consistent, and it tended to happen when he lifted his left arm up to grab something off the table. 

Finally, we rolled him one last time. His nurse straightened the collar of his schwanky new, just-out-of-the-wrapping pajamas, and jerked, winced, and cursed softly. She'd stuck herself on a pin.

A pin. In the collar of the new, schwanky peejays. We found the source of the stabbing pain--but who puts pins in pajamas? It's like starching baby clothes.

You mean this opera involves handcuffs?

Word salad is the strangest, funniest, sometimes most charming part of a brain injury. It's the inability of the brain to make your mouth come out with the right word at the right time, so things tend to get a little skewed. Patients will ask when their sweater is due, rather than their medications, or tell you that you're the flossiest sausage they've ever seen.

Each person tends to substitute words in a particular way, so after a day or so you can figure out what they mean. I'm still scratching my head, though, over the guy who looked at me solemnly and said "You're handcuff and chocolate, Nurse."

It might be the best compliment I've ever gotten.

The trouble with normal

Looking around, I see that I have a collection of medical books and magazines from the 1920's through the 1940's. Most of 'em have subjects like "Clinical Syphillology" (1938), or "Your Health: HOW TO AVOID A NERVE CRACK-UP" (1943), and all but one were found for my by my Beloved Sister.

I'm thinking it might be fun to excerpt some of the articles--especially ones from the popular press--just to see how "normal" has changed in the last 60-odd years. F'rinstance, didja know that some folks thought it was harmful for people over 35 to exercise at all? I wonder what Attilla the Cheerleader would think of that.

(For those who are interested, titles come, in order, from:

Neko Case

U2

Michelle Shocked

REM

Bruce Cockburn)