...because I really can't call it cooking.
Warning: girly foof ahead.
The local Quick-ee-Mart had a sale on various frozen entrees this week, so I tried some off-brand eggplant parmesan and a box of frozen fish.
I hesitate to say this, but both of them were quite yummy.
I'm sure I'll bloat up like a pufferfish from the amount of salt they contained, but *damn*. TV dinners sure have come a long way since the 1970's. Not that I ate them then, you understand, Mom being given to soy products and home-made bread, but I remember seeing them in the chest freezers at friends' houses.
It's a good trick to have stashed up a sleeve for one of those nights when, after work, seven minutes seems like too long to wait for dinner. I'm not going to be eating them regularly, though.
In other news, Beloved Sister seems to have settled on a wedding dress. The pattern she loves is the pattern I had originally chosen for a bridesmaid's dress, which is fine and dandy. I was having doubts about the fullness of the skirt for a morning wedding, so I was happy to have her take it off my hands.
Though, as she pointed out in an email, having two people in a wedding wearing the same cut of dress would give the old biddies something to talk about.
In that spirit, I've gone for this:
Hello, Tiger
sans bows and in the narrow-skirt version. The temptation to have it made in black duopioni is almost overwhelming, but that would give the biddies too much to talk about, so I'm thinking of going with a sedate olive green or gold. Maybe even a deep brown, with cut-and-polished hunks of amber to go with. The only requirements for the wedding are "Vintage Preferred" and "You Must Rock, Roll, and Destroy Hotel-Room Furniture, In A Metaphorical Sense, Of Course", so I'm good to go.
Hell, I've got 'till October to decide. If all else fails, I can always find something in orange and silver taffeta with an ass bow.
(This is the point in each post where I normally bring up some fine thing about work, but I am *so* not in the mood this week. The past week has seen collective asses saved by good charting (yours truly's), insane family members abusing patients in my presence, and a knock-down-drag-out between one of the management team and myself, so scruit. Maybe I'll blog about it later; maybe not.)
In the meantime, is anybody doing anything special for Lent this year? I'm observing Eastern Orthodox Lent, primarily because it falls on the Monday following the big Scottish Hoedown, and I want to have a Hair-Down Hoedown this year and drink plenty of warm beer.
I will not be wearing sackcloth and ashes, unless you count Dickies scrubs as sackcloth.
Monday, February 27, 2006
Wednesday, February 22, 2006
The horror of the ordinary
Mom and Dad bought me a set of barrister bookshelves for my birthday. They arrived last week, but I only managed to bribe Chef Boy into helping me haul five bulky boxes up the stairs today.
Barrister bookshelves are those nifty things that come in sections, with glass fronts that lift up and slide out of the way. These are a walnut finish, a dark glossy brown, with small brass knobs on the front of each to help you lift-and-slide. They stand just over five feet high, all put together, and sneer at the rest of the furniture in the bedroom with undisguised snootyness.
So I set them up (releasing, in the process, approximately forty metric tonnes of packing material; Dad warned me) and put the books from the shelf they're replacing into them.
Into, that is, one and one-third shelves of them. Maybe one and a quarter shelves.
So, naturally, the solution is to buy more books.
It did occur to me, briefly, to simply move the books from the shelves in the living room into the new shelves. But what good would that do? I'd be left with another set of empty bookshelves (these built by my grandfather) and would *still* have to find something to fill them.
Meanwhile, the desk I use is looking shabbier and shabbier every second. It's one of those Target specials that's meant to look like Mission, except it comes in a big flat box and never quite goes together correctly. Every time I type, there's a subtle oscillation because the nuts and bolts *almost* work.
So, naturally, I'll have to look for a new desk. An antique one, I think, maybe even a rolltop. (Wouldn't *that* be schwank.)
And, now that I think about it, the filing cabinet that sits next to the desk has never been entirely satisfactory either. It's good to hold the printer, but it's another Target buy, from a flat box, with pre-drilled screwholes that didn't quite go in on center.
Or maybe I'll build a desk. They rarely make 'em as small as I need 'em, and I'm not a bad rough carpenter. Chef Boy has a shopful of woodworking equipment and the skill necessary not to remove digits while dremmelling, or whatever you call it.
Anyway, it won't be an ordinary desk. Nor will it be an ordinary filing cabinet that replaces this one. The bookshelves will see to that; they're gazing in disgust at the horror of the ordinary that is my furniture.
Barrister bookshelves are those nifty things that come in sections, with glass fronts that lift up and slide out of the way. These are a walnut finish, a dark glossy brown, with small brass knobs on the front of each to help you lift-and-slide. They stand just over five feet high, all put together, and sneer at the rest of the furniture in the bedroom with undisguised snootyness.
So I set them up (releasing, in the process, approximately forty metric tonnes of packing material; Dad warned me) and put the books from the shelf they're replacing into them.
Into, that is, one and one-third shelves of them. Maybe one and a quarter shelves.
So, naturally, the solution is to buy more books.
It did occur to me, briefly, to simply move the books from the shelves in the living room into the new shelves. But what good would that do? I'd be left with another set of empty bookshelves (these built by my grandfather) and would *still* have to find something to fill them.
Meanwhile, the desk I use is looking shabbier and shabbier every second. It's one of those Target specials that's meant to look like Mission, except it comes in a big flat box and never quite goes together correctly. Every time I type, there's a subtle oscillation because the nuts and bolts *almost* work.
So, naturally, I'll have to look for a new desk. An antique one, I think, maybe even a rolltop. (Wouldn't *that* be schwank.)
And, now that I think about it, the filing cabinet that sits next to the desk has never been entirely satisfactory either. It's good to hold the printer, but it's another Target buy, from a flat box, with pre-drilled screwholes that didn't quite go in on center.
Or maybe I'll build a desk. They rarely make 'em as small as I need 'em, and I'm not a bad rough carpenter. Chef Boy has a shopful of woodworking equipment and the skill necessary not to remove digits while dremmelling, or whatever you call it.
Anyway, it won't be an ordinary desk. Nor will it be an ordinary filing cabinet that replaces this one. The bookshelves will see to that; they're gazing in disgust at the horror of the ordinary that is my furniture.
Saturday, February 18, 2006
Pour, sip, read. Pour, sip, read. Damn.
Just a cautionary note for readers:
I ordered two Bill Bryson books on a Barnes & Noble gift card. Both of them arrived in the mail yesterday. I picked them up from the same apartment office that holds my bookshelves today.
"I'm a Stranger Here Myself" is a very, very funny rendition of what it's like to move back to the US after two decades in Britain. I was giggling at the beginning and laughing so loudly at the end I was afraid I'd bug the neighbors.
Especially endearing was his description of having all his belongings spray across an airport floor: "My hair, concerned and unable to help, went into panic mode." Possessed of Panic Mode hair myself (note: gorgeous ringlets only happen past eight inches in length; before that, hair stands on end), I snorked and snorked and snorked some more.
But: Oh, dear. "In A Sunburned Country" made me want to go to Australia. So much so that the only thing keeping me from running up the credit cards was the bottle of Dalwhinnie, and that to such an extent that I just eyed it balefully and said out loud, "Dear sweet Jesus. Is that how much Scotch I've had? Oy." Pour, sip, read is likely to be my M.O. for the next day or so.
Mom testifies, hand on heart, that the only thing keeping her from Oz is the idea of flying there coach-class. DVTs, apparently, are enough to keep at least one Parental Unit in the Pacific Northwet. One of my colleagues, on a long-term assignment to the cardiac care unit, is planning to go there for three months--at least--in a few weeks. I doubt she'll ever come back, working as she will be in a place where men outnumber women three to one. And she's a natural blonde, too.
I must go to Australia. Beer is the national pastime and the national drink; it's been compared favorably with the state in which I live. Geographic state, I mean, not the state of pour-sip-read. Australia has a whole lot of venomous critters, which means I'd fit right in.
It would only cost me US$2830 for a non-stop. Maybe I could get the credit limit raised.
Edited to clarify: Mom writes that it's not the threat of DVT that's stopping her from flying to Australia again, rather, "it's the idea of having to see a movie like 'Titanic' both over and back.'" Having been subjected to "Dick Tracy" on the way to Denmark and "Titanic" en route to somewhere I can't recall, I sympathise.
Does Qantas have films of cute lil' ol' platypi?
And, (query for those better-versed in monotrematics than I), what exactly is poisonous about a platypus's spurs? What sort of poison is it?
I ordered two Bill Bryson books on a Barnes & Noble gift card. Both of them arrived in the mail yesterday. I picked them up from the same apartment office that holds my bookshelves today.
"I'm a Stranger Here Myself" is a very, very funny rendition of what it's like to move back to the US after two decades in Britain. I was giggling at the beginning and laughing so loudly at the end I was afraid I'd bug the neighbors.
Especially endearing was his description of having all his belongings spray across an airport floor: "My hair, concerned and unable to help, went into panic mode." Possessed of Panic Mode hair myself (note: gorgeous ringlets only happen past eight inches in length; before that, hair stands on end), I snorked and snorked and snorked some more.
But: Oh, dear. "In A Sunburned Country" made me want to go to Australia. So much so that the only thing keeping me from running up the credit cards was the bottle of Dalwhinnie, and that to such an extent that I just eyed it balefully and said out loud, "Dear sweet Jesus. Is that how much Scotch I've had? Oy." Pour, sip, read is likely to be my M.O. for the next day or so.
Mom testifies, hand on heart, that the only thing keeping her from Oz is the idea of flying there coach-class. DVTs, apparently, are enough to keep at least one Parental Unit in the Pacific Northwet. One of my colleagues, on a long-term assignment to the cardiac care unit, is planning to go there for three months--at least--in a few weeks. I doubt she'll ever come back, working as she will be in a place where men outnumber women three to one. And she's a natural blonde, too.
I must go to Australia. Beer is the national pastime and the national drink; it's been compared favorably with the state in which I live. Geographic state, I mean, not the state of pour-sip-read. Australia has a whole lot of venomous critters, which means I'd fit right in.
It would only cost me US$2830 for a non-stop. Maybe I could get the credit limit raised.
Edited to clarify: Mom writes that it's not the threat of DVT that's stopping her from flying to Australia again, rather, "it's the idea of having to see a movie like 'Titanic' both over and back.'" Having been subjected to "Dick Tracy" on the way to Denmark and "Titanic" en route to somewhere I can't recall, I sympathise.
Does Qantas have films of cute lil' ol' platypi?
And, (query for those better-versed in monotrematics than I), what exactly is poisonous about a platypus's spurs? What sort of poison is it?
Lashings of Parmesan
The weather went to shit night before last. In less than a day--in less than twelve hours, actually--the temperatures dropped from 82* to 22* Fahrenheit (for those of you who measure in Cee rather than Eff, that's from 28 to -6). It began to rain, then sleet, then "wintry mix", which translates no matter where you live into something that will coat your car and in which you do not want to drive.
I was prepared. I had stolen a Bill Bryson book, "The Mother Tongue: English and How It Got That Way" from the hospital library, had bought a bottle of Dalwhinnie, and had stocked the fridge with coffee and milk and eggs and bacon.
What I wasn't prepared for was this: that my sister's shipment of birthday presents would arrive this week, as would a five-box shipment containing a barrister bookshelf from my parents. I hauled the boxes from Beloved Sister up three flights of stairs, but left the crates of bookshelf bits in the apartment office. Until such time as I can enlist the help of some poor idiot to haul them up 45 vertical feet, there they'll stay. I wasn't about to carry them myself (or hump them, nod to Paeds RN) because, while they're not particularly heavy or ill-balanced, they are bulky. Three flights of steep concrete-and-metal stairs coated with ice do not mix well with bulky boxes containing glass-fronted bookshelf parts.
Beloved Sis sent many items that could be construed as scrubs or as pajama pants, depending on the offensiveness of their color combinations. I am not being insulting with that observation, by the way; the tag on one particularly strident set of scrubs read "these colors may not be a good idea." She also sent four antique medical books. I *love* ancient medical books--and these, while not particularly ancient (the oldest dates from 1914)--are stunning examples of their type.
There's one on "A girl's responsibility for race progress", one on Our Mysterious Life Glands (with disturbing pictures), one about Reading Character Through Analysis of the Features, and the crowning touch, a book (published in 1931) entitled "Studies In Ethics For Nurses." That last will, I expect, produce plenty of fodder for future blogging, provided I can get through it sober.
Anyway, dealing with that embrass de riches took most of the morning, after which I took a nice long nap. Then I got up and whipped up some spaghetti with things found in the fridge and lashings of Parmesan, and read Bryson and stuffed my face.
Provided I ever get the bookshelf bits up the stairs (that is, if the ice ever melts), "Studies In Ethics For Nurses" will look nice in the top one.
I was prepared. I had stolen a Bill Bryson book, "The Mother Tongue: English and How It Got That Way" from the hospital library, had bought a bottle of Dalwhinnie, and had stocked the fridge with coffee and milk and eggs and bacon.
What I wasn't prepared for was this: that my sister's shipment of birthday presents would arrive this week, as would a five-box shipment containing a barrister bookshelf from my parents. I hauled the boxes from Beloved Sister up three flights of stairs, but left the crates of bookshelf bits in the apartment office. Until such time as I can enlist the help of some poor idiot to haul them up 45 vertical feet, there they'll stay. I wasn't about to carry them myself (or hump them, nod to Paeds RN) because, while they're not particularly heavy or ill-balanced, they are bulky. Three flights of steep concrete-and-metal stairs coated with ice do not mix well with bulky boxes containing glass-fronted bookshelf parts.
Beloved Sis sent many items that could be construed as scrubs or as pajama pants, depending on the offensiveness of their color combinations. I am not being insulting with that observation, by the way; the tag on one particularly strident set of scrubs read "these colors may not be a good idea." She also sent four antique medical books. I *love* ancient medical books--and these, while not particularly ancient (the oldest dates from 1914)--are stunning examples of their type.
There's one on "A girl's responsibility for race progress", one on Our Mysterious Life Glands (with disturbing pictures), one about Reading Character Through Analysis of the Features, and the crowning touch, a book (published in 1931) entitled "Studies In Ethics For Nurses." That last will, I expect, produce plenty of fodder for future blogging, provided I can get through it sober.
Anyway, dealing with that embrass de riches took most of the morning, after which I took a nice long nap. Then I got up and whipped up some spaghetti with things found in the fridge and lashings of Parmesan, and read Bryson and stuffed my face.
Provided I ever get the bookshelf bits up the stairs (that is, if the ice ever melts), "Studies In Ethics For Nurses" will look nice in the top one.
Humpin'.
A tip for those who plan to spend a significant amount of time in the hospital, any hospital:
No matter how long you plan to stay, or how important you think you are, please do not bring your own furniture. And try to keep the amount of stuff in your room to a minimum. Three potted plants and a couple of tchochkes, fine. Twelve, not so good.
Because after I'm done hauling your console table bedside table potted plants various knickknacks bedside table chest of drawers ottoman clothing books magazines two bags full of makeup up three floors and installing them in another room, I will have a serious talk with you and your wife.
And your wife will cry. Not because I'm being mean, hard as it is to believe, but because she wanted to make your room "homey" and "comfortable" and I'm telling her that that's a no-go. Because, see, when the room is full of stuff of varying sizes, purposes, and fragilities, it's very difficult to see how I'll get a code cart into your room if, Frog forbid, I should ever need to.
And, you know, no matter how long you're staying here, please remember that it's a hospital, not a studio apartment. When three-quarters of the stuff I've humped on the elevator is your wife's, there's a problem.
Nobody, and I mean nobody, needs to be keeping a three-quarter length fur coat with fox trim in the closet in their hospital room. Really.
Aside from that forty-five minute period when I was wondering what, exactly, the facility was paying me for as I moved furniture, this was a good week. A busy week, true, with every floor full to the gills and overflow all over the post-anesthesia care unit, but a good week. Nobody coded, the person who *did* seize on me lo those many months ago went home mostly intact, and I only had to pull out the Mean Nurse Jo persona once, on a guy younger and stronger than me with an inch-long incision in his back.
All the faceless people have gone home to heal. One of them will be coming back next week for further plastics work, but that won't be the same caliber of treatment he's undergone thus far, so he ought to bounce back pretty quickly.
The two difficult folks I had this week, one with status epilepticus and one with status migraine, both seemed to respond to the massive doses of drugs we kept throwing at them and have left. Migraine Man went home with a drug that might destroy his kidneys but will keep him pain-free, while Epilepticus Woman went over to the monitoring unit to make sure that she's not having subclinical craziness in her head even on drugs.
The very nice man who came back completely unresponsive died easily and quickly, saving his family the hell of having to wait a week or even two while his breathing slowed down and he got more agonal. That's an odd thing to be thankful for, I guess, but I'll be thankful nonetheless. Occasionally a massive heart attack or pulmonary embolus or re-bleed can be a merciful thing, and not just for the patient.
Drama-filled weeks at the hospital make for great blogging but hellish working conditions. As does hauling furniture.
No matter how long you plan to stay, or how important you think you are, please do not bring your own furniture. And try to keep the amount of stuff in your room to a minimum. Three potted plants and a couple of tchochkes, fine. Twelve, not so good.
Because after I'm done hauling your console table bedside table potted plants various knickknacks bedside table chest of drawers ottoman clothing books magazines two bags full of makeup up three floors and installing them in another room, I will have a serious talk with you and your wife.
And your wife will cry. Not because I'm being mean, hard as it is to believe, but because she wanted to make your room "homey" and "comfortable" and I'm telling her that that's a no-go. Because, see, when the room is full of stuff of varying sizes, purposes, and fragilities, it's very difficult to see how I'll get a code cart into your room if, Frog forbid, I should ever need to.
And, you know, no matter how long you're staying here, please remember that it's a hospital, not a studio apartment. When three-quarters of the stuff I've humped on the elevator is your wife's, there's a problem.
Nobody, and I mean nobody, needs to be keeping a three-quarter length fur coat with fox trim in the closet in their hospital room. Really.
Aside from that forty-five minute period when I was wondering what, exactly, the facility was paying me for as I moved furniture, this was a good week. A busy week, true, with every floor full to the gills and overflow all over the post-anesthesia care unit, but a good week. Nobody coded, the person who *did* seize on me lo those many months ago went home mostly intact, and I only had to pull out the Mean Nurse Jo persona once, on a guy younger and stronger than me with an inch-long incision in his back.
All the faceless people have gone home to heal. One of them will be coming back next week for further plastics work, but that won't be the same caliber of treatment he's undergone thus far, so he ought to bounce back pretty quickly.
The two difficult folks I had this week, one with status epilepticus and one with status migraine, both seemed to respond to the massive doses of drugs we kept throwing at them and have left. Migraine Man went home with a drug that might destroy his kidneys but will keep him pain-free, while Epilepticus Woman went over to the monitoring unit to make sure that she's not having subclinical craziness in her head even on drugs.
The very nice man who came back completely unresponsive died easily and quickly, saving his family the hell of having to wait a week or even two while his breathing slowed down and he got more agonal. That's an odd thing to be thankful for, I guess, but I'll be thankful nonetheless. Occasionally a massive heart attack or pulmonary embolus or re-bleed can be a merciful thing, and not just for the patient.
Drama-filled weeks at the hospital make for great blogging but hellish working conditions. As does hauling furniture.
Tuesday, February 14, 2006
What I Cook On My Day Off When The Flyboys Are Being Assholes
Or, Gosh, I'm Glad I Didn't Have A Souffle In The Oven
Fruit Salad: honeydew melon that actually smelled like melon, alors!, pineapple ditto, alors! strawberries that taste like strawberries, and a can of sour pie cherries. What is *up* with the Quickie-Mart's produce section this week? In addition to thumb-thick asparagus, they had real fruit.
The cherries are in there primarily because I had a can of cherries that I was about to eat all in one sitting and didn't feel like torturing myself.
Rice cakes, made out of jasmine rice squished into a 1/3 cup measure (greased) and quick-fried in ghee until the outsides are crunchy.
To be served with corn relish: fresh sweet corn off the cob, tiny black beans, garlic sauteed until it's golden and crunchy, a hit of soy, a hit of chili paste, and some sesame seeds, toasted. (Weird, I know.)
Thumb-thick asparagus will be roasted. Yum. I got two pounds. Does anybody realize how much TWO POUNDS of asparagus is?
I also made chicken salad with pecans and cucumbers and red bell peppers, all very finely chopped up, and some onion.
About midway through the ghee-making process came the first of three sonic booms. The flyboys from the local AFB were breaking the rules again, making the windows shake and things fall off the shelves and freaking out all the dogs in the neighborhood. They do this about twice a year; fly fast and high over town, so fast you can't see much more than a black speck, and you don't know what's going on until the booms hit. Very irritating.
At least it's better, though, than the yearly airshow. My apartment is under the takeoff path at the municipal airport. When the airshow comes to town, I get treated to the sight and sound of dozens of WWII and Korean War-era bombers and fighters laboring up into the air entirely too slowly. I'm always afraid that the last remaining model of whatever rare bomber is there this year won't make it and will crash into my roof.
The biplanes and triplanes aren't as bad. You get the feeling that one could run straight into you and it wouldn't hurt, much.
In other news, my birthday was Sunday. Chef Boy took me to brunch, where we ate entirely too much and I had three mimosas (gee, mimosas are good! Why didn't anybody tell me before?) made from mandarin orange juice. The restaurant is Argentinian, the food is pricey but plentiful, and I'll never want to eat scrambled eggs again.
Beloved Sis sent a copy of a book that's been out of print for years ("The Dog Days of Arthur Cane") and which I'm saving for dinner reading.
And that is all. I have no work stories, having been mercifully absent from The Land Of Brain for three days now.
Fruit Salad: honeydew melon that actually smelled like melon, alors!, pineapple ditto, alors! strawberries that taste like strawberries, and a can of sour pie cherries. What is *up* with the Quickie-Mart's produce section this week? In addition to thumb-thick asparagus, they had real fruit.
The cherries are in there primarily because I had a can of cherries that I was about to eat all in one sitting and didn't feel like torturing myself.
Rice cakes, made out of jasmine rice squished into a 1/3 cup measure (greased) and quick-fried in ghee until the outsides are crunchy.
To be served with corn relish: fresh sweet corn off the cob, tiny black beans, garlic sauteed until it's golden and crunchy, a hit of soy, a hit of chili paste, and some sesame seeds, toasted. (Weird, I know.)
Thumb-thick asparagus will be roasted. Yum. I got two pounds. Does anybody realize how much TWO POUNDS of asparagus is?
I also made chicken salad with pecans and cucumbers and red bell peppers, all very finely chopped up, and some onion.
About midway through the ghee-making process came the first of three sonic booms. The flyboys from the local AFB were breaking the rules again, making the windows shake and things fall off the shelves and freaking out all the dogs in the neighborhood. They do this about twice a year; fly fast and high over town, so fast you can't see much more than a black speck, and you don't know what's going on until the booms hit. Very irritating.
At least it's better, though, than the yearly airshow. My apartment is under the takeoff path at the municipal airport. When the airshow comes to town, I get treated to the sight and sound of dozens of WWII and Korean War-era bombers and fighters laboring up into the air entirely too slowly. I'm always afraid that the last remaining model of whatever rare bomber is there this year won't make it and will crash into my roof.
The biplanes and triplanes aren't as bad. You get the feeling that one could run straight into you and it wouldn't hurt, much.
In other news, my birthday was Sunday. Chef Boy took me to brunch, where we ate entirely too much and I had three mimosas (gee, mimosas are good! Why didn't anybody tell me before?) made from mandarin orange juice. The restaurant is Argentinian, the food is pricey but plentiful, and I'll never want to eat scrambled eggs again.
Beloved Sis sent a copy of a book that's been out of print for years ("The Dog Days of Arthur Cane") and which I'm saving for dinner reading.
And that is all. I have no work stories, having been mercifully absent from The Land Of Brain for three days now.
Friday, February 10, 2006
The sun's over the yardarm *somewhere*.
Another entry in the Person With No Face contest:
Weird eye tumor extending into the bone of the skull near the temple and up over the brow. Weird eye tumor (and half the patient's face) removed by our crack team of Weird Eye Tumor Removal Pixies. Weird eye tumor site becomes very swollen and starts to leak Weird Eye Tumor Post-Removal Fluid.
So here comes one of the Pixies with a giant needle attached to the end of a giant syringe and whams it into the person's face in order to draw out some of the fluid.
I left the room precipitously.
And I did not have the egg-drop soup for lunch, no sir.
In other news, Amazon has a nifty widget I'm thinking about getting to carry lunch in. The bento box has always appealed to me, but a bento jar? Even better.
I also may have a supplier for my vintage glasses and sunglasses fetish. My crazy optometrist has a crazy father who recently found a cache of new-old-stock 1950's and 1960's glasses frames. He's promised to bring some of the best ones to the shop so that I can spend my hard-earned tax refund on them. Cat's eyes, here we come!
It's raining here, for the third time since July. I've promised myself a beer and a nap, in that order, so I'm off to get started.
Weird eye tumor extending into the bone of the skull near the temple and up over the brow. Weird eye tumor (and half the patient's face) removed by our crack team of Weird Eye Tumor Removal Pixies. Weird eye tumor site becomes very swollen and starts to leak Weird Eye Tumor Post-Removal Fluid.
So here comes one of the Pixies with a giant needle attached to the end of a giant syringe and whams it into the person's face in order to draw out some of the fluid.
I left the room precipitously.
And I did not have the egg-drop soup for lunch, no sir.
In other news, Amazon has a nifty widget I'm thinking about getting to carry lunch in. The bento box has always appealed to me, but a bento jar? Even better.
I also may have a supplier for my vintage glasses and sunglasses fetish. My crazy optometrist has a crazy father who recently found a cache of new-old-stock 1950's and 1960's glasses frames. He's promised to bring some of the best ones to the shop so that I can spend my hard-earned tax refund on them. Cat's eyes, here we come!
It's raining here, for the third time since July. I've promised myself a beer and a nap, in that order, so I'm off to get started.
Wednesday, February 08, 2006
The joke around here is...
....that there'll never be a "CSI" set here, because there's only one DNA sample and no dental records.
I just watched a neighbor pour about a gallon of used oil onto the parking lot, with no plans to clean it up. Genius.
It has been an annoying day.
I just watched a neighbor pour about a gallon of used oil onto the parking lot, with no plans to clean it up. Genius.
It has been an annoying day.
Tuesday, February 07, 2006
Coolest Thing Ever....
Care for another monotreme? This one not in Australia?
Oooo. I get so cheerful and happy and giggly when I read things like this.
I will never be a normal goil.
Oooo. I get so cheerful and happy and giggly when I read things like this.
I will never be a normal goil.
Monday, February 06, 2006
Simplify, simplify, simplify!
Thoreau never had a cell phone, that's for sure. And a land line, and a T1 connection for his computer, which he also didn't have. Still, I'm taking his words to heart--in this case. I'm ignoring the bit about "beware any enterprise that requires new clothes" as Beloved Sister would probably not be happy if I showed up in sweatshirt and jeans to her wedding. "Who's the chippie in the sweatshirt? Is she the bride?" "No, the one in the big white dress is the bride."
Anyhow. I'm ditching the land line (not yet, Mom; I'll give you plenty of warning) and switching cell phone plans to the one that lets you talk for four hours for $29.99 rather than the one I have, which charges double that much for nothin'. And I've got a new cell phone coming at some point, thanks to Working Assets Wireless (yes, Dad, that hippy liberal commie pinko phone company) that will replace my two-ton dinosaur-fueled current cellblock. They say they're sending me a phone that takes pictures. Who'da thunkit? With the technology available nowadays, somebody really ought to make a new version of "King Kong". That would be cool.
I've also cleaned out my fridge and the cabinet under the sink in the bathroom, so I can tell if I have soap or not. Mom and Dad left me with the legacy of the 1970's in that I am always prepared for stagflation, invasion by Cuba, or nuclear war. I have so much backstock of everything from soap to water that the local Mormons are envious. (No joke. I have, like, *edible* stuff backstocked. Not mixes.) Chef Boy, not being much of a backstocker and not ever having lived with a chemical toilet in the pantry (the pantry built, by the way, especially to stock Perma-Pak dried foods and vacuum-packed wheat), is scared. I think he thinks I have a complex.
I planted basil seeds today in those little pop-up peat pots that come in 12, 24, or 36-pot sets. That'll save me from having to drive thirty minutes to find more than an ounce of one kind of basil for $6.99. This might not be considered *simplifying*, exactly, since I'll now have to take care of three different basil plants, but it'll save me some bucks. Plus, those little peat starter kits are just too damned cute.
So, if I head out next days off (in eight days) and get me one o' them mighty-fine rollup shades of shadecloth, I should be able to get a little container garden going on the porch. Believe me, with the money I spend on produce (the farmer's market guys smile when they see me coming), this is simplifying.
I wonder if I could grow melons on the third floor, or if that would constitute an unreasonable hazard to my downstairs neighbors.
Anyhow. I'm ditching the land line (not yet, Mom; I'll give you plenty of warning) and switching cell phone plans to the one that lets you talk for four hours for $29.99 rather than the one I have, which charges double that much for nothin'. And I've got a new cell phone coming at some point, thanks to Working Assets Wireless (yes, Dad, that hippy liberal commie pinko phone company) that will replace my two-ton dinosaur-fueled current cellblock. They say they're sending me a phone that takes pictures. Who'da thunkit? With the technology available nowadays, somebody really ought to make a new version of "King Kong". That would be cool.
I've also cleaned out my fridge and the cabinet under the sink in the bathroom, so I can tell if I have soap or not. Mom and Dad left me with the legacy of the 1970's in that I am always prepared for stagflation, invasion by Cuba, or nuclear war. I have so much backstock of everything from soap to water that the local Mormons are envious. (No joke. I have, like, *edible* stuff backstocked. Not mixes.) Chef Boy, not being much of a backstocker and not ever having lived with a chemical toilet in the pantry (the pantry built, by the way, especially to stock Perma-Pak dried foods and vacuum-packed wheat), is scared. I think he thinks I have a complex.
I planted basil seeds today in those little pop-up peat pots that come in 12, 24, or 36-pot sets. That'll save me from having to drive thirty minutes to find more than an ounce of one kind of basil for $6.99. This might not be considered *simplifying*, exactly, since I'll now have to take care of three different basil plants, but it'll save me some bucks. Plus, those little peat starter kits are just too damned cute.
So, if I head out next days off (in eight days) and get me one o' them mighty-fine rollup shades of shadecloth, I should be able to get a little container garden going on the porch. Believe me, with the money I spend on produce (the farmer's market guys smile when they see me coming), this is simplifying.
I wonder if I could grow melons on the third floor, or if that would constitute an unreasonable hazard to my downstairs neighbors.
Many apologies....
First, to those of you who couldn't access the blog reliably over the last couple of days: Blogger has been having some unscheduled downtime for the last week as they migrate things and try to fix disks. There's going to be another outage this evening at 7 pm PST. The Blogger folks say that'll be the end-all, be-all fix.
Second, to those of you concerned that I might either leave nursing altogether or move to Seattle and disappear, don't worry. I think it was a combination of too little sleep and too much "Dancing With The Stars" that put me in such a foul mood.
I had planned to make chicken biryani this week, but a patient with an AVM pretty much blew those plans. Arterio-venous malformations aren't uncommon in people's brains, but they can appear anywhere on the body, sometimes with disturbing results. One of the most disturbing things is the color of the skin around them; it looks a lot like biryani before it's cooked.
This particular patient had an untreated facial AVM that was about the size of my hand, fully extended and with fingers together. I wear a size 7 glove, by the way, so that ain't a small AVM. The thing had displaced her right eye down onto her cheekbone and had puffed her eyelids out (and the rest of her periorbital tissue) to the point that the right side of her face looked like nothing human. When your eyeball and eyelid extend past the end of your nose, that's a problem.
Apparently the thing had come up suddenly and had grown so fast that there wasn't much she could do about it; AVMs can be like that. We'd embolized the thing a couple of times already, and she'll have surgery to remove it today. She'll lose her right eye--there's nothing we can do to replace an eye that's been displaced that far for more than a few hours--and will need some pretty extensive plastic surgery to minimize scarring, but at least she'll keep most of her skull.
Which is not the case, unfortunately, with another patient. This one had had basal cell cancer on his nose and had had it frozen off years before. Note to the interested: NEVER have a basal cell carcinoma removed by freezing. The process might not get all of it, and you may end up with a migrating basal cell cancer that invades your sinuses, your eye socket on one side, and your frontal bones.
Whereupon we would have to remove the whole damned upper quarter of your face and replace it with a flap graft from your scalp, or thigh, or chest. This is not a way to spend a week, never mind the disfiguring consequences of having thigh skin and muscle taking up what used to be your eye socket and frontal sinus.
Still, even that's better than having some piece of artillery go all crazy on your ass and blow off one side of your face. I'm not sure if it was a shoulder-mounted grenade launcher or what; all I know is that Walter Reed did all they could for the guy and then shipped him to us for definitive plastics and skull reconstruction. Thankfully his brain escaped harm, though I don't know how. We got him for a couple of days so that we could do the cranial reconstruction; he'll be shipped down a few floors sometime this week for the facial part of the deal.
All those, though, pale in comparison to what it must be like to be the parents of a twelve-year-old with a major aneurysm. Unruptured, so the question is this: should we go ahead with a carotid sacrifice and try to bypass and remove the aneurysm, knowing that our kid will likely be gorked out and severely disabled for the rest of his life, or should we skip the surgery and try to control his pain, living with the knowledge that the aneurysm could blow at any point and kill him?
You can see why "Dancing With George Hamilton's Tan" seemed like a good idea at the time.
Second, to those of you concerned that I might either leave nursing altogether or move to Seattle and disappear, don't worry. I think it was a combination of too little sleep and too much "Dancing With The Stars" that put me in such a foul mood.
I had planned to make chicken biryani this week, but a patient with an AVM pretty much blew those plans. Arterio-venous malformations aren't uncommon in people's brains, but they can appear anywhere on the body, sometimes with disturbing results. One of the most disturbing things is the color of the skin around them; it looks a lot like biryani before it's cooked.
This particular patient had an untreated facial AVM that was about the size of my hand, fully extended and with fingers together. I wear a size 7 glove, by the way, so that ain't a small AVM. The thing had displaced her right eye down onto her cheekbone and had puffed her eyelids out (and the rest of her periorbital tissue) to the point that the right side of her face looked like nothing human. When your eyeball and eyelid extend past the end of your nose, that's a problem.
Apparently the thing had come up suddenly and had grown so fast that there wasn't much she could do about it; AVMs can be like that. We'd embolized the thing a couple of times already, and she'll have surgery to remove it today. She'll lose her right eye--there's nothing we can do to replace an eye that's been displaced that far for more than a few hours--and will need some pretty extensive plastic surgery to minimize scarring, but at least she'll keep most of her skull.
Which is not the case, unfortunately, with another patient. This one had had basal cell cancer on his nose and had had it frozen off years before. Note to the interested: NEVER have a basal cell carcinoma removed by freezing. The process might not get all of it, and you may end up with a migrating basal cell cancer that invades your sinuses, your eye socket on one side, and your frontal bones.
Whereupon we would have to remove the whole damned upper quarter of your face and replace it with a flap graft from your scalp, or thigh, or chest. This is not a way to spend a week, never mind the disfiguring consequences of having thigh skin and muscle taking up what used to be your eye socket and frontal sinus.
Still, even that's better than having some piece of artillery go all crazy on your ass and blow off one side of your face. I'm not sure if it was a shoulder-mounted grenade launcher or what; all I know is that Walter Reed did all they could for the guy and then shipped him to us for definitive plastics and skull reconstruction. Thankfully his brain escaped harm, though I don't know how. We got him for a couple of days so that we could do the cranial reconstruction; he'll be shipped down a few floors sometime this week for the facial part of the deal.
All those, though, pale in comparison to what it must be like to be the parents of a twelve-year-old with a major aneurysm. Unruptured, so the question is this: should we go ahead with a carotid sacrifice and try to bypass and remove the aneurysm, knowing that our kid will likely be gorked out and severely disabled for the rest of his life, or should we skip the surgery and try to control his pain, living with the knowledge that the aneurysm could blow at any point and kill him?
You can see why "Dancing With George Hamilton's Tan" seemed like a good idea at the time.
Thursday, February 02, 2006
When it absolutely, positively cannot be about work.
I go back to work tomorrow after five days off, the first three of which I spent incredibly tired and feeling as though someone had scrubbed my left maxillary sinus with Brillo. The last two days I've spent running around doing errands, getting my teeth cleaned and my eyes checked, and doing laundry.
Fun times.
This evening I'm drinking Scotch (thanks, Beloved Soon-to-be-Brother-In-Law!) and watching, to my faintly bemused horror, "Dancing with the Stars". And trying to plan what to do for my 36th birthday and reading the latest issue of "Mental Floss" during the commercial breaks.
Oh, mercy. George Hamilton's tan is doing a slowed-down samba to a live version of "Do the Samba" or whatever that awful Miami Sound Machine song is, and I'm worried it might fall and break a hip. If tans have hips.
Anyway, I'm waiting to go to bed before work. Michelle has, as usual, an intelligent take on one of the most common problems that nurses and invisible doctors like anesthesiologists have: we know before the patient does what's going on. And that sucks.
I've been wondering over this week if it's maybe not time to get back into non-hospital nursing, more because of the commute time (40 minutes each way is long, especially on the 3rd of 3 days) than because of the emotional stress, though that stress is playing a role. I've had some really difficult cases this past fall and winter, and I'm getting stress-related illnesses as a result. For me, that means tummy trouble and sinus infections and possibly an aneurysm down the line, as well as trouble sleeping the night before I go back to work.
Don't get me wrong: I love what I do. Neurology and neurosurgery are ripe with opportunities to educate, amusing in the variety of problems we see, and incredibly elegant. I never knew how damned elegant the human nervous system could be; it fills me with awe and joy every time I see a manifestation of a tiny problem writ subtly on a patient's behavior or body.
But it's getting tiring, seeing people who will probably not get much better. Say what you want about working with pregnant teenagers, women in their 30's with unsuspected STDs, and women needing abortions: at least it opened up avenues to the future. Those folks had an entire future opened up to them that was multifaceted and unbounded; the patient with a massive bleed or thalamic stroke often doesn't have that option.
Ha. This was going to supposed to be an essay on the various options I have for spending my 36th birthday, which unfortunately coincides with Chef Boy's prep day for The Biggest Holiday Of The Year (Valentine's). Instead of pondering flying out to The Palms of Dubai or getting a mani-pedi, I'm missing working public health.
I don't know. I decided, the day the 27-year-old mother of a pregnant 13-year-old came in with her daughter, that I needed a new job. I had, in fact, just told the 13-year-old, who was in methadone treatment, that she was pregnant. Her mother looked at me and said, "What do you expect? Do you want me to cry? 'Cause I'm not gonna cry."
I wanted to shout, Yes, I want you to cry, because your daughter has somehow repeated the awful life that you lived. Your daughter has made her future that much more difficult and that much more bleak by deciding that her mama did it, so she can too. I want you to cry for whatever failure of yours it is that allowed your otherwise bright and engaging daughter to start shooting up heroin and sleep with God knows how many men.
Instead I went to the bar and stared at the wall for hours, hoping that I could down enough alcohol to make it possible for me to sleep without making it impossible for me to drive.
I'd take Lunesta, but Miss Cat would flip out over the glowing butterfly.
Planned Parenthood needs a recovery room nurse for a clinic. It's part-time, and it's forty miles away (again), but...well.
Every nurse has the chance to make a difference every day she works. Even if you have five vent-dependent, gorked-out patients, you have the ability to make a difference. Somebody, somewhere, if you're doing your job right, will end the day feeling better than they did when the day started.
I suppose it's a difference in type of heartbreak. The same heartbreak over and over gets old; eventually, trading 32-year-olds with gliomas for 13-year-olds with unplanned pregnancies (Query: Can a 13-year-old plan a pregnancy?) begins to sound like an option. Again.
Fun times.
This evening I'm drinking Scotch (thanks, Beloved Soon-to-be-Brother-In-Law!) and watching, to my faintly bemused horror, "Dancing with the Stars". And trying to plan what to do for my 36th birthday and reading the latest issue of "Mental Floss" during the commercial breaks.
Oh, mercy. George Hamilton's tan is doing a slowed-down samba to a live version of "Do the Samba" or whatever that awful Miami Sound Machine song is, and I'm worried it might fall and break a hip. If tans have hips.
Anyway, I'm waiting to go to bed before work. Michelle has, as usual, an intelligent take on one of the most common problems that nurses and invisible doctors like anesthesiologists have: we know before the patient does what's going on. And that sucks.
I've been wondering over this week if it's maybe not time to get back into non-hospital nursing, more because of the commute time (40 minutes each way is long, especially on the 3rd of 3 days) than because of the emotional stress, though that stress is playing a role. I've had some really difficult cases this past fall and winter, and I'm getting stress-related illnesses as a result. For me, that means tummy trouble and sinus infections and possibly an aneurysm down the line, as well as trouble sleeping the night before I go back to work.
Don't get me wrong: I love what I do. Neurology and neurosurgery are ripe with opportunities to educate, amusing in the variety of problems we see, and incredibly elegant. I never knew how damned elegant the human nervous system could be; it fills me with awe and joy every time I see a manifestation of a tiny problem writ subtly on a patient's behavior or body.
But it's getting tiring, seeing people who will probably not get much better. Say what you want about working with pregnant teenagers, women in their 30's with unsuspected STDs, and women needing abortions: at least it opened up avenues to the future. Those folks had an entire future opened up to them that was multifaceted and unbounded; the patient with a massive bleed or thalamic stroke often doesn't have that option.
Ha. This was going to supposed to be an essay on the various options I have for spending my 36th birthday, which unfortunately coincides with Chef Boy's prep day for The Biggest Holiday Of The Year (Valentine's). Instead of pondering flying out to The Palms of Dubai or getting a mani-pedi, I'm missing working public health.
I don't know. I decided, the day the 27-year-old mother of a pregnant 13-year-old came in with her daughter, that I needed a new job. I had, in fact, just told the 13-year-old, who was in methadone treatment, that she was pregnant. Her mother looked at me and said, "What do you expect? Do you want me to cry? 'Cause I'm not gonna cry."
I wanted to shout, Yes, I want you to cry, because your daughter has somehow repeated the awful life that you lived. Your daughter has made her future that much more difficult and that much more bleak by deciding that her mama did it, so she can too. I want you to cry for whatever failure of yours it is that allowed your otherwise bright and engaging daughter to start shooting up heroin and sleep with God knows how many men.
Instead I went to the bar and stared at the wall for hours, hoping that I could down enough alcohol to make it possible for me to sleep without making it impossible for me to drive.
I'd take Lunesta, but Miss Cat would flip out over the glowing butterfly.
Planned Parenthood needs a recovery room nurse for a clinic. It's part-time, and it's forty miles away (again), but...well.
Every nurse has the chance to make a difference every day she works. Even if you have five vent-dependent, gorked-out patients, you have the ability to make a difference. Somebody, somewhere, if you're doing your job right, will end the day feeling better than they did when the day started.
I suppose it's a difference in type of heartbreak. The same heartbreak over and over gets old; eventually, trading 32-year-olds with gliomas for 13-year-olds with unplanned pregnancies (Query: Can a 13-year-old plan a pregnancy?) begins to sound like an option. Again.
Tuesday, January 31, 2006
The sky is indeed falling, just not very fast.
Okay, so Alito got confirmed. And it's likely that in the next decade or two, we'll see either states' laws become more restrictive of abortion, or we'll see Roe overturned completely.
A little background first: Roe V. Wade didn't legalize abortion across the board, without restrictions, in every state. All it said was this: in the first trimester, a woman's right to an abortion cannot be subject to unreasonable restrictions by the state. "Unreasonable restriction" is a broad term: one that's been brought to the courts when states have attempted to pass parental or spousal consent or notification laws, laws restricting minors' access to abortion, waiting periods, education, and so on.
In the second and third trimesters, abortions are subject to a variety of restrictions that vary from state to state.
So let's take a worst-case-scenario view and say that the Constitutional right to privacy that is accepted as part of the not-specifically-named rights therein is decided not to cover the right of a woman to terminate a pregnancy.
Two things would then happen: a legal challenge would likely be mounted on the basis of equal protection under law--an argument that I find more compelling than the right to privacy in this particular case, as well as one that I'll leave for non-fluff-brained commenters and bloggers to handle.
The other thing that would happen would be this: access to abortion would return to a pre-Roe patchwork. It would likely be illegal where I live and in several surrounding states. Travel to New York and California would become commonplace for middle-class women, while other women would be either screwed to the wall or forced to obtain illegal abortions.
And, by the way, don't assume that women aren't already forced to obtain illegal abortions. Only 13% of counties in the US have an abortion provider; most of those providers are in urban states like Washington, California, and New York. I saw my first patient with complications from an illegal abortion during nursing school and my second only about a month ago. The situation for women in states where there are already notification laws and waiting periods is grim; there's no reason that it wouldn't get grimmer if, say, the three abortion providers within a day's drive of me went away.
But that's not really what I'm wanting to address here. The thing that bothers me about the thought of returning to pre-Roe days is this: each state will, in accordance with its rights under the Constitution, be able to define the beginning of life.
Think about that for a minute in context of pharmacists (who are, or who should be, nominally scientists) refusing to refill birth control pills or fill emergency contraceptive prescriptions on the basis that they might "abort" an embryo. Think about it in the context of doctors who refuse to fit women with IUDs for contraception on the same principle, even though repeated studies have shown that IUDs prevent ovulation and destroy sperm rather than embryos. All the science in the world won't convince these soi-disant scientists; do you think there'd be better luck with politicians?
Although Griswold V. Connecticut, which legalized birth control for married couples (and, as a result, opened the door to the contraceptive freedoms that you and I enjoy) will likely stand, access to contraceptives will probably become more difficult. Some forms might be legislated away, or surrounded by the sorts of requirements and caveats that make doctors loathe to prescribe them. After all, if legislators can require that abortion clinics meet the same standards as ambulatory surgery centers (which perform more complex and demanding surgeries), why not require that doctors meet special standards for, say, inserting an IUD? After all, women have been known to vagal out and seize during the procedure before.
That's scary enough for me to look wall-eyed at my pals in Canada and make sure their addresses in my book are current. What's worse, though, is what's likely to happen to us as healthcare providers.
It was not unusual, back in the day, for doctors to be wary of providing even lifesaving treatment to women who were bleeding after an induced illegal abortion, for fear that they might be prosecuted for assisting in an illegal termination.
It was not unusual for the police to show up in the septic wards or the ED to question women who were suspected of trying to self-abort, or suspected of having seen an illegal practitioner.
It wasn't unusual for women to place themselves at the mercy of untrained abortion providers and suffer the consequences of abortion and sterility.
Many years ago, when I was still working at the clinic, I had the opportunity to talk to a woman who'd had an illegal abortion, and who was sterile as a result. The folks in the emergency room were so nervous about being questioned or prosecuted that she bled nearly to death before one doctor finally intervened...at which point he had to go before the hospital ethics committee and the police to explain his actions.
Moiv has a heartbreaking post on this. The thing that scares me most about her post is one little mention of an abortion provider being called to help set up a "septic ward"--the place where women who'd had illegal abortions and had had complications were cared for. There's at least one hospital near me that's contemplating the same thing.
So, as healthcare providers, we'll get a triple role if Roe is overturned:
If we live in a state where abortion is across-the-board illegal, we'll be seen as informants for the police, witnesses for women who claim they'll kill themselves if they don't have an abortion, and caregivers for women who don't get the lucky straw in the illegal-abortion lottery.
If we live in a state where abortion is legal, we'll see an influx of women, probably mostly middle-class, coming across state lines and choking clinics and hospitals. Some of those women will have complications, even from a relatively safe procedure: it happens. And, if the state that woman with complications came from criminalizes crossing state lines, we may be called upon to release medical records or otherwise testify to her situation and our care.
Caregiver, witness for the prosecution, witness for the defense.
This is what'll happen, people. Not all those women will end up in septic wards, by the way. Pennyroyal, an herb that causes intestinal cramping and pain and can occasionally dislodge a pregnancy, comes in an oil-extract form that is highly toxic to the liver. When a person tries to self-abort with pennyroyal oil, she'll likely end up on a floor that deals with livers, kidneys, or neuro issues as a result of hepatic encephalopathy.
If worse comes to worst, it's gonna be an interesting ride.
A little background first: Roe V. Wade didn't legalize abortion across the board, without restrictions, in every state. All it said was this: in the first trimester, a woman's right to an abortion cannot be subject to unreasonable restrictions by the state. "Unreasonable restriction" is a broad term: one that's been brought to the courts when states have attempted to pass parental or spousal consent or notification laws, laws restricting minors' access to abortion, waiting periods, education, and so on.
In the second and third trimesters, abortions are subject to a variety of restrictions that vary from state to state.
So let's take a worst-case-scenario view and say that the Constitutional right to privacy that is accepted as part of the not-specifically-named rights therein is decided not to cover the right of a woman to terminate a pregnancy.
Two things would then happen: a legal challenge would likely be mounted on the basis of equal protection under law--an argument that I find more compelling than the right to privacy in this particular case, as well as one that I'll leave for non-fluff-brained commenters and bloggers to handle.
The other thing that would happen would be this: access to abortion would return to a pre-Roe patchwork. It would likely be illegal where I live and in several surrounding states. Travel to New York and California would become commonplace for middle-class women, while other women would be either screwed to the wall or forced to obtain illegal abortions.
And, by the way, don't assume that women aren't already forced to obtain illegal abortions. Only 13% of counties in the US have an abortion provider; most of those providers are in urban states like Washington, California, and New York. I saw my first patient with complications from an illegal abortion during nursing school and my second only about a month ago. The situation for women in states where there are already notification laws and waiting periods is grim; there's no reason that it wouldn't get grimmer if, say, the three abortion providers within a day's drive of me went away.
But that's not really what I'm wanting to address here. The thing that bothers me about the thought of returning to pre-Roe days is this: each state will, in accordance with its rights under the Constitution, be able to define the beginning of life.
Think about that for a minute in context of pharmacists (who are, or who should be, nominally scientists) refusing to refill birth control pills or fill emergency contraceptive prescriptions on the basis that they might "abort" an embryo. Think about it in the context of doctors who refuse to fit women with IUDs for contraception on the same principle, even though repeated studies have shown that IUDs prevent ovulation and destroy sperm rather than embryos. All the science in the world won't convince these soi-disant scientists; do you think there'd be better luck with politicians?
Although Griswold V. Connecticut, which legalized birth control for married couples (and, as a result, opened the door to the contraceptive freedoms that you and I enjoy) will likely stand, access to contraceptives will probably become more difficult. Some forms might be legislated away, or surrounded by the sorts of requirements and caveats that make doctors loathe to prescribe them. After all, if legislators can require that abortion clinics meet the same standards as ambulatory surgery centers (which perform more complex and demanding surgeries), why not require that doctors meet special standards for, say, inserting an IUD? After all, women have been known to vagal out and seize during the procedure before.
That's scary enough for me to look wall-eyed at my pals in Canada and make sure their addresses in my book are current. What's worse, though, is what's likely to happen to us as healthcare providers.
It was not unusual, back in the day, for doctors to be wary of providing even lifesaving treatment to women who were bleeding after an induced illegal abortion, for fear that they might be prosecuted for assisting in an illegal termination.
It was not unusual for the police to show up in the septic wards or the ED to question women who were suspected of trying to self-abort, or suspected of having seen an illegal practitioner.
It wasn't unusual for women to place themselves at the mercy of untrained abortion providers and suffer the consequences of abortion and sterility.
Many years ago, when I was still working at the clinic, I had the opportunity to talk to a woman who'd had an illegal abortion, and who was sterile as a result. The folks in the emergency room were so nervous about being questioned or prosecuted that she bled nearly to death before one doctor finally intervened...at which point he had to go before the hospital ethics committee and the police to explain his actions.
Moiv has a heartbreaking post on this. The thing that scares me most about her post is one little mention of an abortion provider being called to help set up a "septic ward"--the place where women who'd had illegal abortions and had had complications were cared for. There's at least one hospital near me that's contemplating the same thing.
So, as healthcare providers, we'll get a triple role if Roe is overturned:
If we live in a state where abortion is across-the-board illegal, we'll be seen as informants for the police, witnesses for women who claim they'll kill themselves if they don't have an abortion, and caregivers for women who don't get the lucky straw in the illegal-abortion lottery.
If we live in a state where abortion is legal, we'll see an influx of women, probably mostly middle-class, coming across state lines and choking clinics and hospitals. Some of those women will have complications, even from a relatively safe procedure: it happens. And, if the state that woman with complications came from criminalizes crossing state lines, we may be called upon to release medical records or otherwise testify to her situation and our care.
Caregiver, witness for the prosecution, witness for the defense.
This is what'll happen, people. Not all those women will end up in septic wards, by the way. Pennyroyal, an herb that causes intestinal cramping and pain and can occasionally dislodge a pregnancy, comes in an oil-extract form that is highly toxic to the liver. When a person tries to self-abort with pennyroyal oil, she'll likely end up on a floor that deals with livers, kidneys, or neuro issues as a result of hepatic encephalopathy.
If worse comes to worst, it's gonna be an interesting ride.
Saturday, January 28, 2006
I'm drunk. And I'll be having orgiastic sex tomorrow.
With a black guy.
A *gay* black guy.
A gay black Catholic clergyman.*
In a wheelchair.
No, that is not what I said.
It's what I wish I'd said, though.
I knew today that I was coming down with a sinus infection. In addition to the swimmy feeling and the pressure over my right cheekbone, I felt unreasonably aggressive and bitchy. (Chorus of my coworkers: "...aaaand this is different how?")
So, after running into something with my car (no injuries, just paint transfer off of the concrete barrier in front of the convenience store) and not feeling any better with Sudafed, I called in sick.
Whereupon the night mangler asked, "Do you mind if I ask what's wrong?"
Yes, I mind.
I mind immensely.
Not only am I doing you a favor by not double-dosing at least two patients tomorrow or coughing my crap onto their lumbar drains, I'm being nice enough to call you in time for you to find a sub.
And it's none of your business why I'm calling in. Okay? I could have a cold, or a stomach bug, or just be horribly hung-over; it's enough that I'm calling to say "I'm feeling peaked".
Perhaps you should ask the two other nurses who worked sick last week why they *didn't* call in. Those of us who worked with them for three days are feeling decidedly puny.
Unless I have smallpox, or bloody sputum, or avian flu, my reasons for calling in are my own business.
But I got her.
Instead of simply saying "I have a sinus infection; sorry" I described the multi-colored snot that my sinuses are producing, the pain, the lollygagging feeling, and the diarrhea.
Sweet dreams, night mangler.
*Or clergy-woman. Whatever works for you.
A *gay* black guy.
A gay black Catholic clergyman.*
In a wheelchair.
No, that is not what I said.
It's what I wish I'd said, though.
I knew today that I was coming down with a sinus infection. In addition to the swimmy feeling and the pressure over my right cheekbone, I felt unreasonably aggressive and bitchy. (Chorus of my coworkers: "...aaaand this is different how?")
So, after running into something with my car (no injuries, just paint transfer off of the concrete barrier in front of the convenience store) and not feeling any better with Sudafed, I called in sick.
Whereupon the night mangler asked, "Do you mind if I ask what's wrong?"
Yes, I mind.
I mind immensely.
Not only am I doing you a favor by not double-dosing at least two patients tomorrow or coughing my crap onto their lumbar drains, I'm being nice enough to call you in time for you to find a sub.
And it's none of your business why I'm calling in. Okay? I could have a cold, or a stomach bug, or just be horribly hung-over; it's enough that I'm calling to say "I'm feeling peaked".
Perhaps you should ask the two other nurses who worked sick last week why they *didn't* call in. Those of us who worked with them for three days are feeling decidedly puny.
Unless I have smallpox, or bloody sputum, or avian flu, my reasons for calling in are my own business.
But I got her.
Instead of simply saying "I have a sinus infection; sorry" I described the multi-colored snot that my sinuses are producing, the pain, the lollygagging feeling, and the diarrhea.
Sweet dreams, night mangler.
*Or clergy-woman. Whatever works for you.
Wednesday, January 25, 2006
Okay, fine, whatever.
I love my boyfiend.
This is why: I called him an hour ago and said, "Look, I'm in a foul, foul mood that hasn't gone away since last night and I don't want to inflict this on anybody, I just want to listen to polka music and clean my closet out, so can we skip lunch and get together this afternoon instead?" and he said "Yes."
No "why are you in a foul mood?", no "aaawww, honey, it's not that bad", no bull about it. Just "Yes."
Because it *is* that bad.
I sent an email about a week ago to the Great Sub-Leader at work, pointing out some errors in ins-and-outs that one of our techs had made.
Ins-and-outs (I&O) are a big deal on a neuroscience floor. When your patients are at risk for things like diabetes insipidus or syndrome of inappropriate antidiuretic hormone, it's a good idea to keep an eye on how much they drink versus how much they pee, because that'll help you catch problems early.
Likewise, it's a good idea to have an accurate blood pressure and respiratory rate on these folks. The tech in question had falsified blood pressures and fucked up respirations before in charting--in one case, she had charted a patient with agonal, death-is-on-the-way breathing of about six a minute as having tachypnea. My patients always breathe in unison, at 16 a minute, every time she works. They all have BPs in the 130's over 80's.
In short, there is a problem here. It's not necessarily one of intelligence, since she routinely wears shoes with laces that she's tied herself; it's more one of indolence and not caring.
This is the same person, by the by, who inflicted a reverse Trendelenburg (head-down, feet-up) position on a patient who was being fed through a tube without stopping the feeding first, thus almost killing him. No joke.
So there's a history here that goes back about two years. This latest email was an attempt by yours truly to actually document some of the bullshit that's been going down lately.
The response from Subcommandante Merkin today was as follows:
"You have to give her the benefit of the doubt. There is no malice in her."
No malice? Benefit of the doubt? This tech has a list of write-ups and policy violations as long as my commute, yet management won't get rid of her, for fear she'll sue. News flash, kids: in a work-at-will state, suing is a near-impossibility unless the fired person can show proof of discrimination or malice (speaking of malice). Even then, it's not likely she'd win, or even tie up the case in court for years. Judges here, while weird in social matters, tend to look slitty-eyed at the rights of workers.
When I worked at Planned Parenthood, we had a family planning associate who faked blood pressures. These were healthy patients in for annual exams, undergoing no medical procedures, at no particular risk for anything. And that FPA got fired immediately, on the grounds that faking medical information is A Bad Thing.
My manager doesn't have the same standards. ....Hello?
So, okay, fine, whatever. I'll deal with the fact that I have a person who takes until 1530 to do baths on three patients. I'll handle having to do my own I&Os; I do that anyway for the most part. I'll recheck blood pressures every couple of hours, even though that cuts into time that I could spend doing things that only a nurse can do, like analyzing lab results and deciding on courses of action.
We need good techs. Our facility rewards good techs handsomely, and I work with some *excellent* ones. It's hard physical labor, and the techs are the first people to notice when a problem crops up. Three of four of our techs I trust to give hand-off report on complex patients to a doctor. Three of four of them I trust to handle the first stages of an emergency before they yank the call cord out of the wall. One of them recently saved my bacon during a code. These are smart people who understand that getting blood pressures and tracking ins-and-outs is not shitwork; it's valuable, basic to the patient's outcome, and not to be faked.
This fourth one, though, regardless of malice, is going to kill somebody one of these days. Being smart is not enough. Being thoughtful is not enough. Being paranoid is close to enough, but it doesn't get the job done on its own. You need a combination of all of those things, and she doesn't have any of them.
Which means I have to take time that I do not have in order to double-check every. Single. Damned. Thing. She. Does. to make sure that she hasn't "missed" anything.
I can't afford to give her the benefit of the doubt. My patients can't afford it.
Unfortunately, Subcommandante Merkin thinks that the only thing the facility can't afford is a suit.
This is why: I called him an hour ago and said, "Look, I'm in a foul, foul mood that hasn't gone away since last night and I don't want to inflict this on anybody, I just want to listen to polka music and clean my closet out, so can we skip lunch and get together this afternoon instead?" and he said "Yes."
No "why are you in a foul mood?", no "aaawww, honey, it's not that bad", no bull about it. Just "Yes."
Because it *is* that bad.
I sent an email about a week ago to the Great Sub-Leader at work, pointing out some errors in ins-and-outs that one of our techs had made.
Ins-and-outs (I&O) are a big deal on a neuroscience floor. When your patients are at risk for things like diabetes insipidus or syndrome of inappropriate antidiuretic hormone, it's a good idea to keep an eye on how much they drink versus how much they pee, because that'll help you catch problems early.
Likewise, it's a good idea to have an accurate blood pressure and respiratory rate on these folks. The tech in question had falsified blood pressures and fucked up respirations before in charting--in one case, she had charted a patient with agonal, death-is-on-the-way breathing of about six a minute as having tachypnea. My patients always breathe in unison, at 16 a minute, every time she works. They all have BPs in the 130's over 80's.
In short, there is a problem here. It's not necessarily one of intelligence, since she routinely wears shoes with laces that she's tied herself; it's more one of indolence and not caring.
This is the same person, by the by, who inflicted a reverse Trendelenburg (head-down, feet-up) position on a patient who was being fed through a tube without stopping the feeding first, thus almost killing him. No joke.
So there's a history here that goes back about two years. This latest email was an attempt by yours truly to actually document some of the bullshit that's been going down lately.
The response from Subcommandante Merkin today was as follows:
"You have to give her the benefit of the doubt. There is no malice in her."
No malice? Benefit of the doubt? This tech has a list of write-ups and policy violations as long as my commute, yet management won't get rid of her, for fear she'll sue. News flash, kids: in a work-at-will state, suing is a near-impossibility unless the fired person can show proof of discrimination or malice (speaking of malice). Even then, it's not likely she'd win, or even tie up the case in court for years. Judges here, while weird in social matters, tend to look slitty-eyed at the rights of workers.
When I worked at Planned Parenthood, we had a family planning associate who faked blood pressures. These were healthy patients in for annual exams, undergoing no medical procedures, at no particular risk for anything. And that FPA got fired immediately, on the grounds that faking medical information is A Bad Thing.
My manager doesn't have the same standards. ....Hello?
So, okay, fine, whatever. I'll deal with the fact that I have a person who takes until 1530 to do baths on three patients. I'll handle having to do my own I&Os; I do that anyway for the most part. I'll recheck blood pressures every couple of hours, even though that cuts into time that I could spend doing things that only a nurse can do, like analyzing lab results and deciding on courses of action.
We need good techs. Our facility rewards good techs handsomely, and I work with some *excellent* ones. It's hard physical labor, and the techs are the first people to notice when a problem crops up. Three of four of our techs I trust to give hand-off report on complex patients to a doctor. Three of four of them I trust to handle the first stages of an emergency before they yank the call cord out of the wall. One of them recently saved my bacon during a code. These are smart people who understand that getting blood pressures and tracking ins-and-outs is not shitwork; it's valuable, basic to the patient's outcome, and not to be faked.
This fourth one, though, regardless of malice, is going to kill somebody one of these days. Being smart is not enough. Being thoughtful is not enough. Being paranoid is close to enough, but it doesn't get the job done on its own. You need a combination of all of those things, and she doesn't have any of them.
Which means I have to take time that I do not have in order to double-check every. Single. Damned. Thing. She. Does. to make sure that she hasn't "missed" anything.
I can't afford to give her the benefit of the doubt. My patients can't afford it.
Unfortunately, Subcommandante Merkin thinks that the only thing the facility can't afford is a suit.
Grouse: It's What's For Dinner
Cindy-Lou Who looked across the table at me just before report began. She widened her big brown eyes and said, "Y'know, this working-short shit is really starting to blow."
Yep. Can't put it better than that. This working-short shit is really starting to blow.
We're working short because a lot of us have been working sick, because working sick is the only way to avoid working short. (Note: that will make sense only if you're a nurse.) Now our manager's down with a cough so bad she can't eat, one of our nurses has been confined to bed by his doctor on the threat of hospital admission if he gets up, and the rest of us are sort of sniffly.
Never mind that Management did some sort of wonky air-filter cleaning thing that filled the entire hospital with the smell of burning rubber and diesel fumes. What up with that, dawg?
There's been a lot o'yakking over the last decade about our Terrible Nursing Shortage and What A Tragedy That Is and How On Earth We Can Fix It. Suggestions have ranged from higher pay and better bonuses (which might work, if nurses weren't so inculcated with the idea that big bonus = scarily understaffed facility), on-site daycare (huh? Who would want to expose their child to the bugs in a hospital?), more flexible hours (now, cutting out mandatory overtime might help), and fun little bonuses like on-site massage and cool totebags.
Can I inject a little dose of reality here?
Going back over the many books I've read on history, both general and specific to nursing, I've noticed one thing: Good nurses have always been hard to come by. During each World War, there was talk of drafting nurses; incentives were offered to civilian women who were willing to take shortened training courses and go off to serve as RNs in the military. In the 60's and 70's, there were efforts by folks who ran hospital-based programs (usually three-year courses that produced on-the-spot-trained nurses who then worked for the hospital for a time) to make their curricula more attractive to students. The only blip I remember that bucked the Terrible Tragic Nursing Shortage Trend came sometime in the 1980's, I think, and I have only anecdotal evidence for that: a nurse I knew vaguely went off to be a stock trader.
Hell, my antique medical books mourn the lack of decent nursing care in hospitals, and the difficulty of finding a nice, sober woman to come in by the day to the house.
So, basically, we're working now with the same formula we've always been working with: There are more sick people than there are folks willing to care for them. Even if we doubled the number of working nurses tomorrow, nothing would change; hospitals would simply build more wings and schedule more surgeries to take care of the endless lines of sickies outside their doors.
Let's assume that we can't change the Terrible Tragic Shortage. What could make life better for your average working nurse?
It ain't tote bags or pedicures. It's not even higher pay, though that might make a few people more cheerful.
It's people in other professions Getting A Clue.
A third-year internal med resident asked me yesterday how much break time we got during a shift. I said we got fifteen in the morning, half an hour for lunch, and fifteen during the afternoon, though we took what we could when we could.
"Can you skip all your breaks and leave an hour early?" she asked. I peered closely at her to make sure she wasn't joking. She wasn't. She simply had no clue, after years of working with and around nurses at various hospitals, what the job entails. I'm not sure what she thinks we do.
Upper management in hospitals is usually comprised of people who've either never worked in hospitals as nurses or doctors or who did so so long ago that "I walked sixteen miles uphill in the snow to get to the ward where I supervised 29 patients by myself" isn't too much of a stretch. They're management experts and efficiency experts and safety experts, but they have no real gut sense for how acuity affects staffing levels. Most of the patients that I took care of yesterday would've been dead even fifteen years ago, in ICU eight years ago; now they're on the floor in a high-acuity unit. The people in charge of budgeting for our unit have no idea what it's like to work with an open ventriculostomy or three. For them, "brain injury" means Poppa's a little forgetful these days.
I got snarked at by an attending the other day for "turfing" a patient wrong. Apparently, that means I asked for a consult from some service that I shouldn't have; there's some obscure way of going from specialty to subspecialty (for this guy, at least) that I'd not heard of before. The fact that the patient was showing worrisome signs of Some Very Severe, Life-Threatening Complications didn't faze him; he was more worried about his "turf" as regards the case.
I would love to have Dr. Turf, that internal med resident, and our Great Leader follow me for a week. Hell, even a *day*, if I could be sure that they'd actually have to work during that day. I would love for them to get a clue, in other words.
Let's be honest: nine-tenths of the cleanup work, the tidying up of loose ends that's done in a hospital is done by a nurse somewhere. Most of the emotional support a patient gets from non-family members is provided by a nurse. The nasty complications that get caught early are caught by a nurse. The wonky test results get re-draw orders written by a nurse. And those three patients with tubes draining brain juice are taken care of by a nurse who's trying to make sure they don't end up with fulminant meningitis while she's doing re-draws and fixing doctors' mistakes on paperwork.
I hereby propose National Get A Clue Week. One week out of the year, at a time of their choosing, every resident and management person, as well as attendings selected for their attitudes and indolence, would work on the floor with nurses. Full twelve-hour shift, they break when their nurse breaks, they stick to her or to him like glue.
It wouldn't solve the shortage; there's not a lot we can do about that. But maybe, just maybe, it would imbue those folks who think of us as starched white angels with a sense of what it is we do all the hell day long. And that, perhaps, would change their attitudes and actions and make our jobs a little less insane.
Yep. Can't put it better than that. This working-short shit is really starting to blow.
We're working short because a lot of us have been working sick, because working sick is the only way to avoid working short. (Note: that will make sense only if you're a nurse.) Now our manager's down with a cough so bad she can't eat, one of our nurses has been confined to bed by his doctor on the threat of hospital admission if he gets up, and the rest of us are sort of sniffly.
Never mind that Management did some sort of wonky air-filter cleaning thing that filled the entire hospital with the smell of burning rubber and diesel fumes. What up with that, dawg?
There's been a lot o'yakking over the last decade about our Terrible Nursing Shortage and What A Tragedy That Is and How On Earth We Can Fix It. Suggestions have ranged from higher pay and better bonuses (which might work, if nurses weren't so inculcated with the idea that big bonus = scarily understaffed facility), on-site daycare (huh? Who would want to expose their child to the bugs in a hospital?), more flexible hours (now, cutting out mandatory overtime might help), and fun little bonuses like on-site massage and cool totebags.
Can I inject a little dose of reality here?
Going back over the many books I've read on history, both general and specific to nursing, I've noticed one thing: Good nurses have always been hard to come by. During each World War, there was talk of drafting nurses; incentives were offered to civilian women who were willing to take shortened training courses and go off to serve as RNs in the military. In the 60's and 70's, there were efforts by folks who ran hospital-based programs (usually three-year courses that produced on-the-spot-trained nurses who then worked for the hospital for a time) to make their curricula more attractive to students. The only blip I remember that bucked the Terrible Tragic Nursing Shortage Trend came sometime in the 1980's, I think, and I have only anecdotal evidence for that: a nurse I knew vaguely went off to be a stock trader.
Hell, my antique medical books mourn the lack of decent nursing care in hospitals, and the difficulty of finding a nice, sober woman to come in by the day to the house.
So, basically, we're working now with the same formula we've always been working with: There are more sick people than there are folks willing to care for them. Even if we doubled the number of working nurses tomorrow, nothing would change; hospitals would simply build more wings and schedule more surgeries to take care of the endless lines of sickies outside their doors.
Let's assume that we can't change the Terrible Tragic Shortage. What could make life better for your average working nurse?
It ain't tote bags or pedicures. It's not even higher pay, though that might make a few people more cheerful.
It's people in other professions Getting A Clue.
A third-year internal med resident asked me yesterday how much break time we got during a shift. I said we got fifteen in the morning, half an hour for lunch, and fifteen during the afternoon, though we took what we could when we could.
"Can you skip all your breaks and leave an hour early?" she asked. I peered closely at her to make sure she wasn't joking. She wasn't. She simply had no clue, after years of working with and around nurses at various hospitals, what the job entails. I'm not sure what she thinks we do.
Upper management in hospitals is usually comprised of people who've either never worked in hospitals as nurses or doctors or who did so so long ago that "I walked sixteen miles uphill in the snow to get to the ward where I supervised 29 patients by myself" isn't too much of a stretch. They're management experts and efficiency experts and safety experts, but they have no real gut sense for how acuity affects staffing levels. Most of the patients that I took care of yesterday would've been dead even fifteen years ago, in ICU eight years ago; now they're on the floor in a high-acuity unit. The people in charge of budgeting for our unit have no idea what it's like to work with an open ventriculostomy or three. For them, "brain injury" means Poppa's a little forgetful these days.
I got snarked at by an attending the other day for "turfing" a patient wrong. Apparently, that means I asked for a consult from some service that I shouldn't have; there's some obscure way of going from specialty to subspecialty (for this guy, at least) that I'd not heard of before. The fact that the patient was showing worrisome signs of Some Very Severe, Life-Threatening Complications didn't faze him; he was more worried about his "turf" as regards the case.
I would love to have Dr. Turf, that internal med resident, and our Great Leader follow me for a week. Hell, even a *day*, if I could be sure that they'd actually have to work during that day. I would love for them to get a clue, in other words.
Let's be honest: nine-tenths of the cleanup work, the tidying up of loose ends that's done in a hospital is done by a nurse somewhere. Most of the emotional support a patient gets from non-family members is provided by a nurse. The nasty complications that get caught early are caught by a nurse. The wonky test results get re-draw orders written by a nurse. And those three patients with tubes draining brain juice are taken care of by a nurse who's trying to make sure they don't end up with fulminant meningitis while she's doing re-draws and fixing doctors' mistakes on paperwork.
I hereby propose National Get A Clue Week. One week out of the year, at a time of their choosing, every resident and management person, as well as attendings selected for their attitudes and indolence, would work on the floor with nurses. Full twelve-hour shift, they break when their nurse breaks, they stick to her or to him like glue.
It wouldn't solve the shortage; there's not a lot we can do about that. But maybe, just maybe, it would imbue those folks who think of us as starched white angels with a sense of what it is we do all the hell day long. And that, perhaps, would change their attitudes and actions and make our jobs a little less insane.
Sunday, January 22, 2006
Friday, January 20, 2006
Good news, chilluns, good news!
My pal with ovarian cancer?
Doesn't have cancer at all, thanks be to Frog.
Turns out what she had is some sort of crazy rare benign growth that thankfully didn't contain hair and teeth but is related to that sort of germ cell tumor. She's good.
She's been off Ovarex for a few days now and is feeling much better.
Her family got a little snitty, calling this a "scare" and an "over-reaction", but my feeling is this: when the docs are united in putting a young patient on what's normally a salvage drug for ovarian CA, *they're* pretty damned scared.
She looks like a cross between one of the Desperate Housewives and Skeletor, ie, skinny and absolutely no ass, but is no longer sort of...flat. It's amazing what that 20% difference in "You might live five years" to "You will live five years" will do for a girl's mood. Plus, all her hair has not quite fallen out yet, so she's leaving it.
Thanks to all who sent good wishes and advice and email and hats. I think the general outpouring of goodness had a lot to do with this.
Doesn't have cancer at all, thanks be to Frog.
Turns out what she had is some sort of crazy rare benign growth that thankfully didn't contain hair and teeth but is related to that sort of germ cell tumor. She's good.
She's been off Ovarex for a few days now and is feeling much better.
Her family got a little snitty, calling this a "scare" and an "over-reaction", but my feeling is this: when the docs are united in putting a young patient on what's normally a salvage drug for ovarian CA, *they're* pretty damned scared.
She looks like a cross between one of the Desperate Housewives and Skeletor, ie, skinny and absolutely no ass, but is no longer sort of...flat. It's amazing what that 20% difference in "You might live five years" to "You will live five years" will do for a girl's mood. Plus, all her hair has not quite fallen out yet, so she's leaving it.
Thanks to all who sent good wishes and advice and email and hats. I think the general outpouring of goodness had a lot to do with this.
Thursday, January 19, 2006
This is what I do all day
(With apologies to Beloved Sister, who originated the title.)
0420: get up, get coffee, wonder again why I took a job that requires a forty-minute commute. Sit outside on the porch with the cat and a cup of that coffee.
0440: get into shower.
0620: walk into work, with (hopefully) unwrinkled scrubs, a professional mein, and artfully applied makeup. If it's a good week, my nails will be short and my cuticles tended.
0700-1900: take care of other people.
For the bored patient who's being converted from heparin to coumadin, try to think of a new metaphor that will explain the difference between PTT and INR and the actions of heparin and coumadin. "There's this herd of zebras, see, who all have terrible static cling...." Act out said metaphor to gales of laughter from previously-bored patient.
For the patient who's experiencing intractable pain secondary to anxiety following surgery, reassure him that he will indeed be able to play bad country music on his guitar again. Keep opinion of whether or not this is a good thing to myself. Draw many diagrams of nerve plexuses (plexi? Resolve to look that up) and explain why the pain is worse now than it was prior to surgery. Bite back snotty response when patient's wife makes the predictable "We're not going to let you go home tonight" comment.
Remind self that "we're not going to let you go home" is a huge compliment, and those folks don't know I've heard it five thousand times before.
Eat lunch.
Maybe.
Readjust a heparin drip and bitch at the poor hapless lab personnel who cross my path, because the PTT is two hours late.
Reposition one or two or more of any number of patients, my own and other people's.
Chart. (That should actually be a constant background noise, like a bunch of Gregorian monks with nothing better to do. "Chart. Chart. Chart. Chart.")
Pee. It might be the first time today, but probably not. Every nurse has his or her priorities; mine is peeing.
Discuss end-of-life care with a woman whose son is dying of an easily-treatable brain tumor. Treatable, that is, if you have insurance or if the indigent care department of the hospital hadn't cut you off two years ago.
Consider the possibility of taking up recreational drug use. Decide against it; all the good stuff is tracked.
Chart. (omni in microscopicae chaaaaaaaaartuuuuuuuuussssss....)
Coffee.
Report.
1920-2000: drive home.
post-2000: sit on porch with cat and drink. Could be lemonade, could be Scotch; the important thing is that it ends the day. Wonder how on earth my feet could possibly smell *so very bad*. Admire 0.5 cm dents in ankles from socks; consider, then reject, wearing supphose to work. Wonder if heparinizing patient has thrown herself out of the window through boredom yet. Pee. Note that cat is avoiding my feet. Marvel at the dents that my beeper and waistband have put into my waist.
Consider eating. Recall that the only things in the fridge are biryani rice and leftover nachos. Decide that those sound pretty good anyhow. Eat.
Sleep.
On a day that I have off, that last line is repeated at least twice the following day, along with "drink more coffee" "pee some more" and "poop".
Most nurses I know spend their days off pooping and sleeping, like babies.
I'm on to the latter right now.
0420: get up, get coffee, wonder again why I took a job that requires a forty-minute commute. Sit outside on the porch with the cat and a cup of that coffee.
0440: get into shower.
0620: walk into work, with (hopefully) unwrinkled scrubs, a professional mein, and artfully applied makeup. If it's a good week, my nails will be short and my cuticles tended.
0700-1900: take care of other people.
For the bored patient who's being converted from heparin to coumadin, try to think of a new metaphor that will explain the difference between PTT and INR and the actions of heparin and coumadin. "There's this herd of zebras, see, who all have terrible static cling...." Act out said metaphor to gales of laughter from previously-bored patient.
For the patient who's experiencing intractable pain secondary to anxiety following surgery, reassure him that he will indeed be able to play bad country music on his guitar again. Keep opinion of whether or not this is a good thing to myself. Draw many diagrams of nerve plexuses (plexi? Resolve to look that up) and explain why the pain is worse now than it was prior to surgery. Bite back snotty response when patient's wife makes the predictable "We're not going to let you go home tonight" comment.
Remind self that "we're not going to let you go home" is a huge compliment, and those folks don't know I've heard it five thousand times before.
Eat lunch.
Maybe.
Readjust a heparin drip and bitch at the poor hapless lab personnel who cross my path, because the PTT is two hours late.
Reposition one or two or more of any number of patients, my own and other people's.
Chart. (That should actually be a constant background noise, like a bunch of Gregorian monks with nothing better to do. "Chart. Chart. Chart. Chart.")
Pee. It might be the first time today, but probably not. Every nurse has his or her priorities; mine is peeing.
Discuss end-of-life care with a woman whose son is dying of an easily-treatable brain tumor. Treatable, that is, if you have insurance or if the indigent care department of the hospital hadn't cut you off two years ago.
Consider the possibility of taking up recreational drug use. Decide against it; all the good stuff is tracked.
Chart. (omni in microscopicae chaaaaaaaaartuuuuuuuuussssss....)
Coffee.
Report.
1920-2000: drive home.
post-2000: sit on porch with cat and drink. Could be lemonade, could be Scotch; the important thing is that it ends the day. Wonder how on earth my feet could possibly smell *so very bad*. Admire 0.5 cm dents in ankles from socks; consider, then reject, wearing supphose to work. Wonder if heparinizing patient has thrown herself out of the window through boredom yet. Pee. Note that cat is avoiding my feet. Marvel at the dents that my beeper and waistband have put into my waist.
Consider eating. Recall that the only things in the fridge are biryani rice and leftover nachos. Decide that those sound pretty good anyhow. Eat.
Sleep.
On a day that I have off, that last line is repeated at least twice the following day, along with "drink more coffee" "pee some more" and "poop".
Most nurses I know spend their days off pooping and sleeping, like babies.
I'm on to the latter right now.
Sunday, January 15, 2006
Hobbyists, part one zillion
This is the time of year when, if you work in the typical hospital, the patients who come to you are either very sick or very weird. Sick, because everybody who had a choice about having surgery came in before the end of the year, so as not to have to pay a huge deductible; weird, because the post-Christmas letdown brings in the folks who really, really love their narcotics.
We've got 'em all over the spectrum this time. The one who mixes up whatever liquids are left in the room, complete with pills he's cheeked, to simulate vomit. The one who's complained for so long of pain at 10 on a 1 to 10 scale that she's become addicted to strong painkillers, yet can wander outside, complete with IV pole full of stuff, to smoke during the worst pain crisis. The one who Munched himself into four unnecessary surgeries, years of heavy steroids, and finally, an almost-complete dehiscence of his gut.
I want to put the new Munchers into a room with the experienced Munchers so that they can see what they're getting into.
If you're a Hospital Hobbyist, there is a possibility that you will eventually make yourself sick. Since we deal with people who have diseases that have to be diagnosed by exclusion and that often have wierd and vague symptomatology, we get a fair number of hobbyists. We also get a fair number of folks who started out as hobbyists but have actually become ill. Whether they're injecting Dilaudid and Demerol through their own implanted port at home, or simply going from doctor to doctor to get Vicodin until their livers give out, they will come to us at some point.
Yes, yes, I know: another person cannot rate your pain for you. A nurse has to believe that a patient is really experiencing the pain they say they are. Pain is the fifth vital sign, and should be treated with effective drugs, not shots of saline.
Please. There's a limit.
If you're in pain, you generally don't wait until the nurse is in the room to act like it. (Same with seizures: if you're lying there watching TV while I'm spying on you from outside, only to seize when I walk in the room, I'm going to wonder.) If you're in pain, you generally don't have the energy to steal vials and ampules of goodness from other facilities and stash them in your room when you're with us. If you're in pain, you sure as hell won't have the energy or desire to hang out in the smoking court for four hours, bringing a wide variety of interesting individuals back with you for a little tete a tete.
Eventually, if you complain of severe and unremitting pain long enough, we're going to start using non-narcotic drugs to treat that pain. It could be steroids, which thin your skin and leave you moon-faced and irritable. It could be immunomodulators, which leave you open to lovely infections. It could even be surgery, rather than drugs, as a last-ditch effort to relieve that headache, gut pain, or back pain you've been complaining about for years. You might end up with a shunt here, a colostomy there, or a hunk of metal somewhere else. Is it worth it?
On the other side of the unit is the patient who's really, really fucking sick. She might've had an aneurysm diagnosed shortly before Katrina wiped out the CT scanner; maybe he woke up one morning with CSF pouring from his ear. Could be fulminant meningitis, could be a stroke. If you bite through the tubing leading to your PCA in an attempt to siphon off more painkiller, you take me away from those people that need me.
Some days I go to work with a light heart and a happy smile, knowing that I'll have a chance to actually help somebody feel better, maybe even help them heal a bit. Other days I go to work with a sense of duty, reminding myself of the hourly rate I earn. This week has been full of that second sort of day.
There are still compensations, don't get me wrong. I just worry on my day off about the sick, sick people that I might've missed something on, or might've not taken prime care of, because I was busy rooting under a patient's mattress for the ampules of Demerol stashed there.
We've got 'em all over the spectrum this time. The one who mixes up whatever liquids are left in the room, complete with pills he's cheeked, to simulate vomit. The one who's complained for so long of pain at 10 on a 1 to 10 scale that she's become addicted to strong painkillers, yet can wander outside, complete with IV pole full of stuff, to smoke during the worst pain crisis. The one who Munched himself into four unnecessary surgeries, years of heavy steroids, and finally, an almost-complete dehiscence of his gut.
I want to put the new Munchers into a room with the experienced Munchers so that they can see what they're getting into.
If you're a Hospital Hobbyist, there is a possibility that you will eventually make yourself sick. Since we deal with people who have diseases that have to be diagnosed by exclusion and that often have wierd and vague symptomatology, we get a fair number of hobbyists. We also get a fair number of folks who started out as hobbyists but have actually become ill. Whether they're injecting Dilaudid and Demerol through their own implanted port at home, or simply going from doctor to doctor to get Vicodin until their livers give out, they will come to us at some point.
Yes, yes, I know: another person cannot rate your pain for you. A nurse has to believe that a patient is really experiencing the pain they say they are. Pain is the fifth vital sign, and should be treated with effective drugs, not shots of saline.
Please. There's a limit.
If you're in pain, you generally don't wait until the nurse is in the room to act like it. (Same with seizures: if you're lying there watching TV while I'm spying on you from outside, only to seize when I walk in the room, I'm going to wonder.) If you're in pain, you generally don't have the energy to steal vials and ampules of goodness from other facilities and stash them in your room when you're with us. If you're in pain, you sure as hell won't have the energy or desire to hang out in the smoking court for four hours, bringing a wide variety of interesting individuals back with you for a little tete a tete.
Eventually, if you complain of severe and unremitting pain long enough, we're going to start using non-narcotic drugs to treat that pain. It could be steroids, which thin your skin and leave you moon-faced and irritable. It could be immunomodulators, which leave you open to lovely infections. It could even be surgery, rather than drugs, as a last-ditch effort to relieve that headache, gut pain, or back pain you've been complaining about for years. You might end up with a shunt here, a colostomy there, or a hunk of metal somewhere else. Is it worth it?
On the other side of the unit is the patient who's really, really fucking sick. She might've had an aneurysm diagnosed shortly before Katrina wiped out the CT scanner; maybe he woke up one morning with CSF pouring from his ear. Could be fulminant meningitis, could be a stroke. If you bite through the tubing leading to your PCA in an attempt to siphon off more painkiller, you take me away from those people that need me.
Some days I go to work with a light heart and a happy smile, knowing that I'll have a chance to actually help somebody feel better, maybe even help them heal a bit. Other days I go to work with a sense of duty, reminding myself of the hourly rate I earn. This week has been full of that second sort of day.
There are still compensations, don't get me wrong. I just worry on my day off about the sick, sick people that I might've missed something on, or might've not taken prime care of, because I was busy rooting under a patient's mattress for the ampules of Demerol stashed there.
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