HN Special Feature: TeeVee Show Review!

I was really, really not wanting to put too much mental effort out tonight; two days straight of The Great Influenza and starting Pinker's How The Mind Works had left my brain box empty except for a quivering lump of greyish Jell-O.

So I flipped on the tube and stumbled on something called "The Ghost Whisperer." I was intrigued: a show about a person who trains ghosts to canter, trot, and gallop? A medium with laryngitis? You gotta understand, I may not get out much, but I watch TV even less.

What I got was Jennifer Love Hewitt and some guy I vaguely remember from the old one-season wonder "Relativity" (as well as Snow White: A Tale of Terror, with Sigourney Weaver as the evil stepmom) playing a paramedic (him) and an antique store owner (her) living in a small, peaceful Eastern Seaboard town.

So far so good.

As things progressed, though, I started to wonder: if this chick who sees dead people (all the time!!) and tries to send them into the light has been doing this since she was six, how come she's still flipped out by manifestations of what should be, by now, a fairly routine occurance? I mean, even her husband and business partner are treating her visitations with the sort of wry humor that connotes total acceptance of the weird.

Also, what up with the hallucinations? I mean, she's hallucinating all the damn time. Either that, or the dead aren't very good at communicating, since a planeload of people about to come down (this week's plot) can only focus their combined energies on one person. Everybody else is missing the obvious, like half-frozen people in pilot's uniforms wandering around. If J-Love's character is living in a small town, and her husband's a paramedic, you *know* somebody's said something to him about this by now. "Uh, Bob...you know, I hate to mention it, but your wife keeps screaming and clapping her hands over her ears in line at the Wal-Mart. Has she seen a doctor?"

Furthermore, what up with the eyeliner and Goth-Girl costumes, dawg? There was one scene in this week's episode in which Our Heroine was walking across Ye Olde Towne Square, the only person in town (and they all seemed to be on the square at that moment) wearing head-to-toe black and eyeliner fit for a Mod Squad audition. That, in most small towns I know, would get you looked at funny at the least, and probably not guarantee a lot of business for your antique store. ("Same As It Never Was." Cute, guys.)

At one point in a subplot, an architect stops in for a consult on remodelling the antique store and mentions that he's "passed by this place" a number of times. At that point The Cat snorted and said, "Yeah, 'cause he's freaked out by Little Miss Death Hallucinatron, here."

Then there's the subplot with the rookie paramedic who gets freaked out by the sight of blood, and Sensitive Husband Paramedic Guy has to be his big-brother type and get him over it in time for a plane full of sort-of-dead, mostly-frozen people who've been talking to J-Love for the last fifty minutes to crash...right into Smallton! Or Greenville, or whatever it's called.

According to the preview for *next* week's show, the whole upshot of the dealie-o is that J-Love will have to somehow armor her black lace cardigan and go up against The Devil Himself (dun dun dun) to save the souls of the mostly-dead, pretty-well-freezer-burned folk on the plane. There's a lot of symbolism about a pocket watch and doves coming back to life and love never dying, and Beelzebub wears a really, *really* bad hat and hisses a lot in J-Love's ear.

The Cat, pausing in her paw-licking, opined that Satan is getting lamer and lamer every year. "Whatever happened," she asked, "to 'Sinners in the Hands of an Angry God?' Or Dante? Or even 'The Gospel of Peter?'"

I told her I had no good answer, and so we're going to bed.

I'm blaming The South Bitch Diet.

So, um, you know when you get a scary troll on your blog? And you go and enable the "moderate comments" dealie on the blog template? And you forget to, um, type in your email address in that thingy so that the Blogger software can let you know when a comment's been posted? And none of the comments get posted, for, like, six weeks, so you think nobody's reading your stuff and you start posting titles like "BOOBIES!" and stuff?

Just be glad I'm not a programmer or proofreader, people. I figured out the comments glitch today, and let's just say boy is my face red.

It should work now. I take back all the nasty things I said about you, Blogger. It was entirely my own fault, mea culpa. And thank you, various commenters, for the nice things you've said.

On to bigger and worser things:

All you folks who have done SBD or who know patients or family members who have done it, I have a question: How do you get the freaking headaches to stop?

I'm well-hydrated, I'm eating everything I should. Last night I was in the grips of a three-day-long headache and finally ate a pita sandwich. The headache disappeared and hasn't returned since. I had a half-cup of rice today, which I think might account for that. Is this headache going to continue through the first phase of the diet? If it's that bad, should I just say to heck with it and start with Phase II? I don't eat much in the way of simple carbs anyhow, so that wouldn't be too bad.

It was bad enough yesterday that I took four ibuprofen, something I never, ever do, and the headache *still* didn't disappear. It went from "making me afraid to try to drive" to "moderately distracting". And no, I haven't cut down on caffeine. I wasn't having that much anyhow.

I can handle hunger and muscle aches and bad skin. I can handle constipation, the Plagues of Egypt, bad relationships, and traffic. I just cannot handle unrelenting headaches of near-migranous intensity. Any help would be appreciated.

In other news, since The Boys are off at the AANS conference, I'm home today, huzzah! Things will begin to pick up on Thursday, when they return, but I'll be off work then and (I hope) refinishing my dining table. The Cat and I had a little mutual-admiration society going this afternoon, so she should be able to handle being not At The Forefront of The Human's Mind for a day or so.

Note on the last big post: The song lyrics in italics are from Barenaked Ladies's "The Old Apartment" and Jackson Browne's "In the Shape of A Heart", mixed up together. "The Old Apartment" can be found on the album Rock Spectacle, while "In the Shape of A Heart" is on Lives In The Balance. You can hear lots of Browne cuts on his website, jacksonbrowne.com, which almost makes up for him being a drunken wife-beater. And for imbuing me with a lifelong *thing* for skinny dark-haired guys with dark eyes.

And that is all for now. Comments remain moderated, but now I know how to fly this bitch, so we'll do fine.

Blogger Band-Aid

Suggested by Les, brilliant correspondent.

Blogger's bug won't allow people to post on the first post on the page, so I'm trying something new: A band-aid post to knock the *real* post down a notch, so it can be commented upon.

Let me know how it works.

Finally, enough time off.

Of course, I'll pay for it starting tomorrow.

I had two days off this week and three last week and actually put them to good use. Chef Boy and I went to a food show, a nightmare of fried things and processed things attended by the chefs of places like Applebee's and Chili's.

I kid you not: I saw six people so obese that they could not walk and had to use those little scooters to get around. Obesity doesn't necessarily lead to mobility problems, but the lightest of these folks was, by my estimation, somewhere north of 400 lbs. That's gonna give you problems at some point.

Apparently, this particular food show is a big draw with church groups and social groups: people buy tickets for however much, then grab a to-go box from one of the product booths and fill it with fried things.

The only booth that had fresh food had no samples available. It was torture, walking past heirloom tomatoes and bags of salad and not being able to eat anything but chicken-chili-cheese dogs (the most foul thing I've ever put in my mouth) and crawfish empenadas (a close second). There's a list of about eight things I will never eat again, even under duress, and the food show provided all but three. (The other things are Danish ammonia-and-salt licorice, anything flavored with asafoetida, and Tofu Pups.)

I also bought books, to wit:

The Tale of Despereaux, by Kate DiCamillo. I was not crazy at all about Because of Winn-Dixie, but this is a charming story well-told. I like the style, I like the rat Chiaroscuro, I like Miggery Sow.

Eragon, by Christopher Paolini. So far it's failing to entrance me, but I understand it gets better after the first eight chapters or so.

How the Mind Works, Steven Pinker. Because I felt like I oughta, and because I liked the interviews with Pinker that I saw on YouTube.

John M. Barry's The Great Influenza. I'm not sure I haven't read this one before, but if I did, I don't remember it and so should read it again.

The South Beach Diet. Yes. My belly measurement has reached truly worrying levels, as have my fasting blood glucose and cholesterol numbers. Two of the internal med docs I work with recommended this book, independently of one another, and they're both the biggest fitness-freak Diet Cops I've ever met, so I'm going to give it a shot. Hell, I can do anything for two weeks, especially an induction plan that includes things like broccoli and Brussels sprouts and black beans.

Lesson learned: If you don't listen to your doctor when he tells you you need to make small changes, you'll end up having to buy diet books and looking askance at potatoes. Which is probably a good thing, as I don't want to end up like Miggery Sow, cauliflower ears and all.

Dinner with Chef Boy's family, a whole bunch of laundry, and some more naps rounded out my days off. Work I'm not even going to mention; Eric over at eric135 says, rightly, that February and March are the nastiest months of the nursing year, and April isn't far behind, at least at our facility. We seem to be having a run on subarachnoid hemorrhages and glioblastomas (with six you get eggroll!) and I'm just plain tired of thinking about it.

Besides, it's nice to have something like a life now and then.

The shape of a heart

I drove past the old house today. It's the house I grew up in; the one the 'Rents sold to us shortly after we got married.

I hadn't driven past it in three years. Not through trying, but because my daily life doesn't take me to that end of town any longer.

The Erstwhile Hub and the Erstwhile Best Buddy are living there, still. Shortly after I left, and she left, she moved back in.

It was a time I can't forget
Full of sorrow and regret
And the shape of a heart
And the shape of a heart

There were two things left that I cared about, the dog that I saved that I left behind, because it was better for him, and the rose bush that had grown as tall as the second-story windows when Mom and Dad bought the place.

Why did you paint the walls?
Why did you clean the floor?
Why did you plaster over the hole I punched in the door?
This is where we used to live.

I walked around to the back fence (stalking behavior, I know; email me if you're in a chastising mood) to see if the dogs were still there; I guess they'd been taken in for the night.

The rose bush is gone. Dug up, cut down, it doesn't matter. It's gone. All ten feet of it, each way, with blooms that used to come like clockwork in April and again in June and then sometimes in December if it was warm.

these things used to be mine
I guess they still are, I want them back

Now there's nothing that ties me there. For three years or more, I'd assumed that they'd keep the rose bush at least. In some weird sense, I'm free of the two of them, of all the badness that happened unexpectedly after an amicable divorce, when it turned out that he couldn't let go and she was determined to put herself in the right.

That's twelve years of my life you're talking about. Which isn't much, given a life expectancy of 107 years, but it's a lot to me now.

You keep it up
You try so hard
To keep a life from coming apart
And never know
What breaches and faults are concealed
In the shape of a heart

More than twelve years, it's the two people who made me mostly what I am now, more than I ever made myself. I had known her from the time I was 18. She had stood by me, mostly, through the roughest parts of my life and the best. And he was the first person I'd ever met, and so far the only one, that I thought I could stay with until I died.

And I held it in my hand
For a little while
And dropped it into the wall
Let it go, heard it fall

We bought an old house on the Danforth
She loves me and her body keeps me warm
I'm happy here
But this is where we used to live


Only memories, fading memories
Blending into dull tableaux

First things first....

Blogger has a bug which disallows comments on the newest post on every page, unless you're using some combination of IE and luck which I've only hit on once. I know some of you have encountered that bug, and I apologize. There's no way I know of to fix it in the template, so you'll have to keep either emailing me with comments or wait until a new post comes up to comment on the second-newest.

Today, as I was manhandling a casserole into the fridge, I caught the third finger of my right hand against the corner of a drawer I had carelessly left open. The corner (being that weird melamine veneer stuff) ripped a swath of skin and meat off the first knuckle of that finger. For the first time in a very long time, I looked down after doing myself an injury and saw I was bleeding.

Copiously.

Luckily for me, it didn't involve a fingernail. I'm sure I've told this story before, but I once sliced a chunk out of a fingernail with a mandoline as I was slicing some vegetable or another. I actually fainted when I had to change the bandage on that finger. I had foreseen that possibility and so had a friend standing by with ammonia and Scotch and ice packs, all of which she put to good use.

So I stood there, watching in fascination, casserole forgotten, as I bled. I don't usually injure myself with sharp or penetrating things; my hurts tend to be more of the blunt-trauma, falling-over variety. Or of the roundhouse-to-the-left-kidney variety, one of which I sustained a week ago and am only now feeling normal after.

One of our patients with no risk whatsoever for seizures had a seizure. He's a big guy--six-eight and three hundred pounds at least, and not fat. We're talking Olympic athlete standard of fitness and muscles from here to Toledo. And he, of course, is the one who has the tonic-clonic seizure to end all tonic-clonic seizures. I've never seen anything like it.

His wife screamed out over the call system, so the charge nurse and I hit the door at a dead run. Credit to the charge for saying simply, "Shit." and turning on his heel for oxygen and Ativan and the crash cart, but I had to stay in the room and get this guy on his side.

Down goes the bed--they're heavy when you grab the CPR emergency release--and I hauled the patient over on his side so he wouldn't choke on the blood and vomit and foam that was seeping out from between his clenched teeth. A rigid, tall, heavy, muscular patient who's in the grips of a seizure that's made every muscle tetanic is not easy to get over onto his side; it amazed me that I could manage. But I did.

He seized long enough that we could run for a mask, for more Ativan, for a suction setup and O2 monitor and blood pressure monitor and EKG leads and he *still* hadn't finished. Conservatively, I know his seizure lasted at least forty seconds, and probably more like two minutes, with no dimunition until after we'd given him a total of 4 milligrams of Ativan, fast push.

Then it was suction and Venti mask and EKG leads and where the hell's that respiratory therapist and more sedatives and Jesus Christ somebody get me a four-by for all this blood, then reasoning out that the goose-egg on his forehead came from his repetitive pounding of said head against the bedrail during the clonic portion of the seizure, and then off to CT scan.

And I went away and gibbered for a few minutes, even though he wasn't my patient, because if there's one thing I hate more than a code it's a seizure. And this one...dear sweet Christ on a crutch, I can honestly say I didn't know the human body could make such sounds. Or that eyes could roll quite like that. Or that people actually, really and truly, *foamed at the mouth*.

Years ago, when I was still at PP, a patient's boyfriend had a seizure that culminated in one of our waiting-room chairs being kicked through a tempered-glass window. This one was much, much worse. I'm just glad that we had three bedrails up; there's no way I could've held him on the bed without the support of the rails. Even so, one was bent so far out of alignment that it's not usable.

And at some point I sustained a really lovely bruise over my left kidney. I'm not sure if I got it during the scrum to get Ativan into the guy, or if he whacked me with a flailing leg without my noticing, but it's there. It's *still* there, I should say, and still makes me wince when I roll over in bed. I guess I'm lucky not to be peeing blood.

Just thinking about it makes me gibber some more and feel sort of shaky.

The best part? Dude had a bladder infection from a catheter we'd had in him during back surgery. We gave him Levaquin, which apparently lowers seizure thresholds in otherwise normal folks.

So his risk factor, looking back, was a commonly-used antibiotic.

Er.

I think I'll tough-out the next sinus infection, thanks.

And go put an ice pack on this flank.

Boobies! Boobies! Boobies!

Nota bene: there are no boobs in this post. The title line is merely an attention-getting device.

A nice guy came in a couple weeks ago with a huge tumor. This particular huge tumor is growing in his chest, wrapping around his spinal column, compressing his lungs and heart, and dropping down to involve one kidney. His symptoms started about five months ago and got steadily worse; he's lost the use of his legs and bowel and bladder control.

He came to us through a relative of a friend of a former patient who *also* had a huge tumor. She had heard somehow of the guy's predicament and called her relative's friend's former surgeon, who said to bring the guy in.

His predicament, to wit: being discharged from a charity hospital because the only surgeon who was not willing to operate gratis demanded full payment for service up front. This particular wanker apparently works on contract with The Other Hospital, so there wasn't a lot anybody could do. He was also apparently the only surgeon willing to attempt a tricky and complicated resection, so my patient was screwed. To the wall.

Now, as in all great Suthun states, we have one city which continually congratulates itself on its international appeal, its liberalism, its ability to absorb people of all ethnicities and cultures into a huge melting pot/salad bowl of wonderfulness. This particular guy emigrated from his home country during a time of, shall we say, political unrest, and landed in That Great City.

Whereupon, after working and paying taxes and so on for umpty-ump years, he was told by one nurse to "go back to your own country to get your surgery". Yeah, I'll bet the Khmer Rouge established *great* surgery programs in its medical schools. Then there was the accusation by a doctor at the hospital that the patient was over-playing his symptoms in order to get free treatment for himself and the presumed ten kids he had, because, as the doctor pointed out, people like that come here to take advantage of the system.

And then there were the nurses and nurses' aides who pulled slanty-eyed faces and spoke with fake Chinese accents to him and his family.

Lovely crowd, that. There is something to be said for a well-aimed tornado or six, eh?

At any rate, he's with us now, and he'll get treatment for free. He had his first surgery over the weekend, an anterior resection of the bulk of the tumor, in order to allow him to breathe. The neurosurgery and kidney stuff will come a little later in the week. I think he's glad he left Self-Absorbedville and landed with us, poor sot.

It still amazes me, even after (*cough*) years of being on this planet, that people can be outright viscous hateful bigots. Especially people who have a professional charge and a moral responsibility to be better than everybody else when it comes to their job. There don't seem to be enough tornadoes to go around.

Is it a sin to call in sick when you're really not?

Because I have a bottle of Becker Vineyards' Viognier here, and a slab of salmon, and a little miniature Dachshund across town that would love to play tug with a sock.

(Nota bene: Becker Vineyards is in a place called Fredricksburg, in Texas, in the Hill Country. It produces a really superior Viognier. You should have some, even if you have to scour your local wine store for it.)

I also have a kitty-cat who hasn't seen me for Two Whole Days, and for whom I just installed a Cat-A-Comb (one of those corner groomer widgets that contains catnip). And I have a bed, which I haven't seen much of lately, and a Chef Boy who's feeling a bit put out that I haven't seen much of *him* lately.

At work, it's Glioma Season. Any nurse will tell you that things like appendicitis, brain tumors, and heart attacks tend to come in waves; this is our Glioma season. Subarachnoid Hemorrhage Season starts in a few weeks, when the thunderstorms and resultant pressure drops start to get *really* nasty...but for now, it's all tumors.

She has a glioma that extends from the bottom of her right frontal lobe, just above her sinuses, to the middle of her frontal lobe, and might have fingers reaching into her temporal and parietal lobes. So far it's skinny and isn't affecting her thought processes, though her balance is a little off. I discharged her on Monday. She'll come back next Monday for a biopsy. There's not a lot we can do besides a confirmatory biopsy and gamma-knife radiation; her tumor is in a really, really nasty spot and a really, really nasty configuration.

"So," she said, "the doctor was just in here telling me that this is probably brain cancer."

"Yep," I replied.

"And it's going to kill me if it is?" she asked.

"If it is, it will." I said.

"Mmmm. I suppose I ought to do all those things I always wanted to do, then," she mused.

"That would probably be a very good idea." I said.

"How long do I have before I...(flapping hands helplessly, crossing eyes, and sticking tongue out of mouth)?"

"Maybe six months. More probably three." I replied.

I wasn't telling her anything she hadn't already heard from the doc, and she isn't the sort of person that appreciates bush-beating.

Unexpectedly, she asked me, "Do you know Trout Fishing In America's version of 'Last Days of Pompeii?'"

Do I. "On the last day of Pompeii/Thought I heard some poor boy say/Oh, wow, man/If I knew then what I know now..."

I giggled. She giggled. One of the lines is about "I woulda filled up on chocolates, cigarettes and booze/given some perfect stranger the blues". We were both thinking about that.

"If I don't show up on Monday," she said, "I'm in France. I'm spending all my money and eating good cheese and chocolate and flirting madly with men two decades younger than I am."

"Rock on," I said. "Have some Camembert for me."

She won't be back for that biopsy.

Down the hall is a woman with three children, in her late twenties; a totally non-average patient for a glio. Hers is large and aggressive and likely to take her body before it takes her mind, yet she's cheerful and happy.

"I can't believe how blessed I've been," she says, after a group of her friends from church leave. "One of my friends told me that I'm the sort of Christian that she wants to be. All of these people have shown me such love and such tenderness. I feel like I've fallen into a whole group of Good Samaritans."

She thanks me for her care and promises to pray for me. She leaves a lovely thank-you note that mentions me by name and lavishes praise on all of us.

"Serious denial" says the PA, whom I'm not real fond of these days.

"Maybe she really *is* blessed" I retort.

And here is where I find the motivation *not* to call in sick, *not* to spend the day with perfectly healthy people, doing perfectly pleasant things. I've met two people who've gotten the worst possible news a person could get, yet they intend to live the hell out of their lives in the twelve or fourteen weeks left to them.

I'm going in tomorrow with the express purpose of living the hell out of the day, no matter how many are given to me thereafter. If I drop dead of an aneurysm at 19:08, at least I'll have had fun. And maybe made a difference.

One thing's for sure: I'll be humming, "And now that I'm a goner/All that lava rushing 'round that corner/Oh, wow, man--I ain't complaining/Only thinking out loud/You know that my life would be different/My love would be different/If I knew then what I know now."

long trung thanh

She's a nice woman; a little thin for her height, but solid muscle and bone. She had a brain tumor in an odd spot; although we managed to get it all out, it still had an impact on her legs. She's learning to use them now, just yesterday she walked 300 feet with only a gait belt.

She's the head of the SWAT team for the town two counties over. Not something you'd expect a pretty blond to be doing for a living. But she is, and she's apparently very good at it--good enough that the Thin Blue Line has been in evidence 24 hours a day outside her room since her surgery.

See, when a cop gets hurt in the line of duty, it's a tradition for the other cops to sit outside his or her room, one at a time, all day and all night long. I don't know if they run errands or just sit and eat sandwiches and read the paper, but I've seen them in every case where a cop has ended up at our hospital.

It's more unusual for cops to pull their vigil when one of their own gets hurt, or gets sick, outside the line of duty, but that's what these guys and women are doing. On their own time, they come and occupy a chair outside her room. Inside, there's a party going on--somebody brings in grinders and a sixer of beer, and shares everything with the nurse ('cept the beer, of course; it wouldn't do to drink on duty) and we all have a nice time.

Three rooms down is a gangbanger. He got part of the top of his head taken clean off by a bullet about a week ago. He's beginning to come around now, but he's going to have problems with speech and spatial relations for the rest of his life. His room is quieter. When his mom or aunties show up, there's a lot of talk but not much laughter. Sometimes, they pray.

And outside his room, on a chair, down the hall from the cop, is one of his buddies. Every hour around the clock, in shifts, they come to sit and keep vigil in the same way the cops do.

The khaki shirts and brown pants clash a little with the tattoos and blue bandannas, but we're all getting used to it. Grinders and beer in one room, wings and Pibb in the other. They'll all get along fine as long as they're here.

I asked one kid who showed up for the night shift why he was giving up his time to sit in the hallway in the hospital. "Respect." he said. "Loyalty."

Gettin' the mojo back.

Thank you, V.S. Ramachandran.

This book, Phantoms in the Mind, is one of those books you never knew you needed--badly--until it came along. I'm a bit late in reading it, like about eight years, but at least I've found it now.

He out-Sackses Oliver. He postulates interesting hypotheses on why people with partial blindness have hallucinations. He has a fantastic theory on phantom limbs that also addresses foot fetishes, and includes a couple of cool experiments that you can try at home with only a cardboard box and a mirror. He gets into the temporal lobe experiments that showed that religious experience is tied to electrical activity in the brain. He makes the connection between the left and right sides of the brain clear and discusses neglect syndrome in that context, brushing against Freud on the way.

In short, this book will get neuro folks excited again about what they do.

I think I'm going to order A Brief Tour of Human Consciousness next.

The Slump

It's ironic, really.

Just when I feel like I've hit a slump, writing-wise, and that I don't have much new to say, a very nice person from a trade publication sends me an email saying, "Hey! We wanna reprint X, Y, and Z weekly from your blog? That okay?" and I say Yes.

After all, how much new can you say every few days about gliomas and spinal cord tumors and customer service initiatives?

The amount of paperwork I do for an admission has quadrupled; the amount I do for a discharge has tripled. That's not as a result of HIPPA or joint commission requirements, it's a customer service plan presented by management.

The risk factors for an incurable brain tumor still include a happy life with well-behaved, intelligent children under the age of ten, a fulfilling job and loving spouse, and a pleasant and even temperment. Mean people never die.

The crack team of transplant nurses a couple of floors down from us are doing a lot of MUDs these days, which is taking a toll on them as a team and individually. MUD stands for Matched Unrelated Donor--it's a bone-marrow transplant of the last-ditch-effort sort--and people generally die, from what I understand, in particularly horrific ways after one. One of their nurses finally cracked about a week ago and left, just like that, because she couldn't stand to see any more twenty- and thirty-year-olds with their skin sloughing off and grade IV diarrhea. We see the nurses, looking haggard and drawn, in the elevators sometimes. We send them anonymous chocolate bars and flowers and do what we can to help them hold it together.

But there are compensations, even when my writing bug goes away for a while and it seems like everybody is dying all at once.

I had two very pleasant, healthy patients yesterday, both of whom had things that were not only curable but curable quickly and with minimal fuss.

One of my other patient's mothers bought me breakfast. Yum.

Another patient took the time to write out complimentary notes for every nurse that had taken care of him, every tech who'd helped him to the bathroom, and every transporter he'd been wheeled around by. No, I wasn't one of those nurses; I just provided names and pieces of paper, but it was nice to see.

I learned yesterday that you have to see the compensations when they come. The compensations might not be on the same scale as the horrific stuff, though. Most people who die in the hospital are sick in ways we can't even imagine--every system they have has shut down, or is screwed up, and they're in pain for a long time before they go. It's an extended, torturous way of dying, and we see it a lot.

Two or three pleasant people who look happy to see you and cooperate in their own care might not seem to compensate for the unfair and unpleasant outcomes of somebody you really liked, but they do--if you let them.

I think all nurses go through whatever this is. It's not burnout. I still want to get up and go to work, I still enjoy what I do when I get there. I still feel incredibly fortunate that I'm able to do what I do, and that there are other people willing to pay me for it. It's just that days are beginning to look the same.

I know it'll pass--this has happened in other jobs before. It's interesting to imagine what'll snap me out of the all-days-the-same mindset, and I'm willing to wait for that.

In the meantime, you guys might have to settle for more posts on potroast and crafts.

This is post #326.

I like the symmetry of that number.

I haven't worked in days; all I've got to tell you is old gossip from the unit. Like, it must really suck to have your discharge paperwork in hand and then suddenly hemorrhage and fall over, just like (snaps fingers) *that*, and die. That must just suck.

Just as it must suck to be the nurse whom the priest berates (and this is not gossip; I was there to see it) because said nurse called said priest in on a Sunday to give Holy Communion to a patient. Seems the priest didn't want to have to fight traffic.

Which made Gina, my six-foot-two-inch-tall, Baptist chaplain friend remark, "Well, some get called by God. Other people just get a text message."

Heh.

I've spent the last couple of days doing very little, and today doing quite a lot. For several days this week, it's rained and rained and rained, which we needed badly, and which gave me the excuse on Saturday to stay home in my pajamas, sample a new beer (Konigsberg Haven Quadrupel), and read. Today I hung out with Chef Boy at the grocery store and then went book shopping. I'll fill you in on my neurologically-flavored selections once I've had a chance to read 'em. Right now I'm unapologetically reading James Herriot and waiting for my potato to finish baking.

And I'm kicking myself, because there was a guy selling unidentifiable bits of Hispanic food from a handcart this afternoon, and we didn't stop. Of course, I had tacos carne asada with cilantro and onion in my lap, but who knows? Perhaps he could've had an appetizer in his cart.

Speaking of which, I recently made a mental survey of my neighborhood and found this: it is possible to get elotes from a cart, cabrito, kim chee, baba ganouj, fresh pita and tortillas, and fresh French bread within a two-mile radius. As well as your windows repaired, ironwork done, your saltwater aquarium dealt with, and your Christian bookstore needs taken care of. Oh, and you can get run over by a train, too.

You can keep your lily-white suburbs. Gimme the 'hood, any day.

Good news, bad news.

The good news is that one of my patients whom I thought wouldn't live last weekend is now sitting up and talking. Not making a lot of sense yet, but talking. She knows she's in the hospital and she recognizes people. Two weeks ago I had her in the ICU stepdown unit; one week ago I thought we'd have an empty room when I came back this week.

The other good news is that I'm off for three days, it's pouring rain, and I have ample supplies (Belgian quadrupel ale, science magazines, Good Omens, and French bread) to last out the weekend in my pajamas.

And The Cat is seemingly content. This is *very* good news indeed, as The Cat tends to draw blood when things aren't going her way. (How did I end up with a neurologically-damaged cat? Someday I'll tell that story.)

The final good news is that my pal Heather, Wielder of Hammers, had to bow out of a retail madness get-together today. I wasn't feeling real up to retail, let alone retail in the rain, and Heather shops like the Luftwaffe blitzed London, but with a smile. So here I am, in my pajamas with my quadrupel, pondering the bad news.

The bad news is this: a patient's sister felt it necessary to come see me at work, to let me know that my patient is on life support--or was, since she's probably dead by now--at a different hospital, fifty miles away.

You try really hard in this business not to like people. I mean, you *like* people, otherwise you wouldn't be a nurse. What you try to keep from doing is realizing that a particular patient would've made a really, really good friend had you two not met when she was diagnosed with a rare and aggressive degenerative neuromuscular disease.

You try really hard not to like people that you know you're going to lose soon.

Devic's Syndrome is often referred to as a type of multiple sclerosis, but it's really not. It's much more systematic than MS, and in its way is crueler. First it takes your eyes--the primary symptom of Devic's is a preference for the optical nerve--then it takes your legs, then your bowel and bladder control, and finally your ability to breathe.

All of this happens quickly and without the changes in mentation or personality that happen sometimes with MS.

There isn't really any effective treatment. You can start the person on chemo, and they'll lose their hair (a long-standing joke was that her hair was longer than mine before mine started to grow out), or you can put them on various pheresis therapies that might make them feel better for a time (another long-standing joke was that I used the same vein over and over, in an attempt to carve my initials into it), but really...nothing much will make a difference.

And so, blind and bedbound, with the same interests and intelligence and humor that she had before she got sick, my patient told me that I'd better shape up--or else she'd come kick my butt when she could walk again.

I think both of us knew at that point that she wasn't going to get to kick my butt. Neither of us wanted to admit it.

I had to pass the news on to other people who'd worked with her. That's not fun, either.

"Somewhere, somehow, I know she's going to be healed" said her sister.

I know she will be, too. But what happens to the almost-friends she leaves behind?

Yes, I removed some comments.

Because I don't believe in trolls.

I know they exist, but I prefer to stick my fingers in my ears and sing la la la la until they go away, or until such time as they stop ignoring civilized rules of behavior.

Such civilized rules include:

No calling other posters names. That includes everybody. "Stupid" is no better than "cunt", but I'll remove the most offensive posts first.

No infighting.

No pissyness. That is reserved for me, and me alone, when I'm talking about residents.

...play nice, or go home.

Edited to add: Anon, if you'd like to know *why* nurses at my facility bathe & bag on a regular basis, without our being understaffed, and why we don't have a problem with it, you're welcome to email me. I'm even forgiving the cunt comment for this.

"You ought to be kinder."

That was the ultimate line of an email I got this weekend, from somebody who'd read the blog but hadn't commented.

The gripe the correspondent had was that I, apparently, am not kind enough on my blog--that I bitch and rant and moan and generally take people to task here.

Hm. Let's see why. In the last seven working days, I have:

*Been physically assaulted (thankfully not injured) by a demented patient whose family stood by as he lifted me by one arm and tossed me around...

*Been threatened with shooting by a young man who thought we were being mean to his father by not letting Dad smoke in his room, with his oxygen mask on. (For those keeping score, this now makes three-of-three in terms of times I've been threatened with shooting in healthcare settings.)

*Had to have a little heart-to-heart with a tempermental attending, revisiting points I've made before, such as the concept that calling a nurse a "stupid bitch" isn't going to win friends and influence people...

*Had to mention legal terminology in order to get action on a personnel issue; no further details until later...

*Dealt with a patient who left AMA after it was revealed to him that no, he wasn't going to get any more narcotics...

*Done the work of two people after a nurses' aide simply wandered off the floor in the middle of the shift and couldn't be found for two hours...

*Scoured the hospital complex for a confused patient who was allowed to leave the floor in a wheelchair despite orders to the contrary...

*And was verbally abused by a family member claiming to be a nurse who couldn't understand why we might actually enforce isolation rules.

In between I clarified orders written by residents who don't understand the concept of "PRN means *for* something specific" and "legible handwriting makes the difference between digoxin and Demerol", moved patients up in bed, out of bed, from one bed to another, handled countless bedpans, showered a few people, gave pain meds, passed dinner trays, answered the phone approximately 10 to the 23rd time, comforted the sister of a patient on life support, and bathed and bagged one dead body.

During all of that, except for the bit about being blown away with a shotgun, I managed somehow to keep a cheerful expression on my face and not give in to the temptation to strangle somebody. I didn't yell, I didn't call anybody names; I even threw a few jokes in there now and then. I managed to do a few nice, kind things for a few people that were not included in the daily plan of care. And I made at least one person feel better.

I think I'm kind enough at work, thanks.

Must-read

Here

The Bugaloos: They're in the air and everywhere.

(Inspired by the PGY2 resident who now refers to me as "Bugaloo", a nickname I find simultaneously charming and disturbing.)

I am not fanatical about bugs.

Yeah, I scrub my countertops and cutting boards with hot water and soap after I cut meat on 'em, and I wash my hands about forty times a day at work. But when it comes to hugging a patient with HIV, or touching a person on their skin with my bare, clean hand (provided they don't have any open areas, of course), I don't flip out.

Which is why I got so irritated with a couple of coworkers this week.

One of 'em asked me if it was safe to let a newly-diagnosed HIV+ patient to use her pen. For her, not for him.

Once I was done goggling, I said yes. That coworker's trepidation might've stemmed from the fact that this poor guy had herpes lesions *all over* his skin, a result of being undiagnosed for a year or more after infection. Note to the wise: if you end up with a huge skin rash that defies dermatologists, go 'head and get an HIV test. It can't hurt.

Anyway, this guy was quite pleasant, dealing pretty well with the shock of having just been told he was poz. But the HSV lesions presented a problem, one which I dealt with by wearing an isolation gown any time I had to get up close and personal with acreage of his bare skin.

Why? Two reasons:

First, even though herpes is not a tough virus in the sense that molluscum or smallpox is, there's the offchance that a virus or three might survive on my scrubs. I could then conceivably shed that virus elsewhere.

Second, and much more important in this case, my patient has a combination of open sores on his skin and a compromised immune system. Since he hadn't begun any sort of treatment yet, it's a rational step to reverse-isolate with him, especially since I had another patient with Clostridium difficile infection. Bacterial bugs are much more robust than viral particles, and I didn't particularly want to expose Mister T-Cell Count at 2 to any sort of bacterial veneer I might be wearing.

Then came the coworker who commented, as I was briefing a couple of students on the HIV+ patient over lunch, that she'd moved out of her dorm room in college because her roommate had contracted herpes.

God love the nursing students . They all looked carefully blank as I explained to cow-irker that, unless she and the roommate were sharing toilet seats in a way as yet undiscovered by Hustler magazine, she had nothing to worry about.

That sort of thing drives me absolutely up the wall. Even with modern education, I *still* run into nurses who are unwilling to touch HIV positive patients, even as they wander in and out of isolation rooms whistling, not wearing gowns. I *still* run into nurses who haven't the faintest idea how things like Chlamydia, mononucleosis, pinkeye, and hepatitises are transmitted, or who get it all wrong.

Maybe I'm oversensitive, having spent a good deal of time in the past with people who had varying degrees of infectious disease (ooooh, I like that rhyme!). Maybe I'm peevish because I don't like to see people isolated from touch and contact because they have a Highly Publicized Infection That Still Carries A Huge Social Stigma. Maybe I'm grumpy because I wonder what on earth these people were doing in class while I was absorbing information about how and why to keep my patients and myself safe.

The single most important thing we can do for our patients is to touch them without hurting them. Most people they see in the hospital, us included, do many unpleasant things to them. They can go an entire day without being touched in such a way that doesn't cause pain. That's why it's important for us to hug, or squeeze a hand, or stroke somebody's hair: without painless, pleasurable touch, the human soul starts to die.

So yeah, I 'm not fanatical about bugs. I cover my mouth when I cough, I wash my hands, I use standards when dealing with blood and body fluids and nasty oozy things.

But once in a while you have to take off the gloves and be human.

Dull is good.

The past week at work has been dull. Dull is good.

Status Migraine Guy is back, but he's calm and his pain is controlled. I don't know about you, but if I had a migraine that had run for two and a half weeks, I'd just chuck myself out the window and be done with it. I've only had one, but that one (and not a bad one, from what I hear) was plenty.

Our Customer Service Scores Tra-La are down for the months of December and January. This is a Big Deal to the management. Consequently, we're neither getting TEAM t-shirts this month (a good thing), and they're putting in place all sorts of bizarre procedures in order to improve Customer Service (a bad thing).

Part of the problem is that the CS scores are determined by questionnaires sent to the patients or the families after their stays. If somebody's either dead or gorked from a major brain injury, there's not a lot of hope that the person or people will find the time to fill out a thirty-question form, rating everything from the food to the cleaning staff on a scale of one to five. One would hope that they'd have better things to do.

Now, when you study mailed questionnaires in sociology class, it's assumed that a forty percent return rate is fantastic. Return rates normally run around 30%, with the majority of those surveys returned from people who have strong feelings--usually negative--about the subject being surveyed. Don't ask me why this is; I don't remember.

Anyway, if you cut the folks who can no longer read and write out of the survey pool, and remove a percentage of the families from that pool because they're taking care of Auntie Mae, you've smallified your return pool to those folks who were a) very sick at the time they came in, b) still have some memory of it, and c) care enough to return a 30-question form after rating things from 1 to 5.

Unfortunately for us, several of the people who returned their questionnaires have one or another type of dementia. One survey came back with three pages of single-spaced ranting attached; another had hand-written complaints about attempted kidnappings and abuse in the margins. There were others not as dramatic.

Those kind of affect the CS scores.

The amusing thing is that every member of Manglement with whom we nurses deal, from the lowliest charge to the uppermost uppity, has forgotten that crazy people skew results. Rather than throwing out three pages of paranoid rantings, they're basing practice changes on them.

Which basically boils down to "Keep your head down and give 'em whatever they want."

The floor nurses have given the new posters, training manuals, and inspiring speeches a collective shoulder shrug and are keeping on keeping on. If you have a patient who's convinced that the guys from the OR are going to kidnap her and sell her to white-slave traders, there's not a lot you can do (outside of, say, Haldol) to improve her Customer Service Experience.

What I heat up on my day off...

...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.

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.