The word of the week:

REFUTE.

I'm just a-sittin' over here, refudiating everything.

By golly. (*wink*)

I got up this morning and put a flashlight into my mouth (all the more amusing if you know that the flashlight is one of those spatula-shaped ones with the LED lights and the flat handle) and shined it on Cap'n Lumpy, and said out loud, "Aagh aaaghooee aaaghooo ooo ehh ehhooo eeeee aaagheennnng *gronk*."

Translated, that means "I absolutely refuse to let you be anything nasty."

It's not denial. I understand quite clearly that this could indeed be something awful, but I cannot dwell on that and get anything done. It's more the stubbornness that comes out when somebody either tells me I can't do or shouldn't do something, or that options are limited.

So, listen up, Cap'n Lumpy: You are benign.

It's interesting to be in this position, of not knowing, that so many of my patients have been in. (What a sentence; sorry.) I'm finding that the advice I used to give in absolute cluelessness is actually pretty good. Such as, "Panic for a full 48 hours at a minimum. Once you're done panicking, you can make decisions."

And, "For God's sake stay away from Google."

I didn't do *that*, of course. Instead, I went online as soon as I got home and started looking stuff up. Then I realized that my heart was pounding and my palms were sweating, and that this was not necessarily a good thing, and I stopped. Because, really? Nine out of ten of the things you see on Google, or read about, are both absolutely textbook examples of whatever you're looking up, and also the most severe, awful textbook cases you could imagine.

It's also interesting to note that what I always used to say about paranoia is true: No matter how calm you are intellectually about something, small things will start looming large in your lizard brain and make you crazy.

F'rinstance, I woke up with a headache and stuffy sinuses this morning. Given that I'd spent the whole day yesterday alternately sobbing hysterically and swigging Scotch, this should not have been a surprise. Instead, though, of looking at stuffy sinuses and a headache as a sign of overindulgence in both panic and alcohol, I immediately figured that Cap'n Lumpy had invaded my sinuses overnight and was going to kill me in the next ten minutes.

*sigh* Geez m'knees, woman. Get a freaking grip, willya?

I have to thank everybody again for their continuing thoughts and prayers. I laid in bed this morning for a few minutes after the alarm went off, feeling really fortunate to have all you guys rallying around. So, thank you.

Provided the reputing works, and the prayers work, and I slide out of this unscathed, I will have learned about sixteen dozen gross new good lessons about all sorts of stuff. And no, I don't intend to list them all here.

If everything goes south and I do indeed have a Planet-Destroying Horrible Yikes Thing in my head, well, at least I've gotten a kicky new purple toothpaste and some free floss out of it.

Y'know what the weirdest part of all of this is?

(First of all, thank you, each and every one of you, for your thoughts/prayers/offers of scotch/offers to let the dog out/et cetera. It means so, so much right now; you can't know.)

So, yeah. I was having dinner with The Man of God and his Lovely Wife, and in the middle of the second bite of pizza, with us all trying to make polite conversation, I burst out, "Can we all please stop pretending that everything's okay? Because it's not."

Regardless of what happens next, I have four days ahead of me in which things will not be okay. Maybe, at the end of it, this'll all be some huge false alarm, and I can spend a couple of weeks in relieved bliss and then go back to fucking up the way I always have. Or maybe I'll get a diagnosis that mandates whiskey and gardening, and I can continue to fuck up the way I always have.

Either way, until one or the other happens, things are Not Okay.

I've spent all day apologizing to people for having to give them the news that things are not okay. I have--and this is rather a shock--more people than I expected that I wanted to tell.

(And secondly, if I didn't tell you in person and you found out about this through Facebook or the grapevine, my apologies. I didn't go in any sort of order, and at about two o'clock I found myself utterly unable to repeat the same words again.)

Can we please stop pretending that it's all okay? Thank you. I feel better now.

My pal Jo, who works the night shift opposite me, had the most appropriate reaction: a moment of silence and then the word "Shit" said calmly and without emphasis.

This is not okay.

I fear losing my airway, or worse, my ability to swallow. I fear chemo and radiation and enough of a chance that going through those things would seem like a good plan. I fear losing. I fear the process of dying, even though I've seen it more times than I can count and mostly, it's been an okay thing.

And I *have* to think about these things now, because if I get a nasty diagnosis on Tuesday, I'll be too shocky to think about them then. It's like putting an emergency kit in your car: you do it early in hopes you won't ever have to use it.

Meanwhile, the cats are playing with their toys and Max is lying on the floor staring at me and wondering why I didn't bring him more pizza bones. I have Rob and Adam and Shannon coming over tomorrow, and I don't have to pretend that things are okay with them. I do have to cook, which might be a bit of a challenge, given how much alcohol I've consumed today, but what the hell: the Chinese place delivers.

So most things are okay. This right here, this thing I'm doing with the whole breathing and digesting and metabolizing bidness, is not okay, but most things are. And they will continue to be.

So maybe it'll be okay after all. Either way, at some point it'll cease to matter, right?

Living in the present, part two

Well, I've told Mom. And I've told my sister. And friend Pens the Lotion Slut is on her way, and I've told the love of my life via voice mail, so I might as well tell the world:

I opened my mouth today for the dental hygenist, and she said, "Um....how long have you had that lump on your palate?" and "I'm going to have the doctor look at that" and "Excuse me while I get the camera out to take a picture of that lump" and "We'll just get a 360 on the X-ray on this, and I won't charge you for it, but I want to see the soft tissue involvement."

I laid on the comfy reclining chair with my head in the comfy head-holder and watched the clouds blow past the pine tree branches and tried to come to terms with the fact that the people at my dentist's office--who see a lot of weird shit--thought that I had something in my throat that is Bad News.

You can be as nice as possible when you run into a lesion like the one I have, but one thing is true: when the doc gets solemn, and the hygenist gets solemn, and the person behind the desk is solemn as they make the appointment for you with the oral surgeon who can't see you before Tuesday, you know it's not good.

Not. Good.

I might have cancer.

Really, truly cancer.

I've thought about this so much over the last three hours that it's gone completely third-person.

Radical neck dissection. CT of the neck and chest. Bronchoscopy. Radiation. Chemotherapy. Tracheotomy; not being able to talk.

If it comes to that, no. Just....no. I may be ridiculous and vain and petty, but I would like to preserve my ability to taste food and swallow steak and Scotch and my relatively-normal-looking face, and not have all that treatment.

They really and truly think I might have cancer.

I look at the thing on the right side of my hard palate, right behind my molars, and I can't believe it. It's big, yes, but it's innocent-looking. Kind of pink, kind of vascular, but not anything weird or lumpy or scary. It's nothing I noticed, for however long it's been growing there.

Now, of course, I know it's there. That side of my throat feels swollen and sore, and though I know it's globus hystericus, I wonder: does that mean that my lymph nodes are involved? Because that decreases the chances of survival from 57% to 17%.

Stoya and Bossman just called. Both of them told me not to panic, to wait for a formal biopsy and diagnosis. Neither of them know how hard that is.

I used to wonder why the first question my patients would ask--via voice or whiteboard--was "When can I get back to work?"

I wondered about that. Why on earth, with a diagnosis like this, would you want to go to work?

Now I know. I plan to ask the doc on Tuesday that very question. Because it's not "when can I go back to work". It's "when can I feel some control again" and "when will people treat me like a normal person" and "when can I pretend everything is okay".

I might have cancer.

The doctor is solemn.

The hygenist hugged me as I left, and told me to take care, and let them know how things turned out.

If I'm dramatic enough about this, maybe it'll turn out to be a false alarm. Maybe I should play it up, and ignore how often I have to pop my ears because the right one feels full.

I am sore afraid.

Living in the present

The fascinating (well, one of the fascinating) things about working in the CCU is that it teaches you to live in the present.

The moment when my car about ended up in the lake today? Was not unfamilliar. I've had the same feeling when I've tried to suction an inch-long mucus plug out of a patient's lung, or when I've tried to start an impossible IV, or when somebody's coded for the sixth fucking time in a day.

The universe collapses to what you're doing right then, all emotion disappears, and your thinking is incredibly clear and precise. It's as though a road map of what's about to happen is laid out in front of you, and you simply manage the situation, with all the diverse things that entails coming naturally to you.

I used to have that feeling in micro class. One of the prerequisites for my nursing degree was a combined micro and patho class, with a hugely complex three-hour lab twice a week. I loved that lab; I'd show up early and leave late and blast through the assigned stuff, to the point that the instructor would give me contaminated cultures or shit he'd found living on a deerhide to analyze. Everything in the world would stop. All I could see was whatever was in the field in front of me, and the lack of emotion and judgement was clean and cold, like snow. Either something got stained with methylene or it didn't; there was no sorta-staining going on.

It's the same with nursing. Nine times out of ten I have to page the doc if a patient codes; more than once they've called me back with no clue as to what's happening. I've had to break it to them non-gently, as in "Mrs. Whittaker is coding right now. She has no rhythm except for compressions" as soon as they identify themselves. There is no room for comfort at those times.

But that, in a way, is freeing. You either die or you don't; we get you a stable rhythm or we call the code (or I suck that glob of snot out of your lung/I don't, and you code, or I get that IV/I don't, and you code, or I manage this crisis/I don't). There is no "a little bit dead" or "a little bit alive". Even on pressors, maxed out and on a vent, you're technically alive.

And that? Is what I love about critical-care nursing. I spent more than a decade, counting what I did as a paraprofessional, being warm and fuzzy. I like the fact that right here, right now, what I see is concrete. Even in my unit, where we're much more human than they are down in the surgical CCU, there are absolutes. I go to work, and all the emotional drama of being human recedes. You're either alive or you're not; you're either injured or you're not. There's still plenty of space for the warm fuzzies; I do gobs of educating and encouraging and rehabbing in my job, but it still comes down to the cold, hard facts: are you fucked up or are you not?

If you're all jacked up, I'll help your ass out. If you're not, I'm kicking you out to go to rehab.

I wonder sometimes if I could qualify as being somewhere on the Asperger's spectrum, as I'm certain my pal Jo (yes, there are two of us) on nights certainly does. I wonder sometimes if my folks saw the social anxiety I'm still plagued with and shoved me into music and acting as a way to combat that--to learn to act like normal folks. I wonder, amazed, at the gift I maybe have? of being able to combine the snow-clean, cold, emotionless scientist with the warm-huggy-loving education-crazy, comfort-giving snuggly nurse.

All I know is this: the times when I yearn for microscopy are the times that something like a flooded highway or a coding patient are likely to come up to save me. And the times when I'm feeling as sensitive as a bashed thumb, all purple bruised nerve endings and swollen, taut skin, are the times when somebody will suddenly be human to me, and I can reciprocate.

I am so, so, so damn lucky.

Auntie Jo Faces the Apocalypse, then Turns Tail and Runs Away

Auntie Jo doesn't know if you've heard, but there was some rain in Texas this week. It apparently came from some hurricane or other bashing against the south end of the state.

Auntie Jo is no stranger to rain, bad weather, or zombie hordes, having grown up here. However, she doesn't remember there ever being a rain like this one. Sure, that storm drain in Littleton overflowed last year, trapping her in rapidly-rising water, but this was... ... ...

I'll just tell you the story, shall I?

I went into work late. We didn't have any patients in the neuro critical-care unit, and I'd asked to be pushed back if that were the case. At about nine, Stoya called, so I got my skates on and wandered out into the fairly heavy, but nothing unusual, rain.

It was ten to ten at that point.

Everything went well for about five minutes, until I reached the southern edge of Littleton. Then traffic slowed to a crawl, the rain got heavier and heavier, and I watched with some interest as the water in a drainage ditch rose and rose, until it was covering the highway and creeping up the wheels of the truck in front of me.

Just after eleven, I called my boss. I had spent an hour on the road and had gone approximately ten miles, and the highway department had closed the highway due to high water. Closed. The. Highway. I remember this happening exactly twice in my lifetime: once due to a tanker truck that exploded and spilled fuel all over the road, and once because some creek north of here in nowheresville hopped its banks and flooded the road close to the Oklahoma border. It never happens between Yeehawville and Bigton, though. Ever.

My boss, Frog love her, said, "We'll deal with it." I had not made the decision not to try to make it until I was on the phone with her. As we were talking, I looked to my left and saw that one of the many fingerlike projections of Lake Giganto had come across the highway just ahead of me. My lizard brain kicked in. I decided to turn around.

The highway patrol guys (and lordy lordy how I would hate to be a cop in those situations!) had opened one whole lane of the road, and people were picking their way across the (moderately deeply flooded) area. I downshifted to second, said a little prayer, and proceeded across with the stately grace for which I'm known.

Everybody made it but me. The Honda's wiring harness hangs low and wobbles to and fro, apparently, because suddenly the car just freaking quit working. There was water lapping against the bottom of the car (odd sensation, that), the power steering went out, the engine quit with a horrible sound, and I was left wrestling the car to the side of the road, thankfully out of the water. Inertia is a very useful tool sometimes; it can get you out of a puddle as easily as it can get you into one.

So. I'm on the side of the road with a very nice man tapping on the window asking if I'm all right. After I opened the door (no power for the windows, dammit!) and reassured him, I sat for what felt like an hour, shaking, and then restarted the car. It caught and came to life on the second try.

It was nearly noon at that point.

The homebound traffic was moving faster. I was going a whole thirty miles an hour at the moment that an eighteen-wheeler and I went through the same puddle simultaneously, and the truck's wheels created a wash that lifted the Honda clear off the road and sloshed me over to the right shoulder. "Oh no, not again" was not what I was thinking. I was not thinking anything. I felt strangely calm and remote, and the two seconds I was not in control of the car lasted a week. Then the car's wheels caught the gravel on the shoulder, the electrical system coughed once and decided to continue to work, and I spun out the ass-end of the car to the edge of a ditch before I managed to get back on the highway.

It was not raining in Littleton when I finally got home at twelve-thirty, having spent two hours and forty minutes going twelve miles in one direction and twelve miles in the other.

Reader, I will not lie: I came in, called Boss Lady and Stoya to let them know I was okay, and then poured myself a healthy shot of the 18-year-old Laphroiag I'd been saving for a special occasion. Then I made myself a sandwich, ate it, and poured myself another shot. It was halfway through the second shot that I quit shaking and sweating.

Max and I snorgled on the kitchen floor for a while before I took a nap.

I am never doing this day again.

I luff heem. Then I keel heem.

Not a bad day, per se, but sort of disheartening.

Stable CVA with new MI? Fine. Transfer him upstairs to CVCCU.

Hypertensive crisis? Good deal. Fix it, then transfer her to the floor.

Cerebellar bleed with an increase in ICP? Off you go to the SCCU for an emergency shunt placement.

Of course, I did come home four hours early. That was nice. I made an enormous salad for lunch tomorrow and reflected on how nice it would be if "The Extra Man" were playing right now, or, failing that, a re-screen of "The Triplets of Bellville."

Now I'm off to cuddle two kitties (who are grooming each other and purring loudly in Poppy's old green velvet chair) and drink beer. Because it's Labor Day, and seeing the results of your labor going off to other units is a little disheartening.

An answer to Markus' and Sarah's question: How to Start A Blog

I got a very, very sweet email this week from Minion Markus and his wife, Minion Sarah. In it, they asked how I decided to start a blog, and why things weren't rough at the beginning, and how other people could do it, too.

Given that I'm finally a Real Blogger (I got an offer recently in which some poor sot offered to pay me for writing) and not one stuffed with sawdust, I figured I'd give that whole stack of questions a shot. Herewith, Jo's rules for becoming a blogger:

1. Pick something you can stick with.

For me, this was nursing. I do it practically every day; even when I'm off, I think like a nurse. My life has slowly begun to revolve around efficiency (twelve pairs of identical socks) and idiot-proof solutions (nonstick pans).

2. Shake it up now and again.

Your blog can't be all one damn thing day after day; that's not how people live. It's okay to blog about your cats, your wardrobe, your home renovations; it's fine to talk about product reviews or occasionally get political. You'd be shocked how many comments and reads off-topic things get: my most-commented posts are the ones about how being a nurse changes you, but the most *read* ones are the ones about Max or the Avatars of Concentrated Evil (aka the cats).

3. Start slow.

A post every three to seven days is plenty when you're starting. In that vein....

4. Don't be discouraged if you don't have the writing thing down right away.

Markus mentioned in his email that this blog seemed very polished from the git-go. It was, because I spent HOURS editing things when I first started. I had grown up with a very academic, concise writing style that still managed to inject humor (my father's), but it was hard to get the correct balance at the beginning. Given that most blog posts are short, because that's sort of the point, I had to edit the hell out of things for the first year or so.

Rough writing is fine. Bad writing is not. You will get to the point where you can tell the difference in the first few lines. If a story isn't going somewhere, don't try to force it.

I'm not saying that I'm a good writer, necessarily, but that I have a defined style that seems to grab and hold people. Once in a while I'll post something that makes me feel like God on the seventh day and that, in retrospect, I can't believe I wrote. Those moments are worth the thousands of semi-literate, semi-interesting things that show up here.

5. You are not your blog.

If I got upset over every criticism that I get, I'd be in therapy even more than I am now. Thankfully, the people who get upset about what I post can rarely spell or punctuate correctly. That gives me the luxury of a better grasp of technical English than they apparently have, which means I can pretty much ignore 'em.

Still, it's important to remember that You Are Not Your Blog. Criticism and kudos should be given exactly the weight of the electrons it took to send 'em in.

6. Do not shy away from snot.

"If it bleeds, it leads" is a chestnut, but it's a true chestnut. Sometimes, the grossest, most horrible things can lead you into meditations on the Bigger Meaning Of Life. You just have to go there.

7. Be not afraid.

I was afraid--really and truly afraid--when I started blogging about my diagnosis of depression. I was scared that people would brush off some of my darker writing with an "Oh, she's a whackjob anyhow", or that I was revealing too much. I agonized for several hours over whether or not to push the "post" button.

Thankfully, nobody was an asshole. The last thing a depressed person--even a stable depressed person--needs is people to be assholes. Instead, I got comments and emails and even a couple of e-cards from people who were pulling for me.

That experience taught me not to be afraid. Saying, "I lost a patient today through a stupid mistake, and it really sucks" is something we all dread having to do, but doing it in public? is now a whole lot less intimidating. Because we do make mistakes.

8. It ain't all that.

This is a corollary to "you are not your blog". Your blog ain't the be-all and end-all. If you find yourself getting all wrapped up in it, and wondering what happened to those last three followers who dropped away, it's time to get outside.

9. Emotion should be used like hot mustard or daikon: it's a condiment, not the meal.

Too much pathos ruins a blog, or turns it into something you'd see from a thirteen-year-old.

10. You should always, always doubt.

Doubt your abilities. Doubt your talent. Doubt whether you're keeping your readers engaged. Doubt whether you ought to do this at all, or maybe just hang it up instead and start searching for the perfect cinnamon roll recipe. Doubt is an extremely powerful thing in writing of any sort; it makes you work harder and edit more carefully.

And with that, I leave you to start your own blogs. Me, I have a date with some hard salami and a homemade batch of sourdough bread. I'm still looking for that cinnamon roll recipe, though; feel free to email me.

Saturday Night, maybe-I'm-getting-a-cold Random:

Massive Clusterfuck in 3...2...

Dear Doctor Mellowly:

I understand that things get busy in the ED at around nine on a Friday night. I also understand that the availability of Urdu translators is limited in this area.

Still, when you have a patient in her late eighties, with family members who can translate for you, present at your ED with excruciating neck pain, quadriparesis (weakness in all four limbs), a visible contusion on her head and one on her neck, and a history of fractures secondary to osteopenia (weakness of the bones), who fell at home, it might behoove you to do a c-spine (neck) X-ray.

Yes, yes, I know. The radiology department is busy with drunks and gunshot wounds. Still, consider doing an actual X-ray and not just a head CT. Because, you see, that would prevent you from sending your itty-bitty, fragile patient out to Sunnydale's neuro critical care unit in the middle of the night with a broken neck rather than with a stroke.

At least you were nice enough to give her an ice pack to relieve the pain from the hangman's fracture* that she had.

When she showed up in the Sunnydale NCCU, our nurse was bright enough to connect the weakness in all four limbs with the neck pain (as you failed to do) and order a c-spine. Which showed the chunk of bone floating freely in MeeMaw's spinal column. She also ordered a chest X-ray, going by that gut feeling that we nurses sometimes have, and discovered a high thoracic fracture as well.

MeeMaw, surprisingly, is fine. I transferred her this morning to the surgical CCU, where they put her in a pair of tongs that provided a few pounds of traction. I had given her ten of Decadron IV shortly before that, so the feeling in her hands and feet was beginning to come back when I left today. She's damned lucky that in the move from the ED bed to the ambulance cot, the fracture didn't take her life. And somehow, she managed not to be paralyzed over the forty miles of bumpy roads she had to ride to Sunnydale.

Seriously, dude? This was a colossal fuckup; a sentinel, never-event. And I put all the wheels in motion, along with my night-shift counterpart, to nail your ass to the wall. In fact, I recommended to my boss that he not call your hospital's risk management department to clue them in to what had happened: it was that serious.

I don't know if you were drunk on-shift (again) or what. What I *do* know is that, after misdiagnosing a rotator cuff tear, cervical myelopathy, appendicitis, and a broken neck as things that need to come to *my* unit as neurological emergencies, you deserve to be spanked.

*A "hangman's fracture" is a fracture of the part of the spine that connects your head to your neck. The usual mortality for such a critter is around 60%. As in immediate mortality; the figure rises if you include misdiagnoses from folks like Dr. Mellowly.

Quick wonky technical note:

Blogger comments are acting up again. If you've submitted a comment in the last 72 hours and don't see it, my apologies. Please resubmit it, and I'll try to publish it again.

Thanks!

It's a conspiracy.

Damn, that's some sharp eyeliner.

When I eat a mostly high-protein, low-carbohydrate diet, my back is broad in relation to my hips, and my waist mostly disappears.

When I eat carbohydrates, my boobs and butt get so large that my waist looks small by comparison (like a VW Bus would look small by comparison to a mastodon; let's be real), and my belly gets all voluptuous. I wiggle. I jiggle. I look like Girl, Inc. (It's water retention. This is why people on Atkins lose fifteen pounds in two weeks: they diurese like crazy.)

My beloved coworker Anamma brought me rice today. And potatoes. And jackfruit seeds. And a tiny amount of chicken, with the bones still in, all in curry.

And my beloved coworker Susamma asked me what sort of Indian man I was looking for, exactly.

I've got it all figured out: they want to marry me off to an Indian man. The only way to accomplish this, apparently, is to make me into a smaller-nosed Ganesha, and then introduce me to all the brothers/brothers-in-law/cousins they have.

I'm on it. There's still flatbread and roti and curry with cauliflower to be had. Athletic build be damned; bring on the starch!

I dare you to watch this and not grin like a lunatic:

Does anybody else have the urge to do the routine they learned as part of Strutter tryouts in high school? I hear this song, and "Let's Hear It For The Boy" and I'm transported to that two weeks in June of 1984, before I realized I. Can't. DANCE.

Totally not (well, mostly not) work-related.

Walp, I learned something today.

We have two Chinese intensivists at work. I had always wondered why, when they ate lunch with the nurses, things like "Pass the salt" were said as "Pass the salt", while things they said on the unit were prefaced with "please" and "thank you". Turns out, thanks, NPR! that "pleases" and "thank yous" are considered a more formal sort of address in Chinese, and that using them in a social situation (which lunch is, given that The Manhandler is showing us what she learned in pole-dancing class) is considered offensive. It's sort of the difference between "Dear John" and "My Dear John" for those of us who read Victorian lit.

This helps explain why they're so formal on the unit and so abrupt off of it. Especially when we're all at Joe's having a beer, and things....devolve.

All of which helps me not at all when it comes to the relationships between Eastern European or Indian doctors. One of the things I love most about working at Sunnydale is that I work with people from all over the world. One of the things I hate most is not knowing jack about the cultures that these folks come from. With the folks from Eastern Europe and India it's especially hard, as customs vary from city to city and even neighborhood to neighborhood, depending on where you're hailing from. When two of the Indian docs are apparently in the middle of a shouting match and about to go hand-to-hand over something, it's a little disconcerting.

It's even more disconcerting to find out that they're merely discussing where to go to lunch, say, or who's got the better cricket team.

Likewise, when one of the docs from Moldova or Chechnya or Bjorkistan starts frowning and talking through her teeth, I'm concerned that something must be Very Wrong about something I've done. It rarely is; mostly, it means that the doc in question is merely concentrating, or thinking (again) about lunch, or is working differential equations in her head.

Noti bene for my fellow nurses in this situation: accept any food offered you; it will be uniformly delicious. Do not attempt to guess where somebody is from. If you guess "Russia" and it's actually some tiny offshoot of the Soviet Union's breakup that you've never heard of, and that only came into being in 1997, you will be in the doghouse.

Also, never, ever, ever drink with Russians. You will be sorry.

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

I've had three days off of work, which has given me plenty of time to think about these things (if I had actually been thinking about them, which I wasn't). It's also give me plenty of time to stand, chin on hand, and consider how exactly I'm going to hang the typewriters from the wall. This has become my new Holy Grail: hang the typewriters in such a way that they're both interesting-looking and accessible. Given that I have 24" on-center, sorta, wall studs, this is going to be a challenge.

Oooo. Maybe I could hang them in a straight line, right down the middle of the wall to the side of the arch going into the dining room.

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

I did squats yesterday and ran for the second time in months. Today I ran again. I am sad and sorry today; I will be sadder and sorrier on Friday.

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

My massage therapist, when I walked in yesterday, didn't even say hello. All she said was, "Who's Adam?"

I told her that Adam is the husband of Friend Rob (not Abilene Rob; he's not been holding out on you) and a friend of mine. She'd heard that I'd gone to dinner with some Adam guy the other night, and was hopeful. I hated to disappoint her, so I told her instead that both Adam and I had come to the conclusion that we could be brother and sister: both stocky, redheaded, freckled, and short.

We wandered around the shopping area where he works and then went to a teeny restaurant for dinner. I waited until after we'd consumed chicken and cheese and greens to hit him with the dessert selection. His eyes bugged out. It was marvelous to see somebody with an actual sweet tooth enjoying little tiny hazelnut cookies and caramel and berries.

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

I need a stud-finder-finder. Mine is somewhere buried in the shed, and I need it to hang those typewriters. Except it's too hot to go out and paw through the shed.

Monday Morning Remedy!

Ay Ay Ay, Woof Woof Woof!

Sunday get-yer-engines-runnin'

So I'm taking care of this dude who has cancer...

....really *bad* cancer, as in "you don't want this sort of cancer, ever" cancer, and I've just wasted about a half a milligram of hydromorphone more than was ordered in the tubing, so he's feeling pretty good.

So I lean over him, and I remind him that he should let me know if he's uncomfortable--because, what the hell, he's gonna die anyhow; the graft's fighting his body--and I'll bring him more meds. Even if it's not time. He doesn't need to know that; he just needs to know that once his pain hits a four on a one to ten scale, I'll be there with the happy drugs.

And he says to me, "How many counselling classes did you need to take before you learned how a person feels?"

I said, "None. It's all experience." I didn't tell him that grimacing and guarding and short, gasping breaths are indicators of pain, universally, that don't need a lot of training to recognize.

"Trial and error," he said, "that's bullshit."

"I've been doing this longer than I'm willing to admit" I said, "and you wouldn't believe the number of patients I killed before I got to you."

That brought a smile.

I'm sure there was some point, maybe working at Planned Parenthood or the abortion clinic, when I realized that what was coming out of the person's mouth didn't match what was on their face, or in their body language. I can't remember that particular moment, but looking back, I'm sure it happened like a lightning strike.

Ever since then, I've been much more conscious of what the person isn't telling me. I had one nursing instructor who bothered to touch her patients with an un-gloved hand, and I've followed her example ever since. Sometimes a simple skin-to-skin touch makes all the difference in letting somebody know that you're not just some sort of health-care-providing automaton; you're a person like them who actually gives a damn what they're feeling.

If I have to hurt somebody by starting an IV or a catheter, I try to touch them just afterwards without gloves on, just to make sure that their last memory of the whatever-it-was isn't plastic and pain. Sometimes I even hug my patients without a gown on, zut alors! despite the rules.

By the same token, sometimes it's best to just shut the hell up. The dude I was working with was worried that his insurance wouldn't cover his return to the ICU. I let him vent for about ten minutes about how stupid his insurance company was, and it helped. His heart rate went down, his blood pressure dropped. Shutting up and being a body in the room who's attentive is a therapeutic intervention just as much as a Cardene drip is.

And as much as I hate to admit it, a lot of nursing has to do with intuition and gut feelings. We don't get trained in intuition, but we all use it. You have to develop the skill, and so you do.

The joys of loose cannons.

And I thought the acute-care floor I used to work on was bad.

I've been pulling shifts in critical care the past couple of weeks, because the patients we've gotten have been critical enough to need easy access to things like Femostops and ventilators. I had forgotten how nutso these girls could be.

I say "girls" because we're all female and I'm usually the granny of the bunch, except for Kemal, who's Muslim, so we're trying to go easy on him this month. He gets a little punchy anyhow at the end of the day after not eating or drinking anything, and it's harder to resist the temptation to be highly inappropriate when you're hungry or thirsty. When Kemal's there, we're kind and gentle helpmeets and angels. When he's not, things like this happen:

Cap'n Obvious, the critical-care med fellow, had asked why, after being raised by fine upstanding churchgoers and having gone to a religious college, I no longer went to church.

I said, "Well, the last time I went, the whole place spontaneously combusted the minute I walked through the door. The pastor got a little annoyed."

The look on the devoutly-Catholic unit secretary's face was enough to make Cap'n O. burst into laughter. He kept laughing until his attending showed up, at which point he turned a delicate shade of purple in an attempt to keep from busting a gut.

Or the conversation between The Bomber, Kitty-Kat, Cap'n Obvious, and me on the subject of what one does in an ocean-view cabin in Oregon for a vacation. Cap'n Obvious, true to his internal med roots, prefers doing active things on vacation, like climbing mountains. Or ziplining. Or, and I wish I were kidding, swimming with whales.

"So what do you do?" Cap'n Obvious asked.

"Drink." said The Bomber.

"Have sex?" suggested Kitty-Kat.

"Go out for a hike and take a picnic lunch," I said, thus proving how old I really am.

"And then come back and drink." The Bomber said.

"And have more sex. Kinky sex" added K-K.

"Yeah, like when I imagine I'm Ben Bernanke and the guy is a Keynesian economist." That was me.

And again, Cap'n Obvious turned a little red and a little purple and bent over and puffed out his cheeks. The neurosurgery team was rounding at that point, and it wasn't quite appropriate for a fellow to be seen peeing his shorts.

Then we did a little forks-in-a-blender, and Manhandler made fart noises with her armpit, and then we all went home.

I would

just like you all to know:

I have a monster knot in my left calf.

As in, so bad it made me think I have a DVT. Nope, just a monster knot.

How come?

Atilla made me do one hunnert-n-twenny (three sets of forty) calf raises on a step yesterday. With twenty pounds in each hand.

Then running.

And then more lifting.

If I were Hyperbole&1/2, I would be drawing pictures of screaming people with really, *really* muscular calves right now.

Ow.

Ten years; I never spoke your name.

But I was made for you.