Product Review: How Long Has It Been Since I Last Did This?

People, you need to know: I am the Queen, Undisputed, of Mascara.

I am asked routinely by perfect strangers in the grocery store if my lashes are actually mine.

They are the one truly, undeniably, irrevocably good feature I have. No matter how short my hair is or what my nose happens to be doing on a given day, my eyelashes are On Fucking Fleek, as the kids say, all the time. They don't fall out, they take dye easily, they're long and thick and look like false ones if I load up on mascara.

If I have one vanity, it's my eyelashes. They are the one immutably good thing about my face. My eyebrows go from Crazy Recluse to Mountain Man in a day; my cheekbones appear and disappear like blue sky in the Spring; my nose may or may not have a bump in the middle or on the end, depending on how much salt I've eaten in the last twenty-four hours. But eyelashes? I so have that shit covered.

Currently my eyelashes are longer than my hair. Really.

As a result of all this, I've become obsessed with mascara. See, when your lashes are long and thick but transparent, you depend on mascara to make them visible. Without mascara, I remind people uncomfortably of a white rabbit, like I'm about to be locked in a cage and have household cleaners tested on me. Without mascara (or dye in the summertime), my eyeballs blend seamlessly into my face at large, making me look like a washed-out X-Files alien.

I fucking live for some goddamned mascara, is what I'm sayin'.

And, today, I have reached a milestone: with the delivery of a one-hundred-point sample from Sephora, I have now tried every mascara currently available on the US market. I'm not exaggerating. I've spent something like a thousand bucks in the last two years on mascara: drugstore, mid-market, high-end. There is no grocery-store trip I take that doesn't end with a couple of tubes in my basket. I've used Maybelline, and Cover Girl, and NYX, and ELF, and NY, and Dior, and Lancome, and Clinique, and every other mascara you can name.

Yes. I have an Excel spreadsheet.

It's taken me a decade, but I am prepared now to offer you my winner of all winners, my mascara Holy Grail, the one makeup product that, if it is discontinued by the manufacturer, I will spend good foldin' cash money to buy a hundred tubes of offa eBay before it all goes dry.

That mascara is:

Ardency Inn Punker.

It comes in one color: black. It has a curved brush, which is a pain in the ass, but I'm willing to put up with it for the formula. It's wax-based, it dries incredibly fast, it does not clump even when you come to the end of the tube, It is not waterproof, but it is tear-and-sweat resistant. It does not smudge under your eyes, even if you have oily undereye skin like I do. It is safe for contact lens wearers and has never amplified my allergies. It makes lashes look great with one coat, amazing with two, and drag-queen-worthy with three.

You do not have to comb out between coats unless you want to.

And it works with false eyelashes.

My Asian coworkers love it because it dries fast enough that it doesn't dot up on their eyelids. My Indian coworkers love it because it gives them that natural-looking, yet-can-be-seen-from-space look that they love. My Hispanic colleagues love it because it's a true neutral black, not something with blue or red undertones. I love it because I take my makeup tips from drag queens and it makes me look amazing. I routinely put four coats on before work, combing between each (though I don't need to) and slay strangers with my full, soft, incredibly draggy eyelashes.

You can get it at Sephora or on Amazon, but it's twice as expensive on Amazon.

Dior Diorshow comes in a distant second, but you'll pay more for it.

Maybelline Full & Soft is a good drugstore replacement, but be prepared to reapply and reapply and reapply and reapply to get the same effect.

Ardency Inn Punker: if you wear mascara, go get you some.

Cancery McCancersons. Don't like it? Click back.

I had the first of the five-year hurdles last week: I saw my dentist. Me and my surgical deficit, we went in to the same office and sat in the same chair, but with a different hygienist, one who didn't once have twins kicking me in the face while she worked on my teeth. I sat and looked up at the same goddamned pine trees that I saw when they said they thought I might have cancer, and I waited for a verdict.

Everything is fine, they said. My teeth and gums are really healthy. I need to floss more. There is no evidence of disease.

For anybody else, that would be a milestone, a real one. For me, it's kind of a milestone. It's a milestone that everybody else has created, not knowing that the sort of tumor I had shows up again, usually in a nastier form, after twenty years.

Those of you late to the game should know: five years ago, at forty, I had half my hard palate and all of my soft palate removed due to something called polymorphous adenocarcinoma. Mine was low-grade, leading to the initialism PLGA, and try searching *that* on Google. You'll end up knowing more about golf than you ever wanted to.

When I was diagnosed, the article on Wikipedia was a stub. You could've edited it to add what you knew to help others. There was one paragraph in one textbook about it.

ANYWAY. After a hellish year that you can read about by clicking on the 2010 and 2011 archives, I had a prosthetic that was better than my original mouth. I had no need for nightlights, since I had had enough rads to glow in the dark. I was well-versed in CTs and PETs and MRIs, with and without contrast, and with the recovery process that goes with having bone saws in your head.

In October, I will be officially five years out. The trouble is that five years means, simultaneously, nothing and everything.

In October, it'll be five years since I stood at my kitchen sink and looked out the back window and prayed and wished that I could spend more time gardening.

I haven't spent any more time gardening.

In October, it'll be five years since I called The Brother In Beer with the news that my lump was malignant. He spent the next couple of nights wondering what the hell he was doing so far away.

We're together now, and he's The Boyfiend, but I haven't been as present as I should've been.

In October, it'll be five years since Nikki and Lara got really sick, not just big-surgery-and-plastic-shit sick, and had to lose their hair and get irradiated. I never had to do any of that. They were solid as rocks, the both of them, when what I was going through was so much small potatoes.

The Boyfiend's father is celebrating his five-year anniversary too, celebrating freedom from a much nastier type of cancer that meant a G-tube and head-and-neck radiation and all the things that go along with that.

Here's the breakdown:

I didn't have a really nasty cancer.

The cancer I did have has a recurrance period way beyond what most people think about. Anything can happen in twenty years, and most things do.

Max, the dog who kept me company when I couldn't talk at all, is dead. Mongo is here now. The cat-boys were barely out of kittenhood then, and are now adult cats. One is huge and muscular, the other is sleek and flexible. They'll all be dead by the time I have a real clear checkup. Hell, the guy who did my surgery will have retired by then.

Things have moved on, except they haven't, really.

I realized today that I've internalized this bullshit anniversary. Mostly, I think, because twenty years is too much to think about. If I can make it five years, then maybe I can make it seven, or nine, and eventually forget about what happened, except that I'll still have that Thing I have to put in my mouth to talk. Maybe I can reconcile myself to another fifteen years of wondering if the tumor's come back.

If I think about it as a whole, as in "I have to fear every checkup for the next fifteen years," then I want to fling myself out a window.

I realized today that I've spent the last five years putting things off, vamping 'till ready, because I believe in this five-year mark that means nothing. And now I wonder if I'm going to keep putting shit off for another fifteen years. I hope not.

Wouldn't it be fucking hilarious if my CT or MR shows something growing on a lung? Or my intestines, or liver, or meninges? It would certainly give me something to do, but I'm not sure I'd be grateful.

What do you say when you have nothing to be afraid of, yet you're still afraid?

I never realized until now how much having most of the inside of my head exposed to air had affected me. I'm ashamed: it shouldn't be such a big fucking deal. Lara has gone out and run marathons, for God's sake, and I've just sat here paralyzed, navel-gazing.

Despite all of that, I'm still afraid. I have no reason to be, but I am.

This is what I don't get.

Dr. Vizzini was rounding today with his residents and said, apropos of a patient, "It's all about that bass/'Bout that bass/No treble."

And he was met with expressionless faces and nods of assent.

So why should I, when I weaved through that same group of residents two seconds later, while carrying a depleted breakfast tray, get the side-eye for

"I think it's pretty clear/That I ain't no size two/But I can shake it shake it/Like I'm supposed to do"

When it came with the applause of the attending?

I mean. Srsly, guize. If you're gonna accept the attending starting a thang, you gotta accept a nurse capping that thang off.

If Dr. Vizzini says it's okay, then it's okay.

'Cause I won't be no stick-figure silicone Barbie Doll. (she-doo-bee-doo-bee)

Guise? Guise? I need advice.

All drama, all joking, all silliness aside: I need srs advice.

Keith did two things in the past week that were so boneheaded, so arrogant, so overstepping-of-boundaries, so completely idiotic, that I feel like it's getting to be a quandary just working with him.

(And yes, before we go any further, he's been written up and counselled and so on, and has returned from those meetings with a halo of righteousness.) (It's nearly impossible to fire anybody at Sunnydale.)

I'm going to look up my legal responsibilities tomorrow, once I've metabolized the bottle of wine I just drank to get over this day, but I have a question about ethics, to wit:

What is my ethical responsibility to patients who are not my own, when I know that the nurse who is caring for those patients is at least minimally competent and at worst actively dangerous?

I have never had to ask this question before. I hope I never have to ask it again.

I'm baffled. If it were up to me, Keith would be gone before the start of the shift tomorrow. Not only has he done some incredibly dangerous shit, he's lied about it, and about other stuff, and even falsified his charts. Lesser things got somebody fired from a Planned Parenthood clinic I worked at.

And I do not know what to do.

Rated on a scale of one to ten, with one being stuck in a nice, comfortable elevator equipped with chaise longue and Benedict Cumberbatch and several bottles of good Scotch, and ten being told I have CANSUH, this is over and beyond and way past ten. At least with CANSUH, I had somebody who told me "you're not gonna die from this" and somebody else who said "you're not even gonna have to be trached."

I am, in short, worried that something that Keith does will make me lose my license because I didn't act on my own prior to his injuring-or-worse somebody. Legal stuff I can look up. What's the ethical take on this?

Anybody?

Bueller?

By request: White Girl Bibimbop

Here is my version, filtered through My Korean Kitchen and Kitty's Filipino father.

Music for cooking:

MmmBop (can be altered to "bimmmbop, baby, bimmmbop, baby")

Besame Mucho (you can sing along with my beloved Cenobio: "Ses-a-me, ses-a-me, ses-a-me mucho, ses-a-me!")

Any Decemebrists song in which people do not die or live lonely lives; Joni Mitchell (the strummy years); Bare Naked Ladies.

Ingredients and equipment you will need:

A sharp knife
A big frying pan, wok, or covered omelette pan
A cutting board
Something to stir stuff with

Sesame oil
Soy sauce
Garlic
Ginger (optional, but it makes your kitchen smell nice)
Brown sugar

Bean sprouts (if all you can get are canned, skip this part. Canned bean sprouts are gross.)
Spinach, bok choy, or napa cabbage
Carrots
Mushrooms: preferably oyster, shiitake, woodears, or anything other than those bland button things (I got two packages of "Gourmet Blend" from the local HEB.)
Beef. It can be ground, very thinly sliced sirloin or tenderloin, or mince if you're in Australia or Europe. (Mince is good enough for My Korean Kitchen, so it's good enough for us.)
Zucchini. Broccoli. Kale. Whatever. What have you got? It's all gonna get wilted later.
An egg or two.

Rice. Make more than you think you'll need.

Preparation:

For each quarter-pound/120 grams of beef, mix:

one tablespoon each of soy sauce and sesame oil
a teaspoon, roughly, of chopped garlic
a half-teaspoon of brown sugar
as much grated ginger as you feel is advisable (optional)

Mix it all up and either mix it into your beef mince or pour it over your very thinly sliced beef (or tofu, if you don't eat vegetarians).

(Protip: beef can be sliced more thinly than you imagine possible if you freeze it for an hour first, then use a very sharp knife.)

While this is marinating, chop up your bok choy or Napa cabbage, or slice your spinach up a bit.

Julienne (that is, cut into matchsticks) the carrot and/or zucchini.

Slice or rinse or otherwise parcel out the mushrooms you've gotten your paws on.

Chop up whatever else you've got in the way of vegetables.

Keep all these things separate. If you have actual bok choy, you'll want to cook the stems first. I got baby bok choy, so that wasn't necessary.

Take your big pan and heat up a smidge of sesame oil in it. Add some of that chopped garlic you've got hanging around.

Add the bok choy/cabbage/zucchini/spinach and cook it just until it's wilted. You don't want mush; you want things to retain their basic character.

Scoop that shit out of the pan and put it somewhere out of the way.

Put the carrot in there. Cook it for about three minutes, or until it's tender but still crunchy. Err on the side of crunchy.

If you have decent bean sprouts, dump out the carrots and put the bean sprouts in their place. Cook a minute or two, until they're just-barely tender. You should not need more oil or water; the bean sprouts have plenty of water on their own.

Now dump out the bean sprouts. You *are* keeping the veggies separate from one another, right? Good.

Add the barest squidgen of oil to the pan, turn the heat up, and add the mushrooms. You want to sear them rather than have them release all their liquid. Once they smell good, dump 'em out.

(Yes, we're using a lot of plates. It's worth it.)

Now cook your meat. What I do is pan-fry it, then drain it through a fine-mesh strainer, so all the fat goes away and all the garlic stays in the mix. You want the heat high, but not high enough to make the residual oil in the pan smoke all over the place. Eugh.

Dump out the meat. Turn the heat off under the pan.

Now here is where I diverge from real bibimbap and go to the true round-eye version. Normally, you'd be layering all this stuff atop cooked rice and topping it with chili sauce and--here is the key--a sunny-side-up egg.

I hate uncooked eggs. Plus, I have to take this shit to work and reheat it in the microwave. So I do what Kit's dad does, and scramble an egg per serving, and cook it like a flat, plain, browned omelette.

I beat that egg to death, then pour it into the pan (which is still warm from the meat) and let it set. Once it's brown, I flip it over all of a piece and let it brown on the other side. Then I take it out, chiffonade it (that is, cut it into delicate fine strips) and sprinkle it over the rest of my booty.

To serve, plate up some rice. Put portions of everything you've just cooked in beautifully-arranged order atop the rice. You can top it with chili sauce, or sprinkle sesame seeds over it, or just dig in with a side of kimchi.

I'm sure there's a formal recipe for the chili sauce, but I just use the stuff that comes in the little jars and mix it to taste with sesame oil and soy sauce. Sometimes I add some leftover garlic if I feel really bold.

And there you have it. You can make all this stuff ahead of time, cook the rice fresh, and nuke your pre-prepared ingredients, then put it all together. Or you can do what I do, which is attempt something like a Michelin chef would plate, then say "Fuck it" and mix it all together in a plastic container. Either way, it's tasty.

Finally, a post that is not about Keith.

Although I am working with him for two days, starting tomorrow, so I'll have tons of new material.

Which is the only thing that's keeping me sane right now.

Anyway. Working with Keith--although this post is definitely not about Keith--got me thinking about the other people I work with.

First on my list of People I Love are Marcie and Kitty. I love them for different reasons. Kitty I love because, although she's a child genius and graduated from college at, like, seventeen, we have lots in common. We read different-but-overlapping books (she introduced me to Miss Peregrine's; I'm introducing her to Gerald Durrell and Dorothy Sayers and Ellis Peters), we like the same music, mostly, and we both have a ladyboner for history. Her ladyboner is for Asian history, mine is for European, so we have lots to talk about. Plus, we both like to cook, so we have mini-potlucks every time we work together (good for my recipe book, rotten for my waistline).

Marcie, in addition to being sweet and funny and silly and gorgeous, is one of the finest nurses I have ever met. The only criticism I have about her is that she doesn't use the big brass balls I know she has often enough, and so gets steamrolled by the likes of Keith and some of the more clueless residents. However: if I have a thorny problem, or a tricky question, I head straight to her. You can see her mental Rolodex flip-flip-flipping as she comes up with the exact answer you need in a matter of seconds. Plus, she has the best assortment of facial expressions I've ever seen. And she loves her dogs.

Coming in a close second are Deborah and Jim.

Deb is six feet tall, clocks in at about two-fifty, and has amazing biceps. Oh, and purple hair. And an attitude. And is the person you want on your side, whether you're in a fight or a code. She's also a great drinking buddy.

Jim is as large as Deb, but has a manic energy that she keeps under control. He vibrates all over the floor--kind of scary in a person of that size--and has a huge, booming laugh. It's not often you hear laughter in the hospital, so it's nice to hear his. He likes football, and beer, and cute fuzzy bunnies. If ever I need a hug, it's Jim I want. Since I am not a huggy person, I can't think of better praise.

We have a whole assortment of other folks: Liss, who's as likely to fall over her own feet and run expensive equipment into the walls as she is to look at you; Debbie, who is nearly to retirement and has no qualms about telling you she just farted in the med room; and Marty, Marty, and Marty: all three guys have the same name and could not be more different. One's from Uganda, one's from East Texas, and the third is from San Francisco. In order, they like soccer, shooting, and sailing.

There's also Kamal, who, along with Minna, will be starting Ramadan fasting in a week. Things always begin well during these warm-season Ramadans, then begin to get kinda tetchy toward the end. Kamal looks ashy and exhausted, and Minna starts dropping things and wandering around in a daze. (Yes, you can eat before and after sunrise/sunset, but come on: the days are long, the nights are short, and you have to sleep sometime.) I'm looking forward to Ramadan backing up to a time that's not quite so wearing on the nurses and residents.

And there's Randy, who lives umpteen miles away from Sunnydale, out in the middle of freaking nowhere, and does dryland farming and ranching. He has two years' worth of food stored up, all-terrain bikes for his wife and kids (with mounts for rifles on each), believes strongly that the world is going to hell, and brings us fresh eggs. He's the one who greeted the two Israeli nurses who were here on a research trip with a snapshot of the cougar he'd shot on his land*. He has a moustache worthy of respect and exercises by running his forty acres and pitching hay bales over his head every time he comes across one.

Basically, I work with an assortment of cartoon characters. Given the antics of my dog--who leaned over the plumber's shoulder yesterday and wagged his tail gently as the plumber explained every step of replacing a gas valve to him--and the behavior of the cats, who continue to find new high places to hang out (on top of doors? REALLY??), I am beginning to think I live in the world's best alternate-reality novel. Kind of Pratchett, maybe with a few of Gaiman's flying square-rigger ships thrown in, and a bit of Heinlein when it comes to people like Deb. And Minna, who, when I had trouble finding a can opener before a potluck, took a huge knife in hand and said, "Give that can to me. I am from a third-world country; I can get in to it."

I am a lucky person.

Even adding Keith to the mix.

But this post is not about him.




*Yeah, I'm not crazy about his shooting a cougar either, especially given that it was a female. However, he has an eight-year-old son who raises goats for FFA, and who goes out to feed them at sunrise and sunset. Given that a cougar will happily attack anything the size of an eight-year-old, I can see his reasoning. Things are different out there.

The Quotable Keith (also, weather update)

We are fine here in Littleton. Bigton has hellish flooding, as do Houston and Dallas, but we in the sticks are far enough uphill of everything that we're not getting washed away. Thanks to everybody for the good wishes; I have purchased a teeny canoe for the cats and have outfitted the dog in a diving suit with one of those round windows in the helmet.

And now, what you've all been waiting for. . . .

Keith, CNRN, PCCN, CSRN, CCRN: "Why would a patient with Hashimoto's encephalopathy be on a neurological unit, rather than on med-surg, seen by endocrinology?"

Keith, CNRN, PCCN, CSRN, CCRN: "I've never understood why myesthenia gravis patients and people with Guillain-Barre came to a pulmonary unit."

Keith, Expert On Weather: "What we need is about five more feet of rain. Then we won't be in a drought for, like, years."

Keith, Arbiter of All Things Religious: "Josh Duggar was just curious. It's not like touching his sisters was molesting them."

Keith, Man of Men and Understander of Wimminfolk: "What women need is a good home and family. It's why feminists are always so angry."

Thank you. Thank you all. Good night.

Lists.

Things I need to do this week:

1. Buy floaties
2. Figure out some way of keeping my trash bins from being washed down the street
3. Review alternate routes to work in case Lake Littleton overflows the ancient two-lane bridge that spans it
4. Grow gills and webbed feet

The rain hasn't been as bad here as it has been in North Texas, but Jeez. Everything Deep In The Heart of Texas is soaked.


Things I need to do to deal with Keith:

1. Answer patiently when he asks me why a patient with Hashimoto's encephalopathy is on a neuro unit rather than under the endocrine service
2. Ignore his assertions that Josh Groban is Classical Music
3. Not correct him when he gets the timeline of inspiration backwards vis a vis Vivaldi and Bach
4. Figure out where to hide his body at work, and
5. How to dispose of it without getting DNA all over my car


Things I need to do around the house:

1. Weed the front beds, if it ever stops raining
2. Buy a dehumidifier
3. Re-up flood insurance
4. Prep three sets of scrubs for this coming week
5. Brush Mongo
6. Groceries


Things I need to cook:

1. Omelettes for the coming week (my preferred breakfast; usually involves mushrooms)
2. Chef salad, pasta, that fantastic quinoa salad my neighbor fed me, White Girl Bibimbop (aka MmmBop)
3. Something for dinner each night
4. That goes with cheap white wine


Phone calls I need to make:

1. Mammogram
2. Dentist
3. Vet
4. Mom
5. Lotion Slut Sister Pens
6. Dial-a-Prayer

Adventures in Keithland, part I

We have one rule at Sunnydale that is unbreakable. It has to do with scheduling, and it goes like this: everybody, no matter how long they've been with the crew or what their lives are like, has to work weekends once in a while. The official rule is that every person works one Friday, one Saturday, and one Sunday, with an additional Friday or Saturday thrown in, every schedule. The schedules cover eight weeks, so this is not an onerous requirement. Most folks get it over with by working one F/S/S run and then picking up an extra weekend shift as they please.

Except for Keith, who has filled out every tentative schedule from now until Christmas and has not put himself down on any Sunday on any of them. We chatted about that the other day.

"Well," Keith said, after I had pointed out the problem, "I suppose I could try to work a Sunday, since y'all have been so accomodating of my school schedule."

I replied, more patiently than I felt, that he should not try, but do, because it is the one rule that we have. The One Fucking Rule, for God's sake.

Keith said that he likes to go to church on Sundays. Said it makes him feel all "rejuvenated."

Now, even in Bigton, the liberal enclave of Texas, folk like to get their religion on now and then. However, the One Rule applies to everybody. Doesn't matter if you're a Jew who needs Friday off prior to sundown. Doesn't matter if you're Muslim or Hindu or a devout Cafeterian:  you work what you agreed to, or you drop back to part-time or leave.

Also, there are two other people on the staff who are devout churchgoers. Even if I and every other person on staff worked every Sunday from now until Judgement Day, we would probably not cover all our bases every week. Plus, that's unfair.

Plus, Keith, this is what you signed up for. Vadge up.

Because, honestly, if you really want to feel rejuvenated in a Christlike fashion, I could nail you to a cross.

So anyway, I sent out an email about it as soon as we'd finished our discussion, because ain't nobody got time for involving the manager in something like a schedule problem.

Keith then regaled me with tales of the first earthquake he'd ever felt, and don't ask me how he got started on that, and how it was a magnitude 7 in some place like Singapore or Central Iowa. I said, mildly, that I hadn't heard of Singapore being damaged by a magnitude 7 earthquake, nor Des Moines, and wondered aloud if he knew what a logarithmic scale actually meant.

I did not use the term "fucking idiot" at any point and for that I should get a medal.

It happened again.

After the Day of the Seizing patient, Kitty and Courtney and I took three days off. We met again, yesterday, when a patient's family member (not the same patient, not the same family member) caught her shoe on a perfectly flat place on the floor and fell.

I saw her fall. She didn't even have the chance to get her hands out in front of her. She landed with a horrible smacking noise, right on her face. And so we hit the panic button and who should come around the corner but Courtney.

Who helped us check the person out, helped us help her up, got her back into the room she came from (she refused to go to the ED), and then stood and stared at us. With a "REALLY??" expression on her face.

What she said really doesn't bear repeating. I guess, when you have a father who spent time in the Navy, you learn lots of interesting turns of phrase.

And that was my day yesterday.

Today I worked with Keith, and came up with some interesting turns of phrase of my own. But now is not the time for those stories. Now is the time for a pizza and wine and bed.

Well. That was hairy.

It was a normal day in the CCU at Sunnydale (Hospital for the Hellmouth). Admissions, discharges, multiple procedures requiring conscious sedation, doctors getting all fumble-fingered with the new order templates, the bathrooms out of order.

It was normal until Courtney showed up. Court stands barely five feet tall, might weigh a hundred pounds soaking wet, and is the finest nurse I know. She's worked in every critical-care area there is, from trauma to burns to places where twelve drips on one patient are the norm, and once crawled into a crushed car--while seven months pregnant and on a flight crew--to retrieve the unconscious victim of an MVA. She is the bomb.

Normal became fantastic when she stopped by. She had the role of emergency responder that day, carrying her bag with all her magical devices in it. When somebody goes bad, instead of calling a code (that is, if they're still breathing), you call the emergency response person. And when it's Court, you know you're getting a quality response. Plus, she's funny as hell.

So I was glad she was there when the family member of one of my stroke patients stepped out into the hall, grabbed his head, and then passed out in his sister's arms. Sister lowered him to the ground, screaming for help, and Courtney and I were there before he'd hit the ground. I turned him on his side, Court hit the panic button that would call everybody to help, and Kitty got the crash cart.

And then he started to seize. Ever tried to start a line in a six-five man with crap veins while he's in the middle of a tonic-clonic seizure? I don't recommend it as a fun way to start your weekend. I couldn't get anything, so I handed him off to Courtney, who found a vein in his arm that I had tried for and missed. Kit was setting up suction and popping a nonrebreather on him at that point, and I was trying to keep his head from slamming into the wall any more than it had already.

At that point respiratory showed up. And pharmacy, and the internal med PA, and every damn nurse on the planet. Courtney was busy taking care of our now-patient, so I was the one who got to direct things: You, call 911 and get us an ambulance. You, call the ED at Holy Kamole and give 'em the heads-up on this dude. You and you, get the vitals the machine is rattling off every minute. You, stand by with your bougie and tubes. Who's recording, even though this isn't an official code? Nobody? Okay, you do that. You, go get a gurney and a lift board so we can get this dude off the floor. Where's Ginny the Inappropriate Chaplain? You, page her. Get her up here.

All done slick as snot, with no raised voices, no panic, no missed steps. He seized four times in five minutes. We gave him Ativan in an attempt to stop the seizures, and he ate it up. It took 5 milligrams of the stuff (for nonmedical types, that's two-and-a-half to five times what it normally takes) to get him quieted down.

Then the EMS guys showed up. I love paramedics. They started two more lines in a literal minute, started fluids, got the guy's airway protected, and wheeled him off.

And, after we all took a deep collective breath, Courtney sat down in the station and said, "Okay, y'all. That went well, but what could we have improved?" and we had a debriefing session.

It was the smoothest emergency response I've ever seen. I'm really proud of all of us. Nobody's hair caught fire, nobody panicked, nobody was just standing around with nothing to do. The people who had tasks did them, while the people who weren't tasked with something melted away to go take care of their own things. It was fucking model.

And it happened at 1805, and all of us got our charting done and got out on time.

I work with good people.

Dear Cheerful Nurse from the ED at County General. . . .

Thanks for calling. Thanks for being so cheerful! I don't know how you do it, working, as you do, in the pits of hell.

I apologize for that patient who stumbled into your ED today. He stumbled into ours, here at Sunnydale, with a chief complaint of having fallen over due to weakness on his left side. When the CT and MRI didn't show anything, the folks in our ED transferred him to the Neuro CCU. . .but not before he started demanding pain medication for his stroke pain.

Because strokes, as you know, are painful.

(end scarcasm)

Anyway, I got him up here and determined that, while he did show some weakness on the left side, it was distractable. Sometimes it moved to the right side. Sometimes he complained of tingling and numbness all over. At least, that's what I think he said; it was hard to tell, given how many teeth he was missing. Yes, yes, he told me he wasn't a heroin addict too. I'm sure he wasn't; after all, if a person's a heroin addict, that means they'll have tracks all over and crappy veins, and it only took two tries with a Sono-Site to find a vein in his upper arm, so that's not so bad, right? Right?

Oh, you saw those healing puncture wounds, too? Well, I'm sure we can agree they weren't from heroin. Of course not.

Gosh, you sure are cheerful.

Yeah, he told me that he was heading over to County, since the folks over there knew how to treat him. After all, because he's not a heroin addict, there's no reason he shouldn't get Dilaudid or methadone for his stroke pain. He repeated that a number of times to both me and the doctor, who said he was messing with the wrong sheriff. Given the doctor's age, accent, personality, and ethnicity, all I could think of at that point was Cleavon Little in "Blazing Saddles," and I'm certain I made a spectacle of myself, going red-faced in an attempt not to bust out laughing. Luckily, the doctor had seen "Blazing Saddles" too, and caught my eye, and said, "'Scuze me while I WHIP THIS OUT" before pulling the records that had come up from the ED with the patient.

I do love my colleagues.

But not nearly as much as I love you, Cheerful Nurse from the ED at County General. You're indefagitable.

Where were we? Sorry. Oh, yes, the track marks. That didn't come from shooting up any and every imaginable substance while not living on the streets. Yes, we saw those. You'll notice, if you look at the guy's feet and under his tongue, more of them. No, I did not look at his penis. Sorry. My exam was truncated.

My exam was truncated by his starting to swing at me, demanding AMA paperwork, and generally being a cussing asshole. I was fine with him swinging at me while I was standing at the foot of the bed, but once I moved in to try to take out his IV, the swinging got a lot closer and a hell of a lot more personal. Which explains why he showed up at CGED with an IV from Sunnydale still in his upper arm. Consider it a favor from me to you; you don't have to risk sticking him. Y'know, he tried to stab the above-mentioned Doctor Sheriff with a shiv made from a spoon when Doc Sheriff asked him a few simple questions, I'm sure you'll agree that leaving the IV in was the best choice. Discretion is, after all, the better part of not contracting blood-borne diseases.

That was why I had Danny wheel him out after he signed out AMA. Danny is six-five, three-fifty, Polynesian, and covered with interesting geometric tattoos. Somewhere, there's a photo of me curled up under the desk in the fetal position as a result of that patient interaction. I can send it to you if you're interested. That's really all I can tell you. No, no, you don't have to send him back, you can keep this one.

Thanks. 'Bye, now. Byeeee.

Hey, I just met you, and this is crazy,

. . .but I have the sudden urge to smack you over and over and over with a shovel across the back of the head, so could you sit down?

Thanks.

I am like Grumpy Cat: my life is empty without someone to hate.

After a rough period in December, when it seemed every nurse in Texas had disappeared without leaving so much as a shoelace behind, things are good in the CCU. We're staffed well. There's Kitty, who has sold her soul to the Devil in exchange for the ability to do a razor-sharp wing with liquid eyeliner *every* *time*. There's Marcie, who is good and beautiful and brilliant and so sweet I dread having to tell her that there is no Easter Bunny. And she's been a nurse for ten years, too, so this is not something that's going away. There's the night crew, who refer to themselves collectively as Team Awesome, and who are not overstating things. And there's Keith.

Keith (not his real name; if they pick me up for murder, they can't prove it) is the smartest nurse ever. He already has a master's under his belt at the age of 30, he's working on his DNP in adult acute care? Or critical care? Or something? He knows every policy and procedure in the manual. HIPAA is an open book. He can, he assured me on day one, run a code by himself. He is a fucking genius. He has been a nurse for five years.

He does not know how to set up a suction rig. He does not know what angioedema looks like. He does not understand how swallowing works, and that silent aspiration is a thing. He does not, in fact, know how to run a code at all, let alone by himself.

Now, I'm willing to excuse all of that and more in a new nurse. Contrary to how I might sound on here, I am the preceptor you want. I'll entertain any question without making you feel like a moron, because even supposedly stupid questions usually have logical backing. I'll show you cool shit and get you into the transplant OR and pull strings so you, too, can hold a heart as it beats outside somebody's body. You can practice IVs on me.

However. If you're a supposedly experienced nurse, who's worked four places in five years (wtf is up with that it's not like the economy has been great why did that not trigger anybody's warning bells oh my GOD), and you make a critical medication error, giving five times the dose of an opiate to an opiate-naive patient, and then turn your back on them in order to futz with the computer, and *then* try to blame the error on *me,* I will cut you.

If you try to pin something on Marcie that she did not do, then boy, your life as you know it just got a whole lot worse.

Keith's head and me, May 2015

Can I get an A-men.

For the time being, we have appealed to Wonderful Boss as a group, and Keith is going down to the bowels of Holy Kamole in order to train with Betty in Interventional Radiology. Betty is sixty. Betty is a dedicated Crossfitter and member of a motorcycle club. Betty runs a six-minute mile, faster than she did when she was an Army nurse. Betty is two years away from retirement and takes even less shit than she used to.

Keith will know, if he knows nothing else, how to dose people for conscious sedation. And what to do if he fucks up. And he'll know exactly why it's a bad idea to try to bully the people he works with.

I feel alive again. I feel like I'm no longer wasting my time, if there's an ego to destroy and dreams to crush.

Or maybe that's the double-bacon cheeseburger I ate for lunch talking.

Thoughts, various.

I would really like to be in Seattle right now. From now until mid-October sounds about right; that means I would miss tornado season here. Tornados, strong thunderstorms, hail--it all sends me, shaking and swigging whatever alcohol is in the house, into my safe closet for hours, usually a couple times a week. I hate heavy weather. Call it a remnant of my days in Kansas, including living through the infamous Wichita/Haysville/Andover tornado of 1991.

Failing that, I would like to be up in the Blue River or over in the Comal for the next few days, not going back to work.

*** *** ***

An email arrived today from a woman who had a palatectomy on Friday.

This is comparable to a dodo sighting. In four years, with God only knows how many hits to this blog for "palatectomy," "obturator," and "palate cancer," I have only heard from one other person who'd had a palatectomy before now, and she was introduced to me by my uncle. Given how quickly oral cancer is becoming The Latest Thing, you'd think I'd have a coterie of fellow bionic-mouth wearers, but I don't. It seems that most oral CA people get nasty stuff at the base of their collective tongues, or on their tonsils, not in their minor salivary glands.

The emailer asked how long it would be before the hole closed up.

Honey, I said, that hole is never gonna close up. That's gonna be with you for life. How did nobody tell her that before? WTF?

Which took me back to the months after surgery, when my obturator was equal parts problem and blessing. I searched all over the Innerwebs for palatal reconstruction, eventually finding somebody in Alberta? Saskatchewan? Someplace in Canada, who would do palatal reconstruction in adults, with only poor-to-fair results.

It took a good three months before I accepted that I would indeed be wearing this Thing in my mouth until the day I keeled over. After that period of adjustment, I started experimenting. I discovered that having a removable mouth was actually superior, in many ways, to stock equipment.

For instance: I rarely have to pop my ears on an airplane, and almost never have pressure and pain with a sinus infection. (Of course, I can't wear my obturator when my sinuses are really inflamed, but you take what you can get. At least I can sleep without sitting up.) I am proof against pizza burns, Dorito stabs, and all but the most aggressive Cap'n Crunch bits. I have something cool to show the medical students and nurse interns, and I have won several bets on how much I can fit in my mouth at once. (The trick is breathing carefully, so as not to send stuff down your airway.) Nothing but poppyseed muffins cause me any trouble any more, and I never liked poppyseed muffins anyhow, so no great loss.

It's weird, how a simple email from a person can bring it all back. It's like I haven't come all that far after all. Then I remember: I saw Maricel, the tech at The Prosthodontic Elf's office, wax like the moon during her first pregnancy. The second pregnancy, I only knew about during the eighth month. I've missed the third one altogether. So that's something.

*** *** ***

Mongo comes home tomorrow. I have to bail him out first thing. I will be setting my alarm. I've had trouble sleeping without him curled up on my feet, or in the small of my back. The cats have been strangely needy this week; I think they miss him, though they'd never admit it. A seventy-pound dog leaves a huge hole when he's not where he's supposed to be.

*** *** ***

Can we please stop pillorying people for shit they tweeted five years ago? Tweets I would've made five years ago would've had me strung up by six or eight groups of people with whom I now identify. Jeez, people: personal growth. Look it up. It's a thing.

My Dog Is A Fugitive From Justice.

My dog is on the lam.

My dog is living under an assumed identity.

My dog is being shielded by others at great cost to themselves.

My dog is an asshole.

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

While Boyfiend (formerly Brother In Beer) and I were spending a nice few days in the Pacific Northwest, watching Der Alter Jo get hitched, Mongo The Magnificent (aka ThugDog) was being dogsat by a very nice woman who keeps pups in her home and charges very reasonable rates.

He had a lovely time. I have more than sixty photographs of him running through the woods, swimming in the lake, chasing ducks (aka Water Squirrels), and sleeping on the nice woman's couch. In most of those pictures, he's side by side with her foster dog. Her foster dog is sweet, ancient, and tolerant.

The last day he was there, on his last outing, he got upset with Dogsitter's Dog and snapped at him. Dogsitter's Dog of course retaliated, because even at ninety years older than dirt, he still has some self-respect. Dogsitter tried to break up the fight. Using her hands. Near the dogs' heads.

And got bitten. Not intentionally, not badly, not in a mean-spirited way, but she had to go to the ED when her hands started to swell. And the ED, following the law, called the cops. All dog bites in this county have to be reported.

(Which brings up the following conundrum: if a burglar breaks into my house and Mongo bites him/her, and then said burglar is taken to the ED for treatment by the cops, does that count as a reportable incident? Or do the cops simply wave their hands and say "Eh"?)

Anyway, things started going Keystone Kops in the ED. The salient point in all of this is that I live in one city, the dogsitter lives in another, and the bite took place in a third, very small, city, just inside the city limits. The first cop--one from my town--showed up, decided it wasn't his jurisdiction, and left. The second cop showed up, the dogsitter refused to give him any information about me (more on this in a minute), and he left.

And the next day, in succession, the dogsitter had the police from four different cities show up at her door with animal control trucks, ropes, lassos, dart guns, and various other implements of distruction. They pounded, she said, on the door. In succession. And she refused to answer the door. (Here I have to credit her heart and cut her some slack for being flustered. If cops were pounding on my door, I would hesitate to answer it as well, for fear that the dogs in my care would be taken away in the paddy wagon, with nobody sorting the good dogs from the bad ones.) Anyway, she said squat until they showed up with a warrant.

(I don't know what the police from the fourth city were doing. Maybe it was a mistake? Maybe a show of moral support? Maybe they had to run to the store for a few things and just dropped in on their way? I dunno.)

When they showed up with a warrant, she called me. I had known she had gotten bitten, but had figured things would work themselves out in the noiseless-tenor way that they normally do. I mean, I had no idea she had bucked the police.

I had to get on the horn with three successive animal control and sheriff's divisions before I found the person who could deal with my problem, only she had left the office about ten minutes before.

So tomorrow, I am staying home from work. I will call my vet, explain the problem, and ask for a quarantine cage. It's the law here that any dog who bites a human has to, if its vaccinations are up to date, be quarantined for ten days. I can't quarantine Mongo at home, since it wasn't a family member who got bitten.

Then I will call the third city sheriff's office and say, "My dog is a fugitive from the law, and I am calling to turn him in." And we will go from there.

No, it doesn't feel quite fair that Mongo has to be quarantined because somebody got in the way of his teeth. On the other hand, I can see the dogsitter's problem: when you see two dogs going at it, the immediate instinct is to shut that shit down, any way any how.

And while it was accidental, I can see the reason for any-skin-break-is-reported. If I asked for an exception, they'd have to make exceptions for every blockhead with a truly dangerous asshole dog, and then where would we be?

So, the upshot is, Mongo gets another vacation. Not as much fun, and not as heavy on lakes and ducks, but another vacation.

And I have to figure out whether to outfit him in a striped outfit, an orange jumpsuit, or just put an ankle bracelet on him and write "LOVE" and "HATE" on his paws.

Things got a little busy.

There was an ice storm. And Friend Abilene Rob and his lovely bride-to-be Alice moved closer (hooray!). And The Boyfiend started physical therapy, and finished it, and now doesn't think he had a failed back surgery. Which I had been telling him, but when does any Boyfiend ever listen? Never.

We're also ramping up for That Yearly Festival That Makes My Commute Hellish, aka South By Fuck You. And our supplies manager's son died of septicemia, which is something you really wouldn't imagine happens any more, but apparently it does, so we were out of supples for about six weeks. Like, no insulin syringes for two weeks out of supplies. Which is horrible, but not as horrible by a long shot as watching your only child die of septicemia.

Also Friend Lisa's husband died, which was scary. He's my age, and he had a sudden heart attack. Just. . .went to sleep, as my mother says, and woke up dead. I assured her, when she asked the other day, that he felt nothing. Just went to sleep and woke up saying "Dafuq?" at the Pearly Gates.

Then another bout of bad weather, although not as bad as the first. I got the stomach bug that was going around and lost nine pounds in six hours, all fluid. Then I got better.

And through all of that, I felt really burned out. Not just burned out on blogging, but burned out on nursing in general. I was looking for jobs outside of nursing. I was considering learning to code, even though dealing with computer scientists is the last thing on my list of Things I'll Do Someday Before I Die, and last on my list of Things I'd Do If The Alternative Were Being Stuck In The Eye With A Bamboo Sliver.

See, we've had some changes at Sunnydale. As a result, we've lost probably thirty-some nurses, the same number of nurses' aides, half a dozen doctors, and not enough Manglement. We've been so short lately that people are calling safe harbor every shift. Manglement's focus has been on getting us new monitors, new isolation gear, and new urine-sampling devices, so it's been. . .well, it's been a recipe for burnout.

It's bad when critical-care nurses call safe harbor. It's really bad when rehab nurses call safe harbor.

It's been really bad.

I started thinking: I deal with people every day who are in extremis. Most days, I can't go home and leave my job behind. Part of that has to do with the job itself; part of it is the fact that I've become the de facto manager of my unit and the de facto mentor for several new nurses. I took a couple of days off--literally two--and came back to people with their hair on fire, asking where I'd been, a stack of paperwork six inches high on a desk that I don't have, and a new nurse having a crisis of confidence.

And I thought, where is the benefit to me? What on earth am I getting from this, aside from a steady, if variable, paycheck? I used to feel a sense of accomplishment at the end of the day. No matter how bad things had been, I knew that there had been one person, at least, who felt less pain at the end of my shift than they had at the beginning. Now, it seemed like, I had so many people yanking me so many different directions that I couldn't even be sure of that one simple thing.

I went in stressed, I worked for twelve hours frazzled, and I left feeling guilty and like I simply wasn't enough.

Most people go to work, get a paycheck, get insurance, get vacation time, and that's enough. Those things are the benefits that they look for. Their work is a thing they do, not the thing that they are. They turn off at the end of the day, shuck the coder/garbage man/shoe salesman/flight attendant skin and reveal their Real Person skin.

It's not that way for nurses. It's not that way, I suspect, for teachers or ministers or doctors or God only knows what other professions. Maybe if you're born to be a garbage man, you never take off that skin. Who'm I to say? Point being, if you're one of those people who's in one of those professions, it's bound up in you to the extent that being a Good Whatever is the main benefit of your job.

So, for about a month and a half, I was burned. the fuck. OUT. Not only was I not wanting to be a nurse, I was not a nurse. I had no curiousity about nursing stuff. I didn't care about medicine. All I wanted to do, and all I did, was explore the wonderful world of Amazon Prime Bad Movies and rearrange my closet. I went to work depressed, left more depressed, and didn't sleep well that night.

Then something changed. I don't know what it was. I knew, going into the period of burnout, or brownout, or whatever you call it, that it was temporary: this has happened every year or two for as long as I've been nursing. Still, the thing that pulls my head out of Burnsville is always a mystery.

This time, it was maybe palliative care for a Mohawk woman. There are lots of tricky technical, cultural details to be aware of when somebody from the Confederation dies. Maybe it was the kid with Ehlers-Danlos type 4, who reminded me of another bright, driven person with the same disorder and the same prognosis. Maybe it was the birthday card my pal Abbs made for me. I don't know.

Six weeks ago I left my job feeling like I wasn't enough. It was a gaping wound. Yesterday I left my job knowing for sure that I hadn't been enough, but that I had done my best, and that I would be enough for some other person some other time. And that was okay.

Yeah. . . .no. I'm having some thoughts about BSNs.

I'm an ADN-prepared nurse. Those of you who've been here for a while know that I often refer to those two years (three, actually, counting prerequisites) as the Hardest Work I Ever Put In For An Extended Period of Time. It was like drinking from a firehose, like trying to cross a raging river while wearing combat boots, like riding a bull with no previous experience. And the instructors I had hammered one thing home over and over: that we, as front-line nurses, had the right and the responsibility to consider ourselves colleagues of our BSN or MD or PA coworkers, not as helpers or assistants.

Of course, that was in the days of The Nursing Shortage. ADNs like me were being fought over by multiple hospitals. Nobody in my class started work at a nursing home; we all got acute-care or better jobs right off the bat.

Now my facility is going for Magnet status, which means BSNs are the basic standard of nursing education. And I have some problems with that.

First, I've seen a massive drop-off in terms of the diversity of our nursing staff. Used to be, Manglement would hire people with ADNs, provided they had either a bachelor's degree in something--anything--or equivalent experience not related to nursing. As a result, I got hired with a man who'd worked as a hospital chaplain for ten years, a woman who'd been in the Navy for a decade, three people from three different African countries, and a guy who'd been a medic in the first Gulf War (1990's) and had worked as a mechanical engineer afterwards.

Now they hire BSNs. And since they hire only people with BSNs from colleges here in the US, we have a crop of new hires who are all white, middle-class, and in their twenties. All of them are native-born, all of them are young, and for all of them, this is their first job outside of, say, Sonic. They're also all female.

This is a problem. This utterly fails to reflect our patient population. Not that that's a necessity, but for Heaven's sake: you ought to have at least some employees who can connect on some level with the people they're caring for.

Second, the BSN programs in Texas seem to focus mainly on management and leadership. Which is all well and good, but you're getting folks who, at the end of their senior year, have absorbed a ton of nursing theory and still have no time-management skills. As a result, we've lengthened the preceptor period for new grads to sixteen weeks. The preceptor period for ADNs was twelve weeks. Why? Because, at the end of our last semester, we were providing care for five patients. The BSN-prepared nurses provide care for two.

And they don't catch up. I'm seeing BSNs who, after two years on the floor, are still having time-management issues severe enough to attract Manglement's attention. They're schooled in critical thinking, they're schooled in history, but they simply don't have the chops to handle more than two post-op admissions in a shift. (Oh, Lord, how I wish I were exaggerating.)

Third and finally, I'm working with a lot of new grads who don't have a good fund of general knowledge (to use the MD's term). I'mma be a snob here and suggest that a working knowledge of, say, how to Google effectively, or American history, or politics, might all be good things to have on a day-to-day basis while you're living your life and doing your job. I'm not getting that from the new grads I work with. I have the reputation of knowing everything there is to know about everything simply because I know how to look shit up. I can assess sources, decide which ones are bunk and which ones are decent, and move on from there in a winnowing process. The new nurses I work with (and by "new" I mean "anybody who's graduated in the last three years") do not have that ability. I don't know if it's a liberal arts education or maturity or what, but unless it comes to them from a textbook, they do not know how to analyze information.

Maybe it's a lack of curiosity. When I get a patient from Backobeyondistan, I try to find out everything I can about their culture and belief systems. I'm the only one who does that. *sigh*

ANYWAY. There is a place for BSNs, no doubt. I'm planning to start mine this year, so's I can continue to work somewhere other than assisted-living facilities. Some BSN degrees (though not the ones here, from what I can tell) give graduates an excellent foundation in pathophysiology, assessment, and basic sciences. (Ours tend to require two semesters of state history and a couple of classes on theory.) Some actually prepare students to be nurses, not just research-bots or management candidates.

Overall, though? I'd rather see more diversity in the graduates we get. I want to see middle-aged, fat women like myself who are on their second or third career. I'd like to get into a conversation about Buxtehude with a dude who got his BA in organ music, then went back to school when his carpal tunnel got too bad. I'd like to see the occasional Indian nurse, or Filipino/a nurse, who took the exact same courses for her or his degree but has been denied a job because his/her  diploma didn't have "US" on it.

I'd be interested to hear what you guys have to say.

Christmas by myself this year!

How I learned to stop worrying and stopped giving a shit--and became a better nurse.

It's the classic nursing moment: after you've spent uncounted minutes putting a gorgeously neat, clean dressing on a wound, a doctor walks in, takes the dressing down, and wanders off without a word.

(Which makes me wonder about the nurses who reference this moment: are their doctors that unpredictable? I always catch mine in the morning and ask when they plan to round; it's easier to work in a dressing change after six neurosurgery residents have looked at it. Maybe they don't have easily-cowed residents.)

That, at the very least, prompts an eye-roll and the exhalation of breath through gritted teeth. That's the bottom of the nurse-exasperation scale: the top is the shouted "What the FUCK do you think you're doing??" Somewhere in the middle is the terse conversation, either with a doctor or a family member, in the hallway, with a candlestick and Colonel Mustard.

Y'know what? I no longer have those conversations. Or, rather, I do, but they're not nearly as terse.

I no longer sigh heavily when a patient has explosive diarrhea right after I've rolled out a new pad.

I no longer roll my eyes when I hear that Manglement has opened a new critical-care unit and hasn't hired anybody to staff it.

I no longer, in short, give a shit. And it's made me a much better nurse.

See, there are things worth getting upset about. If I have a post-aneurysm-clipping patient whose blood pressure won't stay down, even with all the drips I can throw at them, *that's* worth flipping out about. If I have an acute ischemic stroke patient whose pressures won't stay up, even with ditto, *that's* worth a phone call or two. If the pharmacy forgets to send the super-special tubing with that bag of potassium phosphate, then yeah, I'mma get on the line to them.

But the usual, boring, irritating stuff, like dressings hurled flang-dang all over the bed? Not worth giving a shit over.

Likewise, every single corner must not be exactly perfect on the top sheet when the patient's up in a chair. I'll have a chance to fix it once they get back in the bed. Every single label doesn't have to be printed out on the in-room label printer if doing so means my labs will be delayed by twenty minutes; I can always send 'em down with a plain, pre-printed label. I can, if necessary, deal with too many patients in one assignment, because I have learned how not to give a shit. I have, in short, learned to prioritize.

More than prioritization, though, the art of Not Giving a Shit has helped preserve my mental health. I have a colleague who is brilliant, talented, very-very-very smart--the sort of nurse who walks around with a halo of golden light because she is just. So. Good.

She loses sleep over minor stuff: whether or not somebody will get mad at her because she missed charting the KVO rate on an IV for three hours, or didn't match the P&P exactly when she ran hot salt on somebody. It affects her personal life, it sometimes comes close to paralyzing her professionally, and it makes her miserable. She needs to learn not to give a shit.

I would say to her: First, is the patient safe? If so, excellent. Is the patient comfortable? Even better. Is the patient clean, fed, and neat-looking? You get a gold star. Is the patient calm in their mind about what's going on? Then you can sleep easy.

The fact that you might not've checked blood return every two hours on an IV, instead letting it go to two-and-a-quarter or two-and-a-half hours, is not worth worrying about. You'd kept a weather eye on that IV, you knew it was good; fifteen or twenty minutes will not make the world catch fire. Five cc's an hour is not a huge deal.

My Not-Give-A-Shit list goes something like this, in order of Not-Givingest to Most-Givingest:

1. Emails from anybody with extensive lettering after his or her name. If it comes from the president of the university, it gets deleted right away.

2. Emails from management that go out to everybody. Those get deleted, usually, without being read. If it's important, they'll cover it in a staff meeting.

3.  Emails from management that go out to my unit. I'll glance over them.

4. Orders from doctors that say things like "be sure patient is fed dinner" or "turn Q2 hours." Well, DUH.

5. Saline locks that don't work on patients with multiple saline locks. I'll take them out and may or may not start a new one, provided that person has at least one other working IV.

6. KVO orders that don't conform to unit policy. I'll run your IV at 5cc/hour; I may or may not get around to rewriting the order that the doc placed for "KVO fluids." (In my head is the Grecian chorus of They Ought To Know How To Order It By Now.)

7. No orders for Tylenol when the docs have already ordered Norco. They're cool about me stepping a patient down.

8. Patients not getting turned or fed appropriately. This raises my hackles.

9. OT or PT skiving off a patient who they feel is too much trouble. In truth, I only have one occupational therapist that I have to watch closely; he looks for reasons to shorten his patient list. Dude, "patient already up in chair" does not mean you don't have to see them. The PTs and OTs where I work are spectacular. Except for that one dude.

10. Not breathing. That will get me full-on, hair-on-fire, running down the hall, giving a shit.

And I will have time to care, because I have learned how not to, for lesser stuff.