Mucus, autonomic dysreflexia, and vaguely irritated bovines.

Mucus

I have a cold. Or a sinus infection; I can't tell which. All I know is that life is currently not happening without pseudoephedrine, a drug I normally avoid at all costs. It makes me do what I did this morning; that is, wake up at 2:20 and not be able to get back to sleep until six.

If I could just sleep standing up, that would be much better.

Autonomic Dysreflexia

Here beginneth the first lesson: autonomic dysreflexia is, according to Taber's Cyclopedic Medical Dictionary, a condition commonly seen in persons with an upper spinal cord injury that is caused by massive discharge of sympathetic reflexes from the sympathetic nervous system.

In English, what that means is this: A person with a complete or incomplete injury of the spinal colum somewhere high, usually in the neck, will occasionally have episodes of hugely high blood pressure, tremors, sweats, panic attacks, and other nasties. These are most often brought on by, believe it or not, a full bladder. A fecal impaction takes second place. Other causes might include positioning or bedsores.

I had five patients on Thursday. Four of 'em I cured by noon, which left me to deal with Patient Number Five. He's a high incomplete tetraplegic (quadriplegic) who had a partial transection of his spinal cord at about C6. Feel that bump at the back of your neck, just above your shoulders. His break happened just above that.

He's a nice guy. He's been a quad for about six years and has been married to his equally nice wife for three. (Note to the gaping masses: quadriplegics can and do have perfectly satisfying lives, including sex lives. It depends on the injury, the deficits, and the person.) He came in because he'd started having odd pains in his belly when he laid down in certain positions. His doctor figured it was his implanted muscle-relaxant pump malfunctioning.

(Note to the interested: baclofen pumps can be implanted in the abdomen and programmed to disperse small amounts of baclofen or baclofen in combination with other drugs to the spine, thus reducing muscle spasms and pain.)

At about one o'clock, this poor guy went into an almost-endless cycle of autonomic dysreflexia. His bladder wasn't full, he wasn't impacted, his positioning was fine, he had no bedsores. *Nothing* could explain what was going on...

...until I took a look at his labs with Sparky, his doc. "Sparky," said I, "I know his urinalysis shows colonization, but is it possible that that colonization could've turned into an active infection?" Sparky pondered for a minute, then decided that I might have a point there.

People who've had bladder infections will tell you that even a tablespoon of urine in an irritated bladder can drive you to distraction. I think that was what was happening with this guy, though I never got a definitive answer. The rest of the day I spent giving him huge doses of baclofen and Demerol in an attempt to break the spasms and the blood pressure problems by breaking the pain cycle.

The trouble with a high spine injury is that the body wants to work on a positive-feedback mechanism. Any mechanical engineer will tell you that that will lead to a burnout in machinery. In a human, it leads to blood pressures of 290/155.

It was not a fun afternoon. He stabilized during the night shift, though, and presumably is on his way home now.

And vaguely irritated bovines

Question: what do you call it when a person has a brain biopsy that comes back inconclusive for Creutzfeld-Jakob disease?

There is no answer for that one. If I knew of a good punchline, I'd've used it already.

Yet another patient came in with some indefinable brain problem that causes them to shake, become nonresponsive, and curl up in a ball. The biopsies we did don't show anything definite, so the diagnosis will probably be made on autopsy (as so many of them are with troubles like this).

CJD is different, by the by, from "mad cow".

Mad cow disease, or variant CJD (vCJD) hits early in life, in a person's twenties or thirties. It starts with odd neurological defects that often involve quite a bit of pain and takes several years to kill the victim. It's transmitted by--and pay attention, here--eating the neural tissue of infected animals. Chuck roast is fine, filet mignon is safe. T-bones are a little tricky, and ground beef (especially the mystery-cut ground stuff in the prefab chubs) is most dangerous, as it's extracted by a process that often mixes in bits of spinal tissue by mistake.

Creutzfeld-Jakob disease, on the other hand, is spontaneous. It has no recognized trigger, though genetic mutations might play a role. For some reason we don't understand, tiny proteins in the brain called prions suddenly start flipping over and turning into what's essentially a mirror image of their old selves. They induce other proteins to do the same, and you eventually end up with a brain full of holes like Swiss cheese.

It hits people in their 50's to 70's and takes about six to eight weeks to finish them off. As far as we can tell, it's relatively painless.

(Tangent: People often ask me if I'm worried about getting vCJD from eating beef. My answer is this: I commute 40 miles a day on a hugely busy highway and cross a busy street to get to work; I stand a much higher chance of ending up pasted to the front of a city bus than I do of getting vCJD. Go ahead and eat your steaks, people.)

CJD is quite rare. Only about one person out of a million will get the disease, which means we've got the area's biggest CJD population rotating in and out of our hospital. You know it's bad when all a nurse has to say during report is, "Well, it's typical CJD" and everybody around the table nods in understanding.

And finally, a piece of good news

Georgia of Odious Woman has been kind enough to link this blog from hers. Omigoodness!

I urge you to check out Odious Woman. Georgia is a crack writer and makes even lifting weights and running sound fun.

I saved somebody's life yesterday

Well, I helped, at least.

I sucked a mucus plug out of a patient's trache, no big deal. But it's left me unexpectedly shaky and flipped out.

Here's the deal: I had a patient of a sort I'm not used to: a radical neck dissection for laryngeal cancer, with a tracheotomy that was fresh. Frech traches are nasty, since your body produces lots of mucus to try to deal with the insult of having a hole cut in your airway, plus you have lots of swelling. Those issues combined with the fact that the trache tube can come out make a fresh post-neck-dissection patient a bit of a worry all around. I was paranoid-ly checking on her every fifteen minutes all morning.

The patient's daughter came out of the room at 0918 and said, "Jo?" in that tone of voice that means "I hope whatever's happening isn't really happening." I flew into the room to find my patient panicking and unable to breathe--no breath sounds in the chest, no air movement through the tube. So I called Dave, our charge nurse, and he brought in an ambu-bag. (Ambu-bags are those squeezy things that pump air into your lungs when you're on "E.R." on a gurney being rushed down the hallway by Noah Wyle.)

Her oxygen saturation had gotten to 25% by the time Dave and I managed to knock that plug loose, me with suction and him with the bagging. 80% is considered a critical level.

At 25%, a person goes limp. Her mouth falls open, her eyes dilate, and she doesn't respond. Her heart kind of flutters around in her chest, unable to keep beating without the stimulus of the lungs.

Then, when you finally knock that damned plug loose with the bag and the suction, her breath rushes back into her throat with a huge rattling sound and she starts to grimace. That's when you come back into your body and realize dimly that everything you've done for the last two-and-a-half minutes has been totally automatic, without thought, without conscious action. You realize that you've ordered a crash cart and that it's appeared from somewhere without your noticing, that Daughter and Son-In-Law are looking a bit tense, and that you're shaking.

Then you look at the clock and see that it's 0922. It feels like 1630.

Like I said, a mucus plug is officially no big deal. They happen a lot, so you're prepared for them: the fresh trache is near the nurses' station, right across from the cabinet where the respiratory team keeps its supplies. I didn't have to call a code (thank you, God, thank you), and my patient came back fine and dandy, if a little tired.

It affected me much more badly. When her O2 sats dropped to 25, I thought "Fuck." That was all. Just "fuck." Not "Fuck, now I'll have to code her" or "Fuck, now she's dead" or "Fuck, her pupils aren't reacting" just "Fuck." With everything else rolled into it.

Dave looked at me afterwards and said, "Good job." From him, that's high praise.

I went and got mashed potatoes and green bean casserole and buttered carrots for lunch.

Cholesterol

I am turning thirty-five in a few months. That means I'm older than Britney Spears, thank God, and still younger than Daniel Schorr.

Beloved Sister just got her cholesterol back from the lab. It's high, and her LDL and HDL suck, as she put it, dead rat. This makes me nervous, since Beloved Sis has much better lifestyle habits than I do. She doesn't work 14-hour days, doesn't drink to excess, doesn't eat Sonic. She also works out constantly and can donkey-press something like 700 pounds.

35 is the benchmark age for a lot of stuff. First mammogram if you have a first-degree relative with breast cancer, baseline cholesterol, aneurysm territory. It's osteoporosis risk and think about retirement funds, why don't you own a house and a working car time, oh you never had kids, risk of thus-and-so jumps mightily. You're more likely to get hit by a bolt of lightning than marry a terrorist, Toyota Scions are too young for you and the Mini is pushing it, why don't you get an Accord?

However, it's okay to like Garrison Keillor. You don't have to wear neon colors. Blue eyeshadow is beyond the pale, and nobody expects you to be really, really skinny and flat-chested. Long narrow skirts are acceptable. You get very strong in your thirties, and 35 is when you can show off your amazing biceps and deltoids. Coffee becomes a way of life rather than just a beverage. Drinking no longer carries with it the fear of hangovers, and nobody looks at you funny if you say you like Scotch, neat. You become much more interesting than a 20-year-old.

Still, I won't be a healthy forty-five year old unless I find out what my cholesterol levels are and start exercising again. *sigh* Time to forgo the donuts and start the cardiovascular workouts again.

Oh, and a few more things....

Fluff segregation

Yet another person has expressed disbelief that my entire winter wardrobe has been assembled from scratch in ten minutes. Note to the general public: all girls are not clotheshounds. I may show some alarming tendencies in that direction, but I rarely follow up on them.

Irregular Choice shoes might be the new followed-up-upon tendency.

I woke up this morning with Fruvous's (Moxie Fruvous) "Fly" going through my head. I don't know why. This, of course, brought back sitting on the roof of Lloyd, singing snippets of "My Baby Loves a Bunch of Authors" and hearing jhave say, resignedly, "You know the Fruvous." (Well, duh. They're the choice of bookish nerdgirls everywhere.) That was shortly after we watched the bald eagle spiral out of sight over the mountain and shortly before I had far too much wine.

The hospital cafeteria has come up with something surprisingly good for breakfast. I forget what it's called, but it seems to be a mixture of egg and maybe masa flavored with cumin and chili and topped with salsa and cheese, then baked in a water bath. It's kind of like Migas for the Masses.

Speaking of migas, I have a surfeit of good corn tortillas and some excellent jack cheese. Hmmm. Breakfast.

I opened all the windows this morning (it's only about 60 right now) and the cat is loving it. She likes to sit on the bedroom windowsill and feel very butch.

Interesting is a curse.

God and I are going to have a little come-to-Jesus meeting.

I found out Monday morning first thing that the intelligent, polite, charming 21-year-old man I took care of prior to his brain surgery had a metastatic tumor, not a primary tumor as we'd hoped.

Quick definitions: "metastatic" means "arising from somewhere else in the body." "Primary tumor" means "started wherever it is and might go somewhere else if it gets the chance."

Metastatic brain tumors are bad news. Because of the way the body works, the brain is segregated from the rest of the body by something called the blood-brain barrier. This is, in short, the thing that keeps you from getting an infection in your brain every time you get sick. It's very difficult for critters, viruses, cancer cells, and drugs to cross the blood-brain barrier (with a few exceptions that I won't go into here).

See, cancer loves the brain. The brain uses pure glucose for energy--nothing else. A PET scan, in which slightly radioactive glucose is injected into a person's body to show the areas of high cellular activity, will show the brain and various glands as bright white. That means that there's a whole lot goin' on in those areas. It'll also show cancerous tumors as bright white. That's because cancer cells are normal cells with their inhibitions removed: they reproduce and use glucose at phenomenal rates.

If a cancer cell gets into your brain, it's in heaven. No immune response to speak of, nice soft tissue that won't keep it from forming a tumor and expanding, and all the food it wants. It's a tough trip to get there, but once you're there, man, you've got it made.

So this fit, handsome, charming young man has cancer *somewhere* (we don't know where) that's gotten jiggy enough to move into his brain.

And this is patently unfair. Mean people, I've noticed, tend to live for damn near ever with very few problems. The good ones get shafted.

Still, the fact that this kid is healthy and fit and has a loving family and a wonderful girlfriend works in his favor. I am remaining resolutely optomistic and refusing to believe that he won't get better. So many of our patients *do* get better that it's hard to take when one doesn't. I am therefore avoiding pessimism.

But God has got some explaining to do, and I hope He's ready.

Other things I'm avoiding

I'm avoiding replying to an email at the moment because I haven't found quite the right casual, insouciant tone to use in it. It's one of those emails that could be the fuse to a powder keg, and I don't want things blowing up in my face. Not in a bad way, you understand, but in a complicated way.

I'm avoiding thinking about how hard it is to get used to not being constantly off-balance. For years I was off-balance on a regular basis--not in a bad way, but in a challenging, interesting way. Things have settled down and gotten peaceful lately, and it's a bit tough to get accustomed to.

I'm avoiding wondering why creditors are calling my phone number looking for other people. With my luck, my identity has been filched and some bad guy is running up tons of debt buying junker cars under my name.

And, right now, I'm avoiding cleaning house.

Welcome to Stepford.

Be afraid.

It's just after noon now, and already today I have made breakfast for my boyfriend and done some sewing. Not only did I make breakfast, I made *popovers* for breakfast. Unfortunately, I was distracted by scrambling eggs as I took them out of the oven and so didn't pierce them quickly enough to keep them from sagging over sideways and collapsing.

We dubbed them "flopovers". They're still good.

After breakfast (sausage, eggs, flopovers, and a fruit salad with strawberries, pineapple, and blueberries) I pegged the legs of a flare-legged suit I bought on sale. Then I cuffed them.

When the nice guy from the fire department showed up to inspect the sprinklers in the apartment, he found this domestic scene: David on the couch with a cup of coffee, reading an article Dad wrote about reindeer being sold for meat in the 1920's. The cat at his feet, purring. Me sitting at the kitchen table, hemming a pair of slacks.

Very unusual.

Of course, twenty-four hours ago I was suffering with a sore throat and stuffy ear and general malaise. This sudden domesticity is probably just a symptom of the cold I've got.

Baby, I can't hang upon no lover's cross for you

The local PBS affiliate is running its annual pledge drive now and has a Jim Croce retrospective on. I had completely forgotten about Jim Croce's existence until tonight. Now I'm afraid that David will decide I'm too much of a dork to hang out with if I tell him that I really, really like Jim Croce.

The only drawback to the man's music is that I turn into a blubbering mass of sobbing uselessness every time I hear one of his sad songs. Which, frankly, are most of 'em. I think it's a consequence of growing up with a seven-years-older sister who listened to Croce during the peak of adolescent angst. Looks like a trip to Amazon is in order, just to get this out of my bloodstream.

In other news, I have one patient who's waiting to die at the moment. I've described dying before as being a lot like labor in that eventually the process takes over and the person is no more than a vehicle for the process. What I haven't talked about is the long, long period in the waiting room (as it were) while you all wait for something, anything, to start happening.

We're at that point right now with this patient. Her husband is worn very, very thin, and the hard part is just about to start. Unfortunately, she's not with us in any real sense of the word; she hasn't spoken a coherent word in a year or more, since she was mugged for her purse in a grocery shop parking lot. So it's harder for him; he has to make her come alive to everybody in an attempt to reassure himself that she actually was like that.

All told, I prefer the easier business of a stiff drink and Jim Croce and self-examination to thirty minutes in a room with someone whose loved one is dying.

The night before the morning of

Goin' in to work tomorrow, yes I am.

I've spent a very productive couple of days cleaning out and rearranging cabinets, buying groceries and making brisket and coleslaw and mashed potatoes, and spending Quality Time with David.

A note to the culinarily intrepid: do not eat at Big Time Bob's Burgers without a supply of diuretics on hand. The burgers are magnificent but have so much salt in them that you'll swell up like a pufferfish. I swear.

Did you know that some people go to the hospital for a hobby? We have three frequent fliers, two of whom are the equivalent of He Who Must Not Be Named for nurses. The third is rapidly approaching that status.

People who hospital for a hobby are uniformly crazy. There's no other explanation. They're not sick, exactly--they might have weird orphan diseases, yes, but other people with the same disease putter along fine for years without constant visits to El Schwanko Hospital Du Jour. Mostly they're addicted to painkillers that are expensive and difficult to get outside of official channels. I'm sure that Dilaudid is easy to obtain if you're, say, a roofer or a diner waitress, but most of our patients don't fall into the easily-connected-with-roofers category.

I mention this for two reasons: one is that I'll have to deal with, again, a patient who's on rotation through the nursing staff. She's that bad--nobody wants to assign her to the same person two days in a row lest the nurse's head explode. It's either that or I'll get floated to the cardiac floor; either way I'm not looking forward to my assignment.

The other reason is that Arlene is scheduled for yet another knee surgery tomorrow. You'd think that somebody who'd been literally run over by a motherfucking TRUCK and who'd had to have her knee replaced, oh, six times as a result would be grumpy. Or martyred, or at the very least addicted to heavy painkillers. Arlene is not. Instead, she sends me funny political cartoons and reminded me tonight that she was coming in. I have to remember to take her Jon Stewart tape back in to her.

I really hope that when my lifestyle catches up with me and I end a drooling idiot in the chronic-care section of the hospital, I can at least be a *funny* drooling idiot. The charming sort of drooling idiot who looks at the clock and says (as a patient of mine with dementia once did) "Somewhere, there's an opera going on." I want to be the sort of drooling idiot that people enjoy seeing come in, rather than one of these understimulated and overfed whackjobs who want *this* dosage of *that* pain medication.

Off to bed. Saving the world takes a lot of sleep.

Back from vacations, with a vengeance...

Canada was nice. The Hill Country was nice. Sunday alone in my apartment with nobody talking to me and not having to go anywhere was very nice indeed.

Which is a good thing, as the last two days at work have been Work with a capital W. I'm using words I haven't used since nursing school. Words like "polycythemia" and "hypoalbuminemia" and I'm having to actually look up lab results in my little cheat book to find out exactly what a RDW/WBC ratio is.

In other words, the hospital is full, full, full and we're getting patients that should be going to the other floors. In the last two days, I've had two blood dyscrasias, a huge abdominal surgery, a guy with a major eye problem that I won't go into here because I got thoroughly squicked, and a couple of broken and repinned legs. And toes. Toes with pins sticking out of them.

|||shudder|||

So today it's laundry, groceries (already done. David used his discount card at the store for my groceries; this must be love), bills and mail and checkbook-balancing, and playing with the cat. Later I might vacuum.

It'll be a nice change from trying to conduct three two-chamber IV pumps to push their contents into somebody who's suffering from fluid overload. It'll be a nice change from having to stock a room with sterile saline and sterile gauze *just in case* my patient's eye decides to pop out of his head. It'll be a *very* nice change from having to adjust traction and readjust pins and so on.

Georgia's post on Monday ...

...made me realize how much I've changed, physically, in the last 17 years.

Half my life ago, I had headshots taken by Mom, who's not such a bad photographer, in preparation for going to music school. It was standard procdure then to submit both tapes and photos; I don't know if it still is.

The Jo at 17 has a perfectly unlined face, enormous blue eyes, and lips that take up most of the picture. She has no discernable bones. She's vaguely sad-looking, as though teenagehood hasn't been what the teen-books in the local drugstore and newsstand told her to expect. (*snork*)

The Jo at 34 that looks back at me from the mirror has smaller eyes and thinner lips. She doesn't weigh 117 pounds; her weight now is closer to what people call "that size". She has wrinkles that show up when she smiles or is dehydrated or tired. She looks like somebody who has been through a number of ill-advised relationships, a divorce, nursing school, several deaths, a couple of really hard jobs...and has come out of it happier and with a better sense of humor.

It's funny, how we age. If we're lucky, we see more value in a mobile, lined face than we do in one that's forever frozen into fantasy. If we're lucky, we can count the rolls and lines and curves as badges of experience rather than markers of incipient decay. If we're lucky, we'll celebrate the first grey hair (Hooray! I'll look more like Dad!) rather than flipping out.

It's like the picture over my bed says: "What a relief that as we age we retain our scars on the outside, rather than on the inner cuff."

Dull is good. Creative is better.

The most exciting thing I did yesterday was dig a splinter out of Sparky's finger. Sparky is a physical medicine and rehab attending who works with spinal cord injuries. Her nickname is her own suggestion; everybody has nicknames at work.

Anyhow, Sparky came up to me with a splinter in her finger, so I washed it down with chlorahexadine, slapped on a pair of gloves, and popped that sucker out with an 18-gauge injection needle. Took about thirty seconds from start to finish.

We like dull days. Being a nurse on a neuro unit is a lot, I think, like being a cop: long stretches of routine punctuated by absolute frantic insanity. You learn to love the long stretches.

And during the long stretches, we get creative as only a bunch of over-intelligent, high-strung people with an assortment of issues can get.

Miss Italy brought an ancient Polaroid with equally-ancient film, so we took a series of sepia-toned candid photographs and posted them on the walls with appropriate captions. Those joined the brighter Polaroids that Carolita takes on a regular basis. We've also cut questionable pictures out of the fashion magazines provided to the patients and stuck 'em up on the wall.

Once in a while we'll line dance in the nurse's station. We sing songs. The only thing we don't do is roast marshmallows, and that only because the fire extinguishers would kick in.

And, of course, everybody has to have a nickname. We have T-Bird, C-Dog, Even Steven, Megace (that's a type of medication used to stimulate appetite), Amiemamie, T-Max (the maximum temperature a patient sustains over a shift), C-Lo (one of the neurology residents), Sparky, Peg Leg, Budgie, Judy/Judsie, Cindy-Lou-Who, Godlike Tim, and Carolita. Some of these people are doctors; most are nurses. It must make for an interesting time for the patients, as we've pretty much given up on formal names on the floor.

All this silliness drives the administration crazy. Pity the poor floor manager who has to put up signs in the break room about whose ACLS is about to expire: the pronouncement at the end of each posting is "Disciplinary action, up to and including termination, may be taken."

We don't take well to things like that. When somebody printed out and posted a picture of a well-endowed domme, complete with whip, just under the "disciplinary action" notice, it came down. We kept putting it up. Finally the administration gave up.

We got a "contract" about "customer service" a few weeks ago. Now, given that our primary mission is good health care rather than customer service, this was rather a shock. Also, given that our floor is the floor on which every VIP that comes into the hospital gets put on, due to the level of that indefinable "customer service" and the quality of care we give, we were a bit surprised. The memo--er, Contract--specified things like smiling when speaking to patients and helping each other out with lifting and so on.

I've worked all over the hospital, as have all my colleagues. The general feeling on every floor is that though we may be weird, we're the tightest group of nurses in the building and the best at what we do. So the Contract was insulting.

We signed it, though, and turned it in.

Three days later The Semi-Bigwigs came for a surprise inspection of the floor. We all, keeping the Contract in mind, walked around with rictus grins on our faces, saying things like, "Thank you, valued member of the health care team!" "No, thank *you*, my esteemed colleague!" "No, truly, you're too good to me!"

Not a word about the Contract has been spoken since.

This is why I love where I work: no matter the reputation we might have as tetchy, strange geniuses, we all pull together--and the other floors respect us. When Beloved John died, we chose a couple of representatives from the floor to go to his funeral. The rest of us planned to stay and work.

Until thirty minutes before the funeral started, when a phalanx of nurses from other departments strode on to our floor and started taking over our patients. They came from every department: cardiology, surgery, PACU, admitting. As a result, every single one of us got to attend John's funeral in our scrubs with our stethoscopes still hanging around our necks. By mutual unstated consent, we didn't remove the badges and doodads that mark us as nurses when we walked into the church, either.

Not a bad group to be a part of. Not a bad thing to do for a living.

General pains in the ass, or things I hate to do...

At work

I hate having to hand an attending's head back to him after he's bitten mine off in the nurse's station. Note to attending physicians who "know the protocol" and have "never had a problem like this before": if you really knew the protocol, you wouldn't have done the damnfool thing that caused you to have a problem.

And if you make your problem my problem, one of us will end up regretting the encounter. Hint: it won't be the short redhead with the bad attitude.

At home

Thank you, Nice Man From the Polka Club, but no, I don't want to go out with you. At all. I'm busy enough with work, boyfriend, travel, boyfriend, work, boyfriend, hobbies, boyfriend, and so on not to have any free time.

No, not even five minutes for a cup of coffee so you can get to know me better. Really.

And I'm washing my hair tomorrow. On Tuesday I'm joining a convent.

On the road

Yes, I'm returning from Canada. Yes, I was only here for four days. In Banff, actually. At the Banff Centre. Visiting a friend who's at an arts conference there. No, I didn't leave my bag unattended. Here's the list of what I have to declare. Passport. Government-issued ID. No, those are earrings. Yes, that is a small jade figurine for my sister. Because it's cold in Seattle and I thought my father would like a sweater. Alpaca. Yes, that's an animal product. No, no fruit. No, no wood with bark on it, either. No, no cheese. [Ed. note: cheese ?] Sure. Thank you. Have a nice afternoon.

Oh, Canada...

Perhaps that should be "Ow! Canada!" My legs feel like I've been hiking for three straight days. Wait a minute...

I leave here tomorrow. So far I've hiked up a mountain and a half, soaked my feet in a very cold river and my body in very hot springs, eaten Alberta beef and drunk the local beer, and had interesting talks on neurology and computing with high-tech artist types.

Quick highlights:
 
The view from the top of Tunnel Mountain after Joey and Magda and I hiked it after a huge lunch my first day here.

The feeling that Myocardial Infarction Was Imminent during that hike. (4,600 feet is a bit different, oxygen-wise, than sea level.) Joey tried to distract me by asking questions about how, exactly, the body manufactures red blood cells.

Seeing a deer trying to cadge a treat from a diner at the outdoor cafe at the Centre.

The sound of Bow Falls and the feel of the Bow River on very hot, very achy feet. Going in more than ankle-deep means you really feel the current.

The Grumpy Texan Scale for hikes: A score of 1 means it's flat, shady, and free of mosquitoes, with a bar 200 metres away. A score of 10 means it's the hike that Joey and Magda and I took the second day I was here--at the end of that one, I was gasping and sobbing for breath, saying, "Guys, I am NOT HAVING FUN!"

Helping Joey buy hiking boots. "Don't you have anything more...fashionable?"

Jhave mentioning casually that the Northern Lights two nights ago weren't as good as they normally are. (I missed them, dammit.)

The discovery that a size 10 in Canada is larger than a size 10 in the States.  Given that Tommy's Pub in downtown Banff has the best onion rings I have ever eaten (skip the elk burger, but definitely get the onion rings), this is a good thing.

Vincent's birthday drink last night, when Joey, Magda, Sue, Jhave, Vincent and I all sat on the roof of Lloyd and drank various adult beverages. At one point I tipped my head straight back and decided that they grow more stars here than they do anywhere else I've ever been.

If it weren't for the cat...

I would be here for another week. It's that good. So far this vacation has had everything: good food, cool nights, interesting conversations with attractive people, and great shopping (Christmas is pretty much done now). Joey and Magda and I are a two-thirds Polish Three Stooges: when we arrived at the halfway point at Tunnel Mountain, they looked out over the cliffs and river and Joey said, "Oh! It's so beautiful I will kill myself!" That is apparently some sort of Polish Inside Cultural Joke.

I have to decide today if I need another piece of luggage to haul home all the presents I bought. At some point, I'll go into Banff, but for now it's time for another cup of coffee.

Up, up and away!

Goin' to Canada today. I'll see you happy people in about a week.

Completely off any conceivable subject

Watch this:

The Art of Survival

See Canada Next...

My arrival in Canada, the first time I visited, was inauspicious. I got
there with US$20 in my pocket and a backpack on my back to find the
woman who was supposed to meet me...not there.



After wandering for an hour or so through the airport in Toronto,
wondering what the hell I was going to do, I heard an overhead page
calling my name. When I went to the ticket counter I was confronted
with two guys in coveralls and wool caps who offered to take me to the
hospital. Turns out the woman who was supposed to pick me up had
wrecked her car just short of the airport, and these guys had stopped
to help. They were working and so had to hurry, but they figured that
the hospital wasn't too far out of their way.



So I went with them. Their names were Chris and Pete. Strangely, I
remember that and very little about the hospital. I certainly remember
what they drove: a refrigerated container truck hauling fish. I sat on
a milk crate between the bucket seats in the front and breathed fish
fumes the entire way to Guelph, or wherever the hell the hospital was.



The trip improved, I suppose, but just barely.



So this time I'm heading to Banff, Alberta. There's a wealth of
information on Banff all over the Web--everything except how to
pronounce the name without sounding like an idiot. Pal Joey, who
invited me, promises aboriginal dances and spa days and hiking and
caves and fine dining. "There's not a lot of shopping, though" she
said, as though shopping were something I'd want to be doing in a town
with caves and hot springs and ptarmigans. And elk and bears,
apparently. Erp.



I arrive at oh-dark-thirty p.m. and have an hour's wait before I have
to catch the Airporter in to town. It's a two-hour drive, so I'll get
there sometime just after midnight. If I miss that one, I *think*
there's another shuttle that leaves later, but I'm unsure. I may have
to see what sort of overnight accomodations Calgary International can
provide.



Or just look for a fish truck.

A very productive day off...

Man A. and I woke up about six, dozed for a bit, then got up and had coffee and laid around for a bit. It's too hot to do much else. Walking outside feels as though you're stepping into a blood-temperature sauna.

Then I went off to Planned Parenthood for the annual Twiddly Bits Exam.

The phrase I never, *ever* want to hear again, coming out of *anybody's* mouth, is the one that came from the NP who did my exam: "I'm really pretty aggressive when it comes to Pap smears."

Once I'd escaped there, I went grocery shopping. I then came home and made broccoli-rice casserole--the white-trash kind with Cheez Whiz and canned cream of mushroom soup and Minute Rice. I'm capable of making quite a nice one with real ingredients, but once in a while I'm in the mood for a good old-fashioned Methodist supper casserole.

Then off for a haircut, then to buy two pairs of shorts and a bag to take to Canada next week. My duffel bag was too large and my backpack too small, so I went looking for the perfect five-days-in-Banff bag--and found it, at 50% off.

I now have everything I need for this trip: sunscreen, two pairs of shorts, a pair of hiking boots, a pair of sandals, a crushable schwanky dress, some t-shirts, and a swimsuit. Anything else would be overkill.

Now it's two-thirty. I've drunk five pint glasses of water, a pint of limeade, several small cups of water at the hair salon, and a Pale Ale. I've sweated out everything I've drunk, I think. Just keeping up with hydration in this weather is a full-time job.

So it's time for a nap. I won't be drinking water, but at least I won't be sweating.

...and this is why I love my outlaws...

The Erstwhile Hub has some of the best family in the world. His stepmother is a marvelous woman. His dad is the cerebral, hard-working type who can use a chainsaw without cutting off his fingers and design and build an aesthetically-pleasing and solid structure. His aunt and her partner are wonderful women.

This is why I called my ex-step-mother-in-law just now and spent an hour on the phone with her. My Outlaw Mam is one of those steel-ribbed, totally-no-bullshit women that this state grows now and then. I can let my accent come out with her like I can with nobody else. "I" turns into "Aaaahhh" and I use phrases like "bless his heart" that would make my Yankee parents cringe.

"My word!" she exclaimed when she answered the phone. "I have my toothbrush in my mouth--hang on a second."

Although it came out as "Maaaah worrrrrd! Igh hab mah toodbrdgh ib by boughth--hadgh ob a schlecogngh."

I told her quite frankly that the reason I hadn't called is that I had wanted the Erstwhile Hub/New Lover dyad to have a chance with them, without comparisons. After all, these people were my primary relationships for my adult life; it's only fair that she and Ex-FIL get to know them without my butting in.

And here's where she is *so cool*: She said *nothing* about them.

Not to me, not at all. She could've ripped on the both of them; I know that they've visited since The Debacle. She could've been gossipy and mean. She told me once that she liked me much better than she liked The Erstwhile Hub...but she was fair. And just. And refrained from commenting on them both.

This is why I love Mam. She's a better person, hands-down, than I am. She keeps her mouth shut even if it pains her. If there's something she has to say, she says it once and goes on.

That's something to aspire to.

Odds and Ends

Thirty-six hours at work in a row will make even the most gifted person nutso.

I'm not the most gifted person. Therefore I am absolutely exhausted and crazy at the moment.

I did, though, have four of the best patients *ever* yesterday: a back surgery, an implanted intrathecal pain pump, a brain tumor (benign), and a pituitary tumor (benign, but we didn't get all of it).

The back surgery patient reminded me of my ex-step-mother-in-law (the sane ex-MIL, that is). She and her husband and I just clicked immediately. When I found out that she'd had to put her beloved poodle down the day before she came in for surgery, I sent her a card and a flower from the gift shop. We can do that for free for patients who need it.

Her husband had a joke foot in a pants-leg that you could stick under the covers, in a drawer with the foot part hanging out, or (as I did) under your lab coat so only the foot hung out in view. We had a good time scaring the hell out of the residents with that foot.

The implanted pain pump patient was in his eighties, sharp as a tack, still living independently, and a generally fascinating man. He's what my dad will be in twenty years, God willing. He told me stories about being a cargo plane pilot in India in World War II, flying missions into Burma and China.

The benign brain tumor patient was my age with a wonderful family. She and her sisters and I sang songs in five-part harmony before she went to surgery.

The pit tumor patient was very young--20--and really scared, but I liked her immediately. She and I spent a lot of time talking about what her surgery meant and why her body was reacting the way it did and so on.

All in all, an emotionally exhausting but satisfying day.

Size matters

We have two people in this week who have major cranial defects. These are doctor-created cranial defects, and thus are better than the alternative. The alternative is having your cranium infected with nasty bugs or having your brain swell to the point that it squooshes up against the inside of your skull and dies.

When I say "major", I mean major. As in half of the top of your head is gone.

Bone flaps out bother me. The small ones I can handle without any problem, but the big ones still give me pause. There's just something about talking to someone who's perfectly rational and normal and happy but whose head slopes away into nothingness just west of midline that squicks me out.

I never realized until I started seeing this on a regular basis how much space there is between your brain and your skull. I always thought that the brain was packed in there, nice and neat, like a suitcase packed by someone more talented and patient than I. For the most part, that's true--there's not so much space there that you could swing a cat. But the difference between perception of "not a lot of space" and the reality is huge.

The reason having half your head gone is disturbing on an aesthetic level is that most of the stuff that shapes our skulls is on the outside of the bone. Think about the top of your head for a minute: you think of hair and bone, right? You've forgotten about all the muscles in your scalp, all the tendons and ligaments that connect this to that, all the padding that goes on top of your brain-case. If you take that away, you end up with somebody who looks fine in profile (from one side, anyhow) and who looks like a scooped-out melon from the front.

Plus, you can see the pulse of the brain through the skin. Yes, the brain pulses. It doesn't just sit there in your skull humming popular songs to itself; it has arteries and great big ol' veins that feed and drain it. Cut a hole in the skull to take a look at the brain and the whole thing is pulsing quietly away. I'm sure that sometimes it's humming popular songs in time to the pulse, but I can't hear them from the outside. Take the protective bone away, though, and the whole shooting match becomes quite clear: this lump of cholesterol and nerves is jammin' away inside your skull.

Speaking of major defects

We have one orthopedic surgeon who's quite fond of narcotics. For his patients, that is, not personally. The people he operates on get a scheduled list of huge doses of things like OxyContin and Lortab. This makes them, since they're usually older and not equipped to handle drugs like that, prone to going nuts.

I had one of his patients yesterday. The previous day she'd been fine, if a little focused on her bowels. Yesterday, though, she was confused and impulsive, trying to get out of bed and wander down the hallway. After a number of phone calls and various tests, we discovered that she didn't have a pulmonary embolism, didn't have blood clots in her brain, and was probably suffering from narcotic overload.

Which is a comforting thought--stop the narcotics, and eventually you'll stop the problem--but meanwhile, I had to keep running hither and yon to keep her from hurting herself.

With confused patients I can usually take anything in stride. This woman yesterday, though, had me longing for a drug I could abuse. For some strange reason, she frustrated me no end. I was at the point of losing my temper with her, though what was happening wasn't her fault at all.

That makes you feel bad. I don't expect to like every patient I have simply because they're sick, but I still feel bad when one of them makes me want to scream.

Plus, there's the worry that they won't ever get better. Most of 'em do, of course, but you still wonder.

Tomorrow I start a three-day run. Monday, Tuesday, Wednesday is generally the hardest thirty-six hour stretch at work, given that we have surgeries galore on those days. I am not looking forward to this at all. I do, however, have four days off in a row just after this run, so I can look forward to *that* instead.

At work, even when I'm not at work.

As virtuous men pass mildly away,
And whisper to their souls to go,
Whilst some of their sad friends do say,
"Now his breath goes," and some say, "No."

Manny died last week. Manny was one of those guys you saw everywhere and knew well enough to shoot tequila with, even if you didn't ever have dinner with him.

He was short and had very long hair. After three shots of tequila a couple of Hallowe'ens ago, I told him he was the second long-haired Mexican I'd fallen instantly in love with in my life. He laughed and laughed at that.

He drummed. He was on *fire*. And he sang and boogied and generally made parties more fun and boring nights at the bar interesting.

Wouldn't you know he had a brain tumor. It killed him eventually, the way glios always do. He was 45.

Yeah, well, fuck you too.

I've been on one of the receiving ends of some rather nasty commentary today.

A friend of mine is trying to leave her husband.

Unfortunately for her, the husband in question is a control freak who's torn her down bit by bit over the years until she lacks the spine to get the hell out. He says she's too fat, not fertile enough, stupid (rocket scientist, anyone? I ask you), not perfect enough, whatever.

He's an arrogant bastard. If ever I get the opportunity to meet him, I'll happily push his teeth out the back of his head.

Apparently, some mutual buddies of ours see my advice, and others' advice to Friend Who's Trying To Leave, as "shrill." As in, "you're self-appointed experts, so shut up and just sit there." Thank God I'm not the only one that the Perfect Crew has bitched at today.

I'll show you shrill.

Shrill is the feeling you get when you've turned yourself into an acrobat trying to make another person happy and he still fucks around on you.

Shrill is the noise you make when you finally discover that no, you're not a mean person or a bad person and yes, people actually do like you for yourself.

Shrill is the sound of your own voice when you hear the person on whom you've built your life suggesting that it might be nice to turn your twosome into a threesome.

I take that last one back. Shrill is the sound your car tires should be making as you leave that sorry ratbastard.

This is not an apology

I have a great idea for anybody who thinks I'm too "shrill": *You* come home sick from work to find your husband and your best friend of 16 years just out of the sack. *You* move out of your house in four days--or better, do what I did: Have your husband be so anxious to be rid of you that he moves you out.

You spend an immense amount of energy and time trying to make somebody else happy, just to watch it crumble in the face of something new and different.

I will lay you even money that you couldn't do it. I would happily lay you double-to-nothing that you couldn't come out of it as well as I have.

And you know what made it possible?

The memory of all the shrill voices of my friends. They screamed at me for years that The Erstwhile Husband was a jerk, not treating me right, taking advantage. They wondered out loud, shrill-ly, why I was putting up with the passive-aggressive bullshit he laid out. It was those echoes that made me tough enough to leave.

When somebody you love is being hurt by someone not fit to black their boots, you must be shrill.

At the end of the day

When it's all said and done, I'm not bitter about what happened. I am extremely bitter, though, about people who discount the passion that fondness for one person can make a group of people exhibit. I'm quite jaded about the folks who sit back when they know somebody's being hurt and abused and say, "Oh, well, it'll all happen as it's supposed to; just let it ride."

Sometimes you need an intervention.

And, had this not already been an extremely weird and unpleasant day, I'd be staging one right now. Me and my anodized pink practice bat.

Yesterday

Earlier

"My husband needs help scooting up in bed" the woman said.

Her husband had just walked 75 feet without help, two days after very minor surgery.

But I went into the room anyhow. Sure enough, he was lying in bed, all six feet two inches of his college-football-player self, with his feet pressed against the footboard.

"I need to move up in bed." he said.

I replied, "Then I suggest you get out of bed, take two steps toward the head of the bed, sit down on the edge of the bed, and lie down again."

"But I've been moving myself *all day*!" he protested.

"Tough," I said. "No way in blazes am I going to lift you in that bed. You're a foot taller than I am, a hundred pounds heavier, five years younger, and in good shape. You'll have to do it yourself."

Later he complained that I had embarrassed him in front of his friends. "Son," I said, "you're lucky I wasn't trying to embarrass you. Weren't you ashamed to have to ask me to do something you knew damn well you could do yourself?"

Later

Merging onto the highway on the way home from work, I got behind one of those people you just know are going to be trouble.

Sure enough, she merged on to a six-lane, busy highway at 35 mph.

She then proceeded to cross two lanes (with signal; I'll give her that) at 40 mph.

This in an area where traffic in the slow lane routinely moves at 60.

I lost sight of her as I strained my poor car's engine to get out of her way.

Even Later

Getting *off* the highway to come home, I almost died.

The exit that I take is short and uphill. At the end of the uphill bit, there's a quick swing to the left, a double white line (DO NOT CROSS DOUBLE WHITE LINE), and then a stoplight about a hundred yards downhill.

The person in front of me stopped. Dead. Just on the other side of the hill. Apparently they don't have merge lanes on service roads in Tennessee. That's the only reason I could think of as to why Mister Tennessee Plates On The Minivan Man would simply...stop. In a lane of traffic where everybody's coming off the highway like bats out of hell.

Which left my ass hanging out behind his, vulnerable to the next lifted Dodge pickemup that barreled over the hill. I beeped, quickly and politely, to remind him that he needed to get out of the way, and that it was possible to do so without CROSSING DOUBLE WHITE LINE.

Oy. He did, thank God, get out of the way. And I got home alive, just barely.

The things you learn watching TV...

I rarely watch TV. Therefore, on the days when I work out in the weight room, I make it a point to find the baddest TV possible and really immerse myself in it.

Today it was three miles' worth of treadmilling to a movie on the Sci-Fi channel called "Arachnid." Arachnid is apparently Latin for "movie so bad it'll make you giggle and almost sprain your ankle."

Here's What I Learned

Spiders large enough to kill people are bulletproof.

They therefore must be killed by a man with a machete.

Not just *any* man with a machete, however. The machetes of Loyal Amazonian Natives Who Guide The White Folks Through The Jungle are apparently not good enough.

Further, spiders large enough to kill people spit poison and have nasty screams and icky bitey parts.

The poison, however, has no apparent effect on Our Hero. Even though a loogieful of poison is enough to knock a Loyal Native Guide and The Friendly Acceptable Black Guy In Fatigues out of the action for twenty minutes, it does not affect the hero.

Nor do the icky bitey parts. A love tap on the throat with said parts is enough to kill the Learned Spanish-Accented Entemologist but the same bitey bits won't penetrate Our Hero's neck.

A Learned Spanish-Accented Entemologist can produce a surprising variety of agonized cries even after a Big Spider has eaten eaten his throat out.

The Cute, Busty Curly-Haired Nurse will get it first (after all the natives have been eradicated, that is, and just before the Acceptable Black Guy bites the dust). This makes me wonder about my idea of doing medical missions.

A public service announcement from your friendly neighborhood nurse

Several years ago, while chatting with my sister on the phone, I learned that she didn't have a first-aid kit at home. I was shocked. Even though I don't have one myself, I strongly believe that everybody *else* should have one, just so they don't call me at 3 am for advice on what to do with a bleeding finger.

Here's a list of what I keep in the ol' casa, even if it's not all in the same place:

The Ideal First-Aid Kit

1. Band-Aids of various sizes, including a box of those hideously-expensive clear ones that you can leave on through a shower or two. I don't use any sort of Band-Aid very often, but the minute I run out you can guarantee that I'll slice a finger wide open somehow.

2. An elastic bandage, two inches across. You only need one. If you sprain an ankle falling over the cat, it's nice not to have to hop down three flights of stairs, hop into the car, and try to drive a standard transmission vehicle to the store to pick up something with which to wrap said ankle.

3. A bag of frozen peas or corn, for ice-packing.

4. Gatorade powder, Dramamine or Bonine, and maybe some Pedialyte frozen popsicles. Nothing's better to combat a case of the stomach flu or a really toxic hangover than Bonine/Dramamine and Gatorade or Pedialye. Mix the Gatorade half-strength; drink the Pedialyte or eat the pops straight. This will help you not get too dehydrated when you're garking up every meal you've eaten in the last two weeks.

You might notice that there's no Immodium or similar anti-diarrheal there. That's because, if I have the runs, I'm not going anywhere anyhow. Besides that, if there's something irritating your intestines to the point that your body's trying to expel it, you really *need* to get rid of it, not let whatever-it-is sit around in your gut doing more damage.

5. Aspirin. I don't take Tylenol or acetaminophen-containing things because I challenge my liver quite enough as it is, thank you. If you have more than two drinks a week, you probably shouldn't take acetaminophen, either. It's tough on your liver, and you need your liver.

6. Sharp-pointed tweezers, a pair of bandage scissors, and strong medical tape. You can fix almost any problem with those things.

7. A hot-water bottle. Champion for cramps and muscle strains.

8. Hydrogen peroxide and alcohol, bought in bitty bottles and replaced every few months (the peroxide, that is; the alcohol will keep forever). Buy 70% rubbing alcohol--stronger is not better when it comes to topically-applied alcohol. In a pinch, you can use at least forty-proof liquor for disinfecting cuts, though I'd personally stay away from rum or anything flavored.

9. Double- or triple-antibiotic ointment. Yes, you really ought to have some of this lying around, just in case.

10. A bottle of el-cheapo saline solution, the sort used for contact lenses. I'm not talking about the protein-removing no-rub solution, but the plain old 0.9% saline. It's handy-dandy for washing out cuts or open blisters. Back when I had dogs who were clumsy and/or enthusiastic about running into sharp things, I went through a big bottle every month. It's only 99 cents at the drugstore, if you get the store brand, and when you have a cut that has ook embedded in it, nothing's better for getting the ook out.

There you go. Aside from the Gatorade, hot water bottle, and frozen peas, you can stick all of this stuff on one shelf in your bathroom or kitchen and be prepared in case you end up as ungraceful as I am.

This is how it goes.

The pediatric patient I wrote about a couple of days ago? She smiled at me today.

Made my entire *week*.

I also had a great conversation with an 88-year-old woman who'd left college when her mom died to raise her two younger brothers...just before WWII started. Amazing.

And a third patient, a woman whom I'd admitted a few days ago, said "Don't tell any of the other nurses, but I think you're better than any of them. I like you."

Some days are just great, and then there's the gravy....

Like pulling up to the local drive-in burger place and seeing a woman who used to be an old patient of mine from Planned Parenthood, some six years ago. She has three kids now and is about to go back to school and looks happy and well and healthy.

Good things about being single

1. You can clean the entire place and an hour later, it will still be as you left it.

2. You can clean the entire place in an hour, since you don't have to have a place big enough to house multiple people.

3. Ordering pizza with what you like on it, not what somebody else likes on it.

4. Two beers is enough.

5. Never finding your toothbrush inexplicably wet.

6. The seat *stays* down.

7. Laundry. Not as much of it, that is.

8. Walking around naked in your place without having somebody else grabbing you, snickering at your butt, or commenting on your cellulite.

9. Dates. (this might also go on a "bad things about being single" list)

10. Not having to wake up next to anybody unless you want to.

Oh, my freaking God.

This is going to be another one of those hard things to talk about. I will, however, provide happy snippets for those willing to slog through the difficult stuff. They'll be down at the bottom, so be patient.

Background

We are not an all-purpose hospital. There is no obstetrical or labor and delivery unit, there is no dedicated cardiology unit, there's no pediatric unit. We work with several other fine hospitals within spitting distance with those things, so we don't do 'em. We do neurology and plastic surgery and tricky cancer treatments. Specialization means quality care in some cases.

However, once in a while we get a pediatric patient with something that the kid-doctors across the street don't feel comfortable treating. That was the case this week, when I got a teenager from the ICU.

She has a fairly rare blood disorder that can cause problems with clotting and hemoglobin levels and so on. She'd stroked out once as a child, and we'd done some stuff in concert with the child specialists to try to keep her from stroking again.

Unfortunately, the things we did didn't work. Worse, they screwed her up royally. This happens once in a while; you can't predict if or when a coil or clip or stent is going to come loose or migrate. You can't tell which patient is going to bleed suddenly and require emergency surgery. She ended up in the operating room getting a frontal lobectomy (chopping out a piece of brain to save the rest) after a major bleed and uncontrollable swelling put her life in danger.

Foreground

She came back to me two days ago. A month before she had left our floor on her way to the OR talking, laughing, walking, and with a wicked sense of humor. She returned with a dent in her skull, eyes that won't go to the right, and no use of most of her body. She's got a tube in her stomach, a tube to breathe through, a tube in her bladder, and a vacant expression. She knows what's going on, to a large extent, but is trapped behind the wall that repeated brain injury puts up.

They'd kept her in the ICU for a month to make sure she was stable. During that time, her hair matted and her skin got ashy and yeasty, nobody really talked to her...it sounds horrible, but it's the way of intensive care: you're more concerned with keeping your dying patient alive than with making sure they're clean and stimulated.

Still. I scrubbed her down yesterday and the washcloths came out black. Not the usual caramel-brown coloring that you see when a dark-skinned patient sheds skin cells, but black. With dirt. And sweat. And old shed skin. I cut the mats out of her hair and noticed that in some places she was bald--the matting had gotten bad enough that the hair had been pulled out by the roots. I rubbed her down with cocoa butter from head to foot in an attempt to soften some of the dead skin on her scalp, her back, her arms. I used a pick on her hair until I got the worst of the tangles out. During the entire process, she didn't grimace or fight me; she just laid there, occasionally closing her eyes and moving slightly into my hands as I rubbed her down.

Her mother was amazed at the change. Her pediatrician and I were furious at the state she'd gotten into. Most of the nurses at our hospital are white, and this kid was black. It's not that nobody took care of her *because* she was black, just that white folks don't generally know what sort of special care black skin and hair requires. Frankly, at a certain point, you have to get over your own fear of looking like some sort of ignorant cracker and *ask* how to take care of hair and skin that's different from your own. If you don't, your patient will end up with bedsores and broken skin and compromised health.

It wasn't just that she was dirty. It was that nobody had thought for a minute that she might need different care than they would, if they were lying intubated for a month in a bed.

A rare occurance

I almost broke down, talking over her case with the pediatrician. We ranged over social issues to personal issues to family issues, and I just got more and more frustrated with how my patient and her family had been treated. There was much more to it than her cleanliness, believe me. It was like her family, because they're quiet and shy, had just been forgotten.

But dammit, things will be different now. They *will* be. This girl will be clean and comfortable and happy. And someday, if I do a good enough job, she'll recognize me and smile at me like she does at her doctors and her mother.

Happy moments from the past week

1. A charming older man calling me an angel simply because I brought him a cup of coffee.

2. Hugs from the biker couple who'd dreaded coming in to our facility, thinking that nobody would respect them or treat them well because they both have multiple tattoos and leather vests.

3. The response from my patient's pediatrician when she saw the care I had given her patient.

4. Seeing some of our residents circulating back in after a rotation at a different hospital.

5. Flirting madly with an 89-year-old patient with myasthenia gravis and seeing him smile.

Unscheduled non-job fluff

Today's Phone Conversation From Weirdland

*ring* *ring*

Me: Hello?

Voice: Diane?

Me: Beg pardon?

Voice: Is this Diane Wilson?

Me: Nope, sorry. Wrong number.

Voice: But your name is Wilson, right?

Me: Yep, but I'm not Diane.

Voice: Oh. Um...do you happen to *know* Diane, or where I could get in touch with her?

A Stupid Thing To Say

At the convenience store this morning I was faced with a thin young man with dark wavy hair brushed ever-so-slightly forward and a pair of wide clear grey eyes. Heavy eyebrows, well-shaped lips. Slight gap between his front teeth. Entirely too young to be away from his mama, but cute as a collie pup.

He let me buy Certain Restricted Items after I rattled off my birthdate (my ID was in the car) and assured him that I wasn't the ABC in disguise.

Then I asked, "D'you ever get sick of people telling you you look just like Frodo?"

"After I did that nice thing for you!" he protested.

"No, no," I said, "I meant it in a commiserating, I-look-like-Molly-Ringwald way. Really."

He said, "Yeah, I do, kinda."

Fuck this shit, man.

After three weeks of diet and exercise, watching my fat intake and cutting out alcohol, running on the treadmill, lifting until my shoulders groan, and generally being miserably hungry and sore all the time, I discovered this morning that I am now too large to fit into the clothing that fit three weeks ago.

From here on out I'm going to live on Whoppers and Bud.

Pity my poor sister

My sister and her boyfriend just adopted a new dog. He's an American Bull Terrier cross (that's Pit Bull to all you non-technical readers) who is dignified, calm, affectionate, and watchful. He has only one apparent fault so far, and that's a certain exuberance around pups of the opposite sex. This wouldn't be a problem, except that he weighs sixty-five pounds and is solid muscle. Exuberant muscle is hard to deal with.

Beloved Sis and Lucky Man have decided to give him a few weeks to make sure that he's trainable--or rather, that they can train him out of lunging, enthusiastically and affectionately, at female dogs. If they can't, they'll return him to the adoption service. I have no doubt that he'll do fine.

So I'm going to sally out tomorrow and buy them a selection of the finest noisemaking dog toys available on the market today. Beloved Sis sent my old Greyhound a Screaming Monkey toy (bite it and it screams "ayaaaa ayaaaa ayaaa aiiiiii aiiii aiiii aiiiii") that the dog loved. Her dog is getting two. And some Kongs with holes for treats. And squeaky things. And jingly things. And, if I can find it, something noisy that glows in the dark.

I owe my sister a lot.

Pity my poor downstairs neighbor.

Last night I stayed up until well past midnight, cleaning and lecturing myself on not being a dickhead (see previous post). At about midnight-thirty, I opened the door to the porch, intending to let in some fresh air.

Instead, I disturbed a sizable red wasp that had been perching there.

Cue thumps, bumps, and "EUGH! BLAR!" noises as I knocked it off my shoulder onto my foot, off my foot onto my shirt, and off my shirt onto the wall.

Quick cut to me panting, retreating across the suddenly-very-small apartment, searching for something with which to whack the wasp.

I ended up killing it with a rolled-up copy of my Advanced Cardiac Life Support review text. It took a lot of whacking and much dancing around to avoid the dying, drunken, broken wasp as it attempted to take its revenge.

Eugh. Blar. Yuck. |||shudder|||

Land Mines

Just after I got divorced (well, actually about five months afterwards), friend Juliet told me that I should watch for land mines. "Land Mines" being defined as "canalized ways of thinking that worked for you in the past but now will throw a monkey wrench into your life."

Background

The man I was married to had a crazy mother. I don't mean Collected Precious Moments Figurines crazy; I mean Threatened to Shoot Us On Our Wedding Day And Never Really Improved crazy. I was probably the only bride in recent local history who chose her wedding dress with an eye to how well it would hide a flak vest.

Looking back, I think that probably should've been a clue.

Anyway.

TMIWMT went crazy, slowly, over the nine years of our marriage. Part of that was very likely my fault--I made demands on him that, had he had fewer stresses or a less-nutso family, he could've probably handled. I couldn't see that, though, and so kept pushing and pulling and yelling and generally making his life harder and harder until he couldn't see any way out besides fucking around on me. For him to do that means that he must've been miserable beyond expressing. I know I was.

So. Crazy mother who makes crazy demands, like "come over this very minute and clean my house, which means taking a shovel to the piles of rotten food all over and the dead rats and so on". Crazy schedule trying to start a variety of small businesses over the years and keep them going. Craziness in that he went to California and ended up working for another crazy person and staying away for better than a year.

Given that this was the first significant relationship of my adult life, and given that it lasted twelve years, you can see what I'm up against in the Land Mine department.

Foreground

Pal Keith can probably attest to the fact that when somebody gradually goes nuts, you don't notice right away. Instead, if you love them, you try to make them saner by changing your behavior and your reactions. (Parenthetical note: this is why the saying, "You can't change a person, but you can change your reaction to them" is so damning. It ought to be "You can't change a person, so run the hell away if they're nuts.")

Everything will eventually, if you're involved with a real nutcase, become your fault. Note here that I'm not talking about abusive relationships; that's a whole different kettle of fish. Abuse, be it emotional or physical or both, involves one person purposefully destroying another person's sense of self in order to gain and maintain control of them.

Being involved with a nutcase involves a person pushing aside their own ideas of what's sane and second-guessing their reactions in order to try to make things normal. Eventually this becomes second nature. Then you're really screwed.

Where I am now is screwed

Man A. and I reconciled a couple of weeks ago. I like him. A lot.

Tonight he's over at his mother's house, fixing some stuff she can't fix and doing a couple of quickie remodeling jobs. I'd like to see him Friday, but he's not sure how work is going to be, so I might not get to.

Work. Mother. Work. Mother. Work. Mother.

You can see the land mines here, right? Thought you could.

A normal person would say, "Gosh, what a nice guy Man A. is. He's helping his mom out, his nice, sane, normal, charming mom..." (I've met her and know this for the truth) "...and isn't that responsible and caring of him? Isn't it nice that he comes from such a close-knit family?" A normal person would understand that occasionally work is crazy-making, especially when you cook for a living.

Unfortunately, I am not normal. I am canalized to believe that Mother and Work equal Abuse and Desertion.

So I've been cleaning the apartment for the last two hours, talking out loud to myself in an attempt to defuse these particular land mines.

1. I get frightened when Man A. doesn't want to see me right now or can't drop everything to do so. This is totally unreasonable on my part. For God's sake, he's a grown man with a family and so on. Besides that, if he were clingy and remora-like, I would be flipped out by *that*.

2. But there's still a little, irritating part of me that curls up into a ball and rocks back and forth when he says we might not see each other this week. That's the part of me that spent fifteen months asking her husband when he would come home, and another seven years keeping dinner warm for him when he worked late.

3. If I could cut that whimpering part of me out and throw it away, I would. In a second. Because that's the part of me that's scared of everything, and being afraid makes me treat people unfairly and illogically.

4. Unfortunately, you can't cut tumors out of your soul as easily as you can cut them out of your body. So that whimpering bit is staying for now, and I'm not really sure how to deal with it, other than by making very sure that I treat Man A. well, without the whimpering bit's influence. Or with as little of it as I can manage, at any rate.

These are land mines. Clearing a field of land mines, especially when it's your entire life, pretty much, is hard.

Do they sell special boots for this?

Surly to bed, surly to rise...

It has been a Vaguely Grumpy Day. Maybe it's the heat. Maybe it's the humidity. Maybe it's lack of sex. Maybe it's lack of beer. Maybe it's lack of calories.

Yesterday, however, kicked ass. I went to a nice little scrub shop in the next town over that was packed *full* of interesting scrubs. I have a reputation at work to maintain, being the only nurse there with sushi scrubs, scrubs with cowboys on 'em, and scrubs showing Stepfordesque women who obviously love their appliances. Thanks to Beloved Sister for those.

The Haul yesterday was as follows:

One pair royal blue scrubs with multicolored embroidery around the neck and sleeves. The top made me think of saris.

One top with chickens on it. Chickens. I ask you, what less-likely pattern could you find for a scrub top?

One top from French Kitty, with winking Mod cat-faces on it.

One set of scrubs in a bluish lavender, which will undoubtedly freak out my coworkers, since I hate pastels.

One set of Dickies dark denim scrubs.

Two pairs each of navy and black pants.

And, when I got home, my white Dansko clogs had arrived. And, on the way up to my apartment, the nice man from the building across the lot gave me several fresh-caught sea trout filets. Not that I know what sea trout is, or what I ought to do with it, but I'm going to experiment tonight.

The marine life around here ranges from the inadvisable (gar, anyone?) to the bizarre ($10-per-pound scallops) to the acquired taste (squid and catfish and other things too strange to mention). I'm thinking that "sea trout" might actually be a name for something you don't really want to know much about. Like "monkfish". I saw a monkfish in a seafood shop once, still wholly corporate, and had nightmares for weeks.

Anyway, back to the scrubs. I think I might just be grumpy today because I have all these amazingly nifty things to wear to work, and I still have today and tomorrow off. The feeling of being cheated will stop abruptly at 4:20 Thursday morning, but for now it seems as good an explanation as any other.

Hell Cat said I should eat, nap, and get up again in a better mood. She said it works for her. She and I had salmon for lunch (her portion plain, mine with pesto) and now we will nap.

Later I will clean the oven and mop and vacuum and then sail out in the evening for a nice little drink at the local bar.

And perhaps I will be less surly tomorrow.

This is why I was grumpy.

This is hard to talk about

I work with a nurse's aide who is a very sweet person. Not the sharpest tool in the shed, unfortunately, but very sweet.

We've been having problems with vital signs being made up or not taken, input and output numbers being very, very wrong (this is a problem on a unit where I&O is a huge part of watching for trouble), baths not getting done for days...

...and, a couple of weeks ago, a situation that happened with a patient of mine that put them in danger. The aide did something that I had talked to her about a number of times before that's absolutely inexcusable. And this time, it hurt somebody, and I had to pick up the pieces.

We talked about it yesterday. I had finally snapped and sat down and vented about the problem with my coworkers over lunch. One of the other aides offered to speak to this particular person, and did, but (I suspect) did it in a not-very-graceful way.

So she came to me and we talked about what had happened.

She protested that a) she'd found the personal sitter with the patient doing the same thing, and b) that this wasn't something that was worth getting upset about.

My response, with my voice soaring higher and higher and my temper becoming evident, was that a) I don't give a damn what an untrained sitter does, *you* don't do the same thing, b) I'd talked to you about this very thing multiple times before, and even taken it to the supervisor, and c) if a patient nearly coding wasn't enough to get upset about, then what was?

I want to cry out of frustration and anger and disbelief every time I review that conversation in my head. This is not the first time we've had this talk, nor is it the first time that some of this stuff has been brought to her attention. I've talked to the supervisor about it, and our supervisor has said, "Well...I'll talk to her. We'll work on that."

Unfortunately, talking doesn't seem to be working. And it's gotten to the point now that I don't feel I can trust her--after comparing notes with the other nurses--to even take vitals or write down proper intake and output.

Not that I'm perfect by any means. Paperwork is my thorn bush, and sometimes I forget to put things down, too...but at least I don't make shit up.

And I simply don't have time most days to either do this stuff myself or to check her every move.

So I don't know what to do. Aside from keeping a written record of every time I notice something wrong or off and presenting it to the supe, I mean. And like every other person in a tight working environment, I don't want to look like a troublemaker.

Actually, I wouldn't mind looking like a troublemaker or like I'm targeting this person (because, frankly, I am) *if it meant that something would get done about her.* The problem is that I don't trust the supervisor to make a tough call. That would mean that I'd launched some sort of Safety Jihad with no real results.

*sigh*

This will require much thought and a lot of fast footwork to keep up with her for the next several months.

Grumpy Nurse.

Grumpy Nurse would like to make the following public service announcements. Sit down, read, and shut the heck up.

Things not to do in the hospital

If your children do not know how to stay in your room, instead preferring to run up and down the halls, playing on the equipment and entering other patient's rooms, please do not invite them to visit you on a Sunday afternoon.

If you have a particularly obnoxious child who tries to grab charts to read them, asks personal questions of the nurses and patients, and screams when it doesn't get its way, that child will be bound, gagged, and sold to Kurdish yak herders at our first opportunity. I'm not joking.

Please do not invite twenty of your closest friends to have a party in your room, complete with alcohol and loud music. Yes, this has actually happened.

Please do not complain to us about the food service. We have an excellent chef. You get a menu each day, with the option of substituting *anything you want* on that menu. If you want lobster and steak, some poor schmo will have to drive out and get it for you, but we'll do it.

If, however, you don't bother to fill out the menu, don't bother to call the food service number on your patient information card, and don't bother to let the visiting dietician know your food preferences, you cannot bitch. Unless you tell us, we have no way of knowing that you're allergic to lettuce, tomatoes, and bran. Unless you say something, we can't know that you don't like salmon. Unless you say something, you might just end up with a big plate of shut-the-fuck-up rather than the macrobiotic diet you're whining for.

Back to children: Do not allow your children, no matter how cute they are, to play with the call bell. If they pull it out of the wall, your nurse (me) will respond as though there's an emergency. You won't like that.

Do not pat, stroke, or attempt to kiss your caregivers. I would've thought that this was obvious. I don't care who you are or how many planes you own; if you grab my breast, there will be a confrontation that only you will regret.

Things not to say to a nurse

Grumpy Nurse thought we'd already covered this, but apparently some of you are slow learners. Therefore, here's another round:

"You must make a lot of money."

Um, not really. Today, however, after taking care of *you* for ten hours, with two hours still left on my shift, I am definitely in this for the money rather than any feeling of satisfaction I get.

"Are you married? Do you have a boyfriend? Would you like to meet my son?"

I'm not even going to get started on how inappropriate these questions are. Perhaps the only one worse is:

"How about you come home with me and be my personal nurse?"

Yes, I have gotten that question. Not, as you might think, from nasty men, but from elderly women with more money than sense. They're generally the same people who try to tip me (more on that in a moment). For some reason, really rich people seem to get the idea that they can purchase or squeeze anything out of anybody else.

"Here. Take this and buy yourself something nice." (Usually said as the patient is trying to hand me a twenty-dollar bill.)

Let's get one minor point straight right now:

I am a professional. I may be funny and cute and cuddly and make you feel better, but I am not your friend. I am a nurse who is paid to keep you alive, help you get better, and take care of your complex and dangerous problems.

Do not even attempt to tip me. In doing so, you're insulting me and demeaning my profession. I know what nursing was like in the 1940's and 50's; I can read history books. Things are not like that now, however...and I doubt that any nurse who took pride in her profession, at any point in time, would ever have been flattered by a tip.

Besides that, everything nice that I want costs way more than twenty bucks.

"Bitch. Cunt. Motherfucker."

It is always inappropriate to curse at the person who has control of the catheter, the needle, the IV drip, or the medications with narrow therapeutic indices.

I've never yet been sadistic--but it's been a temptation. It's a little-discussed fact of nursing that, when faced with an openly abusive patient, we tend to fantasize about pulling on Foleys or leaving wrinkles in the sheets. Those of us who are sadistic are sociopaths who rightly end up in court, but we all have those moments.

Do not abuse your nurses. We are doing the best we can. We cannot be six places at once, or do more than three things at once.

If you're very unlucky, you'll be like the man who cussed me out last Tuesday. I leaned down next to his ear and whispered, "You have the choice of being nice and getting help, or being mean and being alone. If you say those things again, I will walk out of here and not come back."

Have I made things a little clearer?

I certainly hope so. If you have any doubts that what you're about to say or do is appropriate, nice, kind, or necessary, please don't say or do that thing. Thank you.

I would really hate to subject you to a lecture about how to be decent.

And, if after all of this, you still persist in being an ass, there's always the county hospital (aka Bedlam) down the street. I'd be happy to transfer you there.

Never give in to a craving for cookies.

I suppose I should've known on Sunday night

Sunday night, as I was getting ready for bed, the water pressure dropped significantly. In this town, that means that somewhere there's a broken water main, and you'd better get cracking on filling up jugs and bowls with what water there is. So I was. Then the tornado sirens went off.

The man I was married to is a HAM radio operator. He helped work out the protocol for blowing the sirens. I knew, therefore, that this was serious business. I'll skip the excitement of listening to the weather radio and waiting for the all-clear and just say that I didn't, between the thunder and the sirens, get a lot of sleep.

what was going to happen on Monday

Monday was busy, busy. I had three patients who were of major concern: the first had had a large meningioma removed from her frontal lobe. The second was dying. The third had intractable pain.

But damn, they were stable. Pain Woman had gotten a new cassette for her PCA pump (that's that patient-controlled painkiller with the little button you push). Phred, the beloved night nurse from Vietnam, had put it up for me at shift change. Phred always takes care of me. Dying Woman was, well, dying. There's not a lot you can do when somebody's doing that. She was still talking and responsive at the time, so the main job was to keep her comfortable. A Do Not Resuscitate order doens't mean you leave the person to rot; you just don't burden them with life support. Meningioma Girl had no drift, pupils were equal and reactive; not even a headache.

Then Dying Woman was taken off DNR status and put on a full-code status. Why this happened, I'm still not clear. I'm not certain she knew what she was asking for, but it's better to be safe than sorry.

Then Pain Woman started having problems.

Then, just as I'd gotten the problems with PW resolved and the politics surrounding DW dealt with, I got a craving for cookie. Everybody was taken care of, my other two non-scary patients were bopping along just fine, and I figured a trip to the lobby for a cookie would not go amiss.

I'll never do that again

I was downstairs when Meningioma Girl had a generalized tonic-clonic ('grand mal') seizure.

Not gonna go into that, no sir. All I know was that I had a feeling of impending doom that I shook off. When I returned to the floor, they told me she had seized. Two of my colleagues were in the room, taking blood pressures and so on (the patient was post-ictal by this point and very sleepy). I moved fast.

As I was headed down the hall to get a milligram of Ativan, the respiratory therapist came out of Dying Woman's room to tell me that she had suddenly become nonresponsive. With a DNR patient, that's not a real big deal. It's simply another step in a natural process. With a code patient, it means a lot more.

"Ben," I said, "you have to deal with this. I can't. I've got a seizure down the hall."

Ben did, thank God. And the patient was fine.

I would not have gotten through the rest of that afternoon, what with stat CT scans and Cerebyx needing to be run and so on, had it not been for my coworkers. Three of them picked up so much slack that they were as busy as I was.

And the moral is....

This is why I love working where I do. If one person is snowed, everyone else pitches in to the best of their ability to make life easier. They don't just get patients up to the bathroom or take pain medications in to them; they draw blood, put nasogastric tubes down, take phone orders, set up BiPAP machines. I've done it for other people, and on Monday they did it for me.

I was so touched I nearly cried. Well, touched *and* tired.

And I will deny myself cookies now. There's nothing worse than being downstairs, or worse, at the McDonald's next door, and having a stat page come over your beeper.

A perfect day.

Today started with a long, lazy morning in bed and out of it as I tried to recover from the effects of not-even-a-pint of dark beer last night. Ugly, ugly. I now remember why I don't drink dark beer.

Several gallons of water, a backrub, three aspirin, four cups of coffee, and some scrambled eggs later, I took a shower. I found a bar of heather soap I thought was gone and used that.

Then I dressed in my favorite elderly and quite filthy jeans, a tank top, and a linen shirt. I grabbed a straw hat that makes me look like one of the dancing mushrooms from "Fantasia", loaded on all the big amber jewelry I own, and went out to the town square.

One day a year our town becomes "Dogton." The central square is given over to the Dog Days Festival. Businesses around the square, including restaurants, allow dogs inside. There are booths of pet goods, dog-themed jewelry, single-breed adoption agencies, the SPCA, you name it. The name of the city is officially changed for this one Saturday in June and anything goes--if you're quadripedal.

I petted six Greyhounds, a 156-lb. bloodhound who told me in no uncertain terms that he loved me, an Irish wolfhound named Ranger, several Boxers and Bulldogs and Beagles, and a couple of 57-flavor mutts with bicolored eyes. Oh, and the Great Danes (three, including one all-white with blue eyes) and the chocolate-colored Shar-Pei.

Then I bought a large, heavy amber pendant from the beautiful Indian woman who runs a shop out of her house. I said hi to my Pakistani friend who displays glass bracelets on beds of red lentils. I stopped in the Irish imports store to say hello to Liam (Irish), Dawn (not Irish), and Pudge (canine) and hear Liam talk. I was bought a beer and given a tour of the new wine store downtown by the very handsome owner of said store. Then I went and had a blackened cheeseburger and fries at a patio restaurant and shared some of my fries with another Great Dane.

Then over to the used bookstore for Laurie King books, then to the coffee shop for a breve, then into the blessed air-conditioning of my car to come home to more blessed air-conditioning.

I'm now slightly woozy and very happy. It was cloudy all day, so I didn't even have to wear sunscreen. I'm crusted with salt from sweating and festooned with dried ribbons of spit from the bloodhounds. I'm covered with sixty breeds of dog hair. I wonder if I should just give up and shower now, taking the chance of falling asleep with my head under the running water, or nap first and then change the sheets.

It's rare that a day this good all around comes along.

"Shit oh dear," said the Countess...

Part One

Arlene emailed tonight and mentioned that she'd really like to be able to comment on what shows up here. I could, I suppose, enable the "comments" section, but for two things:

1. With my luck, I'd end up getting stalked by some guy with a nurse fetish.

2. Nobody reads this blog anyhow, so why bother?

The thought of somebody else commenting on my writing, even someone as nice and kind and sensitive and marvelous and with a great sense of style (okay, I'll stop now) as Arlene terrifies me. I'm not a writer the way my sister and father are. I've had exactly one thing published: A letter to "Ms." magazine. I don't show this blog to just anybody. Mention the names "Eurotrash" or "Belle" and I quail.

Even linking terrifies me.

Sure, it'd be nice to be linked. Link me! I'm cute and friendly and I use lots of punctuation! The trouble is that with linking comes weirdos, and I deal with enough of them in work, outside of work, and in the mirror as it is.

Part Two

I do NOT need a vintage silk-satin olive-green circle skirt with a black velvet waistband and black velvet polka dots all over it. Even if it is amazingly cheap on Ebay, even if it is my size, and even if I can think of eight places to wear it. Charge card, get thee behind me!

Nor do I need any Pierre Hardy shoes. Even if they do come in a black-velvet rounded toe style that would, come to think of it, look lovely with the skirt.

...or maybe I do.

Part Three

The orthopedics department is moving all of its large joint surgeries out of our hospital. More to the point, they're moving off of our floor. I don't know if it's going to be every surgeon, or just a few, or if they're going to keep complex cases, or what. Suffice to say that this is the beginning of what feels like a long slow slide into hell.

Part Four

A potato exploded in the oven today. I was in the shower, humming some little song, when I heard a bang. I figured it was the woman downstairs hanging up pictures. When I checked my tater, it had exploded.

Or not so much exploded as decloaked. The potato was intact. The skin of said potato was in one piece, mostly, but on the other side of the oven. I've never seen that before.

It was yummy anyhow.

Part Five

The Cute Goateed Greek Neurologist shaved off his goatee. This makes him look like somebody's Greek grandmother. Or maybe about ten years younger; I can't decide. Unfortunately, there's no good way to tell a resident that he looks like Doogie Houser anyhow and any more youngification will not inspire confidence in his patients.

Thankfully for my fingers, Cute Grandmotherly Greek Neurologist has the same initials as Cute Goateed Greek Neurologist, so I won't have to be clever again.

Sometimes I just have to wonder.

I've been having what I call "brain static" dreams lately. You know the ones--they're the dreams in which nothing really makes sense. Things happen faster than the cuts in a music video. You're wandering around in your pajamas, looking for a snowcone stand, and then suddenly there's a giraffe right there, telling you jokes.

The cool thing about dreams--both the brain static sort and the intricately plotted, sense-making sort--is that nobody really knows why they happen. I have my own pet theory on dreaming, which goes like this:

Brain static dreams happen just before you wake up. They're the last-gasp attempt of your temporal and frontal lobes to discharge all the detritus of your last several days so that you can concentrate on being awake. They "mean" nothing. They don't symbolize anything except that you're a bit stressed out. They are, in short, your brain's way of cleaning out your huge mental refrigerator.

The intricately-plotted sort are a bit different. Those dreams tend to have bits in them that make you wonder if maybe your subconscious isn't trying to get something out of its system. These are the dreams that your brain makes up when you're ignoring something important. They mostly happen in the middle of the night and are longer.

I just had a really cool one of the second sort, even though it devolved into brain static by the end. I could play guitar in my dream--something I've never even seriously attempted--and sang two songs of my own composition that were really, really good. Nice harmonies, nice key changes, the whole shooting match.

Given that I ended that dream wandering down the service road of the highway naked, I'm not sure that I want to know What It Meant. I don't really care. Let the psychologists and neuropsychologists worry about why we do what we do inside our own heads. I'm just happy that my mind has such an incredible imagination independent of my consciousness.

Obligatory trivia

I have a wisdom tooth that is lying sideways in my upper jawbone. It will never erupt, which is a good thing, considering that if it did I'd have a tooth in my ear. Yes, its cutting surface is toward my ear.

I drive an old Honda Civic hatchback named Nash. I love him. He has gotten me through horrible weather, moved my house more than once, and never been unreparably sick.

"A Case of You" is, IMO, the most perfect love song ever written.

I wear a size 9 shoe and a size 7 1/2 glove. Given that I'm 5' 2" on a tall day, this means my hands and feet must've been recycled from someone else.

I base my fashion taste on what doesn't itch. (credit to Gilda Radner)

Sometimes I get an illogical craving for black-eyed peas.

I have red hair. Real red, yes.

Nursing was not my first career choice. I thought for years that I would be a musician until I discovered that I wasn't any good.

My favorite dog ever was a wolf-hybrid named Elsie. It took her years to really like me, and we didn't truly bond until she got very sick and I took care of her. I miss her, and she's been dead almost three years.

Most of my clothes are black. This is not because I'm grumpy but because I lack any sort of taste in clothing.

I will drive a long way for decent barbecue.

Thunderstorms terrify me.

I can take or leave chocolate, ice cream, cake, and other sweets. I don't crave sugar when I'm premenstrual. Show me a bag of Chee-tos and a bottle of Sierra Nevada Pale Ale, though, and I'm your gal.

The best taco I've ever eaten came from a Mexican restaurant in Winfield, Kansas.

I'm still searching for the perfect salsa.

I like Brussels sprouts.

Despite my horrible lifestyle habits, I am still one of the strongest and fittest people I know. Those who live well get very frustrated when a boozing, overworked nurse can still kick their asses during a 10K walk.

My first boyfriend now sings with a band called "Your Mother" and looks like William Shatner--post-toupee. How the mighty have fallen!

Brown and green and hazel eyes knock me out.

I keep my hair really, really short. For a while I kept it long but it was a pain in the ass.

I write bad rhyming doggerel sometimes, but I never know when the Muse will strike.

I sing songs to my cat about how wonderful she is. She hates that.

Love a nurse. She might save your life.

Today, children, I will introduce a new character in the life of your typical nurse: The Pompous, Ignorant, Condescending Asshole Doctor.

This particular subspecies of MD can be any age, but is usually of the generation that doesn't like nurses and wishes that they still wore caps and cleavage. Generally speaking, the PICA doctor is tall, dignified, homey, and wears a tie to work. It might even be a bow-tie, if you have a specimen of the more gentlemanly sort.

The PICA doc is the one who breezes through the nurse's station on his way to the elevator and informs you that your patient is in "respiratory distress." This will be news to you, since your patient had a normal pulse and respirations ten minutes before, when you last checked on him. When you get through the cloud of dust left by the PICA doc's passing and check on your patient again, you will find him gurgling and wheezing, unable to cough or breathe well, and will have to get things like electrocardiograms and chest X-rays done on an emergent basis.

You'll wonder why this happened. It won't become clear to you until the next day, after multiple nebulizer treatments and suctionings, when the Cynical and Harried Respiratory Therapist starts suctioning out something that looks suspiciously like coffee from your patient's trachea. It'll occur to you that this patient, who is NPO (nothing by mouth) and who has a tube going into his stomach, has been being fed liquids by his family.

His family will confirm this. They'll tell you that PICA doc, who washed his hands of this patient and moved him to another service, told them that it would be a good idea if the patient got liquids by mouth. The PICA doc, in doing so, will have ignored the recommendations of other people--not MDs, but highly qualified--who have said that this patient lacks both the cognitive skills and level of consciousness to swallow.

Let's review the bidding: You have a patient who is just now beginning to come out of the effects of a nasty bleed on the brain. He's being fed through a tube to make sure he doesn't get aspiration pneumonia. He's being followed by the neurologists, not the PICA doc. Yet Mister Doctor Man, without writing official orders, says that it's a fine thing for this patient to be able to breathe in coffee, apple juice, and soda. When your patient begins to have trouble breathing, the PICA doc *leaves the floor* in a blaze of glory.

Think of this. A doctor leaves the area where a patient who has been in his care is in distress. He leaves it up to the nurses and his resident to manage things. In retrospect, I'm glad he did--he might've fucked things up even more if he'd stayed.

There's an unwritten code of conduct in the medical world that bars nurses from screaming down hallways with a claymore in hand to bash stupid people in the head. Thankfully, the service that my patient is now on is populated by humorous, approachable doctors (including the Goateed Greek Neurologist, who promises to teach me to curse in Greek). I know all of their phone numbers now, after that little "respiratory distress" incident and a couple more, and I'm on a first-name basis with some of the residents. Hell, all I have to do with one of the residents is say, "Hey" on the phone and he knows who I am.

I'm trying to decide if I want to file an incident report on this one. I doubt it would do much good in the long run--after all, a fairly new nurse writing up an MD with thirty years' experience is like a gnat buzzing around an elephant--but it sure would be satisfying. It would be more satisfying because I know I'm right. The two neurologists with whom I had to discuss the case were flummoxed by the PICA doc's behavior. One of them called it "horseshit." I don't think that's too strong a word.

At least I know whom to avoid on the floor. If ever I get another one of this guy's patients, I'll know that it'll be a battle to keep the person from being hurt by his doctor's stupidity.

Which reminds me. I need to warn the residents on the next service this guy'll be transferred to to *watch out*.