Internal Medicine:
Fit, well-dressed, with a cholesterol of 130 and the oddest prescribing habits you've ever seen. If you need electrolytes repleted or your INR brought to its proper level (that's a measure of clotting time that's influenced by coumadin), the internal med specialist is your gal. Or guy. If you're a nurse, having an internal med consult means that you'll be cutting tablets into quarters and giving 7.5 milligrams of something that comes in a 25-mg dosage, but only on alternate Thursdays during the dark of the moon.
Neurosurgery:
Brilliant, with a necessary arrogance. Would you want somebody suffering pangs of self-doubt while their fingers are in your brain? Didn't think so. Usually underfed and underslept. Will eat anything that's moving slowly or standing still. Very nice people, overall, since they have to deal with people who can't talk, walk, or make a lot of sense. (Those are the nurses, not the patients.)
Neurology:
Sweet, but from Mars. Odd senses of humor. Usually strange facial hair (on the men, not the women). Sometimes they have a fascination with Bach or zebras or rowing. Older neurologists tend to be courtly in the extreme and wear bow ties.
Orthopedics:
The jocks of the medical world. They are carpenters and craftsmen--and I mean that as praise. A good orthopedist working on your hip will leave you with the equivalent of really good Art Deco woodwork: functional and beautiful, with nothing extra added. If you see a muscular young man or woman of few words striding down the hallway with a tiny box containing magnifying eyeglasses in his or her hand, that's your orthopedist.
They also have very strange senses of humor. A few months ago the C group at our facility had "Talk Like A Pirate Day." "Shiver me timbers! Swab the deck with that dressing, matey! AAARRR!"
Cardiothoracic Surgeons:
I do not work with any of those folks and so have no clue what they're like.
Plastic Surgery:
Artistic, with the emotional lability that comes with artistry. I'm personally uncomfortable with plastic surgeons, as I wonder if they're casting a covetous eye on my double chin.
Urology:
How much does that suck? Proctologists are probably the only people with a more-misunderstood specialty. Urologists, however, have the benefit of access to the scariest-looking pieces of medical equipment in the entire hospital.
General Surgeons:
If you see a resident asleep in a chair at the nurses' station, chances are it's a general surgery resident. They're horribly underslept but have a solid working knowledge of where everything ought to go in the body. If you're a general surgeon, you can take people apart and put them back together with no bits left over. I've gotten speech of a few of them that's beyond "mmmmrrrppphhhh" as I wake them up, but not many.
Endocrinology:
Your average endocrinologist has a second brain somewhere in his body, in which he stores minute bits of important information that came from some obscure study in Backobeyondistan five years ago. They will speak to you as equals, even if their conversation about a complex patient eventually sounds to you like "Grobble grobblescrink mmmmREEEE! ppphhhhbt!"
Psychiatry:
Well-dressed, with a fondness for expensive shoes and dangling pendants (men and women respectively). Pleasant but strange. Psych nurses are nice as well, but strange. You *have* to be a little odd to work psych and be good at it.
The best illustration of a typical non-psych-nurse and psych-nurse exchange I can come up with is this:
Me: (trying to reach a med on a high shelf) "Sometimes I wish I were taller, dammit!"
Psych nurse: "Oh...do you have body image issues?"
Next week: The Nurse's Guide to Nursing Students
Wednesday, October 20, 2004
Saturday, October 16, 2004
A cool circle of Hell, with nice silverware.
Today I had lunch with my boyfriend's family.
They are really very nice people. His brother wasn't there, having had car trouble on the way, but his sister was, with her husband and their three kids. His mom was there as well--the reason for the lunch was her birthday.
Let me preface this tale by repeating that I like these people. They're intelligent, polite, funny, pleasant folks.
The trouble was not them; nor was it their children. It was the lunch itself, or maybe the way events conspired against the lunch.
Background: Boyfriend runs the kitchen at an exclusive little lunch-and-dinner place that's attached to a bed-and-breakfast. Fifty-five people is about as many as get served on a typical night; reservations are strongly recommended for dinner. We went to that restaurant for lunch. David came out wearing his chef gear, taking a break from preparing food for a wedding, and ate with us.
"Us" being a four year old, a two year old, a seven week old baby, Mom and Dad, Grandmother, and me.
I'm childfree for a reason. I have little to no interest in children. They don't bug or delight me; they just don't register. Mostly. Unfortunately, one of the things that I hate is adults bringing small children to exclusive eateries that have nothing to entertain kids.
I was one of those people I hate today. The poor kids were trying their best to amuse themselves quietly and politely, but the bread-basket is only going to last so long and forks hold only so much interest. Babies tend to get fussy and have to be fed. Adults tend to try to have conversations that don't have much to do with kids' interests. And no matter how you try, any meal that involves children is going to revolve around those children. Adult conversation is impossible while you're trying to keep one child or another from amputating bits of itself with a knife or tipping over backwards in a chair.
Add to that Hayseed and Hayseedette, our two "servers". I put "server" in quotes because it took us four tries to get teaspoons and three requests to get lemons for tea. "Serve from the left, remove from the right" apparently means (at least to Hayseedette) "Reach across the person who's eating to drop a spoon with a clank on the table in front of the person to her right." Water refills took two or three requests. Coffee got cold. It was bad enough that David sat vibrating with rage next to me, getting more and more humiliated by the minute. As executive chef, he's not responsible for training the wait staff, but still...it's his kitchen and his pidgin.
At least the food was good. Though I did manage to dip my breast into some red pepper puree (a common problem for the busty, Beloved Sister assures me). Nobody noticed. I think.
The brother-in-law faced the menu with trepidation: Unfussy Foodie greets Schwanky Menu. He ordered a beer with a quiet desperation that made me love him and want to take him down the street for a burger. Sister was busy with Baby, whom I tried to calm down at one point but signally failed to un-fuss, beings as I didn't smell like family. And through it all sat Grandmother, being calm and gracious and keeping the two year old from killing herself with cutlery.
All in all, it wasn't bad--except for Hayseed and Hayseedette. I want to train Hayseedette, since she looks like there might be enough synapses in her vacuous eighteen-year-old head to someday make a half-decent waitress. Hayseed I want to kick in the face. Had I known I'd see him today, I'd've worn heavier boots.
This day started with David and me bent over a power snake, unclogging his sewer line. I would've gladly done that all day.
They are really very nice people. His brother wasn't there, having had car trouble on the way, but his sister was, with her husband and their three kids. His mom was there as well--the reason for the lunch was her birthday.
Let me preface this tale by repeating that I like these people. They're intelligent, polite, funny, pleasant folks.
The trouble was not them; nor was it their children. It was the lunch itself, or maybe the way events conspired against the lunch.
Background: Boyfriend runs the kitchen at an exclusive little lunch-and-dinner place that's attached to a bed-and-breakfast. Fifty-five people is about as many as get served on a typical night; reservations are strongly recommended for dinner. We went to that restaurant for lunch. David came out wearing his chef gear, taking a break from preparing food for a wedding, and ate with us.
"Us" being a four year old, a two year old, a seven week old baby, Mom and Dad, Grandmother, and me.
I'm childfree for a reason. I have little to no interest in children. They don't bug or delight me; they just don't register. Mostly. Unfortunately, one of the things that I hate is adults bringing small children to exclusive eateries that have nothing to entertain kids.
I was one of those people I hate today. The poor kids were trying their best to amuse themselves quietly and politely, but the bread-basket is only going to last so long and forks hold only so much interest. Babies tend to get fussy and have to be fed. Adults tend to try to have conversations that don't have much to do with kids' interests. And no matter how you try, any meal that involves children is going to revolve around those children. Adult conversation is impossible while you're trying to keep one child or another from amputating bits of itself with a knife or tipping over backwards in a chair.
Add to that Hayseed and Hayseedette, our two "servers". I put "server" in quotes because it took us four tries to get teaspoons and three requests to get lemons for tea. "Serve from the left, remove from the right" apparently means (at least to Hayseedette) "Reach across the person who's eating to drop a spoon with a clank on the table in front of the person to her right." Water refills took two or three requests. Coffee got cold. It was bad enough that David sat vibrating with rage next to me, getting more and more humiliated by the minute. As executive chef, he's not responsible for training the wait staff, but still...it's his kitchen and his pidgin.
At least the food was good. Though I did manage to dip my breast into some red pepper puree (a common problem for the busty, Beloved Sister assures me). Nobody noticed. I think.
The brother-in-law faced the menu with trepidation: Unfussy Foodie greets Schwanky Menu. He ordered a beer with a quiet desperation that made me love him and want to take him down the street for a burger. Sister was busy with Baby, whom I tried to calm down at one point but signally failed to un-fuss, beings as I didn't smell like family. And through it all sat Grandmother, being calm and gracious and keeping the two year old from killing herself with cutlery.
All in all, it wasn't bad--except for Hayseed and Hayseedette. I want to train Hayseedette, since she looks like there might be enough synapses in her vacuous eighteen-year-old head to someday make a half-decent waitress. Hayseed I want to kick in the face. Had I known I'd see him today, I'd've worn heavier boots.
This day started with David and me bent over a power snake, unclogging his sewer line. I would've gladly done that all day.
Wednesday, October 13, 2004
Fat and a quarter tit*
Yesterday was Holy Mary Mother of Gawd Revelation Day. Out of curiosity, I measured myself and typed the numbers into the website for bra fitting I provided the other day, only to find that I'd moved from Cute Lacy Numbers to Three Hooks and Minimizer Size. I am now, judging from the numbers, fully a quarter tit.
John in Phoenix is a snookum-wookum who has complimentary things to say about this blog. In response, since he's a nursing student, I've decided to edit and publish my Ten Rules For Nursing Students, originally compiled some time during my third semester. To wit:
1. Type everything. Instructors prefer typed documents.
It's easier, of course, to jimmy handwriting so that you take up the requisite five pages, which is why instructors prefer typing. It's also nice to be able to read what somebody wrote without having to decipher hieroglyphics for hours. Contrary to popular belief, most nurses have handwriting just as bad as that of most doctors.
2. Handwrite everything. Instructors prefer to see your handwriting.
Or, as one particularly flaky instructor told me, "I like to get a *feeeeel* for what you're doing."
3. Concentrate on textbook learning; you'll learn skills in your graduate internship.
Not a bad piece of advice, especially if you have an internship like mine: heavy on tests for the first three weeks.
4. Concentrate on skills; you won't have time to learn them at your first job.
Foleys and IVs are all you really need to know. A trained monkey can do a dressing change. Really.
5. You will always have one instructor who is totally, completely, inarguably from Mars. Deal with it.
My From Mars moment came in a classroom discussion of ethics and the nursing shortage in our last semester, when one of the instructors on the team told us that the reason for the nursing shortage was that "we've aborted a third of our population since 1973." Everybody, for some reason, turned and looked right at me. I said nothing, preferring to marvel at the clear transmission she achieved even while orbiting somewhere outside the Van Allen Belt.
6. One in ten of your female classmates is looking to meet a doctor. One in ten of your male classmates might be, too. Deal with it.
Not much you can do about that one, unfortunately. The most you can hope for is that she'll leave the plum job she gets as soon as she meets a likely resident, leaving the position open for you.
Before anybody accuses me of stereotyping or downing young female nurses, may I present the following evidence? Out of 19 female classmates, one was in nursing school so her husband would "get off her back" about getting a job. She was pregnant at the beginning of our last semester. Another two were self-professed doctor-hunters. A fourth was admittedly in it for the money, and took a job at a pediatric clinic with the expectation that it would be low work/high pay (heh). A fifth was "drifting", in her own words, and didn't know if she'd actually use the degree or take up crystal healing.
Is it any wonder I was valedictorian of my class?
7. You will have no life for two to four years. Don't worry. It'll still be there when you get back.
I swear. Really. Honest. You'll be able to sleep and get haircuts and go dancing and everything.
8. Everybody thinks they flunked the NCLEX. Few people actually do. Go ahead and get blasted anyhow.
9. Yes, you do look dorky in those whites.
10. No matter how bad things are now, they will end. You will eventually be a nurse, subject to redefining hell. Of course, you'll also redefine happiness.
I can't tell you how much weight I lost the last six weeks of nursing school. The speculation on class ranking had really ramped up, and as immune as I tried to stay, I still felt the pressure to come in first. I think the under on me was something like 10 points.
But it ended. Valedictorian means shit in the world, except that older nurses will expect you to be able to recite the latest information on Disease X without pausing, like a computer.
And you know what? Being a nurse is infinitely easier than being a student. For one thing, being pushed out of the nest means not only the freedom to screw up, it means the freedom to make judgements. You're not really allowed to do that as a student. For another, you're finally done with those fucking care plans. For a third, you're able to sleep without dreaming that you've missed a test or three. Instead, you dream of beeping IV pumps.
To all those poor sots out there who have three, or two, or just one semester to go before the NCLEX, I raise a toast. Nursing is *not* the hardest job in the world. Being a nursing student is.
Oh, I forgot one thing:
11. Comfortable shoes. Comfortable shoes. Comfortable shoes. Comfortable shoes. Comfortable shoes, fer Godssake!!
***
*Carl Bennett, quoted by Oliver Sacks in An Anthropologist on Mars
John in Phoenix is a snookum-wookum who has complimentary things to say about this blog. In response, since he's a nursing student, I've decided to edit and publish my Ten Rules For Nursing Students, originally compiled some time during my third semester. To wit:
1. Type everything. Instructors prefer typed documents.
It's easier, of course, to jimmy handwriting so that you take up the requisite five pages, which is why instructors prefer typing. It's also nice to be able to read what somebody wrote without having to decipher hieroglyphics for hours. Contrary to popular belief, most nurses have handwriting just as bad as that of most doctors.
2. Handwrite everything. Instructors prefer to see your handwriting.
Or, as one particularly flaky instructor told me, "I like to get a *feeeeel* for what you're doing."
3. Concentrate on textbook learning; you'll learn skills in your graduate internship.
Not a bad piece of advice, especially if you have an internship like mine: heavy on tests for the first three weeks.
4. Concentrate on skills; you won't have time to learn them at your first job.
Foleys and IVs are all you really need to know. A trained monkey can do a dressing change. Really.
5. You will always have one instructor who is totally, completely, inarguably from Mars. Deal with it.
My From Mars moment came in a classroom discussion of ethics and the nursing shortage in our last semester, when one of the instructors on the team told us that the reason for the nursing shortage was that "we've aborted a third of our population since 1973." Everybody, for some reason, turned and looked right at me. I said nothing, preferring to marvel at the clear transmission she achieved even while orbiting somewhere outside the Van Allen Belt.
6. One in ten of your female classmates is looking to meet a doctor. One in ten of your male classmates might be, too. Deal with it.
Not much you can do about that one, unfortunately. The most you can hope for is that she'll leave the plum job she gets as soon as she meets a likely resident, leaving the position open for you.
Before anybody accuses me of stereotyping or downing young female nurses, may I present the following evidence? Out of 19 female classmates, one was in nursing school so her husband would "get off her back" about getting a job. She was pregnant at the beginning of our last semester. Another two were self-professed doctor-hunters. A fourth was admittedly in it for the money, and took a job at a pediatric clinic with the expectation that it would be low work/high pay (heh). A fifth was "drifting", in her own words, and didn't know if she'd actually use the degree or take up crystal healing.
Is it any wonder I was valedictorian of my class?
7. You will have no life for two to four years. Don't worry. It'll still be there when you get back.
I swear. Really. Honest. You'll be able to sleep and get haircuts and go dancing and everything.
8. Everybody thinks they flunked the NCLEX. Few people actually do. Go ahead and get blasted anyhow.
9. Yes, you do look dorky in those whites.
10. No matter how bad things are now, they will end. You will eventually be a nurse, subject to redefining hell. Of course, you'll also redefine happiness.
I can't tell you how much weight I lost the last six weeks of nursing school. The speculation on class ranking had really ramped up, and as immune as I tried to stay, I still felt the pressure to come in first. I think the under on me was something like 10 points.
But it ended. Valedictorian means shit in the world, except that older nurses will expect you to be able to recite the latest information on Disease X without pausing, like a computer.
And you know what? Being a nurse is infinitely easier than being a student. For one thing, being pushed out of the nest means not only the freedom to screw up, it means the freedom to make judgements. You're not really allowed to do that as a student. For another, you're finally done with those fucking care plans. For a third, you're able to sleep without dreaming that you've missed a test or three. Instead, you dream of beeping IV pumps.
To all those poor sots out there who have three, or two, or just one semester to go before the NCLEX, I raise a toast. Nursing is *not* the hardest job in the world. Being a nursing student is.
Oh, I forgot one thing:
11. Comfortable shoes. Comfortable shoes. Comfortable shoes. Comfortable shoes. Comfortable shoes, fer Godssake!!
***
*Carl Bennett, quoted by Oliver Sacks in An Anthropologist on Mars
Monday, October 11, 2004
Looks like it's time to call in the professionals.
Fair warning: girlyness ahead.
One thing nobody ever tells you when you enter nursing school is this: your hands and feet, after four years of schooling and practice, will be practically unrecognizable.
It's not just washing your hands every ten minutes or less or using alcohol foams on them. It's not just wearing heavy protective leather clogs all day long or running from place to place like a chicken. It's a combination of those things and lifting heavy patients and equipment, as well as not having the time or energy most days to fuss with cuticle remover or foot files.
My feet have grown a half-size since I started school. What was once a nice average 8 1/2 medium pair of feet is now a 9 wide. David said, as gently as possible the other night, "When did you decide to try to grow hooves?" I have calluses between my toes; that's how bad it is.
So I'm thinking that it may be time to enlist the services of a professional pedicurist and manicurist twice a month or so. Pal Joey took me for my first pedicure last summer. My shoes fit differently after the poor woman had finished sanding down my calluses. Not that I'm obsessed with my calluses, or that I'm afraid I'll injure my bed partner (although one callus, on my left small toe, left a scratch on his shin), I'm just sayin'.
Taking care of one's hands--which I do actually do--is a matter of self-interest in the nursing profession. A torn cuticle or a hangnail opens up an avenue for infection, no matter how careful you are with gloves. Long nails (ie, anything past the end of your finger) tear gloves and are a perfect habitat for bugs. I am therefore aggressive about keeping my nails short-short, using a good cuticle remover every other night, and slathering on lotion when I get home from work. As a result, my paws look workmanlike but not abused. It's my feet that resemble something from the Russian Ballet.
I guess I'll call my hairdresser, a patient woman who cuts my hair twice a month, tomorrow. I'll see if her partner has any openings on Wednesday. Her partner has horses and a fascination with straw-bale construction, as I do, so will be open to not putting pink nailpolish on my toes.
We'll see.
One thing nobody ever tells you when you enter nursing school is this: your hands and feet, after four years of schooling and practice, will be practically unrecognizable.
It's not just washing your hands every ten minutes or less or using alcohol foams on them. It's not just wearing heavy protective leather clogs all day long or running from place to place like a chicken. It's a combination of those things and lifting heavy patients and equipment, as well as not having the time or energy most days to fuss with cuticle remover or foot files.
My feet have grown a half-size since I started school. What was once a nice average 8 1/2 medium pair of feet is now a 9 wide. David said, as gently as possible the other night, "When did you decide to try to grow hooves?" I have calluses between my toes; that's how bad it is.
So I'm thinking that it may be time to enlist the services of a professional pedicurist and manicurist twice a month or so. Pal Joey took me for my first pedicure last summer. My shoes fit differently after the poor woman had finished sanding down my calluses. Not that I'm obsessed with my calluses, or that I'm afraid I'll injure my bed partner (although one callus, on my left small toe, left a scratch on his shin), I'm just sayin'.
Taking care of one's hands--which I do actually do--is a matter of self-interest in the nursing profession. A torn cuticle or a hangnail opens up an avenue for infection, no matter how careful you are with gloves. Long nails (ie, anything past the end of your finger) tear gloves and are a perfect habitat for bugs. I am therefore aggressive about keeping my nails short-short, using a good cuticle remover every other night, and slathering on lotion when I get home from work. As a result, my paws look workmanlike but not abused. It's my feet that resemble something from the Russian Ballet.
I guess I'll call my hairdresser, a patient woman who cuts my hair twice a month, tomorrow. I'll see if her partner has any openings on Wednesday. Her partner has horses and a fascination with straw-bale construction, as I do, so will be open to not putting pink nailpolish on my toes.
We'll see.
What's that blue stuff on the weather map?
Oh. It's a flood warning. Lovely.
Chuckleheads on Parade, Part Two
The chucklehead situation I wrote about the other day became so bad on Saturday that I could only sit back and stare with my mouth slightly open. Not only did the patient who got screwed as an inpatient get screwed as an outpatient, but I had another one of Doctor Chucklehead's patients who's going to be in just as bad of shape this morning. Thank God I'm not there to see the rivets pop out of the case manager's skull.
One quick tip for any medico who might be reading: If you write an order at 1700 on Sunday for rehab placement on Monday morning, it's *probably not going to happen*. Case managers have weekends, you know.
I don't want to go into details on the Previous Chucklehead Victim. Suffice to say that the level of arrogance, laziness, and outright disrespect I've seen from The Chucklehead Twins (attending and resident) is unmatched in my experience. Except maybe by the protesters who used to work outside the clinic where I worked. They walked the sidewalk with a baby every day for five years and got paid $38,000 a year by a local anti-choice group for their efforts.
Anyway. The case manager, a slender woman who drinks more coffee than I do, and I will have to figure out a way to do end-runs around Dr. Chucklehead and Friends. The normal routine of explaining, very patiently, why X and Y and Z orders won't work, or why one actually has to *write* an order for what one wants, rather than expecting it to be transmitted telepathically to one or more colleagues, is not going to be enough here. Punishment won't work. A good dope slap would probably be really satisfying, but it won't accomplish much in the long run.
In other news
It's been raining off and on for a week and a half now. This is wonderful for the crops and the grass and all the little birdies, but bad for the people who (like me) have to commute through construction areas. Remind me sometime to tell you what it's like to be slogging along in a Honda Civic when allofasudden the world goes away and you're covered with water.
My car also needs new tires. *sigh*
A Handy Site for Women
More than likely, you're wearing the wrong size bra. I know I am. Check this
out and learn how to fit a bra. As soon as I'm done here I'm getting out the tape measure.
Testing, testing
This week we have a series of tests at work to requalify us for whatever work we're doing. It's a hospital-based version of the ACLS or BLS or COC or whatever tests are national. In other words, we test three times a year for what normally only gets tested once. The biggie for me will be EKG stuff; I'm not a cardiac nurse for a reason. EKG strips have never made the slightest lick of sense to me. I passed that part of nursing school by taxing my short-term memory to the fullest and then promptly forgot everything I'd learned. Since David will be at a food show tonight and tomorrow, that'll be my time to cram QT intervals and P waves back into my noggin.
And so to bed
It's back to beddy-bye for me. The one drawback of working three days in a row (aside from the punchiness that hits on day 3) is that your body wants to get going at 3 am on day 4. I've been up long enough to get sleepy again. The cat will teach me how to nap.
Chuckleheads on Parade, Part Two
The chucklehead situation I wrote about the other day became so bad on Saturday that I could only sit back and stare with my mouth slightly open. Not only did the patient who got screwed as an inpatient get screwed as an outpatient, but I had another one of Doctor Chucklehead's patients who's going to be in just as bad of shape this morning. Thank God I'm not there to see the rivets pop out of the case manager's skull.
One quick tip for any medico who might be reading: If you write an order at 1700 on Sunday for rehab placement on Monday morning, it's *probably not going to happen*. Case managers have weekends, you know.
I don't want to go into details on the Previous Chucklehead Victim. Suffice to say that the level of arrogance, laziness, and outright disrespect I've seen from The Chucklehead Twins (attending and resident) is unmatched in my experience. Except maybe by the protesters who used to work outside the clinic where I worked. They walked the sidewalk with a baby every day for five years and got paid $38,000 a year by a local anti-choice group for their efforts.
Anyway. The case manager, a slender woman who drinks more coffee than I do, and I will have to figure out a way to do end-runs around Dr. Chucklehead and Friends. The normal routine of explaining, very patiently, why X and Y and Z orders won't work, or why one actually has to *write* an order for what one wants, rather than expecting it to be transmitted telepathically to one or more colleagues, is not going to be enough here. Punishment won't work. A good dope slap would probably be really satisfying, but it won't accomplish much in the long run.
In other news
It's been raining off and on for a week and a half now. This is wonderful for the crops and the grass and all the little birdies, but bad for the people who (like me) have to commute through construction areas. Remind me sometime to tell you what it's like to be slogging along in a Honda Civic when allofasudden the world goes away and you're covered with water.
My car also needs new tires. *sigh*
A Handy Site for Women
More than likely, you're wearing the wrong size bra. I know I am. Check this
out and learn how to fit a bra. As soon as I'm done here I'm getting out the tape measure.
Testing, testing
This week we have a series of tests at work to requalify us for whatever work we're doing. It's a hospital-based version of the ACLS or BLS or COC or whatever tests are national. In other words, we test three times a year for what normally only gets tested once. The biggie for me will be EKG stuff; I'm not a cardiac nurse for a reason. EKG strips have never made the slightest lick of sense to me. I passed that part of nursing school by taxing my short-term memory to the fullest and then promptly forgot everything I'd learned. Since David will be at a food show tonight and tomorrow, that'll be my time to cram QT intervals and P waves back into my noggin.
And so to bed
It's back to beddy-bye for me. The one drawback of working three days in a row (aside from the punchiness that hits on day 3) is that your body wants to get going at 3 am on day 4. I've been up long enough to get sleepy again. The cat will teach me how to nap.
Thursday, October 07, 2004
It's schaDENfreude, asshole!
Confidential to Denise: I really, really do know how to spell 'schadenfreude'. It's just that I can barely type in English most of the time, let alone German.
Some nice person sent me an email asking "What's a typical day like for you?" Herewith, A Typical Day In The Life:
0420: Awaken to the dulcet tones of a BBC announcer soothingly reporting the latest casualties from the Gaza Strip.
0423: Pour first cup of coffee.
0424-0440: Mindless circumambulation with said cup of coffee gripped tightly in paws.
0440-0520: Shower, try to apply eye makeup without ending up in traction, dress, decide on lunch. Leave for work.
0610: Arrive at work. Eat yogurt while sitting in car, listening to the dulcet tones of Carl Kasell totalling up the latest casualties in Iraq.
0625: Stumble in to the breakroom with another cup of coffee, prepare for report.
0640: Report until 0700. Pee if possible.
0700: Start waking up patients. Most of them are grumpy, since they've been awakened every two to four hours for days on end. Check lab results from earlier in the morning. Inform the neurosurgery nurse liason if there's anything amiss. Send people to surgery, CT scan, and echo.
0800: Start charting. Morning assessments are done; all that remains is putting them on paper and hoping that I haven't charted Patient X's assessment on Patient Y's chart.
0803: Think longingly of eggs and bacon in the cafeteria downstairs, then remember latest scale numbers and cholesterol results.
0825: Five minutes for bran muffin.
0830: Begin passing morning medications. Deal with, at a minimum, six new orders and four new crises. Receive patient from ICU.
0915: Finish passing medications. Start calling residents, consults, specialists, the housekeeping people, the guest services staff, family members, and wound care/ostomy care/urology people for help or with information.
1006: Morning routine of physical therapy, bowel programs, and incoming phone calls begins. Take time to pee if possible. Change dressings, check ins and outs, empty drains. Retrieve six new orders from box. Discharge two patients home. Charting.
1128: Begin passing noon medications, hanging antibiotics, giving Decadron, and checking blood sugars and every-six-hour lab reports. Do noon assessments on neurology/neurosurgery patients. Call report on patient going to rehabilitation unit. Chart.
1230: Finish above. Begin to think longingly about sandwich. Retrieve six new orders from box. Send patient to rehab.
1240-1315: Various crises, lunch preparations, and phone calls.
1315: Sit down with sandwich. Take first lustful bite, be called away for lift help or because Patient Y has just had explosive diarrhea that covers the entire back wall of the bathroom.
1330: Return to lunch, if fortunate. If *extremely fortunate*, have time for another cup of coffee and a quick pee break.
1400: IV flushes, any dressings I didn't get to in the morning, afternoon rounds of tests start. Assess non-neurology patients again. Catch up with respiratory therapists for progress reports. Check box for new orders. Find new order written by chucklehead from any one of several services and call for clarifications. Hang new bags of tube feeding. Check ins and outs, empty drains, calculate total IV drips for the last seven hours. Check box for new orders. Hang potassium, magnesium, or calcium drips. Chart.
(Optional: four new crises.)
1530: Look at clock, realize there are only three-and-a-half more hours in the day. Fail to mourn this realization. Start 1600 assessments on neurology/neurosurgery patients. Get two new admits from surgery. Discharge late-home patient. Plow through group of new residents taking tour of unit. Be almost rude to hospital administrator taking group of investors through unit and thus blocking the entire damn hallway so I can't get a bed through. Field call bells from patients with problems ranging from inability to breathe to their fruit basket not containing enough grapes.
1700: Neurosurgery rounds start. Stare dully at wall, wishing I worked a ten-hour shift rather than a twelve-hour. Wonder what to have for dinner.
1745: Neuro rounds end. Reassess patients. Retrieve six new orders from box. Direct men who are impersonating Birnam Wood to various rooms for flowers/potted plant deliveries.
1800: Last push of the day. Hang evening medications, pass evening medications, check IV bags. Long for strong drink. Fill out report sheets. Do quick rounds of rooms, picking up dirty linens and trash, changing water in vases (yes, we really still do that). Check to see that evening labs have been sent. Sometimes, if very fortunate, practice French with Cajun patient or discuss politics with Political Heavyweight Patient over dinner. Chart.
1845: Report to night shift. Give up beeper. Hope I haven't forgotten anything.
1908: Punch out. Go home. Fall over.
Some nice person sent me an email asking "What's a typical day like for you?" Herewith, A Typical Day In The Life:
0420: Awaken to the dulcet tones of a BBC announcer soothingly reporting the latest casualties from the Gaza Strip.
0423: Pour first cup of coffee.
0424-0440: Mindless circumambulation with said cup of coffee gripped tightly in paws.
0440-0520: Shower, try to apply eye makeup without ending up in traction, dress, decide on lunch. Leave for work.
0610: Arrive at work. Eat yogurt while sitting in car, listening to the dulcet tones of Carl Kasell totalling up the latest casualties in Iraq.
0625: Stumble in to the breakroom with another cup of coffee, prepare for report.
0640: Report until 0700. Pee if possible.
0700: Start waking up patients. Most of them are grumpy, since they've been awakened every two to four hours for days on end. Check lab results from earlier in the morning. Inform the neurosurgery nurse liason if there's anything amiss. Send people to surgery, CT scan, and echo.
0800: Start charting. Morning assessments are done; all that remains is putting them on paper and hoping that I haven't charted Patient X's assessment on Patient Y's chart.
0803: Think longingly of eggs and bacon in the cafeteria downstairs, then remember latest scale numbers and cholesterol results.
0825: Five minutes for bran muffin.
0830: Begin passing morning medications. Deal with, at a minimum, six new orders and four new crises. Receive patient from ICU.
0915: Finish passing medications. Start calling residents, consults, specialists, the housekeeping people, the guest services staff, family members, and wound care/ostomy care/urology people for help or with information.
1006: Morning routine of physical therapy, bowel programs, and incoming phone calls begins. Take time to pee if possible. Change dressings, check ins and outs, empty drains. Retrieve six new orders from box. Discharge two patients home. Charting.
1128: Begin passing noon medications, hanging antibiotics, giving Decadron, and checking blood sugars and every-six-hour lab reports. Do noon assessments on neurology/neurosurgery patients. Call report on patient going to rehabilitation unit. Chart.
1230: Finish above. Begin to think longingly about sandwich. Retrieve six new orders from box. Send patient to rehab.
1240-1315: Various crises, lunch preparations, and phone calls.
1315: Sit down with sandwich. Take first lustful bite, be called away for lift help or because Patient Y has just had explosive diarrhea that covers the entire back wall of the bathroom.
1330: Return to lunch, if fortunate. If *extremely fortunate*, have time for another cup of coffee and a quick pee break.
1400: IV flushes, any dressings I didn't get to in the morning, afternoon rounds of tests start. Assess non-neurology patients again. Catch up with respiratory therapists for progress reports. Check box for new orders. Find new order written by chucklehead from any one of several services and call for clarifications. Hang new bags of tube feeding. Check ins and outs, empty drains, calculate total IV drips for the last seven hours. Check box for new orders. Hang potassium, magnesium, or calcium drips. Chart.
(Optional: four new crises.)
1530: Look at clock, realize there are only three-and-a-half more hours in the day. Fail to mourn this realization. Start 1600 assessments on neurology/neurosurgery patients. Get two new admits from surgery. Discharge late-home patient. Plow through group of new residents taking tour of unit. Be almost rude to hospital administrator taking group of investors through unit and thus blocking the entire damn hallway so I can't get a bed through. Field call bells from patients with problems ranging from inability to breathe to their fruit basket not containing enough grapes.
1700: Neurosurgery rounds start. Stare dully at wall, wishing I worked a ten-hour shift rather than a twelve-hour. Wonder what to have for dinner.
1745: Neuro rounds end. Reassess patients. Retrieve six new orders from box. Direct men who are impersonating Birnam Wood to various rooms for flowers/potted plant deliveries.
1800: Last push of the day. Hang evening medications, pass evening medications, check IV bags. Long for strong drink. Fill out report sheets. Do quick rounds of rooms, picking up dirty linens and trash, changing water in vases (yes, we really still do that). Check to see that evening labs have been sent. Sometimes, if very fortunate, practice French with Cajun patient or discuss politics with Political Heavyweight Patient over dinner. Chart.
1845: Report to night shift. Give up beeper. Hope I haven't forgotten anything.
1908: Punch out. Go home. Fall over.
Wednesday, October 06, 2004
Chuckleheads on Parade
I was not going to blog about what happened yesterday at work. As I told friend Arlene, it made me sick to my stomach to even think about. Then, as I was sitting outside with my coffee this morning, I started getting angry.
I have the feeling that what I did yesterday is about to blow up in my face.
Here's the situation: a young HIV positive patient came in for an emergency joint replacement. He has a condition that makes the bone in his large joints die off--it's a side effect of the medication he's been on. He had the surgery Thursday and should've gone for rehabilitation Saturday or Sunday, but he was still at the hospital yesterday. The Chucklehead Brigade from the orthopedic service had decided at the last minute that blood transfusions and more cultures were necessary. He almost left AMA (against medical advice, without formal discharge), but the lead doc on the team talked him out of it.
This kid didn't understand that the fluid a doctor had drawn out of his hip was going to be used for cultures. He didn't understand what the word "culture" meant. He didn't know why they'd transfused two units of blood into him and didn't understand that he'd given consent for the transfusion when he consented to surgery. The lead doc's explanation consisted of "I'm really busy and have a lot of patients in clinic right now, so I don't have time to talk to you."
In short, he didn't understand what was going on, and nobody had bothered to explain it to him.
I had this guy in my care for *four hours* yesterday. Of that four hours--and keep in mind I had three other patients as well, including a new admit--I spent probably two hours with him. That's a huge amount of time for any hospital nurse. This kid needed it, though.
He's poor. He's non-white. He's HIV-poz. His family has limited transportation. He needs to get home, but for some reason he can't conceive, the doctors aren't letting him go. At five yesterday afternoon, as I was filling out his discharge paperwork--because we'd both been told that everything was ready for him to leave--the ortho resident swanned in and said he'd have to stay for an internal medicine consult.
This is when Nurse Jo takes off her cute nurse mask and becomes Ratched.
Long story short, I made a lot of people very unhappy yesterday, including the attending doc who'd done the surgery and then blown off his patient. The patient, however, is going to go home today with pretty much everything he needs, including a long-term venous access for antibiotics. I told him I'd call today at ten to make sure he was on his way home and that if he wasn't, I'd raise hell.
This is what really pisses me off:
For several years, I worked as a paraprofessional with mostly-poor women, some of whom didn't speak English. I managed to make clear the consents that they signed even if they were Chinese-speaking immigrants, even if they were deaf, even if they were illiterate. Literally. I took the time in a busy clinic to do such cutting-edge things as answer questions in plain English. The place I worked didn't have a lot of money, didn't have readily-accessible doctors (the care was provided by nurse practitioners), didn't have a lot of clout politically in the community. And yet I managed to do my job, not only to *minimum standards*, but to what I think were pretty damn good standards.
Why can't a fully-staffed, cutting-edge hospital do the same thing? Why did I have a patient who was ignorant of almost everything that had happened to him in the last three days? Why had nobody informed the doctors that his pain control was bad? Why had nobody talked to him and his family about what was actually going on in his hip joint? Why was *I* the one who had to get angry and motivated in the last four hours of the day and make things happen for this guy?
I swear to God: If one person wants to give me trouble about what I said, did, promised, or acted on yesterday, all everloving hell is going to break loose. The political implications of some of my reactions and actions yesterday might lose me my job--seriously, as it's never a good idea to be insulting to an attending physician--but at this point, they can fucking have it. Any place that spends more effort on getting fruit baskets for some VIP than on making sure a run-of-the-mill patient understands why we're cutting on him is not a place that deserves me.
Some days I really, really wish I lived in the country and worked at some tiny hospital where I'd have the chance to do *happy* things, like helping babies be born or taking care of people who aren't getting jacked around.
*sigh*
I have the feeling that what I did yesterday is about to blow up in my face.
Here's the situation: a young HIV positive patient came in for an emergency joint replacement. He has a condition that makes the bone in his large joints die off--it's a side effect of the medication he's been on. He had the surgery Thursday and should've gone for rehabilitation Saturday or Sunday, but he was still at the hospital yesterday. The Chucklehead Brigade from the orthopedic service had decided at the last minute that blood transfusions and more cultures were necessary. He almost left AMA (against medical advice, without formal discharge), but the lead doc on the team talked him out of it.
This kid didn't understand that the fluid a doctor had drawn out of his hip was going to be used for cultures. He didn't understand what the word "culture" meant. He didn't know why they'd transfused two units of blood into him and didn't understand that he'd given consent for the transfusion when he consented to surgery. The lead doc's explanation consisted of "I'm really busy and have a lot of patients in clinic right now, so I don't have time to talk to you."
In short, he didn't understand what was going on, and nobody had bothered to explain it to him.
I had this guy in my care for *four hours* yesterday. Of that four hours--and keep in mind I had three other patients as well, including a new admit--I spent probably two hours with him. That's a huge amount of time for any hospital nurse. This kid needed it, though.
He's poor. He's non-white. He's HIV-poz. His family has limited transportation. He needs to get home, but for some reason he can't conceive, the doctors aren't letting him go. At five yesterday afternoon, as I was filling out his discharge paperwork--because we'd both been told that everything was ready for him to leave--the ortho resident swanned in and said he'd have to stay for an internal medicine consult.
This is when Nurse Jo takes off her cute nurse mask and becomes Ratched.
Long story short, I made a lot of people very unhappy yesterday, including the attending doc who'd done the surgery and then blown off his patient. The patient, however, is going to go home today with pretty much everything he needs, including a long-term venous access for antibiotics. I told him I'd call today at ten to make sure he was on his way home and that if he wasn't, I'd raise hell.
This is what really pisses me off:
For several years, I worked as a paraprofessional with mostly-poor women, some of whom didn't speak English. I managed to make clear the consents that they signed even if they were Chinese-speaking immigrants, even if they were deaf, even if they were illiterate. Literally. I took the time in a busy clinic to do such cutting-edge things as answer questions in plain English. The place I worked didn't have a lot of money, didn't have readily-accessible doctors (the care was provided by nurse practitioners), didn't have a lot of clout politically in the community. And yet I managed to do my job, not only to *minimum standards*, but to what I think were pretty damn good standards.
Why can't a fully-staffed, cutting-edge hospital do the same thing? Why did I have a patient who was ignorant of almost everything that had happened to him in the last three days? Why had nobody informed the doctors that his pain control was bad? Why had nobody talked to him and his family about what was actually going on in his hip joint? Why was *I* the one who had to get angry and motivated in the last four hours of the day and make things happen for this guy?
I swear to God: If one person wants to give me trouble about what I said, did, promised, or acted on yesterday, all everloving hell is going to break loose. The political implications of some of my reactions and actions yesterday might lose me my job--seriously, as it's never a good idea to be insulting to an attending physician--but at this point, they can fucking have it. Any place that spends more effort on getting fruit baskets for some VIP than on making sure a run-of-the-mill patient understands why we're cutting on him is not a place that deserves me.
Some days I really, really wish I lived in the country and worked at some tiny hospital where I'd have the chance to do *happy* things, like helping babies be born or taking care of people who aren't getting jacked around.
*sigh*
Sunday, October 03, 2004
Shit, oh dear, part two.
Note: avoid this entry if you have a problem with the requisite female blogger's musings on weight and body image.
So, today, I was wandering around the apartment, wondering what that funny stiff feeling was in my lower back. I couldn't bend backwards easily and felt, well, stiff.
I figured it was muscle pain. Then I put my hands on the small of my back and realized that it was my hips keeping me from bending over backwards.
Um.
At 117 pounds, the recommended weight for my height, I am skeletal. At 130, I'm just fine. At 150-something, where I am now, I am not as motile as I'd like to be. Not entirely sessile, mind you, but not terribly flexible.
Plus, I'm getting winded walking up the three flights of stairs to my apartment.
Plus plus, the two male nurses on the floor who are close to me in height weigh eight and eighteen pounds less than me respectively.
Time to start shutting the pie-hole and getting back on the treadmill.
*sigh*
This is a depressing prospect. For most of my life, the trouble's been to keep weight on. In times of stress I simply burned off anything I might've gained in happy times and kept a fairly even balance the rest of the time. Now it's looking like the Dreaded Mid-Thirties Metabolic Slowdown has hit. The fact that it's hard not to eat late at night when I don't get home until eight and that it's hard to get to the gym most nights doesn't help.
I thought it was bad six months ago. I was wrong. It's worse now.
*sigh*
Requisite musings on weight and body image might become as much of a routine here as Blog O' The Morning! is. Don't worry. I'll warn you before I mope.
So, today, I was wandering around the apartment, wondering what that funny stiff feeling was in my lower back. I couldn't bend backwards easily and felt, well, stiff.
I figured it was muscle pain. Then I put my hands on the small of my back and realized that it was my hips keeping me from bending over backwards.
Um.
At 117 pounds, the recommended weight for my height, I am skeletal. At 130, I'm just fine. At 150-something, where I am now, I am not as motile as I'd like to be. Not entirely sessile, mind you, but not terribly flexible.
Plus, I'm getting winded walking up the three flights of stairs to my apartment.
Plus plus, the two male nurses on the floor who are close to me in height weigh eight and eighteen pounds less than me respectively.
Time to start shutting the pie-hole and getting back on the treadmill.
*sigh*
This is a depressing prospect. For most of my life, the trouble's been to keep weight on. In times of stress I simply burned off anything I might've gained in happy times and kept a fairly even balance the rest of the time. Now it's looking like the Dreaded Mid-Thirties Metabolic Slowdown has hit. The fact that it's hard not to eat late at night when I don't get home until eight and that it's hard to get to the gym most nights doesn't help.
I thought it was bad six months ago. I was wrong. It's worse now.
*sigh*
Requisite musings on weight and body image might become as much of a routine here as Blog O' The Morning! is. Don't worry. I'll warn you before I mope.
Friday, October 01, 2004
Friday Fluff
Blog O' The Evening! (Blog of the Evening, Beautiful Blog...)
Incurable Hippie
Site of the Evening....
Regrettable Food
Girly Product Reviews, Inspired by the latest Allure Magazine Issue
Olay Complete Body Wash, Sensitive Skin Formula, is totally free of icky perfumes. It's also good for people with really, *really* dry skin, like me.
L'Oreal Lash Architect super-duper weirdo lash-curling waterproof formula will stand up to mineral baths in odd, out-of-the-way places, but the sensation of feeling your lashes curl is very odd. I'm sure there's some sort of polymer technology at work here, but I'd prefer to remain ignorant and simply throw the tube away. I have enough to deal with at 0500 four days a week without the sensation of various body parts being manipulated by colored liquid.
It also makes me look a whole lot like Carol Channing.
Dove products: buy them. All of them. Soap, lotion, scrub, whatever.
Dove Bars with almonds are the quintessential PMS food.
Toad Hollow chardonnay is good for a crowd. Not too expensive, not oddly metallic and oily, with a pronounced oaky flavor that dissipates if you let it breathe.
Things I have discovered I am expert at:
1. Picking all the Oreo pieces out of a pint of cookies & cream ice cream.
2. Bandage changing.
3. Driving irresponsibly fast in construction zones.
4. Timing french fries in the oven so that they come out exactly as crispy as you want them to.
5. Avoiding political topics in my online life, though I'm feminist and liberal enough in the meat world to glow in the dark.
This last is why you won't see any dissection of the war or the debates or the Presidential campaign or any of the stupid things Governor Hair has done recently here. If you want a feminist political blog, check out whatshesaid.
Incurable Hippie
Site of the Evening....
Regrettable Food
Girly Product Reviews, Inspired by the latest Allure Magazine Issue
Olay Complete Body Wash, Sensitive Skin Formula, is totally free of icky perfumes. It's also good for people with really, *really* dry skin, like me.
L'Oreal Lash Architect super-duper weirdo lash-curling waterproof formula will stand up to mineral baths in odd, out-of-the-way places, but the sensation of feeling your lashes curl is very odd. I'm sure there's some sort of polymer technology at work here, but I'd prefer to remain ignorant and simply throw the tube away. I have enough to deal with at 0500 four days a week without the sensation of various body parts being manipulated by colored liquid.
It also makes me look a whole lot like Carol Channing.
Dove products: buy them. All of them. Soap, lotion, scrub, whatever.
Dove Bars with almonds are the quintessential PMS food.
Toad Hollow chardonnay is good for a crowd. Not too expensive, not oddly metallic and oily, with a pronounced oaky flavor that dissipates if you let it breathe.
Things I have discovered I am expert at:
1. Picking all the Oreo pieces out of a pint of cookies & cream ice cream.
2. Bandage changing.
3. Driving irresponsibly fast in construction zones.
4. Timing french fries in the oven so that they come out exactly as crispy as you want them to.
5. Avoiding political topics in my online life, though I'm feminist and liberal enough in the meat world to glow in the dark.
This last is why you won't see any dissection of the war or the debates or the Presidential campaign or any of the stupid things Governor Hair has done recently here. If you want a feminist political blog, check out whatshesaid.
Thursday, September 30, 2004
Rules for Residents
It's that time of year again. We got a new crop of residents this summer and they're just now beginning to feel confident on our floor. This means that some of them have turned into flaming assholes. Some of them are not so bad, true, but this isn't directed toward the not-so-bad ones.
Please note that the nurse or lab technician will be referred to herein as "she". Nursing and lab teching are primarily female jobs.
The resident will be referred to as "he". While our resident population is split roughly 50/50, I have yet to meet a female resident who yells, uses profanity, or attempts to humiliate nurses in front of other people. Those who try such antisocial tricks have been, invariably, male. Suck it up, boys; it's life.
Rule Number One: Policies, procedures, and standards do not exist solely for the purpose of inconveniencing you.
There must, therefore, be some other reason for them to exist. Perhaps it's patient safety. Or worker safety. Or Federal law. If those considerations pale before the issue of your precious convenience, do not blame the nurse or lab tech who explains the problem to you. Do not complain to them that the policy is unreasonable. Do not threaten them. It will do you no good and only make you enemies.
Instead, express--civilly, please--your frustration with the situation, if you must. Ask for help. Ask for advice. We will then bend over backwards to help you out.
Rule Number Two: If You Are An Asshole, You Will Get Zero Slack From The Floor Staff.
Remember the resident who tried to tell me that an oxygen supply line was misconnected and berated me for same in front of a patient? He now gets called by every nurse on every floor to double-check every damned connection on every piece of equipment to which his patients are hooked. Every time.
He also was hard enough on a charge nurse I work with to bring her nearly to tears. This woman is tough, no-nonsense, and strong. I don't know what he said, but it must've been something. I'm sure he felt good when he hung up on her. I'm sure he felt less good when his attending physician called him on his behavior in the weekly ENT meeting.
Another case: A resident yelled at two nurses in the space of a week for not calling him with lab results. These particular lab results were within normal limits and there was no order to notify him with the results, so we let them go. That's our policy.
That resident got called at odd hours every night for six months by every nurse he worked with. We double-checked everything with him. We called for approval before implementing pre-printed protocols. We called for orders for suppositories and Tylenol. The pharmacists called before implementing pharmacy protocols. The lab staff called with every single lab result on every single patient. Around the clock. For six months.
His behavior has improved.
Rule Number Three: Being A Jerk Will Not Provide Your Patients With Better Care.
If you're personally unpleasant, we will delegate every interaction with you to whomever will accept the assignment. We'll take very good care of your patients--that's our job--but you'll get one, maybe two phone calls a day with all the results and news of the day rolled into three minutes.
Rule Number Four: Being A Nice Guy Will Get You Perks.
We play favorites, openly and unashamedly. If Resident A gets a nickname and plates of food set aside for him from the staff's potluck lunches, there is probably a reason. If Resident B is treated brusquely and with thinly-veiled hostility by the entire staff, you bet there's a reason.
Resident A is also much more likely to find people to help with bedside procedures than Resident B. Resident A will have a staff of willing nurses who will walk through fire for him if something is going badly wrong. Resident B will be told to find documents himself or call the lab on his own.
Rule Number Five: There Is A Very Strong Probability That The Nurses You Work With Know More Than You Do.
"Very strong probability" in this context means "virtual certainty."
Our hospital's average nurse has been working with a specialized patient population for more than five years. She spends hours with her patients several days a week. They tell her things they wouldn't tell their own priests or mothers. She sees them when they're sleeping and knows when they're awake.
She also understands the basic surgical techniques that doctors use and their effects on the body as a whole. She has a grasp of the lab values that she encounters on a daily basis and knows when trouble is brewing.
Most importantly, your average nurse has a good gut sense of when it's about to hit the fan.
Therefore, if a nurse calls you at eleven on a Sunday morning with the news that everything with Patient X is so far going well, but that she has a niggling suspicion that something terrible is lurking just beyond the bend, you should listen.
If a nurse tells you that your new patient is a drug-seeking wacko with aggressive tendencies, don't be condescending. Remember that this nurse is, in all probability, older than you are and has not spent the last fifteen years in school. More than likely, she worked with drug-seeking wackos as a full-time job at some point. Listen to her. Take her seriously. Keep your eyes open. That way, when the patient hoards Phenergan in his bed or throws a chair through her window because she can't get morphine, you won't be surprised.
It's not rocket science, guys.
I promise that your balls will be just as big at the end of the day as they were at the beginning, even if you're pleasant and civil to everyone you see. I promise that your integrity as a surgeon will not be compromised by apologizing to someone that you've screamed at. I promise that things will be much, much easier if you treat those lesser beings who keep your patients alive and healthy with respect and honesty.
If you don't, that's your business. Please be aware, however, that most of us have been through much worse than you. We have no compunction about mopping the floor with your sorry ass if you step over the line.
Please note that the nurse or lab technician will be referred to herein as "she". Nursing and lab teching are primarily female jobs.
The resident will be referred to as "he". While our resident population is split roughly 50/50, I have yet to meet a female resident who yells, uses profanity, or attempts to humiliate nurses in front of other people. Those who try such antisocial tricks have been, invariably, male. Suck it up, boys; it's life.
Rule Number One: Policies, procedures, and standards do not exist solely for the purpose of inconveniencing you.
There must, therefore, be some other reason for them to exist. Perhaps it's patient safety. Or worker safety. Or Federal law. If those considerations pale before the issue of your precious convenience, do not blame the nurse or lab tech who explains the problem to you. Do not complain to them that the policy is unreasonable. Do not threaten them. It will do you no good and only make you enemies.
Instead, express--civilly, please--your frustration with the situation, if you must. Ask for help. Ask for advice. We will then bend over backwards to help you out.
Rule Number Two: If You Are An Asshole, You Will Get Zero Slack From The Floor Staff.
Remember the resident who tried to tell me that an oxygen supply line was misconnected and berated me for same in front of a patient? He now gets called by every nurse on every floor to double-check every damned connection on every piece of equipment to which his patients are hooked. Every time.
He also was hard enough on a charge nurse I work with to bring her nearly to tears. This woman is tough, no-nonsense, and strong. I don't know what he said, but it must've been something. I'm sure he felt good when he hung up on her. I'm sure he felt less good when his attending physician called him on his behavior in the weekly ENT meeting.
Another case: A resident yelled at two nurses in the space of a week for not calling him with lab results. These particular lab results were within normal limits and there was no order to notify him with the results, so we let them go. That's our policy.
That resident got called at odd hours every night for six months by every nurse he worked with. We double-checked everything with him. We called for approval before implementing pre-printed protocols. We called for orders for suppositories and Tylenol. The pharmacists called before implementing pharmacy protocols. The lab staff called with every single lab result on every single patient. Around the clock. For six months.
His behavior has improved.
Rule Number Three: Being A Jerk Will Not Provide Your Patients With Better Care.
If you're personally unpleasant, we will delegate every interaction with you to whomever will accept the assignment. We'll take very good care of your patients--that's our job--but you'll get one, maybe two phone calls a day with all the results and news of the day rolled into three minutes.
Rule Number Four: Being A Nice Guy Will Get You Perks.
We play favorites, openly and unashamedly. If Resident A gets a nickname and plates of food set aside for him from the staff's potluck lunches, there is probably a reason. If Resident B is treated brusquely and with thinly-veiled hostility by the entire staff, you bet there's a reason.
Resident A is also much more likely to find people to help with bedside procedures than Resident B. Resident A will have a staff of willing nurses who will walk through fire for him if something is going badly wrong. Resident B will be told to find documents himself or call the lab on his own.
Rule Number Five: There Is A Very Strong Probability That The Nurses You Work With Know More Than You Do.
"Very strong probability" in this context means "virtual certainty."
Our hospital's average nurse has been working with a specialized patient population for more than five years. She spends hours with her patients several days a week. They tell her things they wouldn't tell their own priests or mothers. She sees them when they're sleeping and knows when they're awake.
She also understands the basic surgical techniques that doctors use and their effects on the body as a whole. She has a grasp of the lab values that she encounters on a daily basis and knows when trouble is brewing.
Most importantly, your average nurse has a good gut sense of when it's about to hit the fan.
Therefore, if a nurse calls you at eleven on a Sunday morning with the news that everything with Patient X is so far going well, but that she has a niggling suspicion that something terrible is lurking just beyond the bend, you should listen.
If a nurse tells you that your new patient is a drug-seeking wacko with aggressive tendencies, don't be condescending. Remember that this nurse is, in all probability, older than you are and has not spent the last fifteen years in school. More than likely, she worked with drug-seeking wackos as a full-time job at some point. Listen to her. Take her seriously. Keep your eyes open. That way, when the patient hoards Phenergan in his bed or throws a chair through her window because she can't get morphine, you won't be surprised.
It's not rocket science, guys.
I promise that your balls will be just as big at the end of the day as they were at the beginning, even if you're pleasant and civil to everyone you see. I promise that your integrity as a surgeon will not be compromised by apologizing to someone that you've screamed at. I promise that things will be much, much easier if you treat those lesser beings who keep your patients alive and healthy with respect and honesty.
If you don't, that's your business. Please be aware, however, that most of us have been through much worse than you. We have no compunction about mopping the floor with your sorry ass if you step over the line.
Saturday, September 25, 2004
TMI, TGDG
Too Much Information, Too Goddamned Girly.*
I should have a T-shirt that says, "My doctor put me on fucking Tequin and all I got was this lousy yeast infection." Not only did I pay $61.95--with insurance, thank you--for the privilege of eliminating a bacterial superinfection in my sinuses, but I get the added joy of trying to figure out which over-the-counter yeast infection remedy is comparable to bribing a Diflucan from the pharmacist at work. Not that I'd ever do that, or that he'd ever comply, you understand; this is merely an intellectual exercise.
The bacteria are gone, thank the gods, which means I'm left to deal only with the viral infection that started it all. I still have to finish the fucking Tequin, but at least I'm not running a high fever. I'm only producing amounts of snot that would make even the most hardened otolaryngologist quail. And I'm coughing like Mimi from "La Boheme," a reference that exactly none of my coworkers got today at work. Sucks to be the only one who can both sing "Mi chiamo Mimi" and get the joke.
Because I know how to have Big Fun on a Saturday night, I bought the following things at the grocery store this evening:
1. A bottle of Toad Hollow chardonnay. Not a bad little wine, even if it tastes like it's been stirred with a 2 x 4. The oak is pronounced.
2. Copies of "Scientific American" and "Allure: The Best Beauty Issue".
3. Generic miconazole cream.
4. Shoe polish (liquid) which I promptly squirted all over my kitchen table (not a big deal) and my carpet (a slightly bigger deal). However, my shoes are now shiny and scuff-free.
Allure's advertising-driven editorials tell me that Neutrogena has come up with some product that makes it possible to plane several layers of skin off your face--without redness or irritation!--while Maybelline has come up with a product that replicates the look and feel of the skin you've just removed. There's also a full-page ad for something called Brava, a breast-enhancement system.
This Brava thing deserves a paragraph of its own. Going to the website will give you no solid information on price, use, or configuration of the product, but it will provide scary hints as to all three.
Brava seems to be some sort of suction-based device that yanks on breast tissue until it expands and fills out. Why this is a good idea, or one which even the most desperate woman would consider, escapes me. Anyhow, you're supposed to strap on the Brava cups ("They're huge! They cover your whole chest!" says one review) in the privacy of your own home ("You can be as discrete [sic] as you like" says another) and then wait for the miracle to happen. In between uses, there are handy tips on reducing skin irritation (use cortisone cream) and fitting the product (strap the cups on with cut-up pantyhose). There's even an 800 number to call for help with financing.
Financing. For a pair of hollow half-globes that yank your tits out of shape until they give in. There is so much wrong with this that I don't know where to start.
Tomorrow morning, once I've got a little more energy, I'm going to attack the remaining shoe polish stain with rubbing alcohol (thanks, Beloved Sister!) and read "Scientific American." You just can't get the same effect from articles on the evolutionary benefits of siblings as you can from articles on peeling off bits of skin and self-curling mascara.
*Anybody who complains about the unusual Personal Squick Factor of this post can reference Belle, Diablo, Joe, or The Good Wife and kiss my ass. Thank you and good night.
I should have a T-shirt that says, "My doctor put me on fucking Tequin and all I got was this lousy yeast infection." Not only did I pay $61.95--with insurance, thank you--for the privilege of eliminating a bacterial superinfection in my sinuses, but I get the added joy of trying to figure out which over-the-counter yeast infection remedy is comparable to bribing a Diflucan from the pharmacist at work. Not that I'd ever do that, or that he'd ever comply, you understand; this is merely an intellectual exercise.
The bacteria are gone, thank the gods, which means I'm left to deal only with the viral infection that started it all. I still have to finish the fucking Tequin, but at least I'm not running a high fever. I'm only producing amounts of snot that would make even the most hardened otolaryngologist quail. And I'm coughing like Mimi from "La Boheme," a reference that exactly none of my coworkers got today at work. Sucks to be the only one who can both sing "Mi chiamo Mimi" and get the joke.
Because I know how to have Big Fun on a Saturday night, I bought the following things at the grocery store this evening:
1. A bottle of Toad Hollow chardonnay. Not a bad little wine, even if it tastes like it's been stirred with a 2 x 4. The oak is pronounced.
2. Copies of "Scientific American" and "Allure: The Best Beauty Issue".
3. Generic miconazole cream.
4. Shoe polish (liquid) which I promptly squirted all over my kitchen table (not a big deal) and my carpet (a slightly bigger deal). However, my shoes are now shiny and scuff-free.
Allure's advertising-driven editorials tell me that Neutrogena has come up with some product that makes it possible to plane several layers of skin off your face--without redness or irritation!--while Maybelline has come up with a product that replicates the look and feel of the skin you've just removed. There's also a full-page ad for something called Brava, a breast-enhancement system.
This Brava thing deserves a paragraph of its own. Going to the website will give you no solid information on price, use, or configuration of the product, but it will provide scary hints as to all three.
Brava seems to be some sort of suction-based device that yanks on breast tissue until it expands and fills out. Why this is a good idea, or one which even the most desperate woman would consider, escapes me. Anyhow, you're supposed to strap on the Brava cups ("They're huge! They cover your whole chest!" says one review) in the privacy of your own home ("You can be as discrete [sic] as you like" says another) and then wait for the miracle to happen. In between uses, there are handy tips on reducing skin irritation (use cortisone cream) and fitting the product (strap the cups on with cut-up pantyhose). There's even an 800 number to call for help with financing.
Financing. For a pair of hollow half-globes that yank your tits out of shape until they give in. There is so much wrong with this that I don't know where to start.
Tomorrow morning, once I've got a little more energy, I'm going to attack the remaining shoe polish stain with rubbing alcohol (thanks, Beloved Sister!) and read "Scientific American." You just can't get the same effect from articles on the evolutionary benefits of siblings as you can from articles on peeling off bits of skin and self-curling mascara.
*Anybody who complains about the unusual Personal Squick Factor of this post can reference Belle, Diablo, Joe, or The Good Wife and kiss my ass. Thank you and good night.
Wednesday, September 22, 2004
Extra! Extra!
The Management is pleased to announce a new feature in this space, born of early-morning insomnia and the slightly hallucinogenic effects of Tessalon Perles.
Blog O' The Mornin'!
This will be an occasional feature, highlighting blogs and websites that The Editor has run across in her bleary-eyed InterWorldWideNet surfing.
Today's entries:
Sure thing, Babs
Spamusement!
Nominations are welcome.
Blog O' The Mornin'!
This will be an occasional feature, highlighting blogs and websites that The Editor has run across in her bleary-eyed InterWorldWideNet surfing.
Today's entries:
Sure thing, Babs
Spamusement!
Nominations are welcome.
Monday, September 20, 2004
Wow.
"Better than 'Scrubs'," he said.
Halfacanuck
"Mucus plugs sound really gross," she said.
Alexa's Escort Blog
Warning: the second link is more explicit than I'd normally put up, but it's also just cute as hell. Anybody who can talk about how much she loves Jimmy Choos at the same time she's mourning the lack of sensation that Viagra gives a 75-year-old man gets my vote.
Warning: the first link is to a blog whose author outdoes me in grumpiness. I mean that in a complimentary way. "I do not want a second pizza. I do not want 30% off." is how I often start my mornings.
Enjoy. I may have to start a Blog O' The Mornin'! feature.
Halfacanuck
"Mucus plugs sound really gross," she said.
Alexa's Escort Blog
Warning: the second link is more explicit than I'd normally put up, but it's also just cute as hell. Anybody who can talk about how much she loves Jimmy Choos at the same time she's mourning the lack of sensation that Viagra gives a 75-year-old man gets my vote.
Warning: the first link is to a blog whose author outdoes me in grumpiness. I mean that in a complimentary way. "I do not want a second pizza. I do not want 30% off." is how I often start my mornings.
Enjoy. I may have to start a Blog O' The Mornin'! feature.
Mucus, take two (now with addendum!)
I normally distrust physicians who have curly hair, dimples, and twinkly brown eyes. Especially if they have wire-rimmed glasses. Especially especially if they wear ties with little golf emblems on them.
I was therefore prepared mightily to distrust the doctor at the local Doc-In-A-Box this morning, until he opened his mouth and said, "Gee, you've had a lot of the same crud in the last year, haven't you? Looks like Tequin got rid of it last time."
Then he whacked on my sinuses and looked surprised when I jerked away (Yeeouch!), listened to my lungs, and nodded sagely when I told him I'd had a patient with pneumonia a few days ago. "Aerosolizing God knows what into the air, coughing in your face" he said.
Now I have a prescription for two weeks' worth of Tequin, a strong flouroquinolone antibiotic which my books assure me is good for everything from gonorrhea to Haemophilus influenzae and will take out methicillin-resistant strep as well.
David came over when I got back from the doctor. He took me for Chinese broccoli and soup, then brought me home. I crawled into bed and woke up a few minutes ago, hungry and disoriented.
I wonder what I'll take if Tequin doesn't get rid of this sinus infection. Leeches? Bleeding? Powdered frogs?
Addendum: I wrote my sister about the sinus infection and the way doctors test for it (by whacking your sinuses with their fingers) and she had this to say:
I remember once a doctor put her thumbs on either side of my nose just below my eyes and shoved, and I circled the ceiling shouting "wakwok" 57 times. On the 58th circuit I bumped my head on the light and fluttered down. This was at least a decade and a half ago and I still check every new doc out to be sure it isn't her.
I was therefore prepared mightily to distrust the doctor at the local Doc-In-A-Box this morning, until he opened his mouth and said, "Gee, you've had a lot of the same crud in the last year, haven't you? Looks like Tequin got rid of it last time."
Then he whacked on my sinuses and looked surprised when I jerked away (Yeeouch!), listened to my lungs, and nodded sagely when I told him I'd had a patient with pneumonia a few days ago. "Aerosolizing God knows what into the air, coughing in your face" he said.
Now I have a prescription for two weeks' worth of Tequin, a strong flouroquinolone antibiotic which my books assure me is good for everything from gonorrhea to Haemophilus influenzae and will take out methicillin-resistant strep as well.
David came over when I got back from the doctor. He took me for Chinese broccoli and soup, then brought me home. I crawled into bed and woke up a few minutes ago, hungry and disoriented.
I wonder what I'll take if Tequin doesn't get rid of this sinus infection. Leeches? Bleeding? Powdered frogs?
Addendum: I wrote my sister about the sinus infection and the way doctors test for it (by whacking your sinuses with their fingers) and she had this to say:
I remember once a doctor put her thumbs on either side of my nose just below my eyes and shoved, and I circled the ceiling shouting "wakwok" 57 times. On the 58th circuit I bumped my head on the light and fluttered down. This was at least a decade and a half ago and I still check every new doc out to be sure it isn't her.
Sunday, September 19, 2004
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 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.
Thursday, September 09, 2004
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.
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.
Saturday, September 04, 2004
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.
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.
Wednesday, September 01, 2004
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.
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.
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.
Wednesday, August 25, 2004
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.
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.
Sunday, August 22, 2004
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 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.
Thursday, August 19, 2004
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.
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.
Wednesday, August 18, 2004
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.
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.
Tuesday, August 10, 2004
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."
...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."
Wednesday, August 04, 2004
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.
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.
Sunday, August 01, 2004
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.
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.
Monday, July 26, 2004
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.
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.
Thursday, July 22, 2004
Sunday, July 18, 2004
Saturday, July 17, 2004
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.
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.
Friday, July 16, 2004
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.
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.
Thursday, July 15, 2004
...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.
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.
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.
Sunday, July 11, 2004
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.
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.
Wednesday, July 07, 2004
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.
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.
Tuesday, July 06, 2004
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.
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.
Saturday, July 03, 2004
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.
"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.
Subscribe to:
Posts (Atom)
