While waiting for news, distractions.

This is so very cool.

Chef Boy's new stove/oven has a Sabbath setting.

He said, when I mentioned that it had a Sabbath setting, "Yeah, I read that in the instruction book. Seems kind of weird."

I pointed out that the laws of the Jewish Sabbath prohibit, as far as I know, lighting cooking fires or lighting lights, so having an oven that would stay on with its light on for 72 hours straight might be a pretty cool work-around.

His question was, "What if I want to make a stir-fry?" I guess you'd have to wait until sunup to start that.

This is what happens when you live in a culture where Judaism and Mormonism are practically unknown, Southern Baptists build a church on every corner, and you know more about the Hindu pantheon than you do the Torah.

Another cool thing, this one rather scary.

As of when I get the phone call later tonight, Chef Boy will be unemployed. Probably. Most probably. And about damn time, too.

If any of you nurses think nursing is an insular, codependent, strange world filled with people who would be better off with minders, you haven't worked in a kitchen yet. The people who open small restaurants are often totally ignorant of what it takes to run a business. They're the sort of folks who will spend $38,000 on a new sportscar while cutting the hours of their staff back so that they can save money. They're weird folk.

Kitchen folk are weird, too, but they're pretty straight-up for the most part. Your average chef might have an ego the size of Alaska when it comes to his cooking, but he's not going to screw you around or lie to you when he's in the kitchen. (Out of the kitchen, approach at your own risk.) These are folk who work with knives, fire, and corpses, think it's okay to take whatever drugs they've found on the floor after closing time, and find humor in somebody cutting off the end of her thumb in a slicer. But they are honest, they do tell the truth, and they understand the Darwinism of the kitchen: either you make it as a line cook and go up from there, or you wash out and go back to the nine-to-five.

So Chef Boy is leaving his peculiarly pathological kitchen and looking for something else to do. He's gotten tired of being undermined and having his hours cut.

Let's have some kharma for the Boy, shall we, that he doesn't end up someplace even worse than Il Ristorante Schwankienne? Thankee.

Meanwhile, I'm sitting here at the computer, staring at the phone, wondering what in hell is taking him so long to call with the news. With every passing minute, my mental image of the proceedings worsens.

Still more coolness

Ever heard of Eaton-Lambert syndrome? I had, but I'd never seen it until yesterday. It's an autoimmune disorder, most commonly brought on by small cell lung cancer, that mimics myasthenia gravis, except in one particular: where people with MG get weaker the more they use their muscles, people with ELS get *stronger* with repetition of motion.

The treatment for both is the same: plasmapheresis.

I'll let you know how the ELS patient does after the first three pheresis treatments. I'm back at work on Tuesday. Until then, I'll bite my nails while waiting for Chef Boy to call and work on killing the dust bunny armies that have invaded my house.

Just a tip...

If you call me at home, and I return your call from work, and tell you that I'm calling from work on my cell phone, and you have both my cell phone and work numbers, don't sound annoyed if you later leave two messages on my home answering machine when you can't get in touch with me there.

I'm just sayin'.

Oh, and another thing...(edit)

If the op report says "glioma" and the residents' notes say "glioma" and the attending's note says "glioma", do not get snarky with me when I give a physician from another service the rundown on gliomas (nasty, fatal) rather than pilocytic astrocytomas (minor, totally curable) when she asks me.

Especially not if you dictated the report that called it a glioma.

If you do, I'll have to do one of two things:

1. Pull the chart and show you your error, which you will not like, or
2. Dump your bludgeoned and charred corpse out of the window.

A further note to the commenter of the other day: we've spoken to the nursing supervisor, the chief resident, and Doctor Assholian's attending about Doctor Assholian's behavior. So far, it hasn't made any difference.

Option #2 is starting to sound good. And totally, totally workable.

Not just in name only

Close encounters of the LDS kind

A group of about five of us started stocking and furnishing the apartment "our" evacuees will be moving into. Just as we were getting started, a couple of the missionaries who live downstairs asked if we needed help. I tasked them with moving a big, heavy couch up two flights of stairs, around three tight corners, and into a living room. And they did. Then they stayed and kept helping, and refused offers of pizza.

I didn't realize one of the women helping out was also a Saint until I started unpacking box after box of Number 10 cans of macaroni, flour, sugar, rice, beans, baking mixes, oatmeal...basically everything you'd need to cook for a month, she'd brought. Everything you'd need to wash your clothes, yourself, or your dishes for a month, she'd brought. She had all of this stuff stocked as extra, even though she's been living off of it since losing her job last year.

All that and a first-aid kit, too. It was a wonder to see. Every time one of us said, "Do we have X?" she'd answer "Hang on, got one right here" and yank some new thing out of her bag. When I asked her about it, she shrugged and said, "Hey. It's what we do."

So the folks coming in have a pantry crammed full of food, a closet crammed full of clothes (in the right sizes!) and a bathroom so stocked they won't have to buy toilet paper or shampoo for, like, six months. Either that or they'll be *very* clean.

We also have a wad of cash for gas cards, gift cards, grocery shopping, deposits to get the electricity turned over to their name, phone service, odds and ends, you-name-its, and a nice dinner out.

Everybody contributed according to their ability, I guess. It was a shock, though, to see a woman who's been unemployed since December who was still able to give so much, simply through storing this stuff since God Knows When. And the two missionaries who helped haul heavy things? Did it with smiles on their faces and in their dress clothes in the 100* heat.

Saints? You betcha.

Triage

soap

Shampoo. Hydrating or not? I suppose it doesn't matter.

shaving cream and razors

two toothbrushes and some toothpaste

towels. Two. No, better get four.

knives. The block set, or the three? Three. They can build around that.

washcloths

kitchen towels

silverware. They'll need silverware.

trash bags

dish detergent

lotion

Tylenol

Band-Aids

tampons and pads

a small lamp for the bedside

"Do we have dishes?" Yes, we have dishes. "How about a coffeemaker?" Yep, got that.

coffee. And filters. Don't forget the filters.

"How about toilet paper?" I don't think anybody thought of that. "Okay, then. I'll get some."

"Oh--wait. Any pets?" No, no pets. (a small sigh of relief here, that they didn't have to abandon their critters)

Paper. Pens. A phone book. A list of decent businesses to buy things from. A gift card for anything else we might've forgotten.

A couch. A bed. A dining room table and a rug. Later, someone will go out and buy a shower curtain.

Pillows. Blankets. Two sets of sheets that will be a little bit big, but should work.

The washing machine churning away at the towels, so that they can use them right away. The dishwasher churning away at the dishes, so that they can use them right away.

Food. More food than you could shake a stick at, stocking the pantry.

Some barstools.

A green plant.

Something to read.

A radio.

They lost everything. They were lucky enough to have the means and the ability to leave everything, but their business and house are now gone. No trace of 'em, *gone*.

They've driven ten, twelve, finally sixteen hours to come here. The management doesn't care that they don't have a housing voucher. "Go ahead and move in; no bills or rent for three months." The rest of us are giving whatever we can cull or buy or do without to furnish the apartment.

Triage means deciding what's important, what you have to do or have or deal with first. When you're looking at somebody who has nothing but what they could stuff in their Civic, that's hard to figure out.

Playing hooky and practice issues...

I need reassurance that what I did was the right thing to do.

It took me over five hours to get home last night from work. What would normally be a 45-minute commute turned into a hell of gridlock thanks to highway construction, people running out of gas, and some genius who miscalculated both the speed of the cement truck next to him and how fast the highway would run out.

Suffice it to say that for five hours I was stuck on a highway in a spot without exits or turnarounds for fifteen miles.

I got home after midnight and called in to work for today. Normally I'd attempt a day on four hours' sleep, with a few naps, but that's not an option at La Schwankola Hospital. You can't nap when you have lumbar drains open.

The Guilt Chip that was installed in my head midway through school is firing full-strength. It's not that we're short-staffed--we've got plenty of people to cover--or that I doubt that I wouldn't be safe, showing up way underslept.

It's that I feel like I ought to be SuperNurse, able to work with *no* sleep (which is better than short sleep), even though I'm sick, even if I've got a broken leg.

My practice would be unsafe were I at work today. That's a given. So I called in. Please, somebody, reassure me that nurses working short of sleep is just as bad as doctors doing it. Reassure me that if I have the choice not to practice if I'll be dangerous, the right thing is to make that choice.

Back to bed.

Read this

This is what my colleagues, bless them, are going through.

Welcome to my universe....

In which a discussion of the radical Marxist feminism of 30 years ago turns into a discussion of whether or not lesbian sex is used as a metaphor for death on "Buffy", and everybody gets very upset 'cept me, who's never seen an episode of "Buffy"...

In which the best list of links for Hurricane Katrina relief was put up by the gals at Go Fug Yourself...

In which a friend of mine loses her job and is made to go through counselling and Narcotics Anonymous meetings even *after* her tox test came back negative for alcohol or drugs, lest she be reported to the State nursing board...

In which the city government of Our Fair Burg has decided that housing Katrina evacuees would be "bad for business"--even though a neighboring town of half our size has turned an old grocery store into a shelter...

And an online pal sent me a picture from her local (Dallas) paper of an evacuee's dog who had been smuggled in a backpack all the way from NOLA, sticking his cute little doggy schnozz out to get some fresh air (I giggled until I cried, and then I cried some more)...

In which a "snack" is corn on the cob, roasted asparagus, and half an artichoke (next week I'll be back to Cheetos and beer, never you mind)...

In which avacados are suddenly something ridiculous like 4/$1, even though gas prices at some stations in my 'hood still hover at *over* four dollars, leaving me to make a huge bowl of guacamole and stay home...

And in which a snack-sized Greyhound (also known as a miniature Dachshund) named Bonnie has decided that I am Her Human, even *after* I took her to the vet for Various Undignified Tests.

Let's get a few things straight

Or, there ain't no "benign" or "malignant" when it comes to your brain

The first thing that most patients ask when they find out they have a brain tumor is "is it malignant?" They want to know if we can take it out, sew them up, and send them home in four days with no need for further treatment.

The first thing most patients ask when their MRIs show white matter lesions is "is that benign?" They want to know if the changes in their brains will lead to them sitting in a chair, reminiscing about something that never happened.

I have a philosophy on that whole question of benign or malignant, and it's this: when it comes to what's happening in your brain-box, all bets are off.

F'rinstance, there's only one brain tumor most of us should lose sleep over: glioblastoma multiforme. Unfortunately, it has the dual distinction of being both the most common type of tumor and the most lethal. You don't get better after a glio, and we can't cure it. It's an extremely aggressive type of tumor that grows fast and interleaves normal tissue with tumor tissue, meaning we can't get it all out.

There are other types of "malignant" brain tumors (meaning they're likely to come back): astrocytomas, metastatic tumors, low-grade gliomas.

There are also plenty of "benign" tumors out there, the most common being the meningioma, which grows on the coverings of the brain rather than in the brain itself.

The problem is this: there is limited space in your skull. Generally speaking, there is only room in there for your brain. If you have a small, easily resectable glioma in a place that's not too valuable, you're likely to live longer and better than somebody with a large meningioma that's compressed tissue in a sensitive spot and done its damage.

It's the same with the various brain lesions that show up on scans.

Most of us, unless we've lived a life free of alcohol, fat, tobacco, caffeine, hypertension, stress, depression, exultation, sadness, and thought, will have white matter lesions in our brains by the time we're 30. Mostly they're not a problem. The only time they start to cause trouble is when they're widespread (like in Alzheimer's) or if they're in sensitive spots. Sometimes they can be a symptom of other things, like hydrocephalus in older folks, which can be more-or-less easily fixed.

Point being, your brain is much like your skin: it shows changes as you get older, but those changes don't generally affect its ability to do its job.

My advice, then, is this: if you're diganosed with tissue changes or a tumor, don't think in terms of benign or malignant. Get a name for the tumor or the changes first, then find out where it is.

If cutting it out will lead to the loss of something that's valuable to you, like your balance or your sense of humor, then it's a bad tumor, no matter what type it is. If cutting it out will allow you to have a good quality of life with minor or no loss of those things that are important to you, then it's a good tumor, no matter what type it is.

If your scan shows changes that are a surprise to you, don't lose sleep over them. If something in your life changed that prompted you to submit to an MRI, then find out if that something could be related to those changes. If it is, find out what the treatments are, and go from there.

"Benign" and "malignant", when it comes to the brain, have more to do with where something is and how it will affect you than *what* it is.

What has happened down here is the winds have changed

Clouds roll in from the north and it started to rain
Rained real hard and rained for a real long time
Six feet of water in the streets of Evangeline

Click

The river rose all day
The river rose all night
Some people got lost in the flood
Some people got away alright
The river have busted through clear down to Plaquemines
Six feet of water in the streets of Evangeline

Click

Louisiana, Louisiana
They're tryin' to wash us away
They're tryin' to wash us away
Louisiana, Louisiana
They're tryin' to wash us away
They're tryin' to wash us away

Click

President Coolidge came down in a railroad train
With a little fat man with a note-pad in his hand
The President say, "Little fat man isn't it a shame what the river has done
To this poor cracker's land."

Click

Standby.

"In a state of emergency, you are creative, you figure out ways to get stuff done. They told me they went overnight and they built 17 concrete structures and the pulleys on them and were going to drop them, I flew over that thing yesterday and it's in the same shape that it was after the storm hit. There is nothing happening, and they're feeding the public a line of bull, and they're spinning, and people are dying down here."--Ray Nagin, mayor of New Orleans

We've been on disaster standby all week. The facility where I work is part of a regional disaster relief network, so when Katrina hit, we assumed we'd be getting a load of folks from University Hospital and Charity, the two hardest-hit hospitals in New Orleans. Tulane has the only working helipad, so we kind of figured that everybody would be boated or crawler-ed over to Tulane, then airlifted out.

So we waited. And waited. And nobody came. Not a trickle, much less a flood. One of the other hospitals in town got six patients rather than the 80 they were expecting. Which struck me as strange, until I heard an interview with a doctor at University on NPR yesterday.

There is very little food and potable water left at any of the hospitals. There has been no power for four or five days, and no flush toilets. They've taken to storing corpses in the stairwells. They're out of medications--not just code meds, but things like insulin and pressors.

And the doctor said he had been watching National Guard crawlers and boats go past all week. They're half a mile or so from the NG staging center, but there has been no concerted effort to evacuate the hundreds of patients in the two hospitals. Volunteers are taking people with critical injuries and so on in their own fishing boats to Tulane, but that's it.

Cell phones have finally started working again--if your batteries haven't gone dead. The administrators of our disaster planning group have been getting really scary phone calls and text messages from the people still stuck in hospitals in NOLA. There are nurses and doctors getting sick with E. coli and Giardia. They're out of alcohol. People are simply up and dying without medications to save their lives.

The National Guard has shifted its focus from search and rescue to shooting to kill when they find looters. The crawlers are passing the hospitals on the way to restore law and order.

Well, I'll be darned.

The Nurseweek article on nurse blogs is out. Thanks to Geena, who posted the link over at Code Blog, and without whom I would've remained ignorant.

We're STAAAAAAHHHHS!

*sigh*

Everybody I know in NOLA got out okay, 'cept one friend had to leave her horse stabled about 45 miles north of the city. I woke up this morning to hear an interview with a man whose biggest worry was the three cats he and his wife had to leave behind when they evacuated. *That's* a buzzkill.

*sigh*

My easiest patient yesterday was the one with blood pressure problems, sugars that ranged from 21 (0700) to 538 (1730), a half-inch thick clot the size of the palm of my hand covering her incision line (the order read: "Shampoo patient's hair and remove clot covering incision." Three hours of H2O2 later, I'd gotten an inch square chipped off), a crazy husband, as in paranoid schizophrenic not on meds, and incontinence of bladder and bowels (the order read: "Do not diaper patient." I guess they were worried about skin breakdown?).

Then there was the guy with the leaking scalp incision who kept throwing PVCs on the monitor. For non-medical types, the heart has its own electrical system, independent of the rest of the body. Sometimes the ventricles (the big chambers at the bottom of the heart) will Contract Prematurely, leading to Premature Ventricular Contraction, or PVC. This is a bad thing if it happens more than, oh, eight times in a row. Like the heart will get its electrical signals all flummoxed and, well, have to be shocked.

I showed the EKG tracing to the PA, who was unconcerned. The damn thing looked like a test strip you'd get on the NCLEX, but PA-Man just shrugged and said he was aware of it.

So I parked the code cart outside that patient's door.

Add in two lumbar drains, a post-angiography patient who kept leaking, and Doctor Asshat, who yelled at me for something that I had nothing to do with, and you have a typical day. Oh. I forgot about the 410-pound patient with the shoulder scope who needed pain medicine every hour.

It got bad enough that, as Dr. Asshat revved up in his bitching, I slapped my hand flat on the chart he was writing in, leaned forward, and hissed "I am trying to make your job easier. Do not bitch at me about policies that I did not write."

It's nice to be considered the Go-To Girl when people are having crises. Even when I'm working sick and putting out only about 80% of my usual effort, that's still better than a lot of people's 100%. Really. Still, it's *not* so nice to be such a go-to girl that I end up with six complex patients when other nurses are carrying three. Especially when two of them are Dr. Asshat's and the third belongs to a resident who's unwilling to write the orders necessary to get things done.

Chef Boy asked last night "Again, why are you doing this? Wouldn't you rather be in a lab somewhere?"

Sometimes I would. It's not the patients that get me; it's the doctors.

Overloaded

Check this out:

Incredible cuteness during daylight hours

I would've posted the link to the one that comes from the National Zoo's website, but the traffic is too heavy for their servers to handle.

I have become a certified Panda Cam addict. Just now I'm watching Mama take a nap as Baby stretches and plays with his wee little paddy paws aaaaawww off in a corner skreeeeeek isn't he the CUTEST THING???

*koff*

Sometimes he makes noises like "rrrraaaar" or "urk" or "squeeee" and sometimes he barks. When his mother grooms him you can hear her slurpy tongue and his urks of protest.

Excuse me. I have to go pound my head on the desk now.

Nightmare

Carrie, the wound care nurse, took me aside before she saw my patient. "You'll need to give her a couple of milligrams of morphine before I change her dressings," she said.

A couple of milligrams of morphine for a patient so light and emaciated I could lift her clear of the bed by myself? I raised an eyebrow and Carrie nodded.

I helped turn the patient, then moved to the other side of the bed so I could take a look at her decubiti while Carrie changed her dressings.

There were four spots where the soft yellowish white of bone showed through. Her buttocks were degloved of skin, as were her upper thighs. She was so thin that we could see the outline of her hip joints through the skin that had long since ceased to hang off her body. When someone is starved long enough, that flaccid look of quick weight loss disappears.

Her nephew, a twitchy guy with a constant sniffle and long sleeves even in August, had been caring for her for five years. According to the other nieces and nephews, he didn't feed her often enough or take care to clean her up more than once a month. I don't remember why she ended up with us, or even what her diagnosis was, but he'd come along with her and spent all of his time in her room, sitting on the couch.

Later that day, after the pain of the dressing changes had worn off, I helped bathe her. And noticed old burns, about the size of a cigar end. And old scars, from God only knows what, on her arms and lower legs. And bruises. Of course, she'd bruise from the slightest touch, but still....

So I called Adult Protective Services. I told them what I'd seen and got transferred to a geriatric nurse case-manager, who'd actually know what I was talking about. She agreed that it was time somebody checked out the living conditions this woman and her nephew had and told me they'd send somebody out in a week, after my patient had been discharged and had headed home.

A month later the patient was back. This time she ended up on a different floor for what was basically in-house hospice care. She died less than twenty-four hours after being admitted. The cause of death on the medical examiner's certificate was listed as heart failure. The examiner noted that the patient was emaciated and that her alimentary canal was completely empty, and postulated that an electrolyte imbalance brought on by dehydration and starvation had stopped her heart.

The APS people were nice enough to contact me a few days later and tell me that they'd found no evidence, on a home visit, of abuse or neglect. The nephew had told them that his aunt was sleeping and was not to be disturbed, so they interviewed him alone.

They told me to contact them if I had any further concerns and gave me a case number. I thanked them, then suggested that they concentrate their efforts on the clients who were still alive.

Her family had known about this for five years. She was in our hospital the first time for two weeks. I was the one who called APS, two days before her discharge.

This is the sort of thing nurses have nightmares about.

And the Stepford Award goes to....

Me.

Damn.

I won the monthly Just Doin' My Job, Ma'am award at work this month.

Every month the hospital management picks three Mini-Stepfords and a Maxi-Stepford to honor with gift certificates (Minis) and big honking taxfree checks (Maxi).

I'm one of the Minis this month. Strangely. My pal Carolita, the only other nurse who's worked at an abortion clinic and knows what it's like to have people pull guns on you, said (when somebody told her I'd won the award), "No, really. Where'd she get the balloons?"

My response to being told that I needed to be in the conference room at 1500 to receive the Mini-Step award was short, profane, and angry. Angry because I didn't want to have to farm my patients off on other overloaded nurses on an already-busy day for half an hour, profane because that's how I am ("You're shittin' me, right?"), and short because I had a patient asking for Dilaudid every hour on the hour without fail and it was five to the hour.

I told the manager that nominated me that I would tell the world that the reason I was nominated was because I had dirty pictures of her squirrelled away. You should've seen her face when the director of nursing asked me if I knew why I'd won. Heh.

But really, all I'm doin' is my job. If a patient doesn't get a tray at dinner and his nurse is busy, *anybody* would go and get that person a tray. If another nurse is busy and their patient needs morphine, *anybody* on my floor would help out. We do what needs to be done without regard for whose patients are whose.

Pretty damned sad, ain't it, when you get an award for doing your job.

Wahooooo!

A relatively new person on the blog scene is a NEUROLOGIST!

To paraphrase, "I'm trying to figure out if I'm a neurologist because I'm strange, or if I'm strange because I'm a neurologist."

It doesn't matter, honey. We'll still love you either way.

Information is Free

There ain't nothin' like a DRAAAAIIINNNN....

Sunday afternoon. I thought I'd have a few minutes to chart, having just opened my patient's lumbar drain. It takes thirty minutes to drain ten cc's on her, to I figured I'd just hop down to the station, enter a few orders, and hang out for twenty minutes or so.

Then the call bell rang.

"I have the worst headache ever" said the voice on the other end. "Worst headache ever" is a klaxon to a neuro nurse; it usually means something like a hemorrhage or herniation. And it was my patient who was complaining.

So off I trotted to see what the problem was. I found her sitting up in bed, at about a forty-five degree angle, with her hands pressed to her forehead.

Her lumbar drain was still open.

Now, then. A lumbar drain is a small, flexible, hollow catheter connected to a measuring device and a collection bag. You'd get one if you had a cerebrospinal fluid leak from somewhere in the whole brain/spinal cord complex. Basically, the premise is this: if you have a leak up high, we take some of the fluid off down low, so as to reduce the overall fluid pressure and allow the leak to close up.

Unfortunately, gravity is not your friend with these devices. The patient with a lumbar drain must remain flat and quiet while the drain is open, lest too much CSF drain out and remove the cushion that your brain depends on to stay in place.

My patient had gotten out of bed, walked to the bathroom and peed, then come back and sat up in bed. In ten minutes she'd drained five times what she normally would drain in a half-hour.

It was the first time she'd forgotten about the drain being open and I can guarantee that it'll be the last.

So I closed the drain, flattened out her bed, upped her IV fluids, and handed her the soda on the table. "Drink this," I said, "the caffeine will help." As soon as I had shot her up with some morphine I called the resident to let her know what had happened.

An hour later, when the headache had subsided, the patient asked me why it had been so bad. What could I say?

"Your brain was trying to migrate down into your chest" was the only reasonable way of putting it.

Links o' the morning!

Several this morning, two of which I'm shamelessly stealing from HypnoKitten:

Eric135

He's a nurse, of course, of course.

March of the Platypi (Last Blog Standing)

Another male nurse, this one in the ER.

Both of these guys have much better stories than I do. *sigh*

Special Sauce

Who has posted here occasionally in the past. Again, much better stories than I have. Dammit. What is it with you people??

Sure Thing, Babs

She's on vacation at the moment. Go back and read the archives anyhow.

And finally, an old favorite, reposted here simply because I laugh out loud every single effing time I read it:

Dogblog

Which reminds me...

In the Tom Swift and Nancy Drew books I've been devouring lately, there're all sorts of references to "trained" nurses. As in, a *trained* nurse puts a chair beside the bed in the hospital for Tom Swift, then smiles at him with her "even, white teeth".

I've got to assume two things from this: that the mention of *training* meant something to people in pre-1950's America, perhaps that "trained nurse" differentiated a person from a sort of "sitter" or "companion", and second, that the state of dentistry and orthodontia must've been so bad that even, white teeth rated a mention of their own.

Goodness. What a sentence.

Or maybe there were packs, nay herds, of untrained nurses darkening the plains of the American west before 1930. The solitary, laconic nurse-herders drove them from the desolate deserts to Chicago, where, with the help of starch and a horsewhip, they were transformed into Trained Nurses.

I kinda like that second theory.

Musings

On Food

You can add anything to eggs. Today it was sausage, tomatoes, pepper cheese, and onion, served with guacamole and fresh tortillas.

Poutine may be the most perfect food ever invented. I wish I could remember the name of the place we went in Montreal (no, it wasn't Frites Alors), but my brain was suffering from too many Cheval Blanc blanche, and I could barely remember anything outside the poutine. I know I was there, though--Magda and Joey have pictures.

On Fashion

It sucks when a cheap and well-reviewed makeup line is sold exclusively at Wal-Mart in the US. Rimmel is supposed to stay put, not smear, be incredibly inexpensive, and not cause breakouts. But I can't shop at Wal-Mart. I just can't.

And how come Old Navy clothing is sized so strangely? I can't wear a 12 in most of their pants and shorts, but a 14 falls off my body as soon as I button the waist. And I wear an eight or ten in their skirts. Whassup with that?

On Fine Literature

I've gotten Chef Boy interested in the original Tom Swift series of books. We read interesting passages to one another out loud and comment on the dialects spoken by the "darkies" (yes, the term is actually used and was acceptable at the time) and the Irish cooks (all named Bridget). Although Tom's a nice guy, in my mind, he still doesn't compare to Frank Merriwell, student leader and officer at Fardale Academy. Why, in two chapters, Frank saved a person from a burning house, then a person from torture, then a sinking ship, then another person from *another* burning house! All this and offensive ethnic characters from such far places as Vermont, too!

All Tom ever does is thrash Andy Foger, the red-haired, squinty-eyed bully, and invent stuff.

In all seriousness, there's a lesson to be learned from comparing such books as the Frank Merriwell series (first published in 1899 or 1900) and Tom Swift (the books I have date from 1910-1911) and the Nancy Drew series of the late 1920's and early 1930's. Nancy Drew books contain all the offensive racial and religious stereotyping of the others, but thankfully skip the offensive gender stereotypes. Even Bess, the wimpy one of the Bess/George/Nancy triad, isn't such a pantywaist as she is in the yellow-backed 1950's rewrites.

On Nursing

I go back to work tomorrow after an unprecedented four days off. I hope I remember where the brain is.

What do geckos eat?

I ask this because I found a pink gecko in my bathroom today.

Pink didn't strike me as being the first color choice of your average gecko, so I slapped on the glasses and took a good look at him/her. Little cloverleaf paddy-paws, check. Big bulgy eyes, check. Black-ringed tail, check. Two inches from nose to tip of said tail, check.

But pink?

It seems healthy and active. I'm afraid to catch it, because it looks so delicate. Besides, don't geckos' tails come off if you try to grab them? And couldn't I break a leg or some ribs or something?

So in the bathroom it stays. I'll put a plant in there later to give it some cover from the Evil Cat Who Eats All Small Creatures, and it already has plenty of water. I figure if I can keep it alive for a few more days, it might climb up onto a wall or some flat surface where I can trap it under a glass and then take it outside.

Sure is a cute little guy. I think I saw it flicking around the corner of the cabinet about two weeks ago--at the time, I wasn't sure whether it was a scorpion (unusual this far East, especially three stories up) or a lizard. I'm glad he's a lizard. A pink scorpion would've seriously screwed up my worldview.

How Half the World Doth Conspire Against Me!*

It was a long week this week. Even though I got an unexpected day off, even though the patients were fairly easy. Only a few seizures, one stat CT, one no-code death.

"I won't take that patient" announced Joe. "She's bleeding. I can't stand the smell of menstrual blood."

"I won't start a Foley on her." said James. "I don't start Foleys on women."

"I don't understand why the charge gave me a fifth patient." said Vincent. "I already had four patients."

Joseph, you don't get to choose. James, I've started Foleys on your female patients for three years straight, now. Vinny, it might be because you're standing around, chatting up the internal med residents, rather than doing your charting. The charge must think you're not busy, if you can yap at blondes in the middle of the morning.

Besides, Vinny, I was carrying six people at that point. Don't bitch.

I don't know if it's PMS, or just me, or some weird concantenation of the moon and the planet Saturn, but I have NOT gotten along with the guys I work with this week. Usually, with the women, it's a short, quick, ugly bitchfest. They start it, I finish it. (I don't do the passive-aggressive thing; it annoys me.) But with the guys I work with, it goes on and on and on and on....

Case in point: I got waved off today because we were overstaffed. Male Charge Nurse says, when he calls me, "Hang around, because I might need you later." (Note: he does this every single time, to every single nurse.)

Me: "No. I am not getting paid to be on call. You either call me in now, or you call me off now. There will be none of this 'Jo, I want you to drive thirty miles through unforgiving traffic to save me from having to take a patient myself.'"

Him: "Well, I can't tell if I'll need you."

Me: "Every other charge nurse can tell. I'm going to turn off my phone and start drinking now. Have a nice day."

Or this, from an online magazine for male nurses: the female respondent to the post points out, quite reasonably, that her brother asks her for help in computer problems....then she gets accused of flaming other posters.

Guys, I love working with you. I'm thankful for your muscle when I need to move a 300-lb patient. I'm proud of your diagnostic skills and thrilled when you're able to get an emotionally traumatized patient to open up. I like having the perspective of men on the floor. I like being able to trade assignments when it turns out that the middle-aged, middle-eastern man I've been assigned to won't allow a woman to examine him. If I can't personhandle a traction setup off the end of a bed, you'll be the first ones I call to unscrew things.

But please. I don't make you bathe the stinky fifty-year-old homeless guys that come in, because I "don't do" stink. I start Foley catheters on men and women both. And I don't chat up the residents. To put it bluntly, I've carried two and three patients when I've charged, and six and seven when I haven't.
Don't make me kill you, boys.

*To be fair, this seems to be a problem only at my facility. The men I work with are whiny, a condition not seen in most male nurses. Which leads me to ask, What UP With That, Dawg?

So here's a question....

You get up early on Sunday morning and put on a pair of linen pants and a dark blue t-shirt.

You hop in the car and head to the local Schwankola Organic Grocery, where there are dozens of things you've never heard of and some things you're a bit scared of.

You load up the cart with magenta peaches larger than your two fists, monster fruit, apples from New Zealand, raspberries, sesame sticks, coffee, little miniature baguettes, stinky cheeses from the four corners of the earth, some Danish butter you love, and a flaxseed cereal that looks like sawdust but tastes like Heaven.

Then you head past the small island where olives and capers and pickled goods of every sort are kept. You pause briefly, admiring the colors of the vegetables.

A man with a heavy Italian accent and the unlikely name of Henry spots you. He offers you various olives to taste, and a debate starts about the relative merits of dry-salt and brined curing. You walk away with a half-pound of tiny, wrinkled, intensely-flavored black olives and a mouthful of pits from your samples.

What do you do with the pits???

I think that's enough imagination for one day, thanks.

So, yesterday, I saw "Big Fish" and read "Life of Pi".

In the same day.

Strangely, I don't remember dreaming.

I think I'll do nice, boring things today, like grocery shopping.

No, Mom, I didn't forget.

I promised Mom I'd post the gazpacho recipe I've hoarded for years, then promptly forgot to do so. Here, then, with no further ado:

Extremely Lazy Gazpacho

Peel four vine-ripened tomatoes. Toss them into a blender.

Blend until relatively smooth.

Chop up one or two peeled and seeded cucumbers (depending on size), a red bell pepper, and a clove of garlic. Add some red onion if you'd like.

Salt and pepper the vegetables well. Pour the tomato puree over them.

(I'm assuming that you'll put them in a bowl, not just dump liquid tomatoes all over the counter.)

Add olive oil, balsamic vinegar, lime juice, and dried thyme or fresh basil to taste.

This will keep for three days, no more, in a Tupper in the fridge.

Further Catch-Up

I've discovered what's wrong with the healthcare industry, at least in part. We have two prn (as-needed) nurses working for us right now. Both have regular jobs as long-term travelling nurses. They both get paid about twenty-three bucks an hour to work with us--that's our going rate.

James makes $45 an hour as a traveller, plus he gets a $1400 monthly housing allowance, tax-free. His company matches his retirement contribution up to ten percent of his paycheck.

Cathy makes $55 an hour, no housing allowance, as a traveller. Her insurance is completely paid for and covers both her and her husband. Her prescription benefit is ten bucks for generics, fifteen for brand-name drugs.

Both of them have worked at the *same hospitals* for the last eighteen months as travel nurses. In other words, the hospitals have been paying God-Only-Knows how much to the agencies that employ James and Cathy to have them work there, rather than expending the time and energy necessary to find their own, permanent, slightly cheaper nurses.

If it didn't mean working for a hospital that had its head up its ass, I'd be a traveller in a second. Well, that and strike-breaking. I don't like the idea of scabbing.

Girly Product Reviews

Been a while since I've done this, and I have four new things that will never leave my medicine cabinet.

Giovanni Cosmetics Wham Jam in Mint. Also sold under the name Whammo! Mint:

It comes in a six-ounce jar, has the consistency of Dippity-Do, and smells of mint. Strongly. You can use it as a shampoo and soap, to shave with, as a foot soak, whatever you'd normally use soap or shampoo for. It's wonderful stuff.

Unlike most multi-purpose soaps, it doesn't leave weird sticky goo all over your hair or body. It's not drying, and it's not as intense as undiluted Dr. Bronner's.

Neutrogena Instant Nail Enhancer

Eeeh. Whatever. It's nice, I guess, for when you're not working, as it tends to fade away after three or four handwashings. The pros are these: it really does dry instantly, it's not nail polish but it leaves your nails looking buffed and pretty, and it doesn't require chemicals to remove.

Just don't put it on too thick or you'll end up with weird booger-like things where it wears off.

ProLinc Cuticle Away Cuticle Remover

This is the strontium-90 of cuticle removers. If you have nasty cuticles from overexposure to chlorhexidine scrubs, this is the stuff for you. One caveat: follow the instructions to the letter, or it'll eat your nails right off. But you do, if you follow the instructions, end up with nicely manicured hands. It even makes Chef Boy's hands look good after a week of cooking and working on his car.

Neutrogena Deep Clean Face Cloths

Supposedly you can control the amount of exfoliation you get with these suckers, but I've not discovered how, yet.

The little washcloths come in a plastic box, thirty to a box, which seems to me to be an excessive amount of packaging. You could, however, use the box later to make a mini-first-aid kit or to carry a salad to work.

One side of the cloth is excellent for removing major facial landscape markers like your nose or lips. The other doesn't do much. They're impregnated with Deep Clean, a salicylic-acid cleanser that foams when you wet the cloth.

I'm using them to scrub my hands and feet and finding them fine for the purpose. I probably couldn't use them daily on my face without ending up like the Terrible Trivium from The Phantom Tollbooth: no face at all.

Mrs. Malaprop In The HOUSE!!

Three things from yesterday:

A nurse who wrote report on one of my patients jotted down that the patient had a "double loomin" subclavian line.

Another nurse, giving me verbal report on a patient, mentioned that the patient was in for an "exasperation" of multiple sclerosis.

A third nurse showed the deepest recesses of her psyche by saying that a MUGA scan was meant to show the "ejaculation fraction" of the heart.

Of course, I was the one who walked into a patient's room with a syringe of morphine in hand and cheerfully announced, "Here's your marijuana!"

Who thinks this shit up, anyway?

No, this is--for once--not about management.

It's about those damned catalogs. You know the ones I mean: they sell cute, springy, witty scrubs and adorable dingle-dangles from which to hang your name tag, and lanyards with the Cause Du Jour printed on them, and so on.

Let me tell you what I do not need. I do not need microfiber scrubs with the look and feel of silk, especially not when they're leopard-print or tiger-striped. Unless there's some branch of nursing that involves no contact whatsoever with bodily fluids, and in which tacky is a good thing, *nobody* needs those.

I do not need genuine gemstone pins that remind me to allow miracles, keep hope alive, live strong, that I'm "special" (yeah, short-bus speshul), that we're all supporting a cure, or that I've parked my car on the third level in section C. Actually, come to think of it, that last might be useful.

I do not need cute plush animals to hang from my stethoscope and hold my name badge. That's just a bad idea all 'round.

I do not need totebags that tell others that I heart nursing, that nurses rock, that nursing is my bag, or that nurses care. I don't, we do occasionally, it's not, and we frankly could, but less.

I do not need shoes that have "just a little bit" of heel. Especially not when they're clog-style with a backstrap. I am here to keep my patients alive, not look fashionable and catch a doctor. Or look fashionable and turn an ankle, which is much more likely to happen.

Needless to say, I do not need anything with kittens or puppies on it. Take it away.

Nor do I need hipster, flare-leg, or capri (!!!)-cut scrub pants.

I don't need a "genuine acrylic" (huh?) stethoscope with a magnified smiley-face under the head. I don't get how those things are supposed to work. They'd make good weapons.

Dora the Explorer, Sponge Bob, and Scooby scrubs are not for me. I understand that those in Pediatrics might find a use for 'em, but is the ratio of Peds nurses so large that we really need four pages of the damned things?

Nor are seasonally-themed prints. Again, some folks like 'em. I'll keep my sushi-print tops, thanks.

I'll tell you what I *DO* need, kiddies: Decent shoes that don't cost $200 a pop and actually fit my crippled, bunioned Size Nines. Scrubs that I can wash on boil and dry on broil without having the elastic shrink on the pants so that I'm cut in half. I need jackets without knit cuffs--ones that end just at the hip and swing freely, so that they look a bit more like a blazer and less like a lump of dough. I need another stethoscope and a fifty-percent discount on the Hickey neuroscience text.

And a massage and a pedicure and maybe a personal trainer. If you can find me a nursing catalog that offers those, I'm in.

"Great Scott!" I cried, springing from my chair

...."I've been reading too much Conan Doyle!"

Holmes, released from his burden of inactivity at last, turned his gleaming eyes upon me. I could see the subtle signs of excitement that, to a casual observer, might appear inconsequential. "Calm yourself, Jo," he replied, "It is a certainty that, after such a trial as you yourself endured last night, you would overindulge in the flowery prose of such an author. However, now is the time to action! The game is afoot!"

Grasping my revolver, I hurried to the door in Holmes' wake. My eyes lit upon the bed that Mrs. Hudson had made up in his absence.

"If you don't mind, Holmes, I'll just lie down here and have a little toes-up."

Isn't it ironic, don't'cha think?

The neuroscience nurse got what was probably only the second migraine of her life last night.

I think I might've had one about three, or maybe ten, years ago. I actually called Beloved Sister, who gets them fairly frequently, to describe the symptoms and make sure I wasn't overreacting.

Though it's hard to overreact when your head feels like one half of it might just pop off at any moment.

What an interesting sensation that is. The trouble with knowing about things like headaches is that you tend to catalog what's going on in your body and your reactions to things as you're lying there hoping that maybe you'll die. It's a fun hobby, but not one I want to practice more often.

Now I'm feeling very logy. I think that's from the two Dramamine tablets I took in desperation, trying to kill the nausea and get to sleep. There's not a headache any more; rather, there's the sensation that a headache will start at any moment. And my head feels like a large porcelain bowling ball balanced on the end of my neck. And colors are very bright, still.

Hildegarde von Bingen was lucky. At least *she* got heavenly visions and snatches of music with *her* migraines. All I got was this lousy post.

What I cook on my day off

How to make summer chili

It's just like winter chili, but everything's fresh.

Get the best vine-ripened tomatoes you can find. If you have a farmer's market nearby, so much the better. Avoid the stall run by the woman with the flower-print dress and big sunglasses, whose tomatoes are all packed head-down in little plastic baskets. Those will be cracked and still green. Go for the fat old guy in overalls with various-sized tomatoes laid out casually on a folding table.

While you're there, pick out an onion. Yellow or white or red doesn't matter.

And some beans. If you can find black beans, fresh, still in their pods, get those. And a couple of ears of corn.

Maybe a pepper or two, if you're feeling adventurous.

Be sure to talk to all of the people selling patty-pan squash, even if it has no place in your chili. Complement them on their produce. Good cooking kharma will follow.

Snag a pint of blackberries or raspberries to snack on while you cook.

When you get home, dig through the freezer for the vegetable or chicken broth you put up last month (or was it the month before?) . Dice the onions, shell the beans, chop the tomatoes. Cut the corn off the ears. Don latex gloves and chop the pepper, leaving as many seeds as you dare.

Throw it all into a huge pot. Add a little cumin; maybe a little extra chili powder too.

Simmer.

Now, then. The important part of this entire process is the music you use to cook by. I recommend Alison Krauss, Emmylou, Cathie Ryan, The Chieftans, early Indigo Girls, and Joni Mitchell. You want women's voices for this--high ones, sweet ones, gravelly ones, all kinds. The Chieftans are in there to bring out the heat of the peppers and to keep you from adding too much salt. Singing along is mandatory.

Midway through the simmering process, which should take at least an hour but can stretch as long as you like, go outside. Making summer chili is the perfect time to talk to the rosy finches who land on your porch railing to tease your cat. They won't fly away when you open the porch door; instead, they'll cock their heads at you, shift their feet, and trill cooking tips.

Winter chili is best made when the wind is awful and the sky is gray. That way, when the smell of the beans takes over the entire house, you can bundle up, go outside, and take counsel with the crows. Summer chili is best made when everything is so ripe it's about to pop.

Turn the heat off under the chili. Whip up some hot-water cornbread right quick and find that hunk of fresh cheese you got from the friend with the goats last week. Have a bowl of chili, sprinkled with mild goat cheese and crumbled cornbread. Sweat.

My day on the boogie board, and all info revealed

You know that cartoon where the guy paddles out into the ocean, catches a wave, stands up and surfs....only to find a shark behind him, taking huge bites out of his surfboard?

That would be my day yesterday. Fridays are always a little on the wacko side, but yesterday was four days rolled into one.

It started on the highway, when I had to slam on my brakes as the guy ahead of me slammed on his brakes. It soon became apparent that there was a mile-long backup on the highway just south of a suicidal merge between the road I was on and another four-lane highway.

After I counted three firetrucks, four MICUs, two helicopters, and eight cop cars going past, I decided that EMS was simply having a little teaparty in the middle of the road ahead.

Good call. The car had apparently tried to merge underneath a flatbed eighteen-wheeler. Its top was torn off, the airbag had deployed, and the highway was covered with patches of what looked a whole lot like blood. No question of what was covering the airbag, the inside of the car, and the emergency workers. I drove past, shaking a bit (I really don't like trauma scenes) and arrived at work only ten minutes late.

To find, to my dismay, that Spleen Guy (see below) was having a stroke. That's a real bummer, don't you know. Add to that his anxiety levels, which are becoming high enough to both constitute something that need a psych referral and are also interfering with his treatment. That lovely nursing-school canard about "contracting" with your patients? Where you tell them you'll be in their room at the top of the hour for ten minutes, and don't call you in between? That only works on sane people, and it's the crazies who need it.

The folks that work in MRI and CT really hate me now. I had to stat both, and they had to deal with a person who was alternately yelling, praying, crying, and generally making their lives difficult.

So I called the chaplain to come talk to Spleen Guy. When he arrived, he mentioned in an off-hand, oh-by-the-by tone that one of our colleagues had been found dead at home the previous morning, having apparently just dropped over and kicked off without warning. A healthy person of 43. Lovely.

Something else happened after that, but I don't remember what it was. Maybe it was lunch, as it was past two o'clock by that time.

Then my encounter with Arrogant Attending. Then home. During the drive I saw nothing, thank God, that would require a closed-casket funeral.

I will say this about my job: difficult it might be, but there's rarely a time when I have to return all recoverable bits of a patient in something the size of a shoebox.

All information, all the time

Seems some of you fine folks are wondering who I am and where I live. In an attempt to answer all email questions at once, here's a list (in descending order of recent-ness):

1. No, I don't work at Parkland in Dallas.

2. A medium-sized city on a major Southern bird-migration route. That's all the more I'm sayin'.

3. No, I probably didn't take care of your brother Bob after his pancreatic resection. I do brains, remember?

4. Yes, the red hair is real.

5. No, I don't make this stuff up. (I feel a bit like Belle de Jour here; next thing you know, somebody's going to be accusing me of being the Valerie Plame leak.) You *can't* make this stuff up.

6. No, sorry, I don't give medical advice over email.

7. Yes, I have an Amazon want list, but I'm not making it public. And no, I don't accept donations (hence the lack of the PayPal button), but thank you anyhow.

8. Yes, I do get paid for hosting Ivo's ad. The money he sends goes straight into either animal rescue or Planned Parenthood. After all, hosting his ad is no skin off my schnozz.

9. An ADN, two-year program. And sorry, but I can't recommend a good program in your state.

10. Yes, you may have that gazpacho recipe. I'll post it later. Unless I've already posted it; I have to go back and check.

There need to be four of me.

That way, I wouldn't have to keep repeating myself.

Today, I had an encounter with an attending physician who'd never been on our unit before. His resident came up to me and asked, "How do I get in touch with the person who's covering for Doctor So-and-So this weekend?"

My answer was this: "Call the neuro rotating pager number (pointing at the board where it's written) and ask the person who calls you back."

Two minutes later the attending came up and asked me the same question.

Forty-five minutes later, I saw the attending wandering around the nurses' station, muttering things like "I hope I never get sick on this unit" and "This is no way to run a service" and "What the hell are they playing at, anyway?"

So I asked him. "Is there a problem?"

"Yes. I can't get hold of the person who's covering for Dr. So-and-So."

"Did you call the neuro rotating pager number?"

"No. I called (list of numbers picked, apparently at random, here). Nobody can tell me what's going on."

So I picked up the phone. I called the rotating pager. Dave called me back, pointed me to Sharma, and I called her pager number.

The attending kept hovering at my back, asking, "Is that an *attending*? Is that an *attending*??"

Sharma called back, had a short conversation with the *attending*, and answered all of his questions.

He hung up, then told me that this is no way to run a unit, he didn't understand what was going on, he hoped he never ended up with us, and he was amazed that people didn't die every day up here.

The Nurse Jo Bag of Snippy Replies was suddenly and annoyingly empty. I stood, staring at him like a calf at a new gate, with my mouth open and my hand frozen on the telephone receiver.

Whereupon he smiled pleasantly, patted me on the shoulder, and thanked me for my help.

I really should get that gun turret installed on the charge nurse's desk.

An old story

With the grace of God, an open window, and a good couple of fans, I managed to keep the fire alarm from going off.

They'd come, the three of them, laden with turquoise, from three states away. They'd come to chant and burn sage and pray for the recovery of the man I was caring for. It wasn't the chants I was worried about; it was the fire department.

The aneurysm wasn't unusual of itself. It was the bleed that happened during surgery that had threatened him, and the resulting rise in his intracranial pressure. Still, he'd pulled through. Now he sat regally in his bed, with one side of his hair long--and matted--and the other side of his head shaved to the scalp.

The three men stayed for a few hours, exchanging gossip and news about what was happening on the reservation. Then they went, leaving smoke from the sage and amulets to speed healing behind.

And the man's wife and I went to work on his hair. We couldn't cut it off; he didn't have the wherewithal to consent to that. And it was a mess--tangled into the sort of dreadlocks that only Southwestern Native American hair can achieve after weeks in ICU.

It took three hours to untangle. He let me braid it, one single braid on one side of his head.

Later, he came back. Much later: his hair had grown out to almost its original length, and was braided in almost-matching braids.

He barely remembered me. What he did remember was the white girl who had forbidden anyone to cut his hair, and who had braided it herself.

Look, I'm sorry,

...but your IV pump is not talking to you.

...but I can't get you a bigger room for free. There are no bigger rooms. Put that money away; I can't be bribed.

...but I simply won't give you a hundred of Phenergan to go with your 75 of Demerol.

...but the doctor won't be in today. It's nineteen on a Sunday.

...but we can't put your husband's head back just as it was. It's going to have to have plastic in it now.

...but I can't sleep with your son, no matter how badly you want him not to be gay.

...but she is just not going to get better. Not after a bleed like that.

...but I can't let your heroin dealer spend the night.

...but your twelve-week-old fetus is not telling you what to do.

...but that Chihuahua will have to go.

...but I can't give you that information. Yelling won't help.

...but there is no Playboy channel here.

I love my job. I love my job. I love my job. I love my job.

Memo to Stupid People:

Before I forget: the Fashion Edition

To that nice nurse in the recovery room:

Isn't it lovely to be young? Isn't it lovely to have a flat stomach with a rhinestone belly-button piercing and a sacral tattoo of a Celtic knot?

Yes, it is. It is lovely to be and to have all those things.

But it is not lovely at work. If you persist in wearing hipster scrub pants and shirts that are a fraction too short, thus allowing all and sundry to see your rhinestones and tattoos, I will be forced to point and laugh.

To the pleasant nurse who works next to me three days a week:

I understand that your nails are brittle and delicate. I understand that you place a high value on your personal appearance. But I don't understand why, given those things, you continue to wear acrylic nails.

Not just acrylics (which, by the way, aren't really allowed in patient-care settings), but acrylics that have grown out, leaving a big gap between the cuticle and the fake part of the nail. That just screams bacteria to me.

Please. Take them off. Wear your nails short and neat, like the rest of us do. Or, if you must keep the acrylics, have them filled once in a while.

And, for the love of God, stop painting them green.

To the gorgeous belly surgeon I know:

Love your 'do. Really. I love the French twist in the back and how it comes down into little stair-stepping teacups on the left side. I love the braids in the front and the tiny curlicues that outline your forehead and cover your ears. But it's been three weeks now, and you don't sleep good. Things are starting to sprout out of your French twist, and the teacups are starting to look more like styrofoam cups.

Maybe something a little more low-maintenance would be good.

To the pleasant, if unkempt, neurosurgeon who put a lumbar drain in my patient the other day:

You've made progress. Thank you. I notice that you're keeping your hair neat and your nails short, which is huge. Honest. I appreciate that you're shaving at least weekly. Nobody likes the "House" look on a resident, and you're cleaning up nicely.

But there's one remaining issue we have to discuss, my friend. It's scrubs.

Surgical scrubs are thin. They're baggy. They tend to ride up in odd spots.

Do you see what I'm getting at, here?

Underwear. Buy it. Wear it. Save the rest of us some trauma.

Step away from the spleen.

He's a nice man. Intensely religious, charming, friendly. He's got a wife and three kids at home, and an AVM that's taken up a significant portion of his spinal column.

An AVM (arteriovenous malformation) is a collection of blood vessels that have developed wrong. We don't know what causes 'em, and most of the time, they don't cause any problems. You can have one anywhere (I've seen 'em in the tongue, belly, arms and legs, and brains and spines). Essentially, the pattern of blood vessels that feeds the tissues normally gets all kerfuffled, and you end up with a huge mass of unproductive arteries and veins that only connect to each other.

Anyway, nice guy. Came in with MRI films taken back in March that showed a small-but-significant AVM in his spine at the junction of his cervical and thoracic vertebrae (that lump on the back of your neck). It had caused a few problems at that point: numbness and painful tingling of his arms, some pain in his chest musculature.

He'd tried to treat it with prayer, herbs, and dessicated spleen tablets. Why the spleen? I have no clue.

[Now, then: I don't mean to give prayer, herbs, and supplements short shrift. In some cases, like repetitive strain injuries, vitamins can help, as can massage. Acupuncture can help some things. Prayer has done some things that make my eyes all slitty and make me say "Hmmmm."]

But an AVM is a surgical problem. And, for all you know, God might intend for you to put the spleen back in the cabinet and contact a good neurosurgeon, so you perhaps had better not delay getting treatment.

Our MRI showed that the AVM had grown. It now stretches from the middle of the back of his neck to where his bra strap would be if he wore a bra. He's lost the use of his legs completely, lacks sensation below the waist, and is rapidly losing the use of his hands.

We hope to embolize and remove the AVM--a process that will take months, more'n likely--and at least save his diaphragm.

The one question I haven't yet asked him is "Why the hell the spleen?" I think I'm a little afraid of the answer.

Knees, knees, knees.

It's that time of year again: every orthopedic surgeon we have has gone on vacation except one. And the one who's left specializes in knee replacements in morbidly obese women.

Last year at this time we had another of his patients. Normally, a person who weighs 200 or even close to 300 pounds has some good muscle in their legs. Depending on comorbidities, folks that large can get around and move a bit, so their thighs and (especially) calves bulk up from moving that weight around.

This patient, who thankfully has not been back, was not one of those people.

She was big. Not just fat, but tall. Big, heavy bones. Broad shoulders. And had apparently spent the last thirty years in bed, stepping out only when absolutely necessary. And had screwed up both of her knees in the process.

Women's knees are particularly vulnerable to damage because of the angle at which our thighbones leave our pelvises. Men's thighbones drop more or less vertically from their more-or-less vertical pelvises, while women, with a flared, wider pelvis, have thighbones that drop down at an angle. Men's legbones line up better, therefore, with all the musculature and ligaments and kneecaps and so on, while women are at an increased risk of ACL tears and cartilage wear and other problems. This could all have been avoided had our original parts list contained more than one style of knee, but we were apparently built, as a species, by the lowest bidder, on spec.

Anyway. Back to our patient. Both legs had the large, stapled incisions that mean "total knee replacement." Both were encased in continuous passive motion machines. Both legs were the size of tree trunks with no perceivable muscle.

And she had Issues. You know what I mean. She didn't have the strength, either of body or will, to lift herself up with the trapeze above her bed. She wouldn't call for a bedpan. (Try changing a bed under a totally inert, 388-pound woman sometime.) She couldn't manage to get two steps from bed to chair, and so had to be pulled from the bed to the cardiac chair to sit up.

Which makes me wonder, why the new knees in the first place? She had no plans to slim down to a more reasonable 300 pounds. She didn't want to move, particularly, and by her own admission had had very little pain with the old knees. She'd gone through a difficult, painful surgery with all its attendant risks and didn't really need the outcome.

I think that particular orthopod has a boat payment due in August.

An awards show of sorts....

What a week.

In honor of the week just past, I present: The 2005 Nursing Weirdness Awards.

Best Line Used In The Context of Patient Care:

"Time to disimpact the midget."

Best New Use of An Old Standby Drug:

"I need a Uroject (lidocaine jelly) to help with this disimpaction."

(No, there's no theme here.)

Best Use of Medical Equipment:

The use of an IV pole by one of our security guys to fend off a violent, confused patient who was attacking nurses.

Best Use of Food Items:

Stacking two bags of white rice and a bottle of molasses from the kitchen around a free-standing drainage bag in order to keep it from tipping over. No, you don't want to know what was in the drainage bag, or even how big it was. And no, I don't know why we had two ten-pound bags of white rice in the clean utility room.

Best Line from an Attending Physician:

(On observing a widespread rash on a patient's back) "Oh, no. I don't know anything about *that*" (while backing away).

Best Line from a Resident:

"Next thing you know, they'll be expecting me to follow up with this guy in clinic."

So Mom and I were talking the other night....

She has, since she is my mother, flattering things to say about this blog.

Goodness me. At least she and I are agreed in our conspiracy to Keep Things On the Q.T. Where Dad Is Concerned. Mom said, when I mentioned that I was just a little freaked out about her reading stuff, "I am sixty-seven years old. Whatever you've done, I've either done or imagined. Relax."

Then she said, "You've been getting some rain lately, huh?"

Yes. Yes, we have, as a matter of fact. Hurricanes are good for that. She made sure that I could get a change of scrubs at the hospital (the neighborhood around the hospital flooded horribly the other day; people weren't able to get to the highway), and then asked:

"And you have a clean pair of underwear with you, right?"

My jaw dropped. Mom actually did a Momlike thing, asking me if I had clean undies. After all, she pointed out, what would happen if I were to be in an accident?

I think Mom's tongue will have to be surgically removed from her cheek.

No blogging for a couple of days.

I've just bought the newest Harry Potter.

Oh, yeah? And what are *you* reading?

Edited to add:

Damn. Damn, man. Read the whole thing in one sitting, with quick breaks to drag scrubs out of the dryer and load the dishwasher.

No spoilers here, but I feel as though my insides have been run over a cheese grater.

And I have the almost-irresistable urge to eat pork potstickers, the ultimate comfort food.

Goodness.

Damn.

Wow.

Why we have protocols.

I've said it before, and I'll say it again: "A policy does not exist to inconvenience you. There is a reason for it."

That was brought home to me last week in a big way.

A patient had come in, had a bad surgical outcome, and had spent the better part of eight weeks bouncing from unit to unit. At one point, some bright person had noticed that the patient was coughing up a lot of junk (sorry for the technical term) and decided to do an acid-fast smear and culture on that junk.

Acid-fast bacteria are a big family. Most of 'em you don't really need to worry about, but one you do: tuberculosis. Our hospital policy says this: if a patient has an acid-fast bacillus positive smear or culture, that person is put into respiratory isolation in a negative-pressure room until it can be determined that they do or do not have TB. It sounds draconian to do that, but it's really quite sensible; the treatment for TB is nasty beyond description and takes a very long time.

So this patient had a negative AFB smear and a positive AFB culture. The micro lab called the floor where the patient was at the time and gave the results to a physician's assistant who had been following the case.

Here's where the system breaks down. The PA, being a Quasi-Important Person with an inflated sense of his own authority, decided that the culture didn't matter, that the patient didn't have TB. How he determined that without psychic abilities escapes me, but the point remains: he didn't notify the infection control folks or put the patient into isolation. In other words, he carefully ignored the protocol that the hospital has put into place for the protection of everyone.

Micro also screwed up. They're supposed to call report, with a read-back, to two people: the resident in charge of the case and the nurse caring for the patient. They didn't. They ignored the protocol that was put into place for the protection of everyone.

So. Fast-forward four weeks. The patient's been on our floor for two weeks. Another bright person, this one from the pulmonology staff, takes a walk through the patient's chart and finds the old AFB positive culture result. The patient is slapped into isolation, where I find them after I come back from a three-day weekend.

I'd taken care of that patient for two weeks solid. Several times I had gotten coughed on and sprayed with mucus (no matter how careful you are, this will sometimes happen). I was told that an AFB-positive culture had *just come back* from micro, hence the sudden isolation.

Which struck me as fine, until I read the chart and noticed that the AFB culture had actually been done back at the end of May. And that it had been positive. And that the patient had been un-isolated and coughing on yours truly, as well as other nurses, techs, support staff, and doctors all that time.

My hair caught fire. I started making phone calls. I found the record of an order for a PPD (purified protein derivative test for tuberculosis), but no record of its having been done on the patient. (Protocol again, this time a failure of a nurse to chart properly.) I wandered into the room and inspected both arms--yep, there's the permanent-marker circle that defines a PPD placement. Okay. It's negative. Back on the phone, I paged the infection control team leader and told her about what had just happened. She paged the PA in question and the chief attending physician of that service. The attending called me, so I had to tell her the same story I'd told everybody from IC to ICU.

The upshot of all of this drama? The patient got some super-duper DNA screening widget test that involves turning urine into gold, or some such, which determined that there was no tuberculosis bacillus present. Period.

(Of course, we'll all have to be tested again in twelve weeks, just to be sure.)

The test costs not-a-little-money. It has to be sent out, and the results in this case were statted, which costs more. The hospital is going to eat that cost. There were also a number of us who'd cared for this patient who'd had to go home and inform our families that we might've been exposed to a particularly icky bacillus. (That was a fun one; Chef Boy was coming down off of having his smoker explode when I told him.)

Yes, TB is hard to catch. Yes, it's treatable. Yes, the chances of my having caught it, even with direct exposure to infective goop, were quite slim.

But the point remains: at least two people in this little drama didn't follow protocol. One didn't follow it because he just knew he was right; the other didn't follow it because they were just plain lazy. As it turns out, everything was fine--and the PA in question really *was* right this time.

Still, it cost us 24 hours of worry and cost me quite a lot of time to clear up.

The worst bit? The PA, since he doesn't work for the hospital itself, can't be written up or otherwise go through our disciplinary--sorry, "counselling"-- process. And the lime pit in my back yard is already full.

Well, that was nice.

I got a very sweet piece of fanmail the other week, from a guy who says that my blog is the "blog by which other nursing blogs should be measured."

Which is a lot like saying that mayonnaise is the condiment by which other condiments should be measured. It gives you a solid median, but there's plenty of room for improvement.

Still. Whether or not I agree, it's nice to get props.

In other news, Kelly (She Who Rocks The Night Shift) is dropping her blog, Time to Lean. I've replaced that link in the list with Shrimplate's blog. No, I'm not a disloyal bitch, just too lazy at the moment to re-figure-out the whole HTML thing. At some point in the future I'll add a list of Gone But Not Forgotten links--blogs that aren't updated any more but which still are worth reading.

Given that it's about to start raining again and that power this week has been spotty at best, I'm going to go eat a bowl of panzanella and hope my refrigerator stays on.

Write an order, dance a jig, beat up your fellow nurses.

"I don't understand why you people are so incompetent."

That's a bad way to begin any conversation. Unless, of course, it's me saying the words, in which case it's perfectly acceptable.

But it's not a good way to begin a conversation with me.

Especially when you're a resident who just started on this unit on the first of the month.

Perhaps especially especially when you're not the sharpest tool in the shed yourself.

Universally Competent and Marvelous Resident (UCMR) was upset that his patient hadn't gotten a number of treatments and medications that UCMR had discussed with one of the nurses. When I say "discussed" I mean *discussed*, as in "Do you think we ought to keep this guy on the high dose pressors he's on, or cut 'em back for a while?" and "Does the wound care service take care of ingrown toenails?" and "What's the procedure for calling a pharm consult for vanc dosing?"

Never mind that these are Very Simple Questions, the answers to which UCMR should've already known. Never mind that the nurse he discussed them with wasn't even the patient's nurse; UCMR had just pulled the poor guy aside during the middle of the night to pepper him with questions.

UCMR lit into me because none of his brilliant ideas had translated into action on anybody else's part.

"You know," I said, trying my best to be gentle, "we can't do anything without an order from you. Just talking about it isn't the same as ordering it, since we don't know exactly what you want."

"Well, you *should*" he protested. "And isn't writing down verbal orders your job anyhow? I don't have time for that shit."

"A verbal order," I replied through my fangs, "should be given as such, not as a series of increasingly idiotic questions. Preferably, it should be given to the nurse caring for the patient. And as for shit, I don't have time for yours. Write your orders and get out of my chair."

Poor UCMR. He really should go into plastics, or some other specialty where people are nicey-nice.

TEAM players

Management has come up with another marvelous idea. This time it's TEAM, a laboring acronym that stands for something like "Teamwork, Enthusiam, Attitude, Managing problems". Here's how it works:

Patients and family members are supposed to fill out little cards the hospital sends 'em a couple weeks after discharge, then mail 'em back, prepaid, with their glowing review of staff members. Each staff member mentioned by name gets a gold star (no, I'm not making this up) next to their name in a file somewhere. When the staff member compiles enough brownie points, they get a nifty T-shirt to wear that proclaims them as a TEAM Player.

Management has its collective crinoline in an uproar. Our unit has gotten the fewest TEAM mentions of any unit since this whole thing started. The assumption on Management's part is that this makes us a bunch of hard-drinkin', dirty-talkin' malcontents without professionalism or caring attitudes.

The reality, of course, is that we have the largest proportion of patients who are totally gorked. Many of 'em either die shortly after they leave us or go to some sort of inpatient rehabilitation. None of those factors make it likely that the patient will suddenly sit up/return from the grave/begin to speak rationally and commend the care he or she got with us. Never mind that the families are dealing with a different set of issues than family members of patients who just had a facelift or breast reduction.

Let's face it, people: Creutzfeld-Jakob disease is not a condition that makes anybody want to fill out a postage-paid postcard six weeks after diagnosis.

So those of us on the Pariah Unit have come up with a plan. We're gonna have white vinyl jackets made up, in the style of 1950's Broadway musical gang members, and have "TEAM PLAYA" embroidered on the backs. We're going to get matching tattoos, set up a wet bar in the nurses' station, and take to dandling Lucky Strikes out of the corners of our mouths. Then we'll mug any nurse we see wearing a TEAM Player T-shirt.

In a few weeks, our reign of terror will be complete. We'll have the hospital under our thumbs. Ice cream sundaes for everybody in OR 7!

Things I do not understand.

1. Why are the French considered cheese-eating surrender monkeys? They mobilized eight million some-odd people for World War I. Over a million of those got killed in combat alone. That's not counting the three-quarters of a million folks dead of disease or badly injured, or the civilian casualties. Yet they were able to contribute another five million bodies for WW II and run a fairly efficient sabotage operation even while being occupied by the Nazis. That doesn't say "run away, run away" to me.

2. How come people in Lexuses (Lexi?) drive so badly? 60 in the fast lane, signalling for MILES without turning and turning abruptly without signalling, cutting people off, playing with their hair. What's up with that? Does owning a Lexus make you stupid?

3. Why won't that guy in 108 get it that I cannot get him a bigger room, no matter how much cash he offers me or how much he cusses? Can I please please please tell him tomorrow that I'm not his nurse because he's so personally unpleasant?

4. What *up* with the pharmacy, dawg? Why can I not get a timed vancomycin dose that only comes every thirty-six hours? Is that not enough lead time for you guys?

5. What's the appeal of those little batter-boogers that seafood fast-food restaurants put under your fried fishlike substances?

6. What *up* with you residents, dawgs? Like, your patient is sick. Do not come to me and tell me that and then stand there like I ought to be able to wave a wand. Write an order. Call a code. Dance a jig; I don't care. Just effing *do* something, okay? Okay.

And that, again, is all.

A Guide to Getting Along With Me, by Nurse Jo.

1. If you are a doctor, please sign the orders you write. What's easier--signing the orders while you write them, or signing them all when I present you with a big stack of incomplete charts and an evil smile, when you're already late for dinner with your wife?

2. If you are a patient with six different diagnoses, all of which must be reached by exclusion, all of which are obscure, and four of which require narcotics to control, you might consider that you're a whackjob.

3. If you're a night nurse, please don't bitch that I "left" you a single piece of not-very-challenging paperwork to fill out during your shift. I had five discharges and six admits today, and your head explodes with one of each, so shut the hell up and fill out the paperwork.

4. If you're a patient's family member, please understand that I don't have the power to get you a "bigger room". There are no "bigger rooms" in the hospital. Yours is as big as it gets. The fact that you're inviting twenty people to witness your being wheeled away for minor surgery is not my problem.

5. If you're a floating nurse on my shift, can the twenty-minute report. We write reports for a reason. You really, really, really don't need to go through every normal system in detail. Hit the high points. We all want to go home.

And home is where I am, with a plate of nachos and a beer.

And I get to do it all again tomorrow.

Well, shit.

Wish I knew whether friend Judy, OB/GYN extraordinaire, is okay.

Damn.

You know you've worked too hard when

You have a dream that Gregory House is leading a tour you're on through Cape Verde, and that you've forgotten your sun hat back at the hotel.

However, I did manage both to avoid dysentery and to earn his praise by figuring out how to manufacture pure oxygen using only a match, a tablespoon of mayonnaise, and a bowl of spinach.

I am *so* done with you.

Just a tip:

If you plan to seize eight times in four hours, please seize at least once during the five hours that you're in the EEG lab. That will save a lot of trouble.

If you're not going to seize in that five hours, please don't seize twice in the five minutes it takes to transport you from the lab to your room.

And, for God's sake, if you do *that*, seize just one goddamned time after I've set up the incredibly complex and nasty portable EEG monitor and glued things to your head. Okay? Okay.

And one more thing, this for another patient:

If I tell you to hold still, it means *hold still*. As in, STOP MOVING. As in stop fucking wriggling around, or this line that's in your artery, or going into your heart, or just in the wrong damn place, will puncture something that I won't be able to put pressure on.

And, while I'm at it, don't tell me how much more money I could be making as a fucking medical equipment sales rep, because that would mean I have to give up this incredibly rewarding and satisfying job, holding you down so you don't kill your own money-grubbing, shallow, awful self.

Um.

Anybody wanna buy a DynaMap?

Quick housekeeping

No, I don't know why Netscape is inconsistent with Blogger's commenting. I can't even fix my own HTML without a handful of Xanax and somebody standing over my shoulder.

Sorry if I haven't replied to your email. It's been rather busy here. Don't take my lack of response for a lack of interest, unless you're calling me a baby-killer or a bad woman, in which case you may. Everybody else, I've got two days starting tomorrow and will run through the inbox then.

General advice: It is a bad idea to eat half a Virginia ham by yourself, no matter how lovingly prepared and wonderful it is. You'll be up all night slugging water.

I'll be back tonight or tomorrow. Salut!

Unusually political post....

Fuck you, so-called "liberals".

Let me lay two things out for all of you right here and now.

1. Abortion is not a "devisive" or "minority" issue. It is a normative fact of women's lives. Forty percent of women under the age of 45 have had abortions. It is *routine* for women in this country to terminate pregnancies. It is a basic part of women's health care.

Whether or not you agree with whether a woman has an abortion is not the issue. This is the issue: Would you support criminalizing, in what's likely to be 21 or 22 states, a procedure that many women have during their lifetimes? Would you be willing to accept the morbidity and mortality that would certainly result from women too poor or too desperate to travel to a different state for a legal procedure?

Which brings me to the second point:

2. Criminalizing abortion criminalizes all aspects of pregnancy loss. If a woman in a non-choice state has a late miscarriage, chances are she will be quizzed prior to or during the delivery of services to determine whether or not she had help in ending the pregnancy. Those people who wish to help women terminate pregnancies safely will be prosecuted, and will likely lose whatever licenses they have. Those who don't care--the kitchen-table idiots--don't have anything to lose.

Consider for a moment what your life would be like if you, or your partner or wife, had a miscarriage and needed medical help. Would you be willing to have that pregnancy loss investigated as a possible crime?

Think it can't happen? One of the women I worked with at PP got into women's health after watching her first patient ever die. Of tetanus. From an illegal abortion. In 1980. She lived in a place where abortion services weren't available.

After the institution of parental consent laws in my home state several years ago, I saw two young women during my emergency department rotations, a year apart, who had both tried to self-abort. One is now sterile. Both were afraid to tell their parents.

I met a woman who, in 1968 in Texas, was denied emergency care during a hemorrhagic miscarriage until she provided the name of her abortionist. The fact that she hadn't *had* an abortion didn't matter to the cops. Her hematocrit got to 15 before a doctor intervened and saved her life. She ended up in the septic ward anyhow, and lost a kidney.

Probably things won't be as bad now as they were from the 1930's onward, when women had to go to literal back alleys to terminate pregnancies. The advent of cheap airfare and better medical technology, along with a generation of medical providers who grew up with legal abortion, will probably prevent too many horror stories. Probably there will be a new Jane Collective, dedicated to helping women get safe illegal abortions. Probably we won't see the return of septic wards, thanks to better antibiotics and better practice.

But I am not willing to rely on probably.

Edited to add this addendum, which I only just remembered:

Several years ago, I was cleaning out the cabinets at our local Planned Parenthood. I came across a file box full of index cards that had come from the women's health clinic that PP had taken over. On one of those cards was the name and phone number of a doctor who performed illegal and safe abortions in the town's only hospital prior to 1973. The police apparently gave him a pass, given that this is a liberal college city.

The doc was my mom's obstetrician. He would've delivered me back in 1970, but he was going under for an emergency root canal at the time. I asked Mom if she knew then that her doctor did illegal abortions. She said she knew. I asked why she chose him.

"Because I knew my life would be important to him, just as my pregnancy was important to him."

My right hand really hurts.

It's stiff, too.

That's because I spent twenty minutes with a hell of a lot of weight on it, leaning into that nice man's groin last night, trying to keep him from either bleeding to death or getting the world's nastiest bruise after that post-A-gram bleed.

That's the bad news. The good news is that, not only did he not bleed, he doesn't even have a hematoma there today. Nurse Jo with the magic fist!

It's not often that you can come home from work and pat yourself on the back for something you did really, really right. So I'm wearing out my other arm, patting away. It didn't hurt that the poor post-surgical nurse is brand new and so stood there gaping like a trout, thus making me look good. She was scared to death, poor thing, having done mother-and-baby for the past fifteen years.

In other news, it poured rain today for umpteen hours (actually about two) just at the time I was at the farmer's market. I stood in the rain and talked organic gardening with the thin, intense guy with tomatoes, okra and peppers with the old fat farmer guy, and blackberries with the blackberry guys.

Then I came home, napped, and made this:

Stuffed Zucchini, Jo-Style

Get you two "Eight-Ball" zucchinis. No, these are not zucchinis that have been mulched with heroin; they're round and about the size of baseballs.

Cut off the tops and scrape out the insides with a spoon, leaving about a half-inch border of flesh on the inside.

Chop that scooped-out zucchini gut stuff up.

Chop up about three tablespoons of onion and a handful of small mushrooms, too, while you're at it.

Heat a pat of butter in a non-stick skillet. Add a handful of chopped pecans and saute them until they start to smell really good. Then dump in the rest of the vegetables. Salt and pepper them once they turn soft, then add a tiny bit of dried thyme or oregano. Garlic is optional.

Just when you think the veggies might be done, when they're looking mushy and slightly browned and marvelous, add a chopped-up Roma tomato or two that you got from the organic gardening guy. Heat the whole kit and caboodle through, then take it off the heat.

When it's cooled a bit, stuff the zucchinis with the veggie and pecan mixture.

Put 'em in a pan, add an inch or so of water to keep 'em from burning, and bake 'em at, oh, about 350 until the sides of the zucchini wonderfulness cups can be pierced easily with a knife. Parmesan cheese, grated over the top during the last few minutes of baking, is really good.

Serve to general applause.

Now, can anybody give me some really good recipes for the umpteen gazillion crookneck yellow squash that Thin Intense Organic Gardening Guy gave me as a bonus?

So I had planned to

Come home today and lift weights. After all, if Georgia can live on 1200 calories a day and exercise like a madwoman, so can I. Right? Right.

But instead, after an alligator-to-the-eyeballs day with an arterial bleed at 1830, I went and had two beers and a grilled portabello mushroom.

With cheese.

NCLEX question: How much blood can one lose from a femoral artery bleed following an arteriogram?

Answer: Not as much as you'd expect, but God it looks like a fucking lot when it's spread around.

Sudden moment of self-doubt: am I still cool?

Hate Coldplay.

Bored by Tom and what's-her-name. (Speaking of which, recent research has shown that certain "important" faces might be stored in a few brain cells devoted exclusively to that purpose in our brains. Thus, we have a few brain cells devoted to Halle Berry, a few devoted to Robert Gould, and so on. Which depresses me. Any number of brain cells devoted to celebrities is too many.)

Love political discussions.

Two vintage painted Mexican tourist skirts in closet.

Hair sticks up all over head without my trying.

Two holes, one in each ear, no tattoos. (Wimpy, wimpy, wimpy.)

Screamingly liberal, still.

Thinking of taking back old part-time job as family planning counsellor at Planned Parenthood.

Can quote lines of poetry.

Make kick-ass mac & chee.

Share that recipe with the world.

Thirty pounds overweight...
...but boobs not yet hitting waistband of jeans.

Excellent intuitive diagnostician, paranoid nurse.

Consumes gallons of Scotch. Neat.

Just commented on 18-year-old's blog. For the record, she writes *hilarious* stuff. Much funnier than my best efforts.

Yeah. I'm still cool.

Whoring and hobbying.

Food whoring and hospital hobbying, that is.

Remember the corn I got? I got more from the farmer's market and mixed it up with black beans and diced tomatoes and some broth from the Dead Chicken of the other night (this was older corn that could be treated this way) and made SOUP. Mmmm. Soup. (There, Kit, is your Corn Whoring.)

As for the hospital hobbyist, here's the story. It's instructive to note that all the time the residents and attending were writing orders, we the nurses were the ones that had to deal with this patient.

Every once in a blue moon, you meet a person with an incredible tolerance for pain medication. For those of you who aren't nurses, the Painkiller Of Choice for a lot of people with a high tolerance or a big addiction is something called Dilaudid.

Whereas morphine and Demerol are dosed in milligrams, Dilaudid is dosed in tenths of milligrams. It's not only whoppingly effective, but it's whoppingly concentrated. Keep this in mind: a patient-controlled pain pump filled with morphine is dosed one milligram of drug to one milliliter of fluid. Dilaudid is dosed 0.2 milligrams of drug to milliliter of fluid.

With addiction (I'm not going to use the word "tolerance" here, since it's not appropriate) comes other problems, most of them psychological. Sometimes it's bad enough that our very-pampered MDs will skip seeing a patient daily, just so as not to have to deal with their weirdness.

Which brings me to the Champion Hospital Hobbyist: a person who spent six weeks in our facility with a wound infection, who was on a Dilaudid pain pump with a setting I had to read twice to believe, who got additional narcotic painkillers and Dilaudid boluses every hour, and who still was able to get up, go down seven stories, walk out to the parking lot, and smoke.

(For the nurses, the pump setting was 0.4 basal, 0.6 q 6 minutes, 30 mg q 4 hour lockout, boluses q1 prn. Which was increased every few days as boredom set in. Along with fifty of Phenergan q2 and the occasional Lortab.)

This patient was crazy enough that the attending had left it to the residents and nurses to handle things for six weeks. We were all wondering if Said Patient was simply going to move in, since there didn't seem to be anything wrong that we had to deal with, when I finally asked Attending the burning question on everyones' minds:

"So...this person's been here a month and a half, and we haven't really done anything. How many nudie pictures of you *do* they have at home? 'Cause that's the only reason I can imagine that we're keepin' 'em."

Champeen Hospital Hobbyist was gone the next day.