Today I went for breakfast at Rosa's. Rosa is a friend of mine who is mother to two charming and intelligent pre-teenage boys, wife to a charming and intelligent man, and mistress to three of the largest dogs I've ever met. Rosa is also from the Phillipines, so breakfast with her consists of rice, eggs, and some sort of dried marine life.
Today it was a combination of squid and fish, dried and then deep-fried. Normally, I'm game for almost anything edible and a number of things that are dubious, but I've got a skeevish reaction to eating anything that stares at me while I'm consuming it. Hence I stayed away from the dried fish and concentrated on the squid.
"Try the baby ones," Rosa said, "they're crunchier."
I eat them, as does her husband, Americano style: in small bites, with bits of garlic rice on the same fork. And they're delicious, especially the baby ones. The fish was a bit too salty for my taste, but the squid were just right.
As I wolfed down squid and rice and eggs and vegetables, three dogs crouched at my feet, not out of affection but because there was room at my end of the table.
The smallest dog, Dallas, is a shiny spaniel cross who weighs about 60 pounds. She's intelligent and suspicious and has decided after repeated exposure to me to delay ripping out my throat until some later, as yet undetermined, time.
The next larger dog is Sam. He's elderly and has had a rough life. If you pet him, he'll follow you everywhere, begging more affection with rolling eyes and a grin.
The chief of the household is named Soldier. He's either a Great Dane and Akita cross, or perhaps Great Dane and Catahoula hound cross; nobody is quite sure. He could be half flying flapdoodle and half Shetland pony for all I know; he weighs more than the other two dogs combined. Unfortunately, unlike the Brontosaur that he resembles, he has no second brain halfway down his spine. He is, however, a sweet-tempered (if dumb) animal with a soft spot for me. We sit on the floor and have a little mutual admiration session every time I go over there.
Which I desperately needed after this last couple of days.
When "they" say that doctors make the worst patients, "they" are discounting those patients whose family members are doctors.
I don't know why it is that everybody who wants to fake something ends up faking neurological disorders. Maybe it's that there are no sure, definitive tests for most neuro problems, barring tumors and abcesses and such. Maybe it's that they think neurologists are too flaky to catch the frauds. Maybe it's that the vast majority of people, even health-care professionals, look at neurology and neurosurgery as some sort of weird half-science practiced in the dark of the moon.
Whatever the reason, the wackos always fake neuro problems. Well, not *always*; sometimes they fake obscure autoimmune disorders with neurological components. Either way, there's Xanax and Valium and Dilaudid involved.
The wackos I can handle. They're generally undemanding, provided they get their needs (for drugs) met, they're normally pretty stable medically. It's the wackos' family members that drive me over the edge. And nothing is worse than a wacko with two close family members who are doctors.
Why? Because those family members will monopolize the lightboxes in the nurses' station as though they were their own personal property. They'll wander off for hours with the chart, ignoring the new orders that need to be posted. They'll call from their cell phones, demanding that you change medications on *their* say-so, even if they're not the primary physician. They'll medicate those family members with stuff they haul in from the office, then forget to mention it to you. They might even start sitting in wheelchairs, having discussions about their family member's case in the hallway, and then leave their detritus and the wheelchairs scattered for you to clean up.
Thankfully, this was not my patient. If it had been, there would've been fireworks. Unfortunately, the antics of the Family Doctors made life miserable for all of us--it's difficult to do your job in a confined space when there are people lurking, answering the phones because it might just be the person they paged, and monopolizing your time.
The last straw came, for me, when one of the Family Doctors opened one of my patients' charts. Note that this patient was not that doctor's family member; it was a patient with the same attending physician. Apparently, Family Doctor #1 wanted to "get a feel for" that doctor's "style" and the way that he comes to a diagnosis.
I learned yesterday that an icy "I. beg. your. pardon." and an equally icy "How *dare* you?" have the same effect on a doctor, even a wacko doctor, that they do on anyone else. Unfortunately, I didn't get an apology from said wacko, but I did extract a promise that the Family Doctors wouldn't be going near the chart rack again.
I fixed them, though. They'd left their family member's MRI and CT films all over the back of the nurses' station, so I just tidied 'em up. The resident and the attending both know where they are, but I doubt that the Family Doctors will be able to find them again.
The sad thing is that all of this hoohaw could've been avoided if somebody in a position to do so (like the charge nurse, or the manager, or the attending physician) had set some limits at the outset.
Maybe I should bring Dallas in on a nice, long chain. Those of us who want to get past her to the station can carry dried squid in our pockets.
Sunday, December 11, 2005
Wednesday, December 07, 2005
Random musings
The benefit of a liberal education
The following scene is why everyone should get at least a couple of years of liberal arts education before doing anything related to their profession:
Me: That's a really nice pendant.
Snooty, more-cultured-than-thou coworker: (archly) Thanks, it's a Mackintosh.
Me: Charles Rennie Mackintosh?
SMCTTC: (looking confused) Er...yes.
Me: (peering closer) Hm. Looks like the motif from the organ screen at Holy Trinity.
SMCTTC: (spluttering)
I was nice enough not to pump my arm and whisper "YES!!" soundlessly until I got into an empty room.
The basics of nursing
It strikes me that the three things that I've said most often in the last almost-four years have been "That's perfectly normal; don't worry", "I'll call the doctor", and "Don't pick."
A lot of nursing involves reassuring patients and their families that yes, everybody gets symptom X after situation Y happens. Especially in surgical situations, people get understandably nervous about things that we nurses see every day.
Yes, it's normal to hear that slooshing sound in your head; we filled the space where the meningioma was with sterile saline solution.
Yes, Mom will be kind of out of it for a few days; she's eighty, and that's what anesthesia does to eighty-year-olds.
Yes, that swelling will go down in a couple of days, but your eyes will stay black for a while.
There's also the occasional situation in which you really want a resident or PA there. Those are the times when it's essential to keep a straight face, show no signs of panic, and say something like "Let me give the resident a buzz and we'll let her clamp lamps on that there."
One of the nurses I work with who's done neuro for years tells the story of the patient she took care of in a neuro ICU whose wound dehisced (split open) and whose brain began to crawl out of said wound. When she saw the shiny grey-and-pink hallmarks of a cerebral cortex out of its natural environment, she calmly said, "Let me put some wet gauze on that; I'll give the doc a ring, eh?"
I always tell my patients this: If my hair catches fire, *then* you can worry. Otherwise, you're paying me an immense amount of money to worry for you; it's ridiculous for you to do it for free.
And, of course, every nurse knows the words "Don't pick."
Don't pick at those staples. Yes, I know it itches, but don't scratch that. Keep your hands away from there. Mister Jones, you'll need to keep your hand out of that, okay? Leave that stitch alone, dear, it's holding the tube in your brain. And so on.
The words "don't pick" might be just as essential to the profession as the words "drink this."
"It's more important to know whether there will be weather than what the weather will be." (The Whether Man, The Phantom Tollbooth)
I got to watch the latest cold front roll in this morning as I sat out on the porch. My porch is sheltered, thank heavens, so even 27* F is relatively bearable if you bundle up and put on slippers. The Cat has to see what the world is like every morning, which is why I was out there.
It's supposed to get nasty today. I can hear my Yankee friends laughing at the idea of a high of 30 and forcasted "wintry mix", but let me tell you: "wintry mix" this far south means one thing--ice.
By this time tomorrow, we're supposed to have three inches of ice on everything. Provided the power lines don't come down, I think we'll be okay. I'll be at Chef Boy's; I'm cooking a celebratory dinner for him tonight and don't plan to get back out in the middle of the storm. No sane person expects to be able to drive on ice, so my plan is to stay put until the insane people get out and clear the roads a bit.
Unfortunately, the reason for the celebratory dinner and the weather are comingled. Chef Boy has to start a forty-mile round-trip with an audition dinner in the middle of it just when the weather gets nasty. He's applied for a job at an Extremely Schwanko Restaurant that just happens to lie at the end of a not-well-travelled road, off a quiet spur of a not-well-travelled highway.
I think I'll make plenty of appetizers and not start roasting the chicken until he makes it back.
The following scene is why everyone should get at least a couple of years of liberal arts education before doing anything related to their profession:
Me: That's a really nice pendant.
Snooty, more-cultured-than-thou coworker: (archly) Thanks, it's a Mackintosh.
Me: Charles Rennie Mackintosh?
SMCTTC: (looking confused) Er...yes.
Me: (peering closer) Hm. Looks like the motif from the organ screen at Holy Trinity.
SMCTTC: (spluttering)
I was nice enough not to pump my arm and whisper "YES!!" soundlessly until I got into an empty room.
The basics of nursing
It strikes me that the three things that I've said most often in the last almost-four years have been "That's perfectly normal; don't worry", "I'll call the doctor", and "Don't pick."
A lot of nursing involves reassuring patients and their families that yes, everybody gets symptom X after situation Y happens. Especially in surgical situations, people get understandably nervous about things that we nurses see every day.
Yes, it's normal to hear that slooshing sound in your head; we filled the space where the meningioma was with sterile saline solution.
Yes, Mom will be kind of out of it for a few days; she's eighty, and that's what anesthesia does to eighty-year-olds.
Yes, that swelling will go down in a couple of days, but your eyes will stay black for a while.
There's also the occasional situation in which you really want a resident or PA there. Those are the times when it's essential to keep a straight face, show no signs of panic, and say something like "Let me give the resident a buzz and we'll let her clamp lamps on that there."
One of the nurses I work with who's done neuro for years tells the story of the patient she took care of in a neuro ICU whose wound dehisced (split open) and whose brain began to crawl out of said wound. When she saw the shiny grey-and-pink hallmarks of a cerebral cortex out of its natural environment, she calmly said, "Let me put some wet gauze on that; I'll give the doc a ring, eh?"
I always tell my patients this: If my hair catches fire, *then* you can worry. Otherwise, you're paying me an immense amount of money to worry for you; it's ridiculous for you to do it for free.
And, of course, every nurse knows the words "Don't pick."
Don't pick at those staples. Yes, I know it itches, but don't scratch that. Keep your hands away from there. Mister Jones, you'll need to keep your hand out of that, okay? Leave that stitch alone, dear, it's holding the tube in your brain. And so on.
The words "don't pick" might be just as essential to the profession as the words "drink this."
"It's more important to know whether there will be weather than what the weather will be." (The Whether Man, The Phantom Tollbooth)
I got to watch the latest cold front roll in this morning as I sat out on the porch. My porch is sheltered, thank heavens, so even 27* F is relatively bearable if you bundle up and put on slippers. The Cat has to see what the world is like every morning, which is why I was out there.
It's supposed to get nasty today. I can hear my Yankee friends laughing at the idea of a high of 30 and forcasted "wintry mix", but let me tell you: "wintry mix" this far south means one thing--ice.
By this time tomorrow, we're supposed to have three inches of ice on everything. Provided the power lines don't come down, I think we'll be okay. I'll be at Chef Boy's; I'm cooking a celebratory dinner for him tonight and don't plan to get back out in the middle of the storm. No sane person expects to be able to drive on ice, so my plan is to stay put until the insane people get out and clear the roads a bit.
Unfortunately, the reason for the celebratory dinner and the weather are comingled. Chef Boy has to start a forty-mile round-trip with an audition dinner in the middle of it just when the weather gets nasty. He's applied for a job at an Extremely Schwanko Restaurant that just happens to lie at the end of a not-well-travelled road, off a quiet spur of a not-well-travelled highway.
I think I'll make plenty of appetizers and not start roasting the chicken until he makes it back.
Sunday, December 04, 2005
A PSA of sorts
You know what's good? What's good is when you have enough empenada dough left over for one more empenada, but not enough filling, so you roll up the dough with brown sugar and butter and nuts. That's good.
On to the serious stuff.
A poster over at LiveJournal has posted the experience of a friend of his whose prescription for Valtrex was refused, confiscated by the pharmacist, and not returned to her. I don't know whether or not it's a true story, and I don't think the LJ community would appreciate me linking to it, but you can check it out over at Pandagon.
If this should happen to you, here's what to do, in order:
1. Get the name of the pharmacist. The *full* name of the pharmacist. Make a note of it, along with the time that he or she was working, and the date.
2. Get the name of his or her superior, if he or she has one.
3. Get the name of the store manager for the pharmacy in question.
If anybody tries to block you at any point, make a fuss. Seriously. Refusing to fill a prescription might not be illegal in most states, but *confiscating* one is. Even if your prescription is returned to you, the pharmacist who refuses to fill it should face public scrutiny for his/her actions.
4. As soon as you get home, call the doc or clinic that prescribed the drug for you. If it's emergency contraception you need, go here to find a list of every-day oral contraceptives that can be used as EC, and their doses. Most doctor's offices will carry at least one of these brands in samples. Demand one.
The doc's office also needs to know the name of the pharmacy and pharmacist that refused your prescription, so that they can steer their patients away from them in the future.
5. Next, call the manager of the pharmacy/drugstore, or, if that person is not available, the consumer help-line for national chains. That can be found on the websites that the national chains run. Give the time, place, and date of the incident, as well as the names of the people involved. Be calm, but remind the person or people that you speak to that this is something that *will* be followed up on, and that *will* be acted upon.
Follow that up with both an email and a paper letter to the folks you've talked to. Keep copies of both. It's time-consuming, but worth it. If you get a response at any point, get names and phone numbers from everyone involved.
Most of the time, you'll get sufficient action from those first five steps to make you calmer, if not happier.
If you're still angry, or if the people you've dealt with up to this point have been a herd of bleating dickwads, do the following:
If there's a university within fifty miles of you, find out if they have a women's right's group. Or look online for the nearest chapter of the National Organization for Women or the ACLU. Call any or all of those folks and tell *them* (time, date, names, places) what happened to you and who you talked to. Ask them if they have any pointers about what you should do next. With luck, you'll get plenty of pointers, ammo, and hell--they might even stage a demonstration.
Then call your local paper. Even *my* local birdcage liner, as in-pocket as it is with the wingnuts, ran a front-page article on women being denied EC and OC at a local drugstore. Can't hurt to try.
All of this requires a lot of effort and that you become a spokesperson of sorts for Women For Whom The Condom Broke. That sucks; you ought to be able to get prescriptions for legal drugs filled with a minimum of hassle and wasted time.
Unfortunately, there is a small (but growing) cadre of people who work as pharmacists who believe that it is their right to make judgements about the people they serve, and judgements about whether or not those people ought to have one drug or another. The only way they'll ever do their jobs fairly--by either filling *every* prescription, or handing them off to someone who will--is if they're called out publicly on their bigotry.
Yes, it's bigotry to deny women oral contraceptives. It's bigotry to deny people with herpes drugs that reduce the frequency and severity of outbreaks on the grounds that they somehow deserve to suffer. You'll notice that all of these things have to do with *other people* making judgements on the validity of *your* sexuality, and that those judgements are necessarily on a case-by-case basis.
I was with a woman who was refused an EC scrip once. I wish I'd made more of a fuss over it; luckily, the wall-eyed bastard who refused the scrip later lost his job after doing the same thing to a rape victim.
Unless we want to have to go through some sort of pseudo-underground machinations *as women*, to get our health-care needs filled, we have to speak out.
Edited to add: Holy shit, lookee here. Seems some pharmacists are now refusing to dispense pain meds and psychotropics (like antidepressants). How far does this bullshit have to go before people start getting angry en masse?
On to the serious stuff.
A poster over at LiveJournal has posted the experience of a friend of his whose prescription for Valtrex was refused, confiscated by the pharmacist, and not returned to her. I don't know whether or not it's a true story, and I don't think the LJ community would appreciate me linking to it, but you can check it out over at Pandagon.
If this should happen to you, here's what to do, in order:
1. Get the name of the pharmacist. The *full* name of the pharmacist. Make a note of it, along with the time that he or she was working, and the date.
2. Get the name of his or her superior, if he or she has one.
3. Get the name of the store manager for the pharmacy in question.
If anybody tries to block you at any point, make a fuss. Seriously. Refusing to fill a prescription might not be illegal in most states, but *confiscating* one is. Even if your prescription is returned to you, the pharmacist who refuses to fill it should face public scrutiny for his/her actions.
4. As soon as you get home, call the doc or clinic that prescribed the drug for you. If it's emergency contraception you need, go here to find a list of every-day oral contraceptives that can be used as EC, and their doses. Most doctor's offices will carry at least one of these brands in samples. Demand one.
The doc's office also needs to know the name of the pharmacy and pharmacist that refused your prescription, so that they can steer their patients away from them in the future.
5. Next, call the manager of the pharmacy/drugstore, or, if that person is not available, the consumer help-line for national chains. That can be found on the websites that the national chains run. Give the time, place, and date of the incident, as well as the names of the people involved. Be calm, but remind the person or people that you speak to that this is something that *will* be followed up on, and that *will* be acted upon.
Follow that up with both an email and a paper letter to the folks you've talked to. Keep copies of both. It's time-consuming, but worth it. If you get a response at any point, get names and phone numbers from everyone involved.
Most of the time, you'll get sufficient action from those first five steps to make you calmer, if not happier.
If you're still angry, or if the people you've dealt with up to this point have been a herd of bleating dickwads, do the following:
If there's a university within fifty miles of you, find out if they have a women's right's group. Or look online for the nearest chapter of the National Organization for Women or the ACLU. Call any or all of those folks and tell *them* (time, date, names, places) what happened to you and who you talked to. Ask them if they have any pointers about what you should do next. With luck, you'll get plenty of pointers, ammo, and hell--they might even stage a demonstration.
Then call your local paper. Even *my* local birdcage liner, as in-pocket as it is with the wingnuts, ran a front-page article on women being denied EC and OC at a local drugstore. Can't hurt to try.
All of this requires a lot of effort and that you become a spokesperson of sorts for Women For Whom The Condom Broke. That sucks; you ought to be able to get prescriptions for legal drugs filled with a minimum of hassle and wasted time.
Unfortunately, there is a small (but growing) cadre of people who work as pharmacists who believe that it is their right to make judgements about the people they serve, and judgements about whether or not those people ought to have one drug or another. The only way they'll ever do their jobs fairly--by either filling *every* prescription, or handing them off to someone who will--is if they're called out publicly on their bigotry.
Yes, it's bigotry to deny women oral contraceptives. It's bigotry to deny people with herpes drugs that reduce the frequency and severity of outbreaks on the grounds that they somehow deserve to suffer. You'll notice that all of these things have to do with *other people* making judgements on the validity of *your* sexuality, and that those judgements are necessarily on a case-by-case basis.
I was with a woman who was refused an EC scrip once. I wish I'd made more of a fuss over it; luckily, the wall-eyed bastard who refused the scrip later lost his job after doing the same thing to a rape victim.
Unless we want to have to go through some sort of pseudo-underground machinations *as women*, to get our health-care needs filled, we have to speak out.
Edited to add: Holy shit, lookee here. Seems some pharmacists are now refusing to dispense pain meds and psychotropics (like antidepressants). How far does this bullshit have to go before people start getting angry en masse?
Friday, December 02, 2005
Well, well, well.
I got my second "TEAM Player" T-shirt the other day (you don't remember the TEAM Playa post?), which seems to indicate that I'm doing my job. Which is a good thing, since sometimes I'm not so sure. Bad days like the one last week really make me wonder if I'm competent (because I catch problems like couplets and triplets before they send a patient to the ICU) or incompetent (which is silly, because even on Dilantin, people sometimes seize).
Luckily for me, the two best nurses I work with had Signally Bad Days this past week, too. One of 'em walked into a patient's room, and the patient...died.
Just like that. Brady'ed down from 70 to 6 and stopped breathing, just like that. Wow. And the patient's wife, thankfully keeping her head on straight, refused a code on him. They'd coded him twice already, and it was time for him to go home.
However, it's unusual to have your first death, or rather, your first unexpected death, at 0715. Lou-Who was shook, but professional, and dealt with the whole baggin'/taggin' thing, then took a break with a nice hot cup of tea. When the floor manager walked in with paperwork Lou-Who had to sign, she (Lou) looked up and asked, "So. Do I get a TEAM T-shirt for this?"
Luz's bad day started with the death of a patient she loved. She walked in to the room at 0845, and the patient just...died. (Holy crap. Two in one morning?) He just quit breathing. He was a DNR, thankfully, so there was no need to start working on him. Instead, Luz comforted his wife, then I helped her bad & tag and made her a cup of tea.
We've drunk a lot of tea on our floor in the last couple of weeks.
Luz's day would've improved had not another patient *tried* to die on her. Luz, however, is determined, and disinclined to let anybody go who hasn't given the whole living thing a good shot, so that patient went to the ICU. It was, ironically, the same guy who seized on me and who left me with a feeling of not having done something vital.
'Tis the season, I guess. Each hospital has its own rhythms. Most of the folks on our floor like to die right before Christmas, perhaps because they're so damned *tired*. The people two floors up on chemo wait until after the holidays, then head out. Either way, we have a ragged time between Thanksgiving and New Year's.
We're having a potluck lunch next week to try to make up for the Bad Days everybody has had lately. I think I'll be taking mac & cheese and maybe a couple of other things, too. There's a need for comfort food.
Luckily for me, the two best nurses I work with had Signally Bad Days this past week, too. One of 'em walked into a patient's room, and the patient...died.
Just like that. Brady'ed down from 70 to 6 and stopped breathing, just like that. Wow. And the patient's wife, thankfully keeping her head on straight, refused a code on him. They'd coded him twice already, and it was time for him to go home.
However, it's unusual to have your first death, or rather, your first unexpected death, at 0715. Lou-Who was shook, but professional, and dealt with the whole baggin'/taggin' thing, then took a break with a nice hot cup of tea. When the floor manager walked in with paperwork Lou-Who had to sign, she (Lou) looked up and asked, "So. Do I get a TEAM T-shirt for this?"
Luz's bad day started with the death of a patient she loved. She walked in to the room at 0845, and the patient just...died. (Holy crap. Two in one morning?) He just quit breathing. He was a DNR, thankfully, so there was no need to start working on him. Instead, Luz comforted his wife, then I helped her bad & tag and made her a cup of tea.
We've drunk a lot of tea on our floor in the last couple of weeks.
Luz's day would've improved had not another patient *tried* to die on her. Luz, however, is determined, and disinclined to let anybody go who hasn't given the whole living thing a good shot, so that patient went to the ICU. It was, ironically, the same guy who seized on me and who left me with a feeling of not having done something vital.
'Tis the season, I guess. Each hospital has its own rhythms. Most of the folks on our floor like to die right before Christmas, perhaps because they're so damned *tired*. The people two floors up on chemo wait until after the holidays, then head out. Either way, we have a ragged time between Thanksgiving and New Year's.
We're having a potluck lunch next week to try to make up for the Bad Days everybody has had lately. I think I'll be taking mac & cheese and maybe a couple of other things, too. There's a need for comfort food.
Tuesday, November 29, 2005
Considering.
Why is it so difficult to have certainty?
I'm a big fan of Ellis Peters's Brother Cadfael novels. For the uninitiated, Brother Cadfael is a Welsh-born English monk who lives in the 12th century and who solves the mysterious crimes that are rampant in the town beyond his monastery walls.
Br. Cadfael came to the monastery after forty years as a Crusader, soldier, and sailor. He's conversus rather than oblatus, which makes for some interesting perspectives (his) on the nature of the Benedictine order to which he belongs, the nature of Divine justice, and the vagaries of humanity.
One thing Cadfael has is certainty. He's certain about the existence of God, the fact that His justice will eventually prevail, and that sometimes humans have to act as God's hands in daily life. He's certain that he can heal the sick (Br. Cadfael is the herbalist and assists the infirmarian in his duties) and bring wrong-doers to justice. Most of all, he's certain of his place.
"We do what we must, and we pay for it. So in the end, all things are simple."
That's a line from the last Brother Cadfael novel, in which he goes recusate in order to rescue his son (conceived during the Crusades) from death.
Being in this business has made me aware that most things are far from simple, far from certain. I envy the certainty that my pal the chaplain has, that all things are for the best. I envy the simplicity that allows a person to see that their life has reached its effective conclusion and thus refuse further care.
I'm thinking of spending a week or so at a convent somewhere. I'm not sure whether it'll be Benedictine or Buddhist, but I think the silence would be useful. Not as a way to reaffirm vocation; as Opus Dei advocates, the vocation I've chosen sanctifies itself every day. Perhaps as a way to settle doubts; whether or not there's some Universal Being up there, it makes sense to decide whether to believe or not, once and for all.
"Agnosticism as a belief system is akin to immobility as a form of transportation."--Life of Pi
For some reason the thought of a week of silence, discipline, and thought is sounding better and better every day. Not as a retreat, mind you, in the typical sense of the word, but as a regathering.
I'm a big fan of Ellis Peters's Brother Cadfael novels. For the uninitiated, Brother Cadfael is a Welsh-born English monk who lives in the 12th century and who solves the mysterious crimes that are rampant in the town beyond his monastery walls.
Br. Cadfael came to the monastery after forty years as a Crusader, soldier, and sailor. He's conversus rather than oblatus, which makes for some interesting perspectives (his) on the nature of the Benedictine order to which he belongs, the nature of Divine justice, and the vagaries of humanity.
One thing Cadfael has is certainty. He's certain about the existence of God, the fact that His justice will eventually prevail, and that sometimes humans have to act as God's hands in daily life. He's certain that he can heal the sick (Br. Cadfael is the herbalist and assists the infirmarian in his duties) and bring wrong-doers to justice. Most of all, he's certain of his place.
"We do what we must, and we pay for it. So in the end, all things are simple."
That's a line from the last Brother Cadfael novel, in which he goes recusate in order to rescue his son (conceived during the Crusades) from death.
Being in this business has made me aware that most things are far from simple, far from certain. I envy the certainty that my pal the chaplain has, that all things are for the best. I envy the simplicity that allows a person to see that their life has reached its effective conclusion and thus refuse further care.
I'm thinking of spending a week or so at a convent somewhere. I'm not sure whether it'll be Benedictine or Buddhist, but I think the silence would be useful. Not as a way to reaffirm vocation; as Opus Dei advocates, the vocation I've chosen sanctifies itself every day. Perhaps as a way to settle doubts; whether or not there's some Universal Being up there, it makes sense to decide whether to believe or not, once and for all.
"Agnosticism as a belief system is akin to immobility as a form of transportation."--Life of Pi
For some reason the thought of a week of silence, discipline, and thought is sounding better and better every day. Not as a retreat, mind you, in the typical sense of the word, but as a regathering.
Observations
1. Moxie Fruvous might be the best band to cook to. Better than Indigo Girls, better than Joni Mitchell, even, though I prefer Joni Mitchell when I'm baking bread. There's something about "King of Spain" and the little shimmy-dance you can do to it that makes chicken pot pie come out really well.
2. The attitude of any given employee of a medical facility is inversely proportional to their skill. That observation includes me.
3. Every child should be taught touch-typing at a young age.
4. Sr. Cathleen and Sr. Mary Catherine of the Benedictine convent in Clyde, Missouri, make great lotion bars and soap. Green Tea scent is my favorite.
5. Brushing the top of your biscuit dough with a mixture of milk and melted butter (sorry, no exact proportions) will make the biscuits stay crunchy even in the microwave.
6. It is good to spend at least one afternoon of your days off in pajamas.
7. Honor Harrington (On Basilisk Station, A Short and Victorious War) undoes all the damage that years of Heinlein and Asimov females have done to me.
8. My boyfriend's sister-in-law is pretty cool for lending me her treasured copy of the first Honor Harrington story.
9. Anybody who feels that an IV-start certification will get them anywhere is probably sadly mistaken.
10. My cat is extremely strange. I have had nothing whatsoever to do with this.
2. The attitude of any given employee of a medical facility is inversely proportional to their skill. That observation includes me.
3. Every child should be taught touch-typing at a young age.
4. Sr. Cathleen and Sr. Mary Catherine of the Benedictine convent in Clyde, Missouri, make great lotion bars and soap. Green Tea scent is my favorite.
5. Brushing the top of your biscuit dough with a mixture of milk and melted butter (sorry, no exact proportions) will make the biscuits stay crunchy even in the microwave.
6. It is good to spend at least one afternoon of your days off in pajamas.
7. Honor Harrington (On Basilisk Station, A Short and Victorious War) undoes all the damage that years of Heinlein and Asimov females have done to me.
8. My boyfriend's sister-in-law is pretty cool for lending me her treasured copy of the first Honor Harrington story.
9. Anybody who feels that an IV-start certification will get them anywhere is probably sadly mistaken.
10. My cat is extremely strange. I have had nothing whatsoever to do with this.
Monday, November 28, 2005
Recipe for a bad day
For the first time in more than a year, I have had a bona fide bad day at work.
It's rare to have a truly bad day. I mean, the day the medication dispenser went down and I couldn't get antibiotics for a patient with fulminant meningitis was pretty bad. The day a patient's family member assaulted me was pretty bad. And yesterday was pretty bad. Three in three years, though, is a good ratio.
Start with a pimple. Put it somewhere sensitive, like between your upper lip and your nose, and make sure that it's painful. It doesn't have to be big, or noticeable, or ugly, but it does have to be painful.
Then, when you wake up, make sure you're not feeling up to snuff. Something must've blown in on the wind night before last, because when I woke up yesterday, every cell in my body was poisonous to every other cell. It felt like a hangover without the alcohol.
Add one patient who seemed determined to seize, code, and die. Before 8 am.
He'd come in with a particularly nasty aneurysm that was snuggling up against his brainstem. Three hospitals had told him the thing was inoperable, but we figured we could either go in through his basilar or femoral artery and at least coil the thing. Turns out that genetic roulette had cursed him with arteries so torturous that we couldn't get to where we needed to be remotely; we had to go in and clip the damned aneurysm in an open surgery.
Which was a success, and not just in the "the operation was a success, but the patient is now trached and tubed and gorked" sense. It was a success in that he could move everything better when he came back than when he left, he knew where he was, and things were looking up.
Until that seizure. I didn't see it; the aide was feeding him breakfast and, for a split second, thought he was choking. She wisely yanked the emergency cord out of the wall and we all converged on the room. By the time I got there, the patient was already post-ictal and nonresponsive even to pain, but with a blood pressure in the high 200's.
And respirations of less than eight a minute. And a number of other little quirks that made the aide roll the cart down to the room, just in case.
I'll spare you the details of labetalol, large-bore IVs, and external pacing.
His daughter, when I called her, immediately asked me if the seizure was a result of her not coming to visit the day before. Yes, she's one of *those*. I went with the resident when she went in to see Daughter and tell her what was up with Dad; I figured somebody had better be there to stem the tide of hysteria and keep the resident from getting stuck in the family room. And yes, it was just as bad as you might imagine. Thanks for asking.
Shortly after I got him to the ICU, I got sent to another floor. Not because of my skill in keeping other people from going to the light prematurely, but because of staffing issues.
I was immediately presented with two patients fresh out of the unit after inguinal lymph node dissections and assorted other things. One guy had had a penectomy (yes, that is exactly what you think it is) for cancer; the other had had his bladder removed for the same reason. Urology is okay, it's interesting and fun, but I hate cardiology.
So when Mister No-Bladder Person started throwing PVC's (this is a very bad thing) in couplets and triplets and generally making the monitor sing pretty songs, I started hating things. A dose of IV metoprolol regulated his rhythm and made me hate things less...until his blood pressure started rising. And rising. And rising some more.
It came down after forty milligrams of hydralazine. To 185/100. An improvement, but not enough of one. So here we go again with the bleeping labetalol and the monitor going nuts and now the patient is sundowning and trying to get out of bed, uncapping drains and yanking catheters and generally being difficult.
At some point in the middle of all of this, Chef Boy called with the news that his gate had blown open and his Dachshund was somewhere in the city, wandering. Somehow this was my fault, he implied in a snarky voice mail message, even though *he's* the one with the house and the gate.
Did I mention the particularly painful and distracting pimple? I thought so.
Finally things calmed down. Mister No-Bladder Guy got his Haldol and went to sleep. Mister Penectomy Guy quit sending his obnoxious wife out to the station with demands for more pillows (you have eight in the room; how many more do you need?) and I got his potassium running and his blood sugar (480) dealt with.
Just then somebody asked me when my baby was due.
I'm not pregnant.
Yesterday was an actual, real-life, nonstop Bad Day.
It's rare to have a truly bad day. I mean, the day the medication dispenser went down and I couldn't get antibiotics for a patient with fulminant meningitis was pretty bad. The day a patient's family member assaulted me was pretty bad. And yesterday was pretty bad. Three in three years, though, is a good ratio.
Start with a pimple. Put it somewhere sensitive, like between your upper lip and your nose, and make sure that it's painful. It doesn't have to be big, or noticeable, or ugly, but it does have to be painful.
Then, when you wake up, make sure you're not feeling up to snuff. Something must've blown in on the wind night before last, because when I woke up yesterday, every cell in my body was poisonous to every other cell. It felt like a hangover without the alcohol.
Add one patient who seemed determined to seize, code, and die. Before 8 am.
He'd come in with a particularly nasty aneurysm that was snuggling up against his brainstem. Three hospitals had told him the thing was inoperable, but we figured we could either go in through his basilar or femoral artery and at least coil the thing. Turns out that genetic roulette had cursed him with arteries so torturous that we couldn't get to where we needed to be remotely; we had to go in and clip the damned aneurysm in an open surgery.
Which was a success, and not just in the "the operation was a success, but the patient is now trached and tubed and gorked" sense. It was a success in that he could move everything better when he came back than when he left, he knew where he was, and things were looking up.
Until that seizure. I didn't see it; the aide was feeding him breakfast and, for a split second, thought he was choking. She wisely yanked the emergency cord out of the wall and we all converged on the room. By the time I got there, the patient was already post-ictal and nonresponsive even to pain, but with a blood pressure in the high 200's.
And respirations of less than eight a minute. And a number of other little quirks that made the aide roll the cart down to the room, just in case.
I'll spare you the details of labetalol, large-bore IVs, and external pacing.
His daughter, when I called her, immediately asked me if the seizure was a result of her not coming to visit the day before. Yes, she's one of *those*. I went with the resident when she went in to see Daughter and tell her what was up with Dad; I figured somebody had better be there to stem the tide of hysteria and keep the resident from getting stuck in the family room. And yes, it was just as bad as you might imagine. Thanks for asking.
Shortly after I got him to the ICU, I got sent to another floor. Not because of my skill in keeping other people from going to the light prematurely, but because of staffing issues.
I was immediately presented with two patients fresh out of the unit after inguinal lymph node dissections and assorted other things. One guy had had a penectomy (yes, that is exactly what you think it is) for cancer; the other had had his bladder removed for the same reason. Urology is okay, it's interesting and fun, but I hate cardiology.
So when Mister No-Bladder Person started throwing PVC's (this is a very bad thing) in couplets and triplets and generally making the monitor sing pretty songs, I started hating things. A dose of IV metoprolol regulated his rhythm and made me hate things less...until his blood pressure started rising. And rising. And rising some more.
It came down after forty milligrams of hydralazine. To 185/100. An improvement, but not enough of one. So here we go again with the bleeping labetalol and the monitor going nuts and now the patient is sundowning and trying to get out of bed, uncapping drains and yanking catheters and generally being difficult.
At some point in the middle of all of this, Chef Boy called with the news that his gate had blown open and his Dachshund was somewhere in the city, wandering. Somehow this was my fault, he implied in a snarky voice mail message, even though *he's* the one with the house and the gate.
Did I mention the particularly painful and distracting pimple? I thought so.
Finally things calmed down. Mister No-Bladder Guy got his Haldol and went to sleep. Mister Penectomy Guy quit sending his obnoxious wife out to the station with demands for more pillows (you have eight in the room; how many more do you need?) and I got his potassium running and his blood sugar (480) dealt with.
Just then somebody asked me when my baby was due.
I'm not pregnant.
Yesterday was an actual, real-life, nonstop Bad Day.
Wednesday, November 23, 2005
So you're working Thanksgiving...
Warning: heavy accent ahead.
Well, so am I.
Even though we get a good lunch--and dinner, if we want it--for free, I still prefer to take my own breakfast to work on holidays.
Herein is Jo's Diner Breakfast, gleaned from the days when I was a Dinette at Jim's ("You don't need no teeth/to eat the beef/At Jim's Diner"; "If you got it, share it; don't smoke it in the bathroom, man."):
One raw potato, peeled and cubed
Two eggs, beaten
A few shreds of onion
A handful of shredded ham
Whatever cheese is to your liking
Set your biscuit dough up and cut it out. Stick it in the oven to bake.
(There are numerous recipes for biscuits; even Bisquick makes a decent biscuit if you eat it hot. Try Brother Juniper's Fluffy Biscuit recipe for a Yankee version or search "angel biscuit" on Google for a Suthun version.)
Fry up your ham and onion until the ham begins to brown.
Scrape it out of the pan and dump the eggs in. When they're settin' nicely, put your sliced or shredded cheese on 'em and dump said ham and onions back on top.
Fold it all over and wrap it up into an omelette when things look good and ready. Don't ask for more specific instructions or Terry the Drunken Cook will go after you with a spatula.
When that's done cookin', stick it into a Tupperware and put it into the fridge.
Parboil your cubed potatoes until they're almost done, then season 'em with seasoned salt (or paprika, salt, garlic powder, and cayenne, in that order).
Slide a quarter-cup of oil into that hot pan you cooked your omelette in. (Yes, I know that's a lot by today's standards, but this is *diner* cooking.)
Dump in your seasoned potatoes. I hope you have a good exhaust fan over your stove.
Cook until they're crispy on the outside, mealy on the inside.
Drain on paper towels. If you're in the diner, you can skip that step.
If you're really hurtin' for gravy, now's the time to make it, with sausage grease and flour in a roux, milk, and more flour to thicken. (You do keep sausage grease on hand, right? In an old coffee can? What are you, some kinda hippie?)
Take the biscuits out of the oven. Let them cool on the counter, then wrap two up in foil. Put your putative gravy in another Tupper, and your now-cooled and drained potatoes in yet another.
Pack the whole caboodle into your bag to be assembled in the morning. Don't forget the jelly.
That kind of cooking shouldn't be eaten every day. Fo' sho'. But for charming Rainbow Children who are hitching from Austin to Portland, Maine for the blueberry harvest, or satisfying old truck drivers or cement layers from the South, nothing can compare.
This year we're having turkey, cornbread stuffing, greens, and pumpkin pie. In homage to the recently displaced Louisianians we've got working with us, those same N'Awlinians have agreed to come in to cook crawfish etouffe, dirty rice, and bread pudding for us.
Happy Thanksgivin', y'all. I have a beer in my belly, a cat in my bed, and Jim's Diner cooking in my fridge for tomorrow.
Well, so am I.
Even though we get a good lunch--and dinner, if we want it--for free, I still prefer to take my own breakfast to work on holidays.
Herein is Jo's Diner Breakfast, gleaned from the days when I was a Dinette at Jim's ("You don't need no teeth/to eat the beef/At Jim's Diner"; "If you got it, share it; don't smoke it in the bathroom, man."):
One raw potato, peeled and cubed
Two eggs, beaten
A few shreds of onion
A handful of shredded ham
Whatever cheese is to your liking
Set your biscuit dough up and cut it out. Stick it in the oven to bake.
(There are numerous recipes for biscuits; even Bisquick makes a decent biscuit if you eat it hot. Try Brother Juniper's Fluffy Biscuit recipe for a Yankee version or search "angel biscuit" on Google for a Suthun version.)
Fry up your ham and onion until the ham begins to brown.
Scrape it out of the pan and dump the eggs in. When they're settin' nicely, put your sliced or shredded cheese on 'em and dump said ham and onions back on top.
Fold it all over and wrap it up into an omelette when things look good and ready. Don't ask for more specific instructions or Terry the Drunken Cook will go after you with a spatula.
When that's done cookin', stick it into a Tupperware and put it into the fridge.
Parboil your cubed potatoes until they're almost done, then season 'em with seasoned salt (or paprika, salt, garlic powder, and cayenne, in that order).
Slide a quarter-cup of oil into that hot pan you cooked your omelette in. (Yes, I know that's a lot by today's standards, but this is *diner* cooking.)
Dump in your seasoned potatoes. I hope you have a good exhaust fan over your stove.
Cook until they're crispy on the outside, mealy on the inside.
Drain on paper towels. If you're in the diner, you can skip that step.
If you're really hurtin' for gravy, now's the time to make it, with sausage grease and flour in a roux, milk, and more flour to thicken. (You do keep sausage grease on hand, right? In an old coffee can? What are you, some kinda hippie?)
Take the biscuits out of the oven. Let them cool on the counter, then wrap two up in foil. Put your putative gravy in another Tupper, and your now-cooled and drained potatoes in yet another.
Pack the whole caboodle into your bag to be assembled in the morning. Don't forget the jelly.
That kind of cooking shouldn't be eaten every day. Fo' sho'. But for charming Rainbow Children who are hitching from Austin to Portland, Maine for the blueberry harvest, or satisfying old truck drivers or cement layers from the South, nothing can compare.
This year we're having turkey, cornbread stuffing, greens, and pumpkin pie. In homage to the recently displaced Louisianians we've got working with us, those same N'Awlinians have agreed to come in to cook crawfish etouffe, dirty rice, and bread pudding for us.
Happy Thanksgivin', y'all. I have a beer in my belly, a cat in my bed, and Jim's Diner cooking in my fridge for tomorrow.
Tuesday, November 22, 2005
I had no idea. Wow.
The Death Post has inspired some excellent comments.
Tell me your stories. Tell me what sticks with you after twenty years, or what shocked you your first year out. Tell me why you do what you do, why you stick with it, why you continue to give a damn.
Post in the comments below, or send your stories to me using the email link. I'll read them all (promise!) and I might ask persimmons to republish a few up here, where everyone can read them.
I am amazed. I am amazed and honored to be called a nurse, and to share that title with the people who've posted below. Thank you.
Jo
Tell me your stories. Tell me what sticks with you after twenty years, or what shocked you your first year out. Tell me why you do what you do, why you stick with it, why you continue to give a damn.
Post in the comments below, or send your stories to me using the email link. I'll read them all (promise!) and I might ask persimmons to republish a few up here, where everyone can read them.
I am amazed. I am amazed and honored to be called a nurse, and to share that title with the people who've posted below. Thank you.
Jo
Monday, November 21, 2005
It's time for another round of....
PRODUCT REVIEWS!
After that last post, I feel the need to reassure everybody that I'm not some sort of deep-thinking, intelligent person. Therefore, I present this week's product reviews:
Gray's Anatomy
Really. Who watches this? I mean, who watches it *seriously*, without laughing at the unintentionally funny moments, like when the surgical intern breaks sterility while working on his dad's butt? Or when the neurologist suddenly performs brain surgery? Or when that same neurologist/neurosurgeon/whatever tells a patient that he has a fifty-fifty chance of surviving surgery to evacuate an epidural hematoma?
Note: This is why you don't have actors performing neurosurgery.
Plus, all the surgical interns on that show look older than I do. I mean, come *on*, casting directors--the residents I work with look about eighteen, the interns even younger. Why have a rode-hard, put-up-wet bunch of young actors who are supposed to be looking young and idealistic?
Judgement: avoid.
Mr. Clean Magic Eraser cleaning sponges
I'm probably going to lose my crunchy-granola badge for this, but these things rock my world. I have no idea what's in 'em, probably PCBs and DDT and fiberglass, but they really do work well. You know those smudges on the wall around the light switch? They take those off. Ditto soap scum of undetermined age on Chef Boy's bathtub.
The only problem is that they're meant to be disposed of. Seems wasteful to toss 'em out after only five or six uses.
But damn if they don't clean well.
Judgement: good, but in small quantities.
Ryka walking shoes (women's only)
Get the wide if your feet are at all normal. If they're really skinny, get the regular. Expensive, but comfortable on the track and at work, though not as nice as the Columbia light-hikers I got on sale a couple of years ago.
Judgement: nice, but pricey. Do not purchase through mail order.
Faux Frog Chardonnay, 2001
The only Chardonnay I've ever tasted that has an aspartame-like finish.
Judgement: run away, run away.
Harry Potter and the Goblet of Fire
Shortened considerably from the book, naturally, but still a good ride. Hardly any Malfoy. Lots of Hermione. Moaning Myrtle makes an appearance, and I think they used a body double in the bathroom scene. The costumes are wonderful. Ralph Fiennes is balletic in his evilness.
Judgement: see, preferably at one of those movie places that will serve you a nice glass of Blue Paddle or two.
After that last post, I feel the need to reassure everybody that I'm not some sort of deep-thinking, intelligent person. Therefore, I present this week's product reviews:
Gray's Anatomy
Really. Who watches this? I mean, who watches it *seriously*, without laughing at the unintentionally funny moments, like when the surgical intern breaks sterility while working on his dad's butt? Or when the neurologist suddenly performs brain surgery? Or when that same neurologist/neurosurgeon/whatever tells a patient that he has a fifty-fifty chance of surviving surgery to evacuate an epidural hematoma?
Note: This is why you don't have actors performing neurosurgery.
Plus, all the surgical interns on that show look older than I do. I mean, come *on*, casting directors--the residents I work with look about eighteen, the interns even younger. Why have a rode-hard, put-up-wet bunch of young actors who are supposed to be looking young and idealistic?
Judgement: avoid.
Mr. Clean Magic Eraser cleaning sponges
I'm probably going to lose my crunchy-granola badge for this, but these things rock my world. I have no idea what's in 'em, probably PCBs and DDT and fiberglass, but they really do work well. You know those smudges on the wall around the light switch? They take those off. Ditto soap scum of undetermined age on Chef Boy's bathtub.
The only problem is that they're meant to be disposed of. Seems wasteful to toss 'em out after only five or six uses.
But damn if they don't clean well.
Judgement: good, but in small quantities.
Ryka walking shoes (women's only)
Get the wide if your feet are at all normal. If they're really skinny, get the regular. Expensive, but comfortable on the track and at work, though not as nice as the Columbia light-hikers I got on sale a couple of years ago.
Judgement: nice, but pricey. Do not purchase through mail order.
Faux Frog Chardonnay, 2001
The only Chardonnay I've ever tasted that has an aspartame-like finish.
Judgement: run away, run away.
Harry Potter and the Goblet of Fire
Shortened considerably from the book, naturally, but still a good ride. Hardly any Malfoy. Lots of Hermione. Moaning Myrtle makes an appearance, and I think they used a body double in the bathroom scene. The costumes are wonderful. Ralph Fiennes is balletic in his evilness.
Judgement: see, preferably at one of those movie places that will serve you a nice glass of Blue Paddle or two.
Friday, November 18, 2005
I have seen people die.
In that sentence, in that thought, the plural form is the strangest part.
I've been doing the death-in-the-headspace thing a lot lately, partly because of my patients and partly because of my aunt.
A side note: the previous entry, the one that Jodi responded to, had a long section about the decision my aunt made earlier this week to die. After I'd posted it, I got an email from Mom saying that she had indeed died, early this morning, and so I edited that portion out. It seemed inappropriate, somehow. She'd made her decision and followed through, and I didn't want to dissect it after the fact.
Anyway, back to the death-in-the-head thing.
The most sobering thing about doing what I do for a living is this: it means that I have done something that, as far as I know, the rest of my immediate family has not. I've done it enough that it's become, at least in the outlines, fairly routine.
I've hugged family members. I've answered the call bell or the person who comes out into the hall with *that tone of voice* or *that look* that means that the person in the bed has quit breathing. I've caught up another nurse on the way to the room to verify the lack of a heartbeat. I've called more residents than I care to think about to verify our verification and chart time of death. I've walked them through the paperwork and told them where to sign.
And, more than that, I've been alone with a number of dead people. The dead are peaceful; they don't ask for cups of coffee when they're NPO or talk politics. I've bathed bodies, removed tubes and wires and IVs, wiped off things I couldn't identify and would rather not think about. I've talked to those people as I've done it, hoping that maybe my persistence in treating them as a living person would speed their souls on to wherever souls go.
I always leave the window open when I do this, no matter the weather. If I have a soul, and if it leaves my body after I die, I do not want to have to work to get outside and fly away. No elevators for me; give me an open window. Supersitious, yes, but part of the private ritual I have.
None of this is stuff my parents have done. My folks, who have a wider experience of life and a much greater understanding both of how stupid and how wonderful people can be, have not (to my knowledge) been around when somebody's died and then taken care of the body. I know my sister hasn't, or I would've heard about it already.
More than that, I've done it *multiple times*. Which is a stunner, when you think about it.
It opens an experiential gulf that I'd not thought about before today. Those of us who midwife the dying are a weird group; we're not generally skeeved out or frightened by the thing that is most taboo in our culture. Most of us have dissected at least portions of bodies; all of us have talked to those still living about the process of dying. It's hard work, as hard as having a baby, and with much the same rhythm as birthing.
The people who understand that, who don't get flipped out by the thought of a person not being immediately available in the body, tend to get chosen for the palliative care assignments on our floor. Oh, yeah, we always give the newest nurse a couple of DNRs who are about to go, just to make sure they can handle it, but after that, there's a cadre of us who seem to get assigned the dying and soon-to-be-dead over and over.
We self-select through our attitudes and our actions. The folks who make the assignments recognize that.
There's still a part of me that wonders, every time one of my patients dies, what on earth those idiots at the nursing school were thinking when they gave me my degree. What made them think that I could do this well? Why am *I* the one that has to be the shoulder and comfort for the living? I ask that not because it's a burden but because I feel so unqualified. The person who takes care of your dying father should be unflappable. Calm. Sympathetic but not overwhelmed by emotion. Distant enough to give you privacy, but not appear cold. I feel too imperfect, too undeserving, to do that job.
And every time, that gulf that lies between my and my folks and my sister, between me and Chef Boy, between me and the other average Janes on the street, grows a little wider. It gets a little deeper.
But I don't worry. I have the gut feeling that this is a gulf that will eventually grow wide enough that I'm back on the same side as everybody else. It'll be more like a discarded orange peel and less like an enforced distance. It'll be interesting to watch that process happen.
I've been doing the death-in-the-headspace thing a lot lately, partly because of my patients and partly because of my aunt.
A side note: the previous entry, the one that Jodi responded to, had a long section about the decision my aunt made earlier this week to die. After I'd posted it, I got an email from Mom saying that she had indeed died, early this morning, and so I edited that portion out. It seemed inappropriate, somehow. She'd made her decision and followed through, and I didn't want to dissect it after the fact.
Anyway, back to the death-in-the-head thing.
The most sobering thing about doing what I do for a living is this: it means that I have done something that, as far as I know, the rest of my immediate family has not. I've done it enough that it's become, at least in the outlines, fairly routine.
I've hugged family members. I've answered the call bell or the person who comes out into the hall with *that tone of voice* or *that look* that means that the person in the bed has quit breathing. I've caught up another nurse on the way to the room to verify the lack of a heartbeat. I've called more residents than I care to think about to verify our verification and chart time of death. I've walked them through the paperwork and told them where to sign.
And, more than that, I've been alone with a number of dead people. The dead are peaceful; they don't ask for cups of coffee when they're NPO or talk politics. I've bathed bodies, removed tubes and wires and IVs, wiped off things I couldn't identify and would rather not think about. I've talked to those people as I've done it, hoping that maybe my persistence in treating them as a living person would speed their souls on to wherever souls go.
I always leave the window open when I do this, no matter the weather. If I have a soul, and if it leaves my body after I die, I do not want to have to work to get outside and fly away. No elevators for me; give me an open window. Supersitious, yes, but part of the private ritual I have.
None of this is stuff my parents have done. My folks, who have a wider experience of life and a much greater understanding both of how stupid and how wonderful people can be, have not (to my knowledge) been around when somebody's died and then taken care of the body. I know my sister hasn't, or I would've heard about it already.
More than that, I've done it *multiple times*. Which is a stunner, when you think about it.
It opens an experiential gulf that I'd not thought about before today. Those of us who midwife the dying are a weird group; we're not generally skeeved out or frightened by the thing that is most taboo in our culture. Most of us have dissected at least portions of bodies; all of us have talked to those still living about the process of dying. It's hard work, as hard as having a baby, and with much the same rhythm as birthing.
The people who understand that, who don't get flipped out by the thought of a person not being immediately available in the body, tend to get chosen for the palliative care assignments on our floor. Oh, yeah, we always give the newest nurse a couple of DNRs who are about to go, just to make sure they can handle it, but after that, there's a cadre of us who seem to get assigned the dying and soon-to-be-dead over and over.
We self-select through our attitudes and our actions. The folks who make the assignments recognize that.
There's still a part of me that wonders, every time one of my patients dies, what on earth those idiots at the nursing school were thinking when they gave me my degree. What made them think that I could do this well? Why am *I* the one that has to be the shoulder and comfort for the living? I ask that not because it's a burden but because I feel so unqualified. The person who takes care of your dying father should be unflappable. Calm. Sympathetic but not overwhelmed by emotion. Distant enough to give you privacy, but not appear cold. I feel too imperfect, too undeserving, to do that job.
And every time, that gulf that lies between my and my folks and my sister, between me and Chef Boy, between me and the other average Janes on the street, grows a little wider. It gets a little deeper.
But I don't worry. I have the gut feeling that this is a gulf that will eventually grow wide enough that I'm back on the same side as everybody else. It'll be more like a discarded orange peel and less like an enforced distance. It'll be interesting to watch that process happen.
Just because you can doesn't mean you should, part II
He came to us four weeks ago with a tumor in his cervical spine. The surgeons resected as much as they could, placed hardware in his spine to keep his head erect, and arranged for him to start radiation therapy.
He came back last week, unable to hold his head up. An MRI showed that the tumor had returned, aggressively, covering and wrapping around the hardware we'd placed recently enough that his scars were still pink.
He's in his forties, with two kids. His wife had to make the decision to withdraw care, and had stayed with him since then. He was breathing near-pure oxygen last night through a mask, in short gasps, his ribs and intercostal muscles showing with every breath. The place in his skull where we'd taken out a bone flap after a brain biopsy was sunken. His wife curled against his chest and talked to him, telling him it was okay to relax, to go, to let go. For her, there was nobody else in the room.
I thought about that as I stood looking at the syringe of morphine I was holding. I'd just drawn it up; his wife had come to me saying that he looked as if he was about to go, and like it was hard work. Could he, she asked, have a little more morphine to ease his breathing?
He was already on a drip--not a lot, but enough to calm the demands his heart was making for oxygen.
You're taught early on that it's not unethical to give pain medication to people in palliative care, even if the amount of medication they receive might hasten their deaths. It's a decision about quality of life rather than quantity, and it's acceptable: no one wants to deny pain medication to a cancer patient in fear that they might either die sooner or become addicted. By the time you hear the word "palliative", it's too late to worry about addiction.
It's a different animal, though, when you're standing in the med room five minutes before shift change (a fact you note with only a part of your attention; at times like this, punching out doesn't matter) with a possibly-lethal dose of morphine in your hand.
If I give him this morphine and he stops breathing, how will I handle it?
He knew what he wanted; his wife knew what he wanted. There would be no problem for him. Not breathing for a few hours more would be no skin off his nose. Knowing the patient, he'd probably--if he were still aware--thank me for the favor.
But his mom and dad? His kids, standing at the bedside? His wife? Me?
There's a big difference between knowing something is ethically clean when you read it in a textbook and pondering the reprecussions when it's you that has to make that decision.
I gave him the full dose of morphine; he kept on breathing. The reprecussions were delayed for a bit in that case.
I wasn't comfortable with the morphine for a number of reasons, mostly because it seemed that I had the potential to cut short some sort of necessary process. Who knows what's happening to somebody else, what sort of transition they're undergoing, as they die? The old-fashioned pillow-on-the-face trick might leave them unprepared to do whatever the hell it is we do after we stop breathing. Either way, why is it my decision? Why is it my responsibility?
And there in black and white is the hardest thing about being a nurse: not accepting that a beloved, brilliant person has decided not to go on living, but realizing that at some point, you may have the task of helping them out, incidentally and unintentionally.
He came back last week, unable to hold his head up. An MRI showed that the tumor had returned, aggressively, covering and wrapping around the hardware we'd placed recently enough that his scars were still pink.
He's in his forties, with two kids. His wife had to make the decision to withdraw care, and had stayed with him since then. He was breathing near-pure oxygen last night through a mask, in short gasps, his ribs and intercostal muscles showing with every breath. The place in his skull where we'd taken out a bone flap after a brain biopsy was sunken. His wife curled against his chest and talked to him, telling him it was okay to relax, to go, to let go. For her, there was nobody else in the room.
I thought about that as I stood looking at the syringe of morphine I was holding. I'd just drawn it up; his wife had come to me saying that he looked as if he was about to go, and like it was hard work. Could he, she asked, have a little more morphine to ease his breathing?
He was already on a drip--not a lot, but enough to calm the demands his heart was making for oxygen.
You're taught early on that it's not unethical to give pain medication to people in palliative care, even if the amount of medication they receive might hasten their deaths. It's a decision about quality of life rather than quantity, and it's acceptable: no one wants to deny pain medication to a cancer patient in fear that they might either die sooner or become addicted. By the time you hear the word "palliative", it's too late to worry about addiction.
It's a different animal, though, when you're standing in the med room five minutes before shift change (a fact you note with only a part of your attention; at times like this, punching out doesn't matter) with a possibly-lethal dose of morphine in your hand.
If I give him this morphine and he stops breathing, how will I handle it?
He knew what he wanted; his wife knew what he wanted. There would be no problem for him. Not breathing for a few hours more would be no skin off his nose. Knowing the patient, he'd probably--if he were still aware--thank me for the favor.
But his mom and dad? His kids, standing at the bedside? His wife? Me?
There's a big difference between knowing something is ethically clean when you read it in a textbook and pondering the reprecussions when it's you that has to make that decision.
I gave him the full dose of morphine; he kept on breathing. The reprecussions were delayed for a bit in that case.
I wasn't comfortable with the morphine for a number of reasons, mostly because it seemed that I had the potential to cut short some sort of necessary process. Who knows what's happening to somebody else, what sort of transition they're undergoing, as they die? The old-fashioned pillow-on-the-face trick might leave them unprepared to do whatever the hell it is we do after we stop breathing. Either way, why is it my decision? Why is it my responsibility?
And there in black and white is the hardest thing about being a nurse: not accepting that a beloved, brilliant person has decided not to go on living, but realizing that at some point, you may have the task of helping them out, incidentally and unintentionally.
Tuesday, November 15, 2005
Time for another "humorous diatribe"
Helpful tips for hospital patients, drawn from life...
1. If your nurse is trying to get a history from you, it's not the time to answer your cell phone, order a pizza, start manicuring your nails, try to set up your 'Net connection, or take calls from your constituents.
2. Likewise, if you're the family member of a patient who has global aphasia (think: unable to speak, write, or comprehend; limited only to pleasant smiles and gestures), now is not the time to book it toward the exit door. Stick around. Knowing what Mom is allergic to is really nice in these situations.
3. If you are one of those people lucky enough to have an entourage, whether privately or publicly funded, they're going to have to leave the room during the exam. The gentleman with the expensive suit, earpiece, and suspicious lump in the armpit of his suit will not tell me more about your neurological status than I can find out on my own.
4. A special note for elderly Yankees, or those who have moved to Florida: I don't know what kind of nurses they have in your universe, but I am not "the girl." I am not a waitress, maid, personal secretary, dogsbody, factotum, or whore. I have a particular job to do, and you're not making it much easier. Plus, the amount of money you donated to the hospital makes little or no difference to me. You're still gonna get stuck.
5. Speaking of needles, I don't care who you are. You don't get to refuse the urinalysis, the IV start, the fluids, getting weighed, the CT scan, or the bloodwork. You are ill enough to be in the hospital; this is what we do in the hospital. I won't argue with you, either; I'll simply tell your surgeon that you're refusing treatment, and you can go home, enormous bleed/fulminating meningitis/giant tumor and all.
6. Please bring your medications, or a reliable list of them, with you to the hospital. This helps me in two ways: I don't have to butt heads with my beloved pharmacists about what sort of small, blue pill you might be taking for your sugars, and (more importantly) it lets me know what sort of person you are. If I see that you have a mostly-full bottle of Cipro with you that your doctor prescribed for you to take "when I'm not feeling well", and I see the name of a tough-as-nails, take-no-prisoners internist on the label, I will immediately know that you're the sort of obnoxious bully who's worth risking a resistant infection for rather than arguing with.
7. Please don't bring anybody else's medication with you. I don't care what Papa takes, only what you do.
8. And for God's sake, don't hide stuff in your bed. I *will* find it and you *will* have it taken away from you. There are doctors who will write orders for a Scotch and soda before bed. Find one.
9. Don't abuse your privilege. I'm talking here about the patients who threaten to call the president of the hospital if there's something they don't like (the food, the resident, the fact that they have to get fingersticks to check their blood sugar). I'm also talking about patients who call out on the call bell and say things like "Goddammit, you idiot, I need you in here RIGHT NOW to adjust my bed!!" (verbatim quote.)
10. And finally, be nice to the support staff. The woman who cleans your room is not (verbatim) "that cute little nigger." The people who transport you from place to place don't lack brains or ears. The person who brings your tray, sets it up for you, and helps you get started on your meal deserves at least a "thank you" for her trouble.
The sad thing is that none of the people referenced above were demented. None of 'em had troubles that would have affected their thought processes. They were just *like* that.
There are dozens of people, of course, who are genuinely sweet and pleasant; the sort of folks that you grow to love in the week that they're with you. Unfortunately for everybody, the assholes of the world are louder and more persistent.
Oh, well. The meek might not inherit the earth, but as long as they're not on a restricted diet, they'll inherit whatever treats and tidbits the nursing staff brings them to tempt their appetites.
1. If your nurse is trying to get a history from you, it's not the time to answer your cell phone, order a pizza, start manicuring your nails, try to set up your 'Net connection, or take calls from your constituents.
2. Likewise, if you're the family member of a patient who has global aphasia (think: unable to speak, write, or comprehend; limited only to pleasant smiles and gestures), now is not the time to book it toward the exit door. Stick around. Knowing what Mom is allergic to is really nice in these situations.
3. If you are one of those people lucky enough to have an entourage, whether privately or publicly funded, they're going to have to leave the room during the exam. The gentleman with the expensive suit, earpiece, and suspicious lump in the armpit of his suit will not tell me more about your neurological status than I can find out on my own.
4. A special note for elderly Yankees, or those who have moved to Florida: I don't know what kind of nurses they have in your universe, but I am not "the girl." I am not a waitress, maid, personal secretary, dogsbody, factotum, or whore. I have a particular job to do, and you're not making it much easier. Plus, the amount of money you donated to the hospital makes little or no difference to me. You're still gonna get stuck.
5. Speaking of needles, I don't care who you are. You don't get to refuse the urinalysis, the IV start, the fluids, getting weighed, the CT scan, or the bloodwork. You are ill enough to be in the hospital; this is what we do in the hospital. I won't argue with you, either; I'll simply tell your surgeon that you're refusing treatment, and you can go home, enormous bleed/fulminating meningitis/giant tumor and all.
6. Please bring your medications, or a reliable list of them, with you to the hospital. This helps me in two ways: I don't have to butt heads with my beloved pharmacists about what sort of small, blue pill you might be taking for your sugars, and (more importantly) it lets me know what sort of person you are. If I see that you have a mostly-full bottle of Cipro with you that your doctor prescribed for you to take "when I'm not feeling well", and I see the name of a tough-as-nails, take-no-prisoners internist on the label, I will immediately know that you're the sort of obnoxious bully who's worth risking a resistant infection for rather than arguing with.
7. Please don't bring anybody else's medication with you. I don't care what Papa takes, only what you do.
8. And for God's sake, don't hide stuff in your bed. I *will* find it and you *will* have it taken away from you. There are doctors who will write orders for a Scotch and soda before bed. Find one.
9. Don't abuse your privilege. I'm talking here about the patients who threaten to call the president of the hospital if there's something they don't like (the food, the resident, the fact that they have to get fingersticks to check their blood sugar). I'm also talking about patients who call out on the call bell and say things like "Goddammit, you idiot, I need you in here RIGHT NOW to adjust my bed!!" (verbatim quote.)
10. And finally, be nice to the support staff. The woman who cleans your room is not (verbatim) "that cute little nigger." The people who transport you from place to place don't lack brains or ears. The person who brings your tray, sets it up for you, and helps you get started on your meal deserves at least a "thank you" for her trouble.
The sad thing is that none of the people referenced above were demented. None of 'em had troubles that would have affected their thought processes. They were just *like* that.
There are dozens of people, of course, who are genuinely sweet and pleasant; the sort of folks that you grow to love in the week that they're with you. Unfortunately for everybody, the assholes of the world are louder and more persistent.
Oh, well. The meek might not inherit the earth, but as long as they're not on a restricted diet, they'll inherit whatever treats and tidbits the nursing staff brings them to tempt their appetites.
Monday, November 14, 2005
A bad idea.
It is a signally bad idea to eat four slices of artichoke-heart pizza and drink a pint of Winter Ale, no matter how hungry you are, then sleep for two hours with a Dachshund perched on your butt, no matter how sleepy you are after your pizza orgy. Waking up in a hot bedroom with a snoozy Dachshund draped over your hip will make you groggy, grumpy, and unlikely to be cheerful when your boyfriend suggests going swimming.
So I'm blogwhoring instead, having cleaned my house and drunk a pot of coffee and generally worked back up to feeling half-human.
Twisty gets bald
In which Twisty Faster preempts the hair loss occasioned by chemo and shows off one of the most elegant heads I've ever seen.
Germans get weird
In which the Shakes share a story that makes me wonder.
Things get scarier
In which Michael Brown suddenly, by contrast, looks like an expert.
The Playpus gets dead. Maybe.
It may be too early to tell.
Kim gets an award.
In which it should be obvious to everyone why Emergiblog won the October NurseBlog Award. (Thanks to whomever it was that nominated me, too.)
Health blogs get listed
I had not known of Globe Of Blogs until tonight. Check it out. Mia's blog Death Maiden is listed, as well as some other interesting nurseblogs. There's at least one interesting-looking single-focus patient blog, as well.
So I'm blogwhoring instead, having cleaned my house and drunk a pot of coffee and generally worked back up to feeling half-human.
Twisty gets bald
In which Twisty Faster preempts the hair loss occasioned by chemo and shows off one of the most elegant heads I've ever seen.
Germans get weird
In which the Shakes share a story that makes me wonder.
Things get scarier
In which Michael Brown suddenly, by contrast, looks like an expert.
The Playpus gets dead. Maybe.
It may be too early to tell.
Kim gets an award.
In which it should be obvious to everyone why Emergiblog won the October NurseBlog Award. (Thanks to whomever it was that nominated me, too.)
Health blogs get listed
I had not known of Globe Of Blogs until tonight. Check it out. Mia's blog Death Maiden is listed, as well as some other interesting nurseblogs. There's at least one interesting-looking single-focus patient blog, as well.
Saturday, November 12, 2005
Because I am not cool
Several years ago, there was a meme floating around the WorldWideInternetsBlogosphere called "One Hundred Things About Me."
Because I am a slowpoke, not inclined to do memes, and still wearing straight-legged jeans without a cool wash on them, I present:
As Many Things As I Can Think Of That You Might Find Mildly Interesting And Might Not Have Known Before:
1. I am a nurse (okay, okay. But it's a definition.) who works mainly with neurosurgery and neurology patients.
2. As a result of that, I'm extremely uncomfortable taking care of heart patients. Brain, easy. Heart? Scary.
3. My mother and I had the same mole on our right hips for years, until I had mine removed.
4. Other than that, and the shape of our foreheads, there's nothing in the way we look to indicate we're related.
5. I don't look much like my dad, either, but I did when I was younger.
6. I have one sister. She's eight years older than me, or nine, depending on what time of year it is. I don't look like her. Which makes me wonder.
7. I also have a cat. She's insane. Not unlike the rest of my family.
8. I like single-malt Scotch. A lot.
9. But I like a good chicken biryani or vegetable biryani more.
10. In fact, the quickest way to my heart is through homemade Indian or Pakistani food.
11. So I weigh about 30 pounds more than I should.
12. But I don't feel any larger than I did when I was a size six.
13. I can walk two and a quarter miles in 30 minutes, not bad for a fat chick.
14. My boyfriend weighs 22 pounds less than me.
15. My cat weighs eleven pounds, two ounces...
16. ....which is what my miniature Dachshund (staying with Chef Boy) weighs, as well.
17. I'm actually a big-dog person, not a small-dog person.
18. I vote Democratic.
19. I'm screamingly liberal on most issues.
20. I hate George Carlin and love Robin Williams.
21. If I were to die tomorrow, I'd want a NOLA jazz band on the way back from the cemetery...
22. ...and a polka band at the wake.
23. I have one ex-husband.
24. Which is fine with me. I'm gleeful, in fact.
25. Although once in a while, when I see his girlfriend riding around town on her scooter, I want to run her down.
26. Which I wouldn't do, because I have a NEW CAR!!!
27. I drive like a fucking maniac. Sorry, Mom.
28. I routinely denigrate residents and nursing students in this blog, but the reality is that I love them all to varying extents and try to be as helpful as I can be at work.
29. Because I was there once, too.
30. I was crap, in fact, in clinicals, but managed with classwork to pull it out in time to graduate.
31. I have a BA in music and sociology (double major) and an ADN in nursing.
32. Which makes me pretty much useless outside the hospital, except I can quote a lot of CS Lewis and Marx.
33. Sometimes I get homesick for Montreal or Banff.
34. But I rarely get homesick for Denmark, unless it's 108* here.
35. I have friends all over the damn world, mostly through the WorldWideInternets.
36. I used to moderate a board on housecleaning and organization (!!!) at iVillage (!!!!!).
37. I am compulsively organized everywhere except the trunk of my car.
38. I'm also compulsively crunchy and granola, letting critters live in my house and share my space peacefully, dude, unless they're like, silverfish or those huge fucking horrible flying roaches, that, like, really squick me out.
39. I make the best scrambled eggs Chef Boy has ever tasted.
40. I also make really good, really dense cakes that melt in your mouth.
41. I don't like chocolate all that much.
42. I use the word "fucking" a lot.
43. I can also cuss in Greek (thanks, Christos!), Russian (thanks, Urev!) and Portugese (thanks, Dario!).
44. I can speak a little French, get myself into trouble in Danish, and read German.
45. I understand enough medical Spanish to follow along.
46. My new favorite snack food is roasted corn with chili powder, lime, and salt (hence the Spanish reference).
47. I had an Internet stalker once, but the FBI was very helpful.
48. I do not want children.
49. But I get along with them fine, and babies crying for hours on end doesn't bother me.
50. Most people strike me as basically good-hearted but a little silly.
51. Which is fine, because I'm way silly myself.
52. I sing along with "Walk Like An Egyptian" every time it comes on the radio...
53. ...which doesn't happen often, since I mostly listen to NPR.
54. I make up silly songs about my cat.
55. I also give animals I know nicknames like "Schnozzhound" or "Grumplemuffin."
56. This causes my coworkers to look at me with some suspicion.
57. I hung a miniature disco ball in the break room, but nobody knows it was me. Heh.
58. I really, really like playing practical jokes on people.
59. But I hate surprise parties or practical jokes played on me.
60. I can quote huge chunks of Donne and Elliot, mostly because I wasted a lot of time taking English classes in college.
61. I once wrote a parody of Gerard Manley Hopkins's "Pied Beauty" that earned me an "A".
62. I like reading Ellis Peters's and Dorothy Sayers's mystery novels in the dead of winter....
63. ...but I never wanted to marry Peter Wimsey.
And that seems to be a good place to stop. "She never wanted to marry Peter Wimsey" would look equally well on a tombstone or a resume.
Because I am a slowpoke, not inclined to do memes, and still wearing straight-legged jeans without a cool wash on them, I present:
As Many Things As I Can Think Of That You Might Find Mildly Interesting And Might Not Have Known Before:
1. I am a nurse (okay, okay. But it's a definition.) who works mainly with neurosurgery and neurology patients.
2. As a result of that, I'm extremely uncomfortable taking care of heart patients. Brain, easy. Heart? Scary.
3. My mother and I had the same mole on our right hips for years, until I had mine removed.
4. Other than that, and the shape of our foreheads, there's nothing in the way we look to indicate we're related.
5. I don't look much like my dad, either, but I did when I was younger.
6. I have one sister. She's eight years older than me, or nine, depending on what time of year it is. I don't look like her. Which makes me wonder.
7. I also have a cat. She's insane. Not unlike the rest of my family.
8. I like single-malt Scotch. A lot.
9. But I like a good chicken biryani or vegetable biryani more.
10. In fact, the quickest way to my heart is through homemade Indian or Pakistani food.
11. So I weigh about 30 pounds more than I should.
12. But I don't feel any larger than I did when I was a size six.
13. I can walk two and a quarter miles in 30 minutes, not bad for a fat chick.
14. My boyfriend weighs 22 pounds less than me.
15. My cat weighs eleven pounds, two ounces...
16. ....which is what my miniature Dachshund (staying with Chef Boy) weighs, as well.
17. I'm actually a big-dog person, not a small-dog person.
18. I vote Democratic.
19. I'm screamingly liberal on most issues.
20. I hate George Carlin and love Robin Williams.
21. If I were to die tomorrow, I'd want a NOLA jazz band on the way back from the cemetery...
22. ...and a polka band at the wake.
23. I have one ex-husband.
24. Which is fine with me. I'm gleeful, in fact.
25. Although once in a while, when I see his girlfriend riding around town on her scooter, I want to run her down.
26. Which I wouldn't do, because I have a NEW CAR!!!
27. I drive like a fucking maniac. Sorry, Mom.
28. I routinely denigrate residents and nursing students in this blog, but the reality is that I love them all to varying extents and try to be as helpful as I can be at work.
29. Because I was there once, too.
30. I was crap, in fact, in clinicals, but managed with classwork to pull it out in time to graduate.
31. I have a BA in music and sociology (double major) and an ADN in nursing.
32. Which makes me pretty much useless outside the hospital, except I can quote a lot of CS Lewis and Marx.
33. Sometimes I get homesick for Montreal or Banff.
34. But I rarely get homesick for Denmark, unless it's 108* here.
35. I have friends all over the damn world, mostly through the WorldWideInternets.
36. I used to moderate a board on housecleaning and organization (!!!) at iVillage (!!!!!).
37. I am compulsively organized everywhere except the trunk of my car.
38. I'm also compulsively crunchy and granola, letting critters live in my house and share my space peacefully, dude, unless they're like, silverfish or those huge fucking horrible flying roaches, that, like, really squick me out.
39. I make the best scrambled eggs Chef Boy has ever tasted.
40. I also make really good, really dense cakes that melt in your mouth.
41. I don't like chocolate all that much.
42. I use the word "fucking" a lot.
43. I can also cuss in Greek (thanks, Christos!), Russian (thanks, Urev!) and Portugese (thanks, Dario!).
44. I can speak a little French, get myself into trouble in Danish, and read German.
45. I understand enough medical Spanish to follow along.
46. My new favorite snack food is roasted corn with chili powder, lime, and salt (hence the Spanish reference).
47. I had an Internet stalker once, but the FBI was very helpful.
48. I do not want children.
49. But I get along with them fine, and babies crying for hours on end doesn't bother me.
50. Most people strike me as basically good-hearted but a little silly.
51. Which is fine, because I'm way silly myself.
52. I sing along with "Walk Like An Egyptian" every time it comes on the radio...
53. ...which doesn't happen often, since I mostly listen to NPR.
54. I make up silly songs about my cat.
55. I also give animals I know nicknames like "Schnozzhound" or "Grumplemuffin."
56. This causes my coworkers to look at me with some suspicion.
57. I hung a miniature disco ball in the break room, but nobody knows it was me. Heh.
58. I really, really like playing practical jokes on people.
59. But I hate surprise parties or practical jokes played on me.
60. I can quote huge chunks of Donne and Elliot, mostly because I wasted a lot of time taking English classes in college.
61. I once wrote a parody of Gerard Manley Hopkins's "Pied Beauty" that earned me an "A".
62. I like reading Ellis Peters's and Dorothy Sayers's mystery novels in the dead of winter....
63. ...but I never wanted to marry Peter Wimsey.
And that seems to be a good place to stop. "She never wanted to marry Peter Wimsey" would look equally well on a tombstone or a resume.
Friday, November 11, 2005
What I want for Christmas
Thursday, November 10, 2005
I don't wanna do your dirty work no more...
So I'll just do my own.
Anonymous comments are back. Both Mom and Vi had trouble commenting without 'em. The trouble occasioned by the rare anon troll is worth having their comments here. Mom, try the names I made up for you, okay? Okay.
Trolls: If you show up here, I will find you out. I will then put you on 180 mailing lists for sex toys that will follow you until the day you die. Alternatively, I will figure out which way you voted in your last local election and put you on 180 mailing lists for the opposite political camp. Be warned. I ain't doin' no Bitch, PhD thang here. I go straight for the jugular.
If you've sent me email in the last few days, I've not answered because (again) my Internets have been down. I've added Geek Nurse to the sidebar, more in appreciation of the Camera Whose Name Shall Not Be Spoken than because the Geek himself asked. Check it out. It's worthwhile. And it's the only Peds-related link I have.
My Samhain resolution was to post Grand Rounds links here, but I failed miserably the first week (see above complaining about Nonrobusto Mister Roboto 'Net access). Grand Round linkage will commence later.
That's all.
Anonymous comments are back. Both Mom and Vi had trouble commenting without 'em. The trouble occasioned by the rare anon troll is worth having their comments here. Mom, try the names I made up for you, okay? Okay.
Trolls: If you show up here, I will find you out. I will then put you on 180 mailing lists for sex toys that will follow you until the day you die. Alternatively, I will figure out which way you voted in your last local election and put you on 180 mailing lists for the opposite political camp. Be warned. I ain't doin' no Bitch, PhD thang here. I go straight for the jugular.
If you've sent me email in the last few days, I've not answered because (again) my Internets have been down. I've added Geek Nurse to the sidebar, more in appreciation of the Camera Whose Name Shall Not Be Spoken than because the Geek himself asked. Check it out. It's worthwhile. And it's the only Peds-related link I have.
My Samhain resolution was to post Grand Rounds links here, but I failed miserably the first week (see above complaining about Nonrobusto Mister Roboto 'Net access). Grand Round linkage will commence later.
That's all.
Just because you can doesn't mean you should, and other lessons
If Mama is 87 years old, demented, obese, with long-standing heart troubles and CAD, a less-than-ideal immune system, and unable to make sense of what's going on, it might not be such a good idea to have her hip replaced.
Especially if the outcome--a six-day stay in the ICU, a raging infection, and general misery for all--is one you've been warned about beforehand.
I'm just sayin'. Mama is going to be lying in bed for the rest of her life anyhow, not knowing where she is, alternately screaming and cursing, Foley and O2 mask and rectal tube and permacath in place, regardless of what you do. Quality of life here is an issue. Would you rather Mama be in pain with a huge fever, in a strange place, with invasive things done to her, or in *controllable* pain in a familliar place, with less likelihood of dying in fear?
If anybody ever does that to me, I will make it a point to die on the table and then haunt them for the rest of their lousy lives.
What a Young Nurse Should Know
Strokes do not necessarily change a person's personality. If Papa is a racist now, after one of his frontal lobes got bludgeoned by a big ol' clot, it's likely that he always had those attitudes, but also had the socialization to keep them to himself.
Likewise, if Auntie is dreadfully unpleasant now that she's lost her right parietal lobe and part of her frontal lobes, it's very likely that deep down, waaaay hidden away, she was pretty unpleasant to begin with.
The trick is to accept the family's apology for Papa's or Auntie's behavior without pointing out to them that you took care of Papa or Auntie last year, prior to this stroke, and not much has really changed.
Nobody told me there'd be days like this...
It has been a hellishly long six days. The two days I've had off in the last eight, the 'Net was down here at Las Casas Del Nonrobust Connection, so I've not been able to blog. That's probably just as well, because any writing I'd be able to produce would sound a whole lot like a drunk running into a wall at 3 a.m.
There are days in nursing when everything goes smoothly, you get your charts opened by nine, you have a chance to eat and even maybe drink a mid-afternoon cup of coffee, and you feel good when you leave the floor. There are other days, when nothing specifically horrible happens, but everything gets all wadded up in a huge ball that takes you hours to untangle. The last six days have pretty much been the latter sort.
It's not that the work recently has been particularly demanding in a physical or mental sense. After all, I'm not the one who has to localize somebody's stroke on the basis of symptoms or read their EEG. There have been no six-hundred pound patients falling out of bed lately (thank God and knock wood). It's just that little, simple things, like accessing a Mediport, took on a new and complicated dimension this week.
The Mediport (a permanent, implanted catheter under the skin of the chest through which one can infuse medications and draw blood) would flush, but not draw. This necessitated my trying to unclog it with TPA and failing, then ordering a chest X-ray, as per hospital protocol. Meanwhile, the patient whose Mediport it was was getting itchier and itchier (liver failure will do that to you) and more and more anemic. All of the falderal about TPA and chest X-rays was necessary, as I didn't want to run a couple of pints of blood into somebody's chest wall unless I was ordered to do so.
Then the one respiratory isolation room on our floor got bolloxed up somehow, so that the exhaust wasn't going to the outside air, but instead to the floor in general. Which would not have been a big deal had somebody discovered it *before* we'd put a possible TB case in the room. Again, not a big deal from a health standpoint, since it'd take a person about a million years of overtime to catch TB from the diluted particles that were exhausted into the air, but a cluster-fuck from a logistics standpoint.
Then the post-op unit sent me the wrong patient. I was waiting for an angiogram and got a belly surgery. Oops. More Three Stooging ensued, with the patient going to another floor, everybody smiling in a rictus of horror and trying to make like we'd planned it that way, and my promising, in a tense whisper, to skin the PACU nurse who'd messed up.
It seems the Universe knew I'd bought a fresh bottle of Bruichladdich.
...Most peculiar, Mama.
The differential diagnosis crew will be hard at work for the rest of the week.
MS behaves differently in different people, that we know. Sometimes you see the characteristic plaques in the brain on MRIs, sometimes you don't. Sometimes there are exacerbations and remissions, sometimes there aren't.
But MS does not behave like this:
An eighteen-year-old male presents with a six-month history of pain in the legs and decreasing coordination, especially truncal control.
Fast forward a year, to the latest exacerbation of what's been diagnosed as MS, despite no clinical evidence: the patient shows a persistent left-going gaze, still complains of intolerable pain in his legs and arms, the use of one side of his body. He never got better, not for one single day, in the intervening year. His family is now reporting personality changes, aggression, fearfulness, and aphasia.
His MRI signal is abnormal in the hippocampus. His EEG is insane.
We're all being very quiet on the floor, waiting for the neurologists to take a brain biopsy (not very useful, as you'd have to get very lucky to get what you need in a single cut), get the results back from his lymph node biopsies, and make a diagnosis.
My Favorite Martian (aka one of the best, most pleasant, least weird neurologists on staff) looked at me with a very solemn expression the other day, after he left my patient's room. He said nothing. I said nothing. Then we went down to the station and, together, ordered all the biopsies and reserved all the ORs that he would need for the next week.
We think we know what it is, and we really hope we're wrong.
Ending on a hopefully-more-cheerful note
The fact of the matter is, I'm not dead. The flu shot I got might've caused me to be sore and grumpy for the last two days, but grumpy and sore are my usual personality traits, so nobody much cared.
I'm off for three days, on for one, then off for two. On the last day of my mini-vacation, I'll be attending a monstrously wonderful pre-Thanksgiving potluck for the third year straight. We get such marvels as biriani and tabbouleh, enchiladas and that weird corn/mayonnaise/chili powder/lime concoction so beloved in Mexico, spring rolls and squid and dried fish. Somebody always fries a turkey, as a concession to the Suthun way of doing Thanksgiving, but we can eat barbecue instead if we like.
(I'll be taking Chef Boy's rolls and my own Danish rice pudding, thanks.)
The New Car continues to be amazing. I fill it up once every couple of weeks, drive it around while I play with all the nifty automatic settings for this and that, and consider my $380 per month well spent.
They charged me the price of a ten-year Scotch the other night when I picked up the Bruich. It's actually a 14-year. And, because I am the original cheap drunk, I can expect that it'll last me at least three more months.
Especially if the outcome--a six-day stay in the ICU, a raging infection, and general misery for all--is one you've been warned about beforehand.
I'm just sayin'. Mama is going to be lying in bed for the rest of her life anyhow, not knowing where she is, alternately screaming and cursing, Foley and O2 mask and rectal tube and permacath in place, regardless of what you do. Quality of life here is an issue. Would you rather Mama be in pain with a huge fever, in a strange place, with invasive things done to her, or in *controllable* pain in a familliar place, with less likelihood of dying in fear?
If anybody ever does that to me, I will make it a point to die on the table and then haunt them for the rest of their lousy lives.
What a Young Nurse Should Know
Strokes do not necessarily change a person's personality. If Papa is a racist now, after one of his frontal lobes got bludgeoned by a big ol' clot, it's likely that he always had those attitudes, but also had the socialization to keep them to himself.
Likewise, if Auntie is dreadfully unpleasant now that she's lost her right parietal lobe and part of her frontal lobes, it's very likely that deep down, waaaay hidden away, she was pretty unpleasant to begin with.
The trick is to accept the family's apology for Papa's or Auntie's behavior without pointing out to them that you took care of Papa or Auntie last year, prior to this stroke, and not much has really changed.
Nobody told me there'd be days like this...
It has been a hellishly long six days. The two days I've had off in the last eight, the 'Net was down here at Las Casas Del Nonrobust Connection, so I've not been able to blog. That's probably just as well, because any writing I'd be able to produce would sound a whole lot like a drunk running into a wall at 3 a.m.
There are days in nursing when everything goes smoothly, you get your charts opened by nine, you have a chance to eat and even maybe drink a mid-afternoon cup of coffee, and you feel good when you leave the floor. There are other days, when nothing specifically horrible happens, but everything gets all wadded up in a huge ball that takes you hours to untangle. The last six days have pretty much been the latter sort.
It's not that the work recently has been particularly demanding in a physical or mental sense. After all, I'm not the one who has to localize somebody's stroke on the basis of symptoms or read their EEG. There have been no six-hundred pound patients falling out of bed lately (thank God and knock wood). It's just that little, simple things, like accessing a Mediport, took on a new and complicated dimension this week.
The Mediport (a permanent, implanted catheter under the skin of the chest through which one can infuse medications and draw blood) would flush, but not draw. This necessitated my trying to unclog it with TPA and failing, then ordering a chest X-ray, as per hospital protocol. Meanwhile, the patient whose Mediport it was was getting itchier and itchier (liver failure will do that to you) and more and more anemic. All of the falderal about TPA and chest X-rays was necessary, as I didn't want to run a couple of pints of blood into somebody's chest wall unless I was ordered to do so.
Then the one respiratory isolation room on our floor got bolloxed up somehow, so that the exhaust wasn't going to the outside air, but instead to the floor in general. Which would not have been a big deal had somebody discovered it *before* we'd put a possible TB case in the room. Again, not a big deal from a health standpoint, since it'd take a person about a million years of overtime to catch TB from the diluted particles that were exhausted into the air, but a cluster-fuck from a logistics standpoint.
Then the post-op unit sent me the wrong patient. I was waiting for an angiogram and got a belly surgery. Oops. More Three Stooging ensued, with the patient going to another floor, everybody smiling in a rictus of horror and trying to make like we'd planned it that way, and my promising, in a tense whisper, to skin the PACU nurse who'd messed up.
It seems the Universe knew I'd bought a fresh bottle of Bruichladdich.
...Most peculiar, Mama.
The differential diagnosis crew will be hard at work for the rest of the week.
MS behaves differently in different people, that we know. Sometimes you see the characteristic plaques in the brain on MRIs, sometimes you don't. Sometimes there are exacerbations and remissions, sometimes there aren't.
But MS does not behave like this:
An eighteen-year-old male presents with a six-month history of pain in the legs and decreasing coordination, especially truncal control.
Fast forward a year, to the latest exacerbation of what's been diagnosed as MS, despite no clinical evidence: the patient shows a persistent left-going gaze, still complains of intolerable pain in his legs and arms, the use of one side of his body. He never got better, not for one single day, in the intervening year. His family is now reporting personality changes, aggression, fearfulness, and aphasia.
His MRI signal is abnormal in the hippocampus. His EEG is insane.
We're all being very quiet on the floor, waiting for the neurologists to take a brain biopsy (not very useful, as you'd have to get very lucky to get what you need in a single cut), get the results back from his lymph node biopsies, and make a diagnosis.
My Favorite Martian (aka one of the best, most pleasant, least weird neurologists on staff) looked at me with a very solemn expression the other day, after he left my patient's room. He said nothing. I said nothing. Then we went down to the station and, together, ordered all the biopsies and reserved all the ORs that he would need for the next week.
We think we know what it is, and we really hope we're wrong.
Ending on a hopefully-more-cheerful note
The fact of the matter is, I'm not dead. The flu shot I got might've caused me to be sore and grumpy for the last two days, but grumpy and sore are my usual personality traits, so nobody much cared.
I'm off for three days, on for one, then off for two. On the last day of my mini-vacation, I'll be attending a monstrously wonderful pre-Thanksgiving potluck for the third year straight. We get such marvels as biriani and tabbouleh, enchiladas and that weird corn/mayonnaise/chili powder/lime concoction so beloved in Mexico, spring rolls and squid and dried fish. Somebody always fries a turkey, as a concession to the Suthun way of doing Thanksgiving, but we can eat barbecue instead if we like.
(I'll be taking Chef Boy's rolls and my own Danish rice pudding, thanks.)
The New Car continues to be amazing. I fill it up once every couple of weeks, drive it around while I play with all the nifty automatic settings for this and that, and consider my $380 per month well spent.
They charged me the price of a ten-year Scotch the other night when I picked up the Bruich. It's actually a 14-year. And, because I am the original cheap drunk, I can expect that it'll last me at least three more months.
Tuesday, November 01, 2005
Needs Meme
Stolen from Badgerings :
Google a first name, in quotes, with the word "needs"
To wit:
Jo needs head.
Thanks, I have plenty of those at work.
Jo needs a 17" PowerBook.
Ergh.
Jo needs surgery.
Lord, I hope not.
Jo needs 2b funky.
Sing it, sister.
Jo needs some room to be used powerfully.
You betcha.
Jo needs help with dressing and washing and still wets the bed occasionally, though she is reliable during the day.
Which one of you has been watching me??
Jo needs a heart and lung transplant.
Well, they're all black and shrivelled up, so...
Jo needs to update her page.
Google a first name, in quotes, with the word "needs"
To wit:
Jo needs head.
Thanks, I have plenty of those at work.
Jo needs a 17" PowerBook.
Ergh.
Jo needs surgery.
Lord, I hope not.
Jo needs 2b funky.
Sing it, sister.
Jo needs some room to be used powerfully.
You betcha.
Jo needs help with dressing and washing and still wets the bed occasionally, though she is reliable during the day.
Which one of you has been watching me??
Jo needs a heart and lung transplant.
Well, they're all black and shrivelled up, so...
Jo needs to update her page.
I promise I won't foam at the mouth.
Not one word about Alito. I swear. Just go read PinkoFeministHellcat on the subject that's attracting the most attention. Oft thought, but ne'er so well expressed.
And please, please don't get me started on civil rights, disability rights and access, and gender equality.
We all knew Miers would be a sacrificial lamb, and that once she withdrew or failed to be confirmed, Bush would come out with his *real* candidate. Now he has, and now things will get interesting.
A word on judicial bypass
The state in which I live requires parental notification for minors seeking abortions. In the years I worked in women's health, I only saw a handful of cases in which young women who had to notify their parents were unwilling to do so, for very good reason.
One case involved a young woman whose father and stepmother had looked the other way while she was raped repeatedly by a cousin. Another involved a girl whose father would've killed her, literally, for bringing shame on his family. Those were the two worst; there were four or five more that, while not as horrible, certainly presented food for thought and caused me to call the equal-access folks for help.
Now, then. Judicial bypass is an option for young women in this state...but there is not one judge in my county who will hear a judicial-bypass request. Not one. They've all decided that judicial bypass takes the rights of parents away. Unfortunately, it's difficult to get a bypass ruling from a judge not in one's home county, even with competent legal help.
It's accepted that parents have a certain amount of dominion over their minor children; that's how parental consent and notification laws have passed in so many states. The spousal notification and consent laws that have been struck down assume that men have the same dominion over their spouses.
Which is a silly assumption, especially considering it doesn't go both ways.
Imagine what it would be like to be living in a county with no judicial bypass option, as a married woman with an abusive spouse, or one who's simply disappeared, or one who's locked up somewhere, and trying, as an adult woman, to get basic, common health care.
Imagine how it feels to be told this: even if you're in a good relationship, even if you and your spouse have made the decision not to continue a pregnancy together, you still don't have the ability to make that decision on your own, simply because you are the one carrying the pregnancy.
This is just like pharmacists refusing to dispense the morning-after pill, people. The onus falls on women in every case. When you show me the cases involving pharmacists refusing to dispense Lipitor or Levadopa to men, or the cases in which men are required to notify their wives before undergoing a radical prostatectomy, then I will believe that all this is about moral repugnance or equalizing voices within a relationship.
Until and unless that happens, I will continue to think that perhaps, just maybe, just a little bit, these sorts of things are about not allowing women full power over their bodies and their lives.
In other news
I got the closest thing yet to an invitation for a date the other night from a resident. Bless his heart, he got all kerfuffled when I started laughing hysterically, right in his face.
Nurses don't date residents. Not, at least, residents that they have to work with. They're residents, after all, and the work-with-this-person-for-years angle doesn't make it any more attractive.
We still have two screamers on the floor. I'm too tired to even consider writing about their latest antics.
The scary nursing student has been booted, not because she's gum on anybody's shoe or because she refused to do maid work, but because she ignored a tonic-clonic seizure one of her patients had and failed to inform the nurse about it.
And that's all the news for now.
And please, please don't get me started on civil rights, disability rights and access, and gender equality.
We all knew Miers would be a sacrificial lamb, and that once she withdrew or failed to be confirmed, Bush would come out with his *real* candidate. Now he has, and now things will get interesting.
A word on judicial bypass
The state in which I live requires parental notification for minors seeking abortions. In the years I worked in women's health, I only saw a handful of cases in which young women who had to notify their parents were unwilling to do so, for very good reason.
One case involved a young woman whose father and stepmother had looked the other way while she was raped repeatedly by a cousin. Another involved a girl whose father would've killed her, literally, for bringing shame on his family. Those were the two worst; there were four or five more that, while not as horrible, certainly presented food for thought and caused me to call the equal-access folks for help.
Now, then. Judicial bypass is an option for young women in this state...but there is not one judge in my county who will hear a judicial-bypass request. Not one. They've all decided that judicial bypass takes the rights of parents away. Unfortunately, it's difficult to get a bypass ruling from a judge not in one's home county, even with competent legal help.
It's accepted that parents have a certain amount of dominion over their minor children; that's how parental consent and notification laws have passed in so many states. The spousal notification and consent laws that have been struck down assume that men have the same dominion over their spouses.
Which is a silly assumption, especially considering it doesn't go both ways.
Imagine what it would be like to be living in a county with no judicial bypass option, as a married woman with an abusive spouse, or one who's simply disappeared, or one who's locked up somewhere, and trying, as an adult woman, to get basic, common health care.
Imagine how it feels to be told this: even if you're in a good relationship, even if you and your spouse have made the decision not to continue a pregnancy together, you still don't have the ability to make that decision on your own, simply because you are the one carrying the pregnancy.
This is just like pharmacists refusing to dispense the morning-after pill, people. The onus falls on women in every case. When you show me the cases involving pharmacists refusing to dispense Lipitor or Levadopa to men, or the cases in which men are required to notify their wives before undergoing a radical prostatectomy, then I will believe that all this is about moral repugnance or equalizing voices within a relationship.
Until and unless that happens, I will continue to think that perhaps, just maybe, just a little bit, these sorts of things are about not allowing women full power over their bodies and their lives.
In other news
I got the closest thing yet to an invitation for a date the other night from a resident. Bless his heart, he got all kerfuffled when I started laughing hysterically, right in his face.
Nurses don't date residents. Not, at least, residents that they have to work with. They're residents, after all, and the work-with-this-person-for-years angle doesn't make it any more attractive.
We still have two screamers on the floor. I'm too tired to even consider writing about their latest antics.
The scary nursing student has been booted, not because she's gum on anybody's shoe or because she refused to do maid work, but because she ignored a tonic-clonic seizure one of her patients had and failed to inform the nurse about it.
And that's all the news for now.
Sunday, October 23, 2005
Domesticity etcetera
There may be nothing nicer than a cold, rainy fall day (temperature: 47*) with "Motown Remixed" (picks: the "Sympathy for the Grapes" remix of "Heard It Through the Grapevine" and "The Tears of A Clown") and cold pizza and a nice pale ale.
Especially when you've just laid down a new rug that really ties the room together--and in this joint, that's a job for tugboat chains and Superglue--and put together the some-assembly-required TV stand to replace the nasty one you got rid of weeks ago.
The TV is plugged in for the first time in six weeks. The TV stand isn't put together *quite* right, but it's passable. Imperfect but solid, like the rest of the place.
Thanks to the miracles of modern commercial architecture, I can leave the porch door open even in the rain. Unless, of course, it's one of those thunderstorms that Darwinizes the stupid and drops quarter-sized hail. The porch faces west, after all.
If I had the energy
I would make a meatloaf and mashed potatoes and corn and beans for dinner. I don't have the energy, however, and so I'll probably end up eating whatever Chef Boy is cooking tonight. One perk to dating a chef: even the hamburgers he makes are ambroisia.
Now off to read
Mary Roach has a followup to Stiff called Spook--a scientific exploration of the paranormal. I'm looking forward to starting it with more cold pizza.
PS:
Shrimplate put a great recipe for duck quesadillas on his blog the other day. It's worth trying.
Especially when you've just laid down a new rug that really ties the room together--and in this joint, that's a job for tugboat chains and Superglue--and put together the some-assembly-required TV stand to replace the nasty one you got rid of weeks ago.
The TV is plugged in for the first time in six weeks. The TV stand isn't put together *quite* right, but it's passable. Imperfect but solid, like the rest of the place.
Thanks to the miracles of modern commercial architecture, I can leave the porch door open even in the rain. Unless, of course, it's one of those thunderstorms that Darwinizes the stupid and drops quarter-sized hail. The porch faces west, after all.
If I had the energy
I would make a meatloaf and mashed potatoes and corn and beans for dinner. I don't have the energy, however, and so I'll probably end up eating whatever Chef Boy is cooking tonight. One perk to dating a chef: even the hamburgers he makes are ambroisia.
Now off to read
Mary Roach has a followup to Stiff called Spook--a scientific exploration of the paranormal. I'm looking forward to starting it with more cold pizza.
PS:
Shrimplate put a great recipe for duck quesadillas on his blog the other day. It's worth trying.
Saturday, October 22, 2005
A brilliant scheme.
Four patients with perfusion problems.
All of them screamers.
One is schizophrenic, with a history of drug and alcohol abuse, as well as bipolar disorder type whatever, the sort that makes one an ultra-fast cycler.
The second has hallucinations, both visual and auditory, because the main arteries leading to her brain are mostly occluded.
The third simply screams in frustration at odd times, due to a combination of drug and alcohol abuse, occluded arteries, uncontrolled diabetes and cholesterol, and previous strokes.
Finally, one patient yells out his door at everyone passing by.
It sounds like this:
"Goddammit! Goddammit! Hey, gorgeous! Hey, gorgeous!"
"Stop the bus! Stop the bus! Stop the bus! Stop the bus!"
"aaaaaAAAAAAAAAaaaaaaaaaaaaRRRRRRRGH!"
"Hey! Hey! HeyheyHeyhey HEY!!"
So I had this thought the other day as I was sitting at the desk, listening to the cacophony for the twenty-sixth hour in a row:
Why not start up a punk band?
I mean, I have the hair. In civvies, I have the clothes. Add some good fuzzy guitar and a cranked-out drummer, and mix in "Hey gorgeous! Goddammit! Stop the bus! HEY!! AAAaaaaaAAAARGH!"
We could call it Nurse Jo and the Screaming Feebs.
All of them screamers.
One is schizophrenic, with a history of drug and alcohol abuse, as well as bipolar disorder type whatever, the sort that makes one an ultra-fast cycler.
The second has hallucinations, both visual and auditory, because the main arteries leading to her brain are mostly occluded.
The third simply screams in frustration at odd times, due to a combination of drug and alcohol abuse, occluded arteries, uncontrolled diabetes and cholesterol, and previous strokes.
Finally, one patient yells out his door at everyone passing by.
It sounds like this:
"Goddammit! Goddammit! Hey, gorgeous! Hey, gorgeous!"
"Stop the bus! Stop the bus! Stop the bus! Stop the bus!"
"aaaaaAAAAAAAAAaaaaaaaaaaaaRRRRRRRGH!"
"Hey! Hey! HeyheyHeyhey HEY!!"
So I had this thought the other day as I was sitting at the desk, listening to the cacophony for the twenty-sixth hour in a row:
Why not start up a punk band?
I mean, I have the hair. In civvies, I have the clothes. Add some good fuzzy guitar and a cranked-out drummer, and mix in "Hey gorgeous! Goddammit! Stop the bus! HEY!! AAAaaaaaAAAARGH!"
We could call it Nurse Jo and the Screaming Feebs.
Required reading for your weekend
Weekend Roundup at Feministe has good stuff.
So does Babs.
For some bizarre reason, May and That Flat-Tailed Guy With The Beak And Poison Spurs both had bizarre patients recently. So did I, but I ain't bloggin' about him.
Go read.
So does Babs.
For some bizarre reason, May and That Flat-Tailed Guy With The Beak And Poison Spurs both had bizarre patients recently. So did I, but I ain't bloggin' about him.
Go read.
Thursday, October 20, 2005
Observations
On Working In a Communicable-Disease Cesspit:
If there is a tummy bug going around work, even if it's confined to the basement and only hits the guys who do landscaping, I will get it.
Any tummy bug I get will have the following symptoms: constant, low-grade nausea, exhaustion, and cold sweats. Anything more than that is unusual.
Any time I get a tummy bug, some wag opines that I *must* be pregnant. The Dedicated Wag Lime Pit in the back yard is getting full.
On Extremities:
This week I took care of a dancer and a professional chef. Chef Boy is also, if you hadn't noticed, a chef. I noticed something that the two lines of work have in common: extremities.
A dancer's feet--especially ballet dancers, which this person was--look like nothing human. They're callused and scarred and lumpy and there are bits missing from them.
Same with chefs' hands. If you work with fire, knives, and corpses all day, your hands begin to look like something Rodin might've sculpted in the grip of a really bad hangover. Chef Boy has been a construction worker as well as a chef, so you can imagine the state of his paws.
On New Cars:
I've been having dreams in which I scar the New Car irreversibly somehow, or the upholstery is torn beyond repair, or the damned thing suddenly changes color to distress orange.
I also worry constantly that I'm going to do something stupid, like reach for a button on the stereo, and hit a button that either sets off a panic alarm or the ejector seat or the thing that spits tacks out of the exhaust pipe.
And yet I haven't read the owner's manual. If finding out that I can unroll the windows remotely (who thought that up?) by mistake is fun, imagine how much fun I'll have trying to figure out cruise control on the fly!
Edited to add one thing of which Shrimplate's latest post reminded me:
Today I was standing in line at the cafeteria to get some nice dry toast and tea, and I heard two anesthesiologist attendings singing Ramones songs.
I chimed in at "I wanna be sedated" and got shocked looks. One doc then smiled and said, "We didn't think anybody else here would know the Ramones."
Pretty soon half the breakfast line was singing along with "Beat On The Brat."
Welcome to my hospital, home of the weird and famous.
If there is a tummy bug going around work, even if it's confined to the basement and only hits the guys who do landscaping, I will get it.
Any tummy bug I get will have the following symptoms: constant, low-grade nausea, exhaustion, and cold sweats. Anything more than that is unusual.
Any time I get a tummy bug, some wag opines that I *must* be pregnant. The Dedicated Wag Lime Pit in the back yard is getting full.
On Extremities:
This week I took care of a dancer and a professional chef. Chef Boy is also, if you hadn't noticed, a chef. I noticed something that the two lines of work have in common: extremities.
A dancer's feet--especially ballet dancers, which this person was--look like nothing human. They're callused and scarred and lumpy and there are bits missing from them.
Same with chefs' hands. If you work with fire, knives, and corpses all day, your hands begin to look like something Rodin might've sculpted in the grip of a really bad hangover. Chef Boy has been a construction worker as well as a chef, so you can imagine the state of his paws.
On New Cars:
I've been having dreams in which I scar the New Car irreversibly somehow, or the upholstery is torn beyond repair, or the damned thing suddenly changes color to distress orange.
I also worry constantly that I'm going to do something stupid, like reach for a button on the stereo, and hit a button that either sets off a panic alarm or the ejector seat or the thing that spits tacks out of the exhaust pipe.
And yet I haven't read the owner's manual. If finding out that I can unroll the windows remotely (who thought that up?) by mistake is fun, imagine how much fun I'll have trying to figure out cruise control on the fly!
Edited to add one thing of which Shrimplate's latest post reminded me:
Today I was standing in line at the cafeteria to get some nice dry toast and tea, and I heard two anesthesiologist attendings singing Ramones songs.
I chimed in at "I wanna be sedated" and got shocked looks. One doc then smiled and said, "We didn't think anybody else here would know the Ramones."
Pretty soon half the breakfast line was singing along with "Beat On The Brat."
Welcome to my hospital, home of the weird and famous.
Whose conscience?
Target is in the middle of a brouhaha because a pharmacist at their Fenton, Missouri store refused to fill a prescription for emergency contraception for a customer.
Target's form letter in response to complaints reads, in part, that Target is committed to respecting the diversity of their workforce (I'm paraphrasing, here), and that thus, Target will refer a customer who wants something Target doesn't carry (or in this case, won't prescribe) to another vendor.
This goes back to the issue of conscience clauses for pharmacists. Nurses and doctors have conscience clauses (also known in some places as "safe harbor laws") that allow them not to take part in procedures or practices that don't jive with their belief systems. A number of pharmacist groups, including Pharmacists For Life, the American Pharmacists' Association, and even the AMA, support this sort of clause for pharmacists.
The trouble arises in cases when pharmacists confiscate prescriptions rather than referring customers to other pharmacies (this happened in my very own home town, to a rape victim) or when they use their position to intimidate or shame women looking for EC. (This has also happened in my very own home town, to the extent that one doctor I worked for refused to send her patients to a particular pharmacy for *anything*.)
There's also a second scenario in which a refusal could be troublesome: if you live in a small town, or even a small-ish town, with three or four pharmacies, what if *nobody* will fill your EC prescription? Even barring that complication, driving from one pharmacy to another takes time, and EC is time sensitive. Never mind that if you've just gotten out of the ER after a rape exam, you're probably not in the state of mind to comparison-shop the various pharmacies in a thirty-mile radius of home.
To top it off, there's this: A woman makes the decision, with the help of her doctor or NP, to get emergency contraception; the pharmacist's refusal to fill that prescription feels to me like interfering in that personal decision. It's as though I were to stand in the door of the OR and prevent a patient from getting a VP shunt because I didn't agree with the process.
I can understand why pharmacists want conscience clauses. Thankfully, I've not yet been in a situation where I've had to call foul myself--partly because I've made a conscious decision *not* to work in a field where the standard medical care incorporates a number of things with which I do not agree.*
The other side of me (okay, the other 90% of me), though, is really, really pissed off that pharmacists would refuse EC, or even the Pill, to customers. I've not yet heard stories of a pharmacist refusing Viagra (the classic counter-argument) or pain medications, or indeed of a pharmacist refusing *any* prescription that doesn't directly have to do with women's control of their own sexuality.
And that, I believe, is the root of the argument. These are folks who want to *not* dispense certain drugs to women. That the drugs have a lot to do with sex, and a lot to do with avoiding pregnancy, feeds into the feeling I have that this is primarily about power rather than about harm to a fetus, embryo, or blastocyst. Show me a pharmacist that won't dispense class C drugs to a woman of childbearing age and I might begin to change my mind...but until then I retain the right to remain conflicted and irritated.
*For the record, that field is labor and delivery/newborn care. I hate the idea of circumcision, and I hated having to assist in one. I'm also not crazy about the intrusive monitoring and "lie-down-shut-up" attitudes I saw in L&D units when I was in school. Being a hippie-dippy wacko who's been at, assisted in, and hung out during home births prior to getting schooled probably has a whole lot to do with that. Point remains, though, that the reason I didn't go into L&D is this: I cannot work in a place where women in uncomplicated, healthy labor are considered to have a medical problem rather than people experiencing something normal.
Target's form letter in response to complaints reads, in part, that Target is committed to respecting the diversity of their workforce (I'm paraphrasing, here), and that thus, Target will refer a customer who wants something Target doesn't carry (or in this case, won't prescribe) to another vendor.
This goes back to the issue of conscience clauses for pharmacists. Nurses and doctors have conscience clauses (also known in some places as "safe harbor laws") that allow them not to take part in procedures or practices that don't jive with their belief systems. A number of pharmacist groups, including Pharmacists For Life, the American Pharmacists' Association, and even the AMA, support this sort of clause for pharmacists.
The trouble arises in cases when pharmacists confiscate prescriptions rather than referring customers to other pharmacies (this happened in my very own home town, to a rape victim) or when they use their position to intimidate or shame women looking for EC. (This has also happened in my very own home town, to the extent that one doctor I worked for refused to send her patients to a particular pharmacy for *anything*.)
There's also a second scenario in which a refusal could be troublesome: if you live in a small town, or even a small-ish town, with three or four pharmacies, what if *nobody* will fill your EC prescription? Even barring that complication, driving from one pharmacy to another takes time, and EC is time sensitive. Never mind that if you've just gotten out of the ER after a rape exam, you're probably not in the state of mind to comparison-shop the various pharmacies in a thirty-mile radius of home.
To top it off, there's this: A woman makes the decision, with the help of her doctor or NP, to get emergency contraception; the pharmacist's refusal to fill that prescription feels to me like interfering in that personal decision. It's as though I were to stand in the door of the OR and prevent a patient from getting a VP shunt because I didn't agree with the process.
I can understand why pharmacists want conscience clauses. Thankfully, I've not yet been in a situation where I've had to call foul myself--partly because I've made a conscious decision *not* to work in a field where the standard medical care incorporates a number of things with which I do not agree.*
The other side of me (okay, the other 90% of me), though, is really, really pissed off that pharmacists would refuse EC, or even the Pill, to customers. I've not yet heard stories of a pharmacist refusing Viagra (the classic counter-argument) or pain medications, or indeed of a pharmacist refusing *any* prescription that doesn't directly have to do with women's control of their own sexuality.
And that, I believe, is the root of the argument. These are folks who want to *not* dispense certain drugs to women. That the drugs have a lot to do with sex, and a lot to do with avoiding pregnancy, feeds into the feeling I have that this is primarily about power rather than about harm to a fetus, embryo, or blastocyst. Show me a pharmacist that won't dispense class C drugs to a woman of childbearing age and I might begin to change my mind...but until then I retain the right to remain conflicted and irritated.
*For the record, that field is labor and delivery/newborn care. I hate the idea of circumcision, and I hated having to assist in one. I'm also not crazy about the intrusive monitoring and "lie-down-shut-up" attitudes I saw in L&D units when I was in school. Being a hippie-dippy wacko who's been at, assisted in, and hung out during home births prior to getting schooled probably has a whole lot to do with that. Point remains, though, that the reason I didn't go into L&D is this: I cannot work in a place where women in uncomplicated, healthy labor are considered to have a medical problem rather than people experiencing something normal.
Tuesday, October 18, 2005
You must read this.
The Lioness, a person who is not only a genius writer but also is nice enough to occasionally read this blog, wrote a lovely piece...
It's called The Jewish Gastronomic Factor, but could as well be called The Methodist Gastronomic Factor (thanks, Mom!) or The Italian Gastronomic Factor (thanks, Lidia!) or the Pakistani Gastronomic Factor (thanks, Hakima!).
It's for anyone who's ever felt the pressure to eat, eat, you look so skinny, no matter the source.
Twisty Faster just had a boob removed because of cancer. This is what cancer looks like, people. Go see the picture, shudder and cringe, and then read what she has to say about her experience. What bugs me is that the folks at the hospital served her nasty cold pancakes and fatty bacon the day after. Twisty, if I were closer, I'd bring you Gournay cheese and French bread and pounds of grapes.
Feministe has an excellent discussion of what makes beauty.
Michael Yon is back in Baghdad. Read his blog.
And for those of you who have money burning holes in your pockets, check this out.
It's called The Jewish Gastronomic Factor, but could as well be called The Methodist Gastronomic Factor (thanks, Mom!) or The Italian Gastronomic Factor (thanks, Lidia!) or the Pakistani Gastronomic Factor (thanks, Hakima!).
It's for anyone who's ever felt the pressure to eat, eat, you look so skinny, no matter the source.
Twisty Faster just had a boob removed because of cancer. This is what cancer looks like, people. Go see the picture, shudder and cringe, and then read what she has to say about her experience. What bugs me is that the folks at the hospital served her nasty cold pancakes and fatty bacon the day after. Twisty, if I were closer, I'd bring you Gournay cheese and French bread and pounds of grapes.
Feministe has an excellent discussion of what makes beauty.
Michael Yon is back in Baghdad. Read his blog.
And for those of you who have money burning holes in your pockets, check this out.
What I did on my days off (includes obligatory food rambling)
!!!DRAMA DOG!!!
So yesterday Bonnie the Miniature Dachshund had her teeth cleaned. She had a bad case of garbage-mouth, so it was way, way, way overdue. Chef Boy dropped her off at the vet's; I picked her up.
When the tech handed her to me, she gave a wail the equal of that produced by the Mystery! opening's Fainting Woman and threw herself on my chest, nose buried in my shoulder. She then went through several minutes of whining and shaking, alternated with gazing into my eyes as if to tell me of the Horrible Tortures she suffered.
Never mind that she spent the whole day in a comfy kennel with little tidbits pushed through the bars by the staff, when they weren't cuddling her and telling her what a sweet girl she is. There was apparently some discussion in the middle of the day over whose lap she would sit on during lunch.
I thought my cat was a drama queen.
No Hair Here
The clippers came out today. I'm now the proud wearer of an inch-long buzz. Note: one inch is much shorter than you might think.
You'd think I'd get *less* attention from men when I have almost no hair, but that isn't the case. At least, it's not the case with the hippie boys down at the natural food store and the punk daddies with kids in strollers. The old men at work love it when I have my curly pompadour, but the younger guys like the middle-aged chick rockin' the grrrl cut. It also keeps the frat boys from yelling out their windows as they drive past.
Plus, I bought a new eyeshadow.
And some new boots.
The boots have a two-and-a-half-inch stiletto heel and toothpicker toes. They're smooth Italian leather. I got 'em on deep, deep discount because I have huge feet. With size 9's, you can wear up to a ten if the toes of the shoes are very pointed indeed. Apparently, few women with large feet buy I Eat Men Like You For Breakfast boots.
And Food, too!
Tonight's dinner will be salmon, asparagus (roasted) and smashed potatoes. I had some cream and half-and-half I had to use up, so I experimented a little and came up with an eggless pseudo-Alfredo.
The pseudo-Alfredo sauce went on the other chunk of salmon I bought after I cut it up and sauteed it with mushrooms and steamed some broccoli. With nice chunky pasta, it will make two lunches.
Plus, I have a pleasant dry white wine (if the guy at the store can be trusted) to go with dinner tonight.
I should be studying EKG tracings. Did I mention that?
So yesterday Bonnie the Miniature Dachshund had her teeth cleaned. She had a bad case of garbage-mouth, so it was way, way, way overdue. Chef Boy dropped her off at the vet's; I picked her up.
When the tech handed her to me, she gave a wail the equal of that produced by the Mystery! opening's Fainting Woman and threw herself on my chest, nose buried in my shoulder. She then went through several minutes of whining and shaking, alternated with gazing into my eyes as if to tell me of the Horrible Tortures she suffered.
Never mind that she spent the whole day in a comfy kennel with little tidbits pushed through the bars by the staff, when they weren't cuddling her and telling her what a sweet girl she is. There was apparently some discussion in the middle of the day over whose lap she would sit on during lunch.
I thought my cat was a drama queen.
No Hair Here
The clippers came out today. I'm now the proud wearer of an inch-long buzz. Note: one inch is much shorter than you might think.
You'd think I'd get *less* attention from men when I have almost no hair, but that isn't the case. At least, it's not the case with the hippie boys down at the natural food store and the punk daddies with kids in strollers. The old men at work love it when I have my curly pompadour, but the younger guys like the middle-aged chick rockin' the grrrl cut. It also keeps the frat boys from yelling out their windows as they drive past.
Plus, I bought a new eyeshadow.
And some new boots.
The boots have a two-and-a-half-inch stiletto heel and toothpicker toes. They're smooth Italian leather. I got 'em on deep, deep discount because I have huge feet. With size 9's, you can wear up to a ten if the toes of the shoes are very pointed indeed. Apparently, few women with large feet buy I Eat Men Like You For Breakfast boots.
And Food, too!
Tonight's dinner will be salmon, asparagus (roasted) and smashed potatoes. I had some cream and half-and-half I had to use up, so I experimented a little and came up with an eggless pseudo-Alfredo.
The pseudo-Alfredo sauce went on the other chunk of salmon I bought after I cut it up and sauteed it with mushrooms and steamed some broccoli. With nice chunky pasta, it will make two lunches.
Plus, I have a pleasant dry white wine (if the guy at the store can be trusted) to go with dinner tonight.
I should be studying EKG tracings. Did I mention that?
Monday, October 17, 2005
How I know I'm not in Hell.
Another nursing student story
So Friday was the first day for some new nursing students--these are not fourth-semester, they're brand-new, first-semester clinical students. From the same program that spawned Weepy, Frizzy, Dopey, and Sleepy, but much, much higher caliber.
The student I was paired with came prepared, knew how to take vitals, and did a complex dressing change by herself (well, with me watching) with minimal coaching.
I asked her if she'd had any experience with wound care before, and she said "No, I just watched while you took down the old dressing, then I went and got what I needed and put it back in reverse order." Considering that most first-semester students (myself included) are so nervous they just want to sink through the floor, this was encouraging.
About twenty minutes before they were due to leave, I gave my student and another student a time-check, to let them know to start wrapping things up in ten minutes or so.
They did two baths in that twenty minutes and finished with time to spare.
We all have a renewed faith in humanity now.
And, by God, with four patients with cerebral perfusion issues on the floor at once, we certainly need it.
Perfusion problems are characterized by wacky behavior. If the person can scream, they'll scream. If they can cuss, they'll cuss. I'd never once given Haldol in three years; on Saturday, I gave three injections of the stuff. The floor sounded like Broadmoor on a Sunday afternoon.
That alone is a good argument for watching your blood sugar and cholesterol, not drinking Beam every single damn night of your life, and having your medical problems treated early and comprehensively. I've come to the conclusion that if you're really dedicated to being a hard-liquor drunk, you should probably just apply the alcohol directly to your brain, thus saving the rest of us a lot of time and trouble.
I worked with a good crew this weekend. Only one of seven people on the floor was the sort of person you really have to watch; other nurses will tell you that that's a good ratio. And it was that good-crew-ness that kept all of us from back injuries and major depressive disorder. Thirty-six hours of four screamers will undo the most sanguine soul.
Now I have two days off. I suppose I should go do an hour or so of exercise, but I think instead that I'm going to putter around the apartment and make a grocery list. Stuffing earplugs into my ears and crawling back into bed sounds good too.
So Friday was the first day for some new nursing students--these are not fourth-semester, they're brand-new, first-semester clinical students. From the same program that spawned Weepy, Frizzy, Dopey, and Sleepy, but much, much higher caliber.
The student I was paired with came prepared, knew how to take vitals, and did a complex dressing change by herself (well, with me watching) with minimal coaching.
I asked her if she'd had any experience with wound care before, and she said "No, I just watched while you took down the old dressing, then I went and got what I needed and put it back in reverse order." Considering that most first-semester students (myself included) are so nervous they just want to sink through the floor, this was encouraging.
About twenty minutes before they were due to leave, I gave my student and another student a time-check, to let them know to start wrapping things up in ten minutes or so.
They did two baths in that twenty minutes and finished with time to spare.
We all have a renewed faith in humanity now.
And, by God, with four patients with cerebral perfusion issues on the floor at once, we certainly need it.
Perfusion problems are characterized by wacky behavior. If the person can scream, they'll scream. If they can cuss, they'll cuss. I'd never once given Haldol in three years; on Saturday, I gave three injections of the stuff. The floor sounded like Broadmoor on a Sunday afternoon.
That alone is a good argument for watching your blood sugar and cholesterol, not drinking Beam every single damn night of your life, and having your medical problems treated early and comprehensively. I've come to the conclusion that if you're really dedicated to being a hard-liquor drunk, you should probably just apply the alcohol directly to your brain, thus saving the rest of us a lot of time and trouble.
I worked with a good crew this weekend. Only one of seven people on the floor was the sort of person you really have to watch; other nurses will tell you that that's a good ratio. And it was that good-crew-ness that kept all of us from back injuries and major depressive disorder. Thirty-six hours of four screamers will undo the most sanguine soul.
Now I have two days off. I suppose I should go do an hour or so of exercise, but I think instead that I'm going to putter around the apartment and make a grocery list. Stuffing earplugs into my ears and crawling back into bed sounds good too.
Friday, October 14, 2005
I'll have to have a word with Dad, I think...
The first time I invite Mom openly to post, and I get my first troll. Coincidence? I think not! Time for a talk with the 'rents about Mom's meds.
So, in interest of feeding the trolls...
I think you have a bad attitude towards nursing students in general from the way you describe things...I remember all too well what it was like to be in their shoes and remember certain nurses treating some fellow nursing students like they were the gum on their shoes but they didn't mind having the students act as nursing assistants and not bother showing them actual procedures that would give them the hands on training they would benefit from when actually out there as a nurse when the time came. I am a nurse as well and look back on my clinical time as not much of a learning experience but more like free maid service....
If you'd read carefully, you'd've noticed that the only nursing students I had a problem with were those in this particular group. It's not that they're gum on my shoes, but that they're not safe and not prepared to work independently, which is what is expected from fourth-year students. Gum on my shoes would, actually, be a whole less scary. (Fun story about this to come later in the week, I promise.)
If you yourself look back on your clinicals as free maid service rather than a learning experience, then I have to wonder what sort of student you were. The only students whom I tag repeatedly with scutwork are the ones who've shown repeatedly that they can't take care of patients safely and well.
re: carnies) Interesting, you teach your child to look down on a whole group of people you know so little about. That's usually called racism, isn't it?
That's usually called a fallacious, straw-man argument.
Saying "carnies are like mummers" is what's called a "sweeping generalization". "Racism" is like this: "Blacks got all the rhythm and Jews got all the power." (Or, to more-finely-point it, it's "racism" for the first clause and "anti-Semitism" for the second.)
Saying "Anonymous trolls who can neither be trusted to read carefully nor to write their way out of a brown paper bag are a pain in the patookus" is what's known as "A stunning burst of insight and perception."
Just thought I'd clear that up for you.
So, in interest of feeding the trolls...
I think you have a bad attitude towards nursing students in general from the way you describe things...I remember all too well what it was like to be in their shoes and remember certain nurses treating some fellow nursing students like they were the gum on their shoes but they didn't mind having the students act as nursing assistants and not bother showing them actual procedures that would give them the hands on training they would benefit from when actually out there as a nurse when the time came. I am a nurse as well and look back on my clinical time as not much of a learning experience but more like free maid service....
If you'd read carefully, you'd've noticed that the only nursing students I had a problem with were those in this particular group. It's not that they're gum on my shoes, but that they're not safe and not prepared to work independently, which is what is expected from fourth-year students. Gum on my shoes would, actually, be a whole less scary. (Fun story about this to come later in the week, I promise.)
If you yourself look back on your clinicals as free maid service rather than a learning experience, then I have to wonder what sort of student you were. The only students whom I tag repeatedly with scutwork are the ones who've shown repeatedly that they can't take care of patients safely and well.
re: carnies) Interesting, you teach your child to look down on a whole group of people you know so little about. That's usually called racism, isn't it?
That's usually called a fallacious, straw-man argument.
Saying "carnies are like mummers" is what's called a "sweeping generalization". "Racism" is like this: "Blacks got all the rhythm and Jews got all the power." (Or, to more-finely-point it, it's "racism" for the first clause and "anti-Semitism" for the second.)
Saying "Anonymous trolls who can neither be trusted to read carefully nor to write their way out of a brown paper bag are a pain in the patookus" is what's known as "A stunning burst of insight and perception."
Just thought I'd clear that up for you.
Thursday, October 13, 2005
My mother reads this blog.
Not only does she read it, but she sends me charming emails now and then, telling me how much she liked a certain entry. She said once that she didn't want to comment, for fear that my coolth factor would be lowered by her leaving messages.
Mom, it's okay. I have no coolth. Comment away if you'd like to.
In other news, the New Car saved Chef Boy and me from dying horribly yesterday. No, there was no wreck; we were on our way from Smalltown to Bigtown for the county fair and I suddenly found myself forced to merge over to the right three lanes and exit. Thanks to 144 hp at redline in fourth gear (about eighty-five miles an hour), we made it unscathed. If we'd been in my old car or Chef Boy's car, we would've been in Atlanta by now, stuck under a double-tandem eighteen-wheeler.
County fairs are always fun. There's a plethora of Food on a Stick and critters like Cashmere goats who want to nibble your fingers and pigs that make pleasant grunting sounds when you scratch their ears. We had all three, combined with enough cheap beer to make us crave Mexican food afterwards, and enough sunshine that I got vaguely pink and extremely headachy once we got home. The skin on my hands was tenting, but several gallons of water, a whole lot of salty food, and some potassium took care of that.
It's a shame pigs are so damned tasty. There was one half-grown red one who smiled at me and pushed his schnozz up under my hand, begging like a dog for scratches.
Speaking of dogs, the rescue folks had their usual array of adorable canines out for display. One half-Husky, half-shepherd male put his paw on my hand, stared up at The Boy with melting brown eyes, and whined softly at both of us. We nearly ended up with two rescued Dachshunds (already at home), a big halfbreed named Hans, two Cashmere goats, and a pig. It's probably a good thing that Boy is more hard-hearted than I am; I'm not sure all that livestock would have been good for the back seat of the car.
But even so, the mammals are better than the chickens. No matter how fancy a chicken is, it still has that weird crazy look that makes you think it might decide to try to kill you in your sleep. Plus, I think they can move their eyes independently, like seahorses can, but only when they're sure you're not looking.
And the chickens, mean as they are, are better than the carnies. After three or four glasses of Bud, I began a dissertation to The Boy about how the lifestyle the carnies lead is very much like that of the travelling mummer in Elizabethan England, and how the Giant Live Boa Constrictor trailers are a lot like travelling patent-medicine shows. He was unimpressed, pointing out that Elizabethan mummers probably had both more teeth and fewer tattoos than the carnies and small county fairs. He passed over the snake/snake oil comparison.
I could use some more pico de gallo and another pound or so of cheese enchiladas with guacamole. Meanwhile, I'm going to take a nap. Recovering from the fair is going to take the rest of the day.
Mom, it's okay. I have no coolth. Comment away if you'd like to.
In other news, the New Car saved Chef Boy and me from dying horribly yesterday. No, there was no wreck; we were on our way from Smalltown to Bigtown for the county fair and I suddenly found myself forced to merge over to the right three lanes and exit. Thanks to 144 hp at redline in fourth gear (about eighty-five miles an hour), we made it unscathed. If we'd been in my old car or Chef Boy's car, we would've been in Atlanta by now, stuck under a double-tandem eighteen-wheeler.
County fairs are always fun. There's a plethora of Food on a Stick and critters like Cashmere goats who want to nibble your fingers and pigs that make pleasant grunting sounds when you scratch their ears. We had all three, combined with enough cheap beer to make us crave Mexican food afterwards, and enough sunshine that I got vaguely pink and extremely headachy once we got home. The skin on my hands was tenting, but several gallons of water, a whole lot of salty food, and some potassium took care of that.
It's a shame pigs are so damned tasty. There was one half-grown red one who smiled at me and pushed his schnozz up under my hand, begging like a dog for scratches.
Speaking of dogs, the rescue folks had their usual array of adorable canines out for display. One half-Husky, half-shepherd male put his paw on my hand, stared up at The Boy with melting brown eyes, and whined softly at both of us. We nearly ended up with two rescued Dachshunds (already at home), a big halfbreed named Hans, two Cashmere goats, and a pig. It's probably a good thing that Boy is more hard-hearted than I am; I'm not sure all that livestock would have been good for the back seat of the car.
But even so, the mammals are better than the chickens. No matter how fancy a chicken is, it still has that weird crazy look that makes you think it might decide to try to kill you in your sleep. Plus, I think they can move their eyes independently, like seahorses can, but only when they're sure you're not looking.
And the chickens, mean as they are, are better than the carnies. After three or four glasses of Bud, I began a dissertation to The Boy about how the lifestyle the carnies lead is very much like that of the travelling mummer in Elizabethan England, and how the Giant Live Boa Constrictor trailers are a lot like travelling patent-medicine shows. He was unimpressed, pointing out that Elizabethan mummers probably had both more teeth and fewer tattoos than the carnies and small county fairs. He passed over the snake/snake oil comparison.
I could use some more pico de gallo and another pound or so of cheese enchiladas with guacamole. Meanwhile, I'm going to take a nap. Recovering from the fair is going to take the rest of the day.
Wednesday, October 12, 2005
Well. Well, then.
This is going to be a bad day for somebody.
You remember Weepy, right? The student nurse who didn't know where the lumbar area is? The one who asked me to "refresh" her memory when it came to taking a blood pressure?
Well, I fired her yesterday. Her and all the other student nurses in her group.
More than that, I filled out an evaluation form for her, and I was not nice. It's not just that she lacks basic A & P knowledge, or that she's a little rusty on some skills: she argues, doesn't do what she's told, and doesn't do her research. She doesn't come prepared. (And I'm not meaning to sound like a despot; there are some times when you simply should not argue and you really ought to jump when somebody yells "jump". There are times when there's not time to ask why.)
I finally went to the Idiot Instructor myself after seeing what some of the other students in the group were up to and told her, essentially, "they're fired." This after a patient one of the students was caring for vagaled out and fell over, and the student a) never showed up in the room after being called and b) didn't check up on her patient later.
And this was the student who is already an LPN. Not a very good one, I'd bet.
I'll admit that I'm pretty demanding when it comes to teaching. If a patient has one pupil that's blown to ten millimeters and another that's reactive and four millimeters, I expect you to notice that during your assessment. I really do expect you, despite whatever fairy tales you might've heard, to do some research on neurosyphillis and know what it does to a person. And if somebody's getting a nasty chemotherapy drug for dermatomyositis, I expect that you will know enough about that nasty drug not to want to handle it with ungloved hands. Especially if you're of reproductive age.
But I really, really did try to cut Weepy some slack. I gave her mad props when she did something right, and I put down on her evaluation form that she's got excellent interpersonal skills. She does. I understand that the finer points of assessment, like interpreting what the hell that breath sound is, will come with practice. And I know what it's like to do stupid things like reaching into a trash can with an ungloved hand, because I've done that myself, so I didn't count some of that against her.
Still, I had to fire 'em. I told our education director "This is it; I ain't takin' no more o' them students" because I'm not safe when one of them is around. I have to literally follow whatever student I have every minute of the day, which leaves my other patients vulnerable and un-looked-in-on.
I spent last evening feeling like I'd kicked a dog. A small, yappy, not very bright and not very likeable dog, but a dog nonetheless. With this poor of an evaluation, Weepy will not graduate. She's spent the last four years getting a BSN, and she will not, now, at the midterm of her last semester, get to see it through. It's not like I have Phenomenal Cosmic Powers when it comes to making or breaking students, but the instructor really can't ignore a two-page written evaluation in my crabbed and tiny handwriting.
Still, she's not safe. That's the bottom line. She simply does not have the basic knowledge or the chops to keep up, even in a small community hospital. I think she's trainable, but it would mean starting from square one. That is not my job.
The instructor--and this is the weirdest part of all--was venting to me about how eight of her ten students are, in her words, incompetent. She couldn't understand why she'd been saddled with a cruddy group, and was sure that somebody somewhere must hate her.
It took me until after dinner last night to realize that the reason I felt weird was that the instructor was treating me *as a peer*, not as a recently-graduated student or a still-attending student. Like I'm actually a nurse, you know?
I guess I am. And I guess part of that whole others'-lives-in-your-hands thing is having the absolutely shitty job of saying "I'm sorry, but you're just not good enough" once in a while, if it means saving other people from something worse.
You remember Weepy, right? The student nurse who didn't know where the lumbar area is? The one who asked me to "refresh" her memory when it came to taking a blood pressure?
Well, I fired her yesterday. Her and all the other student nurses in her group.
More than that, I filled out an evaluation form for her, and I was not nice. It's not just that she lacks basic A & P knowledge, or that she's a little rusty on some skills: she argues, doesn't do what she's told, and doesn't do her research. She doesn't come prepared. (And I'm not meaning to sound like a despot; there are some times when you simply should not argue and you really ought to jump when somebody yells "jump". There are times when there's not time to ask why.)
I finally went to the Idiot Instructor myself after seeing what some of the other students in the group were up to and told her, essentially, "they're fired." This after a patient one of the students was caring for vagaled out and fell over, and the student a) never showed up in the room after being called and b) didn't check up on her patient later.
And this was the student who is already an LPN. Not a very good one, I'd bet.
I'll admit that I'm pretty demanding when it comes to teaching. If a patient has one pupil that's blown to ten millimeters and another that's reactive and four millimeters, I expect you to notice that during your assessment. I really do expect you, despite whatever fairy tales you might've heard, to do some research on neurosyphillis and know what it does to a person. And if somebody's getting a nasty chemotherapy drug for dermatomyositis, I expect that you will know enough about that nasty drug not to want to handle it with ungloved hands. Especially if you're of reproductive age.
But I really, really did try to cut Weepy some slack. I gave her mad props when she did something right, and I put down on her evaluation form that she's got excellent interpersonal skills. She does. I understand that the finer points of assessment, like interpreting what the hell that breath sound is, will come with practice. And I know what it's like to do stupid things like reaching into a trash can with an ungloved hand, because I've done that myself, so I didn't count some of that against her.
Still, I had to fire 'em. I told our education director "This is it; I ain't takin' no more o' them students" because I'm not safe when one of them is around. I have to literally follow whatever student I have every minute of the day, which leaves my other patients vulnerable and un-looked-in-on.
I spent last evening feeling like I'd kicked a dog. A small, yappy, not very bright and not very likeable dog, but a dog nonetheless. With this poor of an evaluation, Weepy will not graduate. She's spent the last four years getting a BSN, and she will not, now, at the midterm of her last semester, get to see it through. It's not like I have Phenomenal Cosmic Powers when it comes to making or breaking students, but the instructor really can't ignore a two-page written evaluation in my crabbed and tiny handwriting.
Still, she's not safe. That's the bottom line. She simply does not have the basic knowledge or the chops to keep up, even in a small community hospital. I think she's trainable, but it would mean starting from square one. That is not my job.
The instructor--and this is the weirdest part of all--was venting to me about how eight of her ten students are, in her words, incompetent. She couldn't understand why she'd been saddled with a cruddy group, and was sure that somebody somewhere must hate her.
It took me until after dinner last night to realize that the reason I felt weird was that the instructor was treating me *as a peer*, not as a recently-graduated student or a still-attending student. Like I'm actually a nurse, you know?
I guess I am. And I guess part of that whole others'-lives-in-your-hands thing is having the absolutely shitty job of saying "I'm sorry, but you're just not good enough" once in a while, if it means saving other people from something worse.
Saturday, October 08, 2005
The book is done.
Thank Frog.
And thank Frog I have about five years to wait until the *next* Gabaldon book, because it'll take me that long to recover. These are not books that you casually put down and then pick back up again.
In student news...
The four students, Weepy, Dopey, Sleepy, and Frizzy, were back with us this week. I steadfastly refused to take any of them, on the premise that none of my patients were very interesting (which was true). I was triply glad I'd done so when Weepy asked me to remind her how to take a blood pressure.
Apparently the Big Discussion with the Idiot Instructor didn't make much of a dent in anybody's skull. Sleepy, Dopey, and Frizzy were still sitting, yakking, and not reading H&Ps well into the afternoon on the day after said meeting.
Only six more weeks. Only six more weeks. As it turns out, *every* unit is having problems with this batch of students--a total of ten. Some units are getting patient complaints about them, even...which makes me wonder why on earth they're allowed to stay.
I Am Ashamed, or What I Cook For Other People On My Day Off
This coming week there'll be a big potluck at work. I work with a number of people who are, shall we say, less than open-minded about their food. I suppose I could treat the folks who like things like spinach enchiladas or hummus or fried rice to some special delicacy, but then I'd have to hear the rest of 'em bitch for hours on end about how I brought some weird hippy dish. These are people who pick the non-iceberg lettuce out of salads, you understand.
So I made something Mom used to be forced to make for church dinners. It's called "Mock Lasagne" and is proof that Methodists can and will casserole anything.
Take a half a pound of pasta and boil it. Fry up a chub of Italian sausage. Drain both. Mix 'em together. Add some peppers and mushrooms you've sauteed, then a bottle of marinara sauce. (I use Newman's Own, just as a little snub to the food idiots.) Dump in about a half a carton of ricotta (the original recipe calls for small-curd cottage cheese, which makes me blanch) and a bag of shredded mozzarella. Stir. Dump into casserole dish, top with Parmesan, and bake.
Once you've heated it through and served it to your coworkers, go have some good stinky cheese and bread to cleanse your soul of the shame.
Ugh.
I am baking a really wonderful chocolate cake, though, with white chocolate mousse filling and bittersweet chocolate shavings on top. That ought to redeem me with the Food Gods, eh?
Oh, by the way
It's "graphite", which is a nice medium metallic grey. And it has a dark grey interior. And power windows which I can't roll down until the tint cures. And a rockin' CD stereo system. And it goes very, very fast if you want it to.
And thank Frog I have about five years to wait until the *next* Gabaldon book, because it'll take me that long to recover. These are not books that you casually put down and then pick back up again.
In student news...
The four students, Weepy, Dopey, Sleepy, and Frizzy, were back with us this week. I steadfastly refused to take any of them, on the premise that none of my patients were very interesting (which was true). I was triply glad I'd done so when Weepy asked me to remind her how to take a blood pressure.
Apparently the Big Discussion with the Idiot Instructor didn't make much of a dent in anybody's skull. Sleepy, Dopey, and Frizzy were still sitting, yakking, and not reading H&Ps well into the afternoon on the day after said meeting.
Only six more weeks. Only six more weeks. As it turns out, *every* unit is having problems with this batch of students--a total of ten. Some units are getting patient complaints about them, even...which makes me wonder why on earth they're allowed to stay.
I Am Ashamed, or What I Cook For Other People On My Day Off
This coming week there'll be a big potluck at work. I work with a number of people who are, shall we say, less than open-minded about their food. I suppose I could treat the folks who like things like spinach enchiladas or hummus or fried rice to some special delicacy, but then I'd have to hear the rest of 'em bitch for hours on end about how I brought some weird hippy dish. These are people who pick the non-iceberg lettuce out of salads, you understand.
So I made something Mom used to be forced to make for church dinners. It's called "Mock Lasagne" and is proof that Methodists can and will casserole anything.
Take a half a pound of pasta and boil it. Fry up a chub of Italian sausage. Drain both. Mix 'em together. Add some peppers and mushrooms you've sauteed, then a bottle of marinara sauce. (I use Newman's Own, just as a little snub to the food idiots.) Dump in about a half a carton of ricotta (the original recipe calls for small-curd cottage cheese, which makes me blanch) and a bag of shredded mozzarella. Stir. Dump into casserole dish, top with Parmesan, and bake.
Once you've heated it through and served it to your coworkers, go have some good stinky cheese and bread to cleanse your soul of the shame.
Ugh.
I am baking a really wonderful chocolate cake, though, with white chocolate mousse filling and bittersweet chocolate shavings on top. That ought to redeem me with the Food Gods, eh?
Oh, by the way
It's "graphite", which is a nice medium metallic grey. And it has a dark grey interior. And power windows which I can't roll down until the tint cures. And a rockin' CD stereo system. And it goes very, very fast if you want it to.
Tuesday, October 04, 2005
I'll see you in a few days, friends.
Damned Diana Gabaldon.
What is there not to love, really, about a book focusing on a World War II nurse who falls back in time two hundred years and becomes embroiled in the Culloden uprising? And what's not to love about the subsequent books in the series?
Well, quite a lot, actually. The first one, Outlander, is one of those cracking good adventure stories with fantastic dialogue and lovely evil bad guys. The next three books in the series get a bit dull, while simultaneously putting people in totally unbelievable situations. The fifth one's a near-complete loss (I use it as a doorstop).
But this one? This one, so far, has all the tang of the first novel.
I am not, not, not, NOT a fan of romance novels. Not at all. Hard science fiction is much more my style. But this series has been such a pleasant bowl of mental farina that I had to get the last book.
And now I'll probably be up until 0200 reading. And not blogging.
I'll let you know when I'm done.
What is there not to love, really, about a book focusing on a World War II nurse who falls back in time two hundred years and becomes embroiled in the Culloden uprising? And what's not to love about the subsequent books in the series?
Well, quite a lot, actually. The first one, Outlander, is one of those cracking good adventure stories with fantastic dialogue and lovely evil bad guys. The next three books in the series get a bit dull, while simultaneously putting people in totally unbelievable situations. The fifth one's a near-complete loss (I use it as a doorstop).
But this one? This one, so far, has all the tang of the first novel.
I am not, not, not, NOT a fan of romance novels. Not at all. Hard science fiction is much more my style. But this series has been such a pleasant bowl of mental farina that I had to get the last book.
And now I'll probably be up until 0200 reading. And not blogging.
I'll let you know when I'm done.
Monday, October 03, 2005
Duuuuuuuude.
So I've been, like, without 'Net access since, y'know, Wednesday of last week.
Duuuuuude.
The Internets finally returned to their coop last night at about six; I recognized the shape my facial expression was taking as I logged on for the first time in five days. It's the same expression that junkies get when you walk in the door with the Dilaudid.
Fortunately, I have several books by Gerrald Durrell that got me through the worst of the DTs; plus, I've been working the last few days.
The reason the 'Net went out was a huge, gigantic, impressive thunderstorm that rolled in Wednesday afternoon, dropping hail the size of quarters and the temperature by twenty degrees (Fahrenheit, for my non-US pals).
In work news, the Idiot Instructor and her Dunderheaded Ducklings will be dealt with tomorrow, and not by me, thank God.
Also, a triumph: I managed to get an IV into a nice old man's ankle yesterday. This was a triple boon, as the patient was a) elderly and very dehydrated, b) three people had tried his arms multiple times with no success, and c) the IV was an 18-gauge. (For non-medical folks, that's about the size of a small finishing brad.) It took one stick, and the best part? When Shaggy, the IV God, leaned over and said, "You got it! Boy, and it's a *hog*, too." That remark carried me through the rest of the day in a good temper.
In non-work news: Today, I signed my life away for five years. Yes, fiends and neighers, I bought a car. The elderly (1993) Civic was getting to the point that small, disturbing things were beginning to happen, so I went out and got me a spandy-new 2006 Accord coupe, five-speed, with a cloth interior and a CD player. It's not been delivered yet, and I have to drive an automatic Element in the meantime, but I'm not complaining. The guy who sold me the car is very human, quite kind, and understood when I got all choked up as I was clearing the junk out of the old car.
So that's it. I'm back. RSS feed should be up and running nearly immediately.
Duuuuuude.
The Internets finally returned to their coop last night at about six; I recognized the shape my facial expression was taking as I logged on for the first time in five days. It's the same expression that junkies get when you walk in the door with the Dilaudid.
Fortunately, I have several books by Gerrald Durrell that got me through the worst of the DTs; plus, I've been working the last few days.
The reason the 'Net went out was a huge, gigantic, impressive thunderstorm that rolled in Wednesday afternoon, dropping hail the size of quarters and the temperature by twenty degrees (Fahrenheit, for my non-US pals).
In work news, the Idiot Instructor and her Dunderheaded Ducklings will be dealt with tomorrow, and not by me, thank God.
Also, a triumph: I managed to get an IV into a nice old man's ankle yesterday. This was a triple boon, as the patient was a) elderly and very dehydrated, b) three people had tried his arms multiple times with no success, and c) the IV was an 18-gauge. (For non-medical folks, that's about the size of a small finishing brad.) It took one stick, and the best part? When Shaggy, the IV God, leaned over and said, "You got it! Boy, and it's a *hog*, too." That remark carried me through the rest of the day in a good temper.
In non-work news: Today, I signed my life away for five years. Yes, fiends and neighers, I bought a car. The elderly (1993) Civic was getting to the point that small, disturbing things were beginning to happen, so I went out and got me a spandy-new 2006 Accord coupe, five-speed, with a cloth interior and a CD player. It's not been delivered yet, and I have to drive an automatic Element in the meantime, but I'm not complaining. The guy who sold me the car is very human, quite kind, and understood when I got all choked up as I was clearing the junk out of the old car.
So that's it. I'm back. RSS feed should be up and running nearly immediately.
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