The weather went to shit night before last. In less than a day--in less than twelve hours, actually--the temperatures dropped from 82* to 22* Fahrenheit (for those of you who measure in Cee rather than Eff, that's from 28 to -6). It began to rain, then sleet, then "wintry mix", which translates no matter where you live into something that will coat your car and in which you do not want to drive.
I was prepared. I had stolen a Bill Bryson book, "The Mother Tongue: English and How It Got That Way" from the hospital library, had bought a bottle of Dalwhinnie, and had stocked the fridge with coffee and milk and eggs and bacon.
What I wasn't prepared for was this: that my sister's shipment of birthday presents would arrive this week, as would a five-box shipment containing a barrister bookshelf from my parents. I hauled the boxes from Beloved Sister up three flights of stairs, but left the crates of bookshelf bits in the apartment office. Until such time as I can enlist the help of some poor idiot to haul them up 45 vertical feet, there they'll stay. I wasn't about to carry them myself (or hump them, nod to Paeds RN) because, while they're not particularly heavy or ill-balanced, they are bulky. Three flights of steep concrete-and-metal stairs coated with ice do not mix well with bulky boxes containing glass-fronted bookshelf parts.
Beloved Sis sent many items that could be construed as scrubs or as pajama pants, depending on the offensiveness of their color combinations. I am not being insulting with that observation, by the way; the tag on one particularly strident set of scrubs read "these colors may not be a good idea." She also sent four antique medical books. I *love* ancient medical books--and these, while not particularly ancient (the oldest dates from 1914)--are stunning examples of their type.
There's one on "A girl's responsibility for race progress", one on Our Mysterious Life Glands (with disturbing pictures), one about Reading Character Through Analysis of the Features, and the crowning touch, a book (published in 1931) entitled "Studies In Ethics For Nurses." That last will, I expect, produce plenty of fodder for future blogging, provided I can get through it sober.
Anyway, dealing with that embrass de riches took most of the morning, after which I took a nice long nap. Then I got up and whipped up some spaghetti with things found in the fridge and lashings of Parmesan, and read Bryson and stuffed my face.
Provided I ever get the bookshelf bits up the stairs (that is, if the ice ever melts), "Studies In Ethics For Nurses" will look nice in the top one.
Saturday, February 18, 2006
Humpin'.
A tip for those who plan to spend a significant amount of time in the hospital, any hospital:
No matter how long you plan to stay, or how important you think you are, please do not bring your own furniture. And try to keep the amount of stuff in your room to a minimum. Three potted plants and a couple of tchochkes, fine. Twelve, not so good.
Because after I'm done hauling your console table bedside table potted plants various knickknacks bedside table chest of drawers ottoman clothing books magazines two bags full of makeup up three floors and installing them in another room, I will have a serious talk with you and your wife.
And your wife will cry. Not because I'm being mean, hard as it is to believe, but because she wanted to make your room "homey" and "comfortable" and I'm telling her that that's a no-go. Because, see, when the room is full of stuff of varying sizes, purposes, and fragilities, it's very difficult to see how I'll get a code cart into your room if, Frog forbid, I should ever need to.
And, you know, no matter how long you're staying here, please remember that it's a hospital, not a studio apartment. When three-quarters of the stuff I've humped on the elevator is your wife's, there's a problem.
Nobody, and I mean nobody, needs to be keeping a three-quarter length fur coat with fox trim in the closet in their hospital room. Really.
Aside from that forty-five minute period when I was wondering what, exactly, the facility was paying me for as I moved furniture, this was a good week. A busy week, true, with every floor full to the gills and overflow all over the post-anesthesia care unit, but a good week. Nobody coded, the person who *did* seize on me lo those many months ago went home mostly intact, and I only had to pull out the Mean Nurse Jo persona once, on a guy younger and stronger than me with an inch-long incision in his back.
All the faceless people have gone home to heal. One of them will be coming back next week for further plastics work, but that won't be the same caliber of treatment he's undergone thus far, so he ought to bounce back pretty quickly.
The two difficult folks I had this week, one with status epilepticus and one with status migraine, both seemed to respond to the massive doses of drugs we kept throwing at them and have left. Migraine Man went home with a drug that might destroy his kidneys but will keep him pain-free, while Epilepticus Woman went over to the monitoring unit to make sure that she's not having subclinical craziness in her head even on drugs.
The very nice man who came back completely unresponsive died easily and quickly, saving his family the hell of having to wait a week or even two while his breathing slowed down and he got more agonal. That's an odd thing to be thankful for, I guess, but I'll be thankful nonetheless. Occasionally a massive heart attack or pulmonary embolus or re-bleed can be a merciful thing, and not just for the patient.
Drama-filled weeks at the hospital make for great blogging but hellish working conditions. As does hauling furniture.
No matter how long you plan to stay, or how important you think you are, please do not bring your own furniture. And try to keep the amount of stuff in your room to a minimum. Three potted plants and a couple of tchochkes, fine. Twelve, not so good.
Because after I'm done hauling your console table bedside table potted plants various knickknacks bedside table chest of drawers ottoman clothing books magazines two bags full of makeup up three floors and installing them in another room, I will have a serious talk with you and your wife.
And your wife will cry. Not because I'm being mean, hard as it is to believe, but because she wanted to make your room "homey" and "comfortable" and I'm telling her that that's a no-go. Because, see, when the room is full of stuff of varying sizes, purposes, and fragilities, it's very difficult to see how I'll get a code cart into your room if, Frog forbid, I should ever need to.
And, you know, no matter how long you're staying here, please remember that it's a hospital, not a studio apartment. When three-quarters of the stuff I've humped on the elevator is your wife's, there's a problem.
Nobody, and I mean nobody, needs to be keeping a three-quarter length fur coat with fox trim in the closet in their hospital room. Really.
Aside from that forty-five minute period when I was wondering what, exactly, the facility was paying me for as I moved furniture, this was a good week. A busy week, true, with every floor full to the gills and overflow all over the post-anesthesia care unit, but a good week. Nobody coded, the person who *did* seize on me lo those many months ago went home mostly intact, and I only had to pull out the Mean Nurse Jo persona once, on a guy younger and stronger than me with an inch-long incision in his back.
All the faceless people have gone home to heal. One of them will be coming back next week for further plastics work, but that won't be the same caliber of treatment he's undergone thus far, so he ought to bounce back pretty quickly.
The two difficult folks I had this week, one with status epilepticus and one with status migraine, both seemed to respond to the massive doses of drugs we kept throwing at them and have left. Migraine Man went home with a drug that might destroy his kidneys but will keep him pain-free, while Epilepticus Woman went over to the monitoring unit to make sure that she's not having subclinical craziness in her head even on drugs.
The very nice man who came back completely unresponsive died easily and quickly, saving his family the hell of having to wait a week or even two while his breathing slowed down and he got more agonal. That's an odd thing to be thankful for, I guess, but I'll be thankful nonetheless. Occasionally a massive heart attack or pulmonary embolus or re-bleed can be a merciful thing, and not just for the patient.
Drama-filled weeks at the hospital make for great blogging but hellish working conditions. As does hauling furniture.
Tuesday, February 14, 2006
What I Cook On My Day Off When The Flyboys Are Being Assholes
Or, Gosh, I'm Glad I Didn't Have A Souffle In The Oven
Fruit Salad: honeydew melon that actually smelled like melon, alors!, pineapple ditto, alors! strawberries that taste like strawberries, and a can of sour pie cherries. What is *up* with the Quickie-Mart's produce section this week? In addition to thumb-thick asparagus, they had real fruit.
The cherries are in there primarily because I had a can of cherries that I was about to eat all in one sitting and didn't feel like torturing myself.
Rice cakes, made out of jasmine rice squished into a 1/3 cup measure (greased) and quick-fried in ghee until the outsides are crunchy.
To be served with corn relish: fresh sweet corn off the cob, tiny black beans, garlic sauteed until it's golden and crunchy, a hit of soy, a hit of chili paste, and some sesame seeds, toasted. (Weird, I know.)
Thumb-thick asparagus will be roasted. Yum. I got two pounds. Does anybody realize how much TWO POUNDS of asparagus is?
I also made chicken salad with pecans and cucumbers and red bell peppers, all very finely chopped up, and some onion.
About midway through the ghee-making process came the first of three sonic booms. The flyboys from the local AFB were breaking the rules again, making the windows shake and things fall off the shelves and freaking out all the dogs in the neighborhood. They do this about twice a year; fly fast and high over town, so fast you can't see much more than a black speck, and you don't know what's going on until the booms hit. Very irritating.
At least it's better, though, than the yearly airshow. My apartment is under the takeoff path at the municipal airport. When the airshow comes to town, I get treated to the sight and sound of dozens of WWII and Korean War-era bombers and fighters laboring up into the air entirely too slowly. I'm always afraid that the last remaining model of whatever rare bomber is there this year won't make it and will crash into my roof.
The biplanes and triplanes aren't as bad. You get the feeling that one could run straight into you and it wouldn't hurt, much.
In other news, my birthday was Sunday. Chef Boy took me to brunch, where we ate entirely too much and I had three mimosas (gee, mimosas are good! Why didn't anybody tell me before?) made from mandarin orange juice. The restaurant is Argentinian, the food is pricey but plentiful, and I'll never want to eat scrambled eggs again.
Beloved Sis sent a copy of a book that's been out of print for years ("The Dog Days of Arthur Cane") and which I'm saving for dinner reading.
And that is all. I have no work stories, having been mercifully absent from The Land Of Brain for three days now.
Fruit Salad: honeydew melon that actually smelled like melon, alors!, pineapple ditto, alors! strawberries that taste like strawberries, and a can of sour pie cherries. What is *up* with the Quickie-Mart's produce section this week? In addition to thumb-thick asparagus, they had real fruit.
The cherries are in there primarily because I had a can of cherries that I was about to eat all in one sitting and didn't feel like torturing myself.
Rice cakes, made out of jasmine rice squished into a 1/3 cup measure (greased) and quick-fried in ghee until the outsides are crunchy.
To be served with corn relish: fresh sweet corn off the cob, tiny black beans, garlic sauteed until it's golden and crunchy, a hit of soy, a hit of chili paste, and some sesame seeds, toasted. (Weird, I know.)
Thumb-thick asparagus will be roasted. Yum. I got two pounds. Does anybody realize how much TWO POUNDS of asparagus is?
I also made chicken salad with pecans and cucumbers and red bell peppers, all very finely chopped up, and some onion.
About midway through the ghee-making process came the first of three sonic booms. The flyboys from the local AFB were breaking the rules again, making the windows shake and things fall off the shelves and freaking out all the dogs in the neighborhood. They do this about twice a year; fly fast and high over town, so fast you can't see much more than a black speck, and you don't know what's going on until the booms hit. Very irritating.
At least it's better, though, than the yearly airshow. My apartment is under the takeoff path at the municipal airport. When the airshow comes to town, I get treated to the sight and sound of dozens of WWII and Korean War-era bombers and fighters laboring up into the air entirely too slowly. I'm always afraid that the last remaining model of whatever rare bomber is there this year won't make it and will crash into my roof.
The biplanes and triplanes aren't as bad. You get the feeling that one could run straight into you and it wouldn't hurt, much.
In other news, my birthday was Sunday. Chef Boy took me to brunch, where we ate entirely too much and I had three mimosas (gee, mimosas are good! Why didn't anybody tell me before?) made from mandarin orange juice. The restaurant is Argentinian, the food is pricey but plentiful, and I'll never want to eat scrambled eggs again.
Beloved Sis sent a copy of a book that's been out of print for years ("The Dog Days of Arthur Cane") and which I'm saving for dinner reading.
And that is all. I have no work stories, having been mercifully absent from The Land Of Brain for three days now.
Friday, February 10, 2006
The sun's over the yardarm *somewhere*.
Another entry in the Person With No Face contest:
Weird eye tumor extending into the bone of the skull near the temple and up over the brow. Weird eye tumor (and half the patient's face) removed by our crack team of Weird Eye Tumor Removal Pixies. Weird eye tumor site becomes very swollen and starts to leak Weird Eye Tumor Post-Removal Fluid.
So here comes one of the Pixies with a giant needle attached to the end of a giant syringe and whams it into the person's face in order to draw out some of the fluid.
I left the room precipitously.
And I did not have the egg-drop soup for lunch, no sir.
In other news, Amazon has a nifty widget I'm thinking about getting to carry lunch in. The bento box has always appealed to me, but a bento jar? Even better.
I also may have a supplier for my vintage glasses and sunglasses fetish. My crazy optometrist has a crazy father who recently found a cache of new-old-stock 1950's and 1960's glasses frames. He's promised to bring some of the best ones to the shop so that I can spend my hard-earned tax refund on them. Cat's eyes, here we come!
It's raining here, for the third time since July. I've promised myself a beer and a nap, in that order, so I'm off to get started.
Weird eye tumor extending into the bone of the skull near the temple and up over the brow. Weird eye tumor (and half the patient's face) removed by our crack team of Weird Eye Tumor Removal Pixies. Weird eye tumor site becomes very swollen and starts to leak Weird Eye Tumor Post-Removal Fluid.
So here comes one of the Pixies with a giant needle attached to the end of a giant syringe and whams it into the person's face in order to draw out some of the fluid.
I left the room precipitously.
And I did not have the egg-drop soup for lunch, no sir.
In other news, Amazon has a nifty widget I'm thinking about getting to carry lunch in. The bento box has always appealed to me, but a bento jar? Even better.
I also may have a supplier for my vintage glasses and sunglasses fetish. My crazy optometrist has a crazy father who recently found a cache of new-old-stock 1950's and 1960's glasses frames. He's promised to bring some of the best ones to the shop so that I can spend my hard-earned tax refund on them. Cat's eyes, here we come!
It's raining here, for the third time since July. I've promised myself a beer and a nap, in that order, so I'm off to get started.
Wednesday, February 08, 2006
The joke around here is...
....that there'll never be a "CSI" set here, because there's only one DNA sample and no dental records.
I just watched a neighbor pour about a gallon of used oil onto the parking lot, with no plans to clean it up. Genius.
It has been an annoying day.
I just watched a neighbor pour about a gallon of used oil onto the parking lot, with no plans to clean it up. Genius.
It has been an annoying day.
Tuesday, February 07, 2006
Coolest Thing Ever....
Care for another monotreme? This one not in Australia?
Oooo. I get so cheerful and happy and giggly when I read things like this.
I will never be a normal goil.
Oooo. I get so cheerful and happy and giggly when I read things like this.
I will never be a normal goil.
Monday, February 06, 2006
Simplify, simplify, simplify!
Thoreau never had a cell phone, that's for sure. And a land line, and a T1 connection for his computer, which he also didn't have. Still, I'm taking his words to heart--in this case. I'm ignoring the bit about "beware any enterprise that requires new clothes" as Beloved Sister would probably not be happy if I showed up in sweatshirt and jeans to her wedding. "Who's the chippie in the sweatshirt? Is she the bride?" "No, the one in the big white dress is the bride."
Anyhow. I'm ditching the land line (not yet, Mom; I'll give you plenty of warning) and switching cell phone plans to the one that lets you talk for four hours for $29.99 rather than the one I have, which charges double that much for nothin'. And I've got a new cell phone coming at some point, thanks to Working Assets Wireless (yes, Dad, that hippy liberal commie pinko phone company) that will replace my two-ton dinosaur-fueled current cellblock. They say they're sending me a phone that takes pictures. Who'da thunkit? With the technology available nowadays, somebody really ought to make a new version of "King Kong". That would be cool.
I've also cleaned out my fridge and the cabinet under the sink in the bathroom, so I can tell if I have soap or not. Mom and Dad left me with the legacy of the 1970's in that I am always prepared for stagflation, invasion by Cuba, or nuclear war. I have so much backstock of everything from soap to water that the local Mormons are envious. (No joke. I have, like, *edible* stuff backstocked. Not mixes.) Chef Boy, not being much of a backstocker and not ever having lived with a chemical toilet in the pantry (the pantry built, by the way, especially to stock Perma-Pak dried foods and vacuum-packed wheat), is scared. I think he thinks I have a complex.
I planted basil seeds today in those little pop-up peat pots that come in 12, 24, or 36-pot sets. That'll save me from having to drive thirty minutes to find more than an ounce of one kind of basil for $6.99. This might not be considered *simplifying*, exactly, since I'll now have to take care of three different basil plants, but it'll save me some bucks. Plus, those little peat starter kits are just too damned cute.
So, if I head out next days off (in eight days) and get me one o' them mighty-fine rollup shades of shadecloth, I should be able to get a little container garden going on the porch. Believe me, with the money I spend on produce (the farmer's market guys smile when they see me coming), this is simplifying.
I wonder if I could grow melons on the third floor, or if that would constitute an unreasonable hazard to my downstairs neighbors.
Anyhow. I'm ditching the land line (not yet, Mom; I'll give you plenty of warning) and switching cell phone plans to the one that lets you talk for four hours for $29.99 rather than the one I have, which charges double that much for nothin'. And I've got a new cell phone coming at some point, thanks to Working Assets Wireless (yes, Dad, that hippy liberal commie pinko phone company) that will replace my two-ton dinosaur-fueled current cellblock. They say they're sending me a phone that takes pictures. Who'da thunkit? With the technology available nowadays, somebody really ought to make a new version of "King Kong". That would be cool.
I've also cleaned out my fridge and the cabinet under the sink in the bathroom, so I can tell if I have soap or not. Mom and Dad left me with the legacy of the 1970's in that I am always prepared for stagflation, invasion by Cuba, or nuclear war. I have so much backstock of everything from soap to water that the local Mormons are envious. (No joke. I have, like, *edible* stuff backstocked. Not mixes.) Chef Boy, not being much of a backstocker and not ever having lived with a chemical toilet in the pantry (the pantry built, by the way, especially to stock Perma-Pak dried foods and vacuum-packed wheat), is scared. I think he thinks I have a complex.
I planted basil seeds today in those little pop-up peat pots that come in 12, 24, or 36-pot sets. That'll save me from having to drive thirty minutes to find more than an ounce of one kind of basil for $6.99. This might not be considered *simplifying*, exactly, since I'll now have to take care of three different basil plants, but it'll save me some bucks. Plus, those little peat starter kits are just too damned cute.
So, if I head out next days off (in eight days) and get me one o' them mighty-fine rollup shades of shadecloth, I should be able to get a little container garden going on the porch. Believe me, with the money I spend on produce (the farmer's market guys smile when they see me coming), this is simplifying.
I wonder if I could grow melons on the third floor, or if that would constitute an unreasonable hazard to my downstairs neighbors.
Many apologies....
First, to those of you who couldn't access the blog reliably over the last couple of days: Blogger has been having some unscheduled downtime for the last week as they migrate things and try to fix disks. There's going to be another outage this evening at 7 pm PST. The Blogger folks say that'll be the end-all, be-all fix.
Second, to those of you concerned that I might either leave nursing altogether or move to Seattle and disappear, don't worry. I think it was a combination of too little sleep and too much "Dancing With The Stars" that put me in such a foul mood.
I had planned to make chicken biryani this week, but a patient with an AVM pretty much blew those plans. Arterio-venous malformations aren't uncommon in people's brains, but they can appear anywhere on the body, sometimes with disturbing results. One of the most disturbing things is the color of the skin around them; it looks a lot like biryani before it's cooked.
This particular patient had an untreated facial AVM that was about the size of my hand, fully extended and with fingers together. I wear a size 7 glove, by the way, so that ain't a small AVM. The thing had displaced her right eye down onto her cheekbone and had puffed her eyelids out (and the rest of her periorbital tissue) to the point that the right side of her face looked like nothing human. When your eyeball and eyelid extend past the end of your nose, that's a problem.
Apparently the thing had come up suddenly and had grown so fast that there wasn't much she could do about it; AVMs can be like that. We'd embolized the thing a couple of times already, and she'll have surgery to remove it today. She'll lose her right eye--there's nothing we can do to replace an eye that's been displaced that far for more than a few hours--and will need some pretty extensive plastic surgery to minimize scarring, but at least she'll keep most of her skull.
Which is not the case, unfortunately, with another patient. This one had had basal cell cancer on his nose and had had it frozen off years before. Note to the interested: NEVER have a basal cell carcinoma removed by freezing. The process might not get all of it, and you may end up with a migrating basal cell cancer that invades your sinuses, your eye socket on one side, and your frontal bones.
Whereupon we would have to remove the whole damned upper quarter of your face and replace it with a flap graft from your scalp, or thigh, or chest. This is not a way to spend a week, never mind the disfiguring consequences of having thigh skin and muscle taking up what used to be your eye socket and frontal sinus.
Still, even that's better than having some piece of artillery go all crazy on your ass and blow off one side of your face. I'm not sure if it was a shoulder-mounted grenade launcher or what; all I know is that Walter Reed did all they could for the guy and then shipped him to us for definitive plastics and skull reconstruction. Thankfully his brain escaped harm, though I don't know how. We got him for a couple of days so that we could do the cranial reconstruction; he'll be shipped down a few floors sometime this week for the facial part of the deal.
All those, though, pale in comparison to what it must be like to be the parents of a twelve-year-old with a major aneurysm. Unruptured, so the question is this: should we go ahead with a carotid sacrifice and try to bypass and remove the aneurysm, knowing that our kid will likely be gorked out and severely disabled for the rest of his life, or should we skip the surgery and try to control his pain, living with the knowledge that the aneurysm could blow at any point and kill him?
You can see why "Dancing With George Hamilton's Tan" seemed like a good idea at the time.
Second, to those of you concerned that I might either leave nursing altogether or move to Seattle and disappear, don't worry. I think it was a combination of too little sleep and too much "Dancing With The Stars" that put me in such a foul mood.
I had planned to make chicken biryani this week, but a patient with an AVM pretty much blew those plans. Arterio-venous malformations aren't uncommon in people's brains, but they can appear anywhere on the body, sometimes with disturbing results. One of the most disturbing things is the color of the skin around them; it looks a lot like biryani before it's cooked.
This particular patient had an untreated facial AVM that was about the size of my hand, fully extended and with fingers together. I wear a size 7 glove, by the way, so that ain't a small AVM. The thing had displaced her right eye down onto her cheekbone and had puffed her eyelids out (and the rest of her periorbital tissue) to the point that the right side of her face looked like nothing human. When your eyeball and eyelid extend past the end of your nose, that's a problem.
Apparently the thing had come up suddenly and had grown so fast that there wasn't much she could do about it; AVMs can be like that. We'd embolized the thing a couple of times already, and she'll have surgery to remove it today. She'll lose her right eye--there's nothing we can do to replace an eye that's been displaced that far for more than a few hours--and will need some pretty extensive plastic surgery to minimize scarring, but at least she'll keep most of her skull.
Which is not the case, unfortunately, with another patient. This one had had basal cell cancer on his nose and had had it frozen off years before. Note to the interested: NEVER have a basal cell carcinoma removed by freezing. The process might not get all of it, and you may end up with a migrating basal cell cancer that invades your sinuses, your eye socket on one side, and your frontal bones.
Whereupon we would have to remove the whole damned upper quarter of your face and replace it with a flap graft from your scalp, or thigh, or chest. This is not a way to spend a week, never mind the disfiguring consequences of having thigh skin and muscle taking up what used to be your eye socket and frontal sinus.
Still, even that's better than having some piece of artillery go all crazy on your ass and blow off one side of your face. I'm not sure if it was a shoulder-mounted grenade launcher or what; all I know is that Walter Reed did all they could for the guy and then shipped him to us for definitive plastics and skull reconstruction. Thankfully his brain escaped harm, though I don't know how. We got him for a couple of days so that we could do the cranial reconstruction; he'll be shipped down a few floors sometime this week for the facial part of the deal.
All those, though, pale in comparison to what it must be like to be the parents of a twelve-year-old with a major aneurysm. Unruptured, so the question is this: should we go ahead with a carotid sacrifice and try to bypass and remove the aneurysm, knowing that our kid will likely be gorked out and severely disabled for the rest of his life, or should we skip the surgery and try to control his pain, living with the knowledge that the aneurysm could blow at any point and kill him?
You can see why "Dancing With George Hamilton's Tan" seemed like a good idea at the time.
Thursday, February 02, 2006
When it absolutely, positively cannot be about work.
I go back to work tomorrow after five days off, the first three of which I spent incredibly tired and feeling as though someone had scrubbed my left maxillary sinus with Brillo. The last two days I've spent running around doing errands, getting my teeth cleaned and my eyes checked, and doing laundry.
Fun times.
This evening I'm drinking Scotch (thanks, Beloved Soon-to-be-Brother-In-Law!) and watching, to my faintly bemused horror, "Dancing with the Stars". And trying to plan what to do for my 36th birthday and reading the latest issue of "Mental Floss" during the commercial breaks.
Oh, mercy. George Hamilton's tan is doing a slowed-down samba to a live version of "Do the Samba" or whatever that awful Miami Sound Machine song is, and I'm worried it might fall and break a hip. If tans have hips.
Anyway, I'm waiting to go to bed before work. Michelle has, as usual, an intelligent take on one of the most common problems that nurses and invisible doctors like anesthesiologists have: we know before the patient does what's going on. And that sucks.
I've been wondering over this week if it's maybe not time to get back into non-hospital nursing, more because of the commute time (40 minutes each way is long, especially on the 3rd of 3 days) than because of the emotional stress, though that stress is playing a role. I've had some really difficult cases this past fall and winter, and I'm getting stress-related illnesses as a result. For me, that means tummy trouble and sinus infections and possibly an aneurysm down the line, as well as trouble sleeping the night before I go back to work.
Don't get me wrong: I love what I do. Neurology and neurosurgery are ripe with opportunities to educate, amusing in the variety of problems we see, and incredibly elegant. I never knew how damned elegant the human nervous system could be; it fills me with awe and joy every time I see a manifestation of a tiny problem writ subtly on a patient's behavior or body.
But it's getting tiring, seeing people who will probably not get much better. Say what you want about working with pregnant teenagers, women in their 30's with unsuspected STDs, and women needing abortions: at least it opened up avenues to the future. Those folks had an entire future opened up to them that was multifaceted and unbounded; the patient with a massive bleed or thalamic stroke often doesn't have that option.
Ha. This was going to supposed to be an essay on the various options I have for spending my 36th birthday, which unfortunately coincides with Chef Boy's prep day for The Biggest Holiday Of The Year (Valentine's). Instead of pondering flying out to The Palms of Dubai or getting a mani-pedi, I'm missing working public health.
I don't know. I decided, the day the 27-year-old mother of a pregnant 13-year-old came in with her daughter, that I needed a new job. I had, in fact, just told the 13-year-old, who was in methadone treatment, that she was pregnant. Her mother looked at me and said, "What do you expect? Do you want me to cry? 'Cause I'm not gonna cry."
I wanted to shout, Yes, I want you to cry, because your daughter has somehow repeated the awful life that you lived. Your daughter has made her future that much more difficult and that much more bleak by deciding that her mama did it, so she can too. I want you to cry for whatever failure of yours it is that allowed your otherwise bright and engaging daughter to start shooting up heroin and sleep with God knows how many men.
Instead I went to the bar and stared at the wall for hours, hoping that I could down enough alcohol to make it possible for me to sleep without making it impossible for me to drive.
I'd take Lunesta, but Miss Cat would flip out over the glowing butterfly.
Planned Parenthood needs a recovery room nurse for a clinic. It's part-time, and it's forty miles away (again), but...well.
Every nurse has the chance to make a difference every day she works. Even if you have five vent-dependent, gorked-out patients, you have the ability to make a difference. Somebody, somewhere, if you're doing your job right, will end the day feeling better than they did when the day started.
I suppose it's a difference in type of heartbreak. The same heartbreak over and over gets old; eventually, trading 32-year-olds with gliomas for 13-year-olds with unplanned pregnancies (Query: Can a 13-year-old plan a pregnancy?) begins to sound like an option. Again.
Fun times.
This evening I'm drinking Scotch (thanks, Beloved Soon-to-be-Brother-In-Law!) and watching, to my faintly bemused horror, "Dancing with the Stars". And trying to plan what to do for my 36th birthday and reading the latest issue of "Mental Floss" during the commercial breaks.
Oh, mercy. George Hamilton's tan is doing a slowed-down samba to a live version of "Do the Samba" or whatever that awful Miami Sound Machine song is, and I'm worried it might fall and break a hip. If tans have hips.
Anyway, I'm waiting to go to bed before work. Michelle has, as usual, an intelligent take on one of the most common problems that nurses and invisible doctors like anesthesiologists have: we know before the patient does what's going on. And that sucks.
I've been wondering over this week if it's maybe not time to get back into non-hospital nursing, more because of the commute time (40 minutes each way is long, especially on the 3rd of 3 days) than because of the emotional stress, though that stress is playing a role. I've had some really difficult cases this past fall and winter, and I'm getting stress-related illnesses as a result. For me, that means tummy trouble and sinus infections and possibly an aneurysm down the line, as well as trouble sleeping the night before I go back to work.
Don't get me wrong: I love what I do. Neurology and neurosurgery are ripe with opportunities to educate, amusing in the variety of problems we see, and incredibly elegant. I never knew how damned elegant the human nervous system could be; it fills me with awe and joy every time I see a manifestation of a tiny problem writ subtly on a patient's behavior or body.
But it's getting tiring, seeing people who will probably not get much better. Say what you want about working with pregnant teenagers, women in their 30's with unsuspected STDs, and women needing abortions: at least it opened up avenues to the future. Those folks had an entire future opened up to them that was multifaceted and unbounded; the patient with a massive bleed or thalamic stroke often doesn't have that option.
Ha. This was going to supposed to be an essay on the various options I have for spending my 36th birthday, which unfortunately coincides with Chef Boy's prep day for The Biggest Holiday Of The Year (Valentine's). Instead of pondering flying out to The Palms of Dubai or getting a mani-pedi, I'm missing working public health.
I don't know. I decided, the day the 27-year-old mother of a pregnant 13-year-old came in with her daughter, that I needed a new job. I had, in fact, just told the 13-year-old, who was in methadone treatment, that she was pregnant. Her mother looked at me and said, "What do you expect? Do you want me to cry? 'Cause I'm not gonna cry."
I wanted to shout, Yes, I want you to cry, because your daughter has somehow repeated the awful life that you lived. Your daughter has made her future that much more difficult and that much more bleak by deciding that her mama did it, so she can too. I want you to cry for whatever failure of yours it is that allowed your otherwise bright and engaging daughter to start shooting up heroin and sleep with God knows how many men.
Instead I went to the bar and stared at the wall for hours, hoping that I could down enough alcohol to make it possible for me to sleep without making it impossible for me to drive.
I'd take Lunesta, but Miss Cat would flip out over the glowing butterfly.
Planned Parenthood needs a recovery room nurse for a clinic. It's part-time, and it's forty miles away (again), but...well.
Every nurse has the chance to make a difference every day she works. Even if you have five vent-dependent, gorked-out patients, you have the ability to make a difference. Somebody, somewhere, if you're doing your job right, will end the day feeling better than they did when the day started.
I suppose it's a difference in type of heartbreak. The same heartbreak over and over gets old; eventually, trading 32-year-olds with gliomas for 13-year-olds with unplanned pregnancies (Query: Can a 13-year-old plan a pregnancy?) begins to sound like an option. Again.
Tuesday, January 31, 2006
The sky is indeed falling, just not very fast.
Okay, so Alito got confirmed. And it's likely that in the next decade or two, we'll see either states' laws become more restrictive of abortion, or we'll see Roe overturned completely.
A little background first: Roe V. Wade didn't legalize abortion across the board, without restrictions, in every state. All it said was this: in the first trimester, a woman's right to an abortion cannot be subject to unreasonable restrictions by the state. "Unreasonable restriction" is a broad term: one that's been brought to the courts when states have attempted to pass parental or spousal consent or notification laws, laws restricting minors' access to abortion, waiting periods, education, and so on.
In the second and third trimesters, abortions are subject to a variety of restrictions that vary from state to state.
So let's take a worst-case-scenario view and say that the Constitutional right to privacy that is accepted as part of the not-specifically-named rights therein is decided not to cover the right of a woman to terminate a pregnancy.
Two things would then happen: a legal challenge would likely be mounted on the basis of equal protection under law--an argument that I find more compelling than the right to privacy in this particular case, as well as one that I'll leave for non-fluff-brained commenters and bloggers to handle.
The other thing that would happen would be this: access to abortion would return to a pre-Roe patchwork. It would likely be illegal where I live and in several surrounding states. Travel to New York and California would become commonplace for middle-class women, while other women would be either screwed to the wall or forced to obtain illegal abortions.
And, by the way, don't assume that women aren't already forced to obtain illegal abortions. Only 13% of counties in the US have an abortion provider; most of those providers are in urban states like Washington, California, and New York. I saw my first patient with complications from an illegal abortion during nursing school and my second only about a month ago. The situation for women in states where there are already notification laws and waiting periods is grim; there's no reason that it wouldn't get grimmer if, say, the three abortion providers within a day's drive of me went away.
But that's not really what I'm wanting to address here. The thing that bothers me about the thought of returning to pre-Roe days is this: each state will, in accordance with its rights under the Constitution, be able to define the beginning of life.
Think about that for a minute in context of pharmacists (who are, or who should be, nominally scientists) refusing to refill birth control pills or fill emergency contraceptive prescriptions on the basis that they might "abort" an embryo. Think about it in the context of doctors who refuse to fit women with IUDs for contraception on the same principle, even though repeated studies have shown that IUDs prevent ovulation and destroy sperm rather than embryos. All the science in the world won't convince these soi-disant scientists; do you think there'd be better luck with politicians?
Although Griswold V. Connecticut, which legalized birth control for married couples (and, as a result, opened the door to the contraceptive freedoms that you and I enjoy) will likely stand, access to contraceptives will probably become more difficult. Some forms might be legislated away, or surrounded by the sorts of requirements and caveats that make doctors loathe to prescribe them. After all, if legislators can require that abortion clinics meet the same standards as ambulatory surgery centers (which perform more complex and demanding surgeries), why not require that doctors meet special standards for, say, inserting an IUD? After all, women have been known to vagal out and seize during the procedure before.
That's scary enough for me to look wall-eyed at my pals in Canada and make sure their addresses in my book are current. What's worse, though, is what's likely to happen to us as healthcare providers.
It was not unusual, back in the day, for doctors to be wary of providing even lifesaving treatment to women who were bleeding after an induced illegal abortion, for fear that they might be prosecuted for assisting in an illegal termination.
It was not unusual for the police to show up in the septic wards or the ED to question women who were suspected of trying to self-abort, or suspected of having seen an illegal practitioner.
It wasn't unusual for women to place themselves at the mercy of untrained abortion providers and suffer the consequences of abortion and sterility.
Many years ago, when I was still working at the clinic, I had the opportunity to talk to a woman who'd had an illegal abortion, and who was sterile as a result. The folks in the emergency room were so nervous about being questioned or prosecuted that she bled nearly to death before one doctor finally intervened...at which point he had to go before the hospital ethics committee and the police to explain his actions.
Moiv has a heartbreaking post on this. The thing that scares me most about her post is one little mention of an abortion provider being called to help set up a "septic ward"--the place where women who'd had illegal abortions and had had complications were cared for. There's at least one hospital near me that's contemplating the same thing.
So, as healthcare providers, we'll get a triple role if Roe is overturned:
If we live in a state where abortion is across-the-board illegal, we'll be seen as informants for the police, witnesses for women who claim they'll kill themselves if they don't have an abortion, and caregivers for women who don't get the lucky straw in the illegal-abortion lottery.
If we live in a state where abortion is legal, we'll see an influx of women, probably mostly middle-class, coming across state lines and choking clinics and hospitals. Some of those women will have complications, even from a relatively safe procedure: it happens. And, if the state that woman with complications came from criminalizes crossing state lines, we may be called upon to release medical records or otherwise testify to her situation and our care.
Caregiver, witness for the prosecution, witness for the defense.
This is what'll happen, people. Not all those women will end up in septic wards, by the way. Pennyroyal, an herb that causes intestinal cramping and pain and can occasionally dislodge a pregnancy, comes in an oil-extract form that is highly toxic to the liver. When a person tries to self-abort with pennyroyal oil, she'll likely end up on a floor that deals with livers, kidneys, or neuro issues as a result of hepatic encephalopathy.
If worse comes to worst, it's gonna be an interesting ride.
A little background first: Roe V. Wade didn't legalize abortion across the board, without restrictions, in every state. All it said was this: in the first trimester, a woman's right to an abortion cannot be subject to unreasonable restrictions by the state. "Unreasonable restriction" is a broad term: one that's been brought to the courts when states have attempted to pass parental or spousal consent or notification laws, laws restricting minors' access to abortion, waiting periods, education, and so on.
In the second and third trimesters, abortions are subject to a variety of restrictions that vary from state to state.
So let's take a worst-case-scenario view and say that the Constitutional right to privacy that is accepted as part of the not-specifically-named rights therein is decided not to cover the right of a woman to terminate a pregnancy.
Two things would then happen: a legal challenge would likely be mounted on the basis of equal protection under law--an argument that I find more compelling than the right to privacy in this particular case, as well as one that I'll leave for non-fluff-brained commenters and bloggers to handle.
The other thing that would happen would be this: access to abortion would return to a pre-Roe patchwork. It would likely be illegal where I live and in several surrounding states. Travel to New York and California would become commonplace for middle-class women, while other women would be either screwed to the wall or forced to obtain illegal abortions.
And, by the way, don't assume that women aren't already forced to obtain illegal abortions. Only 13% of counties in the US have an abortion provider; most of those providers are in urban states like Washington, California, and New York. I saw my first patient with complications from an illegal abortion during nursing school and my second only about a month ago. The situation for women in states where there are already notification laws and waiting periods is grim; there's no reason that it wouldn't get grimmer if, say, the three abortion providers within a day's drive of me went away.
But that's not really what I'm wanting to address here. The thing that bothers me about the thought of returning to pre-Roe days is this: each state will, in accordance with its rights under the Constitution, be able to define the beginning of life.
Think about that for a minute in context of pharmacists (who are, or who should be, nominally scientists) refusing to refill birth control pills or fill emergency contraceptive prescriptions on the basis that they might "abort" an embryo. Think about it in the context of doctors who refuse to fit women with IUDs for contraception on the same principle, even though repeated studies have shown that IUDs prevent ovulation and destroy sperm rather than embryos. All the science in the world won't convince these soi-disant scientists; do you think there'd be better luck with politicians?
Although Griswold V. Connecticut, which legalized birth control for married couples (and, as a result, opened the door to the contraceptive freedoms that you and I enjoy) will likely stand, access to contraceptives will probably become more difficult. Some forms might be legislated away, or surrounded by the sorts of requirements and caveats that make doctors loathe to prescribe them. After all, if legislators can require that abortion clinics meet the same standards as ambulatory surgery centers (which perform more complex and demanding surgeries), why not require that doctors meet special standards for, say, inserting an IUD? After all, women have been known to vagal out and seize during the procedure before.
That's scary enough for me to look wall-eyed at my pals in Canada and make sure their addresses in my book are current. What's worse, though, is what's likely to happen to us as healthcare providers.
It was not unusual, back in the day, for doctors to be wary of providing even lifesaving treatment to women who were bleeding after an induced illegal abortion, for fear that they might be prosecuted for assisting in an illegal termination.
It was not unusual for the police to show up in the septic wards or the ED to question women who were suspected of trying to self-abort, or suspected of having seen an illegal practitioner.
It wasn't unusual for women to place themselves at the mercy of untrained abortion providers and suffer the consequences of abortion and sterility.
Many years ago, when I was still working at the clinic, I had the opportunity to talk to a woman who'd had an illegal abortion, and who was sterile as a result. The folks in the emergency room were so nervous about being questioned or prosecuted that she bled nearly to death before one doctor finally intervened...at which point he had to go before the hospital ethics committee and the police to explain his actions.
Moiv has a heartbreaking post on this. The thing that scares me most about her post is one little mention of an abortion provider being called to help set up a "septic ward"--the place where women who'd had illegal abortions and had had complications were cared for. There's at least one hospital near me that's contemplating the same thing.
So, as healthcare providers, we'll get a triple role if Roe is overturned:
If we live in a state where abortion is across-the-board illegal, we'll be seen as informants for the police, witnesses for women who claim they'll kill themselves if they don't have an abortion, and caregivers for women who don't get the lucky straw in the illegal-abortion lottery.
If we live in a state where abortion is legal, we'll see an influx of women, probably mostly middle-class, coming across state lines and choking clinics and hospitals. Some of those women will have complications, even from a relatively safe procedure: it happens. And, if the state that woman with complications came from criminalizes crossing state lines, we may be called upon to release medical records or otherwise testify to her situation and our care.
Caregiver, witness for the prosecution, witness for the defense.
This is what'll happen, people. Not all those women will end up in septic wards, by the way. Pennyroyal, an herb that causes intestinal cramping and pain and can occasionally dislodge a pregnancy, comes in an oil-extract form that is highly toxic to the liver. When a person tries to self-abort with pennyroyal oil, she'll likely end up on a floor that deals with livers, kidneys, or neuro issues as a result of hepatic encephalopathy.
If worse comes to worst, it's gonna be an interesting ride.
Saturday, January 28, 2006
I'm drunk. And I'll be having orgiastic sex tomorrow.
With a black guy.
A *gay* black guy.
A gay black Catholic clergyman.*
In a wheelchair.
No, that is not what I said.
It's what I wish I'd said, though.
I knew today that I was coming down with a sinus infection. In addition to the swimmy feeling and the pressure over my right cheekbone, I felt unreasonably aggressive and bitchy. (Chorus of my coworkers: "...aaaand this is different how?")
So, after running into something with my car (no injuries, just paint transfer off of the concrete barrier in front of the convenience store) and not feeling any better with Sudafed, I called in sick.
Whereupon the night mangler asked, "Do you mind if I ask what's wrong?"
Yes, I mind.
I mind immensely.
Not only am I doing you a favor by not double-dosing at least two patients tomorrow or coughing my crap onto their lumbar drains, I'm being nice enough to call you in time for you to find a sub.
And it's none of your business why I'm calling in. Okay? I could have a cold, or a stomach bug, or just be horribly hung-over; it's enough that I'm calling to say "I'm feeling peaked".
Perhaps you should ask the two other nurses who worked sick last week why they *didn't* call in. Those of us who worked with them for three days are feeling decidedly puny.
Unless I have smallpox, or bloody sputum, or avian flu, my reasons for calling in are my own business.
But I got her.
Instead of simply saying "I have a sinus infection; sorry" I described the multi-colored snot that my sinuses are producing, the pain, the lollygagging feeling, and the diarrhea.
Sweet dreams, night mangler.
*Or clergy-woman. Whatever works for you.
A *gay* black guy.
A gay black Catholic clergyman.*
In a wheelchair.
No, that is not what I said.
It's what I wish I'd said, though.
I knew today that I was coming down with a sinus infection. In addition to the swimmy feeling and the pressure over my right cheekbone, I felt unreasonably aggressive and bitchy. (Chorus of my coworkers: "...aaaand this is different how?")
So, after running into something with my car (no injuries, just paint transfer off of the concrete barrier in front of the convenience store) and not feeling any better with Sudafed, I called in sick.
Whereupon the night mangler asked, "Do you mind if I ask what's wrong?"
Yes, I mind.
I mind immensely.
Not only am I doing you a favor by not double-dosing at least two patients tomorrow or coughing my crap onto their lumbar drains, I'm being nice enough to call you in time for you to find a sub.
And it's none of your business why I'm calling in. Okay? I could have a cold, or a stomach bug, or just be horribly hung-over; it's enough that I'm calling to say "I'm feeling peaked".
Perhaps you should ask the two other nurses who worked sick last week why they *didn't* call in. Those of us who worked with them for three days are feeling decidedly puny.
Unless I have smallpox, or bloody sputum, or avian flu, my reasons for calling in are my own business.
But I got her.
Instead of simply saying "I have a sinus infection; sorry" I described the multi-colored snot that my sinuses are producing, the pain, the lollygagging feeling, and the diarrhea.
Sweet dreams, night mangler.
*Or clergy-woman. Whatever works for you.
Wednesday, January 25, 2006
Okay, fine, whatever.
I love my boyfiend.
This is why: I called him an hour ago and said, "Look, I'm in a foul, foul mood that hasn't gone away since last night and I don't want to inflict this on anybody, I just want to listen to polka music and clean my closet out, so can we skip lunch and get together this afternoon instead?" and he said "Yes."
No "why are you in a foul mood?", no "aaawww, honey, it's not that bad", no bull about it. Just "Yes."
Because it *is* that bad.
I sent an email about a week ago to the Great Sub-Leader at work, pointing out some errors in ins-and-outs that one of our techs had made.
Ins-and-outs (I&O) are a big deal on a neuroscience floor. When your patients are at risk for things like diabetes insipidus or syndrome of inappropriate antidiuretic hormone, it's a good idea to keep an eye on how much they drink versus how much they pee, because that'll help you catch problems early.
Likewise, it's a good idea to have an accurate blood pressure and respiratory rate on these folks. The tech in question had falsified blood pressures and fucked up respirations before in charting--in one case, she had charted a patient with agonal, death-is-on-the-way breathing of about six a minute as having tachypnea. My patients always breathe in unison, at 16 a minute, every time she works. They all have BPs in the 130's over 80's.
In short, there is a problem here. It's not necessarily one of intelligence, since she routinely wears shoes with laces that she's tied herself; it's more one of indolence and not caring.
This is the same person, by the by, who inflicted a reverse Trendelenburg (head-down, feet-up) position on a patient who was being fed through a tube without stopping the feeding first, thus almost killing him. No joke.
So there's a history here that goes back about two years. This latest email was an attempt by yours truly to actually document some of the bullshit that's been going down lately.
The response from Subcommandante Merkin today was as follows:
"You have to give her the benefit of the doubt. There is no malice in her."
No malice? Benefit of the doubt? This tech has a list of write-ups and policy violations as long as my commute, yet management won't get rid of her, for fear she'll sue. News flash, kids: in a work-at-will state, suing is a near-impossibility unless the fired person can show proof of discrimination or malice (speaking of malice). Even then, it's not likely she'd win, or even tie up the case in court for years. Judges here, while weird in social matters, tend to look slitty-eyed at the rights of workers.
When I worked at Planned Parenthood, we had a family planning associate who faked blood pressures. These were healthy patients in for annual exams, undergoing no medical procedures, at no particular risk for anything. And that FPA got fired immediately, on the grounds that faking medical information is A Bad Thing.
My manager doesn't have the same standards. ....Hello?
So, okay, fine, whatever. I'll deal with the fact that I have a person who takes until 1530 to do baths on three patients. I'll handle having to do my own I&Os; I do that anyway for the most part. I'll recheck blood pressures every couple of hours, even though that cuts into time that I could spend doing things that only a nurse can do, like analyzing lab results and deciding on courses of action.
We need good techs. Our facility rewards good techs handsomely, and I work with some *excellent* ones. It's hard physical labor, and the techs are the first people to notice when a problem crops up. Three of four of our techs I trust to give hand-off report on complex patients to a doctor. Three of four of them I trust to handle the first stages of an emergency before they yank the call cord out of the wall. One of them recently saved my bacon during a code. These are smart people who understand that getting blood pressures and tracking ins-and-outs is not shitwork; it's valuable, basic to the patient's outcome, and not to be faked.
This fourth one, though, regardless of malice, is going to kill somebody one of these days. Being smart is not enough. Being thoughtful is not enough. Being paranoid is close to enough, but it doesn't get the job done on its own. You need a combination of all of those things, and she doesn't have any of them.
Which means I have to take time that I do not have in order to double-check every. Single. Damned. Thing. She. Does. to make sure that she hasn't "missed" anything.
I can't afford to give her the benefit of the doubt. My patients can't afford it.
Unfortunately, Subcommandante Merkin thinks that the only thing the facility can't afford is a suit.
This is why: I called him an hour ago and said, "Look, I'm in a foul, foul mood that hasn't gone away since last night and I don't want to inflict this on anybody, I just want to listen to polka music and clean my closet out, so can we skip lunch and get together this afternoon instead?" and he said "Yes."
No "why are you in a foul mood?", no "aaawww, honey, it's not that bad", no bull about it. Just "Yes."
Because it *is* that bad.
I sent an email about a week ago to the Great Sub-Leader at work, pointing out some errors in ins-and-outs that one of our techs had made.
Ins-and-outs (I&O) are a big deal on a neuroscience floor. When your patients are at risk for things like diabetes insipidus or syndrome of inappropriate antidiuretic hormone, it's a good idea to keep an eye on how much they drink versus how much they pee, because that'll help you catch problems early.
Likewise, it's a good idea to have an accurate blood pressure and respiratory rate on these folks. The tech in question had falsified blood pressures and fucked up respirations before in charting--in one case, she had charted a patient with agonal, death-is-on-the-way breathing of about six a minute as having tachypnea. My patients always breathe in unison, at 16 a minute, every time she works. They all have BPs in the 130's over 80's.
In short, there is a problem here. It's not necessarily one of intelligence, since she routinely wears shoes with laces that she's tied herself; it's more one of indolence and not caring.
This is the same person, by the by, who inflicted a reverse Trendelenburg (head-down, feet-up) position on a patient who was being fed through a tube without stopping the feeding first, thus almost killing him. No joke.
So there's a history here that goes back about two years. This latest email was an attempt by yours truly to actually document some of the bullshit that's been going down lately.
The response from Subcommandante Merkin today was as follows:
"You have to give her the benefit of the doubt. There is no malice in her."
No malice? Benefit of the doubt? This tech has a list of write-ups and policy violations as long as my commute, yet management won't get rid of her, for fear she'll sue. News flash, kids: in a work-at-will state, suing is a near-impossibility unless the fired person can show proof of discrimination or malice (speaking of malice). Even then, it's not likely she'd win, or even tie up the case in court for years. Judges here, while weird in social matters, tend to look slitty-eyed at the rights of workers.
When I worked at Planned Parenthood, we had a family planning associate who faked blood pressures. These were healthy patients in for annual exams, undergoing no medical procedures, at no particular risk for anything. And that FPA got fired immediately, on the grounds that faking medical information is A Bad Thing.
My manager doesn't have the same standards. ....Hello?
So, okay, fine, whatever. I'll deal with the fact that I have a person who takes until 1530 to do baths on three patients. I'll handle having to do my own I&Os; I do that anyway for the most part. I'll recheck blood pressures every couple of hours, even though that cuts into time that I could spend doing things that only a nurse can do, like analyzing lab results and deciding on courses of action.
We need good techs. Our facility rewards good techs handsomely, and I work with some *excellent* ones. It's hard physical labor, and the techs are the first people to notice when a problem crops up. Three of four of our techs I trust to give hand-off report on complex patients to a doctor. Three of four of them I trust to handle the first stages of an emergency before they yank the call cord out of the wall. One of them recently saved my bacon during a code. These are smart people who understand that getting blood pressures and tracking ins-and-outs is not shitwork; it's valuable, basic to the patient's outcome, and not to be faked.
This fourth one, though, regardless of malice, is going to kill somebody one of these days. Being smart is not enough. Being thoughtful is not enough. Being paranoid is close to enough, but it doesn't get the job done on its own. You need a combination of all of those things, and she doesn't have any of them.
Which means I have to take time that I do not have in order to double-check every. Single. Damned. Thing. She. Does. to make sure that she hasn't "missed" anything.
I can't afford to give her the benefit of the doubt. My patients can't afford it.
Unfortunately, Subcommandante Merkin thinks that the only thing the facility can't afford is a suit.
Grouse: It's What's For Dinner
Cindy-Lou Who looked across the table at me just before report began. She widened her big brown eyes and said, "Y'know, this working-short shit is really starting to blow."
Yep. Can't put it better than that. This working-short shit is really starting to blow.
We're working short because a lot of us have been working sick, because working sick is the only way to avoid working short. (Note: that will make sense only if you're a nurse.) Now our manager's down with a cough so bad she can't eat, one of our nurses has been confined to bed by his doctor on the threat of hospital admission if he gets up, and the rest of us are sort of sniffly.
Never mind that Management did some sort of wonky air-filter cleaning thing that filled the entire hospital with the smell of burning rubber and diesel fumes. What up with that, dawg?
There's been a lot o'yakking over the last decade about our Terrible Nursing Shortage and What A Tragedy That Is and How On Earth We Can Fix It. Suggestions have ranged from higher pay and better bonuses (which might work, if nurses weren't so inculcated with the idea that big bonus = scarily understaffed facility), on-site daycare (huh? Who would want to expose their child to the bugs in a hospital?), more flexible hours (now, cutting out mandatory overtime might help), and fun little bonuses like on-site massage and cool totebags.
Can I inject a little dose of reality here?
Going back over the many books I've read on history, both general and specific to nursing, I've noticed one thing: Good nurses have always been hard to come by. During each World War, there was talk of drafting nurses; incentives were offered to civilian women who were willing to take shortened training courses and go off to serve as RNs in the military. In the 60's and 70's, there were efforts by folks who ran hospital-based programs (usually three-year courses that produced on-the-spot-trained nurses who then worked for the hospital for a time) to make their curricula more attractive to students. The only blip I remember that bucked the Terrible Tragic Nursing Shortage Trend came sometime in the 1980's, I think, and I have only anecdotal evidence for that: a nurse I knew vaguely went off to be a stock trader.
Hell, my antique medical books mourn the lack of decent nursing care in hospitals, and the difficulty of finding a nice, sober woman to come in by the day to the house.
So, basically, we're working now with the same formula we've always been working with: There are more sick people than there are folks willing to care for them. Even if we doubled the number of working nurses tomorrow, nothing would change; hospitals would simply build more wings and schedule more surgeries to take care of the endless lines of sickies outside their doors.
Let's assume that we can't change the Terrible Tragic Shortage. What could make life better for your average working nurse?
It ain't tote bags or pedicures. It's not even higher pay, though that might make a few people more cheerful.
It's people in other professions Getting A Clue.
A third-year internal med resident asked me yesterday how much break time we got during a shift. I said we got fifteen in the morning, half an hour for lunch, and fifteen during the afternoon, though we took what we could when we could.
"Can you skip all your breaks and leave an hour early?" she asked. I peered closely at her to make sure she wasn't joking. She wasn't. She simply had no clue, after years of working with and around nurses at various hospitals, what the job entails. I'm not sure what she thinks we do.
Upper management in hospitals is usually comprised of people who've either never worked in hospitals as nurses or doctors or who did so so long ago that "I walked sixteen miles uphill in the snow to get to the ward where I supervised 29 patients by myself" isn't too much of a stretch. They're management experts and efficiency experts and safety experts, but they have no real gut sense for how acuity affects staffing levels. Most of the patients that I took care of yesterday would've been dead even fifteen years ago, in ICU eight years ago; now they're on the floor in a high-acuity unit. The people in charge of budgeting for our unit have no idea what it's like to work with an open ventriculostomy or three. For them, "brain injury" means Poppa's a little forgetful these days.
I got snarked at by an attending the other day for "turfing" a patient wrong. Apparently, that means I asked for a consult from some service that I shouldn't have; there's some obscure way of going from specialty to subspecialty (for this guy, at least) that I'd not heard of before. The fact that the patient was showing worrisome signs of Some Very Severe, Life-Threatening Complications didn't faze him; he was more worried about his "turf" as regards the case.
I would love to have Dr. Turf, that internal med resident, and our Great Leader follow me for a week. Hell, even a *day*, if I could be sure that they'd actually have to work during that day. I would love for them to get a clue, in other words.
Let's be honest: nine-tenths of the cleanup work, the tidying up of loose ends that's done in a hospital is done by a nurse somewhere. Most of the emotional support a patient gets from non-family members is provided by a nurse. The nasty complications that get caught early are caught by a nurse. The wonky test results get re-draw orders written by a nurse. And those three patients with tubes draining brain juice are taken care of by a nurse who's trying to make sure they don't end up with fulminant meningitis while she's doing re-draws and fixing doctors' mistakes on paperwork.
I hereby propose National Get A Clue Week. One week out of the year, at a time of their choosing, every resident and management person, as well as attendings selected for their attitudes and indolence, would work on the floor with nurses. Full twelve-hour shift, they break when their nurse breaks, they stick to her or to him like glue.
It wouldn't solve the shortage; there's not a lot we can do about that. But maybe, just maybe, it would imbue those folks who think of us as starched white angels with a sense of what it is we do all the hell day long. And that, perhaps, would change their attitudes and actions and make our jobs a little less insane.
Yep. Can't put it better than that. This working-short shit is really starting to blow.
We're working short because a lot of us have been working sick, because working sick is the only way to avoid working short. (Note: that will make sense only if you're a nurse.) Now our manager's down with a cough so bad she can't eat, one of our nurses has been confined to bed by his doctor on the threat of hospital admission if he gets up, and the rest of us are sort of sniffly.
Never mind that Management did some sort of wonky air-filter cleaning thing that filled the entire hospital with the smell of burning rubber and diesel fumes. What up with that, dawg?
There's been a lot o'yakking over the last decade about our Terrible Nursing Shortage and What A Tragedy That Is and How On Earth We Can Fix It. Suggestions have ranged from higher pay and better bonuses (which might work, if nurses weren't so inculcated with the idea that big bonus = scarily understaffed facility), on-site daycare (huh? Who would want to expose their child to the bugs in a hospital?), more flexible hours (now, cutting out mandatory overtime might help), and fun little bonuses like on-site massage and cool totebags.
Can I inject a little dose of reality here?
Going back over the many books I've read on history, both general and specific to nursing, I've noticed one thing: Good nurses have always been hard to come by. During each World War, there was talk of drafting nurses; incentives were offered to civilian women who were willing to take shortened training courses and go off to serve as RNs in the military. In the 60's and 70's, there were efforts by folks who ran hospital-based programs (usually three-year courses that produced on-the-spot-trained nurses who then worked for the hospital for a time) to make their curricula more attractive to students. The only blip I remember that bucked the Terrible Tragic Nursing Shortage Trend came sometime in the 1980's, I think, and I have only anecdotal evidence for that: a nurse I knew vaguely went off to be a stock trader.
Hell, my antique medical books mourn the lack of decent nursing care in hospitals, and the difficulty of finding a nice, sober woman to come in by the day to the house.
So, basically, we're working now with the same formula we've always been working with: There are more sick people than there are folks willing to care for them. Even if we doubled the number of working nurses tomorrow, nothing would change; hospitals would simply build more wings and schedule more surgeries to take care of the endless lines of sickies outside their doors.
Let's assume that we can't change the Terrible Tragic Shortage. What could make life better for your average working nurse?
It ain't tote bags or pedicures. It's not even higher pay, though that might make a few people more cheerful.
It's people in other professions Getting A Clue.
A third-year internal med resident asked me yesterday how much break time we got during a shift. I said we got fifteen in the morning, half an hour for lunch, and fifteen during the afternoon, though we took what we could when we could.
"Can you skip all your breaks and leave an hour early?" she asked. I peered closely at her to make sure she wasn't joking. She wasn't. She simply had no clue, after years of working with and around nurses at various hospitals, what the job entails. I'm not sure what she thinks we do.
Upper management in hospitals is usually comprised of people who've either never worked in hospitals as nurses or doctors or who did so so long ago that "I walked sixteen miles uphill in the snow to get to the ward where I supervised 29 patients by myself" isn't too much of a stretch. They're management experts and efficiency experts and safety experts, but they have no real gut sense for how acuity affects staffing levels. Most of the patients that I took care of yesterday would've been dead even fifteen years ago, in ICU eight years ago; now they're on the floor in a high-acuity unit. The people in charge of budgeting for our unit have no idea what it's like to work with an open ventriculostomy or three. For them, "brain injury" means Poppa's a little forgetful these days.
I got snarked at by an attending the other day for "turfing" a patient wrong. Apparently, that means I asked for a consult from some service that I shouldn't have; there's some obscure way of going from specialty to subspecialty (for this guy, at least) that I'd not heard of before. The fact that the patient was showing worrisome signs of Some Very Severe, Life-Threatening Complications didn't faze him; he was more worried about his "turf" as regards the case.
I would love to have Dr. Turf, that internal med resident, and our Great Leader follow me for a week. Hell, even a *day*, if I could be sure that they'd actually have to work during that day. I would love for them to get a clue, in other words.
Let's be honest: nine-tenths of the cleanup work, the tidying up of loose ends that's done in a hospital is done by a nurse somewhere. Most of the emotional support a patient gets from non-family members is provided by a nurse. The nasty complications that get caught early are caught by a nurse. The wonky test results get re-draw orders written by a nurse. And those three patients with tubes draining brain juice are taken care of by a nurse who's trying to make sure they don't end up with fulminant meningitis while she's doing re-draws and fixing doctors' mistakes on paperwork.
I hereby propose National Get A Clue Week. One week out of the year, at a time of their choosing, every resident and management person, as well as attendings selected for their attitudes and indolence, would work on the floor with nurses. Full twelve-hour shift, they break when their nurse breaks, they stick to her or to him like glue.
It wouldn't solve the shortage; there's not a lot we can do about that. But maybe, just maybe, it would imbue those folks who think of us as starched white angels with a sense of what it is we do all the hell day long. And that, perhaps, would change their attitudes and actions and make our jobs a little less insane.
Sunday, January 22, 2006
Friday, January 20, 2006
Good news, chilluns, good news!
My pal with ovarian cancer?
Doesn't have cancer at all, thanks be to Frog.
Turns out what she had is some sort of crazy rare benign growth that thankfully didn't contain hair and teeth but is related to that sort of germ cell tumor. She's good.
She's been off Ovarex for a few days now and is feeling much better.
Her family got a little snitty, calling this a "scare" and an "over-reaction", but my feeling is this: when the docs are united in putting a young patient on what's normally a salvage drug for ovarian CA, *they're* pretty damned scared.
She looks like a cross between one of the Desperate Housewives and Skeletor, ie, skinny and absolutely no ass, but is no longer sort of...flat. It's amazing what that 20% difference in "You might live five years" to "You will live five years" will do for a girl's mood. Plus, all her hair has not quite fallen out yet, so she's leaving it.
Thanks to all who sent good wishes and advice and email and hats. I think the general outpouring of goodness had a lot to do with this.
Doesn't have cancer at all, thanks be to Frog.
Turns out what she had is some sort of crazy rare benign growth that thankfully didn't contain hair and teeth but is related to that sort of germ cell tumor. She's good.
She's been off Ovarex for a few days now and is feeling much better.
Her family got a little snitty, calling this a "scare" and an "over-reaction", but my feeling is this: when the docs are united in putting a young patient on what's normally a salvage drug for ovarian CA, *they're* pretty damned scared.
She looks like a cross between one of the Desperate Housewives and Skeletor, ie, skinny and absolutely no ass, but is no longer sort of...flat. It's amazing what that 20% difference in "You might live five years" to "You will live five years" will do for a girl's mood. Plus, all her hair has not quite fallen out yet, so she's leaving it.
Thanks to all who sent good wishes and advice and email and hats. I think the general outpouring of goodness had a lot to do with this.
Thursday, January 19, 2006
This is what I do all day
(With apologies to Beloved Sister, who originated the title.)
0420: get up, get coffee, wonder again why I took a job that requires a forty-minute commute. Sit outside on the porch with the cat and a cup of that coffee.
0440: get into shower.
0620: walk into work, with (hopefully) unwrinkled scrubs, a professional mein, and artfully applied makeup. If it's a good week, my nails will be short and my cuticles tended.
0700-1900: take care of other people.
For the bored patient who's being converted from heparin to coumadin, try to think of a new metaphor that will explain the difference between PTT and INR and the actions of heparin and coumadin. "There's this herd of zebras, see, who all have terrible static cling...." Act out said metaphor to gales of laughter from previously-bored patient.
For the patient who's experiencing intractable pain secondary to anxiety following surgery, reassure him that he will indeed be able to play bad country music on his guitar again. Keep opinion of whether or not this is a good thing to myself. Draw many diagrams of nerve plexuses (plexi? Resolve to look that up) and explain why the pain is worse now than it was prior to surgery. Bite back snotty response when patient's wife makes the predictable "We're not going to let you go home tonight" comment.
Remind self that "we're not going to let you go home" is a huge compliment, and those folks don't know I've heard it five thousand times before.
Eat lunch.
Maybe.
Readjust a heparin drip and bitch at the poor hapless lab personnel who cross my path, because the PTT is two hours late.
Reposition one or two or more of any number of patients, my own and other people's.
Chart. (That should actually be a constant background noise, like a bunch of Gregorian monks with nothing better to do. "Chart. Chart. Chart. Chart.")
Pee. It might be the first time today, but probably not. Every nurse has his or her priorities; mine is peeing.
Discuss end-of-life care with a woman whose son is dying of an easily-treatable brain tumor. Treatable, that is, if you have insurance or if the indigent care department of the hospital hadn't cut you off two years ago.
Consider the possibility of taking up recreational drug use. Decide against it; all the good stuff is tracked.
Chart. (omni in microscopicae chaaaaaaaaartuuuuuuuuussssss....)
Coffee.
Report.
1920-2000: drive home.
post-2000: sit on porch with cat and drink. Could be lemonade, could be Scotch; the important thing is that it ends the day. Wonder how on earth my feet could possibly smell *so very bad*. Admire 0.5 cm dents in ankles from socks; consider, then reject, wearing supphose to work. Wonder if heparinizing patient has thrown herself out of the window through boredom yet. Pee. Note that cat is avoiding my feet. Marvel at the dents that my beeper and waistband have put into my waist.
Consider eating. Recall that the only things in the fridge are biryani rice and leftover nachos. Decide that those sound pretty good anyhow. Eat.
Sleep.
On a day that I have off, that last line is repeated at least twice the following day, along with "drink more coffee" "pee some more" and "poop".
Most nurses I know spend their days off pooping and sleeping, like babies.
I'm on to the latter right now.
0420: get up, get coffee, wonder again why I took a job that requires a forty-minute commute. Sit outside on the porch with the cat and a cup of that coffee.
0440: get into shower.
0620: walk into work, with (hopefully) unwrinkled scrubs, a professional mein, and artfully applied makeup. If it's a good week, my nails will be short and my cuticles tended.
0700-1900: take care of other people.
For the bored patient who's being converted from heparin to coumadin, try to think of a new metaphor that will explain the difference between PTT and INR and the actions of heparin and coumadin. "There's this herd of zebras, see, who all have terrible static cling...." Act out said metaphor to gales of laughter from previously-bored patient.
For the patient who's experiencing intractable pain secondary to anxiety following surgery, reassure him that he will indeed be able to play bad country music on his guitar again. Keep opinion of whether or not this is a good thing to myself. Draw many diagrams of nerve plexuses (plexi? Resolve to look that up) and explain why the pain is worse now than it was prior to surgery. Bite back snotty response when patient's wife makes the predictable "We're not going to let you go home tonight" comment.
Remind self that "we're not going to let you go home" is a huge compliment, and those folks don't know I've heard it five thousand times before.
Eat lunch.
Maybe.
Readjust a heparin drip and bitch at the poor hapless lab personnel who cross my path, because the PTT is two hours late.
Reposition one or two or more of any number of patients, my own and other people's.
Chart. (That should actually be a constant background noise, like a bunch of Gregorian monks with nothing better to do. "Chart. Chart. Chart. Chart.")
Pee. It might be the first time today, but probably not. Every nurse has his or her priorities; mine is peeing.
Discuss end-of-life care with a woman whose son is dying of an easily-treatable brain tumor. Treatable, that is, if you have insurance or if the indigent care department of the hospital hadn't cut you off two years ago.
Consider the possibility of taking up recreational drug use. Decide against it; all the good stuff is tracked.
Chart. (omni in microscopicae chaaaaaaaaartuuuuuuuuussssss....)
Coffee.
Report.
1920-2000: drive home.
post-2000: sit on porch with cat and drink. Could be lemonade, could be Scotch; the important thing is that it ends the day. Wonder how on earth my feet could possibly smell *so very bad*. Admire 0.5 cm dents in ankles from socks; consider, then reject, wearing supphose to work. Wonder if heparinizing patient has thrown herself out of the window through boredom yet. Pee. Note that cat is avoiding my feet. Marvel at the dents that my beeper and waistband have put into my waist.
Consider eating. Recall that the only things in the fridge are biryani rice and leftover nachos. Decide that those sound pretty good anyhow. Eat.
Sleep.
On a day that I have off, that last line is repeated at least twice the following day, along with "drink more coffee" "pee some more" and "poop".
Most nurses I know spend their days off pooping and sleeping, like babies.
I'm on to the latter right now.
Sunday, January 15, 2006
Hobbyists, part one zillion
This is the time of year when, if you work in the typical hospital, the patients who come to you are either very sick or very weird. Sick, because everybody who had a choice about having surgery came in before the end of the year, so as not to have to pay a huge deductible; weird, because the post-Christmas letdown brings in the folks who really, really love their narcotics.
We've got 'em all over the spectrum this time. The one who mixes up whatever liquids are left in the room, complete with pills he's cheeked, to simulate vomit. The one who's complained for so long of pain at 10 on a 1 to 10 scale that she's become addicted to strong painkillers, yet can wander outside, complete with IV pole full of stuff, to smoke during the worst pain crisis. The one who Munched himself into four unnecessary surgeries, years of heavy steroids, and finally, an almost-complete dehiscence of his gut.
I want to put the new Munchers into a room with the experienced Munchers so that they can see what they're getting into.
If you're a Hospital Hobbyist, there is a possibility that you will eventually make yourself sick. Since we deal with people who have diseases that have to be diagnosed by exclusion and that often have wierd and vague symptomatology, we get a fair number of hobbyists. We also get a fair number of folks who started out as hobbyists but have actually become ill. Whether they're injecting Dilaudid and Demerol through their own implanted port at home, or simply going from doctor to doctor to get Vicodin until their livers give out, they will come to us at some point.
Yes, yes, I know: another person cannot rate your pain for you. A nurse has to believe that a patient is really experiencing the pain they say they are. Pain is the fifth vital sign, and should be treated with effective drugs, not shots of saline.
Please. There's a limit.
If you're in pain, you generally don't wait until the nurse is in the room to act like it. (Same with seizures: if you're lying there watching TV while I'm spying on you from outside, only to seize when I walk in the room, I'm going to wonder.) If you're in pain, you generally don't have the energy to steal vials and ampules of goodness from other facilities and stash them in your room when you're with us. If you're in pain, you sure as hell won't have the energy or desire to hang out in the smoking court for four hours, bringing a wide variety of interesting individuals back with you for a little tete a tete.
Eventually, if you complain of severe and unremitting pain long enough, we're going to start using non-narcotic drugs to treat that pain. It could be steroids, which thin your skin and leave you moon-faced and irritable. It could be immunomodulators, which leave you open to lovely infections. It could even be surgery, rather than drugs, as a last-ditch effort to relieve that headache, gut pain, or back pain you've been complaining about for years. You might end up with a shunt here, a colostomy there, or a hunk of metal somewhere else. Is it worth it?
On the other side of the unit is the patient who's really, really fucking sick. She might've had an aneurysm diagnosed shortly before Katrina wiped out the CT scanner; maybe he woke up one morning with CSF pouring from his ear. Could be fulminant meningitis, could be a stroke. If you bite through the tubing leading to your PCA in an attempt to siphon off more painkiller, you take me away from those people that need me.
Some days I go to work with a light heart and a happy smile, knowing that I'll have a chance to actually help somebody feel better, maybe even help them heal a bit. Other days I go to work with a sense of duty, reminding myself of the hourly rate I earn. This week has been full of that second sort of day.
There are still compensations, don't get me wrong. I just worry on my day off about the sick, sick people that I might've missed something on, or might've not taken prime care of, because I was busy rooting under a patient's mattress for the ampules of Demerol stashed there.
We've got 'em all over the spectrum this time. The one who mixes up whatever liquids are left in the room, complete with pills he's cheeked, to simulate vomit. The one who's complained for so long of pain at 10 on a 1 to 10 scale that she's become addicted to strong painkillers, yet can wander outside, complete with IV pole full of stuff, to smoke during the worst pain crisis. The one who Munched himself into four unnecessary surgeries, years of heavy steroids, and finally, an almost-complete dehiscence of his gut.
I want to put the new Munchers into a room with the experienced Munchers so that they can see what they're getting into.
If you're a Hospital Hobbyist, there is a possibility that you will eventually make yourself sick. Since we deal with people who have diseases that have to be diagnosed by exclusion and that often have wierd and vague symptomatology, we get a fair number of hobbyists. We also get a fair number of folks who started out as hobbyists but have actually become ill. Whether they're injecting Dilaudid and Demerol through their own implanted port at home, or simply going from doctor to doctor to get Vicodin until their livers give out, they will come to us at some point.
Yes, yes, I know: another person cannot rate your pain for you. A nurse has to believe that a patient is really experiencing the pain they say they are. Pain is the fifth vital sign, and should be treated with effective drugs, not shots of saline.
Please. There's a limit.
If you're in pain, you generally don't wait until the nurse is in the room to act like it. (Same with seizures: if you're lying there watching TV while I'm spying on you from outside, only to seize when I walk in the room, I'm going to wonder.) If you're in pain, you generally don't have the energy to steal vials and ampules of goodness from other facilities and stash them in your room when you're with us. If you're in pain, you sure as hell won't have the energy or desire to hang out in the smoking court for four hours, bringing a wide variety of interesting individuals back with you for a little tete a tete.
Eventually, if you complain of severe and unremitting pain long enough, we're going to start using non-narcotic drugs to treat that pain. It could be steroids, which thin your skin and leave you moon-faced and irritable. It could be immunomodulators, which leave you open to lovely infections. It could even be surgery, rather than drugs, as a last-ditch effort to relieve that headache, gut pain, or back pain you've been complaining about for years. You might end up with a shunt here, a colostomy there, or a hunk of metal somewhere else. Is it worth it?
On the other side of the unit is the patient who's really, really fucking sick. She might've had an aneurysm diagnosed shortly before Katrina wiped out the CT scanner; maybe he woke up one morning with CSF pouring from his ear. Could be fulminant meningitis, could be a stroke. If you bite through the tubing leading to your PCA in an attempt to siphon off more painkiller, you take me away from those people that need me.
Some days I go to work with a light heart and a happy smile, knowing that I'll have a chance to actually help somebody feel better, maybe even help them heal a bit. Other days I go to work with a sense of duty, reminding myself of the hourly rate I earn. This week has been full of that second sort of day.
There are still compensations, don't get me wrong. I just worry on my day off about the sick, sick people that I might've missed something on, or might've not taken prime care of, because I was busy rooting under a patient's mattress for the ampules of Demerol stashed there.
Monday, January 09, 2006
Coming soon....
I have had a hell of a day. Can you say retroperitoneal hematoma and bleeding out of a kidney? I knew you could.
However, I am not yet so zonked on Chee-tos that I could let this slip by:
January 22nd is Blog For Choice day.
You can expect something foaming-at-the-mouth then.
However, I am not yet so zonked on Chee-tos that I could let this slip by:
January 22nd is Blog For Choice day.
You can expect something foaming-at-the-mouth then.
Sunday, January 08, 2006
The jig is up; the gloves come off...
Beloved Sister sent me this email in response to the post below:
I have decided that every female who is blood-related to me, however
distantly, whether they attend this wedding or not, must on our wedding
day wear a dirndl, an apron, and one of those Dutch hats with the
earpoints that flip up. So you don't have to worry about looking like a
Russian peasant. You'll look like a Flemish peasant. Stay tuned for
color picks and mandatory accessories.
distantly, whether they attend this wedding or not, must on our wedding
day wear a dirndl, an apron, and one of those Dutch hats with the
earpoints that flip up. So you don't have to worry about looking like a
Russian peasant. You'll look like a Flemish peasant. Stay tuned for
color picks and mandatory accessories.
Something tells me I should go get a froofy pink dress with big puffy sleeves and a butt-bow. I just *should*. And a poodle on a leash. With a rhinestone collar. And Big Hair. Like something from Etiquette Hell. Just to teach her a lesson.
The jig is up.
WARNING: boring girly stuff ahead. Nursey stuff later.
Beloved Sister has actually set a date (well, she has to re-set it, because of the conflict of a football game that weekend) for The Wedding. Which means, apparently, that she's actually getting married.
Which means that I have to start trying to look less like a fuzzy-headed, rather plump, goggle-eyed mouthbreather and more like something she would want in her wedding pictures. I am not too proud to admit that I don't particularly look forward to resembling a Russian peasant in a bridesmaid's dress, either.
So I'm joining Brooke and Eileen in the Great Weight-Loss, Weight-Lift Hoo-Ha of 2006.
Lest you think I'm totally girly, I had a revelation the other day when I tried to lift a patient out of a chair with only one other person helping. I've gotten so out of shape that it left me panting. I am no longer strong enough to do my job well, hence the weight-lifting part. *sigh*
On to the nursey bits.
I got floated to another floor. This in itself is not unusual; we often float nurses between floors at 11 am or 3 pm depending on staffing.
What was unusual was that I got floated to a fully-staffed floor.
The nurses had gotten so far into the weeds in the morning that they needed a runner in the afternoon so they could finish their charting and so on. I started an IV, took a few blood pressures, sat with a one-on-one patient (well, he was sound asleep, so I watched "Animal Planet" for a while), and picked somebody up off the floor (more about that in a second).
They'd already gotten one floated nurse; she was the only one who had gotten everything done and didn't need a hand. Now, this floor isn't known for its general efficiency and poise, but I didn't realize things had been so bad in the morning that only the person used to being sharp would actually be on top of things.
To boil it down: the nurses on the floor I floated to have such poor time-management skills that they needed somebody to save their collective asses midway through the shift. That somebody was me. Staffing was happy to float a nurse, at $Outrageous/hour, to be a dogsbody and general factotum.
I was not thrilled. My floor has the highest patient-to-nurse ratio of the hospital on a regular basis, mostly due to short-staffing. We routinely float nurses to other floors so that somebody else can go home (overtime issues, usually). We complained when the first staffing grid came out and got cut by one patient per nurse, so we were each handling five high-acuity patients on day shift. After that, complaining didn't help, so we all got very, very fast and efficient. There is little screwing around on our floor. If you have a patient with an open ventriculostomy (ie, we're draining out brain juice on a continuous basis), one with a lumbar drain, one with seizures, and two knee replacements, you don't have time to chat.
There was nothing but screwing around on the other floor. If you haven't been able to complete paperwork you got at 10:30, and it's 17:00, and the paperwork consists mainly of vitals and allergies, there is a problem.
Things came to a head at ten 'till go-home. A woman came out of a room to inform us that her husband was sliding out of his wheelchair. Nobody moved but me and one attending, an extremely elegant and disciplined woman in very high heels.
We untied the Posey vest that was strangling him, manhandled him back to bed between us, and then left the room to go back to the nurses' station, where four nurses were still sitting, staring at us like calves at a new gate.
I almost said something snarky. Then I remembered earlier in the day, when I actually needed help with a combative patient who outweighed me by about 100 pounds. I had yanked the call bell out of the wall, setting off the emergency call. And I waited, trying to keep the patient from either doing himself or me an injury.
Ten minutes later, after I grew as many arms as an octopus and managed to get him restrained, I walked out to the nurses' station and turned the emergency call light off myself.
To say I'm bugged would be an understatement. I don't mind helping out when people have a truly bad day--I've been almost in tears myself a few times when coworkers have come to my rescue. But I do mind immensely getting stuck with the cleanup when a bunch of folks've been doing their nails all morning.
Beloved Sister has actually set a date (well, she has to re-set it, because of the conflict of a football game that weekend) for The Wedding. Which means, apparently, that she's actually getting married.
Which means that I have to start trying to look less like a fuzzy-headed, rather plump, goggle-eyed mouthbreather and more like something she would want in her wedding pictures. I am not too proud to admit that I don't particularly look forward to resembling a Russian peasant in a bridesmaid's dress, either.
So I'm joining Brooke and Eileen in the Great Weight-Loss, Weight-Lift Hoo-Ha of 2006.
Lest you think I'm totally girly, I had a revelation the other day when I tried to lift a patient out of a chair with only one other person helping. I've gotten so out of shape that it left me panting. I am no longer strong enough to do my job well, hence the weight-lifting part. *sigh*
On to the nursey bits.
I got floated to another floor. This in itself is not unusual; we often float nurses between floors at 11 am or 3 pm depending on staffing.
What was unusual was that I got floated to a fully-staffed floor.
The nurses had gotten so far into the weeds in the morning that they needed a runner in the afternoon so they could finish their charting and so on. I started an IV, took a few blood pressures, sat with a one-on-one patient (well, he was sound asleep, so I watched "Animal Planet" for a while), and picked somebody up off the floor (more about that in a second).
They'd already gotten one floated nurse; she was the only one who had gotten everything done and didn't need a hand. Now, this floor isn't known for its general efficiency and poise, but I didn't realize things had been so bad in the morning that only the person used to being sharp would actually be on top of things.
To boil it down: the nurses on the floor I floated to have such poor time-management skills that they needed somebody to save their collective asses midway through the shift. That somebody was me. Staffing was happy to float a nurse, at $Outrageous/hour, to be a dogsbody and general factotum.
I was not thrilled. My floor has the highest patient-to-nurse ratio of the hospital on a regular basis, mostly due to short-staffing. We routinely float nurses to other floors so that somebody else can go home (overtime issues, usually). We complained when the first staffing grid came out and got cut by one patient per nurse, so we were each handling five high-acuity patients on day shift. After that, complaining didn't help, so we all got very, very fast and efficient. There is little screwing around on our floor. If you have a patient with an open ventriculostomy (ie, we're draining out brain juice on a continuous basis), one with a lumbar drain, one with seizures, and two knee replacements, you don't have time to chat.
There was nothing but screwing around on the other floor. If you haven't been able to complete paperwork you got at 10:30, and it's 17:00, and the paperwork consists mainly of vitals and allergies, there is a problem.
Things came to a head at ten 'till go-home. A woman came out of a room to inform us that her husband was sliding out of his wheelchair. Nobody moved but me and one attending, an extremely elegant and disciplined woman in very high heels.
We untied the Posey vest that was strangling him, manhandled him back to bed between us, and then left the room to go back to the nurses' station, where four nurses were still sitting, staring at us like calves at a new gate.
I almost said something snarky. Then I remembered earlier in the day, when I actually needed help with a combative patient who outweighed me by about 100 pounds. I had yanked the call bell out of the wall, setting off the emergency call. And I waited, trying to keep the patient from either doing himself or me an injury.
Ten minutes later, after I grew as many arms as an octopus and managed to get him restrained, I walked out to the nurses' station and turned the emergency call light off myself.
To say I'm bugged would be an understatement. I don't mind helping out when people have a truly bad day--I've been almost in tears myself a few times when coworkers have come to my rescue. But I do mind immensely getting stuck with the cleanup when a bunch of folks've been doing their nails all morning.
Tuesday, January 03, 2006
Today I cooked.
Today I cooked puttanesca casserole (puttanesca sauce over ziti with tiny crumbles of good cheeses throughout) and blueberry muffins and some Americano-style fried rice. I boiled pasta and crushed tomatoes and melted butter.
Because today a friend of mine called me. She's 27. For the last three months she's been steadily losing weight--attributing that to stress--and having dyspepsia, diarrhea, abdominal pain, and bloating. The onco nurses in the readership know, of course, where this is going.
She has stage I ovarian cancer. She's going in tomorrow for surgery to remove the ovary and the Fallopian tube; she's been on Ovarex for about three weeks now.
Thank God, I suppose, that it's stage I. Depending on what sort of cancer it is, she has between a sixty percent and an eighty percent chance of surviving to her 32nd birthday. It's weird to think of sixty to eighty as good news; with brain tumors, you generally die or you don't.
It's weird to think that there's a 20% to 40% chance--if all goes really well--that she won't live to be as old as I am.
I've ordered a pink wig. She's a "Sex In The City" fan; she'll get the reference. I'm also taking over some big earrings, since she's already losing her hair, so she can be one of those bald women who are all about earrings.
And mashed potatoes. She's down to a size 2; the woman is five-eight at least and looks healthily slender in an 8. And a mix CD for courage. And some macaroni and cheese, since she needs the calories.
I promised her that when she's ready, I'll shave her head for her with the same clippers I'll use to shave mine.
I'm proud of my reaction when she told me. Rather than freaking out, I said, "Well, shit. That sucks. But, you know, you can't die. You'll save your husband some paperwork (she's in the middle of a divorce), but dying is really not all it's cracked up to be." She laughed. She's looking for things to make her laugh, these days.
So today I cooked. There's a limited amount I can do to make my friend laugh, the night before her surgery, so I'll cook. At least it keeps me from crying.
Because today a friend of mine called me. She's 27. For the last three months she's been steadily losing weight--attributing that to stress--and having dyspepsia, diarrhea, abdominal pain, and bloating. The onco nurses in the readership know, of course, where this is going.
She has stage I ovarian cancer. She's going in tomorrow for surgery to remove the ovary and the Fallopian tube; she's been on Ovarex for about three weeks now.
Thank God, I suppose, that it's stage I. Depending on what sort of cancer it is, she has between a sixty percent and an eighty percent chance of surviving to her 32nd birthday. It's weird to think of sixty to eighty as good news; with brain tumors, you generally die or you don't.
It's weird to think that there's a 20% to 40% chance--if all goes really well--that she won't live to be as old as I am.
I've ordered a pink wig. She's a "Sex In The City" fan; she'll get the reference. I'm also taking over some big earrings, since she's already losing her hair, so she can be one of those bald women who are all about earrings.
And mashed potatoes. She's down to a size 2; the woman is five-eight at least and looks healthily slender in an 8. And a mix CD for courage. And some macaroni and cheese, since she needs the calories.
I promised her that when she's ready, I'll shave her head for her with the same clippers I'll use to shave mine.
I'm proud of my reaction when she told me. Rather than freaking out, I said, "Well, shit. That sucks. But, you know, you can't die. You'll save your husband some paperwork (she's in the middle of a divorce), but dying is really not all it's cracked up to be." She laughed. She's looking for things to make her laugh, these days.
So today I cooked. There's a limited amount I can do to make my friend laugh, the night before her surgery, so I'll cook. At least it keeps me from crying.
Monday, January 02, 2006
Cat came back/The very next day...
So I went to pick up The Cat at the vet today.
The receptionist looked at me when I came in and said, "I'm here to ransom my cat" and replied, "The man-eating tortie with the bad attitude? I'll have our vet tech go get her."
The tech wouldn't touch her. Nobody would. I was about to go in there myself and haul her out of her boarding kennel when the guy who gets picked for the awful jobs volunteered, bless him.
My cat has the only chart at the office with a huge CAUTION sticker on it.
*sigh* My cat is Gregory House in a fur coat.
What I cook on my day off:
In other news, I've come across a close approximation of Buca di Beppo's canellini beans and arugula. Herewith:
1 can of canellini beans
about a half cup of petite-dice tomatoes and juice
five or six nice-sized cloves of garlic, chopped
a teaspoon or so of oregano
salt to taste
Dump all of that into a saucepan and let it simmer until the flavors blend and the beans get good and soft. It should be more stewy than liquidy.
Add:
A couple of big handfuls of baby spinach, whole, or a couple of big handfuls of arugula, chopped up.
Simmer (barely) until the greens are soft and wilted. This will not take very long at all.
This makes enough for two generous side dishes or one serving for a real beans-and-greens nut.
Also,
Product Reviews!
Bissell Quick Steamer Powerbrush
This is a miniature upright carpet shampooer, not really a steamer, that you can get at Lowe's for 84 bucks. You fill the back chamber with hot water and a cleaning solution, then turn the thing on and press the trigger. It sprays automatically, scrubs your carpet, and then suctions up the dirty (oooicky) water.
This damn thing works like a *champ*. The only drawback is with the dirty water collector: not only do you have to empty it three times for every full tank of cleaning solution, but it has some weird vent/opening arrangement that means you'll spill water all over the carpet if you're not paying attention. Other than that minor quibble, I am in love with this machine.
It's good for spaces 8'x8' or thereabouts. Since I don't have too much contiguous space in my wee apartment, it works fine. It even raised the trodden-down pile in the living room. You'll still have to pretreat things like cat pee stains, but on ordinary ucky tracked-in greasy yuck dirt it works great. And the carpet will dry in an hour or two if you turn on the ceiling fan.
Judgement: If you have crappy carpets, this is the widget you need.
L'oreal Volume Shocking Mascara
I have six skinny eyelashes. This product made me have two skinny eyelashes, like a Muppet. Furthermore, the eyelashes were bizarrely Tammy-Faye-esque in their clumpiness.
See, this mascara *ought* to work. There's a comb applicator on the color side (it's one of those two-sided deals with a colorless foundation prep), which is the greatest way ever to apply mascara. Unfortunately, they've done something funky to the comb so it's not actually a comb, per se; it's more a toothy V-shaped thingamajig that deposits approximately ten pounds of goop on each of your six skinny lashes, then sticks them together.
What a disappointment, especially for twelve fucking dollars. If you have six skinny lashes, stick with Maybelline Full & Soft.
Judgement: Run away, run away.
American Airlines Snack Box
In case you haven't noticed, there is no longer meal service on most domestic airline flights. Instead, for three bucks, American (and I assume other carriers) will sell you a "snack box" full of processed food that will presumably keep you from chewing off your seatmate's arm out of hunger or boredom.
We were offered the same snack box on two flights (same menu, I mean). The first flight, Chef Boy and I were curious and so got a couple. The second flight we smuggled on McDonald's and a flask of bourbon.
The snack box contains one chocolate biscotti, semi-stale; one one-ounce hunk of unidentifiable processed cheese in foil, two "water crackers", one pack of yogurt-covered raisins, and a breakfast bar from some manufacturer I don't remember.
I skipped the raisins and the breakfast bar. The cheese was...well, I'm sure I've run into something like it before; you could probably use it to close up holes in peoples' skulls. The water crackers, thank God, they didn't manage to mess up. The biscotti was semi-stale.
Judgement: Avoid. Get a bagel or something and carry it on.
I'm going to go eat an entire pan of greens & beans now.
The receptionist looked at me when I came in and said, "I'm here to ransom my cat" and replied, "The man-eating tortie with the bad attitude? I'll have our vet tech go get her."
The tech wouldn't touch her. Nobody would. I was about to go in there myself and haul her out of her boarding kennel when the guy who gets picked for the awful jobs volunteered, bless him.
My cat has the only chart at the office with a huge CAUTION sticker on it.
*sigh* My cat is Gregory House in a fur coat.
What I cook on my day off:
In other news, I've come across a close approximation of Buca di Beppo's canellini beans and arugula. Herewith:
1 can of canellini beans
about a half cup of petite-dice tomatoes and juice
five or six nice-sized cloves of garlic, chopped
a teaspoon or so of oregano
salt to taste
Dump all of that into a saucepan and let it simmer until the flavors blend and the beans get good and soft. It should be more stewy than liquidy.
Add:
A couple of big handfuls of baby spinach, whole, or a couple of big handfuls of arugula, chopped up.
Simmer (barely) until the greens are soft and wilted. This will not take very long at all.
This makes enough for two generous side dishes or one serving for a real beans-and-greens nut.
Also,
Product Reviews!
Bissell Quick Steamer Powerbrush
This is a miniature upright carpet shampooer, not really a steamer, that you can get at Lowe's for 84 bucks. You fill the back chamber with hot water and a cleaning solution, then turn the thing on and press the trigger. It sprays automatically, scrubs your carpet, and then suctions up the dirty (oooicky) water.
This damn thing works like a *champ*. The only drawback is with the dirty water collector: not only do you have to empty it three times for every full tank of cleaning solution, but it has some weird vent/opening arrangement that means you'll spill water all over the carpet if you're not paying attention. Other than that minor quibble, I am in love with this machine.
It's good for spaces 8'x8' or thereabouts. Since I don't have too much contiguous space in my wee apartment, it works fine. It even raised the trodden-down pile in the living room. You'll still have to pretreat things like cat pee stains, but on ordinary ucky tracked-in greasy yuck dirt it works great. And the carpet will dry in an hour or two if you turn on the ceiling fan.
Judgement: If you have crappy carpets, this is the widget you need.
L'oreal Volume Shocking Mascara
I have six skinny eyelashes. This product made me have two skinny eyelashes, like a Muppet. Furthermore, the eyelashes were bizarrely Tammy-Faye-esque in their clumpiness.
See, this mascara *ought* to work. There's a comb applicator on the color side (it's one of those two-sided deals with a colorless foundation prep), which is the greatest way ever to apply mascara. Unfortunately, they've done something funky to the comb so it's not actually a comb, per se; it's more a toothy V-shaped thingamajig that deposits approximately ten pounds of goop on each of your six skinny lashes, then sticks them together.
What a disappointment, especially for twelve fucking dollars. If you have six skinny lashes, stick with Maybelline Full & Soft.
Judgement: Run away, run away.
American Airlines Snack Box
In case you haven't noticed, there is no longer meal service on most domestic airline flights. Instead, for three bucks, American (and I assume other carriers) will sell you a "snack box" full of processed food that will presumably keep you from chewing off your seatmate's arm out of hunger or boredom.
We were offered the same snack box on two flights (same menu, I mean). The first flight, Chef Boy and I were curious and so got a couple. The second flight we smuggled on McDonald's and a flask of bourbon.
The snack box contains one chocolate biscotti, semi-stale; one one-ounce hunk of unidentifiable processed cheese in foil, two "water crackers", one pack of yogurt-covered raisins, and a breakfast bar from some manufacturer I don't remember.
I skipped the raisins and the breakfast bar. The cheese was...well, I'm sure I've run into something like it before; you could probably use it to close up holes in peoples' skulls. The water crackers, thank God, they didn't manage to mess up. The biscotti was semi-stale.
Judgement: Avoid. Get a bagel or something and carry it on.
I'm going to go eat an entire pan of greens & beans now.
Sunday, January 01, 2006
Santa's Oversights
I was having trouble sleeping. In lieu of slumber, I started making a list of things Santa apparently overlooked this year; I didn't find any of them under the tree. Listen up, Big Guy: I expect you and all ten reindeer to come through next year.
1. An instantaneous-travel device, with one portal here, one at work, and one at Green Lake in Seattle. It would, of course, have to be secured somehow so confused residents and joggers didn't end up blundering around my kitchen. It'd be so nice to be able to skip the commute and go jogging instead.
2. One of those automatic massage tables like Lazarus Long had on Tertius. That would really come in handy right now.
3. Failing that, the whole refresher.
4. A flying car. With radar and a cloaking device. Nothing fancy, really; just something to allow me to zip around doing errands a bit more efficiently.
5. Synthahol, like on the old Star Trek.
6. Antigeria. That could be fun for a while.
7. The sudden and simultaneous implosion of all Starbucks and McDonald's everywhere. Also any brewery that makes mass-market beer.
8. A plate of really good poutine. I feel like sending my pals in Montreal a telegram: AM STARVING STOP SEND POUTINE STOP SITUATION CRITICAL STOP PS DON'T FORGET THE BACON AND MUSHROOMS
9. A time-travel machine. With appropriate vaccination schedule.
10. One of two: a one-day cure for the common cold, or a one-day cure for athlete's foot. Either would probably promote human happiness and world peace; I'm not picky.
1. An instantaneous-travel device, with one portal here, one at work, and one at Green Lake in Seattle. It would, of course, have to be secured somehow so confused residents and joggers didn't end up blundering around my kitchen. It'd be so nice to be able to skip the commute and go jogging instead.
2. One of those automatic massage tables like Lazarus Long had on Tertius. That would really come in handy right now.
3. Failing that, the whole refresher.
4. A flying car. With radar and a cloaking device. Nothing fancy, really; just something to allow me to zip around doing errands a bit more efficiently.
5. Synthahol, like on the old Star Trek.
6. Antigeria. That could be fun for a while.
7. The sudden and simultaneous implosion of all Starbucks and McDonald's everywhere. Also any brewery that makes mass-market beer.
8. A plate of really good poutine. I feel like sending my pals in Montreal a telegram: AM STARVING STOP SEND POUTINE STOP SITUATION CRITICAL STOP PS DON'T FORGET THE BACON AND MUSHROOMS
9. A time-travel machine. With appropriate vaccination schedule.
10. One of two: a one-day cure for the common cold, or a one-day cure for athlete's foot. Either would probably promote human happiness and world peace; I'm not picky.
Saturday, December 31, 2005
Happy New Year, everybody!
Chef Boy and I got home this afternoon, and after I ate, I was so tired I went to bed and napped for a while.
Christmas was lovely, unsullied by things having to do with work. Chef Boy and I met Brooke of odious woman at a place called Pike Pub for dinner and a beer. She's funnier and more charming in person than in her blog, even, and has really great glasses. She gave us great tips for living in Seattle ("Get a light box, some antidepressants, and be prepared to pay through the nose for housing") and showed us a good time. Thanks, Brooke! I had what I thought was going to be a funny post about our meeting worked out in my head, but I'm just too damned tired.
Beloved Sister's boyfriend announced their upcoming nup-shulls by giving her a gorgeous diamond. Now, I am not a fan of diamonds, generally, but this one was really cool--it was set like a little flying saucer about to land. The big joke for the next three days was getting blinded by The Ring. Yes, we're lame jokesters in my family.
Mom and Dad's cat, Astro (a Maine Coon cross) decided he didn't loathe me as much as he thought he might. Beloved Sister's dog, Bones (a Staffordshire Terrier mix) decided my lap was a good place to sit in the car. It was highly animalistic, as Mom would say.
Beloved Sis and CB and I also made the biennial pilgrimage to Archie McPhee. Everything I loved was on sale, which I take as evidence that maybe I didn't burn down that orphanage in a past life. Or, at least, that I didn't lock the doors first.
Seattle itself was beautiful, with frequent sun breaks and only one day of pouring all-day rain--the last day we were there. We got to see Heather and Will, friends of mine and purveyors of wonderful IBS remedies, in their new setup, a warehouse at Pioneer Square. I'm so pleased for and proud of them I can hardly stand it, and I can testify: if you have IBS, Crohn's, or colitis, you'd do well to visit Heather's website.
We saw the new baby otter at the Aquarium (cute overload!) and an entire family group of gorillas hanging out at the zoo. Also a tapir, looking disgruntled, and an elephant having a bath/snack/rubdown all at once in the elephant barn. That last was worth the price of admission; who knew a several-ton elephant would lie down on her side and stretch like a cat while being hosed off by her keepers?
Recommendations after this trip: the Wallingford Pub on 35th really does have the best bacon cheeseburger in town. Anthony's, whether it's the Home Port or the fish-and-chips stand on the pier, has excellent fish. The local beer is marvelous, no matter what you get: I had no bad beer for five days. Take the 522 express bus if you're leaving downtown for Wallingford; the other routes are milk runs. Archie McPhee continues its tradition of being the world's best source for rubber rats and cool Hindu-themed snackboxes. Sully's near the zoo (Phinney and about 60th, I think) was having technical problems the day we went (the women's bathroom ceiling had fallen in) but Sully himself was gracious and poured me a pint of really good IPA. Take his suggestions on what to drink. And be sure you hit the Space Needle if you're a first-timer. Really. It's cheesy and touristy and pricey, but it really is cool to see all of Seattle spread out underneath you.
And now I am sleepy again and will ring in the new year with a snooze.
Christmas was lovely, unsullied by things having to do with work. Chef Boy and I met Brooke of odious woman at a place called Pike Pub for dinner and a beer. She's funnier and more charming in person than in her blog, even, and has really great glasses. She gave us great tips for living in Seattle ("Get a light box, some antidepressants, and be prepared to pay through the nose for housing") and showed us a good time. Thanks, Brooke! I had what I thought was going to be a funny post about our meeting worked out in my head, but I'm just too damned tired.
Beloved Sister's boyfriend announced their upcoming nup-shulls by giving her a gorgeous diamond. Now, I am not a fan of diamonds, generally, but this one was really cool--it was set like a little flying saucer about to land. The big joke for the next three days was getting blinded by The Ring. Yes, we're lame jokesters in my family.
Mom and Dad's cat, Astro (a Maine Coon cross) decided he didn't loathe me as much as he thought he might. Beloved Sister's dog, Bones (a Staffordshire Terrier mix) decided my lap was a good place to sit in the car. It was highly animalistic, as Mom would say.
Beloved Sis and CB and I also made the biennial pilgrimage to Archie McPhee. Everything I loved was on sale, which I take as evidence that maybe I didn't burn down that orphanage in a past life. Or, at least, that I didn't lock the doors first.
Seattle itself was beautiful, with frequent sun breaks and only one day of pouring all-day rain--the last day we were there. We got to see Heather and Will, friends of mine and purveyors of wonderful IBS remedies, in their new setup, a warehouse at Pioneer Square. I'm so pleased for and proud of them I can hardly stand it, and I can testify: if you have IBS, Crohn's, or colitis, you'd do well to visit Heather's website.
We saw the new baby otter at the Aquarium (cute overload!) and an entire family group of gorillas hanging out at the zoo. Also a tapir, looking disgruntled, and an elephant having a bath/snack/rubdown all at once in the elephant barn. That last was worth the price of admission; who knew a several-ton elephant would lie down on her side and stretch like a cat while being hosed off by her keepers?
Recommendations after this trip: the Wallingford Pub on 35th really does have the best bacon cheeseburger in town. Anthony's, whether it's the Home Port or the fish-and-chips stand on the pier, has excellent fish. The local beer is marvelous, no matter what you get: I had no bad beer for five days. Take the 522 express bus if you're leaving downtown for Wallingford; the other routes are milk runs. Archie McPhee continues its tradition of being the world's best source for rubber rats and cool Hindu-themed snackboxes. Sully's near the zoo (Phinney and about 60th, I think) was having technical problems the day we went (the women's bathroom ceiling had fallen in) but Sully himself was gracious and poured me a pint of really good IPA. Take his suggestions on what to drink. And be sure you hit the Space Needle if you're a first-timer. Really. It's cheesy and touristy and pricey, but it really is cool to see all of Seattle spread out underneath you.
And now I am sleepy again and will ring in the new year with a snooze.
Saturday, December 24, 2005
Hallelujah, Noel, be it Heaven or Hell...
A 2005 retrospective, done now because I expect to be too zonked from travelling on New Year's Eve to do it then, and because I'm avoiding the laundry.
For another year, I've avoided being hauled in by the IRS, FBI, BON, or DON. The NSA and the CIA don't want me, either.
I did not get married this year. w00t!
Nothing burned down and I didn't kill anybody, either accidentally or on purpose.
My cat doesn't hate me any more than she did last year.
I have a new car, the same (wonderful) apartment, and a few new friends. Chef Boy and I will have been dating for two (!!) years in January. No wedding bells are in the picture, so keep your toasters.
I put on a few pounds, but those'll come off eventually.
We lost a few patients, one attending, and one resident. The patients leave little-bitty holes, not because they don't matter but because you lose so damned many that unless you prioritize, your soul will look like Swiss cheese inside of a week. The attending left a big hole. The resident left a great yawning chasm, horrible, since she was younger than me and infinitely more deserving of life.
Hal, Stacy, Bill, Doreen, Mark, Marie...say hi to everybody up there, okay?
Our beloved friend John failed for the second year in a row (speaking of dead people) to quit calling in dead and come in to work again. We're getting pretty fucking sick of covering for him.
Kristen had a baby and has a new kitten. Lydia has a new granddaughter. T-bird got married. No marriages failed, and one was saved by the skin of its teeth.
Emmy's husband does not have cancer, thank God. Amy's baby lived her first year with very few problems; not bad for a 26-week preemie. My oldest goddaughter from my first marriage graduated high school this year. The world keeps turning.
Bonnie the Drama Dachshund adopted me as her human.
I got a really, really kick-ass pair of boots. And I got interviewed for a Major National Publication on blogging. That was fun.
And, in hopes that some of her good kharma will rub off on me, I'll be buying Brooke from Odious Woman a drink this week (excited squealing).
I'll catch up with you guys later; perhaps from Seattle, where I will be hanging out with the family, or perhaps from an undisclosed location after I return from the Pacific Northwet.
For another year, I've avoided being hauled in by the IRS, FBI, BON, or DON. The NSA and the CIA don't want me, either.
I did not get married this year. w00t!
Nothing burned down and I didn't kill anybody, either accidentally or on purpose.
My cat doesn't hate me any more than she did last year.
I have a new car, the same (wonderful) apartment, and a few new friends. Chef Boy and I will have been dating for two (!!) years in January. No wedding bells are in the picture, so keep your toasters.
I put on a few pounds, but those'll come off eventually.
We lost a few patients, one attending, and one resident. The patients leave little-bitty holes, not because they don't matter but because you lose so damned many that unless you prioritize, your soul will look like Swiss cheese inside of a week. The attending left a big hole. The resident left a great yawning chasm, horrible, since she was younger than me and infinitely more deserving of life.
Hal, Stacy, Bill, Doreen, Mark, Marie...say hi to everybody up there, okay?
Our beloved friend John failed for the second year in a row (speaking of dead people) to quit calling in dead and come in to work again. We're getting pretty fucking sick of covering for him.
Kristen had a baby and has a new kitten. Lydia has a new granddaughter. T-bird got married. No marriages failed, and one was saved by the skin of its teeth.
Emmy's husband does not have cancer, thank God. Amy's baby lived her first year with very few problems; not bad for a 26-week preemie. My oldest goddaughter from my first marriage graduated high school this year. The world keeps turning.
Bonnie the Drama Dachshund adopted me as her human.
I got a really, really kick-ass pair of boots. And I got interviewed for a Major National Publication on blogging. That was fun.
And, in hopes that some of her good kharma will rub off on me, I'll be buying Brooke from Odious Woman a drink this week (excited squealing).
I'll catch up with you guys later; perhaps from Seattle, where I will be hanging out with the family, or perhaps from an undisclosed location after I return from the Pacific Northwet.
Friday, December 23, 2005
Let us all sing praises....
To the Best Boyfiend Ever (Chef Boy)...
...who took my antisocial, biting cat to the vet today to be kennelled for the Christmas holiday. She hates everybody but him. I think this is a very good sign.
To Amazing Nurses' Aides...
...who meet the doctor you've paged STAT when your patient goes into anaphylactic shock and are able to tell her exactly what time things started going south and what you've done so far, including dosages.
...and who deal, without complaint, with a paraplegic patient who I've just fed lots of laxatives to because he hasn't had a bowel movement in a week...
...and who manage, even when things are going to Absolute Hell, to make one patient after another laugh.
To The Talented Young Doctor Mike...
...who always manages something snarkier than I could ever have thought up on the spur of the moment...
To Doctor Bob...
...who brings me pictures of his Siamese cat unwrapping Christmas presents and thus turns a horrible day into a funny, bearable one...
To Glenda from the lab...
...who understands that STAT means STAT and who always, always gets her blood on the first try...
To my fellow nurses...
...who wipe butt when I have no time, who handle crises when I have no brain, and who remind me what on earth I got into this business for when I have no hope.
Happy Christmas, everybody.
...who took my antisocial, biting cat to the vet today to be kennelled for the Christmas holiday. She hates everybody but him. I think this is a very good sign.
To Amazing Nurses' Aides...
...who meet the doctor you've paged STAT when your patient goes into anaphylactic shock and are able to tell her exactly what time things started going south and what you've done so far, including dosages.
...and who deal, without complaint, with a paraplegic patient who I've just fed lots of laxatives to because he hasn't had a bowel movement in a week...
...and who manage, even when things are going to Absolute Hell, to make one patient after another laugh.
To The Talented Young Doctor Mike...
...who always manages something snarkier than I could ever have thought up on the spur of the moment...
To Doctor Bob...
...who brings me pictures of his Siamese cat unwrapping Christmas presents and thus turns a horrible day into a funny, bearable one...
To Glenda from the lab...
...who understands that STAT means STAT and who always, always gets her blood on the first try...
To my fellow nurses...
...who wipe butt when I have no time, who handle crises when I have no brain, and who remind me what on earth I got into this business for when I have no hope.
Happy Christmas, everybody.
Wednesday, December 21, 2005
So, just after I went to sleep,
I ended up with the same nightmare-situation, I can't believe this is happening patient that I had over the weekend. Only with more tubes and wires and with a worse blood pressure, if such a thing were possible.
Then somehow I got a NICU patient as well. Now, I don't do newborns; never have. But they had to overflow the NICU somewhere, and so up I ended with some five-pound, very sick little kid. RSV, or something. Anyway, kid couldn't breathe. Bad deal.
Then I got *another* patient, who just sort of left the room and disappeared. Guess I should've been happy that one could walk, but I would've liked to have seen her before she left the floor.
Just about that time, Mom called with the news that Dad had left her for some 50-year-old ER nurse. She looked a proper chippie, too. Mom decided to move in with me.
And then I had to find some obscure diagnosis in some obscure book that kept changing titles every time I put it down, while trying to figure out why there was an obese, bloated, bald teenager sitting on a stool on the other side of the counter.
I woke up just after the OR called and some surgeon was talking to me like I was Central Sterile.
No more combinations of "House", loaded baked potato, and Dogfish Head IPA right before bed.
Then somehow I got a NICU patient as well. Now, I don't do newborns; never have. But they had to overflow the NICU somewhere, and so up I ended with some five-pound, very sick little kid. RSV, or something. Anyway, kid couldn't breathe. Bad deal.
Then I got *another* patient, who just sort of left the room and disappeared. Guess I should've been happy that one could walk, but I would've liked to have seen her before she left the floor.
Just about that time, Mom called with the news that Dad had left her for some 50-year-old ER nurse. She looked a proper chippie, too. Mom decided to move in with me.
And then I had to find some obscure diagnosis in some obscure book that kept changing titles every time I put it down, while trying to figure out why there was an obese, bloated, bald teenager sitting on a stool on the other side of the counter.
I woke up just after the OR called and some surgeon was talking to me like I was Central Sterile.
No more combinations of "House", loaded baked potato, and Dogfish Head IPA right before bed.
Tuesday, December 20, 2005
You know it's One Of Those Days when...
I first had an inkling of trouble when the call bell rang and all we heard from the intercom was a scuffling noise. One of the physical therapists and I went into the room as quickly as we could, hustling our little butts, and found fists, and nurses dancing and feinting like Ali, and general chaos.
He'd been a rancher all his life. We don't grow people like this any longer: well over six feet tall even in his seventies, never drank or smoked, never sick a day in his life until his aneurysm bled. The bleed had unfortunately affected only his personality and not his body; he was standing, bleeding from where he'd tried to remove the second Foley catheter, screaming, "GODDAMMIT! I'll KILL you! Let GO OF ME!!"
He's a strong sonofabitch, I'll tell you that. Two nurses got his arms--staying well away from his hands, as he'd already tried to break one nurse's wrist and another one's finger--and I put a shoulder into his belly and shoved him onto the bed. Once we got him into restraints, one on each limb, and a vest, he continued to fight. The bed shook and creaked and groaned until his nurse got some Ativan into him.
The irony is that we knew him from before, when his wife came in for surgery. He was (before the bleed) the sweetest man you'd ever hope to meet. Polite, courtly, took good care of his family. Now he's trying to get out of the hospital, pulling out multiple lines, and punching security guards in the face.
Later, one of the nurses asked me about the amount of force that's acceptable when you're subduing a combative patient. She was in there with one other person when he started to go berzerk, and was merely staying out of his way as best she could, dodging his punches and kicks.
"I was afraid to grab his arm or put him on the floor, because I was afraid I might hurt him" she said. Now, this is a tiny woman--smaller than me--who spent the first half of her life in very rough neighborhoods. She's taken punches from patients before with no more than a blink.
"Lou," I said, "whatever amount of force is necessary, without breaking bones, you use. If somebody is trying to hurt you, the objective is to get them tied down and sedated before they can manage to break something of yours." Hence my shoulder-in-the-solar-plexus trick: I've found it works well with a distracted, combative patient.
It doesn't work so well with the oriented, mean patient. One of our nurses is out following surgery for a broken neck that a patient broke on purpose.
The woman weighed close to five hundred pounds and was, put simply, meaner than Satan. When the nurse taking care of her got close enough one day, she simply reached out, grabbed the nurse's head, and pulled. Score: nurse with cervical fractures, patient refused services forever.
Luckily, the nurse will be fine. The patient? I don't give a damn.
I woke up this morning sore and exhausted and couldn't remember why I was so achy. Then it hit me--I'd spent several minutes riding a bucking bronco of a man down onto a bed, then holding his legs down.
Nursing. It's glamorous! It's exciting! It's the toughest job you'll ever lay in stores of Advil for.
He'd been a rancher all his life. We don't grow people like this any longer: well over six feet tall even in his seventies, never drank or smoked, never sick a day in his life until his aneurysm bled. The bleed had unfortunately affected only his personality and not his body; he was standing, bleeding from where he'd tried to remove the second Foley catheter, screaming, "GODDAMMIT! I'll KILL you! Let GO OF ME!!"
He's a strong sonofabitch, I'll tell you that. Two nurses got his arms--staying well away from his hands, as he'd already tried to break one nurse's wrist and another one's finger--and I put a shoulder into his belly and shoved him onto the bed. Once we got him into restraints, one on each limb, and a vest, he continued to fight. The bed shook and creaked and groaned until his nurse got some Ativan into him.
The irony is that we knew him from before, when his wife came in for surgery. He was (before the bleed) the sweetest man you'd ever hope to meet. Polite, courtly, took good care of his family. Now he's trying to get out of the hospital, pulling out multiple lines, and punching security guards in the face.
Later, one of the nurses asked me about the amount of force that's acceptable when you're subduing a combative patient. She was in there with one other person when he started to go berzerk, and was merely staying out of his way as best she could, dodging his punches and kicks.
"I was afraid to grab his arm or put him on the floor, because I was afraid I might hurt him" she said. Now, this is a tiny woman--smaller than me--who spent the first half of her life in very rough neighborhoods. She's taken punches from patients before with no more than a blink.
"Lou," I said, "whatever amount of force is necessary, without breaking bones, you use. If somebody is trying to hurt you, the objective is to get them tied down and sedated before they can manage to break something of yours." Hence my shoulder-in-the-solar-plexus trick: I've found it works well with a distracted, combative patient.
It doesn't work so well with the oriented, mean patient. One of our nurses is out following surgery for a broken neck that a patient broke on purpose.
The woman weighed close to five hundred pounds and was, put simply, meaner than Satan. When the nurse taking care of her got close enough one day, she simply reached out, grabbed the nurse's head, and pulled. Score: nurse with cervical fractures, patient refused services forever.
Luckily, the nurse will be fine. The patient? I don't give a damn.
I woke up this morning sore and exhausted and couldn't remember why I was so achy. Then it hit me--I'd spent several minutes riding a bucking bronco of a man down onto a bed, then holding his legs down.
Nursing. It's glamorous! It's exciting! It's the toughest job you'll ever lay in stores of Advil for.
Saturday, December 17, 2005
Just a quick update...
I have now eaten five times and have not yorked (credit: Dr. V) once.
I think tomorrow will be ducky. Just lovely.
Tonight I actually ate half a burger and three french fries. Yay me.
Chef Boy looked concerned earlier and said "Six pounds in five days? You're going to waste away to nothing!" Considering that I still outweigh him by almost 25 pounds, can you not see why I love the man?
If it *is* my appendix, it'll just have to wait until Tuesday to come out. That's my final offer.
I think tomorrow will be ducky. Just lovely.
Tonight I actually ate half a burger and three french fries. Yay me.
Chef Boy looked concerned earlier and said "Six pounds in five days? You're going to waste away to nothing!" Considering that I still outweigh him by almost 25 pounds, can you not see why I love the man?
If it *is* my appendix, it'll just have to wait until Tuesday to come out. That's my final offer.
From the *duh* files...
Nurses face sexual harrassment
Really? You don't say. Grunt Doc, DB's Medical Rants, and Code: The Web Socket have all taken stabs at this; Alwin at C:TWS has a particularly funny experience to recount.
I regularly get sexually harrassed at work by patients; whether it's sweetie or honey pie, or let me fix you up with my son, or even (once) a man trying to pull me into the bed with him for a kiss. It comes with the territory when you're working with brain-injured people. When you're missing part of your frontal lobes, or they've been otherwise damaged, you're not going to have the same control and pay the same attention to social norms that other people do. At any road, it happens at least twice a month.
It also happens to the female residents and doctors. There have been times when I've had to knock on a patient's door and say something like, "Doctor X, there's an urgent phone call for you at the desk" in order to get Doctor X away from the patient who's *sure* that her nephew's business partner's son, who sells used cars in Atlanta, is just the man for her.
The worst is when you're standing over a patient, assisting a (male) doctor with a procedure, when the patient pipes up with "Don't you think Doctor Y is cute?" My answer from the start has always been a puzzled look and "When?"
I have some theories as to why this happens so often. First, it's because some of our patients are brain-damaged. There's not much you can do about that, really. Second, a lot of patients (especially the older gentlemen) seem to think that when one social norm goes away (like I'm wiping your ass for the fortieth time today), the others go away too, and they can say or do whatever they want acceptably. This misconception also explains the amazingly bigoted stuff I hear from patients on a weekly basis.
And, finally, let's face it: a lot of patients grew up in the 1930's through 1950's, a time when nurses were seen as passive, accomodating helpmates. The popular image of the Sexy Nurse hasn't died yet (Google "Head Nurse" sometime and see what you come up with, oi!), but it was infinitely more popular in the days of Cherry Ames and her ilk. (And yes, I know WWII was a different matter, but it was statistically a blip.)
So you've got brain damage, combined with a lack of societal norms, combined with the idea that nurses will do anyone...er, I mean any*thing* for another person.
The funny thing is this: our facility spends hours and hours teaching young interns how to avoid sexual harrassment by nurses.
I'll wait until you're done laughing.
They don't brief the female residents on how to handle dirty old men or nosy old women. They don't brief the male residents on how to deflect the sorts of questions that make men blush and stammer. And they're certainly not briefing *either group* on how not to make yourself look like an idiot by intimating that certain female colleages get more OR time because they have pretty hair (yes, I heard that one two weeks ago. From a *female* PA, who lost pretty much all the professional respect I had for her).
The point here is that nurses can't win. On the one hand we're being exposed to lecherous weirdos and weirdettes, while on the other, our future colleagues are getting the idea that we're rapacious, predatory, sex-crazed fiends. Our female MD colleagues don't have much more luck. And pity the poor male nurse, who's automatically seen as prissy, if not outright gay. (And anybody who assumes all male nurses are gay is the sort of person who's going to have a problem with gay guys. I guarantee.)
So, okay, what do we do about it?
Well, first of all, nurses' training programs and doctors' training programs can be realistic about the problem. Where I work, there are a lot of young nurses and a whole lot of young residents. Yes, sometimes they do end up dating, but the problem isn't so widespread that it causes problems in the professional arena. So we could probably drop the insistence to the interns that it's the nurses they'll have problems with and save some time and trouble there.
Second, hospitals and other facilities need to be realistic about the problem. The first line of defense is the nurse's own reaction, true, but if the behavior continues, she or he needs to be certain that there will be somebody to back her or him up in her refusal to countenance the behavior. If your charge nurse or nurse-manager falls down on the job, you're left to "solve" the problem on your own, which usually means either getting somebody to go into the room with you every time, or foisting the assignment off on another nurse. Raising conciousness rarely works in such a short period of time.
Finally, families need to be realistic about the problem. Yep, you heard me: I said "families". I've had patients' family members egg the patient on as they were harrassing me or another nurse. That kind of thing usually stops as soon as I get my mouth open. But the point remains that a lot of people seem to think it's cute that Grampa's a tit-grabber or that Papa is a bigot.
It's a weird job we do, nursing. I'm just glad that nobody's tried to get me up against a wall--yet--or done anything really violent. Yet.
Really? You don't say. Grunt Doc, DB's Medical Rants, and Code: The Web Socket have all taken stabs at this; Alwin at C:TWS has a particularly funny experience to recount.
I regularly get sexually harrassed at work by patients; whether it's sweetie or honey pie, or let me fix you up with my son, or even (once) a man trying to pull me into the bed with him for a kiss. It comes with the territory when you're working with brain-injured people. When you're missing part of your frontal lobes, or they've been otherwise damaged, you're not going to have the same control and pay the same attention to social norms that other people do. At any road, it happens at least twice a month.
It also happens to the female residents and doctors. There have been times when I've had to knock on a patient's door and say something like, "Doctor X, there's an urgent phone call for you at the desk" in order to get Doctor X away from the patient who's *sure* that her nephew's business partner's son, who sells used cars in Atlanta, is just the man for her.
The worst is when you're standing over a patient, assisting a (male) doctor with a procedure, when the patient pipes up with "Don't you think Doctor Y is cute?" My answer from the start has always been a puzzled look and "When?"
I have some theories as to why this happens so often. First, it's because some of our patients are brain-damaged. There's not much you can do about that, really. Second, a lot of patients (especially the older gentlemen) seem to think that when one social norm goes away (like I'm wiping your ass for the fortieth time today), the others go away too, and they can say or do whatever they want acceptably. This misconception also explains the amazingly bigoted stuff I hear from patients on a weekly basis.
And, finally, let's face it: a lot of patients grew up in the 1930's through 1950's, a time when nurses were seen as passive, accomodating helpmates. The popular image of the Sexy Nurse hasn't died yet (Google "Head Nurse" sometime and see what you come up with, oi!), but it was infinitely more popular in the days of Cherry Ames and her ilk. (And yes, I know WWII was a different matter, but it was statistically a blip.)
So you've got brain damage, combined with a lack of societal norms, combined with the idea that nurses will do anyone...er, I mean any*thing* for another person.
The funny thing is this: our facility spends hours and hours teaching young interns how to avoid sexual harrassment by nurses.
I'll wait until you're done laughing.
They don't brief the female residents on how to handle dirty old men or nosy old women. They don't brief the male residents on how to deflect the sorts of questions that make men blush and stammer. And they're certainly not briefing *either group* on how not to make yourself look like an idiot by intimating that certain female colleages get more OR time because they have pretty hair (yes, I heard that one two weeks ago. From a *female* PA, who lost pretty much all the professional respect I had for her).
The point here is that nurses can't win. On the one hand we're being exposed to lecherous weirdos and weirdettes, while on the other, our future colleagues are getting the idea that we're rapacious, predatory, sex-crazed fiends. Our female MD colleagues don't have much more luck. And pity the poor male nurse, who's automatically seen as prissy, if not outright gay. (And anybody who assumes all male nurses are gay is the sort of person who's going to have a problem with gay guys. I guarantee.)
So, okay, what do we do about it?
Well, first of all, nurses' training programs and doctors' training programs can be realistic about the problem. Where I work, there are a lot of young nurses and a whole lot of young residents. Yes, sometimes they do end up dating, but the problem isn't so widespread that it causes problems in the professional arena. So we could probably drop the insistence to the interns that it's the nurses they'll have problems with and save some time and trouble there.
Second, hospitals and other facilities need to be realistic about the problem. The first line of defense is the nurse's own reaction, true, but if the behavior continues, she or he needs to be certain that there will be somebody to back her or him up in her refusal to countenance the behavior. If your charge nurse or nurse-manager falls down on the job, you're left to "solve" the problem on your own, which usually means either getting somebody to go into the room with you every time, or foisting the assignment off on another nurse. Raising conciousness rarely works in such a short period of time.
Finally, families need to be realistic about the problem. Yep, you heard me: I said "families". I've had patients' family members egg the patient on as they were harrassing me or another nurse. That kind of thing usually stops as soon as I get my mouth open. But the point remains that a lot of people seem to think it's cute that Grampa's a tit-grabber or that Papa is a bigot.
It's a weird job we do, nursing. I'm just glad that nobody's tried to get me up against a wall--yet--or done anything really violent. Yet.
Friday, December 16, 2005
I'm getting tired of this.
Mostly because it's become predictable.
Get up. Feel okay. Think, "I can go to work today. Good deal."
Drink a little coffee. Drink a little water.
Stumble to bathroom either to a) lose coffee and water immediately, or b) lie on the floor in a cold sweat with the room spinning, then lose coffee and water.
Fall prey to a number of nasty intestinal symptoms.
Return to floor. Sweat some more. Feel the beginning of a pounding headache.
Haul self, on hands and knees if necessary, to phone. Phone in sick.
Answer various questions about degree and type of symptoms. Why on earth do they want to know this? *I* don't want to know this about *myself*.
Stumble back to bathroom. Stick thermometer in mouth, note return of fever. Note intensification of pounding headache. Note rumblings of a sort that bode ill for the health of my GI tract.
Stumble, several minutes and one more cold sweat later, back to bed. Lie there panting.
Wake up several hours later feeling borderline normal. Eat half a boiled potato. Meditate on the gastrocolic reflex almost immediately thereafter.
Back to bed, panting. Wonder what everybody's doing at work. Wonder if I'll live long enough to return. Wonder when this is going to stop.
Remember what happened on Wednesday morning. Haul self to kitchen and drink a little ginger ale. Haul self to bathroom to retrieve thermometer.
After ten minutes in bed, take temperature. Fever is unchanged. Head still hurts.
Fall asleep. Wake up. Post bitchy whiny blog entry on illness.
Lather, rinse, repeat.
**For those of you who are thinking that there might be a Little Jo at the end of this, please don't worry. As far as I know, pregnancy occurs most often in people not contracepting and is generally not accompanied by a fever, gut cramps, and other GI symptoms. But thanks for your concern.
Get up. Feel okay. Think, "I can go to work today. Good deal."
Drink a little coffee. Drink a little water.
Stumble to bathroom either to a) lose coffee and water immediately, or b) lie on the floor in a cold sweat with the room spinning, then lose coffee and water.
Fall prey to a number of nasty intestinal symptoms.
Return to floor. Sweat some more. Feel the beginning of a pounding headache.
Haul self, on hands and knees if necessary, to phone. Phone in sick.
Answer various questions about degree and type of symptoms. Why on earth do they want to know this? *I* don't want to know this about *myself*.
Stumble back to bathroom. Stick thermometer in mouth, note return of fever. Note intensification of pounding headache. Note rumblings of a sort that bode ill for the health of my GI tract.
Stumble, several minutes and one more cold sweat later, back to bed. Lie there panting.
Wake up several hours later feeling borderline normal. Eat half a boiled potato. Meditate on the gastrocolic reflex almost immediately thereafter.
Back to bed, panting. Wonder what everybody's doing at work. Wonder if I'll live long enough to return. Wonder when this is going to stop.
Remember what happened on Wednesday morning. Haul self to kitchen and drink a little ginger ale. Haul self to bathroom to retrieve thermometer.
After ten minutes in bed, take temperature. Fever is unchanged. Head still hurts.
Fall asleep. Wake up. Post bitchy whiny blog entry on illness.
Lather, rinse, repeat.
**For those of you who are thinking that there might be a Little Jo at the end of this, please don't worry. As far as I know, pregnancy occurs most often in people not contracepting and is generally not accompanied by a fever, gut cramps, and other GI symptoms. But thanks for your concern.
Thursday, December 15, 2005
Gar.
Yesterday I called in sick.
I called in sick because, for the first time in my life, I actually *lost conciousness* as a result of a combination of nausea, standing up too fast, and general ookiness.
Passing out is an interesting experience. First come the black spots in front of the eyes and a feeling like the world is moving in new and strange ways. Then comes the feeling that it's absolutely necessary that you get horizontal *right now*. When you do, there's nothing at all for a few seconds (I wasn't out for very long), then a return to the floor moving unpleasantly, compounded with a nasty stinky cold sweat. And retching. And the shakes.
As I shoved the chair behind me and sagged to the floor, I remember thinking quite clearly two things simultaneously: "This is how my patients feel" and "I don't want to fall over like my sister did and hit my head on something."
Twenty minutes later, I was feeling fine, if a bit tired. So I went back to bed and slept for four hours. Then I went out and got some Sprite and Gatorade, rehydrated, ate a little something that stayed down (wonder of wonders!), and went back to bed.
In four days I've lost four pounds. No, the skin on my hands isn't tenting any longer, and my eyes aren't sunken.
The strangest thing is this: in between bouts of nausea, I have cravings for tomatoes, asparagus, corn, and honeydew melon. That's all. The normal sick foods like crackers and toast have no appeal.
Later I'll go out to the grocery store and stock up on cravings foods. Maybe I'll get a couple of cans of vegetarian vegetable soup. At this rate, my cholesterol will be down to 130 and I'll weigh that much by March.
God, what a nasty bug.
Back to bed now.
I called in sick because, for the first time in my life, I actually *lost conciousness* as a result of a combination of nausea, standing up too fast, and general ookiness.
Passing out is an interesting experience. First come the black spots in front of the eyes and a feeling like the world is moving in new and strange ways. Then comes the feeling that it's absolutely necessary that you get horizontal *right now*. When you do, there's nothing at all for a few seconds (I wasn't out for very long), then a return to the floor moving unpleasantly, compounded with a nasty stinky cold sweat. And retching. And the shakes.
As I shoved the chair behind me and sagged to the floor, I remember thinking quite clearly two things simultaneously: "This is how my patients feel" and "I don't want to fall over like my sister did and hit my head on something."
Twenty minutes later, I was feeling fine, if a bit tired. So I went back to bed and slept for four hours. Then I went out and got some Sprite and Gatorade, rehydrated, ate a little something that stayed down (wonder of wonders!), and went back to bed.
In four days I've lost four pounds. No, the skin on my hands isn't tenting any longer, and my eyes aren't sunken.
The strangest thing is this: in between bouts of nausea, I have cravings for tomatoes, asparagus, corn, and honeydew melon. That's all. The normal sick foods like crackers and toast have no appeal.
Later I'll go out to the grocery store and stock up on cravings foods. Maybe I'll get a couple of cans of vegetarian vegetable soup. At this rate, my cholesterol will be down to 130 and I'll weigh that much by March.
God, what a nasty bug.
Back to bed now.
Tuesday, December 13, 2005
Everybody's doin' it...
One of the links at Grand Rounds this week has a focus on a suggested code of ethics for medbloggers and a list of questions we should all be able to answer.
So, because everybody's doin' it....
1. Who runs this site?
Jo. I'm an RN (ADN) with a bachelor's degree in music and one in sociology. I've got almost four years' experience in neuroscience and ten years as a women's health advocate and paraprofessional.
2. Who pays for the site?
Blogger. The ad to your right for Ivo Drury's site generates as much income as Ivo finds fair, which is then donated by me to either Planned Parenthood (to provide exams and Pap smears for women who can't afford 'em) or to local animal charities.
3. What is the purpose of the site?
Yarking and complaining, with the occasional burst of decent information.
4. Where does the information come from?
Mostly from my own experience. If it's something that's useful or interesting, you can bet I've stolen it from another site somewhere.
5. What is the basis of the information?
Huh? Didn't you just ask that?
6. How is the information selected?
It's selected based on what I figure will be interesting to those few poor unfortunates who read the blog. There's going to be an emphasis on neuroscience, women's health (especially reproductive health issues), and feminism, mostly because I'm a feminist neuroscience nurse with background in happy hootchie care.
Oh, and food. I like writing about food. Matter of fact, I have some salsa in the fridge that you guys have just got to try.
7. How current is the information?
I try to keep anything that's seriously scientific current to within the last month or so. For reasons of privacy protection, most of the stories I post about my own experiences on the floor are not only changed detail-wise, they're put into a different time-frame. Therefore, the things that I write about happening "last week" might actually have happened six months ago, or vice versa.
8. How does the site choose links to other sites?
I link to what I like. Generally speaking, I like sites to have some sort of track record before I link to them. I'm also extremely lazy, so link-swapping takes weeks for me to accomplish.
9. What information about you does the site collect, and why?
I was unaware that I could collect any information at all, actually. I'm not technically savvy.
10. How does the site manage interactions with visitors?
Comments are welcome; obnoxious comments get deleted. Deal. (credit Bitch, PhD.) Personal emails are welcome if somebody has a question that they feel uncomfortable posting, or that they think requires a longer answer.
***
On a different note, I don't know that these questions go far enough for the average personal-experience blogger. I feel very strongly that nobody's confidentiality should ever be compromised for my own convenience or anybody else's amusement or edification; if there's one thing I take very seriously, it's that.
If somebody emails me with a personal story about something that happened to them in the hospital, I'm not going to post it here without prior permission. Excerpts from personal emails, if I get permission to use them, get changed around in such a way that it's not going to compromise anyone.
Hell, I've even changed what I've said about where I live, so that the area isn't immediately recognizable. It's not worth some wacko figuring out that Jo is actually Becky Smith, who works at Podunk Memorial Research Facility and Rib Shack in Lolitaville, Texas. That compromises both me and my patients.
Those of us who write based on personal experience cannot take this issue seriously enough. I'd like to see a code of ethics drafted for the personal-experience blogger. Who wants to start?
So, because everybody's doin' it....
1. Who runs this site?
Jo. I'm an RN (ADN) with a bachelor's degree in music and one in sociology. I've got almost four years' experience in neuroscience and ten years as a women's health advocate and paraprofessional.
2. Who pays for the site?
Blogger. The ad to your right for Ivo Drury's site generates as much income as Ivo finds fair, which is then donated by me to either Planned Parenthood (to provide exams and Pap smears for women who can't afford 'em) or to local animal charities.
3. What is the purpose of the site?
Yarking and complaining, with the occasional burst of decent information.
4. Where does the information come from?
Mostly from my own experience. If it's something that's useful or interesting, you can bet I've stolen it from another site somewhere.
5. What is the basis of the information?
Huh? Didn't you just ask that?
6. How is the information selected?
It's selected based on what I figure will be interesting to those few poor unfortunates who read the blog. There's going to be an emphasis on neuroscience, women's health (especially reproductive health issues), and feminism, mostly because I'm a feminist neuroscience nurse with background in happy hootchie care.
Oh, and food. I like writing about food. Matter of fact, I have some salsa in the fridge that you guys have just got to try.
7. How current is the information?
I try to keep anything that's seriously scientific current to within the last month or so. For reasons of privacy protection, most of the stories I post about my own experiences on the floor are not only changed detail-wise, they're put into a different time-frame. Therefore, the things that I write about happening "last week" might actually have happened six months ago, or vice versa.
8. How does the site choose links to other sites?
I link to what I like. Generally speaking, I like sites to have some sort of track record before I link to them. I'm also extremely lazy, so link-swapping takes weeks for me to accomplish.
9. What information about you does the site collect, and why?
I was unaware that I could collect any information at all, actually. I'm not technically savvy.
10. How does the site manage interactions with visitors?
Comments are welcome; obnoxious comments get deleted. Deal. (credit Bitch, PhD.) Personal emails are welcome if somebody has a question that they feel uncomfortable posting, or that they think requires a longer answer.
***
On a different note, I don't know that these questions go far enough for the average personal-experience blogger. I feel very strongly that nobody's confidentiality should ever be compromised for my own convenience or anybody else's amusement or edification; if there's one thing I take very seriously, it's that.
If somebody emails me with a personal story about something that happened to them in the hospital, I'm not going to post it here without prior permission. Excerpts from personal emails, if I get permission to use them, get changed around in such a way that it's not going to compromise anyone.
Hell, I've even changed what I've said about where I live, so that the area isn't immediately recognizable. It's not worth some wacko figuring out that Jo is actually Becky Smith, who works at Podunk Memorial Research Facility and Rib Shack in Lolitaville, Texas. That compromises both me and my patients.
Those of us who write based on personal experience cannot take this issue seriously enough. I'd like to see a code of ethics drafted for the personal-experience blogger. Who wants to start?
Your regular blogger, now with viruses!
A follow-on to yesterday's incoherence: Shakespeare's Sister takes a look at the Oslo post-abortion study from a statistical angle, along with stuff that wasn't published in the BBC article and that I didn't think to look up. Thank God there are people out there doing my work for me. They think so I don't have to!
Unless my reactions to chlorpheniramine maleate (the stuff in Advil Sinus/Allergy) have changed drastically overnight, I seem to have picked up a simultaneous belly and head bug. Blogging will be light for the next couple of days as I rush between the bathroom and the Kleenex factory.
Disinfect your computer screens, people. I am not playing around.
Unless my reactions to chlorpheniramine maleate (the stuff in Advil Sinus/Allergy) have changed drastically overnight, I seem to have picked up a simultaneous belly and head bug. Blogging will be light for the next couple of days as I rush between the bathroom and the Kleenex factory.
Disinfect your computer screens, people. I am not playing around.
Monday, December 12, 2005
Back into the fray....
This pissed me off.
*deep breath*
*several deep breaths*
As I've mentioned before, I worked at an abortion clinic. I also was a volunteer post-abortion counsellor, and moderated an Internet message board for women who were having emotional problems post-abortion. I'd like to think that the years of doing those things have given me a fairly good handle on the years of pain and suffering and guilt that some women feel after an abortion.
There are a couple of angles I'd like to pursue, here. The first one is the easier one to dissect: that, if you're living in the U.S. and you've had an abortion, you're *expected* to feel guilt, shame, and regret. I don't know what it's like in the U.K. or in Scandanavia, but here there's a constant subtext that women who have abortions regret them, that they wish they could go back and change things, that somehow the procedure has damaged them.
Which isn't true. It's simply not true.
Let's get one thing straight: women whose lives are going fine and dandy generally don't have abortions. Often an unintended pregnancy is the last thing on top of a lot of *other* things, like being broke or in an unstable relationship or immature, that breaks the proverbial camel's back. Having an abortion is not just a response to a crisis pregnancy; it's a response to a whole set of other crises that a pregnancy compounds.
What I saw time and time again was this: women without guilt, women without shame, put their abortion into proper perspective. They took responsibility for the decision and understood the context of the action. They did not (and this is important, so remember it) feel coerced into having an abortion; it was their own choice from the get-go.
Yet they had doubts about themselves because they didn't feel guilty. A friend of mine expressed it well: "I spent two years feeling guilty because I didn't feel guilty."
How much of that guilt and shame that women feel is being brought on by being told, over and over, that there's something shameful and wrong with them for having had an abortion? How many times can a woman see a bumpersticker that says "Real Mothers Don't Have Abortions" or hear someone dismiss women who terminate pregnancies as "sluts" before it starts to take a toll?
The second angle is nastier, darker, and more complex.
There were some women I saw at the clinic--a small minority, maybe one in twenty--who were being browbeaten into terminating their pregnancy. Those women didn't get services. Instead, we called the shelter or the cops (in the case of "my boyfriend/father said he'd hurt me if I didn't do this") and let people who were qualified to deal with the situation handle it.
There were a number of women I encountered in post-abortion counselling, both in the meat world and online, who had guilt. Lots of it. And they had one thing in common: they had had an abortion not because they felt it was best for them, but to please somebody else.
The line that sticks in my head is one from an online correspondent who said this: "My partner wasn't ready for fatherhood and left me when he found out I was pregnant. I had an abortion, but he didn't come back. Now I'm alone, and I don't even have a baby to look forward to."
Some of those women were really, really young when they got pregnant, and their parents basically made the decision for them. Hard enough to be fourteen and pregnant (with all the weirdness that that situation must've come from in the first place) and then have yet another piece of bodily control wrested away from you. If somebody says, "it's for your own good", look at them with slitty eyes...but a girl in that situation has no option.
Just as abortions don't happen in a vacuum, they don't fix everything. I reckon that the majority of women who had real problems dealing with their abortions had the idea going in that somehow life would be roses and cherries afterward; as though solving this one, monumental problem would solve all the others. And, of course, it doesn't work that way. You're still broke, your lover is still gone, you still live in a crappy apartment, your parents are still the sort of wackjobs that would enable your having sex at the age of ten.
I think that, as a culture, we need a reality check. Let me start here:
Even with perfect use, most contraceptive methods have at least a one-percent failure rate. In the U.S., the average failure rate for the most popular birth control method (the Pill) approaches 12%. That means that even with consistent contracepting, some women are going to get pregnant. Some of those women are going to terminate those pregnancies.
Even the most conservative estimates of abortion rates show that more women have abortions than get breast cancer. It's anywhere from one in three (WHO numbers) to one in five (AGI numbers) versus one in seven or eight.
Therefore, abortion is a common experience.
Therefore, we need better systems in place to help women deal with abortion. And not just the procedure itself and the aftereffects, but the whole complex web of situations that lead up to the decision to terminate. At my clinic, the number-one reason for having an abortion was not using birth control. We dealt with that by making contraception cheap and easy to get, even giving a year's worth of pills away to women after they'd had a follow-up exam and their Pap results had come back.
But that's only barely pricking the surface of the problem of unintended pregnancy.
It would be nice if women weren't stuck in situations where they felt that abortion was their only reasonable option. Affordable child-care and decent health programs for children and mothers would go a long way toward solving that particular difficulty. So would wider availability of job-training programs. So would better health care in general for women.
I'll say it again: abortions don't happen in a vacuum. Sometimes it's a simple choice, but it's not ever an *easy* choice--remember the difference. If we as a society deal with the issues that complicate unintended pregnancy rather than sweeping them under the rug, we'll lower the number of abortions performed. If we deal with the issue of abortion openly and honestly and without shame, we'll lower the proportion of women who feel damaged and wounded.
This is not just about the fetuses and women. This is not just about terminating pregnancies. Our societal response to unintended pregnancy is evidence in microcosm of how much or how little we value women, pregnant or not.
And it's not just about guilt, shame, and regret. Getting past those emotions, looking realistically at the whole of a person's life, and finding resources to deal with crises of every sort is what we ought to be doing.
*deep breath*
*several deep breaths*
As I've mentioned before, I worked at an abortion clinic. I also was a volunteer post-abortion counsellor, and moderated an Internet message board for women who were having emotional problems post-abortion. I'd like to think that the years of doing those things have given me a fairly good handle on the years of pain and suffering and guilt that some women feel after an abortion.
There are a couple of angles I'd like to pursue, here. The first one is the easier one to dissect: that, if you're living in the U.S. and you've had an abortion, you're *expected* to feel guilt, shame, and regret. I don't know what it's like in the U.K. or in Scandanavia, but here there's a constant subtext that women who have abortions regret them, that they wish they could go back and change things, that somehow the procedure has damaged them.
Which isn't true. It's simply not true.
Let's get one thing straight: women whose lives are going fine and dandy generally don't have abortions. Often an unintended pregnancy is the last thing on top of a lot of *other* things, like being broke or in an unstable relationship or immature, that breaks the proverbial camel's back. Having an abortion is not just a response to a crisis pregnancy; it's a response to a whole set of other crises that a pregnancy compounds.
What I saw time and time again was this: women without guilt, women without shame, put their abortion into proper perspective. They took responsibility for the decision and understood the context of the action. They did not (and this is important, so remember it) feel coerced into having an abortion; it was their own choice from the get-go.
Yet they had doubts about themselves because they didn't feel guilty. A friend of mine expressed it well: "I spent two years feeling guilty because I didn't feel guilty."
How much of that guilt and shame that women feel is being brought on by being told, over and over, that there's something shameful and wrong with them for having had an abortion? How many times can a woman see a bumpersticker that says "Real Mothers Don't Have Abortions" or hear someone dismiss women who terminate pregnancies as "sluts" before it starts to take a toll?
The second angle is nastier, darker, and more complex.
There were some women I saw at the clinic--a small minority, maybe one in twenty--who were being browbeaten into terminating their pregnancy. Those women didn't get services. Instead, we called the shelter or the cops (in the case of "my boyfriend/father said he'd hurt me if I didn't do this") and let people who were qualified to deal with the situation handle it.
There were a number of women I encountered in post-abortion counselling, both in the meat world and online, who had guilt. Lots of it. And they had one thing in common: they had had an abortion not because they felt it was best for them, but to please somebody else.
The line that sticks in my head is one from an online correspondent who said this: "My partner wasn't ready for fatherhood and left me when he found out I was pregnant. I had an abortion, but he didn't come back. Now I'm alone, and I don't even have a baby to look forward to."
Some of those women were really, really young when they got pregnant, and their parents basically made the decision for them. Hard enough to be fourteen and pregnant (with all the weirdness that that situation must've come from in the first place) and then have yet another piece of bodily control wrested away from you. If somebody says, "it's for your own good", look at them with slitty eyes...but a girl in that situation has no option.
Just as abortions don't happen in a vacuum, they don't fix everything. I reckon that the majority of women who had real problems dealing with their abortions had the idea going in that somehow life would be roses and cherries afterward; as though solving this one, monumental problem would solve all the others. And, of course, it doesn't work that way. You're still broke, your lover is still gone, you still live in a crappy apartment, your parents are still the sort of wackjobs that would enable your having sex at the age of ten.
I think that, as a culture, we need a reality check. Let me start here:
Even with perfect use, most contraceptive methods have at least a one-percent failure rate. In the U.S., the average failure rate for the most popular birth control method (the Pill) approaches 12%. That means that even with consistent contracepting, some women are going to get pregnant. Some of those women are going to terminate those pregnancies.
Even the most conservative estimates of abortion rates show that more women have abortions than get breast cancer. It's anywhere from one in three (WHO numbers) to one in five (AGI numbers) versus one in seven or eight.
Therefore, abortion is a common experience.
Therefore, we need better systems in place to help women deal with abortion. And not just the procedure itself and the aftereffects, but the whole complex web of situations that lead up to the decision to terminate. At my clinic, the number-one reason for having an abortion was not using birth control. We dealt with that by making contraception cheap and easy to get, even giving a year's worth of pills away to women after they'd had a follow-up exam and their Pap results had come back.
But that's only barely pricking the surface of the problem of unintended pregnancy.
It would be nice if women weren't stuck in situations where they felt that abortion was their only reasonable option. Affordable child-care and decent health programs for children and mothers would go a long way toward solving that particular difficulty. So would wider availability of job-training programs. So would better health care in general for women.
I'll say it again: abortions don't happen in a vacuum. Sometimes it's a simple choice, but it's not ever an *easy* choice--remember the difference. If we as a society deal with the issues that complicate unintended pregnancy rather than sweeping them under the rug, we'll lower the number of abortions performed. If we deal with the issue of abortion openly and honestly and without shame, we'll lower the proportion of women who feel damaged and wounded.
This is not just about the fetuses and women. This is not just about terminating pregnancies. Our societal response to unintended pregnancy is evidence in microcosm of how much or how little we value women, pregnant or not.
And it's not just about guilt, shame, and regret. Getting past those emotions, looking realistically at the whole of a person's life, and finding resources to deal with crises of every sort is what we ought to be doing.
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