Cue "Gee, Officer Krupke!"

"You--take him to a headshrinker!"

So I saw my pal Pedro, also known as Doc Pedro, PCP, today.

Doc Pedro wasn't having the best of days. Somebody's grandchild was trying to systematically dismantle his waiting room as somebody's grandchild's grandmother made a big stink about nothing, and in walks his primo, pure-dee, brass-plated Headcase Du Jour.

Poor Doc Pedro. He's sending me to a headshrinker. On accounta, she says, channelling Action and Riff, I'm depraved. And on account of the "cyclical nature of my depression." Yes, he really talks like that.

Never mind that four years of good control on Effexor is the longest damn cycle I've ever seen, Jack, and maybe he got me mixed up with somebody else; I'm headed off to find a psychiatrist.

All joking aside, there's a definite period of adjustment when you come to terms with the fact that you need medication to function like a normal person. Then your medication gets doubled on the same day that your PCP tells you he can't really manage your care any more, and you're forced to look at yourself in the sunshade mirror of your car and say,

I am mentally ill.

I have a chronic condition that is not curable, but is manageable with lifestyle changes and medication.

I will be doing this the rest of my life.

Whereupon, driving up the street, it suddenly made sense to me why some people actually kill themselves.

I, of course, not wanting to deprive the Reading Public of my thoughts, did not drive my car under a bus. Instead, I went out and got an order of nachos with extra guacamole and drank a beer. Then I considered my plight.

I am mentally ill. I will be doing this the rest of my life. I will be managing, with any luck, my illness with lifestyle changes and medication. Forever.

Then I swallowed another Effexor. Doc Pedro doubled my dosage today, given that all my symptoms are those of somebody whose body has grown accustomed to Effexor. He wasn't willing to change my meds, fearing that that would merely confuse any other practitioner I consulted.

So, here I am. I'm depraved, not on account of I'm deprived (unless it's some intrinsic genetic failing), but I'm depraved. Just knowing that I have some problem that he can't help me fix makes me feel better. You know those questionnaires that you take, where the max score is 21? I got 18. I think anything over 15, for him, merits a referral.

I swear to Frog I'll find the silver lining in this. (See? My mood's improving already.) It might take a while, but I'll find it.

Meanwhile, I have to find a shrink I can handle. Good thing I work on the Brain Unit, eh?

Reflections of a Nutjob

It has come to my attention that I am a nutjob. Not a hard-core nutjob (meaning, I take only one medication, and the lowest effective dosage of that one), nor an unmedicated nutjob, but a nutjob nonetheless.

Please. I am not "depressed" or "differently serotonined". Euphemisms are for the differently brained. I am nutso. A whackjob, if you prefer that terminology. A crazy. Whoo-whoo-whoo, a la Moe of the Three Stooges. I have a shopping list of things that gets me through the day, most of them mind-altering substances of varying availability (Caffeine, Effexor, Caffeine, Simple Carbohydrates, Norepinephrine, Effexor, Scotch, and venlafexine for dessert). I have been known to have anxiety attacks for no particular reason, and in fact had one today.

So. In the spirit of past Things To Do lists, here's:

What To Do If You Know A Whackjob, Version One-point-Zero

1. Do not, under any circumstances, indulge their desire to talk about nuclear holocaust or other forms of apolcalypse. See, whackjobs get anxiety in weird ways, and this is one of them. Steer them away from the David Brin and onto the Spider Robinson, where everything turns out okay.

2. Do indulge their desires for simple carbohydrates and alcohol, within reason. Carbs raise serotonin levels while alcohol in moderation can keep the garden-variety nutcase from jumping off a bridge. Make sure it tastes good, and you'll have accomplished another goal: showing the loonie in question that tomorrow is indeed another day.

4. Crazymeds dot org (thanks, Anon, for the correction!) is an excellent resource website for both the interestingly-brained and their friends and relations. True, there are some postings on the site what will make you say "Wooo. Buh?", but overall, it's a nutjob presenting what it's like to be a candidate for the whackshack with grace and humor.

5. If your crazy pal needs a warm body around, be that warm body. I cannot tell you what a difference it makes from the loonie perspective to have somebody around who can quote Bloom County and make coffee. It's invaluable.

6. If you work with even one other person, do not make denigrating comments about crazy folk at work. That one other person might be me, and I might be on a short leash due to my antidepressants not working all that well, and then there might be a lot of mess to clean up. Crazy people *are* different from you, yes: we're often smarter and more creative. We're certainly posessed of a well of nastiness that you can't even conceive of. So be nice.

7. Answer the phone at 3 am.

8. Don't pressure the nutcase in question to go out in public with you. Often, nutcases such as myself can't muster the energy to go to the bar or a restaurant. It's simply too overwhelming. Bring by a clamshell of Chinese instead if you really want to see me.

9. Make sure the nutcase keeps their doctor's appointments. This is not such a problem with the minorly-medicated, but can be a real issue with those of the brotherhood who take multiple meds or meds in major doses.

10. If in doubt, call 911. I am not saying here that this has ever been an issue for me. I have been blessed up to this point with having not had any serious thoughts of self harm....but I can certainly see how some people might.

If you work with, live with, or love a moderately- to severely-depressed person, or a person who deals with bipolar disorder, keep in mind that calling the fuzz in might someday be necessary. This does not mean that you or the other person has failed; it's a modern response to an age-old problem that used to drag the median lifespan down. Think of it as your way of boosting our national life expectancy.

Tomorrow I see my Muppet-like doctor. We'll talk about how to regulate this pinkish lump of neural tissue behind my eyes. I'll certainly, since everything is fair game here, keep things updated.

Frog Soup

I feel like the guy in the cartoon who brings his car into the shop, complaining that it's running rough, only to have the mechanic point out that he's missing two wheels on one side of the vehicle. *There's* yer trouble, with the understood "dipwad" coming as a modifier.

My antidepressants aren't keeping up with changes in my brain chemistry. Oh, boy. It took me a while to realize this, but now I'm on board.

Funny thing, depression: it's a lot like that old wives' tale about putting the frog into a slowly-heating pot of water. By the time you realize there's a problem, you're nearly Froggy Consomme. There's a long history of Frog Soup on the female side of our family; the previous generations mostly self-medicated with alcohol and charity work, but the women of my generation and Beloved Mom's generation have pharmaceuticals.

However, even modern medical miracles can sometimes lag behind when it comes to the Wonder That Is The Jo-Brain, so I'm snarkier and less energetic than usual. (Comments about how this makes me a super-snarky three-toed sloth will not be approved, people.) And in that nonenergetic, snarky mode, I bring you....

Rules for Stupid People, Some Of Them Residents, Part Three Thousand and Sixty-Five

1. If I page you post-call, it's not because I like playing with the pretty buttons on the phone. It's because you've written the prescription wrong, failed to include your DEA number, and written for over the maximum allowable dispensation of narcotics. So don't snark when you call me back.

2. If you don't call me back, even after I've paged you 911, don't snark when I get your attending to deal with it. I *will* start removing your digits if that happens.

3. Stamp your fucking H & Ps, okay? I can't let an unmarked H & P, lacking any indication of who it's on, just sort of migrate into a chart somewhere. Digit removal, people, digit removal.

4. I don't date residents. Ever. Stop asking already.

5. Pathologists are not allowed to turf. If you attempt to turf over a biopsy that should've been in my lab five days ago, things will get nasty indeed. I don't care who you are or who you work for; I have a guy whose brain is turning to mush, probably because of something infectious, and we needed that biopsy last week. You think I'm snarky with the residents? You should see me with attendings, who *ought* to know better.

6. Don't drive 45 in the left lane. Even if you're in a Prius. Thank you.

7. Don't ever, ever tell me that I need to have more information, or a better grasp of the information available, before I come to you with a question. I might then be forced to point out (in front of either your attending or your fellow, whichever is there) that you haven't left a note in the chart in, oh, three or four days. That will suck. And not for me.

8. I don't care how much of a genius you are: if you start to jack around in somebody's spine without wearing a mask and gown in addition to your sterile gloves, I'll stop you. And if you snark at me, one of us will be sad later. Hint: it will not be the nurse who had to reinforce proper sterile technique.

9. If I've ordered a scan with and without contrast, I really do mean "with and without", regardless of whether you think the contrast will be helpful. Trust us on this one, okay? Thanks.

10. Dictation can be fun! Really! They offer a free lunch every Tuesday and Thursday down in the dictation cave so that you can dictate what you should've dictated ten days ago and eat at the same time! It's great! You should try it!

It struck me about a year ago that the life of a nurse goes like this: Know All, See All, Fix All. It also struck me that we really, as a professional group, ought to agitate for better ways to get other people to do their jobs better. I'm thinking either a mass issuing of Super Soakers or some slingshots and M & M's as ammo.

MBTs and my MCL: Not Quite a Love Story

I have strained my right MCL. That's apparently a ligament in my knee (I don't remember; I was drunk that day in A & P, I guess) that does something like keep one's knee from bending at some crazy angle toward one's other leg. Mine is strained, not torn, which is a good thing. It means that I can still shop for groceries and do laundry and work, though I do all those things with a limp and a pronounced disinclination to squat, and it also means that I won't need surgery.

It happened like this: I had just gotten out of a nice, hard 30-minute workout on the treadmill and exercise bike, and spotted my buddy Bunsen. Bunsen's half Golden Retriever and half Traveling Salesman, as Mom would say, and is about a year old and about 80 pounds. He's also enthusiastic about playing Chase The Ball And Then Tackle The Human. We played Try To Tackle The Human for about twenty minutes, during which time I had to feint repeatedly to each side...while wearing my MBTs.

When you buy the things, they come with a little booklet that cautions you to be careful of doing things that require lots of feinting to each side. They also caution you against doing things that require a combination of balance and weight, like lunges. What they don't caution you against is being a blasted idiot, so of course I went out and was a blasted idiot.

The chief of the ortho department's reaction was this: "Dude. Bummer. A week or two. Ice. Bummer." (Yes, he really talks that way.) Chef Boy's reaction was this: "Wow, that was stupid." (Yes, he's really that supportive and gentle.) Chef Boy did provide me with an ice pack and some ibuprofen last night, though, and I was able to head out and pick up coffee and bread today. I'm going to spend the rest of the day icing this dadratted knee off and on and reading fashion magazines.

Tomorrow starts a week of intensive upper-body training and, I guess, very little in the way of aerobic exercise. I suppose I'll have to wrap my leg, or something, to provide extra stability while I'm wandering around work.

Take-home from this experience: Do not, under any circumstances, no matter how happy he is to see you, play with a puppy pal while wearing your MBTs. Run home and change your shoes first.

Huzzah. Nnnng.

This is post #350. Huzzah. Nnnng.

Meh. That's all I have to say today: meh.

This morning's workout didn't go all that well, and then Chef Boy added insult to injury by guilting me about not wanting to go to the pool with his kids. Never mind that I was surrounded by pots, pans, half-empty jars of spices I've not used in a couple of years, and a few plastic and Pyrex containers I'd never seen before. I was cleaning out the kitchen cabinets, obviously, and not in any shape to trot into a swimsuit and go to an indoor pool.

Meh.

The crazies have come out of the darkness at work. They're all lined up in the chairs in the family waiting room: from the person who wants gait training for her semi-vegetative daughter (who's been like that for, oh, about twelve years now) to the family member who insists that she *will* read her husband's chart *whenever* she likes, they're all there. If they're not there, they're getting underfoot, attempting to 'help' with things like moving people, changing dressings, or (I kid you not) inserting central lines.

Note to crazies: your daughter hasn't bothered to open her eyes except to pain for twelve years. Gait training is not a possibility. Also, you may *not* read the chart, it's against the rules. And finally, if a resident is putting in a central line or lumbar drain, or if I'm putting in a Foley catheter, the last thing we need is your grimy little paw in our way.

To those of you nice enough to send me links and do your own trackbacks: I promise, promise, *promise* I will get to blogrolling you either tomorrow afternoon or this weekend, whichever can provide more coffee and chocolate. I'm terrible about updating things, I know, and I plan to do a major update...sometime soon. Promise. Really.

Nnnng. Meh. Blar.

I think I'll cook today. That'll make me feel better, having a clean and well-organized kitchen with good and happy and well-cooked food in the fridge.

But first I'm going to go chew my cuticles and say "meh" some more.

This is the coin.

They sat her up every morning at eight, put makeup on her face, and dressed her in a sweet pink bedjacket with lace around the collar. They begged her to eat, to get into a chair, to walk around the floor and go to the gift shop, even after she had a pathological fracture from the cancer that was eating her body from the inside out.

Her daughter dressed her in clothing that wouldn't reveal the mass that was growing on her side, a mark of the cancer that had come back, or the tubes that came out of each side of her chest to drain the fluid that was accumulating there.

We'd talked about hospice, but they wouldn't hear of it. Mom was going to get better, by God, and she'd have surgery to fix that arm, even after the orthopedic surgeon told them there was no chance of it healing.

Finally, after admissions at three different hospitals, they took her home. They'd heard the same thing at three different places. It was obvious there wasn't any hope, that her best chance at comfort was morphine in her own bed. All they'd let her have with us was ibuprofen. She hurt all the time.

She died the day after they left our floor.

***

They were both shocked when the doctors came in with the news: tests showed that he had, at most, a few hours to live. Life expectancy is funny that way: you can go from weeks to live to hours to live in almost no time.

Still, he wouldn't take morphine. Not because she wouldn't let him, but because (his words) he didn't want to lose the hours he had left. They'd been married forty years, and she'd been with him through all the important times, so he wanted to be with her now, when he was dying.

He lasted four and a half hours. They lay together on the bed, holding hands, talking about how wonderful their lives together had been. At the end, he got sleepy, so she cuddled his head into her shoulder and held him even after he'd stopped breathing.

This is the same coin, the coin that has hard-won, painful life on one side and a gentle death on the other. The one side is selfishness and pain, the other is acceptance and love.

These are the coins that we pay the ferryman with.

MBTs and me: a product review

So I got some new shoes the other week: Masai Barefoot Technology, they're called, and all I have to say about that is this: if the Masai have to spend the amount of money on their bare feet that I had to spend on these shoes, it's a wonder they can eat.

Anyway, I promised a review of the shoes.

They were recommended to me by a number of orthopods and physical therapists for plantar fasciitis. That's a condition in which the bottom of your foot stretches too much, or doesn't stretch enough, or something, and you end up with heel pain that makes it nearly impossible to walk after a day of work. So, taking a deep breath, I ordered a pair of these babies online.

Consider the MBT shoe: it is big. As in, it looks like a basketball's been cut in half and glued to the underside of the shoe. In addition, it has some sort of rocker action, the upshot of which is that when you stand normally, you actually have to balance your weight over the middle of the shoe. This led Chef Boy to ask, "Do they come with training wheels?" a reference to my fabled clumsiness. My sister remarked that that quip led her to consider Chef Boy her hero, and I said, "Shut up."

So you've put the things on and are balancing cheerfully in the middle of your foot. Or, alternatively, you've rocked back onto your heels so as to not have to waggle constantly to stand up. The first thing you notice when you start to walk is this: they're a very well-balanced shoe. As in, even *I* can't fall over in them. So snark away, Chef Boy and Beloved Sister, I'm doin' all right.

The second thing you notice is how heavy the damned things are. I don't know what sort of technology the engineers stuck into the oversized soles of these shoes, but it seems to be made of lead and gold. They're *heavy*.

That said, my heel hurts about the same after a day at work. But! On the morning after, it does not hurt *at all*, which means that I can pretty much walk to the bathroom rather than having to hobble and curse. Also, they do give my legs a good workout--not so much at work, since I'm used to walking around for twelve hours, but boy hidey! After a thirty-minute trot on the treadmill, I can feel muscles I only dimly remember from comparative anatomy class.

I can also run in them for several minutes at a stretch, having to stop only because my aerobic capacity is shit, not because my shins hurt. That is good. Very, very good.

And, strangely or not, the rocker-action of the shoe makes it easier to walk fast or trot than it does to walk slowly. That's nice, especially when you're trying to get as many miles in on the treadmill as you can. You have to walk with a shorter stride and in a more concentrated manner, or else your toes will brush the ground and you'll lose your rhythm. It's more like a forced march than a walk, but then, treadmilling is always more like a forced walk for me.

I'm sitting here contemplating the insertion points of my quadriceps--I can feel all of them, on both legs--after a thirty-six minute trot on the treadmill in the shoes. That's okay. My heel hurts a little, but not terribly, which is better than okay. And my bank account hurts a little more, but I'm dealing with that.

Bottom line: If you're happy with your Danskos, keep 'em. If, however, you spend the majority of the day wondering when the hell your heel will quit hurting, it's worth it to try a pair on to see if they work for you.

No big surprise here...

You Are Wolverine

Small but fierce, you're a great fighter. Watch out! You are often you're own greatest enemy. Powers: Adamantium claws, keen senses, the ability to heal quickly

Which of the X-Men Are You?

I need an intervention.

Tonight, after realizing that people really *don't* get any less annoying when you know them better, I had the following for dinner:

A large handful of cherry tomatoes. Okay, two large handsful.

Bacon.

Coleslaw.

Beer.

In slightly more cheerful news, this is the way of eating that has sustained me for years: weird food at weird hours, heavy on the vegetables and complex carbs, light on the meat. (I don't consider bacon meat; it's more a condiment.) I went back to it after three weeks on South Bitch sent my blood pressure to 150/100, shock! My BP is now back in the basement where it belongs.

In even more cheerful news, Carolita handed me an antique ad from a medical journal that she'd culled from among the equally antique books at her mother's house. It begins with the line "Experience Is The Best Teacher", references Camillo Golgi (a famous 19th-century neuroscientist), and ends with the claim that "More Doctors Smoke Camels Than Any Other Cigarette." It's now framed and resting atop the bookshelf that holds my ancient medical books.

Beloved Sister had the unenviable experience of interviewing a candidate for a job today who'd put semi-naked pictures up on his website. Oooooh, nipples. Love 'em. I wonder if her head has actually exploded, or if her brain simply oozed out one ear and crawled away across the conference room.

Speaking of brains, the Seriously No Kidding Single Most Squicky Thing I've Seen Recently came home to roost the other day: a guy who hadn't bothered to wear his seatbelt and went through the windshield of his car...and then had his frontal lobes (well, most of 'em), his sinuses, and his frontal skull removed.

There's a divot in his skull that I could put my fist in. Eugh. And no, he's not doing much these days.

Nor am I, except going to bed.

This had better be all for a while. Dammit.

The last two days at work have been...well.

Mister Annoying Screaming Man came back a*gain*. Mr. ASM is one of those frequent-flyers who has some dementia, though not enough to keep him quiet and compliant, and who does things like leave his walker across the room at home and take repeated face-plants into the linoleum. The first six or seven times he came back, it was cute. It's not cute any more.

I took his care over about an hour before my shift ended and went to start an IV. He's been in the hospital before. He's been stuck before. He knows the drill, remembers it, knows he has to have a saline lock in his arm. Why, then, when I pierced his skin with the needle, did he scream and dope-slap me on the back of my head?

I jerked, the IV start needle ripped upward through his skin, and blood splattered my face and scrubs. That made a nice contrast to the vomit, feces and urine I'd already been splattered with.

Earlier that day I'd had the sort of patient everybody dreads--a brittle type I diabetic who refuses to manage his blood sugar or stick to his diet. There's a certain type of person you know is going to be trouble, usually shortly before he goes in to DKA or his glucose dumps down into the teens, and this was that guy. After a hearty breakfast of five (!!!) glazed donuts, coffee with sugar, and some chocolate milk, he started feeling a little tetchy. He was kind enough to unload breakfast on my shoes--thank God I was wearing my old Danskos--and my scrubs. Lovely.

The vomit was joined a short time later by shit. And sweat. There's some Universal law somewhere that says that isolation patients with nasty intestinal bugs must a) weigh something on the wrong side of 400 pounds, and b) want their thermostat turned up to 85. You know those plastic isolation gowns? They don't protect worth a damn.

There was no isolation gown nearby when my seriously demented patient yanked out her Foley catheter and started waving it around, speckling everybody with pee. Of course, she was on pyridium.

*sigh*

Chef Boy floated the idea of moving to Brazil and running a B & B last night. You know, there are times when moving to the Southern Hemisphere, learning Portugese, and living in the middle of nowhere tending orchards and sheep seems like a really fine idea.

Oh, and I did get the IV started on the second try. A combination of barely-controlled rage on my part and several towels wrapped around his bleeding hand kept him quiet.

The Glamorous Life of a Neuroscience Nurse

Hugh called *again* last night, sobbing, stumbling drunk, begging me to take him back. I've got to change my number; he just won't leave me alone.

It was fun in the beginning, when all we did was have quick dinners out, followed by long evenings of piano-playing, tap-dancing, and singing Judy's old songs. He loved my rendition of "The Man Who Got Away", especially when I did it as though I was half-smashed, wearing huge false eyelashes.

Then I made the mistake of telling him I liked his sideburns. After that, things began to go downhill. He was always so *serious*, talking about how we could move north, excavate a little den of our own, and raise a few litters of kits. He just couldn't understand that I wasn't ready to settle down, especially not with such a player. I mean, what about Kate? And don't tell me that that kiss with Meg was all acting.

So I told him as gently as I could that we'd have to go our separate ways. He took it hard. But really, what's a girl to do?

Plus, the claws were, frankly, a pain.

Therapeutic Communication

"Roll over" I said.

"So you can see my incision?" he asked.

"No, so I can kick your no-good ass," I replied. "You've been giving me grief all day, and I've had it up to my moustache with your antics."

"Gobsmacked" would be the best word to describe his expression at that point.

The call bell system was dead. The cable was dead. The plumbing was under the control of some evil spirit. All of this had happened on the third day of his having to be flat on his back due to a low-pressure headache, and he was fed up. So he called the operator, the receptionist, the concierge, the assistant to the assistant to the President, and complained.

The one person he didn't call was me.

For two days he'd been cursing at nurses, throwing things, and generally making a pain of himself. The last nurse to take care of him had exited the room with some speed as the sound of smashing crockery came from behind her. This is a nurse whose dad was a Merchant Marine, so it's not like she couldn't handle it. But she couldn't handle it any more. So I went in to resite an IV that was giving him trouble, cussed right back at him, and got him for the full twelve hours the next day. Seems he liked my style.

I pointed out to him, at varying volumes and at some length, that he was paying me to make his life easier. Why, I asked, would he pay a lawyer to accomplish in two weeks what I could manage in two minutes if he simply gave me the chance? Why risk being branded a whiner when I could get him what he wanted (short of fixing the cable myself, which he seemed to expect) with a minimum of trouble and effort? Why, essentially, did he insist on being the most difficult of difficult patients--one with a legitimate complaint who says nothing until the pot boils over--rather than answering my questions honestly and letting me *make his life easier*? I'd tried to draw him out earlier, a number of times, and he'd simply waved me off.

Screw therapeutic communication. Sometimes it doesn't work. Sometimes it does, true; there are times when a patient simply needs a listening ear and somebody to say "Uh-huh, and then what?" over and over. But--and this is a big and delicate but--there are times when you have to throw it out the window and be blunt. Speak the language, as they say. Walk the talk.

He gave me cookies and a hug and an apology. I walked out with a smart remark and a toss of the head. We understand each other now; even if there's another crisis in the middle of the night tomorrow, I know he'll behave like a human being rather than the whistle on a teakettle.

*** *** ***

In other news, I'm rereading Bill Bryson's book on Australia. If you hear that I've cleared out my savings account and taken up a job travel nursing, you'll know what to expect: bulletins from the billabong.

*** *** ***

The Cat seems to love the Feliway Comfort Zone diffuser I got her. It's a pheremone-squirting widget that you plug into an electric outlet--supposedely, it combines "friendly pheremones" in such a way as to make cats happier and more relaxed. All I can say is this: after four hours of having the thing putting away, The Cat laid down in the middle of the floor and purred, allowing me to rub her belly. That hasn't happened in nine years. Maybe the neurologically-damaged Cat just needed some Happy Kitty Smellatrons; I dunno. I'm not questioning the results. (Mom: Try it for Astro.)

*** *** ***

The MBTs are, so far, a revelation. I'll let you know how they continue to work out.

Non-Work-Related, Part Deux

Girly Product Reviews, part Nine Gazillion

Amlactin Lotion

Friend Penny swears by this stuff for wrinkles. I haven't yet tried it on my face, but it works wonders on very dry legs and feet. It doesn't smell like anything, either, which is nice. And a little goes a long way; a lot will cause your skin to just sort of give up and peel off.

Flexitol Hand Balm

Another recommendation from Friend Pens, the Lotion Slut. She actually recommended the Heel Balm this way: "If there were something that worked on the rest of my life as well as Flexitol works on my heels, it would be called Dammitol."

The hand balm is petroleum-based, which means you can't use it during working hours, but it makes a nice overnight treatment for very rough, dry hands. It was originally developed for diabetics. It's easy to wash off and odorless, and again, a little goes a long way. Also good for feet.

Sally Hansen Beyond Perfect Nail Polish

I bought Whore Red (no, that's not the name, but it might as well be), painted my toenails with it, and they stayed unchipped and extremely shiny for three weeks. Plus, it came off with a minimum of strain. The only warning on this one I can come up with is, you'd better get a color you like. It'll be there for a while.

Old Navy Capri Pants, pickstitched, Just-Below-Waist

I found out after I bought two pairs of these that they were "Real Simple" magazine's pick for best capris for people under 5' 5" tall. Now, that's too much of a categorization for me, but I *did* buy two pairs of these pants. The waist is low, but not so low that you get that overgrown-teenager look. In fact, if you're short-waisted, the waist will hit *almost* at your natural waist, thus avoiding the Mom Jeans look and the muffin-top simultaneously. They wear like iron. I wash them on Boil and dry them on Broil and they don't shrink.

Gap (I know, I know) Flared Linen Skirt

At $68, this is a 'spensive piece of clothing...but I've already patterned two other skirts off of it and they're ready to hit the sewing machine. Good thick linen lined with cotton, eight gores, zip closure, French seams that should last forever. If you're short, do not mess around with the regular sizing; go for the petite.

This skirt hits at the natural waist and hangs almost to the ankle. It's perfect for people who live where the summers are sunny but who don't want to wear SPF 45 all over every damned day.

As soon as I get the MBTs in the mail, I'll review those too. Provided I don't fall off them and break my neck.

Non-work related

Sometimes a girl just has to turn her back on the brainstem, you know?

We were talking at work the other day about beautiful words: words that have their own intrinsic value as sounds, like "sycamore". Or "glioblastoma". Or "brook". We came up with quite a few, but the best remark came from a foreign doctor who remarked that "pus" was the best English word he'd ever learned. "Sounds like what it is and what it looks like. There's no question, when you hear the word 'pus', what the other person is talking about."

Apropos of nothing, United Nude shoes has usurped the place that Irregular Choice used to have in my heart. Any company that puts out a pump based on the Eames chair gets my vote. Unfortunately, I have no excuse whatsoever to buy even the least-pricey of their designs, as I just dropped a couple bills on some MBTs. They come highly recommended by the orthopods and physical therapists at work. Chef Boy's reaction was, "Do they come with training wheels?" No, but they do come with an instructional DVD, which kinda scares me. Still, if they ease my plantar fasciitis, they're worth it.

Pal Joey has a wedding to go to in Quebec City while I'm in Montreal this July. Anybody know of anything I should see or do while I'm there? Keep in mind that my French is limited, rusty, and slow.

Simple rules.

1. If you have to jack with it, it's wrong.

This goes for everything from IV tubing to new shoes to long-standing romantic relationships. If you have to jack with the tube-feeding tubing to get it to go into the IV port, you've got it wrong. If you have to walk like a kangaroo in Earth Shoes in your new shoes, return them. If you have to jack with your responses in a long-time relationship, it's time to rethink.

2. If in doubt, give oxygen.

Again, this goes for everything from nonresponsive patients to relationships. Space is a good thing.

3. Sternal rubs cause bruising out of proportion to their usefulness.

This does not mean you should necessarily stop using them. After all, bringing one patient back from the brink of grokdom is worth a few bruises, right? Right. The trick is knowing when, by looking at your patient's sternum, one more mofoing sternal rub is not going to do the trick.

4. Always set two alarms in case of power failure.

That one's self-explanatory.

5. Less than a quarter-tank of gas is just asking for trouble.

Even when gas is $3.40 a gallon.

6. If you love, love, love a place, you should either buy it (if it's a condo or a house) or move there (if it's a city) without thinking too hard about the alternatives.

Another alternative may be better to the logical thinker, but will it make you happier? I think not. (Joey, listen up.)

7. Pate de fois gras always tastes better when you have several months of anticipation invested in it.

I'm going travelling in July, yes I am.

8. Cocaine and methamphetamine are the only scary drugs.

9. When you're eating faux-Mexican, just go 'head and get a to-go box right at the start.

That way, when the waitstaff brings you a four-part symphony in pseudo-burrito, you can put it away rather than munching on it all evening.

10. Support hose, no matter how good they feel at 0900, will always twist in some heretofore-unimagined way and cut off your circulation during a code.

You have been warned.

Pen-i-ten-shurry.

"You," she said grimly, through clenched teeth, "are gonna end up in the pen-i-ten-shurry for this. They're gonna come let me out tomorrow and you're gonna go to the pen and I'm gonna laugh when the cops come to get you."

It was three-and-a-half hours into a four-hour drama, and I was getting rather tired of the situation. I replied, as calmly as I could, that I was not going to the penitentiary or to jail or to hell, no matter how often she repeated those suggestions, and that she was not getting out of this place tomorrow.

Subarachnoid hemorrhages are weird things. They happen most often when an aneurysm, a weak area in an artery, cuts loose and bleeds. What happens next is confusing and fascinating; the patient ends up with what's essentially a sterile meningitis (inflammation of the coverings of the brain and spinal cord). The ability to speak clearly sometimes disappears temporarily, and the person tends to take long vacations from reality.

Combine a subarachnoid hemorrhage with a couple of other organic problems that have already caused substantial damage, then add on a subdural hematoma. That's bleeding under the toughest layer of meninges that cover the brain, and is most often caused by a blow or counter-blow injury to the head. Subdural hematomas fall under the category "walk, talk, and die", because they tend to expand rapidly, compressing the brain tissue under them and on the opposite side of the brain. We keep SDH patients under close observation for several days for that reason.

Even if those patients aren't wandering off the floor, attacking ICU nurses when said nurses don't come up with discharge paperwork, and begging to be left alone long enough to have a quiet cigarette outside.

Had I been able to, I would've ordered a toxicity screen, both blood and urine. Unfortunately, after she came back upstairs from the lobby of the ICU, I had been busy holding her down. For three and a half hours. That kind of energy--the sort of energy and strength that allows an 80-pound patient to break through soft restraints and a restraint vest and requires 160-pound me to kneel atop her--doesn't come only from a subarachnoid hemorrhage or subdural hematoma.

It started innocently enough, with a long-distance phone call to her elderly mother, asking Mom to come pick her up. When Mom arrived, having not checked with the nurses to determine whether she could take her daughter home, things went straight to hell. The patient, amazed and angry that she wasn't going home, became increasingly violent. We got Mom out of there pretty sharpish when it was obvious that we would have some serious work to do.

The end toll on the patient goes like this: ten milligrams of Haldol IM, three of Versed IV, eight of Ativan IV, and four-point soft restraints, Posey vest, and bruises on wrists and ankles where people had to hold her down. (Note for nonmedical types: that's enough sedative and antipsychotic medication to take down a 200-pound man and make it necessary to bag him. She just got calm.)

Oh, and I ran a fourteen-gauge (note for nonmedical types: a fucking huge) IV into her left ankle with one stick. She didn't like it, but I felt better.

The end toll on the staff is as follows: One black eye, one certainly sprained and possibly broken finger, one sore back (that's the only one that's mine, thank God), several puncture wounds from filthy fingernails, and one inch-wide bite wound on a forearm.

The bite wound happened to a very sweet, slightly slow nurses' aide who happened to look away at a critical moment. I feel terrible for her, not least because she had to get vaccinated for tetanus and all the various other things one can get from a human bite, and she hates needles. I will say this, though: she held on like a bulldog even with blood from the bite running down her wrist and hand.

I bought her a pair of heavy black rubber elbow-length gauntlets today at the hardware store. I'll wrap them in pretty pink paper with a girlish bow and give them to her the next time I work.

HN Special Feature: TeeVee Show Review!

I was really, really not wanting to put too much mental effort out tonight; two days straight of The Great Influenza and starting Pinker's How The Mind Works had left my brain box empty except for a quivering lump of greyish Jell-O.

So I flipped on the tube and stumbled on something called "The Ghost Whisperer." I was intrigued: a show about a person who trains ghosts to canter, trot, and gallop? A medium with laryngitis? You gotta understand, I may not get out much, but I watch TV even less.

What I got was Jennifer Love Hewitt and some guy I vaguely remember from the old one-season wonder "Relativity" (as well as Snow White: A Tale of Terror, with Sigourney Weaver as the evil stepmom) playing a paramedic (him) and an antique store owner (her) living in a small, peaceful Eastern Seaboard town.

So far so good.

As things progressed, though, I started to wonder: if this chick who sees dead people (all the time!!) and tries to send them into the light has been doing this since she was six, how come she's still flipped out by manifestations of what should be, by now, a fairly routine occurance? I mean, even her husband and business partner are treating her visitations with the sort of wry humor that connotes total acceptance of the weird.

Also, what up with the hallucinations? I mean, she's hallucinating all the damn time. Either that, or the dead aren't very good at communicating, since a planeload of people about to come down (this week's plot) can only focus their combined energies on one person. Everybody else is missing the obvious, like half-frozen people in pilot's uniforms wandering around. If J-Love's character is living in a small town, and her husband's a paramedic, you *know* somebody's said something to him about this by now. "Uh, Bob...you know, I hate to mention it, but your wife keeps screaming and clapping her hands over her ears in line at the Wal-Mart. Has she seen a doctor?"

Furthermore, what up with the eyeliner and Goth-Girl costumes, dawg? There was one scene in this week's episode in which Our Heroine was walking across Ye Olde Towne Square, the only person in town (and they all seemed to be on the square at that moment) wearing head-to-toe black and eyeliner fit for a Mod Squad audition. That, in most small towns I know, would get you looked at funny at the least, and probably not guarantee a lot of business for your antique store. ("Same As It Never Was." Cute, guys.)

At one point in a subplot, an architect stops in for a consult on remodelling the antique store and mentions that he's "passed by this place" a number of times. At that point The Cat snorted and said, "Yeah, 'cause he's freaked out by Little Miss Death Hallucinatron, here."

Then there's the subplot with the rookie paramedic who gets freaked out by the sight of blood, and Sensitive Husband Paramedic Guy has to be his big-brother type and get him over it in time for a plane full of sort-of-dead, mostly-frozen people who've been talking to J-Love for the last fifty minutes to crash...right into Smallton! Or Greenville, or whatever it's called.

According to the preview for *next* week's show, the whole upshot of the dealie-o is that J-Love will have to somehow armor her black lace cardigan and go up against The Devil Himself (dun dun dun) to save the souls of the mostly-dead, pretty-well-freezer-burned folk on the plane. There's a lot of symbolism about a pocket watch and doves coming back to life and love never dying, and Beelzebub wears a really, *really* bad hat and hisses a lot in J-Love's ear.

The Cat, pausing in her paw-licking, opined that Satan is getting lamer and lamer every year. "Whatever happened," she asked, "to 'Sinners in the Hands of an Angry God?' Or Dante? Or even 'The Gospel of Peter?'"

I told her I had no good answer, and so we're going to bed.

I'm blaming The South Bitch Diet.

So, um, you know when you get a scary troll on your blog? And you go and enable the "moderate comments" dealie on the blog template? And you forget to, um, type in your email address in that thingy so that the Blogger software can let you know when a comment's been posted? And none of the comments get posted, for, like, six weeks, so you think nobody's reading your stuff and you start posting titles like "BOOBIES!" and stuff?

Just be glad I'm not a programmer or proofreader, people. I figured out the comments glitch today, and let's just say boy is my face red.

It should work now. I take back all the nasty things I said about you, Blogger. It was entirely my own fault, mea culpa. And thank you, various commenters, for the nice things you've said.

On to bigger and worser things:

All you folks who have done SBD or who know patients or family members who have done it, I have a question: How do you get the freaking headaches to stop?

I'm well-hydrated, I'm eating everything I should. Last night I was in the grips of a three-day-long headache and finally ate a pita sandwich. The headache disappeared and hasn't returned since. I had a half-cup of rice today, which I think might account for that. Is this headache going to continue through the first phase of the diet? If it's that bad, should I just say to heck with it and start with Phase II? I don't eat much in the way of simple carbs anyhow, so that wouldn't be too bad.

It was bad enough yesterday that I took four ibuprofen, something I never, ever do, and the headache *still* didn't disappear. It went from "making me afraid to try to drive" to "moderately distracting". And no, I haven't cut down on caffeine. I wasn't having that much anyhow.

I can handle hunger and muscle aches and bad skin. I can handle constipation, the Plagues of Egypt, bad relationships, and traffic. I just cannot handle unrelenting headaches of near-migranous intensity. Any help would be appreciated.

In other news, since The Boys are off at the AANS conference, I'm home today, huzzah! Things will begin to pick up on Thursday, when they return, but I'll be off work then and (I hope) refinishing my dining table. The Cat and I had a little mutual-admiration society going this afternoon, so she should be able to handle being not At The Forefront of The Human's Mind for a day or so.

Note on the last big post: The song lyrics in italics are from Barenaked Ladies's "The Old Apartment" and Jackson Browne's "In the Shape of A Heart", mixed up together. "The Old Apartment" can be found on the album Rock Spectacle, while "In the Shape of A Heart" is on Lives In The Balance. You can hear lots of Browne cuts on his website, jacksonbrowne.com, which almost makes up for him being a drunken wife-beater. And for imbuing me with a lifelong *thing* for skinny dark-haired guys with dark eyes.

And that is all for now. Comments remain moderated, but now I know how to fly this bitch, so we'll do fine.

Blogger Band-Aid

Suggested by Les, brilliant correspondent.

Blogger's bug won't allow people to post on the first post on the page, so I'm trying something new: A band-aid post to knock the *real* post down a notch, so it can be commented upon.

Let me know how it works.

Finally, enough time off.

Of course, I'll pay for it starting tomorrow.

I had two days off this week and three last week and actually put them to good use. Chef Boy and I went to a food show, a nightmare of fried things and processed things attended by the chefs of places like Applebee's and Chili's.

I kid you not: I saw six people so obese that they could not walk and had to use those little scooters to get around. Obesity doesn't necessarily lead to mobility problems, but the lightest of these folks was, by my estimation, somewhere north of 400 lbs. That's gonna give you problems at some point.

Apparently, this particular food show is a big draw with church groups and social groups: people buy tickets for however much, then grab a to-go box from one of the product booths and fill it with fried things.

The only booth that had fresh food had no samples available. It was torture, walking past heirloom tomatoes and bags of salad and not being able to eat anything but chicken-chili-cheese dogs (the most foul thing I've ever put in my mouth) and crawfish empenadas (a close second). There's a list of about eight things I will never eat again, even under duress, and the food show provided all but three. (The other things are Danish ammonia-and-salt licorice, anything flavored with asafoetida, and Tofu Pups.)

I also bought books, to wit:

The Tale of Despereaux, by Kate DiCamillo. I was not crazy at all about Because of Winn-Dixie, but this is a charming story well-told. I like the style, I like the rat Chiaroscuro, I like Miggery Sow.

Eragon, by Christopher Paolini. So far it's failing to entrance me, but I understand it gets better after the first eight chapters or so.

How the Mind Works, Steven Pinker. Because I felt like I oughta, and because I liked the interviews with Pinker that I saw on YouTube.

John M. Barry's The Great Influenza. I'm not sure I haven't read this one before, but if I did, I don't remember it and so should read it again.

The South Beach Diet. Yes. My belly measurement has reached truly worrying levels, as have my fasting blood glucose and cholesterol numbers. Two of the internal med docs I work with recommended this book, independently of one another, and they're both the biggest fitness-freak Diet Cops I've ever met, so I'm going to give it a shot. Hell, I can do anything for two weeks, especially an induction plan that includes things like broccoli and Brussels sprouts and black beans.

Lesson learned: If you don't listen to your doctor when he tells you you need to make small changes, you'll end up having to buy diet books and looking askance at potatoes. Which is probably a good thing, as I don't want to end up like Miggery Sow, cauliflower ears and all.

Dinner with Chef Boy's family, a whole bunch of laundry, and some more naps rounded out my days off. Work I'm not even going to mention; Eric over at eric135 says, rightly, that February and March are the nastiest months of the nursing year, and April isn't far behind, at least at our facility. We seem to be having a run on subarachnoid hemorrhages and glioblastomas (with six you get eggroll!) and I'm just plain tired of thinking about it.

Besides, it's nice to have something like a life now and then.

The shape of a heart

I drove past the old house today. It's the house I grew up in; the one the 'Rents sold to us shortly after we got married.

I hadn't driven past it in three years. Not through trying, but because my daily life doesn't take me to that end of town any longer.

The Erstwhile Hub and the Erstwhile Best Buddy are living there, still. Shortly after I left, and she left, she moved back in.

It was a time I can't forget
Full of sorrow and regret
And the shape of a heart
And the shape of a heart

There were two things left that I cared about, the dog that I saved that I left behind, because it was better for him, and the rose bush that had grown as tall as the second-story windows when Mom and Dad bought the place.

Why did you paint the walls?
Why did you clean the floor?
Why did you plaster over the hole I punched in the door?
This is where we used to live.

I walked around to the back fence (stalking behavior, I know; email me if you're in a chastising mood) to see if the dogs were still there; I guess they'd been taken in for the night.

The rose bush is gone. Dug up, cut down, it doesn't matter. It's gone. All ten feet of it, each way, with blooms that used to come like clockwork in April and again in June and then sometimes in December if it was warm.

these things used to be mine
I guess they still are, I want them back

Now there's nothing that ties me there. For three years or more, I'd assumed that they'd keep the rose bush at least. In some weird sense, I'm free of the two of them, of all the badness that happened unexpectedly after an amicable divorce, when it turned out that he couldn't let go and she was determined to put herself in the right.

That's twelve years of my life you're talking about. Which isn't much, given a life expectancy of 107 years, but it's a lot to me now.

You keep it up
You try so hard
To keep a life from coming apart
And never know
What breaches and faults are concealed
In the shape of a heart

More than twelve years, it's the two people who made me mostly what I am now, more than I ever made myself. I had known her from the time I was 18. She had stood by me, mostly, through the roughest parts of my life and the best. And he was the first person I'd ever met, and so far the only one, that I thought I could stay with until I died.

And I held it in my hand
For a little while
And dropped it into the wall
Let it go, heard it fall

We bought an old house on the Danforth
She loves me and her body keeps me warm
I'm happy here
But this is where we used to live


Only memories, fading memories
Blending into dull tableaux

First things first....

Blogger has a bug which disallows comments on the newest post on every page, unless you're using some combination of IE and luck which I've only hit on once. I know some of you have encountered that bug, and I apologize. There's no way I know of to fix it in the template, so you'll have to keep either emailing me with comments or wait until a new post comes up to comment on the second-newest.

Today, as I was manhandling a casserole into the fridge, I caught the third finger of my right hand against the corner of a drawer I had carelessly left open. The corner (being that weird melamine veneer stuff) ripped a swath of skin and meat off the first knuckle of that finger. For the first time in a very long time, I looked down after doing myself an injury and saw I was bleeding.

Copiously.

Luckily for me, it didn't involve a fingernail. I'm sure I've told this story before, but I once sliced a chunk out of a fingernail with a mandoline as I was slicing some vegetable or another. I actually fainted when I had to change the bandage on that finger. I had foreseen that possibility and so had a friend standing by with ammonia and Scotch and ice packs, all of which she put to good use.

So I stood there, watching in fascination, casserole forgotten, as I bled. I don't usually injure myself with sharp or penetrating things; my hurts tend to be more of the blunt-trauma, falling-over variety. Or of the roundhouse-to-the-left-kidney variety, one of which I sustained a week ago and am only now feeling normal after.

One of our patients with no risk whatsoever for seizures had a seizure. He's a big guy--six-eight and three hundred pounds at least, and not fat. We're talking Olympic athlete standard of fitness and muscles from here to Toledo. And he, of course, is the one who has the tonic-clonic seizure to end all tonic-clonic seizures. I've never seen anything like it.

His wife screamed out over the call system, so the charge nurse and I hit the door at a dead run. Credit to the charge for saying simply, "Shit." and turning on his heel for oxygen and Ativan and the crash cart, but I had to stay in the room and get this guy on his side.

Down goes the bed--they're heavy when you grab the CPR emergency release--and I hauled the patient over on his side so he wouldn't choke on the blood and vomit and foam that was seeping out from between his clenched teeth. A rigid, tall, heavy, muscular patient who's in the grips of a seizure that's made every muscle tetanic is not easy to get over onto his side; it amazed me that I could manage. But I did.

He seized long enough that we could run for a mask, for more Ativan, for a suction setup and O2 monitor and blood pressure monitor and EKG leads and he *still* hadn't finished. Conservatively, I know his seizure lasted at least forty seconds, and probably more like two minutes, with no dimunition until after we'd given him a total of 4 milligrams of Ativan, fast push.

Then it was suction and Venti mask and EKG leads and where the hell's that respiratory therapist and more sedatives and Jesus Christ somebody get me a four-by for all this blood, then reasoning out that the goose-egg on his forehead came from his repetitive pounding of said head against the bedrail during the clonic portion of the seizure, and then off to CT scan.

And I went away and gibbered for a few minutes, even though he wasn't my patient, because if there's one thing I hate more than a code it's a seizure. And this one...dear sweet Christ on a crutch, I can honestly say I didn't know the human body could make such sounds. Or that eyes could roll quite like that. Or that people actually, really and truly, *foamed at the mouth*.

Years ago, when I was still at PP, a patient's boyfriend had a seizure that culminated in one of our waiting-room chairs being kicked through a tempered-glass window. This one was much, much worse. I'm just glad that we had three bedrails up; there's no way I could've held him on the bed without the support of the rails. Even so, one was bent so far out of alignment that it's not usable.

And at some point I sustained a really lovely bruise over my left kidney. I'm not sure if I got it during the scrum to get Ativan into the guy, or if he whacked me with a flailing leg without my noticing, but it's there. It's *still* there, I should say, and still makes me wince when I roll over in bed. I guess I'm lucky not to be peeing blood.

Just thinking about it makes me gibber some more and feel sort of shaky.

The best part? Dude had a bladder infection from a catheter we'd had in him during back surgery. We gave him Levaquin, which apparently lowers seizure thresholds in otherwise normal folks.

So his risk factor, looking back, was a commonly-used antibiotic.

Er.

I think I'll tough-out the next sinus infection, thanks.

And go put an ice pack on this flank.

Boobies! Boobies! Boobies!

Nota bene: there are no boobs in this post. The title line is merely an attention-getting device.

A nice guy came in a couple weeks ago with a huge tumor. This particular huge tumor is growing in his chest, wrapping around his spinal column, compressing his lungs and heart, and dropping down to involve one kidney. His symptoms started about five months ago and got steadily worse; he's lost the use of his legs and bowel and bladder control.

He came to us through a relative of a friend of a former patient who *also* had a huge tumor. She had heard somehow of the guy's predicament and called her relative's friend's former surgeon, who said to bring the guy in.

His predicament, to wit: being discharged from a charity hospital because the only surgeon who was not willing to operate gratis demanded full payment for service up front. This particular wanker apparently works on contract with The Other Hospital, so there wasn't a lot anybody could do. He was also apparently the only surgeon willing to attempt a tricky and complicated resection, so my patient was screwed. To the wall.

Now, as in all great Suthun states, we have one city which continually congratulates itself on its international appeal, its liberalism, its ability to absorb people of all ethnicities and cultures into a huge melting pot/salad bowl of wonderfulness. This particular guy emigrated from his home country during a time of, shall we say, political unrest, and landed in That Great City.

Whereupon, after working and paying taxes and so on for umpty-ump years, he was told by one nurse to "go back to your own country to get your surgery". Yeah, I'll bet the Khmer Rouge established *great* surgery programs in its medical schools. Then there was the accusation by a doctor at the hospital that the patient was over-playing his symptoms in order to get free treatment for himself and the presumed ten kids he had, because, as the doctor pointed out, people like that come here to take advantage of the system.

And then there were the nurses and nurses' aides who pulled slanty-eyed faces and spoke with fake Chinese accents to him and his family.

Lovely crowd, that. There is something to be said for a well-aimed tornado or six, eh?

At any rate, he's with us now, and he'll get treatment for free. He had his first surgery over the weekend, an anterior resection of the bulk of the tumor, in order to allow him to breathe. The neurosurgery and kidney stuff will come a little later in the week. I think he's glad he left Self-Absorbedville and landed with us, poor sot.

It still amazes me, even after (*cough*) years of being on this planet, that people can be outright viscous hateful bigots. Especially people who have a professional charge and a moral responsibility to be better than everybody else when it comes to their job. There don't seem to be enough tornadoes to go around.

Is it a sin to call in sick when you're really not?

Because I have a bottle of Becker Vineyards' Viognier here, and a slab of salmon, and a little miniature Dachshund across town that would love to play tug with a sock.

(Nota bene: Becker Vineyards is in a place called Fredricksburg, in Texas, in the Hill Country. It produces a really superior Viognier. You should have some, even if you have to scour your local wine store for it.)

I also have a kitty-cat who hasn't seen me for Two Whole Days, and for whom I just installed a Cat-A-Comb (one of those corner groomer widgets that contains catnip). And I have a bed, which I haven't seen much of lately, and a Chef Boy who's feeling a bit put out that I haven't seen much of *him* lately.

At work, it's Glioma Season. Any nurse will tell you that things like appendicitis, brain tumors, and heart attacks tend to come in waves; this is our Glioma season. Subarachnoid Hemorrhage Season starts in a few weeks, when the thunderstorms and resultant pressure drops start to get *really* nasty...but for now, it's all tumors.

She has a glioma that extends from the bottom of her right frontal lobe, just above her sinuses, to the middle of her frontal lobe, and might have fingers reaching into her temporal and parietal lobes. So far it's skinny and isn't affecting her thought processes, though her balance is a little off. I discharged her on Monday. She'll come back next Monday for a biopsy. There's not a lot we can do besides a confirmatory biopsy and gamma-knife radiation; her tumor is in a really, really nasty spot and a really, really nasty configuration.

"So," she said, "the doctor was just in here telling me that this is probably brain cancer."

"Yep," I replied.

"And it's going to kill me if it is?" she asked.

"If it is, it will." I said.

"Mmmm. I suppose I ought to do all those things I always wanted to do, then," she mused.

"That would probably be a very good idea." I said.

"How long do I have before I...(flapping hands helplessly, crossing eyes, and sticking tongue out of mouth)?"

"Maybe six months. More probably three." I replied.

I wasn't telling her anything she hadn't already heard from the doc, and she isn't the sort of person that appreciates bush-beating.

Unexpectedly, she asked me, "Do you know Trout Fishing In America's version of 'Last Days of Pompeii?'"

Do I. "On the last day of Pompeii/Thought I heard some poor boy say/Oh, wow, man/If I knew then what I know now..."

I giggled. She giggled. One of the lines is about "I woulda filled up on chocolates, cigarettes and booze/given some perfect stranger the blues". We were both thinking about that.

"If I don't show up on Monday," she said, "I'm in France. I'm spending all my money and eating good cheese and chocolate and flirting madly with men two decades younger than I am."

"Rock on," I said. "Have some Camembert for me."

She won't be back for that biopsy.

Down the hall is a woman with three children, in her late twenties; a totally non-average patient for a glio. Hers is large and aggressive and likely to take her body before it takes her mind, yet she's cheerful and happy.

"I can't believe how blessed I've been," she says, after a group of her friends from church leave. "One of my friends told me that I'm the sort of Christian that she wants to be. All of these people have shown me such love and such tenderness. I feel like I've fallen into a whole group of Good Samaritans."

She thanks me for her care and promises to pray for me. She leaves a lovely thank-you note that mentions me by name and lavishes praise on all of us.

"Serious denial" says the PA, whom I'm not real fond of these days.

"Maybe she really *is* blessed" I retort.

And here is where I find the motivation *not* to call in sick, *not* to spend the day with perfectly healthy people, doing perfectly pleasant things. I've met two people who've gotten the worst possible news a person could get, yet they intend to live the hell out of their lives in the twelve or fourteen weeks left to them.

I'm going in tomorrow with the express purpose of living the hell out of the day, no matter how many are given to me thereafter. If I drop dead of an aneurysm at 19:08, at least I'll have had fun. And maybe made a difference.

One thing's for sure: I'll be humming, "And now that I'm a goner/All that lava rushing 'round that corner/Oh, wow, man--I ain't complaining/Only thinking out loud/You know that my life would be different/My love would be different/If I knew then what I know now."

long trung thanh

She's a nice woman; a little thin for her height, but solid muscle and bone. She had a brain tumor in an odd spot; although we managed to get it all out, it still had an impact on her legs. She's learning to use them now, just yesterday she walked 300 feet with only a gait belt.

She's the head of the SWAT team for the town two counties over. Not something you'd expect a pretty blond to be doing for a living. But she is, and she's apparently very good at it--good enough that the Thin Blue Line has been in evidence 24 hours a day outside her room since her surgery.

See, when a cop gets hurt in the line of duty, it's a tradition for the other cops to sit outside his or her room, one at a time, all day and all night long. I don't know if they run errands or just sit and eat sandwiches and read the paper, but I've seen them in every case where a cop has ended up at our hospital.

It's more unusual for cops to pull their vigil when one of their own gets hurt, or gets sick, outside the line of duty, but that's what these guys and women are doing. On their own time, they come and occupy a chair outside her room. Inside, there's a party going on--somebody brings in grinders and a sixer of beer, and shares everything with the nurse ('cept the beer, of course; it wouldn't do to drink on duty) and we all have a nice time.

Three rooms down is a gangbanger. He got part of the top of his head taken clean off by a bullet about a week ago. He's beginning to come around now, but he's going to have problems with speech and spatial relations for the rest of his life. His room is quieter. When his mom or aunties show up, there's a lot of talk but not much laughter. Sometimes, they pray.

And outside his room, on a chair, down the hall from the cop, is one of his buddies. Every hour around the clock, in shifts, they come to sit and keep vigil in the same way the cops do.

The khaki shirts and brown pants clash a little with the tattoos and blue bandannas, but we're all getting used to it. Grinders and beer in one room, wings and Pibb in the other. They'll all get along fine as long as they're here.

I asked one kid who showed up for the night shift why he was giving up his time to sit in the hallway in the hospital. "Respect." he said. "Loyalty."

Gettin' the mojo back.

Thank you, V.S. Ramachandran.

This book, Phantoms in the Mind, is one of those books you never knew you needed--badly--until it came along. I'm a bit late in reading it, like about eight years, but at least I've found it now.

He out-Sackses Oliver. He postulates interesting hypotheses on why people with partial blindness have hallucinations. He has a fantastic theory on phantom limbs that also addresses foot fetishes, and includes a couple of cool experiments that you can try at home with only a cardboard box and a mirror. He gets into the temporal lobe experiments that showed that religious experience is tied to electrical activity in the brain. He makes the connection between the left and right sides of the brain clear and discusses neglect syndrome in that context, brushing against Freud on the way.

In short, this book will get neuro folks excited again about what they do.

I think I'm going to order A Brief Tour of Human Consciousness next.

The Slump

It's ironic, really.

Just when I feel like I've hit a slump, writing-wise, and that I don't have much new to say, a very nice person from a trade publication sends me an email saying, "Hey! We wanna reprint X, Y, and Z weekly from your blog? That okay?" and I say Yes.

After all, how much new can you say every few days about gliomas and spinal cord tumors and customer service initiatives?

The amount of paperwork I do for an admission has quadrupled; the amount I do for a discharge has tripled. That's not as a result of HIPPA or joint commission requirements, it's a customer service plan presented by management.

The risk factors for an incurable brain tumor still include a happy life with well-behaved, intelligent children under the age of ten, a fulfilling job and loving spouse, and a pleasant and even temperment. Mean people never die.

The crack team of transplant nurses a couple of floors down from us are doing a lot of MUDs these days, which is taking a toll on them as a team and individually. MUD stands for Matched Unrelated Donor--it's a bone-marrow transplant of the last-ditch-effort sort--and people generally die, from what I understand, in particularly horrific ways after one. One of their nurses finally cracked about a week ago and left, just like that, because she couldn't stand to see any more twenty- and thirty-year-olds with their skin sloughing off and grade IV diarrhea. We see the nurses, looking haggard and drawn, in the elevators sometimes. We send them anonymous chocolate bars and flowers and do what we can to help them hold it together.

But there are compensations, even when my writing bug goes away for a while and it seems like everybody is dying all at once.

I had two very pleasant, healthy patients yesterday, both of whom had things that were not only curable but curable quickly and with minimal fuss.

One of my other patient's mothers bought me breakfast. Yum.

Another patient took the time to write out complimentary notes for every nurse that had taken care of him, every tech who'd helped him to the bathroom, and every transporter he'd been wheeled around by. No, I wasn't one of those nurses; I just provided names and pieces of paper, but it was nice to see.

I learned yesterday that you have to see the compensations when they come. The compensations might not be on the same scale as the horrific stuff, though. Most people who die in the hospital are sick in ways we can't even imagine--every system they have has shut down, or is screwed up, and they're in pain for a long time before they go. It's an extended, torturous way of dying, and we see it a lot.

Two or three pleasant people who look happy to see you and cooperate in their own care might not seem to compensate for the unfair and unpleasant outcomes of somebody you really liked, but they do--if you let them.

I think all nurses go through whatever this is. It's not burnout. I still want to get up and go to work, I still enjoy what I do when I get there. I still feel incredibly fortunate that I'm able to do what I do, and that there are other people willing to pay me for it. It's just that days are beginning to look the same.

I know it'll pass--this has happened in other jobs before. It's interesting to imagine what'll snap me out of the all-days-the-same mindset, and I'm willing to wait for that.

In the meantime, you guys might have to settle for more posts on potroast and crafts.

This is post #326.

I like the symmetry of that number.

I haven't worked in days; all I've got to tell you is old gossip from the unit. Like, it must really suck to have your discharge paperwork in hand and then suddenly hemorrhage and fall over, just like (snaps fingers) *that*, and die. That must just suck.

Just as it must suck to be the nurse whom the priest berates (and this is not gossip; I was there to see it) because said nurse called said priest in on a Sunday to give Holy Communion to a patient. Seems the priest didn't want to have to fight traffic.

Which made Gina, my six-foot-two-inch-tall, Baptist chaplain friend remark, "Well, some get called by God. Other people just get a text message."

Heh.

I've spent the last couple of days doing very little, and today doing quite a lot. For several days this week, it's rained and rained and rained, which we needed badly, and which gave me the excuse on Saturday to stay home in my pajamas, sample a new beer (Konigsberg Haven Quadrupel), and read. Today I hung out with Chef Boy at the grocery store and then went book shopping. I'll fill you in on my neurologically-flavored selections once I've had a chance to read 'em. Right now I'm unapologetically reading James Herriot and waiting for my potato to finish baking.

And I'm kicking myself, because there was a guy selling unidentifiable bits of Hispanic food from a handcart this afternoon, and we didn't stop. Of course, I had tacos carne asada with cilantro and onion in my lap, but who knows? Perhaps he could've had an appetizer in his cart.

Speaking of which, I recently made a mental survey of my neighborhood and found this: it is possible to get elotes from a cart, cabrito, kim chee, baba ganouj, fresh pita and tortillas, and fresh French bread within a two-mile radius. As well as your windows repaired, ironwork done, your saltwater aquarium dealt with, and your Christian bookstore needs taken care of. Oh, and you can get run over by a train, too.

You can keep your lily-white suburbs. Gimme the 'hood, any day.

Good news, bad news.

The good news is that one of my patients whom I thought wouldn't live last weekend is now sitting up and talking. Not making a lot of sense yet, but talking. She knows she's in the hospital and she recognizes people. Two weeks ago I had her in the ICU stepdown unit; one week ago I thought we'd have an empty room when I came back this week.

The other good news is that I'm off for three days, it's pouring rain, and I have ample supplies (Belgian quadrupel ale, science magazines, Good Omens, and French bread) to last out the weekend in my pajamas.

And The Cat is seemingly content. This is *very* good news indeed, as The Cat tends to draw blood when things aren't going her way. (How did I end up with a neurologically-damaged cat? Someday I'll tell that story.)

The final good news is that my pal Heather, Wielder of Hammers, had to bow out of a retail madness get-together today. I wasn't feeling real up to retail, let alone retail in the rain, and Heather shops like the Luftwaffe blitzed London, but with a smile. So here I am, in my pajamas with my quadrupel, pondering the bad news.

The bad news is this: a patient's sister felt it necessary to come see me at work, to let me know that my patient is on life support--or was, since she's probably dead by now--at a different hospital, fifty miles away.

You try really hard in this business not to like people. I mean, you *like* people, otherwise you wouldn't be a nurse. What you try to keep from doing is realizing that a particular patient would've made a really, really good friend had you two not met when she was diagnosed with a rare and aggressive degenerative neuromuscular disease.

You try really hard not to like people that you know you're going to lose soon.

Devic's Syndrome is often referred to as a type of multiple sclerosis, but it's really not. It's much more systematic than MS, and in its way is crueler. First it takes your eyes--the primary symptom of Devic's is a preference for the optical nerve--then it takes your legs, then your bowel and bladder control, and finally your ability to breathe.

All of this happens quickly and without the changes in mentation or personality that happen sometimes with MS.

There isn't really any effective treatment. You can start the person on chemo, and they'll lose their hair (a long-standing joke was that her hair was longer than mine before mine started to grow out), or you can put them on various pheresis therapies that might make them feel better for a time (another long-standing joke was that I used the same vein over and over, in an attempt to carve my initials into it), but really...nothing much will make a difference.

And so, blind and bedbound, with the same interests and intelligence and humor that she had before she got sick, my patient told me that I'd better shape up--or else she'd come kick my butt when she could walk again.

I think both of us knew at that point that she wasn't going to get to kick my butt. Neither of us wanted to admit it.

I had to pass the news on to other people who'd worked with her. That's not fun, either.

"Somewhere, somehow, I know she's going to be healed" said her sister.

I know she will be, too. But what happens to the almost-friends she leaves behind?

Yes, I removed some comments.

Because I don't believe in trolls.

I know they exist, but I prefer to stick my fingers in my ears and sing la la la la until they go away, or until such time as they stop ignoring civilized rules of behavior.

Such civilized rules include:

No calling other posters names. That includes everybody. "Stupid" is no better than "cunt", but I'll remove the most offensive posts first.

No infighting.

No pissyness. That is reserved for me, and me alone, when I'm talking about residents.

...play nice, or go home.

Edited to add: Anon, if you'd like to know *why* nurses at my facility bathe & bag on a regular basis, without our being understaffed, and why we don't have a problem with it, you're welcome to email me. I'm even forgiving the cunt comment for this.

"You ought to be kinder."

That was the ultimate line of an email I got this weekend, from somebody who'd read the blog but hadn't commented.

The gripe the correspondent had was that I, apparently, am not kind enough on my blog--that I bitch and rant and moan and generally take people to task here.

Hm. Let's see why. In the last seven working days, I have:

*Been physically assaulted (thankfully not injured) by a demented patient whose family stood by as he lifted me by one arm and tossed me around...

*Been threatened with shooting by a young man who thought we were being mean to his father by not letting Dad smoke in his room, with his oxygen mask on. (For those keeping score, this now makes three-of-three in terms of times I've been threatened with shooting in healthcare settings.)

*Had to have a little heart-to-heart with a tempermental attending, revisiting points I've made before, such as the concept that calling a nurse a "stupid bitch" isn't going to win friends and influence people...

*Had to mention legal terminology in order to get action on a personnel issue; no further details until later...

*Dealt with a patient who left AMA after it was revealed to him that no, he wasn't going to get any more narcotics...

*Done the work of two people after a nurses' aide simply wandered off the floor in the middle of the shift and couldn't be found for two hours...

*Scoured the hospital complex for a confused patient who was allowed to leave the floor in a wheelchair despite orders to the contrary...

*And was verbally abused by a family member claiming to be a nurse who couldn't understand why we might actually enforce isolation rules.

In between I clarified orders written by residents who don't understand the concept of "PRN means *for* something specific" and "legible handwriting makes the difference between digoxin and Demerol", moved patients up in bed, out of bed, from one bed to another, handled countless bedpans, showered a few people, gave pain meds, passed dinner trays, answered the phone approximately 10 to the 23rd time, comforted the sister of a patient on life support, and bathed and bagged one dead body.

During all of that, except for the bit about being blown away with a shotgun, I managed somehow to keep a cheerful expression on my face and not give in to the temptation to strangle somebody. I didn't yell, I didn't call anybody names; I even threw a few jokes in there now and then. I managed to do a few nice, kind things for a few people that were not included in the daily plan of care. And I made at least one person feel better.

I think I'm kind enough at work, thanks.

Must-read

Here

The Bugaloos: They're in the air and everywhere.

(Inspired by the PGY2 resident who now refers to me as "Bugaloo", a nickname I find simultaneously charming and disturbing.)

I am not fanatical about bugs.

Yeah, I scrub my countertops and cutting boards with hot water and soap after I cut meat on 'em, and I wash my hands about forty times a day at work. But when it comes to hugging a patient with HIV, or touching a person on their skin with my bare, clean hand (provided they don't have any open areas, of course), I don't flip out.

Which is why I got so irritated with a couple of coworkers this week.

One of 'em asked me if it was safe to let a newly-diagnosed HIV+ patient to use her pen. For her, not for him.

Once I was done goggling, I said yes. That coworker's trepidation might've stemmed from the fact that this poor guy had herpes lesions *all over* his skin, a result of being undiagnosed for a year or more after infection. Note to the wise: if you end up with a huge skin rash that defies dermatologists, go 'head and get an HIV test. It can't hurt.

Anyway, this guy was quite pleasant, dealing pretty well with the shock of having just been told he was poz. But the HSV lesions presented a problem, one which I dealt with by wearing an isolation gown any time I had to get up close and personal with acreage of his bare skin.

Why? Two reasons:

First, even though herpes is not a tough virus in the sense that molluscum or smallpox is, there's the offchance that a virus or three might survive on my scrubs. I could then conceivably shed that virus elsewhere.

Second, and much more important in this case, my patient has a combination of open sores on his skin and a compromised immune system. Since he hadn't begun any sort of treatment yet, it's a rational step to reverse-isolate with him, especially since I had another patient with Clostridium difficile infection. Bacterial bugs are much more robust than viral particles, and I didn't particularly want to expose Mister T-Cell Count at 2 to any sort of bacterial veneer I might be wearing.

Then came the coworker who commented, as I was briefing a couple of students on the HIV+ patient over lunch, that she'd moved out of her dorm room in college because her roommate had contracted herpes.

God love the nursing students . They all looked carefully blank as I explained to cow-irker that, unless she and the roommate were sharing toilet seats in a way as yet undiscovered by Hustler magazine, she had nothing to worry about.

That sort of thing drives me absolutely up the wall. Even with modern education, I *still* run into nurses who are unwilling to touch HIV positive patients, even as they wander in and out of isolation rooms whistling, not wearing gowns. I *still* run into nurses who haven't the faintest idea how things like Chlamydia, mononucleosis, pinkeye, and hepatitises are transmitted, or who get it all wrong.

Maybe I'm oversensitive, having spent a good deal of time in the past with people who had varying degrees of infectious disease (ooooh, I like that rhyme!). Maybe I'm peevish because I don't like to see people isolated from touch and contact because they have a Highly Publicized Infection That Still Carries A Huge Social Stigma. Maybe I'm grumpy because I wonder what on earth these people were doing in class while I was absorbing information about how and why to keep my patients and myself safe.

The single most important thing we can do for our patients is to touch them without hurting them. Most people they see in the hospital, us included, do many unpleasant things to them. They can go an entire day without being touched in such a way that doesn't cause pain. That's why it's important for us to hug, or squeeze a hand, or stroke somebody's hair: without painless, pleasurable touch, the human soul starts to die.

So yeah, I 'm not fanatical about bugs. I cover my mouth when I cough, I wash my hands, I use standards when dealing with blood and body fluids and nasty oozy things.

But once in a while you have to take off the gloves and be human.

Dull is good.

The past week at work has been dull. Dull is good.

Status Migraine Guy is back, but he's calm and his pain is controlled. I don't know about you, but if I had a migraine that had run for two and a half weeks, I'd just chuck myself out the window and be done with it. I've only had one, but that one (and not a bad one, from what I hear) was plenty.

Our Customer Service Scores Tra-La are down for the months of December and January. This is a Big Deal to the management. Consequently, we're neither getting TEAM t-shirts this month (a good thing), and they're putting in place all sorts of bizarre procedures in order to improve Customer Service (a bad thing).

Part of the problem is that the CS scores are determined by questionnaires sent to the patients or the families after their stays. If somebody's either dead or gorked from a major brain injury, there's not a lot of hope that the person or people will find the time to fill out a thirty-question form, rating everything from the food to the cleaning staff on a scale of one to five. One would hope that they'd have better things to do.

Now, when you study mailed questionnaires in sociology class, it's assumed that a forty percent return rate is fantastic. Return rates normally run around 30%, with the majority of those surveys returned from people who have strong feelings--usually negative--about the subject being surveyed. Don't ask me why this is; I don't remember.

Anyway, if you cut the folks who can no longer read and write out of the survey pool, and remove a percentage of the families from that pool because they're taking care of Auntie Mae, you've smallified your return pool to those folks who were a) very sick at the time they came in, b) still have some memory of it, and c) care enough to return a 30-question form after rating things from 1 to 5.

Unfortunately for us, several of the people who returned their questionnaires have one or another type of dementia. One survey came back with three pages of single-spaced ranting attached; another had hand-written complaints about attempted kidnappings and abuse in the margins. There were others not as dramatic.

Those kind of affect the CS scores.

The amusing thing is that every member of Manglement with whom we nurses deal, from the lowliest charge to the uppermost uppity, has forgotten that crazy people skew results. Rather than throwing out three pages of paranoid rantings, they're basing practice changes on them.

Which basically boils down to "Keep your head down and give 'em whatever they want."

The floor nurses have given the new posters, training manuals, and inspiring speeches a collective shoulder shrug and are keeping on keeping on. If you have a patient who's convinced that the guys from the OR are going to kidnap her and sell her to white-slave traders, there's not a lot you can do (outside of, say, Haldol) to improve her Customer Service Experience.

What I heat up on my day off...

...because I really can't call it cooking.

Warning: girly foof ahead.

The local Quick-ee-Mart had a sale on various frozen entrees this week, so I tried some off-brand eggplant parmesan and a box of frozen fish.

I hesitate to say this, but both of them were quite yummy.

I'm sure I'll bloat up like a pufferfish from the amount of salt they contained, but *damn*. TV dinners sure have come a long way since the 1970's. Not that I ate them then, you understand, Mom being given to soy products and home-made bread, but I remember seeing them in the chest freezers at friends' houses.

It's a good trick to have stashed up a sleeve for one of those nights when, after work, seven minutes seems like too long to wait for dinner. I'm not going to be eating them regularly, though.

In other news, Beloved Sister seems to have settled on a wedding dress. The pattern she loves is the pattern I had originally chosen for a bridesmaid's dress, which is fine and dandy. I was having doubts about the fullness of the skirt for a morning wedding, so I was happy to have her take it off my hands.

Though, as she pointed out in an email, having two people in a wedding wearing the same cut of dress would give the old biddies something to talk about.

In that spirit, I've gone for this:

Hello, Tiger

sans bows and in the narrow-skirt version. The temptation to have it made in black duopioni is almost overwhelming, but that would give the biddies too much to talk about, so I'm thinking of going with a sedate olive green or gold. Maybe even a deep brown, with cut-and-polished hunks of amber to go with. The only requirements for the wedding are "Vintage Preferred" and "You Must Rock, Roll, and Destroy Hotel-Room Furniture, In A Metaphorical Sense, Of Course", so I'm good to go.

Hell, I've got 'till October to decide. If all else fails, I can always find something in orange and silver taffeta with an ass bow.

(This is the point in each post where I normally bring up some fine thing about work, but I am *so* not in the mood this week. The past week has seen collective asses saved by good charting (yours truly's), insane family members abusing patients in my presence, and a knock-down-drag-out between one of the management team and myself, so scruit. Maybe I'll blog about it later; maybe not.)

In the meantime, is anybody doing anything special for Lent this year? I'm observing Eastern Orthodox Lent, primarily because it falls on the Monday following the big Scottish Hoedown, and I want to have a Hair-Down Hoedown this year and drink plenty of warm beer.

I will not be wearing sackcloth and ashes, unless you count Dickies scrubs as sackcloth.

The horror of the ordinary

Mom and Dad bought me a set of barrister bookshelves for my birthday. They arrived last week, but I only managed to bribe Chef Boy into helping me haul five bulky boxes up the stairs today.

Barrister bookshelves are those nifty things that come in sections, with glass fronts that lift up and slide out of the way. These are a walnut finish, a dark glossy brown, with small brass knobs on the front of each to help you lift-and-slide. They stand just over five feet high, all put together, and sneer at the rest of the furniture in the bedroom with undisguised snootyness.

So I set them up (releasing, in the process, approximately forty metric tonnes of packing material; Dad warned me) and put the books from the shelf they're replacing into them.

Into, that is, one and one-third shelves of them. Maybe one and a quarter shelves.

So, naturally, the solution is to buy more books.

It did occur to me, briefly, to simply move the books from the shelves in the living room into the new shelves. But what good would that do? I'd be left with another set of empty bookshelves (these built by my grandfather) and would *still* have to find something to fill them.

Meanwhile, the desk I use is looking shabbier and shabbier every second. It's one of those Target specials that's meant to look like Mission, except it comes in a big flat box and never quite goes together correctly. Every time I type, there's a subtle oscillation because the nuts and bolts *almost* work.

So, naturally, I'll have to look for a new desk. An antique one, I think, maybe even a rolltop. (Wouldn't *that* be schwank.)

And, now that I think about it, the filing cabinet that sits next to the desk has never been entirely satisfactory either. It's good to hold the printer, but it's another Target buy, from a flat box, with pre-drilled screwholes that didn't quite go in on center.

Or maybe I'll build a desk. They rarely make 'em as small as I need 'em, and I'm not a bad rough carpenter. Chef Boy has a shopful of woodworking equipment and the skill necessary not to remove digits while dremmelling, or whatever you call it.

Anyway, it won't be an ordinary desk. Nor will it be an ordinary filing cabinet that replaces this one. The bookshelves will see to that; they're gazing in disgust at the horror of the ordinary that is my furniture.

Pour, sip, read. Pour, sip, read. Damn.

Just a cautionary note for readers:

I ordered two Bill Bryson books on a Barnes & Noble gift card. Both of them arrived in the mail yesterday. I picked them up from the same apartment office that holds my bookshelves today.

"I'm a Stranger Here Myself" is a very, very funny rendition of what it's like to move back to the US after two decades in Britain. I was giggling at the beginning and laughing so loudly at the end I was afraid I'd bug the neighbors.

Especially endearing was his description of having all his belongings spray across an airport floor: "My hair, concerned and unable to help, went into panic mode." Possessed of Panic Mode hair myself (note: gorgeous ringlets only happen past eight inches in length; before that, hair stands on end), I snorked and snorked and snorked some more.

But: Oh, dear. "In A Sunburned Country" made me want to go to Australia. So much so that the only thing keeping me from running up the credit cards was the bottle of Dalwhinnie, and that to such an extent that I just eyed it balefully and said out loud, "Dear sweet Jesus. Is that how much Scotch I've had? Oy." Pour, sip, read is likely to be my M.O. for the next day or so.

Mom testifies, hand on heart, that the only thing keeping her from Oz is the idea of flying there coach-class. DVTs, apparently, are enough to keep at least one Parental Unit in the Pacific Northwet. One of my colleagues, on a long-term assignment to the cardiac care unit, is planning to go there for three months--at least--in a few weeks. I doubt she'll ever come back, working as she will be in a place where men outnumber women three to one. And she's a natural blonde, too.

I must go to Australia. Beer is the national pastime and the national drink; it's been compared favorably with the state in which I live. Geographic state, I mean, not the state of pour-sip-read. Australia has a whole lot of venomous critters, which means I'd fit right in.

It would only cost me US$2830 for a non-stop. Maybe I could get the credit limit raised.

Edited to clarify: Mom writes that it's not the threat of DVT that's stopping her from flying to Australia again, rather, "it's the idea of having to see a movie like 'Titanic' both over and back.'" Having been subjected to "Dick Tracy" on the way to Denmark and "Titanic" en route to somewhere I can't recall, I sympathise.

Does Qantas have films of cute lil' ol' platypi?

And, (query for those better-versed in monotrematics than I), what exactly is poisonous about a platypus's spurs? What sort of poison is it?