Munge.

I've spent a nice portion of the last two days cleaning munge out of my own house and out of Chef Boy's. That is what happens when you're in a profession that deals with cleanliness and service; you find it necessary to be clean and serviceable when you're not working.

Which I'm not. CB and I were supposed to travel way south and east this weekend, to the place where the Wild Things are and Spanish moss grows, but we decided against it. So instead, I cleaned. And as I cleaned, I thought back to the last few weeks...

I was cleaning a patient's room. Sometimes we do this, especially if things have gotten disorganized and messy. I do this a lot if things in my "work area" (ie, anywhere I say) have gotten kerfuffled.

He's a frequent flyer, through no fault of his own. Neurofibromatosis has left him, for lack of better words, lumpy and blind, with crippled feet and hands. He has a bad case of NF. It's not just pigmented spots here and there; it's large aprons of skin with huge tumors on them. Three years ago his father, in an excess of concern, offered me money to "make sure (my son) don't turn gay." Despite that, the patient and I are still friendly. The fact that his dad is mad as pants has nothing to do with him.

He's young. "I'm almost twenty-four," he said from the cardiac chair, "and I haven't ever been on a date."

"I'm almost thirty-seven and I haven't either," I replied, rather tartly.

"Yeah, but you're not covered with tumors," he said.

"How do you know? You're blind, man!"

He shot back, "You don't sound lumpy."

"You don't sound lumpy" will go down for posterity along with "You don't sweat much for a fat chick" as Weird Compliments to Pay Somebody.

*** *** *** *** ***

Okay, so we've established that eventually, after you watch enough people die, your soul gets to be like that Baby Swiss cheese, full of itty-bitty holes.

My pal Carolita brought up a person we'd both taken care of some months ago; a person who'd died on my shift. In my care. And I'd bathed his body and comforted his mother and wife and bagged & tagged him and sent him to the morgue.

I had forgotten about him.

Not just his name; his entire existence.

I had promised myself when my first patient died that I would never, ever forget a person who died under my hands. Midwifing a soul out of a body is the most honorable and sacred thing I do. I can't allow the frailties of memory to screw that up.

And yet, here was one I'd forgotten. Other people had died more tragically and more unexpectedly and more horribly in the intervening year, so this guy had gone on to be one of those people you only remember if they're brought to your attention.

I still feel bad about that. As long as somebody somewhere remembers a person, they're not really, truly dead...and who better to remember them than the person who was with them when they died? What makes it worse is that I was actually in the room when this patient died. That doesn't happen often; it's a matter of chance that you're there.

So my soul is full of little bitty Swiss cheese holes. And apparently my brain is, too. The only thing now, I guess, is to write about people as they die, to make sure they stay alive in electrons if not in neurotransmitters.

*** *** *** *** ***

Success Story:

The woman in the doorway looked at me and said, "You don't remember me, do you?" I had to admit that while I had forgotten her name, I remembered that she had a big bear of a husband and a huge, weird, dysfunctional family, and that her husband had been diagnosed with a brain tumor about six months ago.

She had brought her husband back. He was having seizures, a natural consequence of having a glioma invading your brain.

"I want you to see one of your success stories" she said.

She told me that he had been given a prognosis of six weeks at the most, but that steroids and chemo had allowed him to live that many months. Yeah, he wasn't himself most of the time, but he was still here, and that was all that mattered, right?

Right.

I was confronted with a bloated, vacant man who had none of the charm and spice of the man I'd cared for. He sat uncomprehending, staring at nothing, until I touched his arm and said, "Hey. Big guy. What's up?"

Then he looked at me without remembering who I was, or where he was, and made some sort of reply that didn't make sense.

But he's there. In body, at least.

I was reminded that "success" differs for each person and in each situation, and that I can't always be the arbiter of what defines a good outcome.

*** *** *** *** ***

In other news, I have an interview tomorrow, by phone, for a nursing magazine. Part of the interview will be about mistakes new bloggers make. God knows I've made 'em all, so I'm well-qualified to speak.

I will be doing the interview on my brand-new Hello Kitty telephone.

How good is that?

Change of Shift!

Over at Fat Doctor.

Busman's Honeymoon*

Okay, so more randomness....

I just watched "House" and "3 Lbs.".

Watching Stanley Tucci operating on a basilar artery aneurysm is more fun than watching Hugh Laurie go through simulated withdrawal, but not by much. As friend Lisa says, "HL could create a need for forearm porn in any woman." Tucci doesn't have that gift. Plus, he's too short to be a neurosurgeon.

Aside from that, and the whole "neurologist sleeping with her patient" thing, because everybody knows neurologists never get laid, and aside from the piano in the lobby (ripoff from "House", anyone?), and aside from the blue coats the residents wear...well, it's pretty much where I work.

So much so that when the patient said, "You're a terrible doctor" and the neurosurgeon replied, "Yeah, but I have steady hands, and that's all you should care about" I gasped in recognition.

More so at the lobby. That was really, really creepy. And the OR registrar.

They're following me. They are.

But neurosurgeons don't associate with neurologists. The surgeons are too arrogant, the -ologists are too flaky. Plus, they don't speak the same language.

Anyway. Fun show. Good for popcorn and entertainment value, and they're not trying to Deepen the Characters the way they are on "House".

*** *** *** *** ***

When are we gonna have a show in which nurses aren't invisible?

*** *** *** *** ***

Mom and Dad bought a house in Seattle. They discovered (on the cusp of the housing boom, their luck) that the house was too small to house all of Dad's books. So they bought another.

Then Dad remembered that the winters in the Pacific Northwet are really rainy. And dark.

So, instead of investing in a lightbox and some Wellbutrin, they found a place in Mexico, Land of Manana.

They've just gotten back from a couple of weeks of Manana. I'm wondering if they've regretted...wait, no. I'm wondering *how many times* they've regretted not getting a lightbox and some Wellbutrin.

Dad, always the optomist, said, "My Spanish sure got a workout."

*** *** *** *** ***

I hurpled along (yes, Virginia, "hurple" is actually a word) on the treadmill today for a half hour while watching ABC news and discovered deep within myself an urge to be a Roller Derby Queen.

Well she might be nasty
She might be fat
But I never met a person
Who would tell her that
She's my big blonde bomber
My heavy-handed Hackensack mama

Think of it: I could wear a black unitard with the spinal column on the back, and a helmet with a brain on it.

Well, she's five foot six
And two-fifteen
My bleached-blonde mama
With a streak of mean

It almost, *almost* works.

'Cept I gotta learn how to skate.

*Apologies both to D.L.S. and J.C.

Random Ruminations

Thanks to the holidays, I've not been at work much the last week or so. Our census is low enough that us full-timers get waved off for a shift at a time.

So this will be not so much about work.

Two requests for favors, first:

1. Who's using the new Blogger Beta, and how's it working for you? I'm not keeping up with the Blogger group on Google, so I'm looking elsewhere for advice and experiences.

2. Who's fairly fluent in German? I have an old Mercedes Selekta typewriter with the instruction manual, but the manual's all in a German I can't decipher. I'm curious to find out what it says. The pictures alone are great.

*** *** *** *** ***

Yes, I collect typewriters. I found a Corona model 3 yesterday at the Big Junk Barn, cheaply priced, so I snapped it up. The collection started with the Smith-Corona portable (1926) that my grandfather used in his business and expanded with a post-war Remington manual. That Remington doesn't look like much, but any burglar I hit on the head with it would be sad and sorry indeed. There must've been a glut of steel on the market in the late 1940's, 'cause this thing is built like...well, like a solid-steel manual typewriter.

A couple of years ago, when I should've been hunting for a desk, I found the Mercedes. I'm not sure how common they are in the US, though I've found a few eBay listings in French and German for them. It's quite a nifty little machine--the keyboard, rather than having "QWERTYUIOP" as the top line, has "QWERTZUIOP", with the Y where the Z normally is on an English keyboard. There's also an umlaut key, like a shift key on an English keyboard, and an eszett key. Plus, the nifty instruction manual, which features a nice-looking if heavily marcelled woman.

And then there's the new Corona. It's six inches high and eight wide at the front, and widens enough to accept a typical 8 1/2" sheet of paper over the roller. It's cute! It's bitty! I can't figure out where the locking mechanism is for the carriage! I'm going to need a whole new set of shelves to display these bastards soon!

*** *** *** *** ***

There's a doctor at work we've nicknamed "Stat Daddy". This is because he writes every order--*every* order, even those for, say, magnesium citrate or a Fleet's enema, as a stat order. Which makes it tricky to decipher what he actually wants. Did the patient perf a bowel? Are they having seizures? Is the doc just an asshole?

So, the other week, I get an order for "Dulcolax suppository PR x1 stat."

*siiiiigh*

"Doctor Stat Daddy," I approached him, "Does the patient really need this suppository stat?"

"Well, he's cramping, and he says he's really uncomfortable," replied Stat Daddy.

What Stat Daddy didn't know was what I knew: that the patient was bowel-obsessed and had been taking literal handfuls of laxatives, stool softeners, and GI stimulants for four days. He was having pretty-much-constant diarrhea with the attendant gut cramping that six Sennokot pills three times a day will give you. Oh, that and I found an empty bottle of Milk of Magnesia, the super-value size, in his trash.

You could say we had issues there.

So I pointed out as gently as possible to Stat Daddy both the ins and outs the patient had had, as well as the previous nurses' charting, in which it was revealed in neat handwriting that said nurse had discovered the patient's laxative dependency.

*siiiigh*

No, I did not give the Dulcolax suppository.

*** *** *** *** ***

In other news, That Damned Cat has temporarily abandoned peeing on the rug for an equally annoying, if less smelly behavior: now that the days are getting short and she knows it'll be cold soon, she's taking up the exact geographic center of the bed every night. I'm doing yoga in my sleep to avoid crushing her head.

*** *** *** *** ***

Speaking of crushing heads, as well as doing fun things with them, I saw my first Liberace-ized patient two weeks ago. This guy was in his seventies and, I kid you not, had had so much plastic surgery that his eyes wouldn't close completely when he slept. That, and he'd had what I suspect was one of those Teflon implants in his upper lip, which meant he talked like Mushmouth from the old Fat Albert cartoon.

Note to the general public: If you're in for surgery to revise the scars from your previous plastic surgeries, you've had too much surgery.

You're beautiful; you're beautiful....

I need to know if anybody else does this:

When I go to a restaurant, which I do fairly often, being possessed of both plenty of folding money and a boyfriend who's sick of cooking, I look at the other patrons.

When I go to the bar, my usual hangout, for a burger and a bump and a beer, I stare at the bartenders, male and female.

When I wander down the street near one of the local colleges, I gaze at the students. Obsessively.

Because they are, all of them, beautiful. No matter what might lurk within their bodies (a brain tumor, a broken bone, a deep vein clot just waiting to cause pain), they're *whole*. They're beautiful because they're whole.

They don't even have to be young. The eighty-year-old men helping their wives pick out groceries strike me as being as gorgeous as the twenty-year-old waitress at the pizza joint downtown. Because they're all whole.

One of the biggest current joys of my life is working out, simply because I *can*. I know I have a left side and a right side; I know which side is stronger (left, strangely; Mom, did you retrain me as a child?). I can lift heavy things and run on a treadmill without collapsing. I can do this.

Back in the day, during nursing school, I kept a journal during the psych ward part of our training. It wasn't by choice; it was assigned, and woe be to the poor instructor who had to read it. In that journal, I talked about my fear of being taken for an inmate of the hospital we went to. The only thing that separated *me* from *them* was the key that I had, that I could easily lose or have taken from me.

There's a different "me" and "them" in the hospital world. For now, I'm still in the camp of the whole. But I'm in contact with the un-whole, the grieving, those who've lost a part or a half of their bodies, enough that I'm reminded that it's a very small difference.

So. If you see me staring at you, it's not your beautiful forearms or your curly hair that's causing it. It might be, instead, the way you put your hand on the small of your wife's back, the way you have since 1946, even though she's now in a walker. It might be the way you use every finger to pour a drink, with the cork of the bottle between a ring finger and little finger you're still aware you have. It could be the way you break into a run to cross the street in front of my car, without even thinking of what you have to do to accomplish that.

If I had it in me, I would break in to Whiny English Singer-Songwriter mode and compose a little tune.

Be thankful that I don't, eh?

The Good Wife

Say what you will about Ginny, our chaplain: for being a Godly woman, she has the worst sense of timing in the world.

It had been an officially long day. From the time the 20-year-old started seizing to the point at which I finished holding pressure on an arterial puncture site that had broken open, it was the sort of shift you don't want to work, let alone be charge for. And there I was, charging.

I had wandered into the break room in search of something to eat--it was about six o'clock, just before the end of shift--and Ginny came in after me.

"Hey...you know that guy with the huge glioma? The young guy?" She gave me a few other details so I would remember exactly *which* young guy she was talking about. He was a typical glioblastoma patient: loving family, good job, healthy up to the point that he developed personality changes and seizures. Eight months before, we'd taken out as much of the tumor as we could manage and sent him off for experimental chemo.

He'd come back last month after failing treatment. (I love how we medical types say that: "The patient failed treatment." Not "the treatment failed the patient," which is how it actually works. No, the patient fails. Our treatment *never* fails, right? It's those damned patients who screw up.) We'd pumped him full of steroids, told his family that his brain was now officially mostly tumor, and recommended hospice.

Which his lovely young wife had agreed to. It was, after all, the best decision: stop cutting the poor man open, quit exposing him to nasty chemotherapy, and let him enjoy his kids while he could. He'd been at home for three weeks, doing about as well as you could expect--in other words, dying pretty peacefully. His wife had taken him home, despite the care he'd need, because she didn't want him to be alone. They'd barely been separated in fifteen years of marriage; she didn't want to start now.

"So," Ginny continued, "His wife dropped the kids off a couple of days ago with their grandmother, got into the car, drove out to the lake, and took a couple handsful of pills and drank a half a bottle of vodka before she passed out."

"She didn't" I replied. "Yeah, she sure did," came the response.

At which point I surprised everyone, myself most of all, by turning around and bursting into tears.

I guess it shouldn't have been such a shock. That I burst into tears, I mean. When you see enough people die, you start to grieve unexpectedly over peripherals--the dog they've left behind, who wonders where its human went off to, the kids who take the news that Mommy isn't going to be around anymore stoically, without really understanding. You can't grieve over every patient you lose, because if you did, your soul would be shredded into little bitty bits.

So you get into peripherals. The news that yet another person you cared for has ended up in the City section, under Obituaries, is met with a "Damn shame, that. Nice guy" and you go on.

What makes a person so indispensible to another person that their death would trigger an attempt at suicide? Is it grief that drives people to down Xanax and Valium and Skyy, or is it fear? Why do the weirdest, least-well-adjusted (at least on the outside) people manage to continue living after somebody dies, and the best-adjusted people with the best support systems just give up?

Those questions end up filed under the same heading as "Why do glioblastomas hit nice people?" and "How come mean people live forever?" There's a folder somewhere labelled "Damned if I Know".

So there's the peripheral for the week, or month, or season. The good wife, the one who didn't want her husband to be alone.

In which Jo reaches new levels of self-absorption

One thing I have to say to all you back-aching nurses out there, you with plantar fasciitis and aching necks and the whole nine yards:

Hire a trainer, do.

I've had thirty-six sessions with Carol, the Cheerful Drill Sergeant, and I've signed up for seventy-two more. In thirty-six sessions, I have:

*gone from lifting five pounds on latissimus dorsii flyes to lifting ten;

*gone from lifting eight pounds for fifteen reps on bicep curls to lifting fifteen pounds for fifteen reps, or twenty pounds for twelve;

*put on ten pounds;

*lost a dress size;

*and have developed the sort of muscles in my back and legs that make me grin and hug myself.

Carol is about five-four and weighs a hundred and twenty pounds. You would think somebody like me could break her in half until you notice that you can see the muscles move under her clothes the way a jaguar's muscles move under its fur. She tells me happily, three times a week, that I only have to do fifteen more reps of whatever Evil Multi-Muscle Exercise she's brought with her from the depths of the torture chamber.

She reminds me to kick the punching bag higher and not to cheat on form with various weightlifting exercises. She looks grim when I complain about having to get on the stair-climbing machine. She asks me every week if I've stopped eating cheese yet. Occasionally, she tells me, "Good workout" in a sort of offhanded way that is better than trumpets and flags flying.

She doesn't laugh at me when, in an attempt to get a high lateral kick to land on the bag, I miss it completely and go stumbling across the weight room.

More than that, she's helped me get to the point where two things have happened: first, I haven't been sore after a day's lifting patients in weeks. Second, another coworker said something when she thought I couldn't hear her: "Get Jo to help lift this person. We'll need a lot of muscle."

My plantar fasciitis flared up yesterday for the first time in three months. It's better today. The GERD I suffered with is gone. I no longer hurt when I wake up on the third day of working. And I can lift patients safely, catch people when they fall without fear of injuring myself, and beat my boyfriend at arm-wrestling.

It's amazing. I used to be a pizza-and-beer girl. Now I eat lean protein and veggies or fruit five times a day. I used to think, as I was showering on a day off, "Gosh, I wonder what the bar has in the way of tapas tonight?" Now I think, "Y'know, I really need to work on my shoulders more."

I walk with the springy step of a weightlifter. My posture has improved to the point that other people notice. Thanks to weeks of pushups, my boobs now start at my nose: *that's* perky. And I look like I've lost fifteen pounds, even though I'm on track to be the first two-hundred-pound size eight in the history of women's clothing.

Hire a trainer, all you nurses. You'll no longer feel like strangling the nearest resident, much. You'll wake up refreshed at the time you normally wake up grumpy. You'll find a new appreciation for Boca Burgers and salad, though the whole turkey thing might take a little time. Even if you don't give up cheese, you'll feel so much better.

It's about time we recognized, as a group, that our profession demands muscle as well as brains.

I'm going to go off now and...maybe do a few pushups. I've gotten up to fifteen military-style (straight-legged) and would like to work on form.

Weekly Change of Shift is up....

Over at Life in the NHS.

In Which Nurse Jo Calls Bullshit.

Anybody who's worked in a hospital in any capacity can tell you that the nutjobs come out right before the holidays. Not *during* the holidays, mind you--that's when the really sick people stay at the hospital rather than heading home--but just before.

I had fourteen patients (counting admissions and discharges) in two days and only one of them was not a nutcase. Unfortunately, Non-Nutcase Guy went home the same day as his admission. He was that healthy. I wish he'd stayed; I could've used the company.

Every nutjob save one had a neurological condition of some sort that defied all manner of scans and testing. One was demonstrating both la belle indifference and arc-de-cercle, but the latter only if she knew someone was watching. Funny thing: the only thing that cured those compulsive backwards archings was repeated injections of Dilaudid.

Another had real problems with formal neurological testing but was functionally fine. Babydoll, if you're walking around in your room with no trace of the shuffles or the sways, you ain't gonna have that bizarre of a neuro exam five minutes later, when the doc walks into the room.

Why, *why* do people always try to fool neurologists? Why not cardiologists or orthopods or thoracic surgeons? Is it that we don't understand the brain the way we do joints and hearts? Or is it that some folks have a special place in their hearts for neurology and its adherents?

I have, in the last two days, been confronted with a patient who claims to be allergic to water. And every antibiotic known to man. *Every* one. They all cause laryngeal edema and laryngospasm, two things that can kill a person if we don't poke a hole into their trachea somewhere south of that swollen, closed-off larynx to allow them to breathe.

But no, I was told, there's no need to put a tracheostomy tray by the bedside. Because, you see, if the patient in question merely holds up this electrical widget to their temple, it will cause their brain to produce chemicals that will keep their laryngospasm from getting bad enough to kill them.

No, really.

I had a patient who claimed to have an anaphylactic reaction to tomatoes. And severe and constantly-changing food allergies that could kill at any moment. And who required a special diet so that their energy fields wouldn't undergo a conversion to a negative polarity.

No, really.

This was, of course, the same patient who managed to put away two Big Macs (which have no tomatoes but which do include Thousand Island dressing, the main component of which is...oh, never the hell mind) in ten minutes, when she thought I wasn't going to notice.

And the one who was allergic to cotton. This allergy was, according to the five-page list of allergies that accompanied the patient, diagnosed by spiral CT scan.

No, really.

And the one who had the rash and hives and difficulty breathing when given oral Dilaudid, but who could handle the IV form just fine. But only just before he went outside to smoke. Because the nicotine from the cigarettes helped calm down the anaphylactic reaction.

No, really.

When I admitted the patient with the oxygen saturation of 88 percent on room air, I tried to put oxygen on her. "Don't do that," she protested. "I'm allergic to oxygen."

I gave up. I left the room on some pretense I don't recall just now.

One of the orthopedic residents found me in an alcove, laughing until the tears ran down my cheeks.

It's time...to impart wisdomses!

1. If you tell a resident that you'll take care of bowel management for them, not only will he or she sign anything you write, s/he'll love you forever.

2. Don't call at 0300 for a sleeping pill for a patient.

3. White is a magnet for ook of all sorts.

4. Your favorite clogs have just been discontinued, and your favorite pen is about to run out of ink.

5. The cutest bartender is always taken.

6. There is no substitute for dental floss.

7. The volume of ook that will splatter on you is directly proportionate to how much you like the scrubs you're wearing.

8. The doctor who yells at you is actually trying to make up for the size of his or her genitalia. Don't let it rattle you.

8a. Remember that you can go home at seven; they're on call. Smile.

9. The word "pomegranate" never looks like you've spelled it right.

10. If you're a student, don't fret: you'll never use care plans again.

Damn.

I had a fast-food salad last night.

I've spent the last five hours being very sick.

I'm not taking the CNRN today, obviously.

Damn.

Addendum

I'm taking a moment during one of the commercial breaks during "Grey's Anatomy".

I watched it last week a little goofy, with Chef Boy. He had a nice bottle of Bordeaux.

I'm watching it this week sober.

When I'm tipsy on good wine, I like the show. I mean, really like it. It's touching, even.

When I'm sober, I throw things at the TV. Like slippers. And packets of ranch dressing from Sonic.

That should tell every non-medical person something about "Grey's Anatomy."

Poetry and musings, like

An ode to my fucking cat, Evinrude the Neurologically Deranged:

Why do you pee on the rug?
My house has been filled with your fug.
You don't use your box,
Though it's not behind locks;
Why do you pee on the rug?

Why do you pee on the rug?
I've tried every potion and drug.
The Feliway spray
Only lasted a day;
Why do you pee on the rug?

Why do you pee on the rug?
A permanent frown's on my mug.
I can't have in guests
You small, furry pest;
Why do you pee on the rug?

Why do you pee on the rug?
You're a ten-inch-tall, fourteen-pound thug.
I can't find an answer
To this pee-staining cancer.
Why do you pee on the rug?

Why do you pee on the rug?
You're not a nice cat, you're a lug.
You're so down in my eyes
You might be euthanized;
Why do you pee on the rug?!!!

(Nota bene: I do not intend, under any circumstances except those merciful, to euthanize my cat. From the time she came to me soaked in insectide [Thanks, evil humans!] as a kitten to the day she recovered from distemper, she has been my best buddy. But this peeing on the rug thing is getting to me. I have ordered a carpet steamer.)

(I should note here that Evvie really is neurologically damaged, thanks to the early immersion in insecticide. Until the age of two, she had a disconjugate gaze, which still reappears when she's tired. And she bites. And freaks out for no reason. But I love her. Even though my house smells like a Crazy Old Cat Lady's house. Next time it's wood floors or nothing.)

Musings, like

I know an Irritating Californian who moved to The Great Stars At Night Are Shining Bright State a few years ago, just like the rest of the irritating people from California did. And like the rest of the Irritating Californians, he's helped drive up property values and destroy ranchland with his McMansion.

He recently moved away from the big city into a town that's easily mispronounced and is now complaining about 1) the outcome of the mid-term elections and 2) the weather. These two things are related in a tangential way; trust me.

His big bitch about the mid-term elections is Speaker Pelosi. "As a long-time resident of The Bay Area (tm), " he says, "I dread a Pelosi-led Congress." "I didn't see much of the consensus-building Pelosi you refer to during my time in The Bay Area (tm)." "The thought of Speaker Pelosi, since I lived in The Bay Area (tm), gives me the willies."

Okay. Fine. We know you lived in The Bay Area. You now live in a fully Red state, so you should be happy.

But no. It was 89 degrees deep in the heart today, and California Dreamer had to complain about that, too. "I just don't like waking up to 44* and having it be nearly 90* by the end of the day" he whined.

Look. This state has famously weird weather. It's mostly hot and dry. As the man said, if he owned both Hell and here, he'd live in Hell and rent out the state. This state is known for weather that kills the stupid and preserves their corpses at the side of the road. It's where even the most stoned of hippies knows not to camp under a pecan tree or in a dry ditch, as the one drops limbs without warning and the other fills up with water ditto.

I pointed out that The Bay Area is supposed to be nice this time of year. It did not earn me points.

That's okay. I'm not the one who moved to a small unpronounceable town in the middle of the state and is raving about how countrified it is.

This guy is actually happy that he has goats near him.

On the south side of his property.

I can't wait until August.

Testing....testing....

The Certified Neuroscience Registered Nurse exam is tomorrow. That is, it's tomorrow in a city far enough away that I have to get up at an even more horrifying time than my usual horrifying awake time in order to get there. Originally, a bunch of what-I-thought-were-my-friends and I had planned to carpool up to The Test, but I was the only one who registered in time, so I'll be making the drive by my lonesome.

And taking a four-hour, 250-question test about the brain and spine and all the marvelous things that can go wrong with them.

I've been studying. But I'm still shocked at how much I've forgotten since my internship. I guess I haven't really seen that much variety in my four years at La Schwankienne Boutique Hospital; perhaps (if I pass) I should parlay the CNRN designation into a job at the Cleveland Clinic. Or Johns Hopkins, where they have that guy who cures gliomas.

Speaking of gliomas, the young mother with a glioma is doing...much better. It's another case of withdrawing treatment to see the patient improve.

There's one thing that won't improve if you withdraw treatment, however: an eighteen-year-old cocaine overdose with attendant heart failure and anoxic brain damage. That was one of my patients yesterday.

I am going to go to every beautiful, healthy young person I know and ask them if they snort cocaine. If they do, a massive ass-kicking will commence without warning. I'm starting tomorrow night at the bar, as soon as I'm done driving back from That Test.

Fierce!

I'm sitting here repeating quietly and happily, 'First female Speaker of the House...first female Speaker of the House...first female Speaker of the House...'

Waitaminit.

First female Speaker?

Ever?

What the Hell?

Go get 'em, Nancy.

What's in *your* wallet?

I am looking for a pen. It is, I think, a Pilot G7 with black gel ink and a medium point. It is the pen I use to balance my checkbook. Without this pen, no checkbook-balancin' is a-gonna happen. So I have to find this pen.

It is not in the drawer where I keep the checkbook and check register. It is not next to the telephone. It is not in my purse. It is, most significantly, in the pencil bag I use to hold the detritus of my day as a nurse.

I did, however, find the following things:

1. One five-hundred milligram capsule of acetazolamide (Diamox). Why?

2. One dosepak blister card containing a multivitamin.

3. One each of those little plastic ampoules of albuterol and Atrovent that one uses to give nebulizer treatments. These I remember: Joe the Respiratory Therapist gave 'em to me when I had bronchitis. For a while, I also carried around my own nebs tubing.

4. Two Halls Menthol cough drops, still in wrapper.

5. Three sticks of peppermint Extra gum, not in outside wrapper. I know it's Extra because it's the last gum I bought.

6. A pair of straight forceps.

7. A pair of curved forceps. Why I have these, I don't know.

8. A pair of iris scissors. Ran my finger into the point of 'em just now, ow.

9. Fourteen alcohol wipes.

10. Twelve cotton 2-by-2s in various stages of decrepitude.

11. Three Introcan Safety-W 20 gauge, 32 mm long, 60 ml/min IV needles in their wrappers.

12. $1.26 in small change.

13. An empty acetaminophen blister pack. I took the acetaminophen.

14. Three partially-used rolls of tape, two of which come in those IV start kits.

15. One 14-french red rubber catheter. Unused. I think my coworkers stuck that in there as a joke.

16. Two highlighters, one Sharpie retractable marker courtesy of Lovenox, two Relpax ballpoints, one Viagra ballpoint (nice pen), one ancient Dr. Grip ballpoint, four red ballpoints, and one mechanical pencil.

17. Two penlights. Both work.

No checkbook-balancing pen. Dammit.

Weekend Reading....

I don't know how I missed Retrospectacle, a blog by a third-year PhD candidate in neuroscience.

And, of course, the weekly Change of Shirt is up at Disappearing John's place. He's done a stellar, stellar job with this week's edition--one of the best I've seen. Oh--the Winnah of the Wild Blog Name Contest? OB-GYN Kenobi.

I stumbled into work on my last day

...and asked one of the patient care techs if "I'm too sexy for this party" was a valid reason for calling in, or if "I'm itching like a man on a fuzzy tree" would play better.

"Depends" he replied. "Do your friends say you're as white as a bug?"

Another nurse chipped in with, "What would the history look like for something like that?"

Somebody else said, "'I held my nose, I closed my eyes, I took a drink?'"

Then the case manager, going to get coffee, pointed out, "The social history would probably say, 'Mama's got a squeeze-box; Daddy never sleeps at night.'"

We all giggled.

"What about the discharge note from the doc?" Carolita mused.

The Accentless Egyptian Doctor (the AED) looked up from stirring his coffee and said, "'Grampa's done got rhythm; the old man throwed them crutches down.'"

*** *** *** *** *** *** *** *** ***

The AED and I have been working pretty closely on one of those cases you hate working closely with a doctor on: a young person who's perfectly healthy aside from the fact that her frontal lobes are eaten up with glioblastoma.

We took a chunk out of her left frontal lobe about a year ago. Earlier this week, just after her 28th birthday, she started vomiting and losing her balance. So her family, aware that there was a golf-ball-sized tumor in her right frontal lobe despite a year's worth of chemo, took her in for an exam.

She was admitted to us with dehydration and went through the MR scanner.

Which showed that, in just about three weeks, the golf-ball-sized tumor had grown to encompass her entire right frontal lobe, most of her right temporal lobe, and a good portion of her right parietal lobe as well.

Plus she's septic. It's a line infection from a central line put in so she could get chemo.

I spent most of Tuesday doing fun stuff like drawing blood samples, getting chest X-rays done, and talking to her family about what, exactly, septicemia means in the context of somebody who has about two weeks to live anyhow. Her dad, the main mover in terms of her care, is deeply in denial about his daughter's chances of either recovery (none) or survival (ditto) at this point. The attending physician had already told him that he (physician) would not order treatment for the sepsis, nor would he prescribe steroids for the edema in her brain. But Dad wanted serial blood cultures and chest X-rays and the like in hopes that they could find something, anything, to give them hope.

He finally asked me what it would be like if they treated the sepsis and she died from the brain tumor. I had the unenviable job of telling the man that first, his daughter would commence to seizing at odd times throughout the day, regardless of the doses of anti-seizure meds she was on. Then she'd probably (hopefully) lose consciousness, and finally, the edema in her brain would cause her brainstem to get squashed, stopping her breathing.

They're going to get hospice. Eventually. Maybe. Perhaps her husband would rather she stayed at the hospital. Maybe her dad will convince him that she needs to go to another facility for more chemo.

With any luck, she'll die of sepsis before the second set of cultures comes back. It would be kindest.

Sometimes I truly, deeply, madly hate my job.

I've added a rather important link to the sidebar...

It's for Condoms4Life, a group affiliated with Catholics for a Free Choice. The group's purpose is to get Benedict XVI to overturn the Church's ban on condoms for disease prevention.

This is a worthy thing. Most Catholics in this country are in favor of both contraception and disease prophylaxis; a growing number of Catholics in the countries hardest-hit by the AIDS epidemic are pro-condom. In areas where women have very little power, either politically or in personal relationships, condoms (both the male and female sort) offer another option a woman has to try to protect herself from contracting HIV.

What would be lovely would be an HIV-specific vaginal microbicide. Lovelier still would be a vaccine. Best of all would be a sea-change in societies where women don't have the power to refuse sex, prostitution is a means of survival (a very dangerous one) and education efforts on HIV have fallen woefully short.

Condoms are at least a start. We can't do a whole lot about the asinine policies of the present national leaders, but we can support private groups that work to prevent the spread of a disease that's knocking out an entire generation of folks.

Married off.

O God, who hast consecrated the state of Matrimony to such an excellent mystery...Look mercifully upon these thy servants. from "The form of Solemnization of Matrimony" in The Book of Common Prayer

Marriage. Marriage is what brings us together today. Marriage, that blessed arrangement, that dream within a dream. from The Princess Bride

Well, Mother, we were happily married this morning, and a very pretty wedding it was. from Busman's Honeymoon, Dorothy L. Sayers

*** *** *** ***

We did indeed get Beloved Sister married off. She is now Missus Beloved Sister, a title which made both of us say "Ack!" the first time we heard it.

There were no disasters. Well, there was one disaster, when the organ at the church shorted out and stopped playing, but that happened prior to the service. Double-stick tape and waterproof mascara stopped any other disasters dead in their disastrous tracks.

Beloved Sis looked amazing, like a portrait from the late Renaissance had walked out of its frame. The flowers and candles were lovely, and we didn't catch anybody on fire (thank God) or have any problems with arrangements of pepperberry and orange roses falling over on top of the ministers. Dad didn't trip on the way down the aisle, the groom didn't faint, the lights stayed on.

And it was a beautiful day. Seattle yanked out its best weather this weekend, with the fog burning off early and the sun shining its little sunny heart out. It was chilly, yes, but when you're wrapped up in silk and tulle (B. Sis) or black wool (me), who's going to complain about not sweating?

Everyone got enough to eat and drink at the reception, and the little groom on top of the cake only fell off a couple of times, which was funny rather than otherwise. Chef Boy and I had our foam fingers (the #1 foam fingers one waves at football games) at the ready, each decorated with names and dates.

All in all, it was quite pleasant. I have to go back to being a nurse this week, but this'll give me something to think about during unpleasant moments.

Not About Work

Let's review the bidding: T-minus some-odd days and counting

The Beloved Sister, aka The Bride, has her dress. She has her crinoline and her veil and her pearl and crystal necklace. She has her shoes; with luck, she'll have flowers which I have already categorically refused to help arrange, as flowers die at my touch. Instead, I will pour wine and keep the dog entertained.

The Bride looks, even when she's trying hard to be sexy, like a milkmaid. She's all blond hair and buxom figure and rosy cheeks. Thus, she'll look perfect and wholesome and bridelike in her cream-colored silk and Mom's veil ("If you're sure you want the kharma from that," I said, "you're welcome to it, since I wore it too") and pearls. The Groom will be pleased.

He'll probably be even more pleased once I walk down the aisle. See, I *don't* look milkmaidish and wholesome. I do not glow. Instead, from the time I was a child, I have looked as though I just got out of bed, no matter what I do. As I've gotten older, it looks as though I've gotten out of a very well-populated bed. (Hi, Mom!) I have a dress that could cause a riot, shoes that are a miracle of modern engineering, and pearls that say, "Yes, I'm black and shiny and irregular; screw you."

We'll be diametrically opposed, The Bride and Her Attendant. I'll pour the wine; she'll say the vows. I'll keep the annoying relatives and friends at bay; she'll glow cheerfully and cut cake. I'll be the bouncer, and retrieve whatever vases sticky-fingered guests have tried to steal; she'll be bridelike and happy and, probably, not eat.

Which reminds me to put aside a plate of food for her. Brides never eat enough on their wedding days.

When I got married, Beloved Sister went back to the house in the 100* heat to retrieve the flowers we'd left behind by mistake. She had to drive an unfamilliar car through an unfamilliar town to do that, and then she had to get past the watchful wolf-hybrid that lived at my house. She managed all of that, and was still back in time for the wedding, unfazed.

I owe her.

I especially owe her for the full cup of rice she managed to throw down my cleavage as Der Hub and I ran out of the reception.

Bride, be warned. I am practicing my overhand pitch.

Oh, dear. Now I can't sleep.

I watched the PBS special on the Freedom Riders and CORE and the SNCC tonight, the one about the downtown Nashville boycott and the nationwide Woolworth's boycott in the early 1960's. And I was gobsmacked, as I am every time I see that special, that the sort of racism and hatred shown existed in my sister's lifetime. And I wondered, as I do every time I see that special, what the hell people were thinking.

Well, well. Then I clicked over to Pandagon. One of the commenters there, Pam Spaulding, has a website of her own as well called Pam's House Blend. You'd figure, being an outspoken Black feminist lesbian, that she'd have to take some shit from people who seem to crawl out of the sewers from time to time...but she linked to a Blogger site that blew. My. Mind. Not only is it chock-full of the sorts of things that make me nauseated, but it's primarily focused on her. Which makes it not only hate speech but harassment.

And yes, I tagged that sumbitch and then sent Blogger an email, pointing out the site, pointing out that it was harassment, and said please do something about this now thank you.

Every time I think we've evolved as a society I run across weirdos like that. Pure kooks. Pure hate-filled, bile spewing kooks that literally make me throw up in my mouth a little bit. And I wonder: what would I do if I had to take care of one of those people?

I mean, I'm in the South. And I've heard some real gems come out of people's mouths in the last few years. For some reason, the folks with brain tumors or massive strokes are rarely the ones with outspoken, bigoted views, who find it acceptable to use racial slurs in public. It's the people who've just had, say, a lumbar laminectomy. They don't even have the excuse of having had a hole cut in their head.

But by the time I hear that sort of garbage from one of my patients, I'm already committed to taking care of them for the day. So I slap them down, as politely as I can, by telling them that a) that sort of language is *not* acceptable to me, b) they won't use it in front of me, and c) they've had their one chance. Next time, they get another nurse.

And yeah, I have had to turn over care a couple of times to the charge. I hate to do it; I'd frankly rather just leave those folks in the bed, but somebody has to make sure their miserable little shriveled souls don't leave their bodies in an untimely fashion.

But. What would I do if, say, a Klansman came in for surgery?

I know they exist. I know some of them live around here, probably in the same neighborhoods as the Birchers and the disciples of Phelps.

Would I take care of that person? *Could* I? I mean, I have a duty not to harm, right? And I have a duty to serve. All that stuff in the Nightingale Pledge is stuff I agree to do every day when I put my clogs on and head out the door. But could I, in good conscience, agree to help heal and succor somebody that I figure is better off dead?

What about a rapist? Child molester? The guy who starved his aunt to death? What if *he* came back? What about some dude who habitually beats up his wife? If I knew about it in advance, would I take them on?

All I know for sure is that if Red Peters shows up on my floor, he'd best be prepared to start his own damn IV.

Lousy...

...bastards.

Why, yes, Questions 1 and 4 do have a practical application.

Friday afternoon at about 1530, I was hit by what can only be called a solid wall of ugh. I think it was brick ugh, perhaps coated on one side with titanium and on the other with lead. With little lead weights hanging down from strings of ugh at the top of the wall. Little lead weights filled with ugh that would bonk me on the head now and then and make me either sit down suddenly or run for the bathroom.

I spent Friday night ransacking my kitchen cabinet for drugs. (Note: don't keep drugs in the bathroom. The heat and humidity aren't good for them.) I think I took two allergy pills, a couple of decongestants, a Mucinex, perhaps a Dramamine (I don't really recall), a whole lot of zinc, some ibuprofen, and a couple of things from the bottom of my purse that, upon reflection, might've actually been Dentyne Ice gum covered with lint. Anyway, it seemed like a good idea at the time. And then I slept all night, in two-hour stretches each time.

I lathered, rinsed, and repeated all day yesterday, washing up on the shore at about 2030, convinced I would have to go to the doctor today, I felt so wretched. Then Chef Boy showed up, bearing a bottle of bourbon.

Say what you will about alcohol use and the immune system: When the Evil Exploding Butt Syndrome has stopped and you're dealing with nothing more than a nasty head cold, a couple of very powerful hot whiskeys with lemon can do a lot of good. I'm not sure that continuing the application of bourbon is all that good an idea; Chef Boy took a leaf from the old Johnny Walker ad, in which the influenza bug is repelled by the sight of cheap Scotch, and continued medical self-administration. He's not feeling nearly as good as I am today.

I'm feeling so good, in fact, that I'm bored. I'm not well enough to clean house, but not sick enough to sleep any more. I don't have cable. I've read the latest issue of "BARK" twice and gone through all my old books to see if there's anything I don't really remember that well. I suppose I could finish up some pre-Beloved-Sister's-Wedding shopping, but I don't feel well enough for that, either.

I think what I'll do instead is draw up and fabricate an ugh-proof suit to wear all winter long. That way, when the one person on the floor who handles every chart and piece of paper in the department comes in sick again, and when little Billy is garking in every available bathroom, I will stay well.

Or maybe I'll just carry around a bottle of Johnny.

A Quick Quiz

Do you qualify to be in or near my hospital? Take this simple quiz to find out!

1. Little Billy has had vomiting, diarrhea, and a low-grade fever for four days. Do you:
a. Keep him at home until his symptoms subside
b. Take him to the pediatrician for evaluation
c. Stock up on Pedialyte and ride it out
d. Take him to the hospital to see Grandma, who just had an open aneurysm clipping?

2. You arrive an hour and a half ahead of your admission time. On being told there will be no bed for fifteen minutes, do you:
a. Go outside and peacefully smoke a cigarette
b. Pick up a magazine and look at the pretty pictures
c. Engage in charming conversation with your spouse
d. Exhibit behavior that requires a visit by Security, a call to the cops, and an arrest on charges of assault and battery?

3. You are concerned about your mother's well-being. Do you:
a. Ask your mother's nurse for updates during the day
b. Ask the charge nurse for updates during the day
c. Ask the doctors for updates during the day
d. Walk into the nurses' station, open your mother's chart, and then exhibit behavior that requires a visit by Security?

4. You are an employee at a busy hospital. You have a cold. Do you:
a. Stay home with DayQuil and some movies
b. Sleep it off at home
c. Have friends bring chicken soup to your house
d. Come to work, snot and sneeze all over everything, and infect half the floor?

5. You are a doctor writing transfer orders for a patient. Do you:
a. Ask the charge nurse for the transfer order protocol
b. Write the transfer orders on independent order sheets
c. Make the effort to have legible handwriting
d. Jumble transfer and in-house orders together in an impossible scrawl and, when told that's not acceptable, exhibit behavior that requires a call to Security?

If you answered A, B, or C to any of the above questions, you are not qualified to come to the hospital in any capacity. If you answered D to any of the above questions, please come on down and join the herd of a whole lotta stupid that's been goin' on.

Happy Dance! It's a new Change of Shift!

Dammit. I almost typed "Change of Shirt" again.

Okay, fine. Here's the latest Change of Shirt.

Loopy, Lazy, and Linktastic.

I suppose I could post about the last couple of days at work, but I really don't feel like it. See, I got really sick yesterday after my workout from a combination of this week's stress and a huge bout of circuit training, and then I felt so bad last night that I forgot to take my antidepressant, and then I had weird dreams about planes nearly crashing and me nearly losing The Cat on the streets of Paris. So when I got up, I took the usual dose of antidepressant, but then discovered that I had no coffee (jarring music) and the combination of Lapsang Souchong tea and enough venlafexine to drop a rhino made me feel so bad that I had to go back to bed for a while.

Plus, The Cat is garking up hairballs and being lethargic. She doesn't feel so good, either.

But I *do* have links. I got one of those memes from Chocolate & Raspberries, along with a couple of other people (thanks, Crystal!) that asks for your seven favorite songs and your seven favorite blogs. I don't *have* seven favorite songs (well, I do, but they change every ten minutes), but I do have bloggy wonderment. So let's get to it:

Bad Hair Day is the less funny, more coarse sister of Go Fug Yourself...but it's worth reading anyhow. Good tips here on how not to end up looking like Fergie.

I've mentioned Dogblog before. It deserves mention again. I especially love the picture of the basset hound with glowing green eyes who has ACQUIRED TARGET LOCKED ON TARGET BASSET BOT SAYS HELLO in the archives.

For more critter fun, there's Cute Overload. CO is the hottest thing going right now; I feel quite smug that I've been reading it since its inception. The only drawback to CO is that some of the smaller animals tend to make their way into my non-antidepressant-brained dreams.

If you need a laugh, you must go to The Comics Curmudgeon. I discovered a real appreciation for bad comics here.

There's also Snarkywood. It's along the lines of GFY. My only complaint is that they don't update it enough (same deal as with Dogblog).

For those questions that just can't be answered well enough by Google, there's Wikipedia. If you're not already addicted to Wiki, you ought to be.

Shakespeare's Sister is a left-leaning (hell, it's a screaming liberal lefty commie blog, just like mine) group blog that's all about the politics.

I read The Disgruntled Chemist a lot, just for fun. It's nice to read somebody smarter than oneself.

That's eight. Have a good time. I'm going back to bed after I do some dishes.

Mmmmmm....

I really, really meant to do the seven by seven that other bloggers have tagged me with tonight. I swear I did.

But I got distracted with making biriyani.

Oh, my God. I make some kick-ass biriyani. I do.

You can taste the ghee in the plain rice. The yogurt-marinated chicken is perfect and tender. The onions are burnt to just the right burnt-onion taste, and the potatoes are brown.

I think I'll go Google "Sindhil Ramamurthy" and "John Abraham" (my friend Deepa says, "And he has a name you can pronounce!!") now.

Mmmmm. Biriyani.

In fact, if you don't bite into one of those *$(*(*$#@&* dried tamarinds contained in the Bombay Biriyani mix, it's perfect. PERFECT, I tell you.

Mmmmm.

From the "Oh, Shit, I Forgot" Files...

Check this out.

I have no clue how long Janet has been blogging, or how long she's been a nurse. What I *do* know is this: if you want to model your nursing blog on somebody, model it on Janet's. She writes in a simple, straightforward style with understandable language and heart-wrenching simplicity. It's fast becoming my new favorite, along with Sid's.

You know it's time for a glass of wine when...

...a memo describing an upcoming change in hospital policy gets you so angry that you send a snarky, venting email with scarcely a word under three syllables off to your manager, ranting about how un-Einsteinian Upper Manglement is.

And then, even though you prefaced it with the disclaimer that it was venting and snarking and nothing more, your manager finds that it so perfectly describes the mood of The Lowly Worker that she forwards it.

To everybody.

Everybody, that is, except the president. Who will probably hear about it anyhow, within a matter of days.

Good thing I used nice, big words and phrases I can look back on with pride, such as "(the) headlong gallop down this precipitous slope to mediocrity" and "the breathless pursuit of the lowest common denominator."

The memory will keep me warm in the cardboard box I'm sure I'll be living in starting Monday.

Best blog.

Read this. As usual, I'm late on the boat, but I just spent an hour reading Dr. Sid. Can't wait to get back to him.

Minor Procedural Gripes.

If you are a doctor, please, *please* do not use the nurses' computers when the doctors' computers are entirely unoccupied. And if you do, please, for your own sake, don't grouse when I say "Excuse me, please" politely and make a long arm to reach for my charting. Even if you are an attending--and I'm talking to you, Doctor Wire-Rimmed Oncologist--I will slit your belly and hold your smoking entrails up before your dying eyes if you refer to me at work as a bitch. Outside of work I'll just kick your ass.

Just so's we understand each other. That memo? Got sent. Have a nice Monday, doc.

Jack And Jill V-Cut Spicy Barbecue Flavor Potato Chips should either be available free of charge in the continental United States or banned as a controlled substance. No more importing them from the Phillipines, people. If I can only get my Spicy Barbecue Flavor Chip Fix twice a year, I get grumpy.

Which reminds me: Mom, Dad, why did you have to raise me so that my comfort foods are refritos and blackberries? Why couldn't I have been a *normal* kid?

If you're a resident, please keep in mind one simple thing: I work at one hospital. You work at three, in rotation. Therefore, I know the rules at my hospital better than you do. Your attempt to bully me into breaking the rules at my hospital because you're too lazy to come out on a Saturday will result in your attending being...unhappy. The less said about the sequelae, the better.

If you're a nursing student, please, *please* do not look at me like I've just grown a third head and am about to take a bite out of you with it. I promise, I want you to succeed. I will go to a lot of trouble to make sure you get a good clinical experience. Just don't stammer and go silent when I say "Hello". I like you. I really like you.

Note to other nurses: If a patient is deaf or does not speak English, yelling will not make them suddenly un-deaf or fluent. A lot can be accomplished with smiles and nods and an interpreter.

I don't care if you drive a Prius: don't go 45 in the passing lane.

I'm off to my usual Sunday comfort-food and "Extreme Makeover: Home Edition" fest. And I hate the producers, actors, and director of "Grey's Stupid Whiny Anatomy" for making me curious about what happens between Meredith and Doctor McFacelift in the season premiere. I hate them. Hate them. And yet....I wonder.

Burke is much, much hotter, by the way. But Gregory House? Hottest of all.

He can almost kill me five times in forty-two minutes any time.

Quick note:

In case I should disappear for a while, it's not because I'm busy strangling hammer-wielding intruders or because I've fallen victim to some strange bug. The provider of Innernetwebwideness that I use has decided to stop providing a hookup, so I've had to go with a Large Corporate Provider. The LCP says my Innernetness will be accessible by 10/5, and I don't know how long the old line will stay up.

That is all. Return to your regularly scheduled more important things.

Results of a recent study show...

...that among nurses who watched a cumulative 4.5 hours of "Grey's Anatomy", 100% repeated, over and over and over during the course of the show, "I AM SO GLAD I DO NOT WORK WITH YOU PEOPLE."

Ten percent of respondents also volunteered the information that they would rather enoculate themselves bilaterally with a rusty runcible spoon than watch the Season 3 premiere.

Thank you. That is all.

So you're a nurse. Now what?

I got a request for a post about role confusion (that awful feeling that comes from being a new nurse), and it sounded like a good idea. The transition from student to preceptored nurse isn't as hard as you'd think; you still have to show up on time for various classes and lectures, you still have somebody following you around, you still feel like there's some leeway for mistakes.

Coming off a preceptorship, though, is a whole 'nother deal. All of a sudden, you're a Nurse. But you don't feel like one; instead, you feel like some shmuck that's been picked up off the street and dumped into scrubs. Things seem really, really hard--even simple things, like a focused assessment of a patient.

Here's what I learned when I was a new, nervous nurse, then:

1. You will not kill anybody.

Unless you do something spectacularly idiotic, which is very very very rare, you will not kill anyone. You have people looking out for you--this is true throughout your nursing career--and every action you're expected to take has gone through a number of people more experienced than you.

2. Remember the First Rule Of Nursing: If you have to jack with it, it's wrong.

That one little rule will save you every time. Hospital and clinic work has been streamlined and perfected over the years so that it's practically tired-new-nurse proof. Therefore, if you find yourself having to improvise or make things up to get something done, take a good look at what you're doing. The likelihood is that you're either doing the right thing wrong or the wrong thing altogether.

3. If you do screw up, report it immediately.

Nobody is going to fire you, yell at you, or make you feel like an idiot. (Chances are, you'll do that last one to yourself.) Everybody, even Super Nurse Extraordinaire, makes mistakes every day. That's why we have procedures in place to, say, double-check settings on pumps and so on. If you screw up, it's important to report it so you can have help figuring out *why* you screwed up, and how to manage the situation in the future.

4. Ask questions.

Everybody asks questions, including Super Nurse Extraordinaire. Most of us ask them constantly. We all double-check each other, help each other out with weird titrations, give second opinions on whether or not that patient is more or less gorked than the day before. Your colleagues are part of a team that includes doctors and other nurses and X-ray techs and respiratory folks. Ask 'em all questions. If anybody tries to make you feel stupid, respond politely and be effusively thankful. That'll embarrass them no end.

5. Honesty is the best policy.

If a patient asks you how long you've been a nurse, *be honest*. You're not fooling anybody. If you don't know something, *say so*, then vow to find out the answer. This, too, happens every day.

6. But don't volunteer information.

I say this not because patients are stupid or mean. I say this because if you give somebody too much information, it can be truly overwhelming. Stick to answering the questions you get asked, like "How long until I can shampoo?" or "When will my stitches come out?" Don't go into a dissertation on possible side effects that only occur in 0.1% of the population. This is a lesson I learned the hard, hard way.

7. Fake it.

Act confident and friendly, even if fear makes you want to throw up and pass out. Eventually you will feel confident and friendly. In the meantime, nobody else will have to deal with your vomit or prone body.

8. Going home in tears is not necessarily a bad sign.

You will be so overwhelmed, stressed out, and exhausted that you will occasionally sag against the wall of the elevator and weep. This is a normal part of the stress that comes with being a nurse. It becomes less frequent as you learn more. It's okay. Here, have a cookie.

9. People will occasionally do mean things or get inappropriate with you.

Wackos can smell a new nurse. I got odd suggestions, inappropriate physical contact, and outright bullying more in the first six months I was a nurse than I have in the following three-and-a-half years. Be patient. Eventually you will develop that Nurse Callus that allows you to see the loonies coming and deal with them. In the meantime, lean on your charge nurse and your colleagues to help you get out of rooms unscathed. And if you're getting consistently shitty assignments with a higher-than-normal proportion of weirdos, complain. It's not fair to saddle the newbie with all of the nutjobs.

10. You will, someday, feel like a nurse.

I remember when that happened. I had had a day during which I had made only a couple of minor mistakes, caught them before they'd done any harm, and had caught a problem before it developed into something severe. Further, I had had time to pee and eat and actually take *time* with my patients.

That didn't happen until I'd been a nurse for more than a year--maybe even more than two. I don't remember the exact date, but I do remember the feeling. It was though I had finally gotten the hang of swimming with the current.

This will happen to you, too. I can't stress that strongly enough. Nursing is a constant learning process. You feel off-balance every day of your professional life, and there's always something you don't know. Nevertheless, there will come a day when you realize that you're looking ahead of what's immediately in front of you, and when care plans finally begin to make sense. You'll build on skills you already have when it comes time to learn something new. Yeah, you'll fuck up royally the next day and go home in tears, but you'll have had that one day when you can say, honestly, 'I am a nurse.'

And then, a few years down the line, you'll be chatting with a notoriously hardassed doctor and apologize for doing something dumb, like calling her at 3 am, and she'll say, "Y'know, if it comes from a good nurse, I don't really mind it when I get called at 3 am." And she'll smile, and you'll know that Good Nurse = You.

A tribute to ED nurses....

PORTLAND, Oregon (AP) -- A nurse returning from work discovered an intruder armed with a hammer in her home and strangled him with her bare hands, police said.

Susan Kuhnhausen, 51, ran to a neighbor's house after the confrontation Wednesday night. Police found the body of Edward Dalton Haffey 59, a convicted felon with a long police record.

Police said there was no obvious sign of forced entry at the house when Kuhnhausen, an emergency room nurse at Providence Portland Medical Center, got home from work shortly after 6 p.m.

Under Oregon law people can use reasonable deadly force when defending themselves against an intruder or burglar in their homes. Kuhnhausen was treated and released for minor injuries at Providence.

Haffey, about 5-foot-9 and 180 pounds, had convictions including conspiracy to commit aggravated murder, robbery, drug charges and possession of burglary tools. Neighbors said Kuhnhausen's size -- 5-foot-7 and 260 pounds -- may have given her an advantage.

"Everyone that I've talked to says 'Hurray for Susan,' said neighbor Annie Warnock, who called 911.

"You didn't need to calm her. She's an emergency room nurse. She's used to dealing with crisis."

Hat tip: Grunt Doc

Read this.

Thou Art With Us.

The Bowels of the Hospital

In most hospitals in the US, poop is the nurses' purview.

Shit is our shingle.

Bowel movements are our raison d'etre.

It's an ugly fact of life, but it's true: if you have a patient who's undergone brain/cardiac/leg/facial surgery (anything, practically, short of surgery for an intestinal obstruction or ileus), it is your responsibility as a nurse to make sure that they're regularly moving their bowels. Pooping on schedule, as it were. Dumping a load like clockwork.

That sounds easier, to the lay person, than it actually is. See, we hand out narcotics like candy (what? They're not candy?), and narcotics slow the passage of feces (or "stuff", in the medical terminology) through the bowel. Stuff that takes a long time to pass through the lower intestine becomes dried out as more and more water is absorbed. Sometimes the lower intestine itself gets lazy, and then you have the dual problem of dry Stuff and Lazy Bowel.

In short, we deal with a lot of constipated patients a lot of the time.

Normally, protocols demand that a patient move (or "open", for our friends in the UK and Oz) their bowels no less than once every 48 hours. After certain surgeries, like an open aneurysm clipping, once every 24 is preferred, as to avoid straining and possible increase in thoracic and intracerebral pressure. I thought it might be nice and amusing and edifying to go over the ways in which we manage that. Note two things: that I'm on my second beer, or else I'd *never* be typing about poop, and that these hints and tips do not apply to spinal-cord-injury patients, who are a whole 'nother ball of wax. Or dung.

Stuff Softeners: The First Line of Defecation

Docusate sodium and docusate calcium fall into this category. They're over-the-counter medications that draw water into the bowel in small amounts, allowing Stuff to remain soft, pliable, and evacuate-able in the normal person. Note that overdosing a patient on Stuff Softeners is a bad idea, as the Stuff will become so soft that it either just sits there, or turns into diarrhea. Stuff Softeners won't work for a patient who has pre-existing problems with constipation or who's badly impacted. Don't waste your time.

Milk of Magnesia: The MOM of All Remedies

MOM is technically a saline laxative. Saline laxatives work by drawing water into the bowel, following the principle that heavily saline solutions on one side of a membrane will attract water to balance their concentration. (Am I reminding you of chemistry yet?) MOM works best, I've found, on an empty stomach, two hours before any medications, and when followed by sixteen ounces of water. It's good for the moderately-constipated patient with no huge health problems (the usual neurosurgery candidate, in other words).

Prune Juice: Grandma's Remedy or Old Wives' Tale?

I've never had a lot of success with prune juice, even warmed, unless it's with people who've been using it for years as a laxative. Apparently it contains some chemical that causes the bowel to move. The downside is that it won't work with most folks. The upside is that it's the Drink of A Warrior, according to Whorf (/geek).

Stimulants: Use At Your Peril

Bisacodyl and Bisacodyl Uniserts, also known as Dulcolax or Correctol (tablets and suppositories) are stimulant laxatives, as is senna (Sennakot). Both will send your patient into low-earth orbit if they're not terribly backed up, and will cause hemorrhoids if they are. I use the pills as a last resort and the suppositories as a next-to-last resort. The major drawback of stimulant laxatives is cramping; the secondary drawback is major, major pooping.

Magnesium Citrate: When Your Best Just Isn't Good Enough

Give a patient a glass full of ice-cold cherry flavored mag citrate and a straw, tell 'em to drink it fast, and then...stand back. You'll hear their bowel sounds from the doorway. Mag citrate is a saline laxative--the difference between it and milk of mag is volume. More volume equals more water equals more...well, you get the idea. I love mag citrate, though it should be used with extreme caution in people with electrolyte imbalances. It'll cure what ails you, for sure.

Back Door Remedies: When You Get Stuck

Enemas are often the nurse's best friend. You can have plain enemas (tap water or saline, warmed, with or without a little liquid soap added), weird enemas (SMOG or bubblegum or milk and molasses), or dreaded enemas (The Dreaded Triple-H).

Plain enemas are used most often as cleansing treatments. They help the patient get rid of whatever's up there, plus, they leave the intestine relatively clean in the process. My personal favorite is 750 ml normal saline warmed in a graduated cylinder in the microwave, with the remaining room-temperature saline added until the temperature is comfortable. (Note: it should feel slightly warm on your wrist.) I'm not crazy about soap; it seems too turn-of-the-century to me, though there is plenty of evidence that the irritant nature of castille soap helps with evacuation. Personally, a liter of warm saline in yer poop chute seems like irritant enough to me.

SMOG, bubblegum, and...molasses? You're Kidding, Right?

No, children, I am not.

SMOG stands for saline, milk of mag, and glycerine. Bubblegum enemas are saline with some liquid docusate sodium added. Both are low-volume enemas that depend on the chemical ingredients for Stuff softening and stimulation. They're prescribed, in my experience, by well-meaning residents who have no clue what they're up against. The experienced nurse goes for...

Milk And Molasses: An Unlikely But Effective Combination

250 ml of whole milk (or thereabouts), mixed with an equal amount of ordinary molasses, warmed, works a treat. The molasses draws water into the bowel while the milk greases the works, as it were. Results are fast and gratifying (for the patient). We keep a gallon jug of molasses in the clean utility room and go through it in about three weeks. This, along with the half prune juice, half mag citrate cocktail, should be in every nurse's arsenal.

The Triple-H: High, Hot, and a Hell of a Lot

We're talking tap water or saline (my preference) in quantities of a liter. Or more. The outcome should be obvious. I only use these in extremely constipated patients with attitude problems.

Disimpaction: A Manual Manual

Disimpaction is unpleasant for both nurse and patient. Probably less pleasant for the patient, but it's close. We do manual (sticking fingers where fingers normally don't go) disimpaction when a patient has a rectum and lower bowel full of hard, dried feces that they can't excrete. It *hurts*. Using lots and lots of lubricant and a gentle touch will help, but you can't get around the fact that you're ouching somebody who's already ouched out.

It should be avoided at all costs, and not just because it lacks dignity. You can easily traumatize delicate tissue while doing a manual disimpaction. And, frankly, if a patient gets *that* impacted while in the hospital, somebody isn't doing their job. Even a mineral oil enema to loosen things up and grease them along is preferable to the trauma of disimpaction. You can always do a cleansing enema afterwards.

And there, children, you have it. Probably more than you wanted to know, but at least a bit helpful for the new nurse or student. Enjoy your day, eat your salad, and for heaven's sake, don't let your patient go more than 36 hours without a tour of the porcelain empire.

Wahoo! Change of Shift is up...

...and I'll be happy if I can ever stop typing that as "Change of Shirt". *sigh*

Right here.

Odds & Ends

Firstly, because I am a huge noobnik, the link to the latest Change of Shift. I suck, I know. This is going up late.

Secondly, Mike from Scrubcap sent me a very nice email, asking if I'd link to his site. Sure, Mike! The only thing that bugs me about his caps is that he's only got two patterns for the caps that work for women with short hair. And it's not personal; I rarely wear the things myself. It's just a matter of principle.

The featured cap in that link is for the Oklahoma Sooners, which a quick Google informs me is a college football team. Boomer on, Sooners.

Thirdly, an answer to the nice email correspondent who asked me if I'd ever considered posting pictures of, say, my cat or my workplace. The answer on the cat is this: If ever she did anything interesting, I would be happy to start a Friday Cat Blogging feature. Unfortunately, she tends to lie in one position, either asleep or facing the camera with an "I'm going to rip your throat out, asshole" expression.

As for the workplace, same deal applies: If my coworkers ever did anything interesting, I'd take pictures. As it is, we're all drunk at work, lying around in attitudes of total dissipation while our patients hit the bell, so it's no go.

Fourthly, on a completely boring, girly, personal note, I got a "Well Done!" certificate from my personal trainer. I thought it was sweet, a child young enough to be my daughter giving me a fancy computer-printed certificate. The downside was that there were no gold stars on it. The upside is that she's impressed and a bit mystified by my strength and stability gains. Seems I've blown the top off the curve as far as building muscle mass goes. Wahoo me. Boomer on, Jo.

(You know, I may be snarky, but the fact that she printed up a certificate really touched me. It wasn't one-size-fits-all, as it had brains and cats on it. If she adds pictures of Robert Smith circa 1985 to the next one, I'll know we're getting along.)

Umm...what else? Oh, yes: the latest Change of Shift has an excellent post on "Communicating with the Doctor". I wish somebody had given it to me five years ago, just before I graduated. Instead, I had to figure all that stuff out myself, which led to me making a howling ass of myself on the phone more than once. All new nurses and nursing students should read that one.

Did I just mention the year 1985? Seems I did. Excuse me while I go take some Geritol. (Do kids these days even know what Geritol is/was?)

In other news, I have a product review for those of you who wear mascara. See, I had to replace all my eye makeup after that pinkeye thing, and I ended up buying some Maybelline waterproof Sky-High Curls mascara. Because it was on sale. Waterproof because I have to wear waterproof eye makeup for Beloved Sister's wedding, because I don't want to look like Robert Smith, circa 1985, by the end of the ceremony.

Anyway, it works well. Yes, it is waterproof, which means you'll have to use something oily to take it off. And yes, it does curl your lashes, in a weird process that involves you being able to feel your lashes curling. If I had done major drugs in college, that probably would've provoked a flashback. It does not clump, but it takes forever to dry, so don't sneeze after you've put it on. Overall, I give it a good rating, if you like waterproof mascara.

Ooooh. The best part of that mascara purchase? Was finding out that every-damn-thing at the local Target is on clearance. See, they're building a Super Target down the road, so the Non Super Target is moving. That means that all the cool stuff you never wanted to buy before, because $15 seemed like a lot to pay for a furry Sponge Bob pillow, is now 60% off. So I have all the cool eye makeup I could ever want (thanks, pinkeye!) and some other nifty stuff, as well. Boomer on, Target.

And finally, after swimming and dinner and champagne (ugh) at Friend Teresa's, I've decided that Borzois are my new favorite sighthound breed. She has three of them--one skinny, one fat, one shy. The shy one did the lean/nit/burrow thing that sighthounds are known for, plus she was furry enough to really cuddle. I'll always be a sucker for Greyhounds, but Borzois are now running a close second.

So You're Starting Nursing School...

Tips for student nurses of all ages, drawn from my own limited experience:

1. Put aside inviolable time to study every damn day. Even weekends, even holidays. Don't get into the habit of thinking that you'll do it later, or that you can catch up. Study every day. You'll be glad you did.

2. Put aside inviolable time to think about something other than nursing every damn day. That includes not thinking about nursing blogs, or blogging your own experience. If you don't keep some other interests alive, you'll turn into StudentNurseBot, and you'll go crazy.

3. Yes, you will have no social life. This will not bother you. There's plenty of time for a social life after you've passed the NCLEX; nurses are notoriously hard partiers.

4. Make the effort to look as nicely pressed and crisp and clean and starched as you can during clinicals. Really and truly, it makes a difference. You'll not only feel more confident, but your patients will feel better about having you in the room. And if you have a crappy day, at least you looked good.

5. A word about your patients: on the whole, patients don't mind having student nurses. Some of them love it. Think about it: they get individualized attention from someone who's detail-oriented. They want you to succeed.

6. A word about nurses: on the whole, nurses want you to succeed as well. In four years, I've only seen one group of students that I felt couldn't hack it as even marginal nurses. The other students I've seen I have wanted to help, encourage, and see do well. Yes, there is the occasional wackjob or sadist who hates students. You'll be able to pick that person out of a group in no time and avoid them.

7. Another word about nurses: on the whole, nurses do not eat their young. The ones that do (and I work with one) bite everybody, not just the new nurses. And nobody likes them. Their colleagues avoid them, the doctors try to do end-runs around 'em, and management knows their tricks. Do not let the Nurse From Hell ruin your day.

8. Look around at the class you're in. Two thirds of the people in the introductory courses will probably wash out. Support them, study with them, and lean on them anyway. The relationships you form in nursing school last for about five minutes after pinning, but they're the most important relationships you'll have during school.

9. Some of your professors hate nursing. Some of them will try to discourage you, or will show favoritism to particular students for unfathomable reasons, or will be nasty without cause. Ignore those professors. Cultivate respectful relationships with the instructors who love what they do.

10. Pay attention in A&P. Learn enough skills to pass your skills lab, but don't fret about starting a zillion IVs. Know your drug book backwards, but remember that you'll have a set formulary in your hospital--you won't have to remember everything forever. Care plans suck, but they're useful in figuring out disease processes and really do come in handy sometimes. Never use "Potential For" as a nursing diagnosis more than once in a care plan. Make sure you have good pens. Always carry an extra scrub jacket.

And get out there and kick some ass. Being a nurse is infinitely more pleasant and much, much easier than being a student. Soon you'll be done with school. While you're doing it, remember that those of us who've been there are pulling for you.

Sung to the tune of "Heartbreak Hotel"

*strumming guitar*

I woke up at one this morning
And didn't know what to do
My eyes were welded shut with
This nasty yellow goo

Oh, I've got the pinkeye, baby
Yeah, I've got the pinkeye, baby
And don't'cha know I
Wanna diiiieeeee

I went to see the doctor
And all she said was "Wow...
"You sure 'nuff got the pinkeye
"Go fill this scrip right now"

'Cause I got the pinkeye, baby,
Yeah, I got the pinkeye baby,
And I got this burning
In my eeeeyyyyeeeeessss

I went on to the drugstore
And there the folks all screamed
They'd never seen the pinkeye
Be quite this bad, it seemed

And oh, I say
I got the pinkeye, baby
Yeah, I got the pinkeye, baby
And I am so bummed that I could cry.

Downside: I have to throw away all my eye makeup. Upside: I get to buy new stuff, which means I could conceivably change my image from Competent Nurse to Crazy Punk Rocker.

Downside: I have seven days of truly disgusting eyedrops. Upside: The drops kill even C. perfringens, so I won't get gas gangrene in my eyeballs.

Why I love students and GNs, and why you should too.

This past week, I was at the fifty-seventh minute of the eleventh hour of my shift when a GN I hadn't met before approached me and introduced herself. Turns out she wasn't looking for me, but we had a nice chat anyhow.

I asked her if she was getting a thrill from signing "RN" rather than "GN" after her name, and something amazing happened. I don't think she realized it, but she stood up a little straighter, her face glowed, and she said, "Yes. I'm really proud."

Turns out Dad and Mom had both been working three jobs to put her through school. She did very, very well and passed the NCLEX first shot, and now got to sign "RN" after a name composed mostly of consonants. You bet she was proud. Her whole family is proud of her, and rightly so.

And *that* is why I love new RNs. It's not just that they keep me on my toes during preceptoring with questions I've never thought of. It's not that they're seemingly inexhaustable and willing to work hard, because everything is so fresh and interesting. It's not just that they come up with questions about procedures and policies that make me go, "Buh?" and realize that there's a better way to do things. It's that they are so damn *proud*.

They've worked very, very hard for two or three or four years, often while mastering English as a second language or relearning algebra that they'd gladly forgotten twenty years before. They've busted ass through difficult courses with instructors who were, at best, flaky and at worst, actively discouraging about nursing as a career. Some of them turned their backs on lucrative jobs doing something else in order to answer a calling they'd ignored for too long.

They have every right to be proud. And seeing a new nurse's face light up when you ask about the "RN" thing is marvelous. It reminds me why I do this.

Nursing students do everything that a GN does, but more so.

I remember coming on to the floor on the first day of clinicals my first semester. I was so frightened I thought I'd throw up, and seriously considered running away. As the semesters wore on, I got less nervous, but I got much, much more tired. I see that process now with students.

The nursing students we get are excellent. The one exception that I complained about bitterly last year was just that--an exception. The SNs ask questions about anatomy and physiology that require that you keep your chops up. They cheerfully volunteer for tasks that seasoned nurses hate, because it gives them experience. Inserting a rectal tube is a brand-new, shiny job when you're just starting out, after all.

And they're cheerful. On very little sleep. I had classes Monday through Wednesday, starting at seven in the morning and going until three in the afternoon, after which I would spend at least a couple of hours in the lab or the library. Thursday and Friday, clinicals started at 6 am and often didn't end until after 4 pm.

The students I work with have schedules at least as harrowing, and some of them drive two hours or more to our hospital, but you never hear complaints. Maybe a wan smile or two, or somebody might crash and burn for a day or so toward the end of the semester, and have to be revived with coffee and chocolate, but they show up smiling, work their butts off, learn new stuff every day, and graduate.

What with the shortage of nursing instructors and the lack of places in programs, you have to be exceedingly bright to even get into a nursing school. Where I am, two-year programs produce most of the bedside nurses, and the entrance exams are very, very tough. The programs are competative--perhaps thirty people will finish from a starting group of over a hundred and fifty. The women and men who graduate with an associate's degree should be proud of themselves.

And I'm proud to work with them, both as students and as new graduates. I hope I'm as good to them and for them as they have been for me.

Thanks, guys. I'll see you next semester.

The Conga Line

Today I slept.

It's been a long week. We've had a number of folks with undiagnosable whatevers--things that we either have to wait for the disease to progress to be able to diagnose, or for the patient to die so we can diagnose whatever hit them on autopsy--and that always is hard.

So I got up this evening, after sleeping most of the day, and cooked. I had a bottle of wine, three different kinds of cheeses, and a selection of fun vegetables, so I cooked.

And just after ten o'clock, I was suddenly the head of the conga line.

Every nurse has a conga line. It's made up of the patients who die--the ones whose names you remember, whose various afflictions you remember--the ones you might've known even before you were a nurse.

Unexpectedly, I felt Darlene's hands on my shoulders. I kept washing dishes until I knew that Velva was behind her, kicking in rhythm to whatever four-beat polka they play where she is. Curt joined in, his wool sweater as scratchy as it ever was before herpes took his sight and hearing, and made his sister take over the coffee shop. Last in line came Astin, dead of metastatic breast cancer that we caught too late. She and Darlene kicked in perfect rhythm, while Velva and Curt had a good time making up new steps to the music.

I conga'ed around the apartment, macaroni and cheese and zucchini cakes forgotten.

Some of my patients pray to Saint Therese. I pray to the people that I loved--and who hasn't fallen in love with a patient, wished they had been friends with them before--for help, and guidance, and compassion.

And sometimes we dance with them, in a silent conga, grinning, as the music only we can hear and the hands only we can feel guide us.

An Open Apology to My Filipino Colleagues

Guys, I'm sorry.

I know you do better for my patients overnight than I can during the day. Gerb, I appreciate your attempts to teach me to talk dirty in Tagalog. Michelle, thanks for the custard cakes and the joke about the sausage and bread and fish. Ester, you rock my world when you start IVs for me. Jay, you've pulled more folks back from the brink down in post-op than I can count. None of you complains about the schedule, or about the bigots you have to work with, or about the assholes that pepper your day. Along with the Indian and African immigrants and the occasional Slav or Russian, you make my hospital a fun, interesting place to work. I love you all.

But I cannot, cannot eat pork adobo.

I have tried. I like fried eggplant and little squiddy-squids for breakfast. I rock the lumpia whenever you decide to bring some extra. I'll eat anything that you put in front of me, really.

Except pork adobo.

Kill a chicken, pluck a parakeet, slay a sturgeon. Put it into adobo sauce or dry it and fry it and serve it up cold; I don't care. Just don't put pork in front of me, please, with or without that delicious white rice that I can't seem to cook myself.

I feel *so bad* for not liking what is supposed to be the summit of Filipino cuisine, at least according to my coworkers, who can debate for hours the relative merits of various recipes for it, all the while switching into and out of English at baffling speed.

I had a big bowl of the stuff yesterday for lunch. Don't get me wrong; I love the way it tastes. But after? Oh, my stars and garters, it was like trying to work out with a hangover today.

So no more delicious, soft, tender, perfectly-cooked, meltingly wonderful bits of pork in a tasty sauce for me.

I think I'll go on a four-day juice fast now.

Progress.

The chocolate cake for Thursday is made. For those interested, it's the recipe off the back of the Hershey's cocoa box, which even Chef Boy says is the best he's ever tasted. It stays moist for *days*.

The salad for the next two days is made. Artichoke hearts, cabbage, romaine lettuce, baby corn chopped up, red pepper, cucumber, tomato.

My laundry is mostly done.

The patient with the weird collection of symptoms turns out to have both a demyelinating process of some sort and a bizarre, very rare form of bone tumor. "I've...uh...never heard of that" I said to Doctor Number One. "Neither had we." he replied. Doctor Number Two points out that this is not the time for that patient to be playing the lottery. Patient says that's fine with him, just as long as the state doesn't come after him for the amount of the jackpot next week. Mayo says they're not entirely certain that the tumor is what they say it is, but what they say it is is the closest match. We may have something entirely new here.

After five sessions with Der Trainer, I've encountered a new embarrassing reaction at work. Previously, people used to ask when my baby is due. Now, they say "Oh! You had your baby!" Friend Pens, in her wisdom, told me I should reply, "Yep. And as I get stronger and more fit, I will be able to kick your couthless ass more thoroughly."

More reason to think that Just Because You're A Doctor Doesn't Mean You Know Everything: a patient, a doctor, decided to manage her own Parkinson's medication. No problem there, as most Parki patients prefer to continue the routine that's kept them functional for years. But! If you try to "wean" yourself prior to your brain stimulator being turned on, you will indeed fall over and freeze, and we'll have to pick your rigid body up off the floor. Note to all concerned: This is not as easy as it looks. Six people and a bedsheet later, we got her back to bed.

"House" is on tonight. It'll be the first chance I've had in months to watch an episode. I hope it's a good, snarky one. My record is still good: I've only missed two diagnoses in all the time I've been watching--the first was the pregnant teenager with autoimmune weirdness, and the second was the guy with the stuff that's transmitted through pigeon poop. I even got the nun with the IUD.

On a completely serious note: If you work crazy hours, can't motivate yourself to exercise, and hate your life, please consider dropping the dough to hire a trainer. Yes, it's expensive. Yes, it's embarrassing to realize how out-of-shape you really are. But damn; this is the second-best money I've ever spent on anything (the first being the clams to get away from The Ex Husband). No really noticable changes in my body yet, but my stamina is improving, and I feel wonderful.

And I'm not even tempted by the cake.

Why do you come here when you know I've got trouble enough?

I finally got to say it.

"Are you shitheads gonna do the same thing to me this time that you did last time?" he demanded.

"He told me that nobody would help him with his bath last time. And that the doctor wouldn't come see him. He told me he was in here ten days without a bath." she concurred.

"Ma'am, Sir," I replied, "let me be straight with you. You weren't given bed baths last time because when the aides came in, you would curse and throw things at them.

"Then you'd get up and shower.

"The doctor stopped coming in after you threatened to kill him and his family. You've been fired by every nurse on the floor except me.

"The aides have been instructed, for their own safety, not to enter your room.

"I am the only person here who is willing to take care of you. And if your behavior is anything like it was the last time you were here--any cursing, any throwing things, any threats--I have instructions to discharge you immediately. If you assault anyone, I'm going to call the police."

There was a brief silence.

"Where am I supposed to go if you discharge me?" he asked.

"You may go to any other hospital of your choice. We will assist in your transfer." I said.

"No place else will accept him," his wife said, "They've all got do-not-readmit on his chart."

Another brief silence.

Then I gave him twenty of immediate-release oxycodone, four of dilaudid, and a milligram of Xanax and went away. That was all he really wanted anyhow.

Damn. Mention poutine, and the world beats a path to your blog.

I'm not much in the mood for IMAGE WARZZ today, sorry, SS and Bob, because I had that dadratted physically and verbally abusive patient come back in AGAIN. If he hates us so much, why does he keep coming back?

Anyway. I see your naturalistic images and raise you...

this.

He looks like he would love some poutine.