I heard a new acronym the other day.
Acronyms are common in medicine and nursing. We have "ETOH", shorthand for "alcohol" (it's the chemical formula for drinkable alcohol, not the rubbing sort), which is also often used as a shorthand for alcohol abuse.
There's "SOB", which isn't a description of the patient's personality, but instead stands for "Shortness Of Breath".
And "TURP". TURP means Trans-Urethral Resection of the Prostate, a method of removing part or all of the prostate gland.
"BRCA" is one everybody knows about, thanks to recent news stories about the breast- and ovarian-cancer gene BRCA1. BRCA is, of course, BReast CAncer.
"GBM" is one I use a lot--it stands for GlioBlastoma Multiforme, the number-one brain tumor you don't want to get.
The new one? "TUD".
"TUD...." I thought. "TUD. I wonder what TUD means. Trans-urethral....no, that's not it. Topical....no."
Finally, I started asking everybody else on the floor if they'd heard the acronym before. Nobody had. And nothing makes a group of nurses feel dumber than an acronym they can't figure out, so we were an unhappy bunch. I finally caught up with the doctor who'd written the history and asked what on earth TUD meant, and she said:
"Tobacco Use Disorder."
Tobacco use disorder. The patient is a smoker. No, wait, not a smoker, but a person with tobacco use disorder. I rolled the term "tobacco use disorder" around in my brain for a while, wondering when we'd get hit with "Dietary Fat Disorder" or "Inactivity Syndrome" or "Fewer Teeth Than A Chicken."
Most of the time I'm in favor of medical language. It's hung on for years for a reason: it's exacting and precise, it's descriptive, and it's relatively easy to translate for the lay person if you take a little time. I'm not a huge fan of the idea that we need to write in plain English rather than use medical terminology, partly because most of the doctors and nurses I run into can't write plainly, but can manage medical terminology.
But this time? I'm in favor of ditching the acronym TUD and going back to "smoker", with a quick comment or two on PPD (pack-per-day) and when the person quit, if they already have.
Tobacco Use Disorder, if it catches on, is going to cause Exploding Head Syndrome.
Monday, December 11, 2006
Friday, December 08, 2006
Apparently I'm falling down on the job...
...because the Focus On Patient Care hasn't been what it could be lately.
Patient Care, people! That's what it's all about! Unless, of course, you work for La Schwank Hospital, in which case it's about Customer Service. But I'll get to that in a minute.
So. Boys and girls, let's go over this one more time:
Attendings:
If you have a resident to admit and discharge patients, please make sure that resident knows that he or she is to admit and discharge patients. That way I won't have four patients waiting in their rooms, twiddling their thumbs, while I wait for orders. And call six residents in round-robin fashion, looking for somebody, anybody, to write diet and activity orders.
If I have a patient who's just been admitted to the unit with bleeding from hinty-bazillion places, and I call you because the orders say to call you when the patient arrives (bleeding from hinty-bazillion places, oh, and now there's some weird swelling going on, too), please don't lecture me about "turfing". Not only do I not know what "turfing" is (it seems to have something to do with the perceived size of your genitalia relative to how many calls you get in a day), I don't care. Take it up with the other attending, who's been working this case with you for weeks.
I know you have a rule that I'm not supposed to call you before seven in the morning. Occasionally, I break rules. Like the other day, when your patient had a massive stroke and had to be moved to the ICU and placed on a vent. Sure, I called you at 0655 (and no, I do not kid), but was that really a reason to scream and holler for a minute and a half? I would've called your resident, but you don't have one.
Finally, if you're an attending I've never seen before in my life, from a service I've never seen in nearly five years of working at La Schwank, please don't be offended if I ask your name. Especially please don't be offended if I ask your name after you've walked up to me and started spouting off verbal orders without preliminaries. You may be considered God wherever it is you came from, but here you're just another damn thing I have to deal with.
Residents:
Don't put that vacuum container filled with strangely-colored body fluids down on the desk and tell me to "take care of this" without telling me where it came from, who it came from, and what the bloody hell I'm supposed to do with it. If you omit those minor details, that Evac bottle will sit on the corner of the desk until you're out of surgery. At least label the damn thing with the patient's name so I can divine your intentions from your badly written, detail-free note.
Do not--and this I am saying for the last time, before I come hunt you down--put an unstamped, un-labelled loose order sheet on the desk. Ever. There are charts for a reason, there are stampers and labellers for a reason, and you have a pen in your hand. If I don't know who those orders are for, none of them will get done.
Stay the fuck away from my pencil case. Next time I see you riffling through my stuff looking for something like a penlight, you're gonna lose digits. "MD" does not mean "My Domain."
While I'm at it, where were you raised, that you think using *my cellphone* without permission is acceptable? If you and your pencil-case-riffling colleague don't stop this, Patient Care will suffer because I'll be out back, shoving your bodies into the incinerator.
PAs, NPs, and other and sundry people:
I'm calling you at the office because you submitted the wrong damn set of order sheets to the PACU. That means that your patients have meds ordered that we don't have, and you're referring to protocols that we don't follow. Don't snark at me because I called you to inform you of this fact. Just get me the correct order sheets and I'll figure it out on my own.
Read the allergy list prior to prescribing meds to which the patient is allergic. Please. This is only the forty-millionth time I've pointed this out to you.
Please know the protocols for the hospital at which you've been practicing for ten years. Thank you.
Customer Service People:
I know the patient's daughter called you, angry because I wouldn't order a food tray for the patient. Hear me out: the patient cannot swallow and is a silent aspirator. Do not make my job harder by sending a food tray up to make the daughter happy.
The time to come in, cheerfully dropping off a basket of fruit and a newspaper, is *not* when I'm involved in an unpleasant and potentially embarrassing bedside procedure. Knock first.
Things like isolation rules cannot be relaxed just because somebody's stepfather twice-removed gave a load of dough to the hospital eight years ago. No matter how important the patient, they cannot bring their own furniture to the hospital. Don't tell them they can.
I've been too nice lately. It's time to get out the whip and Bettie Page-style nursing outfit and start cracking down on folks.
Patient Care, people! That's what it's all about! Unless, of course, you work for La Schwank Hospital, in which case it's about Customer Service. But I'll get to that in a minute.
So. Boys and girls, let's go over this one more time:
Attendings:
If you have a resident to admit and discharge patients, please make sure that resident knows that he or she is to admit and discharge patients. That way I won't have four patients waiting in their rooms, twiddling their thumbs, while I wait for orders. And call six residents in round-robin fashion, looking for somebody, anybody, to write diet and activity orders.
If I have a patient who's just been admitted to the unit with bleeding from hinty-bazillion places, and I call you because the orders say to call you when the patient arrives (bleeding from hinty-bazillion places, oh, and now there's some weird swelling going on, too), please don't lecture me about "turfing". Not only do I not know what "turfing" is (it seems to have something to do with the perceived size of your genitalia relative to how many calls you get in a day), I don't care. Take it up with the other attending, who's been working this case with you for weeks.
I know you have a rule that I'm not supposed to call you before seven in the morning. Occasionally, I break rules. Like the other day, when your patient had a massive stroke and had to be moved to the ICU and placed on a vent. Sure, I called you at 0655 (and no, I do not kid), but was that really a reason to scream and holler for a minute and a half? I would've called your resident, but you don't have one.
Finally, if you're an attending I've never seen before in my life, from a service I've never seen in nearly five years of working at La Schwank, please don't be offended if I ask your name. Especially please don't be offended if I ask your name after you've walked up to me and started spouting off verbal orders without preliminaries. You may be considered God wherever it is you came from, but here you're just another damn thing I have to deal with.
Residents:
Don't put that vacuum container filled with strangely-colored body fluids down on the desk and tell me to "take care of this" without telling me where it came from, who it came from, and what the bloody hell I'm supposed to do with it. If you omit those minor details, that Evac bottle will sit on the corner of the desk until you're out of surgery. At least label the damn thing with the patient's name so I can divine your intentions from your badly written, detail-free note.
Do not--and this I am saying for the last time, before I come hunt you down--put an unstamped, un-labelled loose order sheet on the desk. Ever. There are charts for a reason, there are stampers and labellers for a reason, and you have a pen in your hand. If I don't know who those orders are for, none of them will get done.
Stay the fuck away from my pencil case. Next time I see you riffling through my stuff looking for something like a penlight, you're gonna lose digits. "MD" does not mean "My Domain."
While I'm at it, where were you raised, that you think using *my cellphone* without permission is acceptable? If you and your pencil-case-riffling colleague don't stop this, Patient Care will suffer because I'll be out back, shoving your bodies into the incinerator.
PAs, NPs, and other and sundry people:
I'm calling you at the office because you submitted the wrong damn set of order sheets to the PACU. That means that your patients have meds ordered that we don't have, and you're referring to protocols that we don't follow. Don't snark at me because I called you to inform you of this fact. Just get me the correct order sheets and I'll figure it out on my own.
Read the allergy list prior to prescribing meds to which the patient is allergic. Please. This is only the forty-millionth time I've pointed this out to you.
Please know the protocols for the hospital at which you've been practicing for ten years. Thank you.
Customer Service People:
I know the patient's daughter called you, angry because I wouldn't order a food tray for the patient. Hear me out: the patient cannot swallow and is a silent aspirator. Do not make my job harder by sending a food tray up to make the daughter happy.
The time to come in, cheerfully dropping off a basket of fruit and a newspaper, is *not* when I'm involved in an unpleasant and potentially embarrassing bedside procedure. Knock first.
Things like isolation rules cannot be relaxed just because somebody's stepfather twice-removed gave a load of dough to the hospital eight years ago. No matter how important the patient, they cannot bring their own furniture to the hospital. Don't tell them they can.
I've been too nice lately. It's time to get out the whip and Bettie Page-style nursing outfit and start cracking down on folks.
Tuesday, December 05, 2006
Pity the pretty.
No, seriously.
Lightning strikes are like...well, like lightning strikes. They're mostly predictable, in that you know one might be coming if the sky gets stormy, but also strangely random, in that you can be a perfectly happy, outgoing sixteen-year-old in a lake at one moment, and then the next and forever a person in a high-backed wheelchair, gorked out.
One hole to shit through, another to breathe through, and an indwelling catheter so that your urine doesn't eat through the skin on your legs and buttocks. The high-backed chair is there so that your natural tendency to torque backwards is controlled. Splints for your hands and feet complement the chair; there'll be no decorticate positioning going on, not while your parents are alive.
Your hands and feet are smooth. You never use them. Your toes and fingers are perfectly manicured, colors changing depending on the season. Your hair is styled every morning by your older sister, who gave up a college scholarship to help take care of you, and to tell you how pretty you are. So very pretty.
Pretty is all you were ever known for. Being born pretty is a curse; the pretty girl never gets the chance to develop any other talents.
Dead John was nice-looking, in a sort of retired-hippy, craggy, fiftyish guy sort of way. He couldn't be trusted to not wear black boxers with red print on them under white scrubs, but mostly he cleaned up all right.
What I remember him for, though, was the way he used to barricade himself inside the one-hole bathroom on the floor and chart. We'd page him, and he'd call us on his cell phone: "I'm in the bathroom, dammit!"
Or the way he'd answer any question that rephrased "How are you?" "Lovin' life" or "Workin' for the maaaan", he'd say, and it seemed so odd coming out of him that I'd always laugh. I would laugh at his enormous white-framed, mid-eighties sunglasses, too, and the way his cell phone played "Ride of the Valkyries" every time his wife called.
And the time he wore the tuxedo shirt and bow tie to work on New Year's. And the way he'd flutter around the med room, delaying everybody else.
Point is, I loved him and I remember him for more than being pretty, though he was easy on the eyes.
Pity, then, the poor bartender at my usual watering hole. Through no fault of his own, he was born with a perfect nose. Through hard work, he's developed the sort of build that makes random women at the bar cheer when he bends over to grab a tapped-out keg.
Still, I didn't look forward to seeing him until the night that I made some offhanded joke and he responded with something lightning-quick and funny. The man somehow overcame the hell of being pretty and managed to develop a brain and a wit besides, though how many people actually see that is debatable.
Should he (Frog in his Spaghettiness forbid) be struck by lightning, or pasted by a bus, or develop some nasty brain tumor, I promise I'll remember the brain and the wit. The pretty is easy-come, easy-go, plus I hear it gets harder to maintain as you age.
Pity the pretty ones. Cherish those with seams in their heads or warts on their noses, who might have something more interesting to give.
Lightning strikes are like...well, like lightning strikes. They're mostly predictable, in that you know one might be coming if the sky gets stormy, but also strangely random, in that you can be a perfectly happy, outgoing sixteen-year-old in a lake at one moment, and then the next and forever a person in a high-backed wheelchair, gorked out.
One hole to shit through, another to breathe through, and an indwelling catheter so that your urine doesn't eat through the skin on your legs and buttocks. The high-backed chair is there so that your natural tendency to torque backwards is controlled. Splints for your hands and feet complement the chair; there'll be no decorticate positioning going on, not while your parents are alive.
Your hands and feet are smooth. You never use them. Your toes and fingers are perfectly manicured, colors changing depending on the season. Your hair is styled every morning by your older sister, who gave up a college scholarship to help take care of you, and to tell you how pretty you are. So very pretty.
Pretty is all you were ever known for. Being born pretty is a curse; the pretty girl never gets the chance to develop any other talents.
Dead John was nice-looking, in a sort of retired-hippy, craggy, fiftyish guy sort of way. He couldn't be trusted to not wear black boxers with red print on them under white scrubs, but mostly he cleaned up all right.
What I remember him for, though, was the way he used to barricade himself inside the one-hole bathroom on the floor and chart. We'd page him, and he'd call us on his cell phone: "I'm in the bathroom, dammit!"
Or the way he'd answer any question that rephrased "How are you?" "Lovin' life" or "Workin' for the maaaan", he'd say, and it seemed so odd coming out of him that I'd always laugh. I would laugh at his enormous white-framed, mid-eighties sunglasses, too, and the way his cell phone played "Ride of the Valkyries" every time his wife called.
And the time he wore the tuxedo shirt and bow tie to work on New Year's. And the way he'd flutter around the med room, delaying everybody else.
Point is, I loved him and I remember him for more than being pretty, though he was easy on the eyes.
Pity, then, the poor bartender at my usual watering hole. Through no fault of his own, he was born with a perfect nose. Through hard work, he's developed the sort of build that makes random women at the bar cheer when he bends over to grab a tapped-out keg.
Still, I didn't look forward to seeing him until the night that I made some offhanded joke and he responded with something lightning-quick and funny. The man somehow overcame the hell of being pretty and managed to develop a brain and a wit besides, though how many people actually see that is debatable.
Should he (Frog in his Spaghettiness forbid) be struck by lightning, or pasted by a bus, or develop some nasty brain tumor, I promise I'll remember the brain and the wit. The pretty is easy-come, easy-go, plus I hear it gets harder to maintain as you age.
Pity the pretty ones. Cherish those with seams in their heads or warts on their noses, who might have something more interesting to give.
Oh, no you didn't.
Let's say you're a manager in a hospital. Let's say that you have excess staff because nobody's doing surgery, much, during this inter-holiday period. Let's say, specifically, that you have extra staff in two departments: Neurosurgery and Transplant.
Now, then. Neurosurgery will need staffing this morning, while Transplant will need staffing this afternoon, when ICU transfers start to come in. You have three extra nurses on each unit to cancel.
Do you:
a) Staff Neuro with a neuro nurse, waving off the transplant nurses until the afternoon, or:
b) Send a transplant nurse to Neuro, then call a neuro nurse to go to Transplant in the afternoon?
If you answered "a", you obviously do not work for La Schwankienne Hospital Du Monde. I, unfortunately, do, which is how I found myself in the midst of Transplant and asking questions like, "Now, where did they put that kidney, again?"
In other news, I grabbed The Work Pal Who's Been Sworn To Secrecy because she knows about my blog and told her, "Hey! I have exciting news!" (Meaning that I'd had that interview, y'know?)
Her response? "Oh! Chef Boy bought you something with a diamond in it!!"
My head did not explode then. It exploded later, when I told a non-work pal that I had exciting news, and she said the Exact Same Damned Thing.
Let's take as read my howling objections that marriage shouldn't be considered the pinnacle of a woman's life. Let's ignore for the moment the fact that I don't wear diamonds and haven't since I started learning about the diamond trade and the human rights abuses inherent therein. Let's pass over both my general and specific objection to marriage both as an institution and as a thing that I would want to do again on my own.
Let's instead take the next thing that came out of Work Pal's mouth, after I told her that no, I wasn't getting be-diamonded and betrothed.
"Well," she said confidentially, "you might want to think about it anyhow. I mean, you're not getting any younger [yes, she actually said that] and the time's going to come that you might want somebody, but nobody will want you."
Hm. The time might come, eh? Which means that I, of course, ought to hook up with the first charitable soul that comes along (since I am, as she pointed out, not immune to the Inexorable Maaaaarch of Tiiiiime), just in case the time comes at some future date that I might want somebody to kill bugs or lift heavy things.
I'd better get cracking, eh? I mean, hell, at 36 I'm already twenty years past my use-by date, am I not? Well, eighteen, at least. Because we all know women get all dried up and flaky and ooky after twenty-five, thirty at the latest.
Wait a minute. Nobody would want me *now*, right, since I'm like, all wrinkly and stuff. So I guess my time has passed. I suppose I'll either have to marry Chef Boy posthaste, just in case, or find somebody with even lower standards than he has. To take on a woman who's past her prime and not getting any younger. You know. Wrinkly and stuff. It'd have to be a nice man, a kind man, involved in charity work and able to look past ook. A monk. That's it. I need to meet and marry a monk. Right.
I would like to say that if I hadn't already been on edge, her comments wouldn't have bothered me...but they would've. That whole third-wave feminist thing comes to the fore whenever I hear obdurate stupidity, and it comes *screaming* to the fore whenever I hear that particular sort of obdurate stupidity. Yeah, I was primed to be pissed, but I probably would've gotten equally as pissed if I'd spent the day napping. (Us old folks need a lot of sleep.)
What I don't get is that she's not that much older than I am. I mean, she's right at the right age to remember her mom having consciousness-raising sessions in the living room. She grew up in a fairly liberal political climate and is, in practice, a walk-the-talk feminist. And she wasn't just making fun; no, she was serious. Which boggles my exploding head.
Many, many moons ago I was involved with the birth of a women's political group at one of the colleges here. It was great while it lasted; that is, it was fantastic until everybody that was running it left.
To get married.
*sigh*
Now, then. Neurosurgery will need staffing this morning, while Transplant will need staffing this afternoon, when ICU transfers start to come in. You have three extra nurses on each unit to cancel.
Do you:
a) Staff Neuro with a neuro nurse, waving off the transplant nurses until the afternoon, or:
b) Send a transplant nurse to Neuro, then call a neuro nurse to go to Transplant in the afternoon?
If you answered "a", you obviously do not work for La Schwankienne Hospital Du Monde. I, unfortunately, do, which is how I found myself in the midst of Transplant and asking questions like, "Now, where did they put that kidney, again?"
In other news, I grabbed The Work Pal Who's Been Sworn To Secrecy because she knows about my blog and told her, "Hey! I have exciting news!" (Meaning that I'd had that interview, y'know?)
Her response? "Oh! Chef Boy bought you something with a diamond in it!!"
My head did not explode then. It exploded later, when I told a non-work pal that I had exciting news, and she said the Exact Same Damned Thing.
Let's take as read my howling objections that marriage shouldn't be considered the pinnacle of a woman's life. Let's ignore for the moment the fact that I don't wear diamonds and haven't since I started learning about the diamond trade and the human rights abuses inherent therein. Let's pass over both my general and specific objection to marriage both as an institution and as a thing that I would want to do again on my own.
Let's instead take the next thing that came out of Work Pal's mouth, after I told her that no, I wasn't getting be-diamonded and betrothed.
"Well," she said confidentially, "you might want to think about it anyhow. I mean, you're not getting any younger [yes, she actually said that] and the time's going to come that you might want somebody, but nobody will want you."
Hm. The time might come, eh? Which means that I, of course, ought to hook up with the first charitable soul that comes along (since I am, as she pointed out, not immune to the Inexorable Maaaaarch of Tiiiiime), just in case the time comes at some future date that I might want somebody to kill bugs or lift heavy things.
I'd better get cracking, eh? I mean, hell, at 36 I'm already twenty years past my use-by date, am I not? Well, eighteen, at least. Because we all know women get all dried up and flaky and ooky after twenty-five, thirty at the latest.
Wait a minute. Nobody would want me *now*, right, since I'm like, all wrinkly and stuff. So I guess my time has passed. I suppose I'll either have to marry Chef Boy posthaste, just in case, or find somebody with even lower standards than he has. To take on a woman who's past her prime and not getting any younger. You know. Wrinkly and stuff. It'd have to be a nice man, a kind man, involved in charity work and able to look past ook. A monk. That's it. I need to meet and marry a monk. Right.
I would like to say that if I hadn't already been on edge, her comments wouldn't have bothered me...but they would've. That whole third-wave feminist thing comes to the fore whenever I hear obdurate stupidity, and it comes *screaming* to the fore whenever I hear that particular sort of obdurate stupidity. Yeah, I was primed to be pissed, but I probably would've gotten equally as pissed if I'd spent the day napping. (Us old folks need a lot of sleep.)
What I don't get is that she's not that much older than I am. I mean, she's right at the right age to remember her mom having consciousness-raising sessions in the living room. She grew up in a fairly liberal political climate and is, in practice, a walk-the-talk feminist. And she wasn't just making fun; no, she was serious. Which boggles my exploding head.
Many, many moons ago I was involved with the birth of a women's political group at one of the colleges here. It was great while it lasted; that is, it was fantastic until everybody that was running it left.
To get married.
*sigh*
Monday, December 04, 2006
Omigawd just what I needed after a long day...
Check this bad boy out.
Note: you will need a good pipe to the Internetweb.
Note: This is why I have always loved and will always love octopi. Even when I'm eating their babies with endive and artichokes and pink wine in Montreal.
Edited to add: Did you know that there's such a thing as an octopus's garden?
No, really.
My friend Lou, a master diver, told me about it. In addition to being nominally famous and good at not getting himself killed under water, he tells really good stories.
Anyway, he was out diving off the coast of Oregon or Northern California once, somewhere where there are lots of octopudlians.
He noticed that one octopus had scooted into his cave (octopi like little caves to live in) and that he had put an arrangement of rocks and shells and bits of detritus in a semicircle around the entrance to his cave. That's the "octopus's garden" that Ringo wrote about. They have eyes like ours, and brains that recognize patterns, so it makes sense.
Lou moved a few things out of place in the octopus's arrangement, then moved back and tried to look as much like a lump of seaweed as he could.
After five minutes or so, a looong arm came snaking out from the cave and the octopus put everything back where it was before.
Although they'd never make it on Cute Overload, I still rank the octopus as my favorite animal. The pangolin comes in a close second.
Note: you will need a good pipe to the Internetweb.
Note: This is why I have always loved and will always love octopi. Even when I'm eating their babies with endive and artichokes and pink wine in Montreal.
Edited to add: Did you know that there's such a thing as an octopus's garden?
No, really.
My friend Lou, a master diver, told me about it. In addition to being nominally famous and good at not getting himself killed under water, he tells really good stories.
Anyway, he was out diving off the coast of Oregon or Northern California once, somewhere where there are lots of octopudlians.
He noticed that one octopus had scooted into his cave (octopi like little caves to live in) and that he had put an arrangement of rocks and shells and bits of detritus in a semicircle around the entrance to his cave. That's the "octopus's garden" that Ringo wrote about. They have eyes like ours, and brains that recognize patterns, so it makes sense.
Lou moved a few things out of place in the octopus's arrangement, then moved back and tried to look as much like a lump of seaweed as he could.
After five minutes or so, a looong arm came snaking out from the cave and the octopus put everything back where it was before.
Although they'd never make it on Cute Overload, I still rank the octopus as my favorite animal. The pangolin comes in a close second.
Interview with a vampire...
...the vampire being me, since I've gotten into this habit of getting up unreasonably early even on my days off. Future nurses, be warned: Your circadian clock will be an early career casualty. Right after your social life and waistline.
Anyhow. I had a fun interview with a writer for Nurse Week/Nursing Spectrum yesterday. We went over the whole "how to get started as a nurse blogger", "how to protect privacy", and "tips for new bloggers" thing, and then she asked a tough question:
Why start a blog?
Not only that, but she asked it three times, in three different ways. This, by the way, is one of the cardinal signs of a good interviewer: restating a question in order to get a slightly different perspective each time.
So why blog? Why write, for that matter?
I subscribe to the theory proposed by Isaac Asimov: that every writer is, at heart, a cheerful monster of ego. You *have* to be, to write anything; your assumption is at the outset that somebody will read what you're putting out. More than that, you assume (if you're published) that they'll pay to read what you're putting out. If you blog, the assumption is that they'll ignore the rest of the World Wide InterWebWonderNet and click over to your site to read what you say.
Sure, you start blogging to vent steam about work, or to share stories you think are important. Or you start out as a person who gathers nifty links from hither and yon and puts them into rational order, but before you know it, you're commenting on those links, and then on others, and then you're actually writing.
So the thing that starts a person blogging is usually specific. For me, it was Beloved Sister (who is actually a *writer*, as in, that's what she does and she's been published, and stuff) saying, "You know, you really ought to write some of this stuff down."
But what keeps me writing is my own cheerful self-regard.
Would I write if nobody ever commented? Probably. I went for a year with no comments enabled on the blog. I'm not looking forward to the day when people quit reading, though; it's valuable to have feedback in comments and in email.
Would I write if what I was putting down turned out to be absolute dreck? Oh, hell yeah. Because, you see, (and this was part of what we discussed in that interview) nine times out of ten, the stuff I dash off without thinking that I later regard as absolute slop is the stuff that rings the loudest bells with other people. It's the stuff that people comment on, that they email me about, that they say touches them.
(This is not because people who read this blog like junk. It's because my mental editor is turned off when I dash something off, so maybe the voice is different. More honest, less contrived.)
At the end of the day, the answer to the question "Why write?" is "Well, 'cause I gotta." On some level, life is better now that you're writing, be it in a journal or on a blog or for a Major National Publication. Things may not have turned overnight into Caramel Apples and Puppies For Everybody, but they're *better*. When you don't write, things aren't as good. You end up with a lot of things to say, all backed up in your head, and your thoughts get all tangled and weird.
Writing, be it on a blog or on paper, is the mental equivalent of a nice hard workout. You do it at first because you feel like you ought to, that there's something you ought to be saying. Later, once the endorphins take hold, you do it because you have to.
Anyhow. I had a fun interview with a writer for Nurse Week/Nursing Spectrum yesterday. We went over the whole "how to get started as a nurse blogger", "how to protect privacy", and "tips for new bloggers" thing, and then she asked a tough question:
Why start a blog?
Not only that, but she asked it three times, in three different ways. This, by the way, is one of the cardinal signs of a good interviewer: restating a question in order to get a slightly different perspective each time.
So why blog? Why write, for that matter?
I subscribe to the theory proposed by Isaac Asimov: that every writer is, at heart, a cheerful monster of ego. You *have* to be, to write anything; your assumption is at the outset that somebody will read what you're putting out. More than that, you assume (if you're published) that they'll pay to read what you're putting out. If you blog, the assumption is that they'll ignore the rest of the World Wide InterWebWonderNet and click over to your site to read what you say.
Sure, you start blogging to vent steam about work, or to share stories you think are important. Or you start out as a person who gathers nifty links from hither and yon and puts them into rational order, but before you know it, you're commenting on those links, and then on others, and then you're actually writing.
So the thing that starts a person blogging is usually specific. For me, it was Beloved Sister (who is actually a *writer*, as in, that's what she does and she's been published, and stuff) saying, "You know, you really ought to write some of this stuff down."
But what keeps me writing is my own cheerful self-regard.
Would I write if nobody ever commented? Probably. I went for a year with no comments enabled on the blog. I'm not looking forward to the day when people quit reading, though; it's valuable to have feedback in comments and in email.
Would I write if what I was putting down turned out to be absolute dreck? Oh, hell yeah. Because, you see, (and this was part of what we discussed in that interview) nine times out of ten, the stuff I dash off without thinking that I later regard as absolute slop is the stuff that rings the loudest bells with other people. It's the stuff that people comment on, that they email me about, that they say touches them.
(This is not because people who read this blog like junk. It's because my mental editor is turned off when I dash something off, so maybe the voice is different. More honest, less contrived.)
At the end of the day, the answer to the question "Why write?" is "Well, 'cause I gotta." On some level, life is better now that you're writing, be it in a journal or on a blog or for a Major National Publication. Things may not have turned overnight into Caramel Apples and Puppies For Everybody, but they're *better*. When you don't write, things aren't as good. You end up with a lot of things to say, all backed up in your head, and your thoughts get all tangled and weird.
Writing, be it on a blog or on paper, is the mental equivalent of a nice hard workout. You do it at first because you feel like you ought to, that there's something you ought to be saying. Later, once the endorphins take hold, you do it because you have to.
Saturday, December 02, 2006
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?
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?
Tuesday, November 28, 2006
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.
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.
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.
Saturday, November 25, 2006
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?
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.
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.
Thursday, November 16, 2006
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.
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.
Wednesday, November 15, 2006
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.
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.
Sunday, November 12, 2006
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.
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.
Friday, November 10, 2006
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.
I've spent the last five hours being very sick.
I'm not taking the CNRN today, obviously.
Damn.
Thursday, November 09, 2006
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."
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.
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.
Wednesday, November 08, 2006
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.
Waitaminit.
First female Speaker?
Ever?
What the Hell?
Go get 'em, Nancy.
Saturday, November 04, 2006
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.
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.
Friday, November 03, 2006
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.
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.
Thursday, November 02, 2006
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.
"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.
Sunday, October 29, 2006
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.
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.
Tuesday, October 24, 2006
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.
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.
Thursday, October 12, 2006
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.
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.
Monday, October 09, 2006
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.
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.
Sunday, October 08, 2006
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.
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.
Saturday, October 07, 2006
A Quick Quiz
Do you qualify to be in or near my hospital? Take this simple quiz to find out!
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.
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.
Thursday, October 05, 2006
Sunday, October 01, 2006
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.
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.
Tuesday, September 26, 2006
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 *$(*(*$#@&* dried tamarinds contained in the Bombay Biriyani mix, it's perfect. PERFECT, I tell you.
Mmmmm.
From the "Oh, Shit, I Forgot" Files...
Check this out.
I have no clue how long Janet has been blogging, or how long she's been a nurse. What I *do* know is this: if you want to model your nursing blog on somebody, model it on Janet's. She writes in a simple, straightforward style with understandable language and heart-wrenching simplicity. It's fast becoming my new favorite, along with Sid's.
But I got distracted with making biriyani.
Oh, my God. I make some kick-ass biriyani. I do.
You can taste the ghee in the plain rice. The yogurt-marinated chicken is perfect and tender. The onions are burnt to just the right burnt-onion taste, and the potatoes are brown.
I think I'll go Google "Sindhil Ramamurthy" and "John Abraham" (my friend Deepa says, "And he has a name you can pronounce!!") now.
Mmmmm. Biriyani.
In fact, if you don't bite into one of those *$(*(*$#@&* 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.
Friday, September 22, 2006
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.
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.
Sunday, September 17, 2006
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.
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.
That is all. Return to your regularly scheduled more important things.
Thursday, September 14, 2006
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.
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.
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.
Tuesday, September 12, 2006
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
Monday, September 11, 2006
Sunday, September 10, 2006
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.
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.
Thursday, September 07, 2006
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