Product Reviews: Things that are worth the money and things that ain't edition.

So I had this shed kit, right? And I had it built last week by a couple of guys from Mr. Handyman, right? Which inspired this post.

Handy Home Products 10' x 10' Princeton Wood Gable Shed

Oh, Jesus. Where do I start? My Sainted Mother asked how the assembly went the other night, and I told her, "If I were blogging, I'd call it a cluster-fuck". Yeah, it was bad. The lumber was cut to the wrong lengths. The siding was of two different, incompatible types. The FUCKING INSTRUCTIONS WERE WRONG. Which is why I'm glad I had....

Mr. Handyman guys to build the thing.

They are expensive. Be warned. The cost of having the shed assembled was four times the original price of the shed kit, plus money for extra lumber and screws and so on. But honestly? Three grand for the assembly was totally worth it, because now I have a shed that won't fall down, won't leak, and that I didn't have to get drunk over on my own. Plus, they cleaned everything up, left me the usable dimensional lumber and extra shingles, and even raked up all the bits of wood and sawdust and threw them away. Nota Bene: It took a Master carpenter and a Journeyman carpenter TWENTY FUCKING HOURS to set up the shed kit. Don't say I didn't tell you.

In other news,

Borghese Crema Saponetta Facial Cleanser...

...is not all it's cracked up to be, sadly. I spent the $$$ on this stuff after reading nothing but positive reviews on Amazon, reading another blogger's raves about it, and talking to the Italian woman at work, who has gorgeous skin. It does nothing for me. It cleans well and takes off makeup, but it leaves this weird waxy residue on everything from your face to your sink. I'm happier with the Aveeno Clear Skin Foaming Cleanser I buy from the grocery store. However!

The Clarisonic Skin Brush rocks my world. Yeah, it's bloody expensive. I consider this retribution for the fact that I didn't really have acne as a teenager or young adult, but am getting it now. The last laugh's mine, though, as I can now afford an appliance that really digs shit out of your skin and makes it smooth and even and lovely.

Speaking of things that make other things clear and lovely, I recently tried Rain-X on my windshield. Results were mixed: it worked great at keeping the windshield clear in light rain, but didn't do so well when it came to not streaking or smearing with bugs. I used it to good effect on the back window of the Honda (Note to Honda: Please Put A Rear Wiper On The Accord. Thank You.) and it worked *great*--until I washed the car. You have to be *really* careful when you wash, and make sure to get all the Rain-X off, or else you end up with weird smeary bits that don't go away.

And, finally, a Tool Review. No, this isn't a review of the latest internal medicine resident to make me hypertensive; this is a review of the Black & Decker Rechargeable Drill With Enormously Heavy Battery Pack.

Now, Chefboy likes Mikita, as they're made for professional builders (which he was, in between cheffing gigs). Mikita, however, is too rich for my blood, so I bought one o' them nifty B&D thingies from Target.

And it has held up *beautifully*. It is heavy, so be careful to switch hands when you use it or else be prepared for sore forearms. It lasted through umpteen bazillion holes drilled and screws screwed the other day as I was reassembling the kitchen, then (without recharging, I'll have you know), did a great job on ramp-building and 2 x 4 screwing. I'm recharging it right now, but I really doubt that I need to. As far as I can tell, the charge will last through building a small house with no problem.

Tomorrow I head to Home Despot to buy shelving pegboard cabinets fried eggs sardines socks hammers nails small hooks etc for the shed. I don't intend to do a PR post on sardines. I promise.

In which Auntie Jo loses it and levels unwarranted criticism at people she doesn't know

Y'know how everybody has pet peeves? And how those pet peeves are totally incomprehensible to the rest of the world? My pet peeve (this week; it might be different later) is bad writing.

Not that I consider myself a great prose stylist, or anything, but dayum. I mostly avoid the worst breaches of English writing. Mostly. This is not something I could say about a lot of stuff I've been reading lately, both online and in print. Thus, here follows a list of the things that make Auntie Jo get out the wire hangers and start screaming about pronouns:

1. No more passive voice--EVER!

I don't recall where I saw it, but I ran across the phrase "Birth was given to the idea..." and immediately stopped reading. "Birth" is never "given" to anything. One can give birth, or one can be born, but for Frog's sake, don't use the passive voice to describe the act. Gaaah. This one sets my teeth on edge.

2. Periods are fun in moderation.

Run-on sentences can be used to nice effect, as can sentence fragments. I'm fond of fragments myself. However, if you're consistently expressing yourself outside the subject-verb framework, you might want to stop writing prose and get a gig writing bad free-verse poetry. 

3. If you're writing for a public audience, can the racist and sexist slurs.

On second thought, don't. I want fair warning that you're an asshole.

4. Paragraph breaks: We haz 'em.

This one's a tendency that a lot of bloggers have: they write and write and write and it's lovely stuff, but you can't tell where the hell you are in the essay because there are no damn paragraph breaks. 

Here's a hint: Hit enter twice and continue with a new thought. 

Yes, this is a structural complaint rather than a stylistic one. How, though, will I ever be able to follow your style--or your substance, for that matter--if I can't find my way out of one huge long unending jeebus grits where's the next paragraph column of text?

5. Adding -y does not make it an adjective. Adding -ly does not make it an adverb.

Fashion magazines do this all the time. You can't just create new words by adding sometimes-vowels to the end of 'em. (Well, you *can*, but you get my point.) I was flipping through a girly mag that somebody'd left behind in the breakroom and stopped dead when I hit the descriptor "Studio Fifty-Four-y." Good thing I carry ammonia capsules with me, as that unbridled use of the adjective-mode gave me the vapors.

6. Tame Cute.

Our local birdcage liner is bad, bad, bad about this. An otherwise serious wire story about, say, Pakistan will be headlined with a pun. An otherwise serious local story about high-school dropouts will contain clever double-entendres and wordplay. Yes, we know you're smart; you wouldn't be writing for a newspaper otherwise. That's enough.

7. There are different writing styles. One of them is appropriate for your use. Find it.

You don't have to be formal on a blog. You *can* be--there's no law against it--if you're doing a thoughtful, well-reasoned essay. Likewise, you can occasionally (VERY OCCASIONALLY) toss a little fillip into a piece of serious writing. The trick is to know, not only your audience, but the purpose your writing is filling. 

8. Spelling correctly is fun!

That's what the great gods of the computer world made spellcheck for.

9. Profanity, used in excess, can be really fucking annoying.

I kid you not: I read a blog post t'other day that was so full of f-bombs and s-bombs and q-bombs and the like that I couldn't follow the writer's train of thought. Stylistic trademarks aside, calm the hell down and try to write clearly, okay? (This is my big bugaboo, made worse by the fact that My Sainted Mother reads this blog and probably has to scrub her eyeballs afterward.)

10. And finally, please, for the love of all that's holy, have a point.

Even if it's just venting about other people's writing.

(Bonus peeve: Did I mention that plural words are NOT formed by the addition of apostrophe-S?)

This is fun.

Very Good Taste posted a list of 100 things every omnivore should eat. You're supposed to go through it and mark what you've eaten, to see where you stand when compared with the ideal.

Here 'tis....

1. Venison*
2. Nettle tea*
3. Huevos rancheros*
4. Steak tartare*
5. Crocodile (I've eaten alligator. Does that count?)*
6. Black pudding*
7. Cheese fondue*
8. Carp*
9. Borscht*
10. Baba ghanoush*
11. Calamari*
12. Pho*
13. PB&J sandwich*
14. Aloo gobi*
15. Hot dog from a street cart*
16. Epoisses
17. Black truffle*
18. Fruit wine made from something other than grapes*
19. Steamed pork buns*
20. Pistachio ice cream*
21. Heirloom tomatoes*
22. Fresh wild berries*
23. Foie gras*
24. Rice and beans*
25. Brawn, or head cheese
26. Raw Scotch Bonnet pepper (only once, and to my great distress)*
27. Dulce de leche*
28. Oysters*
29. Baklava*
30. Bagna cauda*
31. Wasabi peas*
32. Clam chowder in a sourdough bowl*
33. Salted lassi
34. Sauerkraut*
35. Root beer float*
36. Cognac with a fat cigar (I've had the cognac, but not the cigar. So, close but...)
37. Clotted cream tea*
38. Vodka jelly/Jell-O*
39. Gumbo*
40. Oxtail*
41. Curried goat
42. Whole insects*
43. Phaal
44. Goat’s milk*
45. Malt whisky from a bottle worth £60/$120 or more*
46. Fugu
47. Chicken tikka masala*
48. Eel (I think I remember eating eel once, but I'm not sure, so I'm not starring it)
49. Krispy Kreme original glazed doughnut*
50. Sea urchin (bleah)*
51. Prickly pear*
52. Umeboshi (bleah)*
53. Abalone*
54. Paneer*
55. McDonald’s Big Mac Meal*
56. Spaetzle*
57. Dirty gin martini*
58. Beer above 8% ABV (duh)*
59. Poutine (Oh Poutine, my favorite food!)*
60. Carob chips (bleah)*
61. S’mores*
62. Sweetbreads (nyeah, okay)*
63. Kaolin
64. Currywurst
65. Durian
66. Frogs’ legs (In Louisiana, with gumbo)*
67. Beignets, churros, elephant ears or funnel cake (State Fair, duh)*
68. Haggis
69. Fried plantain*
70. Chitterlings, or andouillette* 
71. Gazpacho*
72. Caviar and blini*
73. Louche absinthe
74. Gjetost, or brunost*
75. Roadkill (you have got to be fucking kidding me)
76. Baijiu
77. Hostess Fruit Pie*
78. Snail*
79. Lapsang souchong (my favorite tea)*
80. Bellini*
81. Tom yum*
82. Eggs Benedict*
83. Pocky*
84. Tasting menu at a three-Michelin-star restaurant.
85. Kobe beef
86. Hare*
87. Goulash*
88. Flowers*
89. Horse
90. Criollo chocolate
91. Spam*
92. Soft shell crab*
93. Rose harissa*
94. Catfish*
95. Mole poblano*
96. Bagel and lox*
97. Lobster Thermidor
98. Polenta*
99. Jamaican Blue Mountain coffee*
100. Snake (State Fair, duh)*

Not too bad, eh? I have to credit having coworkers from all over the world and some travel for the number of asterisks on the list.

How experienced a nurse are you? Take this simple quiz and find out!

A patient arrives on your unit with the following list of allergies:

Hydrocodone, codeine, morphine, Demerol, Zofran, Reglan, beef, iodine, tomatoes, Provera, Lupron Depot, acetaminophen, ASA, wheat products, soy, synthetic estrogens, Benadryl, corticosteroids, epinephrine, ketorolac, Ultram, metoprolol, oral potassium, oxygen, Lipitor, fenfluramine, PCN and analogues, mycins, Trazodone, Haldol, allopurinol, Lithium, and Lasix.

Your response is:

A. "Gosh, this person has a lot of medical issues. I'd better get to researching the possible side effects of the other drugs I might give them!"

B. "Gosh, this person must be obese, bipolar, and have hypertension and diabetes. Drag-O."

C. "Hmm. The only two drugs NOT on that list are Dilaudid and Phenergan. Also, oxygen? What, he breathes methane at home? This person is a nutcase."

If your answer was A:

You are obviously a new nurse, concerned with providing good care while protecting your patient from harm. Good for you! Concentrate on that.

If your answer was B:

You are a proficient nurse. You've learned the basics and can recognize common drug interactions and side effects. Keep working! You're doing great.

If your answer was C:

You are an expert nurse. Those of you who answered C will not need me to explain why.

Ah, the shock of role transition.

Somebody, I don't remember who now, with a glass of wine in me, asked what I would say to the newbies who are having the SHOCK of ROLE TRANSITION as they go from being a student to being a new grad/new nurse/newbie.

Honestly? All I remember from the first months of nursing practice is this: I prayed every day that I wouldn't kill somebody, and I felt horribly alone.

Both those feelings, it turns out, were bogus. Like, "Boh-oh-oh-oh-oh-oh-GUS!!" the way Tom and Ray say it on "Car Talk". Bogus, like we never imagined it could be in the 80's. Bogus, like carob is to chocolate, or Cool Whip is to whipped cream.

Being a newbie is *hard*. It's almost as hard as nursing school in that the amount of information you have to absorb is huge; it's just more focused. Being a newbie is scary, in that you don't really know what you're doing yet. Being a newbie is frustrating, in that you know some things you're being asked to do are wrong and stupid, but you don't know how to communicate that to more experienced nurses and doctors yet.

The thing to remember is this: If you're a newbie in a precepted program, you have somebody following you every step of the way, making sure you don't screw up. Nobody is going to let you kill a patient. And even if you come close, we're not going to let the worst happen. *Everybody*, from pharmacists to physical therapists to the other nurses, is looking over your shoulder--not to catch you in mistakes, but to make sure you feel confident enough to make decisions on your own and yet stop you if they're the wrong ones.

As for not knowing what you're doing, the honest truth is that a lot of times I don't know what I'm doing either, and I've been doing this for six years. As in, this specific thing, and nothing else. And I *still* run into stuff that flummoxes or stumps me. There are always people around that know more than you, and who won't make fun of you if you ask very basic questions. The trick to being comfortable as a nurse is not in learning everything; it's in getting rid of your ego so you can admit comfortably what you don't know.

And, finally, frustration. I have a story to tell about this particular problem:

Years ago, when I was still being precepted, I had a patient admitted with fulminant meningitis. It could've killed her; it's considered a huge huge huge fucking run around with your hair afire emergency. 

The very moment she was admitted was the moment that our computerized drug distribution system went down. Pharmacy was totally unable to fill any orders, since they didn't have access to anybody's allergies or tolerances or drug levels or *anything*. So, because I was a newbie, my patient with fulminant meningitis went for six hours without her first dose of antibiotics. I gave myself an ulcer in the meantime, trying to do things by the book.

I will never stop being grateful to her doctor. Rather than call me out on the floor and ream me a new one, as he had every right to do, he took me aside and explained what the problem was, and asked me why the patient hadn't gotten her meds. I explained as best I could, suddenly not 31 any longer but 10, stuttering and tearful and ashamed, and he was firm but kind. No harm had come to the patient, but he was unhappy with the level of care. He offered to go to bat for me and get the drugs from pharmacy himself--not in an "I'll go down there and kick their asses" sort of way, but in a "maybe they don't understand how serious this is" way. 

The thing I learned from that awful experience was this: No matter how set the procedures and protocols are, you can always do an end run around them. Sometimes it means finding a sympathetic doctor or pharmacist to write you an order or float you the first dose of meds. Sometimes it means going down to the kitchen to talk to the folks there about what, exactly, "halal" means. If it can be done, you can find a way to do it. The best thing to do is to set up a reputation for being pleasant, creative, and a little stupid right at the start, so when you start doing imaginative things to get your patient good care, people shrug and say, "What the hell, it's only Jo."

The upshot of all this lecturing is this: Good nurses remember, if not the details, at least the general outlines of being a newbie. They will help you out. Glom onto them like death, and do not let them go. I have a mentor at work, and you should too. Don't fret about feeling like an idiot; other people do every day, too, and you'll develop a callus against that sort of self-consciousness. And don't forget: At some point, someday, you'll find that you're finally swimming with the current rather than struggling to stay afloat, and you'll feel like a Nurse. Finally. And you'll grin like an idiot, and go on to make a stupid mistake, and realize that that's what the profession is all about. 

Neat-o site and a question:

In reverse order.

First, for those of you who work in hospitals/clinics/whatever that require uniforms or particular scrub colors: Does your facility provide any sort of scrub allowance for employees? (Nursing students, sorry, but I just want the working RNs/aides/PTs/OTs/secretaries etc. to answer this one.) Do you have particular scrub shops where you can get an extra discount? How about folks coming to the facility itself to sell scrubs? Tell me all about it.

Now, for those of you *looking* for scrubs, here's a site which has--hurrah!--coupon codes! One of the very pleasant founders emailed me the other day and asked that I put it up. 

Find Nurse Uniforms

Why this theme in particular? Because Sunnydale General has decided to go to a choice of scrub colors, all of which are hideous, beginning in November. Two of the choices are so very unflattering that I'm thinking of going with straight old-fashioned whites. Not the the degree that I'll wear a skirt and blouse, mind you, but whites. This uniformity craze seems to be a trend--I've heard lots about it from other RN friends of mine lately.

*sigh* The last time I wore whites was in nursing school. We'll see if they've come up with non-see-through pants since then.

I'm good enough, I'm smart enough, and dammit, people like me!

So...new nursing students. How y'all feeling right now? Classes start in, what, three weeks? Two?

Got your shoes ready? Got your pens and pencils? Paper? Xanax? Good.

Following is a list of tips drawn from what I remember of my own school experience, back when the earth was still cooling:

1. You are smart enough to get through this. 

You got in, right? That's no small task in a field where there are anywhere from 30 to 200 applicants for every slot in nursing school. Rest assured that if you were smart enough to get in, you will be smart enough to finish--and finish *well*--provided you remember one thing:

2. This may be the hardest work you've ever put in in your life.

I've heard from doctors who became nurses and nurses who became doctors that nursing school is harder than med school by a country mile. This is not because doctors don't learn as much, but simply because nursing school is compressed into about half the time. Even if you're getting a BSN, the nursing-clinical-focused coursework will only take up about the last three semesters of your schooling. If you're going through a bridge or two-year program, you'll have to hit the ground at a dead run. Therefore...

3. Do a little every day. Do a lot when you can.

I cannot stress enough how important time management is for nursing students (and nurses!). Set up good habits early on and they will see you through the last semester when you can't eat, can't sleep, and can't remember who that person is that you promised to love and cherish until death. Do Not Put Off Studying. Also, Don't Study Too Far Ahead. Set yourself a goal of, say, three chapters of thus-and-so every night--one review of the last class period's material, one of today's material, and a quick run-through of next week's--and stick to it. Do this every damn night. No exceptions. It's only for a couple of years; you can go dancing later. That said,

4. Schedule something non-nursing related every week, even if it's only a movie. 

Otherwise you'll turn into a Nursing School Automaton like I did. You'll lose weight, sanity, sleep, and perspective. That last is most important, because...

5. No matter what they tell you, this is not the be-all and end-all.

You get brainwashed into thinking, in nursing school, that this is the most noble, valuable, challenging (morally, ethically, intellectually) thing you could do; that it's the pinnacle of everything everybody everywhere has ever done.

I call bullshit.

Nursing school is a weird cross between professional training and entering a convent. You get your own language, clothing, and ceremonies, true...but there is a world out there outside of nursing. Try not to get so buried that you lose the ability to laugh at yourself, your professors, and the utter silliness of most care plans.

6. You will meet asshole instructors.

Unfortunately, (and here I put on my flame-proof Big Girl Panties), there are nursing instructors out there who either got totally disgusted with the profession and are bitter, or who couldn't make it as floor nurses for one reason or another, and are bitter. With luck, you'll only run into one during your schooling--but you *will* run into one. Keep your head down, do your work, and try to avoid antagonizing that person. He or she can't help what she or he is.

7. You will meet crazies.

Both in school and out of it, you will meet people who are absolutely mad as pants. If that person is a classmate, try to be polite but distant: You do not need any emotional drama while you're going through school. (Also, avoid gossiping and joining one faction over another. It's lonelier, but you'll be glad you stayed aloof when the crap hits the creamer.) If that person who's crazy as a pet raccoon happens to be a floor nurse or a patient to whom you're assigned, see tips from #6 for conflict avoidance.

8. If you meet a nurse whom you'd like as a mentor, say so right then. 

I get requests from nursing students for my email address after I've worked with 'em a couple of days. I always give 'em the address. Having a shoulder to lean on, a more experienced person to bounce things off of, or a mentor can make a hell of a difference in your sanity. And please be aware, beloved students, of this caveat: If I tell you you shouldn't work with me after you've worked with me for three sessions, it's not because I don't like you. It's because, this early in your training, you need to see a variety of work styles, time-saving tricks, and management skills. Don't get into a rut too soon.

9. Along with "Don't get into a rut too soon", don't make up your mind what you want to do too soon. 

I was *sure* I would be the world's most ass-kickingest women's health NP when I finished school. I interviewed at Sunnydale General on a total lark and ended up taking the job, also as a total lark. It was one of the best decisions I've ever made--probably not as smart as leaving my husband, but certainly in the top five. Go on at least one wacked-out job interview that you'd never consider actually accepting, be it to Medecins Sans Frontieres or to County General Hellhole. See where that takes you. You might find that you were really cut out to be a neuro nurse rather than an oncology nurse, or that working in the jungles brings you great joy. And, keep in mind that if you hate the whole process and are miserable,

10. You can always leave. Leaving nursing does not mean you're a failure.

Nursing is not for everybody. Every student finds him/herself dreading clinicals and tests, yes, but there's a general consensus that the end result will be worth the trouble. If you find yourself contemplating a career in nursing with nothing more than misery and despair, for God's sake get out now and find something else to do. It will not necessarily make you as much money or give you as much prestige (stop snickering), but money and prestige are empty cups when you cry every morning as you slap on mascara. 

If you *do* get partway through your training and decide to quit, everybody you're leaving behind will look at you with pitying incomprehension. You won't be able to speak the same language as they do any more. You might not keep in touch with all your old buddies. Don't let it get to you. The important thing is that you do what makes you look forward to getting up in the morning.

Handmaidens, Helpmeets, and the Problem of Nursing

There's a lot of discussion about the OMGWTF Nursing Shortage and of how to get younger, more diverse folks into nursing. What I've seen lately proposed as solutions make sense, but they don't get to the root of the problem: Nurses are seen as handmaidens and helpmeets to doctors rather than as scientific professionals in their own right, who often practice with a surprising degree of autonomy.

Two illustrations of that, from the educational angle: I have a colleague who never fails to mention that she finished pre-med school at the top of her class, passed the MCAT, and was accepted to medical school, but took to nursing as a sort of Med-Lite second-best when she decided she wanted to have kids and a husband. Further back, when I was starting nursing school, every single dadratted classmate I had, practically, said with starry eyes that she "wanted to *help* people!" as a reason for getting into the business.

Now, helping people is a fine undertaking. I do a lot of it myself every day, though I think of it in terms of educating my patients or working with other disciplines in the hospital to help those patients heal. And going from med school to nursing is a fine thing, too, (though I disagree with the reasons here), as it gives you a different perspective on the science of nursing.

But nursing is way, way more than helping people and being a sort of handmaiden to a big, strong, masculine-smelling doctor. By not emphasizing the technical, intellectual, skilled aspects of nursing practice, we're losing a lot of possible nurses to PA school or computer science courses. "They Dare To Care" is a touching ad campaign, but it doesn't showcase what we do every day as practitioners of a science that is equal to but different from medicine.

I'm not going to list out here what I do every day that could be considered intellectually challenging and deserving of respect; I've done that over and over in previous posts. Instead, let's look at the Helpful Handmaiden misconception and see how it impacts nursing as a whole:

First, public perception of nursing focuses too much on the "caring", touchy-feely aspect of the work. This discourages people like me, who are a little crusty and a little crotchety, from entering the profession, for fear of encountering a bunch of fuzzy-headed huggers with little or no spine. It took working with nurses for me to realize how wrong that stereotype was.

Second, take that public perception again, and narrow it down: Nurse equals handmaiden, which equals subordinate role, which means that any man in nursing must be happy with a subordinate role, which means any man in nursing must be gay. And a bottom, to boot. With that stereotype, you may now kiss still more of your potential nurses goodbye, as they go into manly sciences like software development and electrical engineering.

Third, let's take the Helpful Handmaiden Model onto the college campus: If nurses are primarily caregivers and assistants, then there's not much to teach students, is there? Therefore, we can pay a pittance to our nursing instructors and not lose out. 

Let's be blunt, here: Being a nursing instructor, especially in a small department like the one at the school where I got my degree, must suck. College instructors don't have cushy jobs as it is--growing up in a family of academics taught me that--but being told you're responsible for lesson plans and teaching three courses a semester, *plus* two clinical groups, *plus* being required to sit on various committees and boards, is particularly challenging in terms of time and creativity. 

To add insult to injury, the school where I went required at least a master's degree in nursing to teach lower-level classes. A PhD in nursing was preferred for upper-level classes. That's a lot of education...and I, as a brand-new, fresh-out-of-the-gate nurse with no experience, made double what the instructor of my first nursing courses made. After six years, I'm making more than the best-qualified instructor at that school, for considerably less effort.

In short, if you want decent nursing instructors and enough of them, you have to treat nursing with the respect it deserves. Helpful Handmaidens don't get no respect, but careful, observant scientists do.

Fourthly and finally, let's take that Helpful Handmaiden into the hospital and see what that stereotype does to us as a profession. 

If nurses are primarily interested in Helping People, and if they're assistants to Big Manly Doctors, it means that they therefore are selfless martyrs. Selfless martyrs don't mind being saddled with too many patients, being told to work mandatory overtime, and being shorted vital equipment, supplies, and support staff. Selfless martyrs, after all, welcome the opportunity to make do and mend and do everything themselves.

Now let's imagine what would happen if we had the concept of nurses as scientists and advance troops on the line of patient care: We'd get staffing. And supplies. And a say in how hospital policy is developed. And support staff, so we don't have to clean rooms and take out trash. And lower patient ratios, so we could actually, you know, *monitor* and *educate* patients and provide better care. We'd get better-qualified professors in nursing departments who could actually afford to make a living. The phenomenon I encountered, that of an instructor so burned out on nursing practice that he or she couldn't stand to be in the hospital any more (and communicated that dissatisfaction to the students) wouldn't be as common. And, finally, we'd get a more interesting, diverse, experienced crowd going to school. 

How do we get to the point where the handmaiden stereotype is dead? Activism, education, being loud and pushy (frankly) with hospital administrators, and--most importantly in my view--never downplaying what we do. 

I am not "just" a nurse. When people say, "You seem awfully tough for a nurse", I respond, "Nurses are tough." When somebody asks me why I didn't go to medical school, I tell them that I prefer nursing both because of the range of knowledge I have to master and the flexibility it gives me with my patients. When a patient tells me I'm "too smart" to be a nurse, I ask them seriously if they want a moron coordinating their care. And every time I meet a nurse-to-be, I hand out my email address and tell 'em to contact me if they want help, advice, or just to blow off steam. 

It'll take a while to change the stereotype. It'll take a lot of work, too, but it's the only way to reverse the trend of younger nurses getting burned out and leaving the field as older nurses hang on out of guilt. Helpful Handmaidens are handy to have around the house, but they don't get stuff done. Pushy Smart Tough Professionals do.

If dogs wrote personal ads

MATURE, DIGNIFIED male seeks calm and loving partner for long walks on the beach, quiet evenings at home, and belly rubs. I am h/w proportionate, have a full head of reddish-brown hair (no grey yet!) and keep my nails carefully trimmed. I enjoy soft music, good food, relaxing times together, and the occasional snack. Write MAX, box XXXX.

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

ATHLETIC BLOND seeks energetic friend for adventures! Interests include property destruction, digging in the dirt, scratching my own back, tearing up shit, property destruction, barking, running around in circles, shedding, property destruction, and (if I'm given the chance) desecration of the world's most sacred archaelogical sites. Call me! Come on! Come on! C'monc'omonc'mon! Let's go run around together!!! BOOF!! to STRIDER, box XXXX.

I don't give a damn 'bout no stinkin' dogs.

Jolly Green Gumball.

A tip for those of you who bought a swimsuit prior to starting weightlifting:

It won't fit any more.

Several years ago, prior to meeting Atilla The Cheerleader, I bought a swimsuit. It's green, with a square neck. It fit three years ago and looked okay, actually.

Then I got lats. And shoulders. And pectoral muscles. And my legs went all square and muscle-y, and I got biceps. The belly's still there, but I look more fit.

And the swimsuit? Holy lord, it *so* does not fit any more.

Square-neck suit + big lats + impressive shoulders + pecs that are things of beauty = Jolly Green Gumball.

I have ordered a plain black V-neck from Land's End. Humph.

Panic: Ur doin' it wrong.

I know this sounds impossible, but our hospital has been on Disaster OMGWTF Footing for the last month.

Yes, fiends and neighbors, the last month.

Disaster is usually reserved for, you know, actual disasters. Like plane crashes. And hurricanes. And, I dunno, maybe huge leaks of refrigerant, or bioactive compounds from some horrible lab somewhere that're turning everybody into bunny-hopping happy zombies with bad 80's hair.

Or the air conditioning going out. That's also a disaster. But anyway. We've been on Disaster Footing, with Code Whatevers that Signify An Internal Disaster, daily except for weekends.

Why, you ask? Because of a computer glitch. 

Scheduling is all fucked up, is the short answer. Somebody somewhere has been transitioning to some wonderful computer system that's going to be all ice-cream bars and puppies in the long run, but in the short run...eesh. All the operating rooms are triple-booked, which must be fun. Can you imagine? Close your eyes....

THE SCENE: SUNNYDALE HOSPITAL

THE CHARACTERS: VARIOUS NURSES AND O.R. TECHS

Opening: MORNING in the OPERATING ROOM, wide-angle

TECH #1: What are you doing here? I'm supposed to be setting this room up for a left pharyngeal troponetic farumulunectomy!

TECH #2: Huh? I'm here to set it up for a transverse myelopical zummulation ablation!

TECH #3: Both you guys are high. I've got a complete radical sympathomimetic wangulation scheduled here for 0800.

NURSES: We don't CARE what you're here for! Just set up for SOMETHING!!

Meanwhile, in recovery, things are going badly as well. And on the acute care floors, we're having conversations with Manglement that defy belief:

MANGLER: You need to get six patients out, double up four, and send three to rehab. Who've you got that can move?

NURSE IN NOMINAL CHARGE: Uh...well, these two spines could go to rehab, and we could double up the cranis, but we have eight patients in isolation and another five that are total-care. Six is the most I can give you right now.

MANGLER: What about that one? (Stabs finger at bed-board) That one looks pretty good. Why can't you send *him* home?

NINC: Uh...'cause he had a kidney removed about two hours ago?

MANGLER: Tell him to MAN UP!!

So. It's been a fun month.

I am so, so very glad that I am not officially in charge of anything. Disaster gives me a chance to spend time with my patients, believe it or not, because nobody's coming in or going out. Everybody is so incredibly critically ill that we don't have time to deal with the folks who are merely very, very sick. If you can ignore the people in positions of power who are running around with their collective hands in the air, you can actually get quite a lot of edumacatin' and patient care done.

This week I had a dude who'd been burned in a fire on a floating oil rig. You could look down the hole in his neck, where things had failed to heal, and see his first rib. Also a patient with something we haven't been able to diagnose yet but which is probably going to be fatal, and a patient with metastatic melanoma, and one with a glioma the size of my hand, and a couple of people who'd had bits removed that you normally leave in place so the person can live.

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

Meanwhile, Strider removed a cable-TV cable from where it was stapled on to the outside back wall of the house. The thing was covered in so many layers of paint that I didn't even know it was there, so I don't quite know how he determined it existed. Anyway, he carefully nibbled off all the paint in a spot about the size of his schnozz, then pulled the cable off and laid it gently on the ground in a pile. I think this means he approves of my decision not to have a television.

Max is, by contrast, even more polite and well-behaved than usual. He's renewed his love affair with the pug next door and comes to give me updates on how lovely she is and how her eyes are limpid pools of melted chocolate.

I want to be my dogs.

585 Posts! Time for fluffitude!

Notable Links I Enjoy, By Jo...

Style Spy: A fashion blogger from just down the street. I envy her life, her pumps, and her friend Plumcake's Cadillac.

Your Pharmacist May Hate You: Drugmonkey doesn't know this yet, but I'm going to carry him off on my hot-pink, nitro-fueled Vespa.

Blomma Finds: Things to lust over for the home.

Shedworking: A UK blog on sheds. Go ahead, check it out. Lust for things for your garden.

fisforfrank: I cannot say enough good things about these folks. I stumbled on their Etsy store while I was looking for knobs for the kitchen cabinets, and ended up buying almost all my knobs from them (a few pulls came from other sources). The knobs are like tiny pieces of sculpture and are reasonably priced, because the quality is so very high. If you're looking for something to dress up a piece of furniture, your kitchen, or your desk, go here first. It's a small company based in Dallas, and every single thing is hand-cast and original. They also do custom work!

Peep Research: Speaking of fluffitude (or fluffithelium), this site is a classic. Be sure to check out the surgery that successfully separated conjoined Peep quintuplets.

Old House Gardens: Now that I have a yard of my own, I spend hours drooling over this site. Soon, soon, antique hyacinths and dahlias will be MINE! (Muahahahaha....)

Pictures, for those that wants 'em.

Strider, looking sweeter than he actually is:

Max, my snugglebunny strudel-noodle:

You can see why I'm considering trading in the Accord for a Honda Fit.

It's a pun.

Hello to everybody who navigated here from the LA Times!

You won't, unfortunately, find any advice on how to be a "head", or charge, nurse. Nor will you find anything resembling Penthouse Forums. Nor will you find anything on that foam that rises to the top of a glass of beer (well, you might, but it's not the theme of the blog). 

It's *Head* Nurse. Neuroscience. Like, head-brains-neuroscience? Pun? Got it?

Head Nurse. Neuroscience. Brain on top, spine down the back. 

You may laugh now. 

Yeah, everybody makes that mistake. You would not *believe* some of the comments I have to reject.

Original mention here.

Good Advice

When you're driving down the highway and somebody passes you going eight zillion miles an hour, check your rearview mirror--there's always a second one following.

A little loose powder dusted under your lower eyelashes will keep your mascara from smearing.

Hang all bags and place all pumps so you can see them from the door of the room.

Buy ten pairs of socks, all the same color, for work. That way you can match socks in the dark.

If you're starting an IV on a frail little old person with prominent veins, don't use a tourniquet. Just drop the arm over the side of the bed and let the vein engorge that way. You won't blow the vein when you flush the IV.

The heaviest bell peppers contain the most seeds, and the largest avacados have the biggest pits.

If you're mixing Mucomyst and Coke for oral administration, draw the Mucomyst up in a syringe and put the tip of the syringe under the surface of the Coke before you squirt the med in there. That way it won't smell so bad.

Lettuce cannot be frozen. Bananas can.

Bleach on a Q-Tip will remove small stains from white fabric.

Keep napkins in the glove box.

Always have an extra pen.

Keep a little container of plain flour nearby when you trim your dog's nails. The flour will stop the bleeding if you cut the quick of a nail, and it doesn't sting like styptic powder.

Keep your hands away from your face, and don't pick that zit.

A bedspread covers a multitude of sins.

Warm the saline before you flush the Foley.

Label all tubing with big black letters on silk tape flags in several places.

Apply concealer cream with a small brush rather than your fingers. You get better coverage, and you'll use less product. The Sonja Kashuk brushes from Target are good.

Never ever ever wear the same pair of shoes two days in a row.

Keep the receipt.

Cotton undies. Always.

Holy freakin' kamole, it is too damned hot.

A hundred and six outside Casa Del Thank God For Airconditioning, friends. That's what it is today. Ah, nothing like that dry, baking Texas heat in the summertime, except for when it's a hundred and six outside with humidity of seventy-four percent.

This time of year, all I eat (seems like) is peanut butter and jelly sandwiches and water. And frozen veggies, straight out of the bag, applied to temples, wrists, and ankles.

When I was in Seattle two weeks ago, it was sunny and 75. And everybody I ran into, from the barmaid at the fish bar to the cashier at Archie McPhee, started the conversation with something like, "Gosh, isn't it hot? I can't stand this heat." Given that the low that morning at the Dallas airport was a full ten degrees warmer than Seattle's high, I was not inclined to be sympathetic.

Speaking of disinclining to sympathy, we have a new crop of residents in most services (well, comparatively new; they came on on July 1st) and the same crop of neuro guys on new rotations. I had to tell one of 'em the other day that just because you change services does not mean that you get to write craptastic, freaky orders and then complain when we call you to clarify. 

The rest of the residents range from outstanding to just fine. There's always one, though, and it's our destiny to work closely with him for the next two months, since he's covering two services at once. 

The only reason I look forward to working with him is because it means I'll be in air-conditioning for twelve hours.

Happy Birthday, Mom!

This is actually a day early, as my time off ends tomorrow. *sigh*

My Mom will be seventy years old tomorrow, July 16th. Hooray!

People who lived to be 70:

1. Methuselah (969)

2. Benjamin Franklin (84)

3. Helen Keller (88)

4. Florence Nightengale (90)

5. George Burns (100)

People who did not live to be 70:

1. Jesus (33?)

2. Mozart (35)

3. Eva (Uncle Tom's Cabin, age 6?)

4. Rumwold (Anglo-Saxon saint, aged 3 days in 662)

5. Amelia Earhart (42)

Things that happened in July, 1938:

1. Steam locomotive "Mallard" (Hi, Dad!) sets land speed record of 126 mph.

2. Wrong Way Corrigan takes off on the 18th, heading (he thinks) for California. Later, he lands in Ireland. Wups.

3. Mauthausen concentration camp built (eesh.)

4. Two barns were destroyed by fire near Sheboygan.

5. Brian Dennehy was born (actor).

If you search "70 Things" on Google, you're likely to come up with:

1. "70 things you need to know about future employees"

2. "70 things to expect in a disaster" (My favorite: "Things will get better only after they get considerably worse.")

3. ""70 things to always remember" 

4. "Who held a gun to Leonard Cohen's head?" (article from The Guardian)

5. "70 Things To Do In Iceland" (too easy.)

If you search "70 year old mother" on Google, you're likely to come up with:

1. "70-year-old gives birth to twins ('I did this for women everywhere,' says mum)"

2. "A mother reveals 70-year-old secret"

3. "Turkey with my 70-year-old mother" (recipe help or travelogue? You decide.)

4. "Thief jailed after 20-mile chase with 70-year-old mother dozing in seat next to him"

5. "Seattle Native is Mother Of 70-Year-Old Sal D'Amato's Baby"

And finally, Rob Brezsny says:

I really do feel that you're here with me as I create these horoscopes. In a sense, you're my assistant. Our telepathic connection is utterly palpable and practical. The hopes and questions you project my way stream into my higher mind, coloring my psychic environment and enriching my desire to give you exactly what you need. Now, in accordance with the astrological omens, I'm asking you to give our collaboration more conscious intention. It's time for you to be aggressive about seeking help and inspiration -- not just from me, but from everyone. Try this for starters: Once a day for five minutes, visualize that you and I are sitting face-to-face and discussing the issues that feed your longing to be brave and free and authentic and smart and loving and creative. 

And Now For Something Completely Different....

or, That Didn't Work At All.

Some time ago, right after I moved in here, I bought some great midcentury modern wallpaper to put in the kitchen. The kitchen project was stalled until this week, when I had a few extra days off work.

So down came the horrible masonite on the walls. I taped and mudded and sanded and primed and put up the first wall's worth of paper.

The Kitchen said, "What the hell do you think you're doing?

I replied, "Putting up wallpaper. What does it look like I'm doing?"

The Kitchen snapped, "I hate that stuff. Take it down right the hell now."

ME: Buuuhhh...buuuhhh....I like this wallpaper!

KITCHEN: *I* don't. I'm not Midcentury Modern, you idiot; I'm Postwar Cute!

ME: Uh...there's a difference?

KITCHEN: Well, duuuuhhh. Yeah.

ME: So what's Postwar Cute?

KITCHEN: Take a look at me, Bozo! I've got glass-fronted cabinets and wide woodwork and high ceilings! Lots of cute cabinets! I need small-figured wallpaper with a chair rail and white paint, not this uber-modern faux Fifties crap!

ME: Um......

KITCHEN: Take. It. Down. Now. Or you'll never cook in this town again.

So I took it down. We eventually compromised: white walls with stencilled, multicolored polka dots in cascade, painted in Fiestaware colors.

Which means the kitchen won't be done before Wednesday, when my time off ends. Dammit. 

You know, I used to be sure my mom was crazy when she told me that every room in the house told her what color to paint it. I'm not so sure now.

Can we just print this out, post it on the fridge, and be done with it?

You know it's going to be a bad day when you walk in and somebody immediately calls a code.

Except this one wasn't a code. It was, technically, a "Rapid Response Team" situation, but given that the patient ended up intubated and 100% ventilated, it was a code. But I'm getting ahead of myself.

A lot of families hate the idea of signing a DNR (Do Not Resuscitate) on Grandpa or Grandmother. They think that a DNR means "Do Not Treat" or "Ignore" or "Hasten the Death Of" rather than what it actually means.

To wit: Grandpa was not in the best of shape when he came to us X days ago. He'd had two major ischesmic (clotting) strokes and a large, horrible bleed in his brain and was breathing irregularly and gaspingly when he was delivered to us by a relieved ambulance crew. Grandpa hadn't moved on his own or responded to anything short of pretty intense pain for days. Grandpa was a full-code, or a "Do anything and everything to save this person's life" when he came to us.

Let me be totally clear here: Grandpa was in no way, shape, or form, ever going to get better. The best neurologists and neurosurgeons in the country had already determined that. Okay? Okay. You got it. Grandpa's gonna die; the only question left is how.

So I wander in to work, already tired and strung out from the sort of weekend nobody wants to have. After I'd been there not three minutes, somebody hollers out of Grandpa's room to call the RRT...so I did. Despite not being on the clock and not officially there yet, I called RRT. (My compassion continues to overwhelm me, as I'm sure it does you.) Then I wheeled myself and the code cart into the room and took a good look at what was going on.

What I saw was an 87-year-old man in the last stages of life. Agonal breathing, cold extremities, you name it--this guy had a bus to catch and was running after it as fast as he could. Family, being in the room, was flipping out and demanding we "do everything".

So we did. Those of you with relatives who are in the "do everything" camp might want to cut this bit out and show it to those relatives. Here's what we did:

We started three large-gauge IVs in the man's arms and legs. We called an anesthesiologist (who just happened to be wandering past) into the room to intubate, as Grandpa was not breathing well on his own and bagging him (ie, providing artificial respirations with a manual device) wasn't working. 

The anesthesiologist had to try four times to intubate Grandpa. His airway had been damaged by people suctioning it out in a ham-handed fashion. When I finally got a 16-French (read: small) bougie up, Anesthesiologist guy managed to get it down Grandpa's throat at the cost of a whole lot of blood being shed from those damaged throat and airway tissues. There was blood everywhere. 

At that point, Grandpa stopped breathing on his own, following the natural course of things, and we had to do chest compressions. You could hear the sound of his ribs breaking outside the room. I broke at least three of them myself, straddling this ancient man and counting "one-and two-and three-and...." and trying to get three inches depression with each push.

There were people bagging and cursing and blood flying everywhere as Grandpa's arms jerked with the compressions, ripping the needle that the respiratory guy was using to draw labs out of Grandpa's arm.

We pushed drugs you've never heard of more times than is interesting to tell about in an attempt to get a heartbeat, *any* heartbeat, on this man. You can't shock a flatline, and we didn't...but we didn't get much of anything out of him. IVs in his arms blew as we pushed drugs too fast, raising enormous discolored lumps on his arms. We replaced the IVs with ones in his legs and a central line in his groin, the only place we could find a vein that was engorged enough to poke.

Every time the doc who took over compressions from me pushed, more blood would squirt out of the various holes we'd made. This was not natural bleeding; this was artificial bleeding from a dead person that was caused by us forcing his heart to squeeze.

Finally, finally, with family in tears in the hallway, we managed to get a shockable heartbeat. And finally, finally, we put on external pacing pads that would deliver a mule-kick through the man's shattered chest every few seconds in an attempt to remind his heart to beat. And finally, finally, *finally*, with blood bubbling out of the breathing tube (from the broken ribs) and oozing out of the various holes I and my colleagues had made in him, we managed to get him stable enough to take him up to the ICU and put him on a ventilator to breathe for him and drugs and drips to keep his blood pressure stable.

That, my friends, is what a code is like. 

That is what you're wanting for your family member.

And this was a clean code. That's the horrible thing: we only coded this guy for a total of about five minutes; the rest was all pre-code intubating and sticking. 

If you come in with a DNR, I will bust my balls to save your life. If it comes to it, though, and you stop breathing on your own, I will not torture you in order to get a few extra minutes of fake "living" out of your cooling carcass.

If you come in as a full code, I'll bust my balls to save your life, even to the extent of breaking your freaking ribs in the process. I'll hate it, but I'll do it.

Talk to your families, people. Decide how you want to go. But please, please be aware of what you're asking when you ask for it.

Product Reviews: Shit That Works Like It's Supposed To Edition

It's been a while since I've done one of these. Therefore, without further ado, Shit That Works Like It's Supposed To:

1. Cline Vineyards Viognier, 2007

I've only ever tasted Becker Vineyards' (just down the road! Try the lamb!) viognier before, and found it a little on the sweet side. Cline Vineyards is a California establishment that produces a semi-dry viognier with a nice, peachy aftertaste that also includes a little oak and some citrus. It's good for drinking when the temperature is, say, 102* for the fifth stinkin' day in a row.

2. MyChelle Fruit Fiesta Facial Peel

The blog on which I read the first review of this product mentioned "vat of acid" and "having my face used as a pinata at a school for wayward children". I didn't find it all that difficult to endure, but then, late-thirties acne has me inured to almost anything. My face, when I washed it off, was clean and smooth and well-moisturized, with nary a hint of redness. This is a keeper. It didn't even fade my freckles!

3. Sara Lee 45 Calories & Delightful 100% Multi-grain bread

Don't kill me. Friend Heather, who is a successful yoga teacher and Weight Watchers' devotee, swears by this stuff. I had been eating the Pepperidge Farms 15-Grain Shred Utility What The Hell Is This? Gristle? Bread for years in order to get my full RDA of grains. It made me sleepy. The Sara Lee stuff, though it's probably made with black magic, tastes just as good with peanut butter and fills me up without making me nap afterwards. 

4. M.A.C. Loud Lash mascara

I have one complaint with Loud Lash: It's not manufactured any more. If you can find some on eBay in an unopened package, grab it. This shit stays put through a twelve-hour day during which both the water and power go out, meaning no electricity, and it will. Not. Come. Off. You'll have to use straight oil to dissolve it. Which means you'll have to buy either an oil cleanser or plain olive or coconut oil, but it's worth it. 

5. Parachute (or any brand, really) Pure Coconut Oil

Speaking of oil, did you know that coconut oil is molecularly quite close to sebum?

That means that you can rub it on your face and leave it there for a couple seconds and it'll dissolve not only makeup, but blackheads. It'll condition your hair beautifully if you put it on said hair when said hair is dry and shampoo it out afterwards. It'll take care of nasty dry-skin rashes with no fuss.  Best of all, a huge bottle of it is $1.67 at Mida's All Indian All Asian Bazaar, Your One-Stop Shop For All Asian Needs, which means you'll have bank left over for some stick-on bindis for when you're feelin' fly.

6. And, last but not least, Le Vent Du Nord.

Just go buy a couple of albums, already. It's the best toe-tapping, dance-inciting, nasal-projected-singing music Quebec has to offer. And the guy on guitar is cute.

Odds and Ends

Things not to do:

Show up tanked on the day of surgery.

No matter how nervous you are about having brain surgery, it's probably best not to appear at the hospital at 6 am completely schnockered. It'll require a delay in the start time. 

Yank the spike out of a REALLY big bag of fluid.

You all know that I am Genius Incarnate when it comes to being clumsy in new and creative ways. In the past, I've spilled most of the contents of the pharmacy on myself...but I reached a new high recently when I accidentally yanked the spike out of a three-liter bag of saline that was hanging at about head-level.

No, I don't want to talk about it any further. Thank you.

Sell drugs out of your hospital room.

Calling security is a pain in the ass. Could you not wait until you got home to make some extra bank?

Attempt to mug one of our employees in the parking garage.

Because, though she looks tired and vulnerable, she might actually end up being a second-degree black belt and wind up kicking your lousy ass. The cops who responded to the yanked emergency phone arrived to find one mugger, in a bruised lump on the concrete, and one rather pissed-off, medium-sized woman who just wanted to go home to bed.

Have two dogs, each well over a hundred pounds, and only a Honda Accord to move them around in.

I could solve this problem in one of two ways, I guess: 1) Buy a new car, like an xB or a Versa, that has room enough for two guys who each stand more than 25" at the shoulder. Or, alternatively, I could 2) Cobble together a lightweight cart and train them to pull it. That way I'd save the money on gas, give the boys some exercise, and look cool doing it.

The only problem would occur if Strider were to see a snack on one side of the street and Max a potential belly-rub on the other. 

Roll a loaded linen cart over your toes.

No, surprisingly, this did not happen to me. Owie, though.

Eat like, fourteen cups of blueberries at once because, you know, they taste soooo good.

I did this. It was actually more like three cups. That's still enough, though, for Interesting Things to Happen.

Ah, the glamorous life. I livez it.

Two questions:

First, which one of you smart-alecks sent me the subscription to Glamour?

It was in my mailbox today. Ha, ha, ha. Very funny. (*golf clap*)

Second, who has recommendations for dog training books? Strider is apparently even younger than his rescue foster thought and is a total doofus. He needs training before he puts on that 20 lbs. he needs. Sheesh.

Daily Strider Tidbit: He has what I'm now calling the Strider Boing: It's a move where he leaps straight up in the air, all four paws off the ground at once with his spine parallel to the ground (so he's not on his hind legs, if you see what I mean). He gets a good 30 inches of vertical air under those paws. This move is usually accompanied by a basso profundo BOOF! and can be seen in moments of great excitement, like when Brownian motion occurs or the planet is circling the sun.

Max is exhausted but happy. I need to go rub his belly now and reassure him that he's the best boy EVER. I never thought I'd see the day when a 110+ lb. German Shepherd mix looked small, but here we are.

Strider, day two

Scene: The back yard, morning

STRIDER: Dude. What *is* that thing?

MAX, yawning: Lawnmower.

STRIDER: What's it do?

MAX: Shortens the grass so we get better back-skritches.

STRIDER, examining lawnmower from all angles: Is it dangerous?

MAX, rolling on back: Just stay away; you'll be fine.

STRIDER: ....Okay. I guess I can't herd it. *sigh*

Scene: The living room,  afternoon

MAX: Don't go there, man. I'm warning you. I've tried it.

STRIDER: Aw, c'mon. It's cute and fuzzy! What harm could it do?

KITTY-CAT: I'll kill ya! I'll kill ya! I'll taste blood! Murder! DIE! DIE!! DIE DIE DIEDIEDIE!!!

(KITTY-CAT swipes at STRIDER with claws out.)

STRIDER: Holy shit, dude! She's got needle-paws!

MAX: Told you. You can't win with that one. It's crazy.

Scene: The back yard, nightfall

MAX: Doh dee doh doh dum dee dah dum dee dah....

STRIDER: Laa laaaa laaaa *roll roll roll* *scratch scratch* daaa deee hummm hummm...

MAX: Dah doh dee la la doh dum diddly dum....

STRIDER: Laaaa laaaa laaaa li loooo...wait. GO AWAY!!! GO AWAY!!! GO AWAY!!!

MAX, running after: Yeah! What he said! 

STRIDER: What was that?

MAX: Uh...it was The Hooman. But no worries. She's used to it when she comes home.

Meet Strider.

No, not that one.

I picked up a very sweet, very very very large dog yesterday from a very very very kind woman who fosters Pyrenees and other large dogs.

Strider is a close-to if not pure-bred Anatolian shepherd. I wanted a dog who was calm, athletic, not inclined to hysterics, and large enough for Max, the German/Anatolian cross who rules the back yard, to play with. Strider met all of those qualifications, plus he has a very sweet face.

So off I went in the Honda, not knowing what to expect. Strider had been picked up in Houston and had spent some time in a really awful kill-shelter there. He had mange, pneumonia, heartworms, had been underfed, and generally wasn't in the best of shape when he got rescued. The woman who fostered him has done an amazing job: he's healthy, healing, and not the least bit shy or timid. He still needs some more poundage, and his face is a mess (from healing mange and being chewed on by other dogs), but I expect he'll be in tip-top shape in six weeks or so.

His ad on Petfinder said he wasn't a big barker, didn't jump on people, and was generally well-behaved and low-maintenance. 

I think he's blooming already. He remodeled the outside utility room last night (it was almost empty anyhow, and there was nothing in there I wanted), then announced his presence to the dogs next door this morning. He barks like a Great Dane. When I went outside to greet him and Max, he *plopped* both front paws on my shoulders and licked my face.

Good boy. Gooooood boy. Nice doggie.

Max is amazed that there's another dog large enough for him to wrestle with. Strider, thank Frogs, is following Max's lead when it comes to playing and wrestling: 230 combined pounds of tooth and muscle in a dominance struggle is not what I want to deal with on my own. 

Let me say a word here about rescuing animals:

If you want a dog, cat, pig, donkey, guinea pig, chicken, or goat, please consider rescuing an animal from a shelter or rescue group before you consider buying one from a breeder. If you're really wanting a purebred animal, there are rescue groups for practically every breed out there.

The benefits to rescuing an animal are huge. First and most importantly, every dog that's rescued from a shelter or placed by a foster human is one dog that doesn't get euthanized. Animal overpopulation is a huge problem; most shelters have to euthanize not because the animals are unhealthy or vicious, but because the shelter has no more room. 

Second, if you get a dog or cat or whatever from a rescue group, you have backup that you don't get from the guys who sell puppies on the side of the road. Somebody has lived with the animal for some time and can tell you about its personality and quirks. Many times, the foster family will crate- and housetrain the animal, take it to obedience classes, and generally do all the dirty work of socializing the animal for you.

And third, you know what you're getting into with a rescue animal. They're mostly adult, someone has their medical history all there for you, and the dog/cat/donkey has already got a vet. If there's a problem, you can call the foster or rescue group for advice.

Yes, adopting an animal from a rescue or shelter is expensive--the group has to cover expenses at least partially, and everybody there is volunteer or badly paid. Every bit of cash goes to the critters. Yes, it's a tough process--home visits and vet interviews are the norm, because the folks who adopt out critters want to be sure they all get good homes. But think of it like this: these are animals who've already been labeled "unwanted" by some other human, so it's natural that their caretakers would want to prevent that happening again.

I now have three rescue critters: Max, Strider, and Evvie the Cat. I would not trade any of them for the world; rescued critters are the best ever.

And now, since that particular sermon is over, I have to go shower and run out and get some larger dog toys.

My family, problem-solvers extraordinaire.

So, my uncle. Nice man. Hunts and fishes, but eats what he kills. Raises good dogs and raised two good kids. The sort of grandfather you'd want for your child, you dig? Goes to baseball games, can fry a mean catfish, has a good sense of humor. Sober, steady, church-going. I've never heard him raise his voice and have only heard of one time (and this was hearsay) when he used a naughty word, and that was "hell". Or "damn"; I don't really recall which.

My uncle. My Beloved Mother's baby brother, the one who loves Chefboy and is never in a bad mood? That one?

Sent a cosh.

A real, live, spring-handled, lead-ended, leather-wrapped cosh. As in, I'm not entirely certain this is legal within city limits cosh. Eight inches long, weighs about two pounds, makes a satisfying and painful thwap when you whack it into your palm, would easily fracture somebody's frontal skull. No lead pellets dropped into eelskins here; this is a serious weapon in an itty bitty package.

Apparently he read (sweet hopscotching Jesus, if he's reading this, I'd better clean up my fucking language) or heard about the patient taking a swing at me. And he got a little irritated on my behalf.

"She can put it" he told Beloved Mother, "in her pocket. Nurses have big pockets."

It has quite the loop strap on it, too. If I don't want to get too close to somebody and still land them in ICU overnight for observation, I could conceivably swing the thing at arm's length.

My methods of self-defense have been limited, these last twenty years, to ducking and running and imagining how, exactly, I would get to the fire extinguisher and loose it into some bad guy's face before Max ripped out his throat (always assuming Max would do that; it's not been put to the test, knock wood). I've never hit anybody with a cosh. I've never carried a cosh in my pocket. I've never even SEEN a cosh, for cryin' out loud; my naming it thus is informed by my taste for good and not-so-good detective fiction.

Nonetheless, I am now the proud posessor of an eight-inch-long (fourteen with handle), spring loaded, lead-tipped widget that's wrapped in braided black leather and looks like something either Bettie Page or your local pr0n store would carry.

And I can keep it in my pocket. My big nurse's pocket.

I can't wait to see the docs' expressions when I pull it out instead of a penlight. 

Gracious snakes.

I post, I go to bed. I wake up earlier than God, and bang! Six comments in six hours.

Strike a nerve, much?

Some study I Googled last night said that 430,000 nurses report that they're victims of violence or intimidation on the job every year, and that that number is likely low due to under-reporting. Seems that a lot of nurses think that getting clocked or yelled at is just part of the business of being a nurse, and that some managers think it's whiny if you report being a victim of violence.

Hm.

You know, what pisses me off most about last night, is this: (well, two things, actually)

First, that the first-line person, my manager, did not automatically go to bat for me. Instead of laying out ground rules, he attempted to perform some weird magical act of conflict resolution that would somehow make it all okay. 

That has two results. The first is that the person who swang/swung/swinged at me has no incentive to change that behavior. "Act badly, get coddled" is the message.

The second result is that I know, now, that if I attempt to set firm boundaries with a person, like "Do not try to hit me. That behavior is unacceptable" I have absolutely nothing with which to back that up. I am really and truly on my own as a caregiver. If the person then complains, or tries to rough somebody up, we're back to Conflict Resolution and Good Customer Service.

And this makes me sit back and scratch my head and slurp my coffee thoughtfully.

The majority of comments left after yesterday's post talked about lawsuits and criminal charges, which tells me this: That I am not alone in working for a facility that has no plan in place for dealing with patient-on-caregiver or family-on-caregiver violence. I'll bet doghair to donuts that all of you guys have codes for civil disturbances or codes for when some nut comes onto the floor waving a gun, but that there's no code to call when a patient tries to cold-cock you.

So. Sunnydale has no plan. Sunnydale's Corporate Manglement has no plan. It's nursing, Three-Stooges style, except the pratfalls are real. So what will I do the next time this happens?

That's a hell of a question. If I'm feeling tough, I might well file charges and insist upon a root-cause analysis of the problem. (RCA's are when all the mucketies get together and go, seriously and with intent, over the entire history of something that has gone Very Wrong.) I might make noises about lawsuits and editorials for nursing magazines. I might even be serious.

Because, as I said before, the only way to get the folks on the carpet to listen is to threaten either their bottom line or their good public image. 

Now: one thing to get straight this second is that I would not, unless Manglement or the hospital were way, way in the wrong, sue anybody for money. I'm not really interested in that sort of drawn-out, pain-in-the-ass process, and it wouldn't end up solving a damned thing, as the facility (if somebody *were* to get hurt) would settle in return for a non-disclosure agreement.

What I *would* do is insist on new standards of behavior for patients, family members, and visitors. What I want is a policy in place that says, If you do X, then Y will happen. What would make me happy about working where I work is a recognition on the part of all the managers that The Customer Is Not Always Right, and that there are some things that are beyond the pale. 

Right now, all of us, whether we're in the ER or on the floor, are subject to threats that would never fly in any other business. If you holler abuse in a bar or try to start a fight, you get thrown out. If you throw a temper tantrum in a restaurant, you'll get thrown out. If you try to injure somebody in public, you're gonna have to talk to the police. But swing at or holler at a nurse? It's all part of the game.

Why are we less safe at work than we are in a bar? Why are the standards of behavior so much lower for the consumers of our product? Because, quite frankly, if the patient is going to be treated as a consumer of healthcare, they need to be subject to the same standards of behavior that consumers of alcohol, groceries, or cut flowers take for granted.

The answer to the problem of violence against nurses is simple: People who are violent or threatening need to be refused care. The way to get that policy implemented is much, much more difficult.

I think I'm going to lean back, furrow my brow, and slurp some more coffee while I think about it.

This "Customer Service" bullshit has got to stop.

Normally, I never post immediately on coming home from work. I'm too frazzled, too scattered, and unable to complete a spoken sentence, let alone a written one.

Today, though, it's different. Today, for the fourth or fifth time in as many years, I had a patient take a swing at me. What's different about today is that this particular patient was alert, oriented, knew where he was and what he was doing, and was trying to hurt me.

This patient was the typical Sunnydale Hospital* frequent-flier: pages and pages of old charts, all of them with extra pages attached from nurses who'd had run ins with him. The documentation was complete and careful and clear: this particular person was a nutjob. No way 'round it; he had enough baggage for the Rolling Stones on tour.

His course was also typical: noncompliance with the simplest of instructions, obscenities screamed at nurses, pharmacists, and doctors, and the final lovely touch of hiding narcotics in his room. That was just recent visits. It didn't take him long to get a file this (holds fingers apart at arms' length) thick.

So he took a swing at me. And screamed obscenities. And I reported it, as I was supposed to, to my boss, one of the Manglement Trifecta on the floor. (Winky, Blinky, and Nod, as I call them, do the work of one person, and do it.... Anyway.) Winky went on into the room, and there....

...Practiced Good Customer Service and Conflict Resolution.

The upshot? I got told the patient didn't like me--big shock, as he didn't like anybody--and was told not to do whatever it was I did to get him upset again.

Managers, read this, if you read nothing else:

Customer Service Does Not Mean Putting Your Nurses In Harm's Way.

This was a patient who'd already threatened to kill two surgeons. He had come up on out of the bed with a pharmacist and had caused three of the toughest nurses I know to refuse to take him on as a patient. Now, I am not the shrinkingest violet on the block, but one thing here ought to be perfectly clear: The only way to deal with a problem like this is to get rid of the source.

Patients like this ought not to be readmitted to the hospital. They ought not to be "counselled" about their behavior. There ought to be no quarter given: if you swing at a nurse, or scream obscenities, you should be told briefly and bluntly that that behavior is unacceptable, and if necessary, you should have a security guard posted outside your room.

The fact that this guy wasn't ditched from the hospital admit list tells me that Sunnydale doesn't give a good goddamn about their nurses' safety. The fact that my charge nurse, Winky, didn't lay down the law tells me that he cares more about our floor's customer satisfaction scores than about *my* safety.

And that tells me this: Managers, listen up: the only way you guys will ever pay attention is if we, the people on the front lines, start making a stink. 

Next time some direct descendent of Einstein swings at me, I am not going to get out of the way. I'm going to let them hit me.

And then I'm going to file battery charges.

And then I'll talk to your board of directors, Sunnydale, about the whole situation, and how much compensation I ought to get for mental anguish. Because the only way to get large groups of carpeted-area manglement types to pay attention is to talk about negative publicity and dollar amounts.

I'm not fucking kidding. There is no reason in the world that I ought to have to put up with somebody who's actively violent still being in the hospital after he's behaved like a beast. There's no reason that the charge nurse or house supervisor or whatever shouldn't march into the room and tell the person who's a nutjob that nutjobbiness is unacceptable and *will* stop, NOW, or the patient can go home. 

There is, in short, no reason for me to feel less safe working at Sunnydale than I did working at an abortion clinic. And I do. 

*w00t Buffy.

Butt Tufts and Other Hazards of Southern Life

Or, what I do on my day off.

Max is shedding. Among those of us with double-coated dogs, there's a less-polite, more-descriptive term: "Blowing the coat". Max is blowing his coat.

Yesterday it was close to 100* here. In one day, Maximus Doggitude went from looking like a gentleman, albeit a shaggy one, to looking like he'd earned the nickname "Banjo" by living under a bridge for six months. My neighbors, who live with a good-natured pug and a corgi who never ventures outside except under duress, were amazed to see me pulling handfuls of hair out of Max's coat, especially on his hindquarters. Anatolian shepherds, being a mountain breed, tend toward large poofs of fur to keep their hrbls warm in the winter. Max's hrbl frbls were out of control.

Doggie dreadlocks, only six days after his last intensive grooming session. Every sparrow and mockingbird on the block is wearing comical mustaches of Max Fur, soon to be lining their nests.

Speaking of sparrow nests, I had a heartbreaking moment the other day when I noticed that a piece of decorative trim had come off the side of the house, just around the soffit. It had exposed a long empty space, and in that empty space were shreds of grass and other material. That spells "sparrow nest", which in turn spells "rodents looking for prey" and "rotting wood", so I climbed up on the world's shakiest hand-me-down ladder to have a look. I got out the entire nest (why does a small bird need a nest as long as my arm?) and dropped it to the ground before noticing it contained unhatched eggs. Two were broken. Three were intact. The parent sparrows were flipping out.

I put the nest, as close to whole as I could manage it, in the crook of a tree nearby. Given that the only bird with a sense of smell is the vulture, I figured the parents would adopt the nest again with no problem. They did...until the next big thunderstorm. *sigh* I feel like a baby bird murderer.

In gardening news, things are mixed. The dill and lavender are doing well (though Max chewed up half the lavender plant today; why I do not know) and the tomatoes are fruiting. The Romas are behind time, having gotten munched by some unknown bug, but the cherry tomatoes and heirlooms are already setting tiny green fruit. The cilantro got as high as my shoulder before seeding out. I pulled it yesterday morning and tossed it on top of the compost pile, intending to dig it in later on, once I'd bought a pitchfork. Before I was able to do that, I saw Max, head and shoulders into the compost pile, delicately yanking strands of seeded cilantro out and eating them. 

I had wondered why, for weeks on end, the cilantro seemed to be self-pruning. I know now that the Weirdest Dog In The World had been chewing bits of it, perhaps to freshen his breath for the pug next door. Fortunately he doesn't seem to have the same taste for basil as he does for cilantro and lavender. The dill and basil are safe, which is good for him. If he were endangering my future pesto binges, we'd have to have a talk.

I'm already planning the garden for next year. I want to build four raised beds, two square and two long, with cedar poles and plenty of fencing to keep the dog and the neighborhood tomcat, who sleeps in my lettuce, out. One bed will be for perennial plantings, asparagus and strawberries. The other will be for things like carrots and tomatoes and radishes and bush beans. Lettuces and cabbages (fall crop), brussels sprouts (ditto), and pole beans will go into the long beds, along with cucumbers melons perhaps kiwis peppers herbs etcetera.

In the front beds, which I have yet to till and de-grass (dammit, sigh), will go perennial herbs like rosemary and lavender and dittany and oregano.

There's a lot to do when you have a house. I'm just now learning this. I've not even mentioned the difficulty of finding a black toilet seat (better in keeping with the theme of the bathroom and its historical roots) or an affordable vented oven hood. Or what it takes to find a really good screen door, or the spasms I'm having over whether to save the original, Art-Deco doorknob and plate from the back door when I replace it with something that's not mostly glass.

Even with the sleep I lose over such things as whether the wallpaper for the kitchen ought to be 1950's vintage repro or 1940's, it still makes a nice change from primary leptomeningeal melanoma and Ted Kennedy's brain tumor.

Today I got yelled at 4.3 times in twelve hours.

And it didn't bother me a bit.

I've grown inured to the yelling-at that some doctors, pharmacists, other nurses, house supervisors, patients, and facility management specialists (read: Janitors) do.

I used to bristle. I used to take offense. Occasionally I would vent.

Now, if the person doing the yelling is doing it face-to-face, I imagine that person covered with banana pudding. If the person doing the yelling is doing it over the phone, I giggle. Audibly.

Because, you see, *everybody* yells at nurses. We get caught between the proverbial rock and steel plate, and we are the recipients of everybody's frustrations. Toilet broken? Yell at the nurse. Did payroll fuck up your overtime again? Yell at the nurse. Can the pharmacist in Alabama not read your handwriting? Inform the nurse stuffily that that's the same DEA number you've used for the last five years. 

Then listen to the nurse (well, *this* nurse, at any rate) giggle helplessly at your stuffiness.

This is the time of year when I face both burnout and brilliant ideas simultaneously. The time I don't spend updating the blog is time I spend out weeding the garden and grooming the dog. This time of year, I'd like nothing better than to get fired for smarting off to somebody, just so I could work for triple or quadruple what I'm making now, with plenty of time off to weed and groom and just lie in the sun. I know I won't feel that way come January, though, when things are cold and rainy, so I mostly hold my tongue.

And giggle. Audibly. Audibly, but not offensively. Because, honestly? Not one damn thing I got yelled at today had anything to do with me or my nursing. One was a doc who was pissed at a pharmacist; the next was the pharmacist who was pissed at the doc. The third was a patient who had an entirely different nurse. The fourth was a manager who got annoyed that I actually followed hospital policy (and they wonder why I'm such a loose cannon) and did what I was supposed to do.

Keep your yellow "Live Strong" wristbands. You can have your pink ribbons and red dresses and grey ribbons and God knows what else. I am wearing, from here on out, a smiley face. Giggling is my new cause.

You may be next.