In which Jo answers questions posed by a semi-anonymous reader.

A couple of weeks ago (or a little more), I got a very nice email from a young man (God, I love being able to say that) who had some questions about nursing and about the blog. He'd read a bit and was interested in learning about stuff I don't necessarily mention here. With his permission (Hi, Chris!), I have excerpted some of his questions and my answers. I think this might be for a class of some sort; Chris, I hope you get a decent grade on your paper.*

You sound sometimes like you really hate your job.

Honey, *everybody* sounds like they hate their job sometimes. I don't. I get frustrated and angry sometimes--not with patients, but with manglement and doctors and sometimes family members--but I love what I do. It's like a cocktail party, but with more blood.

What's the thing that pisses you off about nursing the most?

On a micro level, it's the lack of positive reinforcement I get from my bosses. Yes, I have more than one, and yes, they all suck at telling you you're doing a good job. Fuck up on your charting and you get an immediate email and a correctional meeting; manage to get a hostile family member to calm the hell down and get on board with a plan of care and you hear nothing. My bosses, for the most part, suck rocks. That's discouraging, but not enough that I'm gonna find another job. (I originally typed "mob" for "job", and that's about right.)

On a macro level, it's the "Dare To Care" stereotype of nurses and nursing. If you've read back over the last year or so, you've seen how I yammer on about being a scientist first and a warm, fuzzy person second. One interesting thing that illustrates what I mean: we had a doc write for QID (four-times daily) massages for a patient. Uh...I can't *do* QID, thirty-minute massages. Leaving out that I don't have the training, I have four or five other patients who are, you know, in varying stages of critical. We had to do some hasty education with that doc.

What's the one thing about your job you like best?

Making a difference, as hokey as that sounds. If I'm able to touch a patient with my bare hands when I know they haven't been touched by anybody without gloves in a week, I know it'll make both of us feel better. I love being able to relieve pain and alleviate fear. I love being able to educate. I love being able to learn, most of all--and I learn things from my patients every day. I know more now about structural engineering, how to manage Crohn's disease, Asian art, nonstochastic physics, politics, and being a rodeo clown than I ever imagined I would know.

The patients are the absolute best part of my job, hands and spines and brain pans down.

You sound like you work for Dr. House. Is everything always so complex at your job?

No. I write about the cool stuff; the stuff people might not have heard about before. Lumbar surgery and neck surgery aren't all that interesting. Lumbar surgery on an 800-pound patient is more interesting. Brain worms are *way* more interesting even than that. 

Plus, I do work at a research hospital. We see shit every day that most nurses never see in a lifetime. I Googled a diagnosis that a patient of mine had once and got 35 results. So the stories about CJD or crazy-ass neuroleptic syndromes or conversion disorder might make it on to the blog most often, but they're probably only about 40% of what I do. The other 60% is plain old boring ordinary craniotomies and lumbar laminectomies.

LVN or RN?

Based on my experience, I'd have to say go for the RN. That'll differ from place to place, of course, but Texas is moving away from using LVNs as primary caregivers. Big County Hospital now, in fact, requires that all entry-level nurses have a BSN. 

There's a joke: "What's the difference between an LVN and an RN? About ten thousand dollars a year." That's *kinda* true, and *kinda* not. A lot of the things I do an LVN could do as well or better. Some things, though, LVNs can't do because of the guidelines set out by our state board. For instance, while they can intervene to fix a problem, they can't assess the patient--either baseline or in response to their fix. Now, most places you'll find LVNs acting basically as an RN, doing assessments and whatnot, but they're not *technically* supposed to. 

It's a silly distinction on a lot of levels. Unfortunately, the way things are here, you're pretty much locked into working either at a long-term-care place or overnights with shitty staffing in a hospital if you're an LVN. You have a lot more freedom as an RN.

So, yeah: RN. The choice between a two-year and a four-year degree is a whole 'nother ball of brain worms, though.

What one piece of advice would you give somebody starting nursing school or starting a nursing career?

Find a mentor. Do it as fast as you can, and lean on that person for support throughout your schooling or the first few years of your career. It makes a huge difference.

My mentor in nursing school was one of my instructors. She was, hands down, the best teacher I have ever had in any subject in any school I've attended. Luckily, she was both an active nurse and my clinical instructor, so I got to see a real pro in action during clinicals.

The thing that impressed me most about her, and what made me want to be like her, was her combination of dignity and warmth. When she dealt with doctors, she had their respect. She stood very straight and was extremely professional--almost like something out of an old movie, but without the "Yes, Doctor" subservience. She knew her worth and the worth of her work.

And with patients, she was amazing. She was the person who taught me how to approach people first thing during the shift. She would walk into the room, introduce herself before she approached the bed, and then make the person in the bed or the chair her *total* focus for five or six or ten minutes. Sometimes she'd just rest a hand on their arm while they talked to her; other times, she'd fix some seemingly-minor (but huge to the patient) problem right away, without waiting. In that small space of time, she established a rapport with the patient that let her give really good care, because the patient knew she wasn't going to get distracted or screw them over by being in a hurry.

I learned more from just watching her in one semester than I did the first three years I was nursing. She was the best.

Hm. Maybe I ought to drop her an email and let her know all this. I doubt she'd remember me, but it's nice to hear when you've made a difference.

Any other questions you want answered? Post 'em here or drop me a line.

*Dude: Edit out the word "fuck", okay?

Oh. So that's where they come from.

Here.

It's only made of short stories

I still haven't found what I'm looking for

Y'learn something new every day, I guess. I've seen seizures that manifest as the good, old-fashioned generalized tonic-clonic (shaking, grunting, scary, traumatic for everybody) sort; I've seen seizures that manifest as anxiety attacks or giggling fits or simply staring off into space for a bit.

I had never seen a somebody seize where the only symptom was that they were looking for something they couldn't find. 

It took us a while to figure out what was going on. There weren't any acute neurological changes that I could see in the patient during these episodes--he stayed alert, oriented, aware. There weren't any acute changes that we could see in MRIs or repeated CT scans. We figured it was some weird anxiety thing going on--until the video EEG showed seizure activity concurrent with the patient's desire to find his wallet.

The residents and I were looking over the video record and saw the first telltale signs of a complex partial seizure corresponding to the patient's asking where his wallet was. 

Well, I will be damned. Okay, then. Load 'em up on Keppra. 

Short, sharp. Shocked.

Another nurse's patient had complained for the last hour or so of shooting, stabbing pain in one particular area of his shoulder. Given that he'd had a lumbar laminectomy, we couldn't figure out why his left shoulder would feel as though something was stinging it. Was it a problem with positioning during the surgery? Was it some unrelated problem in his cervical spine? Was it just one of those weird things that would go away on its own?

We rolled him and checked the shoulder. Nothing. We did range-of-motion. Nothing. Xrays showed nothing. Still that sharp pain. It wasn't consistent, and it tended to happen when he lifted his left arm up to grab something off the table. 

Finally, we rolled him one last time. His nurse straightened the collar of his schwanky new, just-out-of-the-wrapping pajamas, and jerked, winced, and cursed softly. She'd stuck herself on a pin.

A pin. In the collar of the new, schwanky peejays. We found the source of the stabbing pain--but who puts pins in pajamas? It's like starching baby clothes.

You mean this opera involves handcuffs?

Word salad is the strangest, funniest, sometimes most charming part of a brain injury. It's the inability of the brain to make your mouth come out with the right word at the right time, so things tend to get a little skewed. Patients will ask when their sweater is due, rather than their medications, or tell you that you're the flossiest sausage they've ever seen.

Each person tends to substitute words in a particular way, so after a day or so you can figure out what they mean. I'm still scratching my head, though, over the guy who looked at me solemnly and said "You're handcuff and chocolate, Nurse."

It might be the best compliment I've ever gotten.

The trouble with normal

Looking around, I see that I have a collection of medical books and magazines from the 1920's through the 1940's. Most of 'em have subjects like "Clinical Syphillology" (1938), or "Your Health: HOW TO AVOID A NERVE CRACK-UP" (1943), and all but one were found for my by my Beloved Sister.

I'm thinking it might be fun to excerpt some of the articles--especially ones from the popular press--just to see how "normal" has changed in the last 60-odd years. F'rinstance, didja know that some folks thought it was harmful for people over 35 to exercise at all? I wonder what Attilla the Cheerleader would think of that.

(For those who are interested, titles come, in order, from:

Neko Case

U2

Michelle Shocked

REM

Bruce Cockburn)

Wow. I get letters. Okay, then: a clarification.

Boy, you blog about emails and what do you get? More emails. And comments. And the sense that not everybody understands what the heck this whole...what you call it? "Blogging" thing is about.

So let's start at the beginning, shall we?

1. "Leave the poor patients out of it."

I do, my friend; I do. The patients I blog about here have been so combinized, fictionalized, sex-change-ized, and anonymized that often, reading back over the past couple of years, *I* can't remember who I was talking about. As I've said before, if you think you recognize yourself, whether you're patient, doctor, nurse, administrator, or taxi driver, you're delusional.

I don't know how to say it any more clearly than that, and I don't know how to do it any better. A blog about nursing wouldn't be much good unless it was, you know, about *nursing*. And nursing has to do with taking care of patients.

2. "Could you please recommend a good neurosurgeon/neurologist/internalist in New Jersey/Boise/Guatemala?"

No, I'm sorry. I can't. I work in a very insular, very circumscribed world in which the surgeons are the researchers are the pioneers are the only people doing X, Y, and sometimes Z. I don't know jack about normal hospitals or neuroscientists. 

3. "Can you recommend a good nursing school/tell me what nursing school will be like?"

Again, no. I'm sorry. My experience is seven years past now and is unlikely to reflect on your experience at all. I can offer tips on care plans--if you crazy kids are even doing care plans these days--and I can offer sympathy and encouragement, but you're better off doing a Google search for solid information.

4. "Your blog isn't work/child/parent/bunny safe! My boss is mad at me because of your blog! What if a child found your blog! There's too much profanity! You're mean! There's nothing of educational value to be found on this blog!" (note: last sentence taken verbatim from an email. Yeah, I know.)

(*Rubbing forehead*) 

If you are surfing the Innertubenets at work, what your boss finds on your computer is your problem. It is neither my problem nor my fault that you're wasting time here. *shrug*

If your child is reading my blog, that's your problem. It is not mine. This blog is not child-safe, nor has it ever pretended to be. (See above, re: profanity.) It is equally un-parent-safe; my Beloved Mom screens what she'll let my Sainted Father read here, probably because she knows his eyeballs would melt like something out of Indiana Jones...but that's beside the point.

I will not change either tone or content of the blog in order to conform to what people think is appropriate for groups of people that shouldn't be reading the blog in the first place. My response to the cry of "What about THE CHILDREN???" is a blank stare and the question, "So? What about 'em?"

As for educational value: I am putting this in bold because it is important, so listen up:

This is not a public service blog. This is not an educational blog. It has never been and never will be either. Posts with tags or titles including the words "Public Service Announcement" are titled and tagged with tongue firmly in cheek.

If you want reliable information on medical conditions or varying political views, I suggest you investigate medical journals and op-ed pages. If you want what I give you, which is neither reliable nor balanced, sit on down and stay a while.

Re: Me being mean: Here, yes. In real life? Only when necessary. And since we're here, I feel I can say that you should take yourself elsewhere and play with your dolly until you feel better.

5. "Can you tell me what to do about (obscure medical condition)?"

Oh, God, honey. No. Go see a doctor. Don't ask some stranger on the 'Net about your OMC. While I sympathize and will worry about you and ask for updates, I won't give you advice. The only advice I am qualified to give is that you'd get from any (other) moron on the street: If it won't stop bleeding, see a doctor. *Very* occasionally I'll stick my beak in, but only in those situations that seem urgent or emergent. If you've got trouble, see somebody in person.

6. "Your probably ugly you act so mean and uppity your probably fat and gay too why dont you leave nursing i hope i never get a nurse like you if i was their id kick your fat ugly gay ass."

Guilty as charged. Except for the "gay" part. Mostly, I am not gay. Mostly, I am sort of cranky.

You'd better hope I *don't* leave nursing. If I did, I'd quit blogging. If I quit blogging, you'd not have this blog to read. And if you didn't have this blog to read, how would you get your blood pressure up to a level at which your brain is (temporarily) perfused?

Oh, and: Punctuation. Look into it.

Are there any further questions? Any issues that need further clarification?

No?

Good. We now return you to your regularly scheduled, compassionate, intelligent, moderate, beautifully-written, touching fuzzy stories of love in the....wups. Sorry! Wrong blog.

Let's talk about compassion.

I've gotten a couple of comments in the last week that I haven't published. Both of 'em came from women (or a woman, posting as two) who claim to have kid(s) with AVMs on their faces; both of 'em took me to task for a lack of compassion. Apparently, I'm supposed to have compassion when I'm posting here, about my patients, and the doctors, and my nutso coworkers. (I should mention that both comments were personally abusive and name-calling, which triggers the auto-dump feature on the Nurse Jo Robot. That's why they're not here.)

Normally, criticism doesn't bother me. Blame it on the codeine, 'cause I'm gonna answer my critics:

Lady (or Ladies), you don't want me to have compassion on this blog.

Why not? Because, if I'm compassionate here, it means one of two things:

1. I've not used up all my compassion on my patients.

2. I'm drunk.

Let's be real, People: You don't come here for compassion and warm fuzzies. It's like the man said--come for the stories, stay for the snark. And, honestly, who wants to read me tear my heart out over patients that've torn my heart out?

I could talk about walking down the hall with Darlene, her arm around my waist, as we discussed the best way to tell her eight-year-old daughter that Mom wasn't going to live much longer. I could talk about Velma, and how she cried about having to go to hospice, because her mind was still there though her body wasn't. Or I could tell you about Ben, who told me frankly over dinner that he was damned ready to die, but was holding on for the good of his wife and kids, who weren't ready to let him go yet.

But you don't want to hear about that. Nor do you want to hear about the 13-year-old girl with the horrendous congenital AVM that would likely kill her, whose toenails I painted the night before she went into surgery (all but one, so they could put a pulse ox on in the OR), so they'd be pretty for the surgeons. You don't particularly care about the fifteen-year-old boy whose Moya Moya had so screwed up his brain that I was the only one who could get him to consent to surgery, and only then after coming in early and rocking him on his bed like a baby. And I'm certain, as the mother of an eleven-year-old with an AVM, that you don't care about the time I summoned up all the crappy, rusty Danish I could muster to help comfort a dying woman who couldn't remember that she wasn't at home, in Copenhagen.

You'd rather hear the snark, and read the snappy lines. I don't blame you. If my working life were snappy lines and snark, it'd be something for ABC or FOX to run in a half-hour between family comedies. It wouldn't be what I live every day, where real people hurt, and die, and sometimes don't die...and those of us who are living are left to pick up the pieces.

This is an important point for those of us who blog, and those of us who nurse: People will criticize you for not being the constant comforting angel that they think you ought to be. To hell with them. The important thing is that you do what you are meant to do for those people who find themselves in your care. 

That means you won't always be unsnarky when somebody wants you to be. You may not always want to talk about work when you get home. Sometimes, if you're a bit under the weather or a little too far into your cups, you might surprise your drinking companion with some heartbreaking story. The important thing is that when it counts, where it counts--with your patients--you aren't holding back.

I spend enough time questioning whether or not I did what was best for my patients. I spend hours after every work day going over every. damn. thing. I did. and trying to figure out if there were a way to say it better, do it more gently. In the middle of my day, I am a nurse. When I come home, I am a blogger. If the nurse part bleeds into the blogger part, it means I'm not doing my job--either job--well enough.

And so, critics, up yours. It's a shame you didn't read farther or dig deeper. I'm sorry for you, and I'm sorry for your kid--but I'm not sorry for my patients. What they get is the absolute best of what I have to give. What the blog gets is the cynical, tired leftovers.

Would you rather it be the other way 'round?

How to have the flu

Day one: Be amazed how very bad you feel. Take Tylenol. Lie down, covered with every blanket in the house, while dressed in a sweater, two pairs of pajama pants, socks, and a hat, and shiver.

Day two: Repeat Day One, while coughing.

Day three: Get some good drugs. Take them. Fall over into a shivering, feverish stupor, completely worn out by your hour-long trip to the doctor and pharmacy. Wake up. Eat some soup. Marvel at how good soup can taste. Fall over again.

Day four: Wake up. Ponder the fact that you are still alive. Take some drugs. Drink some coffee. Realize that this is the second cup of coffee you've had in four days. Sit on couch, worn out from making coffee. Once you're rested, make some soup. Eat it. Fall over.

Day five: Wake up. Look around you. Notice your dog is still there. Wonder who's been feeding him for the past few days, then remember dimly that some guy in a chef's outfit has been stopping by several times a day to check on you and bring you Sprite. Take drugs.

Pat dog. Let dog out. Notice that the weather is beautiful. Make some toast.

Sit on the couch and shake while the toast is cooking. When the toaster dings, drag self into the kitchen, amazed at how weak you are. Realize as you take toast out of toaster that the weakness is probably due to hunger. Devour two slices of toast with peanut butter and retire to couch with a cup of coffee. Read an OZ book, then nap.

Wake up. Decide soup sounds good. Have some soup. Go back to bed. Sleep for three hours.

Wake up. Take drugs. Tell self that if you have to eat soup again, you'll turn into one of Warhol's paintings of a Campbell's can. Plan sandwich for dinner.

Realize you are exhausted from sandwich-planning. Retire to couch with book; go directly to sleep.

Wake up.  Vow to self not to forget how absolutely crappy this past week has been, and that you will, in future, show more kindness to people who have to get out of bed after brain surgery and walk. Vow to self to have a better selection of soup in the pantry in the future. Vow to have an entire case of Scotch in the storage room. 

Blog.

Fall over. Sleep. Dream of sandwich.

Quick Tips:

1. If there is no mail delivered in The Most Important City in The Most Important State Of This Here Union, Yee-Haw, you know that the weather was bad that day.

2. Similarly, if you roll down your car's window and the quarter-inch-thick sheet of ice on said window sits there, and you are then able to punch a perfect cartoon hole through it with your weakened fist, you know there was a lot of ice last night.

3. Codeine cough syrup, while not as blindingly effective as Tussionex, is quite the bomb. 

4. It also makes all the keys on your keyboard be in the wrong places.

5. If your hair hurts, you have the flu (this is the official word from the NP I saw today).

6. My temp is down to 101.2. This is better than 102.6 or 103.1. I am tired of sounding like a radio station.

Doin' it old-school style

I have the flu. The good, old-fashioned, can't-sit-up-for-more-than-thirty-minutes FLU. With a temp that hovers somewhere between 101 and 102.4

And because the Weather Gods hate me, the threat of icy roads/actual icy roads/generally bad conditions has closed not only my doctor's office but every doc-in-a-box in the area for the last two days. 

Which means I'm starting Day Three of Old-Fashioned Flu. Which means I'm no longer a candidate for antivirals. Which means I'm riding this out old-school style: leapfrogging acetaminophen and ibuprofen, forcing fluids, and wishing desperately for some cough syrup.

I know I railed against Tussionex last time I was sick, but right now I would happily pay a hundred bucks for a dose of the stuff. I'm so high on dextromethorphan (which doesn't work; I know that, but I'm desperate) that I can barely walk straight.

This morning I woke up at 0430 in a drenching sweat, thinking "Thank God! My fever's finally broken!" It had--to 101.

*sigh*

So it may be a while before I post again. I'm going back to the couch.

In which Nurse Jo asks a favor

If anybody out there is in contact with LPN With An M16, could you please let me know how she's doing? You can pass my email (linked to the right, under "Speak") on, too, if she's in a place where she can easily email.

I'm really worried about this nonending headache she's had. I know I'm getting all mother-hen-y, but...I'm concerned.

I do not want this to be LPNcM16.

At last.

We all sat in the break room and watched the inauguration with our noses practically pressed up against the TV.

This was one of the best days of my life.

Lots of work to do tomorrow, people. We'll get on it when the sun comes up. But, for now:

I had a *really* bad day.

But, instead of complaining, I want to show you what I came home to tonight:

It's not *your* bed. It's *our* bed.

No, really, you can take the other half.

Or perhaps I'll come over here, for belly rubs.

Hey! Why'd you stop?

Things that do not impress me: An abbreviated list

1. That you are a Marine.

It impresses me not at all that you are a Marine. It impresses me less than not at all that you're a Marine if you tell me this repeatedly, at the top of your lungs, in between hollering obscenities. Marine, civilian, or little box turtle, you're all the same when you have a subarachnoid bleed.

2. That you are friends with the founder of the hospital.

If you really were, pal, he'd be here visiting. Trust me on this.

3. That you are a retired surgeon.

The last time you practiced, nurses were still wearing skirts and caps (I wish I were exaggerating). This does not make you qualified to direct your own care. Moreover, the fact that you're in the hospital with a brain injury makes you even less qualified to direct your own care.  

4. That you, at 30, have spent more time in the pokey than I've spent in school. 

Convicts and criminals do not scare me. Nor do they impress me. Your teeth, however, are a different matter--I find the ones that are left both scary and impressive. How'd you let 'em get to that state? It's like something out of the dark ages. Kinda explains those multiple abscesses and the two mycotic aneurysms in your brain.

5. Peeing on the floor as a form of protest.

If you really wanted to impress me, you'd go pee on the board of directors' conference table. Doing it in your room just means one more damn thing for me to clean up.

First, a couple of warnings

1. This is insane in the membranous material. 

2. If you have trouble with vertigo or a fear of heights, do not click the link. Really.

3. It's a full-screen video, so unless you have a high-speed connection, don't bother.

That said....

http://vimeo.com/moogaloop.swf?clip_id=1778399&server=vimeo.com&show_title=1&show_byline=1&show_portrait=0&color=&fullscreen=1

Is there a doctor (or an NP or a pharmacist) in the house?

Turns out it's not a cold, or isn't a cold any more. It's my annual bout with sinus infection and bronchitis. 

Which leads to a question: Why on earth does every NP or doc I see at the doc-in-a-box not want to prescribe Tessalon Perles for my cough? They are firmly against Tessalon and intead write scrips for Tussionex.

Now, I know Tessalon is dangerous if you chew the little capsules, and I know that it "only" lasts something like three hours in the average person. I know that Tussionex (by contrast) has the added benefit of having an antihistamine in it, and that hydrocodone works beautifully as a cough suppressant. However, I hate, hate, hate anything with hydrocodone in it. 

It makes me stupid. It makes me constipated. When I do finally wake up after taking a half-dose of the stuff, I'm shaky and nauseated. It kills the cough, yes, but the side effects are horrendous. Right now I'm willing to put up with the side effects, but I'll probably dump the three-quarters full bottle of Tussionex down the drain in three days, when I've reached my limit.

Tessalon is nice. I take it, I don't cough all night, I wake up un-stoned and happy and well-rested in the morning, without all the crappy side effects of the narcotic stuff. 

Even after 'splaining this to the NP last night, even after pleading for something non-narcotic, I walked out with a scrip for...Tussionex. The NP told me firmly that she refuses refills for that particular drug, so don't even ask. And I wondered, again, why anybody would prescribe something potentially abuse-able with a wide range of fun side effects rather than prescribing something *else*, without the abuse potential and the side effects, even when asked.

I figure there's some huge, good reason for that. What is it, you guys?

Random thoughts, inspired by this virus.

I just finished a lovely hour reading Can't Spell, DVM's blog. Contrary to her title, she can indeed spell, mostly. And the stories are definitely worth a look.

Which reminds me: one thing that people always say to me, when I start talking about critters (especially dogs), is "Why didn't you become a vet?" The answer is very simple: I can't stand to see an animal in pain or afraid. People don't bother me a bit, because people can mostly understand words--or, if they can't, because of a stroke or brain tumor or whatall, they still retain basic human understanding of things like touch and smiles and singing. Critters in pain flip me right the hell out. I have no clue what to do and react badly. 

Once, manymany years ago, Evvie-cat got her front leg stuck in the crack of a staircase and hung up on an old twenty-penny nail. I was in hysterics as I called the mobile vet (thank Frog for mobile vets!). Dr. Mobile came, dropped a towel over her head, unhooked The Flannelcat from the nail, shot her up with antibiotics and maybe a tetanus shot (I may be remembering that wrong; somebody please tell me if cats can get tetanus), and earned my undying gratitude for two minutes' work.

The point here is that I have no trouble at all dealing with a generalized tonic-clonic seizure, a bleeding arterial puncture (which is more like a fountain than a bleed), a patient who's fallen and is unconscious, a code, or even a traumatic amputation. One injured animal, though, would send me over the frigging edge.

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

Speaking of vets, mine has a pet kangaroo that somebody abandoned at the clinic. 

Now, we're in Texas. Texas is a long way from Australia, which is where kangaroos are, as far as I know, from. I suppose you could import a kangaroo, but let's be serious: what would you then do with said kangaroo?

Apparently the kangaroo loves the vet and hates everybody else.

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

I think I've come up with Nurse Jo's Perfect Formula for Surviving A Nasty Cold: Delsym (grape flavor is actually not so bad!) ibuprofen, Mucinex (plain, please; don't overdose on dextromethorphan or go with unnecessary decongestants), soup, and Vick's Vaporub.

A happy puppy and a plate of cheese sticks go a long way, too. So does a glass of wine.

Wups! Happy Puppy is asking to be let in. Hang on...

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

...so. The Cat Thing. 

This house feels terribly empty without a cat.

I think my birthday gift to myself will be a cat. The birthday is two months from now; I figure that's time enough to get over the bleak feeling of having done a cat-avoidance shuffle-step when there is no need, or of checking the couch before I sit down.

I'm going to get a cat that doesn't rush the door. It doesn't have to be a kitten, though the first crop of them will probably be showing up in the shelters in late February. It *does* have to be a shelter cat. And it will be spayed or neutered and NOT declawed. Furniture is temporary; cut-off finger-ends are forever. Future Cat and Max will learn to deal with one another.

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

And speaking of Max, he's a wonder. Does anybody else have a Bullfrog Dog who goes "MMMMMmmmmmmMMMMMMM" when you rub his ears? His nickname these days is Mister Hayes.

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

And, finally, a link I found at Can't Spell, DVM that is totally worth reading: LPN with an M16.

Be well, Army LPN. Come back to us in one piece. Bridge to an RN. I would be more than proud to work with you.

And thank you.

Unaccountable cheerfulness + cough = impending cold

I felt unreasonably lighthearted when I woke up this morning. Then I started coughing; a deep, chesty cough that leaves me sounding like Harvey Fierstein and Eartha Kitt's love child. That combination warns me that I need to stock up on Delsym, decongestants, and zinc, for a cold is definitely on its way. 

Of course, I also don't have to go back to work until Friday. My boss, with a quickness and sensitivity that left me floored, gave me a mental-health day off today. 

Being a nurse gives you plenty of opportunities for gaining perspective. The day after Evvie died, I went back to work. One of my patients had a hyperventilating drama-queen attack about having four staples taken out of her head. I sent another patient to ICU before 8 am so he could be intubated, placed on a fentanyl drip, and sedated in order to control the pain he was having from widespread bone cancer.

I'd say seeing your cat killed lies exactly, perfectly in between those two extremes.

It's also nice to have a job that takes up the majority of your day and leaves you so exhausted at the end, mentally and physically, that any emotional pain that you have feels like it's happening to somebody else. The last few days have sucked big jaggy rocks, yes, but they would've sucked more had I been a waitress or a checkout clerk or an accountant. Or, frankly, if I'd stayed home and stared at the empty couch and wept.

As it was, I ran around like a chicken and solved problems and passed meds and changed dressings and, while I didn't smile much or make a lot of jokes, I was at least functional.

*sigh*

The next few weeks will be tough. The hardest part of this has been watching Max react to the fact that there's no cat in the house. Max grew up with dog-loving cats and had always treasured the hope that Evvie would someday like him; he keeps looking for her behind the couch and the Christmas tree. Watching him search behind things with his tail wagging, then watching the wag slow and stop and the tail droop...it's hard.

But. Eventually there will be another cat. With luck, it'll be a Max-friendly cat. 

And in the meantime, I'll stop over at the neighbors' house in the next couple of weeks and offer to help them dog-proof their fence for real.

My cat just got killed.

So here I am, writing.

The postman came to deliver a 50-ounce reservoir for the pet fountain I'd gotten Evvie. She must've slipped out the door while I was taking the thing. She never went out in the front yard, only in the back, where she stayed inside the fence with Max.

The first inkling I had that something was wrong was a scuffle in the bushes outside the office. I heard a growl and a larger scuffle, and ran outside without even realizing why. There were the two dogs from across the street, Sammy and Veruca, with Evvie in between them.

They broke her back, or her neck. At any rate, it was quick. I chased Veruca out of the yard and across the neighbor's yard--she had Evvie in her mouth--and managed to scare her off on the other side of Preacher Paul's yard. Evvie was already dying at that point.

She didn't seem to be hurting. She was stretched out on her side, breathing slowly, and I petted her head and told her she was a good kitty and that I was there with her. She coughed three times, I guess because she started to fibrillate, and then her body relaxed and she was dead.

It's not all that different with a cat than it is with a human.

The woman--girl, really--who was in the house was much more freaked out than I was. I don't blame her, or the dogs...the dogs were doing what their breeds *do*. They hopped a huge chain-link fence to get out and run around, and Evvie just happened to be in the wrong place at the wrong time. 

I wrapped Evinrude up in a pillowcase and buried her in the back yard, in a corner of the garden. Maybe I'll put some horrible little cat statue over her grave. In the meantime, though, there are cement stepping-stones over it to keep Max from digging. He was quite confused and concerned about the whole thing.

Evvie was thirteen. She was a horrible cat. She never caught a mouse in her life, and was prone to slash and bite without warning. Occasionally she would deign to let some privileged human, like Chef-Boy, pet her while she was on their lap. She hated dogs, vacuum cleaners, and brooms. She peed on the rug and scattered her food and water everywhere. She shed like a beast. 

Just before the postman knocked, she was stretched out, full-length, on my belly. She was letting me play with her paws, and purring. I'm glad she didn't die when I was pissed off at her, or when she had an empty belly or was cold. I loved her, in spite of her.

Dammit. Dammit. Dammit.

A Christmas Gift Poem

The whole week before Christmas, you know what I did?

I stayed home and sewed on a nine-foot-long squid.

The gift that my boyfriend had wanted for years:

I decided to make one, in spite of my fears.

Twelve yards of pink fabric was where it began;

I patterned and researched and worked out a plan.

The cutting was easy. The stuffing was harder.

I'd've done it a month ago, if I'd been smarter.

The folks down at Wal-Mart were silent with scorn

As I checked out my goods on a cold, icy morn:

Ten pounds of white fluff and a dozen cheap pillows

To fill up my Squid with the softest of billows.

The tentacles, each five feet long as they are,

Were hardest to sew on (and fit in the car).

The eyes were the simplest: I just glued them on.

The fiberfill? Half the world's stock is now gone.

The day before Christmas, I stood there and stared

At this huge cephalopod that I had prepared

And pondered just how this gift might be received;

"Love it or hate it, it's done. I'm relieved."

I hauled it the half-mile to Chef-Boy's lair

Arranged it, half-sitting, on his bed with care;

And stepped back, unsure of the scale of the thing

Now that it was finished, The Minky Squid King.

If I had been thinking, before I had lugged it

The half-mile to David's, I ought to have bugged it.

I missed his reaction, but here's what he said:

"I screamed, then I laughed, then I hugged its pink head."

He loves it! I'm happy. The project is done.

Though it drove me half-crazy, I guess it was fun.

Dave filled me with fear, though, when I heard him say,

"Now all it needs, dear, is a toothfish. For prey."

(Yes, I did make a nine-foot-long stuffed pink Colossal Squid out of Minky fabric for Chef-Boy. Yes, I do have pictures. Not very good ones at this point, but some. Once we get more pictures of Squidly [we plan to pose him sitting at the computer, on the couch, driving, etc.] I promise to post them.)

(Also, please don't ask me for patterning advice on Squid. I did it on the fly, cutting away the bits of fabric that weren't Squidlike. It's testament to my nonexistent sewing skills that the damn thing turned out approximately one-third larger than I had intended it to. Six feet by two? That's a manageable squid. Nine by three? Not so much.)

Hot Air Vent

Every year at Sunnydale, we have a big Christmas party. I mean *big*. Our floor feeds all our employees, the employees from various other departments, and sundry patients and family members. We plan the thing for weeks in advance and everybody chips in.

There are rules. If you don't bring enough food to feed a minimum of twelve folks (or one hungry resident), you have to pony up cash. There's no set amount, but whatever is given should be given without our having to pester you or your whining about it. Likewise, if you didn't bring something or pay money, you don't get to take any leftovers home. And, finally, we leave the vast majority of food for the night shift and residents, who reciprocate throughout the year.

Sounds reasonable, right? And you know where this is going, right?

I have two coworkers: The Thiever and The Bitcher. 

The Thiever steals anything and everything that isn't tied down: potted plants, toilet paper, items left unclaimed in the lost and found, people's empty totebags that are left a moment too long, clean Tupperware from the kitchen.  I understand that two kids and a deadbeat husband can make things tight, but c'mon. There is a limit.

Plus, she hates giving money for parties and doesn't cook.

The Bitcher has not--and here I do not exaggerate, for once--ever eaten anything besides meat and starch in my presence. Everyone else's food is fair game for her wrinkled nose and expressions of disgust. Vegetables are a foreign concept, as is any cheese that is not processed. She lacks even the most basic dinnertime manners. She would give my mom a heart attack.

Plus, she hates giving money for parties and doesn't cook.

I know you can see the end of this tale, like the steeple of a church rising up from the Alberta horizon, but bear with me. My blood pressure is insanely high.

Friday was the annual Xmas Do. Those of us who cook spent hours preparing food (and a good chunk of our own change), setting up the tables, and making sure things were hot. There was a turkey. There was a ham. There were various side dishes including, but not limited to: greens, macaroni and cheese, scalloped potatoes, mashed potatoes, dinner rolls, bean casserole, an enormous green salad with walnuts....you get the idea. I made four pies and a cake for the dessert course. We rocked out. 

Come afternoon, The Thiever arrived with--and again, here I am not exaggerating--a stack of plasticware and a couple of trash bags, and proceeded to scrape, pile, dump, and ladle all of the leftovers she could fit into the plastic containers. This after not giving any money or time to the party fund or even bothering to show up for the damn thing.

The Bitcher joined her in the kitchen and offered a running commentary on what was good, what was bad, and what was just plain too weird to eat. 

I was washing dishes and so got to see and hear the whole thing. After hearing my beautiful Potatoes Savoyarde denigrated as being "funny-tasting" (that would be the Gruyere, thanks), I lost it. I put down the sponge and grabbed the plastic container with the half of an apple pie in it.

And I snarled, "Get OUT." Like a pink-eyed pig on a fire escape, I was.

I was met with expressions of disbelief.

"Neither one of you," I hissed, "Did one fucking thing for this party. You" (stabbing finger at The Bitcher) "refused to eat anything without complaining about it. And you" (ditto at The Thiever) "didn't bother to show up, pay even five bucks, or cook anything. You do not get leftovers. Bitcher, you do not get any more food from me."

"I am not done cooking, but I am done cooking for you two damn fools."

And with that, my beloved, blessed, wonderful coworkers, who had heard the whole thing, all stood up silently and began to unload the various plastic tubs and boxes from The Thiever's bags and return them to the fridge for the night shift. The Bitcher stood there flummoxed and protesting that she was only joking, but everybody ignored her.

And on Christmas Day? When we're all working together again and a few of us are bringing breakfast? 

My two worthless colleagues will have to brown-bag it or buy something from the vending machines. I am *through*.

Next Time, Call 911: A Public Service Announcement

I'm cutting the snark for this one, people.

A friend of mine (let's call her Jan and say she's an accountant, shall we?) told me on the phone that one of her coworkers had developed some worrying symptoms while at work. She'd suddenly been unable to remember anything beyond showering that morning, her speech became slow and her thought processes confused, and she began to drag one foot.

Jan told me that they sent the woman home with her husband. I told Jan--trying my best not to be judgmental, because Jan is in no way associated with the medical profession--that she should've called 911, that those were the symptoms of a stroke.

Jan replied, "We tried to convince her, but she wouldn't let us call the ambulance."

And here's the PSA part of this post:

The next time somebody you work or live with exhibits symptoms like speech difficulty, memory loss, numbness or tingling on one side of the body, gait disturbances, or simply something that seems "off"--like a really bad headache--call 911. 

It doesn't matter if they want you to or not. This is a "Fuck you, I'm calling 911" moment.

See, with strokes, there's a really, really limited amount of time during which treatment can do any good. With ischemic (clot) strokes, it's in the neighborhood of three hours. With hemorrhagic (bleeding) strokes, it's even less--time is of the essence in either case.

And, quite frankly, the person with the symptoms does not get to make the decision on what's appropriate. They're the ones having the symptoms, right? Uh...yeah. And their brain is already not right.

It's really hard not to make somebody like Jan feel defensive when you say, "Listen: next time, just call 911, okay?" It's also really hard to make the decision to call when the person you're calling about is quite upset that you would do such a thing. And, of course, there's a whole 'nother level of bumblefuck that ensues if the person with the symptoms gets it together enough to refuse ambulance transport.

The point here is that you only have one brain. What you do with it is your business, of course, but if you notice something off-key with your own or another person's brain, it's the responsible thing to do to notify people who have good drugs and machines that go beep. If it's a false alarm, dandy. But if it's not, and you send that person home to sleep....

Well. Jan's coworker is fine. What she had was either (probably, since I'm no diagnostician) a TIA or an atypical migraine. Jan and her other coworkers are still encouraging her to see a doctor next week.

The coworker got lucky.

Next time, call 911. Please.

*sniffle*

Rest in peace, First Lady. May you and the Great Bird explore the universe.

My Trekker heart is sad.

Things that solve a bad week....

Head Nurse Salutes....

A disciplinarian for the ages.

RIP, Bettie.

Things that make me go * blink *

Nurses can, as I illustrated in my last post, be jerkwads who jump to conclusions.

Every once in a while, though, somebody goes above and beyond and says something that makes me go *blink*.

About a young, gay, HIV+ guy I was taking care of: "You have to watch out. Those people will try to spit on you or bite you and give you the AIDS."

Me: *blink*

About a young female sex worker with a galloping case of CNS cancer: "What do you expect, with a lifestyle like that?"

Me: "Tell that to the chick in the next room." (A young female Evangelical Christian missionary with, you guessed it, a galloping case of CNS cancer.)

About a woman who topped 400 pounds and had recently had gastric bypass: "Jesus Christ, woman! Go for a walk!"

Me: After we all rolled our eyes at that nurse, I started thinking about how we wouldn't tell people with heroin addiction to just say no--after all, Nancy Reagan was rightly criticized for a simplistic approach to drug addiction. Yet we expect people with chemical imbalances just as serious as those in drug addictions to...what? Push away from the table? Just say "no" to a slice of pie? Why aren't food addictions treated as carefully and aggressively as drug and alcohol addictions?

About a man with a history of clinical depression: "Oh, great. Another whining drama queen."

Me: "Excuse me? EXCUSE ME? What the FUCK??" (Yeah, the Effexor makes me a little aggressive sometimes. Wanna make something of it?)

About a recent African immigrant who had lots of family in the room: "You can't tell those people anything. They're just animals."

Me: *blink* *blink* *gape*

My Ghanian coworker: "Excuse me? Excuse me? What the FUCK??"

About a female bodybuilder who'd come in for back surgery: "That sort of muscle on a woman is just so dykey."

My bodybuilding coworker: (leaning her muscular upper body over the table) "What? I can't hear you. Could you repeat that, please?"

Yeah. So we have some winners in our ranks, for sure. Sheesh.

The only thing to do, when faced with a bigot or a jerk, is to call them out on it. Sometimes you have to call them out repeatedly and loudly, as in the case of the nurse (now thankfully gone) who'd expound on the sinfulness and horribleness of various lifestyles other than her own. Sometimes a raised eyebrow is all it takes. And sometimes, in the case of the nurse who warned me that my patient would "try to give me the AIDS", all you can do is blink and walk away.

In which a bigoted jerk* jumps to conclusions and learns a lesson.

The patient was pretty typical for rural areas around here: no teeth to speak of, a lifetime of smoking, sun exposure, and manual labor, no education past about the ninth grade. He enjoyed Jerry Springer, betting on cockfights (illegal but still big money-makers around here), and the occasional night out with the boys, bowling.

I was changing his dressing. It was one of those involved dressing changes where you end up next to the bed for half an hour, taking off layers of this and that with your mask and gown on. CNN or CNBC or MSN--one of those channels involving political analysts--was on, and he was making light conversation about cockfighting.

Then the subject changed.

"This Barack Obama..." he began. I mentally steeled myself for what was to follow. People will say anything to a nurse, especially when she's wearing full isolation gear and a mask with an eyeshield. 

"This Barack Obama. I'm looking forward to having him as President."

I glanced up and said "mmmmm", which is my usual reaction to patients who talk politics. I was waiting, as it were, for the punch line.

"He looks like a smart guy," the patient continued, "and he seems to be pickin' people for his cabinet who may not necessarily agree with him all the time, but who know their stuff. It'll be nice to have a smart person in office again."

I blinked. "Mmmmm?" I said.

"Well, you know, Bush was all right there for a while, but he kinda got a lot o' yes-men up in around him, and things just ain't been goin' right. Obama may not have a whole helluva lot of experience, you know, but he's doin' all right so far."

I blinked again. I glanced at the patient. "Mmmm? Mmmm."

"I don't think it's elitist," he continued, gesturing at one of the talking heads on the TV, "to have a constitutional expert up in office. I mean, we've seen what the Patriot Act did for civil liberties and for privacy rights, and it's just been a mess. Plus, you add in that whole...whaddya call it? Kyoto protocol? That one we didn't sign? We need to git on that, right now."

I finished taping down the dressing and took off my mask. "You seem to have some pretty unusual views about politics, my friend," I said. This is, after all, a solidly Republican area.

"Well, just because I didn't finish high school don't mean I can't watch CNN and listen to NPR," he replied.

So I sat down for a few minutes. It was the end of the shift and the day had been light, and I had time. We talked about Obama, the recent court challenges to the FLDS out west, and whether or not romance, as a concept, was dead. At the end of it he shook my hand and told me that, if I ever developed an interest in watching roosters fight, I should look him up.

(*That, of course, meaning me.)

The Thanksgiving Party At Sunnydale General...

I'm on the left.

(Stolen from Manolo For The Big Girl, with thanks.)

In which Jo gets a bit snippy

When one blogs, one gets comments. One also gets emails.

It's amazing what people will say in emails that they won't say in comments. It's like the kid who bullies only when he's alone with another kid, not in front of witnesses. 

Apparently, folks don't like my grammar. They don't like my tone. A couple of 'em really hate the personal posts, while others don't like the posts about Manglement (or the fact that I refer to Manglement as Manglement). A few take issue with the new layout of the blog and get personally insulting in the process. There have been more than a few men (all have been men) who have gotten their socks in a twist because of my silly insistence that perhaps a) nurses ought to think of themselves as professionals and b) health care is one of those things that you shouldn't have to mortgage your life to get. Those guys are by far the worst in terms of being just plain rude. Guys, guys: you kiss your mother with that mouth?

I have this to say:

People. This is a blog.

There are approximately seventeen quintillion blogs out there. Approximately half of those are medical or nursing blogs. The other half, as near as I can tell, are divided about equally between cute animals doing cute things and beauty/celebrity/fitness topics.

The influence of this particular blog on anything going on in the world is proportional to its share of the Great Blogging Pie. In other words, with eight-and-a-half quintillion nursing and medical blogs out there, this one is just not that important.

You can relax, I swear. Nobody is gonna read HN and decide that it's time to overthrow the medical establishment, thus depriving you of whatever it is about your career that you find so important to protect. There is not a secret cabal of coruscating feminist nurses somewhere underground that uses HN as its template for revolution, its manifesto, its creed. HN is not going to raise your taxes, restructure your insurance company, take all the profits you make by inventing drugs and devices, turn nursing into some Amazonian society, or kick your puppy. Especially not that last bit.

Also, I am not undermining your attempts at formalized writing. See above: this is a blog. You ought to be concentrating on blogs that have posts that begin with letters and numbers and leet-speak, for God's sake. 

I am not making fun of you. Well, maybe a little. If you're the sort of doctor who reads a fictionalized account of my day and assumes that the doctor I'm talking about is you, rather than a composite of all the docs I deal with on a daily basis, then yes, I'm going to mock you. Relentlessly. You deserve it for being so damned self-important.

I do not talk to my patients the way that I write. Come on.

If you're so moved, either positively or negatively, by something that I write here, you're welcome to email me. The link's to the right. If you want to fawn, compliment, or give me big props, that's lovely. It gives me a nice warm feeling that lasts about a second, until everything snaps back into perspective.

If you want to send criticisms, that's lovely too. Just make sure they're rational and not personally insulting, okay? Ad hominem attacks will be promptly forwarded to the trash folder.

And if you just want to rant about how HN is destroying the foundations of nursing as a Blessed, God-Ordained Helping Role or how HN is fomenting revolution or how HN is a Feminazi mouthpiece, please, turn off the computer. Go outside. Pat your puppy.

It is just a blog. There are seventeen quintillion of them out there. Keep that in mind.

What to Expect When You're Expecting A Craniotomy!

Here beginneth, by the way, a series on what patients can expect from various fun procedures that are common at Sunnydale General.

So you're having a craniotomy. Let's gloss over, for the moment, whether it's for a tumor or an aneurysm clipping or an external-to-internal carotid bypass, shall we? Most craniotomies have the same side effects and recovery time, so we'll ignore the whole range of reasons for them and focus on the important thing: Somebody way smarter than you will have his (or her) fingers in your skull.

Actually, that's not quite accurate. Somebody way smarter than you will have a series of microscopic instruments inside your skull. The point is, though, that your skull will be opened up (a thing that's never meant to happen) and closed again. Great. What can you expect from the process? Read on:

Prior to Surgery

The day of surgery, you'll be expected to show up at the hospital early in the morning, probably with freshly-shampooed hair. You'll be hungry and thirsty, having not had anything to drink or eat that morning. Somebody will start an IV line on you and fluids, which will help with the thirst part, and give you a dose of something to make you happy. Then you'll be wheeled into the operating room.

Surgery Itself

At this point, one of two things will happen: you'll either be put out completely by the friendly anesthesiologist, or you'll be moved to the operating table, *then* be put out by the F.A. Your head will be positioned in a head-holder (tough medical terms, I know!) and anything from a small strip of hair to half your head will be shaved, depending on the surgeon.

Note: Most docs now shave only what they have to, so don't think you'll lose all your hair.

While you snooze, your head will be scrubbed with a sterilizing soap and draped with sterile drapes. Somebody else will be working on your other end, putting in a urinary catheter.

Once everything is ready, you'll have surgery. Since I have no clue what actually goes on inside the brain during surgery, and you'll be asleep for it, let's move on to the post-surgery period.

After Surgery

You'll wake up, more or less, in the ICU. You'll have wires on your chest, IV and intra-arterial lines in your arms and possibly feet, and you'll feel like hell. Your throat will be sore from the breathing tube they put down you to keep you breathing, and you'll still have that damned catheter in. You'll also probably have a doozy of a headache. This will all cease to matter as the fact that you're in the ICU dawns on you, and you have to cope with bright lights, beeping machines, and nurses coming in every few minutes to make sure your neurological exam hasn't changed. Expect them to ask you silly questions like "What day is it?" and shine bright lights into your eyes over and over. 

After a night or two in the ICU, you'll be moved to a neurosurgical acute care unit. All but one or two IVs will come out, along with the line in your wrist that monitored your arterial pressure. Expect some major bruising there, by the way.

After I introduce myself, I'll take out your catheter. You have eight hours to pee, which shouldn't be a problem. The catheter removal doesn't hurt (at least the way I do it) and you'll feel a lot better after it's gone.

You'll be able to eat regular food if you can, and I'll manage your nausea if you're feeling queasy. Don't ask for Phenergan, by the way, since you won't get it. It makes you too sleepy.

I'll be checking your neuro status every four hours, or more often if I'm a tad worried about you.

The first afternoon out of ICU, you'll probably sleep. This is normal. You might feel *great*, what with all the anesthesia still in your system, but you'll be sleepy the next day for sure. Either way, sleepy or not, you're getting up into a chair and walking a little bit, just so I can be sure everything got put back into the right place.

Okay, So Now What?

Let's take a look in the mirror, shall we?

You'll notice that, if your incision is along the front or side of your head, you have a whopping black eye and a whole lot of swelling on your face. This is totally normal and will go away completely within about ten days. You'll also see a shaved strip or patch of hair with either staples or sutures in it. That's where they went in, and those staples/sutures will come out in about ten days, just as you're looking less like you've been hit by a truck.

You might have punctures in your forehead from that head-holding widget I mentioned earlier. Those will heal and leave very small scars if there are any scars at all.

There are probably bruises on your arms from the IV and a huge bruised area on your right wrist from the intra-arterial line. Your jaw (if your incision is in the front or side) is sore, or your neck (if it's in the back) feels like you have one hell of a crick in it. We can take care of that; just ask for pain meds.

You will probably hear ticking, dripping, thunking, swishing, or popping noises inside your skull, especially if the incision is on the front or side, or around your ear. That is Totally Normal, and is a result of air in your head moving around. You are not insane. The surgeons *always* forget to mention that, and it makes people worry.

You will get very tired very easily. Keep this in mind. You'll find that mental things, like crosswords or reading, tire you faster than physical things. This is because you're basically trying to walk on a sprained ankle--in other words, you have to keep using the part of your body that's been injured or insulted, even as it heals.

Even with the tiredness, you may have trouble sleeping. This is due entirely to the fact that you're getting Decadron, a steroid, to reduce swelling inside your brain. That side effect will go away as soon as we start tapering (lowering the dose) of Decadron, so don't fret. In the meantime, ask for a sleeping pill.

You'll notice that I'm loading you up with laxatives and stool softeners. This is a major deal, since constipation goes hand-in-hand with pain medicine, and I don't want you straining. If you go more than two days without pooping, I will take Drastic Measures. 

Speaking of pooping and peeing, I'll take great interest in how much you drink and how much you pee. This is because opening the brain or spine can lead to various problems with how your body handles fluids, and I want to make sure that's not happening with you. 

After Discharge

When you go home, you'll want to take it easy for two to six weeks. Walk, eat, sleep, sit up in a chair, be calm. You'll have a followup appointment in about two weeks with your surgeon, at which time you'll chat about the surgery and he'll make sure he didn't leave any bits out. 

Make sure your diet is good. Your appetite will probably suck, so eat good food when you get hungry. Include protein and some fat. Avoid junk. Drink plenty of water.

Nap occasionally. Let your body tell you what it wants to do.

And don't worry about screwing something up. Depending on your doctor's orders, you may or may not put antibiotic ointment on your incision or take oral antibiotics. As long as you don't scrub the incision line with a toothbrush (and yes, I have had people do that), it won't get infected.

Don't perm or dye or relax your hair for about six weeks after the staples or sutures come out, though, 'cause that scar is still delicate. And don't use a hairdryer: it'll cause staples to become uncomfortably hot.

Finally, remember that you have had brain surgery. It might be six months before you get your stamina back, okay? Take it easy. In a year, this'll all be a bad memory.

Here endeth the first lesson.

11.11, 90 years ago.

In Flanders Fields the poppies grow 
Between the crosses row on row, 
That mark our place; and in the sky 
The larks, still bravely singing, fly 
Scarce heard amid the guns below.

We are the Dead. Short days ago 
We lived, felt dawn, saw sunset glow, 
Loved and were loved, and now we lie 
In Flanders fields.

Take up our quarrel with the foe: 
To you from failing hands we throw 
The torch; be yours to hold it high. 
If ye break faith with us who die 
We shall not sleep, though poppies grow 
In Flanders fields. 

And one for Canela Cruz, in Iraq now...

Ashbah

The ghosts of American soldiers
wander the streets of Balad by night,
unsure of their way home, exhausted,
the desert wind blowing trash
down the narrow alleys as a voice
sounds from the minaret, a soulful call
reminding them how alone they are,
how lost. And the Iraqi dead,
they watch in silence from rooftops
as date palms line the shore in silhouette,
leaning toward Mecca when the dawn wind blows.

What I cook on my day off, when I have a cold

It's been raining buckets all day. Just now it's raining double-buckets, which makes me glad that I have a cold and the next two days off. The cold isn't bad, really; I've been taking loads of zinc, which really does seem to help hold off the worst of the symptoms.

I also have a loaf of bread and a pot of soup. Therefore, the recipes:

Nurse Jo's When-You-Have-A-Cold, Clean-Out-The-Fridge Soup

1 small box chicken or vegetable broth

1 normal-sized can of diced tomatoes in juice

1 normal-sized can of red kidney beans, drained and rinsed

Dump all of these into a big pot. In a skillet, saute without browning

A half of a fist-sized yellow onion, diced 

A couple of cloves of garlic, minced (I use, like, six; but I'm weird)

A couple of stalks of celery, de-stringed (you do this by breaking the tops off and zipping the strings down the stalk)

Dump the skillet's contents into the pot once everything is nice and soft and fragrant. Turn the heat under the pot on to the point where it's not quite boiling. Add:

A small potato, peeled if you like and cut into cubes

Some corn (I used frozen)

A couple of handfuls of sliced-up green beans (I used frozen)

Some carrots, chopped 

Zucchini, yellow squash, peppers, more tomatoes; whatever you have in the fridge.

Simmer for about twenty minutes, or until the potatoes are almost done. Add:

A biggish bunch of parsley, tied with a string if you've got it

Some lemon zest if you've got it; if not, try thyme

A little rosemary (everybody has rosemary, right?)

A shocking amount of ground black pepper

More salt than you would think

Continue to simmer until the potatoes are nice and soft and come to bits when you poke them.

Eat with Basic White Bread:

Sometime earlier in the morning, if you want bread, you will have wanted to mix up in a nice, big bowl:

4 cups high-gluten ("Better for Bread") flour

A cup and a half, roughly, of water (room temp is fine)

A packet of instant ("Rapid Rise", "Better for Bread Machines") yeast

A tablespoon of salt

Mix that mess on up until it makes a big lump in the middle of your bowl. The dough should look shreddy and weird and kind of like it doesn't really want to stick together.

Dump that mess onto a clean counter that's been lightly floured, or onto a big cutting board, ditto. Knead it by pushing down with the heels of your hands in the middle of the mass, pushing outward, and then folding back in toward you. Do this for ten to twelve minutes. Don't skimp. Turn the dough around between foldings to make sure it's all evenly beaten up. Meditate on something pleasant while you knead. Pleasant thoughts make good bread.

At the end of 12 minutes, you will have a cohesive mass of still-fairly-dry dough. It'll be tacky, but not sticky, and you won't have to have flour under it to keep it from sticking to the counter or cutting board. 

Scrape the remnants of dough etc. out of your bowl and toss in a tablespoonful or so of good oil. Toss the dough ball into the bowl, turn it once so it's nicely coated, and cover the bowl with a damp towel. Set it all aside and forget about it for one and one-half hours. First, remove a stick of butter (not margarine not Promise spread not I Can't Believe It's Not Nuclear Waste--BUTTER) from the refrigerator.

At the end of 90 minutes, which I suggest you use for a nap, punch the dough down. Without removing it from the bowl, push into it gently but firmly with your fist, all over, until it looks sort of deflated and defeated and flaccid. It will give off a nice yeasty smell when you do this. 

Cover it back up and go do something else for another 90 minutes.

At the end of your second nap, dump the now-floofy and soft dough back out on your countertop or cutting board. Rummage around until you find a pan that measures 9 by 3 by 4 inches, or a good flat cookie sheet, or something to hold the dough while it bakes. Butter or grease the pan/sheet/flowerpot well.

Turn your oven to 350 degrees.

Return your attention to the dough. Squoosh and push and coax it into something resembling a loaf, or a round peasant loaf, or a long baguette, or a bust of Elvis. Put it into your greased pan/onto your greased cookie sheet/into your flowerpot and let it rise for, oh, 30 minutes or so, or until its top is nicely rounded over the top of the vessel it's in. You'll know it when you see it; your brain will say, "Oh! That's a loaf of bread! Dayum!"

Put bread in oven. Bake for anywhere from 45 minutes to an hour and 15 minutes. It's ready when it's a nice, even, golden brown all over (this bread will not get very dark) and when the bottom makes a good, hollow THUNK when you tap it. 

Note: If this is the first time you've made bread--and I swear you can, with this recipe--you will be entranced with the THUNK the bread makes when you thwack it with your finger. Do not sit in front of an open oven, bread in your oven-mitted paw, THUNKing the bread over and over.

Take it out of the oven and let it cool on a rack, out of the pan, for about 40 minutes. This part is REALLY FUCKING IMPORTANT, okay? If you cut into it when it's still hot, not only will it accordion on you and smoosh all down and get weird, but it will taste of uncooked dough. Bread continues to bake on the inside when the outside is done. So leave it alone. Do what I did today: take some cold medicine and have a whiskey-and-lemon and read for a bit. The butter will be soft enough to spread, and I promise the bread will still be warm when you cut into it.

If you're *really* smart, you'll start the soup when the bread is about ten minutes from being done--that is, when it's blonde instead of golden and doesn't *quite* smell like bread yet. That way, you can have your finished soup and your bread and butter and your hunk of smoked cheese from a dude that makes such things out of buffalo milk for dinner, and your dog will (as Max did tonight) sit quietly next to the table, whining and hoping you feed him some bread.

And then you can take some more zinc and feel good about your day off.

What the hell is WRONG with you people?

Quick update: My folks are apparently in Mexico and are fine. Uh...okay.

Now, then: What the hell is WRONG with you people? Are you all mad as a sack of badgers? Where the hell do you get off? Whiskey Tango Foxtrot, you guys?

I mean, really. Do not (I repeat, do not) start a fistfight with your relative in your elderly and ill other relative's hospital room. If you do, I will be forced to call the police. And the po-pos, having dealt with your lousy self already, will not be happy that they have to come break that shit up.

Again.

Also, do not piss and moan and complain until I move heaven and earth to find an interpreter that speaks the same language as your patient from Furthest Backobeyondistan, then fail to show up at the hospital, or even return your pages, after I find the one person in the very large metropolitan area that speaks East Wanganese. The East Wanganese interpreter will be very disappointed, and the family members will be disappointed, and there will be unhappy people wandering around, wanting to start fights in some language other than English.

Luckily, since I know exactly no East Wanganese, the torrent of abuse that was levelled at me because of your idiocy, Doctor, rolled off my back like so much milk off a cornflake.

And finally, and I can't believe I am having to say this yet a-bloody-gain, the hospital is not the place to host Tupperware parties, drinking bouts, drug deals, furniture sales, porn movie festivals, panhandling competitions, the 2008 TV-Stealing Olympics For The Poorly Dentitioned, or any other harebrained, jackassed idea you might have.

Whatever you think is a good idea, I can tell you right now is totally inappropriate, will probably have the aforementioned police showing up at your room, and might get your rhino-assed self kicked straight back to County General. 

I am now going to finish this Scotch and go back to bed. Your behavior had better have improved by Wednesday, or else I'll give you something to whine about.

JAMES JAMES MORRISON'S MOTHER/SEEMS TO HAVE BEEN MISLAID

Has anybody seen my parents? If so, could you please contact me and let me know they're okay? 

I'm afraid, what with the outcome of this election, that they've decided to move somewhere more right-wing without telling Beloved Sister and me.

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

Max has learned to bay.

He's made great friends with an extremely wiggly, extremely friendly half-grown Basset hound down the street (whose owners are kind enough to let her off-leash to come visit him) and has learned her tricks.

Given that she's a bass and he's more tenor-to-alto in his baying, it makes for a funny duet. You hear the lower, deeper dog noise and expect that Max would be making it, but instead it's Gretchen The Basset. Max is the one whining and whickering in a high voice and baying way up, an octave above Gretchen's bay.

Max and I sang a duet to the passing ambulances and firetrucks the other day, and Gretchen joined in from four houses down. 

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

Today I did 60 pushups, military-not-girly, and then did 60 lat pullups with 20 pounds and some shoulder rows (30 lbs) and some shrugs (20 lbs) and 60 Aaaahnuhld bicep curls with 15 libs apiece. My upper body is a thing of beauty. It's also very, very sore.

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

If you are a rehab nurse with a patient on a bowel program, please, please make sure the patient actually takes a shit now and then. Especially after they have a barium swallow. That will save me from the fun of milk-and-molasses enemas followed by slow Go-Lytely feeds followed by projectile vomiting (the patient's, not mine), followed by the realization that there are now no bowel sounds where there used to be a few, followed by Reglan IV, followed by erythromycin in an attempt to get the bowels loosened up, followed by an admission of failure, a GI service consult, and surgery.

Thank you. Really.

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

I do not think, coruscating feminist that I am, that it is sexist to ask what the fuck was up with Michelle Obama's dress the other night.

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

Have I mentioned how glad I am that we will have a vice president who doesn't believe that Adam and Eve co-existed with dinosaurs? I mean, really. Do people like Sarah Palin (young-Earth creationists, that is) use antibiotics? Or any sort of genetic testing? Or any of the boons that science has granted us? Because if they do, they should be outed as hypocrites.

It puts me in mind of a Doonesbury cartoon from a year or more ago, in which a doctor was telling his patient that he (the patient) had TB. He offered the patient the option of prayer or antibiotics, reassuring the guy that the antibiotics were "intelligently designed".

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

If anybody has any good sources for upholstery fabric, please email me at the link to the right.

Housekeeping note:

I've deleted a couple of links.

They were to blogs that were, for the most part, much more conservative politically than I am. It's not because the authors are conservatives that I deleted them; I agreed with those authors more often than you'd think, and on a wider variety of issues.

The reason I've deleted the links is this: in the aftermath of the Presidential election, the comments sections of those blogs, including comments left by the authors of the blogs, contained some of the most vicious, mean-spirited, and even out-and-out racist shit I've ever read. 

I understand that Republicans and other conservatives must be angry and disappointed as hell right now. If Obama had lost, I would probably still be in bed, planning only to nurse a hangover and learn French prior to my move to Montreal. I would be peevish about a stolen election and bitter and crying. So it's understandable that there's some serious, serious grouchiness out there in Conservative-Land.

What's not acceptable is the amount of vitriol and the thinly-veiled racism. Vitriol is understandable and even allowable in small amounts, but gallons of it poisons discourse. Racism isn't understandable or allowable, even in small doses. If you want to make jokes about getting rocks of crack at the polling station or how watermelon is going to be the new national food, you go right ahead--but I'm reserving my right not to have that sort of crap linked from here.

This isn't a pouty, I'm-not-reading-your-blog-any-more whine. It's an explanation of why, the day after the election, my links list is shorter. 

When the code doesn't work

Everybody loses patients. Everybody remembers the patients they lost--maybe not by name, or even by face, but you remember. Every patient who dies leaves a little hole in you.

The first one is the worst for most people. And it's bad enough when it's a patient who's been shifted to comfort care; it's worse when it's a failed code. When you walk into a room to find a person, who was fine half an hour or an hour before, is just plain dead, it's shocking. Codes are shocking, too, in their violence and their (usual) pointlessness.

That happened to a coworker of mine the other day. Her patient had been fine and stable and cheerful all shift long and had laid down to take a nap near the end of the shift. He was scheduled to go home the next day. When she made her last put-'em-to-bed rounds of the day, she found him not breathing, not pulsing, not responding. Just plain dead.

And we coded and coded and coded and it had the predictable result.

So what do you do when a code fails?

Well, first, you allow yourself a little freak-out. If you're lucky enough to work where I do, the other nurses on the floor will pick up the slack for ten minutes while you lock yourself in the bathroom and flip your lid. If you're not lucky that way, you'll have to do it while you fill out paperwork and call the eye harvester folks.

Then you figure out what went wrong. In most situations, absolutely nothing anybody could've done would've prevented the death. Short of overdosing a patient on medications or giving them the wrong blood or shoving a tube feed into an arterial line, dying is not something we have a whole lot of input into. Still, it's helpful to think about what led up to your patient's stopping breathing, if only because it'll reassure you that you didn't screw up.

Then you deal with your other patients. It's easy to forget, in the aftermath of a code, when you're overwhelmed with emotion and paperwork, that there are four or five or six other people that are still alive that are depending on you. 

Finally, at the end of the shift, you go home. 

Think about your patient. Raise a toast to 'em, if that's how you roll. Talk to your partner. Hug your kids or your dog or your cat. Roll into bed, with or without the general anesthetic of your choice onboard, and remember that every shift is a new one.

Everybody dies. Some of us die more easily than others, and in better situations. There is not a damned thing you, as a nurse, can do to prevent a death if it's gonna come anyhow. The best you can do is learn from the situation if it's less-than-ideal and use that knowledge to improve the lot of the next folks you take care of.

Yes, We Did.

Is there a physicist in the house?

You remember, I'm sure, the high school physics demonstration of the space/time continuum and how gravity affects both space and time. It's the one that uses a rubber sheet and balls of varying sizes and weights.

Your teacher (or the guy on the public-access cable channel who had sticky-up white hair and a bad lab coat) stretched the rubber sheet tight to illustrate space/time. Then she (or he) dropped a marble or a tennis ball or a bowling ball into the middle of it, and the sheet bent around the ball. Right? You with me so far? After that first object was dumped into the sheet, everything that came after gravitated toward the heaviest thing on the sheet, remember?

So here's my theory: a patient arriving from post-op or directly from admissions has the same effect on the space/time continuum as that bowling ball did when dropped on the rubber sheet. Every other patient you have will proceed to call, fall, bawl, or maul the lab tech, even if they've all been quiet and happy all day long. 

Here's what got me thinking about this, and I wish I were making this up: a patient arrives post-op. I settle them in and take vitals. As I'm doing this, I get paged that another patient has arrived from the admissions department. I settle that person in, return to the post-op patient to tie up some loose ends, and get paged that a doctor wants to see me. On the way to the desk, my phone rings with the news that another patient needs pain medication. As I'm talking to the doc at the desk, six people--and Lord, do I wish that were an exaggeration--come up to me within two minutes to let me know that *another* patient has a headache. Meanwhile, my final patient has fallen in the bathroom after an entire day of walking independently and having been discharged by physical therapy.

Ten minutes before the first patient arrived from the post-op unit, I had finished my rounds and made sure everybody was comfy.

I need a physicist to confirm that post-op patients and outside admissions bend the fabric of space/time, please. Anybody?

Saying Goodbye.

Today I loaded Strider into the car.

We drove east along a little state highway. Over the lake, across the creek, past the McCain/Palin billboard, up and down the hills where the oaks are just turning color. The sky is cloudless and blue today, and Strider had his nose out the window when he wasn't resting his head on my arm.

When we got to the place where I had gone to pick him up six months ago, he got very excited. He greeted his foster mom by rearing up and putting his front paws on her shoulders, then bending down to lick her face. She was thrilled at how beautifully his coat had come in, and how all the mange he'd had was gone. I was glad to see that he still remembered the person who'd held him on her lap (all 80 pounds of him, at the time!) and sung to him when he was so sick with pneumonia that he couldn't sleep.

Then his foster mom introduced him to her female Anatolian shepherd, popped them both into the back seat of her truck, and I hugged him goodbye through the window. The last thing I saw was his butt, tail wagging, as he got comfortable with the other dog in the truck.

Strider did well here for the first four months. Then, as he got out of puppyhood, he started developing a personality that just didn't jive with Max's. They were fighting every day, and Max (being slightly smaller and older) was getting the worst of it. I was having to patch him up nearly every night. Max was scared and miserable, Strider was turning into an aggressive bully, and I was at my wits' end.

So Strider-Man is now going to be on a farm in the far, far northeast corner of Texas, up beyond Dallas, near the Red River. It's border country, hilly and green with creeks on the property he can swim in and coyotes he can chase. That'll be his job: he'll be running the fenceline on fifteen acres and protecting everything on the property. He'll be good at it, and it'll be good for him to have both a job and almost-unlimited space to run. I expect him to be rippling with muscle, tougher than leather, and completely his own self by the middle of next year.

I am going to miss him a lot. He's a good boy. Very nearly the best boy ever, if Max hadn't already had that title.

Max, meanwhile, is basking in the sun, somehow aware that nobody's going to come out of the corner of the yard, knock him down, and worry his head. He's looking forward to renewing his acquaintance with the pug next door and going for long sunset walks.

Maybe someday I'll try another buddy for Max. For now, though, he has to get his mojo back and remember what it's like to be Top Pup.

Stridey-boy, Big Stupid Goofball, Snorgle-Pup, Scrimble-Nimble, Nom-Hound, I'll miss you.