W00T! Wait, what?

My boss, who is a good sort, has offered me a different job.

I'm not sure what to do. Well, no: I am sure what to do, and I've told Boss Lady what will have to happen for me to accept the new job. I'm just not sure she can make it happen.

Sunnydale's CCU has become less neuroscience-focused and more everything-surgical over the last five years. For me, this is bad: I like neuroscience, and I like working with patients who have weird stuff wrong with their brains. A good day, for me, is brain worms and undiagnosed CNS disorders and a couple of glioma resections. A fair day is a fresh head-and-neck dissection. A bad day is freaking kidney resections and freaking gut resections; I've had a lot of bad days lately.

Because Sunnydale's historic focus has been on research and neuroscience, the change to Big Al's Surgi-Mart has been bad for the hospital, as well. There simply aren't enough CCU beds to accomodate folks with brain problems.

So Sunnydale is opening a new critical care unit, focused strictly on neuroscience. I have been offered the chance to be one of the very first nurses on that unit. Clinical trials would take place there; we'd see brand-new strokes; people with weird shit would be in there all the time.

It sounds great. It's a daytime position, and it's just what I want to do.

The problem? The start-up budget is zero. There are cannibalized beds and pumps all over the new unit, and some of the rooms have only portable monitors in them. We don't even have a dedicated EEG monitor. There is also no dedicated moolah for nurses; my wages would come from a combination of general funds and the current CCU budget.

I've told Boss Lady that three things have to happen in order for me to take the job:

First, I have to be guaranteed hours. As I told her, I do not have two incomes in my household; I am sole support of myself and three hungry animals. No hours, no bueno.

Second, if the opportunity arises for me to go back to a guaranteed daytime shift in the CCU, I want first dibs. Not third, not second, not "Let's wait and see what happens". First dibs. It's job security I can't afford to be without at this point, especially as Sunnydale's last try at a secondary CCU petered out after a few months due to lack of funds.

And third, if the job goes away (see petering out, above), I get moved to CCU on days, period. At full-time hours. No excuses, no exceptions.

Boss Lady came in seventy-two hours before my one-month deadline for finding a solution. For that I give her full marks. I'm just hoping that she, and Sunnydale's army of neurologists and neurosurgeons, can make this new CCU work and grow.

The chance to shape the care of neuroscience patients in a critical and acute-care setting is absolutely phenomenal. I have *lots* of ideas about how things should be done, starting with things like how soon we start physical and occupational therapy and continuing on to how the damn place should be set up (hint: it's nice to be able to see all your patients in the CCU, not have some of them stuck back in what's essentially a closet). I would love to be part of a research team again and to work on clinical trials. We've got a double-blind coming up that sounds fantastic.

Any prayers, positive thoughts, and general good kharma anybody feels inclined to send out will be gratefully accepted. This could be the start of something absolutely magnificent; it just has to get rolling. And get money. And get patients.

Wednesday Top Predator Snorgles:

Okay, I know the story of this: Luna the orca was separated from his pod and imprinted on humans. (Luna died in 2006 after efforts to get him to go wild failed.) It's not surprising that an imprinted wild animal would go with what he knows, right?

But what the heck is up with this one? This is a major predator. It eats, you know, meat. And things about the size of humans. And has lots of big, sharp teeth with which to dismember you. It's cute and cuddly, yes, and I'd love to snorgle it....but I would be very aware of the teeth behind the lips.

(I note that the woman in the video is not touching the seal except to make kissyface at it. I would be hard-pressed not to give it back-scratches. Seriously. This is why I am someday going to be typing with my toes.)

Tuesday Meditation: On Prayer

The Man of God (my neighbor, Pastor Paul) and I were talking about prayer. I mentioned to him that my Brother In BFE had said that he was trying to pray more; that he felt like he didn't pray enough (or maybe at the right times).

I told TMOG that my first thought in response to that was, "What? You don't pray as you breathe?"

And TMOG pointed out, quite rightly, that I am fortunate in being able to do what Buddhists call walking meditation, and what I call prayer while breathing.

I am not much of a Christian. I'm still not down, Dawg, with the primary tenets of the Christian faith, chief among them being Jesus' divinity. I studied comparative religion in college and so learned about a donkey-headed half-man, half-god who was nailed to a tree and raised from the dead three days later. I have too much doubt to call myself a Christian, though I might call myself, on a good day, a follower of Christ. (Paul-the-Pastor says that Christian disciples go all the way up on the cross, while followers stop at the bottom of the hill. I'm down here, at the bottom of the hill. Join me! I have cookies!)

And yet I pray. I pray intercessory prayers, for people I work with who are sick or hurting. I pray intercessory prayers for my patients. I pray intercessory prayers for myself, because there are things that I want to change.

Most of the time, though, the prayers are wordless. They come out of me as simply as a breath and as regularly. What began as a conscious effort when I was in school has evolved to a very simple state of being, in which weeding the garden is a prayer. Dusting the bookshelves is a prayer. Dealing with the be-damned cats is sometimes not so much a prayer as a florid curse, but I'm working on that one.

There are times when words simply won't do. Those times happen most often when I'm confronted with a person so sick, so beyond my help, that I can't even comprehend what on earth I'm supposed to be doing here. It's in those times that a still, small voice (there is a little cloud/it is like a man's hand) tells me to do the simplest thing first. I consider that an answer to a wordless prayer.

I would not be here, talking about this, were it not for the work I do.

In the main, I am a scientist. I look dispassionately on what works and what doesn't; the idea of a double-blind study is like crack. But there is a part of me that prays with every step as though I were counting the beads on a Buddhist rosary: one hundred and eight, with subsidiary strands: enough to get lost in the process.

We are all dichotomus. The friend who has been seeking Christ finds he doesn't pray enough. I, who have never sought Christ but instead raged at God and cursed Her less-understandable ideas, am the one who prays as naturally as breathing.

From Brother Cadfael's Penance, by Ellis Peters:

If it was the sharp, clear cold of frost outside, it was the heavy, solemn cold of stone within the nave, near darkness, and utter silence. The similitude of death, but for the red-gold gleam of the constant lamp on the parish altar. Beyond in the choir, two altar candles burned low. . .Now he had now true right to mount the one shallow step that would take him into the monastic paradise. His lower place was here, among the laity, but he had no quarrel with that; he had known, among the humblest, spirits excelling archbishops, and as absolute in honor as earls. . .

. . .He lay down on his face, close, close, his overlong hair brushing the shallow step up into the choir, his brown against the chill of the tiles, the absurd bristles of his unshaven tonsure prickly as thorns. His arms he spread wide, clasping the uneven edges of the patterned paving as drowning men hold fast to drifting weed. He prayed without coherent words, for all those caught between right and expedient, between duty and conscience, between the affections of earth and the abnegations of heaven. . .

Back when I was a kid,

My dad had preseason tickets to the Cowboys games. He got 'em from a colleague of his at the university, and would take me on the days when neither of us had much to do the next day (it was a long drive for a six-year-old) and his colleague wouldn't be there himself.

The seats were in row TT, for Tippy-Top. You could look down from where we sat and see pigeons flying underneath, through the windows set into the walls of the stadium. And because preseason games are generally in August and heat rises (regardless of how large the hole in your roof is), I remember mostly being extremely hot, uncomfortable, and wondering how the peanuts and Cokes the guys were selling tasted.

The first time I saw Texas Stadium, I was amazed at the size of the thing. It hovered on the horizon like an enormous egg. Dad pointed out that we were still a good five miles away. Then we were a mile away, walking up from our parking space, and I was fascinated by the steel girders you could see on the outside of the building. I had never seen construction like that, being only six, and it was the coolest thing ever.

Those were the days of Too-Tall Jones, Harvey Martin and his grin, and Tom Landry's hat. I have what's probably a false memory of looking waaaaaaaay down through Dad's binoculars, which I never quite got the hang of, and seeing that famous hat. I do recall quite clearly seeing Too-Tall make one of his field-goal blocking leaps, though Dad had the glasses at that point and what I saw was no more than a tiny man downfield who suddenly was much taller than everyone else.

Texas Stadium is officially gone now. The next time I drive to Dallas, I won't have to crane my neck and risk rear-ending the car in front of me in order to catch a glimpse of that inhumanly large hovering egg, though I'll probably do it out of reflex anyhow. I never did get to eat any peanuts or hot-dogs (at least, I don't think I did), but I did get to see Too-Tall's jump.

And maybe Coach Landry's hat. Just maybe.

And a Sunday Camelid Extravagaaaaanza! (for Joey)

Years ago, when I was still married, El Erstwhilo worked with a guy who had a llama ranch.

Llamas are a big money-maker, apparently; these folks worked year-round to keep their champion show llamas in top form. A groomed, buffed-up llama is a lovely sight. A shaggy, muddy llama after a winter of being out in the field is less so, but still charming.

A few facts I have llearned about llamas over the years: (primarily about female llamas, as male llamas are assholes and should be avoided lest you get kicked or barfed upon)

1. Mmama llamas are intensely curious and protective of their babies. If you wander into a field with a bunch of llamas, you will soon be surrounded by quiet, tall creatures with no upper teeth who will then solemnly investigate your ponytail, your shoelaces, and the collar of your shirt.

2. Baby llamas are cutest when they're about the size of a greyhound. Mama llamas will let you pet and look at their babies, but don't ever try to grab one.

3. Llamas of any age will attempt to chew your ponytail off, under the excuse of seeing what it tastes like. This is especially true if you have red hair; red is one of the few colors llamas can see.

4. Llamas are no respecters of personal space.

5. If you find yourself in the middle of a llama convention, you'd best hope you're more than five feet tall. If you're not, you'll find yourself doing a sort of desperate semaphore in an attempt to get the people who are with you to notice that you are surrounded (see number four, above) by llamas who would like nothing better to chew your ponytail, your shoelaces, and your shirt collar, cuddle up next to you, and use you as a tool to scratch the itchy bits on their sides. The baby llamas, meanwhile, will be busily engaged in repeated attempts to remove the back pockets on your jeans using just their lips and noses. Llama spit is viscous and does not come out in the wash.

6. Llamas do not smell. That is, they don't stink like horses or smell like dogs; they are quite odorless. I assume they smell in that they can perceive odors.

7. Llamas all poop in the same place. Llama poop looks like larger rabbit pellets, and because they are essentially neat animals, they have communal poop spots. Makes walking the paddock a hell of a lot easier.

8. Llamas are excellent guard animals. Here, people use them as guards (usually along with Anatolian shepherds or donkeys) for everything from goats to chickens. If a group of Mmama Llamas sees a coyote come through the fence--and here, remember that our coyote crossbreeds can reach upwards of 60 pounds--they will surround the coyote and stomp him to death.

9. Even so, llamas do not have hooves. They have big soft smooshy feet with huge calluses on the bottoms, like sandbags.

10. They chuckle and make deep, resonant sounds, almost like a purr, when they're happy. You can hear that sound most easily when you've dug both hands into a winter-roughened llama coat and started scratching, pulling out handfuls of loose hair. That activity, given the softness of llama wool, combined with the noises they make, is incredibly relaxing and pleasurable.

And that is all I know about llamas.

Sunday Stevens; Sunday Sonnet

Crank it.

From Rickety Contrivances of Doing Good:

Bed 1.1

Right now I feel less holy than a head
of cabbage. It’s too early for a break --
I’ve only seen three patients -- so instead
I’ll choose an easy room (I hope) to make
this stretch less draining. Ah, one-one’s asleep;
that worked out well. He’s middle-aged and gaunt,
cheeks sunken, forehead bloody, clothes a heap
beside the bed. He twitches. Spirits haunt
his dreams: distilled, I think. Oblivious
to wailing from next door, he snores in peace,
hands pillowing his cheek. I’m envious.
I practice seeing Christ in him, release
my anger at the mom, note mocking doubt.
So easy to be loving when they’re out.

Middle of the night note:

I just returned from the local grocery hut, the one that has a sign on an aisle directing the shopper to "asceptic juices" and "bubbling, pure, and still waters".

They have a large Caribbean food section.

In that section was a mix for Cock flavored soup. (Dude. Chicken.)

You have *no* idea how hard it was for me to put that packet down and pass it by. It would've been a perfect gift for almost everyone I know.

The comfort of other nurses (and nursing students)

Nursing is hard. (cf Barbie, "Math is hard!") It can be lonely, overwhelming, frustrating, irritating, enraging, satisfying, thrilling, scary as hell, and sometimes hilarious.

Nurses need nurses. Back when I started nursing, I was so burned out on the whole "talk about nursing all day/dream about it all night" thing that I'd done in school that I made friends who weren't nurses, on purpose. Then, about two years into the deal--about the time I started the blog, not coincidentally--I realized that there was a shortage of people I could talk to who would really understand what I did for a living. In one sense, it's like being a veteran or having lived through a natural disaster: explaining the backstory for everything that happens would take too long for a civilian audience, and dilute the power of the stories.

Once you've had somebody die with your hands on them, or brought somebody back to life with a combination of chest compressions and epinephrine, your life changes. Your worldview is never quite the same, and you never have a truly bad day again. After all, you're vertical, right? And you're not in the bed. And there are no tubes in your bladder or throat, so it's all good.

There are very few people who really *get* that. Most of 'em are other nurses, or nursing students who have seen a few things.

Abilene Rob has a brilliant description up on his blog just now about what it's like to watch a heart bloom in the cath lab, once the dye is injected and goes through the heart. Watching a brain bloom like that is what made me first believe seriously in God. (Sometimes that belief gets tested, as in cases of GVHD, but that's another post for another time.) He and I have had some nice chats about watching doctors tear open an incision line with their hands in order to evacuate clots that were cutting off important avenues for blood and air, or folks with such serious jaundice that they're dark orange.

Other nurses have consoled me when they've sensed that I've been less-than-myself. They've sent emails, or funny e-cards, or just let me know that they're thinking about me after I've, say, lost a patient in a particularly brutal way.

Sometimes I get an email from a civilian who says, "My mom was a nurse, and what you talk about is what she talked about at dinner when I was a kid. It makes me feel closer to her to read about what you do. Thanks for doing it." That helps immensely, knowing there are non-nurses out there who really get it.

We need to take care of each other. We need to take care of the students who depend on us to learn not to kill people. I'm incredibly fortunate to work in a place where nurses don't eat their young, but those places still exist. Cannabalistic nurses need to be called on their behavior and told it's not acceptable; new nurses need to be nurtured and toughened up and cut some slack. Students need to be shown all the cool shit we do, and how vital even the most boring stuff is, even at the same time they're shown why we still smile after years when we say "I'm a nurse."

Never say "I'm just a nurse." What we do is trench work: difficult, dirty, sometimes heartbreaking, occasionally dangerous. It requires skill and brains and an ability to deal with people that is tested every damn day on the job. We--you--are not "just" anything.

Be careful out there. Watch each others' backs. And pat your own for the job you do. I'm proud to call you a colleague.

Musical Friday

Make that "Punchy as Hell because I've had two hours of sleep in the last twenty-four and just lifted really heavy, plus I've got leftovers from Louie's in the microwave" Friday:

Or maybe it's "Yeah, it's a new dress; makes my ass look great, doesn't it?" Friday. Or perhaps "Thanks; my neighbor cut it last Monday" Friday. Or, on the offchance, "Quit hittin' on me; I can see that picture of your wife in a yellow dress on your iPhone" Friday.

Oh, I see: it's Fierce Friday.

Oh! And before I forget...

A revised version of the classic "Fashion Tips For Nurses" has gone up at ScrubsMag.com.

The article, if you really feel like reading it (and there's no new ageless wisdom there that hasn't already showed up here, sorry) is here.

ScrubsMag is one of the few, really-truly nursing-focused websites I visit on a regular basis. Not too silly, not too earnest: just right.

Heh.

Definitely worth clicking on. (Girls With Slingshots)

The sheets that glow in the dark, by the by, can be had from Garnet Hill. Look in their children's bedding section.

Oh, and a question...

There is a set of sheets I want.

It costs over one hundred dollars.

BUT!!

It has glow-in-the-dark Martians and flying saucers on a dark blue background.

What do you think? Turn-off, or turn-on?

Don't tell anyone, but...

I'm kind of adjusting to nights.

I know, I know.

Several Faithful Minions gave me excellent advice that was backed up by the not-natural-night-shifters I work with. I try to get at least twenty minutes of sunlight a day, flip when I'm off for more than a couple of days in a row, and don't get stressed out about not sleeping: resting is enough.

And I take multiple short naps during the day.

And then I get up and go to the grocery store at about 1 a.m., which affords me the opportunity to see the shelf-stocking guys doing a synchronized dance to some song I've never heard, and hear Yes on the overhead radio. Yes? I'll be darned.

And, of course, I cook.

Auntie Jo's Extra-Cheap, What's On Sale This Week Italian Bean And Sausage Soup

(modified, believe it or not, from the Weight Watchers website)

Take three turkey Italian sausages, or a half pound of the chub stuff, whatever's cheaper, and either squeeze it out of the skins or squish it out into a pan.

Saute over medium-high heat until it's mostly browned. Drain.

Chop a medium onion and three cloves of garlic. Dump it into the reserved sausage grease and saute until soft.

Dump onions, garlic, sausage, and a big can of tomatoes (on sale for 57 cents!) into a big pot. Add two regular-sized cans of white kidney (cannelini) beans and some water, or some chicken broth, or a mixture of both. Or you can use about three cups of cooked dried beans, but I don't keep white ones around.

Add whatever seasonings you like. The recipe calls for sage, but I hate sage, so I used more oregano and some red pepper.

Simmer until it's all combined, about as long as you want to wait plus ten minutes.

If you could get frozen artichoke hearts on sale (rare) or frozen chopped spinach on sale (common), I would bet they'd be good in this. Likewise a sprinkle of Parmesan or some small pasta, if that's your thing.

Oh, and the Annual Spring Shearing has happened. The sweet hippie chick from across the street came and cut eight inches of hair off my head; it's now jaw-length and extremely curly. I look sort of like an angora rabbit who's been on a bender and is beginning to have regrets.

And now it's time to find a decent recipe for flatbread. The roti recipe I posted didn't work for me; be warned.

"Ronnie," I say, a little louder than is natural, "Ronnie, I'm going to brush your teeth now."

Ventilator-associated pneumonia is a big (in the words of Joe Biden) fucking deal. It can be prevented with careful deep suctioning and good mouth care. And good mouth care is what I'm doing now.

Once during the shift, I use a toothbrush connected to suction. Twice during the shift, I deep-suction and swab.

This patient is younger than I am, with no risk factors for laryngeal cancer. The surgeons had gone in, expecting to take a biopsy, but had ended up having to take her whole larynx. She was a singer, before. I was a singer, before.

I shake off the associations and continue. I've already turned up her paralytic drip so she won't bite down on the brush. "Ronnie, here comes the brush. I'm just brushing your teeth, okay?"

I hate it when nurses end their sentences with the word "Okay?" I prefer statements: We're doing this, NOW. You're going to get out of bed. I am going to brush your teeth. But this time, I say, Okay?

She grimaces, but she doesn't have the coordination necessary to bite down on the toothbrush. For a long two minutes, I scrub: it's important to get the mouth bacteria off the teeth before I suction, to make sure they can't migrate past the endotracheal tube cuff and into her lungs.

"Ronnie, I'm going to suction you now. If you cough, that's okay; I can take care of that. Go ahead and cough. That's right; good cough. Give me another."

I suction under and behind her tongue, then grab the suction connected to the ET tube to suction down further, where her cough might've brought up some garp.

There is a boom-box in the corner playing her favorite music. She was a contralto, unlike me: I sang early music, with the occasional foray into Britten and the moderns. She sang the Magdalen in cantatas and led her church choir's alto-section woodsheds. I sang songs that nobody really knew the rhythm to, they were so old. She sang songs that had been written down long after the ones I sang had passed on.

They took her larynx, and left her her life. Whether or not it's a life she would want, not being able to sing, is not my problem. It is not my problem. I shake off the associations and move on.

There's a lot of crap in her lungs. I get a whole load of it out, then give her a break. I turn up the Versed, so that she won't remember any of this, and get the hell out of the room. I don't sing to my patients any more; they're generally not sick enough.

Back in the day, when I was in school, I sang to premature babies. It was my last semester, and I was constantly exhausted. The nurses would find me a pair of twins, or a baby who was so premature he looked like a monkey, with hair all over, and I would button them or him into my uniform top and lie back in a rocking chair. I'd sing them to sleep, and myself to sleep, with songs from "Jesus Christ Superstar" or "Fame" or the things the troubadours sang in the 1300's.

Since then, I have sung once, to one other person, outside the hospital. "Oh, wow, man/I ain't complainin'/Only thinking out loud/My life would've been different/If I knew then what I know now..."

I hope she can turn her singing voice into something else.

Enough with the sweet sentimentality. It's time for some bitching.

1. When a nurse charges, we give them little phones to carry around. That way, we can reach them when something like a code or a respiratory-team response happens. If you are a charge nurse, please carry your phone so we can reach you, and some gooberhead like me doesn't have to respond to RTRs with a little box and a befuddled expression.

2. If you smoke before rounds, Doctor, please flap your coat around outside so you don't choke the rest of us with your putrid cigar smoke. Or smoke better cigars. Please.

3. You're going to get a bath. I don't care what you say. You're in the ICU, you get a bath. If not now, later. Seriously. If I can smell you from the door, you might get two. Believe me, it's not fun for me, either, but it does help cut down on infection rates.

4. Neuro-breath may be the worst thing ever. It's not due to intubation--non-intubated patients get it too--and it has nothing to do with overall oral hygiene. It's a weird, awful bad breath that people who've had bleeds get. I do not know why, and I'd like to, so that there might be some chance someday of some bright person solving the problem.

5. Delicate-featured, pale redheads should never wear as much makeup as you're wearing, Doctor. Trust me on this. If you're leaving smudges on your own labcoat by turning your head, you've got too much paint on.

6. While I'm at it, can every owner of every beauty and fashion blog in the world please get over this putting-eyeliner-on-the-inside-rim-of-your-eye kick? It looked like crap in 1983, and it looks like crap now. Not only do you end up with irritated eyes and black eye boogers, you look like a tired old whore. Or at least I do. Because I believe in truth in advertising.

7. The time to schedule every single elective aneurysm clipping in a three-state area is not the week that our main CT develops some weird software problem and has to be taken apart.

8. And while I'm at it, the time to mention that oh, yeah, I forgot, I *do* have some metal implants in this arm from when I broke it as a kid is *not* as I'm sliding you into the MRI. Especially when it's a stat MRI. Perhaps especially-especially when the resident on call has already dragged his exhausted ass out of bed and come up here to admit you, and he's already cranky.

9. If your six-hundred-pound mother-in-law has just had an extremely risky gastric bypass surgery, she is not allowed fried chicken to eat. Please don't try to smuggle it in under your shirt.

10. Likewise, when we've just had a huge scare regarding Fifth's Disease and immunocompromised patients (and pregnant nurses) is not the time to attempt to smuggle your small baby into the ICU in a tote bag.

There. I'm done now. You can expect more sweet sentimentality and wide-eyed wonder next week.

Saturday Song:

Gaga!

Happy Pony Express Day!

One hundred and fifty years ago today, at about 0715, the first rider on the Pony Express left St. Joseph, Missouri on a ten-day trip to California. He carried, in addition to a pistol, letters that cost $5 at the time to send: about $100 in today's money.

The Pony Express lasted a bare 18 months, before the telegraph made communications speedier and more reliable. Still, the PE has a place in American folklore and especially a place in St. Jo's history.

St. Joseph is a medium-sized town these days. Because of the confluence of rail and river back in the day, there are a number of brick and stone houses dating to the time when brick and stone were expensive to move. There are rowhouses in varying conditions for sale, most of them in the network of streets named for St. Jo's founder's children. Any native (including my parents) can name off the streets rapid-fire and in order: Messanie, Angelique, Sylvanie, Charles...and so on. Any native can tell you how the numbered streets run, and where you can cross between Edmond and Felix to get to Fish Galore. Everybody knows where the YMCA is.

The Pony Express Museum in St. Jo is one of the more interesting museums I've ever been to. There are, besides the usual dioramas of riders and horses crossing the mountains, stuffed examples of the wildlife the riders might've encountered, including a bobcat over the door to one of the exhibits. It's a strange little dark vaguely rickety museum, but the people who work there are passionate and have fascinating stories.

After your trip to the museum, you can head over to Jerre Anne's, a venerable cafeteria which my mother swears still has the same line ladies as it did in the 1950's. You can still get merengue-topped pie and liver-and-onions there if you want, or macaroni and cheese, or string beans cooked to that classic cafeteria point of no return. Jerre Anne's website says that they'll ensure you a "memorable dining experience", and I can attest that every time I've been there, it's been memorable.

You could also go to the state mental institution and check out the Glore Museum, in which you can find exhibits tracing the history of the treatment of mental illness. It's something to see: department-store mannequins repurposed into the ice baths that schizophrenics used to be put in to calm the voices.

My family didn't do that; we kept our crazies in the attics. Now we keep them out on the street and in the living room.

St. Jo, to me, is early-morning walks with my grandparents, who always carried a bag of dog biscuits for the dogs on their walking route. It's the taste of raspberries in the North 40 (what we called an extra parcel of land Granddad used for gardening) that were warmed by the sun. It's the smell of my Granny II's attic and the joy engendered by back stairs and speaking tubes. It's the feel of the shade from the pine trees around the country club, or the ice-cold water in the Moila swimming pool, and that damned high-dive I finally conquered. It's the bone-deep pleasure that comes from knowing that my family built a whole lot of stuff here; I come from (as the man said) a long line of brick and stone.

Happy 150th anniversary, Pony Express. Happy anniversary, St. Jo. I promise to eat at Jerre-atric Anne's when I next come back.

Addendum to Friday Night Fabulous: the one post anywhere on the Internets....

....that always makes me tear up.

Yes, you are.

Friday night Fabulous

Check out the dude in the tiger suit on audience left:

*Totally* my kind of dancer.

The President gets to look at awesome stuff.

Not sure how I missed this, but Animal Review gets a thumbs-up tonight.

This is the coolest semi-origami I've seen in a very long time. Click the blue bar to the right-lower side of the page to print.

Eats! Nom nom nom the roti.

Last but not least, the only condom commercial in the world that will make you misty-eyed. Totally safe for work and Mom.

An announcement:

I'm leaving nursing.

This has been coming for a while. Over the last eight years, I've experienced a lot and learned a lot, but it's time I go back to my first love.

For that reason, this blog is going to transition to a static site between now and May, when I re-enter school to get a degree in sports turf management from the University of Mississippi. It's going to be a difficult readjustment, but I really think it's for the best.

The nursing experience will continue to serve me well, especially in dealing with mower-related injuries.

It is, really, all about blood.

There was blood on my front door. There was blood on the pedestal of the toilet, from a cut on her leg. There was blood in the sink--less blood than you might expect, but enough to stain it. There was blood on a door frame, where she'd richocheted off in coming through to the bathroom, where I put cold cloths on her ruined face.

An old friend of mine went looking for a beating and got it. Or maybe not; maybe she was looking only for resolution of the awful telephone calls her ex-lover had been making, and she didn't think he'd actually get violent again.

He did, and she showed up on my doorstep late at night, her face a mass of bruises and blood and snot, all mixing with her tears and her inability to speak.

I had never seen the damage one person could do to another, not up close without warning or intermediary. I've always seen it a couple of days after the fact, or in the clean environment of a clinic or shelter. It's never invaded my house and my peace before, not like this.

There were phone calls after that, and a conversation with a very nice cop with a twisted sense of humor, then trips to the police station and the emergency room. I found myself at home at two o'clock in the morning, making unanswered phone calls in an attempt to decompress. Eventually, unable to sleep, I called Nurse Ames, who I knew was working, and met her for breakfast a few hours later. Nurse Ames is sweet, soft-voiced, unflappable, and the toughest bitch kitty I know.

I got home to an email message from Land's End. Apparently, Sane Me had taken over and ordered Freaked-Out Me an entirely new set of bathroom towels. I needed them anyhow; the old ones are ragged and literally coming to pieces, even if they hadn't been spotted with blood.

There wasn't a lot of blood, but it wasn't blood I was prepared for or shielded from. It was blood that was born of a series of really, truly, amazingly bad decisions on the part of somebody I'd hoped would be smarter. It was blood that I didn't want to have to deal with, that should never have dripped on my floor, gotten smeared on my wall. There were myriad better ways to handle this that would've never meant bloodshed, and all those myriad ways got ignored. That left me to deal with the aftermath and the consequences and the public records and the police statements.

I am angry, and I am sick. I'm sick because the person who did the damage was methodical, almost scientific in his application of fists. I'm angry because the person to whom it was done knew better. She crawled back to the tiger cage after the tiger had taken off her leg. Nobody, ever, anywhere, deserves a beating--but you have a responsibility to your own self not to place yourself willingly into that situation when the alternative is easier.

There was no need for this. From start to finish, there was absolutely no need. I've had trouble sleeping since that night, and I've had trouble finishing both meals and sentences. I don't know what happened to my old friend; my first reaction--and I think it's a good one--was to offer help, and when that help was refused, I cut off contact. I don't need that brand of crazy coming around. Willfully putting oneself in harm's way without a larger purpose is not something I can support. Especially not when everyone around you has been campaigning against it for a year or more.

Things tonight are quiet. The dew has already risen; it's humid out, and we'll have storms in a few days, but for now everything smells fresh and new and, most of all, clean. The salvia is getting ready to explode in that way that it does, out in the front beds. Tomorrow I'll buy tomato plants and lavender and basil, scrub the remaining blood off of the grout in the bathroom, and change the sheets. In the afternoon I'll mow and plant and then lift weights.

I used to be annoyed by the amount of hair that my boys shed. Between Max and Notamus and Flashes, there's a lot of hair balling up and rolling around my floors. Now, though, I'm grateful that I can turn on the vacuum and have it be out of sight, out of mind, and gone.

It all seems to be about blood this week.

So instead of telling yet another blood story, I'll tell a fun food story.

It's fairly obvious that, even if you live in a big town, there are a limited number of places that will deliver food after about ten pip emma. (Unless you're in, like, New York or Sydney or Tokyo or Montreal, which are laws unto themselves.) It's also obvious to anybody who's seen the neighborhood that there are an even smaller number of places that will deliver to Sunnydale after dark. Seriously: You Do Not Want To Walk Across The Street To McDonald's Once The Sun's Gone Down.

So, when a coworker and I got the munchies the other night, we were temporarily at a loss. He said, after some discussion of what we might want to have brought in, "Just let me handle this, okay? You like Thai food, right?"

Saying I like Thai is like saying the ocean is moist. I don't know what half of it is, I can't pronounce the other half, but I like it and I like it hot enough to bring tears to my eyes and make my nose run. So Coworker got on the phone and, after a short discussion in Thai with somebody on the other end, hung up with a satisfied look on his face.

Turns out he lived in Thailand as a kid. Turns out he has a buddy that runs a little takeout joint that nobody's ever heard of. It also turned out, once the food arrived, that nothing he'd ordered would ever be found on the menu of your average Thai takeout place.

There was roti (which is a weird kind of stretchy, speckled, unleavened, absolutely addictive pancakey bread) with curry sauce. There were broad, flat noodles with green curry and little shreds of meat and enough spice to make me cough. There was a...I don't know, a *something* with rice and coconut, in a sauce I'd never tasted before with basil leaves in it, that combined subtle perfume with homicidal heat. And for sweets, there was rice with coconut and...something, and canteloupe with basil and coconut and...something else.

Apparently this was Mom's home cookin', Thai-buddy style. With a little Malaysian influence and maybe something else thrown in.

I ate all of it. I have no clue what most of it was. I even hoarded some of the leftover rice in order to pour leftover sauce on it for a snack at three o'clock. It was some of the best food I have ever had, delivered in boxes by a very small, rather worried-looking man who spoke not. one. word. of English save "Thank you!"

It's a damned shame for my tastebuds that I don't work with that particular nurse more often, but it's a very good thing for my waistline.

This is what you don't want to think to yourself upon entering a room:

"Hm. Where's all that blood coming from?"

You especially don't want that to be your first thought when your patient is intubated and ventilated and Dipped and generally not terribly responsive.

Moreover, you don't want that to be your first thought, because your second thought will invariably be, "Gosh. I wonder if that blood is still coming, or if it's stopped."

Especially when the last time you saw the patient was about three minutes ago.

And the last thing you want to do in that situation--but the first thing you ought to do--is pull back the sheet. There's a moment, when you realize that yes, that is blood on the floor and around the foot of the bed, that your hand reaches out automatically to twitch the sheet off of the patient. There's a nearly-simultaneous moment during which you hesitate and your brain prepares itself for whatever the hell is under there. The drip-drip-drip of blood on the floor is not a sound any nurse ever wants to hear.

What was under there was just a picnic. The patient had had an angiography at a hospital in Nowheresville and had developed, as the patients from that hospital tend to do, an abscess at the angiography site. I don't know if they lick their catheters clean between cases, or what.

Anyway, I twitched back the sheet. I saw a pulsing mass of mixed blood and pus, a result of the abscess eating through the wall of the artery. And I, with gloves already on, dropped the washcloths I'd gone to get onto that mass and pressed the knuckles of my right fist hard into the now-squirting angio site. And yelled bloody murder.

Two of my nursing buddies came in hard on the heels of that yell, assessed the situation in a glance, and ran back out. One got a whole wad of towels and washcloths; the other called an overhead emergency page for surgery and then gave the OR folks the heads-up. A doctor and an intern followed and spelled me on the pressure-giving. An RT came in like the hounds of hell were on her heels and, without asking questions or making any statements, began to ready the patient for transfer to the OR.

From the time I walked in to the room to the time I ran out of the room, alongside the OR gurney, keeping my fist pressed hard into that groin, was less than three minutes. I'm not real clear on how we got the patient from the bed to the gurney; all I remember distinctly is that two pairs of hands came down atop my fist as we did a sheet transfer, keeping the bleeding under control.

I work with the best people on the planet. Maybe six words were exchanged during this whole drama, terse instructions on moving the patient and a count of "One...two...three" as the transfer happened.

And yes, it is just like it looks on TV. Jogging down the hallway of the basement, the fluorescent lights making stripes of brightness in the dark, one person bagging the patient as others push the stretcher, and me, fist sunk up to the wrist in somebody's bleeding body.

I remember it as a series of snapshots that got dropped into the film of my otherwise-routine night: the resident's face as he realized what had happened. The attending's expression as she scrubbed in for an emergent bypass. The intensely concentrated look of the respiratory therapist as she loped at the head of the stretcher, watching the monitor for oxygen saturation. The sight of my glove, now loose and filled with blood, as I pulled it off over a sink.

The OR manager looked at me funny when I asked him for a key to the scrubs cabinet. "Why do you need scrubs?" he asked. I looked down and realized that, aside from a few spots on my shoes, I had not gotten a drop of blood on my uniform. I do not know how.

The sight of clean ciel blue scrub pants over slightly bloodied Nikes was more unreality than I could handle. I sat down, hard, and breathed deeply for a few seconds before I went back up to the floor.

The patient will be fine. The bypass went well, transfusions over the next couple of days will take care of the blood loss, and the abscess--which had gone deeper than anybody had suspected--is now drained.

So am I.

I think this really and truly might be my neighbor's dog.

Because this picture looks suspiciously like the ones we were taking of his pooch, after Max wrestled him all over the yard in the snow, and there was only one snowdrift left untouched.

Advice needed: current and former nursing students, this one's for you!

A particularly intelligent Faithful Minion and I have been shooting emails back and forth for a week or so. She's having a problem staying motivated through her first semester of nursing school, and I've hit a wall in the advice-giving department. I'm turning it over to you guys.

The problem, as far as we've worked it out, is threefold:

1. Nursing school, and its methods of evaluating knowledge, bears no resemblance to anything else on the planet. Even if you've done well in school before, you're unlikely to do well on the first one or three or six quizzes or tests you take, simply because the testing format is so strange. By "strange" I mean "all the questions come in an NCLEX format and that's freaky as hell."

Query one for Faithful Minions: How do you work out the correct answer when faced with NCLEX-style questions? How is this process different than it was in, say, English class or Biology 101?

2. Screwing up tests and quizzes makes one fearful and anxious of doing it again. This leads to test anxiety, which is a true black, shaggy bitch on your shoulder.

Query two for Faithful Minions: How do you get rid of test anxiety?

3. Screwing up tests and quizzes makes one feel idiotic and unmotivated. Never mind that nursing school is like unto nothing else on the planet except maybe a bad Surrealist novel; it's still happening.

Query three for Faithful Minions: How do you get your mojo back and stay motivated in the face of fuckups?

I have to confess: as my memories of nursing school get foggier, my ability to say anything sensible on this subject dwindles. I'm putting it out there for you guys with the certainty that somebody else will be able to deliver in the brilliance department.

Git to it.

I just had a realization.

I am a crazy old lady, forty years early.

Definitions: "Old" means, to me, at least eighty. Although, given the long-livedness of my family, I should probably push that to eight-five or ninety.

"Crazy" means a cackling, cigarette-holder-waving, martini-drinking, be-lipsticked woman with heavy black-rimmed Harry Potter glasses with one of those beaded chains on them. Also many cats, also insane decor. Also big bell-sleeved pieces of clothing that might or might not have been Victorian men's smoking jackets at some point in the past.

"Lady" means being able to cackle, wave your Sobranies around in your ivory holder, drink your pink gin at four pip emma on the dot, and still have people coming over to eat your potroast and sit on your insanely decorated couch.

Aside from the smoking jackets and ivory cigarette holder (and the martinis; I've never liked martinis [Sorry, Granddad and Granny!]) I'm there. Proof?

Following Sal's lead, I've been looking into color in my wardrobe. Also something more than jeans and V-necked T-shirts and cardigans. Gudrun Sjoden is my new obsession.

Also obsessive? Glass beads. In different brilliant colors.

And displaying my Fiestaware and various other midmod ceramics. On shelves. Above the doors of the kitchen and dining room. Where the cats can't get to them. HA!

Also biscuit tins and salt boxes that date to the turn of the century.

Also really good power tools. I'm thinking I may need to upgrade my two B-level drills for one A-level. But holey kamole are they expensive!

Also another tool belt. Currently, I have a black-and-pink, studded, Hello Kitty belt with the typical hammer loop/nail pouches/level hook on it. The belt has strangely become too large over the last several months, so I'm looking for another. Preferably one that Lady Gaga would wear while putting up picture frames with nothing in them.

And this. I do not know why.

That was just plain weird.

"Get me eight ounces of whole milk. Not skim, not two-percent, but whole milk" the doctor said.

"Okay" I replied, thinking he was running low on calcium.

He gave the milk to the patient to drink, then told me to time out exactly ten minutes. So I did.

Then he went in, interrogated the patient as to whether he'd drunk the milk, interrogated me as to whether it had been exactly ten minutes, and pulled the patient's chest tube.

I have never heard of this before. Whole milk prior to pulling a chest tube? Huh? Does anybody have any clue?

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

The flight RN was, as most flight RNs are, long and lean and rather weathered.

"You'll like this one" she told me, with a grin. "She's ninety years old and sharp as a tack. No health problems, no history, no meds at all. Had four kids at home and has never been in the hospital."

"Wow" I said. "That's pretty amazing. Did you guys have any trouble on the flight up?"

"Nope," she said, "Once we let her into the cockpit so she could see how a plane actually flies, everything was very quiet."

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

The animal therapy folks came by last night. Normally we don't let Rottweilers in to the ICU, but everybody who's immunocompromised has gone somewhere else, and we have a couple of patients who really need therapy starting NOW.

Rosie the Rottweiler is enormous, calm, kind of drooly, and a leaner. She leeeeaaaans into you in order to get her ears scratched. This is normally not a problem for me, except Rosie weighs more than I used to (somewhere north of 180 lbs) and is persistent.

It's very difficult to give a five a.m. report to a doctor--especially an attending who has a history of being hard to work with--when a nearly-two-hundred-pound dog is leeeeaaaaning on your legs and asking, through subterranean mutterings, to be scratched.

Yes, I work in a children's book.

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

Out of the blue came the request: would I be willing to rework Fashion And Beauty Tips For Nurses for wider publication? Never one to turn down a chance at self-aggrandizement, I immediately said yes.

The article should be published shortly in ScrubsMag. They have a website, scrubsmag.com, which is quite informative and rather a lot of fun. It's like Vogue for nurses.

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

Max recently saw the "F*CK YOU; I'M AN ANTEATER" Interweb meme and has decided to try to imitate it. I keep reminding him that he's not an anteater, but he won't listen.

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

A not-natural-night-person I work with gave me some excellent tips on working nights that I'd like to pass on, as they've helped me regain what little sanity I had.

1. If you have more than two days off, flip the middle days so you're awake when it's light.

2. Spend as much time as possible outside during those days.

3. The day before you go back, take a long nap in the afternoon. Then go to bed early, but set your alarm for midnight or one a.m. Stay up until your regular time, then sleep.

4. Work all your nights in a row if you can possibly manage it. Yes, the third or fourth night sucks, but then you have three or four days off.

5. Do not attempt to flip for a single day, or even two days. That trick (and I quote) never works.

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

There is a Scottish Festival coming up in June in Arlington, which is quite a drive from here, but which may be worth it. There's something about piping. And men in skirts.

Seriously: How badass is this? The British took pipes and drums with them into the Falklands.

And Ghurkas. Pipes and drums and Ghurka regiments are, if you know your military history (thanks, Dad!), the most terrifying combination ever.

Slap My Bitch Up

This is what happens when you give a bored, bored woman access to free eyeshadow and eyeliner.

It doesn't show in the picture, sadly, but the shadow is black with turquoise sparkles. It's also considerably more whorey than in this snap.

I am having fun.

This is my life.

In which Jo reserves the right to be condescending as hell.

There is some....person I've never met on my Facebook feed.

(Yes, I'm on Facebook. At least it's not MySpace, okay?)

He argued today, in response to an article posted that talked about healthcare reform protesters shouting what's called "The N Word" at members of Congress, that calling somebody a mouth-breather and calling somebody a N-asterisk were exactly equivalent.

Even if the person doing the shouting in the second case, the perp if I can call him that, was a white male.

And he defended that position. Twice.

(No, no, don't do that! You'll get a nasty, nasty bruise on your forehead if you bang it on the desk that way. Stop.)

Here's what I wrote in reponse:

Robert, I just got up from a nap and am feeling fairly rested, so I'll try to 'splain this to you:

The word "Nigger" has historical connotations not unlike those carried by the word "Juden". It harks back to a time of the enslavement of a group of people, and the later marginalization and murder of members of that group by the dominant members of society, white men. For a white person to call a black person a "Nigger" is to knowingly invoke that context, thus adding a level of threat to the insult.

One white person calling another a mouth-breather is, while fairly silly, not at all comparable. For one thing, there is an equal historical power balance assumed in the relationship. For another, there has never been a wholesale enslavement, degredation, or slaughter of mouth-breathers by other members of society.

I would invite you to test my statements by calling members of whatever ethnicity you like mouth-breathers, then trying the experiment with the other word.

Post-racial society my *ass*. It may be just me, but it seems like the bigots and their defenders are coming out of the woodwork, especially with the healthcare debate going on. (See Penny's comment on "The Morning After The Nights Before", below, for an example.) Something has made these folks feel safe, and I'm not sure what it is.

Whatever it is, the same people weren't yelling about government-subsidized highway construction or the heavy government subsidies of gasoline, or even the billions of dollars spent on the war in Iraq--when a white guy was in office. In fact, when I heard a story on lifting government subsidies on gasoline a couple of summers ago on NPR, I heard exactly the same sort of panicked rhetoric from the same sorts of people, about how it would DESTROY THE UNIVERSE OMG WE'RE ALL GONNA DIIIIIIEEEEE!

*sigh*

I guess there'll always be ignorant people in the world, like those folks on Medicare interviewed on NPR who didn't want the government involved in their healthcare, by gum. I guess there'll always be people who are bigoted and mean-spirited. I just wonder what force of nature lifted their rocks so they could crawl out, blinking, into the sunlight.

Shit. Sorry, guys.

For anybody who was worried by a title that read, "Hi. My name is Jo, and I need somebody to talk me down", I apologize. That was actually about redoing my kitchen now that I've gotten sick of the brightly-colored dots, but I hit "enter" too fast and posted only the title without meaning to.

It's down now. And my kitchen, despite the dots, is untouched. If I do decide to repaper the walls and change out the backsplash and repaint the cabinets and keep the hardware and put in a vent a hood and refinish the floor and paint a floorcloth and replace the door that's missing....

*whew*

....well, I'll let you know.

Middle of the night music.

I seem to have a thing for bass and baritone voices these days.

I also seem to have a thing for the Magnetic Fields.

The morning after the nights before.

Holy crapping monkeys, as my coworker Kathy would say, it's been a week. Working four nights in a row leaves you in much better shape than, say, working two nights, being off for a day, and then working two more....but HCM, what a mess I was this morning.

I'm finding that I really like becoming a generalist. Though Sunnydale is primarily a neuroscience facility, we also see what are called "complex" patients. Those are folks with massive, complex medical histories that wouldn't normally be able to get the sort of surgical or medical care that we provide in the itty-bitty towns where they live. As a result, this week I've taken care of a patient with a neobladder (so freaking cool--hey! Let's make a new bladder out of this piece of intestine! How about it?), one poor dude with some whacked-out chest surgery, a woman with an incredibly complex breast reconstruction that involves moving some bits here and other bits there, and a couple of people with your average, every day, run-of the mill stuff like aneurysms and infiltrating sinusitus, who also have X, Y, Z, and Z to the X wrong with 'em.

My eyes still glaze over when I see an EKG rhythm other than normal sinus, but I *really* dig seeing fresh post-op patients and their various problems.

Sometimes those problems require more of a light touch than at other times.

I was settling in a fresh post-op last night whose angiogram had run later than we'd expected. They'd managed to coil the dude's aneurysm, but one of the coils had gotten loose and had had to be retrieved, which took a little longer than usual. He was fine--grumpy about having to lie down flat for six hours, but otherwise okay--so I was able to take some time between hourly neuro exams and chat with him.

He started talking politics. Now, regular readers of this blog know that I don't talk politics or religion with my patients. If they ask, I'm a Democrat, a conservative Republican, a Christian, or a Blorgian yak herder--whatever gets me out of the room and doesn't raise either of our blood pressures. So this time, as in the past, I kept my eyes down, my hands busy, and my mouth shut while Aneurysm Dood bloviated.

Health care, as it turns out, is not a human right. Nope, no sirree. Health care of any sort is one of those things that the deserving work for, by God, and no socializt preznit is going to tell *him* any different. Why, if you need something, you should just go to the emergency room, right? (I didn't say a word. I swear.) Nobody should get what they haven't earned; if they take something for free, like health care, they're nothing but a drain on the system.

(Parenthetical note: why did this guy assume that I would agree with him that health care isn't something that everybody ought to get? I mean, did he not realize that I see the effects of untreated hypertension and diabetes every day? I know, I know; rhetorical question.)

In fact, that's what *he* did. He had a terrible headache, and some vision changes, and drove himself to the hospital--no socializt ambulance for him!--where it was discovered that he had an aneurysm that was just about to go nucular, if you'll excuse the term.

Whereupon he was airlifted, on a two-hour whirlybird flight, to our fine facility. We called in the neuroradiology fellow, a couple of CNAs, the radiology techs, a nurse or three, and promptly coiled his aneurysm. We then moved him to the CCU, where I was busy dealing with his incredibly labile blood pressure.

Where, glory be to the Great Watchmaker and technology, he was well enough to bitch about socialized medicine and the takeover of our good, clean American society by left-wing radicals interested in running our lives to the nth degree. He'll spend the morning in the CCU tomorrow, then be ambulanced home to Teensyville, where he'll return to normal life, except for a checkup in six months.

I was glad we were able to help him out, even if his particular views were odious to me personally. I was even more glad when I saw his face sheet, with the code next to the financial number that means his care was paid for by the hospital as a charity case. Everything, from the airlift to his breakfast in the morning, will be financed by Sunnydale; it's part of our commitment to provide free care to one in five patients.

Those damn socializts. By which I mean us.

I could be bounded in a nutshell, part three.

I'm on call tonight. Even if I don't go in, it's still better than splitting shifts, because I managed to sleep most of the day.

With very bizarre dreams.

Something about working nights gives rise to what The Erstwhile Husband and I used to call "defrag dreams"--the sort of nonsensical, emotionally-laden-yet-distant-feeling, bizarre dreams that are your brain trying to sort things out and toss the trash. My general rule is that if it makes enough sense for me to not categorize it as bizarre, it's a dream that I need to pay attention to. If it's one that makes me say, "How fucking weird" four times in fifteen minutes, it's a defrag dream.

I was a cop, I was a nurse, I was standing outside the house I lived in when we got married, holding a gun on a guy who was trying to shoot down a police helicopter with what looked like a water pistol. I was a cop, I was a nurse, I was running back and forth silencing pumps and giving meds in my cop uniform, knowing that I had to change clothes soon before the manager arrived and balked at the handcuffs at my belt, and wondering if there was an empty room where I could do so.

I woke up and fell back to sleep with cats purring on my belly. There was a patient dying, and we were unable to do anything about it. The crash cart wouldn't come open, the pump wouldn't work, the pressure bags wouldn't hold pressure. The patient was dying, and the doctors were sorting out something in another room, and there was a lot, a lot of noise.

I woke up and fell back to sleep. This time I was getting married again, with my late ex-mother-in-law running the show (a nightmare for sure). Back to the old house, looking through alternatives to the hideous wedding dress she'd picked out for me, finally deciding on something Mom pulled out of a box that looked like a feltboard covered with child-drawn flowers. Holes in the roof, squirrels running everywhere, and in the middle of it, the summons to come to work. All my colleagues were at the wedding, and nobody was there to work, so I got asked to come in. I didn't go. For some reason, the wedding program had a picture of a baby wearing heavy, black-wire-rimmed round glasses and a top hat. I was walking down the street as guests passed in large farm carts, picking up the spent shell casings from the first dream.

When I finally woke up from that one, I decided to frost and decorate the cake for tonight's baby shower and damn the torpedos. Now that that's done, I think I'll feed Max and unload the dishwasher and then look for something else grounded in reality to do.

Working nights feels unreal. Even driving to work--it's an opposite commute--knowing that I'll be up when All These Other People are asleep feels unreal. Once I get there, the feeling of unreality subsides, but doesn't disappear completely. After a few days of steady night shifts, I find myself living in a world almost as weird as a defrag dream.

There are two spent shell casings in my desk drawer. Maybe I'll make them into earrings.

Tuneful Tuesday

You can't go 'round just sayin' stuff because it's pretty

And I no longer drink enough to think you're witty.

By request: Fashion And Beauty Tips For The Boy Nurse

(See the comments on the previous F&BT post. A nice anonymous boy asked for tips, so here they are!)

I'll reiterate here about cleanliness, short fingernails, and clean shoes and scrubs. Those are important no matter what sex you are, or whether you're a student nurse or a full-fledged, ass-runnin' nursey type.

However, there are a few boy-specific tips I can share:

Tip The First: Beards: either don't have one or keep it neat.

I love a good beard. Really and truly, I do. However, something that's chest-length or scraggly or otherwise unkempt should either be shaved off or neatened up. Same goes for pornstaches of any description: if you can floss your teeth with it, it's too long.

And don't ever go with long sideburns or muttonchops. Please.

Tip The Second: Shaving: early and often.

Please, guys, shave before clinicals and/or coming to work. There are about a jillion ways to remove hair from your face and neck; if one doesn't work, another certainly will. Razor bumps can be kept at bay with a quick daily swipe of a Stridex pad. Trust me: I have more acreage to shave on a biweekly basis than you do, and Stridex works.

Tip The Third: Leave the bling at home.

Nobody wants to see masses of jewelry on women, and nobody wants to see it on men, either. A class ring plus a wedding band is all I really want to look at on your paws. The large crosses or eagles or whatever you're stringing around your neck should either be tucked under a shirt or taken off.

Tip The Fourth: Underwear. It matters.

Especially for those of you wearing whites as students (and thank God the schools I work with are getting away from them), undies matter. Print boxer shorts, blue briefs, or weirdly colored...er...mesh things will show. White underwear under your whites, please (do they sell men's underwear in nude/buff colors? I don't know), boxers or briefs or whatever. Don't make the mistake The Late Lamented Friend John made of wearing Valentine's boxers under whites.

Tip The Fifth: And this one is unisex, about piercings and tattoos...

Piercings and tattoos bother me not a bit. I should not, however, be able to see either easily while you're a student (restrictions relax a little at my facility once you're hired). Piercing shops sell nearly-invisible keepers for holes pretty much anywhere in your face. Tongue piercings are usually not an issue unless you're one of those annoying people that clacks it against your teeth constantly. Just make the effort. That's all I ask. (Note that if you wear a piercing or tattoo as a religious or cultural matter, you should not be required to take it off and I will back you up to the hilt on the matter.)

Tats are a little trickier to deal with. Covering them up is your only option. One of my dearest ex-coworkers, now in nursing school, has to wear UnderArmor under his whites on a daily basis, because he has two full sleeves. This will not affect his job prospects, I don't think, because Dr. Skippy has two full, gorgeously colored sleeves himself, and he's a damn surgeon.

(Oh, yeah: if you have noticeable nipple piercings, please put, I don't know, maybe a band-aid over them. Or wear an undershirt. That stuff can be really, really distracting.)

Tip The I've Lost Count: Hair other than that on your face.

If you have a luxurious growth of chest hair, bravo for you. Please wear a crew-necked T-shirt under your scrubs. I work with a surgeon who, despite being a mild-mannered type, is furred to an extent that I didn't think was possible, and I know more about his chest hair than I really want to. Ew. Don't make that mistake.

Likewise, if you have long hair--and this is particularly important for guys, as long hair is still seen in some parts of the world as a little daring--it *has got to be neat*. Ponytails or a single tight braid are more than acceptable. Again, if this is a religious or cultural requirement for you, there should be no question but that you're allowed to do your thing. If it's not, though, make the effort to keep that stuff under control. Shaun White's a damn cutie, but I wouldn't want him changing a sterile dressing on me.

Tip The Final, on Special Considerations (also unisex):

I've worked with Muslim women and Sikh men both as students and as coworkers. I've worked with Indian women who wear a bindi or a red mark near their hairline, Christians who veil or wear only skirts (the women, not the men), conservative Jewish men who have full beards, and even a couple of First Nations men who'd never cut their hair in their lives.

Whether you're wearing a nose ring, a bindi, a headscarf, or a turban, to do so is your right. If anybody gives you crap about it, you might have to go up the chain of command until the situation is resolved, but DO IT. Religious symbols worn on the body are a right, especially if they're an integral part of your beliefs, and you can work out a way to maintain that symbol without it being a distraction. Do not let anybody tell you different.

And, if you're working with me and somebody gives you shit about your cap, your bracelet, your unusual underwear, or your nose piercing, I reserve the right to beat them half to death with a used Foley catheter. Just come see me during normal business hours.

What makes me happy, Monday night edition

The spots on my kitchen wall.

Clean sheets and blankets on a very-nearly-all-white bed.

My toothbrush holder.

It has been a good day.

I was waved off last night for four hours, so I took a nap and ate a burrito.

Then they failed, utterly and completely, to call me in for the remaining eight hours of the shift.

For those of you who haven't been following along perhaps as closely as you should've, that means I got to sleep in the dark at wake up at 0730 (adjusted time).

Last night I went to bed after a charming email and a bottle of pale ale. This morning I woke to cats who, against their wills, had not destroyed the house, a dog who was so happy to have his belly rubbed that he invented new grumble-sounds, and a package from Friend Pens the Lotion Slut on the front porch.

By nine this morning I had gone grocery shopping, cleaned the fridge, and run the dishwasher. This afternoon I spent mowing the back yard and getting about six million new freckles (hooray! It's freckle season!). Tomorrow I'll do the front yard and dig the dead stuff out of the front beds, then make a chocolate cake with Italian cream icing. Overnight, I'll do laundry.

And then the night-shifting starts again. It's been a blessing, though, to have a couple of days to be a real person.

Fear Not. The hipster boys are actually quite polite.

You may have heard about the music festival that's starting up here in Texas, down in Bigtown. Well, we here in Littleton have our own, complimentary music festival that runs in concert with The Big One.

As such, Those Darn Kids across the street have a number of big names staying on their floor tonight. None of these people are members of bands I've ever heard of, but I'm assured that they are, indeed, Big Names in the indie-rock, alt-country, mod-punk circuit. Those Darn Kids, who throw an annual party that is almost completely silent despite featuring two live bands and 400 invited guests, are big on those circuits, too.

Which means I get odd knocks on the door now and then.

Tonight it was one of Those Darn Kids with a Big Name in the alt-whatever world. I shuffled to the door in my bathrobe and opened it (the door, not the bathrobe) to find the cute guy from across the street* with a sheepish-looking alt-rocker next to him. The alt-rocker was holding his arm at a funny angle. Turns out he'd sprained his wrist loading Fenders into the band van, and needed ibuprofen, an ice pack, and a more professional wrapping job than the hippies in the crew had been able to provide.

So I dug out an appropriate ACE, fed him ibuprofen, fixed him up a pack of frozen edamame, and told him to rest his wrist for a couple of days, if he could. Turns out they're off for a day or so, then play a big gig at Fred's Friendly Beer Warehouse down in Bigton. He should be able to wield his drumsticks or strum his bass or whatever it is he does (cowbell?) by then.

Sometimes being a nurse is an enormous pain in the ass. Sometimes it makes me giggle once I'm alone and have shut and locked the front door. Those Darn Kids are very helpful, demolishing outbuildings and hauling rock for me, but never before have I been treated with courtly deference by two dreadlocked young bucks while wearing nothing but a cat-snagged bathrobe and Birkenstocks.

*For reals? From a distance of twenty years, since he is exactly one-half my age, I can look at this kid and wonder how he walks down the street unmolested. Golden-brown tan even in the dead of winter, blond dreadlocks, ice-blue eyes. They didn't make 'em like that when *I* was twenty, or if they did, I was too buried in books to notice. We share a birthday, and I refrained from mentioning this year that he was born at the same time I was finishing my senior thesis is sociology. Gracious, it's odd getting old.

Bad Omen or Fertility Symbol? You decide.

Since I've started working in the CCU, six--no, seven--of my coworkers are seeing their marriages break up.

And six of my female coworkers are pregnant.

Don't drink after me.

Fashion and Beauty Tips for the New Nurse

I'm constantly asked by Faithful Minions, "Jo, how in hell do you do such a demanding job while remaining a paragon of beauty and style? The rest of us grovel in the dust at your feet, wearing worn-out, ill-fitting Landau scrubs, or stand in a huddled group in the parking garage, waiting for the vision of loveliness and grace that is you to bless us with a look."

It's not easy. Gliding in a lightly-scented cloud of gorgeousness takes *work*. But, because I am just that good, I'm going to share some of my secrets with you, my FMs of the female persuasion (or the male FMs with long hair and a yen for MAC cosmetics).

Fashion and Beauty Tip The First: Get scrubs that fit. Nothing is worse, when you're trying to resuscitate a patient, than having your pants rip (or worse, fall down, happened to a friend of mine, true story, and we still give him hell about it). VPLs are never good and are a sign you should go up a size. If you're new to the scrubs-buying game, go to your local scrub outfitter and try on about six different brands until you find the one that works for you. After that, buy in bulk.

Fashion and Beauty Tip The Second: Keep your hair out of the way. Second only to ripped pants is the sudden sinking feeling when you realize that you've dipped your luxurious locks in a puddle of piddle or poo. My hair is mid-back-length and I wear it (variously) in a bun, a braid, or a loose pony tail that I can be sure won't flop over my shoulder.

Fashion and Beauty Tip The Third: Good shoes, good shoes, good shoes. Cute is an option if you're lucky; if you're not, pop those paws into something supportive and well-fitting. Avoid marketed-to-nurses cheap-ass shoes and go for the Birkenstocks, the MBTs, the Danskos. You're on your feet for twelve hours, and you only get one pair of feet.

Corollary to The Third Tip: Take care of your feet. Pare down callouses with reasonable frequency, keep those nails short, and use plenty of lotion after your shower. Corns and bunions should be dealt with by a reputable professional, not by you with a razor blade.

Fashion and Beauty Tip The Fourth: Take care of your hands. Dry skin and cracked cuticles aren't just crappy-looking; they're avenues for nasty skin infections. You could spot a WWI nurse back in the day because of the scarred, twisted nature of her hands; they got infections in their hands from a combination of cracked skin and nasty bugs. Don't let this happen to you.

Corollary to The Fourth Tip: The posessor of the most beautiful hands I've ever seen is also one of the least self-conscious people I know. If *he* can do it, so can you. No excuses.

Fashion and Beauty Tip The Fifth: If you wear makeup, please do so with skill and aplomb. And not too much. Once upon a time, I worked with a woman who wore crazy hair, tons of paint, and bright-red claws to work. (She did GYN exams, for Frog's sake.) Do not be like her. If you look like Siouxie Sioux, even the brain-damaged folks on the unit won't want you near them. I wear concealer, mascara, light-brown eyeshadow, and draw my eyebrows in before I go off to Sunnydale, and that's plenty.

This tip goes for perfume as well. Normally I am not a fan of perfume on nurses, though I'll make the occasional exception for something that smells clean or citrusy. Let's be sure, though, that somebody else can only smell it on you when they're on top of you (so to speak) and that you're not asphyxiating the people a block away.

Fashion and Beauty Tip The Final, And I Can't Believe I'm Having To Say This:

CLEAN.

You should be clean. Your scrubs should be clean. Your fucking shoes should not have fucking grass stains on them or dog shit on the soles or be all beat-up and raggy looking (I'm looking at you, Vinnie). Your hair, for God's sake, should not be greasy. You should not roll into work at six ack emma wearing the remains of last night's makeup. Lab coats (if you wear one) should be relatively white and free of stains, cigarette burns, and the remains of a burger from two weeks ago (I'm looking at you, Doctor Skippy).

If you're one of the unfortunate few who still has to wear whites, invest in a good color-safe bleach, some Borax washing soda, and a good hot-water detergent. Use those regularly. Chlorine bleach will yellow your whites and make the fabric weaker. See ripped pants, above.

And unless you poop rainbows and fart cotton candy, you should be wearing antiperspirant. Don't give me that crap about how sweating is natural and beautiful. Yes, sweating is natural and beautiful, but not at work. There's never an excuse for looming over a patient with pitted-out, stinking, stained scrubs. If you sweat *that much*--and I do--wear a T-shirt under your scrub top and seek out clinical-strength antiperspirants. It took me years to find a roll on (Mitchum unscented, by the way) that would keep me from knocking my patients over with my funk. Yeah, my armpits are probably going to peel off in the next ten years, but it's worth it not to have to put non-rebreather masks on everyone I come into contact with.

Oh, and brush. your. fucking. teeth.

Thank you, and good night. Enjoy being just as bright and shiny a special snowflake diamond as I am, and be sure you carry a little vial of smelling salts for those who are knocked out by your physical attractiveness.

Saturday morning music.

Brother has the sunny spot, so I shall cover my face with my hind foot.

Click to encuten.