*Twiddling thumbs*

No news is good news, right?

Right.

My incisions itch. I wore pants today, for a short time; long enough to head to Target to pick up a new water bucket and rug for Max. He's ignoring them both, being resistant to change. Eventually he'll cop to the fact that Old Dog Hips are more easily levered from the floor when the feet below them have something to grab hold of, and that Old Dog Mouths like water from nice, fresh buckets rather than two-year-old, scuzzy things, but for now? he's ignoring both with glacierlike calm.

Two things that shock me today: how swollen Mah Belly actually is and how stupid people can be.

I put on a dress that fit fine the day before surgery and was surprised that it wouldn't zip up past my waist. I figured the belly-swelling was a two-to-three-day thing, at the absolute outside, and that I'd be back to normal by day five (which this is). Sadly, no.

I also figured that, given that we're getting more and more patients with strokes in the CCU, there would be--at some point--a drop-off in the number of people admitted under stroke protocol who later turned out to have such conditions as, say, a torn rotator cuff.

Sadly, no.

Going over the recent chart audit submissions from here at Casa Del Piles of Sleeping Mammals, I was distressed but unsurprised to see that the guy whose job it is to compile all the charts to audit had, as has been his habit, included a bunch of people without strokes and missed a number of folks with them.

A little explanation: chart auditing is one of those things which the Accrediting Agencies require hospitals to do for the accreditation. Because Sunnydale and Holy Kamole are both now stroke centers, it falls on us to audit the charts of people who come in with stroke symptoms to make sure that we're doing things like telling them to quit smoking, getting them head CTs in a reasonable time, and doing NIH scales. I got volunteered for the job of doing chart audits because I don't spend enough time already either taking care of patients or making sure people don't suddenly leap out of bed like so many gazelles, eating utensils in hand, ready to attack other nurses.

For whatever reason, the guy who makes up lists of charts for me to audit has about a fifty percent success rate in actually picking out the folks who have had strokes or strokelike symptoms. Fifty percent. That means that half my time is spent picking through charts, reading notes, and looking desperately for something that says "stroke," only to find that the person I'm reading about had, say, a bad reaction to chemotherapy (not making this up), a case of food poisoning (not making this up), or a fecal impaction (o how I wish I had made that up).

The other half of my time is spent--and I kid you not, it's probably close to 40% of the remaining time I spend on audit-related stuff--looking through the charts of everybody that Sunnydale or Holy Kamole has discharged in the past three days, and usually finding stuff that Chart Guy has missed.

Ten percent of that time is spent actually auditing the charts of stroke patients. Since most of them come to me, it's quick and easy: I can and do do it from memory, mostly.

So, yeah. The TL;DR of the preceeding complaint is that I'll have twenty or so (at last count) charts to transcribe to paper and a couple hundred to slog through on the hunt for missed strokes. I don't know what Chart Guy's problem is, honestly, except that he's probably as overworked and understaffed as the rest of us.

In other news, uh. . . .I got nothin'. Der Alter Jo has damaged her knee in some unique and painful way, so we're both lying up on our respective couches feeling like extras from "Spirit of '76." I finished Bill Bryson's book At Home with the result that I now have a list of six more books that I really ought to read. I'm getting into the first season of "Torchwood" and now want to buy a Roomba vacuum for the sole purpose of naming it Ianto.

Off to turn the a/c down some more, and maybe pour myself a glass of something intoxicating, before I get back into chart audits. Hospital administration would be so much more pleasant--and probably more productive--if we were allowed to tipple at our desks.

Owling; because planking is so yesterday.

I just saw the first example of Owling I'd seen on the 'Webs.

You have to perch in a crouched position like a bird on something unlikely.

I think this might be a new trend at Sunnydale.

F'rinstance, I could Owl on the person who went after Kari with silverware the other day. You do not go after my colleagues with sharp things; how many times do I have to tell you this?

Number of people who have tried to stab, punch, kick, or bite Jo or her colleagues: 11.

Number who have succeeded: 1.

That leaves ten who have failed. You are not the exception.

*beat* *beat*

So, yeah. Owling. It doesn't look as though it's particularly physically challenging, and I wouldn't have to lie on my stomach. I could, you know, crouch on the staircase leading to the roof access just above the 9th floor stairwell. Or Owl on the unit secretary, provided she's in a good mood and not hung over. Or Owl on an empty bed. Or, hell, a full bed, provided the person in the bed isn't noticing much.

Propofol + Jo = Owling Deluxe.

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

In other news, Friend Penny tells me that *everything* weighs more than five pounds and *everything* is below waist height. I am not allowed to lift anything heavier than the first or lower than the second. Even so, I have scooped Notamus up from the floor (12 lbs) (lower than my waist) and snuggled him, and the only side-effect I have had is a buzzing kitty on my shoulder. Still, I won't be moving heavy boxes full of Stuff any time soon. It's truly astounding what you can feel from just three small puncture marks.

The one in the depths of my belly button itches terribly. The one to the right of my belly button, where they did all the actual pulling & tugging, does not--but there's an area about the size of a half-dollar, two inches down, that's about to drive me NUTS. And, of course, I move faster than light when the boys decide (either singly or together) that they need to hop up into my lap/belleh.

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

I am waiting for my post-op pictures to show up on Facebook.

I hope I photograph, slackjawed and roll-eyed, well.

0215 Sunday:

*bleeerrrrt?*

MROOoooooOOOW.

(rattle rattle rattle THUD)

Mmmmrrrr?

Mmmmrrrr.

(pat pat pat pat THUD pat pat pat pat)

Meeeeeeh? THUD

MRROOOWWW.

(silence)

*creeeeaaaaaak*

Bllllrrrrt?

CRASHBANGTHUDCRASHBANGCRASH

*tinkle*

*tinkle*

*tink*

Mrrrroooooow?

BORED. *blam* BOOOORED. *blam* BOOOOOORED!! *blam*

(A little "Sherlock" humor there, special for Der Alter Jo.)

I do this Recovery Thing very badly.

First of all, I hate pain medicine. Dilaudid makes me woozy and dizzy, hydrocodone makes me itch, it's too early to take naproxen or ibuprofen, and whiskey is ten miles away and thus totally out of the question. But I *hurt*, so I end up taking the Lortab as it's been prescribed, especially after Notamus decides that his fourteen pounds needs to be on my lap right the hell now. And I itch, and it doesn't help much, and I'm still stuck with this cat on my tum.

Secondly, I have entirely too much energy of entirely the wrong sort. I can't lift anything that weighs more than five pounds. That makes laundry difficult and taking out the trash impossible, and made folding up the futon today something that I considered, then rejected. Don't even ask about the gymnastics it took to get Max's food bowl off the porch and into the house.

I suppose I could edit the stuff I've written for Scrubs, but if there's anything worse than my writing when I'm on painkillers, it's my editing when I'm on painkillers. All of a sudden, major arguments go away and subject-verb agreement seems not to matter in the least. I become one of those people who insert's apostrophe's rand'omly into word's. Worst of all, I start adding things that, to my sleep-deprived and drug-addled brain, sound funny. It's like SNL in the mid-nineties.

Thirdly, I am very, very, very grumpy after surgery. Maybe it's the constant itch; maybe it's the inability to *do* much, or maybe it's the cat walking on the keyboard, but I get foul-tempered and out of sorts. I've been reminding both the boys today that "cat" is only one letter away from "hat" and that it won't stay too hot for fur headcoverings forever. It's unfair; they're actually being very sweet, if a bit clingy, but I'm taking my temper out on everything from bran muffins to ceiling fans that need to be dusted.

(Speaking of cats, Ibid showed up this evening earlier than usual and wearing a cute little pink collar with a bell on. She has a new home, hurrah! She acted quite pleased with herself and declined food, but accepted pets.)

And, finally, *you* try to be serene and relaxed when your belly is so bloated you can't breathe deeply. I have some remarkable bruising that's only just now starting to show up, as well as some fantastic marks from the tape they used on the operating drapes: I'm allergic to adhesives, apparently. My right shoulder is sore, even though they obviously worked hard to press all the CO2 out of me prior to closing me up.

It's a good thing I own ten empire-waisted dresses. Der Alter Jo asked hopefully if I'd be able to make Marcus Wallaby, MD's birthday party this weekend, and I had to respond, "Dear, I can't even wear pants. Only sluts run around without drawers, so the answer is no."

I guess it's a good thing my social life is in shambles. I'm in no shape to be pretty, popular, or charming just now. I can go to bed, sleep three hours at a stretch, and then get up and surf Craigslist for project cars and nobody'll be the wiser.

Bah. Lortab. Bah. *blam*

What Fresh Hell Was That? or, My Day At Holy Kamole.

My doctor doesn't do surgery at Sunnydale, because apparently they don't have the right sort of laparascopes, or the walls aren't sufficiently lined with gold, or something. So Der Alter Jo and I were at Holy Kamole at oh-dear-thirty yesterday, her limping on a busted knee and me casting the side-eye at everything, for Animal's eviction.

Preop nurse, resident, attending, preop nurse again. More urine, more blood. Cute little backless dress. A fond farewell to being able to bend over easily for a while.

A brand-new nurse intern started my IV and did a slammin' job. I have veins like hoses in the backs of both hands, so when she hesitated between an 18-gauge and a 20-gauge 1.5 inch IV, I told her to go big or go home. One stick, flawless placement, and she only needed help on taping the thing up. Not so on my other hand, where some Einstein in the OR tried three times on the back of my paw, blew one vein and missed two, and finally did the med-student start on my wrist just below my thumb. Brand New RN Whose Name I've Forgotten, you rock.

Then EKG leads and a KVO rate bag of fluids, then two CNAs came in to introduce themselves and one brought Versed. Then down the hall on a surprisingly comfortable gurney (why can't Sunnydale get some of those?), into the OR, which was smaller and more crowded than I expected, and another shot of something into my IV. Aaaaaaand goodnight.

The disturbing thing about general anesthetic is the complete lack of a sense of time passing. Your brain tries to rationalize it later, but at the time, you go to sleep in the OR and wake up simultaneously in post-op. I do vaguely remember being extubated and hearing somebody ask if the doc wanted the Foley out, but that moment collapsed into the going to sleep/waking up moment. All I know is that I went into a controlled coma with one set of friendly people and woke up to another set, including Friend T-Bird, who is liberal with the Diluadid. Somebody handed me my prosthetic, which I tried earnestly several times to put in backwards until I figured it out.

I precepted T-Bird when she was a new nurse. She's now an experienced post-op nurse and a new mother, and both seem to agree with her. She was blooming. It's so nice to watch frightened, shy people really get into their groove. Plus, I don't think I know anybody prettier, which is nice to wake up to.

Back up to the post-op recovery room. Der Alter Jo at the bedside, giggling over my inability to move and my drunken philosophizing. A sudden brain-stem-level urge to get the HELL out of there, and so ice chips. And Sprite. And getting up on my own (woooooooo....*listing heavily to one side*) and peeing and getting discharge paperwork. Into a wheelchair, which, thinking back, Der Alter Jo could probably have used better than me, what with her knee.

Car. Highway. DAJ is another one of those conservative looking types who can push a Prius up to 90 and keep it there, so I just shut my eyes and replayed Disney cartoons in my head.

As of right now, I'm surprisingly comfortable. If I had a wide-angle lens I'd take a picture of my stomach. Never flat, even at the best of times, it's now assumed some really weird contours and bruises. The trochar punches form an equilateral triangle with my belly button at the top, about four inches on a side. I have a hard time getting up or down quickly, but once I'm one way or the other, I'm good. I have bowel sounds and can pee on my own. Eating is no problem. I do the splinted-deep-breathing-and-coughing thing once an hour, because coughing and laughing hurt.

The most uncomfortable part of my body is my throat, from the intubation. The anesthetists were very excited at seeing what they called an "A-one-plus-plus airway." I guess that's anesthetist humor.

The Boys are playing with all my ID bands. The folks at Scrubs Magazine sent a lovely bunch of flowers. I have a full refrigerator. I can't complain, unless I drop something on the floor that I really need.

Oh, and the doc said that Animal had chips of calcium (unformed teeth), hair, and sebaceous pockets. That last is medicalese for "that stuff that makes up zits." I feel like I've had a teenaged boy removed from my reproductive system. I feel twenty years younger. (ba-dump KSSSH.)

I'm home; all is well.

Bloated belly, three band-aids, and a disinclination to move quickly. That's what I've got.

Oh, and one less unwanted tenant.

Can this be all for a while? Thank you.

Uh....yeah. I have no idea how to do this.

I'm sitting here staring at two little packets of Hibiclens scrub. I have to SCRUB MAH BELLEH with one tonight and one tomorrow morning, prior to Animal's eviction.

The nurse at the presurgical testing hootenanny didn't tell me anything specific, and I was too flummoxed to ask anything specific. She just handed me the little packets and said, "Scrub once the night before, and once before you come in, and prepare to be ashy." She then looked at me more closely and corrected herself: "Dry. You'll be dry. You're already ashy."

So, um. . .what do I do? I mean, I assume I should pay some extra attention to my navel, since one of the trochars will be stuck through it, and that I should scrub gently, without trying to take the skin off. But should I leave the suds on for two minutes, or something? Use a black rooster rather than a washcloth to apply the stuff? Put my right foot in, then out, then shake it all about? Is there something special I need to know?

Searching "preoperative chlorhexadine scrub" leads me to interesting studies of iodine versus chlorhexadine and a stunning PDF, with illustrations, of how to scrub your horse prior to surgery. Since I don't own a large scrub brush, I can't follow those instructions.

Ideas?

The weirdest thing about this surgery bidness?

Is this: Dr. Crane didn't type and cross me prior to removing El Lumpacito, because there was little chance of his running into any major vessels during surgery. Dr. T decided to do a T&C because, as she put it, there's a lot of *stuff* in the belly, and better safe than sorry.

So, when the type & cross results came up in my email, I opened them expecting to see a blood type of O-positive, which is what I'd always thought I was.

I'm A-positive. Without, as it turns out, antigens to anything. Given that I've never had a transplant or a transfusion of any sort, that wasn't a surprise. The A+ part was, though.

I had to check in the mirror to make sure my eyes are actually blue.

Ah, the first week of July....

I'd like to know what Einstein decided that the first of July would be a good time to introduce new residents to their units. I mean, it's right before a holiday (this year's been especially bad, what with the three-day weekend), people are going on vacation, and patients always crump on holidays.

Always. It's one of those immutable laws of the medical Universe: if you have a person who's had, say, a minor bladder-scoping procedure, that person will choose a holiday (preferably one with a three-day weekend involved) to have something completely nuts happen that lands him or her on six drips and a vent. We once had a patient who came in to have a couple of teeth removed prior to some other surgical procedure who coded on the table: it was the day before Thanksgiving.

I mean, *really*? (Side-eye at Murphy and his laws.)

One good thing about having residencies that last at least five years, which is all of the ones that I work with regularly, is that you don't get too many bright-eyed, idealistic young medicos on July first. Most of the docs who rotate in and out of the units have been there before and have just been out doing research, or something. They're the same exhausted, cynical people we've worked with forever.

We do have one rather dashing new fellow ("fellow" in the academic sense, though he's also got XY chromosomes) with a Spanish accent and Italian shoes. He glided in yesterday, did a very thorough exam on one of my patients, then discharged her home without any fuss or muss. It's nice to see efficiency. I doubt the Italian shoes and silk tie will last through August. I hope the lack of drama does.

July is also the beginning of the yearly fiscal crunch for State-funded agencies here Deep In The Heart. Some of my colleagues have simply gone missing, laid off in the face of gazillions of dollars of shortfalls. Others are walking around looking tense about the possibility of losing their jobs. It's all Manglement positions that are being cut, no front-line staff, but that doesn't make it any easier. Nobody's hiring, either. What that means at the end of the day is that if you're working in research, you now have thirty more cats/pigs/rats to deal with in addition to the ones you were already taking care of. If you're a mid-level Mangler, you've got six more pages of audits and quality-improvement surveys to do every week, and no help.

Maybe they could get the residents to help with the audits. It'd at least give 'em a chance to sit down once in a while.

Self-Portrait Sunday

What you should never, ever do.

You should never buy a five-bill German vacuum, no matter how much disposable income or desire for Teutonic clean you have. Never, ever.

Because if you do, you'll end up with a cute little blue vacuum that has all the personality of a milkmaid and all the determination of a Dalek. And you will vacuum. And you'll find, as you vacuum, that there are things that you maybe might have missed vacuuming for the last four years.

Like your walls. Your walls.

Your walls, that have dog hair and cobwebs up near the ceiling. And wolf spiders as big as your thumb lurking in the baseboards. Yes, I screeched like a girl. Then I complimented Ms. Wolf Spider on her coloring and put her gently outside. But anyway.

Your Blue Teutonic Charming Vacuum will enable you to vacuum those walls, and the doors, and the tops of things that have dust on them, and then maybe the kitchen cabinets, because boyo, don't those have some dust on them? And then you'll get to the baseboards and suddenly realize that all the little delicate moldings on the mirror in the dining room probably trap dust too, so you'll vacuum that.

At this point, Max will get annoyed. You'll pull out the TV/DVD player to watch a movie, but you'll realize that those are both covered with dust, so you'll vacuum them. And then you'll think about your office, and how your desk hasn't had any glass in the windows for ages, and you'll open a bottle of wine and go vacuum the office.

Which will lead to vacuuming the bathroom walls and the storage drawer under the stove and the cabinet where you keep the rice and the utility room.

Max will have long since gone outside to get away from the eternal, infernal vacuuming, and your toenails will not be Tiffany-metallic blue, and you will have drunk a half bottle of wine without realizing it.

And then it will come to you that, in order to get the kitchen walls really clean, you must scrub them with Method spray soap and white melamine scrubby things from Target.

Which is why you should never buy a five-bill German vacuum, no matter how cute it is.

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

Excuse me. I just realized I forgot to vacuum the back side of the guest room door.

Gracious!

After most of a week without 'Net (due to a horrible thunderstorm that produced lightning that hit and split in half a tree in my neighbor's back yard, sending one half of the tree into *my* back yard, but more on that later if at all, because it really sucked and I don't want to go into it) and most of a week with really heavy patients, including one sweet, charming gentleman who insisted on leaping from his bed like a gazelle though he had no use of his right side, and most of a week during which I've been grousing about not being able to take NSAIDs (see charming gentleman, above) for my back, I'm back.

My massage therapist is very unhappy with me. She will continue to be unhappy with me tomorrow, when we meet for another session of elbows-on-back, yank-the-leg-into-weird-positions massaging and stretching. I did yoga this week, and refrained from lifting heavy things over and over, and I was still flat on my back on the floor for most of the day today thanks to that sweet guy in the surgical CCU. He was very apologetic about making me grab him around the waist and swing him into a chair at the very last second.

Uh....updates. Yes. IbidKitty is coming around nightly to eat her chow, though I rarely see her now, as it's getting dark later and later. Max is lovely, thanks to my brother-in-law's suggestion that what I thought was a seizure was maybe old-dog farting-with-bonuses, and perhaps lentils would help. The Boys are dangerous and deadly, and would like all of you to be very, very afraid. And then give them belly-rubs and head skritches. Attila is in California at a yoga class and will be gone until after I have surgery.

I still have not been able to watch any of the Dr. Who episodes involving the Weeping Angels after the first one ("Blink"), which means I'm missing a lot of River Song history, which is frustrating. But the Angels are scary.

The Powers that Be have implemented three new daily audits that must be done on every patient every day, adding to the two that we already did ibid opcit, and making our lives that much harder.

The house is still standing despite the baseball-sized hail that fried my Interwebs connection and dented the siding (all but one dent popped out the next day). Surprisingly, I didn't have any roof damage. I think that was primarily due to the fact that the fucking hail was coming down at a 35-degree angle thanks to the 70-mph straight-line winds. After the power went out, Max went to the Disaster Closet, opened the door, and went straight in. He knows what's right.

I have a new bottle of metallic robin's-egg blue nail polish. It's posh, rathah.

And that is all.

People make me so MAD.

There was a little kitty out in the front yard the other night when I got home from work. She seemed unafraid but cautious, so I talked to her a bit and got some meows in response. I forgot about her until last night, when she showed up in the back yard--and any cat who does that is either ballsy or desperate, given that that's Max's territory--and meow-meow-meowed until I came outside.

(I should mention here that I live in a part of town heavily populated by what my marvelous pal E. calls "stupidents." Everybody moved out about a month ago. Some of them apparently left a cat behind. It happens every year; some folks think animals are disposable.)

Poor little cat was skin. And. Fucking. BONES. Her spine and tail were sharp through her skin, she was covered with scabs, and there were big patches of fur gone from her back legs and belly. At one point, she was a floofy, long-haired cat: now she's a bristly, skinny, patchy-haired cat with her ribs showing.

What could I do? I fed her. When I went outside later, she was as ravenous for affection as she had been for food. We sat for a bit and I petted her--carefully, since I'm nervous around strange cats--and then she ate some more. She did the head-bump, pet-beg, eat, head-bump thing for about a half hour, by which time I was fairly sure that she wasn't pregnant and wasn't sick. I got my hands around her and picked her up briefly; she might weigh four pounds. The boys watched it all from the window, interested but not pissed off.

If she sticks around, I'll feed her up and then take her to the vet to get her spayed (or, on the off-chance it's a him, neutered), because I'm sure whatever moron left her behind didn't bother to get her altered; get her shots and so on, and then I'll probably have another cat.

I've seen dogs with their ribs showing. I've never seen a cat with its ribs showing. I've also never seen a cat so thin that you could see each individual joint of its tail through its fur.

Poor baby. There is a special place in Hell for the people who abandoned her.

What I did today (a paraphrase of an earlier email)

Woke up late. Ate breakfast. Read Kelly's The Great Mortality. Napped. Woke up. Ate lunch. Texted Abilene Rob to see how his NCLEX went and got encouraging news. Napped again, this time under a pile of cats. Considered doing laundry, cleaning the bathroom, buying a new Weed-Eater (the last one caught fire the last time I used it), or dyeing my eyelashes. Rejected all options as being too labor-intensive. Started Jeffrey Steingarten's It Must Have Been Something I Ate. Let Max in out of the heat. Rubbed his belleh. Went out and picked up a six-pack, and on the way in to the house, picked a tomato off the plant in the front beds. It's now ripening on the windowsill.

What I most emphatically did not do today:

Answer phone calls, frantic or otherwise, from any hospital, clinic, coworker, or doctor. Get tested for anything. Have anything plastic refitted. Slide into any tubes, magnetized or otherwise. Suction, rinse, or wipe snot out of my enlarged oral cavity. Think about what I could or could not eat. Be exposed, therapeutically or not, to radioactivity. Think about having cancer. Take pain medications. Research anything. Worry about whether I'll have enough energy tomorrow or the next day to do what I want to do.

In short, it was a beautiful, ordinary, lazy golden day: the first one I've had since August of last year. Even if things go to shit tomorrow, I'm going to treasure this twenty-four hour period. Thank God for ordinary days.

A Burma-Shave-worthy offering from my sister:

"When you're sick

Here's how you know:

Even doctors

Mutter 'Whoa.'"

I learned today what you do not want to hear when you open up your trap for the prosthodontist. What you do not want to hear is one tiny syllable, uttered in a quiet voice and with force:

woo

That noise means there's bone exposed on the backside of what used to be your palate, before your palate was removed by a nice man who resembles a wading bird, and it's exposed because the prosthetic palate that the pleasant prosthodontist fit to your trap has rubbed the flesh away from the bone.

Note that I did not actually feel this happening. I thought the prosthetic was irritating one of my adenoids, or a softer bit of tissue further back in my throat. I was completely unprepared for the

woo

However, the prosthetic now fits like a dream. I no longer sound nasal, my hard k's and esses have improved, and I don't have to rinse the thing every ten minutes to remove built-up spit.

Aside from the whole bone-showing, owie-zowie thing, it's great. With a couple of tiny modifications, this will probably be the palate that I end up wearing from here on out.

I still want glitter, or rainbows, in the final version.

Thank God I'm a nurse.

My father once wondered aloud what it was that made me the only nurse in a family of academics. He answered his own question to his own satisfaction with the observation that I'm the only one who was ever good at math (my 9th grade algebra teacher is staring in disbelief) and has let the subject lie since then.

I had dinner with the Sainted Mother and Honored Father tonight. I was once again reminded, during the course of the meal, how very glad I am that I'm a nurse.

See, Dad was talking about academic politics and who gets what professorship and what one's ranking in the department was dependent on, and how that was affecting this, that, and the other thing. And I was sitting there, alternately casting my eyes Heavenward and thinking, "Y'know, if some jackass tried *that* shit around me, they'd never set foot in my unit again."

Even though there's politics involved in my job, it's not the sort that touches your average floor nurse. Even though there's the little matter of the state budget, or the little matter of the performance improvement scores, or the tiny issue of staffing, I'm generally immune to everything besides the delta between Patients Alive At 0700 and Patients Alive at 1900. Less than one is good. One or more needs explanation.

I grew up in academia. I was the world's best paper-writer in college, having been inducted early into the world of poundage of production equalling quality of execution. Becoming a nurse, with its no-bullshit, no-slack way of looking at the world, was a shock. People told you things once and expected you to remember them! There were immediate consequences to your actions! Fucking up was not something you could put in an errata notice in the next edition!

It's very comforting. You're either breathing or you're not. You either have the chops or you don't. Mediocrity is not something that can be hidden, and crazy-pants behavior doesn't last long on the unit. Every problem, no matter how complex, becomes simple once you break it down into its component parts. You cannot argue with an arterial blood gas result.

Thank God I'm a nurse. Maybe the academic world needs more of us, running around like badgers with chainsaws.

So there's this new doc....

....who's missing an arm. Nice guy. Just happens to be missing an arm.

Joanna and I were watching him walk down the hall when she turned to me and said, "I wonder if he ever does The Fugitive as a one-man show?"

Max got a bath today.

And boy is he unhappy about it. He's lying on the floor near the doorway between the dining room and the kitchen, alternately shooting me mournful looks and licking his delicate paws.

He also got his toenails clipped. For his reaction, see the previous sentences.

He's a big dog with a whole lot of fur and huge claws. His claws look like parrots' beaks and are just about as hard. Even with the racheted kind of nail clippers, it takes me both hands and a lot of sweating and cursing to clip one nail.

All of this happened today because I think he had a seizure overnight. I woke up to find him lying in a puddle of urine and feces, but unaware that he had soiled the floor. Normally if he has to go out, he's all up in my grill no matter the time of day (or night). He got up and walked fine after, though his back legs are chronically weak, and his reflexes were fine when I Furminated him this morning. If it had been a spine thing or a loss-of-control thing, he wouldn't have been as strong as usual, and he would've been extremely embarassed about soiling in the house. He has standards. If, however, he seized and then slept through the post-ictal period, he wouldn't be aware of what had happened.

So I'm thinking, hoping, praying seizure. Seizures I can handle. Spine problems or joint problems, or, God forbid if You love dogs and I know You do, a tumor, I don't know that I could handle.

Anyway, he got a bath. It was time for his annual bath anyhow; the ecosystem that grows during the fall, winter, and summer in his undercoat has to get evicted yearly to make room for new inhabitants. I'll take him to the vet on Tuesday to have an X-ray and make sure there's nothing screwed up in his lumbar spine.

Much as I hate to say it, I think this might be his last summer. The heat has gotten harder for him to handle as he's gotten older, and now he's a very old dog. His heart was damaged early on by heartworms, so there's that. And now this whole spine/tumor (no, God, please)/seizure thing. . .he's been put down, pushed around, apprehended, and put up wet, and every critter has its limits.

He is, however, the best boy ever. Even if he takes the varnish off the floors because he wants to come in when he's soaking wet. He's a good boy.

I met somebody today.

I am so excited.

Just over the freaking MOON.

Today, I met somebody--introduced by my uncle, no less--who had her palate removed, same as I did eight months ago. She's three weeks out of surgery.

She sounds just like I did three weeks out of surgery. I don't know that I ever subjected you guys to the absolute depths of suckiness that I was feeling then; I don't remember. The first paragraph of her email, though, was exactly what I was thinking then, so much so that I sucked in my breath and said "Oh, my GOD."

There is somebody like me out there. Better than that, there's somebody like I was all that time ago, when things were really, really bad. She can hear from one person, at least, that things get better. It'll remind me that that's true every time I say it.

She's gonna be *fine*. Fine as freshly-fluffed froghair. Just like I am.

Wow.

See, here's the thing:

If you're working on some massive project or presentation for work and you suddenly get a dull headache and lose half your visual field, it's not normal. The dull headache might be, but the loss of half of your eyesight isn't.

If you wake up in the middle of the night totally blind and without the use of one side of your body, that's not quite right either.

And when you're sitting at breakfast and can't talk, well, that's out of the ordinary. Especially if you've already had a cup of coffee, and doubly-especially if one side of your face quits working, causing you to drool.

All of these situations would warrant, at the very least, a call to your doctor. I mean, it's conceivable that you might, in the first scenario, be having some sort of atypical migraine...but wouldn't it be better to know? If something is going wrong with your sight or coordination or speech, wouldn't that freak you out just a little bit?

I would think it would. Yet all of the people who experienced those symptoms above either went back to bed to sleep them off or kept on chugging along with their respective days. By the time they got to me, all three of them had had massive embolic strokes. They'd delayed long enough that there was nothing we could do except start 'em on aspirin and do rehab. One dude kept cutting hay until his entire back forty was done, then dragged his no-longer-working left side up to the barn and called his wife.

This puzzles me. I know that getting the hay in is important, especially with rain in the forecast. But isn't...I dunno, the fact that you can't feel one side of your body a little more important? Don't you think that being able to lift your arm should have priority here?

If you have a seizure, you go to the hospital or somebody calls 911. Same deal with losing the function in your legs, or losing control of your bladder: you'll go to the doctor if you think you've got MS. What is it about strokes that makes people not start worrying? Don't tell me that it's a function of the stroke itself, because it happens no matter where the stroke is.

It makes me wish that strokes came with some sort of awful green discharge or a rash, or something. Maybe if people could see that something's wrong, they'd be a bit more panicky.

>shakes head<

Sometimes nothing works.

Bad is having a patient with no IV access who is currently critical, and on whom starting an IV is like sticking a rock.

I'm not a bad IV start, really. I manage to get crazy shit on veins in the thumb, for Christ's sake, when nobody else can get anything. You give me a coding patient with a foot that's unburnt and relatively perfused (for a foot) and I can start a 20 gauge.

Really bad is not being able to advance a catheter, and having to give meds through the sixteenth of an inch that you've managed to float into a vein with prayer and incantations and maybe a chicken waved over the patient.

Worse is the situation where they've been okay, then not okay, then sort of okay while the labs say they're not okay, and the clinical signs say they're really touchy, but you still sort of think they're okay, maybe, but suddenly they crump.

Worst is when you acknowledge that they've crumped. You've got eight channels running in the CCU and they're not getting any better, but you keep playing with the Levophed to try to keep their BP within range.

Oh shit is when you realize it's all over. You can't do anything more; you've used up all the tricks in your particular bag o', and it hasn't been enough. All you can do is watch this thing, this person, go down the drain. Slowly. Despite all interventions.

No matter what you do, sometimes it isn't enough. Sometimes, in the face of all your training and all the things you've picked up over the years and even all the little crazy tricks you've tried that might not be in the protocols and might even be a bad idea, it isn't enough and the person, the life you've tried to save, the thing you've invested so much time and emotion in, they die.

It started out fine. She weathered a few bumps in the road, what with electrolytes and pressures going nuts, and she did okay. Then she fell over and there was not a damned thing I could do. I'd known her for two years, with her pulmonary hypertension and her crazy blood sugars and her dialysis, and I knew what had to be done.

None of it worked. None of it *worked*. Something, somewhere, ought to work in cases like this. Nothing does.

I guess, once you have enough experience, that you shrug and go on and say, "It just wasn't meant to happen." You deal with the next thing that has to be done and you put that last thing behind you, no matter how big it was.

I can't do that yet. I don't know that I'll ever be able to. This is where I feel most alone: I can't call Beloved Sister or Sainted Mother and say "I lost somebody tonight," because, for one thing, it's not something they could understand. For another, it was less a failure of things I did or didn't do, but more a recognition that nothing at all was working.

Sometimes nothing at all works. You do the debriefing and the root cause analysis and you go back over your charting and your actions, and everything is right, but nothing worked. You know it's not you, specifically--that the human body has tricks up its sleeve that we can't even imagine--but you still feel like you weren't enough.

Sometimes nothing works. Those are the times you remember when stuff that you did *did* work, and you wait and hope for the next time that that might happen.

The times that you fuck up through comission or omission are better. The times when there is nothing at all in the world to be done are the ones that keep you up.

Ignore the ad at the beginning. I think this might be a good song for Fall.

Ooo! The ad didn't come up for me the second time. Huzzah!

Congratulations, new graduates! You'll be fine.

Really.

You won't kill anybody.

No, I mean it. Seriously. Just remember Jo's First Rule of Nursing:

If you have to fuck with it, it's wrong.

This was brought home to me in a big way just yesterday, when I had a patient with one of those don't-stop-it-or-they'll-die drips. The pharmacy sent a bag with a certain concentration of drug, and that matched the doctor's order, but the pump....was fucked. I couldn't make the drug dosage on the order match the drip rate in the pump's library, no matter how much I fucked with it.

So I stopped. Because fucking with it until you can't remember exactly how you got to where you are means it's wrong. I got another pump, with a different drug library, and I reprogrammed that pump, and everything was fine and dandy.

Advice for the new nurse, graduate nurse, or intern, gleaned from five minutes' worth of actually paying attention over the last decade:

1. Do not freak the fuck out.

There will be time to learn everything you need to know. There will be people who are willing to answer your questions, and people who will have your back (even if you don't know it at the time) and people on whom you can call when things hit the fan. You are not doing this on your own. Everybody has been where you are; sometimes we feel like we're right there with you once again.

2. Actually killing somebody means that a lot of things have gone wrong.

Therefore, it's extremely difficult. With any medication or procedure or what-have-you, there is a string of quality-assurance checks that happen that are meant to ensure that you, New Nurse, will not make a mistake. Trust the procedure, but verify. Which brings us to:

3. Be sure to ask for help or advice when you're not feeling confident.

I ask for help every damn day, and I have been doing one thing for eight years. How many of you have done one thing for eight years? Show of hands?

Yeah. That's what I thought.

The point here is that the human body, even independent of doctors' orders, can do crazy shit with very little warning. Don't bully on through if you don't feel good about it. It's worth it to look like an idiot, or to take the extra five minutes to verify a policy or drug dosage.

4. This ain't no party; this ain't no disco; this sure as hell ain't no fucking Grey's Anatomy.

Don't sleep with your coworkers.

I don't care how cute that nurse is: you're asking for trouble if you have a horizontal relationship. Ditto the resident, the intern, the attending, the other nurse's boyfriend. Just don't. If you must have a relationship with another nurse--a decision which might lead to endless arguments about who had the worse code that day--make it a nurse you don't work with directly.

I, and your other coworkers, thank you.

For this one, Rob, I'm looking at you:

5. Don't work too hard.

There is time. Coco Chanel said that there was time for love and time for work, and no time for anything else. If you adhere to that philosophy, you'll be a crappy, burnt-out nurse in no time. I know you have loans to pay off and an electricity bill that's two months overdue, but you can't kill yourself the first six months out of school. Any knowledge or insight you gain will be overwhelmed by stress hormones.

Take some time to rediscover what you loved before you started drinking from the firehose that is nursing school. Remember what it's like to wake up in the morning (or evening) with nothing to do all day (or night). Read for pleasure. Go catch a movie. Spend a couple of hours doing nothing but daydreaming and petting the dog. It'll not only help you stay healthy, it'll make your brain more able to retain information, true fact!

You're done. You've walked the stage, you're about to take the NCLEX (and you'll pass, I swear), you're getting ready to start a hell of an adventure.

Congratulations! And I look forward to working with you.

I'm really looking forward to a week off.

It will come as no surprise to anybody that people can be stupid.

I wonder why it still surprises me sometimes. The level of inexcusable, inexplicable, unbelievable stoopid I've encountered lately has left me looking forward to having holes punched in my belly. At least I'll get a nap, and at least I'll be at home for a week.

People, please:

If we tell you Papa mustn't drive after his stroke, that means Papa must not drive. Not "not drive long distances" or "not drive a Toyota" or "not drive to the store." It means that Papa now lacks decision-making ability, part of his visual field, and most of the use of one side of his body, and Must Not Drive. Even a big car, even for short distances, even in town.

This is a hospital. It's in the inner city, on a busy street. People come in and out and through on a regular basis. Some of them have business here, while some are merely cutting through our lobby in order to shorten the trip from point A to point B. We can't predict who's going to be coming in and out. Therefore, it's a very bad idea to leave your computer, your iThingy, your purse (no, I am not kidding), your children, *whatever*, unsupervised for long periods of time in the ground-floor lobby.

Likewise, if you choose not to reveal that you have valuables on your person (which means I can't inventory them and lock them in the safe), I am not responsible if your aunt, cousin, ex-husband, or daughter takes those valuables away while you're laid up in the bed. It says so right there on the admission sheet.

No matter how long ago you had that reaction to that drug, it's still an allergy. If penicillin made your face swell up and your breathing get funny six months ago, it's likely to do the same again. Please tell me these things. While we're at it, tell me if you have a food allergy. Some things I can predict, like that the guy whose rabbi visits twice a day might not want bacon on his breakfast plate. Other things, like that you're allergic to nuts, are not immediately obvious.

If Mama is ninety-plus years old with multiple medical problems and occludes the big arteries in her brain, then converts to a hemorrhagic stroke, it might be time to let her go. I do understand that this is a horrible shock to you and that it's tremendously difficult, but please: you are not doing her any favors by leaving her on a ventilator and pressors and a tube feed for three weeks. There is no Mama in there any more.

Check a blood sugar before you give insulin to your patient. That way I won't be trying desperately to start an IV in a stenosed, disappearing vein that belongs to the person with a blood glucose of 20. (Jesus H. Creeping Roosevelt: how many times do I have to say this?)

And, finally: I know I am strong. I know there's a certain amount of noblesse oblige that comes with being stocky and squat and able to lift heavy things. That doesn't mean, however, that if you ask me to "help" move your patient from the bed to the chair, you can stand by quietly as I lift your patient bodily, pivot him (with only toe-touch to the floor on his part), and place him in the chair by myself. Although I am so feminist that I glow in the dark and kill noxious weeds at twenty paces with only a glance, I will be doubly pissed off if you're a man and bigger and stronger than I am. Help means help. Picking up a person and slinging him over my shoulder means my back hurts today.

Do you suppose, if I stay under general anesthesia long enough, that the collective IQ of the planet will have gone up a few points by the time I wake up?

I just won five bucks.

Although I doubt Laura-Loo will pay, because she wasn't all that keen on the bet in the first place.

We had a patient with symptoms of psychogenic origin (English: crazy as a pet raccoon) discharge home the other day. I bet her that the patient would call within forty-eight hours with either a problem or a claim that we had failed to return some of their (controlled substance, held in a lockbox) prescriptions.

I returned all of the prescriptions on discharge, and made sure I saw the patient put them into their suitcase. I even noted that in the chart.

They called today, claiming we'd lost a bottle of controlled-substance drugs.

We're never accused of failing to return antibiotics or hormones or other non-formulary drugs without a significant street value or abuse potential. It's always the amphetamines, Oxycontin, and Fentanyl lollipops we lose.

Of course.

Random, and updates.

Dr. Crane emailed me on Tuesday with a single line: "MRI looks good. No tumor."

That was fucking amazing, guys. I wasn't aware that anybody was even looking for a tumor. I just thought they were, you know, getting a baseline for my new skull configuration.

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

If you wake up from your afternoon nap totally blind, it's probably not a good idea to wait a full twenty-four hours before you go to the emergency room.

On the upside, though, it gives me a chance to see a really nice case of cortical blindness in action, along with temporal lobe edge-sensing and a lack of confabulation. The patient's hypothalamus got hit in the stroke as well, with the effect that they seem to be unable to regulate body temperature.

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

Likewise, if your spouse has had a stroke, it is not a good idea to allow them to drive. Home. From the hospital. Just. Sayin'.

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

And finally, let me make this perfectly clear:

We Can Tell If You Are Cray-to-the-Cray.

If you insist (par example) that you have to have an MRI because of some whacked-out set of symptoms that correspond to no possible hit in your brain to me, then insist that you *can't* have that MRI because of some whacked-out implant that nobody has ever heard of to the doctor, we will treat your case with what's known as a "high level of suspicion."

I still do not know, nearly ten years later, why people think faking neurological symptoms will somehow fool neurologists and neuroscience nurses. We have seen it all before, including things that hadn't been described before we saw them. I, personally, me, Little Jo The Neuro Nerd, have seen two things that weren't named before the patients showed up on our doorstep, and one additional thing that our most experienced neurologist had never seen, but only read about. He told me I could retire happy after that one.

You can't get past us. We are the Cerebrus of the medical system. Just give up, already.

Please note that here I am not describing conversion syndrome, which is a positively hellish disorder in which your body basically takes over your brain. I am talking about hydromorphone-craving malingerers. Dilaudid's a great trip; I'll give you that. But it's not worth four days in a CCU, with me standing over you like an angel of Hell.

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

In other, more personal news, my GYN thanked me today for being the easiest, least emotional, most logical and productive surgery consult she'd ever had.

Yes, Animal is being evicted. On July 7th. I have yet to tell my boss.

My GYN, whom I'd thought was seven feet tall and as impressive as Michelle Obama, actually turned out to be a rather short, fragile-looking woman with huge eyes and a ready grin. It's amazing how one's perspective changes when there's no speculum involved.

Animal is roughly the size of, oh, I dunno, a starling's egg? A robin's egg? Say, four cee-em one way and three cee-em the other? And, thankfully, there was no indication of malignancy on this super-de-duper microsonic amazo-sonogram. Teeth and hair and possibly some waxy substance (me thinking "WAXY BUILDUP" from the commercials), yes, but not anything scary.

So not big, but big enough to torque, which would be a fucking emergency. So we're going to take it out. Not that there was any question, mind you: as long as I'm still relatively young and healthy, and have met my deductible, why not go in for another $13,000 nap?

It'll be laparoscopic and will involve four band-aids to my belly. Worst-case scenario, which neither Dr. Impressive nor I think is likely, would involve the ONC/GYN staff coming in to do a lavage of my belly and take out both uterus and tubes. More'n likely I'll get out in under an hour.

My recovery nurse, whom I've already lined up, is named Tiffany. So is my surgeon. All I need now is a gashog with the same name and we'll be set.

Remember when we all were kids, and we were told "Girls can do anything they want!"? That time is now. I'm a middle-aged woman going under the knife with a female, black surgeon and a female recovery nurse, and probably a female anesthesiologist.

Wow. Things sure have changed since the 70's.

Things that made me cry today.

I don't usually cry. I'm not a crier, unless you load me up with bourbon or give me a sick kitten.

But today?

The tornado in Joplin. Der Alter Jo is from there, and some of her friends are still practicing in the triage centers set up after the tornado destroyed the hospital.

Prison conditions in California.

The woman who sat down next to me at Dr. Elf's Prosthodontic Wonderland, who'd had the right side of her jawbone taken out three years ago and had been unable to eat or swallow since. Her three wishes were to go out in public without being self-conscious, to be able to talk on the phone and be understood, and to let her grandchildren see her smile.

I was so excited for her when she walked to the back of Dr. Elf's office. She was starting something that, while it may not make her perfect, would make her whole.

And this:

My jaw dropped and I leaked tears on the way back from Dr. Elf's.

Early Sunday morning listening:

*whew* *sigh*

No grabbings so far this week. No screaming family members with threats of suing and retribution, no codes called for patients who get out of control, no fires in the rooms, no weird semi-recognizable things in the cafeteria waving up from the steam trays.

Something's bound to happen soon, but I'll take calm and cheerful where I can get it.

This was an unexpected day off. I'm not quite sure what happened in the surgery department, but for once we didn't have sixteen more brain surgeries than beds, plus nephrectomies, plus belly resections and Whipples, so they called me off at five. At nine I called my charge nurse and asked, quaveringly, "Do I have to come in?" She told me to stay home. It was wonderful. Laundry was did, dishes was did, and soon my hurrr will be did as well--it's growing out into that unflattering Giant Q-Tip Look I try to avoid.

All of which leaves me tapping my fingers a bit.

This last year has felt a bit like Limbo. The feeling's been especially strong since about Christmas, when it became clear that I wasn't going to have to deal with radiation or further resections or anything like that. The CCU is up and running, though we still don't have the number of patients I'd like to see. The unit itself is mostly stable, though. I'm not sick, I'm not in danger of losing my job, the animals and house are running themselves, just as I set them up to do. . . .

I'm thinking of going back to school. Maybe for a BSN and maybe not, and certainly not this year, as I still have this prosthetic and one more to pay for. One prosthetic equals a semester of employer-subsidized work at one of the local universities, and my priority has to be speech. Nothing stops me from being a bookworm, though, so it's off to Amazon I go for texts on things like pathophysiology and organic chem--things I've gotten rusty on since the last time I was in school. And Texas government and English and Poli Sci and all the other subjects I could test out of to earn higher placement in a program.

Meanwhile, it's time I fed the dog and took the clippers to my head. This is the bi-weekly night of buffing, razoring, clipping, waxing, scrubbing, and tweezing, all the while hoping I don't uncover something Much Worse than I already have.

Limbo, limbo, lim-bo. It's a bit like brownout. It's also a little bit like the Doldrums in The Phantom Tollbooth.

Well! That hasn't happened in a while!

Today a patient grabbed and shook me as a terrier might shake a rat. Although I am, in my own opinion, prettier than most rats, and most terriers I've met--Jack Russells included--are saner than this guy was. Baseline asshole, cray-cray secondary to Versed. I put the flat of my hand on his chest, pushed him back, and hissed "Lie the fuck down and shut the fuck up and don't do that again, asshole" as the surgeon behind me went wide-eyed and silent.

It had already been a long forty-five minutes. I'd discharged all of the patients from the neuro CCU, so I was down in surgical CCU to help out. Five minutes after I walked in, a patient came rolling up from surgery, having had something complex done to a carotid artery. We were all settling her in--the Mankiller, the Manhandler, and I--when something odd made her monitor go "bonk bonk beeeeeeeep." I figured it was me, since I was futzing with the cords and unplugging things, until I heard people in my immediate vicinity shouting the patient's name.

Oh.

God, I hate it when that happens.

Shortly after that, CrazyPants rolled in, and so I was tasked with calming down a shouting, punching, shaking patient who'd just had a throat resection.

Right now I've got something obscenely cheesy baking in the oven and I am drinking white wine. My sister sent a hand-me-down in the shape of a gorgeous blue-green dress that I was born to wear, and a cute little hand-knitted uterus with Fallopian tubes. I am going to watch Dr. Who again until my head explodes and then check my upper arms for bruises.

Lock up your sons, lock up your daughters, lock up your husbands....

...'Cause they conferrin' degrees on ERRYBODY up in here!

We got Abilene Rob graduated, on time and in good standing, and he'd better not fail the last final he has on Wednesday. If he had comments enabled on his blog, I'd suggest you go over there and offer your congratulations, but he doesn't. So just head over there and hang out for a bit, or something. Have a drink. Dust some bookshelves.

I drove the Endless Hours (tm) to Abilene in a dress, expecting a day of sightseeing with him and his family, whom I had not met. It's important to make a good first impression, especially when you have the sneaking suspicion that every tale involving yours truly has hinged on roasted gopher and long runs from the Law. Rob's a good friend, but he's entirely too honest with his mother, so I was expecting the worst: the patented Mom Side-Eye as she tucked her wallet behind her and attempted to steer the conversation away from prison conditions and the regulation of tattoo parlors.

Instead of Side-Eye, I was met with Windex.

When I knocked on the door, a dark, intense, pretty woman immediately hugged me and introduced herself as Rob's Aunt. She then shoved a bottle of all-purpose cleaner into my paw and instructed me to get started dusting down his bookshelves. Those of you who have lived through nursing school know that some things, like basic home maintenance and personal hygiene, tend to slide. Those of you who've travelled through or lived in West Texas know that dust is a part of life. The two together had prompted all of the relatives who'd gathered for Rob's graduation to do a home makeover of the Extreme type on a tight budget and short notice. So I changed out of the dress and did my part for Dust Abatement.

Rob's mother is relaxed and friendly. His older aunt is, as I said before, dark and intense (but friendly). His younger aunt is blonde and bubbly. His uncle parallels my uncle in spooky ways, down to the name and profession and fondness for toys. They are all, as you'd expect from the family that spawned him, brilliant and funny and talented. It was a little like hanging out with my own family, but without the alkaline snarkiness and puns.

And he graduated! For real! And he has a job all lined up!

I cannot remember being more proud of a friend of mine. I had no doubt that he could do it, and do it well. And he did.

And the commencement ceremony was a hoot. West Texans have fewer inhibitions about whoopin' and hollerin', and graduation is the perfect time to show off that between-the-teeth whistle you've been perfecting for years, out with the cattle. At first it was a little jarring (well, a lot jarring), given that I come from a family of Uptight Academics Who Wear Their Caps And Stoles Correctly. Then it got to be fun. Plus, the college has one very talented singer-slash-organist, who should sing the National Anthem at every baseball game forever, in perpetuity.

Then dinner and drinks, then bed, then up early the next day for a session on the porch with coffee, then a party, then more drinks and dinner again and bedtime.

I am so proud of him. He's a brilliant, talented, funny, kind person with a good heart and an excellent brain. This feels a little like I've shepherded somebody through something, even though I didn't do anything but link to his blog and occasionally bug him with emails during finals weeks. He is going to be...wait, no: He is already the kind of nurse I would love to work with, and whose name on the schedule would prompt a sigh of relief.

Rob, dude, you are awesome. Business will continue, I am sure, to be good.

Love,

Yer pal,

Jo

Bad-ass Good Boy! of the day:

The dogs that work with forces like Navy SEALs have their canine teeth (their four fangs) capped to prevent or repair the damage that can be done to a working dog's teeth. Those canines wear down fast, especially when you're training a critter to do things like bite body armor.

So they get their fangs capped. With titanium or stainless steel. Gold and amalgams aren't strong enough to withstand the bite force of a big dog.

Who's a good boy with beautiful white teefies? Who's a gooood boy? Who is? You are!

(I, for one, welcome our titanium-toothed canine overlords. I hope Kong has a toy for this.)

Limbo, limbo, lim-BO

Quick Animal update:

Animal is two inches (roughly) long and some undetermined measurement the other way. Nobody has any idea what he is, but everybody agrees that for now he's not a big deal. Don't ask me how that works.

Re-sono in three weeks, with the doc in the room, then everything will get decided.

Meanwhile, I'm going to go do some dishes.

This is why Abilene Rob is worth knowing.

A Medical Comedy Scripted By The Marx Brothers

I, too, am tired of these motherfucking snakes on this motherfucking plane.

So today I get a call on one of the internal phones. These phones have super top-double-secret numbers that are only dialable from other phones in the hospital system. I pick up the phone. The voice on the other end asks for me by my real, long-form name, the one that I normally keep hidden in a Hawaiian records office.

It's the scheduler for the OB/GYN, reproductive endocrinology, reproductive oncology people. She wants to know if I've scheduled the ultrasound followup for the hot spot they found on my PET scan. The one on my right ovary.

(*sound effect of screeching brakes*)

Me: What? What motherfucking what?

Her: Uh....has Dr. Crane's office not called you with the PET results?

Me: No. How 'bout you tell me what the fucking motherfuck is going on here?

Her: Well, they found a hot spot on your right ovary and I'm sure it's benign most of these things are it's probably nothing but we want to check it out right away so how's tomorrow at two o'clock?

Me: (trying not to sound panicked) Fine. Whatever. Great. *click*

After I hung up the phone, I yelled to my partner that I was heading downstairs for a bit, then borrowed the boss lady's office to have a nice thorough bout of hysterics (I made the appointment for the ultrasound and follow-up first, though). Hot spot, PET scan, ovary, age 41, adenocarcinoma already, holy crap.

Boss Lady sent me home. She didn't even give me a chance to argue, just called in somebody else and shoved me out the door. So home I came, and watched Dr. Who until my brain exploded. Then I took a nap.

When I got up, I discovered two things: That Dr. Crane had left me a detailed voice message after the tone, and that he'd also sent an email. His communications had crossed with the phone call from the folks at OB/GYN, so I had missed 'em.

In both messages, he said that the "hot spot" was something that, according to the radiology people, looked consistent with a dermoid cyst. They'd seen it six months prior, on my first PET, but given that we were busy with other stuff, had elected to advise a wait-and-follow approach. The thing, whatever it is, is unchanged in size and uptake from the last scan, but it's still there. Given that dermoid cysts (those are the weird things with teeth and hair in 'em) can burst and cause peritonitis and so on, the Radiology Guys figured a diagnostic u/s would be a great idea. I agree with that, so I'll be prodded with a wand tomorrow.

I just love incidental findings.

So, yeah. My head, by the way, is fine. My neck and chest both look lovely. My belly, aside from the fact that I have Animal from the Muppet Show on my ovary, is pristine. My adrenal glands were a little overactive, but as Dr. Crane said, that's to be expected on a follow-up scan for cancer.

Teeth and hair. On my ovary.

This explains why I've had the compulsion to floss my Fallopian tubes.

Endings. Beginnings. (Dude. I know you follow me on Blogger.)

My ex-husband is selling the house we bought shortly after we were married. It's the house I grew up in; Mom and Dad sold it to us for super-cheap. He's asking about five times what we paid for it.

And you know what?

He ought to get every penny. It's totally worth it. He's prettied it up with refinished floors and fresh paint and a deck, but more than that, he's rewired the whole darned 3200 square feet and put in new windows and insulation. I heard all this from guys that I'd hired to do the same work on Casa Del Animules.

The kitchen looks great. The second-floor bathroom is a vintage dream. The room I called my study, where I first started to get online, is gorgeous.

Clint, dude, you do good work. Despite all our differences, that is one thing I will never, ever dispute: you do very good work.

So that's the end of a chapter. The house I knew is bordering on unrecognizable: for one thing, the kitchen is both more attractive and more usable than it ever was when I lived there either time. For another, did I mention that he added this huge, gorgeous deck where once was a totally worthless and dangerous set of concrete steps? Seriously, this is a great house.

Another thing ended today: I got a pretty good preliminary report from Dr. Crane. Although the finals from the PET won't be back until tomorrow at the earliest, and yes, I plan to risk a written reprimand to sneak into the computer system and find out what they are, the basic report looks good.

I seem to have a cure.

I am now a person who had cancer. Subject, of course, to any revelations contained in the report from the radiologist.

I seem to have a cure.

The theme of the Life Of Jo seems to be this: the things that suck the most are the things that leave me with the most lasting, most valuable lessons.

I hated my first husband for a long time. It wasn't until I started admitting things, like that he taught me how to be an autodidact, and taught me how to wrestle out the important points of an argument, and how to call bullshit, that I realized how valuable he was to me. Most of what I am, intellectually, I owe to Clint. We may have been a crappy match other than brain-wise, but he had a brain the equal of which I have not yet met, even in years of working with neuroscientists.

I hate that I had cancer. I'm still in the process of hating it; hating that I have two plastic palates soaking in water on the kitchen counter, hating that bedtime stories and casual conversation are both limited by whether or not I have my mouth in. Still, it's getting easier: I'm getting more intelligible without the Device in, and I can make jokes about it, like that I sound like an adult in a Charlie Brown cartoon without it.

I can't remember now what I sounded like without a palate in. Sometimes it comes back to me, mostly in dreams, but even my dreams now are like my real life: I sound funny without help.

Sometimes I dream about the old house. In one dream, all the furniture was suspended above the floor, and the walls were being replaced with cedar shakes. In another, the entire back yard had been plowed up and planted with soybeans. Mostly, though, they're peaceful: I walk through the house, touching things I remember that have been long sold or destroyed.

I can't remember now what I was like before I met Clint. Five years ago that would've been cause for frustration and anger. Now I'm just thankful that he taught me things that have lasted beyond all the shit we put each other through. Maybe, if I'm lucky, having had (can I say that yet?) cancer will be the same way.

I am full of Valium and Mexican food and this might just be the way to live.

The PET scan went fine. Final results probably won't be back until tomorrow, but Dr. Crane says the look he took seems okay, except that I have a stone in my tonsil. "I don't know why I didn't just go ahead and take those out," he said, referring to my tonsils, "I was in there anyhow."

He got a big ol' side-eye on that one.

Nurse Ames looks like a fluffy bunny that would come apart if you spoke to her harshly, but she drives like a NASCAR wannabe. Even with horrible wrecks between Littleton and Bigton, she managed to get us there on time and in one piece, and with minimal gleeful cackling.

I'm going to go hang up my scrubs now for tomorrow and then try to stay awake long enough to feed Max this evening. *sssskkknnnnkkkkzzzzzzzzzzzzzz*

Bad/Worse/Worst Volume 2: A quick update

Bad: Having a cat try to steal your roasted asparagus while you watch "Miss Congeniality".

Worse: Having that cat succeed. NOM NOM NOM says Notamus, eating asparagus.

Worst: Cat asparagus pee.

Srsly? The worst. Even multi-cat ain't up for this shizznit.

Or peenit. Wev. Ew.

>_<

Odds and Ends

Poor Max has had some broken sleep lately. Flashes (the smaller, stripey, smarter cat) has decided that he misses cuddling with a dog at night and so has started sneaking onto Max's bed when he thinks Max is asleep. If Max is asleep, Flashes cuddles until Max wakes up. At that point, Max lies there for a moment, thinking the doggy equivalent of "he's right behind me, isn't he?" and getting more and more freaked out, until he can't stand it any more and has to get up and go sleep in the kitchen. I've been finding Flashes on the very edge of Max's bed in the mornings, looking sort of lonely.

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

Bad is having a tube in your brain.

Very bad is having a tube in your brain that then gets infected.

Worst of all is having a tube in your brain that drains nothing but pus and chunks of brain tissue. Jo went *erp* O_< at that.

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

If you haven't already read Mindpop, go do so immediately.

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

The drought, while not broken, has been moderated in the worst way over the last few days. A series of thunderstorms/tornadoes/supercells dropping golfball-sized hail has formed right atop us this week. While we've gotten some much-needed rain--maybe all of Littleton won't burn to the ground!--it's been exciting. I tried to lie down for a nap today and was disturbed by the howl of the weather sirens and the BANG BANG BANG of hail on the windows.

Max was unaffected. So were the cats. Little bastards wanted to go outside and play in it.

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

The interview with the nice writer for Reader's Digest went swimmingly. Thank you for all your suggestions. I have one to add: "I'd never tell a patient that he's a moron for waiting a week for his stroke symptoms to improve before coming to the hospital." Although, you know, I'd like to. Especially when his wife bitches me out because "we're not doing anything" for the guy. Lady, there's nothing we *can* do. Aspirin, make sure he's not in a-fib, make sure there's no patent foramen ovale, rehab: that's the prescription for moronity right now.

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

Nurse Ames and I are making our semi-annual pilgrimage to Dr. Crane's tomorrow. There's one stop we have to make first, at the PET center. My single Valium is safely packed away in my purse. I've gone from unworried to completely freaked out to fatalistic and drinking too much wine. Just as I was reminding myself that nothing was likely to have popped up in six months, the Steel-Toothed Brain Ferrets chimed in with the fact that it was only six months between a clean check-up and the discovery of The Toomah.

Oh, well. If the PET's clean, I'll celebrate for years. If it's not, I'll have more material for the blog.

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

Bad is having a tube down your throat.

Worse is having a tube down your throat and an intensivist that doesn't know how to set the ventilator correctly.

Worst of all is sustaining lung damage because your intensivist set the ventilator wrong. Then you end up with us. Whether or not that is an improvement is up for debate.

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

And finally: A group of us (including the Cute Neurosurgeon and That Other Really Cute Guy and The Third Really Cute Guy, The One With The Crazy-Eyes) from work have started meeting for fun, adult events like going to the kids' exhibits at the science museum in Bigton (with flasks; that's what makes it adult) or going off to the driving range (with flasks). We're all heading out to a burlesque show this weekend; one of the girls from the CCU is making her girdle-and-pasties debut. We plan to dress.

La Belle Dame Sans Merci, a colleague who can wear a fascinator without looking ridiculous, is lending me a waist cincher. I am practicing using liquid eyeliner to make those little cat's-eyes lines and have bought a new dress. I am stepping up my game. Der Alter Jo has mentioned that she might join the fawn-walking-on-ice brigade in a new pair of FM pumps, and Stoya is going to wear something red and strapless that will make her look tigerish and exotic.

When I asked La Belle Dame what she planned to wear, she said, "Oh, just this black dress I've got. And five-inch platforms. And a fascinator. And gloves." Hence the stepping-up of the game.

Wish me luck. The evening will be a win if I can escape without a broken ankle. I haven't worn heels since I surprised Mom at her own birthday celebration a few years ago.

Last minute request for the Minions:

I have an interview tomorrow morning with a very nice person who's writing an article for Reader's Digest that's to be called "50 Things Your Nurse Won't Tell You." It's in the same vein as the ones she's written about what airline pilots and waiters won't tell you.

What would *you* not tell your patients?

Sunday night fluff:

There's a reason the saying is "Crazy as a pet raccoon."

If you need a little breather from OCD raccoonosity, click here. I fell instantly in love with this platypus and now want to know what sins I have to commit to come back as one in my next life.

Continuing the weird-animal theme, check this out:

I love him, too.

And, finally, the classic site for all Weird Animal Afficianados: Tamandua Girl's Living With Anteaters. The site chronicles her life with Pua, Cinco, and her other critters. Pua was a rescue, as was Stewie (rest in peace, little dude).

This should put to rest Stoya's question, "But what do they eat?"

Oooo. That last song's been up for too damn long.

Try this one instead.

My oldest friend Rob (not Abilene Rob, the Other Rob) posted this to his FB page and I fell in love.

Things here have been... ... ...odd. I've considered, more than once in the last couple of weeks, going back to waiting tables.

The NCCU is under-peopled, so The Big They (aka Manglement) want the nurses to certify as chemotherapy nurses as well, so that we can help out in case of too many chemo patients and not enough chemo nurses. It's an interesting proposition, but I think I might be the only one that feels that way. Two of the other nurses I work with will probably set their teeth and be done with it (though, on second thought, one of 'em is pregnant, so that's a no-go), while the third, Der Alter Jo, has said, "I don't want to be a chemo nurse."

I wouldn't mind being a chemo nurse, but what we're being signed up for isn't exactly chemo-chemo: It's bone-marrow-transplant chemo. Which sucks. Because you have to kill somebody's immune system without killing them. And that's hard, emotionally, because the folks in question are really, really sick. So, yeah, I'm with DAJ on this one.

That's the beauty of dealing with primarily neuro patients: although they might have chronic diseases like diabeetus or hypertension, they're mostly pretty healthy. Really sick people don't have strokes and live. Really sick people end up getting bleeds, or falling over from heart attacks, or ending their lives in some way that's pretty darned irreversible. Because my patients have things going on that are reversible or at least work-around-able, I end up doing a lot of education and tailoring treatment plans; things that I'm good at. I spend, in short, a lot of time looking at my patient rather than looking at the monitors above the person. Chemo nursing of the type The Muckety-Mucks want us to do is the exact opposite of that.

On the other hand, if I train for this, I'll keep my job and my health insurance. Which is worth doing. And, to be less cynical, I'll get a whole new set of skills, and learn a whole new set of things that I've forgotten since nursing school. So there's that.

There have been many Interpersonal Dramas of the Irritating Type in the hospital lately. Interpersonal Dramas are hard for those of us who don't like interacting with normal people, and who don't like drama. The hardest part, for me, has been not simply reacting like a tornado and carving a ditch through the middle of the hospital. Instead, I've been reading anthologies of old science fiction on the Kindle and hugging my knees in a corner in the dark. The tl;dr of this is that smart people can be really, really, really stupid, and I don't want to be stupid.

Um....what else? Oh, yes: follow-up PET is on the 26th. I'm not officially freaking out about it yet, though I can feel Intimations of Freak-Out beginning in the pit of my stomach. It's like, the first PET was clear, the sono I had to have for lumpy boobage was clear, so is this the third-time-charm? And other paranoid thoughts, repeated endlessly in a moaning, droning hum under the day-to-day stuff my unconscious has to deal with, until I end up in a corner with my Kindle, hugging my knees in the dark. You know the drill.

In critter news: Max had an existential crisis today. The postman, with whom he has a long-running agreement, showed up in the front yard at the same time that the ice cream truck drove along the street that runs parallel to the back fence. Max moved faster, motivated by the desire to play with the postguy and hatred for the ice cream guy, than I've seen him move in years. All of his Kangal came out and he tucked his butt up and raced from back to front to back of the yard with legs like steel springs. He didn't catch either one, but he had a hella good time trying.

The cats are insane. They're busily deconstructing the closet as I type, and shedding everywhere. Neither one of them will tolerate the Furminator for very long; it awakens a deep desire in both of them to KILL BROTHER. I'm convinced that kitty-eyes are like The Terminator's eyes, with instructions scrolling past in small print for every situation. Unfortunately, the default is usually KILL BROTHER. At least they've grown out of KILL ANKLE. I would hate to see what 24 lbs. of cat could do to my legs that hasn't been done already.

And there's a really cute guy at work. Friend Pens is being encouraging, which is silly. But he's really cute.

And that is all. Go back and listen to that song again. It'll do you good.

Unintentional creepiness of the day, brought to you by Ingrid Michaelson.

I hadn't given "Girls and Boys" a really, really good listen until I was on my way home last night.

This song? Is probably supposed to be about unrequited love and should fill me with despair and sympathy. Instead, I find it inutterably creepy. Like Creeper McStalkersons creepy. Like Crazy-Eyes creepy. Way creepier than "Every Breath You Take" creepy. Bunny-boiling creepy.

*shudder*

In other news, it's now Less! Than! A! Month! until Friend Rob graduates from nursing school, and I am just so excited that I could fdafdskaht. He needs to sell his motorcycle, so if you're somewhere out in West Texas and haven't completely burned up in the wildfires, check this out.

Um....what else? Oh, yes. The secretary is painted, though I still have to put the glass back in the doors somehow and figure out how to touch up the paint without messing things up.

Notamus has learned how to open all the step-on trashcans in the house.

There has been a horrific bug of some sort going around the hospital. I avoided (strangely) the sore-throat-cough-sinus part, but caught the gack-herk-bleh-tummy part. But now I'm better.

And finally, waiting a week for your stroke symptoms to subside before you present to the emergency room is probably not a good idea. We can't do a whole lot for you.

More later: blood! Bones! Bingo!

Oh, and by the way....

It's really weird to be missing a tooth. Even a tooth you don't think much about.

When popcorn goes to get lost in a tooth, you tend to notice if it's a tooth you've had avulsed. It ought to be there, and it's not.

You never get away from it, do you?

Edited to add:

I know this is really ungrateful, and I should be thankful for what I have, but:

On the 26th, I've got the first PET scan since surgery. What will I do if that PET shows something nasty? I *know* it's unlikely. I *know* that, statistically, my chances of having a recurrance are nil until 15 years post-first-diagnosis, but I still worry. My surgeon, who was one of the guys who differentiated PLGA from things like ACA and HGA, was surprised at how well I was doing. I have a hard time getting past that.

His pessimism scares me. The reaction of my prosthodonsist, Dr. Elf, scares me: he's always so amazed at how well I'm doing.

More than that, I am not whole. I am not whole in a very big way. I will never *be* whole, in that my Brother In Beer will still look at me when I try to talk with my prosthetic out and shake his head and say, "Sorry".

At some point, this thing in my head will stop being a party trick.

I would like to be understood without a plastic bit.

With the plastic bit, I have to choose what I say. Now, and for ever.

Maybe that's the lesson I have to learn.

It's never a boring day when three things happen:

Uno: I got the day off, totally unexpectedly. Which was wonderful, because being cancelled, with the attendant risks of being called in, always makes me super-productive. I now have three clean cabinets and a clean utility room.

Dos: Eyelashes are dyed and cuticles are dealt with. If you've seen either, you understand what a challenge this is. The fact that I did it simultaneously--dyeing eyelashes AND pushing back three months' worth of overgrown cuticles--without injury is amazing.

Three: I managed somehow to draw blood while vacuuming the living room today. Don't ask me how. Stoya responded to my text on the subject with "I don't Even. Want. To. Know" to which I replied, "Don't worry; I have no clue, either." One minute I was sucking up rug bits; the next I was bleeding.

Never a dull moment here at Casa Jo.

Fun links to follow while I'm painting my secretary!

(Ain't come to play; I come to get this job done!)

Elsita has been back for a few months, posting outfits on The Hidden Seed. Sometimes I wish I had her closet, but then I realize I'd just wear the same shorts and t-shirt every day, because I live in a place where the climate is hell.

Think Geek is my go-to for wardrobe updates. I really, really want the t-shirt that says "If You're Not Part of the Solution, You're Part of the Precipitate."

The Mary Sue is a great read for chick geeks, the people who love them, and the people who want to be chick geeks.

Are you depressed by the nosedive that Jezebel has taken? I was, until I found Persephone and The Hairpin. Persephone skews a bit more serious; The Hairpin is the sister website of The Awl, which has the motto "Be Less Stupid." When it comes to girly stuff, The Hairpin certainly makes you less stupid. There are tutorials! on eyeliner! by a producer of "This American Life"!

I really love The Ugly Green Chair. Most people can either write or take pictures. Whitney can do both, and does. Plus, she cooks.

NSFW, Not Safe For Mom! Somebody some time ago sent me a link to Sexy is for Everybody, a body-positive, inclusive, ethical porn site. Online porn isn't my cuppa (the letter-passing scene in Pride and Prejudice is hot enough for me), but if you're looking for something less skanky and weird than, say, Fleshbot, you should check this out.

And, finally, if you are a high school or college student who's having a hard time getting through whatever piece of classical literature's been assigned to you, you should check out Myths Retold. I found this through Antonia Cornwell's blog, Whoopee, which should be nominated for the Fucking Ass-Kickingest Blog Of All Time award. Warning: both blogs contain about as much profanity as this one, which makes them both NSFB (not safe for boss), although Antonia's is all "facking" and "bloody" and "fanny", which just makes me want to drink tequila with her that much more.