Had a bad day? Have an otter having its morning bath.

With a shoutout to Friend Johnny, who is Portuguese, like this otter! (I don't know if she bathes like this, though.)

I'd have fun nursing stories for you, except I haven't got any.

I've had nine patients in the last week or so. One of them had a stroke. The others were referred to us, for reasons I don't understand, for everything from constipation to heartburn to a torn rotator cuff.

If an emergency room doc can't tell the difference between constipation and a stroke. . . .Oh, dear.

Just Oh, dear.

So instead I'll talk about Dia de los Muertos and the costume I've worked up for this year's street party. I didn't make last year's party, due to that little altercation with a bone saw, so this year I'm going as. . .

a nurse.

Yep. A nurse. With a white dress (Barco still makes 'em: double-breasted, button-down nurse dresses with knee-length skirts and long sleeves) and cap (White Swan makes those, out of cotton, with a button in the back) and black-and-white sugar skull makeup, excepting the big red cross in the middle of my forehead and the drop of blood on my chin.

Basically I'll be my own calavera, complete with bottle of tequila and black-and-white flowers in my hair (small ones, so as not to compete with the cap).

The cap I'm going to trim out with black grosgrain ribbon, ditto the sleeves of the dress, and find a wide-enough piece of grosgrain for a belt. White stockings and black heeled oxfords, and all I'll need is some dude dressed as a calavera Navy guy to recreate The VJ Day of the Dead.

Dad was all excited that I was returning to a gentler, more modest past until I told him that the dress was for DdlM.

Pictures to follow, provided the makeup turns out and I don't end up in a white dress with some dude with a faltering grip on reality and a harpoon following me around.

Oh, yeah. I was reminded that I hadn't posted details about that date.

Uh. . .maybe I need to start another blog. Just for the comedic effect.

He ordered tacos at a Salvadoran restaurant, requested that they be brought without lettuce or tomatoes, made a face at the fried plantains, didn't touch the black beans, picked the cheese off of his tacos, and then left a dollar tip.

I came home and watched cute animal videos for a while.

I love the "artist" in the beret.

Letters! I get letters!

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

Note: This post is Not Safe For Work, Mom, or Life. If you are faint of heart, scroll on past.

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

Every blogger out there gets the occasional nutso comment or email. There's a dedicated group of trolls that reads HN and occasionally submits comments. I hear from the "ALL FEMALE NURSES ARE PERVERTS AND UNPROFESSIONAL" guy, the anti-vaccination folks, and the dude who claims to be an MD and says nurses don't know anything about anything, on a fairly regular basis. Sometimes I get somebody new up in this grill, and I always watch to see if they come back. It's exciting. I love my regulars, but it's nice to see a new face.

I got a comment on the post about the State Fair and the dude with an autoimmune disease the other day. I've sat on it because I couldn't decide what to do: ignore it, put it up and watch the fur fly, ask for contact info so I could excoriate the sender privately, or turn it into a post and let it rip?

Nice didn't win. Here's what somebody submitted:

Jo,

You know what, it really sounds like you need to be serviced. I'm going to go out on a limb, here. I'm young (well, relatively so), hung, and I'll bang you. I'll make things right in your world, guaranteed. I know writing is a sort of release for you, but I'll give you a release that'll make you forget about writing for a good while....
You just name the time and place.

Sincerely,
Anonymous

Ain't that something?

I have tried to take this point-by-point and be funny about it, but I really can't. I do admire the dude's grasp of basic grammar--unusual among trolls--but that's it.

Anonymous Commenting Dude, you need to cut back on the booze and the self-esteem. Only somebody drunk enough to be stupid and stupid enough to be mistakenly confident would ever submit something like this. Seriously, what were you thinking?

I mean, has this sort of approach worked for you in the past? Have women you've catcalled out of your car actually come running, hopped into the back seat while removing their clothing, and said, "Okay, baby, let's go"? Do the fifteen-year-olds you creep when they babysit for the neighbor's kids find your descriptions of yourself cute? Have you ever had an actual interaction with an adult female? I would think not, given what you seem to believe is appropriate for a conversation-starter.

I have less than no interest in getting "banged" or "serviced" by you. In fact, I've found that if a person, male or female, talks up their talents in any area, it's highly likely that they have no talents to speak of. (This is an oblique way of calling you a needle-dicked bug-fucker who couldn't find a woman's crotch with both hands and a candle.)

Plus, you're an asshole.

You probably got some sort of naughty thrill out of imagining me opening your email and sitting there, shocked expression and all. While you were typing one-handed, did you fantasize about how fast I would be posting a note asking for your contact info?

Did you have a vision of me laughing out loud, then showing your comment to everybody in the immediate area, emailing it to several more people, and collecting their extremely amused reactions? Because that's what happened. I wasn't creeped out or freaked out or turned on; rather, it was the funniest damn thing I've gotten in the HN inbox in years.

So why spend the energy to respond to this in public? Because guys who think like you do deserve to be mocked. (You really deserve to be humiliated, but given that I don't know who you are, I'll settle for mocked.) If I'd had the inclination, I would've found out your name and put it up here for the world to see, but you know what? Not worth it. It'd be too much energy expended for too little return.

Much like, I expect, being serviced by you would be.

Okay, this is ridiculous. And it doesn't change my view on having WILD FUCKING ANIMALS as pets. . .but.

When I watch this, even though they're two different species, I know what he means, because I live in this place with Max every day:

Max was feral when we found him. He was skeletal at 37 kilos/81 lbs and was perfectly able and willing to attack anything that looked like food. For months he would not come near me, no matter how non-aggressive I tried to be when I approached him. He would either shy or snarl; neither option was comfortable.

Yeah, he's not a half-ton grizzly bear, but he's certainly able to kill the cats. He won't do that, though, because he recognizes that cats have Sharp Pointy Bits at the end of their paws. He respects the cats, and the cats respect him.

He's also capable of killing *me*. You don't ever live with a hundred-pound animal without having that somewhere in the back of your mind. The reason he doesn't get obnoxious when we're irritated with each other, I think, is that he understands that I respect him and recognize his autonomy. I never give him a command without reason, but at the same time, if he disobeys the command (like "sit/stay"), he knows I'll take a second look at the situation. One hundred percent of the time, so far, I've deferred to his judgement.

Yeah, no. He's not a bear. But I kind of understand what this is like, to rearrange your life a bit so that a critter can have Thanksgivings in your house (although Max doesn't care for turkey; instead, he gets his own plate of pumpkin pie).

He's a good boy. A good boy. And he eats birthday cake just like the grizzly does.

*shiver*

Had a bad day? Have a cub-'n-bucket.

Gar. GAR. GAAAAAARRRRRRR!!!

Tomorrow, the State Fair starts in Yeehawton.

And dammit, I am going to drive and drive and drive sometime in the next twenty-four days and go to the State Fair. Because two years ago, I was too busy being heartbroken and stood up to go, and last year, I was too busy bein' all cancery and shit. I want me some fried food.

In the meantime, I have advice for the Minions: Don't get an autoimmune disease that affects your nervous system.

The patient in question is a normal, boring guy who went on his normal, boring, noiseless way until the day when he suddenly seized. Multiple times, in the presence of his family, and then multiple times in the presence of the emergency department peeps.

Then, while he was hospitalized, he got confused and combative. Then he got really weird and stopped breathing on his own. Then he ended up with us and did nothing but twitch and seize for four months.

Six months after he first had a headache that turned into Hell, this dude is waking up. Turns out he has a weird autoimmune situation going on: nearly all the people who get his particular syndrome are female; the ones who aren't have tumors on their thymus gland. Less than a tenth of a percent of folks develop this thing with the hard-to-pronounce name on their own, in the absence of triggering factors.

This guy is, of course, one of those perfectly inoffensive, perfectly boring people who had nothing at all wrong with them, who went on to develop an autoimmune disorder so rare that even Wikipedia doesn't have more than a stub on it. It's the autoimmune fuckup version of my cancer, basically, but without the good drugs and the pleasant outcome.

HOWEVER! He has, statistically speaking, a good chance of recovering. From what we can tell, if you wake up at all, you're pretty much guaranteed a happy ending. It just takes a while.

In the meantime--and this is why I would advise against getting any weird, obscure disease--we've tested him for everything from viral infection of the central nervous system to heavy metal poisoning to parasitic infestation. He's had so much blood drawn over the last four months that he's required two transfusions. For a while, we had a drain in his back to draw off CSF, just because it was easier than doing repeated lumbar punctures.

Now that he's kind of sometimes a little bit following some commands, I'm sending him off tomorrow to a long-term intensive rehab program. There, he'll learn how to swallow and talk and walk and tie his shoes again. If he's lucky he won't remember a damn thing about the last half-year. If he's really lucky, he can hit the State Fair along with the rest of us next year.

And if I see him there, you can be sure I will buy that man a Shiner and a corndog.

Whiskey-soaked donuts, Tornado Taters, unicycle, eight small rubber balls.

Or, the title of this post has nothing to do with the post itself.

I got the Definitive Obturator fitted today. There was no speech bulb attached; that'll come on October 6th, after Dr. Elf has a chance to mold the thing off of this current obturator, which works great both in terms of speech and of snot drainage.

You guys, I am *so* excited.

Remember how much I hated the first obturator? Remember how I got used to the second obturator, but kind of didn't like it because it fell down in the back and was heavy and made it harder to talk?

This one is. . .well.

It's shiny, shiny silver metal. I have no clue what the metal is; it looks like that cheap stuff they make adjustable rings out of--the kind you get out of the gumball machine. It's got integrated tooth hooks, which means they're much less likely to break off. And it's got this loop on the back which'll hold the speech bulb, and *that* means that the shape and size of the bulb can be changed as needed without as much effort.

I'll post comparison pictures after I get the D.O., but for now, imagine a retainer. You know how retainers have that plastic part that covers up your entire palate? That's what I've got now. The D.O.'s palatal widget is about a third the thickness of the plastic one, and it doesn't cover the area just behind my front teeth. That means that not only is it lighter and easier to put in, but it also doesn't change the way I talk. I've learned that the speech bulb is only part of the equation: good enunciation requires tongue contact with the backs of your front teeth.

(This is especially important for singing, for reasons I don't completely understand but have experienced. I talk fine but I lisp when I sing.)

When Dr. Elf put the D.O. in, it was like wearing nothing. I'm not kidding: the feeling was as close to having a normal mouth as I've experienced in nearly a year. It was. . .comfortable. Not just comfortable, it was unnoticeable. I could tell the difference even without the speech bulb.

There are two pieces of bad news: first, I will no longer be fully protected from Dorito Abrasions and Pizza Burns. I'll have to re-learn how to eat like a normal person. The second bit of bad news is that Dr. Elf had to grind down several teeth to get the occlusion right; there's only so much grinding you can do on tiny metal hooks before you weaken them. My tooth enamel had to be slightly sacrificed in two places to get my bite correct. Tooth enamel ain't no thang, y'all; it's totally worth it to have this new widget work.

The upside to the tooth grinding is this: When the first obturator was being fitted, Dr. E. had to grind off bits of the posterior edge of the anterior side of my eyeteeth. Given that *this* grinding of teeth involved the anterior edge of whatever tooth is behind the eyetooth, I now have even more prominent fangs than I used to. When I smile a certain way, I look like a vampire. This is a look I really, really dig: it's body mods with a medical excuse.

In sum, this new obturator/speech bulb combo is going to be bad-ASS. It's gonna be Terminator Mouth from here on out. I think that this might actually be an improvement on the normal human mouth, in fact: it'll cover most of the area of my palate that used to get burned from too-enthusiastic hot-food consumption, yet not impede my speech.

Okay, enough of that. Thank you, all of you who sent reassuring emails and posted reassuring comments after The Twerpacle (the minor debacle involving That Guy I Was Dating). In a surprising demonstration of Good Timing, the Universe decided to make my pal and coworker Dame Hammet (points for those who got the Brother Cadfael reference) want to introduce me to her cute friend who's tall and skinny and funny. Pray for me this Sunday, around 7:30 pm Central time.

***I should mention here that TGIWD isn't actually a twerp. His behavior was twerpy (and so was mine), but he's a hell of a person, and any woman who is able to sort through his various issues is getting a massive catch. (Feed him up, girl. Them elbows is sharp.)***

And yes, I've already picked out my outfit. And my shoes. And my eyeliner. Not that I'm nervous, or excited, or anything.

This "dating" stuff is fun. Who knew? Now that I've gotten over the Fear Of The Obturator Causing Uncomfortable Conversations (take it or leave it, buddy), I'm kinda enjoying myself.

Coming Up: Why you should try to avoid autoimmune diseases!

Nursing stuff later this week. For now, *sigh*.

That Guy I'm Dating is now That Guy I Was Dating.

Because, after six weeks, he still hadn't figured out whether or not he liked me. I mean, really? All the signs were there, dude: You brought me an LED mod for my mini-Maglite, you wanted to hang out whenever, all that other stuff, and you weren't sure whether. . .you. . .liked. . .me?

Getting upset over this would be like getting upset because I can't communicate with somebody who speaks only Russian. Abilene Rob, being the sort of stand-up guy he is, and a very good friend besides, was exasperated on my behalf. I think he said something like, "He had your boobs right there and he didn't know what to do with them? What kind of idiot is he?"

Ah, Rob. Always there to pick up a girl's self-esteem.

Anyway, this has led to my re-reading the profiles of those poor fools deluded enough to check me out on A Famous Online Dating Site. From my perusal, I have determined the following:

1. Every man in Central Texas describes himself as laid-back. This explains the droves of horizontal men lining the streets.

2. Few men in Central Texas can spell, punctuate, or put together a sentence. There were at least half-a-dozen guys whose profiles left me all, "What? What?"

3. If a man is six-three and three hundred pounds with a bad goatee, he wants somebody at least ten years younger with a slim or athletic build.

4. I am too old for forty-one-year-old men. (Yes, one of them actually *told* me this after I'd emailed him, my rockin' profile notwithstanding.)

5. Every guy around here is looking for a mother for his children. Most also have few to no teeth, and one in six admits freely that his mother thinks he's gay and that he's looking to change that.

I could have the problems Stoya has, though: Within 24 hours of getting an account on A Famous Online Dating Site, she had over fourteen hundred "winks." That's one thousand four hundred, or a one followed by a four and two zeros. There is such a thing as having too many choices. Stoya is about to just pull the plug and spend the rest of her life in her apartment, cowering under the bed.

I, on the other hand, would like to dissect That Guy I Was Dating, and find out what he uses in place of a brain.

Please, nobody suggest I start dating musicians. This place is as full of musicians as a fleabag hotel is of fleas, and you know the old joke: What do you call a musician without a girlfriend?

Homeless.

See? I have a sense of humor! Call me!

Home again, home again, etcetera.

I could happily live the rest of my life in central California, near the coast, provided I didn't have to do anything to earn a living. Could somebody please invent a time machine so that I could invest in Microsoft stock early? Thank you.

Pens the Lotion Slut and I keep emailing and texting each other with the words "Best Vacation EVER" and "CONDORS."

We ("we" being Pens and me) arrived late in the morning Sunday at San Jose and were whisked, as much as a bus can whisk, off to the CalTran station near the airport. There's some wonky stuff going on with construction there that would've made it impossible for Beloved Sis to pick us up, so we just rode the bus through town, with Pens asking things like "What's that vine?" and "Is it always so gorgeous here?" (Answers: Bougainvellia and Yes.)

Beloved Sister and Brother-In-Law have a little place in Monterey--and by little, I mean little--with a guest house/studio out back. Pens and Beloved Sis and I installed ourselves there and proceeded to eat lots of bread and hummus and snackages, complete with thyme-infused olive oil. Then B.S. and B.I.L. made us ravioli and butternut squash puree with sage butter and perfectly sauteed zucchini with the sweetest bell peppers ever. I should've known at that very moment that it's nearly impossible to get a bad meal in central California.

Seriously? Had I posted during the past week, this would be the Head Food and Condor blog. Because we saw CONDORS. But before that, I saw HUMPBACKED WHALES. And before that, I sprained my knee.

On Monday, Pens and I went to see whales on the Monterey Bay Whale Watch tour. We took the Sea Wolf II from the wharf at 0900 sharp. It was during the boarding (boarding? Embarking? Getting-on-the-boat?) that the boat went *wibble* and my left knee went *gronk* and I stumbled, practically into the arms of the handsome man who was charged with getting my landlubber ass onto and off of the boat in one piece. Sadly, I caught myself and sadly, my knee swelled to the size of a small grapefruit during the trip.

But I saw three humpbacked whales: a mother and calf and a big male lazily doing the flipper-slap on the surface. And dozens of Risso's dolphins pacing the boat and breaching, and several sea lions (distinguishable from harbor seals by their longer flippers) scamming for scraps. Penny ended up belowdecks in the cabin, green and sweaty from seasickness. At least I won the genetic lottery *somehow*: Penny could be mistaken for a European fashion model, but *I* got the steady cerebellum that allowed me to stand at the bow of the boat and go whooping over the waves while eating a sandwich and ignoring the groans of the dying.

It was, truly, one of the best moments of my life.

Then we went to Cambria. If you ever have to go to Cambria, stay at the White Water Inn. They have cookies! And, if you go straight across the street, dozens of ground squirrels will meet you on the boardwalk and beg for food. I have pictures; they are forthcoming.

Also, if you ever have to go to Cambria (and poor you, having to go to one of the most gorgeous spots on this earth), you should eat at JJ's Pizza. I'm not sure why it got only three and a half stars on Yelp; it's seriously the best pizza I have ever eaten, and close to if not the best hamburger. Plus, the dude who couldn't work the bottle opener for my Sierra Nevada IPA was both charming and handsome.

When you go to Cambria, you have to do two things: See the Hearst Castle and eat at Indigo Moon. The tours at the Castle have been cut to 45 minutes, which is just enough that your head doesn't *quite* explode from the beauty of the place. I kept walking past medieval tapestries and triptychs and saying, "Wait. . .I saw that in a book."

Indigo Moon is that sort of experience, but in food form. Beloved Sis had a risotto that made me determined to learn how to make risotto, with a cheese that I will be ordering in bulk. Pens had a tomato-basil soup that (and I will not lie, here) I was unreasonably proud of already having the recipe for. I had seafood fettucine that will live forever in my memory. Get the Harmony Wineries Riesling: it's the only Riesling I have ever liked. It's superb.

I've been so caught up in the food that I haven't even mentioned the condors. So, CONDORS: As we were driving along Highway 1, a route that is fucking lousy with vistas, we passed a low stone wall with two large, ugly birds sitting on it. One had a nasty pink head; the other had a less-nasty grey-feathered head. The dialogue in the car went something like this:

Pens: Vultures?

Me: Too big.

Beloved Sis: TAGS.

Beloved Sis and Me, together: HOLY SHIT CONDORS.

So we screeched to a halt and walked back to get within ten feet of two California Condors in all their impressive, irrepressable ugliness, and take pictures. Other people were hopping out of their cars and grinning maniacally at us.

Penny mentioned, being the bird-person that she is, that number four looked like she was getting a bit agitated, and what happened? Everybody moved back and let the birds calm down.

Then we saw two more condors soaring over a cliff. Protip: They look a lot like vultures, but marked differently and WAY bigger than vultures.

AND I spotted a purple-freckled starfish and several anemones and a hermit crab in a tidepool, AND Beloved Sis has great pictures of a bright-orange starfish in another tidepool, AND we saw a sunfish at the aquarium, AND Pens is Beloved Sis-and-Brother-In-Law's favorite person ever, AND there were many cuddles with my pit-bull nephew sweetums snuggums Bones, and we all slept eight hours a night at least without nightmares or insomnia.

I'm so glad I took a vacation I could not afford to a place I had left, the last time I was there, with loathing and disgust. I want to do this every week. Tell me, those of you who live in California: do you ever get tired of being surrounded by Nature that isn't trying to kill you?

Say nice things about me, 'cause I'm gone. . .

Tomorrow I leave for California, where I will be spending a week in the lap of near-luxury, if not outright dissipation, in the company of Beloved Sister and Friend Pens The Lotion Slut.

Beloved Sis has been emailing all week with details about the tiny goats'-milk soap she's wrapped in Japanese printed paper and arranged lovingly in tiny straw baskets in the guest-house bathroom. Pens said today on the phone, "It just makes me feel bad to think that we're going to be using up all her toothpaste and stuff, you know?" To which I replied, "Beloved Sis will be like a pig in a wallow, knowing that she can go out and buy new Vetiver soaps and wrap them in delicate paper with flower-petal inclusions. GET OVER IT ALREADY."

There is whale-watching scheduled. And wine-tasting. And pedicures and facials and a B & B in Cambria after the tour of the Hearst Castle. I am taking a pair of leggings on this trip, bought special today at Target: that's how you know I'm serious about being in Northern California.

What this means for you, the devoted minions of Head Nurse: I will not, unless circumstances permit, which I certainly hope they don't, be posting. I'll update you on the Hospital Follies du jour when I get back. You're on your own.

There may be pictures, too.

PS: Thanks for the good wishes and prayers; my house is on the other side of Bigton from the fires, which are now mostly-contained. If y'all want to donate money or clothing or household goods to the folks in Central Texas who lost fucking everything, please talk to your local Red Cross chapter. We need animal chow, too--everything from cat food to horse feed. Thank you.

This made me laugh right out loud.

From Buzzfeed.

Pens The Lotion Slut emailed me this morning

To point out that it's been a year.

I hadn't even thought about it until I got her email. I wasn't sure what to feel or think this morning, and I'm still not this afternoon. I had to go back and check the blog entries for this time last year to be sure.

A year ago I had, though I didn't know it for sure yet, cancer. Not a nasty sort of cancer, not an invasive sort, but cancer. Amanda The Amazing had found it during my routine tooth cleaning and had looked very solemn about it. So had the dentist, and the receptionist, and everybody else.

I remember feeling as though I'd been walking along on a treadmill that had suddenly sped up. I was barely keeping up, keeping my feet under me, as other people made phone calls and tried to find an oral surgeon that would accept an emergency appointment within a few days.

The next few weeks were like that all the time. I went from one oral surgeon to another to an ENT to CT and MRI and PET scans and had a lymph node biopsy (just thinking about it makes the right side of my neck hurt again) without really being aware of what was going on. I remember eating lunch with Nurse Ames, high on Valium, after the PET scan. I remember Abilene Rob coming to town the day that the biopsy came back positive, and trying to eat dinner with him. I watched him clean his plate--you have never met anybody who can eat like Rob can--while still feeling like I was in a film that had been speeded-up.

I remember it was the most beautiful fall I'd seen in years.

Today is a beautiful day, too. The quality of the light's the same, and the trees--those of them that are still green--are up against a perfect blue sky the same way that they were last year. Things have quit burning down to the extent that it's eerily familiar outside.

Max is still here. Pens and my Beloved Sister and Parents are still here, Rob is still here, my Brother In Beer is still here. The cats are still here. I yelled at Notamus today for stabbing me with one of his claws, a thing he knows he's not supposed to do, then felt bad for yelling at him, then felt incredibly grateful that things are normal enough that I can yell at him.

Part of my mouth is gone forever. It got cut out with a bone saw and ended up on a pathologist's counter, cut into frozen sections and analyzed. Somewhere at Dr. Elf's there's a mold of what used to be in my mouth, including a dent that marks the mirror image of where the tumor used to be. ("That's the tumor," he said, showing me the hollow on the alginate mold.)

I have three new friends, all "cancer buddies"--Lara, whose general pissed-offed-ness at the whole Cancer Mess made it okay for me to be pissed off too; Tashi, who provided comfort and love and concern even in the middle of her own hell; and Nikki, who didn't come along until after everything was over, but who provides some of the best on-going one-liners ever.

I have a lot more patience than I used to. I have a better understanding of what it means to be on the other side of my job--how little you remember from moment to moment when you're terrified, how huge even simple things seem, how hard it can be to get the hell out of bed. I missed a lot of work between diagnosis and surgery because, most days, it was just too damn hard to get out of bed.

Now, if something is going to hurt, I can tell my patients that honestly. I can also recommend Dilaudid wholeheartedly and without reservation. I know firsthand where to put an IV, how it feels to get up the first time after surgery, and what "tired" really means. I never want to see pureed anything ever again.

I have a lot of debts I can never pay. Lola and T-Bird, Carolita and James, Nick and Aud, Nurse Ames and Stoya and The Manhandler--all the nurses who took care of me inside the hospital and out--I want to buy them all dinner every night for a year. Beloved Sister made me a communication board because we didn't know if I'd be able to talk after surgery, and some of the magnets from it are still on my fridge, because they're hilarious. My folks were about as non-strange as it's possible for parents to be in that situation. My Uncle Jon came down and played housewife for a week, making it possible for me to go back to work. The Man of God and His Lovely Wife fed me, Beth and Matt buzzed my hair. . .I'd have to start a whole new blog just to say thanks.

And you guys: When I needed information, you sent me loads. When I doubled back and asked you please not to any more, you sent pictures of kittens instead. I got prayers and outpourings of love and good, solid ass-kicks when it was appropriate.

Some things have changed. Some things haven't. Some things changed for a while, then went back to the way they'd always been. It's been--and it seems weird to say this--a good year.

This picture is copyrighted by Deanna Roy

Austin skyline today.

I get all excited about the weather, and then everything catches fire.

I may be rather scarce for the next couple of days. The fires aren't near Casa Jo, but the air is horrible--smoky, hazy, awful--and I'm staying glued to the fire maps on the Innerwebs.

Pray for rain, Peeps. We need it, bad. It was enough that every stock tank was dry; now they're dry and ON FIRE.

OMG. It's supposed to be 80 here tomorrow.

And the low?

In the fifties.

I might just live long enough to go to California with Pens The Lotion Slut and see Beloved Sister.

In the meantime, the Universe reminded me that there's something worse than having a chunk gone out of your head: Joint Commission survey prep.

For those of you who are lucky enough never to have heard of the Joint Commission (the Joint Commission on Accreditation of Healthcare Organizations, aka "TJC," aka "JCAHO," aka "Our Benevolent Overlords"), it's a not-for-profit organization that sends out "Surveyors" every so often to your local hospital to determine whether or not people are charting, washing their hands, sterilizing instruments and changing lightbulbs--all the stuff that goes into running a hospital.

Surveys are usually unannounced. You can be sure that the middle manglement of every hospital in every city across this great land is on speed-dial to every other hospital the minute TJC shows up, to warn everybody that The Beast Is In The House. You don't want to be caught unprepared, without liners in your trashcans or with mops in the corners of the utility closets.

Accreditation is bullshit. When a survey's expected, the management of a hospital decrees that every chart will be audited for errors and omissions. Every bit of equipment that normally languishes in the hallways between uses gets taken away and stored somewhere. Things that are normally unlocked, like syringe drawers and storage room doors, are locked by the housekeeping staff, who usually have the only keys. Nurses are subject to surprise searches to be sure nobody's carrying meds in their pockets. Floors get polished and bathrooms get cleaned.

And then, once TJC has either not come or has come and gone, things go back to their usual comfortable, vaguely disorganized state. About the only thing that Joint Commission accreditation tells you is whether or not the management of a facility can handle having a bag of rabid weasels thrown into their midst unexpectedly, because that's what it looks like.

Prep is horrible. Everybody who shows more intelligence than your average turnip is handed a stack of charts to audit--in other words, you go back from day one of a patient's stay and look at everything everybody has written--and correct. Correction means hunting down the folks who made an error and sitting on them until they fix the error (or omission). Given that we move patients between Sunnydale and Holy Kamole all the time, chart prep means hours and hours of soul-destroying fiddly work, followed by the opportunity to have doctors and nurses from two hospitals and all the associated clinics pissed off at you, the auditor.

My job this week was auditing, along with precepting a new experienced nurse for the unit. Thankfully the nurse was sharp and with-it, or else I would've leapt out the window by nine ack emma. Chart audits are the worst thing I can think of to do at work.

But we're prepared! For the survey! And it'll be great!

Never mind that another hospital in Bigton got surveyed a couple of years ago and won accolades from the JC folks, only to return to having potato chips show up in supposedly-sterilized surgical kits. I'll bet their trash bin liners looked fantastic.

Two Stupid Things in two days: a new record?

As I was leaving the doctor's office after my annual how-you-doin' checkup, he said, as a sort of by-the-by, "You've gained six pounds in the last year. You'll need to watch that."

This after a long discussion of what sort of cancer I'd had and how I'd recovered and what my further treatment would be like, if I had to have any. This after he'd asked how the psychosocial aspects of recovery had been, by querying "How's your social life*?" in his Muppety voice.

I turned around in the hallway after the weight warning and looked at him levelly. "I've been busy" I said, and walked out.

Because, really? The last thing on my mind since just about eleven months ago has been Weight Fucking Watchers and not eating too many calories.

The first Stupid Thing had come the day before, so maybe I was a little over-reactive.

A woman I work with very occasionally--maybe twice in three years--asked why I'd cut my hair. Before I could respond with something neutral and funny, another nurse said, grimly, "She had cancer and was afraid she'd lose her hair to radiation." Leaving aside whether or not it's quite sporting to scoop somebody on something like that, things got a bit uncomfortable.

Nice Lady I Barely Know had a lot of questions. I don't mind answering questions about what happened to me; very few people, after all, even think that head-and-neck cancer is A Thing, let alone that you can lose part of your palate to it. I answered as best I could, and then she said this:

"Well, at least you don't have anything to worry about any more!"

Nice Lady I Barely Know put her foot straight fucking into it with that comment. I *know* it was meant to be reassuring and optomistic, and I treated it that way, but really? I have more to worry about now than I know what to do with.

I have, for starters, a very much increased risk of developing another, different sort of oral or oropharyngeal cancer. Call it two to three times the risk of your average person: my mucus membranes have shown that they'll react badly to HPV infection, and that reaction won't go away unless my DNA gets reworked in the manner of a Time Lord's.

I also have, not to put too fine a point on it, a couple of surgical sites that will never heal any more than they've already done. That means that inhaling my food, wearing a big plastic or plastic-and-metal thing, and having to explain shit to people will never go away. I can't emphasize how much that's affected things up to this point: I wear a MedicAlert bracelet, I don't go out to eat as much (because I can never tell when something might decide to exit my schnozz rather than head toward my gut), I have to tell *every* medical person I deal with about the prosthetic. And then I have to explain. Again.

Which brings us to the Social Life aspect of the whole deal. I hadn't realized, until I'd talked to other young and young-ish cancer survivors, how much that can factor in to starting--or ending--a relationship. I've been on a couple of dates with a new guy, and now I wonder, every time he doesn't email or call, if he's flipped out either by my lack of anatomy or by the idea that he might be buying into something that could end Very Badly Indeed. I used to worry about my belly or my cellulite or that huge zit on my chin; now I worry about the fact that I have this thing in my past and this plastic thing in my present and future.

And, finally, I have something that normal people don't: An every-six-months reminder of what pure gutwrenching fear is like.

I have to get scanned in November. I'm dreading that, almost as much as I'm dreading the dentist visit I have in September, a year to the freaking *day* that Amanda the Hygienist found Lt. Lumpy. I'm dreading the chest CT I have to have next year, to make sure that the tumor didn't seed into my lungs. Every six months for the next couple of years I get to go back to the CT center, drink the barium, take the Valium, wobble out of the room after the scan, and go on to the MRI.

These things are just part of the deal, I guess. They don't make me any more special or tragic or brave or stalwart than any other person who had rogue cells cut out of her body. I actually had it easy by comparison to my pals like Lara and Nikki.

But. When my tongue, out of habit, traces the curve where Dr. Crane cut out my palate, or when I have to run for my prosthetic when the phone rings, or when somebody acts relieved because I only took a few days off and wasn't out for some health crisis, I remember.

I used to have a favorite dress. It was a double-layered thing from Gudrun Sjoden, a Scandanavian store, and it had tiny lines of ornate embroidery around the cuffs and hem and neckline. It's the dress I wore when I went to the dentist last year. It's still hanging in my closet. I haven't had the balls to put it on again. Maybe I will this year, when I go see Amanda.

It would be the first step in not worrying so much.

*"Social Life" meaning "sex life" to my doctor. Which, to give him props, was the first time I'd been asked about it by any medical perp involved in my care. But still: DO NOT WANT to discuss that with Dr. Muppet.

*pant* *pant* *pant*

I'm twisting my spine at a worrisome angle, checking behind me to make sure I still have a butt. I had thought I had run it off this weekend, but no, it's still there.

Something happened last week that I forgot about until yesterday, one of those once-in-a-lifetime moments that nurses hear about happening to other people but don't believe will ever happen to them:

I had a sensible, intelligent, well-informed patient leave AMA and I totally agreed with his decision.

This particular patient had some pretty complex, chronic problems that had been exacerbated by a combination of dehydration and missed medications, and he ended up in the emergency room at Holy Kamole with weird symptoms. The fine folks at HK sent him to us for definitive diagnosis and treatment. Turns out he had missed some meds and gotten dehydrated.

So we ran a few liters into him and titrated his meds back up to therapeutic levels and were getting ready to get him on out when one of the new attendings on service decided we needed to do a much more thorough workup for stroke, something that did not actually happen to this patient. That would've required he spend several more days in the hospital, according to the doc, even though everything could be done as an outpatient.

So he asked about checking out AMA. The attending covering for Doctor Overreactive is a rational sort, but was worried about officially discharging somebody else's patient. So we did everything we'd normally do for a discharge except fill out the official paperwork, and off he went with a smile.

I'm still not entirely sure that this doesn't signal the End Times. Usually, if a patient checks out of our facility against medical advice, it's because they're either angry about the treatment they've gotten or are peevish because they're out of drugs. People who leave in the middle of treatment for whatever landed 'em in the hospital are not in the best of headspaces. This guy? Totally fine.

In other news, the appointment with Dr. Crane went fine. I got poked and squoze and told to make appointments for scans in November. Nothing's swollen in my neck, thank God, but he still wants a CT and an MRI to make sure I'm good on a radiological level. He dithered for a couple of minutes about whether to do both a with-and-without contrast CT *and* an MRI this time, saying he didn't want to "scan me to death," until I said "Dooood. I had CANSUH. Scan me all you want, okay? Just make sure it hasn't come back." So: scans in November, chest and abdominal CTs sometime next year, and then on to regular follow-up in perpetuity.

Next time I'll tell you about the Stupid Thing somebody said to me regarding having had my mouth hacked on. For now, I'm due another cup of coffee.

Bizzy Backson.

(Does anybody else remember that bit from "The Tao of Pooh"? I can't believe parts of that book are still taking up space in my memory.)

Today I have an appointment with Dr. Crane. I'm not sure what, exactly, is going to happen, except that I'll get my sinuses scoped (ohboy) and probably get an appointment set for yet another MRI and PET scan later on in the fall. No matter how big a pain in the ass being a CANSUH patient is, the follow-up is a bigger pain in the neck.

Speaking of pains in the neck, Dr. Elf started the molding process for The Final Bug yesterday. Here's what happens when you're having a Bug molded to the Giant Hole in your head:

First, the doctor will inspect your teeth and decide that, like a large farm animal, you need to have bits ground off of some of them. This will make it easier to hitch the wires on the prosthetic to your teeth later. If you're like me, with a relatively good set of teeth, the doc will have to grind quite a bit (WHEEEEEEZZZZ goes the dremel tool) to make the wire grooves. It doesn't hurt, but it is annoying, and leaves you feeling like you have bits of things stuck in your teeth. It also takes a surprisingly long time to do, as he's going micrometer by micrometer.

After that, as you're still in the comfy dentist's chair, you relax--until you hear the doctor say "We're going to need rope. Lots of rope." You wonder what "rope" is, and why they'd need a lot of it, and are relieved to find out that it's wax rope, meant to take impressions of your teeth for the obturator mold.

The rope goes into a metal widget that's shaped like a horseshoe, but hollow. That gets shoved into your trap and held there for a few seconds, so that your teeth can make a good impression.

Then comes the alginate molding. This is the truly annoying part of the process. Alginate is this pink stuff that's made, I think, of seaweed. It's sticky as hell, has to be very, very cold when it goes in (in order to hold a clean impression), gets *everywhere*, and tastes foul. Seriously: I had it in my ears before they were done.

The doctor cranks the chair back until you're lying feet up, head down at about a 25-degree angle, then instructs you to tip your head back as far as possible. Then he goops alginate all over the front and back sides of your teeth (mmph) and shoves another horseshoe thing into your mouth, full of a shockingly huge amount of alginate. This is meant to take an impression of The Defect.

The effect is like being gagged with Play-Doh. Luckily, the surgery left me without much of a gag reflex, so I was able to lie there without panicking and meditate on the wonders of medical technology. Once Dr. Elf waggledwiggledyanked the the mold out of my mouth, I was much happier.

Dr. Elf showed me on a plaster mold what he wants to do with the final, definitive obturator. In order to cut down on the bulk, he wants to make the front of the thing metal, and smallify it by about two thirds. He'll do that by leaving the area immediately behind my front teeth free of obturator: I'll have a sort of hourglass-on-its-side bit of metal that hooks to my back teeth with the speech bulb attached.

This is good for three reasons: First and most importantly, the whole contraption will be lighter. It won't fall down on the back of my tongue and make me sound like a retainer-wearing kid with a bad cold. Secondly, it'll take up less space and thus theoretically be more comfortable to wear for long periods of time. And third--and more important to him than to me--it'll be hooked to teeth further back, so nobody will be able to see the wires unless they're really looking. I don't mind the wires, but he wants a good aesthetic result as well as a good functional one. *shrug* Whatever, dude. You're the perfectionist.

Dr. Elf also sprang what could be a fun thing or a wearing thing on me: He's giving a talk to some otolaryngologists later this fall and wants me to come be a show-and-tell for people without palates. I told him I'd be happy to sit up straight, mind my manners, and let doctors shine lights into my mouth. He said he'd let me know when and where this thing is happening.

So! Three weeks until the TerminatorMouth comes back from the molding company, then more fittings and filings and grindings of plastic. I was a little disappointed that I won't get a glittery My Little Pony Palate, but TerminatorMouth is a good second choice.

Had a bad day? Have some sleeping leopard cubs.

First they play a two-step, then a Cajun waltz. If you don't dance, then it's your fault.

La Belle Dame Sans Merci, Der Alter Jo, and Heidi The Goat-Girl and I (along with respective spouses) went down to the river this weekend. We stayed in an elderly farmhouse with wavy floors and an entire batallion of mice, ate tons of smoked sausages and bratwurst and potato salad, and floated the Comal for a record five hours. The Comal wasn't much lower than I'd ever seen it (and I've seen it once about four feet higher, which is a story in itself); we just hung out in the shade under a bridge for about an hour.

It was a good weekend. There was plenty of food, plenty of beer and tea and coffee and bottled water, plenty of cold spring-fed river to tube down, and I only lost a couple of things in the chutes.

For the uninitiated, the "chutes" are places where the city fathers and various engineers have decided that the river is too dangerous (second chute) or the bridges too low (first chute) to be safely navigated by crowds of semi-drunk people in big rubber innertubes. Years ago, you had to haul out of the river and walk around one particular bridge, but the more moronic segments of the population didn't, and got stuck under the bridge and drowned horribly. Hence, the chutes were put in--one at the low bridge, and one just above a small waterfall that's much more treacherous than it looks. I nearly drowned going over Stinky Falls once.

Anyway, here's how it works: you're sitting in an innertube, thoughtfully provided with a drink holder and handles, and probably tied on to other innertubes containing either people or coolers or both. Right before you get to the chute, you untie from everything except your cooler tube and manuver yourself into position so that you're (ideally) going down the chute feet-first.

As you enter the chute, you're going slowly. Then things begin to go very wrong indeed, as you spin around, lose sight of your companions, and eventually get spat out of the chute going remarkably quickly, into a surprisingly strong whirlpool-like current. That was where Der Alter Jo rescued the tiny baby snapping turtle, who was as dizzy and confused as she was.

The second chute is a bitch. It doesn't help that the signs above the river warn you that a "Tube Shoot" is coming up--it makes it sound like rednecks with guns will be taking potshots at your sunburnt self. It was at Stinky Falls that I managed to get the cooler tube (with water, not beer, in it) and my own tube safely over the edge and down into a companion's hands, then fell over the edge of the falls and lost my hat and the bottle of sunscreen.

The River Gods got a full set of clothing from us that day: La Belle Dame's shoes went first, followed by two T-shirts and a cute little cover-up, and then my hat. Nobody lost their sunglasses, their mind, or consciousness. We all got vaguely, patchily sunburned in weird places. We all stayed well-hydrated.

And then we finished Saturday night at the best damn dive bar I've ever been to. A band called The Chubby Knuckle Choir played, we ate cheeseburgers and drank Maker's Mark, and wrote our names on the wall behind the table. It's the only dive bar I've ever been to with a haunted flush outhouse.

Back to work this week, with a follow-up with Dr. Crane and His Band of Merry Sinus-Scopers and a remolding appointment with Dr. Elf. I wish I could move the river to my front yard.

Y'know what's depressing?

This is what's depressing: I've been through breakups, job changes, CANSUH, failed romances, and all manner of crises, large and small, and the biggest load of squee-ing, fan-girl email I get is occasioned by my father's comment on this blog.

My Sainted Father makes *one* comment (about mailing his liver to Abyssinia) and I'm innundated by emails saying things like, "OMG! Was that really your dad? You sound just like him!! Is he cute??"

Dad and I used to play a game at dinner to drive Mom wild. We called it the "New Mommy Material" game. Dad would posit theories like "Pia Zadora would make a good New Mommy" and I would shoot them down or offer alternatives. If Sainted Father ever wants a New Mommy with medical training, can I offer him all your email addresses?

Good God, has it been that long since I posted?

Sorry, you guys. It's been busy around here. (In the same way that the ocean is moist or the Pope occasionally attends religious services.)

Hey, kids! Drugs are bad! Because if you do drugs, you might find that your drugs have been cut with something that contains strychnine, and you'll find yourself rolling around on the floor with your heels touching your head. As if that didn't suck enough, you'll then find yourself intubated and sedated in a hospital somewhere so that you don't twitch and jerk yourself out of the bed. And you'll stay that way for three weeks and counting.

And, while we're at it, intravenous injections of hydrogen peroxide aren't great either! I don't care if the self-styled guru who does your colonics says they'll keep you young. They won't. All you'll get is some nasty shit cutting loose into your brain. Please, please do not ask me, as I'm discharging you, when it'll be safe for you to go back to doing whatever woo treatment brought you in here in the first place, because it'll be very hard for me not to get snarky right then and there.

Only about thirty percent of the people exposed to syphillis will, if untreated, go on to develop the tertiary stage of the disease. It's still a good idea to finish your treatments if you've been diagnosed with the pox, so as not to end up with neurosyphillis thirty years after the fact.

Also, weird demyelinating diseases: Please do try to avoid them, especially if you're offered one which we can't identify.

And don't get your aneurysm clipped by a general surgeon in Backobeyondville. Really.

These last two weeks have left me and everyone else at Sunnydale with our jaws hanging open and our eyes wide. Weird isn't weird where I work, but this much weird, and this severity of weird, is.

I was watching Notamus eat my guacamole last night

...before taking it away from him in a hurry, because aren't avocados really bad for cats? Johnny?

Then I looked over my shoulder to see Max carefully licking his right paw and washing behind his ear with it. He then did the same thing with his left paw.

Something is broken in the space-time continuum.

Yo! Smart people! You are not disabusing me of my stereotypes.

Got up yesterday morning, set the makeup gun to "Slut" and checked my email. (This is my usual routine for work, and no, I'm not trying to catch a doctor. If I don't layer on whore paint with a trowel, people ask me if I'm sick. This is Texas.)

In the email was a note from a Faithful Minion who told me that somebody had quoted something on HN out of context. When I followed the link, I found that not only had HN been quoted out of context, the person who'd quoted me had gotten the quote wrong, and drawn completely wrong conclusions about what they'd misquoted.

On a professional website. A, like, *big* professional website.

So I sent the person in question a very nice email, correcting and expanding.

Once I got to work, I was told by a patient's family member that that patient was "very important and, actually, famous." This did not stop me from looking blankly at the patient and saying, "So. They let you cross the street by yourself" after he'd asked me one of those questions that just defies belief. ("They're gonna put me under for this surgery, right?" "Oh, no, we think the suffering of surgical patients brightens up the joint. NEXT!" Even worse than that. Swearsies.)

Then, about lunchtime, I checked my email again. In it was a snotty note from the person I very nicely corrected and a confused note from a Minion who read something wrong.

Reading comprehension: The Lost Art Of The Covenant.

I've long believed--since before I ever met the first Nobel Laureate I ever met--that truly brilliant people ought to be given minders. There should be somebody following every Genius Grant recipient around, making sure they don't leave their car keys in the freezer or put their shoes on the wrong feet. If you've won a prize for anything intellectual, you would automatically be issued some nice, boring, sensible person who'd tell you not to wear those shoes with that pair of pants and who'd make sure you didn't leave your head in the taxi.

My Sainted Father is one of those folks who'd misplace limbs if they weren't glued on. My Beloved Mother has spent the last fifty years making sure he doesn't wander out under a bus or absentmindedly mail his own liver to Abyssinia. She deserves a medal.

I deserve, after limiting my snark to the words "You're welcome, Doofus" more than once, a drink.

Please, smart people. Get it together. Or at least present a semblance of togetherness when you're around me.

Had a bad day? Have a beluga whale and a mariachi band.

Nothin' like blood up to your elbows.

The neuro CCU didn't have any patients, so I took myself down to the surgical CCU to be a general dogsbody and bottle-washer. And got my ass run off for three days straight.

It wasn't so much the lack of staffing as it was the acuity of the patients. And it wasn't so much the acuity of the patients as it was the cluelessness of the residents. And it wasn't so much the cluelessness of the residents as it was that every single damn thing that could go wrong, *did*, usually all at the same time, which was of course right around lunch.

Elizabeth called me into one of her rooms to ask if the leaking from around a JP drain was normal. Yeah, sometimes it is. . .but that drain site was leaking a little more than I would strictly consider okay. So, as Deidre packed Surgi-Cel around the area, trying to stanch the worst of the leaking, and Elizabeth called the resident, I tried to figure out where the blood was coming from. No go. There were enough holes in the poor patient to make any of them a contender, and no obvious source of blood.

Which means that the blood was coming from *inside* the patient, not from the hole the drain came out of. This is always bad, because it means that you have to re-open the surgical site and see what the heck is going on.

In came the resident. He looked at the drain site and said, "Walp, looks like the bleeding's stopped for now." I looked at him from across the bed and said, "On the outside, maybe."

And just then the patient turned his head and coughed out a fountain of bright red arterial blood from his trache.

Which is how I got blood up to my elbows. The patient is fine, by the way: a quick re-exploration of the area showed a small artery hadn't been properly dealt with during the surgery and had reopened--nothing that a few stitches, or something, and about six units of blood couldn't fix. When I saw him the next day he was relatively pink-cheeked and cheery.

What I've not mentioned until now is that, as all of that was going on in the room (and you know how it is, with Get me a suture kit please and Can somebody please call the fellow and Hold this there and tape that here), there was a person just next door whose head suddenly blew up like a beach ball for no apparent reason, and a person down the hall whose MAP (mean arterial pressure, a measure of how well you're perfusing) dropped into the 20's (bad), and another person who leapt out of bed over the bedrails despite having a dense right hemiparesis, and the fire alarm went off.

Just then the helicopter crew showed up, bagging a person who'd fallen off of something tall and hit his head and been transferred to us.

Run that tape back and play it over and over for two more shifts. This is why I took a five-hour nap today and will order a pizza tonight.

Odds & Ends

Man, Rimadyl works FAST.

Max woke up this morning and trotted (trotted!!) outside, with scarcely a trace of stiffness, then spent about ten minutes barking at something I couldn't see with a vigor I haven't heard in three years, at least. Then I let him in, because five ack emma barking is not a thing in this neighborhood. Although it might become a thing, because Max is groovin' back to his badass self.

No weird memory issues the last few days, either.

Now, of course, I feel like shit because all of this must've been related to the pain his back was causing him. And I didn't notice. But he's stoic, so how would I have noticed? Anyway, I think he might keep going for a few more years, now that he's able to boink around the yard going BAROOOF at things.

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

Turns out that Bossman had a meeting with The Big Evil Bossman and one of the BEB's Minions, a woman I used to like and respect until she got too close to the BEB and started acting more like him than like herself. What is it about Evil Bosses? How do they corrupt the minds of the innocent? And, more than that, what was Minion doing at a meeting about the NCCU with our Bossman? WTF? She has zero CCU experience and doesn't even run a floor that has to do with our specialty.

All these questions will have to wait until Monday to be answered. The upshot of the last meeting was that BEB can't understand why (because he too has exactly zero critical-care experience) we would want heart monitors on our patients in the NCCU.

.... ..... .... .... ....Yeah.

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

I have finally figured out liquid/gel eyeliner. This is a huge deal for me. Back in the day, I wore the shit out of that stuff, but as I've gotten more mature (read: as I've gotten lines around my eyes) the mid-Eighties Rococo Raccoon Look is less and less appropriate for work.

Last night I took some time and figured out a better way to do liquid eyeliner, which involves lining the inside of my upper eyelid, and will try this bad boy out with the green-and-black rhinestone-encrusted glasses which Abilene Rob said made me look hot. I'm thinking it'll be a sort of Nutso Cat Lady Librarian Meets Studious Nurse Thang, and I'm all over that.

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

Why I love The Hairpin, part three gazillion: because they introduce me to websites like this.

'Zhausted.

Max has arthritis in his spine. His bloodwork was perfect, his right hip is fine, his left hip is all jacked up with arthritis, and his spine--especially the lower back--is a mess.

He now has the tippy-top super-duper prescription glucosamine supplements from Hades, a bottle of generic Rimadyl, and a bad sedative hangover. Luckily, he's a meditative drunk rather than the pacing, panting sort.

That's him, passed out with his head on the nice cool bathroom tile. Poor guy.

Had a bad day?

Have a baby hippo.

Max news!

Thank you, first of all, to all the folks who sent/commented with tips and tricks for old, arthritic dogs.

The vet says two things:

1. It's probable that the trouble with Max's hind legs is arthritis in his hips. HOWEVER. There is a rare degenerative spinal disease that tends to hit German Shepherds, so he's going in for X-rays on Thursday to make sure that it's actually arthritis.

2. The memory loss doesn't concern her yet, because it's recent, sporadic, and correlates with the horrible heatwave here. I am to keep a journal of when he goes blank and, if I get more than five or six instances in the next couple of months, to bring it back to her. My marvelously intuitive brother-in-law might be right: this might be Max saying "I hate the heat and there are ants biting my butt."

Also, he has Old Dog Teeth and Old Dog Skin Weirdnesses, but we're not going to put him under to deal with them. His heart's fine, his bloodwork is pending, but honestly? I don't see the point in putting a 107-lb, eleven-year-old dog under general anesthetic to have a couple of minor, benign skin-things removed and his teeth cleaned. They're not *that* bad.

I learned today that the fastest way to get a reaction out of people is to take your very large old dog into a liquor store on the wrong side of the tracks. There's a store here that sells 471, a pale ale I particularly like, and so I ran past there on the way home from the vet's, with Max in tow. I took him in because, in 100-degree heat, you don't leave any animal in any car for any length of time.

We walked past Mexican roofers with cases of Corona Light in their arms, gang-banger wannabes with saggy shorts and gold teeth and bandannas, and scary-skinny blonde white women with prison tattoos, and all of them were totally silent. Max was prick-eared and perky; he likes going new places. Not one person said one damn thing to me, the chunky chick in the empire-waisted flowy hippie-dress. Except one guy, who came in, stopped dead in the doorway, and said, "Woah." I reassured him that Max was friendly, so he came closer, scratched Max behind the ears, and said, "He's a big man, ain't he?" I replied that yes, he got that way through drinking all my beer, and the guy chuckled while Max drooled on his shoes.

Max is now lying on the dining room floor, and taking up most of it, because he has had a Very Big Day.

Oh, well.

I have had One Of Those Days.

Worry about work kept me up late last night; the heat kept me in today. I did some basic grocery shopping, but forgot to get coffee. Max seems better--of course, because he has a vet appointment tomorrow.

Today, a friend of mine whom I love and respect was bitching about how the development of cellulite has kept her from buying shorts. It was dramatic enough that I nearly said something like, "What a coincidence! I've been looking for months for shorts that'll coordinate with the huge hole in my head, the sores I get on my tongue from the prosthetic, and the wires that poke my gums."

Anger from work is obviously spilling over.

Tonight I'm going to read All Creatures Great And Small and eat a pile of toast. Tomorrow I'll see the Prosthodontic Fairy, then take the Zoaters to see the doctor he once tried unsuccessfully to bite, then come home and make salads and lunch for the rest of the week. It'll be a productive day, which is better than a day spent worrying and pacing.

Something is going to happen soon, I know that. I just wish I knew what it *is*.

*pace* *pace* *bang* *bang* *pace* *pace*

I do not know what to do.

DAJ and I have been chatting prior to her leaving on vacation. She's got worries about the NCCU, and so do I. She's the best formal, businessy-type letter-writer I've ever met, and I'm good at editing, so we're going to work together--after she gets back--on a formal letter of complaint about what's been going on. Meanwhile, all of us are going to keep on filling out incident reports and yelling and pointing out problems and inadequacies, and I'm going to ask for a meeting with the person who's the head of education for the chemotherapy nurses. I'm going to throw myself on her mercy and ask her if she thinks it's a good idea that we, the NCCU nurses, take over chemo administration after our chemo unit moves across the street.

I'm also going to chat with the director of the unit.

But, after that, then what?

Here's the deal: we're moving the unit sometime later this year into a designated space. Rather than carving out space in underused rooms with borrowed beds and semi-working monitors and pumps, we're going to have an actual six-bed unit, with *stuff* that works. I'm holding out hard for central monitoring (the patients could be monitored remotely in the surgical CCU, but I don't like that idea for a number of reasons) and in-room recording monitors. Frankly, not having those two things would be a dealbreaker for me.

I'm also holding out (dealbreaker again) for actual written policies as concern staffing and duties, not a make-it-up-as-we-go approach, which is what we've got. The Big Boss of the Block told me a few weeks ago that the reason we don't have formal policies yet, after ten months of being open, is that we don't *officially* open for business until this coming fall.

Which makes me wonder what we've been doing since September.

All of this is making me very thoughtful.

The Big Boss is a bully and a terror. I've known this since I started working under him five years ago, and he and I have gone head-to-head on a number of issues ranging from his harassment of other nurses to the way he treats people on committees. He doesn't like me; I don't like him. We can work together, just barely, provided our interests don't conflict too much. We both realize this.

I'm not sure I can outlast him. He's older than me, and much fatter, and in rather poor health. Unfortunately, given that he's a lump of Concentrated Evil, he's likely to last in his current position for a very long time. Evil don't die easy.

Should I leave now? Should I wait, since this unit has become my baby, and leave after we transition to a workable space? (Just the space we were given is nearly impossible, given how it's laid out. I mean, really--you guys wouldn't believe it if I told you.) Should I stick it out, hope to outlast the Big Boss, and continue to fight the good fight?

I don't think I can stick it out. I'm convinced that part of the reason I got cancer was the amount of stress I was under during the year before I was diagnosed. I don't want a second malignancy.

At the same time, how easy would it be for me to get another job within Giganto Research & Education, Inc, parent company of Sunnydale, with Big Boss still in the picture? Leaving the GREI fold isn't workable right now for a number of reasons I don't want to go into.

Will an infusion clinic hire a nurse they have to train? Is there a way I can make myself more or less bulletproof as regards Big Boss? If I'm not naturally very diplomatic, how do I learn those skills, and will they actually do me any good? Should I try to get another job here in the state, or just up and move to Missoula? Should I stick it out for a year while DAJ finishes her degree, then move with her to Seattle so we can split rent?

I tossed and turned last night and had to do deep meditative breathing to keep from getting so angry I couldn't sleep. I simply am at a loss.

I think I'll go make a coffee cake.

Let's get one thing straight right the hell now.

I am not a fan of small dogs.

If you give me the choice between a stubborn, grouchy big dog of unknown origin and a cute little white fluffy eager to please purebred that weighs less than 20 pounds, I'll take my chances with the grouch.

However: my old vet, the one with the overalls and the goats in the waiting room and the six rescued Greyhounds on her land, once told me this:

In a fight between any dog and a Chihuahua, she would bet on the Chihuahua, unless the other dog was a Greyhound.

Give it up for Paco, the crime-fighting, bad-ass good-boy of the day!

Eeeyep. Yep, yep, yep. Juuuuust about quit my job today.

For two reasons:

1. My boss is a moron.

2. My boss is a fucking moron.

Seriously: You should have more than six months' experience as a working nurse before anybody gives you a managerial job, no matter how brilliant an organizer or genuinely nice a person you are.

Because, if you have some experience on the floor or in the unit or in a clinic, you would not:

1. Double the number of patients in my unit without warning and without giving me any extra resources.

2. Look at me like a calf at a new gate when I suggest that those of us who might be administering chemo (there is no policy as yet) will have to get and maintain competency, and, given that chemo is an entirely different specialty, that this might be a big deal.

I walked in today to find eight patients and two nurses, which doesn't seem like a big deal, until you remember that these patients are in a critical-care setting, we are doing total care on people who are hemiplegic, altered as hell, and tend to have rapid neuro changes, and there weren't even enough monitors for the patients we had. One of them was on a not-centrally-monitored ancient thing somebody dug out of a basement storage room.

This is, as of yesterday at noon, the new policy: fill all the beds imaginable with all the patients we can get, until something breaks. We were damned, damned lucky today that nothing broke. The guy who lingered on the edge of crumping managed not to crump, the woman who has a violent history with us and was actually labelled as a "Do Not Return" (she was admitted by mistake) managed not to punch anyone, and we got through the day.

Then in the middle of the day, Bossman comes to me to chat about the whole deal, and I bring up the "Oh, by the way, you're also going to be giving chemo" thing. He truly did not understand why maintaining competency would be a big deal. "There are protocols and regimens in books this thick," I said, holding my thumb and forefinger about three inches apart. He had no idea. I am not a chemo nurse, and *I* knew that shit, just from being around it.

Now I am going to drink. Maybe not a lot, and maybe not hard liquor, but I am going to drink. With any luck, it'll mellow me out enough that I don't end up staying up late and writing letters to the medical director, the state board of nursing, the state board of morons, and the paper.

Holy. Crapping. MONKEYS.

Y'know what's great about being a nurse?

What's great is this: when your worried neighbor texts you just before dinner because her seven-month-old has a weird rash just spring up, and you can go over there and see him and her and reassure her that yes, it's just heat-rash, he'll be fine.

Because--and this is what gets me--her pediatrician told her the same thing, but she and her husband wanted to talk to a nurse, because nurses really know what's going on.

(Never mind that I know next to zilch about pediatrics, and that heat-rash is pretty easy to diagnose.)

It gives you the warm fuzzies.

(Plus, I got to play with a baby for a few minutes which, if you are a fan of babies for a few minutes at a time, as I am, is not a bad thing.)

And then this afternoon, Max.

I'd noticed he hasn't been barking at the mailman recently. And he needs encouragement to get up from the slippery wood floor; his back legs don't work as well as they did even six weeks ago.

Today I found him standing in the living room with a "what the hell did I come in here for?" look on his face. The last week, he's been standing stock-still and just staring at random times.

He's wuffing at the cats more often, but also staying still and licking their backs and heads more often, which confuses them. When he rolls over for belleh-rubs now, it's an even chance that I'll get a look that says fear and confusion versus a look that says rub mah belleh.

My boy is old. He didn't *get* old; he just suddenly *is* old. One day he was fine; the next he woke up in a puddle and couldn't get up easily and started forgetting stuff. His ears still twitch reflexively when I call his name; it's just now he can't remember his name every time. About one time out of three it's just a sound, not something to respond to.

Just now he's barking at the dogs walking past the house with their humans. If I didn't look outside, I'd think he was only a couple of years old, except that the barking stops too soon.

All I want is for him to have a good Fall and maybe half the winter. I want him to be mobile and happy without all this horrible heat that forces him indoors for most of the day. If he has to go down, I'd prefer he go down all at once, like he was hit by a meteorite. God knows he lived through enough to kill most dogs in his first nine months. I remember how apologetic he looked after he got the Huge Nasty Injections in his back muscles to kill heartworms, just after we rescued him: he kept moving from couch to floor to chair to floor and finally back to chair, just trying to get comfortable.

I will never, ever be ready to say goodbye to my friend, but I at least want him to be able to enjoy one last cool season, with fog and rain and being Braveheart, before he goes.

Shit shit shit shit shit. *bangs head on knees*

As I told Der Alter Jo on Monday, it's a rare morning that I wake up and think to myself, "Y'know, I really should've drunk *more* last night."

Call this a rare morning. Also, please butter my ass and call me a biscuit; I'm feeling peckish.

The Fearsome Foursome (that's us in the Neuro Critical Care Unit) have finished our chemotherapy certification course. That means that, after several hours of hanging chemo under supervision, we'll be okay to be "chemotherapy resource nurses" at Sunnydale. Our chemo unit is moving over to Holy Kamole sometime this year, which means all our chemo nurses will be unavailable without major advance notice.

So Sunnydale will need resource nurses. Which is understandable, but. . . .

There are real questions as to what our scope of practice will be. Will we act as actual chemo nurses, hanging chemo on those very, very rare occasions when somebody needs it? If so, how will we maintain our skills? What about the safety issues surrounding patient care in our unit if we're somewhere else, monitoring a chemotherapy infusion? If we're both certified and competent (two totally different things; the latter has to do with practice, the former with book-larnin'), will we be expected to pull shifts in the new cancer unit at Holy Kamole? Or are we merely meant as a "resource" in the most basic sense--somebody to call if a patient has a delayed reaction or a bad IV?

The other nurses in the unit are very upset. Der Alter Jo, who is an intensivist and neuro specialist, is understandably bothered that the specialized unit she signed up for is getting diluted in terms of duties and resources. "If you're gonna have an intensive neuro care unit, have an intensive neuro care unit" is how I'll paraphrase it. She has worked so hard to make certain that the CCU's been utilized appropriately and has gotten adequate staffing, and that the other nurses have all been treated with respect and given resources. I can see why she's frustrated and angry. The other two nurses we work with are worried about safety and whether or not we're going to screw things up, plus they're understandably upset about having to learn an entirely new specialty--jack of all trades means master of none.

*sigh*

I volunteered to take these worries to Manglement, provided DAJ put 'em all into some sort of coherent formal letter. I guess we'll have a meeting soon about it. (Meetings: BAH.)

Something tells me that Manglement and the neurology folks are not on the same page about what's going on. I only thought I was worried before.

Tuesday night mellow

You've got tombs in your eyes

But the songs you've punched are dreams

July Moneygrubbin':

Mary is a friend of my pal Lara's friend Nikki. Mary is 38, and was diagnosed two years ago with stage 3B tongue cancer. For those of you who aren't fluent in solid-tumor staging, that's not good at all.

Mary has been in remission since March of this year. She recently started hyperbaric treatment to help rebuild the bone in her jaw. A word (or many) about hyperbarics:

When you have chemo, and more especially when you have radiation, to kill off a cancer in your head or neck, everything suffers. All the structures in your head and neck are affected, especially cells that replace themselves quickly, like those in your salivary glands and in the lining of your mouth and throat.

Because the treatment is really fucking intensive, and because it kills off your salivary glands, and keeps new blood vessels from forming, things happen after radiation that are decidedly not cool. For one thing, your bone? Doesn't heal if it's injured. It just sits there and rots. Hyperbaric oxygen therapy, or "diving" is supposed to fix that. You sit in a big, huge can, usually with pure oxygen pumped in under enormous pressure (at least ten times the atmospheric pressure you'd feel at sea level), and that forces pure oxygen into your bloodstream and thus into other tissues. That in turn causes what we in the biz call "angiogenesis," which is Fancy-Pants Medicalese for Growing New Blood Vessels All Over.

"Well, Jo, that's fanfuckingtastic," you're saying to yourself. "What does this have to do with anything?"

Let me tell you: Mary had radiation to her neck and face. She lost her salivary glands. As a result, her teeth are breaking off at the roots. She can't have them pulled unless she undergoes this hyperbaric oxygen treatment, because the lack of blood vessels in her jaws mean that her face will, and I am not joking here, simply fall apart. I have seen it happen, and it is about the ugliest thing you can think of.

Mary's going to need dentures after this tooth-yanking and hyperbaric treatment is done. She probably has the same insurance company as I do: it'll cover her hyperbarics, and the tooth-pulling, but won't cover the anesthetic for her tooth-pulling (for the love of God) and won't cover her dentures. Which means, tra la, that she'd do this all without sedation and then not be able to eat.

So you should, if you're looking for a place to drop a dime or two, give her your money.

Her blog is here, the fundraising page is here, and here's a video interview she shot recently:

Shoulda listened to the doctor when she said "No Heavy Lifting."

Unfortunately, her definition of "heavy lifting" and mine differ. Apparently they differ substantially.

Before anybody panics, no, I did not herniate through my incisions (near as I can tell). I didn't tear anything or pull anything loose; I just did a little too much yesterday. Specifically, I went grocery shopping.

See, I shop at this place where the sackers are paranoiacally careful about how they bag up your food. I did *not* take my nice reusable bags with me, specifically to avoid the sort of weight that can be put in those bags. So I got umpteen bazillion bags of groceries, some with one package of rolls or one carton of eggs in them.

Also see, I do twenty-pound bicep curls on a fairly regular basis--sixty of 'em at a time. Plus, I lift more weight than I really want to talk about with my back and legs. I figured that I'd be golden for lifting umpteen bazillion very light bags of groceries. After all, I can straight-arm a 17-pound bag of dog food with no problem, right? Right.

Loading a dozen one- and two-pound bags of groceries into the car and then unloading them into the house undid me. I had actual pain for the first time since day two post-surgery: a feeling like I'd been repeatedly punched in the right side of my gut. I can still tell that it's there, though it's not actually hurting this morning.

I cannot freaking believe that *groceries* did me in. I mean, yeah, if I had been doing hot naked unassisted power ultimate yoga, or running miles at a time, or trying my usual lifting workout, I could see that there would be a problem. And I understand that the belly muscles are connected to the everything-else muscles. But, really: groceries? Rotisserie-seasoned, deli-thin-sliced chicken breast? Eggs? A carton of milk?

The deep frustrated grumbling you hear is me.

Let's drop that last title below the lead, shall we?

Notamus is gonna get his comeuppance tonight. I have on the stove spaghetti sauce--pasta is one of his favorites, the little weirdo--with fake meatballs (soyballs?)(wheatballs?) and artichoke hearts.

Knowing him, he's gonna try to snatch a fakeball. I'm gonna let him. And boy will he be surprised when he realizes that it's not the sort I usually make, with the egg and the breadcrumbs and the veal and the pork and so on. If I'm lucky he'll have a facial expression worth capturing on camera.

*nod nod nod*

As to why I'm eating spaghetti and fakeballs when it's approximately a zillion degrees outside, it's because I can't bestir myself to go to the grocery store. When the low is 89F/almost 32C, the idea of hunting and gathering at the local market loses its glow.

Things are bad here this summer. Summers in the middle of Texas are always dry, but I've not seen a summer this dry in my life. Really and truly: there's not a crop in Central Texas that's survived this long, and most ranchers in the area and north of here are selling off all their stock in order to pay their bills. They can't afford to feed 'em, because nothing is freaking growing.

The upside is that there are fewer mosquitos than I remember there ever being. The downside is that everything in my yard is dead or dying. The upside to *that* is less maintenance later on, especially when you consider that those of us here in Littleton's Hippie Quarter aren't saddled with the demands of homeowners' associations.

Yeah, so: No rain means no grass, no herbs, no grain. No grain means no cattle going to feedlots means hugely high beef prices in about a year and a half, as there will be no mature cattle to slaughter then. No rain and temperatures of over 100F for the foreseeable future also means a dimunition in the number of fleas and ticks and mosquitoes, but also huge grass fires.

I am constantly amazed, especially when it comes to summers here and winters in the western part of the state, how people could've settled here in the first place. I mean, where I live isn't so bad: there's water, natural springs and the like--but west of here? Northwest of here? Those first settlers were BAMFs of the first degree. There is one natural lake in Texas. One. The rest are manmade.

I listened to an interview once with a guy who did water management or crop management or was a fire chief or something, out west of Midland. He said (and you'll have to supply the drawl for yourself), "You take a map of Texas, you draw a line down the middle. To the left of that line, it don't rain." Precipitation comes in the form of snow, ice, hail, sleet, and a horrifyingly heavy sort of drench that washes away roadbeds, but it doesn't rain like it does in Columbus or Boston or Seattle.

Every year about this time I begin to get rain-hungry.

And fake-meatball hungry. Time to mind-fuck the cat.

My pussy smells like fish.

Which wouldn't be a problem, except the fish (she says, with emphasis, giving Notamus the side-eye) was meant for my dinner.

This afternoon I told Der Alter Jo the charming story of how Notamus had once intercepted a piece of pepperoni, mushroom, and black olive pizza while it was on its way to my mouth. He got a healthy shark-bite out of it before he bounced off the wall.

What? You try eating pizza when something with teeth is going after it and see what you do.

So, tonight, I had made myself a lovely tuna salad with chopped cornichons and shredded cucumber and grated onion and a delicate lashing of mayo. I had planned on eating it with pita bits and maybe itty shreds of veggies.

I mixed up the tuna with the mayo (home-made, by the by, with lemons I squeezed myself and olive oil carefully dribbled into the blender) and the onion and the cornichons and then turned my back to assemble the other bits of dinner.

When I turned around, I found one Notamus eating MY TUNA.

*cue frustrated troll noises*

So: Notty got two-point-six ounces of tuna. With fixin's. I got pistachios and wine.

HAT is only one letter different from CAT.

(And, post-scriptally and parenthetically, how weird is it that my cat likes sour French pickles? Because the underlying aroma of his breath is cornichons, overlaid with TUNA. Bastard.)