Good Frogs. Has it been that long?

I see I haven't posted since the middle of last month. My apologies.

I've been working a lot, which means new stories for you! but I'm also between keyboards at the moment.

More later this week, I promise. Nothing horrible has happened; I've just been busy.

I'm all right; don't nobody worry 'bout me.

Well, not really.

This week we had a party for Neuroscience Nurse's Day, or Week, or Something Along Those Lines. I was interested to see that the woman who holds herself out as the Director of Neuroscience Nursing (a few years' experience as an ortho rehab nurse, followed by a decade in manglement) wasn't there. Ironic, fitting, all that stuff.

I was more bitter than usual these days. *Everything* pissed me off, even stuff that could've worked to my advantage. Good things pissed me off just as much as bad things, and wishy-washy things pissed me off most of all.

For instance, I work with two mid-levels. One is fantastic. The other is a clueless tinpot tyrant with an ego problem. Fantastic Midlevel and Fantastic Case Manager and I had been working on med-surg to rehab placement for a patient under a return agreement with another hospital (his case is complex) since the patient was admitted almost a month ago. It had been arranged that Sweet Complex Guy would go back to his original hospital, since he's a resident of that particular county and can therefore get services for which bill collectors won't hound him. (Some counties in Texas do it right.)

At the absolutely last possible second--and I mean after the ambulance had been arranged (difficult, because he required vasoactives while en route)--Clueless Tinpot stopped Sweet Complex Guy's transfer. The reason? He was afraid that "SCG would end up rotting in a med-surg bed and his family wouldn't be taught what they need to know." Clueless Tinpot decided to try for a "charity bed" in our facility.

As Fantastic Rehab Manager said, "No bed here is a charity bed. I have explained this to Clueless Tinpot Tyrant over and over. Even if that patient meets all of our specifications for discount services, he'll still have people calling him constantly, and his credit will be ruined by the bills."

None of this, I just realized, will make any sense to you unless you're one of the medical club, so let me put it in English:

We had a patient transferred to us by a county facility. That hospital paid all of the patient's bills while he was with us, with the understanding that he would be sent back once we were done with our peculiarly specialized care. The sending facility has systems in place to provide free, quality care to this dude, provided that we sent him back needing specific things.

And Tinpot Tyrant fucked it up. Not only will my nice, sweet, complex-but-promising dude be two hours from his family, he'll have to deal with the demands of our billing department (not fun; I can testify that they screw things up fairly regularly) for the next two years or so.

And I have to deal with this guy daily. Between making sure that he actually writes orders that he's going to yell at us later for not carrying out and being certain that his orders don't suck, I'm already tired. He's slated for a manglement and marketing job soon, and I hope his transition is smooth and speedy.

Seriously: If you have somebody on a high-sodium diet and six additional grams of sodium tablets a day, and they drop their sodium from 139 to 135 after you lower their hot-salt drip for six hours, would *you* write an order discontinuing that drip immediately?

I thought not. Especially if you want to keep their sodium between 140 and 150 to keep their brain from swelling. Three-percent and 23% saline are useful in limited amounts, but they're useful.

Okay. Enough with the overmedical jive.

I miss my dog. He wasn't my baby, or my furbaby; he was my buddy. We were intellectual equals, no question. He was a stubborn asshole at times, but I never knew his judgement to be off. It's very weird, being here without him snoring and shedding and licking Flashes all over. I step over a body that isn't there, in the middle of the night, when I have to pee. My brain twitches toward the back door every day at dinnertime.

I haven't had the vadge yet to go out to the back yard. Yesterday, I thought maybe I could do it today. Now I'm thinking I could maybe manage it tomorrow.

Thank you all for your kind thoughts. They're a huge, huge comfort, even if I can't respond to everybody individually.

Now Flashes wants 'tentions. I'm going to give him some skritches and heat up beans for dinner.

Max.

When I met Max, he was still a puppy. He might've been nine or ten months old, with those perfect white adult teeth that hadn't seen any wear, except where one was exposed to the roots, where his gums had been stripped away.

The Erstwhile Hub saw him on his way to work and called me, saying, "There's a dog trying to die in the empty lot two doors down." My response was, "Not on my watch."

I went and lured him to our front yard and tried to feed and water him, but he didn't eat or drink much. He was emaciated, his eyes and cheeks sunken, and he looked exhausted. I loaded him into the Honda hatchback I had at the time and drove him to a vet I'd not been to before because my usual vet was closed on Wednesdays.

They told me he was probably very old and probably wouldn't make it, and showed me the X-ray of his gut, full of rocks and sticks. For some reason, I said "do what you have to do to save him." They ran two liters of fluid into him over a couple of days, keeping him sedated so he wouldn't chew the IV out of his arm. I went to see him both days, kneeling down by his cage and saying, "You must not die, you must not die."


He had a cracked hip and two cracked ribs and heartworms from hell and torn-up pads. The vets figured he must've been thrown or fallen from the back of a pickup, and walked all the way from the highway to my neighborhood.

When El Erstwhilo and I divorced, I left Max behind. I was moving into a 600-square-foot apartment and working sixteen hour days, and I couldn't take him. Later, when Erstwhilo thought he might be moving to Ireland and couldn't handle the thought of quarantine, I took Max back. I had just bought a house. Having him made everything better; he was the only thing I missed from my marriage.

Max died Saturday. I was out of town, visiting The Boy in Kansas City. My neighbor called to say that he'd gotten up and boofed around the yard that morning, then had lain down to have a nap and had simply not woken up. I got home this afternoon and found him lying where they'd tucked a sheet over him, looking exactly as though he'd just gone to sleep with his head between his front paws.

There were no signs of distress. He'd gone to sleep in his own back yard and woke up on the other side of the Bridge, where there are dozens of mail carriers on crutches and an ice-cream truck with a flat tire.

This is what I'd been praying for. Whatever Thing is there, out there in the Universe, watching over deserving dogs, gave Max a death in keeping with his life: quiet, gentle, without fuss or pain.

He was my Zoater-Bloater Max-Nose Spoon-Hound, and I'll miss him. I'm thankful, though, that his last days didn't involve vets and needles and fear.

Happy Trails, buddy. May many kitty-bellies present themselves for snorgling on the other side. I'll see you in a little while, okay? :)

Y'know how you feel when a friend does something really great?

That's how I feel right now. My pal Nikki, late of "CatsNotCancer," is doing THIS.

Nikki, although you wouldn't know it to look at her, has ovaries of titanium and shoots laser beams out of her eyes. On vacation, she goes to Australia and rubs Great White Sharks on the belly, to which they respond by rolling over and purring. If she meets a rattlesnake while she's out hiking, the rattlesnake bows politely and gets out of the way. Bees fear her. Butterflies worship her. She's dressed by a posse of bluebirds and little woodland creatures every morning, after which she distributes semiautomatic weapons and shoulder-mounted grenade launchers of Truth to all of them, the better to fight for justice.

Because, you know, this lawsuit isn't all she's done. She's also been a hell of a pal to me.

And if BCBSTX doesn't see reason as regards the Obturator of Doom, you can bet I'll be channelling Nikki when I go see them. With a smiiiiiile.

I really need to stop yelling at my boss.

But honestly, when somebody calls me when I've got two phones already ringing off the hook, a patient who's about to code, six people lined up to ask questions about random neuro stuff, a housekeeper with a query about whether or not something obscure needs to be done today or can wait until tomorrow, and four people leaping out of bed in their usual confused way, it is NOT the time to tell me that I have to check the crash cart this month, myself, alone, today.

I *will* snap at you. And, if you're a condescending asshole (sorry, Bossman! But you were!) and point out to me that ICU nurses have a lot to do, too, I will respond by noting that your average ICU nurse has patient care aides, a secretary, a charge nurse, and a manager to do what I am just that moment doing all by my lonesome. I might even respond at a higher-than-normal volume.

It's a good thing that Bossman had me check the cart, as it turns out. Even though it meant that I missed an assessment on one patient (not a big deal; he was stable as a rock) and didn't get lunch until 1430, it was a good thing. Because I found that the crash cart, ostensibly checked by other people on the unit each month for several months, was full of stuff that was expired. As in, expired in 2009.

Now we have a nice, spandy-fresh cart with magnets in their proper places, salem sump tubes that aren't in packaging so old that both it and the tube have become discolored and brittle (holy crap you would not BELIEVE), and the proper number of needles, large and small, and medications, unexpired. It only took me three hours, between answering phones, helping turn patients, resetting monitors, taking delivery of a cartload of supplies, and fixing the computer that decided suddenly to regress to its roots.

I keep reminding myself that I have a mini-vacation coming up next week, and another one a couple of months after that. They don't keep crash carts on planes, do they? . . .*Do* they?

Big Drama at Sunnydale.

Phiddipus audax, the Daring Jumping Spider (how much do you love that name?) is making its summer home in my house. We do this every year: I see a cute black spider with white spots and bluish-green what-d'ye-call-em (those things that the fangs come off of. Not pedipalps, the one that starts with "c") and catch it and put it outside. This year I missed the Mother of All Audax, and she spun a nest at the corner of the wall and ceiling in the kitchen.

After some research, I decided that the thought of several hundred, maybe as many as a thousand, spiderlings was more than I could stomach, and sucked her into the Miele. I feel awful about it, but we need the rain. (Bonus points for the first Minion who understands that last sentence without using Google.)

Sunnydale's NCCU is in the grip of Big Drama these days. A particularly difficult doctor and a couple of grouchy colleagues of mine have made it their mission in life to submit incident reports for everything, and I mean *everything.* Unfortunately, the doctor writes up nurses for things that she, the doc, should've done (like writing orders) rather than get in trouble with *her* boss, and the grouchy colleagues are sending off irate and insulted emails about things like the lack of housekeeping standards 'round those parts.

I got written up for three things, two of which my boss and I agreed weren't really relevant. The third was not only totally justified, but pulled me up short. I've gotten careless about making sure orders get written, so it looks like I've been haring off on my own, making treatment decisions. This is obviously bad. Nurse Jo is going to spend more time checking orders prior to punching out, and probably doing a lot more last-minute running around to fix things as a consequence.

So yeah, I fucked up. I got called on it. Though I'm not crazy about the *way* I got called on it, it's a good reminder that you have to behave like a brand-new nurse all the time in order to make sure you're not getting careless.

The whole shebang also pulled me up short because it made me realize how scatterbrained I've become in the last few weeks. It made me analyze, thoroughly, *why* I might've gotten scatterbrained and careless, and I came up with what I think's a pretty good reason: I'm overburdened.

When I'm primary nurse in the NCCU (we usually have three nurses, with one taking three patients, another taking two or three, and a third helping out in the absence of a patient care aide), I have a patient load of three. These are acutely ill people who are generally leaping out of bed or desatting or doing some combination of the two, sometimes with a third fun thing thrown in.

I'm also charge nurse, dealing with staffing and bed assignments and crises. I'm also acting as secretary, breaking down charts and answering the phones and entering orders. The facilities management and biomedical repair staff deal only with me: they ignore the other day-shift nurses and hold on to their questions or problems until I'm on staff. I'm also the only person who's allowed to do certain tests (with hyperagitated goo and saline), so I do all of the ones in the entire hospital, as well as the clinic next door. Plus, I do around a hundred chart audits a month to make sure we're in compliance with whatever brilliant idea the Joint Commission's come up with this week.

Some of this stuff has *got* to be delegated. The most obvious solution is to delegate the chart audits, probably to the night staff (which will, I'm sure, make me their most favorite person ever). The other stuff, I'm not so sure about. We've got to get more people trained in the more obscure test protocols; the obvious solution is to train the charge nurses for the other CCUs. I'm not sure how well that'd go over, though, as they're just as overwhelmed as I am.

My first step is to chart exactly how much time I spend doing things other than direct patient care. Given that I round three times a day with residents, midlevels, and attendings, then implement whatever they want implemented, I think that charting'll show I'm really busy. Add in all the other stuff, and. . .well, it'll make a good argument for me getting some relief.

And hopefully, if I get some of this crap off of my to-do list, I'll be able to concentrate on what I'm there for: you know, taking care of sick people and not screwing up.

While you're waiting for a real post. . .

For The Boy.

0:04 at Casa Del Snotbags

I'm strung out on pseudoephedrine (that beautiful demon) and researching plants from exotic nurseries. These are not, as you might think, nurseries that have dancing poles and topless women all over the place; they're nurseries from whom you can get things like amorphophallus* and elephant ear.

Notamus is out in the Kitty Koop, watching the bats with envy. He's convinced he can become a bat by his next birthday if he only tries hard enough. The best thing about being a bat, he thinks, is that he'll be able to fly to chase craneflies rather than just jump. (Sometimes I hold him up so he can reach one that's particularly high on the wall. Yes, I spoil my cats.)

Flashes is sitting on the kitchen windowsill, playing Bonk That Junebug. The junebug lands on the kitchen window screen and sits there. Flashes noses it, and it goes *bonk* onto the outside sill. Then it climbs back up and sits. Flashes paws it, and it goes *bonk* again. Lather, rinse, repeat. Infinitely.

They have both taken to leaving half-chewed junebug corpses in my shoes. This is better, believe it or not, than cranefly legs *everywhere*, including my pillows. It's like a battalion of drag queens with bad eyelash adhesive came over when they do that. "I love you; have a piece of bug" seems to be the new cat-speak.

Max's ears are coated with triple antibiotic and the rest of him is coated with citronella spray. He has a pleasant, lemony scent, like an enormous mobile air freshener. I really should've groomed him today, but the logic of headcolds is that you can't move during the day and have tons of energy at night. He's sleeping in the kitchen, alternately snoring and boofing very quietly as his paws twitch. I think he's finally catching the ice cream truck.

My cold is, strangely, better. I still can't produce anything more than a squeak when I talk ("I'd not mind that he speaks/In gibbers and squeaks/But for seventeen years, he's been dead") and my throat is kind of sore, but I feel almost okay. I sneezed something truly horrifying out of the operative side of my sinuses this morning; it almost made me re-think the wisdom of daily antihistamines for allergies. There's such a thing as stuff getting too dry up in there.

Still, I managed to make it out to the store for real Sudafed and soup and tater tots. As I went through the checkout line, the sixty-ish woman who was checking remarked on my lack of voice. I whispered apologetically, "Yeah, I have a cold."

"Honey," she said, "You go home and make yourself a toddy and feel better. Don't mind if all you want is your mamma. I get a cold, all *I* want is *my* mamma."

That made me feel better. Plus, The Lovely Diana gave me a recipe for a hot toddy that consists of honey, heated up, and double that amount of rum. She says it won't bring my voice back, but I won't care. It's apparently an old Cuban recipe, used far and wide on everybody from children to ancient grandfathers, and she swears it's safe as houses. Given her propensity for being attacked by wildlife on vacation, I'm not sure I trust her, but I'm willing to try anything.

Tomorrow's to do list: Nap, Rum, Nap.

*Okay, that's almost as bad as topless nurserypeople.

My poor Max!

I got home tonight to discover that The Best Boy had a bloody head. Not specks or splotches of blood, but patches of bright red rubbed-off blood that had come from somewhere else. When I looked closely at his ears, I discovered that they were covered with the awful, horrible, nasty, icky biting flies that drink blood and come around in the spring.

Vampire flies. On my boy.

So I brushed them off and let him in and anointed him with antibiotic ointment. Then Flashes sat down and groomed his head, so that the blood wouldn't make him any less handsome. You could see where he'd shaken, hard, trying to get the flies off, and where he'd rubbed his face with his paws to discourage them.

Poor guy. I have no idea where the flies came from. It's war, though: tomorrow, rain or shine, I am putting out freaking fly traps and laying down cedar granules and nematodes.

And I have a cold. This is the first time I've been head-sick (as opposed to tummy-sick) since surgery. Eighteen months and no clinging head cold; this one could not be dislodged with zinc and Emergen-C. It is, of course, the Worst Cold Ever, and I Need My Mommy. I have completely utterly totally lost my voice and there are interesting poppings going on in the neighborhood of my right ear.

But I'm much more worried about Max. I, after all, have bourbon. Max only has ointment. He's sprawled out on his bed right now, sound asleep. I wish I could give him some Maker's.

I also wish I had a toaster that didn't have two settings: Raw and Burnt.

I also wish I had a gallon of Mom's Mexican chicken soup.

I guess this is what those damned swollen nodes in my chest were trying to tell me.

Clean CT!

No nasties in my chest.

There were a couple of swollen lymph nodes, one borderline, but once Dr. Crane looked at the back of my sinuses (conveniently exposed for his perusal) he said, "Oh my gosh! You have a lot of goop in there, for sure. Y'know what'll fix that up, is a Solumedrol Dose-Pak. . . "

(glances over at my face)

". . . . or not. Um. . .you don't like Medrol?"

"It makes me want to hug people."

"It makes you want to hug people. . . .?"

"Until they stop breathing."

The swollen lymph nodes are a reaction, apparently, to the horrid allergy season that's hit us this year.

My next scan is an MRI in four months. Wahoo!

Tap, tap, tap. Drum, drum, drum. Twiddle, twiddle, twiddle.

There's a lot going on at work, but I'm too distracted to write about it right now.

I had my first follow up chest CT today, with and without contrast, wahoo. Stevie was very kind and put a 22g IV into my 18g-worthy hand vein, so I have only a minor bruise on the back of my paw. Given that I bled for forty freaking minutes after I scraped my knuckle the other day, a minor bruise is a good thing. Maybe my aspirin dose needs adjustment.

Tap, tap, tap. Twiddle, twiddle, twiddle.

I'm obsessively checking my work email. Last time I had a scan, Dr. Crane sent the results to me there. I don't know how long it took, though, because I hadn't checked my email in days and days. Now I'm trying to remind myself that no news is good news, and trying *not* to read into Tracy's expression as she was helping me off the CT sled. Her usual expression is no expression and that's what I got today so that's got to be good, right?

Drum, drum, drum. Pace, pace, pace.

Surely it's going to be fine. Right? Right. Negative CT. Negative CT. Think negatively. Even if there is something there, it means that whatever-it-is was found quickly, so it'll be relatively easier to treat. Right? Right. But it'll still be negative. My goal for this year is to not have surgery.

Twiddle, twiddle, twiddle. Check email. Nothing.

I have to make lunch for work tomorrow, but I have no appetite and am therefore uninspired.

I'm going to go steam some asparagus. It beats pacing and twiddling.

WAHOOO! More than a thousand followers!

I wish I had something to give as a prize for Follower One Thousand and Follower One Thousand One. You're Minions; that'll have to do.

Welcome, Minions! Await my orders.

Thanks to all you knitters! And odds and ends.

The Project is well underway at this point. Thanks a thousand times to all of you who responded; the person who ended up getting the assignment emailed me this morning and said, "Well, it's actually done now. I had some yarn left over."

Sooooomebody (singsong voice) had toooo much coffeeeeee!

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

Apropos of nothing, have I mentioned lately how much I hate Large Music Festivals? It's not like Bigton can't survive for another decade on the backs of the musicians who've flocked here like roaches to a trash can. Still, they have their Damn Music and Technology and Whatever Festival every damn year about this time, and every damn year about this time, traffic is worse, people are stupider, and I get grouchier than usual. Thank Frogs the weather sucked the first weekend, or I'd've never gotten to work at all. I think next year I'll take the weekend of the time change through the end of Big Stupid Festival off entirely and go hide somewhere like Prince Edward Island. Or someplace with penguins. Penguins would be nice. They don't consider day-drinking an Olympic sport.

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

Max has a new friend. Man of God and His Lovely Wife sold their house and moved to Bigton after he got The Call from a small church looking for a fighting young priest who could talk to the young. Max and I miss them terribly; they were excellent neighbors with a very sweet dog, but the new neighbors are promising. They have a rescued French bulldog and a cross-eyed Bengal cat (first one I've ever seen--he was surrendered to the pound because of his cross-eyed-ness), and Max is busily making friends with both of them. The cat only goes outside on a lead. This is a good thing, as he's the biggest damn feline I've ever seen outside of a zoo and I am not kidding. He's fucking terrifying.

New Neighbor Husband seemed a bit frat-boyish at first, but he's beginning to relax. He's gotten the vibe of the neighborhood (nobody uses poison on their lawns, we all compost) and has quit mowing the yard in a button-down shirt and loafers. New Neighbor Wife is kind and funny, and was quite sympathetic to my locking myself out of the house the other morning.

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

Oh, that? Yeah. . .well. We had some really severe storms here the other day: there were tornadoes not too far away (tornadoely speaking) and hail and all sorts of scariness. The Beardman, my other neighbor, came over to let Max out a couple of times during the day and make sure he was all right. In doing so, he locked the doorknobs of both front and back doors. I never lock the doorknobs, just the deadbolts.

So when Attila showed up the other day for our training session, I was standing on the front porch (it was 0630, and raining) with a cup of coffee. I turned to let us both in to find the door was locked. No problem; the back door's unlocked! Except it wasn't. And the key that normally lives on Max's collar was in Beardman's pocket.

So I borrowed Attila's car key and slashed the screen in my bedroom window. New Neighbor Wife walked out to her car in the middle of all of this and, to give her credit, merely looked at me questioningly. I explained the situation, and she said Oh, How Awful and offered Husband's assistance in re-screening the window. Then Attila levered herself up over the windowsill and unlocked the door, and life went on as normal.

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

All thing considered, I think the neighborhood got lucky when this couple decided to ditch the lights of Bigton and commute instead. Now if only their cute! cute! cyooooot! little Frenchy would decide I'm trustworthy and play-with-able. I almost had him liking me yesterday, but then he got all watchdoggy again.

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

In Attila news, I am now not only squatting, deadlifting, and good-morning-ing more than she can lift (being built like a gazelle), I now *bench* more than she can lift. This is going to require either a reworking of our training sessions or the purchase of the weightlifter's equivalent of a Hoyer.

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

And that is all for now. Eventually I'll work up an interesting (in the sense of the Chinese curse) day I had recently for public consumption. Right now I'm going to go vacuum all the cobwebs off the ceilings and chase the geckos back outside.

One of those days.

Once in a while, something happens at work that is so traumatic, so difficult to talk about, that I don't even want to post it on the blog. One of those things happened this week.

The minute I turned away from the cauldron on the cafeteria line that held "Fresh Seafood Gumbo," though, everything got better.

Ba-donk-ksssshhh!

But seriously, folks: this was One Of Those Weeks. I got a lecture from the director of nursing about being on my Best Behavior (Best Beloveds) when it came to taking care of the family member of a VIP. "We're going to give him, of course, the same standard of care that everybody gets," said the DON, "but we might need you to expedite some of the testing, like the MRI, for him."

"Soooo," I said, unaware of what my mouth was actually doing, "We're *not* actually giving him the same standard of care as anybody else." 'Cause if you're on Medicare, that MRI's gonna take thirty-six hours.

It's a wonder I haven't been fired thirty times over. I called the bed board to report the arrival of Le Petit Prince with the words, "The Eagle has landed. Repeat, the Eagle has landed. With his diamond chariot and his staff."

Let's face it: If you work in practically any non-profit healthcare facility these days, especially one in the state where Guvnuh Goodhair has yanked funding for various things you used to do, you are dependent on donors to do things like fix the a/c and make sure you have enough money to buy IV fluids. I live in Texas; therefore, I am used to whoring for money to make sure my less-fortunate patients get the private funding they need to get treated. Ever since I watched a guy die of a treatable brain tumor because of lack of indigent-care funding, I have whored more cheerfully and fluffed-and-puffed in a more dedicated fashion than you would ever believe.

LPP hopped the line in the emergency department with a problem that had been going on since sometime in September and which had recently, despite not changing, gotten insupportable. Therefore, our Prince presented hisself at the ER with vague complaints of. . .something.

I admitted him and his Something ahead of two actually emergent patients with actually emergent problems--though, thankfully, they'd gotten good care at their local EDs in the meantime. They just kind of had to wait around for a bit, one on the helipad, the other in a buggy (ambulance, for you civilians), until we'd gotten His Highness settled in.

(Just now Max put his head in my lap, bad breath and shedding ear-puffs and all, reminding me that no matter how stupid we humans are, there are still dogs who love us.)

HRHLPP will be fine. There's nothing wrong with him that six weeks drying out and a few B vitamins won't cure. My other two patients will be fine: one got TPA in a timely fashion, administered correctly by an on-point ED MD (shout out to all the ED docs!) who'd never actually done it, but who read up on it on the Internet from his tiny, six-bed ER; the other got a nifty new experimental drug we're testing and seems to be getting over her aphasia even as we (ahem) speak.

It's not his fault his daddy's rich. He was a nice guy: said "Please" and "Thank you" and was admirably brief and succinct in the description of his symptoms. Daddy is currently funding a study on the benefits of various anticoagulants in the acute phase of stroke (the beneficiary of which was in the next room over), so I had little trouble being nice to him. We even had a few things in common: birdwatching, politics, and music.

Even if your client is nice, it doesn't make it any easier to whore, though.

Question for the minions: anybody here know how to knit?

If so, please shoot me an email at johannebertha at gmail you know the rest.

Thankee. I may have a commission for you.

For Tashi and Wash, on the occasion of their third anniversary, belatedly.

Peeps, a request:

That you send your best wishes to Nurse Ames, who has spent thousands of minutes waiting for me to get done with yet another damn scan and driving me back and forth to said damn scans, tomorrow. She's having her stapes replaced with a titanium replica and her eardrum repaired in some way that I don't understand, starting about 2:30 pip emma central time.

What the hell do I know? I do strokes. All I know is that she's a little anxious, and so am I.

Prayers, hip-shakingks, om-sayings, and capybara-snuffles would all be appreciated.

As for me, I'm getting started on soup right now.

I don't tell anyone about the things we have planned. . .

Your voice is my favorite sound.

You know what ammolite is, right?

It's the fossilized shell of a squidesque beastie that lived in the late Cretaceous (IIRC) period and which died out with the dinosaurs. The shells of those guys were apparently made of something very much like the stuff that makes pearls, but the fossilizing of their shells makes them all opalescent and gorgeous and rainbow-glittery.

Imagine the darkest, reddest amber you can, and then shoot green and yellow through it. That's ammolite. It's amazing. It's also found only in a very few places, from Utah to Saskatchewan, and around my neck.

Yes, friends and neighbors, this is mine. (Dry-washes hands, cackles.) It's a craptastic picture, but I was shooting and shooing a cat away at the same time.

Der Alter Jo and I were looking at this piece at a street fair, and I walked away.

Then I doubled back, with DAJ giggling with glee, and handed over my bank card. I knew that if I didn't get it, I would think about it forever, just like I do with a necklace I passed over in Alberta lo these many years ago.

In other news, things at the new NCCU are. . . . .well. Exciting? Thrilling? Slap-yo-mama-type fun? Sure: let's just call it that and leave it alone. I'll tell you: if it's not a stroke that takes out one entire side of your body, or a brain problem that leaves you face-blind (I passed over "prosopagnosia" and then typed "face-bling," which is what I've got around my neck, yo), or a previously-undescribed demyelinating disorder, we ain't got it. It's been one of those weeks where residents and nurses high-five one another over lab results, in other words.

Best moment of the week, and possibly of my entire life ever, came when one of my coworkers, who teaches jazz and ballet on the side, spun around in her chair to answer an intern's question. The thing was, she had her left ankle behind her head at the time, as she was trying to stretch out a cramp in her glutes. I had just put an empty accordian folder on my head as a hat and was humming to myself, and one of the midlevels was playing Bejeweled on her phone. It was Anything Can Happen Day in the NCCU.

I really think that shows like "Scrubs" and "House" are/were great for hospital staff. People get used to seeing craziness on TV, and it doesn't bother them nearly as much when they encounter it in real life. Unless, like that intern, they're just looking for the nearest vending machine.

What to do on your day off.

Wake up to a cat licking your knuckles. Roll out of bed, stopping mid-roll to rub the doggy belleh presented to you. Start the coffeemaker, then pee.

Check your messages. Notice that your trainer has cancelled your training session for the day. Hope that she doesn't have the violent stomach ailment that's been going around.

Leave the house an hour after waking up, having spent more time than is necessary in the shower with mounds of scented soapsuds and lots of implements. Make your way to Target.

Find that everything you need--boring stuff, like dish soap and lotion--is on sale. Grab a bag of work socks as an impulse buy. Think of how nice it'll be to have a dozen pairs of the same socks.

On the way home, decide to visit the strange little nursery on the edge of town. (NB: One of my few unbreakable life rules is never to shop at a nursery that doesn't have resident cats.)

Roll on into that nursery and greet the Domestic Orange Jumbo who patrols the perimeter. Meander slowly down the rows of trees (Japanese maples are big this year) and hardy annuals until you get to the greenhouse. Push aside the plastic sheeting that covers the door, walk into the greenhouse, and take a deep breath of warm, humid, growing-things-scented air.

Take a few more deep breaths.

Dodging craneflies, examine the offerings. Consider buying four-inch pots of catmint. Discard this idea when you remember how prolific and invasive catmint is. Sniff hard when you bend down to look at the Carolina jessamine and Asian jasmine in teeny pots. Admire the Meyer lemons and wish you could remember to bring such a thing inside when it gets cold.

Walk out of the greenhouse and enjoy the change from warm and humid to cool and slightly muggy.

Walk to the next greenhouse. Stop along the way to pet an argumentative calico cat and a black-and-white cat with long whiskers. Realize that the combination of greenhouse and relative outside humidity has made your hair go native in a big, bushy way.

Enter the second greenhouse. Breathe deeply. Realize that this one is mostly roses, but don't go back out, even though you don't want roses. Stroll the aisles of rose plants, reading every card and smelling every bloom. About halfway through, pick up the calico cat who's followed you in and carry her so she'll stop complaining.

Leave the second greenhouse. Stop to commiserate with the nursery's owner, who thanks you for paying attention to the bitchy calico (now curled up with her head on your shoulder). Discuss the drought, the invasiveness of artemisia, how Home Depot has ruined foundation plantings, and whether you can divide buddelia by whacking at it with a shovel.

On the way home, stop to pick up tacos from the taco truck.

Eat your tacos. Update your blog. Take a nap.

My head, let me show you it.

We had a patient recently who had something I've never seen before (for that matter, neither had the physician). He'd infarcted his corpus callosum.

Now: If you're not a brains person, this won't mean jack to you. It's a very big deal, though, for a couple of reasons: first, the corpus callosum has a huge blood supply coming from (if memory serves) three different arteries. Second, infarcting (cutting off the blood supply) it means that you end up with something called split-brain syndrome.

See, the C.C. is the part of your brain that ties everything together. It's a big ropy mass of white matter--the stuff that has the thinking bits of your brain in it--that acts as a communication corridor between the right and left sides of your brain. It allows you, for instance, to be able to recognize a chicken, describe that chicken, name that chicken (sounds like a bad game show title), and talk about what sorts of implements you'd need to take care of said chicken. Besides a knife and fork, I mean.

Occasionally we'll cut the corpus callosum as a last-ditch attempt to stop a really horrible case of epilepsy. That's usually done on children who simply can't stop seizing, no matter what we do pharmacologically, and it's usually done at a very young age, because the ability to overcome that callosotomy, as it's known, decreases as you get older. If it's done too late, or if it happens later in life as the result of a stroke or other injury, you end up with split-brain syndrome.

I'll bring back the chicken and let Wikipedia explain what split-brain syndrome does:

A patient with a split brain, when shown an image in his or her left visual field (the left half of what both eyes take in, see optic tract), will be unable to vocally name what he or she has seen. This is because the speech-control center is in the left side of the brain in most people, and the image from the left visual field is sent only to the right side of the brain (those with the speech control center in the right side will experience similar symptoms when an image is presented in the right visual field). Since communication between the two sides of the brain is inhibited, the patient cannot name what the right side of the brain is seeing. The person can, however, pick up and show recognition of an object (one within the left overall visual field) with their left hand, since that hand is controlled by the right side of the brain.

The same effect occurs for visual pairs and reasoning. For example, a patient with split brain is shown a picture of a chicken and a snowy field in separate visual fields and asked to choose from a list of words the best association with the pictures. The patient would choose a chicken foot to associate with the chicken and a shovel to associate with the snow; however, when asked to reason why the patient chose the shovel, the response would relate to the chicken (e.g. "the shovel is for cleaning out the chicken coop").

Obviously, it's going to be a drag if your C.C. gets all jacked up. It's hard, given the other problems this dude has (like an almost total lack of white matter, thanks to diabetes and hypertension and a bunch of other stuff), to get a really clear read on how it's affecting him and whether or not he even notices. We thought that he had some left-sided neglect (more on that, per Pens's request, in a later post) combined with a major psychiatric overlay (given his history). It wasn't until we saw the MRI, with the corpus callosum lighting up like Christmas, that we realized what, exactly, the problem was. Golly!

(Yes, I actually said "Golly!" upon seeing the guy's MRI. Sometimes I say "Gee whiz!" as well. Ironically, of course. Because I'm hip.)

Now I'm left with a wet, cold chicken who's been in a snowy field and has to be returned to her cozy coop over at Wiki.

Cross your extremities.

I'm waiting for a call back from the insurance peeps. They called earlier regarding my appeal, I called 'em back, got voice mail, and left a message.

Pray, chant, shake your booty, light incense, whatever.

Thanks.

My week, by Jo.

This past week, I was stroke coordinator, advisor to the publications department, advisor to the computer guys who are installing new monitors, preceptor to two nurses, secretary, patient care aide, transporter, housekeeper, fire-putter-outer (figuratively, not literally, thank Frogs), chief inspector of electrical outlets, general dogsbody, and carrier of a full patient load.

I have this weekend off. Except work has called four times as of 0500 this morning to see if I'd like to work extra.

Extra work is not on my schedule. Last night I went to bed just after 5 pip emma, as the sun started to go down. I slept eleven and a half hours and feel almost human.

Things are bad at Sunnydale General: we've got a number of people out with work-related injuries or stress-related problems, our census has ballooned over the last six weeks, and we're all run to nubbins. On top of all of that, I've had such a sore butt over the last two weeks that I've been barely able to walk.

Conversation between me and Der Alter Jo at the Korean barbecue:

Me: My ass hurts.

DAJ: Cross your legs like this: (demonstrates).

Me: (crossing legs like that) scream

DAJ: That's piriformis syndrome.

Conversation with Dr. PMR:

Me: My ass hurts. Friend of mine says it's piriformis syndrome.

DPMR: Cross your legs like this: (demonstrates)

Me: Aw HELL to the no.

DPMR: You work out on an elliptical, right? And you run the stairs here?

Me: Yep.

DPMR: You're a moron. It's piriformis syndrome. Quit running the stairs. And do these stretches. And use a heating pad and NSAIDs.

Me: scream

If there were a Twitter tag for this entire month, it would be #tinyscream.

As the topper, I think one of the docs that I like best is leaving the stroke program. I'm not sure yet, having only heard the most whispered of rumors, but I'm worried.

Kentucky is gorgeous, though, as is Missoula. I could move, right? Right? Even with my sore butt and my worn-to-a-nubbin temper?

Danish cooking: it's messy.

First you go to the local butcher and ask for a pound of ground pork, the leanest possible, run through the grinder four times. No more, no less. Four times.

Then you get a pound of veal, run through the grinder twice.

Run home, put that in the fridge, and run out again for the following:

1. White bread with which to make breadcrumbs

2. Sour cream, heavy cream, dill, and selzer

3. Cloves, pepper, and salt

4. Frozen red currants (you have NO IDEA how hard it is to find frozen red currants) and raspberries

5. Unsalted Danish butter, Lurpak brand.

When you get home with all that glory, you'll do the following:

Mix half a cup of flour, two eggs, half a cup of heavy cream, half a cup of selzer, and about a cup of breadcrumbs with the meats. Add a smidgen of salt, a buttload of pepper, and a couple of pinches of cloves. Knead it all together and stick it in the fridge.

Put your currants (two packages) and raspberries (ditto) into a nice, heavy stockpot with enough water to keep them from burning. Simmer until everything's soft. Blend the mess in your blender (being careful not to let it explode out of the top), and then strain it through a strainer lined with cheesecloth. Twice.

Return it to the rinsed stockpot with a quarter-cup of cornstarch mixed with water, and simmer until the mixture begins to look gelled. Then pour it into an appropriate container and refrigerate.

Look around your kitchen and marvel at the red splotches everywhere.

Now it's time for meatballs. Grab a golfball-sized hunk of meat mixture out of the bowl and shape it into something like a flattened egg. Repeat eleven times, then fry the meatballs in a third of the butter you bought. Repeat twice more. While you're doing that, you can plan out mincing up the dill and mixing it into the sour cream to make a dill sauce.

While those frikadeller are frying, why not try to clean up some of the fruit splash from your counter, backsplash, stove, table, and person? Well, why not? Because it'll never work. Just learn to live with red splashes every-damn-where.

Remember dimly how your Danish host mother managed to do both frikadeller and fresh ham and rodgrod med flode without making the kitchen a horrible mess, and without spilling stuff on herself. Gaze around your own kitchen and marvel at the number of sieves and pots you've used at this point, only halfway through. Load the dishwasher. Pour yourself some aquavit.

Consider pickling your own beets to go with the frikadeller and roasted potatoes, then dismiss the idea.

Consider repainting the kitchen walls in a glorious, vibrant shade of pink. Consider it twice.

Eat a hot dog, drink a beer, go to bed.

Why I love my job, part umpty-umpty-ump:

1. Standing around on rounds with the chairman of the department and the United Nations of Neurology (aka the residents), trying to figure out what the hell is wrong with a particular person. "He can't read out loud, but he can read silently and give you a good summary of what he's read." "Do you suppose that guy has edge-sensing and blindsight? That would be really cool. I've never seen a case of blindsight before." "How the heck are we supposed to get her to eat all of her food if she has total extinction of the left side?" (Me, having read Oliver Sacks: "Just tell her to turn her plate to the right until more food appears." Neurologists, not having read Oliver Sacks: *gaping in amazement*) "What about that one dude who sees only in black-and-white? Is that any better?"

2. Seeing function come back after TPA administration. Normally we don't do MRIs prior to TPA, just CTs. The MRI suite is always so busy that holding TPA until we have a solid MR image would push most of our patients out of the window (in terms of time, not literal defenestration). That means it's always kind of a crapshoot in terms of what we'll see, depending on whether the embolus was a clot or plaque or whatever.

3. Learning even tinier details of brain anatomy every single day. Just when I think I've got a good handle on things, some genius comes up with a theory that a patient's symptoms are due to a minor derangement of Whargarrbl's Foci of Bolognese's Range of the Straits of Inglewhazzit. It all starts to sound like Terry Pratchett, and I'm off to the textbooks again.

4. Learning really gross things about gross anatomy. Turns out there's a nasty situation that can happen inside an artery that causes a big snotlike glob of fat and plaque to detach partway and hang there in the blood streaming from the artery. Except that it's attached at one end to the wall of the artery, so it just goes "hrrbl hrrbl hrrbl" and blops around, occasionally causing TIAs. I can't remember the name of it, but if I see it again, I'll know it.

5. Knowing enough to explain what's going on when somebody in a different department starts freaking out about the YouTube video with that octopus? That's dead, and in soup, but then somebody pours vinegar over it? And I can explain how the acid in the vinegar stimulates the sodium channels and makes the octopus-food-corpse-guy want to crawl out of the bowl. That's really cool. I like that part.

In which Nurse Jo performs an assessment:

Nobody died over the last four days: good.

TPA given to two people who needed it: good.

TPA given to one person who has a factitious/psychological disorder: well, no harm done.

Intubation of one patient: very, very good call.

Extubation of another patient: good. I'm glad her daughters got to be there.

Lotioning of a patient: Jeebus grits, why did this woman have to use Johnson's Baby Lotion? I hadn't smelled that smell in better than twenty years. It took me back to watching my grandmother get ready in the morning, in her alcove lined with mirrored closets, and her vanity mirror with Johnson's on the table.

I think I might have to go buy some Johnson's Baby Lotion just for the helluvit.

Self:

Oh, dear.

Noticeable right nasolabial flattening. Left neck musculature overcompensates for right on swallow. Left and right shoulder shrug equal. Right facial and neck dermatomes non-compensatory; total extinction of buccal and mandibular distributions. Compensation adequate.

Crooked smile: my new trademark.

So, yeah. Hey. How you doin'?

Well, we're moved.

We have a spandy clean new unit with seven (!!!) beds, monitors, a central monitoring station, computers that work, (oh, crap, I just realized I have to call them about the call light system) and beds and so on that actually function and don't have bits broken off of them.

So that's what I've been doing for the last couple of weeks. That, and the usual keeping people from falling out of their chairs or having larger strokes or otherwise having complications that would keep them in the hospital for weeks and weeks.

The first thing I did in the Spandy New Unit was stretch my arms out from my sides and turn in a complete circle. That did not used to be possible. The second thing I did was walk from one end of the floor to the other, giggling, and saying "wahoo!" softly. Then I got my poop in a group and got the patient we had to move to her new room.

It feels a bit like a shakedown cruise. There's still a lot of stuff that doesn't work, and things that could be neater or more convenient, but we'll work those out in time. Right now, I'm just grateful to have a place to put people where I can be relatively sure that the walls won't catch fire and I can get them into and out of the rooms through doors wide enough to admit hospital beds.

While you're waiting for a real new post, kd lang.

Things They never tell you about having had cancer:

1. While cancer might be simultaneously boring and terrifying, it beats waiting for the surveillance scans. There's an up-and-down rhythm to getting your lymph nodes biopsied (ow!) that just isn't matched by the four-month drag that is waiting for your first chest CT.

2. Growing your hair out after having had cancer sucks just as much as it does when you're well. You still have weird flippy pieces and flat bits, and you still look like hell, but at least nobody says anything snarky. They just look at you and say, "You lookin' good. Whassup with yo' 'fro?" (credit: Friend Lisa from work.)

3. Every beer, every french fry, every night out on the town is larded with guilt that This Might Be The Thing that tips you over the edge into another horrible diagnosis.

4. Your blood pressure will always be a source of concern for the nurses at your surgeon's office, and they'll waste lots of paperwork on you before you say, through gritted teeth, "MY PRESSURES ARE HIGH BECAUSE I DON'T WANT ANOTHER BIT CUT OUT OF MY HEAD, THANK YOU VERY MUCH."

5. Your foresight in putting all your favorite colognes at the back of the closet during the first week of treatment will be rewarded when a patient in the chemotherapy unit says you smell good.

Redemption rips through the surface of time

(Bruce Cockburn, Lou Reed, and Roseanne Cash)

"...and guess what? I felt the baby kick today."

Merry Christmas, y'all.

Question From A Young Nurse: But What About The Feelings?

A Young Nurse asked Auntie Jo for advice this week. Poor, deluded Young Nurse.

Our correspondent asked this: "What do I do when a doctor or older nurse snickers at an answer I give to a question, or takes me aside later and tells me that I should've done something different? I have six patients, and I'm new to the night shift. I can't keep everything straight all the time. I want to kill them. What should I do?"

Dear Young Nurse,

We were all there, once. Those of us who got over it became the sort of nurse that your Auntie Jo is. Right now, I have a cat rubbing on my shoulder, a cold beer to the right of the keyboard, a happy dog frolicking in the back yard, and a list of men who want to be seen with me.

Those of us who didn't get over it became the doctor and nurse you're working with.

Practically, what you can do is this: Do what residents do. At the start of your shift, make out index cards that have each patient's name on them in big, bold lettering, so you can't miss it. On those cards, write the essential lab results and neuro/cardio/gastric/renal changes the patients have during the shift. Update them as you need to. That way, if you're ever caught out by a question, you can yank your index cards out of your pocket (be sure to wear scrubs with pockets at the waist) and answer the question quickly.

Doctors *love* it when you do things that they did as residents. It makes them feel very smart, and they will treat you better as a result.

As for the nurse: be humble. Shrug things off with a "Well, I'm still learning. Someday I'll have all that stuff on the tip of my tongue, like you do!" Make sure your back is turned when you roll your eyes. Mean nurses love that sort of thing, even as it makes them wonder if they're really *that* decent of people (answer: No, you're not, and you're going straight to a flaming-hot Hell when you die).

But what about the feelings?

It is hard, and I acknowledge that it's hard, not to reach out gently and wrap your scrawny little hands around somebody's neck. As The Bloggess once said, "A hug is just a strangle you haven't finished yet." I would suggest that you find a nice, private place to feel those feelings.

Feeling something like rage or disappointment doesn't mean you have to act on it. It just means that you've opened the door marked "RAGE" or "DISAPPOINTMENT" and have gone in and browsed through the goods on offer. It's best to do it in private so you're not interrupted. Rage, rage, against the asshole nurse or doctor who decided to get his or her rocks off by humiliating you. Then set it aside.

Resolve that next time you'll be so bulletproof that you'll embarrass them without meaning to. Resolve that next time you'll have the perfect l'esprit d'escalier and won't forget to say something like "up yours, motherfucker" when it's warranted.

Resolve--and this is both the most difficult and most important thing--that you won't let this make you think less of yourself or your practice. Some people are just assholes. Instead of bundling the urge to finish the hug up inside yourself, practice letting it out in the car.

All you can do is the best you can do. Be prepared, be on point, and if things don't go your way, don't fret: you've done your best. Believe it or not, your best doesn't have to be perfect. This is a twenty-four hour a day job. Self-doubt is a killer, because the minute you doubt yourself, you start doubting that little voice in your gut that tells you something ain't right.

If all else fails, Talisker. It's a good Scotch for beginners.

Am I old yet?

A coworker of mine reminded me recently that 2012 will mark my tenth year at Sunnydale General (Healthcare for the Hellmouth). Reader's Digest called me a "long-time" nurse. Doctors refer to me as "experienced."

So am I an Old Nurse?

I would argue not, and this is why: Old Nurses are people who still know how to work stuff you only heard about in nursing school, and who remember techniques and tricks (and are willing to teach them to you!) that you've never even considered.

Take Wendy, one of the nurses I work with. She's not an old nurse, having been a nurse for only slightly longer than I have--but she's an Old Nurse. She can count drip rates and work them out to milliliters per hour, having worked in rural hospitals. She can make a mean hot pack. She knows how to access the really bizarre permanent catheters that we sometimes see. She doesn't remember the days when pneumocephalus was induced as a diagnostic tool, but she's done stuff--like reducing dislocated shoulders--that I've only read about. In fiction.

On the opposite side of the coin, I was a New Nurse with eight years' experience under my belt when I went to the CCU. No matter how good you are at one thing, if you move to another, you're automatically a novice. That's not a particularly comfortable role to inhabit, but it does do wonders for an overblown ego and a sense of entitlement. At the same time you're being humbled, however, you're being encouraged to ask "Why?" (That is, if you don't work in a bad environment.) "Why?" is one of the most important questions we can ask on a daily basis; it's the only one that leads to changes and improvements in care.

So, no, I'm not an Old Nurse. Not yet. At this rate, I may never *be* an Old Nurse. Although, I will say--my willingness to get post-op patients up out of bed without waiting for physical therapy has gotten shocked, admiring reactions from CCU nurses.

If I ever do get to Old Nurse status, I want to be asking "Why?" still. Those are the best sort of Old Nurses to have around.

HA.

And a Huge Shock:

Teddy Bear the Fretful Porpentine is from My Home Town!

I might have to ask to meet him (and bring him erk-erk-eeenh-eeenh-gitback! noms) next time I'm up there.

Updates, of a sort.

I saw Dr. Elf today for the last time until April. The New Bug is performing beautifully; I'm even able to lie on my stomach for a massage without any nasal regurgitation (aka saliva running out my nose). He thanked me for being such a happy patient; I thanked *him* for being kind on the days when I was not happy. There were plenty of those.

So, April: I go for a chest CT. That's scary as hell. Apparently, polymorphous adenocarcinoma rarely metastasizes, but when it does, two things happen: it goes to the lung or brain, and it's incredibly virulent. My brain, so far, is clear. (My coworkers would say that it's not just clear of cancer, it's clear of thought and reason as well.) My neck is clear. I'm very happy that the lymph nodes in my neck are clear, by the way: the radiologist who read this last CT was the same dude who read the last one, and he said something like, "I note that the lymph node in the right neck, swollen in the pre-surgery CT scan, has returned to a normal diameter and density." I'm hoping nothing nasty shows up in April.

ANYway, the same day I see the CT guys and Dr. Crane, I see Dr. Elf for a follow-up. As he said, this is a dynamic process. As I age, as I lose or gain weight, as I sing more or less, the prosthetic will need to be modified. We'll let it float until April unless something major happens.

Speaking of major, two things happened this past week: BCBSTX denied my appeal and simultaneously refunded me about a tenth of the money that they ought to admit they owe me. What this means in real terms is that I now have to appeal to the Office of Employee Benefits at Giganto Research and Education Corp. Beloved Sister is helping me set up the most impressive packet of information ever, including slightly nauseating pictures of The Deficit, in order to do that. So, more of that.

Enough about me. In work news. . .

It's getting harder and harder to get one of the cross-covers to call me back. She's a nice girl, if a bit scatterbrained and inclined to panic. I'm thinking that I ought to just page her in haiku:

Your patient's IC

P is rising. Perhaps

You should come see him.

or

Wind through falling leaves

Like gas in patient's bowels.

Please order senna.

In sadder news, one of my coworkers simply didn't wake up last week. He was thirty. As is usual for this sort of unexpected death, there'll be an autopsy; likely he had sudden cardiac arrest or a PE. And, as is usual for this sort of death, nobody had a bad thing to say about the man. He was, as a friend of his said, a "good hand"--coming from a deep East Texas country boy, that's high praise.

I know I'm not supposed to wish death on anybody, but wasn't there somebody out there who set kittens afire that could've died, rather than the nice young guy with four kids? I liked working with him, knew I could trust him, was glad to see him in the mornings. Greater praise no nurse hath for any man.

Aaaand in less-sad news, we have a new place for the NCCU: we're taking over a unit on the floor above where we currently are. We'll have real doors that close or not, as we choose, and real monitors, and real beds, and real pumps! Just the luxury of more than four square feet of desk space (and half of that taken up with a sink) is more than I can think about without giggling. We should be there by the end of next month.

Finally, read this by Xeni Jardin. She captures better than I ever could the feeling of being out there, beyond reach of the people you depend on most, stuck in a new place.

"When I finally got through, someone else's voice was coming out of my mouth, and it was taking forever for the stuttery radio transmissions to beam through space, from the cold planet I was lost on, way out here, far from home."

Two and a half minutes of nomming Teddy Bear.

This is. . .amazing.

Real posts a bit later, after I get back from buying new blades for my reciprocating saw.

In case you've had an especially bad day. . .

I present the Strontium-90 of cute animal videos.

This is not a title I bestow lightly. Until today, the best-ever cute animal video was that of a porcupine who thought he was a puppy. He's been dethroned by a greedy porcupine. At least they kept it in the species.

Behold: Teddy the Selfish Porcupine!

Man. That is one fretful porpentine.

The Evolution of a Bug.

The scans were clear. I have a flowery turbinate that bears watching, but that apparently can be a normal variation. Next flip-out comes in April, with CTs of my chest and belleh.

I also got the new obturator fitted yesterday. It works. It works wonderfully, in fact. So, in honor of the New Bug, a retrospective:

The obturator on the far left is the first one I had, the surgical one. The speech bulb was added later, and they had to change the position of the wire on its right side, hence the weird plastic outpouching. I broke off the wire on the top right by biting on it.

The obturator in the middle is the interim one. Note the thumb-sized snot channel, meant to drain away what doctors euphemistically call "secretions." You'll notice that it's narrower and longer than the surgical bug, as a result of my head healing and changing shape.

The obturator on the far right is the one I'm currently wearing. It's made of chromium nanowhatsit, some nonferrous material that's only found in conjunction with unobtanium. It's hollow to cut down on weight, and no, that hollow doesn't fill up with crap. I was amazed.

See how the shapes have changed as I've healed? You can't really tell from this picture, but the first Bug is so large I can't close my hand over it, and I wear a size 7 glove. The newest one is so petite and light that it feels like nothing. Plus, since it doesn't cover the backs of my front upper teeth, I can do things like bite into an apple.

Notamus loves the fabric I laid out as a background. He started milk-treading it just after I took this picture. Weirdo.

First obturator, alone. Damn, that was huge.

Second obturator, alone. That loop of metal inside the plastic speech bulb is meant to stabilize things. Look how tiny the obturator part is, and how fat the speech bulb is in contrast to the first one!

It's like I'm watching my own baby grow up, she says, clasping her hands to her breast.

Well. Enough of that. I've got sausage and potatoes and sauerkraut to eat. With my new obturator.

BIG DRAMA today at Bigton's Scanning Centre!

Call out the Marines! Get the helicopters going! Phone the Prezznit!

Or, at least, call the security guys and have them come and scratch their heads.

There was an Opossum (from the Proto-Algonquin aposum, or white beast) in one of the trash bins this morning at Scanning Central. The security guys, the maintenance guys, the housekeeping folks, and the animal control peeps were all alerted. Everybody ran about and waved their hands.

Until one of the valet parking dudes rolled the trash bin (with aposum inside) carefully over to a landscaped bit of ground with plenty of bushes and tipped it over. The white beast made its way (trundle trundle trundle, wide-butt-ily) to the far side of the landscaping and disappeared.

Possums got big teefs.

And so do I. Scans were today; results of scans and possibly an Evolution of the Bug, tomorrow.

Black Friday Relief. (not that I went anywhere, mind)

It's like I put a quarter in the scumball machine.

No, I will not hide you from the cops who have come to investigate your lousy ass for leaving the scene of an accident in which you hit a pedestrian while cracked off your noodle.

No, that minor forearm injury will not qualify you for disability.

No, you may not leave the critical care unit to smoke one with your buddies.

Yes, I do intend to start this IV on you. You can threaten to hit me all you want; it's still going in.

Yes, we enforce visiting rules. No, conjugal visits are not an option.

Get your child out of the CCU. Now. I have already explained this to you twice. You cannot smuggle a toddler in under your coat and not get found out.

You do indeed have gonorrhea. Sorry. Now roll over and take this shot.

And you do indeed have syphillis. All the shouting in the world won't change that; besides, it's annoying the Clampetts on the other side of the curtain.

You may not see your "clients" in my unit.

Telling me that you'll sue me if I do one thing you don't like is not the way to build a therapeutic relationship. Neither is having your lawyer call me to demand details of your care. There is such a thing as confidentiality.

Yes, I am a fat bitch. Pointing that out neither hurts my fee-fees nor makes me more inclined to be cheerful.

Thank God for little grannies who come in with their unfailingly polite, helpful family ranged around them. Grandma can hold court from her bed as long as she likes, and you guys can stay as long as you like, bandanas and weird droopy-ass pants and all. You may be scary looking, but you're obviously good to her. You're also very nice to me. Thanks for the chicken pot pie.

Had a bad day? Have some ducks and a cop.

Here.

H/t to Friend Pens for this!

One thing about being single

. . .is that you learn how to do things on your own. You get used to doing things on your own, and even begin to like it.

Today, for example, I hung wallboard and panelling (not that I like panelling, but I had to match the stuff that was already on the walls). Last weekend, I took down an eight-by-eight-by-two built-out closet that was messin' with the feng shui of the bedroom where I type. Tomorrow I'll bake a couple of pies (home-made crust, thanks) and tape and mud the wallboard in the utility room. I did all of this on my own, except for loading the stuff into the bed of my neighbor's truck today. I'm used to doing stuff on my own. I'm good at it.

Which is how I came to be lying atop a fighting, screaming, thrashing man, holding his wrists with one hand to keep him from punching me and threading an NG tube down his nose with the other hand. I figured I could do it on my own.

After all, I reasoned, with six of Ativan and God only knows how much of Haldol already in his system, he's well sedated. He withdrew to pain thirty seconds before I busted out the KY and the NG tube, so I figured I was good to go.

I was wrong.

As he felt the bed starting to rise, both of his legs went over the bedrail and he started screaming. It was a full-blown, woman-like scream that went on and on and on. Dude could've made a killing in opera, I tell you. I figured that he, like most patients with encephalitis, would stick to the screaming and maybe make a small gesture here and there with one arm.

Again, I was wrong.

He scooted all the way to the end of the bed, got his legs out, and proceeded to try to buck his way out of the situation. Which is why I laid atop a person who had a history of projectile-vomiting blood and punching unsuspecting phlebotomists.

I was very glad to see Figgy, the stocky and strong intensivist, come through the door at a run. Figgy and I managed to get the guy back into the bed and tied down, then ran him down to CT.

It was a long day. I'd give my kingdom (with new wallboard!) for a thousand milligrams of methocarbomol right now.

What we talk about on slow days.

Is there an animal which, in its baby form, is not cute?

I assert that there is, though I don't know which one(s) that might be. The Mankiller swears that all baby animals are adorabubbles. We went on a Google search to see what might, in the baby-critter world, be uncute.

Llamas are cute as babies. So are goats. So are Tasmanian devils. Even Chinese Crested puppies are cute, which I was not expecting. Baby parrots are about the furthest thing from cute ever made, but even they, with their oversized beaks and button eyes, have a certain charm. Baby reptiles are cute because something scary in a large form is cute when it's wee.

We are still looking for the baby animal that won't make us squee and want to snuggle it.

The Mankiller and I also discussed the concept of Intrinsic Funniness, which I mentioned here a couple of days ago. Elephants, pennyfarthing bicycles, large moustaches, tweed blazers with leather elbow patches, and half-grown puppies are intrinsically funny. We agreed on those things. Possibly intrinsically funny things (those things which need more study) are mice, any consumable good that has a name like "Ho-Ho" or "Ding-Dong," certain shoes (white bucks and those loafers with tasseled tongues), balloons (opinion is divided between funny and scary), people in drum circles (funny or tiresome?), and bologna. Personally, I incline to the idea that bologna is funny. The Mankiller isn't so sure. She thinks bowling shoes are funny, but I find them overdone. I find pit bulls hilarious, especially when you rub their bellies and make them banjo, and she says they're too politicized.

We agree that although they are the butt of many jokes, the following things are not intrinsically funny: Jews/Poles/Irishmen/Your Best Friend (whatever ethnicity he is), the Wicked Witch of the West, the suburbs (more depressing than funny), anything Scots, garbage disposals, utility companies, and the Works Progress Administration. That last came out of a conversation with Richard the Respiratory Guy, who asked, "What can you never imagine anybody telling a joke about?" I came up with "the WPA;" The Mankiller came up with something I can't talk about on a family blog.

Suggestions? Disputations? We can't spend all day hacking our coworkers' Facebook pages; we need some help.

Best voicemail ever.

"Hi, this is Dr. So-and-so from Littleton Animal Hospital. I have Max's blood test results here, and they all look great. Wonderful. Take care; 'bye."

Max has been on Rimadyl for three months, and it's like we've knocked five years off of his age. He had blood tests run today, and a nail clipping (HORRORS IT'S A PAWDICURE HORRORS), and all is well.

Elsie-Mo got hit by the doggy equivalent of an incoming asteroid. I think it might, *might* just take that much to take Max out. For a dog who's half German Shep and half Huge Enormous What The Hell, he's doing well.

I love my Flying Flapdoodle Snacktracker. It was a good voicemail.

Dear Blue Cross and Blue Shield of Texas,

You have pissed off the wrong fat bitch.

I was moderately pissed off before now, when I discovered that you reimburse my prosthodontist one-hundred and fifteen percent of Medicare reimbursement, or approximately a thousand bucks for each prosthetic. You don't allow appeals, and you've ignored letters from my surgeon and the prosthodontist.

Now I'm *really* pissed, because this is what I found out today:

The lowest reimbursement for an oral prosthetic offered by any of the insurance companies with which Dr. Elf deals is fifty percent.

BCBS in other states covers between 60% and 90% of prosthetic costs. Even BCBS Oklahoma.

BCBS Texas covers close to all of the cost for limb prostheses.

BCBS TX, you are in deep, deep shit. See, when all this started, with me running up bills that I will never, ever be able to pay off (even at the competitive rates offered by the pleasant people at the credit card company, when they found out all these charges were for medical expenses), I was determined to blow into your offices like a bulldozer and make something change. If it didn't change for me, I reasoned, I could change it for the next poor bastard who lost part of a palate to cancer.

Now, a year on, I've lost energy for the bulldozer approach. Instead, I've decided to take the poppy-seed-under-the-prosthetic approach. A poppy seed doesn't do much, at first, but then it becomes annoying. As it digs into the mucosa left behind by a palatectomy, it gets painful. After a few hours, you're dealing with outright pain, runny eyes, a swollen set of sinuses, and--worst of all--the tissue around the poppy seed has become irritated enough that you have to use commando tactics to get it dislodged.

My finding out about differing reimbursement rates coincided with your sending me the same polite form letter you sent me a year ago: "Since we have not been successful in reaching you by phone" (even though the first letter had my diagnosis, Subtotal Palatectomy, right there in the header) "we invite you to call us to help us resolve any issues you have in your care. . . ."

Oh, Blue Cross, *never* ask me what you can do to make my life better. I'll tell you. I'll give you printouts, even, with diagrams and charts with circles and X-es on the back.

Strangely, darling BCBSTX, something very interesting has started to happen in the media, as well: Bigton's local paper has started doing an expose series on practices within Giganto Research and Development's operations. This follows a comparable expose done by Local Paper's sister paper north of here. Given that Giganto Inc owns Sunnydale, and that Giganto is the subscriber to your insurance, and that I am a paying member of BCBSTX's insurance pool, wouldn't it be interesting to have things like your reimbursement rates made public? I mean, things like oral prosthetics aren't even covered in your brochures' fine print. It might be nice, what with oral cancer rates on the rise, for the general public to know exactly what you cover and what it means for the people who pay for your service if you don't cover something they need.

Don't get me wrong, Blue Cross: I'm grateful that you covered the majority of the cost of my surgeries and follow-up. Without you, I'd be declaring bankruptcy. Still, it seems a little unfair that you'd cover the prosthetics necessary for a person to, say, walk, yet not cover the prosthetics necessary for her to maintain her own airway. If I needed an AFO or a hook-hand, you'd be at the plate. Now that I need something that lets me talk and not choke when I drink, you're bowing out.

And that sucks. More specifically, it's sucks for you. I may not be able to keep bulldozing, but I can sustain the level of annoyance required to feel like a poppy seed forever.

It is ON, bitches.

Odds and Ends after a few days off

A couple of mornings ago, a big, BIG owl launched itself from the mulberry tree in the back yard and went flying off west. I think it was a Great Horned Owl; I'd heard its call enough times to recognize it when I Googled it. The sunrise colored it cream and pink and erased any bars on its wings. It returns to the mulberry tree late at night after it hunts and spends the early-morning hours calling.

A Cooper's hawk nearly got a dove yesterday in the neighbor's back yard. I heard screaming and ran to the kitchen window, just in time to see a dove fight its way out of the hawk's talons and see the hawk soar up, screeching. I hope the dove's okay. The same hawk has made at least one sortie against The Boys while they're in their Kitty-Coop; I've found her feathers hanging off the wire mesh ceiling of the coop. At least it's not a red-tailed hawk; Cooper's are big enough to hurt an eight-pound cat, but the red-tails we grow around here could kill one of the boys, easy.

The low last night was about 35 degrees F. Max came in this morning puffed up, feeling ten years younger, and doing his hurpling puppy-dance, so I gave him an egg yolk and a tiny amount of bacon grease in his kibble. One thing about having a sense of smell about a billion times better than ours: it means you don't need much bacon grease to have a good time.

One of the sweet hippies across the street and I got to talking. Turns out he let everything die in his garden this summer. That made me feel much better about not watering the yard-long beans or worrying about the tomatoes after the tree fell on them. Strangely, both his globe basil and mine have come back from the drought and horrible temperatures and are leafing out as good as new. Note to self: make spicy-globe basil my new groundcover.

Man of God's child is pulling up and cruising the house with the help of convenient, ten-month-old-child-height handholds. He has blond hair like his father and dark eyes like his mother and already looks to turn out taller than either one of them. He smiles and reaches out to me when I say hi, even though I've been the one to examine the various rashes he's gotten so far and set his parents' minds at rest.

I put together an elliptical trainer today. The reviews on Amazon said it would take me about two hours, and it did, from the time I cut the first strap on the shipping carton to the time I tested it out. Then I fixed a couple of wonky drawers in the pantry and eyeballed what it would take to demolish the built-in closet in this office. All of this has left me with the smug feeling of accomplishment that presages an email from a Fulbright scholar taking me to task for my grammar. Bring it, boys! *I* can put together an *elliptical*.

One last wildlife note: I went out this morning, way early, before sunrise, to take some things out to the recycling bin. It's one of those heavy-duty plastic things on wheels that stands about three and a half feet high. I opened it and--there in the glow of the streetlights--saw a pair of eyes looking back at me. So I closed it again, abruptly, and wheeled it to where the light was better. Inside was an adolescent raccoon, looking very apologetic and perhaps a bit ashamed at having caroused on black-bean cans and empty beer bottles all night. He scrabbled pleadingly on the inside wall of the bin, so I laid it down on its side and let him get out before I dumped cardboard into it.

Raccoons are, I have decided, intrinsically funny, like elephants. Or turnips, or pennyfarthing bicycles, Jell-O, forgetful professors, sex, any number of bodily functions (come to that), peacocks, getting caught in the rain, religious authorities, people in hats, or umbrellas.

I'm tired of this body. Can I trade it in?

First it was six months of constant sinus infections. Then it was cancer, and not even a cool kind of cancer with pretty ribbons. Oral cancer comes with a maroon-and-white ribbon, which is not a good color combination for me. In between all that, I screwed up my neck and threw out a knee, then the other knee. Then I got an abscess. In my groin.

Of all the things I've subjected myself since I started writing this blog, getting a doctor to take a gander at the egg-sized, painful lump in my right groin was the most humiliating. Lying in an exam chair, with my right leg out at an angle, pointing to the problem while modestly covered by several sterile drapes is not going to go into my personal-best album.

The doctor, who was wearing a pink button-down shirt and a bow tie, was pleased. He called it a classic presentation, and pointed out the various identifiers of an abscess to the nurse standing next to him. I was busy trying to be someplace else, at least mentally, and didn't pay attention until he hit the thing with freezing spray and incised it.

I'll spare you guys the details. Suffice it to say that the nurse said admiringly, "This ought to be on YouTube." The bow-tied doctor took cultures, irrigated the area with sterile saline, gave me aftercare instructions and a prescription for Bactrim DS, and left the room. The nurse dressed my groin with sterile gauze and antibiotic ointment and a cubic yard of tape. I went to the pharmacy for drugs and then came home, figuring that that would be it.

Until yesterday morning, when the kindly doctor called me himself to tell me that he'd decided, on the basis of the cultures, to add another antibiotic to the regimen. I'm now on both Bactrim DS and Augmentin, eight hundred and seventy-freaking-five milligrams of the latter, both twice a day.

Turns out that it's nothing I did: I quizzed him quite thoroughly on that. It seems that there are bacteria that live normally on your skin and keep it healthy (that I knew) and are quite peaceful in their proper places. When they get inside your skin, though--and this can be through a small abrasion or cut or just by chance--they turn into the sorts of bacteria you don't want anywhere. That's what made me end up with a kiwi-fruit-shaped mass of crap in Area 51: normal skin flora and fauna.

I'll say this for Doctor Bow-Tie: he's human. He told me the story of his own abscess, which he got while a resident, and how it was a tossup whether to have a fellow resident deal with it or go to an outside doctor. He praised my wisdom in not tackling the thing myself, given the proximity of various blood vessels and lymph nodes, some of which were already badly swollen and tender. Apparently he sees several of these a week: who knew the human body was such a soup of potential horror?

The most painful part of the whole ordeal was calling in to work. I was told, solemnly, not to work the day after, to monitor my temp every four hours, and to call the doctor's office if I developed a fever or chills. Trying to tell your boss that you've had an alien removed from the house next door to The Queen of All She Surveys is not easy. Telling a blog audience of a couple thousand is cake by comparison.

So, People: watch yourselves. No amount of personal cleanliness, good diet, or virtuous living can save you from the horror that is quad antibiotic coverage. A one-to-ten solution of bleach to water might help, but I'm not going to bathe in that.