Ohai. September was sort of busy.

A few folks have asked for updates on our Fantastic Integrated Computer System and about the woman who went to the non-accredited nursing school. Herewith:

The FICS is. . . .well, most of the functionality has been turned off. Which is nice, as it doesn't feel like Big Brother is right over your shoulder all the time. Basically, none of the tracking features worked right. Hell, the call lights and information boards in the rooms didn't even work right, so away they went, to be replaced with the old setups. Nobody is crying.

As for the tech who went to the wrong school: Somebody asked why accreditation makes a difference, if her grades were good and she'd had previous floor experience. It makes a difference because accreditation is the way that hospitals and clinics know that a particular school is teaching material that's up-to-date and useful. It's based, as far as I know, on things like NCLEX passing rates and the qualifications of the teaching staff as well as the course requirements. Whether or not it's one more bit of Press-Ganeyesque BS I don't know; all I know is that you simply won't get hired if you don't have a degree from a school with accreditation.

And yeah, she and I talked about it; she's going to work where she can until she gets enough experience that it won't matter where she went to school. I don't know if that'll work or not, but here's luck to her.

In other news, it's been a while since I gave y'all a good, old-fashioned, gross nursing story. Here you go:

The patient was a woman in her fifties or early sixties. She was obese, had alcohol and opiate dependency, and was diabetic. She was in the preop area of another hospital, prior to getting some toes snipped off, when she started complaining of a headache and then fell over and seized.

Big aneurysm. Big, big blown aneurysm. The hospital, having no flies on its collective self, transferred her to Sunnydale to have that aneurysm clipped, even though it wouldn't make much of a difference to her functionality. So she showed up at Sunnydale NCCU intubated and sedated, got her clipping done, and stayed intubated and sedated for about twenty-four hours (the usual routine).

Except that about six hours after surgery, both of her legs got all swollen and funky. Oops. That's not a part of the usual routine. Turns out she'd somehow clotted off her IVC filter. That's a doohickey that looks a little like a miniature colander--you get one in your inferior vena cava if you have large or repeated clots in your leg veins. It's supposed to strain out any clots that might go to your lungs or head and hurt you. Anyhow, hers got all full of clots, which basically means you lose the blood flow back to your heart from your lower body. If you're thinking that's not good, you'd be right.

Out comes the heparin drip. More clots, more problems. Eventually, she managed to sustain pretty substantial damage to both kidneys, which required pressor support (drugs that go through your IV line to help your body maintain a livable blood pressure) and continuous renal dialysis (which is a big blood-scrubbing machine that we only use when things are Indeed Dire). We cut off the heparin and started using leech spit (yes, really) to anti-coagulate her, but the damage was done. She had some clotting disorder that's rare enough in women (why do we always seem to find those?) that nobody had tested her for it until she came to us.

Here's where things get interesting. Patient had two sons, one of whom was beyond batshit on the crazy scale. Mama made one good decision in a rare moment of sobriety and made Sane Son her power of attorney and medical liason. He was all for stopping the heroic measures. Beyond Batshit Son, however, was still part of the family, and used his time in the NCCU to cause problems, raise hell, and generally put up such a fuss about continuing life support that the docs felt hogtied by family drama.

Meanwhile, the patient had infarcted her bowels, meaning she had a belly full of dead intestine. She'd put on about forty pounds of water weight and looked like an enormous balloon person in the bed. Her skin was weeping excess fluid all the time, to the point that we put super-absorbent pads all over the bed and hoped for the best. The only things keeping her alive at that point were nine different drips (I counted), a ventilator, a dialysis machine, and sheer dumb bad luck. Her hands and feet were gangrenous. She no longer responded even to pain. Her reflexes were gone.

Beyond Batshit Son, despite being told that her chances for recovery were nil, continued to insist that Mama be kept on life support. He even called Adult Protective Services to tell them that his brother was abusing Mama--imagine APS's surprise when they investigated and found a Mama-Lump in a bed in a critical-care unit. This continued for a couple of weeks, until I degloved one of Mama's legs by accident.

"Degloving" is a nice word for what happens when you're so sick, or so burned, or so generally unlucky that your skin simply comes off. We were turning her, using the pads we'd put under her to absorb fluid, when I felt something mushy in the pad under her thigh. I figured it was just the super-absorbent gel in the thing and shifted my grip. . .which was when the nurse across from me blanched and shuddered.

The skin on the back of Mama's left thigh had sloughed off her leg. You could see layers of fascia and muscle underneath, and the lump of shed skin and fat was hanging off in a flap. There wasn't any blood; even with multiple drugs to keep her blood pressure up, she wasn't pushing enough of the red stuff to bleed when that happened. She leaked clear fluid.

Shudder.

With that, the docs on the case sat down in a meeting, collectively sacked up, and turned off the ventilator. The patient, grateful for the relief, died without fuss four minutes later. Given that the accidental skinning happened over a weekend, it took 'em all a couple of days to get together, but they did it. Beyond Batshit Son was never on board with the decision and had to be escorted off the premises by a couple of no-nonsense cops.

And that, my friends, is your Requisite Gross Nursing Story for the month. Sweet dreams!

You can't handle the truth!

Dr. Ali and I were talking about our recent (constant) staffing problems last night. I said I couldn't figure out why a unit with patients with things like GBS and big MCA strokes (one makes you not breathe, the other can make you have fatal heart arrhythmias without warning) wasn't considered a priority in staffing. I mean, we had a code a couple of weeks ago when some poor sod went into ventricular fibrillation (non-medical definition: your heart quits beating and just shivers: very bad), and only one nurse on the floor. It was touch-and-go, but we got said poor sod coded, stabilized, and later discharged.

Dr. A. told me something he'd heard earlier this week from a VP of development: that the neurocritical care unit is only important in that we bring in money for the neurosurgical service.

(Imagine me standing there, open-mouthed, silent.)

Yeah.

Sunnydale General is supposedly going for a comprehensive stroke certification, but the department that handles everything from strokes requiring TPA to non-surgical neurological emergencies is considered worthwhile only because we send the occasional patient to the surgery guys for a cartotid endarterectomy or aneurysm clipping.

I asked Dr. Ali how he'd responded. He told me he'd told the VP of development that our unit was making plenty of money on its own, thanks, and that he didn't like to refer patients for surgeries that weren't proven to work. (That last is some obscure insult referencing some sort of study on CEAs, I guess; I don't know the details.) It was a calm, intellectual burn from one doc to another.

Still, to be told flat out that the unit that you're working on, that you've been helping to develop for umpteen years, isn't considered important by the big uppity-ups. . . .is disheartening. Although it does explain why we're having such a hard time getting funding for equipment and staff.

In other news, I worked with a patient care aide this weekend who was concerned about her ability to get a job after she graduates nursing school in December. She's been doing externships and internships and has great grades, but hasn't even had a nibble on the job front.

We went over all the things she was doing right, and all the things she might be doing wrong, and then I took a look at her resume.

She's graduating from a for-profit school that is not accredited.

Again, imagine me standing there, open-mouthed and silent.

This woman will owe more than $50,000 for two years' worth of classes from a school that lacks even the most basic accreditation from any authority. She therefore will not be able to get a job anywhere but the LTAC that employs her part-time now, and maybe not even them, as an RN. Add to that that her chances of getting into a decent nursing school for a BSN are practically nil, except if she goes back to Consolidated Larnin' Collidge, and she's screwed.

I can't. . .I can't even. Talk about predatory marketing: they promised her that in just under two years, she'd have earning potential that nobody in her family has ever had. They told her that the job market for nurses is hot, which it is--provided you've got a degree from a recognized school and are willing to slog for a few years. They then helped her get loans that are about four times what I paid for a degree from an accredited program, but didn't happen to mention that a) the interest rates are huge, and b) her education would be worth practically nothing.

She's not stupid, but she's not well-educated. She's poor, she's got a GED, and she took the only offer she got. She's a hard worker and driven as hell, but she's hobbled herself with a bullshit "degree" from a place that has classes in a storefront.

It was a demoralizing week at work.

A late-summer, end-of-summer treat: fried green tomatoes.

I did not learn to make these when I was growing up. As far as I can remember, my Sainted Mother, being more or less a Yankee, never fried a green tomato, let alone okra or the leftovers of grits that had been left to become solid in the refrigerator.

At some point in the last ten years, though, I learned to make fried green tomatoes. They're not economical--very few people have enough tomato plants that finding a use for them is necessary, at the end of the season. They're not Paleo, or Atkins, or Clean--they're something you make as a special treat, to serve with fresh mozarella or shrimp or sausages, or just on their own, as soon as they come out of the pan.

They are purely Southern, in the sense that some version of FGTs extend from West Virginia all the way to Arizona. They are best made with green tomatoes found, by chance, at the farmer's market: the kind you get at the grocery store don't have enough flavor. Grab a half-dozen or so, stock up on cornmeal and breadcrumbs and fat, and go at it.

(This recipe can be made gluten free by the substitution of rice flour for the flour and gluten-free breadcrumbs for the breadcrumbs. Don't waste your money on panko; get the cheapest breadcrumbs you can find at the grocery store, or make your own from heels and odds of bread you've stored in your freezer. A blender helps here.)

You will need:

A large frying pan. Cast iron is best, but anything NOT non-stick will work.

A spatula or pancake turner.

Two large plates and a shallow bowl.

A fork. A knife. A horizontal surface onto which to slice the tomatoes.

Salt, breadcrumbs, cornmeal, pepper, at least three eggs, and a whole lot of oil or Crisco. Also four to six green tomatoes, the most symmetrical and greenest you can find.

To begin:

Obtain your tomatoes. Wash them briefly under cold running water and slice their ends off. Be miserly in slicing off the blossom end, as it's the most tender part, and promiscuous in slicing off the stem end. Green tomatoes have not yet formed a tough core, but who wants to eat stem? Now slice the tomatoes.

Some people swear by thick slices, at least a half-inch. I find I get better results with thinner slices--anything from a quarter-inch to almost paper-thin, depending on my mood and skill with the knife.

After slicing your fruit, lay them flat on a large plate or cutting board and salt them. You don't have to go nuts with the salt; this step is meant to draw out the extra juice and keep the breading from getting soggy. While they're sweating on the cutting board or plate, set up your breading station: on the first plate, dump a good amount of plain flour. On the second, dump equal amounts of breadcrumbs and corn meal, mixed well. I use a blender to do this because I am FANCY.

In the shallow bowl, mix up as many egg whites as you can scrounge up. Do not use whole eggs for this; the fat in the yolk will make your tomatoes soggy.

Now melt some Crisco (or lard) or heat up some vegetable oil (not olive!) (not butter!) (bacon grease is okay and traditional) in your frypan. You want it hot enough that a little pinch of flour sizzles when you toss it in there. Keep the heat at medium or medium-high. A half-inch of melted fat in the pan is the right amount. Too much and you'll end up with soggy, greasy tomatoes. Too little, and the fat will suck off all the cornmeal and burn.

Take your sliced tomatoes and pepper them. Press them gently into the flour. You want them coated with flour on each flat side. Don't worry about the edges where the skin is; they'll take care of themselves. (I do not recommend shaking the tomatoes with flour in a bag, as this will cause the innards of the tomatoes to fall out. Take the time to press them into the flour and you'll be much happier.)

Now dip them into the egg white. This will make your fingers gooey. Coat them with the breadcrumb-and-cornmeal mixture and set them aside in a single layer to wait for frying.

When the fat is hot, place five or so tomato slices into it. You want them to be uncrowded and in a single layer. Let them sit and sizzle until you see that they're beginning to get brown up the sides. Turn them carefully and allow to sizzle for a couple minutes more--the second side takes much, much less time than the first.

Remove to paper towels, (or do what the finest cook I know does: use slices of cheap white bread in place of paper towels. Use those bread slices to drain everything from bacon to fish, and then, at the end of a week or so, grill them by themselves and serve them with lots of ham gravy) and drain.

Continue in this way until the fat starts to smell like burning cornmeal. When that happens, stop everything. Take the pan off the heat and let it cool for a half-hour or so (your tomatoes will wait, I promise), then pour the fat out of the pan and replace it with clean fat. This step is essential. Otherwise, you'll end up with burnt-tasting FGTs.

You can eat them out of hand. You can layer them with slices of good mild cheese, or grate a tiny amount of good hard goat-cheese over them. You can cover them with shrimp or ham or sausage gravy. You can, if you like, layer them in a casserole with fresh sliced zucchini and ripe tomatoes and a little grilled eggplant and call it Southern Ratatouille, but I won't eat it.

They are best eaten as they are, with extra salt if you need it, off a plate, on a porch or in a kitchen in the middle of the dog days, below the Mason-Dixon line. You can fry okra or catfish if you have any cornmeal left over and feel very virtuous about not wasting food. I layer them with fresh mozzarella if I'm feeling fancy, or throw them into a roll with mayo, lettuce, and cheese and call it an FGT po-boy.

But most often I eat them as they come out of the pan, crisp and tangy and citrusy. These are the perfect bridge food between the humid hot horrible summer days of August and the crisper fall days to come. Enjoy.

A surgeon walks into a neurocritical care unit. . . .

Actually, he rolled in. On a stretcher. After a TIA. Transported by EMS from the airport. And it was, sadly, no joke.

There are surgeons nobody hears about, even if they've been working in the same place for twenty years. There are surgeons you only ever hear good things about. Then there are surgeons like Dr. Guts, about whom the most complimentary thing I've ever heard is, "Well, he's not quite Satan."

This is a man I once saw push a chart rack (remember those? Welded wire, meant to hold eight or so charts at once? Big, heavy three-inch plastic chart binders, full of paper, each weighing more than a couple of pounds?) over on to a unit secretary because he didn't like something that had just happened. Nothing having to do with the secretary. If she hadn't jerked out of the way, I think the weight might've broken both her forearms.

And here he was, in my unit. I should mention that Dr. Guts has quite the reputation for patching up people whose lower intestines have sustained damage of one sort or another. He's particularly good at reattaching colons to anuses.

Like attracts like.

The first words out of his mouth when I walked into his room were "GODDAMMIT! Why is this goddamned hospital so fucking disorganized??" I greeted him, introduced myself, and prepared to do a neuro exam.

"I was examined" he sneered--and I'd never actually seen anybody sneer before; I thought it only happened in books-- "by a qualified physician less than four hours ago. I do not wish to repeat the exam."

"Good" I said. "That's gonna save me a lot of time the next time I have to assess one of your patients."

He looked at me.

"Because an exam by a qualified physician means that exam will stay stable, right? Now, look right here at my nose."

He hated the food. He hated our MRI suites. He kept complaining that the hospital was disorganized--a hospital he helped found--and that everything in the world was wrong. He bitched about the doctors, the night nurses, the phlebotomists from the lab.

Finally, midway through his second (and last) day on the unit, I said, "Is it possible for you to be any less of an asshole? Just for a minute?"

His wife, sitting on the couch with a book, said, "She has a point, dear."

A week later he was back on the wrong side of the bedrail, this time for a cardiac problem. Thankfully, not in my unit.

Styling the bedroom? Ain't nobody got time for that!

If you've been reading this blog for a while, you'll know that I've become addicted to renovation/decorating/house blogs.

It's a shameful thing.

It's a shameful thing because, to be honest, my addiction (which started when I bought this house, seven or so years ago) has resulted in nothing except my painting every wall in the house white. Well, and putting up those two-inch-wide, faux-wood blinds that JCPenney sells because I was sick of uncleanable Roman shades. Did that today. Lost some patience, some years of my life, and not a little bit of blood.

Somehow, despite being glued to Anna's and Daniel and Max's escapades, and reading Chezerbey with the sort of dedication I usually reserve for science fiction, I have missed all the finer points of design.

Dudes, I Used Pelican Tile In The Bathroom. In my defense, subway tile was still too expensive for my budget at the time, and I was under a huge time constraint, as a house functions best with a working bathroom. Still, I look at those squares of tile and kick myself every time I pee.

And, worst of all, I'm ashamed. My bedroom's been described as "stark"--as in, all-white, no frills, no tchotchkes sitting on things, and very few things for tchotchkes to sit on. The living room is mostly neat, with several bookshelves, but I spend most of my time keeping the dog-hair and cat-hair under control, not working out vignettes with the Thai dragon Dad got me years ago.

I'm a good cook. I'm fantastic at makeup. I can dress myself with only a minor amount of trouble. I can refill the windshield-washer-thingy in my car with no problem. I make gorgeous compost. I can handle power tools without losing digits, and my solder doesn't drip. I'm not the worst nurse you ever worked with. But I cannot for the life of me decorate.

I was excited when The Boyfiend told me he was bringing his Schlitz chandelier. (Which has since been lost, but I'll go into that tragedy later if ever.)

Tomorrow I'm going to IKEA. I'm going to buy curtains, following Dana's advice and getting the longer ones, and I'm going to put them up. I'm going to put them up, moreover, on the nifty bendy curtain rods I got a million years ago from West Elm. It's going to be fabulous.

Aaaaand they will make the rest of the bedroom look skanky and as if it needs to be repainted, which it does, but dammit, who has time for that when there are tomatoes to grow?

Neophilia.

Gracious. Has it been nearly a month?

There's been a lot going on.

ANNOUNCEMENT NUMBER ONE: I have a new boss.

Not only do I have a new boss, I have a *fantastic* new boss. The honeymoon period is long over; I've worked with this person in a boss-capacity for going on two years now.

This boss, unlike the last boss, does not say things like "All vasoactive drugs are the same" and "I don't see why you're worried about your skills; you're a critical-care-trained nurse, right?" and "*I* had to work a whole twelve hours twice this week, so why can't *you* come in for a couple of extra shifts?"

All of which are verbatim from Old Boss's mouth.

New Boss says things like, "I'm expected at neuro rounds in ten minutes" (OB never managed to make a single round) and "No matter what happens, your unit will be taken care of" and "I don't know much about the brain, so I'm taking three classes in the next month to get up to speed."

NB also says things like, "It sounds to me like you guys aren't getting what you need in terms of support. What are your top three priorities, and how can I make those things happen?"

Also taken verbatim from New Boss's mouth.

I can't go in to too much detail right now, because every time I think about how my charts are being audited by somebody who actually cares, or my unit is being staffed by somebody who has actually worked as a nurse in a critical-care unit for more than nine months and who, moreoever, still does work in a critical-care unit to keep their skills fresh, I get all giddy and I can't type.

Everybody is happy about this: from speech pathology to physical therapy to the housekeeping staff, everybody's happy.

ANNOUNCEMENT NUMBER TWO: I have a new dog.

His name is Mongo, after the "Blazing Saddles" character.

Mongo likes snuggles, and kitties (and the cats love him), and playing catch, and carrying his stuffed toys around, and climbing up on top of me when there's a thunderstorm, and going for car rides, and generally being a capital-D Dog.

He's a golden retriever with separation anxiety. If he can't see me, but he knows I'm around, he flips out. I've asked the neighbors, and he hasn't been an asshole when I leave for work, so, good. We had a thunderstorm the other day when I wasn't here, and Mongo went calmly into his doghouse (evidence: he wasn't wet when I got home) and hung out.

His old human had to move and couldn't keep him. He's a year old. I never thought I'd have anything other than a shepherd or LSG or northern breed, but that was before I met Mongo-Man. He's the sweetest, lovingest dog I've ever met, even if he does bark when I mow the lawn. It took the cats about twenty-four hours to warm up to him; after that, I found them all three playing on the rug in the living room. Mongo was on his back with Flashes on his chest, biting his neck, and Notamus was playing with Mongo's tail.

Mongo is behind my chair right now, snoring.

And yes, he came with the name. It is appropriate.

No pictures yet because I can't get him to slow down long enough to take a snapshot.

ANNOUNCEMENT NUMBER THREE: Consolidated Research & Healthcare Corp, holding company of Sunnydale General, has done the dumbest thing EVER.

For years now, we've had color-coded scrubs according to discipline. The head of CRHC decided to drag us boldly into the 1970's, and has mandated that we all--from nursing to PT to housekeeping--will wear dark blue scrubs, the sort of blue you see in the cheaper catalog pages. Not only that, but they'll be embroidered (and thus un-returnable, in case they don't fit) and available only from one company.

I got mine today. They're cheap as fuck. As dark as they are, you wouldn't expect that a nude bra would show through them, but boy-hidey if it doesn't. They're available in two fabrics: Horrible Polyester and Slightly Less-Horrible But More Transparent Cotton-Poly. Other people, who got theirs earlier, have reported such things as the back seams on the pants ripping as they were put on or the shoulder seams ripping under the slightest stress. I can see why.

My only question is who's making money off this. Somebody somewhere has to be getting a cut of Sunnydale's employees' business.

Never mind that our patients, let alone our staff, had come to rely on color-coding to tell who was who. It's a nice thing, to be able to look up in the middle of a code and see maroon scrubs and know that RT has arrived. Those days are gone; now we'll have six-by-three inch plastic hangtags behind our IDs that state our discipline.

Of course, a fair number of my patients can no longer read, and depended on scrub color to tell what was going on.

I'd happily eat the cost of these scrubs if The Powers That Be came back and said, "Wait, never mind, bad idea," but I don't think that's gonna happen.

So I'll just go off and rub some MongoBelly. He loves that.

What's in *your* closet?

It's that time of year again, Minions. Those of you in Tornado Alley know what I'm talking about firsthand. Those of you not in the Alley know what I'm talking about thanks to the coverage of what happened in Granbury and Moore.

The Disaster Closet at Chez Jo is up and running once again. Hooray.

What, you might ask, is a Disaster Closet? Is it a closet where you keep your Bai Ling costumes? Your emerald-green eyeshadow? The mutant cakes that failed to rise?

Nope. It's where the cats and I go (and eventually The Boyfiend and The Dog, if ever the latter shows up) when the sky turns the same color as that eyeshadow and the sirens blow.

It's not common around here to have tornadoes, but tornadoes are not the problem ninety percent of the time. I once heard a storm-spotter describe a tornado as a sneeze in the middle of a really bad thunderstorm, and that's true. The majority of the time, damage in storm-hit areas comes from straight-line winds, hail, and--the big danger--flying debris.

That's why they say to get into an interior closet or bathroom with no windows. Trees falling, debris flying around--those are much more likely to injure or kill you than a direct hit from one of Mother Nature's sneezes.

Besides, if you take a direct hit from a twister, even a small one, there's not a lot your house will do to protect you.

(A quick aside, as people are surely thinking this: "Why a closet? Why not a basement or storm cellar?" In this part of the country, Austin north to OKC, it's difficult if not impossible to dig basements. We have three types of impediment: heavy clay soil, a layer of quartz or limestone between two and ten feet thick, and high water tables. Safe rooms are common in larger buildings, but it's damned near impossible to excavate deep enough even for a small storm shelter, let alone a basement. It's perverse to think that we settled the most dangerous part of Tornado Alley without figuring that out, but there you are.)

Anyway, and this is not bad advice for anybody anywhere anytime, it's a good idea to have a central location for Stuff You Might Need Later. Here's what I put in mine (all of this fits on a shelf above my head):

1. Weather radio with flashlight and cellphone charger. It's solar- or crank-powered and gets good reception even in the D.C.

2. A couple of big bottles of water. If the forecast looks particularly bad, I might stick a six-pack in there, too. (Only sort of kidding.)

3. First aid kit with pressure dressings and so on.

4. Insurance paperwork for me, the house, and the car.

5. Extra medications, extra contact lenses, extra pair of glasses.

6. A prybar. No, really. It's great to have a shelter from bad weather, but on the offchance that my roof caves in or blows away, I want to be able to get *out* as well.

7. The cats' carrier. They both go into one.

Everything except the carrier can either go on the shelf or, more likely, be slung in a cross-body bag and put on my person. So far, I haven't had to use the Disaster Closet in its fullest capability, but there's little sense in being unprepared.

Which reminds me of a funny story: a couple of years ago, we were having some pretty intense weather. Hail was hitting the sides of the house rather than the roof, the winds were so strong. Max and the boys and I were riding it out in the living room, waiting to see if the weather guys blew the sirens. When the sirens went off, Max fixed me with the stinkeye, then went to the closet, pried open the door with his claws, and went in. I followed him.

So, this whole Angelina Jolie thing. . .

Y'all have heard she had her boobs removed because she carries a mutant BRCA gene, right? And that she's gonna have her ovaries taken out pretty soon, too, right?

I cannot *believe* what folk been sayin' about that. First of all, it's nobody's place to have an opinion on what she does with her own body, even if she puts it out there in an op-ed in the New York Times. Second of all, if you have the kind of opinion that says, "She should've considered what that would do to her fans" or "She should've tried yoga and broccoli first," I will take you down.

Or, I would've, but then I read this:

Oh Fuck You.

Don't want your real name bruited about on Teh Interwebs? Don't sign it to a jackassed comment on those Interwebs.

Thanks for your input, Jackasses. No, really. Now I know who not to slow down for when I see a group of people crossing the street.

Saturday Night Sing-Along:

"It took me four days to hitchhike from Saginaw" is the most gorgeous line in this song.

Or maybe "I said, 'Be careful, his bow tie is really a camera.'"

Still a favorite.

I had a post all worked out about how I'd lost all joy in my job. . .

And then it got cold.

Let's review the bidding: Yesterday, the high was 85*F. That's somewhere north of 29 degrees for you guys who are using a sane and sensible temperature scale.

Last night, the low was 50*F. Today, the *high* was 47*F.

Tonight, it's supposed to get down close to freezing. I hope the tomato plants and basil live.

In short, go home, Texas weather. You're drunk.

I refuse to talk about nursing right now, because Manglement has indeed sucked all the joy out of my job recently. Instead of being sad that a friend of mine is leaving for a new job, I'm burning with envy.

So instead, let's talk about food. I have a craving right now for, not necessarily in order, osso buco, marrow on toast with capers and parsley, home-made donuts, and eggplant parmesan. All of those are wonderful, fun things to cook, and all of them will be totally untenable by Monday, my next day off, when the high is supposed to be in the 80's.

As much as people bitch about the foreignization of 'Murka, there is one benefit (well, more than one, but I'm concentrating on food right now): the amazing selection of offal available at my schwanky-danky, formerly snow-white grocery store.

I can get marrow bones so cheap it'd make you cry. Neck bones are even cheaper--hell, sometimes they *give them away*, which is just what you want for a lovely stew. The veal shanks that go into osso buco are not eighteen dollars a pound; they're practically free--if I ask for them at the butcher counter, I can get lovely meaty shanks for the price of ground beef.

And weird fish? We got weird fish, for pennies the pound. We haven't got that one with the human-looking teeth, at least not whole, but you want a monkfish tail? Eighty-nine fucking cents a pound, my friend. Yeah, you have to take that bad boy home and skin it yourself, but honestly? Not That Hard.

Also nopales, or cactus paddles: de-thorned and fresh, or pickled, or whatever. Dried squid in the bulk bins (particularly good deep-fried and served with scrambled eggs and sauteed eggplant OMG). Weird greens that I *think* might be amaranth, or some version of kale I haven't yet tried. Fruit that resembles pinecones. Fruit that looks like stars. DURIAN, FROZEN IN SLICES OR WHOLE IN A MESH BAG. And jackfruit.

If you haven't yet tried jackfruit, make friends with somebody from a culture that eats it regularly. The damn things get up to forty pounds, so it's not like there won't be enough to go around. Try it. Learn to tell a ripe one from one that's just soft.

And no, I haven't tried the durian yet. I can say that yes, it is the worst-smelling thing I've ever laid nostrils to, aside from a corpse plant in full bloom, and I totally understand why it's illegal in some places to take one on the bus or keep one in your hotel room. The smell is penetrating. You're afraid you'll never get it out of your nostrils. The inside, though, is supposed to be heaven.

Maybe I'll try a bit of frozen durian. A whole durian is large and intimidating, in addition to being smelly--I'm not sure I could get one home and cut it up without ruining it. You know those little spiny balls that sweetgum trees drop? Make that about eight pounds and you're looking at a durian fruit.

Anyway, food: Lots of it, most of it I've never tasted before, some of it (like fresh peas and beans and okra) is growing in the back yard as we speak. Most of it that I'm craving is winter food. It'll be warm again before I get a chance to eat anything more than cafeteria catfish (which, strangely, Sunnydale does beautifully and only on Fridays). I'll have to make do with fresh artichokes and asparagus and strawberries with almonds on a bed of butter lettuce.

Hell of a time to show up, complications. Hell of a time.

So, when I visited the lovely Nikki and her cronies up in Seattle (heeeeeyyyy!), I came down with a Horrible East-Coast Plague brought by the lovely Lara. Lara is Gwyneth Paltrow; don't let anybody tell you different. Some say the world will end in fire, some say in ice; *I* say it will end with an innocent-sounding sneeze from Pittsburgh.

Three days ago, I came down with Plague Two-Point-Ought.

The doc could do nothing for me, since I declined her kind offer of multiple opiates for cough suppression. Even as lovely as that stuff can be, I'd rather cough until my toenails come loose than itch and be constipated and paranoid for days on end. Delsym, combined with Tiger Balm, Benadryl, and bourbon, does just as well.

She did, however, tell me that I can probably expect this to happen more often in the future. Not that she has a whole lot of patients with their palates missing, but, as she pointed out, it's only natural that the deficiencies in my muscosa would lead to greater susceptibility to virii.

I wash my hands. I alcohol-foam them. I keep them away from my face. I take prenatal vitamins, for God's sake, and zinc, and Vitamin D. I clean my prosthetic until it shines like unto the sun at noonday on the new-fallen snow. I stay away from sick people (yes, yes, I know, but stroke does not equal sick), I eat well, I exercise moderately at the frequency recommended by experts.

I fucking FLOSS.

And I got two colds in six weeks, both of which have left me sounding like I ate a bagpiper and producing snot the likes of which I won't describe.

Bourbon. Focus on that, chum. Bourbon, and Benadryl, and sit sleeping up so you don't cough.

Yeah. Somethin' like that.

Yep.

(Another one of) Jo's Annual Gardening Post(s)

It's been a good-news, bad-news kind of almost-month.

The good news is that we're very busy at Sunnydale (Healthcare for the Hellmouth). The bad news is that we're so short-staffed in every department except the one that does, like, colonoscopies and stuff that I've had five-patient days lately. As in, start with two, discharge those, get three.

The good news is that The Boy is moving down here in a couple of weeks, and that he has a fabulous new job that will keep me in beer to the point that I'll need to have my own floating scooter to get around the house. The bad news is that he's got shingles.

Yes, shingles. I diagnosed them over the phone after thinking to myself, "Gee, poison ivy doesn't usually occur along dermatomes along with a scratchy throat and a headache." He later went to an actual medical professional and confirmed it, and got all the meds he needs to fight off the outbreak.

Which is good, because the bad news is that I've never had chicken pox, and my titers have been falling the last few years. Herpatic encephalopathy is all fun and games until somebody goes blind or dies, and I, personally, have no intention of spending my remaining years drooling onto my own shirt while sitting strapped into a high-backed chair.

...Even though that sounds a lot like work.

Good news: I have, thanks to The Boy, newly weeded and replanted front beds. Bad news: we lost two tomato plants to unknown causes. Good news: there's a cardinal nesting in my rose bush, and she's laid three eggs. Bad news: I now have to find out what cardinals eat.

Good news: Changes are afoot at Sunnydale!

Bad news: They involve uniforms, not staffing. Manglement--and by this I mean the Tippy-Top people, who haven't, as far as I can tell, set foot in either Sunnydale or Holy Kamole in ten years--have decided that we all need to wear the exact same thing. From housekeeping to nursing to radiology, we'll all be wearing the same. damn. thing. Clinics to hospitals, top to bottom.

Good news: The uniforms are cheap. Bad news: They're in extremely limited sizes and are 100% polyester.

But, you know, what do you expect? When you're faced with a shortfall in staffing that's brought about by crappy working conditions and low pay, why *not* require everybody to buy new uniforms from the one place that you've declared will sell them? Bravo, Manglement, for addressing the troubles in our facilities in a constructive and thoughtful way!

Good news: I planted beans and peas and melons and carrots and radishes and okra this past week. Bad news: I watched a blue jay, that bastard, pull up each and every okra plant one by one and fling the sprouts around. The next batch I put in will be coated with cayenne pepper and bobcat pee. And will be hiding special Bastard Blue Jay Killing Machines.

Unmitigated good newses: The Boys went to the vet today and got a collectively clean bill of health. The exact words the vet used were "perfect," "beautiful," and "sweet." They're now sleeping off both the trauma of being cooed over and petted by six attractive young women, and vaccines. Flashes huddled in the exam room sink while Notamus tried to stand on his head in the corner of the room, but they both got over their jitters pretty quickly.

And now I am going to go Google cardinals' diets and head to bed. That's very good news indeed.

Malarkey: How to Put It Over Effectively.

For some reason which I have been, as yet, unable to discern, those members of the public who are most inclined to attempt malarkey at the hospital choose neurological afflictions as their mode de malarkification.

I am SO TIRED of people who insist--insist!--that there is indeed a brain tumor, right here (points to right temporal lobe), despite the evidence of repeated MRIs to the contrary. I am equally as tired of people who have trouble remembering on which side they ought to be weak. And I've had it up to my moustache with folk who think that squinting is a facial droop.

So, in the interest of having something actually fascinating to deal with, I've come up with a list of things that malingerers shouldn't try, because we've seen them all before.

Numero Uno: SQUINTING IS NOT FACIAL DROOP. Seriously. I have all these fun little tests that I can do to prove it to you, plus: I watch you when you think I'm not watching you. Oh, and I read the charting from your forty previous admissions, so I know what you're likely to try. How many times do I have to say this, anyway?

Number Two: If you're gonna have weakness, make sure it's not distractable.

Number Two, subsection A: If you're gonna fall over, do it on a hard surface once in a while. We have a name for what you're doing: it's astasia-abasia, and it means we know you're bullshitting.

Number Two, subsection B: The same goes for upper extremity weakness. If you pretend to pass out, seize, or otherwise suffer an alteration in your level of consciousness, you bet I'll hold your hand about a foot above your nose and then drop it. If it misses your nose, I know you're faking.

Number Three: Telling me that you're allergic to morphine and "all NSAIDS" will not get you the IV Dilaudid you want. I weep for you, the Walrus said, I deeply sympathize: Dilaudid is the best shit ever in the history of the universe, and I certainly understand why you want it. However, you won't get it. Nor will you get Phenergan IV, or any of the other cool drugs, like Stadol. Here; I'll help you fill out the AMA paperwork.

Numero Quatro: Threatening to sue me won't work. Don't try it. Besides being rude and laughable, it's out of character for your illness for you to be able to holler unslurred words at me.

Number Five: This might bust up the angel-at-the-bedside myth about nurses, but: We Judge By Appearances. If you have no teeth, a heavy backwoods accent, track marks on your neck, and smell like an ashtray, we're going to be very, very cautious about what you're reporting in terms of symptoms.

Number Five, Addendum One: Likewise, if we read in your chart that you're on your fourth revision of a gastric bypass, have recently gotten out of rehab for the third time, and are allergic to morphine and all NSAIDS (see above), we're gonna lock up the narcotics.

Number Five, Addendum Two: In the same vein (no pun intended), we automatically double or treble the amount of alcohol use you admit to. That's why you're getting Librium with your scrambled eggs.

Number Five, Addendum Three: Yes, I will search your bag, your bed, your closet, your pockets, and everyplace else you could hide a stash after your family visits. I know these rooms better than you do, so don't even try.

Thank you for your time. We at Consolidated Research and Healthcare, Inc. know that you have a choice in healthcare providers, and we thank you for choosing us. We hope, wherever your final destination may be, that you have a safe trip. We hope to see you again soon, perhaps even in a sober state.

It's the Most Horrible Time of the year, and other observations. . .

The Festival That Cannot Be Pronounced has begun--well, technically is beginning--in Bigton. Littleton, where I live, is not unscathed by this yearly influx of techies, hipsters, and people who haven't seen soap in entirely too long. The traffic is horrible, my favorite beer store is out of my favorite beer, and the highways are full of people who, as they approach both downton Bigton and Sunnydale General, aren't quite sure where they're going. Hilarity, if you mean hilarity-in-a-natural-disaster-sense, often ensues.

Luckily, I've been flat on my back since Monday. Why, you ask? Well, let me tell you:

This past weekend, I flew to Seattle to attend the Emerald City Comic-Con. With me there were Tashi of Learning to Hope, Mary from The Bright Optimist, Lara of Get Up Swinging, and Nikki, late of CatsNotCancer, who let us all crash at her pad.

Let it be recorded here that we, the group of women who if combined into one body, might make a fully functioning human being, had a hell of a time. We saw celebrities. We took pictures. Nikki and Tashi cosplayed and looked kickass doing it. I stretched my skillset by painting a tattoo on Tashi and fixing her wig. Lara became the human landing pad for a tiny kitten named Magda, who learned to kitty-parkour while we were there. The amazing Coyote, most patient man in the Universe, kept us supplied with donuts, fried chicken, and emergency telephone numbers. We played with makeup. We swapped war stories. We talked, ninety-nine percent of the time, about things having nothing to do with cancer (mostly Magda, who is at the Excruciatingly Cute stage). Der Alter Jo joined us one day, and it was all good.

Except that Lara brought some amazing East Coast Death Rhinovirus with her, and by day four, we were all down for the count.

The fun started on Friday night, when Lara damn near passed out during a midnight bathroom break, and yelled for Nurse Jo. By Saturday night, Nikki was feeling peaked, and by Monday, I was fully in the grip of the plague and on a plane home (sorry, seatmates).

I don't know what they do differently in Pittsburgh, but their upper respiratory infections are like nothing on this earth. In terms of body aches, it was right up there with the flu; the only difference was more snot and a lower fever.

Today I rose from my bed, looked around blearily, and ate some soup. Tonight I'll go to bed early and sleep through the night with any luck. Tomorrow it's back to work for me.

It was a hella fun time.

I love my friends.

Let's talk about how not to be an asshole to your patients.

Or, for that matter, to your family members when they're in the hospital.

(Inspired by this post at XOJane, and by my own experience over the weekend.)

I had a patient this past weekend who was, by any definition, a Big Girl. Several inches over six feet, broad and strong in proportion to her height, and well over 300 pounds. She'd had a crazy-ass, rare clot in a weird place that had landed her with us. She also had a relative who, while well-meaning, was a royal pain in the patookus in regards to her weight. The relative, incidentally, was also tall, but very, very slender. And had an obsession: her relative's--my patient's--weight.

So I'm in the room, talking to the patient about her Cray-Cray Clot, and the relative starts in about the patient's weight. "You need to tell her she's fat," the woman says, "and that she needs to lose weight."

This is true. She is fat. She's way the hell over what any rational person would consider a healthy weight.

Nonetheless, she had recently finished a half-marathon. She played tennis twice or three times a week, and led a water-aerobics class a couple times a week. Her mobility was not impaired. Her lipids and blood pressure were normal. Medically speaking, she had no problems at all save an extra hundred pounds.

So I turned to the patient. "Do you own a mirror?" I asked. "Yes" was the reply. "Do you know that you're fat?" I asked. "Yes, of course" said the patient. "Are you aware of research that finds that extra weight can lead to health problems?" "Yes."

"There. Done" I told her relative.

Which brings me to my first rule of dealing with fat people: Do not treat them as though they don't know they're fat. 

As a fat person myself, I am constantly reminded that I'm fat. I can't buy clothes from straight-size stores, I am always the largest person in any group picture, and there are some things I find uncomfortable to do because of my weight, like going down stairs. (Going up stairs is easier on the knees, and my aerobic capacity means I'm often outdistancing my skinny colleagues. Still. . .)

If you're fat, you know it. Please give us fat folk the benefit of the assumption that we have brains.

Then the relative asked me straight out if the Cray-Cray Clot was due to the patient's weight.

It wasn't, and I told her so. It was due to the fact that the patient has a rare clotting disorder that hardly ever shows up in women.

In asking that question, Relative had fallen into the same trap that all the doctors who'd seen Patient had fallen into for months. Despite an unyielding headache and neurological changes, the docs who'd seen her hadn't looked at her brain; instead, they'd blamed her weight for her symptoms. Doing so had led to a three-month delay in diagnosis, incalculable damage to her brain and spine, and a lot of pain.

This is Rule Two: Not everything that is wrong is due to excess weight. Do not be blind to the fact that there might actually be a problem that can't be expressed in BMI.

Back in the day, doctors blamed wandering uteri for everydamnthing that went wrong with their female patients. This is exactly the same thing: blaming the most obvious factor for all the trouble ever. Fat equals wandering uterus in today's medicine. Do not blame fat: look for an underlying cause. Examine your patient's general health and activity level. Dig deeper.

Eventually, Family Member took me aside and asked me to have a serious talk with the patient about her weight. If she would just eat less, Family Member said, all her problems would be solved.

I leave it as an exercise for the reader to determine whether or not this is true. (Hint: it's not.)

By the time you get to be fifty, or a hundred, or five hundred pounds overweight, there are other things going on besides overeating. It's not a failure of willpower or a lack of knowledge and understanding. Thirty years ago, we had that attitude about drug abuse: if the person would Just Say No, things would be unicorns and rainbows and the world a better place.

Really severe obesity is a product of a multitude of factors, most of which have nothing to do with food per se. Therefore, my addressing one facet of the problem by saying "Hey, I just met you, and this is crazy, but you eat like a fucking pig, so cut back, maybe" is not going to help. At best, it's telling somebody something they already know. At worst, and most commonly, it demonstrates a lack of respect for whatever deeper issues that person's dealing or not-dealing with.

Morbid obesity is like heroin addiction: it starts from a place deep in somebody's psyche and has to be addressed holistically.

So here's Rule Three: Fat is not about food. Fat is about something else. Don't insult your patient, or your loved one, by assuming that it's just about the calories.

"If you want to help," I told Family Member, "you could reassure Patient that you love her no matter what her size is, and that you'll be there for her if she needs you. Right now, you're telling her that your love and acceptance is conditional on her being thinner. That's a losing game."

Finally, and without illustrative examples, here is Rule Four:

Fat is a descriptor, just as "strong" or "red-haired" or "really good at eye makeup" is. "Fat" does not mean "lazy" or "slovenly" or "smelly" or "bad."

Fat is just another adjective. Avoid making value judgements about somebody just because they're bigger than you, or--equally important--hating yourself because you're not at an ideal weight.

If I had my way, everybody would feel comfortable being who they are. Nobody would feel bad about how they look or however it is that they don't conform to whichever ideal is in fashion. People would eat greens and trot around enthusiastically and take their baby aspirin daily and be cheerful about their futures.

That's not likely to happen soon, so in the meantime I'll deal with the fracas surrounding fatness.

Loud Cheers! (For several reasons. . .)

Doctor Annoyance is going away. I don't care where or when, though I know when the when will be, and believe me, it's not soon enough: he's going away.

Doctor A has been a thorn in my side now for longer than I care to consider. He's one of those doctors--you know, the ones who can't find a phone number on their own, or who ask you stupid, unimportant questions in the middle of a crisis, or who think they're being cute when what they're really being is totally off the chain and for God's sake will you just TAKE IT DOWN A NOTCH ohmygawd how many times do I have to tell you

. . . .Anyhow, he's going.

And, with him, goes another colleague--one so toxic (as the kids say) that I didn't know how much my work life was being affected.

I wrote a piece t'other day for Scrubs about toxic workplaces and nasty, poisonous coworkers. I hadn't connected that bit of writing with anything that was going on in my own precious unit until now. Turns out I was speaking more truth than I had ever imagined.

For the last two years, my daily life's been made more unpleasant by somebody who can't see the good in anything. Swear to Frog, if this person won the lottery, patented a device to reverse global warming and remove pollution from the air, and cured cancer, all in one afternoon, there would still be bitching happening. Some people are never happy, and this is one of those folks.

And they're leaving. Cue my happy-dance. They're leaving, and they're taking Doctor Annoying with 'em, and for the next week, I am going to be blissed out and just smiling like a fool.

In other Hooray news, I have a confession to make: a sexist, horrible, awful confession:

There is some serious eye-candy happening in my unit these days.

We got a new crop of residents in as part of the half-year switcheroo, and although I know most of them, there are a few lovely strangers to gaze upon. (Yes, yes, I know. They're all young enough to be my children and they're professionals and so on and so forth, but dayum.) HR has also given the go-ahead to hiring what seems to be America's/Australia's/Canada's/Backobeyondistan's Top Model candidates for the night shifts, and all of 'em are orienting, in succession, to the NCCU.

Aside from a I-will-always-say-something-stupid moment when I tried to guess where one of the newbies was from (I guessed Ireland; turns out the correct answer was New Zealand), things have been going swimmingly. Not only are these guys--because they're all male, and what's up with that?--easy on the eyes, they all came in knowing what three-percent saline is for and how to do an NIH stroke scale exam. They're all experienced. They're all certified. All I've had to do the last three weeks is show 'em where the coffee machine is, tell 'em how to access the computers, and turn 'em loose. This is in contrast with what I've been doing lately, which involves equal parts babysitting, computer training, and hand-holding.

Is there an asteroid due to hit soon?

Because, if there is, I want to open my mouth as wide as possible and show it my tonsils before I get blown to cinders. And therein lies the last Hooray bit of news: my two-and-some year's checkup was clean as a whistle.

Dr. Crane said that thing that used to be my mouth looked "beautiful," and as I was getting all puffed up about it, added, "The Prosthetic Elf always does such good work." Still, it's nice to know that I am still officially without evidence of disease. The next exam's in August, and I'll have a good old time freaking out about that, as I'm supposed to get an MRI a week prior.

I'm tempted to deck out an IV pole with streamers and fake flowers and ride it around the unit, waving like Queen Bess at everyone.

Seems my job definition just expanded.

The screaming was so loud that it brought me out of the room nearest the nurses' station with a "What the HELL?"

It was a toddler. I don't know jack about babies, except that they're generally wet at one end and loud at the other. This one was both. This one was open-mouthed, red-faced, screaming its little head off, in the arms of my flummoxed-looking coworker. He (the toddler, not my coworker) seemed to be about walking age, maybe a little younger; a cute kid, aside from that awful noise.

So we took him into one of the larger storage rooms and proceeded to play games like "What's on my head?" and "Can we shut you up with cookies?" Coworker dealt with the diaper while I went back to being a nurse.

After thirty minutes of nonstop hollering (poor kid was really upset), the child's father came back to get him. The child's father is an attending physician--not on the neurocritical care service, thank God--and had come in for morning rounds. His wife was out of town. Apparently babysitters do not exist.

Except in the neurocritical care unit! This is the fourth time in as many weeks that a male, attending physician has brought one or more children with him and left said child(ren) in our care for anything up to an hour. One dude dumped his kids off in the nurses' station break room around lunchtime with hasty instructions to "feed them something and keep them entertained."

I can't even. There are so many things to unpack here that have to take them in list form:

1. It's flu season. Children are, it's generally recognized, moving receptacles of bugs.

2. Hospitals are notoriously dirty places. Kids put everything in their mouths. Bad combination.

3. Nurses are not babysitters. We have things to do, even on weekends.

4. Bitches do not, universally, love babies.

5. Can you imagine what would happen if a resident brought in his or her kids?

6. Oh, God, if a female resident or attending brought in her kids, she'd never live it down.

7. Kids are noisy. It's part of being a kid. Units where stimulation is kept to a minimum is not a place where kids can or should be noisy.

8. You are old and experienced enough to know better.

9. WHAT THE HELL ARE YOU DOING, BRINGING YOUR KID TO ROUNDS? It's not like rounds are a sudden, unforseen emergency. They happen every day at a given time. You have time to prepare, to have a plan A and a plan B and even a plan C, should that be necessary.

Thankfully, the charge nurse of the other CCU that shares our floor said something to the doc. Had I opened my mouth, I would've blasted him to a cinder and salted the charcoal. Still, we wrote him up--the only concrete action we can take when a physician does something so inappropriate.

If this were just one physician, or just one service, it'd be easier to handle. Instead, it's different guys at different times, which means it's a part of the hospital culture. That'll be fun to address.

So, guys, if you're thinking that it's a slow Saturday at Sunnydale General, and that nobody'll mind watching your child for however long you need 'em to, just don't.

Just. Don't.

In Which Auntie Jo Weighs In On A Controversial Subject. . .

I used to own a gun.

It was a gun specifically designed to kill people with as much efficiency and as little subtlety as possible: a twenty-gauge shotgun with a barrel so short it skirted the legal limits, bought without a background check on the grey market, loaded with shells full of buckshot. I didn't buy a twelve-gauge because I'm a lady, and larger shotguns kick like hell.

If I had fired it, it would've put a huge, bloody hole in my target, the wall behind and on either side of him, and anything else within about twenty feet.

I bought it about six weeks before I had surgery, from a guy at work. I paid in cash and felt better, because I knew that in my weakened, post-surgical state, as a woman living alone, I would not be able to fight off any intruder who had gotten past shatterproof windows, steel doors, and Max.

(I still miss Max terribly. I never felt safer than when he was lying in the exact spot where he could see both the front and back doors at the same time. He was a Good Boy.)

Still: I was looking at several weeks, if not several months, of recovery from a nasty surgery. I felt small and alone and afraid, and so I bought a vaguely illegal gun that required no skill to shoot. I'm such a newbie that a friend of mine cleaned and loaded it for me and showed me how the safety worked.

Once I got better, I sold it back to the guy who'd sold it to me, for the same price, as it had not been fired. Now I have a can of wasp spray, which is both blinding and neurotoxic. In the words of my hippie massage therapist, it'll fuck a body up.

Beloved Boy owns a number of guns. He hunts, so he has guns, QED. He has one self-defense weapon, a semi-automatic Czechoslovakian pistol with a reminder to "Owner's Manual: Read Before Using" etched on the barrel. Its clip holds 18 rounds of ammunition which, if it hit you in the right spot, would be instantly lethal. If it were to hit you in the not-right spot, it'd be very messy and damaging. If you hold the trigger down, it shoots, then pauses, then shoots, which (as I understand) is what makes it semi-automatic. It's a gorgeous piece of technology and not one I'd ever want to use.

That said: I support the right of the individual to bear arms. I support the idea and practice of a well-armed local defense force, as exemplified by the National Guard. The Second Amendment and I are buddies from way back.

I do not like semi-automatic weapons with large-capacity magazines. Nobody needs them, and nobody should have them, including Beloved Boy.

Because, frankly, all it takes to kill a human is a single-shot, pump-action shotgun with the correct sort of ammo. Load that sumbitch with the right stuff, and you're pretty much done with the discussion. More than that is way too much icing on the cake.

Guns aren't meant to paint pretty watercolors. You wouldn't use one to wash your car or change a baby's diaper. Guns are meant to kill, whether it's ducks or deer (oh God oh God I know I'll have to roast a duck at some point please don't make me clean it ew) or people. There has to be a limit, a boundary, to the amount of killing any one person can do at any one time.

So yeah, I'm all for renewing the ban on assault weapons. I want limits on high-capacity magazines, because for God's sake, who's going to hunt a fucking deer with a 36-shot clip? If the Tyrants of the Twenty-First Century come after us, they'll be armed with nervines and poison gas and nonlethal weapons that'll make Star Wars look like a children's cartoon. No assault weapon is worth its weight if you're vomiting and having uncontrolled diarrhea from sub-sonic vibrations.

I wish, at the end of the day, that I'd trusted Max more, that I hadn't felt the need to spend money and brain-time on something lethal. I had shatterproof glass and fireproof and kickproof doors and a big, handsome boy with huge teeth; what more did I need? I bought a gun because I felt weak and small and afraid.

And I wonder how many other people feel weak and small and afraid in the face of what life sends them, and compensate by getting an AR-15.

This is what I've learned, in two-plus years of no palate. . .

I got to thinking about this the other night, as I was rinsing out the enormous (well, not enormous, but it feels enormous) hole that goes directly from my mouth to my right sinus:

1. Sinuses catch a lot of stuff.

Seriously. The crap I wash out of my sinuses every couple of days would make a strong man shudder and a scientist's eyes gleam with excitement.

2. You don't know how lucky you are to have a palate until you don't.

You normal people have NO IDEA how much snot you produce. Trust me on this one.

3. I can't eat flour tortillas under any circumstances, and should probably stay away from baked potatoes, Tater Tots, macaroni and cheese, and muffins.

Some things stick to my obturator with the tenacity of an angry giant squid. Other things work their way into my turbinates, to be sneezed out a few days or a week later, causing me great alarm.

4. I am so fucking lucky not to have had to have radiation.

I had a patient today who had radiation to his face and neck and who felt pain while eating a can of peaches. Just chewing had caused a pathological fracture. The surgical response was to remove half of his lower jaw. My pal Mary is dealing with a less-horrible, but still awful, sequel to radiation. I was very, very lucky.

5. When you have something that's considered rare, information and statistics and so on change in a matter of months.

When I started the journey with CANSUH, the stats were that three of every four patients that got what I have, polymorphic low-grade adenocarcinoma, were female. Now it's four men in every five patients. Smoking and drinking seem to have little to no bearing on whether or not you get it. Endogenous or exogenous estrogen no longer matters. Spicy food isn't considered a problem, unless you get some of that Thai long pepper up over your obturator. See comment on point #2.

When I started this whole thing, the assumption was that a complete cure could be had with aggressive surgical resection. Now the understanding is that PLGA can come back seven, ten, even twenty years after resection, and even if radiation was used as an adjunct.

When I started treatment, PET scans were considered the standard for monitoring. Now, given the indolence of the tumor, doctors are questioning how effective technology is. Apparently, a tumor can get to be quite a respectable size before it shows up on scans. Now, hands-on scoping and poking is the latest thing.

Essentially, I got told during my last ENT visit with Dr. Crane that the best I could do was NED--No Evidence of Disease--forever.

Well, shit.

In a way, it sucks to go from "we have a complete cure" to "you have to be careful." In another, it's nice to know where I stand. I never really trusted that "complete cure" thing anyhow. When you've had a piece of your body removed with a bone saw, you tend to get a little spooky about confident predictions.

All of this sounds, in the balance, negative.

However: I'm sitting here, more than two years after my surgery, blogging. I just scratched my own back and felt how incredibly dense and thick my back muscles are. I'm strong, I'm fat (which, if you're in my shoes, is not necessarily a bad thing), I'm back to lifting weights three times a week and running nine-minute miles. I can do yoga without falling over much. The Boy can understand me when I talk without my obturator in, and says it's getting easier to do so with every passing month. (He takes me the way I am; I am so incredibly lucky for that.) I have all but one of my teeth; two if you count the one that was never going to erupt, since it was lying horizontally under my cheekbone.

I look normal. That is such a huge, huge thing. I sound normal. That's even bigger. Two years ago, I wouldn't have believed you if you'd told me that I would *feel* normal with an obturator in--do you remember the struggles I had? I do.

The cancer might come back, or I might get some other type. I'm half-expecting to have to say, "Mother-FUCKER. AGAIN???" when I get my mammogram this year.

The difference between now and two years ago is this: Not only do I know I can survive all the stuff that happened, I know I can do well through and after it.

I can do anything, now. Just about damn near with very few exceptions anything.

In the two days I've had off since the holidays. . .

. . .I've gotten into an Ancient Cookbook Frenzy.

One thing I can say for people in the sixteenth and seventeenth centuries: they had one hell of a collective sweet tooth. Make a pie of artichoke bottoms? Strew it with sugar before you serve it to table. Boil a calve's chaldron (which I just found out is entrails) and spice it with mace and nutmeg and cinnamon? Sprinkle a little sugar over that mofo before you serve it up in a pasty. Roast a rooster? Sugar. Making a nice (meaning exacting) recipe for biskit? Sugar. Sheep's feet? Sugar.

When a recipe starts with "Take a pound of sugar, seirced, and lay it onto four pounds of butter, add enough flower to make a past with rosewater and fresh Milk," you know you're really on to something.

My goal is to find recipes that don't involve too much sugar, like roasted capon with a cream/anchovy/egg yolk sauce, and try to make them. The trick is deciding when "enough" is really enough, as most of the recipes say to bake, boil, or chafe something until it is enough or is meet.

The best instructions I've found so far are for Makeing a Caudle After the French Manner, in which you are directed to Seethe as much Milk as is fit on the Coals of the Fyre, and when little Pimples appear, you are to Take It Off and Coole It by the Fyre until it is Hardened, which, ew.

In that vein, I offer two recipes, primarily for Friend Penny The Lotion Slut, but also for anybody who needs soup. Non-vegetarian alternatives for the first are given in parenthesis.

Auntie Jo's Pseudo-Mexican Veggie and Corn (and Chicken) Soup:

In preparation:

Pour one box of vegetable stock (chicken stock)--Kitchen Basics makes an excellent one--into a very large pot

Set to seethe over a low fyre.

Meanwhile, chop one small or one-half of a large Onyon
Two Peppers, either Poblano or Bell, (but not green bell, because they suck)

And wilt (fry over very low heat) them in a little vegetable oil

Open three cans of beans: one white, one red, one black. Dump them into a colander and run water over them until those weird starchy white bubbles no longer form. This process will take out the fartification chemicals.

(If you want to make this with chicken, now is the time to add your preferred cut of said bird to the stock. When it's simmered enough that there's not actual blood coming out of the meat, you can pull out the meat and shred it, then return it to the stock.)

Add the onion/pepper mix to the stock.

Add one can of petite diced tomatoes with juice.

Pour in enough water that you've got a kind of watery thing going on. You're going to cook this for a good while, so don't be afraid to add plenty of H2O. I usually add about four cups.

Now add your beans. If you have a bag of frozen corn in the freezer, the cheap sort that is sold for fifty cents a bag, add that too. A can of shoepeg or regular corn, well-drained and rinsed, will do as well.

If you're doing this right, you should have about a gallon of very watery soup: enough to make you wonder if this was a good idea. You're doing fine, don't worry. (How I wish this reassurance came in 16th century recipes!)

Now for two spices: cumin and chili powder. You are a fool if you use hot chili powder for the majority of this, since you want to dump in at least a quarter-cup of each. Seriously: you want this sonofabitch to be a dark red color with a hit of cumin to your nose. If you want the heat, you can add a couple tablespoons of hot chili powder about midway through, but don't use all hot; you'll be sad.

Allow to come to a boil to kill off bacteria. Then simmer for several hours, or until it looks like supper. (For reference, I usually have at least an inch of soup-ring around the edge of the pot before I serve it.)

This makes a lot of soup. I freeze about three quarts every time I make it. Serve with shredded cheese and tortilla chips, either on the side or crumbled in. Do not sprinkle with sugar before taking to the table.

Auntie Jo's Weird Pseudo-Tabbouli Thing Made With Kale

I'm actually very proud of this. It keeps forever and tastes better the second, third, and fourth day.

Get you one bunch of kale. Curly or not, doesn't matter. It's cheap, so maybe you should get two.

Get you a bunch of parsley. The flat-leaf Eyetalian kind is best, but you can skate by with that curly stuff.

Get the other half of that onion out of the fridge.

Buy a long English cucumber, one red or yellow bell pepper, and three good tomatoes, if any are to be found in the winter.

Make sure you know where your salt, pepper, olive oil, and lemon juice are.

Be warned: this is a labor-intensive recipe.

Wash your kale in several changes of water. The easiest way to do this is to fill a really big container with cold water, plunge the vegetables in and swish them around, then yank them out. Empty the container and rinse and refill, then repeat. You can't be too careful with kale, as it tends to be sandy.

Do the same with the parsley.

Dry them both by shaking them out, then wrapping them in a dishtowel. Set that mess aside.

Peel and seed your cucumber, or don't peel it. Just seed it. Whatever. Chop it very, very finely.

Chop your tomatoes very, very finely. Save as much juice as you feel like.

Ditto your onion. Ditto your pepper, removing the seeds and weird white membrane first.

If you have garlic, mince a couple of cloves of that, too.

Set all of that aside. Now you're starting the really labor-intensive bit:

Stem the kale. This is most easily done by simply grabbing the leafy parts of the kale and ripping them off the stem. A little stem is okay, but not a lot, as kale stem is best digested if you have four stomachs.

Stem the parsley. You don't have to be as careful with this. As a matter of fact, I usually just cut off the top two-thirds of the bunch and save the rest for stock.

Chop the kale and the parsley together (you should have about equal amounts of each) very, very finely. No, finer. No, finer than *that*. You want the two to be indistinguishable on the cutting board. Seriously: chop it fine fine fine. Otherwise, the kale will be tough.

Mix the kale/parsley stuff with all your other veggies. Salt generously. Use some pepper. Squirt more lemon juice than you think is wise over it, then finish with a dollop of olive oil. Stir. Refrigerate. Eat entire bowlsful for lunch.

Sometimes I add quinoa to this to make it a main dish. Sometimes I just eat it straight out of the bowl, standing in front of the fridge, when I get home from work.

You could possibly use a food processor for the chopping, but only if you're better with a food processor than I am. I got kale and parsley pesto the first time I tried, and haven't gone back.

Do not Boyle with a Large Blade of Mace, or bruise with Sugar, or Bake in Coffin until Fit.

I missed Christmas Day, but. . .

May you all have the Humor of Donna

The Heart of Rose

The Patience of Rory

The Balls of Amy

The Bravery of Martha

The Belief of River

The Courage of Clara

And the Love of Tashi

http://images2.fanpop.com/images/photos//Tardis-in-Space-tardis-6289810-1280-768.jpg

To welcome in this new year.

"But you. . .

. . .you were fantastic."

Arizona north of Phoenix is, as Beloved Pens says, fucking lousy with vistas. Coming up over a series of hills you weren't aware you were climbing, the whole earth opens up to reveal hills the size of small mountains, creekbeds that probably haven't had water in them in years, and is that a mesa out there in the distance?

I trundled along in my speed-governed econo-box, and my mouth dropped open as I topped that last hill on 17. All I could think to say was "Holy. Shit."

Arizona is a weird place. I hadn't been through there in years--the last time was in 1996 or so, and we bypassed Phoenix for Flagstaff--and I had forgotten how you see places in the desert.

The first way is in the details: the grinding sameness of saguaro cactus, which at first is incredible and then just blends in to the sagegrass and the sand. The second way is in a car, where everything moves fast enough that you're taken by surprise by the whole picture when a vista opens right up in front of you. The third way is from a plane. Nothing's human-scale any more; it's a glorious, perspective-less panorama of mountains and dry washes. You wonder, looking at it from the air, if anybody who'd settled the area would've kept going if they'd known what was ahead of them.

I wondered that same thing about Tashi before Kevin's memorial service this weekend. If she'd known what was going to happen, what she'd have to go through, would she have stuck with him? The grinding sameness of the day-to-day chores of dealing with somebody whose brain is altered, when vistas don't open up with the regularity that they do on the highway; what would she have done?

The answer came when Tashi said this: "Even though I only knew him for about a year before the cancer started changing him, he was so amazing that the love he gave me made it worthwhile to stick around."

And, "The cancer never got *him.* He was never his cancer. He was always himself."

Speaking literally, Kevin lost. He died of brain cancer. It won.

Speaking in every way that matters, he won. He owned that cancer, and beat the hell out of it. The proof is in how all of his friends remembered him: a silly, loving, incredible, creative, goofy, loyal man who cared more about other people than he did himself, and loved everybody. Those things that made Kevin Kevin didn't change just because he had a tumor.

I've never laughed so hard at a party in my life, even one where the guest of honor wasn't dead.

Kevin's friends told stories and provided details. Tashi told us what it was like to take care of him when he was sick. The two combined opened up a big, detailed portrait of a person I wish desperately that I'd known. I was honored and lucky to hear all about him, though, and for that I'm grateful.

Tashi said at one point that Kevin was the kind of guy who made other people want to be better people.  I had been thinking that exact same thing just seconds before.

Thank you, Tashi, for introducing me to Kevin. He was fantastic.

RAAAAAAAAAN-dom

I just painted my fingernails a dark, elegant grey. My toenails are a sparkly dark red, except for the nail on the fourth toe on my right foot, which is grey. Tomorrow, when the polish is totally dry, I will decorate the nail on my left fourth finger with bright pink stripes.

This is all for Kevin's memorial service, which is Saturday in Arizona. I will be wearing, per his wishes, bright-colored comfortable clothing (ink blue baggy pants, grape-purple artist's smock with a green t-shirt underneath, Converse and a saffron-dyed scarf from India). There will be, if my Interwebs research is correct, pie available at the service. I am all about pie. Hence the baggy pants.

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The Boy and I are texting. I say he should check out Baker Seeds; he says I should check out Forestry Supply. Little does he know that I already have a wishlist from FS that's as long as your arm.

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Best salad ever: greens, including baby kale (NOM), bell peppers, tomatoes, cucumbers, corn, black-eyed peas, cheese, FRIED OKRA, little bits of carrot and olive. I'm kind of on a kale kick at the moment, which is good, as the hippies across the street have approximately eight gazillion tons of the stuff to give away. They're desperate. I eat the teeny new kale plants in salad, since it doesn't have to be cooked or massaged or whatever, and the older leaves chopped up for tabbouli.

The folks at Baker Seeds say that kale will grow whenever there's even a hint of warmth in the air or soil. That doesn't really express how kale will take over your garden, your yard, your life, if the air temperature isn't below thirty degrees. It was eighty degrees here today (what the fuck global warming stop it STOP IT) and, sure enough, there were bitty kale sprouts coming up from the ground.

Some say the world will end in fire, some say in ice. I say the world will end in kale and cucumber vines.

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

Speaking of cucumber vines, have I told you guys the story of Mom's killer melons and pumpkins?

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Or the time she planted luffa gourds and zucchini in the same garden, and they cross-polinated? I noticed that nine of ten blurbs for luffa gourds I saw in gardening catalogs this year noted that they would not cross-pollinate with other squashes. Technology: saving us from weird stir-fried squash.

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

Don't tell The Boy, but I'm thinking of redecorating the bedroom, to make it more Boy-friendly.

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

Attila made me do some weird new back exercise today. Given that I dealt with hemiparetic and tetraplegic patients last week, all weighing over three hundred pounds, I am sore as hell this evening.

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

And that is all for this evening. I'm off to make stripes of Scotch tape and pink nail polish.

So we have this new computer system.

The whole damn thing's been reworked, top to bottom, and it's rumored to be the best, most efficient, most amazing computer system in the history of EVAH. Lab tests and MD notes and medication administration and tiny bits of lint from the dryer are all linked together; all that's linked to some magical whoozit that records when a nurse enters a room, what equipment s/he uses while there, and when s/he leaves. It's rumored, in short, to be the best. damn. thing. since SLICED FUCKING BREAD, MAAAN.

Except, well, it doesn't work.

And I mean, all joking and superlatives aside, it doesn't work.

For instance: let's say you have a patient who wants only one Lortab, rather than the two that were ordered. Instead of pulling two out and wasting one, or just doing an RN override on the Diebold that holds the meds, you have to now call the doctor and get an order for only one Lortab. And then wait for that to be entered and linked and so on.

Yeah.

Let's say you have to waste a partial dose of a medication, like when a patient gets two milligrams of morphine but the morphine comes in four-milligram ampules. The old way to do it was pull, waste at the machine, chart. The new way is pull, have two people scan the med at the bedside, waste at the bedside, do an override to administer 2mg of an ordered medication, then go back and enter the waste at the machine.

And, because everything is now coordinated, Les Machines keep track of how long it takes you to get *back* to the Diebold and waste. If it's more than about a half hour, your administration will get flagged for investigation, because you might be huffing morphine. Which is fine and dandy unless you have five (or six, or eight) patients to deal with. Nurses with huge patient loads often waste everything at the end of the shift.

Let's say you have a person on a heparin drip. Even if you only want to enter the same drip rate hour after hour after hour, you still have to scan the person's armband, scan the bag, and get a witness. This is the new rule for every titrate-able drip in the system. For us, it's not a big deal: we might have one or two drips running in the NCCU on a person. In the med-surg CCU or in the neurosurgical CCU, though, it's a big deal: imagine having to scan-scan-witness-verify for eight drips on each of two patients. Every hour. On the hour.

And, finally, let's say you go into a room that holds a person who's been admitted for a TIA. They're neurologically intact, fine and dandy, and on only aspirin and an antacid. If you leave the room before a certain number of minutes have elapsed when you're giving those meds, you get flagged for not doing sufficient patient teaching on the Tums and Bayer you just administered. If you take too long--that is, if your patient is on six different meds, five of which are new, and the person has questions--you get flagged for inefficiency.

THIS IS WHERE I GET ALL CAPSLOCKY. The trouble with setting up difficult failsafes in a time-crunch-prone profession like nursing is this: once the new checks are set up, all the older ones get scrapped. We no longer have the pop-up windows on our med records that alert us to possible double-dosing. Instead, we have a huge, long, convoluted process to go through that guarantees nothing, as most of our peers are too time-crunched to double-check us.

We learned, less than four hours after the system was implemented, how to get around it. By the end of day shift on Monday, most nurses had copied the scan-codes from med labels and stuck them to the back of their ID cards. We'd also figured out how to copy the med-admin codes from the patients' armbands and stick them to the charts. We worked around the new, cumbersome failsafes. . . .

. . .but we didn't have any other checks or warnings to alert us when we'd fucked up. In other words, our system now has only one point of warning for each patient, and that point has already been sabotaged in the name of saving time.

So we have this new computer system. It reminds me a lot of a story I heard from one of my colleagues. He and his wife bought a gorgeous, brand-new house where everything, from the computer to the thermostat to the hot-water heater, was controlled through the Internet. Their online service provider suffered an outage that lasted three days (he's in the boondocks). During that time, they had no heat. Or hot water. Or air-conditioning. Or TV, phone, Internet, or burglar alarm service. Reprogramming things manually wasn't an option. Why should it be, with this shiny new system?

No system should ever have only one point of failure. Even muskrats and beavers have a back door out of their homes. Manglement's reduced a perfectly workable checks-and-balances system to something with one point of failure, in the name of Patient Safety, and we've already figured out workarounds.

In other news, the hospital-wide campaign to leave our badges in the bathrooms for extended periods of time seems to be working. Manglement might be monitoring our pee-breaks, but we'll work around that, too. (I wonder what they'll say when they see that four of us were in the public men's restroom on the ground floor for six hours on Tuesday?)

Tips for Everybody:

There's nothing like coming in to work, feelin' all efficient and enthusiastic, to find that you're two nurses short in a three-nurse unit. Unless it's finding out that a different department expects your unit to staff theirs for some undetermined amount of time in the morning and again in the afternoon.

Dear Doctors: Please don't wear your ID tags on your belts. Especially please don't do this if you're an observant Muslim, a conservative Coptic Christian, or a member of some other staunchly upright religious group. See, if you've got both a name with eighteen syllables and a strong moral sense, it's gonna be embarassing for both of us if it looks like I'm starin' at your junk while trying to read your ID.

Tip for myself: Next time it seems like a patient is globally aphasic, shaking her head and smiling gently whenever you try to get her to do something, make sure it's not because she speaks only Romanian.

A gentle note to Manglement: top-down initiatives, like locator chips in ID cards, timers in employee bathrooms, and noise-and-motion sensors in nurses' stations and common areas, can and will be hacked.

Many, many thanks to the elevator inspector who sang loudly in the elevator shaft as he was doing a routine inspection of that elevator's braking system.

Also many thanks to whoever it was that joked up a pile of mattresses sitting in a storage room by sticking a can of peas in there, so it peeked out one side.

Best Line of the Night

We've been having some trouble with our sheets lately. We get one size of sheet, but have three sizes of bed. In the past, the sheets fit the largest beds but were a little loose on the other two types. Recently, Manglement decided that knit sheets were better than woven, and so dumped sheets on us that, until they're washed the second or third time, fit every bed beautifully. After the second or third washing, though, you'll hurt yourself trying to get them on to the bed. (I wish I were exaggerating, but one of my coworkers is out with a torn rotator cuff right now. It went when she was trying to change a bed.)

Anyway, Deepa and I were changing a bed under one of our patients, a guy whose stroke had left him both paralyzed on one side and unable to speak easily. Deepa, struggling with the corner of the sheet and unwilling to lift the mattress to force the sheet on to it, exclaimed, "It is so small that we can't get it on!"

Our hemiparetic, expressively-aphasic patient said, clear as a bell:

"That's what *she* said."

Y'all, I am blessed in friends.

Tashi just emailed me. She's starting her own fundraising efforts for Mary.

Tashi.

Who, by all rights, should be allowed to recover and rest and be quiet for a year or more, is fundraising for Mary.

Which proves again what I already knew: I have the best friends ever, and Tashi is the most amazing one of the bunch.

Peeps, we got a job to do here.

Some of you know Mary Osheskie, or read her blog The Bright Optimist.

Mary was one of the first people to contact me privately after I got my cancer diagnosis. She was also the only other oral cancer patient who was a woman and about my age. Her story makes mine look like a walk in the proverbial park:

Mary's a lifelong nonsmoker and nondrinker, so when she was diagnosed with stage III squamous cell carcinoma of her tongue (at an age about forty years younger than is typical, no less) it was a huge shock. She had a partial glossectomy--in other words, the docs took out half her tongue and replaced it with muscle from her arm.

Then she had head-and-neck radiation. Y'all remember how scared I was of radiation. Everything that terrified me, from a tracheostomy to losing every tooth and a bunch of bone, happened to Mary. All of her teeth are gone, her jawbone is jacked beyond recognition in several places, and--as if all that weren't enough--she had a recurrance of the cancer recently and had to have *more* tongue cut out. Luckily, she's fine now, but she still ain't got no teeth.

Now, for your average toothless person, that isn't a problem. You go to the dentist or prosthodontist, you get some implants or some dentures, and you're back to eating apples in a couple of weeks.

Mary's got a different set of troubles. She's got to have posts put into her jaw to hold specially-made dentures in place, because her jawbone alone won't take the stress of the dentures. Plus, most of the bone that's left (after surgeries to remove the dead stuff) is really, really freaking fragile. And of course, after radiation, she's not capable of healing as well as somebody who hasn't been fried.

In short, she has to have an oral surgeon do both the preliminary post-setting and the molding of the dentures, as well as follow her afterwards to make sure there's not further tissue death or infection. It's a big fucking deal.

It's such a big fucking deal that the surgery alone was going to cost $45,000 (US) and not be covered by Medicaid. Mary's on Medicaid because, after having a feeding tube and a trach and a zillion rounds of radiation and hyperbaric dives, she was indigent and disabled.

BUT!! Mary got the news today that her state Medicaid board is going to cover her surgery. She's going to be able to get the posts put in and things ready for a set of dentures. They're even going to cover anesthetic--which, if you read her blog, was not the case for having ALL OF HER TEETH EXTRACTED HOLY SHIT.

So Mary's getting her bone spicules filed down and her posts put in. But she still needs dentures.

She's a thirty-something woman with no teeth right now, and I'd like to help her make that not be the case.

Let me remind you of what you've done in the past: You gave more than eight hundred dollars to the Oral Cancer Foundation, which is run out of the founder's living room, for research and awareness. You gave Tashi Pratt-King a thousand bucks when it looked like she and Kevin (Wash) would lose their home--you guys got her over the hump, and allowed her to keep taking care of Wash until his death this past September. You also bought two Therabites for people with oral cancer who couldn't have afforded them on their own--devices that allowed people to regain the ability to open their mouths more than a few millimeters. Those Therabites, by the way, are still being sanitized and passed around.

And you made me very, very proud and grateful in the process.

Mary needs twenty thousand dollars for dentures. Medicaid won't cover them. Let's do this thing.

Let's commence Operation: Choppers.

Give Forward Fundraiser

Indiegogo Fundraiser

There is also a PayPal link on Mary's blog, linked above.

Thank you, guys.

Happy Coming-Out Day!

I had this whole long post about little old men going septic in my head, but then I just lost the will to type it all out. Instead, let me leave you with a Wayback Machine comparison of what things were like when I was sixteen, versus now, twenty-five years later (as a starting point). . . .

*woo-woo sounds of a time machine ramping up*

Twenty-five years ago, WHAM! put out a video that implied that George Michael was straight. Come to think of it, they also released a single ("Work") that pretty much declared right out that he was straight. (George, George, how little we teenaged girls knew ye.)

This year, a tweener pop star with a devastating hook ("Call Me Maybe") produced a video in which it became apparent that the boy she liked was gay, and the joke was on her.

Twenty-five years ago, I was two years away from making about a dozen friends in Chicago, all of them gay men.

This year, I have one close gay male friend who survived the AIDS epidemic. One.

Twenty-five years ago, as a matter of fact, "AIDS" came into being as a name. The other candidates were LAV and HTLV-III. The name(s) replaced what it had been called, either GRID (gay-related immune disorder) or "gay cancer."

This year, the majority of HIV positive people will be straight women of color, although the rate of HIV infection is again increasing in young gay men, who now see the disease as a manageable chronic condition, rather than the nine-month diagnosis-to-death thing it was in 1986.

Twenty-five years ago, my oldest friend was raped by some guys in our high school. He was targeted because he was gay.

This year, there was a special flag team composed of GLTBQ high-school students in a gay-pride parade in Bigton.

Twenty-three years ago, I saw posters in the windows of restaurants and bars in Chicago that showed the photographs of men suspected of having AIDS. They were put up as a public service to other gay men, so they knew who to avoid. The practice started in San Francisco in the early 1980's, when there was no test for HIV, and people's first symptoms were either Kaposi's sarcoma or PCP pneumonia.

Last week I had to explain Kaposi's sarcoma to a much-younger nurse who'd never heard of it, and who'd never realized that the AIDS epidemic was a big thing.

Fifteen years ago, Ellen DeGeneres came out on television, on the Oprah Winfrey show. That led some obnoxious so-called Christian minister to refer to her as "Ellen Degenerate." (Her response? "I heard that one in the fourth grade.")

Six years ago, Neil Patrick Harris coming out prompted a collective yawn from the public and, as far as I can tell, failed to incense any obnoxious so-called Christians.

Twenty-five years ago, I knew no gay people who were married. This year my friends Joe and George will get married. Deena and Deb have been married for five years and have a second baby on the way, and Sid and Sam are celebrating their tenth anniversary.

Happy CODay to all my gay and genderqueer buddies. Even though all of you are so far out that the closet's now lost beyond the curve of the earth, you all had tough times. Here's to real equality, the valuation of all people on the strength of their character, and the freedom to love whomever you love. Let's work to make it happen in a fraction of the time it took us to get this far.

I need laundry advice.

I can get anything except benzoin stains out of scrubs, but I need help on a non-stain-related issue.

Recently, I got four sets of Wink scrubs. They fit better than Urbane, though they're cut along the same lines: Wink seems to be made with women with hips in mind, while Urbane assumes you're young and athletic and built like The Mankiller, who looks like a boy with boobs.

Anyway, these scrubs. 65% polyester, 35% cotton, tons of pockets. Love 'em.

But even after two wash/dry cycles on Boil and Broil, they are stiff and rustly, and they still have the creases from packaging. How do I get those out?

Do not say "fabric softener." That shit is of the devil and gives me rashes.

Ideas?