I am Spartacus.

Background

For those of you who wander the blogosphere and the links on the right, this will not be news. For those of you who don't, it might be.

The gist of the situation is this: Two bloggers, Amanda Marcotte and Melissa McEwan (of Pandagon and Shakespeare's Sister, respectively) were hired by John Edwards' presidential campaign to blog and do netroots support work.

Bill Donohue, the leader of the Catholic League, the largest conservative Catholic organization in the country, got his crinolines in an uproar about this. Reason being, Amanda and Melissa have blogged about the Catholic Church's opposition to women's rights, birth control, human rights movements in third-world countries, the use of condoms in preventing HIV transmission, and its opposition to equality for gays, lesbians, and transgendered folks.

Which would've been fine. I mean, it's Donohue's right to get peevish about things with which he disagrees just as much as it is Marcotte's and McEwan's right to get peevish.

Trouble is, Donohue called in some of his less-rational supporters. The result was, predictably, flame wars on both blogs, calls for the resignation of both Melissa and Amanda, and lots of right-wing pressure on Edwards.

And when I say right-wing, I mean *right-wing*. As in crazy right-wing.

Amanda and Melissa both resigned from Edwards' campaign. Amanda's visibility as a target was making it hard for the campaign to do anything but field hate mail; Melissa was dealing with escalating threats from nutjobs against her and her family.

Yes. Death threats.

Hello.

The people who are threatening both bloggers aren't Catholics. They're not even Christians. They are, instead, people who are using a religious shield for their own brand of hate. Having been on the receiving end of this sort of thing myself--though not to the degree nor with the intensity that both Melissa and Amanda have--I feel the need to stand up and say this:

If I disagree with you publicly over tenets of your religion, I will accept that my right of free speech comes with the responsibility to listen to your rebuttal.

However, if you threaten me or my family, all bets are off.

Two very intelligent, thoughtful, capable young women got shafted and slammed, not necessarily because they were posting on the Catholic Church's policies, but because they dared to be intelligent, thoughtful, capable young women. This is evidenced by a number of comments and emails both have received: they don't contain refutations of claims; instead, they're full of rape threats and intimations that the bloggers are ugly or not real women.

This shit has got to stop. I call it when I see it in real life; I'll call it here on the blog.

Things Nobody Can Pronounce Week Is Here!

Every once in a while you get one: a week in which every second patient, it seems, has something nobody can pronounce. Or, at least, can't pronounce without practice and enough tries that some endocrinologist somewhere starts to snicker.

We don't have an emergency room. If a patient returns to us for some reason, they're usually triaged downstairs in the triage department, but sometimes they end up on one floor or another. (Keep in mind here that I'm not talking about people who, say, show up with one arm in a garbage bag or with a huge gaping hole where their head used to be.) We had somebody like that this week: she was in diabetic ketoacidosis, something I not only hadn't seen since nursing school, but stumbled over trying to pronounce.

And, since we're a research facility, we often get other hospitals' GOKs. GOK stands for God Only Knows, the sort of thing that's most often diagnosed on autopsy. In the past ten days, I've had a patient with olivopontine cerebellar ataxia (say that five times fast), one with gliomatosis cerebri (also known as infiltrative diffuse astrocytosis), and one poor schmuck who showed up with neurocysticercosis (worms in your brain). Oh, and the one with afibrinoginemia. (You don't clot. Dude.)

When people with unpronounceable diagnoses start showing up in droves, there's a corresponding rise in bizarre lab tests. Neurologists are particularly bad about ordering blood tests that can only be done with a reagent made from the fangs of Tibetan fruit bats. When the lab calls me with the news that the leptospiritus-santusomphalowaggle-L53 test can only be done during the dark of the moon on Thursdays, the conversation rapidly devolves into something like this:

Lab: "The doc ordered a 4,5-endopthalamucoid whingzap study on this patient's CSF. The 4,5-E-W test is obsolete. It's been replaced with the trigemisalamisofgame test with the Elisa ketohamonryenomustard confirmation, but we can only draw that on alternate Saturdays during April."

Me: "But my patient has leptocryptosanguinofibrinogingliomaturia! And a midline shift! I've got to get this lab done! Can I draw it myself?"

Lab: "Yeah, sure. Just be sure that you use a 20-gauge needle and move diagonally, and only on the black squares. Oh, and don't get your patient wet after you draw it, and for God's sake, *don't* feed him after midnight."

I've developed a persistent twitch under my right eye. The internal medicine residents assure me that it's common, nothing to be concerned about, and should go away as soon as I stop my exposure to unpronounceable words.

Wow. And advice.

So I was reading Twisty Faster today, because a pal of mine told me she'd linked this blog as an example of People Who Write About Lunch (and, ironically enough, I'd just finished a batch of mac & chee, which was the post Twisty had linked to), and I remembered that Bitch, PhD. is one of my all-time favorite blogs.

I read the comments on a post of hers about collective nouns and saw Head Nurse mentioned by somebody I'd never heard of before--the blogger who writes Battle Axe. It's a young blog, but Big Girl seems to have it *down*. I'll be watching that blog with interest.

No pressure, BG. Really.

There is nothing more exciting than seeing your blog mentioned in the third person by somebody you don't know.

Advice for People Who Use The Phone

1. Never, ever apologize for "bothering" a person who's on call. The correct thing to say is "thank you for returning my page." Saying, "I'm sorry to bother you, Doctor X..." makes whatever you're dealing with seem insignificant and belittles your role as a nurse/resident/whatever.

2. If it happens that you screwed up and phoned somebody who's not on call, the right thing to say is "Sorry", followed by a quick replacing of the handset on its cradle. At our hospital, this could also be a quick "My bad" or "Bad nurse, no donut." Either way, you apologize and get the hell off the line.

3. Have the chart in front of you. It took me *months* to learn that.

4. Ask the nearest nurse who's on call for the weekend. That'll save you from ever having to use #2.

5. If you're a resident, please, please, PLEASE identify yourself both by name and by specialty. "This is Barkejcwicz, Urology" is a lot faster than me having to ask "What specialty are you?" or "What the hell did you say?" This is especially important if you have a name like Chu or Young or Green or Smith or Amir. There are six Dr. Amirs in rotation just now; I may have paged both Urology Amir and ENT Amir, and I really don't want to get them mixed up.

Advice For Family Members

1. No matter how good an idea it seems at the time, don't give that pill.

2. The time to call me is as the patient is trying to discontinue his PICC line/NG tube/catheter, not after.

3. "Well, he's had them before, and I didn't think it was a big deal" is not what I want to hear when you tell me your brother had a seizure right as I left the room. Please call me back in.

4. If you're going to punch your son's girlfriend in the eye, make sure you do it off hospital grounds. And that she puts that baby down first.

5. Finally, and most important, *ask me*. If you have a question about something, ask. If something doesn't seem right to you, ask me what the heck is going on. If you're confused, ask me to explain. That is what I am here for. It's my job, my greatest pleasure, and a sure way to make certain your family member gets good care. Use me.

Advice for People In Nursing School

1. Don't panic. We're not all like your instructors.

2. That pink thong? Cute, but not good (oh, so not good) under the white scrub pants.

3. Ask us. If you need help, or you're confused, ask us. Some of us even dig working on care plans, and will rattle off interventions that will make your week. Just ask.

4. Act confident. Eventually you will be.

5. Do, or do not. There is no try. This goes especially for things like IVs and NG tubes. "I'm going to start an IV on you now" inspires more confidence in both patient and practitioner than "I'm going to try to get an IV on you."

Advice for People Who Blog

1. Go for wider columns instead of narrower. It's easier on aging eyes. Like mine.

2. Write it all down. You can always edit later.

3. The stuff you hate will be the stuff that strikes a chord with other people. I don't know why this is, but it's true: every time I write something that, in retrospect, I hate, other people find something in it to love.

4. Satire is hard. Parody is harder. Funny is usually pretty easy.

5. Spellcheck, I have learned the hard way, is your friend.

And that is all for now. The Cat is trying to convince me, through anguished meowings and paw-pats, that it's time for a nap.

Big Girl, keep writing. And thanks for the props.

...and then there were three!

This is really, really cool.

There are three of us. Three of us named Jo. I didn't know that until tonight, when I was checking out Change of Shift. Jo from Coffee and Conversation I had already met online, but I hadn't seen Jo from Sinus Arrhythmia (and Ponies from Betelgeuse).

Once upon a time, I was the only Jo I knew about. Now I feel all warm and fuzzy, not only because the world of nurse blogging is getting bigger faster than I ever thought it could, but because there's more than one Jo out there. It's nice to have company.

And no, I'm not worried that anybody's going to get us confused with each other. If anybody needs to, you can think of us as the girls from Apartment 3-G. I'm the redhead.

Change of Shift!

A day late, but here.

Product Reviews, #493

The Hypochondriac's Guide To Life. And Death. by Gene Weingarten

This book, which Beloved Sister sent me as a birthday present and which I opened early, is....really good. I mean, really, really good. Buy a copy. Laugh hysterically and stomp on the floor, and make your downstairs neighbor file a complaint with the apartment complex management. It is that good.

Part of the reason I love this book so much is that it explains the neurological exam in layman's terms, much more funnily than I could.

Four Emus Sauv Blanc/Semillon white wine, $4.89 on special at the Mini Mart

A good table white. It has a screw top, which facilitates drinking bottle number three or four, if you go that way. It's also good for making cream sauce with plenty of garlic and lots of heavy cream. Not too sweet, with a pleasant lemony flavor.

Stone Pale Ale

Lemony. There's that word again. I can drink approximately four ounces of this before I have to crawl off to bed, but Chef Boy assures me it's a fine IPA. From the makers of Arrogant Bastard Ale.

TIGI Bed Head Uptight Heat-Activated Curl Maker

It works. If you have moderately curly hair, it'll make you Ringlet Girl or Boy. However, it is heat activated, so you'll have to blow-dry with a diffuser with the dryer set on 'hot'. Which necessitates Biolage Ultra-Hydrante conditioner. Which also works magic.

Since I have been using these two products (four days) I have had three people describe me as "beautiful." That's a better track record than even Dior DiorShow Mascara.

John Edwards

Avoid. He fired two liberal bloggers I adore, Amanda Marcotte and Melissa McEwan (or maybe not; check this space for updates) because reich-wing weirdos got their panties in an uproar. I'm going for Obama this year.

Best Collective Nouns

It was a dull stretch on Saturday, and we were coming up with collective nouns. You know, those words used to describe a group of something, like "a gaggle of geese" or "a murder of crows".

Here, then, are the three best we came up with:

Neurologists: A dither of neurologists.

Surgeons: A strut of cardiothoracic surgeons.

Nurses: A grumble of nurses.

As opposed to a group of nurses who are punching out at the end of a shift, in which case it would be "a yeehaw of nurses".

My name is Jo, and I am a "Grey's Anatomy" fan.

There. I said it.

I suck.

Rocks.

Big ones.

You have to understand; I hate "Grey's Anatomy" with the burning of a thousand white-hot suns. I don't care about Meredith Grey's anatomy, her love life, or anything else. I don't care who's sleeping with whom, or who doesn't wear rings, or who watches pay-per-view in Vegas, or who's named Iphigenia. Although "Calliope Iphigenia" is the single best classics-themed name I've ever heard. Ever.

But tonight, when Meredith's mother had this sudden, never-before-documented return from amnesia? That brought me to tears. Not the bit where Meredith goes in to talk to her, only to realize that Mom has slipped back into Nowheresville; the bit before--where Mom learns that she's actually cukoo, and nothing will help.

Because I do occasionally see that at work. And then I go eat, like, six bags of Jack & Jill bar-b-Q potato chips. And some lichee nut jello. And a cheeseburger. And then I sit in the breakroom and burp and stare into space.

And frankly? If I had a patient so toxic that opening them up would knock out half the surgical staff? I have a list of people to go first. Bring 'em on.

Maggots and leeches and }}}shudder{{{, oh my!

If you are my sister, or if you are eating, skip this post.

I got a question the other day from a friend of mine about maggots and leeches. Specifically, she wanted to know what sorts of situations warrant the use of maggots or leeches, and how on earth maggot therapy or leech therapy actually works.

So I thought I'd put the answers up here. If you're a lay person or have never worked with leeches or maggots, or even if you have, you might find the following kind of icky.

Maggots

Maggots are the larvae of flies. They hatch from eggs and spend their lives as larvae eating dead (and sometimes living) tissue, feces, dead plant material, what-have-you. Maggots are the obsessive-compulsive garbage men of the natural world. With the exception of a couple of species of beetle (one of which is kept specifically for cleaning the bones for display skeletons), no critter is better at eatin' dead stuff and gettin' it out of the way.

In certain situations tissue will die. Let's take the example of a diabetic person with a nasty wound on his foot: because the nerves in his foot have died off as a result of his diabetes, and because there isn't a lot of blood circulation there ditto, the wound has gotten truly horrible. As in, gangrenous, black, bits of infected crap hither and yon, eating into the deeper structure of the foot.

(Here I'm describing a wound I actually saw, though not the worst one. The worst diabetic foot I ever saw had four toes that came off in the bandages when I unwrapped them.)

Okay, so dude has a bad foot wound. Standard practice would normally be to do a "sharp debridement" of the wound--in English, that means snipping away the dead tissue (it doesn't hurt)--in order to let the underlying healthy stuff grow and heal the problem. Unfortunately, there are a number of situations in which sharp debridement isn't an option. If the wound is too big, or too deep, or the proportion of dead tissue is truly awful, or if the structures involved are really delicate, you don't want to get in there and just start scissoring away.

So we send in the maggots. ("Isn't it rich? Aren't we a pair? Me in a hole in his foot, you in his hair?")

Maggots do three really cool things: They eat dead tissue, they *don't* eat live tissue (if you have the correct species), and they sweat antibiotic goo out of their skins. So they're perfect for cleaning out really icky wounds.

Plus, since they're sterile (both ways, in that they're non-infective and won't turn into flies), they're easy to get *out* of the wound. You put 'em in, cover the area with a loose bandage, warn the patient not to soak the affected bit in water, and three weeks later, hey presto! Big fat maggots that fall out and have to be wrangled across the floor.

Which is the downside--collecting them all after they come out of the bandage. But it's worth it, to be able to look at a formerly-necrotic, stinking wound that would've otherwise necessitated amputation, and see healthy pink granulating tissue.

Leeches

Don't disrespect the leech. It could be your best friend if you have the misfortune or poor judgement to, say, stick your head inside the business end of a combine and get your ear torn off. (Yes, another actual case.) (Or if you have, say, major facial trauma or limb trauma with a lot of bruising and hemorrhage under the skin.)

The patient, whom I'll call Albert E., had had his ear reattached but had developed a fairly common complication of tricky teeny-eeny plastic surgery: the reattached ear had gotten congested with blood. The swelling was such that it threatened to cut off blood supply to the ear and kill the tissue, so we stuck a couple of leeches on the worst-off parts of the ear and scalp.

Leeches are easy to work with. They don't talk politics and they don't take breaks. They also have both an anticoagulant and (if I'm remembering right) an anesthetic in their spit, so it doesn't hurt the person to have a couple of purply-black worms on their skin. The absolute worst thing that can happen with leech therapy is that a leech is yanked off before it's done feeding: in that case, the mouthparts might be left behind, causing an infection.

The second-worst thing that can happen is that a leech attaches itself to someone other than the patient, like the nurse. Which is why you always wear gloves and use forceps in handling the little guys.

Leeches are also a biohazard, in that they're full of human blood, so you can't just toss 'em in the trash. We dispose of ours in containers of rubbing alcohol (yikes eek ow yuck gar ick) and then in sharps containers after we've put that Sorb-O stuff in the alcohol.

There you have it: The two grossest things you're ever likely to see working as a nurse (or being a patient)--but with the redeeming quality that they're actually useful.

Well, *that* was a total suckfest.

I tried. I really did. I took the various pills in the various ways prescribed and tried six ways of taking them to minimize side effects, but in the end the Wet Grey Blanket of Blah got to me anyhow.

Chef Boy looked concerned enough about my staring, unsmiling, out the window that I finally gave up and called the brain doc today. Normally I prefer to tough side effects out, but this time...so, anyway. I called.

And the response was not what I'd expected. The response I'd expected was "Stay on the meds for a few days more and see if you feel better." What I got was "Woh. Gah! Um, best start back on your original dosage, okay? And call me back in a week."

So I'm back to taking lotsa Effexor. Which is okay; as I said before, I can deal with the hunger and sleepiness side effects so long as I'm sane. This past two weeks, I've been neither hungry nor sleepy, but it's because I've been totally unenergized and not willing to move.

Brain Guy says it'll be a few days before my mood is back up to speed, though my memory and coordination should improve faster. Which will be a relief; I've felt like an early-stage Alzheimer's patient for the last four days, unable to remember what I had for breakfast. And don't even talk to me about the coordination problems.

So. The saga will continue, I'm sure. For now, though, it'll be nice just to approach within spitting distance of normal again.

What I do on my day off...*

I must read up on legal issues in neuroscience nursing. The article's been sittng on my computer, bookmarked, for three weeks. I wonder if it covers the legal ramifications of bonking stupid family members in the head.

Gotta make a cake for work. I make a mean pie, too, but they only want cake. Cue Madame Antoinette.

When I opened the kitchen cabinet today to get the cat food out, about a gazillion plastic containers landed on the cat. Gotta clean that out, too.

While I'm at it, I suppose I ought to sort out Books I'm Done Reading from Books I'm Still Working On. They're all piled together on a table.

Speaking of which, I need a decent chairside table for the living room.

And my sock drawer is a mess.

And the cat needs to be Furminated.

Maybe I ought just to suck it up and go to Target rather than to my usual grocery store.

I wonder what size filters my air conditioner takes.

Oh, and I need to drop off that lease agreement at the apartment office.

What's in the dryer?

*These ruminations and plans to catch up with life brought to you by Wellbutrin XR, 150 mg.

Local Shopper Nearly Dies At Health Food Store. Details At Eleven.

Holeeee shit.

Take a medium-sized town. Sprinkle a couple of universities in it, then imbue it with a thriving art and music scene. Populate it with hippies young and old, the sort who know who Aldo Leopold was and work summers at Sprout Farm. And, like, live in ferrocement domes. Dude.

Then put it thirty miles away over dangerous highways from the nearest Whole Foods Market.

You can then imagine what my time today at the health food store was like.

Worse, the HFS was having its annual customer-wonderfulness weekend, with 15 to 50 percent off everything in the store. I thought Wal-Mart was bad the day before Christmas; this was miles beyond that.

I got out of there with the blocks of Callebaut I'd gone for, a bottle of vitamins, some Pellegrino, and my sanity. Just barely. A few steps out of the store, I turned wide-eyed and speechless to a man wearing a Vietnam Veterans cap. "My wife was acting like we shoulda got here at four a.m. and stood on line" he said. "Maybe we shoulda."

Things Not To Ask The Nurse, Volume One Gazillion

....but first things first. Change of Shift is up here.

So. Mama's been in the hospital now for months with something nobody can identify, and it's not looking good. Right now we're betting on either some sort of wasting disease like CJD or a particularly rare diffuse glioma.

I knew I'd have problems when, weeks ago, I met Sonny for the first time and he said, "If you should happen to make a mistake mixing medicines, I'm not going to mind."

Er.

Okay.

This is the fourth hospital Mama's been in. She's had various bits and pieces taken out and put in in an attempt to fix whatever the hell is wrong; she finally ended up with us when it became apparent that the taking-out and putting-in wasn't working. That's how it always goes: months after you might expect a diagnosis, or at least a stinkin' brain biopsy, a very sick person lands in one of our beds, a testament to other people's inability to know when to say "stop".

Well, Sonny wants to say "stop." Papa, not so much--he's convinced that a little full-brain radiation and a few drugs and hey, presto! Mama will sit up and ask for a Coke. That's not gonna happen, barring the sort of miracle that seems only to have happened a few thousand years ago.

So Sonny's been dropping little hints here and there. "How long would Mama live if we unplugged everything?" Days to weeks. "What's the most likely thing to kill her?" Pneumonia, but we're treating that.

Finally, Sonny asked me point-blank yesterday how much morphine, exactly, I would have to give Mama to slow her breathing down to the point that it got the job done.

"More than I could ever manage to get or to give" I replied. Then I pointed out to him that putting the metaphorical pillow over Mama's face wouldn't do him any good anyhow; she's a full code, so even if she stopped breathing, we'd bring her back and it'd just be more of the same.

The ironic thing is this: over two months ago, when Mama landed on our doorstep, she and I had a conversation. (This was when she was still able to talk and make sense.) She was strongly pro-euthanasia for herself, should she ever get to the point where (and here she was explicit) she was fed through a tube, was in danger of developing bedsores, and couldn't speak.

Check, check, and check. Unfortunately, Mama discussed these issues with the nurse and not with her family.

Our hospital's in a really, really bad neighborhood. Pretty much anything you want can be found within a few blocks of the parking lot, be it whores or crack or opiates. I'm wondering how dedicated Sonny actually is.

In the meantime, I've talked to both attendings and the DON on the quiet. Papa knows nothing of this. I've referred the problem off to the ethics committee and to the chaplains. Then I requested that I not be assigned to that patient again for at least a week. Then I went back and made double-damn sure *everything* was charted. Including my refusal to give morphine or other sedatives to Mama because Papa refused them.

If Mama died peacefully in the night some night after Papa went home--Sonny stays every night on a rollaway bed--I would not be surprised. Nor would I be surprised if she were dead long enough before discovery that she couldn't be coded. Nor would I be surprised if, on autopsy, opiates were found in her bloodstream.

They won't be *my* opiates, is all I can say.

So, this sloth in Germany.

You know, Mats. The sloth that was part of a study on how animals move? Yeah, that one. He was supposed to climb up a pole and then back his way down the pole so that researchers could figure out how sloths back down things.

Well, he refused to comply. For three years.

So the researchers sent him off to a zoo, where he can live in slothful glory for the rest of his days.

That's not the point, though. The point is this: every story I read about Mats said that he refused to climb backward down the pole *even when tempted with spaghetti, his favorite treat.*

Who the hell figured out that sloths (or at least this sloth) like spaghetti? Does Mats like a light tomato-based sauce with plenty of basil, or does he prefer a creamy sauce with clams and capers? How does Mats feel about anchovies? Can sloths tell the difference between hand-grated Parmesan and the stuff out of the can? Where do they stand on green peppers in the sauce? Do they like linguine better than cappellini?

The mind reels.

I am a miserable ovoid creature.

Well, not really. Not so much.

Tomorrow I start the 75 milligram-Effexor-plus-Wellbutrin thing. The taper has been bearable so far, though I went a bit faster than was probably necessary (or advisable) just because I fucking hate counting out little bitty pellets and scraping the remainder into a gel capsule. I've had a few shocks here and there--the parasthesias that are so common with tapers and discontinuation--but aside from one hour yesterday, they've been okay.

Barely.

Working out helps. Lots and lots of carbs, in the form of everything from potatoes to beer to broccoli, helps. Bach and Lyle Lovett and Cute Overload help. Chef Boy's baffled but open-minded sympathy is invaluable.

And my boss, when I said, "Look, I'm temporarily nuts right now" said, "You go ahead and be nuts; if you have to call in, it's not going to be a problem." First sign of humanity I've seen in six months.

All in all, this has been...okay. I mean, the parasthesias and the sleepiness and confusion are better than the constant hunger I had on 150 mg. of Effexor. The vaguely blah mood has been harder to deal with, but it's still better than the best day I had when I was depressed. I'm partly cloudy, with occasional periods of What The Fuck, but it's still workable.

Y'know, the hardest thing to deal with when you're a freshly-diagnosed or freshly-re-medicated depressive is this: You will have to do this for The Rest Of Your Life. Santa ain't gonna put normal brain chemistry into your stocking some Christmas. We are all stuck with the brains we have; some require more tweaking than others, and it's the thought of tweaking at intervals until I'm dead that daunts me.

But tweaking is better than depressed. Depressed is boring as hell; tweaking at least is interesting.

Side effects suck, too. I mean, I'm 40 pounds heavier than when I started this whole shebang; just tapering from 150 to 137.5 mg of Effexor showed me that the antidepressant is mostly to blame. My appetite is gone.

But side effects suck less than being depressed. Having no interest in anything outside your bed is much, much worse than having no interest in food.

The hardest thing to handle on a social level is other people's reaction to the news that yes, I'm a little off-balance, but that's because I have my fingers in my own brain just now. My trainer has been baffled but sympathetic, the two coworkers I really trust have been fantastic. Still, it's something I feel I *ought* to be ashamed of, being depressed.

But feeling antsy about revealing why I'm weirder than usual is so, so, *so* much better than working hard to not lose it in normal social situations.

In sum, I would say this: I was terrified of losing my security blanket, that blanket being Effexor in the dose I was taking, with all its attendant problems. (The hunger was not so bad when compared to the sudden spikes in blood pressure that could've caused me to stroke.) My shrink (God, that's a weird thing to say, "my shrink") pointed out that fear of a known pain is totally rational, and that he didn't blame me for not wanting to go back.

That terror was unfounded. I may be unusual, but I am not doing so badly, cutting down on antidepressants. I have great hope for the future, in that I will be a normal, happyish person who will not get barred from all-you-can-eat buffets.

I am going to be okay. Despite having brain chemistry that's whacked out right now, I really believe that. And that's a nice adjunct to four years of antidepressant therapy.

Trust me to get a bizarre side effect.

My brain's map of my body has gone totally cattywampus.

I'm on day four of my slow, careful taper.

Last night I went to bed my usual self; in other words, I was five-two and about 175 pounds.

This morning I am at least five-seven and skinny. And flat-chested.

Oh, and my arms are each about eight feet long. And my joints have been oiled with WD-40, so they're very loose.

It's weird, but not unpleasant. And having eight-foot-long arms sure makes it easier to get a fresh cup of coffee without leaving the couch.

In The Room

(An excerpt from a poem by James Thomson)

And while the black night nothing saw,
And till the cold morn came at last,
The old bed held the room in awe
With tales of its experience vast.
It thrilled the gloom; it told such tales
Of human sorrows and delights
Of fever moans and infant wails,
Of births and deaths and bridal nights.

Of Births

She was young--25--and female--and pregnant. Statistically, the last person you'd expect to be diagnosed with a glioblastoma. She was six months pregnant when the diagnosis came.

Gamma knife radiation was very carefully undertaken, with lead shields for both the operators and the fetus. Chemo and other standard treatments were out of the question; we had a baby to protect.

She held her daughter and breastfed her a few times before she became unresponsive and started seizing. Her daughter came to see us today, along with her father. She's a beautiful baby; barely two months old with a head of dark, curly hair and the biggest, roundest brown eyes you'd ever want to see.

And Deaths

Before that was the woman with inoperable metastatic cancer. We all expected her to live a week; after all, her family had asked that fluids be provided via an intravenous line, and the oxygen was going full-blast.

And Bridal Nights

This happened a few years ago. She had been planning their wedding when she had a horrible bleed, a class IV, just a few weeks before the day.

We kept her for two months. She had a stomach tube and a tracheostomy tube and other tubes running here and there to maintain some semblance of dignity.

Eventually she got transferred to the neuro rehab unit. Nobody could understand why she couldn't speak or respond until one bright nurse realized that her bleed had destroyed her hearing.

So she got hearing aids. And one of our nurses who's handy with a sewing machine altered her wedding gown to fit her thinner frame. And another nurse who's good with flowers brought armloads she'd grown herself. And the chaplain volunteered her services.

So, six months after her original wedding date, our patient walked down an aisle in the tiny chapel in the basement, wearing a gown tailored to disguise her feeding tube. Sure, she walked with a walker, but her groom had tears in his eyes all the same. We were all there. The patient and her family were kind enough to invite us, and to hold the ceremony during our working hours.




"I know what is and what has been;
Not anything to me comes strange,
Who in so many years have seen
And lived through every kind of change.
I know when men are good or bad,
When well or ill," he slowly said;
"When sad or glad, when sane or mad,
And when they sleep alive or dead."

People, relax.

I'm tapering the Effexor dose very slowly. As in, I'll probably be off of it by about 2018 or thereabouts. Or at least, that's how it feels right now.

Nobody panic. I promise I won't lose it.

Just had to reiterate that point. Seems a lot of folks misread, or I mistyped and gave the impression that I was dropping my dose in half immediately.

I'm going to go nurse this incipient head cold now.

Who am us? Us am PAPOON!

Because Us Am NOT INSANE!*

I saw the Brain Doctor today. He was youngish and rumpled and bespectacled and goateed, like he'd come from Central Casting. He listened to my two main reasons for visiting him (1. My Other Doctor Is A Noodlehead; 2. J'ai faim toujours) and asked a few careful questions.

When he'd established that My Other Doctor had upped the dosage of my antidepressants without first checking six other things, and that MOD had decided I was bipolar on the basis of a misread chart, his polite and careful questioning gave way to an enormous eyeroll. The hunger side effect of Effexor was one he hadn't seen before personally, but one he wouldn't be surprised by. The sleepiness thing made him nod and jot a couple of notes down on a pad. Then he made the following recommendations:

1. I am not bipolar. I think I said something like "Well, *duh*" at that point.

2. That I taper the dose of Effexor I'm taking very, very slowly and carefully (the story of the missed-dose side-effects made him sit up and say "Woh." Just like that.) and supplement if necessary with Wellbutrin.

3. That I get various levels of various things tested, like my thyroid level. I suspect I'm not hypothyroid, but he wants to rule it out anyhow. If it turns out I'm not hypothyroid but I still want to try augmenting the Effexor with thyroid hormone, we can give it a shot. He assures me there's precedent for this. Um, okay. I'm more inclined to trust him than Mister Doctor You're Bipolar.

4. That if I hate the Effexor taper or the Wellbutrin augmentation or anything else about the process, I call him right away and let him know so he can do some hand-waving and dose-adjusting and we'll go from there.

I'm inclined to be optomistic. First off, the guy may be a brain doctor with a schwanky office in a nice part of town, but he's a bit off-kilter. He broke off in the middle of an explanation of something-or-other to do a double-take at the window and then say, "It's *raining*" in a disappointed voice, as though I'd turned down a plate of his own home-made cookies. "It wasn't supposed to do *that*," he persisted. I liked that immediately.

Second, he's more than willing to entertain the idea that I might be super-duper sensitive to the brain chemicals I'm ingesting and therefore ought to be able to taper them the way I feel is fit.

Third, The Eyeroll. I knew there was some eye-roll-deserving stuff going on with Other Doctor, but I didn't realize how eye-rolly it really was.

Fourth, his reaction to my description of my family was, "So...you're all a little weird, right?" Right.

So I begin tapering Effexor from 150 to 75 tonight. (Cue suspenseful music.) (Note: I will be doing this very, very, very slowly and carefully. Don't anybody fret.)

I can't thank you guys enough. The first time I posted about being a nutcase, more people than I thought read the blog came out of the woodwork to offer support and advice. The second time, when I asked specifically for help and ideas, you guys burned up the email and the comment boxes helping me out.

It's touching and heartening to know that people are so open to advising even poor-to-middlin' writers. I'll keep updates coming.

*These obscure references brought to you by Jo's Obscure Reference and Piano-Tuning Service.

Whoops. That'll take some 'splaining.

The latest issue of the Journal of Neuroscience Nursing reminded me of something.

There's an article in this issue about the possibility that Al Capone, who suffered from some interesting psychological pathologies (putting it gently), may have had neurosyphilis. The authors cite his bed-making habits and megalomania, among other things I don't recall because I haven't read the article carefully yet; only skimmed it.

Anyway, we had a little situation some time ago at the hospital.

A very nice couple had come in. They'd been married for donkey's years, had kids all in their forties, and had had a pretty good life...until the husband started manifesting some signs of dementia. His memory had gotten poor, his gait ataxic, and he was beginning to be incontinent. His primary care doc had sent him to us, thinking that there was a chance he had normal pressure hydrocephalus that could be controlled with a shunt.

So neurosurgery put in a lumbar drain (for the non-medical types, it's a drain that goes into the small of your back through which we can drain off cerebrospinal fluid and reduce the pressure in the brain) and drained it religiously for a few days, every four hours. Physical therapy and neuropsych came in and administered a battery of tests, both before and after, to see if there was any improvement after draining.

No go. As it is in the majority of cases we see, the dementia is due to something else. So neurology came in and started running a battery of tests to determine what, exactly that something else was.

It's basic practice to run a test for syphilis early on, just as it is to run tests for HIV and a number of other, less common things. We'd only had one syphilis serology come back positive before, so nobody was expecting that.

Especially not the patient or his wife.

Sammy the neurosurgery resident wandered into the nurses' station, looking for me. I'd had care of the patient for two weeks, off and on, and Sammy was wanting some moral support when he went into the room to tell the patient and his wife that the cause of his dementia was a bad decision he'd made probably twenty or thirty years prior.

Syphilis, you see, is a tricky little bug. It's a bacterium that can be easily cured with high doses of antibiotics administered in a certain way over a certain time frame, but if it's not cured, it tends to hide out in the body. Over time, it can cause things like weird lumps in joints, strange rashes that come and go, and eventually (if you're one of the roughly thirty percent of people who's unlucky) neurological complications. Or cardiac complications. Or bits of your face--though this is increasingly rare--can begin to fall off. Most people catch it and get treatment fairly early, though Oliver Sacks recorded a case of a woman who developed neurosyphilis seventy years after her infection.

Apparently our man had had a little fling, or had visited a prostitute, or had somehow otherwise put himself in a position to catch this particular spirochete. And he'd done it long enough ago that he'd probably thought he'd gotten away cold. His wife's reaction was such that it was unlikely he'd ever confessed to his indiscretion.

Poor resident Sammy had to break the news. I went in as multiple moral support person, and afterwards we had a cup of coffee. There are some things you just would rather not remember much of after the fact; that half-hour in the patient's room was one of them.

I don't remember what happened to that couple. I know he was treated, but there was no way we could reverse the damage that had been done. I know she was referred to the state health department for treatment. I know there was icy silence from that room from the time Sammy and I walked out until the time they were discharged. But after that? He probably had some 'splaining to do.