Pictures, for those that wants 'em.

Strider, looking sweeter than he actually is:

Max, my snugglebunny strudel-noodle:

You can see why I'm considering trading in the Accord for a Honda Fit.

It's a pun.

Hello to everybody who navigated here from the LA Times!

You won't, unfortunately, find any advice on how to be a "head", or charge, nurse. Nor will you find anything resembling Penthouse Forums. Nor will you find anything on that foam that rises to the top of a glass of beer (well, you might, but it's not the theme of the blog). 

It's *Head* Nurse. Neuroscience. Like, head-brains-neuroscience? Pun? Got it?

Head Nurse. Neuroscience. Brain on top, spine down the back. 

You may laugh now. 

Yeah, everybody makes that mistake. You would not *believe* some of the comments I have to reject.

Original mention here.

Good Advice

When you're driving down the highway and somebody passes you going eight zillion miles an hour, check your rearview mirror--there's always a second one following.

A little loose powder dusted under your lower eyelashes will keep your mascara from smearing.

Hang all bags and place all pumps so you can see them from the door of the room.

Buy ten pairs of socks, all the same color, for work. That way you can match socks in the dark.

If you're starting an IV on a frail little old person with prominent veins, don't use a tourniquet. Just drop the arm over the side of the bed and let the vein engorge that way. You won't blow the vein when you flush the IV.

The heaviest bell peppers contain the most seeds, and the largest avacados have the biggest pits.

If you're mixing Mucomyst and Coke for oral administration, draw the Mucomyst up in a syringe and put the tip of the syringe under the surface of the Coke before you squirt the med in there. That way it won't smell so bad.

Lettuce cannot be frozen. Bananas can.

Bleach on a Q-Tip will remove small stains from white fabric.

Keep napkins in the glove box.

Always have an extra pen.

Keep a little container of plain flour nearby when you trim your dog's nails. The flour will stop the bleeding if you cut the quick of a nail, and it doesn't sting like styptic powder.

Keep your hands away from your face, and don't pick that zit.

A bedspread covers a multitude of sins.

Warm the saline before you flush the Foley.

Label all tubing with big black letters on silk tape flags in several places.

Apply concealer cream with a small brush rather than your fingers. You get better coverage, and you'll use less product. The Sonja Kashuk brushes from Target are good.

Never ever ever wear the same pair of shoes two days in a row.

Keep the receipt.

Cotton undies. Always.

Holy freakin' kamole, it is too damned hot.

A hundred and six outside Casa Del Thank God For Airconditioning, friends. That's what it is today. Ah, nothing like that dry, baking Texas heat in the summertime, except for when it's a hundred and six outside with humidity of seventy-four percent.

This time of year, all I eat (seems like) is peanut butter and jelly sandwiches and water. And frozen veggies, straight out of the bag, applied to temples, wrists, and ankles.

When I was in Seattle two weeks ago, it was sunny and 75. And everybody I ran into, from the barmaid at the fish bar to the cashier at Archie McPhee, started the conversation with something like, "Gosh, isn't it hot? I can't stand this heat." Given that the low that morning at the Dallas airport was a full ten degrees warmer than Seattle's high, I was not inclined to be sympathetic.

Speaking of disinclining to sympathy, we have a new crop of residents in most services (well, comparatively new; they came on on July 1st) and the same crop of neuro guys on new rotations. I had to tell one of 'em the other day that just because you change services does not mean that you get to write craptastic, freaky orders and then complain when we call you to clarify. 

The rest of the residents range from outstanding to just fine. There's always one, though, and it's our destiny to work closely with him for the next two months, since he's covering two services at once. 

The only reason I look forward to working with him is because it means I'll be in air-conditioning for twelve hours.

Happy Birthday, Mom!

This is actually a day early, as my time off ends tomorrow. *sigh*

My Mom will be seventy years old tomorrow, July 16th. Hooray!

People who lived to be 70:

1. Methuselah (969)

2. Benjamin Franklin (84)

3. Helen Keller (88)

4. Florence Nightengale (90)

5. George Burns (100)

People who did not live to be 70:

1. Jesus (33?)

2. Mozart (35)

3. Eva (Uncle Tom's Cabin, age 6?)

4. Rumwold (Anglo-Saxon saint, aged 3 days in 662)

5. Amelia Earhart (42)

Things that happened in July, 1938:

1. Steam locomotive "Mallard" (Hi, Dad!) sets land speed record of 126 mph.

2. Wrong Way Corrigan takes off on the 18th, heading (he thinks) for California. Later, he lands in Ireland. Wups.

3. Mauthausen concentration camp built (eesh.)

4. Two barns were destroyed by fire near Sheboygan.

5. Brian Dennehy was born (actor).

If you search "70 Things" on Google, you're likely to come up with:

1. "70 things you need to know about future employees"

2. "70 things to expect in a disaster" (My favorite: "Things will get better only after they get considerably worse.")

3. ""70 things to always remember" 

4. "Who held a gun to Leonard Cohen's head?" (article from The Guardian)

5. "70 Things To Do In Iceland" (too easy.)

If you search "70 year old mother" on Google, you're likely to come up with:

1. "70-year-old gives birth to twins ('I did this for women everywhere,' says mum)"

2. "A mother reveals 70-year-old secret"

3. "Turkey with my 70-year-old mother" (recipe help or travelogue? You decide.)

4. "Thief jailed after 20-mile chase with 70-year-old mother dozing in seat next to him"

5. "Seattle Native is Mother Of 70-Year-Old Sal D'Amato's Baby"

And finally, Rob Brezsny says:

I really do feel that you're here with me as I create these horoscopes. In a sense, you're my assistant. Our telepathic connection is utterly palpable and practical. The hopes and questions you project my way stream into my higher mind, coloring my psychic environment and enriching my desire to give you exactly what you need. Now, in accordance with the astrological omens, I'm asking you to give our collaboration more conscious intention. It's time for you to be aggressive about seeking help and inspiration -- not just from me, but from everyone. Try this for starters: Once a day for five minutes, visualize that you and I are sitting face-to-face and discussing the issues that feed your longing to be brave and free and authentic and smart and loving and creative. 

And Now For Something Completely Different....

or, That Didn't Work At All.

Some time ago, right after I moved in here, I bought some great midcentury modern wallpaper to put in the kitchen. The kitchen project was stalled until this week, when I had a few extra days off work.

So down came the horrible masonite on the walls. I taped and mudded and sanded and primed and put up the first wall's worth of paper.

The Kitchen said, "What the hell do you think you're doing?

I replied, "Putting up wallpaper. What does it look like I'm doing?"

The Kitchen snapped, "I hate that stuff. Take it down right the hell now."

ME: Buuuhhh...buuuhhh....I like this wallpaper!

KITCHEN: *I* don't. I'm not Midcentury Modern, you idiot; I'm Postwar Cute!

ME: Uh...there's a difference?

KITCHEN: Well, duuuuhhh. Yeah.

ME: So what's Postwar Cute?

KITCHEN: Take a look at me, Bozo! I've got glass-fronted cabinets and wide woodwork and high ceilings! Lots of cute cabinets! I need small-figured wallpaper with a chair rail and white paint, not this uber-modern faux Fifties crap!

ME: Um......

KITCHEN: Take. It. Down. Now. Or you'll never cook in this town again.

So I took it down. We eventually compromised: white walls with stencilled, multicolored polka dots in cascade, painted in Fiestaware colors.

Which means the kitchen won't be done before Wednesday, when my time off ends. Dammit. 

You know, I used to be sure my mom was crazy when she told me that every room in the house told her what color to paint it. I'm not so sure now.

Can we just print this out, post it on the fridge, and be done with it?

You know it's going to be a bad day when you walk in and somebody immediately calls a code.

Except this one wasn't a code. It was, technically, a "Rapid Response Team" situation, but given that the patient ended up intubated and 100% ventilated, it was a code. But I'm getting ahead of myself.

A lot of families hate the idea of signing a DNR (Do Not Resuscitate) on Grandpa or Grandmother. They think that a DNR means "Do Not Treat" or "Ignore" or "Hasten the Death Of" rather than what it actually means.

To wit: Grandpa was not in the best of shape when he came to us X days ago. He'd had two major ischesmic (clotting) strokes and a large, horrible bleed in his brain and was breathing irregularly and gaspingly when he was delivered to us by a relieved ambulance crew. Grandpa hadn't moved on his own or responded to anything short of pretty intense pain for days. Grandpa was a full-code, or a "Do anything and everything to save this person's life" when he came to us.

Let me be totally clear here: Grandpa was in no way, shape, or form, ever going to get better. The best neurologists and neurosurgeons in the country had already determined that. Okay? Okay. You got it. Grandpa's gonna die; the only question left is how.

So I wander in to work, already tired and strung out from the sort of weekend nobody wants to have. After I'd been there not three minutes, somebody hollers out of Grandpa's room to call the RRT...so I did. Despite not being on the clock and not officially there yet, I called RRT. (My compassion continues to overwhelm me, as I'm sure it does you.) Then I wheeled myself and the code cart into the room and took a good look at what was going on.

What I saw was an 87-year-old man in the last stages of life. Agonal breathing, cold extremities, you name it--this guy had a bus to catch and was running after it as fast as he could. Family, being in the room, was flipping out and demanding we "do everything".

So we did. Those of you with relatives who are in the "do everything" camp might want to cut this bit out and show it to those relatives. Here's what we did:

We started three large-gauge IVs in the man's arms and legs. We called an anesthesiologist (who just happened to be wandering past) into the room to intubate, as Grandpa was not breathing well on his own and bagging him (ie, providing artificial respirations with a manual device) wasn't working. 

The anesthesiologist had to try four times to intubate Grandpa. His airway had been damaged by people suctioning it out in a ham-handed fashion. When I finally got a 16-French (read: small) bougie up, Anesthesiologist guy managed to get it down Grandpa's throat at the cost of a whole lot of blood being shed from those damaged throat and airway tissues. There was blood everywhere. 

At that point, Grandpa stopped breathing on his own, following the natural course of things, and we had to do chest compressions. You could hear the sound of his ribs breaking outside the room. I broke at least three of them myself, straddling this ancient man and counting "one-and two-and three-and...." and trying to get three inches depression with each push.

There were people bagging and cursing and blood flying everywhere as Grandpa's arms jerked with the compressions, ripping the needle that the respiratory guy was using to draw labs out of Grandpa's arm.

We pushed drugs you've never heard of more times than is interesting to tell about in an attempt to get a heartbeat, *any* heartbeat, on this man. You can't shock a flatline, and we didn't...but we didn't get much of anything out of him. IVs in his arms blew as we pushed drugs too fast, raising enormous discolored lumps on his arms. We replaced the IVs with ones in his legs and a central line in his groin, the only place we could find a vein that was engorged enough to poke.

Every time the doc who took over compressions from me pushed, more blood would squirt out of the various holes we'd made. This was not natural bleeding; this was artificial bleeding from a dead person that was caused by us forcing his heart to squeeze.

Finally, finally, with family in tears in the hallway, we managed to get a shockable heartbeat. And finally, finally, we put on external pacing pads that would deliver a mule-kick through the man's shattered chest every few seconds in an attempt to remind his heart to beat. And finally, finally, *finally*, with blood bubbling out of the breathing tube (from the broken ribs) and oozing out of the various holes I and my colleagues had made in him, we managed to get him stable enough to take him up to the ICU and put him on a ventilator to breathe for him and drugs and drips to keep his blood pressure stable.

That, my friends, is what a code is like. 

That is what you're wanting for your family member.

And this was a clean code. That's the horrible thing: we only coded this guy for a total of about five minutes; the rest was all pre-code intubating and sticking. 

If you come in with a DNR, I will bust my balls to save your life. If it comes to it, though, and you stop breathing on your own, I will not torture you in order to get a few extra minutes of fake "living" out of your cooling carcass.

If you come in as a full code, I'll bust my balls to save your life, even to the extent of breaking your freaking ribs in the process. I'll hate it, but I'll do it.

Talk to your families, people. Decide how you want to go. But please, please be aware of what you're asking when you ask for it.

Product Reviews: Shit That Works Like It's Supposed To Edition

It's been a while since I've done one of these. Therefore, without further ado, Shit That Works Like It's Supposed To:

1. Cline Vineyards Viognier, 2007

I've only ever tasted Becker Vineyards' (just down the road! Try the lamb!) viognier before, and found it a little on the sweet side. Cline Vineyards is a California establishment that produces a semi-dry viognier with a nice, peachy aftertaste that also includes a little oak and some citrus. It's good for drinking when the temperature is, say, 102* for the fifth stinkin' day in a row.

2. MyChelle Fruit Fiesta Facial Peel

The blog on which I read the first review of this product mentioned "vat of acid" and "having my face used as a pinata at a school for wayward children". I didn't find it all that difficult to endure, but then, late-thirties acne has me inured to almost anything. My face, when I washed it off, was clean and smooth and well-moisturized, with nary a hint of redness. This is a keeper. It didn't even fade my freckles!

3. Sara Lee 45 Calories & Delightful 100% Multi-grain bread

Don't kill me. Friend Heather, who is a successful yoga teacher and Weight Watchers' devotee, swears by this stuff. I had been eating the Pepperidge Farms 15-Grain Shred Utility What The Hell Is This? Gristle? Bread for years in order to get my full RDA of grains. It made me sleepy. The Sara Lee stuff, though it's probably made with black magic, tastes just as good with peanut butter and fills me up without making me nap afterwards. 

4. M.A.C. Loud Lash mascara

I have one complaint with Loud Lash: It's not manufactured any more. If you can find some on eBay in an unopened package, grab it. This shit stays put through a twelve-hour day during which both the water and power go out, meaning no electricity, and it will. Not. Come. Off. You'll have to use straight oil to dissolve it. Which means you'll have to buy either an oil cleanser or plain olive or coconut oil, but it's worth it. 

5. Parachute (or any brand, really) Pure Coconut Oil

Speaking of oil, did you know that coconut oil is molecularly quite close to sebum?

That means that you can rub it on your face and leave it there for a couple seconds and it'll dissolve not only makeup, but blackheads. It'll condition your hair beautifully if you put it on said hair when said hair is dry and shampoo it out afterwards. It'll take care of nasty dry-skin rashes with no fuss.  Best of all, a huge bottle of it is $1.67 at Mida's All Indian All Asian Bazaar, Your One-Stop Shop For All Asian Needs, which means you'll have bank left over for some stick-on bindis for when you're feelin' fly.

6. And, last but not least, Le Vent Du Nord.

Just go buy a couple of albums, already. It's the best toe-tapping, dance-inciting, nasal-projected-singing music Quebec has to offer. And the guy on guitar is cute.

Odds and Ends

Things not to do:

Show up tanked on the day of surgery.

No matter how nervous you are about having brain surgery, it's probably best not to appear at the hospital at 6 am completely schnockered. It'll require a delay in the start time. 

Yank the spike out of a REALLY big bag of fluid.

You all know that I am Genius Incarnate when it comes to being clumsy in new and creative ways. In the past, I've spilled most of the contents of the pharmacy on myself...but I reached a new high recently when I accidentally yanked the spike out of a three-liter bag of saline that was hanging at about head-level.

No, I don't want to talk about it any further. Thank you.

Sell drugs out of your hospital room.

Calling security is a pain in the ass. Could you not wait until you got home to make some extra bank?

Attempt to mug one of our employees in the parking garage.

Because, though she looks tired and vulnerable, she might actually end up being a second-degree black belt and wind up kicking your lousy ass. The cops who responded to the yanked emergency phone arrived to find one mugger, in a bruised lump on the concrete, and one rather pissed-off, medium-sized woman who just wanted to go home to bed.

Have two dogs, each well over a hundred pounds, and only a Honda Accord to move them around in.

I could solve this problem in one of two ways, I guess: 1) Buy a new car, like an xB or a Versa, that has room enough for two guys who each stand more than 25" at the shoulder. Or, alternatively, I could 2) Cobble together a lightweight cart and train them to pull it. That way I'd save the money on gas, give the boys some exercise, and look cool doing it.

The only problem would occur if Strider were to see a snack on one side of the street and Max a potential belly-rub on the other. 

Roll a loaded linen cart over your toes.

No, surprisingly, this did not happen to me. Owie, though.

Eat like, fourteen cups of blueberries at once because, you know, they taste soooo good.

I did this. It was actually more like three cups. That's still enough, though, for Interesting Things to Happen.

Ah, the glamorous life. I livez it.

Two questions:

First, which one of you smart-alecks sent me the subscription to Glamour?

It was in my mailbox today. Ha, ha, ha. Very funny. (*golf clap*)

Second, who has recommendations for dog training books? Strider is apparently even younger than his rescue foster thought and is a total doofus. He needs training before he puts on that 20 lbs. he needs. Sheesh.

Daily Strider Tidbit: He has what I'm now calling the Strider Boing: It's a move where he leaps straight up in the air, all four paws off the ground at once with his spine parallel to the ground (so he's not on his hind legs, if you see what I mean). He gets a good 30 inches of vertical air under those paws. This move is usually accompanied by a basso profundo BOOF! and can be seen in moments of great excitement, like when Brownian motion occurs or the planet is circling the sun.

Max is exhausted but happy. I need to go rub his belly now and reassure him that he's the best boy EVER. I never thought I'd see the day when a 110+ lb. German Shepherd mix looked small, but here we are.

Strider, day two

Scene: The back yard, morning

STRIDER: Dude. What *is* that thing?

MAX, yawning: Lawnmower.

STRIDER: What's it do?

MAX: Shortens the grass so we get better back-skritches.

STRIDER, examining lawnmower from all angles: Is it dangerous?

MAX, rolling on back: Just stay away; you'll be fine.

STRIDER: ....Okay. I guess I can't herd it. *sigh*

Scene: The living room,  afternoon

MAX: Don't go there, man. I'm warning you. I've tried it.

STRIDER: Aw, c'mon. It's cute and fuzzy! What harm could it do?

KITTY-CAT: I'll kill ya! I'll kill ya! I'll taste blood! Murder! DIE! DIE!! DIE DIE DIEDIEDIE!!!

(KITTY-CAT swipes at STRIDER with claws out.)

STRIDER: Holy shit, dude! She's got needle-paws!

MAX: Told you. You can't win with that one. It's crazy.

Scene: The back yard, nightfall

MAX: Doh dee doh doh dum dee dah dum dee dah....

STRIDER: Laa laaaa laaaa *roll roll roll* *scratch scratch* daaa deee hummm hummm...

MAX: Dah doh dee la la doh dum diddly dum....

STRIDER: Laaaa laaaa laaaa li loooo...wait. GO AWAY!!! GO AWAY!!! GO AWAY!!!

MAX, running after: Yeah! What he said! 

STRIDER: What was that?

MAX: Uh...it was The Hooman. But no worries. She's used to it when she comes home.

Meet Strider.

No, not that one.

I picked up a very sweet, very very very large dog yesterday from a very very very kind woman who fosters Pyrenees and other large dogs.

Strider is a close-to if not pure-bred Anatolian shepherd. I wanted a dog who was calm, athletic, not inclined to hysterics, and large enough for Max, the German/Anatolian cross who rules the back yard, to play with. Strider met all of those qualifications, plus he has a very sweet face.

So off I went in the Honda, not knowing what to expect. Strider had been picked up in Houston and had spent some time in a really awful kill-shelter there. He had mange, pneumonia, heartworms, had been underfed, and generally wasn't in the best of shape when he got rescued. The woman who fostered him has done an amazing job: he's healthy, healing, and not the least bit shy or timid. He still needs some more poundage, and his face is a mess (from healing mange and being chewed on by other dogs), but I expect he'll be in tip-top shape in six weeks or so.

His ad on Petfinder said he wasn't a big barker, didn't jump on people, and was generally well-behaved and low-maintenance. 

I think he's blooming already. He remodeled the outside utility room last night (it was almost empty anyhow, and there was nothing in there I wanted), then announced his presence to the dogs next door this morning. He barks like a Great Dane. When I went outside to greet him and Max, he *plopped* both front paws on my shoulders and licked my face.

Good boy. Gooooood boy. Nice doggie.

Max is amazed that there's another dog large enough for him to wrestle with. Strider, thank Frogs, is following Max's lead when it comes to playing and wrestling: 230 combined pounds of tooth and muscle in a dominance struggle is not what I want to deal with on my own. 

Let me say a word here about rescuing animals:

If you want a dog, cat, pig, donkey, guinea pig, chicken, or goat, please consider rescuing an animal from a shelter or rescue group before you consider buying one from a breeder. If you're really wanting a purebred animal, there are rescue groups for practically every breed out there.

The benefits to rescuing an animal are huge. First and most importantly, every dog that's rescued from a shelter or placed by a foster human is one dog that doesn't get euthanized. Animal overpopulation is a huge problem; most shelters have to euthanize not because the animals are unhealthy or vicious, but because the shelter has no more room. 

Second, if you get a dog or cat or whatever from a rescue group, you have backup that you don't get from the guys who sell puppies on the side of the road. Somebody has lived with the animal for some time and can tell you about its personality and quirks. Many times, the foster family will crate- and housetrain the animal, take it to obedience classes, and generally do all the dirty work of socializing the animal for you.

And third, you know what you're getting into with a rescue animal. They're mostly adult, someone has their medical history all there for you, and the dog/cat/donkey has already got a vet. If there's a problem, you can call the foster or rescue group for advice.

Yes, adopting an animal from a rescue or shelter is expensive--the group has to cover expenses at least partially, and everybody there is volunteer or badly paid. Every bit of cash goes to the critters. Yes, it's a tough process--home visits and vet interviews are the norm, because the folks who adopt out critters want to be sure they all get good homes. But think of it like this: these are animals who've already been labeled "unwanted" by some other human, so it's natural that their caretakers would want to prevent that happening again.

I now have three rescue critters: Max, Strider, and Evvie the Cat. I would not trade any of them for the world; rescued critters are the best ever.

And now, since that particular sermon is over, I have to go shower and run out and get some larger dog toys.

My family, problem-solvers extraordinaire.

So, my uncle. Nice man. Hunts and fishes, but eats what he kills. Raises good dogs and raised two good kids. The sort of grandfather you'd want for your child, you dig? Goes to baseball games, can fry a mean catfish, has a good sense of humor. Sober, steady, church-going. I've never heard him raise his voice and have only heard of one time (and this was hearsay) when he used a naughty word, and that was "hell". Or "damn"; I don't really recall which.

My uncle. My Beloved Mother's baby brother, the one who loves Chefboy and is never in a bad mood? That one?

Sent a cosh.

A real, live, spring-handled, lead-ended, leather-wrapped cosh. As in, I'm not entirely certain this is legal within city limits cosh. Eight inches long, weighs about two pounds, makes a satisfying and painful thwap when you whack it into your palm, would easily fracture somebody's frontal skull. No lead pellets dropped into eelskins here; this is a serious weapon in an itty bitty package.

Apparently he read (sweet hopscotching Jesus, if he's reading this, I'd better clean up my fucking language) or heard about the patient taking a swing at me. And he got a little irritated on my behalf.

"She can put it" he told Beloved Mother, "in her pocket. Nurses have big pockets."

It has quite the loop strap on it, too. If I don't want to get too close to somebody and still land them in ICU overnight for observation, I could conceivably swing the thing at arm's length.

My methods of self-defense have been limited, these last twenty years, to ducking and running and imagining how, exactly, I would get to the fire extinguisher and loose it into some bad guy's face before Max ripped out his throat (always assuming Max would do that; it's not been put to the test, knock wood). I've never hit anybody with a cosh. I've never carried a cosh in my pocket. I've never even SEEN a cosh, for cryin' out loud; my naming it thus is informed by my taste for good and not-so-good detective fiction.

Nonetheless, I am now the proud posessor of an eight-inch-long (fourteen with handle), spring loaded, lead-tipped widget that's wrapped in braided black leather and looks like something either Bettie Page or your local pr0n store would carry.

And I can keep it in my pocket. My big nurse's pocket.

I can't wait to see the docs' expressions when I pull it out instead of a penlight. 

Gracious snakes.

I post, I go to bed. I wake up earlier than God, and bang! Six comments in six hours.

Strike a nerve, much?

Some study I Googled last night said that 430,000 nurses report that they're victims of violence or intimidation on the job every year, and that that number is likely low due to under-reporting. Seems that a lot of nurses think that getting clocked or yelled at is just part of the business of being a nurse, and that some managers think it's whiny if you report being a victim of violence.

Hm.

You know, what pisses me off most about last night, is this: (well, two things, actually)

First, that the first-line person, my manager, did not automatically go to bat for me. Instead of laying out ground rules, he attempted to perform some weird magical act of conflict resolution that would somehow make it all okay. 

That has two results. The first is that the person who swang/swung/swinged at me has no incentive to change that behavior. "Act badly, get coddled" is the message.

The second result is that I know, now, that if I attempt to set firm boundaries with a person, like "Do not try to hit me. That behavior is unacceptable" I have absolutely nothing with which to back that up. I am really and truly on my own as a caregiver. If the person then complains, or tries to rough somebody up, we're back to Conflict Resolution and Good Customer Service.

And this makes me sit back and scratch my head and slurp my coffee thoughtfully.

The majority of comments left after yesterday's post talked about lawsuits and criminal charges, which tells me this: That I am not alone in working for a facility that has no plan in place for dealing with patient-on-caregiver or family-on-caregiver violence. I'll bet doghair to donuts that all of you guys have codes for civil disturbances or codes for when some nut comes onto the floor waving a gun, but that there's no code to call when a patient tries to cold-cock you.

So. Sunnydale has no plan. Sunnydale's Corporate Manglement has no plan. It's nursing, Three-Stooges style, except the pratfalls are real. So what will I do the next time this happens?

That's a hell of a question. If I'm feeling tough, I might well file charges and insist upon a root-cause analysis of the problem. (RCA's are when all the mucketies get together and go, seriously and with intent, over the entire history of something that has gone Very Wrong.) I might make noises about lawsuits and editorials for nursing magazines. I might even be serious.

Because, as I said before, the only way to get the folks on the carpet to listen is to threaten either their bottom line or their good public image. 

Now: one thing to get straight this second is that I would not, unless Manglement or the hospital were way, way in the wrong, sue anybody for money. I'm not really interested in that sort of drawn-out, pain-in-the-ass process, and it wouldn't end up solving a damned thing, as the facility (if somebody *were* to get hurt) would settle in return for a non-disclosure agreement.

What I *would* do is insist on new standards of behavior for patients, family members, and visitors. What I want is a policy in place that says, If you do X, then Y will happen. What would make me happy about working where I work is a recognition on the part of all the managers that The Customer Is Not Always Right, and that there are some things that are beyond the pale. 

Right now, all of us, whether we're in the ER or on the floor, are subject to threats that would never fly in any other business. If you holler abuse in a bar or try to start a fight, you get thrown out. If you throw a temper tantrum in a restaurant, you'll get thrown out. If you try to injure somebody in public, you're gonna have to talk to the police. But swing at or holler at a nurse? It's all part of the game.

Why are we less safe at work than we are in a bar? Why are the standards of behavior so much lower for the consumers of our product? Because, quite frankly, if the patient is going to be treated as a consumer of healthcare, they need to be subject to the same standards of behavior that consumers of alcohol, groceries, or cut flowers take for granted.

The answer to the problem of violence against nurses is simple: People who are violent or threatening need to be refused care. The way to get that policy implemented is much, much more difficult.

I think I'm going to lean back, furrow my brow, and slurp some more coffee while I think about it.

This "Customer Service" bullshit has got to stop.

Normally, I never post immediately on coming home from work. I'm too frazzled, too scattered, and unable to complete a spoken sentence, let alone a written one.

Today, though, it's different. Today, for the fourth or fifth time in as many years, I had a patient take a swing at me. What's different about today is that this particular patient was alert, oriented, knew where he was and what he was doing, and was trying to hurt me.

This patient was the typical Sunnydale Hospital* frequent-flier: pages and pages of old charts, all of them with extra pages attached from nurses who'd had run ins with him. The documentation was complete and careful and clear: this particular person was a nutjob. No way 'round it; he had enough baggage for the Rolling Stones on tour.

His course was also typical: noncompliance with the simplest of instructions, obscenities screamed at nurses, pharmacists, and doctors, and the final lovely touch of hiding narcotics in his room. That was just recent visits. It didn't take him long to get a file this (holds fingers apart at arms' length) thick.

So he took a swing at me. And screamed obscenities. And I reported it, as I was supposed to, to my boss, one of the Manglement Trifecta on the floor. (Winky, Blinky, and Nod, as I call them, do the work of one person, and do it.... Anyway.) Winky went on into the room, and there....

...Practiced Good Customer Service and Conflict Resolution.

The upshot? I got told the patient didn't like me--big shock, as he didn't like anybody--and was told not to do whatever it was I did to get him upset again.

Managers, read this, if you read nothing else:

Customer Service Does Not Mean Putting Your Nurses In Harm's Way.

This was a patient who'd already threatened to kill two surgeons. He had come up on out of the bed with a pharmacist and had caused three of the toughest nurses I know to refuse to take him on as a patient. Now, I am not the shrinkingest violet on the block, but one thing here ought to be perfectly clear: The only way to deal with a problem like this is to get rid of the source.

Patients like this ought not to be readmitted to the hospital. They ought not to be "counselled" about their behavior. There ought to be no quarter given: if you swing at a nurse, or scream obscenities, you should be told briefly and bluntly that that behavior is unacceptable, and if necessary, you should have a security guard posted outside your room.

The fact that this guy wasn't ditched from the hospital admit list tells me that Sunnydale doesn't give a good goddamn about their nurses' safety. The fact that my charge nurse, Winky, didn't lay down the law tells me that he cares more about our floor's customer satisfaction scores than about *my* safety.

And that tells me this: Managers, listen up: the only way you guys will ever pay attention is if we, the people on the front lines, start making a stink. 

Next time some direct descendent of Einstein swings at me, I am not going to get out of the way. I'm going to let them hit me.

And then I'm going to file battery charges.

And then I'll talk to your board of directors, Sunnydale, about the whole situation, and how much compensation I ought to get for mental anguish. Because the only way to get large groups of carpeted-area manglement types to pay attention is to talk about negative publicity and dollar amounts.

I'm not fucking kidding. There is no reason in the world that I ought to have to put up with somebody who's actively violent still being in the hospital after he's behaved like a beast. There's no reason that the charge nurse or house supervisor or whatever shouldn't march into the room and tell the person who's a nutjob that nutjobbiness is unacceptable and *will* stop, NOW, or the patient can go home. 

There is, in short, no reason for me to feel less safe working at Sunnydale than I did working at an abortion clinic. And I do. 

*w00t Buffy.

Butt Tufts and Other Hazards of Southern Life

Or, what I do on my day off.

Max is shedding. Among those of us with double-coated dogs, there's a less-polite, more-descriptive term: "Blowing the coat". Max is blowing his coat.

Yesterday it was close to 100* here. In one day, Maximus Doggitude went from looking like a gentleman, albeit a shaggy one, to looking like he'd earned the nickname "Banjo" by living under a bridge for six months. My neighbors, who live with a good-natured pug and a corgi who never ventures outside except under duress, were amazed to see me pulling handfuls of hair out of Max's coat, especially on his hindquarters. Anatolian shepherds, being a mountain breed, tend toward large poofs of fur to keep their hrbls warm in the winter. Max's hrbl frbls were out of control.

Doggie dreadlocks, only six days after his last intensive grooming session. Every sparrow and mockingbird on the block is wearing comical mustaches of Max Fur, soon to be lining their nests.

Speaking of sparrow nests, I had a heartbreaking moment the other day when I noticed that a piece of decorative trim had come off the side of the house, just around the soffit. It had exposed a long empty space, and in that empty space were shreds of grass and other material. That spells "sparrow nest", which in turn spells "rodents looking for prey" and "rotting wood", so I climbed up on the world's shakiest hand-me-down ladder to have a look. I got out the entire nest (why does a small bird need a nest as long as my arm?) and dropped it to the ground before noticing it contained unhatched eggs. Two were broken. Three were intact. The parent sparrows were flipping out.

I put the nest, as close to whole as I could manage it, in the crook of a tree nearby. Given that the only bird with a sense of smell is the vulture, I figured the parents would adopt the nest again with no problem. They did...until the next big thunderstorm. *sigh* I feel like a baby bird murderer.

In gardening news, things are mixed. The dill and lavender are doing well (though Max chewed up half the lavender plant today; why I do not know) and the tomatoes are fruiting. The Romas are behind time, having gotten munched by some unknown bug, but the cherry tomatoes and heirlooms are already setting tiny green fruit. The cilantro got as high as my shoulder before seeding out. I pulled it yesterday morning and tossed it on top of the compost pile, intending to dig it in later on, once I'd bought a pitchfork. Before I was able to do that, I saw Max, head and shoulders into the compost pile, delicately yanking strands of seeded cilantro out and eating them. 

I had wondered why, for weeks on end, the cilantro seemed to be self-pruning. I know now that the Weirdest Dog In The World had been chewing bits of it, perhaps to freshen his breath for the pug next door. Fortunately he doesn't seem to have the same taste for basil as he does for cilantro and lavender. The dill and basil are safe, which is good for him. If he were endangering my future pesto binges, we'd have to have a talk.

I'm already planning the garden for next year. I want to build four raised beds, two square and two long, with cedar poles and plenty of fencing to keep the dog and the neighborhood tomcat, who sleeps in my lettuce, out. One bed will be for perennial plantings, asparagus and strawberries. The other will be for things like carrots and tomatoes and radishes and bush beans. Lettuces and cabbages (fall crop), brussels sprouts (ditto), and pole beans will go into the long beds, along with cucumbers melons perhaps kiwis peppers herbs etcetera.

In the front beds, which I have yet to till and de-grass (dammit, sigh), will go perennial herbs like rosemary and lavender and dittany and oregano.

There's a lot to do when you have a house. I'm just now learning this. I've not even mentioned the difficulty of finding a black toilet seat (better in keeping with the theme of the bathroom and its historical roots) or an affordable vented oven hood. Or what it takes to find a really good screen door, or the spasms I'm having over whether to save the original, Art-Deco doorknob and plate from the back door when I replace it with something that's not mostly glass.

Even with the sleep I lose over such things as whether the wallpaper for the kitchen ought to be 1950's vintage repro or 1940's, it still makes a nice change from primary leptomeningeal melanoma and Ted Kennedy's brain tumor.

Today I got yelled at 4.3 times in twelve hours.

And it didn't bother me a bit.

I've grown inured to the yelling-at that some doctors, pharmacists, other nurses, house supervisors, patients, and facility management specialists (read: Janitors) do.

I used to bristle. I used to take offense. Occasionally I would vent.

Now, if the person doing the yelling is doing it face-to-face, I imagine that person covered with banana pudding. If the person doing the yelling is doing it over the phone, I giggle. Audibly.

Because, you see, *everybody* yells at nurses. We get caught between the proverbial rock and steel plate, and we are the recipients of everybody's frustrations. Toilet broken? Yell at the nurse. Did payroll fuck up your overtime again? Yell at the nurse. Can the pharmacist in Alabama not read your handwriting? Inform the nurse stuffily that that's the same DEA number you've used for the last five years. 

Then listen to the nurse (well, *this* nurse, at any rate) giggle helplessly at your stuffiness.

This is the time of year when I face both burnout and brilliant ideas simultaneously. The time I don't spend updating the blog is time I spend out weeding the garden and grooming the dog. This time of year, I'd like nothing better than to get fired for smarting off to somebody, just so I could work for triple or quadruple what I'm making now, with plenty of time off to weed and groom and just lie in the sun. I know I won't feel that way come January, though, when things are cold and rainy, so I mostly hold my tongue.

And giggle. Audibly. Audibly, but not offensively. Because, honestly? Not one damn thing I got yelled at today had anything to do with me or my nursing. One was a doc who was pissed at a pharmacist; the next was the pharmacist who was pissed at the doc. The third was a patient who had an entirely different nurse. The fourth was a manager who got annoyed that I actually followed hospital policy (and they wonder why I'm such a loose cannon) and did what I was supposed to do.

Keep your yellow "Live Strong" wristbands. You can have your pink ribbons and red dresses and grey ribbons and God knows what else. I am wearing, from here on out, a smiley face. Giggling is my new cause.

You may be next.

Take *that*, work frustrations.

This post was going to be titled "When Morons Attack".

But I ran a mile.

Then I lifted weights.

Then I stretched. And did some yoga.

And now I'm cheerful and warm and relaxed and no longer concerned with morons. Instead, I think I'll go buy some doggie nail-clippers and then hang out with Max for the rest of the day.

Spring. Sprang. Sprung.

This is the time of year when it's hard to go to work. The weather is beautiful, the birds are singing (did you know male mockingbirds will sing all night long in search of a mate? They will. Especially the ones in my back yard), Max is wanting belly-rubs, there are music festivals and art shows outside in the sun, and I'm stuck inside with patients with disseminated vasculitis and brain stem tumors and stupid, stupid families.

The past few weeks have been a sojurn in the Land of the Tiny-Brained.

For instance, if you have a family member with a fistula that communicates between esophagus and trachea, and that person is unable to swallow in the first place, and has a tracheostomy to make it possible for them to breathe without choking, and the nurse has said six times in the last three hours that you are NOT to FEED that person, why on earth would you try to make them eat oatmeal?

I spent ten minutes deep-suctioning oatmeal out of the guy's lung.

Likewise, if you have the nastiest chest wound in the history of ever, and you're going for your fifth surgery to debride it, and you've been told over and over not to eat or drink anything preparatory to surgery, why would you tell the anesthesiology resident who comes to consent you that, by damn, you *are* going to drink this Dr. Pepper, and he's not going to be around if and when you get aspiration pneumonia, so he shouldn't worry his pretty head?

 Just because you had an LPN license for six months twenty-five years ago does not mean you necessarily know more about anesthesia than the guy who does it for a living.

And, finally, if you have the nastiest stomach wound in the history of ever, one so bad that you had to stuff washcloths in it to keep the pus from pouring out and getting all over your clothing, why would you undo the work of two surgeons, a wound-care nurse, and an hour of OR time to undo your wound-vac dressing and stuff the wound with washcloths again?

"It needs air to heal" is not an acceptable explanation.

I'm not even going to tell you about the disseminated vasculitis patient who screamed. Constantly. And cried and whined and hollered. Not their fault; vasculitis in the brain makes you completely crazy. But still, it's difficult (note ironic use of understatement!) to deal with a screaming, crying, whining, abusive patient for twelve hours straight when the other three people you're caring for hit the call bell Every. Twenty. Minutes. Without. Fail. All. Shift. Long.

And this was, comparatively, a good assignment. The other patients on the floor were worse.

Nobody wants to go to the hospital. No sane person wants to spend any more time than necessary indoors during the six weeks of the year when the weather here isn't actively trying to kill you. That, unfortunately, means that the only people in the hospital right now are both very, very sick and completely nuts. And, according to a newly-delineated Universal Law, the amount of shit you get from a family is inversely proportional to the total number of teeth in the room.

I was considering throwing up my hands and becoming a bank robber yesterday. Or a train robber. On a pink Vespa scooter. With pink leathers and a white full-coverage Bell helmet with a reflective faceplate. And saddlebags with fringes. 

The pharmacist on call looked at me thoughtfully and said, "I'm a little concerned that you seem to have thought this out so thoroughly."

Well, yeah. The one thing that's stopping me is the knowledge that if you get caught robbing trains, your time inside doesn't end at 7 pm. 

A Day In The Life

Getting Better All The Time

There's been an outbreak of what I'm convinced is norovirus at work. Norovirus is That Nasty Stomach Bug family of viruses--the sort of bug that incubates in a day or so and takes a day or two to resolve. Since all nurses work some degree of sick most or all of the time, it makes sense that something that could only be eradicated by bleach and scrubbing might be lurking in the viral soup that is our hospital.

My turn was yesterday. I was pretty damned puny, but Chef Boy brought over bread and ginger ale, and I ate soup and laid on the couch, making noises like the cartoon woman in the introduction to "Mystery!" Today I am better, though not enough better to, say, climb the Matterhorn or work out. I shall (she says, determinedly) finish the laundry and nap.

Sky of Blue, and Brain of Green

What makes your brain the color and consistency of pea soup in about three days?

I wish that were a riddle. Instead, it's something that happened to one of my patients (now dead). Mayo took their sweet time over the biopsies and sent back a detailed pathology report that said, in essence, "We have no fucking clue. Try Hopkins."

It's been about five years since we had a patient who had a true God Only Knows diagnosis. That last one garnered laurels for a couple of fellows in neurology who presented a paper on the patient's decline. What it did not get anybody was a name for that person's condition, a cause, or a cure. 

Dr. Dink, the psychiatrist who writes my prescriptions for Happy Brain Pills, said, "Well, those are the interesting cases, you know." Yeah. Interesting. Because it's never any fun at all when somebody gets better. That gave me an insight into the shrink personality.

Fixing A Hole

Finally, a non-neuroscience happy ending. 

A couple years ago we had a patient with a big hole. I mean a *big* hole, the sort of thing you could easily put your head in. Mediastinitis, it's called, and it's an infection in your chest that's usually caused by rupture of one of the organs there. In this person's case, it was the result of surgical infection. The hole went from the middle of the breastbone down into the belly and tunnelled every which way. It was so badly infected, necrotic, and generally nasty that it took weeks and weeks to heal, and we had to repaint the room after the patient was gone--it smelled that bad.

He's fine. Two weeks ago, he came breezing in, more than a hundred pounds lighter and quite fit, totally recovered, and with only a half-dollar-sized, puckered white scar on his chest to show for his ten weeks of hell. That was nice.

Run For Your Life If You Can, Little Girl

In non-nursey news, I bought a treadmill. I am totally, totally in love with my treadmill, to the extent that I get up a bit earlier every day than I used to and hurple along for a few minutes before I get ready for work. It's quite fine. The cat has no opinion on it, while the dog looks at it with deep suspicion and loathing, but does not actually run off when I start it up. 

The damned thing weighs 300 pounds and has a control panel that looks like it belongs on the bridge of the Enterprise. I haven't yet discovered how to make it do laundry, but it does nearly everything else. It took two guys with experience in the process an hour and much multilingual cursing to put it together and get it working. Man, I love my treadmill.

You Like Me Too Much

I've finally had--and gotten rid of--my first patient-stalker.

It happens to everybody at some point: you take care of a patient who decides for some reason that you're the be-all, end-all, and that (to add to the weirdness) they simply must hang out with you outside of work and be your babydoll. This probably happens much more often to people in the brain business (be it psych or neuro), but hadn't as yet happened to me. 

Well, now it has. A traumatic brain injury will make a person think anything's possible. Thankfully, a combination of carefully-timed hiding in utility rooms and non-diplomatic "go aways" has made that patient, well, go *away*. 

If this ever happens to you, be aware: It's not always something you can predict or prevent. Especially with brain-injured patients, there's not going to be a way to control their reactions to your actions. The simple act of changing a dressing can, for them, become a declaration of your undying devotion. The best way to handle it is the way you'd handle a recalcitrant child: with firm repetition and without panic.

The End.