Hi. My name is Jo, and I am totally demoralized.

Or not. It's been a rough week.

I talked to the friendly folks at the employee benefits office on Tuesday about the Ongoing Drama Of The Obturator. (For those of you coming in late, the prosthetic I wear to replace my palate/protect my airway/allow me to eat, drink and talk was not paid for by insurance. Given that the whole process cost as much as a new car [Hyundai, not Mercedes], I was a little peeved by that, especially given that the insurance company [Blue Cross/Blue Shield of Texas] first denied that it was medically necessary, then failed to follow their own rules on covering prosthetics.)

So I appealed, all the way to the Office of Employee Benefits. Beloved Sister and I worked up and sent a multi-page appeal letter complete with charts, diagrams, copies of reciepts, photographs of my mouth post-Harrowing, and ninety other things. The nice folks from the OEB asked me to send them a couple of additional pieces of paperwork, which I did. . .and I waited. They told me the whole kit and kaboodle had gone to some doctor who reviews things like this for them, so I waited.

And waited. I had no idea how long it would take for said doctor, who probably has a desk full of appeals, to get his head around mine.

So, when I called on Tuesday, I was expecting that things might not be fresh in the OEB's hivemind, given that the submission date for my appeal was back in March. I was not expecting them to tell me that the case had been closed for lack of documentation.

Well, to be more exact, first they told me that there wasn't anything there. Then they told me that yes, they'd found the file, but it'd been closed for lack of documentation.

Now: given the eight-page letter (with charts, diagrams, and circles and Xes on the back) and the two times I faxed the same information to my contact at the OEB, this was not what I was expecting. The nice contact at the OEB told me it would take her a couple of days to get everything together (right after she told me that everything was printed out and gathered up) for her boss to look at, so he could decide what was going on. So I told her I'd be calling her first thing Friday morning.

I am, to be nice about it, gob-fucking-smacked at this whole thing. I mean, I understand if they deny the appeal. Even though BCBSTX claims to reimburse non-network providers of prosthetics at 60% of cost, and even though they claim to reimburse at standard market rates (manifestly untrue; they actually reimburse less than Medicare or any other provider), I can see that they could finagle a way to deny my claim. That is, after all, their business.

Let me be a little more clear for you: The purpose of an insurance company is not to leverage your premiums into providing efficient, quality care for you. The purpose of an insurance company is to make money for their shareholders.

However, going back to the OEB: the University of Texas is a huge system, with many, many employees. The Office of Employee Benefits is, by necessity, the sort of bureaucracy that can handle that volume of employees. You would think that they could, at some point, have sent me a letter--not a certified letter or a wax-sealed scroll via elephant, just a letter--to tell me that they'd closed my file because I hadn't submitted some document or another.

Or, alternatively, they could've contacted me at the address, two telephone numbers, or email address that they had to let me know they needed more paperwork.

But they didn't.

Somewhere, somebody fucked up. I intend to find out who it was, and make them figure out how to fix it.

At first I was coldly enraged. I told Beloved Sis that the noise she was hearing was the sound of the bolts that hold Hell down shearing loose. Then I spent two days feeling horribly sick and depressed and stressed out. It's amazing how canalized anxiety becomes in the body.

Now I'm just peevish and determined.

Peevish. And determined. Very determined.

Odds, Ends, Updates

OEU the first:

I saw Dr. Crane today and had my tongue yanked around and both of his hands in my mouth at the same time. The exam was clean, the MRI looked "great" (his words; he's not given to superlatives) and I don't have to see him again until February. I won't have any scans then, either.

I said, "No scans?" He told me that at two years, in his experience, it's safe to begin backing off the surveillance scans and just go with eyes-on exams. It's simultaneously exciting and weird to know that my interior doesn't have to be irradiated for everybody's psychological comfort. I worried before every scan; now I'll worry that I'm not *having* scans.

"Nearly cured" is a strange place to be.

OEU the second:

Now that I've told Mom, it's time to tell you guys: I'm dating somebody. Seriously. As in, Talking Marriage Serious. He's marvelous beyond description, with just enough of the annoying human things that everybody has to keep him normal, and I've known him since we were both teenagers. His name is Brother In Beer (yes, the one who sent the lovely flowers after surgery). He's intelligent and funny and sweet and writes beautifully and routinely throws himself down rocky hillsides while perched on a bike. (Yes, he wears a helmet.)

I'm pretty stoked.

OEU the third:

Work sucks. We're staffed for twelve in the surgical CCU and have eighteen to twenty patients every day--even our code bed is full--which means that the staffing in the neuro CCU has been short. If everybody in the SCCU is tripled, they can't exactly send two people to help us out in the NCCU with our six or seven patients.

Plus, we've been having a rash of codes lately.

OEU the fourth: 

Aside from the staffing thing at work, things are going really well around here. I've not been *here* as much as I'd like; there's a lot of writing I've been doing for money that cuts into my blog time. As soon as I get this month's stack of articles sent off, though, I'll tell you funny stories about the Guy With No Memory At All and touching stories about bunnies.

Basically, this summer can be summed up in one well-known phrase: Two out of three ain't bad.

Semi-demi-hemi-annual MRI today!

And no, I don't have the results yet. I won't for several more days.

This was how it went:

http://www.marriedtothesea.com/072412/

This was me this morning. . . .

...when I'd discovered I've been drinking decaffeinated coffee for the last ten days.



GIFSoup

This was in my back yard an hour ago.

Yes, they really are that big. That's a tarantula hawk. It's a critter that eats nectar and pollen, but lays its eggs in tarantulas.

And no, that is not my hand. I've seen a lot, and even held a hissing cockroach, but I'm not that butch.

At first, I was terrified. Then I came around to the idea that this incredibly large critter, which kinda hops around in flight, is pretty cool. I just don't go outside when she's around. Luckily for me, they're not a communal species.

So, yeah. Tarantula hawk in my back yard. Friend La Belle Dame Sans Merci posted to my Facebook page, "This means you either have lots of tarantulas in your back yard, or a lot of tarantulas with hatching T-Hawk eggs in them."

I thanked her for being such a fucking comfort in my time of distress.

Good Lord, it is hot. And humid.

I've just done all my cooking for the week, except for assembling salads, which are best assembled at the fifty-ninth minute of the eleventh hour. Protip for those of you too hot to eat real food: cut up a shitload of vegetables all at once and put them into little containers. Assemble your nommable salad before work out of the little containers. Seriously, this is the best thing I ever learned from Serious Salad Eaters.

We got a doohickey to fill out this week from our Big Boss, about how our Lesser Bosses are doing. Instead of boring you with the boxes I checked, I figured I would put down the letter I wrote in my head while assessing my bosses for a dozen things which do not matter to anybody but management:

Dear Big Boss,

You want my opinion on my other two bosses. You even sent me a survey form to fill out at a third-party website, with the assurance that my replies will be completely anonymous and confidential and not be prejudicial to my continued employment with Sunnydale General.

Instead of filling out yet another useless survey (because, really, whether or not I'm being given positive feedback on how I'm doing my job is not a major issue around here), and because I know as well as you do that surveys are neither anonymous nor non-prejudicial, I've decided to tell you what I really want in a boss.

For starters, I'd like fewer of you. I have four at last count: Small Boss, Bigger Boss, you, and your Horizontally-Equal On The Org Chart Colleague. Of those people, I see Small Boss the most, with Bigger Boss coming in a very, very distant second. I've seen you exactly four times in the last two years, and your Horizontal Equal not at all. The way I figure it, it's ridiculous for me to submit memos about how I plan to hang educational posters in the family room for Horizontal Equal's approval, since she's never, to my knowledge, seen the family room I'm talking about. Maybe we could take her out of our org chart's hierarchy? While we're at it, could you either show up regularly or just stay away?

Because, really, your visits here contribute nothing to the smooth running or the "culture" (whatever that is) of the CCU. You've shown up once to bitch about the placement of warning signs, once to introduce me to somebody I'll never see again, once to warn me about a VIP showing up, and once because, I dunno, somebody in Manglement complained that you weren't showing up enough. Honestly, your visits take time away from my patients and fuck up my train of thought. If I had the chance to get used to you, or didn't see you at all, things would be much, much better.

While we're on the subject of bosses, it sure would be nice if my Bigger Boss had an inkling of what happens in a critical-care unit or on a stroke unit. See, he has about six months of CCU experience, and that was years and years ago. Our old boss, whom you chased off, used to lead codes. Our current boss stands around looking impotent and gets in the way. Maybe he could be retrained to work in a critical-care setting, then work a shift or two a month to keep his skills up. That way, we could at least use him as a charge nurse when there are four nurses, all of whom are tripled, and not enough support staff to make a dent in our patient loads.

It would also kick ass if Bigger Boss and Small Boss made sure that people who work in my NCCU actually have the certifications you claim to require for employment here. So far, I'm the only person who works here who has all of them. We've been open three years (in August), and that seems like plenty of time for folks to do the online NIH course and the other required stuff. It'd be awfully nice if I could give report to another nurse and not have them go jaw-sagging blank when I say something like "hemiparesis" or "gaze preference" or "NIH score of 16."

Finally, if you're really dedicated to a complete reworking of the Culture of the Institution, hire some more damn people. If need be, hire unqualified people with a modicum of brains; I'll happily train them. Just get me some bodies up in here, so I'm not forced to work day in and day out with nurses who are floated here from the CVICU. It's not fair to them, and it's not fair to our patients. They can spot a-fib from a mile away, but they're not used to doing neuro assessments and don't understand our BP parameters. Have mercy on the nurses who are more comfortable with a Swan-Ganz than a ventriculostomy, and Get Me Some Damn Staff.

Oh, wait: that wasn't my final point. My final point is this: if you're going to hold me responsible for stuff, and yell at me when it doesn't get done, or pass things off to me, and expect me to work extra and train new people, the title of "Mangler" would be peachy fucking keen. I have to admit that it's not the title I'm after so much as the pay grade. In any event, since we're speaking of Bosses, you're making me a FIFTH layer of boss-ness between the people I work with and the real world, and I'd like to be compesnated for it.

Much love and many happy capybara kisses,
The one who makes sure the plumbing gets fixed,

Jo

In which Auntie Jo lays down the law.

I love my job I love my job I love my job I love my job.

However.

People: Please research the symptoms of whatever disease or disorder you're going to try to mimic. Most physical troubles, including neurological ones, have a certain expected set of symptoms. Even conversion disorder has an expected course: while the physical manifestations of psychological stress might be weird and unexpected and unexplainable by other means, they're consistent.

A stutter that goes away with opiates is not a disease. It's an attempt to get drugs.

Likewise, there's a name for what you're doing: it's "abasia-astasia," and it means "No, she won't fall over and hurt herself; she'll only fall if I'm there to catch her or she's near something soft."

And frankly? If your weakness is distractable to the point that you yourself cannot remember which side you're weak on, I will call bullshit on your shenanigans and send you out the door tout suite.

I don't just have the population of Greater Sunnydale to thank for this; I have the combined Great Minds at Holy Kamole's emergency department. Therefore, I have some law to lay on them:

If you call and ask me to accept a stroke patient, you'd sure as shootin' better have done an NIH stroke assessment on that patient and be able to tell me his score. If you haven't, I'll tell you to call me back once you've assessed the patient, then hang up the phone gently.

Same deal if you call me with a patient who has a constellation of symptoms and you don't know his history. Same deal if you call me and say, "Well, we're not really sure what's going on, but we'd like to send him over to your NCCU."

Same fucking deal, dear doctors, if you call with a ninety-year-old, demented patient who has a temp of 38.2, whose labs show that he's dehydrated and has a UTI, and who is experiencing the same symptoms he had when he had his stroke two years ago. Incidentally, he's therapeutic on coumadin.

And, just as a reminder, if I accept this patient because I want to put a stop to your whining, but specify that he is to go to the regular neurology floor, do not under any circumstances then tell the bed board that I'd cleared him for a bed in the NCCU. The Wrath of Jo will be visited, not upon your grandchildren's grandchildren, but upon you, comprehensively and cheerfully.

This is because, as might be expected in a critical care unit, I actually have sick people to take care of. I got one on a Cardene drip, one with the most labile blood pressure I've ever seen, good Lord what is she doing going from 220 systolic to 77, maybe an abdominal binder would help, and one who is, sadly, getting ready to go home to Jesus due to a combination of factors, not least of which is an infection with some bacterium that only two people have ever gotten before. I got problems, in other words, because I got patients with problems.

Joe-Bob looking for a hit of dilly is not a problem. At least, he's not *my* problem. He's *your* problem. If you try to make him my problem, you'll have another problem, and probably a whole set of problems of varying, interesting types, right after that.

Thank you, as Katniss said, for your consideration.

Good God I love both of these people, whoever they are.

Here

and

Here.

This is what happens when I try to live like a normal person. . .

Neighbor Beth is here. She's wiping down the kitchen as I slowly, slooowly type this, for reasons which will become clear in a minute.

Those of you who follow me on Facebook will know that I had a cheerful afternoon of productve semi-drunkeness with Neighbor Beth (who is Not Good With Blood). After the prosecco had worn off, and with a liter of water and tea under my belt, I mandolined my right ring finger.

There was a sudden spray of blood. Then there was a heartfelt "Oh, SHIT" from me, as I realized that the suddenly-numb sensation in my right paw was due to my having halfway cut off my right ring finger. I tried everything: direct pressure, flour, glue: nothing worked for longer than I care to think about. Poor Beth, who hates her own blood and has a tenuous relationship with other people's blood, mopped up mine for the 40 minutes it took for shit to stop happenin'.

I'm more than a little annoyed that this happened while I was sober. Beth is more than a little annoyed that she had to scrub blood off my spice shelves. AND I had to throw away a perfectly good, blood-soaked tea towel.

None of the zucchini was affected, though. Which is good: we have a Pickle Party coming up in two weeks.

I kind of wish I'd accepted Beth's offer of another bottle of wine. My finger hurts.

Good Frogs. Has it been that long?

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

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

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

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

Well, not really.

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

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

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

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

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

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

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

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

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

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

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

Okay. Enough with the overmedical jive.

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

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

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

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

Max.

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

I really need to stop yelling at my boss.

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

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

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

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

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

Big Drama at Sunnydale.

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

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

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

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

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

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

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

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

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

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

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

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

For The Boy.

0:04 at Casa Del Snotbags

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

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

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

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

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

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

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

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

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

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

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

My poor Max!

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

Vampire flies. On my boy.

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

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

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

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

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

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

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

Clean CT!

No nasties in my chest.

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

(glances over at my face)

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

"It makes me want to hug people."

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

"Until they stop breathing."

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

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

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

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

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

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

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

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

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

Twiddle, twiddle, twiddle. Check email. Nothing.

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

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