Thank you, V.S. Ramachandran.
This book, Phantoms in the Mind, is one of those books you never knew you needed--badly--until it came along. I'm a bit late in reading it, like about eight years, but at least I've found it now.
He out-Sackses Oliver. He postulates interesting hypotheses on why people with partial blindness have hallucinations. He has a fantastic theory on phantom limbs that also addresses foot fetishes, and includes a couple of cool experiments that you can try at home with only a cardboard box and a mirror. He gets into the temporal lobe experiments that showed that religious experience is tied to electrical activity in the brain. He makes the connection between the left and right sides of the brain clear and discusses neglect syndrome in that context, brushing against Freud on the way.
In short, this book will get neuro folks excited again about what they do.
I think I'm going to order A Brief Tour of Human Consciousness next.
Tuesday, March 28, 2006
Thursday, March 23, 2006
The Slump
It's ironic, really.
Just when I feel like I've hit a slump, writing-wise, and that I don't have much new to say, a very nice person from a trade publication sends me an email saying, "Hey! We wanna reprint X, Y, and Z weekly from your blog? That okay?" and I say Yes.
After all, how much new can you say every few days about gliomas and spinal cord tumors and customer service initiatives?
The amount of paperwork I do for an admission has quadrupled; the amount I do for a discharge has tripled. That's not as a result of HIPPA or joint commission requirements, it's a customer service plan presented by management.
The risk factors for an incurable brain tumor still include a happy life with well-behaved, intelligent children under the age of ten, a fulfilling job and loving spouse, and a pleasant and even temperment. Mean people never die.
The crack team of transplant nurses a couple of floors down from us are doing a lot of MUDs these days, which is taking a toll on them as a team and individually. MUD stands for Matched Unrelated Donor--it's a bone-marrow transplant of the last-ditch-effort sort--and people generally die, from what I understand, in particularly horrific ways after one. One of their nurses finally cracked about a week ago and left, just like that, because she couldn't stand to see any more twenty- and thirty-year-olds with their skin sloughing off and grade IV diarrhea. We see the nurses, looking haggard and drawn, in the elevators sometimes. We send them anonymous chocolate bars and flowers and do what we can to help them hold it together.
But there are compensations, even when my writing bug goes away for a while and it seems like everybody is dying all at once.
I had two very pleasant, healthy patients yesterday, both of whom had things that were not only curable but curable quickly and with minimal fuss.
One of my other patient's mothers bought me breakfast. Yum.
Another patient took the time to write out complimentary notes for every nurse that had taken care of him, every tech who'd helped him to the bathroom, and every transporter he'd been wheeled around by. No, I wasn't one of those nurses; I just provided names and pieces of paper, but it was nice to see.
I learned yesterday that you have to see the compensations when they come. The compensations might not be on the same scale as the horrific stuff, though. Most people who die in the hospital are sick in ways we can't even imagine--every system they have has shut down, or is screwed up, and they're in pain for a long time before they go. It's an extended, torturous way of dying, and we see it a lot.
Two or three pleasant people who look happy to see you and cooperate in their own care might not seem to compensate for the unfair and unpleasant outcomes of somebody you really liked, but they do--if you let them.
I think all nurses go through whatever this is. It's not burnout. I still want to get up and go to work, I still enjoy what I do when I get there. I still feel incredibly fortunate that I'm able to do what I do, and that there are other people willing to pay me for it. It's just that days are beginning to look the same.
I know it'll pass--this has happened in other jobs before. It's interesting to imagine what'll snap me out of the all-days-the-same mindset, and I'm willing to wait for that.
In the meantime, you guys might have to settle for more posts on potroast and crafts.
Just when I feel like I've hit a slump, writing-wise, and that I don't have much new to say, a very nice person from a trade publication sends me an email saying, "Hey! We wanna reprint X, Y, and Z weekly from your blog? That okay?" and I say Yes.
After all, how much new can you say every few days about gliomas and spinal cord tumors and customer service initiatives?
The amount of paperwork I do for an admission has quadrupled; the amount I do for a discharge has tripled. That's not as a result of HIPPA or joint commission requirements, it's a customer service plan presented by management.
The risk factors for an incurable brain tumor still include a happy life with well-behaved, intelligent children under the age of ten, a fulfilling job and loving spouse, and a pleasant and even temperment. Mean people never die.
The crack team of transplant nurses a couple of floors down from us are doing a lot of MUDs these days, which is taking a toll on them as a team and individually. MUD stands for Matched Unrelated Donor--it's a bone-marrow transplant of the last-ditch-effort sort--and people generally die, from what I understand, in particularly horrific ways after one. One of their nurses finally cracked about a week ago and left, just like that, because she couldn't stand to see any more twenty- and thirty-year-olds with their skin sloughing off and grade IV diarrhea. We see the nurses, looking haggard and drawn, in the elevators sometimes. We send them anonymous chocolate bars and flowers and do what we can to help them hold it together.
But there are compensations, even when my writing bug goes away for a while and it seems like everybody is dying all at once.
I had two very pleasant, healthy patients yesterday, both of whom had things that were not only curable but curable quickly and with minimal fuss.
One of my other patient's mothers bought me breakfast. Yum.
Another patient took the time to write out complimentary notes for every nurse that had taken care of him, every tech who'd helped him to the bathroom, and every transporter he'd been wheeled around by. No, I wasn't one of those nurses; I just provided names and pieces of paper, but it was nice to see.
I learned yesterday that you have to see the compensations when they come. The compensations might not be on the same scale as the horrific stuff, though. Most people who die in the hospital are sick in ways we can't even imagine--every system they have has shut down, or is screwed up, and they're in pain for a long time before they go. It's an extended, torturous way of dying, and we see it a lot.
Two or three pleasant people who look happy to see you and cooperate in their own care might not seem to compensate for the unfair and unpleasant outcomes of somebody you really liked, but they do--if you let them.
I think all nurses go through whatever this is. It's not burnout. I still want to get up and go to work, I still enjoy what I do when I get there. I still feel incredibly fortunate that I'm able to do what I do, and that there are other people willing to pay me for it. It's just that days are beginning to look the same.
I know it'll pass--this has happened in other jobs before. It's interesting to imagine what'll snap me out of the all-days-the-same mindset, and I'm willing to wait for that.
In the meantime, you guys might have to settle for more posts on potroast and crafts.
Monday, March 20, 2006
This is post #326.
I like the symmetry of that number.
I haven't worked in days; all I've got to tell you is old gossip from the unit. Like, it must really suck to have your discharge paperwork in hand and then suddenly hemorrhage and fall over, just like (snaps fingers) *that*, and die. That must just suck.
Just as it must suck to be the nurse whom the priest berates (and this is not gossip; I was there to see it) because said nurse called said priest in on a Sunday to give Holy Communion to a patient. Seems the priest didn't want to have to fight traffic.
Which made Gina, my six-foot-two-inch-tall, Baptist chaplain friend remark, "Well, some get called by God. Other people just get a text message."
Heh.
I've spent the last couple of days doing very little, and today doing quite a lot. For several days this week, it's rained and rained and rained, which we needed badly, and which gave me the excuse on Saturday to stay home in my pajamas, sample a new beer (Konigsberg Haven Quadrupel), and read. Today I hung out with Chef Boy at the grocery store and then went book shopping. I'll fill you in on my neurologically-flavored selections once I've had a chance to read 'em. Right now I'm unapologetically reading James Herriot and waiting for my potato to finish baking.
And I'm kicking myself, because there was a guy selling unidentifiable bits of Hispanic food from a handcart this afternoon, and we didn't stop. Of course, I had tacos carne asada with cilantro and onion in my lap, but who knows? Perhaps he could've had an appetizer in his cart.
Speaking of which, I recently made a mental survey of my neighborhood and found this: it is possible to get elotes from a cart, cabrito, kim chee, baba ganouj, fresh pita and tortillas, and fresh French bread within a two-mile radius. As well as your windows repaired, ironwork done, your saltwater aquarium dealt with, and your Christian bookstore needs taken care of. Oh, and you can get run over by a train, too.
You can keep your lily-white suburbs. Gimme the 'hood, any day.
I haven't worked in days; all I've got to tell you is old gossip from the unit. Like, it must really suck to have your discharge paperwork in hand and then suddenly hemorrhage and fall over, just like (snaps fingers) *that*, and die. That must just suck.
Just as it must suck to be the nurse whom the priest berates (and this is not gossip; I was there to see it) because said nurse called said priest in on a Sunday to give Holy Communion to a patient. Seems the priest didn't want to have to fight traffic.
Which made Gina, my six-foot-two-inch-tall, Baptist chaplain friend remark, "Well, some get called by God. Other people just get a text message."
Heh.
I've spent the last couple of days doing very little, and today doing quite a lot. For several days this week, it's rained and rained and rained, which we needed badly, and which gave me the excuse on Saturday to stay home in my pajamas, sample a new beer (Konigsberg Haven Quadrupel), and read. Today I hung out with Chef Boy at the grocery store and then went book shopping. I'll fill you in on my neurologically-flavored selections once I've had a chance to read 'em. Right now I'm unapologetically reading James Herriot and waiting for my potato to finish baking.
And I'm kicking myself, because there was a guy selling unidentifiable bits of Hispanic food from a handcart this afternoon, and we didn't stop. Of course, I had tacos carne asada with cilantro and onion in my lap, but who knows? Perhaps he could've had an appetizer in his cart.
Speaking of which, I recently made a mental survey of my neighborhood and found this: it is possible to get elotes from a cart, cabrito, kim chee, baba ganouj, fresh pita and tortillas, and fresh French bread within a two-mile radius. As well as your windows repaired, ironwork done, your saltwater aquarium dealt with, and your Christian bookstore needs taken care of. Oh, and you can get run over by a train, too.
You can keep your lily-white suburbs. Gimme the 'hood, any day.
Saturday, March 18, 2006
Good news, bad news.
The good news is that one of my patients whom I thought wouldn't live last weekend is now sitting up and talking. Not making a lot of sense yet, but talking. She knows she's in the hospital and she recognizes people. Two weeks ago I had her in the ICU stepdown unit; one week ago I thought we'd have an empty room when I came back this week.
The other good news is that I'm off for three days, it's pouring rain, and I have ample supplies (Belgian quadrupel ale, science magazines, Good Omens, and French bread) to last out the weekend in my pajamas.
And The Cat is seemingly content. This is *very* good news indeed, as The Cat tends to draw blood when things aren't going her way. (How did I end up with a neurologically-damaged cat? Someday I'll tell that story.)
The final good news is that my pal Heather, Wielder of Hammers, had to bow out of a retail madness get-together today. I wasn't feeling real up to retail, let alone retail in the rain, and Heather shops like the Luftwaffe blitzed London, but with a smile. So here I am, in my pajamas with my quadrupel, pondering the bad news.
The bad news is this: a patient's sister felt it necessary to come see me at work, to let me know that my patient is on life support--or was, since she's probably dead by now--at a different hospital, fifty miles away.
You try really hard in this business not to like people. I mean, you *like* people, otherwise you wouldn't be a nurse. What you try to keep from doing is realizing that a particular patient would've made a really, really good friend had you two not met when she was diagnosed with a rare and aggressive degenerative neuromuscular disease.
You try really hard not to like people that you know you're going to lose soon.
Devic's Syndrome is often referred to as a type of multiple sclerosis, but it's really not. It's much more systematic than MS, and in its way is crueler. First it takes your eyes--the primary symptom of Devic's is a preference for the optical nerve--then it takes your legs, then your bowel and bladder control, and finally your ability to breathe.
All of this happens quickly and without the changes in mentation or personality that happen sometimes with MS.
There isn't really any effective treatment. You can start the person on chemo, and they'll lose their hair (a long-standing joke was that her hair was longer than mine before mine started to grow out), or you can put them on various pheresis therapies that might make them feel better for a time (another long-standing joke was that I used the same vein over and over, in an attempt to carve my initials into it), but really...nothing much will make a difference.
And so, blind and bedbound, with the same interests and intelligence and humor that she had before she got sick, my patient told me that I'd better shape up--or else she'd come kick my butt when she could walk again.
I think both of us knew at that point that she wasn't going to get to kick my butt. Neither of us wanted to admit it.
I had to pass the news on to other people who'd worked with her. That's not fun, either.
"Somewhere, somehow, I know she's going to be healed" said her sister.
I know she will be, too. But what happens to the almost-friends she leaves behind?
The other good news is that I'm off for three days, it's pouring rain, and I have ample supplies (Belgian quadrupel ale, science magazines, Good Omens, and French bread) to last out the weekend in my pajamas.
And The Cat is seemingly content. This is *very* good news indeed, as The Cat tends to draw blood when things aren't going her way. (How did I end up with a neurologically-damaged cat? Someday I'll tell that story.)
The final good news is that my pal Heather, Wielder of Hammers, had to bow out of a retail madness get-together today. I wasn't feeling real up to retail, let alone retail in the rain, and Heather shops like the Luftwaffe blitzed London, but with a smile. So here I am, in my pajamas with my quadrupel, pondering the bad news.
The bad news is this: a patient's sister felt it necessary to come see me at work, to let me know that my patient is on life support--or was, since she's probably dead by now--at a different hospital, fifty miles away.
You try really hard in this business not to like people. I mean, you *like* people, otherwise you wouldn't be a nurse. What you try to keep from doing is realizing that a particular patient would've made a really, really good friend had you two not met when she was diagnosed with a rare and aggressive degenerative neuromuscular disease.
You try really hard not to like people that you know you're going to lose soon.
Devic's Syndrome is often referred to as a type of multiple sclerosis, but it's really not. It's much more systematic than MS, and in its way is crueler. First it takes your eyes--the primary symptom of Devic's is a preference for the optical nerve--then it takes your legs, then your bowel and bladder control, and finally your ability to breathe.
All of this happens quickly and without the changes in mentation or personality that happen sometimes with MS.
There isn't really any effective treatment. You can start the person on chemo, and they'll lose their hair (a long-standing joke was that her hair was longer than mine before mine started to grow out), or you can put them on various pheresis therapies that might make them feel better for a time (another long-standing joke was that I used the same vein over and over, in an attempt to carve my initials into it), but really...nothing much will make a difference.
And so, blind and bedbound, with the same interests and intelligence and humor that she had before she got sick, my patient told me that I'd better shape up--or else she'd come kick my butt when she could walk again.
I think both of us knew at that point that she wasn't going to get to kick my butt. Neither of us wanted to admit it.
I had to pass the news on to other people who'd worked with her. That's not fun, either.
"Somewhere, somehow, I know she's going to be healed" said her sister.
I know she will be, too. But what happens to the almost-friends she leaves behind?
Wednesday, March 15, 2006
Yes, I removed some comments.
Because I don't believe in trolls.
I know they exist, but I prefer to stick my fingers in my ears and sing la la la la until they go away, or until such time as they stop ignoring civilized rules of behavior.
Such civilized rules include:
No calling other posters names. That includes everybody. "Stupid" is no better than "cunt", but I'll remove the most offensive posts first.
No infighting.
No pissyness. That is reserved for me, and me alone, when I'm talking about residents.
...play nice, or go home.
Edited to add: Anon, if you'd like to know *why* nurses at my facility bathe & bag on a regular basis, without our being understaffed, and why we don't have a problem with it, you're welcome to email me. I'm even forgiving the cunt comment for this.
I know they exist, but I prefer to stick my fingers in my ears and sing la la la la until they go away, or until such time as they stop ignoring civilized rules of behavior.
Such civilized rules include:
No calling other posters names. That includes everybody. "Stupid" is no better than "cunt", but I'll remove the most offensive posts first.
No infighting.
No pissyness. That is reserved for me, and me alone, when I'm talking about residents.
...play nice, or go home.
Edited to add: Anon, if you'd like to know *why* nurses at my facility bathe & bag on a regular basis, without our being understaffed, and why we don't have a problem with it, you're welcome to email me. I'm even forgiving the cunt comment for this.
"You ought to be kinder."
That was the ultimate line of an email I got this weekend, from somebody who'd read the blog but hadn't commented.
The gripe the correspondent had was that I, apparently, am not kind enough on my blog--that I bitch and rant and moan and generally take people to task here.
Hm. Let's see why. In the last seven working days, I have:
*Been physically assaulted (thankfully not injured) by a demented patient whose family stood by as he lifted me by one arm and tossed me around...
*Been threatened with shooting by a young man who thought we were being mean to his father by not letting Dad smoke in his room, with his oxygen mask on. (For those keeping score, this now makes three-of-three in terms of times I've been threatened with shooting in healthcare settings.)
*Had to have a little heart-to-heart with a tempermental attending, revisiting points I've made before, such as the concept that calling a nurse a "stupid bitch" isn't going to win friends and influence people...
*Had to mention legal terminology in order to get action on a personnel issue; no further details until later...
*Dealt with a patient who left AMA after it was revealed to him that no, he wasn't going to get any more narcotics...
*Done the work of two people after a nurses' aide simply wandered off the floor in the middle of the shift and couldn't be found for two hours...
*Scoured the hospital complex for a confused patient who was allowed to leave the floor in a wheelchair despite orders to the contrary...
*And was verbally abused by a family member claiming to be a nurse who couldn't understand why we might actually enforce isolation rules.
In between I clarified orders written by residents who don't understand the concept of "PRN means *for* something specific" and "legible handwriting makes the difference between digoxin and Demerol", moved patients up in bed, out of bed, from one bed to another, handled countless bedpans, showered a few people, gave pain meds, passed dinner trays, answered the phone approximately 10 to the 23rd time, comforted the sister of a patient on life support, and bathed and bagged one dead body.
During all of that, except for the bit about being blown away with a shotgun, I managed somehow to keep a cheerful expression on my face and not give in to the temptation to strangle somebody. I didn't yell, I didn't call anybody names; I even threw a few jokes in there now and then. I managed to do a few nice, kind things for a few people that were not included in the daily plan of care. And I made at least one person feel better.
I think I'm kind enough at work, thanks.
The gripe the correspondent had was that I, apparently, am not kind enough on my blog--that I bitch and rant and moan and generally take people to task here.
Hm. Let's see why. In the last seven working days, I have:
*Been physically assaulted (thankfully not injured) by a demented patient whose family stood by as he lifted me by one arm and tossed me around...
*Been threatened with shooting by a young man who thought we were being mean to his father by not letting Dad smoke in his room, with his oxygen mask on. (For those keeping score, this now makes three-of-three in terms of times I've been threatened with shooting in healthcare settings.)
*Had to have a little heart-to-heart with a tempermental attending, revisiting points I've made before, such as the concept that calling a nurse a "stupid bitch" isn't going to win friends and influence people...
*Had to mention legal terminology in order to get action on a personnel issue; no further details until later...
*Dealt with a patient who left AMA after it was revealed to him that no, he wasn't going to get any more narcotics...
*Done the work of two people after a nurses' aide simply wandered off the floor in the middle of the shift and couldn't be found for two hours...
*Scoured the hospital complex for a confused patient who was allowed to leave the floor in a wheelchair despite orders to the contrary...
*And was verbally abused by a family member claiming to be a nurse who couldn't understand why we might actually enforce isolation rules.
In between I clarified orders written by residents who don't understand the concept of "PRN means *for* something specific" and "legible handwriting makes the difference between digoxin and Demerol", moved patients up in bed, out of bed, from one bed to another, handled countless bedpans, showered a few people, gave pain meds, passed dinner trays, answered the phone approximately 10 to the 23rd time, comforted the sister of a patient on life support, and bathed and bagged one dead body.
During all of that, except for the bit about being blown away with a shotgun, I managed somehow to keep a cheerful expression on my face and not give in to the temptation to strangle somebody. I didn't yell, I didn't call anybody names; I even threw a few jokes in there now and then. I managed to do a few nice, kind things for a few people that were not included in the daily plan of care. And I made at least one person feel better.
I think I'm kind enough at work, thanks.
Tuesday, March 07, 2006
Sunday, March 05, 2006
The Bugaloos: They're in the air and everywhere.
(Inspired by the PGY2 resident who now refers to me as "Bugaloo", a nickname I find simultaneously charming and disturbing.)
I am not fanatical about bugs.
Yeah, I scrub my countertops and cutting boards with hot water and soap after I cut meat on 'em, and I wash my hands about forty times a day at work. But when it comes to hugging a patient with HIV, or touching a person on their skin with my bare, clean hand (provided they don't have any open areas, of course), I don't flip out.
Which is why I got so irritated with a couple of coworkers this week.
One of 'em asked me if it was safe to let a newly-diagnosed HIV+ patient to use her pen. For her, not for him.
Once I was done goggling, I said yes. That coworker's trepidation might've stemmed from the fact that this poor guy had herpes lesions *all over* his skin, a result of being undiagnosed for a year or more after infection. Note to the wise: if you end up with a huge skin rash that defies dermatologists, go 'head and get an HIV test. It can't hurt.
Anyway, this guy was quite pleasant, dealing pretty well with the shock of having just been told he was poz. But the HSV lesions presented a problem, one which I dealt with by wearing an isolation gown any time I had to get up close and personal with acreage of his bare skin.
Why? Two reasons:
First, even though herpes is not a tough virus in the sense that molluscum or smallpox is, there's the offchance that a virus or three might survive on my scrubs. I could then conceivably shed that virus elsewhere.
Second, and much more important in this case, my patient has a combination of open sores on his skin and a compromised immune system. Since he hadn't begun any sort of treatment yet, it's a rational step to reverse-isolate with him, especially since I had another patient with Clostridium difficile infection. Bacterial bugs are much more robust than viral particles, and I didn't particularly want to expose Mister T-Cell Count at 2 to any sort of bacterial veneer I might be wearing.
Then came the coworker who commented, as I was briefing a couple of students on the HIV+ patient over lunch, that she'd moved out of her dorm room in college because her roommate had contracted herpes.
God love the nursing students . They all looked carefully blank as I explained to cow-irker that, unless she and the roommate were sharing toilet seats in a way as yet undiscovered by Hustler magazine, she had nothing to worry about.
That sort of thing drives me absolutely up the wall. Even with modern education, I *still* run into nurses who are unwilling to touch HIV positive patients, even as they wander in and out of isolation rooms whistling, not wearing gowns. I *still* run into nurses who haven't the faintest idea how things like Chlamydia, mononucleosis, pinkeye, and hepatitises are transmitted, or who get it all wrong.
Maybe I'm oversensitive, having spent a good deal of time in the past with people who had varying degrees of infectious disease (ooooh, I like that rhyme!). Maybe I'm peevish because I don't like to see people isolated from touch and contact because they have a Highly Publicized Infection That Still Carries A Huge Social Stigma. Maybe I'm grumpy because I wonder what on earth these people were doing in class while I was absorbing information about how and why to keep my patients and myself safe.
The single most important thing we can do for our patients is to touch them without hurting them. Most people they see in the hospital, us included, do many unpleasant things to them. They can go an entire day without being touched in such a way that doesn't cause pain. That's why it's important for us to hug, or squeeze a hand, or stroke somebody's hair: without painless, pleasurable touch, the human soul starts to die.
So yeah, I 'm not fanatical about bugs. I cover my mouth when I cough, I wash my hands, I use standards when dealing with blood and body fluids and nasty oozy things.
But once in a while you have to take off the gloves and be human.
I am not fanatical about bugs.
Yeah, I scrub my countertops and cutting boards with hot water and soap after I cut meat on 'em, and I wash my hands about forty times a day at work. But when it comes to hugging a patient with HIV, or touching a person on their skin with my bare, clean hand (provided they don't have any open areas, of course), I don't flip out.
Which is why I got so irritated with a couple of coworkers this week.
One of 'em asked me if it was safe to let a newly-diagnosed HIV+ patient to use her pen. For her, not for him.
Once I was done goggling, I said yes. That coworker's trepidation might've stemmed from the fact that this poor guy had herpes lesions *all over* his skin, a result of being undiagnosed for a year or more after infection. Note to the wise: if you end up with a huge skin rash that defies dermatologists, go 'head and get an HIV test. It can't hurt.
Anyway, this guy was quite pleasant, dealing pretty well with the shock of having just been told he was poz. But the HSV lesions presented a problem, one which I dealt with by wearing an isolation gown any time I had to get up close and personal with acreage of his bare skin.
Why? Two reasons:
First, even though herpes is not a tough virus in the sense that molluscum or smallpox is, there's the offchance that a virus or three might survive on my scrubs. I could then conceivably shed that virus elsewhere.
Second, and much more important in this case, my patient has a combination of open sores on his skin and a compromised immune system. Since he hadn't begun any sort of treatment yet, it's a rational step to reverse-isolate with him, especially since I had another patient with Clostridium difficile infection. Bacterial bugs are much more robust than viral particles, and I didn't particularly want to expose Mister T-Cell Count at 2 to any sort of bacterial veneer I might be wearing.
Then came the coworker who commented, as I was briefing a couple of students on the HIV+ patient over lunch, that she'd moved out of her dorm room in college because her roommate had contracted herpes.
God love the nursing students . They all looked carefully blank as I explained to cow-irker that, unless she and the roommate were sharing toilet seats in a way as yet undiscovered by Hustler magazine, she had nothing to worry about.
That sort of thing drives me absolutely up the wall. Even with modern education, I *still* run into nurses who are unwilling to touch HIV positive patients, even as they wander in and out of isolation rooms whistling, not wearing gowns. I *still* run into nurses who haven't the faintest idea how things like Chlamydia, mononucleosis, pinkeye, and hepatitises are transmitted, or who get it all wrong.
Maybe I'm oversensitive, having spent a good deal of time in the past with people who had varying degrees of infectious disease (ooooh, I like that rhyme!). Maybe I'm peevish because I don't like to see people isolated from touch and contact because they have a Highly Publicized Infection That Still Carries A Huge Social Stigma. Maybe I'm grumpy because I wonder what on earth these people were doing in class while I was absorbing information about how and why to keep my patients and myself safe.
The single most important thing we can do for our patients is to touch them without hurting them. Most people they see in the hospital, us included, do many unpleasant things to them. They can go an entire day without being touched in such a way that doesn't cause pain. That's why it's important for us to hug, or squeeze a hand, or stroke somebody's hair: without painless, pleasurable touch, the human soul starts to die.
So yeah, I 'm not fanatical about bugs. I cover my mouth when I cough, I wash my hands, I use standards when dealing with blood and body fluids and nasty oozy things.
But once in a while you have to take off the gloves and be human.
Dull is good.
The past week at work has been dull. Dull is good.
Status Migraine Guy is back, but he's calm and his pain is controlled. I don't know about you, but if I had a migraine that had run for two and a half weeks, I'd just chuck myself out the window and be done with it. I've only had one, but that one (and not a bad one, from what I hear) was plenty.
Our Customer Service Scores Tra-La are down for the months of December and January. This is a Big Deal to the management. Consequently, we're neither getting TEAM t-shirts this month (a good thing), and they're putting in place all sorts of bizarre procedures in order to improve Customer Service (a bad thing).
Part of the problem is that the CS scores are determined by questionnaires sent to the patients or the families after their stays. If somebody's either dead or gorked from a major brain injury, there's not a lot of hope that the person or people will find the time to fill out a thirty-question form, rating everything from the food to the cleaning staff on a scale of one to five. One would hope that they'd have better things to do.
Now, when you study mailed questionnaires in sociology class, it's assumed that a forty percent return rate is fantastic. Return rates normally run around 30%, with the majority of those surveys returned from people who have strong feelings--usually negative--about the subject being surveyed. Don't ask me why this is; I don't remember.
Anyway, if you cut the folks who can no longer read and write out of the survey pool, and remove a percentage of the families from that pool because they're taking care of Auntie Mae, you've smallified your return pool to those folks who were a) very sick at the time they came in, b) still have some memory of it, and c) care enough to return a 30-question form after rating things from 1 to 5.
Unfortunately for us, several of the people who returned their questionnaires have one or another type of dementia. One survey came back with three pages of single-spaced ranting attached; another had hand-written complaints about attempted kidnappings and abuse in the margins. There were others not as dramatic.
Those kind of affect the CS scores.
The amusing thing is that every member of Manglement with whom we nurses deal, from the lowliest charge to the uppermost uppity, has forgotten that crazy people skew results. Rather than throwing out three pages of paranoid rantings, they're basing practice changes on them.
Which basically boils down to "Keep your head down and give 'em whatever they want."
The floor nurses have given the new posters, training manuals, and inspiring speeches a collective shoulder shrug and are keeping on keeping on. If you have a patient who's convinced that the guys from the OR are going to kidnap her and sell her to white-slave traders, there's not a lot you can do (outside of, say, Haldol) to improve her Customer Service Experience.
Status Migraine Guy is back, but he's calm and his pain is controlled. I don't know about you, but if I had a migraine that had run for two and a half weeks, I'd just chuck myself out the window and be done with it. I've only had one, but that one (and not a bad one, from what I hear) was plenty.
Our Customer Service Scores Tra-La are down for the months of December and January. This is a Big Deal to the management. Consequently, we're neither getting TEAM t-shirts this month (a good thing), and they're putting in place all sorts of bizarre procedures in order to improve Customer Service (a bad thing).
Part of the problem is that the CS scores are determined by questionnaires sent to the patients or the families after their stays. If somebody's either dead or gorked from a major brain injury, there's not a lot of hope that the person or people will find the time to fill out a thirty-question form, rating everything from the food to the cleaning staff on a scale of one to five. One would hope that they'd have better things to do.
Now, when you study mailed questionnaires in sociology class, it's assumed that a forty percent return rate is fantastic. Return rates normally run around 30%, with the majority of those surveys returned from people who have strong feelings--usually negative--about the subject being surveyed. Don't ask me why this is; I don't remember.
Anyway, if you cut the folks who can no longer read and write out of the survey pool, and remove a percentage of the families from that pool because they're taking care of Auntie Mae, you've smallified your return pool to those folks who were a) very sick at the time they came in, b) still have some memory of it, and c) care enough to return a 30-question form after rating things from 1 to 5.
Unfortunately for us, several of the people who returned their questionnaires have one or another type of dementia. One survey came back with three pages of single-spaced ranting attached; another had hand-written complaints about attempted kidnappings and abuse in the margins. There were others not as dramatic.
Those kind of affect the CS scores.
The amusing thing is that every member of Manglement with whom we nurses deal, from the lowliest charge to the uppermost uppity, has forgotten that crazy people skew results. Rather than throwing out three pages of paranoid rantings, they're basing practice changes on them.
Which basically boils down to "Keep your head down and give 'em whatever they want."
The floor nurses have given the new posters, training manuals, and inspiring speeches a collective shoulder shrug and are keeping on keeping on. If you have a patient who's convinced that the guys from the OR are going to kidnap her and sell her to white-slave traders, there's not a lot you can do (outside of, say, Haldol) to improve her Customer Service Experience.
Monday, February 27, 2006
What I heat up on my day off...
...because I really can't call it cooking.
Warning: girly foof ahead.
The local Quick-ee-Mart had a sale on various frozen entrees this week, so I tried some off-brand eggplant parmesan and a box of frozen fish.
I hesitate to say this, but both of them were quite yummy.
I'm sure I'll bloat up like a pufferfish from the amount of salt they contained, but *damn*. TV dinners sure have come a long way since the 1970's. Not that I ate them then, you understand, Mom being given to soy products and home-made bread, but I remember seeing them in the chest freezers at friends' houses.
It's a good trick to have stashed up a sleeve for one of those nights when, after work, seven minutes seems like too long to wait for dinner. I'm not going to be eating them regularly, though.
In other news, Beloved Sister seems to have settled on a wedding dress. The pattern she loves is the pattern I had originally chosen for a bridesmaid's dress, which is fine and dandy. I was having doubts about the fullness of the skirt for a morning wedding, so I was happy to have her take it off my hands.
Though, as she pointed out in an email, having two people in a wedding wearing the same cut of dress would give the old biddies something to talk about.
In that spirit, I've gone for this:
Hello, Tiger
sans bows and in the narrow-skirt version. The temptation to have it made in black duopioni is almost overwhelming, but that would give the biddies too much to talk about, so I'm thinking of going with a sedate olive green or gold. Maybe even a deep brown, with cut-and-polished hunks of amber to go with. The only requirements for the wedding are "Vintage Preferred" and "You Must Rock, Roll, and Destroy Hotel-Room Furniture, In A Metaphorical Sense, Of Course", so I'm good to go.
Hell, I've got 'till October to decide. If all else fails, I can always find something in orange and silver taffeta with an ass bow.
(This is the point in each post where I normally bring up some fine thing about work, but I am *so* not in the mood this week. The past week has seen collective asses saved by good charting (yours truly's), insane family members abusing patients in my presence, and a knock-down-drag-out between one of the management team and myself, so scruit. Maybe I'll blog about it later; maybe not.)
In the meantime, is anybody doing anything special for Lent this year? I'm observing Eastern Orthodox Lent, primarily because it falls on the Monday following the big Scottish Hoedown, and I want to have a Hair-Down Hoedown this year and drink plenty of warm beer.
I will not be wearing sackcloth and ashes, unless you count Dickies scrubs as sackcloth.
Warning: girly foof ahead.
The local Quick-ee-Mart had a sale on various frozen entrees this week, so I tried some off-brand eggplant parmesan and a box of frozen fish.
I hesitate to say this, but both of them were quite yummy.
I'm sure I'll bloat up like a pufferfish from the amount of salt they contained, but *damn*. TV dinners sure have come a long way since the 1970's. Not that I ate them then, you understand, Mom being given to soy products and home-made bread, but I remember seeing them in the chest freezers at friends' houses.
It's a good trick to have stashed up a sleeve for one of those nights when, after work, seven minutes seems like too long to wait for dinner. I'm not going to be eating them regularly, though.
In other news, Beloved Sister seems to have settled on a wedding dress. The pattern she loves is the pattern I had originally chosen for a bridesmaid's dress, which is fine and dandy. I was having doubts about the fullness of the skirt for a morning wedding, so I was happy to have her take it off my hands.
Though, as she pointed out in an email, having two people in a wedding wearing the same cut of dress would give the old biddies something to talk about.
In that spirit, I've gone for this:
Hello, Tiger
sans bows and in the narrow-skirt version. The temptation to have it made in black duopioni is almost overwhelming, but that would give the biddies too much to talk about, so I'm thinking of going with a sedate olive green or gold. Maybe even a deep brown, with cut-and-polished hunks of amber to go with. The only requirements for the wedding are "Vintage Preferred" and "You Must Rock, Roll, and Destroy Hotel-Room Furniture, In A Metaphorical Sense, Of Course", so I'm good to go.
Hell, I've got 'till October to decide. If all else fails, I can always find something in orange and silver taffeta with an ass bow.
(This is the point in each post where I normally bring up some fine thing about work, but I am *so* not in the mood this week. The past week has seen collective asses saved by good charting (yours truly's), insane family members abusing patients in my presence, and a knock-down-drag-out between one of the management team and myself, so scruit. Maybe I'll blog about it later; maybe not.)
In the meantime, is anybody doing anything special for Lent this year? I'm observing Eastern Orthodox Lent, primarily because it falls on the Monday following the big Scottish Hoedown, and I want to have a Hair-Down Hoedown this year and drink plenty of warm beer.
I will not be wearing sackcloth and ashes, unless you count Dickies scrubs as sackcloth.
Wednesday, February 22, 2006
The horror of the ordinary
Mom and Dad bought me a set of barrister bookshelves for my birthday. They arrived last week, but I only managed to bribe Chef Boy into helping me haul five bulky boxes up the stairs today.
Barrister bookshelves are those nifty things that come in sections, with glass fronts that lift up and slide out of the way. These are a walnut finish, a dark glossy brown, with small brass knobs on the front of each to help you lift-and-slide. They stand just over five feet high, all put together, and sneer at the rest of the furniture in the bedroom with undisguised snootyness.
So I set them up (releasing, in the process, approximately forty metric tonnes of packing material; Dad warned me) and put the books from the shelf they're replacing into them.
Into, that is, one and one-third shelves of them. Maybe one and a quarter shelves.
So, naturally, the solution is to buy more books.
It did occur to me, briefly, to simply move the books from the shelves in the living room into the new shelves. But what good would that do? I'd be left with another set of empty bookshelves (these built by my grandfather) and would *still* have to find something to fill them.
Meanwhile, the desk I use is looking shabbier and shabbier every second. It's one of those Target specials that's meant to look like Mission, except it comes in a big flat box and never quite goes together correctly. Every time I type, there's a subtle oscillation because the nuts and bolts *almost* work.
So, naturally, I'll have to look for a new desk. An antique one, I think, maybe even a rolltop. (Wouldn't *that* be schwank.)
And, now that I think about it, the filing cabinet that sits next to the desk has never been entirely satisfactory either. It's good to hold the printer, but it's another Target buy, from a flat box, with pre-drilled screwholes that didn't quite go in on center.
Or maybe I'll build a desk. They rarely make 'em as small as I need 'em, and I'm not a bad rough carpenter. Chef Boy has a shopful of woodworking equipment and the skill necessary not to remove digits while dremmelling, or whatever you call it.
Anyway, it won't be an ordinary desk. Nor will it be an ordinary filing cabinet that replaces this one. The bookshelves will see to that; they're gazing in disgust at the horror of the ordinary that is my furniture.
Barrister bookshelves are those nifty things that come in sections, with glass fronts that lift up and slide out of the way. These are a walnut finish, a dark glossy brown, with small brass knobs on the front of each to help you lift-and-slide. They stand just over five feet high, all put together, and sneer at the rest of the furniture in the bedroom with undisguised snootyness.
So I set them up (releasing, in the process, approximately forty metric tonnes of packing material; Dad warned me) and put the books from the shelf they're replacing into them.
Into, that is, one and one-third shelves of them. Maybe one and a quarter shelves.
So, naturally, the solution is to buy more books.
It did occur to me, briefly, to simply move the books from the shelves in the living room into the new shelves. But what good would that do? I'd be left with another set of empty bookshelves (these built by my grandfather) and would *still* have to find something to fill them.
Meanwhile, the desk I use is looking shabbier and shabbier every second. It's one of those Target specials that's meant to look like Mission, except it comes in a big flat box and never quite goes together correctly. Every time I type, there's a subtle oscillation because the nuts and bolts *almost* work.
So, naturally, I'll have to look for a new desk. An antique one, I think, maybe even a rolltop. (Wouldn't *that* be schwank.)
And, now that I think about it, the filing cabinet that sits next to the desk has never been entirely satisfactory either. It's good to hold the printer, but it's another Target buy, from a flat box, with pre-drilled screwholes that didn't quite go in on center.
Or maybe I'll build a desk. They rarely make 'em as small as I need 'em, and I'm not a bad rough carpenter. Chef Boy has a shopful of woodworking equipment and the skill necessary not to remove digits while dremmelling, or whatever you call it.
Anyway, it won't be an ordinary desk. Nor will it be an ordinary filing cabinet that replaces this one. The bookshelves will see to that; they're gazing in disgust at the horror of the ordinary that is my furniture.
Saturday, February 18, 2006
Pour, sip, read. Pour, sip, read. Damn.
Just a cautionary note for readers:
I ordered two Bill Bryson books on a Barnes & Noble gift card. Both of them arrived in the mail yesterday. I picked them up from the same apartment office that holds my bookshelves today.
"I'm a Stranger Here Myself" is a very, very funny rendition of what it's like to move back to the US after two decades in Britain. I was giggling at the beginning and laughing so loudly at the end I was afraid I'd bug the neighbors.
Especially endearing was his description of having all his belongings spray across an airport floor: "My hair, concerned and unable to help, went into panic mode." Possessed of Panic Mode hair myself (note: gorgeous ringlets only happen past eight inches in length; before that, hair stands on end), I snorked and snorked and snorked some more.
But: Oh, dear. "In A Sunburned Country" made me want to go to Australia. So much so that the only thing keeping me from running up the credit cards was the bottle of Dalwhinnie, and that to such an extent that I just eyed it balefully and said out loud, "Dear sweet Jesus. Is that how much Scotch I've had? Oy." Pour, sip, read is likely to be my M.O. for the next day or so.
Mom testifies, hand on heart, that the only thing keeping her from Oz is the idea of flying there coach-class. DVTs, apparently, are enough to keep at least one Parental Unit in the Pacific Northwet. One of my colleagues, on a long-term assignment to the cardiac care unit, is planning to go there for three months--at least--in a few weeks. I doubt she'll ever come back, working as she will be in a place where men outnumber women three to one. And she's a natural blonde, too.
I must go to Australia. Beer is the national pastime and the national drink; it's been compared favorably with the state in which I live. Geographic state, I mean, not the state of pour-sip-read. Australia has a whole lot of venomous critters, which means I'd fit right in.
It would only cost me US$2830 for a non-stop. Maybe I could get the credit limit raised.
Edited to clarify: Mom writes that it's not the threat of DVT that's stopping her from flying to Australia again, rather, "it's the idea of having to see a movie like 'Titanic' both over and back.'" Having been subjected to "Dick Tracy" on the way to Denmark and "Titanic" en route to somewhere I can't recall, I sympathise.
Does Qantas have films of cute lil' ol' platypi?
And, (query for those better-versed in monotrematics than I), what exactly is poisonous about a platypus's spurs? What sort of poison is it?
I ordered two Bill Bryson books on a Barnes & Noble gift card. Both of them arrived in the mail yesterday. I picked them up from the same apartment office that holds my bookshelves today.
"I'm a Stranger Here Myself" is a very, very funny rendition of what it's like to move back to the US after two decades in Britain. I was giggling at the beginning and laughing so loudly at the end I was afraid I'd bug the neighbors.
Especially endearing was his description of having all his belongings spray across an airport floor: "My hair, concerned and unable to help, went into panic mode." Possessed of Panic Mode hair myself (note: gorgeous ringlets only happen past eight inches in length; before that, hair stands on end), I snorked and snorked and snorked some more.
But: Oh, dear. "In A Sunburned Country" made me want to go to Australia. So much so that the only thing keeping me from running up the credit cards was the bottle of Dalwhinnie, and that to such an extent that I just eyed it balefully and said out loud, "Dear sweet Jesus. Is that how much Scotch I've had? Oy." Pour, sip, read is likely to be my M.O. for the next day or so.
Mom testifies, hand on heart, that the only thing keeping her from Oz is the idea of flying there coach-class. DVTs, apparently, are enough to keep at least one Parental Unit in the Pacific Northwet. One of my colleagues, on a long-term assignment to the cardiac care unit, is planning to go there for three months--at least--in a few weeks. I doubt she'll ever come back, working as she will be in a place where men outnumber women three to one. And she's a natural blonde, too.
I must go to Australia. Beer is the national pastime and the national drink; it's been compared favorably with the state in which I live. Geographic state, I mean, not the state of pour-sip-read. Australia has a whole lot of venomous critters, which means I'd fit right in.
It would only cost me US$2830 for a non-stop. Maybe I could get the credit limit raised.
Edited to clarify: Mom writes that it's not the threat of DVT that's stopping her from flying to Australia again, rather, "it's the idea of having to see a movie like 'Titanic' both over and back.'" Having been subjected to "Dick Tracy" on the way to Denmark and "Titanic" en route to somewhere I can't recall, I sympathise.
Does Qantas have films of cute lil' ol' platypi?
And, (query for those better-versed in monotrematics than I), what exactly is poisonous about a platypus's spurs? What sort of poison is it?
Lashings of Parmesan
The weather went to shit night before last. In less than a day--in less than twelve hours, actually--the temperatures dropped from 82* to 22* Fahrenheit (for those of you who measure in Cee rather than Eff, that's from 28 to -6). It began to rain, then sleet, then "wintry mix", which translates no matter where you live into something that will coat your car and in which you do not want to drive.
I was prepared. I had stolen a Bill Bryson book, "The Mother Tongue: English and How It Got That Way" from the hospital library, had bought a bottle of Dalwhinnie, and had stocked the fridge with coffee and milk and eggs and bacon.
What I wasn't prepared for was this: that my sister's shipment of birthday presents would arrive this week, as would a five-box shipment containing a barrister bookshelf from my parents. I hauled the boxes from Beloved Sister up three flights of stairs, but left the crates of bookshelf bits in the apartment office. Until such time as I can enlist the help of some poor idiot to haul them up 45 vertical feet, there they'll stay. I wasn't about to carry them myself (or hump them, nod to Paeds RN) because, while they're not particularly heavy or ill-balanced, they are bulky. Three flights of steep concrete-and-metal stairs coated with ice do not mix well with bulky boxes containing glass-fronted bookshelf parts.
Beloved Sis sent many items that could be construed as scrubs or as pajama pants, depending on the offensiveness of their color combinations. I am not being insulting with that observation, by the way; the tag on one particularly strident set of scrubs read "these colors may not be a good idea." She also sent four antique medical books. I *love* ancient medical books--and these, while not particularly ancient (the oldest dates from 1914)--are stunning examples of their type.
There's one on "A girl's responsibility for race progress", one on Our Mysterious Life Glands (with disturbing pictures), one about Reading Character Through Analysis of the Features, and the crowning touch, a book (published in 1931) entitled "Studies In Ethics For Nurses." That last will, I expect, produce plenty of fodder for future blogging, provided I can get through it sober.
Anyway, dealing with that embrass de riches took most of the morning, after which I took a nice long nap. Then I got up and whipped up some spaghetti with things found in the fridge and lashings of Parmesan, and read Bryson and stuffed my face.
Provided I ever get the bookshelf bits up the stairs (that is, if the ice ever melts), "Studies In Ethics For Nurses" will look nice in the top one.
I was prepared. I had stolen a Bill Bryson book, "The Mother Tongue: English and How It Got That Way" from the hospital library, had bought a bottle of Dalwhinnie, and had stocked the fridge with coffee and milk and eggs and bacon.
What I wasn't prepared for was this: that my sister's shipment of birthday presents would arrive this week, as would a five-box shipment containing a barrister bookshelf from my parents. I hauled the boxes from Beloved Sister up three flights of stairs, but left the crates of bookshelf bits in the apartment office. Until such time as I can enlist the help of some poor idiot to haul them up 45 vertical feet, there they'll stay. I wasn't about to carry them myself (or hump them, nod to Paeds RN) because, while they're not particularly heavy or ill-balanced, they are bulky. Three flights of steep concrete-and-metal stairs coated with ice do not mix well with bulky boxes containing glass-fronted bookshelf parts.
Beloved Sis sent many items that could be construed as scrubs or as pajama pants, depending on the offensiveness of their color combinations. I am not being insulting with that observation, by the way; the tag on one particularly strident set of scrubs read "these colors may not be a good idea." She also sent four antique medical books. I *love* ancient medical books--and these, while not particularly ancient (the oldest dates from 1914)--are stunning examples of their type.
There's one on "A girl's responsibility for race progress", one on Our Mysterious Life Glands (with disturbing pictures), one about Reading Character Through Analysis of the Features, and the crowning touch, a book (published in 1931) entitled "Studies In Ethics For Nurses." That last will, I expect, produce plenty of fodder for future blogging, provided I can get through it sober.
Anyway, dealing with that embrass de riches took most of the morning, after which I took a nice long nap. Then I got up and whipped up some spaghetti with things found in the fridge and lashings of Parmesan, and read Bryson and stuffed my face.
Provided I ever get the bookshelf bits up the stairs (that is, if the ice ever melts), "Studies In Ethics For Nurses" will look nice in the top one.
Humpin'.
A tip for those who plan to spend a significant amount of time in the hospital, any hospital:
No matter how long you plan to stay, or how important you think you are, please do not bring your own furniture. And try to keep the amount of stuff in your room to a minimum. Three potted plants and a couple of tchochkes, fine. Twelve, not so good.
Because after I'm done hauling your console table bedside table potted plants various knickknacks bedside table chest of drawers ottoman clothing books magazines two bags full of makeup up three floors and installing them in another room, I will have a serious talk with you and your wife.
And your wife will cry. Not because I'm being mean, hard as it is to believe, but because she wanted to make your room "homey" and "comfortable" and I'm telling her that that's a no-go. Because, see, when the room is full of stuff of varying sizes, purposes, and fragilities, it's very difficult to see how I'll get a code cart into your room if, Frog forbid, I should ever need to.
And, you know, no matter how long you're staying here, please remember that it's a hospital, not a studio apartment. When three-quarters of the stuff I've humped on the elevator is your wife's, there's a problem.
Nobody, and I mean nobody, needs to be keeping a three-quarter length fur coat with fox trim in the closet in their hospital room. Really.
Aside from that forty-five minute period when I was wondering what, exactly, the facility was paying me for as I moved furniture, this was a good week. A busy week, true, with every floor full to the gills and overflow all over the post-anesthesia care unit, but a good week. Nobody coded, the person who *did* seize on me lo those many months ago went home mostly intact, and I only had to pull out the Mean Nurse Jo persona once, on a guy younger and stronger than me with an inch-long incision in his back.
All the faceless people have gone home to heal. One of them will be coming back next week for further plastics work, but that won't be the same caliber of treatment he's undergone thus far, so he ought to bounce back pretty quickly.
The two difficult folks I had this week, one with status epilepticus and one with status migraine, both seemed to respond to the massive doses of drugs we kept throwing at them and have left. Migraine Man went home with a drug that might destroy his kidneys but will keep him pain-free, while Epilepticus Woman went over to the monitoring unit to make sure that she's not having subclinical craziness in her head even on drugs.
The very nice man who came back completely unresponsive died easily and quickly, saving his family the hell of having to wait a week or even two while his breathing slowed down and he got more agonal. That's an odd thing to be thankful for, I guess, but I'll be thankful nonetheless. Occasionally a massive heart attack or pulmonary embolus or re-bleed can be a merciful thing, and not just for the patient.
Drama-filled weeks at the hospital make for great blogging but hellish working conditions. As does hauling furniture.
No matter how long you plan to stay, or how important you think you are, please do not bring your own furniture. And try to keep the amount of stuff in your room to a minimum. Three potted plants and a couple of tchochkes, fine. Twelve, not so good.
Because after I'm done hauling your console table bedside table potted plants various knickknacks bedside table chest of drawers ottoman clothing books magazines two bags full of makeup up three floors and installing them in another room, I will have a serious talk with you and your wife.
And your wife will cry. Not because I'm being mean, hard as it is to believe, but because she wanted to make your room "homey" and "comfortable" and I'm telling her that that's a no-go. Because, see, when the room is full of stuff of varying sizes, purposes, and fragilities, it's very difficult to see how I'll get a code cart into your room if, Frog forbid, I should ever need to.
And, you know, no matter how long you're staying here, please remember that it's a hospital, not a studio apartment. When three-quarters of the stuff I've humped on the elevator is your wife's, there's a problem.
Nobody, and I mean nobody, needs to be keeping a three-quarter length fur coat with fox trim in the closet in their hospital room. Really.
Aside from that forty-five minute period when I was wondering what, exactly, the facility was paying me for as I moved furniture, this was a good week. A busy week, true, with every floor full to the gills and overflow all over the post-anesthesia care unit, but a good week. Nobody coded, the person who *did* seize on me lo those many months ago went home mostly intact, and I only had to pull out the Mean Nurse Jo persona once, on a guy younger and stronger than me with an inch-long incision in his back.
All the faceless people have gone home to heal. One of them will be coming back next week for further plastics work, but that won't be the same caliber of treatment he's undergone thus far, so he ought to bounce back pretty quickly.
The two difficult folks I had this week, one with status epilepticus and one with status migraine, both seemed to respond to the massive doses of drugs we kept throwing at them and have left. Migraine Man went home with a drug that might destroy his kidneys but will keep him pain-free, while Epilepticus Woman went over to the monitoring unit to make sure that she's not having subclinical craziness in her head even on drugs.
The very nice man who came back completely unresponsive died easily and quickly, saving his family the hell of having to wait a week or even two while his breathing slowed down and he got more agonal. That's an odd thing to be thankful for, I guess, but I'll be thankful nonetheless. Occasionally a massive heart attack or pulmonary embolus or re-bleed can be a merciful thing, and not just for the patient.
Drama-filled weeks at the hospital make for great blogging but hellish working conditions. As does hauling furniture.
Tuesday, February 14, 2006
What I Cook On My Day Off When The Flyboys Are Being Assholes
Or, Gosh, I'm Glad I Didn't Have A Souffle In The Oven
Fruit Salad: honeydew melon that actually smelled like melon, alors!, pineapple ditto, alors! strawberries that taste like strawberries, and a can of sour pie cherries. What is *up* with the Quickie-Mart's produce section this week? In addition to thumb-thick asparagus, they had real fruit.
The cherries are in there primarily because I had a can of cherries that I was about to eat all in one sitting and didn't feel like torturing myself.
Rice cakes, made out of jasmine rice squished into a 1/3 cup measure (greased) and quick-fried in ghee until the outsides are crunchy.
To be served with corn relish: fresh sweet corn off the cob, tiny black beans, garlic sauteed until it's golden and crunchy, a hit of soy, a hit of chili paste, and some sesame seeds, toasted. (Weird, I know.)
Thumb-thick asparagus will be roasted. Yum. I got two pounds. Does anybody realize how much TWO POUNDS of asparagus is?
I also made chicken salad with pecans and cucumbers and red bell peppers, all very finely chopped up, and some onion.
About midway through the ghee-making process came the first of three sonic booms. The flyboys from the local AFB were breaking the rules again, making the windows shake and things fall off the shelves and freaking out all the dogs in the neighborhood. They do this about twice a year; fly fast and high over town, so fast you can't see much more than a black speck, and you don't know what's going on until the booms hit. Very irritating.
At least it's better, though, than the yearly airshow. My apartment is under the takeoff path at the municipal airport. When the airshow comes to town, I get treated to the sight and sound of dozens of WWII and Korean War-era bombers and fighters laboring up into the air entirely too slowly. I'm always afraid that the last remaining model of whatever rare bomber is there this year won't make it and will crash into my roof.
The biplanes and triplanes aren't as bad. You get the feeling that one could run straight into you and it wouldn't hurt, much.
In other news, my birthday was Sunday. Chef Boy took me to brunch, where we ate entirely too much and I had three mimosas (gee, mimosas are good! Why didn't anybody tell me before?) made from mandarin orange juice. The restaurant is Argentinian, the food is pricey but plentiful, and I'll never want to eat scrambled eggs again.
Beloved Sis sent a copy of a book that's been out of print for years ("The Dog Days of Arthur Cane") and which I'm saving for dinner reading.
And that is all. I have no work stories, having been mercifully absent from The Land Of Brain for three days now.
Fruit Salad: honeydew melon that actually smelled like melon, alors!, pineapple ditto, alors! strawberries that taste like strawberries, and a can of sour pie cherries. What is *up* with the Quickie-Mart's produce section this week? In addition to thumb-thick asparagus, they had real fruit.
The cherries are in there primarily because I had a can of cherries that I was about to eat all in one sitting and didn't feel like torturing myself.
Rice cakes, made out of jasmine rice squished into a 1/3 cup measure (greased) and quick-fried in ghee until the outsides are crunchy.
To be served with corn relish: fresh sweet corn off the cob, tiny black beans, garlic sauteed until it's golden and crunchy, a hit of soy, a hit of chili paste, and some sesame seeds, toasted. (Weird, I know.)
Thumb-thick asparagus will be roasted. Yum. I got two pounds. Does anybody realize how much TWO POUNDS of asparagus is?
I also made chicken salad with pecans and cucumbers and red bell peppers, all very finely chopped up, and some onion.
About midway through the ghee-making process came the first of three sonic booms. The flyboys from the local AFB were breaking the rules again, making the windows shake and things fall off the shelves and freaking out all the dogs in the neighborhood. They do this about twice a year; fly fast and high over town, so fast you can't see much more than a black speck, and you don't know what's going on until the booms hit. Very irritating.
At least it's better, though, than the yearly airshow. My apartment is under the takeoff path at the municipal airport. When the airshow comes to town, I get treated to the sight and sound of dozens of WWII and Korean War-era bombers and fighters laboring up into the air entirely too slowly. I'm always afraid that the last remaining model of whatever rare bomber is there this year won't make it and will crash into my roof.
The biplanes and triplanes aren't as bad. You get the feeling that one could run straight into you and it wouldn't hurt, much.
In other news, my birthday was Sunday. Chef Boy took me to brunch, where we ate entirely too much and I had three mimosas (gee, mimosas are good! Why didn't anybody tell me before?) made from mandarin orange juice. The restaurant is Argentinian, the food is pricey but plentiful, and I'll never want to eat scrambled eggs again.
Beloved Sis sent a copy of a book that's been out of print for years ("The Dog Days of Arthur Cane") and which I'm saving for dinner reading.
And that is all. I have no work stories, having been mercifully absent from The Land Of Brain for three days now.
Friday, February 10, 2006
The sun's over the yardarm *somewhere*.
Another entry in the Person With No Face contest:
Weird eye tumor extending into the bone of the skull near the temple and up over the brow. Weird eye tumor (and half the patient's face) removed by our crack team of Weird Eye Tumor Removal Pixies. Weird eye tumor site becomes very swollen and starts to leak Weird Eye Tumor Post-Removal Fluid.
So here comes one of the Pixies with a giant needle attached to the end of a giant syringe and whams it into the person's face in order to draw out some of the fluid.
I left the room precipitously.
And I did not have the egg-drop soup for lunch, no sir.
In other news, Amazon has a nifty widget I'm thinking about getting to carry lunch in. The bento box has always appealed to me, but a bento jar? Even better.
I also may have a supplier for my vintage glasses and sunglasses fetish. My crazy optometrist has a crazy father who recently found a cache of new-old-stock 1950's and 1960's glasses frames. He's promised to bring some of the best ones to the shop so that I can spend my hard-earned tax refund on them. Cat's eyes, here we come!
It's raining here, for the third time since July. I've promised myself a beer and a nap, in that order, so I'm off to get started.
Weird eye tumor extending into the bone of the skull near the temple and up over the brow. Weird eye tumor (and half the patient's face) removed by our crack team of Weird Eye Tumor Removal Pixies. Weird eye tumor site becomes very swollen and starts to leak Weird Eye Tumor Post-Removal Fluid.
So here comes one of the Pixies with a giant needle attached to the end of a giant syringe and whams it into the person's face in order to draw out some of the fluid.
I left the room precipitously.
And I did not have the egg-drop soup for lunch, no sir.
In other news, Amazon has a nifty widget I'm thinking about getting to carry lunch in. The bento box has always appealed to me, but a bento jar? Even better.
I also may have a supplier for my vintage glasses and sunglasses fetish. My crazy optometrist has a crazy father who recently found a cache of new-old-stock 1950's and 1960's glasses frames. He's promised to bring some of the best ones to the shop so that I can spend my hard-earned tax refund on them. Cat's eyes, here we come!
It's raining here, for the third time since July. I've promised myself a beer and a nap, in that order, so I'm off to get started.
Wednesday, February 08, 2006
The joke around here is...
....that there'll never be a "CSI" set here, because there's only one DNA sample and no dental records.
I just watched a neighbor pour about a gallon of used oil onto the parking lot, with no plans to clean it up. Genius.
It has been an annoying day.
I just watched a neighbor pour about a gallon of used oil onto the parking lot, with no plans to clean it up. Genius.
It has been an annoying day.
Tuesday, February 07, 2006
Coolest Thing Ever....
Care for another monotreme? This one not in Australia?
Oooo. I get so cheerful and happy and giggly when I read things like this.
I will never be a normal goil.
Oooo. I get so cheerful and happy and giggly when I read things like this.
I will never be a normal goil.
Monday, February 06, 2006
Simplify, simplify, simplify!
Thoreau never had a cell phone, that's for sure. And a land line, and a T1 connection for his computer, which he also didn't have. Still, I'm taking his words to heart--in this case. I'm ignoring the bit about "beware any enterprise that requires new clothes" as Beloved Sister would probably not be happy if I showed up in sweatshirt and jeans to her wedding. "Who's the chippie in the sweatshirt? Is she the bride?" "No, the one in the big white dress is the bride."
Anyhow. I'm ditching the land line (not yet, Mom; I'll give you plenty of warning) and switching cell phone plans to the one that lets you talk for four hours for $29.99 rather than the one I have, which charges double that much for nothin'. And I've got a new cell phone coming at some point, thanks to Working Assets Wireless (yes, Dad, that hippy liberal commie pinko phone company) that will replace my two-ton dinosaur-fueled current cellblock. They say they're sending me a phone that takes pictures. Who'da thunkit? With the technology available nowadays, somebody really ought to make a new version of "King Kong". That would be cool.
I've also cleaned out my fridge and the cabinet under the sink in the bathroom, so I can tell if I have soap or not. Mom and Dad left me with the legacy of the 1970's in that I am always prepared for stagflation, invasion by Cuba, or nuclear war. I have so much backstock of everything from soap to water that the local Mormons are envious. (No joke. I have, like, *edible* stuff backstocked. Not mixes.) Chef Boy, not being much of a backstocker and not ever having lived with a chemical toilet in the pantry (the pantry built, by the way, especially to stock Perma-Pak dried foods and vacuum-packed wheat), is scared. I think he thinks I have a complex.
I planted basil seeds today in those little pop-up peat pots that come in 12, 24, or 36-pot sets. That'll save me from having to drive thirty minutes to find more than an ounce of one kind of basil for $6.99. This might not be considered *simplifying*, exactly, since I'll now have to take care of three different basil plants, but it'll save me some bucks. Plus, those little peat starter kits are just too damned cute.
So, if I head out next days off (in eight days) and get me one o' them mighty-fine rollup shades of shadecloth, I should be able to get a little container garden going on the porch. Believe me, with the money I spend on produce (the farmer's market guys smile when they see me coming), this is simplifying.
I wonder if I could grow melons on the third floor, or if that would constitute an unreasonable hazard to my downstairs neighbors.
Anyhow. I'm ditching the land line (not yet, Mom; I'll give you plenty of warning) and switching cell phone plans to the one that lets you talk for four hours for $29.99 rather than the one I have, which charges double that much for nothin'. And I've got a new cell phone coming at some point, thanks to Working Assets Wireless (yes, Dad, that hippy liberal commie pinko phone company) that will replace my two-ton dinosaur-fueled current cellblock. They say they're sending me a phone that takes pictures. Who'da thunkit? With the technology available nowadays, somebody really ought to make a new version of "King Kong". That would be cool.
I've also cleaned out my fridge and the cabinet under the sink in the bathroom, so I can tell if I have soap or not. Mom and Dad left me with the legacy of the 1970's in that I am always prepared for stagflation, invasion by Cuba, or nuclear war. I have so much backstock of everything from soap to water that the local Mormons are envious. (No joke. I have, like, *edible* stuff backstocked. Not mixes.) Chef Boy, not being much of a backstocker and not ever having lived with a chemical toilet in the pantry (the pantry built, by the way, especially to stock Perma-Pak dried foods and vacuum-packed wheat), is scared. I think he thinks I have a complex.
I planted basil seeds today in those little pop-up peat pots that come in 12, 24, or 36-pot sets. That'll save me from having to drive thirty minutes to find more than an ounce of one kind of basil for $6.99. This might not be considered *simplifying*, exactly, since I'll now have to take care of three different basil plants, but it'll save me some bucks. Plus, those little peat starter kits are just too damned cute.
So, if I head out next days off (in eight days) and get me one o' them mighty-fine rollup shades of shadecloth, I should be able to get a little container garden going on the porch. Believe me, with the money I spend on produce (the farmer's market guys smile when they see me coming), this is simplifying.
I wonder if I could grow melons on the third floor, or if that would constitute an unreasonable hazard to my downstairs neighbors.
Many apologies....
First, to those of you who couldn't access the blog reliably over the last couple of days: Blogger has been having some unscheduled downtime for the last week as they migrate things and try to fix disks. There's going to be another outage this evening at 7 pm PST. The Blogger folks say that'll be the end-all, be-all fix.
Second, to those of you concerned that I might either leave nursing altogether or move to Seattle and disappear, don't worry. I think it was a combination of too little sleep and too much "Dancing With The Stars" that put me in such a foul mood.
I had planned to make chicken biryani this week, but a patient with an AVM pretty much blew those plans. Arterio-venous malformations aren't uncommon in people's brains, but they can appear anywhere on the body, sometimes with disturbing results. One of the most disturbing things is the color of the skin around them; it looks a lot like biryani before it's cooked.
This particular patient had an untreated facial AVM that was about the size of my hand, fully extended and with fingers together. I wear a size 7 glove, by the way, so that ain't a small AVM. The thing had displaced her right eye down onto her cheekbone and had puffed her eyelids out (and the rest of her periorbital tissue) to the point that the right side of her face looked like nothing human. When your eyeball and eyelid extend past the end of your nose, that's a problem.
Apparently the thing had come up suddenly and had grown so fast that there wasn't much she could do about it; AVMs can be like that. We'd embolized the thing a couple of times already, and she'll have surgery to remove it today. She'll lose her right eye--there's nothing we can do to replace an eye that's been displaced that far for more than a few hours--and will need some pretty extensive plastic surgery to minimize scarring, but at least she'll keep most of her skull.
Which is not the case, unfortunately, with another patient. This one had had basal cell cancer on his nose and had had it frozen off years before. Note to the interested: NEVER have a basal cell carcinoma removed by freezing. The process might not get all of it, and you may end up with a migrating basal cell cancer that invades your sinuses, your eye socket on one side, and your frontal bones.
Whereupon we would have to remove the whole damned upper quarter of your face and replace it with a flap graft from your scalp, or thigh, or chest. This is not a way to spend a week, never mind the disfiguring consequences of having thigh skin and muscle taking up what used to be your eye socket and frontal sinus.
Still, even that's better than having some piece of artillery go all crazy on your ass and blow off one side of your face. I'm not sure if it was a shoulder-mounted grenade launcher or what; all I know is that Walter Reed did all they could for the guy and then shipped him to us for definitive plastics and skull reconstruction. Thankfully his brain escaped harm, though I don't know how. We got him for a couple of days so that we could do the cranial reconstruction; he'll be shipped down a few floors sometime this week for the facial part of the deal.
All those, though, pale in comparison to what it must be like to be the parents of a twelve-year-old with a major aneurysm. Unruptured, so the question is this: should we go ahead with a carotid sacrifice and try to bypass and remove the aneurysm, knowing that our kid will likely be gorked out and severely disabled for the rest of his life, or should we skip the surgery and try to control his pain, living with the knowledge that the aneurysm could blow at any point and kill him?
You can see why "Dancing With George Hamilton's Tan" seemed like a good idea at the time.
Second, to those of you concerned that I might either leave nursing altogether or move to Seattle and disappear, don't worry. I think it was a combination of too little sleep and too much "Dancing With The Stars" that put me in such a foul mood.
I had planned to make chicken biryani this week, but a patient with an AVM pretty much blew those plans. Arterio-venous malformations aren't uncommon in people's brains, but they can appear anywhere on the body, sometimes with disturbing results. One of the most disturbing things is the color of the skin around them; it looks a lot like biryani before it's cooked.
This particular patient had an untreated facial AVM that was about the size of my hand, fully extended and with fingers together. I wear a size 7 glove, by the way, so that ain't a small AVM. The thing had displaced her right eye down onto her cheekbone and had puffed her eyelids out (and the rest of her periorbital tissue) to the point that the right side of her face looked like nothing human. When your eyeball and eyelid extend past the end of your nose, that's a problem.
Apparently the thing had come up suddenly and had grown so fast that there wasn't much she could do about it; AVMs can be like that. We'd embolized the thing a couple of times already, and she'll have surgery to remove it today. She'll lose her right eye--there's nothing we can do to replace an eye that's been displaced that far for more than a few hours--and will need some pretty extensive plastic surgery to minimize scarring, but at least she'll keep most of her skull.
Which is not the case, unfortunately, with another patient. This one had had basal cell cancer on his nose and had had it frozen off years before. Note to the interested: NEVER have a basal cell carcinoma removed by freezing. The process might not get all of it, and you may end up with a migrating basal cell cancer that invades your sinuses, your eye socket on one side, and your frontal bones.
Whereupon we would have to remove the whole damned upper quarter of your face and replace it with a flap graft from your scalp, or thigh, or chest. This is not a way to spend a week, never mind the disfiguring consequences of having thigh skin and muscle taking up what used to be your eye socket and frontal sinus.
Still, even that's better than having some piece of artillery go all crazy on your ass and blow off one side of your face. I'm not sure if it was a shoulder-mounted grenade launcher or what; all I know is that Walter Reed did all they could for the guy and then shipped him to us for definitive plastics and skull reconstruction. Thankfully his brain escaped harm, though I don't know how. We got him for a couple of days so that we could do the cranial reconstruction; he'll be shipped down a few floors sometime this week for the facial part of the deal.
All those, though, pale in comparison to what it must be like to be the parents of a twelve-year-old with a major aneurysm. Unruptured, so the question is this: should we go ahead with a carotid sacrifice and try to bypass and remove the aneurysm, knowing that our kid will likely be gorked out and severely disabled for the rest of his life, or should we skip the surgery and try to control his pain, living with the knowledge that the aneurysm could blow at any point and kill him?
You can see why "Dancing With George Hamilton's Tan" seemed like a good idea at the time.
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