Wow.

Just...wow.

I opened my email box yesterday afternoon, about an hour and a half after posting "Gee, Officer Krupke!" and found more than two dozen emails. Some were comments on the blog postings about my brain; others were just emails, sent to say "hang in there" or "throwing yourself under a bus is a bad idea" or "look at me; I'm stable and healthy and have been doing this for thirty years".

I can't thank you all enough. It's a relief to know, of course, that you're not alone, but it's also a relief to know that there are people in the world who are nutjobs like me but who can also use paragraph breaks and spell correctly.

A couple of points I need to clear up: I am not going to toss myself off a high building, or even a low one. Suicide is not attractive in the least.

Also, I'm feeling better. Either I have the fastest chemical-reaction time known to man or this is the placebo effect; either way, I'm not arguing. This happened the first time I upped my dosage of Effexor, from 37.5 to 75, even though "everybody says" that it takes a week or two. I'm a little speedy yet, but feeling much better.

Too, I think I figured out what Doc Pedro meant by "rapid cycling". The last time I saw him was March of 2005, and he didn't get the date right. He thought I'd gone from peachy to miserable in three months, not in fourteen. Regardless, I'm still going to find a shrink. I got a little grumpy when I realized Pedro hadn't read my chart right, for Chrissake, but that just reinforces my next two points:

Doctors are human and can screw up, especially in minor ways, especially when they're stressed out; and,

It's never a bad idea to hold up a hand and say "Wait. Stop. I don't understand." If *I* can fail to do that, as somebody who's used to dealing with doctors all the time, *anybody* can.

Still, shrink it is. Brain chemistry is a specialty, and I have some questions about my med that Pedro couldn't answer.

Thank you all again for your emails and comments. It was really and truly like being borne up on a huge wave.

Cue "Gee, Officer Krupke!"

"You--take him to a headshrinker!"

So I saw my pal Pedro, also known as Doc Pedro, PCP, today.

Doc Pedro wasn't having the best of days. Somebody's grandchild was trying to systematically dismantle his waiting room as somebody's grandchild's grandmother made a big stink about nothing, and in walks his primo, pure-dee, brass-plated Headcase Du Jour.

Poor Doc Pedro. He's sending me to a headshrinker. On accounta, she says, channelling Action and Riff, I'm depraved. And on account of the "cyclical nature of my depression." Yes, he really talks like that.

Never mind that four years of good control on Effexor is the longest damn cycle I've ever seen, Jack, and maybe he got me mixed up with somebody else; I'm headed off to find a psychiatrist.

All joking aside, there's a definite period of adjustment when you come to terms with the fact that you need medication to function like a normal person. Then your medication gets doubled on the same day that your PCP tells you he can't really manage your care any more, and you're forced to look at yourself in the sunshade mirror of your car and say,

I am mentally ill.

I have a chronic condition that is not curable, but is manageable with lifestyle changes and medication.

I will be doing this the rest of my life.

Whereupon, driving up the street, it suddenly made sense to me why some people actually kill themselves.

I, of course, not wanting to deprive the Reading Public of my thoughts, did not drive my car under a bus. Instead, I went out and got an order of nachos with extra guacamole and drank a beer. Then I considered my plight.

I am mentally ill. I will be doing this the rest of my life. I will be managing, with any luck, my illness with lifestyle changes and medication. Forever.

Then I swallowed another Effexor. Doc Pedro doubled my dosage today, given that all my symptoms are those of somebody whose body has grown accustomed to Effexor. He wasn't willing to change my meds, fearing that that would merely confuse any other practitioner I consulted.

So, here I am. I'm depraved, not on account of I'm deprived (unless it's some intrinsic genetic failing), but I'm depraved. Just knowing that I have some problem that he can't help me fix makes me feel better. You know those questionnaires that you take, where the max score is 21? I got 18. I think anything over 15, for him, merits a referral.

I swear to Frog I'll find the silver lining in this. (See? My mood's improving already.) It might take a while, but I'll find it.

Meanwhile, I have to find a shrink I can handle. Good thing I work on the Brain Unit, eh?

Reflections of a Nutjob

It has come to my attention that I am a nutjob. Not a hard-core nutjob (meaning, I take only one medication, and the lowest effective dosage of that one), nor an unmedicated nutjob, but a nutjob nonetheless.

Please. I am not "depressed" or "differently serotonined". Euphemisms are for the differently brained. I am nutso. A whackjob, if you prefer that terminology. A crazy. Whoo-whoo-whoo, a la Moe of the Three Stooges. I have a shopping list of things that gets me through the day, most of them mind-altering substances of varying availability (Caffeine, Effexor, Caffeine, Simple Carbohydrates, Norepinephrine, Effexor, Scotch, and venlafexine for dessert). I have been known to have anxiety attacks for no particular reason, and in fact had one today.

So. In the spirit of past Things To Do lists, here's:

What To Do If You Know A Whackjob, Version One-point-Zero

1. Do not, under any circumstances, indulge their desire to talk about nuclear holocaust or other forms of apolcalypse. See, whackjobs get anxiety in weird ways, and this is one of them. Steer them away from the David Brin and onto the Spider Robinson, where everything turns out okay.

2. Do indulge their desires for simple carbohydrates and alcohol, within reason. Carbs raise serotonin levels while alcohol in moderation can keep the garden-variety nutcase from jumping off a bridge. Make sure it tastes good, and you'll have accomplished another goal: showing the loonie in question that tomorrow is indeed another day.

4. Crazymeds dot org (thanks, Anon, for the correction!) is an excellent resource website for both the interestingly-brained and their friends and relations. True, there are some postings on the site what will make you say "Wooo. Buh?", but overall, it's a nutjob presenting what it's like to be a candidate for the whackshack with grace and humor.

5. If your crazy pal needs a warm body around, be that warm body. I cannot tell you what a difference it makes from the loonie perspective to have somebody around who can quote Bloom County and make coffee. It's invaluable.

6. If you work with even one other person, do not make denigrating comments about crazy folk at work. That one other person might be me, and I might be on a short leash due to my antidepressants not working all that well, and then there might be a lot of mess to clean up. Crazy people *are* different from you, yes: we're often smarter and more creative. We're certainly posessed of a well of nastiness that you can't even conceive of. So be nice.

7. Answer the phone at 3 am.

8. Don't pressure the nutcase in question to go out in public with you. Often, nutcases such as myself can't muster the energy to go to the bar or a restaurant. It's simply too overwhelming. Bring by a clamshell of Chinese instead if you really want to see me.

9. Make sure the nutcase keeps their doctor's appointments. This is not such a problem with the minorly-medicated, but can be a real issue with those of the brotherhood who take multiple meds or meds in major doses.

10. If in doubt, call 911. I am not saying here that this has ever been an issue for me. I have been blessed up to this point with having not had any serious thoughts of self harm....but I can certainly see how some people might.

If you work with, live with, or love a moderately- to severely-depressed person, or a person who deals with bipolar disorder, keep in mind that calling the fuzz in might someday be necessary. This does not mean that you or the other person has failed; it's a modern response to an age-old problem that used to drag the median lifespan down. Think of it as your way of boosting our national life expectancy.

Tomorrow I see my Muppet-like doctor. We'll talk about how to regulate this pinkish lump of neural tissue behind my eyes. I'll certainly, since everything is fair game here, keep things updated.

Frog Soup

I feel like the guy in the cartoon who brings his car into the shop, complaining that it's running rough, only to have the mechanic point out that he's missing two wheels on one side of the vehicle. *There's* yer trouble, with the understood "dipwad" coming as a modifier.

My antidepressants aren't keeping up with changes in my brain chemistry. Oh, boy. It took me a while to realize this, but now I'm on board.

Funny thing, depression: it's a lot like that old wives' tale about putting the frog into a slowly-heating pot of water. By the time you realize there's a problem, you're nearly Froggy Consomme. There's a long history of Frog Soup on the female side of our family; the previous generations mostly self-medicated with alcohol and charity work, but the women of my generation and Beloved Mom's generation have pharmaceuticals.

However, even modern medical miracles can sometimes lag behind when it comes to the Wonder That Is The Jo-Brain, so I'm snarkier and less energetic than usual. (Comments about how this makes me a super-snarky three-toed sloth will not be approved, people.) And in that nonenergetic, snarky mode, I bring you....

Rules for Stupid People, Some Of Them Residents, Part Three Thousand and Sixty-Five

1. If I page you post-call, it's not because I like playing with the pretty buttons on the phone. It's because you've written the prescription wrong, failed to include your DEA number, and written for over the maximum allowable dispensation of narcotics. So don't snark when you call me back.

2. If you don't call me back, even after I've paged you 911, don't snark when I get your attending to deal with it. I *will* start removing your digits if that happens.

3. Stamp your fucking H & Ps, okay? I can't let an unmarked H & P, lacking any indication of who it's on, just sort of migrate into a chart somewhere. Digit removal, people, digit removal.

4. I don't date residents. Ever. Stop asking already.

5. Pathologists are not allowed to turf. If you attempt to turf over a biopsy that should've been in my lab five days ago, things will get nasty indeed. I don't care who you are or who you work for; I have a guy whose brain is turning to mush, probably because of something infectious, and we needed that biopsy last week. You think I'm snarky with the residents? You should see me with attendings, who *ought* to know better.

6. Don't drive 45 in the left lane. Even if you're in a Prius. Thank you.

7. Don't ever, ever tell me that I need to have more information, or a better grasp of the information available, before I come to you with a question. I might then be forced to point out (in front of either your attending or your fellow, whichever is there) that you haven't left a note in the chart in, oh, three or four days. That will suck. And not for me.

8. I don't care how much of a genius you are: if you start to jack around in somebody's spine without wearing a mask and gown in addition to your sterile gloves, I'll stop you. And if you snark at me, one of us will be sad later. Hint: it will not be the nurse who had to reinforce proper sterile technique.

9. If I've ordered a scan with and without contrast, I really do mean "with and without", regardless of whether you think the contrast will be helpful. Trust us on this one, okay? Thanks.

10. Dictation can be fun! Really! They offer a free lunch every Tuesday and Thursday down in the dictation cave so that you can dictate what you should've dictated ten days ago and eat at the same time! It's great! You should try it!

It struck me about a year ago that the life of a nurse goes like this: Know All, See All, Fix All. It also struck me that we really, as a professional group, ought to agitate for better ways to get other people to do their jobs better. I'm thinking either a mass issuing of Super Soakers or some slingshots and M & M's as ammo.

MBTs and my MCL: Not Quite a Love Story

I have strained my right MCL. That's apparently a ligament in my knee (I don't remember; I was drunk that day in A & P, I guess) that does something like keep one's knee from bending at some crazy angle toward one's other leg. Mine is strained, not torn, which is a good thing. It means that I can still shop for groceries and do laundry and work, though I do all those things with a limp and a pronounced disinclination to squat, and it also means that I won't need surgery.

It happened like this: I had just gotten out of a nice, hard 30-minute workout on the treadmill and exercise bike, and spotted my buddy Bunsen. Bunsen's half Golden Retriever and half Traveling Salesman, as Mom would say, and is about a year old and about 80 pounds. He's also enthusiastic about playing Chase The Ball And Then Tackle The Human. We played Try To Tackle The Human for about twenty minutes, during which time I had to feint repeatedly to each side...while wearing my MBTs.

When you buy the things, they come with a little booklet that cautions you to be careful of doing things that require lots of feinting to each side. They also caution you against doing things that require a combination of balance and weight, like lunges. What they don't caution you against is being a blasted idiot, so of course I went out and was a blasted idiot.

The chief of the ortho department's reaction was this: "Dude. Bummer. A week or two. Ice. Bummer." (Yes, he really talks that way.) Chef Boy's reaction was this: "Wow, that was stupid." (Yes, he's really that supportive and gentle.) Chef Boy did provide me with an ice pack and some ibuprofen last night, though, and I was able to head out and pick up coffee and bread today. I'm going to spend the rest of the day icing this dadratted knee off and on and reading fashion magazines.

Tomorrow starts a week of intensive upper-body training and, I guess, very little in the way of aerobic exercise. I suppose I'll have to wrap my leg, or something, to provide extra stability while I'm wandering around work.

Take-home from this experience: Do not, under any circumstances, no matter how happy he is to see you, play with a puppy pal while wearing your MBTs. Run home and change your shoes first.

Huzzah. Nnnng.

This is post #350. Huzzah. Nnnng.

Meh. That's all I have to say today: meh.

This morning's workout didn't go all that well, and then Chef Boy added insult to injury by guilting me about not wanting to go to the pool with his kids. Never mind that I was surrounded by pots, pans, half-empty jars of spices I've not used in a couple of years, and a few plastic and Pyrex containers I'd never seen before. I was cleaning out the kitchen cabinets, obviously, and not in any shape to trot into a swimsuit and go to an indoor pool.

Meh.

The crazies have come out of the darkness at work. They're all lined up in the chairs in the family waiting room: from the person who wants gait training for her semi-vegetative daughter (who's been like that for, oh, about twelve years now) to the family member who insists that she *will* read her husband's chart *whenever* she likes, they're all there. If they're not there, they're getting underfoot, attempting to 'help' with things like moving people, changing dressings, or (I kid you not) inserting central lines.

Note to crazies: your daughter hasn't bothered to open her eyes except to pain for twelve years. Gait training is not a possibility. Also, you may *not* read the chart, it's against the rules. And finally, if a resident is putting in a central line or lumbar drain, or if I'm putting in a Foley catheter, the last thing we need is your grimy little paw in our way.

To those of you nice enough to send me links and do your own trackbacks: I promise, promise, *promise* I will get to blogrolling you either tomorrow afternoon or this weekend, whichever can provide more coffee and chocolate. I'm terrible about updating things, I know, and I plan to do a major update...sometime soon. Promise. Really.

Nnnng. Meh. Blar.

I think I'll cook today. That'll make me feel better, having a clean and well-organized kitchen with good and happy and well-cooked food in the fridge.

But first I'm going to go chew my cuticles and say "meh" some more.

This is the coin.

They sat her up every morning at eight, put makeup on her face, and dressed her in a sweet pink bedjacket with lace around the collar. They begged her to eat, to get into a chair, to walk around the floor and go to the gift shop, even after she had a pathological fracture from the cancer that was eating her body from the inside out.

Her daughter dressed her in clothing that wouldn't reveal the mass that was growing on her side, a mark of the cancer that had come back, or the tubes that came out of each side of her chest to drain the fluid that was accumulating there.

We'd talked about hospice, but they wouldn't hear of it. Mom was going to get better, by God, and she'd have surgery to fix that arm, even after the orthopedic surgeon told them there was no chance of it healing.

Finally, after admissions at three different hospitals, they took her home. They'd heard the same thing at three different places. It was obvious there wasn't any hope, that her best chance at comfort was morphine in her own bed. All they'd let her have with us was ibuprofen. She hurt all the time.

She died the day after they left our floor.

***

They were both shocked when the doctors came in with the news: tests showed that he had, at most, a few hours to live. Life expectancy is funny that way: you can go from weeks to live to hours to live in almost no time.

Still, he wouldn't take morphine. Not because she wouldn't let him, but because (his words) he didn't want to lose the hours he had left. They'd been married forty years, and she'd been with him through all the important times, so he wanted to be with her now, when he was dying.

He lasted four and a half hours. They lay together on the bed, holding hands, talking about how wonderful their lives together had been. At the end, he got sleepy, so she cuddled his head into her shoulder and held him even after he'd stopped breathing.

This is the same coin, the coin that has hard-won, painful life on one side and a gentle death on the other. The one side is selfishness and pain, the other is acceptance and love.

These are the coins that we pay the ferryman with.

MBTs and me: a product review

So I got some new shoes the other week: Masai Barefoot Technology, they're called, and all I have to say about that is this: if the Masai have to spend the amount of money on their bare feet that I had to spend on these shoes, it's a wonder they can eat.

Anyway, I promised a review of the shoes.

They were recommended to me by a number of orthopods and physical therapists for plantar fasciitis. That's a condition in which the bottom of your foot stretches too much, or doesn't stretch enough, or something, and you end up with heel pain that makes it nearly impossible to walk after a day of work. So, taking a deep breath, I ordered a pair of these babies online.

Consider the MBT shoe: it is big. As in, it looks like a basketball's been cut in half and glued to the underside of the shoe. In addition, it has some sort of rocker action, the upshot of which is that when you stand normally, you actually have to balance your weight over the middle of the shoe. This led Chef Boy to ask, "Do they come with training wheels?" a reference to my fabled clumsiness. My sister remarked that that quip led her to consider Chef Boy her hero, and I said, "Shut up."

So you've put the things on and are balancing cheerfully in the middle of your foot. Or, alternatively, you've rocked back onto your heels so as to not have to waggle constantly to stand up. The first thing you notice when you start to walk is this: they're a very well-balanced shoe. As in, even *I* can't fall over in them. So snark away, Chef Boy and Beloved Sister, I'm doin' all right.

The second thing you notice is how heavy the damned things are. I don't know what sort of technology the engineers stuck into the oversized soles of these shoes, but it seems to be made of lead and gold. They're *heavy*.

That said, my heel hurts about the same after a day at work. But! On the morning after, it does not hurt *at all*, which means that I can pretty much walk to the bathroom rather than having to hobble and curse. Also, they do give my legs a good workout--not so much at work, since I'm used to walking around for twelve hours, but boy hidey! After a thirty-minute trot on the treadmill, I can feel muscles I only dimly remember from comparative anatomy class.

I can also run in them for several minutes at a stretch, having to stop only because my aerobic capacity is shit, not because my shins hurt. That is good. Very, very good.

And, strangely or not, the rocker-action of the shoe makes it easier to walk fast or trot than it does to walk slowly. That's nice, especially when you're trying to get as many miles in on the treadmill as you can. You have to walk with a shorter stride and in a more concentrated manner, or else your toes will brush the ground and you'll lose your rhythm. It's more like a forced march than a walk, but then, treadmilling is always more like a forced walk for me.

I'm sitting here contemplating the insertion points of my quadriceps--I can feel all of them, on both legs--after a thirty-six minute trot on the treadmill in the shoes. That's okay. My heel hurts a little, but not terribly, which is better than okay. And my bank account hurts a little more, but I'm dealing with that.

Bottom line: If you're happy with your Danskos, keep 'em. If, however, you spend the majority of the day wondering when the hell your heel will quit hurting, it's worth it to try a pair on to see if they work for you.

No big surprise here...

You Are Wolverine

Small but fierce, you're a great fighter. Watch out! You are often you're own greatest enemy. Powers: Adamantium claws, keen senses, the ability to heal quickly

Which of the X-Men Are You?

I need an intervention.

Tonight, after realizing that people really *don't* get any less annoying when you know them better, I had the following for dinner:

A large handful of cherry tomatoes. Okay, two large handsful.

Bacon.

Coleslaw.

Beer.

In slightly more cheerful news, this is the way of eating that has sustained me for years: weird food at weird hours, heavy on the vegetables and complex carbs, light on the meat. (I don't consider bacon meat; it's more a condiment.) I went back to it after three weeks on South Bitch sent my blood pressure to 150/100, shock! My BP is now back in the basement where it belongs.

In even more cheerful news, Carolita handed me an antique ad from a medical journal that she'd culled from among the equally antique books at her mother's house. It begins with the line "Experience Is The Best Teacher", references Camillo Golgi (a famous 19th-century neuroscientist), and ends with the claim that "More Doctors Smoke Camels Than Any Other Cigarette." It's now framed and resting atop the bookshelf that holds my ancient medical books.

Beloved Sister had the unenviable experience of interviewing a candidate for a job today who'd put semi-naked pictures up on his website. Oooooh, nipples. Love 'em. I wonder if her head has actually exploded, or if her brain simply oozed out one ear and crawled away across the conference room.

Speaking of brains, the Seriously No Kidding Single Most Squicky Thing I've Seen Recently came home to roost the other day: a guy who hadn't bothered to wear his seatbelt and went through the windshield of his car...and then had his frontal lobes (well, most of 'em), his sinuses, and his frontal skull removed.

There's a divot in his skull that I could put my fist in. Eugh. And no, he's not doing much these days.

Nor am I, except going to bed.

This had better be all for a while. Dammit.

The last two days at work have been...well.

Mister Annoying Screaming Man came back a*gain*. Mr. ASM is one of those frequent-flyers who has some dementia, though not enough to keep him quiet and compliant, and who does things like leave his walker across the room at home and take repeated face-plants into the linoleum. The first six or seven times he came back, it was cute. It's not cute any more.

I took his care over about an hour before my shift ended and went to start an IV. He's been in the hospital before. He's been stuck before. He knows the drill, remembers it, knows he has to have a saline lock in his arm. Why, then, when I pierced his skin with the needle, did he scream and dope-slap me on the back of my head?

I jerked, the IV start needle ripped upward through his skin, and blood splattered my face and scrubs. That made a nice contrast to the vomit, feces and urine I'd already been splattered with.

Earlier that day I'd had the sort of patient everybody dreads--a brittle type I diabetic who refuses to manage his blood sugar or stick to his diet. There's a certain type of person you know is going to be trouble, usually shortly before he goes in to DKA or his glucose dumps down into the teens, and this was that guy. After a hearty breakfast of five (!!!) glazed donuts, coffee with sugar, and some chocolate milk, he started feeling a little tetchy. He was kind enough to unload breakfast on my shoes--thank God I was wearing my old Danskos--and my scrubs. Lovely.

The vomit was joined a short time later by shit. And sweat. There's some Universal law somewhere that says that isolation patients with nasty intestinal bugs must a) weigh something on the wrong side of 400 pounds, and b) want their thermostat turned up to 85. You know those plastic isolation gowns? They don't protect worth a damn.

There was no isolation gown nearby when my seriously demented patient yanked out her Foley catheter and started waving it around, speckling everybody with pee. Of course, she was on pyridium.

*sigh*

Chef Boy floated the idea of moving to Brazil and running a B & B last night. You know, there are times when moving to the Southern Hemisphere, learning Portugese, and living in the middle of nowhere tending orchards and sheep seems like a really fine idea.

Oh, and I did get the IV started on the second try. A combination of barely-controlled rage on my part and several towels wrapped around his bleeding hand kept him quiet.

The Glamorous Life of a Neuroscience Nurse

Hugh called *again* last night, sobbing, stumbling drunk, begging me to take him back. I've got to change my number; he just won't leave me alone.

It was fun in the beginning, when all we did was have quick dinners out, followed by long evenings of piano-playing, tap-dancing, and singing Judy's old songs. He loved my rendition of "The Man Who Got Away", especially when I did it as though I was half-smashed, wearing huge false eyelashes.

Then I made the mistake of telling him I liked his sideburns. After that, things began to go downhill. He was always so *serious*, talking about how we could move north, excavate a little den of our own, and raise a few litters of kits. He just couldn't understand that I wasn't ready to settle down, especially not with such a player. I mean, what about Kate? And don't tell me that that kiss with Meg was all acting.

So I told him as gently as I could that we'd have to go our separate ways. He took it hard. But really, what's a girl to do?

Plus, the claws were, frankly, a pain.

Therapeutic Communication

"Roll over" I said.

"So you can see my incision?" he asked.

"No, so I can kick your no-good ass," I replied. "You've been giving me grief all day, and I've had it up to my moustache with your antics."

"Gobsmacked" would be the best word to describe his expression at that point.

The call bell system was dead. The cable was dead. The plumbing was under the control of some evil spirit. All of this had happened on the third day of his having to be flat on his back due to a low-pressure headache, and he was fed up. So he called the operator, the receptionist, the concierge, the assistant to the assistant to the President, and complained.

The one person he didn't call was me.

For two days he'd been cursing at nurses, throwing things, and generally making a pain of himself. The last nurse to take care of him had exited the room with some speed as the sound of smashing crockery came from behind her. This is a nurse whose dad was a Merchant Marine, so it's not like she couldn't handle it. But she couldn't handle it any more. So I went in to resite an IV that was giving him trouble, cussed right back at him, and got him for the full twelve hours the next day. Seems he liked my style.

I pointed out to him, at varying volumes and at some length, that he was paying me to make his life easier. Why, I asked, would he pay a lawyer to accomplish in two weeks what I could manage in two minutes if he simply gave me the chance? Why risk being branded a whiner when I could get him what he wanted (short of fixing the cable myself, which he seemed to expect) with a minimum of trouble and effort? Why, essentially, did he insist on being the most difficult of difficult patients--one with a legitimate complaint who says nothing until the pot boils over--rather than answering my questions honestly and letting me *make his life easier*? I'd tried to draw him out earlier, a number of times, and he'd simply waved me off.

Screw therapeutic communication. Sometimes it doesn't work. Sometimes it does, true; there are times when a patient simply needs a listening ear and somebody to say "Uh-huh, and then what?" over and over. But--and this is a big and delicate but--there are times when you have to throw it out the window and be blunt. Speak the language, as they say. Walk the talk.

He gave me cookies and a hug and an apology. I walked out with a smart remark and a toss of the head. We understand each other now; even if there's another crisis in the middle of the night tomorrow, I know he'll behave like a human being rather than the whistle on a teakettle.

*** *** ***

In other news, I'm rereading Bill Bryson's book on Australia. If you hear that I've cleared out my savings account and taken up a job travel nursing, you'll know what to expect: bulletins from the billabong.

*** *** ***

The Cat seems to love the Feliway Comfort Zone diffuser I got her. It's a pheremone-squirting widget that you plug into an electric outlet--supposedely, it combines "friendly pheremones" in such a way as to make cats happier and more relaxed. All I can say is this: after four hours of having the thing putting away, The Cat laid down in the middle of the floor and purred, allowing me to rub her belly. That hasn't happened in nine years. Maybe the neurologically-damaged Cat just needed some Happy Kitty Smellatrons; I dunno. I'm not questioning the results. (Mom: Try it for Astro.)

*** *** ***

The MBTs are, so far, a revelation. I'll let you know how they continue to work out.

Non-Work-Related, Part Deux

Girly Product Reviews, part Nine Gazillion

Amlactin Lotion

Friend Penny swears by this stuff for wrinkles. I haven't yet tried it on my face, but it works wonders on very dry legs and feet. It doesn't smell like anything, either, which is nice. And a little goes a long way; a lot will cause your skin to just sort of give up and peel off.

Flexitol Hand Balm

Another recommendation from Friend Pens, the Lotion Slut. She actually recommended the Heel Balm this way: "If there were something that worked on the rest of my life as well as Flexitol works on my heels, it would be called Dammitol."

The hand balm is petroleum-based, which means you can't use it during working hours, but it makes a nice overnight treatment for very rough, dry hands. It was originally developed for diabetics. It's easy to wash off and odorless, and again, a little goes a long way. Also good for feet.

Sally Hansen Beyond Perfect Nail Polish

I bought Whore Red (no, that's not the name, but it might as well be), painted my toenails with it, and they stayed unchipped and extremely shiny for three weeks. Plus, it came off with a minimum of strain. The only warning on this one I can come up with is, you'd better get a color you like. It'll be there for a while.

Old Navy Capri Pants, pickstitched, Just-Below-Waist

I found out after I bought two pairs of these that they were "Real Simple" magazine's pick for best capris for people under 5' 5" tall. Now, that's too much of a categorization for me, but I *did* buy two pairs of these pants. The waist is low, but not so low that you get that overgrown-teenager look. In fact, if you're short-waisted, the waist will hit *almost* at your natural waist, thus avoiding the Mom Jeans look and the muffin-top simultaneously. They wear like iron. I wash them on Boil and dry them on Broil and they don't shrink.

Gap (I know, I know) Flared Linen Skirt

At $68, this is a 'spensive piece of clothing...but I've already patterned two other skirts off of it and they're ready to hit the sewing machine. Good thick linen lined with cotton, eight gores, zip closure, French seams that should last forever. If you're short, do not mess around with the regular sizing; go for the petite.

This skirt hits at the natural waist and hangs almost to the ankle. It's perfect for people who live where the summers are sunny but who don't want to wear SPF 45 all over every damned day.

As soon as I get the MBTs in the mail, I'll review those too. Provided I don't fall off them and break my neck.

Non-work related

Sometimes a girl just has to turn her back on the brainstem, you know?

We were talking at work the other day about beautiful words: words that have their own intrinsic value as sounds, like "sycamore". Or "glioblastoma". Or "brook". We came up with quite a few, but the best remark came from a foreign doctor who remarked that "pus" was the best English word he'd ever learned. "Sounds like what it is and what it looks like. There's no question, when you hear the word 'pus', what the other person is talking about."

Apropos of nothing, United Nude shoes has usurped the place that Irregular Choice used to have in my heart. Any company that puts out a pump based on the Eames chair gets my vote. Unfortunately, I have no excuse whatsoever to buy even the least-pricey of their designs, as I just dropped a couple bills on some MBTs. They come highly recommended by the orthopods and physical therapists at work. Chef Boy's reaction was, "Do they come with training wheels?" No, but they do come with an instructional DVD, which kinda scares me. Still, if they ease my plantar fasciitis, they're worth it.

Pal Joey has a wedding to go to in Quebec City while I'm in Montreal this July. Anybody know of anything I should see or do while I'm there? Keep in mind that my French is limited, rusty, and slow.

Simple rules.

1. If you have to jack with it, it's wrong.

This goes for everything from IV tubing to new shoes to long-standing romantic relationships. If you have to jack with the tube-feeding tubing to get it to go into the IV port, you've got it wrong. If you have to walk like a kangaroo in Earth Shoes in your new shoes, return them. If you have to jack with your responses in a long-time relationship, it's time to rethink.

2. If in doubt, give oxygen.

Again, this goes for everything from nonresponsive patients to relationships. Space is a good thing.

3. Sternal rubs cause bruising out of proportion to their usefulness.

This does not mean you should necessarily stop using them. After all, bringing one patient back from the brink of grokdom is worth a few bruises, right? Right. The trick is knowing when, by looking at your patient's sternum, one more mofoing sternal rub is not going to do the trick.

4. Always set two alarms in case of power failure.

That one's self-explanatory.

5. Less than a quarter-tank of gas is just asking for trouble.

Even when gas is $3.40 a gallon.

6. If you love, love, love a place, you should either buy it (if it's a condo or a house) or move there (if it's a city) without thinking too hard about the alternatives.

Another alternative may be better to the logical thinker, but will it make you happier? I think not. (Joey, listen up.)

7. Pate de fois gras always tastes better when you have several months of anticipation invested in it.

I'm going travelling in July, yes I am.

8. Cocaine and methamphetamine are the only scary drugs.

9. When you're eating faux-Mexican, just go 'head and get a to-go box right at the start.

That way, when the waitstaff brings you a four-part symphony in pseudo-burrito, you can put it away rather than munching on it all evening.

10. Support hose, no matter how good they feel at 0900, will always twist in some heretofore-unimagined way and cut off your circulation during a code.

You have been warned.

Pen-i-ten-shurry.

"You," she said grimly, through clenched teeth, "are gonna end up in the pen-i-ten-shurry for this. They're gonna come let me out tomorrow and you're gonna go to the pen and I'm gonna laugh when the cops come to get you."

It was three-and-a-half hours into a four-hour drama, and I was getting rather tired of the situation. I replied, as calmly as I could, that I was not going to the penitentiary or to jail or to hell, no matter how often she repeated those suggestions, and that she was not getting out of this place tomorrow.

Subarachnoid hemorrhages are weird things. They happen most often when an aneurysm, a weak area in an artery, cuts loose and bleeds. What happens next is confusing and fascinating; the patient ends up with what's essentially a sterile meningitis (inflammation of the coverings of the brain and spinal cord). The ability to speak clearly sometimes disappears temporarily, and the person tends to take long vacations from reality.

Combine a subarachnoid hemorrhage with a couple of other organic problems that have already caused substantial damage, then add on a subdural hematoma. That's bleeding under the toughest layer of meninges that cover the brain, and is most often caused by a blow or counter-blow injury to the head. Subdural hematomas fall under the category "walk, talk, and die", because they tend to expand rapidly, compressing the brain tissue under them and on the opposite side of the brain. We keep SDH patients under close observation for several days for that reason.

Even if those patients aren't wandering off the floor, attacking ICU nurses when said nurses don't come up with discharge paperwork, and begging to be left alone long enough to have a quiet cigarette outside.

Had I been able to, I would've ordered a toxicity screen, both blood and urine. Unfortunately, after she came back upstairs from the lobby of the ICU, I had been busy holding her down. For three and a half hours. That kind of energy--the sort of energy and strength that allows an 80-pound patient to break through soft restraints and a restraint vest and requires 160-pound me to kneel atop her--doesn't come only from a subarachnoid hemorrhage or subdural hematoma.

It started innocently enough, with a long-distance phone call to her elderly mother, asking Mom to come pick her up. When Mom arrived, having not checked with the nurses to determine whether she could take her daughter home, things went straight to hell. The patient, amazed and angry that she wasn't going home, became increasingly violent. We got Mom out of there pretty sharpish when it was obvious that we would have some serious work to do.

The end toll on the patient goes like this: ten milligrams of Haldol IM, three of Versed IV, eight of Ativan IV, and four-point soft restraints, Posey vest, and bruises on wrists and ankles where people had to hold her down. (Note for nonmedical types: that's enough sedative and antipsychotic medication to take down a 200-pound man and make it necessary to bag him. She just got calm.)

Oh, and I ran a fourteen-gauge (note for nonmedical types: a fucking huge) IV into her left ankle with one stick. She didn't like it, but I felt better.

The end toll on the staff is as follows: One black eye, one certainly sprained and possibly broken finger, one sore back (that's the only one that's mine, thank God), several puncture wounds from filthy fingernails, and one inch-wide bite wound on a forearm.

The bite wound happened to a very sweet, slightly slow nurses' aide who happened to look away at a critical moment. I feel terrible for her, not least because she had to get vaccinated for tetanus and all the various other things one can get from a human bite, and she hates needles. I will say this, though: she held on like a bulldog even with blood from the bite running down her wrist and hand.

I bought her a pair of heavy black rubber elbow-length gauntlets today at the hardware store. I'll wrap them in pretty pink paper with a girlish bow and give them to her the next time I work.

HN Special Feature: TeeVee Show Review!

I was really, really not wanting to put too much mental effort out tonight; two days straight of The Great Influenza and starting Pinker's How The Mind Works had left my brain box empty except for a quivering lump of greyish Jell-O.

So I flipped on the tube and stumbled on something called "The Ghost Whisperer." I was intrigued: a show about a person who trains ghosts to canter, trot, and gallop? A medium with laryngitis? You gotta understand, I may not get out much, but I watch TV even less.

What I got was Jennifer Love Hewitt and some guy I vaguely remember from the old one-season wonder "Relativity" (as well as Snow White: A Tale of Terror, with Sigourney Weaver as the evil stepmom) playing a paramedic (him) and an antique store owner (her) living in a small, peaceful Eastern Seaboard town.

So far so good.

As things progressed, though, I started to wonder: if this chick who sees dead people (all the time!!) and tries to send them into the light has been doing this since she was six, how come she's still flipped out by manifestations of what should be, by now, a fairly routine occurance? I mean, even her husband and business partner are treating her visitations with the sort of wry humor that connotes total acceptance of the weird.

Also, what up with the hallucinations? I mean, she's hallucinating all the damn time. Either that, or the dead aren't very good at communicating, since a planeload of people about to come down (this week's plot) can only focus their combined energies on one person. Everybody else is missing the obvious, like half-frozen people in pilot's uniforms wandering around. If J-Love's character is living in a small town, and her husband's a paramedic, you *know* somebody's said something to him about this by now. "Uh, Bob...you know, I hate to mention it, but your wife keeps screaming and clapping her hands over her ears in line at the Wal-Mart. Has she seen a doctor?"

Furthermore, what up with the eyeliner and Goth-Girl costumes, dawg? There was one scene in this week's episode in which Our Heroine was walking across Ye Olde Towne Square, the only person in town (and they all seemed to be on the square at that moment) wearing head-to-toe black and eyeliner fit for a Mod Squad audition. That, in most small towns I know, would get you looked at funny at the least, and probably not guarantee a lot of business for your antique store. ("Same As It Never Was." Cute, guys.)

At one point in a subplot, an architect stops in for a consult on remodelling the antique store and mentions that he's "passed by this place" a number of times. At that point The Cat snorted and said, "Yeah, 'cause he's freaked out by Little Miss Death Hallucinatron, here."

Then there's the subplot with the rookie paramedic who gets freaked out by the sight of blood, and Sensitive Husband Paramedic Guy has to be his big-brother type and get him over it in time for a plane full of sort-of-dead, mostly-frozen people who've been talking to J-Love for the last fifty minutes to crash...right into Smallton! Or Greenville, or whatever it's called.

According to the preview for *next* week's show, the whole upshot of the dealie-o is that J-Love will have to somehow armor her black lace cardigan and go up against The Devil Himself (dun dun dun) to save the souls of the mostly-dead, pretty-well-freezer-burned folk on the plane. There's a lot of symbolism about a pocket watch and doves coming back to life and love never dying, and Beelzebub wears a really, *really* bad hat and hisses a lot in J-Love's ear.

The Cat, pausing in her paw-licking, opined that Satan is getting lamer and lamer every year. "Whatever happened," she asked, "to 'Sinners in the Hands of an Angry God?' Or Dante? Or even 'The Gospel of Peter?'"

I told her I had no good answer, and so we're going to bed.

I'm blaming The South Bitch Diet.

So, um, you know when you get a scary troll on your blog? And you go and enable the "moderate comments" dealie on the blog template? And you forget to, um, type in your email address in that thingy so that the Blogger software can let you know when a comment's been posted? And none of the comments get posted, for, like, six weeks, so you think nobody's reading your stuff and you start posting titles like "BOOBIES!" and stuff?

Just be glad I'm not a programmer or proofreader, people. I figured out the comments glitch today, and let's just say boy is my face red.

It should work now. I take back all the nasty things I said about you, Blogger. It was entirely my own fault, mea culpa. And thank you, various commenters, for the nice things you've said.

On to bigger and worser things:

All you folks who have done SBD or who know patients or family members who have done it, I have a question: How do you get the freaking headaches to stop?

I'm well-hydrated, I'm eating everything I should. Last night I was in the grips of a three-day-long headache and finally ate a pita sandwich. The headache disappeared and hasn't returned since. I had a half-cup of rice today, which I think might account for that. Is this headache going to continue through the first phase of the diet? If it's that bad, should I just say to heck with it and start with Phase II? I don't eat much in the way of simple carbs anyhow, so that wouldn't be too bad.

It was bad enough yesterday that I took four ibuprofen, something I never, ever do, and the headache *still* didn't disappear. It went from "making me afraid to try to drive" to "moderately distracting". And no, I haven't cut down on caffeine. I wasn't having that much anyhow.

I can handle hunger and muscle aches and bad skin. I can handle constipation, the Plagues of Egypt, bad relationships, and traffic. I just cannot handle unrelenting headaches of near-migranous intensity. Any help would be appreciated.

In other news, since The Boys are off at the AANS conference, I'm home today, huzzah! Things will begin to pick up on Thursday, when they return, but I'll be off work then and (I hope) refinishing my dining table. The Cat and I had a little mutual-admiration society going this afternoon, so she should be able to handle being not At The Forefront of The Human's Mind for a day or so.

Note on the last big post: The song lyrics in italics are from Barenaked Ladies's "The Old Apartment" and Jackson Browne's "In the Shape of A Heart", mixed up together. "The Old Apartment" can be found on the album Rock Spectacle, while "In the Shape of A Heart" is on Lives In The Balance. You can hear lots of Browne cuts on his website, jacksonbrowne.com, which almost makes up for him being a drunken wife-beater. And for imbuing me with a lifelong *thing* for skinny dark-haired guys with dark eyes.

And that is all for now. Comments remain moderated, but now I know how to fly this bitch, so we'll do fine.

Blogger Band-Aid

Suggested by Les, brilliant correspondent.

Blogger's bug won't allow people to post on the first post on the page, so I'm trying something new: A band-aid post to knock the *real* post down a notch, so it can be commented upon.

Let me know how it works.