This is fun.

Very Good Taste posted a list of 100 things every omnivore should eat. You're supposed to go through it and mark what you've eaten, to see where you stand when compared with the ideal.

Here 'tis....

1. Venison*
2. Nettle tea*
3. Huevos rancheros*
4. Steak tartare*
5. Crocodile (I've eaten alligator. Does that count?)*
6. Black pudding*
7. Cheese fondue*
8. Carp*
9. Borscht*
10. Baba ghanoush*
11. Calamari*
12. Pho*
13. PB&J sandwich*
14. Aloo gobi*
15. Hot dog from a street cart*
16. Epoisses
17. Black truffle*
18. Fruit wine made from something other than grapes*
19. Steamed pork buns*
20. Pistachio ice cream*
21. Heirloom tomatoes*
22. Fresh wild berries*
23. Foie gras*
24. Rice and beans*
25. Brawn, or head cheese
26. Raw Scotch Bonnet pepper (only once, and to my great distress)*
27. Dulce de leche*
28. Oysters*
29. Baklava*
30. Bagna cauda*
31. Wasabi peas*
32. Clam chowder in a sourdough bowl*
33. Salted lassi
34. Sauerkraut*
35. Root beer float*
36. Cognac with a fat cigar (I've had the cognac, but not the cigar. So, close but...)
37. Clotted cream tea*
38. Vodka jelly/Jell-O*
39. Gumbo*
40. Oxtail*
41. Curried goat
42. Whole insects*
43. Phaal
44. Goat’s milk*
45. Malt whisky from a bottle worth £60/$120 or more*
46. Fugu
47. Chicken tikka masala*
48. Eel (I think I remember eating eel once, but I'm not sure, so I'm not starring it)
49. Krispy Kreme original glazed doughnut*
50. Sea urchin (bleah)*
51. Prickly pear*
52. Umeboshi (bleah)*
53. Abalone*
54. Paneer*
55. McDonald’s Big Mac Meal*
56. Spaetzle*
57. Dirty gin martini*
58. Beer above 8% ABV (duh)*
59. Poutine (Oh Poutine, my favorite food!)*
60. Carob chips (bleah)*
61. S’mores*
62. Sweetbreads (nyeah, okay)*
63. Kaolin
64. Currywurst
65. Durian
66. Frogs’ legs (In Louisiana, with gumbo)*
67. Beignets, churros, elephant ears or funnel cake (State Fair, duh)*
68. Haggis
69. Fried plantain*
70. Chitterlings, or andouillette* 
71. Gazpacho*
72. Caviar and blini*
73. Louche absinthe
74. Gjetost, or brunost*
75. Roadkill (you have got to be fucking kidding me)
76. Baijiu
77. Hostess Fruit Pie*
78. Snail*
79. Lapsang souchong (my favorite tea)*
80. Bellini*
81. Tom yum*
82. Eggs Benedict*
83. Pocky*
84. Tasting menu at a three-Michelin-star restaurant.
85. Kobe beef
86. Hare*
87. Goulash*
88. Flowers*
89. Horse
90. Criollo chocolate
91. Spam*
92. Soft shell crab*
93. Rose harissa*
94. Catfish*
95. Mole poblano*
96. Bagel and lox*
97. Lobster Thermidor
98. Polenta*
99. Jamaican Blue Mountain coffee*
100. Snake (State Fair, duh)*

Not too bad, eh? I have to credit having coworkers from all over the world and some travel for the number of asterisks on the list.

How experienced a nurse are you? Take this simple quiz and find out!

A patient arrives on your unit with the following list of allergies:

Hydrocodone, codeine, morphine, Demerol, Zofran, Reglan, beef, iodine, tomatoes, Provera, Lupron Depot, acetaminophen, ASA, wheat products, soy, synthetic estrogens, Benadryl, corticosteroids, epinephrine, ketorolac, Ultram, metoprolol, oral potassium, oxygen, Lipitor, fenfluramine, PCN and analogues, mycins, Trazodone, Haldol, allopurinol, Lithium, and Lasix.

Your response is:

A. "Gosh, this person has a lot of medical issues. I'd better get to researching the possible side effects of the other drugs I might give them!"

B. "Gosh, this person must be obese, bipolar, and have hypertension and diabetes. Drag-O."

C. "Hmm. The only two drugs NOT on that list are Dilaudid and Phenergan. Also, oxygen? What, he breathes methane at home? This person is a nutcase."

If your answer was A:

You are obviously a new nurse, concerned with providing good care while protecting your patient from harm. Good for you! Concentrate on that.

If your answer was B:

You are a proficient nurse. You've learned the basics and can recognize common drug interactions and side effects. Keep working! You're doing great.

If your answer was C:

You are an expert nurse. Those of you who answered C will not need me to explain why.

Ah, the shock of role transition.

Somebody, I don't remember who now, with a glass of wine in me, asked what I would say to the newbies who are having the SHOCK of ROLE TRANSITION as they go from being a student to being a new grad/new nurse/newbie.

Honestly? All I remember from the first months of nursing practice is this: I prayed every day that I wouldn't kill somebody, and I felt horribly alone.

Both those feelings, it turns out, were bogus. Like, "Boh-oh-oh-oh-oh-oh-GUS!!" the way Tom and Ray say it on "Car Talk". Bogus, like we never imagined it could be in the 80's. Bogus, like carob is to chocolate, or Cool Whip is to whipped cream.

Being a newbie is *hard*. It's almost as hard as nursing school in that the amount of information you have to absorb is huge; it's just more focused. Being a newbie is scary, in that you don't really know what you're doing yet. Being a newbie is frustrating, in that you know some things you're being asked to do are wrong and stupid, but you don't know how to communicate that to more experienced nurses and doctors yet.

The thing to remember is this: If you're a newbie in a precepted program, you have somebody following you every step of the way, making sure you don't screw up. Nobody is going to let you kill a patient. And even if you come close, we're not going to let the worst happen. *Everybody*, from pharmacists to physical therapists to the other nurses, is looking over your shoulder--not to catch you in mistakes, but to make sure you feel confident enough to make decisions on your own and yet stop you if they're the wrong ones.

As for not knowing what you're doing, the honest truth is that a lot of times I don't know what I'm doing either, and I've been doing this for six years. As in, this specific thing, and nothing else. And I *still* run into stuff that flummoxes or stumps me. There are always people around that know more than you, and who won't make fun of you if you ask very basic questions. The trick to being comfortable as a nurse is not in learning everything; it's in getting rid of your ego so you can admit comfortably what you don't know.

And, finally, frustration. I have a story to tell about this particular problem:

Years ago, when I was still being precepted, I had a patient admitted with fulminant meningitis. It could've killed her; it's considered a huge huge huge fucking run around with your hair afire emergency. 

The very moment she was admitted was the moment that our computerized drug distribution system went down. Pharmacy was totally unable to fill any orders, since they didn't have access to anybody's allergies or tolerances or drug levels or *anything*. So, because I was a newbie, my patient with fulminant meningitis went for six hours without her first dose of antibiotics. I gave myself an ulcer in the meantime, trying to do things by the book.

I will never stop being grateful to her doctor. Rather than call me out on the floor and ream me a new one, as he had every right to do, he took me aside and explained what the problem was, and asked me why the patient hadn't gotten her meds. I explained as best I could, suddenly not 31 any longer but 10, stuttering and tearful and ashamed, and he was firm but kind. No harm had come to the patient, but he was unhappy with the level of care. He offered to go to bat for me and get the drugs from pharmacy himself--not in an "I'll go down there and kick their asses" sort of way, but in a "maybe they don't understand how serious this is" way. 

The thing I learned from that awful experience was this: No matter how set the procedures and protocols are, you can always do an end run around them. Sometimes it means finding a sympathetic doctor or pharmacist to write you an order or float you the first dose of meds. Sometimes it means going down to the kitchen to talk to the folks there about what, exactly, "halal" means. If it can be done, you can find a way to do it. The best thing to do is to set up a reputation for being pleasant, creative, and a little stupid right at the start, so when you start doing imaginative things to get your patient good care, people shrug and say, "What the hell, it's only Jo."

The upshot of all this lecturing is this: Good nurses remember, if not the details, at least the general outlines of being a newbie. They will help you out. Glom onto them like death, and do not let them go. I have a mentor at work, and you should too. Don't fret about feeling like an idiot; other people do every day, too, and you'll develop a callus against that sort of self-consciousness. And don't forget: At some point, someday, you'll find that you're finally swimming with the current rather than struggling to stay afloat, and you'll feel like a Nurse. Finally. And you'll grin like an idiot, and go on to make a stupid mistake, and realize that that's what the profession is all about. 

Neat-o site and a question:

In reverse order.

First, for those of you who work in hospitals/clinics/whatever that require uniforms or particular scrub colors: Does your facility provide any sort of scrub allowance for employees? (Nursing students, sorry, but I just want the working RNs/aides/PTs/OTs/secretaries etc. to answer this one.) Do you have particular scrub shops where you can get an extra discount? How about folks coming to the facility itself to sell scrubs? Tell me all about it.

Now, for those of you *looking* for scrubs, here's a site which has--hurrah!--coupon codes! One of the very pleasant founders emailed me the other day and asked that I put it up. 

Find Nurse Uniforms

Why this theme in particular? Because Sunnydale General has decided to go to a choice of scrub colors, all of which are hideous, beginning in November. Two of the choices are so very unflattering that I'm thinking of going with straight old-fashioned whites. Not the the degree that I'll wear a skirt and blouse, mind you, but whites. This uniformity craze seems to be a trend--I've heard lots about it from other RN friends of mine lately.

*sigh* The last time I wore whites was in nursing school. We'll see if they've come up with non-see-through pants since then.

I'm good enough, I'm smart enough, and dammit, people like me!

So...new nursing students. How y'all feeling right now? Classes start in, what, three weeks? Two?

Got your shoes ready? Got your pens and pencils? Paper? Xanax? Good.

Following is a list of tips drawn from what I remember of my own school experience, back when the earth was still cooling:

1. You are smart enough to get through this. 

You got in, right? That's no small task in a field where there are anywhere from 30 to 200 applicants for every slot in nursing school. Rest assured that if you were smart enough to get in, you will be smart enough to finish--and finish *well*--provided you remember one thing:

2. This may be the hardest work you've ever put in in your life.

I've heard from doctors who became nurses and nurses who became doctors that nursing school is harder than med school by a country mile. This is not because doctors don't learn as much, but simply because nursing school is compressed into about half the time. Even if you're getting a BSN, the nursing-clinical-focused coursework will only take up about the last three semesters of your schooling. If you're going through a bridge or two-year program, you'll have to hit the ground at a dead run. Therefore...

3. Do a little every day. Do a lot when you can.

I cannot stress enough how important time management is for nursing students (and nurses!). Set up good habits early on and they will see you through the last semester when you can't eat, can't sleep, and can't remember who that person is that you promised to love and cherish until death. Do Not Put Off Studying. Also, Don't Study Too Far Ahead. Set yourself a goal of, say, three chapters of thus-and-so every night--one review of the last class period's material, one of today's material, and a quick run-through of next week's--and stick to it. Do this every damn night. No exceptions. It's only for a couple of years; you can go dancing later. That said,

4. Schedule something non-nursing related every week, even if it's only a movie. 

Otherwise you'll turn into a Nursing School Automaton like I did. You'll lose weight, sanity, sleep, and perspective. That last is most important, because...

5. No matter what they tell you, this is not the be-all and end-all.

You get brainwashed into thinking, in nursing school, that this is the most noble, valuable, challenging (morally, ethically, intellectually) thing you could do; that it's the pinnacle of everything everybody everywhere has ever done.

I call bullshit.

Nursing school is a weird cross between professional training and entering a convent. You get your own language, clothing, and ceremonies, true...but there is a world out there outside of nursing. Try not to get so buried that you lose the ability to laugh at yourself, your professors, and the utter silliness of most care plans.

6. You will meet asshole instructors.

Unfortunately, (and here I put on my flame-proof Big Girl Panties), there are nursing instructors out there who either got totally disgusted with the profession and are bitter, or who couldn't make it as floor nurses for one reason or another, and are bitter. With luck, you'll only run into one during your schooling--but you *will* run into one. Keep your head down, do your work, and try to avoid antagonizing that person. He or she can't help what she or he is.

7. You will meet crazies.

Both in school and out of it, you will meet people who are absolutely mad as pants. If that person is a classmate, try to be polite but distant: You do not need any emotional drama while you're going through school. (Also, avoid gossiping and joining one faction over another. It's lonelier, but you'll be glad you stayed aloof when the crap hits the creamer.) If that person who's crazy as a pet raccoon happens to be a floor nurse or a patient to whom you're assigned, see tips from #6 for conflict avoidance.

8. If you meet a nurse whom you'd like as a mentor, say so right then. 

I get requests from nursing students for my email address after I've worked with 'em a couple of days. I always give 'em the address. Having a shoulder to lean on, a more experienced person to bounce things off of, or a mentor can make a hell of a difference in your sanity. And please be aware, beloved students, of this caveat: If I tell you you shouldn't work with me after you've worked with me for three sessions, it's not because I don't like you. It's because, this early in your training, you need to see a variety of work styles, time-saving tricks, and management skills. Don't get into a rut too soon.

9. Along with "Don't get into a rut too soon", don't make up your mind what you want to do too soon. 

I was *sure* I would be the world's most ass-kickingest women's health NP when I finished school. I interviewed at Sunnydale General on a total lark and ended up taking the job, also as a total lark. It was one of the best decisions I've ever made--probably not as smart as leaving my husband, but certainly in the top five. Go on at least one wacked-out job interview that you'd never consider actually accepting, be it to Medecins Sans Frontieres or to County General Hellhole. See where that takes you. You might find that you were really cut out to be a neuro nurse rather than an oncology nurse, or that working in the jungles brings you great joy. And, keep in mind that if you hate the whole process and are miserable,

10. You can always leave. Leaving nursing does not mean you're a failure.

Nursing is not for everybody. Every student finds him/herself dreading clinicals and tests, yes, but there's a general consensus that the end result will be worth the trouble. If you find yourself contemplating a career in nursing with nothing more than misery and despair, for God's sake get out now and find something else to do. It will not necessarily make you as much money or give you as much prestige (stop snickering), but money and prestige are empty cups when you cry every morning as you slap on mascara. 

If you *do* get partway through your training and decide to quit, everybody you're leaving behind will look at you with pitying incomprehension. You won't be able to speak the same language as they do any more. You might not keep in touch with all your old buddies. Don't let it get to you. The important thing is that you do what makes you look forward to getting up in the morning.

Handmaidens, Helpmeets, and the Problem of Nursing

There's a lot of discussion about the OMGWTF Nursing Shortage and of how to get younger, more diverse folks into nursing. What I've seen lately proposed as solutions make sense, but they don't get to the root of the problem: Nurses are seen as handmaidens and helpmeets to doctors rather than as scientific professionals in their own right, who often practice with a surprising degree of autonomy.

Two illustrations of that, from the educational angle: I have a colleague who never fails to mention that she finished pre-med school at the top of her class, passed the MCAT, and was accepted to medical school, but took to nursing as a sort of Med-Lite second-best when she decided she wanted to have kids and a husband. Further back, when I was starting nursing school, every single dadratted classmate I had, practically, said with starry eyes that she "wanted to *help* people!" as a reason for getting into the business.

Now, helping people is a fine undertaking. I do a lot of it myself every day, though I think of it in terms of educating my patients or working with other disciplines in the hospital to help those patients heal. And going from med school to nursing is a fine thing, too, (though I disagree with the reasons here), as it gives you a different perspective on the science of nursing.

But nursing is way, way more than helping people and being a sort of handmaiden to a big, strong, masculine-smelling doctor. By not emphasizing the technical, intellectual, skilled aspects of nursing practice, we're losing a lot of possible nurses to PA school or computer science courses. "They Dare To Care" is a touching ad campaign, but it doesn't showcase what we do every day as practitioners of a science that is equal to but different from medicine.

I'm not going to list out here what I do every day that could be considered intellectually challenging and deserving of respect; I've done that over and over in previous posts. Instead, let's look at the Helpful Handmaiden misconception and see how it impacts nursing as a whole:

First, public perception of nursing focuses too much on the "caring", touchy-feely aspect of the work. This discourages people like me, who are a little crusty and a little crotchety, from entering the profession, for fear of encountering a bunch of fuzzy-headed huggers with little or no spine. It took working with nurses for me to realize how wrong that stereotype was.

Second, take that public perception again, and narrow it down: Nurse equals handmaiden, which equals subordinate role, which means that any man in nursing must be happy with a subordinate role, which means any man in nursing must be gay. And a bottom, to boot. With that stereotype, you may now kiss still more of your potential nurses goodbye, as they go into manly sciences like software development and electrical engineering.

Third, let's take the Helpful Handmaiden Model onto the college campus: If nurses are primarily caregivers and assistants, then there's not much to teach students, is there? Therefore, we can pay a pittance to our nursing instructors and not lose out. 

Let's be blunt, here: Being a nursing instructor, especially in a small department like the one at the school where I got my degree, must suck. College instructors don't have cushy jobs as it is--growing up in a family of academics taught me that--but being told you're responsible for lesson plans and teaching three courses a semester, *plus* two clinical groups, *plus* being required to sit on various committees and boards, is particularly challenging in terms of time and creativity. 

To add insult to injury, the school where I went required at least a master's degree in nursing to teach lower-level classes. A PhD in nursing was preferred for upper-level classes. That's a lot of education...and I, as a brand-new, fresh-out-of-the-gate nurse with no experience, made double what the instructor of my first nursing courses made. After six years, I'm making more than the best-qualified instructor at that school, for considerably less effort.

In short, if you want decent nursing instructors and enough of them, you have to treat nursing with the respect it deserves. Helpful Handmaidens don't get no respect, but careful, observant scientists do.

Fourthly and finally, let's take that Helpful Handmaiden into the hospital and see what that stereotype does to us as a profession. 

If nurses are primarily interested in Helping People, and if they're assistants to Big Manly Doctors, it means that they therefore are selfless martyrs. Selfless martyrs don't mind being saddled with too many patients, being told to work mandatory overtime, and being shorted vital equipment, supplies, and support staff. Selfless martyrs, after all, welcome the opportunity to make do and mend and do everything themselves.

Now let's imagine what would happen if we had the concept of nurses as scientists and advance troops on the line of patient care: We'd get staffing. And supplies. And a say in how hospital policy is developed. And support staff, so we don't have to clean rooms and take out trash. And lower patient ratios, so we could actually, you know, *monitor* and *educate* patients and provide better care. We'd get better-qualified professors in nursing departments who could actually afford to make a living. The phenomenon I encountered, that of an instructor so burned out on nursing practice that he or she couldn't stand to be in the hospital any more (and communicated that dissatisfaction to the students) wouldn't be as common. And, finally, we'd get a more interesting, diverse, experienced crowd going to school. 

How do we get to the point where the handmaiden stereotype is dead? Activism, education, being loud and pushy (frankly) with hospital administrators, and--most importantly in my view--never downplaying what we do. 

I am not "just" a nurse. When people say, "You seem awfully tough for a nurse", I respond, "Nurses are tough." When somebody asks me why I didn't go to medical school, I tell them that I prefer nursing both because of the range of knowledge I have to master and the flexibility it gives me with my patients. When a patient tells me I'm "too smart" to be a nurse, I ask them seriously if they want a moron coordinating their care. And every time I meet a nurse-to-be, I hand out my email address and tell 'em to contact me if they want help, advice, or just to blow off steam. 

It'll take a while to change the stereotype. It'll take a lot of work, too, but it's the only way to reverse the trend of younger nurses getting burned out and leaving the field as older nurses hang on out of guilt. Helpful Handmaidens are handy to have around the house, but they don't get stuff done. Pushy Smart Tough Professionals do.

If dogs wrote personal ads

MATURE, DIGNIFIED male seeks calm and loving partner for long walks on the beach, quiet evenings at home, and belly rubs. I am h/w proportionate, have a full head of reddish-brown hair (no grey yet!) and keep my nails carefully trimmed. I enjoy soft music, good food, relaxing times together, and the occasional snack. Write MAX, box XXXX.

**** **** **** **** **** ****

ATHLETIC BLOND seeks energetic friend for adventures! Interests include property destruction, digging in the dirt, scratching my own back, tearing up shit, property destruction, barking, running around in circles, shedding, property destruction, and (if I'm given the chance) desecration of the world's most sacred archaelogical sites. Call me! Come on! Come on! C'monc'omonc'mon! Let's go run around together!!! BOOF!! to STRIDER, box XXXX.

I don't give a damn 'bout no stinkin' dogs.

Jolly Green Gumball.

A tip for those of you who bought a swimsuit prior to starting weightlifting:

It won't fit any more.

Several years ago, prior to meeting Atilla The Cheerleader, I bought a swimsuit. It's green, with a square neck. It fit three years ago and looked okay, actually.

Then I got lats. And shoulders. And pectoral muscles. And my legs went all square and muscle-y, and I got biceps. The belly's still there, but I look more fit.

And the swimsuit? Holy lord, it *so* does not fit any more.

Square-neck suit + big lats + impressive shoulders + pecs that are things of beauty = Jolly Green Gumball.

I have ordered a plain black V-neck from Land's End. Humph.

Panic: Ur doin' it wrong.

I know this sounds impossible, but our hospital has been on Disaster OMGWTF Footing for the last month.

Yes, fiends and neighbors, the last month.

Disaster is usually reserved for, you know, actual disasters. Like plane crashes. And hurricanes. And, I dunno, maybe huge leaks of refrigerant, or bioactive compounds from some horrible lab somewhere that're turning everybody into bunny-hopping happy zombies with bad 80's hair.

Or the air conditioning going out. That's also a disaster. But anyway. We've been on Disaster Footing, with Code Whatevers that Signify An Internal Disaster, daily except for weekends.

Why, you ask? Because of a computer glitch. 

Scheduling is all fucked up, is the short answer. Somebody somewhere has been transitioning to some wonderful computer system that's going to be all ice-cream bars and puppies in the long run, but in the short run...eesh. All the operating rooms are triple-booked, which must be fun. Can you imagine? Close your eyes....

THE SCENE: SUNNYDALE HOSPITAL

THE CHARACTERS: VARIOUS NURSES AND O.R. TECHS

Opening: MORNING in the OPERATING ROOM, wide-angle

TECH #1: What are you doing here? I'm supposed to be setting this room up for a left pharyngeal troponetic farumulunectomy!

TECH #2: Huh? I'm here to set it up for a transverse myelopical zummulation ablation!

TECH #3: Both you guys are high. I've got a complete radical sympathomimetic wangulation scheduled here for 0800.

NURSES: We don't CARE what you're here for! Just set up for SOMETHING!!

Meanwhile, in recovery, things are going badly as well. And on the acute care floors, we're having conversations with Manglement that defy belief:

MANGLER: You need to get six patients out, double up four, and send three to rehab. Who've you got that can move?

NURSE IN NOMINAL CHARGE: Uh...well, these two spines could go to rehab, and we could double up the cranis, but we have eight patients in isolation and another five that are total-care. Six is the most I can give you right now.

MANGLER: What about that one? (Stabs finger at bed-board) That one looks pretty good. Why can't you send *him* home?

NINC: Uh...'cause he had a kidney removed about two hours ago?

MANGLER: Tell him to MAN UP!!

So. It's been a fun month.

I am so, so very glad that I am not officially in charge of anything. Disaster gives me a chance to spend time with my patients, believe it or not, because nobody's coming in or going out. Everybody is so incredibly critically ill that we don't have time to deal with the folks who are merely very, very sick. If you can ignore the people in positions of power who are running around with their collective hands in the air, you can actually get quite a lot of edumacatin' and patient care done.

This week I had a dude who'd been burned in a fire on a floating oil rig. You could look down the hole in his neck, where things had failed to heal, and see his first rib. Also a patient with something we haven't been able to diagnose yet but which is probably going to be fatal, and a patient with metastatic melanoma, and one with a glioma the size of my hand, and a couple of people who'd had bits removed that you normally leave in place so the person can live.

*** *** *** *** *** *** *** *** *** *** *** *** *** *** ***

Meanwhile, Strider removed a cable-TV cable from where it was stapled on to the outside back wall of the house. The thing was covered in so many layers of paint that I didn't even know it was there, so I don't quite know how he determined it existed. Anyway, he carefully nibbled off all the paint in a spot about the size of his schnozz, then pulled the cable off and laid it gently on the ground in a pile. I think this means he approves of my decision not to have a television.

Max is, by contrast, even more polite and well-behaved than usual. He's renewed his love affair with the pug next door and comes to give me updates on how lovely she is and how her eyes are limpid pools of melted chocolate.

I want to be my dogs.

585 Posts! Time for fluffitude!

Notable Links I Enjoy, By Jo...

Style Spy: A fashion blogger from just down the street. I envy her life, her pumps, and her friend Plumcake's Cadillac.

Your Pharmacist May Hate You: Drugmonkey doesn't know this yet, but I'm going to carry him off on my hot-pink, nitro-fueled Vespa.

Blomma Finds: Things to lust over for the home.

Shedworking: A UK blog on sheds. Go ahead, check it out. Lust for things for your garden.

fisforfrank: I cannot say enough good things about these folks. I stumbled on their Etsy store while I was looking for knobs for the kitchen cabinets, and ended up buying almost all my knobs from them (a few pulls came from other sources). The knobs are like tiny pieces of sculpture and are reasonably priced, because the quality is so very high. If you're looking for something to dress up a piece of furniture, your kitchen, or your desk, go here first. It's a small company based in Dallas, and every single thing is hand-cast and original. They also do custom work!

Peep Research: Speaking of fluffitude (or fluffithelium), this site is a classic. Be sure to check out the surgery that successfully separated conjoined Peep quintuplets.

Old House Gardens: Now that I have a yard of my own, I spend hours drooling over this site. Soon, soon, antique hyacinths and dahlias will be MINE! (Muahahahaha....)

Pictures, for those that wants 'em.

Strider, looking sweeter than he actually is:

Max, my snugglebunny strudel-noodle:

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

It's a pun.

Hello to everybody who navigated here from the LA Times!

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

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

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

You may laugh now. 

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

Original mention here.

Good Advice

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

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

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

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

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

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

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

Lettuce cannot be frozen. Bananas can.

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

Keep napkins in the glove box.

Always have an extra pen.

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

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

A bedspread covers a multitude of sins.

Warm the saline before you flush the Foley.

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

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

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

Keep the receipt.

Cotton undies. Always.

Holy freakin' kamole, it is too damned hot.

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

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

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

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

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

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

Happy Birthday, Mom!

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

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

People who lived to be 70:

1. Methuselah (969)

2. Benjamin Franklin (84)

3. Helen Keller (88)

4. Florence Nightengale (90)

5. George Burns (100)

People who did not live to be 70:

1. Jesus (33?)

2. Mozart (35)

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

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

5. Amelia Earhart (42)

Things that happened in July, 1938:

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

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

3. Mauthausen concentration camp built (eesh.)

4. Two barns were destroyed by fire near Sheboygan.

5. Brian Dennehy was born (actor).

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

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

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

3. ""70 things to always remember" 

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

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

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

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

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

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

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

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

And finally, Rob Brezsny says:

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

And Now For Something Completely Different....

or, That Didn't Work At All.

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

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

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

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

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

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

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

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

KITCHEN: Well, duuuuhhh. Yeah.

ME: So what's Postwar Cute?

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

ME: Um......

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

1. Cline Vineyards Viognier, 2007

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

2. MyChelle Fruit Fiesta Facial Peel

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

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

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

4. M.A.C. Loud Lash mascara

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

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

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

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

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

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

Odds and Ends

Things not to do:

Show up tanked on the day of surgery.

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

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

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

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

Sell drugs out of your hospital room.

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

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

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

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

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

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

Roll a loaded linen cart over your toes.

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

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

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

Ah, the glamorous life. I livez it.