WAHOOO! More than a thousand followers!

I wish I had something to give as a prize for Follower One Thousand and Follower One Thousand One. You're Minions; that'll have to do.

Welcome, Minions! Await my orders.

Thanks to all you knitters! And odds and ends.

The Project is well underway at this point. Thanks a thousand times to all of you who responded; the person who ended up getting the assignment emailed me this morning and said, "Well, it's actually done now. I had some yarn left over."

Sooooomebody (singsong voice) had toooo much coffeeeeee!

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

Apropos of nothing, have I mentioned lately how much I hate Large Music Festivals? It's not like Bigton can't survive for another decade on the backs of the musicians who've flocked here like roaches to a trash can. Still, they have their Damn Music and Technology and Whatever Festival every damn year about this time, and every damn year about this time, traffic is worse, people are stupider, and I get grouchier than usual. Thank Frogs the weather sucked the first weekend, or I'd've never gotten to work at all. I think next year I'll take the weekend of the time change through the end of Big Stupid Festival off entirely and go hide somewhere like Prince Edward Island. Or someplace with penguins. Penguins would be nice. They don't consider day-drinking an Olympic sport.

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

Max has a new friend. Man of God and His Lovely Wife sold their house and moved to Bigton after he got The Call from a small church looking for a fighting young priest who could talk to the young. Max and I miss them terribly; they were excellent neighbors with a very sweet dog, but the new neighbors are promising. They have a rescued French bulldog and a cross-eyed Bengal cat (first one I've ever seen--he was surrendered to the pound because of his cross-eyed-ness), and Max is busily making friends with both of them. The cat only goes outside on a lead. This is a good thing, as he's the biggest damn feline I've ever seen outside of a zoo and I am not kidding. He's fucking terrifying.

New Neighbor Husband seemed a bit frat-boyish at first, but he's beginning to relax. He's gotten the vibe of the neighborhood (nobody uses poison on their lawns, we all compost) and has quit mowing the yard in a button-down shirt and loafers. New Neighbor Wife is kind and funny, and was quite sympathetic to my locking myself out of the house the other morning.

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

Oh, that? Yeah. . .well. We had some really severe storms here the other day: there were tornadoes not too far away (tornadoely speaking) and hail and all sorts of scariness. The Beardman, my other neighbor, came over to let Max out a couple of times during the day and make sure he was all right. In doing so, he locked the doorknobs of both front and back doors. I never lock the doorknobs, just the deadbolts.

So when Attila showed up the other day for our training session, I was standing on the front porch (it was 0630, and raining) with a cup of coffee. I turned to let us both in to find the door was locked. No problem; the back door's unlocked! Except it wasn't. And the key that normally lives on Max's collar was in Beardman's pocket.

So I borrowed Attila's car key and slashed the screen in my bedroom window. New Neighbor Wife walked out to her car in the middle of all of this and, to give her credit, merely looked at me questioningly. I explained the situation, and she said Oh, How Awful and offered Husband's assistance in re-screening the window. Then Attila levered herself up over the windowsill and unlocked the door, and life went on as normal.

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

All thing considered, I think the neighborhood got lucky when this couple decided to ditch the lights of Bigton and commute instead. Now if only their cute! cute! cyooooot! little Frenchy would decide I'm trustworthy and play-with-able. I almost had him liking me yesterday, but then he got all watchdoggy again.

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

In Attila news, I am now not only squatting, deadlifting, and good-morning-ing more than she can lift (being built like a gazelle), I now *bench* more than she can lift. This is going to require either a reworking of our training sessions or the purchase of the weightlifter's equivalent of a Hoyer.

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

And that is all for now. Eventually I'll work up an interesting (in the sense of the Chinese curse) day I had recently for public consumption. Right now I'm going to go vacuum all the cobwebs off the ceilings and chase the geckos back outside.

One of those days.

Once in a while, something happens at work that is so traumatic, so difficult to talk about, that I don't even want to post it on the blog. One of those things happened this week.

The minute I turned away from the cauldron on the cafeteria line that held "Fresh Seafood Gumbo," though, everything got better.

Ba-donk-ksssshhh!

But seriously, folks: this was One Of Those Weeks. I got a lecture from the director of nursing about being on my Best Behavior (Best Beloveds) when it came to taking care of the family member of a VIP. "We're going to give him, of course, the same standard of care that everybody gets," said the DON, "but we might need you to expedite some of the testing, like the MRI, for him."

"Soooo," I said, unaware of what my mouth was actually doing, "We're *not* actually giving him the same standard of care as anybody else." 'Cause if you're on Medicare, that MRI's gonna take thirty-six hours.

It's a wonder I haven't been fired thirty times over. I called the bed board to report the arrival of Le Petit Prince with the words, "The Eagle has landed. Repeat, the Eagle has landed. With his diamond chariot and his staff."

Let's face it: If you work in practically any non-profit healthcare facility these days, especially one in the state where Guvnuh Goodhair has yanked funding for various things you used to do, you are dependent on donors to do things like fix the a/c and make sure you have enough money to buy IV fluids. I live in Texas; therefore, I am used to whoring for money to make sure my less-fortunate patients get the private funding they need to get treated. Ever since I watched a guy die of a treatable brain tumor because of lack of indigent-care funding, I have whored more cheerfully and fluffed-and-puffed in a more dedicated fashion than you would ever believe.

LPP hopped the line in the emergency department with a problem that had been going on since sometime in September and which had recently, despite not changing, gotten insupportable. Therefore, our Prince presented hisself at the ER with vague complaints of. . .something.

I admitted him and his Something ahead of two actually emergent patients with actually emergent problems--though, thankfully, they'd gotten good care at their local EDs in the meantime. They just kind of had to wait around for a bit, one on the helipad, the other in a buggy (ambulance, for you civilians), until we'd gotten His Highness settled in.

(Just now Max put his head in my lap, bad breath and shedding ear-puffs and all, reminding me that no matter how stupid we humans are, there are still dogs who love us.)

HRHLPP will be fine. There's nothing wrong with him that six weeks drying out and a few B vitamins won't cure. My other two patients will be fine: one got TPA in a timely fashion, administered correctly by an on-point ED MD (shout out to all the ED docs!) who'd never actually done it, but who read up on it on the Internet from his tiny, six-bed ER; the other got a nifty new experimental drug we're testing and seems to be getting over her aphasia even as we (ahem) speak.

It's not his fault his daddy's rich. He was a nice guy: said "Please" and "Thank you" and was admirably brief and succinct in the description of his symptoms. Daddy is currently funding a study on the benefits of various anticoagulants in the acute phase of stroke (the beneficiary of which was in the next room over), so I had little trouble being nice to him. We even had a few things in common: birdwatching, politics, and music.

Even if your client is nice, it doesn't make it any easier to whore, though.

Question for the minions: anybody here know how to knit?

If so, please shoot me an email at johannebertha at gmail you know the rest.

Thankee. I may have a commission for you.

For Tashi and Wash, on the occasion of their third anniversary, belatedly.

Peeps, a request:

That you send your best wishes to Nurse Ames, who has spent thousands of minutes waiting for me to get done with yet another damn scan and driving me back and forth to said damn scans, tomorrow. She's having her stapes replaced with a titanium replica and her eardrum repaired in some way that I don't understand, starting about 2:30 pip emma central time.

What the hell do I know? I do strokes. All I know is that she's a little anxious, and so am I.

Prayers, hip-shakingks, om-sayings, and capybara-snuffles would all be appreciated.

As for me, I'm getting started on soup right now.

I don't tell anyone about the things we have planned. . .

Your voice is my favorite sound.

You know what ammolite is, right?

It's the fossilized shell of a squidesque beastie that lived in the late Cretaceous (IIRC) period and which died out with the dinosaurs. The shells of those guys were apparently made of something very much like the stuff that makes pearls, but the fossilizing of their shells makes them all opalescent and gorgeous and rainbow-glittery.

Imagine the darkest, reddest amber you can, and then shoot green and yellow through it. That's ammolite. It's amazing. It's also found only in a very few places, from Utah to Saskatchewan, and around my neck.

Yes, friends and neighbors, this is mine. (Dry-washes hands, cackles.) It's a craptastic picture, but I was shooting and shooing a cat away at the same time.

Der Alter Jo and I were looking at this piece at a street fair, and I walked away.

Then I doubled back, with DAJ giggling with glee, and handed over my bank card. I knew that if I didn't get it, I would think about it forever, just like I do with a necklace I passed over in Alberta lo these many years ago.

In other news, things at the new NCCU are. . . . .well. Exciting? Thrilling? Slap-yo-mama-type fun? Sure: let's just call it that and leave it alone. I'll tell you: if it's not a stroke that takes out one entire side of your body, or a brain problem that leaves you face-blind (I passed over "prosopagnosia" and then typed "face-bling," which is what I've got around my neck, yo), or a previously-undescribed demyelinating disorder, we ain't got it. It's been one of those weeks where residents and nurses high-five one another over lab results, in other words.

Best moment of the week, and possibly of my entire life ever, came when one of my coworkers, who teaches jazz and ballet on the side, spun around in her chair to answer an intern's question. The thing was, she had her left ankle behind her head at the time, as she was trying to stretch out a cramp in her glutes. I had just put an empty accordian folder on my head as a hat and was humming to myself, and one of the midlevels was playing Bejeweled on her phone. It was Anything Can Happen Day in the NCCU.

I really think that shows like "Scrubs" and "House" are/were great for hospital staff. People get used to seeing craziness on TV, and it doesn't bother them nearly as much when they encounter it in real life. Unless, like that intern, they're just looking for the nearest vending machine.

What to do on your day off.

Wake up to a cat licking your knuckles. Roll out of bed, stopping mid-roll to rub the doggy belleh presented to you. Start the coffeemaker, then pee.

Check your messages. Notice that your trainer has cancelled your training session for the day. Hope that she doesn't have the violent stomach ailment that's been going around.

Leave the house an hour after waking up, having spent more time than is necessary in the shower with mounds of scented soapsuds and lots of implements. Make your way to Target.

Find that everything you need--boring stuff, like dish soap and lotion--is on sale. Grab a bag of work socks as an impulse buy. Think of how nice it'll be to have a dozen pairs of the same socks.

On the way home, decide to visit the strange little nursery on the edge of town. (NB: One of my few unbreakable life rules is never to shop at a nursery that doesn't have resident cats.)

Roll on into that nursery and greet the Domestic Orange Jumbo who patrols the perimeter. Meander slowly down the rows of trees (Japanese maples are big this year) and hardy annuals until you get to the greenhouse. Push aside the plastic sheeting that covers the door, walk into the greenhouse, and take a deep breath of warm, humid, growing-things-scented air.

Take a few more deep breaths.

Dodging craneflies, examine the offerings. Consider buying four-inch pots of catmint. Discard this idea when you remember how prolific and invasive catmint is. Sniff hard when you bend down to look at the Carolina jessamine and Asian jasmine in teeny pots. Admire the Meyer lemons and wish you could remember to bring such a thing inside when it gets cold.

Walk out of the greenhouse and enjoy the change from warm and humid to cool and slightly muggy.

Walk to the next greenhouse. Stop along the way to pet an argumentative calico cat and a black-and-white cat with long whiskers. Realize that the combination of greenhouse and relative outside humidity has made your hair go native in a big, bushy way.

Enter the second greenhouse. Breathe deeply. Realize that this one is mostly roses, but don't go back out, even though you don't want roses. Stroll the aisles of rose plants, reading every card and smelling every bloom. About halfway through, pick up the calico cat who's followed you in and carry her so she'll stop complaining.

Leave the second greenhouse. Stop to commiserate with the nursery's owner, who thanks you for paying attention to the bitchy calico (now curled up with her head on your shoulder). Discuss the drought, the invasiveness of artemisia, how Home Depot has ruined foundation plantings, and whether you can divide buddelia by whacking at it with a shovel.

On the way home, stop to pick up tacos from the taco truck.

Eat your tacos. Update your blog. Take a nap.

My head, let me show you it.

We had a patient recently who had something I've never seen before (for that matter, neither had the physician). He'd infarcted his corpus callosum.

Now: If you're not a brains person, this won't mean jack to you. It's a very big deal, though, for a couple of reasons: first, the corpus callosum has a huge blood supply coming from (if memory serves) three different arteries. Second, infarcting (cutting off the blood supply) it means that you end up with something called split-brain syndrome.

See, the C.C. is the part of your brain that ties everything together. It's a big ropy mass of white matter--the stuff that has the thinking bits of your brain in it--that acts as a communication corridor between the right and left sides of your brain. It allows you, for instance, to be able to recognize a chicken, describe that chicken, name that chicken (sounds like a bad game show title), and talk about what sorts of implements you'd need to take care of said chicken. Besides a knife and fork, I mean.

Occasionally we'll cut the corpus callosum as a last-ditch attempt to stop a really horrible case of epilepsy. That's usually done on children who simply can't stop seizing, no matter what we do pharmacologically, and it's usually done at a very young age, because the ability to overcome that callosotomy, as it's known, decreases as you get older. If it's done too late, or if it happens later in life as the result of a stroke or other injury, you end up with split-brain syndrome.

I'll bring back the chicken and let Wikipedia explain what split-brain syndrome does:

A patient with a split brain, when shown an image in his or her left visual field (the left half of what both eyes take in, see optic tract), will be unable to vocally name what he or she has seen. This is because the speech-control center is in the left side of the brain in most people, and the image from the left visual field is sent only to the right side of the brain (those with the speech control center in the right side will experience similar symptoms when an image is presented in the right visual field). Since communication between the two sides of the brain is inhibited, the patient cannot name what the right side of the brain is seeing. The person can, however, pick up and show recognition of an object (one within the left overall visual field) with their left hand, since that hand is controlled by the right side of the brain.

The same effect occurs for visual pairs and reasoning. For example, a patient with split brain is shown a picture of a chicken and a snowy field in separate visual fields and asked to choose from a list of words the best association with the pictures. The patient would choose a chicken foot to associate with the chicken and a shovel to associate with the snow; however, when asked to reason why the patient chose the shovel, the response would relate to the chicken (e.g. "the shovel is for cleaning out the chicken coop").

Obviously, it's going to be a drag if your C.C. gets all jacked up. It's hard, given the other problems this dude has (like an almost total lack of white matter, thanks to diabetes and hypertension and a bunch of other stuff), to get a really clear read on how it's affecting him and whether or not he even notices. We thought that he had some left-sided neglect (more on that, per Pens's request, in a later post) combined with a major psychiatric overlay (given his history). It wasn't until we saw the MRI, with the corpus callosum lighting up like Christmas, that we realized what, exactly, the problem was. Golly!

(Yes, I actually said "Golly!" upon seeing the guy's MRI. Sometimes I say "Gee whiz!" as well. Ironically, of course. Because I'm hip.)

Now I'm left with a wet, cold chicken who's been in a snowy field and has to be returned to her cozy coop over at Wiki.

Cross your extremities.

I'm waiting for a call back from the insurance peeps. They called earlier regarding my appeal, I called 'em back, got voice mail, and left a message.

Pray, chant, shake your booty, light incense, whatever.

Thanks.

My week, by Jo.

This past week, I was stroke coordinator, advisor to the publications department, advisor to the computer guys who are installing new monitors, preceptor to two nurses, secretary, patient care aide, transporter, housekeeper, fire-putter-outer (figuratively, not literally, thank Frogs), chief inspector of electrical outlets, general dogsbody, and carrier of a full patient load.

I have this weekend off. Except work has called four times as of 0500 this morning to see if I'd like to work extra.

Extra work is not on my schedule. Last night I went to bed just after 5 pip emma, as the sun started to go down. I slept eleven and a half hours and feel almost human.

Things are bad at Sunnydale General: we've got a number of people out with work-related injuries or stress-related problems, our census has ballooned over the last six weeks, and we're all run to nubbins. On top of all of that, I've had such a sore butt over the last two weeks that I've been barely able to walk.

Conversation between me and Der Alter Jo at the Korean barbecue:

Me: My ass hurts.

DAJ: Cross your legs like this: (demonstrates).

Me: (crossing legs like that) scream

DAJ: That's piriformis syndrome.

Conversation with Dr. PMR:

Me: My ass hurts. Friend of mine says it's piriformis syndrome.

DPMR: Cross your legs like this: (demonstrates)

Me: Aw HELL to the no.

DPMR: You work out on an elliptical, right? And you run the stairs here?

Me: Yep.

DPMR: You're a moron. It's piriformis syndrome. Quit running the stairs. And do these stretches. And use a heating pad and NSAIDs.

Me: scream

If there were a Twitter tag for this entire month, it would be #tinyscream.

As the topper, I think one of the docs that I like best is leaving the stroke program. I'm not sure yet, having only heard the most whispered of rumors, but I'm worried.

Kentucky is gorgeous, though, as is Missoula. I could move, right? Right? Even with my sore butt and my worn-to-a-nubbin temper?

Danish cooking: it's messy.

First you go to the local butcher and ask for a pound of ground pork, the leanest possible, run through the grinder four times. No more, no less. Four times.

Then you get a pound of veal, run through the grinder twice.

Run home, put that in the fridge, and run out again for the following:

1. White bread with which to make breadcrumbs

2. Sour cream, heavy cream, dill, and selzer

3. Cloves, pepper, and salt

4. Frozen red currants (you have NO IDEA how hard it is to find frozen red currants) and raspberries

5. Unsalted Danish butter, Lurpak brand.

When you get home with all that glory, you'll do the following:

Mix half a cup of flour, two eggs, half a cup of heavy cream, half a cup of selzer, and about a cup of breadcrumbs with the meats. Add a smidgen of salt, a buttload of pepper, and a couple of pinches of cloves. Knead it all together and stick it in the fridge.

Put your currants (two packages) and raspberries (ditto) into a nice, heavy stockpot with enough water to keep them from burning. Simmer until everything's soft. Blend the mess in your blender (being careful not to let it explode out of the top), and then strain it through a strainer lined with cheesecloth. Twice.

Return it to the rinsed stockpot with a quarter-cup of cornstarch mixed with water, and simmer until the mixture begins to look gelled. Then pour it into an appropriate container and refrigerate.

Look around your kitchen and marvel at the red splotches everywhere.

Now it's time for meatballs. Grab a golfball-sized hunk of meat mixture out of the bowl and shape it into something like a flattened egg. Repeat eleven times, then fry the meatballs in a third of the butter you bought. Repeat twice more. While you're doing that, you can plan out mincing up the dill and mixing it into the sour cream to make a dill sauce.

While those frikadeller are frying, why not try to clean up some of the fruit splash from your counter, backsplash, stove, table, and person? Well, why not? Because it'll never work. Just learn to live with red splashes every-damn-where.

Remember dimly how your Danish host mother managed to do both frikadeller and fresh ham and rodgrod med flode without making the kitchen a horrible mess, and without spilling stuff on herself. Gaze around your own kitchen and marvel at the number of sieves and pots you've used at this point, only halfway through. Load the dishwasher. Pour yourself some aquavit.

Consider pickling your own beets to go with the frikadeller and roasted potatoes, then dismiss the idea.

Consider repainting the kitchen walls in a glorious, vibrant shade of pink. Consider it twice.

Eat a hot dog, drink a beer, go to bed.

Why I love my job, part umpty-umpty-ump:

1. Standing around on rounds with the chairman of the department and the United Nations of Neurology (aka the residents), trying to figure out what the hell is wrong with a particular person. "He can't read out loud, but he can read silently and give you a good summary of what he's read." "Do you suppose that guy has edge-sensing and blindsight? That would be really cool. I've never seen a case of blindsight before." "How the heck are we supposed to get her to eat all of her food if she has total extinction of the left side?" (Me, having read Oliver Sacks: "Just tell her to turn her plate to the right until more food appears." Neurologists, not having read Oliver Sacks: *gaping in amazement*) "What about that one dude who sees only in black-and-white? Is that any better?"

2. Seeing function come back after TPA administration. Normally we don't do MRIs prior to TPA, just CTs. The MRI suite is always so busy that holding TPA until we have a solid MR image would push most of our patients out of the window (in terms of time, not literal defenestration). That means it's always kind of a crapshoot in terms of what we'll see, depending on whether the embolus was a clot or plaque or whatever.

3. Learning even tinier details of brain anatomy every single day. Just when I think I've got a good handle on things, some genius comes up with a theory that a patient's symptoms are due to a minor derangement of Whargarrbl's Foci of Bolognese's Range of the Straits of Inglewhazzit. It all starts to sound like Terry Pratchett, and I'm off to the textbooks again.

4. Learning really gross things about gross anatomy. Turns out there's a nasty situation that can happen inside an artery that causes a big snotlike glob of fat and plaque to detach partway and hang there in the blood streaming from the artery. Except that it's attached at one end to the wall of the artery, so it just goes "hrrbl hrrbl hrrbl" and blops around, occasionally causing TIAs. I can't remember the name of it, but if I see it again, I'll know it.

5. Knowing enough to explain what's going on when somebody in a different department starts freaking out about the YouTube video with that octopus? That's dead, and in soup, but then somebody pours vinegar over it? And I can explain how the acid in the vinegar stimulates the sodium channels and makes the octopus-food-corpse-guy want to crawl out of the bowl. That's really cool. I like that part.

In which Nurse Jo performs an assessment:

Nobody died over the last four days: good.

TPA given to two people who needed it: good.

TPA given to one person who has a factitious/psychological disorder: well, no harm done.

Intubation of one patient: very, very good call.

Extubation of another patient: good. I'm glad her daughters got to be there.

Lotioning of a patient: Jeebus grits, why did this woman have to use Johnson's Baby Lotion? I hadn't smelled that smell in better than twenty years. It took me back to watching my grandmother get ready in the morning, in her alcove lined with mirrored closets, and her vanity mirror with Johnson's on the table.

I think I might have to go buy some Johnson's Baby Lotion just for the helluvit.

Self:

Oh, dear.

Noticeable right nasolabial flattening. Left neck musculature overcompensates for right on swallow. Left and right shoulder shrug equal. Right facial and neck dermatomes non-compensatory; total extinction of buccal and mandibular distributions. Compensation adequate.

Crooked smile: my new trademark.

So, yeah. Hey. How you doin'?

Well, we're moved.

We have a spandy clean new unit with seven (!!!) beds, monitors, a central monitoring station, computers that work, (oh, crap, I just realized I have to call them about the call light system) and beds and so on that actually function and don't have bits broken off of them.

So that's what I've been doing for the last couple of weeks. That, and the usual keeping people from falling out of their chairs or having larger strokes or otherwise having complications that would keep them in the hospital for weeks and weeks.

The first thing I did in the Spandy New Unit was stretch my arms out from my sides and turn in a complete circle. That did not used to be possible. The second thing I did was walk from one end of the floor to the other, giggling, and saying "wahoo!" softly. Then I got my poop in a group and got the patient we had to move to her new room.

It feels a bit like a shakedown cruise. There's still a lot of stuff that doesn't work, and things that could be neater or more convenient, but we'll work those out in time. Right now, I'm just grateful to have a place to put people where I can be relatively sure that the walls won't catch fire and I can get them into and out of the rooms through doors wide enough to admit hospital beds.

While you're waiting for a real new post, kd lang.

Things They never tell you about having had cancer:

1. While cancer might be simultaneously boring and terrifying, it beats waiting for the surveillance scans. There's an up-and-down rhythm to getting your lymph nodes biopsied (ow!) that just isn't matched by the four-month drag that is waiting for your first chest CT.

2. Growing your hair out after having had cancer sucks just as much as it does when you're well. You still have weird flippy pieces and flat bits, and you still look like hell, but at least nobody says anything snarky. They just look at you and say, "You lookin' good. Whassup with yo' 'fro?" (credit: Friend Lisa from work.)

3. Every beer, every french fry, every night out on the town is larded with guilt that This Might Be The Thing that tips you over the edge into another horrible diagnosis.

4. Your blood pressure will always be a source of concern for the nurses at your surgeon's office, and they'll waste lots of paperwork on you before you say, through gritted teeth, "MY PRESSURES ARE HIGH BECAUSE I DON'T WANT ANOTHER BIT CUT OUT OF MY HEAD, THANK YOU VERY MUCH."

5. Your foresight in putting all your favorite colognes at the back of the closet during the first week of treatment will be rewarded when a patient in the chemotherapy unit says you smell good.

Redemption rips through the surface of time

(Bruce Cockburn, Lou Reed, and Roseanne Cash)

"...and guess what? I felt the baby kick today."

Merry Christmas, y'all.

Question From A Young Nurse: But What About The Feelings?

A Young Nurse asked Auntie Jo for advice this week. Poor, deluded Young Nurse.

Our correspondent asked this: "What do I do when a doctor or older nurse snickers at an answer I give to a question, or takes me aside later and tells me that I should've done something different? I have six patients, and I'm new to the night shift. I can't keep everything straight all the time. I want to kill them. What should I do?"

Dear Young Nurse,

We were all there, once. Those of us who got over it became the sort of nurse that your Auntie Jo is. Right now, I have a cat rubbing on my shoulder, a cold beer to the right of the keyboard, a happy dog frolicking in the back yard, and a list of men who want to be seen with me.

Those of us who didn't get over it became the doctor and nurse you're working with.

Practically, what you can do is this: Do what residents do. At the start of your shift, make out index cards that have each patient's name on them in big, bold lettering, so you can't miss it. On those cards, write the essential lab results and neuro/cardio/gastric/renal changes the patients have during the shift. Update them as you need to. That way, if you're ever caught out by a question, you can yank your index cards out of your pocket (be sure to wear scrubs with pockets at the waist) and answer the question quickly.

Doctors *love* it when you do things that they did as residents. It makes them feel very smart, and they will treat you better as a result.

As for the nurse: be humble. Shrug things off with a "Well, I'm still learning. Someday I'll have all that stuff on the tip of my tongue, like you do!" Make sure your back is turned when you roll your eyes. Mean nurses love that sort of thing, even as it makes them wonder if they're really *that* decent of people (answer: No, you're not, and you're going straight to a flaming-hot Hell when you die).

But what about the feelings?

It is hard, and I acknowledge that it's hard, not to reach out gently and wrap your scrawny little hands around somebody's neck. As The Bloggess once said, "A hug is just a strangle you haven't finished yet." I would suggest that you find a nice, private place to feel those feelings.

Feeling something like rage or disappointment doesn't mean you have to act on it. It just means that you've opened the door marked "RAGE" or "DISAPPOINTMENT" and have gone in and browsed through the goods on offer. It's best to do it in private so you're not interrupted. Rage, rage, against the asshole nurse or doctor who decided to get his or her rocks off by humiliating you. Then set it aside.

Resolve that next time you'll be so bulletproof that you'll embarrass them without meaning to. Resolve that next time you'll have the perfect l'esprit d'escalier and won't forget to say something like "up yours, motherfucker" when it's warranted.

Resolve--and this is both the most difficult and most important thing--that you won't let this make you think less of yourself or your practice. Some people are just assholes. Instead of bundling the urge to finish the hug up inside yourself, practice letting it out in the car.

All you can do is the best you can do. Be prepared, be on point, and if things don't go your way, don't fret: you've done your best. Believe it or not, your best doesn't have to be perfect. This is a twenty-four hour a day job. Self-doubt is a killer, because the minute you doubt yourself, you start doubting that little voice in your gut that tells you something ain't right.

If all else fails, Talisker. It's a good Scotch for beginners.