I missed Christmas Day, but. . .

May you all have the Humor of Donna

The Heart of Rose

The Patience of Rory

The Balls of Amy

The Bravery of Martha

The Belief of River

The Courage of Clara

And the Love of Tashi

http://images2.fanpop.com/images/photos//Tardis-in-Space-tardis-6289810-1280-768.jpg

To welcome in this new year.

"But you. . .

. . .you were fantastic."

Arizona north of Phoenix is, as Beloved Pens says, fucking lousy with vistas. Coming up over a series of hills you weren't aware you were climbing, the whole earth opens up to reveal hills the size of small mountains, creekbeds that probably haven't had water in them in years, and is that a mesa out there in the distance?

I trundled along in my speed-governed econo-box, and my mouth dropped open as I topped that last hill on 17. All I could think to say was "Holy. Shit."

Arizona is a weird place. I hadn't been through there in years--the last time was in 1996 or so, and we bypassed Phoenix for Flagstaff--and I had forgotten how you see places in the desert.

The first way is in the details: the grinding sameness of saguaro cactus, which at first is incredible and then just blends in to the sagegrass and the sand. The second way is in a car, where everything moves fast enough that you're taken by surprise by the whole picture when a vista opens right up in front of you. The third way is from a plane. Nothing's human-scale any more; it's a glorious, perspective-less panorama of mountains and dry washes. You wonder, looking at it from the air, if anybody who'd settled the area would've kept going if they'd known what was ahead of them.

I wondered that same thing about Tashi before Kevin's memorial service this weekend. If she'd known what was going to happen, what she'd have to go through, would she have stuck with him? The grinding sameness of the day-to-day chores of dealing with somebody whose brain is altered, when vistas don't open up with the regularity that they do on the highway; what would she have done?

The answer came when Tashi said this: "Even though I only knew him for about a year before the cancer started changing him, he was so amazing that the love he gave me made it worthwhile to stick around."

And, "The cancer never got *him.* He was never his cancer. He was always himself."

Speaking literally, Kevin lost. He died of brain cancer. It won.

Speaking in every way that matters, he won. He owned that cancer, and beat the hell out of it. The proof is in how all of his friends remembered him: a silly, loving, incredible, creative, goofy, loyal man who cared more about other people than he did himself, and loved everybody. Those things that made Kevin Kevin didn't change just because he had a tumor.

I've never laughed so hard at a party in my life, even one where the guest of honor wasn't dead.

Kevin's friends told stories and provided details. Tashi told us what it was like to take care of him when he was sick. The two combined opened up a big, detailed portrait of a person I wish desperately that I'd known. I was honored and lucky to hear all about him, though, and for that I'm grateful.

Tashi said at one point that Kevin was the kind of guy who made other people want to be better people.  I had been thinking that exact same thing just seconds before.

Thank you, Tashi, for introducing me to Kevin. He was fantastic.

RAAAAAAAAAN-dom

I just painted my fingernails a dark, elegant grey. My toenails are a sparkly dark red, except for the nail on the fourth toe on my right foot, which is grey. Tomorrow, when the polish is totally dry, I will decorate the nail on my left fourth finger with bright pink stripes.

This is all for Kevin's memorial service, which is Saturday in Arizona. I will be wearing, per his wishes, bright-colored comfortable clothing (ink blue baggy pants, grape-purple artist's smock with a green t-shirt underneath, Converse and a saffron-dyed scarf from India). There will be, if my Interwebs research is correct, pie available at the service. I am all about pie. Hence the baggy pants.

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The Boy and I are texting. I say he should check out Baker Seeds; he says I should check out Forestry Supply. Little does he know that I already have a wishlist from FS that's as long as your arm.

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Best salad ever: greens, including baby kale (NOM), bell peppers, tomatoes, cucumbers, corn, black-eyed peas, cheese, FRIED OKRA, little bits of carrot and olive. I'm kind of on a kale kick at the moment, which is good, as the hippies across the street have approximately eight gazillion tons of the stuff to give away. They're desperate. I eat the teeny new kale plants in salad, since it doesn't have to be cooked or massaged or whatever, and the older leaves chopped up for tabbouli.

The folks at Baker Seeds say that kale will grow whenever there's even a hint of warmth in the air or soil. That doesn't really express how kale will take over your garden, your yard, your life, if the air temperature isn't below thirty degrees. It was eighty degrees here today (what the fuck global warming stop it STOP IT) and, sure enough, there were bitty kale sprouts coming up from the ground.

Some say the world will end in fire, some say in ice. I say the world will end in kale and cucumber vines.

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Speaking of cucumber vines, have I told you guys the story of Mom's killer melons and pumpkins?

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Or the time she planted luffa gourds and zucchini in the same garden, and they cross-polinated? I noticed that nine of ten blurbs for luffa gourds I saw in gardening catalogs this year noted that they would not cross-pollinate with other squashes. Technology: saving us from weird stir-fried squash.

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Don't tell The Boy, but I'm thinking of redecorating the bedroom, to make it more Boy-friendly.

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

Attila made me do some weird new back exercise today. Given that I dealt with hemiparetic and tetraplegic patients last week, all weighing over three hundred pounds, I am sore as hell this evening.

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And that is all for this evening. I'm off to make stripes of Scotch tape and pink nail polish.

So we have this new computer system.

The whole damn thing's been reworked, top to bottom, and it's rumored to be the best, most efficient, most amazing computer system in the history of EVAH. Lab tests and MD notes and medication administration and tiny bits of lint from the dryer are all linked together; all that's linked to some magical whoozit that records when a nurse enters a room, what equipment s/he uses while there, and when s/he leaves. It's rumored, in short, to be the best. damn. thing. since SLICED FUCKING BREAD, MAAAN.

Except, well, it doesn't work.

And I mean, all joking and superlatives aside, it doesn't work.

For instance: let's say you have a patient who wants only one Lortab, rather than the two that were ordered. Instead of pulling two out and wasting one, or just doing an RN override on the Diebold that holds the meds, you have to now call the doctor and get an order for only one Lortab. And then wait for that to be entered and linked and so on.

Yeah.

Let's say you have to waste a partial dose of a medication, like when a patient gets two milligrams of morphine but the morphine comes in four-milligram ampules. The old way to do it was pull, waste at the machine, chart. The new way is pull, have two people scan the med at the bedside, waste at the bedside, do an override to administer 2mg of an ordered medication, then go back and enter the waste at the machine.

And, because everything is now coordinated, Les Machines keep track of how long it takes you to get *back* to the Diebold and waste. If it's more than about a half hour, your administration will get flagged for investigation, because you might be huffing morphine. Which is fine and dandy unless you have five (or six, or eight) patients to deal with. Nurses with huge patient loads often waste everything at the end of the shift.

Let's say you have a person on a heparin drip. Even if you only want to enter the same drip rate hour after hour after hour, you still have to scan the person's armband, scan the bag, and get a witness. This is the new rule for every titrate-able drip in the system. For us, it's not a big deal: we might have one or two drips running in the NCCU on a person. In the med-surg CCU or in the neurosurgical CCU, though, it's a big deal: imagine having to scan-scan-witness-verify for eight drips on each of two patients. Every hour. On the hour.

And, finally, let's say you go into a room that holds a person who's been admitted for a TIA. They're neurologically intact, fine and dandy, and on only aspirin and an antacid. If you leave the room before a certain number of minutes have elapsed when you're giving those meds, you get flagged for not doing sufficient patient teaching on the Tums and Bayer you just administered. If you take too long--that is, if your patient is on six different meds, five of which are new, and the person has questions--you get flagged for inefficiency.

THIS IS WHERE I GET ALL CAPSLOCKY. The trouble with setting up difficult failsafes in a time-crunch-prone profession like nursing is this: once the new checks are set up, all the older ones get scrapped. We no longer have the pop-up windows on our med records that alert us to possible double-dosing. Instead, we have a huge, long, convoluted process to go through that guarantees nothing, as most of our peers are too time-crunched to double-check us.

We learned, less than four hours after the system was implemented, how to get around it. By the end of day shift on Monday, most nurses had copied the scan-codes from med labels and stuck them to the back of their ID cards. We'd also figured out how to copy the med-admin codes from the patients' armbands and stick them to the charts. We worked around the new, cumbersome failsafes. . . .

. . .but we didn't have any other checks or warnings to alert us when we'd fucked up. In other words, our system now has only one point of warning for each patient, and that point has already been sabotaged in the name of saving time.

So we have this new computer system. It reminds me a lot of a story I heard from one of my colleagues. He and his wife bought a gorgeous, brand-new house where everything, from the computer to the thermostat to the hot-water heater, was controlled through the Internet. Their online service provider suffered an outage that lasted three days (he's in the boondocks). During that time, they had no heat. Or hot water. Or air-conditioning. Or TV, phone, Internet, or burglar alarm service. Reprogramming things manually wasn't an option. Why should it be, with this shiny new system?

No system should ever have only one point of failure. Even muskrats and beavers have a back door out of their homes. Manglement's reduced a perfectly workable checks-and-balances system to something with one point of failure, in the name of Patient Safety, and we've already figured out workarounds.

In other news, the hospital-wide campaign to leave our badges in the bathrooms for extended periods of time seems to be working. Manglement might be monitoring our pee-breaks, but we'll work around that, too. (I wonder what they'll say when they see that four of us were in the public men's restroom on the ground floor for six hours on Tuesday?)

Tips for Everybody:

There's nothing like coming in to work, feelin' all efficient and enthusiastic, to find that you're two nurses short in a three-nurse unit. Unless it's finding out that a different department expects your unit to staff theirs for some undetermined amount of time in the morning and again in the afternoon.

Dear Doctors: Please don't wear your ID tags on your belts. Especially please don't do this if you're an observant Muslim, a conservative Coptic Christian, or a member of some other staunchly upright religious group. See, if you've got both a name with eighteen syllables and a strong moral sense, it's gonna be embarassing for both of us if it looks like I'm starin' at your junk while trying to read your ID.

Tip for myself: Next time it seems like a patient is globally aphasic, shaking her head and smiling gently whenever you try to get her to do something, make sure it's not because she speaks only Romanian.

A gentle note to Manglement: top-down initiatives, like locator chips in ID cards, timers in employee bathrooms, and noise-and-motion sensors in nurses' stations and common areas, can and will be hacked.

Many, many thanks to the elevator inspector who sang loudly in the elevator shaft as he was doing a routine inspection of that elevator's braking system.

Also many thanks to whoever it was that joked up a pile of mattresses sitting in a storage room by sticking a can of peas in there, so it peeked out one side.

Best Line of the Night

We've been having some trouble with our sheets lately. We get one size of sheet, but have three sizes of bed. In the past, the sheets fit the largest beds but were a little loose on the other two types. Recently, Manglement decided that knit sheets were better than woven, and so dumped sheets on us that, until they're washed the second or third time, fit every bed beautifully. After the second or third washing, though, you'll hurt yourself trying to get them on to the bed. (I wish I were exaggerating, but one of my coworkers is out with a torn rotator cuff right now. It went when she was trying to change a bed.)

Anyway, Deepa and I were changing a bed under one of our patients, a guy whose stroke had left him both paralyzed on one side and unable to speak easily. Deepa, struggling with the corner of the sheet and unwilling to lift the mattress to force the sheet on to it, exclaimed, "It is so small that we can't get it on!"

Our hemiparetic, expressively-aphasic patient said, clear as a bell:

"That's what *she* said."

Y'all, I am blessed in friends.

Tashi just emailed me. She's starting her own fundraising efforts for Mary.

Tashi.

Who, by all rights, should be allowed to recover and rest and be quiet for a year or more, is fundraising for Mary.

Which proves again what I already knew: I have the best friends ever, and Tashi is the most amazing one of the bunch.

Peeps, we got a job to do here.

Some of you know Mary Osheskie, or read her blog The Bright Optimist.

Mary was one of the first people to contact me privately after I got my cancer diagnosis. She was also the only other oral cancer patient who was a woman and about my age. Her story makes mine look like a walk in the proverbial park:

Mary's a lifelong nonsmoker and nondrinker, so when she was diagnosed with stage III squamous cell carcinoma of her tongue (at an age about forty years younger than is typical, no less) it was a huge shock. She had a partial glossectomy--in other words, the docs took out half her tongue and replaced it with muscle from her arm.

Then she had head-and-neck radiation. Y'all remember how scared I was of radiation. Everything that terrified me, from a tracheostomy to losing every tooth and a bunch of bone, happened to Mary. All of her teeth are gone, her jawbone is jacked beyond recognition in several places, and--as if all that weren't enough--she had a recurrance of the cancer recently and had to have *more* tongue cut out. Luckily, she's fine now, but she still ain't got no teeth.

Now, for your average toothless person, that isn't a problem. You go to the dentist or prosthodontist, you get some implants or some dentures, and you're back to eating apples in a couple of weeks.

Mary's got a different set of troubles. She's got to have posts put into her jaw to hold specially-made dentures in place, because her jawbone alone won't take the stress of the dentures. Plus, most of the bone that's left (after surgeries to remove the dead stuff) is really, really freaking fragile. And of course, after radiation, she's not capable of healing as well as somebody who hasn't been fried.

In short, she has to have an oral surgeon do both the preliminary post-setting and the molding of the dentures, as well as follow her afterwards to make sure there's not further tissue death or infection. It's a big fucking deal.

It's such a big fucking deal that the surgery alone was going to cost $45,000 (US) and not be covered by Medicaid. Mary's on Medicaid because, after having a feeding tube and a trach and a zillion rounds of radiation and hyperbaric dives, she was indigent and disabled.

BUT!! Mary got the news today that her state Medicaid board is going to cover her surgery. She's going to be able to get the posts put in and things ready for a set of dentures. They're even going to cover anesthetic--which, if you read her blog, was not the case for having ALL OF HER TEETH EXTRACTED HOLY SHIT.

So Mary's getting her bone spicules filed down and her posts put in. But she still needs dentures.

She's a thirty-something woman with no teeth right now, and I'd like to help her make that not be the case.

Let me remind you of what you've done in the past: You gave more than eight hundred dollars to the Oral Cancer Foundation, which is run out of the founder's living room, for research and awareness. You gave Tashi Pratt-King a thousand bucks when it looked like she and Kevin (Wash) would lose their home--you guys got her over the hump, and allowed her to keep taking care of Wash until his death this past September. You also bought two Therabites for people with oral cancer who couldn't have afforded them on their own--devices that allowed people to regain the ability to open their mouths more than a few millimeters. Those Therabites, by the way, are still being sanitized and passed around.

And you made me very, very proud and grateful in the process.

Mary needs twenty thousand dollars for dentures. Medicaid won't cover them. Let's do this thing.

Let's commence Operation: Choppers.

Give Forward Fundraiser

Indiegogo Fundraiser

There is also a PayPal link on Mary's blog, linked above.

Thank you, guys.

Happy Coming-Out Day!

I had this whole long post about little old men going septic in my head, but then I just lost the will to type it all out. Instead, let me leave you with a Wayback Machine comparison of what things were like when I was sixteen, versus now, twenty-five years later (as a starting point). . . .

*woo-woo sounds of a time machine ramping up*

Twenty-five years ago, WHAM! put out a video that implied that George Michael was straight. Come to think of it, they also released a single ("Work") that pretty much declared right out that he was straight. (George, George, how little we teenaged girls knew ye.)

This year, a tweener pop star with a devastating hook ("Call Me Maybe") produced a video in which it became apparent that the boy she liked was gay, and the joke was on her.

Twenty-five years ago, I was two years away from making about a dozen friends in Chicago, all of them gay men.

This year, I have one close gay male friend who survived the AIDS epidemic. One.

Twenty-five years ago, as a matter of fact, "AIDS" came into being as a name. The other candidates were LAV and HTLV-III. The name(s) replaced what it had been called, either GRID (gay-related immune disorder) or "gay cancer."

This year, the majority of HIV positive people will be straight women of color, although the rate of HIV infection is again increasing in young gay men, who now see the disease as a manageable chronic condition, rather than the nine-month diagnosis-to-death thing it was in 1986.

Twenty-five years ago, my oldest friend was raped by some guys in our high school. He was targeted because he was gay.

This year, there was a special flag team composed of GLTBQ high-school students in a gay-pride parade in Bigton.

Twenty-three years ago, I saw posters in the windows of restaurants and bars in Chicago that showed the photographs of men suspected of having AIDS. They were put up as a public service to other gay men, so they knew who to avoid. The practice started in San Francisco in the early 1980's, when there was no test for HIV, and people's first symptoms were either Kaposi's sarcoma or PCP pneumonia.

Last week I had to explain Kaposi's sarcoma to a much-younger nurse who'd never heard of it, and who'd never realized that the AIDS epidemic was a big thing.

Fifteen years ago, Ellen DeGeneres came out on television, on the Oprah Winfrey show. That led some obnoxious so-called Christian minister to refer to her as "Ellen Degenerate." (Her response? "I heard that one in the fourth grade.")

Six years ago, Neil Patrick Harris coming out prompted a collective yawn from the public and, as far as I can tell, failed to incense any obnoxious so-called Christians.

Twenty-five years ago, I knew no gay people who were married. This year my friends Joe and George will get married. Deena and Deb have been married for five years and have a second baby on the way, and Sid and Sam are celebrating their tenth anniversary.

Happy CODay to all my gay and genderqueer buddies. Even though all of you are so far out that the closet's now lost beyond the curve of the earth, you all had tough times. Here's to real equality, the valuation of all people on the strength of their character, and the freedom to love whomever you love. Let's work to make it happen in a fraction of the time it took us to get this far.

I need laundry advice.

I can get anything except benzoin stains out of scrubs, but I need help on a non-stain-related issue.

Recently, I got four sets of Wink scrubs. They fit better than Urbane, though they're cut along the same lines: Wink seems to be made with women with hips in mind, while Urbane assumes you're young and athletic and built like The Mankiller, who looks like a boy with boobs.

Anyway, these scrubs. 65% polyester, 35% cotton, tons of pockets. Love 'em.

But even after two wash/dry cycles on Boil and Broil, they are stiff and rustly, and they still have the creases from packaging. How do I get those out?

Do not say "fabric softener." That shit is of the devil and gives me rashes.

Ideas?

Culture clashes and advice for Yankees

For those of you wondering about Tashi, she's doing as well as can be expected. She has good moments and bad ones, but that's par for the course.

We've had an influx of Northerners this summer, so I feel like I can share a little advice with them:

This is central Texas. Things move much more slowly here. Nevertheless, we have been known, while driving, to pass on the right.

Speaking of driving: going the speed limit, unless you're near a known speed-trap, is Not Done here. We have places to be and miles to go, so we generally drive like bats out of hell. Just keep up with traffic and you'll be fine. Don't go the speed limit in the passing lane; you'll likely get killed or yelled at.

I understand that things work differently in Chicago or New York or wherever it is you're from, but here you *can't* be abrasive and expect to get things done. If the movers tell you they'll be there between twelve and three, but you need them to be there right at twelve because you've got the freight elevator reserved from two to four, explain that. Don't, as I heard one person say, snap back, "You will not be there between twelve and three! You'll be there at twelve!" She later wondered why the movers came late and moved slowly. Just be polite. It costs nothing and greases the wheels.

If you have to ask how to "style" "cowboy boots" (they're called just "boots") then you probably shouldn't be wearing them. As Lyle says, buy your jeans a little longer.

The heaviness of the accent does not always indicate the education level, general intelligence, or personal wealth of the speaker.

Women of a certain age are always referred to with "Miz" preceding their first names, and only then if you've been invited to call them by their Christian name. This holds true in most small towns (it does in mine) and some large cities. In fact, it's best not to call anyone by their first name unless you're sure it's okay.

"Ma'am," "Sir," "Please," and "Thank You" are not optional. And don't, unless you want a reputation for being difficult, walk straight up to somebody and tell 'em to do something without first asking how they are and being pleasant.

Bless their hearts, they don't know any better.

Speaking of culture clashes, I was listening to an NPR interview a few weeks ago with a guy who says that culture influences perception of color; in other words, the context in which you're raised determines to a large extent how many colors you see and what you call them. He said, for instance, that the ancient Greeks had so few delineations between colors that they essentially saw in black, white, and bronze.

I snorted mentally at that until the other day, when Friend Deepa, who can't believe my hair, was touching it gently and cooing, "Golden hair, golden hair." Now, my hurr is red--at the most, it could be called strawberry-blonde when I've been out in the sun. When I corrected her, she said positively, "No, your hair is golden." I said, No, my hair is red.

She then pushed back her own hair to show me the earrings that she wears which, like those of most of the Indian women here, are twenty-four carat gold, so pure it's brassy. "Your hair," she pointed out, "is the same color as my earrings. So it's golden."

Point to Deepa. I stand corrected.

GERONIMO!!

Tashi brought Wash's ashes home today in his Tardis urn. This completes this stage of his journey. Next stop: Wherever, Whenever.

Regularly scheduled blogging will resume whenever this localized weather system gets off my face.

Allons-Y, Wash! Good journeys.

Kevin Pratt-King

1985-2012

Prayers for Tashi and Wash, please. . .

Wash is in Hospice right now. He told Tashi on Sunday that he thought he was about to die, watched an episode of Dr. Who, and was unconscious before the end of it.

Please keep them both in your thoughts, but especially Tashi. She proved every day what love is.

Thank you.

In which Jo gets a little pissy about language.

Gifting.

Gifted (passive voice).

Skirting.

When did "gift" become a verb? When did it become acceptable to say that your mother-in-law gifted you with a Precious Moments figurine? How is it okay to say that something is good for gifting or is giftable?

And when did skirting start describing pieces of fabric with buttons at the top? Skirting is either something one does around an issue, or vinyl sold by the linear (not lineal) foot at the mobile-home dealership. One buys a skirt. One does not purchase skirting to wear on one's body, unless one is suiting up for a particularly bizarre costume party. (Halloween costumation ideas, right here on Headly Nursingtons!)

A million years ago, my parents would sit around the breakfast table in their bathrobes, reading out loud from the Wretched-Comical, our local newspaper. Dad went into fits one day over the headline "GIFTABLE SWEATERING," then read the accompanying ad copy out loud with hoots and snorts. I think it might've been 1980 or thereabouts; my sister was home for Christmas break from college. She, being the English major in the house, had lots to say about giftable sweatering.

Then, about a month ago, somebody on my beloved Hairpin used the term "for gifting." The somebody in question was an actual contributor, not a commenter, and nobody called her out on it. Nobody. "Gifting" was okay.

I felt a little like I'd been dropped into a reality I wasn't familliar with. With which I wasn't familliar; whatever. I'm not opposed to splitting the infinitive if it makes reading easier.

I am, however, opposed to gifting and skirting.

(Before anybody asks, yes, I'm poncy about "nursing" as a job description as well. "Nursing" feels like it ought to be limited to breasts and babies. "Being a Nurse is My Bag" doesn't flow, though, and looks crappy on a reusable grocery sack. Yeah, I'm weird.

At least I'll never turn "surgeon" or "patient care aide" into verbs. That's my promisation.)

Well, *that's* never happened before.

Friends and neighbors, I got my ass kicked on Monday.

And when I say I got my ass kicked, I mean I got my ass kicked.

Let me explain: there are a number of unfortunate things that can happen to make a normally nice, cheerful person batshit insane. Things like drug abuse, encephalopathy, encephalitis, vasculits, meningitis, strokes in unusual places, tumors--you get the idea. There's a lot of stuff out there that can hit your brain in such a way that your personality does a one-eighty, but most of those things are very, very rare indeed.

When they hit you, though. . .wow.

Granddaddy came in with a few personality changes and some increased sleepiness (note for new neuro people: your A-number-one sign that there's a problem is irritability and decreased consciousness in tandem) and steadily got worse. He was transferred to us with a Posey vest on, keeping him in his wheelchair as he cussed and ranted.

At some point in the proceedings, he tried to stand up and tip the wheelchair over backwards in order to get out of it. Gweneth, the steadiest and most sensible of patient care aides, was there in a second, keeping Granddaddy from overbalancing, and Stoya went around to his front to see if she could calm him down. I was close behind her. Too close, as it turned out.

Granddaddy threw a punch. Stoya did some sort of Matrix move to avoid it (thank goodness, as it would've messed up her face), and the punch landed squarely in my solar plexus.

Well! I wasn't expecting that at all.

I made a noise like a duck and went down. I'm not ashamed to admit it: have you ever been punched in the gut? I hadn't. I've been hit in the face, which only makes me angry. I've been whacked about the head and shoulders, which is disorienting and painful, but not too handicapping. Being hit in the stomach, though, right in the breadbasket, so hard that the breath gets knocked out of you? You fold up like a sack of potatoes, which I did.

Unfortunately, I folded up right where Granddaddy, still Posey'd in to his chair, could get to me with both fists and feet.

In retrospect, it's funny. It must've looked like something out of a comedy film, or that clip on YouTube where the dude in the Darth Vader costume gets attacked by a playful dog. At the time, though, all I knew was that I was getting wailed on by an angry person with what felt like superhuman strength. Oh, and I couldn't breathe.

Gweneth managed somehow to get the wheelchair unlocked in the middle of all of this and get Granddad out of range. Stoya got his arms, I got the Haldol, and things quickly got better from there.

Y'know, IV Haldol is strongly not recommended, because it tends to cause heart arrhythmias, but at that point, we didn't care. In a few minutes, things calmed down to the point that Grandpa could go back to bed.

The bruises are fading now. He didn't actually hurt me, but he sure woke me up. This is not something you think about when you're taking the NCLEX.

ERMEHGERD SCHNERZZLES

Stolen from CuteOverload. CRANK UP THE VOLUME, PEEPS.

I have the letter!

Yes, my friends, the letter from the OEB that tells me that I am getting Moneys from the insurance people is here in my hot little paw. As I said to La Belle Dame, though, I ain't chillaxin' until that check's cleared.

With my luck, BCBS will skim 90% of it off for processing costs. Which will, of course, lead to the recently-repaired Hell Bolts being sheared again.

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I have made a new friend.

A few days ago we got one of those patients in: you know the sort, that come without CDs of scans and with minimal information from the transferring hospital. Luckily, this nice little old lady had no medical history, and not because she'd never been to the doctor. She was, at eighty-something, simply that healthy. A lifelong non-drinking, non-smoking vegetarian, she'd had a TIA as a result of a brief dip in her already-low blood pressure.

So, upon her arrival to the NCCU, I paged the dude on call. And paged and paged. Finally, I sent a text page reading "Are you alive? If so, call Jo at XXXX. Minimum three minute rates apply."

The dude on call called me back immediately and apologized. Turns out that between consults and admits at Holy Kamole, he had more than fifteen patients to see. I said I just wanted him to know that I'd gone ahead and entered orders under his name, using the NCCU order protocol, to which he said, "Oh, are *you* the one who entered all those brilliant orders? You clever little thing, you."

"Yes, darling," I said, "I did enter those orders. Now, you'll have to swing by and work your magic on our sweet LOL, but the rest is taken care of for now. Just decide whether you want heparin and let me know, okay?"

"Brilliant!" he replied. "I'll be there as soon as she gets to sleep and the nurses have relaxed for the evening."

He greeted me the next morning, after no sleep, with a muffin. He thanked me for saving him a half-hour's work and making his life easier.

I may have to reassess my attitude toward new fellows.

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

It dawned on me yesterday that when my boss is not around, stupid shit happens much less often.

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

The Apocalypse is nigh: it is August in Central Texas, and I have all the windows open. We've gotten some rain in the last couple of days, and it's now a balmy 70* at just past 0800. All the fans are on, the a/c fan is whirring away, and the cats are napping on the north-facing windowsills.

After two years of really weird weather, this is a relief. This is how it's supposed to be here: daytime highs in the 90's, occasional rains that flood the highways, and brisk mornings. Ever since everydamnthing burned down last year, I've been watching the skies and the winds. Normal is a little disturbing, but I'll take it.

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

Three big things are going to be happening here in the next few months:

1. A template and step-by-step instructions on how to fight insurance companies. Once the template and instructions are up, I'll put permalinks in the sidebar for anybody who wants to use them. Not everybody has the resources and time I do; it's a no-brainer to distill everything I've learned in the last two years, and all the expert help I've had, into something you can fill in, print out, and send off in order to get your money back.

2. HN might be migrating to a new platform. I haven't decided yet. If HN does move, it'll have the same look & feel and the same layout as before, or as nearly as possible.

3. I am dog-hunting. More to come on that as things develop.

Well, well, well.

That appeal? The one that got lost, then found, then didn't have enough paperwork attached?

JUST GOT APPROVED FOR EIGHTY PERCENT REIMBURSEMENT.

They just called.

You may commence celebrating.

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

Or not. It's been a rough week.

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

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

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

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

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

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

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

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

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

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

But they didn't.

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

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

Now I'm just peevish and determined.

Peevish. And determined. Very determined.