My Boyfiend's Back.

I go back to work tomorrow after ten days off. Why, you ask, did I take ten days off in the middle of what is decidedly not vacation season?

My boyfiend's back.

Specifically, his two-level microdiscectomy and associated recovery time.

Boyfiend had worked really hard all late summer and early fall, getting the brewery where he works up and running (yes, Boyfiend makes beer for a living. It's a perfect match.) and had started, just before Thanksgiving, having some pain in his knee. He'd messed up the knee years ago in a bike accident (yes, he rides bikes. Yes, he has a fixie. Yes, he has a beard and skinny jeans and flannel shirts.) and we'd thought it was just overwork. . .

. . . until the day that that leg was so numb he nearly fell getting out of bed.

I'll spare you the fun and games involved with the diagnosis of his problem, except to say that about six weeks into it, I said, "Honey-Bun, Snoogums, Sweetie-Pie, this shit is for the birds. I've got you an appointment with a neurosurgeon at Sunnydale General."

Whereupon he had a myelogram and various other things done that made the surgeon say OMG WTF, and then he went into surgery, where the surgeon opened him up and said OMG WTF EVEN WORSE THAN I THOUGHT OH NOOOOEEEES, and then the surgeon fixed him and closed him up and he's been pretty much fine.

I told him before surgery that he'd take less pain medication recovering from the surgery than he did prior. He did not believe me. I was right.

So for ten days I've been on light nursing duty. Boyfiend is not a whiner, he doesn't moan for attention, and he doesn't get in the way. Mostly he's been sleeping and reading and eating entire pints of ice cream late at night.

Monday he'll get his staples out. Then he can begin, very carefully, to be slightly more active. It'll be months before he's allowed to throw kegs around like Hulk Brewer again (if ever he can), but at least he'll be further away from surgery.

I have to say: it's been nice, after years and years of taking care of back-surgery patients, to get to see one get better.

Hey la, hey la.

Me working yesterday, after the time change.

Bladder, why you do me this way?

Back in nursing school, I had an instructor. Everybody has one of those instructors--the ones whose classes make you yearn for the sweet release of death, or at least a nice case of vascular dementia. I don't remember what she taught, although it couldn't have been that important, since we only met twice a week.

She had three hobbyhorses that she managed to work into every class: homeopathy, the importance of cleanses (you know, take a lot of laxatives and eat only pureed grapefruit stuff), and the fact that the nursing shortage was caused by legalized abortion. Oh--one more I forgot--that all nurses hated each other and the profession and ate their young and so on and so forth. You can imagine what it was like to be in her class. I would sit there Tuesdays and Wednesdays for an hour and a half each time, gritting my teeth and smiling blankly.

Plus, she was one of those people who believed that gayness could be cured and God sent disease as a punishment. A real winner.

That was the instructor, now that I remember back, that not-so-subtly implied that I'd somehow cheated my way to graduation, despite having a really nice, shiny GPA and good clinical recommendations.

I always never wondered what happened to her after I graduated.

Yesterday my bladder started acting all funny: it would produce a rhythmic thump whenever I turned left and started using more oil. So I went, this morning, to one of those generic Get You In, Get You Out clinics to see if I could pee in a cup and get some drugs. And who should greet me when I walked in?

Yep. That nursing instructor, now an NP in GYI/GYO Clinic. Which, not surprisingly, is attached to a locally-run pharmacy that has all sorts of homeopathic and frightening christian-y literature on the shelves. You can get your oscilliconum or whatever it's called at the same time you catch up on the latest thinking about God's great plan to punish sinners in the apocalypse. Which is happening next Monday.

Fortunately, they also had Bactrim DS, so I had that going for me.

And she didn't prostelytize or suggest that I take whatever weird sugar pill du jour she favored. The only thing she said that made me shudder slightly and recall that bland, focusless smile was this: that I must not eat a lot of red meat because there were so few nitrites in my urine. (Bacteria in the bladder that are the cause of UTIs produce nitrites as part of their metabolism. One reason for not having nitrites come up on a dipstick is that fresh urine has entered the bladder and the bacteria there haven't had time to push nitrites into it.) She did mention how horrible nursing was for her, and how the "nurse curse" was the cause of my bladder troubles.

I smiled a bland smile and waggled my head noncommittally. Then I gave her twenty-five bucks and trotted down the hall to the pharmacy, where three days' worth of antibiotic was a whopping $1.50.

Wow.

Things that irritate me, part seventy gazillion and thirty-eight

If you're an instructor teaching nurses, please remember that we do "see one/do one/teach one." All you have to do is tell us what we need to know, once, and move on. Your (endless fucking horrible irritating) anecdotes (that attempt to cast you in a good light but instead make you look like the arrogant asshole you are) are not necessary. 

Running out of booze.

Patients who are reasonable, normal people while you're in the room, but turn into manipulative weirdos the minute you leave. The trouble with calling people like that on their behavior is that it's never satisfying.

Staying late in class because of anecdotes.

People who put on lots of light-colored eyeshadow or powder and either don't wear mascara or don't knock the powder off their eyelashes after they're done applying. Your mascara habits are your business, doll: I prefer mine as long as the list of people I hate and as black as my heart, but you do you. Just make sure you don't look like you've got eyelash dandruff from hell, okay?

Mushy broccoli. (This is one thing our cafeteria actually does well. I eat a ton of broccoli.)

Men--and they are always men--who ascribe political motives to the fact that I wear my hair in a buzzcut. Dude, if I were looking to be less attractive to men (and women, and mutant kangaroos), I would be wearing some other style, because this buzz brings all the boys to my yard. I wear it like this because it's easy, I can do it myself, and it looks sharp.

Tripping over the cat, when it's the cat's fault, and hearing that awful noise he makes. I have one who's especially bad about running under my feet.

Bigots.

Nail polish that looks hot in the bottle but ends up being some wimpy color on your nails.

Glitter everywhere.

Not getting my eyebrows on even.

Undercooked carrots.

Stockings, socks, or pantyhose that shift weirdly and cut off circulation at odd times.

Missing phone calls.

No fucking toilet paper why can't you assholes put a new roll in what is wrong with you WERE YOU RAISED BY WOLVES??

Lists of what annoys a person.

 

I have to go back to work in the morning.

(Actually, all I wanted was an excuse to use this gif. But it's pretty close.)

I am pleased to report that I am no longer a starfish.

Starting Friday night, I turned my stomach inside-out every hour or two for twenty-eight hours. 

It SUCKED.

Somehow I've managed to avoid--and here I'm knocking frantically on every piece of wood within reach--sinus infections, the flu, things falling on my head, alien abduction, and major broken bones this year. But I got whatever stomach bug is going around, and it SUCKED.

But now I'm better. 'Bout damn time, too.

Mongo, when I got home on Friday, was solicitous. He did everything but hold my hair back for me (because I have no hair to speak of) and then curled up next to me on the couch, carefully avoiding my stomach, and gazed soulfully into my eyes. He's a good boy. The only thing he couldn't do was get me ginger ale and meclizine, because he doesn't have a driver's licence and can't make change. 

In other news: The Powers That Be are expanding the neurocritical care unit, again. Apparently we've done well enough, what with staying full and winning awards and so on, that they want to add four more beds *and* an epilepsy monitoring area. I'm not entirely clear on where all these new beds will be, but whatever. I'm hearing rumors that they want to retrofit a couple of rooms for some mysterious purpose, as well: whether that means light-blocking shades or ceiling lifts, nobody has said. It's all very exciting and fluxy.

We've been seeing more patients with movement disorders and demyelinating diseases, as well, which is nice. Most of the nurses I work with are old med-surg or cardiac critical care folks, so Guillain-Barre and myesthenia gravis and Parkinson's are new territory for them. I learn more answering their questions than I realized I would.

Finally, there is a nice man coming this morning to fix the drain line from the kitchen sink. Ah, the glories of living in an old house. Do they ever stop? No. No, they don't.

I got this comment on a long-ago post. . . .

http://justsaynotonursing.wordpress.com 

It's a list of thirty-six reasons nobody should go into nursing. The author is a woman who spent eighteen years in a field she hated, then went on to get a medical degree and became a medical registrar. She's in Australia.

I'm having a lot of thoughts about this. The first two were along the lines of "How on earth did you survive that long in a job you hated?" and "Why did you even bother?" (Incidentally, I emailed her those two questions, figuring that the answer to the second would be either "kids" or "money," but I'm interested in the answer to the first. I would've flang myself out the window, I said, long before the tenth year.)

My next thought was: Does nursing in Australia and New Zealand really differ all that much from nursing in the US? Yes, it's damn near impossible right now for a new grad to get a job, but our programs aren't exactly easy to get into (certain exceptions apply). Yes, some doctors disrespect nursing and nurses, but the vast majority are collegial. Yes, you run into nurses who maybe shouldn't be allowed to cross the street by themselves, but again, the majority are pretty smart. And yes, bullying happens, but not everywhere and all the time.

And then there was this: She's spot-on as regards post-graduate education for nurses. Under the heading "Don't Get Me Started" in my own personal bitch list is the fact that we *still* have "Therapeutic Touch" listed as a treatment modality, even after repeated studies have shown zero therapeutic benefit to waving your paws a couple inches over a patient's body. If we expect to be taken seriously as providers, we have got to cut the bullshit and do real evidence-based practice.

The combination of Alison's list and the comments on it (forty-some and counting) give me what the kids call All The Feels. I know it's just one person's writing. Some of it I agree with, some of it had me wide-eyed and thankful that I don't work where she did. 

My experience is, to be frank, pretty limited. I went through a highly-ranked, competitive program and got hired at a nationally-ranked research and academic facility. In twelve years I've run into only three doctors (one resident and two attendings) who treated nurses like highly-trained monkeys--and, for what it's worth, they treated everybody that way, from other doctors to their patients. My work life has been about as good as you can get, barring the brain-farts from Manglement that happen in any workplace.

What do you think? Discuss it here; Alison's blog isn't the place for trolling or extended debates.

It's coming. It's coming for all of us.

At this point, it doesn't matter whether it's a mismatch between this year's flu shot and this year's virus, or a secret government plot, or just plain crappy luck: everybody I know, practically, has the flu.

We have nine full-time nurses in our unit. Two of them have pneumonia. A third is out for another week, until the Tamiflu and chicken soup kick in. The remaining half-dozen of us are bathing in alcohol foam, refusing to get too close to each other (I swear; it's like Sweden up in there), and running away from anybody with the slightest hint of a cough. I myself have taken to bathing daily in boiling bleach and wrapping myself in plastic wrap, head to toe, before I leave the house. I figure a nice tight seal will still leave me enough oxygen to get to the grocery store and back.

Today I took advantage of a sale on soup at the local weird grocery store. I have something like ten cans of Campbell's in the cupboard, as well as a pot of homemade Mexican-inspired chicken soup simmering on the stove. I'll be making a simple salad later, with cucumber, red bell pepper, plum tomatoes, oregano, feta cheese, and about six cloves of raw garlic. (That number is not an exaggeration. Raw garlic, when blended with olive oil and white balsamic vinegar, gets surprisingly mellow.)

I'm not even letting Mongo kiss me.

It's hard, to be honest. Everybody but me in the neurocritical care unit is from somewhere else, and they're all from touchy places like Southern India and the Phillipines and Italy. We practically snuggle while we're giving report. I'm the one person who's not A Delicate Tropical Flowah, so I'm the only one who's treating this lack of hand-on-knee, hug-and-cheek-kiss as normal. All the dark, large-eyed beauties I work with are starting to look positively glum. It's the paranoia.

Because, really? Having the flu--and I have had the flu, the real thing, twice in twelve years--is generally not as bad as you expect it to be. (The one exception to that is the first time you have it. That is the worst you will ever feel, ever, short of being shot repeatedly in non-critical places with non-expanding bullets, then roasted over a dying fire, then drawn and quartered by somebody with a dull knife, and finally hanged by an incompetent knot-tier.) A few days of body aches, some pills to swallow, the inability to walk to the couch without getting winded. The best thing about the flu is that when you start feeling merely bloody, it's like you feel great. The worst thing is the anticipation.

So I'm being proactive. I have now got three large tins of Tiger Balm Ultra (the white stuff) coming in the mail. I stocked up on soup, as I mentioned before, and plan to go out tomorrow for ginger ale and ramen (only because I forgot today). I'll get some of those Totino party pizzas. I'll splurge on the big bottle of ibuprofen. Maybe pick up an extra hot water bottle, or even a heating pad.

Putting things in perspective: My pal Joy came down with the flu on Thursday of last week, the same day that my pal Stacy got salmonella food poisoning. Joy is now, thanks to the miracles of modern antivirals, back at work teaching. Stacy just today managed to get through an entire shower without having to sit down in the middle of it.

. . . . .Still. You can talk all you want about the partial protection conferred even by a mismatched flu vaccine, realize intellectually that it's not as bad as a bad hangover, and still want a canvas mask with a bird's beak on the front when you walk around work.

In short, save yourselves. Invest in bleach-manufacturer stock and buy some NyQuil.

This was an ethical problem with a simple solution.

If you have a patient who's been a heavy drinker and heavy smoker (like five 40-ouncers and a couple packs a day) since their teens, and they're now in their 60's, and they live with family members who are unlikely to stop smoking and drinking just to keep them healthy, and they also live in a food desert and have multiple comorbidities and things generally suck, it is not a dereliction of duty not to suggest that they get their carotid arteries Roto-Rooted in order to restore blood flow to their brain after a minor stroke.

Especially since no amount of improved blood flow is going to repair the damage caused by forty years of vascular dementia. You could've driven a truck through this guy's sulci. I mean, seriously. There was so little working brain tissue in his skull it would've been a crime to reperfuse it.

So we sent him home on blood pressure medicine that he won't take, and aspirin that he won't take, and comforted ourselves with the knowledge that, had we done everything in our power to make him better, he would've been nickel-and-dimed to death with tiny strokes. This way, what with the drinking and smoking and high-fat food, he'll likely have one huge stroke and that'll be it.

*sigh*

In response to a question below in the comments on the last post: Where I come from, "CCU" means "Critical Care Unit." It's the same as an ICU. NCCU, therefore, is Neurological Critical Care, whereas NSCCU is NeuroSurgical Critical Care. There is no difference, just as there is no difference between an LVN and an LPN--they're both skilled nurses who aren't allowed to hang blood in this state. The difference in terminology is a conceit of the facility, nothing more.

And with that I'm going to go eat junk food and fall down for a couple of days.

You know how, sometimes, things get brown and ucky and dull?

That's the way things have been around here, lately. Every couple of years I kind of brown-out--not burn out--on work, and blogging, and people and nursing generally.

Then I get better.

That is what happened this last couple of months: I browned out and then got better.

A lot of it had to do with work. You guys might've heard that the flu season has started. We have a thirty-bed medical CCU, and sixteen of those beds are filled by people under the age of 50 on ventilators or ECMO (a way of oxygenating blood by taking it out of your body, zapping it with O2 through a membrane, and returning it--sort of like lung dialysis) because of the flu. These are previously-healthy people, too. The old and sick ones are just flat-out dying.

Plus, there seems to be a sale on myesthenia gravis these days. I hear that if you have six patients with MG in your NCCU at once, you'll get an eggroll. I need our eggrolls to be delivered, please.

Meanwhile, as the plague is sweeping the state (and our staff), we were preparing for a couple of really hugely fucking important surveys. One was a TDH (Department of Health) thing that happens occasionally, just to make sure we're not all licking our hands clean between patients. Another was a certification survey, which was a very, very big deal, given that the surveyors would be coming to our unit, primarily, and going through charts and asking tough questions and so on.

Joint Commission surveys are generally held to be bullshit. They go like this: everything gets repainted, stuff gets put in storage rather than left out in the halls, the bathrooms finally get fixed in the locker rooms, and you get multiple nastygrams from chart auditors in the weeks leading up. Then the JC shows up, does whatever it is they do (pity the poor souls, though it's probably better than whoring), and things go back to normal.

This was not a JC survey. It was actually, you know, hard: thorough and comprehensive. Two very nice people showed up without much warning one morning and started asking me questions about neuroanatomy. One of them stuck around until the afternoon, watching us care for patients (there are certain things you do differently for neuro patients, and differently if they're, say, stroke patients versus neurosurgery), sitting in on patient education, and generally making me and my coworkers nervous. The two of them were critical care specialists, too, which made it even more fraught.

We passed. We passed perfectly, with no demerits. First time out, spandy-new NCCU, and we fucking aced it. Nobody else in the country has ever done that on this survey. So we got that going for us, which is nice.

Our manager, for whom I would take a bullet, bought us a huge lunch to celebrate. Our manager's manager, another woman I'd step into the line of fire for, came up the next day and was so overcome she was actually teary-eyed. The director of medical services and the critical-care big boss came up and congratulated us. So did the president of the entire Consolidated Research and Medical Care Gargantuan Whingnut, of which Sunnydale General is a part.

And the new nursing officer? The individual Der Alter Jo and I nicknamed The Dalek? Said nothing. No acknowledgement whatsoever.

This is the person who's responsible for approving hiring and firing and wages and working conditions and safety and all that shit, and he has not said word one about a survey which, to be honest, focused less on medical care and more on nursing care.

I kind of expected that, to be honest. Still, it sucks that the person whose job it is to make sure that my colleagues and I have safe, sane, decently-provided working conditions, continuing ed, all that stuff, was absent from the hallelujah chorus.

It baffles me that somebody so tone-deaf could keep moving up through the ranks like he has. I wonder what photos he has in his posession.

Anyway, it's been a hard slog of a couple of months. I don't know if things are getting better, or if I'm just getting acclimated to being torn four different directions at once for twelve hours at a stretch. I gained all of the seventeen pounds I had so carefully lost, and slept worse and bitched more than is normal for me, but that all seems to be evening out now.

Anyway, I'm back. Mongo is a big, furry goofball. The cats are just fine as froghair. Boyfiend is doing something brewerish tonight. Sherlock is in his flat and all is right with the world.

The traditional annual Christmas song post!

It's never a good sign when. . . .

It was shaping up to be a pretty good day. I got up a little early, packed my lunch, put the dog outside, left for work on time, and made it to work without incident.

Where I walked in to find a patient, destined to be my project for the day, sitting on the floor of his room, screaming. And kicking and tantruming. Like a three-year-old. Refusing to get off the floor. Floods of tears. Demands that we call varied and sundry people.

I've got such a hangover from that day that I still can't form complete sentences.

Here's all you need to know: functional exam, drug-seeking, requesting Dilaudid (of course). Fourteen chart notes by the end of the shift just on my part. Approximately twelve hundred words from the various therapies. Screaming. Crying. More screaming. More demands for Dilaudid. Refusal of blood tests, vital signs, drugs, and therapies.

Drama.

I have had bad days before. Never ever have I had a day that made me question why on earth I became a nurse. (Not that I'm seriously questioning it now, but at about 1700 on that fateful afternoon? Definitely.) If somebody had made a cartoon of my leaving work, there would've been little puffs of smoke coming off the ground under my sneakers.

At one point the patient told the docs that we had left him on the floor for an hour as he screamed for help. (Note here that he did not fall; he simply sat down and refused to move.) The attending shot me a look, to which I responded with my best BlankStupidFace.

I just. . . .I just. . . .don't get that shit. And I don't play into it, either. Late in the day, the patient refused to answer the simple, yes/no question of whether he'd like to go to the bathroom. I told him to use his words.

Yes. I snarked. But I have had it with crazy junkies who fake strokes. I've also had it with attending physicians who, faced with a clear MRI, a gorgeously normal CTA and CT, and perfectly fine bloodwork (all collected before my little prince had his meltdown) decide to order vasculitis panels, autoimmune panels, and umpteen other tests to determine if there's a physical reason for The Cray.

Boo, this patient is acting out and acting up. He is so far off the chain that the chain itself is lost behind the horizon. He won't accept treatment no matter what we do, so let him go. Let him go home, sans hydromorphone, and do his thing.

And for God's sake, don't bring him back. In a town this size, there are certainly some acceptable medical facilities that are not ours.

Let's talk about cancer.

Three years ago at this time I was lying on the couch, watching St. Elmo's Fire with Friend Pens The Lotion Slut, feeling rather giddy from a combination of red wine and Vicodin. I had just had the majority of my hard palate and all of my soft palate removed due to a case of oral cancer. If you want to read the whole story, go back to September of 2010 in the archives.

(St. Elmo's Fire is a good movie filled with terrible people. Skip it; that way, you won't have to wish for that two hours of your Vicodin- and red-wine-soaked life back.)

Let's talk about oral cancers. There are a lot of them, some of them frightening, some of them less so. All of them are on, as they say, the rise, due to a number of factors. Here are some interesting things about OC that you may not know:

1. A large number of oral cancers are due to the human papilloma virus. In different forms, HPV can cause warts on your fingers, genital warts, cervical dysplasia and cancer, or lumps in your mouth, or oral cancer. There are innumerable strains of HPV. Most of them are harmless. Some are really a bitch to get and to treat.

2. Oral cancer, which used to be the province of men over the age of 60, is increasing in young women. Part of this has to do with the near-ubiquity of HPV in the population. A lot of it has to do with the fact that young women now smoke more and drink more than young men. Alcohol or smoking predisposes you to oral cancer; doing both at once is a great way to lose chunks of your tongue or jaw.

3. Oral cancer is underdiagnosed in young people. Part of this has to do with the fact that the thinking on OC hasn't caught up with the reality. Part of it has to do with how often young people visit the dentist. I go to the dentist twice a year; my OC was found by The Fantastic Hygienist at my dentist's office. It had grown from nothing to a two-centimeter lump that I had not noticed in half a year.

4. Oral cancer has a huge impact on your life, no matter how minor it is. I got lucky: all I have to do for the rest of my life is wear a metal-and-plastic prosthetic that protects my airway and allows me to speak, and get yearly checkups (complete with MRI and CT scans and all the associated radiation) to make sure that I still have no evidence of disease. Some people, like my pal Mary, have lost much, much more than that to this disease, and the consequences are ongoing.

5. Oral cancer can hit you even if you don't smoke, or drink, or have sex. Mary, for instance, had a stage III squamous cell carcinoma of the tongue that was HPV negative. She is a lifelong nonsmoker and nondrinker. OC doesn't play favorites.

6. Which leads me to THE MOST IMPORTANT POINT OF ALL: If you see or feel a weird bump in your mouth, get it checked out. If you've got a gut feeling about it, don't stop asking for answers until you know what's really going on. OC is still one of those things that docs don't expect to see in people my age (forties) without other risk factors. I was incredibly lucky in that I had a dentist who was paranoid as fuck about the thing on my palate. Other people have not been so fortunate; as a result, they've had to undergo things like feeding tube placements and the loss of all of their teeth.

My cancer, polymorphous adenocarcinoma, doesn't have known risk factors. The article in Wikipedia on it is still only a stub. It's rare, it's non-invasive (usually), and can normally be treated with what's called "wide excision," also known as "taking out most of your mouth and changing your life forever." The type of cancer I had was indolent, meaning that it didn't spread or grow very quickly. It could happen to anybody. It happened to me.

So, on this third, give or take, anniversary, I have this one request: think about oral cancer. Go to the fucking dentist. It doesn't matter if you haven't been in fifteen years; they get off on that stuff. Get your mouth checked out. Avoid what I went through.

Of plumbium and bidets, of subway tile and new nurses, of cabbages and kings.

This week was long. People, I tell you: wearing leads for seven hours a day, five days a week, will wear. you. the fuck. out.

Let me back up.

Sunday last I stepped through my bathroom floor. Yes, that bathroom floor. The bathroom floor that the Ex Chefboy and I spent something like six weeks demolishing and redoing. I stepped through the floor. Because it had rotted. From something. I don't know what. Don't ask me. La la la la laaaa.

Monday I started cross-training for angiography/interventional radiology/that weird place waaaaay down the hall in the basement next to the operating rooms where they make you wear hairnets, like, 24/7.

Tuesday I felt my hip joints grind in a way that I hadn't felt before.

Wednesday I was fairly confident with the charting, but still hating the leads. You try wearing ten or so poundses of lead on your top and bottom (ten pounds each, my friends) for several hours at a stretch and see how you like it.

Thursday I realized that they'd given me a male lead-vest with double shielding over the chest because nothing else would fit over my bazooms. And *that,* best-beloveds, is why aformentioned bazooms will be permanently droopy from here on out.

Today I discovered that, starting this coming week, I will be precepting a new nurse for twelve weeks. She's coming into the NCCU as a new hire. I have never, ever precepted a new person for that long. Not that I'll be doing it all by myself, but I'll be doing the majority of her  Hey Lookit This Ain't This Cool edumacation.

And at some point during this week I realized that what I want, deep in my heart of hearts, more than happiness or a living wage or a fuzzy kitten, is a bidet.

Let me back up again.

It looks like at least one of the walls and most of the floor in the bathroom is/are a total loss. That means sledgehammering and chiseling and generally demolitioning the tile out and laying new Hardi-Board and waterproof stuff. Waterproof cement board is great, and it generally works, but it's not meant to withstand the bursting of a pipe that carries Unimaginable PSI of water under said waterproof board. I had, apparently, the one situation for which RedGard and Hardi-Board are not rated.

We don't have to do everything right now. Most of the demo and reconstruction can wait over the winter, thank Frogs. I can use that time to save up my pennies and decide what I really, really want in the bathroom. Which is kind of a story in itself. . .

Seven-nearly-eight years ago, subway tile was the exclusive province of Brooklyn hipsters. Seriously: they hadn't even moved out to Williamsburg yet, and subway tile was available only by special order through the big-box stores here. It's what I wanted, but couldn't afford, so I went with Pelican 1 x 1's all over the floor and up the walls and have kind of dealt with it ever since.

Now I'm looking at subway tile. And console corner sinks. And a BIDET.

I was introduced to the miracle that is the bidet in Denmark twenty-something years ago (also: that was the last time I rode a bike. Coincidence? Maaaybe.) and reintroduced to it while visiting Pal Joey in Quebec. Bidets, People, are the shizz. Nit. I swore that my Forever Home would include a bidet in every bathroom when I had a bathroom all to myself, complete with bidet, lo those many years ago.

But putting a bidet--a real one, not one of those toilet-seat make-do's, in the bathroom would require a smaller sink. Which I'm good with. I mean, what do you use a sink for? Washing your hands, taking off makeup, brushing your teefies. That's it. Corner sink = perfectly functional situation, if it means getting a bidet.

Say it with me: BEEEEEEEE-DAAAAAAAAAAAY.

Mmmmm. You see?

I have had fucking MOUTH CANSUH, and I will have my bidet now, thank you.

But back to the leads: I learned a whole, whole lot this week. Most of it was charting in a totally unfamilliar system, but some of it was fun stuff about how the hell G-tubes get put in, and what you have to worry about with patients who have aneurysms coiled, and how some doctors who are fine in the unit are assholes in the OR.

Most of what I learned can be boiled down to two things: If you have shoulder problems, like I do, get an apron instead of a vest. That way, the bulk of the weight can be carried around your waist rather than on your delicate bursal nerve plexus. Also, radiology techs are the coolest guys in the hospital. I worked with The Daves (two guys named Dave who are indistinguishable when in full sterile gear), and they were *so amazing.* The nurse who was training me was great, yes, but she didn't always catch all the stuff I was screwing up as I was doing it, and so couldn't correct me with a quiet word from under a mask. I brought The Daves cookies today. It was not enough.

Another thing I learned: if you really, really like your job and find interesting things in it every day, you will communicate that enthusiasm to the person you're helping out who's new. That's what The Daves and My New Pal Sherri (the nurse who trained me) and My Old Pal Andrea (the other nurse in the department) did. It was fun. And educational. And my shoulders hurt.

And one final thing I learned: If you give a woman a bidet once, she will not stop thinking about it for two decades.

An Illustration of How Nursing Shapes One's Thinking

This morning I stepped through the bathroom floor.

Yes, that bathroom floor. The one an ex-boyfriend of mine and I spent six weeks working on. I was turning on the shower when *crunch* went my right foot, right through some tile.

BN (Before Nursing), I would've panicked. AN (After Nursing), here's my thought process.

1. Is it a problem?

Yes.

2. Is it a problem that will prevent me from showering?

No.

(Get into shower.)

3. Is this a problem that will require me to wake up Boyfiend for his opinion?

No. It can wait.

4. What are the best-case and worst-case scenarios when it comes to fixing this problem?

Best: Replace a few squares of floor tile

Worst: Rip out entire bathroom and replace everything; live with Boyfiend while bathroom is being dealt with

Median: Rip out part of the bathroom and replace, bathe in kitchen sink

5. What is likely to have caused this problem?

In descending order of likelihood:

a) Wonky plumbing in the wall that we didn't notice the first time
b) Rot from bad grout lines in the floor
c) Leftover damage from pipe breaking under house
d) Ants or termites or some other bug
e) Aliens have decided to use my bathroom floor as a portal to another universe

6. What does this mean for the problem as it stands?

Ask for Home Depot gift cards for Christmas. Wait until Boyfiend to drink coffee before examining the floor. Make popovers.

(Get out of shower, make popovers.)

Ohai. September was sort of busy.

A few folks have asked for updates on our Fantastic Integrated Computer System and about the woman who went to the non-accredited nursing school. Herewith:

The FICS is. . . .well, most of the functionality has been turned off. Which is nice, as it doesn't feel like Big Brother is right over your shoulder all the time. Basically, none of the tracking features worked right. Hell, the call lights and information boards in the rooms didn't even work right, so away they went, to be replaced with the old setups. Nobody is crying.

As for the tech who went to the wrong school: Somebody asked why accreditation makes a difference, if her grades were good and she'd had previous floor experience. It makes a difference because accreditation is the way that hospitals and clinics know that a particular school is teaching material that's up-to-date and useful. It's based, as far as I know, on things like NCLEX passing rates and the qualifications of the teaching staff as well as the course requirements. Whether or not it's one more bit of Press-Ganeyesque BS I don't know; all I know is that you simply won't get hired if you don't have a degree from a school with accreditation.

And yeah, she and I talked about it; she's going to work where she can until she gets enough experience that it won't matter where she went to school. I don't know if that'll work or not, but here's luck to her.

In other news, it's been a while since I gave y'all a good, old-fashioned, gross nursing story. Here you go:

The patient was a woman in her fifties or early sixties. She was obese, had alcohol and opiate dependency, and was diabetic. She was in the preop area of another hospital, prior to getting some toes snipped off, when she started complaining of a headache and then fell over and seized.

Big aneurysm. Big, big blown aneurysm. The hospital, having no flies on its collective self, transferred her to Sunnydale to have that aneurysm clipped, even though it wouldn't make much of a difference to her functionality. So she showed up at Sunnydale NCCU intubated and sedated, got her clipping done, and stayed intubated and sedated for about twenty-four hours (the usual routine).

Except that about six hours after surgery, both of her legs got all swollen and funky. Oops. That's not a part of the usual routine. Turns out she'd somehow clotted off her IVC filter. That's a doohickey that looks a little like a miniature colander--you get one in your inferior vena cava if you have large or repeated clots in your leg veins. It's supposed to strain out any clots that might go to your lungs or head and hurt you. Anyhow, hers got all full of clots, which basically means you lose the blood flow back to your heart from your lower body. If you're thinking that's not good, you'd be right.

Out comes the heparin drip. More clots, more problems. Eventually, she managed to sustain pretty substantial damage to both kidneys, which required pressor support (drugs that go through your IV line to help your body maintain a livable blood pressure) and continuous renal dialysis (which is a big blood-scrubbing machine that we only use when things are Indeed Dire). We cut off the heparin and started using leech spit (yes, really) to anti-coagulate her, but the damage was done. She had some clotting disorder that's rare enough in women (why do we always seem to find those?) that nobody had tested her for it until she came to us.

Here's where things get interesting. Patient had two sons, one of whom was beyond batshit on the crazy scale. Mama made one good decision in a rare moment of sobriety and made Sane Son her power of attorney and medical liason. He was all for stopping the heroic measures. Beyond Batshit Son, however, was still part of the family, and used his time in the NCCU to cause problems, raise hell, and generally put up such a fuss about continuing life support that the docs felt hogtied by family drama.

Meanwhile, the patient had infarcted her bowels, meaning she had a belly full of dead intestine. She'd put on about forty pounds of water weight and looked like an enormous balloon person in the bed. Her skin was weeping excess fluid all the time, to the point that we put super-absorbent pads all over the bed and hoped for the best. The only things keeping her alive at that point were nine different drips (I counted), a ventilator, a dialysis machine, and sheer dumb bad luck. Her hands and feet were gangrenous. She no longer responded even to pain. Her reflexes were gone.

Beyond Batshit Son, despite being told that her chances for recovery were nil, continued to insist that Mama be kept on life support. He even called Adult Protective Services to tell them that his brother was abusing Mama--imagine APS's surprise when they investigated and found a Mama-Lump in a bed in a critical-care unit. This continued for a couple of weeks, until I degloved one of Mama's legs by accident.

"Degloving" is a nice word for what happens when you're so sick, or so burned, or so generally unlucky that your skin simply comes off. We were turning her, using the pads we'd put under her to absorb fluid, when I felt something mushy in the pad under her thigh. I figured it was just the super-absorbent gel in the thing and shifted my grip. . .which was when the nurse across from me blanched and shuddered.

The skin on the back of Mama's left thigh had sloughed off her leg. You could see layers of fascia and muscle underneath, and the lump of shed skin and fat was hanging off in a flap. There wasn't any blood; even with multiple drugs to keep her blood pressure up, she wasn't pushing enough of the red stuff to bleed when that happened. She leaked clear fluid.

Shudder.

With that, the docs on the case sat down in a meeting, collectively sacked up, and turned off the ventilator. The patient, grateful for the relief, died without fuss four minutes later. Given that the accidental skinning happened over a weekend, it took 'em all a couple of days to get together, but they did it. Beyond Batshit Son was never on board with the decision and had to be escorted off the premises by a couple of no-nonsense cops.

And that, my friends, is your Requisite Gross Nursing Story for the month. Sweet dreams!

You can't handle the truth!

Dr. Ali and I were talking about our recent (constant) staffing problems last night. I said I couldn't figure out why a unit with patients with things like GBS and big MCA strokes (one makes you not breathe, the other can make you have fatal heart arrhythmias without warning) wasn't considered a priority in staffing. I mean, we had a code a couple of weeks ago when some poor sod went into ventricular fibrillation (non-medical definition: your heart quits beating and just shivers: very bad), and only one nurse on the floor. It was touch-and-go, but we got said poor sod coded, stabilized, and later discharged.

Dr. A. told me something he'd heard earlier this week from a VP of development: that the neurocritical care unit is only important in that we bring in money for the neurosurgical service.

(Imagine me standing there, open-mouthed, silent.)

Yeah.

Sunnydale General is supposedly going for a comprehensive stroke certification, but the department that handles everything from strokes requiring TPA to non-surgical neurological emergencies is considered worthwhile only because we send the occasional patient to the surgery guys for a cartotid endarterectomy or aneurysm clipping.

I asked Dr. Ali how he'd responded. He told me he'd told the VP of development that our unit was making plenty of money on its own, thanks, and that he didn't like to refer patients for surgeries that weren't proven to work. (That last is some obscure insult referencing some sort of study on CEAs, I guess; I don't know the details.) It was a calm, intellectual burn from one doc to another.

Still, to be told flat out that the unit that you're working on, that you've been helping to develop for umpteen years, isn't considered important by the big uppity-ups. . . .is disheartening. Although it does explain why we're having such a hard time getting funding for equipment and staff.

In other news, I worked with a patient care aide this weekend who was concerned about her ability to get a job after she graduates nursing school in December. She's been doing externships and internships and has great grades, but hasn't even had a nibble on the job front.

We went over all the things she was doing right, and all the things she might be doing wrong, and then I took a look at her resume.

She's graduating from a for-profit school that is not accredited.

Again, imagine me standing there, open-mouthed and silent.

This woman will owe more than $50,000 for two years' worth of classes from a school that lacks even the most basic accreditation from any authority. She therefore will not be able to get a job anywhere but the LTAC that employs her part-time now, and maybe not even them, as an RN. Add to that that her chances of getting into a decent nursing school for a BSN are practically nil, except if she goes back to Consolidated Larnin' Collidge, and she's screwed.

I can't. . .I can't even. Talk about predatory marketing: they promised her that in just under two years, she'd have earning potential that nobody in her family has ever had. They told her that the job market for nurses is hot, which it is--provided you've got a degree from a recognized school and are willing to slog for a few years. They then helped her get loans that are about four times what I paid for a degree from an accredited program, but didn't happen to mention that a) the interest rates are huge, and b) her education would be worth practically nothing.

She's not stupid, but she's not well-educated. She's poor, she's got a GED, and she took the only offer she got. She's a hard worker and driven as hell, but she's hobbled herself with a bullshit "degree" from a place that has classes in a storefront.

It was a demoralizing week at work.

A late-summer, end-of-summer treat: fried green tomatoes.

I did not learn to make these when I was growing up. As far as I can remember, my Sainted Mother, being more or less a Yankee, never fried a green tomato, let alone okra or the leftovers of grits that had been left to become solid in the refrigerator.

At some point in the last ten years, though, I learned to make fried green tomatoes. They're not economical--very few people have enough tomato plants that finding a use for them is necessary, at the end of the season. They're not Paleo, or Atkins, or Clean--they're something you make as a special treat, to serve with fresh mozarella or shrimp or sausages, or just on their own, as soon as they come out of the pan.

They are purely Southern, in the sense that some version of FGTs extend from West Virginia all the way to Arizona. They are best made with green tomatoes found, by chance, at the farmer's market: the kind you get at the grocery store don't have enough flavor. Grab a half-dozen or so, stock up on cornmeal and breadcrumbs and fat, and go at it.

(This recipe can be made gluten free by the substitution of rice flour for the flour and gluten-free breadcrumbs for the breadcrumbs. Don't waste your money on panko; get the cheapest breadcrumbs you can find at the grocery store, or make your own from heels and odds of bread you've stored in your freezer. A blender helps here.)

You will need:

A large frying pan. Cast iron is best, but anything NOT non-stick will work.

A spatula or pancake turner.

Two large plates and a shallow bowl.

A fork. A knife. A horizontal surface onto which to slice the tomatoes.

Salt, breadcrumbs, cornmeal, pepper, at least three eggs, and a whole lot of oil or Crisco. Also four to six green tomatoes, the most symmetrical and greenest you can find.

To begin:

Obtain your tomatoes. Wash them briefly under cold running water and slice their ends off. Be miserly in slicing off the blossom end, as it's the most tender part, and promiscuous in slicing off the stem end. Green tomatoes have not yet formed a tough core, but who wants to eat stem? Now slice the tomatoes.

Some people swear by thick slices, at least a half-inch. I find I get better results with thinner slices--anything from a quarter-inch to almost paper-thin, depending on my mood and skill with the knife.

After slicing your fruit, lay them flat on a large plate or cutting board and salt them. You don't have to go nuts with the salt; this step is meant to draw out the extra juice and keep the breading from getting soggy. While they're sweating on the cutting board or plate, set up your breading station: on the first plate, dump a good amount of plain flour. On the second, dump equal amounts of breadcrumbs and corn meal, mixed well. I use a blender to do this because I am FANCY.

In the shallow bowl, mix up as many egg whites as you can scrounge up. Do not use whole eggs for this; the fat in the yolk will make your tomatoes soggy.

Now melt some Crisco (or lard) or heat up some vegetable oil (not olive!) (not butter!) (bacon grease is okay and traditional) in your frypan. You want it hot enough that a little pinch of flour sizzles when you toss it in there. Keep the heat at medium or medium-high. A half-inch of melted fat in the pan is the right amount. Too much and you'll end up with soggy, greasy tomatoes. Too little, and the fat will suck off all the cornmeal and burn.

Take your sliced tomatoes and pepper them. Press them gently into the flour. You want them coated with flour on each flat side. Don't worry about the edges where the skin is; they'll take care of themselves. (I do not recommend shaking the tomatoes with flour in a bag, as this will cause the innards of the tomatoes to fall out. Take the time to press them into the flour and you'll be much happier.)

Now dip them into the egg white. This will make your fingers gooey. Coat them with the breadcrumb-and-cornmeal mixture and set them aside in a single layer to wait for frying.

When the fat is hot, place five or so tomato slices into it. You want them to be uncrowded and in a single layer. Let them sit and sizzle until you see that they're beginning to get brown up the sides. Turn them carefully and allow to sizzle for a couple minutes more--the second side takes much, much less time than the first.

Remove to paper towels, (or do what the finest cook I know does: use slices of cheap white bread in place of paper towels. Use those bread slices to drain everything from bacon to fish, and then, at the end of a week or so, grill them by themselves and serve them with lots of ham gravy) and drain.

Continue in this way until the fat starts to smell like burning cornmeal. When that happens, stop everything. Take the pan off the heat and let it cool for a half-hour or so (your tomatoes will wait, I promise), then pour the fat out of the pan and replace it with clean fat. This step is essential. Otherwise, you'll end up with burnt-tasting FGTs.

You can eat them out of hand. You can layer them with slices of good mild cheese, or grate a tiny amount of good hard goat-cheese over them. You can cover them with shrimp or ham or sausage gravy. You can, if you like, layer them in a casserole with fresh sliced zucchini and ripe tomatoes and a little grilled eggplant and call it Southern Ratatouille, but I won't eat it.

They are best eaten as they are, with extra salt if you need it, off a plate, on a porch or in a kitchen in the middle of the dog days, below the Mason-Dixon line. You can fry okra or catfish if you have any cornmeal left over and feel very virtuous about not wasting food. I layer them with fresh mozzarella if I'm feeling fancy, or throw them into a roll with mayo, lettuce, and cheese and call it an FGT po-boy.

But most often I eat them as they come out of the pan, crisp and tangy and citrusy. These are the perfect bridge food between the humid hot horrible summer days of August and the crisper fall days to come. Enjoy.

A surgeon walks into a neurocritical care unit. . . .

Actually, he rolled in. On a stretcher. After a TIA. Transported by EMS from the airport. And it was, sadly, no joke.

There are surgeons nobody hears about, even if they've been working in the same place for twenty years. There are surgeons you only ever hear good things about. Then there are surgeons like Dr. Guts, about whom the most complimentary thing I've ever heard is, "Well, he's not quite Satan."

This is a man I once saw push a chart rack (remember those? Welded wire, meant to hold eight or so charts at once? Big, heavy three-inch plastic chart binders, full of paper, each weighing more than a couple of pounds?) over on to a unit secretary because he didn't like something that had just happened. Nothing having to do with the secretary. If she hadn't jerked out of the way, I think the weight might've broken both her forearms.

And here he was, in my unit. I should mention that Dr. Guts has quite the reputation for patching up people whose lower intestines have sustained damage of one sort or another. He's particularly good at reattaching colons to anuses.

Like attracts like.

The first words out of his mouth when I walked into his room were "GODDAMMIT! Why is this goddamned hospital so fucking disorganized??" I greeted him, introduced myself, and prepared to do a neuro exam.

"I was examined" he sneered--and I'd never actually seen anybody sneer before; I thought it only happened in books-- "by a qualified physician less than four hours ago. I do not wish to repeat the exam."

"Good" I said. "That's gonna save me a lot of time the next time I have to assess one of your patients."

He looked at me.

"Because an exam by a qualified physician means that exam will stay stable, right? Now, look right here at my nose."

He hated the food. He hated our MRI suites. He kept complaining that the hospital was disorganized--a hospital he helped found--and that everything in the world was wrong. He bitched about the doctors, the night nurses, the phlebotomists from the lab.

Finally, midway through his second (and last) day on the unit, I said, "Is it possible for you to be any less of an asshole? Just for a minute?"

His wife, sitting on the couch with a book, said, "She has a point, dear."

A week later he was back on the wrong side of the bedrail, this time for a cardiac problem. Thankfully, not in my unit.

Styling the bedroom? Ain't nobody got time for that!

If you've been reading this blog for a while, you'll know that I've become addicted to renovation/decorating/house blogs.

It's a shameful thing.

It's a shameful thing because, to be honest, my addiction (which started when I bought this house, seven or so years ago) has resulted in nothing except my painting every wall in the house white. Well, and putting up those two-inch-wide, faux-wood blinds that JCPenney sells because I was sick of uncleanable Roman shades. Did that today. Lost some patience, some years of my life, and not a little bit of blood.

Somehow, despite being glued to Anna's and Daniel and Max's escapades, and reading Chezerbey with the sort of dedication I usually reserve for science fiction, I have missed all the finer points of design.

Dudes, I Used Pelican Tile In The Bathroom. In my defense, subway tile was still too expensive for my budget at the time, and I was under a huge time constraint, as a house functions best with a working bathroom. Still, I look at those squares of tile and kick myself every time I pee.

And, worst of all, I'm ashamed. My bedroom's been described as "stark"--as in, all-white, no frills, no tchotchkes sitting on things, and very few things for tchotchkes to sit on. The living room is mostly neat, with several bookshelves, but I spend most of my time keeping the dog-hair and cat-hair under control, not working out vignettes with the Thai dragon Dad got me years ago.

I'm a good cook. I'm fantastic at makeup. I can dress myself with only a minor amount of trouble. I can refill the windshield-washer-thingy in my car with no problem. I make gorgeous compost. I can handle power tools without losing digits, and my solder doesn't drip. I'm not the worst nurse you ever worked with. But I cannot for the life of me decorate.

I was excited when The Boyfiend told me he was bringing his Schlitz chandelier. (Which has since been lost, but I'll go into that tragedy later if ever.)

Tomorrow I'm going to IKEA. I'm going to buy curtains, following Dana's advice and getting the longer ones, and I'm going to put them up. I'm going to put them up, moreover, on the nifty bendy curtain rods I got a million years ago from West Elm. It's going to be fabulous.

Aaaaand they will make the rest of the bedroom look skanky and as if it needs to be repainted, which it does, but dammit, who has time for that when there are tomatoes to grow?