Knitting in the dark

more letters on my business card

2011-06-11T09:51:00.000-07:00

So last week I officially became a certified hospice nurse, I passed the Certified Hospice and Palliative Nurse exam (150 questions, 1 hour, 92% correct). It wasn't too hard...I studied for maybe a total of 8-10 hrs over a couple of weeks, just read the curriculum book and study questions and reviewed a bit with another hospice nurse who took the exam the same day. All this gets me is a few extra cents an hour and the right to add these letters, CHPN, after the RN on my name tag and business card. The main reason I took it is just because it says, "I care about what I do so I took some time to prove it."

In other business of dying news, I'm changing my position! At the end of the month, I will move into an RN float position and out of my current RN case manager position. I'm pretty excited about it. While my 1+ year as a case manager has been an invaluable experience, the thing it mostly taught me is that I enjoy the nursing part more than the manager part of that job. Our patient load is exploding, which means hours of overtime and often unexpected events or phone calls leading to looooong days. I've worked a few weekend triage shifts, where I just see patients with emergent needs. I get to swoop in, meet the patient and family, assess the most urgent issues or problems, and attempt to provide a solution. So that's what I'll be doing as a float nurse. No more pages, phone calls, re-certifications, discharges, care conferences, etc. Just see my assigned patients for the day, chart on 'em, ensure appropriate follow-up from the care team is in place, close the computer, and DONE. Sure, the OT is nice on the paycheck but it's just not worth sacrificing my nights and evenings to charting charting charting. Plus, I'm really looking forward to the variety and new challenges of this new position. I perversely enjoy the challenge of "difficult" patients or "interesting" family dynamics when I know that it's just for that one shift. Also, after a year or so of learning a new thing, I tend to get a bit squirrelly...I start thinking, okay, this stuff is no longer terrifying or overwhelming, what's NEXT? That's a pretty cool perk about my job, and nursing in general, is that there are so many different opportunities, positions, educational chances, etc, that's there's really no excuse for boredom or stagnation.

and then I almost died..

2011-05-10T21:34:00.000-07:00

Ok, so this "headache plan" of mine... Hm. The verdict is still out. The diet itself is kind of a pain in the ass to follow...I'm having a really hard time eliminating onions, citrus (esp lemons and limes in my cooking!), yogurt, and aged cheeses. I mean, life without cheddar? Are you kidding me? I even sunk so low as to Google "substitute for parmesan" because God knows nothing livens up a salad, veggies, or pasta like a kick of parm. It may be that none of those things are be a "trigger" for me, but the migraine book guy advises to cut all possible triggers out of your diet before adding them back in slowly, and individually. Which of course makes a bit of sense...but has HE tried cooking without lemons, limes, onions, yogurt, feta, etc? Obviously he must enjoy a rather bland diet. Other sources I've read on tyramine in foods advise limiting quantities of those items to small daily doses. Which is sort of what I've been doing, since I cannot find things like onion-free salsa and I drank half a bottle of "citrus zest" flavored sparkling water before realizing what I'd done.

But the diet modifications are like a trip to Disneyland (or in my case, a yarn store) compared to the caffeine elimination. I thought I was ahead of the game, tapering off my coffee habit over the course of two weeks. I cut down from about 16 oz each morning (with the occasional tea or soda here or there) to about 6 oz per morning, and then...NOTHING. Yesterday, Day 1 of the Great Caffeine Withdrawal, went sort of okay. I felt icky and foggy in the morning, took three Aleve (yes three, yes I know what the label says, trust me I'm a nurse) and actually made it through the day. I was a bit irritable and drowsy and had a mild lurking headache but all in all, I thought, hey, not so bad! Until this morning. I woke up with a vague headache behind my right eye (yesterday it was my left eye), feeling a little foggy and muzzy. Had a cup of peppermint tea and three Aleve (stop judging), and went about my day. Only today, the headache and irritability only got worse and worse. I made it home by 1:30, had some lunch, and had to lay down for a nap. I woke a few hours later with the same headache but worse, tried to eat dinner, but nothing helped. Finally Matt convinced me to take an Imitrex and I even took a couple of Excedrin Migraine too. Obviously they helped because I'm sitting in front of a glaring computer screen typing somewhat coherently at the moment and not sobbing and moaning in a dark room.

So yeah. Caffeine Cold Turkey plan aborted. On to Plan B: tapering caffeine slowly. Tomorrow I will try to switch to tea and see how that goes. After all, I have an unopened box of PG Tips and it would be a royal shame to let that go to waste.

Oh my aching head.

2011-05-01T21:53:00.000-07:00

I hate it when there's a long pause between blog posts on a blog that I read, and when a new post finally shows up, the blogger spends an inordinate amount of time making excuses and apologizing for the silence. So, I'm not going to do that. I haven't blogged in a while. Now I'm back. Make of that what you will.

So I'm trying out this new migraine plan, based on this book by David Buccholz, Heal Your Headache: The 1-2-3 Plan for taking charge of the pain. I can't remember where I heard of this book, just that I kept coming across references to it on various headache sites and finally thought I'd see what all the fuss was about. Thankfully, there was a Kindle version available because I am both impatient and lazy. Keep in mind that I am full of snark and skepticism, and am the first person to mock "self-help" books and whatever diet plan is the flavor of the month. But I also have chronic headaches and migraines, and it sure would be nice to not have them control my life anymore. So I read the book. And, despite being soap-boxy and arrogant and overbearing, it pretty much makes sense. The author explains the three steps to taking control of your headaches: Stop taking "quick-fix" abortive migraine meds that are causing rebound headaches, eliminate dietary triggers, then try a preventative medication to raise your migraine threshold. The premise, while the author doesn't delve too deeply into the physiologic explanation, does make sense: you can't control external headache triggers (stress, sleep, barometric pressure), you CAN control internal triggers, such as diet and caffeine. And triggers are cumulative, so while peanut butter may not give you a headache one day, on another day when other triggers have accumulated peanut butter will be enough to hit your threshold, and BOOM. Headache.

I'll give this plan a try, since it can't hurt, and maybe it will even help. The diet is kind of hard to stick to: no caffeine, no citrus or bananas, no hard/aged cheeses, among other things. Eventually I'll try to add things back in on a trial basis, since I can't fathom an existence without onions, garlic, yogurt, parmesan, or lemons. So far so good, but it's only been about a week. I'm down to about half a cup of coffee in the morning, and I plan to taper that to nothing by the end of the week. I haven't had any headaches but it's early days yet. I have "cheated" a bit, but in tiny amounts. Like tonight I had caesar dressing on my salad, which usually contains some "forbidden" ingredients: anchovies, lemon, parmesan.

I'll try to post updates with my progress and results on here. I'm having trouble finding recipes for this diet, so maybe I'll post some of my attempts to modify recipes to fit the diet on here.

Night nurse

2010-09-07T04:28:00.000-07:00

I often tell myself, or others, in a (sort of ) joking manner, that "there are no emergencies in hospice." It helps me keep my perspective and maybe even stress levels under control. But that doesn't stop me from waking up in the middle of the night, with a sudden realization that I forgot to chart something. In the persistent, niggling way that only middle-of-the-night-lying-there-in-the-dark thoughts will do, this thought kept circling through my brain, kept me awake, and finally insisted that I get out of bed. I logged into my work laptop and sent the order: I had forgotten to change the patient's bath schedule from once weekly to twice weekly. Phew, now I could rest easily. No wait...since I'm right here in the front of the computer, I think I'll check on the status of the other patient I saw yesterday. Oh, that reminds me, I might as well submit that supply order request now so I don't forget later. Which leads us to here, with me typing a blog post at 0430 in the morning. While there might not be any "emergencies" in hospice, there's a different set of priorities that can take on the same significance. A bath is definitely never "STAT," but to the exhausted daughter at her father's bedside, knowing that someone is coming today to give her dad bath because he's now incontinent and needs much more frequent cleaning might be the only thing giving her a little relief or comfort. The added stress that I feel, while not emergency status, is that if I don't remember to change the bath schedule, it just won't get done. It doesn't just roll over onto the next shift like in the ICU, family member can't just put their call light on again or the computer doesn't pop up a little reminder to the next nurse. So that's what wakes me up at night.

Maybe my old night-shift schedule is too deeply ingrained in my brain. This used to be the time when I would toast some bread or get my yogurt out of the fridge, sit down in front of the computer, and finish up my charting or complete my nursing shift note, reviewing my shift and making sure I didn't forget anything.

So there you go...that's what goes on in the mind of a hospice nurse in the middle of the night.

What's in your car?

2010-05-18T06:46:00.000-07:00

When my hospice nurse orientation finished and I was officially "set free" to drive the streets of King County visiting patients, I was given my "car kit." It consisted of nursing supplies in four large brown paper bags. No good drugs or anything like that, we're not allowed to carry narcotics in this state. But since I'm on the facility team and almost all my patients are living in facilities such as Assisted Living or Skilled Nursing facilities, I rarely if ever need to bring supplies to them. For several weeks these brown paper bags lived in the back of my car, with adult incontinence supplies embarrassingly peeking from the top of them. Finally, a couple of months into the job, I got fed up enough with shifting them around to accommodate Costco trips to actually organize them. I bought some pretty-colored storage bins from Target and sat myself on the floor, surrounded by nursing supplies, and inventoried. I still don't actually need most of it, but at least now I know what I have:

Adult diapers, large and extra large
Bath wipes, x 2
Dressing supplies, including gauze, abd pads, tegaderms, and even my very own suture removal kit and two pairs of bandage scissors
Isolation gown, goggles, and mask
Lotsa rubber gloves. Can never have too many of those
Foley catheters, urimeters, leg bags, a urinal
Various creams, lotions, skin care ephemera
Two sizes of emesis basins
thermometers
A sphygmomenometer! And a stethoscope! Apparently I didn't really need to be using the set I'd purchased seven years ago for nursing school.
Lab collection supplies

I feel a bit better now actually knowing what I'm carrying around in my car, should any of my patients need something at the spur of the moment. Typically I can order supplies for them and bring them on the next visit, but there's always the family who waits till the last minute..."Hey, you don't have any extra diapers on ya, do you ?"
"As a matter of fact, I do! Let me just run to my car..." Thusly averting a messy situation.

And also, when your little puddle-drinking poo-sniffing dachshund starts suffering from diarrhea which turns bloody, it sure was convenient to have rubber gloves and a stool specimen cup laying around with which to take a sample to his vet. I don't think that was the intended purpose of the "car kit," but hey, now the little guy is started on his course of Flagyl and hopefully he'll be back to his energetic puddle-drinking poo-sniffing self soon.

So, to answer your question, yes, those are adult diapers in my car. What's in your trunk?

Nursing from the streets

2010-05-06T21:00:00.001-07:00

So here I am, a full-fledged Hospice Case Manager Nurse. A month out of orientation, on my own, managing my own case load, and I can still safely say that I pretty much love this job. I realized that I loved it on Tuesday, after a grumpy, rainy, 45-minute drive to Newcastle. I may be a day-walker now, a recovering night-shifter, but I have not and will never quite get used to having to get up early in the morning. So I grumbled and scowled my way through rush hour traffic, gripping my coffee, trying to hear the bossy GPS directions over NPR, and squinting through the blustery, gray weather. After two wrong turns and a U-turn I finally arrived at my destination, and found my way to my new patient's front door. I met the patient and his wife, answered their questions and explained how our hospice services could help them. Yes, they could call and speak to a nurse 24 hours a day if they needed to. No, we would do everything we can to keep him from having to go to the hospital ever again. Yes, if he wants to eat apple pie, let him eat apple pie (in small bites and sitting straight up, of course). The patient's wife sighed deeply and relaxed back into her chair, years faded from her 84-year-old face, and she finally smiled at me. "Thank you," she whispered. "Thank you for what you do."

So I got back in my car, and steeled myself for a 30-minute drive on the highways through the sheets of rain to Issaquah. But my grumpy mood was gone, and I didn't mind the drive.

The view from the other side

2010-03-24T19:07:00.000-07:00

I'm five weeks into this new hospice gig that I'm doing, and although I'm still on orientation, I am here to report that I'm pretty sure I really love it. I almost admit that hesitantly, because I'm doing things that I always swore I'd hate, things I scoffed at, things I mocked and derided others for doing. Okay, maybe that's a little harsh, but you get the picture. Those things include: sleeping during the night, waking up early each morning, working five days a week, having to do errands and shopping on the weekends...I could go on. Because to be honest, I LOVED night shift. I loved only working three days a week, and I was giddy over being to go shopping or do errands in the middle of the week. The middle of the night, even. I could avoid traffic and most of all, CROWDS. I did the nocturnal thing really well, and the few early mornings I've been forced to contend with have left me grumbly, crabby, and generally miserable. To be fair, I probably induced the same feelings in those unfortunate enough to be around me in the early mornings.

Well, nothing drastic changed...I'm still not a morning person, and given my druthers (what the heck are druthers, and why is someone giving them to me? Like a present?) I'd be staying up late and sleeping in till past noon. Oh well. But I've adjusted to this new schedule, in part because I'm a creature of habit...I ADORE habit. And routine. It's just so comforting. So the regularity of this new schedule fits me well. And I guess I'll give Matt a little credit...since I've moved in with him, my old night schedule got progressively more annoying and inconvenient. I was only home with him a few evenings a week for dinner, and those nights weren't the same week to week, and it was frustrating. Now I get to be home every night, and every weekend, and it turns out that five-day-a-week things isn't so bad when the shifts are only eight hours long, leaving me with plenty of time after work to walk the dogs, cook an Indian feast, plant some vegetables, whatever strikes my fancy. I'm not advocating either schedule/lifestyle over another, I'm just saying you gotta find what works for you at the right time for you.

At this point, you'd be forgiven for thinking that I changed jobs simply due to shift and schedule concerns, and while that is a huge piece of my overall contentedness, the nursing aspect of what I'm now doing versus what I was doing is the main thing. But that's a big topic for another post, and right now it's easier to write about and be silly about simple things like sleep schedules.

I'm sort of concerned that I need to rename the blog, or start a new one...since I'm no longer literally "knitting in the dark." Now it's more like "driving during the day" but that isn't too catchy...I'll have to ponder that.

And now for something completely different...

2010-02-15T21:52:00.001-08:00

I quit my job. I got a new job. I start next week.

I will be an outpatient hospice case manager nurse. I will be working Monday through Friday, daytime hours, no nights, no weekends, no holidays. I have heard rumors that this is the schedule that most people keep, being up and about during daylight hours, sleeping at night, and keeping somewhat "regular" hours. I haven't lived this way in nearly eight years, since I started nursing school, so this may be an interesting, if possibly difficult, transition. I actually feel completely ready and excited for this schedule change however, which is something I honestly never thought I would ever say. I loved nigh shift, I was a great "day sleeper," I loved having three to four days off a week, doing my errands in the middle of the week, going to the grocery store at 2am. But I sort of over that now. I'm over working interminable, often-grueling 12 hours shifts, the sore back, the aching feet, losing half my week to the sleep/eat/work routine with no room for anything else. I'm over inpatient-unit manglement policies and procedures and decisions, isolation gowns, and short-staffing headaches.

I'm excited for the new job, both for the schedule but even more so for the hospice work...more on that transition later. Maybe I should start a new blog, chronicling my adventures as a visiting hospice nurse, interspersed with my attempts at photography, my foray into vegetable gardening, and my efforts at cooking 660 different curries? Or maybe this is all just a natural continuation of Knitting in the Dark...?

job opening

2008-03-27T16:03:00.000-07:00

So, last night. Blah. It was my first night using the brandy-new computer charting system recently unveiled at work. It wasn't too bad, but added a lot of time and confusion and discomfort to my charting process at work. I didn't have any huge problems with it, although I'm fairly sure I only charted about 12% of what I was supposed to. In the midst of the confusion, and the weirdness of no longer having paper MARS (it's all electronic now) I missed my patient's chemo dose. So it ended being about three hours late. In the morning when the managers got there they all flipped out and I stayed late writing an incident report and feeling like the sloppiest stupidest nurse ever. BUT by that point in the morning I was numb and sad and annoyed and just sick of looking at computers at all.

My patient died last night...not the missed-chemo patient, a completely different patient. A young man I'd cared for over the past several weeks. I wasn't his nurse last night but spent some time helping the family and was able to have a nice talk with them before I left in the morning.

Meanwhile, the ICU admission that I got was the furthest thing from the cakewalk DNR/DNI hemonc patient that I expected. What exactly do you do when your patient rips her leads off, smacks you out of the way, and insists on leaving the unit to smoke despite the fact that her lips and hands are blue and her oxygen saturation is 68%? I wish I could just say fine, go ahead then, and come on back when you're ready to accept our help. Uff.

Anyway. Tonight is definitely a Pagliacci's night. Yes, I use food as a coping mechanism. Is that so wrong? It's cheaper than crack.

...

2008-03-16T13:19:00.000-07:00

On my unit, we rarely see the newly-diagnosed cancer patients. By the time they arrive on our doorstep for transplant, they've been through at least a round or of chemo, sometimes even a prior transplant, and definitely been indoctrinated by the Clinic with at least a rudimentary knowledge of self-care and a set of expectations for their transplant. Many patients have done their own extensive research on their disease, the treatment options, facilities, etc. So while I still answer a lot of questions and do a lot of patient-educating, it is usually from a very matter-of-fact place. It may sound cold to say this, but in reality, my patients are cancer patients first, and then become real people to me second. It's inevitable...the first thing you learn about someone is their disease, their treatment, their lab values. You focus on this and then later the details of them take form...they are also someone's mother, or sister, or teacher. In their 'other life' they spent the majority of their time gardening or traveling instead of getting chemo and puking.

Last summer, working in another medical-surgical ICU, a young woman was admitted and immediately assigned to me, as I happened to have a lot of oncology experience. She showed up at the ER with some vague complaints, nothing too troublesome. She had hoped for some pain meds and a comforting, routine explanation for her headaches. After all, she was young and otherwise healthy. She was starting a new job the following week and wanted to be ready to jump into it. Then a routine blood test revealed a type of blood cancer in an advanced stage of crisis. Within 24 hrs, she had been admitted to the ICU, had two invasive central lines placed, undergone a procedure which removed all her blood from her body and separated the white blood cells, and heard words like "cancer," "leukemia," and "chemotherapy" thrown around.

By the time I meet her, she is feeling okay but her eyes are nearly swollen shut from crying and her voice is hoarse. I tell her the experience I have in oncology, in particular this type of cancer and treatment, and ask her if she wants to talk about anything or ask me anything. She mutely shakes her head, then whispers, "I don't even know what to ask. I just have stupid questions,"
"There are no stupid questions at all," I say.
"Well, I don't even know how to act. When other patients find out they have cancer, do they just cry all the time too? Is that normal?"
"Oh my god of course it is!" I told her. "It probably wouldn't be normal if you didn't cry!" Later, she asks me:
"Will you tell me something? No one else will tell me this, but have you ever seen anyone with this disease get better? No one will tell me if I could die. All they tell me are numbers."
How do you tell someone who is barely in her mid-20s that yes, she could die? That unfortunately, you see more people who die from this than who get better? That some of the things she is going to go through are going to make her want to die?
"It's cancer. The treatments for it are really really hard. Yes, you could die. But you could live, too. People do, and I've seen them. It's one day at a time, sometimes one hour at a time, and sometimes that's the best we can tell you," and I even get a bit teary as I squeeze her hand, till one of us makes a silly joke to break the mood and laugh a little. I tell her what I often tell patients, how I've seen how amazingly strong she is, and how much love I've seen surrounding her from her family and friends, and that more important that any medicine we could give her. When I say this, I believe it a little more than I usually do. I think I say it almost as much to comfort myself, and to give myself hope, as much as I do for her. She is a person to me first, and a disease second, even incidentally. She worries about losing her gorgeous long hair and makes jokes about the revealing hospital gowns, she wears funny socks just because she can and her friends start a blog for her. And knowing how dangerous it is, I let myself hope. Really hope. Some people do get better from this. So why not her? It has to be her.

After our initial meeting last summer, I could count the number of precious weeks that she was actually out of the hospital versus in it. She died last week, in my ICU. I wasn't her nurse but I don't know if I could have been. Even though I feel like I should have been. For her. I had trouble even helping her nurses with her, because I found myself just staring at her face, her swollen-shut eyes and her bald head, searching for traces of that brave, funny girl I met last summer.

Scaredy-cat nurse

2008-03-16T12:58:00.000-07:00

I'm not one to wax philosophical and claim that I live my live by nebulous quotes and cliches, but I recently read that Ralph Waldo Emerson said, "Always do what you are afraid to do." And I was just thinking that maybe I've unintentionally done that.

I was a wee young nurse tech buckaroo roundabout five years ago, wide-eyed and scared to death just to walk into a patient's room on the oncology unit I just started working on. I would rehearse to myself how I would greet the patients and introduce myself, just so I wouldn't sound silly, and I lived in fear that eventually a patient would say to me, "What are you doing here? You obviously don't belong here, you don't know what you're doing." Mercifully, and shockingly, that never happened. I would walk past the ICU rooms and glance furtively in, trying to discern the actual patient from the spaghetti-tangle of wires, lines, and blippy-beepy machines, and shake my head. Scary. Crazy. If asked to assist an ICU nurse with turning or cleaning her patient, I remember gingerly lifting lines or wires simply to hold the patient's hand, always keeping one eye-ball glued to that ET tube as if a hiccup might dislodge it, causing the patient's untimely and messy demise and of course it would all be my fault. I imagined that I could never work in the ICU, I didn't have the knowledge, or the drive, the stamina to handle being that on-edge and stressed out all day long.

To make a long story short, I of course ended up as one of those crazy ICU nurses. I guess it was a combination of being fascinated by what I didn't understand...the physiology, the pharmacology, the intensity of the human situation, that drove me to want to figure it all out. It was probably a little bit of, "Hey, if Nurse XYZ can do it, then so can I!" And maybe you could boil it down to that little quote, "Always do what you are afraid to do."

And now tonight I'm going to be in charge...not a huge thing, there are no special classes or knowledge or certifications required, and the amount extra that I'll get paid will barely pay for my end-of-stretch pizza. But something makes me want to try it. I think it's a little bit the sense of ,"Ok, what's next?" I attribute that to the fact that I am an eternally lazy person, and I must always be working towards a next big goal or my motivation falters and I slip into a boring rut. So, after RN, ICU RN, what was next? Charge RN, I guess. And of course, CCRN ICU RN, coming soon :) I used to think I would hate being in charge, and there's still a chance that I might be right. After all, I don't think I'm a manager-type person...I don't like organizing things, I don't particularly like telling other people what to do, and although I've been working on, I'm not as assertive as I'd like to be. I'm much more content to remain quietly in the background, mostly doing my own thing. But hey, it'll be an interesting change, a new perspective at work, and at least I can say I tried it.

Dog hospital

2008-03-13T13:21:00.000-07:00

Something strange has been happening in my wiener dog family... when Ted went to the vet to get his teeth cleaned, Tessa got sick with some nasty GI virus. When Tessa went to the vet to get her teeth done, Ted got sick with some nasty GI virus. How weird is that? What is going on? My normally healthy little dogs are rarely sick, despite the nasty bits and pieces they occasionally try to snack on during our walks. So, yet again, I am making boiled chicken and rice to sooth the tummies of my little dogs, giving them lots of cuddles, very frequent trips outside, and washing the rugs. Tessa is doing better after her dental surgery and it appears that she can still keep her tongue inside her mouth (one worries about these things as the old girl loses more and more teeth).

Puffy eyes

2008-03-10T18:14:00.000-07:00

I have lots to say, its swimming around in my head and as soon as I have a little time off I think I'm gonna spew it all on here.

I've been working a lot. My patients are young and they are dying. I cried last night at work, for only the second time in five years there. Of course, I've cried on the way home plenty of times, I've cried during Dawson's Creek and Law and Order cathartically for my patients, but sometimes...even if you try to be professional and do you your job and keep in inside, it creeps up on you. Thank goodness for kindhearted colleagues who simply pat you on the shoulder, make you a cup of tea, hand you a box of tissues, and tell you to walk and away and take a little break.

More later. When the eyes are a little drier so I can see what I'm typing.

Hellooo echoechoecho

2008-02-29T20:44:00.000-08:00

Remember me? I don't post around here much anymore. I would make excuses that I haven't had much interesting or exciting news to report, but as evidenced by past blog posts, I seem to have been quite capable of posting about completely irrelevant or boring topics in the past.

Maybe I'm a little burned out on writing about nursing topics, or about my patients. There's something so private and intimate about the situations that I'm sharing with my patients, they're experiencing such painful, terrifying, or life-altering experiences, that it often feels like a betrayal or even just a belittling act to write about them in my blog. They own their illnesses and their experiences, its not really mine to share with anyone. And of course we are all intimately familiar with HIPAA...I would always change any revealing details of my patients and most of the time anyone I write about is a composite of several patients. But it is often those small, identifying details about someone or their story that makes the story special, or interesting, and to change those details simply for the point of sharing the story takes something away from it. Of course I realize nursey blogging can also be about the nursing experience, and being a nurse, rather than the patients' stories, but it is also pretty hard to separate the two...one experience is defined by the other's, and vice versa.

So...on to the nursing content...I'm taking a CCRN study course this spring so I can take the exam in early summer. I'm not terribly excited about the study course except that I get paid for some of the hours and it is essentially the external motivation that I need to make myself study to take the exam.

Tonight I'm off work but I'm playing nurse to a sick little dachshund...she seems to be suffering from some kind of GI upset...frequent bouts of emesis and liquid stool through the day today. In laymans' terms, I'm discovering puddles of poo and puke in various corners of my home, and now both the kitchen and the bathroom rugs are in the laundry. But our favorite Auntie to the doggies delivered us some dinner, so I wouldn't have to leave the sick puppy alone, and I cooked up some extra bland chicken and rice dinner for her. She seems to be tolerating the dinner so far...and sleeping comfortably on the couch.

Seacaucus, sawcaucus.

2008-02-08T18:40:00.000-08:00

I'm going to caucus for Obama because I don't believe there should be a woman as president. They are too emotional and generally have bad judgment. Not to mention, they are terrible drivers.

I.Am.Totally.Kidding. Well, except that that driving thing. Women suck at it.

Does anyone else remember back in the day, when it was considered rude to ask someone who they were voting for, that it was none of their business? Because I'm not sure why the phlebotomist who drew my blood today felt like it was totally okay to ask me who I would vote for. So I told her that convicted felons aren't allowed to vote, so at least I don't have worry about it. Because I'm too lazy to look it up, anyone have any good links that help explain Obama's policies/plans for healthcare reform? Sure, he may be inspirational and full of hope, blah blah changecakes, but I'm too cold and dead inside to be swayed by a moving speech or a touch of inspiration. I want plans.

And also...I am NOT defending the misogynistic theocracy of Saudi Arabia, but I have to play devil's advocate on this article, "Saudi Cops Grab U.S. Woman..."

Sure, it might be a bit crazy to a lot of the world that unrelated men and women cannot be together in public, but thems the rules over there. So this American woman knowingly broke the law, and goes to jail for her offense, and uhm...? Sorry. Maybe I just have a problem with her because when the power goes out in your office, you GO HOME for the day. Whee! Day off. What was she thinking? You do NOT break the law simply to get a little more work done for the day. Sheesh. Maybe a night in jail helped loosen her up a bit. Kidding. Again. Totally. Kidding.

And, Mr. Restoftheworld? You do not get off poking fun of Saudi's silly laws against women or highlighting an amusing anecdote to show how "backwards" those people are. In the same article, substitute "woman" for "racial minority"...are you still scoffing and smirking and shaking your head? Or are you sending in UN Peacekeeping forces and demanding universal human rights? Anyway. But at least they don't let women drive over there... IAMKIDDING! Get a grip.

Let's see...here is where should apologize for not updating lately. I'll try harder in the future. But to recap: Love my "new" job again, nightshift rocks, TESOL class lots of fun, cancer patients depress and inspire me. I'm considering taking the CCRN, being charge nurse, going to Turkey, making mini Turkey meatloaf muffins, going to Egypt and Jordan, and a retirement plan. I knit Foliage from Knitty.com (and I love it!), a feather and fan pattern baby blankie and matching hat, and I'm working on a long grey scarf and another baby hat. I'm totally addicted to Law and Order, it's like TV crack, and I can't turn it off. Ever.

Just something to make you smile on a Sunday morning...

2008-01-20T11:10:00.000-08:00

I've been seeing these Alli ads on TV for a while now, and of course, like the skeptical nurse that I am, I've been doubting how 'easy' and 'wonderful' this drug is. Everyone knows there is no miracle drug for weight loss. Except the millions who spend billions on them every year. But anyway. As soon as I heard the description "blocks fat from absorption in your digestive track" in the advertisment, I knew this must pharmaceutical doublespeak for "shitstorm." I became determined to get my hands on a package insert from this drug in order to translate the side effects into layman's terms, since I was fairly certain the more accurate and descriptive words like "bowels let loose in your pants" and "buttmud" and "wet farts" would not be listed. However, someone beat me to this, and you should read it too...

Alli Side Effects in Layman's Terms

More knitting, less nursing

2008-01-05T12:46:00.000-08:00

I do fully realize that this is supposed to be a nursing blog but it's fairly devoid of any nursey content. But in between calling off sick with nasty colds and being cancelled due to low census, I haven't really worked much lately. And I actually miss working. My bank account really really misses me working, but that's another story. I was really hoping to go to work tonight but whatever crawled up my nose last night has set up camp in my head so I had to call in sick. And since this is my second cold in a month, I wonder if I have a compromised immune system, possibly secondary to leukemia? I'm not a hypochondriac, per se, however being an oncology/ICU nurse I tend to look for zebras. That's one of my favorite sayings, by the way. They say it to med students, when they are diagnosing patients. "When you hear hoofbeats, don't look for zebras," or something like that. Just meaning that always rule out the most likely scenario first. Anyway, I digress. Because I took cold medicine and my head is cloudy.

Last night I went to Pizza Hut because I suddenly needed to have me some stuffed crust pizza. And it was the most bizarre experience ever. I ordered online, and the email reply said it would take 20 minutes. So I went to pick it up, 20 minutes later. After a few minutes, someone finally comes to the counter to acknowledge me, and says it'll be a few more minutes. How magical that he knows that, I think, considering he didn't even ask my name for my order. Then a guy in mismatched navy sweats comes in, and the same thing happens to him. In the meantime, while he is waiting, he gets a call on his cell phone.
"Really? So he had another seizure? You're taking him to the hospital now?"
It was bizarre, hearing his end of the conversation. I stared at the Mountain Dew in the locked soda case and pretended I was not a nurse. After hanging up, Navy Sweats starts getting anxious and demanding to see a manager, because his food was supposed to ready 10 minutes ago. By this point, two more people have come in, are waiting for their orders, and the phone is ringing constantly. No one at all is approaching the counter to let us know where our food is. Some employee calls to another, "Can we stop taking orders?" Uhm, can you do that? I can sympathize, when things are crazy in retail or food service, you totally want to lock that door and stop customers from coming in because you don't give a shit if more money is to be made, you are making minimum wage and you are miserable. But anyway. Navy Sweats is getting all indignant and ranting about how he had better be compensated for his wait. Some woman in a crazy hat and a knee brace is trying to sympathize and make jokes. A 12-year-old employee comes out to explain that they're really backed up, running out of stuff, etc. Navy Sweats is not mollified. I'm thinking that at this point, Navy Sweats should just pop next door for some teriyaki then head home to his seizing friend. But anyway, no one asked me. Finally, his pizzas come out and the manager is all, "Uhm, just give me ten dollars." I finally got mine and was only charged half price, but then went to my car only to discover that Crazy Hat Knee Brace Lady had blocked my car in with her 1982 white Buick. Seriously. I felt like I was back in Pittsburgh for a little while.

Here's a funny story my dad told me. He was in Canada, at Immigration trying to get his work permit. Ahead of him in line was some strange looking older guy. He couldn't hear what the guy was saying, as he was kind of mumbling, but he could hear the customs agent's end of the conversation. The customs agent looked at the guy's paperwork, and said, "It says here you have a couple of felonies." The guy mumbled a little. The agent continued,
"For weapons possessions?" Now, at this point, one would assume the customs agent should merely stamp a big fat red "denied" on this dude's paperwork and turn him away. However, this particular agent is too intrigued...
"They were assault rifles, you say?" Mumble mumble.
"How many?" Mumble mumble mumble.
"Wow. That certainly is a lot, sir. Did you have permits for those, uhm, assault rifles?" Mumble mumble.
"Hmm. I can see how that caused a legal problem for you." Mumble mumble.
"No, I'm sorry, I cannot allow you to have a work permit to enter Canada with." Mumble mumble mumble. STAMP.

Thanks, Canada. On one hand, kudos to you for policing your borders. On the other hand, maybe you could have referred him somewhere else? Instead of back to the US.

...

2007-12-27T13:07:00.000-08:00

Woke up to this headline this morning: Bhutto Assassinated in Attack on Rally.
Admittedly, I didn't even click on it right away because in my blurry coffee-deprived eyes I thought it said something about another attempt. But this time they did succeed. She was the daughter of a prime minister of Pakistan and twice prime minister herself, one of the first to be democratically elected in an Islamic country. But you can read her obituary here for yourself.

While upsetting and sad, I am nearly as disturbed by the fact that this story ranks number 10 on the NYTimes "most emailed" stories list this morning...just below "100 Simple Appetizers in 20 Minutes or Less." No, I'm not worried or appalled at American's knowledge of world events or priorities. I am currently investigating which countries will accept my application for political asylum. On the grounds that if I have to remain in the USA I will be clinically "annoyed to death."

Ok, back to nursing content. Later.

sniffle

2007-12-22T11:05:00.000-08:00

I'm sick. I've spent the past several days on the couch, making sure that my tissue box, tissue disposal system (brown paper bag), TV remote, computer, and phone are all in a lovely semicircle arms-reach. This is chiefly because once the dogs settle in on me under the brown not-real-fur pimpin' cool blanket, it is very difficult to shuffle and shift them around simply to reach the phone or throw away a tissue. And also because I'm a little bit tired and lazy. Although I prefer the term 'efficient.' So I won't bore with you a litany of complaints or a disgusting barrage of my symptoms, because I just have a cold. A bad one, but a cold. So the chances are pretty good that you either have it, have just had it, or know someone who's had it. And the only thing worse than being sick is hearing someone complain about being sick, or list the details of their illness for you. So I'm sparing you. Before you get all worried and ask, "Wait, aren't you supposed to be a nurse? Don't you listen to sick people for a living?" Yeah, yeah, yeah. I am, and I do, and I actually enjoy it. But unless I am wearing scrubs, have a stethoscope around my neck, and am getting paid hourly (plus night differential!) I don't want to hear about your post-nasal drip or hang nail. I like to think of it like I'm a sort of super-hero. At night I put on scrubs, go out into the dark, minister to the sick, clean up their vomit and their bottoms, hold their hands, dry their tears, keep them breathing till the sun comes up. Then during the day, I put on a fleece jacket and comfy tracky bottoms with an elastic waist, curl up on my couch, think snarky mean thoughts about my neighbors, shout obscenities at women drivers who don't use turn signals, and generally practice being lazy and self-indulgent and somewhat bitter.

Whatever. I'm sick, indulge me.

Oh! The whole point of this post wast to highlight the difference between my old job, at the Place I Would Rather Chew My Own Foot off Than EVER Return to, and my current job, The Place Where I Learn Theres-no-place-like-home... So when I used to call in sick to the old job, here's how it went:
Me: Hello, is this the charge nurse?
Charge Nurse: Yeah.
Me: Hi, this is Rosebuttons. I'm not feeling well, I'm calling in sick for my shift tonight.
CN: *Sigh*. Uhm, ok. Fine.
Me: Uhm, ok, well, thanks....bye?
CN: *click*

Here's how it went when I called in to my current job:
CN: Hi Rosebuttons! Are you calling in sick?
Me: Yeah, I'm still not feeling much better yet...
CN: Aw, I'm sorry. You don't sound great, I'd probably send you home anyway if you tried to come in to work! Now listen, you stay home and rest, just take care of yourself. Hope you're feeling better soon!
Me: Aw, thanks, Charge Nurse! Hope to see you soon.

Granted, these different conversations could be attributed to either a.) differing personalities of the charge nurses, or b.) the fact that the first hospital does not have a resource pool or agency nurses they can pull from to cover absences, but I would like to attribute it to the fact the unit at the second hospital actually cares about their nurses, their well-being, and values their contribution to the unit as a whole. And therefore this attitude and culture carries over into individual interactions between staff, and greatly affects their attitudes towards work. Anyway. Carry on with your gift-wrapping or cookie-baking or whatever you people do around this time of year. I've got cable TV and knitting waiting for me.

Note to self

2007-11-11T20:42:00.000-08:00

Personal reminder to Rosebuttons:

Reality just called, it wanted me to tell you that...you are a nurse.

Contrary to evidence of recent activities, you are not actually a member of the jet-set idle-rich who have nothing better to do than jet around the world, hang out in world-class cities, wander aimlessly through museums, and take three-hour lunches with copious amounts of wine or ridiculously named cocktails.

Starting tonight, you actually have to go to *work*...you know, that place where you attempt to earn a laughable piece of paper some call a paycheck? Because traveling is not actually free, as much as you may be certain that it should be, as it is definitely one of your inalienable rights as a human being and apparently as necessary to you as air, water, and caffeine.

And also, at this place called *work* you actually have to do stuff, like show up at a certain time, and stay for a prescribed number of hours, and complete eleventy-bazillion tasks. But wait, here comes the scary part...you also have actual responsibilities. Like monitoring invasive lines and equipment with the purpose of keeping a human being alive. And delivering important medications, and assessing problems, and communicating with other people (whether you want to or not). It is wise to note that these responsibilities and tasks are a bit harder and more important than the tasks that you've most recently been doing, such as trying to decide between the chicken or the fish, or if you should nap before or after dinner, or if you should hop on the metro or just walk through the streets of Paris to get some falafel. Because no one probably died if missed the metro train or if you accidentally napped for two hours instead of one.

So anyway, I know you haven't really forgotten that you are a nurse, but sometimes it is much more pleasant to avoid reality for a while. Sorry. Hey, wait, where are you going? I'm talking to you, Rosebuttons. What are you doing on that computer? Is that the British Airways site you're looking at? Are those little numbers and letters flight times and dates? Seriously, Rosebuttons. Wait, how much? Seriously? Well, London is wonderful this time of year...

Wanderlust

2007-10-16T17:05:00.000-07:00

As if I need a reason, I'm leaving town. I'm going so far away from the MICU that rectal tubes and being kicked at and poo-covered will be distant memories.

But don't worry! You won't miss me too much, I'll be right over here for a little while :)

Seriously.

2007-10-16T16:43:00.000-07:00

Seriously. Are you tired of my whining, I-hate-my-job, my-job-is-sucking-the-life-from-my-weary-bones posts? Because, seriously. Last. Night. Sucked.

I don't even know where to start, except to make sure emphasize the fact that I am sick and tired of trying to take care of ETOH-w/d GIB with ESLD, encephalopathy, confusion, and of course nutso. And because that alone is not fun enough, the doctors like the write orders for me to give them either lactulose or Golytely because nothing makes a nurse happy like cleaning up liters and liters of liquid poo. So yeah, that was my night, times two, since I had two patients, in the same situation.

To save you time, I'll sum up the highlights:
- Wondering why his oxygen levels dropped a bit on the monitors, I checked in on Loony #1, only to find him and his bed covered in feces. Patient had a feces-covered washcloth in his mouth, shoved into his mouth, and refused to part with it when I tried to take it out. A brief struggle ensued. Not pretty. And also, my internal nursey filter for How to Speak Therapeutically and with Empathy to Patients at all Times has officially gone south. I now find myself saying things like, "You cannot have poop in your mouth! Open up!" I believe I also heard myself utter, "Seriously. Because it's just gross."
- Wondering why Loony # 2 was not mumbling for a few moments, I checked in to find him attempted to pull out his IV lines and any other tube he could find. When I tried to thwart his efforts, he grabbed at the IV line and pulled the entire IV pump and pole into his bed. Then, since I'm such a party-crasher, he got really pissed off and tried to push me away and wave his arms and hit me.
- When I called out for help to restrain Loony #2, the other nurses ran into Loony #1's room, assuming that's where I was. I'm all, "No, I'm in the OTHER crazy room!"
- During restraint process, involving 5 RNS and a boatload of Ativan, Loony #2 creatively called us all every obscenity he could find. It turns out he's quite an angry misogynist, as he declared that we were all dykes. Big nasty dykes. My neuro assessment was further complicated by his answers to my questions..."Do you know where you are, Mr. Loony?"
"Yeah, I'm at Dyke Central!"
"Do you know what day it is, Mr. Loony?"
"Yeah, it's the Day of Dykes on Trikes!"
There is no checkbox for those responses on the CIWA protocol (alcohol withdrawal) flowsheet, however.
- Loony #1 exercised his lungs for at least two hours by constantly yelling, "Help me!" then claiming that he would be telling his lawyer all about this.
- Later on, Loony #2 earned himself ankle restraints after I dodged several feet and leg kicks aimed at my head. And that internal nursey filter? It didn't stop me from telling him, "Seriously. Just stop talking. Stop talking now." But I could honestly think of no empathetic, therapeutic way to get him to stop spewing every nasty word for women's private parts along with a description of them.

So seriously. At least I feel completely justified when I say, "I need a vacation."

Word.

2007-10-14T18:42:00.000-07:00

With apologies to Head Nurse, what she says explains a lot...

Nurses believe in God, I think, primarily to have somebody to blame. All I can say is, when God and I meet up at the end of my life, we are gonna have one Hell of a Come-to-Jesus meeting.

Things that are funny...

2007-10-14T16:44:00.000-07:00

There are certain things that seem hilarious at four in the morning, that sort of lose something during the "real day" when normal people are awake and the sun is shining.

Last night at work the palm of my hand kept stinging every time I put alcohol gel on it. I noticed I had a tiny divet in my palm, the shape of a fingernail, I must have been clenching my fists while sleeping again. So the following conversation took place:

Me: This little cut on my hand is killing me! Stupid alcohol gel...
RN Friend: Weird. What's it from?
Me: (examining hand closer) Not sure...strange place for a cut...must be stigmata.
RN Friend: Cool. You should use that as an excuse to call in sick.
Me: Ooh! Good idea! 'Hi, Charge Nurse? Yeah, this is Rosebuttons RN. I'm calling in sick for my night shift tonight, maybe the next few nights too...yeah, I've got the stigmata.'
RN Friend: Perfect. They can't argue with that, you know you can't come to work if you can't control your secretions.
Me: Total infection risk.
RN Friend: I gotta get some of that stigmata.

So on my handy List of Excuses for Calling in Sick, I shall add Stigmata right after Scurvy and right before Pink Eye.

Again, apologies for insulting any more religious groups, as I probably did in my previous post as well. But what good is an organized religion if they can't laugh at themselves too?

Bloodless

2007-10-09T16:29:00.000-07:00

Last night I took care of a patient who had recently undergone chemotherapy and radiation, and was admitted to the MICU with severe anemia. Specifically, his hematocrit on admission was 14. Then the next day it was 13, then 12, then 11. That's what we call Super Low (or critical, whatever) since the average male should have a hct of at least 45% and we would nearly always transfuse for hct of less than 25%. But this particular patient, due to his personal religious beliefs, refused any transfusion of any type of blood products. He was not confused, and quite oriented, and understood that he could die without a blood transfusion. His cancer is still treatable, but he could not have any more chemo or radiation until his blood counts were back into a safe range. I think I am usually very nonjudgemental of my patients lifestyles, religions, or personal beliefs, but I am having a lot of trouble with this one.

His wife stayed overnight in the room with him, despite it being against our unit policy. But other nurses had previously allowed her to, and once the precedent has been set I hate being the bitch who suddenly enforces the rules. So I agreed to it, but with the warning that if her presence interfered at all with nursing care, I would have to ask her to leave. She put his side rail down and pushed the chair-bed right next to his bed, but I constantly had to wake her up and push the chair aside in order to be able to access my patient. Since he had just received four liters of Golytely and required very frequent cleaning up, I needed to make her move quite a lot. Freakin' Golytely. At one point, upon seeing the entire bed transformed into a lake of dark brown foul-smelling liquid, she sighed and said, "Wow. Awww. Wow. I'm just so surprised, he's only had one little Ensure shake in the past few days." Umm...four liters of Golytely go in, four liters of Golytely must come back out. And then some. I wondered if dayshift had silently administered the Golytely into his feeding tube without explaining the outcome? And she hovered around while I cleaned him, at one point even patting me soothingly on the shoulder and saying, "Aww. Wow, you poor thing. Wow." I bristled. Good thing the lights were dim in the room, or she may have noticed me narrow my eyes and the little hairs on the back on my neck stand up. I'm a nurse, a highly trained and well-educated ICU nurse, this is my job, this is what I do, I'm being paid for it and I chose to be here. Don't pat me on the shoulder.

The patient was pale as a ghost, lethargic and very weak. I didn't draw labs on him since the docs didn't order any, and they want to minimize blood draws as much as possible, for obvious reasons, so I don't know what his hct was this morning. The charge nurse and I discussed possible transfer out of ICU to the medical floor...after all, what could we do for him? Yes, he was full code status, but we could not transfuse. We cannot treat his life-threatening anemia, except with epo shots and iron supplements. He is not a surgical candidate. He is not intubated and his other vital signs and pressures are stable. So it sort of makes sense, he doesn't need to be in the ICU. But it struck me that his status would be downgraded, to a different level of care, essentially because of his religious beliefs. Is that weird?

I'm still thinking about this one. I'm still having trouble with it, because it doesn't make sense to me and I have trouble accepting it. Sure, a lot of religious convictions and beliefs don't make sense to me, but usually I can accept the differences in belief and move on from there. But this just doesn't sit well with me. I can't wrap my little secular head around it. Why does that one specific thing in the bible, regarding blood, get translated and adhered to so literally? Why do they accept all of our other medical advice and interventions without investigation or comparison to scripture?

And I'm confused by myself...I left the same t-shirt (his garments?) on a Mormon patient in the ICU for days and days and worked around it, I carefully wrapped and re-wrapped a head scarf around a young Muslim woman each time before a male physician entered her room, I timed certain medications around prayer times so a Muslim patient could pray, I made fifteen-minute checks on a my Hasidic Jewish patient because after sundown on a Friday she could not use the call light, I've bent the unit policy and allowed more than the requisite number of visitors into a patient's room so they can pray together, and not one bit of any of these actions bothered me. Rather, I consider it to be a crucial part of a nurse's job, since I am caring for the whole patient. But at the same time, I guess none of those things ever compromised a patient's care or well-being, either.

So anyway. This is just a big old can of worms I might be opening. Perhaps this is a controversial topic, maybe I seem callous or judgmental. I sort of feel that way. But I just don't get it.

Overheard at work...

2007-10-05T23:08:00.000-07:00

Chipper Dayshift Charge Nurse: Good morning, Susie!* How was your vacation?
Dayshift Nurse: It was wonderful, I had a great time. Until I had to come back to this hellhole.
Chipper Dayshift Charge Nurse: (nervous giggle) Oh, haha, it isn't that bad, now is it?
Dayshift Nurse: (without a trace of irony) Yes, it is.

I promise, the above conversation was overheard at work, and I also promise, it wasn't me. Not yet anyway. I suspect that I will actually have to return from my Grand Adventures, however. So stay tuned.

To anyone out there who is not a nurse, or a travel nurse, or in a job or field where it may be difficult to find jobs, and if you hate your job, and every cell of your body cringes at the thought of starting yet another 12 (or 8) hour shift, I heartily sympathize with you. Because just this morning I realized that if I didn't have just a few weeks left at this hospital assignment, and if I didn't have a bazillion other nursing job options to pick and choose from, I would be even more morose and depressed and whingey than I already am. And that's saying a lot.

I've had four days off of work, and it felt absolutely sinful and delicious. I slept late every morning (I love you, Mr. Melatonin and your little buddy Benji Benadryl), I cleaned my house (even the bathroom floors!), I cleaned out my closet (must make room for Paris shopping!), went to the grocery store, and dropped off the clothes at Goodwill. I also made it to the pharmacy because unhappy stressed ICU nurses must NEVER run out of migraine medicine.

And oh! The best part. HBO and Showtime On Demand. My thoughts so far? The Tudors: Showtime should probably have left the period piece to BBC or A & E. But I will continue to watch it. Because it's Jonathan Rhys Meyers. I'm obsessed with all things Tudor-history, as geeky as that may be. Weeds: Love it, but maybe a bit too much cops/gangsta drama this season. Californication: So far, funny funny. And pretty well-written. And David Duchovny? Yes. Just...yes. I have loved him ever since the days when I would have given my right pinky finger just to be the Agent Scully to his Mulder, and he rocks in this show, as a drunk and drugged-out bitter divorced misplaced New York writer bitching about living in LA.

So that's what I've been up to lately. Sorry, not much nursing content in this post. Mostly because I've had a few days off, but also because I hate my job. Which makes me sad, because I used to love being a nurse, and I've even had jobs where I would truly look forward to starting a shift. I want to love nursing again. I miss you, nurseywork.

On skin windows and flying patients...

2007-09-27T16:22:00.001-07:00

Last night was a gorgeous, huge, glowing full moon yet all I can think to write about are pressure ulcer dressings and modes of moving fatty boombalatty patients who would otherwise kill your back. I'll never be a poet at this rate, topics like that just don't translate very eloquently.

Last night I lifted my 110 kilogram patient with just one finger! No, I'm not freakishly strong or even gifted with special powers, although it's understandable if those are the first conclusions you reach. It turns out the PUH MICU has installed these overhead lifts in each patient room, so if you put the special sling under your patient, you simply attach the straps of the sling to the arms of the lift, use the handy-dandy push button controls, and lifto-shifto, you can boost that patient up in bed! In mere seconds! Your old-beyond-its-years nursing back thanks you profusely, as do your colleagues who are too busy to put on gloves and risk their own backs just to help you get your patient straightened up in bed. The sling thingy even tilts a little sideways so you can put some pillows underneath and turn your patient with ease. You know, to prevent nasty pressure ulcers...which brings me to my next point...

Maybe this is already a universally known technique, (and by universal, I mean widely known to the huge population of people who are RNs and deal with skin care issues...perhaps not yet material for Good Morning America, but of growing importance to a wee minority...) but a colleague at PUH has introduced me to duoderm windows! It's a stroke of genius, an inspiration of brilliance. So...you know when you have those nasty tunneled oozing pressure ulcers, and of course by their very nature they are in the most inconveniently dirty places, such as the on the very underside of your patient, a mere centimeter (sometimes not even!) south of the a*us? So of course keeping a dressing over such an ulcer, nonetheless keeping it clean and dry, becomes a seemingly insurmountable problem. Then if you do manage to put a dressing over it, each time you have to change it, you are just bothering and irritating the already-sensitive skin by peeling stickies off it? Well...get ready for this...my brill-ee-unt colleague crafts a window out of duoderm, places it over the offending sore, then packs it, and covers it with gauze and finally a piece of tegaderm which adheres to the duoderm, but not the patient's skin! SO, the duoderm stays in place and each time the site is soiled you do not need to rip off a piece of duoderm, plus you can change the tegaderm as much as you might need to without hurting the adjacent tissue!

Oh my goodness. I think this has turned into one of those, "You know you spend too much time in hospitals when these things get you you excited..." posts. So sorry. Soon I will be in Europe and perhaps I will be excited by things like world-class art, ancient monuments, and legendary pain au chocolat. I certainly hope so. I just have to survive 168 more hours of work before I leave....I know, I know, could I have thought of a more depressing way to say, "I leave for Paris in less than three weeks!"??

*This is an example of the patient sling I am in love with.
*Disclaimer: The people in this photo are not me and my patient, nor do they even remotely resemble me or my patients. For example, notice the cheery smiles on their faces and the sunlight streaming in through the window...and that's just to start with...

Just checking in...

2007-09-25T21:35:00.000-07:00

In case anyone is wondering, I'm still here, and I'm still alive. Somehow. Even though throughout the month of September I've only got seven whole days off. In response to Clean Dry and Intact's comment, I'm not sure I have very good advice on how to survive five shifts in a row...when I had the time, I tried to clean my whole house, do every piece of laundry, and run every little errand that I had, so there'd be nothing to worry about or stress over during my long stretch at work. But now, since I've only got little onesie or twosie days off, I just try to rest and sleep as much as possible on my days off. Then I try to schedule to get just one little thing done before I go to work each night...even if it's as little as taking out the garbage. In the meantime, I'm considering the pros and cons of hiring an errand boy. Can I get an au pair even if I don't have kids?

NurseSF asked why I use acronyms for the hospitals I work at, and whether it's better to do that or to be honest about where you work, etc. I'm not really sure what's best, but for myself, I'm just paranoid about HIPAA. I always change any details about my patients that I write about in order to protect their identity, even their genders or ages. I guess I'm just worried that if someone recognized me or the hospital I write about, they might think I'm revealing private patient information. I don't really mind if people I work with read this, but I just wouldn't want it to get back to the managers or anything. I suppose there's a slim chance of that, but just to be safe...

So underneath my bitter, tired, overworked facade, I'm truly super-duper excited about my upcoming trip to Paris. I'm just a little too worn out from working to open my guide books and focus on the teeny French words on the pages at the moment. Thank goodness I have three weeks left till I leave. Wait, only three weeks?! Damn.

On second thought...

2007-09-10T10:23:00.000-07:00

There are some things which can be defended with the age-old excuse: "It seemed like a good idea at the time." But even I have to admit that there are some things to which I have to say, "No, it never seemed like a good idea. But maybe later, down the road, I'll look back and say, 'it was sort of a good idea,' " Case in point, somehow scheduling myself to work 12 out of 14 consecutive night shifts. Yes, 12-hour night shifts. Yes, I realize that's 144 hours, or a couple of 72-hour work weeks. But I'm hoping that as I'm sitting at a sidewalk cafe in Paris, ordering another bottle of wine, or browsing the little boutiques in Le Marais district and contemplating an adorable pair of red shoes, I tell myself, "Self, I'm really glad you worked some extra hours because it's making my adventure in Paris so much more better," except with better grammar of course. And in French.

I'm working at both hospitals now, PUH, and per diem on my old unit... the hospital that is like an old boyfriend to me. You know, comfy, I have good memories from our time together, I miss it there, and time and other hospitals only serve to help me forget the reasons why I left in the first place. But anyway. I'm sort of hoping that by splitting up my shifts, some at each hospital, it won't make a 5-night stretch feel like five nights. Heh. Stop snickering at my faulty logic. Paris! Red Shoes!

Oh! And now for some nursing content....things that are also NOT a good a idea: (Ahem..residents, listen up...) No matter how "unresponsive" you think your intubated patient is, always always always always ALWAYS write PRN sedation orders for him. Always. Because when said patient is an angry sweaty confused 400-pound man, and he suddenly wakes up with a tube in every orifice, and you're a little too slow returning his nurses's pages, there really isn't too much said nurse could have done prevent him from contorting his massive body in such a way to pull the ET from his throat. Wrist restraints be damned. Additional things that suck about this little vignette: Patient was already requiring 100% ventilator support, meaning that when he removed the ET tube from his throat, I had to call a code to get lots of people in that room STAT to re-intubate him. And sedate him. And also, you know how night shift nurses kind of work like a big team, and really step in to back each other up? Yeah, not so much. Apparently this is not universally true. The two other travellers on the unit really stepped up, one of them watching my patient for a couple of brief intervals to let me take brief breaks off the unit, and also helping me change a foley and insert an NG then lavage until clear. The other helped me turn and clean the verylargesweatypatient then even offered to take my other patient from me once she realized how swamped I was with verylargesweatypatient. To be fair, later in the shift the charge nurse stepped up and helped me set up my arterial line and drew labs for me when the three sets I had drawn hemolyzed.

Another little piece of advice to residents: When the patient's hematocrit drops from 48 to 32, please notify the nurse and ask her to re-draw the blood sample before you order a GI consult, and order four units of blood on the patient. Which I would have done, had I noticed the lab value before the residents did. But I didn't, because I was too busy titrating drips, inserting a foley and an NG, and various other little tasky things.

Anyway. I'm done ranting now. Back to work tonight, at the Old Boyfriend Unit (OBU). Kind of looking forward to it. But in the meantime, there are guidebooks to tab.

I am highly trained professional

2007-09-04T10:52:00.000-07:00

And occasionally I get poop in my hair at work. And no, it's not my own poop. Although, as the astute Jodi pointed out, "I think this is one of those cases where even if it was your own poop, it wouldn't be any less gross." I love that Jodi thinks like me, by acknowledging that indeed there are situations where the fact that the poop is your own versus someone else's DOES make it less gross. Yes indeed, I am a well-educated and highly trained professional. I spent lots of money and went to years of schooling in order to be paid to where your poop, on my head. How did the poop get on my head? Seriously, do you really want to know? Are you thinking to yourself, "Wow, that sounds gross. I'd better take steps to avoid that happening to me." Yeah, I doubt it. You're thinking, I will never complain about the papercut I got at work again. And to nurses out there...I bet you really don't want to know how it happened either, because I know you're all chuckling to yourself but thinking, "At least it wasn't me....this time." And FYI...try not to fling sheets off the bed, no matter how carefully you think you checked it.

So...contrary to the above anecdote, I really am liking my job at PUH. I'm back on night shift now, and so far everyone is pretty cool to work with and I think I'm getting into the swing of things fairly quickly. For some reason, I've been feeling braver as a nurse lately. Like last week I did three peripheral blood draws. No big deal, right? Right, except that's more than I've done in three years as an oncology nurse ("What? You mean some people don't automatically have central lines placed upon hospital admission?! That's crazy talk.") My usual response to an order requiring a peripheral stick is to call the phlebotomist, or look at the patient's arms myself, and failing to see a huge neon sign with an arrow saying, "Right here! Even a blind monkey couldn't miss it!" I sweetly ask another nurse to help me. No, I'm not proud. I was a blood draw weenie. Finally I sort of realized that I couldn't avoid peripheral sticks for the rest of my nursing career, and maybe it would be fun to have one more skill. Next up: IVs. Uff.

And also...after I just revealed my generally pathetic lack of skills as a bedside ICU nurse, I've decided to take the CCRN. I know, blood draws AND certification?! Crazy talk. Oh well. No one doesn't want an extra dollar an hour, right? Plus, dorky old me, thinks maybe it will be fun to study and learn more or refresh myself on general critical care knowledge. There's something strangely enlightening about studying something that you're already doing...that super-wattage lightbulb that goes on..."So THAT'S why my patient's heart rhythm kept going into Tourssade's...."

And also...even MORE exciting that CCRN, and blood draws, and poop in the hair....(I know, settle down, already!) I'm planning a huge vacation, the biggest trip of my little 31 years. I'm going to Paris and New York City in October! Okay, maybe my trip to Saudi Arabia was bigger, but I hardly planned a bit of it. It was more like, "The private royal plane is leaving around 8am. Your driver will pick you up at 7:30. Maybe you should pack or ask a maid to pack for you." So yeah, turns out this time around I have to fly coach and arrange my own travel and even pack myself. Hah. Anyway, I've got my plane tickets, and even places to stay, but I'm totally overwhelmed and freaking out by the amount of planning I need to do. I've got mountains of guide books, but I haven't even started tabbing them yet! Uff. But it's a good kind of exciting freak-out. Enough to make me forget about buying a house or studying for the CCRN to even studying my Arabic or French. Fortunately my closest friends have left the country for a few weeks, leaving me lots of extra time for planning and hermiting with my computer.

Not so bad

2007-08-24T10:04:00.000-07:00

I am tentatively reporting that so far, I think I really like my new job. Of course, it's very early days so far...but it really seems to fit. Beyond the goodies like computer charting, I'm just so tickled and happy to be back at a teaching hospital, I love seeing the gaggles of white-coated students and interns following their attending on rounds, looking like sleep-deprived fearful ducklings and mumbling incoherently as they step on the back of each other's shiny new Danskos when the attending stops the parade unexpectedly. I love listening in on rounds if I'm available, I love the new equipment and latest technology and the use of PEEP trials and arterial lines and how everyone actually knows what a hemoglobin A1C is, and why we should draw them. I love the air beds and water beds and sand beds. And so far, most of the nurses seem really nice, and welcoming, and helpful. The other day I volunteered to help an intern insert a foley catheter, only to discover that it was her very first one EVER, and so I actually taught her how to do it.

Maybe it's because my first job as a nursing tech was at a teaching hospital, and then my first two years as an RN were at teaching hospitals, but something about this job feels a bit like coming home. Slipping back into my comfort zone, with familiar insulin drip algorithms and other such protocols, it's nice.

Anyway, it's all good. It's very important for a lazy, homebody person like me to have a job that I actually enjoy, a place I want to go to, and I've got that again. Phew :)

They found me...

2007-08-20T21:36:00.000-07:00

Today I started my new job. I now have an ID badge which states "U. S. Government" and all ten of my fat little fingerprints are squirreled away in the FBI and CIA databases. Grrrreat. Talk about an walking experiment in cognitive dissonance...that's me. Take the little left-wing socialist Arabic-speaking child of marxist hippies who throws up into her mouth a little at the mere sight of George Dubya slap a government badge on her.

Anyway, other than that, I'm sure the new job will fine....the usual use of my overpriced education and professional skills...life-saving, split-second decisions and critical thinking: "Is this stool liquid to justify the insertion of a rectal tube? Here comes the finger puppet!"

In space-time-continuum news, I've re-entered the 21st century, as evidenced by the fact that this hospital exclusively uses COMPUTER CHARTING for everything. It's so freakin' snazzy I might need to buy some new scrubs just to keep up.

Ack. I think I'm overtired.

Like a shark...

2007-08-19T09:50:00.001-07:00

I am moving on, my contract at Private Suburban Community Hospital has ended, and instead of renewing I've decided to work closer to home. So tomorrow I'll be starting at Public Urban Hospital, or PUH. I ended up liking my time at PSCH, the other staff were so nice and warm and welcoming, the equipment was generally new and up-to-date, and the pace was fairly easy-going and straight-forward. But I refuse to drive over an hour each way to work in the fall, in the dark, in the rain....blah blah blah commutecakes. I was so happily and genuinely surprised that when I showed up for my last shift at PSCH, the other nurses had planned surprise potluck for me, gave me a card, some funny party gifts, and another nurse even came in on her day off to bring a cake with palm trees on it! It really was touching. Not touching enough to make me stay, because I am like sharknurse...move or die...heh. So, I keep moving on...

Bad things happen

2007-08-02T09:02:00.000-07:00

Yesterday, a tragic event happened in Minneapolis, which happens to be sort of where I grew up, so it's especially sad and spine-tingly to watch the scenes of the collapse. The bridge collapse during rush hour must have been terrifying and the families of the the dead, injured, and the missing have my whole-hearted sympathies.

Yesterday, more tragic events happened in another part of the world. I'm not comparing numbers, or saying that the more people who are killed makes one tragedy more significant than another. And I'll readily admit that the closer something is to your home, the more personal ties you have to it, the more significant an event becomes to you. But I wonder how the four major cable news networks that are devoting hours and hours of coverage to this event fail to see the irony of their complete lack of mention of other tragic events happening in the world. Obviously we care more because this happened in the US, and probably because it was a seemingly random and senseless event.

But seriously people..."we" spend billions of dollars invading a foreign country, illegally occupying it for years, destroy its infrastructure, so what entitles us to the luxury of looking the other way as hundreds and thousands die over there day, week, and month?

Anyway. Thank god it's shark week on the Discovery Channel, so I have something else to watch on TV rather than being incensed and depressed by the TV news. But why do they stop at shark week? Why don't we get camel week, or tiger week? Or pony week? I love ponies too.

Back in the saddle

2007-07-06T09:37:00.000-07:00

Here I am...I'm back. Back in Seattle, back at work (although a different hospital now...same poop, different county), back in my house with my wee doggies. I was thinking maybe I should start a whole new blog, since I am no longer working night shift and I'm doing doing very much knitting in the summer time, so I'm hardly knitting in the dark anymore. But how many blogs should one girl have? So for now I'll just keep this one, since I'm rather be working night shift and I'm sure I will knit more again, and I'm essentially lazy and can't be bothered at the moment to set up a new blog. Maybe next time I leave the country on another grand adventure, I'll make a new one :)

So anyway. Here I am but I don't really have much to say. And is anyone out there anymore? I have some tales from the ICU to tell...but I'll save those for later. For now, I just have an idea of what I what would do if I ran the world. Now, believe me, I rarely get these ideas, because I'm pretty much happy to let the lunatics run the world and to hole up on my desert island with my little dogs, a bottle of rum, and a Bob Dylan CD. My very own tiny version of isolationism, as enacted by the Republic of Rosebuttons. BUT I have one little request to make, to the people who are running the world: Everyone who is climbing or wants to climb Mt Everest...? Stop it. Get off the mountain. It's officially closed. Forever. First of all, people, why? Because it's there? To prove something? That's the lamest most egocentric reason of all. There are lots of things that we humans can do, or might want to do, but we shouldn't. And if you have something to prove, why don't you go to Africa and vaccinate some babies, or take over FEMA, or adopt an abandoned puppy, or just let that guy merge in front of you on the highway without giving him the finger? But I digress. As Einstein said, "Only two things are infinite: The universe and human stupidity. But I'm not certain about the universe." So if you have something inane to prove to yourself or your peeps, go ahead and do it, it's none of my business. BUT...here's where I get pissed off: When, in the course of reaching your self-centered and pointless goal, it becomes acceptable to eschew all implicit moral behaviors, to stop being human. There is an acceptable code, on the mountain, that if another climber can no longer walk, you leave him or her to die. The reasoning is rational and cold: You hardly have enough energy to walk by yourself, it would be impossible to save another person by carrying them off the mountain as well. Implicit in this code is the idea that everyone is completely on their own on that mountain, no one can save anyone else, or even help anyone else. So climbers routinely walk by dying and dead people on their quest for their 15 minutes at the top of the world. And it is ok, because that's the code, and other people do it. BUT, as it turns out, there is no pot of gold on top of that mountain, there is not even a cure for cancer, or AIDS, or the secret to peace in the Middle East. There is not even very much oxygen up there. Yeah, perhaps there is a personal accomplishment, but if you're looking for accomplishment, try undergoing and surviving cancer treatment. Or flying cross-country with a one-year-old by yourself. For fuck's sake, just learn to change a flat tire. What I'm trying to say in my roundabout way, is that I have a huge problem with a useless activity that allows people to justify foresaking their own humanity and their duty to be human towards other people. Now, I'm the first person to snark at your whinging, snotty child on an airplane, or call you some choice four-letter words if you cut me off on the highway without your turn signal, and I might even whisper something about your poor judgment in selecting spandex shorts to my equally snarky friends, because I'm the first to admit I'm not the warmest or nicest person, and in general I don't like most people. BUT, if I found you lying on the ground, and you needed help, I would stop and use my sock to tourniquet your gaping flesh would or just hold your hand so you weren't alone, not because I'm a nice person, but because I'm a human being, and that's why we're here. And maybe I didn't climb to the highest point on the planet, but if that one other person 's life was a bit better because I was where I was, then that's okay. So, you crazy Everest climbers, get off that mountain. I think you left something down here on Earth...it might be your humanity.

Heh

2007-01-10T04:49:00.000-08:00

This is awesome news: Zoo puts humans on display.

The last line of the article sums it all up, I love it.

I'm off to see a man about a horse. In Hyde Park, that is.

'doh

2007-01-08T09:12:00.000-08:00

Thanks for your comments guys, I'm touched when I hear people are actually reading me :) Anyway, I'm an eejit...I will definitely send you bloggy invites but turns out I need your email addresses to send the invites too, and I can't seem to figure out how to see your emails from the comments (if that's possible at all). So, I'm sorry, but can you email me instead of comment? I'm srrussso at gmail dot com.

Thanks again! I'll figger all this stuff out someday...

...on a jet plane

2007-01-07T23:34:00.000-08:00

...don't know when I'll be back again.

I'm not sure if I'll be posting here much in the next several months, but maybe I'll pop in once in a while with a funny story or anecdote. I'm leaving for London tomorrow afternoon, with essentially a one-way ticket. From there, I'll travel on to Saudi Arabia with my employer to work as a private nurse for three to six months.

I'll be continuing to blog and write while I'm abroad, from a different blog, Arabian Nightshifts. However, it's one of those annoying invite-only blogs, as I don't feel entirely comfortable making it public, for just anyone to stumble upon. You know, employer privacy, national security, little things. But I'm not trying to shut you out, oh no! I want to share all that I can with anyone that I know. So, if you want to continue reading, and you want a fancy schmancy bloggy invite, just leave me a comment! Even if I don't "know" you, if I know your blog or we've made a vague passing acquaintance and I'm fairly sure you're not the Minister of Defense of the Kingdom of Saudi Arabia, I'll let you in. Oh, and if I know you for reals, as in, I know your birthdays and your mother's maiden name, you're getting an invite soon anyway once I get things up and running. My main motive in the "invite-only" idea is to not have it available on random search engines or to people just clicking through. Like, the muttawah (religious police) or officials in the Kingdom. Not a good place to offend anyone, if you know what I mean. Just trying to keep a low profile ;) I don't know a whole lot about innernet securty, but I figure this is fairly safe way to go. If I'm entirely off base, let me know, eh?

So yeah. I wish I could write an eloquent and concise post about how it feels to organize and pack up your whole little world, to systematically check out of This American Life for a short but indeterminate period of time, to say farewells and thank yous and love yous to all who matter to you but to keep wondering if you said it enough, but I'm sort of at a loss. I also wish I could explain how I'm still in disbelief about what I'm about to do, that I think I'm really super excited and thrilled to be embarking on this adventure, and that I hope that I remember how exciting this all is when I'm suddenly wondering what the fuck I'm doing and where the hell I am. But I can't, I'm just packing and checking things off lists, and going through the motions trying really hard not to cry, so I'm sorry I'm not doing a better job of writing about it.

Stay tuned, whether I see you over at Arabian Nightshifts, or when I'm back here, writing about returning to work at the Children's Hospital. And thanks for all the fish.

Schmoo

2007-01-07T15:26:00.001-08:00

IMG_1889.JPG
Originally uploaded by rosebuttons.

These are my schmoos, my babies, my "pack," my favorite little creatures ever. This week and especially this weekend has been full of "lasts," which are bittersweet. Each wonderful moment with my friends or my family stings a bit as I realize that it's the last one for a long time, and I wish the moments would dilate so I can hold them longer, and imprint them on my brain to remember later.

And I can't get enough of these little guys, of their wet noses, or velvet ears, or soft naked bellies, even their wheezey, regular snores when they're sleeping cuddled next to me. Their liquid brown eyes follow me worriedly as I clean the house, drag out the suitcases, and make piles everywhere. So I stop each time I walk by then, and smoosh their faces, scritch the top of the heads, tell them they're best dogs in the world. But it just sucks, because I can't make them (or me) feel better by making sure we've got each other's emails, or promising to write and call regularly, or even by telling them when I'll be back. All they know is that something big is going on, their little world is changing, and I might be leaving. I guess that's sort of all I know, too.

And then there were three

2007-01-05T16:28:00.000-08:00

Three days, that is. Until I leave. Eek.

This week has been filled with making lists, crossing things off lists, adding things to the lists...farewell dinners with friends, organizing bills and payments, mail forwarded, getting the car serviced and washed, getting my hair cut, my brows waxed, shopping...

But of course I still found time to lay on the couch, cuddle with the doggies, and enjoy my mindless cable TV. Thanks to Nicole, I found this: Effects of drugs and alcohol on spiders. Go ahead, just try not to laugh out loud.

Now I'd like to do some more of that laying on the couch with the dogs, but I must go and pick up my prescriptions before my insurance expires tomorrow. And then I must go to the Apple store and pick up Sims 2, because, well, why not? How else will a girl pass the time on transatlantic flights or those lonely nights in the desert? And maybe I'll pick up a pair of speakers, because as fabulous my wee macbook is, it does not seem to have great sound.

And I might be rather brave, or probably just a little stupid because it is 4:30 on Friday, and I am about to head out in the rain across the ship canal bridge, on my way to U Village. That will mean nothing to you if you're not from Seattle. And if you are from Seattle, I can hear you snickering at me.

Obligatory 2007 post

2007-01-03T09:55:00.000-08:00

I hid on my couch and avoided any New Year's Eve celebrations this year, mostly because I was still sicky sniffly achey but also because I had decided not to succumb to the pressure of making plans, coordinating people, ensuring a good time, blah blah fish cakes. So Steph brought us some yummy pizza (with extra red sauce on the side, thank you!) and we watched Creature Comforts on the BBC, laughed at the goofy dogs, then parted well before midnight. Not a rockin' celebratory night by any stretch, but as comfortable (elastic waist pants were worn by all) and cozy as I needed. As Jodi said, it will turn into 2007 whether we celebrate it or not. And I figure that I've got a whole year of brand new exciting adventures ahead of me.

So lets see, is this where I'm supposed to make New Year's plans, or even resolutions? I think I'm going to pass on that one too. I've made enough plans (quit job, go to London, spend some months in Saudi Arabia, come home, get job back, buy a house, travel the world, buy myself a pony, etc) and resolutions only depress me because it forces me to think about what I want to change about myself instead of what I already pretty much like about myself. So, all by itself, with no lists or planning on my part, I think 2007 is going to change me and force me to look at and understand the world and myself in profoundly different ways. And hey, if I lose a few pounds in the process, that would be nice.

Turning the corner

2006-12-30T17:54:00.000-08:00

I think I may (knock on wood!) have turned the corner, in that at least I don't feel as bad as I did yesterday, so maybe I'm on the upswing. I seem to have developed a nasty-get-that-girl-into-viral-isolation hacking couch, and my tissue box and bag are my constant companions, and I'm still needing an hour's nap for every hour I'm awake, but I'm rather pleased that I don't feel any worse. I even perked up a bit at the thought of maybe going to Costco with Jodi, but it didn't take long for me to realize a.) it's Saturday of a holiday weekend, are you inSANE? and b.) the ten-minute phone conversation exhausted me and wore out my croaky voice enough.

I'm more well-equipped now too. I have many boxes of soft poofy tissues, many gallons of beverages in the fridge, some gorgeous raspberry sorbet, and MTV is re-running a marathon of the Road Rules/Real World Challenge. Dude. The only thing better than an MTV reality marathon is being sick enough to justify watching it since your brain is already mush. And I've got the funniest movie evAH, Wedding Crashers, starring one of my boyfriends, Vince Vaughn, and the Sims for amusement. So, call the sick line, I'm not going to work anymore and I'm calling in sick from life. At least for the weekend. Because come Monday morning, I think I'll be handed my discharge papers from the Sick Couch. I guess I'd better be ready to get ready to leave the country. The country, the continent, the time zone, yaddy yaddah desertcakes.

And now, it's dinner time at the Last Meal in the Country Cafe. Tonight's special: Velveeta shells and cheese. Dude.

Low Bentham

2006-12-30T00:08:00.000-08:00

I feel guilty not having any photos posted lately, because I know, dear reader, that sometimes you just feel like looking at the pretty pictures instead of reading someone's droll words. I'm still figuring out this whole mac thing, and iPhoto, and so I haven't been able to upload any new pics. Or rather, the photos are all on the computer, I'm just having trouble organizing and finding them. So, for now, you can look at this photo of the village of Low Bentham in Lancashire, northwest England. It's where my parents lived for six months in 1996, while I was living an hour south in Lancaster. My dad recently put this photo on his flickr site, and I haven't ever seen it before. It gave me a twinge of homesickness.

Speaking of sick, yes, I am, thank you for asking. As a BMT and PICU nurse, I take care of some very sick people. People in varying degrees of organ failure, people with their mouths and esophagus ulcerated and bleeding, people with blistered skin falling off their bodies, people requiring constant infusions of pain medication, people with cancer, people who are dying. Therefore, sometimes I find it hard to complain about or even mention being sick, since I am obviously pretty well off compared to my patients. But jeeeeezus christ I feel like ass. Like a shitsickle warmed up and refrozen. My throat is scratchy and sore, my neck aches from swollen glands, my nose is blocked up and intermittently, my eyes are red and itchy and teary, my entire head is throbbing like it's caught in a vice, and my tummy is rumbling and nauseous. Today I felt a lot worse than the day before, so I'm hoping today was the low point and I can only get better from here.

I'm glad I'm single and I live alone, so I don't have to brush my hair or worry about how grody I sound when I cough. But being single kind of sucks because even though I'm a walking Sicky McFugliness, and I've called in sick from life, I still have to empty my own dishwasher and walk the dogs and go buy my own tissues with lotion and A & D ointment (for my raw, chapped nose. Don't laugh. I'm single and I can have a shiny red nose if I want. See the vicious cycle here?) Sure, a few well-meaning friends ask how I am and if they can bring me anything, but I can't really ask them to do the things I really want, like empty my dishwasher, or put the kettle on for the hot water bottle while you're up, can I? Plus I can hear the audible relief in their voices when I tell them I don't need anything, but thank you, and they are so relieved they don't have to venture over to the Sick House, risking their own health and eyesight upon glimpsing red-nosed-messy-haired-hacking Rosebuttons. I know how it is.

In other headlines from the Sick Couch, my fancy-ass graphite grey T-Mobile moto razr phone thinks its too good to accept text messages from Verizon phones. I can send and receive calls, and send texts, I just can't receive any. This may prove to be a bit of a problem considering my two friends have Verizon phones. And also considering I much prefer texting to speaking on the phone as a method of communication. Ugh.

The darling Matrix is back from the dealer's, although they were too busy to wash her inside and out so they "owe" me a wash. So, $165 later, she's happy and running great, but still a dirty lil' mofo.

I think I may still be covered under my previous health insurance, so instead of crying and beating myself up for not realizing this sooner, and instead of being pissed off that it's a freakin' holiday weekend and everything is shut (didn't we just have a freakin' holiday weekend? Get back to work, lazy America!), I shall take a deep breath and plan to get my headache meds filled as a three-month supply next week. Cross your fingers on that one.

Ok, my whining and complaining is done for now. Carry on as you were.

Shniffle

2006-12-29T12:14:00.000-08:00

Ugh...still sick, reporting from the couch. Yesterday I got a brief and sudden spurt of time in which I wanted to clean and organize around 4pm, I'm hoping that hits again today. Until then, I want to do nothing more than lay on the couch, watch bad TV, and not stray too far from my tissue box.

I thought I had more to say. But I don't. Time for a nap.

Any chimp can play human for a day...

2006-12-27T22:22:00.000-08:00

Just a cool line from Rilo Kiley, my latest favoritest album.

So the days count down, until I leave the country. I've done a few things, but I feel like the time is ticking by and nothing will get done.
Here's what I've accomplished so far:

bought a new mobile phone (quadband, GSM)

cancelled my previous mobile phone contract, because I couldn't use that phone outside of the US or Canada
made an appointment to get my hair cut and my eyebrows waxed
made a doctor's appointment

suspended my cable TV and internet service (I'm using my neighbor's wireless service, and the cable won't be officially suspended until the day I leave. Live without my DVR? Are you kidding?)
bought a converter/adapter kit for electrical thingies
Saw Night at the Museum (okay, not exactly necessary for going abroad, but definitely necessary for my sanity)
made an appointment for an oil change and check-up because my car's "check engine" light came on this morning
balanced my checkbook and realized I can't afford the oil change, hair cut, brow wax, or new clothes until I get my paycheck advance from my foreign employers
found out I probably don't have health insurance coverage after this month
found out that I won't get my paycheck advance until I get to London
bought lots of tiny travel things and generic OTC meds for my first aid kit to take with me
Had to use some of the Airborne and zinc lozenges and cold medicine already for the runny nose and itchy sore throat that I have now

But anyway, somehow I guess everything will get done. Somehow I'll pay for what I need to pay for. And somehow I'll get to London.

Happy Boxing Day to all!

2006-12-26T13:01:00.000-08:00

This is Ted and Stinky Duck, looking on sadly as I ignore him while I play with my new favorite toy, my wee Macbook. Photo taken by macbook itself. That's my leg on the left, you might recognize me by my polar fleece uniform that I am wearing in order to couch surf in the utmost style. And yep, I lists and lists of things to do before I leave the country in two (eek!) weeks but today I am being lazy and recovering from my 60 hour work week. I might nap now, then shower and go to Target and then the Verizon store in order to investigate the possibility of buying a cell phone that I can use in London and SA. Wish me luck. On the phone search, that is. Not so much on the napping or Target shopping, I do pretty good with those activities :)

Happy Christmas!

2006-12-25T20:55:00.000-08:00

Happy and merry Christmas to you and all you love!

Oh. My. God. I just worked. 60 hours this week, five days in a row. Three days in the PICU, two in the hem-onc ICU. Today, at the eleventh hour (actually, the 57th hour, but who's counting?) my patient turned his stable, perfusing sinus rhythm into an atrial flutter, two-to-one conduction. Which means that his atrium squeezed about 300 beats per minute, and the ventricles squeezed 150 times per minute. That's pretty fast if you're my 100 kilogram 62-year-old male, and not my 5 kilogram 9-month female patient. An EKG was done, cardiology was called in, and excitedly decided to cardiovert the patient. They were super excited because he was already anticoagulated thanks to coumadin treatment for an aortic valve replacement ten years ago. It's not advisable to cardiovert the heart of a patient who may have been in this unstable atrial rhythm for a while without anticoagulation, because there's a risk they may have formed a clot in the atrium which would then be sent elsewhere in the body, plugging up important spaces in the lungs or brains or whatnot. Anyhoo, we sedated the patient, shocked him, and finally started an amiodarone drip which actually converted him. What I'm trying to say is that the last few hours of my excessively long stretch of working were filled with much too much activity and business and now I am so freakin' tired. And I have no idea why I'm telling you all about cardioversion instead of sitting back and watching the BBC and letting my brain melt away.

Santa decided I was a good girl this year, because a shiny white Macbook showed up two days ago on my doorstep! It is just so cute that I invited it inside and I think I'll keep it.

More later, as I recover. So, to sum up, in case you're wondering, working five twelve-hour days in a row sucks a lot.

Main Street, Yemen

2006-12-21T06:19:00.000-08:00

If you know where this line is from, you are awesome: "When we get to Yemen, can I stay with you?"

Also, in Things That I Think Are Funny: While in B'ham this week, my dad told me about a news story involving a holiday display on someone's yard with a nativity scene. Someone stole the baby Jesus out of the manger, as often happens. Those baby Jesi must have a high black market value. Anyway, the family replaced the baby and it was stolen yet again. So, the family replaced the baby one more time. And yet again, it was stolen. However, this time, they found a note in its place. The note read: "IOU two baby jeez"

London calling, part two: The electric bugaloo

2006-12-19T23:02:00.000-08:00

My dilly-dallying from a few days ago about "do I keep the apartment / do I put it all in storage" has been solved, by powers beyond my control (thank you, "Dangerous Liaisons," for my all-time favorite excuse). Turns out, THEY would like me to come to London on January 8th. Okay, fine, sort of short notice, but I can do it. However, I cannot (and will not!) pack up my apartment and move it all to a storage unit in about 20 days, while working and trying to tie up every other loose end in my life. MAYBE it's possible but I sure don't wanna do it, so I'm not gonna. Anyway, tomorrow I'm going to buy a ticket to London. From there I will eventually make my way to Saudi Arabia, and I will be chillin' in the desert for a few months...maybe until May. July, at the LATEST. But it all depends. On you know, trying to live in 120 degree heat, wearing an abaya and a niqab, eating rice and lamb, all that stuff. And over the next 20 days, I must buy an airline ticket (yes, I will be reimbursed!), a laptop, new clothes (on the more modest side), cancel my utilities, change my address (to where?! I don't know yet...), make copies of my passport, organize and file my papers, visit my doctor, load up on my prescriptions, buy oodles of dog food...sheesh, there's way more stuff. Oh yeah, tell my boss I'm leaving. That's a biggie. On top of all that stuff, say good-bye to my family and friends and my wee precious niece and my dogs and try really hard not to cry every minute of the day because it would really hinder my plans of getting all this stuff done. Each time I picture saying goodbye to the dogs, I well up. I'm going to be a mess.

The weirdest? Thinking that I won't be wearing pants or driving a car for so long. I have so much more to say about this bizarre adventure I'm about to embark on...I think in the near future I will start another blog devoted to it...and I think I will call it Arabian Nightshifts.

Now, back to knitting tiny things. Distraction is a wonderful stress reliever.

A very Buttons holiday

2006-12-18T22:59:00.000-08:00

Greetings from my favorite holiday getaway, Bellingham! Since my actual xmas weekend will consist of 60 hours of taking care of sickies, I'm spending a few days up here with my wee family. Not wee as in Roloff wee (dude, I love those guys!), but wee as in just me, mum, and dad. Well, and three small dogs. But anyway. So far it's been lovely, and we are "celebrating" in true Buttons family fashion. There is a wee tree, Norfolk pine, with a few wee gifts underneath. Our holiday meal tonight was Japanese, following by a driving Tour of Lights with appropriate "ooohs" and "ahhhhs" and lots of excitement over the dancing Santa. The slowly moving electric light-up reindeer, also appropriately creepy for the holidays, were our second favorites. Then we all curled up under blankets with a couch and a dog apiece, and watched Sense and Sensibility while mum did her crossword, I knit, and dad read the latest New Yorker. With our cups of tea and biscuits, of course. Tomorrow perhaps we will open some gifts and then head off to a matinee. Ahh, good times.

I promise to show you photos of this years' woolie gifts and the warm and toasty recipients, as soon as pressies are opened tomorrow!

Blow me away

2006-12-15T19:40:00.000-08:00

So last night it was a bit windy here in Seattle. If you were actually in the Puget Sound area last night, you'll know that statement is the understatement of the year. I was having trouble sleeping anyway, probably because a.) it was night time, and I'm noctornal, and b.) my afternoon nap was too late in the afternoon. For some reason, the wind was way noisier in my bedroom than the living room, so I ended up on the couch with the doggies, sort of half-sleeping, and developing a headache. So I called in sick for my shift today and went back to sleep until 10am. When I re-awoke then, I was dismayed to find my cable TV and internet were down, although I fortunately did have electricity, which is apparently more than a lot of Seattle could claim. I spent a very lonely and quiet day watching movies and reading and knitting. To be completely honest, it's fairly close to how I usually spend my days off, except for the fact that since I couldn't watch cable TV or check my email or pretend to shop online, I was itching with boredom. But now the cable is back, and lo, there is nothing on worth watching. And no emails of any interest, and surfing the internet sounds boring. I'm such a brat.

I have a bit of a housing dilemma. I have to move out of my place when I go...well, over there. So naturally I'll have to give up the apartment, although I adore it, and it's perfect for me and my wienie kids, and I don't want to rent anywhere else. I have to move all my stuff into storage, then when I get back, I have to stay with my parents or friends until I a.) buy a house and move into it, or b.) find an apartment and move my stuff into it only to re-move again in a few months when I finally buy a house. This plan sort of sounds reasonable on first glance. But it is complicated by two very important points: I hate moving. I hate packing, cleaning, moving, everything. I don't so much hate the unpacking part of it but that's not really the point. And in this plan, I have to move twice. Maybe three times. And secondly, I can't stand living with other people. No matter who they are, I hate sharing my space. I wish I could just return from...over there and go house shopping, pick a place I like, and move into it, all within a week. The only other alternative to this plan is to keep my apartment, keep paying rent on it and not move my stuff out, and it will be here, waiting for me when I get back, then when I find a place to buy, I'll move then. Unfortunately, that lovely plan is a bit more expensive than renting a storage locker and sucking it up living with friends or family. Ugh. Did I mention how much I cringe at the thought of having to put on pants to go to the bathroom? Or not being able to watch what I want on TV all the time? I know, I'm a brat.

What I learned today

2006-12-11T19:27:00.000-08:00

1. Baby-sitters are allowed to break some rules. Despite what so-called child-rearing experts say about making the baby fall asleep on their own in their little cribs, sometimes a sleepy warm baby on your chest is enough to make you fall asleep yourself, and share a lovely nap with the baby. I had the best of intentions of getting up to put the blinky-eye-rubby baby into her crib to sleep, but well....

2. Saudi Arabia is a particularly frightening, corrupt, and fundamentalist part of the world.

3. Headache pills are worth more than their weight in gold, not only to me. When I opened my new box of pills and found only half the amount that was supposed to be there, I cried. A lot. Then cried some more because I was so befuddled by my own crying over headache pills. And then I cried some more because I was so sad that the difference between having headache pills and not having headache pills makes such a huge difference to my quality of life. As in, a life that I would like to have apart from laying prostrate on the couch in the dark trying not to breathe too hard because even breathing hurts. So I am either taking them in my sleep or there is a stupid or corrupt pharmacist out there who has my precious pills in his pocket. I'm going to call the pharmacy tomorrow to talk to a manager but I'm not sure I'll be able to do it without crying.

4. Using the deposit function on an ATM machine delays the posting of your check to your account by several precious days, causing annoying "insufficient funds" charges to be posted to your account in the meantime. Next time, walk inside the bank.

Urgh. I'm hungry. And I'm really freakin' sick of having a headache.

Back and forth and back again....

2006-12-09T19:17:00.000-08:00

The past week I haven't really been able to see straight since when I close my eyes all I see are lists of pros and cons scrolling past. It is, of course, the age-old classic question: Should I stay or should I go? More exactly, should I stay here and continue along in my fairly comfortable if vaguely unexciting life, OR should I take off for three-ish months (depending on whether you use the lunar or the julian calendar), live on the Red Sea in Saudi Arabia working as a private nurse for a foreign dignitary? Complicating the matter are the issues that I've just started a new job which I love, I would have to give up my apartment and find someone to take care of my dogs, but I would be making nearly a year's salary in those three months time. Then throw into the mix other random worries which creep into my mind...how will I get my prescription headache medicine? Will I have to eat lamb? Am I really okay with the government keeping my passport and visa while I am there, having to where a niqaab and abaya, and not laughing in public? My boss turned out to be super supportive, and said that I should go, and I'd always have a job here when I got back. Phew. My friend S offered to take care of my doggies for me, and nobody except me loves them as much as her, so double phew. My friend J offered to help me sit down and literally make lists of lists in order to prepare to go, so phew again. Then my family said uh-uh. Don't go. And other assorted things related to public beheadings and misogynistic theocracies. *screeeech.* (those are the brakes.) My family has never ever asked me NOT to do something. Well, not since I was four and I was told never to cut the cat's whiskers off again. But they've otherwise been very supportive of everything that I wanted to do, whether or not they truly agreed with me, they stood behind me. So now I'm all a-fluster and rattled again.

I'll admit, the money, whether it be blood/oil money or not, is really tempting. The carrot dangling in front of my face, promising paid-off credit cards, student loans gone, a down-payment on my very own house, a pony, is almost more than I can resist. Then there's just the whole experience of it all, the opportunity to see a part of the world and a culture that I would never otherwise be able to.

I need more headache medicine, these lists are making my head hurt.

Bah humbug

2006-12-05T13:58:00.000-08:00

Nothing like trying to do some routine errands on an otherwise uneventful random Tuesday afternoon in December to bring out my holiday spirit. However, in my case, "holiday spirit" refers to growing amounts of frustration and increasing periods of shouting at other drivers, giving people the finger, and loudly reminding people in the post office that the line started back there and they just cut in front of me. Yes, I'm that person, the person who hates the Blue Angels, and grumbles throughout the holiday season. I'm the big wet blanket, the wet weekend in Bournemouth, whichever expression you choose. Because you should have been telling those people who you are buying unnecessary, overpriced, underused gifts for that you think they're swell throughout the year, but you waited until December because Hallmark and the Temples of Consumer Greed (i.e. malls) tell you to.

Anyway, I'm a scosh on the crabby side today, something that I hope a jacket potato with tuna and corn, a movie about crossword puzzles, and some knitting will sort out. I think I'm just a bit down over the death of Elizabeth I. Okay, so I know it was in 1603, but I just watched Helen Mirren's portrayal of it last night, and it was terribly moving and well-done, so I'm just a bit down.

And also, nothing like some holiday traffic and stupid drivers to make me feel like throwing on an abaya and checking out of Western society for several months. Did I mention my latest job opportunity? I'm sort of keeping it mum until things become more certain, but I'm sure I'm already at the top of several government lists for my recent google searches alone. Stay tuned.

Proof of snow

2006-11-30T16:59:00.000-08:00

This was the view from my parent's living room window in Bellingham, as it dawned on me that I would not be driving back to Seattle that day. I did eventually make it home, obviously, after knitting several more hats and hot water bottle cozies.

I worked two days of 'per diem' at my old job this week. The first day wasn't too bad, just had one intubated patient, fairly smooth going. The second day sucked ass, and the unit was crazy as well, but I was kind of glad. It was a nice reminder as to why I left, and that I made the right decision for myself. And so as to not interrupt my two-year stretch of not letting my patients die on my shift, I left at 3:30 when my shift ended although the patient's withdrawal of life support was going to start within the hour. Also, kudos to Dr W, who was the most direct that I've heard any doctor be with family on our unit. "Your wife is going to die. If we allow things to continue as they are now, she will die within the week. Probably closer to 48 hrs. Maybe sooner. Her disease has already made that decision for her. But you have the decision to make about how she will die." Sounds harsh, but he somehow conveyed the utmost compassion, empathy, and wisdom in that statement. And, cancer scores again.

Today I went into work then found out I wasn't supposed to be there. Oops. My surprise day off was lovely though, I managed a trip to Target and two naps.

Snow day

2006-11-26T13:57:00.000-08:00

So yesterday I was supposed to drive back home from Bellingham, but sometime in the afternoon it seemed like a better idea just to take a little nap on the couch and relax with my knitting for the evening and just drive home this morning. However, the snow storm that came in overnight sort of changed those plans and now I'm stuck. Funny how yesterday, I was reluctant to leave but today I'm desparate for my own house, and gray, mean rainy Seattle. I miss my dishwasher, clean clothes, and fast internet connection. The doggies are missing going outside and not being buried in snow. The "storm" isn't very bad, it's still quite warm outside, and about 6 inches have fallen so far. Nothing compared to Wisconsin standards. However, the lack of a snow plow or salt or sand trucks makes it suck a million times worse than a Wisconsin storm. Not to mention the other drivers on the road, who I won't even get started with. Let me just note however, that contrary to popular belief, "four-wheel-drive" does not actually mean, "Magic ability to drive in any weather condition without adjusting your driving." Because nursing license or not, if I see you driving like an idiot in your SUV and swerving to a stop into a telephone pole because you thought 4-wheel-drive meant "don't bother increasing your braking distance," I'm not getting out of my warm car to help you. Ok, I might get out because of ethics/shmetics, but as soon as I grab your empty head and hold your neck in traction, while I'm looking at you and assessing how much you're bleeding, I'm going to remind you that you're an awful driver and maybe next time you'll actually assess road conditions and use a little of the common sense you probably just bled out. Anyway. Maybe I'm crabby. But unless you grew up in the midwest, get your ass off the roads. Unless you are driving the ONE snow plow that Bellingham might own. I think I'm being overly optimistic on that one though. Now look, I got all worked up about other drivers.

Change of venue

2006-11-22T23:31:00.000-08:00

First of week of new job, which I guess soon will just be "job," is done. So far, it's pretty good. It's still early days, of course, but I think I will like it there.

I used to work at a place I affectionately and bitterly called the "Last Chance Motel." Because it was. People came there for the last-ditch treatment option, after failing several other treatments. They are supposedly aware of the risks of the treatment, but are willing to risk it in order to buy themselves a few months or even years of more time with their loved ones. Or they come because they just can't "give up" or they are incurably optimistic or only believe that complications and side effects happen to other people. Whatever their reasons, they showed up, bald, smiling bravely, with sad worried eyes. Anyway, I always felt a cloud of resignation hanging over my head, over everything we did. It sounds horrible, but when every one of my patients had the same outcome, regardless of what we did, how hard we fought, it's hard not to get resigned to it. When a blood culture came back positive for gram negative rods, we sighed our collective sigh, our shoulders drooped, and we reflexively ordered the appropriate antibiotics. In the back of my head I would think that I wasn't surprised, it was only a matter of time, and wondered if this would be the straw that would help our patient to the inevitable end just a little bit faster. Because it was the Last Chance Motel. We tried really hard, and we kept hoping, believing that sometime, some patient has to be the one who makes it. But really, we were waiting for the families to realize what we all already knew.

At the new job, I think I'm going to call it the Not Fair Club. Not because anyone anywhere ever deserves to get cancer or to get sick, but because kids are supposed to be playing outside and wrestling with their siblings and whining for more candy and laughing, and when you're a kid life is supposed to be simple and easy and most arguments can be countered with a big ol' "But it's not fair!" Because when you're a kid life is supposed to be fair. So lying in a hospital bed with tubes in every orifice and sutures across your belly and almost nearly dying because the tumor they just took out of you weighed almost as much as you really isn't fair. So we aren't resigned to any outcomes here, the only acceptable outcome is getting that kid out of that bed and home again so he can pull his brother's hair and smear peas on his face and make his mom laugh again. So when his blood cultures come back positive for gram negative rods our hearts drop and we stamp our feet and pout, "Damn it! It's not fair!" and we order those antibiotics and we check and double check that they are the best ones possible and we didn't miss anything.

Hrm. It's hard to talk about the old job without sounding heartless and dead inside, but I just can't really phrase it right I think.

Anyway, happy thanksgiving to those of you choosing to celebrate genocide and barbaric empiricism with gluttony and excess. Heh. I like the way that sounds. Don't worry, it's not like I would ever turn down a day off of work or a large tasty feast. I'm going to eat Greek food and see a matinee and hang out with my family in Bellingham.

Home again

2006-11-21T21:47:00.000-08:00

Yes, I'm back safe and sound. Yes, I have hundreds of photos to pick through and upload and share with you. Yes, it was totally worth it and the best trip ever and I'm so super glad that I went. Yes, I nearly stayed. It was much closer than you think. Job offers from foreign dignitaries involving obscene amounts of cash can make one seriously rethink one's career direction. I'd love to tell you more but then I'd have to kill you. Besides, negotiations are still open. Never say never, especially if you can get a pony out of the deal.

But I will tell you more about the trip. And the "real" job that I started yesterday. Once I catch up on sleep, get un-jet-lagged (I'm not really jetlagged, I don't think I actually get jet-lagged, but it's a glamorous excuse for not having cleaned my apartment, caught up on emails or the blog, and yawning a lot at work.)

In the meantime, here's a preview of trip highlights:

Day One: Land at Heathrow (early!), take the tube to the hotel where I'm staying, and notice that this is the view from my window. Spend the rest of the day exploring London via Hyde Park, Oxford Street, and end the evening with the East End and Jack the Ripper.

Day Two: Revel more in the history of London, starting with the Tower, ending somewhere around Trafalgar Square with some famous portraits in between.

Day Three: Continue meeting my old Tudor buddies, at Hampton Court, after cruising high above London to check out some awesome views.

There is much more, including a train ride to York (complete with a train station baguette and a copy of OK magazine! Anyone else get how fun that is?!), driving on the other side of the road, finding the East Coast of England, an abbey built in a triple-digit year, the most beautiful church ever, and 49 hours with one of my dearest friends. But, as I already mentioned, I'm jet lagged. So I'm off to bed. I promise, photos tomorrow.

The great outerwear crisis

2006-11-11T10:34:00.000-08:00

You guessed it, there was bowling going on last night. A fabulous birthday party for my fabulous friend, complete with cupcakes, bowling, and a Tom Collins drink special. Good times.

It was but a brief respite from the Great Outerwear Crisis (GOC) and the overall Getting Ready for London hoopla, although I am handling it fairly well. I have Outerwear #1, a black 3-in-1 parka, waterproof, rainproof, with a cozy fleece liner that I am taking. Both for dark and rainy London but moreso for the days out on the Yorkshire moors. BUT yesterday my new fabulous raincoat/trenchcoat arrived from England. Here is a photo that looks uncannily just like me modeling it:

I know I know, the resemblace is creepy. But I digress. So this coat, Outerwear #2, is waterproof but, in spite of the removable quilted liner, not quite as warm at Outerwear #1. However, it is infinitely more stylish and just plain CUTER and this is LONDON folks. Park Lane, to be exact. And now I am thinking that the a good compromise would a wool peacoat...and the awareness of the Nordstrom Half-Yearly sale in the back of my mind...

So now I must go back to more immediate concerns, since I leave TOMORROW (can I put any more words in CAPS in this post?!) such as cleaning the house (hate coming home to a week-old mess! Plus, it's just sort of polite for the person who has to stay here with the wee doggies), packing (bringing us right back to the GOC!), and possibly finding time to go to Nordstrom. Oh! And finalizing my itinerary. So far, here's the plan:

Monday: Arrive in London. Ignore fatigue and jetlag. Breakfast with my friends, walk across Hyde Park to the Victoria and Albert Museum.

Tuesday: Train to Hampton Court. Tate Britain in late afternoon, if time? Jack the Ripper tour at night.

Wednesday: Tower of London in the morning, National Gallery and Portrait Gallery in afternoon. V & A is open late that night in case I didn't make it on Monday.

Thursday: Walk across St James Park, Cabinet War Rooms, take a picture of 10 Downing Street? Train to York in afternoon. Pick up rental car, meet E, eat takeaway and stay up till all hours giggling over Dawson's Creek.

Friday: Tour the Yorkshire moors, including Robin Hood's Bay, Rievaulx Abbey, and Whitby. Maybe ghost walk at night?

Saturday: Depending on the weather, drive up to Alnwick and maybe even Bamburgh. OR bop around York, the minster, the York wheel, yarn shops, the ghost walk.

Sunday: Get up wayyyy to early, drive down to London Heathrow, catch my flight home. Cry a bit.

There, sounds doable doesn't it? Your suggestions, either for solving the GOC or for the intinerary, are welcome. Get ready for many many many photos upon my return!!

London calling

2006-11-07T13:14:00.000-08:00

Tonight is my last real shift on my unit. I'm pretty much in some kind of denial over it, since I've signed on to work there per diem (filling in for a minimum of a shift per month) so I keep telling myself that I'll be back, it won't be that different. But of course it will: I won't be spending around 40 hours per week there, with the same people, doing the same things, anymore. I will miss everyone but I'm hoping that the people I will truly miss are the people I see outside of work anyway, so we will just make more concerted efforts to make plans and see each other. I will miss our patients and their families, but I will meet new ones. Mostly I'm sure I will miss it the most once I start at the new place...I will miss the sense of familiarity with a place, the consistency, the comfort. But familiarity, consistency, and comfort are also words for complacency and boredom, so I still know that I am doing the right thing.

And I'm a bit distracted anyway....did I mention that I'm going to London on Sunday?! Yes, this Sunday!! I'm so so so so excited. I'm bursting. Simply bursting. I'm picturing myself on a big jumbo jet taking off over across the pond with my iPod (eek! Must update the iPod!) on and my knitting in my lap (eek! Which project shall I bring with me? Are knitting needles okay on the plane?! What IS okay to bring on the plane!?) and an Elizabeth George mystery, or perhaps a book on the War of the Roses, on my lap and my bucky pillow around my neck and I get all smily and fluttery and happy. My Must-See in London List keeps growing, but the Tate Modern, the V & A, the Tate Britain (and the Tate-toTate Ferry! Do you love that?!) top it, the Tower of London is of course a MUST, I'd like to get on the London Eye if I can, walk through Hampstead Heath and Hyde Park, down Oxford Street....oh! And there's an entire museum about Florence Nightingale!! Oh! And the National Gallery and National Portrait Gallery. And must consider if I can make it to Hampstead Court as well. Eek. After three days in London, I'll head up to York to see the fabulous E, where we'll rent some mini-micro-impossibly-wee car and toodle about the Yorkshire moors and hopefully even Northumberland, stopping only for sheep crossings and to eat cheese sarnies and drink tea and poke about in castles (Bolton Castle, Castle Howard, and Alnwick top that list) and ramble down narrow cobblestoned streets (Durham, Whitby and Richmond top that list) and take countless photos. However, lists aside, if nothing at all gets done off the lists but I simply spend six days sitting in pubs, drinking cider and sometimes a Guiness with black currant, eating pub food and reading the Guardian, it will all be okay. It will be wonderful. I only lived in England for six months (ten years ago!) and have only been back twice to visit since then, yet all this planning and anticipation still feels like a homecoming...instead of saying "I'm going to England," I keep feeling, "I'm going back to England."

Small things

2006-11-04T17:02:00.000-08:00

Last night, I arrived at work and chatted for a bit with the day shift RN about my orange hat (which she recognized from the Stitch N Bitch book!) and glimpsed my patient's wife and daughter in his room. I didn't get a chance to say hello, but thought I'd see them once my shift started. When I came back for report, the day nurse told me they had gone home. "Once they found out you were his nurse again, they felt comfortable enough to leave and get some sleep tonight," she said. Aw. Jeez.

Later, Dr. McAwesome put an arterial line into my patient (a beautiful one! A work of art! Pardon the really really bad pun). He joked that the patient didn't really need one but he was looking for an excuse to spend more time with me on our last night together. Then he stopped by in a bit to check on things. "Everything ok, Rose?"
"Yep, he's fine, the line works great, his pressure is normal," I said.
"No, with you, how are YOU?" he joked.
"Oh, I'm great. A bit hungry, I would love a sandwich, but overall, I'm feeling great!"
He laughed and continued on down the hall.

A bit later, a huge tray of sandwiches appeared in our break room. Dr. McAwesome truly lives up to his name.

Early in the morning, Charge Nurse, Nurse J, and I were chatting about the frustrating inability of certain medical teams to make decisions. "Seriously, they need to shit or get off the pot," I added. Suddenly J looked alarmed and jumped up. "That reminds me, I left my patient on the bedpan!" and she darted down the hall.

Ok, this was valuable time I could have spent eating Easy Mac, yet I chose to share those little pearls from my night with you. Aww.

Gotta run. Hope no one floats aware in this flooding rain. But seriously, in the rain's defence, at least this is hard-core, sheets of rain, lakes of water kind of rain. None of that pissy spitty rain we usually get. Bring it.

Just playing around

2006-11-03T16:59:00.000-08:00

I've updated my avatar, to the left, to show me at work. Yup, there's Nurse Rose, diligently taking care of her critically ill patient, wondering if anyone else has noticed that gorilla in the room named Death.

I'll probably change it tomorrow because that's kind of grim and macabre, even for me. But some days, like the gray days that it rains nonstop and I've only had 24 hours off to recover from work but must go back tonight, those days it's hard to find a lighter side.

Three nights left!

All in a day's....

2006-10-28T00:33:00.000-07:00

Today started out not to good but at least it ended well...

I woke up around 9 with a horrible migraine, after dreaming that I was having a headache for probably a few hours. So I took my magic little pill, which chased away the headache but left me sleepy and drugged when I finally woke up around noon. I spent the next few hours on the phone with credit union people and bill people, getting increasingly frustrating answers and no helpful information. I battled homecoming traffic to the hospital to have my TB test read (good news: I don't have TB!) then I battled Friday afternoon grocery store moms (but found a sale on diet Coke!) then battled more homecoming traffic back home. By then I was so hungry, frustrated, and annoyed, that I took a nap. I'm a good napper.

But then I woke up, showered, and went to go hear Bill Bryson talk. And he was funny and amusing and I'm so glad I went. Then I met a fellow, J, for a drink on Capitol Hill. He turned out to be a red-headed Jewish PhD candidate from Pittsburgh. He was taller than me and didn't have girly hands. He was funny in that self-deprecating academic way that only Jews and academics can be. In case you don't me at all, those are all very very good things, on my list of "People I want to spend time with."

So, I am now a happier girl than when I woke up. I am going to knit, watch Big Love, then read another chapter in the Biography of Elizabeth. Ahhh, life is good. Well, it's not so bad.

Things that are sweet

2006-10-28T00:23:00.000-07:00

IMG_1245
Originally uploaded by rosebuttons.

Although of course this entire little baby is the sweetest, cutest thing, and there isn't anything about her that isn't adorable, I love this photo because it highlights that perfect smooshable cheek, that tiny kissable ear, and those wee little fingers....my favorite bits.

outdated!

2006-10-27T00:19:00.000-07:00

That's me, I'm out-dated. I've dated too much this week. Ugh. I don't even have the energy to update you on each of the fellows...I used it all up straightening my hair and smiling a lot. Tonight I took the night off to knit and watch Big Love and eat gnocchi in vodka sauce and of course I drank some more Argentinian wine. I have a magnet on my fridge that says, "Sorry I can't go on a date with you, I need to stay home and knit." Oh, so true.

Is it true that Lexus makes a car that can parallel park itself? Because I saw it on a commercial, so it has to be true. And I am truly disgusted. Us true parallel parkers (doing it the old-fashioned way, with my hands on the steering wheel...I know, CRAZY!) must refuse to be replace by a machine. Parallel parking is a skill, a true art-form if you will. And I will. Yep, in two moves, that's right, and I'm proud of my skills. So I thumb my nose at you, Lexus, and you lazy Lexus-drivers. If you can't parallel park your own car, then a.) Stay off the road, Soccer Mom, or b.) Find yourself a cozy little parking garage and pull that sucker in head first. Ugh. I hope your parallel-parking computer in your fancy-ass Lexus breaks and there you will be, double-parked, wondering why everyone who actually knows how to drive also knows how to use their horn. Does the Lexus beep at other drivers for you too, when they cut you off? Then make you a latte? Can you hear that noise? Listen closely. That's me gagging. On your Lexus exhaust.

Size matters

2006-10-20T06:05:00.000-07:00

It's no secret that I love tiny things, miniature things, diminuitive things....you get the picture. And it's probably no secret that I love England, Great Britain, London, all things from the UK.... so it follows (I loved doing corrollaries in geometry) that I LOVE this. Love it.

You just keep me hangin' on...

2006-10-19T23:31:00.000-07:00

Mr. F passed away yesterday. He had a soft-tissue infection just over his left hip bone, the result of an infected bone marrow biopsy site. After a couple of I & Ds in the OR and many many surgeons poking, debriding, cauterizing, stitching...and many many RNs packing, re-dressing, lavaging, infusing platelets, cursing surgeons...anyway, the infection was about the size of a melon. Well, the amount of flesh missing was would have been the size of a melon. It was horrible but fascinating. Poor fellow.

Anyway, the topic of this post was my musing that despite the fact that about 95% of my patients die within a few weeks of their time with me, and although I've been an RN for nearly two years, and although I've wrapped countless post-mortem bodies and handed countless boxes of tissue to family members and silently hugged grieving spouses/children/siblings/friends, never has MY patient expired on MY shift. Ok, wait, one did...a young women who we withdrew care on during my orientation in the ICU. They always wait till I go home...at least a few hours, sometimes a whole shift, then they go. Weird.

Tomorrow I'm off to my favorite little city, Portland. I've got some new CDs for the car ride (the new Beck and Portland's own, The Decemberists), a list of "needs" from Powell's, and my fleece. Really, I don't need anything more.

Of course I will miss this little face:

But he will be in good hands, getting lots of little doggie snacks and belly rubs and play time with his stinky duck. Now, I must be off to bed, I have to get through my biography of Elizabeth I before I move onto the story of Mary Stuart and the "mysterious" murder of her asshole husband, Lord Darnley. This stuff is better than soap operas!

Oh, no word from my new boss on the possibility of changing my start date. Looks like Europe may have to wait....

So sorry!

2006-10-17T16:49:00.000-07:00

Have you missed me? I am a horribly neglectful bloggie friend.

First, it's official, I've given notice at Old Job and accepted New Job. So good-bye oncology ICU, hello pediatric ICU! I'm so super excited and scared to death and a bit sad and a lot nervous. But overall, it feels like the right thing and the right time to be doing this.

I have ten shifts left at Old Job, and suddenly last night decided it might be nice to hop over to Europe in between jobs, to treat myself and rest and rejuvenate my spirit, etc. So I'm attempting to get my start date moved back by a week, which would give me 12 days off. I'm leaning towards a brief but juicy tour of Budapest and Prague, although Amsterdam and Paris is a close second. But I've always wanted to go to Glasgow and tour the art and architecture of Charles Rennie Mackintosh. Plus the Scots are just awesome people. Then there's always the idea of just flying into London or Manchester, renting a car, and spending a week touring cold drafty castles during the day and sitting in warm toasty pubs with E at night, eating a lot of fish and chips and laughing our arses off at Dawson's Creek. Any ideas/suggestions? Of course this is all dependent on getting my start date moved and scraping together a small pile of cash...

Boys and dates in general, super lame. I'm tired of all the weirdos. And metrosexuals? You all need your own dating website. Or least you must identify yourself as such on your profiles. Because nothing makes me want to flee the restaurant faster then seeing you and the hair-with-product in it and your casual-yet-expensive jacket and your twitchy too-small hands. Somehow, not attractive. Give me mismatched flannel and endearingly out of place hair, along with big man hands, any day.

Change of Shift

2006-10-05T17:04:00.000-07:00

It's up, it's official, the new Change of Shift over at Emergiblog. Head on over to read bits and bobs from the inner workings of nurse's minds, it's not for the faint of heart, but it is truly engrossing :) And of course, there's a little something from yours truly...

OH! I got to go to the morgue last night! These next 16 shifts will be filled with "I've always wanted to...". When the guy (totally blanking on his job title) came to pick up the body in room 34 (who was also a daddy, a son, a husband, a victim of a horrible disease, but mostly a really awesome guy, but I'm sure HIPAA prefers I just call him the body...) I helped him roll the black-shrouded 'mystery' cart downstairs. Then I helped him attach chains to sling under the white-plastic zipped up body-shaped parcel, attach the chains to the hydradaulic lift, raise the body off the cart, drop it down onto another stainless steel 'stretcher' and roll on into the refridgerated compartment. He then slammed the door shut, taped a stamped name-sticker to the door, and that was that. Full circle.

randomity

2006-09-30T12:03:00.000-07:00

That's my new made up word.

Last week I went out with J, a night nurse, and we apparently had a wonderful time. We had Vietnamese food, then continued on for coffee and cheesecake, then even walked in the park a bit. We stayed up until 1:00am, and the next day I was all happy and giddy and couldn't wait to see him again. Three days pass, and now I no longer want to see him again. We exchanged a few emails, the usual, "I had a great time, hope we can do it again." So that's not the problem. I have no idea what happened inside my head, except that the happy giddy feeling has been replaced and now I just feel weird about him, not entirely comfortable, and am remembering the not-so-good things rather than the "aww" things about the date. Nothing in particular was "not-so-good," so I'm having a really hard time explaining this. Except that now it's bothering me that he never asked the names of my dogs, and I think he was kind of pushy and cocky. Last night he called a couple of times, but didn't leave a message. In case I haven't mentioned this before, I'm really big on a few little things, like phone etiquette. Like, I obviously KNOW that you called (twice!) so a normal, polite thing to do would be to leave a simple message and I will call you back when I can. Do you think that if you call more than once, I will eventually be fooled into wondering what that funny beepy sound is, coming from this small piece of gray plastic, and press the start button?! Anyway, I'm confused by myself on this one. I just don't want to see him again. So there.

Last night little Ted was very ill, it was very heartbreaking. The vomiting and diarrhea are no fun of course, but it's even sadder to see him so lethargic and depressed. I ordered a pizza, and he slept in the other room the whole time I was eating! He was too sickies to even scratch his butt. This morning he seemed a bit peppier, although rather annoyed that all he got for breakfast was rice. I may go get him some boiled chicken (can I buy it pre-boiled? I don't want to touch it raw. And how does one boil chicken? Should I just cut it up, then throw it into boiling water?!) and cottage cheese for his dinner, maybe that will be more appetizing while remaining bland enough for his upset tummy. I also want to give him pedialyte for dehydration and metronidazole for a tummy bug and draw his electrolytes, but I must just be a doggy-mom first and a nurse second. Sigh.

In exciting news, this week I discovered these. Go look! NOW! And now I must look to my left in order to see myself, because I am absolutely BESIDE MYSELF in the cuteness that these things are. Can you even STAND it?! Can you IMAGINE the lambs?! ARGH! So I am well chuffed (and British, for a moment, apparently) that my dream farm, of miniature animals, will truly be complete. The pygmy goats, mini horses, and wee piggies will be pleased to have some wooly friends.

I have a job interview this week (shhhhh). I am super excited and nervous, not so much over the interview itself, but that if I get this new job, of the transition I will have to make. And it's a strange thing to reconcile in my mind, because I love my current job. I love the unit, and my co-workers, and my patients and their families. I love the work we do, the teaching and research environment, the support of the whole medical team, and the sunrises. But I don't love the medically futile things that we do, when I stop doing things FOR the patient and do things TO him, when people aren't afforded the dignity of dying peacefully and when they are ready. I don't love taking care of someone for weeks and weeks and always losing them in the end. I feel like a weenie because there are many wonderful nurses in our ICU who have been doing this for years and continue to do this, and I wonder what they're made of that I'm missing, because I can't do it anymore. But I also became a nurse there, I started as a wee nurse technician, only two quarters into nursing school, scared of someone else's vomit and fumbling my way around a glucometer, and I grew up into an emesis-bucket holding IV-starting ICU nurse. And now I guess I just want to see what else is out there.

Dating updating!

2006-09-24T22:05:00.000-07:00

Gosh, I've been neglectful...are you all gasping for details on my coffee date with R?! Probably not, but you get them anyway. No juicy details to impart, but I will say that I was pleasantly surprised (comment from J: "Why are you always so surprised when a date goes well? Are you expectations that low?!") Uhm, I guess they are. But seriously, considering my past history, I think I'm still entitled to be surprised when someone shows up in clean, unripped clothing and buys me a cup of coffee. Anyway, R was pretty cute, funny, and smart. And also had a sweet sensitive side, since he wants to be a writer and loves reading. Aww. We even made plans to try to get together soon for dinner, so he's either a good liar and says that to all his dates or he actually maybe liked me a little, at least enough to want to see me again.

Tonight I went out to sushi with C, who I almost didn't go out with because he works in sales and lives on the east side and tried to get me to come over there for dinner. BUT I held out, convinced him to come to this side of the water, and gave him a chance. It was a not-unpleasant evening, but nothing memorable.

Tomorrow may be dinner or drinks with J, who happens to be a night shift nurse. Maybe we'll stay up all night trading stories about mucous plugs or nectrotizing fasciitis. I can't wait!

Oh, when I got home from sushi with C, I went to go comb my hair and a live spider fell out of it. Heh. If C doesn't call again, I guess I know why!

Also, I'm contemplating changing hospitals and units. Not that I don't love my unit and my coworkers and patients, but my interest has been sparked in something else. And I feel like I need to move on before I completely burn out, at least emotionally. My SuperNurse facade may be fooling you (and me) but in reality each of these patients and family members who get to me, then leave me, take a little bit of me with them. I don't want to give away any more information about my future plans until they're more concrete, but I'm already re-reading chapters in my nursing texts and checking the mileage from my house to New Hospital, so maybe I'm really ready. Stay tuned...

Smitten

2006-09-22T22:44:00.000-07:00

IMG_1117
Originally uploaded by rosebuttons.

Who doesn't love Jon Stewart? Not this little girl! Only three months old, and already showing good taste. She's hoping that his sons are available when she turns 40, and is ready to start dating.

Death of a squirrel

2006-09-22T22:20:00.000-07:00

This is the story of a hapless wee squirrel. A stuffed wee squirrel, bought for Ted while on vacation down AT the shore (the AT in that phrase carries a significance only you right coasters will understand), in an attempt to provide him with one more toy than the single stinky duck that he singularly loves. So, once Tessa fell asleep on the couch (I didn't actually have to wait very long for this to happen) I brought out the squirrel and presented it to Ted. Tessa just KNEW something was up, and the rest is history.

What do you have there? A new creature? A squeaky creature? I'll have that, thankyouverymuch. I must make sure it's dead.

Hey! She took my squ-- Hm, my butt itches.

I will soon rid the house of the squeaking creature! Resistance is futile.

Sigh. When are the snacks?

Don't worry. Ted may look quite pitiful in that last picture but I assure you that he got over the theft of his squirrel within three seconds and is much happier scratching his butt and looking for snacks than de-squeakifying small woodland creatures. He leaves that to Tessa. And yes, the fun never does end around here.

Rest now, my friend

2006-09-22T21:56:00.000-07:00

He was 55 years old, I'll call him Sam. He'd once said that he was afraid of dying because "there will be a lot of empty pages in my book." I'd taken care of him nearly all of my shifts for the past six weeks, throughout his stay in the ICU. For the first few weeks, he was intubated and sedated. His son and daughter told me that he was slightly hard of hearing, but would prefer to have the television on in the background. The Learning Channel or Discovery, if possible. So all night long, I kept the channel on one of those, switching only to avoid infomercials. In the quiet of the beeping pumps and whooshing ventilator, I would fill the silence by talking to him about what was on TV as I drew his blood, changed his dressings, gave him his bath. Together we learned about the black plague and Emperor Caligula. Some nights were rougher than others...but we got through cold sepsis and some other hypotensive crises and looked like maybe we'd made it through the weeds. Weeks passed and eventually he was extubated (breathing tube was removed). He was slow to wake up, but each day became a bit more interactive. He could indicate if he had pain or not, nod and smile, he even had the good grace to smirk at my bad jokes. My nurse friend, J, and I got him onto the cardiac chair and wheeled him around the unit as the sun rose, to say hello to everyone and check out the views. He smiled more, and preferred to sit in front of the window when possible. He couldn't speak very well yet, but I got pretty good at carrying on a conversation with him my interpreting his nods, smiles, shoulder shrugs, and eyebrow lifts. I remember the morning we watched the rain come down, and lamented that somehow, we'd missed the end of summer.

One night I came on shift to find that he'd been reintubated two days before, and was worsening overall. Liver failure, possible GI bleed, counts dropping, unknown infection. The next night, he had a little blue sticker next to his name card on the door: Do Not Rescusitate. I continued to administer his medications, check his blood sugars, draw his labs, record urine output, turn him side to side, keep his mouth and eyes clean. I watched as his blood pressure dropped lower and lower. I called his daughter, who came in at 4am to spend the night. I said goodbye at the end of my shift, knowing it was the last time I'd see him. But in my mind, the last time I really saw him was the morning we'd watched the rain come down, and lamented that we'd missed the end of summer.

Those pages in your book, Sam? They're not empty.

So I am sad now. The same small sadness that I don't feel quite entitled to, since I know his children and his family are truly grieving, and compared to them, I barely knew him. It doesn't get any easier, because now when I feel sad, it just adds on to the sadness that I had for Billy, and for W., and the guy with my dog's name, and and and...

It was inevitable...

2006-09-16T21:17:00.000-07:00

There they are, the Wiener Twins. It was about time, really. I've had at least one dachshund for over ten years now, and the hot dog costumes were bound to happen eventually. And they are worth it. There you have it.

Update on Love and Other Catastrophes: Mr.Lovesmelovesmenot finally fades completely into the background, after a performance of asshole proportions, impressive even by his own previously-set asshole standards. I think I still hear the fire trucks, something about some bridges burning. Ah well. So, my tears are wiped, the drinks are drunk, and I'm moving on. I'm jumping right back onto that dating train, if only for a bit of distraction and a reminder that maybe there are decent guys out there, ones who will pay for dinner, tell you that you look nice, and call when they say they will. I am meeting Bachelor # 1, R*, tomorrow for coffee. He told me a funny story about something he heard on NPR in an email, so I guess I'm a sucker for NPR-quoting microserfs. Stay tuned!

I have no good stories involving blood, mucous, or toenails, as I haven't worked in nearly ten days. Ahhhhhhhhhhh.

Here are some of my favorite things: Malbec, Dreyer's fat-free vanilla frozen yogurt, and sour gummi worms. Not all together, silly. That would be gross. Now, if you'll excuse me, I have big plans to cuddle with my little doggies, sip my wine, and watch Nip/Tuck.

Big walkies!

2006-09-09T21:07:00.000-07:00

Today was the big 5K PAWS walk at Magnuson Park. Despite the typical Seattle September weather, we were there, along with over 1000 other Seattle doggies.

We signed in, then got the doggies properly attired in their stylish PAWS bandanas. Unfortunately they did not have Weenie Size and Tessa occasionally got her paw stuck in hers, and Ted's dragged through a few puddles.

While we were waiting for the walk to start, Ted wandered off and we had to convince him that he was not part of Team Terrier.

Then, we were off! Following the signs...

And five kilometers and two very wet bellies later, we were done, to much applause. Which the Wonder Weenies took in stride of course, because really, why shouldn't there be much applause for them all the time?

You know you're a dog person when...

2006-09-08T20:11:00.000-07:00

This week in the ICU... two other nurses and I were just finishing bathing a patient, and stuffing pillows into pillow cases. K comments, "It was time that toenail came off anyway. I mean, did you see the tissue around it? It's necrotic. That nail was..." she glances at the sedated pt, then back at us, "that nail was D-E-A-D."

Me: "You're right, the nailbed isn't even bleeding. It's a good thing we removed it -- " then J cuts me off, "What?! Just because she's sedated and intubated she can't spell?" and suddenly K and I realize what she had just done, and bust up laughing.

Also, on a related note, we've discovered what really makes seasoned ICU nurses squirm. Nurses who have suctioned rivers of poo, poked and prodded open, oozing wounds, had skin blisters pop all over them, dealt with tenacious mucous plugs...show them a toenail which has fallen off, and they get a little weak at the knees. A whole toenail.

Well, tomorrow is the big PAWS walk! The dogs are currently resting up, after carbo-loaded and stretching. Okay, so they'd be 'resting up' anyway, but you get the picture.

Walking for Wildlife!

2006-09-06T10:54:00.000-07:00

Me and my chubby couch potatoes are going to get off our butts on Saturday and do the PAWS Walk! It will be a challenge...for me, because I have to be awake around 8:00am, and for them, because, well, they're looking a little sausage-like lately. BUT it's only 5K, and I'm fairly confident we can all do it. Will try to get some cute pics but in the mass doggy confusion it might be hard! Anyway, if you're at all inclined, head over to my webpage to learn more about it, and what PAWS does in our community. And of course donations are greatly appreciated, you will get wet doggy kisses via email :)

In other news, I'm leaving town next week! Well, only for one night. But sometimes, that's all you need. Me and the my fearless travelling companions, the Wonder Weenies, and S, are all heading south to the ocean. We will learn about fruit that grows in bogs, eat pizza, run (two-legged creatures will be walking) on the beach, take lotsa photos, and enjoy our peaceful cabin in the woods. Ah. It will be lovely.

And now, your Ted for Today:

Today's Ted

2006-09-04T13:16:00.000-07:00

Too-close shot of little Ted's head, just because. I think everyone needs a daily dose of Ted, so here is yours.

And now I am going to make a little pizza with little mozzerrella balls, because it's a little kind of day. I'm also going to clean the bathroom later. Maybe a little.

Hello? Reality calling. Please pick up line 6.

2006-09-03T20:46:00.000-07:00

I am a terrible terrible person but I spend much of time of at work feeling quite frustrated by family members of my patients. Okay, that's an exagerration, it's not that much time. But proportionately, the amount of frustration I feel towards them is much more than I should (like never) since their loved ones are super sick, dying, in pain, all of the above.

So last night my fellow RN/friend fielded an early-morning phone call from a family member, and from listening to her end of the twenty-minute phone call, and watching the expressions on her face, I knew it was the exact type of phone call we've both taken many many times before. A concerned family member/friend calls, in our night-shifty case, early in the morning, and wants to be updated on their friend's condition. And here is where the Great Divide in understanding and information begins, from health care provider to family member.

ConcernedFamilyMember ["Connie"]: So, how is my sister? ["Susie"]? Any changes over night?

Nurse: (after verifying through several means and fingerprints and a hair sample that this person is who she says is and can be privy to Susie's super-secret-private health care information). She's doing okay, there were no major changes to her condition over night.

Connie: Oh good, so she's doing better then?

Nurse: Well, she's staying about the same. But she didn't make any changes for the worse, so that's a good thing.

Connie: Well that's good! Is she awake?

Nurse: Not exactly. She's on a lot of sedation and pain medication right now.

Connie: Oh. But shouldn't we wake her up? Is it bad that she's so sedated?

Nurse: No, it's actually a good thing. If her sedation levels are decreased, she tries to pull out her breathing tube and she grimaces like she's in pain, so we're trying to keep her very comfortable.

Connie: Well, if she's more awake, maybe she'll breath better on her own? And come out of the ICU sooner?
Here's where Nurse quietly takes a deep breath, closes her eyes, and starts to continue this conversation privately in her head, not saying what she actually wants to...

Nurse: No, she's not ready to breathe on her own yet, we do breathing trials everyday to determine that. But thanks for your opinion, even though you are not a medical professional, we really need people like you to do our jobs because otherwise we never would have considering your very educated point. Where do you work? Can I come and watch you, and tell you how I think you should do your job? I bet I don't need any special training either.

Connie: So how much longer then? A few days? A week?

Nurse: There's no way to say that at this point, as she's still dependent on dialysis since her kidneys aren't working yet, and she's on several heart and blood pressure medications...

Connie: Are those medications something she'll be able to take when she goes home?

Nurse: No, those medications are currently only in IV form, and they have to be running continuously... Or she'll die. Do you get that? She's super sick and has a high chance of dying. She's on life support and the ventilator and drips are the only things keeping her alive, minute to minute. If we could give her a pill and let her go home, believe me, we would have done it.

Connie: Because my Uncle Harry...he was on dialysis, but he got to go just a few times a week, and he was fine. And he was on this medication that made him make more urine. Have the doctors tried that? Since Susie's not peeing?

Nurse: Every case is very different. The doctors are doing everything they can to support Susie until her system starts to be able to recover on it's own. And again, thanks for your expert opinion. I'll pass it on to the docs, since they're really not actually doing anything, and your idea is probably the best they've heard all day.

Connie: Okay. Also, I noticed her toenails are looking kind of yellow, when I was there yesterday. She usually puts some cream on them for fungus or something. Does she still have that? Because she needs that twice a day.

Nurse: I'll will look into that, and make sure that's being addressed. Because that's super important. Because you know what else? Her kidneys shut down and her heart isn't sending enough blood to her toes and her medications are making them turn black and her lungs are filling with fluid and blood and she has clots throughout her liver that makes the rest of her skin look yellow and I need to change the dressings over her blistering skin and make sure her cardiac drip doesn't run out and suction her so she gets oxygen but dammit, her toes better not have fungus! I guess I am a lazy nurse because I didn't even put her toe cream on.

Connie: Yeah, because she needs that twice a day. I can bring some in if you don't have any there. And is her purple quilt in her room? Because that looks really pretty on her.

Nurse: Don't worry about it, we can get some here. And yes, the quilt is there. But it's on the chair, not on her. If it were on her it might get covered in liquid green stool, mucus, or blood. Probably all three. And also, you should be worrying about Susie's life, not Susie's toes. You should be hugging her children and thinking about how she lived her life, and how she'd want her life to end. You should be just sitting near her, if you can, and telling her how special she is, and playing her favorite music, or taking her dogs to the park and scratching them behind the ears, and not going to the pharmacy for her toe cream. Because Susie is very near death and this is going to be a terrible way for Susie to die. Do you get that?

Connie: Well, thanks for filling me in. I'll be in later in the afternoon. If you get a chance, let Susie know that I called. And that...we love her.

Then her voice cracks, and my eyes fill up, and I sigh and head into Susie's room to adjust her blood pressure drip and look for the toe cream.

Fire in the sky

2006-08-29T10:18:00.000-07:00

This morning I woke up and my bedroom door was slightly ajar, and there was a strange light coming from the living room. I lay there, completely confused, wondering what possible light I could have left on overnight, and I was sure I'd remembered to turn them all off. After a few moments, and after I glanced at the clock, I realized it was just sunlight. I've heard that happens in the mornings, actually much of the day in fact. Hm.

I was quite pleased to see this article in the New York Times. As Tessa is always saying, it's about time more people realized they are associated with greatness.

Now I must suck down my coffee to fortify myself and perfect my Mean Voice in order to call my payroll supervisor. She f*cked up my last paycheck, and no one messes with Nurse Ratched's paycheck. No one.

In the meantime, I leave you with this thought of the day:

Belated

2006-08-27T16:31:00.000-07:00

It was your birthday last week, so I just wanted to say welcome to your new decade, it's going to be wonderful. I have my camera with me nearly constantly but I'm kicking myself that this is the only photo I took of you on the actual day. I think that's okay though, since this is how I know you...walking along a path, with you at my side, calling for small dogs and laughing at their exploring. They were probably just at our feet in this shot. So anyway, happy birthday again, and here's to several dozen more years.

Are my eyes open? ...NO!

2006-08-23T20:40:00.000-07:00

Bonus points if you can tell me where that title line comes from. Hint: It's from a sitcom.

My eyes are only half-open right now because I'm super tired but I think most of the super-tired that I'm feeling is actually the hazy weird feeling that I get after I take my migraine medicine. Good news: I no longer have a headache. Bad news: I feel like I'm underwater. Blurble.

Nothing much else to report. Oh, Bellingham is still there, still lovely and peaceful and relaxing. And also quieter and has cheaper more abundant parking. So there, Seattle. Pictures to come soon.

I've been taking care of S. at work for the past two weeks, the latest in my never-ending stream of post-transplant super-sick intubated patients. I read in his chart notes that he told the social worker, pre-transplant, that he hoped for the best outcome because, "...if not, my book will have a lot of empty pages." So far I've pulled S's blood pressure out of the toilet two separate nights and convinced him not to die of cold sepsis one night. But that's all fodder for another post. Right now my eyes are blinking too long and I can hear the ice cream and bad reality TV calling me from the other room.

And also, Boy still eludes me. Another weekend that he's out of town, another week to wait to see him. Ah well. At least I don't feel smothered.

The Ones

2006-08-15T08:05:00.000-07:00

This morning a nurse friend and I had a conversation about The Ones That Get to You. These are the patients who, for undefinable reasons, just get to you. Somehow you connect with them on a different level than with your other patients. They are the patients who wander into your thoughts on your days off. Routine or mundane tasks caring for them aren't bothersome or easily put off. When they or their family members say "Thank you," and you respond, "No problem," what you are really saying is: "No, thank you. Thank you for reminding me again why I am a nurse, why it is important that I come to work, for providing me with the inspiration and energy to do my job..."

I wish I could say that all of my patients inspire me to give my whole self to my job and my tasks, but they don't. I don't slack off or not care about the other patients, but The Ones That Get to You are special. As my colleague put it, from the moment you feel that connection with these special patients, something tugs at your heart and starts to hurt a little. Because caring that much more about them means hoping that much harder. You lose just a smidge of your "professional objectivity" and you start to believe that maybe this patient is the one that fits into the "10% survival rate" category. You cling just a little bit more to the lab values that start trending positively. And you hurt a whole lot more when things don't go well, because you hoped just that little bit harder. But in exchange for the disappointment and the hurt and the loss when they lose their fight, you had that connection. You witnessed courage, strength, and in the end, peace.

The Ones That Get to You are the ones that I would much rather have met for the first time at cocktail party, or standing in line at Starbucks, or at the dog park. Because, then, in a perfect world, that would mean they didn't have cancer, and maybe we would have been friends.

Baby love

2006-08-10T23:43:00.000-07:00

"Hey, Mum, that dishwasher is nasty. Buy me a new one. Please. T'anks verry mutch." (as said in an Irish accent. Just because that would be super cute.)

"Go ahead, mom, take your time doing your household stuff and helping Mr. Repairman. I'm very content here in Auntie Rose's lap. She's fun. She keeps telling me about the pony she's going to buy me and teach me to ride. That sounds pretty cool. Also, what's icecreamferbreakfast? She said I can eat that with her..."

This was pretty much my view for most of the day, but it doesn't get too much better than that. I even got a few smiles out of those chubby one-dimpled cheeks, and I'm mostly certain they weren't even gas. We watched HBO on-demand and drank some formula and had a couple of Code Browns (official hospital-speak for poop-in-the-pants) and even managed to put our own little fist into our mouth without missing and poking ourselves in the eye. And when you're six weeks old, that's big stuff.

I must say, after spending 48 hours this week taking care of people at the end of their lives, some slowly dying and some actively dying, and having to interact with people facing serious and debilitating and scary diseases, and needing three people to help me clean a 200-lb adult's Code Brown, hanging out with someone at the beginning of her life, who's just figuring out what she likes and doesn't like, is pretty cool. Somehow it's refreshing and comforting. Somehow it seems to restore the part of me that gets used up every time I wrap another body for the morgue cart, or hug a mother who is saying goodbye to her son.

Yes, Ted, you are still my firstest and my favoritest baby. Although you are an incredibly needy little thing...

This is my view the rest of the time...

The countdown begins...

2006-08-07T18:19:00.000-07:00

As of this writing, I have forty-five minutes. Exactly forty-five minutes for the phone to ring and Nurse-In-Charge to tell me to come to work, for my regular shift, and earn my regular pay. BUT if the phone rings in forty-six minutes or thereafter, and the Nurse-In-Charge tells me to come to work, I will earn time-a-half plus two extra hours of pay. Let the nail-biting commence...

But also I have to admit that I don't really want the phone to ring at all, I want to stay home in elastic-waisted pants and a tank top (yes, I really am that spoiled that now I think even scrubs are 'getting dressed' and 'restrictive.' And yes, I realize that this means there will be moomoos in my future.)

So while I wait and try not to watch the clock or the phone, I have some fabulous tidbits of reading for your entertainment: First, I apparently have a very presitigious job. Go ahead, let it out, I know you're snickering too. It's a lovely sentiment and all, but apparently these people who wrote this article or voted in this poll have never actually seen nurses work, or probably ever met a nurse.
Above, nurses on a day off. Yes, we are alpacas. I do not have any photos of us discussing a fecal fat collection, wiping our patient's butts, suctioning liquid stool, gloving up to pick pills out of a basin of puke, packing a rectal abscess, taping a plastic bag over a dead patient's head, or, doing the windmill dance with our scrub pants pulled up to our armpits to the lady lumps song while pretending to spank each other at four a.m. Perhaps the term 'prestigious' in the survey was loosely interpreted to mean, "Thank god there are people weird and crazy enough out there to do that job because you couldn't pay me enough to step away from my cushy desk job which is lacking any contact with body fluids at all."

Also, Dr. Hebert has written a moving and eloquent entry on the case of the charges against the doctor and two nurses from a New Orleans hospital regarding their questionable actions in the immediate aftermath of Katrina. I've been wanting to say a bit about this lately, but he puts it into words much better than I could. It's extrememly thought-provoking, and unfortunately the case is going to get very polarized because of the hot-button issue of euthanasia. As an oncology and ICU nurse who has been a part of countless discussions and situations of end-of-life care and issues, this case seems to strike close to home. But also having seen families go through absolutely unimaginable horrors with their sick loved ones and losing people, I know that until you are actually in your own little hell, until your own unimaginable horrors are visited on you, there is no possible way to guess how you might react. Therefore, I don't think it's possible to truly understand or to judge how others react while they suffer through their little hells.

And finally, read this med student's post about his experiences in the MICU. As I read this, I kept looking over my shoulder to see if he was on my unit, and I wondered if I'd seen him at the code the night before. It's funny how I alternate between feeling like my job and my work environment and situations are so surreal and bizarre that no one else would understand, to reading a doc or a nurse's blog entry and becoming convinced that he or she has followed me through my shift and saw exactly what I saw.

CHA-CHING! It's now officially 7:00 pm.

What I learned at work last night

2006-08-06T08:07:00.000-07:00

The one time you don't walk-super-fast (because you NEVER run in a hospital) to an emergency light, it will really actually be a code and not just an "Oops, did I bump that switch on the wall?"
In a code situation, just pick something, and just do it. That way it's harder to freak out. Like, grab the ambu-bag off the wall, open the box, put it together, plug the tubing onto the oxygen, turn up the oxygen, place the mask on the patient's face, chin-lift-jaw-thrust, hold the mask in place super tight and squeeze that bag. Doesn't seem too complicated but it becomes complicated when people are yelling, "Get the doctor! Where's the doctor? I called him! Where's the CPR board? Where did his son go? Normal saline wide open now!" among many other things I probably didn't hear.
When you're doing something, just do it, don't worry too much about doing it right. Remember, the patient is already dead. I felt a twinge of, "Aw, sorry..." as I yanked his head back and pushed my fingers under his jaw to pull it forward till my tiny rationale mind realized that when someone is doing compressions on your chest while someone else digs a needle around in your groin looking for a femoral vein, the guy had bigger problems than if I maybe bruised his chin.
When you need something, don't just ask. It won't get done. So find someone, make eye contact, and say, "Betty Boop! [insert name here] I need a liter of saline!"
You have to take care of each other first and foremost. When the nurse whose patient it was looks gray and shaky, don't ask her if she's okay. Just lead her to a quiet room, put a warm blanket around her shoulders, hand her a glass of water. Then let her talk, or not talk, but just sit near her. She'll be in shock, and freaked out, and questioning everything she did and didn't do. So let her say those things, but keep reminding her that she did everything she could have done, she did her best like she does every night at work, and she's going to be okay.
In real life, there is no Foreshadowing Music of Doom. Otherwise, we would have heard it during the our conversation about the above-referenced pt's quality of life, probably life expentancy, and the nurse's comment that hopefully he should die sooner rather than later, or his suffering will simply be needlessly prolonged...cue code light. See previously mentioned chain of events.

...

2006-08-06T07:58:00.000-07:00

So this happened.

Despite everything we do, leukemia continues to be relentless and indiscriminate.

In the Navy!

2006-08-03T11:27:00.000-07:00

The US Navy was in town last night. Well, not all of them, I guess, but many of them in their little white outfits (I suppose it's more manly to call them uniforms?) were having a night on the town (shore leave?) in Belltown. So what's a girl, even a dirty-socialist-patriot-hating-anglophile girl, to do? Well, after three martinis, dance with them of course! Every 'civilian' guy who happened to go out in Belltown last night wore a permanent scowl as he nursed his drink against the wall, cursing himself for not joining the navy and getting to wear a shiny white outfit that draws drunk girls to him like moths to a flame. Hahah.

Oh, and...
Dear Seattle,
We hate the Blue Angels. Nobody is impressed by them, nobody thinks they're cool. We think it's a great big old waste of money to pay those overgrown toddlers to fly around in their million-dollar toys, causing unnecessary noise pollution and indescribable traffic headaches. They make our doggies quiver and pee on the floor and do nothing to improve hangover headaches. So yeah, to sum up, not impressed. Spend your money on something else. However, if they were dogfighting or having some kind of 'demolition derby' in the sky, that'd be cool.

Things that are gross

2006-08-02T10:54:00.000-07:00

First of all, I am not one to brag about the gloriousness that is Seattle in the Summer (apart from Seafair, tourists, traffic, and bikers taking up my lane of traffic), mostly because it's already crowded enough here and Seattle has already gotten a fat little ego and behaves pretty pretentiously about its great old self (but I digress.) As I was saying, I like to keep the secrets of the green, lush, sunny, temperate, rainless summer to myself, lest hoards of *gasp* right-coasters or worse, tourists, clog up my fair city. Also, it's just not nice to remind your friends in other parts of the country who are sweating and melting and sweltering and mostly complaining like crazy that you are so damn comfortable in your AC-free house in just an old skirt and a t-shirt. Ahhh. BUT...my point was that when you log on to Weather.com to see if you need to wear a light sweatshirt over your tank top as you walk around the lake, and the headline reads "Heat wave! Dangerous record highs!" then, in little letters at the top it reads, "local weather: Seattle, 64" you can't help but snicker a little and sigh happily. And before you go poking your little Rosebuttons voodoo dolls with blistering hot needles and sending me sucky weather karma, let me remind you that I spent 12 years in the midwest, that's "America's Heartland," (those are Quotes of Sarcasm), the Flyover States, aka the land of 10-month winters with temps around minus 50 and two months of sauna-like humidity and heat and mosquitoes bigger than kittens. So yeah, nasty hot summers suck. Huge hairy balls. However, Seattle summers don't suck. But shhh. Don't tell. I think the airport closes for the summer anyway, so you can't come. So do the highways. (Seattle drivers snicker, "Tell me about it. Just in the summer?")

Yesterday I went to Target, and bought some cheap clothes that I may or may not have needed. Then I ordered some Indian food, and stopped first at another Indian restaurant along the way to buy a jar of the Best Stuff Ever, mango relish. I was tempted over to the nearby Walgreens to buy some hair dye (currently burning itself into my scalp. Gotta shower soon, T minus 6 minutes). But between the restaurant and my car I had a mild spaz attack and dropped the bag with my hair dye and mango relish, causing the top to loosen and spew oily mango relish all over...my hands, the hair dye box, etc. So I sort of wiped off my hands the best I could and proceeded to the next Indian restaurant to pick up my eggplant bharta, self-consciously aware that I smelled like mango pickle. And although he was super nice and gracious, I could tell the guy at the counter was thinking, "These silly white girls. She is nowhere near of Indian descent, and I am not fooled by her attempt to slather herself in mango pickle. No free mango lassi for her.'' *Sigh*

edited to add: The title of this post refers to smelling like mango pickle, and wondering whether my hair will smell like mango pickle forever. I just got a little sidetracked as I checked the weather...

Randomly random

2006-08-01T18:53:00.000-07:00

This is Ted. Tell him he's a big dog, he likes it.

This is the culprit, cute as he may be. He is the reason behind my weekly trips to Target for more and more underwear. Trust me, you don't want to know the details. However, I am about to go again tonight...not buying underwear tonight, just returning some things I bought on impulse while I was there last night buying underwear. Yep. I've got a lovely date planned with myself for tonight...I'll hop up to Target, then order some Indian food and pick it up on the way home, then watch Bridezillas and Hex on DVR, and possibly Unbreakable from Netflix if I'm still awake. I know, it doesn't get any more exciting than that. I don't know how I handle it either.

Hey nurses...is anyone else out there starting to get all into (I almost said 'excited' but then realized that even I am not that dorky) the idea of going back to school to get your masters and maybe even be an NP only to be gobsmacked by this bizarro DNP thang?! Can anyone else explain to me why this is happening (I know, I know, four-year doctorate prepared patient care provider yaddy yaddy more cheap labor for the Health Care System Monster sorry personal opinion). I'm mostly tempted to say f*ck 'em, I'm gonna be a stinkin' masters-prepared NP anyway and if you want to pay me less or fire me in 2015 than fine, I'll be happy milkin' my pygmy goats and teaching kids to ride ponies. Then a little bit of me says, hey, if my current Health Care System Monster is willing to pay for nearly all of it, who am I to turn down the chance to get a doctorate and just be done with it?! Those are my thoughts, as small as they are. Discuss amongst yourselves. Opinions?

I'm thoroughly annoyed with myself because I'm In Waiting. Waiting for a boy to email/text/call, if you must know. I hate being like this, because I'm an independent grown-up who doesn't sit around waiting for boys to call and dammit, they should be lucky if I even deign to answer their call. Stop laughing, I like to tell myself that. It almost sort of works.

So anyway, thanks for tuning in. I have a date with Target and Bombay Grill and the TV, mustn't be late.

What she said

2006-07-31T07:57:00.000-07:00

Last night I asked my colleague how her patient W was doing, since I'd taken care of her for several weeks in the ICU. W had been extubated (breathing tube removed, was breathing on her own) two weeks ago, and been moved out of the ICU to floor care last week. She was starting to nod yes/no to questions but was not very interactive and hadn't said anything at all. My colleague said W was doing okay, slowly getting better, but somewhat depressed. So I stopped by to see her, tell her who I was, and that she looked a million times better, and was making good progress. She nodded a little while I spoke and seemed aware that I was there. A few hours later, her nurse found me again. "I need you again in W's room, come with me," was all she said. I went and stood near W's bed, and her nurse said, "W, tell Rose what you just said to me." I glanced skeptically at her nurse, but took W's hand and looked at her. "I want to go home," she said simply. "You want to go home?" I replied. She nodded, looking me right in the eye. And while I'm always loath to make promises to patients, I told her, "Of course you do. And of course you're going to go home. Not tomorrow, and probably not as soon as you'd like, but that's the path you're on. Every day you get stronger, and every day we all work really hard to get you ready to go home. And you're working the hardest at it. So I can hear it in your voice now W, that you're getting better and you're going to go home."

Then I went back to my own patient's room [ed: another RN had been watching my patient and my monitors while I was in W's room], to continue titrating his levophed to maintain a blood pressure that actually perfused his organs with blood and adjusting the amount of oxygen the ventilator was giving him. He is really sick, at least as sick if not sicker than W had been. Some of them get better, and some of them don't, I don't know why. Maybe if I knew why then I wouldn't be hopeful when the situation was futile or I wouldn't distance myself when there really was hope.

There was also a code on the unit tonight, not my patient however. I was entering the room just as two young doctors ran onto the unit then stopped short in the doorway. "Shit, I hate it when we're the first doctors at a code. Have you ever run a code before?!" one said to the other.

So I hear it's your birthday...

2006-07-23T15:23:00.000-07:00

Thank you Jerry, and yes, it was yesterday! I'm officially an old lady, the big three-oh. It's a good thing, because now my knitting and sewing and old-lady name and wiener dogs all make a lot more sense. Plus, it feels kind of cool not being stuck slogging through my 20s anymore. I'm so over the 20s. The 20s were all about going to class and figuring things out and deciding what to be and what to do and what not to do. Not that I've got anything much more figured out, but I have learned things like not to keep drinking after you've thrown up (age 19), not to keep calling the boy if he stops returning your calls (age 20), how to read as little of possible but still ace the test (age 21), and how to get a real job that pays the bills (age 28). So now that I've got that stuff out of the way, I can be 30 and fabulous. And I'm going to try all sorts of new things. Already, I've been to Jack in the Box for the first time and eaten my first mussels (two different events, obviously). And it's only going to keep getting better from here!

I'm not going to tell you how hot it is here, nor am I going to complain about the weather. Contrary to popular belief (based upon the amount of people who do it), whining about the weather does not actually change it. Apparently, there are plenty of other blogs out there doing that if that's what you want to read. But I am going to mention that if you have absolutely nothing important that you need to be doing or anywhere you should be going, if you can get away with wearing nearly nothing, if you enjoy bad reality TV, and if you surround yourself with icy cold beverages, sprawl on the couch and point all the fans at you, this weather suits me fine.

I am also pondering why my neighbor, the Laundry Slut, continues to have at least eleventy billions loads of laundry to do EVERY weekend despite the fact that from April till October he NEVER wears a shirt. Tessa is currently barking up a storm at him because he's out in the yard, and even Tessa understands that public nudity is a privilege, not a right. A right specifically reserved for Colin Farrell and the Italian soccer team. And last I checked, furry Laundry Sluts were not members of that team.

Oof, I've left my post. Back to the couch, I don't think I've seen this particular episode of Kathy Griffin: My Life on the D-List.

I'm still here...

2006-07-18T21:11:00.000-07:00

I haven't posted anything in a while, so I thought I'd drop in to say hey, I'm still around. Been working a lot lately, taking care of W. for a few weeks now. She's sometimes a tough patient, but I keep requesting her now, for whatever reason. Maybe because it gets easier to more experience you have with a patient, the whole "the devil you know..." thing. Maybe because the more you invest in taking care of someone, the more you have to be there for them. Last night her daughter asked me, "Is she going to wake back up? Is my mom ever going to be my mom again?" I don't know. Nobody knows. Maybe, or maybe not. There's such a super-fine tightrope we walk at work, giving realistic expectations but not extinguishing hope. Never extinguish hope, that's all some of these people have. You've got to hope for the best, because, really, what choice to do we have? Our chaplain told me once (someone else probably said this first, so I apologize for not giving credit where due), "Always hope for a miracle but never expect one."

Someone died this week. He was a cool guy. I want to link you to his obituary in the New York Times so you can read about his life and everything he did, but I'm too paranoid about HIPAA. He taught me that regardless of political affiliation, some people are just good people. He was warm, curious, funny, and open. He wanted to hear what you thought just because you thought it, not because you supported a particular party or 'side.' He wanted you to know more about politics, but he would give you a book or literature and encourage you to learn something through your own eyes then come back to discuss it with him. He found humor wherever he could. The love and compassion he inspired in his family members, evident from the way they looked at him and laughed with him was moving. He was genuine in a disarming way. When you strip away preconceived ideas and deal with people just as human beings, you are often surprised but always rewarded. It's unfortunate that sometimes it takes illness and suffering, or just putting someone in a neutralizing hospital gown, to approach that situation. So thank you sir, I feel lucky just to have met you.

I'm on stand-by tonight for work but I just received an 'ominous' call from my charge nurse, so I might be putting those scrubs on after all...

Tales from the Last Chance Motel

2006-07-10T01:12:00.000-07:00

Last week at work, I took care of J., the woman who was in withdrawal and suffering from extremely altered mental status, although she was coming around a bit. I also took care of W., an engaging southern politician who said things like, "I have a five-pound appetite but a three-ounce stomach." He was a genuinely nice guy, the kind of person who, when he asks you how you are, asks you because he actually wants to know. I admitted him one night then got him ready for discharge him the next. So I came back to work this week and was guilitily pleased that J. had been transferred to another unit the day before. Then I found out that she had died that morning, a victim of her aggressive stage-four gastric cancer. And although I had discharged W., he had been re-admitted the next day but was currently on his way back home, via air ambulance, as he had relapsed and suddenly gotten sicker, so he wanted to be home to die. That night my another patient on my unit died, and I helped her nurse wrap up her body. My patient is also awaiting a celestial discharge, but remains full-code status and continues to undergo all treatments, such as mechanical ventilation, kidney dialysis, and a levophed drip (cardiac medication to keep her blood pressure up). She has gained over 80 lbs in less than three weeks, and when I move her or touch her she cries. Her tears are bloody and leave permamently stained rivers down her cheeks. Last night one side of her neck started swelling up like a baseball and we found a strange (fungal?) rash/spots across her chest. Yesterday another patient that I'd had a few weeks ago received her stem cell transplant but shortly thereafter went into respiratory distress, acute renal failure, and suffered a huge MI (heart attack). She was intubated and dialysed but her blood pH had been around 6.1 for nearly four hours. That's real BAD. So...yeah. I don't know why I'm typing all this, except that its what I mean when you ask me, "How was work?" and I say, "It was okay."

Wakey wakey

2006-07-04T02:02:00.000-07:00

Although not a great photo, this is a view of the sunrise as seen from many of our patient rooms. After spending a darkened night making sure patients are breathing, whispering around sleeping family members, using a flashlight to check name bands, and ruminating over the horrors and unfairness of cancer, its always a comforting yet bittersweet surprise when the sun starts to come up, and the world outside starts to brighten. As if to say, "Things won't always be this bad."

My patient this week was going through probable benzodiazepine withdrawal, which presents somewhat similarly to alcohol withdrawal. Which is not a pretty picture. She may have taken up to 90 clonazepam tablets over six days, which is about 5 times the maximum recommended dose. She was delirious, narcoleptic, agitated, anxious, noncommunicative, impulsive...well, all that and a bag of chips. Oof. I'm drained from those three days of making sure she didn't pull out her central line, reaccessing her implanted port when she did pull it out, keeping her hands away from her foley catheter, listening to her cry, and hoping she didn't have any more seizures. Also, three deaths over the past three days on our unit, although all during day shift.

Then this morning I couldn't fall asleep because I was having this strange shooting and intense lower back pain each time I tried to lay down, which was rather bothersome. I couldn't remember hurting myself while bending or turning or lifting a patient, although it's certainly possible. All I could think of was, "Pt c/o lumbosacral pain, rated 7/10, nonradiating, sudden onset. Relieved with ibuprofen 800mg PO and diphenhydramine 25 mg PO. Reassess pt comfort q8hrs."

It's July!

2006-07-01T16:43:00.000-07:00

Happy July 1st everyone! I hope you all enjoy this lovely sunny summer month, the barbecues, the swimming, the sunshine. Ahh. Just, please, whatever you do, do not get sick or injured. Buckle your seatbelts, wear your helmets, cook your meat thoroughly, remember that "beer before liquor..." Do whatever you must do to avoid having to go a hospital at all costs. Because July 1, all across the country, is the first day of being a doctor for all new doctors. Don't get me wrong, the first-year residents are, for the most part, a group of highly trained, motivated, caring professionals. Ready to save lives. Just as soon as they figure out the appropriate dose of tylenol and make panicked calls to their attendings. I worked with an R1 last night was only five days old (awww!), still wet behind her cute doctor ears. So fresh and new, actually, that she was still getting ice packs for patients herself. And bless her, she was sooo sweet and caring, and trying so hard. But her comment to another nurse last night sums it all up: "You have no idea how many patients we'd kill if it weren't for you guys." (meaning us nurses! Like me! Hah! Yep, now you should be scared!)

For the past several weeks, although I've been feeling better for a few days, I've had basically a persistent headache which evolves into a migraine every third day or so, and had to take excedrin or nsaids on a daily basis. Last night, I admitted a patient from another oncology floor, a young woman in her early thirties who had mental status changes and a seizure. The nurse giving me report began by saying, "So this young woman presented to the ER last night with intractable headaches but appearing otherwise normal..." By this morning she was incoherent, unable to communicate, and thrashing in bed, agitated and unconsolable. At one point in the night she was foaming blood from her mouth because she bitten down so hard on her tongue. I had to pinch her nose shut to get her to open her mouth and stop biting her own tongue. We have no idea what is wrong with her. But yeah, I have an appointment with my doctor to discuss my headaches.

Yawners

2006-06-30T00:56:00.000-07:00

Yawners
Originally uploaded by rosebuttons.

The Famous A. has a comment on reading this blog, apparently. Everyone's a critic. Ah well.

This post contains neither nursing content nor knitting content, maybe because I've had four days off work and it just seems too hot to be knitting. But mostly because this little person is just too darn cute and far more interesting than anything I can blither about purling or the reasons why cancer sucks.

Today I went to Target and spent far far too much money because a.) Queen sheet sets were on sale, and b.) I have to buy new underwear on a weekly basis because Ted eats it. Seriously. He snoots it right out of the hamper and chews it up. Grody, I know. Then I went to happy hour where I could only have one drink because I had to drive home. So I think I need to either a.) Hire a full-time driver, b.) Use my bus pass to get to and from happy hour, or c.) Pretend my car is always in the shop and make people pick me up. I'll be pondering my options.

Oh and also...even though I have recently fallen head-over-heels for the charms of the above-mentioned tiny person (have you SEEN her?!), I still despise the rest of the world's children. Today I was leisurely enjoying a refreshing beverage at Starbucks until a hoard of blond childfreaks descended upon the bench next to me and proceeded to bang on the bench with their toys and screech loudly and constantly at the top of their lungs. Their parentard conveniently disappeared into a nearby store. Apparently, children don't grasp the concept that an evil glare means "Shutthefuckup" until they are quite a bit older. I would gladly have taught them that but I didn't have the patience today. As I was buying a snacky in Starbucks, their parentard came in to order a drink and her ineptitude at ordering an iced tea was saddening. Here's one of my pet peeves #415: When someone orders a drink but insists on using a hand signal to show what size of drink she wants, instead of using her Grown-Up Words. PEOPLE! Puh-lease! Anyway, as I was saying, apples...and trees...not that far apart.

Hello, world!

2006-06-29T00:18:00.000-07:00

12 hours old
Originally uploaded by rosebuttons.

Today I met the most fascinating little person, little A., who just made her debut yesterday. She is modeling her very first handknit hat here, and quite adorably as well. I can't wait to get to know her better. And as her aunt, I get the fun job. I don't have to worry about whether she eats her peas or puts her socks on backwards or finishes her calculus homework before TV, I get to take her shopping and teach her to ride a pony and tell her which boys to avoid (pretty much all of them, but at least we have a while). Although I'm sure she'll have even more interesting things to teach me as time goes by.

So happy birthday, A., and welcome to the world. We're awfully glad you're here :)

...

2006-06-24T16:59:00.000-07:00

Billy died in the early hours of Thursday morning, the night after my last night shift taking care of him. After a conference with his doctors, his family made the decision to withdraw life support and place him on comfort care measures. He was extubated and died peacefully on a morphine drip with his family at his side. He was 25. I will remember the floppy blond hair and the wry grin from the photo above his bed rather than the war-torn body he left in the ICU bed.

I am sad and feel strangely guilty that I wasn't there. I never met his mother, just spoke to her on the phone each night I was his nurse.

I haven't even cried yet but last night I had three patients who needed their nurse to crack jokes with them, sigh in empathy at their pains and complaints, and make sure they got their antiobiotics on time. And we march on...