more letters on my business card

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..

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.

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

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?

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

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

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...

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

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.

...

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

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

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

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*

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.

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...

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

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.

...

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*

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

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...