Wednesday, December 14, 2011

Names

I like words and letters. I like how shuffling them around can result in endless meanings.

When I was a little girl, one of my favorite activities was playing boggle by myself. I would shake the dice and then find as many words as I could in two minutes. After the buzzer, I would scrutinize the board, writing down all the words that I hadn't found during the time limit.

If I found more before the buzzer than after, I won.

On the bus, I rearrange advertisement script in my mind, coming up with as many new sentences as I can. Or I try to just change character spaces. (shoestore up the stairs = shoes tore up the stairs)

When I study the unit census for staffing purposes, I automatically pick out the names with alternate meanings and make up sentences. I don't even really think about it, it just happens.

When I see the last names: Armstrong, Cox, Foster, Good, Paynes, I am going to chuckle. When the next two admissions are named Burns and Seaman. I will start to laugh uncontrollably.

Then I'll be embarrassed when my coworkers ask me what's so funny.

Sigh.

Saturday, December 10, 2011

Missing Disappointment on a Perfect Day

It was the perfect day to be disappointed. Early morning, I walked home underneath soft fluffy snowflakes. The crystal crusted arms of the trees had stolen the stars from the sky. Lavender and magenta streaks of cloud welcomed the sun.

At home, I mixed a new batch of Chai using English breakfast tea and an extra clove. Lovely. I deeply breathed in the steam and melted against the arms of an overstuffed loveseat.

Wiggling my toes in my new fuzzy socks, I pulled my legs underneath me and opened my laptop.

I opened the email from the medical school that interviewed me. My vision went blurry with moisture (I blame the steam of the tea). I reread it twice. My heart thumped.

All that disappointment I had bolstered myself against dissipated.

I got in!!


I didn't realize the stress I had felt the duration of this year until the moment of its disappearance.

I'm going to be a doctor!

Monday, December 5, 2011

Manly Food

One of my patients last night was eating voraciously. In addition to an enormous meal from the hospital kitchen, he devoured 3 TV dinners, 1 PB&J sandwich and two pieces of toast and jelly.

Around 0200, he called out for another snack. After discussing it with his nurse, I brought him a couple of saltine packets.

A tirade spewed forth.

"I'm a MAN. I've traveled the world and have a MAN's appetite. I'm not a little boy and don't want no little boy snacks!"

He threw the crackers at me and said he wanted a MAN's snack.

I asked him what he wanted and he told me:

"a chocolate sundae."

I wonder how he feels about quiche.

Friday, December 2, 2011

No Idea

I have no real idea of how my interview went. My interviewer was very nice and the hour we spent together was relaxed and conversational. We chatted about travel and ancient history. He seemed impressed that I had read Pliny, knew the different historical names of Istanbul and that Alexander the great was from Macedonia.

He asked me why I had gone to a community college before a 'really hard school' and about my mother's illness and pulmonary hemorrhage.

I asked about the clinical rotations during third/fourth year and the new simulation center.

He didn't ask me questions about what I was currently doing or give me any ethical stumpers to deal with.

I got a really good vibe from the school. The current students were very friendly and candid and the other interviewees were amiable.

It would be so nice to be accepted.

Sunday, November 27, 2011

Thursday Interview

My first (and thus far, only) medical school interview is this Thursday. I had hoped that I would have heard from another school by now. I'm incredibly stressed that this may be my one and only chance.

I decided to splurge and spend $30 more on a hotel room within walking distance to the campus.

My aunt- the crazy (in a fun way) one who took me on my first trip abroad (Turkey) wants to go with me. My youngest uncle lives nearby in an institution for developmentally disabled and she wants to visit him while I'm on campus.

I'm torn. It'll be nice to have someone there afterwards to talk about the experience but I'm afraid that she'll be critical of my weirdness beforehand (you know- waking up 4 hours early to obsess over my hair, clothes, review possible questions/answers etc). Besides, she doesn't really sleep. I learned that early during our Turkish adventure. I'm working the night shift all this week and will probably want to rest most of the day before the interview.

One of my favorite patients died yesterday. I found out through the hospital grapevine that he had been readmitted at the other hospital in our system for pneumonia and quickly crashed. He had been a quadriplegic who just conquered all obstacles. He ran his own business, drove and just celebrated life. It breaks my heart that someone so strong and inspirational is gone. RIP Dwayne. You'll be missed.

Friday, November 25, 2011

Faces

Last night, one of our lovely confused LOLs grasped my cheeks with her hands and told me that seeing my face made her feel better.

Aw. Shucks.

Then she tried to bite my arm.

Wednesday, November 23, 2011

Wallet Blues

I lost my wallet last night. I spent the entire day looking for it.. under my bed, between books on the shelves, in the fridge, in the car; I tore my apartment apart searching. I drove to work hoping desperately that it would turn up in my locker or the unit lost and found.

Nope.

Sigh.

I immediately checked my balances online and.. whew.. everything was fine. So I called my banks and cancelled my cards. I drove to the DMV and applied for a new license. Then I stopped by the bank and withdrew enough money to last the next week.

Now, I'm at home and going through a bag of cards and letters that were sent to my mom during her hospital stay, a chore that I've procrastinated on for the last year. It makes me sad.

Between a letter from my grandmother and a card from an old neighbor is... baddam bam... my wallet.

ARGHHHHH!!

(I have NO IDEA how it ended up in this bag of letters which had been stowed deep into the recesses of my closet-- I'm blaming the cat.)

Sigh.

Oh and I just got rejected from Brown University SOM.

Friday, November 18, 2011

Stupid Pet Peeve

It's trivial but I hate it when I tell someone that I'm sorry as in..

"You hurt your back? That sucks, I'm sorry."

or

"Your grandmother died? Oh, I'm so sorry!"

and they respond with

"Oh that's okay, it's not your fault."

Argghh. I know that your Didi's death wasn't my fault! She lived in freakin' Mumbai!

Sometimes I'll clarify that I wasn't apologizing but offering sympathy and sometimes, like the cashier at the grocery store with the aching back, I'll just let it go.

It still peeves me though.

Thursday, November 17, 2011

Rent

I received a phone call from my landlord today complaining that I hadn't paid November's rent which was due on the 10th.

I insisted that I had and that she had cashed the check a full week before the rent was due. We argued over it for a few minutes before I told her that I would send her confirmation today.

So my morning had been spent going to the bank, retrieving a copy of the cashed (and stamped) check, then scanning and emailing it to my landlord.

She hasn't responded yet to my message.

I've always taken pride in paying my bills early and am really irritated with this affair.

Wednesday, November 16, 2011

The Catheter Interrogation

First thing this morning, a urologist came to place a supra pubic catheter bedside. The patient had been retaining crazy amounts of urine and neither his nurses nor his orthopedic surgeon could place a foley in him. So urology was consulted.

The doctor had called in a list of supplies that he'd need bedside by 0530. Apparently he was rather rude to the evening secretary about it, saying 'everything better be ready", in a 'you people always mess up' sort of way. But I know the evening secretary is something of a sensitive whiner, so I took her report with a grain of salt.

He arrived examined the patient and then decided to try his hand at placing the foley first, giving me and the patient's nurse a new list of supplies. We have coude catheters in different sizes and foley kits stocked on the floor so much of his list was immediately manageable. But he wanted Urojet (lidocaine) syringes too. We don't have them in our McKessen so it was a short process to get them up to the floor. He needed to write an order, I faxed it to pharmacy and then immediately ran down to pick them up.

He was NOT HAPPY.

Though it took 10 minutes tops to get them (5 of which were taken by him arguing about writing the stupid order), he was incredibly put out. I heard about how ridiculous we were, how he doesn't have time for this stupid delay.. etc, eye rolls and disdain galore.

Fortunately for the patient, he was able to successfully place the foley. Whew.

A few minutes later, I stopped in the room to check on the patient and I noticed that his collection bag had over a 1200 cc in it.

I remembered reading somewhere that draining the bladder too quickly can cause the patient major discomfort so I pointed it out to his nurse. She was busy doing her end of shift med pass and instructed me to ask the urologist if she should clamp the catheter.

So I did.

I thought he would attack me.

He completely lost his temper and flayed into me.

"That's the stupidest thing I've ever heard! Why do you think to clamp the catheter? Why?" and then he waited. It took me a moment to realize that it wasn't a rhetorical questions but that he actually wanted a response.

I tried told him that I had read somewhere that it could hurt the patient if the bladder emptied too quickly but as soon as I started talking he restarted his rampage.

I was mortified. I tried to explain that I was just an aide and the messenger for the nurse but he kept at me. I can't remember everything that he said; I was flustered and just trying to escape. I remember him saying that they don't teach nurses to be doctors and thrusting a new order at me, written in block letters as though I were in grade school, DO NOT CLAMP CATHETER. It was the only completely legible order he'd written thus far.

He ended up staying to yell at me for longer than it took him to place the foley.

So much for his valuable time....


I'm totally re-writing one of my evil book characters in his honor and he's (the character) is going to suffer.



.

Monday, November 14, 2011

Book

I spent hours and hours writing my med school applications. Now that they're done, I'm at loose ends and am trying very hard not to obsess over my statuses. Watched pot and all that...

So I've spent the last few weeks maintaining that creative momentum and focusing it into a story.

I am writing an FBI/armed forces thriller. Ha ha ha ha! It's absolutely ridiculous but I'm having so much fun. I've done a lot of research and am surprised at how much I've learned.

I was never really interested in military history before. Now I have a new appreciation for what my grandfather must have experienced as a ranger in the 6th Battalion during WW2. How I wish now that I had the knowledge/interest to talk to him about his experiences before he died. I didn't even realize before the significance of his being a ranger, a member of the special forces. It's thrilling to have have a personal connection to something that is so romanticized now. I'm trying to balance the romance with reality in my story.

I've fleshed out the plot and have composed about 60 pages but the more I research, the more I have to add to my story. I know that I'll probably never finish it but the process is, so far, fantastic.

Wednesday, November 9, 2011

Impatience.

There's a nurse on our unit who come in nightly to regale us with tales of how awful her husband is. She dyes her hair only because he prefers blondes. She can't eat this or that because he thinks she's fat. He won't help her at all. He expects her to support them with her night shift and then take care of everything like chores, shopping, all aspects of child care while he sits on his duff and watches television during the day. She's always so tired blah blah blah.

Tonight's tale was about how he controls all of the money including her wages using direct deposit into in accounts that she has no access to. If he's feeling generous, he allots her a $5 weekly allowance. If she ¡misbehaves!, he'll take the money back.

First, I think she's totally full of crap. I don't doubt that the husband is a total jackass, but I'm pretty sure she stretches the truth unrecognizably.

She comes in with her stories and everyone fawns over her.. "oh he's awful!" "He should be shot for or " "You should kick his ass to the curb" and she preens under the attention.

I usually try to avoid engaging with the more manipulative staff but she put me on the spot and directly asked me what I thought in front of the rest of the crew. I tried to prevaricate but she was a bloodhound, asking me over and over.

I finally turned and told her that I thought she was spineless, that if she had such an issue with his money control to deposit her paycheck into her own damn account. He didn't hold a gun to her head when she signed up for direct deposit.

After that, she answered every phone call with "U8, Spineless speaking." Seriously, how old is she?

I would love to be a fly on the wall when she goes home and regales her husband to all of the stretched stories of how awful everyone is toward her at work.

On a more positive note, tonight was hellishly busy but I was working with my two all time favorite nurses and we totally rocked it. I love how efficient, sensitive and cool they are with the patients. Over the last year, I've learned so much from them about how to work with even the craziest, most difficult patients calmly and effectively.

Around 0300, "Dr. Armstrong" was paged to U7, one of the more dangerous pysch floors. We then heard thumping and shouts in the south stairwell. Unperturbed, Jackie, not taking her eyes off the IV line she was priming, strolls over and flips the lock on the door knob. A "Dr. Armstrong" is the hospital code for a combative patient. Moments after she locked the door, we heard a thud and more yelling.

Later, we discovered from the nursing supervisor, that one of the patients actually kicked in the door of the secured ward and escaped into the stairwell. I only caught some of the details in passing. Apparently, the patient had enough time to defecate on the stairs before pushing past the security guards to escape downtown. He assaulted one of the police officers chasing him and is now in jail. It capped the already crazy night.

Tuesday, November 8, 2011

Fungi




I took a walk in the woods this morning and the recent wet spell we've had has sprouted some amazing mushrooms.





During college I found plant biology painfully boring but the mushrooms.... the colors, the strange reproductive cycles, their romantic ephemerality...




A mycology course (maybe a medical mycology elective?) and a taxonomy course are definitely on my bucket list. I so wished that I could identify the different species on my hike today. Is it really nerdy that I wish I were a fungi taxonomist?






Beatrix Potter, the creator of Peter Rabbit, was also a bright naturalist. She spent years studying fungi reproduction and illustrating mushrooms in England. Her scientific drawings are stilled used by mycologists to identify different species.

Friday, November 4, 2011

Monday, October 31, 2011

Settling In..




Well, I'm getting used to my new apartment. My neighbors are musicians. Yep. Alt Rock. Sigh. Toulouse is not amused.




I love it nonetheless. Here are the aforepromised photos.





There's been a delay on the house closing. Lawyers. Hopefully, we'll finally finalize it this week. In the meantime, I've been popping up there to check on it and take advantage of the laundry. Yesterday afternoon, I was vacuuming and heard "knock, knock, knock" on the door.

I opened it up and, lo and behold, there was the mayor of my small town holding a small ceramic bowl.

I invited Mr. B in and we chatted for a few minutes. Apparently, his son bought the house and the mayor was unaware of the delay in closing. He was wandering around the property last week, found my collection of wheat pennies in the garage and took them home. When he found out about the delay, he wanted to return the money. He was embarrassed. We walked through the house together and he mentioned some things that 'John-John' wanted to change and asked about the family. I had never really known him, his kids were older than me, but he was my brother's little league coach and shared booster club responsibilities with my mom and several aunts and uncles.

After he left, I burst out in laughter. I was robbed by my mayor! It struck me as incredibly ironic.

Work has been remarkably smooth. The nightmare patient that I had mentioned last time was only with us for a few days and since then, our census has been mostly comprised of easy ortho patients.

No more news on the medschool application front. I'm still 'under review' at all of the other schools. The waiting is impossible. BAH.

Wednesday, October 19, 2011

New Digs


I'm settling into my new apartment. It's a tiny studio in an old Victorian house with ceilings higher than the room is wide...

I'm using an old refurbished library study table for dining.

I last rented a mother-in-law basement apartment, draped in grapevines and filled with books, that I christened the li-burrow. I haven't yet thought of a clever name for this new place. I'll post some more photos when I finally organize the living/bedroom. It's filled with boxes now and not very inspirational.

We have a patient at work. I'm not able to express the turmoil that this patient throws the hospital into when (s)he is here. I've been on the unit for over a year an this is the second visit. It's an incredibly stressful time for nursing staff, manager and hospital administration. This patient only comes to our floor for reasons that I can't go into without violating HIPAA. I can only say that they're unique and awful. I'm not experienced or clever enough to adequately change the details and still portray the magnitude of this person's effect on us. We get extra staff and the nursing supervisor relocates her center of command to our floor for the duration of the patient's stay. It doesn't help with the stress levels of the nursing staff. My manager hand selects the staff assigned to the room. Though he picks his most reliable, most patient and most experienced, it's not an honor.

The last time, the patient stayed 2 months. I'm not looking forward to another two months of complete anxiety before every shift. Bah.

I received my first med school interview offer. I'm thrilled but my loneliness yesterday was amplified in my hunt for someone to share my excitement. I mentioned it to my coworkers but they were more concerned that this means I may not be there next year. My brother disapproves of my ambition (I'm too old) and my west coast friends couldn't talk last night.

I'm still excited though!!

Monday, October 10, 2011

Libraries


I love books. I adore books. I hoard books. When I moved to Seattle, I culled my library from almost 1000 volumes to 200. Four years later, I moved again and culled 500 more from my collection. When I came back to the east coast 3 years ago, I sent 15 boxes ahead. 2 were clothes, one was packed with keepsakes and 12 were full of my favorite volumes.

I have no problem throwing out anything else. My great grandmother's cake pan? Bah, it's rusted and unusable. The faded notebook that she painstakingly copied recipes into? A treasure! Don't ever ask me to give up my copy of The Quiet American that I read while sipping 'white coffee' next to Hoan Kiem Lake in the sultry Viet Nam mornings.

I would rather lose a finger than the tattered A Tree Grows in Brooklyn that my grandmother read to my mother and then to me when I was a child. I was Francie. Knowing that my niece will pick up the same pages next year (when I pass it on) that 3 other generations have caressed thrills me.

I can't do libraries. I try. Over the years, I've moved a lot. I have a system: move stuff, contact PO, contact banks, get new driver's license and car registration and obtain library card. But I have never returned a library book on time. Not once. While packing yesterday, I came across 3 library books, the only books that I've checked out from the local library since moving here.

I can leave my childhood home without a backward glance (stupid albatross) but returning those books brought tears to my eyes. The one was the last book that I read to my mother before she died.

I drove home and cried. Then, I drove back, paid my $82.15 fine and checked the book out again.

Sunday, October 9, 2011

Isolation

All five of our isolation rooms are sequestered in one hallway on our unit. I was walking back from helping woundvac dressing change and found myself stopping in each room to chat with the patients. I knew them all well. I chatted with Dean* (MRSA) about his kids; Ira* (VRE) shared his news about his UNOS status; Frances* (MRSA) asked me for a cigarette and we laughed together at the inside joke; and for a few minutes, Robert* (CDIFF and MRSA)and I competed to see who could get the most Jeopardy questions right. He won. Stupid "Sports Venues".

I headed back to the desk and, out of curiosity, checked to see how long my friends on the I-ward had been here. At July 7th, Ira was the newest admission. Three months. Like the others, he's settled in. He has his favorite snacks in the kitchen fridge, a mountain of pillows to burrow into, piles of linens, dressing changes and unopened Nepro spilling out of cupboards and closet. Photos of his dog are on the wall and an extension cord keeps his cellphone and nook within reach.

After her transplant, my mother lived in the hospital for 11 months. We settled her in as best we could with soft throws, poster-sized photos of family on the wall, homemade hospital gowns, radio, magazines, toys, anything that we could think of to make it more comfortable. She hated it. She had no interest in anything but getting home.

I don't see that with my I-ward friends. Both Robert and Frances have been on the verge of going home several times over the months but they got stressed, become enraged and argued with the discharge planners. Then they had relapses, Robert became septic and Frances' tissue flap reopened.

Over the weeks, I've learned bits and pieces about my patients lives. Ironically, the time they spend in the I-ward is less isolating than their home lives. They each have a different story but, without exception, they are lonely and enjoy the 'perks' of living in a hospital: constant company, all the food they can eat, any need/desire filled by just pressing a call bell button.

Over the last year, I've noticed a steady increase of 'social admissions' to our unit. I think it's due to the aging local population, the depressed economy and the cutbacks at the nearby psychiatric hospital. A lot of its inpatients have been reevaluated to outpatient status. The recent flooding also destroyed 2 nearby nursing homes and countless homes.

It's scary and sad to me, that the awfulness of being in a hospital is actually preferential to what awaits outside.

Though my mom never made it out of her hospital stay, she had something better to look forward to, to work for. We all, up until the very end, had hope and desire that she'd make it home. In that way, we were fortunate.

No news on the med school application front.

Tuesday, September 27, 2011

My Month of Scramble

I sold my mom's house last week; the buyers paid cash and are forgoing an inspection which means a fast closing. EEK. and Yay.

I'm scrambling to find new housing, storage for my parents' things that we're keeping, and all the little errands that one doesn't realize until that time of moving is upon them.


I received my second med school rejection, ironically from my #2 dream school. Bah.

Work is interesting. Last week, one of the patients developed a really weird icky crush on me. He followed me around and asked me every day to join him in a new activity. Play Scrabble? Go to the zoo? In all honesty, it was creepy because he was not mentally impaired in the slightest. Somehow it's easier to understand/think cute/tolerate a patient's romantic interest if they're elderly and demented or young and MR. I don't understand how a middle aged man could rationally think it a good idea to ask out the nurses/aides.

We had a mandatory aide meeting yesterday, a punitive grousefest. Apparently, the aides aren't doing their jobs properly, have bad attitudes and things need to change. This was all based on our recent Press Ganey scores. The nursing aides are the front line to patient care after all. Later, my manager pulled me aside, basically told me that he didn't have any problems with my work and asked me to 'keep an eye on the moods of my coworkers'. I don't really know what he meant by that but I felt manipulated nonetheless.

I love autumn. I drove to work today and noticed the trees preening at their reflection in the river. I can't remember seeing the leaves change last year. It's astonishing how grief and sadness can blind one to such beauty.

Tuesday, September 13, 2011

Nighttime Serenade

Tonight, I stayed several hours past my shift end to sit with a confused elderly patient. "George" had a psych history and a broken hip. For various reasons, he had a triple lumen catheter and an order for TPN. Just before 2nd shift he pulled out his line and offered it to his nurse like a wedding ring, asking her to marry him.

I had worked with George before. He was unfailingly cheerful and absolutely adorable in his confusion. He was definitely one of my favorite patients. Because he was tugging on his foley and newly placed peripheral line, I volunteered to stay and guard his wandering hands.

He called me his little black Jewish kitty-cat and asked to pet my fur (I'm neither black nor Jewish) but happily acknowledged that I was a cat who didn't like to be petted and sang to me instead: "Kitty-Cat I Love You" to the tune of Bull Moose Jackson's big hit.

George didn't seem to have any short term memory; he constantly asked where he was, did his parents know he was there, why we had kidnapped him, when I was going to have my baby. (I'm not pregnant). *sigh*

Despite his misinterpretation of my physical homage to all things cheese (my little potbelly), we had a great time together telling stories and tearing pictures of cats out of the stack of magazines that someone had left him.

Outwardly, he and my mother were complete opposites. He was a tall black millwright and my mom was a tiny white schoolteacher. She died young and he had reached a blessed age. But their eyes were the same: brown and slightly bulging. He and my mom were both confused but so very loving and so happy to meet new faces.

It breaks my heart that he's transferring tomorrow to a university hospital for surgery and I won't be able to follow up on him.

Saturday, September 10, 2011

Disaster

My area is under a state of emergency right now. I worked a 20 hour shift at the hospital yesterday and am looking into another long shift today. The region is devastated, without drinkable water and many homes without electricity. Emergency command centers and shelters have been set up throughout the county.

I'm amazed at how well everyone worked together these last couple of days. The folks who actually made it, driving hours in convoluted directions, without complaint buckled down to work and spirits were remarkably high. We didn't know how long we would be the only ones who would be able to work and so my manager set up a rotating schedule partway through the day so that we could get some sleep.

A rep whose presentation was canceled, dropped the food off on our floor and so we dined. Because we couldn't use the municipal water, our coffee dispenser was shut off (it is connected directly to the water line.) A neighbor of the hospital dropped off a couple of percolators so that we could refuel.

Another aide came in to relieve me around 4:00 this morning and I began my journey home. Only one bridge in the area is functional and so I have to drive 2 hours on a winding path in the opposite direction to get on the right side of the hill/river in order to get home.

I was the only car in the middle of nowhere when a red sports car wheeled in front of me and then over-corrected to go flying into the tree in someone's front yard.

Immediately stopped, I put my hazards on and called 9 1 1. Describing what happened to the operator, I got out of my car to approach the accident. As I'm walking up, the boy who had been driving, stumbled into the yard, turned to look at the car, said "oh shit!" and took off across the road into the woods.

And so I told the operator. She said someone would be out as soon as they can. Considering the area was in a state of emergency, that 'as soon as they can' was 2 hours and 15 minutes. After giving my statement, they let me go and I began the long trek home.

Tuesday, September 6, 2011

Changes (and cleaning)

I know that I've been subtle about my frustrations with the folks at work. (tongue in cheek) A UA on the third shift has given her notice and I volunteered to step in. My manager is very thankful that I'm helping out and I'm really thankful that I get to work permanently with a stronger team.

I'm going to miss the greater opportunity to talk with patients during 2nd shift. I've found, though, the last few months I've been scrambling so much to do both the secretary's and aide's work I didn't have time to spend with patients anyway. I'll be glad to wear just one hat on this new shift.


On the cleaning note, I was out of town this weekend. I spent Saturday and Sunday up at my family's cabin. Coming home, I found my cat sitting on the window sill behind the kitchen sink watching the squirrels on the deck. Like she did all last winter...



As I turned to make a cup of tea, a mouse, A MOUSE!, ran across the stove and down into one of the burners. UGH! What's the point in having a pain-in-the-ass-she's-lucky-she's-so-cute cat if she doesn't mind roommates of the rodent extraction? I HATE rodents. Always have. I barely tolerate chipmunks and squirrels outside and the thought of them in my house makes my skin crawl. Their sharp pointy teeth that never stop growing are creepy. Besides, all of my work in Yellowstone has made me uber-aware of awful diseases (hantavirus, LCM etc) spread by little pointy toothed vermin.

I immediately pulled the stove out from the wall and, using a bottle of bleach, began scrubbing every surface I could reach. In my entire kitchen. For 3 hours. Then I went down to the 24hour drug store and bought a couple of traps. So far, I've only caught one and let it go across the street in the woods. My uncle mocks me for not killing them. He says that they'll just come back. But I can't rationalize killing something just because I hate them. Otherwise, all old drivers who go half the speed limit and don't use their turn signals...

Thursday, September 1, 2011

Little Friends


I almost ran over this tiny snake with the lawn mower.









This salamander was hiding beneath the fallen leaves under the deck.









This monster joined me in my morning shower. I could see her even without my glasses... and I shrieked!!


Rejected and Dejected.


I received my first rejection today and to my first choice. It had been a shoot-for-the-moon dream but it still stings. I haven't heard anything positive yet. I'm trying very hard not to be pessimistic.

Monday, August 29, 2011

Tripping Down the Stairs of Higher Education

I have heard that the college experience transcends generations, that Powerpoint is the main difference between a Harvard freshman class in 1900 and a Harvard class today. My parents and I bonded over similar experiences. As a non-traditional (read: older) student though, I have always been acutely aware that in many ways my academic experience has been profoundly different than even that of those my own age.

Students now deal with the enormous lectures halls and the reviled clicker questions. The body of knowledge to learn and the competition for top grades seem to grow exponentially before our eyes.

Each generation, each class, seems to develop radical ideas that change the world and the way we learn. When our parents had few resources outside their professors and material libraries, we have virtual access to libraries and scholars across the world as well as instant access through sites like Pubmed and Biomed Central (among countless others) to cutting edge research. We can clarify any confusion we may have about lecture material from almost infinite sources during the lecture. There is a beauty in the changes that America has witnessed in higher education. It is incredibly exciting to be right there and witness new developments unfold.

For example, Einstein fundamentally changed the world of physics for future students like Richard Feynman who, in turn, amended it for the new generations. Lisa Randall is continuing this evolution for current and future scholars. The biochemistry that I learned last year is radically different that that I would have learned had I studied it with my high school classmates. When they were studying advanced biochemistry lab techniques, the human genome had not been completely mapped. Certain technologies, like gene sequencing, that were cost-prohibitive to even postgraduate research centers then are now common in undergraduate laboratories. I was able to witness the development of new approaches like the development and use of homing endonucleases to cut HIV DNA that already been inserted into the host chromosome. But despite seemingly vast differences, the feel of college is the same.

Students are taught in essentially the same manner. Though we see a growing trend of non-traditional early learning philosophies (e.g. Montessori), at the collegiate level, the lecture method grips the undergraduate world just as we see in favorite stories like Tom Brown’s Schooldays or Tales of St. Austin’s. We suffer the same 500 seat lecture halls that our parents did as freshman, and at the graduate level, the fierce defense of one’s dissertation to a critical examining panel echoes softly in the memories of Cambridge’s fierce Wrangler mathematical examinations. Both parents and children relate to and laugh at the antics of Rodney Dangerfield in Back to School.

The students themselves are essentially the same. Roger Ashcam who wrote The Schoolmaster, a treatise on proper teaching in the 1560s, claimed “Some wits, moderate enough by nature, be many times marred by overmuch study and the use of some sciences, namely, Music, Arithmetic, and Geometry. These sciences, as they sharpen men’s wits overmuch, so they change men’s manners oversore… Mark all mathematical heads, which be only and wholly bent to those sciences, how solitary they be themselves, how unfit to live with others…” We can assume had he known the future evolution of chemistry & physics, he would have also securely included their scholars. We can all see this truth today. Everyone, regardless of her age, can remember growing up with a Milhouse, Urkel or Screech.

We see in the structures of universities, their classic Georgian or Gothic architecture, a lingering look to the past. The traditions of Greek Life, though on the wane, still exist. Students are still proud of being a multi-generational legacy. Memories of college shared between generations are that of a place out of time: days that start late and nights that never end.

The substance of academia is in constant transformation but the experience of being there is fundamentally the same. Though some of those newly found ideas shake the foundations of our world, our experiences, those joys found in intellectual awakening and the contribution of ideas to the great body of knowledge, may be shared trans-generationally.

As Ronald J. Daniels told the most recent freshman class of John Hopkins University “So although universities are in one sense symbols of permanence, they are – owing to their devotion to ideas -- paradoxically incredible engines of change. They change science and art, history and philosophy – even our understanding of what it means to be human – by the ideas they generate.”

Why am I waxing poetic over the college experience? Having dined at the smorgasbord of learning delights, having been able to choose to study something in depth under the guidance of great scholars, I have recognized how important it was in the development, the maturation of my character. The pleasure I feel when I can go to an art museum with an (somewhat) educated eye or read something, understand and appreciate some of its underlying social, economic historical forces is indescribable. But it is more than that. I was a full-fledged adult with strong opinions and curiosity before I pursued my college education. Post-college, I can look back and recognize that my full-fledged status did not mean fully formed. I know that my thinking and opinion formation now is deeper and more critical than before and I hope (and expect) that as I continue on in my education, that I will grow keener and more thoughtful.

On a greater scale, education is the driving strength of the development of our culture and nation. We would not be able to compete in the global market without the innovation an educated population develops. Those symbols of permanence and engines of change are undeniably some of the greatest sources of the innovation required to keep our country one of the most enlightened and innovative nations in the world.

I know that certain medias’ portray ‘the educated elite’ as unnecessary and even threatening to ‘normal people’; I see the fundamentalists try to disparage and discredit scientists in their attempt to sell creationism over evolution and I always laughed at the silliness. I mean, all of the comforts in our life, the luxuries (food, clean water, electricity, medicine etc) that allow us to focus on things other than physical survival, are due to the innovations by the very people that are being discredited.

But there are increasing unhappy trends in our status as the innovative and educated nation that make it more difficult to laugh off silliness. For the first time, we are looking into a future whose children will be less educated than their parents. They'll be less educated in a world of growing education opportunities. As a population, we need more, not less, education to compete on the global stage. We need more education to evolve as a society. Last year, the United States fell to an international rank of eighteenth in secondary education. That is almost as low as an developed nation can fall. We seem to be losing our drive to become the strongest or we're using a warped meter stick to measure our progress. Whatever the cause of this educational downturn, I’m just saying that I probably won’t be dismissing any silly attitudes anymore.

*The statistics I cited are from the Organisation for Economic Co-operation and Development.

Saturday, August 27, 2011

Hurricane Savior

So... tonight wasn't as awful as I had feared. Vile Princess is terrified of the hurricane Irene. She lives on the river and "just knew" that her apartment was going to be flooded. I explained that we're several hundred miles from the coast and will probably have nothing more than some big winds.

She shook her head frantically and pointed to the satellite image. "It's headed right to us!" I grabbed her Mountain Dew bottle and blew, waving my hand behind it. See... wind felt here but stopped by the hills. Hooray for the Appalachians!

Now I'm her new BFF and she was positively sweet to me for the rest of the night. I hope her memory lasts. Wish me luck tomorrow!!

Working Blues

I went to work yesterday refreshed and determined to maintain my good humour but the moods of some of my coworkers were just awful. I was running the desk and so was forced to be the central communicator for nurses, physicians, aides, and patients.

Usually, I get anxious when Dr. Pita* comes to the unit. Her mercurial temperament can be scary to work with. She can go from friendliness to dragon in three breaths. But yesterday, I was so happy that she decided to do all her dictating at our nurses' station. She was there for almost 3 hours which gave me a reprieve from the snipping and snarling of my coworkers. They're always more polite when a physician or supervisor is within earshot.

The girl who cried is one of the greatest culprits of nastiness. A significant responsibility of mine is to answer call bells and then call the nurse or aide needed to the room. I heard "Jesus Christ" (with accompanying eyeroll), "take them yourself-I'm done", "fine-FINE!"(with hand up, palm toward me) and other 'tude responses throughout the entire night.

One of the nurses commiserated with me after a particularly vile comment: "she's like that with me too." Argh. That almost makes it worse; I could almost rationalize her behavior if it was animosity solely directed toward me but that she just indiscriminately spews obnoxiousness...

Well, we're not allowed to police each other and I need to be more 'tolerant' of my coworkers. Bah. Think happy thoughts, think happy thoughts, think happy thoughts.

Tonight I'm scheduled to work with the vile princess and another moody grumpy aide. I'm absolutely dreading going in. (think happy thoughts think happy thoughts think happy thoughts.. )

Thursday, August 25, 2011

Back

I'm back from the cabin. It was a lovely interlude from the daily grind. I received a call during the trip from my brother... "we're here to celebrate with you... our car broke down... will you pick up your cake and some groceries..."

My brother is the most responsible person in the world (seriously!) and spend the entire weekend peering into the hood of his minivan with all the neighborhood men (beer in hand), trying to diagnose the issue.

In the end, his family borrowed my car while his was being repaired and today, I drove several hours south, and he several hours north, to exchange our vehicles.

Oh, I also dropped my phone into a local lake and so was without transport and communication for the entire week. It was a true vacation!



Saturday, August 20, 2011

"Now Comes Good Sailing"

I'm heading deep into the woods to my family's little cabin. This next week, I'm vacationing from people a la Thoreau; major break but with the occasional visitor. Here's hoping I can use this time to finish the rest of my school applications. I'm only halfway done and it's already late August!

Today is my birthday. When I blow out my candles, I'll wish for my parents back.

I'll leave you with a list:

1. The Crawling Eye
2. Jodhaa Akbar
3. Wit
4. Down by Law
5. Office Space
6. Guru (the one with Aish and Abhishek)
7. Starship Troopers
8. Stand by Me
9. Guess Who's Coming to Dinner
10. The Treasure of the Sierra Madre

*honorable mentions..
Dhoom 2 -but only because I'm totally in love w/ Hrithik Roshan
Dead Man -because Jim Jarmusch is a GENIUS
Indiana Jones & the Last Crusade- do I really need to explain this one?
Shawshank Redemption- this was actually on my top 10 until I thought about Sierra Madre, which won out by a hair

Fun Fact of the day: Katharine Hepburn's mother, Katharine Martha Houghton was the cofounder of Planned Parenthood with Margaret Sanger.

Thursday, August 18, 2011

Chicken Pox


One of the new nurses on the unit has a moderate case of the chicken pox. Policy here is that anyone who had contact with the infected needs to demonstrate either a recent immunization or an adequate varicella titer.

When I was hired last year, my titer was low. When I was six, I had had a severe case of chicken pox; if you closely examine my cheek and shoulders, you can still see the pockmarks. Because I've read that those who actually have had the disease demonstrate lower measured titers than those who are vaccinated, I declined to get a booster shot when I went through orientation. The clinic was across town and I didn't want to take an entire afternoon to get a shot I didn't need.

I am now presented with a choice: either take 28 days of unpaid medical leave or get the booster shot. I, of course, am getting the vaccination - I would need to for school next year anyway. It's just one more irritating errand in my already insanely busy life.

The irony is that the new nurse's infection is due to a booster shot she received during her orientation.

Monday, August 15, 2011

Rebirth



Today, my mother's birthday, I walked, reflected, found a tiny sparrow's nest, and ate ice cream with fresh picked blackberries.

Panegyric

The weather this weekend has been misty and gray. The trees quiver with the weight of the moisture on their leaves. With every gust of wind, the dew patters to the ground to echo the footsteps of my ghosts as they run through the woods.

One year ago yesterday, I decided to change my mother's care to palliative. It was the day before her 55th birthday. After some contemplation, I had decided not to wait until after her birthday to sign the paperwork. Though it had felt like I was giving up just when I should have been celebrating her life, I had finally recognized that she had given up long before and I just wanted her pain to ease. I didn't want her to have to struggle through her birthday.

Over the last year, that decision, all the decisions over the course of her care haunt me. I question if I should have waited, if I should have made the decision weeks earlier. I wonder if my self-interrogation stems from the melancholy that I feel right now, struggling with the convergence of her birthday, her death, my birthday (the 20th) and the anniversary of her funeral. I probably won't ever know if I made the right choice for her and that abrades me. I hope that as time passes, the erosion resembles less the calving of glaciers, monstrous pieces felled in a swoop, and more the gentle tumbling of sea stones.

Last night, a husband, surrounded by his family, decided to transfer his wife to hospice. The time spent in her room with her family was like a crampon squeezing my heart but they seemed desperate to have someone they trusted, who had cared for their wife, there to reassure them of their decision. I stayed because her daughter wouldn't let go of my hand and I couldn't bring myself to extract it.

The staff lounge was awash with comments like "it's about time" and judgments about the family's decision, a typical occurrence during these transitions. I completed her paperwork and then took a 5 minute bathroom break to rinse my grief from my eyes.

My sadness for her family and their coming sorrow, my sadness for the other six patients that I've transferred to hospice, particularly those who had no loving family to take on the burden of loss, and my memories of my beautiful vibrant charismatic mother sit like lead in my chest.

It's ironic that those who are most vocally critical of the choices that families make are those who have had the least experience dealing with any major decision, loss or grief and the least experience with the patient and her medical history. There were nurses who had never worked with the patient, never read her chart, never met her or her family who felt comfortable deriding the family and what they perceived as an unnecessary delay of the inevitable.

With a few questions carefully chosen to prick holes in their balloons of certainty, I made my point that this was a complex situation that could not be boiled down to an imprecise diagnosis and that making these types of decisions isn't easy or simple for clinicians who've been in the field for decades, let alone the families who are newcomers.

I started this post intending it to be a panegyric for my mother and the incredible staff at the Kindred LTACH in Wilkes-Barre, PA. Throughout the last months of her life, they nurtured the joy that she felt being around people- not an easy thing to do working in a hospital. Despite their many responsibilities and her inability to respond, they took time to visit with her and amuse her. They also supported me completely as I tried to navigate the bayou of treatment options. When my mom reached her limits and began to withdraw, I requested and they unhesitatingly joined me, her physicians and an ethical committee to discuss withdrawing treatment.

I am grateful that they demonstrated the power of empathy in softening the uncertainty and distress a family feels in these circumstances. Though, as an aide, I have no medical authority to ease the doubt and fear someone has in making a decision, I can follow the example set by the folks at Kindred. I hope that I made the family's trauma easier last night. I hope that I will always remember as vividly as I do now what it felt like grieving, frightened, unsure and dependent on the guidance and understanding of doctors and nurses.





Friday, August 12, 2011

Choices

Finishing my stint on third shift this morning, I stepped into the clear cool air and watched the beautiful blushing sunrise. It was a serene moment after a long night and a tense early morning.

One of our patients had left AMA just after morning labs. Last week, high on cocaine, Russell** started a bar fight and injured his shoulder. Dr. Joe told him that the surgery would be delayed for several days to allow his body to metabolize the cocaine. Russ was not happy to be stuck in the hospital for a week and recompensed by abusing the nursing staff: dumping his urinal over his sheets and the floor, barking at us when we walked by and spitting at anyone who came into the room.

We, of course, avoided him as much as possible. Well, Dr. Joe neglected to mention to Russ that he would have to have another drug screen before the surgery. Apparently his visiting friends had decided to bring him more drugs instead of flowers. When the lab tech went in to draw his blood, he went a little nutso, pulled out his IV and, blood dripping down his elbow, stormed out of the room toward the nurses' station screaming about bovine stool and ordering us to procreate with ourselves. Thinking he was going to attack us, we called a security code.

After the grey coats wrestled him back to his room, Dr. Joe came up and told him that the surgery was, yet again, delayed. Russ decided that he didn't want the surgery and demanded to be allowed to leave. Dr. Joe, quite angry and quite willing, retrieved the AMA paperwork and Russ left.

I stopped by the grocery store for cat food on my way home. I settled in the express line as a heavyset young woman unloaded her cart of items with the corresponding WIC vouchers on the counter. I had the rest of the day off and so buried my natural impatience with a magazine.

I soon found myself eavesdropping on the transaction ahead of me. The woman, refusing to pay the 58c difference for a bunch of grapes, told the cashier to take some grapes out of the bunch. I watched as the scan was voided, grapes removed, rescanned, voided, grapes removed, rescanned, voided, grapes removed, rescanned, voided and then grapes added one by one until the weight matched the amount allowed by the WIC voucher. *sigh*.. "day off.. day off.. day off.. breathe.."

The cheese came next without issue. The juice wasn't juice but punch and not allowed under the rules of the program. Argument. Huffing. Return with Lemonade. Argument. Huffing. Apple Juice.

Finally, the cashier began scanning the non WIC items: HungryMan dinners, bagels, jars of baby food and beer. Total $21.53. Oh, only have $18.37.. Big eyes look at the cashier then move to me. I bury my face in the magazine. Hummm... Ok, take the baby food off.

I drove home judging her. I drank my black coffee and judged her. I thought about the choices that she could have made but didn't. I began to reflect on the decisions that I have made that could be better and I felt guilty. I could have had something other than that blueberry muffin this morning. I could have had tea instead of wine last weekend. I make awful decisions all the time: too much cheese, not enough greens, not enough water, reading trashy novels instead of literature, watching True Blood. I have a degree in chemistry and a passion for studying nutrition. I still make crappy lifestyle choices. I think most people do.

Lady, you're doing alright. Keep going to your classes at WIC and keep fighting for every grape. Please just don't do it in the express line. And don't date anyone with a gimpy shoulder; he's bad news.






Wednesday, August 10, 2011

Night Shift Vacation

I've been working third shift this week. It's amazing how tranquil the small hours of the morning can be on the unit. The lights dim and, as we walk down the hall, the only sounds are those of our footfalls and the occluded IVs chirping like birds chattering in the woods.

Patient interactions are softer, quieter. They raise bleary eyes when I wake them for vitals or glucose testing and immediately nod off afterwards.

During the day, my job is hectic, a continual scramble to stay atop of the endless tasks and requests. At night, I mostly mitigate patient squabbles: she won't turn her TV off, He snores-I want a different room.. etc.

The staff, too, is more seasoned, less gossip-girl petty and fun to work with. The team in general has a perverse sense of humor- befitting a group that works the 'graveyard shift'. Last night, one of the nurses taped little devil horns and paper pitchforks to all of the office supplies (staplers, pencil sharpeners, computer mice) at the nurse's station just to annoy the morning secretary, Anna. Anna's celebrity doppelganger is Dwight from The Office. She's incredibly pedantic. This is great for dealing with time clock issues but she gets worked up over the craziest details.

The nurses on the night shift have developed an art to annoying Anna. It was so much fun to watch her huff around this morning tearing down little paper horns. After about ten minutes, she settled down to organize her desk. She then went to fax new orders to pharmacy. When she lifted up the scanner only to find more horns, she bellowed, bellowed, "Okay, who did this? Paper costs money people! No wonder we're always overbudget! This is ridiculous, Who did this?" She then glared at everyone in the nurses' station as though someone had stolen her purse. It was awesome.

If I didn't know that I would be bored within a week by the routine, I would request a permanent transfer to third shift.

Friday, August 5, 2011

Poison Ivy




I went hunting blackberries yesterday before work in the hills beyond my house. Through the misty rain, the sun had cast a mauve glimmer on gray shale and the birds' loud chatter drowned out any stray noises from civilization.




It was a much needed diversion into serenity. My hamster wheel had been spinning furiously and stepping off reminded me of the bigger picture. Attitudes at work drive me mad but it's only a brief interlude. It will only be at most 10 more months until I'm back to school (fingers crossed!).

So I walked in the woods with dew soaking my sneakers and breathed in the absence of people. Coming up over a knoll, the sun beamed through the trees and from across the meadow. There, I saw the bush. Enormous, succulent and inky berries glinted in the light.

I made my way forward and noticed the wide jade green leaves that surrounded the fruit. Poison Ivy. I stopped a moment and thought about the symbolism, the correlation with my work dissatisfaction and my ultimate goals. I couldn't help but laugh aloud, startling a small flock of goldfinches into flight.

I continued to the bush, thankful in many ways, that I don't react to urushiol and I picked the berries.


And I made a blackberry, ginger compote for my salmon.

Monday, August 1, 2011

Crying at Work

In Floating, I alluded to the reality that staff on my floor don't always do their jobs thoroughly. It's a major frustration; the onus of work usually falls on the shoulders of only a handful of people.

I get particularly fed up when our manager seems to coddle the biggest transgressors. He does have his favorites. Usually leaving before our shift starts, he's not much of a presence and I've always attributed his lack of enforcing job responsibility to his ignorance of what really happens during the evening.

When I first started, I really liked my manager. He was welcoming and warm and seemed to really try to create a happy work environment. As the first months past, he seemed really receptive to all of my little ideas for the unit, posting bed phone numbers over the information board in each room, changing the location of the linen carts to be more generally accessible etc. I reorganized the way that the medical teams, patients and nurses were listed on our charge board, color coding them to make the information much easier to read. You should have seen the way they did it before, it would take minutes to figure out who the doctor and lead nurse was for each patient! I was allowed to join the unit council (their first aide!) and I thought, despite my lowly status as a grunt, my thoughts, ideas and concerns were being heard. I took on all the training of new PCAs and attended workshops to improve my clinical mentoring skills.

Last month, another aide, ignoring an imminently dangerous situation for the patient, neglected to do something important. I stepped in and performed the required task, then followed the her to the nurses station. I confronted the aide and told her that she could not disregard those types of situations.

Well, she started to cry and complained that she was having a really bad day. Her brother was having oral surgery to have his wisdom teeth removed and she was so anxious about it. She became hysterical,(seriously!) and needed a twenty minute smoke break to regain her composure. Of course, I was rolling my mental eyes the entire time.

The next day, I was called into the NM's office and scolded. He informed me that it was not my place to police my coworkers(!) and that, and I quote, "not everyone has your work ethic". I told him that I was indeed having trouble adjusting to lack of my* work ethic in my coworkers and that my actions stemmed purely from my concern for the patient. He nodded sympathetically and asked me to work on my tolerance.

Of course, I've thought that maybe I was out of line or too harsh with the other aide. I talked it over with one of the nurses who had been present though. She reassured me that it happened as I remembered: 10 seconds of me getting the aide's attention, telling her to do her job and her becoming histrionic. She confessed that she too has been scolded for scolding someone else.

I'm currently looking for a new job** but I'm saddened and frustrated by the entire scenario. I absolutely love the work that my job entails (but not the poop part) and I hate that I'm leaving with such sourness. All that I've read about the evolution of healthcare shows that the culture is one of increasing openness to policing each other in the effort to generate fewer mistakes. To be slapped in the face with the very antithesis was shocking.


*my work ethic being that I actually do my job!
**I did call the 'anonymous' hotline two weeks later for an incident that I wasn't directly involved in. I haven't seen nor heard any outcomes but I hope that someone is looking into the mess that is my unit.

Salmon Again



Salmon poached in white cooking wine with garlic, capers, roasted red bell peppers and green olives

Cabbage Salad
shredded with jalapeno, currants and raisins, tomato, green pepper, onion, apple cider vinegar, sugar, cayenne pepper, lime juice and lots of ginger.

Sunday, July 31, 2011

Coming Home

After spending over a decade away from the itsy bitsy town in which I grew up, I'm still not accustomed to the small world that it is.

I still get a fleeting thrill when I see a local license plate before I remember that I'm actually home and they're more than common.

Last night, a nurse floated to our unit and, because it was relatively quiet, we got to chatting. She had just moved from Atlanta but, like me, grew up here. Oh, we went to the same high school! 84?, I graduated in 96. Did you know ___? What's your last name? Howe?!!! You're Franny's granddaughter?! Kathy's daughter!???

It turns out her father was a close friend of my grandpa's and my mom used to babysit her. We both, in our giddy, not-used-to-small-town-relations way, laughed and shared anecdotes all night until, like a pin in our bubble, two of the other nurses related how they discovered that they were cousins in an amazing story of medical drama and common relatives.

Humphh. Small towns.

Saturday, July 30, 2011

Nighttime Events

Yesterday, because of the construction, the census on U8 was low and I was expecting to get called off. Rather, another unit needed an aide so I floated down to the JD Rehab Center, a subacute care wing of the hospital.

I arrived to find Andrea, an ICU nurse, had been borrowed too. Andrea and I have worked together many times and have become friends. We laughed together as the night began because it was a vacation; most of her patients didn't even take medications and many of mine were independent.

Ironically, I wasn't allowed to do anything but task, no charting, testing glucose or vitals because I'm not a certified nursing assistant. So my responsibilities were minimal. After the last few months of juggling both the responsibilities of an aide and unit secretary, this was refreshing. Andrea teased incessantly, tickled by my certification limitations. She thought it was a riot and would demand proof that I was qualified to carry a dinner tray or empty linen carts.

The night dragged painfully though. After what would have been a double upstairs, the clock read only 3 hours into the shift on JDR.

Then the fall occurred. Apparently, the family of Grandma Smith* had unplugged her bed alarm while they were visiting. Its shrill beep was annoying to them. After they left without resetting it, 94yr Granny Smith decided to go to the bathroom to change. We found her crying for help in a pool of blood and vomit.

Andrea and I kicked into gear like Emil Fischer's lock and key enzymes. She checked vitals and stabilized her head while I went to the desk to call a rapid response team and the ED for a lift board, cervical collar and stretcher.

The nursing staff on JDR is amazing. They're friendly, good with patients and very good at their job. They don't have many medical emergencies there though and so seemed grateful to step back to let Andrea and I take control.

The residents, newly minted PGY1 and PGY2, examined her pupils, spoke with their attending and down we went to CT. I stayed at Gran's head, pushing the stretcher with one hand and holding the emesis basin with the other. When she would get sick, I would stop the stretcher, we would slowly angle the lift board and let her vomit on her side. Her wide eyes locked with mine and she held my hand tightly. I know that she was frightened by the fall and the rapid conversations flying over her head. I wasn't really needed in the medical part of the emergency other than as a strong back so I tried to keep a constant gentle flow of words to only her to give her something to focus on. I explained everything that they were doing before they did it and her breathing slowed and deepened.

We took her to CT, then XRAY and back to her room. She settled in quickly. Andrea dressed the wound on the back of her head and I swabbed her mouth out, washed the blood and vomit off her face and shoulders and changed her gown. She even laughed at some of my lame jokes. "What did one snowman say to the other?**" Then I stepped aside and let the CNA test her blood sugar.


*not Mrs. Smith real name. Also many details have been changed to protect her, or his?, identity and the identity of my medical institution.

**answer to really lame joke: "do you smell carrots?"

Friday, July 29, 2011

Matcha

After a long day, nothing relaxes me like a cup of matcha. I like to brew mine in milk -sacrilege! I know!- instead of water; it cuts through the bitterness better.

Thursday, July 28, 2011

Cleaning

The hospital is undergoing renovations. Last night, the construction workers were on our unit. They taped up little tents and began asbestos cleaning under the ceiling tiles. They were being cautious. They had even put up double drop doors in their tents to prevent any contamination when they entered or left.

Partway through the effort, I walked into the little kitchenette where we keep snacks/ice/drinks for the patients only to find one of the workers rinsing his vacuum canister in the sink. Dude.

He totally bypassed the closed/locked door with the sign on the front saying U8 staff only. (They have a master key to access all the rooms.) He was washing a disgusting greasy dusty cylinder in what was obviously a kitchen sink. I was horrified. I asked him what he was doing and then kicked him out of the kitchenette.

He claimed that he couldn't find another sink. I pointed to four sinks in the hallway and directed him to two different bathrooms, all closer to the work area than the kitchenette. Seriously, you couldn't have asked? *facepalm*

Wednesday, July 27, 2011

Cauliflower Quiche



I like to experiment with food. I often take random ingredients and try to combine unusual but complimentary flavors. This one was a winner.

3 eggs
1.5 cups grated cheddar cheese
.5 jalapeno pepper minced
lots of ginger
1/4 cup cream
1/4 cup water
1 package frozen cauliflower
handful of frozen spinach
handful of currants
salt/pepper to taste
bake in pie crust for 1+ hour (until firm) at 350*
garnish with currants and Italian parsley

Monday, July 25, 2011

Neighbors

My mother died last year and I've been trying to sell her house. It's a pain; the housing market in this area is incredibly depressed and mine is one of a dozen for sale in this neighborhood. I do what I can on a nursing assistant salary to maintain it. Spending hours weekly landscaping in the yard and tinkering in the house, I've become very handy. I've taught myself how to put up drywall, repair cupboards, fix burst pipes and paint/stain with the masters.

My neighbors are the same as when I was a child. I grew up with Krissy. We caught critters, played softball together and fantasized about pooling our money for a horse. The horse was to go in my backyard which I mistakenly convinced myself was zoned for farm animals. I think my father let me believe that, hoping that I would save money instead of spending it.

Krissy had a baby when she was a teenager and her parents, who live next door, often watch over him while she's at work. Over the years, particularly through my mom's extensive illness, Jack, Krissy's dad, has helped us tremendously. He mowed my mom's lawn, shoveled her drive, carried her groceries and brought in her mail when she was too weak to stand.

He was the very best neighbor anyone could have. Now he'll yell at me to be careful when I'm on the roof replacing shingles or painting ducts. He's always available in a pinch if I run out of gas or need an extra pair of hands.

His grandson, though, is a punk. Jerome is 12 now and the most disrespectful, destructive little brat I've ever had the misfortune to meet. We used to have a basketball hoop over our garage. I took it down after Jerome and his friends broke windows and cracked and shattered the vinyl siding along the garage wall.

I've come home to find shingles missing from the garage roof where they dive into the ground pool. The deck/pool is surrounded by lattice. I spent days painstakingly staining it only to find my efforts damaged from their rambunctious antics in the pool.

I've told Jack that I prefer the boys not come over without supervision. I've mentioned the damage but it has had no affect on curbing more wreckage.

I don't know what to do. Jack has been an amazing friend and neighbor over the years and I want to be able to extend open invitations to my parents' amenities. I just can't afford repairing all the destruction his grandson causes though. I've hinted that Jerome isn't welcome but it doesn't make any difference to his indulgent, doting grandparents.

This situation sucks. Any ideas out in blogland?

Sunday, July 24, 2011

Real Men Eat Quiche


Quiche is an awesome dish. Simple to make, easy to experiment with and impressive to serve. My burly manly-men cousins love quiche unabashedly, without exception, and will always stop by to help around the house if I have snacks handy. This quiche helped me get my refrigerator repaired in record time!
This is my twist on the classic Italian salad.

3 eggs
1.5 cups shredded cheddar
1/4 cup mozzarella (perline)
lots of fresh basil chopped
3 Roma tomatoes diced
1 jalapeno minced
1 cup milk
1 pie crust
1/2 cup whole wheat flour
salt/pepper to taste

Bake at 375* (until firm) and let sit 1/2 hour before serving. Garnish with fresh basil.

Juggling Thoughts

We have a nurse on our unit. John* is incredible with the patients and acutely intuitive about their well-being. He's saved several lives by noticing that a patient is 'off' and calling the appropriate people to take care of it.

He sucks at multitasking though. His medicines are always administered late and he can't give a decent concise report during shift change. We all, nurses and aides alike, dread following his group. There's always information missing and tons of catch-up to do before we can start our own assignments.

I recently read Dr. Ofri's Lancet contribution and thought about John and then about my own future as a physician. My experience thus far has been relatively painless. There's a certain triage that people use when they multitask. Providing orange juice for a glucose reading of 56 trumps the coffee for a visitor in room 654. Occasionally, When I'm juggling 10-15 requests, I'll sometimes overlook one.

It scares me that I may forget something vital when I'm a physician. Will I remember to order a CBC on a patient with a GI bleed? How can I be smart enough to manage the care of so many patients when I can forget to bring someone a ginger ale?

Dr. Ofri's editorial has relived my mind (somewhat) in that I won't be the only doctor with these fears.

Poached Salmon and Bean salad


Last night, I made poached salmon with a garlic caper butter and a three bean salad.

Three Bean Salad:
l can black beans
l can red kidney beans
1 can white kidney beans
1 can corn
5 cloves garlic
1 bunch cilantro
3 plum tomatoes
2 large cucumbers
3 fresh limes squeezed
1 sweet onion
1 green pepper
2 jalapenos minced

Fragile Flower Syndrome


My grandmother has what she has denominated 'FFS'. It's a delicate balance to treat her hypertension, hyponatremia and Meniere's disease (for which she takes hydrochlorothiazide, a diuretic) and she'll often call me over to check her blood pressure.

The heat wave has hit her hard but she giggled today when I told her as I wrapped her arm with the cuff that she looked like a wilted daisy with her white hair and dark eyes.

Saturday, July 23, 2011

Temples

I have a cousin who is addicted to crack. Our family has struggled to understand how he could have made the choices that forced his life into a downward spiral. We discuss what approaches to take, limitations to set, anything to help Beck come back. But he doesn't want to. He lies, manipulates and steals, neglecting his children and watching his debt grow.

It's heartbreaking to see my aunt weep, grieving at the loss of her son and fearing for the welfare of her grandchildren. Their mother died of an overdose two years ago and Beck has sole custody. Though his house could be featured on an episode of Hoarders and his electricity and water are periodically shut off, he doesn't fall below the threshold of what is unacceptable to Social Services and so his children remain with him.

I see his jittery hyperactivity and the tracks on his arms when he comes to ask me for money; his electricity, water, phone etc are about to be shut off. I see the boy I played with as a child, catching snakes and salamanders, climbing trees and building forts.

My patient tonight, a woman with liver failure, is febrile and having seizures from alcohol withdrawal. Sedated, she didn't move when I took her vitals and washed her up. I was tender, reverent when I rolled her to her side to clean stool from her bottom and salve with protective ointment. Though she was alone, I could see the child that she was and the people who love her despite the abuse she gave to her own body. I hoped that my cousin would be treated gently when he crashes and is brought to a hospital unit like mine.

I swam tonight, alone in a crook of the river. I could feel the water against my body and the freedom of my limbs. I flew, buoyed by the water, unhindered by gravity. I love my body. It is the only house that the essence of me will have. I am amazed sometimes when I look at my arm, think about its function and then raise it purposefully, only to demonstrate to myself that my mind has control of it. I'm telekinetic with my own body. It does what my mind tells it to.

I could wax poetic, citing Descartes and his mind-body dichotomy, but I'm a Spinoza girl. I see the physical connection, calcium released and synapses firing, between my thoughts and the movement of my arm. It works beautifully and I don't want to mess it up.

I'll have a glass of wine with dinner and a scotch on special occasions. I love the taste, the dimension, the artistry that can be found with alcoholic beverages. I've even been happily intoxicated on occasion.

There's a turning point, a threshold that people pass when they immerse themselves completely into habits that destroy the function of their body.

I wash bodies for a living. Every day, I help someone to eat, walk, communicate or clean themselves. I hold reverence for their bodies and the function those bodies have in housing the special being that makes the individual. I'm gentle even when the patient is not. It's a gift to be there cushioning the body, encouraging someone to respect the majesty of their own body when they don't see it themselves.

I treat the open wounds of my patient tonight. I hope that she wakes from her sedation and recrosses that threshold into a place where she respects the gift of her body. I hope that my cousin rediscovers his own gift before he destroys it completely .

Friday, July 22, 2011

Jalapeno, Tomato and Cabbage Slaw




1 small cabbage head shredded
2 large plum tomatoes diced
1 handful of chives chopped coarsely
1 large red jalapeno chopped finely
1/4 apple cider vinegar
1/4 honey
2 cloves garlic minced
and a tiny bit of ground ginger
squeeze 1/4 fresh lime

salt and pepper to taste...
The ginger adds some dimension to an uncomplicated dish.

The Fountain

People often ask me at work why I want to go into medicine instead of nursing. I often say in partial jest that I don't like poop. The other, non-jesting half raised it's head last night.

An elderly patient was admitted with a broken hip from a local nursing home yesterday morning. Throughout the day, XRAYs were taken, EKGs performed and Ike* was medically and cardiology cleared for surgery on Monday. It was an arduous exhausting day for the poor, confused man.

As the evening progressed, Ike began to become more confused. Sundowners syndrome is a common phenomenon with some disoriented elderly people. In Ike's case, he became spatially disoriented and lost control of his bowels.

His nurse, Tina and I noticed his incontinence and gathered the supplies needed to clean him up; washcloths and towels, bedclothes, a new gown and Proshield, a skin protectant. We rolled him to his unfractured side and I began the cleaning process.

Afraid that he was going to fall, Ike began howling and let his bowels loose. It was Old Faithful. For several long moments the stool shot up into the air, splattering the sheets, the bed rail and my shoes. I quickly grabbed the clean towel and, in a futile attempt to dike the flow, placed it against his backside.

After the fountain tapered off, I gingerly took the towel away and resumed my wiping. Whoosh, the geyser erupted again spraying the front of my shirt. I snatched the bedpad and all the washcloths and again tried to dampen the flying stool.

This cycled continued for at least 20 minutes, all the while Ike was howling, Tina was trying to reassure him and I was trying to trench the lake of poop. It was awful. Tina was rubbing his back, whispering to him and avoiding my eyes. She snickered a couple of times but for the most part, stalwartly restrained her laughter. I'm sure that I was a sight; covered from shoulder to toes in poop and frantically using anything handy to stop the pool from cascading to the floor.

Later, as I wiped the streak on my cheek away in the staff room shower, I couldn't think of any of my more noble reasons for preferring medicine to nursing.

*all names and details have been changed to protect the identities of anyone who may be totally embarrassed by the occurrences that I described.

Thursday, July 21, 2011

Egg Salad


Down to the dregs of my larder, I made up this little salad.

Boiled eggs
dash of salt and pepper
lots of fresh garlic
a little chopped sweet onion
frozen spinach
and dill to taste
a tiny bit of mayo to hold it together

It came out deliciously!

Ethics of Eating

There's a patient on the unit, a friendly undemanding young woman. Except for her diabetes and the cellulitis that brought her in, she has no other major medical issues. Which is surprising because she's beddridden due to obesity. She would need to lose over a hundred pounds to reach a BMI of 100. She's too heavy for any of our bariatric lift equipment and, though she rolls well in bed, two of our nursing staff have been hurt cleaning up her incontinence.

In his very first order set, the hospitalist requested Physical Therapy and Occupational Therapy to work with her 3x daily. The amazing strong gentlemen of our PT department were able to bring her to the edge of the bed (not an easy task for anyone on an airbed!) and do some ROM exercises with weights! We were so happy and proud of *Dolores. Then...

She refused. Every time someone would try to help her to the edge of the bed for meals, encourage her to use her little hand weights or ask her to try any form of exercise, she would become angry and uncooperative. She would throw the weights onto the floor and become unresponsive.

*Dolores is not this patient's name. All details have been modified to protect identities of both the patient and the hospital staff.

It's been six weeks since she arrived at the hospital. Her infection has cleared and she's medically well. The nursing home she came from no longer has a bed and other nursing homes/rehab centers won't accept her until she demonstrates some willingness to work on regaining functionality.

Our dietary service limits the concentrated sugars and carbohydrates she's served but her mother keeps her well supplied with candies and soda pop despite our requests that she not.

Every time I work with Dolores, I'm frustrated. As an aide, I have little autonomy in my work with her. I cannot refuse or limit her HS snack without a calorie restriction order. I cannot force her to use her weights or incentive spirometry. I cannot search through her mother's tote to prevent the mars bars or cherry coke from entering the room and Dolores' digestive system.

I've always adhered to Kant's categorical imperative (the second formulation). Shadows come though, as Kierkegaard predicted, because people are freakin' LAZY. Unchecked, people don't behave rationally. Dolores' laziness has become pathological.

Do we have a responsibility as healthcare givers, to set limits and enforce regimens on those who refuse to adhere? It becomes a catch-22 when someone refuses care but is too weak/ill to go home. What do we do when they're refusing care and refusing to leave?

Do we have the right to become enforcers, trumping their free will in these situations?