a B

Did you know that naproxen and glyburide are highly protein bound? This can result in increased glyburide levels, as the Aleve competes with protein binding sites, causing hypoglycemia. I didn't know that. It wasn't anywhere in the reading, class notes, lexicomp, or epocrates--but it was on the clinical pharmacology EXAM!!!! And I got it wrong. 88%. I haven't gotten a B on a test in 6 years and I'm pissed off.

Arghhhh.

It's been an almost perfect storm at work the last two weeks, equal elemental forces converging consisting of responsibility--I charged--3 level one trauma admits, short staffed, inexperienced staff (but great attitudes--what a group)--severed limbs, unredeemable patients, severed limbs, constant diarrhea, crazy family members, and leaking rectal tubes (between my two patients I had 17 linen changes on Saturday).

I had weird dreams involving that surgeon I kind of like. I had to insert a rectal tube. He wanted to kiss me, moved a strand of hair out of my eyes. He'd also grown his hair out and looked a little bit like Brad Pitt in Legends of the Fall (a really stupid, hokey movie). "I don't have time for that," I snapped (in the dream). "We've got to get a new Zassi in you right now.!"
I'll never forget the look of disappointment and betrayal in his eyes... Then I woke up next to Jay and felt all guilty.

I told Marcy about the dream.

"He deserves a rectal tube." She said. "Maybe it would get that stick out of his ass. And it wasn't like you were having sex with him. I don't think Jay would be jealous of that kind of interaction. Unless he's weirder than you know."

He might be. I caught him lying last week. Maybe that's why I'm having dreams about putting rectal tubes in my coworkers! He did go visit the 28 year old bartender in Summerville when he was on his shoot. He had told me that he didn't even go into town. We went down to visit his son in Summerville last week. "Haley's (her name's Haley, too--can you believe it? another one!) going to think I live down here, now," he said, musingly, as we were driving. "I've been in that bar almost once a week lately."

"I thought you said you didn't get into town."

Silence. Whoops.

"I never said that."

"Yes, you did."

"No, I didn't. You're just looking for trouble."

I let a few minutes pass. Then I said, "You know, you need to accept that, now you're 53, and with the head injury and all, you're probably not cognitively intact enough lie anymore."

We choose our poison, don't we?

I had a patient who had taken to his bed. He'd just decided...that was it. Not getting up anymore. Young guy. Lay in bed. Watched MTV. Those horrible reality shows--the one with that girl with all the tattoos...oh my god, what a waste of a life. Curled up in bed. Smoked two packs of cigarrettes a day. He developed contractures. He could only turn to the right. His organs became compressed, he couldn't breathe. He developed osteopenia. His bones fractured--hips and ribs. Wore a diaper. We couldn't do anything for him. And he chose this. One day at a time. Our bodies and our lives form the shape of our minds and hearts.

Dear Reader. Life is imperfect. Stand in the sunshine. Stand and stretch and move as much as you are able. Move through your pain. Breathe deeply. Love those around you impeccably. Learn as much as you can. Serve and love your world. Forgive yourself and others. I will try if you will.

Love,
Haley