3 weeks now of keeping Tonks quiet. 5 more to go. She can only go outside and walk around 3 times a day for ten minutes at a time. When she does walk, she walks sideways, like a crab. It takes her a few minutes to get her backside in line with her front. I try to carry her around the house as much as possible because she hates the cage so much, but sometimes, I have to put her back in it. They say that golden lhasas are reincarnated dalai lamas. Not a bad way to come back, I guess.
Yesterday was my overtime shift. They gave me a student midway through it. Dumber than a post.
"Could you please turn on the lights?" I asked her. We were doing a dressing change.
"I don't know where the switch is," she said. "Sorry." The lights stayed off. She stood by the sink with her hands clasped behind her back.
Okay.
Call me crazy, but we're all Americans, right? And all the light switches here in America look pretty much the same, and ICU rooms are pretty small--so how much mental acumen does it take to scan four walls looking for the light switch? Christ, what does this woman do in hotels, sit there in the dark? Maybe she just carries a flashlight with her everywhere.
My patients were easy, but busy. One of them had just been diagnosed with terminal cancer. Not really an ICU patient, but he had had some respiratory distress on the floor and so had been taken up here for observation.
"Am I going to die?" he asked me.
"Not imminently." I said, heartlessly.
"What does 'imminently' mean?" he asked.
Sometimes, blessedly, you get a second chance to be human.
I pulled up a chair. "It means that you are doing really well up here." He was. He would get teary and strange sometimes (well, who wouldn't?) but he had a really great attitude and was willing to try anything we asked of him.
But you know, these talkers...these die-ers....they take up all your fucking time.
I didn't get home til 10.
Taco Bell. If you cut a trauma nurse open, you will find beans and cheese.
This morning, there was no milk of course, so no cafe con leche. The house was in shambles (it was perfect Friday night) and I started sobbing in the kitchen. It's garbage day, there are clothes all over the bathroom floor. I know my kids have a hard life, but couldn't they do a dish? I yelled, took away tv, car, and church.
Which is funny. I guess that's good about my kids--taking away church is a punishment. Huh.
So that was a lovely way to start the morning. I went to Ernie's, hoping to run into Soupy, our ME, because I wanted to talk to him about the girl we coded, but he sort of avoided my gaze. I wonder what's up?
But Staci was at the counter. I change most of the names in this blog and alter identities enough to make them fiction, I hope, but I'm going to keep Staci Roberts real, because she deserves to be famous, and she wouldn't mind being written about.
Staci is the best musician I know. She brilliant. Voice like butter, songs so startling and true you can't believe you don't already know them. She's a little bleary, a lot lost. When I met her ten years ago, she was 17 and living on the street. It was winter and she was sitting on a bench downtown with Pedro. Pedro was playing the trumpet and she was singing this song about the street she wrote called Simple Life. She had her guitar case open and was collecting change. She's not really pretty, she looks a lot like me. People often think we're sisters. Our voices are a lot alike: we've recorded together a couple times and you can't tell who's singing. Her voice is a lot richer and truer than mine is, though. I really need the mike, she never does. I handed her my tape and put a dollar in the case--I had just moved back and was looking for people to play with. She called 3 months later.
So we caught up. She'd actually been in the ICU a few weeks ago, the weekend I was gone. I hadn't even known she was there. Drunken car wreck, she'd been a passenger. Intubated, plastic surgery, tried to punch the anesthesiologist. The usual. She looked good, though.
"I'm just glad you're okay," I said.
"You just don't know what to do with me, do you?"
"I have no idea."
"I lost my brother," she said, "in the ambulance." Staci carried the ashes of her dead brother in a jar around her neck.
"I'm so sorry--do you want me to talk to security? See if they have them?"
"yeah, sure."
Talen brings me breakfast, without me even ordering it. "Did you hear," he asks, "I'm leaving."
I can't believe it. Talen's been at Ernie's forever.
"Where are you going?"
"New York. Brooklyn." He smiles. He looks so happy. "I'm going to be 40 next month. I can't stay at Ernie's my whole life."
"Yeah...your tattoos would all scrunch up together...it would be sad to watch..."
Ah...changes. He puts my gum on the counter this morning. In front of me on top of my check.
Tuesday, November 13, 2007
Sunday, November 11, 2007
Mysteries
Sometimes the things that happen in my job are so surreal and strange I can't believe it.
I feel like people see me as someone outside of reality, I don't know how to put it. I'm not sure exactly what I mean. I feel people tell me things and speak to me in ways they would never speak to anyone else. I don't know how to respond, and I end up saying these sort of grandiose, prophetic things. I sometimes feel I am speaking in a dream.
Today, a girl came in, a trauma. A teenager. She coded upon entering the door of the unit. It was a terrible, long, desperate code. We gave her 20 units of blood, 7 units of FFP, 1 of Cryoprecipitate, 2 of platelets, and 45 bags of fluids. We squeezed it in with our hands, there were two OR procedures in the room, because we didn't have time to get her to the OR. and we suctioned 6 liters of blood--I kept refilling and emptying cannisters, emptying her blood into the sink. We didn't have time to think.
The code was called and she was pronounced. We began getting her ready and cleaned up--the place was an unbelievable mess--and just without thinking, I reached down and checked her carotid.
And felt a pulse. Strong and sure.
I always want to shout, but I've gotten really good at speaking quietly and evenly. In fact, the more I want to scream, the quieter and calmer I am. Wiz is good at this too, and so, when he acts like this--calm and sure and even, I get really scared, which the staff doesn't understand. so I whisper, "Baggins, she's alive. Feel. "
Baggins puts his stubby little hands on her neck. Baggins has an 18 year old girlfriend. He has a naked picture of her on his cellphone. Watching Baggins touch younger women makes me nervous.
"Fuck." Baggins says. "Fuck, fuck, fuck."
I start bagging her.
"get her back on a board, do we have a med box?"
I yell for anesthesia. The respiratory therapist checks her pupils. They are reactive. They were fixed. For one incredible exalted moment, I feel like there's a swan in my heart, unfolding its wings. She's alive. Everyone comes back in. The attending is carping, "a thready pulse often persists for a few minutes, the patient is dead."
"With all due respect," Baggins says, "this girl is still alive." Oh, Baggins, you little asshole, I love you so, I think.
But in the end, we lost her. She just bled out, and there was nothing we could do.
The attending turns to me, she's a little dried up leaf of a woman,--"You," she says, "turn off the monitor, do not check a pulse, do not assess or evaluate her, we're leaving her alone now."
Whatever. Who knows what we lost in those minutes that we missed. Of course I checked her.
Then I went out to talk to the family. The attending had just gotten through telling them the news and is standing by the door. I walk into the consult room--a drab, windowless, soundproofed room that smells like cigarrettes, even though smoking has been banned at the hospital for years. The mother is dry eyed, my age, plump, in a green acrylic sweater.
"Hello," she says, "I'm the mother."
"Hello," I reply. "I'm the nurse."
"Did you see how beautiful she is, did you see how beautiful my baby is? Did you see her beautiful hair?" she asks me
"She is so beautiful," I say, feeling a little surreal. "Her hair is so thick and blonde."
And then the mother starts sobbing. I put my arms around her. There's a lot of family around, but they seem just flummoxed. "I've always been afraid," the mother says, "I've always thought I would die. I always thought I would never live to have children," she's sobbing into my shoulder, and I don't think the others can hear her. "Do you think this is an accident, and I was supposed to die instead, and that somehow I made this happen, by being so afraid of it? Do you think I called it?"
"No," I say firmly.
"Why was I always so afraid? Why?"
why do people ask me these questions?
"Because children connect you immediately with the miracle and mystery of life, and the mystery makes you afraid, but that's just part of it. You're afraid because you're alive in the mystery, and unsure of the outcome, and oh, so tied to it by your love. That's the fear And everyone has it. You didn't call it." I speak without thinking in these situations, I figure that what pops out of my mouth is probably better than anything I could actually plan on.
We are sudden allies, we two, who have never met till this moment. She wraps her arm around my waist like a sister. "I want to go see her, now." she says.
"Are you sure?" I ask. "You don't have to if you don't want to."
"Will you stay?"
"I'll stay."
"How long can I stay?"
"As long as you need to."
We walk into the unit, and even though her husband is with her, oddly, it is me she clings to. And the oddest thing is that this feels perfectly natural. I feel like I've known her my whole life.
So we go in and she holds my hand and tells me all about her daughter--all about her--and in this moment I would give anything and everything except my kids for these people not to have this happen. Iwould trade my house and my car and every single thing--if there was some bargain to be made somewhere along the way that would have spared them this--I would have made it, I swear to god I would have.
Sorrowful mysteries.
I'm nominally a buddhist, but at times like these, it is the rosary that makes the most sense to me. It is Mary's suffering and Christ on the cross.
Listen, oh child of noble family...we are all the same. You and I. There is no difference between us, here and now and past and present. You are your neighbor. You are the stranger. So, prayers and love to all broken hearts tonight. They are our own.
That's my 1/2 hour.
I feel like people see me as someone outside of reality, I don't know how to put it. I'm not sure exactly what I mean. I feel people tell me things and speak to me in ways they would never speak to anyone else. I don't know how to respond, and I end up saying these sort of grandiose, prophetic things. I sometimes feel I am speaking in a dream.
Today, a girl came in, a trauma. A teenager. She coded upon entering the door of the unit. It was a terrible, long, desperate code. We gave her 20 units of blood, 7 units of FFP, 1 of Cryoprecipitate, 2 of platelets, and 45 bags of fluids. We squeezed it in with our hands, there were two OR procedures in the room, because we didn't have time to get her to the OR. and we suctioned 6 liters of blood--I kept refilling and emptying cannisters, emptying her blood into the sink. We didn't have time to think.
The code was called and she was pronounced. We began getting her ready and cleaned up--the place was an unbelievable mess--and just without thinking, I reached down and checked her carotid.
And felt a pulse. Strong and sure.
I always want to shout, but I've gotten really good at speaking quietly and evenly. In fact, the more I want to scream, the quieter and calmer I am. Wiz is good at this too, and so, when he acts like this--calm and sure and even, I get really scared, which the staff doesn't understand. so I whisper, "Baggins, she's alive. Feel. "
Baggins puts his stubby little hands on her neck. Baggins has an 18 year old girlfriend. He has a naked picture of her on his cellphone. Watching Baggins touch younger women makes me nervous.
"Fuck." Baggins says. "Fuck, fuck, fuck."
I start bagging her.
"get her back on a board, do we have a med box?"
I yell for anesthesia. The respiratory therapist checks her pupils. They are reactive. They were fixed. For one incredible exalted moment, I feel like there's a swan in my heart, unfolding its wings. She's alive. Everyone comes back in. The attending is carping, "a thready pulse often persists for a few minutes, the patient is dead."
"With all due respect," Baggins says, "this girl is still alive." Oh, Baggins, you little asshole, I love you so, I think.
But in the end, we lost her. She just bled out, and there was nothing we could do.
The attending turns to me, she's a little dried up leaf of a woman,--"You," she says, "turn off the monitor, do not check a pulse, do not assess or evaluate her, we're leaving her alone now."
Whatever. Who knows what we lost in those minutes that we missed. Of course I checked her.
Then I went out to talk to the family. The attending had just gotten through telling them the news and is standing by the door. I walk into the consult room--a drab, windowless, soundproofed room that smells like cigarrettes, even though smoking has been banned at the hospital for years. The mother is dry eyed, my age, plump, in a green acrylic sweater.
"Hello," she says, "I'm the mother."
"Hello," I reply. "I'm the nurse."
"Did you see how beautiful she is, did you see how beautiful my baby is? Did you see her beautiful hair?" she asks me
"She is so beautiful," I say, feeling a little surreal. "Her hair is so thick and blonde."
And then the mother starts sobbing. I put my arms around her. There's a lot of family around, but they seem just flummoxed. "I've always been afraid," the mother says, "I've always thought I would die. I always thought I would never live to have children," she's sobbing into my shoulder, and I don't think the others can hear her. "Do you think this is an accident, and I was supposed to die instead, and that somehow I made this happen, by being so afraid of it? Do you think I called it?"
"No," I say firmly.
"Why was I always so afraid? Why?"
why do people ask me these questions?
"Because children connect you immediately with the miracle and mystery of life, and the mystery makes you afraid, but that's just part of it. You're afraid because you're alive in the mystery, and unsure of the outcome, and oh, so tied to it by your love. That's the fear And everyone has it. You didn't call it." I speak without thinking in these situations, I figure that what pops out of my mouth is probably better than anything I could actually plan on.
We are sudden allies, we two, who have never met till this moment. She wraps her arm around my waist like a sister. "I want to go see her, now." she says.
"Are you sure?" I ask. "You don't have to if you don't want to."
"Will you stay?"
"I'll stay."
"How long can I stay?"
"As long as you need to."
We walk into the unit, and even though her husband is with her, oddly, it is me she clings to. And the oddest thing is that this feels perfectly natural. I feel like I've known her my whole life.
So we go in and she holds my hand and tells me all about her daughter--all about her--and in this moment I would give anything and everything except my kids for these people not to have this happen. Iwould trade my house and my car and every single thing--if there was some bargain to be made somewhere along the way that would have spared them this--I would have made it, I swear to god I would have.
Sorrowful mysteries.
I'm nominally a buddhist, but at times like these, it is the rosary that makes the most sense to me. It is Mary's suffering and Christ on the cross.
Listen, oh child of noble family...we are all the same. You and I. There is no difference between us, here and now and past and present. You are your neighbor. You are the stranger. So, prayers and love to all broken hearts tonight. They are our own.
That's my 1/2 hour.
Saturday, November 10, 2007
Love
Nicholas has friends over: the beautiful Madonna and three other boys that look exactly like Nick, differing only in the severity of their acne. They're all sitting on the couch eating fritos and watching Transformers.
Nick is doing better. His grandfather gave him a car on the day after Madonna broke up with him. It's a 92 Thunderbird, bright red, and he really souped it up. It's kind of a county boy's dream--floor matts with flames, red and black leather seat covers, which is not Nick's dream, but he's happy to have a car. So happy, in fact, that he actually jumped up and down a litle bit, just a teeny little bounce. He asked me, "How long do you think I have to wait to remove the flamey floor mats without making Granddad feel bad?"
So, nothing like a car to balance out a girl, I guess.
I'm so tired.
My orientee had to deal with her first death today. She had a hard time with it. I feel nothing, I think. Just tired. It went smoothly, the patient was elderly and the family withdrew care and within 15 minutes, the patient had passed. The doctor was there to pronounce this time.
Last night both kids were out of the house--Lilly at her best friend's and Nick at a debate tournament so I went out to Jay's. We had a drink with Hunter before we headed out--I told you about him before. Hunter has recently gotten himself trapped into a relationship with Sybil, an old girlfriend from 20 years ago of Jay's (things get incestuous in our town). For the annual pumpkin festival parade, he and Sybil and their kids dressed up as monkeys, and dressed their VW bug as a monkey, too.
"Let me tell you," Hunter says, smacking his reptilian lips, "Sybil makes a pretty sexy monkey."
"I think that's enough." Jay says.
"I mean," Hunter continues, "if Sybil really were a monkey, I would cross species." Sybil's a bit of a grifter--a pretty bird in her mid forties, running out of options, looking for a soft place to land. Never learned how to do anything, never held a job. I know a lot of women like this--and they all seem to end up okay. I'm a little resentful--I've worked so hard to make it by myself. Maybe I should have taken a different tack--but then again, I'm not that pretty. And then again again, who would want to end up with Hunter?
"If I were a monkey," Jay asks me, "would you still love me?"
He never uses the word love.
"Of course. What about if I was something, like a rabbit?"
"I wouldn't fuck you, but I would still love you."
"Would you date other women?"
"Well, that depends."
"On what?"
"Are you saying that you are a rabbit, or did you turn into a rabbit. Were you you first?"
"I turned into a rabbit. Sybil cursed me."
"Can you talk?"
"Yes,"
"Okay, then no. I wouldn't date other women. Or at least, I wouldn't bring them back to the house. Because you would yell at me and then they would freak out."
"But you would go to their houses. How would you protect me from the cats while you were away?"
"This is a silly conversation."
"You started it."
"I asked you if you would still love me if I were a monkey , a monkey is a primate. A rabbit is something completely different."
"the issue is unconditional love, not what species I've transformed into."
We stop talking, watch a movie about a guy who starts a movie theater on Fiji, stop watching in the middle, make love.
I'm falling asleep.
"I would still have sex with you, " Jay says, "and I would still love you, even if you did turn into a rabbit."
Well, I think, sometimes you just have to take what you can get, I guess.
That's my 1/2 hour.
Nick is doing better. His grandfather gave him a car on the day after Madonna broke up with him. It's a 92 Thunderbird, bright red, and he really souped it up. It's kind of a county boy's dream--floor matts with flames, red and black leather seat covers, which is not Nick's dream, but he's happy to have a car. So happy, in fact, that he actually jumped up and down a litle bit, just a teeny little bounce. He asked me, "How long do you think I have to wait to remove the flamey floor mats without making Granddad feel bad?"
So, nothing like a car to balance out a girl, I guess.
I'm so tired.
My orientee had to deal with her first death today. She had a hard time with it. I feel nothing, I think. Just tired. It went smoothly, the patient was elderly and the family withdrew care and within 15 minutes, the patient had passed. The doctor was there to pronounce this time.
Last night both kids were out of the house--Lilly at her best friend's and Nick at a debate tournament so I went out to Jay's. We had a drink with Hunter before we headed out--I told you about him before. Hunter has recently gotten himself trapped into a relationship with Sybil, an old girlfriend from 20 years ago of Jay's (things get incestuous in our town). For the annual pumpkin festival parade, he and Sybil and their kids dressed up as monkeys, and dressed their VW bug as a monkey, too.
"Let me tell you," Hunter says, smacking his reptilian lips, "Sybil makes a pretty sexy monkey."
"I think that's enough." Jay says.
"I mean," Hunter continues, "if Sybil really were a monkey, I would cross species." Sybil's a bit of a grifter--a pretty bird in her mid forties, running out of options, looking for a soft place to land. Never learned how to do anything, never held a job. I know a lot of women like this--and they all seem to end up okay. I'm a little resentful--I've worked so hard to make it by myself. Maybe I should have taken a different tack--but then again, I'm not that pretty. And then again again, who would want to end up with Hunter?
"If I were a monkey," Jay asks me, "would you still love me?"
He never uses the word love.
"Of course. What about if I was something, like a rabbit?"
"I wouldn't fuck you, but I would still love you."
"Would you date other women?"
"Well, that depends."
"On what?"
"Are you saying that you are a rabbit, or did you turn into a rabbit. Were you you first?"
"I turned into a rabbit. Sybil cursed me."
"Can you talk?"
"Yes,"
"Okay, then no. I wouldn't date other women. Or at least, I wouldn't bring them back to the house. Because you would yell at me and then they would freak out."
"But you would go to their houses. How would you protect me from the cats while you were away?"
"This is a silly conversation."
"You started it."
"I asked you if you would still love me if I were a monkey , a monkey is a primate. A rabbit is something completely different."
"the issue is unconditional love, not what species I've transformed into."
We stop talking, watch a movie about a guy who starts a movie theater on Fiji, stop watching in the middle, make love.
I'm falling asleep.
"I would still have sex with you, " Jay says, "and I would still love you, even if you did turn into a rabbit."
Well, I think, sometimes you just have to take what you can get, I guess.
That's my 1/2 hour.
Friday, November 9, 2007
Monkeys
Classes on "How to be the MAN" continue...Today instead of working the floor, they pulled all of us out for management classes. Wiz must have been taking his medications because he actually managed to say civil reasonable things to me in a setting outside the hospital. Usually at these things, Wiz looks at the table in front of him and doesn't make eye contact with anyone in the room, like an autistic child, but today, after my 3rd or 4th attempt at pleasant-ness ("would you like an apple? I brought two, and they're organic." did the trick)He even made a joke.
The administration building for the hospital is really interesting--it's built in a circle, with round windows like a ship. It doesn't have any square corners, which is actually a little bit unnerving, subliminally. I think I've managed to internalize euclidean structure and anything else really shakes me up. The building is also freezing--all the time--and located near the highway. For some reason, the building vibrates constantly, to the point that the powerpoint presentations shimmer. But if you're okay with sitting for 8 hours in a building that feels like it's in an earthquake at the arctic circle, listening to white men in suits who make a lot more money than you ever will drone on about compliance, the revenue cycle, and payroll, it wasn't a bad way to spend the day. On my breaks, when I could, I sat on one of the balconies that overlooked some red and gold maple trees. I tried to pretend the highway wasn't there and focus on the trees, and pretty much succeeded.
What amazes me is how much goes into making a hospital run. I can't believe this whole batch of monkeys (I mean humans) ever came up with it. I'm reading about bonobos (catching up on last month's Believer) and I don't think they're so different than we are--how did we get from there to here? I mean--this baroque insurance coding system--and whole professions dedicated to hammering out payment systems--and all the coordination--the food, the housekeeping, the billing--how on earth did we come up with it all? When I was little there was this story about a snail who's shell kept getting more and more elaborate, until eventually the snail couldn't carry it around and died. (surely it didn't die--it was a children's book after all--but I don't know--the 70's--remember Hope for the Flowers? Yuck. Hate that book. The caterpillars falling off the top of the pile...chilling)
We're all worried about the changes in Medicare, of course. Medicare pays for 40% of hospital bills. Starting in 2009, medicare will no longer reimburse nosocomial infections. So here's what's going to happen: 1)in spite of all the lovely feel-your-butt rhetoric about how this is not a shaming culture, nurses are going to be blamed for giving patients infections. 2)Hospitals--not our hospital because we're good guys (we are!) and we admit everybody--will start avoiding admitting tricky patients (like the horrible private hospital across town who turned away 19 illegal guatemalans from a car accident without triaging any of them 2 years ago, because they decided they were all Level one and needed to be sent to us--they weren't, and precious time was lost and hence, precious, albeit 'illegal' lives) 3) Docs will avoid last ditch/hail mary interventions which just might work because they're worried about infection 4)every single patient, whether he has a hangnail or chest pains will be subjected to every imaginable test within the first 4 minutes of arrival, so we can pick up on anything preexisting and get paid for what we do.
What a mess. Infection is a risk of any hospital stay. We already carry around most of the things that will eventually make us sick and kill us, the little buggies are just waiting for us to get sick enough in order to take over . Our immune systems do the job, but trauma and surgery depress our immune systems, and things that wouldn't normally make us sick, do. Of course, hospitals need to tighten up on infection control--but a lot of it is unavoidable, I think. The system's going to collapse.
Okay, that's my 1/2 hour and my soapbox. My Saab's in the shop and I have to get there before it closes.
The administration building for the hospital is really interesting--it's built in a circle, with round windows like a ship. It doesn't have any square corners, which is actually a little bit unnerving, subliminally. I think I've managed to internalize euclidean structure and anything else really shakes me up. The building is also freezing--all the time--and located near the highway. For some reason, the building vibrates constantly, to the point that the powerpoint presentations shimmer. But if you're okay with sitting for 8 hours in a building that feels like it's in an earthquake at the arctic circle, listening to white men in suits who make a lot more money than you ever will drone on about compliance, the revenue cycle, and payroll, it wasn't a bad way to spend the day. On my breaks, when I could, I sat on one of the balconies that overlooked some red and gold maple trees. I tried to pretend the highway wasn't there and focus on the trees, and pretty much succeeded.
What amazes me is how much goes into making a hospital run. I can't believe this whole batch of monkeys (I mean humans) ever came up with it. I'm reading about bonobos (catching up on last month's Believer) and I don't think they're so different than we are--how did we get from there to here? I mean--this baroque insurance coding system--and whole professions dedicated to hammering out payment systems--and all the coordination--the food, the housekeeping, the billing--how on earth did we come up with it all? When I was little there was this story about a snail who's shell kept getting more and more elaborate, until eventually the snail couldn't carry it around and died. (surely it didn't die--it was a children's book after all--but I don't know--the 70's--remember Hope for the Flowers? Yuck. Hate that book. The caterpillars falling off the top of the pile...chilling)
We're all worried about the changes in Medicare, of course. Medicare pays for 40% of hospital bills. Starting in 2009, medicare will no longer reimburse nosocomial infections. So here's what's going to happen: 1)in spite of all the lovely feel-your-butt rhetoric about how this is not a shaming culture, nurses are going to be blamed for giving patients infections. 2)Hospitals--not our hospital because we're good guys (we are!) and we admit everybody--will start avoiding admitting tricky patients (like the horrible private hospital across town who turned away 19 illegal guatemalans from a car accident without triaging any of them 2 years ago, because they decided they were all Level one and needed to be sent to us--they weren't, and precious time was lost and hence, precious, albeit 'illegal' lives) 3) Docs will avoid last ditch/hail mary interventions which just might work because they're worried about infection 4)every single patient, whether he has a hangnail or chest pains will be subjected to every imaginable test within the first 4 minutes of arrival, so we can pick up on anything preexisting and get paid for what we do.
What a mess. Infection is a risk of any hospital stay. We already carry around most of the things that will eventually make us sick and kill us, the little buggies are just waiting for us to get sick enough in order to take over . Our immune systems do the job, but trauma and surgery depress our immune systems, and things that wouldn't normally make us sick, do. Of course, hospitals need to tighten up on infection control--but a lot of it is unavoidable, I think. The system's going to collapse.
Okay, that's my 1/2 hour and my soapbox. My Saab's in the shop and I have to get there before it closes.
Thursday, November 8, 2007
Smoking
So I've been thinking about Russians this morning, and I'm also experiencing an almost uncontrollable desire to smoke. I used to smoke. I started when I was 14 years old and I took to it like a pro--I smoked about 2 packs a day until I turned 22--then I quit cold turkey. But it's interesting watching your brain flip around. You don't realize how much you lie to yourself until an old addiction rears its head. And so strong, too! It was like SMOKING has just been waiting, flexing his muscles, hanging around in his wife-beater shirt--still looking good, still smelling like sin and violetas, maybe a little scruffier. But good, good good. I'm driving back from dropping off Lilly and it just hits me like lust--and I start thinking--one won't hurt--and I can almost taste it--almost feel it between my fingers--and I start thinking about how I'll just smoke it in the driveway and then throw the rest of the pack away--and how my friend Matt's mom has been smoking 40 years and she doesn't have cancer, so not everyone gets cancer who smokes, and Robinson Crusoe smoked tobacco and he was just fine (even if he is a fictional character--remember that great scene in that book when he discovers tobacco?--it's so funny) And then I realize what's happening, that my mind is like this little kid trying to manipulate me--and I'm a nurse! The secret to managing an addiction--to anything--a person, a substance, an act--is this: You have to accept that you will never stop loving whatever it is you love. You will never ever stop wanting a cigarrette. There will never be a substitute. You just have to realize that you will wake up almost every day wanting one or 16 or whatever desperately and that you will live with that for the rest of your life. And then you need to realize that it is not any different from when you were actively using--you never got enough then, did you? And you're never going to get enough now, either. Suck it up. That's my daily motto: suck it up. Okay, not really. That's my daily motto....today. But finally after 12 years, the cravings went away, so today is a surprise.
18 years ago yesterday, I ran away in the middle of the night with someone I met in a bar--married him and had two kids (Lilly and Nick). My fiance had cheated on me, and I had just quit smoking the week before, so I think I might have been technically insane. We just jumped in the car and started driving. And then we went a little bit farther, and a little bit farther, and then we were in New Orleans, and then, we somehow crossed some line, the line when you can't turn around and ever go back, and it was completely out of our control. The road got us, the river just swept us out to sea.
It's hard this time of year--people talk about wanderlust--but if you're cursed with it, it's as much of a problem as smoking. I start chafing in November, and I still find myself going--always have--when I was 13 I ran to Atlanta--it's this strange thing, because, I'm seem so quiet and darn normal. But I slip out of back doors and find myself on trains or buses heading who knows where, and I feel so alive. When I'm running away, I feel so completely myself. I feel like the world is really mine, and that I am in the middle of my own story, instead of a handmaiden in the stories of others--I don't feel male or female, old or young. I just hold my nose and plunge...man...
we get this idea that we have to stay in the stories others have written for us--but we don't, not really. The world is a big place, and you are free, even though you might not realize it. We think we have to act out these scripts, but we don't. It's scary when you think of it, because the stories we receive kind of keep us in dreams, and keep us from living and waking up to our moments and our choices--if you really feel the clarity and potential of each moment--as well as the terror and the death in it--you can get overwhelmed.
But if you ever want to know it, who you really are, for a little bit, one morning, just keep driving until you remember your story and turn around.
18 years ago yesterday, I ran away in the middle of the night with someone I met in a bar--married him and had two kids (Lilly and Nick). My fiance had cheated on me, and I had just quit smoking the week before, so I think I might have been technically insane. We just jumped in the car and started driving. And then we went a little bit farther, and a little bit farther, and then we were in New Orleans, and then, we somehow crossed some line, the line when you can't turn around and ever go back, and it was completely out of our control. The road got us, the river just swept us out to sea.
It's hard this time of year--people talk about wanderlust--but if you're cursed with it, it's as much of a problem as smoking. I start chafing in November, and I still find myself going--always have--when I was 13 I ran to Atlanta--it's this strange thing, because, I'm seem so quiet and darn normal. But I slip out of back doors and find myself on trains or buses heading who knows where, and I feel so alive. When I'm running away, I feel so completely myself. I feel like the world is really mine, and that I am in the middle of my own story, instead of a handmaiden in the stories of others--I don't feel male or female, old or young. I just hold my nose and plunge...man...
we get this idea that we have to stay in the stories others have written for us--but we don't, not really. The world is a big place, and you are free, even though you might not realize it. We think we have to act out these scripts, but we don't. It's scary when you think of it, because the stories we receive kind of keep us in dreams, and keep us from living and waking up to our moments and our choices--if you really feel the clarity and potential of each moment--as well as the terror and the death in it--you can get overwhelmed.
But if you ever want to know it, who you really are, for a little bit, one morning, just keep driving until you remember your story and turn around.
Wednesday, November 7, 2007
Lawyers
While Lilly's at church on Wednesdays, Jay and I go out and drink.
Just kidding. We go up the street a block and get a glass of wine at The Bank, which is really a bar. I used to go to mass on Wednesdays before I met Jay, but now I go to the Bank. I have to say, dating a Muslim was healthier physically than dating a Catholic--no drinking, lots of veggies, and almost no nitrites--from bacon, etc. I drink probably three times as much as I did two years ago--which still isn't a lot, but I can see why Jay has a little trouble with the tummy. The Bank s on the corner, and everyone goes there to see who's with who and who's out walking around. It's owned by a friend of mine, Lisa, from junior high. I still can't get over the fact sometimes that we all grew up and ended up doing grownup things in our town--it seems like we're playacting. "Can you believe we're this old?" Lisa asked me once. "Speak for yourself." I told her.
Jay's sitting at the corner of the bar with his best friend, Hunter. Hunter is our local pit bull of a lawyer, who plays on a bigger stage, I guess. He owns a casino in Monte Carlo, of all places. He's hideous--like a James Bond villain--looks like a reptile--bald and oily and fat, but he's weirdly charming and mesmerizing--'like a snake who's about to eat you' is how Jay puts it. Our kids go to school together. I'm glad they are friends, because when Jay and I run out of conversation, Hunter and I can talk--about fiction mostly--Hunter's a big reader. But tonight, Hunter has another agenda:
"I'm deposing you soon," he says, smiling nastily.
"Oh, shit, you took the case?"
About a year ago, a Russian prostitute was admitted to the unit with mysterious sores, presumably burns, that had become infected. She had been hidden, and had become septic. She died, after one of the most disturbing codes I'd ever been through--I had to climb on the bed in order to give chest compressions, my hands had slid over the burns, which was gross--but the worst part was that right before she coded, she looked at me,--she'd been unconscious for days--and she tried to say something to me, and I couldn't understand her, She kept trying, but I just couldn't read her lips, I could almost hear her in my mind--but not quite, and sometimes I still see her face, trying to tell me whatever she was trying to tell me before she died. There were some very strange things about the case--before she died she had also started bleeding from her eyes.
Soupy had done the autopsy and he'd ruled septic shock as the cause of death, but for me, there were still unanswered questions. I was working the night shift when it all hit the fan. I went to the diner that morning and told Soupy all about it--but he couldn't find any hard evidence of hemorraghic fever--but her death was so strange. I think it stays with me still because she was so young, and I felt her life was just lost--there just aren't supposed to be people like this in Little Dixie--you know? I felt she was the tip of the iceberg and that more should have been done to find out who she was and why she ended up dying this way...there was a 'fiance' who was so clearly a pimp...I don't know. She was this person who never got to be a person at all, always living this shadow life
So, here's Hunter, ruining my time wih Jay
"Don't do this to me."
"You had her more than anyone else. You were there when she died." I hadn't told him that, so that means he's subpoenaed records.
"If anything happens to my nursing license as a result of this, Hunter, I and my children are moving in with you, do you understand? We will show up at your door with our 4 dogs, two cats and video games."
"Will you leave Jay and ride around on the back of my motorcycle?"
"Donor cycle."
"agh, nursing's ruined you. You used to be fun."
"I'm moving in with you, too" Jay pipes up.
"You can't ride on the back of my motorcycle."
He leaves. "I'll be in contact."
Jay and I nurse our drinks, after he leaves. I'm drinking Bailey's, he's having the usual vinegary pino grigio.
"We need different friends," I say at last.
Jay nods.
that's my 1/2 hour
Just kidding. We go up the street a block and get a glass of wine at The Bank, which is really a bar. I used to go to mass on Wednesdays before I met Jay, but now I go to the Bank. I have to say, dating a Muslim was healthier physically than dating a Catholic--no drinking, lots of veggies, and almost no nitrites--from bacon, etc. I drink probably three times as much as I did two years ago--which still isn't a lot, but I can see why Jay has a little trouble with the tummy. The Bank s on the corner, and everyone goes there to see who's with who and who's out walking around. It's owned by a friend of mine, Lisa, from junior high. I still can't get over the fact sometimes that we all grew up and ended up doing grownup things in our town--it seems like we're playacting. "Can you believe we're this old?" Lisa asked me once. "Speak for yourself." I told her.
Jay's sitting at the corner of the bar with his best friend, Hunter. Hunter is our local pit bull of a lawyer, who plays on a bigger stage, I guess. He owns a casino in Monte Carlo, of all places. He's hideous--like a James Bond villain--looks like a reptile--bald and oily and fat, but he's weirdly charming and mesmerizing--'like a snake who's about to eat you' is how Jay puts it. Our kids go to school together. I'm glad they are friends, because when Jay and I run out of conversation, Hunter and I can talk--about fiction mostly--Hunter's a big reader. But tonight, Hunter has another agenda:
"I'm deposing you soon," he says, smiling nastily.
"Oh, shit, you took the case?"
About a year ago, a Russian prostitute was admitted to the unit with mysterious sores, presumably burns, that had become infected. She had been hidden, and had become septic. She died, after one of the most disturbing codes I'd ever been through--I had to climb on the bed in order to give chest compressions, my hands had slid over the burns, which was gross--but the worst part was that right before she coded, she looked at me,--she'd been unconscious for days--and she tried to say something to me, and I couldn't understand her, She kept trying, but I just couldn't read her lips, I could almost hear her in my mind--but not quite, and sometimes I still see her face, trying to tell me whatever she was trying to tell me before she died. There were some very strange things about the case--before she died she had also started bleeding from her eyes.
Soupy had done the autopsy and he'd ruled septic shock as the cause of death, but for me, there were still unanswered questions. I was working the night shift when it all hit the fan. I went to the diner that morning and told Soupy all about it--but he couldn't find any hard evidence of hemorraghic fever--but her death was so strange. I think it stays with me still because she was so young, and I felt her life was just lost--there just aren't supposed to be people like this in Little Dixie--you know? I felt she was the tip of the iceberg and that more should have been done to find out who she was and why she ended up dying this way...there was a 'fiance' who was so clearly a pimp...I don't know. She was this person who never got to be a person at all, always living this shadow life
So, here's Hunter, ruining my time wih Jay
"Don't do this to me."
"You had her more than anyone else. You were there when she died." I hadn't told him that, so that means he's subpoenaed records.
"If anything happens to my nursing license as a result of this, Hunter, I and my children are moving in with you, do you understand? We will show up at your door with our 4 dogs, two cats and video games."
"Will you leave Jay and ride around on the back of my motorcycle?"
"Donor cycle."
"agh, nursing's ruined you. You used to be fun."
"I'm moving in with you, too" Jay pipes up.
"You can't ride on the back of my motorcycle."
He leaves. "I'll be in contact."
Jay and I nurse our drinks, after he leaves. I'm drinking Bailey's, he's having the usual vinegary pino grigio.
"We need different friends," I say at last.
Jay nods.
that's my 1/2 hour
Tuesday, November 6, 2007
Alice
"How do you reconcile your christianity with your buddhism?" Alice asks me this morning. We are sitting in the living room of her 2nd house, the house she keeps in town. Her real house is an old riverboat captain's mansion on the river, but the drive is long and when the weather gets bad or her kids just have too much going on, they stay here. She also uses the downstairs as her office--she's a physician. She's originally from Tennessee, part of a famous fundamentalist, right-wing tribe--converting to Anglicanism was just huge for her--caused a real rift in her family. She's ten years older than I am and is the only person I ever talk to about God and religion. We talk for hours. We used to talk about medicine, too, but no longer.Sometimes I get a little bit frustrated with her as a doctor--I don't think she's rigorous enough, which is the same reason, come to think of it, that I get frustrated with her as a parent. She was raised so strictly that she never disciplined hers, and as a consequence, they're just unbearable. Our kids are the same age, and I look at the mostly mannerly creatures mine have evolved into and compare them with her goth antisocial future serial killers and just want to get down upon my knees....all that said, I love her. It's funny how you can like someone so much and really not agree with a thing they do.
I ran into her at school when I was dropping Lilly off. She was getting out of her ancient Mercedes, balancing coffee and books--"Do you want to meditate with me?" she asked.
So here we were, in her decorator living room, sitting on lemon silk brocade couch pillows on the floor waiting to begin.
"I don't." I replied succinctly.
"Do you worry that it's idol worship?"
This is interesting. This has come up twice this week. A nurse at work asked me if I had buddhas in the house, and, when I said that I did, informed me that I was idol worshipping.
"Do you believe you're saved by grace?" I ask her.
"Yes."
"Is that going to ever change?"
She laughs. "No."
"if you sit and breathe for 1/2 hour, when you stop, will you not still be saved?"
"I'm saved."
"then I think we're okay."
"I know......" she drawls, swinging her grey hair out of her face, "I just started doing this a few weeks ago....and I remembered you said something about doing it...so I wanted to try it with you. I just wonder if I should spend the time praying instead."
"You pray all the time."
"Every minute."
"So, even if you just sit here, I'll bet you'll pray anyways."
Alice has felt desperately guilty her whole life and has no idea why this is so. She is forever trying to make it up, by praying all the time and doing good works. About a year ago, she missed a diagnosis on an infant, and the child is now a vegetable. The details are unique, so I won't go into them, and she was not found guilty of malpractice, but still it shook her to the core. She sort of skated sideways--has become deeply involved in alternative therapies, etc., but I think this is an abdication of the real work of medicine and one she will probably come to regret, but I do understand her desperate wish to not have the responsibility for bringing harm, however inadvertent. She has been losing herself in dreams, I think, wandering in the woods, doing shaman work with some guy in Colorado.
What she needs, and this is coarse, but true, is a good extramarital affair.
But I don't say this.
"Do you do something before you begin?" she asks.
"I say the bodhissattva vow."
"How does that go?"
"Ummmm....." my mind is suddenly blank. We start giggling.
"How long have you been doing this?"
"22 years. Okay, no, I have it. Shu Jo Mu Hen Sei Gan Do/Bon No Mu Jin Sei Gan Dan/HoMon Mu Ryo Sei Gan Gakku/Butsu Do Mu Jo Sei Gan Jo"
"And that means?"
"infinite are all beings, I vow to save them
infinite are all Dharmas, I vow to master them
infinite is the buddha way, I vow to attain it.
Wait. I'm forgetting something."
She shakes her head, "I'm so impressed. I had no idea you were this into this. How often do you do this"
"Every day."
"Since I've known you?"
"Way before that."
"How do I not know this about you?"
Good question. I just shrug. Everyone's a mystery, really, aren't they?
"I can't believe I can't remember the whole thing...."this is really bothering me. How can I say the same thing every single day and not remember it? I don't even remember which thing I'm forgetting. Do I have any of it right at all?
"nevermind, let's just do it."
"the guy who leads the vipassanna group says 'shall we'" Alice offers
I know the guy who leads the Vipassanna (sp?) group. Almost biblically. Another thing Alice doesn't know about me.
"Bong!" I say, doing my best impression of a gong, which makes Alice laugh again, and hit the button on the timer.
We sit for 1/2 hour, breathing. Alice moves around a lot, rolling her head back and forth, tapping her foot, looking around the room. I stay straight and keep breathing. The timer goes off. And right then, the missing piece of the vow floats into my mind, as if had been hiding from me, waiting to play a trick
"I kept having Fahre's (sp?) requiem run through my mind" she says dreamily.
"Infinite are all attachments, I vow to be free of them."
"My goodness, why would you ever want that?" she asks, bemused.
Well, that's my 1/2 hour.
I ran into her at school when I was dropping Lilly off. She was getting out of her ancient Mercedes, balancing coffee and books--"Do you want to meditate with me?" she asked.
So here we were, in her decorator living room, sitting on lemon silk brocade couch pillows on the floor waiting to begin.
"I don't." I replied succinctly.
"Do you worry that it's idol worship?"
This is interesting. This has come up twice this week. A nurse at work asked me if I had buddhas in the house, and, when I said that I did, informed me that I was idol worshipping.
"Do you believe you're saved by grace?" I ask her.
"Yes."
"Is that going to ever change?"
She laughs. "No."
"if you sit and breathe for 1/2 hour, when you stop, will you not still be saved?"
"I'm saved."
"then I think we're okay."
"I know......" she drawls, swinging her grey hair out of her face, "I just started doing this a few weeks ago....and I remembered you said something about doing it...so I wanted to try it with you. I just wonder if I should spend the time praying instead."
"You pray all the time."
"Every minute."
"So, even if you just sit here, I'll bet you'll pray anyways."
Alice has felt desperately guilty her whole life and has no idea why this is so. She is forever trying to make it up, by praying all the time and doing good works. About a year ago, she missed a diagnosis on an infant, and the child is now a vegetable. The details are unique, so I won't go into them, and she was not found guilty of malpractice, but still it shook her to the core. She sort of skated sideways--has become deeply involved in alternative therapies, etc., but I think this is an abdication of the real work of medicine and one she will probably come to regret, but I do understand her desperate wish to not have the responsibility for bringing harm, however inadvertent. She has been losing herself in dreams, I think, wandering in the woods, doing shaman work with some guy in Colorado.
What she needs, and this is coarse, but true, is a good extramarital affair.
But I don't say this.
"Do you do something before you begin?" she asks.
"I say the bodhissattva vow."
"How does that go?"
"Ummmm....." my mind is suddenly blank. We start giggling.
"How long have you been doing this?"
"22 years. Okay, no, I have it. Shu Jo Mu Hen Sei Gan Do/Bon No Mu Jin Sei Gan Dan/HoMon Mu Ryo Sei Gan Gakku/Butsu Do Mu Jo Sei Gan Jo"
"And that means?"
"infinite are all beings, I vow to save them
infinite are all Dharmas, I vow to master them
infinite is the buddha way, I vow to attain it.
Wait. I'm forgetting something."
She shakes her head, "I'm so impressed. I had no idea you were this into this. How often do you do this"
"Every day."
"Since I've known you?"
"Way before that."
"How do I not know this about you?"
Good question. I just shrug. Everyone's a mystery, really, aren't they?
"I can't believe I can't remember the whole thing...."this is really bothering me. How can I say the same thing every single day and not remember it? I don't even remember which thing I'm forgetting. Do I have any of it right at all?
"nevermind, let's just do it."
"the guy who leads the vipassanna group says 'shall we'" Alice offers
I know the guy who leads the Vipassanna (sp?) group. Almost biblically. Another thing Alice doesn't know about me.
"Bong!" I say, doing my best impression of a gong, which makes Alice laugh again, and hit the button on the timer.
We sit for 1/2 hour, breathing. Alice moves around a lot, rolling her head back and forth, tapping her foot, looking around the room. I stay straight and keep breathing. The timer goes off. And right then, the missing piece of the vow floats into my mind, as if had been hiding from me, waiting to play a trick
"I kept having Fahre's (sp?) requiem run through my mind" she says dreamily.
"Infinite are all attachments, I vow to be free of them."
"My goodness, why would you ever want that?" she asks, bemused.
Well, that's my 1/2 hour.
Subscribe to:
Posts (Atom)
