Little Birds

No one reads this blog but me. And I don't read it, at least not more than the sentence preceding the one I'm typing right now. There's something sort of lovely about this, but also something sort of lonely.

Talen is back from Brooklyn. I didn't ask him why... or what happened...he just gave me a hug and asked me "#3? With raisin toast?"

I didn't even know I missed him.

Wow, I'm lonely.

Today I got sent home on call (hooray). It's funny, you know, the hospital forgot to put my overtime in my last paycheck (nice) and that was a loss of something like $2500--and I am facing the last three days of the month with exactly 92 cents in my checking account--and $11.88 in outstanding checks--and I'd still rather have the time. Money be damned. You can never get a day back.

I'm worried about my patient, though. A little old lady. I've been taking care of her for the last month. Little old ladies always get under my skin. Farmer's lung. She has a year to live.
Husband's a trucker. He just loves her, loves her. She's tiny and funny and cranky. True what my grandmother said--no one loves you for being easy. She's getting stronger. I told them not to accept this prognosis--I think if she got home and got happy she might live a lot longer. I don't know how to be kind to people, really. I get so scared and stiff. How do you be as good to people as they deserve without visiting your own crap on them? Without your ego and your need for approval tainting your interactions?

No one will ever love me that way. I want it too much.

Wiz loves her, too. He's usually really hard assed with patients--good--but kind of hard. But he treats her like a little child. He picked her up in his arms to move her to the chair and called her 'pumpkin.' Sometimes, I really love Wiz. And sometimes he's just repulsive, like when he's walking around with shit on his scrubs and eating graham crackers off the ICU floor just to gross me out. "Ummm--nothing like the taste of acinetobacter in the morning...breakfast of champions..."

She apparently takes in strays--wild animals find their way to her door, her family tells me. I was running with Lilly in the cool spring twilight, thinking about this, when I noticed a bird sitting at the side of the road. It didn't fly off as we ran by it.
"Do you think it's sick?" Lilly asked.
It was a sparrow. A girl sparrow. I couldn't see anything wrong with her, but her head looked a little funny, and when I put my hand next to her, she hopped onto my finger. I cupped my hand around her and stood up. The sparrow remained on my finger, peeping and trembling.
We began to walk home. I felt strangely gifted, as if I were holding a star instead of a bird, or as if the trembling hand of an ancient god was holding mine, some rare faery spirit, reaching out from their world. Everything seemed to still and come into an almost painful focus, the way it does sometimes when you are making love with someone you really love. Lilly ran on ahead back to the house to get a box. I kept walking with the little bird cupped in my hand.
As I passed under my neighbor's big pine tree--funny how some trees somehow have their own little world around them, isn't it? I mean, I'm walking on the chattahoochee in my street, past the magnolias and crabapples and forsythia, and then I'm under this pine, and all the sudden, there's this green shadow and sense of the black forest, and I'm thinking--wow--six feet of a completely different planet under this tree--and the sparrow suddenly takes flight, as if she could do it all along, and flies up into the pine.
Thinking she might be sick and fall out of the tree, I stood there underneath it, looking up into the dense green branches for the bird. I could hear her, but I couldn't see her. Lilly found me this way, when she came running back with the shoebox.
"What are you doing?"
I told her, not taking me gaze from the tree, still looking up. "I'm just waiting to see if she's okay."
Then a big splat of bird poop hit me on the shoulder.
Deadpan, Lilly says:"I think she's probably okay."
"Right."
I can't believe how quickly things can go from the sublime to Three Stooges in this world.
I told my patient this story, thinking she'd laugh, but she just looked at me and started weeping inconsolably.
Then, after about 5 minutes, she held out her little club fingered hands and mimed squishing the bird. She shood a finger at me as if to say, "That's what you should have done."
There and back again.
That's my 1/2 hour.

Rice

Did you know there's a rice shortage?

That's kind of scary.

I know things are getting tighter and tighter and that I have less and less money, even though I'm making more than I ever have.

I think we all might be getting into trouble.

I'm making rice right now. Organic short grained brown valencia. I'm going to heat it up with last night's black beans. It's the quick and easy recipe from Memories of a Cuban Kitchen, my secret weapon. I love Cuban food.

In my book, there's an inscription: "To Willow, the best husband in the world. Love, Diana and Dean.

Kids are back, I'll tell you the rest of the story tomorrow.

Jealousy breathing

I'm trying to figure out why I'm so stupid. If you have any insight into why you are so stupid, please drop me a line. Maybe it will help me figure myself out.

I found out through very devious means that I'm completely ashamed of, prompted by the usual psychic sirens that LIES LIES LIES are being told.. that Jay had sent a book of poetry to his ex girlfriend. A book of poems by Elizabeth Desmond. Then he followed it up with a sample--one about plums...except it's really about sex, and probably, in his mind, it's about sex with her, the fucking ratfuck weasel ratfuck.

She's married. They had an affair about 4 or 5 years ago. He pushed her to leave her husband and she did--and then Jay dropped her. Which made her mad. Strange girl. She called on Christmas Eve this year.

I've thought about doing all sorts of things. Like sending her husband a note, or covering Jay's car with rotten plums.

And, check this out...her name is Haley, too. Just like me and the other Hali.

I wish I didn't know the things I know. One of the problems with my practice has been that as a result of sitting all these years, I have become very good and noticing things. My ego dream has been lifted--only a little--but still--and I see things, for the most part, very clearly--except emotional realities--and I can't make strong decisions for myself. For example, I know I should leave this situation, but I'm not going to. I guess I will, eventually. But then I think of myself. I'm not married. I have male friends who send me books and cd's and visit me on vacation. My father has had close relationships with women, intellectually and spiritually intimate friendships. Are those wrong?

I want the one I'm sleeping with to think of me and me only.
The error bred into the bone is to be loved and loved alone.
My practice just falls apart when it comes to things like this.
The best I've been able to do is resolve to not check up on him and to focus more on living my life for me and mine. I'm wearing this little string around my wrist and I'm adding a bead for each day I do right. I know that's judging the day--but I'm thinking of it as a 12 step program. When my thoughts go to scenarios involving imaginary confrontations I touch the beads on my wrist and breathe and focus on the world around me. I don't think it's virtuous to spy, so I'm stopping for that reason. Things manifest at different times, when the conditions are right for them to do so.
Everyone's heart blooms when it is spring.

Mysteries

Took two weeks off.

I feel better about everything.

Went camping in the freezing rain with Jay at Horseshoe Canyon. It was beautiful.
Jay said last night, "You know, that was the best time, and it was completely accidental."
It was. We just went without checking the weather forecast, set up the tent and hoped for the best. We had some dim idea of climbing--and we did. Freezing fingers on the beautiful Arkansas rock. We just sort of arrived and made the best of it. When it was too wet, we hung out in our sleeping bags in the tent and read books. At night we drank hot Bailey's by the campfire and I got out my fiddle and played every song I knew. We ate a lot of organic cheese doodles and chocolate and I gained 5 pounds (which I actually needed to do, I was getting way too bony). We took walks through the pastures and spent about 2 hours watching baby goats. The land was a like a dream, covered with mist, greening with spring. We found an old wooden swing and climbed over boulders and harassed each other and got smelly and made shadow puppets with our hands on the tent wall. It was grey outside and in, and we totally lost track of the time. Cell phones didn't work.
Kids got back from their dad's Sunday evening. I've been having a great time, cooking, noodling around the house, bleached the basement floor, caught up on the laundry. Took Karma, my yellow lab out on long walks every day. It's been raining, but who cares?
If you're in the right space, everything feels like a pleasure.
There's this beautiful upswell of good green energy pulsing through, makes every bit of life seem beautiful.
okay, so Zen thought.....the ego judges, right, and if we'd been judging--"oh it's too cold, too wet, too this too that" to climb, we never would have gone, and we wouldn't have had the experience we had. Don't prejudge. Just show up for what's happening.
You come back from something like that and everything gets looked at fresh--you see so clearly the things that trap you!
Stupid things--like I weigh myself every day, and if I'm not where I think I should be (133 pounds), I just don't eat. Or I eat only juice. Or I eat everything I want to eat (cheese doodles) and feel guilty and crappy.
What a stupid thing to feel guilty and crappy about. I mean, I'm not out defrauding old ladies or running stop signs or jaywalking, I'm eating bad food! (Not so bad, even, I mean, nothing has to die to make cheese doodles)I'm two pounds over.
Or--I start into my old habits--"I must spend 30 minutes excercising, and 30 minutes lifting weights" I don't know. I guess that's the world of form--and, admittedly, form can save your ass. Form are the lifesaving practices of culture, they keep us from the wind and wolves. The artificial scaffolding of timekeeping keeps us reaping and sowing, managing our energies effectively--and in the Trauma Unit, form is sometimes all I have to keep me from losing my mind and throwing myself weeping over my patients broken bodies (drama!)but I guess the key is detachment--to recognize it as form and form only and not get trapped into thinking it's anything else, and to let form serve you, rather than the other way around. One hand or the other, because there have certainly been times when form was all I had, when zen has only been habit and not heart. In the space of a half hour, it will fluctuate 300 times between heart and hand.
I think I solved my koan, by the way.
What is this?
This is what.
3 years. What is this? What is this? What is this? What is this?
Then I just started giggling.

So, Tuesday, at Ernie's, Lilly and I were sitting there--and we couldn't figure out the time. All the clocks appeared to be working, but they all showed slightly different times. Lilly had ordered almost everything on the menu--french toast (which they're famous for), sausage, poached eggs, hash browns...and couldn't eat it. The check was $9.82 for two people. Only at Ernie's.
"Is it time to go?" Lilly asked.
"I don't know." I don't wear a watch because something about my electromagnetic field just screws them up, and I'd forgotten my phone.
I got up to ask April, our waitress. April's maybe 5 years younger than I am, has been working at Ernie's since she was a freshman in college. She's a little overweight, but pretty, strawberry blonde hair. She's smart, but can't seem to decide on anything to do with her life. She was getting her Ph.D in political science, then took a leave of absence, then went back, then took another leave. Then she became a realtor for like two seconds, she's got one of those voices--a whiskey voice--she's what you call a great girl. You know? Maybe 2 generations removed from the farm, hip but grounded. She's going to be the same at 50 as she is now, but it's not like that'll be bad or that she's old before her time--just consistent. So, anyways, I ask her what time it is, and she tells me--8:00. "I know," she laughs, "none of the clocks show the right time around here."
I've spent a lifetime with malfunctioning clocks--it was a lot worse before I had kids--the energy was out of control then--so I understand.
"The place is haunted," she says.
"Really?"
"Really. Clocks have not worked here since that waitress disappeared in the 70's."
"What waitress?"
"Becky Doisy." April leans back on the counter, eyes sparkling, she likes to tell a story."Becky Doisy was a waitress here, and one morning she just never showed up. They never found her, or found out what happened to her. And ever since then, the clocks haven't worked at Ernie's. Haven't you ever noticed the graffitti on the wall in the bathroom?"
Of course...I always notice it. I just never thought about it. I thought it was some movie reference or something. Ernie's graffitti is pretty erudite.
"Who Killed Becky Doisy?"
"Yep. No matter how many times we repaint the bathroom, it's always the first thing to show up. And, check this out, it comes up through the paint. Right where it was before."
"You think it's her?" I ask.
"Yeah--there's some weird shit here."
"If it's her," I muse "she's probably haunting you because whoever killed her is still showing up at Ernie's."
April stops smiling.
"You think so?"
I feel like we're in a Nancy Drew mystery all the sudden. Like a story has started that is going to take us all over and that we have suddenly become actors in something bigger. Ernie's was just a setting before, a place for lost souls to get the 3.79 breakfast special. Now there's another player.
"Well, of course. She's probably trying to let us know. You're probably still handing him biscuits and gravy."
"I never thought of that."
We look at each other. We look around the restaurant, at the regular faces we both know so well. The rain falls outside, cold and grey.
Who killed Becky Doisy?

That's my 1/2 hour.

Overtime

Here's what I think--I think I'm going to actually garden this year.
The house is a mess. Working 4 days in a row is almost impossible to do, and keep sane. Jay warned me I would go crazy if I continued to do this. I think he might be right. I'm taking some time off next week, thank goodness. The kids will be gone. Everyone I meet and see seems like an imposition. Everyone an annoyance. I don't know how people live the way they do, self included. People seem too close. Their smells bother me, their hair, their conversation. Everyone looks foolish. Everyone is too fat or too thin, or too loud. I'm becoming a fascist.
The worst offender, of course is myself.
I don't want people to talk to me, sound itself is almost intolerable.
I felt better after I sat for awhile, but it's safe to say, I think, that my nerves are pretty raw.
By the fourth day of work, my inner dialogue is almost unbearable. Mondays. I hate Mondays. The most self-righteous, patronizing group of nurses work Mondays.
Wiz calls them the Monday Saints.
"Ahh...the saints of the unit, so clearly aware of their superiority--what would we do without them?"
Ughhh. They are insufferable, the bunch of them.
$564 I get for dealing with them.
Monday money.
Who are the Monday saints?
There's Regina, who I've told you about before. The one who refuses patients. There's Nathan--29, self-righteous, full of advice, always delivered in this folksy way, with the subtext of "you suck"--i.e. "Did you want her in the chair that long?"
There's Walter. Who puts Jesus into every sentence. Such as "do you think we have enough nurses to handle another admission?"
"I think we do, but it doesn't matter if I think so, it matters if Jesus thinks so."
or.."How's your wife doing after her gallbladder surgery? Is she getting better?"
"Jesus is making her better."
or "Achoo!"
"Bless you, if it is what Jesus wants."
or..."How are you?"
"I believe I am well, but I know I am blessed by Jesus."
SHUT UP!
Jesus...
It's my orientee's second to last week. Then she's out on her own. I'm not sure how much I actually like her. She's a good, reasonably competent nurse but I'm finding she has this strange, almost psychotic blind spot when it comes to her own errors. For example, last week, we had an admission--septic, pressures falling, and we were starting pressors. She didn't check or label her lines and started the dopamine at the same rate the maintenance IV fluid was written for--a dose that would have probably outright killed the patient in about 15 minutes. Because I'm on top of her, I caught it, but when we discussed it at the end of the week, she had completely rewritten the incident in her mind.
"the drugs we use are scary," she said.
"Yes, they are. You found that out the hard way, didn't you? We had a near miss."
"Yes we had that dopamine hanging and we didn't know whether it was ours or whether it had come from the other hospital."
"No, that's not the incident I'm talking about."
"Well, don't you remember?" she asks. "There were two bags and you were running them both?"
"No, " I said slowly. "That isn't what happened."
"Yes it is."
"No it isn't. Let me remind you--you started to run the dopamine at the same rate as the IV fluid because you hadn't checked or labeled your lines."
"I don't think that's what happened...." she started to get really defensive.
"That is exactly what happened. Do you remember it now?"
"I don't remember it that way."
I started to feel exasperated.
Finally, I got her to admit what happened. But the incident, and our review of it, really has me worried.
Things move so fast in our unit that mistakes or almost mistakes are bound to happen. It's why we have so many checks and double checks and it's why we try to cultivate a blame-free atmosphere. It's got to be a place where you can admit to mistakes, or lack of knowledge, so that everyone can bring their best to treating the patients. If she covers or reframes, she'll screw someone up, and the hostile blankness in those opaque brown eyes really bothered me.
During rounds, the Dragon did a terrible thing.
I was letting my orientee handle rounds, and she was interrupting inappropriately--this is another thing that bothers me about her--she doesn't listen to other people.
He turns to me and in the middle of her sentence he growls, "You don't like her very much, do you?"
I was taken aback. I don't. But I thought I was covering it.
"Of course I like her!" I mean, what do you say?
"She doesn't like you very much," he says to my orientee. "You'd better step it up."
Well, two points for the Dragon, I guess. But...I'd rather be putting a nurse I could trust out there. I really think there's something a little wrong with this one. But how do you quantify that? She's hitting all her marks...
well that's my 1/2 hour.

Who breathes?

Folded in, contracted, like an umbrella, rusted together, welded stiff. Curled in agony, curled like a fetus. Malnourished--the rehab in Virginia hadn't been doing their job. Tried to put pillows between her knees, couldn't pry them apart. Veins flat and flaccid, bones piercing the skin from the inside out. Jaw clenched like a pit bull, the teeth loose and dirty from lack of oral care, bed sores, break down, perfed stomach, septic. Cold. Warmed her up. The only thing that moves are her eyes--her left eye seems to see and perceive. I didn't get this at first.
I've become hard. I watch students and new nurses come into our unit and they're so soft, so compassionate and caring. Slow. Gentle. But if you're going to become good at this, you have to make a compromise between fast and gentle. And sometimes gentleness and kindness aren't what you think they are--but that's a different meditation. I have lately very few patients that really get to me, but I wanted to throw myself over this child and weep.
First time on a motorcycle. 17. Went for a ride on her best friend's (a boy) new motorcycle. Climbed on the back. Here she is in our unit.
Old head injury--over 7 months. I don't usually see them after they leave here and go to rehab.
She looks like a concentration camp victim.
"Is this normal? Is this what happens? Was she neglected at the rehab?"
Cindy Chang, our impeccably dressed, workaholic, incomprehensible chinese unit dietition answers me, "is what happens, head injury, no muscle, cachexis. See it all time."
But I'm still horrified. "But couldn't we fatten her up somehow?"
She smiles. "Obesity big problem in America."
"Shut up."
When the girl doesn't like what we're doing, she bites down and holds her breath. She's intubated, because she's been septic. But it resolved miraculously quickly. God, young bodies are miracles. So are old ones. But young ones, even compromised. Boom boom boom. Life force surging through. She hates the tube.
I try all weekend to get her extubated. Over the weekend, we have, unfortunately, our laziest nastiest respiratory therapist working. She just wants to keep her intubated. The residents, new to the floor are scared and intimidated. The RT keeps finding excuses.
"She'll get pneumonia."
"Her lungs are clear," I argue
"She doesn't have the ability to clear her secretions."
"So she should stay intubated all the time? She wasn't intubated in rehab."
"We might have to go to the OR again."
"Anesthesia could intubate her again...I believe that's part of their skill set..."
I don't want to get to nasty with her, because, in the long run, I need the good will of this fucking RT more than winning my point of extubating this girl 2 days early. It's like a chess game around here, some times. Know your pieces, know how they move. How far you can push them, when you can get them into position for someone else to take them off the board. If it was life threatening, I'd get nasty, but we aren't yet to the critical point of risking VAP (ventilator acquired pneumonia). I could push it faster, but in the next room, someone is busy dying--on pressors, desatting, and this RT isn't good with stress--to be effective with the other, more critical patient--but at 1500 on Monday, after battling it for 4 days and being put off--I finally get hot. I drag Baggins, our diminutive fellow into the room. The girl's lips are swelling and blistering around the tube, the tape cuts into her cheeks.
"RT didn't extubate?" he says, surprised.
"RSVI's too high--but that's her baseline. It's just an excuse. All day."
We get the RT in--
"We're extubating now." He says.
"Her RSVI's too high. And she holds her breath when she's mad"
"Let's just give it a shot."
"Okay--I've got to go check the ventilators on the other side, and go to CT scan, but then I'll do it." Hedging.
"Okay," Baggins says, "I'll go ahead and do it. You have your pager, right?"
Sometimes, I hate Baggins, and sometimes I love him.
So we extubate. The girl sighs a long sigh. Then starts breathing and falls asleep. Sats high. Jesus.
Would you do that to your kid?
In between our usual inane conversations about things like excess body hair, we talk about this.
Quality of life.
But how can you ascertain that? And you know, you're not here just for yourself. You're here more for other people. We fear suffering so much, we say we fear causing it, but we cause it all the time. I don't think this is true, when people say that. I think they fear something else. If it were my kid, and he was still looking out at me through his good eye, and holding his breath when he got mad and biting nurses, I could not let him go. We think a life is worth something only if meets certain standards, and this error in thought is what leads us to both passively and aggressively commit acts of violence on others--others of other races, of other creeds and faiths. It's why we're able to go to war in Iraq, it's why we're able to ignore the Sudan, it's why we're able to ignore the poor of our own country. Same error--we think we're God and can decide when a life is worthwhile and when it's not.
Who breathes you?
Who is breathing?
The girl, the creature, skin and bones, lies in our tower, our twilight ship. Breathing just as surely as you and I.
Breath of the world. Breath of all. We can only serve.
That's my 1/2 hour

Nick's Birthday

Today's Nick's birthday. He's seventeen years old. After I dropped Lilly off at school today, I took the car in to be inspected (you would not believe cosmic forces arrayed against renewing my tag--all of yesterday was about trying to get my tag renewed and failing, miserably--but that's another story). The mechanic, a very blue-eyed base player, hit on me last week. I had stopped in at the station to fill up the Saab and it broke down right there. Right at the pump. I had to buy a new battery, but at least I got flirted with. So, long story short, I decided to get the car inspected there--I mean--go where you're appreciated, right?
"It'll take about 45 minutes." he told me. He had told me yesterday the car didn't need to be inspected, something which the girl at the DMV, dripping with bling set me straight on. I have never seen more rhinestones on a daytime ensemble. Earrings, fake chanel pendant, jeans, even the tips of her nails.
"The mechanic told me I didn't need to have the car inspected."
"He told you wrong--"waving a gleaming hand. "Just go back and tell him from me. I'll let you in to the front of the line. I'll remember you."
I love the Little Dixie DMV. This is the only DMV in America that's actually kind of fun to go to. I've never had a bad time there. I've never waited more than 6 minutes for help.
I went back to the garage, but they were full. So that's why I was there this morning.
So this morning I'm there in the cold with 45 minutes on my hand. Near the garage is the town cemetery, Office Depot, a Walgreen's, an Sherman elementary school (where I went to school--one of the first integrated classes--I was beaten up daily and had corn thrown at me every day at lunch), and the public library. I decided to go to the library.
My dad bought Nick this huge black down coat from a store in a mall. Nick refuses to wear it. "It's a gangsta coat, Mom," he informs me. It is. But it's warm. So I wear it. It can probably stop bullets. I walk up the hill to the library, and peek in the door. A well groomed young woman walks up who cannot be anything in life other than a librarian. She smiles. "Are you Libby? No badge yet, huh? I'll swipe you in."
I must look sort of eager and respectable. She thinks I'm a new employee. For a second, I play with the idea of pretending to be Libby for the morning. Good practical joke? Yeah....but I'm all respectable now and too many people know me. They would think I'm losing my mind.
"No...."
"Oh,--the library doesn't open til 9" she tells me pleasantly.
So I keep walking.
I decide to go to the cemetery. Every day, I try to do one weird thing. No matter how small. It keeps me engaged. And, believe it or not, other than the time I accidentally kicked a ball into the cemetery in 1st grade and had to go retrieve it (the cemetery borders the playground), I have never gone in by myself.
So I turn in down the narrow black asphalt road.
Funny how we keep our conventions, even in death. The tombstones of married people, for example--the wife's is always shorter than the husband's. Here are the names I've grown up with--the names of streets and stores and colleges. Some of the dates are heartbreaking. Farther back, the stones change, smaller, carved, names fading, dates in the 1700's--and lots of phrases like this: "born in Virginia in 1786--died here in 1850." The first people came to our town in the early 1800's from Kentucky. I look across at the empty fields--sparsely scattered with stones. The Taco Bell. The empty part was supposedly filled with slave graves. The plots are for sale now. The Taco Bell was built on the graves. It was stuck by lightening the first year it opened. We know why...
There's the stone for the 1st president of the university--and next to him is one for his son. I read the dates--1839-1859. Buried his son. Nothing in here can tell that story.
I think about Nick, 17 today. All the birthdays behind us. The childhood behind us. His childhood's in the proverbial can. Done. All the things I wanted for him.
On his first birthday, Nick and I went to the zoo. We rode an ancient, patient, sawbacked elephant. I still remember the stiff hairs on its back and it's astonishing shiplike sway as it walked in a circle. There were flamingoes, and Nick was so delighted--we had to go back again and again--he loved them best.