Well, they found Becky Doisy's killer.
There's a picture of her in the paper this morning. She's 23 years old. She looks pensive, wistful, intelligent, and a little fierce. I never knew what she looked like.
23.
Oh, oh, all you fierce wild girls,with your angel hearts spilling poetry all over, Be careful out there.
Love,
Haley Patton
Wednesday, September 30, 2009
Monday, September 28, 2009
Flunking ACLS
Well, the John Prine song I love best is..
You come home late and you come home early
You come on big when you're feeling small
You come home straight and you come home curly
Sometimes you don't come home at all
So what in the world's come over you
And what in heaven's name have you done
You've broken the speed of the sound of loneliness
You're out there running just to be on the run...etc.
The code I was so proud of--something happened and no one will tell me what.
"You don't want to know," Wiz said, cutting me short when I asked. "I can't believe it. It's appalling. Just stay well clear of this."
And do I care about the patient? No. All I want to know is "is it me? me? me? Did I do something wrong?" Ego.
Wiz looks agonized. Truly upset. What happened, I wonder? I can't look it up on the computer--because the patient's not on the floor any more and that would be violating HIPPAA. I don't want to ask too many questions, because if Wiz is getting some heat, raising people's awareness of it will just make it worse, and there are a lot of people who don't like Wiz. That goes for everyone involved, actually. Did Drunken Disaster do something wrong?
I'm taking the ACLS refresher this week. No more teachers. Just a computerized dummy and a simulation, which doesn't always record the actions you take. You wear headphones, and they've simulated the sound of breathing and all the beeps and hmms of the monitors, and half of the work is figuring out your way around the computer. I believe I'm becoming stupider with every passing day. And as you make stupid choices, or click on the wrong god damn thing, the patient gets worse, and so your nice day off wearing clean clothes and regular shoes turns into a little flashback of hell. I was in there eight hours. With an hour break to turn in the reimbursement forms for two of the zen students' trip to Mt. Baldy. Of course, there are things left out, because they're Nick and Lilly's age, so I'm sitting arguing pleasantly with the reimbursement czar, and finally in exasperation I end up calling one of them to bring the correct documentation NOW PLEASE, sounding exactly like his mother. "Okay," he says meekly, "I'll be right over."
Hard to keep from being mom...
Then back to the education building--which is way, way, way over on the other side of town, in this terrible building with no right angles It's supposed to stimulate creativity, but it makes me feel as if I have low blood sugar. The whole building trembles slightly with the passing traffic from the highway, and it's always freezing cold. Not just the temperature--but a strange, layered cold that seeps into your very soul. I hate that building.
I pull into the parking lot and almost have a head-on with the only person who has ever written me up--on something stupid--5 years ago--I won--then I go back inside the cramped little simulation room and try to finish up my simulations--and actually don't, I'm ashamed to say.
5:00. I reward myself with chocolate brownie ice cream. Jay buys. We sit out on the sidewalk in the crisp fall air, not saying too much. He looks so good. He smells so good. I wish I could trust the smallest little particle of him. But I don't. I should have paid attention. Mistrust comes back at you like a scorpion's tail. You hang on at first, just wanting things to be okay, but then, whoosh. The sting. And the slow, hard baked anger, that eventually poisons and silences..
I go home. I've got an email saying they made a mistake about my raise, and I'm actually NOT getting one. Then Jay calls. He left his keys inside the bank and wants to know if he can borrow one of my cars tonight. I drive back downtown, park on 9th and walk up the street to the bar.
I've been feeling the strangest way, lately, as if all my pretty is just leaching out of me. As I'm going up the street, I see Hali, Jay's ex, walking in that self contained, complacent, replete way she has. She's a pretty woman. She's walking her bicycle, she has a tiered skirt swinging around her shins and clogs. I think bad thoughts, try not to. But really, why is she such a part of our lives? She senses my glower, gives me a tentative wave. She looks like Elena when she does that, and I give her a real smile and wave back. Elena who's shy, and funny, and who I like most of the time.
I wish I understood anything.
Jay's at the bar with Hunter, who is staggeringly drunk. He lectures us about being positive. "The trick to life is to stay positive."
"Another trick," I say, snarkily, "is to stay sober."
But I'm probably wrong about that, too.
I loan Jay Nick's thunderbird. And Jay drives off. I get hit in the stomach suddenly, watching the taillights disappear, with an ache so hard I want to curl up in the street. For my son, for the past, for this fragmented life. Where is it all going? What was I thinking?
Hohum.
That's my 1/2 hour.
You come home late and you come home early
You come on big when you're feeling small
You come home straight and you come home curly
Sometimes you don't come home at all
So what in the world's come over you
And what in heaven's name have you done
You've broken the speed of the sound of loneliness
You're out there running just to be on the run...etc.
The code I was so proud of--something happened and no one will tell me what.
"You don't want to know," Wiz said, cutting me short when I asked. "I can't believe it. It's appalling. Just stay well clear of this."
And do I care about the patient? No. All I want to know is "is it me? me? me? Did I do something wrong?" Ego.
Wiz looks agonized. Truly upset. What happened, I wonder? I can't look it up on the computer--because the patient's not on the floor any more and that would be violating HIPPAA. I don't want to ask too many questions, because if Wiz is getting some heat, raising people's awareness of it will just make it worse, and there are a lot of people who don't like Wiz. That goes for everyone involved, actually. Did Drunken Disaster do something wrong?
I'm taking the ACLS refresher this week. No more teachers. Just a computerized dummy and a simulation, which doesn't always record the actions you take. You wear headphones, and they've simulated the sound of breathing and all the beeps and hmms of the monitors, and half of the work is figuring out your way around the computer. I believe I'm becoming stupider with every passing day. And as you make stupid choices, or click on the wrong god damn thing, the patient gets worse, and so your nice day off wearing clean clothes and regular shoes turns into a little flashback of hell. I was in there eight hours. With an hour break to turn in the reimbursement forms for two of the zen students' trip to Mt. Baldy. Of course, there are things left out, because they're Nick and Lilly's age, so I'm sitting arguing pleasantly with the reimbursement czar, and finally in exasperation I end up calling one of them to bring the correct documentation NOW PLEASE, sounding exactly like his mother. "Okay," he says meekly, "I'll be right over."
Hard to keep from being mom...
Then back to the education building--which is way, way, way over on the other side of town, in this terrible building with no right angles It's supposed to stimulate creativity, but it makes me feel as if I have low blood sugar. The whole building trembles slightly with the passing traffic from the highway, and it's always freezing cold. Not just the temperature--but a strange, layered cold that seeps into your very soul. I hate that building.
I pull into the parking lot and almost have a head-on with the only person who has ever written me up--on something stupid--5 years ago--I won--then I go back inside the cramped little simulation room and try to finish up my simulations--and actually don't, I'm ashamed to say.
5:00. I reward myself with chocolate brownie ice cream. Jay buys. We sit out on the sidewalk in the crisp fall air, not saying too much. He looks so good. He smells so good. I wish I could trust the smallest little particle of him. But I don't. I should have paid attention. Mistrust comes back at you like a scorpion's tail. You hang on at first, just wanting things to be okay, but then, whoosh. The sting. And the slow, hard baked anger, that eventually poisons and silences..
I go home. I've got an email saying they made a mistake about my raise, and I'm actually NOT getting one. Then Jay calls. He left his keys inside the bank and wants to know if he can borrow one of my cars tonight. I drive back downtown, park on 9th and walk up the street to the bar.
I've been feeling the strangest way, lately, as if all my pretty is just leaching out of me. As I'm going up the street, I see Hali, Jay's ex, walking in that self contained, complacent, replete way she has. She's a pretty woman. She's walking her bicycle, she has a tiered skirt swinging around her shins and clogs. I think bad thoughts, try not to. But really, why is she such a part of our lives? She senses my glower, gives me a tentative wave. She looks like Elena when she does that, and I give her a real smile and wave back. Elena who's shy, and funny, and who I like most of the time.
I wish I understood anything.
Jay's at the bar with Hunter, who is staggeringly drunk. He lectures us about being positive. "The trick to life is to stay positive."
"Another trick," I say, snarkily, "is to stay sober."
But I'm probably wrong about that, too.
I loan Jay Nick's thunderbird. And Jay drives off. I get hit in the stomach suddenly, watching the taillights disappear, with an ache so hard I want to curl up in the street. For my son, for the past, for this fragmented life. Where is it all going? What was I thinking?
Hohum.
That's my 1/2 hour.
Monday, September 21, 2009
12 Hours
I'm tired.
We had two codes in two days. One Saturday and the other on Sunday. We have an almost entirely new staff and no one, apparently, can think very well.
I am normally a pretty scattered, ditsy person. I can never find my keys. My house is a mess, and I always seem to be a day late and a dollar short, but at work, I am weirdly competent. Maybe it's the fact that the environment is so controlled? And when things get really hairy and bad, I hate to say this about myself, because it sounds like bragging (I think it's okay because I'm so miserable about so many other aspects of myself--my hair I can't seem to do anything about, my unfulfilled potential, my flat violin playing. my sloppy mothering), but when things get really hairy and bad, I'm a fucking machine. I am really good at thinking very clearly and taking action when everyone else is freaking out. It's like my competency is inversely proportional to that of the people around me.
Maybe that's how ADD is an adaptation?
But normal situations--like grocery shopping--take me 5 times as long as anyone else.
Well, that's enought about me.
Both patients lived. And one's survival was kind of funny. We had coded this guy for 25 minutes. No pulse. Nothing. We'd gone through three drug boxes. The wife had been in the room during the code, crying, but not interfering.
Mac, who was the code physician, turned to her. "I don't know what else to do." He told her, helplessly. She stood by the bedside, sobbing, stroking her husband's hands.
The little medical students in the room continued to practice chest compressions on the guy, rotating through, so they could get their check-off.
Mac turned to us--"Can you guys think of anything else to do? Is there anything we haven't done?"
I was the recording nurse. In a code, everyone is assigned a role. There's a drug nurse, a code nurse, a recording nurse, and a code physician. Then there are 37 other people who just show up, criticize and generally get in the way.
I looked down at my form, which has a list of all the meds you can give during a code.
"The only thing we haven't given is bicarb."
"He's not acidotic." Mac says.
"You asked."
"Okay. Give him some bicarb. What the hell."
2 meQ of bicarb.
"It's in," says Kim. Kim's one of our new disasters. Here's a sample: Last week she was a no call, no show for her shift. She called in at 10am and blithely explained, "I'm so sorry--I went out drinking the night before and was still too drunk at 6:30 to come to work!" Laughing. Like we would all laugh with her and think this was just fun little shenanigans. Why she's still on our staff is beyond me. That's the nursing shortage, folks.
"Stop compressions. Check pulse."
We wait. Then: beep beep beep beep. P...qrs...t...p...qrs...t. Regular rate and rhythm.
Giovanni, our new fellow--I've talked about him before, right?--"and that, my lovelies is a pulse."
After these, though, I can't do anything. All my meds are late, I seem to move through jello. Two days of this. No wonder I have now been diagnosed with adrenal insufficiency. I have a dim suspicion this is connnected to Adderall.
Oh, well. You gotta have something. Didn't JFK have Addison's?
It's amazing how much the world outside does in 12 hours. Last Thursday, I was on the river.
Jay's organization, River Rescue, held a formal party on one of the sand bars. It was wonderful. 120 people, the environmental aristrocracy of the state, were transported by boat to the island, which had been transformed into paradise--sort of a hippy paradise--but paradise nonetheless. We ate jambalaya and caramel cake on white tablecloths. We wrote our dreams for the river and hung them on a tree constructed out of driftwood on the edge of the island. We sat by the fire afterwards singing John Prine songs and launching fouchees (these are fire balloons made of ingeniously folded newspaper--they look like willow-the-wisps). A generator had been lugged out to the island and the tables and tents were strung with tiny blue lights. Made silent, silent laughing love in the tent. Got miraculously called off the next morning, so I was able to wake up and see the mist coming up off the river in the sunrise.
Good times.
That's my 1/2 hour.
We had two codes in two days. One Saturday and the other on Sunday. We have an almost entirely new staff and no one, apparently, can think very well.
I am normally a pretty scattered, ditsy person. I can never find my keys. My house is a mess, and I always seem to be a day late and a dollar short, but at work, I am weirdly competent. Maybe it's the fact that the environment is so controlled? And when things get really hairy and bad, I hate to say this about myself, because it sounds like bragging (I think it's okay because I'm so miserable about so many other aspects of myself--my hair I can't seem to do anything about, my unfulfilled potential, my flat violin playing. my sloppy mothering), but when things get really hairy and bad, I'm a fucking machine. I am really good at thinking very clearly and taking action when everyone else is freaking out. It's like my competency is inversely proportional to that of the people around me.
Maybe that's how ADD is an adaptation?
But normal situations--like grocery shopping--take me 5 times as long as anyone else.
Well, that's enought about me.
Both patients lived. And one's survival was kind of funny. We had coded this guy for 25 minutes. No pulse. Nothing. We'd gone through three drug boxes. The wife had been in the room during the code, crying, but not interfering.
Mac, who was the code physician, turned to her. "I don't know what else to do." He told her, helplessly. She stood by the bedside, sobbing, stroking her husband's hands.
The little medical students in the room continued to practice chest compressions on the guy, rotating through, so they could get their check-off.
Mac turned to us--"Can you guys think of anything else to do? Is there anything we haven't done?"
I was the recording nurse. In a code, everyone is assigned a role. There's a drug nurse, a code nurse, a recording nurse, and a code physician. Then there are 37 other people who just show up, criticize and generally get in the way.
I looked down at my form, which has a list of all the meds you can give during a code.
"The only thing we haven't given is bicarb."
"He's not acidotic." Mac says.
"You asked."
"Okay. Give him some bicarb. What the hell."
2 meQ of bicarb.
"It's in," says Kim. Kim's one of our new disasters. Here's a sample: Last week she was a no call, no show for her shift. She called in at 10am and blithely explained, "I'm so sorry--I went out drinking the night before and was still too drunk at 6:30 to come to work!" Laughing. Like we would all laugh with her and think this was just fun little shenanigans. Why she's still on our staff is beyond me. That's the nursing shortage, folks.
"Stop compressions. Check pulse."
We wait. Then: beep beep beep beep. P...qrs...t...p...qrs...t. Regular rate and rhythm.
Giovanni, our new fellow--I've talked about him before, right?--"and that, my lovelies is a pulse."
After these, though, I can't do anything. All my meds are late, I seem to move through jello. Two days of this. No wonder I have now been diagnosed with adrenal insufficiency. I have a dim suspicion this is connnected to Adderall.
Oh, well. You gotta have something. Didn't JFK have Addison's?
It's amazing how much the world outside does in 12 hours. Last Thursday, I was on the river.
Jay's organization, River Rescue, held a formal party on one of the sand bars. It was wonderful. 120 people, the environmental aristrocracy of the state, were transported by boat to the island, which had been transformed into paradise--sort of a hippy paradise--but paradise nonetheless. We ate jambalaya and caramel cake on white tablecloths. We wrote our dreams for the river and hung them on a tree constructed out of driftwood on the edge of the island. We sat by the fire afterwards singing John Prine songs and launching fouchees (these are fire balloons made of ingeniously folded newspaper--they look like willow-the-wisps). A generator had been lugged out to the island and the tables and tents were strung with tiny blue lights. Made silent, silent laughing love in the tent. Got miraculously called off the next morning, so I was able to wake up and see the mist coming up off the river in the sunrise.
Good times.
That's my 1/2 hour.
Tuesday, September 15, 2009
A letter from Home
I continue reading Raise High the Roof Beam Carpenters and Seymour: an Introduction.
Did you catch the pun on his name?
Seymour. See More. Seymour the mystic. Seymour the prophet.
I read this book last when I was probably Lilly's age. I parcel out Salinger's stories because he hasn't written that many, and I want them to last me my whole life. This is an idea I got from my ex, Charles. Another poet/saint. We lived together my first year at Dartmouth in a little two-hundred year-old house that had been rebuilt and rebuilt, near the velvet rocks. It was painted state park restroom chalk blue, was freezing cold, and had an unhappy and hostile, if ineffective ghost in the attic. When I realize that I was Lilly's age when I was doing this, throwing away my life, I freeze with fear. Oh, well.
The reasons you make the choices you make.
J.D. Salinger is/was my favorite author. Then came Dostoyevsky. And then Murakami. But from 12-16, when I was making all the important life decisions, it was JD. I was a crackerjack 16 year-old. I have to say, in terms of the world, I really peaked at that age. I mean, I've done other things since, good secret things, things that I'm happy with. I like myself better now. But you and I both know I haven't exactly burned a trail to greatness. But at 16, I was a baton twirling, singing, tap-dancing, poetry spouting, national merit finalist. I got into both Duke and Dartmouth. Which should I choose? J.D. Salinger lived near Hanover. I decided that I was going to Dartmouth.
So I'm reading this again at 40-something. And I love him so much more. And dislike him, too. Which I didn't the first time around. But I know more about him, of course. There's so much in it that you miss. That's kind of a wonderful thing, isn't it, about getting older? Finding what you missed? I didn't have a lot of real compassion when I was 16. Compassion has been a long time coming. The lotus is a good image for that. So is the rose. Rose of sharon, abide with me. It unfolds, just like that, when you finally get silent. Many petaled, infinite, fragrant.
Ok. So I went to Dartmouth to seek out JD Salinger. And I wanted to sit down with him and talk to him. But then I read Seymour--the part in which he talks about the students who beat their way to his door. And I realized (surprise!) that I was not the first person who had had this idea. I put my little idea away, ashamed. And, although I did indeed meet J.D. Salinger, twice, it was purely by magical accident. And I didn't talk to him about anything. I said "good morning" the first time, and the next time I showed him where a book on the New Yorker was in the bookstore. And the only things he said to me were, "Good morning" back, early on a sunny October day, and "Wallace Shawn was the ONLY editor the New Yorker has ever had. The magazine doesn't even exist any more."
Back to Seymour. Buddy outlines the types that visit him. But he misses one. He misses the reader, who, reading feels the writer is writing a letter specifically to her, putting into words all the things she suspected but could never really articulate, and that no one around her ever expressed. He misses the one who (crazily?) feels that at last she has always been an orphan, and has now heard from her family. Now that I'm writing and thinking about it, it was my mother who first read me For Esme with Love and Squalor. I think she was giving it to me so I would know her heart.
Call no man Raca. We don't get to know anyone here, do we?
That's my 1/2 hour.
Did you catch the pun on his name?
Seymour. See More. Seymour the mystic. Seymour the prophet.
I read this book last when I was probably Lilly's age. I parcel out Salinger's stories because he hasn't written that many, and I want them to last me my whole life. This is an idea I got from my ex, Charles. Another poet/saint. We lived together my first year at Dartmouth in a little two-hundred year-old house that had been rebuilt and rebuilt, near the velvet rocks. It was painted state park restroom chalk blue, was freezing cold, and had an unhappy and hostile, if ineffective ghost in the attic. When I realize that I was Lilly's age when I was doing this, throwing away my life, I freeze with fear. Oh, well.
The reasons you make the choices you make.
J.D. Salinger is/was my favorite author. Then came Dostoyevsky. And then Murakami. But from 12-16, when I was making all the important life decisions, it was JD. I was a crackerjack 16 year-old. I have to say, in terms of the world, I really peaked at that age. I mean, I've done other things since, good secret things, things that I'm happy with. I like myself better now. But you and I both know I haven't exactly burned a trail to greatness. But at 16, I was a baton twirling, singing, tap-dancing, poetry spouting, national merit finalist. I got into both Duke and Dartmouth. Which should I choose? J.D. Salinger lived near Hanover. I decided that I was going to Dartmouth.
So I'm reading this again at 40-something. And I love him so much more. And dislike him, too. Which I didn't the first time around. But I know more about him, of course. There's so much in it that you miss. That's kind of a wonderful thing, isn't it, about getting older? Finding what you missed? I didn't have a lot of real compassion when I was 16. Compassion has been a long time coming. The lotus is a good image for that. So is the rose. Rose of sharon, abide with me. It unfolds, just like that, when you finally get silent. Many petaled, infinite, fragrant.
Ok. So I went to Dartmouth to seek out JD Salinger. And I wanted to sit down with him and talk to him. But then I read Seymour--the part in which he talks about the students who beat their way to his door. And I realized (surprise!) that I was not the first person who had had this idea. I put my little idea away, ashamed. And, although I did indeed meet J.D. Salinger, twice, it was purely by magical accident. And I didn't talk to him about anything. I said "good morning" the first time, and the next time I showed him where a book on the New Yorker was in the bookstore. And the only things he said to me were, "Good morning" back, early on a sunny October day, and "Wallace Shawn was the ONLY editor the New Yorker has ever had. The magazine doesn't even exist any more."
Back to Seymour. Buddy outlines the types that visit him. But he misses one. He misses the reader, who, reading feels the writer is writing a letter specifically to her, putting into words all the things she suspected but could never really articulate, and that no one around her ever expressed. He misses the one who (crazily?) feels that at last she has always been an orphan, and has now heard from her family. Now that I'm writing and thinking about it, it was my mother who first read me For Esme with Love and Squalor. I think she was giving it to me so I would know her heart.
Call no man Raca. We don't get to know anyone here, do we?
That's my 1/2 hour.
Monday, September 14, 2009
Capitulations
It's hard to think on Monday mornings, after three days on the floor. I can't even type my password in correctly to log on. Then I forget my username. Or, I don't exactly forget it, I remember it but my fingers type the wrong thing.
I had two old men. One had a traumatic brain injury. One had Parkinson's and dementia. His bright black eyes, fringed with beautiful long lashes peered out at me, knowingly. He bristled with white hair. Neither would do anything I asked. At all. The one with Parkinson's couldn't enunciate. "OOOOHAAAAY!" he'd say. "OOOOHHHAAAAAY" He could only hold his head at a 45 degree angle back, staring at the ceiling with his gleaming black eyes. He held his hands close-in, stiff. I couldn't bend them. I wasn't about to force him. His daughter was one of those women who have never been able to be young and is a little put-out about it. Pretty, but burdened. No true laughter. I know just how she feels. Now. I asked her for her contact information. She gave it to me saying, "I'm the only one who didn't run away. You'll always be able to reach me." His wife was like a child. A little lost. She wore the same clothes the entire weekend--all three days--visibly dirty and torn. Grimy. You could see how pretty she'd been. Short buzz cut hair that was falling out. She smelled like the street--like piss and booze and smoke. The daughter kept rolling her eyes when she referred to her. The "wife" she called her. "Oh," I asked, "Is she not your mother?" Exasperated, exhausted sigh. "Yes. She's my mother." At one time, apropos of nothing, the daughter says to me, "I'll say this for our family, we come together in a crisis."
It was true. You could pick up the tension between everyone. But they weren't playing it out too much. They were all focused on the father, on his well-being. Even "the wife"
"We're very dysfunctional." The daughter informed me.
"You're behaving like champs here."
"You have no idea." She and her husband both start to giggle.
At lunch I reread Raise High the Roof Beam Carpenters. I bought it for Lilly, but she wasn't interested. They had fried chicken. Second weekend in a row (it's usually every other Sunday). Our hospital makes some of the best fried chicken I've ever had. I sat on the little cement patio in the sunshine and ate. I have to get outside at least once a shift. Wiz never takes lunch, never goes outside. I used to follow his example--but then I decided that it wasn't a moral failing to take a 1/2 hour break in a 12 hour shift. I know he secretly sees this as a betrayal of the order, but I think a little sanity is called for. I make everyone else take lunch, too. He makes fun of me. "I think I'll go take a break now," he mimics.
"Go. You need one."
He grunts, waves me off.
Back in the room, I discovered that the OR had just absolutely botched my old man's arterial line dressing. They'd used non-sterile skin tape--the catheter was about half out--wonderful. Which meant that changing the dressing would pull the cathether out. The family had left the room. I've gotten into the bad habit of talking to myself in front of my patients--who are mostly gorked--I was working over his art line, the god damn tape sticking to my gloves, trying to save the line. Muttering to myself. "the god damn OR. What the hell. I mean, what the hell." And my patient, who'd been fighting me all day, looks at me and says, "wahheyoo?"
So I told him. "Well, look at this dressing on your arm." He lifted his wrist up and looked at it. "See? It's covered with sticky tape--right on the catheter that's going into your wrist. It's sloppy. It drives me crazy."
"I-orry."
"It's not your fault."
"I-orry." And, for the first time in three days, he relaxes his arm and turns his palm up so I can get to the dressing.
That's my 1/2 hour.
I had two old men. One had a traumatic brain injury. One had Parkinson's and dementia. His bright black eyes, fringed with beautiful long lashes peered out at me, knowingly. He bristled with white hair. Neither would do anything I asked. At all. The one with Parkinson's couldn't enunciate. "OOOOHAAAAY!" he'd say. "OOOOHHHAAAAAY" He could only hold his head at a 45 degree angle back, staring at the ceiling with his gleaming black eyes. He held his hands close-in, stiff. I couldn't bend them. I wasn't about to force him. His daughter was one of those women who have never been able to be young and is a little put-out about it. Pretty, but burdened. No true laughter. I know just how she feels. Now. I asked her for her contact information. She gave it to me saying, "I'm the only one who didn't run away. You'll always be able to reach me." His wife was like a child. A little lost. She wore the same clothes the entire weekend--all three days--visibly dirty and torn. Grimy. You could see how pretty she'd been. Short buzz cut hair that was falling out. She smelled like the street--like piss and booze and smoke. The daughter kept rolling her eyes when she referred to her. The "wife" she called her. "Oh," I asked, "Is she not your mother?" Exasperated, exhausted sigh. "Yes. She's my mother." At one time, apropos of nothing, the daughter says to me, "I'll say this for our family, we come together in a crisis."
It was true. You could pick up the tension between everyone. But they weren't playing it out too much. They were all focused on the father, on his well-being. Even "the wife"
"We're very dysfunctional." The daughter informed me.
"You're behaving like champs here."
"You have no idea." She and her husband both start to giggle.
At lunch I reread Raise High the Roof Beam Carpenters. I bought it for Lilly, but she wasn't interested. They had fried chicken. Second weekend in a row (it's usually every other Sunday). Our hospital makes some of the best fried chicken I've ever had. I sat on the little cement patio in the sunshine and ate. I have to get outside at least once a shift. Wiz never takes lunch, never goes outside. I used to follow his example--but then I decided that it wasn't a moral failing to take a 1/2 hour break in a 12 hour shift. I know he secretly sees this as a betrayal of the order, but I think a little sanity is called for. I make everyone else take lunch, too. He makes fun of me. "I think I'll go take a break now," he mimics.
"Go. You need one."
He grunts, waves me off.
Back in the room, I discovered that the OR had just absolutely botched my old man's arterial line dressing. They'd used non-sterile skin tape--the catheter was about half out--wonderful. Which meant that changing the dressing would pull the cathether out. The family had left the room. I've gotten into the bad habit of talking to myself in front of my patients--who are mostly gorked--I was working over his art line, the god damn tape sticking to my gloves, trying to save the line. Muttering to myself. "the god damn OR. What the hell. I mean, what the hell." And my patient, who'd been fighting me all day, looks at me and says, "wahheyoo?"
So I told him. "Well, look at this dressing on your arm." He lifted his wrist up and looked at it. "See? It's covered with sticky tape--right on the catheter that's going into your wrist. It's sloppy. It drives me crazy."
"I-orry."
"It's not your fault."
"I-orry." And, for the first time in three days, he relaxes his arm and turns his palm up so I can get to the dressing.
That's my 1/2 hour.
Monday, September 7, 2009
City of New Orleans
Went to see District 9. It was really good. At least I think it's good. It held my attention from the first frame. And I liked that the creatures were made to be so repulsive, so that there was a real emotional journey the audience had to make in order to find them sympathetic. Much the same thing happens with my patients. At first they're overwhelmingly horrific, but then I get to know them, and their humanity pokes through--or rather, mine does. I seem to lack a heart. What I mean by this, is that my empathy does not kick in automatically. I am almost always repulsed initially. I have to talk to myself, to make my patients into stories. I describe them to myself as if I were reading about them in a book..."He lay there--the ET tube had twisted and was pulling at his mouth which was covered in herpetic blisters brought on by the stress of his condition" and then I think--"Jesus, I'd better fix the ET tube." This is a constant practice. I "write" every inch of my patients to myself this way--and then I nurse them. But I don't do it automatically, which shames me. Wiz does it automatically. The great nurses do. I have to break it down...I want to be nice, but I'm not nice. I always have to think, "what would a nice person do in this situation?" And then I do it. But I'd mostly rather be reading a book. Lilly and Nick have both told me they feel this way, too. Does everybody, I wonder? I think maybe a lot of people do. Religious practice is exactly that--practice. Church services held once a week, mass every morning. We need to be reminded. We need to renew our vows to each other, every day.
I dropped Nick off at Loyola a week and a half ago. New Orleans. A strangely empty city. But it feels like she's growing. She doesn't feel dead. Loyola is in the Garden District, and I liked its noble, underdog feel. Its gingerbread peeling red brick ramparts next to solid, rich old grey Tulane. The Jesuit ideals of Social Justice embedded in the paving stones outside the library...the flowering trees, Audubon park with its shady live oaks (I guess?) and ibis. Girls in blue plaid skirts and long straight gleaming hair. And the streetcars! I really loved the streetcars. Walked around, thought about my old lost friend Barry Gifford. He was right, it felt a lot like the Grove. I sent him a letter before we went, but it was returned "unable to forward" Probably for the best. Nick and I took the train--the City of New Orleans. Coach. From Carbondale, Il. We sat in a bar waiting for 1:30am, watching two men in french cuffs and a very drunk, plump, red haired girl in an expensive black dress.
"Never trust anyone in french cuffs." I told Nick. "There is no need for any normal American male to ever, ever wear them unless they are planning to take advantage of you." The bar-owner, a man named Tip, dressed entirely in a carhart jumpsuit, first distrusted us (we were carrying all our things, including pillows, in a cart,like homeless people), then liked us (I ordered Bauchant), even walking us down the tracks to the Amtrak station once the bar closed--we knew where it was, but, as my grandmother always said, it is wise to let people be kind to you when they want to. Never know when you'll have to hang out in Carbondale.
Home, I discovered that I suddenly wanted every thing clean. With a toothbrush.
Saturday, Wiz calls me over. He was clerking. We are short staffed, and doing more with less. So the nurses are clerking. Dangerous.
"Sit."
I sat.
He looks at me with his blue-yellow lizard eyes. "Patton, you need to find a way to deal with your children growing up that does not involve disinfectant, a toothbrush, and a green scrubby. You're taking the wax off the floors. Look."
The floor is polka-dotted with white spots. Hundreds. Where I've cleaned, I've left the floor cleaner than the surrounding tiles. And I cleaned the chairs, and the rubber areas around the sink. And the venetian blinds in the patient's rooms. And the computers. And I took care of my patients--exquisitely, I might add.
"No one trusts medical care in a hospital with dirty floors."
"True."
We're silent.
"Ahh, the deafening silence of reality." He says.
"It's not about Nick. I just want every thing clean."
"Passages by Gail Sheehy. That would be a good book for you." He muses.
"Don't go all soft on me."
"I am nothing like you think I am." He tells me.
"Neither am I." I reply.
That's my 1/2 hour.
I dropped Nick off at Loyola a week and a half ago. New Orleans. A strangely empty city. But it feels like she's growing. She doesn't feel dead. Loyola is in the Garden District, and I liked its noble, underdog feel. Its gingerbread peeling red brick ramparts next to solid, rich old grey Tulane. The Jesuit ideals of Social Justice embedded in the paving stones outside the library...the flowering trees, Audubon park with its shady live oaks (I guess?) and ibis. Girls in blue plaid skirts and long straight gleaming hair. And the streetcars! I really loved the streetcars. Walked around, thought about my old lost friend Barry Gifford. He was right, it felt a lot like the Grove. I sent him a letter before we went, but it was returned "unable to forward" Probably for the best. Nick and I took the train--the City of New Orleans. Coach. From Carbondale, Il. We sat in a bar waiting for 1:30am, watching two men in french cuffs and a very drunk, plump, red haired girl in an expensive black dress.
"Never trust anyone in french cuffs." I told Nick. "There is no need for any normal American male to ever, ever wear them unless they are planning to take advantage of you." The bar-owner, a man named Tip, dressed entirely in a carhart jumpsuit, first distrusted us (we were carrying all our things, including pillows, in a cart,like homeless people), then liked us (I ordered Bauchant), even walking us down the tracks to the Amtrak station once the bar closed--we knew where it was, but, as my grandmother always said, it is wise to let people be kind to you when they want to. Never know when you'll have to hang out in Carbondale.
Home, I discovered that I suddenly wanted every thing clean. With a toothbrush.
Saturday, Wiz calls me over. He was clerking. We are short staffed, and doing more with less. So the nurses are clerking. Dangerous.
"Sit."
I sat.
He looks at me with his blue-yellow lizard eyes. "Patton, you need to find a way to deal with your children growing up that does not involve disinfectant, a toothbrush, and a green scrubby. You're taking the wax off the floors. Look."
The floor is polka-dotted with white spots. Hundreds. Where I've cleaned, I've left the floor cleaner than the surrounding tiles. And I cleaned the chairs, and the rubber areas around the sink. And the venetian blinds in the patient's rooms. And the computers. And I took care of my patients--exquisitely, I might add.
"No one trusts medical care in a hospital with dirty floors."
"True."
We're silent.
"Ahh, the deafening silence of reality." He says.
"It's not about Nick. I just want every thing clean."
"Passages by Gail Sheehy. That would be a good book for you." He muses.
"Don't go all soft on me."
"I am nothing like you think I am." He tells me.
"Neither am I." I reply.
That's my 1/2 hour.
Tuesday, August 11, 2009
The Insayne roote
Well, I have officially entered the land of the insane.
I am finishing up both my health assessment final projects and my research proposal. I am doing this all by the 21st. I think. I hope. I haven't left the house. I'm living off armour thyroid, b vitamins, cafe con leches and grape nuts. When I sit zazen, all I do is cry. Then I get up and memorize cranial nerves (along with some other stuff, like heart murmurs). I've had three classes prior to this where I had to memorize cranial nerves--I have to rememorize them every time. I wonder if I've actually learned anything. I always have to run through in my mind--"On Old Olympus' Towering Tops" Sometimes however, at work, someone will ask me an academic question, and the answer will just weirdly pop out. Blurp. Like a knowledge lugie. (sp?) And I think: "I didn't even know I knew that!"
So, while I was sitting zazen this morning, feeling guilty for not using the 1/2 hour to study, I started thinking about Joaquin Phoenix.
There's this great line in this Julio Cortazar story The Pursuer, where all the sudden the main character (pretty much exactly based on Bird) is in a recording session and he freaks out and stops the session saying, "I'm playing tomorrow!" or something like that. And I think this has something to do with what Mr. Phoenix is trying to do. What happens when you drop the spin and the plan and just sit there?
It's even worse now. We are never where we are. Our culture is about smoke and mirrors. People don't even get to die. We think we have created immediacy with the internet, etc., but we have just made more shadows. Everything is up for grabs, everything is open for comment. This is why the families in the ICU are so awful. We have nothing that coaches us for finality, because everything now has the illusion of living on and on. As Wiz says, "Hello, Mr. Reality." We are lost in dreams--and mostly, oddly, dreams of being known. We want to be loved and known. And known in our world = recorded and broadcast. Our phrases are canned. We spout movie lines to each other instead of coming up with conversation. All communication is heuristic. Secret handshakes. Are you red or blue.
Well, best of luck, Mr. Phoenix. Remember there are other places, other lives. It's a big world. You can truly step out of your frame, if you want to. What about nursing school?
That's my 1/2 hour.
I am finishing up both my health assessment final projects and my research proposal. I am doing this all by the 21st. I think. I hope. I haven't left the house. I'm living off armour thyroid, b vitamins, cafe con leches and grape nuts. When I sit zazen, all I do is cry. Then I get up and memorize cranial nerves (along with some other stuff, like heart murmurs). I've had three classes prior to this where I had to memorize cranial nerves--I have to rememorize them every time. I wonder if I've actually learned anything. I always have to run through in my mind--"On Old Olympus' Towering Tops" Sometimes however, at work, someone will ask me an academic question, and the answer will just weirdly pop out. Blurp. Like a knowledge lugie. (sp?) And I think: "I didn't even know I knew that!"
So, while I was sitting zazen this morning, feeling guilty for not using the 1/2 hour to study, I started thinking about Joaquin Phoenix.
There's this great line in this Julio Cortazar story The Pursuer, where all the sudden the main character (pretty much exactly based on Bird) is in a recording session and he freaks out and stops the session saying, "I'm playing tomorrow!" or something like that. And I think this has something to do with what Mr. Phoenix is trying to do. What happens when you drop the spin and the plan and just sit there?
It's even worse now. We are never where we are. Our culture is about smoke and mirrors. People don't even get to die. We think we have created immediacy with the internet, etc., but we have just made more shadows. Everything is up for grabs, everything is open for comment. This is why the families in the ICU are so awful. We have nothing that coaches us for finality, because everything now has the illusion of living on and on. As Wiz says, "Hello, Mr. Reality." We are lost in dreams--and mostly, oddly, dreams of being known. We want to be loved and known. And known in our world = recorded and broadcast. Our phrases are canned. We spout movie lines to each other instead of coming up with conversation. All communication is heuristic. Secret handshakes. Are you red or blue.
Well, best of luck, Mr. Phoenix. Remember there are other places, other lives. It's a big world. You can truly step out of your frame, if you want to. What about nursing school?
That's my 1/2 hour.
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