They Can't Take That Away

I know this is probably my imagination, but sometimes my brain just feels tired--like I'm squeezing it too hard. Does your brain ever feel this way? I mean, my brain actually hurts. Not a headache. My brain. Like it's pumping iron and not doing very well.

I was so tired after work yesterday that I forgot where I was in the grocery store. Lilly and I went grocery shopping and in the candle aisle, Lilly showed me an article in one of the celebrity glossies about Glee--a show we've both become addicted to (I have to say--I don't really check men out physically--other than butts--I kind of notice butts--BUT!--other than that, I'm really a smell and snuggle girl--but what's his face in Glee--the teacher guy has a really awesome body. Not that I'm buying into this whole celebrity culture thing, but, you know, the truth's the truth!)--we were there late after work buying milk and lightbulbs, in the freezing rain. With the dog--and when I looked up from the magazine, I suddenly couldn't remember which direction the cash registers were. It was so scary. I had to close my eyes and re-orient myself. I think I'm going to start making myself play chess online.

I worry about my brain a lot. I think I'm just doing too much. This happened to me when I was getting a divorce, 15 years ago. I had everyone's phone number memorized and I just forgot them one day. Every single one. I went to a doctor about it, who told me I was just stressed and that when my life improved, the phone numbers would come back. She was right. They did. I just think about my grandfather and all his little post-it notes all over the house--sort of a flowchart on how to conduct a daily existence ('the faucet turns to the right'--that sort of thing) and I get worried. Of course, he was almost 90, so maybe that's ok.

Some of the things I'm forgetting worry me. For example, on my 18th birthday, my friend Evan Marquit took me to New York for the first time. It was really a beautiful night. First we went to Cafe Un Deux Trois with his older brother, a stockbroker, and his wife. They were prototypical screaming 80's successes. Both stockbrokers, both funny and sharp and kind and unapologetically capitalist. They had a little machine with an antennae that they put on the table during drinks that showed them the world markets, and they kept an eye on it. The table cloths were paper and you could draw on them. Which was really cool, then. (Now it's everywhere, I know) We had some sort of clear, awful tasting liqueur with coffee beans floating in it. About half-way through, Evan's brother noticed I wasn't drinking, smiled and ordered me vodka tonic. My first one. "Trust me." He said. Then we went to his apartment for dinner. I don't remember what we had, but I do remember that it was all black and white and had a Baldwin baby grand. Which is the best piano. Screw Steinway. And there were two godiva chocolates at each plate. And I'd never had those either. Then we went to see La Cage--and I recognized someone from my high school in the chorus line--so we went backstage and talked to him. Evan tried to argue me out of it. "No, you don't recognize anyone--you don't know anyone in this show." But I did! Dennis Callahan. He was dressed all in leather--some sort of jumpsuit with lots of zippers. Oh, New York! What it does to county boys.....ok. So then we went to Rick's on 86th (after a stop at a fortune teller who told me I would have three children, die at 82, and marry Evan), a piano bar, and Evan told the pianist that I could sing. So they called me up there. And I sang. I was wearing a green velvet drop waist dress that my mother had made for me.

It was my birthday a few days ago, and I was thinking all about this evening. Because I was Lilly's age. But then I got to the song part--and I couldn't remember what I sang! I could remember that the chocolates at my dinner plate had rasberry liqueur in them and the beans floating on the clear liqueur--I can remember Evan's sister-in-law's beautiful red suit--but I couldn't remember the song. I went through all the songs I would have known at that time--God Bless the Child? No. Ghost of yesterday? No. Cry me a River? probably not. And a funny thing happened with that memory, every time I thought of a song, I could almost convince myself that that was the song I'd sung. Ok. I'd think. That's it. And I could almost see and hear myself, sitting next to the pianist with my eyes clenched shut, facing away from the audience, singing into the mike.

So--the present. My birthday. I go to the alumni club with my parents and Lilly. It's raining. I've been at clinicals all day. I decided to invite Jay at the last minute, because I figured then he'd get the hint to refuse and he wouldn't have to deal with my mother at some interminable, horrible family event. Which unfolds predictably, with my mother saying, "Where's Jay? Couldn't be bothered to celebrate your birthday after 4 years?" And then I'm mad at Jay and at them all--my parents for being too crazy to introduce to boys and my boyfriend for not EVER sucking it up and dealing with them, and my mother for being mean. "She's on High Crazy Mean--"Lilly mutters to me as we edge up to the buffet. We're put in an almost empty dining room--the bar, actually, which has been converted into tables to handle the overflow from the main room--it's homecoming. There is one other couple--a romantic couple--mixed--sitting in a corner by the window. This compels my mother to make comments about black people throughout the meal which Lilly and I and my father ignore. It's just pretty much unabated awful.
"Do you want a brick?" my mother asks me. "We bought a commemorative brick." After dinner, she shows me the brick on the walkway outside the center. "We'll buy you one after you get your Masters--and even if you don't. I really don't see how you're going to do it. I didn't get through law school--there's no shame in not finishing."
We're waiting under the awning for my father to bring the van so he can drive me to where I've parked--all the way in East Jesus behind the hospital. About a 20 minute walk.
"Let's walk," Lilly suddenly suggests.
"You don't want to walk. You're anorexic. You can't afford the calories." Mom says.
"Let's walk." I concur. I kiss everyone. My father arrives. "Bye!"
And off we go.
Thank god.
No one's out. The rain's falling softly, and it's really not that cold. Lilly and I walk with our arms around each other under the umbrella, smelling the sweet rain smells of the gardens on campus and the turning trees. Even at night, you can still see the trees are golden as you walk under them.
Dinner disappears.
"Do you want your present?" Lilly asks.
"Sure! You have it with you?"
"I do." She pulls out a little box.
"Little boxes always have the best presents." I say. I open it up. It's a tiny little cloissonne elephant box. "It's beautiful!"
"thank you. See you can put your fuzzies in it."
"Thank you."
We're standing under a gingko tree. The wet leaves are all over the steps. We start to walk and Lilly starts to hum a song, then sing softly, "The way you hold your hat...the way you sip your tea..."
I join in..."the memory of all that.."and it suddenly floods back to me. That was the song I sang at Rick's on 86th. 25 years ago. We sing it all the way back to the car. No one's around, just my red-haired daughter and me, walking across the dark campus, arm and arm.

Happy Families

Nick left yesterday. He'd come home on the City of New Orleans to visit. He spent most of his time with his girlfriend, Katy. Which was fine. But I got a few nice hours with him yesterday. We've had rain and rain and rain, but the weekend was beautiful. 4 crystal October days. The leaves are in full glory. We met my folks at Ernie's for breakfast, and decided to walk there instead of drive. So we took the long walk along Broadway and I got to hear about every class. I've decided that I really like walking. I think it works a kind of magic. If we had driven, Nick and I would have shuffled around the house, lost in our own parallel worlds until it was time to leave. Then we would have gotten into the car and listened to the radio on the way there. This way, we were forced into proximity. He's such a nice kid.

I read this review of a new french film, I forget which one, in which the reviewer talks about the "tenderness and support" of families. And he's so right. When families are working the right way, that's what's happening: tenderness and support. It's hard to talk about and it isn't very interesting or dramatic, but it's the common ingredient in all happy families. And, despite everything, I think that Nick and Lilly and I are basically a happy family. Lilly's hovering at a very consistent 126.8 pounds, which, her doctor points out, is a little odd. "It's interesting to me that you are able to maintain your weight at the same value. It's almost as if it's on purpose." She was saying that we're not out of the woods yet. 126.8 pounds is exactly the amount Lilly needs to weigh in order to cross the threshold into normal BMI range. So she's still anorexic. She's still controlling every bite. I'm just relieved she's not an anorexic with liver and heart failure. Now if we could just get her to unclench. But how does she do that? I don't know how to do that. I'm obsessive compulsive (personality, not disorder). When I'm unhappy it gets worse. I used to write down everything I did during the day. I still sort of do that, but not to the extent I used to--where I couldn't ever do anything because I was too busy writing it down. I wrote things down because I felt guilty. I felt that I wasn't worth anything, and so I wrote down what I did to prove that I was doing something. This reached a fever pitch when I was married because my husband would accuse me of not doing anything. Taking care of young children is formless--it's so hard to pinpoint exactly what you do. The "mommy ghetto"--isn't that what it's called? The days would just be gone before I knew it. And I was really trapped inside the house. But my minute managing has really served me well, I think. I'm very productive. But I'm not very free. I think it's probably harmed Lilly. I think Lilly has received, by ongoing unrelieved example, my mindset. She probably received it in the womb. So is our family really happy? If we have problems, are we really happy?

Maybe I should leave it at this: we mostly function, love each other very much and treat each other well most of the time, and we are sometimes happy. There are problems, and there is tenderness and support. So I think that's ok. That sounds about like everyone else.

Saw Bright Star yesterday with Jay. Wrong movie to see. Good movie, but not the right one to see. During the credits, Keats poetry is read by the actor playing him. Jay leans over to me and whispers, "I think we know too many people in the audience to leave and not be considered philistines." I agreed and we sat gritting our teeth until it was done and we could go get a drink.

That's my 1/2 hour.

The Flu

Wiz is still missing. He's just evaporated. Everyone asks me where and how he is. Like I would know? I just shrug. "He's okay." I say. I was certain he'd be back by now. Then they start talking. It's interesting--people rarely talk to each other or with each other; they talk for themselves. I heard about 8 little monologues yesterday--themed "Wiz"--and they were all fictional. Geraldine, our unit clerk, whose sharp goose voice I hear even in my dreams, asks me once, gives me a look when I shrug her off. "I'm very worried about him." She says. "He don't have no flu, do he?"
I told everyone he had the flu. I figured that would explain the extended absence. I told them his whole family had it.
"Sorry."
The problem with Wiz being gone is that people pull things with me they never would dream of with Wiz. Sally, the House Mom sends patients to me and expects me to be able to take them immediately, without staff. "You just need to do this." She tells me.
"Then I need a nurse." I tell her.
Two hours later, after the patient has been wheeled in while I'm still getting report over the phone. I get one. Not ok. This is the third time this has happened, a patient rolling in almost unannounced. Wiz has told me in the past to do whatever Sally asks. "Your job is to make her job easy." I think they have a long friendship. I've seen pictures of her. She was once immense--easily over 300 pounds. She was in a terribly abusive marriage. Now she's thin and dry and wary. I like her, mostly, because she is always honest. But she can't stand being challenged. So this time, I simply printed off the record of every page I'd sent and received from her and handed it to her when the bed came in. "I told you about this." She said. "No, Sally, I'm really sorry," I said, very nicely (not fake nice), "you really didn't." No apology, but I know that in the endless hospital game of tit for tat talleys we all keep, I've earned some points. Maybe she's getting the flu.
Wiz's quote: "She's an oasis." I don't know about that, Wiz.
My staff are like little puppies. They crowd around me over every decision, every conversation. They look over my shoulder when I make notes and figure out staffing or send emails. I guess this is the downside of being accessible. I haven't decided whether this is good or bad. I think it's good.
"That's just bullshit," Marcy says, as the patient rolls in. "You need to call her and tell her we're not the fucking MNICU's dumping ground."
"Yeah, ok, Marcy, I'll delegate that to you. Be sure to use the word 'fuck' a lot."
Then my attending lurches in for rounds, looking just terrible. He hands me a folded paper towell upon which he's written a list of items and instructions. "Please do this for me," he rasps. "I'll be in room 12. Get the residents." He staggers into the room, sits down in the chair.
I look at the paper towell. "Are you serious? You need to go home."
"I need to round" he croaks. "Just do it. Please. Don't commit fraud, of course. Don't tell anyone."
I go to the OR, pilfer some D5LR and zofran. Start an IV on him. "Can't you do it somewhere besides the AC?" he whines.
"Listen," I snap, "starting an IV on my attending is nerve wracking enough. I'm a wretched stick. I'm going for easy here."
"You're getting blood all over everything."
I just focus. And say a prayer to the IV fairy (who really exists). And I get it! Hooray. "You can stand across the room and hit my veins," he croaks."When I was an EMT I used to let people practice on me. No, I'm sorry. You're a saint. I've been throwing up since 3 am this morning. This will get me past that. I mean, you're really a saint. Like Mother Teresa."
"She's not a saint yet. You know, " I tell him, just to make conversation while I sit there and watch the IV go in, and make sure he doesn't pass out or anything, "there's like a whole clinical ladder of sainthood. Takes years."
"Really?"
"Yes. You have to have three miracles--witnessed, and some other stuff. There's all sorts of points you have to earn. Takes centuries. It's very complicated."
"I'm Baptist. We don't go for all that."
"Yep. Leave the catholics to handle all the paperwork. You were an EMT--do you want a basin?"
"No," he urps.
"Do you have a fever?"
"No."
"Mind if I check?"
"Fine."
No fever.
"I told you so. Yes, I was an EMT. 14 years."
"Really? What made you become a doctor?"
"I hated doctors and one day one of them told me to quit my fucking whining and become one if I thought I could do it better. I still fucking hate doctors."
"You should have become a nurse."
"No fucking way. Am I saying fuck too much?" He says this because I have made a habit of handing him a bar of soap every time he says "fuck" I carry them in my pockets during rounds.
"That's going in too fast."
He's opened the clamp all the way.
"No it isn't."
"Yes it is." I tighten the clamp.
"Fine."
"I'll check back on you in 15 minutes."
"Fine."
He's a lot better. Color's better, and he's sitting up straight. "Good. Go get the residents."
He finishes rounds with the IV in his arm. I give him another bag.

That's my 1/2 hour.

The Lucky Dark

All my good intentions went out the window yesterday. I was absolutely mired in blackness. It came on suddenly, for no good reason. I wandered around the house thinking, "what's the point?" Finally, I just crawled into bed with a novel (Bartimaeus--Ptolemy's Gate. I finished it) until 4:00. Then I roused myself and somehow got to staff meetings. The evening was better. I got some homework done. Went to bed gratefully at 10:11. No call from Jay. Maybe that was part of the problem. My feelings get hurt when he doesn't call. Sometimes we do so well, and I really like him, and sometimes I think he's a jerk. I think boyfriends should call you once a day, and if they don't, they should be punished. I start worrying--I'm getting older, I won't be pretty, I'm too old to find someone else--you know... this could happen. I'm terrified of dying alone. Poor Boo dog, dying by herself, downstairs on her little blue blanket in the bathroom. Which is still there. I look at my chin, checking it for signs of crumbling, checking my jawline for that window dressing valence look we all start getting. Looking askance at women slightly older than me, and younger than me, and my age. Is it happening? Is it catching?

This came on very suddenly. Maybe it's the weather, which is unseasonably cold, rainy and gray. Dreary. And I haven't exercised. Maybe I'll force myself to take a little walk. But yesterday I was just about incapable of action and that really frightens me. I used to be like that, about 10 years ago, and everything fell apart--I lost my job, my relationship. I had an affair with a married cop that made things even worse. I would have dreams about lying in the cold night rain naked on an asphalt street while people stepped on me. It was a terrible time. That was the year I watched Rushmore over 200 times. I couldn't appreciate my children. The cat died. The sewer pipe broke and it flooded my basement. I cried all the time. I still sat zazen. I would sit and sweat and sob.

Depression. I really don't want to get hit again. It was so beyond me. It sank everything.

Ok. Well, I know what I have to do. I just have to keep going through the lists, setting my timer, taking my breaks, and doing what I need to do. I sit, I'm surrounded by thick fog. Everything, even simple, simple things, seem absolutely beyond me. Everybody has blue days. And yesterday was a blue one, for whatever reason. The day before was fine. So I'm sure it will get better. I'll put off the big existential questions. I think those questions are just awful. What is the meaning of life, etc. I'm one of those people who can't think about those things too much. Because I'll just lie down and die.

I'm reading Being With Dying by Joan Halifax. Just something light and distracting before bed and while in the loo. She talks about St. John of the Cross, and how "suffering, pain, dying, failure, loss, and grief" are the "lucky dark"--she states, "[T]hat great Christian saint recognized that suffering can be fortunate because, without, there is no possibility for maturation."
I think that's a lot to put on to suffering.

That's my 1/2 hour. Exactly.

High Heeled Nurses

I finally started clinicals yesterday. If there's a negative about this master's program, it's that the clinical coordination is very poor. It's a very patched together affair. Frustrating.

I like my preceptor. She's about eight years older than I am. She's from New Hampshire, and She's named Halene. Just to keep things confusing. she's a trekkie. She even has a picture in an enterprise uniform photshopped into a scene with Data, Warf and Deanna. And she's smart---smart, smart, smart. The view from this perspective is interesting. We rounded with the physicians through the ICU's. The bedside nurses in the other ICU's seem to just evaporate--they fade into the woodwork. They're not acknowledged at all. Rumply and worn. The divide between the tellers and the doers was very clear. It was very strange.

Not a lot of work gets done at the administrative level. No one manages their time well. There's a lot of standing around, leisurely conversations about kids and stuff--I'm not saying she doesn't work, because she obviously does, but the time pressure is obviously not so keenly felt. I feel I have to use every minute in my life, this isn't something people really seem to understand at this level. But there are probably subtleties I'm not picking up on. People dress nicely. They have time for lunch and they wear nice shoes. Halene hasn't lost too much touch with the realities of the bedside, which is refreshing. She realizes for example the danger of our task oriented ethic, and she's good at seeing systems as a whole--the larger forces at work in a situation. I also caught the whiff of a lot of blame resting on bedside nursing (not from her, just from the tenor of the conversations I got to sit in on). And I realized something: everything you do gets noticed by someone.

Hmmmm.....Nursing is a self-hating profession. The ones who rise really never, ever, want to go back to their blue collar roots. It's like having poor, obnoxious, immigrant relatives--you want them as far away as possible. And who wouldn't want to be away from it, once you get the chance to, once you realize that your world doesn't have to be comprised of shit and blood and death and blame? Exhausting 14 hour days with no time to eat or rest. Who wouldn't?

In her quiet office, we met with the multidisciplinary team to plan patient care. One of the patients had just had care withdrawn. All the sudden we heard screaming and wailing, sobbing--an endless, endless cacophony. "What's going on out there?" the physical therapist asked.
"they just withdrew care on Mr. Rawalpindi." Halene said. Rawalpindi had been in a coma for two years. He got pneumonia and had too many complications. Then we heard the sound of retching. We sat in the office with the door closed and listened. The screaming and yelling and sobbing and retching sounds continued. We continued on with the meeting, raising our voices a little over the noise from the waiting room.

We went to another meeting. The noise continued.

"I guess it's not as bad as a Klingon funeral." Halene commented.

That's my 1/2 hour.

Rules

Oh, it's so hard to sit sometimes. Especially on Mondays after 3 days straight at work. I feel like work is this weird hiatus from my real life, which is waiting for me, tapping its foot on Monday morning. The ICU is this strange twilight ship that takes off Friday morning and lands late Sunday night. I sort of have these dream states in between which consist of sleep, sex, and an approximation of dinner. Then 4 days to be sort of normal. Lilly's insight has proven to be a breakthrough in the state of the house. It's been livable for a week now, with not too much effort. Who knew?

I'm always searching for the recipe. The one rule.

I was there until 2130 last night. Charged all weekend. Wiz was gone again. I got a cryptic email from him thanking me for my friendship and asking that I not try to find out what was going on and not talk about him. I emailed him back, gave him my cell, told him if he was in trouble I could have someone there in 15 minutes and that whatever was happening, he had my support.

What a funny little animal. Everyone asked me what was up. I blithely lied and told them his whole family had the swine flu. Every one clucked in sympathy. Hooray for H1N1! Oh,Wyczkoski. I hope you're all right.

Then all weekend, I ran the place. I tried to be Wiz, with limited success. But there is something about just jumping in and doing things that seems to lend itself to success. The whole crew now is brand new--graduate nurses. And they know nothing. They don't even know sort of regular adult things--like don't interrupt,and show up on time and don't call in drunk. Don't talk during report. Drunken Disaster got belligerent during report yesterday morning. She had some questions I asked her to hold til we got through hearing report--
"I'm just asking a question about my pay!"
"Okay, but we need to address that after report.'
"I was just asking. Jesus."
"Yes, but now it's time for report. Please go ahead, Kyle."
I fired off an email to our manager. Which I've never done. Wiz would be disappointed. He hates tattling. But I'm pretty worried about this person. I don't think she belongs here. I feel strongly about this. I worry about people who seem to not notice or care about regular social boundaries, even in small ways. In my experience, this always is a harbinger of deep seeded mental illness, a lack of empathy and disassociation from the rest of humanity. I know that's a lot to ascribe to small discourtesies and I've probably been drinking my own bathwater. There are the rules that are there because of social control--stupid rules--like jaywalking. Our town is so quiet, who cares about jaywalking? Big deal. There are the money rules which seem to be made by people who want to keep other people in their place. But then there are other rules--like drinking and driving, or running red lights--and the unwritten rules we have to have to function--sometimes it's just rudeness, but sometimes it's something much worse. And with a nurse in an ICU, the potential and temptation for worse is huge. Primo Levi (to paraphrase) said that when someone is facedown in the mud, the human temptation is to keep walking over him, not help him up. There are a lot of people face down in the mud on this twilight ship.
Hmmmm.

That's my 1/2 hour.

Hark Hark...

The tornado sirens are going off. It is exactly noon in Paloma. The sirens are tested every Wednesday. At the same time, all dogs in the city lose their minds. Mine are no exception, they are howling and whimpering along with every other dog in the neighborhood.

I spent the morning staving off squalor. Lilly, on the way to school, said, "I was thinking--if we could just do the laundry and the dishes and keep the bathroom clean, the rest would probably take care of itself." A lightbulb went off. Cleaning is not something you do, clean is something you are. So I put in about 4 hours achieving laundry, dish, and bathroom stasis--picked up all the clothes in the house, sorted them, started churning them through the machine. Did the same with the dishes, scrubbed down the bathroom. And here I am. Now, though, I'm wondering it was all a way to avoid doing my classwork, which I am two days late with.

I got a pleasant email from the group leader with the subtext--"where the hell are you?"
I don't know...I'll pick up the threads today. Took 2 days off over the weekend--then came back Monday and discovered I was in charge. That keeps happening. Wiz has mysteriously called in for 4 days. "Family trouble." he said curtly. It's well established that whenever I charge, everything goes to hell. Not that I run things poorly (I'm not stellar, but I'm not awful, either) but if anything can go wrong it will. Arteries will start spurting blood, unannounced gunshot wounds will come rolling through the door. Staff will accidentally cut themselves with razors, codes right and left (one day we actually used up all the defibrillator pads on my shift). And everyone, but everyone will get diarrhea at the same time. And then there'll be the weird things that happen when I charge--for example, last week, the TV in room 3 just exploded--on its own. White burst of light, the sound of breaking glass and smoke. We had to move all the patients from that side to the other side--that sort of thing.

Clara, our week-day unit clerk rolled in, saw it was me charging, and sighed. "I'm going to call ahead of time, and if you're charging, I'm going to call in sick." It was 0730.

"That's not fair, Clara. Nothing's happened yet. It was a quiet night."

"I'm giving it 45 minutes before the shit hits the fan." She says pleasantly. Clara is paralyzed from the waist down, is chronically ill with CHF, and is a single mother. She has the most beautiful, soothing voice. She should be on the radio. And she has this sort of even calm--this way of fielding craziness--that is something to see. She also has this folksy way of stating even the most unpleasant contentious things that makes them sound perfectly reasonable. She's magic.

My pager goes off.

"I guess I meant seconds." She says, "Here we go."

She was right. GSW to the head. Suicide. We couldn't get the family to understand how serious it was.

"Is he very sick?" the mother asks Marcy, on the phone.

"He shot himself in the head and he has no responses."

"Well, does that mean he's sick?"

That's my 1/2 hour.