Meh.

I've decided it's not the heat here in Central Texas that bothers me; it's how long it lasts. I could easily handle a worse summer than we've had here--only a couple of days over 100 degrees!--if it just ended sooner.

Something about the constant bright sunlight and the lows in the 80's really wears me down.

So does work. Work is wearing me the hell down, People.

I almost had to call in the Ethics Peeps this week. Mama is dying of a nasty sort of metastatic cancer that's hit her brain, liver, spine, and various other bits of important equipment. She has a midline incision from her breastbone on down that won't heal, a couple of cracked ribs from a previous code, 3+ edema every-damn-where, she's breathing too fast and her heart's wearing out, and she's seizing constantly and has been for about the last three weeks. Oh, and she has a galloping infection under her scalp, where a bone flap was taken out when some other neuro guys somewhere else resected a tumor in her brain. That's the least of her problems, frankly.

We've spent the last two weeks trying to convince Son that perhaps Mama should, when Jesus calls, actually pick up the phone. She was a full code this entire time. That means, for you non-medical people, that if her heart or breathing had stopped, we would've gone into Super Nurse Grey's Anatomy Mode and tried our best to bring her back. (Well, not really. I would've walked slowly to that particular code.)

The trouble is that, when you're trying to save people who are that sick, you end up torturing them.

Even the best, most well-executed code has only about a three-in-ten chance of bringing the patient back. And by "bringing the patient back," I don't mean they walk out of the hospital. I mean we stabilize them enough to get them into the CCU, where they'll be intubated and sedated and have drugs pumped into them that will keep their blood pressure up while causing their intestines to slough off and their hands and feet to turn black and gangrenous and we'll put 'em on external continuous dialysis and they'll have tubes coming out of every orifice. . . .

It's ugly. In twelve years, I have heard of--not actually seen--one patient leave the hospital under his own power after a code. Part of that has to do with the people we code: not many, because we're big on comfort care and being rational. Part of it has to do with the population we serve: once your brain goes bad, there's not much point in keeping your heart beating, and no real good way to do it.

Anyway. Mama and I had gotten well-acquaint (or as well-acquaint as you can with somebody who twitches and moans) and I was looking forward to the probability that I would be breaking more ribs, causing her belly wound to come apart and her guts spill everywhere, and generally doing something I didn't want to do. We actually had a call in to the ethics committee about Mama, when a doc I had not met before came sailing in like a white knight and saved the fucking day.

The dude is new to the hospitalist program. I met him for the first time after he'd been straightforward and a tiny bit brutal with Son about Mama's chances. I could've hugged him. Instead, I called Ethics back and told 'em to stand down.

Mama is now a DNR. She's not on palliative care yet, but I'm happy just being able to not have to consider coding her.

Sometimes things work out okay, relatively speaking.

What I thought/What I said

The interviewer asked, "What's making you want to leave your current job?"

I'm tired of watching my coworkers coming in, looking defeated.

I haven't had a sit-down lunch in six weeks. One of my coworkers weaned her baby early because she couldn't get anybody to relieve her so she could pump breastmilk.

Our acuity increased at the same time our director cut our staff, so there are delays in care that I find unacceptable.

We've been rebranded a "step-down" unit, so none of us will get critical-care raises or credit, but we're still taking CCU patients. We still float to the CCUs.

The attitude of the administration to our unit is "do more with less; you're nothing but big whiners." When the director brushed off legitimate concerns with the response that we were "jibber-jabbering," I died a little.

I showed up at six yesterday and started working immediately, because there were three admissions at once and none of the resources or help we were promised were available.

We're having falls and bad patient outcomes as a result of short-staffing, and we're getting disciplined for them.

I can't get a damn MRI statted because I can't find somebody who can monitor a patient on a drip in the tube.

Our manager refuses to back us up when things get dangerous.

The doctors I work with recognize the problem, as do the nurses in other departments, but still nothing is done.

I'm exhausted from not eating, not peeing, not taking a day off, and the rest of my life is suffering.

Although we stand in solidarity as a unit, the director is telling his bosses that there are a few bad apples spoiling the whole bunch, and that getting rid of them would fix the problems.

Which is why, I guess, that all but one of us are looking for new jobs. And that one person is reconsidering.

Because when you have a wife who's on palliative chemotherapy, even a potential gap in insurance coverage beats working here.

The training and education we were promised hasn't materialized.

We're used as a dumping ground for VIPs, when actual sick patients are pushed to other, even more crowded units.

We've won awards and have certifications out the wazoo, but the things that made those certifications and awards are gone now.
Yet we're still expected to make do, somehow.

And if we stand firm on staffing grids and patient safety, we're written up and our patients are moved elsewhere, to make room for the aforementioned VIPs.

I dread coming to work every day. The only thing that makes it possible for me to sleep the night before a shift is Benadryl. And bourbon.

I'm terrified that something horrible will happen, that a patient will die or be injured, because we don't have enough staff.

That almost happened last week. A patient with a sudden neurological decline had to be transported to the operating theater by two doctors, because we were short nurses to monitor him.

I miss the days when I could leave work and not ruminate on possible mistakes or oversights I might've made.

I miss being a nurse rather than a combination unit secretary, patient care aide, phlebotomist, janitor, social worker, and engineer.

Broken equipment stays broken for months.

Our infection rates are up and our patient satisfaction scores are down. We've been told we can be disciplined for both.

I loved this job for years, and fought really hard to keep just this thing from happening. I'm incredibly proud of the work that we do and the outcomes we've had in the past. We've done it all together, as a group of very stubborn nurses, in spite of--not because of--our managers and administrators. I'm tired now, and I want to back off and not fight every single day for basic safety and resources.

"Well, I've been doing the same thing for more than a decade, and I felt like it was time to branch out and broaden my skill base."

I finally got the hog skull clean and got another Cancer Buddy.

Our network reaches around the world. It is above the law, beyond the government, and untouchable by the church. No power in the 'Verse can stop us.

So I was talking (ie, emailing) to my newest Cancer Bud tonight, and I twigged hard on something she said to me: that her dread of chemo was "just me feeling sorry for myself." It kinda set me off.

Back when I was recovering from having my mouth resected, I posted something in which I vented about feeling sick, and tired, and not knowing what was going to happen, and being in pain. And a very well-meaning commenter pointed out that I should suck it up and deal, because after all, my tumor was minor and I was going to live.

Which was true. It was also about the wrongest thing, I've since learned, that you could say to anybody with cancer.

Instead, you should encourage them to feel like shit about their diagnosis, because their diagnosis is shit.

It doesn't matter how "easy" a course a person with cancer has, or how "minor" their tumor is: from the moment you're declared free of evidence of disease, that is the best you can hope for, ever. I will never be cured. I will always, I hope, be NED (no evidence of disease).

Every dentist's appointment, every visit with my surgeon, every MRI or CT or plain old doctor-poking-at-my-neck exam is fraught now. I used to enjoy getting my teeth cleaned. Now I wonder if there's something that I've missed in the week leading up to it, and wonder if there's something that *they* missed in the week after. Those feelings do go away, of course, but they ramp back up in the month or week or day before another appointment.

Even something as simple as biting my tongue in my sleep--and I'm a terrible tongue-chewer--makes me paranoid to the point of spending dozens of minutes in front of the mirror, yanking my own tongue back and forth and peering at it.

So, yeah. This fall will be four years. After five, I'm good until twenty, given the statistics, unless more people get my sort of cancer and the statistics change.

And I am still allowed to feel sorry for myself if I wish, because that's how you integrate something like this into your life.

As I told New Cancer Buddy, eventually some ridiculousness about your situation will make you see the humor, however dark, that's there. You'll stop your pity-party and get on with things. . .but that pity-party, that grieving for the way things were before you had to put in a prosthesis or before you lost your nipples or your thyroid, is important. It helps you reconcile the way things used to be with the way they'll be from here on out.

Being brave--or being expected to be brave--is a horrible burden to place on somebody who's going through this, no matter how minor or low-grade. Everybody needs the freedom to flip the fuck out, and people with cancer are often denied it--"brave" is seen as the only truly acceptable way to deal with the diagnosis.

Years ago, there was an article in the "Onion" headlined something like "Local Man Fails to Put Up Brave Fight In Face of Cancer Diagnosis." That's how ingrained the Brave Thing is.

So, fuck Brave. I may be deeply disappointing Sara Bareilles, but I say flip out like you need to flip out. There's always time later to pick up the pieces.

There's a hog skull in my kitchen, next to the stove.

It's soaking in three-percent peroxide as we speak.

I spent the early morning taking it out of its enzyme bath, scraping bristles and cartilage, miraculously rehydrated, off its surface. Then I soaked it all day in Dawn dishwashing detergent and warm water, to see if it needed degreasing. It didn't. So now it's soaking, upside down and looking rather ghastly, in a sixteen-quart Sterilite container with lid, on special at Target for $2.59.

It has two unerupted molars and inch-and-a-half long tusks that curve out and up, leading me to believe that this was a 14-month-old (or thereabouts) male hog. I know it's male; I do not know its exact age because it was feral.

Boyfiend owns a parcel of land waaaay to the northwest of here, where towns with names like Uz now exist only in old folks' memories and brackish wells. If you go way up past Yeehawton and past Joe and west of Era, you'll find his ancestral lands. Back in the day, the communities there were so insular that the German-language newspaper was still published during the Great War. Pretty much everybody is related to pretty much everybody else. There are tiny winding roads that cut through the llano and run past tumbledown stone houses, and those roads have the names of his grandfathers and uncles.

And, of course, there are hogs.

Feral hogs are nasty. They turn arable land into wallows, kill young trees and sometimes young livestock, foul water and trample native species into the mud, and can and will kill a man with little notice. If you were to go mushroom hunting along the banks of the Red River on the Texas side, you'd hear them rustling through the underbrush in snorting groups, though you'd never see one. The male grows, as he ages, a three-inch thick curtain of cartilage from his neck to his hips that covers his vital organs. You can't shoot through it with a .45 (though a .308 will make a dent) and his skull is too thick to penetrate. An adult male feral hog can weigh hundreds of pounds, move at 30 mph (48 kph) in short bursts, and has no known predators besides man. Add razor-sharp tusks as long as your hand, a voracious appetite, and a harem of sows that can birth a dozen piglets as early as six months old, and you have a capital-P Problem.

As fierce as hogs are, a group of hungry coyotes can bring down a young one, and that's what happened. Boyfiend and his brother were out on their land several months ago and found the carcass of a young hog, mostly eaten. Boyfiend thoughtfully marked the spot and returned this week, triumphantly bearing a skull that nature and nature's creatures had rendered (mostly) clean. He handed it over to me with his hand wrapped in a plastic bag. I took it and exclaimed and danced around and then put it in to soak for two days in a solution of Biz and warm water.

Even when they're mostly clean, soaking skulls smell pretty bad. Scraping the thing with various sizes and shapes of scalpels and utility knives was disturbing as well. Cartilage is tough until its soaked, and then it gets this weird. . .gelatinous texture. Luckily it's easy to tell cut-away-able stuff from bone.

I think the skull will turn out pretty nice (purty naas) once it's done. I won't be able to get all the weathering and fungus marks off of it, but it'll at least be clean, mostly white, and disease- and pathogen-free. I'll let it sit outside in a place that gets sun all day yet is protected from Mongo and the cats (ie, the shed roof) and we'll see how it looks in August. About that time I'll have figured out where to put it in the house, so I can turn it over and admire the teeth, and trace the curves of the orbits and the dents where skull muscles attach.

It was a good finish to a week that saw me getting punched repeatedly in the tits.

Contrary to how I might sound here,

I am rarely in a mood to authentically injure somebody.

Yesterday was different.

We've had staffing changes and new responsibilities added and a whole bunch of other bidness I won't go into; suffice to say that things have been tense and difficult for the last couple of weeks.

It was 1430. I'd spent three hours trying to keep an insufficiently-sedated patient from crawling out of an MRI tube, then gotten gut-punched. People on ventilators, even if they're sedated, can come up with a surprising amount of will and strength and coordination.

I wanted a cup of coffee. Correction: I was dying for a cup of coffee. The floor manager had recently cleaned out our station, preparatory to The Great And Terrible Joint Commission coming for a visit. I figured, since I keep my coffee pods in a cabinet that's designated for personal effects, that they wouldn't go anywhere.

Our floor manager is great. She's skilled, hard-working, empathetic, and determined. We're very lucky to have her. I admire her a lot.

But she moved my coffee. I opened up the cabinet, saw that it was gleaming, clean, and empty, and immediately said, "I will shank the bitch who moved my coffee."

After looking for the coffee pods for fifteen minutes, I gave up and had a cup of the elderly, stewed stuff in the breakroom. (Is there some physical law that prevents breakroom coffee from ever being fresh?)

Note to everybody, everywhere: You don't just move a woman's coffee without warning. Doing so might invoke disciplinary action, up to and including termination. With extreme, undercaffeinated prejudice.

Oh, hai.

It's been. . .a month? Six weeks? Seven weeks?

God, who knows. All I know these days is getting up in the dark, working under artificial lights, going home in the dark, and praying for the sweet, sweet release of death.

Not really. But close.

In the time since I last caught up with you guys, I have survived The Annual Music Festival That Makes My Commute Home Even More Unpleasant, three more checkups with various CANSUH doctors (all clear!), and a staffing reduction.

Because when you win awards and have fantastic patient outcomes and get featured in advertising campaigns, with pictures and everything, that's how you're rewarded: with staffing cuts.

And it's rained a couple of times, which is kind of a big deal, because our county usually breaks up and dissipates large thunderstorms. I think it's a function of having so much hot air here every couple of years, when the Legislature is in session.

But anyway, yeah: Manglement decided that we were just too damned efficient and fantastic, and so cut our staffing by a third. One of our nurses is out taking care of an aging/sick/dying parent, so that meant that I worked, like, all the time. I barely had time to eat something that wasn't fast food, let alone write.

It's frustrating to be managed by a person who has no critical-care experience. It's equally frustrating to be managed by somebody who hasn't laid paws on a patient in, oh, at least fifteen years--and it's worst of all when those two people are combined into one. I feel sort of like a character from "Savage Chickens"--there's this robot with a board with a nail sticking out of it who comes around whenever somebody Important is about to tour the facility, but otherwise never shows up.

So we're all trying to focus on the positive. Two of our nurses recently had babies, which is always nice if you like babies, and I am, so far, not going to have to have more surgery to chop malignancies out of my head. Boyfiend's foot-drop has completely resolved. The cats and dog are making a habit of cuddling together, a la A Peaceable Kingdom. Nobody's tried to punch me lately. (Well, they tried, but they didn't connect. Much.)

I have a couple good stories to tell. I also have some eyebrows to pluck. You can tell, by looking at my eyebrow game, which takes priority today. Tonight, I will be dining on white wine and scrambled eggs and biscuits with sausage gravy, oh fuck yeah.

My trainer brought in a new piece of equipment today: the big yoga-whoozit ball:

Little did she know I'd already found my spirit animal.

My Boyfiend's Back.

I go back to work tomorrow after ten days off. Why, you ask, did I take ten days off in the middle of what is decidedly not vacation season?

My boyfiend's back.

Specifically, his two-level microdiscectomy and associated recovery time.

Boyfiend had worked really hard all late summer and early fall, getting the brewery where he works up and running (yes, Boyfiend makes beer for a living. It's a perfect match.) and had started, just before Thanksgiving, having some pain in his knee. He'd messed up the knee years ago in a bike accident (yes, he rides bikes. Yes, he has a fixie. Yes, he has a beard and skinny jeans and flannel shirts.) and we'd thought it was just overwork. . .

. . . until the day that that leg was so numb he nearly fell getting out of bed.

I'll spare you the fun and games involved with the diagnosis of his problem, except to say that about six weeks into it, I said, "Honey-Bun, Snoogums, Sweetie-Pie, this shit is for the birds. I've got you an appointment with a neurosurgeon at Sunnydale General."

Whereupon he had a myelogram and various other things done that made the surgeon say OMG WTF, and then he went into surgery, where the surgeon opened him up and said OMG WTF EVEN WORSE THAN I THOUGHT OH NOOOOEEEES, and then the surgeon fixed him and closed him up and he's been pretty much fine.

I told him before surgery that he'd take less pain medication recovering from the surgery than he did prior. He did not believe me. I was right.

So for ten days I've been on light nursing duty. Boyfiend is not a whiner, he doesn't moan for attention, and he doesn't get in the way. Mostly he's been sleeping and reading and eating entire pints of ice cream late at night.

Monday he'll get his staples out. Then he can begin, very carefully, to be slightly more active. It'll be months before he's allowed to throw kegs around like Hulk Brewer again (if ever he can), but at least he'll be further away from surgery.

I have to say: it's been nice, after years and years of taking care of back-surgery patients, to get to see one get better.

Hey la, hey la.

Me working yesterday, after the time change.

Bladder, why you do me this way?

Back in nursing school, I had an instructor. Everybody has one of those instructors--the ones whose classes make you yearn for the sweet release of death, or at least a nice case of vascular dementia. I don't remember what she taught, although it couldn't have been that important, since we only met twice a week.

She had three hobbyhorses that she managed to work into every class: homeopathy, the importance of cleanses (you know, take a lot of laxatives and eat only pureed grapefruit stuff), and the fact that the nursing shortage was caused by legalized abortion. Oh--one more I forgot--that all nurses hated each other and the profession and ate their young and so on and so forth. You can imagine what it was like to be in her class. I would sit there Tuesdays and Wednesdays for an hour and a half each time, gritting my teeth and smiling blankly.

Plus, she was one of those people who believed that gayness could be cured and God sent disease as a punishment. A real winner.

That was the instructor, now that I remember back, that not-so-subtly implied that I'd somehow cheated my way to graduation, despite having a really nice, shiny GPA and good clinical recommendations.

I always never wondered what happened to her after I graduated.

Yesterday my bladder started acting all funny: it would produce a rhythmic thump whenever I turned left and started using more oil. So I went, this morning, to one of those generic Get You In, Get You Out clinics to see if I could pee in a cup and get some drugs. And who should greet me when I walked in?

Yep. That nursing instructor, now an NP in GYI/GYO Clinic. Which, not surprisingly, is attached to a locally-run pharmacy that has all sorts of homeopathic and frightening christian-y literature on the shelves. You can get your oscilliconum or whatever it's called at the same time you catch up on the latest thinking about God's great plan to punish sinners in the apocalypse. Which is happening next Monday.

Fortunately, they also had Bactrim DS, so I had that going for me.

And she didn't prostelytize or suggest that I take whatever weird sugar pill du jour she favored. The only thing she said that made me shudder slightly and recall that bland, focusless smile was this: that I must not eat a lot of red meat because there were so few nitrites in my urine. (Bacteria in the bladder that are the cause of UTIs produce nitrites as part of their metabolism. One reason for not having nitrites come up on a dipstick is that fresh urine has entered the bladder and the bacteria there haven't had time to push nitrites into it.) She did mention how horrible nursing was for her, and how the "nurse curse" was the cause of my bladder troubles.

I smiled a bland smile and waggled my head noncommittally. Then I gave her twenty-five bucks and trotted down the hall to the pharmacy, where three days' worth of antibiotic was a whopping $1.50.

Wow.

Things that irritate me, part seventy gazillion and thirty-eight

If you're an instructor teaching nurses, please remember that we do "see one/do one/teach one." All you have to do is tell us what we need to know, once, and move on. Your (endless fucking horrible irritating) anecdotes (that attempt to cast you in a good light but instead make you look like the arrogant asshole you are) are not necessary. 

Running out of booze.

Patients who are reasonable, normal people while you're in the room, but turn into manipulative weirdos the minute you leave. The trouble with calling people like that on their behavior is that it's never satisfying.

Staying late in class because of anecdotes.

People who put on lots of light-colored eyeshadow or powder and either don't wear mascara or don't knock the powder off their eyelashes after they're done applying. Your mascara habits are your business, doll: I prefer mine as long as the list of people I hate and as black as my heart, but you do you. Just make sure you don't look like you've got eyelash dandruff from hell, okay?

Mushy broccoli. (This is one thing our cafeteria actually does well. I eat a ton of broccoli.)

Men--and they are always men--who ascribe political motives to the fact that I wear my hair in a buzzcut. Dude, if I were looking to be less attractive to men (and women, and mutant kangaroos), I would be wearing some other style, because this buzz brings all the boys to my yard. I wear it like this because it's easy, I can do it myself, and it looks sharp.

Tripping over the cat, when it's the cat's fault, and hearing that awful noise he makes. I have one who's especially bad about running under my feet.

Bigots.

Nail polish that looks hot in the bottle but ends up being some wimpy color on your nails.

Glitter everywhere.

Not getting my eyebrows on even.

Undercooked carrots.

Stockings, socks, or pantyhose that shift weirdly and cut off circulation at odd times.

Missing phone calls.

No fucking toilet paper why can't you assholes put a new roll in what is wrong with you WERE YOU RAISED BY WOLVES??

Lists of what annoys a person.

 

I have to go back to work in the morning.

(Actually, all I wanted was an excuse to use this gif. But it's pretty close.)

I am pleased to report that I am no longer a starfish.

Starting Friday night, I turned my stomach inside-out every hour or two for twenty-eight hours. 

It SUCKED.

Somehow I've managed to avoid--and here I'm knocking frantically on every piece of wood within reach--sinus infections, the flu, things falling on my head, alien abduction, and major broken bones this year. But I got whatever stomach bug is going around, and it SUCKED.

But now I'm better. 'Bout damn time, too.

Mongo, when I got home on Friday, was solicitous. He did everything but hold my hair back for me (because I have no hair to speak of) and then curled up next to me on the couch, carefully avoiding my stomach, and gazed soulfully into my eyes. He's a good boy. The only thing he couldn't do was get me ginger ale and meclizine, because he doesn't have a driver's licence and can't make change. 

In other news: The Powers That Be are expanding the neurocritical care unit, again. Apparently we've done well enough, what with staying full and winning awards and so on, that they want to add four more beds *and* an epilepsy monitoring area. I'm not entirely clear on where all these new beds will be, but whatever. I'm hearing rumors that they want to retrofit a couple of rooms for some mysterious purpose, as well: whether that means light-blocking shades or ceiling lifts, nobody has said. It's all very exciting and fluxy.

We've been seeing more patients with movement disorders and demyelinating diseases, as well, which is nice. Most of the nurses I work with are old med-surg or cardiac critical care folks, so Guillain-Barre and myesthenia gravis and Parkinson's are new territory for them. I learn more answering their questions than I realized I would.

Finally, there is a nice man coming this morning to fix the drain line from the kitchen sink. Ah, the glories of living in an old house. Do they ever stop? No. No, they don't.

I got this comment on a long-ago post. . . .

http://justsaynotonursing.wordpress.com 

It's a list of thirty-six reasons nobody should go into nursing. The author is a woman who spent eighteen years in a field she hated, then went on to get a medical degree and became a medical registrar. She's in Australia.

I'm having a lot of thoughts about this. The first two were along the lines of "How on earth did you survive that long in a job you hated?" and "Why did you even bother?" (Incidentally, I emailed her those two questions, figuring that the answer to the second would be either "kids" or "money," but I'm interested in the answer to the first. I would've flang myself out the window, I said, long before the tenth year.)

My next thought was: Does nursing in Australia and New Zealand really differ all that much from nursing in the US? Yes, it's damn near impossible right now for a new grad to get a job, but our programs aren't exactly easy to get into (certain exceptions apply). Yes, some doctors disrespect nursing and nurses, but the vast majority are collegial. Yes, you run into nurses who maybe shouldn't be allowed to cross the street by themselves, but again, the majority are pretty smart. And yes, bullying happens, but not everywhere and all the time.

And then there was this: She's spot-on as regards post-graduate education for nurses. Under the heading "Don't Get Me Started" in my own personal bitch list is the fact that we *still* have "Therapeutic Touch" listed as a treatment modality, even after repeated studies have shown zero therapeutic benefit to waving your paws a couple inches over a patient's body. If we expect to be taken seriously as providers, we have got to cut the bullshit and do real evidence-based practice.

The combination of Alison's list and the comments on it (forty-some and counting) give me what the kids call All The Feels. I know it's just one person's writing. Some of it I agree with, some of it had me wide-eyed and thankful that I don't work where she did. 

My experience is, to be frank, pretty limited. I went through a highly-ranked, competitive program and got hired at a nationally-ranked research and academic facility. In twelve years I've run into only three doctors (one resident and two attendings) who treated nurses like highly-trained monkeys--and, for what it's worth, they treated everybody that way, from other doctors to their patients. My work life has been about as good as you can get, barring the brain-farts from Manglement that happen in any workplace.

What do you think? Discuss it here; Alison's blog isn't the place for trolling or extended debates.

It's coming. It's coming for all of us.

At this point, it doesn't matter whether it's a mismatch between this year's flu shot and this year's virus, or a secret government plot, or just plain crappy luck: everybody I know, practically, has the flu.

We have nine full-time nurses in our unit. Two of them have pneumonia. A third is out for another week, until the Tamiflu and chicken soup kick in. The remaining half-dozen of us are bathing in alcohol foam, refusing to get too close to each other (I swear; it's like Sweden up in there), and running away from anybody with the slightest hint of a cough. I myself have taken to bathing daily in boiling bleach and wrapping myself in plastic wrap, head to toe, before I leave the house. I figure a nice tight seal will still leave me enough oxygen to get to the grocery store and back.

Today I took advantage of a sale on soup at the local weird grocery store. I have something like ten cans of Campbell's in the cupboard, as well as a pot of homemade Mexican-inspired chicken soup simmering on the stove. I'll be making a simple salad later, with cucumber, red bell pepper, plum tomatoes, oregano, feta cheese, and about six cloves of raw garlic. (That number is not an exaggeration. Raw garlic, when blended with olive oil and white balsamic vinegar, gets surprisingly mellow.)

I'm not even letting Mongo kiss me.

It's hard, to be honest. Everybody but me in the neurocritical care unit is from somewhere else, and they're all from touchy places like Southern India and the Phillipines and Italy. We practically snuggle while we're giving report. I'm the one person who's not A Delicate Tropical Flowah, so I'm the only one who's treating this lack of hand-on-knee, hug-and-cheek-kiss as normal. All the dark, large-eyed beauties I work with are starting to look positively glum. It's the paranoia.

Because, really? Having the flu--and I have had the flu, the real thing, twice in twelve years--is generally not as bad as you expect it to be. (The one exception to that is the first time you have it. That is the worst you will ever feel, ever, short of being shot repeatedly in non-critical places with non-expanding bullets, then roasted over a dying fire, then drawn and quartered by somebody with a dull knife, and finally hanged by an incompetent knot-tier.) A few days of body aches, some pills to swallow, the inability to walk to the couch without getting winded. The best thing about the flu is that when you start feeling merely bloody, it's like you feel great. The worst thing is the anticipation.

So I'm being proactive. I have now got three large tins of Tiger Balm Ultra (the white stuff) coming in the mail. I stocked up on soup, as I mentioned before, and plan to go out tomorrow for ginger ale and ramen (only because I forgot today). I'll get some of those Totino party pizzas. I'll splurge on the big bottle of ibuprofen. Maybe pick up an extra hot water bottle, or even a heating pad.

Putting things in perspective: My pal Joy came down with the flu on Thursday of last week, the same day that my pal Stacy got salmonella food poisoning. Joy is now, thanks to the miracles of modern antivirals, back at work teaching. Stacy just today managed to get through an entire shower without having to sit down in the middle of it.

. . . . .Still. You can talk all you want about the partial protection conferred even by a mismatched flu vaccine, realize intellectually that it's not as bad as a bad hangover, and still want a canvas mask with a bird's beak on the front when you walk around work.

In short, save yourselves. Invest in bleach-manufacturer stock and buy some NyQuil.

This was an ethical problem with a simple solution.

If you have a patient who's been a heavy drinker and heavy smoker (like five 40-ouncers and a couple packs a day) since their teens, and they're now in their 60's, and they live with family members who are unlikely to stop smoking and drinking just to keep them healthy, and they also live in a food desert and have multiple comorbidities and things generally suck, it is not a dereliction of duty not to suggest that they get their carotid arteries Roto-Rooted in order to restore blood flow to their brain after a minor stroke.

Especially since no amount of improved blood flow is going to repair the damage caused by forty years of vascular dementia. You could've driven a truck through this guy's sulci. I mean, seriously. There was so little working brain tissue in his skull it would've been a crime to reperfuse it.

So we sent him home on blood pressure medicine that he won't take, and aspirin that he won't take, and comforted ourselves with the knowledge that, had we done everything in our power to make him better, he would've been nickel-and-dimed to death with tiny strokes. This way, what with the drinking and smoking and high-fat food, he'll likely have one huge stroke and that'll be it.

*sigh*

In response to a question below in the comments on the last post: Where I come from, "CCU" means "Critical Care Unit." It's the same as an ICU. NCCU, therefore, is Neurological Critical Care, whereas NSCCU is NeuroSurgical Critical Care. There is no difference, just as there is no difference between an LVN and an LPN--they're both skilled nurses who aren't allowed to hang blood in this state. The difference in terminology is a conceit of the facility, nothing more.

And with that I'm going to go eat junk food and fall down for a couple of days.

You know how, sometimes, things get brown and ucky and dull?

That's the way things have been around here, lately. Every couple of years I kind of brown-out--not burn out--on work, and blogging, and people and nursing generally.

Then I get better.

That is what happened this last couple of months: I browned out and then got better.

A lot of it had to do with work. You guys might've heard that the flu season has started. We have a thirty-bed medical CCU, and sixteen of those beds are filled by people under the age of 50 on ventilators or ECMO (a way of oxygenating blood by taking it out of your body, zapping it with O2 through a membrane, and returning it--sort of like lung dialysis) because of the flu. These are previously-healthy people, too. The old and sick ones are just flat-out dying.

Plus, there seems to be a sale on myesthenia gravis these days. I hear that if you have six patients with MG in your NCCU at once, you'll get an eggroll. I need our eggrolls to be delivered, please.

Meanwhile, as the plague is sweeping the state (and our staff), we were preparing for a couple of really hugely fucking important surveys. One was a TDH (Department of Health) thing that happens occasionally, just to make sure we're not all licking our hands clean between patients. Another was a certification survey, which was a very, very big deal, given that the surveyors would be coming to our unit, primarily, and going through charts and asking tough questions and so on.

Joint Commission surveys are generally held to be bullshit. They go like this: everything gets repainted, stuff gets put in storage rather than left out in the halls, the bathrooms finally get fixed in the locker rooms, and you get multiple nastygrams from chart auditors in the weeks leading up. Then the JC shows up, does whatever it is they do (pity the poor souls, though it's probably better than whoring), and things go back to normal.

This was not a JC survey. It was actually, you know, hard: thorough and comprehensive. Two very nice people showed up without much warning one morning and started asking me questions about neuroanatomy. One of them stuck around until the afternoon, watching us care for patients (there are certain things you do differently for neuro patients, and differently if they're, say, stroke patients versus neurosurgery), sitting in on patient education, and generally making me and my coworkers nervous. The two of them were critical care specialists, too, which made it even more fraught.

We passed. We passed perfectly, with no demerits. First time out, spandy-new NCCU, and we fucking aced it. Nobody else in the country has ever done that on this survey. So we got that going for us, which is nice.

Our manager, for whom I would take a bullet, bought us a huge lunch to celebrate. Our manager's manager, another woman I'd step into the line of fire for, came up the next day and was so overcome she was actually teary-eyed. The director of medical services and the critical-care big boss came up and congratulated us. So did the president of the entire Consolidated Research and Medical Care Gargantuan Whingnut, of which Sunnydale General is a part.

And the new nursing officer? The individual Der Alter Jo and I nicknamed The Dalek? Said nothing. No acknowledgement whatsoever.

This is the person who's responsible for approving hiring and firing and wages and working conditions and safety and all that shit, and he has not said word one about a survey which, to be honest, focused less on medical care and more on nursing care.

I kind of expected that, to be honest. Still, it sucks that the person whose job it is to make sure that my colleagues and I have safe, sane, decently-provided working conditions, continuing ed, all that stuff, was absent from the hallelujah chorus.

It baffles me that somebody so tone-deaf could keep moving up through the ranks like he has. I wonder what photos he has in his posession.

Anyway, it's been a hard slog of a couple of months. I don't know if things are getting better, or if I'm just getting acclimated to being torn four different directions at once for twelve hours at a stretch. I gained all of the seventeen pounds I had so carefully lost, and slept worse and bitched more than is normal for me, but that all seems to be evening out now.

Anyway, I'm back. Mongo is a big, furry goofball. The cats are just fine as froghair. Boyfiend is doing something brewerish tonight. Sherlock is in his flat and all is right with the world.