In which Auntie Jo lays down the law.

I love my job I love my job I love my job I love my job.

However.

People: Please research the symptoms of whatever disease or disorder you're going to try to mimic. Most physical troubles, including neurological ones, have a certain expected set of symptoms. Even conversion disorder has an expected course: while the physical manifestations of psychological stress might be weird and unexpected and unexplainable by other means, they're consistent.

A stutter that goes away with opiates is not a disease. It's an attempt to get drugs.

Likewise, there's a name for what you're doing: it's "abasia-astasia," and it means "No, she won't fall over and hurt herself; she'll only fall if I'm there to catch her or she's near something soft."

And frankly? If your weakness is distractable to the point that you yourself cannot remember which side you're weak on, I will call bullshit on your shenanigans and send you out the door tout suite.

I don't just have the population of Greater Sunnydale to thank for this; I have the combined Great Minds at Holy Kamole's emergency department. Therefore, I have some law to lay on them:

If you call and ask me to accept a stroke patient, you'd sure as shootin' better have done an NIH stroke assessment on that patient and be able to tell me his score. If you haven't, I'll tell you to call me back once you've assessed the patient, then hang up the phone gently.

Same deal if you call me with a patient who has a constellation of symptoms and you don't know his history. Same deal if you call me and say, "Well, we're not really sure what's going on, but we'd like to send him over to your NCCU."

Same fucking deal, dear doctors, if you call with a ninety-year-old, demented patient who has a temp of 38.2, whose labs show that he's dehydrated and has a UTI, and who is experiencing the same symptoms he had when he had his stroke two years ago. Incidentally, he's therapeutic on coumadin.

And, just as a reminder, if I accept this patient because I want to put a stop to your whining, but specify that he is to go to the regular neurology floor, do not under any circumstances then tell the bed board that I'd cleared him for a bed in the NCCU. The Wrath of Jo will be visited, not upon your grandchildren's grandchildren, but upon you, comprehensively and cheerfully.

This is because, as might be expected in a critical care unit, I actually have sick people to take care of. I got one on a Cardene drip, one with the most labile blood pressure I've ever seen, good Lord what is she doing going from 220 systolic to 77, maybe an abdominal binder would help, and one who is, sadly, getting ready to go home to Jesus due to a combination of factors, not least of which is an infection with some bacterium that only two people have ever gotten before. I got problems, in other words, because I got patients with problems.

Joe-Bob looking for a hit of dilly is not a problem. At least, he's not *my* problem. He's *your* problem. If you try to make him my problem, you'll have another problem, and probably a whole set of problems of varying, interesting types, right after that.

Thank you, as Katniss said, for your consideration.

Good God I love both of these people, whoever they are.

Here

and

Here.

This is what happens when I try to live like a normal person. . .

Neighbor Beth is here. She's wiping down the kitchen as I slowly, slooowly type this, for reasons which will become clear in a minute.

Those of you who follow me on Facebook will know that I had a cheerful afternoon of productve semi-drunkeness with Neighbor Beth (who is Not Good With Blood). After the prosecco had worn off, and with a liter of water and tea under my belt, I mandolined my right ring finger.

There was a sudden spray of blood. Then there was a heartfelt "Oh, SHIT" from me, as I realized that the suddenly-numb sensation in my right paw was due to my having halfway cut off my right ring finger. I tried everything: direct pressure, flour, glue: nothing worked for longer than I care to think about. Poor Beth, who hates her own blood and has a tenuous relationship with other people's blood, mopped up mine for the 40 minutes it took for shit to stop happenin'.

I'm more than a little annoyed that this happened while I was sober. Beth is more than a little annoyed that she had to scrub blood off my spice shelves. AND I had to throw away a perfectly good, blood-soaked tea towel.

None of the zucchini was affected, though. Which is good: we have a Pickle Party coming up in two weeks.

I kind of wish I'd accepted Beth's offer of another bottle of wine. My finger hurts.

Good Frogs. Has it been that long?

I see I haven't posted since the middle of last month. My apologies.

I've been working a lot, which means new stories for you! but I'm also between keyboards at the moment.

More later this week, I promise. Nothing horrible has happened; I've just been busy.

I'm all right; don't nobody worry 'bout me.

Well, not really.

This week we had a party for Neuroscience Nurse's Day, or Week, or Something Along Those Lines. I was interested to see that the woman who holds herself out as the Director of Neuroscience Nursing (a few years' experience as an ortho rehab nurse, followed by a decade in manglement) wasn't there. Ironic, fitting, all that stuff.

I was more bitter than usual these days. *Everything* pissed me off, even stuff that could've worked to my advantage. Good things pissed me off just as much as bad things, and wishy-washy things pissed me off most of all.

For instance, I work with two mid-levels. One is fantastic. The other is a clueless tinpot tyrant with an ego problem. Fantastic Midlevel and Fantastic Case Manager and I had been working on med-surg to rehab placement for a patient under a return agreement with another hospital (his case is complex) since the patient was admitted almost a month ago. It had been arranged that Sweet Complex Guy would go back to his original hospital, since he's a resident of that particular county and can therefore get services for which bill collectors won't hound him. (Some counties in Texas do it right.)

At the absolutely last possible second--and I mean after the ambulance had been arranged (difficult, because he required vasoactives while en route)--Clueless Tinpot stopped Sweet Complex Guy's transfer. The reason? He was afraid that "SCG would end up rotting in a med-surg bed and his family wouldn't be taught what they need to know." Clueless Tinpot decided to try for a "charity bed" in our facility.

As Fantastic Rehab Manager said, "No bed here is a charity bed. I have explained this to Clueless Tinpot Tyrant over and over. Even if that patient meets all of our specifications for discount services, he'll still have people calling him constantly, and his credit will be ruined by the bills."

None of this, I just realized, will make any sense to you unless you're one of the medical club, so let me put it in English:

We had a patient transferred to us by a county facility. That hospital paid all of the patient's bills while he was with us, with the understanding that he would be sent back once we were done with our peculiarly specialized care. The sending facility has systems in place to provide free, quality care to this dude, provided that we sent him back needing specific things.

And Tinpot Tyrant fucked it up. Not only will my nice, sweet, complex-but-promising dude be two hours from his family, he'll have to deal with the demands of our billing department (not fun; I can testify that they screw things up fairly regularly) for the next two years or so.

And I have to deal with this guy daily. Between making sure that he actually writes orders that he's going to yell at us later for not carrying out and being certain that his orders don't suck, I'm already tired. He's slated for a manglement and marketing job soon, and I hope his transition is smooth and speedy.

Seriously: If you have somebody on a high-sodium diet and six additional grams of sodium tablets a day, and they drop their sodium from 139 to 135 after you lower their hot-salt drip for six hours, would *you* write an order discontinuing that drip immediately?

I thought not. Especially if you want to keep their sodium between 140 and 150 to keep their brain from swelling. Three-percent and 23% saline are useful in limited amounts, but they're useful.

Okay. Enough with the overmedical jive.

I miss my dog. He wasn't my baby, or my furbaby; he was my buddy. We were intellectual equals, no question. He was a stubborn asshole at times, but I never knew his judgement to be off. It's very weird, being here without him snoring and shedding and licking Flashes all over. I step over a body that isn't there, in the middle of the night, when I have to pee. My brain twitches toward the back door every day at dinnertime.

I haven't had the vadge yet to go out to the back yard. Yesterday, I thought maybe I could do it today. Now I'm thinking I could maybe manage it tomorrow.

Thank you all for your kind thoughts. They're a huge, huge comfort, even if I can't respond to everybody individually.

Now Flashes wants 'tentions. I'm going to give him some skritches and heat up beans for dinner.