Thursday, December 29, 2005

Fresh Coffee

Every spring there was a kind of minor population reversal that took place in the mountains. The locals, all screaming-bonkers with cabin fever, would head out for warmer climes, while vacationers would trickle into the bed-and-breakfast places and hotel resorts.

The lakes would have thawed well enough for boating and fishing, the trails just patchy with ice and snow could be hiked before bug season took hold, and the south-facing cliffs so prominant around there would attract early-season climbers.

Local doctors especially would take off, kids out of school, so the operating room did few electives. One surgeon, my very favorite Dr. Riley, always stayed around because he was from John Hopkins and life was slow and vacation-like for him here just about all the time.

It was a weeknight and there were only three patients in our little eight-bed intensive-care unit. I had a fresh carotid endarterectomy done by Dr. Riley, and she was having some of the usual blood-pressure concerns. I was watching her arterial line and giving her the occasional dose of hydralazine or labetolol.

Nikki had a vent patient with pneumonia who wasn't doing great, but hanging on well enough.

My other patient was riding his bicycle down the highway hill by town hall when a local drove by towing his fishing boat. The trailer hitch failed and the boat swung out and struck the bicyclist. He had a fractured pelvis and some other breaks, and he'd lost some blood so I was giving him transfusions. But he was basically okay. Okay for a bicyclist that got hit by a boat, that is.

Nikki and I cruised through the early evening hours of the night shift, chatting a lot about this and that. We had actually worked together at another hospital years earlier, when I was a nurse aide, so we often talked about those days.

Once in a while Jane, the night nurse supervisor, came through to see how we were doing and to tell us that the emergency room was as quiet as expected. That was good, because if we got loaded up with new arrivals there weren't any additional nurses to come in. People were out of town, and in that remote region there just were no such animals as agency nurses who could be called in if demand required more working bodies in nurse uniforms. We weren't much worried about it, though.

Janie called at about 10:30 to tell us that there was a crash and patients were coming in. A family of five from Canada had a head-on collision into a pickup with an elderly local couple in it. When they hit the ER she'd have a better idea of who would go where, but we could expect a little action.

A little action. In a few hours the unit would be full.

The father/driver smacked his chest into the steering column and his R-waves were tiny, plus the chest scan showed maybe a little tamponade so he needed to be monitored. There were three girls, a teen with a fractured clavicle and some bad cuts, a twelve-year-old who would need to be C-spine cleared but not until morning, and an eight-year-old with a broken arm and some bruising, also clavicular. They were all wearing their safety belts. You could tell from the bruises. Like stripes.

The mother had a nasty broken leg and enough blood loss to require monitoring. Nikki took the mother and the oldest girl, and I took the father and the two little ones. They weren't really "critical" but Janie thought it would be better to keep them with their parents.

Our little hospital had no pediatric unit. Just us. A kid shows up, and presto! You're a peds nurse. None of the floor nurses had taken a PALS course, probably anyways.

The husband and wife in the pickup died at the scene. They were unrestrained and they also had a bunch of unsecured stuff in the back of their truck. Like a chainsaw, some cut wood, and a plastic container of kerosene. The saw had smashed through the back window of the truck cab, and the kerosene tank had ruptured and its smell was all over.

There's no trauma like head trauma. It was probably pretty quick for them.

But it was a little rough on the squads that came out. They're all volunteers. People you see at the grocery store. People you buy furniture from. Not hard people.

We did our transfusions and gave pain meds and dealt with the shock of it all. The twelve-year-old kept asking me if "the police were going to take her dad away for killing those old people," and I just said "no, it was an accident." But Janie said he would probably be cited for some violation or other. Lane crossing.

The eight-year-old asked me to sign her arm cast.

The hours flew by. Nikki and I were exhausted, but doing okay, a little proud of our efforts really. This is my "once I had five patients assigned to me in the ICU so stop your whining" story. We sort of liked the stress of it all.

Morning approached. Time for coffee, but neither of us had drank much of the last pot, and it had been hours. The coffee at the bottom of the glass carafe had evaporated down to a syrupy brown sludge. I couldn't stop to make more because I was so busy going from patient to patient, and neither did Nikki, but she was desperate.

It was after 5 a.m. and she couldn't go on without an immediate caffeine fix. I was bleary, too, but I did not imagine what she did next. It was as real as the chair I'm sitting in right now.

Nikki ran the hot water from the sink, and swirled a little into the muddy bottom of the coffee carafe, reconstituting the remains. She poured this into a cup as I looked on, stunned.

"You're not going to do that," I said hopefully, and she said "Oh yeah, well just watch me!" and she stirred in some sugar and creamer.

The cup contents turned ashen gray, like some chalky volcanic drool. Then Nikki took a long hard drink of it.

"Not so bad," she said.

"Liar," I replied. Back to work.

Janie had persuaded a couple day shift nurses to come in a little early to help us out. We were so glad to see them come rolling in. We were tired and hungry. The first thing Anne did when she arrived was to put on a fresh pot of coffee.

She took a whiff from the carafe and said "Yuck, this stuff is disgusting. How old is this?" and I said that Nikki had just made it.

Sunday, December 25, 2005

What Makes It

The car driver had smashed into him while he was motorcycling, circled around to view the damage, then sped away leaving the patient down on the street. The sharp ends of fragmented tibia and fibula sprouted like long nasty thorns from his pulpy lower leg.

Man, that is cold. I marvel at the meanness of so many people. I would think that eventually I would become numb to it all. After all, what that hit-and-run driver did was really no worse than what the Bush administration has done to New Orleans.

Recurrently bombarded with meanness. All of us. Daily.

But I do not go numb. Instead I am resolved, despite my inner sloth and zen-like moral indifference, to work. That, and play classical guitar music. We all need some kind of release, and I'm getting too long in the tooth for marathon running anymore.

It wasn't bad for a Friday that was to begin a holiday weekend. But then I walked into a room to announce that a patient had been formally discharged, as her repeat labwork was fine, when their spouse said that they had to get to their pharmacy by 5 p.m. closing or the patient wouldn't be able to get their Lovenox prescription filled. It was 4:50 by my Casio.

I rushed to call their pharmacy while the spouse hurried over there, only to find out when the pharmacist called back that the medication was not covered. The patient was your basic charity case who probably had been surviving on doctor's office medicine samples and mercy care for quite some time.

Trouble. This would be a hassle. Lovenox is so pricey that there was no way they could purchase it out-of-pocket.

The in-house on-call case manager didn't return my page, and when I tried to page the daytime case manager they also were unable to get back to me. The resident for this patient, one of my very favorite doctors, did take my calls even though he was out of the hospital.

In the midst of this 5-minute period of great hassledom, two of my other patients had called out for pain medications. The leg guy obviously needed this frequently and regularly. But I had just given him 6 milligrams of morphine 40 minutes ago. The other patient was known to be threatening to staff if he did not get what he wanted when he wanted it. I had been getting along with him perfectly well and I did not want to spoil that therapeutic relationship by holding him up on a little Dilaudid.

Busy times three.

Then the grand-daughter of my other patient down the hall came up to me, while I was on the phone with the resident about the foiled Lovenox, to tell me that "her grandfather had blood on his diaper."


I followed her to the room to find him amongst a pile of bloody Attends and hospital pajamas. Though incontinent, he was fairly independent, but apparently he had pulled out his running intravenous line while freshening up. He'd had a bit of a stroke way back when, so his mentation was just a little off, too.

Four places to be, one nurse.


I think when he bled all over the fresh brief and pajamas, he just put on another set, which subsequently got bloodied, and then he would change out to another set of briefs and clothing, only to have that get red and messy, too, not realizing that his arm continued to drip blood from the intravenous site.

He just kept changing clothes, probably for all of about ten minutes. But a little blood goes a long way, and as he moved his arm to pull up his clothing, the intravenous site pumped a little blood instead of clotting off.

There were probably four or five bloody briefs, bloody hospital gowns, and bloody pajama bottoms lying on the bathroom floor around him. Bloody towels and washclothes, too. His left side was painted red in blood from his chest down. Like I said, a little goes a long way, and a lot can happen in ten minutes.

All nurses know this feeling. Waiters and waitresses call it "in the weeds." A mad rush to be in four places at once.

Well, stopping the bleeding is usually a good place to start.

So I did that, then went to get a bunch of linen and IV supplies for Mr. Red. Another nurse offered to medicate one patient, while I mixed a cocktail for the other, then I cleaned up Mr. Red and got him tucked into bed.

The resident called in the meantime and gave me orders to hold the discharge on Lovenox lady, because without it she would be at risk for tossing a clot. She had a history of having done that before, hence her lack of toes on one foot. Both feet, actually, but it was just the one that had no toes at all.

I just now see some irony in these two particular problems: one patient bled while the other was a clot risk.

Sometime in this madcap half-hour I had lost my composure. I took the Lovenox lady's chart to the charge nurse, urgently explained the problem, and said that I didn't have time to address it immediately because these other little problems were "pissing me off."

She naturally offered to help, but I couldn't really expect her to sort it all out. She did help type up the discharge paperwork, but that turned out to be a waste as the patient ended up staying.

Another night in the hospital probably goes for a good grand. Half that would pay for the Lovenox she needed. Oh well. It's the best health care system in the world. That, and Halliburton is the best food provider on the planet.

Within the hour I had replaced Mr. Red's intravenous line and everything else slipped into place as the next shift started to trickle in. Pain under control for those two, Lovenox lady merrily ate her supper, dinnertime insulin coverage for everyone. Day three was coming at last to its end.

I saw Andre walking in, and went to give him a hug. I'd known him for years at work in another hospital. When I asked him how things were he said "not good" and I could see the moisture welling up in his eyes.

His significant other, with whom he'd been living for the better part of a decade, had just decided to leave him after he had spent time and money supporting her through school. He was taking this hard. We all would.

She was even seeing, among all the other people she was now rotating through her life, someone who worked here, and she was also a good friend of Mr. Pulp-Leg, and Andre feared she would come to visit him but with a new lover in tow. Not pretty, that.

And Andre then told me his doctors had just found a lung tumor, after he explored his developing shortness of breath. He was not told of its size, and he was worrisome about having to wait weeks for more follow-up diagnosis and treatment.

Plus, his ex-lover's sister had come to live with them, but after the break-up she had taken Andre's second car and a cell phone and disappeared into the big city swirling masses. $600 cell phone bill in Andre's name, then he had it turned off.

I had been having a good day until it all broke loose at 5 p.m. Then it fell together.

Andre had been having a good life until recently, but it is against all hope for it to resolve as easily as my piddly troubles did.

I do not go numb. I am humbled and chagrined at my break with composure in the face of self-pity and stress, but I remain resolved.

Never give up, even if everybody else does.

Andre and I talked, him tearfully, for a half-hour. That's eons in "nurse-time." Then he was called by his patients, interrupting us, and I finished up my documentation, leaving an hour-and-a-half after my shift ended.

Tuesday, December 20, 2005

Dudley Don't-Right

From his early business failures with Arbusto and Harkin, through his scandalous leap-frog admission to the Texas Air National Guard in which he protected the southwestern skies from Vietcong attack, to his failure to show up for a Guard required physical, on through his driving-while-intoxicated incidents, up to his Florida vote-counting fiasco, then his failure to protect our country from terrorist attacks even though he was expressly warned of just such hijackings, he has throughout these passings always been regularly rescued by powerful friends.

Now that he has assumed the most powerful political position in the world, he has no more friends who are more powerful than himself, and no one to rescue him from the jams in which he has put himself and our once-noble country.

I've said it before but I find myself saying it again: as an untreated alcoholic, he will worsen and escalate without required intervention. But as he has little, if any, insight into his problems, there will be no intervention, unless we the people remove him from power and see to it that he is properly institutionalized.

There is no other effective treatment for him.

He has imprisoned American citizens without due process of the law. He has trashed duly-made foreign treaties which by the Constitution are the law of our land. He has spied upon the private communications of Americans without regard for Constitutional protections and without warrant.

He has failed to protect out citizens on home soil from terrorist attacks, and he has failed to protect our servicepeople abroad from a difficult insurgency; an insurgency that he himself had a hand in creating, as it did not exist before he foolishly declared war on a weak and hardly threatening third-world secular dictatorship.

(I heard a kool-aid drinker on a radio call-in show a day or so ago who decried that "Saddam fired upon our planes that were enforcing the Iraq no-fly zones." And just how many of those planes were hit by this fire?


Our planes bombed Iraq radar and anti-aircraft positions almost weekly, and never suffered from an Iraq strike. Some threat, that.)

He has failed to guard the economic surpluses built up by his competent predecessor, instead creating a deficit greater than the world has ever seen.

He failed to prevent the drowning of New Orleans, after failing to appoint even a remotely-qualified person to direct the agency that was supposed to manage such emergencies. The nation watched on television as the bodies floated by in the floodwaters and he himself clumsily held a supporter's guitar. He can't even do that right.

His failures continue to escalate. The brakes are off.

So what next?

More failures, more escalation, more disregard for our treasured Constitution.

Where will it end? Nuclear war? A total economic collapse? Martial law and the suspension of future elections?

These are this man's trajectories.

Who will come to the rescue?

Happy holidays!

Saturday, December 17, 2005

Tree Link

Iris and Fern will show you how to set-up and properly maintain your Holiday Tree in Tree Decorating 101.

Wednesday, December 14, 2005

1001 Days

If it were a pole, it would be large enough so that somebody could run a big patriotic American flag up it. Sometimes people do so. But it isn't a pole, it's an eye-mote. A blindingly effective one.

A common theme fails to emerge from three recent items in the Arizona Republic. "Crucial freeways crippled," by editorial writer Kathleen Ingley appeared a couple weeks ago. In this she decries the gridlock that affects Valley highways, and she has some suggestions, such as "better planning," for managing this adjunct to sprawl.

"Nearly round-the-clock gridlock on I-17 and I-10 may be inevitable. But the economic toll would be so immense that we should pull out all the stops to avoid it.

Inevitable. Okay then.

As a counterpoint to Ingley's piece, James Hahn replied later with "New freeway will only lure more cars." His point of view is that gridlock is not only inevitable, it's a sign of "stability." More housing developments will require more highways to serve them, which will foster the growth of more sub-divisions, and around and around the Maypole this circle dance will continue to go, so to speak.

(snip) "The roads are bad and getting worse, true. But consider what would happen if they suddenly got better: Commuting and travel times would go down and it would become more attractive for new developments, more Anthems, to be built.

And once they are built, presto! Road conditions will degrade again as new residents fill the roads. Back to where we are now.


Other forces must come into play to quell the growth. Perhaps it will be higher housing costs or the limits on water. But improving road conditions won't solve anything in the long term.

I think we are stuck in a stable system, and thy name is gridlock."

Other forces. Right.

And today, on the 1001st day of our latest Iraq war, we find the Robert Robb essay "False anxieties fueling new China syndrome." He argues that China's growth is nothing we need to fear, because at present their economy is really much smaller than ours and it will be some time before that country can compete against us as an equal. Even though we owe them a great deal of money.

"Even if China continues its current pace of growth it would only have an economy about a quarter the size of the United States' by 2025. China's ambition is to have per capita GDP in just the $3,000 range by mid-century.

To get even that far, China must overcome some fairly significant obstacles. Right now, China's economic growth is largely export-driven. To truly develop the domestic economy will require extensive liberalization and the establishment of a non-political rule of law. Right now, China ranks very low on the Index of Economic Freedom published by the Heritage Foundation and the Wall Street Journal."

Significant obstacles. Yuppers.

All three of these writers fail to address the one main thing that is at the heart of our issues of sprawl, highways, economic growth, and competiveness in world markets:

Gasoline. (Click for chart.)

We won't need more freeways to relieve the inefficiencies of gridlock, per Ms. Ingley, if the price of motor fuel becomes prohibitively expensive, but I do not think that Mr. Hahn was thinking about that exactly when he wrote of "other forces" that might adversely affect suburban growth. And Mr. Robb entirely ignores the real fuel that will power China's economic growth. Like every other modern economy, theirs will depend on cheap petroleum. They will compete very strongly against us as fellow customers for oil.

None of the three pieces I've cited above even mention the word "gasoline."

Well, Ms. Ingley touches upon the notion of using a "gas-tax" for something-or-other, but she ignores the term as it relates to fuel. The words "oil," "gasoline," and "petroleum," though, actually do not appear in these articles. Amazing.

I suppose most people, like these three, do not consider much that oil is a finite resource. Well, maybe James Howard Kunstler and a few other voices screaming from the concrete and blacktop jungles of peak-oil edge-city wilderness. (Here, shrimplate leaves the computer to perform a horrific minute-long lung-collapsing Yoko-scream, then returns to the keyboard.)

I did send a polite and very snark-free e-mail to Kathleen Ingley shortly after her editorial appeared, but I've gotten no reply from her.

"Dear Ms. Ingley,

Your recent editorial concerning valley highways was interesting and raised many important concerns, but you completely left out the most vital consideration:


What will the traffic on our highways look like when the price of fuel goes up to $5 per gallon? Or $10 per gallon? Many people are already paying $5 to $10 for their daily commute. What will happen to edge-city development when that same commute costs $30 to $40 per day?

The era of cheap fuel will end someday. Perhaps quite soon. It would be prudent to consider planning for that inevitable day. Why aren't we?

Thank you for your time,


Maybe she doesn't like being called "Ms."

Saturday, December 10, 2005


Here's a photo of Kansas University Professor Mirecki before the beating, and in this you can see how good he looked shortly after he was ambushed by two alleged supporters of "Intelligent Design" being taught in schools.

The local sheriff's department is investigating.

He said he was not pleased with the sheriff’s investigation because he had been “treated more like a criminal than a victim.”

He said he was interviewed by officers several times, “once for five hours straight. They keep asking me the same things over and over. They seized my car; they entered my office and seized my computer. They said they need them for their investigation but it didn’t make any sense to me.”

Mirecki was going to teach a course at Kansas University that compared I.D. to other creation mythologies. He was the head of the department of Religious Studies there until recently. He still holds his tenured position as a professor, but he has "resigned" his chairmanship.

Mirecki had made some indelicate comments, under a pseudonym, to an online opinion board.

In the e-mail message to a listserv, Mirecki said of intelligent design: “The fundies want it all taught in a science class, but this will be a nice slap in their big fat face by teaching it as a religious studies class under the category ‘mythology.’ ” Mirecki said he was “doing my part” to upset “the religious right” and signed his posting “Evil Dr. P."

Of course, after being outed, which in itself is rather creepy, by a conservative gadfly bass-player with attention-deficit disorder, Mirecki apologized. But it had all really hit the fan by then. Then he got beat up. The university says they will continue with plans to offer the course, but Mirecki will not be teaching it.

His health insurance would probably drop his coverage if he did teach that class. It's Kansas, after all. Things happen there.

Wednesday, December 07, 2005

What We Mean When We Say Waste

We can all think of people, maybe we never knew them personally, who had great talent and potential and they just chucked it all by living very badly. Kurt Cobain was probably one such person. Robert Downey Jr. may yet snuff himself out, but so far he's proven he can outlast some of his problems.

One of my favorite examples of this type of person was Jaco Pastorius, bass guitarist for the seminal fusion-group Weather Report. He literally revolutionized the use of that instrument, changing it forever. Not too many people do things like that. But he succumbed to heroin and died violently, at too young an age.

"What a waste of life," people say.

Sometimes I get a pretty close look.

A short time ago this patient overdosed on methamphetamine, developed a hypertensive blood-pressure crisis, and with that a parenchymal bleed into the ventricles. There may have been a stabbing or a gunshot along with the overdose scenario.

Drugs and trauma. Oh, great.

The nice neurosurgeons put a hole in their skull and drained away that, but a lot of life got drained away with it. The patient had this wierd decerebate posturing with their left arm, preferring to hold it straight down their side with the fist turned outwards. They could move their right arm and leg some, always pulling at the tube that supplied air to their tracheostomy collar.

Their tongue deviated left.

Aphasic, but I did not know if that was global or just expressive, meaning: they could not talk, but did they understand what was being said in within their hearing? I hope not much.

Easy patient, really. Suction every couple of hours, turn and position, wipe up their crap, feed them through the PEG tube inserted into their stomache, dangling like a long, thin, latex umbilical cord. Come back later and repeat.

That's all there is for this person for the rest of their life. And they were young, as in not as old as I am. Not halfway through an average American lifespan.

Suction every couple of hours, turn and position, wipe up their crap, feed them through the PEG tube inserted into their stomache, dangling like a long, thin, latex umbilical cord. Come back later and repeat. Empty urinary catheter bag.

Suction every couple of hours, turn and position, wipe up their crap, feed them through the PEG tube inserted into their stomache, dangling like a long, thin, latex umbilical cord. Come back later and repeat.

Transfer patient to long-term-care facility, where they will spend their lives trapped in that looping paragraph, until a bad case of pneumonia or urosepsis finally kills them.

Aside from having to confront that gloomy existential abyss of a life on and off during the day, it was otherwise a pretty good shift. That's the horror of it. It's too easy.

Sunday, December 04, 2005

All Doing Stuff

Wherever I am going and whatever I am doing, deep down inside I am really just Blackberrying.

Nobody in the lane, and nothing, nothing but blackberries,
Blackberries on either side, though on the right mainly,
A blackberry alley, going down in hooks, and a sea
Somewhere at the end of it, heaving. Blackberries
Big as the ball of my thumb, and dumb as eyes
Ebon in the hedges, fat
With blue-red juices. These they squander on my fingers.
I had not asked for such a blood sisterhood; they must love me.
They accommodate themselves to my milkbottle, flattening their sides.

Overhead go the choughs in black, cacophonous flocks ---
Bits of burnt paper wheeling in a blown sky.
Theirs is the only voice, protesting, protesting.
I do not think the sea will appear at all.
The high, green meadows are glowing, as if lit from within.
I come to one bush of berries so ripe it is a bush of flies,
Hanging their bluegreen bellies and their wing panes in a Chinese screen.
The honey-feast of the berries has stunned them; they believe in heaven.
One more hook, and the berries and bushes end.

The only thing to come now is the sea.
From between two hills a sudden wind funnels at me,
Slapping its phantom laundry in my face.
These hills are too green and sweet to have tasted salt.
I follow the sheep path between them. A last hook brings me
To the hills' northern face, and the face is orange rock
That looks out on nothing, nothing but a great space
Of white and pewter lights, and a din like silversmiths
Beating and beating at an intractable metal.

Sylvia Plath
23 September 1961

I just love the sound of that.

Saturday, December 03, 2005

Snap Smack

Once in a while we will see a patient who has been fighting cancer and the pain that goes along with it. They don't come to people like me for that. But maybe they've had a little chest pain and we want to rule them out for an infarct.

If indeed their cardiac enzymes are negative and the echocardiogram and stress test results look okay, I guess you could say that they "outfarcted."

I didn't even walk into the room without dilaudid in hand. Early the first of my two lovely days with these people, we had the doses adjusted upwards. The spouse questioned every pill and injection I gave. I always came in with the meds in their little packages and opened these at bedside, naming and explaining each one.

The spouse always said that I could "just leave them there" and that they would "help" the patient take them, but since I suspected the spouse had the same kind of drug problems that the patient had, I always stayed and assured myself the pills were properly swallowed by the patient. Spousie had their own little stash of various pills and talked sometimes of their own stupifying pain issues and their heroic efforts in dealing with it.

We increased the MS Contin dose from 100mgs twice a day to three times a day. That amount of morphine, alone, would probably adequately sedate a classroom full of hormone-crazed junior highschool students for a day or two.

Let me try to give some idea of how I think morphine is typically dosed, very generally speaking:

If you are having a heart attack, 2 to 4 mgs of morphine (which dilates the cardiac arteries a little, too) usually eases the pain, in conjunction with aspirin and nitroglycerin, which in themselves are not pain medications. If you fall off the roof and get all trauma-like with broken bones and stuff, 10 to 15 mgs of morphine will help you deal with it enough to probably forget about it. I'm just guessing.

Spousie asked me to call the doctor to get that dosage increased every time I went into the room, armed as I was with only 4 mgs of intravenous dilaudid. That dose is likely to translate to maybe about 20 mgs of morphine, I would guess, as dilaudid is about the strongest stuff legally allowed in this country. Maybe Fentanyl is more concentrated. Heroin is not prescribable. I didn't bring it up. They had enough ideas of their own.

Every two hours, on the even hours, within a minute or two of the hour, I knocked on the door with my bundle of Dr. Roberts intravenous elixer. Half a minute late had spousie on the call system yelling at the secretary to get the nurse to their room immediately.

But wait... if you order now, you'll get the Ginsu knives.

Yes, also a complete set of anti-anxietals were prescribed. Klonopin 2 mgs and Xanax 2 mgs each every 8 hours, ("Keith Richards" amounts) with additional doses of Ativan occasionally ordered by the medical doctor, just so I could get spousie to shut up with their constant demands for more drugs for the ailing patient, I guess.

You don't always give medications to treat the patient. Sometimes you give it just to make their family shut up for awhile.

The patient had back and knee pain. Allegedly had a broken foot, too, according to spousie, but they still walked out to the patio to smoke regularly.

The neurosurgeons wanted to immediately excise an abscess (somehow I found time to give the patient intravenous and oral antibiotics, too,) and do a laminectomy, but the patient wanted to wait until they paid their rent. Otherwise they'd be too nervous for the surgery. It was all our fault for making them so nervous, and that made their pain worse, too.

Couldn't we see that?

Since they were from another state, they of course needed to finalize a rental apartment and get a new bank account here, too, so they needed to postpone surgery a few days for all that. Case Management arranged to have a bank clerk come to their room so a a local account could be set up.

The other state's health insurance did not cover their stay with us, naturally. I suspect they had come to our own fair city to avoid legal troubles in the Land of Arnold. They were told that if they continued to refuse the surgery we could arrange to transfer them to a hospital in their home state, a conversation which escalated into yelling and demands for increased pain medications and anti-anxietals, every time.

Spousie even called hospital management a few times, ranting on about how awful we all were for insisting on doing surgery that the patient both needed and wanted, just not today. First they had to have their medication doses increased.

On the one hand we wanted to kick them out for refusing non-elective surgery, but on the other hand, the patient needed it so it wouldn't be nice to do that. The patient and spousie "fired" a series of neurosurgeons, residents, nurses, and managers who tried to persuade them to do something besides sit in the hospital soaking up narcotics like a bog on a foggy day.

I just went in every two hours and delivered the dilaudid and then got the hell out of there, so they loved me. I was their best bud. They said they would write letters about me.

How nice.

Anyways, there are only about two ways you can get to tolerate taking these drugs at these doses: cancer with its often accompanying metastatic pain, and heroin or cocaine addiction.

The patient did not have cancer. Dying cancer patients usually don't need that much morphine, anyways. But then, they don't have this patient's problems.

Friday, December 02, 2005

Post-Carbon Patsy Cline

In my humble opinion:

No analysis. No examination of underlying facts. No consideration of the future. No anticipation of change.

That's the crux right there: No anticipation of change. Is that not the stupidest of all things? What, pray tell, could be more stupid? The word OIL is not even mentioned. Stupidity beyond my own imagination. I need help to be that stupid. No, even with help I am incapable. God knows they, the Goldwater Institute, have tried, but I still remain less stupid than they themselves, despite their grand efforts and media access. They try harder, admittedly. Credit where credit is due, as dad always said.

Nice office space, though. No link. Because they suck. Oh well. Too bad. But just for fun, here's an example of their think-tank product. It has to be seen to be believed, it's so granitic in its stupidity:

Sprawl is a dirty word in Phoenix these days. According to one Arizona Republic columnist, "Limiting sprawl and turning development back into our cities would go far to addressing a host of ills, including Balkanization and destructive competition."


As the author notes, among the great cosmopolitan centers of the Western world, London's population density peaked in the early 19th century, Paris in the 1850s, and New York City in the early 1900s. Before and since then, expanding economies with increasing incomes have exhibited what I will call the inexorable centrifugal force of growth.

She does not mention oil at all. Not at all.

Nor does she specify "the author." It's a need-to-know basis kind of thing, I guess. Heck, it's a freaking newspaper, not a scholarly article. So who needs standards? Or even information? The print articles are just there to fill up space between store advertisements.

She later goes on, however, to cite the feckin' "invisible hand" of Adam Smith. Very impressive. Almost as impressive as "the inexhorable centrifugal force of growth." That's called "cancer" in the real world. And it kills and there is no cure. Oh well. Everybody dies sometime. Might as well die stupid.

Loser. Pathetic. I have to tell you, history has shown that Adam Smith's hands were plainly visible to all who knew him. Not invisible.

They weren't oily. Not much, anyways. Maybe that's why she fails to mention it. Or maybe she's an idiot.

What will happen to people who live in homes that are oversized and too far from their places of work when petroleum prices normalize according to the laws of supply and demand? Gas goes to $10 per gallon. Inevitable. It's a finite resource. Only a matter of a little time. After all, Bush basically doubled the price of gas in his few short years of economic demolition. And he's not done yet.

The cities of Europe developed suburbs when the locomotive and automobile made transportation quick and cheap. Those days are soon coming to an end. And just who, of all people, is the truest herald of the post-carbon cheap fuel age?

Patsy Cline.

"I Fall to Pieces" will well apply to suburban living soon.

Unable to afford the high prices of heating/cooling huge 3500-square-foot edge-city homes while commuting 45 miles per day, each, to and from work, two-job families will soon find the suburban lifestyle unsustainable. Their yards will not be big enough to grow the "victory gardens" they will need to supplement their food needs, due to the excessive cost of groceries as transportation costs multiply the prices at the local supermarkets. Supermarkets they can't afford to drive to frequently.

As Patsy Cline admonished us decades ago, many of us will soon be Walking. After midnight. To work, if there is any, and to stores, school, medical care, and other areas of social need, because driving will be prohibitively expensive.

Suburbs will die, and inner cities, as well as rural farms, will become the places where people eek out lives, jobs, and commerce. Cannondale stock may actually become listed on the NASDAQ again. If there even is a NASDAQ.

Maybe the Goldwater Institute can afford to pay people to be stupid, but I seriously doubt that we can base our entire future economy of that concept.

Sunday, November 27, 2005

The House of What?

Non-representational art has always come easy to me. Since ever I was quite young I've liked the paintings of de Kooning, Jackson Pollack, and especially Kandinsky.

Our household will probably never be able to afford original artworks by any of those painters, but we do have some things like this painting, but by different elephant artists, for example. We also have things done by actual humans who are not even close relatives of ours.

Good and enjoyable art doesn't have to represent anything. It can be like music.

This aesthetic, however, does not at all apply in American politics.

I hereby proclaim that we call the House of Representative the House of Abstract Expressionists, especially in light of recent polls. Like this Harris survey taken a week or so ago.

This scientifically-conducted poll taken by one of this world's premier pollsters concludes that 63% of the Americans who were asked favor pulling our troops out of Iraq in the coming year.

Well, somebody, like Becca maybe, should set this winger straight:

"Congratulations to House Republicans and Arizona Rep. J.D. Hayworth for finally standing up and making the anti-war Democrats put up or shut up.

On Nov. 18, the Republicans forced the House to vote on a bill that simply said it is the consensus of the House that we immediately remove our troops from Iraq. It was very plain to see on C-SPAN that the Democrats were hopping mad to be forced to choose between their rhetoric and what is best for the country. They wanted this as an issue and did not really want a real solution, but the final vote was 403-3 to keep our troops in Iraq."


That is just so pitiful. Poor thing.

Hey, wait there just a dog-gone minute. Becca already did straighten out this issue, and in the same exact newspaper in which this guy had his letter printed, but hers was up the day before!


"To be accurate, the 403-3 votes were based on a wholly irresponsible and blatantly partisan GOP reinterpretation of Rep. John Murtha's remarks. That it came to such a shattering defeat says more about the GOP's ability to rewrite the views of Democrats in their own image than it does about the Democrats' ideas."


I guess the guy must have missed that.

He probably misses a lot of things. Like reality.

Anyways, a 403-3 vote. Sheesh. Just who are these people representing? I don't think they are "representing" anything. Certainly not the 63% of Americans who are currently maintaining their sanity.

Paintbrush-wielding elephants would be more responsive to the current political leanings of the American citizenry than either our own House or the people who write the loopy pro-Iraq-war letters to newspapers.


It was cold but not too bad. I didn't need a hat. Wool gloves were fine. It was early spring of 1977 and the leaves had not yet begun to sprout but there was no snow.

I walked to the bus station, wrote them a check for a few dollars, and was on my way to Fredonia outside Buffalo. I had a ticket to see Valdimir Horowitz the next afternoon, at Kleinhans Music Hall in the big town.

The man was a lion. He was in a second prime period of his career. There had been a number of years, a decade-plus, in which he did not concertize. It was said that for one year-and-a-half period he never even left his apartment in New York, preferring to stay at home with his ever-protective wife, who herself was the daughter of the legendary conductor Toscanini.

There is a story about Toscanini at some famous opera house about to conduct some three-hour-long major work, whatever, let's just say it was Aida for effect, though it well could have been Fidelio for all I know.

Anyways, the story goes that just before the opera, the bassonist of the orchestra madly approached Toscanini and said "Maestro, I'm in a fix. The low E-flat key on my bassoon is broken, and I don't have time to go home and get my other instrument."

Toscanini ruminated for a moment and replied "Don't worry about it. You don't have any low E-flats in Aida."

He knew his stuff, that Toscanini. Good memory. He obviously didn't smoke a lot of reefer.

Anyways, I stayed with a college friend. His mother had corralled me into singing and playing in her church choir, which was the best one by far in my home town. Later I would be best man (but not best shoes,) at his wedding.

The next day we drove to Kleinan's to hear Horowitz, who always played afternoon concerts after eating a meal of Dover sole.

He opened with an obscure Clementi sonata, did some Rachmaninoff etudes-tableax, then the Chopin B-flat-minor Funeral March sonata. My brain was on "wow" the whole time. After the A-flat Polonaise I thought the piano was going to collapse, because somehow Horowitz was able to play very, very loudly, but it held up for three encores, including Mozskowski's "Etincelles" or "Sparks," and Schumann's "Traumerei."

I heard him play that on TV on the "live from Moscow" concert in real time a few years later. Two of my beloved dogs, a red Saluki and a black-and-white Borzoi, died that same morning. I can't stand hearing it anymore. I have the CD but it's dusty.

The next day I found that the Buffalo bus station, unlike the provincial college-town station I came from, did not take checks. Naive was I. Sheesh. I ended up pounding on the door of the local Methodist church, because I assumed they were all as nice a bunch of people as my choir-mates back home.

They just happened to have a bus of hyperactive old ladies heading east out of Buffalo to go to a quilting festival or something, so they gave me a ride. They also gave me doughnuts and cashed a $10-dollar out-of-town check. Bunch of sweetie-pies. No Horowitz fans among them though, but they were impressed I had travelled hundreds of miles to hear him.

I mailed them a thank you note and small church donation a week afterwards.

They turned south before the highway back to college turned north, so I had to do a little hitching. My first and shortest hitch was just to get through the Thruway Exit Booth, because they wouldn't let me just walk out onto the Thruway. That was a ride of about a hundred yards. I continued east after the guy dropped me off on his own way west.

Some guys in a van got me as far as the highway north, where a beer-guzzling mullet-cut wild-and-crazy pothead took me all the way to Watertown. He could drive and moon other cars at the same time. But he didn't kill me and drop my body in a ditch, so it all worked out okay.

Another short hitch got me into town to the Greyhound station, where I paid my three dollars and took a bus for the final stretch.

My friends, almost all pianists themselves, cheered me as I walked into the dining hall. They pawed me. Well, at least Janine did, she was just like that, and they asked me all about Horowitz, and I talked about the absolutely weird electrical thing that spread though the air of the auditorium the moment he walked on stage.

Later we all went to the big concert hall at Crane and heard the Juilliard Quartet play Ravel.

Back in those days, that was a big weekend for me.

Wednesday, November 23, 2005

Three Days in One

The day before, the patient had gone to radiology specials to have a pocket of fluid drained. Yesterday, the 22nd of November, they got news that the fluid contained malignant cells.

I knew so the minute I knocked gently on the patient's usually-closed hospital room door only to be politely shooed away by the doctor, a guy I really respect. Though I went to the desk to chart, mentally I was preparing a cocktail of p.r.n. medications I was going to offer the patient as soon as the door opened.

Before I had a chance to go get those, the patient's spouse came out and requested some pain medicine for the patient, and they were about due anyways, and I suggested that maybe I'd bring the anti-anxietal too and they thought that was not such a bad idea.

Though the patient, younger than me and just handed a death-sentence, broke my heart, I held it together and they did not shower in my own tears. Much, anyways.

Earlier in the day I had mentioned that it was Saint Cecilia's Day, but we all know it was another day, different from the celebration of music's patron saint.

Some of us nurses discussed where we were on that day. So-and-so was in 7th grade. Another was home sick from school and watched it all unfold on television. I was at school. Many nurses noted that at that time they had not yet been born.

People say I think about death too much. My family says so, and so does my analyst. I protest that I myself think about death just the right amount of time, but that everybody else thinks about it too little.

Long ago when I was attending nursing school I worked as a monitor-tech-slash-nurse-assistant-slash-unit secretary. They had me do things that the nurses were just basically too busy to do. Sometimes I set up sterile fields for Swan insertions, sometimes I did computer order-entry, sometimes I just sat in front of the monitors and watched cardiac rhythms float by like slow minutes on a lazy summer day out-of-doors.

Sometimes I wrapped up people who had passed on.

This one old guy was someone I had worked with several times over the years, first on the medical-surgical floor where I had worked previously, then later in the ICU where he died. I got the shroud kit and closed the door and curtains to the room, and washed his breathless pale corpse.

He had gone quietly, with some family members present who did not want him desperately coded. They had stepped out for me to do my job after they had said final good-byes. For some reason the television in the room was still turned on. I could barely hear it. Once in a while as I worked to prepare his body for the morgue I could not help but look up at the picture.

It was Denise Austin's fitness show. She was doing a rodeo with her legs and performing a soft-core wide-open split when the door to the room opened.

It was a family member who had not yet gotten the news that the patient had died. They must have just walked into the ICU without going through the usual process of calling in from the waiting area, and they missed the relatives who had just gone home. They gave me a shocked and disgusted look and abruptly left.

At least I had the patient somewhat covered at that point. But spread-eagled Denise on the television must have seemed quite inappropriate to them.

I tried to chase them down to see how they were doing, but they had disappeared out of the unit. Then I explained to the nurses what had happened. They seemed unconcerned about the emotional state of the family member who had just found out, in a peculiarly bad way, that their loved one had died. The nurses were more alarmed that their perimeter had been broken and that the person had just strolled into the unit without proper announcement.

Me too.

That's one dead body story. Nurses have those.

Anyways, back to the day at hand. The patient and their family kept telling me how much they appreciated the comfort I was providing for their grimly-diagnosed loved one. They were one-and-all a very gracious and lovely bunch of people, and I made sure to tell them that a lot. But the patient's news of the day changed things.

Like that day changed us all back in 1963. We struggle still to regain what we lost then.

And like the voice of Saint Cecilia resounding with comforting music we can all hear and feel.

How we need that music. How we need to change back, in some mysterious way that I cannot begin to explain.

Be Somebody's Thanksgiving

In some states it's as simple as checking a box on the back of your driver's license card. But in practical terms, the process is a little more complex, and upon your demise your family will be asked about it and some simple paperwork will need to be processed.

One of the best movies that you will probably never get a chance to see is Jesus of Montreal. I was lucky enough to see it with a devoutly Catholic friend when it first came out back in 1990 or so. A great retelling of the story we all think we know anyways, it's worth hunting down.

In it, a struggling actor is asked to perform the yearly re-enactment of the Stations of the Cross outdoors on the hill that signifies the beautiful city of Montreal. There are many scenes in the movie that are synonymous with events from the story as told in the Bible, such as the trashing of the money-changers. Near the end, in the play-within-the-film atop Mount Royal, the lead character of the film is injured while upon the cross.

He dies. One of the memorable closing scenes of the movie includes a woman whose eye bandages are removed, and who can then see because of tissues donated from the body of the lead character. Another person receives the heart.

I think you know what I'm getting at here.

And you know what they say. "Donate Life."

Hey, it's free.

Does anybody out there recall the old Doonesbury sequence in which a conservative character gets a heart transplant and the donor was a liberal? If I had a few hours I'd search their archives for the correct link, but then I'd just get lost reading all the old strips. It's amazing what you find there.

Sunday, November 20, 2005

Rhymes With Fall

In Gilbert, Arizona, this is what they do for fun on weekends. They wrestle cows. No, they don't buy them dinner first. No movie afterwards.

Deep in my mind's recesses, somewhere under a pile of old Herman's Hermits vinyl records, is an early memory I have of going to Gilbert. I was a little kid, and dad piled the family into the 1960 Ford Falcon station-wagon, then only a couple-few years old, and we went for a Sunday afternoon drive.

Such a thing will soon be indeed a thing of the past, as fuel prices inhibit purely recreational motoring.

Anyways, we went to Gilbert and there was nothing there really except a ditch alongside some railroad tracks which passed by an old water tower. It's all still there, but now within the midst of about a couple hundred thousand people. People who weren't there a few decades ago. A town that was open fields those few decades ago.

Friday, November 18, 2005

Textbook Examples

Another shiny nugget from the mother of all lodes, the Arizona Republic Letters-to-the-Editor page, don't you know. These come out on such a regular basis that somebody should start a blog just for the sake of dismantling these things for frequent fun, education, and entertainment.

A letter full of fallacies indeed. Well, not full full, just a little full. Just two fallacies are cited for, but then also perpetrated on, the reader.

In criticism of a previous letter-to-the-editor, this writer asserts the following:


"He says Rosa Parks has done more to change the U.S. than many other famous persons. He also argued that she is one of the only people who symbolized the true meaning of our Constitution."

On the face of it those are two perfectly logical and acceptable statements. Rosa Parks is all that. I think the letter-writer is assuming, note assuming, that the original statement was a fallacy of the all-instead-of-some variety. Unfortunately the wording defies the argument. "Some" and "one of the only" are not "all." So the writer of the letter sees a fallacy where there is none.

Rosa Parks has done more to change the U.S. than many other famous people, like Kevin Bacon, for example, or Cindy Lauper, who are both very widely known.

And Parks is one of the only people who symbolized the true meaning of our Constitution. Of course she's not the "only" person to have done so. Many people have, and she is one of them. She is an icon for many of us who value civil rights for all, myself included.

Then the young student of logic continues with these observations:

"The fallacies I found here are overgeneralization and pity. Steve overgeneralizes when he writes that Rosa Parks has done more than any other individual since Martin Luther King. Katz also uses pity in his letter. But if Katz wants to catch the reader appropriately, he should lay down facts and avoid pity. "

Maybe the first letter, to which the young writer refers, does make the rather overgeneral claim that Parks "has done more" than so-and-so, but without an actual citation from the original we will not know. (My albeit brief search could not exhume the original LTTE by Steve Katz from the Republic's archives, so I can do no better that the young writer herself.)

Likewise, the critic herself includes no citation of the "pity" she says should be avoided in logical argument.

By injecting such an emotion-laden word, though, isn't she herself committing just that fallacy, the use of emotionally-charged words? Especially in light of her neglect to provide of an example of such, ignoring her own admonishment to "lay down facts."

Hey, there's another thing. The young critic has tried to apply two logical fallacies to Katz's letter, and these just happen to be the first two listed in one of the most-commonly cited texts on this subject, "Straight and Crooked Thinking" put out by Robert H. Thouless back in 1930, but a popular college standard still for those who study such things. Hmmm. The first two. Well now.

Mere coincidence? I do NOT think so!

And maybe I should not be so rough on a young and perhaps impressionable high school student, but the very fact that she chose Rosa Parks to pick on just scares the hell right out of me. Maybe she could start like someplace here and do a philosophical analysis of the people who attacked the freedom marchers on Bloody Sunday back in 1965, continuing to mix a little modern American history in with her studies of the principles of logic.

There are better targets on which young cubs can sharpen their logical claws, like Virginia Abernethy, for example, who perhaps actually deserves some criticism for her views, which straddle the line between "separatism" and "segregation."

Maybe that's it. Maybe that's the real problem here.

Monday, November 14, 2005

Facts Are Stupid Things

Some people may be surprised to find out that Arizona has a State Legislature. Yes, this is apparently so, and it turns out that the people elected to that political body actually do things sometimes, which is why, I suppose, they are paid. Not much. I hear it's about $20K a year. They must make up the rest of their income on tips, I guess. Who, besides say a freshman Phoenix policeman, can live on such a paltry salary?

You may be thinking that perhaps there is a reason why the people of the Grand Canyon state are so frugal with their compensation for their political representatives, or whatever they are. Well, there is. You see, some of those representatives appear to be sometimes quite stupid, in my humble opinion.

For example, take this "My Turn" column appearing in the local paper of record, the Arizona Republic. It was written by legislature member Steve Tully, who I am sure is a very good and adequately groomed person, despite obvious errors. In this piece he wrote:

"I wish to respond to Talton's comments by paraphrasing Ronald Reagan. It is not that Talton knows so little, it is that he knows so much that isn't true. "

Well, Ronald Reagan said a lot of things but he never said that. Mr. Tully gets it absolutely reversed, and a little twisted up, to boot. I think he, like Reagan himself, was struggling with his memory, because it was Mondale who said this in response to Reagan in their first presidential debate way back in the B.I.B.P. (Before Ipods Became Popular) Era:

"Well, I guess I'm reminded a little bit of what Will Rogers once said about Hoover. He said it's not what he doesn't know that bothers me, it's what he knows for sure just ain't so."

This was in response to Reagan's absurd claims regarding the social "safety net" when he had proposed, as he had done for almost his entire political career, to cut Social Security. I recall watching this on television, and this was the crux of the debate. How Mr. Tully could mess this up is something I will never know, and perhaps I fear knowing.

Now here are some examples of some things that Reagan did actually say:

"My name is Ronald Reagan. What's yours?" –introducing himself after delivering a prep school commencement address. The individual responded, "I'm your son, Mike," to which Reagan replied, "Oh, I didn't recognize you."

"What does an actor know about politics?" –criticizing Ed Asner for opposing American foreign policy.

"Trees cause more pollution than automobiles."

"All the waste in a year from a nuclear power plant can be stored under a desk."

Maybe that was part of his problem.

And of course, Reagan said this:

"Facts are stupid things." –at the 1988 Republican National Convention, attempting to quote John Adams, who said, "Facts are stubborn things"

You know, everybody make mistakes. There is an entire industry, for example, that profits from the tongue-slips of our current brain-deficient president. But then Mr. Tully ends his words with this admonishment:

"Talton closed his diatribe with three suggestions. I have three for Talton: Soften your heart, open your mind and do your research."

"Rut-ro," as Astro would say.

I think that Mr. Talton, whose article here was the spark for Mr. Tully's rubber-tire-fire, will be preparing a follow-up of some kind. The guy's just asking for it.

Popcorn anyone?

Friday, November 11, 2005

Big Things

Most of these places, that is to say, "urban-density" in-building, condo/loft-style homes, have yet to be actually put up. There are many currently under construction, a few that are new and ready for occupation, and some that have been around for quite awhile.

I do not think it is too soon to abandon the suburbs to return to town or city living. When the era of cheap carbon fuel begins to wind down, like right now, shorter commutes and smaller living spaces will become premium and unless somebody decides to build a giant pharmaceutical factory requiring five thousand highly-paid employees out in Queen Creek, nobody will be able to sustain a home there. Same goes for Estrella, Fountain Hills, and those knock-up fake towns north of Peoria, for example.

No, we are not going to go Japanese.

By Western standards, the typical Japanese home is very small. In the major cities, most families live in tiny apartments. One third of the housing in Tokyo averages only 121 square feet while the average Japanese home is 650 square feet.

That's small. Consider this:

In recent years, the trend on Long Island certainly has been toward larger, aggressively un-claustrophobic houses. In Nassau County, planners say, new and renovated housing is typically in the 2,800- to 3,500- square-foot range -- with luxury homes of 4,000 square feet and more becoming ever more common. In the Northeast, the median new house size in 1973 was 1,450 square feet, according to annual U.S. Census housing surveys. Last year, that figure was 2,361 square feet.

That's big. Probably too big for most double-income families (and what family isn't these days?) to clean and maintain, so such tasks become "out-sourced" to the not-so-merry-maids, handymen, and the like.

A few posts back I commented on a LTTE found in a Northeastern newspaper, written by a woman bemoaning her high heating bills. Those, of course, are only going to get much much worse. Another writer submitted his own comments in a LTTE which appeared a day or two later:

A 2,500-square-foot house in Rensselaer is not average. That Bonny Parsons decided to buy a 2,500-square-foot house that is heated by oil shows her poor judgment. Everyone knows oil is the most expensive form of energy around. Now she wants to heat up her bedrooms with electric heaters, thinking her bill will not top $1,000 a month. Yes, she's average -- in her own mind.

Well, that's a bit harsh. I am more sympathetic, and concerned. It's the math. Math, and the economy.

Heating (or in the case of the Valley of the Sun, cooling) a 2,500-square-foot home is simply a lot more expensive than heating a 200-square-foot Tokyo flat. That's one part of the formula.

Then multiply the cost of heating a large home by the total number of such big domiciles, and subtract that total cost from other areas of consumer spending. Voila: recession. A big long no-end-in-sight hit on consumer spending.

It's like gasoline. Every three bucks you put in your gas tank is one less vanilla latte. So to speak. It's just more money sucked out of the economy and sacrificed on the glowing funeral pyres of Exxon/Mobil.

So I am stuck asking myself if it's just too late.

For the suburbs, probably yes, it is too late. Like, way.

Big mortgages, big commutes, big homes, big yards, big fuel bills, big plasma televisions, big car payments, big credit card bills...

No money for Barbie and Ken at Christmastime, no money going anywhere except to Uncle Sam and Uncle Halliburton and cousin Big Oil, who, by the way is a Saudi prince. Did you know you owed him money? Your Chinese cousin gets a piece of your mortgage, too, you know.

Yes. You have a Chinese cousin. Lots of them, actually, and if they need oil, they can walk to the Middle East to get it.

But can you walk to work, or to get a gallon of milk?

Can you even sell a gallon of milk to a family that has no money left over after paying their home heating bills this winter?

We should have paid more attention to President Carter's energy plan back when we actually had the chance. And maybe thought about living in a smaller place a little closer to work.

Wednesday, November 09, 2005


Bahia mi rumba.

Me personally, I like firefighters, teachers, nurses, prison guards, and public employees. Generally speaking, they help people. You might not think so if you are an arsonist or inmate, or even perhaps a delinquent junior highschool student. But me, I like 'em.

And I want them to be able to have some say over their work, for they know it best.

Take firefighting, for example. You would never stop a fireman in mid-task, say for example, rushing into a burning home to retrieve a trapped toddler, to criticize his work style, promotion structures, and union politicking. Yet many people (beware the link) rail on and on about teachers, as if they know as much about the work as teachers themselves.

Then such people might even riff upon the term "trapped toddler" with scathing remarks about the so-called indoctrination of school students. As if that would be funnier this time than the last eight million times some libertarian griped about public schools.

Anyways, bravo for the people of California, for rejecting the Anuhld's many propositions in the recent special voting.

It must have been some party:

Dogging the governor, as it has for months, was the California Nurses Assn., which organized a luau at the Trader Vic's in the same hotel. As Schwarzenegger's defeats mounted, giddy nurses formed a conga line and danced around the room, singing, "We're the mighty, mighty nurses."

When you're sick in a hospital bed, you will not be able to petiton your government for redress.

The nurse-staffing law, signed by former Gov. Gray Davis, was the first in the nation to require hospitals to have a certain number of nurses for each patient on all wards. The regulations took effect in 2004. This past January, ratios on busy medical and surgical units were scheduled to increase. But in November Schwarzenegger blocked those new increases, causing tensions with nurses to rise.

The California Nurses Association immediately took the matter to state court, arguing that Schwarzenegger could not halt the law by using an emergency regulation, a little-used rule that allows the governor to suspend state laws during emergencies, such as an earthquake. The judge ultimately ruled that the nursing shortage did not constitute a dire emergency and the administration had therefore overstepped its bounds.

Old news, but good news.

That Arnie is so clever. As the article from Women's e-News shows, he tried to declare the nursing shortage an "emergency" so he could suspend laws that mandated safer hospital nurse-patient ratios. Brilliant, that.

In the face of rising floodwaters, he would attempt to halt the deluge by drooling.

Propositions that would affect union politics and teacher tenure were defeated in this special election, and Scharzenegger was made lame. As if he weren't lame enough already.

Thank goodness for the nurses of California, as well as many other people, for their principled opposition to this lug. It gives hope to all of us who move and shake, make the coffee, transfuse the blood, grade the homework, mind the convicts, and get the stuck cats out of the trees.

Sunday, November 06, 2005

Come Again?

This shows up probably on a monthly basis over in the Eschaton comments, and I've always liked Yeats, so here it is in its entirety:

The Second Coming   
Turning and turning in the widening gyre
The falcon cannot hear the falconer;
Things fall apart; the centre cannot hold;
Mere anarchy is loosed upon the world,
The blood-dimmed tide is loosed, and everywhere
The ceremony of innocence is drowned;
The best lack all conviction, while the worst
Are full of passionate intensity.

Surely some revelation is at hand;
Surely the Second Coming is at hand.
The Second Coming! Hardly are those words out
When a vast image out of Spiritus Mundi
Troubles my sight; somewhere in sands of the desert
A shape with lion body and the head of a man,
A gaze blank and pitiless as the sun,
Is moving its slow thighs, while all about it
Reel shadows of indignant desert birds.
The darkness drops again; but now I know
That twenty centuries of stony sleep
Were vexed to nightmare by a rocking cradle,
And what rough beast, its hour come round at last,
Slouches towards Bethlehem to be born?  
William Butler Yeats
Printings: The Dial (Chicago), November 1920; The Nation (London), 6 November 1920; Michael Robartes and the Dancer (Dundrum: Cuala, 1921); Later Poems (London: Macmillan, 1922; 1924; 1926; 1931).

For those that may be further interested there is some useful commentary here and some insights down in the posted comments, here.

Lines 7 and 8 seem to see the most action these days.

I will leave with one observation of my own about the poem: falcons have no need for falconers.

Saturday, November 05, 2005

Another Proud Bush Supporter Speaks Out

Can somebody translate this into plain English for me, please?


"Of course liberals never need a rationale for cowardice. Few leaders have ever been called to task for showing their yellow streak in the face of terror and tyranny. "

Really? I guess all those stories about Clinton avoiding the draft by winning a prestigious scholarship to study in England were examples of "liberal media bias." then, eh? Well, the writer did say "few."

Let us refresh our memories regarding those who have served in their country's proud military forces:

Prominent Democrats

* Representative Richard Gephardt, former House Minority Leader - Missouri Air National Guard, 1965-71. (1, 2)
* Representative David Bonior - Staff Sgt., United States Air Force 1968-72 (1, 2)
* Senate Minority Leader Tom Daschle - 1st Lt., U.S. Air Force SAC 1969-72 (1, 2)
* Former Vice President Al Gore - enlisted August 1969; sent to Vietnam January 1971 as an army journalist, assigned to the 20th Engineer Brigade headquartered at Bien Hoa, an airbase twenty miles northeast of Saigon. More facts about Gore's Service

* Former Senator Bob Kerrey... Democrat... Lt. j.g., U.S. Navy 1966-69; Medal of Honor, Vietnam (1, 2)
* Senator Daniel Inouye, US Army 1943-'47; Medal of Honor, World War Two (1, 2)
* Senator John Kerry, Lt., U.S. Navy 1966-70; Silver Star, Bronze Star with Combat V, and three awards of the Purple Heart for his service in combat (1)
* Representative Charles Rangel, Staff Sgt., U.S. Army 1948-52; Bronze Star, Korea (1, 2)
* Former Senator Max Cleland, Captain, U.S. Army 1965-68; Silver Star & Bronze Star, Vietnam (1, 2)

* Senator Ted Kennedy (D-MA) - U.S. Army, 1951-1953. (1)
* Senator Tom Harkin (D-IA) - Lt., U.S. Navy, 1962-67; Naval Reserve, 1968-74. (1, 2)
* Senator Jack Reed (D-RI) - U.S. Army Ranger, 1971-1979; Captain, Army Reserve 1979-91 (1)
* Senator Fritz Hollings (D-SC) - served as a U.S. Army officer in World War II, receiving the Bronze Star and seven campaign ribbons. (1)

To cite just a few.

In interest of fairness, let us also name some from the other side of the aisle:

Prominent Republicans

* Speaker of the House Dennis Hastert - avoided the draft, did not serve.
* Former House Majority Leader Dick Armey - avoided the draft, did not serve.
* House Majority Leader Tom Delay - avoided the draft, did not serve (1). "So many minority youths had volunteered ... that there was literally no room for patriotic folks like himself."
* House Majority Whip Roy Blunt - did not serve
* Senate Majority Leader Bill Frist - did not serve. (An impressive medical resume, but not such a friend to cats in Boston.)
* Majority Whip Mitch McConnell, R-KY - did not serve (1)
* Rick Santorum, R-PA, third ranking Republican in the Senate - did not serve. (1)
* Former Senate Majority Leader Trent Lott - avoided the draft, did not serve.

Secretary of Defense Don Rumsfeld - served in the U.S. Navy (1954-57) as an aviator and flight instructor. (1) Served as President Reagan's Special Envoy to the Middle East and met with Saddam Hussein twice in 1983 and 1984.

* GW Bush - decided that a six-year Nat'l Guard commitment really means four years. Still says that he's "been to war." Huh?
* VP Cheney - several deferments (1, 2), the last by marriage (in his own words, "had other priorities than military service") (1)
* Att'y Gen. John Ashcroft - did not serve (1, 2); received seven deferment to teach business ed at SW Missouri State
* Jeb Bush, Florida Governor - did not serve. (1)

* Karl Rove - avoided the draft, did not serve (1), too busy being a Republican.

There's this and a lot more over at that real blog, Required reading, which I guess explains why the guy who wrote the LTTE to the Arizona Republic which I snipped above is so bloody unfamiliar with the simple facts of the matter.

He said another little thing, too:


"I love how the liberal media turn everything, including Scooter Libby's lying, into a convoluted attack on our president's "rationale for war."

Somehow having every intelligence agency in the world reporting exactly the same condemning information is not rationale enough."

Apparently he has never heard of Hans Blix nor Scott Ritter. You know, a couple people who were actually there on the ground in Iraq looking around for themselves, instead of home listening to hate radio and drinking cheap fizzy urine-colored watery plonk, which some devout Republicans call "beer."

The letter-writer flatly concedes that Libby has lied, though. Funny, that.


It must have been something like twenty years ago, back when it was "The McNeill-Lehrer News Hour" weeknights on PBS. As a political junkie even before the explosion of the number of cable networks (CNN was just a baby at that time,) this was the best source of political information on television for me then.

I recall an episode that featured a story on "the nursing shortage." Funny that. Did you know that there was a nursing shortage twenty years ago?

But now, decades later and thanks to the Sacred, Wondrous, and Infallible Free-Market Laws of Supply and Demand, we still have a nursing shortage.

A couple of keys notions snipped from a Consumer Reports article, now two years old:

"(snip)... The shortage of nurses--particularly registered nurses--and other staff at the nation's hospitals has reached critical proportions. On average, 13 percent of nursing positions at U.S. hospitals are unfilled, with some hospitals reporting vacancy rates of more than 20 percent. And the pressures of working in understaffed units is making hospital jobs less desirable. Hospital administrators report that despite strenuous recruiting efforts, higher salaries, and sign-on bonuses of up to $10,000, they are having more and more trouble filling their nursing positions."

If a hospital offers you $10K to take a job there, I assure you that you will regret it. That's another story, though. Remind me to tell it someday.

Any ways, this talking head on the News Hour had apparently studied the amount of time it takes a hospital nurse to respond to a patients' call, and the number they came up with was twelve minutes, which they described as some kind of statistical average for U.S. hospitals in general.

You can die in twelve minutes.

And that was decades ago, during the old, not-so-bad-as-it-is-now nursing shortage.

It doesn't take me that long, but I count myself as fortunate as one is likely to be as a staff nurse. My nurse-patient ratio is very good, considering the current political climate regarding health care in this god-forsaken mess of a country, and in a political "red state," at that, with certain problems in health care relating to undocumented workers, among other issues.

As a result, the costs of medical care for immigrants are staggering. The estimated cost of unreimbursed medical care in 2004 in California was about $1.4 billion per year. In Texas, the estimated cost was about $.85 billion, and in Arizona the comparable estimate was $.4 billion per year.

Personal note of criticism: the article that I snipped that from appears on the Federation for American Immigration Reform website, and from what little I know, those numbers, namely $400 million a year here in Arizona, seem reliable. But I do not think that all undocumented immigrants bring with them the risk of tapeworm, so don't lay that on me, if you please.

I have my own ideas about border control. Like just stop it. Open the borders completely and let the free market allow people to decide for themselves where they want to live and work. I am sure there is a nursing shortage in Cancun as well as here. Let us address that urgent need promptly. Oh, the humanity.

Immigration is a very good thing for The Great SouthWest, but politically we just do not know how to handle it, because we are governed at the federal level by idiots, morons, and gangsters.

Anyways, there's a nursing shortage and it takes a while for a nurse to get to you as a sick and nearly helpless hospital patient, so what do you do? Consumer Reports has this radical suggestion:

Bring your own help. Patients, nurses, and national quality experts concur: Given the shortage of nurses, the most important thing to bring with you to the hospital is a reliable family member or friend to run interference for you.

"No one who is basically helpless--a child, a person with a cognitive impairment, a person who cannot ambulate, a person who is sedated--should be left alone in the hospital unless they are in intensive care," says Kathleen Maynard, a Florida nurse who saw her Alzheimer's-afflicted father through four hospital stays in three years. "I am speaking as both an R.N. and a family caregiver. Hospital staffing is so strained that patients do not get the care they need."

Bring your own help.

Well doesn't that just sock it to me, a registered nurse in a hospital setting, right in the old codependent gut. Oh well.

I am supposed to be able answer all the needs of all my patients all the time. This is like having many jobs all at once, and I simply cannot be in more than one place at a time. That is the most difficult thing about hospital nursing, by the way: Juggling multiple tasks.

You must hyper-task at all times. No single one of those tasks need be clinically difficult nor even interesting, really. But for example, if two patients call for pain medicine at the same time, then one of them isn't going to get their medication as soon as the other. Ah... the laws of physics apply to nursing, too. Who would have ever considered that seriously?

Friday, October 28, 2005

Tales From the Northeast

The following was snipped out of a LTTE in a recent edition of the Times Union, the newspaper of record in Albany, the capitol city of New York State:

This past May, I totaled up our first year's home heating oil usage. Between September 2004 and May, we purchased 2,400 gallons of home heating oil at a total cost of almost $5,800. We saw the price of our heating oil go up from $1.549 to $1.959 at our last fill-up.

The woman goes on to write that she kept her thermostat between 60 and 68 degrees all winter, and she "bundled up" a lot. Double socks and fleece on all the time.

Fleece. How romantic. Like... winter camping trips.

During the really hot summer months here in the Valley our cooling bills, as reflected in our electricity usage, top out at about $180 monthly. We bought a more efficient refridgerator so this past summer our usage was actually down a little from the summer before. But even at that maximal rate (the cost of which is sure to increase, perhaps dramatically, per kilowatt-hours,) our total energy bills would "only" be $2160 for the year, and in reality it's probably a good bit under $2000.

We are both frugal and lucky, I know. I do the laundry at night.

And if we had to cut back on energy use even more, we wouldn't freeze. Sweat some, yes, hypothermia, no.

Comparisons can be interesting.

Thursday, ExxonMobil became the most stark example yet of how much big oil companies benefited from the huge run-up in oil prices during the third quarter even as two major hurricanes ripped through the industry's Gulf Coast infrastructure. Exxon reported:

Net income up 75 percent to $9.92 billion. That is the most a U.S. company has earned from operations in a three-month period and greater than the annual gross domestic product of entire nations including Cameroon and Zimbabwe.

Snipped from the Free Press from Burlington, Vermont, another pretty cold place in the winter.

They'll be doing some complaining about their heating bills too, as soon as their electricity is restored after their recent big storm. No electricity, no whining e-mails to editors.

When we lived up that aways we heated our home mostly with wood, with electricity back-up. Of course, if we were away for a few days and the woodstove smoldered out, and the electricity had failed, I suppose in that kind of situation the parakeets would not have done well.

Five cords of wood cost $165 then, ($33 per cord) and we went through about twice that in a typical winter, which begins in late August there. Sheesh. No kidding, though.

Some years, in the spring before the thaw, I'd stack up 15 cords if we had scant little left over. A friend of mine who still gets wood from the same guy up there now pays $55 per cord, or $275 for a 5-cord truckload. That's still a lot cheaper than what the Albany letter-writer will pay to stay warm this year.

Small communities tucked deeply away in thick forests will somehow manage to stay warm. I guess. But there's a tipping point to the number of trees a community can sacrifice to the Great Buddha of Being Warm in The House. Call that theory the "Peak Cordwood" effect curve.

The Albany woman concludes with:

This year, we are cutting back our estimated heating oil usage by 400 gallons and will be keeping our thermostats set at a base of 50 degrees. We are buying three cords of wood and will be using our fireplace to heat the first floor, and electric space heaters to warm our bedrooms at night.

Fireplaces are notoriously wasteful of good heat. I would recommend that they buy a fireplace woodstove insert with all the money they are going to save by freezing their butts off this winter.

Yeah. Right on.

We will start to see the stories trickle out soon. Homes demolished by chimney fires. Frozen old maids dead alone in their rural farmhouses. Children sick from the cold. Unhappy chilly homeowners like the woman above.

But hey, profits are up.

Sunday, October 23, 2005

Harriet Who?

Such a beautiful and mild sunny morning, the coffee's good, the child and spouse are with me, Sunday Baroque is on the radio, and I'm doing a little light reading.

Buried well into the Supreme Court nomination questionaire that Harriet Miers filled out for the Senate judicial committee was this:

I was lead counsel for Interstate Fire & Casualty Company (an excess insurance carrier) in this suit that the Catholic Church in Dallas filed seeking to obtain indemnification from liability and defense costs from its insurers. The Catholic Church was seeking coverage after a jury returned a $101.6 million verdict against the Church based upon eleven separate incidents of sexual abuse and child molestation by Father Kos, who had been an active member of the Diocese of Dallas. (Father Kos was also indicted and convicted for his acts). The jury had found that Father Kos committed his acts while acting in the course and scope of his employment. The jury also found, among other things, the Diocese committed fraud and intentionally concealed facts relating to Father Kos. Interstate Fire & Casualty, as well as the other insurers, denied coverage because Father Kos's actions were intentional acts that were not covered by the Catholic Church's insurance policies.

There were numerous issues raised in this litigation, including whether sexual abuse and child molestation are intentional acts that are not covered by insurance and whether the insurance companies had a duty to defend the Diocese in the lawsuits filed against it. The case also involved questions of whether Texas public policy precluded insurance coverage for acts of sexual abuse and child molestation. The case settled prior to trial.

Well, isn't that special.

I supppose somebody has to protect large insurance carriers from the predations of the Catholic Church, so that payouts to molested children will have to come from somewhere else. Lawyers do that.

But if Miers is being sold on her "character," then why didn't she work on behalf of the victims themselves, rather than a corporation? That, I suppose, is just what she does. So now, that settles that. We all have our own values, now don't we?

Maybe I've read too many Alice Miller books. If a person or policy does not support children (and we all carry childhood in ourselves throughout our lives,) then I do not assign value to them or that.

Of course I do not support Harriet Miers. I'm not a total "moran." She's no Erin Brockovich. And no, I do not much like what I've heard about one of Miers' real estate deals, either.

Since Miers really has no judicial experience, the White House is playing up her religious conviction and her character. So much for her character, so that leaves us with... what?

A vote against Roe, and a vote against any and all future rulings that may affect Bush himself. Rulings that may involve, say just for example, treason.

Saturday, October 22, 2005

342 Bras in Greenwich

I'll bet this guy has a lot of very interesting friends.

The story itself is just begging for a punchline.

Friday, October 21, 2005

Another Four Hundred Dollars

About two-thirds of homes in the Midwest use natural gas for heating, and the price of that resource has gone up quite a bit. The Energy Information Administration estimates that it will cost the average household another $146 over last years' heating season prices, and this is $408 more than the average cost of the 2002-2003 cold months.

So what's another $400? Just skip a few dinners out, maybe miss an opera or a couple ball games.

Don't worry, be happy.

Well, I'm a worrier. My spouse says I should be on something. And she's probably not incorrect.

I could stop worrying. But worrisome issues would not go away. I just wouldn't care as much. I'd put the opera tickets on a charge card.

Weak production - although production increased by 0.5 percent in 2003, it was not sufficient to offset the 3 percent decline in production during 2002. The industry in 2003 drilled the second highest number of gas wells in a single year, however production has not increased proportionally.

(Snipped from the EIA report linked above.)

So they drilled more natural gas wells, but production has not increased proportionally. That is to say, production for each well is not the same. It is declining for some wells.

This is the time of year in which our home energy bills decline, because we don't need the air-conditioner during the cooler months. We are lucky, in that respect. But if you own a natural-gas-heated home in the Midwest, your luck is slowly running out. Sell and move to the Valley of the Sun. Everybody else is doing it.

Then I won't worry about you all so much.

Instead, I will worry about inflation. When the price of fuel goes up, so does the price of everything else.

Eventually this effect will make everything change. We ain't seen nuthin yet.

I should repeat that.