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.

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."

Whoopee.

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.

Blood.

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.

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?

None.

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!

Tree Link

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

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.

(snip)

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:

Gasoline.

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,

shrimplate"

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

Mirecki

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.

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.

All Doing Stuff

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

  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.

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.

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."

(snip)

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.