Tuesday, August 30, 2005

Four Times Lucky

He owned a popular restaurant on the south side of town not too far from the highway that ran north from New York to Montreal. Sometimes my parents went there, back in the day, perhaps to finish off an afternoon at the racetrack. Not my kind of place though. My Datsun 240Z did not go so well in a parking lot full of white Cadillacs, one might say.

The word was that he had gotten somewhat behind on his gambling debts.

Because such a dire financial situation can be quite stressful, the police explained, this patient had become depressed. So depressed, in fact, that he took a small-caliber automatic weapon and delivered a line of four bullets into his own chest, but thankfully he survived. A miracle really.

Each bullet entered his torso at about nipple level, one between his right nipple and his armpit and clean through, another medial to this and just right of the sternum, another just left of the sternum hit a rib, and the fourth between the left nipple and armpit.

"Warning shots," I thought to myself as I washed him up.

He kept telling me to jump out the window. Two stories up, and my shift was nowhere near over, so I stayed. "You're not safe, they're gonna come through the door right now," he said. For a moment I worried.

Four bullets straight on into the ribcage, and no chest tubes, no myocardial trauma, no lung resections, no aortic damage. Just bandaids. With luck like that, he had gambling debts?

Sunday, August 28, 2005

Who's Lying Now

"Not everybody thinks the way you do," I have recently been told, by the likes of local columnist Dick Foreman, and though I cannot quote him with such exactitude, one Doug MacEachern.

Projection and desperation, I say. Of course not everyone thinks like me. They certainly don't, and that is to be expected. Their paychecks, columnists and editorial writers as they are, probably depend on the fact that they think a certain way, or at least pretend that they do, I would guess.

But I can say this: MOST people think the way I do, at least regarding the way Bush has mishandled this war. The looting, the bombing of civilians, the Abu Ghraib scandals, the lack of guarding major weapons dumps, the lack of diplomacy, the loosing of the Iraqi army, the deaths of our servicepeople, and on and on. Most Americans hate this crap, despite the inane pleadings of media lackeys.

I have been told, in apparent honesty, that "we" are fighting and killing the bad guys over there, and that this is good and well. Apparently there are just enough bad guys in the world to engage our poor sitting-duck troops in Iraq and the forgotten Afghanistan, with absolutely none, not even maybe a little over a dozen (like the number involved in the 9/11 attacks on us, for example,) left over to secretly plan to attack again, right under our noses. No, they wouldn't do that, would they?

"We're fighting them over there so we don't have to fight them here," is what out brainless leaders tell us, and so many columnists apparently believe that.

But do our enemies believe that?

I will tell you "no."

I will tell you that Bush has played into the hands of bin Laden, according to his own manifesto. But Bush doesn't read, except the headlines once in a while. He has people read for him. Great.

Bin Laden has declared "Your problem will be how to convince your troops to fight, while our problem will be how to restrain our youths to wait for their turn in fighting and in operations." Unfortunately, that is true. Our military enlistments fall below even the revised-down numbers.

In 1998 bin Laden wrote:

"The best proof of this is their eagerness to destroy Iraq, the strongest neighboring Arab state, and their endeavor to fragment all the states of the region such as Iraq, Saudi Arabia, Egypt, and Sudan into paper statelets and through their disunion and weakness to guarantee Israel's survival and the continuation of the brutal crusade occupation of the Peninsula".

Bin Laden told us that Bush was going to attack Iraq, and well, unfortunately, that was also true.

Bush on the other hand has fed us one lie after another. This is not right. Our leaders are supposed to be more dependable than our sworn enemies. But they aren't. So we are in trouble.

Condoleeza Rice warned of mushroom clouds over American cities. Let's just hope she was lying about that.

Thursday, August 25, 2005

I Dig a Diva

I do not know why, but some voices, particularly female voices, just do something to me. Callas is one. Sam Phillips is another. She could sing "Happy Birthday" to me and I would have to go freshen up afterwards. Usually it's a mezzo-soprano, and thank the stars above we have a glut of them now, but sometimes it's a big steely jack-hammer of a sound like Leontyne Price. Or a "Bollywood" singer with a name too polysyllabic for me to recall here, my mind being somewhat limited even musically.

Tomorrow it will be the incredible Dawn Upshaw. My friends in the business say she's a little past her prime, but not so long ago she was winning Grammies, a total of three, I believe. We travel to Santa Fe to hear her in Golijov's Ainadamar, about the execution of poet Garcia Lorca, a fave also.

My spouse took me to the Met once to hear Cecilia Bartoli sing Despina in Cosi. When she first came out on stage she pulled the set behind her on a big long rope. She pulled an entire house onto the stage, then sang a bitchy aria about all the work she has to do for the two divas that she serves.

Later she has her big one. All men are fickle, she says, and unworthy of a woman's fidelity ("In uomini, in soldati"). So ironic, in the context of Cosi fan Tutti.

I will recall that, with tears in my eyes, as I lay dying hopefully many long years from now, and not so soon.

Upshaw has a most unique and natural voice. If you are unfamiliar with Gorecki's Symphony of Sorrowful Songs then stop what you are doing and go out and buy a copy right now. It was Upshaw's first hit, in which she sings actual words written by an 18-year-old girl on a Gestapo cellar wall. It was a traffic-stopper during New York drive-time when it was first played on public radio there. Tranquil and doomed yet... tranquil.

I must pack now. The voice calls me.

Monday, August 22, 2005

Dogs and Cats

There is this rule I have concerning patient viability: if an adult patient of about average height weighs less than my dog, then that is Not Good. This rule, over the years, has become more stringent and more likely a predictor of patient outcome, as we have gone from owning rather quite big dogs to, in deference to my spouse's preferences, sturdier but not-quite-as-big dogs.

So this admission was a cachectic 90-year-old man who looked the part of a poster-boy for cancer or some other chronic wasting disease. My wrists were of greater diameter than his legs, and I am myself rather slight.

His lungs rattled like loose tools in the back of 1960 Chevy pickup truck going over ten miles of bad road. Dragging chains. Karen Carpenter on her death-bed probably looked better. No kidding. And though my dog had been placed on a stricter diet by our ever-chastising Dr. Vet, this patient underweighed him by many pounds.

We settled him into bed, examined him, cranked up his oxygen a little, and then his deranged family came to the nurse station, demanding to know "what was wrong with him."

The oldest daughter seemed most insistent, and after sizing up the situation and escorting people to the patient's room, I pulled her aside and apologized for the lack of a family lounge on our unit. There in the hallway I simply said "Your father is dying."

I just tell people what I think. Of course, I cannot offer a medical diagnosis, but I do not feel comfortable holding back on things about which I feel some certainty.

She didn't want to hear it. "There's nothing wrong with him, he's never been sick in his life, he was very athletic, that's not what the doctor told us," and on and on. You could float a barge on it. And she accentuated her plaints of denial with demand after demand on behalf of her poor dad, who was doing all he could just to draw air without lapsing immediately into a coma. To my ears, his every rapid sour breath said "Vent me."

But as there was "nothing wrong with him" the daughter did not want such matters as artificial ventilation even to be discussed. Ever. Anywhere.

Every obvious and reasonable observation I brought to the daughter's attention regarding her father's plight was met with a ferocity I usually associate with large cats in the wilds protecting their babies from, say, hyenas or something.

As a matter of fact, she demanded that we get him up out of bed. "He wants to get up in a chair and he hates being in bed," she insisted. The tele monitor showed his resting heartrate at 140-something, and I explained that in my humble opinion and in light of the stress already suffered by this patient, perhaps now was not the right time.

"Then get somebody else to do it," she demanded. I looked to her husband, and quietly told him that as a nurse, I could not work like this. The look on his face said "sorry opinionless bastard" to me, and by then the daughter and other family members had assisted the patient to a sitting position at the edge of the bed. A moment later he fell over sideways back onto the pillows.

They were furious with me for assisting the patient to a more comfortable position in his bed. While I left the room they howled at me for my merciless cruel behavior towards their dear father in his moment of need.

As expected, my manager was brought into it, and he was as usual quietly supportive of me.

The next day, actually, it was my manager who cared for the patient, because we had sick calls and I suppose everybody just thought it would be better that way. I remember the family seeming to be a little less histrionic in its demands.

The patient died early that afternoon.

Thanks, Howard

No, not that "Howard." I found this little gem while perusing the comments over at Eschaton:

One huge problem Bush has is that all of the abstract pro-Iraq war arguments--freedom, flypaper, war on terror--are unmeasurable, whereas anti-Iraq war arguments are grounded in concrete facts: lives lost, money spent, terrorists trained in Iraq. You would think our first MBA president would have known that any project needs quantifiable benchmarks. Like the old joke: "Whatcha doin'?" "Nothing." "How will you know when you're done?"
Howard McNear

That's why we here in this portion of the political spectrum are routinely referred to as reality-based. We address concrete reality. Lives. Dollars and cents. Jobs. Numbers. Simple truths. Things that can be counted, and ideas that can be counted upon to work well.

Then, of course, you have all the rest on the Bush end of the debate spectrum: the Intelligent Design is a Theory crowd, the Dominionism fascists, the Light at the End of the Tunnel sect, the Mission Accomplished set-designers, the Save Social Security by Giving it to a Bunch of Rich White Guys proponents, et al ad infinitum. You know, people who have "values." Immeasurable values, that is.

I suppose it is much easier to fool people with talk about abstract values than it would be to fool them with the simple truth.

Cindy Sheehan is not fooled. She can count to one. And that is too much.


This stuff was so bad, that not even Hitler would use it.

In the great carnage of 1916-17 there were approximately 17,700 gas casualties counting the Somme, Chemin des Dames, and Passchendaele alone. These numbers would grow considerably higher due to the large number of deaths after the war that would be directly attributed to gas exposure. Despite this high casualty count for both sides, the use of gas continued to grow. By 1918, one in every four artillery shells fired contained gas of one type or another.

In 1918 a German corporal by the name of Adolf Hitler was temporarily blinded by a British gas attack in Flanders. Having suffered the agonies of gas first hand, his fear of the weapon would prevent him from deploying it as a tactical weapon on the battlefields of the Second World War.

(The link is here.)

But of course Hitler had non-tactical uses for gas during the World War Two period. Damn him.

It was really great how the generals knew that these weapons were really just weapons of terror, creating confusion and death both for the attackers and the defenders, but use continued to grow until the war itself ended. What does that tell you?

They never learn. Well, young Adolph did, because he was in a gas attack, unlike the generals of World War One (or, as "musician" Lawrence Welk once referred to it, World War eye. I was at my grandparents house, it was on TV, and I heard that myself.)

I could get sick from the irony. Humor protects me.

Andre Malraux wrote about the gas attacks, and around here somewhere I've got a copy of "Lazarus" in which he describes an episode so chaotic and horrendous that opposing fighters left their trenches and began saving everybody they could, even enemy soldiers. The leaves melted off the trees. Warriors on all sides had come to realize that at that moment, they were not enemies.

The gas was the enemy, and they conspired as well as they could so save themselves from it, dragging one another, coughing and heaving, away from the killing low clouds.

I suppose they did it without even thinking, just going on some impulse deep in the lizard brain activated by a sudden and perhaps unconscious stimulation that made them stop the fight long enough to try to save one another.

Is that the same impulse you felt when you saw little Ali Abbas on the cover of Newsweek back in the spring of 2003? Somebody, some of us perhaps, saved him, Yet some of us also bombed his arms off.

I have not linked to a photo of that famous magazine cover because in your mind's eye you can probably already see it. It has become and will likely remain as one of this folly's lasting emblems, like the famous girl in the picture from the Vietnam War era.

Even if we "win," we will lose, because to win we will just be making a lot more little Ali Abbas. And they will grow up, and they will not be our friends, because of what we did to them. So we will end up killing them, and a bunch of our own soldiers, too, because our leaders are dumber than you-know-who and they will never learn.

To command is to serve, nothing more and nothing less.
Andre Malraux

What does that tell you?

Friday, August 19, 2005

Sylvia Plath at 2:30 A.M.

Usually there first occurs a mysterious and beautiful introduction, sometimes as brief and soft as a French Baroque unmeasured harpsichord prelude, but sometimes as passionate and driving as Tristan and Isolde. These are actually quite enjoyable, but for the dread of the impending pain, if I am awake to savor it.

Unfortunately, these attacks often come in the darkest night hours. Typically, about 2:30 in the morning. I hate that because then I miss the good part. I don't much notice the aura if I am dozing during it. It becomes interwoven in the loose dream-fabric of my usually fitful attempts at sleep.

Just now I am realizing how the glowing waves of the Encinitas red tides very much resemble the visual light-storms of my auras. The beauty of these is beyond description.

Then comes the discomfort. Often other sufferers employ the term "vise-like" to describe the grip in which the pain squeezes the head; or rather, a good half of it. Throbbing, scintillating, pounding, hammering, the God of Ache arches through the hemisphere with the dull tenacity of an hydraulic lift upon which an auto rises for inspection.

Then all work stops. Other stars in the constellation begin to shine. The bladder calls. For me, a round of explosive sneezes numbering in the teens passes before the wet-sock leprechauns stuff my nose adroitly. At least that stops the nasal runniness. The tour includes a halt for the lower digestive tract, and often an episode of emesis.

Emesis with or without nausea. It depends, like so many things, on nothing. Interesting, that.

I've had hospital patients who get "abdominal migraines" without headache; frequently these are young males. Sorry, those. One was misdiagnosed with porphyria, of all things, for years, becoming addicted to opiates and getting a PortaCath in the process. But that's another story. One of the few times we called the local police to help us with a patient. They all knew him and his mother.

Life before Imitrex: caffeine. With a healthy ibuprofen dose. Not good in the middle of all-precious sleeping time. NSAIDs and vomiting do the esophagus no good, no good at all, and lead to other concerns. I would then be up. and as the migraine leaked out of my head, I could catch up on a little reading or studying.

So as not to disturb the others, headphones are nice, and when the headache fades I am still awake but a little music becomes tolerable and passes the time until drowsiness recurs.

My introduction to Imitrex (sumatriptan succinate,) the first of a subsequent whole family of vasoconstricting triptans, (I think Relpax, or eletriptan, is the latest newcomer,) came after a span of three days of intense sleepless pain. I had missed work, and finally my spouse took me to the local ER at the hospital in which I was then newly employed, in the middle of their night shift. My oral temperature was 94-something degrees from putting ice on my head. Useless, that.

Don, the nurse supervisor who I came to know later (marathoner and demerol thief, another story,) administered a subcutaneous dose of Imitrex, then a brand-spanking-new drug, and within five minutes the leaden fog on my head lifted and I was free at last.

Well not free free. I was uninsured, having just started that job. The ER bill was about $650 which I had payroll-deducted over the next few months, harmlessly.

I was the only patient in that rural ER.

A 3 a.m. code was called on the floor where I worked the day shift.

While lying on an ER gurney, time passes by at the rate of continental drift.

We finished the lovely paperwork and went home.

At that time Imitrex came only in an injectable form, still the best route in my opinion, as then one's probable emesis will not cause one to "waste" a dose (an oral dose, anyways,) away. For a mere $75 you got two doses. I quickly learned that about a half-dose would work for me, and research showed that worked with a good number of other migrainers. Still, it added up over those periods in which the migraines came a few times a week.

Now there are nasal sprays and tablets, and I have insurance so I do not need a $37.50 headache to justify a dose of Imitrex.

Lucky ducky me.

Like an elephant not wishing to confront the mouse in his path, the migraine turns and lumbers away, leaving only the dark quiet peacefulness that slowly succumbs to the dawn.

Monday, August 15, 2005

Lucky to See

It wasn't really all that red, but the water near the shore did sometimes look a little muddy. Mostly clear. During the day we didn't notice anything at all, really. That there was a rather uncommon red tide only became apparent after sunset, when the waves began to eerily flicker and glow.

It was beautiful while we stood in the shallow water where the ocean meets the beach. It was beautiful as we gazed up and down the coast for miles. And it was beautiful from the viewpoints up on the sandy bluffs. We went every night.

As the waves crested, for a few seconds the frothy peaks would flare up with an electric green-blue light. This snuffed out as the wave would smooth itself onto the slope of the shore. There was only a faint crescent of a moon, and as the waves lit up rather brightly this phenomenom was visible all along the beach as far as one could see.

Of course, it was nice during the day, too.

Sunday, August 14, 2005

And She Just Wants to Ask Him Why

Regarding the Camp Casey movement, and yes, Virginia, it is a movement, President Bush has taken time from his all-important vacation to remind us all that he has to get on with his life. Unlike a certain (currently dead) soldier whose mother is presently changing the debate about this senseless war.

Bush needs five weeks of vacation, just to sit around and think up insensitive and utterly stupid things like that to say.

Somebody remind me where I read this, but the thing about Cindy Sheehan is that she, as stated above, is changing the debate.

It's not about weapons of mass destruction, nor Saddam's non-existent ties to bin Laden, nor spreading democracy (for the women of Iraq this is a particularly piquant point,) nor securing a large reserve of fossil fuel, nor preserving America's freedom, nor even about stuffing Halliburton's coffers with loot.


It's about sending our young people off to die and destroying their families.

Aragorn gets it, so why don't some of your local newspaper editorialists get it?

Sunday, August 07, 2005


Beach books:

Bush on the Couch: Inside the Mind of the President by Justin A. Frank, M.D.

Braddock: The Rise of the Cinderella Man by Jim Hague

The Godless Constitution: The Case Against Religious Correctness by Isaac Kramnick and R. Laurence Moore

I usually bring a chess book, so I'll continue working through David Bronstein's coverage of the 1953 Zurich International Chess Tournament. His annotations are golden.

The young one and I, we're taking a break from C.S. Lewis but we will be thoroughly prepared when the anticipated new movie comes out at the end of the year. Instead we're reading-aloud Warriors: Into the Wild, by Erin Hunter, the beginning of a series about the Thunderclan and various other cats. It's a wonderful re-imagination of the local feral and pet cats that inhabit what appears to be an English countryside farm.

I am still moving up the metronome on Fernando Sor's Variations on a Theme From the Magic Flute, which I never played back in my college days, oddly. Searching still for some other fairly large piece to tackle, maybe a Dowland fantasie or a Weiss suite.

No work. No computer. No worries.

Saturday, August 06, 2005

Over the Rainbow

Where do spoken words go after these are sounded out? Do they just disappear, trailing off into nothingness? Or do they continue to resound throughout the boundless sphere, leaving history in their ever-widening wake?

No, I'm not asking this in the spirit of a religious searcher, I just want to know how all the various things come about; how they are made and how then they become un-made. As in, where do things go?

The universe is made of stories, not atoms.
Muriel Rukeyser

How do stories begin and end?

Where, precisely, do things come from?

Where do nurses come from?

Well, nursing schools, of course. But some people come out of these programs pretty much as raw material, not as "nurses" yet. They only develop their full potential after sustained apprenticeship in a clinical setting. However, there are others who leave nursing school like Athena, bursting forth in full armor and regalia.

Recently I worked with a student who was Robert-Redford-knocking-the-lights-out-in-the-movie-The-Natural good. Some people are just born with the ability to thread an IV catheter into a vein so tiny it would qualifiy for cosmological string-theory study.

And then there are "the dumb ones," but these are rather rare, only because nursing programs are such meat-grinders that if a student shows any propensity at all for failing the board exams (and thusly pulling down the success rate of the program, which nursing school deans do not like,) then they get the boot. They go to business school, I suppose, and then on into the lost realms of investment banking, law firms, upper management, or congressional politics.

Needless to say, that does little to allay the nursing shortage.

Over the years I have seen many people who, with a little effort on the part of their instructors and other working nurses, could have been pulled along. But these are exactly the kind of people that get the hatchet before the final stages of training.

I enjoy working with both the bright ones and the dim ones. The dimmer the better, as far as I'm concerned, as they will benefit more from training than somebody who already displays skills. It's fun to see the light spreading on their abilities, as these develop.

They become part of the chain. Every day, a nurse will learn something from a patient, another nurse, a doctor, or a technician. And then sometime in the future, they will apply that bit of crust of knowledge on to another's healing process. It gets passed along in an ever-increasing outward spiral. It goes someplace.

Thursday, August 04, 2005

People Who Need People are the Loneliest People

I do not think that it would be unfair to say that Patrick Haab has a mental health condition that would benefit from treatment. It seems I am not alone in holding this opinion.

Two months after arriving in Kuwait, the records state, Haab was pulled out of the cultural awareness class by his superior and ordered to talk to a chaplain. A few hours later, he became distraught, threatened to commit suicide and got into a scuffle with military officials attempting to take away a hidden knife.

There will be more of our service men and women returning to our shores with problems similar to, and greater than, those displayed by the unfortunate Sgt. Haab. That, after all, is just what war is all about. It's about ruining people.

According to the records, he received counseling for five months and a military official said "he did not think Sgt. Haab was ready to return to duty or become a functioning part of society." Military officials found out that while on "med hold" at Fort Bragg, Haab spent $12,000 on a .50-caliber sniper rifle. They were concerned enough to contact the Surgeon General's Office.

Robert Anglen has the whole story here.

This comes to light after the revelation of President Bush's 2006 budget, which of course includes huge cuts to federally-supported mental health care programs. It is possible that Sgt. Haab may not get sufficient treatment to allay further problems.

I do not think that the unfolding tragedy of his life is yet over. I truly fear for what is yet to come.

I am also wondering why Bush would wish to cut funding for the treatment of people who suffer as Sgt. Haab does. Perhaps Bush really doesn't think that such people even need medical help. So why fund it?

Maybe Bush thinks there's nothing wrong with Sgt. Haab.

Let me also say this: because so many of the homeless and mentally ill are military veterans, any cuts to programs that serve the homeless and mentally ill are budget cuts against veterans themselves.

Again, any cuts to programs that serve the homeless and mentally ill are budget cuts against veterans themselves.

Maybe the Bush Republicans think there's nothing wrong with that. It's really better to give Barbara Streisand a large permanent tax break, no?

Monday, August 01, 2005

Put This on a Yellow Ribbon

Let's see. Say you're a Bush Republican, and you're bored. Nothing to do. Think. What would you do? What would you do?

I know! To satisfy "making the tax cuts permanent," you'd take money away from the troops. AGAIN! Why not? Who's going to try to stop you? John Kerry? Michael Moore? Molly Ivins?

They tried to warn us. They're still trying, and so am I. Lot of good it did the last couple times around, though.

What's it going to be, folks, more hardship for those families who have members serving our country, or a permanent tax break for Ben and J-Lo? If you're a Bush supporter, that's easy. Some military people get shafted out of a few hundred dollar's worth of monthly mortgage money, and the Hollywood celebrities you just love to hate keep enough yearly tax breaks to buy a new Lexus every September until this hell freezes over.

Go ahead. Just try to pin this one on Clinton or the Democrats. Make my day.