Tuesday, August 22, 2006

9... Knight C-6 to B-8

The patient had independently gotten up to a chair. The primary doctor had already blown through and the only order they had left was to advance the patient's diet. For the first time in three weeks the patient could take a regular meal.

Not jello. Not broth. Not weak tea made from cardboard shavings and bits of plastic cartons. Real food.

"Anything happen while I was out pestering old sick people?" I asked the patient.

"One of the doctors came in and said he was going to change that," the patient said, nodding towards the intravenous antibiotic bag hanging from the IV pole.

Being somewhat a wordy person, I felt that some sort of explanation was in order. Doctors have little time for these things. It's something that nurses take upon themselves to do, sometimes. A matter of style.

Explaining medication changes to patients is important to me. I feel that if a patient understands why we do things, these things works better. Kind of a logotherapy thing. If the patient has an understanding of how and why we are putting them through things, then the things work better.


The patient's chart indicates that the infectious diseases consulting specialist, Dr. A., changed the antibiotic from IV Zosyn to oral Augmentin. I really like Dr. A. mostly because he usually wears a kufi and though I am not personally of his persuasion I have a few myself that I sometimes wear on special occasions, such as trips to the opera or other special dress-up events.

When I explained this to the patient they said "Oh no, I can't take Augmentin because it makes me sick."

After sending the order to pharmacy, transcribing it, and securing the medication, I halted. Then I put out a page to Dr. A. and waited for his call-back, then explained that Augmentin makes the patient sick, according to them.

"OK, cancel the Augmentin and give Levaquin 500mg p.o. daily and Flagyl 500mg. p.o. three times a day."

"Thanks, Dr. A., " and I dutifully wrote the order in the chart, faxed it to pharmacy, transcribed it onto the medication administration record, and awaited its fulfillment in the computer-controlled medication dispensing machine on our unit.

I stopped by the patient's room to explain that we had changed the medication to different ones.

"Oh no," they said, "I can't take Flagyl, that makes me sick," they said.

So I again put out a page to Dr. A. and when he called back I gave him the patient's concerns, and he ordered to stop the Flagyl.

"What about the Levaquin?" I asked, and he said just to stop it all and return to the IV Zosyn the patient had been on all along.

So I wrote down the phone order in the patient's chart, and faxed this to Pharmacy, and transcribed it back again into the patient's Medicine Administration Record, chuckling as I explained to nurses and staffers around the station that I'd basically just wasted 20 minutes doing nothing but establishing a patient's intolerance towards certain antibiotics.

Right back where we started. No changes, yet several changes. The pharmacists on the other end of the fax machine must've thought I was a fool. Square one, change, square two, change again, square three, another change, square four, put the knight back on B-8. The Breyer variation of the black side of the Ruy Lopez.

So to speak.

I went back to the patient and explained that now we weren't going to really change anything, and forwarned them that they might also have intolerances to other antibiotics as yet untried, to which they nodded possible agreement.

It's a good thing to know.

In the CD changer:

Edward Elgar Symphony #1 in A-flat, Sir Adrian Boult in a live performance at the BBC Proms recorded at the Royal Albert Hall in 1976.

Kiran Ahluwalia, born in India but raised in Toronto, doing Ghazal song-forms.

"Return To Dark Side of the Moon" tribute album. Tommy Shaw, of all people, sings "Money." I almost don't hate him anymore. Frighteningly good. Edgar Winter on sax.

Ruth Laredo playing the complete Scriabin piano sonatas.

The Best of Taj Mahal.

Saving for an I-Pod and pricey headphones.

Saturday, August 19, 2006

Don't Shoot

I appreciate in this order:

Breathing good air, drinking clean water, eating healthy foods, maintaining comfortable body temperature, my beloved family, language, art and technology. Affordable energy's awfully nice, too.

"Nature is a language- can't you read?" Morrissey and The Smiths

e.e. cummings has been a favorite ever since my junior highschool English teacher Mr. Dreyer sketched out one of cummings' more disjunct works on the blackboard and helped us through the maze, after which the path seemed all too clear.

73 Poems, 26

if seventy were young
and death uncommon
(forgiving not divine,
to err inhuman)
or any thine a mine
to say would be to sing

if broken hearts were whole
and cowards heroes
(the popular the wise,
a weed a tearose)
and every minus plus
--fare ill:fare well--
a frown would be a smile

if sorrowful were gay
(today tomorrow,
doubting believing and
to lend to borrow)
or any foe a friend
--cry nay:cry yea--
november would be may

that you and i'd be quite
-come such perfection-
another i and you,
is a deduction
which(be it false or true)
disposes me to shoot
dogooding folk on sight

It's well-established that Bush, like Reagan and his father before him, isn't much of a reader. Brother Neil is dyslexic, as is Bush Sr. Our president is not contrite about this condition. He maintains arrogance and cold disinterest instead.

That's why we have a mountain of government debt and in the decades to come even our grandchildren will still be digging out from under it. It's why the wars are going so poorly. It's why the 9/11 attacks, though predicted in a presidential daily briefing, proceeded unmet. It's why the economy has only been good to a very small handful of already obscenely rich people.

Everything is a language, and Bush can't read.

Tuesday, August 15, 2006


I have to net this lovely little butterfly before the winds of truth blow it off to internet oblivion:

"Pederson's plan, as published in the Aug. 7 Republic, says nothing about increasing our supply of oil, focusing only on alternative energy. Unfortunately for Pederson, a Democrat running for the Senate, you can't just force people to stop using oil. It ignores practicality and common sense.

While alternative fuel is an important component of any energy plan, an energy plan without mentioning oil is not much of a plan at all. Kyl's approach, on the other hand, is much more realistic: invest in alternative energy in tandem with increasing oil supplies through domestic oil exploration."

Domestic oil production peaked in 1970. Just as predicted by geophysicist M. King Hubbert back in 1956.

"The United States passed its own oil peak -- about 11 million barrels a day -- in 1970, and since then production has dropped steadily. In 2004 it ran just above 5 million barrels a day (we get a tad more from natural-gas condensates). Yet we consume roughly 20 million barrels a day now. That means we have to import about two-thirds of our oil, and the ratio will continue to worsen." (James Howard Kunstler)

Spot the right-wing propaganda code-words: "increasing oil supplies through domestic oil exploration." I don't know why he doesn't come out and say that he's simply referring to drilling in the Arctic National Wildlife Preserve. It's so obvious. And isn't drilling the preserve a Republican family value?

There just ain't that much oil up there, but our desperation is such that many people insist we have no choice but to pump those preserves. Others say why bother?

"James Kendell, one of the authors of the study, [from the EIA] said the refuge would add to domestic production, but “when you’re talking of a world oil market of over 75 million barrels a day, adding 900,000 barrels by 2025 is a drop in the bucket.”

I could go on, as you well know.

The main concern is that the Kyl plan is no plan at all. Maybe if we used every drop of Alaskan oil; no, that's not enough, make that every drop of all our domestic oil, then maybe we'd be able to tool up for alternative and conservation-based energy strategies.


"Realistic" indeed. Any energy plan that includes "increasing oil supplies through domestic exploration" is no plan at all, but a short-lived fantasy.

The writer is also quite wrong in his assessment that " you can't just force people to stop using oil. It ignores practicality and common sense." Of course you can, when you run out of it, or when it simply becomes significantly more expensive. Nonetheless people will persist in dreaming that the present way of easy motoring will go on and on.

The writer of that letter is a dreamer. Peak oil, however, makes insomniacs of some of us others.

"I said "Far out, - What a day, a year, a laugh it is!"
You know, - Well you know you had it comin' to you,
Now there's not a lot I can do..."

Friday, August 11, 2006

Nice Shoes

There are many technologically backwards countries on this planet, countries with poor leadership to boot. Literally. Those countries with oil reserves might actually, at least for a little while more, have something worth defending militarily, but other countries may just be run by politicians that are belligerent towards "American interests."

There are about 18-and-a-half million Syrians and I personally do not know any of them. Neither does this guy, I'll bet. That much we have in common. Not a lot, yet so much, ironically. Sigh.

He's worried that "they," who he lumps in together with 67 million Iranians and 24 million North Koreans, will glass him in some kind of religious end-times battle which he specifically refers to as "Armageddon."

"At the rate we are going, we will pussyfoot around until Iran, North Korea and Syria decide they can win an Armageddon. They want nuclear weapons, and I think we should give them some: airmail, special delivery. Real shock and awe."

So in a nutshell, he advocates the nuclear genocide of about 100 million people.

This guy has a lot of enemies. Well, that's one possibility. Another consideration would be that he's insanely paranoid.

Here's another juicy little thing he has to offer:

(Snip) "Unfortunately, a large liberal contingent says we must fight our enemies in such a way that no one can win."

The Arizona Republic editorial board deems this worthy of printing, perhaps as a warning to his neighbors to keep their children inside when he's out and about.

A phat 62% of us, that is to say, fellow American citizens, don't like the way this "war" is going, and that's down from 66%. Large liberal contingent? Feh. That 62% includes the middle no matter how you slice it.

But our goofy media pundits, ever diligent in their fluffing of our mad king, have apparently been successful in painting the vast majority of the political center as "liberal extremists."

The middle majority is the leftist extreme. The far-right extreme is the the bipartisan middle; you know, like Lieberman on Fox News. Yes, it's nuts, but that's what it's come to.

This is what you do, as a way of demonstrating the appropriateness of this media characterization of the politics of typical American voters:

Before you leave home to go off to wherever today, pull your pants down over your head, tie your belt around your ankles, cover your groin and butt-crack (forget the undies) with your Keds and well, just skip the shirt. It'll keep the story simple.

Et Voila! Your costume now parallels the way the media wishes to present your politics. Good luck at work. Then again, your boss probably dresses the same way. Like the letter writer quoted above.

Sunday, August 06, 2006

Give a Foot They Take a Yard

The hospitalist and the surgeon were confronting the patient. He had blatently lied to them and they were unhappy about this. They were interested in transferring him to the Veterans Administration hospital. He wasn't going for that, oddly.

Initially he'd told them he'd already been to the VA and "they told him to just go home and let his black toe fall off." Instead he presented to our emergency department in pain and the doctor there admitted him. So it went.

Here he went through a period of violent delerium tremens. It would have been nice if he'd informed us of his alcoholism but he did not deem that sufficiently important. Nor did he seem to think that his cocaine and methamphetamine problems were worth admitting to, for that was part of his plan all along. His diabetes, which he did claim, was obvious enough, due to his sky-high blood sugar levels and the necrotic toe.

He was well-known to the VA, as was discovered when the fax machine began to spit out his records from there. He had signed a consent allowing us to pursue his charts from that hospital.


How ironic.

That's how our hospitalist and surgeon came to know that the VA had him scheduled for surgery to remove the ischemic toe. But they would not go heavy on the Dilaudid there, because he was a junkie. He came to us and lied to get a few days of narcotics.

Now he will lose the whole foot. The days he spent lying to us were critical ones. Necrosis progresses quickly sometimes despite aggressive use of antibiotics, and unfortunately he had wasted time. He should have gone to the scheduled surgery.

Instead of that, he chose to lay about and soak up our Dilaudid until his lies unravalled and the story became clear, and rather than accept a transfer to the VA hospital, where he would have to wait for surgery again but without access to the lovely narcotics he so desired, he left. If he'd been truthful it would not have turned out this way.

All this will cost him a foot. At least.

Our tax dollars will buy him a prosthetic one shortly.

Expect blowback.