Tuesday, January 30, 2007

Wallace Stevens Day

There were call-ins over the weekend so I picked up a double-time shift. Woopity-doo. Beats coal mining. At least so I hear.

Some nurses work their 12-hour shifts "all in a row." Personally I feel that this makes me increasingly stupid as the days go on, so that by the end of such a string my faculties are wasted somewhat in the manner of that state of mind obtained by many college freshmen. And women. I prefer instead to work no more than two days at a time. It's tiring enough.

I guess I just don't do stupid well.

And on my days off I practice and cook things that are fun to make and eat.

But not today.

While I was making mucho dinero Sunday the Young One Who Has Memorized The Score Of Salome By Richard Strauss and who also persuaded me to purchase for them their very own four-inch chef's knife when they were six years old ended up in the Emergency Department with nothing.

Phone call from spouse:

Above-mentioned child has sore throat, headache, and can't move their neck without hurting. Of course, as a nurse, I am sort of between ownership of home thermometers. "Are they hot?" is answered by "Whaa?"

Residents on the ward suggested lumbar puncture. "That's what I'd want for my kid," said one of my faves. (I wish I could name here here. She is the best resident ever. And she also likes things like this." So we have this understanding.

I bought a stuffed kitty for The Young One Who Thinks She's Leaving Home Is The Saddest Song Ever and in an hour or two they were discharged without incident. No tap or even bloodwork. Trauma-free ED visit. Go home. Come back when you're really sick. And give us a few hundred bucks just to call it even.

Monday was typical. Busy as all get-out. But no get-out. All my assigned folks stayed.

So today is poetry day.

In college I had a radio show. Unformatted, but mostly I played classical and far-out jazz. That's where my brain is.

I'd read stuff occasionally between album cuts. We had those way back when.

Like this:

"Among twenty snowy mountains,
The only moving thing
Was the eye of the blackbird.

I was of three minds,
Like a tree
In which there are three blackbirds.

The blackbird whirled in the autumn winds.
It was a small part of the pantomime.

A man and a woman
Are one.
A man and a woman and a blackbird
Are one.

I do not know which to prefer,
The beauty of inflections
Or the beauty of innuendoes,
The blackbird whistling
Or just after.

Icicles filled the long window
With barbaric glass.
The shadow of the blackbird
Crossed it, to and fro.
The mood
Traced in the shadow
An indecipherable cause.

O thin men of Haddam,
Why do you imagine golden birds?
Do you not see how the blackbird
Walks around the feet
Of the women about you?

I know noble accents
And lucid, inescapable rhythms;
But I know, too,
That the blackbird is involved
In what I know.

When the blackbird flew out of sight,
It marked the edge
Of one of many circles.

At the sight of blackbirds
Flying in a green light,
Even the bawds of euphony
Would cry out sharply.

He rode over Connecticut
In a glass coach.
Once, a fear pierced him,
In that he mistook
The shadow of his equipage
For blackbirds.

The river is moving.
The blackbird must be flying.

It was evening all afternoon.
It was snowing
And it was going to snow.
The blackbird sat
In the cedar-limbs."

Man, that's cooler than Miles and Coltrane.

Time for chamomille tea. And scales. And slur studies.

Friday, January 26, 2007

Shorter Than Haiku

Two-by-four, face, jaw surgery.

Where did that tooth come from?

Patient self-decannulates tracheostomy, maintains saturations.

Hat tip to Disappearing John.

Even the average workdays are getting a bit off-center. There was a code down the hall. I was at the front desk when some of the specialty nurses were wheeling a patient back to their room after a procedure, and I heard one of them say "everybody's running."

I thought they were just joking that we had spotted them coming and were all running away from helping them settle the patient back in, but it was really that they had seen one of the hospitalists and some nurses rushing to a room. Then I heard somebody say "they're going to call it," so I started running too.

When I had seen which room they were going to, I knew it was going to be interesting because I'd seen that the patient was up in the cadillac chair. That's where they were when compressions were started. In the few minutes it took to get them back into bed another thirty or so people showed up. The usual routine. Compressions, shocks,intubation, drugs. The ventricular tachycardia went away, blood pressure last at 170/100 and pulse strong. Out the door and off to intensive care.

The monitor techs caught it originally. The patient had been seen by their doctor just minutes before coding. Then V-tach. We were guessing that since they had a chest tube maybe they'd thrown off a clot.

The patient with the jaw surgery was doing very well. The surgical technique used to repair it was neat and elegant, with an inch-long incision horizontal below the eye, and another incision within the oral cavity. Minimally invasive. Really beautiful work. They went home after a run of IV magnesium.

On a routine walkabout I noticed that one of my assigned patients had a tooth sitting on their bedside stand.

"Where did that come from?" I asked, and they said "I don't know. My mouth, I guess." They were going for surgery with general anaesthesia the next day so I made sure they didn't have other teeth that might bust loose during intubation.

On another walkabout I popped in on a slightly confused oldster only to see their trach cannula dangling uselessly out of its socket. It had been capped for days anyways and was probably due to be removed, but usually we do this for the patient ourselves. They had also pulled out their saline lock but there was very little blood from that.

That patient had pitched forward out of the caddy chair the day before when assigned to someone other than myself. They had a family member that liked to call us up to micromanage, over the phone, all the patient's care. Turning, changing, boots on, boots off, that kind of thing. I practiced a little passive-aggressive codependency by calling that person at their job just about every hour all day long to update them on things.

You wouldn't know it from reading this blog but I am actually very professional and personable while on the telephone, and the family member thanked me profusely for the calls. They even felt secure enough to stay home with their young children rather than visit the hospital with a list of demands and complaints.

That's nice.

Sunday, January 21, 2007

Cowering, Not Cowering

The performance of our woeful Secretary of State Condoleeza Rice before the Senate Foreign Relations Commitee must be seen to be believed. It's just as astonishing as the Attorney General Alberto Gonzales' denial, abandonment, and hostility towards the centuries-old writ of habeas corpus. These people are positively medieval.

Rice said that it was "highly unlikely that the military would tell the president we expect X number of casualties" in her squirming response to California Senator Barbara Boxer.


"Pentagon planners this week warned President George W. Bush that his "troop surge" plan could double U.S. casualties in Iraq in the coming year and result in 10,000 or more American deaths by the end of 2008."

Easily found here. Amazing. She's either lying or unprepared, and both these are simply unacceptable. Though I suppose Senator Boxer could have had an aide google it up before she posed the issue before Rice. Maybe she had, but in the video it didn't seem like Senator Boxer was setting up Rice with that type of rhetorical trick. She just put Rice on the spot.

It's not a partisan thing anymore. The recent polls ALL show a two-against-one disapproval of Bush's handling of his war. The president is no longer in line with the people of his country. He's an outlier. (Pun intended.)

The Newsweek poll shows that only 24% approve of Bush's handling of the situation he created in Iraq. I would wager that that's the same group of people who also in recent polls said that Jesus will return in 2007. Is there an office betting pool for that?

Aside: Back in the day there were many acolytes of Moe Loogham. Perhaps many persist. There were and maybe still are different factions in respect to Moe: the "Moe is coming" crowd, the skeptical "Moe is not coming" group. I myself was of the opinion that he was already here but wouldn't go away.

Disclaimer: My spouse was a random participant in the Newsweek Poll conducted by Princeton Survey Research Associates International January 17-18, 2007. They were very happy to have been polled and called me at work to tell me about this.

Saturday, January 20, 2007


They came in complaining of hip pain after suffering a ground-level fall at their place of work a couple weeks ago. Back pain was also increasing. The patient was in their late-forties and had no other health history. So naturally, they were assigned to a telemetry bed for heart monitoring.

Well, they were a little anemic, too, with a hemoglobin in the 7's. A couple units of packed red blood cells fixed that.

Real problems began when the CAT scan results came up.

At The Great Muffin Factory Institute, all radiology films are digitalized, so these and written reports can be viewed anytime on any unit via a computer system. The scans for this patient revealed vertebral compression fractures and lesions, rib fractures and lesions, cracks and lesions also in the skull, pelvis, and femurs. There was a 4-centimeter opacity at their L4-L5 area and that probably accounted for the shooting pains down their leg.

I'm not radiologically very keen but even I could see that things were a real mess and the word-balloons over the doctor's heads were all flashing "mets" to me. (The link has an image of hip fracture secondary to bone metastasis from renal cell carcinoma, coincidentally.)

The residents told me that they didn't want the patient up walking around, because their lumbar disks may be invaded by tumor, and the vertebral bone was chalky and very weak. A fall, or even a spontaneous rupture could leave the patient paralysed. But the patient didn't want to hear that.

"I'm not like you," is what they told the night-shift nurse. "I believe in Jesus and there's nothing wrong with me. I feel fine."

Initially they'd refused the rib bone biopsy and MRI. Eventually they relented and the biopsy was done. We all knew what the results were going to say. But not the patient and the family.

After reviewing the MRI checklist and obtaining the patient's written consent they said just as they were at the machine that they thought they might be allergic to contrast dye. Then they said they weren't. Then they said they didn't know. They had never had an MRI before. But they heard the contrast made people get rashy. The techs sent her back. The patient just didn't know what they were thinking.

The following day the residents and radiologists convened. There was the little matter of a slightly high creatinine level; because, as it turns out, the CAT scan showed kidney lesions too so it was concluded that the cancer was originally renal cell. They really needed that MRI though, because if the mass on their L4-L5 was what they thought it was then the patient would need neurosurgery immediately.

The patient was standing in the bathroom grooming. I advised them of the risks, and they said, "there's nothing wrong with me. I have Jesus," and they walked back to bed, so tired that they were unable to get their legs up onto the bed without my help.

A few weeks ago we had an elderly woman who was lingering near death but her son was in deep denial about this. "I'm a christian and I believe my mother will get better," he said. She was eighty pounds of skin and bones, unable to eat, unable to stand, and crippled additionally by heart failure and pneumonia.

"My father was sick and he got better," he said. I asked him once where his father was, and without irony he said that he'd died. The doctors got tired of arguing with the guy and there was nothing left to be done in an acute setting anyways, so they wrote orders to transfer her to a skilled nursing facility. She died in the night before the transfer.

It's always fundamental religion that accompanies such denial about a poor prognosis.

I've never had a patient or family proclaim that "they were atheists and they wanted everything done;" indeed, the very few patients I've had over the decades who admit atheism have always, to a person, very graciously accepted news that pertained to their imminent mortality. In my experience, they seem to move through the stages of grief as naturally as they moved through life itself. Easily, anyways.

You'd think that people with a fierce belief in heaven would be looking forward to going there.

Instead they fight. Like hell, I should add.

Instead of quietly passing away at home sufficiently medicated and surrounded by family they die alone in the middle of the night, often in pain because family members insist morphine might make them die quicker.

And when that death comes it hits the family hard, like a meteor. They cry and tremble, barely able to support one another. Nobody says "they're at peace now." Nobody smiles. They just hurt. All the pain smashes into them all at once because they have refused to acknowledge the inevitable grief.

Maybe it's best just to grieve a little every day.

Monday, January 15, 2007


When I was in high school one of my English teachers was a real Blake fan. He liked to perch on his desk with his feet up on the waste can. And he always walked to and from the school. He also took many of us on some wonderful adventures as director of the Canoe Club.

The Clod and the Pebble:

"Love seeketh not itself to please,
Nor for itself hath any care,
But for another gives its ease,
And builds a heaven in hell's despair."

So sung a little Clod of Clay,
Trodden with the cattle's feet,
But a Pebble of the brook
Warbled out these metres meet:

"Love seeketh only Self to please,
To bind another to its delight,
Joys in another's loss of ease,
And builds a hell in heaven's despite."

An electronic representation of the original can be seen at the wonderful William Blake Archive, which is always worth a visit.

Am I wrong to interpret this lovely little poem through the human cognition discoveries made by George Lakoff and the Rockridge Institute? It seems to fit. The malleable clod, quite co-dependent and self-effacing, would seem to have grown up on the receiving end in a "strict-father" household, while the hard pebble, though with life passing it by in the waters of the brook, would seem to be the strict one itself.

Perhaps similarly the local Phoenix Union High School issue, with their Superintendent Raj Chopra, can also be viewed from this stance.

"The Classroom Teachers Association and the Arizona Education Association believe the highest degree of academic success is achieved and sustained through collaboration. CTA stands ready to work with Superintendent Chopra and his administration, the new board and the community to foster enduring student achievement within a new culture of respect, professionalism, and cooperation. We call on all within the district to demonstrate that same commitment. Districts can achieve long-term excellence because of their commitment to these values, not at their expense."

The CTA simply calls for collaboration and dialogue, as would those who come from a "nurturant-parents" upbringing, while it seems that the issue derives from Superintendent Chopra having sought to exclude them from some decision-making which he preferred to undertake by his own authority, as a "strict father."

I have no dog in this fight. I just read what I read. But it seems to me that any case to be made for inclusion of teachers in decisions regarding their own work would be the way I'd want to go.

Nurses face the same thing when management doesn't fully consider things from their vantage point at the patient bedside. Jo at Head Nurse calls this "manglement" as opposed to "management." That's a word that should be a meme.

Sunday, January 14, 2007

The Way Cold Weather Affects Certain Things and the Scottsdale Loop 101

Is it possible? I hardly think that I could be one of the first locals to point out the obvious connection between this, regarding the Scottsdale 101 loop and speed cameras:

"Scottsdale's Loop 101 speed enforcement cameras did, in fact, slow down drivers."


"And the evidence continues to mount that if the photo enforcement were made permanent, Arizona drivers could benefit by saving millions in medical and insurance costs, not counting the lives that would be spared."

Compared to the Speed Control Bikini Bandits. (Not work safe.)

It's just got to work better here in Arizona than it works in Denmark. Our weather is more condusive, being warmer and therefore easier on the women outside along the highway. Or am I wrong?!

Wednesday, January 10, 2007

Upside-Down Zarathustra

What is the sense in this?

"In the process, the superintendent threw out entire sections of a 37-year-old, 137-page agreement between the union and the district. The much-streamlined agreement now amounts to just 60 pages and, to make a long story short, the union wants its 77 pages worth of power back.

What places the union's power-grab into a fishbowl is the remarkable change that has occurred in the Phoenix Union High School District since Chopra's arrival. In less than five years, Chopra has wrought some astonishing improvements in student performance."

So the superintendent "threw out entire sections of a 37-year-old, 137-page agreement," yet in the next breath this is described as "the union's power-grab."


Seems like it's Chopra who's grabbing the power, and the union just wants their say. After all, they do the actual work of educating.

The article goes on to genuflect before the amazing acheivements that Phoenix Union High School superintendent Raj Chopra has single-handedly made, despite the subversive attempts of the very classroom teachers who maintain the forefront of student education, contrary to the concerns of the teacher's union.

Unions are bad. Whenever people who actually do the work get together to participate in decisions that affect directly their area of expertise, they must be condemned. After all you do not want actual plumbers making decisions about the function of your toilet. You want bureaucrats to design your flushing system, no?

See what I mean?

No, I do not know the whole story here. My child does not attend these schools (they attend an adjacent system that is more highly appreciated by local real-estate people, homeowners, and renters.) But I sincerely doubt that draconian public efforts by just one person, who is not himself part of any classroom, are responsible for the acheivements of the Phoenix Union High School district.

The teachers in the classrooms with the students deserve ALL the credit. I believe they themselves improved their performance, if that is indeed the case, despite the superintendent. I applaud his decision to make lesson-plans applicable only after his approval. At least he cares that much. But how many successful lesson-plans has he himself written?

That's not his job, you say? I would agree.

Let the teachers do lesson plans without his interference, for they are the professionals best-educated to do just that. Instead Chopra should be down at the Arizona Legislature right now demanding about four times the money they allow him to work with, so he could hire teachers he really wanted and initiate programs that would take our students beyond the dismally low national ratings we now claim.

I do not think that's why he was given his present job. Truly, I believe he was given this position so he could herald the students of Arizona into the third-worldization of this state, as well as the middle-class of the United States in general.

Construction workers, taxi drivers, produce-managers, and the rest of the backbone of the Arizona economy need just to get out of high school as soon as possible, with as little education as is required to allow them to resist their lifelong economic exploitation at the hands of their elites, who themselves need little education to oversee their machines of greed.

Thus spoke Chopra.

Sunday, January 07, 2007

Why Rush Limbaugh Really Is a Nazi Creep

When I'm in the combustion-engine family transportation device (which is rated 34 in the city) I sometimes find myself listening to A.M. radio, and we do after all have a flagship liberal talk station here in The Valley of Free Solar Energy Over Three-Hundred Days a Year Which We Have Yet to Fully Appreciate With Our Advanced Technology.

When they go to a commercial break I push different buttons and sometimes other voices, demonous and horrifying, emanating like loose neutrinos and just as piercing, come through.

As providence would have it, at just the moment I went to Rush a liberal caller had made it past the screeners. At first he politely expressed objection to Rush's term "enviromentalist whackos" when discussing people who advocate for clean air and water and such. The caller suggested that Rush might develop a better understanding of the beauty of nature if he'd go out and hike the forests and mountains, and that maybe Rush would then use less divisive terms.

As if. The image of Rush in a Boy Scout outfit trudging the mountain trails made me throw up in my mouth a little bit.

Rush defended his rudeness with more by claiming that we was merely "describing the truth" or some such obvious childish evasion. This was after he'd said that he had a greater appreciation for the enviroment and "creation" (tossing a sop) than the caller, who he had never personally met.

Then the caller said that they were not going to get anywhere on the enviroment and mentioned the Iraq war. Very few people support the McCain Doctrine (the caller did not use my terminology) for sending more troops into the grinder, the caller noted. Rush then told the caller that he "just hated America and wanted us to lose," and the caller said that was an unfair characterization and Rush had only spoken to him for a few minutes.

Then came the good part. Rush proclaimed that things were going well in Iraq and that more people were being killed in a lot of large cities here in America.

He meant, I am sure, that violent urban death rates here in The Land of The Formerly More-Or-Less Free outstrip the handfuls of American troops that die pulverized each day in Iraq.

Rush completely avoids any concern at all for the tens and most likely hundreds of thousands of Iraqi civilians, women, children, and the elderly, who have been lost and crippled by the violence. He doesn't acknowledge their humanity. So these deaths do not concern him. He does not see these people as human, no more than Hitler and his ilk saw early twentieth-century Jewish people as fellow humans.

It's as if Rush is deliberately evading the simple scientific fact that all of us, each and every person, shares the genome. That probably accounts for some of his spectacular racist slip-up comments.

Saturday, January 06, 2007

KSFO/Hate Speech/Spocko/Corporate Lawyers

You are listening to the radio and you hear inciteful hate speech, insinuating that for example a prominent politician has a bull's eye painted on her, or that millions of Indonesians be killed solely for being of Muslim faith.

Let's say you decide to notify some of the companies that choose to buy advertising time on this radio station... you tell them some of the things you've heard and as proof you send sound-files so they can hear it for themselves.

Just suppose that some of those companies have actual mission statements that forbid things like racist hate speech, and one or two or more of those companies pull their advertising from that radio station.

Then you get a cease-and-desist letter from the radio station's corporate lawyers.

This is the story of Spocko.

This is just my own little way of proclaiming "Hey, what is it with all those Jews in the boxcars?!"

Just saying.

Isn't It Obvious

Some time ago NTodd put up the numbers regarding civil unions in Vermont on his blog Dohiyi Mir. The ratio of divorces to marriages there for heterosexual couples have been rattling along at over 40%, while the number of civil union dissolutions during the five years these have been available is quite scant.

For example, in the year 2003 there were 5,988 heterosexual marriages and 2,495 divorces, while there were 1,397 civil unions and a mere 14 dissolutions of these.

NTodd sardonically notes this as evidence that gay civil unions have "destroyed the institution of marriage in Vermont."

Hey, the numbers don't lie!

I have probably mentioned before, here and elsewhere, that we have been through his Intersection several times. We'd take a ferry over to the Vermont side and explore the country roads. Sometimes we took in a few events at the jazz festival in Burlington or went to something at the Flynn.

It's an interesting little corner of the world.

Tuesday, January 02, 2007

But Slowly

There is a small bulletin board on the hallway wall between rooms 29 and 30. Usually it was quite ignored, and for many months after I began work there it remained blank. Then one day I decided to write upon it:

"Oh snail,
Climb Mout Fuji
But slowly, slowly."


I got it from Franny and Zoey.

After a while that got erased and some Hallmark Cards kind of sentimental phrases went up. No big deal.

Lately it's become a proclamation board for New Year's Resolutions. Some want new cars. Some want new career options. Some want to just win the lottery.

I wrote that I wanted to take a few new cooking classes. There's one in a couple weeks for kids and parents on pizza. That's so cool. I hope I can persuade The Young Strauss Critic to go along with me, as it's a class geared towards the young. That would be nice.

World peace would be nice, too, but first we have to change a few things here.