Fine Night

"Jack's on call for the night," said Liz as we did the narcotic count, "which must be a real pain in the neck for him because that means no beer for that boy," and we chuckled. "But if anything happens it won't take him long to get here, and same goes for Jost."

He was the respiratory therapist and he also was not actually on the premises. Just available if needed. That's how it was there, if you can imagine that.

The only patient in our little ICU was Debbie, and she was very well-known to me both from this stay and previous visits. I'd first met her years before when she'd had a Nissen fundoplasty. They wheeled her in with respiratory distress weeks ago and this time she became ventilator-dependent.

Liz added that the ER was almost empty and the floor telemetry beds, which we monitored from the ICU, had a few openings as I could see from the blank spaces on the tele screens.

"See you in the morning," said Liz, and I went in to say hi to Debbie. She smiled when she saw me, and I chatted along as usual about news and weather as I did tracheostomy care, checked the vent, and turned her. That was my routine every hour or so throughout the night.

In between I read, puttered around the unit, snacked, and listened to music:

October Project
The Love That Whirls by Bill Nelson
Alice's Restaurant

Plus some Beethoven quartets and some Cecilia Bartoli.



It was a long night. Nothing happened.

"There was all kinds of mean, nasty, ugly-lookin' people on the bench there . . . there was mother-rapers . . . father-stabbers . . . father-rapers! FATHER-RAPERS sittin' right there on the bench next to me! And they was mean and nasty and ugly and horrible and crime fightin' guys were sittin' there on the bench, and the meanest, ugliest, nastiest one . . . the meanest father-raper of them all . . . was comin' over to me, and he was mean and ugly and nasty and horrible and all kinds of things, and he sat down next to me. He said, "Kid, what'd you get?"

I said, "I didn't get nothin'. I had to pay fifty dollars and pick up the garbage."

He said, "What were you arrested for, kid?" and I said, "Litterin'"' . . . . And they all moved away from me on the bench there, with the hairy eyeball and all kinds of mean, nasty things, till I said, "And creatin' a nuisance . . . " And they all came back, shook my hand, and we had a great time on the bench talkin' about crime, mother-stabbin', father-rapin', . . . all kinds of groovy things that we was talkin' about on the bench, and everything was fine."

Let Us Forever Honor Pat Tillman

THESE ARE THE CLOUDS

THESE are the clouds about the fallen sun,
The majesty that shuts his burning eye:
The weak lay hand on what the strong has done,
Till that be tumbled that was lifted high
And discord follow upon unison,
And all things at one common level lie.
And therefore, friend, if your great race were run
And these things came, so much the more thereby
Have you made greatness your companion,
Although it be for children that you sigh:
These are the clouds about the fallen sun,
The majesty that shuts his burning eye.


"These Are the Clouds" is reprinted from The Green Helmet and Other Poems. W.B. Yeats. Dundrum: Cuala Press, 1910.






“I can see it like a movie screen,” Baer said. “We were outside of (a city in southern Iraq) watching as bombs were dropping on the town. We were at an old air base, me, Kevin and Pat, we weren’t in the fight right then. We were talking. And Pat said, ‘You know, this war is so f— illegal.’ And we all said, ‘Yeah.’ That’s who he was. He totally was against Bush.”

Sakura

The most recent CT scan showed that another pancreatic tumor had developed and the blood vessel involvement made surgical resection just about impossible. Sorta like this:



Only bigger and a lot worse.

It had also spread so that fluid was filling up around his lungs. The chest tube that was inserted drained three liters within a few hours; more was coming, from his peritoneum. At least it was clear. There was such a lot of it, though.

For some reason his family members wanted a PET scan done so that they could "see" the new tumor. In color. Why, I don't know. Sandy said they just "wanted to run up the bill before he died" so their guilt at letting him go would be pacified by rather large medical bills.

Sure. That makes a lot of sense.

Actually, it does. Really. For some families that is how their grief functions; how it plays out. They might not feel the pain of losing their beloved until they get the bill. Then it all comes home like an emotional cruise missile aimed right at the heart.

Quarks

Powerful voices.

Big dogs.

Harsh landscapes.

Difficult notations.

Athletic demands.

More than other people, what is it that we fear?

Skylights

Not a Ham Sandwich

At my three o'clock lunch break I read this, linked here:

"NEW ORLEANS - A grand jury refused on Tuesday to indict a doctor accused of murdering four seriously ill hospital patients with drug injections during the desperate aftermath of Hurricane Katrina, closing the books on the only mercy-killing case to emerge from the storm."

Let's not get crazy here and conclude from this incident that, if you are a healthcare worker who defers evacuation to instead stay behind in a disaster to somehow carry on caring for the sickest of the sick, you will not be sued. Or in this case, subject to possible criminal prosecution.

In a similar situation what would you; yeah, you, the lawyer in the back row who fled the city the moment you heard a storm was coming, what would you have done?

"Pou and two nurses were arrested last summer after Attorney General Charles Foti concluded they gave "lethal cocktails" to four patients at the flooded-out, sweltering Memorial Medical Center after the August 2005 storm."

Me? I would have done my best. As I assume Doctor Anna Pou and those nurses did.

I'm too tired to research this. I've come off a thirteen-hour day. Endometriosis, a bladder stone as big as your fist, an obstructed ileostomy, and other joyful noises sang praises to my long workday. But I have to ask, when Dr. Pou was stuck in her hospital with those patients and nurses, where exactly was Attorney General Charles Foti?

In New Orleans, I hope. Otherwise he's just coming off like a total ass.

"Foti said Tuesday that the grand jury had erred.

He released reports from four medical experts who determined the deaths were homicides."

Four medical experts. Were they also in New Orleans in the aftermath of hurricane Katrina, abandoned by all but a handful of coworkers, struggling together to serve as only they knew how?

I hope so. Otherwise they would appear to be craven meddlers, professional assassins, people who'd testify to anything for a nickel.

Before and After

There was occasional yelling and screaming coming from one of the patient rooms near the first station. Whenever I strolled down to take a look-see things settled before I got there. It was Dani's post-op patient. I asked her if she needed any help with anything and she said "No. They just don't want to pay."

One of the hospital insurance-coverage specialists entered the room and a moment later the cursing and raised voices started up again. The rest of us went back to doing whatever...

I was getting a bite to eat when Dani came into the lounge to do the same. She explained that the woman just had a mitral valve replacement, but she was not a citizen and her family, which owned several restaurants, strip malls, and other commercial properties, did not carry health insurance.

They had assured the cardiac surgeons that they would pay cash for the procedure and it sure seemed as if this was not unaffordable for them, so she got her new valve.



Whenever she was approached by case management, administration, or even the surgeon, the patient would suddenly develop crushing chest pain, the family would have fits, and all hell broke loose. Dani said she just kept her head down and avoided the room as much as possible. But post-ops do need a little attention once in a while.

"So how's your bunch?" Dani asked me as I finished off an apple.

"OK," I said, "But I've got a patient with a tumor bursting out of her breast."

This woman had come in for a complaint of chest pain. She had infarcted, with a Troponin level several decimal points above normal, so she got stented. Along the way somebody took notice of a two-inch-diameter indurated hard brown raw sore on her breast.

It had been there for months but she was uninsured; a waitress when she was healthy enough to work. So she ignored it.

Thankfully her bone scan was negative.

"That's good," said Dani.

She had a cough though. That cough.

Lunch over.

French Defense Winawer Variation Urban Traffic Metaphor

My opponent was rated about 200 points above me. I played P-K4 and they responded with P-K3. I hate the French Defense.



They went on to remove my QB-3 knight with their bishop, then their queen took a pawn from the same square. Oh well. It was doubled anyways. Things got worse. They snatched my rook with their queen.

I calmly castled, knowing that even after they snagged another pawn, my QR-2 square was not a good place for their queen. And neither of their rooks nor knights had even moved yet. On the other hand, I was down a rook and two pawns only ten moves into the game.

I harrassed the queen and pinned what few pieces they did manage to get out on the board. Their kingside knight went to R-3 and stayed there for the whole game, useless.

Eventually I won the queen by throwing my other rook into its maw, and I anchored a knight on Q-6 which checked his king and kept it in the middle of the board. I scooped up their minor pieces and they resigned a move away from checkmate.


Nice freeway but where are all the cars and trucks?

Nowhere in this article about a plan to relieve New York City traffic congestion is "peak oil" even mentioned, let alone fully considered.

"Congestion pricing" means charging drivers a toll to use roads at times and places where demand exceeds capacity. It also has been imposed on congested downtown streets in Singapore, as well as in London and Stockholm, in recent years. In London and Singapore, you must pay a toll (electronically) to enter the central business district on weekdays. Congestion pricing can also be used on specialized toll lanes on expressways, as in the half-dozen high-occupancy-toll lane projects in various U.S. cities.

[snip]

There are two major flaws in the mayor's initial proposal. First, the proposed tolls are too low to significantly reduce congestion. Since bridge and tunnel tolls would be deducted from the $8 daily charge, most drivers entering Manhattan would pay little. Hence, the plan is projected to reduce traffic by a minuscule 6 percent, far less than the 15 percent to 20 percent achieved in London and Stockholm. And the net revenue would be only a few hundred million dollars per year, not enough to fund much in the way of better transportation infrastructure. So it's hardly surprising that there was so little political support.

I'll bet.

And only two "major flaws?!" Right.

The whole "plan," (delusion would be a better term,) is based on the assumption that traffic will continue either to increase or stay near present levels of crowding.

Feh. Nagonnahoppin.

The same kind of "planning" goes on here in The Valley. More highways. There are actually considerations being made to knock down part of Ahwatukee for a freeway and widen the highways here already.

In the 20-year plan, the Southeast Valley would see several freeway widening projects on U.S. 60, Loop 202 and Loop 101, including extra general-use lanes and carpool lanes. Williams Gateway Freeway, which would extend off the Santan Freeway in southeast Mesa and stretch eastward into Pinal County, is scheduled to be built about 10 years from now.

Newsflash: the earth's center does not consist of a divine ever-renewing reservoir of cheap sweet crude oil.

In a short period of time gasoline prices will certainly top $10 per gallon. There will be scarcities and pump shutdowns.

And as much as I just love the idea, the light-rail project just may, as in maybe just a little bit may, be insufficient to move 4 million people around the Valley a couple times a day. Even ten such light-rail lines won't be enough.

It's really time to do some realistic planning, and get other pieces into play.

By Which a Dim Politician Encounters Truth

The Eye-Mote

Blameless as daylight I stood looking
At a field of horses, necks bent, manes blown,
Tails streaming against the green
Backdrop of sycamores. Sun was striking
White chapel pinnacles over the roofs,
Holding the horses, the clouds, the leaves

Steadily rooted though they were all flowing
Away to the left like reeds in a sea
When the splinter flew in and stuck my eye,
Needling it dark. Then I was seeing
A melding of shapes in a hot rain:
Horses warped on the altering green,

Outlandish as double-humped camels or unicorns,
Grazing at the margins of a bad monochrome,
Beasts of oasis, a better time.
Abrading my lid, the small grain burns:
Red cinder around which I myself,
Horses, planets and spires revolve.

Neither tears nor the easing flush
Of eyebaths can unseat the speck:
It sticks, and it has stuck a week:
I wear the present itch for flesh,
Blind to what will be and what was.
I dream that I am Oedipus.

What I want back is what I was
Before the bed, before the knife,
Before the brooch-pin and the salve
Fixed me in this parenthesis;
Horses fluent in the wind,
A place, a time gone out of mind.




Sylvia Plath
Published in Chelsea Review, VII (May 1960), p.71 and The Colossus, p.14.

Hump-Day Dump-Day

Up with or even before the sun, it's quiet here at shrimplate manor. The east coast newspapers have been posted for hours. I peruse the headlines and opinion pages of several of these. NewsLink is my homepage. Coffee and Conlon Nancarrow on the stereo.

Two-channel. Martin-Logans. No video. Not that I'm proud.

We don't have a president anymore. Perhaps you think as I do that we haven't since the supremes installed Chimpy seven years ago. Now we have royalty. We have a king for whom power is checked only by his own creepy delusions.

Didn't George Washington cross a river to put a stop to this nonsense a long time ago?

If you are perceived to be a threat to national security; that is to say, if anybody in the Administration thinks that they might not like you, your financial accounts can be frozen and your assets seized.

Maybe the Democrats are intentionally limp-wristed in opposition to this development because they rather like the idea of Hillary having comparable powers some months from now. She could imprison these fascist poseurs and take their money to nationalize healthcare, for example.

Whatever.

Hairspray! Travolta in a dress!



Bush gets a colonoscopy. One commenter wrote that this story was just part of "the Friday news dump."

Heheheh.

Kiva Fireplace

Sky Lances

Please let me tell you about my Wednesday at work.

I arrived a little before 7 a.m. as usual. I ate a quick snack at about ten that morning. By mid-afternoon I was very hungry so I took a lunch break at 3 p.m. Much of the rest of my shift was disrupted continually by a difficult personality-disordered drug-seeking patient and I got behind with my documentation, so I had to finish that up after I had reported off to the oncoming night-shift nurses.

I clocked out after 9:30 p.m. Once home I kissed my family members; the human ones that is, then snacked while reading bartcop. After practicing scales and a few etudes I crashed.



Years ago I read Silences by Tillie Olsen. It's an important book. In a nutshell Olsen explains that people who work a lot have little time and energy left over to write plays.

Nurses are fortunate that their occupation pays well enough for us to "put food on our families." But on some days I have no time for anything but work. Then the body must rest, and often the mind also.

Barbara Ehrenreich has written beautifully and effectively about those of us who work like that all the time, every day, yet have difficulty getting by. This is so because... why?

Some Sunday Simic

Private Eye

To find clues where there are none,
That's my job now, I said to the
Dictionary on my desk. The world beyond
My window has grown illegible,
And so has the clock on the wall.
I may strike a match to orient myself

In the meantime, there's the heart
Stopping hush as the building
Empties, the elevators stop running,
The grains of dust stay put.
Hours of quiescent sleuthing
Before the Madonna with the mop

Shuffles down the long corridor
Trying doorknobs, turning mine.
That's just little old me sweating
In the customer's chair, I'll say.
Keep your nose out of it.
I'm not closing up till he breaks.

By Charles Simic

How's the Air Up There

Bao Xishun, Mongolian herdsman. At 7'9" he's the world's tallest man. Recently married, let's all wish him and his bride happiness and prosperity.

Sleepy Kyl

A certain Mr. Yolland from some god-forsaken dusty corner of the East Valley wants to know how Senator Kyl sleeps:

"(Jon) Kyl added that most Republican Senators believe September remains the appropriate time to judge the success of the U.S. efforts to stabilize Iraq."

At current rates, that's about 250 more dead Americans and about $25 billion.

Honestly, Sen. Kyl, how do you sleep at night? - George Yolland, Queen Creek

In a box?



Or perhaps in the more traditional hanging-upside-down repose?



You decide.

14 SEER

The $12,000 Question

I've been a fan of Michael Moore's work ever since Roger and Me. And TV Nation was consistently brilliant, so naturally it came to and vanished from the small screen rather quickly.

Healthcare Olympics from Michael Moore's TV Nation.

From a recent letter-to-the-editor in the local birdcage-liner:

Halfway through his documentary, after describing the injustices and inequities of an insensible and injurious American health care delivery system, Michael Moore asks in his documentary Sicko: "What kind of people are we?"

Well, in this article you can get a bit of an idea of the kind of person Moore himself tries to be. Some snips:

For several years now, Jim Kenefick has been railing against the Oscar-winning director on Moorewatch.com. Recently, Kenefick wrote about the difficulty he was having paying his wife's medical bills. Fellow conservatives guided him toward a cheaper health insurer, but Kenefick said he still had trouble making payments.

We can now confirm to Kenefick that his secret benefactor is none other than the dreaded, detestable, loathsome Michael Moore.

Kenefick admitted the $12,000 "was like manna from heaven at that time. ... My business was almost dead, my wife was very, very ill, and I was racking up a few little health problems of my own. That money made it possible for us to begin to turn our lives around."

Still, he doesn't sound especially grateful.

Having suspected Moore might be his secret patron, he contends that his bete noir made the gift just to publicize "Sicko," which takes aim at America's health-care system and, we've heard, touches upon Moore's covert generosity.

"I knew he was using me," said Kenefick. "Moore is going to try to make me into one of his little puppets."

Like Moore's new movie wasn't getting enough publicity, at least not until l'affaire Kenefick hit the headlines like a showbiz tsunami.

Kenefick's an idiot, but neither he nor his wife should be without proper healthcare.

What kind of person accepts such a gift, one that he really really needs, yet still plays the victim, as if Moore was actually going to make him into "one of his little puppets?" What kind of a person can't even manage to utter a humble "thanks?"

You already know what kind of person: a sicko.

Nurses know. We may not directly donate thousands of dollars to people like Kenefick, but we put our hearts and souls into helping such people when they get ill and end up in our care. No big deal. That's just what we do. That's the kind of people we are.

That Deliverance Guy

The Heaven of Animals

By James L. Dickey

Here they are. The soft eyes open.
If they have lived in a wood
It is a wood.
If they have lived on plains
It is grass rolling
Under their feet forever.

Having no souls, they have come,
Anyway, beyond their knowing.
Their instincts wholly bloom
And they rise.
The soft eyes open.

To match them, the landscape flowers,
Outdoing, desperately
Outdoing what is required:
The richest wood,
The deepest field.

For some of these,
It could not be the place
It is, without blood.
These hunt, as they have done,
But with claws and teeth grown perfect,

More deadly than they can believe.
They stalk more silently,
And crouch on the limbs of trees,
And their descent
Upon the bright backs of their prey

May take years
In a sovereign floating of joy.
And those that are hunted
Know this as their life,
Their reward: to walk

Under such trees in full knowledge
Of what is in glory above them,
And to feel no fear,
But acceptance, compliance.
Fulfilling themselves without pain

At the cycle’s center,
They tremble, they walk
Under the tree,
They fall, they are torn,
They rise, they walk again.


James Dickey, “The Heaven of Animals” from The Whole Motion: Collected Poems 1945-1992. Copyright �© 1992 by James Dickey. Reprinted with the permission of Wesleyan University Press.

Inside

In a small hospital the general word about goings-on spreads quickly, so we had already heard about the guy coming in from the state prison.

The nightshift nurse manager had already gotten some Sotradecol and Buscopan from the pharmacy. They already had the endoscope going in the emergency room and we had a Blakemore tube and suction set up in the ICU.



His labwork was low so they had already crossmatched him for four units of packed cells.

I had no doubt in my mind about what I'd be doing that night.

There were two of us in the ICU and I just had one other patient who was a routine post-endarterectomy with an arterial line. Systolics in the 140's and she was sound asleep.

Before the door to the unit opened we could hear him saying loudly "I'm gonna die!" I looked at Karen, the other nurse; my mentor really, and she shrugged back.

The surgeon was accompanying the patient, blood was already running, and we settled the guy in and Dr. Gellman sunk the Blakemore.

Did I say that there was blood everywhere? The patient was soaked. He'd been coughing. This was not good. Esophageal varices can bleed out very quickly. But after a couple of hours things seemed to be going okay. His blood pressures were always good, he didn't much complain of pain, and the tamponade seemed to be working because the stuff we were suctioning out of his stomache was looking more green than black or red.

He really seemed to appreciate what we were doing for him. He was polite, respectful, but deeply in fear for his life. We talked a little as I cleaned him up. He was in for a long time on drug charges. He'd started selling when he was eight or nine years old.

Along the way he had become a bit of a user himself and damaged his liver. Thus the varices.

He was gone when I came back the next night. He bled out, bradycardia set in, he lost his pressures and died just like he knew he would.

The doctors were pissed off. Dr. Gellman said "it didn't have to happen" and added that if the patient were on the outside maybe a Prilosec prescription and some routine care could have prevented the whole mess.

Chew Duckstab Gum

Sometimes while I am at work I feel like I just get in the way.

I get a moment to do some documentation. A call light goes on and I step up to answer it. A few minutes later I go back to the seat where I was doing my documentation and somebody/anybody else has assumed my spot and placed their own work materials, such as a notebook or perhaps a computer, right on top of my own workbook, which contains the medication records and cardexes for the patients in my team.

That's what we call them: our "team." As if my patients and I were contesting the freakin' World Cup.

Or I'm assessing and maybe even changing the linens for a patient and the rounders come in. The neurology residents, the pulmonology residents, the cardio residents, the medical residents, or The Residents themselves, giant eyeballs and tuxedos and all.


"Duckstab" was a personal favorite. "Six Things to a Cycle" from "Fingerprince" got a lot of vinyl play back in my radio days, too, as well as at home dance parties.

I'd pass out a bunch of chewing gum to all my guests. You had to be there. Only we didn't call it "there." We called it "here."

Chew chew gum chew gum gum.

Things really happened back then. Things happen still, but without the weird masks and goofy music.

Anyways, I'm at work and I'm just trying to do my fucking job and there's a freaking boatload of people in my way, or maybe I'm in their way, because they have to draw blood, or assess the patient's occupational skills for home, or cover their neuro issues, or choose a coumadin dose, or pull their pacer wires, or administer a nebulizer treatment, or they want to take their picture for People Magazine, or they want to do a bedside echocardiogram, or maybe they just want to squeeze my nipples with a wrench until they bleed and throw me out the window, I just don't really know.

I'm the nurse. I'm in the way. So shoot me. But make it quick. Oh forget it. My phone is beeping and one of my other little darlings just went into A-fib with a rate of 160.

Chandeliers

And Us, Too

We had a few days off so we travelled up over the Mogollon Rim to the cool forests and lakes of the Show Low/Lakeside/Pinetop area. The night air was so comfortable, we slept with the cabin windows open. Nature was our air-conditioner at this elevation of seven thousand feet above sea level.

At one point while driving back from one of the lakes there was an old battered pickup truck going along in front of us. It sported a bumper-sticker that read: Welcome to the White Mountains. Now Leave.

The fireworks at the high school went on for forty-five minutes. The best I've ever seen. Spousie and the kid loved it. And nobody in the crowd of thousands seemed to mind that we were there.

Mozart's 40th Symphony

Scooter walks.

Okay dudes and dudettes, here's my plan:

We all go to the ranch or to the Whitehouse or wherever Georgie is and we get him to join us for a game of "Hide and Seek." We make one of ourselves "it." When Georgie hides we all leave without looking for him.

I've got the tab for the beverages.

If we get lucky maybe he'll hide in the jam cellar and we can nail the door shut.

Heheheh.

Subtracting From Orange

Half-And-Half

"You can't be, says a Palestinian Christian
on the first feast day after Ramadan.
So, half-and-half and half-and-half.
He sells glass. He knows about broken bits,
chips. If you love Jesus you can't love
anyone else. Says he.

At his stall of blue pitchers on the Via Dolorosa,
he's sweeping. The rubbed stones
feel holy. Dusting of powdered sugar
across faces of date-stuffed mamool.

This morning we lit the slim white candles
which bend over at the waist by noon.
For once the priests weren't fighting
in the church for the best spots to stand.
As a boy, my father listened to them fight.
This is partly why he prays in no language
but his own. Why I press my lips
to every exception.

A woman opens a window—here and here and here—
placing a vase of blue flowers
on an orange cloth. I follow her.
She is making a soup from what she had left
in the bowl, the shriveled garlic and bent bean.
She is leaving nothing out."

Copyright © 1998 by Naomi Shihab Nye.



In light of this poem I thought it best to choose a photo of Shihab Nye standing on a bridge.

Blue flowers on an orange cloth. Opposites on the color wheel.