Wednesday, April 25, 2007

Frosted Flakes

It was about time to do another round so I was going from room to room checking on my team of patients. This one guy had just eaten his breakfast and was up in the bathroom brushing his teeth.

"He looks good," I thought to myself, knowing that after he was discharged there'd soon be another patient assigned to the room, and I'd be doing the usual ten pages of mindless paperwork/documentation that goes along with admissions.

He'd had a valve repair done last week and had moved along pretty well after they got him off ventilation. Having been (emphasis on past tense) a two-pack-a-day smoker, an extra day or so on the vent was required before he could breath on his own well enough.

He was flossing while I straightened up the linens on his bed and removed his breakfast tray. I heard him say "Oh, that's going to bother me all day" and when I looked into the bathroom he was picking up a strand of dental floss that he'd just used and discarded. After retrieving this from the waste basket, he re-used it, then again tossed it away.

He tongued his teeth to make sure he'd gotten it all from between them.

Sunday, April 22, 2007

Nice Watch

He was about thirty years old when he was admitted to our little community-hospital Intensive Care Unit for chest pain. His enzymes were positive and he did have EKG changes, but he seemed a lot more concerned about making dozens of phone calls to his business associates. Many of the nurses thought he was creepy.

His wristwatch was a very impressive diamond-studded gold Rolex. It was the first of such that I'd ever seen except on the back cover of one of my Miles Davis vinyl recordings.

This guy didn't look anything like Miles though. A little like Dennis Leary with early Justin Timberlake curls.

Like the nurses said: creepy.

Since we didn't have a cardiac catheterization lab at our hospital we routinely transferred such patients to a medical center at the capitol city. A few days after doing so one of our cardiologists told us that the man had refused treatment there and as he was walking out the door, against medical advice, a team of FBI agents and state troopers met him and took him away in handcuffs.

He was a cocaine dealer from one of the Carolinas who had been travelling to Montreal with his female "office assistant" when he was forced by crushing chest pain to enter the system. Said assistant disappeared along with his BMW.

Friday, April 20, 2007

Seconds Out

"Modern conservatism has morphed into a kind of Frankenstein "anti-rule-utilitarianism," advocating that which produces the least amount of good for the greatest number of people."


"Christ never appeared on television asking people to send him money. In fact, he didn't even own anything. Except his robe.

That and a few nails."


"One of the really sad things about global warming is that we may not have a big enough iceberg to put the conservatives on when we finally get around to floating them all out to sea on one."

"Well, there's always Poland."
Zap Rowsdower

"Put them on an Antarctic Ice Shelf."
The Old Man From Scene 24

"We don't need an ice floe; we have helicopters.

OTOH, we could just lash a bunch of them together for the others to drift away on. . .

Hmmmm. I seem to be a tad angry this morning."
Virginia, Liar! Resign!

"Is it wrong to prefer a river full of pirahnas?"

Brick House

Monday, April 16, 2007

I Really Don't Like This One Particularly

"I Don't Like Mondays".

From the YouTube comments:

gdokg (1 day ago)
"Bob Geldof wrote the song after reading a newspaper report on the shooting spree of 16-year-old Brenda Ann Spencer, who fired at children playing in a school playground across the street from her house. She killed two adults and injured eight children and one police officer. Spencer showed no remorse for her crime, and her only explanation for her actions when captured was "I don't like Mondays."

My condolences to the vistims and their families. I cannot imagine worse.

The weather for the Boston Marathon (I've run it six times, but not lately,) was absolutely awful. But they lived.

Sunday, April 15, 2007


Peach-faced lovebirds in "the wild" neighborhoods of Phoenix.

These sweet little parrots are native to southeastern African dry-climate areas but they've taken up residence locally. They hang around up in the palm trees where they use nesting holes made by other birds. It was at Granada Park in the neighborhood south of Piestawa Peak that we first saw them in small flocks.

Until then I'd only seen them in petstores.

During this time of year we spot them daily when we're out walking the dogs, but they don't seem to be attracted to our bird-feeders.

The people who live on the corner have some goats, and we saw coyote scat in the street in front of their house. On a few occasions I've noticed them trotting right down the middle of the street or straight through backyards around here. They like golf courses, because that's where the bunnies are. To a coyote, a golf course is just a great big green smorgasboard.

Coyotes tend to travel in energy-conserving straight lines, unlike domestic dogs who zig-zag all over because they are pretty sure they have food waiting for them at home, unlike their poor relatives Canis latrans who never know where their next meal is coming from.

No recent roof-rat sightings. One of local condo owners reported hearing them at night but they're gone now. In the nearly four years we've had our place here I've seen only one, despite the fruit trees in this area which used to be all orchards, like the Arcadia district. That's where these little out-of-staters first settled when they arrived in The Valley.

Maybe the highway poses a barrier to them and they stay mostly on its east side. Or maybe they just like living in proximity to Alice Cooper.

Iceberg Right Ahead

Darjuna, the nursing assistant, was going around the unit getting nooner vital signs from all the patients when I heard her yell out for help. When I walked into the patient room she was in the bathroom and the patient was just standing there with a blank stare.

This woman was in her early thirties, slim, attractive, full-lipped, and well-coifed. She was smart and had obtained her master's in literature from Yale. Among her personal items were the keys to her Mercedes. She was also a complete psycho.

She started using cocaine many years ago and she had told me earlier that when she initially tried it she "fell in love instantly."

That stuff can be a little rough on the heart. Whenever I've had a relatively young person such as herself admitted to us as a patient with myocarditis and chest pain my first guess is cocaine.

The scars on her inner forearms looked liked she'd been flayed open from elbow to wrist, leaving fish-shaped marks two inches at their widest and running from her elbows to her wrists. From the years when she used needles.

She pleaded for narcotics for her "chest pain" constantly, but because of her history and so far negative work-up the doctors had forbidden morphine and such. They allowed us to treat her with Percocet tablets, though, and the usual IV fluids, antibiotics, and anti-fungals.

Anyways, she was in the bathroom staring at Darjuna when she closed her eyes and her knees began to buckle. We were right there to catch her as she crumpled. We dragged her to bed and obtained vital signs, which were fine. Systolic blood pressure about 100, and heart rate about 105. Same as she usually was. Another nurse who had happened by had been looking at the heart monitors and came to report no arrhythmias.

Then the patient woke up and asked us "what happened?"

"You passed out in front of us," Darjuna said. The patient just laughed and denied it. "No, she's right, I saw you do it too," I said. "You would've hit your head but we caught you," said Darjuna. The patient insisted that this never happened.

Then we noticed a nearly-empty needleless syringe on the bedside stand. It had a bit of cloudy white fluid left in it.

She had cheeked her Percocets, crushed them up in a plastic one-ounce medicine cup after the nurse left, dissolved this in water, drew it up into a syringe that she dug out of the needle box, and injected this concoction into a port on her intravenous line. Then she went to the bathroom, saw stars, and fell like an over-ripe grapefruit from an old tree.

It doesn't matter if you know better. And she did.

We all congratulated Darjuna for her excellent catch.

Saturday, April 14, 2007

Golden Delicious Apples

This may come as a surprise to many who read the Arizona Republic editorial pages regularly: they don't always publish idiotic rantings. They are inconsistent. Sometimes genuinely thoughtful remarks are allowed to slip through.

Like this one:

"We played against them in the Elite Eight round at this year's NCAA tournament, but our connection goes beyond that recent competition. In the pre-season "Paradise Jam" Women's Basketball Tournament in the U.S. Virgin Islands in November, ASU's women's basketball team was scheduled to play Rutgers when a personal tragedy struck our team and we withdrew from the tournament.

The Rutgers Scarlet Knights could have claimed a forfeit victory in the game, but they did not. They honored our loss by showing us extraordinary support, compassion and respect."

Basketball is obviously not the only thing that the players on the Rutgers team do well. I hope your own daughters and sons turn out that way and that they do not take to the unsavory humorless drivel that passes for political and popular discourse in various media these days, particularly amplitude modulation radio signals.

For example, courtesy of Spocko's Brain:

"Something Disgusting Said by Ann Coulter, Disguised as a Joke.

On ABC Radio/Disney station KSFO 560 AM in SF on July 27th 2006 Ann Coulter was talking to Lee Rodgers, Melanie Morgan and Tom Benner (whose pseudonym is "Officer Vic") about the bombing in Southern Lebanon. The first person talking is Lee Rodgers.

Ann Coulter: "On the bright side we hit a couple of UN peacekeepers."
Melanie Morgan: laughs
Officer Vic: "Look at those blue helmets go flyin'"
Coulter: "Somebody has to tell Israel about the installation on 42nd street."

Please LISTEN to the actual audio.
(WMA Audio link 1.01 clip, comment at 45 sec)
[I didn't link the link]

It is widely agreed that Ann Coulter says things that are repellent to decent humans. But when you LAUGH at her obnoxious comments, what does that say about YOUR character?"

In a just world, Ann Coulter and her ilk would be impoverished and defiled and the Rutgers women's basketball team members would have their own empire of money, books, and media popularity.

What does that say about YOUR country?

Thursday, April 12, 2007


If you really want to you can read about the origins of myths surrounding Friday the 13th here.

Though we tend to be rational, reality-based, and comfortable working within the medical model of healthcare provision, nurses also have a widespread and common body of little superstitions.

It's busier during full moons.

Never use the word "quiet."

Deaths occur in groups of three.

Our unit has no room numbered 13. Rooms 12 and 14 are instead adjacent.

It's the same with nurses in the Northeast as it is here in the Southwest. We all know it's silly but we maintain our guard anyway. Whatever. On any given day my twelve-our shift is likely to stretch into a very merry thirteen.

Of Few Words

Our koi fish aren't this big because our pond is narrow and small.

Nancy and Sid.

Must be a cool day; nobody's in the water at Slide Rock in Oak Creek Canyon.

Red tide bioluminescent wave crests, on the beaches north of San Diego. When walking along water's edge your footprints glow for a few moments too.

Rahsaan Roland Kirk, also known as "The One-Man Twins."

Today I Think I'll Bake a Pie

A Poison Tree

"I was angry with my friend:
I told my wrath, my wrath did end.
I was angry with my foe:
I told it not, my wrath did grow.

And I watered it in fears
Night and morning with my tears,
And I sunned it with smiles
And with soft deceitful wiles.

And it grew both day and night,
Till it bore an apple bright,
And my foe beheld it shine,
And he knew that it was mine -

And into my garden stole
When the night had veiled the pole;
In the morning, glad, I see
My foe outstretched beneath the tree."

William Blake, from Songs of Innocence and Experience: Shewing the Two Contrary States of the Human Soul (1794)

Saturday, April 07, 2007

Yay. Insulin pens and devices.

My working life as a nurse is complete. Maybe now Francis Freeperama will write a book about the end of the history of nursing.

I remember when we used to do it the old-fashioned way, not so long ago. It only seems like a week or so.


Iraq as a prep-school football game with spindly and sweet L'il Georgie as the quarterback.

Actual conversation as recollected by the participants:

After contnuous possession and 26 plays, one offensive lineman says to the other: "Hey man, does it seem to you like the football field just keeps getting longer and longer?"

His teamate replies "Yeah. And where the heck are the goalposts? I can't even see them from here."

"I don't even know which way they are!" says the first lineman.

The second asks "And why is that stupid cheerleader quarterbacking?"

The first glances up and says "The clock is counting down the game in effing Friedman Units, man."

The other lineman complains "Don't even look at the score, dude. It's a bummer. I just wish the coach would've given us pads and helmets."

"Dream on," the first guy said, "I don't even have any pants."

"Thanks for reminding me," said the other lineman.

Then came the next snap.

Wednesday, April 04, 2007

Ainadamar, the Fountain of Tears

When I was a highschool freshman, one day my music teacher brought in a then-new (vinyl!) recording of "Ancient Voices of Children" sung by the incredible Jan DeGaetani; music by George Crumb setting poetry by Federico Garcia Lorca.

Lorca and Xirgu

"Gacela del niño muerto"

Todas las tardes en Granada,
todas las tardes se muere un niño.

("Gacela of the dead child"

Each afternoon in Granada,
a child dies each afternoon.)

Struck me right square in my little ninth-grade head, that.

Crumb's music, which is as beautiful on the page as it is to hear because he sometimes fashions his scores in circles, crosses, or even spirals, and the poetry of Lorca too have stuck with me ever since.

A few years back we travelled to Santa Fe to hear Golijov's opera Ainadamar, which is about the murder of Lorca.

Dawn Upshaw, a personal fave, was spectacular and the score was full of hand-drums, flamenco guitars, and long-spun-out vocal rhapsodizing. The recording is even better than my recollection of the live performance. Great stuff.

Back to Lorca:


enters, and leaves,
the tavern.

Black horses
and sinister people
travel the deep roads
of the guitar.

And there’s a smell of salt
and of female blood
in the fevered tuberoses
of the shore.

enters and leaves,
and leaves and enters
the death
of the tavern.

When I read poetry in translation I like to see the original alongside the English.


La muerte
entra y sale
de la taberna.

Pasan caballos negros
y gente siniestra
por los hondos caminos
de la guitarra.

Y hay un olor a sal
y a sangre de hembra,
en los nardos febriles
de la marina.

La muerte
entra y sale
y sale y entra
la muerte
de la taberna.

Death is so common.

Of course today is the anniversary of the assassination of Martin Luther King. I was in gradeschool then and I didn't understand why Americans kept shooting its best leaders, what with the Kennedy murders and all.

Now I have a somewhat better idea about why such things take place.

Death is common. Uncommon people die. But death progresses quickly enough without our help, doesn't it?

Tuesday, April 03, 2007

Downward Job Mobility and No Bad Words

Where do people get their money from? Other people. Corporations also get their money from people.

Poor people have little money so they are sub-prime targets for greedy predation, but they are not immune. Crack and crystal, used cars, cigarettes, and alcohol ensure a steady flow of money into and out of the lower economic classes.

Sometimes rich people take money from one another, which results in a net wash for them as a class. People do sometimes act in a way that benfits them as a member of a class. Karl Marx and F. Scott Fitzgerald were right about that.

What's left is the great American Middle and the crowning achievements this made in the latter half of the 20th century: broadcast media, transportation, space exploration, food production, and the computer Internet.

Now the middle and professional classes scramble while the rich ride their personal elevators up the L-curve.

On our last trip out of Dodge I had a few hours to read Bait and Switch, the (Futile) Pursuit of the American Dream, in which author Barbara Ehrenreich posed as someone "in transition" in the white-collar world of corporate middle-management. Six-figure income types.

Spoiler here: the only job offers she gets are unsalaried sales positions for cosmetics and insurance companies, making "cold calls" for commissions.

Let's call her "Joanie." She was the director of nursing at a hospital I worked in which lay in another part of the Valley. New management came in and turnover increased. Turnover was heavy at the bedside level. The first year I worked there the entire staff on the unit in which I worked "turned over." Nurses, secretaries, aides... everyone but me.

Joanie told us a year later that staff turnover was 89% then. A secretary who I really liked had stuck it out with me that year.

My nurse manager was wonderful but he saw the iceburg and took another job. His replacement didn't last long, and then the director of nursing, Joanie herself, was let go. Soon after that I moved to a house in another part of the metropolis and I don't like commutes so I called my old manager for a reference and he basically got me the job I have now by making a phone call, then *they* called *me* and here I am.

That worked out really well, actually, and I'm ever grateful to that guy for making my job move so easy, and as nursing goes, I have it comparatively well. It still sucks sometimes though.

Not so for Joanie. During my brief "job search" which lasted about a day, I'd heard she was director of a nearby emergency department at a place with a not-so-great reputation. I called her for a reference and she offered me a job there but I was never much of an E.D. nurse. Lazy, I guess. I like patients that already have a documented diagnosis or two or seven.

Then I heard from another nurse in my present facility, a "float nurse," that they worked alongside Joanie one night in an ICU setting. The float nurse was thrilled by this because she and Joanie never really saw things eye-to-eye, and there they were. Suctioning trachs and watching drips.

Peers, not director-to-staff-nurse, dominant-submissive, whatever the dichotomy. Joanie had been forced downwards from being a Director of Nursing to working for one of the local nursing staffing agencies, waiting by the phone each morning for that night's assignment.

The Great American Middle Class is rapidly shrinking as wealth, created by us ("us,"as I consider myself a bitter holdout in that economic category,) is funnelled into the coffers of the very rich.

Doctors who are sons and daughter of doctors work twice as hard as their parents did to maintain a lifestyle a step or two below the one they grew up in.

White-collar jobs are being outsourced just as basic manufacturing jobs were.

The rich get enormous tax-breaks while the other classes see their futures mired by the debt Bush has run up. Someday you may be paying your mortgage in Chinese yuan or whatever denomination of money the Saudi royal family uses.

And yet oddly there's no fight left in us, as a class. We in the middle are insufficiently outraged by what is being taken from us, which is odd because people tend to fight hard to maintain what they have while expending less effort and risk to obtain things they don't already have and don't really need (like very rich people who obtain evermore vast amounts of money without "working" at all.)

This will pass.

Money and wealth are fluid, or gaseous, or like something that won't stay in just one place for very long.

I fear that there are many people in the "losing" classes and very few in the "rich-and-getting-richer" class, and the black market for weapons is quite healthy and freely accessible. And psychopathology seems about evenly distributed throughout all classes.

The United States awaits its Pol Pot, its Stalin, its Caligula.