Friday, May 30, 2008


Tuesday, May 27, 2008

For Real

The Lamentations of Jeremiah

Let's have the names of those people who torture in our name. Put them on Nine Wives for prime-time interviews. Broadcast video of their accomplishments. Let's see it.

If you are a nurse on the job and a patient (not a confused, demented, or otherwise unresponsible one) hits you, report it to your manager and hospital security. Then call the police to file charges. And call me too, so I can bring snacks. Healthy snacks.

Think about where your water comes from. Do so especially if you live in a desert.

Give every soldier everywhere a helmet-cam that webcasts continuously. Let's see it all. The war, I mean. A running subscript showing the escalating costs of the war would also be nice. And caskets. Gotta see those. What's a war without caskets?

The next time you read something, consider the style of language, the vocabulary, the way ideas (if any) are laid out in words. Is it, the thing you are reading, written in a way that would insult the intelligence of an average fourth-grader? Like perhaps this?

Well, no. Not that.

Pick any number between one and a hundred. Then get an echocardiogram done on yourself. Find out what your ejection fraction is and compare that to the number you chose randomly.

Take something flat that you have hanging decoratively on a wall in your home; a painting, poster, or print. Remove it, paint/draw/splash something on its back, and hang it up that way.

Grow something. Tomatos. Crystals. Body hair.

Fill the birdfeeder.

Look at a total stranger in the same manner you would look upon someone you deeply love.

Try to think of something that has no words to readily describe it. Pester your friends and coworkers with attempts to convey this to them.

Imagine that for a moment everybody in the world simultaneously felt lament for that which is but should not be so.

12 Yr-Old Female Basketball Phenom Jaime Nared on GMA

Hat tip to Feministing.

Sunday, May 25, 2008

Sunday Plath: Monday

The Everlasting Monday

Thou shalt have an everlasting
Monday and stand in the moon.

The moon's man stands in his shell,
Bent under a bundle
Of sticks. The light falls chalk and cold
Upon our bedspread.
His teeth are chattering among the leprous
Peaks and craters of those extinct volcanoes.

He also against black frost
Would pick sticks, would not rest
Until his own lit room outshone
Sunday's ghost of sun;
Now works his hell of Mondays in the moon's ball,
Fireless, seven chill seas chained to his ankle.

Sylvia Plath

She began that year still in England, but she was offered a teaching job at Smith College that fall. After moving back to Massachusetts Plath found little time for her writing, so I assume this poem was composed while she was still overseas.

Shortly before her death, Dr. Horder suggested that Plath be seen by another doctor who specialized in what we might now call premenstrual mood disorders. It doesn't add much to my reading of the poem, but I suspect that lunar references may point to such a lifelong difficulty.

Saturday, May 24, 2008

McCain Losing Steam and it's Not Coming Out of His Ears

The downtown Phoenix Convention Center is a big place. Too big, apparently, to maintain proportions with the slim attendence expected for Bush and McCain when they get together for a fundraiser in the upcoming week.

"President Bush is scaling back next week’s fundraising swings for Sen. John McCain (R-Ariz.) at the request of the campaign, which wants the events closed to the press, POLITICO has learned.


A McCain aide said: “The McCain campaign has a policy that fundraising events are closed press. In keeping with that policy, the campaign requested the event be moved to a private home.”

Don't be too concerned about getting there early. There'll be plenty of parking.

Friday, May 23, 2008

Furniture Layout

How Doctors Decide Whether a Patient is Sedated From Opiate Overmedication or Just Plain Dying

He's dead now but when he was alive he spent a lot of money on cigarettes and alcohol, much like many people that you know. He had seen the light years ago though, in no small part due to the love and guidance of his wonderful and supportive wife.

No longer a boozehound with a hacking cough, he had been living a life full of family, friends, and fortune when he was stricken down by non-small-cell lung cancer which quickly metastisized to bone and brain.

He was hospitalized for pneumonia but deteriorated over a week's time. His ability to swallow was impaired so one Monday it decided to place a gastrojejeunal feeding tube. He was fatigued to the point where he would no longer speak because he barely had enough energy to maintain other functions, such as breathing.

I checked on the patient and his wife hourly, did turning and positioning, mouth care, suctioning as needed, and provided morphine for pain as prescribed.

Then I got a call to speak with doctors at the nurse's station.

It needs to be called something else, like the "everybody in the hospital except the fucking nurses station." When it's not crowded with residents, attendings, consulting doctors, therapists entering notes into the computer, and other hospital groupies, it's vacant because us nurses are somewhere closer to the patients themselves.

"We need to hold his pain medication because he's too sedated," said the attending.

"Fucking hell he is," I replied. At least that's what was in the invisible cartoon word-bubble over my head.

"He got seven and a half of oral morphine this morning, three migs IV before we sunk the NG tube for the PEG placement, and I gave him ten through the tube when he got back," and the two residents looked at me as if my hair had just caught fire, which of course it had. That was about equivalent to what he was getting when he was on a pump, which they had stopped the day before.

I may as well have been speaking French to ducks.

Ducks. Not geese. Many geese are native French-speakers but in that horrible Quebecois dialect so despised by Parisians, who are the true guardians of that precise and beautiful language. Rare is the French-speaking duck because most come from Long Island.

Please continue reading because I am saving a punchline for the end.

"Well if he's not oversedated then why isn't he responsive?" the attending asked.

"He's dying," I matter-of-factly replied.

They said that he wasn't like that yesterday, and I said well, that was yesterday. Bozos. They again told me that all pain medications should be held until he wakes up, and I directed them to the recent orders written by the palliative care doc and the pain-management nurse. I also said "No."

The patient wasn't going to wake up to chat about some bullshit with some asshole doctor. That was not a realistic expectation.

Whenever I hear something like "well, he wasn't like that yesterday," it usually comes from a family member who is processing grief and going through denial and bargaining. But in this case it was the attending doctor and a couple residents. They were bargaining with me about pain medications. And in denial. And angry at me for disagreeing with their bullshit.

I added that I was going to do all I could to keep this patient comfortable and that I was just advocating for the patient. The attending said "that meant I was saying they were *not* advocating for the patient," and I pointed out to them that my advocacy did not logically negate theirs. Dickheads.

Then they asked me how I knew he was dying and I said "Well, just look at him. And you could also read the palliative care notes," which said that the patient was clearly in the active process of dying.

One of the residents said she'd been seeing the patient since his admission and that she knew him better than I did. I spend more time with patients in one shift than they do in a week but to understand that they'd have to do math. Like addition and stuff.

They wanted me to call the pain nurse to get the morphine orders changed. Fuck no. I said that her number's in the chart and they could call her themselves. I wasn't going to get into that, again reminding the team that she'd already given increased morphine orders.

The next day one of the residents slipped by without speaking to me and wrote an order to stop the scheduled morphine. I didn't care because the PRN order allowed me to give them ten migs hourly. And besides, moments later the pain nurse called to reinstate the scheduled doses.

After visiting the patient, the palliative care doctor told me he'd called the attending, "but he doesn't get it." I liked that guy, as well as his nurse. They were right with me.

He said one of two things could happen: meds could be held and the patient would get restless and very uncomfortable, or we could medicate him. Either way he was going to die soon. When he and his nurse left they said "thank you for using your brain" and I thanked them for their support.

The oncologist came in while the wife was out hospice-shopping. He called her and asked her to come in because the patient wasn't going to last long enough to be transferred.

Other family members came also. There was a real crowd in the room. Quiet teardrops.

I kept the monitor on so that when his rhythm decayed I'd know.

I medicated him with a few more migs of morphine at 4 p.m. (right after I had my lunch-break,) having promised the wife that I was not going to let him be uncomfortable. Fifteen minutes later his heartrate dropped by half. "Here we go," I said to other nurses as I walked from the monitors to the patient's room. His wife was bent over him, hugging him and crying. A dozen family members stood vigil. I told her, in a quiet voice, that his heart was going and that he would pass soon.

He was gone in ten minutes. About twenty-four hours since I had told the resident team that the patient was dying, not napping.

He died in his wife's arms, surrounded by family members.

I tried paging both residents but they were post-call. The house resident was surprised by the death, even though the patient was DNR and this was expected. He had not been fully informed.

When he came to pronounce the patient he showed me the message they'd left as a report on this patient: "If nurses request increased pain meds do not change orders." Nothing about dying.

Now that's just plain creepy.

So anyways, here's how some attending doctors and their resident teams can tell when a patient is dying, as opposed to being sedated from too much medication: Just fucking listen to the fucking nurse.

Sunday, May 18, 2008

Sunday Plath: A January Nurse


Kindness glides about my house.
Dame Kindness, she is so nice!
The blue and red jewels of her rings smoke
In the windows, the mirrors
Are filling with smiles.

What is so real as the cry of a child?
A rabbit's cry may be wilder
But it has no soul.
Sugar can cure everything, so Kindness says.
Sugar is a necessary fluid,

Its crystals a little poultice.
O kindness, kindness
Sweetly picking up pieces!
My Japanese silks, desperate butterflies,
May be pinned any minute, anesthetized.

And here you come, with a cup of tea
Wreathed in steam.
The blood jet is poetry,
There is no stopping it.
You hand me two children, two roses.

Sylvia Plath
1 February 1963

This is the second of three poems that Plath completed that Friday. The following week her doctor started her on a monoamine oxidase inhibitor. (I'm guessing Parnate.) She would take her own life shortly, dying in the early hours of Monday the 11th. During the intervening week she suffered a bizarre manic bout that kept her awake over three days straight. Dr. Horder saw her daily.

Plath and her children Nick and Frieda had all been sick with flu-like symptoms during that very cold January. Doctor Horder had arranged for a nurse to stay with them for a week to help them get better.

Though included by Ted Hughes in his preparation of Ariel and Other Poems, Plath had already pretty much finished that manuscript months earlier and probably did not intend for "Kindness" to be in it. She seemed to be on to something new.

The blood jet is poetry,
There is no stopping it.

Plath wrote several poems in which nurses and such are figured.

Kate Moses has an excellent website which includes a useful timeline of important happenings in Plath's life.


I was wandering around at the end of my shift. I'd promised the patient in room 31 that I'd give them some Relpax before I left and the pharm had just delivered it. We don't keep these triptan drugs handy, and I didn't want them to wait any longer.

I absolutely hate migraines. The patient had it all: photophobia (the room was darker than Dick Cheney's soul,) nausea, drippy sinuses, noise intolerance, frequent urination, the whole migraine constellation as well as the slow-motion jackhammering in the right side of their head from the back of the neck all the way to their eye.

No aura though. They had common as opposed to classic migraine. Too bad. The auras are the best part.

The Lancet on headaches:

"Similarly, migraine costs American employers about $13 billion a year because of missed workdays and impaired work function, of which close to $8 billion was directly due to missed workdays.


Nevertheless, some individuals may pursue with work despite having migraines, as theirs may be a mild form, or indeed they may just be apprehensive about taking time off. A study (13) showed that when at work with headache, work effectiveness was reduced 41% for migraine headaches. It is apparent despite all the best intentions such individuals have, they may still not be as effective as they would like to be."

Speaking of headaches, the patient across the hall was cussing out the oncoming nursing assistant. After I heard about fifteen really loud exhortations which included the word "fuck" I decided to step in. Fun.

Not kid fun, like riding a bike to the store for a soda and to see the cutie that sits behind you in homeroom. Adult fun, like an uphill bike ride on a moist windy day in the Adirondacks.

The verbally-abused nursing assistant took off in a jiff as soon as I got to the doorway and asked what was going on.

"I told them eight times that I didn't want any fucking male nurses touching me and they should get me my pain medicine because that bitch took the Dilaudid herself and I didn't get it I can tell because I didn't fucking puke and she was gonna give me fucking Haldol and I'm not a fucking psych patient and I don't need that shit, and she was gonna give me something so I didn't get sick but that's how I can tell if I'm getting enough pain med because it makes me vomit and she should have just upped my Dilaudid like the doctor said but instead she I dunno took it herself and got sparked, the bitch. Look I'm in pain here and if I don't get a cigarette I'm gonna go off on somebody so you guys better take me to the ER right now or I'm gonna light the fucker up right now. Call that fucking doctor again. But I gotta tell you if one more male nurse comes in here I'm gonna rip this tube right out and get the fuck outta here and smoke a fucking cigarette..."

And so on.

Once at home I got talking to the delivery guy. He was a recovering methamphetamine addict. He said it used to calm him down. He'd do crystal and then hang out and watch TV. Paradoxical effects.

People just talk to me. Like waiting at the grocery checkout or just walking down the street total stangers approach me, pull out their wallets, and show me pictures of the grandkids and pets. They tell me how their mutual funds are faring. It's always been that way.

This patient was obviously and completely gone. That ethereous void in their eyes, the stunning lack of a personality. They had turned themselves into a paranoid drug-seeking sociopath. Nothing mattered to them except drugs.

And air. Not much choice about that. They had suffered, again, a burst lung bleb which scored them a chest tube and the requisite hospital stay.

"Take this fucking shit out so I can go smoke and that bitch who took my pain med better not be there and if you send another male nurse in here I'm gonna tell them to fuck right the fuck off like I did that doctor who said there was fucking tweak in my blood test, he fucking put it there is what he did..."


Then they lit up a hand-rolled cigarette.

I politely told them that they couldn't smoke here.

Blank stare.


Then they took the cigarette out of their mouth, flipped it around in their hand, and extinguished it by butting it out on their tongue. After that they put it in their pocket for later.

That was enough to convince me.

Friday, May 16, 2008

Glass Block

Wednesday, May 14, 2008

Fewer Branches on the Future Tree

It seems to me that I probably belong to the last American generation that will accumulate more stuff than those that preceded it. Peak oil, peak build-out, peak pile of junk in the garage.

My family does not have a garage. And no, we don't rent any self-storage units, either. We were afraid that if we had the space provided by these, we'd fill them up with stuff.

Our neighbor next door has a two-car garage, but he has to leave his vehicles in the driveway. There are too many plastic paint cans, boxes, plumbing supplies, and rubber chickens cluttering it up so there's no room in there for his Beamer.

As availability of cheap fossil fuels declines, our piles of stuff will get smaller. It'll be too expensive to make some things; many things. And it will become too costly to make things in far-off places where cheap labor (another kind of energy) can be exploited and goods can be shipped profitably halfway across the globe. The "warehouse on wheels" will fail as a business model.

Manufacturing may return to our United States. It'll be cheaper to just make stuff here again, to avoid high transportation costs.

Anyways, my feeling is that the future will look more like the past than the present. Our sons and daughters will have to work harder for less.

Sunday, May 11, 2008

Sunday Plath: The Fragment

This is why I feel that I must occasionally try to bring attention to the poetry of Sylvia Plath; not the entire poem Lady Lazarus, but only a few lines from it:

Is an art, like everything else.
I do it exceptionally well.

I do it so it feels like hell.
I do it so it feels real.
I guess you could say I've a call.

Written in the third week of October 1962. Not a great time in her life; marriage collapsing, alone with young children in need, uncertain recognition as an author (her famous novel The Bell Jar had been published under a pseudonym and most people were unaware of this,) and of course her dangerous emotional deterioration.

So all that showed in her poetry sometimes.

Just sometimes.

The Bee poems, her poems about her babies, and the poems inspired by the landscapes around Devon, for example, all seem relatively neglected compared to the sensation that has accrued around those six lines above. And I just don't think that's fair.

It's a great poem, by the way.

Friday, May 09, 2008

Napkin Rings

Sunday, May 04, 2008

When the Bubble Bursts

When he was a boy his older brother and sister told him to stay inside because it was too windy. His ears were so big, they explained, that if a strong gust caught him it would lift him away and he'd never see home again.

As they walked away outside he pressed his forlorn face up against the window.

At our home-owners' association meetings he was always the funny guy.

Another time they told him that a fairie had buried pennies beneath a bush by the front of their house. His younger sister was also told this. She went to the kitchen and got a spoon so she could dig. He, instead, went to the shed and got a huge crowbar. Accidentally, he drove it down upon her pinky finger.

His big brother heard the cries and came out and picked up the little girl in his arms and she quieted down. Then he told his little brother that he'd just killed his sister, which he believed for a while. The parents came along. The little sister got a couple stitches and she was just fine.

Whenever I took our household trash out to the dumpster there were always lots of empty beer cans in it. Coors Lite. Fucking awful plonky swill, that shit.

He grew up and married, had a daughter that he loved more than anything in the entire world, but things didn't work out and after the divorce he rarely saw her.

He was dogless, except for that time he took care of a poor shy little abused black Labrador Retriever that one of our other neighbors found out on the streets. We took her in, and now she's a big healthy strapping lass.

When we dog people were out and about he was there with us too. Sometimes, if his gate and door were open when it was nice, the dogs would run into his place and sniff around.

His little custom construction business failed. He had to let his workers go and he felt like he'd let them down.

About one-third of all the money generated by the Valley economy comes from the housing business, and that has been sliding into recession due to defaults. A lot of his work came from people buying, remodeling, and flipping houses. The market for that has cooled. Home sales are down 19% compared to a year ago.

Last Sunday his brother-in-law broke into his home through the back door. They hadn't heard from him in a few days, he wasn't answering calls, and his truck hadn't moved from its parking spot.

"Don't come in here," he said to his wife, the sister who dug for phantom pennies with him long ago. She knew.

He was shirtless, the room was littered with empty beer cans ankle-deep, and he had put a pistol in his mouth and pulled the trigger. Probably the Thursday before, the police estimated.

We're memorializing him by putting in a tree. A lemon tree.

Sunday Plath: May 1958

Poems, Potatoes

The word, defining, muzzles; the drawn line
Ousts mistier peers and thrives, murderous,
In establishments which imagined lines

Can only haunt. Sturdy as potatoes,
Stones, without conscience, word and line endure,
Given an inch. Not that they're gross (although

Afterthought often would have them alter
To delicacy, to poise) but that they
Shortchange me continuously: whether

More or other, they still dissatisfy.
Unpoemed, unpictured, the potato
Bunches its knobby browns on a vastly
Superior page; the blunt stone also.

Sylvia Plath

Plath taught at Smith College in the fall of 1957 and spring of 1958. She found this to be more difficult than she had presumed, but then she tended to be rather harsh with herself. Her students and the college people thought very highly of her.

Except for a flurry of eight poems in as many days written during the spring break in classes, she didn't write very much duting her time spent teaching. From her unabridged journals:

Saturday: May 3rd [1958]... Tomorrow I must correct all my exams which I should do in one day- they're short and all on the same subject. Then a close outline of The Wasteland which should take all week. I pick up my ms. of poetry & leaf through it, unable to invent, to create- all my projected nostalgia for my students can't shake the conviction that teaching is a smiling public-service vampire that drinks blood and brain without a thank you.

So she quit teaching.

Her mother was a little disappointed and fearful for her daughter's financial security, but Plath sold two poems to The New Yorker and received enough money from that to pay for several months' rent in Boston where she and husband Ted lived as freelance writers.

I think this is another transitional poem; it's a sonnet but loosened up a bit. Like many of her poems, its subject revolves around inchoate creativity. This theme arose at various times in her life, such as at Yaddo, and later back in England then her "Ariel" voice bashed its way to the surface.

Friday, May 02, 2008

Soap Dish