Friday, December 18, 2009

Don't Let it Bring You Down

She remained such a pleasant young woman, a software engineer from yet another midwestern city, with a slight smile and gentle optimism on her face at all times. That is what amazed me. She had been having a run of bad luck, so one might expect her to be a little bitter about life and such, but she wasn't.

A year ago her mother went to the operating room to have colon cancer treated, and she coded on the table and died a few days later. A few months after that her father passed away, as much from grief as from his own fight against cancer. So she moved from the midwest, along with her quietly devoted husband, here to Phoenix, hoping for a change of luck.

Phoenix has not been good to her.

They bought a house but before they could entirely settle in, it "burned down with them in it," as she said, though they were unhurt. They moved to an apartment in an affordable neighborhood, where she was shot in the lung in a random senseless drive-by assault.

"I was just in the wrong place at the wrong time," she explained.

That was a couple-few months ago. After several weeks of hospitalization she was discharged, only to subsequently develop some complications that landed her right back in. More surgery, chest tubes, and thankfully a pain medicine pump.

Aside from handing her a few pills and helping her get around some, that was my job: to help keep the pain under control, which merrily it was. Without that, it would have been a completely different story, and a startlingly different patient too. With uncontrolled pain, even the nicest person can become a total bitch on wheels.

Wednesday, November 25, 2009

The Hanged Man

If a hospital, or perhaps a chain of hospitals, has a nursing shortage and also due to the poor economy has instituted a hiring freeze, then that shortage of nurses becomes fixed.

As wealth is concentrated upwards into the hands of the lucky few, so misery is concentrated in the lower echelons of society, and there is no one lower on the scale of being than hospital patients. They walk around bare-assed. They are bankrupt. They are not working.

I have a facsimile of John Dowland's First Book of Songs. It folds open with each of four musical parts facing to the four different sides of a table. Four singers and a lute player can seat themselves around it and read the music with their own part facing them. People knew how to sing music from written parts back then.

A rather fancy family might have a chest of recorders, viols, or some other consort of instruments. Sackbutts and krumhorns, anyone? It was home entertainment in a low-energy time, when we did not have electricity funneling various amusements into our homes for us.

An early music specialist came to my college and we formed a "broken consort" of unlike instruments (lute, bandora, cittern, viola da gamba, and flute,) to rehearse and perform a concert of Elizabethan music. I played the little cittern. The only time I ever have. I had been studying on my own and I could read the tablature notation, so the early music professor recruited me for the gig.

The headstock of the cittern I played had a blindfolded man's head carved into it.

Citterns, lutes, mandoras, and other instruments used to hang from the walls of Elizabethan barber shops. Loops of string tacked to the walls would hold the instruments by their headstocks. The blindfolded man was a sort of common joke, as the loop of string would circle under the neck of the hanged man.

While you were waiting for your shave or haircut, you would take an instrument down from the wall and play upon it.

Now we have fucking Fox News everywhere. So I refuse to have my hair cut at a salon anymore. It can grow to my knees.

Sunday, November 22, 2009

What You Don't Hear

I always inform my patients when I am about to do something to them that will cause pain. Usually it involves needles.

My patients like me. They tend to like the unit in which I work, and often they say complimentary things, such as "The nurses here are so good. Very professional, and everybody's been so nice."

Meanwhile the cartoon word-bubble over my head is silently reading out "wait until you get the bill."

That doesn't work on Canadians, though.

Tuesday, November 03, 2009

Brought to You by Your Health Insurance Premiums

Well, eventually they ordered a temporary hemodialysis catheter and proceeded with thrice-weekly dialysis. It was a concession to reality. That's what the man needed in order to live.

However, we were unable to just keep him in the hospital and provide this service indefinitely. So one day they decided to send the patient home. After he was dialysed, they removed the catheter and presto! he was discharged home.

The best possible scenario was for him to return to Mexico for treatment. But he hadn't lived there in fifteen years; he was a legal alien here and had been so for the past twelve years. Unfortunately he had no medical insurance, and legal residency doesn't include that. He really had no place to go back in his home country.

In all likelihood, he just stayed here in The Valley of The Sun. He will soon get pretty sick and he will present at another hospital. Or maybe he will just come back to ours, where we will start this all over again.

Wednesday, October 14, 2009

The Old is New Again

A legal immigrant who will die due to lack of money and will to take care of his failing kidneys.

The alarming number of sick calls from hospital workers this flu season.

The nasty fuss; the monkey-suit mask, gown, and gloves we have to wear to avoid spreading a simple virus.

Bankruptcies due to health care costs, even for those with good insurance coverage.

Fine coffee.

Applied technology. Medical equipment, and home entertainment.

Let's start with the last. I "had to" get a new laptop. Over the years I have accumulated a sizable collection of music on compact discs. My spouse abhors these due to the shelf space they occupy. Now I can download hundreds and hundreds of them onto my computer and Ipod. Wirelessly I can beam the music into my hi-fi system. (I am not fond of the sound derived from those little in-ear headphones; even the pricey ones.) Now I have more room on the shelves for books! at least until Spousie gets me a Kindle or other such book-reader. I can also carry nearly all of my music with me on the Ipod.

In hindsight, it's really not all that different from the little transistor radio I used to take to the beach when I was young so I could listen to Hey Jude while I read Vonnegut and sunned myself.

Interestingly, the latest-generation new Ipod Nano features the addition of FM radio.

What?! No AM radio?!

Sunday, October 04, 2009


If you come to the hospital and you display flu-like symptoms, we will either admit you to an isolation room or kick you the hell out. Nicely.

If you have a child in school, assume that they are at risk. Viruses do not work in terms of degrees of separation; instead, in terms of degrees of connection.

Think about the things that you touch as you go about your business. Gross. Yes, I know. Then think about all the other people who may have touched whatever you're touching, as you make your day.

Multiple homonyms: Flu, flew, flue

Saturday, September 26, 2009


Sedona viewed from Jerome

Two miles in.

The bridge

Dogs swimming at the crossing below Cathedral Rock.

It's hard to take a really bad photograph here.

Schnebly Hill Road view.

Tuesday, September 22, 2009

Structure of Memory

If you work thirteen or fourteen hours per day for a few days in a row, sometimes you get tired.

All of the fascinating little details from the swirl of activities around you for these past days; well, things fade away. You sit at the keyboard and think that one thing you wanted to share which seemed so universally interesting, like breathe itself, has slipped away into the land of the bland.

That in itself is sort of interesting.

What are those little French cookies called? I forget. It think the word rhymes with porcelain.

Saturday, September 12, 2009

A Kettle of Hawks

Jakob was telling me about reality:

"It's like five bucks," he said. "But that's not what it's worth," he clarified for me. "That's what it is."


Then there was the woman who used to teach English and she tried to tell me that there weren't enough vowels.

"Well," I entertained, "If you take just the five vowels and combine them three at a time, that gives you a possible sixty combinations that could enter usage as your alternate vowel sounds, couldn't it?"

She looked at me as if I were crazy and insisted that it still wouldn't be nearly enough, and besides that it was just a ridiculous idea. She thought more alphabetical vowel letters should be created. That's when we silently seemed to agree to disagree.


You have heard that dismissive expression "But you could get a Grand Jury to indict a ham sandwich!"

But just you try getting them to indict a Reuben. Then it's all "Oh no, can't do that" and suchlike.


We were walking along the quiet section of The Avenue of the Pines in Saratoga Springs; the part where the pavement turns east but the old tree-lined avenue continues straight into town. It's all pine needles, shade, and big old trees.

"They sing," the person said, meaning the trees. They guided me over to a few trees, selected an appropriate one, and made me lean up against it, listening with the length of my back.

"Well I'll be," I said, "You're right."

I still hang out with that person a lot.



Nursing is all about the relationship between the patient and the nurse. If, for one reason or another, that relationship cannot be construed as therapeutic, then "nursing" does not happen. Instead it's some other sort of fucking miserable bullshit.

Saturday, September 05, 2009

Le Marteau Sans Maitre

One of my art teachers from decades ago described this tool as a "many-headed hammer."

There are never two sides to an argument. Or rather, there are never only two sides. That is why I crinkle and bristle every time I hear the phrase "both sides of the argument."

We all know that, yet the useage of the phrase persists and it is consistantly abused. Two opposing ideas are all too often inappropriately given equal credence.

For example, someone like Glenn Beck may assert that "the moon is full of laser-eyed Moslem beavers who pose an imminent threat to the safety of all good American families." An opposing voice says "no, it's a barren mini-planet and quite harmless, actually." And so the discussion may proceed, as if each idea were equally respectable.

It does not matter that we consider two sides to every story, because we all know there are as many sides as there are heads on the carver's hammer. What really matters is that the hammer has a master...

Not a clown wielding it.

Bourreaux de solitude

Le pas s'est éloigné le marcheur s'est tu
Sur le cadran de l'Imitation
Le Balancier lance sa charge de granit réflexe.


Executioners of solitude

The step has gone away the walker fell silent
On the face of Imitation
The Pendulum throws its load of granite reflex.

Rene Char, 1934.

This text was used by Pierre Boulez in his 1955 song-cycle Le Marteau Sans Maitre.

Saturday, August 22, 2009

Comparing Health Insurance Plans

A visual representation of the progressive Democratic plan:

(Seattle Childrens Hospital)

But the Republican are offering choice:

Monday, August 17, 2009

That Thing I Quit

I used to, as of a couple minutes ago, go to the Opinions section of the local newspaper and write comments defending reason and compassion. I quit. It's a waste of fucking time.

A great many of the people who write letters-to-the-editor and comments thereon are a bunch of fucking assholes who don't give a flying fuck about anyone, not even themselves. They may be uneducated on the topic of choice, yet they remain staunchly convinced somehow that they know much more than they make evident. And they are never so right as when they are completely and utterly wrong.

They are mean-spirited; more then that, they are in love with mean-spiritedness. It moves them to states of excitement.

And I am fucking sick of them.

They are Blake's pebbles. Let them have the world, their world, and let them ruin it for all of us. In that they will have their hell but call it heaven.

Thursday, August 13, 2009

Tire on the Mountain

Why yes, that would appear to be a worn tire.

On a Maserati, no less.

It must be the economy or something. It's interesting what you can see while walking through an example of The Great American Parking Lot.

Sunday, August 09, 2009

Banking No Crisis

After our trip to Sedona, the car was covered in red rock dust from prowling the dirt roads in order to get to hiking trailheads and scenic views. So yesterday we went to the carwash. Phoenix has a million of these.

It wasn't busy at all, considering it was Saturday. But I counted a dozen-and-a-half people rubbing down the cars.

As we stood under the misters sipping iced tea while waiting, I noticed that workers were running across the street to a parked vehicle. One still nearby us asked another "Where do we cash our checks?" He held his paycheck in hand.

In turn, workers would cross at mid-street to approach the white pickup truck, then they'd come back counting their cash. I even saw a woman come up to this impromptu check-cashing service after walking from a nearby apartment complex.

One of the young men who used this service was the blue-eyed shaved head dude who asked us about a miniscule windshield chip when we drove up to the carwash. Every time you get your car washed at a place like this, they always provide the additional opportunity to have even the tiniest almost invisible little ding repaired, knowing that a lot of auto insurance companies will pay for several of these fixes every year.

Point being, not every person who used the bank across the street appeared to be possibly undocumented.

Friday, August 07, 2009

For No One Dose

While sipping morning coffee (French-pressed,) in the proximity of spectacular Bell Rock, this occurred to me:

A few weeks ago at work I gave a patient an injection of Epogen, a drug frequently used by hemodialysis patients and others at risk for chronic anemia. It was a high dose, 40,000 units, but that's not unusual.

As I prepared the dose in the nurses' medication room, I recall thinking that one dose costs over $500, which is more money than I earn in a 12-hour shift of work. One single dose.

So when people talk about "holding down the cost of health care," I bristle at the thought that cutting nurses' compensation may be on their minds. Or at least reducing the meager yearly increases we are fortunate enough to get.

Us nurses, yes, we really are a bunch of lucky duckies.

Friday, July 31, 2009

Luceat Eis

Iz nise warmi sopt, OK?

A Charm of Finches and Away

The best and easiest way to fall in love with a person is to talk to them. You could also end up hating their fucking guts, but at least for a little while you will see that which is inside them deserving your love. Even if it isn't really there.

Red Molly loved James for more than just his '52 Vincent Black Lightning. She mistook danger for freedom. You see, that is how it is done.

As a nurse, there have been a few times when I have been with someone during the moment they died. One was a thirty-something young man who had already suffered an anoxic event that had destroyed his brain. His eyes were empty. Until he died. Then, as he took his final deep chest-filling breath, his eyes were full of all the people he had loved in his life.

I saw them, just as real as the words you see now. Then he exhaled and I saw them all swirl away deep down into his eyes, which then went dead again. For him I shut his eyelids. For them, too.

Dancing must be exhausting, because young energetic couples invariably begin by moving about quickly, then they gradually slow down, coming to a near-stop eventually. Then they wander off and sit by themselves or among others. That may be a critical difference.

What's the deal?

My spouse calls it insomnia. It's a satanic and discomforting affliction. Yet, it affords privacy.

Climb the church tower and hammer, hammer, hammer away at the bells. You will not break them.

Saturday, July 25, 2009

Three For the Festival

Catrin Finch

She's just released a recording of Bach's Goldberg Variations which she plays on the concert harp. It's an amazing transcription, but that's not the half of it. It's a great performance.

Julia Fischer

Recent recordings of Mozart and Bach concertos, among other things, are attracting a lot of attention to this violinist.

Muriel Anderson

Fingerpicker extraordinaire, harp guitar player, and also simply a great classical guitarist; this woman should be a household name.

Wednesday, July 15, 2009

Les Oiseaux Formidables

Nick Lane has written this wonderful book about ten iconic developments that occurred as life evolved on our planet of flux. P.Z. Myers has a review here.

I'm also working on Bach's Partita in A Minor for solo flute, transcribed by guitarist Denis Azabagic.

It's thinly textured, which seems to make it easy on the fingers compared to the thorny fugues found in Bach's solo lute and violin works. But therein lies the musical difficulty.

Saturday, July 11, 2009

Cheek to Cheek

Moira rarely shares space, which may account for her pickled expression. PorkPie rarely doesn't.

Saturday, July 04, 2009

La Deploration Sur la Mort de Ockeghem

Hat tip to AndyG. Story in the StarTribune here.

"Fireworks called Run Hadji Run were pulled off the shelves of a Wisconsin store after Minnesota Muslims complained that they were racist.

The Minnesota chapter of the Council on American-Islamic Relations (CAIR-MN) said that both the name and the packaging are demeaning. One side of the package has a drawing of Uncle Sam yanking the long beard of a man in traditional Muslim attire, while the other shows a Stealth bomber flying over a group of Arabs riding camels."

It's some little girl's birthday today.

Be safe, people, and stay the fuck out of the hospital.

A Party of Jays

Psychoanalysis takes a long time. Truth is elusive. The self is a chimera. People need to make a living.

We can only really speak meaningfully of things that exist. Perhaps we should put aside all discussion of promises.

We can devise a word or words for each thing that is discovered in our reality. Unfortunately, we can also devise words for things that have never existed and never will exist. This creates problems in language. These problems spread and evolve virally, becoming pandemic.

Once I knew a man named Lou. He'd had a stroke that destroyed his ability to speak, meaning that the Broca's area of his brain had suffered while the Wernicke's area was relatively intact. He could sing though. Bye bye blackbird.

I become deeply agitated upon seeing homes or buildings with complex roof lines. I absolutely could not live in such a place. No dormers nor gables for me, please. Please.

There are about five thousand breeds of dogs. Their innate ability and desire to interact with people subjected dogs to selective pressures to evolve in many different ways. Not so for cats. They only have about a dozen genes that are selectively manipulated by cat breeders for color, body style, etc. Cuteness, maybe.

Headphones on. Lights off. Feet up.

Sunday, June 28, 2009

A Knob of Widgeons

The poor old guy had been using an empty plastic cleaner bottle, for dish detergent or something, as an impromptu urinal. He was weak, suffering from congestive heart failure and a cardiac arrhythmia.

Anyway, he "got it stuck." He had been home for days with his penis stuck in a plastic bottle before he decided it was time to get into the system so he could get things fixed up. Maybe the bottle just got full.

At first the ED team couldn't effectively remove the bottle; they tried cutting it but this just left ragged edges in the plastic which tore into his sensitive member. Finally a talented urologist was able to remove the object without causing harm to the poor old guy.

Then his real treatment began. A diltiazem drip for atrial fibrillation and aggressive diuresis for his heart failure. A few ultrasounds showed that his anatomy was intact.

He had a daughter who lived away in another city. When she called to find out what had happened to her dad (she had been told there was a foreign object involved,) they handed the phone to me. They always do. Fuckers.

Religions are so anthropocentric. Science and evolution are not.

I think that if you practice enough introspection you will eventually come to realize that not everybody is like you. The more you explore the singularity that is yourself, the more you will be open to the diversity of all humankind.

Before you get so sick that you have to go to the local emergency department, you first have to build a hospital and train and hire the staff.

Music as we know it to be is not capable of self-replicating independently. It's more akin to a virus, which must enter something, a cell, before it can reproduce.

It now appears that the disequilibrium of protons around deep-sea alkaline vents may be the kind of energy source that enabled the first living things to occur. Disequilibrium is essential to life. Well, that explains a lot in my life, anyways.

We gave them paint and what did they do with it? They painted targets on things; everything, in fact. So let us not give them bullets.

Saturday, June 27, 2009

In The Pocket

PorkPie getting into the groove.

Friday, June 26, 2009

Once Upon Below

Hydrothermal Life Maker

From the February article:

Lost City is exceptional, Kelley says, because chemical reactions in the seafloor produce acetate, formate, hydrogen and alkaline fluids. All these substances may have been key to the emergence of life, according to work published recently by Michael Russell and A.J. Hall of Glasgow and William Martin of Germany. In addition, acetate and formate found in Lost City fluids may have been an important energy source for the ancestors of methanogens, microorganisms that live off the methane at places like Lost City. It's perhaps one more bit of evidence about where life may have originated, Kelley says.

This could very well be the sort of place whereupon, hundreds of millions of years ago, geochemistry evolved into biochemistry.

Tuesday, June 23, 2009

Jogging Blood Products

I could hear the whirring sounds of the pedals going 'round.

I knocked and entered the patient's room to check their vital signs again. They were sitting on the arm of the couch that each room has. For exercise we had provided them with one of those bicycle-pedal things, and the patient was spinning away.

They were also using the little hand-held barbells to work out their arms.

They paused for a moment so I could get new readings of their temperature, blood pressure, heart rate, pulse oximetry, etc. I checked the IV line to ensure that their transfusion was proceeding well. It was.

The patient was doing their work-out while they were also getting a fucking blood transfusion!

I will never again complain that I do not have time to sneak in a little exercise.

This particular patient has a chronic condition that requires relatively frequent hospital treatment. Needless to say, all of us nurses really admire their spunk. You have to respect a person who puts that much effort into their own care.

Friday, June 19, 2009


I haz its.

No, Thank You

"I don't believe it."

That's what the doctor said over the phone when Lori called him about Mrs. K. As if one of us would wake him up in the middle of the night just to fuck with his head a little.

"The other doctor is right here and I could have him read it to you," Lori told him. No, the doctor replied, adding that she shouldn't have bothered him about this, the patient had been having this pain all along, he had been adjusting her medications for it, and he already knew all about it so why was she calling him again. That sort of thing.

Mrs. K. had been in for an illness unrelated to chest pain and she didn't have a cardiac history. Her lungs were crap and we all know that can cause pain, but this was different.

"She says her pain is like a heaviness, she's guarding her chest, and I've never seen her do this before," Lori told the doc. Lori had ordered an electrocardiogram and had pulled labs off of Mrs. K.'s PICC-line. X-ray was coming up to do a quick portable chest.

"Who ordered all that?" the doctor asked Lori.

"It's a Telemetry floor, Doctor Phlegm. It's what we do."

Since he had declined to have the other doctor, a younger guy on his first hospitalist job, read the EKG to him over the phone, Lori suggested that they just fax a copy of it to Dr. Phlegm. He acquiesced to that, but still insisted it was no big deal.

Two minutes later he called back and ran off a breathless list of orders including labs, an EKG, oxygen, morphine, nitroglycerin, the chest X-ray, (all of which Lori had already initiated) as well as a drip and transfer to intensive care.

I got the story at seven in the morning when I got in for my shift and Lori was reporting off. She speaks with the tiniest bit of the most elegant accent. I don't think Dr. Phlegm likes accents.

They still had a copy of the EKG and it showed definite T-wave elevations in leads II and V6. Mrs. K.'s Troponin levels were twenty times higher than normal range, too. That's pretty much how you define and diagnose myocardial infarction these days.

Lori had nailed it. She did what all of us nurses live for, what we dream of doing; that is to say, she did her job. And all she got for it from the doctor was shit.

Saturday, June 13, 2009

10th Street Mission Slaughter

I will
Think of it as a compromise, or a mad flirtation.

Trois Pistoles

Sasha, self-exiled.

PorkPie iz warmie onn teh ampiflier.

U haz Bonz fur me Fechienne nowz?

Dimes and Punishment

There are different value systems. That which makes a work of art beautiful is aesthetic value. Ethical value informs good moral behavior. The so-called laws of supply-and-demand are said to regulate the value of goods.

Some people think that there is an underlying abstract "goodness" which crosses over from one value-system to another. In some ways I agree. My taste in music and my ability to determine what is "good" in a particular artistic style often informs my moral behavior.

The good in nursing practice consists of the same shadowy stuff as the good in a Lennon-McCartney song.

Having said that, there are of course problems in assigning capitalistic value to ethical, aesthetic, and other parameters of excellence or value. That perhaps is why capitalism cannot ever really work. It is in fact meaningless. Money is meaningless and in itself has no value. It's paper. It's numbers. It defies poetry. It is shit.

Precisely because it is itself worthless, incapable, and ugly; money is used as a medium of exchange.

Saturday, June 06, 2009

What the Rose Is

I am not easily disgusted. Perhaps that is one reason why I've been able to maintain participation in my profession, although I must admit that in my particular area of nursing practice I do not see a lot of trauma. Enough, certainly.

I medicated Jackie with a small boatload of Ativan and morphine before changing her arm dressings. A few weeks ago she had bumped her arm on a table while helping her son move into a new house. Because she regularly took Coumadin due to heart valve surgery years ago, she thought nothing of the bruise she developed on her forearm. Not at first, anyways.

Necrotizing fasciitis. It really doesn't occur all that often, thank the stars. Maybe a thousand cases each year in the U.S. Sometimes it takes a while for people to see that they have a big problem because early symptoms are typically just increased pain at the injured site and flu-like symptoms.

The pain is usually out of proportion to the injury, but pain is subjective. The disease is rare and even many emergency department personnel may not have seen examples of it. Unfortunately it gets missed; that is, until the swelling and bulbous blisters develop. Then all fucking hell breaks loose. Pandemonium.

The most common organism causing necrotizing fasciitis is Group A Streptococcus, which is basically everywhere and comes in a hundred or so variants. It can give you a sore throat or it can kill you.

Back to the patient: Jackie was watching one of those home-and-garden television channels. When I went back to her room after giving the drugs a few minutes to take effect, she began to tell me her plans for redecorating her hospital surroundings.

"I'd like to repaint the walls sea-green and maybe put in a water feature," she said in all seriousness. Then she pondered out loud about patterned material for new window drapes.

When I took morning report the nurse had warned me that Jackie freaked out a little when she initially saw her affected arm the day before when the dressings were changed for the first time after surgery. That's why I was somewhat generous with the drugs.

Oh fuck that. I'm always appropriately forthcoming with pain and anxiety medications. I work in a fucking hospital, for pete's sake. It's stressful for people. (Note to seekers: We can tell you're lying.)

The necrotizing fasciitis had affected her arm from elbow to hand. The outer aspect of her forearm had to be thoroughly debrided. The doctor, a local plastic surgery genius, took muscle and skin grafts from her thigh and reconstructed the arm.

If you are unfamiliar with these sorts of wounds it might appear as if someone took a blowtorch and a sledge hammer to Jackie's arm to make human meatloaf. I feared that perhaps she thought so. But upon my inspection, it actually looked good. Considering the circumstances.

I pointed out the neat lines of staples that secured the edges of the skin graft. The flexor digitorum profundus was intact and working for her and she could move her fingers. But the muscle over it had largely been excised. I explained that her arm would look as if a palm-sized half-inch of the outer aspect of her arm had been scooped away, and it could be lighter in color than surrounding intact skin.

"This muscle graft swelling will go down eventually," I told her, "That's why I'll wrap this up when we're done, and you'll keep it elevated on pillows."

"Oh, that's a nice print!" Jackie said, referring to the television show. "Can we use that for the pillows? Purple silk is so cool and comfy," she added.

I worked very slowly, explaining every step. Her fingers were good, uneaten by the disease. I carefully pulled away the petroleum dressings which had remained nice and moist. Using sterile technique I gently rinsed the wound, not that it really needed it.

We discussed new furnishings. "Maybe a solid lobster-red for the chair instead of that drab print," said Jackie.

"It's like you're reading my mind," I proclaimed. "I love that color!"

Soon the wound was covered with yellow sticky-moist petroleum gauze, covered and protected with sterile cotton gauze, re-splinted to prevent contraction, and wrapped just-right in ACE stretchy bandages.

Then on to the donor site, which was probably about the size of your computer monitor screen. "It looks good," I told Jackie, "And we can secure the dressing with this mesh stuff that you can pull up like a stocking over it. That way it won't fall down when you're walking." I think I used six, maybe seven, five-inch-by-nine-inch Xeroform dressings to cover the whole site then protected it with gauze and ABD's.

Usually plastic surgeons prefer to do these changes themselves; maybe have a physician's assistant or nurse practitioner do it. He must trust us. You have to be fucking careful as all get-out when you're working on donor sites. Very clean, very slow. If you accidentally pull up the donor site you can give the patient a wound that might never heal, and if you introduce another infection then you can just kiss everything off right there.

Same goes for the newly repaired and grafted site too, of course.

In the old days, maybe just twenty-five years ago, they would have just cut her arm off.

Later that day we sent her off the get a PICC line for home antibiotic therapy. She would basically be hooked up to a continuous twenty-four-hours-per-day Penicillin infusion for a month, which sucks a bit less than being one-armed.

She had a line of staples along her inner thigh from her groin to her knee, where they took donor muscle. "This doesn't even need to be covered, Jackie," I said. "But let me know if you want something thin over it so the staples don't rub on anything."

There. Done. Half an hour later she was sleeping.

My boss gave me one of those gift-card things we sometimes use for patients, and Maria the nursing assistant had a few minutes to run to the gift shop to get a little vase with a rose in it. She put that on Jackie's hospital table so she could see it the moment she awoke.

Sunday, May 31, 2009

All Together Now

It was swollen and about the size of a Twinkie.

About an inch in from its end was a little slit about 3/8ths of an inch wide. His scrotum was also swollen; to the size of a softball. Because of his severe phimosis he had developed yeasty infections under his unretractable foreskin. I think this was the root of his other problem: endocarditis. Maybe that was the origin of the infection. Anyway, he had huge mitral vegetation, like the one pictured here:

The urologist wanted to place a Foley catheter into his bladder. Usually that's a nursing task, but the patient had such an unusual anatomy the doc wanted to do this himself. We got a smaller sized catheter, but still he had difficulty passing it through the tiny foreskin opening and then into the urethra. I suggested some morphine for the patient, got the doc's okay, and in a couple minutes got it into the poor guy.

Unable to sense the urethra, the doctor looked up at me and said "You know, I think I'm going to need to do this with a Kelly clamp."

"And some more morphine?" I suggested.

"Yeah. A bunch," the doctor replied.

I like that doctor a lot. He's one of the best in the city. Patients, nurses, and fellow doctors like him too and his work is greatly respected.

I loaded the patient up on the flowery drug of dreams and he said he might even go to sleep later. The doctor wished him nightie night.

The guy couldn't help but remain awake though because the urologist had to insert the Kelly into the tiny slit opening of the foreskin, fish around a bit (there were a few drops of blood,) and then poke that into his urethra. He then opened the clamp a little to spread the target urethral opening wide enough and slid the Foley catheter on and into the bladder. Despite the morphine the patient was grasping the bedrails for all his life. He was in agony, and then...


The doc wrote his notes and I cleaned the patient up a little. Twenty minutes later he was fast asleep and maybe even showed a bit of a relaxed smile upon his face. That I like. I'm not the only one.

Past Lives

Pottery fragments. These we always leave back in place.

A room with a view.

Invisible from below.

Looking north.

This is a likely Hohokam site north of Phoenix and situated above a creek. One corner of it contains low wall wreckage that looks a bit to me like it may have been a storage bin for grain. Perhaps such a thing would be considered quite valuable and worthy of protection.

The Phoenix area is full of such sites, if one looks. The depth of history here is rather amazing.

When I was a child my 'rents sometimes took us kids to various historic sites. Fond memories for me, as I was and remain an inquisitive child. As a family we continue to do this, but we have kicked it up a notch and often explore unexcavated areas.

On the way home we bought jars of mesquite honey from a roadside vendor.

Sunday, May 24, 2009

We Walk

Dogs don't need roads.

View towards Granite Mountain.

This is why I do not kiss dogs.

Monday, May 18, 2009

A Descent of Woodpeckers

Before civilization crowded people into colonies and we roamed the land as hunter-gatherers, dogs would circle our little encampments. Gradually they entered into a domestic bargain with us: they would guard our camp in return for food and later, companionship.

Who invented the bowl? What genius created the first tables? Are there such wise and creative people living among us now?

When agriculture was established and storage bins of seed became necessary, so came our relationship with cats. They protected our stores from vermin, but they did not come to depend upon us directly to feed them until later when we adopted cats as household pets.

There now appears to be paleoanthropological evidence that the Neanderthals, who disappeared shortly after modern humans entered Europe 30,000 years ago, were eaten by us. We have not yet seen the end of cannibalism. It is essential to one of the great Abrahamic religions.

I think that the best way to approach otherness from reality is through the various kinds of art, literature, and music. Of course other people have different opinions and preferences; engaging religion, hallucinogenic substances, or even quantum physics in their endeavors to explore that which is not real.

This photo shows the interior of a megalithic structure which sits in a stand of trees outside Woodstock, Vermont. I have been in it myself. Long ago there were people other than "Indians" living in north America. Nearby
this same chamber
there have been found stones inscribed with ancient Irish script.

I tend to think of ancient homo sapiens as being just like us and facing the same problems in the same ways, for they were in all respects modern. How will we eat? What day is today? Where shall we go now? What do we do with the corpses?

Sunday, May 17, 2009

Saturday, May 16, 2009

Thursday Morning With Ray and Don

The Wednesday night report from the emergency department described him as "Dx GI bleed, coughing up red blood X3days, 20 yr hx heavy drinking." They'd sunk a nasogastro tube, got nothing, and sent him up to us in a wheelchair. That's usually a good sign.

His labwork showed an initial blood alcohol level of 330 on admission to the ED the night before. High enough. His hemoglobin/hematocrit levels were okay but they decided to admit him anyway. We were to do more serial hemoglobin levels and transfuse blood if he got low. The gastroenterologist would see him in the morning and maybe scope him. He could have Ativan if he needed it.

I stopped in to see this patient the next day, Thursday morning, as I was wandering the hospital hallways aimlessly. His IV pump was beeping so I checked it and everything was fine. We chatted a little. He said he'd been taking Naprosyn regularly for some joint problem that he was planning to have surgically corrected sometime. He seemed pleasant enough. Then I went off to do stuff.

An hour or two later, about 11 a.m., Portia pulled me aside and said that he was screaming at her that he wanted to leave.

I don't like it when people scream at my coworkers.

When I walked in to the room he was trying to get dressed and he said "Take this thing out," meaning his IV, so he could pull his shirt on. His face was beet red, he was sweating, and he was trembling.

"Oh," I said. "I know what's going on here. You're jonesing for a drink. You're withdrawing. Man, that cannot feel good. You look sick."

He was. Classic. Textbook. Either that, or he is a very good actor.

That's a still of the late great Ray Milland in The Lost Weekend. He won an Oscar for that performance, the best of his career. The film also scored three other Oscars: best director for Billy Wilder, best screenplay, and best film. It did similarly well at Cannes. Jane Wyman co-stars. I saw it years ago on television. It's stark and unpleasant.

But not as unpleasant as the real thing, I guess.

"This is a problem," I said to Don. ("Don" was the name of the lead character in The Lost Weekend.) "You could stay here a while, and we could help you through this. Really. We've got drugs that'll make this a lot easier for you. This could be it."

He said that he just wanted to go.
He had people to meet.
He was going to leave.
He didn't drink that much, two or three beers a day.
He hadn't had anything to drink in a week.
He couldn't just call and explain to whoever he was supposed to meet that he was sick and in the hospital.
He had to get out now.
He was hungry.
We hadn't let him eat.
He didn't need any tests.
He was fine.

That's only part of the story, of course. Those are just some of the words. I had a few words of my own.

"You're an alcoholic. You're white-knuckling right now. Every cell in your body is screaming. You drink enough to cause bleeding in your digestive tract. You came here because you were vomiting blood. That doesn't get better without treatment. You can go home and take Prilosec, stop the naprosyn, and hope for the best. But you could also stay here and I'll get you enough Ativan to take your discomfort away for a while." He continued to get dressed. Muttering. Barely controlling his anger.

Portia had already told me that she had gone through about the same kind of thing with him. That's when he yelled at her.

He denied an alcohol problem. I asked him about the admission note indicating he had decades of hard drinking behind him, and said he "didn't care" and he started to pull out his IV himself. I asked him to wait a moment. The he got right up in my face and I thought "this is it. He's going to pound the shit out of me," but he held off. I got some supplies and took it out right.

Then Doctor Fela showed up. He asked Don what had happened, and I answered instead.

"He wants to leave, Against Medical Advice, because he's going into withdrawal and he wants to drink," I said. Don agreed to sign the form before he left, saying that he refused any further treatment. Doctor Fela went on to do some documentation. I followed him down the hall.

"I'm sorry for speaking on behalf of the patient instead of letting him answer for himself, Dr. Fela. But you know what? He was just going to lie to you," I said.

"I didn't even really get a chance to see him," said Dr. Fela, but he added that he "couldn't help him anyway."

While Don was waiting at the elevator to leave I approached him again and told him to please come back to us if he gets sick again, and he promised that he would. He had a hint of sadness on his face. He reached out and shook my hand, thanked me, oddly, then left.

My spouse's sister did a few days ago. They weren't close. She was an alcoholic. Bipolar. Did other drugs, too, but it was primarily alcohol. She was found dead at home, blood running out her nose.

As we age, people around us start to die.




I probably would have tried to talk Don into taking some Ativan Wednesday night and on into Thursday morning. Oh well, fuck that, it probably would not have helped. He wasn't in the weeds yet then anyway. Fuck all.

Tuesday, May 12, 2009

Moira on the Mend

She goes up and down the stairs, hops up on chairs, and she doesn't appear to be too uncomfortable. She purrs. Her eyes smile. Peg-leg sounds when she walks.

A Sord of Mallards

When I get tired of being a nurse, I sometimes wish I had another sort of job. One in which my pay would put me in the highest of tax brackets. One in which I could always be wrong. One in which I could just make up shit and get paid for doing so. I suppose what I want then is to become a Republican political strategist.

People had many pets roaming about in their Medieval castles. Scottish deer hounds, cats, wolfhounds, Borzois, etc. These animals would shed, but in those times there were no vacuum cleaners. The shed fur piled up, only to be stomped down flat as people and pets walked about the inner courts. Thus, carpets evolved.

In the future we will mine what are presently junkyards.

An insomniac, I lay awake at night. Hour after hour my thoughts chase me. I think of things that I hate, counting these like so many sheep.

Over the years a faint ringing has developed in my ears. I should probably see a specialist about it, but it's so handy. It just happens to be a high C (assuming A=440Hz.) I use it as a reference note so that I can identify pitches. I do not have perfect pitch, but I can readily determine musical intervals and such.

From middle school on through college I took courses in musical theory, ear-training, sight-singing, transcription, and such. I play games in my head in which I musically notate things that I hear going on around me.

The thing that bothers me is that the ringing note is a C. I would rather that it were E-natural.

I called Senator Max Baucus' office and after five minutes on hold I spoke with a very nice-sounding young lady. I told her that I was a nurse and a member of CNA/NNOC (California Nurses Association/National Nurses Organizing Committee) though I worked in Phoenix, and I support single-payer universal healthcare insurance. I asked her to pass that along to Senator Baucus and she said that she would gladly do that. Then I wished her a good week.

There are people who never do anything themselves. They always get others to do stuff for them. The ones who never do things; well, they are never really happy. Not much. At least that's been my experience. They tend to be miserable fuckheaded louts.

Saturday, May 09, 2009

If At First, A Mother's Child

He was in an untagged van with maybe fifteen other border-crossers when it hit a pedestrian. By the time the police got to the scene most of them were gone; scattered and disappeared into the hot windless night.

Jaime was too weak and tired to run away so he was apprehended. At the Immigration and Customs Enforcement (ICE) center he kept on falling down when they tried to photograph him. That's when they decided to take him to the hospital.

His total CK's were over 65,000 (normal is less than about 200.) He had become so dehydrated and fluid depleted that his muscles were breaking down and releasing all this waste and muck into his bloodstream. He became weak.

He was a young and muscular guy. Six-pack abs.

His blood urea nitrogen was about four times normal and his serum creatinine was almost 8, which told us that his kidneys were waving the white flag. Because Jaime was basically a very healthy twenty-something dude, he responded well to treatment. That mostly consisted of running intravenous fluids like crazy and feeding him.

There was an ICE officer with him at all times. They were nice to him, meaning that they didn't keep him shackled to the bed.

He asked for someone who could speak Spanish so we asked our in-house interpreter to stop by. Jaime said he was feeling better and that he just wanted to go back to Mexico now.

If this was his first attempt to enter the United States illegally, they'd just take him to ICE after we were done juicing him up and getting his kidneys revived. They would fingerprint him, run the prints, and if there were no hits they'd take him to Nogales and drop him off on the other side of the border.

If he had a criminal record he'd be prosecuted. If this were Jaime's second or third attempt to cross in, he'd go to a federal prison for maybe five years.

It's better than being dead.

If he had not been apprehended and hospitalized, he'd have very likely ended up stashed in a drop house with dozens of other people until the coyotes could move them along further. He'd have gotten no medical care, little food and water, and most likely his condition would have deteriorated and he'd have died. Laying on the floor in a crowded room in a boarded-up house. Hiding. Dying.

Or if he became a drag on the coyotes, and if one of the coyotes were a fucked-up psychopath (not all that unlikely) then he could have been just taken out into the desert and killed. So the whole group wouldn't get held back by one sick guy.

If he were simply taken down to Nogales and he tried to cross again, with a body still weakened by a bout of severe dehydration, he could die trying.

I don't want to do the math. It would include the cost of Jaime's hospitalization and the hourly pay for the ICE officers who guarded him. Five figures easy.

I am not some anti-immigration hardass. I'd be happy to see the border gone actually. Then Puerto Penasco would morph into La Jolla. But we do have to face the facts, and that means looking at costs.

Uncom-pensated [sic] medical outlays for health care provided to the state’s illegal alien population is now estimated at about $400 million a year.

I don't know. Is that a lot of money? Probably not. All I know is that without help, Jaime would be either dead or on dialysis for the rest of his life.

Amended per Ruth's suggestion:

I wrote this up the day before Mother's Day, a progressive holiday despite the greeting-card industry. Do they have Mother's Day in Mexico?

Sunday, May 03, 2009

A Spring of Teals?

Charles Darwin was not a very nice man. In fact, he was a fucking bastard. So cruel was he that, if you die, he would consign your soul to everlasting torment for not believing in him and his writings.

Karl Marx believed that some people have more money than others, and because of that they behave differently. That was his heresy. That's why his name is a foul epithet.

Ninetta is accused of robbery. She is tried and sentenced to death, but just before she is executed it turns out that she didn't commit the crime; a magpie did. Rossini's 1817 opera La Gazza Ladra ("The Thieving Magpie") is anti-death-penalty.

Baseball would be much more interesting to me if they used bats, instead of bats, to swing at the ball. But I would feel sorry for the bats.

In my zip code there were 9 home foreclosures in 2007. In 2008, there were 66.

At some point we have to say "No more."

Tuesday, April 28, 2009

The Accumulation of Misery

I was at the nurses' desk giving report. It was evening change of shift and I was looking forward to going home, popping open a case of shells, and pumping lead into schoolbuses. No, not really. It had actually been a good day. I was just thinking that would get your attention. As luck would have it, the real story is much more interesting.

The secretary gave me that look and handed me the phone, saying "shrimpie, I think you had better take this."

"Hi," I said, "This is shrimpie, I'm one of the nurses." I never declare that I'm a charge nurse or anything, because who cares? I certainly don't.

"Hi. I, uh, just took a lot of pills. I think my bipolar schizophrenia has been acting up on me, and I'm depressed about the economy. I can't get work. I think I might want to just kill myself," said a young woman.

"I'm glad you called," I said.

The secretary jotted down the caller's number and handed it to me. Not from here in Phoenix. Deep out among the far reaches of fuck-all Lower Foreclosurestan.

We chatted quite a bit. After a while the young lady assured me that she would seek help. I let the house manager know that I'd gotten the call. I have no idea how that happened. Our little telemetry unit is no place to direct such a call.

The nurse manager suggested that we notify Phoenix police, but instead the oncoming charge nurse googled up the number of the law enforcement agency that works out that way. I spoke to a very nice lady there who said that they would send a car over to the address, which I had gotten after I called back the suicidal young woman. She told me her name too, and that the pills were diet pills. Those made her feel "a little shaky." But that was all.

During the second call, the one I initiated, I also spoke to the woman's brother who told me he would take her to a local hospital which happened to be a sister facility to ours. Some of my old colleagues work there.

I hope they were able to help.

This article on rising suicide rates reprises this salient excerpt:

“The law ... rivets the laborer to capital more firmly than the wedges of Vulcan did Prometheus to the rock. It establishes an accumulation of misery, corresponding with accumulation of capital. Accumulation of wealth at one pole is, therefore, at the same time accumulation of misery, agony of toil, slavery, ignorance, brutality [and] mental degradation at the opposite pole, i.e., on the side of the class that produces its own product in the form of capital.”

Tuesday, April 21, 2009

A Muster of Storks

If I ever go violently crazy (don't worry, I won't,) it will be because of the color beige. It drives me out of my mind. I hate it.

Cats in the wild do not "meow." They only do this in the presence of people.

There are materials that are very dense. This is fascinating.

The class was split about fifty-fifty. Half agreed with the professor that it would be good if you could just take a hypothetical pill that would give you all the benefits of sleep but without requiring that you take the time out of your life to do so. The other part of the class preferred to just sleep the good old-fashioned way.

Today is the tenth anniversary of the Columbine tragedy. I bought a copy of the new book about it. It's a bit creepy. I was shopping with my kid, who got the new Warriors of the Wild book that was just released. I saw the Columbine book and after I explained to them what it was about, they insisted that I buy it because they want to read it too someday.

Sunday, April 19, 2009

In Nomine

Pride in the name of love.