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."