Saturday, April 23, 2011


She wasn't on the unit when I arrived at work in the morning because she had already been sent to Nuclear Medicine to finish up her stress test. The "stress" portion was done the day before and that was clear.

Though young and athletic (she was in fact a school gymnastics instructor,) she had come to the hospital for chest pains and was found to have an arrhythmia; rapid atrial fibrillation. She felt palpitations at home, took two aspirin because she had heard that was good for the heart, and a family member brought her to our doorstep.

She converted to normal sinus rhythm after being on a Cardizem drip for a bit; that was stopped and now she was to take this medicine orally. The cardiology physician's assistant had seen her and their service signed off. The internal medicine doctor wrote orders for her to go home. I provided educational materials on aspirin and cardizem. We had our most excellent dietitian chat with her about a proper cardiac diet. Unlike many people I serve, she was motivated, intelligent, and likely to comply. Everything looked good.

We weren't even going to wait for the nuke med results. The doctor said he'd call her later at home to talk about that with her. She was eager to leave the hospital because her son was playing a game that night and she wanted to be there.

I had removed her telemetry monitor and we were finalizing her discharge instructions; in fact, she was just about to sign a copy for our chart on her when my phone interrupted me.

I hate that.

It was the radiologist. The nuclear portion of the stress test showed a small reversible ischemia in the inferolateral area of her heart, at about four-o'clock to six-o'clock. Ruh-roh, Reorge. We had to stop.

If she infarcted it could look like this:

Big black holes aren't allowed. I don't care what Stephen Hawkings says. By the way, doesn't he look just fabulous in this early photo?

He's incredible. I love that guy.

When I called the cardiologist we received orders to hold up the discharge and consent her for a cardiac catheterization that afternoon. When I told the patient, she cried. I explained everything in plain but explicit and sympathetic terms. I spoke to my boss about her and they also saw the patient to console her and help her understand what needed to be done. The patient decided that she'd rather not bother and asked to leave and have the cath done in a few days on Monday.

She allowed me to run that by the cardiology team, but when I again called them they reluctantly insisted that the testing be completed before leaving. Aside from the legal considerations that's just proper medical practice. We are accountable to complete investigations of issues such as young healthy athletic people who suddenly and unexplicably develop cardiac arrhythmias.

"She knows this!" my boss said while talking with us at the nurses' station, adding "She's a bloody gymnastics teacher, for fuck's sake!"

Ah... that's my boss. Ever the subtle one. They're the best.

After phoning relatives (some of which talked to me on the phone so I could explain the situation,) she decided to stay.

She went to the cath lab at three p.m. and was done in an hour. In report the cath lab nurse said everything was clear and I heard the cardiologist in the background say that the patient could go home later. She had to maintain bedrest for a bit afterwards when she returned to her room on our unit. Generally she was gracious; very much so, and glad it was over and all she would have to do is take some aspirin and cardizem and see the cardiologist once in a while.

I had her out by six-o'clock. Just in time for her to get her son to his game.

Tuesday, April 19, 2011

Cogi Qui Potest Nescit Mori

When I know what to do next, I am generally satisfied.

The little time indicator located at the top right hand corner of my wonderful MacBook Pro says 3:53 AM. Insomnia. The radio has just featured The Pleasure-Dome of Kubla Khan, a masterpiece of American Impressionism. Yes.

The radio directs my attention. What to do next? Listen to it. It throws change-ups. This is rather a different listening experience than popping in a compact disc or selecting a download, because that involves making a choice.

When I got home from work last night at the very reasonable time of 8 p.m., I checked the mail. The snail-mail. It's part of my homecoming ritual. The mailbox was full of nice expectations realized. We got our federal tax return check. Also in the mailbox were a book and some CD's.

I wanted to get the check into the bank. I'm just like that. It could have waited until later this morning instead of last night. But, I do not wait. I just don't. Ever. Even the tiny pause caused by a mere grammatical comma thrusts anxiety upon me.

We listened to the opening track "Stamps." (My spouse had accompanied me to the bank teller machine.) I cannot successfully attempt to describe this music, except to say that is is jazz of a very far out kind. After the head there follows a group improvisation in a non-pulsatile gangly loose rhythm. The drummer shimmers and scoots over his kit without laying down a beat. The cello and bass thump and scratch. The two saxophonists wander about bumping into one another.

My spouse was dumbfounded but delighted. "It's so tight," they said. I was surprised by that comment because most people would probably hear randomness in it. At the college radio station I hung out at back in the day someone had written "spastic drumming" and other insulting misunderstandings on the cover of the original vinyl record. That had also surprised me, because I'd have expected the deejays there to have an understanding of such things. Oh well.

Who would desecrate such a thing?

A coward.

When I do not know what to do next, either one of two things generally happens: I become overwhelmed by the myriad of choices presented to me, as at work where I must make instant prioritizations amid a jumble of demands upon my time and skills, or I become bored because it is three-o'clock in the morning and there is very little around me to sufficiently capture my attention and I must fend for myself.

Boredom kills me.

Friday, April 15, 2011

Conscientia Mille Testes

I saw this over at Feministing and like all good ideas, I had to steal it.


Sunday, April 10, 2011

Juniper Well Ranch, Skull Valley Arizona, April 9th 2011


Four-wheel drive. The trunk of the juniper tree in the background is over three feet in diameter, which makes it rather old.

Snow on the charcoal-ash can.

The driveway to the cabin.

Contreras Road, a dirt country lane. Four miles from pavement.

No television, no internet, woodstove heat, and maybe two radio stations if the wind is right. About twenty degrees Sunday morning, and a sunny seventy-ish when we got back to Phoenix. Arizona is weird that way. We started the day in the midst of late winter and we finished it in the sunny desert warmth.

The kids and the dogs loved it. I welcomed the time to take a break.

We had recently spent a week on Oahu. I think the best way to deal with the let-down of returning from a trip is to take another trip. So we did.

Sunday, April 03, 2011

Astra Inclinant, Non Necessitant

Our sweet old Siamese cat died peacefully last night, snoozing off the running-boards of existence while in his favorite chair. We want to bury him on the property under a Meyer lemon tree we had planted there in honor of one of our neighors; a friend who died at his own hand. But we share this property with others.

There's a pool area out front with lawn and trees wrapping around it. That's where the lemon tree is. I don't want us to be caught burying a dead pet on the premises. I just don't want it to even come up for discussion with others. So we intend to do this under cover of night.

In the meantime, what do we do? Leave him in the chair? What if we have visitors?

"Wait wait! Don't sit there! That's where our dead cat is!" Do I want to have to deal with that?


In order to get a new patient onto our unit, another patient has to go. On rare enough occasion, a room opens up because a patient died. Then a new one gets the room.

I usually don't bring it up, for fear of how the conversation will go:

Me, "So I hear you were waiting all day in the Emergency Room."

Patient, "Yes, it was since I came in last night."

"Well it's a good thing that guy died when he did, or you might have ended up waiting down there for another few hours," I would answer. "But *I* wasn't that guy's nurse," I would quickly add.


This zero-after-the-nine thing I wrote about below is still bugging me. Yet now I have another problem to go along with it.

Suppose you write this:

(1-1)+(1-1)+(1-1)+... it ends up being =0. But suppose you write the same thing a slightly different way:

1+(-1+1)+(-1+1)+(-1+1)+... it ends up being =1.

You could substitute any number for the 1 (except zero... I think maybe,) and you'd still have the same conundrum. It's making me feel a bit paranoid, actually.

Friday, April 01, 2011

All the Lights Are On But the Blinds Are Down



One of the great pop bands from the past performing at the top of their game. Glenn, thinking fast on his feet, recovers instantly when he accidentally leap-frogs a line of lyrics (in the first verse he should have sung "the crew have abandoned ship" instead of "the little hand shakes its fist" which rightly belongs in the second verse.) I'd probably never have noticed without a few repeated listenings to the various live videos available.

They're still out and about. It would be fun to catch a show. I missed them the first time around in my halcyon college days, and now I certainly have a greater appreciation for their stuff.

I love the way the melodic phrases arch. Glenn's singing bobs and weaves.

So much rock/pop music today offers too little. Melodies, hookless, are hardly worth the name, chord changes are stale and unimaginative, mid-tempo rhythms lack drive, and lyrics are whiney and over-wrought with cosmetic sincerity. We need a "new" New Wave. STAT.