Tuesday, April 25, 2006

Return to Sender

During my college years my best friend was a brilliant and artistic person, outspoken and strong-willed, but who constantly struggled with weight concerns. One summer they lost over 100 pounds, only to gain a fair portion of it back over ensuing months.

Later I came to understand just how typical this is, and I worked for a time in a hospital setting with bariatric surgeons and their patients. Now I am convinced that at this time the best treatment for many morbidly obese people is surgery; indeed, when I see a very large person, what I say to myself is not "that person needs to eat more sensibly," but instead I think that person needs surgery.

Many people do not understand this, and continue to think that diet will work for the morbidly obese. To such people I recommend this: go on a 1200-kilocalorie-per-day diet for the rest of your life, then get back to me. Good luck, and have fun.

Having said all that, some people are just fat obnoxious hate-filled pigs.

Like the patient in the corner room, whose call light was always on, whose family had continual little hissy fits over the most mundane things, whose nurse (thankfully not me) made every effort to please them and meet their needs only to get no appreciation for any of their efforts.

This patient was an unhappy sloth who saw it as their remaining life's goal to make as many other people also as miserable as possible, and after many decades of practice they had become quite proficient at this. And their younger family members, whose upbringing had convinced them that such ugliness was normal, played right along with it.

A sucking vortex of meanness and abject misery, plain and simple.

The day before yesterday was the patient's day to be discharged to whatever bright shining hell-hole they lived at, and the nurse was so happy in thinking that the patient would not be there in that corner room the following day. They rejoiced openly.

But on the way out to the stretcher van that was to transport the patient to their residence, the patient fell off the gurney and fractured a shoulder. They also probably broke a thumb, but the fear of a broken hip was ruled out on X-ray. The patient was re-admitted to the hospital and ended up in the very same room, much to the dismay of the nurse so assigned.

Paydirt. The mother load. Ka-ching.

Now the ugliness of their family misery was compounded by revengeful greed, and of course they've got a case.

Later that day I saw a couple strange-looking creatures, like the space lizards in Zathura only a little smaller, poking around until they finally found the patient and entered the room.

While they were visiting the patient did not put on their call light.; not even once, for about a half-hour. Then they wordlessly walked out and down the hall, eyes straight ahead.

Lawyers.

The surgeons decided that the patient was not a candidate for repair, so the plan was to discharge them the next day with a sling for their arm and shoulder. Naturally "I'm so glad I have tomorrow off" was the nurse's constant refrain.

Friday, April 21, 2006

Appearances

Sometimes you hear somebody resort to the old cliche "you can't tell a book by its cover," which in these faith-based anti-liberal hate-filled days of Republican screed is so not true... consider the epic tomes of Michael (fake name Savage) Wiener and Ann (Adam's Apple) Coulter, for example, whose titles alone eloquently save you the bother of actually reading the contents inside.

The Young One Who Pays No Heed to Parental Authority has lately ironically discovered, thanks to me, the songs of the Beatles. So the "White Album" has been in the CD player and as you know the cover of that doesn't tell you anything at all except the name of The Beatles when that was who they were.

Plain white wrapper, music of glorious beauty and variety inside. Who'd 'a thunk it?

He had been bleeding from the moment he returned from the operating room. The doctors had surgically incised a few cysts from each armpit. I didn't see any external sutures. Looked like they slit each open, espressed whatever ooze was in these, (there were a few) and then sent him back to us.

He wasn't my patient, but the looks on the faces of the nurses involved told me to take a stroll down that way. My little team was under control, which I rarely have the pleasure of saying. I'm a magnet for the most unpleasant things usually. Feces, degrading cardiac rhythms, sagging blood pressures. That's my ilk.

The patient's nurse, a nearby nurse, and the admission/discharge/transfer nurse were all taking turns holding pressure on the guy's armpit, but it was still oozing a steady trickle of blood. I brought a few boxes of 4X4 gauze. Then I took a turn myself, holding pressure with a wad of gauze while his nurse injected morphine.

He was talking on the phone while holding his left arm straight out above shoulder level to his side, so we could try to soak up the blood trickling from his armpit. Blood was on the sheet under his arm.

"Careful, he's HIV," said his nurse to me. She looked like she was about to cry, but it wasn't an emotional thing. She was fronting down a case of double pink-eye. I was properly gloved.

Once every few minutes I'd peek under the gauze to note the trickle. The A/D/T nurse spelled me, but I came back later to hold pressure again and see how things were going.

The surgeon who excised the cysts was off, so he told the nurse to try the on-call trauma surgeon, and he just said that he was 45 minutes out and to "hold pressure." The nurse explained that we had been doing that for like over an hour but he had no more to add.

The medical doctors she tried to call deferred it to surgery, but eventually a medical resident showed up and wrote orders for blood pressure meds (170/105 last, 205/110 before going to the OR.) He also ordered some STAT labs so we could check the anticoags and hemoglobin.

A little blood goes a long way. I was holding pressure again when the ADT nurse spelled me and I took a look at the blood.

It looked like blood.

Sure, it was HIV positive and Sam knows I wouldn't want to take that home with me. But it looked like plain old blood and nothing else.

After a couple hours of various nurses holding pressure on a one-centimeter-length armpit incision, it finally eased off bleeding. They'd wrapped a wad of gauze with kling to hold it over the wounds, and no blood was visible. He had his arm down.

I wondered. The next time I have a patient with uncontrollable bleeding from the armpit, I will have him hold his arm down. I do not know why; it's an instinct thing. I mentioned it to the guy's nurse, but it didn't really seem important. It's probably nothing.

"At night all cats are gray."

To which I might add: "At night all black Labrador Retrievers are... gray?!"

Sunday, April 16, 2006

It's About Time For One About Nursing

You want a chocolate cake, fine, I know a dozen recipes just off the top of my head because when I was about 10 years old my mother got sick of me asking for cake and told me to bake my own, We pulled the old Betty Crocker batter-stained cookbook down and from then on I was the family cake wholesaler.

But I'm no pastry chef, and we wanted to make apple turnovers so we went to the local gourmet market to get pre-made pastry and a snack.

Nice scene at lunchtime. A musician outside. An outside sandwich grill going, too. As well as the usual mid-Phoenix scenesters and characters: the tall newsguy dude we feel sorry for, the guy with the Bouvier de Flandres dog, and other regulars.

I think I recognize a woman at a table with others as we settle into an outdoor table ourselves. I sat at the opera next to her last year, and she cried out loud when Magda stuck her head in an oven.

I listened in as they talked about job turnover wherever it is that they slave away their weekdays, and I noted that she had a baked apple smell about her. Perhaps it was the perfume she wore to the opera also? Maybe not. Who wears apple perfume?

In the twelve years I have been a registered nurse I've held seven different positions, most of which have sooner or later involved bending over and grabbing my ankles with my hands while keeping my knees locked straight.

Old joke. But what isn't really funny is this:

"America’s nursing shortage has worsened and is eroding the quality of patient care. A recent study found that 60% of registered nurses are now over 40 years of age and projects that if present trends continue, the nationwide shortage of nurses will exceed 400,000 by 2020. According to the Acute Care Hospital Survey of RN Vacancies and Turnover Rates report by American Organization of Nurse Executives, the average RN turnover rate in acute care hospitals is 21.3% with an average nurse vacancy rate of 10.2%."

When I first came back to the city of Sonoran Tile-Roofed Endless Sprawl, I had been recruited by a large metropolitan medical center. Even though they gave me an appreciable relocation bonus of well into 4 figures, I quit before my orientation ended and I returned the bonus.

Is there a statistic for that? Is it called "nurse turnover" if you quit while still an orientee?

On one of my training shifts I witnessed a perfectly decent nurse, my preceptor in fact, drop a pill on the floor only to pick it up and administer it to a willing patient. So what? you may ask. Five-second-rule and all that.

Not me. Not my style. Okay, so sometimes I bark at the moon and scratch my ear with my foot. But, I don't eat off the floor.

Later that same shift one of the other nurses was talking about shooting cans with his new gun. He went on to say "You know, Mexicans, Africans, Puerto Ricans... Creeped me out totally. And besides that, he kept looking at me funny.

So I quit. That was a Thursday. By Friday afternoon I had completed a couple few interviews, caught up on my sleep, and landed a job that matched the sign-on bonus and even paid a little more in salary.

Of course you may think that the magic invisible hand of the free market, guided by the infallible laws of supply and demand, is responding to these issues of nursing turnover and shortages. Then again, maybe not.

"According to the National Council of State Boards of Nursing, the number of first-time, US educated nursing school graduates who sat for the NCLEX-RN®, the national licensure examination for registered nurses, decreased by 10% from 1995-2004. A total of 9,353 fewer students in this category of test takers sat for the exam in 2004 as compared with 1995."

On my next job, the entire staff of my little 28-bed telemetry unit turned over during my first year there. There were days when I was the only worker on the unit who was not an agency nurse who had just come in for a shift. We went through travellers like Mike Tyson went through ears.
The second year, during a meeting the director of nursing informed me that the turnover rate was only 87%. Much better.

Then she got canned, and my unit supervisor left. He was the guy that had hired me, and I always liked him. His replacement lasted a few months, then the "new" director of nursing was also let go. Sometime during all this we purchased Shrimplate Manor in the central corridor, and I wanted to work at a place closer to home.

I called the guy-who-had-hired-me ex-supervisor, and he insisted I join a specific organization. Before I could even finish my online application, they were calling me, and soon I was working at The Great Muffin Factory.

The turnover rate here is probably about normal, which is to say a lot less than 87%, but I see people come and go.

Things are much worse in nursing homes and long-term-care facilities:

"In May 2005, the National Commission on Nursing Workforce for Long-Term Care released Act Now for Your Tomorrow report which found that there are nearly 100,000 vacant nursing positions in long-term care facilities on any given day, and the nurse turnover rate exceeds 50%. The shortage is costing long-term care facilities an estimated $4 billion a year in recruitment and training expenses."

There was a time when I did about a nine-month part-time stint in a nursing home back in The Dismal Wilderness. I went to work never knowing if it would be an 8 or a 16-hour shift, because if your replacement didn't show up, you had to stay all night. I didn't know much what I was doing anyways, having just come out of school and off an intensive care aide job where I had become familiar with cardiac medications but knew relatively little about stool softeners.

As trends continue, there will be more patients and fewer nurses, which will only increase nursing turnover rates and shortages, as well as good old-fashioned burnout.

It might be different if the magic invisible hand of the free market would respond to increased demand for nurses and retention of nursing staff by actually, you know, paying them more. But where oh where would we ever, as a society, find the money to do this?

Oh, I dunno, maybe here:

"Iraq was awash in cash - in dollar bills. Piles and piles of money," says Frank Willis, a former senior official with the governing Coalition Provisional Authority. "We played football with some of the bricks of $100 bills before delivery. It was a wild-west crazy atmosphere, the likes of which none of us had ever experienced."

We could abandon our notions of pre-emptive wars for oil fought against third-world countries, and in so doing usher in a new period of responsibility and commitment to the healthcare of our fellow Americans, or, as Theodoric of York, Medieval Barber would say, "Naaaah."

Wednesday, April 12, 2006

What Can VooDoo

Sure, many of us live within walking distance of local grocery stores and such. Or within a bike ride to get to work.

"Ervin Goodall, 56, a professional driver pumping supreme grade into his large sedan, was paying $3.29 a gallon.

"It's lot higher than last year, a bigger hit," said Goodall, who added that when it comes to personal driving he's scaling back: no more Saturday day trips."


The modern era of cheap fuel will not be saved from eventual certain oblivion even if a few of us make the ultimate sacrifice of cutting back on Saturday fun drives.

From this article on today's front page. The price of gas is creeping upwards, but drivers are not really cutting back. After all, how can they? Especially in the sea of tract-home suburbia we have lately created for ourselves? We have spent half a century developing a lifestyle that requires we must first drive in order to do anything.

It's like what Tracey Walter says as "Miller" in Repo Man: The more you drive, the less intelligent you are.

As applied to entire societies; well, yes.

Will the suburbs be abandoned and lapse back into fields of roses and local produce? Will the central core of city buildings grow tall and shady, filled with people who pedal to their jobs? How much will that really accomplish anyways?

Yes, I can walk to Basha's, but the avocados cannot. Nor can the coffee beans and the half & half.

Sunday, April 02, 2006

Four and More (Infomercial)

In my humble small kitchen, this Chroma 301 santoku is the knife I most often find myself using. It's blade maintains sharpness enough to get one through both episodes of Kill Bill, but I still have a Chantry sharpener at hand for regular blade maintenence. It's easy and it works on everything. I've never much liked the traditional knife steel. It's too easy to get the wrong angle.

I also like a traditional chef's knife, but I prefer a somewhat smaller blade, that being a simple six-inch chef knife. The bolster on the Wustof is thick and safe. Compared to other German cutlery, this style of bolster is much less threatening, even if Messermeister blades are themselves a little harder. If you compare bolsters you see what I mean.

The Chroma" knives I like have a nasty little sharp edge where the bolster would be if these featured ones. Instead these have a little "pearl" that juts from the handle to guard against getting the hand too forward to the blade.

I'm OK with this, but I have my young one use a German knife. They have their own little four-inch chef's knife which they are very proud of, and though I'd prefer a thicker bolster, they wouldn't trade their blade for any other at this time. Radish trimming. Kinda fun, really.

They picked it out at the kitchen store all by themselves, with good advice from the store cooking coaches. My little one sees no need for the Santoku style blade; instead, moving right up to the traditional cleaver, good for big jobs like quartering a chicken or working out the final episodes of the opera Salome.

We decided that knife blocks took up too much precious countertop space, so we have a magnetic knife rack. Looks way cool, and the blades are easier to inspect for cleanliness. I like the way these look stuck up against the wall above the counter, and it's way better than dulling them in a cutlery drawer.

And now back to our regular programming:

How much money has the Iraq war taken from your pockets so far?

Tuesday, March 28, 2006

Learners vs. Non-Learners

It has lately come to pass that the word incompetent is the single term most likely to be associated with President Bush. It's about time. Those of us who were aware of this all along are quite happy to find others catching on. Yay, team.

"Brownie, you're doing a heck of a job."

— Praising Michael Brown, director of the Federal Emergency Management Agency, the morning after he revealed (in a network television interview) that he did not know about the thousands of people stranded at New Orleans' convention center until a day after extensive media reports on the situation. (Washington Post, "FEMA Director Singled Out by Response Critics", Spencer S. Hsu and Susan B. Glasser, Sept. 6, 2005.)

Incompetent, and also unaware of it. Yes, this has been rather thoroughly discussed among the Atriots and other real bloggers, but I will chime this bell repeatedly until I hear the mainstream media taking it up as an acceptable narrative. Or until hell freezes over, likely first.

We argue that when people are incompetent in the strategies they adopt to achieve success and satisfaction, they suffer a dual burden: Not only do they reach erroneous conclusions and make unfortunate choices, but their incompetence robs them of the ability to realize it.

Snipped from a nifty study put out by the Journal of Personality and Social Psychology a few years back, which you can see here if you like.

It so applies to our current assinine dunce of a president.

And again, thoroughly discussed by the Atriots, god bless 'em all. I just love those people.

The essence of it all is that some people just do not learn from their mistakes. Most of us do. Bush does not. He's one of those "doomed to repeat it" kind of guys. Plus, he's a psychopath, so even if he could learn from mistakes, he wouldn't care if he did, and he wouldn't bother unless it accrued him greater power or ability to command misery upon others.

**********************

The Epic of Gilgamesh is probably the oldest written story to have come down to us over lo so many centuries. Interestingly, part of it involves a pre-emptive attack on a "monster" which turns out very badly for the hero, as his best friend Enkidu (who apparently has the sexual stamina of an ultra-marathoner) is subsequently taken from Gilgamesh and killed.

Let's recap, shall we:

The mighty hero Gilgamesh who somehow fashions himself part-divine pre-emptively attacks a Middle-Eastern "monster" and this turns out badly for him and his nation.

I read Gilgamesh when I was a highschool student. Bush, not much of a reader himself, has probably not been exposed to this. The oldest story known to mankind. And if not exposed to it, how could he then learn from it?

Well, not at all. Which just happens to be the same way he learns from things he has been exposed to. That is to say, not at all.

He just doesn't learn.

Because everything is going OK, and no mistakes have been made, and even though New Orleans was drowning and its population devastated and dispersed, everything was just swell. In Iraq every day more of our young soldiers die senselesly, but this is progress in the minds of many in this Administration.

He screws up, but he thinks everything is just fine, because he is unable to see otherwise. He's blind.

And naked. And, to tell you all the sad truth, quite small, if you know what I mean.

Tiny, in fact.

Miniscule.

There remains a schism between two types of people in the world: those who learn from mistakes, and those who don't.

We apparently now are ruled by those for whom a thousands-years-old story holds no lessons at all. They don't get it, and they never will, because they do not learn, and besides that they are incompetent psychopaths.

Get into the groove, patriots. It's still your country, and mine.

The Sign Says Not to Feed Them

They look just like you and me, but they have no emotional center, no way to put the brakes on their wants and desires. They are not burdened by care for others, and they are quite willing to exploit the empathy of other individuals if this will further their own selfish aims.

"It has often been noted that psychopaths have a distinct advantage over human beings with conscience and feelings because the psychopath does not have conscience and feelings. What seems to be so is that conscience and feelings are related to the abstract concepts of "future" and "others." It is "spatio-temporal." We can feel fear, sympathy, empathy, sadness, and so on because we can IMAGINE in an abstract way, the future based on our own experiences in the past, or even just "concepts of experiences" in myriad variations. We can "predict" how others will react because we are able to "see ourselves" in them even though they are "out there" and the situation is somewhat different externally, though similar in dynamic. In other words, we can not only identify with others spatially - so to say - but also temporally - in time. "


They realize that they are different, yet also generally play-act as if they sincerely do have the same feelings the rest of us have. They wear the "Mask of Sanity." This can be stressful for them, though, and tell-tale slips often occur.

"Our enemies are innovative and resourceful, and so are we. They never stop thinking about new ways to harm our country and our people, and neither do we."

—Bush addressing a group of witnesses at the signing of the Defense Appropriations Act for Fiscal Year 2005 in Washington, DC on Aug. 4.


The article linked above even contains a suggestion that the psychopath is a new kind of hominid, with the survival advantage of lack of a constraining conscience. That scares the heck out of me, and I'd hate to see what the planet would end up like after Homo psychopathosis became the dominant species on our once-fair Earth. I don't think it's yet too late for us to take our country, all countries, back from these monsterous people.

The points bearing repetiton here are that psychopaths are all around us, and they are making a miserable mess of things, and we should do our best to recognize and contain them. We should stop electing them. We should see to it that their political party ceases to have power over us.

This next quote comes from one of the comment moderators for the political blog called "Red State," which was at the center of the fleeting Ben Domenech fiasco at the Washington Post.

"For the record By: Thomas

I repeat: Should the entire American Left fall over dead tomorrow, I would rejoice, and order pizza to celebrate. They are not my countrymen; they are animals who happen to walk upright and make noises that approximate speech. They are below human. I look forward to seeing each and every one in Hell.

To those conservatives who couldn't wait to find wrongdoing where none existed: Gee, funny you didn't get all hyped up about this with Bob Bork. Or Sam Alito. I guess maybe your common sense detector -- or decency reserve -- only kicks in when it gets you something you want?

You're all dead to me, as well. Too bad: One lady in particular was a favorite writer of mine. Ah, well.

If this is mastery, then I'm a donut. - Mike Krempasky


Personally, I think it might very well be that "Thomas" is himself a bit of a psychopath. In that quote he certainly espouses the tone of one. If you hold your nose and peruse that thread you will see that other posters there call him to task, but with the expected futility.

A psychopath of the more severe variety could slaughter a whole dormitory full of schoolgirls and similarly order a pizza, no? And the projection is also a common sign amongst these unholy bretheren; to repeat Thomas:

I guess maybe your common sense detector -- or decency reserve -- only kicks in when it gets you something you want?

I believe he might be trying to tell us that he feigns common decency only on occasions when it would appear to be advantageous for himself. And of course, he tries to weasel out of things later by posting this:

Properly, by the way, I was not "expressing approval of harassment, arrest, immprisonment, torture, or death of liberals and Democrats." I was stating preemptive joy at the sudden, accidental death of the American Left. I'm frequently told by liberals that liberal does not equal Left; I took that as a given.

Yes of course, that's much better. Whatever.

Anyways, the next time you get flamed by some illogical rightwing freeper-type keep in mind that they are most certainly a psychopath. Treat them as such, protect yourself, and above all, discourage their reproduction, both figuratively and biologically.

They have also their disadvantages. They are predictable, they are unclear in their desires, except perhaps to repeatedly harm others, they can be sloppy, and they can be beaten, as they must be.

Satire Over a Cliff

Craig Cantoni (see link below) recently wrote:

"You might think this is a leap of logic, but the installation of new digital cameras and recorders costing $1,400 apiece on 85 Scottsdale Unified School District buses is a symbol of social decay and a harbinger of the nation's eventual demise ("Schools upgrade cameras on buses," Scottsdale Republic, March 2). "

Leap of logic?!

No.

Well, lemming logic, maybe.

So you see, it's not the deficits, which have saddled every man, woman, and child in the U.S with $30K of debt each.

It's not the way the Bush administration has chiselled out whole sections of the Bill of Rights and tossed the rubble into the cold and dirty Potomac.

It's not the failure of our government to yet fully investigate the 9/11 attacks and explain the odd implosion of WTC 7.

It's not the rampant corruption of campaign financing, not the outing of CIA agents, not the immigration issue, not our failure to fund healthcare for the neediest among our fellow countrymen, not the dismal failure of a war in Iraq, nor is it global warming.

It's our misguided devotion to school bus safety that is tearing at the fabric of society.

If Dave Barry were to take over writing columns for Craig Cantoni, yet maintaining his byline, I suspect many people would not see any difference.

Wednesday, March 22, 2006

All Alkaloids End With "ine"

What is pain? How does it work? Downy duck if I know. And I even suppose that I don't care much.

Having said that...

I am rather generous with pain medications. I've worked with enough really hurting people to realize that an amount of pain medication that would probably kill you or me or your average Bengal tiger in a trap does not always relieve the pain of someone like that little old lady in the halo. You know, the one who went through eight 30-milligram Dilaudid PCA cartridges in one twelve-hour shift when I worked with her a few weeks ago?

Chest pain. Tell me about it. I basically don't even bother with sublingual nitroglycerin anymore. Bad habit, you think? Maybe me too.

But if your mother had chest pain rated at an 8-out-of-10 and I gave her a sublingual 0.4mg dose of nitro and took her blood pressure and it was 180 systolic, and then I went and fixed another patient a cup of tea and changed out the bed of a bowel-prepping 95-year-old demented nursing home resident who just luckily came to stay with us, and then came back to your mommy and her chest pain was now a 9 and her pressure was still 180 and I gave her another nitro, you would be very happy, no?

Because I was following protocol.

So I then go answer a call light and take a 50-year-old retired NBA star to the bathroom because he's "afraid to go by himself" and eventually get around to your mommy again, after fielding a few phone calls from out-of-state distant relatives who don't even bother to identify themselves but want to know everything about their dear uncle's condition because they're from Connecticut and they can't get there but federal healthcare information privacy act legislation prevents me from acknowledging that dearest uncle is even a client of ours and they insist that I tell them anyways and I politely apologize and they further insist that I get my manager and then I "accidentally" lose their call so I can see how your mother's doing with her chest pain.

Yes, I do that.

No, I'm not proud.

But there's only so much time in the day.

She looks OK on the monitor, sinus rhythm in the 90's and her pressure's down into the 140's and you're holding her hand but her pain's still a "5" so I go get a couple milligrams of intravenous morphine for her, administer it over a little bit, like a couple television commercials (one of those daytime "judge" shows is on the room TV) and it makes the pain almost entirely go away and your mother says she'd like to take a little nap, but she has a headache (from the nitroglycerin,) so could I get her something for that?

So I get some tea and tylenol and and fifteen minutes later she's sinus rhythm in the 80's and her pressure's 136/80 and the stupid judge just gave the ex-boyfriend his car back when he was plainly being a jerk about the barbecue sauce on his girlfriend's new white shag carpet and her other boyfriend stole the car to pay for the carpet cleaner and was going to give it back anyways, after he got back from Austin because he had to visit his other girlfriend who was sick there. You know, that story.

Sometimes I just go get the morphine first and skip the nitroglycerin completely, and the patient says "thank you" and they get a few moments of precious relief before they go off to the cardiac catheterization lab to get a few stents placed.

There's enough pain in the world. We do not need more. Morphine's cheap and I've got a ton of it in the Pyxis down the hall.

Oh wait... we don't have a Pyxis anymore. Some other thing. Whatever. Some pricey medicine dispensing machine.

Friday, March 10, 2006

Why I Use Brass Knuckles At Work

This comes from a recent LTTE in our locally renowned and ever-useful ink-smeared forest by-product:

"Three years ago, I worked a whopping nine days at two Valley hospitals before I quit for greener pastures. What I saw was two ERs filled with people with the sniffles, sunburn, minor headaches, paper cuts, watery eyes, etc."

No doubt.

I am certain of this not because I myself work in an emergency room flooded by uninsured people who have no other outlet to which they can go with their minor and often non-existent medical issues. My certaintly comes from my experience with such people who manage to actually get fully admitted to my particular work area.

People may be uninsured and deranged, manipulative, a bit stupid, and desparate. But after a couple-few emergency room visits, some will learn that if they exaggerate or outright fake some symptoms, they are in and a heavenload of nitroglycerin, morphine injections, lab draws, X-rays, stress tests and if they really hit pay dirt, a trip to the cardiac catheterization lab await them, luminous in full glory like Saint Peter's gates. And there is our three-star cuisine, of course.

The sugar-free apple pie is very popular.

Finally a day or two later some sympathetic but discerning cardiologist will rub a knuckle on the patient's sternum, note the outcry, write in their sign-off note that the chest pain is "atypical and reproducible," and the hospitalist sends the patient home, if they should happen to have one.

But the next time the patient shows up at the emergency room complaining of severe chest pain that goes down their arm, the knuckle-on-the-sternum trick earns nothing. Because now they know.

Sunday, March 05, 2006

Waters of Babylon

The good news is that huge new areas of coastal playland will become available upon which the slimy rich will put up new vacation-get-away dachas. But the bad news is that other areas will be adversly affected by rising sea levels and climatic instability.

This nice new real estate will be on the lovely continent of Antarctica, already noted for its fine five-star amenities and friendly and colorful locals.

"Those same areas have lost an estimated 5,500 square miles of ice in the last 30 years, calving icebergs the size of Belgium and Rhode Island. In 2002, an entire ice shelf collapsed into the sea.

But the newest work signals a broader loss across the entire continent — an amount equal to more than 13% of the annual sea level rise measured in recent years, the researchers said. The shrinkage is concentrated in the West Antarctic Ice Sheet, which has enough fresh water to raise sea levels more than 20 feet."


That's a lotta feet. Way too many for other coastal places. So say good-bye to Venice.

And Boston.

"Their research shows that over the next century, damage to residential, commercial and industrial buildings and their contents in metropolitan Boston (an area stretching from Ipswich to Duxbury) could exceed $20 billion, depending on how the city responds to rising sea levels. Costs could run as high as $94 billion, if climate weather conditions are more severe than expected."

Say good-bye to Florida and Louisiana. What's left of Louisiana, that is.

"Moreover, a rise in sea level would increase the exposure of many communities to storm waves. This poses a significant threat to low-lying urban areas. At particular risk would be many areas of southern Louisiana and Florida -- the highest point in Florida is only 53 feet above sea level, and the Florida Keys are all less than 10 feet above sea level. In addition, the low-lying barrier islands off the North Carolina coast already are highly vulnerable to the damages associated with storm waves, a phenomenon that will experience increasing stress as sea level rises."

Say good-bye to Manhatten.

"At our Global Initiative, which the Mayor mentioned, in New York around the opening of the UN, we were told that insurance losses from severe weather events in the last 10 years were triple those of any previous decade in history. And I know that if the climate warms for the next 50 years at the rate of the last 10, rising sea levels in the North Atlantic will claim at least 50 feet of Manhatten Island. It might good for the value of the real estate that is left there, but it will be a very bad thing indeed. It will be a harbinger of changing of agricultural production patterns, millions of food refugees created throughout the world, intense disruptions."

It just gets worse. Say good-bye to Beacon's Beach, too. Right sad, the loss of that.

Wednesday, March 01, 2006

Drought

The play was to open that very night, and I was to act as one of the leads. The character was a good fit for me. I was costumed in a black shirt, black pants, black boots, and a black beret. I was also to wear black-framed horn-rim eyeglasses, and I would play a philosophical type.

But I had not yet read the play nor learned my lines.

I flipped through a copy of the script, but I couldn't even find my entry points. And none of my speaking lines. So I just decided to wing it.

As this was a play with occasional musical numbers, I had a song. Of course I didn't know what it was, so when the pit band began and the conductor cued me I improvised a plaintive lament in a minor key, singing with the shattered passion and pianissimo yearning of Blake's wild tiger confined to a depressing zoo, my voice moving in a range narrow as the opening measures of the Rachmaninoff Third Piano Concerto:

This is my philosophy,
its time has come.

It is no philosophy
just for me,
It is no philosophy
for two or three.

It is a philosophy of one.
It is love.


The other players on stage and in the pit were aghast. The audience, however, was relatively clueless as to the improvisatory nature of my dirge, and they came around to the mournful tune and clapped. Routinely enough, like they wanted things to move along to whatever was supposed to happen next.

I woke up with the tune in my head still.

It was a work anxiety dream. I've had these ever since I can remember. But this one had a happier ending than most.

Often I wake up perplexed and exhausted by dreams of impossible workloads, shifting responsibilities and priorities, and interpersonal conflicts gone unresolved. Then I go off to work where it's just the same but real and wakeful.

We sat on the couch and drank our coffee, sharing dreams, before the young one was up and about. My spouse has been going through a series of death-avoidance dreams. I listened to their dream, then recounted mine and sang my sad little cavatina.

It was a cloudy morning with the smell of rain in the air, but none came.

Friday, February 24, 2006

Shoes the Boss

Esophagogastroduodenoscopy. Say that three times fast. We just refer to it as "an EGD," and actually it's not much easy to say that three times fast, either. Anyways, his showed a little esophageal scarring and no active bleed, his bloodwork was stable, so he got a ticket home.

But he couldn't find his boots. "Black and size 9&1/2," he said, adding that he thought somebody had stolen them. Not bloody likely. He was a nice enough guy, very gracious, and I genuinely liked him, but there is probably not a junkie in the city that would steal anything worn by him. Street waifs in Bangalore are not much less-dressed than this sweet soul.

I spent more time calling various departments, Security, the emergency room staff, patient relations, etc., than I spent working on one or another of my other patients.

No boots. We've sent people home in socks many times before. He wasn't going for it. He said he was going to get a lawyer and call the TV station about this. Not that I'd blame him. In that kind of situation I myself would relish being interviewed before the cameras. I look bad on camera, though. Garrison Keillor looks better, and he has devoted his life to radio, for reasons I can directly relate to.

Just because the whole thing kinda was stuck in my craw, I mentioned it to my boss when I ran into her. I just felt like griping, but really I almost didn't tell her because I do not want to be seen as a complainer, though all nurses are, intrinsically, down to their very bones.

So she later came by me and said "I'm going to go to PayLess to get him some new boots. I had him draw a picture of them for me."

?!

I offered a few bucks to her. Not much, as I'd already been tapped for a "last day" party for one of our better nurses who was moving on to a specialty area within the hospital. I overheard the same boss tell that nurse that they were welcome back to our unit anytime, the door was always open.

Funny that. The previous boss was very cool to that nurse, probably due to their open advocacy for unionization. Anti-Arnold stickers and articles posted regularly on their locker door. Cool.

So my boss went and got the guy a pair of new boots, and he was so astonishingly grateful and effusive in his praise for her, for me, for the hospital itself.

Entire days can go by without seeing another person as happy as he was that day. I doubt that those meat-packers who won the lottery were much happier. At least not for long.

My car stalled out on my way home, and I pushed it into a bank parking lot where it now still sits. But I have shoes. Several pairs, actually, not that I'm too proud or anything. And I know how to use these.

I've had many good teachers.

Wednesday, February 22, 2006

Oh Eleanor Not Rigby But Almost

No. You will never walk upon the stagnant roofs of cars stillborn in highway gridlock among the asteroid-belt outer communities of the greater Phoenix metropolitan area.

Never gonna happen. Who's gonna park a car on I-10 when gas goes for $20 a gallon?

Oh yes. Tell me how that is never going to happen. Try to say it with a straight face. Like Condoleeza "mushroom cloud over American cities" Rice.

Yes, we need to plan. For the pending days when cheap petroleum energy are over. OVER.

Go Solar. While you can. I hope we can soon.

You are my sunshine, my only sunshine...

Saturday, February 18, 2006

After Midnight

What is wrong with this place? It was only about twenty minutes past midnight on a Friday when the bandleader apologetically called things off. Apparently it was the end of their third set. They were done. No more Monk, no Mercer, no Gershwin for us. Maybe if I'd waved triple figures to them it may've made a difference, but I'm a nurse, not a doctor.

We finished up after just getting there, then went home and let our fingers do the walking. What a nice way to end the evening. Oh well. Too early for us New Yorkers in the valley of the sun. But is it ever too early?

She was the nicest old lady, ninety-five but going on only seventy, if you know what I mean. "No," she'd say, "Not this time," when I'd answer her call light and ask her if she needed a little assistance to the bathroom again. She just wanted the phone put in her reach.

She'd had a colonoscopy that morning, after having a rough time with the GoLytely prep the day before.

At one point she had vomited a bit of it, and I was obliged to let Dr. N. know about that. He was, like the other gastroenterologists in his service, a bit strict about bowel preparations, so I knew when I called him what he was going to say. "Sounds like she needs an NG tube," he said. Right on, I thought. Like that would help.

She was so good about it, and she apologized to me as if it were somehow her fault or something. I used a 14 French and she took it like a champ. I promised I'd take it out as soon as she had gotten all the prep, so she only had the thing down her nose for an hour or two.

Even after the insertion of it she vomited a little more of the prep solution, but it was plenty enough to get her going. At one point, upon assisting her to go, the stool was so explosive it got all over the walls of the bathroom up to about waist-height. Poor woman. But she was so good-natured about it all.

The young one was doing a sleep-over at her best friends' apartment so we went to a hot new tapas restaurant, and our waitress there was someone we were familiar with from another place, a Thai eatery that we also like.

Weird. That never happens. You can go about for months here and never run into anyone you've ever met before. The Valley is big and wide with many millions of people in it, almost all strangers.

The tapas place was crowded, noisy, and served good food. We'll go again and do the whole menu eventually. Interesting crowd, too. I wasn't the only person there with odd eyeglasses.

Then we went to the local blues club and danced with about every lesbian in the Valley, it seemed. That's always a special treat. The all-woman band we heard brings this on, or maybe it's the place itself. A good and safe hangout. Seems like every time we go there the audience is less than half straight. I like that. Reminds me of my college days.

We stayed for two sets before we took off. Since we weren't really yet ready to call it a night we tried the jazz place. But that ended before it began for us. I guess I don't really know where to hear jazz in the Valley. My stereo, probably's the best place. Plays after midnight, anyways.

The colonoscopy was negative, thank goodness. Such a sweet woman. No matter what happens, she'll be okay.

Monday, February 13, 2006

Suggest and Admonish

Up at 3:20 because I couldn't sleep anymore. I've been that way ever since I was little. That first sip of coffee tasted so good, so I had another. Quiet and dark, only the cats are awake then. I turned on the computer and read online newspapers and blogs. Then I drifted over to the couch to nap.

The young one arrived later and sat on my feet. Then the spousal unit came along making noises in the kitchen and the dog followed.

On my days off work I usually drive the young one to school and walk in with them, staying until the bell sounds and their teacher comes to direct the line of students into the classroom. The young one chats with me and runs around with friends for a bit, and I look around. A little girl with eyeglasses sits on her backpack and talks to noone. A tall boy walks by with a tear awash on the left of his face. One of the young one's friends got a lot of hair cut off over the weekend.

The bell rings and I say good-bye. As I walk out the late kids are running in. One of them was a little girl who was mumbling to herself.

Parents are still pulling up to the school to drop off their young geniuses. At that age, the inner true genius has not yet been scalded out of them. All the young one's friends still shine that way. I hope most of them manage to hang on to this despite life's pressures to abandon that flame as they grow older and learn how to drive.

"The more you drive, the less intelligent you are." (From Repo Man, spoken by "Miller.")

I like to combine trips so I went to pick up a few things at one of the grocery stores. Charles Goyette was on the radio, and he was chatting up his studio guest Steve Benson, the award-winning cartoonist and often lone sane voice in the local newspaper. Mixed in with the humorous give-and-take these two foster among one another, they took occasional phone calls to solicit cartoon suggestions for Benson to consider.

I didn't catch the name of the caller that suggested this:

Imagine Cheney sitting in the corner of a National Rifle Association classroom and he has on a dunce cap, and Bush is asking him "Hey, can I get one of those too?"

Goyette and Benson chuckled.

My condolences and good wishes for a speedy recovery go out to Harry Whittington, along with my sincere admonishment that he endeavor to hang out with a better class of people.

What's wrong with this story?

Sunday, February 12, 2006

WATBs

Recently the Washington Post shut down one of its user comments sections because harsh language was being used.

"Howell's inadvertent error prompted a handful of bloggers to urge their readers to go to post.blog to vent their discontent, and in the subsequent four days we received more than a thousand comments in our public forum. Only, the word "comments" doesn't convey the obscene, vituperative tone of a lot of the postings, which were the sort of things you might find carved on the door of a public toilet stall. About a hundred of them had to be removed for violating the Post site's standards, which don't allow profanity or personal attacks.

To my dismay, matters only got worse on Jan. 19 after Howell posted a clarification on washingtonpost.com. Instead of mollifying angry readers, the clarification prompted more than 400 additional comments over the next five hours, many of them so crude as to be unprintable in a family newspaper. Soon the number of comments that violated our standards of Web civility overwhelmed our ability to get rid of them; only then did we decide to shut down comments on the blog."


So whines Jim Brady.

As many people have correctly pointed out, the Post still hasn't gotten this right: Abramoff donated only to Republicans, and some of his clients did donate to Democrats, but in lesser amounts than they had previous to Abramoff's influence, and there appears to be no evidence, none at least offered by the Post, that funds offered to Democrats were directed by Abramoff. He was busy ripping off these various tribes, so it's far more likely they were giving money to the Dems to spite Abramoff. rather than to please him.

Point is, it's a Republican scandal, but the Post still clings to the fiction that it's bipartisan.

The point I'd like to make, though, goes more towards political strategy than to facts and spin. And it has to do with the very language that Brady cries about.

The rightwing noise machine has been levelling harsh words, to say the least, against the liberal left (which is anybody politically left of Mussolini,) for decades now.

"A late January 2002 quote from Coulter's address to CPAC (the Conservative Political Action Conference).

"When contemplating college liberals, you really regret once again that John Walker is not getting the death penalty. We need to execute people like John Walker in order to physically intimidate liberals, by making them realize that they can be killed, too. Otherwise, they will turn out to be outright traitors."

Her words were applauded by National Security Adviser Condoleeza Rice, Secretary of Health and Human Services Tommy Thompson, and Lynne Cheney (wife of Vice President Cheney), all of whom were in attendance."


From the venerable pie-target Ann Coulter. So not only are roughly half of us fellow Americans likely to become traitors, a few of us need to be killed just to set an example.

We all know the names. Hannity, Limbaugh, Wiener A.K.A Savage, Hewitt, and the rest of the porcine meaty pieces stewing in the belly of the beast.

Well, it turns out that they are very thin-skinned, and we on the reality-based end of the political spectrum can easily draw their attention simply with the creative use of coarse language. The rightwing noise machine has been doing this for years, but because of their so-called family values, they've always held back.

I do that myself on this blog, as generally the language I use here stays within vague bounds of propriety.

But let's face it: people like Jim Brady are Whiny-Assed Titty Babies, to the core, and the more we call them on that, and the more we assure them that if they just did their jounalistic jobs we'd let up maybe just a little, the more they pay heed.

From the Atrios' comments section on Jim "Wanker of the Day" Brady:

"Jim Brady is SUCH a sensitive flower.
Is it because his dad jacked off in a flower pot and Jim came up a blooming idiot?"

bo | 02.11.06 - 8:32 pm | #


More:

"Well I think he's giving us some very valuable information here. When we hit them the same way that the right has been hitting them for years, we draw blood. We've got to keep on doing whatever it takes to draw blood. Eventually at least some of them will figure out that if they're going to get beaten up no matter what they do, they might as well go ahead and print the truth. I say we flood the WaPo again telling him what a WATB right-wing hack he is. Oh, and he's still a liar."

Hecate Malificent | Homepage | 02.11.06 - 8:44 pm | #


And my personal favorite:

"As a liberal Democrat I've been called a communist, a socialist, a terrorist, a terrorist-sympathizer, objectively pro-terrorism, a terrorist appeaser, a traitor, a fascist, an Islamo-fascist sympathizer, a collectivist, a Fifth Columnist, a fag, a fag-lover, an elitist, an intellectual elitist, a moonbat, an idiotarian, a welfare cheat, a heretic, a baby-killer, a hater of troops, a hater of America, a tree-hugger, a pussy, a liberal pussy, a liberal faggot, an anti-Christian bigot, a Nazi, and a Bush-basher.

Only the last one has any basis in reality.

So when Jim Brady accuses me or any other liberal commenter in blog-land of obliterating genuine, civil discussion, my friendly suggestion to him would be to go tie himself to a rail fence and take 20 inches of stallion up his tailpipe."

Buzz Bomb | 02.11.06 - 8:44 pm | #


Oh my. People who fight back. Well, I say when they're down, don't just kick them. Crotch-punch 'em hard then twist their little squirrel hangers off and shove them up their gaping brain-ports so far they choke on 'em. And when they puke out their own well-travelled macadamias, feed 'em to the dogs. Lying whiners. Uncivil indeed.

Tuesday, February 07, 2006

Open Letter to Candidate McCain

Dear Senator McCain,

For the sake of this letter, I am assuming that presidential elections are indeed held in the late Fall of 2008 and you are sworn in as President the following January.

Your presidency, assuming this comes about, will have no chance of ever succeeding.

Because of your fellow Republicans, you will inherit at least two hopeless wars without end. Iraq and Afghanistan are both quagmires. The national debt will continue to slowly twist the life out of the American economy, and the gradual depletion of the world's oil reserves will force hardships upon America that your party has both denied, on the one hand, and hastened, on the other.

Your Republican friends, such as Rick Santorum, will continue the K-Street corruption that infests your party, while regular Americans call out for healthcare, jobs, and debt relief. You will be able to provide none of that.

After a while you might not even want to.

President Bush and his ruinous policies towards the people who fight in our armed services will by then have caused a turnaround in their political orientation, and soldiers will no longer respect your office. Why should they? You will not be able to provide an answer for them. If you could, you would have done so already. But you haven't.

Global warming, the proliferation of crude nuclear weapons, and wildly morphing infectious disease-causing organisms will continue to sap America's energies and because of your fellow Republicans, we will have few allies left in the world to help us.

There will really only be one main question for history to answer regarding your presidency: Will its failure be bad enough to bring down the whole world, or only the United States of America?

Only.

Thank you for your time and consideration,

shrimplate

Sunday, February 05, 2006

Morgenröte. Gedanken über die moralischen Vorurteile

From the pages of my family apocrypha there was long ago a story about a club-owner who had a 1957 T-Bird, much like the powder-blue one owned by my father. Beautiful car, that one. My dad, mostly he motored around on a Matchless Twin motorcycle. But the T-Bird was an acceptable car to him. As cars go. Or went.

My mother drove a Ford Falcon station wagon. I take after her, driving a Hyundai Elantra wagon. I like wagons. But I wish to the great buddha of two-wheelers with my every drawn breath that I had that old Matchless Twin my dad owned.

Talk about cool. You could transport frozen transplant organs on the coolness of that motorcycle. People write songs about motorcycles like that.

Motorcycle songs.

Anyways, this other guy that had a T-Bird also had a pet ocelot. It was a mini-rage back in the day. And the story went that the cat was always docile and normal about the house, like a regular felis catus.

Except, according to the apocryphal story, the day when the ocelot was left alone in the T-Bird for a few moments, in which it shredded the seat covers and anything else in the car interior susceptible to large nasty cat claws.

Car Interior.

Ocelot.

Destroyed. Shredded. Torn Asunder.

Doctors do that.

You think they're nice guys, domesticated, poop-in-the-box and cover-it-up kinda normal cats.

But they are not. They are doctors, and as such will never, despite years of training, betray their indwelling deeply feral ways.

They cannot. To betray their genetic heritage would cause them no easily quantifiable sense of critical personal harm and distress. They must unbear their claws, just as the moon must morph in its cycles from new to full. Just as Frankenstein's monster must drown the little girl in the pond, tragedy immeasurable that it is. Fate always intervenes, and character fails before this grossly dim goddess.

Like a cake out in the rain.

So as this goes, nurses must fear doctors. Close comes the day when a trusted friend, a father-figure, a protective sweet-heart, turns like a rabid weasel to tear at your professional fur. It was ever thus. Ever shall it be so.

Thus spoke shrimplate.

Daybreak: Reflections on Moral Prejudices, 1881, Nietzsche.
.

Wednesday, February 01, 2006

Michelangelo's David and bin Laden's Niece

If there is such a thing as goodness, is it not logical to assume that this is a general principle that underlies "values" in various fields? Is not goodness somewhat "constant" in the areas of both ethics and aesthetics, or behavior and art? for example?

I think so.

That is how I manage the transition from musician to nurse, and then back again, without difficulty. A musician understands and practices "goodness" or "beauty" in the aesthetic realm of concocted sounds, and a nurse understands and practices "goodness" or "beauty" in the ethical realm of behavior to other, frequently ill, fellow human beings. The underlying goodness is a "constant," so to speak.

But all modern religions fail to acknowledge this, and fail more crudely in the application of the concept of goodness even to all people; people they might wish to address and perhaps even "save." Religions are just tribal warfare made manifest in dubious scriptures and even more dubious prophecy. That explains their uselessness, from a moral, aesthetic, or ethical aspect.

Perhaps you see this as harsh. If so, then you are likely not guilty of making the mistake that I assume is so common here. There are those who avoid this mistake. If that applies to you, then I regard your spirituality as morally intact. Not such a common thing, really. Reverend William Sloane Coffin, I bow to. Not all religious people regard others, consistently, as equal.

Both the Bible and bin Laden are uneven in their application of goodness. Gay marriage, anyone?

Check out this:

(vi) You are a nation that exploits women like consumer products or advertising tools calling upon customers to purchase them. You use women to serve passengers, visitors, and strangers to increase your profit margins. You then rant that you support the liberation of women.

That sounds like a bad thing, no? But an honest criticism of modern American television culture, coming perhaps from a Southern Baptist perspective. Or not.

Not, as it is.

But sheesh. What about sexual liberation? Pardon me, but I hold that the regard for the privacy of adult non-violent consensual behavior of any mutually respectful kind; sexual, economic, educational, aesthetic, or ethical, is fair and allowable. It is not bin Laden's business if a penis should encounter, with adult legal consent, anything. Same goes for vaginas and various fruits or other foodstuffs. These are not religious issues.

Sex is the crucible upon which all modern religions fail.

And the reason for this is equality. A thing to be denied one of the sexes. Stupidly, senselessly.

Interestingly, this is both a family and a societal problem. (Warning: yowser alert.) Bin Laden's niece. That is the problem. For Shariah, the Taliban, the Southern Baptists, Jerry Falwell, the American Family Association, and incidentally, my spouse.

Just kidding. No chance there, so no foul.

What the hell.

Be excellent to one another, and party on, dudes and dudettes.