A Rafter of Turkeys

I am on trial for my life. The courtroom is packed with onlookers and members of the media. From behind the desk at which I am seated with my lawyers, I look over at the jury box. The jurors are all dogs. I like dogs, and dogs like me.

I look forward to the day when Leonardo DiCaprio and John Cusack make a movie together.

I am a hospital nurse but due to the specialty nature of the unit I work on, I cannot much discuss some of the things that we do. Just the occasional interesting tidbit. For example, I recently had a patient who had been suffering from diarrhea. For months. The routine tests for such things as clostridium difficile were negative, but we kept sending the tests anyways. We switched around his tube feedings. We stopped these for awhile. Nothing seems to work. He did not have surgery on his digestive tract. I remain puzzled, but a devoted and attendant nurse. Lots of gentle cleansing and protective ointments for his raw skin areas. The patient has become really depressed, but I never give up.

In the wild, cats (Felis catus) do not "meow." They only do this in the realm of humans. Conversely, when I am in the wild I often struggle with the desire to meow and make gutteral hissing noises at birds and small woodland creatures. Which reminds me, today I have to refill the birdfeeder.

Tycho Brahe computed the procession of equinoxes as 51 seconds of arc per year. He didn't have a telescope because they hadn't been invented yet. The modern value is accepted as 50.23 seconds of arc. Not bad for a guy who lost the bridge of his nose in a duel. He wore a silver and gold fake.

Lemonade

So this knucklehead is driving around with his family and they happen upon some kids selling lemonade. Well, actually they were not selling it. It was a very hot day so they were giving it away. So what does Mr. Knucklehead do? He gives them a lecture on free-market ideology.

That really set me off, as my regular readers can imagine.

"No!" I exclaimed from the back seat. "That's not the spirit of giving. You can only really give when you give something you own. They're giving away their parents' things -- the lemonade, cups, candy. It's not theirs to give."

Yes. He has regular readers. Ones who have bowel movements on a routine schedule. They read him here. God in heaven I so hated providing that link.

No wonder America is getting it all wrong when it comes to government, and taxes, and policy. We all act as if the "lemonade" or benefits we're "giving away" is free.

He says.

I call a straw-man argument. Nobody thinks this stuff is free. We all know the costs. This information is everywhere.

The cost of war. Over $1 trillion dollars and growing daily, and so far we've gotten absolutely nothing out of it except a few thousand dead and ruined soldiers.

Chump change, though. Remember the bank bailouts? You have to google that, because your average journalist has the attention span of a heroin-addicted housefly so there's no headlining that today. How does $4 trillion sound to you? Good? Free? Not free?

But of course Mr. Knucklehead doesn't mention those things. No.

And so the voters demand more -- more subsidies for mortgages, more bailouts, more loan modification and longer periods of unemployment benefits.

The real problem with America and its profligate government is voters. Especially those who have homes. Or those who have lost their jobs. They're not worth a few billion dollars. Well, a little more than that. The unemployment benefits extension recently stymied by Republicans would have cost about $33.9 billion. That's a lot of cash, though a tiny number compared to what we spend on war and banks. It's cash that would get immediately spent and circulated throughout our economy though, unlike the hundreds of billions we spend on ordinance that ends up buried in the sands of Araby or bailout cash that winds up in some rich Republican's Swiss bank account. Whatever.

Anyways, Savage is an idiot. There's no arguing with him, I am sure. Ideology like his is impermeable. Fossilized. Never changing. Not reality based.

And because he is that deranged, he lectures little girls on a hot summer day, trying to persuade them out of their joyful kindness.

What an asshole.

There Goes Half

Fired for speaking Tagalog at work.

Well, there goes half the night shift.

I personally work with nurses and other staff members from the Philippines, England, Mexico, Nigeria, Italy, Ethiopia, Canada, India, and even the faraway and exotic realms of Idaho, to name a few places off the top of my head. I hear languages other than American English all the time. Even the doctors can be heard conversing in other languages sometimes.

From ABS-CBN News:

BALTIMORE, Maryland - Four Filipina ex-staffers of a Baltimore City hospital haven’t gotten over the shock of being summarily fired from their jobs, allegedly because they spoke Pilipino during their lunch break.

[snip]

“They claimed they heard us speaking in Pilipino and that is the only basis of the termination. It wasn’t because of my functions as a nurse. There were no negative write-ups, no warning before the termination,” she added.

The nurses were previously required to sign paperwork agreeing to limit lunch and snack breaks, and included in it was an English-only policy that "directs that English should be the only language spoken while the nurses are on ER duty."

Fair enough. Like the guy says, in a code situation you don't want people yelling out commands in a variety of different languages. It's bad enough we still have to deal with all the crappy Latin abbreviations and such that we use everyday. But these nurses were allegedly overheard while they were at lunch. The hospital hasn't actually specified when exactly the nurses violated policy.

And they were fired for this?! What, is there an oversupply of E.D. nurses in Baltimore?! It's going to cost that hospital a good 10K a piece to train replacements. If they can find any. I wouldn't work there. In times of stress I sometimes let out a string of words from Olde Englishe. That would be bad.

Of course, this being Arizona, here it could actually get worse.

"The Arizona Department of Education recently began telling school districts that teachers whose spoken English it deems to be heavily accented or ungrammatical must be removed from classes for students still learning English," The Wall Street Journal reported.

So, joo con be fired por sayeeng "biolet" eensted uff "violet."

Los yikes. There goes half the teachers in south Phoenix.

News You Can Use

Oscar the bionic cat.

Hat tip to Chris Tucker:GOP Delenda Est! over in The Crack Den. Like he says: Science Works.

Have a Heart, Not a Kidney

A sign put up by a Florida urologist who apparently has a problem treating people because of how they vote. Story here.

Rep. Alan Grayson (D-FL), the congressman who represents the district of the Florida doctor discriminating against Obama voters, said, “Maybe he thinks the Hippocratic Oath says, ‘Do no good.’ If this is the face of the right-wing in America, it’s the face of cruelty.”

Cruelty indeed.

I suppose this is where I once again proclaim my Constitutional right as a nurse to refuse to defibrillate Republicans. I just won't do it. I don't give code drugs or do compressions, either. I'll record, and if it's my patient I will facilitate communication with the doctors and staff at the bedside, minimally. But I just don't see the point. I don't defibrillate clams, either.

I walk away and check other patients. They are always ignored during codes, anyway. Well, not if I'm around and the decaying cardiac rhythm belongs to a Republican.

If you cannot tell whether or not this is snark, please refer to the article about the Florida urologist. Do you think he was snarking?

Oh, and by the way, fuck you, doctor.

Keller

Helen Keller was a radical feminist and socialist. She was a founding member of the American Civil Liberties Union. She was not polite and grated hard against the conventions of the day which would keep women out of the public sphere. I like her.

She said "It is hard to interest those who have everything in those who have nothing."

Our current batch of bile-filled corporate talking-heads would hate the likes of her. She would be reviled and ridiculed by Limbaugh, for example, and Hannity would feature her on his show only to interrupt her and badger her. O'Reilly would do the same and then try to probe into her sex life.

But you know what? She could handle it. She had to deal with worse. People who didn't even think that women should be allowed to appear in public; certainly not to speak outside the home.

A Cloud of Blackbirds

The person you are dating is a vampire. Hilarity ensues.


If you ever forget how many cats you have, simply open a can of tuna. Then count them.


I was hanging some IV antibiotics for a patient and I overheard the family members talking. One lady was telling a younger male visitor that Jesus was coming soon and recommending that the man get close to God before this occurs. "I'll be glad to get by God if he allows me to smoke weed," said the young man. They then agreed that Jesus was a stoner. The young man claimed that there are neuroreceptors in the brain that are specific to THC bonding, and he suggested that The Creator made it this way.

The patient himself had suffered a hemorrhagic stroke. One pupil was fixed and he had a facial droop. That was nothing really. During a trans-esophageal echocardiogram he had sustained a perforated esophagus. Later he developed a collapsed lung which required chest tubes. His swallowing was impaired so he was fed through a tube. He was unable to walk or even sit up on his own. Yet the family held to an unshakable faith that he was going to get better.

That's probably not going to happen. He's probably going to go through a series of infectious processes and eventually die of pneumonia or something. I've seen it happen a thousand times before.

I gave that patient everything I had. I gave the family everything I had, too. They loved me. But the patient is still going to suffer a prolonged, very expensive, and miserable death. It's too bad.

A miracle could occur, but it would not be that the patient amazingly recovers. The miracle would be that the family members get some sense about them and see what is really going on. I doubt that is going to happen.

I knock myself out trying, anyways. That's what nurses do. I do not judge. I just work.


Statistics show that mothers earn less and less money with each child that they have. This is part of what we here in America call "family values."


Phoenix is a "horse town." If you have enough room on your property, even if you live smack in the middle of the city, you can have livestock. We were jogging along Central Avenue today and ran by a house that had a goat in the yard. Is Philadelphia like this?


Whoever first said that "necessity is the mother of invention" got it precisely backwards. First things are invented, then everyone has to have it and cannot live without it.


"You cannot make a silk purse out of a sow's ear." My spouse just said that. I am listening in on their phone conversation. My dream for some time now has been to open an internet cafe called "The Pig's Ear." We would serve tasty and nutritious snacks and beverages and feature live jazz on the weekends. Like a 19th-century lyceum, we would also feature guest lecturers on important topics of the day.


Can you love that which is unseen?

A Dole of Doves

I drove by the pawn shop on 12th Street on my way home. There was a woman with a baby carriage outside the late-night window. Now, every time I think my life sucks, I think of her and her baby.

The patient was one of those all-day drinkers. He'd start from the moment he woke up in the morning. Of course he had problems during his hospitalization. He went crazy, really. Delusional. His son called and angrily accused us of not providing his father with enough alcohol. (We were giving him two beers with each meal, including breakfast, plus enough Ativan and Haldol to knock out a herd of rhinos.) "You're not giving him enough alcohol." That is now officially the most co-dependent thing I have ever heard in my entire life.

I have discovered a new kind of cuisine called "crudo." (Restaurant link here.) It's essentially Italian sushimi. Raw fish treated with sea salt, lemon juice, and a bit of olive oil. Dee-lish! But (here it comes) I have a friend who has studied parasitology... And we recently worked with a patient from southeast Asia who had acquired a really nasty lung-eating parasite from consuming raw crabmeat. Dead lung tissue surgically removed. That's actually two "buts."

I know that there are different levels, ranks so to speak, among doctors. Neurosurgeons, for example, seem to have more status than hospitalists. Yet they all treat one another as members of the same elite club and they are polite and deferential to one another's thoughts. Not so with nurses. I sometimes get the feeling from nurses in other departments that they think me and my coworkers are stupid or something. Nurses do not play well together. I do what I can to change this but I am only one person.

I have a Siamese cat with a very long snout. The longest I have ever seen on a house-cat. Yet I have never actually taken the time to measure it and compare this finding with other cat snouts. He also has no upper teeth. I know this because one day I thought "I wonder what it's like in my cat's mouth?" and I acted upon this.

There are many seriously bad things happening in the world. I sometimes occupy myself with smaller concerns, things I can actually address. Not unlike Candide working in the garden, if you will allow me to make the comparison.

530 lbs.

Though many of their residents are somewhat sick, in the sense that they are chronically ill and cannot live independently, nursing homes are not hospitals and there are many rather simple interventions that cannot be done in that setting. For example. most nursing homes cannot provide sustained treatment with intravenous medications. They just don't have enough licensed staff to provide such. So if a resident medically comes to require that sort on intervention, they must be transferred to a hospital.

That is one of the beautiful things about a good nursing home nurse. They can tell when it's time to move a patient.

I have to congratulate the people who discovered that this particular patient had gained thirty pounds. Not real weight as in fat and muscle, but dangerous "water-weight." Because the patient weighed well over five hundred pounds to begin with.

I don't know how they caught this. Did she have a bed with a built-in scale? I do not recall. Even those become decalibrated and useless on a day-to-day basis. Did they have a sling scale that went up that high? I cannot imagine the practicality of doing this. The logistics involved just to roll this woman onto a bedpan were complex and involved four people. Let alone getting her out of bed and onto a scale of some sort.

Anyways, they discovered the dangerous and relatively sudden weight gain (over a month's time only,) and she was sent to us. We diuresed her with intravenous Lasix. Bless the nurse that somehow found a vein to establish IV access. It wasn't me. The woman urinated gallons and gallons. Bless the nurses that inserted the urinary catheter, too. That little procedure took five nurses; two to hold each leg and one to fish around and insert the tube.

The woman responded well to treatment. She still weighs over five hundred pounds and that will kill her someday soon, but in this case, no. Not this time.

We were all surprised when the patient's mother and sister came to visit, for they weren't "big people." Actually they were rather athletic-looking, not even zaftig. Nearly slim. They said that there had been other quite big people born into their family though. As one would expect.

A Bevy of Quail

You cannot say that nothing is as it seems.

We saw a bevy of quail yesterday, the little ones only a couple inches tall scurrying along with their parents.

If I hadn't checked his blood pressure, if I'd gone to lunch instead, he'd probably had circled the drain. Instead I went hungry.

It isn't enough that you have someone to love. That someone has to be near you much of the time. Close counts.

Caramelized onions and prosciutto ravioli in a pink vodka sauce.

Tidings of Magpies

There is no law either natural or civil that says the rich must become richer by any means.

I told a friend that I wouldn't ask her about the novel she is secretly writing. I think I may have lied.

Profits are privatized , while liabilities must be socialized. This is called capitalism.

May I see your papers please? What!? No?

During my university years I was once ticketed by the police for driving an unregistered moped. Remember those?



The police impounded it. One drove off on it, which was comical enough, (imagine a big fat cop steaming along at about 12 miles-per-hour on a red moped) while the other put me in the back of the police car to be brought to the station. There was a bunch of guns in the back seat with me. I mentioned that to the officer driving. "Hey officer, there's a bunch of guns back here," I said. He screeched to the curb. "Get in the front," he said, and I did but he wouldn't let me play with the radio.

After a few days I'd gotten my moped properly registered and I went back to the police station to retrieve it from impoundment. The officer at the desk was disdainful and very rude. I remember telling him right to his face to "fuck off and die." Actually that is an exaggeration. I left out the part about dying. You cannot offend a police officer. It is perfectly okay to use crude language with them as long as it does not contain threats, and apparently this officer forgot to feel threatened at that time. I would not recommend doing this though.

He eventually gave me my key to my "vehicle" and I pedal-started it and rode off. Later the same policemen stopped me for riding without a helmet, even though at that time there were no laws requiring that I wear one to ride a little moped. It was slow. People in wheelchairs used to pass me regularly.

I promised a friend that I would always be there for them; the same one writing the secret novel. Even if they were to leave me, I assured them that I would wait decades for them. I did not lie about that. I am an elephant in that way.

Your Career

There is no aptitude test to take before you become a nurse. The same is true, of course, for many other professions. Any idiot, fool, or halfway intelligent psychopath can wait their turn and go to nursing school, just like I did.

Therefore, fellow nurses, you may find yourself in difficult situations as you negotiate the twisted path of your profession. People will give you bad information. You will react appropriately, only to find out later that you may have caused harm, through no real fault of your own, but it will be on your hands.

This is the story I was told, by a lab technician who I can trust implicitly with everything: a blood glucose level of 526 is reported to a nurse. That's odd, because the glucometers don't even read that high; at that level it would just read "HI." As if it were glad to see you. Our glucometers are then programmed to prompt the user to report the result to a nurse or doctor. The nurse calls the doctor to get coverage for the very high blood sugar level, the lab draws a repeat level to run on their big fancy million-dollar blood chemistry analyzer, the nurse gives the patient a boatload of insulin, and then the lab calls.

The true blood sugar level isn't above 500. It's 220. And here's the kicker. It never happened. The blood sugar level of 526 was ignored because it was an accident that the patient was even checked; they had no order for glucose levels. Somebody checked the wrong patient, got a way abnormal lab value, and blew it off. The patient went untreated.

What went wrong?

People.

If you are working in an environment in which things like this happen, there's really only one thing you can do. Quit and get another job someplace else.

If that is impossible, then make as many friends as you can among the competent people among the staff. Respiratory therapists are good friends. Lab techs, aides, and especially house-keeping people! Call them by name. Ask them about their families. Tell them when they do good work. Bow reverently to them.

They are all you have.

In Wall Speakers

Vivica Genaux
Saluki
Grand Canyon
John Cage score
Acapulco cliff diving

In reverse order!

Monday Dickinson

I DIED for beauty, but was scarce
Adjusted in the tomb,
When one who died for truth was lain
In an adjoining room.

He questioned softly why I failed?
“For beauty,” I replied.
“And I for truth,—the two are one;
We brethren are,” he said.

And so, as kinsmen met a night,
We talked between the rooms,
Until the moss had reached our lips,
And covered up our names.

I Died for beauty by Emily Dickinson. Too good to spoil with comment.

Friday Plath

Winter Trees

The wet dawn inks are doing their blue dissolve.
On their blotter of fog the trees
Seem a botanical drawing.
Memories growing, ring on ring,
A series of weddings.

Knowing neither abortions nor bitchery,
Truer than women,
They seed so effortlessly!
Tasting the winds, that are footless,
Waist-deep in history.

Full of wings, otherworldliness.
In this, they are Ledas.
O mother of leaves and sweetness
Who are these pietas?
The shadows of ringdoves chanting, but chasing nothing.

November 26th 1962



She had, at this point in her life, three more months to live. Her journals seem to have ended the previous July with a description of the funeral of her neighbor Percy, so we don't have any direct access to Plath's thoughts at the time she wrote this. Leda was the mother of Helen.

P.E.

From RadioGraphics.



This is an emergency. This will make you late for lunch. This will spoil your lunch. Get the dilaudid, start the heparin drip, apply O2 if you haven't already, and get more dilaudid. With a little luck, soon your patient will feel better.

Hilo Protest 3/20/10

Notice no teabaggers. Just a bunch of nice people out protesting these stupid wars. We honked and waved and talked to the kids in the back seat about war and better things.

The Chorusing of the Waves

Clarinets, flutes, and oboes, for example, are just tubes. Of air, set into motion by a player. So are trumpets and french horns. So are voices. So are pipeline waves; you know, those tall breaking waves that surfers shoot down the middle of. For a moment, when the wave-tube is correct and the air within it is vibrating, a complex set of pitches can be heard emanating from it. These waves sing.

Bobby McGee

Photo stolen from a most excellent island blog called The Daily Flow. Her travelogue charts the same course of Hawaiian back roads that we took. The picture is of Alahanui State Park.



The ocean beaches here are dangerous and many people have lost their lives in the high surf. This area, however, has an enclosed pool that is warmed to 90F. by lava-heated waters. Perfect. Clear and refreshing. We swam and then went out to walk along the lava flows at water's edge. We found hermit crabs double-hiding in the inches-deep pools maintained by splashing surf.

Back at the rental I espied a sea turtle skimming the waves and called the others to see it too. We saw whales going by the day before.

Like a sea turtle, my ocean is wide. Unlike a sea turtle, I have no shell.

Fossil Braggery

Dr. Donald Johanson had just come out with a new book and he was holding a signing at a store in Scottsdale so off I went, with my young one in tow. There was a group of about thirty or so people there, most of whom had the air of academia about them. My child was the only sixth-grader among the crowd.

During his talk Dr. Johanson must've noticed how my little bowl of shrimp was doing because he drew the audience's attention to the pictures and illustrations in the book, much on behalf of my dear one. Afterwards when we went up to his table to get our copy of Lucy's Legacy autographed, he asked shrimpbowl if they were interested in human origins and to my dismay, they answered, "my dad just made me come here." Ouch.

Then in the days and months that followed, shrimpbowl read the book. They carried it everywhere in their school knapsack. I was not allowed to take it to read for myself. They learned how to recognize various hominid species by being shown drawings of their skulls. Homo floresiensis is their favorite now and shrimpbowl wants to study at the Institute of Human Origins when they grow up.

Anyways, I e-mailed Dr. Johanson this story and he very graciously wrote back that same day, inviting shrimpbowl to come visit the Institute anytime. And we shall do so very soon after we get back on the mainland. Right now, we are still here on The Big Island. Yesterday we watched whales swim by.