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.

Yeah, Another Day

(Photo stolen from the web so sue me.)

My head wasn't really in the game today, but nothing came up at work that was much challenging. A lung patient who was doing well, a paraplegic whose short-term prognosis was very good because he'd soon be over this bout of pneumonia, a guy waiting for Monday to roll around so he could get a video-assisted-thoracoscopy and wedge resection (his sats kept dropping to 80% but he looked good doing it,) and a guy who went home first thing this morning. The patient I got in his place had a complex history including a perforated esophagus with an esophageal stent.

Now that's more like it.

Anyways, I blithered away the day thinking about other things.

My guitar studies have taken an intense turn and this has tossed me into the throes of a deep melancholic nostalgia; for music school, for my old musical friends, and indeed just for the repertoire I used to have. So there's that. I loved it all. The competition, the pressure to perform, the essence of perfection that only marks the beginning of understanding the performance of any given piece of concert music... well, I guess a lot of that can be translated into nursing, but it's not the same.

Nursing is a beautiful thing and I love my coworkers, but nursing lacks music. Sort of. Sort of not.



Tomorrow spousie is taking me to The Big Island along with our child and their same-age cousin. So I had that to distract me from work, too.

Lust and Greed

The Passionflower I have. Because, you know, passion is first.

For My Future Postoperative Patients

I work on a specialty unit. There are types of surgeries done here that no other hospital in the state, and no other nursing unit either, especially works with. I do not write about these things because it might betray my fragile anonymity.

Ironically, I may soon require just such surgery. I will be operated on by doctors that I deal with every working day, and I have complete confidence in them. I will be treated postoperatively by my coworkers. Hopefully it will make me an even better nurse. Hopefully it will be minimally embarrassing.

How would you like to get out of surgery knowing that your nurse has undergone the same thing? I will have been there and done that! So no excuses, buddy. Get up and walk, use your incentive spirometer, get better, and get the fuck out of here.

A Band of Jays

You don't really need anything in order to do nursing. Having a hospital around helps, though.

Six strings will do, but perhaps the ideal is eleven. With bass courses tuned scale-wise downward.

The fucking dog took one of my socks. Just one. I'd rather she took both of them.

Everything is a coincidence.

They tried to have one of their friends (for lack of a better word,) impersonate a doctor to give one of the nurses phone orders for intravenous dilaudid. The scheme didn't work. This is the kind of bullshit nurses have to put up with.

Schools are mostly comprised of empty space. If I were a teacher, I'd have my students use all the space they possibly could, for doing things.

Somewhere, there is a desert that is only one rainstorm away from not being a desert anymore. Lately I feel like I might be living in just such a place.

If pain did not exist, somebody would invent it.

Practicing

The guitar is the most beautiful instrument.

I have had many musician friends who who scratch their heads in puzzlement over that statement. Maybe they don't get the rather small sound, or the repertoire of mostly short concert pieces and etudes. Maybe it's the whole rock music electric thing that throws them off; violinists and pianists are found among rock musicians, but it's a guitar-based style for sure. For me, since I was a teenager, it had been the classical guitar.

It's like holding an orchestra in your arms, it's so colorful. The instrument that seems closest in ability to express different colors is to me the oboe, on which every note seems to have its own distinct vowel sound. I've always liked that, and I could never understand why anyone would want to even out that difference between each note on their instrument, as many are instructed to try to do.

The guitar is, fortunately, a contrapuntal instrument. Like a piano, but without that instrument's incredible ability to generate different lines in music. And the guitar has a huge repertoire, if you include all the lute music from the Renaissance and Baroque period that can be made to fit under the player's fingers. Having said that, we guitarists are always stealing music from other instruments' repertoires. I've played Chopin piano pieces, Bach solo violin music, and Mozart opera arias transcribed for the guitar, and I must say these things sound beautiful on the instrument.

Saint John's Wort

Echinacea

Don't Let it Bring You Down

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

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

Phoenix has not been good to her.

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

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

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

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

The Hanged Man

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

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

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

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



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



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

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

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

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

What You Don't Hear

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

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

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

That doesn't work on Canadians, though.

Brought to You by Your Health Insurance Premiums

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

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

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

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

The Old is New Again

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

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

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

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

Fine coffee.

Applied technology. Medical equipment, and home entertainment.

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

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

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

What?! No AM radio?!

Set

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

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

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

Multiple homonyms: Flu, flew, flue

Sedona

Sedona viewed from Jerome

Two miles in.

The bridge

Dogs swimming at the crossing below Cathedral Rock.

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

Schnebly Hill Road view.

Structure of Memory

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

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

That in itself is sort of interesting.

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

A Kettle of Hawks

Jakob was telling me about reality:

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

*****

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

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

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

*****

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

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

*****

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

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

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

I still hang out with that person a lot.

*****



*****

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

Le Marteau Sans Maitre

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



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

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

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

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

Not a clown wielding it.

Bourreaux de solitude

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

*****

Executioners of solitude

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

Rene Char, 1934.

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

Comparing Health Insurance Plans

A visual representation of the progressive Democratic plan:


(Seattle Childrens Hospital)


But the Republican are offering choice: