Wednesday, March 29, 2006


I am startled at how much I can spend in one day. Ten years ago I was cautious and kept track of every dime. Now I have a decent job that pays pretty good and I am lazy about money.
Being poor taught me nothing about managing money. I guess because I didn't have any to manage.
I also didn't have half the bills I have now.
I have telephone, television , internet and cell phone...Back then I had one telephone and a tiny television with rabbit ears.
Today I bought animal food, the bill was more than what I used to spend for two weeks of people food.
I have a teenager that eats money, twenty dollars a day at minimum.
I have to buy gas for the car and that cost shocks me over and over again.
I need to learn how to spend...and I have an accountant now..HRBlock used to be my accountant.
My accountant cringes when I tell him I never really save, I have crappy life insurance and I didn't bother to invest in one of those education funds for the kid..hell..we were POOR, how was I to know I would get my act together?
So now, late in the game I am trying to figure out the RRSP thingie and saving real money.
My only positive is I have no debts..yeah, the accountant was shocked. But poor people can't get credit cards or mortgages so we pay cash and escape the credit disaster.
I have paid off all my student was the most painful thing I have ever done.
I think poor people shouldn't be saddled with montrous debt so they can get a decent job. It makes no sense. How can someone just out of school with no experience starting at the bottom of the pay scale be expected to hand over a quarter of their pay cheque? It keeps the poor poor though. I know I will never be in the "middle". That amazing tax bracket where everything is possible..a new car..a house. I will always be a used car and a renter kind of person and I am fine with that.
I see some nurses that work every day..overtime,overtime just so they can pay the car payment and the mortgage. They are never home long enough to enjoy the place.
I would be terrified to own my own home. What do you do when you need a new furnace? or a new roof? or the septic tank goes.
Living in the country means septic tanks and septic beds...and that always makes me laugh because septic means something entirely different to me..
I love that if something goes wrong I can pick up the phone and call for help and someone else has to pay.
Living under hundreds of thousands of dollars of debt would make me nauseated all the time.

It didn't stop me from looking at brand new trucks today though.
Forty thousand dollars for a truck..when did this happen? Oh right around the same time urban idiots thought driving a big truck around the corner to buy milk was a grand idea. These trucks are completely yuppified..leather seats for goodness sake! Our truck will be a farm truck, doing what it was built for and having leather seats is ridiculous.
I am supposed to change my work clothes every time I get in?
It is so pretty the idea of driving it through a field to pick up hay is blasphemous.
So, no new truck for me.
The salesman also tried to sell me on the idea of leasing.Why would I want to give this man all my money for years and at the end of it have nothing to show for it? I want to buy a truck so it is mine not the banks or a leasing company who I am sure would be horrified at the idea of me using the truck as an actual work vehicle.

Buying a used vehicle is like being the dance partner of a sociopath. You have no idea when he will dip or stand on your feet or just dump you on the dance floor. I accept that their goal is to make a fool out of me and steal my money. I just do the best I can in an ugly situation.

Why are used car salesman all crooks? Is it because they aren't making enough money? I don't really think so considering they are selling cars that were under water in New Orleans for top price and they bought them for ten bucks..the mark up for a vintage disaster car is huge!
I think they do it because it's possible, we as consumers don't work very hard at not getting duped, we don't even ask basic favorite being "how long have you had the car?"
They always lie but check the air in the tires, it's a dead giveaway to a car that has been sitting around for months in a lot.
Ask if it's ever been in an accident..they always lie..look under the wheel wells to see where they repainted..repainting means accident.
Ask for the work record on the car, they will look horrified but they have to give it to you. I saved myself from two near disasters on that question. There really is no happy explanation to why you put a new transmission, all new braking system and new exhaust into a car other than something bad happened but we still have a ton of money sunk into this car and we need an idiot to come take it off our hands. One guy finally admitted that and offered to give it to me at his cost...
If someone is desperate to get rid of something why would I want to have it?

So, the search still continues. I know there is a perfect truck out there waiting for me..hi truck! I am coming! Could you maybe send some smoke signals my way so I can find you? This searching thing kinda sucks..

Tuesday, March 28, 2006


I know it's been talked to death but what the hell is wrong with you people? Why can you not drive your damn car without aiming it at me on my way home?
I was nearly wiped out by some idiot woman trying to dial her damn phone using both hands on a major highway. You cannot drop down to thirty miles an hour in the express lane without warning so you can have a little moronic chat with some other moron.

I have seen the end results of all your stupidity. You lay in a bed, drooling and incontinent while your family tries to find a nursing home bed to plant your vegetable ass. I have no sympathy for you but for your family? That is the tragedy. While you were juggling your phone,lipstick and Tim Hortons coffee trying to steer with one knee driving at 120km your family was at home under the assumption you had a functioning brain and wouldn't commit suicide by moron on the way home.
You suck.What makes me even crazier is you don't just wipe yourself out you usually take out some unsuspecting normal person.

Honestly, what the hell is your problem? Who is so important that they will drop dead if you don't call them? No one right? Yeah, you say that right now but I can bet you will do it again tomorrow because you are a moron with a death wish and a nice side of sociopath.

Dear Burger King
I love your chicken sandwich and your fries but couldn't you mention to the cashier that fifty piercings is forty eight too many? Especially all the lip and nose ones..they make me anxious and a little sad, not exactly how I want to feel when I am eating all the weekly recommended fat in one meal..Okay?

Oh House..You have fallen in love and what a fine choice. Your new love can cook a fine meal and brought a friend in to keep the house nice and clean. I like him.
I think they should jettison all the medical drama and stick with these two room mates..But it all seems a little familiar..Like it has been done before. is a slob with no manners or tact and the other is neat, tidy...oh! The Odd couple how the mighty have fallen. What happened? Writers take a little vacation time and someone was watching that oldies television station and voila! Why be original when you can blatantly rip off someone else.'s incredible to me that I really loved this show once. I feel kinda dirty and stupid.

The Amazing race was actually kind of cool. How refreshing to hear someone say " I don't want to feel that way" when describing irritation with the love of your life. He admitted he felt angry and told her immediately that it made him feel bad. She is blessed to have found someone as profoundly kind as this man. I do have to admit the old killer fatigue really got a few people here. If they had been less tired they would have quickly realized that they had extra pieces but when it's night time at the end of a killer day finding reasonable solutions to problems is just so damn hard to do.
I am surprised to see the fatigue show up so early. It isn't even half way yet and it will only get harder and harder from here on in. I think the guys have the best chance. Both pairs have a light heartedness to them so they don't get easily frustrated. They aren't really heavily invested in the outcome and seem more than happy to just be playing. I think they could both become incredibly competitive near the end though. When the aching exhaustion creeps in and the travel stops being fun and they are just willing themselves to just keep going? The boys team will bear down and take it.....
That madman dentist and his long suffering wife will surely implode soon enough. We all have seen the "intense" guys just collapse into gibbering idiots when the Race cranks it up a notch.
Just a quick trip to Mumbai and a ride on the train should be enough to send the good dentist over the edge. I can't wait to see that and no I have no sympathy for his wife, she picked him so obviously his brand of crazy was exactly what she was shopping for.
I am just glad they haven't allowed it to become a "Jonathon" fiasco. If it devolves into that kind of abuse I will have to stop watching. I still cannot understand why the producers let that little bastard get away with so much. I would have put him on a plane back to the States five seconds after he gave his wife that shove. I would have sent his wife on a cruise to get away from him.
Grabbing for ratings really tarnished the show..I hope they have learned their lesson.

Today I put into action what I have talked about over and over. Communication with family and patients. It was incredibly hard work, uphill all the way but at the end of it good progress was made. Everyone understands a little more.
Trying to explain human physiology to someone with little formal education can be trying but I have discovered that by drawing simple pictures and using familiar examples it can be done.
I have to admit I got hellishly frustrated a few times. When you have to tell someone that there is no "fix" for something they resist it with everything they have. You have to push so hard knowing that with every word you are causing them terrible pain.
How do you say "we can't help anymore" with compassion and patience? How do you do it so that at the end of the conversation they understand all the whys and hows and they come slowly to the same conclusion?
You spend the time, you listen and shut up. You are brutally honest and you give them room to find their own way.
Always the carrot, never the stick.

Monday, March 27, 2006


She is sitting in my lap trying to catch my fingers as I type. I picked her out. She was tiny,vocal and ever moving. She wanted out and she wanted to come home with us.
I guess that is why I was so upset that she wandered off.
Was her life so bad? Too much love,good food, a best friend that loved her beyond reason? How could all that be a bad thing?
I am glad she came home, glad she picked us again.

Prison Break is awful. Pure cheeeeeese. I can't watch anymore it has become so goofy. What's next? They get hit with an earthquake? a tornado? and a flood but still our ever plucky half burnt hero will find a way!
Did he have to stay up against that heating pipe? Could he not have moved away maybe a quarter step? More importantly the smell of sizzling flesh is OBVIOUS..drunk guard guy wasn't that drunk..he should have smelt something cooking behind him.
Ahh why do I's beyond smurfy at this point.

I have to say I loved the Sopranos. The depiction of Tony after extubation sitting in that chair was so completely perfect. That is exactly what people look like. They look destroyed,damaged..filthy and sad. No matter how much you try as a nurse to snazz them up it doesn't work. Coming that close to death and skipping by it leaves a brutal mark. A scar that sometimes only nursing,patients and families see and feel. That person is new...whatever ,whoever they were? That person has been burned out. I wonder who this new Tony will be.
I also loved how Carmela finally got it. She made a choice , informed consent so to speak when she married Tony but those kids never got it.
Those kids now have to make a choice....become a Gotti and protect and defend at all costs no matter what the charges or bail and run away. Forget that they ever had a mother or father.
The kicker is both those kids are now fair game for the FBI. They make one awful mistake and they will be sent on to the same broken bridge Adriana and Pussy fell from .
I wonder how this will change Carmela?

Question to ponder..If you knew you scored on a hand ball do you admit you did? Should you be punished for doing it?
I don't know..I think you always need to finish the play no matter what. You have to wait for the whistle..if you get caught, well so be it. But it's still cheating isn't it? You know it was a handball right? If you were true to the spirit of the game you should stop the play and admit your foul but the pressure, the money...will you lose your position? will you get benched for a week?
Now that football has become so brutally a "business" full of corporations can you take such a gallant stance if it means your team will lose the points?

Tomorrow more acupuncture..last week I got a few days of better pain control. I want to think the acupuncture is working. The nice man who does it is a little skeptical, he thinks I should have had better results much quicker if it is going to work. I tell him I have always been a bit slower about things..maybe I am right.

Sunday, March 26, 2006

weird question

I have a weird habit. I love nail polish.
Not in the usual getting a manicure way. I love getting a certain type of nail polish, Sally Hansens InstaDri. I love it because it dries really quickly so I can pick it off all in one piece. I am a nail picker , I admit it. Is there a group for compulsive nail picking?

I also am addicted to a certain kind of moisturizer SHISHEIDO....oh it is wonderful and damn it is expensive. My stepmother sent it for christmas and now I am lost without it. I have never conditioned my face before, ever..and now I can't stop.

So I pick off expensive nail polish and rub expensive moisturizer on.....

Does anyone else have weird habits? not you know weird weird..but everyday kinda strange?

I bet I am not as weird as I think I may be...I hope.
Now that the wonder cat has staggered home maybe I will slow down on the nail picking. it would help the budget.
So talk to me, let me know your weirdness I promise not to make fun of you.

she is home,she is home..she is home again


A realistic guide to being a heart surgery patient:

Learn everything you can about your surgery and the treatments you will receive..GRILL that surgeon until you are absolutely sure you know what the risks are and how much benefit you are going to get. Research the risks....How do you feel about stroke? Is it something you are willing to live with? Can you fit regular dialysis into your schedule?
Now that you are thoroughly educated and are comfortable with all the risks and benefits go to the hospital and tour the unit you will recover in.

Now for the surgery:

First: if you are over eighty years old don't have heart surgery. The chance you will survive the surgery and escape stroke, sternal wound infections, failed ventilator weans is about 5%.
No one lives forever, not even you.

It has become more popular to have heart surgery patients come to hospital the day before their surgery for preop prep. This is a horrible idea that exposes patients to agonizing anxiety and then over treatment with sedation. Patients run the risk of being exposed to all kinds of nasty infections before they even have surgery.
Agree to get to the hospital on time and do your own prep. You will need to do a little strategic shaving..have fun with it.

You will go to preop on arrival and get an IV started and have an assessment by a nurse. Your family can be with you prior to surgery but don't be ridiculous about it. Immediate family only...that means no sons-in-law,cousins-in-law, that guy at the corner store who tells good jokes..
You will go to the OR and be met by the nurses who will help move you to the operating table. It will be really cold in there. The idea is that bacteria loves the we keep things too cold for the bad bugs . You can and should ask for a warm blanket. The anesthetist will come in and talk to you and fiddle with machines for awhile and check your IV and move your arms onto the arm boards. The arm boards are not weird torture racks, they are there to keep your arms out of the sterile area so if the doc needs to quickly start a new IV he can do it without trashing the whole sterile field.
Soon it will feel like there are way too many people in the room. You will have at least two nurses, a respiratory therapist,OR tech, anesthesia, a couple of junior doctors, the perfusionist who runs the bypass machine and finally your surgeon will probably come and say hello. The anesthetist will then look in your throat and bend your head back to get a look at how easy or hard it will be to get the breathing tube in. Then he will prepare you for getting knocked out. It always starts with IV medication and sometimes that medication can burn a little going in. Once you are knocked out and the doc has placed the breathing tube you will be as we call it "lined up". The docs will place two different IV's : one in your wrist (or groin) in an artery to monitor your blood pressure, the second in your neck or in your chest right below your clavicle. This IV is big to allow for a second catheter to be inserted and floated through your heart to monitor the pressure in your heart and lungs.
Once this is done someone will call in the surgeon and you will be ventilated with general anesthetic, IV pain medication and a drug that completely paralyzes you.
Generally if a doc has residents or fellows they will do the cutting and harvesting of grafts. Once the chest is open the surgeon will perform your surgery.
Once he is done the assistants will close and transport you to the critical care unit.
You will stay ventilated and will not have your anesthesia reversed. You will wake up naturally.
Your nurse will be giving you lots of pain medicine even before you wake up, she will continue to give you pain medicine whether you ask for it or not (well, the good ones will).
As you wake up you will be asked over and over again to do some very basic must be able to squeeze my hand when I ask you to and let go when I ask you to. You must be able to wiggle your toes on command. Generally you have to very calm, very patient despite the fact that you are gagging horribly on a tube down your throat and are unable to speak and most likely you have both your hands tied to the bed.
That image is pretty damn awful isn't it?
Be aware heart surgery isn't for cowards.
Once you prove that you can breath on your own without the ventilator and you can follow commands and have a stable blood pressure and heart function you get the tube out. You are an active participant in tube need to cough that thing out.

Getting off the ventilator means you aren't bleeding, have a crap blood pressure, stopped peeing means you won the heart surgery lottery.

Things that go wrong:
You can bleed..a much that you need massive transfusions and a return to the OR. Having your chest re-opened increases your mortality rate by a lot..too much.
So when they tell you to stop taking your aspirin.. DO IT
If you know that the food you eat is great for making the blood thin..don't eat it the night before surgery.
Sometimes you bleed because something came undone, it happens and it sucks.

the older you are the bigger the risk, assume that you have brain artery disease if you have coronary artery are a walking stroke risk.
Most of the time postbypass stroke is ischemic..a little clot or chunk broke off during surgery.
These chunks are made up of calcified "clot buster" is really going to be helpful.
The only treatment we offer for stroke is sit around and watch and hope for the best. We do control blood pressure and all that but we do nothing that could change the outcome..we don't have the tools or the knowledge yet.

Acute Renal failure
because you have heart disease it is likely you have disease to the renal arteries. When you have a low enough blood pressure for a long enough time your kidneys will pack it in. The older you are it is almost guaranteed. Especially if you are a diabetic.
A rough surgery with some bleeding can lead to low blood pressure which will lead to renal failure and land you on dialysis.

Failure to wean
If you are old and have heart disease you probably smoked and now have COPD or what we used to call emphysema. So your breathing is bad. Having heart surgery means someone may collapse a lung or two. It takes hard work and lots of deep breathing and coughing to blow those lungs back up..well you really can't do that so you cannot get off the ventilator. Every time we take away the tube and the machine you lay gasping unable to cough and end up retubed..eventually you will get trached and sent to a nursing home to recover.

A lot of you or your loved ones will lose the heart surgery lottery.

Be reasonable. If some bad things happened recovery is going to take time..STOP asking me when they are going to get better..I haven't got a fact I haven't got a clue whether they actually will get better, they could drop dead in the next five back off already okay?
When I say "it's hour by hour" get with the program..ask "how is she/he doing right now" and I have the answer!
Keep the family craziness to a minimum. Yes, it may be a crisis but I still don't care what your brother or sister did ten years ago to get dropped from the will.

Be reasonable, if your loved one failed so badly they had a really bad stroke, are vented with dialysis and need tons of blood pressure support consider that death isn't an enemy....remember they would have died if we hadn't ripped away that option.

If you made it through you need to be proactive. When your physiotherapist tells you what exercises you need to do DO THEM. We pay them a lot of money..your tax money..try taking advantage of their services. Get out of bed as soon as you can.
If you are family don't just sit there, glassy eyed, watching the clock for the respectable visiting time limit. Offer to help them get up, walk with them, help them bath and brush their hair...act like you love them.
Over and over again families tell me that the most intimate moments they had with their parents was washing their back or their face, applying lipstick when they couldn't..fulfilling important, compassionate, necessary jobs. Touching your loved ones.
Don't sit there and wait for the nurse and bitch about the are family get off your ass and help. Hospitals are not hotels..we don't provide spa experiences. If your mother needs some vaseline for her lips do it or even better get her some really nice chapstick.
Sitting in a grumpy group whining about the care solves nothing.If there is something you can do that will make things better do it without whining.

Get Involved.
Nurses are bad at asking for this because we think it reflects badly on us but we are stealing something important away from sons and daughters. Fifty years ago it was still common for people to die at home cared for till the end by their family. When we steal that experience we leave families bereft, with no special, intimate moments of their own to remember.
On the other side they are ill prepared to help in recovery, they don't know what to do to help when their loved one gets home. If they had been encouraged to help during the hospital stay they would feel confident and empowered on discharge. Instead we get families sending loved ones to rehab centers and nursing homes..they could have gone home with help but we never offered that option.

Even in death we never encourage families to take their loved ones home. We know it is possible, we have specialists in home care trained in the art of palliative care but we don't mention it all.
We should give families more credit, we should assume they want to be involved instead of rebuffing their attempts. A little encouragement, a little education and a family member can become an excellent caregiver.
Why don't we do this?

Because we have institutionalized patients and their families. Scared them with our rules, regulations ,white sheets and wailing alarms, red flashing lights and frazzled nurses.
Ofcourse all they want to do is run away as fast as they can.

Health care needs to change, really change. We need to stop writing, talking and having focus groups..we need to force the implementation of change. We need to force the issue ...we all will feel better when we are all on the same health care team.
Wouldn't you feel better knowing your family was there, hands on, ready to do whatever was within their rights to do? I would.

Saturday, March 25, 2006

when being right is wrong

Sometimes you will have a patient who is violating certain parameters or well "being sick" and you have a choice of treatment. You can feel in your bones that your choice of treatment is absolutely right, all prior experience says "this is the right call" and you can end up being horribly wrong.
I hate it when patients do this. I blame them entirely for being so contrary , so stubborn to respond to a well known obvious treatment by promptly trying to die.
A lot of time there is no good reason for their response but other times you find out that the information you were basing your decision on was faulty.
A surgeon or a doctor made an assessment that was wrong. They didn't bother to take the next investigational step or they misinterpreted what they were seeing.
If you start with the wrong information you will ofcourse continue to make wrong choices...and that sucks.

Being a nurse I can only suggest a course of treatment. I cannot order anything and in all honesty I cannot stop a doctor from making a wrong choice. I can refuse to carry out an order if I think it is harmful but I cannot stop the doctor from doing it himself.
Weird imagery of wrestling a doc to the ground right now.
It's weird to have so much responsibility for the outcome but absolutely no power over the treaments.
I used to fight against this, rail against the limitations of my profession. I was endlessly pissed at bad decisions. Now I realize I can only do what my profession allows me to do. I have to find contentment in doing my job and stop worrying about how others do theirs. Even when they screw up so badly I want to scream and quite possibly whack them over the head and wear them as a coat but we'll get to that later.

I wanted to write today about how dumb patients have become. Despite all the talk and hype patients still don't bother to find out anything, They never bother to ask any questions. They read their little pamphlet or watch the five minute video and their only concern is "will it hurt?"
A hysterically dumb question..ofcourse it's going to's surgery...
They never ask how long will I be ventilated? What does ventilated mean? What is a chest tube? Can I see one? What are all these IV's? What do they do? How am I going to pee? Why can't I get out of bed to use the bathroom two hours after surgery when I am ventilated?
Why can't I get morphine every five minutes until I am unconscious for the entire duration of my hospital stay?
Why do I have to cough? Why do I have to get up, feed myself, bath myself when I am on the ward..isn't that the purpose of the nurse? Why can't someone else be responsible for my recovery? Why can''t they do everything for me and let me lay motionless in the bed for a week?

If you knew that moving made you feel better, that coughing prevented pneumonia and independence is the evidence we look for to allow for discharge you would feel better and stop thinking we were trying to torture you. If you knew what all the wires and tubes did it would be less scary and you would feel more confident, hell maybe you would recover faster.
Patients want to stick their heads in the sand so they can have the option of saying "no one ever told me, it's all your fault this happened". We can only offer up so much education..patients need to join in and become a part of the equation.
And stop lying to us..if you didn't quit smoking don't write down you quit. There is nothing worse than trying to figure out why someone is all over the bed, irritable and antsy only to find out they lied and now are in nicotine withdrawal.
If we had known we could have slapped a patch on you and skipped the freak out.

At work I am compulsively neat, everything must be at hand, organized and tidy. At home I am a slob. I cannot reconcile the two me's. I just know I cannot even start working if my bedside is disorganized. I see some nurses who are slobs and it irritates me. I worry that something will happen, like it did a little while back and I wont be able to find a damn thing. I was frantic and furious and thought about it later. I am a control freak...that's my thing, not theirs.

I am ashamed of my country for whacking baby seals over the head for their furcoats. What kind of asshole would wear a baby seal coat? Do you wake up in the morning and say to yourself "oooh dead baby seal..must wear the dead baby"?
I think if we all made a pact to whack anyone wearing baby seal over the head the hunt would stop. I think if all day complete strangers came up to you and whacked you really hard it would change the way you thought about how you dress.
It wouldn't hurt if some brain trust thought maybe we could make more money dragging tourists out on to the ice to see baby seals than whacking baby seals. It worked with the whales , so why not give it a go?

What kind of world is it when we are murdering babies?
I don't care if you and your children starve , whacking baby anythings over the head to make a living is EVIL. In fact I hope you and your whole family do starve..We don't need you in the world.....what the hell is wrong with you? Why not get a real job? How about getting a highschool diploma? You could be the first one in your family to do it.
Canada sucks and so does the Prime Minister for allowing this to go on.
The only bright spot is the ice is very thin, let's all hope the evil ,stupid bastards fall in and get eaten by pissed off baby seal mothers.

Wednesday, March 22, 2006

Polar bears

So, I was over at today a relatively new environmental blog that stee had recommended and read that of all things George Bush is considering making polar bears a threatened species.
So, according to George and his new best boy friend Micheal Crichton global warming doesn't exist so what is up with them goofy polar bears? Maybe it's depression, depression about carrying around toxic pesticides in it's fat from eating fish and seals.
It couldn't be the fact that the ice is taking longer and longer to freeze and they end up in the penitentiary at Churchill for months right?
Health care workers can't decide whether to get the Inuit to stop breast feeding because their breast milk is filled with mercury , pesticides and toxic right?
The oceans are dead or dying, fish stocks have disappeared but two people I know just bought SUV's.
An oil based economy is suicide, Brazil for hells sake knows this..they run on ethanol from sugar cane. Soon they will be the only damn country in the world completely independent from the oil based economy.
So when we are back in the stone age after the oil runs out or it becomes so expensive only Hollywood actors can buy it Brazil will be ticking along laughing it's ass off at us.

Personally there is some part of me that cannot wait for the day the earth kicks us really hard in the ass..not Katrina that was just a tiny warning, not the tsunami, that was tiny too..a really good global asskicking and then we will wake up.

Check out Sludgie..get some facts and start making some reasonable choices before you have to ride your bike.

Oh, today at work..there are no words to describe some patients..sometimes you just have to stop and tell them that you are not their slave and be done with it. I want to stay coldly professional, above the fray but some patients wont let you. They pick,gripe, moan, twist,wiggle and make you NUTS and then their family comes in and suddenly it all makes sense. They are all nuts and no matter how accommadating you are it will not matter. They cannot be satisfied, they have never been satisfied and you, in your puny nurse role are planted on this earth only to serve their every whim.......I wanted to run, screaming from the bedside about a hundred times today.
I was on such a geat run with such great patients..damn them for ruining the streak.

American Idol sucks..all the singers are did they get passed through? How is that twitchy, blinky guy still in the competition? I am totally with Simon and if Paula says one more time how wonderful someone looks I will find her and make her sleep with that creepy Corey guy again. Who the hell cares how they look you idiot? Half the most famous singers in the world are pretty damn strange looking but they can sing a little bit..not like these tone deaf talentless hacks.
That old guy with the gray hair does karaoke every week and paula pees her pants. it's gross.
This is worse than Star Search. Really, do they believe that the next American Idol is going to sing Barry Manilow covers? Or how about trashing Stevie Wonder? Anyone out there going to cough up twenty bucks to listen to this bunch ?

Monday, March 20, 2006

Happy and sad

I loved my patient last night. Loved him..He was everything a good patient is. Co-operative, funny and involved in his own care. He suffered a hell of a scare but handled it with grace and understanding and accepted it as a "shit happens' moment. His family was equally understanding after a good long honest explanation. Telling the truth about complications makes your relationship with everyone so much easier. Trust is everything in my interaction with my patients. I do some pretty painful interventions, they have to trust in me that I do what I do for a reason and that I am doing it for their benefit.

My friend has crashed into burnout. I didn't see it coming but recognized it immediately in his eyes. Burnout is hard to describe for someone who doesn't do the work we do. It is an anxiety, an exhaustion and a worsening feeling that no matter what you do it makes no difference and that no one cares or appreciates your effort. It is a crashing feeling of helplessness and depression.
There is only one cure for it and that is take a vacation and quit your job for something else. You have to do something else for awhile or you will never be able to return.
I have always been on the look out for burnout. We are regularly subjected to caring for the dead and the dying. We are forced to do things that violate all the rules of our compassion, we violate our own ethics because families don't share our beliefs.
When your ethics and morals are written in stone violating them can destroy your soul. I have avoided that by having an open mind, I cling to no religion, no rigid set of rules that would crush me with their weight if I was forced to ignore them.
Nursing is as much about the nurse as it is about the patient. We must remove ourselves from the equation and it is almost impossible. My friend has a rigid view of the world that cannot bend, he still fights against the impossible, still expecting a respect that will never materialize. He so wanted to see change and couldn't understand that moving a monolith is impossible and the monolith will only crush you.
I hope he will go off and re-evaluate, find something that wont challenge his own beliefs so much. I want him to be happy and find why he became a nurse once again before it is too late.

Nursing has become something so different now. Old people used to die, they don't anymore. We keep them going and going, vented with dialysis and drugs and more drugs. We operate on people twenty years ago we would have sent home to die.
I live in terror of the baby boomers getting ill..they believe they will live forever, no matter what. They are willing to do anything to keep going and it will be our responsibility to fulfill their fantasies of perfect health with little effort. They have no idea what we can do and I think they should be horrified.
The future looks bad and I am planning to get out of nursing before they start arriving in waves..all baffled that their bodies have failed .

I wish that every person that comes into the hospital would be forced to declare exactly what their plan for a good death was. They would have to produce a valid living will with a good substitute decision maker ready to do what needed to be done. Only then would they be allowed to be treated. The joy of actually knowing what the patient wanted when it all went to hell would save a thousand cases of burnout.
I wish the public would clue in to what their indecision, their lack of planning is doing to nurses and doctors and their own families. Everybody dies, make a plan already.

In other news , George Bush is an idiot. If the ex prime minister of Iraq says it's a civil's a civil war. How long can he and Cheney keep up the bs? I think Iraq could be in Flames from one end to the other and these two fools would be oh it's fine, it's just a bump in the road..lalalala..look over there at the pretty flowers. I have an awful feeling there wont be anyone left alive to govern if things keep going this way..fifty to sixty people dead a day in Baghdad..Who knows how many dead everywhere else?

I am really surprised at how Chelsea seems to be falling apart at the seams lately. I don't understand it. It seems a failure of confidence and concentration. Maybe not taking their opponents seriously enough. I don't think it's going to change the end result but it's strange. I don't think it's a coaching failure.
I cannot watch Sunderland anymore. It's just awful, the result is obvious . I feel like they should just concede the damn games and save everyone the trouble. What is infuriating is they don't get beat badly. They aren't so awful they get thumped, they lose 1-0 all the time. It's just that they always lose.
Manchester seems shambly too. I don't like Sir Alex, I think he is a vindictive jerk always bullying. He can't or wont just leave a successful line alone. He is always punishing someone and that disrupts the lines and screws the flow of the players. Just leave things alone already. When you are making a last desperate surge it's not the time to start playing around with your defense, or worse embarrassing your strikers. I don't care what Ruud said that hurt the little despots feelings let him play, that is what he is being paid to do.

I love the dark imagery of the Sopranos. It is going to be a really good year. I can't say the same about Prison Break. Nice's called prison break....lets get the break out already with all the characters not just the main ones. A real failure of imagination going on there.

Saturday, March 18, 2006

going shopping and love

I hate shopping for groceries. First I don't cook so hunting for interesting and exotic food is not me. I buy things that go in the oven for thirty minutes and then I tear off the plastic put whatever it is on a plate and announce that dinner is ready. The problem is all the food is the same. I am bored, bored,bored of noodles and vegetables and three small whitish lumps masquerading as chicken..blech.
I can make mashed potatoes..I add a ton of butter and mayo..fat is good for brain function..I wouldn't lie to you, I am a nurse! heh..tastes really good too.
I don't like meat. I am not a PETA extremist though..I just don't like the texture or the taste.
I can't digest red meat and for years I defaulted to chicken because I was raised by immigrants that felt a meal wasn't a meal without a piece of meat. Only really poor people ate vegetables and they were sickly and died early, sad deaths according to my grandmother. Maybe vegetarianism is a reaction to being raised by people who lived in terror of what the neighbours thought.
I never understood that myself but I knew my mother and father both came from very small villages in disparate parts of the United Kingdom surrounded by family that new every damn thing you did all the time.
I guess it did make them constantly vigilant for any sign that they were making a bad impression.
I was raised poor, really poor..the salvation army clothing kind of poor but you would never have known it. My mother went as often as she could, scouring the racks for clothes with "good" labels. She could never keep her mouth shut though. She would tell us as soon as we got home from school what incredible deals she had scored.
Over at Dooce she talks candidly about her post partum depression and her panic. My mother suffered her whole life with depression and panic. Back in the dark ages before effective drugs they did "therapy"....It was useless. You cannot talk the body out of being sick. It would be like telling the cancer victim that she could talk the cancer away. So our childhood was a miserable , terrifying experience. Living with the mentally ill every day is exhausting, maddening and sad.
Part of me can never forgive her for not giving us to my father to raise.
She held such bitterness and rage against him she couldn't see what would have been best. She had a right to be bitter, he was, as Hillary once said of Bill " a hard man to keep on the porch".
He was a good father though and he would have been the sane choice but there is the rub, she was insane and couldn't make sane choices.
My step father stayed with her for many, many years and I hold great admiration for him. He finally left when all of us kids moved out. He felt a real obligation to try to create a home for us, he was an invisible man though. He worked hard and paid our bills and drove my mother to the hospital when she would start screaming and couldn't stop.
When he finally left my mother he disappeared completely. He ignored all contact and I understood completely, He had done his duty to a woman he had loved only for a moment and children he fell in love with forever...he got us through safely and now he wanted a chance to get back to his own life.
It is strange how people fall in and out of your life. I found an old girlfriend recently and to my surprise I still liked her. She was as funny , smart and sarcastic as she was twenty years ago.
She had changed in some small ways, hardened a little about love and commitment. I had wished that she would have met someone to love her as she is lovable but her luck has been bad.
I don't understand much about bad relationships, the kind that hurt you so badly that you are changed in some fundamental way. I got lucky and stayed lucky. I picked someone I liked , I liked the tone of his voice, the way he moved..I knew I would be making a choice for forever.
Maybe if people stopped for a moment and thought "can I stand to listen to that voice for fifty years?" they would reconsider their bad choices.
I don't believe that true love blinds you, lust blinds when you are blinded to egregious faults know this is not love..If I loved this person I would see them wholly..all their faults fully visible. Choice would be possible..lust makes you an idiot.
I remember lust and cringe. It's a good thing memory fades with time.

After hearing about the "pirates" off the coast of Somalia firing on a US naval warship today all I can say is what were you smoking guys? Did you really think you could take on the US Navy?
I can only imagine the reaction on that warship..they were probably laughing so hard they could barely blow the damn pirates up.
I remember when we all cared about Somalia until they showed us they couldn't care less and we had to agree. Sad for the population but you cannot force people to behave, a lesson George Bush the dumber never really understood. Now we have a civil war in Iraq and Iran gleeful. George Bush took a stable country and blew it up so he could play Caesar, Emperor of the known world...What a mess and no way out. Vietnam was a cakewalk compared to this disaster.

You cannot force people to behave. You can only show them a safe way of life and hope they choose that path. You show them the carrot and forget the stick..the stick makes them hate you and forget about the carrot. Why is this so hard?

If George keeps on his path he will force Iran to react and he wont have enough troops to keep Iraq under control while beating up Iran and what about Afghanistan? My country is now trying to stabilize a country that has a government financed solely though drug money and welfare checks from other countries. Afghanistan is Germany after the first world war..destitute and desperate and we aren't paying attention to what is happening. Why is the Taliban still supported there? Why is the country still covered in poppy flowers? Because the people want it that way and you cannot force people to change.
There are danger signs everywhere but we are looking at Iraq and not paying attention to where the real trouble is brewing. Hamas, Taliban....the Saudi's..we have no idea what is happening and we are too stupid to believe that the Saudis are behind the whole thing..The Saudis created the Taliban, the Taliban created AlQueda...none of this has anything to do with Sunnis and Shiites does it? But where is our attention? Diversion everywhere so the Americans don't pay attention to Pakistan and Afghanistan where the real threat lies.
The world has become a really scary place and I wish George Bush was closer to the end of his term and the possibility of a new president was closer so we could begin to start stabilizing the world and start mending hurt feelings and get everyone back on the same side.
I want people to start caring about this planet and it's resources and the creatures including us that live here. We need to stop shooting at each other already.......We have solved NOTHING with this never ending violence, retribution and vengeance.
We haven't evolved at all..still cavemen beating each over the head with rocks.

Friday, March 17, 2006


I had a really bad itchy heels for the last few days and because I am human last I checked I scratched..and scratched some more. My heels now look like I have been walking over ground glass. They thankfully aren't painful, just hideous and still itchy.
I don't like the look or feel of feet. Especially old guy feet with those scary long, sharp toenails.
I have had so many patients with awful feet and I know this is a recurring theme but please enough of the cracked fungus feet.
We had an incredible run of all patients all the time diarrhea this last week. I am amazed the patients didn't disappear into prune shapes from loss of essential fluids. The smell was just overwhelming. Every time a visitor walked in you could see them flinch and then grimace in shared shame and sympathy. I think there can be nothing more destructive to your dignity than to have lost control of your bowels not once but over and over again.
I understand the patients humiliation but damn the sheer workload involved in cleaning up all this is astronomical, Backs were just breaking at the end of the day. It sucks and sucked. We blame the nutritionists who can never seem to get the tube feeds right. Either too constipated or sheer flowing liquid. The docs don't care and refuse to prescribe anything to make it stop. We end the day exhausted and furious with everyone and stinking.
All you want to do is get home and scrub but the smell wont leave the nose and the thought of having to wake up and go do it all over again makes me ill.
Please stop pooping nice people we are tired and we are sure you have pooped enough for all of us.
Here is another conundrum: why do the elderly become bowel obsessed? I have had patients literally in tears over not having a bowel movement for a day. They refused to explain or be reasoned with. No one must have a bm every day, you will not drop dead if you skip a day and no one should be taking laxatives compulsively in fear that it might not happen for them today.

I had a bizarre twelve hours of english as a second language with the most absurdly cheerful guy I have ever met. He babbled away as if we were having a grand conversation..I didn't bother to ruin his delusion I just played along nodding away hopefully in the right places.
It was a lot of fun really. He was so happy and really didn't seem to care at all if he was being understood. Maybe it was the pain medications. His not mine ofcourse.
Nursing can be so strange.

Tuesday, March 14, 2006


I am a sometime fan of the Amazing race but lately I am getting more and more and disgusted by the competitors. I get that it is a race, a competition and a reality show but it is also a chance of a lifetime to see the world and experience their cultures.
I listen to them whine and I want to reach into my TV and whack them really,really hard.
I hate the old decrepit couples who can't stop expecting failure at every turn. They are always throwing in the damn towel at any sight of hardship. The minute they get behind it's an uncomfortable litany of unfairness, they never accept that they made simple mistakes that can be fixed. Their hopelessness and passive aggressive helplessness makes my teeth hurt. Why would you go through the entire audition process blind to the fact that you are going to be stressed, uncomfortable and always out of your element?
Why does it always come as such a damn surprise to these old folks? Did they think there was a special geriatric version?

I was irritated and irritable today.I am amazed at the abilities some people have to avoid work. I have seen people create tiny crawl spaces for themselves, hidden deep behind hospital supplies. You have to carve out a little time to create and send out a search party for them, calling their name while they giggle , hidden in their little cave safe from doing any work. Their greatest achievement is the constantly expanding break. Breaks that used to last fifteen minutes are now an hour, hour breaks are two and a half. They need coffee and lunch and a damn good nap to get through the morning. Then there is an afternoon nap and supper! This doesn't include "hiding" time that could be a few hours too!
I wish it wasn't too late to apply.
Imagine if they used that ingenuity for work..They would have found the cure for cancer by now.
I am all for getting your breaks, hell I'm usually the first one out the door but damn I don't have the guts to skip any work entirely for an eight hour nap. I don't care that they duck work, what I care about is when they are ducking out they are creating more work for me and I don't have any time left to schedule in any more work.If it doesn't affect anyone else I am all for taking a nap but if you are screwing five other people expect them to be really pissed and less than friendly. It's just common sense.

Ever have someone ask you for advice and all you can think is "damn if you are that dumb you deserve everything you get?" But you can't actually say that so you make up some tired bullshit last heard from Dear Abby? Then you are kind of embarrassed you actually said "if you love something let it free and if it comes back to you it was meant to be". I mean who the hell actually says that to people and means it? I said it but I didn't mean it. I just wanted to be able to escape the conversation without laughing and pointing. People can be so blind it's funny.
"He won't let you meet his friends or his family" gosh do you think this relationship will last?
Hell no it won't but you can't say that can you? It would be rude and cruel. I want to . I want to start telling people the brutal truth all the time. Maybe it is a sign of mental illness..Who knows.
Maybe just a sign of sleep deprivation. Or maybe people should just shutup around me but I am one of those people. Everybody knows us, strange people stop us on the street and reveal their life story, everyone comes to us "just to talk". We attract the bizarre, the insane and the brutally unlucky in love. We would like to report to the world that just because we have an open, sympathetic face doesn't actually mean we are actually all that sympathetic. Stop talking to us, you are freaking us out.

Acupuncture was a walk in the park. Absolutely painless. I have no idea if it has done anything but I am happy to report it is the first time I have tried something that didn't have sickening or painful side effects. I hope it helps. I have opened my mind to any possible treatment. Anything is better than doing nothing. I think if I can retain a sense of motion in my treatment, a positivity, I can tolerate the situation better. Stagnation is what terrifies, being stuck with no way out. Sciatica is ridicuously resistant to treatment.
Who knows, next week biofeedback and Kabbalah..I can get some red thread around here somewhere I am sure of it.

Monday, March 13, 2006

Oh how I love thee

The Sopranos that is. Junior! We never suspected for a moment.
I loved the premiere. It reminded me that it wasn't about glamour, it is a brutal soul destroying way of life. Introducing a brand new character as if we had known him all along was genius and honestly we did know him. He was Tony if Tony had not become boss, he was Tony before we met him. I also think he represented what Tony ultimately wants, to escape the life.
I understood why he took his own life. He was trapped by his own actions, his needs. He could not betray Tony without betraying himself, he had nowhere to go. The feds will give him the chair or Tony will put a bullet in his head. He made his own way out.

Long day of doing nothing, waiting for my patient. It's weird to have to wait, wondering if the surgery was a success, will they be easy or difficult to care for? I guess it's a little like family in the waiting room without the personal,emotional connection.

We were talking seriously today about leadership. A lack of leadership sours an entire organization. A good leader is smart, educated about what they are managing. They have real experience so they can understand the needs of the people and the area they manage.
A good leader can make decisions, easy ones and really painful ones. Good managers support their staff always.They are always on their teams side, presenting a united strong front.
Bad managers haven't got a clue about their employees and have never done the job they are supervising. They are indecisive , constantly trying to please everyone.Always trying to avoid conflict so everyone will like them. Bad managers are not interested in education, they do their best to avoid creating time for new learning experiences. They are obsessed with the schedule and track sick time fanatically.Always thinking someone is trying to beat the system, always cynical.
I hate a bad manager. Even when they are good, kind people bad leaders suck the energy from the entire team.
I have been ridiculously lucky in my career. I have had brilliant managers, full of excitement and energy. They are thrilled with any success, small or huge.
I have had strong decisive managers.
I have only had one bad experience long ago when I was quite ill and struggling. It was a very sad experience that reminded me managers are not my friend. They are my employer.
It has changed how I interact with my manager now. I am impressed and feel supported and appreciated and even better understood but still: my manager right?
I had a friend who had a hilarious manager who honestly could not remember the line between employer/employee. He would tell everything to anyone anytime. My friend couldn't wait to call and tell me about the latest wild ride of her boss. He was unhappily married , with a scary girlfriend and a bad drug habit. He would talk about his sad sex life asking everyone for advice.
Despite everyone telling him that his girlfriend was a nightmare he divorced his wife and married her. Shortly after the honeymoon he started coming in with black eyes...No one wanted to be the one to ask what was going on..ofcourse they didn't have to..He couldn't wait to tell all.
He insanely found himself a new girlfriend and his brand new second wife found out and had taken to beating him up.
What do you say to a guy who can't keep it in his pants two weeks after his honeymoon? When he is your boss? She quit . I thought it was the only move she had..Who knows what the insane wife would have done next? She heard through the expert hospital grapevine that he had to call the cops in the middle of the night because she gave him the beating of his life. He moved out and became a medical missionary in South America or the alternate story was he went into a psych hospital for six months...Who knows?
That is my idea of a really bad boss.

I am struggling again with my medications and tomorrow I finally get to try acupuncture. I hope the reader that wanted to know about it will drop by tomorrow night when I tell all.
I also want anyone who has questions about drugs and procedures to feel free to ask. I always think arming yourself with some ideas can be helpful. It is only my experience though, many people have different experiences. I can only talk about what I went through and direct you to others who have gone through the same . Chronic pain is different for everyone. In my "real" life I know three people who have gone through completely different procedures but we can still share our feelings about life and the struggle to work everyday despite our deficits. I do want this blog to be a two way conversation if people have an interest.
Right now I am struggling to find words. A side effect I think of some of my drugs. It is irritating and embarrassing. I have the word in my head I just can't spit it out. It's not quite a stutter really, just a long pause. Everyone is getting used to it and are allowing me that moment instead of playing the word game.
Everyone has experienced the word game:
"Is it a car?"
Is it a house?"
"a dog?"
"NO, give me a second okay?"
"um," what were we talking about again?"
"I can't remember"

Better to just allow for the pause right?
It is amazing that they put up with me, bad back, can't talk..Thank goodness my brain is still valuable. The minute I start forgetting the nursing stuff I am doomed.

I am listening to the news right now. I think it would be incredibly hard to give up a body part..Maybe for my kid or my siblings but I don't think for anyone else. They are talking about how both people will then be unable to work..So no job, no money..Social assistance,.
You can go broke and become homeless...Wow.
I then thought about that jerk who promised his kid a kidney and the judge let him out of prison to take the tests and he bolted. He offered his kid the kidney as a con..It is so low an act it can hardly be described. I wonder what the other prisoners will be thinking when they finally catch him and lock him up?
My hope for that guy is he needs a kidney. No punishment is worse than never ending dialysis while your body slowly deteriorates around you. He can know intimately how his child suffered because of him.
I am good at retribution. I used to spend a lot of time thinking about it before I got tired and stopped caring.

I have a secret, I hate Wolf Blitzer. I think he has mumble mouth (right I am one to talk). He sounds all full of saliva and sloppy tongue. Not that I ever think of Wolf that way but still..All that "you're in the thitsuAtation room" and he can't help repeating his own last three words, like a tic of some kind. I just don't like him and I do remember that time when he got lost in Iraq so his credibility isn't there. What gets me is how he reacts when that old "curmudgeon" Jack Cafferty blurts out something completely outrageous, he is stone faced. That is when I get that he isn't listening to a word anyone else is saying. He is just waiting for his cue to say "this is the thitsuAtion room. Weird right? Jack is another story. He is hilarious because he knows no one is listening. Everyone is talking over each other desperate to get their three minutes of camera time and Jack couldn't care less...So he makes me laugh.
I can't watch the other guy..Mr Immigration..As if immigration is a brand new concept just thought up by radical communists. Interesting side note: with an increase in immigration studies have shown the crime rate dramatically drops. Immigrants that move into small neighborhoods with a collective sense of community create a social conscious that prevents crime. Why doesn't anyone talk about that?

Sunday, March 12, 2006

thoughts: random, disorganized

When I was in training we had to experience different areas of medicine. We would be thrust into the hospital for six week rotations. The standard was geriatrics first, then medicine,surgery,labour,delivery and postnatal care, pediatrics and psychiatry.

I hated psychiatry. Because I was raised by a woman who was seriously mentally ill I hated to be exposed to these people. I had no sympathy,no patience except for those suffering with schizophrenia. To me at that time schizophrenia was the only true mental illness. It had science behind it. Eventually I added bipolar because it reacted so dramatically and positively to medication.
As I got older and reconciled my own feelings about my mother I allowed myself to understand that depression is in fact a real disease. It is not something chosen, it is not a bratty selfish thing like I thought when I was thirteen and feeling lost in puberty.
I had my own transient twenty four hour run in with drug induced depression and my relief, my joy when that black cloud finally lifted truly opened my eyes.
Looking back I missed an important learning experience because I refused to let go of being absolutely pissed at my crazy mother.

My pediatric rotation was heartbreaking, confirming for me that I could never be rational when caring for a sick child..that option was out.
I loved labour and delivery. I loved being a part of such a momentous thing, being a hand to hold, a voice that guided a mother through labour. I couldn't do it for a living though. The threat of a lawsuit for my entire life was too great a burden for my family to endure. Any mother can sue you up to the eighteenth birthday of the child you helped deliver. Some nurses got sued because some kid didn't get into the college of their choice. The mother said she was sure the nurses had done something to make their kid dumb..the dumbness seemed to appear only at college application time and only for Ivy League..the kid got a place at the state college. They settled out of court.I can't live with that over my head.

I was on a medical floor caring for a very kind gentleman who had fainted at home. In his embarrassment he refused to tell his children what was wrong so they called an ambulance. When he arrived he told the doctor he had been bleeding quite profusely from the rectum for weeks.. He explained that he had always had trouble with hemorrhoids so he thought it would just go away on it's own like it had so many times before. I came in that morning, got report and went into see this man. He seemed very sad and humiliated. I asked him what was wrong and he began to cry and said he thought he had soiled himself and that he was very,very sorry.
I held his hand and told him he had nothing to be sorry for , that he was sick and weak and that thesethings happen and that is why I was there to care for him.
I got some clean linen and a basin and asked him to turn over...I couldn't breath when I saw the blood. It was everywhere, thick and red. I quickly washed him and placed new linens. . All I wanted to do was run from the room screaming but something steely inside held me back. I had a job I promised I would do. I did it.
I walked out of that room and straight to the nurse in charge and told her I believed that he was bleeding out through his rectum.
The first time you see a staff gear up for an emergency is awesome. Monitors come sliding in and are hooked up, blood bank is called and runners make mad dashes to the lab and for blood. I got my chance to insert a nasogastric tube. A tube that enters through the nose and is fed carefully down the throat into the stomach and then hooked to suction. Blood came flashing through the tube. This poor man was assaulted by technicians, nurses and surgeons and I never left his side. I cleaned him over and over as he continued to bleed faster than we could pump it back in. Finally the operating room called and said they were ready. I went with him into the OR and held his hand as he drifted under the anesthesia. I watched as the surgeon removed a massive amount of colon but happily said it doesn't look like cancer. I waited with everyone else for the labs decision and we all cheered when it came back no cancer.
I went to the intensive care unit with my patient.
I was so completely overwhelmed. All the IV's , the pumps, monitors and ventilators.
I ended my day knowing that I thrived on crisis. The ICU was my home.
I spent more time with that man who taught me what my vocation was. I was as happy as he was the day of his discharge I think. To see someone at the brink of death pulled back by sheer teamwork, that awesome engine at work.
A six week rotation seems very short in theory but in practice it is more than enough time to teach you what you will love and what you will never,ever want to do.

I had a good laugh reading the New York Times today:
Hospitals short on Ventilators if Bird Flu hits by Donald G McNeil Jr.

Gosh didn't I just write about that a few weeks ago?
There is no way we will have enough ventilators for a quarter of the patients. We don't have enough vents for the patients we already have. I agree with using CPAP and temporary vents. They are cheap and do the job. I really wish the media could stop the panic crap. How about figuring out ways to be ready for when the shit hits instead of whining about what we don't have?
I wish we had more ways to force action instead of so much talking and meeting and holding hearings and blah blah.

We were bored at work the other day and we were talking about how the media and the public hold two completely contrary views of nurses. In movies and television we are usually whores. We sleep with every doctor in the hospital happily passing on gonorrhea or worse mental angst and inability to commit. Please, if Goran wants to marry you and have little Goran babies you would have to be a nutcase to refuse. Then the next exnurse/new doc walks up to bat and gets knocked up. Movies always describe the nurse as hot and visitors ask patients if the nurse" gave them a bath yet" and did they get off. It's bizarre because in the next breath nurses are described as saints full of endless care and compassion. We are given shiny halos.
We were laughing because some of the descriptions are true. Just like in any profession we have nurses who have sex with doctors..lot's of obvious, irritating sex and we have nurses that would not be amiss in a nuns outfit.
The other irritation is nurses all want to be doctors. No we don't. Most nurses love the fact that when their shift is done they can go home. No one calls you at home at three am either. Nurses love the fact that they get to have a real relationship with their patient. Doctors have so many patients it's a wonder they can remember any of them.

Nurses are just like the rest of the world..kinda slutty sometimes, kinda saintly other times.

There is a weird thing that happens in hospitals sometimes that I have never quite figured out how to deal with. Sometimes you will walk in and a patient will be masturbating or their wife or girlfriend will be offering" aid". I understand that people don't lose their sexuality just because they become patients but part of me always says "holy shit" and I am embarrassed. I become all weirdly conservative and pissy. I wish I could just stop being so priggish and leave them be instead of going all nurse and behaving like my patient is being assaulted by a stranger. When they are masturbating alone I feel creeped out.. I know they are as embarrassed as I am but I feel judgmental like Dear Abby " all there is a time and a place for that" but what better time and place? You feel sick, you have pain wouldn't an orgasm be a good thing? Endorphins release and you feel happier painfree..maybe we should encourage masturbation..give a prescription....

Why are we such prudes about the whole thing?

As nurses we have seen a million penises, peni? vaginas, we understand all about sex and needs and how beneficial a healthy sexual relationship can be..I need to stop being so weird and think about how happy it makes my patients and happy patients are easy to care for..that makes my job easier..right?

Saturday, March 11, 2006

the birds

hanging at the barn


I smoke

Yes I do. I love to smoke. I wish I could say "oh that is a terrible thing and I wish I could quit" but I don't think it's terrible and I have no interest in quitting.
I can hear all those cigarette haters gearing up for their smells , it will kill you and if you smoke around me you will kill are absolutely right. So here is a hint..we already know and don't hang around smokers we are evil.
Evil,evil evil.
I would be thrilled if all those people who can't help but offer up their opinions would see me smoking and think of me as a demon and avoid me like the plague I am.I then wouldn't have to listen to their vicious attacks on my character. Just by the simple act of having a smoke you give up your right to be treated with respectful neglect. Complete strangers will snap at you and accuse you of killing their children.
My whole family has smoked at one time or another..I can only imagine my grandfathers reaction if some batty woman on the street started bitching him out..I don't think it would have ended well.

When I was a kid people seemed to mind their own business a little better. They may have known all about your peccadilloes but they never confronted you with them on a street corner. They just gossiped about you quietly among themselves. I think I liked that better.

Sometimes at work I will go out for a smoke, looking for a quiet corner and a little space. Invariably two people will approach me. They keep a respectful distance and light up too. They then begin trashing the nurses,the doctors and the hospital in voices loud enough for all to hear. I know this conversation is directed at me,standing in my scrubs, stethoscope around my neck.I never know how to respond. I am in fact eavesdropping aren't I? They didn't invite me into this conversation but I can feel how desperately they want my reaction. For years I just ignored them,smoked the last of my cigarette and went back to work but lately I have begun challenging them. I am curious about how they are defining bad care. Over and over they talk about being disrespected, not being given important information. They talk about their loved one being moved from room to room.One woman this morning talked of how her husband had been moved sixteen times in two weeks with no reasons given. I talked of how we delegate rooms, how sometimes we get runs of confused,sick,demented patients that need to be close to the nursing station for safety. How some patients have private insurance and they demand a private room and the merry go round starts to appease their need. Sometimes patients get too sick for a certain unit and need to move to another for closer monitoring and then they get moved to a different service and a different floor. It all gets bewildering and without good communication families get lost and frustrated and scared. She went back to her husband happy with the explanation, laughing at the insanity of hospitals and I went back to my unit happy that I had spoken up without feeling defensive, only curious and wanting to understand how we could do things better.
It's always communication, the basic way humans talk to each other. We can assault each other with words or we can shut up and listen,offer explanations that make sense. Be compassionate,show humour..let people know why we do what we do and let them know if we had a better way we would choose it.

From The New York Times by James Broder
"The clash we are witnessing around the world is not a clash of religions or a clash of civilizations" "It is a clash between two opposites , between two eras. It is a clash between a mentality that belongs to the Middle Ages and another mentality that belongs to the 21st Century. It is a clash between civilization and backwardness, between the civilized and the primitive, between barbarity and rationality."
a quote from Dr Wafa Sultan previously Muslim now a secular human discussing what is happening in the Muslim world. I cannot agree more with the good doc. Islamic fundamentalists believe they are fighting the war of the world..good vs evil..Islam against every damn other person alive...regular Muslims know these people are equal to Fred Flintstone in their understanding of the 21st century. People who blow up other people and call it a victory..a religious victory no less are idiots..still rubbing two pieces of wood together and creating fire and thinking they have done something wholly new and important.
The good thing is their children will discover the world through television and the internet and they will realize their fathers were no better than murderous cavemen.
All these men are fools that history will look back on with embarrassment...baffled that someone would be so blind,so barbaric too think that murdering women and children would make them holy in a nonexistent Gods eyes.
What is infuriating is we persist in engaging these people. Us talking to "insurgents" is like us trying to reason with our cat. Like me standing in the kitchen yelling at the cat for killing the innocent mouse. My cat doesn't have the intelligence to understand innocence. When I tell the cat I will get the food or it's toy "later" or "soon" it doesn't have the ability to understand such advanced concepts. Terrorists or "insurgents" are no different. They aren't advanced enough to understand, They cannot delay gratification. They will murder thousands to get what they want right we need to stop talking to them. We need to build a fence around them and get the innocent out. The Barbarians will finish each other off because they cannot work together for a common goal.
We need to stop fighting terrorism and actively ignore these monsters from our long ago past. Ignoring then means no more free television promotion, no more articles making them rock star legends in the homeland. Ignoring them means they don't and can't get any money because they are not recognized at any financial institution. Broke and unknown is how they should be living.Broke and unknown means no one sells them guns or bombs..It is hard to be a terrorist without weapons..Let's remove the weapons.
But if we did then George Bush wouldn't get his chance to be a hero and let's be honest this whole disaster is all about George wanting to be a hero wearing the big boy pants just once.
I think the president of the United States should have to pass a psych test before gaining office, we would have had a whole different history .

I am really in trouble on Sunday night. Greys Anatomy and The yeah..not as hard as I thought..Sopranos hands down. I am thinking about getting a DVR but it's not in the budget.Nothing is in the budget except get out of debt now. I don't owe really anything but still that little bit I do makes me itchy. I can only shrink in horror when I hear those Oprah horror stories of hundreds of thousands. Fifteen hundred and I get nauseated.
We drove up to Turtle Island today and got smokes..what a pretty place even in spring. Note: I have decided spring is here, I don't care if it snows for a week it's still spring, I cannot be dissuaded. I have had enough of winter even though this one was a walk in the park.

Thursday, March 09, 2006


When I first started nursing I remember I couldn't figure out how to hold my hands when I was meeting a patient for the first time. The nurse patient relationship is incredibly intimate in a non intimate way. I will give an example: I get to see you naked , your nakedness is for me impersonal,asexual. Your response is different. Being naked in front of a medical professional brings out many feelings; exposure, embarrassment, fear. I am looking for objective clinical findings but all the patient understands is you have forced me to be naked,vulnerable. The patient is waiting to hear a judgment, a pronouncement, Even something as simple as taking your temperature..The patient waits to hear is it normal? do I have a fever? Does this mean I have an infection? The nurse is just taking a temp..We don't feel the urgency of the result.
This all changes when the nurse becomes a I know how important it is to tell my patient what their temp is and what that means and what we are doing about it.
When I first started I didn't know how to talk with a patient. They were a stranger, a stranger I knew incredibly well..but I only knew their body. I knew their diagnosis, their lab results ..I knew nothing about who the patient was. Did they like chocolate or vanilla ice cream? Did they watch CSI or would they rather watch old MASH reruns?
Did they love their children or were there old hurts there? Would they like me or think I was too slow, incompetent. I was always thinking about me.

After many years I developed a role. I wasn't me, the one who hated doing the dishes and would rather lay on the couch under a comforter than do anything else. I played the "nurse"..friendly,concerned and interested. Patients figured it out and they played their role too and we rarely if ever got to know each other.
I regret that sometimes. Every so often I meet a patient and we click for some bizarre reason and all of a sudden we are talking as if we were old friends meeting up for coffee. I love that moment and I wonder why it doesn't happen very often. Then I am reminded why..these new friends sometimes die. No matter how vigilent,diligent I am sometimes they cannot recover and they are lost.
Losing a patient is painful,losing a patient you decided to make your friend is awful.
So back I go into my role and my patient follows my example.
Patients allow us into their lives,into their bodies, into their tragedy..maybe I should try harder to let them into my life. It seems only fair.

My most recent patient is one I really like..he is my pet as we call it..we all have them from time to time and I think I would probably do just about anything to keep him alive..sad isn't it? it's not my decision who lives,who dies but I don't want anything bad to happen to him. He isn't a saint, he hasn't saved small children and puppies as far as I know. I do know he has lived hard, made some bad choices but he made me laugh. He is alive, present in the world and I respect that, envy that, admire that. So don't die on me.

CSI was weird tonight.I get the attempt at meta but it was irritating. We all know law enforcement isn't all that thrilled that these shows constantly demonstrate how criminals screw up. They are how to manuals for avoiding being caught according to some but let's be serious here. Most criminals are dumber than a brick. They could watch CSI around the clock and still leave evidence everywhere because most crimes are motivated by greed and desperation. Muggings, break and enter,robbery is all about finding some cash to buy meth..these people don't have time to watch crime shows , they are too busy getting high. The really clever criminal already knew about forensics and we can't do anything about that. So watching CSI playing on the theme of what they/we are doing is bad/good was arrogant and weird. Was the show trying to say they were better than all those "other" shows? (see every "Law and Order fill in the blank"). Were they trying to say CSI wasn't the culprit the media was talking about it was that other guy! he did it?
I didn't get it.
I also don't get how little screen time the supporting characters are getting. I like the whole cast and enough already with Marg getting every line, it's boring. I also find Margs face way too distracting. Every one else in the cast is aging without intervention except her and it shows.It makes me feel an overwhelming urge to go over to AwfulPlasticSurgery and make fun of all those idiots with their new horrible breasts and trout lips..ecck..Jessica we are looking at you WTF?

Enough complaining about television. I had a good day, nobody died.

Wednesday, March 08, 2006

eating our young

I always hated that statement. In Nursing it is a well known fact that old nurses hate to train nursing students, I don't know why really. I have some theories: maybe the older nurses are tired, maybe they don't feel all that confident in their own skills and don't want to try to explain why they do the things they do, maybe it's too much extra responsibility.
I like nursing students. I like their enthusiasm and curiousity. They are so far away from burn out to be almost cute.I think mentoring new grads keeps old nurses alive.
But I hate trying to explain why I react the way I do.Much of what I do is instinctual. With experience comes the knowledge of possibilities.New nurses can't see into the future yet. They are lucky to grasp the present, It is impossible to tell a new nurse you are doing this thing because you have this niggling sensation that all is not quite right.You have no real science to back you up, just that feeling that experience tells you to act on. So nursing students feel frustrated and the older nurses feel grumpy and misunderstood. Then the back biting starts and it gets ugly. I think on the whole we can as nurses get way too defensive. We need to maintain our confidence and try to be patient.
It is hard and uncomfortable to remember it wasn't all that long ago you couldn't see into the future either.

Oh Real Madrid! How badly you let me down. You lost to Arsenal for goodness sake.
I really thought you had turned yourselves around. Poor Liverpool , there was never a chance was there? The Champions league is a hell of a litmus test for some of these clubs.

Off to in the morning..dreaded work. I must create a mantra..I love my job, I love my job....


what a boy

Tuesday, March 07, 2006


I like Chelsea,I do really. I think they play great football but I was amazed to see that their football? Not all that great really when Barcelona is in the picture. Chelsea seemed lost,frightened when Barcelona revved up their game. I wondered where did the almost serene confidence go?
I guess even really great teams can be awed by truly brilliant players. Maybe just playing on the same field as Ronaldinho can leave you stunned and cowed.
I was embarrassed to hear about the racial taunts some of the very best players are subjected to.
It left me wondering about monsters lurking everywhere. If you can be one of the very best players of your time and still be attacked racially what does it say about the world? I guess it means that there are still enough people left in the world who would be more than happy to reenact Hitlers reign of terror. No matter what people say we have not changed at all.
We have learned nothing.
I was happy to see the banners in the stands stating those fans refuse to accept racism and intolerance but what of the fans that started this? Where are they? How can we change the way they think? Punishing them only reinforces their delusions of persecution..
I wish I had a clever answer but I don't..all I can hope is their children are better than they are and that it won't be too much longer for that racist generation to die off.

I have just finished reading Chuck Palahniuk's Invisible Monsters. I have read enough of Chuck to realize it's all one theme. Alienation. It's boring. I know it's "perverse" and "cunning" and "wildly inventive" but ultimately alienation is boring. If I can't fall in love with at least one character I can't care about their disconnect and the book fails for me. I couldn't find any way to get close to any of these characters, it may have been intentional that each of these characters was so sketchily drawn. They didn't seem real and the exposure of relationships was so obvious it was irritating. I must have said "I know already geez get on with it" ten times. He chose an affected timeline. He spent way too much explaining the timeline as if the reader would be too stupid to figure out what was flashback and what was present and eventually I stopped caring with each announcement.
I was disappointed and I honestly felt like he has told this same story over and over with different characters and I just spent good money on a repeat.

I am in a battle with Vanity Fair. I love Vanity Fair. I know it's pretentious and that obnoxious name dropper "crimes of the rich and famous" guy is still writing for them but I like the magazine. In each issue there is at least one article that exposes a world I knew nothing about.

Vanity Fair ran into some publishing issues for Canadian subscribers, we didn't get our magazines. I called and got the usual "we are working on it" and "you will have it by Feb 28".
Well the 28th came and went and no magazine. I waited another week and called again, this time I got an asshole, all" it's not our problem" "it will be six to eight weeks" and I got pissed. I asked this prime example of crap customer services rep if she had a copy of the magazine on her desk and she cheerfully said "yes" and I said "mail it to me". It was kind of funny and now I am waiting for the magazine right off the desk of Cynthia, the not very bright rep for Vanity Fair. She said it was coming first class mail..why do these idiots think we are as dumb as they are? I know she doesn't have a copy of Vanity Fair on her desk. I know she doesn't have a desk, she has shelf and a phone attached to the side of her head and she isn't in Canada or the US.
She has no idea what happened to my subscription and she has no power to fix it but she does have the power to obstruct anyone from finding out. She can refuse to let you talk to anyone else but her and she does gleefully. It must suck to have her job.

Things like not getting my magazine make me crazy.It small things that can ruin your day. It is always customer service no matter what service it is that can make you want to pull out your hair.
Many years ago I hurt my back at work lifting a damn huge patient. It was a simple workmens comp case. It has been three years of fighting with them only to finally find out they never had any real intentions of doing what they said they were going to was all smoke and mirrors and cover their ass and now we go back to where we were a year ago. It is customer service at its best..doubletalk, denial, lying their ass off and denying it all a week later, ridiculous absolute favorite "I can't read this can you send me it again?" a few weeks later.."I still can"t read this send it again"...a couple of weeks later" I still can"t read this.." "oh right I can increase the font..hee this windows thing is great isn't it?" Months go by....
The goal of any good customer service rep is to make it so difficult you give up. They deliberately obstruct and bs you into insanity hoping for that moment when you say "oh to hell with this" and they have won.
This is the holy grail of customer make you go away.Kind of strange when six months later they call to ask how you are enjoying the service and wouldn't you just love to sign up for some more abuse.
I don't really care about the magazine or for that matter the workers comp.I care about being dicked around as if I am not a human being. I care about being treated like a problem that needs to go away.
It makes me sad that no one really cares anymore. It's all just do whatever the boss says and put in your day and get the hell out and cash the check. There is no accountability, no one is responsible for all just happens and that is "just the way things go" and "oh well why do you care so much?""you must be crazy".."geez lighten up lady".

I wonder if people start out in customer service actually caring and the never ending litany of "I didn't get it" and" it is broken" grind them down or are they chosen specifically for their already present level of burnout?
A mystery and since no one ever makes any comments one that will most likely be left unsolved.

Still...where the hell is my magazine Vanity Fair?

I watched House tonight, thankful that the writers have pulled back on the weird plot lines and was hit head on by the story. It is a real problem in the real world. When resources are scarce and incredibly expensive we start making some brutal choices. It is true that when you reach a certain age some medical procedures are no longer offered. That heart that you desperately need is not offered to you because there is an eighteen year old on the list right below your name. Doctors have to play God. They have to say the eighteen year old life is more valuable, more important that the seventy five year old. I don't know what criteria they use. The seventy five year old could be a brilliant mind, full of education and experience with a loving family, the eighteen year has only potential unrealized.....who is more important to our society?

Why do we automatically choose the eighteen year old to expend the resources on? Because they are young, because they haven't lived yet and somehow deserve their life more?

Yeah, it's weird.
In Canada we have just introduced some new laws. We have to call the organ donation people any time anyone dies and we have to ask the family within two hours of the death if they want to donate. If we know someone is near death or we plan to withdraw care we have to call the organ donation people and we have to approach the family. I never know how to do this. I want to do it with compassion and dignity but most of the time I just mumble it pulling off a bandaid . I have so far never met any family that knows the answer.
I think we should have experts there to present donation better. It is a worthwhile thing. Honestly you aren't going to need your parts when you are dead so why not give them to someone who needs them? I wish people would tell their family if they want to donate. It would really take a load off me you know? We could avoid that awkward, weird conversation where I mumble at you and you go "huh?" and we both flinch and you say "um no thanks".

I was shocked to hear about Dana Reeve. I never quite understood why she got cannonized for staying with her husband when he became a quad but I always thought she was a pretty cool woman with a great sense of humour. I was damn surprised the cancer got her that fast though lung cancer is a real bitch . I feel for that kid becoming an orphan at thirteen . I wish people would stop talking about how brave the kid is..he should be allowed to completely lose his mind without censure. Man that kid has been battered..his mom was right though..Life is not fair and it's best we all get used to that fact pretty damn quick.

Monday, March 06, 2006


Another day, another disaster .
When I think of Kenya I think of National Geographic. I think of miles and miles of grasslands, zebra and antelope. I have the Disney version of Africa in my head. Cheetah and lion prides happily one getting eaten.
The reality is awful .Miles and miles of dead wildebeest, carcasses rotting in the sun. The earth scorched brown, the trees withered.
Kenya is dying, Kenyans are starving and as usual no one gives a damn.
Why can the world lose its collective goddamn mind over the price of oil but not even notice the death of a country?
How can we pretend to not notice? Rwanda , Darfur and now Kenya and no one says a word. But mention New Orleans and hear the roar.
I have only a little sympathy for you New Orleans. You were told to get out and you refused."It won't be that bad"," I don't have a car,"" I can't pay for a bus to save my life", "I couldn't bother to pick up my mother,grandmother, was too much trouble."..blah,blah excuses..
Lets talk about Darfur..anyone tell them to get out? They don't have television, or a functioning government..where were they supposed to go? I's not like they had fifty other states to move to is it?
How about a drought country wide? Where are they supposed to evacuate to? They don't have Homeland Security and a few hundred billion dollars sitting around..they had the worlds largest tourist attraction but when the animals all starved the tourists went tourists, no money.
The US is struggling over a city whose occupants all had fair warning of disaster and had somewhere to escape to and a system in place to care for , house and feed them when disaster occurred.... The Sudan, Darfur,Kenya have food,no COUNTRY..nothing and that is the worlds reaction..nothing, nothing at all.
Happy Mardi gras New Orleans..Africa is dying but I am sure the fact that your insurance hasn't paid up yet is a much larger world issue right CNN?

Swag bags, we all have heard of them. It's the 'gift" presenters at award shows receive for standing up and saying "the nominees are". Swag bags are worth a hundred thousand dollars. They give them to people who are worth millions. These people are not to embarrassed to take them. It makes me gag. In one night all the medical needs of a refugee camp could be solved, instead Nicole Kidman gets some more free skin care products and a cruise she will never,ever take.
Bono yells at the world to save Africa..the little known fact is the man has never spent a dime of his own money trying. He has more money than the governments of some African nations but he won't invest in the very thing he demands of the rest of the world. I am sick of Hollywood and the music industry hypocrites all. Talk,Talk, about shutting up and buying and supporting a hospital. You could name it after yourself, hell make a chain of Bono and vaccinations!

I understand that a lot of us don't have an extra dime to give another person. I know that a huge percentage of us are living check to check hoping to make it through. That doesn't let all of us off the hook. Africa doesn't want us to go broke, they want us to acknowledge they are drowning. They want us, the struggling ,working poor to wake up and realize through sheer damn luck we were born in Canada, the US, Europe and that our governments have a fund created expressly for the purpose of helping other countries in their time of need. Kenya needs our help and it's our job to tell our government that . We need to remind them that we watched Mutual of Omahas Wild Kingdom and we love lions, zebras and the wildebeest and we love the country that decided that wildlife and it's habitat were important. Kenya made an effort to save all the animals Disney has made billions of dollars off of. Maybe Disney could kick back a few bucks from the Lion King and save a few lions. Maybe in the process of saving lions and elephants we could save Kenyans, people just like us, people no different that those in New Orleans..

Than God for television.., the true opiate of the masses..we watch and learn nothing. We are kept passive like well fed cows grazing on the new episodes of Prison Break ,Lost and The Sopranos. No fascist dictatorship could have thought up something as insidious as primetime programming.

Do an experiment just for yourself. Count how many times you are offered insightful information about Darfur or Kenya in the next week.
Then count how many times you hear about the bow on Charlize Therons Oscar dress.

How many times did you choose to stick with the show that offered that insight?
How many times did you switch to Entertainment Tonight?

Talk with your friends and your family and your community about Africa, who knows you may have some of the solutions right in your home town...
I really like zebra and I want a place for them to live. I think Kenya is the best place for them so I must support the survival of's that easy.
Send the Prime Minister a letter.

  • Google News
  • Edit-Me
  • Edit-Me
  • copyright harleynalice 2006