Monday, December 31, 2007

weirdness abounds

Happy New Year!
I don't really get why we celebrate the new year, maybe because we made it through the last one alive?
The holidays always remind me of bad things. Historically I have always had to work new years and I have to say the ICU is damn depressing this time of year. Because most hospitals close the OR for the holidays and most patients get discharged out before the holidays the patients that are left are always the living dead.
The living dead are patients almost always in their late seventies early eighties who were competent enough to say yes to an incredibly complicated, damn dangerous operation. These people always come in to hospital with diabetes that has never been well controlled so they have terrible circulation and usually an open sore or two that hasn't healed for months but they forgot to tell anyone. They have terrible kidney function because their uncontrolled diabetes has ruined the arteries that supply the blood to them.They all smoked for fifty years and have the crappy lungs to prove it.
So, here they are, New Years, stuck on a ventilator with their brand new trach. Dialysis running continuously beside their bed. On the end of the bed is the machine that provides suction to the wound dressings all over their body. Behind the bed are the ten or twenty IV pumps. One is running in a continuous supply of liquid nutrition right into the brand new G-tube. The other nineteen are for the antibiotics the open wounds need, the fluids that the dialysis machine needs to function, the pain medication and the sedation that makes it possible for the patient to tolerate the agony of all those central lines , chest tubes and open wounds and finally the inotropes that are the ONLY thing keeping this patient alive.
Epi, Levo and Vaso the magic triangle of septic survival. A little renal dopamine because no one can agree if it works or not.
The only side effect is they divert all blood supply to the main organs. That means the feet, toes, fingers and hands slowly turn black dying from lack of oxygen and nutrition. Th open wounds can never heal.
Without the inotropes the heart stops, no blood pressure, no life, sure death.
With the inotropes a long, ugly, painful trip that ends the very same way, sure death.
So, they are the living dead.
Their families drift around the bedside worried about ludicrous things. "He likes to sleep on his side" "She needs her hair washed"..all things we know if attempted would probably kill the patient. We know that any small interruption, any wrong move could push this train wreck into the deep abyss. No matter how many meetings, the families refuse to believe, refuse to understand. Blank faced they tell us of miracles, of a caring, attentive God focused only on their loved one. They tell us of stories on CNN and the internet of incredible survival. We tell them Granny isn't a twenty year old professional athlete in perfect health. They don't care.
Then a new patient. Dying but resolute, no machines for me thank you. We all stop, stunned and helpless.
Is this a patient we can help? Finally. We buff and fluff. We send for music and her own comforter and pillows. We send for her minister. We bring chairs, chairs and more chairs. We help her grandchildren up onto her bed so they can all cuddle and cry and say good-bye.
We create a private room where none exists.
We find the right pain medicine that keeps them comfortable but awake and engaged. We agree with all their choices. No more oxygen? That's fine. Hungry? Food is on it's way.
They don't eat but just enjoy the smell of fresh seafood, the scent of the ocean far away.
Then with family all around smoothing the way they pass quietly, painlessly.

After it is over, this amazing strangely joyous passing, we return to the living dead.

Do me one thing for the New Year.... get a living will. If you are over the age of seventy five and have three or more serious medical problems that include heart disease, diabetes, kidney failure and lung disease don't have major high risk surgery. You don't get to live forever okay? No one does. Try for a little dignity instead.
Choose the DNR.
Watching you die piece by bloody rotted piece for months is a crime against me and I don't think you have the right to torment me, my colleagues and your family just because the technology exists to do it.
If you just can't resist that TAA? Make a plan for when we can stop flogging you please and tell every one about it.
The half a million dollars it costs to keep one living dead can be spent on knee and hip replacements for fifty still living.
Thank you.

Monday, December 24, 2007


So far I have been really supportive of the writers strike. But, not so much today. I am a member of a union and I understand a union has only one power. Solidarity. That means all members must commit to the job action. If you go on strike that means no one with no exceptions can go to work.
I have been seeing over and over the writers union playing with waivers.
How can you be on strike and then say "oh, no, it's okay..we like you so you go ahead and write that is your waiver ".
There are no waivers when you are on strike. The moment management sees you willing to go back to work they can laugh in your face and settle in for a good long wait. Why? because eventually you will hand out enough waivers they can go to court and say we don't have to offer a new contract..these fools are working right now at the old contract level, by choice.
You will have cut your own throat.
Solidarity means it would never cross your mind to ask for a waiver because you know that by doing this you are making a huge statement about your lack of commitment to a new contract.

I expect the writers union to cave under the pressure within six weeks because a quarter of their membership couldn't care less about the rest.

Merry Christmas! Hope Santa got you want you wanted or at the very least got you a gift card from the store where you can buy it.

Friday, December 14, 2007

what you should be watching

Pushing Daisies.
It's the only thing on network television worth watching. It's original, it's breathtakingly beautiful and I don't know any of the actors. Because I have no idea who these people are I can happily believe they are who they say they are.
watch it or I will come to your home.

I am a hater of Christmas. I hate going shopping. I hate buying stupid crap no one will ever use. So I give out gift cards. I get gift cards from the bookstore, the liquor store and the computer store. I think you have the right to buy your own crap you may never use.
Some people think gift cards are impolite and to those people I say..shut up and stop being such greedy pigs. Anyone who has the audacity to complain about receiving a present needs a beating.
I don't care if it's a crappy present you never's a present you selfish, thoughtless jerk.

To Miss Manners and her greedy crew
Because you are so obsessed with getting you think you have the right to judge the value and motives behind the gifts you receive. This tells the world you are a shameless gift whore and the only punishment for that is NO PRESENTS FOR YOU. I think if you get nothing for Christmas maybe the next time someone buys you anything you will be appreciative and deeply thankful. If you get a gift card you will say thank you and buy something you wanted. Then you will take a picture of that purchase and you will send it with your thank you card..wont you?

Christmas really brings out the worst in some people. heh

Thursday, December 06, 2007


What do you do when your kid grows up and leaves home? I am baffled by the transition. All I can think is this kid can't remember to do laundry or pick clothes off the floor, has no idea where money comes from...has never paid a bill..ever.
I have tried to teach this. Over and over. Through example and threats and yelling. Somehow it's all bounced off.
I don't want to be faced with a thousand dollar VISA bill and unpaid rent. I don't want to be responsible anymore.
As a parent do you ever get to be free of fixing disasters? Is there a certain birthday they reach and voila! it's no longer your problem?
Probably not.

Honestly, my kid is a good one, with good intentions. Just a little blind to reality. Willfully, stubbornly blind.

There is a lull in the cold war here at home as the renovations are nearing an end. I have no excuse for taking on a project I knew was too finicky to ever be completed without bloodshed. I must have been drunk when I agreed to it. I blame every home reno show I have ever watched. Especially Mike Holmes. He makes it all look so damn easy. The joys of editing out all the fuckups. There is never a moment when Mike gets silicone all over the floor, toilet and some in his eye is there? Mike doesn't break the corners off drywall and then curse for an hour. Maybe he does but we never get to see it.
How about running out of paint halfway through and then buying what you thought was the same damn white but the new "white" is really more buttery then the stuff already on the wall and now the room is two tone and holy shit here comes the cursing again.
How about sanding down the grout only to discover grout should never be sanded because the dust gives you cancer?
I knew this reno was going to kill me and now I know how.

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