Do the Time Warp

Dude, this is, like, totally weird. It totally feels like a Sunday, but it's a Friday. I mean, Sunday night is my do-laundry-iron-a-week's-worth-of-scrubs time. But it's actually, as I mentioned before, a Friday.

That's the weirdness of having a run of days off in the middle of a working week, and then working the weekend (no, I don't care about working New Year's Eve/New Year's Day, because ushering in 2006 only means I'm that much closer to my mortal demise and becoming th... th... th... thirty. )

Funnily enough, I went out to a Thai restaurant a couple of weeks ago with my husband and a friend, and ordered a pina colada (because I'm a dork when it comes to ordering alcoholic beverages and insist on ordering frozen drinks in the middle of winter). The waiter kept saying weird things like, "You know that drink has alcohol in it, right?" and clueless me, I was all, "Yeah... sure." while thinking, rather rudely, "Duh. Isn't the alcohol the point of the entire drink?" until it slowly dawned on me that he thought I was a teenager trying to pass for a twenty-something. I even had to show him my license with my birthdate and everything beforehe would actually let me order the drink. And I swear he didn't put any rum in the drink, either, because I certainly didn't taste any. He probably thought I had a fake i.d., which strikes me as very funny since it's been years since I've actually had to worry about being carded.

Meanwhile, back to the grind tomorrow. Shhh! Don't tell any one, I'm actually getting bored of sitting at home. Can't. write. anymore. Must. watch. Vincent. D'onfrio. (even if it is a rerun I've seen before).

iSpy. iPod.

Well, well, well, what have we here? Could it be Ibrahim's present finally made it here, despite the fact that we apparently slept through the Fedex man ringing our doorbell at 11:30a.m. yesterday:

JAMIE
[through sleepy fog]
Huuuhn? Issshazt the door thinngie... bell?

IBRAHIM:
[mumbles indistinctly]

JAMIE:
[turning over to get back to sleep]
Muusht be fer the people downshtairs or summut...

IBRAHIM:
[snorts, pulls sheets up over head]

All's well that ends well, though, and Ibrahim dearly loves his new nano iPod. In fact, I think he loves the damn thing more than anything else in the whole wide world, except perhaps me. No, wait, that's not true. I think he actually loves the iPod a little more, because the iPod doesn't say things like, "Did you scrub the icky bits around the base of the toilet this time?" and then go check on the icky bits that men must be genetically engineered not to see and make him clean said icky bits, whilst I do and say these nasty and nefarious things. Methinks, ergo, that the iPod wins his lurve.

Look at that face! You just can't buy that kind of happiness. ( Well, actually, you can, and I in fact did, for $199 plus tax, shipping and handling. Ah , rampant American consumerism, how we love thee.)

Meanwhile, my ass is beginning to take root in the couch from so much bland entertainment in the form of action/adventure movies and Law and Order reruns, viewed with the relish only a LAO junkie deprived of her fix for months can muster. Law and Order is a beautiful thing, and they shouldn't mess with any more spin-offs, or pretty soon we're going to be watching painful swill along the lines of Law and Order: Traffic Violations Squad.

For in the world of Law and Order spin-offs, I maintain there's camp classic, and then there's just shockingly crappy. (If you think I'm wrong, then I'll have you ponder what the hell ever happened to that dismally redundant 'Law and Order: Trial By Jury' spin-off? I guess we liked Bebe Neuwirth more as Fraser's frosty wife than we did as a bitch-on-wheels attorney, for one. Besides, Dick Wolf, we know you and your deep and richly money filled production pockets are more than happy to oblige the public more of what they want, but what the hell was happening in the original Law and Order if not a trial by jury, pray tell? )

Not that we're not game for a little gratuity and camp. In fact, nothing, I repeat nothing is as sublimely ridiculous and therefore as poetically perfect as Vincent D'Onofrio's Detective Goran in LAO: Criminal Intent. Anyone else in that role would be heretical, as when they substituted that lame red-haired chick for Kathryn Erbe's steely-armed Detective Eames during her character-and-real-life pregnancy leave. For weeks I pined and suffered through scene after plodding scene with the red-haired chick whose main purpose apart from providing a life-like rendering of an actual human being, was to voice occasional throw-away lines like "Yes, Detective Goran." or, "I see, Detective Goran." Boring.

As you can see, not much is going on in my world; I have enough time to rhapsodize over television show spin-off characters, and can't bring myself to read high-flutent literature over the holidays, either. Actually, it's all just a big procrastination scheme, the philosophical equivalent of diverting my attention with bright shiny objects, so as not to think about work, and how badly it's gotten to me over the past few weeks. I suppose a job filled with death, suffering and human beings at their worst is bound to get to a person after awhile.

And actually, it's not just work I'm avoiding, it's the analysis of My Whole Life, which I try hard not to do very often, especially during winter months when due to shortened daylight I have to force myself by catapult out of bed each morning. Because it seems that no matter what I do, or where I go, or what plans I have, there's a little secret part of me inside that's all like, "What in hell have you gotten youself into, missy? " It has nothing to do with whether or not I like or dislike my job, my house, my spouse, my car, or whatever. It's just the neurotic way I think. Good lord, thank goodness I wasn't born to be Kierkegaard (poor Soren and that whole severe kyphosis thing, for starters). But I think I get why he wrote the way he did, because by God, if I had to live in Denmark or any place where it's dark and cold six months out of the year, I'd probably be writing philosophical tomes with schizoid titles like, "Either/Or" too.

I also miss school. I don't mean nursing school because that was just plain hell and no mistake. I miss real school where I learned stuff for the joy of learning stuff and not because if I didn't, I could potentially miss something and kill someone (and also, where I supposedly acquired a vocabulary, which seems at present to have gone off on holiday, leaving me with a marked propensity to use generic, nearly meaningless words like "stuff" and "postmodernism.")

I miss the wide-open spaces meant for deconstructing dark Swedish films and reading German philosophy in an attempt to puzzle out the meaning of human suffering. I miss the clamour of ideas and idealism richocheting off each other during a good argle-bargle in class. I miss the hero-worship of certain professors, who were and are only human after all, but seemed so wise and learned, and above all, kind.

So I suppose I don't miss school at all, just the idea of school. I even thought about taking a course at community college in something I'm dreadful at (math, maybe, or physics) just to see if I could do it, but then I think, maybe the light deprivation and filthy cold has gotten to you, after all, Jamie.

Define Irony.

Okay, so here's an example of irony for all of you literature grad students that might want something to ponder:

A patient with a skull and 5"X5" swastika tattooed on prominently on his person specifically requesting that Christian praise music be played during his sugery.

I mean, I suppose it works on a historical level, because presumably, most Hitler-era Nazis were ostensibly Christian, but I just can't imagine any of them wanting to have Michael W. Smith or Amy Grant praising Jesus during their open heart surgery.

I had to hum the refrain to that Bare Naked Ladies song, "If I had a million dollars" all night long at work, because some how it just helped me hang on to the one fantasy I have left to me these days. And that fantasy is the one in which I me win the Powerball, and sit on my ass for a living, instead of what I do now, which is try to use my powers for good and not evil, and try not to throttle people when they make assinine requests at 10p.m. that require an hour's worth of pointless paging of house officers and attendings when I should be monitoring my other patients, the ones with trach stomas that need suctioning, and the ones who can't, you know, take a deep breath like you and me because their lungs are shot to shit and need vent nebs. You know, patients with like, REAL MEDICAL ISSUES.

I mean, adios to my old theological stomping grounds, because I can no longer make sense of the world around me in moral terms. I find the more I try, the less I care to know. Oh Sartre, I understand how I understand thee in ways I never knew possible.

Picture Pages

So, here we are, opening presents... Ibrahim's will come later, because Company X screwed up and didn't send his gift on time.


A new watch! Isn't the model a cutie?


What could this be?


Frosty friends collectible tree ornament! For our fake tree!



Something for Piper, too!
Piper still wants presents, apparently:

A track suit, to replace the one that got unceramoniously cut off me in the ED a couple of years ago after a bad car accident.

A coat! To replace the one that's looking a bit ragged. A button fell off the other day at the nurse's station. I didn't even notice until a doctor picked it up and handed it to me. How embarrassing. Time for a new coat, eh?


The post-Christmas carnage:

Behold! Good tidings, everyone!

Holly Jolly Christmas!!

Christmas this year, was, well... the second Christmas in my life I've spent without my parents. In that respect, it was a big bummer.

Nonetheless, it is "our" (Ibrahim and me) second Christmas together, and that's a nice thing!



We had a nice Christmas Eve together, watching movies, noshing on fruit and cheese, and yes, I finally had that glass of wine (and Ibrahim had his very first two shots of liquory goodness in the form of a buttery nipple. ) We slept in until well past noon, and then let the present opening carnage begin:




Look! It's King kong. Kind of.

Ho ho hum.

So it's Chistmas Eve, and it's the first time in about two months that I've actually dressed up, as in black stockings and a dress and chunky heeled mary janes (because Jamie does not wear high heels if Jamie doesn't have to, and believe me, Jamie finds reasons to never wear same.)

It's a bad sign when half a year into your chosen career you're already considering quitting and living a quiet , exponentially more respectable life in a cardboard box under highway somewhere. I need to figure a way of not letting the stress eat me alive, which it's doing on an alarmingly increasing basis (I started having mild left sided chest pressure on the way home, and I'm always tachycardic and stressed out these days, whether at work or not. I find I'm snapping at people right and left for no oher reason than that I spend all day being snapped at myself and hounded continually.) Example:

IBRAHIM:
Hi, honey. How're you doing, sweetie?

JAMIE:
What do you mean 'How am I doing, sweetie'? What kind of a question is that?! Why are you asking me something like that? Don't you know how I am? I'm cranky! CRANKY, hear me?!

You see what I mean. It's not pretty. Not pretty at all. I'm miserable today and the only thing that could put me in a right mood is vast quantities of mind altering substances, namely, a big fat glass of wine. (Not that that's "vast quantities" but it is for someone who weighs 98 lbs soaking wet).

Really, I can think of only one other time in my life I was so chronically stressed out, and it pretty much pales in comparison with what I"m going through now. (I actually found myself in bed the other night, in a contracted fetal ball, my legs, arms, hands, shoulders and jaw clenched and rigid, and I consciously had to tell myself, "Relax, Jamie. Breathe, and go to sleep.") Very sad.

In basic principle, I love the heart and soul of nursing, I really truly love it, but the politics of power is enough to make anyone consider stocking feminine hygiene products at the local dime store for a living, especially when you're brand spanking new, and just learning the ropes of you job as is. You want guidance and rational answers from medical staff, not moronic tantrums and people responding to your questions as if you're a mentally challenged guinea pig, for god's sake.

Ibrahim's Christmas present never came in the mail on time, which is just one moe thing that sucks about Christmas. Even worse, he has four nicely wrapped presents out there for me, next to our poor plastic Christmas tree (because we're classy like that!)

Good thing, though, Piper is with us today. And uh, I'm not in the hospital until Monday.

Merry Christmas!

You know it's a bad day when you go to work and you don't get off of your shift until the next day.

Funny thing about work lately, I keep thinking superlatives like, "That was the worst day ever!" only to say the same thing a few days later.

I had a run of bad nights--two in a row. This latest I was hounded the entire goddamn shift by a surgical resident who seemed to fit the mold of the proverbial, "God knows everything; surgical residents know it a little better."

It wasn't pretty, and I was at work until 3 a.m. this morning documenting his behavior, in hopes that maybe, some day, some how, nurses will finally get the respect and professionalism due them from other staff members, because GODDAMIT, we're not there to be bent over a barrel and used when housestaff perceives something isn't going their way. And just for the record, we work really, really fucking hard and put up with more shit than most people see in a typical office job in months. Because I care about what happens to my patients, and I want to see them get better, and isn't that what we all got into health care for in the first place?

Our jobs are seen as petty, dispensable, our intellects and assessment skills are ignored and belittled, and tonight, for the first time ever, I actually thought about quitting, and doing something that might preserve and bolster my self respect by comparison, like being a crazy bag lady or that person that pretends to make a living by collecting empty bottles and cans and recycling them for the deposit return fee.

Merry Christmas, any way, since it's Christmas Eve now, and I was supposed to be home yesterday at 11:30p.m. Maybe Bad Santa will heed my wish list: I need liquor. Lots and lots of liquor. And I need it NOW.

Ptoooey. Ptolemy.

I don't know who else is interested in the subjects of my dreams, but since I've been chronicling them in my blog, I've noticed an overriding theme: scholarly pedantry.

Last night, I dreamt about writing an essay on the emergence of heliocentricism,
beginning with the foundation ancient Greek geocentrism in the works of Ptolemy
and ending with the Copernican Revolution.

The funny thing is, when I woke up, and was pondering the dream, I realized "What the hell do I know about Ptolemy, for Chrissake?" Hmmm. Maybe I'm channeling the knowledge of nearby astronomer or astrophysicist, or something, because I have no clue how the hell I ended up dreaming about writing an essay on Ptolemy, of all ancient Greeks.

Let's see, how many figures of antiquity have I dreamt about now? Cicero, for one, and now Ptolemy. I am a sad, sad individual.

Not I Alone

I had to put this funny picture of Piper up on my blog because wow, that last post was just way too serious and self-righteously angry. And no, I didn't mean to take a picture of Piper licking his chops, it just happened. The delay on digital camera photos (at least the one we have) can be quite deceiving. I keep thinking I'm getting these super cute shots of Piper, and then I end up with one of his forehead, or something.

I also have to mention what a lifesaver the nurses are on my unit. They were there for me the whole way; taking the burden off immeasurably, giving wise counsel, helping my patient while I did a discharge, foley'ing the patient so I could actually go get some lunch, paging folks while I was running around like a chicken with my head cut off. Those nurses rock. It couldn't be a better place to be a new nurse, and I am blessed and lucky to work with them. I'm so , so lucky to have those nurses around me, and so was my patient.

gtts and gits

I'm strangely compelled to write about work lately, and I don't exactly know why, except that I am beginning to believe that my latest dream about watching someone commit suicide is a metaphor for something in my own life... if I could just figure out what...

Here's a brilliant bit of conversation I may or may not have had at some point in my nursing career. Scenario: Patient is status-post angioplasty/stent X2 with a nasty looking ooze from the cath site, loaded up with Heparin and started on an Integrilin drip before coming up to the floor. Pt vasovegaled post-procedure and started oozing, requiring a manual pressure hold in the cath lab. We're attending covered on this particular unit, so I paged the attending first, not realizing how silly and futile it would be. Well, I kind of did, but I also pretty much didn't have a choice in the matter.

JAMIE:
[paging attending]
Hello. I see Pt X's orders for his Integrilin drip are standard, that is, at 1 mcg/kg or 12 gtts an hour, but apparently according to report he's actually got renal dosing at 6gtts an hour...

ATTENDING:
[cutting off conversation; huffily]
Hold on, hold on. I don't understand what you're saying. What are you talking about? [Extra snottily]: What's a gtt?

JAMIE:
[internal monologue]
Gtt: from the Latin, gutta, guttae, f., noun: drop. Also standard medical abbreviation for milliliter, or cubic centimeter.

JAMIE:
[to attending, aloud:]
Uh... milliliter, cubic centimeter? Anyhoo, the drip is going at 6 cc's an hour; it's a renal clearance dose. I need the order changed for a renal clearance dose, can you pop that order in for me, please?

ATTENDING:
[indistinct muttering]

JAMIE:
Oh, and the patient is having severe back pain similar to what he had last procedue; says he sustained an old back injury. I see he's only got Tylenol ordered; can we give him something stronger?

ATTENDING:
[huffy again]

No! Absolutely not.! He's got Tylenol ordered, that's what he can have. I'm not ordering anything else. [as if it wasn't perfectly clear the first time] He can just have the Tylenol!

[hangs up phone]

Down but not out, I paged his APRN, who was more than happy to put in the correct order for the Integrilin drip (because you know, it's nice to have correct orders written, and the attending certainly wasn't about to do squat) and eventually got something ordered for pain.

About a half hour later, the patient starts having nausea, vomitting and severe, unremitting radiating pain to his testicles. Due to the fact that he's still slowly oozing from his groin site despite manual pressure and a sandbag and he's on an Integrilin drip, I start to worry, thinking maybe, just maybe, this guy is bleeding into his belly. I get back on the phone with the attending, who is apparently not at all pleased to have to talk to a stupid nurse about potential life-threatening complications of the procedure, because what the fuck would a dumbass nurse know about extraperitoneal pelvic bleeds? I explain the situation, fully and perhaps naiively expecting something rational, like an ultrasound, or an abdominal CT scan, or maybe both, plus a stat CBC, to be ordered.

Oh, wishful thinking.

ATTENDING:
Oh, you know what? Just put a foley in him. He had this problem last procedure. Couldn't void. Put a foley in him.

JAMIE:
[Stunned, but continuing to belabor situation while having simultaneous visions of nursing license spontenously combusting]

Uh? A foley? Just a foley? Are you sure? You don't want a...

ATTENDING:
[confidently, cutting off conversation]

Yes. A foley.

So, back to the drawing board (not to mentioning paging the APRN) it was. Of course, when I explained the same thing to his APRN, the immediate response was, "I think this guy really needs a stat U/S; he could be bleeding into his belly. I'll be up to see him as soon as I can."

Thank you, Jesus. And thank you for creating caring mid-level professionals who don't mind being rational and actually coming up to see a patient in distress.

The funny thing was, both the attending and the APRN came up at the same time, and the attending was all, "We don't need any of that other stuff, just a foley." Oh, really.

Needless to say, I didn't send away transport, and he went down fo the U/S and CAT scan after the foley went in. And lo, the patient did have a bleed in his belly. And lo, the attending, who basically didn't want to be paged all night, shipped him off to an ICU for poor interns and residents to deal with all night.

Ergo, I had to explain to this patient (because apparently the doctor couldn't be bothered to reassure his own patient in person) in some of the most delicate verbal tapdancing I've done in awhile with some fancy crap along the lines of : Don't worry, it'll all be okay, we're just sending you to the ICU so uh, you can be covered by housestaff, because uh, your doctor uh, thinks it would be, uh... safer (yeah, that's it! Safer! That's a good, reassuring word!) if you had in-house coverage overnight, blah blah blah.

PATIENT:
Wow. The ICU, huh? Wow.
[Translation: Oh my god! Something is obviously very, very wrong with me, and you're not fucking going to own up to it, are you?]

JAMIE:
[fibbing, just a little bit, seeing the worry on the patient's face, in what she hopes is her best reassuring tone]

Well, the patients on the subacute side are generally the same level that we take here in our unit; the difference is that you'll have in-house staff covering you all night long. Your doctor feels it will be safer for you.
[Translation: Your doctor doesn't want to be paged in the middle of the night, at all, ever, for any reason, and by the way, he thought a friggin' foley was all you needed, so the fact that you're getting a first year doctor as your primary tonight is probably a massive improvement on the situation.]

PATIENT:
[vaguely]

Oh, okay. The ICU, huh?

Dude, that like, totally sucked. And one of the things that bothered me is how damn nice this guy and his family was; all "Thank you for telling me what's going on." and "I'm so sorry I'm in so much pain; I really hate to bother you." And here I was, trying my best to be helpful and reassuring, and not getting it particularly right on either account. I just hope the guy is okay, in the end, because he deserves it.

Dogue

I'm beginning to sound like a broken record at work, and I'm sure you guys are thinking, "Whiney wuss. Deal with it, already." Okay, I confess, I'm a bit of a whiner when it comes to things which require actual motivation and energy beyond that requisite to sitting on the couch for long periods of time, staring into space vacantly.

But really, last night at work from 3p-7p took the cake. I "floated" which is nursing code for "Ha ha, you're fucked!" A notorious management-born strategy for solving staffing problems on floors on than your own, floating is enormously and I would say almost unanimously unpopular amongst non-float pool nurses. I had the unique privilege last night to find out the root cause for this deep, deep hatred: you get the "heavy" patients on the floor that no one else wants. It felt like some kind of hellish punishment: all of my five patients were incontinent and bedridden and demented, three were on contact precautions and varying degrees of aphasic and dysphagic, one was on a tube feed, one on a heparin drip, three on maintenance fluids, and every single blessed one of them needed to be changed up in the course of the shift.

And that wasn't the worst of it (it got super bad; not code bad, but almost as bad in a different non-patient related way) but I'm beginning to bore myself now, so I'll shut up.

Because sometimes, you need to sit down, shut up, and pet the pooch. The first thing I did when I got home last night was literally run to the dog and lavish inordinate amounts of affection on his person. Having a pet is therapy, I don't care how cheesy and Oprah self-help it sounds.

I tried to take some pictures of him today, but most of them ended up of his forehead, or his ass as he slunk out of sight of that stupid annoying flash, dumb human. He got a bath today, and looks all puffy-headed and darling, but his pictures don't really do him justice. His photographic expressions range from mildly petulant to extreme loathing (presumably of being photographed) and he needs a little bit of grooming but on the balance he is a cute little chap if I do say so myself.

I love my dog, and if I have to go to work and suffer in order to keep him richly supplied with designer dog food and gourmet cookies and such, then so be it.

Ma vie comme un chien

It's official. Not that it would matter if it was unofficial. Work is dreadful, and it snowed six inches on Thursday night, requiring a half hour "dig-the-car-out-of-it's-snowy-entombment" fest yesterday.

I sleep about 12 hours a day now (even on my days off) to recover from the gauntlet that is work, and it says something when your crappy boring dream life is better than your reality. Any way, last night I dreamt en francais, and was doing French homework. Mon Dieu, if my dreams got any more pedestrian I'd have to conjure the spirit of Franz Kafka for some help, not that turning into a large cockroach would do me any favors at this point.

Any way, if I have any say in what I get to become in the next life, assuming there is one, I'd like to be a dog. And not just any dog, but my dog, if that makes any sense. Yeah, dogs lick themselves and roll in deer poop because it smells good to them, but maybe I'd be one of those oddball dog's that doesn't. And if I were my dog... Well. My dog gets to sleep 20 hours a day and be waited on hand and foot. I would honestly have no problem sleeping twenty hours a day, ensconced in someone's warm, hospitable home environs, without a care in the world beyond, "When's dinner? And where's that food lady who feeds and pets me?" I'd never have to grocery shop, clean the house, do laundry, iron, scrub the toilet, get stuck in traffic when I'm late for an appointment, and I'd certainly never have to suction purulent sputum from someone's airway as part of my job description. My dog totally has it made, man.

Unfortunately my present incarnation as gainfully employed human being means I have to go do exactly that (suction purulent sputum, et al) in about half an hour. While my dog sleeps on my couch and looks put out about his lot in life.

Latinam est gaudium et utilis

So I forgot in all my work-related misery what it was I originally intended to post, back in the balmy morn when I thought I was actually going to get lunch and dinner.

I had another geeky dream last night. Where it came from I have no idea, because I was studying cardiac meds and EKG interpretations right before I went to bed, not Classics. Any way, last night I dreamt I was translating Latin sentences out of Wheelock's Latin. As usual, the sentences were war-themed with the occasional philosophical bit thrown in for good measure. And I felt all warm and fuzzy inside, because I had finished the entire book and was now doing the extra bits in the back of the book.

Dude, I'm not saying in my predilication for pointless pedantry is healthy.

I am saying I need to dream about something halfway normal, like vacationing the South of France, or winning Powerball. Because who the hell dreams about Latin homework?

When I Am Old, I Shall Wear Purple

And also, tattoo DNR/DNI on my chest.

I just got off a rather depressing and stressful 12 hour shift, the last eight hours of which I neither drank, ate, or sat down in excess of 5 minutes at a time, charting notwithstanding. It's 2 a.m. now, and the last time I ate anything somewhat substantial (bowl of cereal) was yesterday at 10 a.m.

I want my paycheck, and I want it now.

We promise. We deliver.

Obviously, I am a shameless individual, because not only did I post here about The Barking Christmas Carol Dog, I actually have him/her displayed prominently in my home (never mind the pumpkin, my feeble effort at Halloween decorating).

I think he barks "O Tannenbaum" and "Joy to the World." I think. We only tried the directions ("Press his left paw to hear him sing!") once because Piper got pretty excited over the whole thing and wanted in on the action (whatever that might have entailed from his canine perspective, I can only guess).

I myself have a question: Where are the eyes? I guess I'll go have to look to make sure I don't have some kind of lethal-gene expressing Christmas decoration lurking in all its DNA misfittedness on my living room shelf. Because there's scary, and then there's just downright wrong.

Meanwhile, I worked the perfect "extra shift," a 7a-11a. Golden, baby. Pass meds, do first round of assessments, alert PAs to colace orders (the elderly are obsessed about their bowels) and dropping hematocrits, and just as things get brewing on the floors... on comes your poor 11a-11p replacement to take it all away, Calgon style.

Work is freaking me out lately. I haven't like, cried or anything while I'm at work (although the first couple of weeks I got pretty close a couple of times) but the whole idea of real responsibility can be quite scary after a comparatively leisurely academic career, in which the worst infringement one could possibly commit is the stealing of intellectual property, which while punishable by law, most likely wouldn't directly result in the death, dismemberment or disfiguration of another human being, all of which could potentially happen during hospital shift work.

I mean, I really can't think of a time in graduate school when the failure to footnote would have caused bodily harm, although I'm sure the more creative (or intellectually anal retentive) could conjure such a situation. Plus, as demanding as graduate level work in humanities might be, I can't think of a single time when I had to triage three or four issues immediately and be as accurate as possible in delivering timely consideration and prompt action lest someone suffer dire consequences because of my inaction or misaction. I mean, that's what proofreading, spell-check features on word processor programs and book editors are for, right?

Still, I kind of miss the staid, scholarly existence (even if I no longer have the attention span or aptitude for parsing out obtuse philosophical arguments and applying them to practical situations, like painting the garage or making toast). Any way, it is hard to go from being reliably mediocre in what you do (namely, half-read your assignments and cranking out flat, unispired papers guaranteed to make unremarkable passing grades) to feeling like a bona fide dumbfuck half to most of the time you're at work. It sucks and I would be lying to you if I told you otherwise.

Enough mumbling. Perhaps something exciting will happen overnight, like I will be transported to a world in which it is my patriotric duty to stay and home and do as I please for a princely annual sum. If it doesn't, I have to get up and go to work for another happy funtime twelve hour shift, so I suppose I'd better go pack my lunch/dinner now.

The Winter of My Discontent

Phooey.

Two days into Snow Weather and already the bleak slushy season has grabbed me by the throat and body slammed me down into a wretched mood of discontent. I'm cranky, apathetic and dreading/loathing the months of bitter cold and de-icing-windshield-scrape-athons/snow shoveling at 6 a.m.

Humans should have evolved to hibernate during winter months; it'd make this crappy season a lot more appealing if we could just curl up in the fetal position under a down-filled comforter and sleep for months at a time, and besides, no one would feel guilty about putting on pounds because hey, that's what we're supposed to do for winter reserves. Yeah. That'd be the ticket, wouldn't it?

O Christmas Kitsch, O Christmas Kitsch(!)

To the left of this text is a fine photographic example of what happens when college kids decide to forstall life, getting a job, and making real money, and go to graduate school instead.

They end up poor.

Very, very poor.

So poor, in fact, that when Christmas comes around, the only thing they can pony up for a Christmas tree is a two foot, fiber-opitc plastic fake one that would glow luminiously in the dark, if not for the fact that the ac adapter was lost during multiple cross country moves in pursuit of higher eduation.

Meaning all that is left of the former glory and attraction of said decoration is the fact that it kind of looks wintry and frost-tipped. Or like it has a bad case of tree dandruff.

Sigh.

I had hoped that 2005 was going to The Year I Got It All Together. Well, not everything, but at least the ability to get off my lazy duff and decorate something with fake firtree garland, or make Christmas cookies, or at the very least, get a proper tree. But then that would mean buying ornaments and at the going rate of Hallmark ornaments my plans for fully decorating o' Tannenbaum with something other than popcorn tinsel and popsicle sticks is up there with building my retirement dream home.

I know, you're thinking "There's got to be more to the story, Jamie." And there is. Next installment, meet the Barking Christmas Carol Stuffed Dog. From Walmart.

The Iceman Cometh

This is a picture of our "backyard", as we've dubbed the pretty piece of wooded property that buttresses one side of our condo building, and the scene we woke up to this morning. Yes. The dreaded "S" word: shit. I mean snow. Same difference, really, when I think of the months of craptastic weather and salt and dirt all over the roads, not to mention freezing my arse off for no good reason, stupid northern latitude.

Man, it doesn't do this crap in Tennessee. (Well, yes, it does, but then it goes away after a day or so of everybody closing down the entire city, after first having mobbed and cleared the shelves of the local Kroger because the apocalypse is nigh and all).

Any way, I'm babbling. Around this time I become highly nostalgic for my old haunts and start dreaming regularly about Nashville. (Last night I didn't dream about Nashville at all, but had an equally pleasant dream about chatting with several New College professors. I clearly miss the days when life didn't involve the legal documentation of the amount, color and consistency of a patient's sputum).

I'm writing this while watching the dog stare intently at the radiator, as if locked within are miraculous doggie treasures to behold. Oops. Now he's unwisely gotten too close to the radiator and presumably burned his nose, as he's taken off at an undignified trot and is now sitting in front of me, whining to go outside. Where it's cold and dark. Miserable damn weather. It's like living in Gotham City for five months out of the year.

The CABG patch

(Note: Not to be confused with "The Cabbage Patch" which refers either to a) a nursing unit in which all the patients are vented, trached, comatose = "vegetables" or b) those scary looking dolls that were all the rage back in the eighties, and have somehow made their insidious way back onto the kiddie market, evil minions of Satan than they are).

So, three of my four patients last night were of the "chest pain/ROMI/ACS/USA/status-post cardiac cath/pending CABG" variety. It was hard to remember which one of them actually ruled in for an MI, versus the one which one ruled out but was found to have multi-vessel coronary artery disease anyhoo on cardiac cath... oh wait, they all did.

You see, I have learned my lesson. Never ever shall I assume that because one day on the unit is peachy-keen, that thou shalt have another similar day. Especially in a row. Because lo, I got only one of my patients back yesterday (the last day of my scheduled run of days) and lo, one of my patients had "9/10 chest pain." All chest-clutching and red-faced chest pain to boot. With the family at the bedside.

Jesus Christ. Don't you love it when that happens, because then you're not only trying to stablize the patient, you also have to dislodge distraught and terrified family members from the bedside without looking like some kind of hard-hearted uber-Nazi. Meanwhile, the poor teary-eyed wife in the hallway needs some hand-holding and reassuring, so you have to try to have your "healing hands" moment with her too. Or, in this case, leave it to one of your sucker co-workers who gets roped into the deal while you are trying to fight Pyxis for the damn sublingual nitro bottle, paging the house officer, taking vitals, administering the hard won prised-from-the-jaws-of-Pyxis sublingual nitro tablet, and grabbing a stat EKG.

Short and the long of it, the sublingual nitro did the trick, thank God. Meanwhile, the floor got a bomb of an admission who responded poorly to IVP Cardizem and had to be put on a drip, some one else's BP took a dip, and we got three admissions on the floor at the same time, wait no, four, but my poor guy had to wait in the hallway while housekeeping did the bed, because apparently three hours worth of paging them to come and clean the bed just isn't enough.

So, so glad today is my day off, because really, I've had enough excitement this week, thank you.

Laissez les bonnes temps rouler!

Wurk didn't suck tonight, which is amazing, because I worked an 11a-11p, and those are usually the suckiest of sucky nights.

I started out with three patients, went up to four at some point, discharged one, and admitted a cath lab transfer, whose groin didn't bleed or form a hematoma. I had all my meds, charting, and assessments in the computer by 9pm. It was beautiful. If a little boring. Everybody was sane, nobody rode the callbell all night long, no one had chest pain or dyspnea, blew their IV line or threw sandwiches across the room, no one had pharmacy issues or dietary issues or admission issues. I only had to call the house officer once, to hold a BP med. I actually got a half hour dinner at 6:00pm, and sat for the entire thirty minutes without someone calling me away from my sad little microwave meal to do something for a patient. (I rarely get fifteen minutes to eat dinner, and when I do, I'm eating an apple or something while charting or in between paging the house officer.). It was like that Walgreens commercial, about a utopian place called Perfect. Or as close to Perfect as hospital life gets.

Yeah, baby.