Tuesday, January 31, 2006

Do you dare wear short shorts...?

Ah yes, Nair commercials from 1987. Lavish large amounts of pepto-bismal pink, toxic smelling, possibly neurotoxic /teratogenic exfoliant on legs and wear slutty looking daisy dukes with pride! Complete with cheesy marketing gimmick!

Any way, lucky for you, I am not going to show you a picture of my pallid looking, winter chapped legs. (And if I ever owned a pair of daisy dukes in my entire lifetime, it would be the parallel universe lifetime, where I was, um, Skinny Marie in a deleted scene from Pretty Woman.)

I am, however, going to astound and amaze you with another kind of daring feat of femininity-turned-feminist: I cut off all my hair!!

Actually, I lie. My mother cut my hair, and I still have some of it left. Sadly, I'm not rich or famous enough to do something really eccentric without getting suspended from my job, like go the Demi Moore/Sinead O'Connor/Natalie Portman route and shave my entire head bald. (On that note: Why on earth would someone as pretty as Natalie Portman shave her head bald? I'm not one of the star-struck people who think everybody under the sun is gorgeous just because the media tells us so--I'm sorry, but Paris Hilton's nose reminds me of a pterodacytl's jaw/beak--but I think there are some genuinely beautiful famous people in this world, and Natalie Portman is one of them. )

And also, as a sidebar: if I ever come back in a time capsule as a stunningly beautiful person please, God, let me come back as Audrey Hepburn. And let me star in Charade because that is my all-time favorite movie , at least from the year 1963. The remake The Truth About Charlie sucked, and I didn't even watch it. I mean, hello: Mark Wahlberg?! Thandie Newton?! What were they thinking?! Did the casting folks put random names into a hat, close their eyes, and draw out bits of paper?! How about casting Triumph, the Comic Insult Dog while we're at it?! Jerks.)


Yes, this is the best I can do with the do-it-yourself-digital-camera picture. It looks like a really good DMV/mug shot. And what's with the glowing aura around my shoulders? I also look like I've just swallowed curdled milk and abruptly forced to smile a second later, but whatever. A photogenic person I am not.

Hey... maybe now that I've lopped off all my hair, people will stop with that godawful annoying "you-look-like-Sandra-Oh" line...

Sunday, January 22, 2006

Twilight Zone

Did you ever have a dream that, upon waking, you thought was completely clever and droll, and boy, I should write that down, somebody could make a movie out of that someday! And then, when you wake up a little more, and are shuffling around the house wiping sleep crud out of the corners of your eyes and trying to find the nearest available oasis of caffeine-rich beverages, you realize you can barely remember the dream, and what the hell was so interesting about it in the first place?

Well, I just had a dream like that. Just thought you'd like to know.

You may have noticed that I'm either spluttering about work, or else yammering on about my dreamlife. Which may have you wondering1) Are you Walter Mitty's female, real life counterpart? and 2) Do you have a life outside of sleeping and working?

Ignoring question 1 for the time being, let us contemplate, briefly, the answer to question 2. The short and the long of it is probably 'no.' Truth be told, I'm not sure whose version of 'life' we're talking about here, but Americans on the whole seem to think that any time spent relaxing is evil and must be purged. I disagree. Twelve-to-fourteen hour shifts of backbreaking, on-your-feet-running-around-without-eating are tiring. I do not, therefore, enjoy running around on my days off, and avoid crowds as much as possible. I don't know whether I'm naturally this way, or whether working with people has made me more sensitive to teeming crowds but it seems I'm ironically misanthropic and slightly agoraphobic for someone who has such a public, people-oriented job.

You see, I look at my job as having an alter-ego. There's On-Duty Jamie, who's generally friendly, capable, and affable, and then there's Off-Duty Jamie, who's tired, lazy, doesn't want to be bothered, and frequently mutters unkind things under her breath about people who annoy her.

Oh. No. Major epiphany alert:

I am one of those sad people who will be tragically equipped at being elderly, when the time comes, able to sit for hours in one spot, getting a nice pressure ulcer on my bony ass, spinning garbled, incoherent tales in my dotage, knitting scarves for homeless chihuahas and spending the remainder of the day drooling slightly and looking glazed eyed out into the distance at nothing in particular. (Incidentally, I'll probably be expert at kvetching about my back, also, seeing as it already gets cricky and easily strained as it is).

Any way, as if to confirm our very existence of Mundane Americana Wurld, Ibrahim and I spent three hours at the local Ghetto Mall shopping for some new clothes for him and finding very little of anything wasn't overpriced, fugly, or both. I caught myself doing the little-old-lady thing and griping about the blaringly loud music pumped into most of the stores. Then I wondered, 'Was the music this loud in stores when I was a teenager and I just never noticed it?'

Sigh. It's back to On-Duty Jamie tomorrow. Must go find my telephone booth so I can morph. Hhhhhnnnn... Do they still have telephone booths? I haven't seen one in a long time. Maybe the telephone company realized it was too expensive to give people shelter while making their phone calls, especially since no one really uses them anymore, except in B horror flicks as a plot device, because we've all got cellphones nowadays, or maybe they've all been vandalized out of existence by young, bored hoodlums. Hmmm. What do college kids do for fun nowadays if they can't stuff fifteen of themeselves into a telephone both for kicks? (Don't answer that last question, by the way).






Saturday, January 21, 2006

Why I (heart) My Patients.

Oh, for the love of Saturdays. Contrary to popular belief, Saturdays on a hospital floor are notoriously busy, because Saturdays follow Fridays, which are days when whole floors get discharged on day shift, and a whole new floor admitted, half of which comes up from the ED at 11:00p.m. Friday night.

Saturday day shift is the Clean Up Crew, and the Dealing with Overwrought Family Members Who Can't Understand Why Uncle Ned Has To Stay In The Hospital Another Day Because No, We Don't Have a Star Trek Wand Thing to Pass Over Him To Diagnose and Treat the Patient Instantaneously and Send Him Home. If we could do that, Uncle Ned would have been already seen and discharged by one Dr. Beverly Crusher. And also, Uncle Ned would be in outer space, on a spaceship, in the year 3850.

Saturdays are not fun days, and are generally spent playing a very dull, deeply annoying grown up variation of "hot potato" with patient issues, at least if you're cranky housestaff. Example: Blood pressure 80/50? Patient not looking so hot? Housestaff Solution: Call me back in an hour if patient's blood pressure is <90.>Nurse's intuitive response
: Uh. Patient's pressure is less than 90. Now.

Actually, I feel right at home, because Saturday day shift is basically like any old weekday evening shift, what with the largely indifferent housestaff, nonexistent attendings, and general all-around piss-poor support. The glaring exception is that on weekends, family members are even more pissed off at nursing staff than usual because You're not the doctor! When the hell is the doctor going to come up and see my father/mother/grandmother/uncle/aunt/sister/pet hermit crab?! To which I must dutifully reply, "I'm sorry, the doctor doesn't see arthropods at this hospital. He may, however, consent to seeing your hermit crab."

Any way, it isn't all bad, so can I admit to a guilty pleasure?

I love doing pain assessments on patients whose pain meds are clearly working:

JAMIE:
So, how's your pain now?

PATIENT:
[lolling in bed, shit eating grin on face]
Ggggggreaeeeattttt.

JAMIE:
No, wait... I mean, is your pain is better now?

PATIENT:
[still with shit eating grin]
Hhuh? Whooz askin'? Oh, uuuh huuuuhn... yeaaah...

JAMIE
[charts "patients pain scale 2-10 from down fom 9-10 post 1 mg IVP Dilaudid pushed per protocol; pt states good relief of pain."]

Happiness also lies within getting a patient's uncontrollable metastatic CA pain under control with some good old-fashioned "lead house officers to physician ordering screen and force them to write proper pain management protocol orders" gumption. I got a snotty attitude in return for asking the HO (house officer) to write decent pain management orders, because why the hell would I want my patient's pain under control, for God's sake?! Can't the patient just suffer along with a morphine order that makes him dry heave and doesn't do crap for his pain? What the hell does this look like, a hospital?!

I also had a pre-crump-looking patient (you know the type, 300 bazillion years old, still a full code, going septic and dropping his BP's on top of it). BP's had dropped from 110's systolic in the a.m. to 80's at 12p.m., and very rapidly thereafter to 60 systolic by doppler. He went from feeling "a little tired" this a.m. to looking waxy yellow looking, low grade feverish, diaphoretic, with that purple look under his eyes that nearly always spells "crump" to me (putty colored noses and grey faces also spell "crump" too, usually of the chest pain variety).

One stat EKG, two normal saline boluses followed by maintenance fluids, and a set of stat labs later
his pressure was back up to 98 and bless him, he was looking very perky indeed, peppy enough to sit up, eat his supper and joke with me. He even got up to the commode and pooped without vasovegaling or getting orthostatic, a feat which makes any cardiac nurse's heart beat in wild delight/SVT (I know, we're sick individuals).

And lo, his labs came back. And lo, his 'crit was crappy. So, hemodilution or no, I got an order and hung a unit of blood. Of course, the man was extremely hard-of-hearing, so a typical conversation went something like this:

JAMIE:
[yelling at top of lungs, two inches from patient's ear]
WE. ARE. GOING. TO. HANG. A. UNIT. OF. BLOOD.

PATIENT:
Whaa?

JAMIE:
[screaming at top of lungs; nurses outside at nurses station snickering loudly]
A. UNIT. OF. BLOOD.

PATIENT:
HUH?

JAMIE:
[dogs and small children in neighborhood now whining in protest at decibile level/frequency]
BLOOD.

PATIENT:
CRUD?! Who's got crud?!

JAMIE:
[gesticulating wildly at unit of blood due to expire any second now due to length of conversation]
NO, BLOOD.

PATIENT:
[finally noticing unit of blood]
What in hell is
that?!

JAMIE:
[hurls self out window, has fleeting visions of becoming a pantomime in next life as she hurtles towards pavement below]


The reward for making a silent movie demonstrating Hanging Blood 101, old-fashioned captions and all, was when he said, smiling,"Thank you for helping me. I really felt like I was going to die today, and you worked so hard and got me better. I feel so much better now! You did a great job."

Well, I seriously doubt he would have died today, but it's nice to think he thought he good care.

And that, my friends, is why I (heart) my patients.