Cocaine Diet

I was thinking the other day about how you know, when you're addicted to crack, you're supposed to get all Jennifer Jason Leigh in that one drug film (which may or may not have been about crack, but whatever) or Naomi Watts in 21 Grams (note I'm making all this shit up because I've heard like 5% of they plot in passing, but any way, they all seem like good advertisements for totally skinny.)

Okay, so the thing is, the crack addicts I've seen at the hospital, if anything, need gastric lap band surgery, STAT. They weigh like 250-400 pounds.

I want to say, Honey, where did you crack diet go wrong with you?

Because this is the level of gallows humor I've sunk to these days.

Like the other day, I was taking a blood sugar on a diabetic cocaine user, very friendly, weighed about 260 lbs; we sat and talk about Tennesse and the south, and how she went ot Opryland back before they tore it down and built Opry Mills, teenage mall of consumptive doom (Katy, don't have PTSD flash backs now!). Any way, we feed them this 2g sodium, low cholesterol diet that frankly tastes like shit (incidently, I love when they send up cured roast beef for folks in heart failure, or jello and apple juice for diabetic patients). I seriously don't see why it has to taste like shit, because hey, nourishment is a big part of getting everybody better, right? Didn't Florence Nightengale say something about that in like the 19th century? Probably. I know she had a cleaning fetish. I'll bet she's turning over in her grave thinking of all the C-diff, MRSA and VRE rates in hospitals nowadays.

Any way.

So I take this lady's blood sugar, and it's ungodly high for having eaten a stupid "cardiac" lunch, something like 335. We haven't been giving her anything to spike her sugars, so I say [patient's name change to avoid HIPAA persecution, and I do mean persecution and not prosecution]:

JAMIE:
Honey, what'd you have to eat for lunch to eat, sugar cubes?

PATIENT:
[looks guilty, but knows I'm not gonna bust her balls about so she jokes back]
Nothing.

Jamie:
[jokingly]
Nothing. I see, Flo. And what would "nothing" have consisted of?

PATIENT:
[smiling]
Well, my family brought me a McDonald's meal and shake. It was good too.

JAMIE:
Yeah, they are, Flo. Yeah they are. I'm gonna have to you give you your insulin now, and in the meantime, let's keep the extracurricular diet activities on the downlow as much as possible, okay (wink)? And by the way, thanks for being honest with me. It helps me do my job better.

PATIENT:
Alight, will do. Thanks for the insulin shot.

Okay, so let's analyze that situation a little bit. Here's a diabetic in heart failure, hypertensive, morbidly obsese polysubstance abuser who is noncompliant with her medical treatment. How much are we really gonna do for her any way? In fact, two days later she came right back in the hospital for not taking her meds. Sometimes social work and a visiting nurse is what these people need, not a 20K bullshit cardiac work up.

Secondly, I never punish [as in chide] my clients for eating cake or cookies (unless they are in DKA, which means they might die, and usually by that point they feel so shitty they can't eat any way) or sweets. I mean, my theory is, they are eight,y ninety years old, why take out one of the simplest pleasures of life left to them? Let them eat their cake! Except in a less beheading, French Revoluation, Marie Antionette way.

I love when familes come up and ask, "Can I bring this food up for mom?" and it it's all fried pork, mashed potatos with butter and macaroni and cheese. I often say, "I'm going to pretend you fed her salad for dinner, okay? Just remember this is a cardiac floor."

Basically, one damn piece of fried pork isn't going to send them over the edge, and if a family wants to bring in some stupid little thing for a dying patient, I say let them. At least it's better than having no one visist.

One of my patients who I truly love is ninety years old, lives in a nursing home with her sister. They are dying, not of anything specific, just old age is creeping up on them. LIfe really has no meaning for them any more, and she talked to me once about how she prays every night for a good death, in her bed, at home like her brother. She knows the time is near, and she's not afraid; she's looking forward to it. Life has become a dull puppet show.

Any way, I broke all the nursing/patient relations taboos and bought her a cute little house jacket and furry turquoise ballet slippers to match, and gave her a couple of home made shawls to give to her sister: one was Myrna Stahman's Faoerose style lace called Catherina. I made mine in pure white Shetland, but this is basically what it looks like. I did another, similar all-over-lace-pattern called Alka.

I was going to save them for when I had daughters of mine own, but come on, give a teenage girl an "old granny shawl"?! "That would be like, so totally lame, mom." And then I'd cry and be upset, but secretely. I might have used it for a Christening, or a bridal present, but instead I choose to give it to a sad little old lady with no one in the world to give her presents any more.

My point being when I give away knitted gifts (every nurse on the floor--and I believe there's been seven in the last year and half--who has give birth has gotten a blanket) is that I can always make more. I save some, in case my lame attitude towards having childrens changes, but basically, those two shawls, lovely as they were, had been just sitting around in my closet for years (I knit them back in my New College days--while watching syndicated LAO shows!-- when I had the mental capacity to parse out obtuse philosophers and pay attention to thousands of stitches and memorize complex lace patterns. When I made a mistake, it would often take three hours just to carefully rip back to the part I'd screwed up. But they were beautiful, and I was very proud of them.

I'm happy I had an opportunity to give them to someone who deserves them.