Fall

I think of him the first thing upon waking
the thousand times I wake
staring up into darkness as I shift my child
from one hipbone to the other
pressing the flat of my hand against the protrusion of a tiny shoulder
softly cradling and imagined world.

I think of him and shrug off again the sadness
so immense
that if fills even these protected twilight spaces.
Telling myself what we tell ourselves
on the drive home, as we leave it behind:

That these outcomes are unpredictable
That the skull fracture may vent the pressure
about bleeding and herniation and
the resilience of children and
what we ask of God.

May he open his eyes.
May his father not blame himself.
May the single-mindedness of our hope and belief in intervention
be rewarded with miracles
and not the ache of knowing that the time may have been better spent
helping them to say goodbye.

Revile-ations

I’ve been saying goodbye to people, and I’m UP TO HERE with it right now. Today I said goodbye to dad and Hailey all day. Tomorrow I will drive to Aunt Brenda’s house with Beans in tow to say goodbye to them again, after which I will drive to Gainesville to say goodbye to some friends there.

Yesterday was fun, though. Ma and I orchestrated one of our epic cooking project dinners, with homemade pasta and brownie baked Alaska. If you are unfamiliar with the glory that is brownie baked Alaska, let me elaborate: the best fudgy super-chocolatey brownies ever, with vegan coconut ice cream (strawberry flavor!) piled up on top, all covered in a generous layer of juuuust browned meringue.

It’s incredible. Ma says that Aunt Leta has a version that is set aflame at the table, which is almost beyond my imagining. So, so worth it.

I have found my Ultimate Dessert.

I invited Dad, Hailey, and my cousin Whitney. That combination allowed me to turn over care of the Doodle to my over-eager dad and focus on swatting my mother’s hands away from the pasta maker (DUDE, I’VE GOT THIS, YOU GO DO SOMETHING OVER THERE). Whitney and I made noodles, and the three of us talked smack.

Oh, the smack we talked.

Eventually my dad and daughter rejoined the group, and it was really fun. My parents reminisced about all the pot they used to smoke, Whitney joked about how she refuses to sign any official documents for my uncle’s business (she’s their accountant/financial manager) because she’s pretty sure they’re all going to wind up in jail at some point, Annabelle tore around the kitchen hitting people with giant oven mitts on.

After dinner, Whitney and I took a walk and she laid it on me.

My family is a TOTAL mess. Like, not the funny kind. The deeply disturbing, bad things happening in the dark for years and years kind. Real secrets.

When things like this start to come to light, I have this desperate need to establish some kind of consensus on what happened. And in order to do that, everyone has to know. The whole nasty history has to be pulled out into the daylight and unpacked, so that the various parties can say “I recognize this” or “this doesn’t fit with ANY of these other pieces.”

There are issues with credibility. And I can’t say that I believe or don’t believe because of the magnitude and scale of this thing. 30 year old secrets.

Move Date: Finalized

Salem Hospital called back, and now I have an interview scheduled for June 28th. I am in the uncomfortable position of really, REALLY wanting this job. I’ve wanted jobs before, but I REALLY want this one. Fuckyeah capslock!

The problem is, well, Salem Hospital is kind of the shit. It’s one of the top hospitals in the country. It has Magnet recognition, which is specifically referring to nursing excellence. These are all-stars in the ED. Am I up to that kind of snuff?

I don’t know what I’d do if that kind snuff bit me, ya’ll. It’s serious. I desperately want to be an all-star, kickass ED nurse, but I worry that it’ll be obvious in my interview that I am not, as yet, much of a high-level player. I’m not sure what to do to prepare. Should I study up on dobutamine? What do I say about my challenges and strengths?

So.

I guess I’m going to study up on dobutamine.

Also: we are moving to Oregon on June 26th. Tickets have been purchased…mine and Annabelle’s one-way, my mom’s round-trip. W will be driving the car, stopping to visit his grandfather in NC. Who has apparently just started chemotherapy for a brain tumor, and was not sounding as optimistic as usual in his family update email.

Leapfrogging From Holding Pattern to Holding Pattern

I’m typing this at my mother’s house, where my husband and I have landed, mit DoodlePuss, in anticipation of our coming move to Corvallis, Oregon. Better known as That Godforsaken Town That Doesn’t Need Nurses. I’m trying not to hold it against the entire city, but I am failing. So far I’ve had one interview for the 6 Good Samaritan Health Services (the hospital system that serves Corvallis and all the surrounding areas) jobs that I’ve applied for, a per diem position in the ED in Newport, 1 hour away from my eventual home. I think that the interview went relatively well, but who knows. I am very, very anxious about this whole unemployment thing. I miss the days when I could just…quit. Because eh, you know? Now I’m all HOW WILL I KEEP THE PUSS IN ORGANIC FOODZ?!?

I went out to dinner with my charge nurse and some friends before I left, and amid hugs and well-wishes, I was told in no uncertain terms that my job will always be waiting for me if I come back. It made me cry. Despite all the complaining and paranoid rambling, I became a part of the ED team, and I was sadder to leave than I had ever anticipated.

Not to mention leaving all my friends from nursing school, Claudea and Nicole and Meghan and Linh and Teresa. Those were my peeps. Especially Claudea, I miss her so much already. Last week she arranged for me to fire my very first weapon! We took selfies with guns! Which I can never, never show to my mother. The other pictures are going up on fb tomorrow, because I promised to post proof.

I’m trying not to think that I’ll never see my buddies again, although in almost all cases that is a certainty. Claudea promises to come visit. It’ll be okay.

It feels to me now that I’ve done a lot of moving, although really I’ve just been circling back and back.

In ex-work news (speaking of coming full circle), Amy lost her charge nurse position a couple of weeks ago. Rumors are flying, but the most reliable one is that she badmouthed the hospital to visiting state regulators. She’s back to working on the floor now, probably for a while, maybe permanently. She gave me a long, tight hug on my last day and talked about visiting me. I was all, dude, no worries, my unemployed-cardboard-box-house will be readily expandable! She replied “well, I’ll probably get a hotel, if I still have a job by then.” Ooof. I know how she feels. I was plenty frustrated with her, but I never wanted her to get in trouble. She’s a great nurse. After my initial few posts about her she mellowed considerably into the charge nurse role. She had just gotten that job when I started on the floor, and I think that we spazzed out together a little bit.

Projects:

1. Lose weight…AUGH. 150 lbs still. So much for that whole 27th birthday plan. Oh well. Back on that poor dead horse, I am!

2. Homemade pasta and baked Alaska (because there is no shame in my game)

3. Forcing Ma and Ken out for postprandial walks, to help control their diabeetus (soooo…maybe not pasta and Alaska…)

4. FIND A FUCKING JOB (buried this one in the middle to downplay the PANIC)

5. Teach the DoodlePuss to sleep by herself (she’s snoozing away in her crib right now, so we’re off to a good start)

6. Find an apartment in Corvallis

7. Move

8. Write about things

9. Post more pictures and videos

10. Don’t panic

A National Shame

Annabelle (sleeping across my lap) and I just finished watching a PBS documentary, American Experience: My Lai. I had seen the pictures before, and thought that I knew the story. As it turns out, I was missing key details. For example, since I knew that there had been an investigation and trial, I had always assumed that at least a few of those involved went to prison. I had no idea that the only person ever convicted (of the 30 or so trials that took place), Lt. Calley, was released by the Nixon administration in response to public outcry on his behalf. He served 4 months in jail.

This man ordered 100 people rounded up, pushed into a ditch, and shot. Among other things.

My understanding was that once those photographs were released, public outcry against the war was so strong that the US was forced to concede defeat. This is true, but only to a limited degree. What is truly fucking amazing to me is that people saw those pictures and wrote 25,000 letters to the president requesting that this man’s conviction be overturned.

This is related to the shooting in Connecticut, but probably only in my head.

My first reaction, upon learning of it, was to burst into tears. Then I began making hysterical plans to home-school the Bean, because EFF THAT. I am not sending my baby to school to be slaughtered. One of the things I noticed first in the news reports is that only 2 of the victims made it to the hospital. 18 of the children were pronounced dead at the scene. Gunshot wounds, having seen a few now, do a lot of damage, but with a lot less mess that you’d expect. We have a rule about stripping clothing off of trauma patients, because with a reasonably-sized caliber, you can literally overlook a gunshot. One of my friends at work loves to tell the story of the drunk Vietnamese man, who staggered around the department fighting everyone and shouting in Vietnamese, until he took a turn like my brain bleed lady, got a head CT, and it was discovered that he had been fucking shot in the head. Not a whole lot of area, your head. You’d think that you’d notice somebody had been shot there, but you wouldn’t necessarily.

What I’m getting at is this: you’d expect more wounded. Even children.

One of two things happened. Either this person stood in front of each child in turn and made lethal shots, or he sprayed the room with bullets several times and it took long enough for police to clear the scene that most of those wounded bled to death. It might not have taken very long, but it was far from instantaneous.

Little kids.

At the time when I watched the special on Mei Lai and wrote the first section of this post, Annabelle was 6 months old. In the film they showed a picture of a baby about her age, half naked, shot in the back, lying dead on the ground. Little round baby thighs, with those little dimples…and I didn’t GET it, and I still don’t. I don’t understand what makes a baby an object. When I first started working in the ED, I would literally shake when I took care of sick kids, tried to start their IVs. I couldn’t stand the idea of sticking a crying baby with a needle. I’m more used to it now, but I still hate it. Other nurses and doctors have told me that they feel the same way. It’s so much pressure, because you so badly want to avoid hurting them, for any reason. So, how do you shoot a baby? Is is some mental switch that is flipped by the gun, do guns turn babies into things? Obviously, gun control. But also, how?

The Puss Is Sick

Beany has a fever, and her very first chest cold. She’s been up all night coughing. It’s one of those horrible rattling coughs, where you can hear the phlegm deep down in her chest and you just want to cough FOR her. Terrible, awful. The two worst things about it are that a) in the last couple weeks I’ve pretty much stopped breastfeeding her, so now I’m convinced that she got sick because of a lack of breastmilk antibodies, and b) this is definitely a daycare cough. I’ve heard about 3 babies in her daycare hacking the same way.

The good news is that while she feels terrible at night, during the day she is almost her usual self. Over the weekend she ate very poorly, but I managed to get her eating pretty well today. Tomorrow is another 5 hours at daycare (unless she has a fever when she wakes up, in which case somebody has to stay home with her), then she’s all mine until the following Tuesday.

And my mom is coming down this weekend for Thanksgiving!

EPIC FOOD HOLIDAY WILL BE EPIC.

I’m going to try and manage my weight with small portions, but I’m not going to stress about it too much. Ma doesn’t come down to cook with me all the time, ya know? And I’ve been doing so well with the MyFitnessPal android app so far that I’m really energized and excited, so it’ll be easy to get back on track next week. I’m going to keep count of what I eat, though, just so I can watch the gluttony add up.

I meant to post this with my election screed, but here it is anyway: my favorite anticapitalist song.

This Is Ridiculous

I just spent all day worrying and stewing and steaming up about the ears over work bullshit, rather than enjoying my Beanypuss. Or my day off. This is ridiculous!

New plan:

1. Be self-sufficient! Only ask techs for EKGs and blood cultures! Limit my exposure to assholes!

2. Clean my own rooms.

3. Stock all my rooms with 2 blankets and 2 pillows. Whip these out to astound patients as they arrive.

4. FREE PAIN MEDS FOR EVERYONE!

How is your pain now? Would you like more morphine? Would you rather have dilaudid? How about both! I can do that for you! I was thinking about it, and I’ve become one of those nurses who resists giving people pain meds. That stops today. I’m not going to leave my patients alone until they’re sleeping off the world’s biggest narcotics bender. How’s about that for patient satisfaction surveys!

They. Will. Love. Me.

5. Stay in my patients’ rooms to chart. I’m going to set up a stool in each room and chart as I make rounds, so that I can both avoid my coworkers, increase my patients’ satisfaction, and learn to do without having vital signs printed.

6. Unsubscribe to facebook updates from nearly all the people at my job. Check!

7. Be extra-special-super-duper-sweet to my coworkers! I need references if I’m going to get out of this shithole alive!

8. Double and triple-check my work, so that I don’t make stupid mistakes.

9. Switch patients at the whim of whoever, whenever, for whatever reason. No more taking a stand, no more standing up for myself, just generally a lot more staying seated. That’s how I approached this place in the beginning and it worked for me. Then I got comfortable, I started to let myself be more open with these people, and now I’m getting burned. They’re mostly a nice bunch, but they aren’t my peeps and it’s important to remember that. I want to stay out of the drama.

10. Start wearing makeup every day again. The don’t get too comfortable thing. Gotta have my game face on.

I will update ya’ll on the progression of my 10 Part Doctrine in a couple weeks. In the meantime, I’m done talking about work. I’m done thinking about work while I’m not physically at work. Over it. Done.

In other news: 145lbs today!

Clarification

I am in favor of legalizing basically everything except meth. I have often said, at work, that we should just have a narcotics vending machine in the lobby. GIVE THE PEOPLE WHAT THEY WANT. If they overdose, it’s pretty straightforward to narcan them, or intubate them and let them sleep it off. Narcotics with tylenol and shit added to them shouldn’t be easily available, though, those should stay prescription only. Overdosing on tylenol will fuck your shit up.

About the mentally ill who won’t take their meds, yaaaaaaah granted that’s a problem. Around the 3rd strike, a team of Fergies and a lawyer should get together with the patient and determine whether or not they are mentally capable of making their own medical decisions. If they’re compas mentis, and they just won’t take their meds, well, they’ve got 2 more chances. If they’re non compas mentis, then that’s a different story and they need to be in some kind of monitoring or treatment program that can help them manage their illnesses.

If you are competent and won’t do the things you need to do in order to be medically compliant, we’re not going to take you out back and shoot you, we’ll do everything in the world to help you get on track. However, once you’re past those 5 strikes, We The People will not spend hundreds of thousands (nay, MILLIONS) of dollars on your care when your hot-mess-ness rolls up to the ED door.

Nuts to that.

That is not a rational allocation of resources.

One of the things that I have discovered about myself recently is that I am very much against the redirection of resources away from neonatal ICU care and treatment for people with profound, potentially fatal disabilities. I have a lot to say about this, and Andrew Solomon’s book, a bit later. Right now, my daughter is beating about the head and shoulders with Hand, Hand, Fingers, Thumb, which, if you’ve never had the pleasure, is one of the most bizarre, menacing children’s books ever written.

Seriously, There Was An Election?

Because I didn’t hear about it, not once. My overwhelmingly religious, hysterical, republican coworkers were respectful of the sanctity of our shared workplace and the feelings of the haggard liberals in their midst, and refrained from mentioning it.

No, you’re right. They went batshit crazy.

I tried to head off my inclusion in any conversations that mentioned “obamacare” by stating that I am a communist and that I want to take everybody’s shit and redistribute it. I want a single-payer healthcare system. I considered draping myself in flashing christmas lights and running around with no pants, to emphasize the I AM CRAZY I AM NOT ONE OF YOU message, but in the end, every the insane are not spared. I got to listen to the “he’s going to kill us all and let black people on medicaid move into our houses” spiel for months on end.

It all came to a head on election day. I was working, and trying to avoid thinking about the zombie apocalypse. Because, you know, we were this close. We’re still pretty close. But I digress.

My righteously angry white colleagues were certain of victory. They had the election playing on every available screen. My black colleagues had voted at the earliest possible moment, and were very, very quiet about it. Initially, it looked good for Mittens. There were cheers. Then the tide turned.

Those of us who voted against the zombies started smiling.

My facebook (now full of work people and nursing school people) exploded with racist, hysterical, “our children will be paying for this for ever” nonsense. This included all my relatives on my father’s side of the family. I got into a heated argument with a couple of people over a comment that included the phrase “muslim kenyan.” Then everyone settled down a bit, and started harping on all the ways in which working in the ED makes you an embittered libertarian bootstraps-pusher. And you know, I can kind of feel them on that one.

They’re still wrong, but the anecdotal evidence is overwhelming. Every single person could trot out 115 stories about medicaid patients who were demonstrably trashy, wearing a new manicure and talking on an expensive phone but refusing to pay the $3 copay, entitled, and obnoxious. People who won’t take their kids to the pediatrician but will bring them to the ED in the middle of the night because, eh, it’s free. And you’d better not make them wait in the lobby for their sniffles while you take care of sick people, either.

Daily, we see a parade of these types:

1. Chicks wanting pregnancy tests. That you can buy for $1 at the dollar store. But if you have medicaid, they’re free.

2. People who misunderstand the meaning of the word “free,” and apply it to all things for which they do not have to personally pay.

3. Fat, diabetic smokers who are noncompliant with their medications.

4. People with asthmatic children who smoke IN THE HOUSE.

5. Drug addicts with bullshit pain complaints, who wind up getting dozens of CT scans a year in addition to their ED narcotics fix.

6. Etc. Etc.

Essentially, the ED is overrun with idiots making stupid decision with their lives. And because Valdosta is largely poor, a huge percentage of those served by my hospital are on medicaid or medicare. Certainly, people with private insurance also make stupid decisions. But here, anecdotally, they’re int the minority. I was before I started this job, and I remain, vehemently against all the “lazy stupid medicaid patients” talk in medicine. But now that I’ve worked in the environment and had the “why didn’t you go to your primary doctor for this stupid complaint, oh, okay, yeah I guess making an appointment is an inconvenience” conversation a few thousand times, I’m a little more sympathetic. It’s hard to think about tax dollars being spent on this shit. It’s hard to scrape together the money for my own ED bill ($400 after my crappy insurance pays out, for 5 stitches), and watch others come and go without paying a dime. I wish I’d manned up and taped my cut finger back together, gotten by dad to prescribe me some antibiotics, and saved my $400. That was an $1100 bill before insurance, btw. FFSAKES.

I still want a single-payer healthcare system. But we can’t do it with this model. A lot of things have to change. First and most importantly, expectations have to change in a big way. If your medications are provided to you by the state, and you won’t take them, there should be a 5 strikes policy. 1st strike, we treat you, we restock your medicines, we educate you, we warn you. 2nd-4th strike, same deal. 5th strike, you get moved into a “low interventions, DNR” category. Basic stabilization measures only, comfort care. We will not code you, you are not eligible for an ICU bed. If we can stabilize you and get you compliant with your treatment for 6 months, you can move back into the “full code” category.

If you have certain kinds of terminal illness (not cancer, as that technology is rapidly improving, but multi-systems organ failure, end-stage Alzheimers, etc.) you are automatically a DNR. This is not only to conserve resources, but because coding you is medically futile.

ICU patients should all have their cases reviewed by a team of case managers, intensivists, and social workers. Family member should participate in these meetings, but they should not have the final say. So much of ICU care is about holding onto a dying person because the family “wants everything done.” Billions of dollars are spent every year on such pointless treatments. Palliative care should be considered a regular part of medicine.

Going to primary care for yearly bloodwork and checkup should not be optional. For anybody

Medical malpractice awards should be capped at 100,000. All care for the injured person, including physical therapy and disability support for the family, should be %100 covered by the state, regardless of the family’s “resources.” (The parents of my baby on the vent are currently fighting to keep her medicaid because they have been told by the government that they have too many “resources” in order to qualify for assistance. By which they mean, the family has a second car and a middle-class income. Neither of which enable them to pay the millions of dollars in hospital bills and extended care that their daughter will need throughout her lifetime.)

The problem with medical malpractice as it stands now is that it warps medical care with the premise that there is no acceptable level of risk. Some people are going to have bad outcomes, some clinicians are going to make mistakes. What is needed in these cases is structural review, loss of license for egregious offenders, and payment to the individual/family of pain and suffering compensation, not more than 100K. If doctors are worried about protecting themselves from liability, they will order stupid amounts of testing on everybody.

NO you cannot come to the ED for a pregnancy test, are you fucking kidding?

But! What if the ED was just one part of a large medical complex, centrally located? You walk into a giant building, register, and sit down to be triaged. If you don’t want to wait and you know you want primary care, or to see a specialist, call ahead and make an appointment, then go straight through. Everybody else gets seen by a triage nurse and re-directed to the appropriate place. The ED is reserved for very, very sick people. The mid-acuity people go somewhere else. The people who should have made an appointment for primary care go there instead. All medical records are accessible online, nationally. Every piece of medical information about you exists forever, and can be pulled up at a moment’s notice by any medical professional.

I might like some fingerprint identification, too, for the drug-seekers who like to sign in with fake names.

The whole building is full of doctors and other medical professionals, and it runs 24-7-365. Medical school is paid for by the state, and care areas are incentivized based on community need. If enough people don’t go into primary care one year, the next year people who commit to working in primary care are given a tax break. If the next year the community is short on cardiologists and OBGyns, those specialties get the incentive. Really difficult specialties are better paid in general.

I’m going to keep working on this. What do ya’ll think?