Medicine on TV

So I was watching an episode of a TV drama and there occurred a medical emergency which played out so poorly, I shrieked, "WHAT?!" at the TV. A very fit young man is in the hospital after being beaten up. One minute he's talking, then suddenly the EKG monitor (which an assault victim with no history of cardiac problems would not have) alarms and IMMEDIATELY a doctor comes running in saying "He's crashing. Get me O2 and an ambu bag." The monitor completely flatlines (wrong) and a couple more staff members (nurses, possibly) run in. The MD starts totally ineffective, fake-ass chest compressions with the patient still up at a 30 degree angle in the bed. The nurse with the ambu bag gives a few breaths, then caresses the patient's chin. Huh?

Oh it was so bad. I'm sure police and lawyers get riled by horribly inaccurate portrayals of their professions too. A guy asked me once which TV shows were the most medically accurate. The best one is Trauma: Life in the ER but that's a documentary show so it really doesn't count. I haven't watched it in a while, but ER was pretty decent in that the actors had practiced doing fake intubations, chest compressions, and other procedures. I recall as well that the treatments they rattled off by and large were accurate for the patient's condition. Of course, like all medical shows, the doctors did tons of stuff that really nurses do.

Scrubs is rather bad, both in the wildly inaccurate depiction of medicine and in severely dropping off in quality after the third season. Don't even get me started on House.

And then there's my favorite quack doctor. No not Dr. Nick of The Simpsons. I'm speaking of Dr. Spacemen (SPA-CHE-MEN) on 30 Rock. A couple episodes back Dr. Spacemen (wonderfully played by Chris Parnell) rushes in to see an unconscious man who he instantly and correctly identifies as being in a diabetic coma. After some ineffectual bungling, Alec Baldwin's character says, "Couldn't you just, you know, inject something right into his heart?"

Dr. Spacemen, with a look of concern and pity, responds, "I'd love to, but we have no way of knowing where the heart is. You see, every human is different."

BWAHAHAHA! Thank goodness for Tivo so I can pause and rewind because they weren't done. Spacemen grabs the phone and says, "Is it 411 or 911? [pause] New York. Uh, diabetes repair I guess?"

Oh how I love, love, love Diabetes Repair.

A typical Monday of late, in that it involves work, frustrated desire, and something funny

I didn't make it to the dramatic presentation. I transposed two theaters when I was looking at directions originally and when I realized the mix-up it was too late to make the show. Oh well, there will be other opportunities. I'll just have to stay on top of what's playing and plan ahead. What I like about Houston is that classic and contemporary, much-lauded works get mounted here. Quite different from Austin.

Yesterday work was a study in contrasts. When I started the day, I took two patients with the plan being that I'd give them up at 9 AM to another nurse so that I could get more practice admitting difficult cases. Two hours to assess the patients, document, give medications, while also managing phone calls from family, updating doctors on condition, and providing comfort care isn't much time. I didn't quite make it and by 9:30 just ended up fetching one patient's meds for the relieving nurse to give. Dang. Then I found out that the surgery schedule started late because resident interviews had begun that morning. We wouldn't be getting the kinds of patients I needed till much later in the day. I kept myself busy helping others and studying a little till my manager called me up for my 90 day review. I'm doing well apparently and get a small raise. Yay.

At 3 PM (or 1500 as medicine uses military time) I took back one of my original patients and prepared for a fresh post-op case. He came out at 1700 and the race was on to do as much as I could get done before the next shift showed up at 1845 while also, you know, taking care of the patient. As I was saying to Mybloody last night, I once started to write a post about post-operative care of patients who required heart bypass during surgery but when it took three paragraphs just to establish the basics of hemodynamics, I deleted it. Too complicated and therefore boring for anyone that doesn't want to actually do it I think.

Anyway, I again didn't quite make it in the time allotted. Between assessment, calls and conferences with doctors, warming the patient, managing blood pressure, giving meds, and documenting I didn't get to some paperwork and a few of the less important medical orders. I was and am disappointed that, though improving, I'm still slow. My preceptor said, "You did fine. Are your patients still alive? OK then." To which I replied, "That is *not* the standard I'm shooting for at this point." I'll get there eventually but I'm not one to be patient with my own progress, grumble grumble.

On a lighter note, this made me laugh:

I was ready to be impressed

Oh Houston, I'm trying to like you but you're making it difficult. Last week I got excited because I found out about the Westheimer Block Party. Lots of bands and artists, free, and just a 20 minute walk away. It started at noon, but after a long week at work I slept in, read a bit with Muriel's Wedding on in the background, went to the gym, and ate a leisurely early dinner before heading down to the Party. Three hours later I was walking back home rather disappointed. Here are some notes I jotted down:

- This band would like to be the Strokes. Now they're playing Tom Petty's "American Girl". Huh.

- Bandana. Why?

- The painter of stylized rotund people is here.

- Shitty drummer for a jazz band. Saxomophones.

- Screw is still a going concern in Houston. [Reading the Wikipedia entry, it's still a going concern everywhere. Shows what I know.]

- Between song time > song time = no good + me moving on

- Suck.

- Nice guitar, belongs in better band.

- A song I like! Now sucking.

This was the most entertaining thing I saw.

I really should stop comparing Houston to Austin, but it's hard when the city you love to pieces is not the one you're in and the one you're in jabs you in the ear with mediocre to poor music.

Tomorrow I get my first taste of Houston theater. My cultural hopes are elevated yet wary.

Tiring, yet fulfilling week

Very busy at work this week, particularly today. My preceptor has almost completely stepped back, leaving me to handle things on my own unless I specifically ask her input on my plans or for a hand in boosting in patients in bed and the like. It's stressful doing the job without her help, but she and I agree that I'm ready and I best get as much practice handling the work solo because I'll be switching to night shift soon enough. After a couple weeks with a preceptor to get the hang of the work flow at night, I'll be on my own. Of course I can still ask the other nurses for help or input, but the responsibility will be mine with all the little mental freak-outs that come with shouldering it.

As I said, today was busy. I started the morning with one patient, admitted a fresh surgical patient, transferred the first one to the floor, admitted a third patient, transferred the second one out, then managed the third until shift change. Despite it being so busy, I had time to fall in love with my first two patients. Though their quite different backgrounds played a big part in why I was so taken with them, for confidentiality reasons I can't go into detail and changing the details to hide their identities just defeats the point. I can say that their motivation was a joy. Too often post-surgical patients just want to lie still in bed. These patients wanted to get better and followed the medical plan of care to achieve that. More than once I told one of them, "I wish I could shoot a video of you to show other patients how it's done!" I'll have to remember them both when I have the inevitable bad day.

I still really like my job. Yay.

A taste sensation?

A little Tex-Mex place near my apartment has a drink on the menu called Vampiro. It's a combination of orange, carrot, and beat juice [sic]. In rapid succession I thought of the following definitions for that last ingredient:

beat juice

1. the combination of blood and saliva that flies or leaks from the mouth whilst being pummeled: After he provoked those bikers, they extracted at least a pint of beat juice.

2. reputation for DJing skill: He's got massive beat juice.

3. semen: After holding off for 18 days, the masturbation session resulted in massive beat juice. At least a pint.

Beyond adding a deep red color and therefore justifying the name Vampiro, beet juice just doesn't sound all that appealing. Still, it's preferable to making a drink with definitions 1 and 3.

Anti-clotting med shortage

Though reports vary, it appears that there is a world-wide shortage of heparin. Heparin is an injected medication that prevents clot formation and extension. Where I work it's used to keep IV pressure lines and dialysis catheters from clotting off, to reduce clot formation until longer-term anticoagulation therapy kicks in as well as for the prevention of thrombosis formation in patients who have reduced mobility, i.e. lying in bed all the time. We got word that the normal supply was disrupted and so for single doses would have to use syringes that Pharmacy is preparing and distributing.

After some reading of wire reports, I think I got a handle on the shortage. Starting at the end of last year, there were reports of patients experiencing allergic symptoms such as difficulty breathing, rapid drops in blood pressure, nausea, and vomiting after single doses of heparin. In February, Baxter Healthcare Corp. issued a recall of heparin after many more reports of reactions including some deaths. Later Baxter announced they were suspending manufacturing. A couple weeks ago B. Braun Medical Inc. and American Health Packaging issue a voluntary recall as well.

Turns out that some of the ingredients were originally produced in China. In early March, the FDA found that the Baxter heparin had a substance called chondroitin sulfate in it that had been chemically changed so that it had a similar effect as heparin. Chondritin sulfate is much cheaper - shades of lead-based paint on toys huh? At first, the Chinese government said that quality control on the manufacturing of heparin should be carried out by the importers. They about-faced several weeks ago and issued new guidelines for stepped up testing and registering of suppliers.
Between this lax control on manufacturing and the Tibet crackdown, I'm a little peeved at China.

The Federal Drug Administration (FDA) publicly stated that there was no heparin shortage because of the recalls but, uh, when you've got three of five manufactures recalling it and hospitals practically rationing supplies, that's a problem.

St. Arnold's Brewery, an afternoon of beer

Yesterday I went to the St. Arnold's Brewery here in Houston with some friends. The brewery conducts a tour and tasting every Saturday afternoon. It was packed so the "tour" consisted of an employee with a mic explaining a few things about the brewery, which maybe 25% of the audience cared about. Then he explained the way the tasting worked, which I guess about 75% of the audience cared about (the other 25% were clearly veterans who knew quite well how it worked).

$5 gets you the speech, a souvenir St. Arnold's half-pint glass, and four tokens you redeem for drinks. Even the kids or teetotaling friends can join in as St. Arnold's has a root beer. If your kids are bugging the hell out of you I guess you could go half root and half real beer so they'll become sedated, or possibly belligerent. I kid of course, alcohol for children is a no-no.

I had two Lawnmowers and an Amber. By the time the final call came, I was too full from lunch and beer to use my last token. Next time I'll be more diligent. Click the above pic to go to Flickr for more photos, if you're into that sort of thing.

The South Park me

South Park Studios, where you can watch any episode from the series, recently launched. Following the lead of other animated program websites, they have an avatar generator.
This being South Park (with all that implies), you can chose from the basic body types of Female, Male, Canadian, 4th Grader, and Kindergartner. Skin tones offered are Hispanic, Caucasian, African, and Gay Tan. Yeah. I went with Male and Caucasian. The outfit is the closest I could get to scrubs, though the color is exactly right. Wish I had the Photoshop skills (and the actual program) to take out the "T" and add in a stethoscope and a pocket with pen, scissors, and hemostats. Still, fun!

UPDATE: Mybloody made my wishes come true. Picture now updated with stethoscope, pen, and hemostat. Thanks Mybloody!

My nursing assessment Part I

As I've written about before, patient assessment is a major part of being a nurse. Here's Part I of what I do within 30 minutes of getting a patient either when I'm coming on shift or they roll out from surgery. I was going to type up the whole thing in one post and then I realized how long it takes to write it all out versus just doing it. It's organized by body system and yes, we have a form to remind the nurse of all the things to check.

Neurological

Shine a flashlight in their eyes and watch for pupil constriction. Grade the size of the pupil (esitmated in centimeters) and the speed of constriction (brisk or sluggish). Grade their level of consciousness (alert, lethargic, obtunded, stuporous, or comatose). Grade their behavior (sedated, inappropriate, confused, agitated, or combative). Ask them their name, the day/date, where they are, and why they are there to judge how oriented they are. People who only know they're name are Ox1, if they know they're in a hospital and why and at least can get the month then they're Ox4. While they're speaking, grade their speech (clear, slurred, incomprehensible, or they have a breathing tube in and cannot speak). If they are aphasic, note whther they are having difficulty speaking (expressive aphasia), understanding what I'm saying (receptive aphasia), or both (global aphasia). Put two fingers in their hands and ask them to squeeze and release. Have them push against my hands with their feet and pull back their feet toward their knees. Grade their strength in these movements. Note if they have a drain or pressure monitor to their cerebral spinal fluid and if so the condition of the dressing over it, the level it's at, and the type of drainage (clear, serosanguinous, sanguinous).

Cardiovascular

Listen for heart sounds, note presence of S1 & S2 (the lub-dub sound) and any extra sounds. Check capillary refill at fingers and toes, grade brisk or sluggish (<>3 seconds). Note nailbed color (pink, pale, dusky, cyanotic). Grade the temporal, brachial, radial, dorsalis pedial, and posterior tibialis pulses (palpable, heard with Doppler, absent). Note chest tubes, their placement (pleural, mediastinal), suction applied if any, and what they're draining (clear, serosanguinous, sanguinous). Note pacemaker and/or internal cardiac debrillator and whether it is on. Note whether unused transcutaneous pacemaker wires are wrapped. Print a EKG strip and analyze it for the heart rhythm. Note or adjust the alarm settings for heart rate, blood pressure, and ST segment elevation or depression.

Note all IVs, their size and placement, when they were inserted, how the insertion sites look, and if the dressings over them are intact or due to be changed. If A-line (arterial line used for continuous blood pressure monitoring) and/or CVP (central venous pressure line used for monitoring that pressure as a measurement of right-side heart function and fluid status) present, calibrate the transducers and note how the monitor waveform looks and that the dressings over them are intact and up-to-date.

That's enough for now. I'll get to pulmonary, renal, etc. later. Is this boring? Should I spice it up with stories of things gone wrong?

How explicit before most turn away? Or A Ridiculous Joke

Those that know me well know that I love the band The Magnetic Fields. I interviewed band leader Stephin Merritt a couple time while writing for the UT Austin newspaper. There was a time when I had the money and vacation time to justify flying across the country to Boston or New York mostly to see MF. And despite dropping out of all the other music-related listservs, I've kept up with the Stephinsongs listserv for 11 years. Yah, supa-devoted fan.

Mr. Merritt does not compose autobiographical lyrics despite the seemingly heart-felt pronouncements in many of his songs. Though a relatively modern element in popular music, the confessional, when-I-say-"I"-I-really-mean-me style of lyrics seems to be the default interpretation of critics and audiences. Nobody really thinks that Bob Marley actually shot the sheriff or that David Byrne was a psycho killer do they?

Recently Merritt was interviewed about the release of the new Magnetic Fields album Distortion and had this to say, “In the lyrics, there’s only so much intimate detail that heterosexual audiences can put up with. So even if I were autobiographically inclined, I don’t think I would go very far into details. Fortunately for me, I’m not at all autobiographically inclined, and when I put autobiography into my songs I’m generally joking.”*

So, if Stephin was autobiographically inclined and if he went into intimate details, then we'd have, what, More Songs About Butt-Fucking? Actually, that sounds like a pretty good idea. I'm officially claiming that title for my new queerpunk band Big Black Dildo. Or Cock. Is Big Black Cock better?**

*Stephin Merritt, Los Angeles Times, Jan. 27.
** I almost can't believe that I went this far for stupid Steve Albini joke. Almost.

My SXSW week

So my schedule last week went like this:

Monday

Work 6:45AM - 7:15PM

Tuesday

4 hours of computer modules at work, gym, watched California Split

Wednesday

Work 6:45 AM - 7:15 PM
Drive to Austin 8:30 PM - 11:00 PM
Stuff badges for SXSW 11:15 PM - 11:50 AM

Thursday

Listen to REM from behind Stubb's 12:00 AM - 1:30 AM
Sleep 2:30 AM - 10:30 AM
See bands, wander 12:00 PM - Friday 1:30 AM

Friday

Drive back to Houston 2:00 AM - 5:00 AM
Sleep 5:00 AM - 7:00 AM
Classroom education at work 8:00 AM - 4:00 PM
Watch TV, eat, sit around 4:45 PM - 6:30 PM
Sleep 6:30 PM - Saturday 08:00 AM

Saturday

Drive to Austin 9:00 AM - 12:00 PM
See bands, wander 12:00 PM - Sunday 2:00 AM
Sleep 2:30 AM - Sunday 7:30 AM

Sunday

Drive back to Houston 8:15 AM - 11:00 AM
Think of about how attached I am to Austin and SXSW 11:30 AM - 11:32 AM
Nap, gym, laundry, grocery shopping, watch the original Funny Games 11:32 AM - 9:45 PM

So that's what I did last week. It wasn't a successful SXSW in that I didn't see too many things that impressed me and wasn't able to see any films. In fact the only band I really enjoyed whole-heartedly was The Raveonettes. A few were interesting, but nothing more than that. I'll chalk it up to my own fatigue and jadedness. The kids are alright, must have been me.

UPDATE:
I forgot to write that Black Moth Super Rainbow were great Saturday night/Sunday morning. I really enjoyed their collaboration with Octopus Project last year at SXSW and they clearly came ready this time. They had confederates in the crowd who, at climatic moments, would throw out candy and confetti, spray fake snowflakes, and float (empty) piñatas through the very engaged audience. Every couple of songs, the guy in the band who was crouched on the floor playing keyboards or vocodering would stand up, look around, and seem amazed at the size and excitement of the crowd. Yay for them.

Hi-ho, the derry-o

So I'm at home, organizing stuff with Wigstock: The Movie playing in the background. I've never seen it before and I do like talented drag queens, but still I'm barely paying attention. Near the end of the movie I look up during Crystal Waters drag king performance and say to myself, "Is that Michael K. Williams, better known as Omar on the best TV show ever The Wire, as a back-up dancer?!" Through the magic of Tivo (and a quick Google to confirm that he was a dancer for Waters), it is confirmed. Michael K. Williams, pre-scar, is in Wigstock: The Movie furiously workin' it.

Couldn't find a online clip of it so I just took pictures off the TV screen.

What a difference a day, or a weekend, makes

Today was much, much better. My preceptor apologized for how crazy it got last week and I admitted that I was somewhat demoralized by the experience. She said I did okay and that run-of-the-mill cases were never like that. I offered that other nurses came up to me while I was finishing up paperwork to see if I was okay and had my preceptor left me and gone home?! It was just paperwork and the oncoming shift had already taken over, but it was nice to see that they cared. We laughed about her now getting a reputation for being a harsh, cruel bitch who tosses her preceptees into the deep end of the pool. And then releases the sharks with lasers on their frickin' heads.

We again took two empty beds, but my preceptor (I've got to think of a decent pseudonym for her so I can quit typing "my preceptor") promised that she'd get me something more entry-level. It was another pump case, what we call it when the patient has been on a heart-lung bypass machine during surgery, but a much more stable one. In addition to getting the workflow down that much better, I learned that shivering unrelieved by warming blankets is likely due to a reaction to anesthesia and that Demerol treats it. Cool. I also learned not to throw away IV tubing from surgery even though you're not presently using it because you might need it later to infuse fluids. Noted.

Much better day. I absolutely can do this. Yay.

Brutal day

Thursday night I came home dejected. It was a brutal day at work and I thought, "Do I really what to do this? Can I do this?"

My preceptor has been fairly aggressive in pushing me to take on greater challenges during my orientation. Rather than follow a gentle curve of increasing difficulty—stable post-operation day 2, AV fistula, fem-pop bypass, and so on—we've been leapfrogging ahead as she feels I'm ready. Her assessment of my ability is inevitably higher than my own. She's not cruel or anything, just confident that I can handle it. She's always there when I drop the ball on details, which I do more than I like. I've been doing great with transfers out to less acute floors and stable patients so she wanted me to get more practice admitting patients fresh from surgery. On Thursday we took two empty beds and bided our time with a staff meeting and a discussion of medications.

Our first admitted patient had just undergone a carotid endarterectomy where the surgeon opens the carotid artery on one side of the neck and removes the plaque that is either narrowing the artery or is unstable and may rupture. I haven't seen it done myself, but I've been told it looks like they're scraping out chicken fat. So eat healthy and exercise! On the scale of things, it's not a big surgery. The patient had already been extubated (breathing tube removed) and was awake. I needed to assess her status, keep her blood pressure under control so she wouldn't blow the carotid sutures, and monitor her neurological status on the small chance she could have a stroke. There's other stuff too like talking to family and giving meds, but the first three are the big ones.

She's was doing well and then her urine output dropped. Almost all the patients out of surgery have a Foley catheter in that drains their bladder. It's important that we accurately record their output and after anesthesia it takes awhile for conscious control to return. We like to see at least 30 mL an hour out showing that the kidneys are being adequately supplied with blood to filter and that they are doing so. Less than that for two hours triggers a call to the doctor. In this case, doctor wanted a rapid infusion of fluid running in, what's called a bolus. Problem was that this patient's IVs were running into veins in her arms rather than a larger, central vein. Run the fluid too fast through her peripheral IV and the vein could blow. Which it did. Not really a big deal, saline running into the tissues is going to cause some localized swelling and maybe some soreness, but no serious effects. Luckily the patient had another working IV in her other arm so I switched it over and took out the blown one. These problems, low urine output then blown IV from the fluid bolus, are minor. You have to do something about them, but fairly easy to handle.

So she's mostly squared away when the next patient rolls out. This patient had multiple coronary artery bypasses and was coming out mechanically ventilates and unstable on multiple IV medications to maintain his blood pressure, heart rate, etc. I'll talk more about what a patient who's had open-heart surgery goes through in a future entry, but basically they've had their sternum cut open, heart stopped, bypasses sewn in, heart restarted, sternum closed with wire, and tubes inserted to drain fluid (or possibly air if a lung was collapsed for the surgery). Heavy duty stuff. This guy was quite unstable and had me running for hours trying to get everything done.

I don't have much experience titrating IV medications (increasing or decreasing rate of infusion to keep say, systolic blood pressure below a number set by the physician), in fact we weren't allowed to regulate them while I was in nursing school. I worry about that because while I understand what they do, all I know about dosing is "start low and go slow". The nurses at work tell me that I'll pick up what to start them at and by how much to bump them up or down. Can't come soon enough for me. Whenever this patient was starting to get out of range and my preceptor wasn't immediately available, I would be saying, "Uh, [fellow nurse] which one should I turn up and by how much or maybe I should just wait and see? Ack." Hard to detail what all happened but we had doctors seeing him about five more times for additional orders, procedures, and intense staring at monitors. Keep in mind that I still had that other patient who needed to be monitored, medications given, etc. At the end of the day, I stayed 30 minutes after just to finish all my charting—documenting my narrative of what happened and what I did about it.

Exhausted, I trudged home from the bus stop thinking, "Am I in over my head here? Maybe I should have just gone to a regular ICU."

Nurse humor

The other day I was listening to some nurses talk about patients having to go back to surgery because of excessive bleeding. "Yeah, sometimes they have a prolene deficiency, hypoprolenemia," said one to gales of laughter. I didn't so much get it. Later I discreetly asked my preceptor what I was missing. Prolene is a kind of suture material the cardiovascular surgeons use. Now that is funny.

Heh. Uh, so -emia means "concerning the blood" and hypo means "below normal" so the comical neologism hypoprolenemia means "the surgeon didn't put in enough stitches." See? Hilarious. Less so cause I had to explain the whole thing, but still funny. Well, maybe not to the surgeons.

Spoiled rotten

I forgot to mention this earlier, and this is hopelessly dorky, but the unit where I work has a stat lab to rapidly process our lab samples. Just a couple mLs of blood and I can get a CBC, BMP, and blood gases? With results in five minutes? Glory be.

What I do, Part I

I’ve held off describing my job because I wanted to get my head around it first. It’s going to take a good year before I’m comfortable in my role, but I think I’ve got the basics down enough to at least sketch in an outline. I work in the CVRR, cardiovascular recovery room. The purpose of the unit is to receive patients directly from the operating room where they’ve undergone surgery on their heart or vasculature, recover them from anesthesia, and stabilize them to the point where they can be transferred to an acute care floor or ICU.

Some of the common surgical procedures are carotid endarterectomy (removal of plaque to prevent further blockage), coronary artery bypass graft (CABG, or “cabbage”), heart valve repair or replacement, femoropopliteal bypass (fem-pop, should be a music genre), and arteriovenous graft creation for dialysis. We also get transplant patients - heart, lung, kidney, and I think liver – but that’s much higher level nursing than I’m capable of at this point. The workflow right out of surgery differs according the procedure done, but generally the receiving nurse sets up the bedside with monitoring (which displays EKG, blood pressure, heart rate, oxygen saturation, temperature), suction for oro-nasal and/or chest tubes, oxygen, and supplies like tubes for lab blood draws. When the patient wheels in the nurse hooks up the lines, takes report from the anesthesiologist, and does a rapid assessment of the patient.

Assessment is a huge part of a nurse's job, whatever area of care they're in. It means collecting data such as vital signs, the look and feel of a patient, the statements they make and documenting it to establish trends. It's also the first step of the nursing process known by the acronym ADPIE, assess, diagnose, plan, intervene, evaluate. The nursing process is how nurses organize their care. I'll go into more detail about patient assessment in a future entry.

Getting back to the fresh surgical patient, the goal is for the patient to remain stable in terms of blood pressure, heart rate, oxygenation, etc. This is often accomplished with medications given intravenously. Doctors will write an order like, "Titrate to keep SBP <150." This means the nurse will adjust the rate of infusion of the specified medication so that the systolic blood pressure, the top number representing peak pressure, is maintained below 150. Learning the medications used and why, the interactions between them, and the starting dose to the max dose are pieces I'm slowly acquiring.

Man. I just read over this and realized that I've left a lot out. By way of explanation I'll say this, there's a thing that happens to nursing school students about halfway through their first semester of upper-division classes. They're not civilians anymore. They have a hard time talking or even thinking like non-medical professionals. When they try to explain something, their speech is full of acronyms and jargon before they backtrack and start again, trying to translate effectively. The ability to summarize complex info and relate it on a developmentally appropriate level takes a while to catch up, if it ever does. All this is to say that I forget sometimes how much medical stuff is crammed in my head that I take for granted. So, if I vacillate between being overly simplistic and talking far above your heads, just let me know.

Whew. This post really just flew off the cohesion rails. Oh well. I'll get the train back on track tomorrow.

I think the word I'm looking for is awkward

Today one of my patients was doing well after her surgery and so her doctor wrote orders for her to be moved out of ICU to a telemetry floor where she would be monitored constantly for cardiac problems via wireless EKG. I went through the normal process of a transfer, faxing a written description of her status to her new floor, calling a verbal report to the receiving nurse, disconnecting the IV lines she didn't need anymore, getting her into a rolling chair for the trip, all that. I called the waiting room and asked that her family meet us in the hallway for the trip.

We chatted pleasantly as we rolled to the elevator. I got in first pulling the chair in after me backwards. This is so if there's an emergency, the patient is facing forward. The family filed in after us and we're off. Only we started going down, not up. Oh well, no big deal right? We'll just go down a floor or two and then right back up. At the second basement level, I heard and felt the back door opening. "Dang, please don't be what I think this is going to be."

A quick look back confirmed that yes, the back door was opening because a few undertakers were bringing a body out from the morgue. Oh joy. It was covered of course and dead people don't really bother me, but I was acutely aware that the family of a rather recently critically ill heart patient were staring right at the guys in dark suits and a body bag on a gurney. Thankfully the patient was facing the other way. We all avoided looking at each other and the undertakers stepped back to let the door close. But it wouldn't.

Sure it would start, but then it just popped back open as if to say, "Are you sure you don't want to get off? Really? I mean the morgue is right here." The nervous chuckles stopped after the third time. Finally, dinging and shaking, the door ker-rawled closed on the fifth attempt amid the clearing of throats and intense floor-staring. All I could think was, "I've got to say something. What's the right way to transition from a very real, non-metaphorical confrontation with death?" I went with a far-too-effusive description of her new, private hospital room.

Missing Austin mightily

I've got the profound homesickies.

I miss my friends and the bats and the tower lit orange and a friendly, laid-back populace and the (only slightly smug) awareness that I'm in the oasis that is the political desert of Texas and thinking of how great the park system is every time I drive along Lamar between 15th and 29th and wandering around Emo's waiting for the music to start and fairly-good-to-very-bad art on the walls of every damn coffee shop and cafe and seeing the stalwarts at the SXSW volunteer call and flipping through the new used records at End of an Ear and breakfast tacos on the morning of tests and sitting in the balcony at the Paramount and waiting forever for my burger at Casino El Camino and and and.

Being away from them, I appreciate how wonderful it truly is to have so many long-time friends. Back in Austin I regularly hung out with people I've known for 8, 12, 15 years. That depth of shared time and experience is...I don't know what I'd be without them. It's a downer to have to start over some place else. Frankly sucks is what it does. I'm determined not to wallow though.

Now, can someone tell me where the cool people with knowledge and reason who like making and appreciating all manner of art congregate in Houston?

My favorite moment from SXSW 2007

Standing next to my friend when he was so overcome with joy at Bob Mould's solo acoustic set that he ended up in tears. It was very touching to see a friend's love of music just spill over like that. Yay music! Yay friends!

And you thought getting body checked was rough

Hockey player Richard Zednik is in stable condition at an ICU after having his carotid artery sliced by a skate blade while playing last weekend. I'm not big on hockey, but I am a huge fan of carotid arteries. Especially keeping them intact and patent. The video is not explicit, they wisely avoid showing a lot of blood. Watch the end to see the freak accident that caused it. I hope he recovers without permanent neurological damage.

The squirrel who looks like a tail-less cat

While going through stuff I've had stored away, I came across what I can only guess is the first story I ever wrote back in 1st grade.



The text reads,

"Wans I took a bike ride. I saw a tree and a hill and a filld of flowrs. Well at that minit a squirrel jumped out of a tree. And landid on my bike I rod my bike home and cap the squirrel for a pet and I howp I have anothr avichr."

My spelling has vastly improved (what's with all the missing "e"s?), but sadly my illustration skills have not.

A bit of advice I picked up recently

If you ever find yourself reading a book that, judging from its cover against common wisdom, is full of sardonic observations meant to produce mirth but regards a subject with which you are currently struggling so that instead of laughing out loud or even wryly smirking you are forlornly gazing out a window at an overcast sky or even quietly sobbing, then put that book aside until some distance is achieved. It'll be funny in a year.

Lentil soup

While listening to a bunch of songs last night, I prepped the ingredients for lentil soup. Here's all the ingredients ready to go into the crock pot.


Not pictured is the bouquet garni, the little bag of seasonings that makes the difference between a bland bowl of sustenance and delicious tummy-so-happy time. I don't pretend to understand spices. Aside from dill and rosemary, I have no idea what most of them do to influence the taste of a dish. I just trust recipes and throw in the bay leaves, tarragon, whatever.

I got up in the morning, threw everything in the pot and went off to work. After a about 9 hours of cooking, here's the messy blending part.


Here's the soup. Sure it looks like undifferentiated brown slop, but damn it's tasty with parmesan cheese and a hunk of crusty bread.

Weekend back in Austin

Went back to Austin this weekend to visit friends, pick up some leftover items from my old house, and do some shopping. Friday night was an art opening at End of an Ear where I bought a bunch of music. Then it was off to El Azteca for dinner. Their tamales are far below my gold standard (Curra's), but previously I've loved their mole and the salsa is always incredible. Next door was a hideously excessive Valentine's Day display in a flower shop. This shrimp appears to be allergic to itself, check out those lips. And what the hell do shrimp have to do with VD anyway? Not a shmoopy animal like bears and kittens. The night ended back at Mybloody's where we just sat around and goofed off.

Saturday was all about the acquisition of material objects. A good, steady paycheck will do that I've ascertained. At least I was buying books, music, movies, and furniture. Except for that last thing, I was very happy to be spending money at Austin businesses. Yay for shopping locally. The furniture was from IKEA. Yeah I know. I just needed to something cheap and decent looking. I only need it to last a few years.

Mybloody was all faux-exasperated that I hadn't ever been before, so he showed me how it worked. Thanks buddy! And of course at IKEA we gays run into other gays Mybloody knows. How embarrassingly cliche. Saturday night was a sedate one at Joolie & (name withheld cause I don't remember if he's amenable to being publicly identified)'s. I had to leave early to go to sleep as A) I'm on that sort of schedule what with the getting up at 5 AM for work and B) I had to get the rental car back to Houston.

After a nice, sedate ride back to my new apartment on Sunday, I did laundry and assembled furniture. All-in-all it was a fun, productive weekend though far too brief.

Where I do the nursing thing

Thursday was my first day taking on the total care of a patient on my unit. I wasn't that nervous as my preceptor was three feet away and this patient wasn't as high acuity as others I taken care of in the past. What was different was that I didn't have to ask the primary nurse to get medications for me or print the paperwork for blood draws for the lab. I was the primary nurse. I talked to the family on the phone, discussed the patient's status with the doctors, and endeared myself to at least one nurse on the night shift by bathing the patient before shift change. A good day.

I haven't really talked about the unit where I work. It's called CVRR, cardiovascular recovery room. We get patients right out of surgery for coronary artery bypass grafts, heart valve repairs or replacements, dialysis fistulas, heart transplants, anything to do with the heart or vasculature. The idea is for the patients to be on our unit for a limited amount of time, around a day, before they move on to a regular intensive care unit (ICU) or a monitored floor (called telemetry or just tele). Right out of surgery, the primary concern is keep them hemodynamically stable (heart rate, cardiac output, blood pressure, etc. interacting well to maintain the patient) while they recover from the anesthesia. As soon as possible, we want them off the mechanical ventilator and moving about. There's a lot more to it than that but I'll save some for future posts and for a time when I actually understand it better!

The closest I get to a poop joke

When I was studying for my nursing license exam a few weeks ago I came across a diagnostic test that was new to me. It's called a defecography. Here's what my book says:

Defecography
- Measures anorectal function.
- Thick barium is instilled into the rectum, fluoroscopy is performed, and the
function of the rectum and anal sphincter is visualized while the client attempts to pass the barium.
- No preparation is required.

I disagree. Plenty of mental (and possibly emotional) preparation is necessary to receive a barium enema that you must then crap out while being judged on your ability to do so by medical professionals. They probably videotape it too. Realizing this is a terrible image with which to leave you, I thought of an alternate definition.

defecography /def·e·cog·ra·phy/ (def-e-kog´rah-fē)
n.
The collected musical output of the band Def Leppard: "Photograph" is the best song in all of the Defecography.

Unintential dramaturgy on public transportation

For a fleeting moment, I thought, "Maybe this is one of those theater in public spaces-type troupes." But no, the drama unfolding across the aisle was real.

Cast of Characters

YOUNG MAN, tattooed and deliberately scruffy with fake animal claw earrings
SELF-STYLED HUSTLER, 40, red-faced and somewhat grimy from being outdoors all day

The play takes place on a half-full city bus in Houston on a Saturday afternoon.

At RISE:

(YOUNG MAN sits at the front of a clearly identified Houston bus. He is engrossed, reading Douglas Adams' Dirk Gently's Holistic Detective Agency [great book BTW]. As the unseen driver opens the door at a stop, SELF-STYLED HUSTLER enters right carrying a beat-up plastic shopping bag. He has an unzipped jacket on, but no shirt underneath. His pants and shoes have seen better days. He looks around and, despite plenty of empty seats, sits right next to YOUNG MAN.)

SELF-STYLED HUSTLER

Hey man. You got a computer?

YOUNG MAN

(annoyed)

What?

SELF-STYLED HUSTLER

I said, you got a computer?

YOUNG MAN

Yes.

SELF-STYLED HUSTLER

I'll tell you what then. You can buy this computer stuff off me.

YOUNG MAN

No.

SELF-STYLED HUSTLER

C'mon! Buy my computer shit.

YOUNG MAN

Leave me alone.

SELF-STYLED HUSTLER

Damn! I always said Texas people were rude. Why you gotta be so rude?

(Unseen bus driver, clearly perturbed, makes announcement off stage)

Will the gentlemen who just got on please pay at the front. (beat) Now.

(SELF-STYLED HUSTLER lurches up and goes right to pay fare, leaving bag on floor in front of seat. He fumbles with a wallet before finally extracting a dollar and feeding it into the fare box. YOUNG MAN meanwhile shifts over to take up both his and HUSTLER's seat, then kicks HUSTLER's bag downstage. SELF-STYLED HUSTLER returns and pulls up short when he sees the situation.)

SELF-STYLED HUSTLER

Hey man --

YOUNG MAN
(Barely suppressing rage.)

You're not sitting here. Stop talking to me and go sit somewhere else.

(SELF-STYLED HUSTLER grabs bag and stands right facing away from YOUNG MAN, but clearly still addressing him and the rest of the bus.)

SELF-STYLED HUSTLER

I hate people from Texas. They're either dumb or pretending to be smart.

(As the bus pulls up to next stop, SELF-STYLED HUSTLER exits, yelling over his shoulder)

Dork!

(YOUNG MAN scowls as he reads his book. Curtain.)

I'm not sure what to call it. The Worst Salesman Ever sums it up nicely, but it's rather plain. Yelling and Insulting Your Way to An Almost Violent Non-Sale is a little too on the nose. Ideas?

A damn fine book

A couple days ago I finished reading one of my favorite books again, The Perks of Being a Wallflower. Even on this, the fourth go round, it astounds me how perfectly the author Stephen Chbosky captures how it is to be an awkward teenager who's just figuring himself out and finding The Smiths, Catcher in the Rye, and audience participation at The Rocky Horror Picture Show through new, "weird" friends and a perceptive teacher. The book is just amazing and it makes my insides smile to know that it's also widely read. I'd go into more detail, but I love it too much not to let you experience it fully for yourself. Just to give you an idea though, here's a sample of the way Charlie, the protagonist, thinks. He's just finished making his first mixtape for a friend.

"I had an amazing feeling when I finally held the tape in my hand. I just thought to myself that in the palm of my hand, there was this one tape that had all of these memories and feelings and great joy and sadness. Right there in the palm of my hand. And I thought about how many people have loved those songs. And how many people got through a lot of bad times because of those songs. And how many people enjoyed good times with those songs. And how much those songs really mean. I think it would be great to have written one of those songs. I bet if I wrote one of them, I would be very proud. I hope the people who wrote those songs are happy. I hope that they feel it's enough. I really do because they've made me happy. And I'm only one person."

Ach, nailed it. Really, find it and read it. I've never been in a bookstore that didn't have it (some put it in young adult, some in regular fiction) and I see it pop up in used bookstores regularly. Also, praise and glory to Carole for giving me the book in the first place. Whoo.

Role confusion r/t gender stereotyping, pride, and an unfortunate shade of blue-green

For the first time since moving here, I had this exchange while riding the bus:

Person looking at my scrubs: "Are you a doctor?"
Me: "No, I'm a nurse."

This was a frequent occurrence in Austin. Mostly when I was wearing a lab coat, though sometimes when I was just in scrubs at a hospital or grocery store. I'm never defensive about it because, well, I'm not defensive about being a guy who's a nurse. In anything, I'm ridiculously proud of it as should be clear by the name of this here blog and the pic up there. Plus I really am a Registered Nurse now so it makes me happy inside to say so.

Turns out the person on the bus was about to start surgical tech school and wants to work at a hospital. She knew where I worked based on the color of my scrubs, which brings me to another point. In an attempt to cut down on patient confusion, many hospitals are requiring staff to wear color-coded scrubs. Nurses wear this color, respiratory therapists wear that one, housekeeping this one over here. Nurses at my hospital have to wear teal. Like this:


Couldn't it have been navy blue? ER nurses get to wear black. Damn their oily hides. The really bothersome thing is that my favorite style of scrub pants (made by Cherokee with cargo pockets on both legs, slit pockets, and a fly with a zipper) don't come in teal. Based the various offerings from multiple scrub makers, teal is considered a lady color. Sure they have "unisex" scrubs, but it's not the same. Not to put too fine a point on it, humans with penises need pants with flys.

Thankfully, I was clued in to a shop here in town which will custom-make scrubs with pockets and genitalia access points wherever you want. I'm going to take them the pants I like (in navy blue, sigh) and say, "Make me three pairs in teal that look just like this." Maybe they'll disassemble them and make a pattern a la Project Runway. At least no one has to wear this medical mistake:



There's no way you could actually do the work of a hospital nurse in that thing.

Yes but what are the side E-ffects?

There's a new medication on the market to treat GERD (gastroesophageal reflux disease). It's called AcipHex. Pronounced "Ass Affects." Who named this drug?! On the page you can see what they were going for with the acid and the pH, but as said out loud it's only natural to infer that the drug has an influence on your ass. Did they test market the name? Cause I'm thinking that the majority of interactions went like this:

Marketer: "What do you think of when you hear AcipHex?"

Consumer: (fearfully) "It's going to do something to my butt."

Terrible, terrible name.

Ugly day, better now

Work was fine, more computer training modules, but leaving the hospital I walked into a downpour. Getting home by bus is great, until you have to run blocks in the rain. I ducked into a dessert shop for a hot drink and to wait out the heavy rain. After a chai latte and a slice of green tomato pie, the rain had dwindled to a light drizzle. Now I'm home, in pajamas, about to watch The Wire. Much better.

The limits of providing patient comfort

Lots of necessary, yet often tedious information today in orientation. Small moment of amusement when one PowerPoint indicated some definition of nursing at the hospital as something like outstanding care with a personal touch. So of course I whispered to my friends, "But not, you know, too personal."

Which reminds me of a story a nurse told me. I won't go into the details, but the moral is even if the patient is alert, oriented, and quite handsome, do not assent to his request for a "massage" with full release. Also, don't giggle about it with co-workers the next morning cause you will all get fired for being highly unethical and really stupid in addition to cheap and tawdry. I can't recall an Aesop fable that covers this lesson so perhaps I should write one substituing otters or squirrels for the people. Wombats? Ooh, I can illustrate it with tasteful linocut prints!

¡Átame! or Atase, I don't know Spanish that well

Today was the second day of orientation at my new job. I now have health insurance, a 403(b)—like a 401(k) for non-profits—, and no vacation/sick days for three months. Oh, and an understanding of the standards of nursing practice. The important stuff is what I'm saying. We also practiced putting restraints like these on and tying quick-release knots.




Depending on your sense of humor or kink factor, these might seem mean/sad, adorable (that second one is called a mitten), or stimulating. Well you're all wrong. Hee. Restraints are necessary equipment to prevent patients from doing dangerous things like pulling out tubes and wires. Being ill or injured in the hospital can be disorienting and things sticking into your arms, chest, nose, mouth, etc. tends to be uncomfortable at best. When a patient is not all there and some bit of medical equipment is bothering them, they often pull at them.

I was caring for a patient once that grabbed his Foley catheter (that's the tube that drains the bladder) and pulled so that the tube sheared off where it was taped to his leg. He was lucky. Foleys stay in place because there's a balloon at the end that's inflated with saline to anchor it in the bladder. If the tubing hadn't sheared, he might have managed to pull the balloon THROUGH HIS URETHRA. Yeah. It's happened. The penis maybe doesn't work so well after that kind of trauma.

Restraints are also necessary for even calm, oriented patients if they are intubated (tube down the throat to maintain airway), with or without a mechanical ventilator attached. Cause everything can be fine and dandy, they're writing messages for you, participating in their own care, and then they get a little irritation, start to cough, and the first thing they do is grab the thing sticking down their throat and pull it out. Since the endotrachial tube has a cuff that's inflated to hold it in place below the vocal cords, pulling it out damages the cords badly. So possibly no more talking. And then there's the problem of the patient no longer having a patent airway. Bad stuff.

In conclusion, restraints are often necessary and very much therapeutic despite the initial image of tying a patient down against their will. I realize now that this isn't the cheeriest of topics, though to be it's just part of the job. Uh, just be happy I didn't link to a video of a Foley catheter insertion? Unicorn chaser?

RN. W00t!

I passed. Now I'm a real murse now. Well, actually not until my official letter comes from the state Board of Nurse Examiners in four weeks letting me know that I now meet the minimum standards to be qualified as a nurse. They don't give you a score on the NCLEX. It's just pass or fail. Kinda like that joke, "What do you call the guy that graduated last in his class from medical school? Doctor."

I guess a celebratory glass of wine is in order. Good thing I have a vacuum stopper or I'd have to drink the whole bottle.


UPDATE: Red wine, pizza, and HBO are nice when celebrating. Wheeee!

Lazing around

In an attempt to
1) temporarily distract myself from worrying about my NCLEX results
2) avoid unpacking moving boxes
3) better myself as a human
4) get caught up for the new season

I sat around all day today watching the fourth season of The Wire, the best TV show and/or film ever made to this point IMHO. I'm sure it would amused some of you greatly (ahem) to see me gleefully sniggering or captivated with jaw slackitude. Dear lord I love that show. And in a couple more days I can start watching Season 5!

The final test

This morning I took the final test to determine whether I'm licensed as a registered nurse (RN). The NCLEX, as it's known, determines whether the candidate possesses the entry-level knowledge so as to "provide safe and effective nursing care." It's a computer adaptive test, which means that each succeeding question is determined by how the test-taker is performing. At the beginning of the NCLEX, the computer program gives you a medium difficulty-level question. If you get it right, the next question is more difficult. If you get it wrong, the next question is easier. The idea is to maintain your performance above a line of competency. It's okay to dip below it occasionally, but then the candidate has to answer more questions correctly to rise above the line again.

In addition to level-of-difficulty, questions are categorized by Client Needs category. Candidates have to demonstrate competency in Management of Care, Safety and Infection Control, Health Promotion and Maintenance, Psychosocial Integrity, and Physiological Integrity. You can't crap out in one category and then make it up in another either.

Practically, the computer adaptive format means you can't skip questions and come back to them, a favorite tactic of mine. Really though, the format is not that bad. You are presented a scenario and usually have to choose between four answers. Sometimes you have to fill in the blank, but that's usually a medication calculation question with a numerical answer. The beastly questions are the ones where you must select all that apply with five options. Get one wrong and the whole question is wrong.

Here's an example of a question from a test prep book with my explanation of terms in brackets or a link to a picture:

A nurse is caring for a client with a T5 spinal cord injury. The client complains of a severe headache and is feeling anxious. The nurse notes the client is sweating, is experiencing bradycardia [pulse below 50 beats per minute], and is hypertensive [high blood pressure, exact number is situation- and client-dependent]. Which nursing intervention is most appropriate initially?

1) Notify the physician
2) Medicate with an analgesic [pain-relief]
3) Check for bladder distention
4) Discuss the client's feeling of anxiety

The correct answer is 3. To answer this question you have to know such spinal cord injuries put the patient at risk for autonomic dysreflexia, the symptoms of that condition, the likely cause, and that assessing for a distended bladder is the INITIAL action of the nurse.

This question is at the analysis level in that you have to know some facts and then apply them to the scenario. This is actually a pretty easy question for someone right out of nursing school. It's common knowledge that notifiying a doctor is almost never the right answer (there's always something to do first), and discussing feelings is always a low priority - physiologic concerns first, psychosocial later. So even if you don't remember autonomic dysreflexia, you're down to 50/50 anyway. Getting it down to two answers happens all the time. Often, two or three answers are right and it's just a question of which is more right. It's difficult at first, but nursing school tests are usually written this way so students have plenty of practice with the format.

The minimum number of questions on the NCLEX is 75 of which 15 are unscored because they're just being tried out. After 75 questions, the program reviews your performance and decides that either that you are competent, not competent, or that further assessment is necessary. If the latter, the program keeps giving you questions until the answer is decisive. The maximum number of questions is 265, though few candidates get that many. You have six hours to take the test and again, few take that long.

The first-time pass rate for students from my nursing school hovers aroung 98-100% so I wasn't too worried. Still, it was nerve-wracking to take a test that determines whether I'm allowed to practice what I've been working toward for three-and-a-half years. The general wisdom is that if the questions are somewhat confusing and nebulous, and you walk out not really knowing what the hell you were doing, you performed well. If the questions start to look like:

The brain is

1) protected by the skull
2) insane in the membrane
3) solely for mucus production
4) wait, you mean the one in my head or Big Steve downstairs?

you're in trouble. I took 80 minutes to answer 75 questions of which I definitely, no doubt about it KNEW the answers of about 10. So, good sign! I'll find out the unofficial results Monday or Tuesday. Oh and my diploma came in the mail today, so that's nice.

The highs and lows of moving

So here I am again. I graduated from nursing school in December and moved to Houston a couple days ago. Friday I take the Registered Nurse licensing exam and Monday I start my new job. Just got the series of tubes hooked up to my new apartment so I thought I'd finally post again.

Since arriving in Houston I've been hit my small bursts of excitement prompted by things like moving books and CDs from boxes to shelves, the nice grocery store a 10 minute walk away, a new bed, coffee, finally having time for DVDs again, and anticipation of my new job. Those bursts of excitement have been interspersed with moments of trepidation prompted by things like studying for the licensing exam, realizing that most of my friends are hours away, pondering life in Houston sans car, and anticipation of my new job.

To sum up, life in Houston so far has followed a pattern: unpack, JOY, study, FEAR, shop for groceries, JOY, figure out bus routes, FEAR, ponder my new life, JOY/FEAR. JEAR? FOY?

St. Murse

PS I pledge to post regularly going forward. Sorry about the delay. You know how it is. Or maybe you don't. Anyway, I'll be back-filling posts summarizing school and such from now back to April. Check back in the archives for those posts as I write them.

Delay in posting

Yeah, I know. I've been remiss, again. I'm busy, but also I'm so focused on the future (applying for internships, registering for my last semester, graduation, finding a job, etc.) that I find it hard to concentrate on relating my present life in school. Sorry.

I'll do better in the next week. Or so.

St. Dennis of Bindlestick

Weeks ago I paid $10 to artist Adam Koford for naming rights to a hobo for his Hobotopia series. Here's what he made of the name:



Frickin' awesome. I've got the original artwork on a postcard. Koford posted a nice photo of St. Dennis on his Flickr set.

SXSW Music 2007

Don't really have time to give an exhaustive review of bands and performers I saw/heard, so this is mainly a record for me.

Wednesday
The Pipettes - cute, but the backing band was bored and it showed
[The walk to and from this show netted for free: vitamin water, ice cream, a custom button, poster, and condoms]
Imperial Teen - fun, not as good as a couple years ago
Beirut - packed, loud audience almost overwhelmed band, good not great
The Early Years - interesting, I'd like to hear their recordings
The Mountain Goats - great, though I was tired and therefore not as involved in the show

Thursday
Emmylou Harris - an interview with songs scattered through; funny, sweet, just an amazing person; I heard her perform "Love Hurts", "Green Pastures", and "Boulder to Birmingham"; missed her doing "Orphan Girl" dagnabbit
Martha Wainwright - I see a lot of her family in her
Bob Mould - raging on solo acoustic
Tosca String Quartet + Lambchop - gorgeous, I'm bummed I couldn't see the whole performance
The Octopus Project - good as (almost) always
Golden Arm Trio - just caught a few songs; I used to see them all the time and I really should make a point of seeing them again sometime soon

Friday
Comedy on the Music Circuit panel - hilarious, but could it not have been with Zach Galifianakis and David Cross on the panel? Henry Owings, John Wurster, and some other guy too. Best part was Cross talking about a terribly misguided attempt to open for GBV (I think) after which someone in the audience actually peed on him from behind, whereupon Zach quickly offered a insincere apology.

Kid Koala - His live, heavily manipulated "Moon River" was astounding
Daniel Johnston - Uh, somebody tell him not to do Nazi jokes
Thurston Moore Instrumental
Nethers
Hoodoo Gurus - Dang, they were great
Tullycraft - I though I was too tired to dance and then they just got me on my feet, bravo Tullycraft

Saturday
The Buzzcocks - still tear it up
Bill Calahan - beautiful
Tilly and the Wall - a lot of fun with an enthusiastic crowd
The Octopus Project/Black Moth Super Rainbow - lovely, trippy
Donnie Davies - Heh, Donnie just lipsynced to a guy hidden behind the PA speakers
Kid Koala - again great
Amon Tobin - Good, but not as fresh as he used to be
Junior Senior - Whooo, great way to end the week, lots of sweaty dancing

School health clinical

As part of our half-semester of pediatric nursing, my fellow nursing students and I spent a couple weeks with a school nurse. Before going, I was unenthusiastic. I was sure that spending more time in the hospital would be a better use of our limited time. Turns out, school nursing was of higher value to me. My school nurse had been an ER nurse, which is common. If you think about it, it makes sense. School nurses need to have superior assessment skills and experience triaging patients. As someone who wants to work in an ER, it was great experience and lots of it.

I remember my elementary school nurse as being someone who put on band-aids and let you lie down in her office when you had a stomachache. While we did those things, it's a small part of the job. During my four days there I gave out prescription medications, fed a kid through his gastric tube, washed sand out of eyes, bandaged hands and feet, iced potential sprains, conducted vision and hearing tests, checked temps and throats a hundred times, and on and on. It was busy with a steep learning curve.

For many of these kids, the school nurse is their major source of healthcare. They don't have insurance of any kind and can't even afford to go to outpatient clinics. It's a lot of responsibility for the nurse. On a regular basis, she has to accompany families to appointments to ensure that they go and often to translate as well. Every year she works with the PTA to raise money for eye appointments so kids who need glasses can get them. I see now that school nursing requires quick-thinking, resourcefulness, and huge amount of dedication.

Again, I don't want to go into this kind of nursing, but it was valuable experience and something I will draw upon in the future.

Pediatric clinical

I didn’t write much about my experience in pediatrics. My time for blogging is scant it seems. It was great overall, though slight in patient interaction in the hospital. Because one or both parents are there all the time and they usually like to provide as much personal care as possible, we as students didn’t do much beyond taking vital signs, performing the nursing assessment, and administering medications. Often my cohort could be found in the hall, hungry for something to do.

One day though, I had an infant and mother who’d had a rough night. The primary nurse and I encouraged the mother to take a break, visit the cafeteria, whatever she needed to do while we took care of the baby. While she was gone, we gave the baby her medications, removed her Foley catheter, and saline-locked her IV (basically kept the IV access while discontinuing the continuous infusion). Then I got to hold the baby.

Whoo! Baby-holding. Growing up, my Mom took care of kids in our house so I had lots of experience taking care of them. I forgot how nice it is to hold a little baby, especially if they’re not screaming. It was short-lived as the mom came back soon after. It was nice while it lasted.

My favorite part of this rotation was the observation experiences I did in the pediatric ER and ICU, and not only because I didn't have to complete a lot of paperwork for them. I'd worked in the ER before as a registration clerk and so I knew the layout, but it was such a different experience being there as a nursing student. I found myself focused on patient assessment: what they look and sound like, the history, how the family was interacting. I felt quite nurse-y.

The pediatric ICU was a great too. My instructors couldn't fit me in during the regular schedule, so I volunteered to come in on a Saturday morning so I could have the experience. It was worth the loss of sleep and down time. I lucked out and ended up paired with a great nurse who's also a grad student at my school. She encouraged me to help out with patient care and challenged me with questions throughout the shift. Her two patients (ICU ratio is at least one nurse for every two patient) were toddlers with tracheostomies. They were cute kids, and it was sad that they had to be hospitalized. Worse, because they were trached, when they cried there was no sound. Trust me, a little kid with a tears, a scrunched up face, and no sound is heartbreaking.

Despite enjoying the experience, I'm still drawn toward critical care of adults. I like kids and do well with them, I just think my talents are better used elsewhere.

SXSW 2007: "Famous" people

These are people with whom I interacted, not just saw:

Gilberto Gil - passing in a hallway I saw him, stopped and said I enjoyed his music

Peter Buck (REM) - brushed past me carrying his guitar, his jacket was velour

David Byrne - it seems like I help him every year

David Cross - patient with rabid fanboys which seem to cluster about him everywhere he goes*

Zach Galifianakis - sweet man, much less neurotic and volcanic than on stage

Jonathan Demme - I helped him check in and get his badge, very nice fellow

Dennis Miller - low-profile with cap pulled down low, checking in with his family, I'm really not a fan of him anymore due to his politics. Glad I no longer look like him.

Also, I gave Chris Gore (Film Threat) his SXSW badge. When I called out his name, someone down the hall shouted, "Chris Gore sucks!" and they were serious. Mr. Gore and I both laughed at the random hate.

This is sad, but I can't think of any "famous" women with whom I came in contact.

* Funny story. Several years ago I was working behind the registration desks when Carson Daly came through. After getting his badge, he continued to loiter in the area clearly wanting people to notice him. My fellow volunteers and I considered it haughty, then just pitiful when it became apparent that no one cared. Then David Cross came through and there was a visible and audible tumult. I didn't, but wanted to go up to Daly and say, "The only reason that no one is talking to you is that you are a giant tool."

My head at SXSW 2007

14
Originally uploaded by mybloodyself.

I almost forgot to post a picture for this year. Mybloody clippered the 14. It's how many years I've been volunteering. Not as cool as last year or the year before that, but I couldn't go too crazy what with having to go back to clinical sites this week.

The 14 is now gone and I've gone to a high and tight.

SXSW Film 2007, last two movies I saw

Zoo

The festival synopsis reads, “ZOO tells the story of a seemingly average businessman whose secret sexual life led to his shocking death.” The shocking death is bleeding caused by his colon being perforated by a giant horse cock. That is, an actual horse cock, not just a big human one. Yeah.

I was unconvinced about the desirability of seeing this film, but was assured by a staffer that it was “disturbing, but beautiful”. That description is entirely accurate. Showing influence from Errol Morris, Zoo features recorded interviews from people involved in the case (fellow horse “lovers”, an investigator) played over gorgeously-filmed reenacted scenes. The effect is meditative and far from exploitative. There’s only a tiny glimpse of actual explicit sex and many in the audience didn’t remember seeing it (and not because they’d gouged out their eyes and had tramautic amnesia). It really is a wonderful film; packed screening, audience rapt. Highly recommended.


Helvetica

A documentary about a typeface. I wanted to write this entry in Helvetica, but I don't know how to change the typeface for just one post. The doc is effective in showing how Helvetica was introduced and came to such dominance. The audience was absolutely in on the idea of this film so there was much enjoyment as various typeface experts give sloppy love, or vitriolic distaste, to Helvetica. Interspersed with the talking heads are numerous examples of Helvetica on signs everywhere. The film drags a little toward the end but all in all it's successful. Afterwards and for the next several days, Helvetica stood out like neon for me. Really quite amazing how ubiquitous it is. Recommended.

SXSW 2007 photos

I really need to go to sleep, but here's my photo set from SXSW 2007.

Donnie Davies at SXSW

I'll do a full SXSW wrap-up later, but I had to write about Donnie Davies' show. If you are not familiar with this internet phenomenon, Donnie purports to be an ex-gay Christian singer - he's not really any of those things. Read his thoughts here and be sure to watch the video for "The Bible Says."

A SXSW staffer told me that he'd shown the video to people in the office and one of the music guys was eager to book Donnie Davies. They slyly chose to put him on the same night as The Buzzcocks and Turbonegro, bands with more than a little homo-osity about them.



Donnie hit the stage to loud cheers and they immediately ripped into "Surrender" by Cheap Trip. On the "but don't give yourself away" line, Donnie would cover his crotch and shake his head. They actually pulled off the cover well and most of the audience was on board. Evening Service appeared to be the same band that's in "The Bible Says" video and the MTV interview, including bad wigs.



The next song served as proof that Donnie is totally not gay anymore, no sir. He grinded with the sexy lady dancers while performing a Timberlakian number.



At one point, Donnie asked the audience if there were any homosexuals among them who wanted to get saved. Having no desire to be saved, I nonetheless raised my hand as did several other people. Donnie pulled up a very obviously planted guy named Gary Bentler up on stage and had him demonstrate his limp wrist. In an attempt to "heal" him, Donnie lead us in the C.H.O.P.S. (Changing Homosexuals into Ordinary People) salute, while chanting "Heal Bentler." You can probably guess what the salute and chant devolved into.

Interestingly, in addition to not being an ex-gay (or probably gay at all) or Christian (at least of the scary variety), Donnie's not even a singer. He just lip-syncs while this guy sings off-stage:



Donnie and Evening Service closed with "The Bible Says" which was a rousing success with the audience, at least half of whom had never heard it before. All-in-all a wonderful palate cleanser before I headed off to more music elsewhere.

UPDATE: Due to financial constraints, I have to sell the Donnie Davies t-shirt I bought at the show. I listed it on eBay at the price I paid, $20.

Sun. SXSW Film

Diggers

My first narrative film so far. I generally avoid them at festivals because they're often disappointing and I could be seeing a good documentary instead. I went for this because of the talent involved. Written by Ken Marino (ex-The State, Veronica Mars), exec. produced by David Wain (ex-The State, Stella, Wet Hot American Summer), and starring Paul Rudd among others. It was competent. Kinda cliche indie ensemble film with all the strengths and weaknesses that implies. Great visuals though shooting digital but keeping the 70s film look.


King Corn

If you anywhere close to a typical American or Canadian, your body is rife with corn. Something like 90% of the carbon in your body was corn at one time. King Corn is full of scary/interesting facts like these. Two college grads move to Iowa to farm one acres worth of corn and fill us in on how ubiquitous corn is in our diet. I was dubious that they could keep it compelling over a feature-length documentary, but they pulled it off. I thought I was well-informed on how pervasive high fructose corn syrup is and its probable role in declining health. It's scarier than I knew. As one interviewee put it, it's a good thing that cows are slaughtered when they are, because they'd be dead in six months anyway from the massive corn diet. Apparently eating mostly corn gives them stomach ulcers an makes them acidotic, a supabad condition in people for sure. Im going to suggest that my nursing school buddies see this. Highly recommended.


The Devil Came on Horseback

A brutal, necessary experience. This doc is told through the eyes of Brian Steidle, an ex-Marine officer who gets a job with the African union monitoring the cease-fire between Northern and Southern Sudan. While there taking photos and collecting interviews, he becomes aware of the genocidal massacres happening in the Darfur region. Helpless to avert the killings, rapes, and destruction, Steidle leaves Sudan to return to the U.S. and get the word out. So far, despite the U.N. and the U.S. labeling it as genocide - a label that legally requires intervention - there have only been stern reprimands.

As I said, a brutal, necessary experience. The world needs to know that 13 years after Rwanda, it's happening again and history will judge us harshly if we do not act. Steidle was at the screening encouraging the audience to contact their legislators and come to the Capitol on Monday to register in favor of a bill to divest Texas investment in Sudanese-involved companies. I was moved to do just that. Happily, I saw strong support in the Senate and House for the bill so unless it gets pushed down the agenda it looks likely to pass.

Brian Steidle was at the Capitol as well and I made sure to thank him for his work. There's a sense of sadness and resolve about him that is inspiring and also heartbreaking. It's probably the former Catholic in me talking, but I wanted forgiveness from him for what I haven't done.

Sat. SXSW Film

Cat Dancers

I had no intention of seeing this film because of the aforementioned poster. Then I met up with some film buddies and they convinced me. This would continue to be a theme of the day and I will hereafter bow to their film-picking wisdom.

This doc tells the story of the first exotic animal act in the U.S. Joy and Ron Holiday were internationally-acclaimed dancers who thought ahead to the natural decline of their physical prowess and so transitioned into a touring act that incorporated dance, magic, and exotic cats. When the act grew too large for them to comfortably manage, they added Chuck Lizza to become a trio in more ways than one. From there the movie takes an almost inevitable tragic turn, which of course I will not spoil.

The filmmakers did a smart thing in the opening minutes of Cat Dancers. Ron Holiday is a bit of a comical figure. So, the filmmakers jump in and get it out of the way. Here's this guy who wears wigs and eyeliner. He's more than a bit nelly. And then they move on with the story. I really enjoyed this film. It's mostly interview footage intercut with photos and old 8mm films in a rather traditional manner, and yet the subject and the way it's handled is compelling. I believe it was picked up by HBO so should be showing there soon. Recommended.

Election Day

Election day 2004 from the perspective of voters. Simple idea really, but coordinating crews in 16 different cities must have been quite an undertaking. No revelations or big lessons learned. Just the experience of people voting all over the country: long lines, officials somewhat ignorant of election rules, idealism, apathy, etc. Not a stunning movie, but interesting throughout and a good document for history.

Big Rig

Great film. As with Cat Dancers, I was wary and then goaded into it by friends. Because it's a doc about truckers right? What convinced me was that the director, Doug Pray, also did Scratch and Hype! Glad I succumbed because I loved Big Rig. Turns out truckers are fascinating people who know how to tell a story. Pray and two crewmembers essentially hitchhiked across the country catching rides with truckers while interviewing them. The stories are often personal, but also touch on the commonalities of life as a trucker; long hours, rising gas prices, separation from family. Highly recommended.

Fun with fluids

You make the call!



How did he get urine on top of the urinal?

A) Very tall
B) On purpose, jerk
C) Barely subsided erection
D) That's not urine

1st day of SXSW, and a little blood

It's the first day of SXSW and so far I'm pleased. We're up and ready to go in Registration and I've already seen an amazing example of velveeta-ness. To whit:



Also, the Blood and Tissue Center called me this morning and requested that I come in for a blood donation, not just because they're low on my blood type, but specifically for me. Like the red blood cells, platelets, and plasma I make in my bone marrow. I didn't know whether to be flattered or surveiled (is that a feeling? One of being monitored?). They need fresh drawn blood tomorrow for someone who's having surgery and apparently I match them well as far as antibodies, etc. The impression I got was that I'll donate tomorrow morning while a courier waits to whisk it away. I hope the surgery goes well or else they might hunt me down at the convention center for more.

How to make money with only slight dairy-related regrets

Yesterday after the convention convened for the day, we waited 90 minutes to check in to our hotel (fun!) and then I went to the gym of a different hotel. A short nap and a can of Sparks later, I went with my schoolmates to dinner at a decent seafood restaurant. The blackened redfish and crab bisque I had were delicious. What I ended the meal with, not so much.

As I posted on 2/22, I regularly bet friends money that they won’t do entertaining things. The bet last night was the rapid consumption of all the condiments that came with a baked potato: chives, a kind of Hollandaise sauce, sour cream. The person I bet wouldn't take it, but then the bet was turned back on me by others.

For $15, I did it.


Complete photo documentation can be found on my Flickr stream.

Nursing Student convention 2007

I’m at the Texas Nursing Student Association convention in Galveston for the next several days. The convention business itself is fairly dry, but it’s to fun go on a trip with my school friends where I’m only paying for food and entertainment. From the 2005 and 2006 conventions, I’ve developed a reputation for three things:

1. Taking unflattering photos of my schoolmates,
2. Offering money to my friends to do entertaining things,
3. Eviscerating poorly thought out, badly worded resolutions being considered by TNSA convention delegates

To illustrate:

1.


2. I have offered someone $10 to drink half a bottle of malt vinegar. For $20 plus costs, I encouraged a large guy to walk into Baby Gap and put something on forcibly overcoming the size issue.

3. I did not see it because I was walking up to the mic, but I’m told that whenever I did so, my schoolmates would freak a little because they were excited/concerned about the articulate smackdown coming. Seriously y’all, some of these resolutions were ridiculous and needed to be taken apart in an entirely rational manner. I have been accused of being mean by delegates from other schools, but that’s just an ad hominem attack because they had no counter-argument. So … shut up.

The common format for resolutions (sensible and otherwise) includes a
resolved statement stating that the resolution – if passed – be sent to a variety of different organizations. A sort of heads up on what we’re doing. I was thinking how great it would be if I wrote an absolutely serious, cogent resolution that then requested that it be sent to, multi-Olympic Gold medalist Bonnie Blair, Prince, and whoever turns out to be the father of Anna Nicole Smith’s daughter.*

*thanks to Matt, the co-writer of this thought

Into the bone

Last week in our pediatric lecture class, the instructor showed us the equipment used for intraosseous access. Everyone knows about intravenous (IV) access, but IO is so much cooler. Rather than using a vein to infuse fluids, a bone is used instead. It seems bizarre to jab a needle into a femur or sternum, but bone is highly vascularized and fluids infused by that route rapidly enter the bloodstream. Also, bone doesn’t collapse or roll like veins can, and studies show that there is no increased risk of infection. Right now, IO access is used in critical cases where immediate fluid resuscitation is required.



I’ve seen a child come into the ICU by helicopter transport with an IO line that was started by the flight nurse. It works pretty much like an IV. The needle with attached catheter is inserted and the metal guide known as a stylus is removed. The tubing is hooked up and it’s ready to go.

Sunless exercise or Older folks are weird with the walking way early

It’s just a fact of nature I suppose that older people rise early and do things like go for walks. There are several such people in my neighborhood. Six in the awful, wicked, deplorable AM and they are out there with walking stick, golf club, or baseball bat (yes really, and no it’s not a crime-ridden area).

As I left for my Monday morning clinicals the past two semesters, I always saw at least one. I’d just wave and drive past, internally shaking my head at the folly of elders. To think they’ve lived this long and don’t yet know that one should be fast asleep in bed at 6 AM. Or at least slinking home after an ill-advised “sleepover”.

Weird wacky bunch all I said, until I saw the 5 AM walker. Yes, a small gentleman with a sweatband striding around the neighborhood at 5 AM happy as you please. A hearty “Good morning!” as I drove past on my way home (from work, not sex). Total mental case. Maybe military.

So then one night/morning I’m getting out of my car at 4:07 AM after an emergency trip to Whataburger, when I see it. A walker. I say “it” because no human could possibly be out getting some fresh air at 4 AM. Clearly this is an It. An It in the form an old man striding, striding I say, down the street. The only only only thing keeping me from running after him, I mean It, for a vigorous interrogation was my attire: non-descript grey shirt, pajama pants, bare feet. Perfectly fine when making an emergency trip for pancakes, distinctly unsuited for confronting a possible alien who – let’s face this gimmick is starting to get a bit thin – is really just an old guy walking around at an ridiculous time of night/morning.

I’ll post an update with more details when the stars align and I am up at 4 AM, outside my house, and reasonably dressed.

Live Earth

I want to go to the Live Earth concert in Antarctica. That would be cool right? Both literally and figuratively. Maybe a ice shelf would calve off at the climax of a particularly awesome song therefore highlighting the danger of global warming in a very pump-your-fist-and-shout-yeah kind of way.

Perusing the band list, it's obvious that Snow Patrol should play in Antarctica. Though I don't particularly care for them and I understand that it is often too cold to snow there.

Apples to Apples

I went to mybloodyself's house after work and joined in on a game of Apples to Apples. It's incredibly easy to learn and great fun, especially if you know your friends well.

I won a game and I'm most proud that I knew beyond a shadow of a doubt that Joolie would pick my card to match with Glamorous. Because really what's more glamorous than a Festering Wound?

And thank your lucky stars that I didn't post a picture, though if you insist, go here.

Little babies with tubes

Today was my first day of pediatric clinical. As in previous semesters, I'll spend a day or two of the week at a hospital caring for a patient. My first patient was a month-old baby with a probable obstructed bowel. Adorable, even with the distended belly and nasogastric tube suctioning green bile into a canister.

Mom was ever-present and sweet, which was just annoying. I mean come on, let someone else hold your cute baby for a change. I'm only there for a limited time lady, I want to cuddle the bundle of precious too. Or am I only good for taking vital signs with the tiny, coo-inducing neonatal blood pressure cuff?

(Roughly 6" x 1.5")

Some people. Hrumf.

Honestly, it was a nice day. Children just aren't as complicated as adults it seems. I had a fairly easy patient though. Other students' kids spit out their meds, I just had to make sure the acetaminophen suppository stayed in long enough to melt.