Ike Day 1

The city buses stopped running at noon today so I came in to work early. It felt like a Sunday morning. As I walked down to the bus stop, I saw varying levels of preparation for Ike. Some houses and stores had boarded up their windows, some just taped them, but most were left as is. Aside from the grocery store and a few casual restaurants, businesses were closed with handwritten signs in the windows, CLOSED SATURDAY, OPEN SUNDAY. One gas station had wrapped their pumps and shut down, the station catticorner was raising their prices as I watched from the bus stop.

The ride to the Medical Center was uneventful; less people out and about than usual, but still some riding bikes and walking dogs. As I came into the building clouds were beginning to roll in, though it was still warm and sunny. Out front was a line of cars picking up discharged patients.

After checking in with my unit I was assigned a bed upstairs in a cleared-out patient care area. Shoes off, ear plugs in, diphenhydramine pill taken, I slept for five hours before heading down to my unit at 7 PM. I’m working the desk now. There are more than enough nurses to go around so I’m answering phones, putting orders in, assisting as needed with patient care, those sorts of things.

I haven’t been outside since 11:30 AM. I’m told that now at 11 PM it takes two people to hold the door open due to the wind. Maintenance crews boarded up the windows on the unit so we can’t see outside. There’s a lounge down the hall where you can still see out, I’ll check it out when I get a break in a couple hours.

Updates to come as time and circumstances allow.

Letter meme

The rules: Comment and I'll give you a letter; then you have to list ten things you LOVE that begin with that letter. Afterward, post this in your journal and give out some letters of your own.

Seagulls Screaming gave me M (well, I asked for M and she assented):

Music - Big surprise huh? I'm one of those people that fly to other cities to see bands/music festivals. Magnificent Ms (or what I can make out on my CD shelf as I squint from here): M83, The Magnetic Fields, Man...Or Astroman?, Massive Attack, Marumari, Kathy McCarty, The Meat Purveyors, Ministry (early- to mid-period), Morrissey, The Moth Wranglers, The Mountain Goats, Movietone, μ-Ziq, My Bloody Valentine.

Movies - Love almost as much as music. Marvelous Ms: M, Metropolis, The Miracle of Morgan's Creek, Mulholland Dr., Man Bites Dog, Manhattan, Manhattan Murder Mystery (three Ms!), Miller's Crossing, Mom & Dad Save the World, McCabe & Mrs. Miller, The Muppet Movie. Hey look at that, films by Preston Sturges, Coen Brothers, Woody Allen (2), Robert Altman, Fritz Lang (2) - great directors with distinguished careers all.

Elizabeth Murray - In high school I kept pictures of Murray's artwork taped to my walls after reading about her in the newspaper. There's a wonderful playfulness to her art that thrills me. Several times at museums, I've rounded a corner and been pleasantly surprised to see one of her works across the room.



Medicine - More than just a job.

Midnight - I love the turning of one calendar day to another in the dark of night. On my off days, when I see that it's around midnight I think, "Six to eight hours before I have to go to sleep. Awesome."

Memory - Just the idea of remembering is so incredible when you think about it. Moments imperfectly encoded into organic structure, then summoned forth by will or external trigger.

Moths that drink the tears of sleeping birds - Nature is frickin' amazing.

Monkeys - Well yeah. Monkeys. Even the word is fun to say. Course if I lived in one of those Indian towns where fearless monkeys maraud then I probably wouldn't like them so much.

Moshi moshi - So great that Japanese has a phrase that's only used in one context, answering the telephone.

Matt(s) - Two specifically, here's to you Mr. R and Mr. L.

pre-Ike preparations

As expected, I got a call this evening from my boss at the hospital. The disaster emergency plan is active and I am to be there tomorrow at 3 PM in preparation for Hurricane Ike's landfall. After the nightmare of Tropical Storm Allison, Houston's hospitals put emergency plans in place to deal with future calamities. At my facility, the staff sign up to be on either the Prep and Recovery team or the Ride Out team. P&R works before the anticipated emergency, then evacuates or stays home. The Ride Out team staffs the hospital just before and during the event. Then the P&R team comes in afterwards to relieve the RO staff. Having no local family or pets to look after, I signed up for RO.

I'm neither nervous nor annoyed by the circumstances. I was well-aware that Houston is at risk of experiencing hurricanes and being a nurse at a hospital means contributing to disaster preparedness. It's part of the job. Frankly, I'm glad to go in. I have no car so I couldn't easily leave Houston anyway and the hospital will take care of all my needs.

Tonight I'll pack a bag in preparation for living at the hospital for a day or two. The expectation is that I'll work my regular 6:45 PM to 7:15 AM shift, then sleep in makeshift housing at the hospital. I'm guessing this will be empty patient rooms as part of the plan calls for slowing admissions and stepping up patient discharges in an effort to reduce the hospital census. As all non-emergent surgeries get canceled, it's possible that I'll be working somewhere other than my normal surgical recovery unit.

Currently the eye is predicted to make landfall near Galveston very early Saturday morning. Just looked up the bus schedule and dang, service shuts down at noon so I have to leave even earlier. Alright then, two antihistamine pills are in my near future as I need to be asleep by 3 AM. Updates as time and circumstances allow.

Drank found, imbibed

After reading a AV Club review, I was interested in trying Drank but none of the three non-chain convenience stores in my immediate area had it. Sure, it's distributed out of Houston but my neighborhood was not exactly ground central for screw hip-hop. Then one day I went into a store and there it was. I was way too excited about the purchase and considered drinking a can right then just to take the edge off.

Wait, let's establish some background. A Houston guy named DJ Screw invented a style of hip-hop called screw that slowed down and chopped up the music. Purple drank (or oil or syrup or any of the other names for it) was the drug of choice to accompany the music. Cough syrup containing codeine and promethazine is mixed with Sprite or what have you. Adding Jolly Ranchers is optional, that's how Oscar-winners Three 6 Mafia liked it ("Rainbow Colors", thanks Wikipedia). Codeine is a narcotic and promethazine is an antihistamine mostly used to combat nausea and as a cough suppressant. It also causes drowsiness. So, drink drank and feel kind of drunk, get a lean going. Oh, and DJ Screw and several other musicians closely identified with screw probably died from complications associated with consuming purple stuff.

Drank is marketed as an "anti-energy," completely legal version that will "slow your roll." Instead of prescription medications, the active ingredients are valerian, rose hips, and melatonin. It tastes like carbonated grape Kool-Aid and I can report that it does indeed make one sleepy. Both times I drank Drank, it was in the morning when it was time for me to go to bed (I work night shift remember) and I wasn't particularly tired. Drank worked to send me off to sleep.

The can lists the amount of valerian, rose hips, and melatonin it contains but of course as herbal preparations, there's no standard dosages for them. Oddly, Drank also contains 100% of the recommended daily value of B vitamins, something usually in energy drinks because they supposedly make people feel more alert. Even if that were true (I have my doubts, though not enough interest to research this, sorry), 100% of a vitamin isn't going to have powerful effects. On the down side, Drank is loaded with high fructose corn syrup.

Sadly, the store I bought it from no longer stocks it. I'll endeavor to find another source so that I might bring some on a certain camping trip coming up soon.

Read and unread

Instead of doing something truly productive, I've been catching up on Spacebeer's blog as is obvious from my citing her posts below and adding her to my blogroll. Hi Spacebeer! Why did it take so long for me to read your blog? I've been remiss. Please forgive. Anyway, to placate your ferociousness, here you go:

"someone compiled a list of the top 106 books tagged "unread" on Librarything, and started a nifty little meme.

Here is the plan:
Bold = I've read it for fun [I guess this is a catch-all]
Underline = I read it for school
Italics = I started it but didn't finish
Asterisk = I own it, but haven't read it"

Jonathan Strange & Mr Norrell
Anna Karenina
Crime and Punishment
Catch-22
One Hundred Years of Solitude
Wuthering Heights
The Silmarillion
Life of Pi : a novel
The Name of the Rose
Don Quixote
Moby Dick
Ulysses
Madame Bovary
The Odyssey
Pride and Prejudice
Jane Eyre
The Tale of Two Cities
The Brothers Karamazov
Guns, Germs, and Steel: the fates of human societies
War and Peace
Vanity Fair
The Time Traveler’s Wife
The Iliad
Emma
The Blind Assassin
The Kite Runner
Mrs. Dalloway
Great Expectations
American Gods
A Heartbreaking Work of Staggering Genius
Atlas Shrugged
Reading Lolita in Tehran: a memoir in books
Memoirs of a Geisha
Middlesex
Quicksilver
Wicked: the life and times of the wicked witch of the West
The Canterbury Tales
The Historian: a novel
A Portrait of the Artist as a Young Man
Love in the Time of Cholera
Brave New World
The Fountainhead
Foucault’s Pendulum
Middlemarch
Frankenstein
The Count of Monte Cristo
Dracula
A Clockwork Orange
Anansi Boys
The Once and Future King
The Grapes of Wrath
The Poisonwood Bible
1984
Angels & Demons
The Inferno
The Satanic Verses
Sense and Sensibility
The Picture of Dorian Gray
Mansfield Park
One Flew Over the Cuckoo’s Nest
To the Lighthouse
Tess of the D’Urbervilles
Oliver Twist
Gulliver’s Travels
Les Misérables
The Corrections*
The Amazing Adventures of Kavalier and Clay
The Curious Incident of the Dog in the Night-Time
Dune
The Prince
The Sound and the Fury
Angela’s Ashes: a memoir
The God of Small Things
A People’s History of the United States: 1492-present
Cryptonomicon
Neverwhere
A Confederacy of Dunces
A Short History of Nearly Everything
Dubliners
The Unbearable Lightness of Being
Beloved
Slaughterhouse-five*
The Scarlet Letter
Eats, Shoots & Leaves
The Mists of Avalon
Oryx and Crake: a novel
Collapse: how societies choose to fail or succeed
Cloud Atlas
The Confusion
Lolita*
Persuasion
Northanger Abbey
The Catcher in the Rye
On the Road
The Hunchback of Notre Dame
Freakonomics: a rogue economist explores the hidden side of everything
Zen and the Art of Motorcycle Maintenance: an inquiry into values
The Aeneid
Watership Down
Gravity’s Rainbow
The Hobbit [6th grade reading group - cool teacher]
In Cold Blood: a true account of a multiple murder and its consequences*
White Teeth
Treasure Island
David Copperfield
The Three Musketeers

Man I'm way behind on the classics. Oh well, too many books, too little time.

even patient nurses wound know

Spacebeer finds cool things on the internets. For instance, Wordle. I suspected that somewhere there was a site that created word clouds, but never looked for it assiduously. Here's a cloud of St. Murse blog:



I think I might edit the text a bit and make a T-shirt out of it.

Floating

Last night I worked in another ICU at my hospital for the first time. The surgery schedule has been light with some surgeons on vacation, so my unit has been overstaffed with nurses. It's the way of hospitals, if one unit is overstaffed and another is under, then nurses float to even it out. Technically I'm not supposed to float until I've been off orientation for six months, but my home unit had to keep the experienced nurses to look after the complicated devices (continuous dialysis machines, intra-aortic balloon pumps, ventricular assist devices) which I cannot. Oh well, that's nursing for you.

It was great experience actually. The principle is that floated nurses shouldn't be given a difficult patient load because they're not in their regular environment. Doesn't always happen that way, but it did for me last night. My patients weren't confined to bed, had stable vital signs, and each had only one IV medication running. After assessing them, administering their meds, and performing one dressing change, I didn't have much to do for the rest of the shift aside from charting their vital signs and changing out their IV lines. Then one of my patients who had transfer orders to move to a lower level of care got a room at midnight. After I packed him up and moved him out, I only had one patient for the rest of the shift.

I was able to talk with the other nurses and get a feel for the unit which, though laid out much like the majority of ICUs at the hospital, is very different from my home unit in cardiovascular surgical recovery. With free time on my hands, I read my one patient's H&P (history and progress notes made by doctors) to get a better feel for the situation. Then I moved on to re-reading some hospital policies in an effort to A) know them better and B) stay alert. All in all, it was a nice break from the pace in CV Recovery.

Gross, in a sort of cool way

Squeamish alert! Do not read on if discussion of open wounds gives you the willies.

A nursing classmate of mine told me a wonderfully vile story. The patient she was caring for was a woman whose hysterectomy incision had opened up. I don’t know the specific circumstances of the case, but even well-approximated incisions (the edges coming together nicely) can open up if the stitches or staples burst open due to a forceful cough or errant Valsalva maneuver.

Anyway, that’s just academic. The reality was that the patient was quite obese and the wound was a foot deep. Yep, from the skin all the way down to where her uterus used to be was a solid 12”. Care for such a wound involves cleaning the bed of the wound to minimize the risk of infection and promote healing. It took two people bracing themselves on either side to pull back the sides of the wound enough so that another nurse could get all the way down in there with a sponge.

Wheee! Sometimes nursing is just delicious huh?

Memo to Mr. Misogynist Q. Patient

If, when you ask if I have a sense of humor, you mean laughing when you say, "Now that I've got better blood flow, maybe I can do something with it," while I'm cleaning your catheterized penis, or joining you in denigrating your female relative's job as a way of complimenting mine, then no, I don't have a sense of humor.

Also, refrain from automatically assuming that male staff are doctors. Despite us referring to ourselves as "your nurse," you continually called the day shift nurse and I doctors. The women in the white coat with her name clearly printed on the pocket? She's the surgical resident who scrubbed in on your operation, not as you assumed, the charge nurse.

I am being a little hard on the guy. He was anxious, feeling out of control and his coping mechanism of choice was joking around. It's a much more positive mechanism than regression or somatization. It's why I gave him some slack, kept quiet, and ignored his attempts at humor. And yet, even though he "comes from a different era", you have to know that making sexual comments about the female staff is big fat no-no. By the morning, I was weary of it.

When I leave at the end of my shift, if my patients are awake and likely to be transferred out to a lower level of care that day, I sincerely wish them well. This guy, I just said, "Feel better," without eye contact. Petty, I know, but man he was grating.

Another thing I love is tarnished, though electroplated in hate would be more accurate

While my love of science fiction began in high school, it truly flowered in college thanks to books loaned and recommended to me by a couple of friends (thanks M & E). Many college bullshitting sessions were spent discussing the implications and questions arising from the works of Le Guin, Varley, Brin, etc. Above them all though, was Orson Scott Card. How we adored him. He's descended into almost total suckage over the last decade or so, but still, Ender's Game, Speaker for the Dead, The Worthing Saga? Masterful.

Well, now he's done it. Sure I always knew he was a devout, Elder-kiss-up Mormon, but now he's calling for violent revolution against the U.S. government if gay marriage becomes common. No need for me to rant on as Michael Swaim (who knew Cracked.com had such astute writers?) has laid out the arguments beautifully. Warms the heart really.

Unlike Swaim and others I've seen, I'm not tossing the Card books I treasure. I won't buy another copy new, but good stories are good stories even if they're told by a greedy, bigoted asshole who I nonetheless will endeavor to consider a person deserving of love. And I don't even claim to be a Christian.

Where to start with the wonderfulness of Tom Giesler's anatomical chart art? Hilarious and gorgeous.

Attention to detail: How to avoid dumb questions

A few weeks ago at work the patient care techs were busy and my patients were tucked away so I answered a spate of phone calls to the unit. One call was from the lab, "Patient X? The sample in the green top [test tube of blood] is hemolyzed [red blood cells are ruptured]. We need another one sent."

I walked down the hall to convey the message to the patient's nurse, "Lab called. That sample's hemolyzed. Can you send another one?"

"Well no," she said, looking at me curiously, "The patient's dead."

I looked over at the bed and monitor for the first time. Sure enough.

A little medication-based nursing humor. Very little.

This week I was talking with a couple of women at work and the conversation turned to diets and losing weight. We’re all nurses so we know about the physiological processes involved and how some diets (i.e. Atkins, South Beach) initially show quick response because they result in mostly water loss.

That reminded one nurse of the time she found Lasix among her deceased grandmother’s things. Lasix prevents the kidneys from reabsorbing sodium and where sodium goes, so goes water due to osmosis and all that. No sodium reabsorption means peeing out a lot of fluid. Water weighs 2.2 pounds per liter (or the metrically more sensible 1 L = 1 kg), so that can add up to tidy weight loss. Along with all that water, important electrolytes are also peed out, particularly potassium, a dearth of which can cause life-threatening heart arrhythmias.

With all that in mind (I know, it’s a lot to keep in mind), the nurse explained her logic thusly,

“I found Lasix pills in my grandmother’s medicine cabinet and I was thinking about fitting into pants better, but I had no way to monitor my potassium levels and I don’t like bananas so…”

“Aside from the ethical implications of a health professional taking medications not prescribed for her,” I responded, ”You could have just eaten avocadoes.”

“Avocadoes?!” she exclaimed, “The whole point was to make my butt smaller.”

“Yeah St. Murse,” the other nurse said, “Duh.”

I love my co-workers.

Take every 6 hrs as needed for indifference

Every couple of months the class of new nurses with whom I started meets for continuing education. The day’s agenda always includes time to talk about the challenges of the job. Essentially it’s a good-natured bitch session. Last time we met, someone brought up calling residents for orders and getting a less-than-confident or lackadaisical answer. Residents are still training as doctors and don’t know everything so nurses often coach them along. A common response from the docs is, “What do you usually do?” or “What do you want to do?”

I prefer the first question because it falls back on the routines of the attending physicians. They’re usually asking because hospitals differ in their preferences, not because they are clueless. At Hospital A, the typical orders for nausea are medication X at such-and-such dose and timing, while at Hospital B it’s medication Z. The second question, “What do you want to do?” is more annoying to me, because, you know, they’re the doctor with prescriptive authority. It’s putting the onus on the nurse with the doctor just agreeing or not with the suggestion. The worst though is when they obviously aren’t engaged. As one fellow nurse dramatized it:

Nurse: Doctor, Mr. Smith is getting increasingly hypertensive.

Doc: Uhh. Hydralazine 10 mg, or whatever. I don’t care.

In class I wistfully offered how great it would be if we could write out the order and fax it to the pharmacy just like that.

8/23/08 1935 Hydralazine 10 mg, or whatever. I don’t care.
TORB (telephone order read back) Dr. Apathy/St. Murse, RN

Found: paranoid chart

I found this taped to a bus stop. "Beware LADIES HE Will Come and SEX you at Night" and by HE, the author means SATAN.



My favorite part is "Stupid Idiot Daft Punk." Sure they might be harder, better, faster, and stronger, but apparently they are also stupider, idiotic, and somehow involved with Satan.

Obese begets obesesier

In an August 9th New York Times op-ed piece, Olivia Judson writes about rat studies which show that mothers who consume large amounts of junk food (as opposed to balanced rat chow) while pregnant give birth to babies with a hankering for junk food. Human studies are less definite but,

"...the results of several studies suggest that the very fact of a woman being obese during pregnancy may predispose her children to obesity. For example, one study found that children born to women who have lost weight after radical anti-obesity surgery are less likely to be obese than siblings born before their mother lost weight. Another study looked at women who gained weight between pregnancies; the results showed that babies born after their mothers put on weight tended to be heavier at birth than siblings born beforehand. Since the mother’s genes haven’t changed, the “fat” environment seems likely to be responsible for the effect."

Speaking as a health care professional who routinely cares for obese people, uh, yikes. This could result in a nasty geometric progression of obesity and related disease (diabetes, hypertension, heart and vascular disease, stroke, cancer, sleep apnea) in the next generation. Not to mention the increased incidence of lower back problems in the nurses who have to move such patients. Body mechanics of moving patients was one of the first things I learned in nursing school skills class and rightly so.

Heart, in wire

I commissioned this sculpture from a talented artist, CW Roelle. I like it.

Dark, only slightly muggy, night

As I've said many times before, I don't miss having a car. I really can get to almost everything I need on the bus with advanced planning. Or even spur of the moment. After reading several enthusiastic reviews last night, I immediately wanted to see The Dark Knight. One series-of-tubes search later and I had a ticket to the Angelika downtown. After one bus and a few minutes walk, I was ensconced in a nice seat in an only half-full theater. Hooray for working nights and therefore seeing movies at 9:15 on a Sunday when few jerkwads clog the theater with talking or rampant cell phone use!

Anyway, the movie was great, really pushes out the boundaries of superhero movies. I recommend it. Be prepared though, it's long (2.5 hours) and densely plotted. There's enough plot for two films really, which actually detracts from the last 30 minutes as it introduces a new element, though anyone with a basic knowledge of Batman lore will see it coming. Let me also jump on the pile-on of praise for Heath Ledger's performance. Astoundingly, creepily awesome. I went in with high expectations and he blew me out of the water. Multiple times I audibly, involuntarily horror-giggled.

Though I was prepared for this via a review, it was still remarkable how much of an ensemble film The Dark Knight is. Bruce Wayne/Batman is decidedly *not* foregrounded in either plot mechanics or screen time. I won't take away from the story by explaining further, you'll know what I mean when you see it. Also great is the degree to which the citizens of Gotham are involved in the story. Multiple, nameless Gothamites are essential to the theme of ordinary people taking responsibility for creating civility.

Some elements that distracted me:

- That goofy, scary-voice Bale employs as Batman.

- Why is Nestor Carbonell (the Mayor) wearing so much mascara and eyeliner? (Also, is
his casting a fun nod to him playing Bat Manuel on The Tick?)

- A certain medical aspect of the last bit drove me up the wall. Can't say what it is without spoiling, but argh! No.

- Is the minor character Berg Ramirez (or as his nametag says, Ramirez, Berg) an
obscure shout-out to UT Austin Film/Latin American Studies professor Charles Ramirez-Berg? Cause Berg is not really a first name.

So go see it and then we can talk about it.

At last, poker night

For the first time since moving to Houston I made it back to Austin to play poker with my McJo's buddies. As was clear from my play, I really wasn't paying attention to the game. I'd build up a nice little stack then piss it away while I chatted with everyone, just happy to be surrounded by snarky, opinionated, politically-aware, ego-hammering, magnificent bastards. Regardless, I held on and finished third.

Slept well then had a late breakfast before Mick convinced me to make a specialty shoe purchase. Some other folks at work have Z-coil shoes (spring in the heel) and swear by them. Haven't broken mine in sufficiently to wear them to work for 12 hours and now I'm having a touch of buyer's remorse just from the price. I'm still in the refund window though. We'll see.

Lastly (for Corrosion), shark wants a taco.

Hopkins

ABC has been airing a six-part miniseries documentary about the staff and patients at John Hopkins Hospital in Baltimore. Though it delves a little too much into the personal lives of the doctors (more medicine please!), the ballad-heavy soundtrack is egregious (apparently husky-voiced singer-songwriters = emotion depth), and more nurses should have been profiled (duh), I recommend it as an interesting look at medicine being practiced today.

Thankfully, the episodes are available to watch online.