Who are these other guys?

Aside from my dad, I wonder who these other guys are?

HowManyOfMe.com

There are: 15 people with my name in the U.S.A. How many have your name?

Beneficiary of kindness

Today started early. By 6:50 AM I stood waiting for a UT shuttle bus to take me to campus where I’d catch the Airport Flyer bus. A fellow male nursing student and I are attending the American Assembly of Men in Nursing 2006 Conference in Portland, OR. I was feeling a little stressed because the Cameron Road bus hadn’t arrived when a car pulled over. The driver rolled down the window asking, “Are you going to campus? Get in and I’ll drive you.”

Seeing as how she was an older woman, I wasn’t too worried about being kidnapped, robbed, and beaten. An offering of ribbon candy was possible, but as long as I demurred politely I figured I was safe. Throwing my bags in the back, I got in. Turns out she’s an English professor at UT and picks up students on her way to work all time. At roughly the same time every day, she drives along the Cameron Road route and offers a ride to whoever is waiting for a bus that early in the morning. Remarkable.

We chatted about my impending trip and she told me her great experience with the nurses that cared for her (several men among them) during a hospitalization. When we got close to campus, she asked me where I needed to go and I offered that she could drop me off where it was convenient for her. “I have a handicap permit dear, anything is convenient for me.” So I directed her to the bus stop. She wished me a good trip, I thanked her profusely, and that was that.

I’ve got to find a way to have her kindness recognized.

A great day as a nursing student

Yesterday afternoon I went to the hospital to pick my patient as I do every Sunday. This entails looking through patients' charts on the unit to which I'm assigned in search of one that would provide a good learning experience. I wanted this one patient I'll call Mr. B, but was told he'd be going to surgery in the morning and would be off the unit for hours. As my instructor would not appreciate me sitting on my ass for those hours, I moved on and picked another patient. I spent the requisite time recording all the patient's medications, abnormal labs, history, course of illness, etc into what we call a client database. It's a way of pulling information together in order to be ready to provide nursing care. Driving home, I was disappointed that I wasn't able to take Mr. B.

This morning I arrived to find that my patient had pulled his IV out of his hand the night before, refusing to allow a new one to be started, and was generally hostile to staff. Hmmm, maybe an opening here. I asked about Mr. B and found out that he hadn't gone down to surgery yet. I approached my instructor about switching patients and she was a little apprehensive in that I hadn't prepped to take care of him. In an effort to convince her, I quickly read through his chart, copied down his meds (most of which I knew), and made a case that Mr. B was a much better learning experience. I think it was probably my ebullience that won her over.

I quickly did a general assessment (listen to heart and lungs, take vitals, assess neuro status, etc.) right before transport came to take Mr. B down to surgery, with me in tow. We arrived in pre-op and the nurse started the pre-op questionnaire. When asked about allergies, Mr. B said he was allergic to some __________ drug he was on. The nurse went to answer the phone and I thought, "But he's not on a __________ med. I wonder if he means __________?" So I asked him and he said, "Yes, that's it." Then I did a little teaching about what that medication was used for and confirmed the reaction he experienced. When the nurse came back, I was able to show her in the chart where his negative reaction had been documented earlier. Whoo-hoo, mental hi-five.

There was still some question as to whether I could observe the actual surgery. The patient couldn't take food and drink orally, so the surgeon would place a tube through his abdomen into his stomach to allow for what's called enteral tube feeding. Then liquid nutrition could be regularly pushed through the tube using a syringe. The operating room circulating nurse came by and said I could observe. I put on a cap and mask and off we went to the operating room. The scrub nurse was already laying out the various clamps, cloths, retractors, needle and thread, etc. that would be needed. The anesthesiologist and nurse anesthetist started an IV and got the meds going. Within three minutes, Mr. B was under. The circulating nurse asked me if I'd like to insert the Foley. Absolutely (not ironic in the least)!

At this point I'd like to say that I've already seen more than a few lame Rep. Mark Foley/Foley catheter jokes, and will not propagate more. OK then.

I'd put in a Foley once before, so I wasn't too nervous. Plus A) the nurse was walking me through it and B) the patient was unconscious. That done, I stepped back so she could finish prepping him. A few minutes later the surgeon arrived and in less than 30 minutes:
- Sliced down the center of Mr. B's abdomen through the skin and subcutaneous fat
- Cauterized the small blood vessels (it doesn't smell bad at all really)
- Made an incision in Mr. B's stomach and introduced the tube
- Made an exit incision in Mr. B's left abdomen and pulled the tube through
- Stitched and stapled Mr. B closed

Totally routine, but tremendously cool.

They woke up Mr. B and then off we went to Recovery. The recovery room was bustling - lots of surgeries today - and the nurses were busy hooking patients up to EKGs and oxygen saturation monitors, recording their vital signs, and administering pain medication. I pointed out to Mr. B's nurse that he had an IV medication that had been sent along with him that needed to be started. She told me to find the doctor's order in the chart (always necessary). I did and she started the IV thanking me for catching it. Mental hi-five again. Mr. B was doing great and so we disconnected him from monitoring and back we went to his room. Later in the day, I got to deliver his crushed medications and liquid nutrition through the tube.

I'm sure five years from now all this will seem mundane, but today it was awesome.

Meat Purveyors R.I.P.

They didn't actually die, but Friday night the Meat Purveyors played their last show in Austin. Sigh. Man they are/were so very entertaining.

The night started with Mybloody and I going to End of an Ear so I could exchange some CDs. A store employee (via a scrawled note on a LP sleeve) dared me, so I bought a Juice Newton Japanese import record for $1. Then posed for a photo holding it with a smile that said either "I've been looking for this rare import version with the airbrushed cover forever and now, at long last, I'm holding it!" or "I'm a total douche who buys shit like this just because store employees dare me to." In my defense, it was $1. And her version of "Angel of the Morning" is pure cheezy goodness.

We left and drove over to Joolie's house to pick her up. She showed us some printing she'd been working on. I need a pack of her "Eat a dick" notecards, as do you. Then we headed to Continental Club for the show.

The Weary Boys were meh and we spent most of their set outside talking and going for a slice of pizza down the block. Then Meat Purveyors started and it was glorious. Mybloody had never seen them do their Madonna trilogy ("Lucky Star", "Burnin' Up", and "Like a Virgin" played at breakneck pace) so he was happy when they opened with it. Later they tore through their wonderful version of Ratt's "Round and Round." It's a testament to Ratt's songwriting and the Meat Purveyor's talent that the song sounds so good with twang vocals and mandolin. In between the band energetically zipped through a swath of their own great, punkish, bluegrass originals with at least a few from every album. I really should have gone to see them more often.

We ended the night happy to have seen them one last time and went home to put up our sore feet (mine were from dancing, not from being old).

My fat scar

Since a couple people commented on it, I guess I should explain. My scar is rather noticeable and so for years whenever someone asked me about it, I told them about it.

When I was in sixth grade, I sat next to a boy who'd already failed twice. He was much bigger than all the other boys and even had that wispy, teen moustache. I did well in school, he did not. Very soon after the school year started, he let me know that he would be cheating off of me and that I was to let him. If I didn't, or squealed to the teacher, I'd get pounded.

I didn't care for this, so I came up with a plan. For the next multiple choice test I would circle the wrong answers. He'd copy me, then I'd subtly change them to the right answers. I'm sure at the time I thought it was brilliant. Of course, I hadn't thought it through to the logical conclusion. We got our tests back; he got a 0, I got a 100. That afternoon he intercepted me as I walked home from school, pulled out a knife, and slashed me across the stomach.

Except none of that really happened. The kid was real, but he never cheated off me. I just loved telling people that story and seeing their eyes get big.

The real story is more complicated.

When I was ten I started having abdominal pains often. One night it was bad enough that my mom took me to the emergency room. An ultrasound revealed that I had a multitude of small gallstones. Gallstones, deposits of cholesterol or calcium in the gall bladder, are usually a problem in older folks. It's uncommon for kids to have a problem with them. I only had one of the common risk factors: female, fat (obesity), fair (Caucasian), forty (middle-aged), fertile (multiple children).

After various doctors conferred, the recommendation was removal of my gall bladder. It's not a secretory organ itself, it just stores bile produced by the liver. So you really don't need it; the liver will just dump bile directly into the duodenum (first section of the small intestine). The idea was that if I had lots of small ones when I was ten, it was going to be a problem sooner rather than later. I wonder if part of it was also that I was to be the youngest person at the time to have a cholecystectomy - a badge for the doctors.

My roommate at the hospital scared me a little. He'd been accidentally shot in the jaw while hunting which shattered it, and so couldn't speak distinctly. He also drooled a lot. I got to like him after a day though. I imagine some of my distaste for guns came from seeing what happened to him.

The surgery itself wasn't an issue, though I wasn't awake at the time. When the anesthesiologist started the meds, he had me count back from ten. I recall getting to sev...

Recovery was annoying because I couldn't walk well or eat much. I hobbled down the hallways clutching the handrails on the wall; it felt like my thighs was sewn to my chest. I'd get full after a cup of broth. I steadily improved and was happy to go home with a stitched incision. A couple days later I was eating a hamburger (often fatty foods after cholecystectomy cause upset, but I never noticed it) when somebody wanted to see my incision. I pulled up my shirt and everyone saw the small purplish bump on the incision. Not so good.

The sequence of events is hazy, but I ended up back at the hospital being examined by a very concerned doctor. It was an infection for sure. The doctor was worried enough that he started working on it right there in the exam room. No time for anesthesia to take effect so I got the topical cold spray. I was swabbed with some sort of antiseptic and then the doctor popped my stitches.

The next part explains why I have a high pain threshold. The doctor inserted his gloved fingers into the incision and starting pulling out what I recall as pockets of pus. I distinctly remember looking down and seeing his fingers inside me to the knuckle. A nurse - the one who wasn't holding me down - was talking into my ear trying to get me to visualize something more pleasant. She was talking me through getting a good hit in a baseball game. I remember being annoyed because, though I played, imagining a baseball game wasn't all that wonderful for me. But then how was she to know that I'd rather have her talk me through Greek mythology or the plot to The Westing Game?

Now, when I assess patients' pain level ("What would you rate your pain on a scale of 0-10 with 0 being no pain and 10 being the worst pain you can imagine?"), I always remember the intensity of my level 10 pain.

I can't remember much after the fingers-in-the-incision part. I didn't pass out, I just don't recall. The next vivid memory is being in a hospital room with an IV full of antibiotics and the incision packed with gauze. There wasn't room on the infectious unit, so I had been given a room on what I used to call the "terminal kids" ward. Several bald cancer kids and two cystic fibrosis kids were on the same unit. It totally weirded me out when one of the cystic fibrosis kids came to my room and gave me his toys "because I won't need them soon." His mom came by later to get them, apologizing profusely.

I stayed in the hospital for quite a while getting antibiotic therapy and wound care. The wound care consisted of taking off the cover dressing, pulling out the gauze packing (with yellow-green goo), pouring in hydrogen peroxide, gritting my teeth as it foamed up and stung mightily, twitching in pain as silver nitrate sticks were applied to cauterize the wound, then repacking. Twice a day for a long time. Even after I got out of the hospital, my mom picked me up from school to perform the wound care. Because of the infection, I couldn't just be sewn back up again.

So 20 years later I still have a thickened scar running across my abdomen on the right side rather than a thin, white line. Presently, the standard procedure is to perform cholecystectomies laparoscopically eliminating the need to open the belly. Patients now end up with three white dots where the camera and instruments are inserted. Damnit. At least I got a good story out of it.

Emesis assessment

Here's the text of the Powerpoint slide we just went over in class. Fun stuff.

Emesis [also known as vomit] -- Look at it!

Assessment
- preceded by nausea, precipitating or relieving factors, frequency, is it sudden, projectile, or persistent

-Note color and volume
Clear or greenish vomitus with undigested food-stomach
Bright yellow- bile or upper intestinal
Dark brown with feculent odor- prolonged bowel obstruction
“Coffee-ground” or BRB (bright red blood) - bleeding

The Pumpkin-ing of Yogurt

I just finished a container Lucerne Limited Edition Pumpkin Pie yogurt. As an avid consumer of pumpkin-flavored items (see very first first blog post), I was excited but wary. Turned out to be kinda gross. Oh well. Guess I'll be heading over to 7-11 sometime this weekend to see if they've got the Pumpkin Spice Latte back.

Update: In a pleasant turn of events, the Lucerne Limited Edition Cranberry Orange yogurt is wonderful.

Stoopid medical humor

Today in Skills lab we learned how to operate IV pumps. The instructor demonstrated at the front of the lab so we could all see, but since there wasn't a bed and a dummy right there she let the end of the IV hang down into the trash can. Immediately I thought/said, "This trashcan is hypovolemic. Hang a bag of saline before it gets shocky." See, this is what has happened to my sense of humor. Sad really.

Later, the instructor was explaining that it was important when learning how to use unfamiliar equipment to read the manufacturer instructions or watch the training video that is usually available. Relying on co-workers can result in a game of telephone where proper procedure is transmuted into bad habits through a steady accretion of errors or shortcuts. I turned to a friend and before I could even open my mouth he got there first, "Make sure the cartridge lever is pushed down. Purple monkey dishwasher."

Oh Simpsons, is there any situation for which you don't have a relevant quote?

Anatomical art

Mybloodyself hosted a craft night on Saturday. I'm not particularly crafty, but I do enjoy making shrinky-dinks. Here's a couple:



I just had a test about heart attacks on Friday (96%, whoo!) so it was fresh in my mind. The black part is dead tissue.




This is a salute to an organ I haven't had for more than a couple decades now. The sister of a school friend of mine had to have her's removed this weekend. She'll have three tiny white dots from the laparoscopic surgery while I have a fat 10 cm scar. Ahh medical progress.

Three bloody patients

Don't worry, there won't be any pictures. Unless you really want to look at bloody things. I saw all these people when I was working in the ER.

Patient #1: Gored by a bull

Brought in by helicopter from out in the country, this guy had a scalp laceration and a punctured cheek. He wasn't even in a rodeo, just going about the work of raising cattle.


Patient #2: Open leg laceration

Poor guy was helping a friend with some roof work when a piece of metal sheeting gashed his calf almost down to the bone. You could plainly see the different layers of skin and muscle, fascinating really. Luckily for him, compensating mechanisms had kicked in and he wasn't in any pain. He said it just itched.


Patient #3: Mulitple shallow razor cuts to the face, self-inflicted

I knew what she'd done when I took the paperwork in for her to sign, but I had to make an effort to make eye-contact and stay composed while looking at her face streaked with dried blood. Even though this was the least serious physically, it was the worse of the three. The other two were accidents, this was intentional and indicative of some profound problems. I can't imagine what it will be like to live with fine white scars all over your forehead and cheeks. I hope she got the help she needed. Since then I've seen more than a few girls who cut and the scars on their arms and thighs depress me terribly.

Dang. Didn't mean this to end this under a dark cloud.

On the comedy of trauma, death, and burns

One of my instructors this semester has a great, morbid sense of humor. I often bust out laughing at some of the odd things she says. For instance, “People coming in to the ER are scared because it’s probably the first time that they’ve felt like they were dying. And they’re right, it might happen.” It’s funny to me at least.

Another time she was talking about people who drive themselves or a family member to the hospital instead of calling 911. “I can’t tell you how many people have died of a heart attack at corner of 38th & Lamar [one block away from Seton Main Hospital].” All I could think was, “The corner of 38th & Lamar is haunted! Restless souls at Subway and Relax the Back store!”

During a lecture on shock, our instructor had just said “If that happens, call the rapid response team,” when the phone in the classroom started ringing. She pulled off a great double-take. It was unexpected, perfectly timed, and therefore really funny. It does beg the question of why we have a phone in the classroom. Incoming calls are always wrong numbers.

Just last week she was lecturing about how percentage of burns are estimated and she said that genital burns count for 9%. The class quickly pointed out that her slide said 1%. “I was just trying to wake y’all up. Y'all don’t have a sense of humor.” Cause genital burns are hilarious. In fact, I’m going to show up at open mic night at Velveeta Room and do five minutes on genital burns. It’ll kill.

More odd comedy as it occurs.

"Yay! I like to like stuff I don't like."

- Joolie, after I told her I'd loan her my Sports Night DVDs so she could enjoy a TV show about coworkers putting on a ESPN-like sports news show.

A long Saturday

I worked a 13-hour shift today. Scheduled for 8, but they needed someone to do a transport to a medical hospital for imaging so I volunteered. Transporting is easy money. I accompany the patient to the hospital, sit in the waiting room while they do their thing, and accompany them back to the psych facility. Patients who are cleared to leave the facility are always easy-going, so it's usually a calm trip. We mostly chit-chat about the weather or what the procedure will be/was like, stuff like that.

Afterwards, I went to a friend's place and we watched The Wire on DVD. Didn't get any schoolwork done like I had planned, but I made some money and had a nice evening.

R.I.P. Don Walser

I don't remember when I first heard Don Walser, probably when I was at DJing at KVRX while getting my first degree. I do remember the shiver I felt when I heard his incredibly beautiful yodel. At KVRX there are requirements that DJs exhibit some genre diversity and a Texas component. I played Don Walser's "Cowpoke" regularly partly because he met two requirements at once, but mostly because the power and clarity of the yodeling gave me goosebumps.

I saw him a half-dozen times in the mid-'90s. He was great live with a tight backing band. My favorite time was when he played with Kronos Quartet at Bass Concert Hall. The Quartet was a fan of his and put togther some string arrangements for two of his songs. That arrangement of "Rose Marie" was then recorded for his next album. When they finished playing at Bass, there was a long standing ovation. Knowing they had to give an encore but having prepared nothing else, Walser et al. just played the two songs again. It was wonderful.

Walser stopped performing some time ago due to his declining health. I'm sad to say that I forgot about him until I heard the news of his death yesterday. I pulled out Rolling Stone from Texas and "Cowpoke" thrilled me all over again.

Cowpoke (from the album Rolling Stone from Texas)
Rose Marie (from the album Down at the Sky-Vue Drive-In)

Austin City Limits Festival 2006

I've been late in posting because I was sick during and right after ACL. Note to self: if you don't sleep enough, you always get sick. Right. Moving on.

I skipped Friday in an attempt to generic Nyquil myself to sleep and therefore wellness. I slept about 17 hours on and off from Friday afternoon to Saturday afternoon. It kinda of worked. No more fever, but still with the chest congestion and general malaise. Wait, wasn't I going to move on from the sick talk?

SATURDAY

I Love You But I’ve Chosen Darkness
I like you but you are less-than-compelling today and as a local band I can see you within the next month and there's a big crowd over by the Heineken stage so I've chosen Ghostland Observatory.

Ghostland Observatory

Local band that I have been extrememly remiss in not seeing. Wow. A guy twiddling knobs and playing keyboards (in a floor-length cape mind you), while another guy cavorts about singing in a brash falsetto. Sure, I like that kind of thing, but these guys were pulling people in from all over the place. I'll chalk it up to things sorely lacking from some ACL acts (I'm looking at you Iron & Wine), to whit energy and charisma. Keyboard guy just stood there, but managed to still get across a sense of competence and "Whee! This is fun!". I'm sure the cape helped. Singer dude was a firecracker. Dancin' and singin' and jumpin' and worked it like nobody else I saw all weekend. Bravo Ghostland Observatory, I'll see you again as soon as possible.

The Secret Machines
Meh.

TV on the Radio
Bad sound mix and I wanted to see The Shins more so...

The Shins

Generally good. Since touring after their first record, The Shins have become a more muscular, tight band. Unfortunately, they've also smoothed out some of the odd angles that made me love them. Sure Marty (keyboards/guitar) is still hilarious and the songs are punchier, but my brain doesn't melt with joy over them anymore. Maybe's it's my problem. Hard to say. Still, good show, looking forward to their new album out in January. Oh, they asked people to video record them on cameras and cell phones during one song for a video they were making. 1st problem: most people don't have enough room on their devices for an almost four minute song. 2nd problem: the upload site sucked and couldn't handle my large file.

Calexico
Reliably great, but I was less enthused than during previous shows. Maybe being sick? No, I took that into account when evaluating performances. Well, when you seen a band like 12 times in five years every show can't be fantastic. Surprisingly, they didn't play anything from the EP they did in collaboration with Iron & Wine.

The Raconteurs
Just heard them from across the way. Unremarkable. "Steady As She Goes" was great, but nothing else made an impression as I read about various anemias (yes I studied during the festival, nursing school doesn't stop for culture breaks).

Iron & Wine

Snore. Wanted to like it, but couldn't.

Explosions in the Sky
So great to lie back on the grass as darkness descended and have this band take me away. Lovely. I really should go see them more often.

Massive Attack

Daddy G (original member) was off with his wife and brand-new baby so it was up to 3D (original member), the vocalists, and the backing brand to bring it. And they did. And it was so very good. Despite being a band based in DJing and samples, the live version went far above standing on stage and pushing a button every now and then while the light show does all the work. Granted, the light show was fantastic, but the band (two drummers!) was bombastic and coiled and sinuous and noisy. Seriously y'all, I was in heaven even though I think my fever had returned. While it was great that long-time vocalist Horace Andy was there, it blew my mind that Elizabeth Fraser (ex-Cocteau Twins) was there to sing as well. "Teardrop" was gorgeous. Never thought I'd ever hear her do that song live. Anyway, best band of the festival by far.

SUNDAY

José González

I don't think an outdoor festival is the best venue for José. The crowd was respectful, but a solo acoustic guitar-playing singer just doesn't work in the middle of a humid day with thousands of people milling around or rocking out to other, louder bands not too far away. Not nearly as good as when I saw him at SXSW 2006, but still decent. Did an interesting cover of Massive Attack's "Teardrop". Did not do his cover of Bronski Beat's "Smalltown Boy", maybe when he comes back later then Fall. Why do I like this acoustic-guitar singer/songwriter when so many others bore me? To (mis)quote comedian Zak Galifianakis, "The way you play music makes me feel good inside."

Ween
Practically a parody of themselves now. Have gone over to the dark side, by which I mean that they've become a jam band. Wanky guitar work all over the place. I walked up when they'd started "Spinal Meningitis" (yay!) and walked away at minute two of the wank solo (boo).

White Ghost Shivers

They were probably a new band for a lot of the crowd, hence the almost immediate aggregation of more and more audience and the big smiles. They are very good at showmanship. Look at the outfits and the instruments, you know where there at musically. Naughtier than you might expect though.

New Pornographers

Reliably great. Why isn't this band huge? Big hooks, great singing, what else do you need? I guess Neko isn't dressed sluttily enough. Snerk. I was bouncing around throughout. "Laws Have Changed" makes my endorphins skyrocket. Also, Neko is funny.
Soon after taking the stage, “I can’t peform in these freezing conditions. Stage manager, fetch me my parka.” Later she acknowledged Ween playing across the way and quoted some song that expressed the sentiment "I'd give a blowjob for a joint," which she quickly followed with, “Not really. Well, you’d have to catch me in the right mood.” Hee.

Flaming Lips

Packed audience, they really should have been a headliner. Their theatrics still worked in the daylight though. Streamers everywhere, confetti blowers, dancing girl aliens, dancing Santas (girls & boys), superheroes (or if you prefer, underwear perverts), Wayne in a giant hamster ball rolling around on top of the crowd; it was a show. They really have their visuals honed, I wish they’d play more songs though. As much as the crowd really enjoyed it, I can't help but do that annoying "you should have seen them back in the day." They still play "She Don't Use Jelly," but I miss "Halloween", "You Can’t Stop the Spring", "Bad Day". I tell you, it was incredible to see them in 1994 wrapped in Christmas lights at Liberty Lunch. Still, it's great that they're popular now and so many more people know and love them.

BoDeans
I generally like the BoDeans, but I'm in love with "Fadeaway". It's definitely a loop song for me, I'll listen to it for 20 minutes at a time. While waiting for Tom Petty, I wandered over figuring they'd play it at some point. They did and I got all gooey with joy. Sure it was waaay too long with multiple solos, but I love it so. After some song, they broke into The Ramones' "I Wanna Be Sedated". Nice.

Tom Petty & the Heartbreakers
Knowing that I had to be up for clinical at 5:45 the next morning, I told myself I could only stay for three songs of Tom Petty. I walked out the gate while the third dong was fading away. Good thing too, because it started to rain just before I got on the shuttle bus. Apparently the band stopped playing after the fourth song.

Generally a good year. Not as good as last year or The Pixies year or the REM year, but Massive Attack bumped it up for me.

Ann Richards didn't like me

Like some other people I know, I voted for Ann Richards in 1994. She was so very entertaining. Yay Ann! Sadly, Dubya defeated her. Boo Dubya. Then she went to work for a lobbying firm and while she herself did not lobby for tobacco companies, the firm did. Boo Ann.

I had two run-ins with Ann Richards. The first was in 1999 when I lived near Clarksville. I was walking down West Lynn when I saw her getting out of her car in front of the dry cleaners. For seemingly no good reason, she looked at me disapprovingly. I'm quite certain my hair was my normal color. OK then.

The second time was in the summer of 2001 when I was petitioning outside of Bookpeople for a campaign finance reform measure. Knowing that she was not a supporter, I approached her anyway,
"M'am, can I get you to sign to support campaign finance reform in Austin?"
She stared daggers at me and said, "You cannot. It's a terrible idea."
She marched past me and into the store. Whoo-hoo, Ann Richards chastised me.

So that's my Ann Richards stories. Oh, also just a few months ago I saw Anna Deavere Smith workshopping a new theatre piece about the body and illness in which Smith performed as Ann Richards in addition to many other real people as she's done before. It was great, Smith really captured the voice and presence of our former Governor. See it if it comes back around.

Rectum, reptile, whatever

Tonight I was reminded of a patient that was seen in the ER last summer when I worked there. A quick check of the blog confirmed that I inexplicably hadn't shared this story yet. I heard it second-hand, but I believe it to be accurate.

A frequent flyer (patient that comes in often) strode up to the triage desk and when he wasn't tended to immediately begain knocking on the desk,
"Uh excuse me, excuse me, I need to be seen."
"What brings you in today?" asked the triage nurse.

The patient matter-of-factly stated that his ass was bleeding, probably due to anal sex (I guess he wasn't doing it right). The triage nurse misheard him, but being an ER triage nurse who's seen it all, nonchalantly asked,
"What kind of animal?"
"Animal?!" the patient exclaimed.
"Didn't you say animal sex?"
"Uh-uh. A-NAL sex. Janeesha does not do animals."

When the patients start assessing the staff

Sometimes patients who have prior experience with hospitalization turn it around on staff. After answering several questions from a nurse, once a psychotic woman started asking questions herself like, "What month is it? What year is it?" These are orientation questions to assess mental status. The questions cover orientation to person, place, time, and situation. So staff would ask a patient, "Can you tell me your name? Can you tell me where you are? What's the date (or break it down if the patient knows the year and season, but not the month or day)? Can you tell me why you're here?" Sometimes staff throw in a "Can you tell me who the President is," but these days that might instigate a round of name-calling (can you blame them?).

The psychotic patient continued questioning the nurse, "Do you hear voices?"
"Yes," responded the nurse.
"Who's?"
"Your's, right now."
Patient, slyly, "Hmm, you're a smart one."

Unexpected poetry

"Simple nails, simple tales" - patient

I took care of a patient recently that was psychotic with thought disorder. Psychotic in general use conjures images of a maniac killer. Actual psychosis is severely impaired thought processes and/or perception. It may manifest as hallucinations, delusions (fixed false belief, "There's a microchip in my brain"), paranoia, thought disorders, and/or lack of insight (unaware that thoughts and behavior are bizarre).

This young woman had profound thought disorder. April* spoke constantly, quickly ("pressure of speech" and yes I know this describes me as well), and without coherence. The syntax of her speech was correct, there was just no meaning. It was just a stream of phrases with constant rhyming. I've been told that rhyming is unusual. Regardless, it's remarkable to witness. It would be unethical to record patients but I wish you could have heard her when she was really going. Further, she would incorporate words she heard around her into her utterances. Fascinating, and awfully sad. It's like she had something terribly important to tell you, but couldn't pull it together.

“Suddenly, suddenly this sickness”

In the midst of a stream of nonsense, April said that phrase. It stuck out. Was this a coherent statement? An awareness of what was occuring? Or is that just me imposing order on a virtual white noise of words? I suspect the latter and hope against the former. It would be kinder if she was consciously unaware of what was going on with her and wouldn't have memories of it, particularly given one facet of her behavior.

“Come here so I can taste it. I promise I won’t waste it.”

The staff joked that April had a crush on me. That's putting it lightly. She was very sexually inappropriate, mostly with me. I quickly became very good at flinching away from her grabs at my crotch and eschewing her offers of sexual favors. Sometimes she'd just lean against the wall or straddle a chair, stick out her butt, and somewhat wearily suggest we get started. It wasn't embarrassing for me - she's clearly out of it and I strive to be professional - but it was a tad frustrating.

During shift change when I was giving report to a staffperson coming on, April tried to sit on a table. I gently dissuaded her, "Let's not sit on the table. It's not stable." My co-worker and I shared a rueful laugh, apparently April was a powerful influence.

I think about April's stream of words often. Is it at all connected to the bursts of inspiration that artists experience when they write a great song in 10 minutes? The way freestyle rappers flow? How can we "unhinge" ourselves temporarily while maintaining self-awareness?

* Fake name. As always, I often change details of patients' sex, age, etc. to protect their identity.

Blood Sugar Death Magic

As a nursing student, I like to think I bring a little more to the table while I'm working as a clinical assistant at the psych facility. For instance, I'm constantly trying to educate patients on good food choices. When it comes to the diabetic patients, I'm quite stern. "No, you cannot have ice cream. You have diabetes. Let's think of something that will be a more appropriate snack for you."

I do this work only to see it disastrously undone by patient's families. A patient will have already eaten their facility-provided meal which is physician order for an 1800 or 2100 calorie per day diet, and then patients' families come in for visiting hours with pizza and non-diet soft drinks or big bags of Taco Bell. A meal like that can easily top their ordered calorie intake for an entire day. It's not true in every case, but I've seen it plenty of times and it mystifies me. It's not like the patient was just diagnosed with diabetes. Diagnosing doctors and nurses usually do a comprehensive job of educating patients and their families on food intake, blood glucose monitoring, etc.

"Are you trying to kill your [loved one]?" I'm tempted to say, "Why not just roll a stick of butter in sugar and batter, freeze it, then deep fry it?" Usually I just pull them aside and point out that we're trying to encourage good eating habits and that while food often plays a part in comfort and they of course want to help their loved one feel better, an entire medium pizza or eight tacos will make them feel worse in the long run.

I'm generally not a fan of scare tactics, but sometimes I just want to hand them a photo of diabetic foot ulcers.