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.