The Ugly Years and a Bowl of Soup

Wednesday I perused Allrecipes.com for some new recipes.  We are having trouble getting to eat at home, as some child decided to play school ball, and they have close to 50 games in a 7 week period.  Our dining budget is blown, I've learned that if you skip the "A" game, knowing your child is not playing before the "B" game, you can get in free, and poor Bookworm has probably eaten more Taco Mayo and Sonic in the last five weeks than her whole life combined.

The coaches have them walk the half mile to these two establishments after checking in at the locker rooms.  And just when did my child get old enough to walk with her friends to these places and buy herself some food?

Probably about the time she started looking like this:

She's on the right.  And she has makeup on.  And I think she's really pretty, in a completely unbiased sort of way.  Dang it.

Not "dang it" because she's pretty.  But "dang it" she's in 7th grade, and that is just down right annoying and somehow impossible, but obviously totally possible, considering this is her back to school picture for this year.  And yes, that's 7th grade.  

Raise your hand if 7th grade was your "ugliest year ever."

Pfpfpfpf

Anyway, I found several recipes to try, but this one is a real keeper.  I put all of the ingredients in the crock pot this morning at about 6:30 and Brent simply added the cream cheese about 5:30 and then served it up to the kids about 6pm.  You see, Bookworm had a friend come home from school with her to get ready for the dance.  They were here by 3:30 and were still not ready when I got home at 6:20.  Popcorn was in charge of hair.  However, the waver took so much time with Bookworm, that Grace's friend decided to forgo any wild new styles and went with her simple normal 'do.

Anyway, OF COURSE I was cleaning up the kitchen before I realized I should photograph this recipe and blog it.

Because I've been so short of blog material lately...Well, more lacking any real desire to sit down and look at the computer, much less write a blog.

I thought about putting it in a pretty bowl and sprinkling some shredded cheese on it, and perhaps a dollop of sour cream. Then I got bored and impatient just thinking about it, so I shrugged and decided to just snap a picture of it in the Tupperware bowl , and call it good.  And while my photography skills leave something to be desired, this dish will in no way disappoint.  In fact, Bookworm's friend cleaned her bowl (other than a few tomato chunks) and her parents keep claiming she's a finicky eater...

Spicy Latin Chicken Soup

6 boneless, skinless chicken breasts (I actually used 3, because mine were so huge)
3 cans diced tomatoes (I actually used 1 can diced, 1 can Mexican style, and 1 can of tomatoes with chipotle peppers)
16oz jar salsa verde
1 can pinto beans rinsed and drained
1 can black beans rinsed and drained
frozen corn (it called for one can, but I used probably 2 cups frozen)
2 tsp chili powder
1 packet taco seasoning
1 tsp cumin
cilantro, if desired (and believe me, I don't) 
1/2 c of cream cheese


Place chicken (whole, they will fall apart when you go to scoop it out) in bottom of crock pot.  Add remaining ingredients, except cream cheese and stir.  Cook on low 8-10 hours, or until chicken is very tender.  About 15 minutes before dinner time, soften cream cheese, scoop out a bit of liquid from your soup and then stir in to cream cheese to create a creamy mixture, then pour this into your soup.

Top with shredded cheese, sour cream and tortilla chips as desired.

This soup was a huge hit, and my family was quite pleased to have a real home cooked meal, and not something that was thrown together in 5 minutes or less.  Give it a try and let me know what you think!

A Day's Wages: A Cowgirl's Story: Part 2

As you recall from yesterday's post, life with a certain employer was always exciting. 

Maddening.  But exciting nonetheless.

The weekend following the saga of the crazed cows, my sometimes employer informed me we were to attempt to gather them again. 

I refused.

He promised to have his son and another hired hand on horseback with us.  He also said he had a new plan that involved driving the cattle down the road.  I guess to his house.  I don't recall exactly where we ended up.  I just remember the process of getting there...

Dad convinced me to help out.  And Granddad promised to be there.  I agreed.  And when I say "agreed" you should read that while Dad "asked" he was really "telling"  and refusal was never a real option.

So it's Saturday again.  I had the horses in the corral unsaddled until my employer showed up, miracle of miracles, by noon (7AM was the planned start time) with two horses saddled in the trailer.  It turned up that his son was to be on Star, his hand was on Smokey, and he was to ride one of our mounts.  I quickly spoke up that Blue was mine.  And I saddled him with my saddle before you could say "boo."

We unloaded at the pasture, and Granddad met up with us.  I've always wondered how Granddad happened to be there no matter what time we started.  I guess he was called from the house.  Heck I don't know, as we did not have CB radios or cell phones...

The cattle predictably bolted to the far southwest corner.   Our plan was to drive them through a gate on the North side.  I was feeling pretty confident in our game plan as we now had four horses, and you can do darn near anything with three horses, so four is a bonus!  Well, as we were burning daylight it was suggested that we trot until we got closer to the cattle.

Did I mention Smokey was old?  It took lots of energy just to get him to trot.  And his rider probably weighed over 300 pounds.  Poor Smokey.  He also had a tendency to let out unfortunate bursts of air from his backside as he trotted along...

My employer's son was on Star.  I had experienced gathering cattle with him when we were younger.  It involved him being on Smokey and crying.  Because he was cold.  He ended up going back to the trailer and reloading his horse and riding in the pickup.  The big baby.  I was hoping I wouldn't have to see any tears that day. However, as I felt the sweat run down between my shoulder blades I was relatively certain that his seventeen year old self wasn't going to cry because he was cold.

We drove the cattle up the fence and to the gate they were supposed to exit.  The gate is one I didn't even know existed.  And neither did the cattle.  In fact, the gate had been opened, but it was overgrown with some sort of tall weeds or something.  I can't remember what it was.  I do remember that the weeds/feed/whatever was taller than my horse's head.  And Blue was not happy about riding through it.  He stomped and snorted and hopped around and resisted and did NOT want to go in.  So it definitely wasn't corn.  We had some cattle get in our neighbors corn and like to never got them out because all my horse wanted to do was eat.  Dang horse.

Anyway, the gate was overgrown.  You could not even see a gate there.  Nobody had bothered to stomp down or drive through the trash grown up around it so we could go through the gate. 

The cattle bolted fifty different directions.

My employer proceeded to yell at me.  His son was utterly incompetent and seemed incapable of moving out of a light canter.  Poor Smokey was too overburdened to move out of a jolting trot...

We started all over, gathering up small bunches of cattle that had bolted then grouped up...Granddad had driven through the gate a few times so it appeared that there was an actual place to go.

After much swearing and yelling on the part of my employer and much ineptitude on the part of the "help" provided that day, we finally got the cattle through the gate and headed north up the road.  Granddad took his pickup and went the opposite way to hurry around the section and make sure the cattle did not go the wrong direction at the various road intersections..

I guess we drove them to my employer's corrals.  I don't remember sorting cattle.  Although I'm quite certain I did help.  Gathering cattle to just dump in a corral would be pointless.  Perhaps we just herded them in then let them cool off for a day before sorting was done.  I don't know.

I do remember that when we went home, Granddad followed in his pickup.  And I also remember that my employer said, "Hey!  I need to pay you for all of your help."  I wearily walked up to him, relieved to finally get some monetary reward for my suffering...

He reached in behind the seat of his pickup, then dug around a bit in the console...

And he finally turned around and handed me a ball cap and a pen.  The ball cap was a "ladies" cap.  The kind that has a really short bill and a pompom on top.  They both proudly read "Jones Trucking Company."

I wanted to throw the pen and cap at him.  But I merely took them and turned to walk away.  Granddad had witnessed the exchange and called me over to him.  "Did he pay you last week?" 

"No."  That was all I said.  I don't deny that I have a smart mouth, and that I did even then.  However, there were certain people I did NOT smart off too.  And Granddad was at the very top of that list. 

He quietly reached in his wallet and handed me some cash.  "You don't have to do that,"  I said even as I took the cash from his hand.

He simply lifted his straw fedora hat with his left hand, ran his hand over his nearly bald head with his right, then took a drag on his cigarette which was always firmly held between the first two fingers of that right hand.  He gave me his Granddad smile and told me to take it.

So I did.  I stuffed the money in my pocket, gave him a big hug and a smack on the lips   then went to unsaddle the horses. 

(I miss the smell of Granddad.  His kisses always smelled like Marlboro Light 100s and Original Chapstick.  I still remember him every time I crack open a tube of Chapstick.  Sometimes he had cherry, but I always liked it best when he used the Original.  It still comes in the black tube I can always remember him fishing out of his pocket to apply between drags on his cigarettes.)

And I did not so much as say goodbye to my employer, his son, or his hired hand that day.  I merely walked to the house with my cash in my pocket, and the stupid pen and hat in my hand.

"How did it go?"  Mom asked when she heard me come stomping through the back door.  I showed her what my "days wages" were according to my uncle. 

I think she actually started laughing.  And then I did too.  Dad got an even bigger laugh out of it...

Because you see, Gentle Reader, Jones Trucking was my DAD'S trucking company.  And it had not even existed for at least ten years by the time my employer was "paying" me with the promotional items!

I guess that maybe says something about the quality of work I was doing.

My employer had deemed my two days of sweat and near tears worth a ball cap and pen that my dad gave out as promotional items for his trucking company.

Some people are just utterly clueless...

Guess what?  That's not the end!  No sirrree bob!  I have yet at LEAST one more tale to tell...

But I think that my final tale is the very last time I worked for that employer.  At least it's my last memory of it...

Maybe I've blocked the rest out for sanity's sake.

Stay tuned!

A Day's Wages: A Cowgirl's Story

I should probably change my background.  But who's ready to let go of Christmas?

I need to shower and run to the store.  Sadly, I only found three good coupon deals for me this week, and that is not worth the trip.  However, Popcorn has once again shared all of her pencils to never be returned, and Studmuffin asked me to buy him some new socks.

So to the store I will go.

However, as my mom was telling me about cleaning out some junk I was reminded of a situation I faced as a teenager.  And I realized it was a blog that I MUST write.  So, instead of showering, or doing housework, I brewed another cup of coffee and here I sit to write...

I will not disclose who my employer was at this particular time, as I hate to disparage his name.  However, those who know me will know who this is and they will chuckle and shake their head.

So, here's the background:  In my teenage years I was "forced" by my dad to help a certain gentleman with his cattle.  Whether it be gathering cattle, working cattle, whatever.  If he needed help and called to ask for me, I was  pretty much required to say "yes."  I would like to share a sampling of why I did not LIKE to help him.

Example One:

"Andi, we will need to get these cattle gathered on Saturday.  I will be by at 7:00 to pick you up.  Have your horse saddled and ready to go."

At 9am he would finally show.  Only, his horse trailer was empty.  "Where's your horse?"

"Oh, I haven't caught him yet.  I need you to help me."

In all honesty, I found the less I tried to truly communicate with this individual, or understand his thought process, the better things went.  So, I simply loaded my now irritable horse who has been saddled and tied to the corral for two hours, and climbed in the pickup.

We pulled up to his corrals and there is no horse in the corral.  "Well, they won't come in.  I need you to bring them in."  I was dismayed to realize he meant he wanted me to herd his HORSES  in on my horse.  I had never done such a thing in my life!  We always went to the end of the lane where our corrals go to the pasture, shook a feed bucket and yelled, "HEY HORSES!"  And the horses would come running...

So, I tightened my cinch (it's not nice to have the cinch tight until just before you ride.  Especially if you have no idea when your "employer" will be by to pick you up for the day's work) and climbed on Appy.  I am not sure why I was riding Appy that day, but I do remember it was him.  I usually preferred Blue.  Anyway, I climb on Appy and trotted out to the pasture where I see the horses.  I slowed down as I approached and made a kissing sound with my lips and called softly to them.  Imagine my surprise when a horse who I'd never met, but later learned was named "Bugsy" suddenly laid his ears back, and charged my horse full speed ahead, teeth bared!  I don't know if I reined Appy out of the way or if he dodged out of sheer instinct.  I do remember that in the midst of our dodge that a pair of hooves came flying at my head.  And Bugsy ran away.

You will be impressed to know that I did not immediately concede defeat.  Instead, I focused on Star and my employers ancient horse Smokey, the horses that I knew and tried to herd them to the corrals.  Star had no interest in going where I was directing, and he led me on a merry chase over the river and through the woods...Well, except there was no river or woods, simply a pasture with junk in it.  Smokey merely looked at me as if I were crazy and resumed grazing.

As I was unsuccessfully herding Star and cursing under my breath at the idiocy of some people who don't feed their horses in the corral so they'll learn to come, and the sheer stupidity of myself for agreeing, yet again, to help this person I heard a thundering sound.

Only it was a sunny day.

And it was not thunder.  It was Bugsy.  Coming at me full speed ahead.  Again.  At the sight of that big red horse with the white blaze down his face with ears back, teeth bared, Appy started throwing his head and snorting and stomping.  And facing him.

I was not happy with this reaction.

So I gave Appy a good kick in the sides and a firm click in my cheek and we headed to the corrals.

With Bugsy hot on our heels...or hooves as it were.  He and Star both ran behind me all the way to the corrals where my enterprising employer stood at the gate and promptly shut it behind all of us.  I can still remember that shaky feeling in my chest as I cut into a smaller corral and tried to swing the gate behind me, but of COURSE the gates didn't swing easily and that stupid Bugsy was pitching and kicking the entire time like a crazed thing.  I jumped down and yelled at him to get away as I shut the gate, then took Appy OUTSIDE of the corral to be tied up.

Then I fear I may have voiced some displeasure to my employer over the mental stability of his mounts.

"Yeah, well Bugsy has been a little crazy every since he got mauled by those dogs in town."

Lovely.

Well, I don't remember the details of how he caught and saddled Star with the loony Bugsy in the corral with him, but I do remember it was nearly dinner time (which is noon on the farm) when we were unloading to gather cattle.

FYI:  We were gathering cattle so he could pull the calves that were ready to wean off their mamas.

It was hot.  I was irritable.  And hungry.  Never a good combination.

We unloaded our mounts at the pasture.  The plan was to gather the cattle into a corral in the pasture, then my employer would haul them out by stock trailer.  Sounded like a good plan.  It would have been an even BETTER plan if a feed wagon would have been there to help things along.  Instead we had the two of us and my Grandad who was probably there to keep the peace.  (Grandad was ALWAYS in a pickup.  I know he COULD ride a horse.  He just chose to drive a pickup like a maniac through the pastures herding cattle much the same as I did on a horse.  Only scarier.)

I realize not all of my readers are country folk.  So please allow me to explain how this scenario would have played out if Dad were in charge.  He would have been planning to bring in the cows to sort off calves.  Even though it was summer with plenty of food to eat, he would have been feeding them a smackeral or two of  feed daily with the feed pickup so that they would come to him.  The system is to pull into the pasture honking the horn on your feed wagon, which is an old beat up pickup with the regular bed removed an replaced with a flat bed where you put a bin of feed and a hay fork on back for winter time.  The feed bin has a chute that you lower down and a lever inside the pickup that you flip and drive forward as the "cake" pours out so you can scatter it.  (Before we had a caker, Dad would stand on the back of the pickup with bags of feed while one of us kids would "drive" as he poured it out.  He did the same thing when we still used small square bales.  He stood on top of the stack of bales and scattered out the bale to the cattle while he trusted his offspring who's feet may or may not reach the pedals to drive him.  Did I ever tell you Dad is brave?  Or crazy?)

Sorry, I veered there for a minute.  Back to topic:  Dad would have been feeding the cattle even if it wasn't necessary in anticipation of gathering them.  He also would have instructed his hired hand (that would be me) to ride through them several times early in the morning so they would be used to the sight of a horse and not go berserk.

Well, my employer of that day had done none of that.  He simply planned for the two of us to show up on our horses, herd the cattle to a gate they'd probably never gone through, into a  corral they'd never been fed in, and all of this was to be done starting hours later than it should have.

Well, I'm sure you can imagine all did not go as we would have liked.  The cattle bolted at the sight of the horse.  Once they all reached the far corner of the pasture, we decided to drive them along the fence to the corral.  My employer at drag, me along side as the wing, and Grandad there for moral support. 

And to scare the dickens out of me.

You see, drag is an easy job.  You simply stay behind the cattle and keep them moving forward, which if they're scared of your horse is pretty easy.  The job on the wing is to make sure any cattle who might like to deviate from the course chosen are quickly stopped and herded back with the others....

The problem was that when one would try to break off, I'd have at least one other trying to break free at the same time.  So I would try to head off one, and Granddad would chase the other, full speed ahead, and make me nervous as a cat that I was going to collide with him in our highly disorganized state of chaos.

Not to mention Appy had an unfortunate habit of deciding to pitch in the middle of pursuing cattle at least one time every time.  It was maddening, as he would kick up his back hooves in the middle of chasing a calf and it would just tick you off...He also liked to jump over things instead of go AROUND them.  I hated that tendency.  Especially considering he may not jump the next bit of sage brush, but instead cut sharply around it, making it difficult to maintain a dignified seat if one weren't on guard.  Again, I have no idea why I'd chosen to take Appy that particular day.  I'm getting annoyed with him just thinking about it.

After what seemed like hours we finally got some but certainly nowhere near all of the cattle in the corral.  But not until Granddad had a blowout on his pickup from running over a piece of junk in the pasture in mad pursuit of a cow...

My employer began to yell from his position atop Star "Close the gate!  Close the gate!"  I quickly dismounted and went to grab the panel that was the "gate" and drag it closed.  I say drag, not swing because on old corrals that are found in pastures, the gate is seldom still on a hinge.  Instead it is held up by baling wire and it drags in the dirt all the way closed.  One must physically lift the panel (an old wooden one in this case) and carry it closed.  I was closing the gate and the cattle are running circles in the pen as I'm dragging and shooing at them each time one darts toward me to escape.  Just as I was trying to wire the gate shut with the ever helpful baling wire hanging on another panel, a large charolais cow came charging at me.  I waved my arms and yelled at her to "Get outta here!"

She completely disregarded my gesture of dominance.  Instead she chose to smash into the gate, knocking it completely down and all of the cattle went running out as my employer, finally dismounted and now tying his mount up begins to yell "Stop them!  Stop them!"   Only there were many, MANY more adjectives that were thrown in that are not suitable for blogging...

I didn't get a single one stopped.   And somehow it was all my fault.  By now it was blistering hot.  The cattle were hot and mad.  Appy was staring at me with ears pricked forward as if I should be better than this.  My employer was yelling.  I was mad and trying not to cry.  Granddad was yelling at him because he was yelling at me, and it was just a lovely day.

Lovely.

When all was said and done, we loaded our horses BACK in the trailer because Granddad insisted we were not going to accomplish anything good that day and we went home.  I was not at all secretly relieved.  I think my relief was quite apparent to anyone who had an ounce of observation skills.

And he failed to pay me...

I was madder than an old wet hen... But I didn't say anything.  I just took my horse to the corral and unsaddled him...

You would think that would be the end, wouldn't you?  It's not.  I have more to tell you.  But that will be tomorrow's post.

Putting A Face To It

Today I received an order from one of our kidney doctors to remove a dialysis catheter from one of his patients.  "I don't know why Southwest left this line in when they discharged him a few days ago.  It needs to come out."  The line is one we consider temporary, and not safe to be left in outside of the hospital as it is only held in by a stitch, and if it comes out the patient could bleed to death if proper pressure is not applied.

Just another day in the world of health care...

 I had the patient come to our department after his dialysis treatment.  I noted that he was Mexican.  I asked if he spoke English and he said "Yes."  I asked what his plans were for dialysis if I removed his access.  He simply shrugged.  After a brief interview I realized that he was not sure if he still needed dialysis, and if he did, he was not sure how he was going to receive it. 

"Are you supposed to go home today?"

He said yes he was, but still didn't have an answer how he was supposed to get treatment.  I pulled up his chart on the computer and looked up the note from his doctor.

I was startled at what I found, but I could understand the reasoning behind it...

I had just never found myself in the position of explaining such things to a patient.  After a moment's thought, I read the following doctor's note aloud to the patient:

Patient is an undocumented worker from Mexico.  I instructed patient that he needs to return to Mexico where he can get health care, and continue treatment for his renal failure.  I also told patient that if he develops shortness of breath, he needs to return to the nearest hospital where he will be treated for his renal failure.

The patient became very reserved and stoic after I read the note aloud to him.  I asked if he understood what the doctor was saying.

He shrugged and avoided eye contact with me.  I wondered what he was thinking.  I wondered what he thought I was thinking.  Did he think I felt he didn't deserve health care because he does not have the proper paper work?  My reality is that even if he didn't have paper work, as a laborer, odds are he wouldn't have insurance.  Of course, our state Medicaid system would step in if he were a legal citizen.  Instead, this man has a serious, terminal if not treated illness, and no means to get it paid for. I quietly stood beside him and thought about his situation and the consequences.  I wondered if he was able to fully grasp what was going to happen with him, considering his not quite fluent English.  How do I explain what he is facing?  What do I say to a man that I know is doomed to death if he does not receive treatment?

Sometimes there are just no words to say.




After what felt like an eternity of silence, I asked him if he understood what it meant to lose function of his kidneys.  Again, he shrugged.

"Juan, once you've lost function of your kidneys, it usually means that it's permanent.  They are no longer able to clean out your blood of toxins and fluid.  Those toxins and fluids build up and you end up back in the hospital, unable to breathe.  The best thing you can do at this point is dialysis, which is what we've been doing.  Unfortunately, you don't have insurance, and you can't get insurance because you're not a legal citizen.  That is why Dr. K is suggesting you return to Mexico."

Of course he continued to look straight ahead, and barely acknowledge what I was saying.

"Has anyone talked to you about monitoring how much you drink and changes in what you eat?"  He didn't remember if they did.

I don't doubt that he has been instructed on both of those things.  I just don't think he really understood what he needed to do.  I tried to explain the importance of watching his fluid intake.  I talked about avoiding the salt shaker.  At first I thought he was not going to engage in the conversation.  He surprised me by asking how much he could safely drink in a day.  I told him that it varies from patient to patient, and he needed to ask Dr. K.  "However, a pretty basic measure is not over two liters."

Of course he had no clear idea of liters.  I told him to think of a big bottle of pop, and I got a foam cup and told him to not drink over nine of  those a day.  We discussed that he has to consider liquid from soups, jello, ice cream and even ice.  I gave the lecture on no soda and certainly  no alcohol.  He told me he doesn't drink "cerveza" and I told him I hoped that was so.

I removed his dialysis catheter with a heavy heart.  My mind was spinning with things he needed to know to have any hope of controlling this disease without dialysis.  And yet, I realize that all of those things are really just tiny bandages on a huge gaping wound.  After I removed his catheter I reminded him to leave the dressing on for at least one day.  I reminded him to ask about foods he should avoid, and what level he should keep his fluid intake at.  When I called report, his nurse was off the floor.  I asked the nurse taking report for him to please have her get a dietary consult so the patient can have a better idea of what foods would be safe to eat.

After leaving Juan's bedside, I went to my next patient.  Also of Mexican decent.  She speaks little to no English, and instead of removing, I was assisting in PLACING a permanent dialysis catheter.  She will go home and receive dialysis three times a week, four hours each day...And it will all be paid for by the tax payers because she is on the state Medicaid program.  You see, she is here legally.

Juan is not.

Same disease.  Same background.  Taxpayers will be picking up the tab for both patients.

I can't get  his face out of my mind.  He was a quiet man with unexpected green eyes.  He was slim and well groomed.  After digging through his chart as we chatted I discovered his kidney disease was probably caused by high blood pressure, which he had not realized he had until it was too late.  He still did not understand his high blood pressure when I talked to him.

When I'm outside the walls of the hospital it is easy to say that we have to stop giving health care to all of these illegals.  It's easy to complain about the drain on our budget that their children are, because they all get coverage.  However, when you are looking in the face of that person, and you know that they will surely die without proper care it is a big pill to swallow.

Of course, I realize Juan is still getting health care.  And, he's getting it for "free" as there is probably no way he will be able to pay, and no way for us to collect. 

I was physically ill as I spoke to him.  His condition will only get worse.  He will continue to go into a crisis of fluid overload.  This will cause him to either go to the hospital where he can get a temporary dialysis catheter placed like the one I removed today and receive a few treatments until he's "stable" and the doctor can discharge him and try not to let him weigh on too heavily on his already overburdened conscience.  (After all, any doctor that works for our hospital is not in it for the money.  We are known for giving away free health care.)  Or, Juan will literally drown in his own body fluid because his heart will be overloaded with fluid and literally give out from inability to deal with the fluid.  If by some miracle he is able to manage his fluid intake without dialysis, his kidneys will not be able to manage the waste products and his potassium levels will become so critically high that he will die from cardiac arrest...

So that sucks.

He will continue to be a drain on the system, getting "free health care" because no hospital will turn him away.  This is not near to the cost if he actually received dialysis three times a week, four hours at a time like he probably needs.  But it will still be a cost to the taxpayer. This sporadic treatment given as a result of recurring crisis will take it's toll on his body, and his kidney disease will progress rapidly.

And then he will die. 

So that sucks even more.

As I spoke to Juan today I realized that putting a face to something changes your perspective.  I'm not saying that illegals should all get free health care.  That would just be crazy.  What I will say is that it's a lot easier to say "kick 'em out of the country" when you're talking about a nameless, faceless person.  What will happen to him if he returns to Mexico?  Will he get treatment?  I can't imagine that he will get the level he would here.  I imagine he would be treated from one crisis situation to the next.

But maybe I'm wrong.

All I know is that he is a man.  A human being with a family and friends and hopes and dreams of a better life.  He is a creation of God.  He has a scary diagnosis that I don't think he understands.  I pray for his safety.

Cockroach Killers

Have you ever seen those really pointy toed cowboy boots?  I realize they have actually made it to the somewhat "fashionable" world of western wear.  However, when we lived in the Dallas/Fort Worth area, they were NOT in style.  Anytime we saw someone wearing them Brent would say, "Look at those Cockroach Killers."  Apparently the pointy toe is really good for getting into corners.

Today at work I noticed a bad smell in our department.  Our bathrooms have drains in the floors.  They were designed for showers.  However, nobody actually showers in our bathrooms, so gases build up in the drain pipes and they start to smell.  Our friendly environmental services repairman taught us to pour water into the trap every so often to alleviate the smell.  It works like a charm!

So today I noticed the smell.  I dumped some water down the trap, and the smell remained.  So I dumped some more.  I was on my fourth cup (I was using a large foam cup) and wondering how many cups it would take.  Suddenly a cockroach no less than two inches long climbed out of the drain.  It took all of my willpower, but I held the scream inside my throat (so as to not alert patients to the fact that critters were invading) and jumped up and stomped on it.  However, as I was turning to stomp the quick little critter, three more came darting out...

I stomp, stomp, stomped gave a great big shuddering "Uh-uh-uh-uh-uh" (insert zombie-ish moaning sound) and scratched my body all over, then convulsed some more as I put on a glove, grabbed a paper towel and disposed of the still antenna waving horrors...

Aside:

I had only seen roaches one other time at our hospital, and those actually climbed out of one of a patient's bag and up my arm...And believe it or not, I stifled that scream to, in an effort to not offend the dear lady.  I calmly handed her bag to her as I tried to subtly stomp the roaches that I'd just flicked off of my arm.  She calmly dug a banana out of her bag and began to eat it... Completely oblivious (desensitized) to the roaches that were swarming inside it.

*Shudder*

After she left I killed three more roaches in that bay and nearly had a heeby jeeby breakdown.

Back to present day:

I tried to nonchalantly leave the bathroom to call environmental services.  I decided not to call at the nurses station as we had patients in the department.  I went to an office, and one of the PAs was on the phone.  I went to the front desk, and there was family in the waiting area.  My supervisor wasn't in yet, so her door was locked and I felt weird about waltzing into our doctor's office to use his phone without him there...

I wandered back to the holding area just in time to see one of our female patients come scurrying out of the bathroom and say, "There are BUGS chasing me in there."

Color me mortified!  I said, "I'm so sorry," and walked in to the bathroom to find four more roaches running around the floor.  I stomped, stomped, stomped, stomped, slammed the door shut, leaving the light on, and tucked a blanket under the door.

Now, I realize the blanket wasn't going to stop them, but I was hoping they would want to prefer the dark, and therefore not come out of the drain since I was leaving a light on...

I then gave up all pretenses of subtlety and called environmental services who helpfully informed me pest control was coming that very day, but they were going to ER first...Of course the pest guy had other errands to jobs first.  I don't understand how any pest problem could be a bigger deal than ours.  But there ya go...

Later on I went to chat with the lady and apologize AGAIN and express my mortification over the roaches.  "I have NEVER even seen a roach here.  I am so sorry for your experience."  (Okay, so I fudged a little, but the other roaches were carried in and mostly out by the same patient.)  She laughed and told her family how I saved her from attacking bugs.  We were all laughing about her hysteria when her sister said, "I love your shoes!"

"Thanks!  They make great roach killers!"

And you guys thought they were a purely frivolous purchase!

Stress Eating

When a crisis arrives and I'm at home the immediate reaction is to clean the entire house from top to bottom.

When a potential crisis arrives at work, my immediate reaction is to wish I had some fountain Dr. Pepper and Nacho Cheese Doritos.

Yesterday at about 3:30 my supervisor said, "Is Dr. G going to do that ICU patient tonight?"

"What ICU patient?  He didn't mention it to me."

"It's that patient that coded this morning.  He wants to do her tonight, and he needs anesthesia, but they can't come until after 6."

Well, great.  I immediately began needing some Doritos and DP.  After all, if she coded odds are she's pretty sick.  And I hate dealing with really sick people late in the evening.  The rest of the crew has left, and that leaves the call nurse, the doctor and two radiology techs... unless you drag the ICU nurse into the procedure with you...

I went out to ask the doctor if we "had" to do the case that night, or could we wait and do it the next day and we'd book anesthesia...And of course, that would mean our entire department would be there in case things started going south...

He called the attending doctor who responded, "I think her gallbladder is obstructed.  If that is the cause of her sepsis, then she won't make it through the night."

Well, crap.  I called the anesthesiologist who was immediately annoyed that we were wanting him to put a patient under for a procedure when her labs were terrible, she's on the ventilator, and her blood pressure is still sketchy even though she was on the maximum dose of pressor meds.  (Pressor meds are given when a person's blood pressure is too low.)

 Oh, I just feel compelled to tell you in an aside note that one time I tried to refuse to do sedation on a very sick patient with Dr. G, because I was almost certain they were going to die on the table.  I wanted them to stabilize the patient more before we did the procedure.  He looked at me and said, "Andrea, this patient is going to die very soon if we don't do this.  So, he can either die with us trying to save him, or we can do nothing and he will still die."  What do you say to that?  We did the case, and the patient lived.  But I swear I carried knots in my neck and shoulders from the stress of that case for weeks afterwards....

After speaking with the anesthesiologist, I reported back to Dr. G that the anesthesiologist said I couldn't bring the patient to our department until he had seen her himself in the ICU.  And I was very okay with that...

However, my dad gum doctor just said, "That's okay.  I'm on my way to the ICU right now.  I think we are just going to drain her gallbladder, so I will just need sedation, and you can do that.  Come with me."

I could?  I didn't WANNA do sedation on this lady!  Grrrrrr...I grabbed my DP and chips and headed out the door with him...

(Thankfully, one of the radiology techs that was NOT on call had ran down to the cafeteria and bought me a fountain Dr. Pepper and Cool Ranch Doritos as they were out of Nacho Cheese...She knows me well.)

He and I took off down the hall, sharing my bag of Doritos...Yet, he pointed out that he thinks it's tacky to eat and walk at the same time.  I told him to "Shut up and eat a chip."  And he did.  He knows when he's living dangerously.  (By the way, we tell each other to shut up on a regular basis.  In fact, I pointed out that I've told him to shut up more than any other human in my life.  He said it's ditto for him, unless we count his sister and that took an entire LIFETIME to reach the quantity of shut ups that he's given me.  We aren't sure if this is a good thing or not.)

He walked into her room, where three family members were at bedside.  He immediately started telling them what we were about to do.  As he was talking, I noticed that she was on continuous hemodialysis...This means her kidney function was so poor that they had a machine hooked up pulling her blood out and cleaning it continuously.  I then noticed that her blood pressure was 66/47.

YIKES!!!

I immediately went to find the ICU nurse and tell her that if I had to take this patient and sedate her, then she was darn well coming with me.  And to shove a few more Doritos in my mouth and suck down some more liquid Xanax...Well, fortunately, the nurse had already talked to the attending and convinced her that the patient would probably not survive the transfer to our department and subsequent sedation.  She told Dr. G this, and asked if there was any way possible he could put the drain in at bedside.

"Sure.  We can try that."

How do you spell relief?

Well, we put the drain in at bedside, and the poor woman hurt tremendously as we did it, because her blood pressure was too low to give her anything to ease the pain.  The doctor kept asking us to give her something for pain, but the ICU nurse was adding a new pressor med, and another ICU nurse had joined us for moral support, (and to hold her down because it really did hurt,) and we were all presenting a united "refusal to give pain medicine" front...So, it hurt her really really badly.  But she lived through the procedure.

Dr. G said this is the first time he's drained a gallbladdder without giving some serious meds to get through it.  The three of us just put on our callus nurse faces and said, "Well, now you can check that off your list."  And we all thanked each other for the good work, and I went home, slurping on my drink and wishing I hadn't shared the last of my chips with the doctor...

So, what do you want to eat when you are stressed?  Do you eat at all?  Do you go into a frenzy of activity?  Perhaps you curl into the fetal position and stare at the ceiling fan...

Taking Thoroughness One Step Beyond..

Attention:  I actually wrote this post last week, but never posted it.  I just felt I should confess that this story is late...

I feel better now.



I'm learning to not worry if I'm going to be "short hours" at work because I took a few days off for Fall Break...

God provides plenty of make up hours for me...

In the form of a ten hour, no lunch shift on Monday followed by an eleven hour shift on Tuesday.  On Tuesday I did get lunch, but I took it around eleven or eleven thirty, and believe me that by the time I was clocking out at 7:30, I felt as if I had not received lunch at all...

So, following my whining about hours, I have a nursing story for you...

And it's not a fun story.  I can't even begin to describe the stress and fear and overall sense of sadness I had with the case that is still fresh in my mind...

So instead of sharing a scary, "why am I a nurse" story, I will instead tell you of a conversation that was overheard on Tuesday.

I work with a nurse who could be described as OCD.  And that would not be an overstatement.  We had a long line of patients backed up due to some urgent add on cases, and a delay with an anesthesiologist for a case my doctor was doing in surgery, followed by difficulty with the case causing it to run over.  Consequently we had more than adequate time to prep our patients for their procedures...

Well, OCD nurse can make a fifteen minute duty last two hours if given the chance.  He has this tendency to create work when there's none to be done when he has too much time on his hands.  Strangely, he seems to stress himself out when he has too much time also. He spent two solid hours getting his patient ready.  He even went over discharge instructions before the procedure began, which is actually pretty normal, but it's usually a brief description of what to expect after the procedure and a list of a few restrictions along with a handout.  He was telling his patient not to drive as she was going to receive sedation.  This woman was over 80 years old and no longer drove...And she told OCD nurse so..."Well, I'm just saying you need to be careful about operating any equipment or electronics today.  For example if you have an electric can opener at home, you might want to avoid using it today."

????

Needless to say, we haven't let him live that statement down, and I don't think we will any time soon.

BEWARE THE ELECTRIC CAN OPENER!!!

Getting Voluntold

Let's begin with a definition, shall we?

 

Voluntold:  v Being volunteered for something by a spouse or significant other that you were totally unaware of.

Example:  My wife voluntold me that I was going to coach our sons soccer team.

 

On Friday I was sitting in our break room hating myself and enjoying a cinnamon roll.  Hating myself for the wasted empty calories, but relishing the rich ooey gooey goodness with a stout cup of black of coffee.

Our doctor came into the break room with a soda in his hand and a to go box from the doctor's dining hall.  "I am going to have to leave.  My wife just called and I need to go home and get her then bring her back to the ER."

"Oh no!  Is she okay?"

"She's fine, but she called me crying because her back hurts so bad.  She never cries.  She's been complaining a back pain for a few days, but now it's unbearable.  I walked to work today, so I have to go home then drive her here."

I immediately said, "Do you want a ride home?"

 

"Would you do that? It's only about five blocks.  Is your car near by?"

My coworker Jared said, "It's just in the south garage."  We all park within a small range of each other, and there is a bridge that leads from the garage to an entrance one floor below our department.

"I would really appreciate that," and Dr. G continued to look directly at me.  Probably because I was the one who offered to give him a ride...

 

I promptly turned to Jared who was standing just behind me and gave him a look...

Jared only betrayed his start by a small blink.  He immediately said, "I think I have my keys on me, but let me grab my wallet."  

When Jared returned to work later that afternoon I said, "Sorry I just voluntold you to take Dr. G to get his wife.  But I figured guys should drive guys..."

He laughed and said, "No problem.  I caught on pretty quick when you turned and gave me the look.  I'm not always so quick.  Then when I dropped Dr. G off in front of his apartment he said, 'You are waiting and will drive us right back?'  Suuuure!"  

Poor Jared.  He was voluntold to chauffeur the doctor to his house by me, then voluntold by the doctor to act as ambulance service for the doctor's wife!

By the way:  Last I heard she was okay.  Probably kidney stones. Ouch.

If I Only Had a Brain

I am about to attempt to tell you a work story.  It is a story which could be very complicated and difficult to portray if you aren't a part of the medical field.  But if you will just suffer through and try to see my sheer idiocy, I think you will appreciate it.

This week we have been taking care of a lady who has been in the icu for over two weeks now.  She suffered a hemmorhagic stroke and the neurosurgeon went in to clip the bleed. After surgery she was completely unresponsive.  No reflexes noted.  Her eyes are open but they jerk around, never really seeing anything.  She is on a ventilator, and she initiates breath, but is unable to fully breathe on her own. Her heart is stable.  She has a giant tube coming out the top of her head to drain the excess fluid off, and she has a pressure sensor in there to monitor her intracranial pressure (referred to ICP from this point on.)  She also has staples across half of her head where they went in to do the surgery on her brain.  Her feet and hands are cold and mottled, and her limbs are limp with no muscle tone response noted when you move or reposition her.

This is all very horrific sounding, I know.  It is horrific. Especially when you factor in that the patient's family is English as a second language, and they keep thinking she's going to get better.  I don't see how she's going to get better after two weeks of no response, but I'm not God and that's not my decision to make.  Instead, I just feel terrible for them.

Here's a news flash for you:  I hate  brains.  I love things to do with the heart and cardiovascular system.  I get it.  I specialized in it right out of school, and while neurologic issues have never been completely unavoidable, since I've been in my current job they have been few and far between.  Imagine my joy when I realized on Monday that I was going to have to bring this patient from the intensive care unit to our department and monitor her while the doctor did a cerebral angiogram, which is basically a study of the vessels in her brain.  I got a quick and dirty inservice from the patient's nurse about her drains and what they meant, and especially that her ICP must not get above 20, and her drain needed to stay at the level of her ear.  If the drain was repositioned during transport and was above her ear, it wouldn't drain.  Too far below the ear, and it would drain too fast.

How do I spell stress?  B-R-A-I-N.

Monday we did the procedure with no hitches.  We injected some medicine directly into her brain that was supposed to improve blood flow to her brain. I was annoyed to learn that we would be bringing her back daily until she gets better.  

So we had to bring her back on Tuesday.  On Tuesday I went with one of my nurse friends for our department, and we had agreed to tag team her. I was feeling pretty okay with it, as the previous day had gone fine.

Well, of course by the time I moved her to our table and got my monitor hooked up, and the respiratory therapist put her on a portable ventilator, her ICP had climbed to 28.  "Well crap."  But then as I looked through her chart I realized that it said to notify the doctor if the ICP stayed up more than 10 minutes.  So I waited a bit.

Her ICP didn't budge...I lowered the drain...it still didn't budge, nor did it begin to drain.  I started to sweat.  Profusely.  I was so glad I had another nurse assisting me, and our plan was for her to stay with the patient and do basic care, and I would fetch anything she needed, or call the ICU nurse if she had a question, or whatever needed done...

I paged the neurosurgeon, Dr. X.  We will call him Dr. X as his last name has no less than 11 letters and like 5 syllables, and even after talking to him like twenty times I am still not sure how to pronounce it.

So, Dr. X calls back.  I inform him of her ICP, her blood pressure, her heart rate, her oxygen levels, and I even was able to tell him what her medications were running at.  I was mentally patting myself on the back for having facts, even as I felt sweat trickling between my shoulder blades.

"What is her ventriculostomy pressure?"

Now, this doctor has a pretty strong accent.  I was pretty sure I'd misheard him.  Because it sounded like he said ventriculostomy, and I was pretty sure no such word existed...So, I said, "Excuse me?"

"Ventriculostomy pressure.  What is it?"

"I'm sorry.  I can understand ventricul something or other, but that is all."

"Ventriculostomy.   Ventriculostomy.  Ventriculostomy.  What is the pressure reading on it?"

Okay.  So he DEFINITELY said ventriculostomy.  Which I still felt pretty sure was not a real word.  "I'm sorry sir, but I'm not sure what you mean by that."  I'm pretty sure that instilled all sorts of confidence in my roll as this patient's care giver.

"On the monitor, what does it say her ventriculostomy pressure is?"  Okay.  He just keeps saying the same thing over and over.  Apparently it's real.  And he expects me to know what it is, and what to do about it.

Crapola.

"Sir, I'm sorry, but the only pressure reading I have is off of the Camino, and it says her ICP is 28."

"But there is another monitor coming out of her head.  Do you see it?"

WHAT???? 

"No sir.  I only see the Camino pressure monitor and her drain.  I will call the ICU nurse to come show me what to do."

"Wait a minute.  Aren't you a nurse?"

"Yes sir.  I'm a nurse, but to be honest I'm a PROCEDURAL nurse, and while I had Scott give me a quick and dirty report on how to care for this patient, he never said the word ventriculostomy to me."

He then informed me that he had ordered her drain clamped, and that the ICP had probably raised due to the stress of moving, and I simply needed to open the ventriculostomy during the procedure and leave it open for one hour after...

There was that darn WORD again.

So I called the ICU nurse.  And it turns out that the ventriculostomy is the drain that I was calling a DRAIN.  Because that is what the simple folk call a drain for your brain...a drain.  He showed me that he had clamped the drain off the day before, so no matter how low I moved the drain, it wasn't going to lower her ICP.  Oh did I mention that I all but put that drain on the floor trying to drop her ICP?  Did I mention that by this point my scrubs were soaked in sweat under my lead apron?  I told my nurse friend that while I felt incredibly stupid, at least I'd probably never have to meet Dr. X face to face.

Well we opened the drain, and low and behold the ICP dropped to the normal range, and we were able to complete our procedure.  After we finished up Dr. X, the neurosurgeon showed up...At least I guessed it was him.  He was in a doctor's coat, and he was unfamiliar to me.  I could totally tell he was looking for me.  I decided to take the bull by the horns.

"Hi!  Are you Dr. X?"  Sound cheerful and nonchalantly confident Andi.  Then he will decide that while you may be a ditz at least you're friendly...

"Yes, I am."

"I'm Andi.  I was the nurse on the phone with you earlier.  I'm so sorry for the misunderstanding earlier.  I don't want you to think we don't know what we're doing here.  Except I have never dealt with one of these before.  So I guess that means I really don't."  And I smiled my most winning smile and I gave a little lighthearted chuckle.  Could you just shut up?  Why must you blabber on when you are nervous?  Or happy?  Or sad? 

"No problem. I'm sorry too. I thought I was speaking with the ICU nurse, so I was wondering how you didn't know what the monitors were for."

I was so relieved that he wasn't angry, and surprisingly nice but still relatively sure he thought I was a nincompoop...I decided fleeing was the smart thing to do in this situation...I gently lead him to our control room where I introduced him to our doctor, and headed back to the intensive care with the patient. 

Of course I ran into Dr. X again before I was gone.

Blast it all!  Must this man suddenly be everywhere I have to be?

And I began to blush and sweat even more profusely than I already was..."Hi!" I decided to keep up my light and friendly facade.  It wouldn't do at all for him to realize I never wanted to see him again.

"Hello.  I wanted to apologize about not realizing where you were earlier..." And he proceeded to take me back to the patient bedside and explain that the ventriculostomy pressure was monitored by a bedside monitor in the ICU, so I really could not have told him that reading as the monitor wasn't with me.  And he took the time to explain things to me in a much better detail than the nurse had.  And I was able to understand him easier face to face.

That made me feel much better.

And a little bit less of an idiot.

However, I still hate brains...

On a more positive note, I found out that as of January first two neuro interventionalists will be coming to work in our department, and that all of us have to go through special training to know how to care for brain injury patients.  I can only begin to guess the sort of ego that comes with a person who is willing to work on brains by inserting a catheter into the artery in your groin and working their way to the brain...And I can only guess this will lead to more interaction with Dr. X...

Oh, wait.  That is actually TERRIBLE news.  Blast it all.

Chocolate and Tattoos

I have so much to tell you about!

My new washer, nursery drama, redneck moments...However, today I will just give you a blip of the stuff jostling in my brain to get out.

First, I will share an epiphany with you.  I have a frequent flier patient who is 25 years old.  He has kidney failure, lung problems, and circulatory issues, and he is a train wreck.  He likes heavy gold jewelry.  You know the kind with giant links and huge crosses?  That's his type of jewelry.  He is covered in tattoos.  He has a Nike swoosh on his back and lots of Chinese emblems, and of course a barb wire around his bicep.  The PA Sonya asked him about the one on his right pectoral the other day as she was preparing to place a catheter to drain a fluid collection from around his lung...

"It says destroy. Because my body is destroying itself."

He has no tendency towards drama or neediness.

Oh.  Did I mention he is blind?

Why would a blind man cover himself in tattoos?  How does he know what he's getting?  How does he know what they will look like?  And what is the deal with the heavy gold jewelry?  How does he know what it looks like?

I gotta say, he is one strange skinny white guy...

I got invited to a bunco group tonight as a sub.  They had bowls of snack food at each table...I ate 4 caramels, a handful of M&Ms, some chocolate pretzels, and even a few Twizzler licorice bites.  Then they served a giant slice of chocolate cake with fresh fruit...I opted for strawberries.

I feel great right now.

But I'm pretty sure I will be hung over tomorrow.

Did you know i have reactive hypoglycemia?  This is a condition where your insulin release is okay, unless you eat a huge abundance of sugar or refined carbohydrates.  Then your pancreas has a massive overreaction and dumps insulin like crazy.  The result is a huge sugar crash...Which makes you want more sugar...

I remember the first time a physician told me I had reactive hypoglycemia.  "You made that up.  I am just fine."  And I walked away from that know it all nephrologist and went about my work.  A few weeks later I had a cardiologist mention the possibility of it to me following a discussion on why I loathe donuts...I sneered at him (behind his back) and returned to work, disgruntled that he could not be bothered to bring me a breakfast burrito.

However, this time I went home and googled it.  And I decided that those quack doctors may actually know what they are talking about.

Shocking, I know.

Tomorrow when I wake up with a splitting headache and generalized crummy feelings...I will bemoan those dang doctors who pointed out the cause of my post sugar irritability.

Because I'm pretty sure it's their fault.

How to Get Out of Taking Call on a Snow Day

The director of nursing for our department came strolling through on Monday evening...

She was avoiding eye contact with me.

"Soooo, does anyone happen to know who has call for nurses tomorrow night?"

"Oh, quit pretending.  I know it's me." I replied with my typical submissive attitude.

"Well, okay." And she thankfully found humor in my crummy attitude.  "I don't know if you will have to stay  tomorrow night or not.  You may want to bring a bag just in case."

I rolled my eyes and replied, "I know.  I was planning on bringing one."  And then I stated, quite loudly, "However, I think some of the other staff in this department need to get a little Jesus in their hearts and take call for me!  Y'know, since I was here two nights for the last storm."

Crickets chirping...

My favorite nurse replied, "Well, I have my kids this week, so I can't take it."

Another nurse called in first thing Tuesday morning.  She sent me a text letting me know, with the statement, "I realize I'm on call for Wednesday, so if they make you stay overnight I will be there by 7am."

Excuse me, but how does one reporting nausea, vomiting, and diarrhea ascertain they will be returning to work at 7am the following day?  Hmmmm....

I arrived at work Tuesday morning at 8am.

Turns out that my cry to Jesus was heard!  My director called my hero nurse, Tom!!!  Tom got a little Jesus in his heart when Janet asked him to take my call for me Tuesday night!

Can I get a hallelujah?

Anyhoo, as it turns out, Tom was allowed to go home.  But, the thought was there, and that is what truly counts!

Yeah Tom!!

So, next time you feel downtrodden and oppressed, just look your boss dead in the eye and call on Jesus!  ESPECIALLY if you work at a Catholic hospital... Apparently, that whole guilt thing works out well!

Tuesday's Recap

So, for any of you who are behind, I had to stay at the hospital due to a recent blizzard here in Oklahoma.  You can catch up here and here.

I entered into Tuesday morning tired and bleary but resigned to my fate of staying at the hospital at least one more night.  Possibly two.

They gave me a five dollar voucher for the cafeteria for breakfast.  I opted instead to eat a packet of oatmeal that I found in our break room cabinet.  I had no idea whence it came or who's it was.  There is a relatively good chance it was mine...However there is an equally good chance it was not.  I really did not care.  I was stuck there, and the others weren't and I was going to eat that oatmeal.  I knew if I went to the cafeteria I would load up on junk I didn't need....

As far as I can tell the oatmeal did not give me food poisoning.

I spent a relatively uneventful morning stocking bays and fiddling with paperwork and auditing charts.

Y'know...

Because there weren't any DOCTORS there for me to do actual work.

Yes.  No doctors.  No physicians assistants...Oh!  That reminds me!  I must rewind to Monday night.  I arrived at my department expecting to be alone.  I had been unable to find my pager at home, so I figured I'd left it at work.  I went to the back to hunt it down, expecting to be alone...I about jumped out of my skin when I rounded the corner and someone was there!  One of our PAs was there.

And she was not happy about it.  She let me know how displeased she was that two of her partners had put off 4 procedures for her to do the next day and "I live out where the chickens and hawks nest together and there is no way I will make it in tomorrow, and I'm your PA tomorrow."

"Well, that's interesting.  The call crew is required by the hospital to stay until the storm is over, or roads are clear, or whatever.  The others haven't gotten back here yet."

"Well, sweetie," she replied in her most syrupy voice, "you can bring these patients down here to help me do them in the department instead of at bedside if you want something to do."

"Well, quite frankly, I've been informed I will only be paid 8 hours a day, unless we add an emergent case in the evenings.  So I'm pretty sure I'm not allowed to clock in at 7pm to do procedures with you."

And she rolled her eyes and repeated that it would be easier for her and give me something to do...

I found myself strangely unmoved.

Fast forward to about 10am Tuesday.  I get a fax that says a patient needs a temporary dialysis catheter stat.  I find that very exciting as I have no doctor or PA to place said catheter.  I have already been informed that our PAs (all four of them) are snowed in at their houses, can't get down their streets, and the call doctor is completely booked at another hospital.  And, apparently the other three doctors are snowed in at their houses also...

GRRRRRR

Fortunately, the ER doctor had agreed to do any lines that we needed done.  We just had to bring them down to his department, as of course they can't leave the ER unattended or understaffed...

Guess what?  This patient was on a ventilator and multiple drips and his labs looked like his demise could happen way too easily for my own comfort!  I called his nurse and she informed me that he had been a full code shortly before...

I paged the ordering physician to be sure he was aware of the situation and how we were going to get dialysis access for his patient...

He called me back in less than 30 seconds..."Interventional Radiology, this Andr.."

"Andrea?  What are you doing there?"

"Well, sir, the hospital required that the call crew come in."

"I thought none of your doctors or PAs were there," he answered.

"Well, no they,"

And he interrupted me again, "That just doesn't make sense!  Now, what did you need?"

I instantly found favor with him as he was sympathetic to my plight...I explained my plan and made sure he was okay with me taking his patient off the vent, bagging him down the hall to ER and getting his dialysis line in.

"Yes.  He needs it now."

Cool.  Just so we're all on board.  God was good, and we got the patient down to ER, the line put in him and delivered back to ICU without a single mishap...

WHEW!!!

And that was the most exciting thing that happened all day long patient care wise.

Actually, it was the only patient care I did.  I ran down 4 flights of stairs to help the tech in MRI to discover she didn't actually need help.  So I ran back up 4 flights...

I ran down 3 flights of stairs to check on something random in the Nursing Office...I ran back up 3 flights of stairs.

I ran down 2 flights of stairs to get lunch.  I was planning to use my voucher to get a cup of hot soup.  Did you know they prepared corn chowder or chicken noodle as their soups of the day?  Are you kidding me?  WHERE IS THE STEW?!  I WANT CHILI!!!  And on Wednesday when I went to get lunch the soup was Cheeseburger chowder!  I had never even heard of such a thing!  I suspect that with the bad roads they were desperate for supplies as more people than ever were eating every single meal there.  I bet they just browned some burger and threw it in Tuesday's rejected corn chowder!


Returning to Tuesday:



BOR.  ING.

Well, I did field some calls about add ons and discussed with the doctors if they were urgent and scheduled them for the following day.  But let's be real:  Those weren't keeping me hopping.

My friend Shonda showed up around 5pm.  She was starting her call the next day, and the hospital picked her up so she could be there to start the day bright and early.

She immediately wanted to order takeout.  Strangely, we could not get a single restaurant to answer the phone or agree to deliver in what had now become a ground blizzard.  Doesn't the food industry want to make money?

We all trudged down to the cafeteria.  Taking the stairs, of course...

Now that I've listed my trips up and down the stairs, hows about I tell you what I ate Tuesday?

Chicken strips with gravy
Sugar cookies
Fountain Dr. Pepper
Fried Bean Burrito
TWO snack bags of Lays Original potato chips
Chips and Salsa at about 10pm...

I swear I was eating like I did in high school all over again.  Only I was doing it with the knowledge that my metabolism and digestive system were not prepared for such an onslaught.  The good news is that after our supper settled I made Shonda go walk the tunnel with me.  We have an underground tunnel that connects the main hospital to Bone and Joint and also to Behavioral Medicine.  Seven laps equals one mile.  I made Shonda power walk it with me, and I made her do lunges with me down one of the stretches two times.  She refused to do it every lap...

We then ran up the stairs (okay, not really, our legs were a tad trembly) and went to forage a mattress for her from the broken bed graveyard.

We had decided that come what may, we were sleeping in the bays of our own department.  We work here dang it!  We deserve it!  Imagine our surprise and dismay when a pack of people came dragging linen in to sleep in what was now fold out chairs.  Thankfully, they had apparently found 7 of those to be used in place of the pool floats they had provided them the night before!

After getting Shonda all set up, we decided to use our powers of mind control to see if perhaps the surgery people would let me use their shower if I promised to keep it top secret and  not tell a single soul, I pinkie swear and will be eternally grateful and significantly less smelly...

Especially after all of those stairs and lunges!

Apparently my mind control skills are better than I thought...

Or I really did stink so bad they were eager to get me clean and deodorized! Can I tell you that I never knew using a public shower could be so blissful?  I pilfered a pair of surgical scrubs and headed back down to settle in for some HGTV....

Where I consumed entirely too many chips with salsa.  We then headed to bed.  I actually slept much better on Tuesday, considering I did not wake every time a stretcher rolled down the hallway...

That is until 3am.  I started coughing.

And coughing.

And coughing.

I was afraid to wake my roommates.  I went to get a drink, tiptoeing in the break room so as not to wake Jeff...

I kept coughing...

I grabbed my blankets, and went to the itsy bitsy couch in our lobby.

A lobby I had sworn I would never sleep in, as it was unlocked, had a giant cherry paned picture window that took up the entire hallway wall, and all of the people sleeping in our department were using the lobby as their path to their beds...And any Tom, Dick, or Harry could come through looking for a warm place to stay...

I finally fell asleep sometime after 4am.

And I slept through four random strangers (okay, hospital personnel, but I did not know them at all) walking by me to go back to work, Shonda leaving to shower and returning to blow dry her hair...

Until she woke me up at 6:35.

I was a wreck.

By the time I left work at 2pm on Wednesday I was a mess.  I realized that due to a vomiting child on Saturday night, restlessness knowing I was going to have to stay at work on Sunday night, hospital noises on Monday night, and coughing on Tuesday I had slept only maybe 18 hours.

And, no I did not do much patient care.  Other nurses had arrived by then, and they caught on rather quickly that my decision making skills weren't the best.  Of course, it was pretty obvious when they would ask me a question, and I'd just stare blankly at them...

And when I told them I took the stairs (of course) to the cafeteria and didn't understand what was going on when I walked to where the cafeteria should be...But of course it wasn't.

Because I was on the wrong floor.

I made it safely home.  And I spent Thursday having good times with my family.

So there you have it.

Adventures in camping at the hospital.



What about you?  Did you have an exciting week?  Do tell!

Preparing for Being Snowed in by Ensuring Total Exhaustion...

Our state happened to have a winter storm move in.  Oklahoma is not like those northeastern states.  We aren't prepared for large amounts of snow fall.  We expect large amounts about once a year at most.  Rather than own an abundance of expensive equipment, the state has only enough heavy equipment to open major roads.  And that is not clear roads.  Just open.  They will still be very slick and hazardous...That means that everything nonessential shuts down in the event of winter weather.

Guess what?

Hospitals don't fit that category.  I was on call for the hospital Monday and Tuesday.  Hence, I was required to go to the hospital and stay until the weather cleared up, or the replacement call crew arrived so I could go home.  Whichever came first.

Loverly.

I have so many exciting tales to tell you from my hospital camping trip! From eating my first fried burrito since I was in college to discovering a back way into a unit that was under construction and had broken beds...which we stole the mattresses off of.  It was not so good times had by all surrounded by moments of sheer hilarity.  Not because they were so hilarious.  But because we were tired.  And I was delirious.  I had very little sleep the two nights leading up to this hospital slumber party.

I have so much to say, I don't know where to begin.  I think I will begin at the beginning and post several stories for your reading pleasure over the next several days.  My only regret was that I did not have a camera.  I had a camera phone but they are just not the same, so I don't tend to use my phone as much...

Rewind all the way back to Sunday night.  I had seen the forecast.  I knew what my fate was going to be for Monday and Tuesday.  I was irritated and already past the point of no return exhausted when I tried to go to bed at about 10:30 Sunday night.

I laid down.  I tossed and turned.  I tried deep breathing and prayer and gradual muscle relaxation...I began to sink.  I was falling into dream land.

BUZZ!!!

Dadgummit!  I had put some clothes in the dryer before going to bed and forgot to turn off the cycle signal.  It was 11 pm.  I stumbled to the laundry room, switched off the cycle signal, and went back to bed...

And started the whole prayer, deep breathing, muscle relaxation mantra over again...And, yes Gentle Reader.  Studmuffin was sleeping peacefully.  Which was good as he had to be at work by 5:30 am.

I rest.  I relax.  I was determined not to get out a book as I would for sure not go to sleep then, as I would need to read "just one more chapter."  I finally dozed...

"Abkadefghijhecklmanhopferstewicksiz!"

What the hey diddle?

I woke with a jolt.  What was thaaaat?  Was that someone outside my window?

Silence...

The dog isn't barking so it can't be someone outside....

Maybe I dreamed the whole thing.

"Snorkelemflarpinjehosaphat!"

Oh.  Well that explains it.  Popcorn is talking in her sleep.  Again....No biggie.  I sleep through that all the time!

Rest, rest, rest.  Relax, relax, relax.  Pray, pray, pray...

*BEEP! BEEP! BEEP!*

It is now 4am.  Studmuffin's alarm is going off.  "Fortunately," I sigh to myself, "I don't have to get up yet." And I attempt to sleep.

Rest, rest, rest.  Relax, relax, relax.  Pray, pray, pray.

To no avail...

At 4:45 I gave it up and went to turn on the coffee and make myself some oatmeal.

And that began the day of cleaning the house in preparation for being gone for a few days.  Ensuring there was plenty of food supplies for the fam, and disinfecting from the flu and strep bugs that had descended on our house...Cleaning.  Laundry.  Blah-biddy blah blah blah...

And awake I stayed until I went to bed at 1am Tuesday morning.

But that is a story for the next post.  Which is way more interesting.  I promise.  I will tell you all about the first night camping at the hospital tomorrow.  You will be glad I did...

I puh-ROMise!

Skunks, Potty Mouths, and I Didn't Sign Up For This!

My dog got sprayed by a skunk yesterday at about 5am. I know the time because I actually smelled it in my bedroom!

I would like to announce that this is exactly one year and 8 days since my niece Sarah spotted the adorable ferret/gerbil which was actually a skunk in our culvert!

I had to change scrubs when I got to work because I could still smell skunk...

My bedroom smelled like skunk last night.

I fear that my house STILL smells like skunk, but my olfactory bulb has adjusted...Darn that rapidly adjusting sense organ!

Bookworm is pretty pumped to be on leadership at school. She is the hall monitor in the mornings and the line monitor in the lunchroom...

She heard a kid say the "P" word today. She informed the kid that he shouldn't say bad words.

"P isn't a bad word, IDIOT!"

I asked what she said to him then..."Nothing! I didn't know what to say!"

"Was he in 4th or 5th grade?"

"NEITHER!! He was in KINDERGARTEN!"

Kids these days. She was quite disillusioned. I think she realized she has been given much responsibility with no authority.

I had a "why am I nurse?" moment today....

A patient was very unstable with a massive infection in his left kidney. The urologist had tried putting a stent in the kidney and giving antibiotics. They both proved ineffective. Subsequently, the patient went into septic shock. Septic shock results in increased heart rate and massive dilation of the vessels, which causes blood pressure to drop dangerously low. Other stuff happens, but I was concerned at this moment that the patient was on 3 medications to bring up his pressure and his heart rate down and he was still only in the 80s for his systolic (top number,) and his heart rate was still in the 120s, and his platelets were 12. Platelets are needed to make your blood clot. We like them to be over 150.

Did you catch that? He was 12. We like 150...

I personally like to think that we can actually stop bleeding if it happens to occur.

"Dr, I'm not sure about putting this patient on the table. Can we do this in the ICU using ultrasound?" Translation: I really wanted this to be on the ICU nurses plate, not mine. Just bein' real here.

He looked at me with his serious face and said, "I can only do this under fluoro (that's xray to you non radiology folks). We have to bring this patient down."

"I'm a little uncomfortable with this patient's stability." Never say I give up easily.

"Andi, if we don't get this drain in his kidney, he's going to die."


Allllllllrighty then.

I went and got him. But I wanted to say, "I'm afraid he's going to die on the table."

We don't say that stuff out loud though. Instead we do our job.

And sometimes I think I'm crazy for doing it.

But when I stop and think about something so simple (if using live digital xrays to insert a line into the kidney to drain the infection is simple) can make a life or death difference....

That's pretty cool. And I'm glad God gave our doctor's the knowledge to know what to do. And I'm glad He has made me a small part of it.

So, who wants to grow up and be a nurse?

"You could have licked it right in front of me. I'd still eat it."

I have had a very busy week at work. Don't you just wish I'd shut up already with the work stories?

Too bad. They're all I've got right now, but if you'll hold on to your pants I'll bet you'll be glad you read this...

Or not.

Yesterday was cuh-RAZY! We were ridiculously behind. However, it was due to unforeseen circumstances in which we had multiple add on patients. Please understand, if we are adding on a patient, they need to be seen. Infected abscesses (yummy), clotted dialysis grafts, acute hemorrhaging...All of these things need seen to double quick. You also need to understand that with all of these acute problems, we have routine patients. Follow up checks on abscesses to see if they're healing, biopsies of just about anything you can think of, and so on make up a portion of what we consider "routine." Please understand that I know anyone with a mass on their lung that needs biopsied does not consider it routine. However, it is not urgent. So, if your appointment is for a routine procedure, there is a chance you will get bumped back for the more critical patient...

This is health care people! Not Burger King!

So we were busy. One sign of extreme busyness is when you are explaining to a doctor what you've done thus far, and asking what else he might need, and does he want you to call pharmacy, and does the patient need to start on their back, then be rolled to their belly...

The doctor will stop you.

"Andi. Do you think I'm going to yell at you?"

"No, but I'm not sure what you're going to need for this procedure, so I'm trying to avoid the 'look' followed by the quiet, tightly controlled voice."

He gave me a hug and told me it was going to be alright.

I've never been hugged by a doctor. I typically avoid such shenanigans as they are not appropriate, and no lady better be hugging my husband, so I never make hugging seem welcomed from male staff...

But I really needed that hug. So I hugged him right back. It turns out I was going to need all the support I could get for later on....

I was supposed to be off work by 4:30 yesterday. At 6pm I was getting the last family members of our last outpatient to come see their loved one. This particular family consisted of a wife, an unknown silent woman, and a "son." I say "son" because I later realized he was in no way their son, other than they were good friends, and the patient was old enough to be his dad, so he called my patient "dad."

Is anyone bored yet? I'm giving way too much detail here, I know....

So, I go out to the waiting room. I'm tired. I'm hungry. I'm thirsty. And, yes, I needed to pee.

"Okay you guys can come back now."

Son: Are you married?
Me: Yes.
Son: Do you have children?
Me: Yes.
Son: Do you want more children?
Me: starting to wonder where exactly this is going, Umm, no. I'm good with two.
Son: Well, do you want to practice making more babies?




Yes, Gentle Reader. That was my reaction exactly. Stunned silence followed by profuse blushing, and this statement: "That was inappropriate." And I turned and walked out of the waiting room.

The family followed.

So did he. Drat.

Son: Do you want to go to Vegas? Do you want to get in a hot tub? Is there any chance you might be single soon? Did you know I'm a complete creep? Did you know I have no moral values, and that I am a direct reflection of what is wrong with society today?

Okay, he didn't really say those last two sentences...But he did say lots of things, things I'd rather forget...I did learn he owns a bingo hall. And that he wanted to be the one to drive my patient home so they could hit the strip clubs.

Gag.

I totally ignored his existence and blushed and sweat, and was totally at loss for what to do. He kept talking. As I drove home, I realized I should have told him if he didn't stop bothering me, he had to go sit in the waiting room. Instead, I just tried to ignore him and only acknowledge the patient and his wife.

It didn't work....

Let's move on to today, shall we?

We were swamped. NOBODY got lunch.

Sadly, if nobody gets to eat, I feel better about the situation. Misery really does love company.

I had a piece of toast for breakfast at 6:30. I had two tablespoons of peanut butter at about noon, followed by a snack size Almond Joy....

Strangely, I was still hungry at about five when I rolled a patient to the dialysis clinic. Life is just full of mysteries, isn't it?

Want to know something strange and totally random? There are 3 nurses named David in dialysis. They were all working this evening...

Dave: Man, you guys have been hopping today. We have had a ton of your patients come through.
Me: I know. I don't think any of us even got lunch.
Dave #2: Hey, we have some pizza in the back.
Me: I will totally take it, but first I have to get Julie (my patient) some peanut butter and crackers. She is hungry.
Dave: Oh, the pizza is right by it.
Me: Thanks...

Only I didn't see the pizza and came out with only Julie's snack.

Dave: Where's your pizza?
Me: I didn't see it. I hope to get off soon. I'll be okay...
Dave #2: Wait. I'll get it for you.

And he brought me a piece of canadian bacon pizza with pineapple on a paper towel.

"Thank you so much. I am so hungry I don't even care if it has pineapple." I really don't care for pineapple...Another fascinating factoid that you should totally know, seeing as my husband is half Samoan.

Dave #3: I can't believe you're just eating pizza that David carried to you, and you really don't know where it came from.
Me: Dude, I am so dang hungry, you could have licked it right in front of me, and I'd STILL eat it.

And then they totally wanted to test it out, but I wouldn't let 'em. I do have standards y'know!

Instead, I walked down the hall happily scarfing down pizza before I reached my department so the other starving staff wouldn't feel worse about their lack of food, and have to be secretly bitter that I got a free piece of cold pizza with pineapple which I don't even like and I don't even know for sure where it came from.

The End. I'm off to grab my fifth piece of takeout pizza.

Delirium

It has been an exciting week around here.

Monday I returned to work after 2 weeks off, between Thanksgiving and measles.

I worked a 10 hour day and came home to find supper started and my niece Sarah, who was staying with us for a few weeks, had ran and emptied the dishwasher! Little things make me happy.

Tuesday I worked another 10 hour day, and returned home to find supper made again.

Amen.

Wednesday was my day off, and I told you all about that roller coaster ride of emotions.

Thursday was a "work" day. However, my hospital has 2 days of employee appreciation every year. They rent a theater in the Harkins downtown, give us breakfast in the form of snack bars and nasty coffee that they fool us into thinking will be great by handing it out in Starbucks cups, and hand out tons of awards. They show a video telling us how awesome Saint Anthony is, (click to view one of our commercials about believing in the power of prayer) and have a motivational speaker that is very entertaining.

Then they give us a ten dollar gift certificate to eat anywhere downtown we want. And we get an hour and a half to eat. After working most shifts with only 10 minutes to scarf down something quick, I love this part. We walked along the river, and had a great Mexican food lunch.

In the afternoon they give out more awards, hand out soda and candy, and show a movie. This year we got to see "Morning Glory." I highly recommend it. I laughed, got teary, and left totally relaxed.

And, get this. I got paid for an 8 hour shift to do all of that!

AND IT WAS MY BIRTHDAY!!!

Side note: It is a bit touchy for a slightly hyperactive person to be offered free coffee and sodas, and sit still in a movie theater for 6 hours. It was not very pretty at times.

Friday I went to work, and the staff who had been unable to attend Spirit Day on Thursday went. This left us with a whopping 2 nurses and 2 techs and our supervisor to do what we normally do with 4 to 5 additional staff.

Good times. Good times. I got to work at 6:45 am, and clocked out at 6:45 pm. The group that had covered for us the day before had finished up by 1pm. And they got lunch. I had a banana, two tablespoons of peanut butter, a package of crackers, and a half cup of black coffee to get me through the day. At about 5pm, I was delirious and hungry. I was standing at the desk filling out paperwork, and listening to my patient and his family chat. I got so tickled at something he said, that I collapsed against the counter, head in my arms laughing hysterically.

And I couldn't even say why, or what was funny. But tears were streaming down my face and I was absolutely rolling.

Don't you wish I was your nurse in that state?

I went and brewed a strong cup of coffee, and came to my senses enough to sedate my patient and not endanger any lives.

As I pulled out of the parking garage to come home, I called my hubby to tell him I was finally getting off of work. "What's for dinner?"

"I didn't know what you would want. I figured after such a long day you would be hungry and vicious, so I thought I'd see what you want."

Wow. He knows me well. However, he was skating on thin ice, since he had no idea or plans on what to feed the ravenous beast...

"At this point I'm so hungry, I would eat whatever you put in front of me. And, I'm punchy instead of cranky. However, I will definitely be ready for food when I walk in the door."

He had an egg sandwich ready for me when I walked in and collapsed onto a bar stool.

I finished my evening off with my new Christmas treat:

Eggnog with a dash of ground allspice and a very generous splash of spiced rum.

It is almost certain to make everything right with my world.

Oh, and just to share my good news, I got a Nook for my birthday. I'm loving it, and so is my husband. He is reading the first book he's read since we got married. He is reading "Dracula." This has always been his favorite book, and it seems he is inspired to read now, and I fear we may come to blows over who's turn it is to use the Nook.

Not really.

But we may definitely exchange some words.

Just bein' real here.

Now, I shall end this long, boring post. Thank you for bearing with me.