code rugrat

my little rugrat lover

Oona is a very loving, intelligent and strong-willed girl. I don't worry about her the way I do my son, because I think she's got a strong enough sense of self that she'll never let anyone push her around. She is going to set the world on fire, I knew it as soon as her head popped out of me. I can swear that her body wasn't even out of me all the way yet and she let out a surprisingly hearty for a newborn cry. Is that even possible? I feel like the RN in me should know this stuff, it would seem unlikely but that's the way I remember things. Needless to say once I heard her cry a part of me thought, 'uh oh.' like what have I gotten myself into?

She slept most of the first year, slept a lot. We would wake her up, and she wasn't our first baby so we knew better than to chance things like waking a baby that might then be up all night but she was unbelievably easy and very well rested that first year. I think she was preparing. Storing her energy, like a caterpillar biding her time before she burst out of the cocoon of infancy. Look out.

She has a very different personality than Owen. She has been able to charm the pants off of anyone since she was two or three. She's got incredibly big, beautiful brown eyes framed by long dark lashes and the sweetest little angelic face, I feel like this is some genetic compensation that allows her to unleash her fury and not get harmed as a result. Oona knows how to throw a tantrum. Oona knows what she wants and when she doesn't get what she wants heaven help anyone keeping her from getting what she wants.

I talked to a 'talk doc', Owen's name for a wonderful therapist my ex and I took the kids to during our separation and when Owen had some issues after my dad's death and more recently with a kid whose a bit of a bully. The talk doc thought Owen was doing great so I asked her about Oona because, well certain women can take one look at Oona or briefly interact with her and see just what a challenge Oona will be as a child before she takes over the world as an adult and the talk doc had Oona's personality down from the first day she met her. The talk doc suggested getting a box or basket with items of Oona's choosing to help her soothe herself and preemptively avert a tantrum and I would then give Oona much positive feedback for deescalating on her own.

I discussed the self soothing box or basket idea with Oona and Owen in the car, it's seems we're always in the car, while bringing them home one day. Oona embraced the idea, if only because she was quickly filling that box or basket up with so much stuff that it sounded more like Martha Stewart's craft room. Kudos to Oona for at least thinking to put books in her self soothing container. Owen quietly asked if he could have a box and I said sure, knowing he would never have reason to need this box. When I asked Owen what he wanted to put in his box he said, a hole puncher. He didn't even ask for paper at first but after some prodding said he'd like paper and a hole puncher that makes special shapes. Then he said he'd also like a lighter, not because he's a 9 year old pyromaniac but just because he likes to look at flames but he also knew my parenting skills well enough to realize that there was no way I was putting a lighter in that box. I passed the idea along to Toby and his wife and she said maybe they could download the app for his iPhone (he and Oona have their older iPhones at their house). That sounded safe and clever.

So a few weeks later Oona, Owen and I are in the checkout line at Whole Foods and we're trying to figure out a code that I can call, sort of a secret phrase, when I think Oona's getting close to a meltdown. Oona loved this idea, while I was explaining about codes at the hospital and she kept rattling off every color in the rainbow and then it was code lemon meringue pie and then she hopped up and down (the checkout lady was an older non-tattooed whole foods employee, the less than 1%, and was having a good time just watching Oona in action with this idea and, fortunately, there was no one behind us) and said, I've got it! Code Rugrat! We made our way over to the orchid forest (aka the booths where the they've propped potted orchid plants all along the wall the cordons the section off) and I thought maybe this is just what I need to get us through Oona's next few years until the tantrums end, they have to end eventually right? To my way of thinking 6 seems old for tantrums but what do I know some adults continue to throw them and get away with it.

Thus Code Rugrat was born and damned if I can remember to call that code when Oona starts heating up, in her prodromal phase. I really feel that I need a code (code ennui? code apoplexy? code maladroit mom?) because after getting the kids today from Toby's house (they were away for a week in which I did fuck all around the house, aside from sleep in on the day or two that I could) Oona had like three meltdowns and when she wasn't doing that she was being disrespectful and talking at me with attitude, complete with hand motions and eye rolls, absolutely revolting behavior in anyone but especially my 6 year old daughter. And dealing with that all day all does not make me a happy or  nice person so I'm definitely close to a meltdown of my own after enduring that all day. By 6:30 I was count the minutes until bedtime, a huge headache blossoming on the right side of my head.

the unfortunate outcome  if a code rugrat is not called

independence day

My children are gone for the week, out in the country at my ex in-laws. Last year, when I was still in school, I would have been able to take advantage of this time to myself and do stuff (being me, most likely it would have been fixing stuff up around my 100 plus year old house of cards that I call home). But now that I'm working any free time is eroded, especially working nights this week and last, I sleep fitfully during the day, wake up at noon and can't get back to sleep (which is really really bad if you're going to be working 7 pm - 7 am later that night). I walk around in the drunken fumes of sleep exhaustion, trying to function on four hours sleep, trying to find the right way to explain when I last worked, surprisingly confounding for one that's college educated, not yesterday but last night into this morning. I had a free Monday and I can't even tell you how I spent it except to say that I don't think I got enough done. Slept tuesday to work last night, in a hermetically sealed nurses station where I can't see the outside world. I didn't realize how bad it was storming until I went to get a coffee in the lounge around 1:00 am.

I'm back to work tonight, I'll be missing fireworks, which is no biggie for me since I used to be terrified of them. Seriously they used to render me close to catatonic as a child, way way too loud I remember my mom taking me to watch them outside, spreading a blanket for me and her date and I was five or so, very excited to see the lights in the sky and then it started and I had my first experience with absolute terror, I couldn't move, I might have started crying or screaming, I can't remember. My mom had to carry me to the car, guess I ruined that date.

I'll come home tomorrow and sleep then I get a free day for Friday and then it's back to work, mornings this time, for the weekend and then I get the kids Monday morning. My two free days I don't even know how to properly suck the marrow out of them because I'm still trying to get my body back to being among those who do stuff during daylight hours. How the fuck am I going to accomplish anything, going back to school, cleaning the house, having a life, on this schedule, it's like the employment equivalent of a death eater sucking the life out of me. 

In other, match maker news, match continues to disappoint reaffirming my belief that my golden years will be spent with a vibrator and a stack of saucy erotica, if I can find erotic writing that I actually think is well written and erotic. I had a date last week with a man that I was really getting along well with through writing. He sounded very nice and we have a lot of shared interests and he's a doctor in a related field so I was like cha-ching, I hit the jackpot, a man I can use as a sort of medical pensieve (I'll try to limit the Harry Potter references from here on out).  I should have listened to my gut (Malcolm Gladwell would be so disappointed with me) when there was only one headshot on his profile. Now, to be fair, this man was incredibly kind, unbelievably polite and really interesting. But, let's put it this way, he listed himself as stocky and he's probably a good seventy pounds overweight. Plus I think the headshot of himself was taken a good decade (maybe two?) ago. As soon as I saw him sitting at a table, not facing me, he had left the seat that faced the room for me, like I say unbelievably polite that way, but  all my hopes sort of deflated when I saw his flesh straining at his clothing (just one more Harry Potter reference, like Aunt Marge when Harry puts the spell on her and she starts to swell). He made the chair he was sitting in look so tiny and he was only an inch taller than me. 

And, one other sort of odd thing with the dinner. Well first, I can't believe I didn't post this on Facebook but I saw this slight, asian man with a pleasant face pop up in the doorway and I said to my date, 'Isn't that George Takei' lo and behold it was. Mr Sulu wound up sitting right next to me at a neighboring table. I didn't post it because I never really watched Star Trek, caught an episode here and there, I'm not a trekkie but I have many friends that are, although I'm a friend of George Takei's on Facebook because I love his posts, think they're great, very playful and liberal, he's done a lot for gays just by being his lovable self on Facebook but I'd feel like an imposter bragging about this sighting because, while I was happy I knew who it was in a heartbeat, it's not like I'm going to fawn over this man and disrupt his meal. My date stood up and shook Mr. Takei's hand as he was leaving and thanked him for his work (he's a trekkie). Anyhoo, so I had written that I wouldn't eat much the day of our date because I wanted to fill up on all the sushi at one of my favorite restaurants in Pittsburgh but this man ordered so much flipping sushi and kept holding off on eating certain pieces and kept encouraging me to eat everything, even though I was stuffed half way through the meal, it was sort of weird, like was this some feeder thing? I'm sure he was, once again, just being exceedingly polite and me, being exceedingly untrustworthy and bitchy, I go to feeder fantasies. I hate dating.

In other news I went to see a sports medicine doctor for my ongoing back and hip issues. This guy was funny. At first I couldn't tell if he was flirting with me because #1 I can never really tell when someone is flirting with me, my flirting radar is nonexistent but #2 he'd look, smile and interact with me in a way that made me think 'is there something on my face or stuck in my teeth? is that why he keeps looking at me?' Like I say my gauge for determining if someone finds me attractive, it's nonexistent. And, anyway the doctor is married because he answered a text while talking to me. OH NO YOU DIDN'T! Can I harp on how fucking unprofessional and disrespectful it is to even look at your phone while being with a patient unless you preface it by I'm expecting a call, with intonations of pathology results of the five year old whose life you're single handily trying to save. This doctor is giving the med student who initially examined me a hard time because she didn't make small talk with me and learn about my interests and then he's like, looks at phone, my wife didn't sleep last night, why didn't she tell me she couldn't sleep, she should have woken me up, that's why she wouldn't go to the gym with me, my wife my wife my wife, the uxoriousness he displayed, I'm thinking is this an act or compensation for a cheating mind, heart, penis? Once again displaying my untrustworthy bitchiness.

Well, as a doctor, aside from the phone thing, he was great. He said my situation is different because I'm so flexible, even being stiff and injured I'm exceedingly flexible, he seemed strangely delighted, like he was playing with a new toy, putting me through motions and moving my legs to see just how far they could go. He actually took the time to get a resident, who goes back and forth between this hospital and a competing system, to bring up my MRIs online and then point out to me what he thought was my problem. So after talking to him I decided to hold off on the steroid injection in my back, he doesn't think it will help, try physical therapy yet again to strengthen my core, being flexible (or floppy in my mind) is makes back issues likely because moving so easily it can cause the vertebrae to also move easily. And, my favorite part about the doctor, he ordered a mess load of blood work. But not without quizzing me on what one blood test was 'come on you should know this you're straight out of school.' To my eternal shame I didn't. I'd, in fact, never heard of the blood test (ACE) before. I know what ACE stands for and what ACE inhibitors are but an ACE test to see if I have sarcoidosis? I'm going to bet that test comes back negative. But he ordered so many flipping serum test, seriously they drew something like 7 or 8 tubes. I talked to phlebotomist while my right antecubital vein was squirting in the tubes (I'm sick that I enjoy hearing the blood spraying into a vaccutainer tube) and got info about which tubes do in fact need to have blood up to the black line and which can you cheat on and by how much. All in all that was a productive doctor's appointment. 

I've got to iron my scrubs, I seem to be the less than 1% that do this, and get ready for work.

the unfairness of it all

I was supposed to by working tonight but I got down staffed, which entails being called at the last minute and told not to come in because the patient census is low. Oh and yes I don't get paid, there goes a third of my weekly pay. So I'm at home, scarfed down some food (because I hadn't eaten since 1:30 last night, night shift makes me goofy in every way) and am watching Pretty in Pink with young, lovely Molly Ringwald and her full full lips and beautifully complex teenage characters. Andrew McCarthy looking impossibly young and earnest, and James Spader his perfect foil, the nastiest richie of 80s cinematic history. I just can't deal with Duckie because I never really liked that character in the film, found him annoying, and his current connection to Two and a Half Men, just intensifies my Dukie distaste. How do people enjoy that show? But I'm happy typing away while half watching and listening the eighties soundtrack of this movie.

Owen is the bacon warrior

So last night I got an admission as soon as I started my shift, I was working overnight. Admissions are time consuming and getting one when you first start work, it's like the kiss of death, it already made me feel behind in my work before I even started. My patient had a DVT (deep vein thrombosis) and would require argatroban (an anticoagulant) which would require me drawing blood two hours after I started treatment in order to monitor the patient's PTT and then titrate the Argatroban accordingly. Nightmare! I've never hung Argatroban, I've had a patient with a heparin drip once. I take any of these meds (insulin, anticoagulants, chemo) where you can basically kill a person by infusing at the wrong rate (one missed decimal point) very seriously. But when I looked on the computer to see what rate to start this medication at it required a dosing nomogram (meaning the rate of the medication is determined by the patient's weight, showing a formula of 2 mcgs/kg/min where the mcg/min = 0.01 mg/ml) I read that and was like what the fuck? Please tell me there's going to be more explicit information on how to hang this. 

Oona & I working on her sticker dolly dressing book
while waiting for the Dr to come and check out my back

I had calculated the rate and determined it would be 12.68 ml/hr but I asked another nurse to help me out because I felt the weight of losing my license if I miscalculated on this, not to mention the patient I could potentially kill. Now this nurse I asked for help, she can be a bit passive aggressive, at least I think that's what she's doing I'm not quite sure. She said to me 'I don't mean to insult your intelligence' when we were going over the calculation, which I did correctly (although she has said 'I don't mean to insult your intelligence' to me before, also at times when I don't think I'm being outright stupid, maybe it's her version of a non sequitur dig?)  Then she got short with me, like mother with kids having a meltdown short, because I was shaking my head in frustration at having to calculate this stuff, she was like 'You can't become this frustrated over this.' My response was 'I get worried when I could potentially lose my license and this isn't safe to just send up a label with a rate of 0.01 mg/ml and expect me to figure out the rate.' This belief that you truly learn and become better organized and handle stress well in these healthcare pressure cooker situations is absolute bullshit and I'd really like to see the culture change with the thinking. This nurse was very helpful in helping me call pharmacy to cover my ass and have the pharmacist verify that that was in fact the correct rate and then when he saw that the label didn't reflect this he said he'd correct that in the computer if I could get the doctor to resubmit the order so that it would reflect the patient's weight. Needless to say it got corrected and made a lot easier to figure out but yes I was very frustrated having to deal with that within the first three hours of my shift. Fortunately two hours in the patient was in the goal range for PTT and the patient was still in goal range with morning labs so I didn't have to titrate at all - phew.

I am a robot, well really a dinamap at the dr.'s office.
 Owen loved this contraption and took many a pic of it

I think all of my major issues at work are things that can affect patient safety and what I see as ambiguity or unclear things that can affect the nurse, especially the very busy overworked nurse, why not make sure the the actual rate is calculated and very clearly labeled on said medication rather than send it up and leave it to the nurse with four patients, one an admit, another about to get chemo and a third needing constant pain management to figure it out?! Let me go back to my Amazon example that I beat like a dead horse, they make it basically idiot proof to order a book and I think the same sort of idiot proof steps should be used in healthcare software systems, especially when it comes to high risk medications (meaning you have to have another nurse look at the meds with you).  I know that we as nurses have to think and be able to do math but for God's sake make the job a wee bit easier considering the stresses we're under every day.

Red white and blue day at school and I had nothing patriotic for my kids so
Owen decided to use a soiled cloth napkin as he red around the neck

In other unfairness news. Last week I came home from working night shift to be greeted by cat puke as soon as I opened the door. My cats are trying to kill me, with each and every darting step in front of my path as I walk downstairs. They are trying to break me. Not really but I am really having a tough time having them of late and am counting down the days til they expire. Cruel? Yes but I just don't have the energy for them with my present life, which feels a blur.

Oona's Winter Wonderland game, land on a yellow snow square and you lose a turn

Ooh, it's just at the end of Pretty In Pink where Andrew McCarthy spies Molly Ringwald across the room over the strains of OMD 'If You Leave'  and all will work out in the end even if that pink confection of a dress Molly designed is a nightmare, hopefully she didn't get the scholarship for fashion design. And Andrew McCarthy tells her he loves her, what did they have two dates? Ah, impossible young teenage love.

my never ending hair envy runs deep

There is other unfairness that I want to write about but can't. Unfairness isn't really accurate more 'the hurt of it all'? I have a very hard time if anyone thinks badly of me, strangers, friends, coworkers. I want people to like me and think good things of me; that I'm nice, bright, pretty, funny, helpful. I don't think this terribly strange, don't most people want to be viewed favorably by others? And the way I want to be viewed, well none of it implies power, or trappings of wealth, I think it's all pretty tame. My hair envy, yes I covet that blonde twisted hank of beautiful hair on the girl above but I would be pleased as peach just to have a decent head of shoulder length hair instead of the mange on my head. But then I look at the patients I work with and think maybe I should be happy with my dishwater mange.

This all skirts the real issue that gnaws at me, my quest to attain a body like Doutzen Kroes (I think the genetic cards are stacked against me). No, what's really gnawing at me is more reflective, scab picking maybe? I think the dissolution of a marriage is never happy, even if it is amicable. I think things are always viewed from two (usually very different) points of view. He said she said, he did she did or didn't do. There's going to be a world of hurt when people fall out of love. Anger, rejection, criticism, contempt. None of that is happy stuff. There are many extremely positive qualities to my ex, even if we didn't work well together. John Gottman, who's mentioned in Blink and this This American Life link is great at cutting to the heart of doomed marriages, but the inevitability of continuing to interact with that person you failed with when you have children, it isn't always easy. I think if you have children and once loved this person that you have to keep in touch with that, but this can be incredibly hard, perhaps impossible to do if you can't let go of your anger or hurt. I don't have answers. I just know that it makes for many messy, conflicting, strong emotions that might be good for writing fiction or poetry but are incredibly hard to sit with when they're not on the page.

flip turn

I'm sorry but I'm not one for moderation and once I get into something I tend to get tunnel vision and just focus on that thing for a while, which is why I can never ever play Sudoku because the one time I gave myself fully to that brain teasing experience (5 years ago over Thanksgiving weekend) I was ready to ignore my children and just focus on completing my boxes. I get driven in a borderline pathological way when it comes to sudoku, puzzles, well really anything where I feel I must finish it, the pressure I put on myself on things that don't really matter it's just sort of bizarre.

But anyhow, I am officially registered for my triathlon, which will occur on August 12 at 7:30 am - I'm gonna have a real hard time functioning athletically that early in the morning. My knees, ankles and feet have quickly adjusted to my running. I'm getting better with the swimming too. But my hips are in agony right now. I think it's all connected to my lower back pain, because it will radiate out toward my hips, it's like it rides an angry wave across the top of my ass and then veers sharply and goes down my hip and outer thigh, it is really uncomfortable today. I've taken ibuprofen and it isn't putting a dent in the pain so once I'm done typing this I'm going to slather my ass and thighs in biofreeze and go to bed.

A big adjustment for me with swimming has been learning how to do the flip turn, where you approach the wall and somersault then twist yourself back into position so you can swim yet another lap. Now three weeks ago when I decided to start this training I didn't even know how to do a flip turn, well to be honest I wasn't ready for a flip turn because I was catching my breath after each lap, but you can sort of intuit how it should work. None of reading about it on swimming related websites helped me glean more ideas about it. At first I probably looked like a deranged penguin. I was not graceful by any means, trying to guesstimate when I was close enough to the wall, pacing my breathing (that's the absolute hardest thing for me with respect to swimming) and trying not to get water up my nose. My left big toe still feels funny because I think I jammed it pushing off the wall a week or so ago.

But today I felt my flip turns coming together. I'm able to go back and forth four laps before pausing for a quick breather - I do realize I'm not supposed to pause for breathers in my triathlon so I hope to increase the laps I can do before breaking. I no longer hedge in the water wondering am I close enough to the wall or too close. And the very simple but incredibly rewarding part is when I do it perfectly and my feet push off the wall strongly and I'm not too deep so it's easy to break to the surface. It brings me back to the joy I had about swimming when I was a child. I love how quiet it is underwater and the weightless power I feel darting through the lane before coming up for air.

In totally unrelated news I'm already ready to call it a day with match. I went out to dinner with a very nice man who took me to a very nice restaurant (Umi, my Pittsburgh favorite) and he texted me after the date saying very nice things and how he looked forward to meeting me again. But, this will sound silly perhaps, but the man is conservative. I don't know how I can possibly get along with someone conservative, whose ideology is completely counter to mine. I support gay marriage, the right to choose, universal healthcare, assisting the nation's most vulnerable, not ravaging our natural resources by drilling, fracking or anything else that seems focused on short term gains and fucking our future generations. I know this is an incredibly simple way to look at it but conservatives seem inherently selfish to me, there's that inherent 'hands off it's mine' way of looking at life, or looking the other way when those less fortunate come into view. Like they'll blame them for the choices they made that got them into an unfortunate situation, and yes some people just make stupid choices or fuck up royally and repeatedly. But life isn't a level playing field. Some are born with advantages based on race, class, sex or intelligence. I mean Oona is six and she realizes that some people just don't have it as good or as easy as others and is it really fair to treat them poorly when they can't help being the way they are? Like I said before very simplistic but I don't know, what am I going to say on this second date? How will I broach the minefield that is politics? I get exhausted just thinking of it. Whenever I get a response for match it fatigues me. Not a good sign right?

And I started seeing my previous kind, smart, gentle but very passive fellow again. I don't know. I hate that he can lack confidence and basically be a doormat and let people take advantage of him but I feel like the reason I loathe these qualities in him so much is because I see these qualities in myself and I don't like to look at that. Who the fuck would honestly? So is that really fair? I don't have any expectations, in fact I've been explicit with him on how little I don't expect but that I want to remarry and share my life with someone, so tick tock if he's gonna get his shit together it better be sooner rather than later. But he can make me laugh like nobody else can. And he sees me in this light, well it's like he sees this beautiful, idealized version of me, he imbues all my actions with positivity, he doesn't criticize, he sees a me that I want to be, my best self, if that makes any sense. And I'm sort of like doesn't being in a relationship with someone who brings the best out in you trump everything else?

You still with me? So the picture which has nothing to do with what I wrote above. It's the light hitting my wall. It's like an ephemeral rothko, I love the blurry play of colors with the two weird parallelograms of screen. I wish my iphone had caught just how lovely this temporary play of light was on my bedroom wall. It was heavenly.

swimming

I passed the chemo test but I'm a bit disappointed with how I did on it. I should have done better and I messed up on a couple easy questions just by misreading them, I hate when I do that. Oh well.

In other news I've taken an ibuprofen and am getting ready to do my nightly ritual of biofreeze on my hips and thighs because they are aching. Why you might ask? Well because I've decided to start training for a triathlon. It's happening here in Pittsburgh in August so I'm giving myself almost three months to prepare for it. I started swimming again a couple of weeks ago, swimming I've missed you so much and I never remember getting this winded swimming as a child. Although when I was a kid I also wasn't swimming laps. I'm planning on signing up for a mini triathlon which will entail a 700 meter swim followed by a 12 mile bike ride, and a 5K run - why do they go back and forth between metric? I thought it was a 12K bike ride, my thighs are quivering just thinking about the extra distance. I also thought the swim was 600 meters not 700. Well I've been training doing blocks at the gym where I go from swimming to biking to running, which makes for a very sweaty and smelly me even though I shower after swimming so my hair won't be straw form the chlorine. I'm planning to buy a bike next month and get outdoors on some trails, I won't ride in the street what with the way people drive these days - yes I sound like a total curmudgeon, like I could be Ed Asner's character in Up. I'm hoping I don't make a fool of myself and drown in the swim part of the triathlon, that would be embarrassing. I really wanted to do it because I'm sick to death of doing the same old thing at the gym every day, especially when the hot guy has been MIA so long, well I've switched to the other gym location, where there's a pool, so I can focus on this triathlon goal. I've supplanted my eye candy fantasies with a goal, it's so healthy it's gross. I miss you hot guy.

In yet other news, on the romance front this time. I've joined match yet again. Third times a charm right? I'm thinking it's more like three strikes you're out and might as well depend on a battery operated toy for fun from now on. No. I don't know why I even signed up again. I have no free time to date. Really, if I'm not working I have the kids. I mean I have my days free right now but come summer that's gone so there's really no time to meet a potential match. After work you might say, well I'm basically an overtired, blathering idiot after 12 hours shifts, given to vitriolic diatribes on healthcare - not really gonna go over well on a first date. And my ideal match would be a doctor. Not because I want to be married to a doctor, and all the sort of social prestige that goes with that. No I want to get the MD through osmosis by being with a doctor, even if I know I won't really have an official MD. I just want to understand more parts of the massive puzzle that is medicine. Really healthcare is a such a huge part of my life now and I want to learn more so I want to date someone that I can learn more about medicine from, and who better to do that than a doctor, well at least a doctor that wants to talk about his job when he's not doing it, I don't know what percentage of doctors are like this (probably less than 5%?). Oh yeah and I need doctors that excel at their job, you know the outliers on the right side of the bell curve. I'm making the percentage of doctors who meet my criteria even smaller (<1%?). Oh yeah and they have to be compassionate, articulate and attracted to me. Now you see the seemingly impossible dilemma I face. In the interim I can reread Atul Gawande and dream.

But can I tell  you a friend, who doesn't know of this blog (not many people do know of this blog) who I knew liked me but, well, I'd told him a while ago, very clearly, that I didn't have romantic feelings for them. Well this friend wrote me a very long, very detailed letter about how he's liked me so much for so long and that I make him feel like a teenager, all very flattering stuff that was written to me. But what do I do, I do not feel that way about him at all. And I can't make myself feel that way. I wrote back right away explaining as much, because there's no way I'd ever leave anyone hanging after putting their heart out there that way (I mean I write back to everyone the writes me on match, even when I'm not interested to just say I don't think we're a match). It makes you very vulnerable putting yourself out like that, I get it and I wanted to acknowledge that while still staying true to my own feelings. So I wrote Thursday night when I saw the message and then again this morning (because recovering from work takes me days). And he won't write back. And I take it I won't hear from him and I guess he really wasn't a friend but just someone waiting for something more to happen between us? I mean I feel bad for him but I'm also sort of hurt, if I don't like you romantically then you won't interact with me? I know I'm not hurting as much a him but I guess it just makes me feel like I was almost lied to in a way. Like there was a duplicity beneath the friendship if he had an ulterior motive and won't be a friend unless that's fulfilled. Does that make sense to anyone?

I don't know why my romantic pursuits are so abysmal. Honestly the nicest, sanest, most normal boyfriend I ever had was probably the boy I lost my virginity to, my junior year of high school, he was ayounger man, a sophomore, a young born in August sophomore. A younger man who had an incredible five o'clock shadow at fifteen?! Eric was an absolute sweetheart of a boy and I fucking dropped him like a hot potato one drunken night and damned if I can find anyone that can hold a candle to that boy back in 1986.

Please don't misunderstand me and think I'm still carrying a torch for him. I've moved on and out of the eighties and he's a very lovely memory. I just wish I could meet someone I fit with so well who is also, well, solid, functional, emotionally healthy. I met a man I loved so dearly. Someone who was an incredibly good fit for me. He was what I always wanted in a man; someone equal parts funny, smart and kind. He was so loving and gentle and that was incredibly important to me during the point in my life that I met him. But it wasn't enough. His circumstances were, well convoluted might be the nicest way to phrase it. But I also realized after being with him that it's important that I'm with someone who's assertive (not aggressive). I also have to be with someone who is driven. Driven, to me, is passionate and I can't be with someone who is scared of living. I realize there are  people who might view me that way, as scared of living, based on my rather high strung nature but I actually face my fears head on pretty much constantly and doing that consistently has made me incredibly resilient, even if I don't necessarily present that way. I just need to find a kind, funny, smart, assertive doctor that is like tops in their field and thinks I'm the best, and I'm similarly smitten by him. How hard can that be? Until I happen upon Dr. Unrealistic I can fantasize about him while I'm swimming laps in the pool.

i've been remiss

I've got all these blog posts swirling around in my head but I haven't had a moment to type them out. Life is getting in the way, I'll butcher John Lennon's lovely quote 'life's what happens when your making plans' and say 'life's what happens when I'm thinking of blog posts' but the post are about life so it gets very meta? I don't know something that would have been masturbatorially discussed in one of my English theory classes in college. The endless litany of semiotics, signifier and signified and I just wanted to read and not let my love of reading be squashed with all the modernity bullshit.

Anyhoo, I've got big things to write about, not really BIG but the little big things of every day. But I can't do it tonight because I've got to take a chemo test in the morning so I'm chemo certified for hanging said cytotoxic agents.

But but but, I worked nights this weekend, trying to help out the team I switched from days because we were short staffed and let me tell you I had a moment on Sunday. I am no longer intimidated by the residents, in fact I had one arrogant son of a bitch resident that was giving me a hard time every time I paged him, which was often because I was having some issues with my patients. One patient told me they were hallucinating and I asked him to come up and assess her, 'What do you want me to do just sit with her? I can put in an order for Haldol.' No I told him I want you to come up and assess her before you decide to put in an order for Haldol. And I was firm without being bitchy. And he came up and wanted to give her Ativan, even though the nurse from the previous shift believed this medicine had caused her hallucinations. So I told him, no we're not giving her ativan. And then he's arguing with me that she can't possibly be hallucinating from Ativan and it must already be out of her system by now, blah blah blah I'm an MD. I agreed that it most likely wasn't the Ativan but the Ifosfamide that she had received as part of her chemo regimen (salvage ICE) because Ifosfamide can cause neurotoxicity. 'How do I treat that he asked?' Methylene blue I replied. And then he got mad because I had an answer for something he didn't know but I was quick to say, listen I'm new to this unit but I had a patient with Ifosfamide induced encephalopathy and he was treated with methylene blue, it's an MAOI strangely enough but does something very convoluted involving acronyms CAA & NADH that you can read about if you type methylene blue into wikipedia. I didn't tell him the bit about the CAA &  NADH and to look on wikipedia but everything else I did.

And then I called pharmacy, poor J- I was pestering him nonstop Sunday night, when he put in the Haldol order to find out just what the dose he put in was going to do to my patient, snow her which concerned me because then how would the morning residents, fellows, attending assess her for the neurotoxicity if she's out? I went in and she said she felt better and didn't want the Haldol so that solved that problem for me. But it's such a balancing act, nursing, ugh it's frustrating and annoying as hell sometimes. And I don't know if this patient's baseline was goofy (my euphemism for possible psych issues) to begin with, were there really hallucinations or was this attention seeking, maybe she needed a psych consult. And then there's the patient in another room that's had encephalopathy for how darn long and it still doesn't seem like it's being addressed, it was being blamed on acute kidney injury but that has since resolved but the patient, still very confused. And I'm thinking should I put a post it in the chart for the doctors to see saying 'Do you think an ammonia level might be a good idea?'. Because I don't have the patient right now but please they're testing for everything else maybe check to see if the ammonia is high, it could explain a lot. Well I've got to take my chemo test on the floor tomorrow at ten. Maybe I'll stick a note in there if I get a chance. They'd never know it was me and maybe that's the probably I could be the nurse equivalent of an elf, fixing things when others aren't looking. We'll see I've got to work on my math for this test first.

full

Totally wish I could go through life as exuberantly as my daughter does

Right now I'm typing with my belly so swollen and tight as a drum from having gorged on food as a way of stuffing down my myriad work related worries (and I'm off until Friday). I'm adjusting to work and it's getting easier but healthcare in general is a super duper stressful field, why else would there be signs for workplace counseling everywhere. I've gotten some very positive feedback but my mind is one that hones in on problems to fix, mine and system wide ones, which means I spend a great deal of time frustrated with things I think should be better. And then I'm attending to my patients needs, which I am happy to do. I haven't been getting so emotionally overwrought from a patient end because I can say with a clear conscience that I do the best I can for my patients in terms of care. This is when being a nervous, borderline OCD person works to my advantage. I am on top of my patients issues and make sure the doctors are aware of any problems too. I've become more confident talking to doctors (well the residents and fellows, I still fly under the radar with the attendings). But this line of nursing, while being incredibly rewarding, also sucks the marrow out of me, so then I feel bad and want to treat myself, even if it's ultimately detrimental for my health. I see so many overweight people in healthcare and now I truly get why they are overweight or smoke or become addicted to drugs or perhaps some combination of all three. I need to develop healthier coping strategies, and my car needs me to because my car seat looks like I'm incontinent of bowel and bladder with the many stains on the tan upholstered seats. The result of too many, cookies, brownies, or other chocolate treats and spilled caffeinated drinks marring the seat until it is now shamefully soiled, in a way no amount of OxyClean can remove.

So I'm an addict. I readily admit it, I'm a slave to sugar and chocolate. I've worn clothes from size 0 to size 12 and even when I'm my skinniest (at least with the sagacity of middle age I do realize, objectively, that I can get too skinny) I always feel and see myself at my heaviest. The fact that I eat in my car often enough to have destroyed my car upholstery, well it's a behavior overweight people do, shameful, 'closet' eating, although I know I'm not in the closet but metaphorically it's the same, in that it's sort of hidden in plain sight, but no one in the mile and a half drive notices how much I'm consuming. I hope to some day have a healthy relationship with food but I don't think I have since I was twelve. I peaked at twelve. I was cute and really very bright at that time. It was a brief sliver of time when my happiness far outweighed my worries. I spent all summer biking, swimming, playing gin rummy by the community pool, running around. I was on the diving team, eating huge lunches of cheeseburgers, fries and sodas and then having room for ice cream. I didn't think about what I ate or that amount, I just ate for pleasure or when I was hungry. And I physically was in the best shape of my life, my body was insanely fit, there wasn't an ounce of fat on me aside from my miniscule preteen boobs. I wore a string bikini and didn't think twice about it. That time was so idyllic for me but even back then I'd feel the worry nipping at my insides, I try to remember a time when that nipping wasn't there but I can't and that's not due to my memory being poor.

hipsta-love, posing in the sculpture garden on our walk to pirates game

I don't want to be a reactive eater but from the moment I wake up in the morning I'm thinking about food. Should I have coffee or try to wean myself off caffeine? Should I give up wheat and dairy because my eosinophil count is high and an allergist checked me but I have no allergies (really?) so could it be a sign that I'm intolerant of some food group? Should I try a juice fast for a few days and how would I survive said juice fast and work at the same time, it wouldn't be pretty. I'd been doing sprints up a hill in my neighborhood to try and strengthen my knees and hips in hopes of alleviating the back pain I've had for a year now, it's mild but it's always there and do you have any idea how annoying constant pain. It's more annoying than painful but that annoyance, well it's enervating. So I've been doing these sprints and feeling better until I decided to go to lulu lemon and try on the clothes there. Why I did this I can't explain since I really can't afford $82 work out pants and even if I could afford them, well it just seems wrong to buy stuff that pricey unless it makes me look like a goddess. But it didn't. The mirrors in that store were like some cellulite equivalent of a fun house mirror. I saw dimples places I didn't even know you could get cellulite, it was horrifying. I walked out and the sales girl asked if I was getting anything and I'm like hell no, I'm going to the gym that clothing session was thoroughly sobering. She said the lighting is awful there. Hmmm, lighting. 

my insane daughter looking like a muppet at the pirates game

I've gained ten pounds since starting work (3 1/2 months ago) and I know I need some 'get real' moment soon or I'll be heading towards a gastric bypass this time next year. My boobs and face look better fuller, everything else is looking not so good. And I feel awful. I'm so fucking tired. All the time. My vitamin D is low (12) so according to wikipedia (what did I do before wikipedia?) I'm falling into the rickets category or severe deficiency. Maybe this is why my back hurts. I don't know. I've got cod liver oil but I tend to forget to take it because I'm too tired in the morning or at night. The allergist was very serious and involved with me when I went to him, on my PCPs recommendation, because of my elevated eosinophil count (since March it's been twice the norm). But when he did the scratch test on my arms and I didn't react to anything, except the histamine control, which you're supposed to react to, well he couldn't explain why my count would be high, and then became dismissive, suggesting that maybe it meant nothing. 

Can I tell you how much I dislike doctors that become dismissive once they don't have an explanation for an aberrancy? Like they get mad at you that you and your problem won't fit into the expected norm for medicine? And maybe it's a result of starting Blink and reading about the fists or tiny slices that reveal a whole but I need a new Dr because when I'm explaining a problem that I'm dealing with all I feel is that this doctor doesn't want to take the time with me, like I'm the easy patient he can zone out on, or easily dismiss. My problem isn't a 'real' problem because I'm not hypertensive, obese and diabetic at 43. Because I present well and my issues are nonspecific there can't be anything seriously wrong with me, like it's normal to have a severe vitamin deficiency, have your eosinophil twice the norm, be in pain for a year and be exhausted. Sometimes I fucking loathe doctors. But I'm planning on healing myself for now, meaning I'm going to try really hard not to sweat the ten pound weight gain, with the window to weight gain (how I love The Simpsons) foods I've been eating with abandon I should be happy it's only ten pounds I've gained over the past three months. I'm going to exercise in ways I enjoy (aside from core strengthening, which I hate, but have to do for my back) and not solely from a I need to lose weight perspective. I'm going to try and listen to my body and feed it healthy foods, which in all honesty I don't think I've ever done. I've got my work cut out for me but I'm up for a challenge. I can look at it as my full body spring cleaning. I love to clean.

Living life so fully requires a lot of rest, asleep in my bed with her monkey

My daughter has nothing and everything to do with this post. Her personality is such the polar opposite of mine. I hope she never has these issues, that she continues to be so confident in herself. She's a very picky eater now, and she loves her sweets, but I don't think that means she's destined for food and /or body issues. I think many picky eaters grow out of it and are fine. I think food issues have much more to do with self esteem than pickiness. 

ilove

I am having major iphone love. One because it took me long enough to buy a smart phone and now after having one for less than a month I don't know how I managed before. And two because I finally figured out how ridiculously simple it is to sync my iphone with my macbook air through itunes and now I've got my icalendar synced to both and I am high off of organization fumes. I can quickly figure out the days I have free, when I'm working and schedule appointments without relying on my memory or my scribbles that I put on various bits of paper, which I then run around trying to find where they are or sometimes dumping my paper recycling to see if I inadvertently recycled them prematurely. This makes my life so much more manageable. And my third reason for loving the iphone, the camera, that was my main reason for buying it, and now my hipstamatic envy, well I no longer have to be envious although I do need a tuturial for the various lenses, I'm stuck in a green hued one. Now if I could only figure out what how to make the cute little black hearts on facebook. Or what pinging is.

epic fail

So this week I had a full day of chemotherapy class, in addition to my three twelve hour shifts, which means I qualify for overtime. And I will get overtime for the next three weeks because I have class every Monday morning from 7 to 4. Although I'm happy for the overtime that I'll get paid I don't know that it's worth it given how tired I am all the time. And I'm going to have a test on the many cancer drugs after these four classes and all this learning is making me really really dumb, it could be the exhaustion too. I think my IQ has been halved. I survived my two night shifts this week, thankful for that, I'm working the AM shift this weekend and then class on Monday and then back to an overnight shift on Tuesday, that circadian yo-yo is going to put me over the edge.

The nights this week weren't too bad though and it was my first time working since completing orientation. I'm now officially on my own, which is stressful but I've just accepted this whole first year is going to be super stressful and I'll probably need a facelift by the end of it. Being exhausted on so many levels is a great ager. BUT, all caps means is my blogspeak for tangent, I had people staying with me this week, I didn't even see them until last night due to my hours working. I haven't seen the one fellow in over a decade and the other, who I wasn't as close to, in who knows, maybe seventeen years or so? How can I put this delicately, the one I haven't seen in seventeen years, he looks bad. He looks easily ten years older than he actually is, he's missing teeth, he looks like an alcoholic, which I strongly suspect that he is. He crashed in my son's bed, which meant that last night my kids both slept in bed with me and I got next to no sleep. But as soon as they left this morning I put everything from Owen's bed in the wash and burned an oakmoss candle in his room because it reeked so heavily of smoke. The room reeked of smoke even though he had been smoking outside on my porch. Oh my, I really don't mean to sound judgmental or bitchy with this but it's sort of stunning how greatly your paths can veer with those you knew in your twenties. I feel like I have nothing in common with them anymore. I'm compulsively neat, cannot tolerate the smell of smoke at all (I hold my breath passing smokers), drink maybe a dozen times a year, have few friends and rarely go out, I'm fucking boring as all hell. I mean these guys are living a booze heavy lifestyle and when I see that now it just makes me sad (did I find this romantic in my twenties, was I really that stupid?) because I know where that goes, having seen how, for all my father's intelligence he amounted to nothing but a half million dollar mountain of debt with his death. Although, my father did have many friends, which is more than I can say and that always makes me think of the quote from It's a Wonderful Life 'remember no man is a failure who has friends.'  This man that looks like he's been on a bender since I saw him last seventeen odd years ago, he was very polite and thankful to me for my hospitality. And the thing that struck me the most, aside from his appearance, is that he drove from upstate NY to Pittsburgh, his face swollen from an abscessed tooth (I can only imagine how brutally painful that must have been) to help his friend cope with his father's death. I mean from a medical perspective I assess him and think, this guy's days are numbered given his lifestyle, but I don't know it's sort of touching he'd go to such lengths to help an old friend.  My friend whose father died came by train with his wife, who's pregnant and would have plenty of totally justifiable reasons to bitch or complain but she struck me as calm, cool, collected and infinitely patient. I was only on the periphery of their even staying here, having only saw them from like 9:30 to 11:30 last night and then briefly this morning but although I know I don't fit that lifestyle, have no desire to fit that lifestyle, I would like to have people I could count on being there for me to the extent his friend was.

The nights I worked this week I had the same patients both nights, one being a person who was recently diagnosed with HIV and then received a diagnosis of a certain blood cancer, I can't really think of two worse diagnoses to receive. Of course, when I first learned I would have this patient I got nervous and was thinking I'm gonna contract HIV. I know this is very silly and as long as I'm safe withdrawing blood samples for labs, which I always am, and avoid an accidental fingerstick, I'll be fine. And I was. Fine. But I feel like I have to be honest that when I initially learn a patient I'm caring for is Hep C positive or HIV positive I do a little freak inside. Until I meet the patient and then I exhale and realize I can handle this. Especially this patient, who was sweet and unbelievably appreciative and the patient's parents, completely adorable. There's certain specifics I'd love to note but I don't want to violate HIPPA. But I think when you see a person in this state and hear their parents mentioning things never said, I just see so much guilt and pain and lost opportunities that could have been avoided. Everybody means well but no one wants to hurt the other so years of stuff goes unsaid. I totally get that having been raised with repressed WASPs but I hope to God that I foster an environment of honesty and transparency with my children, if they feel they can come to me and discuss anything then I think that would be one of the biggest rewards and give me a feeling that I've done my job in being a good parent.

This job truly sucks the marrow out of me physically and emotionally but it is unbelievably rewarding in ways no other job I've had even comes close to. The only thing that drives me crazy is I want to know more. I read the patient's charts (like this patient) and I have so many questions why is the patient considered to be HIV positive and not have AIDS, the CD4 counts puts them in HIV positive territory but the lymphoma diagnosis could swing them to AIDS and how do you treat the lymphoma and not kill them by completely immunocompromising someone already immunocompromised? I'm confused. This is where I get antsy to be a nurse practitioner, to be able to talk and learn from the doctors more, because the hospital nursing, there's no time to really do that, you're so inundated with tasks, at least I feel that way. And I just have so many questions that go unanswered. But I'll look things up on my own and try to talk to residents or fellows when it seems like they're receptive  to questions and the cool thing is that some of the stuff I try to deduce on my own, through researching online, well it winds up being the right answer, which is cool. I want to learn more I just wish healthcare wasn't so maddeningly hierarchical. Okay I've got to go to bed now. Hope whomever reads this enjoys their weekend, please enjoy it on my behalf, the nurse who will run herself ragged this weekend. Have a drink or six for me.

not work related

Well work is still kicking my ass, I go through my night rotation this week and next so I'll be particularly logy but I'm not writing anything work related in this post. No I've been reading guilty pleasure books, my reward for stuffing so much oncology related information into my brain it will surely herniate from amount of information I'm trying to understand. So I decided to read Hunger Games, devoured that in a night, and then Catching Fire. I've got Mockingjay on my nightstand and started that but it's a bit slow going. And then I kept hearing about this Fifty Shades of Grey book. When I first heard about it I thought it was yet another young adult novel that had taken off with older adults. Oh how wrong I was. I finished it in a couple of days and I'm just so confused. I don't understand what all the hype is about (and there is a lot of hype, Newsweek has a cover basically related to the popularity of this book) because it's supposed to be a book about this guy being all into dominant/submissive relationships but, I don't know, it seemed really tame to me. And frankly insipid. I mean the writing is at that Danielle Steel level of perfect people although, to be fair, the author does make reference to Tess of the d'Urbervilles numerous times and I'm sure if you graded it on the Flesch-Kinkaid reading index it would be a level or two above Steel and Sidney Sheldon. But the protagonist in the book is named Anastasia Steele, honestly could you be more cliche you've got Danielle Steel's last name with an e added to it, why not pick a protagonist with a name like Ramona Lipschitz just to add some zing. And everyone is too perfect in this book, perfect looking, wealthy, oh and the really pushing the limits of suspension of disbelief, not only is Anastasia Steele a virgin, she has never touched herself. I think if I had read this in seventh grade it would have blown my mind with the sex stuff, but even back then I would have questioned the virgin who has never touched herself. And now I'm middle aged, divorced and I read Dan Savage every week. I guess I thought that this book would be racier, more of a book equivalent of a David Cronenberg film or the movie Secretary but for all the BDSM implied it's really pretty vanilla. I kept waiting for it to get to a really steamy passage and it never did and the main character is so fucking sanctimonious. The dominant lead, who is falling for her so he's falling short on his dominance and power play stuff, quickly doing these all these firsts for him, like sleeping, just sleeping with Anastasia, and letting her use his first name, blah blah blah. And this protagonist is such an annoying twenty two year old self righteous twit; she's all I can't take these first addition books that you're giving me, the audi, the clothes. Honestly this is like a completely unrealistic dream come true, you get a hot, young, insanely wealthy and powerful guy that's showering you with gifts, telling you how beautiful you are, that you bewitch him, plus he plays piano, speaks fluent French and can drive a helicopter. Oh yes, and he's great in bed?! I'd let him brand my ass if he wanted to. People settle for much much less. I guess this is what forty-three plus years and two kids turns me into, a pragmatist. If it's mind blowing sex I think I could very quickly become nonjudgmental about this fellow's kinks. Spoiler alert: The main character gets spanked, blindfolded and has her wrists tied (with a tie and cable ties) the climax of the story (oh my God reading about all this girl's many earth shattering orgasms I wanted to scream 'enough already', well that and her constant peppering of interior monologues consisting of 'holy crap' but the I don't know controversial/steamy end is when this girl is spanked with a belt and she ends the relationship because this fellow's way too fucked up for her if that's what he's into. Really? I mean I'm sure it hurt but um this is the shocking end? Okay, truth be told my sex life has been very vanilla so I don't have any idea what a truly dominant/submissive relationship is like. I've never been spanked (I think I would laugh if someone spanked me) or had my hands cabled tied or anything like what this female lead gets. But I'm like what's the big deal? I want to read about characters more flawed, more human and therefore infinitely more relatable and sympathetic. I'd prefer that this main guy was into something really dirty or weird aside from what I'm thinking are probably more pedestrian kinks, at least in the BDSM community. I mean I don't know I'm not a part of that community but I'm sort of curious what they make of the popularity of this book. I'm just confused by what shocks people (this book?) and what doesn't (how many people are unemployed/uninsured yet people watch the Kardashians?).

I tried to watch a porn film with a guy I was seeing once and we both had to stop it fifteen minutes in, it was that bad. There was nothing hot about it, at all. The people were unattractive and fake looking with teeth impossibly white, they were like Ross's teeth in the episode of Friends where he bleaches them and they're so bright they glow in the dark. And yes I get that it's odd that I would watch a porn film and focus on peoples teeth rather than their privates. I just don't find that stuff erotic at all. Nor this book. I find James McAvoy very erotic. And Hugh Laurie, mon dieu, House is ten times more erotic than this book. Oh how fucked am I that I think that? And watching Sigourney Weaver and Mel Gibson make out in The Year of Living Dangerously, that was insanely erotic to me as a teenager, not so much now that Mel Gibson became such a nutter. What else? the INXS video for 'The One Thing' that was a huge turn on to me as a middle schooler, it just seemed to epitomize debauchery. I guess reading the book made me long for those times when the blood courses so quickly through me it makes my whole body hum. For someone that makes me flush so readily (although I talk to anyone with MD after their name and I seem to blush- ugh!), who causes my breath to catch just by seeing them. I would love to have a relationship with someone who makes me physically feel like a teenager, who wouldn't? I think it's why there's so much infidelity, you meet someone who seems to notice and appreciate you and makes you feel young, that's heady stuff. Especially compared to the banalities of the everyday. I guess the real trick is to find someone who makes you feel that good but who you can share the banalities of everyday with. I haven't found that. In the interim, before I become a crazy spinster with cats, I'll lust after my guy at the gym, who I would readily let spank me. And if he bought me an Audi like Christian Grey does for Anastasia Steele (can you believe the names?) who knows what my hard limits would be, or if there would be any.

Ha, I write with much bravado but in reality, I wouldn't even let a man, a very distinguished older gentleman, buy me strawberries when I was in the checkout line at the Giant Eagle and they were some ungodly price when I thought they were on sale and I started turning bright red (like said overpriced strawberries) as the checker took forever to remove the strawberries from my bill and the man was insisting he'd buy them for me, 'Come on, they're good for your health.' And I'm pretty sure he was flirting with me but I'm like Temple Grandin when it comes to flirting, an anthropologist on Mars, and I was mortified taking so much time in the express lane and I kept getting more and more nervous and could not look at this man, who was like sixty but very kind. I just said thank you after declining his many offers to pay for my strawberries and ran to my car.

april fool

So... I'm sort of going back and forth with ending this blog because I think the things I'm writing about most people don't relate to anymore. When I started this blog Oona was one and my Grandmother had just moved here from Cape Cod. I was still married and a stay at home Mom, doing the odd freelance photo retouching job at home. I'm sort of astounded at how much my life has changed since I put that first post up. I've gotten divorced, gone back to school, gotten my RN and am working on a unit where I'm regularly accessing central lines, that burrow into internal jugular veins, tracing a path through the vein to lie in the distal third of the superior vena cava, nestled right above the heart. I've gone from wondering how I could ever manage to give a person a shot to wondering if I'd like to be a nurse practitioner specializing in oncology, because then I would be able to perform bone marrow biopsies, not from a schadenfreude point of view because this sort of looks terrifyingly painful but I've heard in the right hands patients don't really feel a thing. I want hands that sure, attached to a body that feels equally confident in my skills. That will take time, probably a lifetime, but I don't mind passing the years on that quest. I started my ninth week of orientation today. Oh what a difference nine weeks makes. When I say what a difference nine weeks makes, we'll there was one specific episode today that comes to mind but I'm like how do I explain this in a way that those not in healthcare can understand. I'll try.

I had a patient recovering from a MUD transplant, this is a bone marrow transplant where the recipient gets stem cells from a matched unrelated donor. It's really such delicate balance when it comes to bone marrow transplant, when it comes to so much in medicine, weighing the benefits versus the risks. The risks for graft versus host disease are increased with a MUD but some doctors want to see a little bit of GVHD in order to ensure engraftment (that the patient's body has taken on the new stem cells, which decreases the risk of leukemia recurring). The patient had neutropenic fever (spiking a temp when your immune system has basically been obliterated to take on the donor stem cells) and, my God if you saw all the IV medications going in. I was using all three of the central lines, going from antiviral to antibiotic to antifungal. Potassium and magnesium replacements, immunosuppressive therapy. And there were contact precautions so I needed to wash gown and glove every time going in an out. I went in to get vitals at 4 this afternoon and brought along a dinamap (a machine to take vital signs). So I put a pulse oximeter on to get the patient's oxygen saturation and pulse and the dinamap registers the pulse at 250. On seeing that number I think my heart rate and blood pressure quickly spiked. I palpated the patient's pulse and tried to count it. It was quick, definitely tachy (meaning over 100, it was about 126) but I wouldn't be able to palpate 250. There was continuous pulse ox in the room and I turned that on to double check. It started high but then dropped to right around where I palpated it, high 120s. But there was an image going across the screen, it looked like a rhythm strip (which is an EKG reading you look at for heart function). I'd seen it the other day looking like sinus tach but this one kept looking like the patient was throwing PVC's (premature ventricular contractions) and a run of two (bigeminy) and then three in a row and then it looked like a run of V tach - all of these are very bad to see on a rhythm strip and my heart was still in my throat over seeing the heart rate at 250 even if it was erroneous. I ran out and told the resident I thought he should order an EKG and then started saying what I saw. My preceptor is like how do you know what a run of V tach and bigeminy look like? Not meanly, she was impressed but sort of chuckling at me. The resident ran into the room. And then the other nurses are like, you can't get a rhythm strip off the continuous pulse ox - and they were right. You need to be monitored, which entails having five leads (stickers) hooked up to your torso smoke over fire (red lower left quadrant, black upper left quadrant), clouds over grass (green lower right quadrant, white upper right quadrant) and chocolate close to your heart (self explanatory). I had fucked up. Sent the resident, who's first day it was (wonder how he'll view me now) careening into the room. I felt like such a complete idiot and asshole. I was so scared by that impossibly high number (250!) it clouded my thinking. Maybe it was my own heart that was still having trouble calming down. He came back in and canceled the EKG. I was confused. I've used pulse oximeters plenty of times but there was never a faux incredibly similar to EKG looking rhythm strip attached to them. But I was able to laugh at myself and that's where the pivotal difference is in the time that's passed on the floor. I probably would have bawled early on but now, well I made a fool of myself but no one got hurt. And my preceptor is always saying I'm an excellent nurse, I think she's too kind, but her heart's in the right place and I think she sees that mine is too, that I'm trying my hardest to stay on top of things and keep my patient's safe.

There was a young patient that I wrote of earlier. I really liked her and her Mom. I came in one night having had her just the night before and I knew she was off. I can't explain it, it was just a gut feeling I had. I called the resident on call that night, twice. I kept trying to get her help because her heart rate seemed too high and she was breathing too quickly and she just looked bad too me. The resident blew me off, both times. Chalked up the high heart rate to anxiety. Even when I said 'But she got something for sleep and has been sleeping for four hours and just woke up and she's in the 130s?'. The resident walked in, walked out, did no more than an eyeball assessment then left. But I couldn't put the bad feeling away and went in shortly after the resident left, with the dinamap in tow, just to check her vitals again, to reassure myself. Her heart rate was 165 and her pulse ox was 88% (not good for someone who normally was around 97-98%). She was transferred to the ICU and died a week later. It had been the last day of my night shift. I picked up my children after school that day, it was so beautiful and warm, that we went to the park. A nurse anesthetist I know, our sons are friends, came up to me and asked how work was going and I was talking her about my week and I just wound up crying and talking to her and crying, I just couldn't stop crying, for well over an hour, in the center of the other parents, knitting and eating snacks, and the children running around. Angel, that's her name, truly, and she was an angel to me that day, listened. And she gets it because she's a nurse and it was so unbelievably helpful talking to her.

Angel told me to journal about my days on the job because then I can look back and things and see what I've done right and not beat myself up when I feel like I've fucked up. So I'm writing this post from my new macbook air (13 inches and light as a feather). Once I get Word on this I think I'm just going to puzzle this stuff out on my own. My dream is be to be the nurse equivalent of Atul Gawande, to be able to write that well about medicine, but from a nursing perspective. But I don't know that I can write this way on this blog anymore, it hurts my heart too much. I feel displaced in most every role I inhabit; mother, nurse, friend, other. Maybe I'll switch to pictures if I get around to getting an iphone.

If I was really clever I would have shouted, "April Fool's!" once the resident came back to the nursing station after running to the patient's room for the stat EKG I was recommending but I'm too flipping earnest to be a tease.

7p

7p is what many in the field call the night shift. Brevity being key in healthcare, as evidenced by the many acronyms of medicine that I now get all excited about when I actually know them. I've worked nights this week, my last 3 days are tomorrow through monday night. Back to back to back darkness. If all goes well I'll emerge, like a mole, into the sunlight tuesday morning around 8:00 give or take, to go home, pass out and pray that I can avoid ever working the night shift again. I will gladly work weekends, holidays, hell I'll even skip lunch if I have to, I do it most days anyway, in order to not work the dreaded night shift. Because I am a lady whose circadian rhythms are firmly entrenched in being up at daylight and I do not like abusing my body and psychological well being this way. There is a $1/hr shift differential for working nights, meaning, woohoo you get all of $12-$13 extra for submitting your body to the abuse of a probable carcinogen. I don't know, maybe $10/hr extra would make it worth it for some, but even then I'd choose not to work nights because it makes me mental.


I'm still trying to figure out where I fit in in the world and sometimes it just doesn't seem like there's anyplace for me. I am an admitted control freak and there are so many things at work, little frustrations that take up time and so much energy. The veteran nurses agree that it's a pain in the ass but say you just have to ignore it or get past it. But I'm like why can't we fix this so it works properly? I just see the waste when you let things go, even little seemingly insignificant things. Like what you ask? Well there's a small frig that locks, it stores medications that need to be refrigerated and when I shut the door it doesn't catch, meaning lock, so I hear this insistent beepbeepbeep and try to shut it again. And again and again and still beepbeepbeep. The heat rises to my face and I start getting flop sweat (with the actor that made me love Broadcast News demonstrating it so well below). I ask other nurses what to do. Oh you have to really slam it, is their reply. So I do that, to the point that the frig moves and still beepbeepbeep. Do you know how fucking annoying that is when you have to give a patient vancomycin 3 times in a shift?! And because I am new and I am ssslow and the beepbeepbeep of the frig is just the tip of the iceberg in terms of the obstacles I run into daily. Don't even get me started on how unintuitive and time consuming the computer charting is. Oh my. Hopefully I'll speed up in a year or two but this profession it's like, you're hired and then you're tossed into the deep end. I'm on orientation but it's so busy sometimes (all the time?) that my orientee doesn't really have time to sit and answer all my questions. It's like triage with the questions I can get answers to in a shift. And then I go home thinking, but I still don't know what to do about that or this and did I forget to chart that. It's maddening. I'm doing alright but there are such huge gaps in my knowledge and I am not okay with that. It terrifies me. Now, to be fair, I tend to see every goddamn thing I do wrong and very little that I do right and when I fuck up, even in a very minor, pretty insignificant way, it haunts me.


Another thing that haunts me. I get links from some nursing website through my email and one recently was an article about lucrative second jobs for nurses, because being a nurse doesn't always pay enough. Something I was unaware of in school but see on now that I'm working, I have met many a nurse working two jobs, which usually accounts for five or six 12 hour shifts, in order to make ends meet. And these nurses are older than me and I am flipping exhausted after my three 12 hour (really 13 hour) shifts. Good to know now that my student loans will be kicking in come May. And I still need to get a BSN and then hopefully an MSN, so I won't need a 'lucrative second job'. It's exhausting. The last time I went on vacation was in August of 1998. I went to Italy for a poetry workshop and had to come home early because I was sick- spiking fevers at night, I had no appetite (in Italy of all places!) and lost weight, had a rash and migrating arthritis. It wound up being lyme disease. Closing in on fourteen years without a proper vacation. Sure I've gone out of state for weddings or across the state to Kennett Square for the weekend of my 40th birthday but I'd like a week of mindless idleness under a warm sun where my raynaud's disease is kept in check and I can wear some sandals, take pictures of a different landscape, play with my kids and buy some souvenirs.


All that's missing is my pale body, plenty of sunscreen and a good book.

in the mind of oona

Lucky Oona got puked on yesterday. While getting ready to leave for the day the boy whose locker is next to hers puked and it sounds like Oona and her backpack bore the brunt of the vomit. Driving the kids home I tried to breathe through my mouth to avoid the smell. But although gross, this is also somewhat exciting for Oona because it's a story to be told, where she has a starring role. I put her in the tub for an early evening shower, due to the puke, I figured it best to wash everything including her as soon as I got her home, out of the blue Oona said, "I love Grandma Cat. I ask her questions and she answers them for me." apropos nothing. I could be biased being her mom, but she'll come out with these little gems sometimes. Sure they're a bit off grammatically or round about, archaic perhaps? but that's part of their charm. Or she comes up with an entirely new and ultimately more fitting word, like booby trap for bra. She frequently says things in such a way that I'm hitting myself for not running around with pen and paper to quote her and then I'm mad I'm not a good enough writer to write a novel and pepper it with her dialogue because she is a memorable character. After she was all squeaky clean and in her favorite pj's, fleece pants that are covered in all varieties frosted and and sprinkled donuts and a purple top saying something about loving cupcakes, she hopped onto my lap while I was paying bills online, wanting to do the photo booth. She's a sucker for the effects and mirror is her favorite, which caused her to rhapsodize about how she would love to have a twin because then she would always have someone that wanted to play with her because I'm usually too busy working (ooh, little guilt dagger) and Owen doesn't like to play with her. Then she wondered aloud if her soon to be Stepmom might give her this longed for twin. I told her that twins usually come about the same time that you're born but Oona has a mind that's quick to push aside such pesky details as logic.