New Grand Rounds up

The day off and a new Grand Rounds. What could be better. Check it out over at Musings of a Dinosaur.

Remind me why I work here?

I keep telling myself that it would be so much nicer to do three 12 hour shifts and call it a week. Back in PICU, where patients are small and the body fluids are cuter. None of this call crap, driving all over the state in my ancient car which needs a ton of repairs(and new tires). Most of all, I hate the bullshit that accompanies my job. I haven't ever really worked a corporate job before. In the hospital, if you pull your weight, your peers respect you. People care that you can handle an emergency and that you show up when you say you will. If someone doesn't like you, you pretty much know it.

I have never worked with the amount of complaining and backstabbing as I do with this job. It makes me nuts. You would think that working with death and dying would give people some perspective, but alas, it is not the case. I'm starting to think that someone who I don't get along with is starting to sabotage my reputation-but that'd be CRAZY TALK, right? I mean, we're all adults, right? I'm not usually paranoid, but this week I was totally ready to walk.

Anyway, I went in today and talked with my peeps. That's right, I got peeps. They gave me some perspective and cheered me up. I love my team. I really do love my job. We also got to dissect some discarded organs today too, for an anatomy lesson and that made me happy. Tonight I'm going to get some rest and gear up for my last weekend on call for this cycle.

Oh, and check out Change of Shift over at Protect the Airway. There's some good reads.

Studiously avoiding work...

By reading Grand Rounds. Love the Oscar Theme, BTW. Like Anna Nicole Smith and trainwrecks, I just can't not watch.

1 down, 2 to go

I woke up before anyone else this morning, so I actually have a chance to do some writing. Yesterday's OR went fine and I was home in time for The Soup...mmmm, mindless viewing. We had some glitches...I can't go into everything, but it involved one doctor giving another doctor a piece of his mind for a good 10 minutes while I held the phone(doc on the recieving end was scrubbed in). Both attendings. It was nice not to be the one yelled at for once, usually the TC bears the brunt of everyone's frustrations, but I felt for him.

My last 2 cases that I've gone out on have pretty much been to relieve a coordinator who'se already gotten consent and manage the patient until the OR and then do the OR. It's nice not to be emotionally involved sometimes, especially after this case. You don't always get what you want, but sometimes you get what you need. So I guess I've been given a little break to recharge my mental batteries.

And I love going to the OR. I only worked there for a year-I just like clinical management too much to stay in the OR. I like being in the ICU with the patients and following them day to day. I hope to go back to school soon and get my nurse practitioner with maybe a first assist on the side. When my first daughter was little, I though long and hard about going to med school, but I didn't know if I wanted it enough to devote a decade of my life to it and all the sacrifices that'd go along with it. Once you're a doctor, you can't really turn around and say, "well, I have a million dollars in unpaid student loans, but I think I'd really rather be an artist." I think there's still a frustrated surgeon lurking inside me...it's so amazing to be inside a person, really seeing what anatomy looks like and cutting and sewing and fixing things. I'm still bitter that nurses don't get gross anatomy or even a look at a cadaver cut open once. (At least at my school.) But that's me-the happiest day of 5th grade was when I learned we'd be dissecting frogs.

Anyhoo, last weekend was really quiet and I'm due for an allnighter-we're already pretty busy this weekend, so I'm gearing up for anything.

My weekend

Last weekend, I was on triage. Want an idea of what that's like? Read here. In the meantime, I'm in a holding pattern. I have a young donor and we're going to the OR at 1500. I was just complaining the other day that all my OR's seem to be at 4am. Fortune has smiled on me today, Hopefully, God willing and the creek don't rise, I'll be home in time for The Soup.

I'm thinking of doing a post on the ethics of who gets listed for an organ. Should drug addicts get a new liver? More to come, but I'm interested to hear peoples stories on the matter.

Grand Rounds

Dr. Couz does a great job at Grand Rounds this week. Take a look and you'll find out about the human beings behind the labcoats.

When you watch a child die

People take a surprisingly long time to die. I have seen frail, elderly persons on morphine drips go for days, every breath sounding like their last. When we do a DCD, we never really know how long it’s going to take for that person to cardiac arrest (aka die). We might have a good idea, an educated guess, but no one, except maybe God, knows for sure. I’m up front with the family about this. If the patient doesn’t die within 60 minutes, they can’t be an organ donor. We don’t bring up donation until after the family has decided to withdraw care. Then they’re placed on comfort care, an IV drip, usually a narcotic and a benzo, like morphine and ativan, so they won’t suffer as they die. The DCD donors that I’ve had didn’t have much neurologic function at all and I don’t know how much they really feel, but just having an intact brainstem will make your breathing ragged and gasping and it’s very difficult to watch if they’re not sedated.

It’s weird to get up in the middle of the night to go to work. Triage called me at 1900 yesterday to give me a heads up. Another TC and her orientee were doing a DCD donor and our policy states that two TC’s need to be present for a DCD, or a TC and a hospital services manager. Orientees don’t count, although this one has a good head on her and a lot of nursing experience. Even so, would I go and help them for the OR? The logistics of a DCD are a little complicated, one person usually does the ICU/family support part and one person gets the OR ready and has the teams standing by to start the recovery after the patient arrests (dies).

I tried to nap but I was too wound up. I called triage back to get the info on the patient. I already knew it was a PICU patient, but I found out it was a 5 year old. I reminded myself that I was only doing the OR. I did four DCD’s last year, the youngest was 18 months. That one was grueling. Through a series of misfortunes, no organs were transplanted, which is really heartbreaking when you see how much it means to the parents, who are so desperate to see something good come out of their tragedy.

At 0130, triage called me to say the OR was at 0330 and would I please be at the hospital by 0300. The hospital was 45 minutes away, but I didn’t have to shower and my bag was ready, so I snuggled up next to the baby and tried to sleep for another half hour. After twenty minutes or so I knew it was hopeless, so I kissed her and got up. Love Monkey was still awake, the night owl, so I kissed him goodbye and left. I gassed up the car, got a cup of tea and started the drive. I made it there in no time at all, given the hour. On the walk up to the unit I passed clusters of family, crying quietly.

I walked in and found the TC, her orientee and the hospital services manager, who was quite cranky to still be awake. Those girls do keep better hours than I do, usually. Why was I here? I mean, the orientee is no idiot and she probably has more nursing experience than the other two of us combined. And HS, well, she looks very cute in her scrubs and she does know the hospital, but really we only needed two of us, not four. I’m a big believer in keeping a low profile on the unit and not having a big gang of OPO personnel hovering around.

All right, to make a long story longer. I guess I need the catharsis because believe me, when I got home later in the morning, no one wanted to hear about a dying five year old. I went to the OR to make sure every thing was ready. The staff had done a nice job of setting up an empty room with chairs, dim lights and some low music playing. I was not eager to meet the surgeon. The last time I did an OR in this same hospital, with a pediatric patient, he screamed at me in front of everyone. I introduced myself when he came in, I’m not sure if he even remembered me. The tech was one of my favorites. We went over the case and the plan for extubation and pronouncement. The doc showed his humanity when he started talking about recovering from a little kid. I guess I forgave him then for the screaming.

The music was courtesy of us. Last week I was in the office and saw one of my coworkers sitting on the floor next to a CD player listening to some soothing musical interludes. “It’s music to play during DCD’s”, he explained. “Do we have to use it?” I asked. “Oh, no, it’s just if the family wants.” I quipped that I would rather have some Led Zeppelin playing when I passed, would he please keep that in mind in case I was ever a DCD. Cause I’m really not an easy listening fan.

Back in the OR, the staff was counting instruments, the tech was pounding ice and the surgeon was getting ready to scrub. I was the lookout, to tell them all to be quiet at the first sign of the patient and family. I kept thinking about the time I was the lookout at my sister’s wedding shower and she walked through the other door and the surprise was ruined. This was like waiting for some dreadful party to begin. And they did come in from the opposite direction. I wasn’t ready for what I saw. I guess I was expecting a crib because I’d heard she was small, only 15 kilos. Instead, the staff pushed a bed with a full grown woman in it, her mom, wrapped around the little girl like the pod around a pea. A train of people followed in their wake: the intensivist, the resident, both TC’s, HSM and the little girl’s grandmoms, holding on to each other.

As soon as I saw them turn the corner, I ran into the OR and told everyone to be quiet. The other TC had told me earlier that she expected the girl to go quickly. They got everyone settled. I handed the paperwork to the orientee. If you don’t know what else to do, grab the clipboard and keep track of everything. We had to write down all the times: time in the room, extubation, q5 minutes vital signs, time of pronouncement. The PICU nurse would monitor the drips to make sure she was well sedated. The intensivist walked over to mom and whispered something. She nodded and a minute later he pulled the tube. Mom was crying and kissing her. The grandmoms were crying. I was crying. I kept thinking how I was snuggling my own little girl just an hour before.

See, that’s the problem with having this job and an active imagination. I am always thinking of ways I could die, my husband could die, or the kids could die. It’s a morbid hobby and I go to it the way your tongue seeks out the empty space when you lose a tooth. Give me a situation, and I can find the danger in it. It makes my husband crazy and I’m not sure it makes us any safer. I mean, how much can you worry about? When I worked in the ER, I started to go a little nuts thinking about all the things that can go wrong, all the freak accidents that happen. When I got this job it made me more at peace, for a while, as it made me appreciate what I have. Recently, though, it’s been getting to me again, so I just try and redirect my focus until it passes.

The little girl is still taking agonal breaths in her mother’s arms. My tears have dried a little and I’m starting to wonder why this is taking so long. The other TC was certain that she’d die “right away”. The pump with the morphine is binging and then I realize that the primary ICU nurse is not in the room. She’s out in the hallway. The intensivist goes out and gets her. As discretely as they can they try to get the pump working again. By now, we’ve been in the room watching this little girl die for about 15 minutes, but it seems like hours. A few minutes after the morphine pump is fixed, her respirations taper off, then stop all together. The doc takes his stethoscope and listens, then feels for a pulse. He nods to the nurse. I look over at the other TC. She’s comforting the grandmothers and doesn’t seem to realize the little girl is dead. We only have 5 minutes from this point to make the incision. I walk over to mom, who is kissing her daughter’s forehead. I say gently, “Mom, it’s time.” Then, my coworker comes over and I start to take off the leads and other wires that attach her to the monitor. She picks the girl up in her arms and the nurse and I detach and grab as many lines as we can: foley, numerous IV’s, A-line. We walk as quick as we can to the OR next door. Someone stays behind with the family. We get her on the table and the OR staff springs into action, putting the grounding pad for the cautery on her lower back and taking her gown off. I’m helping untangle the sheets and I find two Matchbox cars rolled up in there. I try not to lose it.

The surgery starts and I go out in the hall to collect myself. The family has left. The other TC walks over to me and says, “Well that went well!” I just look at her. I know what she means-everything went off without a hitch. No problems getting pronouncement, having comfort care started or getting the OR on board. No surprises. And you do get a “high” when you’ve been up all night, running around and juggling a million things. But to say that watching a 5 year old die went well is a stretch for me. Especially when I hadn’t even planned on being in the room, hadn’t mentally prepared myself for all that. That’s just her way, she’s bubbly. The tech comes out and she’s still effervescing. He looks at me. “How’d it go?” He asks. “It was horrible.” I say.

The OR goes fine, Again, I’m not really sure why they needed me, her and the orientee are doing fine. When it’s all over they wash the little one and put a gown on her again, because her mom wants to see her afterwards. I pack up to leave.

I’ve only been out for 7 hours, but on the ride home I’m wiped out. I crank up the radio and Stone Temple Pilots fills the car. The last pediatric DCD I did was an 18 month old who died in a house fire, his mother found lying on top of him, trying to protect him. They were both organ donors. I try to imagine being at the funeral of my husband and baby, the numbness, the endless line of people offering words of comfort. I force myself to stop. As Atticus Finch said in To Kill a Mockingbird, that’s the kind of thing that leads to slow, steady drinkers.

Instead, I start thinking about what kind of music I’d like to die to. I was joking when I said Zeppelin, but now I reconsider-maybe the Rain Song would be nice. After that, I’d pick Beethoven’s Eroica, which I got as a Christmas present one year from my husband, because he said it reminded him of me. Again, I try to think of something else, but in the end I just crank the music up even louder. I want to share this whole night with someone, but how can I tell anyone these things that I see? Sometimes after work I have to choose between being down and bringing someone else down with me. Who wants that? So I just keep writing about it.

The Year in Review

It's a happy, happy birthday to Donorcycle! Just one year ago today I wrote my very first post. Now I'm out of the baby blogger stage and am into the terrible two's-not unlike a certain baby I know.

And, it's official-YOU are donorcycle's person of the year!

Give yourself a round of applause! You deserve it!

I thought I would give you some of donorcycle's best writing(IM not-so-HO). Mostly cause I'm lazy and still haven't finished my new post that I'm working on. For your reading pleasure....

From March 8th, 2006 Fill 'er up

You gotta fill her up with light!

You gotta fill her up with spirit!

You've gotta fill her up with faith You gotta fill her up with heaven!

You've got the rest of life to face ...You've got to fill her up with love!-Sting

The first time I saw Baby Mia, she was more tubes and wires than baby. At 6 months old, she weighed barely 6 kilos. The very first thing you noticed was her enormous, brown belly. She looked like a python that swallowed a pig. Her arms and legs were little, dry twigs. She lay motionless, a tiny speck in a hospital bed, intubated and sedated.

I was still on orientation to the PICU when I met her. It was the first time I had taken care of anyone so small and so sick. In the beginning, it was all I could do to manage her lines and tubes. She had a broviac catheter in her chest, an A-line and endotracheal and naso-gastric tubes plus several IV's and a foley catheter. Following her surgery, she had a draining T-tube. You see, Mia was born with several disadvantages, some medical and some social. Her mother was a drug addict who never received prenatal care. Mia was born addicted and placed in foster care shortly thereafter.

At a few months old, she became increasingly ill and jaundiced. She was diagnosed with Biliary Atresia, a condition where bile flow from the liver to the duodenum in obstructed. Bile accumulates in the liver causing scarring and liver damage. Without surgery a child will die. In addition, half of all these patients will need a liver transplant by age 2 and 70% will need a transplant by age 20. Mia had had her surgery and was now bombarded with complications: pneumonia and infection. When I met her, she was at her sickest.

Fate, luck or angels had given her one break, and she was named Teresa. Teresa was an older, married woman who had already raised her kids and was now a grandmother. For years she had been taking in medically fragile foster children who were hard to place. Nurses with more experience told me how several of her foster kids had died from AIDS. Now she had 2 children she had adopted, both with developmental delays and multiple medical problems. She sat at Mia's bedside day and night. I remember her as always calm. She was in the middle of embroidering a complicated baby blanket for Mia. In the middle was Noah's ark and the border was made up of all the animal pairs. I can see her now, just sitting in the window seat, pushing her needle through the fabric. She'd look up and when we came in and ask about Mia's progress.

I hadn't taken care of Mia for a few weeks when I was assigned to her again. By this time she was extubated and awake. The change was profound. The minute I walked in the room I was greeted with the biggest smile I had ever seen on a baby. She still had a million things in her or on her and her belly was still the size of Rhode Island, but she was happy. Slowly, as the days progressed, we saw less lines and more Mia. One night my preceptor said she needed a bath. She was still so tiny that we just filled up a wash basin with an inch of water and sat her in it. She loved it. Teresa would help out, go home to her family for a few hours and come back for the night. By now she could hold her and give her snuggles and Mia always had a smile. Sometimes, her siblings would come for visits. She adored them and they couldn't get enough of her.

I couldn't get over it. It made me think about all the little complaints I'd have in a day-my feet hurt or I didn't get a dinner break or whatever. Here was a baby who had only known hospitals and surgery, fevers, being intubated and stuck with needles-I don't know if I'd even want to go on after all that, but here was little Mia smiling through it all. Eventually came the day for her to get transferred to the regular floor. She was listed for a liver transplant, but would be stable enough to go home. She was about 9 months old and still couldn't sit up or crawl and she didn't really make any sounds but she could still light up a room. I didn't know if I'd ever see her again.

Eventually, I left the PICU to become a transplant coordinator, a job I had wanted since nursing school. One day I went back to the hospital to pick up some things. I ran into Teresa, Mia and the whole brood on the elevator. Mia was then 6 weeks post transplant. Someone's gift had given Mia a new life. She looked like a new baby. She was chubby in all the right spots and her huge belly was gone. She was sitting up and reaching for things and cooing. And she still had that radiant smile.There are days my glass is half full and days it's half empty. There are even days when I think my glass is dried up and I remember Mia, whose glass is always overflowing.

Mulling it over. In the meantime...

I am working on two long-winded and difficult posts. I keep mulling over in my head how I want them to sound and what I should say. In between call periods and chasing after a toddler. When did my Laughing Baby turn into a Toddler Tornado? In the mean time, I'm posting this link that I keep reading and rereading. I find it helps me when I start questioning my choice of career. I'm going to start carrying it in my go-bag, too. Enjoy. I have to shovel out my house.

Carnival of Hope

Carnival of Hope is up at Rickety Contrivances of Doing Good. I'm especially fond of the lead story, about someone who recieved a heart for Christmas. The link doesn't seem to be working at RCoDG, so try here if you can't read it.

It's my new favorite Carnival....I can't take depressing anymore, so I've moved on to hope. Maybe I'll even write for it one month.

Please don't feed the residents

Back at work with a bang. I knew that I would be called out first, because the last call period for my team I took some ETO time. That means I'm "fresh". I don't feel fresh...Laughing Baby, aka Skootch, has been sick since Christmas night. Even with LM staying up with her during the wee hours, I still feel like I haven't slept in a week. Last night was really bad, the poor wee one had a bad case of the snots and couldn't nurse and breathe at the same time, leading to much unhappiness. The 5am wake up call was very early. I knew I'd be out all day, so I did something I don't do much-I had a cup of coffee. A whole cup where normally I drink decaf. I'm still jittery. And yet, desperate for another cup.

I have a donor, middle aged woman who had a heart attack from a probably accidental overdose(I know, no such thing, you cynics). Her mom is so sweet, she's staying until we go to the OR, which is set at 0300. Please don't even get me started on the surgeon who really could have been here at midnight. The OR was hit with a bunch of level I cases and couldn't take us at midnight anyway, but I'm still sore about it. Do you have any idea how punchy I am at 3am? Even with a good night's sleep? I'm trying to think about my happy place and hope I don't get into a screaming match with him. Please pray for me.

On a happier note, I did inherit a very unstable pt this morning when I arrived. In 12 short( or long) hours, I have gotten her sodium down from 178 to 148, her chloride from 139 to 119, her pH from 7.19 to 7.38 and she is almost off the 800 pressors she was on this morning. Well, with help from the great nurses and my medical director. But, still. Happy, stable donor(knock wood), just like I like 'em.

Anyhoo, the punchiness is beginning, because I'm starting to fuck with the residents. No, seriously, I was waiting for the down elevator and this tall, handsome resident hits the up button. He smiles at me and nods and I think, "Holy, shit! I think he's checking me out" He says, "Hi, you medicine?" I look at him cooly and say, "No, transplant." I get on my elevator and leave him standing there. Ha. It's the second time today I've been mistaken for a doc, but I think that only means I look nerdy.

What I want for Solstice

I recently wrote this for a newsletter I write for monthly. I thought I'd include it here.

What I want for Solstice

My family

CD’s:
Beck-the new one
Sting-the new one
Hiromi(Japanese Jazz Pianist)-Brain

Tix to a Chorus Line on B’way

Ayun Halliday’s –Mamalamadingdong

Book on CD-anything by Wayne Dyer but especially The Power of Intention


This started out as a wish list. A new baby sling. The latest in organic, ecologically-sound, pesticide free woolen baby jammies made by indigenous orphans. That sort of thing. I start to berate myself. “Sure,” I tell myself, “you can wrap it up in an alternative package, but you’re still selling consumerism for the holidays.” That’s no way to celebrate. Especially when I really love this time of year. I like when it starts to get cold and you have to bundle under the covers again. I like Solstice. Having depression, the longest night of the year is very symbolic for me and I like to do a little Solstice magick. I even like Christmas Eve, lapsed Catholic that I am, because when I was little, Christmas Eve seemed like the one night when anything was possible. Improbably, that feeling has managed to stay with me.

Love Monkey and I discuss (read: argue) what, if any Christmas traditions we’ll follow and whether or not we’ll perpetuate the Santa myth. It gets heated at times. Meanwhile, the little one is agog at the displays that are going up. Late last night we made an emergency cranberry sauce and eggnog run. As I was busy rushing around the aisles and trying to avoid the other frantic shoppers, I noticed her looking up. On top of every aisle they had those enormous, lawn displays. You know, the big obnoxious ones that require a generator and a team of elves to set up. The whole horror show. She was delighted. I tried looking at them from her perspective. Bright, garish, full of movement and noise. She doesn’t know a reindeer from a rooftop, but she knows fun when she sees it. Suddenly, this tacky display turned into yet another amazing thing that the world has to offer. We walked around for awhile with our heads up in the air, taking in the sights and forgetting the cranberry sauce altogether. She made the other shoppers laugh and then I’d catch their eye and we’d smile at each other. A miracle of the season-holiday shoppers being nice to, instead of trampling, each other. All brought to you by a little child. Maybe those wise men were on to something.

So whatever you’re celebrating-have a happy Kwanzaa, a joyous Diwali, a bright Hanukah, a meaningful Eid-al-Adha, a merry Christmas, a jammin’ Junkanoo, a beautiful Bodhi day, a shining Solstice and most of all peace, love and happiness in the New Year.

Merry Christmas

I am off for 8 lovely days over the holidays. Last night, we went to Mom's for the Feast of the 7 Fishes. It's an Italian thing, but it's not really the same since my Grandma died 2 years ago. Tonight, we're cocooning and staying in. I'm playing domestic Goddess and cooking, which normally Love Monkey would do and does better than me. It's always "Alton, this" and "Alton, that". But I digress.

Christmas menu: Veggie platter with dip
Roast chicken with gravy
Yukon Gold mashed potatoes
Corn bread pudding
Artichokes
Various Christmas cookies

If you want to stop by, we've got plenty. But bring something to drink. Now I've gotta go make the gravy.

Happy Christmas and a Joyous New Year!

Why I hate email

I get a lot of chain email and I hate it. Even the nice ones. Even the ones that bring a tear to my eye. Here’s a recent email I received (in yellow):

The story goes that some time ago a mother punished her five year old daughter for wasting a roll of expensive gold wrapping paper. Money was tight and she became even more upset when the child used the gold paper to decorate a box to put under the Christmas tree.

I mean, how expensive was this paper? $3.99? $5.99? $10? $20? Was it made out of solid, freakin' gold? Even at twenty dollars, is it worth screaming at your kid? If times were so hard, why did the mom have this fancy-schmancy paper? Why didn’t she use the funny papers or plain paper that she stenciled or had her daughter draw on or something?

Nevertheless, the little girl brought the gift box to her mother the next morning and then said, "This is for you, Momma." The mother was embarrassed by her earlier over reaction, but her anger flared again when she opened the box and found it was empty. She spoke to her daughter in a harsh manner. "Don't you know, young lady, when you give someone a present there's supposed to be something inside the package?"

Again, is this worth your anger “flaring”? And if the little girl didn’t know that presents should contain something, well who did she learn that from? To berate her on Christmas morning, for God’s sake. Ok, maybe she had a good reason to be cranky. Maybe she’s a single mom, and she’s stressed from working nights and trying to keep it together for Christmas and daddy hasn’t paid the child support in 3 weeks and she was up all night putting toys together and she hasn’t had coffee yet. Maybe she had just explained for the three hundredth time that she doesn’t know what time Daddy’s showing up and that even if he could afford a pony, ponies can’t live in apartments. Hey, I’ve been there.

She had tears in her eyes and said, "Oh, Momma, it's not empty! I blew kisses into it until it was full."

Ok, here’s the payoff, the reason you read these sappy things and then wipe your eyes when no one’s looking. A lesson for us all.

The mother was crushed. She fell on her knees and put her arms around her little girl, and she begged her Forgiveness for her thoughtless anger.

Oh, don’t worry. The lesson’s not over yet.

An accident took the life of the child only a short time later, and it is told that the mother kept that gold box by her bed for all the years of her life. Whenever she was discouraged or faced difficult problems she would open the box and take out an imaginary kiss and remember the love of the child who had put it there.

See, why can’t we just have the box full of kisses? No, instead we have to be beaten over the head with the message-Cherish What You Have. Don’t Take Your Loved Ones For Granted. And, of course, Kisses are Worth More Than Gold. Do you notice that someone dies in a LOT of these stories? Maybe she died because her bad mother didn’t deserve her anyway. Or she had to pay off some of her mother’s karmic debt, which, frankly she’s been racking up by the bucket loads. But most of all, she died to teach us a lesson.

I get it already.

In a very real sense, each of us, as human beings, have been given a Golden box filled with unconditional love and kisses from our children, family, friends and GOD. There is no more precious possession anyone could hold.

Well, I don’t know about you, but the love I get, as well as the love I give, is pretty damn conditional. Because that’s what you get from other, imperfect humans. Maybe God gives unconditional love, but you wouldn’t know it from a lot of religions out there.

You now have two choices: 1. Pass this on to your friends, or2. Delete it and act like it didn't touch your heart. As you can see, I took choice No. 1. Friends are like angels who lift us to our feet, when our wings have trouble remembering how to fly. If you receive this more than once in return just know that your friends have also thought of you!

If you’ve read this far, you probably think I’m a total scrooge and maybe a cynical bitch, to boot. Here’s why I really hate these things. It’s because it gives us a false sense of closeness. I call it the “Aw, shucks” factor. We read something like this and it satisfies our need for several things: wisdom, easy answers to complicated questions and a feeling of closeness to others. But it’s the spiritual equivalent of a Snickers Bar. They’re nice once in a while, but your spiritual nutrition shouldn’t depend on them. And that’s just what so many people I know do: they’re feeding their soul with Snickers Bars and nothing else. They get their moment of “Aw, shucks” and then go back to being the same shallow, disconnected people they were 30 seconds ago. So, my secret’s out-I hate these things. I think they are worse than meaningless, I think they’re harmful to our psyches.

I like to read inspirational stuff, I really do. But I want the five-course meal, not a candy bar. Chew on this:

When God wants an important thing done in the world or a wrong righted, He goes about it in a very singular way. He doesn’t release thunderbolts or stir up earthquakes, God simply has a tiny baby born, perhaps to a very humble home, perhaps of a very humble mother. And God puts the idea or purpose into the mother’s heart. And she puts it into the baby’s heart, and then…God waits.

The great events of the world are not battles and elections and earthquakes and thunderbolts. The great events are babies, for each child comes with the message that God is not yet discouraged with humanity, but is still expecting goodwill to become incarnate in each human life.

McEdmond Donald

At least the email isn’t extorting me to pass it on to 10 people in 10 seconds or risk certain death. For that, I’m thankful.

I am IS's worst nightmare

My job gives me a laptop(an IBM thinkpad, which I love), a pager and a blackberry. I am not completely computer illiterate, but it's close. I'm also hard on shoes, if you know what I mean. Really, I'm hard on everything, which is why we have no nice glasses in my house. Needless to say, I really should not be entrusted with a thousand dollars worth of technical equipment. When they asked what type of new laptops we should buy, I immediately thought of this. You know, for my busy lifestyle. My busy, klutzy, lifestyle. Florence King had a word for women like me, a slew foot. As near as I can figure, it's a sort of female Mr. Magoo.

Anyway, now whenever the IS guy sees me, he gives me that look. The look that says, "So, what have you broken today." And here's the thing, I had broken something. Or maybe my daughter did, but that's still my responsibility and now I have to 'fess up. My power cord won't fit snuggly into the damn laptop and it won't charge unless I hold the cord in an awkward position and then stay like that for 8 hours until it recharges. All right, that's not too bad, you say. Except that it's now the second time this has happened with two different computers and I try and tell him that I don't pull on it and I generally treat the cord nicely, and now he's giving me that look again.

I am on my second laptop because I learned the hard way that diaper bags are not meant to hold computers. I went to swing it onto my shoulder, the top was secured(I mean, it just closes with a little tab of velcro, sheesh) and as my bag hit apogee the laptop came flying, nay, soaring out of the bag. In slow motion, it seemed, it flew in an arc. I thought I could hear the sound effects from the Six Million Dollar Man when he used to throw something really far. "Nnnuuun, na, na, na." Then it hit the driveway like a ton of bricks. A small shower of black pieces flew up and it might have left a crater, but I was too afraid to look. Now, here's the amazing thing...it still worked. It didn't look great. But I was happy with it. However, when Mr. IS saw it, he said he had another he could give me and now, here I am with a NEW laptop and a power cord that won't fit in the little hole and recharge. Really, I think they should just give me safety scissors and fat crayons to play with. Sigh.

Why won't they say yes?

I just got finished reading this post at The Wait and the Wonder. (Spoiler alert at the end.) And I'm already fried from 36 hours on triage and a grueling holiday call period last week. I think it really started 2 weeks ago, when I had to deal with some serious crazy family dynamics. Think: lovely, peripheral family, divorced spouse, over protective big brother and a crazy daughter. Now, I almost never say that someone's grief is dysfuntional. Get angry, scream at me, fall out on the floor and pull your hair out, whatever-I understand. But this girl was UPSET. She spent most of the 12 hours I was onsite IN BED with her mother. In the hospital bed with the patient, her mother, who was brain dead and intubated. I can only imagine what the funeral was like. Anyway, she did not consent, even though her mother had indicated on her license that she wanted to be an organ donor. And in my state, that's first person consent, all legal-like, if we chose to pursue, which we did not. She said, "if my mother knew how it would upset me, she would have changed her mind." Mmmm. I think that when you finally meet your mom in heaven, you might have some 'splainin' to do.

Did a case on Turkey Day. Which went great, except that I'm still craving a real Thanksgiving Dinner and if anyone wants to come and cook me a belated one, I'm all for it. Love Monkey and the Teenager did make a to-die-for corn bread pudding with cranberry sauce a la Alton Brown that was amazing. And sweet potatoe pie. But I'm still craving some turkey and gravy. Oh, well, at least I'm off for Christmas, so I'll quit bitching.

This weekend I get to be the person sending the coordinators hither and yon. I was all psyched, thinking that I'd still get to go to the office party, all cool-like, what with wearing my Bluetooth and all, and just triage while boogying down. Unfortunately, the case that was in progress hit several snags, not the least of which was a) no one at the hospital wanted to do the actual pronouncement and b) I had no recovering surgeon. While we did manage to cross those bridges, by the time I got done with all the phone tag it was too late and I was too pooped to party. I heard the food was mediocre and the booze watered down, but still.

Two more no consents this weekend. One woman who died actually had a mom who was an organ donor and told her husband that she never wanted that done to her. So, wishes known, no consent. A young girl also died today, her mom didn't want her cut up, no consent.

I feel like I may be becoming too desensitized to dead people. We were watching CSI Thursday night, the one where the dead people talk, and Grissom is teaching a class of(I guess) new CSI's and I realized that I have been around a lot of dead people. I asked Love Monkey, (also a nurse) "How many dead people have you been around?" He thought for a moment. "I don't know, several dozen." Take my word for it, when you start hanging around with corpses, you realize that they have as much to do with the living person as a tin can has to its contents.

So, (and here's the spoiler) I read about Jackson's death from biliary atresia and I just think: why don't people donate? I just want to say to people, look-your body is going to turn into a puddle of goop whether you like it or not. Embalmed-still goop, just later rather than sooner. I realize it's a gruesome thought no one wants to think about, but it's still true. So please, please donate your organs. Don't let the gift go to the grave.

Happy Turkey Day

I'm a sad turkey. Yesterday, I was out for a few hours than went home because the patient wasn't brain dead and the family just wanted to extubate. And no, he wasn't a DCD candidate, if you're keeping score at home. Then I thought I was going to be releaving my orientee(who got her first consent yesterday-yeah!)and doing just an OR this morning, leaving me free to enjoy my Thanksgiving. Not to be. I got called out to a hospital and drove for an hour only to find the patient they had called me on had coded and was pronounced. No worries, they had another patient in the CCU who was brain dead. Wife had already brought up brain death to the staff and here we are, me and another orientee(yes, I train everyone) staying through the night and keeping this guy going until the OR Friday morning.

It's a nice case. No rushing. 3 organs to share. All night to do it. A few management issues, but he seems to have weathered them. Now, I just got a call saying he's Hep B core positive. I'm waiting for the hard copy before I wake my surgeon. This could put a crimp in my plan. His recipients aren't Hep B positive and I don't if he any of his patients are. So we may have to begin sharing again. We'll see. Right now it's the wee hours and my head feels fuzzy and I miss my family and my baby who I haven't seen in 15 hours.

On a positive note, we did have lumpia and ponsit, two of my very favorite Filipino foods. Especially the lumpia, yum. And apparently there's sweet potato pie waiting at home, when I get there.

9-0

Yeeeeeee
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eeeeeeeeeeee
eeeeee
eeeeeessssssssssssssssss!!!!!!!!!!

It's a Cinderella story

All right Kim, I have to throw down the gauntlet. Because I've read a lot of your posts about Notre Dame, but today baby, is Scarlet Knight Day!

Even my dear, old Dad, who is Irish-Catholic down to his last corpuscle, is rooting for the Red!

Go check out your weather.com and you'll see that central Jersey is unseasonably warm today, blue and sunny skies. Perfect to kick some Louisville butt!

HOORAH! HOORAH! RUTGERS RAH!

RED TEAM, UPSTREAM, UPSTREAM, RED TEAM, RAH, RAH, RAH!

Change of Shift

Disappearing John does a great job of Change of Shift today. Stop by and get his behind the scenes tour of a hospital.