Guess what I got for Christmas??

No, it wasn't coal.

When I left the OPO, sadly I also had to leave my laptop. 14" IBM Thinkpad, mostly indestructible. It was basic black, addressed all my needs, wasn't too heavy. It didn't have a disc drive, cause they didn't want us installing programs, I'm sure, but other than that, I loved it and vowed to never have a desktop again.



Husband told me he was going to me a gift that would change my life. Several things came to mind-a trip to India to spend a week with the Dalai Lama? Hmmm, too expensive and he's probably busy. A winning lottery ticket? A chance to meet Johnnie Depp? (that wouldn't change my life, but it would totally rock!) No, none of those.



He got me my own laptop. This is me, typing away on my brandy new acer, with CD/DVD burner and a webcam. Maybe I could do podcasts!? After I lose 20 pounds and get a makeover, of course.

This past week at work was a doozy. I worked Sat, Sun and Mon with the same sick, intubated kid. Nobody was really sure what was wrong with him, but originally they thought he had croup. Last week, I took care of him and he was doing something really weird-for a couple of hours his CVP would be high-19 to 22 and his urine output would drop. Then, without any intervention, his CVP would return to normal and his UO would increase. I told the intensivist on that day and then never heard anything else about it. I was wondering if he had a coarctation of the aorta, but his pressure was low, not high, and I really thought someone would have picked up on it(he's an older child). Turns out, he has a collateral artery wrapped around his aorta and it's not respiratory at all. Always go with your gut.

So New Year's Eve I was asleep by 10pm. Then the next 2 days I was off and basically did NOT ONE THING. So much for time management, but it's been a long time since I've taken a nap without a kid attached and I'm not apologizing for it.

On the organ front, I've been reading about this girl, Nataline Sarkisyan, who was denied a liver transplant by CIGNA. I was pretty appalled but hadn't written about it because I didn't really have time to delve into it. And if there's one thing we pride ourselves (myself) on here at donorcycle, it's avoiding easy answers and half-truths. So today in my emailbox was a surprisingly in depth article on the case from Maggie Mahar at Health Beat. I did think at the time that it was surprising that doctors would transplant an organ into a person with cancer. Except in certain cases, cancer patients don't usually get transplanted because the immunosuppression drugs already put a person at risk for cancer and there's a high risk of coming out of remission with the same or another cancer. But I thought, well, maybe Nataline was cured by the bone marrow transplant from her brother. Now, reading the article, it says that her doctors gave her 6 months to live WITH the transplant.

Of course, if it was our own child we'd take those odds, but here's the thing-there aren't enough livers to go around. So who should get it? The 17 year old who will probably die anyway, or someone else who will live another 5,10, 20 years? It's a hard choice and I'm trying to come up with an analogy but I can't think of anything that involves such a restricted resource with such emotional appeal. Then, too, the hospital asked the family for $75,000 if insurance wasn't going to pay. I guess some have argued that the hospital could have eaten the cost. I'm not sure if that figure was for the surgery and hospitalization. I do know, that for self paying recipients, the hospital wants to see if they have the resources to pay for the first year of anti-rejection meds, which runs around $50-60,000. Again, this sounds really harsh, but the meds are needed or else the organ will be useless. It's the same reason why people are counseled to see if they are up to all the follow up treatment that comes with receiving an organ. Again, I'm not really sure why that gave that dollar amount to the family, who couldn't come up with the money of course, and the doctors are no longer talking.

I don't know where the answer lies. I'm reasonably sure that if the docs at UCLA felt the transplant was worth it, then CIGNA should have covered it. On the flip side, Maher points out that CIGNA approves 90% of all tranplants. And I do agree with her on this point, by reconsidering their position when it was essentially too late, CIGNA now looks like a horse's ass(My words, not hers).

The one thing I am sure of is that this sort of thing happens because organs are scarce. If you could get one just as easily as you could go the pharmacy for a presciption, no one would have to make these choices. I do hope, if nothing else comes out of this, that all those who fought for Nataline will sign their organ donor cards.

Well, it's Christmas Eve

And we're all sick, except for the dog. I think we must have the most virulent head cold ever seen...it's now over a week and my head still feels 2 sizes to big. Tomorrow I have to work, which is making me feel very Grinch-like. We are all making tons of food, so hopefully it'll be a slow day, no one will die and I'll get to pig out. I've given my teenager the option of waiting til I get home to open presents, or getting up with me at 5am to open them. She just huffed.

Just like in Hooville, Christmas come whether there's presents and a tree or not, so I'm diligently buying presents at the last minute. We were going to have Christmas morning THIS morning, but last night we made the discovery that we didn't have wrapping paper. We do have a tree and it's up but still a little bare. There's lights and garland, but so far no ornaments and the dog keeps eating the candy canes off the tree. Pooter has added to her reportoir with some Christmas words: Woo-woof(Rudolph), Santa Claus, candy cane and sssssssssnowman (the S-N combo is still a trial for her). We have watched the original Burl Ives "Rudolph" a record 823 times over the last week. Every time I watch it I can't help thinking that in real life, Rudolph, the dental elf and Cornelius would all run away to the East Village, where the elf and Cornelius would finally proclaim their love for one another (he is a total BEAR, after all) and Rudy would be panhandling on St. Mark's Place.

In other news, this happy article was posted in a local paper. I've had the pleasure of working with Dr. Laskow and it's true, he is a class act.

Last week I was the primary nurse for an organ donor. My good friend "Hector" got to come out an be the TC and boss me around with 8 gazillion orders and, as usual, the OR was delayed until almost midnight. But this time I got to go home at 7:30pm. His poor orientee was like, "I have to stay HOW long?" I assured her that in no time, she'll be able to stay awake 30 hours straight on 5 hours sleep and then drive home. It's funny that my first job was 8 hour overnights and I could barely stay awake through it. The down side is that if I get woken up in the middle of the night, say by someone snoring(ahem), I'm awake for the duration. I might as well just get up and get a cup of coffee cause they'll be no more sleep for me.

Having a 17 year old donor was sad. I didn't know her at all, having been off the first few days of her admission. When I saw the OPO staff on the unit, at first I was afraid it was for a girl I've been taking care of, on and off, since Thanksgiving. I'm now on a first name basis with mom, dad, younger sister, best friend and several teachers from school. She's been touch and go for weeks and if she doesn't make it I'll be really upset, but I haven't given up hope yet. That's the thing about critical care, some patients are there for so long, you really get attached. We did have one Christmas miracle-a little bugger who's been in the ICU or in subacute care since he was born 10 months ago finally went home. Mom carried him around the unit so we could all say good bye to him.

Well, as you can see, I still have stuff to talk about, so I guess I'll still be blogging for now.

Merry Christmas.

SurgExperiences

Check out SurgExperiences over at Buckeye Surgeon. Now I have to get back to Christmas shopping.

If You Give a Surgeon a Scalpel

(with apologies to Laurie Numeroff)

If you give a surgeon a scalpel, he’s going to want a pick-up.
But wait! He’ll remember that he always operates better with some music.
“Nurse! Can you put on the radio please?”
“Certainly, Doctor. Do you want Rock?”
“No.”
“Classical?”
“No.”
“Country?”
“No.”
“Easy Listening?”
“Oh, God, no.”

Then he’ll remember that he has a Frank Sinatra CD in his car. He’ll want you to page the tech and ask him to run down and get it.
While you’re waiting, he’ll hum a few bars and show off a few dance moves to the scrub nurse. “Yes sir! I used to really cut the rug in my day.” He’ll say.

While he’s dancing, he’ll remember that he’s parked illegally. He’ll have you page the tech and see if he can move his car while he’s down there.
Suddenly, the resident will comment that he’s hungry. A spirited discussion will ensue on where’s the best place for lunch.
“Chinese?”
“No.”
“Thai?”
“No.”
“Italian?”
“No, I had pizza yesterday. Sandwiches?”

The surgeon will remember that a great, new Mediterranean place opened up. You’ll page the tech again while he talks about the great hummus and baba ghanoush. “Wait! I want brownies, too! Tell him to get brownies!”
To fill in the time, he’ll tell a story about the time he vacationed in Greece and lost the keys to the rental car on the beach and they had to walk 10 miles back to their hotel room and his wife didn’t speak to him for 3 days.

Finally, the tech comes back with 5 Frank Sinatra CD’s, the keys to his car, now washed and polished, one pint each of hummus and baba ghanoush, 6 gyros, a 2 liter bottle of soda(it was a special), extra pita, two types of brownies and baklava.
“Hmmm. Now what was I going to do?”
The anesthesiologist looks out from behind his paper and coughs, “Ahem”.
“Oh, yes. I was going to ask for a scalpel.”

To all my favorite surgeons and everyone else:

Happy Holidays and all the best in 2008!!

As most of you know, I quit the TC business in August to spend more time with my family. I'm not really sure where I want to go with this blog. I certainly haven't been spending the time on it that it needs. So I'm taking a hiatus until after the New Year to see where, if anywhere, it's going to go. Thanks,

Susan

Dah Na Na Na Nah Nah Na Na

It's my birthday! Enjoy the tunes.

Yes Virginia, The Saga Continues

Dear Editor—
I am 8 years old. Some of my little friends say there is no Santa Claus. Papa says, "If you see it in The Sun, it’s so." Please tell me the truth, is there a Santa Claus?
Virginia O’Hanlon

So starts the famous editorial written by Francis P. Church 110 years ago this month. He goes on to say that little Virginia's friends are wrong. "They have been affected by the skepticism of a skeptical age." It gives one pause to think what Mr. Church's reaction to the 21st century might be, were he here to see it. Is Santa Claus still real? Well, Newsweek hasn't yet proclaimed, "Santa is Dead", so I guess there's hope.

In my house, the controversy continues. My husband, a man of much romance but not an ounce of sentimentality, has decided to tell our daughter the truth about the Santa "myth",as he puts it. "There are plenty of other, more meaningful myths I want to raise her with," he proclaimed, although so far substitutions are not forthcoming. It should be noted that when Mr. Higgins learned the truth about Santa it was a traumatic event (insert your own instant analysis here). My own fact-finding about Santa was not only NOT traumatic, but is actually remembered fondly-a product of a childhood that is not known for many fond memories. In a nutshell, I read the truth about Santa in a fictional story in one of my mom's magazines. A young boy finds out about Santa, is disappointed but then learns about the true meaning of Christmas and responds by playing Santa himself. It wasn't award winning fiction and I can't really convey what it was that had such an impact on me. Perhaps it was the realization that my parents would go through such hard work to make me so happy and not take any credit for it. Especially since my siblings were so much older and I'm sure were threatened with their lives not to tell me. Whatever it was, the magic of Christmas never left me. Perhaps it's my fertile imagination. In 3rd grade, I wholeheartedly believed in Santa, gnomes and my parent's omniscience.What didn't I believe in? The Easter Bunny, Original Sin and my parent's veracity.

Somewhere in the Santa story is the essence of Christmas for me. Yeah, I know, it's a Christian holiday. It should be about the baby Jesus and all that. But if you read Church's entire response about Santa(and you should, it's a classic for a reason), it goes beyond Christmas and religion to the heart of what makes us human. "I still believe in the good of man" said Anne Frank. Sometimes, that seems as fanciful as Santa and his elves. Yet at work today, I saw a bunch of kids, who have access to the internet, Bratz dolls, Dr. Phil, and Youtube, in a word-kids who should know better-light up when they saw Santa. Santa the Biker came to our hospital this week and the kids went gaga. "It's a miracle!" one girl said, "Santa came in November!"

I think it's more than just the free toys. Most kids I know like the giving of Christmas, as well as the getting. When my eldest daughter was young, her school would have a day where the kids could go and buy cheap presents for their families. I'd give her $20 and you would have thought she was the luckiest girl in the world, able to buy presents all on her own without any parental input. And homemade presents? "I made it!" they shout proudly. If you've never been the recipient of small lump of clay decorated with garish stones and feathers and presented to you as a "paperweight", you are poor indeed.

I don't know where this leaves us with Santa at our house. My husband is still convinced that most people are disillusioned when they learn the truth about Santa. I'd love to hear your stories. I'd also like to win an argument in my house for once. So, if you want to tell your own Santa story, please leave it in the comments section. As for my little one, if she's anything like her parents, I have a feeling she's going to believe in whatever she wants to believe in.

I know what I know

I really haven't been on the internets in over a week, except for quick scans of my email. I did, however, pass PALS (pediatric advanced life support). I think it's the 3rd time I've taken it and it seems to get easier and easier, which is not a good thing. In fact, I think there was too much of the fancy videos and not enough content. I didn't have a problem, but I felt sorry for the people who were taking it for the 1st time, including one respiratory therapist I know who I thought was going to have a breakdown when they gave her the "baby in asystole" megacode. There's no real end to that code, except to call it, but who wants to have a dead baby. It's broken tougher participants than her, to be sure.

So in addition to realizing that I know more about PALS than I thought I did, I also learned in the past week:

I know what to do when someone faints, or almost faints, or is just having a culturally diverse grieving response. Help them to the ground(extra points for avoiding back strain) or a chair. She was up and about before I could bring back water and a cool washcloth. Code purple avoided. (Code Purple is medical jargon for, "help, someone received bad news and fell out!")

I learned how to use the peritoneal dialysis cycler. Than I became the point person for the rest of the floor, because, really, when do we ever use that? On someone who weighs 6 kilos, no less? 4 more kilos and he'll be ready for transplant! Go, little baby, go!

I went to conference on nursing research and learned that if I ever want to get a PhD, I can kiss my family goodbye for 4-6 years. Sigh.

I learned that I have completely fallen in love with a little imp who is probably going to die within the next year. I can't help it...she wormed her way into my heart and that's where she'll stay.

I know (from years in the ER) that when you smell diesel coming through the vent system it's because someone hasn't turned off their truck(or ambulance), which is highly annoying for staff and possibly dangerous for your respiratory patients.

I know that sometimes when people appear unresponsive it's because they don't speak English, are hard of hearing, are just plain scared or all three. Maybe you should check on that before you write them off.

And finally, that like being a Catholic or riding a bike, nursing is something that you never forget, no matter how much time you've been away from the bedside.

I am so not bitter

Can someone please explain to me why amalah is up for a weblog award? Excuse me, but I bitch about my loved ones, I show cute photos of my kids, I have snarky DOWN PAT, for goodness sakes. And I also talk about a little thing called ORGAN DONATION! But do I get nominated? I've been complaining about it all week to the fambly to no avail-they haven't given me an ounce of sympathy.

And the comments!! I'd rather have 2 little 'ol commenters than 167 versions of "OMG! Me too! You're so awesome!"

All right, it's not all about me. But what about the other great mom blogs out there? Like my friend Moreena-top notch writing if I ever read some. (Unlike my perpetually unfortunate grammar-I speak English good, don't I?)

Anyway, I'm voting for Notes from the Trenches out of spite. Not that I'm bitter or anything.

This goddess is NOT bitter

And the word of the day is:

hu·bris /ˈhyubrɪs, ˈhu-/ Pronunciation Key - Show Spelled Pronunciation[hyoo-bris, hoo-] Pronunciation Key - Show IPA Pronunciation
–noun
excessive pride or self-confidence; arrogance.

You may recall a few posts ago where I said I was reasonable sure that the baby didn't have pneumonia. Silly mommy. Last Friday, after spiking a temp of 103.6, her parents(both nurses, thank you very much), decided that maybe medical intervention was called for. Of course, my FP was not on call, so I called the guy covering for him. After telling him the medical history in a nutshell-basically, 5 weeks of being sick, one ear infection, countless sniffles, bronchitis, a lacey rash and now more fevers-he tells us to get our butts to the ER as a CXR is probably in order.

So there you have it, bad parenting example #567. At least it's not as bad as the time MY mom thought I was faking sick to get away from the dinner table and then realized during my bath that I had chicken pox. And she's a nurse, too. So, anyway, Daddy nursed(not literally) the baby over the weekend while I took care of other people's sick kids. Sunday, she was a little better, but then Monday she spiked a temp again and looked really listless, so we were back to the doctor's. She was mildly dehydrated, and the augmentin wasn't working, so he changed her over to zithromax and said to give her more fluids. Hurray for the power of breast milk, since it's the only thing she wanted, except for sips of water. Tuesday, she felt well enough to be cranky and we managed to feed her some bread soaked up with potato-leek soup. Today she was definitely on the mend, enough so that I will only feel a little guilty about leaving her cranky-clingyness to go to PALS manana.

Other than that, we've been forced to watch Signing Times DVDs for hours on end. Pooter calls it "babies". I will say this, it's better than Thomas the Train, "choo choo", which is like kiddie valium. We also watch the "woo-woof", which is a Little Einstein DVD that features, you guessed it, dogs. Thank God the signing ones are good, although I now know every song by heart, including The Silly Pizza Song which I can sing AND do in sign.

All that signing, though, and the Pooter still says something that sounds like "budday" when she wants water. She can sign dog and cat and eat and sun and cookie and a myriad other things, but for life nourishing fluids, she cries and says, "mauw budday?" We're starting to get the hang of it, but it's hard to remember on little sleep.

Speaking of PALS, Good Lord, I haven't been to PALS in almost 3 years. Now, there's homework I have to do beforehand. And they changed all that CPR stuff, too. 30 compressions in 23 minutes, etc. What do I know, everybody I code is intubated and we just pump and bag, pump and bag. Uh-oh, hubris again. Now I've gone and jinxed myself-I'll probably witness somebody collapse on my way to class tomorrow.

Work is, well, scarier in some respects, because being away from the bedside for 3 years has dulled my nursing 6th sense. But I did have a good laugh because they floated a NICU nurse down to us last week and gave her a 17 year old boy. Who needed to be straight cathed every 6 hours. Poor girl wasn't used to wee-wees that big. I helped her through it and hopefully she'll say nice things about me to the NICU nurses so they'll return the favor when I'm floated upstairs to take of some little mouse that doesn't even weigh a pound.

I have managed to make nice with one of the pediatric nephrologists after telling her I used to be a TC. Now she's nice to me, but apparently a little cold to some of my coworkers. My specialty, winning over the difficult people. Just one of my many super powers-sorry, they can only be used for good and not evil. Oh, wait, I think that's hubris again. Sigh.

You want fries with that?

Hospitals continue experimenting with ways to improve customer service, usually at the expense of employee morale. I've had my own experience with that. When I worked in a busy ER, the three biggest complaints were 1)wait time to be seen 2)wait time to be treated and 3)wait time to get upstairs to a room. Almost always, the Press-Gaineys had nice things to say about the employees. Then some big, upstairs Wahoo comes down and tries to teach the nurses how to say "Please" and "Thank You" and THAT leads to cranky nurses. Boy, you do not want your nurses cranky. In fact, right now, go to your nearest nurse and give her some chocolate. THANK YOU.



Working with donor families has given me a whole new perspective on meeting people's needs. When you've spent 8 hours trying to find out if it's possible to recover sperm from a brain dead husband, suddenly getting a cup of tea and a box of tissues doesn't seem so hard. (Please don't ask how they get the sperm-you really don't want to know). Granted, that's an extreme example, but I was taught that you do whatever you can for the donor family, if at all possible. They're giving a tremendous gift. In return, if they need information, a parking voucher, a cup of coffee or a shoulder to cry on, you give it.





I returned to the unit carrying this credo in my back pocket, I guess, without really thinking about it. So I was surprised to hear people grumbling about, of all things, guest trays for patients' parents. "They just came in and now they want to eat? Why didn't they eat at home?" My first thought is, "Why do you care?" It's not extra work, because dietary brings up the tray. It's not impinging on my Christmas bonus, because the patient is billed. I think there's just a certain type of person who is suspicious that someone, somewhere, is getting away with something. They're not bad people. My dad is one. Just don't kick the ball into their yard.



I have to say, also, that I like being nice. I don't enjoy being in a bad mood(no comments from family members, please). Sometimes, I am so cranky I can't stand myself. Last week I had a woman tell me about her four year old daughter, " I don't know where her attitude problem comes from. Life has made me bitter, what's her excuse?" I'm pretty sure that mom can't stand herself, either. And I think I know where her daughter's attitude problem comes from, too. Believe me when I tell you I am not a perky person. The last time I checked, sunshine and rainbows didn't come out of any of my orifices. I like being a pessimest because I would rather be pleasantly surprised than always disappointed. Still, I have found, more often than not, that when you are kind to people they respond with kindness.


So what's the solution? Can you train "niceness" into people? I recently attended a customer service seminar. Well, it was really only an hour, so I guess that makes it a lecture. A message that says, "We want customer service to be a priority, but not so much that we'll spend $50,000 for the famous motivational speaker. Instead, view his motivational video and then motivate yourselves." (Friendly hint, don't motivate yourselves too much or you'll go blind). Anyway, the lecture instructed us to introduce ourselves, explain to the patient what was going to happen and about how long it would take and then thank the patient. Wha? I think this falls under the category of either you already do it or you can't be taught it. I mean, do they really think there are people sitting there going, "Tell the patient who I am? I had no idea! Up 'til know I've just been going into the room, reaching under their gown and asking them to cough."

I think a lot of crankiness stems from burnout, personally. I was floated to the nursery a few weeks ago and they had that one nurse who just seems to infect the rest of the unit with her bad attitude. You know just what I'm talking about if you've ever worked with this person. She bitchd about everything and everyone, including the babies, who she considered "bad." How can a newborn be bad? Makes me glad that my husband went to the nursery with the baby instead of staying with me. Anyway, I was charting and I looked out the window and all you could see was the roof. Vents and smokestacks and gravel and pigeons. I said, to no one in particular, "Wow, your view sucks." Nurse Cranky asked me to repeat myself. "Your view, out the window. It sure is awful." "Oh," she said, "I thought you were talking about my personal point of view."

Now, if you recognize yourself in that example, it is time for a massage. And a job change. Because, really, working in the nursery is NOT hard. (I'm probably going to get lots of comments from nursery RN's telling me how challenging it is to feed, diaper and rotate the little hamsters. Bring it, is all I got to say).

Somewhere in all this is a point. I suppose if we all had jobs we loved and got paid what we were worth and were able to leave our personal issues at home, we'd all be much nicer to the patients. Then we can tackle peace in the Middle East and world hunger. So here's my 2 cents: Be good to yourself and be good to the people around you. If you start to view the world through crap-colored glasses, take a break, get some perspective and lighten up. And if your friends at work start getting obnoxious, say something to them. Then, we can go to as many customer service seminars as they want, knowing we're still providing the same great care we always gave. And if the hospital wants to take credit for our "pleases" and "thank yous", let 'em.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Oh, yeah. Change of Shift is up at Nurse Ratched's Place. See ya there.

House of Plague

We almost cancelled Halloween at our house this year. Half the family is sick, including La Baby who, if she lived with normal folks, would be in the ER right now. But my children know that unless I'm getting paid $45 dollars an hour, the only thing that warrants a trip to the ER is bleeding from the eyeballs or viscera. Poor Pooter. I'm pretty sure it's not pneumonia, but I've spent the last few days with kids whose parents said, "If only I'd brought them to the ER sooner, maybe they wouldn't have quadruple pneumonia."

I also was hoping that Pooter would be able to wear her first real Halloween costume to daycare today, but she's got a fever. She was going to be a bee. Well, she still can be a bee any day of the week, just not for Halloween. We bought the outfit last week at Claire's in the mall and then she wore it at the mall playground and was the delight and envy of all the other l'il childrens. I do have great footage of her bouncing around with bee wings, if I can figure out how to get it off my phone. Once again, Susan 0, Technology 274.

Love Monkey is also sick. I'm pretty certain he no longer has any internal organs from the diaphragm down but as my attending said this week, "Green, black or red is all the description I need." So Teen and I are set to (wo)man the door as she announced she is officially too old to treat or treat. And the cat is going as a chihuaha.

Yo quiero candy, bitches.

Must Read

Well, once again Moreena puts into words all I wish I could say and more. This week, she wrote about the anniversary of her daughter's first transplant. Please go read it. Forever more, when I am confronted with an unknowable question, not unlike Douglas Adam's "42", my answer may well be 3.

Her post brought to mind this poem I wrote down years ago in my poetry notebook. Yes, my poetry notebook. Because TC is really very sensitive inside, with a crusty exterior-like a scooter pie, sort of.


Mama's Promise-Marilyn Nelson Wanick

I have no answer to the blank inequity
of a four-year-old dying of cancer.
I saw her on t.v. and wept
with my mouth full of meatloaf.

I constantly flash on disaster now;
red lights shout Warning. Danger.
everywhere I look
I buckle him in, but what if a car
with a grille like a sharkbite
roared up out of the road?
I feed him square meals
but what if the fist of his heart
should simply fall open?
I carried him safely,
as long as I could,
but now he's a runaway
on the dangerous highway.
Warning. Danger.
I've started to pray.

But the dangerous highway
curves through blue evenings
when I hold his yielding hand
and snip his miniscule nails
with my vicious-looking scissors.
I carry him around
like an egg in a spoon,
and I remember a porcelain fawn,
a best friend's trust,
my broken faith in myself.
It's not my grace that keeps me erect
as the sidewalk clatters downhill
under my rollerskate wheels.

Sometimes I lie awake
troubled by this thought:
It's not so simple to give a child birth;
you also have to give it death,
the jealous fairy's christening gift.

I've always pictured my own death
as a closed door,
a black room,
a breathless leap from the mountain top
with time to throw out my arms, lift my head,
and see, in the instant my heart stops,
a whole galaxy of blue.

I imagined I'd forget,
in the cessation of feeling,
while the guilt of my lifetime floated away
like a nylon nightgown,
and that I'd fall into clean, fresh forgiveness.

Ah, but the death I've given away
is more mine than the one I've kept:
from my hand the poisoned apple,
from my bow the mistletoe dart.

Then I think of Mama,
her bountiful breasts,
when I was a child, I really swear,
Mama's kisses could heal.
I remember her promise,
and whisper it over my sweet son's sleep:

When you float to the bottom, child,
like a mote down a sunbeam,
you'll see me from a trillion miles away;
my eyes looking up to you,
my arms outstretched for you like night.

TGIF

Have you ever been around so many insane people that when you meet some normal folks you just want to kiss them? No. Well, I have had some crazy parents in the past few weeks. Today's little patient had parents who were normal, not fighting with each other and full of common sense. It restored my faith in humanity for another day.

Yesterday was the opposite. I complained so long and hard about some folks that I felt guilty about it and yet still needed to vent. Finally, Love Monkey said, "Susan, let it go." The hard part is when it seems so clear to you what the problem is, but the person experiencing it is just clueless(at least to you). I'm sure I can be just as dense when it comes to my own issues. The hard part was that they were just, so, demanding. I can give people a lot of slack, especially when they're dealing with stressful stuff, but don't think for a second that I'm your bitch. That really pisses me off and then my compassion flies out the window. I guess maybe I'm a little fried lately because I usually have more patience. Ah, well.

Anyway, I'm off for the weekend. Time to recharge. Maybe catch up on writing?

I told you so

Well, word is out. Dumbledore is gay. In case you've forgotten, you heard it here first. That's right, I called it. Now pay up, suckas. Actually, I didn't bet anyone, but if you'd like to lose retroactively and send me some cash, I'd be ok with that. If you've got the time and would like to know where the "gay-ness" shows up in the books, the LA Times will tell you all about it.

Well, I've been spending a lot of my internet time on Facebook. What little free time I have, that is. I've now discovered zombie hugs, tattoos and quizes about my sex life. Hoo, boy, and if you think I don't have a lot of time for the internet...Anyhoo. Now, I know I'm a grownup and all, but seriously, my niece and nephew and their respective sig others are all teaching this year in South Korea and you know the kids today, they're all on Facebook. Even my teenager, who just discovered that I'm on it, much to her mortification. Want your kid to spend less time on teh interwebs, join Facebook. It's much less cooler when your MOM uses it. Tee Hee.

This week, I've actually had a little time to peruse the weekly Grand Rounds. My friend Susan over at Improbable Optimisms has the first spot with a great read on hope. Check it out.

And under the "Better late, if ever" category: The latest Change of Shift over at Kim's.

Meanwhile, Love Monkey and I spent a night at Atlantic City this week. With teh baby, of course. All paid for by his poker habit. Gotta love the comps. It was nice, we spent some time at the beach, but it's no Vegas. In fact, it's a lot like Keansburg with shiny skyscrapers. Ah well. And could someone please tell me why you can't get a decent, cheap meal in A.C.? I mean, you can mortgage your house and go to Ruth's Chris Steak House, but want breakfast for less than $12? Forget it. In Vegas you can get a steak for $1.99, but in AC, 2 eggs, toast and some freezer burned sausages will set you back 8 bucks. Other than the eating, though, we had a good time.

In organ donation news (oh, yeah, this blog is about organ donation), Scientists in the UK are doing studies on giving CO2 after transplant surgery to dilate vessels and improve blood flow to the organs. Now, the funny thing is, the picture in this article is the SAME picture the BBC uses for EVERY organ donation article. I'm thinking, if you're the BBC, you could spare a photographer once in a while to go and get a new shot of something else related to organ donation. Or maybe the Brits are just very frugal. Anyway, I'm off to work, where there's no internet. Very sad.

Ray of Hope

From ESPN, this is the story of the North Carolina mascot who was struck by a car last year and became a donor. Buy more Kleenex and pass this on to everyone you know. If you didn't believe that love conquers death, you do now.

Tuesday!

Holy Crap! I'm up early enough to read Grand Rounds! Version 4.4 is up at NY Emergency Medicine.

Memorial Day

October must be the month for memorial services. I had my pick of two this past weekend, one for the children's hospital and one for The Sharing Network. I picked the later, because I was hoping to see some of the families I've worked with in the past year. And the free food, of course. Then I notice some other folks had their memorial services this past weekend, also.

Sunday, after the service, I had this fine post practically writing itself in my head. Now, in my younger days, I could carry a half-finished poem around in my head for a week and work on it, finally writing it down in almost completed form when I got around to it. Ha! Like I really knew what busy was when I was 20. Anyway, the baby was up sick all night and I had work at 7am Monday and by Monday night it was gone, gone, gone-appropriate lead-in lyrics and all. I'll miss my brain when it's gone.

Anyway, I'm glad I went and I did, in fact, see one of my donor moms. She had driven all the way from Pennsyltucky with her sister and they were glad to see me too. The staff always does a nice job on the service. We(they? See, still doing it) offer folks the option of making a quilt square in honor of their loved one and then my old boss' wife and her friends sew them up into big quilts that hang in the office and get shown at events and donor drives and stuff. I brought one to my daughter's Career Day one year.

They also did a photo tribute at one point. It was amazing to see pictures of all the donors alive and smiling. Especially because I tend to remember them as I first saw them-intubated in an ICU. If you work in a hospital you probably know the feeling. You take care of this patient for so many days that you can forget they're a person. I remember one donor, whose family showed me a picture of her, in better days. "She's beautiful!" I said, because it's hard to visualize what a person really looks like when they're lying flat in bed, with their hair matted down and their face all puffy and their body bruised and there's five miles of tubes and wires coming out of every available body part.

It's nice, even if your patient is just sick, and not an organ donor, to see their picture. It makes them real, you know? Then they're more than just the splenic lac in 18 or whatever. It certainly is easier to do this in PICU, because kids are, well, kids and you'd have to be a cold-hearted snake to not fall in love with them, but it's still nice to see pictures of them taped up in the room.

I don't like to think that people who work with the donors forget their "human-ness" often. I mean, you spend an awful lot of time with the families, crying with them, talking about their loved ones. But it can be tempting, when sleep is a dim memory and you've been sitting around a hospital for too many days to count, waiting for something, anything to happen, to just think of the donor and not the person. How many organs can be recovered, what time can we get to the OR. It's in the language-"I got consent". No, you didn't GET anything. The family GAVE you consent. Maybe it's just me, or maybe I shouldn't blog at 5am when I can't sleep. The people in the business are some of the most caring, compassionate people I've ever met and they don't take donors for granted. As long as you can still see the forest for the trees, is all.

Anyway, I also got to see my peeps, who were (mostly) glad to see me. The highlight may have been the 4 year old kidney recipient and his parents who were on hand to thank the donor families. It's nice to see the living, kicking, cranky, I-want-to-play-I-don't-care-why-these-people-are-here-to-see-me results of your work once in a while. Also, I got to see my friend Pammy-cakes invite the Imam back to her house for drinks. That certainly was worth the price of admission right there.

Well, I've gotten my verbal catharsis and I still can't sleep. Time to clean.

Also for Wednesday

Team Annika needs your help! Moreena, from The Wait and the Wonder is in charge of the American Liver Foundation walk in her area. Help her meet her goal, so she won't have to do anything desperate AND you'll help find a cure for liver disease. Send in what you'd normally spend on beer and wine in a week and it'll be good for everyone's liver!

Meanwhile, over at Nurse Ratched's, there's Grand Rounds with an armed forces theme.

Better Send Flowers

I went to the wake of a friend's father last night. I'm always at a loss for what to say at funerals. I didn't really know anyone there, other then my friend, so I just people watched for a while. Then, I checked out the flowers. He was holding wooden rosary beads. A rosary made out of those tiny roses is nice too, but do you any idea how much that costs? The flowers made me think of my great-uncle's wake. Similiar families, although my friend's "out-Italians" my family by a magnitude of 10. Anyway, when Uncle Micky died, my siblings and I decided to pool our resources and send flowers. Then my sister suggests, since flowers die, wouldn't it be nice if we sent a plant arrangement instead? I left the details to her and ponied up my money.

The thing about my uncle, he was a terrible alcoholic. Later, as an adult, I heard some stories, but as a kid I only knew that he was perpetually cranky and I was a little afraid of him. A year before he died, he went into our community hospital with some ailment and wound up coding, being resuscitated, coding again, another resuscitation and then getting a million complications, including infections. When my aunt didn't make him a DNR, we thought she was crazy. I mean, the man had abused his body for decades, we didn't think he'd survive another code. Just to prove how stubborn he could be, he not only recovered, he made it home. My aunt recalls that the next year with him was a really good year. He certainly was nicer and funnier than I'd ever seen. Goes to show, you can play the odds in medicine but you never really know what's going to happen.

My aunt and uncle have four sons. They're my family's version of the Marx Brothers. Remember them? I think their names were Groucho, Harpo, Marco and, uh, Squiggy. Anyway, these four had an act they could take on the road. They're still the funniest guys I know. Nothing is sacred with them. If you take yourself too seriously, they'll skewer you, but they're hysterical. Anyway, we're at the wake and I look around for our "plant arrangement" amidst the enormous and lavish flower pieces. Then I see this, I don't know, some sort of tropical vine in the corner with a big bow on it. One of my cousins spots me. "Hey, thanks for the vine. I thought it was one of the funeral home's plants, then I realized you guys sent it." His brothers join in for the kill. I think there are jokes about jungles and Tarzan, I'm not really paying attention as I scan the room for my sister. She spent 75 bucks on that?

We do, all, eventually have a good laugh. We try and imagine what Uncle Micky would have said about it, which leads to reminiscing about him. Cranky, and alcoholic, that he was, he was a character and soon his sons have us laughing. Which is, if the person was old and lived a good, long life, a fine way to go about waking someone. I hope I'm enough of a character that I have folks cracking up at my funeral. If you know the person, this is always a good thing to talk about with the family-remembering them, remembering the good times you had.

What not to say? Well, I would caution you to never, ever say "I understand" unless you have been through something very similiar. My friend's dad was home with hospice care for the weeks before he died. My grandmother also died pretty quickly and was at my mom's home under hospice care. My mom and I took turns staying up at night with her. It was hard on everyone, hard to watch her dying, but worth it, knowing she died surrounded by her family.

I wouldn't offer platitudes, either. "Well, he's in a better place" or "God must have needed him more than we did" or whatever people try to come up with to rationalize the person's death. The best bet is sincerity. Say you're sorry for their loss. I like to say to people at funerals that I'm there if they need me, but I think there's too much going on at that moment. If you know of something you can do in the days around the funeral, then make a concrete offer. Can you take their kids for a while so they can make arrangements? Drop off food, run some errands for them. One nice thing to do, after the funeral is over and everyone stops dropping by is to not forget them. Like send them a card and some flowers on the next holiday or on the anniversary of their loved one's death to let them know that someone else remembers, too. Not everyone grieves, right away, either. My sister in law lost her younger brother a few years ago and I remember, almost a year later, she broke down at a family picnic crying. She just needed someone to listen to her.

Meanwhile, my aunt still has that plant. She told me it takes up most of her sewing room, it's grown so big. I'm haunted with the thought that everytime she waters the thing, she thinks about her husband's death, but she seems to have a good sense of humor about it. A trait she has passed on to her children, evidentally. I think she's even going to name it.

But in the future, I'm going to stick with flowers.

My Big Day Off

It's Friday. I've worked 8 hours of overtime last week and 4 this week, the l'il Pooter's still sick and my house looks like who done it and ran. Then working all weekend. While I'm figuring out what to do with my big day off, I'll probably read the latest Change of Shift at Madness:Tales of an ER Nurse. I've been promised some writing time today, but you know I'll probably just clean. God forbid I need an ambulance for any reason, I'll have to tell them my house's been ransacked to save face.

When Everson Walls donated one of his kidneys to Ron Springs earlier this year, it made news. Now it's making legislation. Rep William Lacy Clay (D-MO) is sponsoring a bill named after both players. The Everson Walls and Ron Springs Gift for Life Act of 2007 (HR 3635) hopes to fund a national resource center and grants for organ transplant needs. Walls and Springs together have started a foundation to promote organ donation.

For your weekly carnival update, the new SurgExperiences is up at Suture for a Living, one of my new, favorite blogs. Also, Grand Rounds is up at Musings of a Distractible Mind(note the new blog address). Great Dr. Seuss theme this week, rhymes included!

Happy Reading.

A Tale of Two Jobs

Yes, I love the new job, as my aforewritten post shows. I love the babies, I love taking care of sick kids. I even love(well, maybe like a whole lot) taking care of stupid teenagers who ingest too much beer and fall off car roofs. No, really. I think it's because you can talk to teenagers in a way that you can't talk to other patients. "Dude! What the hell were you thinking?" and they just shrug and look sheepish. Plus, you can get away with the occassional curse word in front of teenagers, as long as their parents aren't around, like when you're hip deep in a dressing change and you drop your last piece of Telfa and now you have to stop everything and walk clear across the unit to get another one and so, without thinking, you mutter, "Mother-f*#ker!"

Sorry, but TC can curse like a sailor. In several languages, including Tagalog. It's a gift.





Anyway, I have had a series of patients in the last 4 shifts, mostly because I am low on the totem pole and so don't get continuity with my patients because some other, more senior, nurse, wants to take care of "her" baby. Whatever. The past couple of days we've had a potential organ donor on the unit and my former colleagues have been present. In was nice, in that I got to exchange some juicy gossip and catch up on the happenings around the office. It also shows me that, just like being Catholic, you never stop being a TC. I still say "us" and "we" when talking about the OPO. Actually, I instinctively typed "my" OPO. See what I mean.





So, even though it's probably good that I got out of that handbasket before it bursts into flames, I have to say-I MISS IT! I miss my old job. Or at least I miss the work, if you know what I mean. I miss the thrill of waiting by the phone and finally getting called out. I miss sitting around ICU's all day waiting for the doctors to finally start clinicals and listen to them whisper about you at the nurse's station. I miss the nervousness when it's finally time to ask the family and then the rush that comes when you know they're going to be a donor and you have 8 million things that need to be done all at once. I miss crying with the families and hugging them and listening to them talk about their loved ones. I miss knowing that you're getting one more person off the waiting list.





Also, I miss the free time I had, when waiting, to write as much as I pleased with no interuptions. I do have more free time now, but it's all spent at home and there are lots of distractions, including one who can crawl all over the desk and say, "Eat dat! Have dat! Want dat!" Right now, as we speak, I have a 2000 word essay in the works, that requires actual research and critical thinking as opposed to my usual snarky ramblings. My fingers are itching to type it, although I hear there's a cream for that now. In former days, I could pass the time in an ICU, tucked into an inconspicous corner, surfing and typing away on the best technology a non-profit could buy, while waiting for a doctor to decide if 96 degrees is too cold to start brain death and is it ethical to start pitressin on a patient who's peeing a gallon a minute if the organ donation people are in the same hospital.





Ahh, well. Maybe when the little distraction is older I'll go back.





Speaking of which:

I Cn Haz Cupcake!

** Sorry bout the run on sentences, I'm trying to finish before "The Big Comfy Couch" is over.

One more reason to be a nurse

If I were a better woman, I'd do my job without regard for accolades and thank you's.

But sometimes Thank You's are nice, too.

Sunday night reading

I've worked all weekend and my feet feel like they weigh 20lbs each. Riding the bike to work is really nice, but that last hill on the way home is a doozy. Tonight I walked the bike up it.

Anyway, I'm overdue for my monthly coop article, so tomorrow will be spent busily thinking up a topic and then writing on it. Better late, if ever, is my motto. In the mean time, if you haven't read it already, Change of Shift is up at Kim's. I have a new post in the works, so check back in a day or two.

LPS(longer post soon)

Well, we all survived the weekend.


And I have to say, Sixteen-odd years and two kids later, I finally feel like a "real" mom. Mainly because I managed(with ample help from Love Monkey) 8 teenagers and one baby for 2 days and there were no injuries, no fights, nobody got lost and everybody got fed(if burnt weenies and ice cream cake count).

The weekend turned out to be nice. Around 9am the rain stopped and the sun came out, even if it was a little windy. Even the old folks came out-Auntie and my mom and dad. I had the most awesome video on my phone of this parade snaking its way out to beach, led by Auntie, with her walker, going full steam ahead, followed by the Teenager holding a huge Jolly Roger flag and various kids carrying all our crap out to the beach and the grandparents bringing up the rear-my mom with her cane and dad carrying the beach chairs. I was even going to post the vid for your delight and edification. But I didn't press record. Because I am tekniklee challenged! Auugh!

We had a nice fire on the beach. We did some swimming until the park ranger yelled at us. We roasted weenies and marshmellows and generally had a great time, including Pooter, who chased every "duckie" (read:sea gull) she could find. It was so great that I want to do the same for my 40th next year, except maybe not in December, unless it's a beach party in Jamaica-hint, hint.

Monday and Tuesday were 12 hour days for me, which I was looking to with dread as I'm still kinda sick. I feel loads better but I have this bronchitic cough that makes me sound like the illegitimate spawn of Betty Davis and Harvey Fierstein. Just what you want in a nurse taking care of your small children. I sound like I have the consumption, but REALLY-I FEEL SWELL!

Anyway, miracle of miracles, our census was low Tuesday, so they let me go 3 hours early! Huzzah! Then, later that night, the Pooter got sick and was up all night miserable. She still a little fragile today, but several doses of motrin and tylenol and some soup have made her happier. So, longer, more relevant posts to come. I'm going back to sleep.

Weekend Report

I've spent the last three days desperately ill, the last two days working and now, at 9pm on a Friday night, I'm leaving for a weekend at the shore with a dozen teenagers.

Please pray to the deity of your choice that:

a. It doesn't rain, and

b. I don't kill anyone.

DT(dear teen) has just called to ask me to bring her hairdryer down. HAIRDRYER. At the beach.

Cough.

This just in....

Donorcycle's official fact checker and stats keeper has just informed me that 100-47 does indeed equal 53, not 63. Thanks, PJ, and keep up the good work. And for the record, you try writing with a toddler climbing all over you. Oh, wait, she was in daycare today....I'll have to come up with some better excuse.

Hollywood Healthcare

Recently, I watched a rerun of CSI. The Las Vegas one, of course, I'm no great fan of either David Caruso or Gary Sinise. But oh, that William Peterson. I just love nerdy guys. Which always gives my husband pause, as in, "hey, that must mean...". Sorry Honey.

Anyway, on this rerun, called "The Organ Grinder", a guy is found dead, yada, yada, bad guys, etc, etc but the guy was poisoned to death and it is IMPERATIVE that his organs be used in the investigation. Except that he was an organ donor. Aaagghhhh! How will we ever catch the criminal? In a scene that somehow manages to combine the trippiness or "Fear and Loathing in Las Vegas" with a graphic Jack the Ripper movie(take your pic), they show a flashback to the organ recovery(they may have said "harvest", I can't remember). "Eight organs in 2 hours," the coroner intones, with organs coming out in quick succession and tossed to waiting surgeons. Then cut to the cadaver, with incisions going up, down and sideways. "A Frankenstein" says Grissom. Oh, Grissom, you're so handsome, but you need to go back to your bugs, baby.

All right, gentle reader, where to begin? First of all, I have never, ever, NEV-AH(as we say in Jersey) seen an organ donor with anything other than ONE midline incision, from the top of the sternum to the pubis. If they're recovering heart valves and other tissue, they make a Y incision for the heart valves and then incisions along the extremities and pelvis to retrieve bones. Just organs, just one incision. And they don't rip out the organs, for goodness sakes. You know, these organs have to be used in a living person, right? Do I need to say they are handled with care? Not tossed around the OR like a live hand grenade. But you, as faithful donorcycle readers, already knew that.

Here's another thing. Many donors require autopsies. They are homocides, suicides, accident victims or sometimes they have just been in the hospital for less than 24 hours, requiring a call to the ME. In NJ, it is ILLEGAL for an ME to deny organ donation because of their investigation. In some cases, they may put limitations on it. For instance, say you were unfortunate enough to be shot in the left lung. The ME might then say that all organs could be recovered EXCEPT the left lung. Which we wouldn't want anyway, seeing as it had a big hole in it.

Here's the other thing. The medical examiner is welcome to COME TO THE HOSPITAL and see the deceased. Either up on the unit and/or in the OR. If they decline, we TC's have a special form, called "The ME operative report" that is filled out with all pertinent info, signed by the surgeon and then passed along to the ME's office, with pictures, blood, bile, urine specimens, copies of the chart and any radiology films, as well. We are a full service OPO, after all. We also call the ME prior to the recovery to set all this up. In this heartbreaking story, the grandparents' hope that their grandson's death would not be completely in vain is dashed by an ME's office that routinely denies organ donations in homicide investigations. A mom in Ohio had the same experience, when the coroner would not allow his organs to be recovered, even though his cause of death was obvious-a gun shot wound to the head. In such cases, it would be within the realm of common sense to deny cornea or eye donation-nothing above the neck. But really, do you need to see his kidneys to know how he died?

I hate to sound like a broken record, but donation is good for the donor's family as well as the recipient. Knowing that someone is going to live on with their loved one's organs is a balm for their wounds.

So where does this leave me with the guys in the crime lab? What would I say if I had an hour alone with Nick and Warrick? Nothing, of course, I'd be too busy staring into their eyes...my goodness, have you seen Gary Dourdan's eyes? Oh, yeah, organ donation-where was I?

You might think, savvy, innernet-reader that you are, that TV is just a harmless pasttime, a way to unwind after a hard day, to put your feet up and have a nice cold one. Well, that would be true for only 67% of you. Because in 2005, a Gallup poll showed that 43% of Americans got their health info from the TV. Out in Cali, a group of OPO's and transplant organizations has started a campaign called Donate Life Hollywood, They explain that if a show's plot contained such inaccuracies about HIV, there would be an uproar.

Dr. Susan Morgan, of Purdue University and author of "Entertainment (Mis)Education, has published two studies showing that the misperceptions of organ donation portrayed on TV keeps people from registering as donors.

It's true. If I think back to all the story lines I've seen on TV about organ donation, they always seem to involve some urban myth-selling organs, buying organs, mutilating bodies, etc. But never do I see them resolve the problems or clarify the myths. Maybe it's not compelling enough TV. Which may explain why I read a lot.

Now, if you'll excuse me, I have a producer to write to.

Rutgers sinks the Navy 41-24

If you watched ESPN tonight, you saw that Rutgers Stadium was a sea of red, with one teeny little corner of white midshipman. Sorry Navy, but RU swabbed the deck with you.

Of course, this is the reason, just here to my left (although she's a bit bigger, now). Pooter now has 2 Rutgers shirts, red for home and gray for away games. I promise she'll always be wearing the shirt for games, cause that's what makes them win, you know.

The odd thing about living so close to the stadium and watching it on TV is the slightly surreal moments. I was watching the game and heard a helicopter on TV. Seconds later I heard it above my house, then heard it heading for the hospital. Then, being the nurse I am, I wondered if it'll be anyone I'm taking care of tomorrow. Fortunately, my neighborhood is quiet, so there's no rowdy partying or beeping, but I'm sure College Ave is hopping right now. Hopefully the ER will be quiet too, but it's very possible that tomorrow morning will see a small crowd of patients sleeping off their ETOH. Well, time for me to go to bed.

Catching up

I haven't been doing much writing lately. I feel like I'm in the doldrums.* Maybe it's the heat. While I generally eschew central air conditioning, I wouldn't mind sitting in a cooler right about now. It could be worse I suppose. At least I'm not in California.

I didn't write my monthly article for the George St. Co-op, which I put up on my Laughing Baby site. At this blog, I've been doing my bestest to bring you light and breezy postings, devoid of actual content, if at all possible. I haven't sent anything to a blog carnival in ages, and, in case you haven't noticed, I'm not writing for the NJO blog anymore. It was all part of a grand plan to start a large project this month, now that I'm only working 36 hours a week instead of 176 (go get your calculators, I'll wait).

I've also been ignoring some of my favorite blogs and blog events. If I have the time I'm going to sit down and read this week's Grand Rounds and Change of Shift. Then, if the baby's not crying yet and the dog doesn't need walking, I'll read the Grand Rounds from the previous week at one of my favorite sites, Rickety Contrivances of Doing Good. I wish I had known, I would have liked to post something for that one-sorry Susan.

Anyway, my horoscope for this week says that if I get off my lazy ass and invest some time in a new project, I'll make loads of dough. Hey, ya never know. But the get off my lazy ass part is good advice from anyone.

*And if you make any analogies concerning hot air and this blog, you'd be right on the mark.

Horseshoe Kidney

Earlier this year I did a recovery from a donor and in the OR we discovered, unknown to everyone including her family, that she had a horseshoe kidney. According to this case study from Britain, such a kidney can be transplanted into a recipient with good results.

This is supported by data from Stroosma et al (2001). 13 In this article,
eight horseshoe kidneys transplanted en bloc and 26, which were split and
transplanted into 47 recipients, were compared with 110 transplants in a
control group. No significant differences were found either in the short- or
long-term post-transplant results. Furthermore, no difference was noted between
results from en bloc or spit horseshoe kidneys.
13,18

Last I heard, the recipient of our donor was doing well, also.

According to my mom, I had a great-aunt who had a horshoe kidney. She died young, but not from kidney disease. I think she had cancer. Apart from being a colorful character and a bit of a hellraiser, she had no other issues.

A horseshoe kidney is what happens when both kidneys become joined at one pole, usually the lower pole. This happens during fetal development, during the 5-12mm embryonic stage when the kidneys are still in the true pelvis and the renal capsule is not yet fully developed. Of kidney fusion anomalies, horseshoe is the most common. It has an occurence of 1 in 400 births worldwide and is not linked to genetics. There have been cases where one identical twin has a horseshoe kidney and the other does not. There is some thought that positioning of the fetus in utero can cause the anomaly, as the kidneys migrate up from the true pelvis into their normal dorsolumbar position. The cause, however, is not really known.

Many individuals with a horseshoe kidney go through life with no idea they have it. Symptoms include frequent UTIs, kidney stones, hydronephrosis, and ureteropelvic junction obstruction, due to the high insertion of the ureter. There is also a higher risk of trauma to the isthmus because it lies anteriorly to the spine. Treatment is usually reserved for when the patient becomes symptomatic; antibiotics for infections, and surgical or nonsurgical interventions for hydronephrosis or stones.

In about 1/3 of all cases, there are additional congenital abnormalities, often occuring along the midline of the body: hydrocephaly, VSD, cleft palate, spina bifida, anorectal malformation, malrotated bowel, club foot and polydactyly. People born with a horseshoe kidney are more likely to also have Wilm's tumor or renal cancer. Two sydromes are associated with horseshoe kidney, Turner Syndrome and Trisomy 18.

Two articles are included here and here for more info. I also found a link to some good pictures of kidney anatomy and abnormalities here, but be warned, it's not for the squeamish. You'll never look at pyelonephrosis the same way again.

I've also been looking at congenital heart defects, but GOOD LORD, it'd take me a week to write all that. Do you have any idea of how many different ways your heart plumbing can be screwed up? It's a wonder and a blessing that most babies are born happy and healthy.

I thought so....

You Are: 0% Dog, 100% Cat

You are are almost exactly like a cat.You're intelligent, independent, and set on getting your way.And there's no way you're going to fetch a paper for anyone!

Are You More Cat or Dog?

Thanks to RLBates for turning me onto this quiz. Her website, Suture for a Living, has a great post on another great surgeon and his role in transplant history, Dr. Joseph Murray. Check it out.

Today in Donation History

Just found out that today is the 39th anniversary of the first multi-organ multiple transplant. You can go here to Wired! for the story. The 5 teams, involving 60 surgeons, nurses and assorted personel(we're gonna need a bigger OR) was coordinated by Dr. DeBakey. Yes, that Dr. DeBakey, as in "pass me the DeBakey." Here's a look at his remarkable career. Another interesting bio is here. The man invented a continuous flow rolling pump in med school, in between studying I guess, that later was instrumental in developing the heart/lung machine. That was just the first in a long line of medical inventions. Dr. DeBakey, by the way, is still on faculty at Baylor.

The surgery, which took place on August 31, 1968, recovered a heart, one lung and kidneys that were transplanted into 4 people at one hospital.

Random musings

Out of the five different patients I took care of these past few weeks, only 1 is probably going to have a normal life span. Two may very well be dead before the year is out. I thought I was leaving the dead and dying and going to work with the living and recovering. Ah, well.







Maybe it's the reason why I've been exploring my spiritual side. (Do we only have a spiritual side? Who was it that said we're not human beings trying to be spiritual, we're spiritual beings trying to be human? 50 points and an organ donor card for the first person to tell me). Anyway, I know Kim talked about this somewhere on her blog, eons ago, but I stumbled across St. John of God this week. Not literally, because as a saint he's in heaven and I think his bones are probably in a church somewhere. St. J of G is the patron saint of nurses, firefighters and bookbinders, if you believe in that sort of thing. He could also be called the patron saint of aimlessly wandering through life until you finally get your s*#t together. That's a little too long to fit on the medallion, but it suits me. I can't say I'm really down with the whole patron saint thing. I keep recalling my best friend and daughter of a Methodist minister in high school who was constantly chiding my Catholic self for worshipping idols. She also used to wear orange on St. Patrick's day. It's amazing she lived to see graduation, but I digress. Anyway, it's nice to find a saint that wasn't gruesomly tortured to death or did fantastic miracles, like levitate or have the stigmata.







Anyhoo, there's nothing wrong with being pierced by arrows or having your breasts sliced off, but old John seems like a more down to earth kind of saint. So I got one of these. Actually, I got the last St. John medallion they had. Like most of my religious leanings, it falls under "can't hurt, might help". Actually, that's a little flippant, even for me, but like poetry and masturbation, I think religious beliefs are something you save for when you're in private. If you want to know what I truly believe, it will require some wine and a long night of talking.

St. John of God

On a lighter note, we finally made it to the beach this week, LM, Pooter and I. We're trying to pull together last minute plans for the 16 year old's B-day bash, so we went on a scouting mission to Ocean County. First of all, what's up with the Seaside Bridge(or whatever it's called)? One side is high enough for boats to pass under, the other side is a draw bridge. Wouldn't it make sense to make BOTH sides high enough for boats to go under? Or do they just like to stop traffic every 5 minutes in the height of Summer? The world may never know. We did find out that Island Beach State Park allows camp fires on the beach and you can stay til midnight as long as someone has a fishing pole. I know this may astound some of my readers in more enlightened areas, but NJ has some really odd beach rules. Like the idea that you have to pay to go on the beach. I was in college before I realized that many parts of the country think this is sacrilege. So, most beaches are swim between the buoys, no campfire, no driving, no dogs allowed kind of places.

Pooter loves the beach. She stood in the surf, tried to catch a few seagulls, which she calls ducks, and did her darndest to dig to China. We came with about 10 pounds of sand attached to us, each. I have also now lost enough weight that for the first time in several summers, my abdomen saw sunlight. Granted, my belly looks more like this:

And less like this:

But one of the great things about being on the far side of 30 is that you really, truly, no longer give a shit.

If only I had that attitude when I had my 19 year old body, I may have conquered the world. Both the world and myself are probably better off for me being young and stupid and now older and (mostly) wiser.

We also found the best bakery, Park Bakery, in Seaside Park. Have you ever had those little Italian cookies, that look like this:

Right? Everybody has. I worked in a bakery when I was in high school and we bought them from a larger bakery. Most small bakeries do that, they don't make them. Hence, they are usually dry, crumbly things. My grandmother used to bake her own, mmmm. Well, Park Bakery makes their own and they are amazing. I had no idea these cookies could taste so good(sorry, Grandma). So the ride home was spent sunburnt and tired, happily munching cookies. I love summer.

Why I <3 Surgery

I've always loved being in the OR. My mom was an OR nurse. When I was growing up we'd watch the shows where they show you the surgery in progress. Totally gory. I loved it. In nursing school we got 2 whole days of OR experience. One in the PACU and one where we observed an operation(unlike my mom's 1950's nursing curriculum, where she was basically prepared to RUN an OR after her orientation there). Much to my dismay, the surgery I got to observe was an arthroscopy of a knee. Big Woop. One of my fellow students, a big fella, got to see the resection of a bowel and promptly passed out. Wuss.



My plan was to work in the OR after I graduated, but in 1996 hospital's were still in denial about the nursing shortage. Even the hospital my mother worked at wouldn't hire me without a year's experience. While I looked for work, I enrolled in an OR certificate course. The first time I scrubbed in, the doctor asked me if I was a righty or a lefty. I told him righty, and he grabbed my left hand and stuck it in this guys abdomen up to my wrist. "That," He told me, "is his pancreas. Don't squeeze." So I didn't. Probably my most memorable operation at the time was a splenectomy on a guy who had idiopathic polycythemia. It started out as a laparoscopic procedure. Just like Jaws, it quickly became a matter of "We're gonna need a bigger hole." They had made an incision to remove the spleen, then they made it bigger. Then they made it bigger. This spleen was bigger than most babies. Seriously, I think it weighted 10 pounds.



Five months after passing my boards I still didn't have a job, so I took the first thing that came my way-nights on a cardiac telemetry unit. Part of my orientation was to take the critical care class and part of taking the critical care class was a ride along with the paramedics. Two minutes into the ride, we got called out to a local quarry where a woman had been electrocuted. It was the first time I ever did CPR. After that, I was hooked on emergency and critical care. We had to supply a nurse every shift to cover codes and I used to beg to be that nurse. A year later I was in the ER.



Cut ahead several years. I had worked almost three years in the ER of a level one trauma center and I wanted a change, so I transferred to the OR. It was still interesting. They put me into a specialty rotation-pediatric orthopedics. Since all things pediatric go together despite the best of logic, I was also trained to do general pediatric and pedi urology. Three completely different specialties. You'd never see an orthopod cross over and do an appendectomy once in a while, right? Whatever, I liked working with kids, even if they were only awake for a short time and I liked ortho. Hammers and screwsdrivers and stuff. Much better than working in vascular with needles so small they make you weep when you drop one and much, much better than, God help me, doing eyes.



The head of our pediatric orthopedics service was(and still is)the captain of the ship. Back when God was a child he had been in the Air Force and he still had a way of making you want to stand at attention and snap your heels together. Frequently, and with no prior experience as a Southerner, I called him Sir. If he saw an unfamiliar face in his OR, he was on the phone to the front desk. If he thought anesthesia was asleep at the switch, he'd yell at them to pay more attention to the blood pressure. I'm pretty sure he is the only surgeon I've ever worked with who even knew the patient had a blood pressure. He loved those kids and he could put in CD rods quicker and more assuredly than I could get dressed in the morning. He also didn't give a fart about anyone else. If you weren't paying attention during the case he'd rip you a new one. If you did your job with competence and alacrity, perfection even, he'd allow you to be in the room the following week. One time we had a kid go into spinal shock. Like a precision machine we finished the case while anesthesia worked to bring up her pressure and the tech gave units of blood from the cell saver. Every time one of the surgeons put a hand out, I put the right instrument into it without them having to say a word. Finally, the crisis was past and they started to close at a more normal pace. I was about 2 seconds too slow in giving him his monocryl and said, "Hey, do you think you could pay attention to the case?" Afterwards, I confronted him. I told him that I had busted my hump to keep up with his furious pace for two hours and he had to bust my (proverbial) nuts over the closing suture? He had no idea what I was talking about.



I probably wouldn't invite him out for a drink, but his group has operated on my daughter.

Some surgeons were pretty aweful. Some threw things. Some really did think that white light emanated from their rectums instead of waste products. But some were also down to earth and very personable. One guy, Chuck, was the hardest working guy in surgery. He had privileges in like, five hospitals and said he'd have to work until he was 80 to pay off his wife's credit card bills. The docs would get lunch every day in their lounge. Every Friday brownies were included and every nurse knew it. Chuck would bring the tray of brownies into the nurses' lounge and we'd all be like, "I don't know HOW these got in here." It takes a smart man to know that if you give the wife the credit cards and the nurses chocolate, all will be well.

The other great thing about the OR I worked in was the people. It was a really amazing group of people who all, mostly, got along and helped each other out and that makes for a great job no matter what you're doing.

But in the end, I missed emergency/critical care too much. Which is why I liked being a TC-you get to incorporate the patient care, teaching, family support and the occasional OR into one groovy job. I wouldn't mind going for first assist when I get my master's, but I'm not sure how I'd incorporate that into an NP position. Well, we'll see.

Change of Shift

Be sure to check out this week's Change of Shift at Nurse Ratched's Place.

Warning:Objects in the mirror may appear sexier than they really are

This is NOT what I look like at work.(although I think I've taken care of the chick on the right in the ER-tough night of partying, has a terrible headache and, oh yeah, can she get a rapid pregnancy test too? Yeah, I've taken care of that one).

Anyway, 12 hours on your feet is a bee-otch. How does Christina do it? In high heels and a garter belt, for goodness sakes. Remember, I've spent the past three years clicking through the hospital halls, giving orders and looking pretty. Now I'm back in sensible shoes and covered in body fluids. Literally. My first day back I had a post op who was nauseous. Guess who forgot how to duck in the last 3 years? Ewwww. Sweet kid. He asked if he got any on me and I just told him, "no honey, you totally missed me." The upshot of all this is that it gives me an excuse to shop for some new, cute scrubs. Dickies seems to be an especial favorite of the PICU set. I'm also on the lookout for some Curious George tops. I wanted this one, but I think it might not be appropriate for the little 'uns. The Little Pooter loves her some Curious George, but I draw the line at Thomas the Train. That show explains a lot about the British psyche, is all I'm sayin.

The past 2 days I've taken care of the sickest baby on the unit. His prognosis isn't good, but if he can make it to 10kg, he might be eligible for a kidney transplant. That might not sound like much. Heck, some of us can probably put on 10kg in a good weekend. But I have a sinking feeling that I'll vote Republican before this kiddie gains 7 more kilos. Not to mention the problems with his lungs, heart and brain.

Speaking of kids and kidneys, one of my sister's students is back on the waiting list for a kidney. She's 16 and her first kidney transplant failed, so she's back on dialysis. Please keep her in your thoughts and prayers that she gets a kidney soon. Here's a brief overview on dialysis, hemo and peritoneal. For a primer on dialysis complications, complete with nausea-inducing pictures, go here. Suffice it to say, being on dialysis is no picnic. Maybe working in the ER for so long gave me a jaundiced view(sorry about the mixed metaphore). Folks who have been on dialysis for a while do NOT look healthy. Their skin is dull, their hair is brittle. Long term dialysis can lead to osteoporosis, anemia, cardiovascular disease and arrhythmias. AV fistulas require special care and can get infected or clotted. Some people just seem to clot frequently and they come in often for AV revisions, but you only have so many sites for a fistula and so much vein to work with. And let's not forget the "routine" problems:you can't travel, you have to closely monitor what you eat and drink and you're hooked up to a machine 3-4 hours at a time, 3x a week. Every Mon-Wed-Fri or Tue-Thur-Sat, without fail, every week, until your kidney comes in. Having coded many people who were undergoing or just finished a dialysis treatmens, it is so heartbreaking to think that they died waiting to be free of that machine.

On a similiar note, my 8th grade science teacher, Mr. P, had an insulin pump for his diabetes. He named it Natalie. Natalie was a girl who liked him when he was a young man and he couldn't stand her but he could never seem to avoid her, either. He hated that pump, hence the name. He died from complications due to his diabetes in my freshman year-I think he was in his 40's, maybe 50. I think if I had to be hooked up to a machine to help me live, I'd name it something a lot ruder than Natalie.

Anyway, I was hoping to have more facts and figures on pediatric kidney transplantation, but google is not my friend this week. In fact, it's making my head ache, which is partly the reason I haven't posted in a bit. I really need to find a good, medical search engine that's free. Help a sister out and let me know if you all have any suggestions. That, plus the New Jersey weather has led me to a state of humidity-induced lethargy that requires lot of bedrest and frequent infusions of iced coffee.