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
eeeeeeeeee
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.

3 cheers for PICU!!!

I would like to extol the virtues of the Pediatric ICU and all who staff them. Why? Because in PICU, your patients aren't combative, they're cranky. Because in PICU, turning and positioning requires 2 hands, not a team of people. Because body fluids are kind of cute when they come out of little behinds, or noses, or whereever.

I've been in this PICU for, hmmm, let us see, 18.25 hours now. My patient is a teen who made the bad mistake of mixing booze, driving and bad weather to her permanent and everlasting sorrow. And the sorrow of her mom, siblings, cousin and young baby. It's been a slog, and I'm emotionally drained. I felt so bad for her mom, then when I found out she had a little baby-home, crying for Mama, I thought I was going to lose it. They chose to donate so that someday, this little one will at least know that his Mama saved 7 other lives. That all sounds so trite to me right now, because I'm exhausted and all I can think about is my little, wee one growing up without me. We(by we I mean the nurses) were sitting around, catching our breath for a few minutes and we started telling each other about "our worst" stories-the worst dead child story, etc. It was getting to be the wee hours and I was too creeped out for that shit. Finally, somebody told a story about her son's toilet training adventures and we were laughing again and THAT is why I like PICU-because nothing will get you out of your own shit like a good poop story.

About Face

As some of you may know, France did the first successful partial face transplant last year. Now, an English surgeon has received the go-ahead from the NHS. The ever thorough BBC has everything you need to know and more about face transplants here, including a link that shows what the journalist would look like with the surgeon's face, if you're really interested.

I was thinking that donating my face would be very, well, icky. Believe me, I'd donate any part of me after death(except my eggs, but that's another matter). But when I read the article and thought about having to go through life with terrible facial burns, or no nose or lips, I changed my mind. Let me know what you think.


Grand Rounds 3.5 is up at Health Care Law Blog. And if you have to catch up on your reading, like I do, Grand Rounds 3.4, check out Emergiblog. Happy Reading!

This just in...

So, I was talking to this nurse today over the phone, trying to get some information on a patient we're following. So I ask her, "Is he on any pressors?"

She answers, "Well, he's on lopressor." And she's serious.

If you think that's funny, you may have been a nurse too long.

Play this!

UK Transplant has this great game about allocating organs. It's addictive. I so need to practice...because, uh, my patients didn't do very well. Also, NATCO, The North American Tranplant Coordinators Organization, has a patient simulation for various professionals: transplant coordinator, hospital development, etc. which is very useful, educational and fun, if you're into that sort of thing. I am.

Better Late, If Ever...

And who reads ANYTHING on a Tuesday? Oh, guess what, Grand Rounds v3.3 is up at Unbounded Medicine, which is a funky site. Go there today and see a neat pic of someone who has there arm, well....just go and check it out. In the spirit of full disclosure, and because I'm a selfish Bee-otch, I only bring up the GR because I'm in it. And I'm listed under the Physician Stories...so please, it's Dr. TC from now on, thank you.

You think you can handle this?

Sometimes, this is my job:

"We do more before breakfast than most people do all day."

And sometimes, it feels like this:

"Faster than a speeding bullet, more powerful than a locomotive, able to leap tall buildings in a single bound. Look, up in the sky, it's...

Yet other times, it feels like this:

Recently, though, it feels like this:

"The hell you will. He's got a two day head start on you, which is more than he needs. Brody's got friends in every town and village from here to the Sudan, he speaks a dozen languages, knows every local custom, he'll blend in, disappear, you'll never see him again. With any luck, he's got the grail already. "

But in reality, I often feel like this:

"Hello?...Hello?...Does anyone here speak English?"

Recently, someone in the comments section asked me what it takes to be a transplant coordinator. Of course, I didn't read my comments, or surf the web at all, for like a month. So, I thought I make it into a post. Sometimes, it does seem like an army of one. Depending what hospital you're at, you're either surrounded my friendlies or behind enemy lines, but I'll take that analogy no further. Sometimes you do feel like Superman, you hit your groove, you haven't slept for 24 hours and you're going on pure adrenalin. And yes, occassionally I DO feel like the Grim Reaper, waiting around the bedside of a dying person. Although I want to be more like Indiana Jones (I even majored in Archaeology, a long, long, time ago), I usually feel more like bumbling Marcus Brody.

I don't want to be too snarky. It is a good job with a good purpose and I still like it. I will say this-my co-workers and I are an eclectic bunch. We're all idiosyncratic. We spend many hours alone in hospitals where we don't know the staff, don't know the doctors and don't know how the system works and yet, within a short period of time, we've got to get the system working and differing parties collaborating toward a single goal.

An ability to stay awake for long hours helps. It's very common to get a call at 5 or 6am saying that you have to be at a certain hospital in an hour. I've arrived onsite to find that the clinicals are already in progress and sometimes the family is ready to be approached. You spend the day managing the patient clinically, sharing the organs, coordinating the teams to come in. Inevitably, the OR is never at a sane hour. So by the time you get in the OR at 3am, you're fried and wondering if maybe a job in food service is the way to go.

Strong clinical skills are a definite requirement. Every donor is different. Some are hemodynamically unstable from the get go. Think a gun shot wound to the head or some other massive head trauma. They're in DIC, or DI. They're hypotensive from blood loss. Other donors are brain dead from anoxia, like a status post cardiac arrest. They may take a week to become brain dead and then you have all the problems of someone who's been immobile and on a vent for a week. Pneumonia, electrolyte imbalances, blood clots. Another challenge is the 180 degree turn in clinical objectives: from a head injury to an organ donor. With a neuro patient, you're trying to keep the ICP down, so you're minimizing fluids and maybe using 3% saline. You're clustering care and not moving the patient so much. After brain death, the patient becomes hypotensive from vasodilation and you're pouring fluids into them. To keep the Na low, or to lower it if it's already high, they're put on 1/2 NS. Suddenly you're asking for chest PT and frequent turning and suctioning. Inevitably, someone will ask, "why are we doing all this on a dead guy?" The best answer I've heard is that when you're taking care of an organ donor, you no longer have one patient, you have up to 8-one for every recipient who's going to benefit from these organs.

And that leads to the important skill:tact. You have to be a diplomat. Some hospitals do one donor a year, maybe. Some hospitals call you every week. Some now what they're doing, some don't have a clue. Some are very excited when they get a donor and are eager to work with you and some...well, not so much. In any event, you can't really go in their like gang busters and start telling everybody what to do. Well, you can. And some have. But it won't make you very popular and you'll make the next transplant coordinator's job that much harder the next time. Not that I'm bitter or anything, I'm just saying.

Add a large dose of compassion. And a good sense of humor. And don't take things personally. So, are you ready to see new places, experience new things and meet new people? And then take their organs? This job's for you.

blogging from the smackberry

The powers that be told me that surfing teh internets is free on our plan. I can only hope that's true or I'm going to have a $5000 phone bill.

Blackberry Hell

It doesn’t pay to get out of bed, some mornings. I was trying to get out of the house and to the hospital early. Well, early-ish, if you get my drift. Laughing Baby was just finishing up her breakfast nosh and was falling back to sleep. I was snuggled up next to her, tapping my toes and checking my email on my brandy new technical device that rhymes with “Smackberry”, waiting for her fall completely asleep so I could sneak out of the room and get ready. Next thing you know, I drop the Smackberry on her head. Oh! Howls of agony! Oh! Great Gobs of Mommy Guilt! Upon further inspection, I think they were more howls of indignation that actual pain and suffering, but not matter-everyone in the house was now awake and I wasn’t going anywhere in a hurry.

Speaking of the Smackberry: this thing is causing entirely too much aggida (Agida? Adgida? Ajjida? Any Italians out there know how to spell the damn thing?) Anyway, after much intestinal distress, I’m starting to like the thing but it is a pain in the ass. I’ve dropped more times than I should admit to. I set the ringer on high and it wakes everybody up in the middle of the night. I set it on low and no one hears it, including me. Yesterday, I was called 12 TIMES and they were ready to send out the bloodhounds to find me when I woke up, checked the phone and said, “Holy Shit!” and wound up having to apologize to all the people who lives I disrupted. Sigh. I am not a techie. I’ll figure out that it does this or that and the family just roles their eyes at me, like, what took you so long? As in, “Hey, this text messaging is great! Do you guys know how to do this?” Sigh.

And it’s turning my coworkers into people I’d rather not spend to much time around. They’re all like, “How come my email doesn’t work?” and “We need a class for this. How can they give us a Smackberry and not give us a training class?” Excuse me, but the last time I got a cell phone, it didn’t come with a class, it came with a Spanish instructor. His name-Manuel.

Every meeting is a flurry of chirps and beeps and bells and rings as people scramble to figure out if they just got a phone call, an email or a message from God himself. I’ve heard that when they elect a new Pope, white smoke will come out of the goddamn thing.

And while I’m kvetching, my house is a disaster. There are ants on the kitchen counter because Love Monkey made some cinnamon toast for the baby and it rained sugar on the counter. “I don’t know,” LM shrugs, “they must be special ants, the kind that only eat sugar.” What? So there it is, an ant parade, in my kitchen. Hopefully, they’ll stay there, because the LM also doesn’t believe in using the high chair, but lets the baby graze throughout the house, like a little goat and so soon the “special” ants are likely to follow said “kid” and her trail of crumbs. Also, blocks are everywhere, Little Einstein CD packs are scattered around and many, many cups and glasses line the bookshelves and cabinets, high up out of baby reach. But don’t worry! Lives are being saved, (including those belonging to ants) and I’m hard at work, living out of my car and eating fast food. I had a professor in nursing school who said she threw a pile of dirt in the corner and when it started to sprout, she knew it was time to clean. Words to live by. Now excuse me, I’ve either got a cricket in my house or the phone is ringing.

Vacation Ramblings

Or How I Went Nowhere On My Summer Vacation

(Disclaimer: the following has nothing to do with donation, you've been warned)

I can't think of anything that excites a greater sense of childlike wonder than to be in a country where you are ignorant of almost everything. Suddenly you are five years old again. You can't read anything, you have only the most rudimentary sense of how things work, you can't even reliably cross a street without endangering your life. Your whole existence becomes a series of interesting guesses.
Bill Bryson
Neither Here Nor There

This is the first year in a long time that we haven't gone anywhere. I mean, I go a lot of places. It's just that there all intensive care units. The locals don't have much to say, being mostly intubated and all. I felt a real longing yesterday while watching Rudy Maxa in Australia. I'm not a big fan of Rudy, who's sort of a Rick Steves for staid, conservative types. For instance, Rudy went to the Gold Coast and watched people surfing. But did he surf? No, Rudy laughed at the very idea. But Steve, he totally would have surfed, even if he looked like a total dork. I'm a big Rick Steves fan.

A big G'Day to all you Down Undah

So it made me long for Australis. I went to Oz several years ago and it made a big impression on me. I stayed a week in North Sydney and woke up every morning to a gorgeous view of the opera house, the harbour bridge and Luna Park's smiling, lunatic face. If you've never been, Sydney is like San Fransicso meets the Bahamas. The people are friendly, like Americans, but nicer, tanner and better looking, with cute accents. I can't really say enough about it. Except it's hard to find decent coffee. We did all the touristy things:the Opera House, Syndey Zoo. We took a tour of the Blue Mountains and saw kangaroos hopping around like deer in our parks. We had billy tea and wellingtons. I ate crocodile, which really does taste like chicken. Oh, how I want to go back. Except that I could put a down payment on a house for what it would cost 4 people to fly there. It's really far. So far, that when it's today in Australia, it's still yesterday back home.

If I went back, I'd want to go all over too and make a big trip of it. I've always wanted to go to Perth, which, as Dame Edna says, is the nicest city 30 hours from everywhere. I go to Adelaide and Uluru and pretty much anywhere, but I'd really like to go to that place where the people live in caves dug in the ground.

And of course I'd want to visit New Zealand, cause, duh, there right next to each other. I mean, look at a map of the Pacific, right there in the lower left. See, they're right next to each other. My ER preceptor was from New Zealand, a snotty girl who all the guys were in love with because she was cute, perky and had the cute accent. Once we had to explain what a back-ho was to her. It was an interesting conversation. Really, all I know about the place is from an old boss of mine at a tool and dye shop I worked at during high school. The job was dead boring, but he used to tell me all about how New Zealand had the best trout fishing in the world and that the weather was in the 80's all year round. He was going to go there when he retired, I hope he made it. And, of course, the whole place is populated by hobbits. But you already knew that.

Tomorrow, if I'm done with cleaning out the basement, I intend to go to the beach. The shore, if you will. Whooopeee! It won't be the Gold Coast. But then, my chances of being eaten or stung by something deadly poisonous is much slimmer.

File under "WTF"

Medscape has an article that debunks an article from last year that says nurses shouldn't be paid well. The economist who did the study reasons, poorly, that if nurses receive low pay they'll do the job out of love and vocation and consequently the quality of nursing will stay high.

Medscape does a good job of showing why this is complete bunk. The first good point they make is that nursing is not just about caring for people, but is also a skilled profession. Think about this:could you imagine asking a doctor to take less pay to keep his motives for becoming a doctor pure? Why stop with healthcare? Can't this economist think of any other professions that shouldn't be motivated by (gasp) a paycheck? How about clergy? Not your average clergy, like my best friend's dad. I know he's not doing it for the money. I'm talking about those Tammy Faye/Jim Bakker types. Or how about keeping the pay down for lawyers? Surely they're not in it for the money? Or teachers? Or police?

One group of professionals that definetly needs a paycut are politicians. You want to be president? Fine, but you're going to make minimum wage. And only work 35 hours a week, so my tax dollars don't have to pay for your healthcare.

For me, what this study is really about is how nursing still labors under a stereotype. (Medscape also makes this point). Because the field is still dominated by women, people don't take it seriously. I remember working at a hospital where they wanted to cut back on our health benefits. A lot of the married women were like, "why should I care? I have my husbands policy to fall back on. " Forget all of us who weren't married and depended on our benefits. The point is that we deserve to get paid what we're worth(and that includes good benefits-how can a hospital rationalize bad health benefits?) We're not caretakers, we're health care professionals.

Also check out Medscapes article about nursing salaries around the country. I know it talks about the cost of living and how it varies to justify why nurses get paid so little in some parts of the country. I realize that a $400,000 house in my neck of the woods might be half that somewhere else. And car insurance is high here, too. But the price of a car is the same no matter where you go. Groceries aren't any cheaper in the South, neither are clothes. So why are some nurses still making $16 dollars an hour? It boggles my mind.

I'm all for the office of the national nurse, but I also think it's time for a national nurse's union.