a snapshot

For anyone who is not clear on what it is I actually do at work, like, specifically, allow me to describe the first two hours of a recent 12-hour day, which day actually was not that recent because immediately after said day I, have mercy, took off for Arizona and didn't touch a computer the whole time. (Unless you count iPhone, which I know totally counts, but I like to think I am capable of living with less technology for a few days. Go me!) So anyway, here is a rundown of the first two hours of this particular not-all-that-special day.

0700 - 0740: Get Report in the Report Room, i.e., eat oatmeal, chug coffee, and furiously scribble down notes on all 19 of the patients from the day and night before, paying particular attention to my assigned four.

0740 - 0745: Check my patients' orders really fast (BUT ALSO THOROUGHLY AND ACCURATELY) on the computer. Document on the computer that I have checked my patients' orders, by entering another order that indicates I did so. Yeah, I don't know.

0745 - 0755: See Patient 1. Who does not speak English and is from Honduras. I speak un poquito de Spanish. He was just admitted over night. He is sitting, tense and nervous-looking, near the locked exit door, fully dressed with his bags packed. I am able to glean from our strained conversation that he does not understand where he is or why he is here. There is something going on with his legs, as he keeps tapping them and looking at me and then looking at them. I tell him that the interpreter--aka "the person who speaks Spanish better than I"--will be here at 8:00. 

0755 - 0805: See Patient 2. Who has an intake appointment at a recovery house at 8:30 and needs to be discharged, like, ten minutes ago. Tell the patient to gather his belongings. Administer his morning medications. Complete his discharge paperwork, make sure his prescriptions are filled and on the unit, gather all his contraband which is stored in the Med Room to return to him. Sit down to assess and do discharge teaching with the patient. Patient has all his belongings on his lap and is eating a maple glazed donut. He has a distant, blank stare. (Have I told you we have maple glazed donuts on the unit pretty much daily? Help me Lord.) Patient expresses understanding of where he is going and what medications he is to take. He receives papers with this information on them, highlighted in bright yellow by me. I ask the patient to sign his paperwork, and he licks the donut glaze off his fingers and then takes my pen. I tell him he can keep the pen. He signs the papers and hands the pen back to me. I tell him again to keep the pen. He looks confused. Something is not quite right here. 

0805 - 0815: The interpreter for Patient 1 is here. She can only stay for 45 minutes. Which means all assessments, teaching, discussion--mine and the doctors'--must be done pretty much now. I do mine first. It turns out the patient believes there were a bunch of men drinking here, in the hospital, on the unit, in his room, last night. He saw and heard them. They poured beer on his pants on purpose, but it has since dried. He is upset about this. Dios mio.*

0815 - 0825: Kill two birds with one stone by getting medications for and introducing myself to Patient 3. Who has cerebral palsy which has left him unable to use one leg, a plastic splint on the other ankle because has he broke it a year ago and it was never fixed properly, and a cast on one of this arms because it was freshly broken in a bar fight. He is withdrawing from alcohol and narcotics. He is a little bit cranky, understandably. He wants to talk at me about his condition for what feels like a really long time. 

0825 - 0830: See Patient 4. Patient 4 is arguably the worst off of the lot, but he is on Constant Observation (i.e., there is a Certified Nursing Assistant watching him and only him and attending to his needs to the extent of his/her license 24/7). He is not going anywhere anytime soon, and I know he is okay. I know going in that he is on the autism spectrum, is non-verbal, i.e., doesn't speak ever, and has some odd compulsive behaviors. I knock on the door and open it and he is cowering behind the door, shivering and nude, except for his orange baseball cap which prevents him from hitting himself in the head. His observer says she will try to get him to put on some pants. I tell her that sounds good.

0830 - 0840: One of our Nurse Elders expresses concern that Patient 2 may not be appropriate for discharge. I reluctantly concur and tell her about the finger-licking-glaze-pen incident. She talks to "the docs" and performs a Mini-Mental State Examination on the patient. He passes. I call a taxi to take him to his Recovery House. I again make sure he has all his belongings and discharge necessities, and I send him down to meet the cab with one of our Support Associates.

0840 - 0841: I take a mental tally of what is going on. Patient 1 is still with the doctors and has no medication orders yet. Patient 2 is discharged, hooray! Patient 3 is medicated and yapping away at the breakfast table. Patient 4 needs his meds. I know he doesn't always take his meds, or will only take them from certain people. I cross my fingers. 

0841 - 0845: Patient 4 accepts his meds. Aaaaah. I now understand why other nurses have been saying how cute he is. He is really quite adorable, and he looks up at me with deep, soulful puppy dog eyes. (His making of eye contact knocks him off the straight autism diagnosis and onto The Spectrum.) He lies down on the bed and begins choking his stuffed toy monkey with his hands, which is one of the few activities that helps him calm down. A-ok!

0845 - 0846: I am behind on my documentation but everyone got their meds and everything is under control! I got this!

0846 - 0848: I am needed at the Nurses' Station. I have a phone call. Our Support Associate is calling from the hospital lobby. She, for valid reasons, briefly turned her back on Patient 2 and when she turned around, he was getting into the wrong cab and took off before she could do anything. Not just the wrong cab, but a cab from a company that we do not have an account with, like we do with the correct company. I tell her to come back to the unit because, really, what else can she do?

0848 - 0850: I go to the bathroom for the first time in several hours and/or tell The Team what is going on with Patient 2 and/or compulsively pick all the nail polish off my fingernails . . . I don't really remember, so I'm just making an educated guess here.

0850 - 0852: I have another phone call. I pick up the line and it is a man with an accent. He sounds very angry. He tells me that he has a passenger who told him to go to X neighborhood, but the passenger does not know where in X neighborhood he is supposed to go. Also the passenger does not have any money. I tell him that actually the passenger is a patient of mine and is not supposed to go to X neighborhood at all, but to an address near the hospital which he has on a sheet of paper which is on his person. The man says he will call the police. I tell him to return to the hospital, where he will be paid for the whole roundabout ride in cash. The man agrees.

0852 - 0858: I attempt to get caught up on my computer documentation and sign of meds I have given and whether or not my patients are experiencing any pain and what, if any, interventions I have provided for said pain.

0858 - 0900: The man calls again. He is downstairs. He says the fare is $12, but he will charge $10 because this is a patient. I thank him. I go find my wallet. There is a $10 bill in it thankgod. I assume the man is not expecting a tip at this point, though he certainly deserves one. The Support Associate, who has since returned to the unit, says she will pay the driver with this $10 and escort the patient to the Recovery House on the bus. I thank her.

Here is a picture of two Shetland ponies wearing cardigan sweaters: 

Image courtesy of Buzzfeed/my friend FAB

*As it turned out, despite a tumor-with-metastases-to-the-brain scare, this patient appeared to have been suffering from alcoholic hallucinosis, which is like a slightly less horrifying and much less dangerous cousin of delirium tremens. Which is a deadly condition that happens to people quite frequently, actually, and is not just a craft beer from Belgium.**

**Delirium Tremens the beer is the third Google result for "delirium tremens." It also, apparently, inspires extreme nerdery from beer reviewers on Beeradvocate.com.

Upon the pour, it yields a deep golden showcase with massive fluffy white crown that stands with exceptional retention. Let the time fly, the head slowly sinks to decent foamy layer covering atop along with plenty of spotty and patchy lace. Rather high carbonation pushes the wave of eternal bubble to run actively towards the crest.

Mmm, beer....

self help

On a diagonal side street in a desolate little pocket between Baltimore's stately, academic Charles Village and the fairly decrepit Greenmount Avenue (which, under the Google heading, "searches related to 'greenmount avenue baltimore'" are "baltimore police beat" and "worst street in baltimore"), lies a warehouse-y building that is home to The Book Thing. The Book Thing is a magical place where there are multiple rooms stuffed full of shelves and piles and bins of books that are organized by category. You know, like a bookstore. Except everything has been donated, there are no checkout counters, and everything is free.

Image borrowed from this random internet person. Thank you, random internet person.

Today, I was feeling particularly sorry for myself for personal reasons I would've blogged about in 2004, so instead of staying in bed all day with the covers over my head like I so desperately wanted to do (although I did spend a good deal of time doing just that), I biked my sorry ass the 3.4 miles (uphill both ways!) in search of more stimulating reading materials for my psych patients. In the approximate words of my all-time favorite advice columnist, Carolyn Hax--when you're feeling blue, you must 1., eat healthily, 2., not abuse substances, 3., get enough sleep, 4., exercise, 5., spend time with loved ones, and 6., try to focus your attentions outward. I'd already had a pile of pancakes with a friend, so this activity would take me to 3 out of 6, and I figured that 3 out of 6 ain't bad (you can take a wild guess as to which 3 I am still, um, working on).

I love shopping for other people, partially because, hello, it's SHOPPING, but there's less guilt because it's not for you and lord knows you don't need any more crap, but mostly because it's fun to think about what people might like to get that they wouldn't necessarily buy for themselves. For example, this Christmas I bought my parents deluxe dog toothbrushes. They were a big hit.

Anyway. So I acquired 23 books, a couple of which--okay, five--were for me. I hope some patients enjoy them, but even if only one book makes one person's day a little better one time, the back strain from carrying 23 books in my backpack on the way home is worth it to me.

I couldn't resist a 1962 copy of "This is the Pekingese," because Pekingese are so captivatingly weird looking and also the author repeatedly uses the term "germ plasm" in the chapter on how dogs (and humans!) perpetuate their genetic material. I also got a collection of Rumpole stories for a smart, sarcastic older man who used to love to read but is so depressed that he hasn't in years (I have no delusions that I will be successful in getting him to start again, but might as well try?). I got Volume 9 in the photography-heavy series "The Ocean World of Jacques Cousteau," because, the most recent day I worked, one of our chronically ill patients perseverated at me for like 30 minutes on how much she loved another volume in the series that we already have on the unit. That one is about dolphins and killer whales, and I figured I'd shake things up a bit and show her some coral reefs.

I also picked up a dictionary--we've had several requests for a dictionary from patients who like to play Scrabble--and I managed to find the same one I grew up with, Merriam-Webster's Collegiate Dictionary, Tenth Edition. Then there's some easy fiction--James Patterson in large print and Michael Chrichton; a couple classics--"National Velvet," "2001: A Space Odyssey," an abridged, illustrated version of "Last of the Mohicans"; a book of tres novelas in Spanish that looks somewhat okay from what I am able to translate; picture books on nature and the history of footwear design; some hippie dippie self-help stuff (that I am totally going to read before I bring in); a couple of books on writing techniques and exercises--I have a fantasy of doing little writing groups with the patients, though our unit serves people at such varied levels of functioning and also I have no clue how to go about leading a writing group; two National Geographics from the early 1960s (I am keeping one--it's worth it to me for the rad Mad Men-esque advertising alone). And something super cheesy and Christian-looking that I am also totally going to read before I bring it in called "My Angels Wear Fur."

Don't judge me. 

And last but not least, and not dog-related, is "The Witch of Blackbird Pond." I was thinking the other day about my favorite childhood books after reading about a girl crush of mine who has images from her favorite childhood books tattooed all over her arms (I already have one). And I thought of TWoBP for the first time in literally decades, and I remember when I was reading it, it was the first time I knew I had to go to sleep to get up early for something in the morning, but I simply could not put it down. Also it scared the living crap out of me. As soon as I saw it peeking out of the children's bin, I knew it was going in the backpack, and I'm looking forward to seeing what kind of effect it has on me 20 years later.

Thank you for your donation, Candice Myerson!

[Insomniac Update: I originally ended this blog post with the sentence, "I am going to die alone under a pile of furry animals," but I thought I should be more positive and cut out the pity party so I threw in the paragraph about the witches book. Not that dying alone under a pile of furry animals would be the worst way to go, all things considered.]

speaking of...

Oh hi. So I've had several half-done blog posts hanging around for, like, the last two months. I don't want anyone to get the wrong idea that I've grown tired of writing about myself, so now, in the midst of working 15 days (errr, nights) in a row with one day off, after working a particularly busy 7pm to 7am (errr, 8am) shift, while eating an obscene amount of Trader Joe's Thai Lime & Chili Cashews and drinking red wine, at 8:36am I have decided it is time to clean out the blog cobwebs.

Please pardon my grammar/formatting/whatever else you may find subpar and/or offensive. 

Speaking of Trader Joe's Thai Lime & Chili Cashews...

I think I have just entered into the Contemplation stage of what we in the biz call the "Stages of Change." No longer am I in denial that eating these delectable, multi-dimensional nuts with increasing frequency is causing me GI distress and my scrub pants to fit more tightly. But at the same time, thinking about "giving up [this] enjoyed behavior causes [me] to feel a [HUGE] sense of loss." I feel I may need to replace my beloved, comforting post-work snack with something a little lighter and less abrasive, but I am not quite ready yet. Whatever the replacement is, it will of course need to go well with boxed red wine. 

Speaking of change, I am hoping that by posting my blog cobwebs I will free myself to start posting other stuff on a more regular basis (probably still in Precontemplation on this front)...

TALKING SHOP

The other night (and by "other night" I mean like two months ago) I hung out with a whole buncha nurses without even planning to (one thing I love about living in a smallish city is that there are only so many areas people congregate). At one bar it was people who work on my unit including my bosses (I clearly work in the right place), and at the other people I went to school with who work elsewhere in the hospital. Our conversation topics were as follows:

*Calling the attending physician at home on a weekend in the middle of the night because you suspect your patient's urinary catheter is clogged, and the doctors on the floor aren't taking you, new nurse, seriously, and it turns out your patient's urinary catheter had like a three-inch clog in the tubing gaaaaaaaaah.

*Whether Resident MD So-and-So is or is not a player.

*How frustrating it is when doctors keep throwing out aggressive, debilitating treatment options at 87-year-old patients with inoperable cancer.

*What to do when you see a former patient out in the wild, i.e., at the Urban Outfitters downtown. Answer? Wait for them to initiate, or, in my case, turn away from them hoping they didn't see you and will therefore not initiate even though said patient was one of your all-time favorites and you'd just love to say hello to her and chat about overpriced faux-vintage clothing and the recognition probably would have made her freaking day, that sweet, shy little soul. GAAAAAAAH.

*How kale was soooo 2011 and swiss chard is the official bitter green of 2012.

SPEAKING OF KALE

I've said this a million (or at least like five) times, but Mimi Smartypants is one of my favorite bloggers in the short history of blogs. While some bloggers have had me utterly captivated, reading two years worth of posts for eight hours nonstop (not exaggerating--I used to work in finance), they generally haven't stuck. I have been reading Mimi's old-school semi-weeklyish posts for almost ten years now and she always makes me snort/restores my faith in humanity. Her description of trying a particular blended kale beverage is worth a read: 

There was no love and no light. There was a bit of energy, if you count how I stayed grimly present-in-the-moment in between sips, sure that if I lost focus I would either vomit or throw the whole thing out the window.

WORDS OF THE DAY/LAST TWO MONTHS

During my downtime at work I like to read all the doctors' notes. They help me put my patients' current presentations into context (don't even get me started on the percentage who have been physically and/or sexually abused as children Jesus Effing Christ), and they introduce me to new medical terminology and phenomena I didn't have time to learn in two years of task-focused nursing school. For example, the rhythmic hypnopompic. According to Wikipedia, this is "the state of consciousness leading out of sleep" in which our "emotional and credulous dreaming cognition [is] trying to make sense of real world stolidity." Which I think basically equates to the time when I was around eight years old and I dreamed I acquired this awesome new Trapper Keeper with dolphins on it, and I woke up and for a second was all excited about my new Trapper Keeper and quickly had to come to terms with how I remained pitifully, un-hiply Trapper Keeper-less. (I freely admit to having just had to look up the words "credulous" and "stolidity" in order to come up with this example.)

colonic seepage - I think this one pretty much speaks for itself, but in case you need clarification: IF YOU TAKE TOO MUCH IBUPROFEN YOU WILL GET TINY HOLES IN YOUR INTESTINES AND YOUR POOP WILL LEAK OUT INTO YOUR ABDOMINAL CAVITY. Thank you, New York Times. 

snuff box - We've had a patient recently whose coping skills are unfortunately limited to punching walls and other forms of self/object-harm, and she had an injured snuff box. According to my old friend Wikipedia: "The anatomical snuff box is a triangular deepening on the radial, dorsal aspect of the hand--at the level of the carpal bones, specifically, the scaphoid and trapezium bones forming the floor." In other words, it's that little groove on the side of your wrist between your thumb bone and your thumb tendon. Back in the day, people used to inhale powdered tobacco from this groove. Neat! 

SPEAKING OF NEAT

Here are some links, in case you are really looking to kill some time.

This is an article (with pictures!) about a guy who took photos of abandoned patient suitcases at an abandoned psych hospital, The Willard Asylum for the Chronic Insane in the Fingerlakes region of New York.

This is a roundup of ancient and modern Chinese architecture that really makes me miss the weird-ugly-stunning-depressing-beautiful-dirty over-the-top-ness (I really can't think of any more eloquent way to put it) of China.

My kind of art:

Big Appetites is a series of fine art photographs by artist Christopher Boffoli. The series presents tiny, meticulously detailed figures posed in real food environments, referencing both a cultural fascination with tiny things as well as an American enthusiasm for excess, especially in the realm of food.

And last but not least, some serious, moving sadness from someone famous for his 99% hilariously unserious Tweets.

fuckin' magnets

So I was all set to work on the post I've been "working" on for like the past two weeks, but something so awesome, so, uh, miraculous happened at work last night that I must share before anything else.

So I get to work last night and am reading though The Report Sheet and, under one new patient's updates is: "12/11: Insane Clown Posse is really a band."

Questioning of coworkers and reading of the patient's intake note revealed that doctors and nurses on the day of his admission thought he was delusional that he was a follower of some made-up "gang of clowns." In reality, the patient is a Juggalo, complete with ICP t-shirt and tattoos, and my coworkers had clearly not been spending much time on the internet in early 2010 when the Miracles video went viral.



The sad part is that the patient is, in fact, quite delusional and bizarre in other ways--his psychopathology just has nothing to do with his following of a band on a label called, wait for it, Psychopathic Records.


In other quirky patient news, we've recently had a sweet old chronic schizophrenic who is preoccupied with the drug Anacin, which he takes to "get wasted." The sad part of this story is that Anacin is a combination of aspirin and caffeine, so whenever he indulges, to the tune of 300 tabs per his report, he OD's on not only caffeine, but aspirin, which as you can probably imagine is toxic in large doses. I tried to do a little harm reduction teaching with him--"Next time you feel the urge, can you just, you know, go drink some coffee?" He stared blankly at me. I hope his discharge plan included a clause about having someone to keep him away from Rite Aid.

i shouldn't laugh, but . . .

WORD OF THE DAY

Recently we had a patient who self-medicated in a weird way (I guess it wasn't that recent because I can't remember), and discussing him in Nursing Rounds brought up talk of a patient from several years back who also self-medicated in a weird way, for a gastrointestinal ailment. By drinking liquidized silver.* Apparently this is A Thing, and the result is called argyria. Argyria is when your skin turns irreversibly bluish-silver from consuming too much silver. It looks something like this:

Not our patient, but rather some guy from Oregon/Northern California (naturally) who has been ingesting liquidized silver for about a decade to help with a skin condition (??)

To these folks' credit, silver is widely used in the medical field for its antibacterial properties, though its use is generally limited to creams and extraordinarily expensive wound dressings.

*Technically it is colloidal silver that intrepid people are drinking, which for those of you who did not take any hard science classes after high school like I didn't is when two substances mix together to a microscopic degree but are not chemically bonded, as in a true liquid. I think.


PATIENT QUOTE OF THE DAY

From a personality-disordered patient whose husband had recently died and who was living in an unstable environment:

"I just want to go get his ashes and my flat screen and get out of there."

Everyone's gotta have priorities.


MEDICAL RESIDENT QUOTE OF THE DAY

From a patient's History and Physical document:

"Pt presents a risk to herself and others due to command auditory hallucinations telling her to eat people, and also pt has not eaten in several days."

Logic!

And speaking of eating, sometimes I have this surreal experience when I watch people eat that is akin to when you look at or think of a totally normal word for too long and then the word starts seeming profoundly weird. Sometimes I'll be watching someone eat, not on purpose--usually my gaze just landed on them and got stuck--and then I'll become overwhelmed by their humanity, in a kind of sad "we are all just a very elaborate collection of cells" kind of way. It is especially overwhelming on the psych unit, when I'll look out at my patient during mealtime, my patient who believes he or she is a prophet of God or Obama's campaign manager or Patti LaBelle's niece (I am making up none of these), but really it's just another unfortunate soul sitting at a plastic table eating overcooked hospital pasta, in a cotton gown worn by countless others before them and laundered with god-knows-what-chemicals, and wearing those little footie socks with the anti-slip grips. It breaks my heart.


LEARNING!

A lot of my patients experience hallucinations--usually auditory, but occasionally visual or even olfactory (once a patient asked me if I, too, smelled the barbeque in her room--sadly, I did not). Unlike a lot of other psychiatric symptoms that I can relate to at least on some level, e.g., depression, anxiety, addiction, mania, paranoia, delusions of grandeur hello ages 13-17, I have no idea what it feels like to hallucinate and I kind of wish I did. Take it away, NPR and neuroscientist/prolific writer Oliver Sacks.

Here is Oliver Sacks chillin' at home in his favorite t-shirt like a boss. 


RECENT HIGHLIGHT

There's this shy, sweet, quiet patient I've helped take care of for almost three months. Being on the shy, quiet end of the spectrum myself (I'd say I'm more on the sour side though, selectively sweet if we're being generous), I've often had a frustratingly difficult time engaging with her. When I've been her nurse, our typical, uncomfortable conversation would go something like this:

Me: "Hey [shy sweet quiet patient], how are you doing?"
SSQP: "Good."
Me: "Any thoughts of hurting yourself or others?"
SSQP: "No."
Me: "Hearing any voices?"
SSQP: "No."
Me: "Are you particularly worried about anything?"
SSQP: "No."
Me: "Okay then, lemme know if you need anything!"

Then the other day I was sitting at a table in the Day Area with another patient, and she was sitting nearby. When the other patient left, we started chatting, just a normal, not necessarily nurse-patient conversation. And then I suddenly felt comfortable and asked her how she was doing with her psych symptoms, which I knew she'd had all along but had been too uncomfortable to ask about directly, or in a way that she would feel comfortable to answer honestly. And she told me about the voices and the paranoia and the delusions, and how they were getting better, and how she felt about being a shy, sweet, quiet girl in her early 20's and newly diagnosed with a major mental illness. "You never think it's gonna happen to you," she said.

I discharged her last night, and she was, finally, smiling and healthy and optimistic. It is nice and refreshing, and way too rare, to watch a patient leave and feel optimistic myself.


ON A LIGHTER NOTE

Here is this:



I wonder if they ever had an article about a Silver Man...

lazy sunday

If you, like me, woke up this morning and took two ibuprofen and three strips of bacon, perhaps you will find comfort in this compilation of internet stuff that other people found and then posted to their blogs or Facebook or Twitter pages and whom I am too lazy to credit.

60-Second Adventures in Religion is a series of cartoons explaining various theories of religion. I think I retained more from this than I did in my year-long Contemporary Civilization class in college. It's from a website I've never heard of but have a feeling I will be spending hours on during my next night shift. (The second vid is my fave.)

99 Life Hacks is a bunch of ideas to solve common household dilemmas. Some of these are kind of obvious or unnecessary but most of them ARE BLOWING MY MIND.

Buzzfeed is always good for a laugh. And laughing at the misfortune of others is one of life's simple pleasures.

Somewhat relatedly, here is a news item about an Alabama boy with down syndrome who was missing from his home overnight and then found the next day in the woods snuggling with a litter of puppies.

A volunteer who followed the family dog to a nearby creek bed eventually found the boy, along with the dog’s puppies. "I heard the dogs barking again and followed him down there and started hollering for the puppies and I hollered for him and he hollered back,” said volunteer searcher Jamie Swinney.

They sure do a lot of hollering down in Alabama!

Lastly, here is a video of a bird trying to wake up a cat.

beeturia, and other important matters

WHY YOUR NURSE IS CRANKY

I would estimate that, on average, about 20% of my workday involves actual patient contact. The rest of it is documenting everything that happens and different protocols and parameters and blah blah blah and looking up orders and paging doctors to get things ordered and giving and getting Report and charging cell phones (patients aren't allowed to have their chargers because, you know, cords) and other little administrative-y type stuff. Today it took me two hours to obtain the appropriate container in which to put a urine specimen for a gonorrhea/chlamydia test.

It went something like this: print label through complicated label printing/scanning process--do not recognize type of specimen container specified on said label--ask coworker if she knows, coworker does not know know--call lab, go through automated system to get ahold of someone in microbiology--explain situation--get told that the particular container needs to be ordered from Central Stores; the various urine specimen containers on The Unit are not sufficient--call Central Stores, get placed on hold for 10 minutes--get sent container via tube system like those at drive-through ATMs--use critical thinking skills to recognize that "URETHRAL SWAB KIT" is wrong container for patient-provided urine sample--call Central Stores again--explain situation--get sent a second "URETHRAL SWAB KIT"--call Central Stores again--get sent correct container, finally--return two incorrect containers so that Unit is not billed for them--transfer urine specimen to correct container via pipette--get overhead-paged while in Treatment Room transferring urine via pipette--yell out into nurses' station: "I AM TRANSFERRING URINE IN A PIPETTE! PLEASE TAKE A MESSAGE!"--put specimen in a bag and into the drive-through-ATM-like tube system to send off to the lab--fin.

Also, I just have to say, I love the word "specimen."

BEETURIA

And speaking of words--I learned a new one last week. "Beeturia," according to Wikipedia, "is passing of pink or red urine after eating beets." [Also, passing of pink or red poop.] I came across this term while looking up another one, hematechezia, which I'd seen in a patient's chart. (Feel free to look up that one yourself.) I had no idea that having pink or red urine after eating beets was a real, medical thing. I thought it was something that just happened to everyone, like when your pee smells like coffee or asparagus after you consume coffee or asparagus. (Please tell me all your pee smells like coffee or asparagus after consuming those things.) But it turns out beeturia only happens to 11-14% of the population. And it is related to iron deficiency. So based on my informal reader poll which showed that 62% of you (including myself) suffer this affliction, I'd say we all need to eat more beef, beans, and spinach.

HAVE YOU EVER BEEN DRUNK?

The other day, a coworker--a sweet older lady not from this country--asked me, "Have you ever been drunk?" I laughed. Then I Tweeted about it. Then I got to thinking...

I have been drinking alcoholic beverages for almost exactly 13 years--since the start of college in the fall of 1999. So let's say I've gotten drunk once per week, on average, considering that many weeks I did not get drunk at all, some weeks I got drunk more than once, and some weeks I got drunk much much more than once helloooo 2006. This means that I have been drunk approximately 676 times. So, yes, dear innocent coworker. I have indeed been drunk. Can I hug you?

THINGS I HAVE ENJOYED ON THE INTERNET RECENTLY

Here are some things I have enjoyed on the internet recently:

You know I love a good advice column, and I have just found a new one! It is called Turning the Screw and it's about existential issues and it's written by Heather Havrilesky who is a real live writer who's sold books and stuff. Here is an excerpt, from a column entitled, "I'm About To Have A Baby And I'm Freaking Out":

You know what's awesome, though? As petulant and unforgiving as they are, babies have a pretty singular way of distracting you from the brutal impact of your slow, sickening decline for a long, long time. They don't just distract, in fact, they create the illusion that you're building something important, rather than just decomposing in slow motion. This illusion of growth/importance is exactly what makes most parents so fucking insufferable. But it also keeps them from murdering themselves and each other. Most of the time.

What's funny about the eve of child-birthing is that you believe yourself to be teetering on the brink of a terrible new life, whereas those who've been there recognize that you're about to be handed a free pass from justifying your existence for the next decade. No one really thinks you're doing something good for the world by bringing another lazy, entitled future film student into the world, mind you. But your hormones are going to feed you that fairy tale, so lean into that shit and savor the hell out of it.

I also used to love Nerve.com and it hasn't been so great lately, but the new feature/hopefully-regular-column called "My Parents Grade My Exes" made me chuckle/wish I had the writer's parents.

Abby (2008-2009) 

Dad: When I think of her, I think of going to a carnival, going to the cotton-candy booth, and getting a white cone with no cotton candy on it.

Mom: Extremely bland. In the world of food, she'd be a big bowl of plain mashed potatoes. No salt. No pepper. No seasoning of any kind. Every once in a while, I wanted to poke her with a stick to see if she was still alive.

Emma (2011) 

Mom: I liked her a lot. What can I say? Too bad you gave her scabies. You guys were like a comedy team. She was very beautiful and she ate like a horse. I really admire that in a girl.

And lastly, a Jezebel.com article entitled, "The Silliest Pink Crap Money Can Buy, None of Which Will Cure Breast Cancer." This made me happy because I've long had a negative gut reaction whenever I see pink breast cancer "awareness" stuff for sale and I've never quite been able to pinpoint why. It's great that there is now widespread knowledge of this disease, but the way we've gone about creating that just seems tacky and disingenuous. And also, there are so many other diseases that could use having people guilt tripped into buying kitschy junk in order to make money for their treatment research.

But then again, maybe awareness regardless of the means is better than no awareness? Also, there is this product:

Like every busy mom, corporate hot shot, and college student, Poo~Pourri is learning how to multitask. They're keeping bathrooms odor free and creating more hostesses with the mostesses, all while raising awareness for breast cancer and aiding in the research for a cure.

I'm sold.

a very important reader poll

Please help out my highly scientific research! All responses are anonymous, and an explanation will come in due time. Thank you.

sweeping up the cobwebs

Oh hey. I keep meaning to blog and then I don't blog and then I feel bad about myself for not doing what I intend to do, and so then I put it off even more and just hope some magical inspiration will come down from the heavens.

And it totally will.

But until then...

Here are the notes I've emailed to myself for the last few weeks. The bold type is verbatim, the rest is my (probably semi-intoxicated) elaboration.

RECOMMENDED FOR YOU

These are the articles recommended to me by newyorktimes.com one day when I was on a work computer and TOTALLY CAUGHT UP WITH WORK AND ALL THE PATIENTS WERE SLEEPING:

"1. The Stone: Deluded Individualism [The article begins: "There is a curious passage early in Freud's 'Ego and the Id' where he remarks that the id behaves 'as if' it were unconscious. The phrase is puzzling, but the meaning is clear: the id is the secret driver of our desires, the desires that animate our conscious life, but the ego does not recognize it as such. The ego--what we take to be our conscious, autonomous self--is ignorant to the agency of the id, and sees itself in the driver seat instead."]
. . .
4. Summer Nights: Savoring the Illicit Thrill of a Glass of Something, Outside
. . .
7. The Lede: Handcuffed Man's Death Ruled a Suicide
8. National Briefing: Smithsonian Museum Emptied After Guard's Suicide
. . .
10. Do Argentines Need Therapy? Pull Up a Couch"

The internet is so smart, yo.

pt uses condoms on and off

This was a quote from a doctor's History and Physical note. ("pt" is shorthand for "patient.") I thought the wording was funny. Apparently I am a seventh-grade boy, with a high sensitivity for syntax.

nose grease for pyxis

The machine/robot-thingy that houses/keeps track of our frequently-used medications is called The Pyxis. It requires a username and a fingerprint scan to get into. The fingerprint part never works unless your finger is moist. The fastest way to facilitate finger moistness in an indoor setting under flourescent lighting and artificial air circulation, I have discovered? Nose grease. Moving on.

Some people want to design the building, and some people just want to swing a hammer.

One of my more outspoken coworkers said this during a night-shift conversation about the upcoming national requirement that all Nurse Practitioners get a doctoral degree instead of just a masters degree. This would mean an extra full year of research-based study, and it appears to be motivated by The Nursing Profession's desire to keep up with the Joneses (Physical Therapy now requires a PhD, for example, and also, of course, there's the Medical Doctors).

For most of my life, I thought I wanted to design the building. I was smart and special and good at things and should reach for the stars! And then I went to college and then I graduated and then I got some promising jobs but nothing was sticking. And then I started waiting tables in Upstate New York and I felt happy for the first time in years.

And I realized that designing the building is not about smarts or specialness or talent; it is about motivation. Because I could do something didn't mean I should. Maybe someday I'll want to get a doctorate in nursing but right now I just want to swing the damn hammer.

no Vaseline or anything else that will make her slippery

An update on the nurses' report for a patient that was too out of control to keep in a regular room, so she was penned in the activity room with sheets covering the windows. Sheets were also covering the patient, because she refused to wear clothing and underpants but was okay with wearing sheets in various toga configurations she'd adjust every 15 minutes or so. She was highly aggressive and oppositional and apparently a big fan of lotion and vaseline.

SINKY POOCH

We have a blackboard in the Day Area that is generally used to write the date and any notes the nurse wants to emphasize during Community Meeting or Goals Group. The chalk is left out, so sometimes a patient decides to contribute to the board. "SINKY POOCH" was one patient's contribution, and it stayed up for several days, to my great delight.

arguing with her baby daddy on the phone and not helping me

This is an accusation a patient made about me to another nurse. Note: I neither have a baby daddy nor have ever talked on the phone (for a non-work-related matter) while at work. The patient, on the other hand, spend lots of time arguing with her baby daddy on the phone. I think maybe this is what Freud called "projection"??

Okay, that is all for now! May you design your buildings and/or swing your hammers to your hearts' content.

home sweet home

This is probably the longest post I have ever posted. And I say posted because I did not actually write it. It consists, simply, of a local Baltimore weekly's reportage of local crime from the last two weeks, and my occasional attempts to mitigate fear and hopelessness with humor. 

Enjoy. And don't walk around late at night in Southeast Baltimore.

These images and headlines are from the online version of the paper. They are just a couple of the many reasons I love this column. Other reasons continue below.

THE MATTER-OF-FACT TONE!
Aug. 7, 3:35 p.m. Someone stole a package of medical instruments from the front steps.

Aug. 7, 9 a.m. A woman told police that an unknown suspect entered through her front door and exited through the rear.

Aug. 1, 10 a.m. Police report that road rage at the McDonald’s escalated into a fight, and the two drivers were arrested.

THE SPECIFICS!
Aug. 9, 1:00 a.m. Police were told that armed suspects entered the dwelling and told everyone to get on the floor and give them their money and jewelry. They then put everyone in the rear room and fled. A purse, 60 oxycodone pills and 94 percocet pills were stolen. [94!]

Aug. 3, 5:00 p.m.  A man told police he got very intoxicated with ten of his friends and felt someone reach in and steal his wallet. He doesn’t know who it was. [1 in 10 chance of figuring it out!]

Aug. 4, 5 p.m.  A clerk reports that a customer was rummaging through a bin. When the clerk offered assistance, the customer fled with nine “Boh Knows Football” t-shirts and other merchandise.

NOT TO MENTION THE DIVERSITY OF STOLEN ITEMS! TV'S, LAPTOPS, AND GPS'S ARE SO BORING.
Aug. 9, 2:30 p.m. Police report that a suspect broke in through a rear door and stole a collection of 15 Marilyn Monroe dolls and jewelry.

Aug. 5, 9:30 a.m. A man told police that someone broke into his car and stole his handicapped placard.

Aug. 2, 3:40 p.m. A woman reported that someone broke her right front window and stole her cane and her parking placard. [AND the cane?!!?]

[Incidentally, there are multiple other reports of stolen handicapped placards (which I always thought were called "dangly things"). Moral of the story, save your good parking spot privileges for when you're in The County?]

Aug. 6, 8:00 a.m. A man reported that someone stole his catalytic convertor [sic]. [I don't know what a catalytic converter is, but I do know how to spell it!]

Aug 6, 5:30 p.m. Police report that a man stole a Nestle strawberry drink and was arrested. [Gross]

Aug. 7, 1:20 a.m. A resident reported that someone entered a rear yard and stole four swivel-back chairs and a wine refrigerator. [Alright, now we're talkin'.]

Aug. 5, 8 p.m. A man reported that someone had kicked in the door to his shed and stolen a snowball machine. [What?]

July 30, 6 p.m.  It was reported that a man stole four bars of Dove soap.

INTERESTING WEAPONS!
Aug. 5, 12:50 a.m. Two men reported that a suspect has assaulted them with a machete. The two men were taken to the hospital with head wounds. [Machete!]

Aug. 9, 2:45 p.m. A woman reported that during a dispute, her boyfriend held a sword to her neck. They struggled until separated by family members. The police arrived and arrested the boyfriend. [Sword!]

July 10, 7:50 p.m. A woman reported that during an argument. another woman had produced a tire iron and hit her in the head. The first woman was taken to the hospital, and the second was arrested. [Produced a tire iron!]

Aug. 9, 11:16 p.m. A man reported that he was walking when one of three men approached him and said, “Amigo, give us your money.” The victim replied that he didn’t have any. The suspects then hit him with a two-by-four. The victim fled and received medical attention. [Were they just walking down the street with a two-by-four?]

THE EDITORIALIZING!
Aug. 11, 1:15 a.m. A man reported that he arrived at a gas station to complain to a drug dealer, “Tony,” that the drugs he had been sold were bad. His business practices insulted, Tony went to his car and came back with a knife, cutting the victim in the face. He then fled in his car. The victim refused to respond to the police station or to seek medical attention.

Aug. 5, 11:14 a.m. A woman reported hearing a suspect in her house upstairs. She called him and he fled to the basement in an attempt to escape. Officers responded and found him behind a locked door, crouched in a defensive stance. He was taken into custody without incident. The suspect had gained entry by removing a second-floor AC unit.

Aug. 10, 2:58 a.m. A man reported that while walking, one of three men approached him and said, “I just want your money.” He then began to reach into his pocket, but the victim smacked his hand and yelled at him. Another suspect implied that he was armed, and the victim challenged him as well. The suspects fled. [This one occurred about a block from my house. So if someone asks for my money, I should just give him a slap on the wrist?]

Aug. 17, 1:42 p.m. A man told police he was inside the bar and got in an argument with another male. The other male left and later returned with a knife and said: “I sharpened this knife just for you.” The owner of the bar took the knife from the suspect, who then fled.

Aug. 13, 10:35 a.m. A man told police that a woman called his house and said he owed several thousand dollars in back taxes. He said he only had $1,000 in cash. The woman said someone would come to collect the money. A male came to his door, shoved him in the face, and took $1,000.

DON'T SAY NO TO DRUGS?
Aug. 18, 2:20 p.m. A man told police another male asked if he wanted to buy drugs. When he said no, the suspect stabbed him in the right thigh.

Aug. 15, 1:14 p.m.  A woman told police she was assaulted by a man because she refused to buy crack cocaine.

POTPOURRI
Aug. 14, 2:53 p.m. A man told police he was walking when a man shouted out: “Stop, money!” He ran away.

Aug. 12, 3:00 p.m. A woman told police that when she was incarcerated for a few days someone broke into her house and stole $500 from a sock in her closet.

Aug. 17, 11:30 p.m., A victim reported that he was walking down the street when a man asked him for a cigarette and then a light. When the victim reached in his pocket for the light, he looked up to see the suspect holding a gun. The suspect demanded he take off and shake out his pants. About $250 was taken.

Aug. 4, 2 a.m.  A man reports that when he woke up in Federal Hill Park, his black iPhone was missing. [Not that I'm victim blaming, but I kinda think that if you pass out in a park until 2am, you don't get to call police when your shit gets stolen. Okay, maybe I am victim blaming.]

July 22, 1 p.m. A man reported that his handyman and the handyman’s girlfriend moved in to his property illegally. 

"all i need is jesus . . . and two extra strength tylenol"

Greetings from my new home! That’s right, I moved, making the two-year stint in my last apartment the longest I’ve lived continuously in any one place since starting college. (Strangely, that’s also about the same amount of time I’ve ever stayed at a job, or sustained a romantic relationship … this doesn’t say anything about me, does it??? That I've had a lot of learning experiences? Yes! Good answer.) Anyway, here are some tips I gained from the latest of my many relocations.

1. If at all possible, move into a place with a garbage disposal. Seriously, it will change your life. My daily stress has been reduced by at least 20% now that I can just wash my strawberry tops, French-pressed coffee grounds, and stuck-to-the-bottom-of-the-pot rice grains down the drain.

2. Do not succumb to laziness and Oprah by hiring 1-800-GOT-JUNK to remove things you no longer want and don’t have the energy to list on Craigslist. Although they will ensure your old dust collectors don't go to waste if possible (like by finding places to donate working electronics so people will actually use them), they cost more than hiring movers to move ALL of your stuff, and they don't tell you this until they get there. Better to donate it to my favorite thrift store, The Sidewalk.

3. Speaking of, if you live in Baltimore, do go to the 7-Eleven on South Broadway in your U-Haul and hire the first three men from Central and South America who jump into the passenger seat to move all of your stuff. Overpay them, because they will be friendly and reassuring and make fun of you when you get the truck with a 14-foot trailer stuck in the alley behind your new house and have to back it out about 100 feet ("Ella esta nerviosa! Hahaha!"). They will then get behind the wheel and do it for you.

4. Don’t drink and move, as much as you feel you deserve it, especially if you have to work a bunch of days in a row afterward, because then you may weaken your immune system and come down with a nasty respiratory infection that will cause you to miss two 12-hour shifts while you are home feverish and "managing your respiratory secretions with a tissue," and you don't get sick time yet so your shenanigans just cost you, like, three times what 1-800-GOT-JUNK did. Just saying.

And last but not least, here are a few recent highlights and fun facts from the world of psych nursing... 

The title of this post is a quote from one of my favorite patients in recent memory. She was the first actively psychotic patient I got to interview. Psychosis is fascinating--in addition to typical hyperreligiosity, this patient also had delusions of grandeur, specifically that she was an undercover cop. She had come to our unit after real cops found her sleeping in an abandoned building. When I asked about her living situation, she told me she lived in an "abandominium." On a test of cognitive functioning, she was asked to write a sentence and wrote "[Patient] was here," in mirror writing. She stated that what she wrote looked normal to her. Apparently mirror writing can be caused by damage to the brain's left hemisphere. Also, by being Leonardo DaVinci. It even happens in Chinese!

I have learned lots of new vocabulary over the last few weeks. Here are a few of my favorites:

Intermittent Explosive Disorder -- "A behavioral disorder characterized by extreme expressions of anger, often to the point of violence, that are disproportionate to the situation at hand." To put it mildly.

Neurovegetative -- The definition isn't actually terribly exciting (pertaining to the autonomic, aka, apparently, "vegetative" nervous system; and for our purposes it refers to illness indicators such as sleep, appetite, and concentration). I just like that I now get to describe people as "neurovegetatively intact."

Zone of Helpfulness -- The zone to which all mental health practitioners should aspire to be in (i.e., neither underinvolved or overinvolved).

Humor -- On a textbook page of therapeutic communication techniques (e.g., active listening, broad openings, restating, theme identification), humor is described as "the discharge of energy through the comic enjoyment of the imperfect." I've never quite thought about it that way!

SPEAKING OF HUMOR

At the beginning of every shift we get a report sheet that contains a brief synopsis, pertinent information, and updates on each patient. After one patient's name, in bold: “Patient needs to wear pants when out of his room.” Ahem. Updates are noted daily and generally include a major treatment change, a discharge plan, etc. A recent update for another patient: "7/30/12: Patient is really a rapper." (Apparently a staff member had confirmed a prior rap career of a patient who claimed as much.)

A nurse told me a story of a former patient who was seen wearing sunglasses out in the Day Area of the unit. She asked him why he was wearing sunglasses. He responded, "Because my future looks bright."

Aaaand I'm out.

holy ***ing **** i'm a nurse: week two

There is something about watching an inspirational video in a drab conference room that makes me profoundly uncomfortable. Especially when said video features still pictures of nature with inspirational words running across them and a soundtrack of "Return to Innocence" by 90's one-hit wonder Enigma.* This experience was foisted upon me the other day during another corporate training and I spent most of the excruciating 4 minutes and 16 seconds picking at my cuticles and wishing my friend E had been sitting next to me so we could poke each other in the ribs and try to maintain straight faces. If you would like to recreate this magical moment for yourself (and I really think you should), just close your eyes . . . imagine you are in an old building in the inner city . . . the walls are beige . . . the chairs hurt your back . . . your business casual outfit restricts your ability to reposition yourself . . . the air conditioner is on a setting that is way too high . . . you have to pee because you've had way too much coffee today . . . the lights dim . . . 

Not the video I watched, but strikingly similar.

Here are some other highlights from Week Two!

1. Part of my training includes reading a whole bunch of hospital Policies and Procedures manuals. They are important and I'm reading them like I'm supposed to, but they are generally not so exciting. There are some hidden gems, however. According to the one for infection prevention and isolation precautions, blowing one’s nose = “managing respiratory secretions with a tissue.” I love hospital speak.

2. Desperately having to urinate/collect myself after watching the aforementioned video, I went into a public bathroom and was delighted to find that of the three stalls, one was empty. And then I realized the door was missing. I was tempted to make like the Chinese and just go, but I was wearing my lab coat and badge and didn't want to appear unprofessional/get in trouble. That's really all there is to the story, and I'm really only telling it so I can post this piss-poor illustration of one of my first public toileting experiences in China (no pun intended . . . okay maybe sort of):

3. On my unit there are many Groups, and they are mostly run by the RNs. Most start with a let's-go-around-the-room-and-share-something icebreaker. As you can probably imagine, when you're doing this multiple times a day, every day, it can be hard to come up with new icebreakers. During Substance Abuse Group this week, the nurse, presumably inspired by the foliage on the patio, spontaneously presented this one: “If you had a yard and could grow any plant in it, and it would grow in copious amounts, what would it be?” Hilarity ensued.

4. There are many reasons why I wanted to work in psych. Here is one. Typical medical/surgical nursing report: “Patient on four liters of oxygen via nasal cannula, has chest tube on the left side to suction with moderate amount of serosanguinous drainage.” Typical psychiatry nursing report: “Watch Patient A with Patient B. Overnight Patient A seen cuddling with Patient B in telephone cubby, and Patient A was really happy about it, if you know what I mean.”

5. Here is another: I had my first near tears experience because a patient’s comments during Substance Abuse Group were so insightful, moving, tragic. His head and his heart were in the right place, but due to a confluence of factors he was standing at the bottom of a very big hill. I wanted to snap my fingers and get him a job and a home and a new family and meaningful activities. But all I can really do at this point is sit there and listen. And hope it works out.

*No offense to Enigma fans out there. I loved that song when I was 12 and a part of me will always love everything I loved when I was 12. Except for Mountain Dew and a certain buck-toothed boy who I had a crush on and who later made fun of the size of my jean shorts because I'd gotten a little fat from being depressed and consuming too much Mountain Dew and low-fat Cool Ranch Pringles. Anyway.

holy ***ing **** i'm a nurse: week one

Oh hey there. It's been awhile. To pick up where we left off . . . I'm officially Nurse Gina now. I got back from China and then a whole bunch of stuff happened and then I got my RN license and an ID badge with letters after my name (and a new pair of Danksos, naturally) and now I have a job on a psychiatric unit where I'm walking around trying to look like I know what I'm doing.

Highlights from Week One:

1. I got through two days of general corporate orientation (i.e., lots and lots of PowerPoint presentations) with only minor back pain that lasted the next two days, and without doing anything unprofessional like passing a note to a friend saying "shoot me now" during a lecture on Professionalism, not that I felt any sort of impulse to do that, or anything.  

2. I ran into friends from nursing school at nursing school during lunch time, even though none of us had any legitimate reason to be at nursing school (and the food is nothing special). We are like little fledglings, not quite ready to fully leave the nest.

3. The first day on my new unit was a success, aside from the part where during morning report my cell phone alarm clock went off, TWICE (I was so mortified the first time it went off that I failed to turn it off and just hit snooze, apparently, as that is what my thumb is most used to doing), and I of course happened to be sitting next to the Nurse Educator and the attending physician.

4. I GET TO WEAR A LAB COAT. I'm sorry, but nothing makes me feel more badass than wearing a lab coat. Okay, maybe wearing OR scrubs. Or Carhartt overalls. Or a spacesuit, presumably, though I imagine you don't feel very badass when you're wearing a spacesuit and you have to pee. 

5. I sat with the patients and ate a banana and a hard-boiled egg (we are encouraged to eat the hospital food with the patients during mealtimes) and introduced myself and started conversations with several of them even though I felt totally awkward and shy. 

6. Guided group stretching time during Fresh Air Break! I love psych.

7. Things said to me today that I enjoyed:

New Coworker: You look a lot like a tech we just hired on [other unit].

Me: Yeah?

New Coworker: Yeah. But she's thicker.

Me: Oh! [nervous laughter]

Me [silently to myself]: I love you.

Patient: Where are you from?

Me: Wisconsin.

Patient: Do they have a lot of murders in Wisconsin?

Me: Oh, uh, I dunno, not that many, I don't think.*

*I do not purport to know anything about the murder statistics in Wisconsin. But something tells me Homicide: Sheboygan would be a lot less interesting than Homicide: Life on the Street, which I only recently learned takes place in good ol' B'more.

8. This newfound Career business has inspired me to live my life with a little more self-discipline. On Monday, I resolved that I would go to two yoga classes per week (at least), and write for 30 minutes a day (at least). I figured these were SMART goals, which in the world of psych nursing means Specific, Measurable, Attainable, Realistic, and Timely. I even created a measurement system, with timeframes. It is now Friday. 

Baby steps.