I'm getting married! You might be shocked to know that I even have a significant other as 1) I almost never write about Sheryl (in the interest of staying in a relationship with Sheryl) and 2) I can hear you wondering who would tolerate a guy so seemingly lost in the dark lint of his own belly button. But it's true and the big day is later this year in August...the 29th to be exact. So now, six months ahead of time, comes the inevitable planning process. Which leads me to today's rant about wedding rings. Not hers, that was planned last summer when I proposed. I wanted her ring to be as beautiful as possible and very traditional. Sheryl, you see, is anything but traditional. It's one of the many things I find so damn attractive about her. But she has lived an "on edge" and "alternative lifestyle" for many years of her life. We wanted our wedding (even though we plan on getting onto a large boat and waiting for orca whales to appear before we exchange our Buddhist inspired vows) to be more traditional. I know it doesn't sound that way but it's true. We have both been married before. Sheryl in jeans and a flannel shirt in front of a justice of the peace...and me in the woods wearing what can now only be described as neo-Baltic, gypsy inspired Indian chic. Sheryl's previous $20 gold wedding band, long since resold and melted down, always seemed to be a sore spot with her so I wanted this ring to be special...and traditional. After looking at a million rings that all start to blur (I mean, really...how many ways can a metal ring with rocks on it vary) I found one I really liked. The sales woman explained that there was a little "ppf" stamp on the inside of the ring. When I looked at her inquisitively she sort of sighed at my ignorance. "Past, present and future" she smiled. Like, by saying those three words a deep meaning was transmitted and understood by those who are (or about to get) married. "Oh, right, right. Yeah, past, present and future" I nodded back to her and scooted out of the kind of retail shop I try to avoid every other day of my life. "Past?" Damn, we've both been married before AND DIVORCED! So it's not as if we want to go dragging up the past as a guide for marriage. "Present?" We're doing well in our relationship right now and staying present to problems that arise and are still in love and the sex is, well, none of your damn business gutter heads, and we love raising two teenagers, so CHECK...the present is good. "Future?" WTF??!! Who the hell knows? I could get whacked by a bus on the way to work tomorrow or Sheryl could fall down our stairwell? As I was walking back to the car I wondered If I could have one of the 'P's and the 'F' scratched off but thought it might be kind of tacky and look kind of 'pre-owned'.
She picked out her wedding dress last night and it's a far cry from a flannel shirt. The 1920's style crepe-over-satin, cap sleeved dress (I know that description makes me sound gay but I'm still not) is also pretty traditional but it won't really cover most of her tattoo's so it's not as if we're going all Ronald and Nancy Reagan. I'll be sporting a new tux however, shiny shoes and all, so I'm hoping to get away from that Bosnia meets New Delhi bit I had going for me last time. In staying with the whole traditional thing I need to get Sheryl a matching wedding ring. I kind of forgot about that part...until she reminded me the other day. It turns out the ring before the wedding is called an "engagement" ring... only to be followed up with another ring (matching of course) called the "wedding" ring. Who knew? I do, now...and will plan accordingly. Then came the time to pick out my ring. In my defense I will call it ring shopping fatigue (or just plain frugality)but it seems that all the silver colored bands that I prefer look EXACTLY alike. Whether titanium, white gold, silver, stainless steel, or platinum they are all shiny silver and kind of boring and perfect for doing the job of saying "Hey pretty ladies, sorry, this hunk of a man is taken!" So I was surprised at Sheryl's response when I said "Hey look, here's a ring on E-bay for $14.95 with free shipping! A discussion was had, let's say, about the relative quality of different precious metals...value...money...quality...money...value...quality. In these matters, my grandfather Temple taught me, it is better to let the women's prerogative prevail. So it looks like along with my shiny black shoes I'll be wearing a shiny silver (scratch that) white gold wedding band. It's funny what comes up when discussing something like a wedding. Something as pragmatic as where to plan the reception becomes super emotional. What one wears becomes of the utmost importance. Emotions wear thin and ...Oh, God, we haven't even approached the subject of invitations yet!
Thursday, January 22, 2009
Naked
"Hey boys, settle down or I'm coming down these stairs AND I'M NOT KIDDING!". I was standing stark naked in the locker room of the local fitness club the other day and my friend Margaret was shouting down the stairwell like a mom who has been in a cramped car too long with too many kids. She was yelling at a bunch of little boys who were totally out of control. In Margaret's defense being in the club after school during kids swim time feels exactly like being in a cramped car with too many kids! A shot of fear ran through me even though I knew it was a bluff. In thinking about it now, safe in my home in the middle of the night, with clothes on, the fear came from one of two places. Not wanting my naked ass to be exposed to my friend Margaret OR, hearing that voice triggered memories of my own mom yelling that same exact phrase at me when I was an out of control little boy. It's kind of amazing what will randomly rock me from my normal ho-hum brain activity and give me a little jolt. All those little kid neurons that are still up there in my brain will get fired off when I least expect it.
So now, as a 46 year old man, I'm looking back and trying to find out what programs still run this old computer. What garbage-in garbage-out routines are still running through me and confounding me as I try to put new, healthier programs into my subconscious not to mention the boys I'm helping to raise now? Because I sure don't want these awesome kids to be run by the low self esteem paradigm that has chewed its way through my life. The programs that run just under the radar and often over the radar and loud and clear. The "you're too lazy, too unfocused, too spacey, too sensitive, too insensitive, too 'whatever I want to slam myself with today' voice that rarely if ever shuts the hell up. Why. Why ask why I guess...it's there so deal with it and be aware of it and don't let it run my life. Is it just me or does anyone else out there hear the constant chatter in their own skull...and if you do what strategies do you employ to quiet them...drugs, alcohol, sex, running from event to meeting to chore to event? Band aids. I'm thinking death might cure it but who knows. No, I'm not suicidal...far from it as I'm not even depressed today. I'm actually feeling great. It's just that I awoke last night at the way too quiet hour of 3am and felt my heart as it pulsed in my ears. I started to watch my mind actively search for things to fret about and chew on. Old dusty corners of my brain were peered into looking for dust bunnies of guilt or regret. The flashlight of awareness was brought out to search under the furniture of past relationships or hurts or awkward situations where I have embarrassed myself. Looking to highlight once again all those times when I have screwed up so I can feel terrible all over again. The visceral gut punch of a memory is just as strong each time it is relived. That well worn road still hurts my feet every time I walk it. Why? What need do I have to search for places and feelings that make me feel bad? Are they unresolved situations or emotions that need to be sifted through until the murky water is clear and the silt is gone? Or is it that I don't think I deserve to be happy and just enjoy this life...and when my calm/rested mind can't take the incongruity goes hunting in the darkness. BLAH, BLAH, BLAH. I'll stop whining now and just put some clothes on in case Margaret comes down here into the murky depths and wants to kick some out-of-control-little-boy's ass.
So now, as a 46 year old man, I'm looking back and trying to find out what programs still run this old computer. What garbage-in garbage-out routines are still running through me and confounding me as I try to put new, healthier programs into my subconscious not to mention the boys I'm helping to raise now? Because I sure don't want these awesome kids to be run by the low self esteem paradigm that has chewed its way through my life. The programs that run just under the radar and often over the radar and loud and clear. The "you're too lazy, too unfocused, too spacey, too sensitive, too insensitive, too 'whatever I want to slam myself with today' voice that rarely if ever shuts the hell up. Why. Why ask why I guess...it's there so deal with it and be aware of it and don't let it run my life. Is it just me or does anyone else out there hear the constant chatter in their own skull...and if you do what strategies do you employ to quiet them...drugs, alcohol, sex, running from event to meeting to chore to event? Band aids. I'm thinking death might cure it but who knows. No, I'm not suicidal...far from it as I'm not even depressed today. I'm actually feeling great. It's just that I awoke last night at the way too quiet hour of 3am and felt my heart as it pulsed in my ears. I started to watch my mind actively search for things to fret about and chew on. Old dusty corners of my brain were peered into looking for dust bunnies of guilt or regret. The flashlight of awareness was brought out to search under the furniture of past relationships or hurts or awkward situations where I have embarrassed myself. Looking to highlight once again all those times when I have screwed up so I can feel terrible all over again. The visceral gut punch of a memory is just as strong each time it is relived. That well worn road still hurts my feet every time I walk it. Why? What need do I have to search for places and feelings that make me feel bad? Are they unresolved situations or emotions that need to be sifted through until the murky water is clear and the silt is gone? Or is it that I don't think I deserve to be happy and just enjoy this life...and when my calm/rested mind can't take the incongruity goes hunting in the darkness. BLAH, BLAH, BLAH. I'll stop whining now and just put some clothes on in case Margaret comes down here into the murky depths and wants to kick some out-of-control-little-boy's ass.
Tuesday, January 20, 2009
The Usual Questions
Familiarity breeds, what, boredom...comfort...um, brain death? It must. How else to explain the group behavior I saw today (and everyday) while riding the ferry home from work today? As I've mentioned before, I live on a small island in the Pacific North West. It's a pain in the ass, it's inconvenient, it's dark all winter, it can be claustrophobic and can be oppressive when the clouds pile up in November (and stay until June!) from their rain gathering campaign across the North Pacific ocean. Pile up like a traffic accident. Cloud after cloud speeding through the air, crashing into one another and crying constantly at the loss of blue sky and light. The carnage continues until there are no more clouds to be seen but only a flat gray cloak of a sky with no definition and no hope of ever going away. Only a cloying blanket of dim moisture hanging above and weeping.
(OK, today is actually stunningly beautiful without a cloud in the sky. Hoar frost clings to the shadows on the ground and the water we are sliding through looks like the window pane of an old Victorian bay window. Not a perfect invisible reflection but textured just enough to be pleasantly interesting.) I couldn't actually write about the flat dull gray skies while they occur because it pushes me a little too close to the "What's the point of it all" side of the BIG QUESTION. The other end of that scale, and the one I am pondering today is, "Oh my God, how can this planet be so perfect and integrated and so damn beautiful?" It's not that I've begun a prescription of antidepressants this week...it's just that the sun is out and the sky is that perfect cold winter blue with no brown haze of summer. How can that not make the funk in my head go away? You know, the moss that builds up under one's eyelids like plaque or the lichen that grows in the sulci (google it) of my cerebrum. Which brings me once again back to where I started (in my own twisted head anyway)...familiarity.
It is a mind killer. As the Washington State Ferries ply these waterways they pass pristine islands. Trees carpet them fighting for light and space all the way down to the rocky shoreline. Not like the planned forests of recently logged tree farms to the east...like bad hair plugs on a bald mountainside. These are rascally and diverse and dense. I just saw a bald eagle sitting on a rock next to a buoy eyeing the kelp-draped low tide outcropping. Seals and river otters swim through the dark green waters. It is an amazing part of this planet to be able to call home (yes, even on a rainy day). But I wouldn't have noticed any of it had it not been for the ferry captain. He or she must have been bored enough to try an alternate route today. Normally the ferries stay on a fixed route. And even though beautiful, the same sights seen too often can become routine. Even when I consciously look for the more subtle details, familiarity kicks in and I end up reading a book as magic floats by just outside the salt sprayed window. Today, instead of passing by the south side of Blakely Island we slid through Peavine pass to the north. Books all around the ferry were put aside and the people were up and about quietly staring at a rarely seen part of our own county. Snags overhanging a low cliff ready to fall to a watery grave...a bright green meadow leaning at an impossible angle...a steep mountainside packed with fir and cedar trees. We were mesmerized as it slid slowly east. It's not as if it were that different from the south side of the island but it was just the fact that it was different at all. As soon as we passed through the narrow channel the sights were once again familiar. The looks of interest and appreciation were soon enough gone as books and magazines were once again raised and we all went back to wherever it is we go that is not here...right here. Now, I'm not preaching...or if I am it is only to myself and have dragged you along for the sermon. But how do we stay awake and alive to all the amazement that is always right in front of our freaking noses? The smooth cool feeling of the keyboards under my fingers right now...the beauty of all the love that is given and received constantly...the pain and suffering that surrounds everything there is...the power of our kids asking us a question and trusting our answers...our spouses constancy/sexuality/support...the taste of a carrot pulled from our garden...or even the fact that it will grow at all! My friend Margaret likes to quote the Bob Dylan line "Those who are not busy being born are busy dying". It's a good line...makes me wonder how much of my life I spend dead. But that's a rabbit hole I'd like to avoid going down today...it's too beautiful outside.
CONGRATULATIONS TO BARACK OBAMA!!!!!!!!!!!!!!!!!!!
(OK, today is actually stunningly beautiful without a cloud in the sky. Hoar frost clings to the shadows on the ground and the water we are sliding through looks like the window pane of an old Victorian bay window. Not a perfect invisible reflection but textured just enough to be pleasantly interesting.) I couldn't actually write about the flat dull gray skies while they occur because it pushes me a little too close to the "What's the point of it all" side of the BIG QUESTION. The other end of that scale, and the one I am pondering today is, "Oh my God, how can this planet be so perfect and integrated and so damn beautiful?" It's not that I've begun a prescription of antidepressants this week...it's just that the sun is out and the sky is that perfect cold winter blue with no brown haze of summer. How can that not make the funk in my head go away? You know, the moss that builds up under one's eyelids like plaque or the lichen that grows in the sulci (google it) of my cerebrum. Which brings me once again back to where I started (in my own twisted head anyway)...familiarity.
It is a mind killer. As the Washington State Ferries ply these waterways they pass pristine islands. Trees carpet them fighting for light and space all the way down to the rocky shoreline. Not like the planned forests of recently logged tree farms to the east...like bad hair plugs on a bald mountainside. These are rascally and diverse and dense. I just saw a bald eagle sitting on a rock next to a buoy eyeing the kelp-draped low tide outcropping. Seals and river otters swim through the dark green waters. It is an amazing part of this planet to be able to call home (yes, even on a rainy day). But I wouldn't have noticed any of it had it not been for the ferry captain. He or she must have been bored enough to try an alternate route today. Normally the ferries stay on a fixed route. And even though beautiful, the same sights seen too often can become routine. Even when I consciously look for the more subtle details, familiarity kicks in and I end up reading a book as magic floats by just outside the salt sprayed window. Today, instead of passing by the south side of Blakely Island we slid through Peavine pass to the north. Books all around the ferry were put aside and the people were up and about quietly staring at a rarely seen part of our own county. Snags overhanging a low cliff ready to fall to a watery grave...a bright green meadow leaning at an impossible angle...a steep mountainside packed with fir and cedar trees. We were mesmerized as it slid slowly east. It's not as if it were that different from the south side of the island but it was just the fact that it was different at all. As soon as we passed through the narrow channel the sights were once again familiar. The looks of interest and appreciation were soon enough gone as books and magazines were once again raised and we all went back to wherever it is we go that is not here...right here. Now, I'm not preaching...or if I am it is only to myself and have dragged you along for the sermon. But how do we stay awake and alive to all the amazement that is always right in front of our freaking noses? The smooth cool feeling of the keyboards under my fingers right now...the beauty of all the love that is given and received constantly...the pain and suffering that surrounds everything there is...the power of our kids asking us a question and trusting our answers...our spouses constancy/sexuality/support...the taste of a carrot pulled from our garden...or even the fact that it will grow at all! My friend Margaret likes to quote the Bob Dylan line "Those who are not busy being born are busy dying". It's a good line...makes me wonder how much of my life I spend dead. But that's a rabbit hole I'd like to avoid going down today...it's too beautiful outside.
CONGRATULATIONS TO BARACK OBAMA!!!!!!!!!!!!!!!!!!!
Wednesday, January 14, 2009
Just One More Reason
I don't hate nursing anymore. I used to when I would work 12 hour shifts for six days in a row only to spend the next week recovering and dreading going back. Now, however, I have recovered from the burnout and actually enjoy my job. There are a lot of reasons why I enjoy going to work these days. This blog entry is NOT about one of them...quite the contrary. This entry is about something I hope I never see again...which is why I have to share it with anyone willing to read this mess.
A guy should change his socks, say, at minimum of , oh, I don't know, every 3 days? I'm being generous here I know. Customarily I change them every day as I'm sure do most of you. Rarely I'll go 2 days if I haven't done the laundry in a while and I'm in a jam (toe jam?). Three days is really over the edge and done by the desperate few who find themselves on a long backpacking journey. But even these folks find a stream somewhere and rinse out the sweat and funk from days of hiking so they can sleep at night in the enclosed space of a tent. I mean, has your own foul odor ever awakened you in the middle of the night... when you roll over and that little puff of air shoots out of your sleeping bag and hits like the sour gasses of a compost heap? It's disturbing to think that your own smell can wake you up. It doesn't jolt you awake like a thunderbolt but insinuates itself into your consciousness just enough for you to do three things: 1. Stop all movement. 2. Pull your arms out of the sleeping bag and put a vapor lock on the top edge to keep all future gasses IN the bag. and 3. Promise to yourself and God that you'll do laundry first thing in the morning. When I was a teenager I'd come up to San Juan Island every summer and stay with my sister Samantha. She had an awesome dog and I just loved it. That Dog (a mid-sized pointer mind you) would crawl into my mummy bag and down to my feet every night and we'd sleep together wrestling for leg room all night long. But after a summer of sweaty boy smell, dirty feet smell and dog smell my sleeping bag would out gas and stink like a laundry basket and dirty dog pillow with top notes of old wet sponge. It was a wonder I could crawl into the thing by the end of the summer but it's amazing what one can get used to.
Which brings me around to what I wanted to write about in the first place. My job...or more specifically my shift the other night. As I said, it is amazing what one can get used to and my patient in room 4 had got used to things no one ever should. STOP! As I write this I'm realizing that no one needs to read about all the detailed horrors of the human condition. There are things better left unwritten (most of my blogs some might say!) and what started out seeming like an excellent gross out subject for blogging about now seems just really sad. So I'll do what I should have started a long time ago and self edit. No need to continue today's great story of another person's suffering. There is way too much sadness and loneliness (and the physical fallout from all that pain) in the world. Help alleviate it in any small way. Thanks for reading. But I did like reminiscing about my smelly summers with Samantha on San Juan.
A guy should change his socks, say, at minimum of , oh, I don't know, every 3 days? I'm being generous here I know. Customarily I change them every day as I'm sure do most of you. Rarely I'll go 2 days if I haven't done the laundry in a while and I'm in a jam (toe jam?). Three days is really over the edge and done by the desperate few who find themselves on a long backpacking journey. But even these folks find a stream somewhere and rinse out the sweat and funk from days of hiking so they can sleep at night in the enclosed space of a tent. I mean, has your own foul odor ever awakened you in the middle of the night... when you roll over and that little puff of air shoots out of your sleeping bag and hits like the sour gasses of a compost heap? It's disturbing to think that your own smell can wake you up. It doesn't jolt you awake like a thunderbolt but insinuates itself into your consciousness just enough for you to do three things: 1. Stop all movement. 2. Pull your arms out of the sleeping bag and put a vapor lock on the top edge to keep all future gasses IN the bag. and 3. Promise to yourself and God that you'll do laundry first thing in the morning. When I was a teenager I'd come up to San Juan Island every summer and stay with my sister Samantha. She had an awesome dog and I just loved it. That Dog (a mid-sized pointer mind you) would crawl into my mummy bag and down to my feet every night and we'd sleep together wrestling for leg room all night long. But after a summer of sweaty boy smell, dirty feet smell and dog smell my sleeping bag would out gas and stink like a laundry basket and dirty dog pillow with top notes of old wet sponge. It was a wonder I could crawl into the thing by the end of the summer but it's amazing what one can get used to.
Which brings me around to what I wanted to write about in the first place. My job...or more specifically my shift the other night. As I said, it is amazing what one can get used to and my patient in room 4 had got used to things no one ever should. STOP! As I write this I'm realizing that no one needs to read about all the detailed horrors of the human condition. There are things better left unwritten (most of my blogs some might say!) and what started out seeming like an excellent gross out subject for blogging about now seems just really sad. So I'll do what I should have started a long time ago and self edit. No need to continue today's great story of another person's suffering. There is way too much sadness and loneliness (and the physical fallout from all that pain) in the world. Help alleviate it in any small way. Thanks for reading. But I did like reminiscing about my smelly summers with Samantha on San Juan.
Sunday, January 11, 2009
Full Moon Party in the ER
The emergency department where I work is small. Ten beds comprise the whole thing. When it gets busy we have to run pretty fast. The nice thing is that it doesn't get that busy too frequently. Having written that I know I'm going to get my ass kicked tonight when I go to work. ER nurses are a superstitious lot and even though I never used to be I've learned to never use the "Q" word while working. Every ER I've ever been in from Hawaii to Seattle is afraid of the word "quiet". It's weird, but true, that when someone says "It sure is quiet tonight" all hell will break loose within 30 minutes. Someone will walk in having a heart attack as the scanner pages out the fire department for a bus rollover and four ambulances roll up to the door. I used to even joke about it when I first started working by loudly saying, "Boy, it sure is quiet in here! HA HA". There would be a few seconds of silence as people stopped talking and turned to glare at me...right before the scanner started squawking and the ambulance bay doors flew open. I didn't do that for long as I kept getting hammered with critical patients every time I said it, not to mention people stopped talking to me. So I've learned to be superstitious with the best of them. I even once worked with a doctor who wouldn't let anyone say the word "pizza" when he was on shift as he was convinced it had the power of the word "quiet". Not believing anything carried the weight of "quiet", one night I joke to him that we should order a pizza later on (I know, I'm a slow learner). He only glared at me (obviously not getting the hilarity of the joke). Hours later after an impossibly busy night of trauma codes and critically dying patients I fervently apologized for my lack of faith...kind of like a professional confessional (ba da boom!).
Last night, there was a full moon. You can only imagine, that if the "Q" word (I have to go to work soon so I'll stop saying it now) works on our imaginations so strongly, something like a full moon wreaks havoc. I'm not sure what would happen if someone actually said the "Q" word ON a full moon night and I hope I never do. Let's leave that monster under bed. So, it was a rather qu, no, calm (a thesaurus is helpful when doing emergency work) night in the ER last evening when I walked by room 5 across from the nurses station. Sitting in the wheelchair next to the bed was a woman that from behind appeared to be having a seizure. Head and body twitching rhythmically and quite energetically. I would have run in and thrown her in bed but there was a nurse standing right next to her asking her questions (and the fact that she weighed approx 350 pounds was also a factor). People having seizures don't answer questions. She was. Here begins the full moon weirdness I thought as I walked into the room to assist. This poor gal was rambling on about her ten thousand symptoms and how the EMTs broke her foot so she couldn't get into bed without help. I steeled my spinal muscles and assisted her to her feet, correction, foot. Did I mention the 350 pounds part of this story? She stood bent over the bed, "wait, wait, wait! Give a minute to get ready here!" As I looked at the other nurse and prepared to roll my eyes northward, the patient startled me back to the present. "Are you offended by nudity?" It was a question that I was totally unprepared for. Multiple answers filled my mind as my colleague busted a gut in a way that only medical people can...full on gut busting belly rolling laughter without making a sound. I bit my lip and filtered through the appropriate responses. "Yours or mine" was the first to be crossed off my list. Rapidly followed by "Oh God NO!". "Yes" would have been a lie though the easiest path. All that came out was "Not at all". Cool, calculated, professional. My answer wasn't really necessary though because by the time my answer came her sweats pants were around her ankles. The mu mu slipped off her top in a speed that belied her girth.
There she was.
"I'm a nudist" was the next thing she said as she started her bizarre shaking all over again. "You have GOT to get in bed right now" was the next thing I said as we tipped her onto the gurney. As I hurriedly left the room I passed a young guy bent over in agony hobbling to room 4. He was pale and sweaty and holding onto his belly. I followed him into the room and started and IV while he writhed and writhed. He could barely answer the questions I was asking. He was in the worst pain of almost anyone I've seen before. That should have set off the first alarm bells. The scars on his belly had shown previous surgery so I was thinking of all the things that could have been causing this much pain. What I didn't think of (and why is their diagnosis always what I don't think of) is that this guy was here to get free drugs. He faked it well and actually writhed enthusiastically for over an hour and a half so I guess he deserved the 3 milligrams of dilaudid (ie, "good sh%#" in his world) he got before he put on his beanie cap and when no one was really paying attention pulled up the collar of his jacket and slid out the door with his ass hanging out of his hospital gown. Not a good look for a criminal. What really pissed me off about the whole thing is that at the same time he came in the ambulance bay doors opened up and brought in a critical head bleed (ie stroke). My energies were then split between someone who really needed all my attention and some jerk who wanted some good narcotics (not to mention the IV site he went home with to give himself all the drugs he could shoot into it). If you see someone out there with an IV hanging from their arm and a hospital gown on, do me a favor and kick him in his bare ass for me. It's now a day later and I'm already excited for the next full moon to arrive.
When I was growing up my dad had a telescope with an 8 inch mirror. A very powerful thing that he would take up onto the hillside on his place in the Santa Cruz mountains. We kids would look through it and see the rings of Jupiter and distant galaxies that were really just blurry stars. But I loved looking at the full moon and all of the craters and even the shadows of the edges of the craters. What a magical place our world is and looking up at the moon was a reminder of that magic. How I wish I could recall that magic of a full moon. These days, hidden behind a thick layer of cold northwest clouds, it now represents haunting memories of drug seekers and unhealthy nudists.
Last night, there was a full moon. You can only imagine, that if the "Q" word (I have to go to work soon so I'll stop saying it now) works on our imaginations so strongly, something like a full moon wreaks havoc. I'm not sure what would happen if someone actually said the "Q" word ON a full moon night and I hope I never do. Let's leave that monster under bed. So, it was a rather qu, no, calm (a thesaurus is helpful when doing emergency work) night in the ER last evening when I walked by room 5 across from the nurses station. Sitting in the wheelchair next to the bed was a woman that from behind appeared to be having a seizure. Head and body twitching rhythmically and quite energetically. I would have run in and thrown her in bed but there was a nurse standing right next to her asking her questions (and the fact that she weighed approx 350 pounds was also a factor). People having seizures don't answer questions. She was. Here begins the full moon weirdness I thought as I walked into the room to assist. This poor gal was rambling on about her ten thousand symptoms and how the EMTs broke her foot so she couldn't get into bed without help. I steeled my spinal muscles and assisted her to her feet, correction, foot. Did I mention the 350 pounds part of this story? She stood bent over the bed, "wait, wait, wait! Give a minute to get ready here!" As I looked at the other nurse and prepared to roll my eyes northward, the patient startled me back to the present. "Are you offended by nudity?" It was a question that I was totally unprepared for. Multiple answers filled my mind as my colleague busted a gut in a way that only medical people can...full on gut busting belly rolling laughter without making a sound. I bit my lip and filtered through the appropriate responses. "Yours or mine" was the first to be crossed off my list. Rapidly followed by "Oh God NO!". "Yes" would have been a lie though the easiest path. All that came out was "Not at all". Cool, calculated, professional. My answer wasn't really necessary though because by the time my answer came her sweats pants were around her ankles. The mu mu slipped off her top in a speed that belied her girth.
There she was.
"I'm a nudist" was the next thing she said as she started her bizarre shaking all over again. "You have GOT to get in bed right now" was the next thing I said as we tipped her onto the gurney. As I hurriedly left the room I passed a young guy bent over in agony hobbling to room 4. He was pale and sweaty and holding onto his belly. I followed him into the room and started and IV while he writhed and writhed. He could barely answer the questions I was asking. He was in the worst pain of almost anyone I've seen before. That should have set off the first alarm bells. The scars on his belly had shown previous surgery so I was thinking of all the things that could have been causing this much pain. What I didn't think of (and why is their diagnosis always what I don't think of) is that this guy was here to get free drugs. He faked it well and actually writhed enthusiastically for over an hour and a half so I guess he deserved the 3 milligrams of dilaudid (ie, "good sh%#" in his world) he got before he put on his beanie cap and when no one was really paying attention pulled up the collar of his jacket and slid out the door with his ass hanging out of his hospital gown. Not a good look for a criminal. What really pissed me off about the whole thing is that at the same time he came in the ambulance bay doors opened up and brought in a critical head bleed (ie stroke). My energies were then split between someone who really needed all my attention and some jerk who wanted some good narcotics (not to mention the IV site he went home with to give himself all the drugs he could shoot into it). If you see someone out there with an IV hanging from their arm and a hospital gown on, do me a favor and kick him in his bare ass for me. It's now a day later and I'm already excited for the next full moon to arrive.
When I was growing up my dad had a telescope with an 8 inch mirror. A very powerful thing that he would take up onto the hillside on his place in the Santa Cruz mountains. We kids would look through it and see the rings of Jupiter and distant galaxies that were really just blurry stars. But I loved looking at the full moon and all of the craters and even the shadows of the edges of the craters. What a magical place our world is and looking up at the moon was a reminder of that magic. How I wish I could recall that magic of a full moon. These days, hidden behind a thick layer of cold northwest clouds, it now represents haunting memories of drug seekers and unhealthy nudists.
Wednesday, January 07, 2009
Dale
The car raced up to the emergency entrance and abruptly stopped with one of those wet skids that send shivers down a cyclists spine. Today I wasn't cycling, sadly, but working the ER and waiting for people to come skidding into the hospital.
"Hey, a guy needs help getting out of his car, he might be having a stroke."
The call for help came from Dale, our security guard who was already at the car door when I got outside. A worried looking woman was standing at the passenger door and I asked her what the problem was as I stuck my head inside the cramped little Toyota.
"We were just sitting down to dinner when suddenly he couldn't speak to me".
As I looked at him I had that instant, "Oh crap", feeling in my gut and yelled at him. "Hello, I'm James, one of the nurses here, can you tell me your name?" For some reason I tend to yell my questions at patients who are more critical as if my anxiety level is related to their ability to hear. Now, as you probably know, one of the symptoms of a stroke is a really bad headache. So it must be really annoying then to already have a throbbing cranium when some nurse comes along and shouts into your face. If he actually could have spoken he probably would have yelled, "Shut the hell up young man, I'm not deaf here I'm just having a stroke!" Followed rapidly by the question, "Why are you asking me stupid questions if my wife just told you I can't answer them?"
What was it that gave me that "Oh crap" feeling as soon as I looked into the car? Was it from some mystical 6th sense that medical people develop over years of practice? Or was it maybe from the fact that he was slumped over and limp with his eyes rolled back into his head? Because actually we nurses and doctors and paramedics and EMT's do develop that 6th sense and it is real. It is an odd thing but there is a psychic connection that exists between people that when listened to strengthens over time like an atrophied muscle. A connection that tells your gut "something is not right here...this patient is not OK", even when, by all outside appearances things look good. An example of this is actually on our trauma reports when we take phone calls from the medics out in the field. We check boxes to help determine the severity of a trauma patient. Things like, 'Did the patient lose consciousness?' or 'How fast was the car going?' This way we can prepare the ER for the severity of the trauma coming to us. But there is one box on the list that trumps all others...'gut feeling of the paramedic' who is actually with the patient. There is no quantifying it but having a person just being with the patient and feeling somehow how the patient is doing is more valuable than a lot of our data. Because, deep down we are all connected. We are communicating in ways we don't even know or acknowledge. If we did in fact open up to the realization that we are touching and moving each other in unseen ways, and feeling each others' pain and suffering, it would force us to really be loving to one another. Rather than that, God forbid, we tamper down the subtleties that connect us and instead focus on our differences. It's a lot easier not having to care so much. But not really...not in the long run and at the cost of loneliness and a feeling of emptiness that accompanies our perceived separation. But that isn't why I started to write this entry today, not at all.
A lot goes on in the first few seconds of seeing a critical patient. Visual cues from how the patient is dressed to skin color to posture and breathing rate etc. Auditory cues from what they are or aren't saying, what is everyone around them telling you. Olfactory cues like is there alcohol on their breath or do they smell of cigarettes. The list goes on and on and I won't bore you (sorry, too late?) but suffice it to say that it can be a bit stressful at the very beginning as your brain processes thousands of bits of data in a very short time to direct your next action. Maybe I'm writing this to justify the fact that when I shouted my question to my patient in the car, and his wife outside said "His name is Wayne" my mind heard the name Dale. I heard Dale and dammit, his name was now firmly Dale. In my own defense I have bad hearing and both Wayne and Dale have a long A sound. Also, Dale the security guard was standing right next to me helping me get the patient, Dale, into the wheelchair. Whatever. I put my index fingers into the patients hands and shouted, "Dale, squeeze my fingers"...no response. "C'mon buddy squeeze my hands tight!" This time there was a strong and equal grip from both hands. I was happily surprised as I was expecting one grip to be much weaker than the other if he squeezed at all (a classic stroke sign). He was actually able to stand and move to the wheelchair and my mind was starting to think of the many other neurological problems that could present like Dale but stroke was still high on the list.
I quickly wheeled Dale into the ER bed 1 and his wife went off to register him in admitting. A lot of things then happened in the next 15 minutes before we whisked him into the CT room for a CAT scan. For a play-by-play it went something like this.
"Dale, we're putting you on the monitor and giving you some extra oxygen now". With this, Dale gave a grunting noise.
"OK, Dale, we're getting an EKG now hold really still". "Hhrrmmph" was all he could muster".
"Dale?", now a more agitated grunt, "I'm starting an IV don't move your arm".
"It's all good, Dale, I'm taking you to CT now to get a picture of your brain".
You see, I like to think I'm a good nurse. And a hallmark of good nursing isn't just skill level and speed and knowledge base but also patient advocacy. I was keeping Dale in the loop. Keeping him oriented to what we were doing even if he couldn't understand I was hoping he could hear and understand some of what we were doing.
This time his lips moved and a long "NNNNN" came from his mouth. "Hey Doc, I think he's perking up a bit, maybe this is just a TIA" (mini stroke that has no lasting neurological impairment) I said, and as we pushed his gurney down the hallway someone from admitting came and put a name band on Dales wrist. Once in CT I had to let him know to be as still as possible for the exam. "Dale, hold as still as you can for the next 2 minutes and we'll be all done". This time his eyes opened and he looked confused and mouthed, "NNN NNN".
I reassured him with "It's OK Dale your in the ER and we're taking good care of you". I was feeling really good about the care we were giving him as he was in the CT room in record time with bloods drawn and all the diagnostics done and in the bag. There was only one thing that was a little concerning. When I got him onto to CT table I looked down at his wrist band and instead of reading Dale as I expected, I saw the name Wayne. Two thoughts ran through my mind as the pencil thin red laser scanned down his face. Either someone put the wrong name band on Dale which I could easily fix...or I had been calling this poor guy by the wrong name all this time.
I pulled him from the CT table back onto the gurney he was looking at me now quite clearly and I knew he was rapidly improving but he was still unable to speak. His eyes were tracking mine now although he did still look a bit confused. The CAT scan was encouraging and showed no signs of a bleeding stroke. "It's alright, um...Dale" (hell, I was already this deep, might as well go all the way), "so far so good".
The TIA symptoms were rapidly fading away like memories of a bad dream and he was now trying more successfully to enunciate. Apparently Dale wasn't lying there just worrying about his terrible stroke symptoms and the possibility of never speaking again or going through months of occupational and speech therapy. He was lying there wondering if we were treating the right guy for the right problem because the first words he uttered were...and the most important thing he wanted me to know was..."NNNOT....DALE!"
Of course the names have been changed to protect the guilty...except mine! We laughed about the name exchange all night and "Dale" ribbed me mercilessly. As I was going home at the end of my shift change that night I heard him yell across the ER, "Goodnight Dale"!
"Hey, a guy needs help getting out of his car, he might be having a stroke."
The call for help came from Dale, our security guard who was already at the car door when I got outside. A worried looking woman was standing at the passenger door and I asked her what the problem was as I stuck my head inside the cramped little Toyota.
"We were just sitting down to dinner when suddenly he couldn't speak to me".
As I looked at him I had that instant, "Oh crap", feeling in my gut and yelled at him. "Hello, I'm James, one of the nurses here, can you tell me your name?" For some reason I tend to yell my questions at patients who are more critical as if my anxiety level is related to their ability to hear. Now, as you probably know, one of the symptoms of a stroke is a really bad headache. So it must be really annoying then to already have a throbbing cranium when some nurse comes along and shouts into your face. If he actually could have spoken he probably would have yelled, "Shut the hell up young man, I'm not deaf here I'm just having a stroke!" Followed rapidly by the question, "Why are you asking me stupid questions if my wife just told you I can't answer them?"
What was it that gave me that "Oh crap" feeling as soon as I looked into the car? Was it from some mystical 6th sense that medical people develop over years of practice? Or was it maybe from the fact that he was slumped over and limp with his eyes rolled back into his head? Because actually we nurses and doctors and paramedics and EMT's do develop that 6th sense and it is real. It is an odd thing but there is a psychic connection that exists between people that when listened to strengthens over time like an atrophied muscle. A connection that tells your gut "something is not right here...this patient is not OK", even when, by all outside appearances things look good. An example of this is actually on our trauma reports when we take phone calls from the medics out in the field. We check boxes to help determine the severity of a trauma patient. Things like, 'Did the patient lose consciousness?' or 'How fast was the car going?' This way we can prepare the ER for the severity of the trauma coming to us. But there is one box on the list that trumps all others...'gut feeling of the paramedic' who is actually with the patient. There is no quantifying it but having a person just being with the patient and feeling somehow how the patient is doing is more valuable than a lot of our data. Because, deep down we are all connected. We are communicating in ways we don't even know or acknowledge. If we did in fact open up to the realization that we are touching and moving each other in unseen ways, and feeling each others' pain and suffering, it would force us to really be loving to one another. Rather than that, God forbid, we tamper down the subtleties that connect us and instead focus on our differences. It's a lot easier not having to care so much. But not really...not in the long run and at the cost of loneliness and a feeling of emptiness that accompanies our perceived separation. But that isn't why I started to write this entry today, not at all.
A lot goes on in the first few seconds of seeing a critical patient. Visual cues from how the patient is dressed to skin color to posture and breathing rate etc. Auditory cues from what they are or aren't saying, what is everyone around them telling you. Olfactory cues like is there alcohol on their breath or do they smell of cigarettes. The list goes on and on and I won't bore you (sorry, too late?) but suffice it to say that it can be a bit stressful at the very beginning as your brain processes thousands of bits of data in a very short time to direct your next action. Maybe I'm writing this to justify the fact that when I shouted my question to my patient in the car, and his wife outside said "His name is Wayne" my mind heard the name Dale. I heard Dale and dammit, his name was now firmly Dale. In my own defense I have bad hearing and both Wayne and Dale have a long A sound. Also, Dale the security guard was standing right next to me helping me get the patient, Dale, into the wheelchair. Whatever. I put my index fingers into the patients hands and shouted, "Dale, squeeze my fingers"...no response. "C'mon buddy squeeze my hands tight!" This time there was a strong and equal grip from both hands. I was happily surprised as I was expecting one grip to be much weaker than the other if he squeezed at all (a classic stroke sign). He was actually able to stand and move to the wheelchair and my mind was starting to think of the many other neurological problems that could present like Dale but stroke was still high on the list.
I quickly wheeled Dale into the ER bed 1 and his wife went off to register him in admitting. A lot of things then happened in the next 15 minutes before we whisked him into the CT room for a CAT scan. For a play-by-play it went something like this.
"Dale, we're putting you on the monitor and giving you some extra oxygen now". With this, Dale gave a grunting noise.
"OK, Dale, we're getting an EKG now hold really still". "Hhrrmmph" was all he could muster".
"Dale?", now a more agitated grunt, "I'm starting an IV don't move your arm".
"It's all good, Dale, I'm taking you to CT now to get a picture of your brain".
You see, I like to think I'm a good nurse. And a hallmark of good nursing isn't just skill level and speed and knowledge base but also patient advocacy. I was keeping Dale in the loop. Keeping him oriented to what we were doing even if he couldn't understand I was hoping he could hear and understand some of what we were doing.
This time his lips moved and a long "NNNNN" came from his mouth. "Hey Doc, I think he's perking up a bit, maybe this is just a TIA" (mini stroke that has no lasting neurological impairment) I said, and as we pushed his gurney down the hallway someone from admitting came and put a name band on Dales wrist. Once in CT I had to let him know to be as still as possible for the exam. "Dale, hold as still as you can for the next 2 minutes and we'll be all done". This time his eyes opened and he looked confused and mouthed, "NNN NNN".
I reassured him with "It's OK Dale your in the ER and we're taking good care of you". I was feeling really good about the care we were giving him as he was in the CT room in record time with bloods drawn and all the diagnostics done and in the bag. There was only one thing that was a little concerning. When I got him onto to CT table I looked down at his wrist band and instead of reading Dale as I expected, I saw the name Wayne. Two thoughts ran through my mind as the pencil thin red laser scanned down his face. Either someone put the wrong name band on Dale which I could easily fix...or I had been calling this poor guy by the wrong name all this time.
I pulled him from the CT table back onto the gurney he was looking at me now quite clearly and I knew he was rapidly improving but he was still unable to speak. His eyes were tracking mine now although he did still look a bit confused. The CAT scan was encouraging and showed no signs of a bleeding stroke. "It's alright, um...Dale" (hell, I was already this deep, might as well go all the way), "so far so good".
The TIA symptoms were rapidly fading away like memories of a bad dream and he was now trying more successfully to enunciate. Apparently Dale wasn't lying there just worrying about his terrible stroke symptoms and the possibility of never speaking again or going through months of occupational and speech therapy. He was lying there wondering if we were treating the right guy for the right problem because the first words he uttered were...and the most important thing he wanted me to know was..."NNNOT....DALE!"
Of course the names have been changed to protect the guilty...except mine! We laughed about the name exchange all night and "Dale" ribbed me mercilessly. As I was going home at the end of my shift change that night I heard him yell across the ER, "Goodnight Dale"!
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