What I want to hear

First

The basement looks awesome! You've been working so hard on it, and it is really coming together! I like the color selection a lot, it makes the room very cozy and inviting. You'd said that I'd like it, and I wasn't sure, but now, you're absolutely right. It's terrific.

You know, when I was here living on my own, I just ignored the basement. It was so much easier to shut the door and ignore it. We really couldn't have had guests over at all.

But now, it's clean, it's attractive, and it's functional. All we need are a few more pieces of furniture, just like you'd designed. Yes, I think a sectional couch in the corner would be great - it would give our guests someplace to chill out but still be involved in the poker game.

Second

You can really sing. I bet if we worked on developing your presence on stage, you could show off your voice. How about we work on that together?

Third

You know, you're organizational skills with the practice council for the unit are really showing. You are making me and this unit look so good and professional. People around the hospital are beginning to notice. I certainly appreciate your efforts - with you in charge of it, I don't have to worry about it a bit.

---

Is there any doubt I am a narcissist?

At least I've become skilled at keeping my expectations in check, and my hunger for this kind of admiration and attention under control.

Quotes I like

Here are a few things I've heard lately that have stuck in my head.

"It makes my boyfriend's junk smell like pie."

From the movie Juno, a worker at the planned parenthood clinic commenting on the blackberry scented condoms. Hysterical.

"You know what you are? You're a fag hag."

One of my co workers after I'd told her under my breath that I love gay men. I do. And, I think I am a fag hag, really. I'm a gay man magnet. I come from a long line of dominant women, in the tradition of Julie Andrews, Liza Minnelli, Cher, Margaret Cho, and Barbra Streisand. I like things that gay men like - music, decorating, sewing/fashion, gardening, good food, computers, liberal politics, dancing. I'm not a converter...I am merely attracted to the qualities behaviors of gay men. It's just the way I am.

In my next life, I'm coming back as a gay man who sings tenor and plays the English Horn and oboe. I could be a professional musician and never be out of work.

I just took an online fag hag test. I am 60% fag hag. Pretty good.

"If someone said three years from now, you'd be long gone
I'd stand up and punch them out, 'cuz they're all wrong."

Pink, in Who Knew? What kind of song has lyrics as low-brow as "punch them out?" And a girl singing it. That's a microcosm of our society. Nevertheless, I'm mesmerized by this song and I think I have to buy it.

"I love everybody, especially you."

Lyle Lovett I Love Everybody. A brilliant juxtaposition of truth, sincerity, and bitter sarcasm.

There are many more, this is all I can think of at the moment. I love quotes.

Beware the Ides of March

March 15. Seems things go wonky around this time. This year was no exception. Work was just weird. Here is one unusual thing that happened.

The Young Patient

I had a young patient on Thursday - he was 15 years old. Apparently he has an irregular heart beat and he had a few episodes of fainting, so he came in for an electrophysiology study and got a Reveal implant. This is a device implanted under the skin in the chest that monitors and records the heartbeat. If you have any episodes of dangerous heart rhythms, the doctor can see exactly what happened, when, and for how long.

This kid was screwed up in a strange way. His history included ADD and other psych problems. He was on several drugs for ADD and anxiety. When you see this as a nurse, you think "Oh no. Meds aren't going to touch him." So it was with him. During the procedure, he was very difficult to sedate, and his pain was unmanageable. When he came back from procedure, I learned that they had given him benadryl IV in addition to the normal sedation - you know they can't knock him out when they pull out the Benadryl!!

All day, there was nothing I could do to satisfy him - in fact, there was nothing anyone could do to satisfy him. It was a losing battle....and unfortunately for me, he had the call light, and he knew how to use it.

He had sheaths in when he returned from procedure. He was not knocked out from procedure....the sheaths were ready to pull, and we did. I medicated him with everything I was allowed to use - 7.5 mg of valium, 4 mg morphine. Even with this, and the lingering effects of the sedation during procedure, when we pulled the lines, he reacted like we were amputating his leg. Moaning, wailing, writhing.

Aside: the doctor didn't even write for any pain management or relaxation medicine. What a dope. I had to hunt him down and tell him what medications to order, write it down, and get it signed. Sheesh. The doctor knew what kind of kid he was dealing with!!!

Once I gave him all the medication I could, I had nothing else to offer. So I had to stay there during the sheath removal procedure, and report his pain was 10 out of 10 or 9 out of 10. This so-called level of pain never dipped be low a 9 all day. 4 percocets and 12.5 mg of promethazine did not help.

Nevertheless, despite this "excruciating" pain, he was able to converse with his family in a calm, rational manner, and he was able to doze off several times. He could readjust his position, and scratch an itch. His blood pressure did not skyrocket, nor did his breathing rate or heart rate increase. In fact, his irregular heartbeat normalized after the procedure, and he was in normal sinus rhythm all afternoon.

I found it difficult to believe that his pain was so intense. Personally, I think this kid knew how play the system and for whatever reason, played it like a violin.

My Philosophy on Patients' Pain

I respect people's pain. I am not in the patient's body and I wouldn't presume to know what they are feeling and going through. Therefore, in most, most cases, when they say 7/10, it's a 7/10 and I address it as appropriate and within my scope of practice.

I am conservative with pain medication because I have a limit to how much I can give and I want to keep my tools available. Pain medication is not candy, so I would like to give a patient as little as possible that effectively manages their pain. I don't want them in pain.

Then there are the outliers and this kid was one of them, in my opinion. These patients can't handle pain, any little bit. To them, there are two levels of pain - 0 and 10. In my limited experience, these patients typically have some kind of psychological issue in the mix. They somehow believe that they should not ever have any pain, and any pain at all is a cause for emergency and drama! The world is ending!! I'm gonna die! Oh, the agony!!

A Note on Promethazine

It's an anti-emetic. It has a reliable side effect of making people go to sleep. I really, really don't like to use it to knock people out. It's not what it's for, and it's also pretty nasty chemical. It irritates veins, burns when it's administered, and can cause dire complications if it infiltrates tissue. I had nothing else to offer this kid, so I tried it - he kept asking for something to make him sleep. And sure enough, it didn't do a thing.

And sure enough, he let me know it didn't do a thing. Over and over. And over.

Heh. At least he didn't barf.

My Philosophy on this Kid

This is really sad. I think this young man has been raised all his life to be the sick kid. It sounds like he's been in and out of the hospital a lot for various episodes of this or that. He has been given every reason to develop and nurture his anxieties, therefore they are present in him. He mentioned at one point that all of his friends are other sick kids- kids with cancer, chronic blood disorders, etc. All he knows is how to behave like a sick kid and his environment reinforces it. And, as an experienced patient, he has learned how to play the system. He knows well how to be the victim.

In fact, that's probably the only way he knows to live.

Another odd thing about him is that he could take multiple pills in one swallow. That's weird for a 15 year old. When I was 15, it was all I could do to take an adult aspirin without gagging!!

It's so sad. It will take years for him to change his reality, if it ever does happen. Who will love him, besides his mother? He'll end up being disabled for something exacerbated by his worry and poor coping mechanisms, and we will all get to pay for his life via our taxes. What a pathetic future!!

Conclusion

I try very hard not to let patients suck me into their lives' dramas. I am a service provider not a player in their lives, and as a matter of self-preservation, I can't get involved. In most cases, keeping healthy distance is not that difficult. Most people have that similar expectation, and things go along smoothly.

Every once in a while there's one that pushes my buttons. It happens because I'm human, too. I start to reflect their anxiety and internalize it...not good! I'm getting to the point where I can recognize it's happening before I get too deep, and I usually can use my coping tools to handle it. As you can see, though, it still breaks through - after all, I'm writing about this a week later!

This blog is one of my coping tools. I hope I have exorcised this demon now.

A few thoughts on the 2008 election

Here are my thoughts.

I tend to prefer Hillary Clinton. I think it's because she's a woman, and she is affiliated with Bill Clinton. When he was president, my life was pretty darn good.

However, I don't think America wants Hillary Clinton. She has fashioned her campaign too much like a man's campaign, in my opinion, because she had to. Well, Americans don't like pushy women. Women who speak their mind. Women who don't deep down just want to stay home and love on their children and grand children. Hillary is not like that. People are just too uncomfortable with it.

Therefore, I think I have to support Barak Obama. I don't think he has the makings for a president, but it sure as hell beats John McCain. I want a democrat in office. Republicans make Americans feel like we have big penises, but we end up doing stupid things, undermining our relations with other countries and we end up in horrendous debt.

Oh come on. Giving everyone $600. How childish. Like that's going to solve any long term problems with our economy. Whoopie doo - I get to fill my SUV tank with gas 6 times. Oooh, a new TV. People aren't going to reduce their debt! People aren't going to pay off a bill! They're going to act like children with their money and buy a toy. And I'll bet you they'll buy a $1200 toy, and just add on the extra $600 to their debt.

Then they don't want to give any money to people on welfare. Because they don't deserve it. ...like we do deserve it!!

The irony is, I live in a red state, so my vote doesn't matter too much anyway.

Nevertheless, I vote. I vote to negate my next-door-neighbor's vote, who chooses her candidate by calling the right-to-life organizations and asking who is pro life. She votes for that person. I'm serious. People really do this (or at least say they do).

Despite the screwed up election processes, and the immature way people choose their leaders, I still love living here in America. I think it's the best place there is. I keep trying to make it a little better.

Heh. I should donate my $600 to the most liberal cause I can find. That'll screw with Mr Bush's great idea.

Winter will never end

It snowed today. It was supposed to be "a few flurries possible." One inch of snow later, it became a few flurries.

Sigh. My seedlings are almost ready!!

Today I had to get a filling in a molar. I have to get another one in about 2 weeks. This is depressing because it's my first filling. I had prided myself on having no fillings. I would say "perfect teeth" but they're not - I had braces as a child, and I have had minor surgery for receding gums. I've got pretty good teeth, though.

Or, had, I might say. I returned home this morning (after brushing that G@##@*%! inch of snow off my car) with a numbed mouth and low spirits. I moped around for most of the morning. I'll get over it, but I sure hope this is a permanent fix. Man-made solutions are error-prone.

Of all the months, March is one of the hardest for me. I'm fed-up with winter. I don't have anything to do. I'm tired of being inside. The outside is not ready for me yet. I think it is March when I initiate change, because I get depressed and desperate for something better. February and March are when I decided to become a nurse. When I find myself back in therapy or counseling. When I initiate projects. When I change jobs, or start thinking about it.

Not much else has been going on, though. A few tidbits:

• My eye sight is pretty good, almost 1 month post LASIK. A little dry from time to time. It is a miracle
  
• Work goes well. I will get my longevity promotion (and pay raise) next week with my 2 year anniversary.
  
• The basement remodel looks terrific. We had poker here two weeks ago and it worked well. I'm not quite done with everything yet, but so far, it's nice.
  
• I am re-reading The Secret. I want it to sink in.
  
• I am trying the positive thinking thing with losing some weight. So far, it's not working so well
  
• Finally, finally, I have had the urge to sew again. I have made 6 more blocks for my bed quilt for Kevin and me. I have enjoyed it muchly!
  
• The vacation to Japan is looking quite likely for this fall...very exciting!!
  

I hope to post something much more interesting soon. It has been a while, so I thought I'd at least give an update.