Sling & Swathe

An ER nurse, broken/mending

A Quiz!

People of Earth! A Quiz:

Which of the following items listed below are appropriate for insertion into the human vagina?

  1. A loofah
  2. Garlic
  3. Golf balls
  4. A tampon

If you selected “D,” congratulations! You, apparently, are in the minority. I’m betting you also own a thermometer and maybe even take a Motrin or two when you feel yucky. Again, this puts you in the minority.

You see, in the world of emergency medicine, there’s this massive wall of ignorance which must be scaled every. Single. Shift. It’s like Sisyphus and his rock, only dumber.

A patient comes to the ER to have their pain taken away, or to feel better, or to have whatever it is that is broken/torn/twisted/hanging off fixed. They tell us a story about their pain, and from this we glean information pertinent to their care. Often, we ask them questions so that we can better understand what exactly brought them to us; I can assure you, these are not hard questions. Examples of hard questions include: “How does language work?” or, “What happens to the human soul after death?” or even, “How long do I toast this Eggo waffle?” It is not, “Where do you hurt? Did you take anything for your pain? Have you ever felt this pain before?” although, based on patients’ replies, one would think that answering them correctly qualifies you for membership in the Mensa Society. A particularly tricky question, apparently, is: “When did your pain start?”  Sometimes this elicits a glance at a watch, or a quizzical look at a spouse (“What time did that start, honey?”).  More often than not, though, the reply is something like this: (usually accompanied by a slow rubbing of the head or chin) “Oh, just after I finished that barbecue at Jimmy’s.”

Aaaahhhh. Ok. So that narrows it down. After the barbecue at Jimmy’s. Perfect. And was said barbecue today? Or two months ago? Or was it in mother-effing 1985??

Sigh. Throw me a freakin’ bone here, people.

Recently, I was interviewing a female of child-bearing age in triage; she had complaints of abdominal pain. I asked whether she might be pregnant. Her response: “Oh, no. There’s no way I could be pregnant.”

Me: “Really? And why’s that?”

Patient: “Well they took my gallbladder out so I can’t have no more babies.”

Me: Literally struck dumb.

I did, however, briefly contemplate whether educating her about the female anatomy and conception was worth the expenditure of my own oxygen. Answer: nope.

Ignorance like this is our daily fare. Like hardened longshoremen, we endure its pounding, unrelenting, crushing waves. We tolerate it with the weariness of a mother. We bear it, because there is no alternative. We accept it because there truly is no end. Just when you think you have plumbed the depths of ignorance and stupidity, a patient plops down in your triage room and tells you that they *think* they have been struck by lighting. So you muster every teeny tiny bit of self control, successfully resisting the urge – indeed the desperate, consuming NEED – to strike them in the face, and instead politely inquire what, exactly, makes them think that they have been struck by a massive bolt of electricity from on high, considering that they have managed to walk into my work space under their own steam, and clutching a bag of Corn Nuts? Some sculptors work in bronze; others clay or steel. Our medium is more like pipe cleaners and dry pasta, maybe some yarn thrown in.

Which brings me to the little quiz at the beginning of this post. Yes, people. Someone actually did use a loofah (well, a piece of it, to be more precise) in lieu of a tampon. Apparently this is an acceptable alternative when you are in a pinch and all that’s left in the Tampax box is the little pamphlet about TSS. But, really, is this why a harmless marine sponge was torn from the loving embrace of its family, from its aquatic community, where it no doubt had hopes and dreams and a vibrant social life??  No, I say! Keep the loofahs out of your vaginas and put them where the good Lord intended – sitting in your shower soap dish, looking like a giant biscuit of Shredded Wheat. Save the loofahs!

And the garlic. Tasty. Rich in vitamin C. Perfect for warding off the Undead, or for adding a little zing to your pizza pie. Perhaps, though, not the best option for treating your yeast infection. Apparently this came as a surprise to a female patient who felt that popping a few cloves into the vaginal abyss would get rid of her persistent itch (and have the unintended bonus of making her smell like an italian restaurant at lunch rush). Which is weird, because I’ve read the ingredient list on the Monistat box, and NO WHERE did I see “garlic”…or shallot, onion, chive, leek, or any other member of the allium family. Garlic wants to be with its BFF butter, smeared all over a warm loaf of crusty bread. Your vag is not a loaf of crusty bread.

I’m not a golfer. I don’t go to the driving range (my astigmatism gets in the way) nor do I watch tournaments on tv (it always looks so hot, right? It makes me thirsty. It’s like I’m watching “Waterworld” but instead of Kevin Costner it’s Tiger Woods). I don’t know what a double bogey is, or an eagle, or a mulligan. I do, however, know that the good folks at Titleist certainly would appreciate it if you didn’t use their product to enhance your sex life.

Yes, you read that correctly.

An adventurous female patient generously allowed her partner to insert two Titleist golf balls into her lady parts. For fun. You know, in the sack. Cuz…who doesn’t want to sound like Yahtzee dice during intercourse? (I know I would. It might draw attention away from the persistent and dispiriting battle being waged between gravity and my boobs, a battle in which my boobs are the decided underdog). Anyway, it seems that, in lieu of post-coital cuddling, her golf-loving gentleman hit the bricks, leaving the patient to retrieve the vaginal sporting goods. So, she arrives at the ER where the doctor (a golfer himself), promptly removed them. Noting that they were Titleists (“most used ball at the U.S. Open”) and therefore of high quality, he gave them a thorough cleaning and took them home for a few holes over the weekend.  

So yes, ER life: soul-crushing, relentless, breath-taking ignorance.

Also, free golf balls.




I hate Nurse Appreciation Week. I find it patronizing and insincere. I know many of my colleagues cherish their Koozies and cheap lunch boxes and hand-held fans – all emblazoned with the hospital logo, of course. To me, though, it always feels a bit like that negligent, selfish son who pretty much ignores his mother all year but makes sure to take her out for a Mother’s Day lunch at Steak & Ale. Or the schlubby, immature husband who buys his wife something extravagant and needless and beyond their financial means to somehow compensate for years of forgotten birthdays and anniversaries. It’s a pretense.

This past week, some hospital representatives walked through the emergency department with two large buckets – one with individual-sized bags of chips, pretzels, and cheese puffs, the other with small portions of cookies. My good friend asked, “Oh, are these for Nurses’ Week?” The little Bean-Counter dispensing the snacks replied, “Um, no. It’s not just Nurses’ Week, it’s Hospital Week.” No, mother fucker. It’s not. It’s NURSES’ WEEK. Take a gander at social media. Even my non-medical friends know. Also, this isn’t little league baseball – we don’t all get a trophy.

We were told we could have one of the two items – “Sweet or salty, pick one. One per person!” A nurse next to me asked, “Why can’t we have both?” A valid question, since each item probably cost the hospital 25 cents. (This same nurse later took down her pony tail, removed her glasses, and presented herself as an entirely different person in order get a second item. Nothing says gratitude like having to steal it).

You see, gratitude – real gratitude – requires depth and specificity. It isn’t a day or a week marked on a calendar. It is not confined to a certain time frame, it doesn’t need recognition with cheap gifts and mass emails. Gratitude can only exist when there is a deficit between what you need or want, and your ability to fulfill that desire. It is when someone bridges that gap that you feel truly grateful.

When I was in the Trauma ICU after my accident, I had abrupt and inexplicably excruciating nose pain. Second to childbirth, it was the worst pain I have ever experienced. I could only describe it as feeling that an ice pick was being jammed into my nose. I was sobbing. My husband had gone home to get some rest. I wanted him, I wanted the pain to go away, I wanted to stop crying. My kick-ass nurse medicated me into oblivion, did her best to keep me calm, and called my husband to come back. Later, when the pain had subsided a bit and Jon was next to me, she saw that I was drenched in sweat and still hurting. The tears, though fewer, wouldn’t stop. She took the blankets off of me, put a wet washcloth on my head, and medicated me again. Finally, I slept. Do you know that I think about that moment almost everyday? I had such a deep and abiding need – to be free of pain, to be comforted and not alone – a need which I was completely and utterly unable to fill. And this nurse – this human, really a complete stranger with no incentive to care for me beyond a paycheck – met my need. The gratitude I feel cannot adequately be put into words.

You know what I’d like for Nurses’ Week? A note from my boss. It could be handwritten, or an email. But I’d like a note that expresses appreciation for something specific to me. For example: “I am so thankful that you are part of my team. I have seen you care for patients, and it fills me with pride to be the leader of such wonderful nurses. Something that I truly appreciate about you is your biting wit/willingness to be brutally honest/sometimes inappropriate but refreshing sense of humor/striking good looks/insert specific character quality of your choosing here. Our hospital is a better place because of you.” Or even, “I saw you taking care of a very sick patient recently, and I found myself hoping that, should I ever be in an ER stretcher, I would have a nurse like you. Thank you for taking such good care of our patients.”

That would be a lovely note to receive, wouldn’t it?

And, even though I know we would all prefer gift cards or just straight up cash, I think most nurses would appreciate a note like that. Because giving out bags of Baked Cheetos or rolling around the hospital dispensing cookies and juice can never convey gratitude. Only words can do that. It is looking someone in the eye and letting them know that, at some point, when you were broken and weary and lost, they met your needs without the expectation of reward. Gratitude is a form of humility. It is saying, “At that moment, in that situation, you were strong when I was weak. You fixed what I broke. You did what I was unable to do. And I am indebted to you.”

And nurses do that shit all day long, knowing that there will likely be no thanks (although you may have a patient yell, “Get me a Bible so I can wipe my ass!” which is basically the same thing).*

So, Hospital Administrators of Earth, please consider this next year when making your plans for Nurses’ Week. Maybe try making it personal and specific, highlighting the many ways your nurses span the chasm of pain and loss for patients every moment of every day. Don’t placate us with potato chips or Rice Krispie treats or coffee (of course we will still eat the shit out of them because, well, food) or phone chargers or Koozies. Say something to us which acknowledges the deficit that exists between what you want (ie, healthy, safe, satisfied patients) and your complete inability to fulfill that desire. Remind us that you are very much aware of and grateful for your nurses, because we do the things that you are unable to. Tell us – specifically and individually – that you are truly grateful for the ways in which we bridge the gap for patients every day.

Cash is always a nice touch, too.


*true story


Yes, this is a post about Christmas. Yes, it is nearly mid-April. But between the five kids, the new house, a rat infestation (more to come on that little gem later) and just general, overwhelming anxiety about life/blogging/etc, four months late is the best I can do. Deal with it.

This time last year I was running so obsessively that I thought doing a quick four miler in a torrential downpour after work would be a fantastic idea. The result of simultaneously attempting to jump puddles while keeping my iphone dry?  An ankle injury that forced me to back out of the half marathon that I had been training for so I could rest and heal over the course of 3-4 months.

The upside of this was that I now had plenty of time to give yoga a try, something I had been interested in for a while but which didn’t fit into my running schedule. I tried a few studios and eventually settled in at The Body Electric in St. Pete. Now, I don’t consider myself the yoga “type.” I’m pretty conservative politically, I’m not sure if pot should be legalized, and I’m only vegan when I’m not drinking (it’s a little lifestyle plan I’ve cooked up that I like to call “The Sober Vegan.” Basically, a glass of alcohol in my hand = cheeseburgers and bacon. So far I’m pleased with the results). I don’t go for a lot of the yoga spirituality – I am not a mountain, and I am certainly, unequivocally, NOT a lotus flower. But I have found that, over the course of the past year, yoga has changed my thinking and my approach to certain situations. Without really noticing it, I find that lessons I learn on the mat carry over into my real life – the most significant of these being the ability to “let go.”

At the end of each yoga session, when you are hot and sweaty and you swear your heart is going to pound right out of your chest, you take rest in savasana, or Dead Man’s Pose. This is exactly like what it sounds: you lay on your mat, supine, arms and legs spread and relaxed, and you attempt to release it all – the sweat rolling into your eyeballs, the frustration at poses you couldn’t get into, the churning in your lower abdomen that sounds suspiciously like the birth pangs of a fart. For those delicious moments your entire being should be focused on, as my instructor says, “letting that shit go.” And she talks to us about what a tremendous skill that is, to stop in the middle of a heart-pounding, adrenaline-inducing, emotionally-charged moment and release that energy, as they say, “into the universe,” and calm yourself. This past Christmas I put that skill to the test.

Some of you may remember that decorating our tree last year sucked balls. That’s putting it mildly. If you were fortunate enough to have missed all the nitty-gritty details, fear not. I’ll do a quick re-cap for you here. Christmas tree decorating 2012 was, as they say, a shitfest. If a formed stool had diarrhea, that would have been our tree trimming experience. It was a complete and total debacle, and, to be quite frank, I’m shocked that we made it out of that holiday season with five living children.

The fragile foundation upon which my expectations of a night filled with carols, cookies, and laughter sat began to crumble shortly after we returned home from purchasing our Christmas tree. Apparently my husband is under the comically quaint notion that a single strand of 100-count lights is completely sufficient for a 6-foot tree. Time has taught me that this magical thinking afflicts all straight men who are not interior designers and/or blind. Seeing the white-hot rage simmering in my eyes like some yuletide cauldron, The Dude wisely agreed to head out into the balmy 75 degree night air to purchase more lights. This left me at home with five extremely excited, antsy children who were anxious to decorate the tree. Of course that was an impossibility, because, as all Type A tree trimmers know, The Lights Must Go On First. So I did my best to keep them entertained/prevent them from being on the business end of infanticide until The Dude returned home an hour later with yet another SINGLE STRAND of 100-count lights.

I did my best – I honestly did – to conceal the fact that my rage had just gone from “simmer” to “boil” by putting on my Mommy Dearest face and quasi-Satanic monotone voice. And just as I was saying something completely insincere like, “Oh, that’s okay. I’m sure there’s a light shortage at all the area Targets, Wal-Marts, and Walgreens. No, no, don’t worry about it. The 200 lights will really light up the bottom 1/3 of the tree,” I heard a crunch, and then tears. The five children who had been waiting patiently so their anal-retentive mother could have the tree done her way had resorted to jumping on the couch, on each other, on their ornaments. Two precious, irreplaceable ornaments, smashed to bits + one homely-looking ill-lit tree + bunches of shattered expectations = a full-blown maternal meltdown during which I’m pretty sure the statement “Santa’s not coming this year, kids!” was uttered at least once. I’m not proud of it, folks.

I’ll spare you the details of what happened next, but suffice it to say that the night ended with child #1 yelling at yours truly (surprising us both) and this Mother of The Year crying on the driveway and moaning something absurd about “ruined Christmases.” It was one of my finest moments, to be sure.

So this past Christmas I resolved that things would be different. This year I stayed at home with numbers 4 and 5 while The Dude took the older three to pick out our tree at someplace decidedly less festive – Wal-Mart. I let the kids put the ornaments on the tree, even though it meant the bottom 1/2 was overloaded, and, due to the presence of an enormous green wreath made of rice and – based on the sheer weight – cement, with my daughter’s picture in the middle, had a decided tilt to the right. I didn’t even get upset that the lights – while sufficient in number – weren’t the right color (apparently most straight men also don’t realize that there is a vast difference between “soft white” and “icicle white.” Sigh.) or that they were blinking on different cycles. Okay. I did make one teensy, tiny comment about having a Vegas strip in our living room, but that was it. And, most importantly, I didn’t sneak back downstairs after everyone was asleep to re-arrange the ornaments into a more Martha Stewart style. I was proud of myself. Maybe I had changed. Maybe I could let go of things. Maybe I had actually managed to shed last year’s skin and a be one of those calm, relaxed mothers.


Until two days later and our tree fell. Not just tipped forward or scooted off balance. Like epically, face-first, go-home-Christmas-tree-you’re-drunk fell. And underneath those branches were the remainder of my precious, irreplaceable ornaments – all smashed to bits.

So I cried. I cried and cried and cried. Like, for days. I realize this may seem ridiculous to some, maybe even most, of my valued readers. But when 15 years of treasured Christmas memories are literal smithereens in your dustpan, it’s a bitter pill to swallow.

At first I felt foolish for being so sad – for walking into the living room and lovingly removing yet another mangled chard from the tree, for sniffing a little bit as I threw one more memory in the trash. And then I remembered an incident from my own childhood, where I accidentally broke a crystal platter that had been a wedding gift to my mother. I remembered her crying and crying, and not understanding why she would be so upset over a piece of glass. Now I understood.  I understood why “just things” can sometimes be more than that – I understood why certain pieces of glass, or wood, or green spray-painted rice wreaths take on significance beyond the materials of which they are made. They become receptacles of memories, tangible reminders of where we have been, of what we used to be. And it’s okay to be sad at their destruction. It’s okay to wish they were still intact. It’s okay to admit that these “just things” had value and importance. But it’s also okay, indeed essential, to – like my mother did as she swept up the fragments of her wedding platter, and as I did with each ornament I tossed in the can – let go. Savasana. To truly and entirely let go of loss and pain and ruined memories and imperfection and struggle. To sigh and breathe in, breathe out all of your personal failures – the stressful holidays, the fights with your spouse or children on days that are supposed to be idyllic. Because, in this world, there is no perfection. There is no storybook Christmas, or birthday, or any holiday for that matter – because we are not perfect. We are impatient and rude and anal and overbearing and controlling. We are all very like my ornaments – fragile, temporary, weak. And that is why, especially for me, it is important to let go. To recognize that life is going to be full of insufficiently-lit trees and smashed ornaments and garish, ridiculously heavy wreaths made of rice. And that’s okay.

Let go.



*I would like it noted, however, that this “letting go” is very much a work in progress.  I’m getting better at it, little by little – but don’t expect me to be all calm and shit.


Bats, people.  Apparently these sonar-using, miniature Chihuahuas with wings are some of the most stealthy creatures on this Earth.  I say this because within the past few weeks I got to participate in administering several of the shots in the Rabies vaccine series.  This sounds terribly glamorous, I know.  But let me reassure you and your jealousy that it was actually very boring and routine from a clinical point of view.  It was, however, interesting to me because I had never given it before and so I was overly excited to learn a new thing.  (Trust me when I tell you that you DO NOT want to have this series of injections.  Ever.  The number of injections varies based upon the patient’s weight, but suffice it to say that it involves multiple injections over a period of days.  I would rather have a high colonic, but that’s just me.)  At any rate, the patient who received the shots didn’t actually know if he had been bitten.  He had no bite marks, and stated only that the bat had “bumped into his head.”  So this was where I scrunched my eyebrows together in an attempt to look concerned/as if I needed clarification, but which was really a very thinly disguised “You, Sir, are a moron” face – until he proceeded to state that his wife had looked this situation up on the world wide interwebs and various sites asserted that, if you were to wake up in a room and find that you had been double-bunked with a bat, you should just assume you had been bitten and get your self to the nearest ER pronto.  Well.  Finding it hard to believe that an animal which looks like God created it out of the spare parts of a whale, a moth, a rat, and a seed pod could somehow manage to puncture human flesh undetected, I consulted with my fellow nurses (and by “consult” I really mean “mock the patient”) who told me that they have heard the same thing.  Apparently my patient was right, and because of his diligence will live to tell the tale and/or turn into a bat.

One of the questions we must ask our patients when gathering information about their medical history is: “Do you have anything implanted in your body that you weren’t born with?”  This always gets a strange look from the patient, so I add: “Such as a port, a pump, a shunt, a stent, or orthopedic hardware?”  I used to think that the bewildered expression on their faces was because, like me, the first thing that sprang to mind when hearing that question was, “Is this nurse seriously asking me if I have had an alien probe/tracking device inserted into my rectal vault?” (okay, okay.  So yes, I did watch an overabundance of Buck Rogers, Star Trek, and “V” growing up.)  But now I realize that it’s because they truly don’t have any idea what some surgeon has placed in their body, or removed, or manipulated.  They barely know what they put into their own bodies, for Pete’s sake.  For instance, the other day a female patient of mine was reviewing her history with me, and when I asked her the above question, the conversation went something like this:

Patient: “Um, yeah.  I have some valve-thingy.”

Me:  “Do you mean you had a valve replacement?  Which one? (because, you know, you’ve got more than one!) What type of valve replacement was it?”

Patient:  “Oh, I don’t know.  They doctor went in there and stuck something inside me.  I’ve got to come in next week to have them put a balloon up somewhere in there, too.”


Okay.  Now I totally get that non-medical people may not know all the hospital verbiage and surgical jargon, that their understanding of body parts/procedures/physiological responses may be very simplistic and limited.  BUT.  You are seriously laying in that stretcher telling me that you allowed another human being (albeit a highly trained and knowledgeable one) to cut into your body, take out a “part,” insert a new, foreign part, then sew you up and send you on your merry way???  And you have no idea what was done or whether it was even necessary???

Sigh.  The same type of situation occurs when we ask our patients whether they are currently taking any medications, and, if so, what the names/dosages might be.  My favorite response is along the lines of, “Um, let’s see.  Well, I take something for my blood pressure.  I can’t remember the name.  It’s a little green pill.”  Which would be a fantastic bit of information if your medication regime consisted entirely of Tic Tacs.  Then I could at least narrow it down to wintergreen or lime.  But since there are probably four pharmaceutical companies currently manufacturing your mystery blood pressure pill, the fact that the only information you can provide is its color is of extremely little value.  Of course I don’t say it with that snarky tone, though.  I do at least try to be professional.  So I ask whether they have a list of their meds, or whether their spouse might be able to “fill in the blanks,” which is often met with a lot of head rubbing, a sheepish grin, and the words, “Gosh, I don’t know.  I just take them cause the doctor told me to.”  And here’s where I really have to bite my tongue, because the mother in me has her chin down, her eyebrows raised, her arms crossed, and she’s saying, “Really.  Really?  You are ingesting, on a daily basis, a substance about which you know nothing simply because your doctor told you to?  What if I pulled out a dusty Tylenol from under the med machine, cleaned it off, and gave it to you?  Would you take it, simply because I am wearing scrubs and don’t look like a serial killer?  If your brother told you to jump off a bridge, would you do it????”

My mother (whose entire medical knowledge comes strictly from Prevention Magazine) always told me that, when it comes to health care, I needed to “be my own advocate.”  No one else was going to be my voice, that I needed to be educated and aware and speak up for my health.  I saw her do this with her own mother, who, at 96 and with dementia, could no longer advocate for herself.  So when my grandmother’s PCP attempted to schedule her for a mammogram and a pap smear (both great diagnostic tools for preventative medicine, to be sure – but, let’s face it – what exactly are you hoping to find on a 96-YEAR-OLD?  I mean, at that stage of life your cervix and what were once called “breasts” are pretty much just organized collections of dust and old cells.  And if you do find an abnormality, or a tumor, what are you going to do about it?  Radiate the poor woman out of existence?)  So my mother, Prevention Magazine in hand, triumphantly defied said PCP by refusing to put my demented but otherwise healthy grandmother through the unnecessary trauma of having her boobs squashed and her cervix scraped.

The sad thing is, though, that too many people are willing to abdicate responsibility for their own health and blindly do whatever it is that their doctor tells them is best.  People don’t want to think for themselves; they want to be directed, to have this test ordered or that body part cut out, or eat this combination of pills.  They mistakenly believe that good health lies in the doing, not the thinking. That if I just take this BP med and this cholesterol pill life will be sunshine and rainbows and I will live forever and ever.  Or, if I could just get that part of my body removed/shortened/cleaned/burned off I won’t be depressed and unhappy anymore.  But it doesn’t work that way.  Life and health are about treating your mind and body with dignity, and living with dignity means speaking up for yourself.  It means telling the doctor “No” when he wants you to take a pill for your blood pressure – but it also means making the choice to exercise and change your diet and putting down the cigs in order to make your heart happy.  And finally, it means, when those changes haven’t helped and your blood pressure is high enough to stroke out a whale, you go back to your PCP and you take the meds as prescribed – and you fill your script regularly and familiarize yourself with potential side effects.  And, for goodness sake, you keep a list of the meds you take in your wallet, in your wife’s purse, in your glove compartment, and at your neighbor’s house.  This is what “being your own advocate” means.  It is not opting to eat tree bark and yogurt and meditating on the meaning of life instead of getting that quadruple bi-pass your doc recommended.  It is partnering with your MD to achieve the best, most realistically-attainable goals for your health.  It is being honest with yourself and your loved ones about the quality of life you’d like to have and to maintain, and then doing your level best to achieve that.

Okay, stepping down from my soapbox now to resume packing (yes, we ARE moving!  More details to come.  Suffice it to say, though, that the new house is triple the square footage of our current home, and the kids’ minds were blown away by having two basins in one bathroom.) Cleaning and tossing out 13 years’ worth of stuff is a dusty, dirty business.  No bats so far.  If I do manage to have one fly into me, though, no worries – I’ll just head to my medicine cabinet and down a bunch of orange Tic Tacs.


At last.  The Time That We Wait All Year For is over, packed up and put away for another twelve months.  Don’t get me wrong, I really do enjoy the festivities – the lights, the carols, the cheesy decorations, the magic of sharing it all with my five favorite little people (I would like it noted, however, that I absolutely DETEST the Elf-On-The-Shelf, and all the “cute” little shenanigans mothers with too much time on their hands make him appear to do.  Seriously.  If you have time to dump out and then clean up a substantial amount of flour onto your floor so it looks like your toy elf is making snow angels, you might want to consider volunteering.  Or a job.  Or perhaps just a nice prescription for Valium so you sleep away the hours you would typically spend making the rest of us “less ambitious” types look like the World’s Worst Parents.)  It’s just that a heightened awareness that this season is supposed to be the Happiest Time On Earth, coupled with the condensed time frame and the pressures to be perfect sort of, well, irritate my anxiety.  Just a bit.  So every year I give myself this little pep-talk, and I say that this year I won’t get so stressed out about little things.  This year I won’t fight with The Dude about how many strings of lights are necessary for the tree to be properly lit.  This year I won’t spend two hours sitting on my driveway, talking myself down from the proverbial ledge because child #2 broke an irreplaceable ornament that commemorated the birth of #3.  This year will be different.

So on Thanksgiving day I did my positive self-talk.  And it seemed to actually be working…until about 10 AM when I found myself seriously pondering how much bleach I could purchase at one time without arousing suspicion because I was honestly going to murder my kids.  Yes.  I was washing the dishes and all five of them were doing something annoying.  And I realized that I had two options: Option A involved the aforementioned bleach, LOTS of cleaning, and the very real possibility of having to spend my declining years in the Pen.  Option B, while not nearly as entertaining, incorporated the use of what I like to call my “android face,” which is a cross between Mommy Dearest’s “No more coat hangers!!!” and the clown from “It.”  I find it extremely useful in circumstances where I want to spank some serious bottom but there are too many security cameras/watchful strangers around.  I chose Option B.  Within minutes, child #4 appeared in the kitchen, wearing her FOURTH outfit of the day.  So I simply turned to her with my dead eyes and frozen, psychotic smile and I swear I saw a shiver go down her spine.  Yes, I freaked her out.  No, she did not return to the kitchen.  Sure, she may have been quietly rocking herself into an oblivion of sweet forgetfulness, but guess what? I didn’t yell!  I didn’t loose my temper!  I maintained the sanctity of Thanksgiving Day!  We were gonna celebrate and eat this damned turkey with smiles on our faces if it killed me!

About an hour later, we watched the Macy’s parade.  All of us.  In one room.  And somehow, for about thirty minutes, bliss reigned in my house.  The Dude and I with all five, curled up on the couch watching the marching bands and giant balloons.  No one tooted, or hit, or took someone else’s toy/book/Pokemon card.  No one tattled or complained.  It was really wonderfully sweet, and I thoroughly enjoyed every single moment…but then it was time for dinner.

Getting five children between the ages of 9 and 2 to sit at a formally set table is a bit like trying to round up cats.  Just when you think you’ve got them all situated, someone decides that now, this very minute, they absolutely MUST poop.  Or they drop their fork.  Or the baby knocks over a glass with the toy truck you gave him in the hopes that he would just stay seated for five seconds already!!  It wasn’t pretty, but finally we were all ready to dig in and enjoy the scrumptious smoked turkey that the Dude had been working on since 4:30 that morning (and it was delicious.  I mean, it was completely smothered in two of Nature’s Five Most Perfect Foods – mayonnaise and bacon – the other three Foods being, of course, croutons, avocados, and cheese.)  No sooner had we said the blessing, though, when the thin veneer of calm that I had just barely been maintaining started to crack.  Child #2 only wanted a roll and turkey.  Child #4 wanted Every.  Single.  Item on the table, and yet would most likely eat none of it.  Child #2 said he was only going to eat a roll, and child #5 took one look at his plate before high-tailing it to his box of trucks.  As I was desperately attempting to return to Android Face Mode, I hear The Dude’s voice say, “Can anyone tell me why we celebrate Thanksgiving?”  And my heart just absolutely sunk.  I realized that I had gotten so caught up in the doing, the baking, the cleaning, the need for perfect holidays, that I completely forgot the reason I was doing it at all.  My little private pep-talks had failed.  I had failed.  So I did what any reasonable working mother of hormone-producing age does when the realities of life are simply too much to bear: I drowned my sorrows in sweet potatoes, Parker House rolls, corn casserole, two kinds of pie, and, of course, The Dude’s Turkey.

The rest of the holiday season went just about the same as Thanksgiving – a lot of mundane, daily activities like work and cleaning and laundry, sprinkled here and there with bursts of deep contentedness, and the occasional flash of white hot rage (“Um, can someone tell me why in the hell our backyard is littered with BRAND NEW red Solo cups????)  But what I realized is that this is how all of life is – the day-in, day-out grind of ho-hum lives – occasionally (and mercifully) interrupted by fleeting moments of happiness, and the holidays are no exception.  A turkey and dressing or a tree and stockings don’t make life more meaningful.  There is no reason to feel that those dates on a calendar must be problem-free, must be total departures from normal life.  It is precisely because life is terribly mediocre that those brief moments of joy which we experience throughout the year are special, and it is those which we should consider to be perfect.

But if the Elf-On-The-Shelf shows up, I swear I’m exercising Option A.


I still remember my first experience ever in the ER.  It was 2007, and I was working as a patient care tech up on a medical/surgical floor.  I was sent down to the ER as a “float” tech, because the dayshift was short-staffed that day.  I was nervous, but excited as well.  Even though I had never worked in the Emergency Department before, I suspected that it was where I truly wanted to be.  This feeling was confirmed when I read room 17’s triage sheet and saw that, under “Chief Complaint” the patient had written: “There is a possum in my rectum.”  And that was it for me.  I was hooked.  From that moment on all of my energy, desire, effort was focused on getting. Back. There.

A few posts back I mentioned that, despite my frequent grumblings and bitter rants, I actually do love my job – and I promised that I would make public the reasons why I am thankful every time I punch in.  So here, in no particular order, are a few of those reasons.  As a disclaimer – every single one of the examples/anecdotes/situations I mention are real and have not been embellished in any way.  Enjoy!

Reason #1:  Working in the ER forces you to get really simple, really fast.  You learn to condense super complicated processes into a few basic, extremely palatable words.  It only took me a few weeks to realize that the vast majority of our patient population is either mentally/intellectually incapable of listening to a five minute explanation of exactly why their legs are the size of a coffee cannister and they can’t breathe,* or they simply just don’t care.  So you develop a sort of medical shorthand, and you find that life is much better when you don’t have to use words like “glycosylation,” “sodium-potassium pump,” or “anaerobic metabolism.”  For instance:

Hemodialysis: “They take all of the blood out of your body, clean it, and put it back in.”

Ascites: “Your liver hates you.”

Quadruple Bi-Pass: “Your heart is dying.”

Impacted: “You are full of poop.”

Catheter:  “A tube goes into your penis and urine comes out.” (My personal favorite)

Reason #2: There is no other place on Earth that makes you feel more normal.  So you’ve been married three times and your second husband was a circus dwarf?  Normal.  You bought a Sam’s Club membership simply so you could buy toothpaste in bulk and satisfy that Colgate addiction?  Normal.  You have a horn growing out of your back that requires bi-weekly shavings, lest it poke through your scrubs?  Totally normal.  Because, unlike your patient in room 19, you did NOT answer “I don’t know, but one thing’s for sure – I’ve got to get that mother-fucking space ship built by morning,” in response to the question, “Do you have any diagnosed medical conditions?”  Nor do you have a screwdriver lodged in your rectum (pointy end up) like the guy in room 6.  And you most certainly don’t have a raging heroin addiction like the pregnant patient you just discharged.  So, despite your weird quirks and poor life choices, you clock out of that place feeling AMAZING.  And then you drive home to clean and re-organize your collection of prosthetic legs.

Reason #3:  I have not always worked in the ER.  I did work for one year as a nurse in a long-term acute care facility, and one of my greatest frustrations while employed there was the fact that the physicians appeared to have absolutely no concern for their patients.  This was probably true to some degree, but the reality is that many of the doctors were truly unaware of their patients’ conditions – because they weren’t around to see them.  They did not go in rooms and actually talk to them – they chose to hover around the charts and check labs.  So it was a welcome change to work in the ER, where the doctors are right there in the mix with you.  Yes, there are a few who micro-manage and will ride you like a Mexican burro at the height of immigration season, but for the most part they are diligent, caring professionals who actually listen to nursing staff when we come to them with a concern.  And sometimes they even stand up for their nurses, which makes you feel all protected and warm and fuzzy inside.  Throw something at an ER nurse?  Hello, Baker Act.  Take a swipe at us?  In comes the ER doc to tell you that, if you “bother MY nurse again” the authorities will be removing you from our facility.  In short, Reason #3 = “collegial atmosphere.”

Reason #4:  In the immortal words of Forrest Gump, “Life is like a box of chocolates – you never know what you’re gonna get.”  Nowhere is this more true than in the ER, except that our “chocolates” are more likely to be filled with prescription drugs, stool, or booze than orange creme or caramel.  But it is this unpredictability, this variety, that I love.  Where else in the world would you have to deal with a patient who has voluntarily had an eggplant inserted into his bumhole?  (And who has just finished telling you about “parties” where people place all kinds of things – rolled up flip-flops being most memorable – into their rectal cavity.)  Few other professions entail wrestling a patient to the ground because, poltergeist-like, they have leapt off the bed, torn off their cardiac monitor leads, and are now swinging them at staff like Spartacus with a cat-’o-nine-tails.   It is both thrilling and terrifying that you truly never know what is coming in those doors.  This is why experienced ER nurses never let their guard down.  Because that lady in black spandex shorts who just signed in for “abdominal pain”?  That bulge in the crotch region ain’t her cell phone.  And despite the fact that she’s emphatically stating, “No baby! No baby!” in broken English, you’re pretty sure a full-term infant is crowning in your triage room.

Reason #5:  The ER is the most honest place I have ever worked, with a large caveat:  it is a deceptive honesty.  It is a brutal, painful honesty that is meant to deflect and protect the doctors and nurses who deal with life’s ugliness on an hourly basis.  For example, when giving report, a nurse might say, “The patient in room 5 is from Generic Name Nursing Home, here with a fever and UTI.”  Other nurse: “How old is she?”  “Oh, I don’t know, she’s old.  Like, she’s made of dust.”  What that nurse really means is, “Please God, don’t let me end up here, having some young girl taking off my bra and catheterizing me for urine.  Please don’t let me be old and alone and abandoned.”  And when a nurse refers to an overdose patient as “gorked,” what she’s hiding is a deep and abiding fear that this young kid laying before her with scrambled eggs for brains could be one of her children.  And you just can’t face it.  So you squeeze your eyes tight and tell yourself that you don’t work in reality, that not everybody ends up a medical disaster.  But there is always a small part of you that doesn’t believe it.  This is why, when a nurse is taking care of a “total,”*she tells her co-workers in a calm, matter-of-fact voice that if she ever ends up in the ER trached-vented-PEGged,* please put a pillow over her face, snow her with all the narcotics known to man, or somehow manage to “accidentally” disconnect the ventilator.  We exaggerate the truth in order to hide it, we put a smiley face on hideous situations and cross our fingers that they won’t happen to us.  We take a deep breath and move on because we have to, because if we didn’t we’d have a psychotic episode or wind up in a catatonic state, sucking our thumbs and clutching the call bell like it was our child.  And then they’d admit us, send us to the psych ward.  And the nurse giving report would simply say, “She’s crazy-cakes.”

*…can’t breathe:  Classic symptoms of Congestive Heart Failure.  It’s gonna take too long to explain that here, just suffice it to say that your heart sucks, your legs swell, and your lungs get full.  And, you’re probably gonna die sooner rather than later.

*”total”:  A patient who requires TOTAL care.  As in, a machine to breathe for them, a tube to feed them, and bags to collect their urine and stool.

*trached-vented-PEGged:  See above.  To simplify it down to ER-speak: your body hates you.


In my last semester of nursing school, when I was heavily pregnant with child number five, I was assigned a CMO* patient on our very first day of clinicals.  The fact that I was given such an easy patient sounded alarm bells in my brain – what if this instructor thinks I can’t handle nursing school because I’m expecting?  What if she thinks I’m an idiot?  What if I have to drop out because of this baby?  What if I never become a nurse??? (Those of you who know me lovingly refer to this psychotic train of thought as “paranoia” or “insecurity.”  I prefer to think of it as “Type A Hypervigilance,” and, since I’m writing this blog, I make the rules, mkay?)  I was desperate to prove to my instructor that I was not a slacker – that I would not let something as minor as a human being growing in my abdomen stand in the way of providing excellent nursing care.  And so, being the earnest nursing student that I was, I informed the RN to whom I was assigned that I was going to bathe the patient.  I will never forget the look of pleading in her eyes, the unspoken, “Please don’t.  Don’t.  It’s barely 7 AM and I’m still getting report.  I haven’t even laid eyes on this patient who’s death you want to hasten by bathing her. And I don’t even want to think about the post-mortem paperwork.  So can’t you please, please, please just be a normal, lazy, tired nursing student and go eat a bagel in the break room??”  But I couldn’t.  I wouldn’t.  I was adamant that my instructor see that I was more than the baby bump in the white scrubs.  I had potential.  So, I gathered up my supplies, enlisted the help of a fellow student, and began bathing my poor little CMO patient.  I started with her face, as we were taught to do in semester one, then moved on to her upper extremities and torso.  In order to wash her back, we gently rolled her onto her left side*…when she promptly died.

I have been rereading some of my previous blog posts over the last few weeks, and I realized that things have been a bit heavy on the “fear” side and pretty light on the “fartleks.”  So, I thought I would update my loyal readers about my running progress.  I have had quite a few “firsts” in the last month – the Dude and I accomplished a long-standing goal of mine, which was to run 10 miles (yes, at one time).  It wasn’t a pretty run, and the final mile was downright ugly (when we got to our stop point I dramatically stumbled and half-fell/half-passed out.  I was going for the look of that female marathoner in the 1984 Olympics who trips, then falls, and finally crawls her way to the finish line.  In my case, however, there was no collective gasp followed by the thousand cheers of Olympic fans.  Just an empty Starbucks parking lot.  And the Dude.  And maybe a homeless guy.)  The next week we actually ran 11 miles, and I finished in an upright position.  The funny thing is, I thought achieving this goal would make me feel like a “real runner,” but it didn’t.  I was proud of myself, I was happy – but I still battle that constant, nagging suspicion that maybe I’m just faking it.  That one day I’ll just up and quit and never run another step.  That maybe I’ll take up the habit of lounging on my couch all day eating Pringles and watching Jeopardy re-runs.  Maybe I’ll actually grow into said couch and when that bowel obstruction I’ve been anticipating for years finally happens the paramedics will have to cut me out of the house, taking me and my Kane’s loveseat to my former place of employment for care.  Oops.  There’s that “hypervigilance” again.

Also in the last month, I had my first running injury.  I would like to say that it was something exotic and medical-sounding, like a torn ACL or busted vastus lateralis (okay, I totally made that one up), but it wasn’t.  It was a split toenail.  Boring, I know.  But I was super excited about it for two reasons:  1)  I busted my nail by running.  That means, on some level, that I ran so hard and so fast that my little nail just couldn’t take it anymore and split straight down the middle (it also means, of course, that I wore out my shoes/they were ill-fitting to begin with.  I prefer to stick with running really hard and really fast.) 2)  I got to use copious amounts of silk sports tape.  It is a little known fact about me that I love, love, love silk sports tape.  Using it makes me feel all athletic and sports-y.  A few months ago I had a blister on my heel (not from running, mind you.  From wearing high-heeled hooker shoes that were a bit too snug but totally completed my look) and I wrapped that sucker in so much silk sports tape that I looked like Lazarus.*  Everyday I lovingly wrapped and re-wrapped before I ran.  I must have gone through three rolls of tape.  And you know what?  It was worth it.  Because inside, I felt like a combination of Laila Ali and Joe Montana.  When I’m wrapping an injury in sports tape, I AM Roger Bannister.*

Over the course of the last few months, I have been running one morning a week with a woman about a decade older than me and about five minutes faster.  I’ll call her the “Flying J.”  Yes, I know this is also the name of a popular truck stop joint, but it was the best I could do on short notice.  Anyway, the Flying J has been running since, well, her conception and, although I was pretty intimidated to join her, I find that I now look forward to our morning runs.  I have actually learned alot about running – and about myself – from her.  I’ve learned that you can’t underestimate the importance of being well hydrated, especially before a long run.  I’ve learned that those packets of energy gel that I used to think were only for complete tools actually do give you a little boost around mile 8. I’ve learned not to fear inclines, but to attack them, to give them all you’ve got so you don’t feel defeated even before you’ve begun.  I’ve learned that running isn’t just about the run – it’s about exploring your neighborhood, enjoying the wonderful surprises that being alone on a trail/rode/sidewalk can provide.  Until the last few months, I had a few set routes that I always used, depending on how far I wanted to go.  I never varied from them, afraid that if I did deviate from my course it would somehow affect my mileage or my pace.  Lately, though, I have just been taking off running – usually with only a vague notion of where I might go.  I have stumbled onto fantastic sunrises on the Clearwater gulf, long, lonely piers just begging to be run on, wooden trails tucked away in small public parks, and beautiful neighborhoods I would otherwise never have seen.

The biggest lesson I have learned, though, isn’t truly a lesson – it’s more of a revelation, a private admission to myself that surely comes as no surprise to those who know me well: I don’t like to be pushed.  There have been several times over the last few weeks when the Flying J and I ran on some overpasses (okay, she ran, I just tried to keep moving and hold back my hot, angry tears) when I literally felt furious inside.  At her, at me, at this stupid activity where you just don’t stop moving but you’re not actually going anywhere.  And I realized that I am not used to being pushed, because, for the most part, I don’t require it.  All of my favorite (and most effective) teachers/mentors/preceptors seemed to know that I am my own slave-driver.  If it’s something I care deeply about (or just don’t want to look ridiculous at) I don’t require the rod and the whip.  I am my own harshest critic, my own time-keeper, task-master, disciplinarian.  The first paragraph of this post is a perfect example.  I could have taken the easy way out, could have eaten that “everything” bagel with six packs of real butter and two tubes of cream cheese that I so desperately wanted (oops, I mean, the baby so desperately wanted.  And yes, I did put all that crap on it.  Don’t judge), but I didn’t.  I forced myself to bathe that patient, to show my instructor that I was up to the challenge.  So what if I inadvertently accelerated my patient’s voyage across the River Styx in the process?  She was headed there anyway.   What I have learned is that, while my “Type A Hypervigilance” might be frustrating to others, it is what got my through that final semester of nursing school, it is what helped me pass my NCLEX, it is what led to my split toe nail, and it is why, even through my pissed-off tears, I will continue to run.


*CMO – “Comfort Measures Only.”  The designation given to patients who are end-of-life and require only palliative care.  This would include, but is not limited to, supplemental oxygen, pain management, repositioning, and, of course, baths.


*left side – Where the all-important left ventricle of the heart is located.  Basically I squished her heart’s biggest and best pumping mechanism by rolling her onto her left side, dramatically reducing the amount of blood pumped to her brain and body.  Whoops.


*Lazarus – Um, the main character from a story in a really popular book.  It’s in the “B” section of your local card catalog.


*Roger Bannister – the first man to run the mile in under four minutes.  Okay, so I’m still at the 9:45 mark on a good day.  But, with sports tape on, I feel really fast.


A few weeks ago there was an article in the paper about a gentleman (and I’m using that term very loosely here) from a town a colleague of mine has affectionately named “New Port Rickity.”  For those of you reading this who aren’t familiar with central Florida’s West Coast, this is a city located in a northern county which has gained a reputation over the years as being a sort of white trash paradise.  Yes, of course there are citizens who are law-abiding and gainfully employed living there – so, lest I offend half of the nursing staff at North Bay Hospital, I will refrain from giving the name of the county.  Let’s just say it begins with “P” and rhymes with “tabasco.”  At any rate, this area seems to be largely populated by people who, while they may consider themselves  “rednecks” or “country,” habitually participate in activities that only lower-class white people do, such as: cooking meth, chain smoking (without shame) while heavily pregnant (usually outside a medical facility), purchasing their weekly groceries at Walgreens, and declining to watch “Here Comes Honey Boo-Boo” because it too strongly resembles real life.  Well, it seems that this “gentleman” decided that he needed assistance from his local Emergency Medical Services staff.  At this point I can’t remember what the exact issue was, although I’m sure it was life-threatening and not something completely trivial like, oh, I don’t know – needing a Tylenol or wanting the police to arrest your neighbor for “borrowing” your meth-cooking bunsen burner without permission.  So EMS arrives at his door and he tells them to WAIT while he finds a babysitter.  And you know what?  Those sons-of-bitches paramedics had the unmitigated gall to tell him that they were unable to do so, which prompts Mr. White Trash to call 911.  Again.  While the ambulance is literally in his driveway (okay, perhaps I’m giving him too much credit.  While the ambulance is literally in the tire-track ridden section of his “yard.”)  Mr. White Trash is then loaded into the ambulance (for some reason the paramedics suspected that he might be intoxicated.  Profilers!) where he proceeds to, once again, use his cell phone to call for emergency assistance.  The most shocking part of all?  I read this article without the slightest degree of surprise or dismay.  It struck the same emotional chord with me as would reading the weather forecast or Sunday’s “Marmaduke” comic.  I just simply wasn’t impressed.  All I could think was, “That was your best, man?  I’ve had patients call 911 from the ER lobby.” (Just as an FYI, this is, even in dire circumstances, never a good idea.  You will annoy the medics, irritate the ER staff, and succeed only in being transported around to the ambulance bay, wheeled through the ER, and off-loaded in the very same waiting room that you just left.  Only now you will have to explain to your insurance company why, on God’s green earth, you left without seeking treatment.)

The article did make me think about something which I thought I understood prior to becoming a nurse, but which I now realize I had only a dim grasp of.  And that is entitlement.  Yes, I knew the basics – expecting something that you don’t deserve and feeling that you’ve been done a disservice when that something isn’t given.  To illustrate my point, I’d like to share with you a conversation I had the other day with a patient – a conversation that is all too typical, but makes you want to put a gun to your head nonetheless.  Then I’m going to finish up by listing my Top Five Greatest Examples of Entitlement in the ER.

Patient X came to the ER for belly pain.  This was their third visit in as many weeks, and they had been told that, in order for the belly pain to go away, a certain-organ-in-their- GI-tract-which-shall-remain-nameless-in-order-to-ensure-that-no-privacy-laws-are-broken would have to be removed.  The patient continued to allow the offending organ to remain in their abdominal cavity, continued to have pain, and thus continued to enter that great revolving door of medicine otherwise known as the Emergency Department.

Me:  Okay, Patient X, I have your discharge papers here.  It looks like the diagnosis has remained the same.  What did the doctor recommend?

Patient X:  Well, he said that I need to have organ x removed.

Me: Oh, okay (and here’s where my friend Mr. Cerebral Aneurysm starts to stir from his brief but deep slumber, and subtle throbs begin just above my right ear).

Patient X:  But no one will take it out.  I mean, no one will do it unless I pay them. (Subtle throb becomes persistent hammering sound).  I went to see a surgeon about it and I waited for a few hours – but when the office manager looked through my chart and saw that I don’t have insurance or medicaid, they told me they couldn’t help me.  Can you believe that?

Me: Well, surgeons have to get paid, I suppose.  They do go to school for a long time. (reflective pause, where I try to put on my best frank-but-compassionate voice).  Well, have you applied for Medicaid?

Patient X:  I keep getting denied.

Me:  Hmm.  Have you considered getting a job?

Patient X:  Oh, I can’t work.  I’m disabled.

Me:  Oh, so you’re on disability?

Patient X:  No. I don’t qualify (persistent hammering is now just a long, low, mournful wail above which his words are barely audible).

Me:  But I thought you said you were disabled?  I’m sorry.  I’m confused.

Patient X:  I AM disabled.  I have diabetes and glaucoma. There’s no way I can work.

Me:  Diabetes and glaucoma?  I guess I need to review your med list – I didn’t see any diabetes or glaucoma meds on there.  What do you take?

Patient X:  Oh, I don’t take anything for them.  My diabetes is borderline and I control it with my diet.  And my glaucoma isn’t actually diagnosed.  I’m pretty sure I have it, though.  My mom has it, and I have to wear glasses.

And it is at this point that I want to jump up on the stretcher, grab this middle-aged, seemingly healthy person by the shoulders and shout, “WHAT THE HELL IS WRONG WITH YOU?  Stop pretending you have disabling medical problems, put your big boy/girl pants on, go out into the community and find a job.  Oh, and maybe while you’re out there, pick up some self-respect, too.  You are NOT disabled.  You know what “disabled” is?  “Disabled” is having to speaking by typing.  With a straw.  It is peeing and pooping into bags.  It is having to go to dialysis every other day to have every drop of your blood removed, cleansed of toxins, and then put back into you.  “Disabled” is needing to have your chest beaten five to six times a day to break up the masses of mucus collected there.  It is any number of debilitating conditions which severely limit the ability of the sufferer to enjoy or even endure this life, but it is most-assuredly NOT your adipose-induced diabetes and your fake Lens Crafter’s-diagnosed glaucoma!!!”

But I didn’t say any of this.  Not one word.  For one thing, I value my job.  I mean, I do have five children to feed.  And, at the rate we’ve been going, I’m sure at least one of them will require some nameless and random bowel surgery in the not-too-distant future, and I figure I might as well start saving now.  But, more significantly, my statement wouldn’t have made any difference.  You see, for this person, Patient X, the diagnosis of “Entitlement Syndrome” came too late.  The mindset was too entrenched.  When Arrogance and Ignorance marry, they produce a greedy, chubby child called Entitlement.  And this selfish brat doesn’t like to be told “no.”

Well, onward and upward.  I’m sure my fellow nurses who read the following list have their own shining examples of unchecked entitlement, but here, in no particular order, is my own personal Top Five Greatest Examples of Entitlement in the ER:

  1. Any patient who, when given a script, looks at you and says, “You can’t just give me the pills?  Well, how much do they cost?  (I don’t know.  Does this look like a CVS shirt?) How am I going to pay for them?  This is bullshit.  I’m gonna go smoke.”
  2. The patient who claimed he had no money, no friends, no family, no way of getting home and (loudly and with generous amounts of profanity) demanded a bus pass.  Then, as he was putting on his jeans, accidentally dropped his roll of twenty dollar bills.  Oops.
  3. The mother of a pregnant teen who decided it would be a good idea to drag along her three toddlers for a 10 PM ER visit.  The mother stated that she and the children were hungry and “hadn’t eaten all day.”  Five turkey sandwiches, milk, crackers, and pudding were provided…but the mother became irrate, demanding vouchers for the hospital cafeteria where she could obtain “real food, like chicken nuggets or something.”
  4. Pretty much anybody who asks that their turkey sandwich be “heated up.”  Really? Last time I checked, this isn’t an Arby’s.  I feel like I should start offering Horsey Sauce.  Oh, and family members who stand outside their rooms, empty coffee cup held high, and sort of jiggle it around in that condescending nonverbal “I need a refill” way.  Sorry, sweetie – but we’re fresh out of Sanka.
  5. Finally, my personal favorite: the patient with abdominal pain in the waiting room who demands to know why another patient (who happens to be having crushing sub-sternal chest pain and a terrible sense of impending doom and an EKG that looks like shit) got to go in before her.  She has, after all, been waiting over an hour and her pain is 10/10.  You know what?  A bed was just cleaned.  We can take you back right now.  Hmm?  What’s that?  Oh. I see.  Sure, you can have a few minutes to finish your bag of Corn Nuts.

*It know it appears, based on my last few entries, that I may have developed some bitterness/cynicism/negativity towards my job and/or the people I take care of.  I am going to address this further in another post, but I wanted to say here that I love my job.  I truly do.  I can honestly say that every time I clock in I consider it the fulfillment of a life-long dream.  And I care deeply about my patients.  I think about them on my off days.  I dream about them.  I feel sorry for them.  This blog is just my attempt to blow off steam, to vent frustrations.  As such, it presents a skewed view of me, my patients, and the relationship between the two.  So, if you haven’t liked the last few posts, stay tuned and give me some time.  I’m bound to dig up some positivity somewhere.


So, it’s been a few weeks since I’ve posted.  I’d like to say that it’s because I’ve been far too busy doing homemade crafts and spending quality time with the kiddos, or because I’ve been boning up (pun intended) on tantric sex moves in an attempt to strengthen my marriage, but, no.  I’ve just spent the last three weeks caught in a horrific web of crappy night shift schedules at the ER.  Three shifts on, then two days off.  Repeat x 3 and you have a very irritable nurse/mother/wife who has only one thing on her mind: survival.

When I come home from work in the mornings, there are three things I always do: eat, clean up, and read.  Okay, well, if I’m perfectly honest, I don’t always do the “clean up” thing.  Sometimes I just throw my scrubs in the hamper, pee, and crawl into bed.  Yes, I know this is gross and my nurse friends will probably lecture me about MRSA* under my fingernails and C-Diff* spores living on my shoes.  And so I am just gonna get it out of the way and boldly say to my fellow RNs: I know.  I know.  I KNOW.  But sometimes the night has been shitty enough that the few extra minutes I get to spend with my pillow and comforter are absolutely worth the risk of contaminating my entire house with a flesh-eating bacteria.

For the last few weeks I have been reading (okay, well, me and a few friends I like to call Herpes Zoster and Pertussis) the first of a three-part series on Lyndon Baines Johnson…and it is at precisely this point that your eyes glaze over with boredom.  Because, let’s face it, when most of us think of LBJ, one of a few images come to mind: the grainy, black-and-white picture of him taking the oath of office on Air Force One after JKF was assassinated; the horrific shot of him on the white house lawn, shirt uplifted, proudly showing the country his scar from some abdominal surgery during which, apparently, the surgeon attempted to removed his thyroid via his grundel* and then allowed his blind, hunchbacked palsy-stricken assistant to “stitch him up.”  Okay, I honestly have no idea what surgery he had, but the incision looks awful.  If you don’t believe me, look it up.  I dare you.  The third image – and this is the one that always struck me as a kid, and was part of why I started this series – is of him holding one of his dogs (I believe a Beagle of some sort) by the ears.  I remember staring at that picture and thinking, “What horrible, cruel person would hold a 25-pound dog by its ears???”  Well, the 36th President of these United States, that’s who.  And, judging by the look on his face, it’s great fun.

That picture sort of sums LBJ up.  He was incredibly selfish, manipulative, heedless of the feelings of others, and desperate for the attention that comes with having absolute power.  He was also terribly lonely, highly intelligent, and possibly the most insecure person to have issued orders from the Oval Office.  LBJ was very much a product of his environment.  LBJ was a survivor.

His family is from one of the harshest regions of Texas – the Hill Country – that, with it’s arid temps, fallow fields, and murderous Comanche Indians, has been chewing people up and spitting them out like empty peanut shells for nearly 200 years.  The individuals who initially settled the Hill Country did not have time for politics, philosophy, art, music, beauty, or really anything that required abstract thought.  Their entire being was focused – for every single second of every single day – upon simply surviving.  Turn your back for a second and you’ll lose your harvest to quixotic weather, leaving you to starve in the frigid winter.  Lower your guard, and, in an instant, your scalp is being removed by a tomahawk-wielding Comanche Indian…while you are still alive and screaming.  And it is from these early settlers that Johnson descended – settlers who were so utterly changed by their environment that life’s narrow focus was upon simply making it through the day with all their body parts intact and food for the next.  Living like that changes you, and your children, and your children’s children.  You become harsh and emotionless.  The sadnesses of life that would reduce a normal man to a quivering mass of tears barely produces a frown.  Life becomes about the big, big picture: am I going to live or die?  There is no time for pity, empathy, commiseration.  You must simply survive.

I’m realizing more and more that the ER is alot like the Hill Country.  It is an environment that utterly alters you, that forces you to have a hard exterior so that you are impervious to the barbs constantly flung at you by the dregs of humanity.  The other day I walked out of a room and said, to no one in particular: “I hate people.”  Immediately I was disappointed in myself.  Mostly because my mother would never allow me to say that I “hated” anybody, but also because I don’t really want to feel that way.  (Although in this case I sort of did want to feel that way because I had just been called a “bitch” by my patient.  Apparently I had not brought her some peanut butter and crackers in a timely manner, so I totally deserved it.  In retrospect I should just start carrying around a small cat-o-nine-tails so that I can begin whipping myself and save my patients the trouble of exerting themselves by verbally abusing me.  Oh, did I also happen to mention that this patient was brought in via ambulance because she said she was having chest pain?  And that said chest pain just happened to begin as she was being arrested for shop lifting?  But seriously, folks, I’m sure she’s a fine citizen.  She probably sells Bibles on the weekend or plants community gardens in her spare time.)  A nurse sitting nearby heard me and said, “Aw, our little ER nurse is growing up.  That’s so sweet.”  And we all chuckled.  And you know what?  It actually made me feel better.  Her statement made me realize that I’m not alone in this “Hill Country.”  I am surrounded by other people who have undergone the same transformation – the transformation required in order to survive and thrive.  Sure, our coping mechanisms may need some fine-tuning (but self-medicating with booze and wearing a hardened mask of cynicism can’t be all bad, right??) but they are what help us, well, help others.  They are what enable us to survive.  So I’m not going to hate myself and the person I’ve become. Yet.  But if you see me holding my pug up by the ears, you’ll know I’ve finally gone completely off the rails.


*MRSA: methicillin-resistant-staph-aureus.  Basically a staph infection that is resistant to any variety of antibiotic that is in the penicillin family.  It is most known for producing hideous, pus-filled abscesses on embarassing parts of the body (i.e., the grundel.  See below).  Most of our patients refer to these as “spider bites.”  Too bad it’s a spider that can easily be avoided by investing in a bottle of Dial soap and practicing what we in the medical field like to call “adequate personal hygiene.”

*C-Diff: clostridium difficile.  A nasty, spore-inhabiting bacteria that gives you stinky, runny poop.  For days.  This is not something one finds “out in the community” (for the most part) but is an infection more commonly experienced by long-term hospital patients, especially those on heavy doses of antibiotics.  How to avoid: um, don’t get sick and land in the hospital.  Also, don’t get old or ever require antibiotics.

*Grundel: Also known as “the Taint,” or that weird no-man’s land between your second hole and your anus (for women) and your scrotum and your anus (obviously for men).  Sorry to be so graphic.  I do work in an ER, afterall.



When I was a kid, we had a large fish tank on our kitchen bar counter.  This was one of those rectangular, shabby-looking tanks which can also double as a hamster cage, and was mostly populated by the five-cent goldfish that aspiring poor people buy.  I’m pretty sure my parents had it as an alternative form of entertainment, being that our television at the time only had six channels – and four of those were letters.  No joke.  Also, because I had a burst of industriousness at age 6 and decided to “wash” the back of the television, the only colors on the screen were red, white, and black.  Mr T from “The A-Team”?  He was black.  Hannibal was red, though.  Even the army green of M*A*S*H was red.  To make matters worse, my parents had removed the knob from the “on” button on the set, ostensibly in an effort to keep us from watching a red-colored Benny Hill running around with scantily clad crimson women while they went on their evening walk.  Too bad for them my teenage siblings discovered that needle-nosed pliers are a perfect tool for turning on broken sets, and we spent many blissful, stolen minutes watching the delightful Mr. Hill and other shows with corruptive potential, such as “The Jeffersons” or “WKRP In Cincinnati” (Gasp!).

But I digress.  In our fish tank was a black fish (I’m pretty sure he cost 10 cents.  My parents must have been feeling rich that day) named General Lee.  Don’t get excited – he wasn’t named after the tough muscle car of “Dukes Of Hazzard” fame.  Nope.  He was named after THE General Lee.  As in Robert E.  My dad is a history buff.  Specifically, the Civil War.  I know this sounds exotic and all, but if you had spent the bulk of your childhood vacations at Florida’s Civil War sites such as Olustee and Dade Battlefields, you wouldn’t be as impressed.  Trust me when I tell you that when you’ve seen one mosquito-infested pine forest, you’ve seen them all.  I mean, the park rangers did their level best, but the only emotion I ever felt when I looked at the displays of stuffed Florida wildlife (and what does this consist of, seriously?  A raccoon and a turtle?  Maybe an anorexic-looking panther?  Sigh) was a deep and abiding sadness that I wasn’t born somewhere more, well, real.

At any rate, this fish – General Lee – had an alarming (and entertaining) habit of occasionally leaping out of the tank and onto the counter.  I’m not sure how many times he pulled this Greg Louganis move, but at least enough times to guarantee him a spot in our family history.  I was reminded of this leaping black fish on Friday when we went kayaking – and while holding a flimsy bait bucket full of live shrimp on my lap, one of those little buggers decided to do a triple sow-cow into the air and land right on my crotch.  I would like to say that I had my “Mama-Is-Awesome” face on, that I carelessly flicked it away with a slightly-annoyed look on my face.  But, since we all know that liars go directly to Hell, I will admit without shame that I screamed.  I screamed in that prolonged, high-pitched bloody-murder shriek that only little girls can do.  I mean, seriously, what the hell???  I was already a bit freaked out by the contents of the bait bucket – to be frank, I sort of felt a little out of breath when I opened the lid for the first time and looked inside. There were 24 LIVE shrimp in there.  And they all had eyes…which were looking directly at me.  Plus, there was some weird ball-shaped grey matter inside their shell which The Dude assured me was a brain but I’m pretty sure was either a) shrimp poop, b) intestines, or c) a little beating shrimp heart (which makes me wonder – do shrimp have brains?  Or a heart?  Or the sudden, uncontrollable urge to LIVE, Damnit!?).  I was also mildly disturbed by the thought lurking in the back of my mind that, mmmm…these guys would look really good in some golden tempura batter with a side of sweet chili sauce.

So the wet shrimp is in my crotch, I am screaming like a psych patient who mated with a Banshee, the kids are staring in silent amazement at their mother’s cowardice, and The Dude is doubled over in hysterics while simultaneously attempting to steer the vehicle and hold the bait bucket that I am about to toss out the window.  It was, in short, not my finest hour.

I think, though, that I did manage to redeem myself as the evening wore on.  The “General Lee” shrimp ended up on the van’s floor mat until I gritted my teeth and forced myself to pick him up and return him to his salty brethren.  Then I took children #2 and #4 out in the kayak – way out, to where it gets kind of deep and creepy and you have the profound awareness that more life is circling below the surface than the human mind cares to contemplate – and enjoyed some quiet talk with each of them (I might add that I used all my best nautical terms as frequently as possible that night – boat channel, tide, prow, windward, poop deck.  I mostly just jumbled them up in random sentences.  The kids were suitably impressed).  Then I returned to shore, dragging my kayak through the muck like Bear Grylls on a good day, and helped the kids fish for seaweed.  I did have a brief conversation with myself at the bait bucket (this was witnessed by child #2.  Luckily he is just as weird as me, so he wasn’t phased in the slightest) about not letting fear rule my life, it’s just a shrimp after all and it doesn’t even have something with which to bite/sting/mangle me so get your ass together and bait the damn hook already!!!!!  And, I’m proud to say, I did it.  I reached into that bait bucket, pulled out a shrimp, and stuck it on my line.  Yes, it was the smallest, least offensive, and most dead-looking of the bunch.  And no, I didn’t catch anything.  Except maybe the slightest sliver of confidence that maybe, one day, I can be more of the Mama I always wanted to be.