Hard lessons of the past 48 hours:

1. You have to double-check that an HIV test has been drawn. Not sure why, but this one doesn't happen in a timely fashion. Dr. Beck told me to "make sure it gets done" and I didn't heed her advice until it was too late.
2. When you're intubating, curve your stylet yourself. I had to cede an airway because of a crook in my stylet I wasn't expecting. I freaked. Not to worry folks, patient got intubated just fine - just not by me.
3. Go fast when you're getting an ABG. You can't poke gently. It's more of a stab. It hurts, but it doesn't work otherwise. (ABG kits are in respiratory cart in old asthma room...which is just one of about a zillion Grady secrets)
4. Do not order blood cultures in the ED unless the patient is admitted. Period. There is no systematic way for following them up and then they end up "floating out there."
5. Know ALL nurses' names caring for your patients. As hard as I try every shift to do this, I end up retaining about one per shift, which just isn't enough. Also find their hangouts - not obvious.
6. Do not get involved in ANY junk, even benign-appearing junk. Once a patient begins telling you about what their girlfriend's mother's cousin sells (this actually happened tonight), you're not going anywhere for a while unless you reroute that train fast.
7. Don't even get into a patient's detailed description of a tiny segmented brown insect and how many of them there are unless it happens to be a spider.
8. Quit at quitting time? This seems to be possible? I can't.
9. CHECK OFF YOUR BOXES.
10. If you think a patient is having a STEMI and you need a repeat EKG and the EKG tech rolls by and you say, "Oh, hi, um, I just ordered an EKG for the patient in room 7-" and he cuts you off and says, "Well you got 'bout 3 or 4 people in front of you then you'll get your EKG," you are completely within your rights to say, "I am very concerned this patient may be having a cardiac event and he needs his EKG to come before the others."
11. You can reduce a rectal prolapse by sprinkling sugar on it. Teaching point of the evening.

* Numbers 6 and 7 were the funniest things I heard all night and I wish I could just walk around and ask people their stories.

Why everything is beautiful

Because it doesn't matter
Whether you have this BMW SUV
Or that hatchback corolla from back when the body was boxy
Frost is on them both
Catching the streetlight
And sparkling.

Mr. Handsome changes his look and more

Before

After

Decatur nature: David Schwartz 1980. Four years we've lived here and this moss has just now grown.

Precious walkers on Post-Thanksgiving Friday. We call it Delicious Friday.

Precious readers and me looking REALLY excited at my own selfie/othersie

Nurse JJ and other visuals

KidV home sick under the care of Nurse JJ

Kid M "helping" KidV's team score

Halloween Potluck - amazing!

On vacation

A tough audience watching KidV's soccer game

Alley-oop: Katie Sobush, Namibia

My friend Katie dunked this one. Her post, "Reconciliation," articulates her experience of wealth disparity in Namibia. Read on:
http://ksobunamibia.wordpress.com/
XOXO

Packing for life

I get really overwhelmed by stuff. M and V's room is off the chain messy right now. V lost her field day shirt and asked me to help her find it. I did not find the field day shirt, but I did find about eleven clothing nests in areas I couldn't have predicted: two in her loft, one beside her night desk, two in craft drawers, one under the futon, one under her dresser, and none of her dresser clothes were where they should be. V= Illicit Storage Mouse.

M's stuff is more organized, but she hangs hers from hooks in layers. Her layering is so lavish that the light from the window is effectively blocked out. M = Fancy Bag Worm.

Occasionally I go through and organize everything from fore to aft, but now I can't. Plus, it's time for them to begin to do this stuff on their own.

I haven't mentioned my stuff. My problem is the thrift store. I have so many clothes - nice ones - that I don't have room for them all. My first world problems are so painful.

Anyway, I have a dream. I dream of packing for a two-week vacation and then boxing up / giving away everything that didn't make the cut, then unpacking to live life. Isn't that okay? The question is, how long would it take for the stuff to multiply again to reach the present level of stuff chaos. (I put my money on 8 months.)

On the other hand, I need this 100% cotton handkerchief, these manilla folders, a pair of dark brown lace-up suede pumps AND a pair of sand-colored oiled leather slip-on pumps. Of course all the camping gear is absolutely necessary. We need twice as many towels as there are people, at least one extra change of sheets per bed, as well as all the receipts we've collected from the previous seven years in case we get audited. Not to mention all the kids' artwork that captures a moment in time now forever lost.

It slips away, doesn't it? It all slips away, and that's the truth. I have taken care of a handful of patients who have been close to death lately. Some knew it, some didn't. All that's there at the end is a gown with snaps, a flannel blanket, and probably a chucks pad. On a bed. The people who surround you are the beginning and the end of what matters. Doesn't matter what they're wearing or if their shoes and belt match...or even coordinate. What matters is the skin of someone's hand touching the skin of your hand, a voice you hear when your eyes are closed, and permission to let go.

Can I hold this thought just tightly enough to get down to 4 pairs of dress pants and 4 skirts, total? We'll see.

Dog Joy

We have a puppy. He is 4 months old

And he is really, really cute. He also has an excellent sense of humor.

There was no ice cream in there, I promise. He achieved it while counter surfing, and this is how I found him: in full mow mow. Jay Jay is a dog's dog, right down to knowing how to dig like the world depends on it.

All the way to China and the end of the day:

We love Jay-Jay.

Some small things

Kids in KidM's class cleaning up after school lunch. I went to have lunch with KidM and KidV and their school, which was delightful. I was given a pack of crystal light powder by a generous friend of KidV's.  I tried to add to a carbonated La Croix drink - it fizzed over and spread across the table before I could stop it. The kids thought me hilarious.

KidV really likes toadstools!

The girls coming home after the bus. KidV has grown an inch in the past 6 weeks. We measured.

My friend, Jenni, wrote this book. Her husband made this stand-up photo op for her booth at the Decatur Book Festival. Yours truly took advantage of a unique opportunity for impropriety.

So this by itself is not funny. Richie appears to be taking something off the hood of the car. What he's taking off the hood is actually two sheep the girls made in Sunday School and set on top of the car because they were locked out. Right at this moment when Richie lifted the sheep, the girls started singing in unison a Seeger Family CD song we know: "Done found my lost sheep! Done found my lost sheep! All together now!"

Decatur Nature 3: 1000 or so new pets

We received 1000 or so new pets by mail:

This green bag contains about 1000 red wigglers that will compost our vegetable waste.

JJ helped us build their nest.

Then we added the worms to their bedding

Lovingly.

And shovingly

I'll add updates about how it's going. We are supposed to let them rest for three days with their new food and then check on them. So far we're really enjoying the process.

Urban nature 2: superhighway

It's not what you're thinking. There's a Super DUPER Highway here. I saw all the first three Urban Citizens along my jogging path yesterday:

Mr. Pius Pants turned his head just to see my iPhone

Puff Daddy Spiky Face is so fast he's blurry

Miss Inches - I also saw Mr. Inches but they look just alike anyway.

Katydid make my car go faster. And survived the ride.

Note at the look on her face: outraged indignation

Ahhhh...nature!
Look out tomorrow to meet our approximately 1000 new pets. And they're not fleas.

Urban nature

I am digging up a patch of earth. It is thick with wire grass. Wire grass invades. Wire grass will go from one tiny buried scrap of rootling to full-fledged Borg in the space of two weeks. It spreads underground with its burrowing clinging fingers of root. I delight in pulling it up, obsessively tracking each narrow leaf to its obstinate origin, often unearthing other tracks of wiry malice as I go. I do this, thinking of how green my greens will be. How our cat and the cats of our neighbors will somehow not prowl through the patch of earth when the seedlings are nigh to sprouting. How this time we will surely remember to water. How this time the thick white bodies of larvae that I grub with my digging paws will not eat the new shoots.

I am running through the woods. A rabbit crosses my path. That's it. A warm, brown, breathing rabbit quick as lightning and delightful in its automatic bounding stride. It is gone. I feel thrilled. I wonder how along the line of its evolution it learned the trick of noiseless speed. 

It's morning. The streetlights are on. Occasionally a lit window announces that an early bird is awake. Through an open window, I can see that someone's screen saver is set on "Stellate." It is the end of a night shift for me and I am jogging, feeling exhilarated to be so wide awake at this dim hour. I jog and jog, obeying my body to the extent that I run slowly, defying it by ignoring the left ankle that hurts with every shuffling step, the cramping gas in my large bowel, and the odd weariness of having slept two hours in the past 24. That's when I hear it: HOO. HOO. Ah, there you are friend; I know you. I have met your cousins, brothers and sisters - you are my friend. I stop jogging and walk. An acorn crunches under my foot. There's that barely-there low moan and then HOO. HOO. I strain to hear an answering "hooo," but it never comes. Just one more HOO and our paths diverge again. I thank my lucky stars that the owl is not picky about screen savers.

We take our bats for granted. They catch our attention and we say: Bat. Our family pauses, looks up at the dimming dusk, and watches the jagged path of the bat. KidV says: it's catching mosquitos. 

I get into my burning hot Subaru at midday. I start the engine and inhale the dusty automotive odor of an overhot car that will surely not pass emissions this year. I drive through a horrible hot intersection then roll to a stop outside Sunrise Senior Living. Something catches my eye - something inside the car. I glance down to follow the motion my brain barely perceived amid the visual din. It's a bright green wisp-thin new grasshopper, obviously young. Its eyes stand up on front of its squared-off head. No sooner can I take note of its unlikely presence than it has jumpflown out the window. I am going Right to the hospital. It goes straight to Town Square.

I am driving out of the hospital way before dawn. I cut beneath the unlit underpass where the freeway flies overhead unseen. Down here, live horizontal bodies lie wrapped in coverings along a wide sidewalk. The shapes of sleeping men and women form long lumps perpendicular to the road, evenly spaced, colorful in my headlights. I try to imagine this as bad - homelessness. Surely it is bad. But here under this bridge everyone seems to have their space. Sometimes I see someone sit up or roll over. Nobody's making trouble. As I pass out the other side again into the purview of the streetlights, I look up out of my open window at the blueblack sky beyond. I see the dark black shape of some smaller predatory nightbird against the sky. For an instant its underside is lit up - white and buff against the streetlight, darker wingtips. Then it is gone.

My insides are a cheeto.

I ate so many cheetos.
Tonight I bought: Prunes, tupperware, scrub brush, latex gloves, goldfish, goat cheese, and cheetos.
Guess which one I have been devouring for one whole hour until the inside of my mouth feels raw.

Mazie is in gymnastics.
Vivian is in Soccer.
We quit scouts - I think.

Our kitchen sink doesn't work. No water in the kitchen. Richie made dinner and washed dishes without water. I am in awe. I sing his praises with a raw cheetos mouth. I really do.

Richie insists JJ our 3 month old puppy is "mentally tired." He looks the part.

AC/DC says: It's a long way to the top if you wanna rock n roll. JJ and I are on our way.

hedonic adaptation and more

Our friend Katie (mom and Pete, you met her) told us about a documentary we should watch, Happy. Just before the onset of internship, Richie and I snuggled up to be educated on the science of happiness. Happy The Movie explained a concept that we sense on some level is true, but is nonetheless fun to measure and name:

HEDONIC ADAPTATION.

 Here's what I know: Cookies make me want more cookies. As soon as I am having ice cream every night, I am jonesing for ice cream 'round 8 pm regardless of my level of caloric satiety. On the other hand, when I keep myself from some small comfort, say, ice cream, it heightens my senses for ice cream. Ice cream can seem too sweet (okay maybe a 3 musketeers can seem too sweet) if I have been eating Real Food exclusively for a bit.



When I deny myself in other ways - of sleep, of relaxation, of time to regroup - I clamor to achieve my comfort set-point by filling in the gaps in my comfort level, usually with food. My metabolism mostly keeps up with it, but I'm not going to tell you that I've never had a day where 3/4 of my calories came from Cheetos and Breyer's. In that order.

The reason I'm writing in the first person, "I, I, I, I," is because, in the words of Gunaratana "I am the punk, I am the crazy." Today I ran a red light - completely by accident. I lingered too long at my left turn, crept forward too far to see the light turn red, and pressed the gas of green car just as opposing traffic began advancing toward me. Yesterday I got confused during signout, spoke out of turn, and then flung my folded paper across the room in some sort of spasm of massive uncoordination. The day before I was eating a very ripe plum that was dripping on my hand, so decided to clean up by stuffing the entire remaining half-plum into my mouth. The pit landed right up against my hard palate, so when I tried to initiate the overstuffed mouth chewing process, I inflicted a mighty scrape upon the roof of my mouth. And worst of all, tonight I yelled at my kids. Now, I was being yelled at, but that's no excuse. My actions were unhelpful.



So, I don't know. I think my weird off-kilterness is from stress. Not some intentional well-circumscribed time of aescetism, but long time without enough sleep or enough time to catch up or process. Long time with busted routines.

Problem: It's just the beginning of residency.

So, I guess I'm okay - theoretically - with being thrust way outside my comfort zone. That's good, right? It gets me off my personal brand of hedonic treadmill. I think I'm resisting the stressors the way I resisted labor out of fear. I'm making up for them by raising my level of hedonic coping. I'm going faster on the treadmill, in other words. More ice cream. More coffee. Just a little more comfort. I owe it to myself. Right? Isn't that right? Wait a minute. Isn't that sort of like what Jack said to the bartender in The Shining? Uh-oh.


At this point, I feel like I might not cope without some treats now and then. I recall now a conversation with a friend who is at her absolute wits' end. She lives M-F so she can play music and drink beer on Sat and Sun. All the doctor sense in me says stop drinking beer, which is probably NOT helping, but all the Spidey sense in me says not til you have Something Else to cling to.

Science recapitulates truth. Religion initially wooed me with truth, and has pushed truth farther than is comfortable in my life (though not far enough). Where does that leave me? Depending exclusively on the strength of the Lord my God. I am weak. I am the punk, I am the crazy. I can't do this alone. I lose purpose, I lose joy, I yell at my kids on my own. Here I am again on my knees. I am partly relieved that it will never stop.