On the Fence

Here is a well articulated and fair article about palliative/terminal sedation. This was a genuine and frightening surprise to me during my first clinical rotation and it continues to be one of those ethical dilemmas with which, inside, I can make no headway. It is probably the number one reason why I have shied away from hospice nursing which I originally suspected to be my calling. My hands and heart don't want to carry the weight. Conscience or cowardice? You decide.

Holy Holy

Happy Birthday, Bonnie.

Thank You.

Cryopreservation

What surprises can be found in the freezer of a home of a 10-year-old boy?

Riget

The Kingdom.
The best hospital-based television drama ever, ever, EVER.

If You Listen to Me...

"THE EDITORS of this publication asked me to compile a list. They asked that I not be too esoteric, and I will try. . . . However, as most people are coming to realize, we as individuals are finding greater connections to smaller things; things smaller in scope and more specific to our tangible and imagined communities. I find that the music that transports me often has a community of admirers bound together only by the love of that music. When I take a look at the dominant music news and discover that, essentially, Bruce Springsteen = Radiohead = Yeah Yeah Yeahs = Madonna = Arcade Fire = Bat for Lashes, it compels me to turn away from the lot."

Read on for recommendations.
However, I believe the message here to be... find your own.

Understanding the Dead

Without memory, there can be no revenge. Lest we forget. Remember me. To you from failing hands we throw. Cries of the thirsty ghosts.


Nothing is more difficult than to understand the dead, I've found; but nothing is more dangerous than to ignore them.

Margaret Atwood, The Blind Assassin

The Spanish Lesson

Applying to new graduate programs is always a challenge. What to say about my past work experience: how much is enough, how much is too much? Amongst all of the queries about clinical experience and life before nursing is the inevitable question: do you speak a second language? The honest answer -- though I had a few years of ASL and can communicate (whatever that means) and some French (not super useful here in California) -- is a resounding NO.

A fellow MEPN, wondering how the hell I got into the program being monolingual said, "You don't even speak a few words of Spanish? " NO. I can fake it, but why would I want to do that when we're talking about a someone's health?

Anyway, The Partner decided that I should have a working knowledge of Spanish to make patients feel like I am, at the very least, trying to communicate. Fair enough. Tonight he began compiling the "Dirty Dozen" words and phrases, as it were. Phrases such as, "How do you feel?", "Are you cold?", "Are you hungry?", "Do you want water?", "Where are you from?".

Listing off possible phrases as we drive through the Mission, from somewhere in the backseat The Kid chimes in: "Are you a virgin?"

Yeah, that one should come in handy. Thanks.

"Paid As Any Other Sickness"

That's right, institutional insurance plan for students, scholars, researchers and dependents. Yes, it is, in fact, a medical school. Read it and weep.

Thanksgiving Message, From Our House to Yours

So I Let Go Now...

In the spirit of Thanksgiving, I thought I should follow the lead of many wonderful fellow bloggers and give thanks.

In the face of this year which, to be honest, has not been one of my favorites, I am thankful for love.

I am not only thankful for the love that I have been given, but for the love that I have witnessed and for the love that has been taken away.

I am thankful for the serenity in my home and the always honest and thoughtful criticality, humor and humanity of those who share it.

I am thankful for all of the year's circumstances that have served to remind me of who I am and who I want to be.

I am thankful for losses perhaps more than I am thankful for accomplishments. Dispossession continues to remind me of the importance hope.

Above all else, hope is the one thing for which I give the deepest thanks.

Wicker Man

Wow, what a great movie. An ethnographic account of paganism and the movie from which Burning Man was born, apparently.

During one ritualistic scene full of phallic representation (and the like) by way of the Maypole, The Kid says, "Pole dancing!"


"Um....noooo....not exactly," I say.
"Oh... Polish dancing!"
Okay. Close enough.

Bongwater & Blood

That guy next door is up on his roof smoking out again.
Have I mentioned him before?
One of these days he's going to fall and break something.
Bongwater and blood everywhere.

M A K E

If I had an ounce of artistic ability, I would do this.
Some of my favorites include 1/06/09: Anti-fingerboarding signs; 1/31/09: Rifle wrapped in yarn; 1/05/09: A Scene from the fictitious horror film, "Honey Bear, Sweet Honey Bear"; 2/16/09: horse; and of course 1/13/09: Lyrics Poster / The Smiths.
*Image from Laser Bread via flickr

For My Heart's a Boat in Tow

The Kid is pretty amazing... evidenced in this rendering of the human heart which he placed amongst my study materials as an illustrative reference. Check it out.

Happy Birthday, Erin J.

Invisible Costume

The Kid was so pissed this Halloween when no one knew who his costume was supposed to represent. What? Hasn't every other ten-year-old wanted to dress up as Claude Rains in the 1933 version of The Invisible Man?

Every time someone asked, "And what are you supposed to be?"
He just stared ahead blankly as if to say, "What is wrong with you people?"

Just a Body

The Kid is ten. Driving home from school last night we had this conversation: "See that dot on their license plate?" he asks, pointing to the car in front of us, "it means that guy's a donor."
"A what? Organ donor? No, they don't put it on your license plate. Someone needing a kidney might run you off the road... they put the dot on your driver's license."


"Oh... Are you a donor?"
"Yes, of course."
"What part of your body?"
"The whole thing."
"Well, that's good. They might as well take it all and help someone else. You won't be needing any of it anymore."
"Does it bother you?"
With some disdain, "No, mom... It's just a body."

WE CARE Solar

If you want to take a position on child birth, consider this. If you want to talk about injustice and what it means to work for women, imagine. If you want to take on a women's rights issue, this is it:

"Maternal mortality worldwide accounts for more than half a million deaths a year...that's the same as one woman dying every minute of every day, and that's an outrage. That should never be happening."
Laura E. Stachel MD, MPH, Founder of WE CARE Solar.

WE CARE Solar "reduces maternal mortality in developing regions by providing health workers with reliable lighting, blood bank refrigeration and mobile communication using solar electricity."

This organization needs, and deserves, your support.

Dweebs and Assholes

Yesterday, after a very pleasant telephone conversation with my former PI (read:boss) who happens to be a successful MD, I related part of our conversation to The Partner.

"So, the Doc said to me, 'I don't like to hang out with other docs. They're all dweebs and assholes'."

After having sat through a very painful weekly Ob/Gyn Grand Rounds that very morning, lead by a particularly unbearable female doc, I remarked, "It's true. Even the women are assholes." The Partner smartly decided that this would be the title of my upcoming tome on feminism:

"Even the Women Are Assholes: The Unthinkable Thoughts of a Feminist."

Illustration credit, obviously, goes to the late, great Kurt Vonnegut.

Song to the Siren

Now from his breast into his eyes the ache of longing mounted, and he wept at last, his dear wife, clear and faithful, in his arms, longed for as the sun warmed earth is longed for by a swimmer spent in rough water where his ship went down under Poseidon's blows, gale winds and tons of sea. Few men can keep alive through a big surf to crawl, clotted with brine, on kindly beaches in joy, in joy, knowing the abyss behind: and so she too rejoiced, her gaze upon her husband, her white arms round him pressed as though forever.

- Homer, The Odyssey

I'll See You in My Dreams

♥ S.L.M. ♥
December 17, 1929 - September 8, 2009

Anthropo Logic

A couple of weeks ago I was on my way to lunch with my former project manager, celebrating one year of liberation from social science and passing of the state boards. A now-doctoral-degree-holding colleague stopped by to say hello and commented that it was fun to keep up on facebook where we had recently become virtual friends. "But your profile picture... you're wearing and overcoat and standing on the street corner. You look a little like..."
"A prostitute?" I interjected.
She quickly corrected me, noting that the appropriate term is "sex worker".

The bias-free insult: how anthro-politcal!

Sudden Birth

So, this is a great video I wanted to keep around for posterity's sake. Labor and delivery instruction via the Berkeley Police Department and Alta Bates Medical Center, circa 1966.
If you decide to watch, just remember: "Keep calm. Keep calm. Keep calm..."

You Can That Heaven Here...

Viaticum

The Kid says, "Do you know why there are so many ghosts these days? Because no one ever places obol on the eyes of the dead anymore, so Charon won't let them into the underworld.

But don't worry, Mom. When you die, I'll leave you with two hundred dollars."

NCLEX Hex

Many weeks have passed since I sat for the dreaded nursing boards, (bka: NCLEX which is the National Council Licensure Examination for Registered Nurses). What a nightmare. Let me say that standardized tests are not my bag. I could say a lot about these tools, as a social scientist. But I won't. Not because I did well on the SAT -- as matriculating community college student I never had to endure them -- but because I have been privileged enough to do well enough on the GRE to get into gradate school, twice. Because, let's face it, it's not about what you know, but how you've learned to test -- and that is about factors that have absolutely nothing to do with intelligence. Let me also point out that I passed with flying colors the qualifying examinations in my doctoral program... 72 hours of exams that did not even come close to the hell that is the NCLEX.

First of all, for anyone who has yet to experience this rite of passage, you will walk away thinking you've failed. Or at least normal people will think this... plenty of my colleagues walked away celebrating the 75 question blue screen moment, a kind of confidence that I will never know in this lifetime. I would have presumed failure. But not that this matters, as I sat through 265 questions and 5.5 hours, having left convinced that I did not answer a single question correctly. This means that never, not once, was I certain of an answer I was giving. That experience erodes confidence very quickly.

Because of laws governing the boards and the insanely detailed waiver I had to sign after being fingerprinted and photographed and finger printed again, I cannot give any hints about test content. But that is not really the useful or interesting part of the story. The interesting part is that this is a psychometric test, which creates a "passing standard" for all of those who sit for the boards. In simple terms this means that every person who takes the exam should get an equal percentage of questions correct and incorrect. As a person performs well, the questions become more difficult until a question is answered incorrectly. In that case, the next question will be slightly less difficult until the person is again answering correctly. Once a threshold is reached, wherein the test-taker has demonstrated that s/he is answering more difficult questions correctly than incorrectly, the the exam will end. This can be at 75 questions, or any arbitrary number in between, up to my 265. Likewise, if one is doing poorly, answering lower-level questions incorrectly more than 50% of the time, the exam will end. The clincher is that once the blue screen appears, you have to raise your hand, are escorted from the room, and then you have to wait up to two weeks for your results.

Many of my colleagues were able to log on to the BRN website and check to see if their names appeared in the permanent license verification system within the next two days, a kind of work-around for those waiting for results by mail. Personally, I took the test on a Friday, expected to see (or rather not see, given my commitment to failure) my name on the site on Tuesday. When my name didn't appear, I prepared for the studying process, again... but, on the advice of a friend, I called the BRN to be certain the documentation in my file was complete. Lo and behold, no transcripts had ever arrived from my institution. I dragged myself to the registrar, paid for transcripts (again) and waited.

One night before bed, about three weeks later, The Kid said, "Mom, I know you passed that test. You're a nurse now." With this bit of kismet, I woke the next morning and checked the BRN. There was my name. The card arrived the next day.

The moral of this long, long story is: never fear. It is a very difficult test for which to study, the questions are very hard to comprehend on first reading (and I am a native English speaker... bless all those who take it with English as a second language), it is difficult to gauge and it is not by any means an accurate judge of what kind of nurse you will be. I am not sure how well it even measures competence. It is, like many other standardized exams, a test of something determined to be a means to find a 'measurable' proficiency among candidates. This does not address ability nor knowledge. I suspect some of the best nurses are those that have to take it more than once. And anyone who has to sit through it more than once deserves a medal of honor.

Irony

The Kid said to me today:
"I hate irony....
when it's happening to me."

Supermother?

Did you read this? Someone should tell Peggy Orenstein that the way to empower a daughter is to empower oneself. The self-effacing feminist might try mythology or, say, history for a few good female heroes. Or how about manga? Baby Cart and the River Styx has a female character who not only can fight the land's most revered, ruthless and dreaded ronin, but she can also jump out of her clothes in a single bound! Eat your heart out, Peggy.

Her only weakness? Motherhood*. Go figure.

Image from Danny Choo via Boing Boing.
*not an Adrian Rich fan. Just making a point.

Sanctified

Hiking today I learned that Fairfax, California (north of the Golden Gate) is home to some slippery friends: rattlesnakes. Climbing up over Cascade Falls I came face to face with this young fella. The yellow bands indicate that he's a juvenile. Young one or not, he was huge and absolutely unmoved by me.

Snakes have a strange power; walking back I jumped at the slightest movement of every single blade of grass. It makes perfect sense why serpents hold such an important place in folklore.

The experience reminded me of this piece of footage I'd seen back in the late '90s. Snake handling at a Jolo, West Virginia Pentecostal Church. - Looking for a little faith? Try Mark 16 set to rockabilly accompanied by some downright fancy footwork.



Keep in mind this footage is relatively contemporary.

Single Point Sorrow

Having given up a lot to go to nursing school, I was full of joy in witnessing a one-time, single-point trapeze training partner preform at this year's annual showcase. According to her website, she also had a couple of gigs at Supperclub here in the city. Excellent.
*My sorrow is over having lost the circus somewhere in the midst of becoming a nurse -- and still not having yet become a nurse.
No circus + no nurse = sorrow.
Photo credit: Seth Golub

Whose Eye is on the Sparrow?

It rains, a gale rises, the big top collapses, fire breaks out, panic, people trample their neighbors to death as faced with the prospect of dying they make the decision, now, swiftly, who matters most. "I matter. I. I. I matter."

...I fly alone, apart from the flock, on long journeys through storm and clear skies to another summer. Hear me!

Towards Another Summer

Zatôichi

"Even with my eyes open wide, I can't see a thing."

Also, this movie has the best closing scene ever.

Frenz

Fleisher/Ollman Gallery's exhibit of works selected by Will Oldham.
It's called Frenz. With performance, too. Philadelphia, PA.

Lang & Cravat

Burt Lancaster is a new fave. And it's not just the face. Nor is it just the physique. Actually, this is my favorite part of his biography: Nick Cravat. This life-long friend of Lancaster was also his partner in a doubles acrobatic/trapeze routine in the mid 1930s and 1940s. He starred alongside Lancaster in nine films. In most he was mute. Cravat's daughter attributes this to his incredibly strong east-coast accent.

Cravat died in January and Lancaster in October of 1994.

A great aside is that the Circus Center has a fabulous doubles acrobatic act. Weirdly, our strong-man base bears a striking resemblance to Lancaster. Take a look for yourself.

Cardiac Infarct

So Sorry, My Sister

...but now I see
I had her before me always,
like a shield. I look at her wrinkles, her clenched
jaws, her frown-lines - I see they are
the dents on my shield, the blows that did not reach me.
She protected me, not as a mother
protects a child, with love, but as a
hostage protects the one who makes her
escape as I made my escape, with my sister's
body held in front of me.

From The Elder Sister, Sharon Olds
For you, in loving memory of
S.B.M. 09/08/1972 - 07/22/2009

Kozure Ōkami

From the manga of the same name.

Recap

Time for a recap of the past few months:

The winter ends, psych and peds rotations begin... and end, I join Facebook, The Kid graduates to the *fifth* grade, the MEPN year ends (hurrah! hurrah!), I meet new MEPNs with new neuroses, I leave Facebook, The Partner finally visits Montana, I receive my interim permit to practice nursing in the state of California, I register for the NCLEX and I come back to Circus Nurse, fresh and new. Okay. Now we're all squared away.

Per Sempre

Without impatience I'll dream.
I'll bend to the task
That can never end,
And little by little at the tips
Of reborn arms
Succoring hands will reopen,
The eyes reappeared
In their sockets will give light again
And suddenly in tact,
You'll have resurrected, your voice
Will be my guide again,
I'm seeing you again forever.

~Giuseppe Ungaretti

The Trick of Humanity

I spent the first day of pediatric clinicals in the intensive care unit. My patient was very young, under one year, born with congenital anomalies that included a heart defect, this one specifically, choledochal cysts and biliary atresia, meaning that she needed both open heart surgery and a liver transplant. She received both, preceded by a miriad of other surgies. When I cared for her, she was nine days post-op. I counted eight IV lines going into her body, exclusive of her pacer wires, NG tube, Jackson-Pratt drain, CPAP and ventilator.

I didn't mind the PICU so much as I expected. In fact, pediatrics seems like a place I would be excited to work, a great surprise to me. Maybe it's the timing. The most significant obstacle would be coming to terms with advanced technology out-sizing the patient. Following yesterday's rotation I felt like this was a huge moral dilemma, so I sought out reserach on the subject and found an interesting article that takes on the distress that PICU nurses face in the wake of modern technology that outpaces moral questions about life at any cost. The authors ask how medical and "life-saving technologies are outstripping our human abilities to comprehend and live with the consequences". Certainly a very worthy ethical question and definitley one that represents what I find the most difficult aspect of peds: what it means to be humane. To me, it looks like humanity tricking us again.

A Home in the World

"I can't consider any of that time as time away, because you don't want to spend half of your life being away or where you shouldn't be. I choose to think of all the time as being present. I'm always home."

I Have Not Seen You

...but slowly you are
forming above my head, white as
petals, white as milk, the dark
narrow stems of your
ankles and wrists,
until you are always with me,
a flowering branch suspended
over my life.
~ for E.J.T. 1973-2009 &
C.V.O. 1995-2009

from Absent One, by Sharon Olds

Movie: A New Euphemism For..?

So The Partner says, "Look at all of those trucks along the side of the road. Do you know what they're doing there?"
"No...." says The Kid.
"They're making a movie."
"What's a movie?"
"Um, a movie" I say, "have you ever seen one?"
"Oh," says The Kid, "I thought you meant something different by 'a movie'... like something truckers get together and do in the woods."

Like the End of Something Wonderful

Were you worried Billy'd crossed over to the other side? Me too. I guess we were wrong. Today's New York Times sports a long-deserved and up-front review of the new album which is weirdly flattering and, at the same time, disparaging.

"Mr. Oldham’s persona is a little bit of a lonesome romantic and a lot of a fool. He sounds generally optimistic, even when he’s singing about treachery...He never flatters himself. He’s not special. His love is effortful and can be one-sided. He’s easily satisfied. He can’t be counted on... Something is always lost in translation with him."

My favorite is the last line in reference to breadth and depth of talent in his accompanying musicians, "There’s a sense here of smart people being made to focus on a strange project."
It's refreshing to see he can still make the critics stutter.

Kandahar Treasure

"I heard a mother had lost her son due to a suicide bomber, and she got up to speak, and she said a beautiful thing. She said, “Whether it’s a Talib who’s being killed, an Afghan policeman who’s being killed, or an international army military person who is being killed, he leaves behind a mother, a sister or a daughter and/or a wife who mourns for him.”

So that saying was quite powerful in saying that women have this inclusive idea of security and owning peace. Stopping the killing for all... is reason enough for them to wage peace. You know, mothers feel the pain of human beings, and they’re calling for and they want this killing to stop." Rangina Hamidi. ~ Kandahar Treasure

The Feminist Conundrum

"So do you have men in other rooms studyin' about theirselves?"

"Not necessary. Men are already studied in every kind of study. Women have been forced to study great men ---"

"Maybe that's the problem... Ditch great people! Erase the bastards... from books and stuff. Just do folks - regular ones - the failures." Snowman (1999)

No Room at the Inn

I discharged my patient to a shelter yesterday with heparin induced thrombocytopenia recently “resolved” by argatroban (tx stopped 2 hours prior), but with no coumadin. I discharged him with a foley. I did so because I was told to do so by the doctor. I put up a totally meager fight and then sent him packing with Thursday’s copy of the New York Times that I’d brought from home, a bag with handles donated by the gift shop, a pair of flip flops and a sweat suit donated by social services, a walker donated by physical therapy and no clear idea of where he was going or how to care for himself. We just put him in a cab and sent him away.

I Am Goodbye

New bonnie video from Drag City

Featured bonnie article from The Wire

And a picture gallery