Role Reprise

Which two male characters from David Lynch’s Twin Peaks shared the stage in a dance musical in 1961?

<--*hint.

Shoot!

There it is. The next 3 months of my life.
New clinical placement: urban immunization clinic.
And the beginning of flu season, to boot.

Phone Home

Entering the room of a hard of hearing patient, Nurse R. overheard the following phone conversation:
"What's the telephone number?
1 - what?
What number was that?
...Is it a number greater than 5 or less than 5?"

As told to me by a fellow nursing student (and awesome future nurse!) a few weeks back.

Lately You're Forgotten Here

"There was something so valuable about what happened when one became a mother. For me it was the most liberating thing that ever happened to me. . . . Liberating because the demands that children make are not the demands of a normal ‘other.’ The children’s demands on me were things that nobody ever asked me to do. To be a good manager. To have a sense of humor. To deliver something that somebody could use. And they were not interested in all the things that other people were interested in, like what I was wearing or if I were sensual. . . . Somehow all of the baggage that I had accumulated as a person about what was valuable just fell away. I could not only be me -– whatever that was -– but somebody actually needed me to be that.

. . . If you listen to your children, somehow you are able to free yourself from baggage and vanity and all sorts of things, and deliver a better self, one that you like. The person that was in me that I liked best was the one my children seemed to want." - Toni Morrison.

More from mothers because they are heroic.

His Mother Too

It's taken me a while to write about last week's patient. Sometimes, separating the sheer gravity of what it is to be human from the what we carry with us is nearly impossible. But this I have come to understand and to rationalize: there is a lot of tragedy in the world, people die needless and senseless deaths every day. There is horrible suffering. What I have yet to process is how people carry on.

This young man was dying. Thirty years old. I hadn't seen him out of bed all week, but as I was getting ready to head to the cafeteria for lunch, out he waltzed, all six foot five inches of him, one hundred and thirty pounds, asking if it was okay for him to take a walk. "Of course," I replied, "Of course."

At his side was his mother. She hadn't left his bedside since he was admitted to our until, ten days prior. This mother had in the past ten years lost her eldest son, her daughter-in-law and grandson. As she walked away, her youngest son towering over her, I imagined him well, healthy, strong arm around her shoulder in comfort rather than for balance from his weakness. I saw her with a son on either side. Two toddlers, a young mother. I tried hard to shake that image and busied myself with another patient until they had disappeared down the hall.

Eventually I made my way to the cafeteria, maybe twenty minutes had passed. Because the walk was tiring, because they had to stop and rest, I came right up behind the two. They both turned, smiled, greeted me -- looking confused at all of the commotion in the cafeteria, and overwhelmed by the world going on around them. As I watched her guide her son slowly back down another corridor, I whispered after her, "I am a mother too." Though she didn't hear me, she turned, smiled, nodded - and as her son slowly disappeared around the corner, I saw her hands grasp the tiny hands of her two sons, one on either side, swinging them gently - smiling.

Synchronicity

We spent the other night watching some of The Olympics with The Kid. Archery, table tennis, track and field, BMX racing, and a little synchronized swimming. "Boys don't do this sport, do they?" he asked. Then, thoughtfully, "I don't mean it as an insult...I think it's just because girls are more agreeable." ? ? ?

No Hugging.

A young patient was admitted to our floor today with hepatic dysfunction. A liver transplant recipient who has had some bouts of rejection, his medical team determined that he will need to be re-transplanted. When asked if he'd noticed anything in particular that may have caused his latest symptoms, he simply reported, "A couple of weeks ago my buddy hugged me real hard and ever since then I've had this terrible pain in my side."

Pretty much cinches for me why the whole hugging thing has got to go.

Share the Love

I failed to mention that the Bonnie-concert is actually a benefit for the Big Sur Volunteer Fire Brigade. Certainly a worthy cause. Also, the performance will be at the Henry Miller Library, a perfect venue, strangely spared from the fires. And finally, tickets are still available. That's right.

(In case you're interested, Ramblin' Jack Elliott headlines the previous night. The man can spin a yarn.... ramble on and on. You'll even get a tune here and there. And, if you're lucky, he'll share the stage with some beardo who will leave you just a little unnerved at night's end. It's all part of the folk-rock experience.)

**Will Oldham, Big Sur, Sept 28th**

I am so happy
I am almost in tears.
Unbelievable!

The Kid, RN

The Kid told me last night as we were about to read a bedtime story: "Mama, when I grow up I want to be a murse."

Now, how sweet is that?

Tom Thumb

Like Jan Svankmajer? Try The Secret Adventures of Tom Thumb (bolexbrothers, 1991). Stop-motion animation combined with pixilation, wherein claymation figures and actors share the same frame, makes for a pretty creepy film. Add that to the generally bleak narrative, and you've got yourself a darn good movie -- especially for someone who's supposed to be studying pharmacology and a nine-year-old who, under a different roof, would probably be watching Mary Poppins.
The Kid tells me he identifies with Jack, the seckel character who disables and robs people with hypodermic needles.

Flying Nurses

Thanks to one MEPN's persistence we made it onto the flying trapeze today; a first for me. Props to the *fantastic* guys who run the program: Scott, our main man, Jiggy Jives and Leo the magnificent. Leo was the catcher for those of us who made it that far (nope, not me) meaning he has both strength and impeccable timing. In fact, all of the trapeze folks seem to have an amazing eye for detail. Watching them work and listening to the feedback given to both novice and advanced fliers is itself worth a visit.

The MEPNs looked great. Hopefully you'll see more here, as all seemed motivated to make it back up the ladder before too long. Maybe I can talk everyone into putting together a flying nurse routine before the next show...

**Yes, the photo is of the circus center, and that is Scott on the lines, but the little person on the trapeze is The Kid. As flying nurse pictures become available, I'll post them here.

How the Other Half Lives

Discharging a patient, recently intubated due to the most severe asthma I have ever seen, I asked, "Have you called for transport."
"Yes," she answered.
"Will you be going home?"
"No."
"Where will you go?"
"I'm embarrassed to tell you."
"A boyfriend's place? Back to your sister's house?"
"No, I'm going to the shelter. But it's a real nice one. They don't even make you have to get out first thing in the morning, and they let me have my hospital bed and CPAP machine. But I don't have the five dollars for transport to pick me up, and the other five dollars to pick up my son."

Social services then gave her the ten dollars, I handed her about fifty prescriptions she won't be able to fill, and I watched her wheeled down the hall, realizing that I find no joy and no pride in caring for those who won't be cared for outside of the walls of the hospital. I want to scream at the shame of it.

Straight Up

Upon notification that he'd have to have a straight catheter, today's patient announced to his sister and elderly parents, "Sorry, you guys are gonna have to leave. I have two beautiful women in the room who want to play with my winkie."

Needless to say, due to what appeared to be either prostate issues or my novice hand, it wasn't a totally painless event, so when the family was ushered back into the room following the procedure, the poor guy just grimaced and winced at the onslaught of "winkie" quips.

Catheterization is less fun (for everyone) than it sounds.

Cultural Incompetence

So, I don't want to say too much about cultural competence as it's taught in health care classes here because I'm liable to get myself into trouble, but, man, there are times when I miss the reflexive thinking and dialogue of anthropologists and sociologists.

Talking tonight over dinner about the abysmal presentation we've received thus far, The Partner pulled out that bone that's been stuck in my craw all week by pointing out the most obviously overlooked problem in discussing race and ethnic relations today: cultural competence means being tolerant of intolerance. So true. And so, so rare.

FYI: Our program is in the School of Nursing. In the School of Nursing also dwells, somewhere in the dark recesses of the Laurel Heights campus, the department of Social and Behavioral Sciences chaired by perhaps one of the most forethinking race theorists in the country. He offers a very critical and astute Race, Class and Gender course for doctoral students (also offered this year: Soc 236 Race/Class Factors in Health Care Delivery). It should be made available to master's nursing students, without question.

Shape Note Singing

It's interesting to note that over the years I've developed a distinct preference for a very specific vocal style. Listen to Derroll Adams, certain numbers of the Harry Smith collection, and, you guessed it, Will Oldham, and a common sound emerges. And I don't think it's as simple as lumping them all into the Appalachian influence genre, as one is wont to do.

Recently, The Partner smartly picked up on the strange likeness to Sacred Harp or Shape Note singing which emerged from spirituals of the south. The initial idea was that vocals could be learned quickly and easily if notations were written as shapes and sung as syllables. "Syllables and notes of a shape note system are not tied to particular pitches (e.g. fa to C) rather, they depend on the key of the piece, so that the tonic note of the key always has the same syllable (fa) and for the other notes of the scale*."

What seemed to emerge was a very peculiar and particular way of "shaping" the sung notes. Listen closely. Even if there isn't time to comprehend it in its entirety, shape note singing is certainly worth a listen and is definitely an influence to be given ample attention.

Superkid Part II

The Kid just flew solo for the first time ever.
Seattle to Kalispell.
He's safely landed.
Now I can sleep.

Liar, Liar Pants on Fire

I have started to think that my friends and fellow nursing students don't really believe this whole circus shtick of mine. Frankly, since nursing school started I don't really believe it anymore either. Well, there's photographic evidence. (I know, I know -- I'm faceless. But there is HIPAA to contend with here, so enough already.)

I have been for a long time at your side

"I see them! Over there against the stormy sky. They are all there..." ~ Det sjunde inseglet




"By this time I'd had the experience of dying patients at the hospital and I was becoming interested in dying and death and resenting the way I'd been deprived of experience of death almost as I would have resented being deprived of love...By the beginning of the next academic year I switched my studies from embryology to death."
~ Daughter Buffalo

I, Antonius Block, play chess with Death.

Most close friends, loved ones, understand my fascination with death and dying. Well, maybe they don't understand, per se, but they are accepting of it. It's the Norse blood, some say.

After dedicating years to the folkloric study of death rituals and legends, cryonics, anthropology da morte, being deprived of death both by exclusion and by default* I have been reacquainted with it in the clinical setting. What an experience.

*In case you haven't noticed, sans the Veteran's Memorial in the Presidio, there are no cemeteries in San Francisco. I won't say what my mind conjures about the implication of that absence, but when in need, one can always visit Colma, California -- the city which has "inherited [our] hundreds of thousands of bodies." The story goes that the San Francisco board of supervisors "evicted" all of its cemeteries in 1912; by 1937, all the bodies were removed, making us San Francisco the city of the living. The city without the dead. Weird.

Sunlit

"Once one's said it, that one must act, one must ask oneself, shall I act within the cultural order I do not believe in but with which I am engaged by times of love or anyway ties of of fellow-feeling, or shall I act within the cosmic order I do believe in, at least in principle, an order indifferent to man? And then again, shall I act by standing indecisive between the two orders -- not striking out for the cosmic order because of my human commitment, not striking out for the cultural order because of my divine commitment? Which shall I renounce, my body -- of which ethical intellect is a function -- or my soul?"

Pedagogical Brilliance

In order to teach proper medication administration and instill confidence, many weeks must be dedicated to scaring the s**t out of nursing students. Brilliant.

The Disappearing Circus

You may have noticed a paucity of circus news here lately... the amazing Xiao Hong is in Beijing for the Olympics and I have abandoned Daniela and her single point trapeze for the sad excuse of clinical exhaustion. But, never fear, one super-circus-motivated nursing student has recruited me to join her for a morning of flying trapeze -- August 16th. Stay tuned.

Miriam & Emma flying at this year's Circus Center showcase. Image, again, courtesy of Seth.

Geri

“Geri is ideal for preparing students for working with real-life geriatric patients, since it features an elderly appearance with skin wrinkles and folds. No other manikin on the market is so realistic and true-to-life.”

Geri has a lot of parts to try to comprehend. And a few anatomical extras, if you see what I mean.

General Medicine

Tuberculosis, methicillin-resistant staphylococcus aureus, acute colitis, cystic fibrosis, cancer, renal failure, necrotizing fasciitis, acute lymphatic leukemia, pneumonia, paralysis secondary to lumbar laminectomy, abscessed abdominal incision with wound vac, inflammation of the terminal ileum secondary to Chron’s disease, herniated intestine causing malnutrition, muscular sclerosis with secondary decubitus ulceration of the bony prominences, dementia, liver failure, more TB, more cancer, more CF, staph infection secondary to hip replacement accompanied by cirrhosis, undiagnosed, undiagnosed, undiagnosed…welcome to general medicine, week 5!