Tommy

Mayor of the Block. That was Tommy. Though I think his jurisdiction may actually have extended a bit beyond the precise block borders. He knew everyone, and was almost eerily up on everything that happened throughout the neighborhood. He knew about houses bought and sold, of course, and nearby stores arriving and going out of business, but his specialty was really the gossip with a bit more meat on its bones.

Tommy lived right across the street from us, in the house where he grew up with his six brothers and sisters. We met him within a day or two of moving in. It was August, and Tommy was typically out of doors most of the day, tooling around in his adjustable-position motorized wheelchair. He greeted us heartily, in his thick local accent, and genially pumped us for information about who we were and where we came from and what we were doing here. He knew about trash pick-up and recycling, about the previous tenants of our apartment and the character of the landlord, about the history of the neighborhood housing stock. (He was strangely uninformative about where to order pizza from, though--maybe his budget didn't allow that kind of luxury?)

A week or so later, the moving company finally saw fit to deliver our furniture and boxes, and it was time to take 18-month-old Cassie to "school" for the very first time so that we could start unpacking. We asked Tommy for walking directions to the day care center. He delivered in characteristically voluble style, and included a lengthy aside about the corner five blocks away where we were to turn onto Birch Street. It seemed that a day or two previous, a police cruiser had somehow managed to crash through the hedges of the house on the corner. The homeowners were irate because they'd had an ongoing dispute with the town about their bushes blocking motorist visibility, and had finally relented and at substantial expense had torn up the old hedge, moving the line in and planting lower shrubs to be in compliance. And now there was an ugly, crushed and battered gap in the line of newly planted bushes, courtesy of Oldhill's finest. (Now, if this was the sort of thing one ended up knowing by asking for directions, imagine what one might have learned by asking for juicy gossip.)

Tommy was also a great giver-of-shit, particularly to the men of the neighborhood. He had a distinct salty, old-school chivalrous streak, and you can bet that Pete would hear about it later if Tommy ever saw me shoveling snow or lugging anything heavy by myself. Pete, for his part, loved to stand around and take the abuse, and then segue to sports talk and general shooting the breeze.

I never fully understood the ailment that put Tommy in his wheelchair. I know that it was something he was born with, and he had numerous operations on his spine throughout his life. He was able to walk as a boy, though, and it wasn't until he was 19 or so that he began his exclusively wheeled existence. He lived with his brother Jimmy, who provided a lot of his care, though he also had daily morning home health aide visits and periodical nursing visits as well. Jimmy is two years younger than Tommy, a plumber forced out of work by an injured arm. Shyer than Tommy, he has a pink slab of a face with little pale blue eyes, and a somehow jolly-yet-beleaguered manner.

It was from Jimmy that we learned the news. Pete came in from taking out the garbage and the recycling with an odd, frozen look on his face. "Is it really cold out?" I asked, confused by his expression, not able to read it. Cassie was sitting next to me on the couch, watching Peep. Pete looked at her--she was fully distracted--then mouthed to me, "Tommy died."

It wasn't actually that unusual to see a fire truck or an ambulance outside Tommy and Jimmy's house. Sometimes Tommy would have trouble with a transfer from toilet to wheelchair, or otherwise end up in a jam, and if Jimmy wasn't home, be forced to call for help. One night a couple weeks ago, though, as I was coming home from work, I saw them actually loading Tommy into an ambulance. I tried to catch his eye to wave, but I don't think he saw me. It seemed a little concerning--Tommy would occasionally end up in a hospital or rehab facility for a week or two, but usually those were planned admissions. I never did find out just what that was about (the neighborhood information network is more sluggish during the winter, for lack of people out on the sidewalk), but he apparently never made it home.

I've since heard from a neighbor up the street that when they took him in, they found something on CT scan in his head. Third-hand medical accounts being what they are, I'm not 100% clear, but it sounds like maybe he had a couple of clots, determined to be inaccessible surgically. Then, last Monday, his sister was visiting him in the hospital, and Tommy asked her for the clicker to change the TV channel. She turned to get it, and when she turned back, he was out. He never regained consciousness and died later that day. He was 50 years old.

Pete and I couldn't make the funeral on Friday, but we did go to the wake Thursday in the early evening. A grandfather clock in the entryway of the funeral home had a little brass plate affixed that read "Tempus Fugit." "Oh, shut up," I thought. Who thinks a memento mori is necessary in a funeral home, for godssake?

Tommy's body in the casket looked like a distant relative of the deceased, with a coat and tie and a sober expression. Fortunately, there were lots of photos displayed around where the man himself was much more in evidence--caught in the middle of laughing and joking and ragging on somebody, or beaming with nieces and nephews. Most of Tommy's siblings seemed a little awkward and uncomfortable, standing there in a kind of receiving line, but Jimmy was beyond that, fully present and wet-eyed in his grief. He seemed startled when I gave him a hug instead of just shaking hands, and I hope it wasn't too out there. A handshake just seemed so inadequate.

And so goodbye, Tommy. Spring won't be spring around here without your reemergence onto the street, your street.

Bad Attitude, QID

I truly do know that there are a zillion worse things, and I still have plenty of blessings to be counting, but I also can't help but notice that gestational diabetes sucks. S-uh-cks.

I am very fortunate not to have a thing about needles or other minor pokings of sharp objects into my flesh. (I'd kind of thought that was a characteristic of all nurses, but working on Wright 10, I learned I was wrong. Some of my co-workers dreaded their flu shot for weeks before managing to force themselves to get it.) Strangely, doing the four-times-a-day fingersticks to test my blood sugar has actually gotten harder rather than easier, though. I still don't hate it or obsess about it, but I'm noticing the distinct beginnings of a build-up of resentment of the nasty poker thingy--um, lancet device--and all related paraphernalia.

My blood sugars have mostly been in target range, which is good, but somehow I still seem to view the glucometer (a One-Touch Ultra, a thoroughly unobjectionable little navy blue instrument the approximate size and shape of a largish skipping stone) as my enemy. I test, as instructed, when I wake up in the morning and two hours after meals. It's really not that onerous a process, and Pete has pointed out that the technology is actually pretty cool. To me, though, the cunning little gizmo can do no right. I test my 2-hour post-prandial level, and the little screen flashes a very satisfactory 97, say. "Yeah, well," I snarl silently at it, "what did you expect when I never eat anything good?" But on those few occasions when I've overdone the carbs a bit, and the little gray screen, in perfect judgment-free deadpan, flashes 138, I think, "oh, shut the hell up, it was just soup with fucking potatoes and barley in it for godssake, leave me alone."

A diet of predominantly low-glycemic index foods makes eating frankly not so much fun. I get weary of trying to think up something okay to eat. I do eat meat when I'm pregnant, so that expands the options a bit, but I'm afraid I've reached the point where meat is just tedious. Pete has now twice very kindly made with his own two hands (and bottles of worcestershire and soy sauce) big batches of beef jerky in the oven. It's delicious, but there's only so far you can go on beef jerky. I spent eleven stupid dollars on a pound and a half of almonds to roast with tamari on them. They were good, but they're gone now. I'm sick of eggs, I'm sick of cheese. There are these low-carb tortillas that are good with peanut butter, though one really can't eat too much of that. And I still like vegetables but have a hard time preparing enough. I'm just too cranky and disgruntled. Well, and tired. I've been struggling with some pretty hard-core fatigue lately. There are times when I get winded and have to sit down just from walking around the house.

One major problem with eating not being much fun is that I seem not to eat enough. I was kind of appalled to discover, at my last midwife appointment, that at a time I'm supposed to be gaining in the neighborhood of a half to one pound per week, I'd actually lost 5 pounds since my visit two weeks previous. Meanwhile, some of the things you read about gestational diabetes actually talk about being careful not to get too much fat in your diet, to which I have been responding with impolite gestures in the direction of the page and dark mutterings about where the hell do you want me to get my calories, then?

Something I haven't noticed, to my surprise, is any particular difficulty in keeping myself from eating sugar, white flour, potatoes. I'll have two bites of Cassie's suppertime pasta, or a large spoonful of Pete's potato salad in the fridge, but I'm not really even tempted to take more. I guess it must just not feel worth it.

Despite that, though, I do seem to be feeling deprived at some level, because I've developed this ridiculously acute awareness of all mentions and instantiations of simpler carbohydrates. Watching an episode of Law & Order, I see Vincent D'Onofrio and Katherine Erbe sweep into a coffee shop to interview somebody about a dastardly crime, and through the whole scene, I can't hear what they're saying, because I can't take my eyes off the platters of really handsome pastry on the counter at the far left side of the screen. Pete, a Red Sox fan of very longstanding, mentions that the team has just signed Coco Crisp as a center fielder, and I immediately get vivid sense memories of all the sugar cereals I've ever loved. (Even the kind of mediocre ones, truthfully--I could so go for a big bowl of Golden Grahams...) Cassie and I go to the playground, and she's climbing on some curved bars she's taken to calling "the big pretzel," and despite the fact that said structure is cold, metal, and painted blue, I find myself off into a reverie about fresh, warm, yeasty homemade soft pretzels with the lovely gritty kosher salt clinging to the brushed-on egg coating.

All of which of course makes me think about the people who are faced with diabetes not for a wimpy two months but for their whole damned lives. Negotiating diet and blood sugar testing and exercise and medications, day in and day out, week in and week out, year in and year out. Almost makes me want to be a little less cranky and pissed off.

Almost.

Note

Just a quick note of gratitude to those who have written such warm, supportive (and very kind) comments on my last few posts. It's been tremendously comforting to me and really helped me pull myself out of the emotional muck.

I guess I tend to write mostly for the satisfaction and solace of sorting through what feels overwhelming and chaotic and making it into some kind of recognizable narrative. It makes me feel less at the mercy of events, a little more as if I have some actual agency in my own life.

The presence of a reading audience (however modest in size--about 15 a day, according to Site Meter, in case you were wondering) turns out to be a welcome bonus, though. How funny for a basically solitary activity to make a person feel so much less alone.

Thanks.

Failure's Mama Wears Army Boots

So I talked with Maureen the nurse manager again yesterday afternoon.

I had left a voicemail for her around midday, saying that I agreed that it was probably impossible for me to continue as a nurse on Wright 10 under the circumstances, and I wondered whether we could defer the question of whether I was resigning or being terminated, assuming that question was still open, for another day or two as I researched some questions related to unemployment. I actually had written out what I was going to say ahead of time so I wouldn't get flustered, and I was kind of relieved she didn't pick up her phone, so I could just go ahead and say it into the electronic void.

I then left a message for Tina, the HR person assigned to our unit. I wanted to find out what she might know about filing for unemployment benefits in my particular situation. She called me back an hour or two later, and I was surprised that she wanted to chat with me, and we ended up talking for 20 minutes. (If it were up to me, I'd probably still be using the phone I got in 1988--supposedly white but now badly yellowing, not cordless, with an actual bell for a ring--but married to Gadget Boy Pete as I am, I talk on a phone with countless useful features, including a screen display of exact time spent at the end of each call.) She didn't have a lot that was useful to say about the unemployment question, except to suggest that I could tell the UI people that I had resigned because I would be terminated if I didn't, which seemed kind of reasonable. She wanted to talk about my situation more broadly, though--maybe (one could cynically surmise) to determine my level of disgruntled-ex-employee-ness (lawsuit? worse?), but once I set a tone of kind of depressed reasonableness, she seemed truly to want to be helpful. She suggested the possibility of applying for a job at the large rehab hospital affiliated with OFH (the same place my dad was for two months in 2004 after his fall). She affirmed that it was way, way better to resign than to be terminated. She reminded me that Wright 10 was a very, very acute unit and in many ways an unusually challenging place to work. I mentioned that Maureen had offered her support in my finding a position in another clinical setting, and Tina enthusiastically urged me to take her up on it. On the practical side, she said that although the rules were that a person couldn't cash out earned vacation/sick time until after 6 months (and I've only been an OFH employee since October 11), they would be able to waive that requirement, and I could at least get my accumulated week-and-a-half's pay.

Minutes after I got off the phone with Tina, the phone rang again, and it was Maureen. She said she had gotten my message (judging by the timing, she had also spoken with Tina about our interaction), and she sounded relieved that I wasn't going to fight it. Her voice was friendly, and she sounded less manager-y and more sincere about her suggestion to get experience in another setting because this just wasn't quite the time for Wright 10. I said that I really did love the setting, the patients, and my fellow nurses on the unit, and ventured that maybe in 2 or 3 years, I might try again. She agreed warmly: "The door is always open." She volunteered that they would not contest unemployment, and I should go ahead and file. And she said that when I was done with maternity leave, I should give her a call about looking for something else.

I had been feeling very discouraged about ever working clinically again. Maybe a desk job was really my only viable option. And trying again in another setting seemed dismally likely to lead to increasing my run of involuntary job losses to 3 in a row. But I think that now, after those conversations and others (with my mom, with my friend Marina, with elswhere...), I'm starting to feel like, "so what?" This was always a grand experiment. For years I'd gone around saying that I could never be an inpatient staff nurse, I just wasn't cut out for it. I'd make a terrible hospital nurse, I'd say. And then I up and decided to do it anyway. And it turns out that it still hasn't been proven that I can't. So maybe I'm not quite up to it on an acute specialty unit, while pregnant, right out of the gate. But it remains to be determined whether I can do it at all. Removing fear of failure from the equation, there's really no reason not to try.

Which is a weird thing to think. How can you remove fear of failure from the equation? That's insane. But for a moment, I find myself believing that maybe I can. I'm probably not fundamentally an everything-happens-for-a-reason girl, but it does strike me as pragmatic and useful to look at most setbacks that way, if you can manage it.

So if the question is "what am I supposed to learn from this?", maybe that's the answer. Maybe this is an opportunity to look failure full in the face... and shrug. (Yeah, yeah, yeah, Failure, you and what army?) And then go about my business and keep trying to do what I want to do.

How crazy is that?

Rules

In the couple days since my almost-firing, I've spent a fair amount of time thinking about it all. The first hour or two after waking is generally devoted to obsessive rehashing of what Maureen said in her quasi-firing, acknowledging some of her points, furiously refuting others. Other hours are spent trying desperately to construct a narrative of my future in which everything all makes sense and comes out for the best (although I'm stymied by having no vision of a plausible scenario).

Pete gently suggests that maybe I need to just have my emotional reaction first, before I figure out what to do next. And that seems like pretty good advice, even if I'm not turning out to be that good at following it. Besides which, ideally I'd like the process to involve, say, entire bags of Cheetos and large hunks of chocolate cake by day, and bourbon on the rocks at night, but being pregnant and currently diabetic sort of puts the kibosh on all that. (I did rebelliously have three bites of potato salad a little while ago, though. Livin' large.)

In the meantime, some parts of life just go on, which is a little inconvenient when one would really like to curl up on the couch and be catatonic for a few days, but is probably ultimately a good thing. In particular, Cassie continues, naturally, to be very much herself.

Last night during her supper, I was eating a piece of American cheese for lack of anything better to put in my mouth. I guess I've given her a general explanation of gestational diabetes, though we haven't talked about it a whole lot. She's made the connections, though, apparently. She looked up at me and asked, "You can eat cheese because it doesn't raise your blood sugar?" Um, yeah, I said. Well, exactly, actually. At that moment, I put her dessert, a bowl with two small scoops of strawberry ice cream, on the counter so I could get out the requested sprinkles. Cassie looked at it and gleefully exclaimed, "Two little bald heads sticking up out of the bowl!" Minutes later, on the subject of nothing in particular, she was musing, "But the world has all different rules..." I agreed heartily that it certainly did. "...for safety," she concluded.

Yeah. Yeah, for safety.

Boot

Well. Even for a blog called Funny Pathetic, it's sort of starting to seem, um, implausible. Again.

I was kind of fired today. I'd call it about 92% fired. The nurse manager, Maureen, said something about my going home to "think about it" and calling her Monday with my "decision," but from everything else she said, I think that was essentially just cowardice on her part. My "decision" was to be whether I really think that Wright 10 is the best place for me right now. But she made it quite clear that my answer was supposed to be no.

Yesterday I had what seemed to me to be an incredibly busy and full (and somewhat discouraging) day, which included one of my 3 patients steadily dropping his O2 sats and ending up on BiPAP. I was at a running pace most of the day. I neglected a couple of things, including one patient's 5pm NPH insulin (he didn't require any sliding scale regular insulin, which I knew). At least as bad, I had left a Fentanyl patch at my crashing patient's bedside instead of returning it to the Omnicell. She said that when it was found, they had to fill out a "narcotics incident report." (This issue had never come up during my orientation, and I was entirely oblivious to it.) Maureen's stance was that this was pretty much the lightest assignment I could hope to get, and there was nothing more that the unit could do to support me. I just wasn't pulling it together. She said maybe I could continue patient care in a less acute setting, like maybe an inpatient hospice (the embarrassingly clear implication being I belonged somewhere where it wouldn't be so bad if I killed somebody, though I'm pretty sure she didn't mean her remark to be quite so pointed). And maybe later I would be up to a setting like Wright 10.

Some pro forma genuflections were made in the direction of my vaunted interpersonal skills. She also acknowledged that I'd been putting in "herculean effort," which in a way might be insulting, but the truth is, I have, and it actually feels better to me to have that acknowledged. I'm not a slacker. I'm just... lame. Fundamentally not cut out for the task-task-task-task rhythm of inpatient nursing work. I mean, I knew that. I've always known that. But I thought I could do it anyway. For some reason, I thought that I'd soldier through, and apply intellect to override my lack of other kinds of aptitudes, and it would be okay. I'd just make it work.

But it looks like not.

Maureen sent me home at 3, despite my putatively being on 7 to 7, saying she'd pay me for the remaining 4 hours. Um. Thanks.

At least now I know why my old preceptor Julie has been so distant and chilly the last two days I've seen her. I thought somehow she was mad at me for something. But it must be that Maureen was consulting with her about whether I could make the grade, and she knew what was up.

It's very strange to realize I might never go back to Wright 10. At all. Ever. The only things I have there are my stethoscope, which I left somewhere on the unit and couldn't find today, and a nice dark blue mug. (Maureen would feel she was getting off cheap if she paid 10 times the postage to mail them back to me rather than having me come back for them, I'd wager.) I wonder what they'll say about me, after I just disappear. For some reason, I want my fellow nurses to know the truth. It really bugs me to think of Maureen giving some evasive, bland, manager-y, fraudulent answer about my whereabouts. We agreed it was best, this just wasn't the time, blah blah blah. I don't know why I care, but I do.

The biggest question, of course, is what the hell do I do now? My mind kind of goes blank when I even try to think about it. There are the short- and medium-term financial questions, which are daunting enough. And there are the longer-term questions about what can I possibly do with my life? Losing two jobs in two years has not really been so great for my employment-related confidence. Is there actually anything I can do for more than a handful of months at a time? Can I find a place I won't get kicked out of? If so, what are the odds it's actually somewhere I'm willing to be?

And then, of course, I'll miss the patients. These patients. That's a loss I just don't know where to put right now. I might never find out whether Mohammed survived the weekend until his brother and wife got here from Saudi Arabia. Or how Owen (the 21-year-old who'd had seizures in-house, sent home to die--we thought it would be within days) made out on his Make-a-Wish-Foundation trip to go snowboarding in Colorado. Or whether Anna the sweet 28-year-old with the arm tattoos actually got her leukemia cured this time around. Or whatever finally happens with poor, long-suffering Mr. B, who was my patient for a long time, and who's been on our unit since mid-November with both graft-versus-host disease and cryptosporidium in his gut.

I alternate between tearful and blank. I don't feel tired, or at least not sleepy. I just feel like sitting and staring into space for about three weeks. Curled up in a ball would be good, too, except with the belly I've got on me right now, any attempt at fetal position would be both acutely uncomfortable and ultimately doomed to failure.

Man oh man. 33 weeks pregnant is really not a great time for this all to be happening. You know, the whole not-killing-us-making-us-stronger thing better fucking be true. It just better be.

Respects

Mr. S died last night. I had never gotten to know him and was just vaguely aware of his name being on the white board, mostly because there was a disagreement about how to pronounce it. It didn't seem right or fair to Mr. S that I should be the only one there when he died. It seemed like somebody who knew him should have been with him. But that wasn't how it went.

I picked Mr. S up at 3:00, from Claire. (3:00 is kind of a quasi-change-of-shift--a lot of nurses work the whole 7A-7P, but there's a bit of a shift in the staffing ratio, and so some go home at 3:00, and the remaining nurses take over their patients.) Claire is in her early twenties and just started on Wright 10 a couple of months before I did. She's petite, with dark hair and porcelain skin, and truly does look a bit like Audrey Hepburn--an effect accentuated by her habit of wearing black shirts and these scarf headbands that look vaguely 1958.

She said Mr. S was Comfort Measures Only, which interestingly rarely gets abbreviated by the nurses to CMO, and the words are even spoken in a slightly low tone. It seems to be about respect for the life that's ending, since if they're on our unit, rapidly approaching death would be the only reason they'd be so designated. (In most cases, patients for whom there is no further oncologic treatment available but still have a while are discharged to home on hospice. There are some patients who are "DNR/DNI" who come to us, but it's generally for some kind of palliative treatment, which might even include chemo or radiation, to make life better or more comfortable.)

Claire walked me through what you do for a patient who's Comfort Measures Only. You don't do vital signs (which feels really strange--otherwise everyone gets vitals done at least every 4 hours). You keep him clean, turn him every two hours, and make sure his IV morphine is sufficient--that he doesn't seem like he's having any pain or air hunger. Mr. S was unresponsive, and his urine output was down to something like 50cc per shift, indicating that his kidneys were shutting down. When I went in, though, he didn't seem to be suffering. Claire had turned his morphine up to 4 mg/hour because she thought he'd been struggling to breathe on 2 mg. During her shift, she'd also noticed that he felt really hot and so had taken his temperature (104.3) and given him a Tylenol suppository, figuring that fevers can make you uncomfortable, too. Mr. S had the raspy breathing that comes at the end (the "death rattle," to be 19th century about it), and didn't open his eyes or move in any way when spoken to. Someone had set his television to some kind of internal channel that was quietly playing church choral music and displaying a stained glass window.

Although I no longer have an actual preceptor for a shift, I do have a "resource nurse" assigned to me to go to in cases where I'm at a loss, and so Carol walked me through the tasks. She told me that mouth care was important (he was mouth-breathing, and his tongue was all dry and coated and nasty), and pointed out that his scrotum was incredibly edematous, and showed me how to arrange things so he wouldn't be uncomfortable. She called in two other nurses to help turn him and boost him up in bed (he was a big guy) and orchestrated changing the linen on the assumption that he'd sweated when his fever came down from the Tylenol.

At her suggestion, I changed his central line dressing, since it was due. I did his mouth care and hung another bag of normal saline. I asked whether we should give him more Tylenol. We measured his temperature at 105.1 axillary. Carol said sure, we might as well, and so she and a PCA turned him, and I got to give my first suppository since nursing school.

I went out for a moment to chart, and then it occurred to me to ask Carol--should I change the caps on his central line also? It seemed kind of silly, since that's mostly to prevent infection and make sure the lines stay patent, which in his case seemed like not much of a priority. Carol hesitated. Well, she said, technically, yes. It only takes a few minutes, and I miraculously wasn't much behind, and it just seemed--I don't know--respectful to give him all the care he had coming to him. I'd even already brought the supplies in to do it, so I decided to go ahead.

I went in, and for the first time that I'd seen, Mr. S opened his eyes. It almost seemed as though he were looking at me, so I talked to him. I asked him if he had any pain, and if having the TV on was okay. But the moment of awareness seemed to have passed, though his eyes remained open.

I went ahead and changed the first cap. It's a task I've done enough times that I know how, but not so many times that I can think about anything else while I'm doing it. I have to focus entirely on what the next step is. (Get a saline flush ready, open the cap package, screw the flush onto the cap while it's still partway in the package to maintain cleanliness if not sterility, prime the cap, take off the old cap, clean the line's end with an alcohol wipe...) That finished, saline and then heparin flushes instilled to keep the line patent, I looked up at Mr. S and realized that he wasn't breathing. What's more, it suddenly seemed to me that I hadn't heard him breathing for a couple of minutes. I'd been so absorbed in trying to change the cap properly that it hadn't risen to the surface of my consciousness.

I took the blue disposable stethoscope down from where it was hanging and listened to Mr. S's chest in several different spots. Not fully trusting myself, I then took his wrist to try to find a pulse. The thing is, I kind of knew just from looking at his face. This is only the second time I've ever been with someone when they died (the first time was years ago, before nursing school, when I was a hospice volunteer), but there really is something that happens to the face. I had known Joseph, the hospice client, reasonably well, but Mr. S I knew not at all. I had never even seen him before his final four hours. But in both cases, although fully unconscious, the dying person was palpably present in his face. Once dead, though, the face pretty much immediately became an inanimate thing. The person was just gone. I guess it's probably partly a circulation/color thing, and maybe something to do with the facial muscles losing tone? I don't know. But it's very distinct. And somehow, I find that reassuring. We as humans have an importance and a presence just being alive. There is an identifiable flame of human life, however small and dim. And its existence is proved by how clearly absent it is when it goes out.

I went out into the hall, and Jill, a young-ish but still relatively experienced nurse, was standing there charting. Um, I said, I think Mr. S just died. So Jill came in with me to check. She took one look at his face and said, "oh, yeah--looks like it's even been a little while." I said that no, it had to be pretty recent because he was moving and opening his eyes not too long before. She said we should go get a house officer (intern or resident) to pronounce him, and then she would walk me through what else needed to be done.

We found Seth the intern sitting at a computer in the nurse's station, just a few steps from the door of Mr. S's room. Jill told him Mr. S has died, and we need you to pronounce him. Seth said that he'd never done that before, but after a moment he got up and headed into the room. Jill and I took a quick detour to grab a shroud kit out of the clean utility room, and then stood in the anteroom (Mr. S was in an isolation room), and she explained it to me. She said we'd have to wait until we found out whether the girlfriend would be coming in to view the body. If not, she described to me how we would bind the hands and feet into position and get the body into the (white plastic) shroud. She showed me the tags we would stamp up with Mr. S's hospital card--one for the toe, one for the outside of the shroud, and one for the bag(s) of his belongings. She showed me the straps used to bind the chin shut, but she said they gave her the willies, and she never used them. The funeral home wires the jaw shut, anyway, she said.

In the next room, despite not having done it before, Seth seemed to know the drill. He shouted Mr. S's name, tried to rouse him, then grabbed a stethoscope and listened to the chest (I think the rule is a full minute). He checked the pupils, and maybe did another thing or two I didn't see. To the empty room, he announced, "Time of death, 7:06."

Since it was so late, Jill assured me that it truly would be okay for me to leave the rest to the night nurse coming on. We couldn't do anything until the intern had made all the necessary calls to the family, anyway. Then there was just the preparation of the body (cleaning it up, taking out the tubes, as well as binding and be-shrouding), followed by getting the morgue key from security, followed by taking the body to the morgue. So I charted what I needed to, signed out to the nurse getting my remaining patient (my third had been discharged a bit earlier), and finally, after establishing that Seth was still in the middle of making phone calls, checked in with Jen, the travel nurse who was supposed to be getting Mr. S. She said it was fine, and I could go put my daughter to bed.

I rode the elevator down alone. I think I was waiting to find out what I felt about the whole thing, since I'd been kind of carefully in efficient-professional mode while I was on the floor. But all there was was quiet, with maybe a distant pressure or weight that was almost sadness. And I got outside, and the rain had stopped, but the air was still unseasonably mild, and I walked to the subway.

Aw, Sugar Sugar

Well, I'm afraid it's official. Gestational diabetes. I had my 3-hour test yesterday and found out the results today at my midwife appointment. (For those to whom the numbers speak: Fasting - 91; 1-hour - 237 (yikes!); 2-hour - 223 (eesh); 3-hour - 137. By the way, the discrepancy between my screening 1-hour (165) and this one is accounted for by the fact that for the screening test, you only have to ingest 50 g of glucose in the nasty orange faux soda, but for the 3-hour you get 100 g. Eeaugh. Truly nasty.)

I suppose it's not the end of the world, but the whole thing does make me feel just awfully tired. I mean, really, I could absolutely have done without having to monitor my diet like a hawk and test my frigging blood sugar four times a day. Yes, that would have been just fine. It also gives a person more to worry about (bigger risks of shoulder distocia, hypercalcemia, newborn jaundice for the kid; greater risk of preeclampsia, among other things, for the mom). Plus it means I have a 50% lifetime risk of developing Type 2 diabetes now. Fuck fuck fuck. It makes me feel like crawling under the covers for a few weeks. Well, or throwing things. One or the other.

So I guess now I start with the blood sugar testing, and we figure out whether I'm going to need insulin or not. I'm fortunately not needle-phobic really at all, but taking insulin would still suck because if you're doing that, you're always at some risk for bad hypoglycemic episodes ("insulin reactions"). Especially if you, for instance, have a job where you don't get to eat on a regular schedule. Hypothetically.

Meanwhile, back at the midwife's office, the midwife I saw today was kind of concerned about my contracting, which continues to be a daily nuisance and sometimes quite distinctly uncomfortable. She did a fetal fibronectin test, which it seems can give a bit of an idea of the risk of delivering within the next two weeks. (My understanding is that a negative means you almost certainly won't, while a positive one is not necessarily a big hairy deal, but just isn't so reassuring.) I'll get the results tonight. She also did a quick internal exam, which I didn't even have to ask for, and said that as far as she could tell, the cervix was still long and closed. So, well, there's that to be thankful for.

I do seem to be developing quite a bit of affection for the small wiggly stranger lately, which is nice. There was a point where I worried it might not happen at all--or anyway not happen until the child was out of diapers or something. These days, I pat it and call it Sweetie and tell it good morning and chuckle fondly at its more extreme gymnastic maneuvers in there. I don't blame it for the miseries of late pregnancy. On the other hand, I am no longer on speaking terms with my irritable uterine wall and my slacker hip ligaments. They have absolutely exhausted my patience.

Oh, by the way, did I mention that Monday I finally had my first day without a preceptor at work? They gave me an almost insultingly light assignment, in addition to requiring me to check in a few times through the day with a designated senior nurse. But you know, it's all good. Moving forward. And it was a real blessed relief not to have anyone breathing down my neck.

We'll see what delights the rest of the week holds. A girl can hardly wait to find out.

Kinship

Cassie and I are looking through a catalog of scrubs. (I'm having a bout of pregnancy-related shortness of breath, and I'm trying to put off leaving the couch by distracting the one who wants me to go play with toys.) She scrutinizes a page of cartoon character scrub shirts--the Pink Panther, Peanuts, Hello Kitty. She spots a shirt with Tweety Bird on it.

"Look! Betty Boop's baby!"

Ritual Chant

Congregant's half of call-and response. Congregant's tone is to be heartily cheerful.

Thanks! Um, not until March 6.

Heh-heh. Yeah, just one. Yeah, we're sure.

We don't know. We're trying not to find out.

Second.

A girl, Cassie. She'll turn four around the time this one is due.

Yes, very excited.

Oh, yes, she'll be a big help.

Heh-heh. Yeah, really just one.

Okay. Thanks. You too.

Funny Pathetic Every Which Way

I might have gestational diabetes. The result of my 1-hour glucose tolerance test was high (165, for those to whom the number means something), and I have my 3-hour test next Tuesday. Now I'm trying to eat only low-glycemic-index foods. Yesterday I got discouraged and disgusted mid-afternoon and ate a big wad of fudge.

My orientation period at work has been lengthened, so despite the fact that this will be Week 14, I'm still not flying solo. It is not considered safe for me to do so. I find this reasonably mortifying. I don't know what to say when friendly fellow-nurses ask me "so, are you on your own now? what week is this for you?"

As of my last exam, the fetus had not turned head-down. The midwife described the position as sort of half-transverse, half-footling-breech. She said 30 weeks was earlier than she usually mentioned it, but since the kid is now considered officially Large for Gestational Age, maybe I should start doing exercises to try and turn it so it doesn't get stuck there, with its head tucked neatly under my liver.

My due date is March 6. I look as if my due date were at least two weeks ago.

I seem to be on an every-other-shift schedule for crying at work. I feel so discouraged. I can't tell whether I really suck or have hypercritical preceptors. Or both. At least I have good moments with the patients themselves; otherwise, I don't know what I'd do.

I can't decide whether or not to buy another pair of maternity scrub pants. The ones that actually fit and have a pocket (thank you very much--I guess I kind of, sort of understand why normal maternity pants never have pockets, though I think it's basically lame, but how can it be forgivable to make scrub pants without pockets?!) are made-to-order and therefore on the expensive side. And I really don't plan to be pregnant ever again. And I just have to get through two more months, if that. And I do have three pairs. But it's a pain to do laundry all the time. And the navy ones are too short and have no pocket. The funny pathetic part? I think about this issue continually. All the time. I have still not decided. It is still not resolved.

I've been contracting a lot. Sometimes it's pretty uncomfortable. Occasionally it comes with pelvic and rectal pressure, which I take as really Not Good. My midwives yell at me to drink more water. I try, I do. But I'm not thirsty. Two liters a day is minimum, they say. I try, I try. Sometimes I get to two liters. Almost never more. I could go into preterm labor, and there'd be only myself to blame.

Our apartment is a hell hole disaster area pit of chaos. At least I changed the cat box yesterday. Which of course I'm not supposed to do. Because of toxoplasmosis. But I wear rubber dish gloves and a bandana over my face. Because it's my cat. My cat who will never die, who will just live forever with her oozing sore, being disgusting and kvetchy. At least she killed 3 mice lately.

Um, yeah. We have mice. They come in from the basement. The landlord keeps saying he's going to fix that window.

I can't find my ATM card.

Intermittently for no good reason, I get all short of breath and miserable. Plus my hips hurt. I am so sick of third trimester I could scream.

I spent time today packing up Christmas presents to send out on Monday. Yes, I do know that today is January 7. It's not even within the 12 Days of Christmas anymore. The drummers drumming left yesterday, pipers piping hot on their heels, nearly drowning out the squeak-squeak of the cart carrying the partridge's pear tree as it bumped over potholes, trailing dejectedly behind.

Basically basically basically I am Not Good Enough in any direction I look, and even if you think oh, well, pregnant and starting as a hospital nurse, that's a lot to take on, even that is my fault because I decided to take it on. I held my head high and said pfft, I'll be okay. I thought I could do it. My mom on the phone yesterday said yes, well, but you are doing it. And I cried and cried.

Almost Nate

I dreamed that it was 3 months after I delivered, and Pete and I had brought our chubby and sweet (and in retrospect mysteriously olive-skinned) baby boy to day care for the first time. There were a bunch of other parents of new infants there, and we were going around the room introducing ourselves and our babies. The turn came around to us, and I started in, "I'm Rosie, and this is Pete, and this is our son..." before realizing we'd never gotten around to naming him. I was so embarrassed that I considered for a split second lying and just calling him "Nate," which was the first name that sprang to mind, but decided immediately that I couldn't get away with doing that. This unfortunately left me with no tenable alternative course, so I got flustered enough to wake up.