funny pathetic

Prime

2009-03-16T16:37:00.002-04:00

I'm 43 today. It's not really a classic milestone of a birthday, but I'm feeling kind of stock-takey nonetheless. Part of it is that I've had these questions milling around in my head in a disorderly way over the past couple months, like volunteers for a charity event that is late to get started. There they are, the grand and burning issues, wandering glumly among the folding chairs and the coffee urn set up inside my cranium, killing time and really starting to wonder whether they should have turned up in somebody else's head instead.

But I've taken the day off of work, and there is a little time before I have to go pick up the little beastie (the Monday system: Pete picks Cassie up at school around 4 and takes her to dance; I get to wait until 5:45 to pick up Emerson). And I told myself I would write a post. It's been months, after all.

Temperamentally, I'm toward the spacey-dreamy-stare-at-an-ant-for-90-minutes end of the spectrum, but now there's also this cross-current. The combination of being a mother of young children* and a nurse has forced me toward an emphasis on the brisk, the efficient--get the blood pressure, chart the breath sounds, wipe down the pulse oximeter, where's your backpack, do you want to wear your shoes or your boots, oh no is your diaper stinky?--that is fundamentally uncomfortable but patently necessary. And I think that being so naturally bad at efficiency, I've developed mental habits that are my attempt to compensate, to push myself with gritted teeth into a range of minimal adequacy in the quotidian tasks of my life.

And one of those mental habits is a continual assessment of the utility of a thing. Any thing. Any thing that takes time or space, at least. And as time has gone on, even the definition of utility has become a shrunken and wizened stub of its former self. "Does it contribute to my work or childrearing?" is about all that remains. In my push just to be Enough, all kinds of other goals and aims and conceptions of The Good have dried up in my mind. Friendship, kinship, art, thought, decent shoes. No room, no room. NOT USEFUL.

And really, how f**ked up is that? And yet how true. It's how I live. How can that be? I mean, hell, my stove top isn't even clean. The dining room table is full of junk. Again. I forget Emerson's mittens at school as often as not. How can I be so hapless that even given such restricted horizon, I still fall short?

I seem to remember reading that whatsisname, the poet, the daffodils guy--Wordsworth! (Yeah, I had to Google it.) had two female relatives running every detail of his household. He never lifted a finger in any way. His meals, his clothes, his everything. Just there. And off he could go, wand'ring lonely as a cloud that floats on high o'er vales and hills. And I wonder--if I really had that option--if I could choose right now to be a coddled poet waited on hand and foot-- lying on my couch in vacant or in pensive mood--would I want that? Would that suit me better?

And no, no I don't think it would. I think I'd be restive and miserable and aching to be useful. (And of course dying to be a mom.)

Ah, I don't know. It seems the Big Questions are going to have to keep milling around in there a while longer. I just don't know.

And, well, on that note, I have to get ready to go pick up the toddler.

*(I initially wrote "small children," but if you know Cassie and Emerson, you know that's not quite right.)

Charlie

2008-11-14T09:57:00.001-05:00

Emerson's favorite toys are cars and trucks, but he is also pretty fond of stuffed animals. He has only recently started naming them.

The black dog's name is Charlie. The white cat's name is... Charlie. The black and white cat's name? Miss Charlie.

Sleep Used to Be My Friend

2008-11-13T09:47:00.003-05:00

My brain was busy last night while I was sleeping. Around 3am, I was transferred from my interesting job in an academic medical department to a data entry position, and subsequently fired a day later for my "cavalier attitude." Then around 5:30 or 6, I discovered a long, jagged scratch down the inside of my whole right leg--inflamed, with ugly yellow-white open areas especially down near my heel. It turned out to be a MRSA infection.

Okay, thanks, Morpheus. I'll take it from here. I've rarely been so pleased to be awake.

Bug

2008-10-17T17:08:00.002-04:00

The evening of my last post, the moral punishment for my griping about my kids was visited upon me in the form of a virus bearing body aches and temperatures in the 101s. I spent a few days on the couch being useless, stewing in the same stinky pajamas for more than 48 hours of it.

This morning I had no fever, and I was supposed to teach, so I decided to venture in to work for a few hours, a little pasty and bedraggled but functional. Cassie, meanwhile, can't seem to figure out whether she's about to throw up or not, and we kept her home today. (The vomiting never materialized, and I'm wondering whether we might have been playing it a bit cautious. One of the interns was telling me that her mother's rule was, "I don't care if I just watched you throw up--if you don't have a fever, you're going to school.")

Pete was at home with Cassie in the morning, and so I dropped Emerson off at day care on my way in to my office. As I was walking out the preschool door, I ran into one of Emerson's classmates being carried in by her daddy. She recognized me immediately. "Thass Em'son's Dad, too!" she exclaimed.

Yeah. Thanks, kid.

Motherhood, Joys of

2008-10-12T21:51:00.002-04:00

Tomorrow is Columbus Day (a holiday of almost unmitigated bogusness, if you ask me, but of course nobody did). This means one long day of non-stop parenting. (It's sort of a trade, because Cassie had Friday off too, for some Teachers' Professional Day whatsihoosie, and Pete did the honors that day because I had to teach. But as you might notice if you look closely, that was just the 6-year-old, which is significantly different from the 2-year-old and the 6-year-old. And plus? She spent a big chunk of the day with the 8-year-old who lives next door doing some fabulous activity supervised by the 8-year-old's dad. I don't even remember what that activity was, because all I keep hearing from Cassie is how he got them slushees afterwards, which was apparently just about the high point of Cassie's life up till now. Anyway, I am hereby putting in for extra parent points. Thank you.)

Now, you know by now that I am very into the progeny of me. I think that Cassie and Emerson totally rock, and sometimes I just look at them and think how ridiculously lucky I am. They are just exactly what I wanted for Christmas, and motherhood is all I wanted it to be. Okay. So that.

But a whole day--a whole day. Oof.

Emerson! EMERSON!! NO THROWING DIRT! Cassie, would you please... yes, that's really nice, sweetheart, but what I'm trying to... Emerson! NOT IN THE STREET! Cassie, if you walk ahead, I think that Emerson will want to catch up with... Carry you? Okay, Em, for a little while, I can carry you... THANK YOU CASSIE, THAT'S GREAT. YOU CAN STOP NOW! Yes, sweetie, we are going home. We're going home now. Yes, you can play with your trucks at home. That's a good idea. Sure, the yellow one. Absolutely. No, Cassie, I think that this is less than a mile. I'm sorry that you're exhausted. Maybe you'll want a nap this afternoon? Cassie, I can't hear you when you talk while you're walking away from me. No, sweetie, I didn't really think that you wanted a nap. It was kind of a joke.

I mean, it's kind of great. It is. But also? It totally fries every nerve ending I have. By the end of a day, my mouth is a little line, and I can't seem to focus my eyes, and no amount of Prozac seems that it could ever be enough. I am so, so, so not built to be a full-time mom. It saps my strength, it saps my sanity, it saps my will to live.

There are people who can do it. There are people who like doing it. And I wish them godspeed, bless their green-blooded little alien hearts. But what I have to say? Thank all that is good and wholesome for my own gainful employment. If I were a housewife in the 50s, I would definitely have ended up either addicted to mother's-little-helpers or hospitalized in a facility with "Lawn" in the name after being found curled in a fetal position in the linen closet whimpering.

Casey-Fink

2008-10-03T18:51:00.006-04:00

So you know how I'm now the teacher of a nice little group of 6 new graduate nurse interns? I have them in "class" 2 or 3 days a week, and they're out seeing patients with their very own preceptor the rest of the time. We're (=I'm) going to be tracking a variety of outcome measures for the program, and today I gave them the Casey-Fink Graduate Nurse Experience survey. (Yeah, I know, whatever--but it's quite well validated!) And it turned out that they're a half-dozen happy little clams, those new grads of mine. I'm so pleased. They love their preceptors and feel all supported and glad they chose to go into home care and stuff. And it so happened that we had our class session on "Interpersonal Issues in the Workplace" today, and when I mentioned in part of my preamble the old saw that "nurses eat their young," (gruesome saying, isn't it?), most of them said they had experienced that kind of thing (i.e., hostility from experienced nurses) as nursing students during their clinical experiences in the hospital, but not one of them has experienced a single speck of it at Our Home Care Agency.

So my heart is full, and my face is all beam-y. I'm just so, so pleased.

You know, quite near the root of the reason I went into nursing originally, there is the experience that I had of a decade of Chronic Fatigue Syndrome during my early 20s-early 30s. The few times that I had an interaction with a really human, empathetic health professional during that time were tremendously important to me. Alongside those experiences were the less positive ones (though thankfully nobody ever went so far as to tell me it was all in my head, or some of the other things that many people with CFS have heard). The combination of the two made me want to do it right, to give the kind of health care that I wanted to get. It somehow made it feel like it could make up the difference, that in doing for others, I'd be doing for myself. It doesn't make a whole lot of rational sense, I admit, but for some reason the emotional calculus is very solid in my head.

And that's similar to how I feel about this program. I want to make it right for a little group of new nurses--to have their entry into the profession be welcoming, well supported, with reasonable and realistic expectations and a thoughtful, stepwise initiation to the necessary skills and knowledge. Nursing is both important and (if you do it right) incredibly complex. It seems worth, to me, the very best introduction you can provide. So how cool is it that I get to make that happen? That it's actually working?

Um, okay, I'll tell you. It's cool. It's very, very cool.

Funny Historical

2008-09-30T12:04:00.003-04:00

It’s an odd moment, isn’t it? I heard on the radio in the car yesterday afternoon, on my way to pick Cassie up and shuttle her to her dance lesson, that the House voted down the economic bailout. All while the experts (such as they are) talked fiscal apocalypse. And the yellow leaves out the window on the right fluttered down, dislodged by a gust of late September wind. And the red pickup entered the traffic circle despite its not really being his turn. And when I got to the school, the after school program kids were out on the playground, and Cassie’s braids were flopping as she bounced a yellow ball with two hands.

It reminds me a little of one of those dreams I sometimes have in which the end of the world has somehow been announced, but for the moment all is eerie, sunny normalcy.

What does it even mean? How real is it? It’s not that I disbelieve what we hear, but it’s all so abstract. Pete points out that as a professor and a nurse, we’re both in fairly recession-proof lines of work, and I do think that’s probably contributing to my weird, muffled feeling as I listen to the news.

During Cassie’s dance lesson, I sat in the basement of the local arts facility while our sprightly little girls in black tights and leotards apparently conducted some kind of thundering elephants-vs.-water buffalo battle overhead. I watched the toddler little brothers and sisters running around the posts and thumping on the soda machine. The mothers sat mostly in twos and threes, talking about kids, and about somebody’s sister who was going out with a real loser.

I remember reading the Diary of Anne Frank in fifth grade (doesn’t that seem kind of young to read the Diary? were fifth graders older in the 70s than they are now?), and being terribly impressed with the momentousness of it all. I sporadically wrote little diary entries for the next few years--aimless noodlings, mostly--hoping that something Historical would happen at any moment. Then I could write about the Historical Times I was living in, and it would be all very important, somehow.

So are we here? Is it really 1929? (I picture us in a couple years, all getting our hair marcelled and making our own sauerkraut and playing cards around the radio.) Are we well on our way to Living in Interesting Times?

It Has Come to My Attention

2008-09-29T11:43:00.001-04:00

Toddlers, like xerox machines, can sense when you are in a hurry.

But xerox machines don't lie down on the wet sidewalk for a little rest.

Status Post Procreation

2008-09-28T19:18:00.004-04:00

Prozac or no Prozac (and at the moment? 40mg of Prozac daily--not the maximum dose, but more than I used to take), the battle against a sometimes breathtaking sense of futility continues. This is something that makes parenthood of small children useful. Because if you can't think of a single reason that anything is worth doing, that any purpose is worth the effort you put toward it, your nihilistic thumb-sucking is routinely interrupted, over and over again, by an urgent need to accomplish tasks that are unquestionably worth doing. Put more milk in the sippy cup. Change the stinky diaper. Say, "who's there?" and then, "interrupting cow who?" Help with the fish puzzle AGAIN. Explain that just because Roy says that he has bombs disguised as regular objects in his backpack doesn't mean that he actually does, and that I do, too, know this for a fact, not least because Roy is seven years old. Read Peepo AGAIN. Explain that yes, Miss Piggy is a pig, and Kermit is a frog, but nobody knows what Gonzo is. Fix the silver dumptruck with the brown back. (AGAIN.) Wash the mysterious sticky stuff out of the end of the right braid.

It's pretty therapeutic. It goes beyond keeping things in neutral territory, and tips the whole life balance determinedly into the positive zone. I read recently that people with children are not happier than people without children, and in fact slightly to the contrary. But I have not a shadow of a doubt that Rosie Bonner with Cassie and Emerson is a much happier person than Rosie Bonner without.

Bland It All to Heck

2008-09-20T21:33:00.004-04:00

My boss praised me yesterday. It was brief. I think maybe it went, "You did a wonderful job with that research." And it was actually mostly just the preface to a request for me to do another similar task for her. But praise doesn't come from her too often in any context, so I have to admit I did take note.

It's an odd relationship. By my lights, she's a strange person, and it might also be surmised that by her lights, I am a strange person. That ought to be true, at any rate. There are some signs, however, that rather than seeing me as a weirdo (which she should), she sees me as not only her protegee, but as an immature, imperfect and unformed version of herself. She will help me along, teach me the ropes, and the glorious culmination will be in a decade or so, when I find that I have finally achieved a state of being just like her.

Most of me does know that this will not happen. But there are times she seems so certain, I feel the chill of it all the same.

JoAnn (let's call her JoAnn, shall we?) is our head of corporate compliance (a VP-level position within our agency), and she seems to take pride in being as bland and corporate as she can be. She's quite smart, smarter than most nurses you'll meet. She got her nursing degree, as I recall, at a secondary campus of a state school in some Appalachian state. She has an MBA, too, with a concentration in computer science. She married for the first time late in life, and I think her husband is a tradesman of some kind. She has no children.

For a person of her intelligence and position, JoAnn seems strangely impressed by people even one or two rungs above her in the hierarchy. Our home care agency is a small subset of a giant and prestigious regional health system, so there are unfortunately many rungs above JoAnn. Because of her role, she ends up going to endless meetings with these people, so I would think that by now she would have figured out, I don't know, that their shit stinks too. But it often seems not to have ever occurred to her.

Writing it out like this, it seems clearer than it does at the office. It makes me think of the first exchange between Hannibal Lecter and Clarice Starling in the movie, where he psychoanalyzes her based on her good bag, cheap shoes, and suppressed accent. JoAnn is smart enough to have gone to fancy schools, but she didn't, presumably because of her background, though I know no details. She seems to be simultaneously disdainful of and intimidated by academics. And she puts appropriateness of behavior above most other concerns.

"I've noticed that you're very chatty on the phone with the preceptors and with patients, and that's great..." (have you noticed that "...and that's great" has a similar valence to "not that there's anything wrong with that"? Is that a recent thing? I've only recently caught on to it.) "...but you have to remember that you're sitting in an executive area now, and so you really have to keep your phone conversations professional."

Eeugh. It absolutely gives me the heebie-jeebies.

She counsels me with a kind of benevolent condescension on how I have to use my hands less when I speak. ("You're very enthusiastic... and that's great...") How I have to be careful not to speak too quickly, and at all times resist the urge to be self-deprecating. How I have to use professional language in my e-mails. Then there was the whole dumb fiasco about the pregnant job candidate (see, silly me, I blithely assumed that because it was illegal and unethical to not hire somebody because she was pregnant, that there was no question of our doing it... It all came out right in the end, fortunately).

What's hard is that I can't easily get her advice out of my head. I can't just naturally be who I am without either somehow in my mind either defying her or caving in to her. I don't know what she's right about and what she's wrong about. I don't know what's style, what's truly unacceptable, and what's just her hideous, bland, ass-covering corporate-speak paranoia. It's kind of awful. I can't help but second-guess. Am I really unpolished and out-of-control, as she implies? Is my reflex inclusion of what I see as humanizing remarks and small bits of humor in e-mails and phone conversations actually just cutesy, embarrassing, inappropriate? That's not what I see reflected back in the people I interact with, but all of a sudden I'm not 100% sure any more.

I'm enjoying the work that I'm doing, and I could certainly see myself doing it for a few years. But I do wonder how my psyche will hold up under nearly daily interaction with JoAnn. I'm hanging in for now, and really nobody knows how things might change. She might get reassigned or promoted or who knows what. Even just changing the cubicle configuration, which is actually scheduled, could change the dynamic (I won't be smack dab outside her office door any longer).

In the meanwhile, maybe I'll try hard to see it as a learning opportunity. I just don't want to be learning the wrong things.

Cassie and Emerson, a Reintroduction

2008-09-16T21:08:00.003-04:00

Cassie is now 6 1/2 and in first grade. Her hair is still light blonde, and she wears it in two braids, just as I did when I was her age. She has Pete's small, dark, slightly Asiatic eyes, though, so she's working a kind of exotic, vaguely Finnish look somehow. And she's still very tall for her age. If you dressed her in something extreme or funky, she could easily be a model in one of those contexts that require a quirky, offbeat aesthetic. (She's frankly a little pasty and sullen for anything fresh-scrubbed and girl-next-door like a Sears catalog or anything. Comme des garcons or Jil Sander would be much more appropriate.)

She loves colors (especially blue and green), making art, looking at art, Pippi Longstocking, Martha Speaks and Word Girl, summer sausage, juice pops, making her little brother laugh, making her little brother whine and cry, going to school, and making potions. She was a big, big Hillary fan (despite having parents who were kind of on the fence), but has now thrown her full support behind Barack Obama. She also thinks that Malia and Sasha are lucky because their dad is famous.

Cassie has asserted a belief in God for a couple years now, although in the last week, she did let slip that she thinks she might be believing a tiny bit less lately. The poor thing has precious little to go on for models of religious faith, although I am at least willing to fill her in about the basics of "what you believe if you're a Christian." Pete just spits nails when the subject comes up.

Cassie is wasting no time in preparing herself for her teenage years, alternating talking incessantly with periods of huffy, surly quasi-silence. She has even precociously mastered the art of flouncing into the bathroom and slamming the door when she's put out about something. I think she's kind of a prodigy.

She lobbied for a while for a dog (starting approximately one day after overcoming her longterm deathly fear of them). One day in the car on the way to swimming lessons, though, I spelled out in great detail just what kind of work having a dog was, and made it crystal clear that Daddy and Mama would not be doing the work because Daddy and Mama did not want a dog. She pondered briefly, and announced she thought she would like to get a bird.

She would also like to know why they put designs on toilet paper, since it's just going to get poop on it.

Meanwhile, Emerson has been honing his already considerable cuteness to a needle-fine point of adorability. It's kind of staggering. This is a creature who could have been specifically genetically engineered for winsomeness. He's plenty good-looking (another brown-eyed blond, but less flaxen and more sandy, and also less exotic and more all-American boy), but it's really
his personality that does it. Affectionate, ingenuous, enthusiastic, warm, humorous. And of course, since he's 2 1/2, there are the myriad charming mispronunciations ("doodles" for "noodles," "Ama" for "Grandma," "mekkah mitser" for "cement mixer") and random perfectly enunciated exclamations a propos of nothing in particular ("Go Red Sox!"). Other parents watch him play on the playground. His day care teacher assured me the other day with great feeling that it was fine that I was almost ten minutes late picking him up--"we've been having fun!"

So my thought now is, at some point in the future Pete and I are just going to have to sit him down and tell him very seriously and firmly: NO SEX WITH INTERNS IN THE OVAL OFFICE.

Rosie Boldly Goes

2008-09-15T20:48:00.003-04:00

So last I mentioned my work, I was gearing up to become a full-time home care nurse. Then I disappeared from my blog for 2 years. The two are not entirely coincidental. Case managing as a nurse in home care was fulfilling and satisfying in some ways; intellectually challenging, interpersonally rewarding. It also ate my life.

I was working consistently between 50 and 60 hours a week, spending all stray moments (during Cassie's swimming lesson, while Emerson napped, and every night from children's bedtime to the moment when I was so sleepy I couldn't keep my head up) with my electronic charting (or occasionally on the phone with the medical supply company, or e-mailing physicians, or making up next week's patient schedule, or something). I know that there are nurses who manage to do the job in less time than that--maybe not in quite so little as 40 hours a week, but nearly. But it's a mystery to me how. Even on good weeks, easy weeks, I didn't come close.

When you hardly have two spare minutes to rub together, it takes a little while to get yourself mobilized to make change. Just maintaining the status quo takes more than you've got, really. But I did finally manage to start a job hunt, after a fashion. I also went in and talked with some of the managers and directors in my own agency. I brought a resume that showed all the nice administrative things I can do. I wrote out some hypothetical job descriptions for positions that could be created... for me. I said that I love home care, and I think that this agency really does give good patient care in addition to good customer service, and I would love to stay, but this job is killing me. Financially I have to work full-time. Is there anything we can work out?

It took them a couple weeks to get back to me, but ultimately the news is good. My role has been evolving over the last year, but at the moment I am doing no patient care. I am full-time coordinator and clinical instructor for a new educational program for nurses who just graduated from nursing school but want to do home care. (Usually new nurses don't do home care because you have to have quite a bit of independence to make the whole alone-in-a-house-with-a-sick-person thing work out well.)

It frankly feels a little--I don't know. Odd. Eerie. Friggin' weird. Clinical instructor? Somehow that implies... well, expertise. Doesn't it? And not grammatical expertise. Not vegetarian chili-making expertise. Not jollying-a-two-year-old-into-getting-his-diaper-changed-without-screeching expertise. No. Clinical expertise. It's truly slightly insane. And yet here I go, doing it. I consulted people and read a bunch of stuff, and then what did I do? I made a curriculum. Unmitigated chutzpah. And then what did I do? I made a two-day training for the experienced nurses who are acting as year-long preceptors. Me training them--that's rich. But we all go along acting as if it's perfectly normal and the accepted order of things.

And so then, a couple weeks ago, the new nurses started. Six of 'em. And now I give lectures, and make them do all kinds of hands-on exercises, and give them assignments. They have to write a clinical journal on the patients they see with their preceptor. They have to do readings I assign and answer little discussion questions. Their very first day, I made them draw my blood.

It's weirdly easy. I mistrust it, it's so easy. Because in my recent experience, real work goes against my grain. I have to be continually fighting my true nature to do my job. Doing patient care requires such an iron grasp on the details, dozens and hundreds of details, that it takes all the teeth-gritting concentration I can give it. Plus there's continually battling my sense of ignorance and inadequacy (in the context of clinical nursing, anyway).

But teaching is so strangely effortless that I have repeated unprovoked, irrational little bursts of dread--the reason being, I guess, that if work feels this easy, it is a lead pipe cinch that I am forgetting something very, very important. And so I have that lead stomach sensation of being just about to remember... remember that I never sent in my passport renewal and I have to catch a plane tomorrow; remember that my driver's license is expired just when I see flashing lights in my rearview; remember that I was supposed to pick up Emerson today and it's already 5:50; remember that Mr. S needed his potassium drawn two days ago. Something. But I never do remember the thing, the horrible thing that is going to make me feel like a total loser miserable worthless screw-up. I just feel like I'm about to remember it. Over and over again. (Ever so pleasant. Somewhat reminiscent of repeatedly hallucinating the smell of vomit.)

But you know, besides the dread bursts, it's actually going pretty well. I think. I don't know. Everybody seems engaged and happy, and they're learning stuff. And other people think we're doing a good job. And I'm getting to make up these clever little ways of teaching things and reinforcing good clinical habits. It truly is total fun. The actual stuff of it.

Plus I'm only working maybe 45 (or, well, maybe 48) hours a week. Sweet deal.

But Thanks for Asking

2008-09-10T20:20:00.002-04:00

Somehow the subject of Ethel Merman came up. Cassie was quizzical, and Pete and I filled her in on the meaning of the cultural reference (complete with some pretty pathetic brassy-esque renditions of "There's No Business Like Show Business"). Pause for reflection. New question: "Is Ethel Merman a bad word to say if you're a Christian?"

Can it be true?

2008-09-07T16:21:00.002-04:00

Well, it has taken pretty much all of the discretionary time that I had to figure out how to get back in to make another post. But I have great ambition to be back in the saddle, bloggish-wise. I suppose this miserable little post will be my placeholder and my pledge. See you again soon!

Workday Morning

2006-10-18T07:19:00.000-04:00

soft heavy warm
still sleeping
sweet breathing
let me lie another hour
with
this (my) baby boy

Fashion Advice

2006-09-17T17:01:00.000-04:00

Oh my god. Can it actually be that I have a few minutes to sit at my computer? I'm a bit dazed and dizzy with the freedom, and run the risk of squandering it.

Let me, then, get right to the point. Here is a list of what you should wear (according to Cassie, naturally) to listen to rock-and-roll music:

sunglasses
necktie
cowboy shirt
cowboy boots
long corduroy pants
cowboy hat

Gender in the Bonner-Wasko Household

2006-07-22T09:49:00.000-04:00

Cassie mused about an issue she was trying to understand: "I think that womans have short hair and ladies have long hair."

Although she's started to hang out a lot more with two female friends, Cassie's best friend of long-standing at school is Paul. Paul is a peanut of a little boy, a week older than Cassie but only up to her shoulder (she's also semi-gargantuan for her age). They both report that he "protects" her on the playground. He loves to play fireman and pretend that he's shooting things. And both Cassie and Paul's favorite color is pink, although there is the important distinction that Cassie favors "medium pink," while Paul likes pale pink.

In the bath, Cassie draped two washcloths over her lap and said "I'm an embarrassed girl. I have a penis."

Meanwhile, Emerson loves to watch sports on television. It's of necessity mostly baseball (Pete's obsession), but a girls' basketball game on last night's Monk had him similarly entranced.

Squeamish Need Not Apply

2006-07-13T21:44:00.000-04:00

If nothing else, I should definitely learn wound care in this job. My last week has included:

- Almost more leg and foot ulcers (pressure sores and stasis ulcers) than I can count. They look, and apparently are, incredibly painful. One particularly Eeyore-esque patient really was strenuously fishing for us to tell her that yes, her pain was worse than anyone else's. We pretended not to notice the heavy hints, but agreed in the elevator as we were leaving that although it's impossible to compare any person's pain to any other's, we could assure her that she won the prize for amount of complaining. By the way, the secret to a tolerable dressing change seems to be a dab of lidocaine gel on a square of gauze, stuck to the wound for about 10 minutes before you start to irrigate it or otherwise mess with it.

- A very mild-mannered and unexceptional-looking silver-haired gentleman with a 4 x 4 square of gauze taped to his face under the left side of his glasses. When the gauze is removed, it reveals a dramatically gaping socket that almost looks like a Halloween-ish exaggeration. The job of the nurse is to take a flashlight and look carefully at the tissue to make sure there's no infection, then clean it out by squirting in sterile saline, whereupon the mild-mannered gentleman sloshes his head side to side several times to get it in all the nooks and crannies, and then expels the fluid out of his nose and into a basin.

- A nice older lady with an incredibly doting and supportive family and a nasty-ass surgical belly wound that's having some healing issues. Wounds that don't heal sometimes get "tunneling" or "undermining," which is where the tissue under the skin kind of gets eroded, and you can get pretty extensive cave-like areas beyond the edges of the original wound. Her daughter Nancy is particularly loving, and also notably earthy and irreverent. When she first saw the extent of her mother's wound, she told her, "jeez, Mom, you could keep your cell phone in there!"

The Stars Say Don't Do It

2006-07-06T16:28:00.000-04:00

Today was my second day on the job (other than a couple days two weeks ago in a little darkened conference room receiving orientation from a nice lady and her LCD projector) as a visiting nurse. I spent it shadowing another nurse as he made visits, many of them actually in the same territory I'll be working.

When I got home, I happened to notice my daily horoscope while I was reading the comics. The first sentence:

"Travel is probably a bad idea today, as is getting involved in other people's problems."

Oh dear. What ever would Nancy Reagan say?

Gainful Employment

2006-07-04T16:27:00.000-04:00

Tomorrow I start work. I'm going to be a visiting nurse, working (as it turns out) for the same home care agency where I temped for a couple months (answering phones, entering data...) while I was doing my RN refresher course. Starting work again is good in a lot of ways, not least of which is the return of regular paychecks. I find myself feeling kind of dazed and vague and maybe apprehensive, though.

This is, other than temping, the first time in ten years that I'm truthfully just taking a job in order to have a job. I never aspired to be a visiting nurse, and it seems almost haphazard for me to have ended up here. In my last few jobs, I've had the feeling of working toward something. My career goals are still not terrifically well defined, but my intent has been ultimately to work on making hospital care better, safer, and more humane. Being a ward nurse, at least I was in a setting that might contribute to my future credibility as well as my understanding of systems issues within hospitals. Of course, being a visiting nurse might provide me with insights I would never have had otherwise, and could lead me to a productive career path I can't yet envision. But in the ways I've been thinking about my future until now, time spent as a visiting nurse seems not to get me anywhere, seems to keep me treading water.

Even less rationally, there is a sense that it's not... I don't know... home care is not where the action is. There's no drama or glamour. I recognize that it's ridiculous, but somehow it affords a person even less of an illusion that one is saving the world. The practical, the down-to-earth, the nitty-gritty daily needs are what the whole thing is about. It's probably at least as useful, truth be told, as hospital nursing, and there are aspects of the job that require skills that hospital nurses don't have to have. It isn't easy work. But still, one doesn't feel fancy doing it.

Still and all, it is good to be going back to work. Before getting the position, my maternity leave (/unemployment) felt uncomfortably open-ended. And a job hunt is not really what one is in the mood for postpartum. Well, postpartum plus having been sort-of fired from one's last two jobs. One feels, to be perfectly honest, like an unkempt, flabby-bellied, urine-leaking, bleary-eyed, damaged-goods screw-up. Not a position of strength, exactly.

I had been dreaming almost nightly that it was finals week, or that I had papers I hadn't even started and would be lucky to get done if I pulled an all-nighter. By day, I was going round and round in my head about whether I should try to get another clinical job right away (i.e., get back on the horse) or look for something in administration or research (i.e., try to get my confidence back first). For two hours, I'd be sure that one was the right way to go, and then the wind in my head would shift, and I'd be certain that I should do the other.

Then one rainy Tuesday morning in May, I came downstairs to the living room with Emerson in my arms and discovered that Pete had left me a little pile of mail on the corner of the couch, and on top was a card advertising a job fair at my old temp work site (let's call it Big Network Home Care). I picked it up, looked at it, and the date was that very day. For a moment I thought "oh, well." But then I realized that there really was no reason I couldn't go. Well, no reason besides having to figure out something to wear that would be roughly presentable and appropriate for a grown-up to wear out in public. This was challenging but not an insurmountable hurdle, and I thought it might actually be kind of nice to start my job hunt with something low-pressure like this. You know, a job I didn't necessarily really want, with people I already knew. It would just get me out in the world, talking to other adults in a professional capacity, and nothing big lost if I came off like a total space case--it would still be good practice, and get me thinking about what I should be saying or not saying. I could work up a patter of sorts and figure out what worked and what didn't.

I put Emerson in his car seat and my resume in a folder, and off I went in the downpour. When I got to the office building, there were signs for the job fair pointing to a makeshift set-up in an empty office area on the first floor, not up to the BNHC offices on the second floor. There were a couple of balloons, a table with some platters of snacks, and another table of various brochures and cards. I helped myself to some juice and a couple of pineapple wedges and walked around jiggling Emerson in the Baby Bjorn on my front while the HR lady finished talking to the one other potential applicant there.

When it was my turn, I was honest about my recent history, including a fairly detailed description of my leaving Other Famous Hospital at the behest of the nurse manager. I said I wasn't at all sure that I would be ready for home care, but I just figured I'd come by and chat anyway. The HR person agreed that my not having two years of med-surg experience (more like four months) could be a problem, but I might as well talk with a nursing supervisor. She then called upstairs, and I heard her mention the name Tammy. Oh, right, Tammy. I remembered her, actually, but I never would have been able to summon her name if I hadn't overheard it. So then in a couple minutes, Tammy came down, and I was able to say, "Tammy! Hey!" and compliment her new hairdo (actually very nice--all sharp and stylish whereas before it had been kind of mousy, fat-girl, don't-look-at-me). I told her the same thing I'd told the HR lady, but we also talked about Tammy's recent divorce (oh, so that's why the hair change...) and her daughter, and my kids, and Emerson smiled at her, and blah blah blah. Finally she said, "Well, I have the same concerns you have about your clinical skills, but why don't we try it. If it's not working out in a couple months, we'll just have that conversation then." Um, okay, I said.

So then all of a sudden I had a job. I hadn't even really said I'd take it, which briefly gave me a "wait a minute" sort of feeling, but I figured I'd sit with it a while, and if I had to, I could always call and back out. But the more I thought about it, the more it seemed okay. Tammy had said they could do what they had done with somebody else recently who had limited clinical experience, which was to pair her up with a particular nurse who had both years of home care experience and a background in teaching, to provide a particularly rich preceptorship experience, advancing the new nurse's independence as warranted by her growing skills. So it seemed like, well, what more could I ask, really? Here was someone who knew and liked me, offering me a chance to learn clinical skills with a one-to-one mentor. I didn't have to lie or exaggerate my confidence or my experience or my skills. I could be hired as-is, even if I was the nursing equivalent of a dented can of peaches.

There's another idea that's been kicking around in my head over the last couple months, too, which comes into play. I have two small children. Maybe for the next couple years, it might even be okay to have a job that's to some degree just a job. Maybe even though I'll be working full-time, there's a sense in which family can come first. It's possible I don't have to be pushing my career forward for a couple years. I could take a brief break from even thinking about it. It seems a little silly that this is a revolutionary idea to me, that it took this long just to think of it. I guess it's proof I'm not very post-feminist, which is reassuring. And it doesn't mean that the career won't come back to its ascendant position in a few years. But for now, maybe I'll just be a plain old working mom. That doesn't sound so bad.

Tomorrow, the World

2006-07-04T13:27:00.000-04:00

I finally managed to trick myself into blogging again.

I've accumulated an awful lot of things to write about, accompanied by a paralyzing combination of resentment (that I get so little time to myself) and guilt (that I haven't been making time for this somehow--you know I really could have if I set my jaw and made it happen). Layered over all of this is a kind of fuzzy, bemused detachment and wordlessness that comes of not writing for so long that I don't actually trust that I have anything to say.

This has been a pretty potent mixture, it turns out, and very effective at keeping my fingers from the keys. But I found the way to make myself post something. I instigated a negotiation with Pete in which I was granted a couple of chunks of hours without childcare duties. This was, of course, not sufficient, since there are a thousand things I'm behind on, a hundred things that urgently need doing (so much so, in fact, that it is a tiny bit tempting to curl up in a motionless ball and do nothing at all, just stare straight ahead and divert my cowardly brain by reading whatever kleenex box or piece of junk mail lies directly in my line of vision). So what I did was this: I made a to-do list, and on it I prioritized cleaning the cat box directly before blogging.

So here I am. I am cheating on my own to-do list. I really, really, really don't feel like cleaning the cat box, so I'm skipping an item and writing a blog entry instead.

This is what passes in my life for being an evil genius.

Sleep of the Blump

2006-04-18T15:18:00.000-04:00

He's asleep! And it seems as though it might stick for a while, even though I've had the temerity to put him down and start typing with two hands. I've been incessantly composing blog posts in my head lo these six weeks, but somehow it never seems to happen that I can actually sit at my computer and put ten fingers on the keyboard.

Of course, now that I'm finally here, I don't know what to say first. I could go in a thousand directions, and I don't know how much time I'll have. It's kind of theatrical and silly--I'm like a spy or a secret lover, sneaking off to send a long-delayed message. Tiptoeing strenuously around with my index finger in front of my round mouth.

Probably the first thing I should do is to put right the lingering impression of poor Baby Emerson as a generator of stink. As it turned out, his rotten-egghood lasted only a couple of days, and as soon as he'd had a poop that wasn't meconium, the smell stopped. Who knows what that was about. Immature digestive tract, something, something. But anyway, it's over now. I even sort of missed it for a couple days, it had been so... distinctive. All of which is not to say that he stopped passing gas, mind you--he's actually quite prodigious in that regard, my favorite being the cheerful little series of pbbfts he emits as he's waking up from sleep and stretching himself this way and that--but it's been almost completely odorless.

Oh, man. He's waking up, and... ooh, maybe he was just crying in his sleep. Whew. He does that sometimes. He also smiles and laughs in his sleep, which can be ridiculously charming. Eyes closed, and big gummy grins, with a squeaky bark of laughter every so often. He smiles occasionally awake now, too, but it's much less often than in his sleep, where he seems to have perpetual parties to attend and friends to greet (if also very serious business to contemplate and disappointments to endure--the variety and distinctness of his facial expressions lead us to believe he has an incredibly rich dream life, next to which his waking routines of eating, fussing, staring at the windows, and having his diaper changed must be pretty dry stuff).

So. Early infancy is really not my favorite. Nope. Still isn't. I guess it is better with Emerson than the first time around, with Cassie. For one thing, I'm not nearly so tortured about having terribly little breast milk and having to provide most of the babe's nutrition from endless bottles of formula. For another thing, I'm on the Prozac, which really has to be to the good. But also, there's at least a sense of the finiteness of this particularly arduous stage. With Cassie, I felt acutely and sometimes almost hysterically that I would never have any freedom of movement or peace or rest ever, ever again. And although parenthood is kind of bad in that way, it's not really as bad as all that. As my brother Eric says, it keeps getting easier as the child grows. And that has been my experience with Cassie, too. Slowly, but actually pretty steadily--a little easier, a little easier. And you get used to it. You truly do. That part about never really being all the way off-duty--it gets to be just a normal state of things rather than a terrific unaccustomed burden.

But still, the first six weeks just suck, and I'm glad they're behind us. The second six weeks are no picnic, either, but at least sleep starts to coalesce. Anyway, it has for Cassie and now Emerson. Emerson, the dear, has actually slept through the night twice now (and almost did last night, except for a few minutes of bleary breastfeeding before dropping right back off). Six to seven hours at a stretch. That's a beautiful thing. Pete's mom says he didn't sleep through the night until he was two years old, by which time his parents were so conditioned to his schedule that even when he finally submitted to a full night's slumber, they kept waking up around 3 or 4 for no good reason.

I wonder whether I'll ever have any nostalgia for my children's babyhood. I know a lot of people do, but I have trouble picturing it for myself. Emerson really is a sweet and delicious baby, with a lovely face and crazy-soft skin. He even likes to cuddle right in, and tuck his warm little head under your neck, which is ridiculously endearing (and never was Cassie's style--she insisted on being held as an infant, but never was particularly snuggly). Pete calls him the Blump for the way he tucks himself all up into a limbless little cuddly bundle. But still I can't wait for him to get older, to stop being a baby and be a toddler. "If they could only stay little till their Carters wear out"? No, no, no. I am more than delighted to pack up those boxes of hand-me-downs and move on up, thanks. Really.

Oh dear. Well, now he's up in earnest, and I'm reduced to typing one-handed, which is kind of difficult to maintain. I do fully intend to keep blogging now that I've started again, though. It's much more satisfying than just writing in my head. I'll figure out some way. Really, I guess there is always typing one-handed. It's probably worth it.

Last One Born is a Rotten Egg

2006-03-07T23:24:00.000-05:00

First let me say that Emerson Bean is just the sweetest, loveliest little baby. He has a pretty little face and a gentle manner and is the cuddliest little lump of newborn you could ever wish to snuggle. I am totally smitten, in a way I truly didn't expect to be, certainly not yet. It's just wonderful.

However.

I can't help but notice that the boy stinks. Yes, ma'am. At least since his second day out, he is little Mr. Gassy Smellypants. This child, master of the silent-but-deadly, emits more sulfur than a mid-size coal plant. It's so--um--remarkable that I asked the pediatrician about it today at our 4-day office visit. She just kind of shrugged and said yeah, some kids are like that.

So. If you come visit and happen to smell something distinctly diabolical, I just want you to know it isn't me.

Big Sister Blues

2006-03-07T23:14:00.000-05:00

Monday night, my second night home from the hospital. I hand off Emerson so I can do Cassie's bath with her. We're in the bathroom chatting and getting her undressed.

Cassie: You were gone a long time.

Rosie: Yeah, I know I was. It was more than two days. I'm sorry I was gone so long.

Cassie: I was unbearably, wickedly bored until you comed home.

Introduction

2006-03-05T17:49:00.000-05:00

Hi, honey, we're home. We would have communicated earlier, but for some crazy reason there was no broadband access in the labor & delivery room (well, or in postpartum either).

The young gentleman to whom we shall supply the pseudonym Emerson Bean entered this world, from his substantially more confined one, on Friday, March 3, at 2:56 am. He weighed in at a dainty 7 lbs., 11 oz., and measured 20 1/2 inches long.

More details soon when things settle down slightly.

Big Baby

2006-02-20T14:38:00.000-05:00

By dates, I reached 37 weeks of pregnancy on Friday. That means that now the kid will not be considered premature, even if I go into labor and deliver in the next 30 seconds. S/he is fully cooked and can show up whenever the mood strikes without any health professional batting an eye.

I, on the other hand, have been talking to the fetus about March 2. There's still kind of a lot to do around here, and I'm just not feeling quite prepared for the arrival of an infant. I mean, jeez. A newborn baby. They're so... you know... time-consuming. Labor-intensive. Inconvenient.

It really is good that there's no turning back now, because I might be tempted. I have so wanted Cassie to get to have a sibling, and that really is worth a whole lot to me. Yes, yes it is. But I've never really been wild about this whole going-through-the-postpartum-period-again business. And now that it's approaching fast, I am finding myself to be no more enthused than ever.

Labor is okay with me. I mean, I'm not exactly looking forward to it. It's intense, and it hurts, and it's tiring. But the first time around, it really was pretty much just a hard day's work (10 hours, first strong contraction to "it's a girl"), and I imagine it will be fairly similar this time. (Thanks to my mom, for the birthin' hips.)

One thing that's different about labor this time, I have to admit, is that I've thought about it very, very little. When you've never done it before, it's hard not to obsess and worry. My biggest fear was losing control and being rude and mean and yelling and stuff during transition. And as it happened, well, maybe I wasn't chatty and sunshiney and the perfect hostess or anything, but I was okay. I said please and thank you (between contractions, we're talking) and had a tiny bit of a sense of humor. Generally, I was more or less myself, plus loud moaning, which worked out fine. But I'd done a lot of emotional preparation. Pete and I went to Bradley classes, and I read books about labor, and I journalled and thought and dreamed and processed. This time around, I have trouble keeping my mind on thoughts of labor for more than 20 seconds. I just kind of... don't care. The first time, I made special mix tapes for myself and mixed selected essential oils into unscented lotion, and poured them into color-coded bottles. I packed the going-to-the-hospital bag carefully and well ahead of time. Pete bought the requisite new garden hose so that I could labor in the water. But in the end, none of it got used. That all was very much not what labor looked like for me. Dilating was a brisk and almost business-like (though noisy) affair, and pushing (for 3 hours, as Cassie finally turned occiput-anterior and then made her enormous way out into the wide world) really sucked, but there was nothing scented-lotion and soothing-music about it. It was just pain and exertion of an almost prosaic, if unusually intense, quality. So it's hard for me to even pay attention to that coming up again. I guess there doesn't seem to be anything to be done to prepare, not really. And I'm not worried about it. It's just there.

Having a newborn, on the other hand, does kind of worry me. It sounds difficult and exhausting and thankless. It sounds significantly Not Fun. And whereas with the first child, all you have to do is get through it however you can, it feels like with the second, you also have to be mindful of making it as easy on the older sibling as you can. You can't just totally shut down all auxiliary systems and go into pure survival mode. You have to try to keep things seeming sort of normal, to the extent that you can.

I don't know. We'll see. Maybe it won't be so bad. At least babies start getting more interesting after not too long. Those first little glimmers of this being an actual individual human rather than only a mooshy blob of infant need--they start showing up fairly early, I think. And it helps.

I had an ultrasound on Friday. The midwives wanted to check on the size of the fetus, what with gestational diabetes and all, despite my good glucose control. (Oh, and did I mention the fact that Cassie weighed 10 lbs. 4 oz. at birth?) The ultrasound size estimate was 8 lbs., with a projected fetal weight gain of 1/2 lb per week from here on in. So this is likely to be another Cassie-sized critter, more or less, which is pretty much what I anticipated. That's what it feels like. Anyway, they got some kind of nice pictures of the face of this kid. It has big cheeks and pouty lips, and its face looks kind of smooshed down into my pelvis. Its expression can only be said to be grumpy. Very, very grumpy. Which I have to admit, kind of makes me like him/her even a bit more than I was able to before. Certainly being smushed upside-down into a cramped, hot, infinitely humid, muscle-walled hell-hole seems to warrant a certain darkness of mood. And then also I think, hey, if we're able to just sit around and be grumpy together, we'll probably be all right after all.

Rosie Bonner is Unemployed

2006-02-20T14:24:00.000-05:00

I finally applied for unemployment benefits last Friday. They have offices where you can go take a number and stand in line and fill out forms and stuff just like in the movies (Fun with Dick & Jane and St. Elmo's Fire leap somewhat incongruously to mind), but you can also apply by phone or even, I think, online. I was pretty depressed that day, I guess, complete with sitting leadenly on the couch for an hour at a time trying to work up the emotional energy to do something, anything (which isn't a state I've reached too often since starting on the nice little white ovals of antidepressant goodness). Getting fully dressed like a functioning adult and going out into the daylight and driving my car to somewhere I'd never been before in order to deal with administrative issues related to losing my job was just not something I felt able to face. Besides that, there was the more rational reason that with the size of the belly on me at this point, the true status of my "looking for work" would have to be deeply suspect to anyone who looked at me. (I mean, looking for work? Honey, the only thing you need to be looking for right now is Labor and Delivery, the sooner the better.) I did have a question, though, so I called the number to talk to a person.

When I called, I got a message that said that all agents (? or something) were currently assisting other callers, that I could call back later, and if I chose to hold, the wait was estimated at "twenty... three... minutes." I immediately felt slightly relieved. Being on hold is doing something. Being on hold with the unemployment office is a noble, productive, necessary part of my day. And yet, all I have to do is sit there. For 23 minutes. Count me in. The only problem was the hold music. I had my radio on an oldies station (not my usual fare, but "Dancing Queen" and "Daydream Believer" had actually lightened my mood enough that I was able to do some cleaning, so I kept it on), and I really did not appreciate the stupid governmental muzak (punctuated, of course, by little recorded announcements about regular office hours and having your child's social security number ready if you were applying for dependent benefits). Despite the cacophony of "Can't Buy Me Love" mixing with what I think must have been "Thorazine for Electronic Strings," I kept my radio on out of dumb misplaced stubbornness.

Finally, there was a brief ringing, and a lady came on and asked how she could help me. I said that I had lost my job and wanted to apply for unemployment benefits. She started asking me the routine questions--who were my employers for the last 12 months, what were the dates of employment, what were the circumstances of my leaving my last position... The circumstances of my leaving. I mean, of course I knew I was going to be asked that, and yet trying to answer, I kind of stammered and found myself overexplaining. "...and the nurse manager said that I just wasn't catching on fast enough," I concluded forlornly. There was a brief pause, and then I said, "so, um, I guess 'poor performance'?" The unemployment lady might have been a bureaucrat, but she was a kind bureaucrat. "Not a good fit," she corrected me, consolingly.

She continued to run through the questions, and I had twinges of conscience when she asked whether I was currently looking for work, and whether I was able to start work now, but at least I was prepared enough to lie without hesitating. Sure. Sure, I can start work any time. Tomorrow, three weeks from now. Whenever. I just have to find an employer who doesn't need me to get through a doorway sideways or mind if my water breaks all over the floor. Well, and there is the moaning. I can do vitals and pass meds between contractions, but do you happen to have any soundproof rooms anywhere? Otherwise I might have to cut out early one day if I get too loud for the patients.

Meanwhile I have the opportunity--again--to ponder--again--the meaning and hidden lessons that may be derived from a bout of unemployment. Again. Of course the topic that leaps to my mind most readily is "what the hell is wrong with me, anyway?" Of the, let's see, 30 months since we moved here, I have been fully unemployed for a total of 13, working as a temp (in an office, answering phones, making photocopies, entering mind-numbing data) for about 8 1/2 and gainfully employed in something resembling an appropriate job for 9. And yet, and yet, I somehow maintain a self-image as someone who is not, in fact, a total loser. Does there come a point when I stop believing that? Does my self-esteem eventually throw up her hands and walk off in disgust, muttering at me "what have you done for me lately"?

I listen to the radio, I watch television, I read the newspaper, and there are people everywhere just doing their jobs. Just working. At the jobs that they have and have had and will continue to have. It looks so effortless. The dj on oldies radio (yes, I'm still at it) asks a caller if he has the day off for President's Day. Yes, he says. Of course. A talking head on the news (or on the Daily Show) is identified by job title. The nurses on Grey's Anatomy have sex with interns in the call room and go on strike... but they don't get fired. Working is what grown-ups do. It's just how the world functions. I feel as though I must be in suspended animation, floating quizzically in the stillness, mutely watching and wondering as the rest of humanity rushes on.

It seems incumbent on me to figure out the pattern, to crack why it is that I'm not much of the working world the past couple years. It certainly has not been my intent. And yet there it is. So it seems foolishly and blindly blithe to fail to notice. But when I think about each instance of unemployment--1) being directionless after having just moved here; 2) having been allowed to resign from Famous Hospital after the e-mail incident; and 3) having been allowed to resign from Other Famous Hospital for failure to perform adequately as a staff nurse--there doesn't seem to be a whole lot of commonality. It seems as though I'm supposed to have an epiphany along the lines of, I don't know, "I need to learn to manage my anger," or "I guess I really do have a drinking problem," or "I reluctantly conclude that I do have to bathe more than once a week." But nothing's really presenting itself immediately. In instance #1, I was new to the area and had been counting on the assistance of a certain VP of patient services to get me some consulting work, and when that fell through, it turned out I had little more thought out and a terrible temperament for hustling up self-employment opportunities. Plus I was depressed. In instance #2, I lost the job through a relatively isolated pissy moment and what turned out to be a significant misjudgment of my co-worker's character. In instance #3, I lost the job through some kind of failure to get up to speed and adapt to an extremely detail- and task-oriented role. The only theme I'm coming up with is some vague sense that I'm just not ideally suited to anything, that I don't quite fit in anywhere. But that's not particularly enlightening, useful, or even necessarily true.

So maybe I just stop thinking about it. Maybe I just work on getting the baby's room ready, pull out and wash Cassie's old newborn clothes, freeze some food for postpartum, pack a going-to-the-hospital bag, and just hang out doing what needs to be done. (Ooh! And cupcakes for Cassie to take to school on Friday because it's her 4th birthday! Eek. Okay.) And we'll worry about employment when it's time to worry about employment.

Historical

2006-02-09T10:00:00.000-05:00

I must have tuned out for a moment while making Cassie's supper, with her chattering away the whole time. So I never did find out what she was referring to when she said:

"It's an old joke... from the 1830's."

Poem

2006-02-06T23:15:00.000-05:00

Okay, so, you know how "your children are not your children; they are the sons and the daughters of life, longing for itself"? Yeah. So, well, here's what happened Sunday afternoon.

Cassie and I went to the playground/park nearby so she could get some fresh air, expel ya-ya's, etc. Unfortunately, due to recent snow meltage followed by a long day of rain, the entire main playground/climbing/slide structure turned out now to be in the middle of a rather substantial pond. Some children in knee-high rubber boots had waded across and were clambering around on the equipment, but I had not anticipated this state of affairs, and neither Cassie nor I was adequately shod to join in.

So we spent a little time at the one slide that occupies a separate, non-diluvian spot in the park, walked around a bit, and ended up sitting at a picnic table, as Cassie contemplated a stick and two rocks she had picked up. She explained to Valentina, her red bear, that sticks came from trees, and that rocks came from the sidewalk or tree bark. [?] Then she cuddled up to me, lay her head on my lap, and rested peacefully a moment. A moment later, she sat up and announced, "I'm gonna make a poem."

"Um, okay," I said.

And then she launched into it. It only took me a moment to realize that I needed to fish paper and a pen out of my jacket pocket, but I already had missed what probably amounted to a full stanza. She was talking fast, and some of what she was saying wasn't intelligible, and I suspect that some of it might not have been words at all, but just syllables to fill out her cadence. So I didn't catch nearly all of it. (And I have to say, parts of it had a more distinct rhythm and scanned better in the original.) Here, however, is what I was able to get down:

Trees blow, trees glow ["grow?" I asked--"no, glow," she said]
Every wish that every wish
And every owl flies at night
In the night sky
And I imagine every shape
That the clouds make
And it goes away to make another shape
And every poem... this poem's long
And [something, something, something] wrong.

And the sun is golden white.

Anything that's gold and blue
Anything that's red and pink
Anything that's blue and green
Into the lightning, blowing leaves.

There is another shape of clouds
And every table, every nook
In the house
And every wish you make into
And there's into tables, into two, into two, into two...
And trees blow, flags wave--
American flags.
Tables cloth, tables cloth, tables cloth...

And every word and nook and neck
Move any branch to the side of the sidewalk
In a grassy, mossy hill.

Valentina, Valentina, Valentina,
Valentina too.
Chimney tops in charge of roofs.

When Cassie was done with her poem, she decided that it was time for me to make one, too. She took the pen and paper, and I did my best to oblige. (I was absurdly self-conscious about making my poem not suck, and I had to pause for quite a while at a couple points. Cassie was very patient as she waited for me to get going again.) She very seriously repeated each line after me, as she was "writing" it, and covered the rest of the paper with strings of loops that in some way must represent my poetic effort.

I think that basically, my question about this episode is "wtf?" I mean, I guess it's not as if we've never read a poem to her, but it's certainly not a daily or even weekly occurrence. Maybe they've been doing poetry in school? But what evidence of school-based poetry-related activity comes generally in the form of cutesy little rhymes about snowmen or apples that get sent home with a day's packet of xeroxed schedules and newsletters. I mean, Dada/Beat blank verse it ain't.

As a child, I was careful about following rules, and being a good girl who did things the right way. I was a cautious and probably somewhat annoying little priss. So I have the hardest time wrapping my mind around just deciding you're going to "make a poem" and then coming spontaneously forth with a fluent stream of words and sounds and images. How do you even do that? My artistic efforts all suffer noticeably from being too cramped, controlled, over-careful, over-determined. Constipated is, in fact, the word that comes to mind.

But Cassie's just not like that. It's the same with drawing. She seems not to feel the slightest pressure to make the kinds of pre-determined images that I think of when I remember drawing as a child--those houses with the square bottoms and triangle tops, the flowers all shaped like cartoon daisies, trees like green and brown lollipops. Cassie goes wild with color and form, mixing media as she goes--sometimes turning out meaningless, dashed-off little scribbles but also occasionally taking the time to produce grand, complex, layered, and genuinely beautiful works (often purely abstract but sometimes incorporating some figurative elements).

It's just weird as hell to me. How does she know she can do that? How does she tap into it? Where does she get permission? And could it be that the silly hippie claptrap about the wisdom and creativity of the natural, unfettered child is... true?

I don't know, man. It just blows my little mind.

Medium Pink

2006-02-03T23:47:00.000-05:00

Cassie has a cold. I have to admit that from my perspective, this isn't a wholly bad thing. Feeling a little under the weather means that Cassie's a bit lower-key than usual, which is easier for me to keep up with at the moment. It also affords me the opportunity to be all maternal and doting in a sit-down-and-speak-in-a-low-loving-voice way rather than a chase-around-the-playground-pretending-to-be-a-mama-bunny-running-with-my-baby-bunny-away-from-a-loud-sound way. I'm afraid I've kind of been falling down on the job in the latter category of motherish responsibilities.

My shrink has, predictably I suppose, been adamant about my not taking this on. She even wrote it out for me as an assignment on the back of an appointment card: "Stow maternal guilt." The thing is, it isn't really even guilt--it's more plain regret. Cassie and I are, at baseline, so easily and fluidly connected, with about as much mutual understanding and respect as an adult can have with a not-yet-4-year-old, that a disruption in the relationship just plain feels crappy. I've been tense, I've been cranky, I've been tired. My patience with shenanigans has been minimal (which--surprise, surprise--does not in any way lessen the child's propensity for shenanigans; rather the opposite), and my sense of humor wan and flickering like a faulty fluorescent light. I've been less flexible, less creative, less energetic. I've just been less.

For whatever reason, this pregnancy is kicking my butt in a way that my first pregnancy never did. I'm tired enough, with these weird spells of shortness of breath accompanied by large-muscle achiness/weakness that actually feels ischemic, that my midwife sent me to my primary care doc to get evaluated.

In my doc's office, my oxygen saturation was 98%, and my peak flow reading (a test usually used in asthma or COPD) was in the high 500s (=good/great), and she decided she basically wasn't worried. She offered to send me for dopplers of my legs, just to rule out clots (which can then go to the lungs as pulmonary emboli, which can lead to shortness of breath... oh, well, and death), but given the situation, that seemed like overkill to me, and she really wasn't attached to the idea. She thought a little, then said well, let's go ahead and draw a CPK (an enzyme that, if elevated, could indicate muscle breakdown)... And a calcium? I chimed in. Yes, she said, and let's get a potassium, too. She sat looking at the computer screen a moment. Anything else? she asked. No, I said, I couldn't think of anything. (To that point, I hadn't really formed much of an opinion about my doctor one way or another, but I am an absolute sucker for being treated like a colleague by my health care provider. I'm now perfectly content to see her instead of the nurse practitioner I usually try to get in to see.)

The upshot is that the blood tests came back normal, and I seem to be doing a little better fatigue-wise the last couple days, though I still seem to need an awful lot of sleep. And as the fallout of being fired settles, I'm probably less uptight. (Though I still haven't been able to break myself entirely of spending stray moments ruminating somewhat obsessively over the stupid details: she said that Mr. F was one of the most medically stable patients, but that's just not true--on my last day they moved him to a private room because they thought he was getting close to dying; I told Claire about missing Mr F's NPH, and he only ended up getting it 2 1/2 hours late; blah blah blah blah ad nauseam). And as Cassie and I have a little more time together, I think we're finding our way back to each other.

The past couple days, Cassie has been sweeter and more tractable. There were a couple weeks where she would regularly get very oppositional, as well as precociously and maddeningly passive-aggressive (does she know she has Minnesota roots?) when I was trying to get her to, say, wash her hands before supper or get her pajamas on. That behavior has substantially receded, though. For my part, I've been able to simmer down and spend more time doing things like voicing Valentina, Cassie's red bear with whom she likes to have long conversations. (During the dark days, Cassie was even having her plastic dolphins peck viciously at poor Valentina's button eyes--I mean, jeez. Showed me where I stood, boy.) We sit and draw pictures together. We look through the Delia's catalog and pick out our favorite t-shirts (Cassie favors the one with the zillion little cartoon hamburgers and the light blue hamster one; I myself like the Fantasia mushroom one). We talk about the various different shades of pink, and which precise one is her favorite color.

It's all making me kind of have to recognize the blessing-in-disguise aspects of losing my job. I really was exhausted and strung out, and it was having repercussions. And now I get to recuperate and reconnect and stuff before having to face being the mom of a newborn. So that's all fine.

I would like, however, to remind the powers that be that I am also quite receptive to entirely undisguised blessings. Painfully obvious blessings. Stark naked blessings, even.

Well. Of course there's Cassie. Stark naked and otherwise.

Tommy

2006-01-30T09:08:00.000-05:00

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

2006-01-29T16:32:00.000-05:00

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

2006-01-29T16:08:00.000-05:00

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

2006-01-24T15:09:00.000-05:00

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

2006-01-23T14:51:00.000-05:00

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

2006-01-21T01:20:00.000-05:00

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

2006-01-18T18:00:00.000-05:00

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

2006-01-11T17:38:00.000-05:00

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

2006-01-10T17:16:00.000-05:00

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

2006-01-08T09:11:00.000-05:00

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

2006-01-07T23:09:00.000-05:00

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

2006-01-07T22:56:00.000-05:00

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.

First Day of the Rest of My Job

2005-12-19T22:43:00.000-05:00

After spending Thursday through Sunday wading the mucky edges of the Slough of Despond and dreading today's arrival, my first shift back at work since Ugly Wednesday. I was, of course, in great need of just getting back to it, already. Four days is way too long to contemplate one's own professional inadequacies without the opportunity to do anything about them.

Fortunately, and perhaps not so surprisingly, today was fine. I never did get an e-mail back about my request to be assigned to a different preceptor, but at the beginning of the day, Linda the Clinical Nurse Specialist just switched me from Jessica to somebody else. I still don't know what she said to Jessica about it, but I had several cheerful and seemingly un-charged interactions with her throughout the day, so I think it's fine. My replacement preceptor was a bit, um, hands-on at first, apparently having been warned about my--you know--issues. And I spent a miserable half-hour or so thinking oh no, not again. But I managed to demonstrate some competence early on, and she backed way off after that, but stayed warm and approachable about the stuff I did need help with. I'm not sure what impression of me she walked away with, but it seemed not to be dire.

Meanwhile, there was the actual patient care. (Oh, that.) My guy with graft-versus-host disease (a risk with an allogeneic bone marrow transplant--your new T-cells from your donor decide to fight off your own tissue as a foreign invader) and cryptosporidium in his gut was having a hard time because he just learned that he's not going to get to go home in time for Christmas, after all. He was being uncharacteristically uncooperative, entitled, and at moments downright defiant. I got him to open up a little about what was going on with him emotionally, and I also got the chaplain (with whom he has a good ongoing relationship) to go see him, and by the end of the shift he was noticeably mellowed.

AND there was my new lady with the head and neck cancer. She's just about to start chemo, and is being put through all kinds of preliminary tests and procedures. Her jaw pain ranges from 5 to 8-1/2 on a 0-to-10 scale, and she is not really able to speak intelligibly because of the massive tumor in her left cheek. She wrote me a note telling me that she had a "fun day" and "enjoyed [me] immensely." Now, if a person can think even for a moment that she had a "fun day" on the day her Port-a-Cath was placed, somebody is doing something right, if I do say so myself.

Of course, I didn't bat 1.000 today. The buff 38-year-old guy in for his first round of MAID (a chemo regimen) for his bone cancer didn't smile at me once, and at best grimly tolerated my ministrations and my apparently not-so-ingratiating presence. But whatever. I measured his pee, I took his vitals, I unhooked his IV lines for a sec so he could get his robe off, and I told him that his mother called. I did what I needed to do.

I'm off again tomorrow (during which I intend to complete approximately a week's worth of Christmas-related tasks, plus two loads of laundry), and then back Wednesday and Thursday. I'm feeling immeasurably more upbeat and relaxed about it after today, and I hope that manages to carry through.

I leave you with a recent Cassie quote: "I have to poop really badly... No, no... I mean, I have to poop really goodly."

Empathlet

2005-12-16T10:32:00.000-05:00

Yesterday after Cassie got home from preschool, we were sitting on the couch. I thought I'd been fronting pretty well, being warm and cheerful. At the moment, though, Cassie was playing with something, and I was looking desultorily through a catalog and thinking about work. Cassie looked up and startled me by asking, "Mama, are you feeling worried?"

"Um, yeah, I guess I am," I admitted.

"What are you worried about?"

I explained that it was nothing about home, it was just about work. What about work, she wanted to know. Oh, I said, I'm just taking a long time to learn some of the things I have to learn. That seemed to satisfy her, and she went back to what she was doing.

It's true that it's hanging kind of heavy on me just now. It might be useful in some soul-stretching way to be attempting something I'm not naturally good at, and to be struggling. I mean, this does fall in the not-killing-us-making-us-stronger category, right? I remind myself that I never expected to be good at this. I knew it would be hard for me, and I could only probably hope for adequacy, at least at first. But I still haven't heard back from my bosses about my request for a new preceptor, and it's making me feel particularly vulnerable and squirmy.

I'm also a little confused as to what to feel. I guess my best judgment is that my performance really has not been so bad as Jessica seems to think it has (Jessica unfortunately being the source of most of Linda and Maureen's impressions of how I'm doing as well). But what if I'm just being defensive? What if it really is that bad, and I'm just scrambling to continue to think well of myself? I try to think through individual situations, examples of where things haven't gone quite right, but I just end up all flummoxed and fuming and depressed. I don't know what to think. I don't know whose judgment to trust.

Well. When I was postpartum with Cassie, I felt at least this bad about my decision to be a parent. I felt trapped in a terrible mistake. And it did all work out pretty swimmingly ultimately. So for now I guess I just hang on and do my best and wait it out a while. And, um, definitely keep taking the Prozac.

Rosie, Problem Child

2005-12-15T04:20:00.000-05:00

A follow-up e-mail I just finished composing (um, yes, it is 4 in the morning...) to the clinical nurse specialist and nurse manager of my unit in the aftermath of an excruciating meeting today (I mean yesterday) with them and my preceptor Jessica. (I cried--repeatedly--which irks me no end. I also had a blinding headache by the time I got home.)

Dear Maureen and Linda,

Thank you very much for meeting with me yesterday. I appreciate your frank feedback and hope that I'll be able to justify your faith in my potential as a nurse on Wright 10. At least please know that I'm trying my hardest and care very much about doing the best job I can.

You asked about things that I thought might help me progress and learn. There actually is one thing that I've thought of, and while I'm not sure that it's possible, I thought that I would mention it. It's a little awkward to ask, but I wondered whether I might be assigned to a different preceptor for some or all of the rest of my time on orientation.

I want to be sure to make clear that it isn't that I don't think that Jessica is appropriate, or nice, or caring. She is all of those things. It also isn't that I don't think I have things to learn from her, or that I think her assessment of my strengths and weaknesses is inaccurate. It is just that, for reasons that I don't fully understand (but I suppose have to do with our very different personalities and styles), working with her, I tend to end up with a kind of black cloud over my head. Something about the dynamic between us results in my feeling discouraged, defeated, defensive, misunderstood, and unvalued. I find myself often having to manage my own emotional responses to our interactions rather than being fully present for the content and learning potential of the matters at hand. I also find myself making dumb mistakes under her scrutiny, which of course (understandably) leads her to feel the need to scrutinize my work ever more carefully, and the pattern is self-reinforcing. (Which isn't to say that I don't make dumb mistakes working with other preceptors! I do! I just think my rate is noticeably lower...)

I very much want to avoid any blame of Jessica--I think she does a fine job, and we're probably just mismatched. The last thing I want is to create any ill feelings between us--I'm very grateful for the care she's taken with me, and very much hope that we can continue to work harmoniously together as colleagues. I was thinking that maybe I would tell her that I just wanted to try to start fresh and put the past behind me, which is also absolutely true.

I am happy to continue working with Julie Piccolo, and I have also enjoyed the shifts I've worked with Marcia Moreau and Sue Kennedy. I've never worked with Liz Carrier, but wonder whether that might not be a good match, too. I understand that there are likely both pedagogical and logistical reasons for new nurses to have continuity with one preceptor, and besides, other people might not have availability, so if it isn't possible for me to switch, I'll understand and just make the best of it.

One final, probably unnecessary, thing--I know it was just a kind of example to illustrate a point, but I want to be sure you know that I'm not in the habit of standing around talking with patients for ten minutes at a time (much less forty-five). I may well waste time finishing a conversation after I have completed my tasks in a patient's room, but it's more on the order of 30-60 seconds. Room for improvement, certainly, but I just wanted to be sure you were aware of the magnitude.

Thanks again for meeting with me, and for all your care and encouragement.

Rosie

Decision

2005-12-12T16:11:00.000-05:00

The Friday before last, I reached 26 weeks in my pregnancy. Third trimester has now begun. This milestone brought with it (quite promptly, I have to say) a sudden, marked increase in uncomfortable Braxton-Hicks contractions, which kind of freaked me out until I talked to the midwife on call that Sunday night, and she reassured me. I've also been getting winded much more easily lately, and sometimes my heart rate goes up above 100 for no apparent reason. And with my big belly, I'm having a harder and harder time slipping, say, between the IV pole and the privacy curtain, or past the other nurse in the med room to get to the automated dispensing computer.

The kid is moving around in there a lot, which I guess is kind of fun, if distracting, and last Sunday Cassie actually got a chance to feel it with her hand. So that was cool. But mostly I'm getting irritated with and tired of this whole pregnancy thing, a feeling I try hard to suppress, since with any luck, I'll be suffering through it for another 3 months. (You hear me, little one? I may kvetch and moan, but you are forbidden to pay any attention. You have to stay in there at least until mid-February, okay?) Novelty and fascination got me through most of my first pregnancy, and besides, I kind of didn't mind waiting, what with anxiety about being a parent and worries about labor and delivery. This time around, though, the crankiness and impatience are setting in way earlier.

The other thing that's different about third trimester this time is that I'm now on Prozac. So I have to make a decision. Some studies have shown neurological symptoms in newborns of moms taking SSRIs during the last months of pregnancy--mostly hypertonia (being too tight, as opposed to being too floppy) and difficulty initiating breastfeeding, as I recall (but don't quote me--it's been a while since I read about it). For a long time, I pretty much assumed that I would stop taking the drug as soon as Week 27 rolled around. I was feeling really pretty solid, emotionally, and thought I might not even relapse if I went off. And anyway, I figured, I've gotten along with untreated depression for a lot of my life, so what's a couple months, in the scheme of things? We're talking about the health of my baby, here. My shrink did seem a little leery, and made jokes about coming to the delivery room with a Prozac IV drip to start as soon as the kid was out. But basically I felt good about the decision.

It so happened, though, that during the week of hospital and nursing orientation for new hires at OFH, I noticed a posted notice while waiting for an elevator. **Pregnant? Depressed? Taking Antidepressants? Do you have questions about depression and antidepressants in pregnancy?** Um, why, yes, I do! Please tell me more, yellow xeroxed sheet of paper! The obliging piece of paper explained that OFH researchers were conducting an observational study of pregnant women with a history of depression. So I used the campus phone on the opposite wall to call the number, and got set up with an appointment for an initial intake visit.

So basically, a research assistant does the initial interview, asking a bunch of the kinds of questions you would expect, about history of depressive episodes and history of treatment and stuff. And then you get to talk to one of the MD study investigators, who does a bit more interviewing, and then you get to ask anything you want. So I laid out what I was aware of, and how I'd made my decision thus far, and asked what she thought. And she was great--nonjudgmental, thorough, thoughtful, and able to pick up on the fact that I had a certain relevant knowledge base already, so she didn't talk down to me at all. And what she said was this: there were two studies published looking directly at this question of the effects on babies of their mothers having been on antidepressants during pregnancy. Both had small N's (she couldn't remember exactly, but on the order of 20 subjects each), and in neither of them were the observers blinded to the exposure status of the babies. (Jeez. Way to go with the study design, people.) She said that, yes, they did find some evidence of some neurological effects on the newborns of mothers who took SSRIs during their 3rd trimester, but it was also notable that they did not control for the severity of the mother's depression, which may itself have an effect. Furthermore, all the effects noted were within the first 48 hours of life. They didn't see anything longer lasting than that. Finally, she pointed out, other studies have shown a many-fold increase in the risk of postpartum depression in women who go off their antidepressants for even a few weeks, as compared with those who stay on.

So basically, my understanding is that even if the effects observed in those studies are absolutely real, and even if you could say with 100% confidence that everyone would have them, you're weighing two days of neonatal neurological symptoms versus a greatly increased risk for maternal postpartum depression. Another thing to consider, the psychiatrist lady said, was that I was on fluoxetine, which has a very long half-life and may well not have the same kind of withdrawal pattern seen with shorter-acting SSRIs. Besides which, I was on a relatively low dose (20 mg), which I should also take into account.

And so I'm staying on my lovely little white ovals. My reasoning now is that I have duties not only to my newborn during the first two days of life, but also to Cassie, and to the baby over the course of its babyhood, and to my patients when I go back to work, and to my marriage, and to myself. A high risk of depression undermines my ability to be fully there for all of the above. And for Cassie, particularly, this is going to be kind of a dicey moment. It's not even the risk of Mama being depressed for a while any old time--this is the period when she gets her blissful only-child life irretrievably altered through no fault of her own. I just need to try to be there for her as much as I possibly can, given the circumstances. The squally, poopy, absorbing, exhausting, distracting, ever-present circumstances.

I feel even more solid about the decision as a few times in the last couple weeks, I've felt for a few hours or a day the front edge of a depression. It ebbs away again, and I'm fine, but newly sobered by what exactly depression means. The gray, heavy kind, and even worse, the sickly yellow-brown miasma kind that taints everything it touches and makes it seem that there is nothing sound or bright or wholesome in the world. Feh. Good riddance.

Vitamin H

2005-12-06T12:27:00.000-05:00

Since my shift-of-agony with my previously wonderful and understanding preceptor, Julie, things have gotten distinctly better, though all is not resolved. For one thing, my next two shifts happened to be with Jessica, and I was busy and running, and she had to step in a couple times to fill little holes, but mostly they went fine. At the end of the second shift, Jessica just said (in a light, rather matter-of-course tone) that I gave very good patient care, and I just needed to work on my time management. This felt to me absolutely fair, and to be honest, I never did think that getting things done quickly and efficiently was going to be my strong suit. I truly think that the best I can hope for in that realm is a general adequacy, a level I'm all too aware that I haven't yet reached.

The non-big-deal-ness of it all made it much easier, then, the next shift I had with Julie, to meet her lingering attitude of Great Seriousness and Sober Concern with a (mostly genuine) brisk optimism. "So," said Julie, in the kind of tone one uses to ask about the results of a nasty court case or a biopsy, "how did your shifts with Jessica go?" I pretended I didn't notice the spirit in which the question was asked, and said, "oh, pretty well! I really tried to plan my whole days myself, and I think I'm getting there. Jessica had to help me out a couple of times, but I managed to get through most of it on my own." This left her mildly nonplussed, which I admit gave me some gratification, and then I bustled off to my tasks, which of course was what I was supposed to be doing. Julie did warm up a bit by the end of the shift, which was good, though we're nowhere near back to where we were when all was sunny and fine.

Then Julie and I had a PM shift (3-11) together last Friday. We agreed that I would take 3 of our 4 patients. One was supposed to be discharged to rehab just a couple hours into the shift, but due to a kind of ridiculous misunderstanding, that ended up not happening, and he had to stay overnight with us. But he was easy (and easy-going), as was my friend the 28-year-old woman with the tattoos, Buddha-calm, and nasty leukemia. They both needed medications and vitals, but that was really about it. Which was good, because patient #3 was a lady with a very extensive psych history (let's call her Ms. Q, because that's not her name) who was starting chemo that night. Ms. Q is a large middle-aged lady with messy hair and prominent eyes (that's from her thyroid condition, though it has the unfortunate effect of accentuating her appearance of instability). She was intermittently lucid and appropriate toward the beginning of the shift, if very needy and tearful and anxious as we got ready to start the chemo. She had a sitter, but was still continually on the nurse call button. Sometimes she'd have forgotten what she wanted by the time I got my gown and gloves on (she was on contact precautions, naturally) and got into the room. We nonetheless got her first unit of blood and her premedications into her without much in the way of untoward incident. Lots of hugs and reassurance, plus a milligram of IV Ativan, allowed the beginning of chemo to proceed as planned. (Originally she consented for chemo herself, but after involvement of the psych team and the hospital's lawyers, her brother also had to sign a consent.)

When Ms. Q's afternoon potassium level came back at 5.1, though, she needed an EKG and some Kayexalate to bring the level back down (5.1 is not horribly high, but when chemo causes the breakdown of cancer cells, even more potassium is released into the bloodstream, so you really need to stay on top of it). Plus she did need that second unit of blood. She refused it all. She switched from "I'm going to be brave; I'm going to fight this cancer" into "I just want to rest. No! Turn off the light! Leave me ALONE! You NEVER let me SLEEP!" (There were moments when I was just flabbergasted by how much she reminded me of Cassie at her tantrum-y worst.) Tom, the sweet overnight intern, came in and managed to talk her back into accepting treatment, but after he left, she changed her mind again.

It ultimately took me, Julie, Tom, and Soledad, the very competent and sweet nurse's aide, to wheedle and cajole and soothe Ms. Q. Oh, well, and there was a little bit of Haldol in there, too, I have to admit. And Julie brought her a grape popsicle. She got all of her treatment, and her EKG was fine, and she didn't spit out the nasty-tasting Kayexalate. She actually gave me no trouble at all about her bedtime insulin, which was a relief. Oh, did I mention that somewhere in there, she lost a huge filling from the front of her mouth? (I stuck it in an emesis basin on top of the refrigerator and promptly forgot about it until the next morning, when I had to call the floor and ask to speak to Ms. Q's nurse.) Anyway, then it was well after 11, and I hadn't done any documentation.

We ended up being there until 1 am. Julie gave me a ride home. AND she said something about how, time-management-wise, she just couldn't think of how we could have done it differently, to get out earlier. That felt to me like a significant change, because from my perspective, it had truly been seeming that whatever running and reshuffling was required, whatever fires needed to be put out, any failure to get everything done on time she considered solely my fault. Maybe it was the fact that she'd actually physically been there for most of this shift that softened her a bit on that point. Maybe she's actually mellowing a little. I guess time will tell. I'm still struggling with whether to say something to her or not. I've been playing it by ear, and there hasn't really seemed to be an opportunity yet. I don't know. It's possible I'm just chickenshit.

Tonight I start a run of three night-12's, 7 pm - 7 am, with Jessica. It is often, if not always, less busy on nights, and with luck a girl actually can get to sit down a fair amount. Not if I'm assigned to Ms. Q, of course. Oh dear.

Today

2005-12-01T23:00:00.000-05:00

Today we sent a 21-year-old home to die. It will be a few days, probably. The lady in 24 coded and went back to the MICU. And my patient in 38B had all his teeth pulled.

I'm so tired I can't see straight. I work 3-11 tomorrow, though, so maybe I can finally write something before that.

No Good, Very Bad Day

2005-11-21T15:02:00.000-05:00

Saturday was my worst day ever at work. Allow me to share with you a partial list of what I did during the course of my 12-hour shift.

I hung a liter of D5 1/2 NS instead of the ordered D5NS (that's all abbreviations for types of replacement fluids, by the way--water with 5 of dextrose and 0.45% sodium chloride, instead of water with 5 of dextrose and 0.9% of sodium chloride) and didn't notice, but my preceptor did, after 300 mL had already run in. (Incidentally, this was a non-big-deal clinically but went a long way toward making me feel like an incomptent boob.)
I spilled a patient's ginger ale all over the floor. I wiped it up, and then should have called housekeeping to come mop it to get rid of the stickiness, but I never did.
I grabbed the sprayer for cleaning out bedpans and somehow depressed the lever prematurely, and got one whole side of the bathroom wet, including the toilet paper.
I forgot to get morning vital signs on the guy in Room 28, and didn't get any until noon.
I totally missed the 10am dose of oral Lopressor for the guy in Room 38. Just somehow didn't see it on the med sheet. Fortunately (?) they were deciding to go up on his Lopressor dose, anyway, so he did get the new higher dose around noon.
I somehow decided that 24 divided by 8 was 4, and so pulled 4 tablets of Zofran to pre-medicate the guy in Room 28 for chemo, instead of the needed 3, and my preceptor noticed it before I did.
I didn't know that you throw away cyclosporine tubing after each use, and spent 5 minutes trying to get the damned locking adapter off the end of the tube, where it was stuck (because cyclosporine is hellaciously sticky stuff--just another little vastly useful tidbit of knowledge for you).
I put on the ID bracelet for a new admission too loosely, so it could slip off her wrist, and I had to ask the unit secretary to print me out another one.
I had a hard time taking an apical pulse on the guy in Room 38. Who can't find a damned apical pulse? (That essentially means I couldn't consistently hear the boomp-boomp, boomp-boomp when I tried to listen to the guy's heart to count the beats in a minute, which I was doing because the pulse in his wrist was all erratic. Gold-standard for pulse, especially when the heartbeat is irregular, is listening to the heart with a stethoscope for a full 60 seconds.)
I repeatedly forgot to get more saline flushes for Room 28, and he was on MRSA precautions, so I had to keep gowning and gloving and then de-gowning and de-gloving as I went in and out and in and out of his room.
I started crying in Room 38 while the patient was in the bathroom, and didn't get my face wiped off in time, and he probably noticed.
As I was leaving around 9:00, 2 hours after my shift was supposedly over, I got all the way downstairs before I remembered that I had left my jacket, with my car keys in the pocket, back up in the break room, and had to go all the way back up and get it.

As you can probably tell, it was one of those days where things start out badly and then just get progressively worse as one loses all faith in one's own abilities, all ability to think clearly, and all concentration for anything but self-recrimination. I am very grateful that none of my little disasters actually had much of an impact on patient care, and shudder to think that they might have.

I've been trying to figure out just what went wrong. I really, really, really don't want to live through another day like that one. Part of it, I think, was that I had been frantic and flustered and rushed the day before. Both at work (a rare 8-hour shift) and then at home, I was running to try to get things done and feeling very frayed pretty much all day. And then I rushed to go to sleep, so I could be rested enough for a 12-hour shift, and then I got up and rushed to work, and so by the time I got there, I was already all jangled. I started out the day without enough calm and attention to sit down and really take in and process a whole bunch of new information about two somewhat complicated patients. I started feeling anxious and overwhelmed almost immediately, and I just never was able to catch up after that.

The other problem was Julie, my preceptor. She's the nice one, the one who always knows just what to say and just how to handle me. Saturday, though, she seemed suddenly to have lost faith in me. Instead of responding to my being scattered and freaked out with her usual relaxed confidence, for some reason she started looking at me like I was really Not Okay. She gave her usual little pep talks about doing what I needed to do to recover, and to try to put things into perspective, and to realize that things were not actually as out of control as they felt like they were. But for some reason, her tone and her facial expression belied her chill-out message. Her nonverbal attitude was one of Grave Concern.

As the day wore on, and I tried to take some opportunities myself to lighten up and get a grip and snap out of my tragic-screw-up mindset, she seemed to make a point of pulling me back down. It was weird. Once I spent a minute, or maybe two, joking around with an old favorite patient, and came back to where she was sitting at a computer with a smilier, more confident manner than I'd had all day. She started in immediately talking very seriously to me, at length, about the things I hadn't done yet (including some that weren't even due for another hour or two). It was the same story after lunch, when I was feeling refreshed and cheered up by sitting around for a few minutes with other nurses in the break room, talking and laughing about dumb things. This time she even managed to mention that it was Week 7 of my orientation, the implication apparently being that I was alarmingly behind where I ought to be. And then, toward the end of the day, I came out of the room of the new admission, having just done the 6-page admission assessment questionnaire (Have you had any changes in your bowel habits? Have you fallen recently? What is your religious affiliation?) as I was supposed to, and remarked to Julie that it was so nice to get to really have a conversation with a patient, that it helped me remember what this was all about, that it was most fundamentally about the people and not about the tasks, and that was the thing about the work that really fed me. She agreed (half-heartedly?), and then a minute or two later gave me another little lecture about how it was very nice to talk with patients and all, but at this stage, I really needed to concentrate on the tasks. As in, I may tell you to try and put things in perspective and that this is just all part of the process, but you need to know that I don't really mean it, and you'd better not think for a moment that you're doing fine and things are okay, because you're not, and they're not, and you sure as hell better wipe that smile off your face, missy.

Sigh. I don't know. We'll see how it goes tomorrow. It's funny. Now I'm even wishing I had Jessica as my preceptor instead of Julie. But maybe we can come to an understanding somehow. If it's bad again, I might even have to say something kind of direct. Bleah.

Further Preschooler Insights

2005-11-21T08:33:00.000-05:00

It's Friday, around 6 pm, and Cassie and I are at the (excellent) local produce market / deli / bakery doing some grocery shopping, because it's the only time I could figure out to fit it in. I have a 12-hour shift the next day and am feeling tired and stressed. Apparently I'm not the only one.

Cassie, after we've been there about 20 minutes: There are a lot of people here having bad days.

Later that evening, Cassie has just started supper.

Cassie: I'm getting less cuter.

Mama (had not noticed): You are?

Cassie: Yes. Big kids and grown-ups are not cute.

And she has a point.

Minutes later, Cassie is pretending that the chicken nuggets on her plate are cars, and the dollop of ketchup is the red light at which they're all lined up.

Mama (incredulous): You're eating cars?

Cassie (agreeing): Eating cars would be yucky.

Mama: Yeah, well, yucky and hard to do.

Cassie: Yucky and hard to do and a choking hazard.

Maxim

2005-11-16T10:23:00.000-05:00

This morning, a propos of nothing I could discern, Cassie stated the following (a quote from something she heard at school or on television? possibly an original thought?):

A girl is not a girl without her strongness.

Not Only but Also

2005-11-14T16:33:00.000-05:00

Oh, and I also have to tell you that I have this great new t-shirt. Even though I got the XL, it kind of won't really fit me until, well, until I'm not pregnant any more (and even then...), and the fabric is thin and flimsy, but I love it and I'm going to wear it anyway.

It reads "are you experienced?" in a 1968 Fillmore West kind of font, and it has a picture of Hello Kitty dressed up as Jimi Hendrix.

Maybe you have to see it.

And while I'm back at the unsolicited testimonials, have you seen Peep and the Big Wide World? It's a kid's show. It has a round yellow chick, and a nondescript red bird who turns out (if you listen closely to the dialog--there aren't really any other clues) to be a robin, and a blue duck wearing a sailor's hat, and it's one of the funniest shows on television, never mind that it's for preschoolers. Joan Cusack narrates. They're just starting a new season, which is a ridiculously exciting event in this house. (We've watched the previously existing episodes into the ground. We can recite whole exchanges by heart. We all sing the theme song together.) Plus it's made by WGBH, and the National Science Foundation has something to do with it, and so I guess it must have--you know--like, protein and fiber and antioxidants in it or something. I mean, it's somehow secretly good for you. Well, they did have moldy bread in it today. That's scientific. Anyway, it's totally excellent, and you should probably watch it, even if your house is preschooler-deprived.

Okay. I think I'm done now. I just can't seem to stop blogging today. Maybe I should go take a shower and give my damned cat (yes, she's still alive) her medicine.

Fallout

2005-11-14T14:32:00.000-05:00

You assume it's going to be the sadness of patients dying. That's the obvious emotional burden, the one that people are thinking of when they say things like, "I guess you have to be a special kind of person to work in oncology." And the truth is, I haven't gotten to that part yet.

Some of "our" patients have died, of course, since I've been working on the floor, but I'd only actually even met one of them, and I didn't know her well. I'd never taken care of Mrs. W myself, though on one occasion she did graciously allow me to come watch the process of flushing her double-lumen urinary catheter (she had terrible hemorrhagic cystitis, a bleeding bladder, and required frequent flushing to get the clots out--they caused her great pain). She was clearly a warm and lovely person, but my own sadness at her death felt distant--there were so many nurses who had genuinely been close to her, and I just hadn't been.

I have started to notice, though, occasional surprising flares of anger. Hatred, even. I spend most of my time in a reasonable, therapeutic, compassionate mindset. Here I am, being there for my patients, providing all I can in terms of understanding, comfort, and care. You know. Professional and warm-but-detached. This is not my suffering, and it's almost presumptuous to take it on myself. But. But every so often, this eruption of red-hot feeling comes through. It fortunately lasts only a couple seconds at most, but it tends to catch me off-guard, even though the kinds of things that provoke it are kind of predictable. The dad getting a bone marrow transplant is visited by his two small children, and has to put on a mask and gown and gloves to spend time with his own babies, and then they go away again, and he waves bye-bye to them through the glass window in the door of his positive-pressure hospital room. I stop in to say hi and chat briefly with N, a rebellious and funny 30-year-old with lymphoma in his own mask and gloves, sitting at the computer in the patient lounge, and as I leave, I pass G, a 21-year-old with metastatic osteosarcoma, who measures his time left in months. I hear from J, a woman in her late 20s with newly diagnosed leukemia, about her lack of health insurance. She's smart and thoughtful and incredibly sweet. In her hospital bed, she knits because her chemo has messed with her vision, and it's hard for her to read. She has amazing tattoos on her arms. She's been finishing up her bachelor's, and next year, she would have been moved into a job category with benefits. The people at the school where she works held a big raffle to raise funds for her care.

And then I get this flash of blind rage. For a moment, I just hate cancer with everything I've got. I want to get a torch and rally a bunch of villagers to TAKE THE FUCKER DOWN. And then before I even take another breath, I realize that's ridiculous, and cancer is not a very well defined villain, and I simmer down, and I go on with my day. But for a while, a kind of unsettled feeling lingers. Who knew I had that kind of anger?

And then, yesterday, the tears came for the first time. Pete had taken Cassie to a children's concert, and I had the house to myself for a couple hours. I was picking out some music to put on to clean by, and I noticed my Norah Jones cd. I don't play it very often, but now I wanted to. Julie, my preceptor, had told me a story that her patient Mrs. G had told her. Mrs. G is a lady in late middle-age, built like a fireplug and now also entirely bald from the chemo. She has a fairly thick accent I haven't yet identified, and is warm and funny and outgoing and generally a real character. She has a framed picture of herself mugging with a lollipop because she thinks that without hair, she looks just like Kojak. She's had a long course, and now she's in for a bone marrow transplant, which entails a grueling and somewhat dangerous regimen, with a hospital stay of at least 5 weeks. She told Julie that a couple days before she came in to the hospital to begin the process, her whole big extended family had gathered. The occasion was maybe some grandchild's first communion or something, but because of Mrs. G's situation, the party was more on the scale of a wedding. Everybody was there. And when the dancing was going to start, the floor cleared, and Mrs. G's son came to get her to dance, and the dj put on Norah Jones's "Come Away with Me." There wasn't a dry eye in the place. (This, of course, extended to Julie and me, misting up talking about it in the clean utility room as we got supplies for a dressing change.)

So I decided to put on Norah Jones, in honor of Mrs. G, as I tidied the living room. And when "Come Away with Me" came on, I indulged myself in a good wallow, summoning a cheesy mental montage of Mrs. G being in the hospital and getting chemo, with all the concomitant boredom and discomfort and frank suffering, as her loving son invited her "come away with me," even though he knew she couldn't. And what I found myself thinking, as I sobbed at my own generated pathos, was not just "how sad," but "I'm sorry." I'm sorry, I'm sorry, I'm sorry.

The emotional difficulty in being an oncology nurse is not just in the grief and sadness, I realized. Part of it is that being a person who administers chemotherapy implicates you in the suffering. Chemo sucks. And yes, you can take a step back and think about how it's the best chance, the only chance, for many of these patients. It could buy them months, years, of life--in many cases, symptom-free life. Sometimes it, along with surgery and radiation therapy, even cures. And that the patients have chosen this route as the least of the possible evils; they actively want this treatment.

But still, chemo sucks. And there is fallout from giving people incredibly toxic substances, putting these vile chemicals right into their veins. And then watching their blood counts fall, watching their liver function test numbers rise, watching their electrolytes get out of whack. Watching the nausea, the fatigue, the mouth sores, the diarrhea, the rashes. Administering packed red blood cells when the hematocrit falls below 25 (normal is around 40), platelets when that count falls below 20 (normal is over 150). Bringing in handfuls of pills, giving medications to control the side effects from the medications you gave to control the side effects of the chemo. And even though you know why, there's still something in knowing that you did this to them. You, personally. You hung up that bag, you strung the tube through the pump, you attached it to the catheter or the port leading directly into their bloodstream. Cytoxan, ifosfamide, etoposide, cytarabine, high-dose methotrexate. You punched the numbers on the pump's keypad to administer the carefully calculated number of cc's per hour of the poison.

Meanwhile, at the end of my shift on Friday, I heard two of the older nurses talking. I didn't know who they were talking about at first, because I always call this particular patient by his last name, and they were using a diminutive of his first name. His mother is in the patient lounge now, crying, they said. Of course you can't blame her. He still has blasts in his periphery. There's nothing more the oncologists can do. It finally dawned on me who "he" was. It was N, the 30-year-old at the computer.

Fuck cancer. Fuck. Cancer.

Finesse

2005-11-14T10:16:00.000-05:00

I'm back on days now, and worked 7A-7P last Thursday and Friday. As a special surprise bonus, I got to have my beloved Julie as my preceptor on Thursday because Jessica happened to have somebody else to precept that day. So that was awfully nice. But then of course I did have to have Jessica on Friday.

Friday morning on the bus, for the very first time in this job, I found myself dreading (ever so slightly) getting to work. And, as it turned out, I wasn't really wrong. Nearly as soon as I got there, Jessica was on me, micromanaging even the smallest details of my day, "correcting" my decisions about which task to do first, giving me little lectures about time management. I managed not to say "Fine, fine, FINE!" but let slip a sort of understated, "Okay, okay, okay, I'll go get the 8 am meds now." It did have a slight edge to it, but was nonetheless substantially filtered down from the "would you shut your flapping piehole and leave me the hell alone?" that might have more accurately represented my true emotions at that second.

Things did kind of settle down after just an hour or two, but I was feeling pretty chafed, and it really wasn't helping my concentration or my efficiency any. Fortunately, there turned out to be some more substantive, actual patient-care-relevant issues to talk about come late morning, and we were able to warm up to each other again a bit. It occurred to me that one school of thought would be to initiate a frank dialog with Jessica, explaining my frustrations and asking for a change in behavior. The advice columnist solution. I briefly tried to consider it seriously, but gave up on it pretty quickly. It just seemed too ham-handed in the situation, and seemed like it would make things more, not less, tense. Plus I really didn't feel like it.

By noon, Jessica was finally pretty much leaving me alone, since she had a new admission to contend with herself. Around 4:30, we reconvened, and she said, "okay, there are 2 1/2 hours left, and there's still a lot to get done," (subtext: you haven't been taking my time management advice, have you?) and had me list what remained to do. Then she offered to take over Room 16 so I could concentrate on 32A for the rest of the day. That was nice of her, though in context, it did have a little shading of I-told-you-so. So I went and finished up with 32A--changed the caps on her triple-lumen Hickman catheter, belatedly got her 4 pm Benadryl as well as the Zofran she requested, hung her vanco, emptied her urine & tidied the bathroom, changed her bed (finally), took her vital signs again (I'd taken them at 4, but then had not written them down, and uncharacteristically forgot the numbers completely), and charted her Is and Os.

There was one notable Jessica moment, when she poked her head in and noticed that the patient had... an orange! If it had been Julie, I know that whatever she said would have been compassionate and diplomatic, but Jessica blurted out a rather snippy and condescending, "Has anyone explained to you what neutropenic means?" and told the patient she wasn't allowed any fresh fruit (as part of the "low-bacteria" diet that people with severely compromised immune systems have to follow). The patient, a kind of salty working class middle-aged woman with newly diagnosed leukemia, quite reasonably replied that she had been told that oranges and bananas were okay because they had thick, protective skins that you didn't eat. Jessica bustled off to ask the nurse practitioner, and the patient mischievously hurried to peel the orange so that she could eat at least one section before Jessica came back. "They're really good oranges," she said to me. I probably should have stepped in, with a gentle, "why don't we wait for the answer, just to be sure..." That would have been the nursely, responsible thing to do, right? But I couldn't bring myself to. I just stood there and, well, maybe kind of twinkled as the patient peeled her orange. Jessica then came back with the news that the nurse practitioner said it was okay. Oh, whew.

When I was talking to our friend Max on the phone shortly after my shift, I was trying to describe what Jessica was like, and I think I was being a little incoherent. Finally, he said, "oh, does she have her hair pulled back into a very tight ponytail?" "Um, yes," I said. "Yes, actually, she does." And he laughed, because then he got the picture exactly.

What's funny, though, is that for all her uptightness, Jessica also cuts corners that I don't feel comfortable with--and that Julie (my role model and exemplar in all nursing standards) doesn't cut. I guess maybe it's that Jessica's tightly-wound-ness is more about rules and efficiency and less about the big picture of providing good patient care. It's really nothing egregious, and I think she probably provides perfectly safe patient care, but she often doesn't go the extra step--doesn't look stuff up when there's a little question; she just fills in paperwork to get it filled in and doesn't take time to think carefully about it. Things like that. Julie always seems to do both, to get things done efficiently and to make sure to serve the larger good of patient care.

At the end of the shift, as we were sitting and charting, Jessica and I were talking (pretty amicably by now, thank goodness), about the weekend and when we were next on together. She had been looking out for me and made sure that since the Clinical Nurse Specialist was on vacation, we got the Nurse Manager to make up a schedule for me for the next few weeks. I was really very grateful, because I was feeling shy about making it happen, but at the same time really wanted to know what my life is going to look like. And we saw on the schedule that our next workday was Tuesday. "So at the beginning of the shift, we'll sit down and plan out the day together," Jessica said. Oh dear, here we go again.

"Um," I said. "Um, I was thinking that maybe I should try to plan out my day myself. I really, really appreciate your stepping in with Room 16 so that I could finish up everything for 32A today. It made it so much easier. But I'm thinking it might be a necessary part of the process for me to, you know, make mistakes, and to some degree suffer the consequences, you know? I mean, not to the point of, I don't know, going to cry in the bathroom or anything, but it just seems like I really have to learn the process of time management from the inside out. So I should try to kind of, you know, go through the process from scratch. So I can slowly learn how to be independent. I mean, if I'm really super overwhelmed, I might have to ask you to rescue me a little occasionally, but I think I should try to do it by myself."

I have to admit, I felt like a frigging genius. None of what I said was at all untrue--I had just managed to find a place to stand from which I could say what needed to be said without it being at all threatening or angry or anything. It was all about my shortcomings and my weaknesses and my vulnerability, and not a whisper about her driving me bats. And she relaxed immediately. She seemed truly relieved. I gave myself an internal high-five.

So that's the plan for Tuesday, and I have to say I'm feeling fired up. My twin (and fortunately complementary) goals: provide excellent, safe, and efficient patient care, and keep Jessica off my damned case. I figure I have to be so good, so thorough, so on top of things, that she isn't tempted to put her little fingers in. I'm in the process of making up my own special scut sheets, a format for writing stuff down and figuring out my priorities and keeping the important things in mind, and prompting myself to do the stuff I have a tendency to forget. And then I'll go in a little early, and I'll read the charts and look up the labs and get everything all mapped out for myself. And buy myself the right to go in and check in and say good morning to my patients before I get their damned 8am meds, if I so choose. We'll see how it goes.

What's the Name for the Meal You Eat at 1 AM?

2005-11-08T17:22:00.000-05:00

So. The night shift. 7P - 7A. I've now done it, twice. I think maybe it was about as hard as I thought it would be, but kind of differently from how I imagined.

My first night started inauspiciously. I usually take public transportation, but I was recently clued into the fact that we get free parking for night and weekend shifts (weekday parking is kind of prohibitive--you either sign up for a remote parking garage or pay fall-down-dead non-validated rates for a spot in one of the patient/visitor garages). Filling out a form and putting a little orange square sticker in my back window allows me to swipe in and out of the patient/visitor garages with my ID at designated hours. So I did that. ("Welcome to OFH!" said the parking office guy, with apparent sincerity, after he handed me my sticker.) And so Sunday night I drove. It was, naturally, dark, this being November and all. And it was raining. And then right as you get off the major crosstown artery to go to the hospital, there's a lot of construction. (Supposedly there's going to be this fabulous new subway stop that's actually going to be handicapped-accessible (that would be a nice little touch for the major public transportation access to one of the largest medical centers in the country, don't you think?), but it doesn't seem to be happening very fast.) And so the streets are now configured a little differently than they were the last time I drove to OFH, which was when my dad was an inpatient there a year ago. So. Well, see, I'm not sure quite... I mean, taking the right fork seemed at the moment... What I'm trying to say is, I somehow ended up going the wrong way on a one-way street. This was Sunday night, and so I managed to get the block and a half I needed to get to the OFH entrance without encountering any other cars, only realizing with horror about halfway along what I was doing. I pulled into the parking garage with my face bright red, emotions split about 30%-70% between delayed-reaction fear and profound, staggering embarrassment. OK, Rosie, nice work, and now you're going to go take care of sick people and be responsible for putting substances into their veins and stuff? Great. Just great.

Fortunately, there was no equivalent event on the oncology floor, though as the night wore on, I did find myself getting stupider and stupider. I had been worried about getting sleepy, but that wasn't it. I really didn't feel drowsy at all. I just felt as if my mind were moving through gradually congealing oatmeal. By the time I was supposed to write my end-of-shift notes in the chart, I sat there for probably a full minute staring at the page before I could even think of how to start.

I was surprised to find that the second night was easier than the first. I had really been able to sleep during the day on Monday, for nearly 7 hours, so I was in something a bit closer to a normal state. I did get sleepy and dumb right toward the end of the 12 hours, starting around 5:30 am, but I was overall significantly sharper. Plus there was a big plate of cookies a patient's husband had brought in for us.

I was also struck by how strangely different time is during a night shift in the hospital. Somehow I pictured 3 am feeling more... more like 3 am, I guess. Instead, it feels like an entirely different time from 3 am in the normal world. It's just that they happen to be called the same thing. Like homonyms. 3 am on the oncology floor felt like a kind of dull, prosaic downtime. Slow, maybe, but not remotely eerie or creepy, and frankly not even that quiet. Michelle and Kelly, two of the younger nurses who are apparently great friends, got the giggles both nights, the first night telling stories mostly on the theme of patients-and-poop, and the second night talking about miserable attempts at downhill skiing.

My new preceptor, Jessica, turned out to be very petite and pretty in a fresh-scrubbed way, with a movie star smile a little bit too big for her face. I probably have about 10 years and 90 pounds on her, but, well, who's counting. She was fine. Sweet, I guess, in a not-too-intuitive way. All the preceptors I've ended up working with since Julie (who I had for my whole "clinical" in my nursing refresher program, and whom I've also had a few times since becoming an employee) just make me appreciate her more. Not only is she a really exemplary nurse, extremely thorough and disciplined and great at keeping big picture and details in mind at once, she's amazingly tuned into just what you need when you're learning. She knows when to step in and help, when to step back and stay quiet, and when to disappear for a while to let you really have some independence. Jessica was never impatient or curt or anything, but she was kind of inconsistent, and our rhythms were all out of whack. The first night, her decision was that I was just going to take one of her two assigned patients (the usual night shift load on this floor is 4-5 patients, but Mr. A was looking really unstable, and it turned out the staffing level permitted her to get just him and one other). So I didn't really do the preparation for taking care of her other patient. But then it turned out that Ms. M really didn't need much between about 9pm and 6am, so I ended up doing a lot with Mr. A as well. And I was never clear on what should be my responsibility and what shouldn't. And then she suggested I write his note, too, at the end of the night. Which was fine, I guess. I mean, I mostly did know what the story was with him. I just felt all unprepared and off-balance. The second night, I got my own two patients, Ms. M again, and then a new lady with leukemia, Ms. G, in for her first round of chemotherapy. And I was able to plan a bit better, and that felt good. But then a couple times, Jessica asked me if I wanted help with some task (e.g., drawing blood off a central line) or felt confident handling it myself, but didn't seem to believe my answer when I said I could do it. She ended up coming with me anyway, which made me feel flustered and hovered-over, and I made some mistakes I might not have made alone, and anyway would have benefited from just working through on my own. I ended up all frustrated and embarrassed. Mad at her, mad at myself, black-cloud-over-my-head-ish.

As ever with trying to write about this job, I still have a zillion unsaid things (many still unformed) whirling around in my head, but I have to go pick up Cassie at preschool now. I had a four-hour nap midday today, and will try to sleep normally tonight. I'm back to the day shift the day after tomorrow, 7A-7P.

Nocturnal

2005-11-06T14:12:00.000-05:00

Tonight, in a few hours, I work a night shift for the first time in my life. (The closest I've come is when I worked in a mall movie theater a couple summers when I was in college. Fridays and Saturdays, the last shows ended around 1 am, and then my friends--fellow Crossgates Cinema 12 employees--and I would hang out, talking and laughing and maybe drinking, and roaming around in the benign, expansive suburban summer nights.)

7 PM to 7 AM. I'm a little intimidated by the thought of it. I do it tonight and tomorrow night--tomorrow night being even a bit scarier, because of course a person can do anything for one night, if there's all the time in the world to recover afterward. But if I don't manage to sleep a lot during the day tomorrow, I'm kind of screwed for my second night.

In a community hospital, I guess there would actually be more to be worried about. All the doctors go home, and it really is the nurses' show. If something goes terribly wrong with a patient, you can page, but the MD is answering from his/her own little bed, and it's up to you (well, and of course the other nurses who actually know what they're doing) to deal with it until such a time as help arrives. In a teaching hospital, though, there are always a few covering interns and residents floating blearily around, maybe snatching naps in the call room but not more than a minute or two away.

So it's not that. It's not really rationally justifiable, I don't think. Certainly part of it is, what if I wimp out? But there's also this weird feeling, like night is for sleeping, and working nights is breaking some kind of taboo. And what if everything's different at night? What if it's strange and quiet and creepy? It makes no sense. I can picture what it will be like, really, and if anything, it will be a little bit boring, and also a drag because the cafeteria's closed. But beyond that, it will be awfully ordinary. But there's this dumb, prickly, lingering sense that I'm going to be encountering the unknown.

Well, and I kind of am, because I have a preceptor tonight I've never met before. People say she's nice. I don't know. Kind of everybody's nice. Well. Some people are a little snarkier and have more of an edge than others, but the culture is awfully strong on the unit that all the nurses are nice to each other. It's really striking.

I also am not sure what happens on nights. I think each nurse has more patients, because there's less to do. Substantially less than half of medications are given at night, and there's not changing the bed and getting the patient washed up and stuff. Dressing changes and line changes usually happen on days. Patients mostly don't go down for tests or anything. If they're lucky, they're actually sleeping through much of the night. There's a little flurry of medications and vital signs and stuff around 8 pm, and maybe a few bed-time-ish things around 10 pm, then maybe some IV antibiotics to hang at midnight. Then at 4 am the poor dears get their morning labs drawn, and occasionally you'll hang an IV medication then too. I don't know. I have trouble picturing the rhythm of it. But, well, my ignorance will not now last much longer.

I'll let you know how it goes. Meanwhile, I am off to take the suggested pre-shift afternoon nap to help gird my gravid loins.

Orientation. Disorientation.

2005-11-04T15:43:00.000-05:00

Gosh. Well. I think the thing is, there's so much that I'm taking in, I'm not sure I have anything coherent to say about it.

I started at OFH (Other Famous Hospital, a very large metropolitan medical center) on October 11. There was a week of the kind of orientation where you sit in a room with other new employees, and a variety of people talk at you in 20-60 minute blocks--the first two days were all new hires, and the following three were just for nurses.

I learned that there are about 19,000 employees at OFH, and it's the second-largest employer in the city. I learned that if you are in a threatening situation, and you don't want to alert people to the fact that you're calling security, you can call the security number and ask to "page Dr. Johnson," and then the person on the line will ask you a series of yes-or-no questions to find out what the situation is, and send a security team right over. I sat next to a Puerto Rican pharmacy tech and learned some basics of Puerto Rican-US relations from the average-person point of view. I learned that I'll get paid weekly.

I got my ID, and in my picture you can just tell that I'm wearing my favorite purple maternity jumper, which I have to send back to Marina now, because she had the temerity to get pregnant herself before I was done using her stuff. (Can you imagine?) On my ID, it identifies me as RN, BSN, and a little part of me feels like it's lying, even though it's officially true.

But it's actually starting to happen--my transformation. I am turning into that hospital nurse that until a year ago I never thought for a minute I'd be. It's weird as hell. I have shifts where I'm so caught up in learning the job that I don't even think about it. But there are still occasional moments when I have that shock and feeling of dislocation. I'm watching my hands do something--spike an IV bag, set the flow rate on the pump, or punch into the Omnicell (= SureMed = Pyxis = electronic medication dispensing thingy) and get out some insulin and draw it up--and I have a fleeting alarm go off: WAIT! I DON'T KNOW HOW TO DO THIS. I'M NOT A HOSPITAL NURSE. And even though less than a second later, I remember that of course I know how to do this--and I can walk myself through how I learned--a slight feeling of unreality, or at least improbability, lingers. My whole self-perception hasn't caught up. I have trouble integrating it into a coherent whole. How is it that I can actually continue to be myself at the same time that I am this creature who wears scrubs, and tracks Is and Os, and knows which line of the triple-lumen Hickman you give the antibiotics through?

The other freaky thing is that I seem to be blissfully happy at it. That's even stranger, really. I haven't figured out how to think about that. Time will tell whether it's lasting, I guess. I've only done--let's see, I've already lost count, but maybe 5 or 6 shifts as a genuine employee. I'm still on orientation (and will be for several weeks to come) and haven't even gotten back to having two patients yet (though I did that a couple times while I was doing my clinical for school). So things could easily get hairier, workwise. I mean, they will for sure in some ways. The thing is, I feel ready for it. The other nurses are helpful and available, and I don't feel alone at all in what I'm doing. That's huge. And I'm also really grooving on doing patient care again. I love, love, love getting to talk to people, making a little relationship with them, making it so they feel heard and noticed and genuinely taken care of. I don't know. It's just so much fun.

I'm starting to think that maybe the novelty is also part of my ultra-Prozac glow these days. As much as I think that I hate being new at things, hate being bad at things, it is also true that I hate feeling stagnant and bored. I get all stale and cranky and in a funk if I'm not learning anything any more. And I guess maybe feeling a little overwhelmed by all there is to know makes me feel exhilarated. It means there's something to strive for, something that's bigger than me. I don't have that claustrophobic feeling of sitting around just breathing my own air. So maybe in a few years, once I kind of have this job down, I'll start feeling itchy again and ready to take on something new. It's actually a little bit reassuring to think so, because it jibes better with my own self-image than this picture of the happy nurse, padding blithely around the ward in her dorky shoes (among the younger, hipper nurses, Dansko clogs--preferably in cordovan--seem to be the de rigueur accompaniment to scrubs, but I find I am content in the ridiculously retro, insanely nursy white lace-ups I bought in nursing school), charting vital signs and emptying urinals with a bizarre sense of deep fulfillment. (I mean, really, wtf?)

I think I have about a zillion more things to say about my last few weeks, but they'll probably keep. I really want to empty wastebaskets and clean toilets, not to mention, um, actually brush my teeth, before I go pick up Cassie at preschool. (I have the hardest time structuring my days off, and I seem only to be able to get things done in a lurching, haphazard way.)

More soon.

What to Eat When You're Three-and-Two-Thirds

2005-10-27T17:07:00.000-04:00

You are now practically a grown-up (except, of course, when you are not--no one here is denying you the prerogative to exclaim "but I'm just a child!" as needed). Here are some changes you might consider making to your current diet:

Think about beginning to dislike macaroni and cheese, reducing by 33% your acceptable dinner entrees (the others being, of course, chicken nuggets and pizza). You might, however retain a fondness for buttered egg noodles, if you want to go a little easy on your parents.

Shake things up a little by suddenly being willing to eat one vegetable. Be careful, though, not to choose a particularly nutrient-rich vegetable. Cucumbers or iceberg lettuce might be good, but we suggest celery. Celery with lots of salt carefully applied by oneself without the help of some buttinsky grown-up (grimly determined expression optional).

You may wish to announce that you don't like raisins any more. If the ensuing discussion includes a mention of grapes without water in them, you may, however, express a great interest in obtaining some of these fabulous fruits. If it turns out that raisins are, in fact, grapes without water in them, you may then feel free to eat them with gusto.

There are also some categories of food that you, the 3 2/3-year-old, should avoid at all costs (N.B.: unpredictable and idiosyncratic exceptions are, however, not only permitted but strongly encouraged).

spicy
hot (more than 2 degrees Farenheit above room temperature)
messy
for grown-ups
green

The real joy in being 3 2/3, however, is in the diet details. Here is a recipe you might wish to insist on having made for you for breakfast two mornings in a row. (You need not ever mention it again.)

1 slice bread, lightly toasted, crusts removed
butter, spread to edges
French's yellow mustard
cinnamon and sugar

Can We Go Back to 2000 and Have a Do-Over?

2005-10-04T12:47:00.000-04:00

The President's press conference was on the radio. Pete isn't teaching today because it's a Jewish holiday, and there are no classes. Pete said, "Listen to his voice. It sounds like he's drunk or something." We listened together. The President's voice is near the top of a very long list of things about him I can't stand. He seems to have two tones of voice--one smug and snickering (that seems to be the one that most impersonators go for), and the other (much more common, in my perception) a perpetually aggrieved-yet-defensive whine, as if continually responding to invisible enemies (a kind of "how many times do I have to try to talk sense to you people about this" tone) regardless of context. But Pete was right. The President definitely sounded a bit off. Pete put his finger on it first: "He sounds depressed."

He really did. His annoying, whiny voice sounded flat and heavy, weighed down by those oh-so-familiar bags of lead. Depression. And for the first time, I actually felt a little flicker of human compassion for the guy. Is it finally starting to dawn on him, as a whole lot of shit is hitting a whole lot of fans (Iraq, FEMA, DeLay, oil prices, plunging polls...), that he's really not up to this, and truthfully never has been?

Ah, probably not, I guess. But still. Still, one doesn't envy the guy. You can blame him, you can dislike him (lord knows), but somehow there's no glee in watching him have to lie in the foul, foul bed he's made. Of course, he's made it for all of us, which makes it worse by a factor of approximately 294 million.

Bleah.

Classic?

2005-10-04T00:30:00.000-04:00

Cassie is coloring a page in a coloring book, which depicts a basket of fruit. She has colored the grapes, the cherries, and the apple red. She looks up at me. "Plums are purple."

Unbidden come marching through my head battalions of pale green Reine Claude plums, squads of round red supermarket plums, neat rows of those speckeledy pink plums. "Um," I say in hesitant agreement, "Lots of plums are purple."

"Well," she says, in a surely-we-can-at-least-agree-on-this acknowledgment of my qualms, "purple is the classic color for plums."

Query

2005-10-04T00:25:00.000-04:00

In addition to her own death, Cassie evidently has other weighty matters on her mind: "Is ice cream really just very, very cold frosting?"

The Mortality, She Is a Beetch

2005-10-03T14:52:00.000-04:00

I didn't think that this part started until, I don't know, age 7 or something. But here we go, apparently 3 1/2 is the age in this case. Several times now, prompted by who knows what train of thought, Cassie has started to cry piteously before bed, face all crumpled up and desolate. When I manage to get out of her what's wrong, it's this (in an incredulous, desperate whine): "when I die, I won't ever be alive again?!"

What does a sweet, gentle, loving, stone-cold atheist mom reply to that? "Buck up, kid, at least you won't burn in hell"?

I've found a bit of success with the assertion (put forth with feigned certainty) that Cassie will not die when she is a child, and she will not die when she is a teenager. She will not die when she is a young grown-up, or a medium grown-up, or even just a sort-of-old grown-up. She will only die when she is a very, very, very old grown-up. (Tvuh! tvuh! tvuh!) Once Cassie asked me, "say that part again?" so I figured I was on the right track.

I have, however, been reduced in the end to pointing out that some people think that we go to Heaven when we die, and some people think that we're born again as new people or animals. We don't really know what happens when we die, since nobody alive has ever been dead before! (This last part even got a little giggle-through-the-tears the last time I used it--must have been the delivery.)

It's so weird, being a parent and having to confront these little controversies and uncertainties and secret personal truths--things that you can very successfully fudge when you're only dealing with adults, because nobody's going to ask. Gender, morality, death. What's the difference between men and women and ladies? Are mosquitoes mean? Why is it not polite to show your underwear when you'r wearing a dress? When is Ennui (the cat) going to die?

Meanwhile, although Cassie is also a a little unhappy about the prospect of my dying, at this point it's also an idea she can approach somewhat philosphically. She tells me, "when you die, I'm going to go and have lots of new adventures."

Most Likely

2005-09-29T14:53:00.000-04:00

Recently, as a not-too-time-consuming procrastinatory/entertainment activity, I've started to Google people from my past: my sixth-grade best friend (now a middle school social studies teacher, best I can tell), my third-grade best friend (impossible to track down, since she has the same first and last name as somebody who's been in the news a fair bit), the boy I had a crush on in the first half of elementary school (Ivy league professor specializing in Japanese popular culture), a particularly flamboyant camp counselor (can't tell what she's been up to--the combination of her first and last names, which seemed initially as though it must be unique, turns out to be a not uncommon upper-crusty joining of two old family names). And then, some people you know are just going to be a lost cause, so you don't bother looking: Margaret Baker, Rebecca Henderson, David Olson, Ricky Smith, Paul Giordano, Tony Peters, Debbie Ginsburg.

A day or two ago, I looked up a boy from my elementary school. He used to be kind of shy and second-smallest in the class, with moss-green corduroy pants, a pale little chin, and a flop of heavy silken dark blond hair constantly in his eyes. He would take time out regularly from third grade to go to the high school for math classes. I had found out some time ago that he and my husband actually went to Ivy University together as undergrads, and I knew they'd been in touch periodically since, though I didn't know details. I pictured him still small and eccentric, still slightly unkempt in green corduroy, and maybe, I don't know, a professor of theoretical physics at Reed or something. Yeah. Um, turns out he's Acting Under Secretary of Commerce for Industry and Security for the Bush Administration. Yikes. There's a picture. Short hair, suit and tie, a strong jaw, and scary, ultraconfident eyes.

Political allegiances aside, it made me think of all those women in the class notes of my college alumnae bulletin. I mean, I know, I know, I know that it's the classic response to reading one's class notes, but I can't help but feel abashed when I see the titles, the achievements. And I know, I know, I know there are plenty of others who haven't scaled any professional peaks, who are just going along, living odd or ordinary little lives. Having kids, gardening, organizing adult soccer leagues, learning to knit. But the other day I realized, reading the New York Times online, that the name in a series of policy article bylines I'd been half-registering as familiar was not that of somebody famous, but of a woman a couple years ahead of me in college. (Not to mention a founding mother of the Cool Smoking Lesbian clique that persisted to my year.)

I guess it all reminds me of what I thought I'd be. I think that a long time ago, I really thought I'd be special. I think I really believed that there was something about me that meant I'd always be lucky, and always impress, and find myself rising inexorably, if perhaps seemingly serendipitously, through some as-yet-unimagined but terribly important professional life. I didn't worry overly much about finding my path, figuring it would just happen, as easily as anything, as easily as I won a spelling bee or got an A+ in Trigonometry. In the high school yearbook, I was "Most Likely to Succeed." I effortlessly believed the hype.

What is it that separates those of us who scrape by, who just manage to get by day to day, from those golden, high-achieving ones we used to sit next to in freshman English? I have these moments of what feels in the instant like clarity, when I think it's mostly just expectations of oneself. That if I fully and naturally believed that I should and would end up as--whatever--President of Habitat for Humanity, a respected character actress in prestige films, US Secretary for Health and Human Services--that I would start doing what it takes to get there. And then I actually might get there, or alternately, might get somewhere just as good.

There's the old joke: Moishe asks G-d, "please let me win the lottery." Each week, Moishe's prayers get more insistent, more pleading, full of reminders that he has never asked for much, and promises that he'll never ask for anything else again. "Please, please, please, let me win the lottery!" Finally, G-d's voice booms down, "MOISHE, DO ME A FAVOR... BUY A TICKET."

I take solace in stories of late bloomers, people whose first notable achievements came in their 40s, 50s, 60s. There aren't that many, but there are some. And it does occasionally occur to me to try to cut myself some slack. My therapist said when I first started going to her, "When I see someone in their 30s or 40s who has clearly not lived up to his or her potential, my first thought is always depression." So, um, yeah, there's that. And there's having spent my 20s with chronic fatigue syndrome.

I'm itchy now, though. Itchy to get on with it, but still unsure what "it" is going to look like. Once I start my job as oncology nurse, I imagine that will keep me busy and striving and absorbed and learning and moving forward for a while. And making myself into a good oncology nurse can be the necessary next step in whatever my (delayed, idiosyncratic) career trajectory is going to be. I might also remind myself that in my heart of hearts, I am just fine not being Acting Under Secretary of anything.

Could We Maybe Call It Something Else?

2005-09-22T09:49:00.000-04:00

Pete signed Cassie up for gymnastics. This kind of gave me the willies. I guess the picture in my head of "gymnastics" is a bunch of skinny, snotty little girls with perky ponytails and lip gloss whizzing around in hideously sporty bodysuits and making fun of the halt and the lame. Insert sweet, earnest, soft, klutzy Cassie into this picture, and... eeuughh. Not good.

See, there's been this ongoing concern about Cassie's gross motor development. At both her 2-year and 3-year check-ups, her pediatrician was concerned that her gait looked kind of funny. The teachers at preschool have mentioned that physically she's not really at the level of other kids her age. At home, she trips over her own feet. She even got an evaluation by a physical therapist who thought maybe one leg was longer than the other. She's clearly a bit pigeon-toed (like her mama). So in discussing the issue with the pediatrician, we agreed to schedule another appointment with an orthopedist. (Pete took Cassie the first time a year or so ago, but the guy they saw kind of brushed them off without even really doing a full exam, treated the report of the physical therapist's concern with derision, and was generally just an arrogant asshole.) And the other half of the plan was to get her in to some kind of extracurricular activity that would help with coordination.

Pete had mentioned swimming lessons, which sounded great, and I was also thinking maybe dance classes (to me, infinitely more gemutlich than gymnastics, probably because the connotation is artistic rather than athletic). But I was dawdling about signing her up for anything, partly because I still don't know what my schedule is going to look like, and partly because spending any money makes me so anxious these days. And then, a couple weeks ago, Pete announced he'd signed her up for this gymnastics thing. And so what could I say? Well, I guess I did kind of make some doubtful, "we can just wait and see how she likes it, right?" sort of noises. But basically, he'd risen to the parenting task, and I hadn't, so we'd do it his way.

Pete took her for the first class last week. It was the day of my job interview, so I was distracted enough not to think about my tender child being subjected to the terrors of a commercially offered gym class (projection, much?). But then when I got home, I remembered all in a rush, and anxiously hit Pete and Cassie up for their verdict. Pete was casual, nonchalant: "It was good." Cassie, on the other hand, was bouncy and very enthusiastic, though I wasn't quite able to follow the whole narrative. Something about frog jumps and walking like a jaguar and having cookies on your arms. I was unspeakably relieved.

Later, after Cassie was in bed, Pete told me about getting to see another of Cassie's peccadillos in action--her preschool teachers had mentioned in our parent conference that while she is utterly reasonable and tractable when you ask her individually to do something, she often seems oblivious to the fact that she is included in "everybody" (as in, "everybody sit down on the rug now" or "everybody put away the blocks"). Pete said it was the same way in gymnastics--she would wander vaguely off until specifically and individually asked to join the group, at which point she would immediately and readily comply. He said that the instructor was not only tuned into this but also articulate about it in a little, informal end-of-class check-in, as well as entirely matter-of-fact and non-judgmental. Well okay, then, I thought. Okay.

This week, Pete was invited to lunch by the Dean, who is apparently going through and meeting with faculty and generally trying to make nice (there are some changes going on in the institution, and faculty are apparently feeling pretty skittish in some quarters). The wisdom is that if you're invited to lunch by the Dean, you go. The problem was, it was on a Wednesday. Daddy-Cassie day. Gymnastics day. So I was called upon to go beyond feeling a distant relief and grudging acceptance, and to participate materially in my daughter's going to gymnastics. I would give her a ride, and then sit outside the gym on the other side of the one-way mirror and watch it all happen.

I dressed Cassie in the requisite comfortable clothes (no leotards involved, blessed be). I made sure she peed before we left. For myself, I brought cinnamon tea and the New Yorker. As it turned out, I barely made it through half an article. The spectacle of one's own child and four others of similar ages jumping around in a primary-colored gym is surprisingly riveting. It also seems that Cassie has made some real strides in gross motor development lately. Running around the mat during the beginning warm-up, she looked graceful and at ease. She frog-jumped and bear-walked seemingly effortlessly. She's still excessively cautious (again, like her mother), needing to be coaxed through the small tunnel, and approaching the inflated bouncing mat shyly and gingerly before every one of her six successful times across it. And there were certainly things that she looked awkward at. But she didn't look out of place with the other children (unfortunately, that was left to Angie, the very pudgy little girl who had trouble even mustering a jump on the bouncing mat). She looked fine. Age-appropriate. And she looked like she was having a pretty good time.

So who knew that this would be an opportunity for my personal growth. Just as Pete manages to pretend that he does not have a spider phobia in front of Cassie, I will keep my inner writhings about the idea of gymnastics to myself. And maybe I'll even learn something.

Seconds

2005-09-20T11:53:00.000-04:00

Being pregnant with a second child is very different from being pregnant with the first. So much so that I'm half-worried I'll forget to go into the hospital when I go into labor. You know, I'll be busy and preoccupied with other things, and it just won't seem that important. Oh, yeah, having a baby. I'll call the midwives any minute now, really, just give me a sec to track down Cassie's other shoe and check the weather online and get in one more load of laundry and maybe write a quick blog post. And one thing will lead to another, and the head will be crowning, and I'll be wishing I'd gotten around to sweeping and mopping the kitchen floor because now it's all gritty under my butt.

I'm actually a little concerned that as a firstborn myself, I'm not ideally cut out to be the mom of a second child. What if I still retain all kinds of long-repressed resentments of the intruder into familial paradise that was my little brother? What if I hold second-childness against my own second child? (Not that my transition to being a big sister was particularly rocky, I don't think. If so, it doesn't show in the home movies, anyway. Plus I think my mom would have said something.) I guess it really is a bit early to say. I'm hoping that as this sort of theoretical child, represented currently as a fat belly and finally ebbing nausea, becomes an actual child, I'll get substantially more excited about it. At the moment, though, I'm uncomfortably ambivalent.

Babies are boring, for one thing. They're dumb little blobs that don't do anything but make noise and stink.

I think I might not have always felt this way. I seem to remember, actually, when Cassie was a newborn, feeling a kind of pity for the parents of those large, ungainly 9-month-olds, and certainly for parents of (shudder) toddlers, all huge and rough and loud and horridly un-cute. Thinking back, it may well be that I have consistently maintained an impressively delusional sense that whatever age Cassie is right now is the very best age that a child could ever be, and a conviction that babies and children in other age categories are simply inherently less lovely. So it happens that right now, 3 1/2 is the fabulous age, the pinnacle of childhood greatness. But I am starting to realize that it is possible that I am not quite entirely impartial on the subject.

So can I count on it happening again? When this one is born (in early March-ish), will I find myself with a sudden sureness that neonate and 4-year-old are the two perfect ages? Man, I hope so.

I remember that before events like moving, or going off to camp, or going off to college, somebody would reassure me that I would make new friends. And I would feel this great indifference, shading into distaste. I don't like people I don't know, I would say. And I guess theoretical babies are really not much different from theoretical friends. I don't like babies I don't know. They're stupid and boring.

At least I have had a few brief moments, split seconds when I've felt excitement about this whole new unknown human who's going to be joining us, along with a pure and sweet love and protectiveness. I had an ultrasound* a few weeks ago, and seeing the little face and limbs and brain and beating heart gave me a rush of that feeling. (Those right-to-lifers who set up "pregnancy crisis centers" and then get conflicted pregnant girls in for an ultrasound right away definitely know what they're doing. It really makes the pregnancy feel less abstract.) And I've had a couple other moments, too, here and there. Even just listening to the fetal heart tones on doppler in the midwife's office helped. And also when Cassie's teacher said that Cassie is talking about this as "her baby" ("Is it your Mama and Daddy's baby, too?" the teacher asked. "No," said Cassie breezily, "just mine.")--I guess because hey, if this baby is Cassie's, too, then it's not an interloper, it really belongs.

Then there were a couple of days a week or so ago when I was feeling some uterine contractions, and it freaked me out, thinking I might be at risk for miscarriage. I spent nearly two days depressed and paralyzed and crazy miserable before I finally called my midwife, and she asked me a couple questions, then said all kinds of reassuring things, including that she was almost certain that the pregnancy was not threatened. Whereupon I felt like singing and dancing and laughing and crying all at once. And then a few days later, I had a very vivid and realistic dream in which I innocently went to the bathroom, and then there was all this blood on the toilet paper, and I got hysterical, and woke up with my heart pounding. So, you know, maybe I do actually care a little bit about this pregnancy.

I don't know. I guess I just have to trust it's going to work out. It really doesn't happen all that often that a mom truly doesn't like one of her children. I guess it's not unheard of, but the odds are probably on my side. I just hope this kid isn't stupid and boring.

* For Early Risk Assessment--have you heard about this? It's new since the last time I was pregnant, so I hadn't known much about it. They do a certain set of measurements--of nuchal translucency--on ultrasound, and perform a couple of particular blood tests, and factor in your age and some other stuff, then they calculate a risk for Down Syndrome as well as Trisomy 13 & 18. So then you can decide whether you want to go ahead and have an amnio. Based on the results, this kid has a 1 in 125 chance of having Down Syndrome and a 1 in 3137 chance of having Trisomy 13 or 18, so I'm going to skip the amnio, especially since I think I probably/maybe/definitely/possibly wouldn't decide to terminate if there were Down Syndrome anyway. In a backwards way, it might even be easier not to know for sure.

Strangely Un-FP

2005-09-16T10:07:00.000-04:00

I had my interview yesterday. Finally. The HR person really did take her sweet time in arranging the meeting with Maureen, the nursing director for the unit. But it happened. We met, and we talked, and I pretty much just told her the Story of Me (including the touchy bit about how it came to be that I left Famous Hospital after the Dramatic Incident), and she told me a little bit about her own story and her values and philosophy for being a nurse manager, and some of the current (very thoughtful) adjustments being made to the nurse training process. She talked about the difficulties and strengths as she's seen them in people like me moving into a staff nurse role. AND and and, at the end of our chat (more than an hour long), she offered me the job.

So in a couple short weeks, I will be an oncology nurse at Other Famous Hospital! This is on the floor where I did my precepted clinical experience for my nursing refresher course, and at this point (probably a bit honeymoon-ish still, I guess) I just can't imagine a better inpatient unit. I have been continually impressed with the level of matter-of-fact, unpretentious commitment of the nurses; their supportiveness of one another; their existing scope of knowledge and the readiness of even the most experienced nurses to learn new things as the occasion arises; their genuine respect and regard for their patients. And none of it is goopy or fake or sugary or over-the-top--it's all so low-key you'd think they weren't doing anything extraordinary at all. And besides all this, the unit is well staffed, and the hospital infrastructure things (supplies, linens, patient transport) as well as the supportive services (lab, radiology, pharmacy) are as close to well-oiled-machine status as I've ever seen in my limited experience with hospitals. Not to mention, the physical therapists are great; the chaplin is great; the dietitians are great; the nurse's aides are great (well, mostly--there is Lazy Cecilia, but she's definitely the exception); the desk clerks are great. I mean, really, it's almost eerie.

I'll be making about the same as I was in my ill-fated position at Famous Hospital, maybe a bit more (especially when you consider $5/hour above base rate for evenings; $7/hour above base rate for nights; and an additional $4/hour above base rate for weekends). And there are vision benefits! I've never had vision coverage before. And for $36 a month, I can join the on-site gym, which apparently has an indoor and an outdoor pool. I mean, jeez. It's almost as if, from Funny Pathetic, I'm being catapulted into Funny Ridiculous Good Luck.

Well, I mean, we'll see, right? Who knows what's coming. Maybe this is the end of seven years of bad luck after breaking some mirror I don't even remember. Or maybe it's Pride Goeth Before a Fall. Or the eye of the hurricane. After all, life is so rich in possibilities for sudden tragedy, never mind sudden disappointments and set-backs. You really don't know.

But, well, at this moment, I may tell you that I have accepted a job in a wonderful place doing really good work; Cassie is happy and healthy and got an excellent haircut this week; and my uterus has nearly reached the midway point between the symphysis pubis and the umbilicus, with nice fetal heart tones. The index for Pete's book is finally done; my Jetta gets good gas mileage; the house is getting a bit less chaotic as I have some days free. And I just got some chamomille-scented baby shampoo to wash Cassie's hair with, and it smells really, really good.

Nausea

2005-09-13T14:40:00.000-04:00

Eep. It's been a really, really long time since I've posted. And now I'm all tongue-tied, and it's hard to make the words come out. I told myself that today I would just put up the fragment of a post I wrote more than a month ago, and then tomorrow I will be braver and stronger and start again trying to make more words on the screen.

By the way, the nausea is still, at 14 1/2 weeks, not entirely gone. But it is way, way better, and I'm duly grateful.

July 27, 2005

In a perverse way, it seems easier to write when one doesn't have anything in particular to write about. Then it's just playing with words, following one's nose, until maybe something develops. Or maybe it doesn't. But then that just leaves more space to write something, anything, as soon as a fragment of an idea arrives.

When there is not only a thing to write about, but a Big Thing, it suddenly seems to get heavier and more difficult. I suppose it has to do the nagging feeling that one can't possibly do justice to the topic with anything less than a bildungsroman-meets-doctoral-thesis to the tune of 1500 heavily footnoted pages. Well, and then there's how a Big Topic gets all kind of murky and boggy and inchoate in spots, especially if it's emotionally laden. There's just not a nice, clean, crisp, dry way to get from here to there. Every attempt to write passages in one's head seems to end with getting stuck up to the chin in a morass of intellectual complexity and mixed feelings.

It wouldn't be so bad if one could just write about other things in the meanwhile. But there's something about the Big Topic that traps a person's mind in a useless high-rev, wheels spinning, burning lots of gas, getting nowhere. It happened to me before when I was trying to figure out a way to write about my struggles with chronic fatigue syndrome. I didn't write for two weeks as my mind spun and spun. Finally I was able to find the wisdom (or luck, or fatigue) just to give it up--telling myself a soothing story about how someday I would really sit down and write about it, just not now--and then start writing again about something else.

This time my wheel-spinning has had a somewhat different quality, but the ultimate result has been pretty much the same. So here's the Big Thing. I'm pregnant. Newly-ish. It will be 8 weeks tomorrow (in that kooky teleological way they count it, from the first day of your last menstrual period, as if from the moment you started bleeding, you were somehow destined to conceive 14 days later). We'd been trying, so it's neither undesired nor unplanned. It's still managed to feel surprising, though. I had begun in earnest to come around to accepting the idea that Cassie might well never get a sibling. (After all, I'm 39 and counting, and fertility starts going down fairly steeply around age 35, and it had taken 2 years to get pregnant with Cassie, and that was 4 years ago, and, and, and... )

One of the things about pregnancy besides the somehow inescapable mind-blowing-ness of it is the morning sickness. Sometimes the nausea is so big in my consciousness, it feels like anything else I think or feel has to squeeze through around the edges of it. The whole center of my mind is taken up with this big, uncomfortably overinflated balloon of queasiness.

When You Assume...

2005-07-16T14:45:00.000-04:00

In my experience, toddler illnesses are often like episodes of the Simpsons. You know how you can never tell what a Simpsons is going to be about at the beginning? Never a truly great Simpsons scholar, I'm afraid I can't give you any actual examples. But there's definitely this thing that they do where the opening scenes seem to be heading the plot in one direction, and then at some point about five minutes in, things veer off in another direction entirely. Say the first five minutes is about, I don't know, Bart getting his first B+ or something, and then you think that the whole episode is going to be about Bart and school, but then Marge and Homer decide to celebrate by taking the kids to an amusement park, and the actual plot turns out to be all about the amusement park. That's a lame example, but I imagine you know what I mean.

And so it is in the world of infectious disease in the under-4 set. The first signs of illness are crankiness and vomitting, and it turns out to be... strep throat. Or the first signs of illness are a fever and clinginess, and it turns out to be... an ear infection so bad it bursts the eardrum. And so it was this time, as Cassie's symptoms leading me to think of a bacterial infection, probably bladder, turned out to be... well, viral, anyway. Quite possibly Coxsackie virus (a.k.a. hand-foot-and-mouth disease), which gives you nasty painful ulcerative sores... in your mouth and throat. The bladder thing is looking now like a total red herring.

So, well, whatever. At least we don't have to figure out ways to get antibiotics into her several times a day. And her fever's gone, or nearly so.

The unfortunate thing (well, besides my having to miss clinical yesterday) is that this is the weekend that Cassie got to bring home Buzz Junior Teddy. BJT is a silver-clad astronaut bear who goes home for the weekend with each preschooler in turn, and gets his adventures documented with photos and narrative in the notebook that comes with him. Cassie's mentioned this whole thing several times in the past, and I think it's kind of a big deal to her. And we just have not been showing little Buzz a very good time. At least I had the presence of mind to take the traveling bear and our camera to the pediatrician's office yesterday, and got a shot of him on Cassie's lap as the doctor listened to her lungs, and then another one of Buzz posed nicely next to the glass jars of cotton balls and tongue depressors. Rather arty.

We hope to be able to go to the art museum tomorrow, if Cassie's well enough. Our friend Lucine would come along, and Buzz could look at the mummies, and a good time might be had by all. I'm keeping my fingers crossed.

Let Me Call You Sweetbladder

2005-07-15T03:58:00.000-04:00

Cassie got sent home from day care this afternoon as per Center policy because her temperature went over 100.5 (it was actually 101.3 by the time Pete got there). Also, Cassie told Paula, Center Director and acting preschool room teacher, that her "heart hurt," which, as Pete said, "freaked the bejeezus out of Paula." Fortunately, on further interrogation when I got home, Cassie indicated that her "heart" was at the bottom of her abdomen, with pain radiating to her vulva.

It seemed like whatever she had going on was probably bacterial, because even at the peak of her ibuprofen, her temp was still 100.8 around 9:30 pm. She woke again crying around 3:15 am, but her temp was now down to 99.9. So who knows what's going on. I'll call her pediatrician in the morning to see if we can go in and get a urine dipped.

The thing is, tomorrow was going to be a little catch-up day for me. I have clinical 3P-11P, so I planned not to go in at all to my temp job. And with Cassie in school, I was going to get to answer e-mails and study about oncologic emergencies a little (at the suggestion of my preceptor) and clean the downstairs toilet and do a load of laundry. You know? Well, as Roseanne Rosannadanna's grandmother always used to say...

3rd Day

2005-07-13T09:17:00.000-04:00

It seems not to be until the next day that the exhaustion of a 12+-hour shift hits me. My limbs feel heavy, and my whole body feels kind of depleted, and I just feel like lying very, very still. During the shift, though, and when I get home at night, I'm mostly all peppy and bouncy, except that my feet just start to hurt. I'm all revved up on adrenaline and this uncanny cheerfulness.

I also hate to even think about my varicose veins. I haven't been able to bring myself to wear support hose in July. But I really, really will once it's September. Or, you know, October. I'm not really claustrophobic, but my legs seem to be. They hate the thought of being closed in the tight grip of an industrial-strength sheath of nylon and lycra. "No! no! no!" they cry out piteously in their squeaky little leg voices, "Air! Air!"

We had three patients on Friday. There was good old Mr. B, who said that the fireworks were, indeed, quite impressive from his hospital room window on the 4th--the best he'd ever seen, even. He looked kind of terrible, somnolent and stubbled and diminished-looking. He said he was feeling incredibly fatigued and sleepy, and I could tell it was kind of freaking him out. So then I started feeling anxious about it too. But Julie, my preceptor, said that at this point in his course (2 days after his bone marrow transplant, after more than a week of nasty-ass chemotherapy), that kind of misery was, unfortunately, pretty well expected, but we'd keep a close eye on him in case he had anything cooking. His temperature actually did get up to 99.3 mid-afternoon (and for somebody with essentially no white blood cells, any little bit above normal is considered a real fever), but to my relief it came back down again promptly. He also got a unit of blood, since his hematocrit had dropped below 25, and we were hoping that might pep him up a little, but it really didn't. His friendly family--wife and two teenagers, a daughter and a son--came in the afternoon, all wearing green shirts for some reason and looked like a doting matched set, but after a little while they just left so he could sleep more, which was all he felt like doing.

Then there was Mrs. R. She'd been needing a sitter because she'd been delirious and trying to get out of bed unaided, and I guess that a couple days before that, she'd been pulling out her lines. The night nurse gave us report, though, and said that overnight, she'd mostly been quiet, sleeping on and off, and that the sitter hadn't had to do anything. And for our 12 hours, she was absolutely the picture of lucidity--thoughtful, wryly funny, gentle. Her very short hair (still growing in after chemo?) was messy from her being mostly bedbound, but ended up looking rather downtown and stylishly tousled, and was remarkably soft to the touch. She had wide, striking eyes in a pale, pale face. She was in her 70s, and her breast cancer had recurred, widely metastatic now. She had had terrible belly pain and vomiting from the tumor invading her small bowel and causing an obstruction, but they'd managed to place a stent to hold open her duodenum, and at least her GI symptoms were now largely resolved. The physicians talked together about having the conversation with her and her family: we think that it's time to stop trying for a cure and shift care to "CMO" (an acronym I actually hadn't heard before but from context could tell must mean "Comfort Measures Only"). The conversation didn't happen Friday, though. I couldn't tell whether they were stalling, or whether their given reason (to wait to talk to the consulting specialists to have the whole picture) was real.

In the afternoon, somebody brought Mrs. R two perfect peony stems--one a full-blown dark magenta bloom with a ring-shaped golden yellow center, and one a plump pink bud ready to open at any moment. She was terribly hoarse, and could barely do more than whisper, but she managed to ask me if we could do something with them. I was the only one in the room, and so I said I thought that unfortunately, since this was an oncology ward, we might not be able to have them in water in the room, but I would check. "Or just put them somewhere!" she said. I think she just wanted to make sure that such beautiful flowers would be enjoyed by somebody. I asked Julie, my preceptor, though, and it turned out that Mrs. R's white counts were fine, and her roommate had just been made a hospice patient that morning, so the peonies could stay in the room. I peered into the locked clean utility room (I don't have an OFH ID to swipe in, so I have to ask a staff member to let me in when necessary) to try to figure out something we could use as a makeshift vase, but the water pitchers were kind of too squat (and distinctly unlovely), and the only other thing that seemed like it might work was the white plastic urinal bottle for male patients. It was the right size, and even had kind of a graceful shape, but I couldn't bring myself to subject the flowers to the indignity. Finally I took a couple more swallows from my 2/3-full Diet Coke and poured the rest out, rinsed the bottle, tore off the label, and brought it in to Mrs. R's room. It was just right.

Finally there was Mrs. T, coming in under her own power, for a carboplatin desensitization. She'd had a possible allergic reaction to it before, at an earlier point in her treatment for ovarian cancer, but other therapies had failed, and the tumor was growing in her belly again, making her feel bloated and achy and taking away her appetite. So now it was time to try the carboplatin again, which meant following an elaborate and very carefully paced protocol to reintroduce it while monitoring her closely. Mrs. T, too, had very short hair ("When I had chemo, all of my hair fell out..." [significant pause, raised eyebrow] "All of it."), which suited her nicely. She was dressed in casually preppy clothes and seemed remarkably relaxed and cheerful for someone who was in to receive a flow of a medication she might be allergic to directly into her bloodstream (for the purpose of treating her recurrent potentially lethal cancer). She explained, though, that her symptoms had been bugging her so much lately that all she wanted to do was get the show on the road and start getting more chemo. She'd even talked her doctor into squeezing her in so she could get it a week earlier than originally scheduled.

We weighed her and measured her, drew another chem panel to verify that her creatinine continued to look great (which it did), pre-medicated her per protocol with Claritin and Benadryl and some other meds I'm forgetting. She'd taken some stuff the night before and that morning, too. And then Julie (clad fetchingly in the brilliant blue gown and special purple gloves used to protect nurses giving chemo) started the carboplatin infusion. Fortunately, it went great. Mrs. T decided to keep her own clothes on, so she was sitting there on the hospital bed as if in Chemo Cafe, in her jeans and blue and white striped button-down (unbuttoned a bit so we had could have access to the Port-a-cath in her chest), reading glasses on her nose, sedately flipping through the newspaper and making pleasant conversation with us when we came in to check on her or hang the next bag of stuff. Her vital signs stayed steady as Gibraltar, and she had no complaints besides a bit of boredom (we developed a running joke that the next time Julie and I came in, we'd do a song-and-dance routine for her). Would that chemo were always so uneventful.

And me, well, I had some more moments of feeling overwhelmed and ridiculously inept, but I think maybe I'm starting to get a little bit inured to the feeling, because it didn't bother me quite as much. And Julie is so very nice about it. Toward the end of the shift, she apologized for being scattered and then (apparently having been looking at my resume again, which was sent to her when she agreed to precept) said something about how even though I hadn't done hospital nursing, I'd done so many high-level nursing things. "You could have come in with a real attitude, with all the things you've done," she said, and gave me to believe that she's seen some real attitudes in her time, "but you're so humble!" I was kind of floored. It hadn't really occurred to me to give myself points for humility, which feels, I must say, very well earned. But I'm grateful and relieved that she sees it that way.

The hardest part now is going back to my dumb temp job. As I get going with clinical, I find have less and less patience for mindless clerical tasks (well, actually I guess I have some patience for the truly mindless stuff, because then I can at least think about something interesting--what's truly killer is the deeply tedious clerical tasks that nonetheless require attention and thought). I get so antsy sometimes I have to get up and walk around a little so I can stay in my skin. And refrain from yelling "WHO CARES?!" at my computer screen.

FUO

2005-07-06T00:09:00.000-04:00

I can't sleep.

It's probably the fault of the cup of coffee I had around ten this morning. We went to visit Pete's parents this weekend, and I forgot to take my antidepressant with me, and I think I revert back to my old caffeine-intolerant self when I haven't had the 'zac in a few days. (Fully medicated, I am able to drink an entire cup of coffee with no ill effects, which is a lovely little thing.)

Rather than lie on the dumb bed and listen to my mind chatter away, which was getting to be a little irritating, I thought I'd come let it chatter at the computer for a while instead. This insomniac mind has, oh gosh, just lots of tedious things to say, let me tell you. Well, I suppose it might have some interesting things to say too, except they're kind of getting lost in all the noise. With a hundred tiny thoughts rattling around like dried beans in an empty Crisco can, no one thought has any more value or weight than any other.

I've been running a low-grade fever for no apparent reason. I had this once before, when I was working as a geriatrics clinic nurse and absolutely running myself into the ground with work and stress. I saw a couple doctors, and as near as we could figure, it was just a different kind of manifestation of my chronic fatigue syndrome. The Infectious Disease doc thought it had something to do with an overproduction of cytokines. In the afternoons, my temp used to get as high as 101.5. I haven't measured in the afternoon this time around. An hour or so ago, it was only 99. But I've felt unpleasantly warm all day. Pink-cheeked. Febrile. It's annoying, but way better than the other kind of CFS times, because fever is the only symptom.

I got a wristwatch finally because if you're a hospital nurse, it's generally considered good form to actually be able to take pulses and respiratory rates. It was $20 at Filene's Basement. It has a metal band, which even with the maximum number of links removed is kind of loose, like a bracelet. I've always before had leather bands, so when I look down, it looks like I put on somebody else's arm by mistake. It makes me feel kind of chic and nonchalant and elegant. I remember when I was an adolescent, I really liked those few times when I'd be at a friend's house and end up having to wear her clothes for some reason (like maybe I'd sleep over when I hadn't been planning to). I felt so un-self-conscious in somebody else's clothes. Like I didn't have to bear the whole weight of my own geeky awkwardness if I wasn't in my own clothes, which, being mine, had become fully saturated with the unforgiveable essence of me.

Last week we practiced starting IVs. We each got assigned a hand with a wrist and brief stump of lower arm attached. The hands are cleverly made for just such an occasion, and come equipped with numerous plump, delicious, sproingy veins. When you take your little needle and access them and push in the IV catheter, they reward you with a nice "blood return" of red food coloring. We also tied one another's arms with tourniquets and cajoled out as many likely-seeming veins as we could, for practice, though we didn't then actually insert any pointy things into each other. My preceptor says that nurses on her unit start their own IVs. For the first time, I can kind of picture doing it myself. Well. You know. Sort of.

This week, our last two class days are devoted to EKG interpretation. My nursing school only offered that as an elective, and I took Nursing Theory instead (fun, if at times maddeningly dumb, and infinitely less practical). I went in this afternoon knowing pretty much nothing except normal sinus rhythm, and I walked out knowing more than that, so it was pretty satisfying. My favorites were atrial flutter (which I'd never before known was distinct from atrial fibrillation) and Grade 3 A-V block. In atrial flutter, there's this attractive regular rick-rack of atrial depolarizations (they call it "sawtooth," but I like my visual metaphor better) between the big ventricular jags. In A-V block, it's so wild because the atria and ventricles, instead of being tightly coordinated and in synch, are just going along, doing their own thing, entirely oblivious to each other. The atria can be contracting along 80 times per minute, and the ventricles can be doing their own independent plod at 25 times per minute, and they might as well be in different rooms rather than part of the self-same organ.

I've been writing out oncology drug profiles on little index cards so I can memorize them and show my preceptor that even if I'm terribly all-thumbs-ish when it comes to practical tasks, I care and am, you know, diligent and stuff. I'm also going to spend some serious quality time with my nursing procedure books and visualize myself doing dressing changes and spiking IV bags and stuff like that over and over again, so that maybe on Friday I can just go in and do some things smoothly.

Also, I have some more unsolicited product endorsements. Stain sticks (which you might think wouldn't actually work but really they do). Camisole/tank tops with shelf bras right in them. Steven Johnson's Mind Wide Open. Whole wheat tortillas. Extra-dark chocolate Petits Ecoliers.

Now that it's 1 am and therefore only 6 hours until I have to get up, I guess I'll try again to sleep. Maybe the noise in my brain will have died down by now.

2nd Day

2005-07-01T21:57:00.000-04:00

13 hours, mostly on my feet. A low point around 11 am when I spent 15 minutes certain that I just could never be ready to be a staff nurse and I really might as well hang it up right now but oh no what would I do instead? But then it got good again. I broke sterility doing a dressing change and forgot to do Mr. B's vitals and then later forgot to check whether his Mesna had all run in or not, but I actually was getting to the point where I could be a tiny bit useful. Julie, my preceptor, also told me I was very smart and doing an impressively good job for just my second day, which cheered me up tremendously. I was feeling like such a dimwitted klutz.

They went back and forth about 5 times about whether or not they were going to send Mr. G back up to us from the MICU, and then they finally did, and he was kind of scarily unstable. They had just pulled out the pigtail catheter from the membrane around his heart (where fluid had been collecting, and starting to cause something they call tamponade, where the fluid builds up so much that the pressure of it impinges on the heart's actually beating. bad, bad news), and his wound kept oozing and oozing. And he was short of breath and wheezy. And then his heart started to go back into atrial fibrillation, which is a fluttering of the upper chambers of the heart, which makes it do its job much less well. And he was sometimes with it and sometimes not. He told his wife and me at one point that we should unload the stuff before the cops came. He referred to his patient-controlled analgesia button as the detonator. He was hooked up to a machine to constantly measure his blood pressure and pulse and oxygenation, and both his pulse and his oxygenation were wildly all over the place. His pulse was sometimes in the 90s, and sometimes in the 160s; his oxygen sats went from 65 to 100 and back again--all within the space of a minute or two. It still wasn't clear whether he was going to go back to the ICU by the time we signed out to the next nurse around 7:45.

Fortunately, Mr. B stayed steady as a rock. He didn't see much of us. I'd slip away periodically to check on him and do his vitals and stuff.

Now my feet hurt. But you know what? They had free nectarines in the cafeteria today.

The Plunge

2005-06-29T08:07:00.000-04:00

So. It happened. I had my first day of clinical. And it was... fine. Nice. Which is to say, a bit anticlimactic after the amount of energy I'd put into being crazy-nervous about it.

My preceptor, Julie, was low-key and pleasant and welcoming. She's 34, has been working on the same floor since she graduated from nursing school 12 years ago. She's my height (but slender as a reed), has hair and eyes the same color as mine, and also has a 3-year-old daughter. I could be her older, fatter shadow.

Our patient assignment turned out to be quite light. We had two bone marrow transplant patients, which I guess could be a handful if they were having problems, but one was a new admit who wasn't even due to start his chemo until the next day, and the other was five days post bone marrow transplant, and so they were just waiting for his white blood cell counts to come back up (from essentially zero) so he could go home. He needs to be watched extremely closely for infection and for serious side-effects from the various nasty substances recently or currently pumped into his body, but at the moment he had no signs of infection at all, and all that was going on with him was a little nausea and a moderate elevation in blood pressure (knock wood). The new guy mostly just needed orientation and teaching, along with a general intake assessment. Both of the patients were very, very nice, and cheerful and matter-of-fact despite their rather tenuous prognoses (both having "failed" initial therapy and now having a chance of survival under 30%).

Some moments in my day:

Getting off of the subway just before 7 am with a whole flock of people in scrubs, all crossing together and heading toward the main entrance of Other Famous Hospital (let's call it OFH). I tried to be cool, but it actually kind of gave me chills.

Realizing that hey, it's just about the beginning of July (which is when new interns & residents start), so I probably won't be the only one on the floor with terror in my eyes. And sure enough, in my first half-hour there, some skinny guy in a lab coat is striking up a conversation and trying to be friendly. (New intern. Sign of panic. Otherwise, people with MD after their names in a teaching institution, in my experience, do not spontaneously reach out and gratuitously act friendly and social with people with RN after their names. It just isn't done.)

Going to teaching rounds of the Bone Marrow Transplant team and forgetting my place and asking the attending a clarifying question as he's up at the board explaining the history and theory of the non-myeloablative BMT process. He gives me a weird look but answers my question.

Making a big deal to my preceptor about how I don't have acute care experience and very little clinical experience in general, and how nervous I am. She's then a little surprised when it turns out that I nonetheless do know some stuff about clinical care. Yeah, well, I'm good at the book-learning part, I say. I'm just terrified by the hands-on, practical stuff. She seems distinctly relieved and says oh, well in that case, you'll be just fine.

Learning to do a whole mask-hand wash-glove procedure every time we enter a BMT patient's room. Forgetting to use the alcohol hand scrub and washing my hands with soap and water because that's the habit I'm in from before alcohol hand scrub was made the standard.

Getting the chance to do the intake interview with our newly admitted BMT patient. He and his family talk about how he used to have a mustache, but he ended up getting rid of it after the first time he got alopecia from his chemo. His wife would have to leave early for work, so he would make his teenage children's lunches. They would find little clumps of hair in their sandwiches, but they loved him so much they didn't tell him. (Eventually, they mentioned it to their mom, and she told him.)

Eating a piece of really wonderful coffee cake brought in by the baker husband of a former patient, who was coming in to OFH to get outpatient follow-up.

So, well, I go back on Friday for another 12 hours. I got a book called Oncology Nursing Secrets or something like that and have been reading up about multiple myeloma and leukemia and mucositis and different classes of chemotherapy and bone marrow transplant and tips for giving super-harsh drugs safely by IV and stuff like that. I'm all excited. I can't believe I'm actually going to be useful for something in the foreseeable future. It's such a rush.

Tizzy

2005-06-26T08:31:00.000-04:00

I'm all in a tizzy. (A quiet, internal tizzy, but then that's me.) Tomorrow is my first day of clinical. Twelve hours on the oncology ward at Other Famous Hospital, 7A to 7P. I'm incredibly nervous, and I'm not even sure about what. From what I've heard, you don't really do much besides watch your first day. Watching. I can watch. I'm all over watching.

Maybe I'm worried my preceptor won't like me. She sounded slightly dubious over the phone, having been forwarded my resume. Are you really interested in oncology? she wanted to know.

Maybe I'm worried I'll say or do something really, really stupid.

I don't even know whether to wear my scrubs and nurse shoes to the hospital or to change once I get there. I mean, I am taking public transportation (on-site parking is something ghastly like $40/day) and I am working with (I mean, observing someone else working with) immunocompromised patients. On the other hand, it sounds kind of like a geeky thing to do, to bring scrubs and change. On the other other hand, that would mean I wouldn't have to be out in public wearing scrubs. (And I care why?)

Will I get horribly hungry? Will I feel really dumb as my preceptor keeps working but sends me off for a lunch break?

What will 12 hours feel like? How exhausted will I be?

Oh dear oh dear oh dearie me.

I'll be fine. I'll be fine. I had a fortune cookie a couple days ago that told me that I could achieve great success with humility and diligence. I will be humble and diligent. Plus gracious. And cheerful. And then humble and diligent some more. Okay. Okay. Wish me luck.

Kvetchy Dame

2005-06-23T11:40:00.000-04:00

Well, the valiant amoxicillin is in the process of vanquishing the streptococcal foe, and this damsel in distress is good and thankful (wait--I'm married; I think that might make me a dame in distress. hmm. well, then.). My fever's gone; I'm not all achy and exhausted any more; and although my throat still hurts a little, it feels like the cleaning lady's been through and gotten rid of the repulsive coating of bacterial scum on my soft palate.

Not only that, but yesterday when I went to class, I finally got to turn in my health form, and the administrator lady walked it over to the student health office herself and pushed it through and got immediate clearance, so I'm fully signed off for my clinical placement. It's finally taken care of, after weeks and weeks of procrastination (and then having to wait to get in to be seen for a physical, and then glitches with getting the form filled out, and then the administrator lady being out for a week...), feeling gnawingly anxious and guilty about it the whole time. Having it done with at this point feels like... like... like peeing when your bladder's really full. (Well, to be honest, maybe a more apt analogy would be the old chestnut about hitting yourself in the head with a hammer because it feels so good when you stop.)

So you might think that I'd have run out of things to complain about, at least briefly. But you would be mistaken.

My sermon for today is entitled Clerical Workers Are Not Appliances, and This Means You, Even If You Think You're Exempt Because You're Already So Enlightened Because You're a Nurse or a Social Worker, or for Any Other Reason. Well. Come to think of it, I guess the title of the sermon is probably all you really need just now. But I'm happy to deliver it in full with no honorarium required (just transportation and maybe some tea and cookies) to any sewing circle, ladies' garden club, scout troop, board of directors, womyn's collective, or motorcycle gang you wish. Just say the word.

Oh, and also? It's not my fault you're tired, so don't act like it is.

Um, and don't be dumb like me and take amoxicillin on an empty stomach. You might be very sorry.

Group A, Beta-Hemolytic

2005-06-22T00:56:00.000-04:00

Strep throat. My rapid in-office test was positive this afternoon, so they didn't bother to send a culture. My temperature was 102.8 (gratifying, since it was an objective measure to reflect--and somehow justify--how crappy I was feeling). I started amoxicillin as soon as I got home from the CVS with my little bottle stuffed full of cream-colored capsules. While I was waiting for my prescription to be ready, I also did some self-pity shopping: an Entertainment Weekly (our subscription ran out, and I've been missing it), an Oprah magazine, a bottle of lime-flavored diet coke, and a big bar of dark chocolate.

I slept most of the day after that. Pete did all of Cassie's evening stuff--dinner, bath, bed. Now I'm tired but not sleepy, and feeling weird and spacy and also intensely bored. I took some tylenol a couple hours ago, so I'm all clammy and sweaty from my fever going down.

Last spring and summer I had five bouts of strep throat, but it had been nearly a year, so I didn't immediately think of it when my throat was getting a little sore. After all, Cassie had been sick with a cold-ish kind of thing, so I figured it was just that. But then I recognized that there was something naggingly familiar about how I was feeling.

There's this particular sensation with strep throat, one that I've spent some time trying to put into words. Putting things into words is important to me, for some reason, and when people say that something is "indescribable," it tends to make me feel exasperated and impatient. It's not indescribable, I think, you're just too lazy to think hard and analytically enough to come up with words to talk about it. So I can't bring myself to give up on finding the right words to describe something so mundane and concrete as how strep throat feels. Part of my problem is that I cant really even figure out what sense I'm using to detect it. It's kind of a feeling, and kind of a smell, and kind of a taste. The closest I've come to describing it is to say that I keep expecting my throat, when I look at it in the mirror, to be covered with the kind of grayish tan scum you find in a kitchen drain that hasn't been cleaned in a while. It feels bacterial. It feels disgusting. It seems as if someone should attack my tonsils with a scrubby sponge and some Formula 409. But, well, anyway, I guess that's what the amoxicillin is for.

Meanwhile, I've been thinking a lot about learning to paint. They're hiring someone permanent at the place where I've been temping. And the administrator for the nursing refresher program is being rather snippy about my getting my health form in late (probably wouldn't bother me much if I didn't already feel stupid and guilty about it). Pete's been working like mad on the index for his book, and it was supposed to be done last Friday, and there's still no clear end in sight, and we're all starting to fray a bit from the extended crisis-mode push. But when I read on-line about how to get started painting, and how to stretch your own canvases, and how to take care of your brushes; when I think about compositions I'd like to start with; when I think about how much practice it will take to be as comfortable with a brush as I am with a pencil, the anxiety and guilt and crap all kind of fall away, and I feel so happy and serene. Painting in my head.

You'll Forgive Me If I Get a Second Opinion

2005-06-20T21:41:00.000-04:00

Cassie had a bit of a fever again today at day care, but by evening she was perking up substantially. I, on the other hand, started feeling worse and worse just as she was feeling better and better. As I was rocking her in the rocking chair as part of our pre-bed ritual, she wanted a story about Gus (Gus is the plump little mouse in Disney's Cinderella--we've appropriated him, and he has different adventures almost every evening), but I felt like I just didn't have it in me. I explained to Cassie that I was sick, and she apparently decided to fix me.

She waved her fingers at my head, cheerfully exclaiming, "Cut, cut, cut! Drill, drill, drill!... Bandaid!"

What $10 Will Buy

2005-06-20T08:14:00.000-04:00

A million years ago, either for Christmas or for her birthday in February, Cassie got a present from one of my aunts. It's a zippered cloth wallet with a girl's face embroidered on one side, complete with yellow yarn hair. A pink ribbon is attached to the two top corners, so it can be worn as a necklace. It came with 6 neatly folded bills inside--a $5 and five $1's. Ever since she received it, I've been meaning to take Cassie shopping somewhere where she could pick out some things to spend it on.

I finally got to it yesterday. For the first time in ages, Cassie was sick this weekend--something viral, no doubt, since her temperature never got above 100.5, and she was cranky and labile but not glazed and lethargic. But still, by Sunday afternoon, we both badly needed a little walk and some fresh air. I didn't think she'd be up to the playground, so decided on a leisurely walk to the old-fashioned-y five-and-dime up the hill. We took our time, and I carried Cassie part of the way, because she was feeling pretty punk, but she was happy enough when we got there. We spent probably half an hour going through the store and looking at things. I kept reminding her that she could pick things out to buy with her money. We looked at various rubber balls, toy cars and trucks and fire engines, pretty little boxes you could keep treasures in, some molded plastic dinosaurs. We smelled the votive candles and remarked on some things that were just like what she has at home (kaleidoscope, inside-out ball). She didn't deign to even look at the sticker books I was pushing, nor the bags of big wooden beads I thought would be such a good idea.

What did she choose to spend her very own money on? A hula-hoop (pink, $3); a big roll of the kind of flat plastic cord that you use for crafts projects when you're 8 and at camp (also pink, $3); and two 4-inch molded plastic ants (black, one with red abdomen, the other with yellow abdomen, price unmarked-couldn't have been much).

So what can I say, except that she's her own girl. And she has two dollars and change left over.

Time Suck

2005-06-13T15:48:00.000-04:00

There's this part of me that still really believes that everyone else manages their time magically right. I know that people complain about how they don't have enough time and have to make compromises, and lots of people are around to preach that you can't do it all. But for some twisted reason, I can't make myself believe it. Somehow I really think that I'm the only loser who doesn't have it figured out.

I do manage to get to work on time (8 am) pretty much every morning, and I make it to my 4-hour nurse refresher classes twice a week. My daughter gets fed and bathed and cuddled, and my cat gets her daily medicine. I try to be really disciplined about getting enough sleep so I don't get a recurrence of the chronic fatigue syndrome. And ocassionally I sneak in a bit of time to blog. But that's about it. Our apartment is a truly embarassing disaster area. I still owe thank-you notes from April. Phone calls and e-mails go unreturned. The shelf in the upstairs bathroom that came down at some point before Christmas is still hanging there at an absurd angle, unrepaired (not to mention undusted). Lord knows I never do anything extreme or exotic like exercise. It feels like a triumph every time I manage to change the litterbox.

My dad and his wife Susan are arriving tonight for a four-day stay before heading back to Honduras, and I feel bad not to have everything nice for them. I feel bad not to have everything vaguely sort of acceptable for them. Not that they'll complain--to the contrary, they just try to help out however they can, which is of course very compassionate and nice, but the whole thing makes me feel like such a dithering fool.

I have a picture in my head of brisk, efficient women. They charge around getting things done and also know things like where's the best place to go for toddler swimming lessons and where to buy watch batteries. They aren't squishy and squinchy and waffling and eccentric. They're firm and tough and no-nonsense. They don't suffer fools. I think they get manicures. They probably drive minivans. Come to think of it, maybe they're stay-at-home moms, which would explain how they know the stuff they know. I don't know. I just know I fall short. I feel like a pale, soft cave creature, blinking ineffectually in the sunlight as sleek, shiny birds swoop nonchalantly overhead, doing things I can't imagine knowing how to do.

I'm tired of being overscheduled, tired of hating the household chaos as I pass by it seven or eight times a day on my way to do something else, tired of trade-offs. It's making me cranky and whiny and burnt out around the edges. It makes me want it to be somebody's fault. It makes me want a swimming pool and a drink and a rainy afternoon someplace soft and clean, with a novel. It makes me want to drop glass objects from 3 stories up for the satisfaction of watching them shatter.

Pete got Cassie an ant farm, and the ants are dying.

Phooey.

Normal Development

2005-06-11T14:44:00.000-04:00

Cassie has a toy she loves, a hand-me-down from our next-door neighbors. It plays songs, and by pressing on different parts of it, you can make the music go fast or slow, or distort the notes in one of two ways. The other night, as she sat on her potty before bath, she played a whole repertoire of intensively modified tunes. She announced the title of each piece after she played it. A partial set list:

Blue Failer
Munko John Willy
Gobble-Gobble
Mummadun Dilly Mama
Hippo Pumpunn
Harriet Smilly Millitumper
Tunafish

(Incidentally, while we're on the subject of the young blond one, she had a follow-up visit with the neurophysiologist yesterday, and it went very nicely. Given her lack of episodes and her normal development (he seemed particularly impressed that she draws eyebrows on the faces of her funny little people), he's not even going to push for an EEG any time soon, and we just go back to check in with him in a year. Eventually we'll probably have a follow-up MRI just to make sure the little funky stuff they saw on the last one("possible delayed myelination in the frontal lobe") has resolved. But that doesn't have to be until she's 5 or 6, and can probably even do it without being sedated, which was the source of all the ghastliness last time. Of course, if she has another seizure, he says, call him. Um, yeah, we say. If she has another seizure, you will definitely be hearing from us.)

Breathe, Dammit, Breathe!

2005-06-09T12:37:00.000-04:00

We had skills lab again in class last night. It had been a couple weeks, and it felt kind of bracing to get back to the nitty-gritty (and scary) stuff after a bunch of med-surg and pharmacology lectures (where even if I don't already know the specific material, and I often do, it's still all academicky and therefore playing to my strengths).

This time it was respiratory-related stuff: trach care, chest tubes, suctioning. We started out nice and easy, with a little video on asthma, and then our instructor passed around a bunch of asthma thingies (inhalers, spacers, peak flow meters). Now, not too long ago, I spent a couple of years in an asthma job, which included patient education, so I'm all over the asthma stuff. I even have a few little practical nuggets to offer when it comes to asthma (something that is true in almost no other clinical area). So I got to start the session feeling all confident and competent, which was nice, because once we hit the other stuff, I was really out of my depth.

Everyone else in the class has done acute care in the past and so at least has memories of dealing with this stuff. So when we're talking about how you ambu somebody before you suction, everybody else can picture it, based on their own experience. I myself can picture it too, but it's only because I watched a lot of ER for a few seasons. (By the way, "ambu-ing" is the same thing as "bagging," which is to say, using those squishy blue football-shaped things (called... ambu bags!) to push air/oxygen into someone's lungs. You want to do it before you suction somebody's airway because while you're suctioning, they're not going to be getting much in the way of oxygen. Since oxygen is something a person does get to missing, it's nice to kind of stock up beforehand.) It's actually kind of scary how much of my knowledge of acute care comes from fictional television programs--mostly ER, but also Gray's Anatomy and even Scrubs. I mean, yikes. Of course, if there were a nice, funny, engaging, compelling, well-researched dramatic series called Med-Surg Nurse, I'd really be set.

When we left class, having just practiced suctioning on one of the tan plastic simulator mannequins (the poor dear had a tracheotomy in addition to the nasty assorted wounds of all major types he had all over his body), I felt all fired up to go suction an airway. Let me at it, I can do it! Of course, that feeling is already starting to fade, and by the time I actually get to a clinical setting, it's going to be gone completely.

My clinical probably won't be starting until the week after next, which could be my fault (because I've been a little bit laggardly about getting my health forms filled out), but which is, to my relief, also the fault of the program's administration, and even if I had all my paperwork in months ago, I still wouldn't have set foot on my unit yet. The grumblings among my classmates about the poor coordination of the administrative aspects of the program are getting louder. One of our classmates actually has her first clinical time set--she starts next Monday--but most of us have only just received the name and phone number of our preceptor.

Our main med-surg instructor, Deb, is being pretty circumspect and not openly rolling her eyes or anything, but last class she did rather delicately say that hmm, well, usually by this time in the program, we would have started clinical and would be able to talk about our experiences together... And after last night's session, the somewhat more earthy Margaret, our skills lab instructor, was a bit more open about her exasperation. The problem, I think, is pretty much entirely Bea, the doctoral-level nurse who's the administrative head of the program. I'm not sure what's up with her. One thing is that apparently her secretary left recently, and Bea herself didn't even know which file drawers to look in for such things as the copies of our nursing licenses or our proof of malpractice insurance. It seems go a bit deeper than that, though, like maybe Bea is having a little personal/professional breakdown of some kind. (Maybe the departure of the secretary was a symptom rather than a cause?) We see her occasionally, briefly, and she's always cordial enough but also tends to look kind of distracted, and somewhere in her eyes maybe even a little hunted.

My emotional reaction to the delays is nearly evenly split between two opposing sentiments: a raging impatience to get on with it, already; and a feeling of blessed temporary reprieve from coming tortures. I really don't enjoy being bad at things. No, see, I really don't. But then, when I get too comfortable in a job, I get antsy and itchy and bored.

At least now it's all been set in motion, and all it takes is momentum and waiting, and I'll end up in a new place. I don't have to decide anything more right now. I don't really have to be brave at this point, I just have to endure being scared, and the rest will take care of itself. I'll let you know how it goes.

The Creative Process

2005-06-05T16:30:00.000-04:00

After bath there are two options: go right up to get pajamas on, or pee on the potty and then get pajamas on. Cassie may try to plead or argue or delay or run around as crazy naked toddler, but these diversions are brief in the face of Mama's iron will. Very soon, the naked butt is on the potty, and then, quickly, pajama-clad. (Mama is firm on this point--a tiny bit because consistency and routine are important to very young children, but mostly because Cassie's bedtime is a Very Important Time in Mama's day.)

So. The night before last, after an uneventful tub, some strange bug crawled into the naked butt in question, and all of a sudden Cassie was shooing me out of the bathroom, emphatically telling me "LEAVE ME ALONE! GO AWAY!" At the same time, she seemed to be doing something complicated with the potty seat that fits on the regular toilet, something that may have involved her car puzzle. I may have seemed a tad hesitant about leaving, because Cassie repeated her orders to "GO AWAY!" and then explained the urgency of this command with "I'M MAKING A MOVIE!"

And so I did. I went away. It worked. I went out obediently and sat on the couch and flipped through a catalog. It was the damnedest thing. See, I guess if you're just stalling and being a dawdly toddler, it brings out the hard-ass in me, and I impose my will. But hey, if you're in the middle of an artistic project, however imaginary, I guess I'm just willing to let you be. I think this was just a fluke, and that it's not a sign that Cassie has learned how to play me that well all of a sudden. But it does give me pause. I may need to do some real girding of my disciplinarian loins before this childhood thing is over.

(By the way, we did finally get her to bed without much trouble, though not until she was done with her project, such as it was. Pete went in to check on her shortly after she'd sent me away, and she got rid of him, too: "DON'T WRECK MY MOVIE!")

Flames

2005-06-03T23:38:00.000-04:00

We hadn't seen Max and Lucine in ages (well, weeks, but still), and last evening they called as they were on their way home from an outing and asked if they could drop by (and, when prompted, renewed their pledge of indifference to the proto-squalor of our surroundings). We were all delighted to see them, including Cassie, who promptly dragged Lucine into her playroom, and kept saying "Lucine?... um... um...," not really having anything to tell her, just wanting to be sure she still had her attention.

Pete had taken Cassie to the grocery store Wednesday (Cassie's in day care Monday, Tuesday, Thursday, Friday--Wednesday is Daddy Day), and in with the frozen blueberries and whole wheat bread, had splurged on steaks and frozen pierogis. So when we couldn't bear to let Max and Lucine leave before the evening was spent, that's what we all had for supper. (Well, I myself am not so much with the eating mammal flesh, but anyway I was a pierogi participant.) Plus a few little stalks each of some lovely young asparagus left over from when my dad and his wife Susan were here and made us all dinner. Pete cooked the asparagus and steaks out on the grill, out in the lovely late-spring evening (a novelty, as until this week we've been having about 3 months of March).

Max and Lucine have recently started Weight Watchers together, and I am recently renewed in my quest to not eat everything I possibly can. This week I had a check-up so I could get paperwork filled out for my clinical rotation, and I weighed 10 lbs more than I did last August, and my blood pressure, formerly a predictable 110/70, was 130/80. Not a horribly shocking number in itself, I guess, but jeez. I'm hoping that getting my weight down a bit will result in my BP coming down also. I have a tickly little thought that maybe it's the Prozac messing with my blood pressure--I don't know whether it does that or not. I'm just crossing my fingers that the weight thing does it, and I don't have to switch meds again. Prozac is my Dumbo's magic feather, if nothing else. Whatever comes up, I can always think "oh, heck, I can deal with this--after all, I'm on Prozac!" and it seems to work very nicely.

ANYWAY, there was this whole big discussion about whether to make one or both packages of frozen pierogis, and I started to bring up the fact that Max, Lucine, and I were all... but then I stopped, because "dieting" is such a repellent verb, and "trying to lose weight" sounds just so weak and whimpery, and I didn't know how to finish my sentence. But then Max chimed in with something about the three of us "reducing," which cheered me up immediately. That's what we're doing! We're reducing! I'm sure if we were British, that would have loads of unattractive connotations, too, but since we're not, it's just kind of cozy and vaguely euphemistic. (It reminds me of how swearing in a foreign language never carries the same emotional punch, even if you know full well what the words mean and native speakers have carefully explained to you how strong they are.) So since the three of us are reducing, we only fried up (fried up, mind you, in butter) one box of the frozen pierogis. Such steely restraint.

And then, as we were lounging about and not yet ready for the evening to be over, Pete turned on the television and looked through the menu of what our cable service offers "on demand" for free. There were a few documentaries, some thick and gooey cheese (Gidget Goes Hawaiian, St Elmo's Fire, something called Teen Sorcery...) And there was Richard Pryor, Live on the Sunset Strip. So we watched that.

It wasn't what I expected it to be. Somehow, you think "Richard Pryor," and you think "shocking" in all the predictable ways--sex, drugs, and ooh those terrible swear words. I don't know. Just the living definition of "working blue." But what was actually striking about it now, from this remove, was how genuine and vulnerable and sincere it reads. This particular show dates from 1982, I think, which means it's after his catching-fire-while-freebasing-and-running-down-the-street-in-flames episode. In fact, in this show, he spends a lot of time talking about addiction and then does a whole description of what it's like to be on fire, and then what it's like to be in a burn ward. And it comes to a raw place where it somehow doesn't even matter whether it's funny or not. It kind of is, and it's kind of not, and both the funny and the not funny stem from the fact that he's up there telling the truth in a way that frankly is not too socially acceptable. If you were at a party and said those things that Richard Pryor is up there saying, people would look stricken and move away from you. It's not the "fuck" and the "shit" and talking about cocaine that's impolite almost to the point of obscenity--it's the bare need and pain. And the naked hope for redemption. That's scalding. And then it's haunting. It hangs over you afterwards, making it seem like life is sad and difficult and kind of important. At one point, he gets a nice laugh with "Racism is a bitch, man," and goes on to observe that just plain old being a human being is hard enough.

Pomp, Circumstance, Silly String

2005-06-02T13:22:00.000-04:00

Pete, Cassie, and I traveled to Indiana this past weekend for Pete's niece's high school graduation. It had been a long time since I'd been to one of those. It was much as one remembers these things to be, only this one somehow even more so, probably because of its midwestern-small-town spin. For maximum authentic feel, it was held in the high school gym, with family members thronging the bleachers all around.

It seemed a little unsporting to me, but Pete's brother-in-law (my brother-in-law-in-law?) went a couple hours early and put down blankets along one bench to reserve seats for us. He was far from the only one doing this, though, so I guess it's accepted practice. Besides which, his 89-year-old mother (she'd have you believe that she's 90, but don't be fooled--her birthday's not until July) was there for the occasion, so it did make sense to get spots that didn't require too terribly much climbing. (She could by all rights have sat in the "special needs" seating down on the gym floor in the section behind the graduating class, but I doubt her pride would allow such a thing.)

Our little family unit definitely tipped its hand as out-of-town city slickers by wearing a suit and pumps, a jacket and tie, and a smocked dress with tights and mary janes, respectively. (We had wondered about dress code, but figured we'd err on the side of formality, which seemed safer, since at least it shows a respect for the occasion.) At the other end of the spectrum were a good number of people in shorts, and my favorite--a guy in boots, Wranglers, a straw cowboy hat, and a navy blue t-shirt with big red letters spelling "Redneck Bass Fishing" and a cartoon of some dopey-looking guys setting off an explosion in a lake and sending dead fish flying through the air.

The graduating class were in royal blue nylon robes and matching mortar boards with headpieces that puckered in an unflattering way on all but the largest, roundest heads. The regalia was more complicated than I generally associate with high school: the top 15% of the class had gold tassels on their caps (the rest had blue and white), and there were 4 different kinds of cords that could hang around a graduate's neck, denoting participation in selected activities (honor society, naturally, but also debate, drama, and one other I'm forgetting--interestingly, there were no athletics-related indicators). Almost all of the girls had long hair, though one I noticed did have her ends dyed blood red, and another had facial piercings, which went a bit oddly with the Jackie O-style large-pearl choker she wore for the occasion.

The speeches (class president, salutatorian, valedictorian, principal, superintendent) were blessedly quite brief, and just exactly what you would expect. They were, in fact, so utterly unsurprising, that I actually felt a little... surprised. I know that the high school graduation speech is not really a genre that tends to inspire much in the way of originality, but I guess I thought that one of them would have a little something, some small spark. I was wrong. Each of the five speakers seemed to have taken the average of all high school graduation speeches ever given and moved the words around on the page just enough to each give his/her own version of the self-same thing. I guess it was impressive, in its own way. One couldn't help but notice, though, that the salutatorian's speech was, embarrrassingly, not consistently grammatically sound (which I can't help but take a bit personally, as a blot on the reputation of high school salutatorians everywhere).

Then there was the calling of the 330-odd names of the graduates (a few Audreys, which I found striking). It was a very white group, with maybe 1 or 2 each of Black and Latino kids. Enough so that you couldn't say it was an "all-white" school, but not even really racially diverse enough for, say, a McDonald's commercial. The social class mix was much broader, though, from the sleek and glossy children of successful midwestern businessmen to the resolutely working class kids (some with seemingly the very same haircuts as the working class kids in my high school class). There were the obligatory introductory pleas to hold applause until everyone's name had been called, and the pleas were roundly ignored as per protocol. I myself could have done without the sporadic sounding of airhorns, but I guess the high school graduation of certain 18-year-olds just calls for very high-decibel celebration.

It seemed like had it had been forever, and we weren't even to the end of the M's yet. The bleacher was getting very hard underbutt (despite the blanket Pete's brother-in-law laid down), and Cassie was getting distinctly antsy. She wanted milk, and I'd forgotten to bring her sippy cup. She'd drawn quietly with colored pencils, and then sat staring blankly for a while (she was tired--travel always messes up her sleep). Now she was really ready for this to be over, and I absolutely didn't blame her. We managed to eke a few more minutes out with the colored pencils, but they only got us through the P's. Pete pointed out that with so few Jews, the alphabet gets front-heavy, so that being at the P's wasn't so bad because there weren't any Sugarmans or Weinsteins or Zuckermans to come after. Even so, I was relieved that when I finally pulled out a bag of Wheat Thins (I'd been saving them as long as I could so she wouldn't get even thirstier), they kept her happy all the way to the Z's.

It was too bad that Cassie was so glazed and cranky and exhausted by the end, because otherwise I think she would have enjoyed the graduates' final eruption, once the last name was called, with cheers and silly string and assorted small projectiles. They didn't throw their hats in the air--though they looked for a moment like they really wanted to--and made do with one lone beach ball bouncing around as they prepared for the recessional.

And finally it was over, and we were slowly filing out of the gym. Back to Pete's sister and brother-in-law's house for a weekend of full-on sun-dappled suburban lounging (great green swaths of soft lawns, big old trees, a dozen royal blue beachballs ("Class of 2005" in red on the sides) scudding in the gentle breeze across the lilypad-shaped swimming pool in the back yard). There were acres of food, including some enthralling aioli and perhaps the best vanilla ice cream I've ever tasted, and I ate until I was sore, and watched Cassie harrass the poor ants and pill-bugs and tried to keep her away from the pool's edge. We saw our dear friend James, who lives only a couple hours away and who had driven down to hang out with us a little, and he and Cassie enjoyed each other a good deal.

I'm kind of glad to be back at home, though. Back where life is stressful and the apartment is a pit o' chaos and the litterbox stinks but we need to get more cat litter before I can change it. I don't know. It's home.

Age-Old Quest

2005-05-31T08:05:00.000-04:00

Last night the bathwater was discolored because we'd been away for the long weekend, and the rust had built up in the pipes. Cassie was dubious at first about getting in, but was finally convinced it was all right. It wasn't long after that that the brownish-yellow tint inspired a new game: as she busily poured the water from cup to bucket and stuffed her washcloth into the honey bear, Cassie told me that she was "making golden metal."

"Oh!" I said. "Did you know that there's a word for that? It's called alchemy."

"I don't call it alchemy," she replied. "I don't call it alchemy. I don't call it alchemy because that's not a good name for it."

Um, well, okay. That shut me up, didn't it? Cassie worked a little more, then confided more of her process:

"I'm adding in some plastic, to make it more comfortable."

Pop

2005-05-25T22:44:00.000-04:00

This past week, our little class of returning nurses went to Other Famous Hospital (which is to say, the same illustrious institution where my dad was hospitalized for two weeks last fall) for our initial orientation to our clinical placements. Tucked around a conference table in a claustrophobic room on the first floor of one of the more historical buildings in the medical center, we listened as a preppy blond woman walked us through a packet of hand-outs. Afterwards, she led us to a basement office to get our temporary IDs and then to a 10th floor office to fill out computer access paperwork. Finally, she gave us a bit of a tour. It's a vast place--multiple connected buildings, a zillion floors--and I actually was kind of glad to know my way around a little bit already (even if some of the memories stirred by the various locations made my chest clench). I think I would have been utterly overwhelmed if I were seeing it all for the first time. We walked around quite a bit, got oriented to cafeterias and cafes didn't really do more than look at the actual clinical units they're assigning us to. My understanding is that they haven't yet finished lining up all the preceptors.

This whole program, we students have privately agreed, seems pretty loosey-goosey in a lot of respects. We get information in dribs and drabs, and still don't know when our clinicals will actually start. What's funny is that from what we can tell, this is actually the tightest-run program of its kind in our area, though it does sort of make sense. There are no particular certification requirements for nurses returning to practice--we have RN licenses, and anything beyond that is at our own discretion (and that of our prospective employers). If a hospital wanted to hire a nurse who hadn't touched a patient in 20 years, they legally could, so long as she had kept her license active (in most states that requires documentation of a certain number of continuing education hours plus writing a nice little check every couple years; in some states, though, you only need the check). So there aren't any mandates or even guidelines for nurse refresher programs to follow.

Anyway, a couple of class sessions ago, our primary instructor announced that they'd already had a request for a returning nurse/student from our program from one unit that had never participated before--would any of us be interested in doing oncology? Everybody else made "uh-uh, not me" kinds of noises, while I felt a sensation in my mind that was kind of like a little *pop* . The sound of a piece fitting into place, I guess, or maybe of a membrane breaking. I want to do oncology. Oh my goodness, of course. I hadn't known, and then she asked, and then I knew, just like that. I didn't want to be too quick and greedy, in case my classmates would think I was pushy, and what if somebody suddenly realized that it was the perfect thing and I stole it from them, but as soon as a small but decent interval had passed, I raised up my little hand and said, um, yes, I would.

And ever since then, I've felt actual, positive anticipation of getting started. When I was assuming I was going to be doing general med-surg, I was kind of looking forward to getting started, at least in a let's-get-the-show-on-the-road kind of way, but it also was looking like a very long spinach-liver-7th-grade-gym kind of experience. Good for me and humiliating in approximately equal measure. But thinking about doing oncology, I guess it's that I feel like I, personally, actually have something to offer. It's not just something I'm doing to have done it, to pay my dues and learn my lessons and make my nursing career grow big and strong, all while sucking at it in a major funny-pathetic way. Oncology seems like a place I might actually belong, where who I am might be as much a help as a hindrance. Even if I still suck at fitting everything I have to do into a shift, and I'm raw-green-new at a lot of procedures, and don't know my [patient's] ass from my [her] elbow in physical assessment, it still changes the whole gestalt. Pain, suffering, fear, joy, presence, uncertainty, life, death. That I can do.

And meanwhile, in class, I've been learning or relearning all kinds of good and useful stuff, which has been heartening and kind of exciting in itself. Interpreting arterial blood gases, which kinds of IV fluids you use in which situations, heart murmurs and split S2 vs. S3 vs. S4, what a pleural friction rub sounds like. Today we had an amazingly good lecture on wound care, and the lady who gave it (a PhD nurse) actually works at Other Famous Hospital, and invited us to give her a call if we ever have questions while we're on the floor.

I kind of could go on and on, but I've been trying for 5 days now to finish this one measly post, and I need to go to bed now. The beauty of the blog is that tomorrow is another day.

Let It Snow

2005-05-20T13:28:00.000-04:00

As I think I might have mentioned once or twice, Prozac agrees with me. (Well, generic fluoxetine does, anyway, if we're going to get technical.) I have developed an almost anthropomorphizing affection and gratitude for those dear little white ovals which, taken two at bedtime, all but eliminate my hair-trigger squirts of dread, while making my lows less low, my difficulties less difficult, my obstacles less obstacular. I know that some people have prohibitively unpleasant side-effects with this particular medication, but since my initial nausea and yuckiness during the run-in period, I have had almost nothing besides the mood elevation.

Almost nothing. The one side-effect that seems to be sticking around is this thing that it does to my dreams. I hesitate to say that it makes them more vivid, though that might in fact be accurate, because to me somehow the connotations of "vivid dreams" include garish colors and, I don't know, talking circus sea slugs or something. And what I'm getting instead is just night after night of these busy, detailed, absorbing alternate worlds. No electric blue singing molluscs, just a lot of the usual reality-based dream fare (heavy on high school and college graduations and reunions lately) but somehow kicked up a notch, and with a sensation, on awakening, of simply trading realities, that one for this.

As usual, my college friend Nora and my high school boyfriend figure fairly prominently in the cast of characters (whatever they represent to my psyche, it's clearly pretty central--they're always showing up in my head during REM). And then there are other friends and family members showing up here and there, occasional guest appearances by random famous people (most recently, the actor Jon Cryer), and lots of fully developed characters with faces and personalities and palpable essences but whom I've never met or seen in waking life.

A few nights ago, my dreams featured a starring role for a college classmate, the famous Lisa Chun. Well, she was famous in our class, anyway, and I daresay in years just above and just behind us. My senior-year girlfriend and her housemate used to roll their eyes and call her "the Wayne Newton of [our college's name here] lesbians," but I am here to tell you she was really the Elvis of [our college's name here] lesbians--you could argue that maybe she was a little sleazy, but her charisma was undeniably real. My little circle of friends were definitely outside the highest status clique (we called them the Cool Smoking Lesbians), but you know, it just wasn't that big a school, so we went to the same parties. Besides which, a cat may look at a king. I am not embarrassed to tell you (okay, maybe I'm a little embarrassed) that Lisa Chun made my knees weak. I suppose that it was a kind of cheeky acknowledgement of Lisa Chun's legend-in-her-own-time status that my friends and I had a whole repertoire of songs (show tunes, Christmas carols, jazz standards) reworded to include her name. Our "Some Enchanted Evening" was probably the most fun to sing, but I find that it's our "Let It Snow" that's been playing in my head a lot recently.

Anyway, the dream itself wasn't all that interesting. It involved some prank or otherwise slightly illicit mission, and we were climbing up gray metal ladders through a multi-story empty warehouse. There was something about various cans of colored paint up on the gravelly roof. I suppose if you were really intent on finding repressed sexuality in there, you could do it, but I'm a little dubious about the Freudian reading. Or maybe I just don't want to believe it, since by the end, Lisa Chun had more or less morphed into Angelina Jolie, who just plain gives me the willies. Be that as it may, since having the dream about Lisa Chun (and especially in the day or two afterwards, when I had that strange feeling of actually having seen her recently--you know how dreams can conjure so completely the feeling of someone, the smell of their personality?), I've been thinking about the phenomenon of bigger-than-life-ness.

The last time I actually did see Lisa Chun was at our 10th year college reunion. I had a weird twin reaction to her. Her lofty stature had to be diminished--she'd gained quite a bit of weight and therefore couldn't help but look kind of cushiony and motherly rather than just effortlessly cool-butch, and she was working in some desperately unglamorous place, like an insurance company or an HMO, while a lot of our classmates were truly in the thick of the fabulous careers we were all supposed to have. But at the same time, the feeling was stubbornly the same. I still couldn't really see her as an actual person. I still did an abominable job of making small talk with her, although I'd been happily and volubly catching up with everybody else, including a friend of hers and fellow-Cool-Smoking-Lesbian (who'd gone to nursing school and become a nurse practitioner, so we had a lot to talk about). I truly could barely be civil, I got so flustered and tongue-tied. I mean, it was really ridiculous. And the excruciating thing was (and is), I know she could tell. She seemed to find it a little bit entertaining. But then the dancing started, and I wasn't really having much of a conversation with anyone, because I'm most basically a dancing fool, and the awkwardness goes away because I'm just so happy to be dancing.

It was toward the end of the party, then, and just a few more songs before we were all going to head off into the night, and there was a bit of dead air as somebody changed the tape on the boom-box. Then, as the music was starting again, Lisa Chun herself came up to me and took my hand and wordlessly led me out onto the floor. And so this was my brush with greatness--a slow dance with the Elvis of [unnamed college] lesbians. I wish I could tell you what it was like, or how I felt, or even what song was playing, but it's frustratingly blank in my memory. I suppose it wasn't really so eventful, when it comes right down to it. But then, at the end of the dance, she stepped back slightly and, confidently and deliberately, kissed me.

Lisa Chun is an exceedingly good kisser. The fact that this was entirely to be expected given her reputation somehow had not occurred to me, and the revelation carried for me the kind of narrative satisfaction that a nice twist ending gives (The Usual Suspects, say, or the season finale of Veronica Mars). It was perfect.

But it brings us back to an individual person having such iconic status that even in the fleshy flesh, the glamor is not dispelled, and the human being, with worries and interests and insecurities and neuroses and quirky habits and habitual blind spots and overused phrases and occasional intestinal gurgles and favorite television programs, is not revealed. How can that be? I suppose that in this case, it's not really so inexplicable. There I was, back at the scene of my postadolescent awkwardnesses and struggles, with those self-same people, and there was Lisa Chun, in her element, in a relatively controllable situation that played to her strengths.

But it undermines my sense of myself as someone who sees people as people, someone who is uncowed by status or other external trappings. My mother, after all, years ago when she was still a very junior employee, used to call her company's vice presidents "Cherry Pie," and I'm my mother's daughter. I sweetly ask the tough-guy gang-banger types on the bus to scoot over so I can sit down. I cheerfully and easily said good morning to the president of the hospital where I worked, and nonplussed the CEO of the last company where I temped by utterly failing to quake when he bellowed at me. So it bugs me that I'm not impervious, that Lisa Chun (or anyone) can strike me dumb (in both senses of the word), can scatter my thoughts and make me stammer and make me forget that people are always just people.

At the same time, though, I feel a little nostalgia for that feeling. It's exhilarating to be subject to the force of a charismatic presence. (My mom and her best friend have a word for that not-necessarily-good-for-you kind of infatuation: cocaine. It seems very apt--a white-hot, ice-cold rush that clears out your sinuses and makes your heart race, and ultimately just makes you crave more.) It's also reassuring, I suspect, to believe in the existence of inaccessible realms, to crave acceptance into a club that would not have us as a member. "Man's reach must exceed his grasp, or what's a heaven for." How drab and dreary if this is all there is. And how crushing the responsibility if the we are all the world has to see it through. How much nicer if there are enchanted and superior creatures out there we can defer to, look to, pretend we aspire to but never really expect to attain kinship with.

And so if we don't have a Lisa Chung or her equivalent in our immediate environment, we can turn to movie stars and rock musicians, famous writers and nationally known politicians, for our fix. Could I keep my head in a room with Barack Obama or Laurie Anderson or Nicole Kidman or David Sedaris? Almost surely not. Celebrity provides that same exciting and deliciously disempowering sensation if you encounter it.

It's actually one of the things I like best about nursing that it pulls in just about exactly the opposite direction. The commonality of people, not just as people, but even more prosaically and concretely as biological entities, is essential to nursing practice. The wretched, homely realities of daily existence as mammals on planet Earth--belching, farting, salivating, peeing, eating, shitting, coughing, breathing, sleeping--which in social interactions we either strenuously domesticate or out-and-out deny, are accepted and seen with the utmost in matter-of-fact interest by working nurses. Assessing those very things is a straightforward and un-charged part of the job. People are people, and we're all in this mess of a life together. I'm glad to be part of a profession where that's how I get to spend most of my time. Even if I can't help but remain susceptible in small spots to wicked glamor.

Boo

2005-05-19T10:54:00.000-04:00

You know, I generally don't approve of calling older people "cute." It seems patronizing and disrespectful. But oh, gosh, sometimes the shoe really, really fits.

I'm entering "event reports" at my temp job, and there's one I kind of have to share with you. It's a report of a patient fall. The elderly man's wife usually makes sure that he's in bed before she goes to bed herself, but on this night, he wants to stay up late to watch a TV program about ghosts. After a bit, she's concerned, so she heads out of the bedroom to check on him, just as he's coming in. He's so startled he loses his balance and falls over backwards. (He is not hurt, which means we get to find this funny and endearing if we want to.)

Then, of course, there's the one where the husband of the woman suffering debilitating depression intentionally gives her a 4-fold dose of her sedative-hypnotic, then tells the nurse on the phone that no visit is necessary because his wife is too tired. Um. Less funny, less endearing. (She, too, was okay, incidentally.)

Tired

2005-05-16T14:52:00.000-04:00

I kind of don't think about it a lot these days, I guess because it makes me sad and mad and tired, and it's nicer just to forget about it, but a defining feature of my 20s was Chronic Fatigue Syndrome. Well, to be accurate, I never really fit the CDC definition of CFS, which includes something like "reduction in activity by at least 50%," and I'd guess my activity was actually only reduced by about 25%. Of course, in order to maintain that remaining 75%, I gritted my teeth and forced myself to do stuff that needed doing (hold a job, do laundry, go grocery shopping) despite feeling like holy hell and wanting so, so badly to lie down. It felt kind of like the very first day of a cold, you know? That day of feeling achy and sick, sore-throated and slightly feverish, and terribly run down, before the rest of the cold kicks in, and your nose starts doing its faucet impression. Only instead of lasting a day (or two), it lasted for 6-9 months at a time.

....

Okay, now it's nearly 2 weeks later. Yikes. My point was going to be that I've been having a small flare-up just now, and it's making everything harder. So, ah, there you go. Case in point.

Actually, my not writing has also had to do with how much I find I have to say about the experience of CFS, some of it still kind of inchoate and/or bound up in grief and anger. So I suppose I've been waiting for that golden chunk of time--you know, that magical unencumbered 5-hour interval that's going to pop up any moment now, when I can really sit and write it all out. And my life being rather short on magical unencumbered spans of 5 hours lately, I've been trapped in a mode of bloggorial (bloggitic? bloggorian? blogoleptic?) stasis, just going around and around inside my head about all the things I could write about chronic fatigue syndrome, that I would write, as soon as the chance presented itself.

I've finally come to the conclusion (inevitable, obvious, yet heretofore somehow elusive) that it ain't going to happen, and I need to move on. I'm also relieved that the current exacerbation seems to be letting up (these things are much shorter-duration for me these days, thank goodness) and making it more possible to write about other things. One day, I'll take the chance to sit and write at length about chronic fatigue, and craft it into a real essay, and post in on Rosie, Long Form. But for now, I miss writing funny pathetic, and I'm going to start doing it again, dammit.

Which is to say, hi, I'm back, didja miss me?

That's the Spirit

2005-05-02T12:58:00.000-04:00

Cassie pooped in the potty! Voluntarily! Yesterday. Peeing in the potty has been happening before bath every night for a while now, but for a long time, pooping was just for the diaper, and the two times she sort of inadvertently ended pooping in the potty, it kind of freaked her out. She still really doesn't want to be bothered with interrupting her activities in any way in the middle of the day for something as tedious as going into a different room and disrobing in order to relieve herself, but at least we're now getting to bracket the day with morning and evening successful potty sessions. I've been resisting, but maybe it's time to break out the bribes. Sigh. Someone suggested having a beloved book that only gets to be read on the potty--maybe that's a good thing to try first.

Anyway. Cassie and I went to the art museum again on Saturday, just the two of us. I ended up having to change her diaper, and we stood in line and waited for the handicapped stall in the ladies' room so that I'd have enough room (she refuses to lie on those changing stations--she feels like she's going to fall, so I have to change her standing up--suboptimal for a poopy diaper, to say the least). I got her all clean and fresh and then decided what the heck, I'll take the opportunity to pee also. While I was on the toilet, Cassie got curious and got down on her hands and knees and started looking into the next stall. I stopped her: "Um, sweetie, please stand up. We don't look at people when they're on the toilet. People need privacy when they're peeing and pooping. Well, not mama and daddy, but definitely people we don't know."

Cassie replied, "But I know everybody!"

Tufted Titmice

2005-04-28T22:02:00.000-04:00

It truly isn't that I mind working hard. I don't. I kind of like it, mostly. But the thing about doing too much of it is that it sucks up all your precious time into its ravenous maw. And you don't get to finish reading The Kite Runner* and you don't get to write in your blog. You don't even remember to do all of your IV drip rate calculation homework. (Plus, might I add, your diet is just appalling.)

I've started my new temp assignment. And I have to say, except for that annoying work's-ravenous-maw part, it's really quite excellent. I think a lot of it is probably that it is a health care-related office, and therefore somewhere that I myself might actually truly work. There are a bunch of nurses around (in my particular area, mostly the kind with MBAs or MPAs and wearing pleasantly frumpy suits and sensible, low-heeled pumps), and everybody's all comfortably serious and altruistic and nice and down-to-earth. I really love it. I feel so at home. Temping at the software company was great because the people were welcoming and fun, and I got to spend many of my work hours doing on-line jigsaw puzzles (dreadfully addictive) and reading my e-mail and writing whatever I felt like. But at the new place, I actually belong.

My supervisor, Kerry, feels like a nurse to me, though I don't think she has any clinical background or credential at all. She's an administrative assistant. But she's worked in health care for most of her career (she's probably a couple years younger than I am), and feels absolutely like a peer. I'm afraid I felt so comfortable with her from the moment I met her that on my very first day, I spilled my whole story to her, including the bit about the circumstances under which I left my last job. She seemed to take the story entirely in the spirit it was intended (and, having worked at Famous Hospital, to my mild dismay, was able to identify Patty, the cardiologist with interpersonal difficulties, by my description, although I had been careful not to mention her name).

Basically, I think it was fine, and Kerry has continued to be extremely warm and collegial, but it just makes me think that here I go again, trusting people. It was trusting Allison (on the basis of a lot more contact than I've had with Kerry) that got me into hot water in the first place. Oh, I don't know. I don't want to get all guarded and cynical, either. It wouldn't be worth it. I'd actually rather get burned here and there than close myself off from people I like and intutitively trust. But still. Maybe I could have held off more than an hour with the Patty Surratt story. I mean, you would think.

The other nice thing about this temp placement is that I've been sitting at a desk with a big window overlooking a little marsh ringed by trees--blond dried reeds framed by the branches of some kind of fancy maple with little red leaves and tiny hanging seed helicopters. It's quite beautiful in any weather, almost as striking with heavy dark gray skies behind it as it is with brilliant blue. And there are birds. Lots and lots of birds. Nothing too exotic (I wouldn't be able to identify those, anyway), but a nice, steady stream of cardinals and blue jays and red-winged blackbirds and black-capped chickadees and mourning doves and something black with an irridescent head. Oh, plus big old hawks, circling above the swamp or perched in the big, bare tree on the far side. It is testament to a childhood spent as my father's daughter that when I saw a little gray bird, about the size of a nuthatch, with a crest and a cream-colored belly and a rusty patch under each wing, the words "tufted titmouse" popped into my head seemingly from nowhere. When I looked up a picture online later, sure enough. Those might be my favorites, actually, pretty but not flashy, and all plump and soft-looking. I have to admit I'm not wild about the name, but what are you going to do.

Meanwhile, my exertions as a nurse-refresher student continue. This week was all skills lab. Oh, plus some videos: body mechanics, giving injections, administering oral meds, the use of a thingy called a "Slipp" for moving patients in bed. The first day was super-basic, mostly just taking vitals, but I was so keyed up that it was actually a little bit challenging. I've taken a thousand blood pressures, but suddenly I was all thumbs--put the cuff on inside-out, had the stethoscope head turned the wrong way. And when my partner at one station took my blood pressure, the diastolic was a good 14 points above my usual. Jeez. I did kind of simmer down the second day, though I still forgot to aspirate before administering an IM injection. I'm tremendously grateful to be getting all this anxious craziness out of my system now, with the plastic patients, so that I can be a little more together when I'm finally back to the flesh-and-blood(-and-consciousness) kind.

I'm also glad for all the school-ish parts sprinkled in, so I have regular opportunities to get my confidence back. Calculations, infection control guidelines, the heartrate below which you don't give the digoxin. Phew. No problem. And my favorite classmate, Janet, and I are continuing to bond. She told me a bit more about her 8-year marriage to a controlling creep (he even wanted her to give up her nursing license), and we talked about how impressed we are with people who are really good med-surg nurses, how amazing it would be to be like them.

One of my responsibilities at my new temp job has been typing in comments from patient satisfaction surveys. It's kind of heartening and inspiring to read what some of these people are writing. "Nurse X was just wonderful. She got me through a very difficult time, physically and emotionally." "I can't praise Nurse Y enough. She is everything a nurse should be--knowlegeable, helpful, friendly, funny, skilled..." One couple said they liked their nurse so much they wished they could adopt him. Some are from patients who are nurses themselves saying how impressed they were. The most poignant ones for me are the ones that say "thank you." Like they're so grateful that people are doing their jobs. Anyway, besides making me feel good about the place I'm temping for, it gets me kind of revved up to go out there and GIVE GOOD CARE. If I can just get the head of my stethoscope turned the right way.

* Starts out interesting enough, if slightly good-for-you (in an expose-yourself-to-other-cultures kind of way) and also kind of writers workshoppish (in a hear-pulleys-and-gears-as-key-elements-of-plot-and-characterization-are-set-into-place kind of way), but gets really compelling soon after the Big Bad thing that has been foreshadowed ad nauseam finally happens.

Run Right Out and Pick Some Up

2005-04-24T22:30:00.000-04:00

Unsolicited testimonials for three consumer products that you might need as much as I do and just not know it yet:

1) Frozen blueberries
I am not really a huge fan of blueberries my own self. I mean, they're fine except for their distinctive, um, blueberry flavor, which I find cloying and, when particularly concentrated (or artificial), frankly nauseating. However. Cassie loves them, but if I spend an arm and a leg to get a little container of fresh ones out of season, chances are good that she'll actually turn up her nose at them because they're too sour. Frozen blueberries, on the other hand, are much cheaper, come in a handy plastic bag you can pour them directly out of, and seem always to be sweet. And blueberries are all good for you and everything, with, you know, anti-oxidants and flavinoids or flavones (or one of those things that are even better than vitamins and fiber and other stuff that regular people actually know about already). When Cassie, who refuses to eat any vegetables at all ever, scarfs a whole big bowl of frozen blueberries, it makes me feel like significantly less of a bad mother.

2) Pre-brushing mouth-rinse stuff
My dentist and hygienist seem skeptical. My mom does, too. But I swear to you, this stuff is why when I ridiculously failed to go to the dentist for 10 years (no exaggeration), and then finally finally got my ass back in the big vinyl reclining chair, I had no cavities. I do floss daily(ish), and that's what everybody seems to want to credit. But seriously, when I travel (and don't bring the rinse stuff because it's sloshy and doesn't pack well), I really, really notice that my mouth gets all gross and mossy at a much faster rate. I just had another check-up, and the dentist remarked to the hygienist how great my gums looked. Trust me when I tell you that it's not my preternatural adeptness at hygiene technique. Daily use of the red icky-tasting swishing fluid. That's it. That's the secret.

3) Prozac
I was depressed. It felt a little as if life were a mucky garden, overgrown--choked--with these unwholesome purple and brown plants, and with ground so unreliable I could be up to my ankle in foul-smelling mud at the slightest misstep. The tiniest little thing would go wrong (oh, look, we're almost out of cat food...), and I could almost literally feel the squirt of some noxious combination of neurotransmitters, and in seconds I'd be awash in guilt and dread. SSRIs (first Lexapro, now Prozac) made the ground solid and sound, and the garden well lit and mowed. It made it possible for me to write; it made my career something I could actually work on; it is conceivable that it might have saved my marriage (at the very least, it made it vastly more pleasant).

I always used to be kind of an agnostic about anti-depressants. You know, you read the rants, the sneering depictions of Americans as greedy, shallow consumers of "lifestyle" medications. And, I don't know, it sounded kind of plausible. I wasn't paying that much attention, really. I'd read the diatribes and nod absentmindedly, critical faculties not fully engaged. But you know what? I have an opinion now. And my opinion is fuck that noise. I think anyone who wants and can safely take SSRIs should get them. That's it. And the neo-Calvinists who think pain is good for us and who value purity above all in their human nature can just go huddle together with others of their kind, but they'd best keep their grubby little mitts off of my brain chemistry, thank you very much.

(It Looks Like Up to Me)

2005-04-22T21:25:00.000-04:00

It's come to this. I've been assigned to a new temp job, and I'm delighted. Maybe ecstatic would be too strong, but anyway I'm definitely very, very pleased.

Since early November, I'd had this very comfy full-time software company gig. Executive Assistant to the CEO (a bit of a boor, but in the office less than half the time), and otherwise general czarina of random menial projects. Everyone (with the exception of the aforementioned Mr. Entitledypants) was very nice and warm and even funny, and I had tons of time with no work to do at all (thus the blog--it all starts to fall into place, doesn't it?). But then they didn't want me any more when my classes started, and I could no longer be entirely full-time (Tuesday and Wednesday afternoons now being devoted to the worthy endeavor of making me less of a menace to future patients). Understandable, sort of, if you look at it from a certain angle and squint.

So we were going to be even further up that ever-familiar creek, financially-speaking, with me not even pulling in temp wages. But then the nice agency found me another position, where they're cool with the leave-at-one-on-Tuesdays-and-Wednesdays thing, and the pay rate is the same. So I'll be making 4/5 of what I was making on a weekly basis. Which means we are not so monumentally screwed we might never recover; we're just, you know, really broke. So that is very cool. And my favorite part is that the temp agency guy told me that the person he talked to at my new (incidentally vaguely health care-related) assignment was all suspicious at first after she saw my resume because she thought it was some kind of underhanded power-play, and I was trying to sneak in and take over, because why would somebody like me be temping? Isn't that sweet? It put me in a good mood for the whole rest of the day.

The only downside, of course, is that now I'm actually going to have to go do a bunch of dumb work. Pfeh. I hate that.

And I've squandered this one lovely week off that I had, because with this evil cold, all I did was lie around and sleep and cough and drink tea and feel sorry for myself. Well, and do a little laundry and read The Pursuit of Alice Thrift. (Entertaining, but more empty-calorie-ish than I'd kind of hoped.)

But now I'm feeling better, and it's spring, it's spring, it's spring. The cherry tree over the driveway is in bloom, and the nice suburban birds are in full warble, and the air smells good. So it really is not all seeming very dire, I have to admit.

Go You Huskies

2005-04-21T11:54:00.000-04:00

Tuesdays and Wednesdays are now my nurse refresher class days. The classes last 4 hours each (with a 10-minute break that stretches to 15 minutes if the Dunkin Donuts in the next building is closed, and we have to walk all the way to the student center to get coffee), from mid-afternoon to early evening. I've had two now.

I like first days of classes. They're so unintimidating. You can't be behind yet. And there's all that time taken up with getting the revised syllabus handed out, and passing around a sheet to write your name and e-mail address on, and going over the list of required and suggested text books. It's all so nice and low-stress. And in this case, we also had to get a little campus tour (at least to see the library and the student center and the office where we could get parking passes) and get our student IDs made.

At this particular institution, they're called "Husky Cards." I'm sure that's some school-spirited reference to valiant sled dogs, but to me the word "husky" conjures only the fat-boy clothes in the Sears catalog. I'm not saying that definition of "husky" is not applicable to me in any way; I'm just saying maybe it would be more polite not to call attention to it on my student ID. When I had my picture taken, though, I was holding my head high to try to prevent double-chin shadows, and also I was trying to look pleasant but not smile so big that my face got all squinchy. The end result was that in my ID photo, I look like one mean mofo, with my chin jutting up and a kind of smug glower on my face. I definitely look like somebody who would take a swing at you, or maybe slash your tires, if you so much as whispered that she might be husky. So I guess it all works out.

There are only seven women in my class. (There was supposed to be an eighth, apparently, but she hasn't shown, so maybe she's thought better of this whole go-back-to-clinical-nursing craziness.) I think that, at 39, I'm probably the youngest by at least a couple years. I also, unsurprisingly, have the least clinical experience of the group. We meet in a classroom that is also the nursing skills lab, so as we sit and listen and take notes, orangey-tan plastic mannequins gape at us from six hospital beds, three on either side.

My favorite classmate so far is Janet. Janet is maybe in her early 40s, and has a way about her that suggests she's a strong person who's been through the wringer. She probably looked like a model not too many years ago, and still has girly long blonde hair. When we went around the room to introduce ourselves and explain a little bit about our background, she alluded to a very difficult divorce around the time she left nursing practice, and a kind of deep weariness passed over her face. During break time, I also heard her talk about her migraines (better now than they were) and an auto accident a while back in which she was injured kind of badly (they still plan to do an MRI of her head to make sure her left-sided headaches aren't trauma-related). But she also has a glow of optimism under the pain and fatigue, and she's friendly with just a little bit of wariness around the edges. I don't know. I like her. I trust her.

My other classmates:
Ellen -- in her early 50s, I'd guess; relaxed, sturdy, no-nonsense, professional, has worked for Head Start as a disability specialist for years
Lynne -- seems kind of sweet and fresh-scrubbed, very pretty face but incredibly dowdy hair and clothes--like an actress cast as a "real person" rural housewife in some slick X Files/West Wing/Veronica Mars TV drama
Lucille -- I'm trying to withhold judgment, but strikes me so far as a kind of negative, pessimistic, passive wet rag. She's in her 50s, I think, and this step has to take some courage, so she must have some spine and spunk in there somewhere. We'll see.
Nancy 1 -- again with the trying to withhold judgment. Strikes me as kind of cavalier and entitled and obnoxious. Doesn't really seem to take nursing seriously. Filipina. Worked as a public health nurse in Manila, but has only worked as a nurse's aide here in the States. May well be cloaking insecurity in brassiness.
Nancy 2 -- seems at first like a bland, shallow jock, but she hasn't said much, so it's really too early to say. She's slim and fit and outdoorsy, worked for years in sales for some medical equipment company that got bought recently and laid off a bunch of people.

Anyway, after all the first-day housekeeping kinds of stuff, we started with a lecture on how health care (and particularly hospital care) has changed in the past 10-20 years. Because of my background, little of it was news to me, but that was fine. Then yesterday we had a dynamic, entertaining lecture on pain control from an outside expert who played her plump-outgoing-Jewish-woman-of-a-certain-age role with effective, if a bit studied, panache. And we went over our homework (some dosage calculations, and some what-tests-are-needed-for-this-patient scenarios), and had a lecture on infection control. So far so good. Nothing to raise my pulse.

Next week, though, is going to be heavy on the scary scary part. Skills lab. Of course, this is mannequins and practice and no expectations, no pressure. I'm also beginning to realize that much like driving (you may recall that I just got my first license a year and a half ago), the skills part of nursing can be broken down into a series of tasks, any one of which can be made quite manageable, and even if you're in a hurry, you're really not doing more than one at once. So you just breathe and focus and think and do what you've been trained to do, and failing that, do what makes sense, and it doesn't actually have to be a big, hairy deal. I'm really starting to think I might not die from this.

Contrary to my expectations, though, I have hit a bit of a snag as far as obtaining scrubs. I happened to speak to Marina, my friend since 1st grade, maid of honor at my wedding, practically a sister, and incidentally nurse-midwife, just before I was going to place my scrubs order. Um, she said, I don't want to throw cold water on anything, but you should probably know that a lot of places are going back to dress codes for nurses. Some places that's one or two specified colors of scrubs (e.g., apricot or sea green), and some places even have nurses going back to whites. So now I have to check with my most likely places of employment to see whether I'll even be able to wear "oregano" or "Caribbean blue" or French Kitty on a pink bicycle before I go ahead and order. Very disappointing. But I suppose there is still hope.

First Day

2005-04-19T08:23:00.000-04:00

Today is the first day of the rest of my life. (I used to love Spencer Gifts when I was a kid--that mall store that had a mixture of posters with uplifting slogans, gag gifts, and crass mugs and t-shirts. I read through them avidly, as if I was looking for clues. Clues to how life worked, I guess. "Today is the first day... " always kind of puzzled me; I just didn't get what it was supposed to mean. I was also befuddled by the button with a picture of a chick hatching out of a shell that read "I just got laid." I knew it must be vulgar, but I couldn't figure it out.) Which is to say, it's the first day of my nursing refresher class. As it's approached, I've come to dread it a lot less and look forward to it more. It's seeming more real, and as it seems more real, it seems more doable. It won't be some vaguely defined nightmare of floating unsupported in insecurity, ignorance, and overwhelm. It will have real people (some of them likely quite nice, actually) and real tasks, and I'll just learn whatever I can.

What sucks is that I'm sick. Some nasty cold. Snot, sore throat, fatigue, etc. And when I took my temperature this morning (I'm tracking it daily for fertility purposes), I maxed out my ovu-thermometer at 100, so who knows--it could be way higher than that! (Poor me!) Actually, it's probably not. I don't feel that bad. But I still feel plenty crappy, thanks, as well as ochen' sorry for myself. Here I am, the achy, feverish young mother (okay, shut up), valiantly getting her golden-haired child off to school (day care), then dragging her exhausted sickly body into the city in order to better herself. See the montage! Hear the soundtrack! Doesn't it just make you weep?

Well. Anyway. I'll tell you how it goes.

Chapter 14, in Which Booty is Shaken

2005-04-18T14:29:00.000-04:00

Lucine and her husband Max came over last night. Lucine and Max are the kind of friends that are so close we often don't even clean before they come over (giving them the privilege of stepping over strewn toys and getting cozy with the dust bunnies under the couch, as emblem of our abiding love). They've provided emergency babysitting, and made emergency pots of vegetarian chili, and schlepped over on the bus in the snow when it would have been so much easier for them to stay snuggled at home, and just generally embodied "through thick and thin" in countless ways. Pete and I tell each other that when they have a baby some day, we're going to have to go move in with them for the first six months and cook all their meals and do all their laundry if we're ever going to have a hope of any kind of favor parity.

Somehow the subject of Creedence Clearwater Revival came up, and Pete was apologizing for not putting any on--"Rosie hates CCR," he said (with regret but no rancor, it should be noted).

"Um, no I don't."

"You don't?"

"No. I'm fine with CCR. They just remind me of high school. I hate XTC."

"You hate XTC??"

"Well, yeah."

"You hate XTC??"

"Um, strongly dislike?"

Anyway, he put on the record, and there was this gloriously sweet moment when all of us--Max, Lucine, Pete, Cassie, and I--were dancing around the living room and dining room to "Suzie Q," (like those corny movie scenes that proliferated after The Big Chill came out, I realize now, in the cold light of day). One of those moments that don't come very often, but when they do, make it all seem easy--make it seem as if the world is so full of love and pleasure that this joy is just what life is made of. A moment that makes happiness seem so readily accessible, you wonder why you ever thought it was hard.

Those moments for me always seem to happen with friends. It makes me wonder about the ideal balance of to-do list-wrangling and social contact. So much of life seems to require charging around, getting things done. I guess you just have to keep deciding, keep choosing, day by day and hour by hour. And maybe in the end do a little more inviting people over to hang out with the dust bunnies.

The Fan

2005-04-15T16:03:00.000-04:00

Cassie seems to have something of a crush on Jon Stewart. When she hears the Daily Show theme music start to play at the opening of the 7:00 re-broadcast, if she hasn't yet finished her supper, she will insist that her high chair be moved into the living room so that she can watch. She gets a bit impatient when anyone else is on screen, though she is now grudgingly accepting, as Pete has explained to her that those other people are Jon Stewart's friends. (Admittedly a bit of a stretch, especially when Ari Fleischer or somebody is on, but it just seemed easier to put it that way.)

A while back, she noticed that not everybody uses his full name. "Mama?" she said. "Some people don't call him Jon Stewart. Some people just call him Jon!" She's mentioned it several times since then. I think it makes her feel kind of exhilarated and in-the-know.

This past Tuesday night, Pete and I were discussing something, somewhat ignoring the television, though Cassie remained transfixed. Then it was time for a commercial (Cassie does not approve of the Daily Show having commercials, incidentally), and the esteemed Mr. Stewart did the obligatory into-commercial sign-out. It's not boilerplate patter to Cassie, though, it's all fresh and new. "He will be right back!" she exulted. "He said he will be right back!" [commercial, commercial, commercial, commercial...] "He's right back!!"

It's a grand, grand world when you're three years old and in love.

The Littlest Docent

2005-04-12T09:21:00.000-04:00

A visit to an art museum is a very different experience with a 3-year-old. The rhythm is entirely changed. Rather than the slow, even, reverent amble of a well-socialized adult, you get lots of stops and starts--a quick trot through three rooms, then 25 minutes in the next. The perspective on what is and is not of interest also gets altered quite a bit. Stairs, doors, and benches are at least as important as the putative art on display, particularly since they're interactive in a way that most of the art is not. And as you can imagine, more attention has to be spent on not running into, getting in the way of, or otherwise molesting other museum-goers.

My mom was visiting us this weekend, and so she and I and Cassie all went into the city together. My mom and I have a long history of going to art museums together, and Cassie and I have sort of become regulars at Local City Museum of Art, but this was our first time all together. I was a little disappointed with how it went, because Cassie was so revved up by the presence of Grandma Sal that she wasn't as interested in the art as she usually is. Even when it's just the two of us, there's plenty of stair-climbing and bench-lying and snack-eating and hallway-zooming, but we also get these great little moments of shared contemplation and discussion. Is that lady in the marble sculpture sleeping or dead? Which stained glass window is your favorite? Is the chimera in the ceiling mural flying or falling? Why is that little statue of the monk crying, and why can't we see his face? How did that man get those boo-boos on his hands? (Incidentally, Pete and I really do try to avoid baby-talk for most things, but somehow "boo-boo" snuck into our vocabulary, and is now pretty well entrenched.) There was less of that kind of thing this time, with Cassie so excited.

We still had a good time, though. Some highlights:

- Eating grapes out on in the sunny courtyard, on a stone bench decorated with carved grapes.

- Fifteen minutes hanging out while Cassie sprawled and read out the spelling of nearly every geographical feature on a stone floor map of the ancient Near East, upside-down. "M, E, D, I, T, E, R, R..." She then traced the course of the rivers with her finger, making a happy little rr-rrt rr-rrt sound, and then pretended to splash through all the bodies of water with Grandma Sal. (Fortunately, that particular room was fairly sparsely populated, so I think our whole-body map enjoyment was not too disruptive.)

- Sitting and looking at Rembrandts, as my mom observed that even the greatest artists seem always to get the hands wrong somehow, and Cassie sat quietly, wholly absorbed for the moment in her copy of "The Caboose Who Got Loose."

- Watching Cassie run up to a green, Mondrian-esque geometric abstraction as if it were an old friend. (She always has seemed more taken with abstract than figurative art, which is a little counterintuitive to me.)

- Holding Cassie's hand as we went into a dark room ("it's too spooky!") that housed a small collection of of Asian sculptures, each in its own little pool of light, and then holding her close as we looked at one particularly lovely and serene dark gray Buddha with what looked like a moonstone in his forehead.

- Noticing, as we sat in the museum cafe, that Cassie was suddenly having trouble with a piece of something, and getting my hand under her mouth in time to catch the entirety of a little glorp of vomit that then emerged. (It made me feel briefly like one of those unflappable veteran moms, as I discreetly deposited the smelly mess into a napkin, and then got the napkin into a plastic grocery bag (carried for the purpose of wrapping a dirty diaper), and tied it off, all without anyone besides my mom noticing that anything was amiss.)

- Watching Cassie pick out post cards in the museum shop--quick, avid, incredibly decisive, as if she already had a mental list of which ones she wanted. Yes, no, yes, yes, no, no, no, yes.

My mom said she might actually like the art museum experience better as led by a 3-year-old. You don't feel obligated to be interested in everything. It's also more kinetic--with all the trips up and down stairs and whatnot, definitely a better work-out.

Procrastination Sludge

2005-04-08T12:32:00.000-04:00

(This is a second go at this post. I had it all written out yesterday, but then it was lost when I tried to publish it, and hitting "Back" just rewarded me with a blank screen. Maddening. Makes me feel slightly better (less defective) to know I'm not the only one.)

I have trouble understanding that procrastinatory behavior and depressed mood are distinct phenomena. I have a habit of seeing them as part of the same thing, at least in the context of my own little (unique yet unremarkable) psychic landscape (grass, trees, maybe a lake, but also, over there, a cruddy strip mall, with dumpsters, and a chain donut store and trash in the parking lot).

(I remember saying something somewhat similar, talking to my previous shrink, and then being struck by the thought, "oh, but I guess when it comes to psychopathology, you don't really want to be original and unusual, do you?" And she said, with some authority, "No... No, you really don't.")

So then I get all confused when depression and procrastination come separately. Not that it's never happened before. It just doesn't gibe with my established mental model of how things work, so I'm surprised every time. I'm bopping along in life, not depressed, maybe not Profoundly Happy, in some kind of choirs-and-major-chords way, but, you know, fine. And yet there I am, going through all kinds of contortions--mentally, logistically, psychologically--to avoid even seeing the thing that I am not doing. Some unavoidable reminder of the existence of the thing might occasionally force itself on my consciousness, and I will, with great energy and verve, push it the hell back away from me and think very quickly of something else. (I might also have the fleeting thought, "what is up with that?" but am soon swept away in thinking very hard and seriously with knitted brow about "is it too warm out to make chili?" or "should I have gotten the cheaper, less cute bathroom rug?")

I cannot tell you how much trouble I'm having making preparations for my nursing refresher course that starts the week after next. Every stupid little step takes so much energy. I have to keep swatting my hands (put down the crossword puzzle) and forcing myself (grinding sound, smell of motor overheating) to do what I need to do. I have now assembled/composed all the pieces of my application for a license in this state and sent them in. I have obtained the necessary form and assembled/composed my application to the nursing refresher program of my choice. But it took me FOREVER. Fortunately, I don't need an in-state license until clinical starts next month, and the program wasn't even close to full, so it was fine. But man oh man. Like pulling f**king teeth. AND it's not over, because I still have to figure out about malpractice insurance (I've never had to deal with this before, because usually you're either a student--in which case, you're practicing under your instructor's license--or you're covered by your employer). And about getting the required physical. And about when and where payment is required. (My mom very generously for Christmas gave me a blouse, and some socks, and a little card with an old fashioned nurse on the outside, and on the inside, an offer to pay for my nurse refresher course! Which is really, truly a great thing. So my squirreliness can't even be about the money, for a change.)

I suppose what it comes down to is that this whole trying to be a hospital nurse is scaring the shit out of me. I'm scared I'm going to suck. I'm scared I'm going to be so overwhelmed I'll cry in front of people. I'm scared I'm going to hurt somebody somehow--give them the wrong medication or run in an IV too fast or forget to tell the doctor something important or fumble in a transfer to a wheelchair. I'm scared I won't know how to do stuff I'm supposed to know how to do. I'm scared I'll be unsupported. I'm scared of that choking feeling where everybody wants something from you and you can't do it all and it's all your fault. I'm scared of being not enough.

So. Well. I suppose that does explain it all a bit, really. But still.

At least there's one part of the preparation that I think I won't procrastinate about at all. See, I have a closet full of office-y clothes, but I've got pretty much nothing to wear on the wards. So I have to shop for some scrubs. I even got a catalog unbidden in the mail recently. There are lots of colors and patterns. I'm thinking slate gray, ceil blue, and maybe "paprika." I'm toying with getting a garish print or two, too. The twee-ness of the "French Kitty" riding a hot pink old-fashioned bicycle in front of the Eiffel tower, all on a girly blue background, somehow calls out to me. I'll let you know what I pick out.

"Blue Graphite"?

2005-04-01T13:59:00.000-05:00

So. I'm driving a new car. I, Rosie Bonner--longtime non-driver, reluctant consumer, hater of new car smell, broke-ass temp--am now tooling around the genteel, historical suburbs in a 2005 Volkswagen Jetta wagon, resplendent and classy in its coat of glam yet mysterious "Blue Graphite." It makes my stomach hurt to think how much we can't afford it, and I still can't help thinking that some unprepossessing little 1996 Civic or something would have been a more appropriate choice, given our financial situation. I'm angry at myself for being so passive during the process. I know nothing about buying cars (Constance, my dearly departed 1990 Camry, was a very generous gift from my mom, who bought it from the mother of someone she works with), and the whole thing makes me feel overwhelmed and stupid and like crawling into a closet and curling up on the shoes and closing the door. So I really didn't push my 1996 Civic vision, and now I'm thinking I should have. We really, really can't afford this car. We're already in debt up beyond our eyeballs, and this is a hella expensive area to live in, and yeah, I'll be working as a nurse, but not until late summer, at the earliest, and even then...

But. But I have to say, I'm really loving this car. They put in all these little aesthetic touches for people like me who don't know from cars, like a chrome plate around the gear thingy. The ignition key leaps cheerfully out of its rectangular black housing like a little squared-off switchblade when you push the silver button. The controls look all contemporary and technophilic, but quietly so, nothing garish or geeky. And the color. The color truly is lovely--its name being silly yet strangely accurate.

Beyond that, it's zippy (well, zippier than the sluggish and beleaguered Constance, at any rate) and steers nice and tight, and I'm going to have to pay attention not to speed. Driving Constance, I could tell how fast I was going, within 5 mph, without looking at the spedometer. I don't know what it is now, exactly--is this car quieter, or is it just that it labors less?--but I'll all of a sudden be going 50 mph in a 35 mph zone, and it's only by a glance at the dashboard that I can tell.

What's weird is that it's as if I'm now this different person--this driver. In a new car, I'm just another American in an automobile, somehow. I'm no longer a driver in a grudging, half-way, on-my-own-terms, hair-needs-washing, eccentric kind of way. Now I'm a busy professional with an on-the-go lifestyle. I'm today's discerning consumer who demands value and convenience. I'm a law-abiding taxpayer who just wants the best for my family. I'm a soccer mom. (Not that Cassie, at 3, has yet discovered the glory of wearing kelly green and white, stuffing padded plastic half-tubes down the fronts of her socks, and chasing around after a ball with a knot of other children who refuse to unclump no matter how much their coach yells directions. I do know that this is not unlikely to be in her future, though, so I suppose I'd better start trying now to summon, from the reserves of my soul, at least a scintilla of enthusiasm, come to think of it.)

Something else that this car represents, though, is an opportunity to start fresh. I can learn all about proper car maintenance and do all the right things at the right times and keep all the records all nice and neat. I don't have to feel guilty. I haven't done anything wrong yet; I haven't neglected anything yet. I'll keep the air pressure in the tires just where it should be, and I'll check the oil and track my gas mileage and get tune-ups and learn all about antifreeze and whatever else I'm supposed to do. I'll get one of those books about car maintenance for lame-ass sissy girl dummies. And then it won't be something that I'm not dealing with because I don't know quite how, and that I dread thinking about because it makes me feel crappy. It will just be what I do.

That will be nice.