Month: March 2013

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From A(cetaminophen) to Z(ofran): An Alphabet of Nurses

You’re in the hospital. Your nurse is trying to make you better. What is s/he bringing you?

Warning: Blunt nursiness to follow. May be too much for those of a delicate temperament.

Acetaminophen: Come on, y’all, you know this one. Tylenol! Takes the edge off pain (except pill-seekers) AND fever. Double whammy.

Beta-blocker: Okay, okay. It’s not technically one medicine. But if it ends in -ol, it’s probably a beta blocker. Like atenolol, propranolol, etc etc. Great for lowering a high blood pressure.

Calcium: “Come on, I take this at home for my bones!” Not so fast, snarky reader. Not only is calcium great for bones, Tums are great for your tummy.

Digoxin: This was one of the first meds we learned about. It helps to slow the heart and prevent arrhythmias. Cool fact: comes from the foxglove plant!

Enalapril: This is an ACE inhibitor, another blood pressure medication. Can cause a nasty cough.

Flomax (finasteride): Look this one up, y’all. But a lot people get it.

Ginger ale: A lot of people swear by it for nausea…

Haldol: OK, I’ve never given this, but in a nod to psych nurses, this is an important one for chillin’ people out.

Ice: Great for pain and fevers. Sometimes old remedies are the best.

Juice: Great for clear liquid diets, bad for blood sugars. Especially popular – prune, effective for the bowels.

K-phos: On dialysis? Take your K-phos with your food!

Lasix: Gets the fluid off by making you go to the bathroom. A lot. Great for heart failure, bad for potassium.

Milk of mag: A fantastic bowel med, especially when mixed with prune juice or coffee in the delicacy known as a “Brown Cow”

Normal saline: Also .9 NaCl!! Almost everyone gets a bag of this. No nutrients, just straight isotonic fluid replacement.

Oxycodone: The gold standard of pain pills. Some permutation of 5-15 q 2-4 hours should get you through (we’ll titrate up slowly because we don’t want you unconscious!)

Potassium: Nasty big horse pills. Or nasty orange powder. Or nasty “K-rider” that will hurt as it goes in. You take your pick.

Quease-Ease: Great for nausea for some, useless give-away for others. Smells minty. My teacher said you could get the same results with an alcohol wipes, but alcohol wipes don’t look nearly as cool as the submarine-like Quease-Ease tube. And the scent lingers for months!

Respect: I snuck this in here instead of Rifampin, because nurses have (or should have) a lot of respect for their patients. Mutual respect is essential to the healing relationship.

Sulfas: Great for infections. Bad for allergies.

Tiotropium: You got COPD? You’ll get this inhaler (AKA Spiriva) 

Ultram: Tramadol, the non-narcotic narcotic

Vancomycin: You got an infection, we’ll give you a PICC and pump you full of this. But slowly. Cuz it bubbles. And it will turn you red. And if it gets into your tissues… it’s bad.

Water: Ice water, and lots of it.  

Xanax: You are getting sleepy… very… sleepy…

Yaz: OK, I don’t give this much either, but the few young women who I treat usually bring their own from home.

Zofran: Great for nausea, oral or IV.

There you have it! A nursing alphabet!!

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Maundy Thursday

I went to my first Maundy Thursday service (that I remember) this year. I even played handbells on a beautiful piece. The  service was lovely and somber and moving and dark, as any service commemorating the night before Jesus died should be. After all the lovely music, after communion, after a message about foot-washing and being a servant, the pastors stripped the altar… black cloth of mourning was draped over a cross and over the tables. Then we left quietly, without the usual greeting and gab that comes with the end of service. I felt as though we were still “suspended,” waiting for a resolution.

Later on I got to thinking – what if I was to commemorate Maundy Thursday by reenacting it?

My buddies and I would follow a random stranger to a private room, where they would all argue. I would wash their feet. Then my best friend would leave the party to betray me. Then I would spend all night praying in a garden while my friends fell asleep instead of keeping me company. Then I would get arrested and go to jail…

***

Our pastor told us that “Maundy” comes from the Latin for “command” (In Spanish, “mandar”) as in John 13:34, “A new command I give you: Love one another. As I have loved you, so you must love one another.”

Whether it’s footwashing…

or forgiving someone who betrays you…

or going the extra mile for someone you dislike…

Whatever it takes, we need to love one another. That’s his command to us.

That’s the best way to commemorate today.

 

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Losing my Brain

I lost my brain tonight.

You can’t blame me. It was a long night. I floated to 2 different floors, had 5 patients over the course of the night, and pharmacy wasn’t sending me my patients stuff . I was just starting to get a handle on things when I lost my brain.

No, no, not my mind (though that was fuzzy too). My brain sheet. Most nurses have a “brain” with reminders of what to do when. Mine had everything with everything marked down – what meds, what vital signs, blood sugars, things to follow up on, when to empty drains…

And I lost it!

Thankfully the charge nurse gave me lunch AND found my brain sheet on the floor of my patients room. I felt like a new woman after my blood sugar climbed back into the normal range and I had my scribbled to-do list in front of me.

So that just proves… Something 🙂

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Thoughts on the End of A Shift

I write this as I walk through the halls after a long evening shift. Fortunately they are empty.I was busy all night, too busy. Nights like this I wonder: was it me? Or was it the assignment?

I know this shift will haunt me. Fortunately my patients were all fine at the end, but… I don’t know what I don’t know!

There’s a lot of guilt that comes with nursing. We want to be everywhere and do everything for everyone and we can’t. We have to delegate. And I will have to forgive myself and let it go.

All right I’m at my car. Breathe in,breathe out. Thank you God I do love my job. And my patients. Bless them all. Good night.

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The Danger of Settlers of Catan

I love games. Card games, board games, dominoes – I enjoy the friendly give and take of games, the chance to focus on an activity together and use my problem solving abilities.

But there is one game that I dislike, and that is the ubiquitous game Settlers of Catan which has a board, cards, and dice. It’s the quintessential game night game – takes a long time, accommodates up to four players, makes people feel “in the know” and cultish while at the same time being very familiar and straight forward.

If you’ve never played, it’s a resource production and utilization game. Every time a particular number is rolled, a certain good is produced. You can use those goods to build certain things and you get points for building them.

How can I not like it?

Well, I don’t. Fine… I’ll play it with you if you really want me to. But here’s why it’s NOT my favorite game.

1) It makes many people mad. Or at the least irritable and competitive. Even good friends. Even when you know it’s “just a game.” Even when the people playing are nice, ordinary, sweet, gentle people every other time you see them.  And it makes people upset because…

2) It’s a game that has a fair amount of tearing down what other people are building. Many of the cards give you the opportunity to take cards from other players, even though they may have been accumulating that particular card for a long time. In addition, every time someone rolls a 7  (the most common roll), they can relocate a piece on the gameboard that then takes away other player’s productivity.

3) It’s a long game that allows people to simmer in their anger and resentment. Instead of – “oh, rats, lost that hand, let’s play another” it goes on and on. “I’m still losing because X took this card and I couldn’t build that important thing and Y built a road where I needed to go and and and.”

I like a friendly bit of competition. I am not saying that games shouldn’t be competitive. Somebody usually has to win. But I don’t enjoy games make people short with each other and snippy and chilly and cause a negative attitude that hangs over the rest of the game.

Maybe Settlers is perfect for some groups. But not for me. I’d much rather play Pandemic, Ticket to Ride, Sequence, Mexican Train, bridge… there are so many good ones! In my view, life is too short to play Settlers.

 

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Pom Pom Sunday

Today is the Sunday before Easter. Palm Sunday, or Pom Pom Sunday as some in our church call it, is the beginning of Easter Week. 
 
If Easter Week were a psych patient, s/he would be a rapid cycler. Palm Sunday: yay he king is coming! Maundy Thursday: A big dinner and an arrest. Good Friday: tears and despair and earthquakes.  Sunday: yay Jesus is risen! There is a lot of emotion and drama in this brief week.
 
I really enjoyed our service this morning, even though the music pastor had travel difficulties and was unable to make it to a Sunday with a great deal of music. Everyone rose to the occasion – the guest organist, the assistant director, the choir member who had played the piano part once before but did great. We in the bell choir processed in, ringing our bells, and everyone else did a parade with the palm branches.
 
I enjoyed the interruption in the routine – memorizing our music! Processing through the aisles! Waving palm branches! Palm Sunday is a rebellious holiday. 
 
It was rebellious then, too. A king who is actually a carpenter, riding on an unbroken donkey rather than a white horse. A shepherd king leading his people with a  staff, not a sword. 
Riding in like a conqueror when he was actually intending to submit, to die for his people.  
 
And the people celebrating him weren’t officials or soldiers or music directors. No one was throwing confetti. No. Instead, common people were laying their coats in the streets. They were celebrating their king.
 
Their king and ours.
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Surviving Weekend Walmart Syndrome

Walmart on Saturday is CRAZY!!! 

It is like rush hour on the free way. Aisles jam-packed with shopping carts. Children like satellites or planets rotating about desperate parents. Peoples of all ages, mobilities, and ethnicities roaming in a cacophony of argument, discussion and intention.

As an avowed introvert, I used to develop “Weekend Walmart Syndrome.” The number of people combined with the amount of crowdedness had a peculiar power to suck out my life and brains and energy. Symptoms included tiredness, grouchiness, negativity, rudeness, pushiness, and frequently forgetting essential items.

In my opinion, the perfect time to shop at Walmart is early weekday mornings. When we were in Florida last summer I would go in around 6 am after dropping Chris off at the hospital. Heavenly!

But sometimes I can’t do that. Sometimes my schedule mirrors the “normal” 9-5. Sometimes I can’t procrastinate any longer – the larder is BARE! At such times, I have to go when the grocery store is at its worst. 

So here are my tips to make that weekend shopping trip survivable.

1) Make a list – a clear list. A definitive list. Don’t think, “if I write down mac and cheese, I will remember the cheese.” No, write down macaroni noodles, cheese, and milk on separate lines. I keep my list on my phone and delete it as I go. It’s nice if it’s organized by aisle or section, but not essential. As long as you know WHAT you have to get, you’re more likely to get it once you’re in the locura of the store.

2) Take a deep breath while you’re still in the car. Before you approach the store with hordes of other anxious shoppers… before you nod at the greeter… before you throw some elbows to get to a good shopping cart… take a deep breath and mentally prepare. “I’m going to get through this and it’s going to be bad but I will do it as quickly as possible and get out.” (An ounce of prevention is worth a pound of cure!)

3) Move quickly and efficiently. On a Monday morning, it’s fine to compare the two brands of soup calorie-for-calorie, unit price for unit price. On a Saturday? Grab that can and run! Trust your judgment. Try something new. Don’t linger in the aisle because you may be run over by a shoppernaut or get stuck in a cartjam.

4) Smile at everyone. Frequently say, “Excuse me,” “I’m sorry,” “on your left” (okay maybe not that one).  But even if you’re as angry as can be, keep that smile plastered on your face!!

Why? Two reasons.

a – The smile will make you feel happier. It’s true! You will feel more positive even as you are choosing to smile rather than yell at that person for taking the last starfruit!

b – The smile and courtesy will make other people treat you better. Even a brief, insincere smile is better than a grimace. You are more likely to get through the cartjam and less likely to get caught up in any fistfights in the produce.

5) Get out of there as quickly as possible, go home, and recover. A nap? Yes. A shower? Probably. Whatever it takes to unwind and get on with your weekend!!

Hopefully you will be able to avoid Weekend Walmart Syndrome. Following this practical plan, I had a decent grocery shopping trip – only forgot one item. You can do it too!

 

 

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Houses Across the Country

I’ve already talked about how different areas of the United States respond to snow. Recently, through discussions with family members, I have been thinking about how dramatically different houses (and labels for houses) are in different parts of the country.

This is mostly related to geography, of course. Is the land swampy or dry? Can you have a basement without it flooding immediately? Do things rot so fast that houses have to be made of brick to last more than ten years? The different kinds of houses in the place you grow up affects your own expectations of a house. Adjusting to the selection in a new place can be extremely difficult.

From five months to eight years, I grew up in a ranch-style house in California. It was a great house as I can see now – close to a park, lots of amazing plants, pretty good neighbors (except they did light the dog on fire by accident)… But when we went to visit my grandparents, I was always enchanted by their multiple story house and basement. What was a basement?! What was a second story?! I wanted stairs. They seemed so glamorous.

I got stairs when we moved to Houston. The three houses we lived in over the 11 years of our “Texidency” were all two-story brick buildings. A basement? In swampy, floody Houston? Ha! An attic? Is that what you call the little space above the ceiling that’s carpeted in fiberglass and soars to 400 degrees in the summer? Yeah, we have one of those.

I only ever lived in dorms and apartments in North Carolina, so I can’t really speak to the style of houses. But in Minnesota, there are a lot of basements. In fact, the most popular style in Rochester appears to be “split foyer” or “bi-level split.” (Apparently this saves money in the building – less building above the ground.)

My husband grew up in Virginia and has had to adjust to the difference Minnesota housing. To him, a ranch style house was always a “long, one-story” house. He’s accustomed to two story houses and only saw basements in older houses in Virginia.  What’s a bi-level split and why is it so popular?

In fact, when we talked with a realtor in another city, she mentioned that Rochester is known for its split foyers. This is probably related to the continuous presence of residents looking for affordable housing.

The type of house you are accustomed to affects your experience. Are you used to coming in, taking off your shoes, then trotting up the stairs to deposit your coat? Are you ready to move between the kitchen upstairs and the hang-out room downstairs? Are you willing to have your bedroom in the basement?

We have just begun the house-looking process, and I’m sure I will have more notes on this issue as our search progresses. For now, let’s just say this: every place is different. Adjusting to the different houses in different areas isn’t just a matter of environment or real estate or comfort. It’s a matter of culture.

 

 

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The Aquifer Theory of Creativity

Some time ago I meant to post about my theory of creativity but… I forgot. Now is a good time because I haven’t written anything for fun for some time – I have been too distracted in the business of daily living, which is extremely important but hopefully will quiet down soon.

My Aquifer Theory does not address how you become creative. Nature? Nurture? Mental Illness? I’m sure it varies from person to person and don’t know enough about that to comment yet.

In my theory, writing is like agriculture. You plant the seeds of the story and then you water them and they grow, and you water them some more, and… you have to keep watering them! (I wish I’d realized this before I killed my houseplants <sigh>)  And the water in this elaborate metaphor is creativity.

No, I don’t know what the sun or the earth is or what weeds would be, but the Bible has a good parable about something similar. 

Ah, good question. You get the water for the fields from wells, I imagine with buckets. There are no irrigation systems or canals or sprinklers in my metaphor.

Where do the wells get the water? Excellent thought…

Every person has an internal aquifer of creativity (an aquifer being an underground, refillable reservoir). Like a real aquifer, this reservoir of creativity can be refilled by experiences. Reading lots of books is a great way to fill the reservoir. Having unique, even painful, experiences. Good conversations, travel, retreats, meditation, workshops, long walks in the woods, lingering sunsets, a wine tasting, a concert, prayer – anything that engages the deeper mind. (Taking a Sabbath!) Being, not doing, is often the genesis of creativity.

So when the well runs dry it is not because you have sapped the aquifer. (This is where the metaphor diverges from real life where in fact you can dry out some aquifers, known as “fossil” aquifers, that are not recharged by precipitation). No, in the metaphor, you control the weather and you can add more rain that will slowly percolate into the aquifer.

***

“Hold on,” you’re saying. “Why can’t I just water the field with rain water?”

Why do you ask such tough questions…

Because the rain is the ACID rain of raw writing/experience and it has to be filtered through the clay and sand and tree roots in the ground before it is distilled into the wild, unbridled creativity that produces readable books and interesting dreams.

Otherwise, it might come out as plagiarism. Your “rain-grown” writing (or art) won’t have the perspective of “well-grown” writing.

Ah, you have a final question for me. “Where did you come up with such a (great/weird/elaborate) metaphor?”

In this case, I think my dad must have something to do with it. As a geophysicist who works with reservoirs and wells and fossil fuels, I think some of his shop talk must have “permeated” (hehe, pardon the pun) my developing ideas on creativity. 

Happy writing, everyone. And just remember, if you can’t write, it’s not that your well has gone permanently dry…

You need to refill the aquifer!!