best med rec this week by far

Medication reconciliation done on a 14-weeker prego who came in with shortness of breath:

1. Methadone

"I can tell you all about it--dose, how long I've been taking it, where I go to get it..."

"Are you taking prenatal vitamins?"

2. Oh yeah, I'm taking those

3. I have an inhaler, but I lost it.



"Do you have an ob/gyn?"

"Yeah."

"Who is it?"

"I can't remember the name."

Father: "Do you mind if I go out? I left my kid in the car."

It's 3 a.m., and they just made runner-up for the Parents Of The Year award. Almost tied with the parents of the 6-week-old who fell off the bed because "he rolled a little." Send more nominations to me. The contest is ongoing.

undercrowded

Ever since we moved to this house I have had trouble sleeping. It seems like I can't get through a night without waking up.

My first thought was that it was because I was working more night shifts. Bigger mortgage=have to work more=more stress=insomnia.

But I think that I have discovered the root of the problem. The bedroom is just TOO BIG. While it is lovely--with 2 closets, a fireplace, a bathroom, and a balcony facing the backyard--I do not feel secure in there. It feels like I am floating around in the open air when I am laying in bed.

I have always felt that I could live happily in a tiny home (that is, if I was able to part with some of the "junk"). I also thought that this was probably a character flaw of mine according to our society. Houses are built so large now--ours is from 1985 but still 3,000 square feet--it seems like living in a behemoth should be a normal way of life. Never mind all the earth's resources that it takes to maintain and run this house.

Our home in Illinois was 1,300 square feet. I was living happier in it. We were all closer. My bed was right next to the window where I could see and hear the oak leaves tap against one another every morning. I had birds to wake me and I could see strands of caterpillar silk reflected in the early sunlight.

I miss the simple life.

Rude Pencil

I found this pencil while unpacking some boxes in my room. Yes, that's right, I am STILL unpacking. That is beside the point.

I never really noticed or cared much about it--probably got it for free from some job fair back when I was a new grad--but now the message is so poignant to me, I am going to place it in one of my memory boxes so that it will last forever. Go on Southern nurses, remind me how rude us Northerners are. Wait a minute, I can't really consider myself a "Northern Nurse" anymore, now can I? Well, I will always be one in heart and spirit. Love live EICU!

expressing yourself

In ER world, nurses see lots of creative and innovative ways that patients choose to "express themselves." Why hold your anger inside when it can only lead to heart disease and aneurysms? Let it all out in the ER. The nurses are trained to therapeutically address your concerns. We are caring individuals.

Some ways that our patients like to release their pent-up feelings and emotions:

1. Tossing the written prescription on the floor in front of the nurse's station and storming out, all because the doc wouldn't write for Lortab or some other narcotic that the patient could sell on the street. Minutes later, housekeeper finds the word "bullshit" scribbled on the stretcher mattress.

2. One of my favorite nurses likes to advise his patients upon discharge to "drink plenty of water, eat your vegetables, and wear your seatbelt at all times in the car." Problem is that obese women who come visit us with barely a cold don't want this advice. "I sat in the waiting room for 4 hours just to be told to eat my fucking vegetables!"

3. Triage assessment on a patient brought in by ambulance goes like this: patient transferred to bed with help of EMS personnel, nurses assist patient into gown and instruct patient to lay down so that we can take vital signs, patient purses lips together and blows out a spitball straight into the air while two nurses are hovering above attaching electrodes. Or sometimes, the wall gets decorated. Safer for the nurse at least.

4. Phrase of the week: "I don't care." I don't care about this shit, I don't care about what you are prescribing me, I don't care what you say even though I myself chose to come here, I am not being admitted, I don't care if I have to pay the hospital bill out of my own pocket if I sign out AMA because you know that I won't pay it anyways.

5. Patient is bleeding profusely from surgical dressing, chux upon chux pooling up with blood. "When will I stop bleeding? Can I take a bath when I get home? Why do I have to stay here?" Fed-up Dr. Q responds with "I can't tell the future." Yes sir, go on home now, get blood all over your car and have your wife call EMS when you decide that you would rather bleed in the hospital.

Now I know why we studied therapeutic communication in school. Because it works so well in the ER. Patients always respond positively to logical reasoning there.

Remedial Composting 095

Let us, just for a moment, forget that it has been in the 20's down here in Tennessee for the past few days. Pretend that nitrogen is infusing all those weeds and unidentifiable green things known as "forbs" with power so that they take over the lawn. Let's ask a few random questions about composting.

1. If the toddler/preschooler throws a 2mm-thick fruit leather down because "it's too sticky!", and it becomes stuck with dog hairs that have been on the kitchen floor for awhile (quite a long time), will this piece of fruit leather then proceed to decompose in the compost pile?

2. What about peanut butter? Or will my dog get to it first?

3. Macaroni and cheese? Does the expensive organic kind break down faster?

4. A pumpkin from last Halloween? Or should I just keep rolling it around the pile in hopes that a raccoon will eventually carry it off?

5. Chex Mix? Does anyone think that the powdered cheese that's stuck on there will affect this process adversely?

6. Bills, if they are finely shredded?

Master Gardener Class #4

I'm not sure if I mentioned on here that I was going to attend the Master Gardener class from January through March. I am trying to progress from growing impatiens and tomatoes successfully to something a little more complicated. Not only that, but the growing environment in Tennessee is crazy different compared to Illinois. More and larger insects, hot and dry summer days, nosy next-door neighbors who prune and cut things down without notice.

The other night at work we had a little downtime, and I was sitting at the nurse's station along with a lab tech who was waiting to get into a room. My "Gardening in Tennessee and Kentucky" book was laying on the desk nearby.

"A garden book? Who's the gardener?"

"That's mine. I am. I'm from Illinois, so I need to learn more about growing things here."

ALERT, ALERT: Probably one of the stupidest questions ever asked to me:

"Does anything even GROW in Illinois? You know, with it bein' so cold up there?"

Hello foo, have you ever heard of "The Corn Belt?"

So today was my fourth class. Every night the "graduated" Master Gardeners serve a spread of food that follows a theme. Tonight was Italian night, I think. There was tomato bread and garlic toast with basil, pesto, and sun-dried tomato spreads, and pasta salad with feta cheese and artichoke hearts. Tonight was my first time ever tasting artichokes, which turned out to be a little bit of a disaster. There was a large woman sitting next to me in class and she had that "dirty" smell that I recognized so easily, the same malodorous stench that waifs around the ER all the time. The smell didn't ruin my appetite, but like my friend said on facebook, it could have influenced my opinion about the artichoke hearts in a negative direction. So I will have to be sure to sample them again sometime in this lifetime.

Continuing on with the food list (and this is about where the Italian ends, except for the pizzelles and pizza rolls)--pumpkin bread, vegetable tray, and nuts. The ongoing discussion in the food line during our halftime break was the impending snow.

"I wonder if the kids will have school in the morning."

"Well, it's got to be colder than in the 40's for them to cancel it."

"I hear the temperature is going to drop tonight and turn to freezing rain."

"They are predicting an inch of snow!"

A winter weather advisory for ONE INCH??? All I could think to myself was, wimps.

The woman who needed to thoroughly clean all of her body folds kind-of ruined the educational experience for me tonight. The speaker, who was a retired professor from the University of Tennessee, kept the discussion light and humorous. But even that didn't help much, because every time the woman laughed she would move around and kick up a new round of stench.

Quotes from the professor:

When speaking of living in Minnesota: "It started snowing in October and you could look outside and see snow until the 16th of April, and we found that somewhat excessive." Almost everyone in the class nodded in agreement.

While showing a slide of a badly-pruned tree that had the terminal branch (top branch) hacked off: "Yes Virginia, you too can have a 40-foot hat rack in your front yard. If you have to prune it again I recommend one single cut right here," and he motioned to the base of the trunk.

Toward the end of night, regarding his being the speaker for the class: "It's all in the unit, everything's in the unit. I don't know why I even do this." That got quite a chuckle from all, but I think he might have been dead serious.

It was overall a fun class, but I have been sitting here typing for the past 20 minutes, home for almost 2 hours, and have changed my clothes. Yet I can still smell that woman. Maybe next week I'll be antisocial and sit in a corner somewhere, just in case.

williamson county snow day

NEWSFLASH: school opening delayed for 2 hours

But you can't even play in this stuff!

Scenes from my backyard (and front, to be fair) II

Embalmed leaves

If anybody can help me identify what the name of this tree is I will buy you a virtual drink. I can't remember what the leaves look like since they have all fallen off, but what stands out for me is the bark. At first I thought it was covered with fungus, but now I realize that that is how it's supposed to be (I hope to God it is, for the sake of the tree!). It is covered in what looks like stacks of misshapen coins. Normally I would look this up myself, but my field guide to trees mildewed while sitting in storage here and it smelled too bad to save, and I have yet to buy another one (one more innocent victim of the move, including many daddy long-legs that made the trip down in boxes).

A pseudo-graveyard, but the only thing really dead here is my will to want to walk through this area in the summertime, down by the creek, where vines of poison ivy cover the ground

Sweetgum balls, which give the tree an interesting profile in the winter. And that is about all the good I can say about them!

Holly and berries. I never realized that this evergreen tree didn't like growing in the North. It seems so northern!

One of the few Tennessee snowmen in existence today. Two minutes after building him he was already beginning to lean backwards.

The aforementioned stream. During the summer it was pretty dry and you could see most of the creek bed. My next-door neighbor has an irrigation pump thingy that sucks up the water for his grass, and I have a theory that he was contributing to our drought. I was going to take some of the stones from the bottom for my garden path in order to give it a natural look, but I had to wait for the autumn to arrive so that the poison ivy would die off. Go figure. It is now a slippery, deep, rushing river. I guess that's what husbands are for--to risk their lives for the sake of the beauty of the house.

what is it about frozen water that is so nostalgic?

It is snowing all around Nashville tonight! AOL news described it as "Rare Snowfall Blankets South." Now I feel like Tennessee is home, or at least my home away from home.

I have every intention of playing in the snow with my kids in the morning before it all melts away. In Tennessee, you cannot count on keeping something like this around for more than a half day, so you need to act quickly.

I'm just so thankful that I have children to share it with. During my college days in Illinois, I used to take my sled to a small hill tucked away within the forest preserve, where I wouldn't easily be spotted by passing cars, and traipse up and down until either my legs gave out or my toes went numb. My oldest daughter was in early elementary school at the time, and she still doesn't know about my winter excursions. It is one of my silly secrets.

I'm wondering what I will do when my two youngest are grown. I very well cannot go out into my front yard and make snow angels alone. I guess that gives me one good reason to look forward to becoming a grandmother someday.

central Indiana sunset on the fly

Driving home from our short weekend trip to Illinois, I caught the end of the day just in time to snap these photos. Rolled the passenger window down--kids screaming in the back "we're cold!"--had to balance the camera on the door at 70 m.p.h. without losing it--hands going numb--kids still yelling for me to hurry up. Pity the life of an amateur photographer's family.