aging hippie chick's Open Salon Blog

Good Mom, Bad Mom

Thu, 6 Oct 2011 16:10:05 -0400

The wheelchair fits in my car, just so.

I’m good at this, after umpteen dinners at Perko’s, my Mom looking glum over her Chicken-Fried Chicken. The faint smell of urine.

I’m a good girl. I’m good.

Last week she was The Good Mom; “I don’t know what I’d do without you”, she said over her Chicken-Fried Chicken. My son, there with his slightly-pregnant wife, beautiful in her happiness, was there to witness. He’s kind, like me. He looked, I thought, bored.

Ten days later, the familiar fall from grace. “You’re so close, and you never come”.

I could have come Tuesday.

Always more I could have done.

Sometimes I imagine life after Mom. Will I be, at last, guiltless, or will my fountain of blame flow unimpeded?

Always more I could have done.

Tonight, the Chicken-Fried Chicken of redemption, perhaps. Minutes of silent scrutiny, then “You should see a stylist and see if they can do something about your hair”. She’s cute in her predictability. Just now, I hate her. I hate that I can’t grow up.

In the car, her hand, all bones and veins, rests in her lap. I take it in mine, big, strong, wrinkly. “You’re a good kid,” patting my hand. My Mom. My Mommy.

I tuck her in, white on white, and smooth her hair: “I love you”. I mean it. We’re both so small.

I dream she’s dead, and I’m lost, looking for the Mom I wanted. In the cold dark I press against Walter’s back, warm, solid. Here. Skin-cotton-skin. The house finch outside sings its first song.

There’ll never not be more I could have done.

MRSA, nose picking, and pulse oximetry

Sat, 17 Apr 2010 02:04:17 -0400

You may have heard a discussion on NPR yesterday about MRSA. (Methicillin-resistant staph aureus, to friends. A nasty bug that causes nasty infections, and is hard to kill.) As an ER nurse, I'm acutely aware of this issue, dealing regularly with the painful (and costly) incision of MRSA abscesses.

While medical and housekeeping staff, and state inspectors, have good intentions, I see glaring gaps in how sanitation is approached.

The primary reservoir for MRSA seems to be in nostrils (warm, moist, frequently touched by fingers. Well, in SOME people. . . )

MRSA is, clearly, spread primarily by hands - either contacting other hands or touching surfaces that other hands touch. Yet the emphasis on between-patient cleaning is on mattresses, pillows, floors, and tables. Less commonly bedrails, and rarely pulse-oximeter probes (the little clip that reads your oxygen level from your fingertip), doorknobs, monitor buttons, or computer keyboards cleaned.

MRSA can live for several days on a surface after deposited there by hands.

At a recent state survey of a hospital where I was working, the inspectors required that plastic blood pressure cuffs be discarded after each pt (they could easily have been wiped down), and went so far as to require triage nurses to write the patient's name on each one with a Sharpie marker. On their next visit they inspected the garbage cans to ensure that we were tossing out one reusable cuff per patient (don't EVEN get me started on how environmentally criminal this is), but made no mention of pulse ox probes, which are routinely placed on finger after finger without cleaning. Many of those fingers have. . . how can I put this delicately?. . . been inside noses, a hotbed of MRSA colonization.

It seems to me a major education of infection control staff and, through them, hospital staff, is in order. I've talked this stuff up, to sometimes-glazed eyes.

Here's what would happen, if I ruled the world:

Pulse oximeter probes would be cleaned with an alcohol swab after each use.

Bedrails, doorknobs, computer keyboards, IV poles, monitor controls, chart holders, pens - anything that numerous hands touch - would be cleaned regularly. If possible, every time they are touched.

Patients who are given a clipboard and pen to sign out would first be asked to use hand sanitizer.

Of course, much of this would be irrelevant if all staff (including - dare I say it? - physicians) would be diligent about using hand sanitizer after EVERY TIME they touch someone or something. It's not hard, if it's available. Which, alas, it often isn't - this leads me to believe that staff aren't using it and don't notice that it's absent.

I'd also like to see research into using heat to treat MRSA infections, as an alternative to the ever-enlarging list of drug-resistant antibiotics. In my own experience, I've never seen it fail for superficial skin infections - a wet washcloth in a Ziploc baggie, microwaved for 15-20 seconds, applied every hour at the first sign of infection. It needs to be as hot as you can stand it without burning the skin. Great caution would be required in those with sensory impairment to prevent burns, but I think research could determine the optimum temperature for effectiveness without damage. There is, of course, not much money to be made in researching this. Wait. . . Ziploc? Oh Ziploc? ? ?

I lost my job. Life sucks. Or maybe not.

Thu, 12 Nov 2009 12:11:33 -0500

So, I got a call on the way to one of my jobs yesterday, in ER, where I work as a travel nurse (a good deal, tax-wise, and flexible). I've been working at the same ER for over a year, because I like it better than any of the other 6 or 8 I've worked in.

Over that year, the place began to feel like home - I stopped feeling shy and started feeling like a fixure, someone who knew where things were, who new nurses could come to for help. I knew the housekeepers and how many kids they had. I knew the lab people by name. I had a reputation as someone who liked to work, who would help out, who could start an IV on ANYONE. It felt cozy, and I felt valued.

Chuck, my "nurse recruiter" had sent an email saying to call him, that it was kind of important. As I was pulling in to the parking lot to go to work, he returned my return call, and said "They're not renewing your contract". For the last year, I've had a series of 13-week contracts, and began to assume this would continue, at least as long as I've got a kid in college.

Not so. This contract will end November 24, my last day scheduled there. 13 days' notice. They're phasing out "travelers", Chuck said.

I've asked the ER manager from time to time about how secure my spot there is. I once said "So, can I keep doing 2 shifts a week until my kid gets through college?" and she answered, in her smiling -without-smiling, vague way "I don't know why not". Then, last month, with rumors of cutbacks flying, I asked "Are they thinking about getting rid of travelers?" and she said, smiling-without-smiling, "Hospitals are always trying to get rid of travelers." Travelers are a sometimes necessary but expensive way to fill staffing gaps. I knew this. And I've been there for 15 months. It felt deceptively solid, this ground I was standing on. Roller skating on, more like.

I clocked in and checked in with the charge nurse, whom I love - whose Halloween party I went to - and told her, swearing I wasn't gonna cry, but I did. She was angry, supportive, sweet. Then I limped through 12 hours, telling some people, holding it together with others.

I must confess something, here. I'M PATHOLOGICALLY NOSTALGIC. I can get sentimental about the freeway exit I once took to a house I used to live in. Or my mom's jar of rancid face cream that's still in her medicine cabinet, because I remember when the Avon representative was at our dining room table, in my childhood home when I was 10, selling it to her. Or an old receipt, scrap of paper, note - anything, because it's old - evidence of my life as it was years ago. I cry every time I move or leave a job. I can't throw out an old tupperware mixing/pouring pitcher because my Dad used to mix pancakes in it. Likewise the bottle of prescription ibuprofen I inherited when he died - I take it when my back hurts (Federal law prohibits this. Don't tell anyone), and get sentimental every time. I doubt I'll be able to take the last one - I'll feel an urge to make the bottle of Motrin into a shrine to my Dad. So sue me.

This fascination with the past mystifies me. But then, time mystifies me - how can I belong in a place for a while, and then not belong there? How can my home town still be there, but not be my home town? What happened to the kid I was then? The young parents mine used to be? Where did we all go? But I blather. . .

Everything nice about work started to hurt. The familiarity of the hallways, which I will be leaving. Every person who said hello and likes me, because I'll be leaving them. Larry, the old alcoholic veteran who comes in once or twice a day for some Ativan or a pain shot and some company, who sent us a Christmas card signed "Larry _____", and his medical record number. Love hurts. Attachment hurts.

I called my sister to see how her gall bladder surgery yesterday went (fine), and cried when she asked how I was and I told her. Went back in, tried to discharge a patient, and started crying. I've never done that before; I said "I'm sorry - I just got some bad news" (I didn't say what. I think I may have sounded noble.) The young woman, who had the flu and was wearing a mask, said "Mom, I'm sick - give her a hug," and Mom geve me a wonderful, obese, all-encompassing hug and told me about a fire last weekend that burned their family house to the ground. I felt better - knowing how much worse things could be, seeing the capacity for kindness that runs rampant in "ordinary fucking people" (as the guy in Repo Man said, I think). We hugged again and said goodbye, wishing each other luck.

Mike, one of my buddies there, told me about his ambulance that had just arrived - a young girl with a blood alcohol of 0.30, who had been found by the river with her pants pulled down, raped, obviously, and left there like that. And I thought of my own daughter, brilliant and not remotely interested in substances, going to college, making funny silent movies, going to Young Democrats conventions because she's so damned smart and funny and lovable. And she's OK. She's not in a river bed, raped.

How do you make sense out of this life? Such beauty and such nastiness, kindness and danger, love and loss all sitting side by side, like they all own the place. Dunno, OS pals. Dunno.

May All Your Dreams Come True (fiction) p2

Sat, 7 Nov 2009 11:11:18 -0500

"Your Mom's doing OK, right now", said Becky, "but she fell and hit her head pretty hard. She's getting a CAT scan, now - kind of a fancy X-ray of her head. We'll know more after that."

Sophie was silent on the other end of the line.

"Is there someone you can call, Sophie? Someone who can bring you in?"

"I guess so. I guess I can call my Dad."

"OK, sweetie. Call me if you need anything."

"Bye. . . " Sophie's voice sounded small. Smaller, even, than the usual 13 year old trying to not sound small.

"It looks like Tracy has some bleeding inside her brain", said Becky when Sophie arrived with her dad. Sophie was wearing her finest Goth regalia, having just returned from school. A tender child in a tough suit.

Paul looked bewildered, pulled back by duty into a situation he thought he was leaving.

What Becky didn't say was that Tracy had a massive subdural hematoma - otherwise known as a LOT of bleeding inside her brain.

"She'll go to surgery, now, and then to ICU - they'll let the pressure out of her brain where the bleeding is, and give her medicines to help, too. Right now, she's asleep; she won't be able to talk to you."

"Is she gonna be OK?" asked Sophie, trying to sound brave, not very successful.

"I think so, sweetie. We just won't know how it turns out until she starts to wake up. Do you want to see her?" Sophie nodded.

Becky led them into Tracy's room. Sophie stared at her mom, pale and unresponsive. "Can I touch her?"

"Sure," said Becky. "Just be careful not to pull on any tubes."

As Becky left the room, Sophie lay carefully across her mother's chest, quiet, her black leather jacket shaking.

The OR came to take Tracy. Becky put a hand on the girl's shoulder and gently pulled her up. "You'll be able to go see her when she gets back to her room. Why don't you guys get something to eat?"

They walked away, Sophie, the new teenager who tried so hard to be tough, and her Dad, whom she hated just now for leaving them. Just outside the cafeteria door, Sophie reached for her Dad's hand. He used the other one to open the door.

Waking in a haze of drugs and swollen brain, Tracy saw Sophie next to the bed. "Dad! She's moving, Dad!" she said. Tracy lifted her hand, intending to brush the hair back from Sophie's face, but her hand only flopped over on the bed. Tracy stared into her daughter's eyes, now running with tears, hoping that stare looked like love. The fiercest love she'd felt. For the first time in months, she could see the child behind Sophie's black eye shadow and multiply-pierced ears. But holding her eyelids up was becoming impossible.

"Mom, I'll wait for you, OK? Come back, OK?" Sophie said in a broken-sounding voice. Paul stood next to Sophie, his hand on her shoulder, looking uncomfortable. Looking out of his element.

She couldn't abandon this kid. She couldn't.

Her eyes closed, and she slipped back into the strange, fitful, darkness. She couldn't quite remember what she'd seen there, but it was a busy place, very busy.

"Mom? Mommy? MOM?"

May All Your Dreams Come True (fiction)

Fri, 6 Nov 2009 15:11:29 -0500

Tracy Haight knew better. She KNEW better. When someone yells "CLEAR!", you back away from the bed. She just wanted to tape the IV a little better - Mr. Hooper was in V Fib, sweating like a pig, and they were about to lose the IV, which they really REALLY needed. So, when Dave Evans, the ER doc, defibrillated him for the third time, Mr, Hooper got his heartbeat back at the same moment that Tracy was knocked back onto the floor.

"Shit!", said Dave. "What happened?"

"Tracy was touching him when you did the last shock," said her friend Joe, the nurse who'd been recording. He'd dropped the clipboard on the floor and was kneeling next to Tracy.

"Jesus, she's unconscious. She's bleeding - she's got a big scalp lac on the back of her head."

While Mr. Hooper gradually gained consciousness and looked on curiously, they slid Tracy onto a backboard and onto the next gurney, and hooked her up to the monitor. She had a regular heartbeat but the numbers in her blood pressure were getting farther apart, a sign that the pressure in her brain was rising from getting whacked. In the finite space inside her skull, her brain was swelling like a bruised muscle. Her breathing increased to try to compensate, but she felt herself pulled away, away.

"Get her in a c-collar", Joe yelled. "The last thing she needs is to wake up paralyzed. SARAH? Can you take over on the guy next door? He'll need an amiodarone drip; he's starting to have runs of V Tach again."

Tracy could hear Joe, sort of. Mostly she saw strange, swirling things in the darkness. Sort of a mystical black velvet painting, which she found much more compelling than the mundane chaos of the ER. "Black velvet painting", she thought. "How tacky."

"Tracy! Tracy, can you hear me? I can't believe this. Her right pupil's dilating. Call CT and tell them we have a stat one."

Becky, the ER manager came in. "What the hell's going on? Everybody's running around like they'd never seen an emergency". Then, "Oh. . ."

"She didn't 'Clear'", said Joe.

"She's breathing at 32, and her pulse pressure's widening," said Becky, starting an IV while Joe was rolling Tracy off to CT.

Tracy didn't react to the IV. Not even a flinch.

Dave and Becky stood in the room, suddenly quiet save for Mr. Hooper's regularly beeping monitor.

"So, Mr. Hooper," Dave said, " you've had an exciting visit to the Emergency Room! You doin' OK?"

Mr. Hooper smiled and gave him a tired "thumbs up". "She alright?" he asked.

"I hope so," said Dave. "I hope so."

Outside the door, Dave said, "I guess we better call her family. Anybody know them?"

Becky did. She knew Tracy's husband had left recently, and she was raising a 13 year old girl on her own. Sophie, that was it. Sophie the latchkey kid. She called Tracy's house.

"Hello?"

"Hi - Sophie?"

"Yeah. Who's this?"

This is Becky, at Memorial. I work with your Mom. Something's happened. Is there anybody you can call?"