Pizza Burn

River doesn't like his job very much.  He makes pizza.  He is getting a lesson in the gustatorial fanaticism of the idiocracy.  Every night he comes home with another story of some morbidly obese customer flying into a rage over a missed ingredient or prolonged wait time or barbecue wings instead of hot wings. They shriek that they should get another order - the right one this time, and it should be free and it should materialize right now, this instant! And no, you can't have the mistake back, because I already ate it, you idiot, I was HUNGRY! The police have been summoned on more than one occasion.  At 10 p.m. he clomps into the house, shoulders slumped, black uniform dusted with flour and smelling of cold grease. As he heads to his room, apron slung over his shoulder, he says under his breath, "I don't understand people".  It has become his favorite saying.

Nature's Wrapping Paper

It was 10:30 p.m. on Christmas Eve when his pager went off.  As the OB/GYN on call for the emergency department he had no choice but heave out of bed with a sigh and put on his clothes in the dark.  His wife rolled over, murmured something indistinguishable and was still.  He smiled fondly at her.  It was ironic that they were childless, him having delivered thousands of newborns to other, at times less deserving, women.  He shrugged into his white coat as he dialed the phone to the E.D., glancing at the glowing Christmas tree, surrounded by neatly wrapped gifts bound by perfect bows.  As the phone purred on the other end he randomly wondered why presents had to be wrapped at all?  Tradition?  Asthetics?  Why not just slide the gift, still in its Amazon box, under the tree?  He chuckled at the image as an E.D. nurse answered curtly, “Main Emergency, what can I help you with?”  “This is Dr. Winchester.  I was paged?”  “Hi Doc, yeah, we have a 38-weeker, 8 cm dilated and crowning.  She’s a teenager, came in by POV, dumped at the front door.  This is her first, no pre-natal education.”  “I’ll be there in 12 minutes – have her draped and prepped for a block.”  He hung up, grabbed his bag and keys and hustled to his car through the crystalline air.

                The E.D. was jammed with its usual flotsam as he strode through the lobby toward the side door, waving his badge at the entry pad.  The locks clicked back, the door swung open.  He raced past miserable, huddled ghouls lining the hallways to bay 36, where he slid open the door and found the familiar sight of knees akimbo, ready to introduce a new soul to the human condition, for better or worse.  The teen mother was crying hard, terrified of the pain and the responsibility.  He grabbed her chart and moved beyond the drape to place a soothing palm on her forehead and gently instruct her on what was about to transpire.  The E.D. physician entered and updated him on her progress - she was fully dilated - delivery imminent.   Dr. Winchester pulled the rolling stool between the girl’s knees and with a gloved hand deftly verified the dilation and crowning, breathing a quiet sigh of relief to feel the fontanel, rather than a gluteal cleft.  He grabbed a thin needle from the bedside table and expertly placed several numbing shots, blocking the nerves that were screaming from the strain.  After an initial reaction to the needle sticks, the young girl visibly relaxed, legs no longer trembling.

                At 12:01 Christmas morning a tiny, healthy human, covered in its waxy coat, tumbled into the world with a gush. He smoothly caught it around the neck and knees, thinking to himself “Vernix – nature’s wrapping paper!”  Even nature, it seems, believes beautiful things deserve to come wrapped.

                The grateful young mom agreed to an adoption. The following Christmas, Dr. Winchester was not on call – he was snuggling his smiling wife and bright-eyed son in front of a merrily crackling fireplace hung with bulging stockings. In the corner, lit with a thousand twinkling lights, stood a fragrant Frazier fir tree, proudly brooding over a neat mountain of perfectly wrapped gifts.  “It’s not the present, or the wrapping, that matter,” he thought to himself –“it’s the spirit behind it.”  Nature had sloppily wrapped his gift and in truth, barely assembled it, but the spirit that sent it was pure Love.

Theodore Roosevelt

Just finished reading a fantastic biography of a fascinating man.  "Dynamic" barely touches this bellicose, egotistical, loud-mouth who also happened to be a really outstanding human being.  His legacy in politics still affects our lives every day. I'm looking forward to the next book in the series.   Read on, my friends!

Why CLIF bars are awesome!

Most of my days as a nurse have been fueled by Gary Erickson's  fantastic little chewy rectangles.  Portability, variety, taste, caloric density, texture, price, packaging, company mission - it's all in there! ( http://www.clifbar.com/products/clif-bar/clifbar ) Plus (this sealed my loyalty forever) when Gary found out that a small school in southern Oregon, of which he was an alumnus, needed long-term sponsorship, he bought the whole thing and allowed the retiring professors, who are unsung national treasures, to remain living on campus.  It seems he spends his days trying to do good and that, my friends, is worth investing in.  So buy CLIF bars, eat CLIF bars, give some Chocolate Chip to the homeless, pass out Sierra Trail Mix on hikes, fill party punch bowls with Peanut Toffee Buzz, jam the bed of your truck with Pecan Pie and Blueberry Crisp at concerts, stuff a room with Banana Nut Bread and Carrot Cake and eat your way out, lay in a stock of Berry Pomegranate Chia and Black Cherry Almond for doomsday - lavish your loved ones with Gary's 68 grams of gastronomic goodness!

Parachuting Among The Gods

When MTV broadcast David Lee Roth doing mid-air splits on the video Jump, with his wild hair flying and big mouth opened in a grin like Animal from the Muppets, everyone’s attention was focused on the fantastic, zippery nylon pants cloaking his sultry shanks.  The buzz in the 8^th grade hallway was centered on ‘parachute pants’ from then on.  Jeff Perkis got them first - he wasn’t in the cool crowd, but his dad was a plumber and made tons of money.  Then Steve Musto and Carter Ash started whistling and clinking when they walked and they were gods when it came to girls liking them, so I ached with the ache of drowning for the same level of cool.

 We were not simply poor, we were mackerel and beans in the slow-cooker poor, rusty water and duct-taped windows.  But earnest pleading moved the powers that be and Mom shelled out $26.00 for some rubbery knockoffs.  I loved having all those zippers, but didn’t dare store anything in the pockets because it would ruin the profile, which, I need to add here, was less than flattering.  No one was kind enough to tell me that parachute pants were made for spindly heroin addicts to store their fixins’ in.  I, who shopped in the ‘husky’ section, looked like a  walking pleather sofa  but I saw myself as one of the cool kids – the grey sheen of the vinyl, the quiet tinkle of the zipper pulls, the myriad useless pockets.  A discussion of the sweat saturating my dingy socks, the ominous creak of distressed fabric when I sat, the rapidly peeling layer of cheap vinyl or the vapor trail of adolescent body odor would have fallen on deaf ears.  I’m not certain I ever washed them or even knew how.

  In hindsight, what saved me from permanent social damage was a rollerskating party where I fell onto those damn zippers so often the magic of coolness began to lose its luster.  Finally, in a frantic pinwheeling attempt to arrest myself before flying into the Pac Man screen, I caromed off the retaining wall and belly-flopped onto the carpet in front of the bewitching Debbie Cates, whom, up until then, I had confidently assumed was too shy to invite me to the Sadie Hawkins dance.  The resulting co-efficient of friction shredded the thin material and I slunk off to the men’s room amid snickers, clutching the remains over my dignity.  What I feel, looking back on those two months, is a nauseous ball of shame just below my heart, but that’s irrelevant (unless I wore them today) - in those heady days of zippered, jumping glory, I was there, among the gods. 

Greased Pig

A home health agency I know just suffered a State Survey.  I say “suffered” because, like a disapproving nun the tight-lipped surveyor hunched in a back room for four days, poring over charts and files guided by her silent, inflexible checklists.  Everyone in the office skulked past the closed door, hushed and tremulous, until finally she gathered her articles of damnation and marched primly away.  A week later came the bombshell: they had been tried and found sorely wanting, so sorely, in fact, that their office was threatened with shuttering.  I happened to know that this office and the people working in it were doing a fantastic job managing their client’s care at home – if the office was shuttered because of a checklist, everyone would lose, no one (outside of the surveyor)would win.  I don’t know the circumstances behind why the surveyor felt she needed to throw such a big rock in the pool, but the fact that she could, and did, re-iterates the glaring power discrepancy that is possessed by regulating bodies such a JHACO, CHAP, OSHA, the health department, the state, etc.  There are so many agencies jumping on the pile (over 90 of them, just at the federal level)trying to control and manipulate healthcare it reminds me of the pig-wrestling contest at the county fair, where the object is to tackle and hold a pig that’s been slathered in tallow – the harder you squeeze it, the quicker it slips from your grasp.  Trying to keep the minutia in line is one of the things making our healthcare system so ponderous and insurance so expensive! Healthcare is not about checklists.  It’s about care, first and foremost.  Maybe the medieval monks had it right, when they were responsible for healthcare; they took you into a quiet place, gently bathed you, fed and watered you and left you to the Almighty, aided by their supplications.  Of course, the average lifespan was 42 years, so at 43 years old I’ve outlived the curve.  Oh well, I can’t afford health insurance anyway. I’ve lived a full life.  I’m ready - let’s do this! Out with the regulating bodies!  In with the greased pig!  Let nature take its course!

D'ants Macabre

My brain had no precedent for what it registered beyond the curtain – lightning exploded behind my eyes, thunder numbed my hearing, my gorge rose, my anus shriveled and I clutched the flimsy curtain to stay upright.  Head buried in my shoulder, I peeked again, from the corner of my eye, with the same results.  “Stop doing that!” my brain shrieked, but no logic can overpower morbid curiosity.   The man in the bed was alone, unconscious, on life support, and had been roughly, agonizingly skinned.

                If an elderly person with friable, papery skin falls and tears their arm or leg in such a way that the skin rolls up like a stocking, the medical term is “de-gloving”; this was no mere de-gloving, this looked like Buffalo Bill was making another suit.  Every inch of this young man, from neck to feet, was a flaky dull red, except the yellowish tendons connecting exposed muscle to bone.  It was horrifying, and fascinating, like an anatomy textbook come to life.  There’s the iliopsoas! And the tensor fasciae latae!  I shivered to imagine the pain he’d be in if he was awake.  Perhaps that’s why he wasn’t – perhaps the brain switched to default mode when this torture ceremony occurred?  I went in search of answers.

                He’d been shut down for five days, his nurse told me, as if he was a cyborg, and truly it was easier to relate to him if your reeling brain quickly shoved him into that category.  He’d been at a friend’s house watching football, knocking back a few.  When the game finished he straddled his motorcycle and ripped down the curvy gravel road toward home, only making a few miles of progress before an aggressive turn dumped him through a barbed-wire fence, into a weedy field.  He lay unconscious and unfound for three days, during which interval a nest of fire ants discovered him and leisurely harvested his tender bits for the winter.  His family couldn’t stand to visit his hospital bed.  I couldn’t blame them – I barely could and I was being paid for it!

                He died two days later, alone, the ventilator and heart monitors beeping forlornly.   It’s hard to say what killed him, ultimately, there’s so many choices – sepsis, kidney failure, electrolyte imbalance, hypotension, toxin build-up.   I think we have to blame the fire ants – they STOLE HIS SKIN, for their own selfish survival.  Who’s on top of the food chain now, PETA?

Old School

It was three days later, in the dry forest of the southern Cascades that he heard them behind him.  In the clear mountain air he heard their voices carrying over the canyon, although he couldn’t make out the words.  His heart quickened, and he left the trail, huffing up the steep mountainside to hide among the firs.  The voices got closer – whoever was behind him was making good time.  He dodged left and right around massive pine trunks, looking back once to see his pursuers in the distance, doggedly following the path he had left.  Panicked, he found a large, hollowed-out trunk, about thirty feet high, evidently struck by lightning some time ago.  He circled it hastily, finding a small opening at the base, just large enough to admit his wiry frame.  He lay on his back and wriggled in head-first, hoping the mat of pine needles covering the ground was thick enough to show no sign of his efforts.  Once inside he placed his back to one side and brought his knees up to brace against the other side, levering himself up that way until his shoulders were lodged firmly enough that he could relax his knees a little.  He knew that if he tried to hold himself there by effort alone, his muscles would tire quickly, and their shaking would alert those following of his presence.

             As his breathing slowed, he heard voices down on the trail he had left just minutes earlier.  They sounded female, and he quietly cursed to himself.  He was running scared from two girl hikers, oblivious to his existence.  If he kept jumping at every shadow, it would take him months to reach Canada!  He stilled his breathing, trying to make out their conversation.  He heard nothing.  Just as he was about to start down, he heard the soft crunch of footsteps on the scree approaching his position.  He froze.  The light entering the tree through the hole below dimmed.  He heard a zipper and the muffled rustle of clothing being moved.   Then came the sound of something scraping the ground, not like a shovel but more like… a boot?  A soft thump shook the trunk, and his heart stopped.  What could they be doing?  Had they dropped their backpacks?  Were they stopping for a snack?  A nap?  A bathroom break?  He broke into a nervous sweat.

            His fears were quickly allayed by the rich, dank smell of feces wafting up from the hole.  Just some coed dropping a load off the trail – he was angry at his fear, angry also at the girl.  Didn’t she know not to squat in front of a dark hole?  Who knew what kind of animal might be in there, eyeing her bum, ready to jump out and chomp a cheek?  He had to stifle his laughter at the image of a badger hanging off the girl’s butt as she shuffled screaming down the mountain as fast as her trouser-bound legs would take her.  He heard her scrape dirt over her waste with her boot and zip up her shorts.  The next sound gave him pause – it sounded like the wheel of a Bic being scraped over a flint.  What the…?   The faint smell of smoke drifted past his face.   She must be old school, he thought, burning her toilet paper instead of burying it.  He heard her footsteps trudging down through the woods, fading until they were gone.

            After waiting a few minutes to make sure she was far enough away, he started to wriggle his shoulders in an effort to descend.  He couldn’t budge!  He tried bringing up his knees to lever his body down, but he was wedged in too tight.  He twisted and rocked his torso, but only succeeded in getting a cramp in his back.  Suddenly, the smell of smoke became sharply stronger.  He could see through the hole ten feet above his head that the blue sky was smudged with white, drifting across the opening.  He grew concerned.  His concern grew to panic when he felt heat through the soles of his boots, dangling below him.  “That stupid girl set my tree on fire!” he raged to himself.  Wisps of smoke trickled past his tightly crammed torso, causing his eyes to water.  He began having difficulty finding good air to breath.  Gasping, he wrenched his body side to side, kicking his legs and heaving his shoulders like a man possessed.  Searing heat was building below him, and he felt sure his boots were smouldering.  Tearing one, last gasping breath, he threw back his head and screamed for help toward the crystalline sky above.

            Far down the trail, one of the hikers turned to her companion.  “Did you hear something?”  Her partner shrugged. “Probably just a hawk or a marmot or something,”   She paused to look out over the Klamath valley, spread out before them in golden swells and amber clefts.  Mount Shasta thrust toward the rich, blue sky, its perfect slopes and snowy peak making it the mountain all other mountains aspired to.  “Isn’t this perfect?” the first one said.  “Mmmmm, - so peaceful,” the other replied.

The Eyes Have It

There’s a guy I know who can only move his eyes. 

                Next time you’re lying in bed, slowly relax your entire body ‘til you’re nice and slack, then open your eyes and look around.  Imagine that’s all you can do, just look around.  Now stop breathing.

                This guy, who can’t move his legs when they’re restless, can’t scratch his nose, can’t wipe his bottom, can’t re-adjust in his chair when his butt gets numb, can’t eat a hamburger, can’t wiggle his toes in a creek, can’t hold his pee when he needs to go, can’t shoo a fly from his face, can’t apply lip balm when his lips are chapped, can’t dance with someone or hold them close, can’t raise his hand to ask a question or get attention, can’t drive, can’t pet a dog, can’t warm his hands over a fire, can’t argue over the best coffee in town, can’t do 99.9% of the things that give us joy and meaning , including breathing – this guy is the poster child for good excuses to do nothing and be bitter.   I feel justified in being bitter and doing nothing when I don’t get my way, or when I’m out of coffee creamer or when someone doesn’t appreciate my extraordinary presence; I feel the urge to hang my head, when I’m with him.

                There is, however, something he can do.  He can have a good attitude about his situation, which he chooses to do.  He discovers what things he can do and pursues those things relentlessly until he masters them.

He discovered that by thinking about every breath he had just enough strength in his diaphragm to breathe shallowly, so during the day he doesn’t need the ventilator; it took him four years to train himself to do this.  He discovered he could move his right thumb and index finger a few millimeters and his left thumb a bit less.  This was all the incentive he needed to get fitted for a custom-built wheelchair which he drives by breaking light beams mounted precisely where his fingers dangle, propelling him, slackly cradled in his chair, anywhere he wishes.  He discovered an adaptive technology that mounts below his computer monitor and tracks his pupil, functioning as a computer mouse.  The world became  his, via the internet, which he uses to take free courses from Ivy League schools on ItunesU while you and I are chuckling at memes of cats. 

                With these tools and a nurse constantly by his side he went to college , got a biology degree then a master’s certificate in technical writing, then wanted more and got another master’s certificate in website design - with only his eyes. Now he builds presentations for fundraising and curriculum for nurses, working on his computer 12 – plus hours each day - with his eyes.  He trundles around the halls of his state legislature with a laptop and a PowerPoint presentation calmly requesting them to stop cutting Medicaid so he can continue to live. The slick politicians jiggle nervously and stare at the wall and tell him they’ll look into it.  He breathes a little bit, wiggles a couple fingers, rolls his expressive eyes and keeps driving - keeps driving -keeps driving.

                His story is jaw-dropping, but it’s his drive and cheerfulness that are shaming to us, who can shoo flies and wipe bottoms and swallow our spit and eat and drink and breathe and curse our weak eyes.  I know this guy,  but I don’t really know him; I can’t even begin to fathom what kind of perseverance and inner strength it takes to pursue your vision when everything is stripped from you; everything, save your eyes.

Know it, by Heart

Lt. Frank Elkins

I'm drawn to characters.  Fortunately, nursing is full of them.  In the hospital I loved witnessing the arm waving, frenetically-spun tales spewed at light speed from the cachectic, substance-addled housekeeper.  Or the quiet wisdom of the dimunitive maintenence man who also taught photography and was so passionate about recycling he wound up creating his own position within the system as head of the recycling program.  There was the acerbic wit of the respiratory therapist who also had a nursing license and his CDL (commercial drivers license for truckers), his own band (which played fantastic 80's rock covers), an impressive armory of semi-automatic weapons and a deep knowledge of disaster prepping.  But Jon Glass RN, oh, he was a whopper - and an enigma.  It seemed humanly impossible to have accomplished all he said he'd done - professional bodybuilder, third-degree black belt, owner of his own record label, world traveler, paralyzed for a year from a deadly disease (now fully recovered) - the list was endless.  One day he told me of his hero uncle, a man among men, Navy fighter pilot in Vietnam, shot down early in the war, remains recovered only recently after a long struggle by his widow, nearly creating an international incident.  "My aunt wrote a book about it", Jon said, "The Heart of a Man".  Aha!  I immediately grasped upon this tangible verification of his fantastical tales by researching it on Amazon.  Sure enough, it existed, but this was no satisfactory proof.  I ordered it and when it arrived, devoured it, gratified to  find in its pages a true man among men.  Still skeptical of Jon's connection, I researched the author, Marilyn Elkins, now Dr. Elkins teaching for a California university.  Glowing from the recent reading of her husband's story I sent her the following effusive e-mail, primarily to thank her but subversively to ascertain, once and for all, the veracity of her lovable, puzzling "nephew":

Dr. Elkins, I just this minute finished your book “The Heart of a Man” and wanted to thank you for your courage and perseverance in encapsulating a small piece of your husband’s life into a vessel meant for sharing and illuminating.  I was recommended the book by a man who says he’s your nephew, John Glass – he and I work together here in Charlotte, NC.  I devoured your book and was particularly struck by Frank’s last journal entry where he describes the drive to prove oneself – that resonates deeply with me.  I had just finished a book about 19^th-century Arctic explorers, “Resolute”, in which that same inner drive fashioned some of the most fantastic and unimaginably grueling enterprises ever chronicled.  That drive has, in my mind, spawned a small host of heroes through the ages.  Belated as it is, I am sorry for your loss - sorry for us all. Thank you again for letting his light shine, warming and whetting the drive to pursue the “better angels of our nature”, for the good of those around us.

Six weeks passed and, frankly, I forgot about the whole thing.  I mean, why did it really matter if he felt the need for hyperbole?  He did great work, I enjoyed his company, he wasn't full of annoying braggadocio - he just quietly dropped these fantastic assertions into normal conversation and they caused me spasms of doubt, that's all.  The world spun, birds sang, life shuffled forward.  Then, just as quietly, a little message popped into my Outlook:

Thanks, John, for your kind words. Give John a hug for me; his mom was Frank's sister.

Hope you have a wonderful holiday, 

Marilyn 

I started grinning, ear to ear. Character, it seems, counts for something, after all.

Uncomfortably Numb

In my role as a government advocate for home healthcare it can be numbing to have to listen to the ambiguous dodging inherent in the replies of professional politicians (how is that even a thing, and why do we treat them with so much deference?).  It reminds me of the old lawyer gag "How do you know a lawyer's lying?  Their lips are moving."  As I read through Edmund Morris' fascinating "The Rise of Theodore Roosevelt" I'm reminded that this grasping for power utilizing evasive and duplicitious maneuvers is nothing new (not that I'm accusing Teddy of that - if anything he was political integrity's staunchest ally).  Among the type-A drivers that are drawn to politics, life is a game, power is the ultimate prize, money and its accompanied pleasures is the path to power.  In a capitalist society (which is still the best structure anyone's come up with, so far) money is the ultimate value, not life, liberty or happiness.  Smart people with marketing or divinity degrees invent a thousand ways to cloak that truism but it's a pretty thin veil and peering behind it was one reason I felt obliged to stop working for the hospital system.  My BAYADA team, along with my wheelchair-bound, vent-dependent client, met with the director of NC Health and Human Services a few months ago.  She is a bright, cheerful, energetic woman with a big heart and she quickly cut to the chase when asked for relief from the constant budget cuts and reduced private duty nursing hours, effectively saying 'no one here is unsympathetic to your plight, but our job (referring to the legislature) is to make $1.00 pay for $1.50 worth of benefits - if you can show me the numbers of how you can make that work, we can have a dialogue.'  I do like to see our taxpayer money being put into improvements in intermodal shipping centers and smoother infrastructure, because those things are increasing our presence as an inland port which is attracting more local and foreign investment, providing more jobs and increasing the tax base - it can turn $1.00 into $1.50. But I don't want all that increased income poured back into business in an unrestrained, poorly managed glorious orgy of growth - I'd like to see at least some of the benefits of productivity doled out to those whose infirmity through no fault of their own prevents them from fully participating in that productivity. (Note: I do not want to see those benefits doled out to those whose indigence or indulgence prevents them from being productive.)  If unemployment in Mecklenburg county is at 5.6% and over 5,000 new jobs were added last year and German manufacturers are arriving in droves, let's drop the talk of cutting the benefits to a man who can only move his eyeballs and yet persisted in aquiring his college degree and two Master's level certifications, who is as furiously productive as he can be, using just his eyes - without a nurse at his side 24/7 he would die within the hour.  Booker T. Washington states that "the highest test of a civilization or a race is its willingness to extend a helping hand to the less fortunate". The redeeming quality of a capitalist civilization is that it provides opportunities that improve the quality of life for everyone in it - not equally, obviously, but definitely better than most of the rest of the planet.  So no more equivocation, elected leaders, no more pats on the back with an "I'll look into it" thrown over your shoulders as you scurry away to your fund-raising luncheons.  Stand up to your craven peers, lock away untouchable funds for those who can't help themselves, give them peace of mind at least, if we can't give them wholeness of body.  Because the thought of the entirety of our august body of leaders dedicated to the single-minded pursuit of wealth, power and pleasure at the cost of the misery of their electorate is unsustainably numbing, indeed.

Jubilant

Nothing lights me up like teaching skills to someone who's eager to learn them. Yesterday in the sim lab I spent three hours with the wife of a paraplegic.  She needed to learn how to suction his new tracheostomy and manage his ventilator, but what she really needed was someone to listen to her jeramiad against the hospital and decode the hospitalspeak that was drowning her.  She left jubilant for the first time in months, confident that she understood the whats & whys and had the strength to handle this new burden.  It's impossible not to share in her joy and be grateful for the years of slogging through training and work that brought me to this job, where I can pay it forward!