Saturday, December 19, 2015

Lucy, Ed, and Carl Hamilton Park

First impressions, outside the hospital, are predictable. Height, weight, color of skin, expression; handshake, attention span, first and last name. Maybe you find out what their laugh sounds like, or you notice how everyone else in the room watches them with wary admiration, or you discover that they spit when they pronounce their sibilants.

Inside the hospital, first impressions are just as predictable, but in different ways. Every shift begins and ends with report, and every report follows the same structure, a whole unit reciting the history and status of each patient every eight to twelve hours, in unison.

This is an anxious fifty-year-old woman, the night nurse told me, patient of Dr. Ling, here for hyperkalemia and possible sepsis secondary to C.diff superinfection. Here is her entire medical history: bowel cancer, diarrhea, multiple intestinal fistulae to both internal and external abdomen, repeated surgical revisions, perineal remodeling with multiple additional fistulae, urinary tract infections, incontinence. Here, look at these reports: learn all about her rectum, her vagina, her most private processes.

Here is a picture of her chest, a scan of her abdomen. Look at her body, right down to the bones. Look inside her. Here are all the molecules we’ve found in her blood, in their rightful and wrongful proportions. Here is a transcription of her heartbeat from twelve separate axes.

Oh, her name is Lucita. She goes by Lucy. Want to go in and meet her now?

I mean, it’s hard to feel like you’re meeting someone for the first time when you’ve just looked at a picture of their rectum. I don’t feel like I’d recognize half my pts’ faces if I ran into them at a bus stop, but if for some reason they bent over and showed me their anus, I would probably remember their name and diagnosis just fine. (Please, if you see me at a bus stop, do not show me your anus.)

Lucy is blessed with the kind of face that can hold its own against a photograph of her rectum. Emaciated from her battle with cancer and its gruesome aftermath, with piercing eyes and a paper-cut mouth, she looks like the kind of person who knows that you’ve seen her rectum and doesn’t particularly care. “Gawd,” she said pleasantly as we put on our isolation gowns, “how long does report take around here? My leg fucking hurts. You guys mind giving me some dilaudid and ativan before we start dialysis?”

Not a terribly aggressive greeting for the ICU. Lucy is new here; up until this admission, she’d mostly stayed on the medical-surgical floors and in oncology. This was her first time being septic, and the first time her wrecked kidneys had failed her so thoroughly that potassium built up and started to poison her, but she already knew the basics of interaction with nurses. We gave her the pain and anxiety meds, just in time for the dialysis nurse to roll his fridge-sized appliance into the room, then politely asked if we could take a look at her midsection.

“What the hell,” she said, and pulled up her gown to display the ruin of her belly. “This one’s a fistula, and this one’s an ostomy, but basically I got shit coming outta all my holes. I got a three-way lady drain, they tell you that?” Sure enough, once we’d peeked at her scarred and seeping abdomen, she displayed her perineal area with perfect nonchalance, revealing a steady trickle of diarrhea from both her vaginal and anal openings and raw, red skin all around.

I winced. Not just because it looked bad, but because things are different with long-term frequent flyers. Nurses are trained to keep straight faces, to act as if whatever we’re looking at is perfectly normal and not at all alarming. This is partially because most of our patients haven’t spent enough time in a hospital to feel comfortable with strangers staring at their assholes.

Mostly, though, it’s because our pts are terrified and mortified. Something is wrong inside them, really wrong—something they wouldn’t recognize if they saw it on a chart, some neglected and uninteresting scrap of meat that suddenly threatens to kill them. The doctor says it’s klebsiella, or a 90% occlusion of the RCA, or acute tubular necrosis, and now somebody is going to do something to your crotch every thirty minutes for the next three days. I mean, just imagine that your survival hangs on your willingness to let some random dude stick his hand up in your junk several times an hour, with the random crotch-handling dude being traded out every four to twelve hours for a new one, and also you can’t shower and you might have just shit yourself.

So we tell people before we touch them, every time. We keep them as clean as possible, and we keep the curtains pulled closed while we’re poking around down there. And we do our best not to make faces, because it’s fucking rude to critique someone’s unwashed ballsack while they’re lying helpless in bed, crushed with humiliation because we just gave them five different medicines to make them shit uncontrollably and all five of them just kicked in.

It helps to feel like somebody is in control of this train wreck. It’s good to know that your nurse isn’t surprised, and has in fact seen this thirty separate times this week alone, and is so unperturbed by your dickcheese that she’s busy chatting with you about the hospital’s terrible scrambled eggs while she scrubs it for you.

But what if this isn’t your first train wreck? What if you’ve been shitting the bed constantly for years, and it’s actually miserable and you hate it and you aren’t even trying to pretend it’s okay anymore, and your nurse comes in all bright and breezy and pretends that everything looks perfectly fine? It undermines your trust in that nurse; it makes you feel like you’re being lied to. Your shit stinks, and you know it, because you have to smell it too.

You don’t want some polite lie about how it’s not so bad. You aren’t embarrassed anymore; you’re angry. You want somebody to acknowledge that this sucks, that you’ve been through hell, and that your butt looks pretty fucked up even to someone who’s seen a lot of fucked-up butts.

So I winced, and Lucy nodded with grim satisfaction. “Hurts like a motherfucker,” she said, and added after a moment’s thought: “I have dilaudid every two hours.”

“I’ll set my watch,” I said, without a trace of sarcasm, and headed off to meet my next patient, whose name we didn’t know.

We get the occasional John Doe, usually a guy found down behind a dumpster with a needle sticking out of his arm, no identification, lungs full of vomit. By some cruel joke of nature, many things that cause vomiting (overdose, trauma, bottomed-out blood pressure) also make you unconscious enough to drown in the vomit while you’re at it. So every few weeks we get a puke snorkeler from downtown, and it takes us a few hours to put a name on the guy.

This John Doe was a little different. He was awake and alert, fiercely bearded with leathery skin. An isolation sign on his door informed me that he was populated with especially unpleasant pathogens. As I sat down to start getting report, he made eye contact with me, bared his brown teeth in something not entirely like a smile, and set to comprehensively scratching his balls.

The ball-scratching continued throughout report. He had driven the night shift nurse absolutely crazy, refusing to answer any questions, shouting and mumbling, demanding pain medication and throwing things if it didn’t arrive quickly enough. Nobody had any idea who he was yet, but around 0330 he had been hauled in for trying to get on a bus, losing control of his legs, and toppling face-first into the fare meter. His lip was still swollen from the impact. “He spits,” the night nurse warned me, “and he’s refused everything except an IV and pain medication all night.”

From outside the room, I watched the man pull up his gown—hands moving in jerky approximations, occasionally fumbling as if frozen stiff—and roll to one side, where he pissed over the side of the bed onto the floor. “No no no no,” cried the other nurse, but the deed was done, and about a half-liter of steaming pee dripped down through the bed rails and spread across the floor. We looked at each other, looked at the floor, looked at the cackling inhabitant of the isolation room, and sat back down to finish report.

I mean, piss isn’t more fun to clean up while it’s still hot.

Getting through report would have been difficult if there weren’t so little to pass on. The guy was supposed to get a CT scan, but wouldn’t lie still, even for the bribe of morphine; other local hospitals were being polled for records of patients who matched his description. He smelled like a mummy found in a latrine, was still wearing his soiled pants, and had almost no strength in his legs. He was, as best she could tell, completely confused. He had an IV in his left arm.

While these few things were conveyed to me, I watched the man clean his vile fingernails—the ball-scratching hand—with his teeth, then luxuriously rub his arms up and down the sheets in slow swimming motions, leaving a trail of foul brown flakes in their wake.

Then we gathered towels and buckets and disinfectant and linens, suited up—isolation rooms require special gowns, huge yellow plastic disposable bags tied at the waists over our scrubs— and dove in.

It took us a little while to clean our way to the bed. Our John Doe watched this process with a frown. “I need a new pair a pants,” he announced. “I need some fuckin medicine. I need a god damned burger.”

I straightened up from my scrubbing. “You don’t eat meat,” I said in mock bewilderment.

“The fuck I don’t,” he replied, incredulous. “I eat all kinda meat.”

“Jimmy? Jim Smith? Nah, man, I know you, you’re a vegan.”

It took him a second to really parse this, and to work up enough vinegar to refute it. “I’m not some fuckin vegan,” he said. “I’m not fuckin Jimmy the Vegan!”

“You sure? You look just like him. You always come to this hospital, right? Jimmy?”

“My name is Ed,” he said. “I eat meat.”

I pulled the top off the dwindling jar of disinfectant wipes and sloshed the contents all over the floor. “Huh. You’re not Jimmy? Which hospital you usually go to?”

Sullen, he gave me the name of another hospital in the area, and I graciously admitted my error. “Nice to meetcha, Ed,” I said, and promised to get him a burger as soon as the doctor said it was all right. “Since we know you aren’t a vegan now.”

I have a few tricks. I don’t know anybody named Jimmy Smith, though. Nor do I know anybody who’s both involuntarily homeless and vegan.

This conversation went on for a while in tiresomely similar patterns, while we finished wiping the floor and the night nurse went to inform Admitting that the pt’s name was Ed and his records were at a certain hospital nearby. He wouldn’t tell me his last name, or why he’d been at the hospital last time, and soon he felt like I was stalling the next dose of his morphine and became aggressive.

I turned on the bed alarm—I wasn’t sure if he could climb out of bed in his current state, but if he managed it he would certainly fall on his face again. Then I scrubbed my shoes with disinfectant, ripped my plastic gown off and crammed it in the trash, and walked away from his garbled threats and curses.

“I’m not sure he’s confused at all,” I confided to the night nurse, who was gathering up her things. “I think he might just be an asshole.”

Fortunately, the intensivist that day is an easygoing sort, and after a short conversation I had an order for a major dose of IV Haldol, a clear liquid diet, and dilaudid every two hours. I gathered my supplies, checked on Lucy, booked the assistance of a CNA, and loaded him with Haldol and opioids until his eyes rolled back.

Then we scrubbed him like a secondhand skillet.

He was covered with tattoos—awful, ballpoint, overpass sleeping bag tattoos. PISS, declared his forearm in wandering stipple. On his thigh was depicted either an ear or a vagina, depending on which way you squinted. He was dotted with small crosses the way some people are afflicted with moles. More than a few of his tattoos, especially the ones on his hands and arms, seemed to have lost the artist’s attention before the drawing was finished: a line here, a shape there. On his left deltoid was a professionally executed tiger devouring a bleeding heart. On his ankle was a rabbit skewered with a knife, easily the coolest tattoo on his body.

While the Haldol held, he was pliant as an old tomcat, each limb draping exactly where we put it, not even protesting as we soaked and scrubbed old shit from around his anus. We changed the bed, dressed him in a hospital gown, gingerly checked his filthy pants for any pocketed valuables, and threw the rotten, shit-soiled garment into a bio-waste bag. We even tucked a bedpan under his head to serve as a makeshift barber’s sink and made perfunctory inroads on the matted crust of his hair.

Then he woke up, started screaming, threw the bedpan and its contents across the room, and feebly attempted to kick the CNA. It took me a while to realize that half of what he was screaming was a torrent of racial slurs.

Turns out, Ed really really doesn’t like black people. Which is a bit much, considering that the CNA—who is a nursing student from Ethiopia—wasn’t the one who’d just been reaming his asshole with a toothbrush and a tub of soapy water. (Sorry, but dried or fresh, shit is not allowed to be on my pts.)

We placated him with Jell-O, which is compatible with a clear-liquid diet, and a lot of smooth talking. The CNA was banished from the room, more for his comfort than for Ed’s. We left him to curse in peace and privacy, and I scrubbed up, put on isolation again, and brought dilaudid and ativan to Lucy.

Her leg really hurt. I examined it, and it was definitely swollen, but Lucy informed me that she’d developed a deep vein clot in that leg a month ago and was taking blood thinner injections for it. “The pain’s getting better,” she said. “I just can’t put weight on it. Hey, can you help me get on the shitter?”

She was hooked up to the dialysis machine, which so I brought her a flat bedpan and let her take care of her business in the safety of her bed while her blood was pumped from her body, scrubbed, and put back in. Afterward, I washed her perineal area thoroughly and carefully with warm water and castile soap, fearing even gentle friction on that horribly macerated skin. I found a tube of rash ointment, thick white paste meant for slathering, the kind of cream you can wipe half off when it’s soiled and replace without ever touching skin, and frosted her ass like a wedding cake.

Every time I touched her leg, or any weight rested against it, she hissed in pain. I finished cleaning her up, slipped her a little extra from the vial of pain medication, and headed off to ask the doctor to have her leg looked at again.

That little extra pain medication, by the way, is what we call the “nurse dose.” If you have a pt whose pain is obviously not quite controlled with 1mg from the 2mg vial, nobody will fault you if you end up wasting only 0.6mg in defiance of the official dose. We can all hear your pt screaming, and we all know an extra 0.4mg isn’t going to kill ‘em.

You have to be careful, though. Opioids are deadly for a reason: they cause unconsciousness and vomiting, aspiration, hypotension, and even respiratory arrest. You don’t want to drug someone into an unbreathing stupor. If you end up giving them half their next dose a little early, well, that happens; if you consistently need to give a little extra, you need to already be asking your doc to write you a better dose.

By now, Admitting was on the phone for me: Ed’s records had been found. He had, in fact, been hospitalized just two weeks prior at the other hospital, and had left against medical advice—AMA—because the doctors wouldn’t let him eat. Why not? Because he had a huge spinal abscess and needed surgery.

“How huge,” I said, watching Ed flop around in his bed and scrape dried mucus from the corners of his eyes.

“I haven’t looked through his records,” said Admitting. “Big enough for surgery.”

Five minutes later I was digging through his records in Epic, our charting system. The abscess was, in fact, huge. Almost twenty centimeters huge, with osseous involvement—that is, the germs were eating through his spine. The CT scan was about a week old, meaning that a week ago this guy needed emergent surgery to keep him from dying or breaking his back spontaneously at any time.

I wouldn’t call this a common side-effect of intravenous drug use, but I can’t say this is the first time I’ve seen it either. Dirty needles put nasty things into the most vulnerable places of your body. Case in point: this guy had also undergone an echocardiogram—a heart ultrasound—at the other hospital, and it revealed a huge vegetative growth inside his heart. This dude had a bacterial colony the size of a cauliflower floret growing inside his heart, merrily chewing away at his valves and heartstrings, like some kind of gently pulsating flesh-eating lichen.

Anything you could pick up from needles, penises, or truck stop bathroom floors, it lived in his body. A whole alphabet of hepatitis; MRSA in his nose and thus presumably all over the rest of his body too; a history of C.diff in his gut.

That last he probably picked up at a hospital. You don’t usually get it unless you’ve been on antibiotics, which kill off your other gut fauna and flora. C.diff is a spore-forming germ, capable of ignoring hand sanitizer and most antibiotics because of its thick skin, and it likes to move in while the house is empty and wreck the whole place. You’ve had E.coli food poisoning; now imagine that all your E.coli has been out for a week while the antibiotics fumigated the place, and that it returns to find something so gross squatting in your colon that it leaves again in disgust. That’s your buddy C.diff, moving into every corner of your intestines and gleefully dumping everything you eat right back out of your asshole in an orange torrent of slurry that smells like homemade kombucha.

You can totally die of it. Treatments start with oral vancomycin and can progress to fecal transplantation—a family member (who we will pretend hasn’t been waiting their whole life for this opportunity) shits in a jar, and the results are mixed with something buttermilk-ish and pumped into your belly by nasal tube. You do not want to burp while this is happening, because your donor will finally get the satisfaction of knowing you tasted their farts.

Don’t worry. Fecal transplantation isn’t usually necessary, and as I said, it’s hard to get C.diff unless you’ve taken a ton of antibiotics or are otherwise immunocompromised. (If this sounds like cold comfort to you, guess what? It is. C.DIFF IS COMING FOR YOU.)

What this meant for me, that shift, was that every hour or two Ed would shit the bed with extreme prejudice, then start screaming invective until we showed up to clean him. Mostly he demanded that we return his pants, even with the frequent incontinence of stool. I made him a compromise, putting a hospital gown on his legs upside-down with his legs through the snap-on sleeves, which left his ass bare and still allowed him to reverse-Snuggie his junk out of sight when he wanted to. I don’t feel terribly charitable for doing this, because believe me, I wanted his junk out of sight too.

Despite his contrariness—he did indeed spit, and pinch, and refuse everything I couldn’t coax him into—he had begun to panic whenever he was alone. He screamed like he was being murdered every ten minutes, and only calmed down once somebody was available to stand in his room while he cursed and mumbled and scratched and demanded morphine.

I thought perhaps he was confused, paranoid, or hallucinating. It was worse whenever a non-white staff member walked past his room—his bizarre racism breakdowns weren’t entirely limited to black people—but sometimes he would just start shrieking like a stuck hog for no apparent reason.

Nor could I give him the benefit of the doubt for being confused. He knew where he was, and why; he knew he needed surgery, which surgery he needed, and why he couldn’t eat for a while beforehand, and still refused any course of action that meant not eating for a few hours. He wanted food, and tons of it, and now. He wanted my continual presence in the room, and a nonstop flow of morphine, and even though getting food and morphine meant I had to leave the room, he screamed invective at me whenever I stepped out the door.

He was terrified, and he had no idea what to be terrified of. It’s weird to think of a person whose spine and heart are both being devoured by infection actually screaming in terror when a black person walks past their room. Like dude, MRSA is killing you horribly, how do you think a hospital employee is gonna make that worse?

I really thought about it, as I gave report at the end of shift and drove home. I thought about it the next morning, taking both pts back from the night nurse, and as I gave Lucy her pain and anxiety medication on schedule. We even talked about it a little: about the way fear slips out of your grasp and sticks to the most irrational things, about the things that scare you when your life has already been a horror movie for a while. What it’s like when something—be it cancer or infection—is eating you, and when you think about that too hard you can feel yourself starting to go crazy.

“Chronic pain fucks you up,” said Lucy, wincing as she struggled to move her leg. “Sometimes you feel pain, just not anywhere in specific. Whatever hurts, sometimes it stops hurting for a while, but your body doesn’t know what that shit’s supposed to feel like, so then you just got pain for no fucking reason. Like right now, my leg looks like a rotten sausage, but my elbow’s fucking killing me.”

Fear, I guess, is the same way. If you’re used to feeling it all the time, it’s hard to keep fear from being your first instinct in every situation.

As the dialysis nurse finished up his run with Lucy, I headed back into Ed’s room, armed with warm wet wipes, a full bed change, and all the isolation garb I could find, including sterile gloves unrolled to my elbows. He had, of course, shit everywhere, and as I came into the room, he greeted me: “Hold on, I ain’t done yet.”

I stood politely at the door of the room, gloved hands folded, while Ed finished shitting the bed and then pissed generously into the blankets as well. Then I set to scrubbing and cleaning, and gently suggested that he let me trim his hair, which he accepted.

While I worked on his hair (which ended up somewhere between ‘buzz cut’ and ‘tonsure’, as I am very bad at hair), we talked about his life. He’d come up the coast about ten years back, mostly by bus and train, after spending a few years homeless in LA. Now he lived a few blocks from one of the major homeless encampments in this area—not in the encampment itself, as most of them forbid drug use—and, apparently, got beaten up and robbed on the regular.

“You gotta be real careful,” he said. “Some kinds of people, I’m not sayin nothin, some people you just can’t trust em. I ain’t sayin anything, I know you gonna call me a racist, but I used to sleep in Carl Hamilton Park.”

I live fairly close to that park. Under sunlight, it’s busy and friendly, full of small children and bicyclists. After sundown, it’s a terrifying hellhole of crime, gang warfare, and drug traffic. A month after this conversation, I took a shortcut past the park to my car, witnessed an exceedingly violent mugging, and ended up shouting at a policeman that the victim had just been kicked in the head repeatedly by three assailants and needed to get in the ambulance now.

And, okay, I realized why this guy’s bigotry was so intense. Carl Hamilton Park had, for the last several years, been ground zero for a vendetta between two gangs of Somalian immigrants whose families back home apparently hated each other. I knew nothing about Somalian culture and history when I first moved to this city, but I assure you that a little time on Google reading about tribal rivalries will make your teeth dry out from hissing.

I mean, it doesn’t cover a lifetime of ingrained racism. I’m pretty sure this guy didn’t just get mugged by Somalians one day and decide that black people are bullshit. But if he was clueless enough to take a nap in Carl Hamilton at night, I can see why his underlying issues might be very close to the surface just now.

That, and he was sick. Sick with something that directly affected his central nervous system. Many parts of your body aren’t capable of telling you exactly what’s wrong exactly when it starts; UTI sufferers often become confused, victims of pulmonary emboli tend to pick at their blankets and wriggle, and bleeders often become outright hostile just before they spatter a bellyful of red on the sheets like a period sneeze. And many neuro-damaged pts—stroke, meningitis, encephalopathy—develop an intense fear and hatred of people.

Sometimes it’s not even all people. Sometimes it’s just the one nurse that has a funny-lookin’ mustache. But generally speaking, some switch flips in their head that sets off the sirens: bad things happening, make other people go away.

This may manifest in violence, or in verbal abuse and outbursts seemingly custom-designed to piss everyone off. It’s like the brain goes, hmmm, I need to get everyone away from me fast, so what’s the most offensive and hurtful thing I could say right now? Surely if I call the nurse a baby-eating lizard priest with a dozen cocks, she’ll leave me alone.

Sadly, no, I was not actually called that thing. I was called all three of those things at separate times and thought they looked pretty together, like fairy lights strung on a wire. I collect terrible nicknames.

Anyway, I can’t really let Ed off the hook. He remained a terrible person no matter how you polished the turd of his personality, and I was not surprised an hour later when we had to call a Code Gray on him because a black person had walked past his room again.

A Code Gray involves a room full of staff and security dedicated to backing down a violent individual, preferably before they actually hit someone. Ed had spotted Maimuna in the hallway and decided that she posed an imminent threat to his well-being by existing. Now, while I can certainly vouch that her pink-streaked hair and sarcastic smile might make you think twice about giving her sass, I can’t say that her presence in the hospital was enough to justify Ed actually trying to put his shit-filled britches back on his body.

He had managed to get out of bed and drag himself to the recliner, where he was gamely working his legs back into the shit-spackled ruin of his jeans. “Ain’t stayin here one more hour,” he said to himself, gnawing his words as if his tongue had offended him. “You got too many a those people around here. I told you, I don’t want nobody in here but good God-fearin whites.”

“Ed,” I said gently, staying as close as I could in case he fell, but keeping out of arm’s reach. “You know you have an infection in your spine, right?”

“You keep tellin me that,” he said. “I feel fine. I’m leavin and you cain’t stop me.”

“I really can’t,” I agreed. “But what I’m worried about is what happens after you leave. You know that infection is trying to eat through your spine, don’t you? And what do you think happens if it eats through your spine?”

“Probably nothin’,” he said, but he stopped putting on his pants.

“Definitely something,” I replied. “You’ve heard what happens if someone severs their spinal cord? Ed, if your spinal cord gets eaten, you can’t move your legs at all.” He didn’t reply, nor did he resume his dressing. I continued: “What I’m worried about is, if you leave this hospital without surgery and that infection eats your spine, you’re gonna be under a bridge somewhere, completely helpless and unable to move your legs, while anybody who walks by can do anything they want to you, and you can’t stop ‘em.”

Ed shrugged. “If I die,” he said, “I’ll be dead. I won’t give a shit.”

“You might get lucky and die,” I agreed. “You might even get luckier, and have somebody call an ambulance, and then you end up in a nursing home with all sorts of people—black, white, Indian, whatever—wiping your ass and feeding you by hand. Or you could just get robbed and beaten, take your pick.”

“They got black people in nursing homes?” He turned a baleful eye on me, letting the shit-caked trousers drop a little.

“Same as anywhere else. Except you don’t get to choose which people you want to be around, if you’re stuck in a nursing home.”

Ed considered this for a minute, scratching aimlessly at his leg. “Well fuck,” he said at last. “I’d rather have surgery than all that bullshit. Fuck.”

It wasn’t the end of the conversation. We took about another hour to get him back into bed. The pants were taken to medical waste disposal, to prevent their ever being used again. Then the surgeon came by and signed off on his consent forms, and plans were made to evacuate the abscesses next morning.

After that, they planned to transfer him back to the other facility for open-heart surgery, if he did well in recovery from the spinal I&D. I handed him off that night with a sigh of relief, and by the time I returned for my next shift he had survived the incision & drainage procedure and been transferred away. I don’t miss him, but sometimes I wonder if they found a cardiac surgeon crazy enough to cut that cake.

Lucy got all of her dilaudid on time, with a little extra for good behavior, and by the time I returned she had started to improve and been transferred to another floor.

None of our staff ever did turn out to be mass murderers or dangerous gangsters, regardless of skin color (or, in Maimuna’s case, hair color).

And I stole a bottle of chlorhexidine surgical skin prep, and spent that evening post-shift disinfecting myself like a white lady who just found out about lice. Then I washed all my pants and poured myself a double of gin and took it to bed with me and turned out the light.


  1. Once again, a beautiful post. I can't help but nitpick everything, you missed a sentence fragment. I probably have some idea of what was missing from context, so it's just a heads up.

    > She was hooked up to the dialysis machine, which [missing words here,] so I brought her

    1. I like to think it's a typo and Elise meant to call it The Dialysis Witch.

  2. Goddamn... Just goddamn. Please don't ever stop writing.

  3. Nothing of substance to my comment, just


  4. Thank you! I learn. You may not think or believe or accept that you are teaching, but you are. I am learning about hospitals, ICUs, how (at least some excellent) nurses think, and about illnesses the like of which I had never even imagined, and which seem to come from the less-desirable parts of Dante's _Inferno_.

    As to the preferred temperature of ejecta and excreta, I wrote this some years ago, while Tori-the-Great-White-Tomcat was still with us.

    I haven't yet decided, despite numerous opportunities to compare, whether it's better to step in what the Big White Tomcat upchucks after it has cooled to floor temperature, or while it's still at his body temperature. FSVO "better", obviously.

  5. The "baby-eating lizard priest with a dozen cocks" made me laugh my face off. Also, is it possible to throw a vegetation clot? Because DAMN.

    w5ego I have pondered the same thing, and still haven't decided either.

  6. The image at
    Pretty much expresses my great appreciation for you.

  7. Your talent for writing is a gift and a curse (for us readers). I read the infamous cat story without batting an eye. But for some reason your description of Ed made me scream "CAULIFLOWER?!? *LICHEN!!??*" in an octave I haven't hit since before puberty. Thanks.

  8. I'm about 160lbs, 5'5'', bought large size comfort scrubs and it fits perfectly, wish some room to shrink from washing. Looks like I can wear it right off the rack, soft but durable material!

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