Bleed

There are impressions, not entirely wrong, that the operating room is a hostile place, or that surgeons are mean and play practical jokes (a la M*A*S*H), that they are silent and serious, or that there is blood spattering everywhere. There is some truth in each. Each expresses personal anxiety more than experience.

Surgeons, especially those who have gone deeply into the realms of subspecialties, say hand surgery, have spent their entire adult lives, two to three times the number of hours most of us spend at work, in class or hospitals. That is their reality, their totality. They often were shuttled into pre med early in their lives, went through college with others like themselves, med school, internship, research, residency, fellowship(s) and further training the rest of their careers. Not always, of course, but enough. That is their peer group, the ones who socialize them, the ones they compare themselves to, the ones who define normal for them. Amazes me that any of them have any bedside manner at all. This is not all, not even most, but the tendency is prevalent. The ones with intact marriages and children they make time for, are more balanced, treat staff more as teammates.

Nurses, techs, for many of them, are at least partially invisible, unless we are sick or injured. The change then is electric. Suddenly, we become 'patient', and they know how to do that, too. I asked a general oncology surgeon to explain mangled, family-relayed information about my sick aunt. He pulled it apart for me, gave me process and prognosis, and hugged me, because she was certainly dying, and fast.

I was getting a migraine, will a rare but blinding aura. I informed the anesthesiologist, so if I dropped or something... he offered IV toredol, which I rolled up my sleeve for, and was able to finish my shift.

A new nurse passed out, knocked her head on the floor, the surgeon broke scrub to check on her, while the experienced resident stayed operating. I bashed my head on a metal shelf, cut my eyebrow, and got more advice and attention from the surgical staff than I ever wanted. The compassion is there, just a matter of knowing the way in.

The sense of humor is rough, no question. And they egg each other on. I still can hear Dr. Townsend, referring to me, "She's slow, but she does poor work." By the time he retired, I knew he was mostly joking.

I have seen the sudden jerk and pull back of pain from being punctured by a sharp trocar, scalpel or needle, while the wielder of the sharp gasps in horror. Only to be laughed at for falling for that old trick. No harm done, but the lesson, intended as a joke, is that it can happen. It happens often enough for real.

During a Laparoscopic Nissen fundoplication, where the stomach is wrapped around the esophagus to act as a functional sphincter for herniation or laxity, the surgeons I worked with had the anesthesiologist slide in a flexible dilator - a Bougee, down, to work as a template, to keep the wrap from being too tight. The repair is sutured down. The bougee is slid out by the anesthesiologist, who this time looked at it, and asked "Is there supposed to be suture in this?" A beat, held breath, then laughter. Not really possible, but for a moment we all had to consider, how the... ?

Few surgeons prefer not to have music, and the techs hate having to work in a quiet room. I've come to appreciate not having to deal with other's tastes in music. Some will not start until the music starts. Shouting is rare, and disruptive, and no one shouts "Stat!" Ok, unless they are joking. "Nurse! Music, stat!" When there is unexpected bleeding, or a resident error, all get very quiet, the anger is tight and focused, insistently calm. No jokes, all attention on the problem to be corrected. Extreme impatience with any distraction, if noticed at all. When the crisis is past, the mood lightens as though nothing had gone wrong.

Yes, they are control freaks. So are OR nurses, and scrub techs. We rely on our habits, and protocols to keep us from the inevitable human laziness. The surgeons do much the same. They are all kinds of personalities, jerks and nasty bastards - annoying when they are also skilled. The kind, sweet ones, more infuriating when they are inattentive or incompetent. The geeks and the jocks, eccentrics and dullards, comedians and frustrated artists, all work long hard hours, and finish each surgery until all is as well as they can make it, before going on to the next. The best ones love what they do, and care about their patients. Not an angel or a demon among them. Always the elephant in the room, though.

Oh, the blood. It was the most surprizing part. Vast majority of surgeries have only small amounts of blood loss. Enough to be cleaned up in a small towel. This is the point of modern surgery, to tightly control the bleeding, and with great success. With a few notable exceptions, C-sections - visually worse because of all the other fluid that is stained and appears to be just blood. And amputations, usually due to cancer or trauma, large wounds that take a while to get mopped up. Even so, not as much as I imagined when I began this work.


And hostile? Not most of the time. It's a strange place, with different rules, not easily penetrated. Those hours of silent intent and fast responses bleed off a part of me that would otherwise turn toxic. Putting my anxieties to work for the good of others.

Hall (Photo)

Moby gets to play in the hall, significantly expanding his scented territory. He prefers chasing mice out there.

Us (Photo)

I can't believe we've been together so long, I can't remember a time when we were apart.

Done

I hit 50,002 words at 1020 this morning. The story is done, althought there may yet be epilogue or filling in later. LATER. Nanowrimo, two years in a row, and both done early.

Ten Things I am amazingly happy about.

1 Sixteen years ago, D and I found each other.
2 This morning, he went to Google Earth, and found satellite photos for where we were stationed during Gulf War I. He'd looked before, but the resolution was too poor. Today, we found both sites.
3 This is his idea of romantic. Mine too.
4 The story flowed, and let me tell it. Enough for now.
5 We are going to a museum today
6 Then lunch at Wok 'n Roll.
7 Moby is the most wonderful cat ever.
8 Moira is the most wonderful friend ever.
9 We are going to see Moira and C in January, as well as babe Plum.
10 You read this, and encourage me, and share your own tales in return.

Thanks

I am grateful beyond words for all of your kind words. Especially after I realized I'd been counting a 600+word segment twice. I have a soft spot for limericks. Thank you, thank you so much.

So, my question. What are the hardest reasons to give thanks? I had a fellow student that I had been slighting of, tell me that she might not be smart, but it hurt her feelings when I cut her off and ignored her, rolled my eyes and sighed when she talked. I was in ninth grade, but I got it. I will always be grateful to her for calling me on my meanness. I still feel badly about how I treated her, but I did listen. I did learn.

Another fellow student called me on always feeling ill, having a bad day, always excusing myself for not being prepared or for leaving early. He prodded me to begin a long, long, hard journey into my own misery and out the other side. Eventually. The other students thought he was being mean. Hurt as I was, I defended him. He was right, after all.

I'm grateful that my parents put me through catholic school. Not easily, not really affordable for a factory worker laid off, then hired as a groundskeeper for a cemetery. I was offered a great education, and was cured of Catholicism at the same time. I will always be thankful, education is never wasted.

Woe

Moby anxiously kneading as the vacuum 'bot runs.

Writing myself into a corner, or at least new territory, where there are endings, but no clear path to any of them. I fear the trite.

tsdi

only 5K to go

I am so tired tonight. My imagination is spinning it's wheels, though. It would be wrong to stop with only 4.5K to go, right?

Mndi (Photo)

45,023

Sun.

43,122

Leonids and Leica

S-day

At six in the morning yesterday, the NOAA had, for the current weather in Boston "N/A VOID." So when I walked out the door, I had to return for an umbrella. Turns out it was about 60F, with 25mph winds, gusting to 40, and 0.7" of rain in that hour. I ran, and was shoved and dampened the whole way to the train. As it was pulling away, me on the wrong side of the platform, a Miracle, the driver stopped, opened his window, and gestured me around the track. Clambered on, damp and grateful and out of breath.

At the notorious Park station, the Red Line was delayed for a disabled train, I stood awhile looking at the uncharacteristically shiny rails, and decided that wet was better than late, so I ran up and grabbed a Green line to the nearer station, and walked the rest of the way. My legs were soaked to the thigh, and I was never so glad that I had dry scrubs awaiting me. I like rain, but when it drives sidewards, less so.

Had a room that was fast and full, but predictable and doable. As long as I get there early enough to be ready, so, right choice.

Quitting time, my jeans were still soaked and clammy, so I snag clean scrub pants for the trip home (I never do this), planning to catch a cab. No cabs. The T, again, but a seat, which is almost as good.

Nothing funny at work but for Hari and Shahzad making fun of me for not understanding a word of what they were saying about cricket. I simply replied that I know nothing of football or basketball, either.

38,217
40,318 ending.

Furday

And glad I am of it. Did not write last night. Read the December Fortean Times which miraculously appeared in the mail.

So, ten things I read about in the Fortean Times.

1. UFO abductees and lightening strike targets have a lot of common symptoms.
2. There is an elephant who speaks a few words in Korean. Apparently.
3. Charles Fort was going for some kind of unified theory, long before the physicists focused there.
4. The Olmec may have had writing.
5. The Romans had a toothpaste named after Messalina.
6. A researcher looking into woodpecker's lack of headaches won an Ignoble prize.
7. There is a lake of sulfuric mud in Java, swamping villages. Triggered, perhaps, by oil drilling.
8. Nichola Tesla could have been both a mad scientist AND a misunderstood genius.
9. Bruce Lee ate hash. Maybe.
10.Three minnows were found in a duck egg.

Th'sdi

How could I resist a One Word meme? I apologize for forgetting where I got this, please leave a note if it was you.

*Via Pilgrim/heretic.

You can only answer one word. No explanations.
1. Yourself
awake
2. Your spouse
amazing
3. Your hair
mess
4. Your mother
neglect
5. Your Father
bastard
6. Your Favorite Item
soft
7. Your dream last night:
blank
8. Your Favorite drink
beer
9. Your Dream Car
electric
10. The room you are in
cozy
11. Your Ex
invisible
12. Your fear
disaster
13. What you want to be in 10 years
home
14. Who you hung out with last night
fictional
15. What You're Not
rested
16. Muffins
eh
17: One of Your Wish List Items
ease
18: Time
dark
19. The Last Thing You Did
words
20. What You Are Wearing
jeans
21. Your Favorite Weather
rain
22. Your Favorite Book
subtle
23. The Last Thing You Ate
breakfast
24. Your Life
full
25. Your Mood
sleepy
26. Your best friend
distant
27. What you're thinking about right now
tea
28. Your car
absent
29. What you are doing at the moment
dithering
30. Your summer
humid
31. Your relationship status
happy
32. What is on your tv
nothing
33. What is the weather like
checking
34. When is the last time you laughed
recently

Weensday

Ok, last week, no woe. This week, I was handed a post on a platter.

I am going down to the Park Street Red Line station, and as I start down the stairs, I hear loud, lounge music. Now remember, this is 0620. I'm thinking, I can't take this, not this early in the morning. And it gets worse, because atop the obnoxious synth pseudo jazz volume, there is a man in full Sammy Davis Jr. get-up, singing a mangeled, not entirely on key version of "Mr. Bojangles." I fished out my shuffle, stuffed the pods in my ears, and cranked whatever song was there as loud as I could stand, until the roaring train washed it all out anyway.

I always tip the T musicians, I didn't think he qualified.

33,001
It's herein one huge, horrible post.

Trouserday

I am grateful that I got today off, since I was feeling distinctly icky yesterday.

And what is it about Moby that friends who have only seen a picture of him, ask after him? Is is just his telegraphic natural charm, or is it that we found just the right name for him?

30,793, and ahead of schedule. I just hope I can turn the corner of this sock, so that it winds up with a complete plot, and not just a series of episodes and stories. But, finishing nanowrimo early is enough blessing all in all.

I have to stop fantasizing about it actually getting published, one day.


32,024 at 1900.

Monnndeeee (Photo)

Moby found a new "under."

28,354, and holding, for tonight.

Oh, and Fellow Novelists, take a little time to listen to NPR being supportive of National Novel Writing Month.

Stolen (Photo)

This is a friend's rescued cat. I did not take this photo. I couldn't resist.


24004

27360

Satyrday (With Photo)

The last two days at work have demanded I pull out every secret from my bag of tricks, often all at once. Uncommunicative surgeons, two attending surgeons in one room, a pediatric patient, flipping patient position, and bed type- mid case. All the fun stuff. And I love feeling I'm the competent juggler in the middle, but after two days of it, I'm tired.

At one point yesterday, I was asked to page the child patient's parents, before I could, scrub asked me to page for a different set of fixation plates, surgeon asked me to page the next surgeon, anesthesia is standing over my shoulder wanting me to order albumin (which takes a different form that has to be filled out perfectly), resident is telling me repeatedly that the suction is not working, the phone is ringing with the stat gram stain results for the allograft, and the med student has contaminated her gown, and needs a new one. I'd have laughed if I'd had time.

I had to put a diaper on the baby on Friday, and mentioned I didn't do this often. Surgeon says, "Well, you should be, you take care of surgeons all day."

That D sent me this photo of Moby "helping" him put down the chicken made it all ok. And he took the train in to escort me home. I babbled at him the whole way (all the while making sure I did not reveal any identifying information).


22033

Friedday.

Ten Things I will say, in response, today.

How are you?
Absolutely.
Yup, sure is Friday.
I am off this weekend.
Are you off this weekend?

Sure, no problem.
Can I go home yet?
No one has shown up.
Now, that would be logical and reasonable, and we can't have that.
Oh, sorry, let me just...

Thorsday

When should we really celebrate the beginning of the year? There is the numerical turning of New Year in the middle of winter (summer for the 'other' hemisphere.) There are either Solstice, Summer or Winter, there is the old argument for Spring as life begins, businesses have various and sundry random fiscal years. I would like to just go with my birthday, but that could get confusing for the other 364ths of the population. I also think that now that we have computers that would make it possible, we could have varying fractions of daylight and dark, so that the hour would be 1/12th of the day, and night. Work in the summer would be longer, but we could nearly hibernate all winter, turned around for night people.

How, in short, would you change the calendar?


18,033

Wodensday

No woe. I like rain, India Quality does a searing and delicious lunch with charming service, errands got run, MST3K DVD came, and I hit the 16K mark.

With some difficulty, admittedly. There it is. Want to complain, and life just doesn't cooperate.

16,187

Tuesday

Sunrise, darkly golden red through a suffusion of yellow leaves, reflected in watered silk glass stream, honking geese in flyover.


13,515

MoanDay

11,871




I am so proud, this took some courage.

Sunday

Saturday

First week, and I already screwed it up. Yesterday should have been 10 Things, and today the work joke. Eh, I'll just switch. Make up for it next week. And offer you this quote from the ever amazing Whiskey River.

"One of the few things I know about writing is this: spend it all, shoot it, play it, lose it, all, right away, every time. Do not hoard what seems good for a later place in the book, or for another book; give it, give it all, give it now. The impulse to save something good for a better place later is the signal to spend it now. Something more will arise for later, something better. These things fill from behind, from beneath, like well water. Similarly, the impulse to keep to yourself what you have learned is not only shameful, it is destructive. Anything you do not give freely and abundantly becomes lost to you. You open your safe and find ashes."
- Annie Dillard
Nanowrimo word count :7070

Ten Things I am looking at right now.

Brown mug
candle in holder I threw, trimmed and glazed myself
liquid hand soap dispenser
paper towel
copy of Tao Te Ching
black watch Timex type
blue watch, free for Nurse Appreciation Day
logitech microphone, with guilt over not adding to One Word Aloud
paper lamp, pseudo Japanese style
stainless steel kettle. The one Moby loves to lap out of when I am pouring his water.

Friday

On Halloween, many nurses and techs showed up with themed scrubs or hats - which is about what you can do in the OR. One nurse wore a jester hat, stuffed points with bells on, which cheered us all. One of our ortho surgeons was in the hall, showing off his "New instruments," two foot long knife and cleaver (in plastic.) Ok, maybe you had to be there.

Thursday

If you could live for a day in an altered loop of time and space, where and when, and what would you do?

I would be 13 and in school with D who would also be 13 and in the same school. We would, I believe, like each other, and reassure each other that we were not alone in our eccentricity.

Wednesday

November and Nanowrimo begin, and it's Wednesday for Woe. I have cramps and misery. Women talking about their periodic discomforts used to embarrass me so badly when I was younger. So my male readers, you are not alone in this. But endure for a moment. I have to, until menopause brings me a big welcome prezzie.

Consider orientation. And what happens when a horizontal canal is stood up, as if on two feet. Add that 'always sexually receptive' cycle of hormones, and the viscosity of blood. Yeah, well, Intelligent Design my fanny. (In the British sense of the word.)

I'm swollen, acne ridden, unbalanced, and in pain. Not moody for moody sake, but as a reaction to interstitial fluids and nausea. Imagine ovaries or testicals, depending on which analagous structure is applicable, being wrenched to the point of pain, but not damage. For three to five days. Every 3-6 weeks.

I rest my winge. And go to write.