These Hands of Ours

My friend Jessica has started a wonderful project, a blog called These Hands of Ours. She's collecting photos of women's hands doing things that are important to them, along with descriptions of the images.

Here's the e-mail she sent out, which is also the sidebar of the blog:

I started a project for my 45th birthday. I'm gathering the hands of inspiring women - photos, self-portraits, snap shots. Women who have inspired me over many years, and the women who inspire them.

Thinking about the things I love about myself, I see a reflection of many women. And I'm creating a portrait - a photo montage of that - including text people send and any links to their own inspiration, websites or blogs.

It's through the women in my life that I am appreciating all the things I've done with those hands, the places they have traveled, the people they have hugged.

I wonder if we can create a huge quilt of inspired hands?

Pass it forward.

Love, Jessica
September 4th, 2008
Greenwich, Connecticut, USA

Above is the photo I sent Jessica (many thanks to Gary for taking it!), and here's the text:

I use my hands for lots of things -- writing, patting my cats, fetching blankets and water and toys for patients at the hospital where I volunteer -- but I rarely delight in my hands as much as when I'm knitting. I learned to knit last fall, and I've knit every day since then. I started with a prayer shawl for a friend whose husband was dying, and since then, I've made many shawls and scarves, and two balaclavas, although I have yet to tackle anything with sleeves.

Knitting reminds me that beautiful things are created stitch by stitch, one small loop at a time. It teaches me patience and perspective. It is both creation and recreation, inspiration and healing. I'm a lay preacher at my church, and last Christmas I preached about knitting as incarnation, as embodiment, the making visible of the holy. Knitting participates in the beautiful Jewish concept of "tikkun olam," the repair of the world; and when my hands use needles and yarn to make something warm and useful, so do I.

So there you have it. If you like this idea, please send Jessica a photo of your hands, with accompanying text. The e-mail address is thesehandsofours(at)yahoo(dot(com).

And let your female friends know! Pass the word!

Oh, and speaking of women (and men!) doing invaluable things with their hands, the latest edition of Change of Shift, the nursing blog carnival, is up and ready for your reading pleasure! Watching nurses in the ER makes me infinitely grateful for our hands and everything they do.

Change of Shift

In the late-links-are-better-than-none department, I'm pleased to link to the most recent Change of Shift, the twice-monthly nursing blog carnival.

Happy reading!

Fashion Plate, and Other Matters

Figaro curled up on my couch yesterday, half on top of one of my knitting bags, which is green and white. The green matched his eyes beautifully, so I took some photos. The matching color didn't show as well as I wanted it to, though.

That first shot's the best for the color match, but this is better of Figgy, since he's wearing his usual hyperalert expression. In the first photo, he looks half asleep.

I'm glad to report that knitting, writing and reading are all going well, and that I swam for an hour yesterday. Unfortunately, it's been impossible for me to walk outside -- although Gary's gamely continued hiking -- because our air quality is so horrible from the California fires. People with respiratory problems are really having a tough time of it. Things aren't as bad here as they must be in California, though.

With all my inside time, I'm looking forward to reading the latest Change of Shift, the nursing blog carnival -- hosted by the ever-energetic Kim -- which begins its third year of life with this edition. Congratulations, Kim! You're an inspiration to us all!

Change of Shift

The latest edition is up over at Nursing Link. Thanks for including me, PixelRN!

Belated Bits o' Blog Business

I'm blogging very late today; I got caught up in other things this morning and afternoon. Here are a bunch of items of varying overdue-ness:

1. This week's Change of Shift is up. Alas, I missed the deadline, but I'm looking forward to reading the edition!

2. Weeks and weeks ago (months, even) I had the great honor of being tagged for the Thinking Blogger Meme by both N=1 and Disappearing John. This really means a lot to me, since I think the world of both these folks. But between my mother's surgery and the end of the semester, it's taken forever for me to tag five people in turn.

Here are the guidelines for the meme:

Should you choose to participate, please make sure you pass this list of rules to the blogs you are tagging.

The participation rules are simple:

1. If, and only if, you get tagged, write a post with links to five blogs that make you think,

2. Link to this post so that people can easily find the exact origin of the meme,

3. Optional: Proudly display the 'Thinking Blogger Award.' (Shown above.)

Here's my list. It was hard to choose five, so please don't be insulted if you aren't included here!

In no particular order:

Elliot at Claw of the Conciliator, who writes thoughtful posts about faith and SF/F, among other things.

Martin at Sun and Shield, who writes thoughtful posts about the intersection between science, faith, and speculative literature.

Tiel at Knocking from Inside, whose poetry always makes me ponder both language and the world it describes.

Rachel at The Velveteen Rabbi, who's also a poet and chaplain, and who's deepened my understanding of Judaism.

Nickie at Nickie's Nook, who helps me understand both blindness and chronic pain, and who makes her readers think long and hard about disability issues, especially in social work. (And Julio gets the World's Greatest Dog award!)

3. Months ago, I registered this blog at The Truth Laid Bear, mainly because I was looking forward to being in TTLB's whimsical ecosystem. But I could never get Rickety Contrivances to show up in the ecosystem, even though the site told me my blog was already registered when I tried to register it again. Very frustrating!

But yesterday, I discovered that, lo and behold, the blog had appeared in the ecosystem after all. I was a lowly insect! That may not sound very impressive, but it has to be better than being an insignificant microbe.

And as of this morning, I'd graduated to slimy mollusc! Gosh! Look, ma: I'm evolving!

At this rate, I'll have a backbone in no time.

The only problem is that now I can't find the ecosystem widget on the TTLB site, so I have to go there to learn my evolutionary status, rather than having it show up automatically on my sidebar.

The ED Sonnets: Room 10

These two have more off-rhymes than usual, but Gary thinks they work as is, so I'm posting them anyway.

In other medblogging news, the latest Change of Shift, the nursing blog carnival, is up over at Emergiblog. Kim very graciously not only included my post, but added an advertisement for my upcoming readings. Thanks, Kim!

*

Chair 10.1

This room has dental chairs instead of beds,
and houses ear infections, injured eyes,
cat scratches, nosebleeds, rashes, boils and hives.
Why are these patients here, I think, instead
of Fast Track? Take this guy, who burned his hands
and needs the dressings changed: emergency?
I’m puzzled, but we banter pleasantly
about his job, the weather, foreign lands
he’s visited. And then in that same tone --
relaxed and casual -- he tells me how
the devil lives inside his radio,
prefers rock stations, won’t leave him alone,
drowns out his favorite songs. “I had to buy
an iPod. He’s not there yet, but he’ll try.”

*

Chair 10.2

And here we have a mom and little boy,
wide-eyed at what they’ve heard. HIPAA, hurray!
I smile to reassure them. They can’t say
a word Chair One won’t hear. “Do you enjoy
this job?” the mother asks. “Oh, yes!” Her code
is clear: You like to talk to folks like that?
I really do: the universe is vast,
exhilarating. These small rooms bestow
huge gifts, God’s strangeness shining from each tale,
particular and poignant. “So what brings
you here tonight?” The child looks up, looks sad.
“Sam bit me. He’s my dog. He was on sale,
but now we have to take him back.” He clings
to Mom. “He wasn’t trying to be bad!”

Unwanted Hospital Adventure

As I mentioned in a previous post, my mother's scheduled for surgery this coming Monday. I now have her permission to tell you that it's surgery to repair an abdominal aortic aneurysm. Her doctors have been aware of this for a while and giving her CT scans every six months to see if it's gotten bigger; her most recent scan showed that it had reached five millimeters, which is when they go in to do a surgical repair.

She's been having a bazillion tests to see if she can withstand the surgery, which we're all hoping they can do laparoscopically, since that cuts the hospital time down from ten days to something more like two.

Today she went to the hospital for a stress test. She wasn't allowed to take any of her meds beforehand, and my sister just called me to say that when Mom got to the hospital, she was out of breath and her heartrate was "a little fast." So she couldn't have the stress test; she was sent to the ER instead.

I believe this is the same ER where Mom had to spend eighteen hours three years ago, when she had to be admitted for a post-surgical infection but there were no beds. None of us have the fondest memories of the place.

All of this just happened. My sister said that my mother sounded basically fine, if upset. Aside from hoping that she's okay, which goes without saying, I also really hope that this doesn't delay her surgery. I hate the idea of her carrying that time bomb around in her belly.

It's been that kind of week; this past weekend, two of Gary's relatives were in the hospital, although things on that front seem to be going as well as they can.

I'll post updates when I have them; with luck, it will all resolve quickly. But first, I'm heading to the gym to work off some of my own stress!

Oh, before I forget, the latest Change of Shift is up. I wasn't organized enough to submit anything this week, but I'm looking forward to reading it!

My sister just called again to say that she's signing out of work to go to the hospital. I'm glad she's there, and I wish I could be.

Later:

Mom's been admitted to monitor heart symptoms, although she's still in the ER. They may do the stress test tomorrow if they can, and they may just keep her in the hospital until the surgery on Monday. I spoke to her briefly, and she's actually relieved to be admitted to the hospital; I think she's found all the tests extremely wearing. She and my sister were squabbling back and forth (good-naturedly) the way they usually do, which I take as a good sign.

It turns out that this isn't the hospital where she had to wait eighteen hours for a bed, although of course that can happen anywhere.

Early evening:

Mom's now in a room -- this is a hospital where all the rooms are private -- and has had an ultrasound of her legs which showed no blockages (I guess her legs are swollen). She's exhausted from the stressful day and has a headache, but says that she's received excellent care "on every account." My sister really likes her nurse, and one of the ED doctors commented that she has an excellent vascular surgeon.

She sounds more cheerful than I would after the day she's had; when I called, she was trying to figure out how to turn on the TV (her nurse was helping her). So I'm feeling more cheerful, too.

It's not easy being green . . .

. . . Unless you’re a sea turtle. And no, I didn't take this picture; I got it off the web. I'll tell you about the turtles in a bit. But first:

Blogging News

The latest Change of Shift is up, posted as a series of limericks in honor of St. Patrick's Day, and I'm proud to be included!

I’ve also been tagged for a fun blog meme, but I won’t be able to participate until I get back home and have more time. Thanks for tagging me, Universal Health!

Today’s Erratum

In my last post, I said that the mandatory boating distance from whales is 100 feet; that should have been yards! Obviously, my vacation is eating my brain.

More News of Mice

The latest FoM review, by Victoria Strauss, is up at the SF Site. It's another very enthusiastic notice, although Straus joins Lalumiere in considering "GI Jesus" the weakest story in the collection. (I feel like I'm watching a tennis match, trying to keep a tally on this one!)

The Second Whale Watch

Here in Maui, yesterday’s expedition wasn’t quite as exciting as Tuesday’s, because we didn’t have hundreds of Spinner Dolphins surrounding the boat. The trip did start out with a spectacular whale breach, followed by pectoral fin slapping; after that, though, things quieted down. There were lots and lots of whales, including mamas, babies, and something called a “competition pod,” or “compod,” where two or more males head-butt each other (or maybe they only lunge at each other) over a female. But most of that was happening under the water, and while the naturalists claimed that they could see what was happening because of their polarized sunglasses, the rest of us with polarized sunglasses couldn’t see a thing. Either the naturalists were making it up, or they have x-ray vision.

We still had a good time, but it was a more placid good time than we’d had on the previous trip.

The Snorkeling Expedition

Gary and I have discovered that we love snorkeling. The boat’s first stop, at Molokini, allowed us to watch gorgeous little fish darting in and out of coral groves, and often swimming almost close enough to touch. Our optical masks worked very well: we could both see fine, even though we’re usually blind as the proverbial bats without our glasses. I heard lots of whalesong under the water, although Gary didn’t hear it. (There were a mama and baby whale quite close to us, and other people saw them breach, but we were watching fish when that happened.) It was really stunningly beautiful, and I can see how snorkeling could easily be a profoundly spiritual experience: just you, the water, the wildlife, and the gentle sounds of whalesong and your own breathing.

Unfortunately, my spiritual experience this morning was marred by three factors:

1. Gary and I were using proper snorkeling form: a dead-man’s float with gentle scissor kicks when we wanted to move somewhere. We were parallel to the plane of the water’s surface. This was how the instructor had told us to position ourselves. Unfortunately, most of the other people on our trip were hanging vertically down into the water, with their fins pumping as if they were on exercycles, popping up to chatter to each other and then plunking their masks back into the water to peer down past their feet. This meant that our own view of fish and coral was often blocked by a sea of pumping legs. I know that any true spiritual experience includes love for one’s fellow humans, but I was having some trouble with that this morning.

2. We had the first iffy weather of the entire trip: it was very cloudy and much cooler than it has been, and the water was very choppy. This meant that Gary and I both got chilly, even wearing wetsuit tops.

3. Probably as a result of #2, I wound up feeling very nauseous on my way back to the boat. Once I crawled aboard, I was okay, but it was touch and go there for a bit.

Me and My Turtle

On to Turtle Town! We saw more Spinner Dolphins on the way, and also had some more whale action. I’d told myself that it would be okay if I didn’t see any turtles, but I really wanted to see one . . . and sure enough, I did! I saw one large turtle, swimming placidly here and there, and I followed him (her?) at the required ten-foot distance. It really was ten feet this time, and not ten yards, because green sea turtles are no longer considered endangered, although they're still on the "guarded" list.

Later I learned that other people had seen a baby turtle: lucky them! I just saw the one. Sometimes I had to back up because I was too close to it. My turtle -- I became very proprietary towards the turtle very quickly -- was graceful and streamlined and soothingly green, and I was very happy; although, once again, my spiritual discipline of lovingkindness towards all living creatures stopped rather short of the idiot who swam about three feet from my turtle and flapped his fins in the creature’s face while trying to get a good shot with an underwater camera. My turtle appeared much less perturbed by this than I was, although it did make a dignified exit for its coral cave shortly thereafter. Honestly, dude: how would you feel if someone did that to you?

I thought about looking for other turtles, but I’d started feeling bad again, almost as green as my turtle was . . . and then rapidly more green, until I had to yank my snorkel out of my mouth to lose my breakfast and yummy boat snacks into the ocean. Delightful.

After that fun experience, I had to swim back to the boat, which wouldn’t have been a problem if I hadn’t been feeling violently ill. I managed to get there, though, and was keeping my remaining cookies down until everybody else got back into the boat . . . at which point I made a mad dash for the railing and hurled over the side of the boat five or six times in quick succession, while the other passengers stared at me. (“And now, ladies and gentlemen, our next eco-tourism adventure: Wild Vomit!”) The captain was very nice; she brought me a glass of cold water and told me, “You’ll feel better when we get going again, hon,” and then told the others, “We’re going to head back now, for the benefit of those of you who aren’t feeling so well.” It turned out that at least one other passenger was also sick, although I didn’t realize it then. When I apologized for fouling the water, the captain said cheerfully, “Oh, no problem! It’s fish food! The fish love you now! They want you to come back!” As Gary observed later, far better I should be sick into the ocean than into the boat.

Gary, alas, saw no turtles at all. He still loves snorkeling, though.

We made it back to the dock without incident, although it took a good ninety minutes for solid ground to stop rolling whenever I stood up. It’s the worst experience of sea legs I’ve ever had.

After a light lunch, a nap and a shower, I felt infinitely better, and Gary and I went for a nice walk on which I found fun inexpensive earrings and a new suitcase. The zipper on my old one had died. The new one is bright red, with yellow flowers and white turtles on it. It’s a little garish, but I definitely won’t have trouble spotting it at baggage claim.

So that was our exciting day. The whalesong and my turtle made everything worth it: I’d happily be that sick three times over, for those two experiences.

Tomorrow’s agenda: a quiet day of beach-lolling, probably a long walk for me and Gary, and then a fabulous dinner at an obscenely fancy restaurant, Nick's Fishmarket in Wailea. We went there for our farewell-to-Maui dinner last year, and it may be becoming a tradition.

Reno News and Review! And Carnivals!

So here's the photo (credit: David Robert) from my Reno News and Review Fifteen Minutes article. (Fifteen minutes of fame, anyone?) It's not the best photo in the world, but it definitely could have been a whole lot worse, so overall, I'm pleased. The article's pleasant, too.

Meanwhile, the ever-energetic Kim has posted Change of Shift over at Emergiblog. Thanks for including me, Kim, and for plugging Carnival of Hope.

Speaking of which, please remember that the deadline's today at 5 PM PST (although since Gary and I will be at a concert this evening, I'll actually accept submissions until 10 PM). I have an exceptionally busy few days coming up, so the carnival will probably be posted sometime tomorrow rather than tonight. Please be patient!

Change of Shift, and Rita Charon

The new Change of Shift is up over at Protect the Airway, and I'm delighted to be included. AC has done a splendid job with this edition, which is clearly organized and provides an excellent sense of what each post's about.

I just have to kvetch, though: does anybody else hate black blog backgrounds? For me, it makes the text very difficult to read, and my middle-aged eyes have enough trouble already!

And for our next topic: Rita Charon and Narrative Medicine.

Charon's a family practitioner in Manhattan, serving mostly poor patients, who runs the Narrative Medicine Program at Columbia (the only one of its kind in the country). This program teaches medical students to be better listeners to patient stories, and to use writing as a way to reflect on their practice and form closer bonds with patients. Charon's also a literary critic and scholar with a PhD in English Lit from Columbia; impressive lady!

On Tuesday, she gave a series of talks at UNR. I was only able to attend one, but it was excellent. Charon's an eloquent and compelling speaker; listening to her, you can tell that she must be a wonderful teacher and doctor.

What struck me most about her talk was her description of how she takes patient histories. The traditional way of doing this is to ask about history of the current illness or condition and then about broader medical history, followed by a review of systems. While Charon gets to all of that in the course of a first visit, it's not where she starts.

She starts, she says, with two sentences; she's trained herself not to say more than that. "I'll be your doctor, and that means that I have to know as much about you as I can. Please tell me what you think it's most important for me to know about you." (I may have the precise wording of that wrong, but that's the gist of it.) While the patient talks, Charon just listens; it took her a while to train herself not to write notes. ("At the beginning, I literally had to sit on my hands.") She said that patients will start all over the place: with family history, with what's happening at home right now, with their fears about their current condition.

She told us how moved many patients are by being asked to do this. One man started crying, because Charon was the first doctor who'd ever asked him what he thought was important.

While the patients are changing for the physical examination, Charon will type up as close to a verbatim transcript of what they said as she can remember. At the end of the visit, she'll give them the transcript and say, "Is this everything?" Sometimes she'll have forgotten something, and sometimes the patients will read the report and say, "Well, we left something out, and we should put it in." Charon told her audience: "You can imagine the things that get left out at first. The traumas, the stillbirths, the losses, the abuse."

Charon gives the patient a copy of this document to take home, as well as putting it in the chart. Her patients get copies of everything that goes in their chart; she encourages what she calls a "co-authored record of care."

Charon's patients must love her. I've certainly never had a doctor take my history that way, and I've had some excellent doctors (as well as some lousy ones). Obviously there are some specialties, like emergency medicine, where this approach would be impractical for time reasons. But I think the state of American medicine would be vastly improved if more physicians listened to their patients' priorities.

And hearing Charon has made me rethink how I introduce myself to hospital patients. I usually say, "I'm a volunteer chaplain, and I visit everyone in the ER to see if anyone needs to talk or would like a prayer." Many patients hear this, correctly, as an invitation to tell their stories, but some patients still seem to view chaplains as people who talk at them. (One recent patient responded to my little intro by glaring and snarling, "I wouldn't call you if I were dying!")

So I think I'm going to try a slightly different intro, something along the lines of, "I'm here to listen to anything you want you tell me." I won't have time to write down what I hear and show it to the patient, but in my work, reflecting what I've heard in how I pray with that patient (if the patient requests a prayer) often serves the same function. A well-worded prayer lets people know that they really have been heard.

At last night's Ash Wednesday service at church, we sang a Taize chant that reinforced the theological importance of listening:

O, Lord hear my prayer,
O Lord hear my prayer;
when I call, answer me.

O, Lord hear my prayer,
O Lord hear my prayer.
Come and listen to me.

When people pray, they want a sense that they're praying to someone, that a living entity has heard them. The same is true when they talk to chaplains, or doctors.

We Got Your Blog Carnivals Right Here

The latest Change of Shift is up, hosted by the always-witty Mother Jones RN. I'm proud to be included.

Also, the Carnival of Hope deadline is 5:00 today: there's still time to send me last-minute posts! Last night I went through what I have so far, and CoH will be unusually large this month. I'm happy to have a lot of good material, but I have much less free time than usual to get it organized and posted. So it probably won't be posted tonight, and may even be posted very late tomorrow . . . and Saturday's not out of the question. The next few days are crammed full of meetings and social stuff, and when I'm not doing all that, I should be grading.

So please be patient with me! I promise that CoH will indeed be posted; I'm just not sure when.

Change of Shift, and New Cat Antics

The new Change of Shift is up over at Emergiblog. Thanks for including me, Kim!

Meanwhile, Balthazar's new favorite toy is the computer. He loves to chase the cursor on the screen, and the other night he sat and watched a movie with Gary, looking very interested at all the colorful moving things. We don't dare get him one of those "kitty TV" DVDs of mice and birds and such, or he'd shred our monitors!

Tomorrow night we're resuming our Friday-evening DVD showings, this time for Battlestar Galactica, so Bali will get to meet some of our friends. He's a very sociable kitten, so I don't expect him to be freaked out by new people.

I haven't managed to get any new pictures of him lately, but when I do, I'll post them.

Change of Shift, et cetera

The latest Change of Shift, the nursing blog carnival, is up over at Emergiblog. I missed the submission deadline for this, as well as Grand Rounds, this week, which means that my daily-visit average will be taking a real hit. Drat! Kim always does a fantastic job with carnivals, though, and I'm looking forward to reading this edition.

After my slow start yesterday, I had a very productive day. I got fifteen files read at the office, although I had to cancel a therapy appointment to do it. I decided that staying put and getting work done was more helpful to my mental health than the appointment would have been.

Then I came home and put together a draft of Carnival of Hope, since I plan to be at the hospital tonight. (The weather's foul again, though, so I may not be. For the last two-plus years, I've missed weekly shifts only for travel or illness, but after the experiences of the last few weeks, I may add inclement weather to that list.) It's a potent -- but small -- edition. There's still time to submit your own post: the deadline isn't until 5:00 PM PST, and since I probably won't be home tonight, I'm willing to extend that to 10:00.

The kitten is still extremely energetic. Thanks to folks who posted cat-medication tips yesterday!

And on that note, time to get ready for work. I only have ten files to go! Woo-hoo!

Change of Shift, and "Minor Complaints"

This week's Change of Shift, the nursing blog carnival, is up over at NeoNurseChic. Thanks for including me, Carrie!

And, while we're on the subject of medicine, here's a subject that's been nagging at me for a while: the issue of people showing up in the ED with "minor complaints." DisappearingJohn wrote this post a while back kvetching about the problem, and during a recent volunteer shift, I heard a doctor venting about the same thing. "These people come in with nothing, nothing! They don't need to be here!"

A few notes: Everybody who talks about this acknowledges that people who don't have insurance have to use the ED for primary care; in addition, DisappearingJohn informs me, laws designed to protect the uninsured mandate that EDs have to evaluate anyone who walks in, even if the triage nurse considers the problem minor. There's also a trend where primary-care providers tell patients, "Just go to the ER," even for problems that might be better handled with an office visit. And some nurse hotlines, cautious about liability, seem to use "go to the ER" as a default (although the one I use has always been good about saying, "No, that's not that serious; you can see your primary tomorrow," or, "This doesn't sound serious now, but if XYZ happens, go to Urgent Care").

However, all these factors aside, I hear in many such complaints an exasperated expectation that patients should be able to figure out for themselves which problems are minor and which aren't.

Dear doctors and nurses:

Newsflash: We can't do that. In most cases, we don't know how to evaluate our own medical conditions. We aren't the doctors and nurses: you are. You're the ones who are trained to figure out if something's minor or if it isn't. That's why you get the big bucks. (Ed. note: Since this line has deeply offended certain readers, I feel obliged to point out that it's ironic; I've never heard it used any other way, but I guess some people have. See comments.) That's why you wear the scrubs and white coats and we wear the oh-so-fashionable gowns gaping in the back, okay?

Also, there are entirely too many people who go to the opposite extreme, who consider their own problems minor and won't seek medical treatment unless other people tell them to. Consider:

* My classmate in graduate school who had a huge red boil on her arm but wanted to wait until after our three-hour seminar to go to the university health service. My cousin had once had a boil like that, and it developed scary red streaks and he had to be in the hospital for a week, so I told her to skip class and go to the doctor. She said no. I said yes. I convinced her. She went to the health service and received very prompt treatment from ashen healthcare providers; about a week later, she told me, "My doctor's only now telling me how serious that was."

* Another friend who had an annoyingly painful paper cut, one she couldn't even see but that hurt like blazes, and who finally went to the doctor for it, feeling really foolish, and who then discovered that she had an antibiotic-resistant staph infection, and who spent quite a while in the hospital and had to take several months off work.

* The time I thought I had a stomach virus and was really embarrassed about going to the ED, even though my aunt the nurse told me to very firmly; the ED staff thought it was gastroenteritis, until the bloodwork came back with a white count of 29,000 (I know I've told that story here before, but it was pretty traumatic, believe me). A friend of mine told this story to a friend of hers who's a nurse, who evidently turned pale and said, "She could have died."

And then there's the sort-of-funny story an urgent care nurse told me once when I went in, feeling very embarrassed, to have a very small and painful splinter removed. (She took it out, and told me that I'd been right to come in.) She'd been working in an ED once when a call came in from a guy who said, "I have a splinter in my hand. Are you busy? Would it be okay if I came in now?" She told him to come in, but she and her colleagues were rolling their eyes about the wuss with the splinter -- until he came in with a 2x4 driven through his palm.

You see, doctors and nurses, if you ask us to decide what's minor and what isn't, sometimes we're going to err on the wrong side. We aren't the best judges of this. You are.

And yes, we all know that you have to deal with too many hypochondriacs, too many people who come to the ED for the wrong reasons (drug-seeking, social contact), too many people whose sore throats and coughs would respond very nicely to over-the-counter medication, and whose germs aren't doing the ED staff and the other patients in the waiting room any good, either.

But think about the other side: the times you have to tell a patient that he's having a heart attack, that she's had a stroke; the times when you have to tell patients and their families that a suspicious mass has showed up on the scan, that it looks a whole lot like cancer, that emergency surgery has been scheduled.

You hate those moments. I know you do. I've seen you steel yourself to deliver bad news. I've heard you say, "Oh, man, we just had a guy come in with an inoperable brain tumor."

I know that the patients with the coughs and sore throats take up valuable time, time you'd rather spend with the patient who's just been diagnosed with cancer. I know that your frustration with "minor complaints" is really a larger frustration at having too many patients and not enough staff. I know you wish you had the resources to give everyone your fullest attention.

But think about it: wouldn't you give anything to be able to tell your cancer patient, "It's nothing, really. You just need a bandaid and some aspirin. You can get dressed now and go home."

Change of Shift. Carnival of Hope. Spa Day.

AC has posted a terrific edition of Change of Shift, the biweekly nursing blog carnival, over at Protect the Airway. My three favorite posts are Marcia's story about leaving a haunted workplace, Blue's beautiful tribute to the many people who took care of her during a long hospitalization, and Marisapan's heartbreaking farewell to a prison patient. But there are many other wonderful posts, too. Head on over for a look! (And AC, thanks for including me!)

Speaking of blog carnivals, today at 5:00 is the deadline for this month's Carnival of Hope. Send me your stories of light in the darkness!

I'm feeling a little lighter myself today, after being completely decadent yesterday. I got up very very very early for my 8:00 appointment with my primary-care doc . . . but at 7:30, just as I was about to leave the house, the phone rang. PCD was ill, so I've rescheduled for January 2. So I sat and chilled out at home until it was time to go to my therapy appointment, where Beloved Therapist once again urged me to see an actual shrink to discuss meds adjustments. BT thinks some sort of multi-drug cocktail is in order. This idea horrifies me, but BT says it shouldn't. I told her I'll think about it if my mood doesn't improve (as it usually does) in January.

In the meantime, we talked about the whole depression-as-invisible-illness problem, and she showed me a fascinating book by a doctor named Daniel Amen, who's used brain-imaging studies to show that conditions often considered purely psychological are physical as well. Among other things, depressed brains don't look like normal brains. Intellectually, I knew that, but it's nice to have pretty pictures to back it up. Amen's website makes me a little nervous, though, because it's so clearly commercial; I know the guy has to make a living, but his site still pushes my pseudoscience buttons. Sure enough, it looks like people who know more than I do agree with me about that. I still like the brain pictures, though.

BT gave me many pats on the back for being so good about exercise; I've been worse this week, but she still says that I'm one of her only patients who makes exercise a priority. So after our appointment, I hied myself to the health club, where I'd been planning to go anyway. When I walked in, I saw a list of available massage appointments, and grabbed one.

I wound up staying at the club for four and a half hours. I soaked in the whirlpool, sat in the steam room, swam for forty-five minutes, baked myself in the sauna, showered, and then had an hour-long massage. Aaaaaaah! Spa day! Bliss!

My massage therapist is applying to nursing school, and told me that the first massage therapists were nurses, because massage is so effective for pain relief. I hadn't known that, but it made sense.

After Spa Day, Gary and I went out for pizza (cheeseless, in my case) with friends. Then we came home and watched an episode of Rome. It was a very nice day.

Today's to-do list: Grading. Shopping. Picking up Gary's relined jacket from the fancy-fur place. Working on Carnival of Hope.

Change of Shift. Pats on Back.

The latest Change of Shift is up over at Fat Doctor. Thanks for including me!

In writing news, I'm almost done with the Fate of Mice galleys (and a good thing, too, since they're due tomorrow). I also have to respond to a long marketing survey by tomorrow. This is stuff I thought I'd get done over Thanksgiving, but didn't.

I've canceled my classes today to give myself more time; I always build a little slack into the course schedule in case I'm felled by the flu -- which I haven't been this year, hurray! -- so we can still get everything done. And I don't think my students are heartbroken.

My mood's been unaccountably low since Sunday; maybe that's just a delayed reaction to last week's stress, but whatever it is, it's both unpleasant and annoying. After four days of feeling like I've been hit by a truck, I need to remind myself that I've also gotten some very nice compliments this week. So, at the risk of sounding like I'm bragging, I'm going to list them.

* Karen Joy Fowler wrote a lovely blurb for The Fate of Mice; this will join similarly lovely blurbs from Pat Murphy, Jo Walton, and Sheila Williams.

* My friend Inez passed along some kind words from her brother-in-law, who taught my story "Gestella" in one of his classes and said it generated quite a bit of student discussion. (Given the polarized response that story has gotten from some readers, I can just imagine!)

* I received unexpected e-mail from the rector of a local church, who not only enjoyed The Necessary Beggar, but used it as a sermon illustration last Sunday.

Also, rereading The Fate of Mice has been a good experience. It's always nice to look back at one's own work and decide that it doesn't suck.

And on that note, back to the galleys!

Change of Shift, and Other Medical Adventures

The latest Change of Shift, the nursing blog carnival, is up over at Life in the NHS.

And in other medical news, I'm horribly behind in every aspect of my life (except, of course, blogging, although even there I haven't responded to some recent comments), and yesterday I had a pretty disheartening conversation with my therapist, who's making noises about either upping my antidepressants or adding another med. At this point, I'm well past procrastination and into the realm of psychomotor retardation, that fun depression symptom where everything takes three times longer than it should because you feel as if each limb is weighted with several dozen pounds of lead. Also, thinking is harder than usual. Since I more or less think for a living, that's particularly annoying and inconvenient. This is rarely a good time of year -- it's grading-crunch time for academics -- but this year, it's much worse than usual.

The problem with depression, though, is that you can't see it on an X-ray or in a blood test. Rationally, I know that this is a realio-trulio chronic medical condition, and that -- as with any chronic medical condition -- I can expect flare-ups. But there's still part of me that suspects that the real problem is that I'm lazy and inefficient. If I were only more ________, I wouldn't be having these problems. Mental-health Mad Libs! Such fun! Fill in the blank with the adjective of your choice!

However, I don't want to up my meds dosage (I've already had a little tachycardia on the current dose, and I'm not eager for more of that), and I'm also loathe to add another drug. So I promised my therapist I'd try a bunch of other things, and see a psychiatrist for a meds evaluation if the other things don't work.

Number one on the list of other things is light therapy. Fall's usually my favorite season, but this year I've noticed myself hating the shorter days, which suggests SAD. So last night, Gary ordered a light box from Amazon. If anybody out there has experience with these gizmos, please let me know.

I was extremely grateful that my therapist didn't tell me to stop blogging. She said, "No, I think that's good for you. You enjoy it. It's a form of self-care." Gary agrees.

And now I really must go try to get some grading done. I was doing pretty well last night, but then the phone started ringing with calls from people I hadn't heard from in a while. Conversation with friends: self-care, or procrastination?

Carnivals. Call for Submissions. Sidebar.

DisappearingJohn has done a splendid job with the latest Change of Shift, the twice-monthly nursing carnival.

Carnival hosts vie with each other to see who can come up with the cleverest "frame narrative," the text presenting the links to the carnival posts. If the host hasn't had a jolt of inspiration, sometimes the carnival is just a laundry list of links. If the frame is too High Concept, though, readers may not have any clue what the posts being linked to are actually about. Sometimes the presentation makes it harder to appreciate the carnival, instead of easier; a good host uses the frame to draw attention to the posts, not to him- or herself. (There are distinct parallels to writing fiction, but I'll spare you!)

I really admire John's frame, designed as a tour of the hospital. It's interesting and lively in itself, but also deftly guides readers to links while giving them just enough information about each post to pique interest. It entertains without showing off, and showcases the links beautifully. Bravo, John!

And on the topic of carnivals, remember that the deadline for Carnival of Hope, with a special Thanksgiving theme of gratitude, is one week from today at 5:00 PM PST. Here's my earlier call for submissions, with full guidelines and instructions.

You have a week. The weekend's coming up. Why not sit down and write a post about something for which you're grateful? It doesn't have to be long.

And, finally, regular readers may notice that I've slightly reorganized my sidebar; I haven't removed any links, but I've relabeled and redistributed them. A few of my favorite bloggers have announced that they're going on hiatus, so I may delete those links eventually. On the other hand, I may just keep them there so readers can browse those archives.

Licensed and Ticketed

Before I forget, Kim's posted the new Change of Shift. I'm honored to be included, and look forward to having time to read the other posts.

Yesterday's snail mail brought my official diocesan preaching license, good for three years and signed by none other than the Rt. Rev. Katharine Jefferts Schori, who I believe will only be here in Nevada for another two weeks or so. I took my preaching exam, a take-home essay test, in June, so I'm very happy to have the piece of paper saying I'm fully legal. My mother had a funny comment: "You mean you've been preaching all this time without a license?" But it's okay, because I had the equivalent of a learner's permit; I was supervised by a mentor who read all my homilies before I gave them. Now I can fly solo.

And, just to prove that we should never take our licenses for granted, or abuse them, I got my second-ever traffic ticket yesterday.

For speeding.

In a school zone.

Bad Susan!

There were no kids out at the time -- which is part of why I zoned out even with the little yellow flashing lights -- so the very nice cop who pulled me over just wrote me up for speeding without the school-zone part. I like cops, who have a difficult job for which they're often underappreciated. Anyone who teaches can relate. I always thank police officers, even or especially when they're ticketing me. (I once heard a cop explain that the two most dangerous parts of their job are domestic-violence calls and traffic tickets: they never know what the driver will do when they walk up to the car.) I was careful to thank this cop after he'd given me the ticket, so he wouldn't think I was trying to brown-nose my way out of the ticket. I think he thought so anyway. Oh well.

It will, of course, be paid immediately, just like the first one was; I deserved both of them, and life's too short to spend in traffic court. Guilty as charged, officer!

The irony is that I was speeding to try to get to a doctor's appointment on time, and then of course I was late because I got stopped. I told the story to the doctor's office staff, concluding, "This just proves that crime doesn't pay," and everyone laughed. Then they told me their speeding-ticket stories to make me feel better.

Gary cracked up when he found out about it. We routinely see people going, like, ninety on local roads (although rarely in school zones): I was doing twenty-five.

Hey, over the limit is over the limit.

Carnivals and Silver Pens!

The latest Change of Shift is up over at Emergiblog. There's a lot of great stuff in this issue (and I'm not just saying that because Kim included three of my posts . . . eeep!). Among many other things, this edition will make you rethink some of what you thought you knew about nationalized health care, and will also give you insights into some, ah, interesting ways to pay for nursing school.

And while we're on the subject of carnivals, please don't forget that the deadline for the October 13 Carnival of Hope is next Thursday, October 12, at 5 PM Pacific Time. Please e-mail your submission directly to me, SusanPal (at) aol (dot) com, including "Carnival of Hope" in the subject line. Your own brief description of the post would be very helpful. I'm particularly interested in posts about how to maintain hope in grim political times, since some of what's happening right now is very frightening indeed. The ACLU called last night, and although I ordinarily have no patience with telemarketers, I both listened to the spiel and gave them twice my normal pledge amount afterwards. (A lot of people I know are linking to this right now, and Will Shetterly has posted this unsettling little report. There's lots more, but I'm sure you can find it on your own.)

On a much happier note, the Silver Pen ceremony on Tuesday was much more fun than I expected. It was in a lovely setting -- the swank golf club has huge windows looking out on the mountains -- and there was excellent food: sushi, sandwiches, shrimp cocktail, little curried-chicken treats. Two female friends who were there made a point of lavishly praising my outfit (bless them!), and many people have said that I did a good job with my reading, although I was much happier listening to Ellen Hopkins, who also won a Silver Pen, and to Ann Ronald, who was inducted into the Nevada Writers Hall of Fame. Some church friends and a number of university colleagues were there, and that did a lot to raise my comfort level.

I'd been planning to wear flat shoes, but discovered a problem with a loose sole right before we left, so I wore heels for the first time in years. I managed to stay upright the entire time, but the experience definitely reminded me why I've been avoiding heels all this time.

So I'm now the proud owner of a sterling silver Cross pen with my name engraved on it, and also of a Certificate of Commendation from Senator Harry Reid. What a hoot!

We had pictures taken afterwards -- both serious shots and goofy ones where the three of us mugged for the camera -- and the photographer's supposed to e-mail those to me, but hasn't yet. I'll probably post at least one when I get them, if they're halfway decent.