Mostly True Stories

Stand up and be counted!

2012-02-16T09:35:00.000-05:00

Just the Worst Doula in the World

2009-05-23T04:17:00.003-04:00

I heard this story from a doc...not sure when or where it happened.

The patient, who also happens to be an unwed mother, needs a blood transfusion because she has been bleeding. A lot. However, she belongs to a religion which forbids blood transfusions. At this point it is not yet an emergent situation but it could totally go that way. The doc is explaining the possible outcomes of different choices that the patient could make and the patient is explaining back to the doctor that, because of her beliefs, she doesn't want a transfusion.

Everything is very civilized.

And then the patient's sister, who is sitting in the corner of the room, pipes in:

You're already going to hell, you fucking whore...go ahead and get the blood so you can live to raise your own baby.

Not an ideal support person to have in the room, really.

Head? Vagina?

2008-12-29T08:43:00.003-05:00

I worked December 23rd, 24th, and 25th. We had all planned a party on the 23rd -- which included awesome items like my salsa and P's fried chicken. However, when we got to work on the 23rd, we saw that someone had put up a sign informing us that our actual party was going to be on the 25th. Now, most of us were working these same three nights in a row. And we had kind of shot our catering wad by preparing whatever it was we brought for the 23rd. And, here in the shallow south? Lots of places where you could buy food are actually closed on Christmas morning. So, right off the bat? No one was expecting a whole lot from the 25th party. We ended up with homemade salsa and chips, taco soup (the kind where you throw a bunch of different cans of stuff together with some browned meat and it tastes surprisingly good) and various Chinese food entrees ordered from a place that, amazingly, was willing to deliver on Christmas night. At about one in the morning, after a fairly uneventful first half of the shift, we sat around and ate these items with a relative lack of holiday cheer -- and serious misgivings about how much gas we might be having later in the shift.

Then we get the call from admissions:

There's a lady up here who feels a head coming out.

Shit.

S and I grab a stretcher, gloves, precip basin and start for the front.

We should really run, we say to each other as we continue to walk fast.

My foot hurts, S tells me.

My taco soup and Mongolian beef are churning, I tell her back.

We start a modest jog.

Have I mentioned that it has been really slow ALL night? I have? Then imagine our surprise when we burst into a lobby FULL of people at 2 in the morning. None of whom, by the way, appear to be anywhere near pushing a head out. So S and I are running around the lobby with a stretcher asking people:

Head?

Head?

Do you feel a head?

Is there a head coming out of your vagina?

Head?

NO TAKERS!

Finally, we find this teenager around the corner talking on her damned cell phone. Are you the one who feels a head coming out. we ask her? She puts up her hand in the universal signal for, don't interrupt me I'm on the phone...

That's the one, we hear D from admissions say.

Rule #1: If you can still talk on the phone, delivery is probably not imminent.

Unusual Bleeding

2008-12-23T00:50:00.003-05:00

The other morning I was admitting a patient fairly close to shift change -- about 0600. She was scheduled for a c/section in about 2 or 3 days, but her water had broken during the night, so she came in and we started getting her ready to have a c/section that morning. Several of us were coming at her from different directions trying to get her admitted, hydrated, labs drawn, ted hose on, preop antibiotics given, shaved - you get the picture. We were trying to get her in the OR before shift change so that we wouldn't end up having to delay a scheduled case. I was asking her questions and putting her baby on the monitor when I notice bright red blood on her abdomen. Not a lot, but enough to make me curious, plus it was all over my hands. Are you bleeding? I said, maybe a little bit sharply. A little, she told me, it started when my water broke. Hmm, probably that isn't where this is coming from, I thought. I excuse myself to wash my hands...which is when I noticed the huge gash in my left thumb. The cheap ass belts that hold our monitors in place sometimes have sharp edges...

The Hazards of Cleaning

2008-12-20T16:34:00.002-05:00

I just cleaned out my jewelry box...and underneath all the tangled beads I found the saddest pair of old lady items ever...what ever possessed me to stash these two things there, I'll never know. A tube of Monistat external vulvar cream...and a tiny tube of Fix-o-dent...

Really?

2008-12-11T08:19:00.003-05:00

Sometimes, in the middle of the night we get strange phone calls from people who want medical advice. My stock answer is, "call your doctor." If they tell me they don't have one, I tell them to get one. If they tell me about symptoms that sound scary, I tell them to come in and have us check them out. But, usually? These phone calls are weird. Here's the one I got tonight.

Yeah, hello? Can you answer some questions for me?

We'll see, I said.

Ok. My brother's girlfriend? She, like, had a miscarriage yesterday? And, now, she's like telling him that she can't have sex today. But she can, right? It's not like she had a baby or nothing.

Absolutely not, I said. If she has any questions about this she should call her doctor. But no sex.

But, like, she's not bleeding or anything.

One of These Things is Not Like the Others: Your Armpit, Your Urethra and Your Vagina

2008-11-13T11:50:00.006-05:00

I've learned so much from this blog. Mainly that people are using the internet to educate themselves on topics about which they never would have asked their local librarian. (How was that for some stilted sentence construction?)

After I posted about learning to put in a foley catheter...I received numerous hits from people googling urethral play. (I've said it once, but it bears repeating - your urethra is not a toy.) After I posted a doctor friend's story about a patient's worry that her partner impregnated her through her armpit, hundreds of people reached this blog after googling armpit sex. I had no idea so many people were either interested in, or already utilizing, the armpit. I bet there are different tastes in armpit sex, too. Some of y'all like it scratchy, right? Actually, I don't really want to know.

Lately, it seems like a lot of people are coming to this site after googling types of vaginas. Or all the different types of vaginas. Or pictures of types of vaginas. And I have to admit that this worries me a little bit. While urethral play and armpit sex are most likely being googled by people looking for a wee bit of scintillation, it could very well be young girls thinking that their lady parts are all funky googling the types of vaginas. Or am I being too naive? Are any young girls really as isolated as I was in the 70s? Is it possible to make it to middle school now without a peer administered sex education program?

Well, if you're worried that your own vagina might not be the right type, stop. Your vagina is FINE! If you're really worried, talk to your GYN. If you came here wanting some scintillation, I don't have any pictures.

I Got Bossified...or Bossed...!

2008-11-10T15:35:00.002-05:00

Is it a little bit sad that I am really, really excited by this?

Stuff You Shouldn't do at the Hilton

2008-11-10T14:39:00.002-05:00

So all that stuff in the picture in my last post? That was stuff that I bought at a 2 story CVS in Chicago with my pants stuffed full of toilet paper after I had awakened to discover that my period had started (with gusto) 4 days early -- and all over the formerly blindingly while 400 thread count sheets.

Nice.

I've had patients that hemorrhaged after delivery who didn't make as big a mess as I did. When I got back to the room, it had already been cleaned...but the mattress pad (from the king-sized bed) was piled in the hall...I suppose they were trying to locate a special biohazard suit so that someone could safely carry it down to the laundry. At least the Chicago PD wasn't there investigating.

The morning that we left I also made the toilet overflow.

So it seems that I now have two ways to make your period start:

1. Wear pretty new underwear -- preferably in a light color
2. Stay overnight in a hotel that you couldn't really afford without the dual miracles of Hotwire and a bad economy.

The Stuff I Bought on my Vacation

2008-11-05T16:51:00.001-05:00

The Power of the Pussy Revisited

2008-10-30T11:59:00.002-04:00

It just seemed, what with everything going on in the national arena this month, that this would be a good time to repost The Power of the Pussy.

Kenny and I were watching The Daily Show last night and somebody got called a pussy during one of those fake "on location" segments. I can't remember just now who did the calling and who was the actual pussy, but I do know that when used as an insult, pussy = weak. HAH. When someone gets called a prick or a dick, it signifies mean, rude, cruel, right? Not strong, necessarily, but certainly not weak.

If you've ever been present during a vaginal birth, you know that whatever else might be true of the pussy, it ain't weak. It's strong, flexible, resilient. It takes care of business, but it also knows how to have a good time. Who started this strange bit of slang usage that equates the birth canal with frailty? (I'm guessing it was someone without a pussy.) As I'm writing this, I can predict my friend P squirming with discomfort. She doesn't care for the word pussy. She won't use it and she shudders when she hears it. (You know it's true, P!)

But as strange as it is that "pussy" is a slang synonym for weakness, isn't it strange that "cunt" (when used as an insult) has an altogether different meaning? While weak men get called pussies, strong women get called cunts. (I just went to look up cunt in my 1978 edition, 2-volume, compact OED (Oxford English Dictionary) because I was having a fantasy that cunt was an old english word: Ye Olde Cunte, or something, first used in 1439: Elinor was a compleat cunt... It isn't in there. Wait! Ok I'm back. I just looked up the OED online. You have to have a paid subscription to look up words. They do have a word-of-the-day feed, but, guess what? Today's word isn't cunt. Surprise, surprise. As I write this, I can sense the future squirmings of my friend J, who hates the word "cunt" every bit as much as P hates the word "pussy."

A discussion of vaginal euphemistic slang insults just wouldn't be complete without mentioning the twat. While pussy signifies weakness, and cunt indicates a sort of cruel strength, a twat is just plain dumb. As far as I know, none of my friends has any particular problem with the word "twat." You just don't really hear a lot of twat these days. The poet Robert Browning mistakenly thought it was some part of a nun's clothing and included the word in one of his poems:
Then owls and bats
Cowls and twats
Monks and nuns in a cloister's moods
Adjourn to the oak-stump pantry
I wonder what exactly he thought a twat was? And what were they doing, the twats and the bats in the oak-stump pantry? It sounds dirty, no matter what he thought twat meant.

A few months after I started working in labor and delivery, Kenny and I went to a party where one of the guests was my undergraduate advisor (for the degree that I got before I went to nursing school.) I can't tell you how much I respect this man and always want to impress him. He very courteously asked me about my newish job and I, having had a beverage or two, went into perhaps more detail than I should. The entire time I was talking, he had a polite, attentive look on his face. After the conversation was over, Kenny whispered in my ear, I hope you realize that you just said vagina to Dr R three times.

Pussy pisses off P. Cunt angers J. I embarrass myself with vagina and nobody uses twat! What a world. If anybody is reading, what are your reactions to these words? Comment! Please!

I voted early and got harassed at the polls!

2008-10-29T19:10:00.003-04:00

First of all, let me tell you: I am a middle aged white woman. This may come as a shock to some of my coworkers, but I am a registered democrat and a rabid Obama supporter. Which is just to say, that I think the harassment was just for the sheer pleasure of it and not racially or politically motivated.

I live in one of the states that requires photo ID in order to vote. My state excepts 6 forms of ID: Driver's license (expired is ok), passport, government employee ID, tribal ID, voter ID. Now, a couple of weeks ago I went out of town (via plane) to help out a family member in need. I go by my middle name. My plane reservations accidently got made in my middle name. My Driver's licence only has my first name and my middle name, while my passport has all my names completely spelled out. So, I made sure I had my passport to use as ID for that flight. So, today, when I went to vote, I still had my passport in my purse -- because that's just the kind of disorganized person I am. So, when the idiot poll worker asked for my ID, I whipped out my passport (because it didn't have to be pried out of the little plasticene pocket in my wallet.
The bitch said I had to have a DL!

Are you refusing to accept my passport? I asked.

No, ma'am, but if you want to vote today, I need to see your driver's license.

But state law says that my passport is an acceptable form of ID. I replied.

I have to verify your address, please show my your driver's license.

I am a registered voter in this county. My address is on file. I have voted in the last 4 elections here. I said sweetly.

The poll worker sitting next to her leaned over at this point and told her that I was right, a passport was an approved form of ID.

Well, everybody else has to show a driver's license but I guess you [sic} just special.

I voted, came home and sent an email to my state secretary of state. I actually got an apology via email within 45 minutes from my county election director.

What if I were a person who was not aware of my rights? Who had never voted before?

The Toe

2008-10-26T15:16:00.002-04:00

Several weeks ago I was helping transfer a newly postpartum patient from L&D to the High Risk Pregnancy Unit. Despite it's name, The HRPU takes care of antepartum and complicated postpartum patients. They also accept "overflow" low risk postpartum patients when our regular postpartum unit fills up -- which happens at least once a week. They generally only have 1-3 nurses on HRPU, most of whom are former L&D nurses.

So, anyway, I was precepting a nurse resident who was literally in one of the last two days of her orientation, so she wasn't really needing a lot from me. We took the patient to the room assigned. There were no nurses at the nurses' station -- not unusual when you only have 2 nurses total. We go to the room, transfer the patient to the bed, orient her, get all of her stuff put away....still no nurse. (We have to do face to face report in the room -- so we're sort of trapped.) I walk out to the nurses station and find one of the nurses freaking out on the phone to a doctor about an antepartum patient's toe. Hmmm. Frankly, my interest was peaked. We don't get a lot of toe stories -- especially not stat toes.

Another nurse walks up and they both tell me that as they were helping the patient to the shower this morning, a bandaid fell of of her right big toe revealing what they thought to be some previously undiagnosed gangrene. Just then the doctor walks up, and I just decide that I'm following the three of them into the room. I haven't seen a good case of gangrene since 1980 when I was on the "Bed and Bath" team at my then local hospital. I have to admit, though, that I'm already feeling suspicious. How could a Bandaid cover the stench of gangrene? Gangrene smells like, "whoa, who's got a week old dead dog in their pocket?"

So we all walk in the room and there sits the toe. Discolored, infected, swollen, pus covered, and definitely smelling strongly of dirty foot. But definitely still living tissue.

The doctor, who I happen to know is having a really shitty, emergency ridden day, stands and looks at the toe.

If this were on your vagina, I would know exactly what to do, she says, but frankly, I am uncertain how to proceed.

Maybe you should call the hospitalist, volunteers one of the nurses.

LOL. The hospitalist. Sort of like calling a code for toothache. I can't even describe the look given to this nurse by the doctor.

Finally, the doc looks back at the toe and tells the patient. I'm tempted to ignore it, because that seems to be what you've been doing.

Would you care for the intervention? Or the Quinoa?

2008-10-24T11:18:00.003-04:00

Every once in a while, we will have a patient come in who is from another, poorer, country, has had limited or no prenatal care for the week or two or three that she has been in the states, and has NO family with her. I used to just sort of wonder and shake my head until I read this article. Wow. Now I admire the courage and sacrifice it must have cost for them to get here.

Recently, I was at a party -- the annual Religious Studies student/faculty/staff pot luck for my husband's department, actually --try not to be jealous. Anyway, I was hanging around working up the courage to sample some of the motley dishes made by 19 yr old neophyte vegans and texting my work buddies who were out drinking and bowling and singing karaoke...sigh....when I was cornered in the dining room by one of the vegans.

Aren't you a nurse?

Yes.

I was in nursing school. I was going to be a midwife, but then some stuff happened and I ended up going for a masters in religious studies.

I see, I said. I actually have quite a lot of sympathy for this kind of plan change as I was going for a masters in religious studies and ended up as an L&D nurse.

I work in L&D, I told her -- then instantly regretted it.

Because then? She started in on this long angry story about her friend and massage client who had a really bad birth experience and it was mainly because the nurses and midwife wouldn't let her just do her birth plan. This particular vegan had gone along to the hospital to be a support person.

At first I tried to be supportive and understanding with a touch of let's talk about something else. I'm so sorry your friend had a bad experience, have you tried the quinoa casserole?

This did not work on vegan girl. She went on to describe her friend's situation:

The friend had spontaneous rupture of membranes for 18 hours before coming to the hospital. She came because she felt she was developing a fever (she was). She felt the hospital staff had no respect for her timetable and just wanted to get the baby born for their own convenience, so they gave her pitocin -- a medicine she had, in no uncertain terms, proscribed in her birth plan. And they gave her antibiotics, another medicine she had said she didn't want. To top it all off, the midwife actually tried to cut the cord herself and the patient TOLD HER HUSBAND TO PHYSICALLY STOP HER AND HE DID! He grabbed the midwife's gloved hand. Then, my vegan buddy told me, the baby nurses punished the patient by taking a really long time with the baby at the baby warmer. And then? The bitches took the baby away to the NICU.

Everytime vegangirl would tell me something new, I would nod, say something sympathetic and then say that I probably would have done the same thing as the nurses.

Start pitocin and antibiotics? Yep. She has an infection! She isn't even in labor yet! Vegan girl explains to me that antibiotics are much worse than any infection.

Cut the cord and immediately hand over the baby to a team of nurses for assessment? Yep. Vegan girl tells me that babies are fine as long as they are still attached to the placenta. Oh...

Assess the baby of a febrile mom with prolonged rupture of membranes at the warmer (where suction and oxygen are in easy reach) instead of on mom's belly? Yep. Vegan girl explained to me that birth was a natural experience and that women have been doing it without the help of doctors since the beginning.

What I want you to know is that I am as crunchy a granola girl as there ever was. I grow all my own vegetables in my backyard. I used to be a vegan, but now the meat I eat is raised by farmers that I know in a nearby county. I believe in natural childbirth. I believe in taking care of yourself and limiting the medications you take. I am certified to teach yoga. I wear Birkenstock nursing shoes!!!! But I also believe in intervening medically in certain birth situations.

There is a communication break down between these two groups: the "going naturals" and the medical professionals. The "going naturals" often don't seem to me to have done their homework. They don't understand why certain interventions might be recommended -- and what might happen if they refuse them. And they almost always seem to see the medical professionals as the enemy.

When your water has been broken for eighteen hours, you have a fever, and you are not contracting or dilating, you probably need some freakin' pitocin.

When your water has not broken, you are contracting every 4-7 minutes and your cervix is changing, pitocin is probably not necessary.

Somebody ought to teach a class specifically designed for these types of patients so that they can really make educated decisions about when to refuse interventions and when to consent. And to be fair, there are a lot of medical professionals that simply discount any point of view but their own.

As always, this is a rant and should not be taken as medical advice.

Excuses and Advice

2008-10-23T11:23:00.003-04:00

This is my first post in several months. I really have no excuse...The dog licked my keyboard, my internet access was limited, I was stuck in traffic for 5 months...Does it help that I've still been reading your blogs religiously? Oh well.

We've had some crazy times at work that have inspired the following little list of advice nuggets for potential patients and their families:

1) If you have asthma and use your emergency inhaler 3-4 times a day, go ahead and bring it with you to the hospital when you're in labor. In the middle of the night, we have instant access only to the meds we frequently use. It will take us a while to get you another inhaler -- or we'll have to call respiratory to come see you. And while you wait, I know you're jonesing for that hit of albuterol.

2) If you don't have any prenatal care, go ahead and tell us this up front. There are some providers that will hold up elective procedures (like epidurals) until they track down your imaginary records. Please don't tell us that you have care with someone that you've never met, because then we call the other hospital and they stop taking care of their patients so that they can look through their files for your pretend records. And just out of curiosity, how is it that after we look for (and fail to find) records for Ann Marie Tottlemeier, you suddenly remember that, on occasion, you like to be called Laverne Garcia?

3) If your family member loses so much blood that they rush her out of the room to the OR, or call a code, or both...please wait until we have her stabilized to ask when her room will be cleaned. The room just isn't a big priority for us -- and it sort of makes you look heartless.

4) If you are an insulin dependent diabetic with a bad memory, carry something with you that explains your insulin regimen.

5) If you come to the hospital in an ambulance, please understand that, eventually, you will be going home. You aren't going to be staying with us forever. So if you don't have or know anyone who has a car, could you at least bring your Medicaid card with you? It just makes it easier to arrange that transport home.

2008-05-18T20:14:00.001-04:00

more cat pictures

Flush it!

2008-05-15T06:48:00.003-04:00

I was helping S admit a patient. The patient's cousin was in the room.

When was the last time you had a bowel movement? I asked the patient.

This morning, she had one this morning, the cousin responded.

Wow, your cousin sure knows a lot about you, I said.

Well, the cousin told me, she forgot to flush it.

Cheezburger Break

2008-05-06T21:18:00.001-04:00

more cat pictures

Cuernavaca Journal: Day 3

2008-04-23T22:25:00.003-04:00

When we get to breakfast this morning, Neil is already at the table. I haven't had a chance to speak to him very much at school, but he is in all of Kenny's classes.

We all greet each other with various levels of Spanish and Kenny and I begin to eat our fruit. Steaming Christmas mugs full of coffee show up in front of each of us. Merry Christmas! Neil tells everyone in Spanish, toasting in our general direction with a Frosty-the-Snowman mug. Chelo laughs and walks back to the kitchen.

Oh Senora.....Neil calls out. I have been wanting the milk, please. Some of Neil's sentence constructions remind me of David Sedaris essays -- especially the one where he goes to the doctor in Paris. I immediately capitalize on Neil's request and pour some milk into my coffee. Chelo goes back into the kitchen.

Oh....SenOOOOra....Neil calls out. I am breakfasting on how many eggs today?

Two, everybody gets two. Would you care for more? Chelo asks him.

No, thank you, this is just fine, but my wife will be wanting to know when I get home.

Over the next few days, Neil will turn out to be a near constant source of comic relief. But both Kenny and I are uncomfortable with the way he treats our hostess. He has been staying with the family exactly one day longer than we have. Listen, he tells us on the way to school, I paved the way for you people. Before I asked, there wasn't even any 1978 margarine for the dry toast!

In class, I start to realize that I am watching the clock. How ridiculous am I? I chose this vacation. I am paying for it. I am HAPPY to be improving my Spanish. Yet, apparently, my amazing capacity for dread trumps all of this. I spend a moment secretly evaluating my classmates. Are they looking forward to the break? To the comida? To after school shopping, touring and beer? I go back to my work and try to be in the moment...and in Spanish. In the Spanish moment. Every once in a while, the merriment from Kenny and Neil's class will interrupt ours. Their teacher, Marilu -- who also teaches one of my classes, has a very charming way of saying super...or super duper. Soooopair doooopair, she says. Also, apparently, Kenny has accidently told the class that he and I ate each other for breakfast instead of we ate breakfast together.

Today, back at Chelo's house, there is a big party. Because it's Wednesday. Every Wednesday, everybody related to Chelo in Cuernavaca eats comida at her house. This explains the 3 dining tables and two kitchens. Chicken mole will be served. I tell Chelo again that Kenny is allergic to nuts -- she tells me that she will have something else available for Kenny. Nuts are not a traditional ingredient in this particular mole recipe (many mole recipes do call for nuts) but she buys the paste already made -- so she can't be 100% sure about a total absence of nuts. The mole is wonderful -- served with crusty bread, iceberg lettuce, beans and salsa as always. Kenny gets a delicious looking chicken milanesa. Our classmate, Chislan, is there because he is staying in the home of Chelo's daughter. Chislan and I talk some in Spanish while Cesar, Chelo's son, corrects us. It turns out he used to teach at a different school -- like 30 yrs ago. That is how he met his American wife -- who teaches at a local Catholic school. Chelo has told me that she had all of her children (either 4, 6 or 7 of them -- I didn't understand the story completely) in this house with no more anesthetic than a cup of chamomile tea. But, in order to do this, you will need very strong tea, she tells me.

After comida, we hop a taxi to Las Mananitas -- an unbelievably expensive and beautiful hotel and restaurant. We just plan to have drinks in the garden. The garden is patrolled by a variety of peacocks and other tropical birds. It is really a beautiful place. I have a Negra Modelo with lime and snack on the complimentary tray of spicy peanuts, pepitas and potato chips with sour cream dip while Kenny has a $12 flan with a double expresso. The waiters are gracious and act as if we are very important even though we are in our sweaty school clothes and obviously not eating dinner. Mexican people, in general, are just very courteous. They are polite to each other and they (for the most part) treat visitors to their country with painstaking hospitality.

After our treats, we walk a couple of blocks, then take a taxi back to our neighborhood. While we are downtown -- in el centro -- we see the Palace of Cortez, which is now a museum, but we don't go in -- it's too late. Back in our own neighborhood, we walk by the taco family. Tacos? They ask us. Tomorrow we tell them. Tomorrow.

It is now day three for both of us without a bowel movement.

Cuernavaca: Day 2

2008-04-22T22:33:00.003-04:00

Nobody in Cuernavaca has a front yard that you can see. Houses are built, in some form of fashion, all the way out to the sidewalk. Last night, as we were walking back to Chelo's house after our beers, we walked by an open garage. A huge grill had been pulled out to the sidewalk. Several youngish Mexicans are gathered around the grill and busy in the garage. Beef is being grilled, tortillas are being heated, smells (oh, the most wonderful smells) are being created. Tacos? They ask us. No, we say. Another time. We are scheduled to have cena (the light evening meal) with Chelo in a few minutes.

We arrive back at the house, let ourselves in through the gate, and go up to our room. We had opened the windows in the room to let some air in and now we are being punished for it. Although the evening air is somewhat cool outside, the room is a virtual oven, or at least a virtual bun warmer. We each take cold showers, change our clothes and go downstairs

Chelo is making quesadillas with flour tortillas and cheese from Oaxaca (sorry, Suebob). Everyone always eats corn tortillas in this part of Mexico. I had told Chelo at comida that I was from Texas and that my family always ate flour tortillas -- as the people of northern Mexico also do. (I love corn tortillas, don't get me wrong -- but flour tortillas are the tortillas of my heart.) We tell her that we don't need her to walk us to school in the morning because we have passed by it during our evening walk (I attended the same school several years ago.) The quesadillas are delicious and I am touched by Chelo's gesture of getting some flour tortillas to make me feel at home.

Upstairs, the room is still hot enough to warm buns. Kenny and I take two more cold showers. We strip down to virtually nothing and lie in the dark each of us on our own bed. I have wet wash cloths strategically placed. The fans are on high. I take half an ambien and a benadryl and pass out almost immediately to the sound of a ceiling fan in need of repair. Cuernavaca is known in Mexico as the city of eternal spring -- and when I visited in the past (in December and January) it was very springlike. Now, with global warming, I think it may have graduated to the city of eternal summer.

The air in the morning is crisp and cool - springlike, indeed. As we walk into the main house for breakfast, a wall of hot air hits us. Breakfast is a plate of cut up watermelon (the fruit in Mexico is a miracle of ripeness and freshness and taste -- and worth the risk of diarrhea), toast and a tub of margarine that looks as though it could have been purchased in 1978, and a plate of scrambled eggs (tomatillo salsa on the side). We eat and head off to school for our placement tests. The school is in what was once a house. It is a lovely property. Kenny and I are each handed placement tests. Kenny, smiling, writes his name on the top and then hands it back, confident in his total lack of Spanish knowledge. I struggle with mine. Subjunctive? Conditional? At one point or another in my life, I have mastered (on paper) every Spanish tense, every mood. Unfortunately, lack of use has driven all of that information from my mind. Now, at work, I rely on simple present and simple past to communicate with my patients. The test frustrates and embarrasses me. After the test, we each have a brief interview. During the interview, it comes to me (in that weird, free association way that realizations are made at inappropriate times) that I had told Chelo that Kenny was allergic to bones (I was trying to tell her that he is allergic to nuts.)

Kenny and I are assigned to our respective classes: Kenny to the beginner class and I to some kind of intermediate one. There are three other people in my class and one of them has the same name as me! We trudge through some grammar (the conditional tense) and make up sentences to say to each other using our new conjugation. My teacher looks a little like Jennifer Lopez. I love the slow clear way she speaks Spanish. Each word is distinct. Over the next five days of class, I will appreciate her amazing teaching skills more and more. I will also start to feel guilty that I am benefiting from these skills -- she wouldn't be able to support herself if she taught Mexican children.

The other students I meet:

Sandy and Maureen. Two well-off white women in their 50s from the midwest. They are having a daring adventure.

Neil. He is staying in our house. He is a travel writer and is actually on assignment.

Mark. Heavily tattooed, mid twenties, from the deep South. Came to Cuernavaca 4 months ago unable to say hello in Spanish. He is leaving in a few days. His grammar is atrocious, but he has a fluidity to his Spanish speech that I envy. He tells me that he dreams and thinks in Spanish now. He seems like his heart is breaking at leaving Mexico.

Anna. A recent law school graduate from the mountain time zone. Is thinking about taking a job in personal injury law in the South.

Chislan. A French Canadian guidance counselor -- he is very fit, in his fifties, and talks about Jack Kerouac at every opportunity. It will take me three days to realize that the reason that he is so hard for me to understand in Spanish is that his first language is French.

By lunch time, Kenny is in a foul mood. He is unused to being a novice in a field of study. The day has been an exercise in frustration for him. He is the least experienced Spanish student in the school. We go home to have a comida of cecina with our family (I'm still not really sure what cecina is -- a sort of wet, cooked beef jerky -- better than it sounds) Then Kenny and I head for the air conditioned mall on the other side of town. We watch August Rush (in English) and then go to Sanborne's for beers and coffees. On the way home, we get caught in a delicious rain storm. The taco family offers us shelter and tacos, but we're full and delighting in getting wet.

When we get back to the room, we find that it is much cooler at night if you close the room up tight during the hot part of the day. We have done this. After cool showers, we head to bed.

Neither one of us has had a bowel movement in Mexico yet.

Cuernavaca Journal: Day I

2008-04-21T23:02:00.003-04:00

Kenny and I got up at about 0430 this morning in order to make a 0930 flight to Mexico City. For the first time EVER, since I started buying discounted plane tickets online, I didn't get flagged for special screening in security. What a luxury.

We are going to Cuernavaca, Morelos, Mexico to study Spanish at a little school called Chac-Mool -- for about a week. We will be staying with a host family in the same neighborhood. Despite the fact that I have taken 7 years of junior high, high school and college Spanish, I am far, far from fluent. However, I can say things like: Please bring me a beer with some lime or I am going to start your IV now. Kenny's mastery of the language is limited to: Hello and I'm sorry. We come armed with dictionaries, verb books, phrase books, and two types of antibiotics.

Our flight lands and then proceeds to sit out on the tarmac for about 20 minutes. ??? Apparently, our plane is too big to negotiate the runway we are on and nobody noticed this until just now. Finally, we get tugged to the gate. Immigration and customs are surprisingly quick and suddenly we are looking for our driver, Vicente, who will take us to our host family's house in Cuernavaca, which is about an hour's drive from Mexico City. We buy some bottled water in the airport and go to the car. I make a tiny bit of conversation with Vicente. Kenny tells him hello and that he's sorry. I sit in the car, letting the wind whip my hair around my face (something that I would never allow in the states) and think about how funny it is that Kenny, who is the real talker in our family unit -- and usually our main emissary of good will to the outside world, speaks no Spanish, while I, the mostly silent one, can actually navigate the language. We are in for an interesting week.

We arrive at the house just in time for la comida, the afternoon meal. The day is sunny and breezy and warm -- I anticipate a house of open windows, ceiling fans. Unfortunately, the house is shut up tight, the fans are all off, and the kitchen is right next to where we will be eating -- so that our dining area has been, in effect, pre-heated. At the table sits an American man eating. We say hola, go to our rooms to put our bags down, but by the time we return, he is gone. We eat a meal of chicken in guajillo chile sauce, iceberg lettuce, pinto beans, tomatillo salsa, and corn tortillas. Our hostess, a grandmotherly woman named Chelo, tells us that she disinfects the lettuce for her American guests. (This is really nice -- because the main way that American's contract Montezuma's revenge is through water contamination -- which means that any raw veggies washed in plain tap water are suspect and to be avoided.) The meal is homey and exotic and delicious all at once. Chelo is the Mexican version of Kenny's grandmother. The dishes and flatware are all mismatched -- there is nothing that appears to have been purchased before about 1978. However, Chelo appears to have a full-time housekeeper and gardener. Although the meal is delicious, I am actively sweating as I eat. (Over the course of the next 8 days I will become familiar with the strange sensation of simultaneously dreading and looking forward to a meal -- the food was always delicious, but the heat in the room was always unbearable.) This is a cultural difference that we become more and more familiar with as the week progresses. Whenever Kenny and I are comfortable (while wearing sleeveless shirts and shorts) the Mexicans will be wearing long pants, long sleeves, sweaters, and once, a long leather coat.

After the meal and much awkward Spanish-only conversation, Kenny and I retire to our room. We walk out of the kitchen, through a little courtyard/utility area and up a narrow flight of stairs which is made narrower by the placement of at least two potted plants on every single step. Upstairs, our room is plain but serviceable. We have two fans, two beds, a desk, a dresser, and a bathroom with a shower. I will come to love this shower over the next eight days. It has a large tiled bench -- a feature that I wish I had in my shower at home. (Makes for easier leg shaving for those of us over 40).

Once Kenny unpacks and I promise him that I will unpack tomorrow (I never did), we go out for a walk around the neighborhood. We stop at a little taqueria on the corner, La Puerta de Oro del Bahio, for beers. The last time I was in Cuernavaca, Rosario, the proprietess of La Puerta told me (I think) about a door in the upstairs room of her house that leads to another dimension. The walls are covered with pictures of UFOs that have been sighted around Mexico City and Tepotzlan. Every available inch of floor space is home to a potted plant, or old bleach bottle full of scummy water and a vine of some kind. I have a couple of Negra Modelos a la cubana -- with lime and salt. These cost me about $1.25 each. I realize, as I am draining the dregs of my first one, that it has been poured over ice -- which is the way "a la Cubana" is usually served. I have been on the ground in Cuernavaca for less than an hour and I have already broken the "no ice in Mexico" rule. Oops.

Baby in the Bed

2008-04-20T20:17:00.003-04:00

So, I kind of knew that the day was going to suck when I got my assignment in report. My patient was 42, pregnant with her first baby, and had brain damage and chronic pain from a car accident she had been in as a teenager. She had basically never been to see a doctor from the time she was released from the hospital in 1979 until she got pregnant. To control her pain? She had been smoking pot daily. To her credit, she freely volunteered this information to her OB and to the nurse who admitted her. She was being induced for IUGR (Intrauterine growth retardation -- there is actually a more PC term for it now than retardation, but I've had a couple of beers and I can't at the moment recall it). Just after I got report, the MD called (did I mention that he's kind of a dweeb?) and ordered a bunch of blood tests and a UDS (Urine drug screen). I have to admit that I don't really get this. Why order a test to confirm what a patient has already told you? But, whatever.

So, I'm in the room. I have a student following me. It is her first day EVER on L&D. I've already got the urine, and I've just stuck a butterfly in this poor woman's AC. I'm drawing like 4 tubes --butterflies are kind of slow, so we're chatting -- which is kind of hard -- because my patient has a speech impediment and a total lack of teeth in addition to the brain damage. Anyway, I'm filling up that first tube and I hear screaming from the room next door.

Oh, sounds like someone is having a baby, I say, when I see that my patient is reacting rather negatively to the screaming. The screaming continues. I start to realize that something is, just, well, wrong with the screaming. First of all, I only hear only one voice. Usually, when someone is screaming a baby out, they have a nurse and a doctor or a midwife -- and everybody is being loud. Push, you might hear. Or, Don't push. Then I realize that what I'm hearing is Ayudame, Ayudame. Which is Help me in Spanish. So I finish up the blood draw and tell my student and patient that I'm just going to stick my head in next door to see if they need anything. My student very sweetly offers to go check on the patient next door. Nah, I say. I'll do it. Did I mention that we were in kind of an out-of-the-way corner of the unit? So I open the door, and I see a sweet-faced hispanic woman sitting up in the bed holding a baby between her legs.

Oops.

I hope she doesn't get a bill.

So, we got that handled and, then, later, my patient's UDS comes back. NEGATIVE FOR CANNABIS!!

How shady is it to sell fake pot to somebody with brain damage? That ain't right.

Tomorrow, Kenny and I are leaving for Cuernavaca, Mexico for 8 days. We will be studying the Spanish and drinking the beer.

I've Got a Call on Line 2

2008-04-17T20:38:00.003-04:00

We have a bathroom in our nurses' lounge. On my first day of work, I got oriented to the bathroom by one of the other nurses:

No pooping in there.

We eat all our meals about 3 feet from that toilet, so it just makes good sense. But where can we poop? Most of us work twelve hour shifts. We poop at work. It's just biology, dude. People poop - even nurses. Well, there is a toilet in the recovery room, and one in the preop area. These are both good choices as long as there aren't any patients in recovery or preop. There is also a bathroom in the sterile supply room. The sterile supply room potty is my favorite. It's pretty private and you have access to a sink -- in case of, well, extra messiness. However, recently, one of our nurses decided that we shouldn't be pooping in their because, get this, poop stench contaminates sterile supplies. Well, maybe it does -- but, if so, maybe they shouldn't have put a toilet in there.

I don't know if it's anxiety or just my schedule, but I almost always have to poop right after I get report (I call it "getting a call on line 2.") So, the other morning, I'm taking my call in the sterile supply potty. Right on the other side of the wall is the preop area -- and I can hear the nurse who has banned pooping in sterile supply admitting a c-section patient right on the other side of the wall! It was sort of inhibiting, but I worked through it eventually.

Congratulations! It's a Mucus Plug!

2008-04-15T20:39:00.004-04:00

When I have a patient in labor, I have to make sure that I chart pretty much every single little thing that happens. But, especially, I have to chart certain milestones. Like...your due date...the first day of your last menstrual period...when your labor started....when your water broke, when your cervix in dilated to 10 cm. When the baby is born...when the placenta is delivered. But, you know what IS NOT A MILESTONE? When you lost your mucus plug. I don't really care. Your doctor doesn't care. Your midwife doesn't care. If you call your midwife at 3 am to tell her that your mucus plug is currently exiting your vagina? and she tells you to put it in a baggie and take in to the office the next day to show the other midwife? She's probably really mad at that midwife (or has a really sick sense of humor -- K, you know I'm talking to you -- and it was just WRONG!)

Actual Overheard Conversation

2008-03-04T13:24:00.003-05:00

I walked into the tail-end of a conversation this morning at the nurses' station. I don't have any idea how it started. It was between one male doctor and about 4 female nurses.

Doctor: I'd really rather have one experienced woman than 70 virgins.

Nurse1: Not interested in the virgins, huh?

Doctor: Well, it's not that I'm against virgins, it's just that they'd all probably be 15, 16 or 17 -- you know how crazy girls are at that age.

Nurse2: Yeah, they'd probably be texting you all the time.

Nurse3: Do you think I'm pretty?

Nurse4: I'm outside your house right now.

Nurse2: I'm thinking about you, are you thinking about me?

Nurse1: Who was that girl you were with last night?

Nurse4: Do you think I'm fat?

I can kind of see his point.