A brief RP update...

Quotes from RP are scarce, as we seem to be usually too far into the game to remember to write them down.

• Quinby: Joseph is also wearing - Me: - a yellow raincoat and red galoshes. Angel: And a strapon. Phloxin: Named Paddington.
• Me: Jen looks at her: "Want to go to the bar?" Lily: "Do I look old enough to go?" Me: Jen shrugs. "Since when is that a problem?" Lily: Damn that Curiosity flaw.
• Me: Liz Isbister. Phloxin: And I'm Brandy Shaggywagons...
• GM: Okay, so you all pile into the car, and go to Columbia Street West. Me: Sorry if we just hijacked your plot...
• Phloxin: So he's got a long nose and a platypus ass. Quinby: Oooh, that sounds kind of hot.
• Me: You look some kinda gangsta Jew.
• Phloxin, talking about Jesus turning water into wine: It tells us Jesus was a lush.
• James (in an outraged voice) Quit it! I'm trying to have a conversation and he's boinging my penis!
• Lily, looking at Phloxin who is wearing a neck pillow on his neck: Now you look like a gangster Jew who was in a car accident...
• Phloxin: I'm getting fondled....hehehe. And it's not by my roommate...hehehe....
• Quinby: I have Investigation... GM: Now where did the clitoris go?
• GM: Because satyrs are little balls of hormones. Me: Or in this case, little vaginas of hormones.
• Quinby: What's that dude's name? Me: The dude? Quinby: The dude! Me: Oh, the dude! GM: What dude? Phloxin: The one with the face.
• Lily: And this one time...at storyteller camp...

Went to a party given by Jen's grandmother, which turned out to be a chance for all the Fae she knew to regain Glamour. And a chance for most of the cabal to get laid. The ramifications of this are far-reaching. See , , and for details. And while I'm thinking about it, does anyone else want a LJ code for a character place to write? I have lots. :) The most interesting thing is the amount of e-mail being exchanged between various party members via the forums. What fun.

Headings and footings:

The last few patients from inpatient peds, most of whom weren't actually my patients. The little girl - three and a half years old, this one, nearly four, and sharp as an everloving tack. She came into the ER with - as BM reported it later - a chief complaint of headache, vomiting, and fever. These, O Best Beloved, are warning signs of meningitis. Especially when we've seen so many kids on the floor with meningitis already. But she had a past history of kidney infections, and the ER people got some CVA tenderness (pound over the kidneys and see if it hurts), and the urinalysis showed a little bit of whites and bacteria, so they admitted her to us with a diagnosis of pyelonephritis. In the middle of the night, BM admitted her and took the history again. And he was struck by the way her mother described her presentation, especially the bit about how her head hurt so bad. From any other little girl of 3 1/2 years old, we might have brushed it off, but this girl is bright - extremely so, and disturbingly coherent. He was struck enough that the next morning we decided to do an LP (a spinal tap) on her to look for meningitis. In infants, you do an LP by getting someone to pin the baby down in an arched-back position, and really don't use much in the way of anaesthetic. In adults, you numb them up good and get their cooperation. From kids D's age, you do conscious sedation. We gave her Versed and morphine. A lot of Versed and morphine. Enough to knock most kids out completely. It still took three of us to hold her down and both residents to do the tap. This kid is an absolute tiger. And even as drugged as she was, she was still conscious enough to ask "why are you doing this to me?" and to listen as I tried to explain it. Didn't matter, she didn't want us to hurt her. I went to see her after the results of the LP were back in - 150 white cells, a clear-cut case of meningitis - and she remembered me. And she listened when I said I wasn't going to hurt her, I just wanted to talk to her and poke and prod a bit. She told us the history of her headaches, and she told us about how bending her neck had hurt in the ER but it didn't now, and she was patient and offered to wake her mom up if we wanted. This is one of the smartest 3 1/2 year old kids I've ever seen. She'll be fine, the LP was entirely a viral meningitis - but it was still an interesting sort of case. We can't figure out how the ER staff got pyelo. But as long as she's in the hospital we're going to work up those two old kidney infections. Any kid who gets a urinary tract infection before the age of 4 should have at least a renal ultrasound. Had an 8-month-old baby with a spiral fracture of the femur. Even walking children have a hard time getting those. That makes two 310's filed in a month. I didn't see him, but I hear his family threw a shit-fit when they found out he was going to foster care. Apparently his auntie was throwing herself across the bed, sobbing about how he should be going home with her, and an uncle was cussing up a storm, and his mother was miffed that she couldn't meet the foster parents. Then there were the twin baby girls. The UVC was afraid they had GBS bacteremia and wanted them admitted, but didn't think they needed an LP (part of the sepsis workup). JL felt they looked like they had a viral illness, sounded like they had a viral illness, and had a history consistent with it. "Why," she asks at morning rounds, "do we have these kids in?" We decided to keep them for another day, since we had pending blood cultures. The adorable little boy baby with asthma, whose grandmother had put braids in his hair. Nobody warned the resident, who called him 'she' and offended Grandma. Whoops. And the kid with viral meningitis who, despite me caring for him for two days, never said a word. He was cooperative and nodded or shook his head, but silent. His parents say he takes a while to warm up to people. JK on the phone to the ER: "Seizing?" Pause. "Sodium of what?" Pause. "Feeding him free water?" Pause. "They're pushing what?" Pause. "I'll be right down there." Baby with a sodium of 119, too low, and having seizures because of it. Apparently, it's a case of WIC syndrome. WIC syndrome, O Best Beloved, is what happens with dirt-poor mothers on the WIC (Women, Infants, and Children) program when they run out of foodstamps or formula coupons. In the interim before they can get more, they attempt to stretch the formula by watering it down progressively more and more. Never mind that the calories and electrolytes are so vital... So baby's mother has been feeding him tap water for a few days. That's all the intake he's gotten. No wonder he's swimming. And the ER doesn't know how to handle a hyponatremic infant. That was interesting. One look at the "possible intubation" on his notes means that he went to R for monitoring. We don't take intubated kids. We aren't an ICU floor. Final reviews by JK and Dr. M: nothing but complimentary. Dr. M: You'll make a good doctor. I'm confident of that. JK: I've had a lot of medical students under me. You're one of the best I've ever seen at your level. If I can only keep going, motivate myself to work all the way through, I have hope. And today - after RP and playing Cranium until late into the night, I went forth to get new tires for Michel-Ange and to pick up our copy of Gokudo. We bought the box set of Boogiepop Phantom on the recommendation of someone who compared it favourably to Lain and Perfect Blue. And this time we opened Gokudo at the counter. The reason they ordered it in was that the copy we purchased was missing a DVD. Well, missing all six DVD's. The box was completely empty. "If you were anyone else," he says as we bring the box in and show him the empty case, "I'd say 'Yeah, right'...but you're regulars." This seems to be a common theme at Suncoast. As he was ringing up all $75 in gift certificates, and having to do it by hand because the scanner didn't work, and then having to redo it because he did it wrong, the kid next to him says "Be glad they're regulars." It was a riot. Went to the chinese food place in the mall. The girl who's always there when we come through stopped. "You cut your hair!" I laughed and nodded. "It looks very cute!" I was a little startled; we don't eat there that often... KS, the resident I worked with on the UVC rotation, noticed too. People know me and recognise me. That always startles me. Called Dad to chat on Thursday or Friday. "I just got done the other night reading most of your Livejournal". I never expected he'd get around to it. Dad's so busy, and it's hard for him to read things - he reads slowly, and usually gets his literature in audio form. So maybe he's still around, reading. In which case, hello :) And that's enough spam for now, O Best Beloved. I'll try to update more frequently and at less length in the future.

Friday. Gloooorious Friday.

A brief noontime update: Studied my everloving tushy off, and was rewarded with an exam that was nothing like what I'd expected. My head is so full, my mind so drained right now, that I don't even remember parts of it. But it's over, and the passing score is only 65%, which I was doing above during my practise studying last night. I hope. I hope I hope I hope. Now it's on to a mentoring meeting at 12:30, with a free box lunch to follow the free lasagna lunch I had too much of after the exam. And then home, to Angel. To sleep. To enjoy my weekend before the prospect of Peds Surgery (yes, O Best Beloved, the next six weeks will consist of rounding at 4 AM, spending the day being pimped as surgeons cut and stitch and repair children, and coming home no later than 5, only to begin all over again the next day) looms too far over my head. Can I survive Peds Surg on 6 hours of sleep a night? We'll see. To note for later: I didn't think she looked like pyelo. What do you mean my child's going to foster care? Tell me why we admitted these twins again? No, that's a little boy baby. Watch out for the braids. His parents say he takes a while to warm up to strangers. And the things that Dr. M and JK said to me in final evaluations. Playing Jeopardy and eating pizza. I want you to become a pediatrician. But for now, the lounge is busy. The computers are in demand. Until then.

What I learned last night...

It is not only amazingly arousing, but intensely fulfilling to know that your husband is willing to drive two and a half hours under the excuse of bringing you a forgotten article of clothing - because he can't be satisfied with masturbating; he has to get you off to be fulfilled. Didn't hurt that he stayed the night, too. *beams*

Today's random memes....

The Ultimate LiveJournal Obsession Test
Category	Your Score	Average LJer
Community Attachment	46.24% There's a party in your comments page, and everyone's invited!	28.83%
MemeSheepage	57.89% I am but one quiz among millions. My brethren surround me on the page.	31.26%
Original Content	53.23% Using LiveJournal to express a few strong opinions	43.66%
Psychodrama Quotient	10.84% Had a comment taken out of context once or twice	17.17%
Attention Whoring	31.82% This quiz is part of a grand scheme to keep people reading	23.73%
Your LiveJournal Obsession Number is: 21211 Click it to see other users who had similar scores to yours!
Take The Ultimate LiveJournal Obsession Test and see how you match up!

I'm considering. My memesheep quotient seems too high, and my original content too low. What do you think, O Best Beloved? Typingtest.com and the others all seem to agree that my typing speed is around 70 WPM, with between 50 and 90% accuracy - I think they use different measures. I like typingtest.com better, as it seems a more consistent measure. Content - actual content - after I get through a few more chapters of review text. I'm going to fail...

A Personality Test, and a moment of introspection.

ENFP - "Journalist". Uncanny sense of the motivations of others. Life is an exciting drama. 5% of the total population.

Take Free Myers-Briggs Personality Test

Now, what it doesn't say is that I'm not an ENFP. I'm a 50/50 split ENFP/INFP, and that makes a lot of sense. Score breakdown as follows: Extroverted (E) 50% Introverted (I) 50% Intuitive (N) 55.17% Sensing (S) 44.83% Feeling (F) 51.72% Thinking (T) 48.28% Perceiving (P) 60.53% Judging (J) 39.47% ENFP as found on keirsey.com is here. And there's a great deal of truth in it, in the drive to be authentic, to relate the stories I've seen, to need to experience everything for myself. And the feeling that part of me is uninvolved, lost to touch. It is worth noting that the iNFp personality type is called "the healer" on Kiersey.com and is also disturbingly accurate in many senses. It puts me in the auspicious company of Albert Schweitzer and Anne Lindbergh. I had a happy childhood. My parents never discouraged my fantasy life. That did not serve to stem the sense that there is something evil or profane within me, nor the need as an adolescent to make atonement for the smallest of perceived sins. Sometime I'll tell you about that, O Best Beloved, and I'll finally tell Mom the truth about a few things. Sometime. But for now, O Best Beloved, confession and repentance are on hold - it's midnight, and time for kittens to go to bed. Extra bonus points for anyone who can tell me the origin of the O Best Beloved construct. Extra extra bonus points if you can tell me where "Nenni" comes from, and why I chose it as a screen name so long ago. This is a test for the people who know a lot about me. The rest of you are welcome to guess. I have read 9 chapters of 20 in my review book. Tomorrow I will finish reading chapters, and then have two days to learn things. Goodnight, to all of you.

A Personality Test, and a moment of introspection.

ENFP - "Journalist". Uncanny sense of the motivations of others. Life is an exciting drama. 5% of the total population.

Take Free Myers-Briggs Personality Test

Now, what it doesn't say is that I'm not an ENFP. I'm a 50/50 split ENFP/INFP, and that makes a lot of sense. Score breakdown as follows: Extroverted (E) 50% Introverted (I) 50% Intuitive (N) 55.17% Sensing (S) 44.83% Feeling (F) 51.72% Thinking (T) 48.28% Perceiving (P) 60.53% Judging (J) 39.47% ENFP as found on keirsey.com is here. And there's a great deal of truth in it, in the drive to be authentic, to relate the stories I've seen, to need to experience everything for myself. And the feeling that part of me is uninvolved, lost to touch. It is worth noting that the iNFp personality type is called "the healer" on Kiersey.com and is also disturbingly accurate in many senses. It puts me in the auspicious company of Albert Schweitzer and Anne Lindbergh. I had a happy childhood. My parents never discouraged my fantasy life. That did not serve to stem the sense that there is something evil or profane within me, nor the need as an adolescent to make atonement for the smallest of perceived sins. Sometime I'll tell you about that, O Best Beloved, and I'll finally tell Mom the truth about a few things. Sometime. But for now, O Best Beloved, confession and repentance are on hold - it's midnight, and time for kittens to go to bed. Extra bonus points for anyone who can tell me the origin of the O Best Beloved construct. Extra extra bonus points if you can tell me where "Nenni" comes from, and why I chose it as a screen name so long ago. This is a test for the people who know a lot about me. The rest of you are welcome to guess. I have read 9 chapters of 20 in my review book. Tomorrow I will finish reading chapters, and then have two days to learn things. Goodnight, to all of you.

"Okay, Nykki, quit showing up my interns..."

Taking a break from studying, briefly. I need a little break. What am I doing here at home instead of at the hospital on evening call like I said I was going to take? Well, around about 14:45 this afternoon, JK looks at me and says "Take the nurses their charts back and go home." Me: But I was going to take evening call tonight, since I need two more, and I don't want to do it Thursday or back to back. JK: When's your exam? Friday. JK: It's possible that kids will come in. But you'd be better served by studying. Unless you really want to stay... I felt bad, and I kind of hedged, and I said "if something interesting comes in, page me, I'll be happy to come in..." And he laughed. "I know you will be." And I know I won't be paged. And I hope he remembered to tell RR that he sent me home. And so I am studying, and I'm feeling guilty about being here instead of at the hospital, and I feel like I'm shirking my job. Even though all I've heard is that I'm motivated and studious and an all-around good student. , kick me. Got my evaluations back for Family Medicine and ER. Pass in FM, High Pass in ER. A note on the FM sheet that I tend to appear disinterested and distracted in small groups, and should work on that. I could've told you that. Presented this morning without being prepped by JK, due to time constraints. Attempted to keep everything in mind that he'd told me. Was complimented both by him and by Dr. M on a presentation well-done. Gearing up for surgery. I did not leave Taika at home like I feared; she was packed under the PSX in my backpack. She is now charging, as I let her run almost all the way down. Saw a few patients, wrote discharge summaries, hassled Dr. M for my paperwork (I'm almost a week overdue on my midsession evaluations, and the office is getting antsy), and ate lunch in a hurry. Beginning to get nervous twisties in my stomach regarding Surgery. Have had many compliments on my hair, including from some faculty/HO's that I didn't even know remembered me from my brief stint in the UVC. I'm starting to like it, although it's still kind of a shocker. Gave a possible aetiology in my differential diagnosis of the little girl with probable viral meningitis that showed up Dr. M. I was proud. "I hadn't thought of subarachnoid haemorrhage, but you're right...acute headache and vomiting, plus lethargy...it could be a haemorrhage." Fortunately her LP has "Viral Meningitis" written all over it. RR laughed - I've been volunteering bits of information about his patients recently that took him by surprise. When I can't talk to the parents, I consult the charts. That's how I knew the kid with the asthma had been seen as an outpatient just a month ago for pneumonia. "Now you see how I feel, Dr. M." H, the boy with the spiral fracture, went home to foster care on Friday night. He's in the hands of CPS now. The girl who took Tylenol is home as well, with a psych referral. Today's Social Work consult was the mother of one of Dr. M's usual patients - a woman who he says has always seemed "put together and on top of things." It turns out that she has a protective restraining order against the children's father because he was abusing her. Did I forget to ask? Dr. M says. I must not have asked her if she felt safe at home...because she seemed so in control... A lesson to all of you, O Best Beloved. Always ask. Safe home plans for the kids are in place, and little PG went home this afternoon. And now I think I'm going to make some couscous and try to make it through 150 pages of book tonight. I'm halfway there.

On a far less serious note...

A couple of things... This got left off the quotes because it took too much work. The party is standing around a preppy outdoor mall on the west side of Fort Wayne, in the middle of the night, having just been told by the vampires they were pursuing that Jen and Liz's roommates were in the women's dressing room of Old Navy. Jen is a Virtual Adept trained by an Ecstatic, demeanour Deviant. She shops at Hot Topic, Nirvana, and the Hallowe'en special limited time store. Currently walking around looking like a vampire princess, complete with tiara and faux bite marks. Liz, a Hermetic with a shy streak, has a credit card from The Limited. Joseph, a devout Catholic who happens to be a Celestial Chorister with an appearance of 2, shops at J. Crew, Old Navy, and the like. Fashion is not on their list of things they have a consensus about. Jen: Old Navy? She looks shocked and appalled. They're in Old Navy? Liz: Come on, it's right this way. Jen: I'm not going in Old Navy...I'll catch something awful. Joseph: What? I was just there the other day. Jen (wailing): Yes, and look at you! It was finally resolved that Jen would stay outside and hack the alarm system while Joseph and Jax rescued the girls. So she was spared this time. In other news, the icon on the previous post will need to be changed, as I have now removed a large portion of my hair. Fifteen inches of it, to be precise. The new 'do is shorter than it's been since about seventh grade, and I'm still getting used to it. See here. Angel says it makes me look younger, and cuter. I'm a little disturbed.

On a far less serious note...

A couple of things... This got left off the quotes because it took too much work. The party is standing around a preppy outdoor mall on the west side of Fort Wayne, in the middle of the night, having just been told by the vampires they were pursuing that Jen and Liz's roommates were in the women's dressing room of Old Navy. Jen is a Virtual Adept trained by an Ecstatic, demeanour Deviant. She shops at Hot Topic, Nirvana, and the Hallowe'en special limited time store. Currently walking around looking like a vampire princess, complete with tiara and faux bite marks. Liz, a Hermetic with a shy streak, has a credit card from The Limited. Joseph, a devout Catholic who happens to be a Celestial Chorister with an appearance of 2, shops at J. Crew, Old Navy, and the like. Fashion is not on their list of things they have a consensus about. Jen: Old Navy? She looks shocked and appalled. They're in Old Navy? Liz: Come on, it's right this way. Jen: I'm not going in Old Navy...I'll catch something awful. Joseph: What? I was just there the other day. Jen (wailing): Yes, and look at you! It was finally resolved that Jen would stay outside and hack the alarm system while Joseph and Jax rescued the girls. So she was spared this time. In other news, the icon on the previous post will need to be changed, as I have now removed a large portion of my hair. Fifteen inches of it, to be precise. The new 'do is shorter than it's been since about seventh grade, and I'm still getting used to it. See here. Angel says it makes me look younger, and cuter. I'm a little disturbed.

And what's been going on the last few days....

They gave me strange duties on Friday, which leads me to my first case - H, who is seven months old. He was brought into the emergency room by his mother, whose story is that she found him in his crib, having caught his hand in the bars and rolled over it, twisting his arm. That's the story. On examination, the baby was found to have a spiral fracture of the humerus. This, O Best Beloved, is a fracture caused indeed by a twisting injury - but normally requires significant force. It's enough to warrant a skeletal survey, where one pins the baby down and takes X-rays of absolutely everything. What those X-rays revealed was frightening. The baby has old healed rib fractures and a thickening of the bone cortex in his tibia suggestive of an old healed fracture. A broken leg in a baby who's not old enough even to crawl... They filed a 310 with CPS, a report that basically indicates that we fear a child is in jeopardy. They sent him to get a head CT to look for damage to the brain. That came back looking good, preliminarily. And so the baby was admitted to our ward, and the mother was told that we were going to have to check him out head to toe because of some old fractures we'd seen. I spent Friday afternoon with mom and baby at the opthalmology clinic, waiting for a chance to look for retinal haemorrhages (another sign of shaken baby syndrome). And she was talking, and I conversed with her, knowing all the time that she didn't yet know why we were looking this baby over. It was hard, O Best Beloved, trying not to let her know anything she didn't already know. And when we got back, she talked to Child Welfare and JK and Social Work, and when they told her what was going on you could hear her scream and cry down the hall. Our guess...our impression, at least, was that she didn't do it...but she knew what was going on. And that's the part that really got me. It's one thing to abuse a child - for there to be something going on in your mind that causes you to hurt them...it's another to stand by and know that something's going on, and to let your baby be hurt. That was one. I'm not involved with his case; for legal reasons, they don't want my name on the paperwork - they don't want me to have to go to court if it comes to that - but I did act as a nurse and take him to the opthalmology clinic. And second is C, who's thirteen. She came in on Thursday afternoon with a toxic acetaminophen level. Apparently, she had a fight with her best friend, and also found out that the guy she's been seeing for two weeks - the one who told her he was 16 - is 21. And her mother said if he came around again she'd call the police. So she decided she'd kill herself. And when she woke up in the morning, she still was determined. So she stole some money out of her mom's purse, walked down to the corner store, bought a bottle of Tylenol and took 24 extra-strength tablets. And went to school. It wasn't until she started getting sick and was taken to the nurse that she finally admitted she'd taken them. After a brief evaluation by the psych unit, it was determined that she wasn't an immediate suicide risk - that she was safe to come up to our floor. And so there we have her, a 13-year-old girl on a 44 hour N-acetylcysteine drip to keep her from developing acute liver failure in the next few days, who was just here in February for the same thing. And this is when you wonder why. Because she's tried it twice, and she uses steak knives to gash at her wrists, and she made a plan, she didn't just do it on impulse. So when RR sent her mom out of the room and went through all the questions you ask anyone over the age of 10 during a history, it was heartrending and yet not surprising to hear her tell him that her uncle and her grandfather had touched her in some unwelcome way when she was six and eleven... She stays with us until her liver is out of danger. Then she goes to psychiatry...and I hope and pray that someone there will help her turn things around. I had a few other patients - asthma, croup, overnight observation and home in the morning - but those two left the impression on me. And such an impression. So much hurt, O Best Beloved, so much pain and cruelty and aberrance in this world. And all I can do is move one step at a time, one patient at a time, what little healing I can do. And then, O Best Beloved, the good. I hand out little surveys to the parents of my patients, because I'm a student. They fill them out, put them in sealed envelopes, and return them to the Paediatrics department. Only Mrs. M didn't. She gave it to the nurse to give to me. And it was all full of "strongly agree" and "agree", and at the bottom where you're supposed to write comments was the following [sic]:

She very nice. You couldn't even tell she was a student she sounded like she knew what she was talkin about like she has been on the job for years.

That, if nothing else, raised my spirits. And the other good thing was a stupid little thing - I got paged out of noon conference to take H over to the opthalmologist's. Paged out. I was vital to the functioning of the ward, even if it was a stupid little thing. Those are the brow-raisers, ...

Quotes, Friday 19 September 2003.

• Me: Nothing quite like a vampire with backwash.
• Me: I have a crack-monkey. I feed it-- Angel: --Tass. Me: Yeah, it smokes tass. Lily: No! No undead crack-monkies!
• GM: I had a train of thought...
• Lily: What's crawling in your air vents? Me: Undead crack-monkey! Everyone gets quiet, stares at the vent.
• Phloxin: I've gone to school for five years in the middle of nowhere just so there won't be any weirdness. I left my country because it was too fucking weird. This is your mess, you clean it up.
• Me: Dear God: Will you tell me where the vampires are going, please? Oh, and P.S. I want a pony. Love, Joe.
• James: Newish socks? Phloxin: Jewish socks? Me: Oh, look! Yarmulkes for your feet!
• James: They're going to Wal-Mart. Me: Because it's open 24 hours, and nobody would notice a fucking vampire in Wal-Mart. Angel: I think if it were fucking, they'd notice.
• Quinby: There are a lot of times that people do things that aren't necessarily correct. James: Like the amount of time you spend on your knees...
• Quinby: Dear God: What the hell is going on? Me: Love, Joe.
• Quinby: An intelligence of 1 and an Arete of 5... Me: Ug hunt... Angel: What? Me: Ug hunt. Angel: Oh, I heard 'a cunt'.... Phloxin: Squishy squishness....squishy squishness....
• Quinby: Mmmm, your bra stops bullets. Me: It's a Wonderbra!

Before I go to bed...

Just for : The little boy with the croup and the psycho dad from hell, JG, was discharged on Friday evening. When we sent him home, he was breathing well, no noises or stridor at all, playful and happy. No reason to keep him here, not enough grounds to file a 310 without causing a lot of hassle, and he seemed fine... At 4:00 on Saturday morning, Dr. M got a call from JK, the resident who was on that night. "Dr. M? This is JK. I've got a little boy here in the ER named JG with stridor..." Dr. M.: "And I said 'Is this a joke?' And I was waiting to hear 'Yes,' or 'He's been intubated', but JK just said very calmly, 'No, it's not a joke.'" And so JG came back in with his mom, spent the night, and went home on steroids. We told you he was sick. I would update, but I can't remember what I've talked about, O Best Beloved. And it's getting very late very fast. So notes for later: Came in yesterday and got assigned to a new asthma patient on the wards. Spent almost 40 minutes getting her incredibly complicated social history. Then forgot to get vitals before presenting. "You turned a home run into a double. Sad..." My decision to order a second EEG on the ALTE kid was justified when it turned up left temporal spikes and slowing. Booyah! Got scolded by JK for not telling him I was going to meet Angel for dinner, as he would have let me off hours earlier. Met Angel for dinner. Had a wonderful time. Finished my expanded H&P, will post most likely for peer review later. Stayed up far too late for that. Admitted children tonight after thinking I would get to go home early for lack of anything to do. Got home at 11:20 or so, despite promises from peds inpatient orientation that "evening call is no later than 10, and you'll get home earlier most nights." Am going to sleep 5 hours tonight, maybe 6, after having gotten 4 the night before, and 5 the night before that. Call it residency training. Medical Students: (will post to med_school community too) I am working with the student newspaper, and we think it would be fun to do an article or several about how other med schools do things. Anyone want to be a correspondant for me? :) No call and no papers tomorrow night, I think I may sleep then, so as to be alert and enthusiastic for this weekend. I must study (I hope Blueprints comes in) as the exam is on next Friday. I can't believe this rotation is almost over. I'm terrified of Surgery. If I'd forgotten vitals in Surgery, I would've become the whipping post for everyone... There's a lot more I wanted to say something about, like how the moon as I drove home was the clean-edged half-circle of a scalpel blade, poised luminous above the earth. About the transformation at birth from quiet, goo-covered infant to screaming ball of arms and legs. About looking up things with JL and the ER doctor with the blonde hair that I felt some strange draw to, briefly. About kids and monitors and croup and asthma and the mom who just never bothers to bring her baby in any more, until the 6-month checkup when the doctor called for an ambulance to admit. About AT, the sixteen-year-old who is bright and beautiful and going to wind up dead, burnt out, or pregnant. Horror. But it's late, I'm tired, and I have to be back on the floors at 7 AM. Radiology rounds at 7:30, for our morning report. Dr. M. thinks I'm doing well, that I need to get a little more experience with organisation, but I'm well-read (since when?) and inspiring and energetic. You want to hear inspiring and energetic? I haven't had time for a shower since Saturday evening. Saturday evening. I don't care that I'll be sacrificing sleep; I need one. If I could've gotten my ass out of bed yesterday, I would've taken one then. This morning was a write-off; I'm lucky I got to school. I'm also blessed by a tiny miracle that involved me deciding to throw the trash away in my car. And I looked at the sign next to the trash can and thought "That's funny. Why is there a key tied to the sign?" And then, my fatigue-befuddled brain said to me, "You know, that looks a lot like the yellow wrist bungee that was on the key to S's place that you lost at home somewhere. You don't suppose..." I did suppose, and I pulled out my new-minted spare key, and compared. It was. I guess I must've lost it in the parking lot. Falling asleep at the keyboard. Rambling. Good night, O Best Beloved.

Happy biiiiirthday, dear Aaaangel!

Happy Birthday,

Angel turns 24 today. I have no presents for him. I don't know what to get him, because the present I really want to get him is too expensive - and I have to choose between paying the mortgage and buying him a flat-panel monitor. Mortgage first. So I'm going to meet him for dinner, around six in Muncie, and hopefully if I get out on time that leaves me a little time to go look for something. So send me e-mails, O Best Beloved. Give me ideas on what to buy for a boy whose ThinkGeek list link I seem to have lost again :(. Update on JG and the Psycho Father of Doom tonight if I have time. Right now, me, my headache that's almost completely gone after one Zomig, and my presentation on the Limping Child are going to go to the hospital and learn how to care for newborn babies.

Addendum....

I love hearing his voice at night, even if he can't be with me. I love the sound of it, the way his timbre is different when speaking to me than when speaking to anyone else. It leaves me feeling safe and heart-mended in the hours of sleep. At least I have that.

Day by day.

A quiet day on the wards. Not much to tell. But I had my midpoint evaluation with JK today (Dr. M tomorrow) and he was most complimentary. He says I have initiative, curiosity, and a lot of energy, that I'm inspiring to be around and that it's unusually motivated of me to go in and see patients I'm not even responsible for. I didn't know he'd noticed. I love seeing patients. And I follow up on labs and I try to help out anywhere I'm needed. Isn't that part of being a good student? He wanted to know how I was getting along, if there were any problems. No, not a bit. I love the wards, I love the residents and the interns, and the nurses are nice. But it does seem kind of slow...and I've never done a normal newborn circuit. So tomorrow morning I'm going to pick up some newborns to help fill my days. And admit/discharge summaries. By all means. And the dreaded question: What do you think you need to improve on? I was expecting it. I knew the answer. I need to work on organization and coherency. Very insightful. They'll come with time. You do much better if you take the time to write your notes out before rounds. And that's true. All of it. The bottom line, O Best Beloved? JK finds me impressive as a student, and feels that I have a lot of qualities that will make me a good doctor. I'm ahead of where he'd expect me to be at the beginning of my third year, and I know what my weaknesses are. I'm doing well. Keep it up. And then I gave my pager number to the intern, in case of admissions in the middle of the night, and I came home and slept for an hour and a half and didn't get working until well after 8. Nobody came in, apparently, as the pager is silent and I was off shift at 10. But I have a printout of the Limping Child outline for presenting tomorrow. And I know what I'm going to say, I think. And tomorrow I get to see Angel for dinner - and then finish writing my expanded H&P which is due Wednesday. And after all that, it's nearly midnight again, and it's far past my bedtime. Goodnight, O Best Beloved.

Sex and Candy.

I took the What Mythological Creature Are you? test by !

Morpheus

?? Which Of The Greek Gods Are You ??
brought to you by Quizilla Yesterday: Got up early, made it to Curves but not to the BMV. Curves was...well, I didn't work out. But Marilyn, the lady there, was most friendly, and she remembered me, and she scolded me for wearing jeans to my measuring, and I lost more weight! Scale said 218, which is a pound and a half less than I weighed when I first joined Curves. Which makes for a total loss since July of 9.5 lbs. I feel good about this, O Best Beloved. I haven't actually lost weight since high school. Then we went garage-saling, and found a new lamp for the study. Then we picked up all manner of computer pieces from the aforementioned study, and decided we had enough parts (including monitors) for a couple new-to-you computers. Down to A+ for some cheap cases, and back home to put ancient 400 and 500 MHz motherboards in them. Angel put one together, with some discovery that we were missing a few cables for things like serial and USB ports (I bet they're in here somewhere), and we need to find a few more of our spare parts before it will work right. Also rebooted the server from its kernel upgrade. And napped, and read my way through Stephen King's The Green Mile, which is a startlingly good book (set of books?) in the not-so-horrorly vein of Eyes of the Dragon, except that he's much more sympathetic to his characters than usual in it. I liked it. Still need to read The Gunslinger. I have part of my expanded H&P and absolutely none of my studying done. Mage RP in the evening was much fun as per . Felt like Psyche is actually really starting to develop a personal attachment to the other characters. Plus, I just like playing her. Now it's church, followed by board meeting, so I will have plenty of time to work on more of my H&P, all the way down to figuring out what the fuck my clinical question for it is. Back to Indy tonight :(

RP Quotes from the new Mage game.

Cast of characters thus far for Mage (): : Leynia, a Russian exchange student, majoring in biology-chemistry and minoring in English. A fifth-year senior. Verbena. : Jax, a first-year from Chicago making up his own biohistory major. Verbena. Has an echoes that causes arousal in everyone around him. : Liz, a second-year transfer sociology major from Loyola in New Orleans. Order of Hermes. : Jen, a first-year computer science major, math minor from New York who's hooked on a mage-only form of XTC. Virtual Adept. : Joseph, a junior transfer student from Wheaton College and devout Catholic who's been suited up with Jax. Major in political science, minors in computer science and music. Celestial Chorus. : The Evil GM. Joining us on Saturday nights when the schedule starts to rotate: .

• Phloxin (conversing with himself): Hi! You're a Shriner, too. --How'd you know? --It's the fez.
• Angel: Healing is a vulgar Effect. Me: Unless you use folk remedies. Angel: Ancient Russian magic...I mean, herbs! Me: Sorry, my English, she is no so good.
• Me: ...the New York equivalent of Boys' Town, because where else can you get bitch boots? Phloxin: Damn straight. Me: Well...
• Phloxin: Give me the fucking Internet!
• Me: Nothing like frostbite of the cock to turn one off.
• Me: She looks up at him. "I sincerely hope you're better at fucking than you are at dancing, because otherwise you're going to have a very lonely life." Phloxin: I want that!
• Angel (picking up the pager): Ha! You called too late!
• Me: I'm Jen. I have seen crack addicts with less energy than you.
• Me: Is that dancing, or epilepsy? Bri: Epilepsy.
• Jorath: You know that little switch? Turn the vibrator off.
• Bri: Bad vampire! Don't bite the faeries!
• James: We are known by many names through life. Whichever one is most appropriate at the time. Me: In that case, I'm probably 'bitch'.
• Me: If I believed in it (the rosary Jen wears as a necklace), would I be wearing it with Jesus's face in my tits?
• Phloxin: Poke, poke, prod, prod, prune, prune, trim, trim, soil, soil. (GM gives her an odd look) I'm working in the greenhouse. GM: OH!
• Me: Phloxy, can you repeat that poke, prod, prune bit?
• GM: You can conserve pot by smoking under the blankets. You breathe the same air over and over... Phloxy: You re-hash!
• James: Parker was a great guy, except his mice were all greasy. Quinby: That sounds faintly dirty. James: So was his keyboard. Quinby: Oh! Those mice.
• Me: No tit-nuzzling Jesuses today.
• GM: And now we're going to play a game to get to know each other. Me: Does this involve knives? GM: No. Me: Damn.
• Phloxin: What would it take for me to get a breeze going? James: Taco Bell run.

RP Quotes from the new Mage game.

Cast of characters thus far for Mage (): : Leynia, a Russian exchange student, majoring in biology-chemistry and minoring in English. A fifth-year senior. Verbena. : Jax, a first-year from Chicago making up his own biohistory major. Verbena. Has an echoes that causes arousal in everyone around him. : Liz, a second-year transfer sociology major from Loyola in New Orleans. Order of Hermes. : Jen, a first-year computer science major, math minor from New York who's hooked on a mage-only form of XTC. Virtual Adept. : Joseph, a junior transfer student from Wheaton College and devout Catholic who's been suited up with Jax. Major in political science, minors in computer science and music. Celestial Chorus. : The Evil GM. Joining us on Saturday nights when the schedule starts to rotate: .

• Phloxin (conversing with himself): Hi! You're a Shriner, too. --How'd you know? --It's the fez.
• Angel: Healing is a vulgar Effect. Me: Unless you use folk remedies. Angel: Ancient Russian magic...I mean, herbs! Me: Sorry, my English, she is no so good.
• Me: ...the New York equivalent of Boys' Town, because where else can you get bitch boots? Phloxin: Damn straight. Me: Well...
• Phloxin: Give me the fucking Internet!
• Me: Nothing like frostbite of the cock to turn one off.
• Me: She looks up at him. "I sincerely hope you're better at fucking than you are at dancing, because otherwise you're going to have a very lonely life." Phloxin: I want that!
• Angel (picking up the pager): Ha! You called too late!
• Me: I'm Jen. I have seen crack addicts with less energy than you.
• Me: Is that dancing, or epilepsy? Bri: Epilepsy.
• Jorath: You know that little switch? Turn the vibrator off.
• Bri: Bad vampire! Don't bite the faeries!
• James: We are known by many names through life. Whichever one is most appropriate at the time. Me: In that case, I'm probably 'bitch'.
• Me: If I believed in it (the rosary Jen wears as a necklace), would I be wearing it with Jesus's face in my tits?
• Phloxin: Poke, poke, prod, prod, prune, prune, trim, trim, soil, soil. (GM gives her an odd look) I'm working in the greenhouse. GM: OH!
• Me: Phloxy, can you repeat that poke, prod, prune bit?
• GM: You can conserve pot by smoking under the blankets. You breathe the same air over and over... Phloxy: You re-hash!
• James: Parker was a great guy, except his mice were all greasy. Quinby: That sounds faintly dirty. James: So was his keyboard. Quinby: Oh! Those mice.
• Me: No tit-nuzzling Jesuses today.
• GM: And now we're going to play a game to get to know each other. Me: Does this involve knives? GM: No. Me: Damn.
• Phloxin: What would it take for me to get a breeze going? James: Taco Bell run.

I have a new rule for you...

...when the senior resident is on call, you get to go home early on Fridays. I left the hospital at about 2:15 today, after drafting up my discharge summary for the sepsis baby. Have discussed matters of weekends with my resident. He says "How about you make up the time during the week?" I said "How about I take an extra evening call a week?" We agreed. I get to spend Saturday and Sunday at home. Yay. The most interesting thing that happened today - besides everyone thinking my pig is too cute - was the update on the kid I mentioned yesterday. Seems around about 6:30, the father decided it was time for him and child to leave. The doctors felt at the time that the child was not stable enough to be discharged. It was explained to the father in plain terms that with his child's condition what it was, there was a very real possibility of him going into respiratory failure and dying if he were to be taken home. Please note: this child was a drop in his oxygen sats away from being intubated. We wouldn't have sent him home even if his parents promised to call 911 at the very first change. What the father did next sealed matters, though. His response to this explanation? "I don't care. We can't fucking afford to be here." Some discussion ensued, during which the father became belligerent. At one point he stated that even if all the the child needed to be discharged was followup meds at home - he wouldn't get them. Things got bad enough that Security was called in. Security escorted the father to the door. And sometime in there, he was overheard saying he was going to come back with a gun. Security was reluctantly convinced not to file a CHINS (Child In Need of Services) report on this kid. Now it becomes a simple fact: We cannot legally or ethically return a child to a dangerous environment. And the father's words, followed by the child's mother's pleas, have raised the question in our minds of whether discharging him would do precisely that. So now instead of being willing to send him home as soon as he's stable - even if he's still sounding like he could use observation - we'll keep him here, because there is significant doubt in our minds as to whether his father would "afford" to call an ambulance in the possible event that this child occluded his airway and turned blue. That's how concerned he seems to be about money. Mom, after Dad was escorted out by Security, began pleading with us to release the child. She's convinced that if we keep the kid, the father will divorce her, and her wifely green card will be null and void, and she'll be deported back to Russia. It sounds like a threat she's heard before. And she begged because "you don't know what he's capable of." This woman looks, acts, and sounds like someone who's completely under her husband's thumb. She acts and sounds like someone who's been abused. But we can't prove it, and we can't file a suspicion report on an adult. The resident there overnight was worried, the nurses were unnerved, and everyone's trying to figure out what to do with this kid. Meanwhile, his X-rays from today show an airway the size of a paper straw and his mother is still trying to get us to send him home. When I left, he was going to have an ENT consultation and we were still wondering whether the parents' attitude would qualify us to file a 310 report with Child Protection Services. There's neglect and/or abuse implicit in withholding necessary medical services from this kid. Is it enough? Will find out Monday after talking with S, the social worker. I told her I was going to want to know what transpired. Damn right I'm going to want to know. But for now...I'm going to pack up and go home, where my Angel is waiting for to spend the weekend with me.

I have a new rule for you...

...when the senior resident is on call, you get to go home early on Fridays. I left the hospital at about 2:15 today, after drafting up my discharge summary for the sepsis baby. Have discussed matters of weekends with my resident. He says "How about you make up the time during the week?" I said "How about I take an extra evening call a week?" We agreed. I get to spend Saturday and Sunday at home. Yay. The most interesting thing that happened today - besides everyone thinking my pig is too cute - was the update on the kid I mentioned yesterday. Seems around about 6:30, the father decided it was time for him and child to leave. The doctors felt at the time that the child was not stable enough to be discharged. It was explained to the father in plain terms that with his child's condition what it was, there was a very real possibility of him going into respiratory failure and dying if he were to be taken home. Please note: this child was a drop in his oxygen sats away from being intubated. We wouldn't have sent him home even if his parents promised to call 911 at the very first change. What the father did next sealed matters, though. His response to this explanation? "I don't care. We can't fucking afford to be here." Some discussion ensued, during which the father became belligerent. At one point he stated that even if all the the child needed to be discharged was followup meds at home - he wouldn't get them. Things got bad enough that Security was called in. Security escorted the father to the door. And sometime in there, he was overheard saying he was going to come back with a gun. Security was reluctantly convinced not to file a CHINS (Child In Need of Services) report on this kid. Now it becomes a simple fact: We cannot legally or ethically return a child to a dangerous environment. And the father's words, followed by the child's mother's pleas, have raised the question in our minds of whether discharging him would do precisely that. So now instead of being willing to send him home as soon as he's stable - even if he's still sounding like he could use observation - we'll keep him here, because there is significant doubt in our minds as to whether his father would "afford" to call an ambulance in the possible event that this child occluded his airway and turned blue. That's how concerned he seems to be about money. Mom, after Dad was escorted out by Security, began pleading with us to release the child. She's convinced that if we keep the kid, the father will divorce her, and her wifely green card will be null and void, and she'll be deported back to Russia. It sounds like a threat she's heard before. And she begged because "you don't know what he's capable of." This woman looks, acts, and sounds like someone who's completely under her husband's thumb. She acts and sounds like someone who's been abused. But we can't prove it, and we can't file a suspicion report on an adult. The resident there overnight was worried, the nurses were unnerved, and everyone's trying to figure out what to do with this kid. Meanwhile, his X-rays from today show an airway the size of a paper straw and his mother is still trying to get us to send him home. When I left, he was going to have an ENT consultation and we were still wondering whether the parents' attitude would qualify us to file a 310 report with Child Protection Services. There's neglect and/or abuse implicit in withholding necessary medical services from this kid. Is it enough? Will find out Monday after talking with S, the social worker. I told her I was going to want to know what transpired. Damn right I'm going to want to know. But for now...I'm going to pack up and go home, where my Angel is waiting for to spend the weekend with me.

How did it get to be midnight again?

Have been goofing off all afternoon. Bought a few presents for Angel. Didn't get started on studying until 9. Didn't get all that far. Now it's time to go to bed, and I haven't gotten you an update on today, O Best Beloved. And today...was interesting. I'll recap the highlight of my day, which was choosing the other new patient who came in overnight to cover, and leaving the kid with croup for the residents. En bref: If your child comes in with croup, and the doctors are concerned enough about it (croup can be very mild, or occasionally a kid will come in with what sounds like impending respiratory failure) to recommend he stay for observation...listen to them. If you happen to be at the Hoosier Healthwise hospital, which gets all kinds of funding to help pay for hospital stays when patients cannot...listen to the financial counsellor. If you happen to be currently going through a bankruptcy, and are completely broke, and have no insurance (except your wife's, which kicks in on the 15th of September - whereas today is the 11th), please consider that the doctors are not saying "we would like to watch your kid just to be on the safe side." Please consider that the doctors are saying "your child's breathing is so close to total collapse that we don't feel like we can responsibly allow him to leave this hospital." Please consider that we are afraid, given the degree and intractibility of your child's stridor, that he might suddenly go into respiratory failure and die.

Isn't that just a teeny tiny bit more important to you than your fucking bankruptcy and the fucking hospital bill?

Don't you think, O Best Beloved, that any rational parent, when told by a doctor - several doctors - that their child is not stable enough to leave the hospital, would then say "okay, we'll do what it takes and worry about the bills later."? The father of A apparently disagrees, as he was threatening to leave at 10 AM when we did morning rounds, before the hospital could "suck one more fucking dollar from me." When it was explained to him that his room billing went from midnight to midnight, he informed us that he was leaving, no matter what condition his child was in, at 11:30. That was as long as he was going to let us keep his kid. Because they couldn't afford this, and the hospital wasn't doing anything to help his kid (observing, pulse ox, and two overnight neb treatments with epinephrine back to back apparently don't count, because we didn't do more treatments or something) and we were just keeping the kid here to make more money. I am speechless. We've explained to him multiple times that his kid isn't in a stable or safe condition. We want him here, where we can have him intubated and breathing 100% oxygen inside of the two or three minutes it would take to get him in the car. Where, should his airway close off as it is obviously threatening to do, he can get the help he needs. We want him in the hospital because it's the best place for him to be. We're fucking doctors. We want to do the best fucking thing for our patients. JL called S, the social worker, and they discussed our options. It's going to be up to R, the first year post-MD - the intern on call tonight - to deal with the situation. To decide whether he thinks that this kid is going to have to stay regardless of his parents' wishes. Because since A is 18 months old, witholding necessary medical treatment from him can be qualified as abuse. And we can call security and have Dad escorted out, and file a report with CPS against the family, and we can make goddamned certain that A stays here, if we think that his situation hasn't improved enough for him to be safe going home. But we have to be certain that that's medically necessary. What a nightmare. Is your child's life not worth more than money? Do you not understand? What gives? I'll leave the rest for another time, as Angel forgot to bug me for bed at 11 and it is now after midnight, and I have to be up at 5:30. Good night.

Open season on interpretations: "remort"

Death came
    in a car
         filled with hellfire,
brushed by
               on butterfly wings,
    paused,
           and looked me in the eyes.
And seeing 
      (for Death would know)
                that we are well acquainted,
           he and I,
Death passed me by.
                "remort" 11-Sep-03

<i>I remembered, this year.</i>

Happy birthday, !

El garatillo

Learned, thoroughly, about asthma tonight. Also took a nap. However, I should go to bed soon. I have made myself another journal (5 codes a month and all, I can squander them) for writing about the things I learn about. If you want all sorts of spam - the sort of things medical students learn, and all - then you can watch and be enlightened. However, entries are quite long and not LJ-cut. I'm writing it for me, O Best Beloved, and giving you a chance to peek through my window. I was going to make an RSS feed of it, but I can't do it directly (can't add feeds from livejournal.com), so I'll have to play around a bit and see if I can fudge it. Otherwise, either watch the journal or deal with the spam, if you're interested. I did not do my expanded H&P. I have delayed it this evening, until the weekend. This means that if I do it tomorrow, I will be Ahead of Schedule. I am, however, Behind Schedule regarding the application to St. Francis, and I should do and mail that this weekend. I did, however, spend quite a lot of time learning about asthma. I should find my guide to topics, and cover those in as much detail. Is tomorrow Thursday already? How time flies. I need to learn more. I wish I'd brought Dr. M's trivia questions home. I know that "el garatillo" is a 17th century nickname for diphtheria, even if I can't find it in association with Goya - or indeed find the painting he showed us and attributed to Goya in any of the image archives online. I can't remember the other trivia, dang it, or I'd have it done. This will work quite nicely, I think, with the connection in my room. I have a couch, which is comfortable enough, and in fact would fold out to form a bed should the need for something more than my twin arise. I should ask if it would be okay if Angel came down, for me to fold out the bed. wants me to run B-movie for her Hallowe'en party. I need to post quotes, oh yes. Lot of things to do this weekend, including getting my pass from Curves (I need to keep working out), eating lots of fresh steamed veggies (I'm living on chicken and cheese sandwiches, soup, Slim-Fast, and cafeteria food, Angel. I need veggies. I'm craving broccoli and cauliflower), and going to the license bureau to get my driver's licence address changed. But right now...I need sleep. Bedtime for Medical Students, O Best Beloved.

YAY!

Today at the hospital was relatively uneventful, except for the baby we'd seen last night. The snuffly one did eventually feed, and without desatting. The well baby...well...he came in with no stool, dropoff in feeding, bilious vomiting, a distended abdomen, and huge loops of bowel on X-ray. And went straight to Riley for a lower GI evaluation, after we determined he did indeed have a patent anus and suctioned a bunch of bilious mucousy stuff out of him. Otherwise, other than me nearly falling asleep once, I did some scheduling of subclavian line removal, looked at patients and monitored them, and generally did scut work all day. Could be worse. Dr. M, my attending, when I said I'd work Sunday morning and make Saturday my day off, said that they might treat me as a special case - since my husband's in Ft. Wayne - and that we'd see how busy we were on Friday. That gives me hope. Lots of hope. Got an e-mail from Dlink this morning:

Date of Reply: 9/9/2003 10:46:54 PM Products: DWL-800AP+ Operating System: Windows XP Home Please try upgrading the firmware on the router to the latest, 2.2 or 3.2. Hard reset the router and reconfigure. Depending on the dates of the 2.18 firmware, there were some problems with repeating being able to work. This may be the case here........... When you entered in the lan mac address of the router into the remote ap field, did you get this off of the status page in the router configuration???

Felt stupid, as I knew there was a firmware upgrade and I hadn't installed it. Did so. Tried again, with little hope. Bing - instant throughput. I am now in my room, with my privacy and my stuff, considering if it might not be advantageous to move the repeater over to the wall directly opposite my room. It would mean I was no longer going repeater to wireless NIC through quite as many walls, but would add some between the router and repeater. Why fuck with it? It's working great. Have been nearly falling asleep all day. Think it would be wise to nap for a bit while Angel is away (I got him a present for his upcoming birthday, yay!) and then do my work. To nap, now.

YAY!

Today at the hospital was relatively uneventful, except for the baby we'd seen last night. The snuffly one did eventually feed, and without desatting. The well baby...well...he came in with no stool, dropoff in feeding, bilious vomiting, a distended abdomen, and huge loops of bowel on X-ray. And went straight to Riley for a lower GI evaluation, after we determined he did indeed have a patent anus and suctioned a bunch of bilious mucousy stuff out of him. Otherwise, other than me nearly falling asleep once, I did some scheduling of subclavian line removal, looked at patients and monitored them, and generally did scut work all day. Could be worse. Dr. M, my attending, when I said I'd work Sunday morning and make Saturday my day off, said that they might treat me as a special case - since my husband's in Ft. Wayne - and that we'd see how busy we were on Friday. That gives me hope. Lots of hope. Got an e-mail from Dlink this morning:

Date of Reply: 9/9/2003 10:46:54 PM Products: DWL-800AP+ Operating System: Windows XP Home Please try upgrading the firmware on the router to the latest, 2.2 or 3.2. Hard reset the router and reconfigure. Depending on the dates of the 2.18 firmware, there were some problems with repeating being able to work. This may be the case here........... When you entered in the lan mac address of the router into the remote ap field, did you get this off of the status page in the router configuration???

Felt stupid, as I knew there was a firmware upgrade and I hadn't installed it. Did so. Tried again, with little hope. Bing - instant throughput. I am now in my room, with my privacy and my stuff, considering if it might not be advantageous to move the repeater over to the wall directly opposite my room. It would mean I was no longer going repeater to wireless NIC through quite as many walls, but would add some between the router and repeater. Why fuck with it? It's working great. Have been nearly falling asleep all day. Think it would be wise to nap for a bit while Angel is away (I got him a present for his upcoming birthday, yay!) and then do my work. To nap, now.

No, when we're doing newborn exams, we never wear clothes....

..we wear scrubs. That's the quote I overheard during a lapse in rounds today. It was...well, disturbing at best. Arrived at 0700 for once, instead of 0710 or 0715, despite taking a shower and snoozing my alarm too long. Pre-rounded on one baby boy, sepsis, doing well. Woke him up to look in his mouth (I can look at ears without waking a baby, but mouths...well, no such luck) and he sneezed on me. It was sort of cute in an "I'm now showered in droplets of respiratory secretions" kind of way. Called JK to get my otoscope handle back before attempting to pre-round on one little boy, stridor secondary to probable croup, and was for once not given another new patient. But he did tell me to copy my chart note so he could write on it. I went to newborn rounds and took my chart note writing to do during them (I don't have any newborns). JK scribbled over my chart note copy, and gave it back to me with a mention that overall it was satisfactory. Change the order of my past history: PMHx, Hosp, PSHx, Meds, Allergies, FMHx, SHx, instead of the essentially random way I was doing it. Get all the information in the HPI. Next to my Review of Systems, he put **good** with little asterisks and everything. That made me proud. JL, in casual conversation as I was discussing my congenital disorganisation and need to compulsively organise everything, told me not to worry so much, that I was ahead of where she'd expect. The interns can't seem to remember whether I'm in my third year or my fourth. I survived the morning pimping session by Dr. M. Rounded with peds around 10:30 or 11. JK prepped me by making me run through my presentation on B with stridor before rounds. He works hard, but he's super laid-back. Reminds me - right down to the initials - of Josh, the pastor's son. We talked over the plan, and I was reassured that I didn't need to know treatments necessarily, just know the differential. It went, overall, quite well, although one of the interns asked a lot of questions. JL says it's rude for interns to pimp the medical students in front of the attending. I didn't know that. Ran out from our rounds to make it to Riley for noon lectures. Today it was on anaemia. Quite interesting, even if I was falling asleep on the spot. Grabbed McDonalds due to driving need for salty french fries and caffeinated pop to keep me going. I'm so bad. Used the old trick of filling my cup with ice completely to cut down on how much actual pop I had. It worked, for a while. Long enough to get me going through the afternoon. I was with the interns on the newborn side. I learned how to do a newborn exam, both from JL and from the interns. I learned how to do a mom talk - funny how everyone does them so very differently - and even got to do some. Checked in on newborn babies, got to pass a nasal catheter to check for patency on a snuffly baby, wrote cards and ran errands - I don't mind the scut work, it gives me time to think - and then it was time for them to go home. I was on evening call tonight, 4-10 PM, usually gets out earlier. And JL was going to let me out earlier. We were capped on our floor because nurses were understaffed, so there were no admits. And there were hardly any babies. And then we decided to go see a C-section. And when we got there, the nurse said Are you Peds? And JL nodded. And she said I hadn't even called you yet. They wanted us there. Failure to progress, possible chorio, generally ickyness. So I stood by and I helped dry off the baby, and I held her up for her father and mother to see, and I stayed out of the way while they suctioned and gave breaths and finally took her over to Special Care, which is the magic word for NICU. She should be fine, precious thing with her head all stretched out and funny-looking from being in the birth canal so long, just needs her lungs cleared out. I took my gown home, all sentimental-like. And some extra scrubs. Then I wandered the nursery and looked at Baby D, who has two very black parents but looks quite white. And the snuffly baby came back, still snuffly. He's got a little chin. Pierre-Robin syndrome (or Robin sequence) can't be ruled out; I haven't looked in his mouth. But his ears and eyes look more normal after seeing his mom's. JL thinks he probably has laryngomalacia. I need to learn about that. He won't eat, sounds awful noisy when he breathes, and is generally a worrying baby. We put a pulse ox on him while he slept, and he seems to be getting enough oxygen. And then Mom came in, and somehow it had gone from getting a taco salad in the cafeteria around 6 or 7, to walking over to Special Care carrying the new baby girl's anti-kidnapping tag and a box of medications around 9, to wondering what Baby A's problem with breathing was. And JL turned to me and said "You want to go home?" I did. I was exhausted and feeling a little useless. "Go home." Called my baby sister on the way to the car, talked for a bit. She's started school at IPFW for the nursing program (good for her!) and is now 4 1/2 months pregnant. Reminded her to take her prenatal vits, congratulated her on it all, and just thought about how things change. In my mind she'll always be my little Ernie, who climbed out onto the roof of the back porch and got stuck, the time I locked her in her room when I was babysitting. Just a little girl. But she's nineteen, and she's going to be a mother soon, and she's going to school, and she's working at getting her own place, and she's not my little Ernie any more. It's strange how things change. It was good to talk to her. We didn't so much grow apart when I went to school as we were never really truly close, not like Michelly and she were. I feel strange trying to make lunch dates with my sisters, feel old. Daddy found a 1980 Mustang for Paul with like 37,000 miles on it. The owner's a mechanic, it's been in proper storage. He's thrilled. It's late now, too late for me to still be up writing, O Best Beloved. I had poetry in my mind when I drove this morning with the radio off. I thought of it again when I stopped to go to the bathroom and just sat in the stall, in the cool and clean and tiled empty space where briefly I was the only person, the only sound. I even pulled my feet up and sat like a little ball, and I loved it. I walked out eating a hamburger (I washed my hands first), and revelled in the startled looks I got. I have some of it written down, but some of it, I think is lost. It will return. I can't even express to you how good it feels to have, even briefly, that flow of tangled words that form poetry, the symbols that collect and gather, that connect me. It reminds me that I am still who I am. Running through my head all day - the theme from M*A*S*H * (Suicide is painless) and Every Rose has its Thorn. What does that say? And I am going to sleep, to be up again in less than six hours. Please don't make me work the weekend...

ARGH!

I hate electronics. Got home. Angel was mowing the lawn, so I went and holed up in my room (still no working repeater) and did my admit H&P from this afternoon while listening to Chicago. Fixed Meeta's PDA. Felt accomplished (it was only 8!) so I tried a few more things with the repeater. Dlink had better fucking well get back in touch with me soon. E-mail support should at least give the courtesy of a "we got your e-mail" e-mail, right? Tomorrow, if I have still heard nothing, I will re-send. And make a fucking pest of myself. There's a good place in my room to work - but I have to choose between talking to Angel and doing work...and Angel wins every fucking time. I feel like crying. I'm so frustrated. And after a day that (despite the disappointment of learning that yes, indeed, I am supposed to work one day of two per weekend) was pretty damn decent. I walked 5.3 miles today, according to the Avandia pedometer. Go me. Maybe I will make headway on my bra size, currently a catalogue-only 40H by the most recent measurements. I am going to get my Nelson's, and read about stridor and asthma. Right now. Because I have to know for tomorrow. ...after I talk to Angel, and quit flipping out.

Noon conference...

Got up today, O Best Beloved, and lingered a bit too long on the snooze. Was ten minutes or so late. But nobody saw me sneak in and I rounded on my patient before asking about new arrivals. " Pick up a few patients, if you want." Well, it was more like a suggestion that I take on helping out with two of three asthmatics. I should have gone over asthma. But I muddled through, somehow. Presented one of the kids, let the intern present the other. JL made me do hers, silly resident. It was a most interesting case, though. The thing we're wondering about this 14 year old asthmatic girl is if her psych history might make her a patient with vocal cord paralysis and not true asthma after all. A most interesting question. It was almost as interesting as the question we were presented in morning report. The baby with a ringworm-style rash, oral ulcers, and dry cough who's been like this since a few days after birth. Peds derm says neonatal lupus has a very rare incidence of oral ulcers, but there she was. Noon lecture is on nutrition. Important Fact: Progestemil Formula tastes extremely bad, according to Dr. G. Bad enough to gag a maggot. Try to avoid it.

Dear D-Link TechSupport:

I am attempting to connect my Sony GRX560 laptop to our DI-614+ wireless router, using the DWL-800 AP+ as a repeater. My laptop has a DWL-650+ network card. I downloaded the latest drivers and firmware for the card and the AP today; the firmware version on the 614+ is 2.16. I ran the configuration wizard on the DWL-800, entering the LAN MAC address for the DI-650, and the appropriate WEP value and key for the network I am on. Everything seemed to go well, and the Home screen displayed packets being sent and received over the wireless on successive refreshes. The access point showed up on my D-Link AirPlus configuration utility without a problem. The problem came when I connected to the access point. I connected without error, with link quality and signal strength between 90 and 100%. However, I was unable to get an IP address - or indeed, it seemed, receive any packets at all from the AP. I tried to manually renew my IP address while watching the Windows "Connection Status" window. Bytes sent incremented appropriately. Bytes Received remained, adamantly, 0. I moved my setup, access point, computer and all, into the same room as the router - postulating that perhaps the AP was not getting enough signal. No such luck; I am still getting no return information from the AP. I tried switching the AP over to Access Point mode from Repeater mode. I changed the channel, even. No luck; the issue persisted. As I watch it sit idly, with no computers connected to it, the green power light is on and the small central light in the amber WLAN area is flickering rapidly. I assume this means that the WAP has a connection. Nonetheless, it is apparently so exclusive as to disallow me from using it. Am I doing something wrong? Have I missed some small but vital configuration step in the easy-to-use and refreshingly uncomplicated setup process? Is there a gremlin in my computer? Please advise. Thank you for your time, Nicole Boersma Tech Support persons on my list: I'm a little punchy; I've spent the last two hours trying to set up this fucking access point. Finally fired off the preceding e-mail to Tech Support (please note: OS was included in a drop-down box; I did not omit letting them know that I am on XP home). Am I a Good Customer or a Bad Customer for being so obnoxiously thorough and cute about it? Do I sound pissed-offf? I didn't want to sound pissed-off. It's not Tech Support's fault that my computer smokes crack in the schoolyard. Lost my house key for S's place. It's at home somewhere, it's got to be. I always check for my keys before I get in the car, and it should've been in my pocket or I would've looked then. I stopped at only one place before I arrived home, then took off my pants and put on scrubs. And I haven't seen it since. I have an extra, will stop and get a copy made tomorrow. Also going to repair Meeta's PPC tomorrow. Also tomorrow night I am going to begin to catch up on all of the things I forgot to do over the weekend. Fucking ADHD. I am, from now on, required to learn about one topic minimum every night, or I'll be cramming like mad before the peds exam. I don't want to have to cram. I also need to do my expanded H&P so that I can return and destroy the copies of chart information I have. I'm sure HIPPA would find a reason to hate me for having them. Purchased Slim-Fast spiffy Hot Meal Options today, in Shells and Cheese flavour. Also another breed of soy shakes. Am currently having dinner - a turkey and cheese sandwich, with precisely six slices of turkey and one of cheese (one serving each) on wheat bread, because my daddy despairs when I eat white bread. I shouldn't eat this late. I'm fucking starving, having forgotten to eat after successfully talking myself out of stopping to get fast food on the way down here. It was a clever ruse indeed, to wait until the exit was almost there before attempting to decide if I felt like eating at any of the restaurants I could see. It was quite effective, really. I kept passing them and then thinking Oh, there was an Arby's there... And by the time I was hungry enough not to care where I was eating, I was only 20 miles away. I could wait, then. Also at Meijer, the $25 webcams. We got one to test it out. It works well enough for me to see my Angel's face, refreshed every 30 seconds. He's freakin' gorgeous. I love that man. Debating a second sandwich, but the beast within my stomach is currently tamed. Rambling now, a little punchy still. I should probably go to bed early so as to gather my thoughts to coherency tomorrow. I wonder what happened over the weekend. Maybe there will be something fun to learn.

Oooh, what a neat feature!

Checked my friends list this morning, compulsively. Semagic popped up a message, to remind me:

Happy Birthday, !

I miss M.

String, or nothing!

Preying mantis on the door. Saw Dad tonight, he got to meet Quinnie finally. Need to get Jen out and let her stretch her wings. Or write more backstory, so as to have a reference point for consistency's sake when making references to her angst. I found a shop in the mall, called Nirvana, that's practically Jen's wet dream place to shop. Mind has now fleshed out her outfits and her look more. Scale says 215; I've lost another pound without really trying. I love being shipped all over the hospital, usually in too much of a hurry to wait for the lift. Mage tonight was much funness. Am made jealous by Angel's command of the six bajillion White Wolf books, but am reassured that he is jealous of my command of things that can go wrong with the human body. Psyche, formerly an ice bitch par none, is now smiling at people, and spending her study time teaching Typheous while cuddled up with his arm around her. This is a breakthrough for her, although she's going to pick up a shovelful of angst as it dawns on her that she's taking time out for herself, rather than working on the very large problem of why her protegee has taken to disembowelling boys with sewing scissors and pulling knives on Psyche's friends. As well as other small matters, like saving the world from a bunch of strangely disturbing vampires. Psyche, as they say, has issues. The psychological ramifications are endlessly fascinating. But she's a teenager, so it's mostly just hormones. No, really, all my characters in RP are loaded with angst. Gabi was the only one who wasn't, and she was a vampire. Option 2 seems to be working, in combination with acidophilus (not taken at the same time as the antibiotics) and a good night's sleep last night. Feeling much better. TMI survey later. Bed now. Angel is waiting.

Have You Ever... 1. Done any drugs? Nothing more than alcohol, tobacco, and secondhand pot smoke. 2. Drank alcohol? Yes 3. Had sex? I'm friggin' married. 4. Fallen in love? Yes. 5. Fallen in love online? So to speak, yes. It was a while ago, but... 6. Met someone from online? Um, yeah. We're the Internet Parent Liberation Front. 7. Tried to set a bug on fire with a magnifying glass? Yep. 8. Torn off a lightening bugs light and smeared it anywhere on your body? No, , it's not an East Coast thing. I've done it. 9. Made a snow angel? Many. 10. Dreamed you could fly? Yes. 11. Ever had a job, if so what? Summer school assistant, Wendy's Drive-through Diva, Processing clerk at the library, Tech Support, Medical student... 12. Bungee jumped? Nope. No real desire to. 13. Felt betrayed? More than once. 14. Seriously contemplated suicide? Seriously? Only to finally discard it as impractical. 15. Attempted suicide? No. 16. Been in a car accident? I've only totalled one car in my life. But I've run it into other cars more than once. 17. Had a close friend to die? Not extremely close. Not yet. 18. Had a close family member die? My grandmother. 19. Seen the Eiffel tower? And been up it. And saw the fireworks in 2000, up close and personal. 20. Seen the statue of liberty? From a boat in the harbour, on a post-concert cruise. 21. Told a secret you swore you wouldn't tell? Probably, a few times, although I try not to make promises if I can't keep them. 22. Stolen anything? A few times. Very minor shoplifting when I was younger. Office supplies. 23. Gone out with someone for their looks? Naah, I usually just play around then. 24. Their reputation? No. 25. Met anyone famous? In some circles. 26. Been on radio or tv? I was on Happy's Place. 27. Been on stage? High school plays, Carnegie Hall concert. 28. Intentionally hurt someone? Yes. Far too many times. 29. Dumped someone? A half-dozen times or more. 30. Been dumped? Just twice. And both times I was about to dump them. 31. Been to Europe? Lived in France. Have visited France, Spain, Germany, Belgium, the Netherlands, and Italy. 32. Been convicted of a crime? Nyet. 33. Been in a mosh pit? Um, back in high school maybe. 34. Been asked for an autograph? Only at school. 35. Been toilet papering? No, isn't that sad? 36. Been toilet papered? Nope :) 37. Loved someone so much it made you cry? Absolutely. 38. Cried over someone of the opposite sex? Too many times to count. 39. Same sex? See above. 40. Had toilet paper stuck to your shoe? *blushes* 41. Been caught with your fly unzipped? I had a pair of jeans once, that I had to safety-pin the zipper up. 42. Had your pants fall down in public? Not that I recall. I stripped, a couple of times, in a group of people most of whom I knew... 43. Been in a fight? Not a knock-down drag-out fight... 44. Cheated on someone? Yes. Several times.

I love you, Jiffy Lube...

Went to get the oil changed in the cars. Dropped them off. Both needed flushes and oil changes and a whole bunch of other stuff, so we went over to the mall and got lunch, applications (Build-A-Bear is hiring! Build-A-Bear is hiring!), and the AMG movie. Started Michel-Ange, to realise he was running nice and quiet and smooth. Except...when I started to drive away, he made this horrid rattling noise. Pulled over in the Best Buy parking lot. One of my wheels was all crookedy. Wound up turning around and going back to Jiffy Lube. Got there just after they closed up and were about to lock up. Explained the situation. He looked it over. Sure enough, rear passenger-side tire was loose. So loose that the lug-nuts weren't even finger tight. Whoops. He apologised. Several times. The other guy said he'd be really mad if it happened to him. Me...everyone makes mistakes. They fixed it, that was the important thing. Fixed it and apologised again. He's all happy now. I didn't ask for compensation, and they didn't offer. I don't need it. Everyone makes mistakes.

There's a bright golden haze on the meadow....

Jen's question-and-answer session is up on . If you want to keep an eye on everything that happens with our next Mage game, you can add it as a friend and watch there. Backstory, quotes, Q&A, summaries, whatever. That's what I did last night, after RP, instead of driving back to Indy. Why? My Attending likes me. A little before ten, he stopped to talk to me. "I hear you're going back to Fort Wayne this weekend." I nodded. "Well, keep your pager on tonight, because unless we get slammed, JL will have everything under control." Beat. "You know what? You've carried the service these last two days. You've done a lot of work. Don't come in at all. We'll see you Monday." I was so fucking happy. Added to the TMI list by her request, and without request, 'cause I have a sneaking suspicion she don't mind. :) , you are on it already. Nabbed a survey from I'll go through later there. Anyone else who wants to be added, just drop a comment here or enter your username in this poll. Sepsis baby is doing quite well - they changed his last name on me, which confused the everloving fuck out of me. I did do the hip checks yesterday on PE, just for thoroughness' sake. Sleeping quietly, getting his antibiotics IV. And I presented him (our only patient!) at rounds, as a case study: "A seven-week-old baby presents to the UVC with complaints of..." and so on, so as to stretch out one patient (and a good one; fever of unknown origin before 3 months is a core topic) for all he was worth. We decided to put in a PICC line instead of leaving the IV in. Maybe he could go home then, for antibiotics, but at least we don't have to worry about him blowing the vein or yanking out his IV. I think, if I'd've known what a fucking huge deal it is to put a PICC line in a little baby, I would've argued JK down from it. The procedure, as JL informed me (also much to her surprise) involves full general anaesthesia. We didn't figure it was that different from doing it in an adult. But JK wanted it done anyway. He and IR and Anaesthesia talked to the mother of the baby. Please note: Mom is 15, dad is 16, and mom's mother is the daytime caregiver. Mom consented and signed the forms. JK was post-call, so he went home. And then, a few hours later...then Grandma called, wanting to talk to a doctor. So JL talked to her. And she talked and talked and talked. And grandma wasn't sure she wanted the line in. And then it became "do we have consent?" Is the fifteen-year-old mom allowed to sign consent forms for her baby? So we called S, the social worker (I love working in a hospital with a largely Medicaid population. Strange things happen all the time.) and she said that yes, Mom was allowed to sign. And then it was "well, the baby's down in IR already, and they took him in immediately, so it's too late to stop now." I'm glad I left before the grandparents came for their visit. So very glad. JL gets paid to do this, and she knows what she's talking about. I'm still learning what a PICC line is. Went with R to see the new admit baby, who's a 2-year-old with croup (What is he doing here? He should be at home) and a bit of lingering stridor, in for observation overnight. He'll be fine. We wrote the note and talked about the differential diagnosis of croup (go for it, !) before R said "Go home. There's nothing for you to do." I left campus at 4:30. I know. I called Dad to tell him about the 15-year-old question. President Bush was in town, downtown. All the fucking roads were slow. It's his fault (please don't kill me, ). I got caught in traffic trying to get on I-65 S to I-70 E, my normal route. It wasn't moving. So I got on 65 N and realised I didn't know where to turn off. Turned around, got stuck in the beginning of the jam on 65 S, and finally made it to Meridian. Even Meridian was slow. Grabbed McDonalds and called in a report home. Coming up 69 it went well until exit 14. At mile marker 15 I made an illegal U-turn, went back to 14, and got off the fucking highway. Nobody was moving. Diverted myself to 13, then 32. I forgot that 32 through Anderson is the most complicated fucking highway there is, and that it adds like 45 minutes to one's travel time. I need to find a different route; work at exit 19 will maintain the traffic jam status quo there for a while. Got home at 8:45. Four fucking hours on the road; it should've taken 3 at rush hour. But RP went relatively well. Quotes forthcoming. They got my villain high and knocked him out that way, rather than bothering to actually fight him. But it worked. Good enough. We'll start preludes for next week. Votes are for Saturday evening RP, which may require a short hiatus until wraps up his campaign. Or we may run a rotating schedule. In any case, I need to change my oil and get out and about this afternoon, and I slept 'till noon. But I feel so much better. Until later, O Best Beloved. Oh, and : As far as Quinby goes, I think it's dawning on her parents that she's here, she's safe, and there's nothing they can fucking well do about it but support her. At least her dad is. I've really not been thinking about it much, other than in terms of what Quin needs to get done to get established here, and how to work with ADHD and not need meds. 'Cause believe me, I know. And I'm just fine with that. And I think it's the coolest fucking thing ever that our church is being so supportive and trying to help.

There's a bright golden haze on the meadow....

Jen's question-and-answer session is up on . If you want to keep an eye on everything that happens with our next Mage game, you can add it as a friend and watch there. Backstory, quotes, Q&A, summaries, whatever. That's what I did last night, after RP, instead of driving back to Indy. Why? My Attending likes me. A little before ten, he stopped to talk to me. "I hear you're going back to Fort Wayne this weekend." I nodded. "Well, keep your pager on tonight, because unless we get slammed, JL will have everything under control." Beat. "You know what? You've carried the service these last two days. You've done a lot of work. Don't come in at all. We'll see you Monday." I was so fucking happy. Added to the TMI list by her request, and without request, 'cause I have a sneaking suspicion she don't mind. :) , you are on it already. Nabbed a survey from I'll go through later there. Anyone else who wants to be added, just drop a comment here or enter your username in this poll. Sepsis baby is doing quite well - they changed his last name on me, which confused the everloving fuck out of me. I did do the hip checks yesterday on PE, just for thoroughness' sake. Sleeping quietly, getting his antibiotics IV. And I presented him (our only patient!) at rounds, as a case study: "A seven-week-old baby presents to the UVC with complaints of..." and so on, so as to stretch out one patient (and a good one; fever of unknown origin before 3 months is a core topic) for all he was worth. We decided to put in a PICC line instead of leaving the IV in. Maybe he could go home then, for antibiotics, but at least we don't have to worry about him blowing the vein or yanking out his IV. I think, if I'd've known what a fucking huge deal it is to put a PICC line in a little baby, I would've argued JK down from it. The procedure, as JL informed me (also much to her surprise) involves full general anaesthesia. We didn't figure it was that different from doing it in an adult. But JK wanted it done anyway. He and IR and Anaesthesia talked to the mother of the baby. Please note: Mom is 15, dad is 16, and mom's mother is the daytime caregiver. Mom consented and signed the forms. JK was post-call, so he went home. And then, a few hours later...then Grandma called, wanting to talk to a doctor. So JL talked to her. And she talked and talked and talked. And grandma wasn't sure she wanted the line in. And then it became "do we have consent?" Is the fifteen-year-old mom allowed to sign consent forms for her baby? So we called S, the social worker (I love working in a hospital with a largely Medicaid population. Strange things happen all the time.) and she said that yes, Mom was allowed to sign. And then it was "well, the baby's down in IR already, and they took him in immediately, so it's too late to stop now." I'm glad I left before the grandparents came for their visit. So very glad. JL gets paid to do this, and she knows what she's talking about. I'm still learning what a PICC line is. Went with R to see the new admit baby, who's a 2-year-old with croup (What is he doing here? He should be at home) and a bit of lingering stridor, in for observation overnight. He'll be fine. We wrote the note and talked about the differential diagnosis of croup (go for it, !) before R said "Go home. There's nothing for you to do." I left campus at 4:30. I know. I called Dad to tell him about the 15-year-old question. President Bush was in town, downtown. All the fucking roads were slow. It's his fault (please don't kill me, ). I got caught in traffic trying to get on I-65 S to I-70 E, my normal route. It wasn't moving. So I got on 65 N and realised I didn't know where to turn off. Turned around, got stuck in the beginning of the jam on 65 S, and finally made it to Meridian. Even Meridian was slow. Grabbed McDonalds and called in a report home. Coming up 69 it went well until exit 14. At mile marker 15 I made an illegal U-turn, went back to 14, and got off the fucking highway. Nobody was moving. Diverted myself to 13, then 32. I forgot that 32 through Anderson is the most complicated fucking highway there is, and that it adds like 45 minutes to one's travel time. I need to find a different route; work at exit 19 will maintain the traffic jam status quo there for a while. Got home at 8:45. Four fucking hours on the road; it should've taken 3 at rush hour. But RP went relatively well. Quotes forthcoming. They got my villain high and knocked him out that way, rather than bothering to actually fight him. But it worked. Good enough. We'll start preludes for next week. Votes are for Saturday evening RP, which may require a short hiatus until wraps up his campaign. Or we may run a rotating schedule. In any case, I need to change my oil and get out and about this afternoon, and I slept 'till noon. But I feel so much better. Until later, O Best Beloved. Oh, and : As far as Quinby goes, I think it's dawning on her parents that she's here, she's safe, and there's nothing they can fucking well do about it but support her. At least her dad is. I've really not been thinking about it much, other than in terms of what Quin needs to get done to get established here, and how to work with ADHD and not need meds. 'Cause believe me, I know. And I'm just fine with that. And I think it's the coolest fucking thing ever that our church is being so supportive and trying to help.