Common Sense Rules

Often times I wish common sense was a prescription. Maybe even intelligence; somehow you can take a pill or two and come out as less of a burden on society. However, almost daily, I see that no matter the power of modern medicine, there just is no cure for stupid. If I have learned nothing over the last year, it is when I will seek out medical care...for anything or anyone that I love.

In some ways, I feel sorry for my kids. Unless there is pus leaking out of more than one orifice, they aren't going to the doctor. If there is no visible deformity or protruding bone from any part of their body, they get ibuprofen and ice. Cast or Ace wrap? I will robably choose the latter. It's got nothing to do with cruelty. It is a matter of common sense. Would I take them to the doctor if they have a stiff neck? Not without a fever. They probably slept wrong. If I went to the doctor's office every time I had a stiff neck, well, I would be MORE broke than I already am. My pillows suck. What can I say.

Some infections can lead to serious systemic complications. Strep, for example, can lead to heart complications if left untreated. Chief complaint of TOE PAIN will make eyes roll. Understand that in advance. Especially when (A) you have had said pain for 3 weeks,(B) have not gone to see your doctor for it and (C) have not taken anything for the pain. WHY ARE YOU HERE? Boredom? If you, as a patient, leave questioning the discharge instructions, or lack thereof, thre is a good chance you should not have been there in the first place.

Also, as a parent or extended relative, do not state, just after introducing yourself to the doctor, that you already know what the problem is. For example, "it's probably GERD because everyone in the family has it." It defeats the purpose of doing an exam and basing a clinical impression of factual data. GERD is a diagnosis of exclusion and unless you have a scope shoved down your throat to confirm acid is eating your flesh, shut up. When asked, what seems to be the problem, never answer "she just needs to get smacked around a bit like all grand kids do." You are risking your status as Grandpa of the year. The party is paid for, and the catering is all the crap left over on the front of your t-shirt. You arne't an expert...in anything...or else you wouldn't be here....at 1AM....in flannel....wearing Famous Dave's....from 2007.

You complain of shortness of breath. This is not a new complaint. You have been here for the same thing the last 20 times this year. You smoke 2 packs a day. You are still confused about how lung function can be compromised by a 3 inch stick. Read the label. Google image "emphysema." Read about COPD....read about home health care....buy a plot. If you came to the hospital thinking that a MD is going to tell you it isn't the cigarettes, and your family is wrong about the 4 interventions performed on your behalf, then your tobacky is wacky.

Common sense should come in a pill. I have bouts of DOH on occasion. Just because I have a couple years of schooling doesn't mean I know everything. I do know, however, how to save myself a hefty medical bill. Common sense. Some people should get some, then keep some on hand for the next time they are dying....kinda.

Non-Emergent

I am all for providing care for the ill, even the chronically ill. My disclaimer is my oath. If a patient comes to the Emergency Room, they will get equal care from me, even if their chief complaint is as annoying as being kicked in the balls repeatedly by a mule. That being said...I gots some problems with some people's definition of "emergency." I may have posted something about it before, at least the definition problem. Every day I work, however, shows me that what I think is an emergency, is not always the case.

For example, if you have to take a taxi to the emergency room...is it really an emergency? I know, you don't have a car. I get it. That's why they have ambulances so you can be transported for care. On the flip side, calling 911 to have an ambulance bring you to the Emergency Room to avoid waiting for an hour in triage, depending on your condition, will most likely put you in triage to wait just like everyone else.

Most ER visits are long. Staff will do their best to make sure that your ER wait is as short as possible, but like a walk-in clinic, you are seen based on accuity and arrival. Both factor into the length of stay. A finger laceration, as painful as it may be to you, is often trumped by someone experiencing chest pain, or stroke symptoms. Common sense. Don't get mad when someone who just got there goes back before you do. Oh, and it has nothing to do with race...FYI.

If you have been diagnosed with antibiotics less than 24 hours prior to your ER visit for similar symptoms, and you haven't filled the prescription from yesterday's visit, don't be surprised if your visits with the doctor is very, VERY short. At the same time, if you HAVE filled the prescription, and HAVE started the medication...YESTERDAY...and still have, let's say, sinusitis...give it time. It's like a cell phone taking a little while to load. The signal has to go to space and back. Great technology. Show some patience. Antibiotics need to build in the system before your problem gets better. Save $500 and wait.

If you chipped a tooth, see a dentist. Especially if it was chipped 3 weeks ago and your face is swollen. Not knowing why your face is swollen is a sign that you should be a ward of the state. The is not a whole lot the emergency room can do for you. We are more prepped to handle....emergencies. Heart attacks, strokes, gunshot wounds, stabbings, motor vehicle accidents. We have specialists on-call that can assist us with those types of...emergencies. Hard to believe we don't have a dentist or a podiatrist on-call, I know, but we don't. We try our best to provide the care you desire. Often times, its a dental block to let you sleep and...go to a DENTIST. If this becomes an on going problem, and this is your 12th visit in 6 months for the same dental pain, all of which have been the same with instructions to go to a dentist, not much will change in the approach to the care that will be given. 2mg of Dilaudid given IV is not the protocol for a chipped tooth, nor is it lawful in the State of Washington. I accept the fact I will not be getting a Christmas card from you. I apologize.

The emergency room is not a spa. Coordination of care is directed by professionals that went to school for a long time to get you in and out the door. There are standards and protocols in place to make sure that you are given care in a timely manner. There is no other way to say it nicely than....go home. There is nothing EMERGENT that can be done with your abscess. It has been incised and drained, cleaned and dressed and the prescription is in your hand. ESPN is on pretty much everywhere. Sportscenter repeats every hour after 10 P.M. You aren't missing much. The are limits to what we can do for you. No offense, but there are people that are waiting for the room. No we cannot admit you for a food tray because there is no reason to admit you. Subway, however, is open.

When entering the emergency room, do not walk from your car, briskly, enter the doors and plop down in a wheelchair and adopt the facial grimace from hell. Funny thing about windows...triage nurses can see through them. You lose credibility when you come for shortness of breath upon exertion and you were seen smoking while you skipped to the door, laughing and talking on your cell phone. Morphing into the wheeze monster who spews sentence fragments while speaking to the triage nurse doesn't fool anyone, especially when your oxygen saturation is at 99%. Notice the signs strategically placed throughout..."It is against Washington State law to dispense prescriptions for narcotic pain medication for chronic pain conditions. You will need to get your narcotics from one physician, typically your primary care doctor." Funny thing about records...we keep them. Today, shortness of breath, the previous 55 visits...back pain. We'll do what we can to get your saturation level from 99% to 100%, but unless your trachea deviates to one side of you have a lung mass...don't be mad when you are sent home with Albuterol instead of 20 Lortab.

I love my job. I love that one day, I will be a practicing nurse. But I love common sense even more. I wish someone could prescribe that...

Realistic Consequences are Best

My 8-year old has a hard time with choices. I believe that it is important to direct children to making good choices now because poor choices are a gateway to SERIOUSLY poor choices that hold more severe consequences later in life. Peyton feels that we hate her. No matter how I try to tell her if that were the case I would help her pack, she still believes that living under my roof is like having her legs broken ala Kathryn Bates in 'Misery.'

"Peyton, can you please go put your clothes away that are in your room?" - WAHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH....whhhyyyyyyyyyy do you do this toooooo meeeeeeee???!?!?!?!??"

"Peyton, please finish your milk and put your dishes in the sink?" - YOOOOUUUUU HAAAATTTEEEEEEE MEEEEEEEEEEEEEEEE!!!!!!!

"Peyton, could you not play in the dirt before you go to school? You will get your clothes dirty." - RAPPPPPEEEEEEEEEEEEEEEE!!!!!!!!!!!!!

It doesn't matter the request. There is always bartering and banter that comes with it. The above are reactions that depict, somewhat, the typical reaction. The atypical reaction is the request is fulfilled without resistance. However, that is about as popular as a Centaur feeding in my lawn. It never happens. It's really hard to come up with a consequence I can actually follow through with. For example, as she is eating a meal she has eaten in the past, I watch her face at the table wrythe and contort into every possible shape to convey to me, non-verbally, that she is eating glass. It's hard for me to watch her behave this way, knowing that there are people, RIGHT NOW, cupping handfuls of urine to satisfy extreme thirst somewhere in the world, and NOT want to throw her through a wall. Instead of saying something reasonable like, "Peyton, if you don't finish your food, you will need to go to bed," I say something like "Peyton, eat...because if you don't I will let loose 100,000 black widows in your room and break your light bulb and lock the door." I can't possibly do that. I hate spiders. I can't handle ONE let alone 100,000. Pfffft...makes no sense.

That's just food. If you want to talk about clothes for school that day, that is an entirely different story. Before she goes to bed, she picks out what she will wear the next day. Seems legit. Until the sun comes up and all bets are off. Setting them out the night before saves time. However, when you have a multiple personality pseudo-disorder, as AM Peyton and PM Peyton are different in ways I cannot convey in words, this is a chore. She has learned that the more resistant she is, the more she will simply get her way as to avoid an adult aneurysm. My bad. I have evolved. So has Mom. Now, what she picks out at night will be what she wears in the morning. If she chooses not to, she will need to go to school naked....because that is realistic. Ok, not so much. I have also threatened to burn her clothes and went so far as to grab the flick lighter and hold her clothes a few inches from it...and thought better of demonstrating pyrotechnic behavior to my son who is sucking this all in. I figure, let her wear fuschia pink shirts with a denim skirt and green and navy blue leggings. The playground police will fix this for me. She will become socially irrelevant, and then she might listen.

As far as she is concerned, her Mother and I know absolutely nothing. Funny how I was the same way. My parents attempted ther whole lives to teach me right from wrong. It wasn't until I was older, maybe wiser, and a parent that I realized that I was wrong. My parents knew everything. Maybe I will dig a grave in the back yard with a blank name plate and tell my kids that that hole is for the first one to give Mom flack?

But that's not realistic....or is it?

The Scariest Thing in the World

Some would say spiders. I am in that group. I hate spiders. Other people are scared of snakes and clowns. I hate clowns too. Snakes don't bother me unless I am covered in them in an enclosed space, which never happens, so I am OK with snakes. Recently, I was exposed to a group of people in a mental health unit that are scared of everything. As not fun as that sounds, I cannot really comment because of HIPPA regulations. To me, the scariest thing in the world is three-fold, and I see it far too often.

White hair, expensive car, and a cell phone.

Under normal circumstances, those singularly placed into society would not elicit fear out of anyone, unless you fear old people, wealth and technology. I don't fear them seperately. When put together, however, it is down right frightening. Take today for example. I was driving down the road, minding my own business, when the nose of a very expensive Mercedes lurched out in front of me traveling down Leslie Road from one of the many side streets that are along this road. I had to brake pretty hard, and audibly said "what the phuck are you doing," glanced over to see who was driving and all I saw was a tall bun of white hair and a cell phone. Let's examine the logic in this, shall we?

First of all, as people age, their reactions become a little slower. It's like being constantly stoned. Reaction times are diminished significantly. This is on a good day, without distractions. It doesn't make much sense, then, to add a cell phone into the mix. I mean, first of all, you have to be aware enough to have the conversation as opposed to drifting off to the good old days sitting in a puddle of your own urine. If the phone call was to her doctor's office telling them "oops I crapped my pants," or "your urine specimen is in the seat cushion of my car," I suppose that could be made....while NOT operating a heavy piece of metal. Bad idea, grandma. Don't do this.

Secondly, it has been my observation that the more expensive the car, the less likely the driver is to obey ANY traffic laws. This includes, but is not limited to, rolling stops, failing to yield, tailgating, speeding, lack of turn signal usage, random cutoffs, inability to stay in one's own lane and speeding through yellow lights. It happens too often with a car whose value exceeds $40,000. This was a NEW Mercedes. New only by observing the sunlight glistening off the chrome wheels. I could be way off. It could be 10-years old and her husband (cabana boy?) has nothing to do but wash the car 4 times a week. Welcome to retirement. However, age plus wealth equals phuck laws, I'll just write a check. Strike two.

A quick aside, since it bears some relevance in respect to the Mercedes reference. My parents drive Nissan's, made in Japan. One of my parent's neighbors commented on their support of the Japanese and how neglectful it was since Japan bombed Pearl Harbor. This particular neighbor drives a Mercedes....made in Germany. Now, I am not one to categorize human atrocities. However, I believe the Mercedes is dirtier. Just saying...

Finally, as people age, they get a condition known as Noassitol. It inhibits the driver of the vehicle to sit up tall while driving, hence the vision of hair talking on a cell phone. Her sunglasses were on the bun. It literally looked like hair was driving. When a head check in traffic, however, reveals the rear door handle, it may be time to raise your level of sight. I am no expert but I believe in order to operate a motor vehicle, most states require the ability to SEE the field in which you are OPERATING said vehicle. Call me crazy, but it makes sense that the driving age is not 10 for that reason, along with many, MANY others. I don't want to be an asshole and get all high and mighty on this woman. I am sure she has lived a great life, and can act as she pleases. However, after you leave your driveway, you kind of need to be more...how do I say this...equipped to drive a car. It is really for the safety of others. Don't get me started if I had to add roundabouts in here.

That will require calculus...

Of Course This Happened

This conversation actually took place. The names have not been changed because anyone willing that would sue me over this can't read, or cannot afford the Internet.

8:47PM (knock at the door)(Kid's scream "I'LL GET IT," and scramble to the door. I yell, "SIT DOWNNNNNNN," and get up to get the door. (door opens)

Ariel - Ummmm....hiiiiiii. I need to ask Peyton something?

Me - Is that a question? Want me to shut the door so you can refocus your energy on your tone of voice?

Ariel - I need to ask Peyton something.

Me - I know I heard that part, although bravo on the change in fluctuation. Unfortunately Peyton is in bed already.

Ariel - can you wake her up?

Me - I can but that involves doing something that makes absolutely no sense. It's almost 9PM.

Ariel - Can you wake her up?

Me - What the fuck?? Your like a parrot. Do you always repeat yourself or is it just really organized Tourette's?

Ariel - (stares back blankly)

Me - (waves hand in front of Ariel's face) Anyone home or is your Mom's pre-birth drinking problem kicking in?

Ariel - I need to ask Peyton something

Me - I know...we've been over this already. What do you need to ask her?

Ariel - I need her to sign my shirt.

Me - That's not really a question. That's more of a demand. A question is like a request...like when your Mom said do you have protection and your Dad said no and then....here you are, verbally waterboarding me with your words.

Ariel - Can she sign my shirt?

Me - she can't get her clothes in her fucking drawers while she is awake. Something tells me, like common sense, that she can't do that while in a coma

Ariel - what's a coma?

Me - It's that thing you aren't using in your hair, with an 'A'

Ariel - Can she sign it on Saturday?

Me - Nope.

Ariel - Why?

Me - we practice a really screwy religion where writing instruments aren't used on any day that ends in Y. That pretty much leaves Saturwednessun which, unfortunately for you, doesn't exist.

Ariel - when can she sign it?

Me - about the same time you become tolerable

Ariel - (silence)

Me - soooo...about never. Does that suffice??

Ariel - Maybe?

Me - again with the questions....I have to go tend to my sheep so don't be offended when the door slams

(door slams)

There is a high probability that this girl, accidentally or not, broke my wife's car window. She has a sociopathic look to her that makes me fear for lives of rodents and local door knobs. She eyeballs Peyton's rabbit like it's a pork chop. I know I am getting old behaving like a grump, but I only have so much patience and I reserve it for my family, and my patients. Beyond that, the Future Serial Killers of America can deal with the rest.

Chief Complaint

I suppose I should clarify what I do at Kadlec. I am a nursing student, not a nurse. I suppose I am a nurse-in-training, but I do not interact with the patients. In all reality, I do, jokingly, once the doctor has done so and it is apporpriate for me to do it as well. Let's say that I have not left a patient's room with the doctor telling me to knock it off. Yeah, I am surprised too. I am a scribe. Not the quiver-n-bow type scribe, but a medical scribe. I make paper. Well, electronic paper. I chart while the physician examines the patient. I track lab results and diagnostic tests for the doctor and prompt him or her to read them, interpret them and I will transcribe these verbal findings onto the chart.

Now, as mundane as that might sound, I love doing it. I love seeing the interaction that the docs have with patients. I love seeing their minds work and asking questions about the process. It is a trememndous learning experience, just as I thought it would be when I first applied. All the doctors are amazing clinicians and I know that when I am done with school I will owe them a debt of gratitude for both teaching me and tolerating me. However, I have seen some really, REALLY stupid things roll into the emergency room. Things that do not require emergent care and things that are referred from doc-in-the-box type clinics for further evaluation. The list of things that should not come into the emergency room is in my head, which, as we all know, can be a very insane place to hang.

A "chief complaint" is the complaint that the patient complains the most about. For example, often times a patient has so many complaints in triage that the nurse has to narrow it down to one. Often times, even that one is bullshit. However, since people come into the emergency room, the deserve proper, adequate care to relive this complaint. The list of interesting chief complaints is somewhat comical since what their diagnosis ends up being often has nothing directly to do with their chief complaint. For the uneducated, however, here is a list of things that do not require EMERGENT CARE...since that is what is done at the EMERGENCY ROOM.

1. Bug Bites - not brown recluse bites or black widow bites, or numerous wasp stings, but just 5-6 mosquito bites, none of which are infected. Simple treatment would include over the counter Benadryl (antihistamine to relieve itching) or Calamine lotion (topical ointment to relieve itching), both of which were not administered prior to arrival. When asked why they came to the emergency room, the parents of this 9-year old indicated that their child was itching these "huge bites," the biggest of which was about the size of a grain of rice. Diagnosis : bug bites, multiple. Prescription: OTC (over the counter) Benadryl. That will be $400 please.

2. Nausea - no vomiting, no diarrhea, just a stomach ache. When asked to grade the pain on a scale of 0-10, with 10 being someone smashing your legs with a sledgehammer, the patient graded it a 9, remote control in hand switching it to the NBA playoffs, feet crossed over each other, bed reclined, ala home recliner comfort. No abdominal tenderness to palpation, no fever, no real illness. I think this guy was tired of dealing with wife and kids while the game was on. A CT scan later to rule out any acute injury, $1000 or so, and off he went. Be sure to drink lots of fluids.

3. "My pee smells really bad..." - Sounds like it could be a urinary tract infection? Sounds serious enough, right? I mean we have all been taught that stinky anything is indicative of an infection, right? If that were the case I have had an ass infection my whole life. While being questioned about recent food, drink or antibiotic use, patient indicated that he had ingested some asparagus prior to arrival. End of exam. Diagnosis - normal exam. Prescription - car keys.

4. Abdominal pain/pelvic pain - I cannot fathom menstrual cramp pain, at least directly. However, every 28 days I do get an indirect idea of how these feel. Ouch. I get it. But when asked if these cramps are different from previous menstrual cramps, the patient indicated these are the same. No abnormal or excessive bleeding. WHY ARE YOU HERE? "I am out of Motrin." Wow....really? This will be some expensive Motrin. Next.

5. "My skin hurts." - Can you describe the type of pain you feel? "No not really." Is it like an itcing or burning pain? "yes, its like that." Is it also like a cramping pain? "yes EXACTLY like that. My skin feels very crampy." Can you tell me one spot that hurts worse that anywhere else? "Right about here (motions hands over his whole body; head to toe)." Have you taken anything for the pain? "I took some Benadryl and Motrin." Did you have any relief? "No, that made it worse." Are you allergic to any medications? "Ibuprofen and Benadryl." Did you know you were allergic to ibuprofen before you took it? "I didn't take ibuprofen, I took Motrin." That's ibuprofen...they're the same thing. "Oh...well, why is it worse?" Because you are having an allergic reaction to the medication you took. "Oh...can I get a shot of Dilaudid then?" I'm sorry, according to your care plan, I cannot administer any narcotics during your visit to the Emergency Room. "Oh ok, well I am feeling much better now. Can I just leave?" This happens quite often...more than you know.

There are many, many more I could illustrate but I don't want to bore you any further. From a student perspective, it is a great opportunity to listen to patients talk and be able to filter out the bullshit. My filter was not as keen as it was before I started. I am a tad cynical when my kids come complaining about certain ailments. When my wife took Peyton, now 8 years old, to the emergency room as a two-year old (see previous blog post from 2005), I laughed before she left, as did the docs at the ER I am sure. Diagnosis, diaper rash. Prescription: diaper rash ointment. I think that visits was about $300. Should have framed the bill. Unless they are bleeding from their numerous orifices profusely, or have dangling limbs bending in ways that God did not intend, they can wait to see a doc-in-the-box.

I don't want my kids to be someone else's blog fodder. They are for mine.

Coupons? Seriously?

My disclaimer for this post is this: I know nothing about it. My anger stems from others who use it while I am shopping and know nothing about it. Just because TLC does a show about it doesn't make it an acceptable practice. I believe Sister Wives is a TLC program.

I rest my case.

Coupon shoppers annoy me. It isn't that they are being proactive and wanting to save a ton of money. To me, at least from what I have witnessed, it is an excuse to hoard. Who needs 12 boxes of saltine crackers and 22 bottles BBQ sauce? It seems to me that what you save in money you lose in living space. I am sure its awesome to never have to run out of water, bread, Hershey bars, laundry soap or thumbtacks. That's awesome for you. You saved $50 on a $200 bill? That's efficient and news worthy. It burns when I pee. But I don't go shari...err....you know what I mean? I don't care. You are better than me. I get it. That's fine with me. Just know that when I open my linen closet, there is linen in there, not 38 boxes of Rice mix, 14 jars of Jif and 33 Power Bars and 4 jars of shoe polish. It's hoarding.

The express line is just that...an express line...express, meaning hurry the fuck up and all 3-ring binders are to be kept in your back back. It's not impressive to pull out a binder that has more earmarks than Obamacare. It's kind of annoying. It causes eyes to roll. Then, you apologize which acknowledges the fact that what you are doing is inconvenient to others behind you.

Checker - Ma'am that will be $39.97 (I say ma'am because its a woman doing this. Guys won't coupon shop...too much work. Besides they don't have coupons for beer.)

Coupon magnate - Wait....I have coupons

Checker - you need to present those before you are rung up. Do you see the sign? (points to sign that says present coupons prior to checkout, fuckchop)

Coupon - I just need to get them out (takes out laptop, can of tennis balls, earmuffs, 22 inches of heavy chain link, one sock, a tube top that says 'OK-95,' 18 chapsticks and a swiss army spoon)...here you go

Checker - .50 cents off Depends? You don't even have Depends in your items?

Coupon - Oh sorry not that one....this one.

Checker - Buy one Trident, get the 2nd one at the same price, must buy 400 Tridents? This one? You realize this is a 15 item or less line right?

About this time there are 8 people with 12 items between them about ready to gang rape this woman. Why? She watches TLC and wants to save a buck. In all reality, to each their own. For the record, I don't care it works for you. I don't care to learn about it. I'm not mad that someone else does it and I don't. It doesn't bother me if you know what the hell you are doing. But if you don't, pardon me if I punch you in the vagina. I just need this milk...this one jug of milk so I can be on my way.

Asshole.

Parent First, Friend Last

First and foremost, parenting styles are different. I get that. However, I believe there is a constant that all parents should share but seemingly few do. That constant is that as a parent, you are a parent first and a friend later. Period. End of story. I believe there is a generation of kids being raised that have little knowledge of right and wrong. Isn't that the job of the parent? If you are right, you get to stay here one more day. If you are wrong, I'll help you pack. I can't remember a time when I mistook my parents for my friends. Thank God or else I could describe a jail cell down to the dots on the cinder blocks.

I love all my kids. However, if they "hate me" because I won't let them do everything they want, so be it. I will get over it long before they will. It's the nature of the beast. I provide food, shelter, clothing, a sense of well-being and moral support...maybe some assistance with homework and a ride or two. Beyond that, let the molding begin. I have heard too many times that "my parents were strict and I hated it, so I am trying to be my kid's friend first," and every time I hear that I want to open up a sterilization clinic. That's not your job. Your job is to provide the knowledge and skills that are required to function in society, not to make sure your child's friends like you. My house is a gathering point for the socially inept when school gets out. I'm glad my kids have friends. Is it wrong that I want to make sure that their friends aren't going to kill a porcupine and hang it from a door knob? I don't think so, and even if it doesn't sit well with my kids, I don't really care and to the parent's who question why I won't let your kids play with mine after school, go fuck yourselves. I'm not a day care center. Spend time with your kids after school. Ask about their day. Don't send them to my house. Example:

(knock at the door, door opens) Hi, I live across the street and my daughter said that you told her she couldn't play with your kids

Me - Correct

Neighbor - Can I ask why?

Me - No

Neighbor - Excuse me?

Me - Which one of the single words did you not understand?

Neighbor - Why can't my kids play with yours?

Me - For starters, hepatitis. But if you want a complete list of reasons, lice, numerous blood borne diseases...ummmm....I am afraid your kids will dumb mine down, tuberculosis, cellulitis, sinusitis and gastroenteritis. Most important however, your kids need YOU, believe it or not. Go help your kids with simple math. If you can't handle that, Google it.

I have heard from my kid's how they hate it at home. I have offered to help them pack and offered to crack their piggy bank for some spending money. It never really goes very far, but honestly, if I didn't love them, I would let them be assholes. My job isn't to be friends and make them happy by fulfilling every request. That's not realistic. McDonald's management won't do that, so why should I? I need to prepare them for reality. Only way that will happen is by P-A-R-E-N-T-I-N-G. It requires a sense of realism. Parenting now, while they are young allows for friendship later. I have grown up always loving my parents, but have found a certain level of respect of their parenting style now that I have kids. Being a pain in the ass early in life has allowed us to become very good friends. I love them for that. I have no doubt my kids will be the same way as they get older. History has proven it.

Whenever I Feel Dumb....

There are times when I feel....how do I put this....blah? When I get these feelings I step outside and get a dose of what real stupidity is. It takes checking the offspring of the same branch of the family tree and I realize that I am not as retarded as....THAT kid, or THAT kid....or even THAT adult. Last time I cehcked parenting was a full time gig. I mean, it's a tough job, no doubt about it. However, at 3:35, when the bus lets kids off the bus, I go outside and get a good whiff of phuck chop. What do I mean? Keep reading....

It's odd to me to write such a heart felt post and then follow it with a profanity-ridden tyrade on the urine-tarnished gene pool that is my hood. However, it doesn't do anyone any good to keep it all in. I'll explode. It's difficult to tell my kids "no" when they ask to play with the neighborhood kids. When they ask why, I have to lie. No, we are eating soon, or no, you need to clean your room. Those are actually lies. What I would love to say is "no, because they will dumb you down," or "you might catch a case of stupid by touching them," or "wearing camo head to toe when you are (A) not hunting, and (B) not in the military is abnormal." My son, bless his heart, asked me why the kids by the bus stop play in the dumpster. I can't say "because that's where trash plays." He will then go to them and call them trash. Not a lie, however, not appropriate either. It's almost like my house after school is a phucking day care for stay at home Mom's who "need a break." Need a break? This isn't Teen Mom. This is motherhood. "But I am a single Mom." So? Why is this my problem? You have had all day to go to the store. Take your kid. One of my daughter's "friends" came over the other day RIGHT...AFTER...SCHOOL and asked if Peyton could play. I said no, because she had homework. The little feral girl said "what's that?" Shiiiitttttttt......really? Spelling, math...you know...the shit you learn at school between recesses and lunch? I get nothing but a blank stare. It's almost like I have to offer her a slice of cheese or a hair brush to get off my porch. So she asks if Jacob can play. Again, I have to lie. Nope, he is working on pefecting the human genome. If nothing else I can use enough confusing vocabulary to induce a seizure so she can shake away. Every 15 minutes, there is a knock on my door. Today, garage sale lady brought my dog a bone. Not the porn version, but literally a bone. WTF? Who does that? "But Eli, that's nice of her." Phuck that. That's weird. I don't care what you say.

I was spraying Weed B Gone on my front lawn after mowing (both concepts are completely foreign to the neighbors) and the son, the only male in the house asks me what I am doing. Building a rocket ship? What does it look like? Picking apples? Every Spring I have a battle with dandelions. Every year they lose. However, it is a process that takes persistence because honestly, for every dandelion I kill, the neighbor's lawn reinfests mine because they have no concept of weed control...hence the two spawns that roam my driveway like the living dead. I had two gallon jugs of this stuff and thought about letting him have one and he could spray their lawn. I thought twice thinking that with my luck, bastard would hit himself in the face with the spray mistaking the jug of weed killer for a can of paint and he might try to huff it. I can only mentor a certain number of children at a time, which usually does not extend beyond MY and OWN. The world can use another camo-wearin criminal that will need medical clearance in the ER before being discharged to jail.

So if you need a dose of confidence, thinking you may be stupid, let me know. I'll give you directions to my hood. You'll feel so much better...

Thank You

When I got sick, I had this epiphany that life was short and I should appreciate every day that God gives me. I am not sure I have really done that. People often tell me that I am burning my candle at both ends. I get asked "how do you do it? How do you go to school, go to work and operate on little sleep?" I don't know. I just do. I have to. My delay in finishng my education has left me motivated to finish. I'm driven, I suppose, to not just finish but finish at the top. That is with school. As far as work, I have obligations that I have to take care of. It isn't about me anymore. I have a family to help provide for. I don't regret anything to date except for maybe not having this mentality when I was 15. Maybe doing this now, later in life, will show my kids that they can do whatever they want to do if they put in the work.

When I started my scribe job, my hope was to make some great relationships with physicians who would help me progress in my nursing career. However, it has been so much more than that. I have seen scared kids come in and doctors treating them with such compassion, even through their pain. I have watched more code traumas than I care to, however the nurses are unbelievable. Everyone has a job to do and they do it without hesitating. They are truly miracle workers. It reinforces in my mind that I have made the right choice in what I want to do with my life. At the same time, it is a constant reminder of how precious and uncertain life can be. There are no gurantees of tomorrow. I have always known this, however, it rings home when you are present when death occurs. Not just natural death, either. We can never expect the unexpected. No one can. I pray every day to let God give me just one more day to impact someone's life. So far, He has given me my wish. What happens, though, when He says it's my time, or someone I love? Then what? Does it make me less apt to pursue nursing or caring for complete strangers? I don't think so. I ask myself these questions all of the time. It all comes back to appreciation; appreciating what you have right in front of you while you can.

Money will not give me happiness. Or you. or anyone else for that matter. Not in the long run anyway. If I had a lot of money, I would give it away. I don't want money. I want to heal people. I want to cure illness. I want to provide comfort. I want to educate. I want to research and diagnose. I want to find reasons why disease occurs, and then spreads. I want a patient that I am taking care of to leave my care better off, not just initially but forever. That can be a big hill to climb, but that obstacle will not deter me from trying. One person at a time can be changed. Imagine if everyone thought about encounters the same way. What kind of world would we live in?

I love my family. I love my Mom and Dad who taught me about resilience and perseverance. I love my brother, my silent pillar of strength, whom I know will always be there if I need him. I love my kids. Savannah, my oldest who is growing too fast and reminds me about how time together is short, yet sweet. Peyton and Jacob, even when they fight, I think of how when they get older, they will love each ther unconditionally as I did with my brother. My wife, my rock, our family's life preserver, someone I admire in ways I cannot put into words. I have learned to appreciate them more through the tragedy of death.

Today is the best day of my life. I know this because it is happening now. I can only control what I do today. Tomorrow is not certain. I pray for it, and God often grants me this prayer, and I start over, tring to bring a smile to an unhappy face. I hope, as a practicing nure, that my patients will leave knowing I cared. I hope my family knows how I cannot be successful in this effort without them. Life is like building a pyramid, one brick at a time. it takes the efforts of many to see the final result. Often times we walk on the backs of loved ones to get to the top. I appreciate the foundation that was laid in the beginning and I cannot express enough gratitude of the sacrifices made by the people closest to me as I lay the final bricks. I hope that they will be with me to see the finished product, and I can look into their eyes and say thank you, even if those are the only words I can use to express a fraction of the feeling.

No one gets what they want by themselves. I realize this more and more every day. I just hope I don't forget to say thank you once in a while. I hope you don't either.

It's Garage Sale Season

This past weekend, we emptied the garage out to clean it and threw a bunch of stuff away. I call it spring cleaning. My wife calls it "I don't want to be called a hoarder." Regardless, it was time that we purged a few things that, to be honest, we haven't touched in almost a decade. It is hard to get rid of things from your past. I am guilty of that very thing. A lot of the things we are holding onto are mine that I have been holding onto for sentimental reasons. I have this vision of my kids wanting to know about me when I was their age. Like they would be looking up to me. Then I think, when my kids are in high school, I will be considered a tool because that is how things progress. The more hip and relevant you attempt to be, the dorkier you are. Sorry Mom and Dad but back then, it was kind of true. =) My parents rocked. Who am I kidding?

Of course, this event started about the time the sun came up. I really have no idea as I was only awakened at 1030 Saturday morning because my wife informed me that she was going to purchase shelves to put in the garage. My eyes were glued shut and as I pried them open, sunlight burned through them, reminding me that I had yet again slept late. I felt incredibly guilty. I through on a hat and shoes and went out to the garage and noticed that it was empty and sitting in our driveway was our history together. I noticed cars were driving by slowly, eyeballing shit they will not get their hands on. I felt compelled to yell "MOVE ALONG, NOTHING TO SEE HERE," as if steering the paparazzi away from Heath Ledger's corpse. One person did happen to break through the verbal bubble. That was our neighbor across the street. She lives on having garage sales. Well, to me, they are sales. To her, it is a way to make rent. She asks me" at a tone and volume necessary for underwater cavern communication "are you having a garage sale," drooling with every step closer to my driveway. I said, simply "no, just cleaning." This must have shocked her to no end. Who in their right mind would....clean? So she repeated her original question. I replied, again, less enthusiastically that I, in fact, was not selling anything. She began to tell me that next weekend some non-profit group was donating their donations to her to sell for income. I cared more about a steel catheter being inserted into my junk than I did to hear about her latest reason for me to dislike my current living arrangements. I feigned interest, similarly to an episode of Sister Wives. It occurred to me that my useless crap could easily be carted across the street and dealt with by someone else rather than having me make multiple trips to the Goodwill Donation wagon in a Honda Accord. My wife, upon her return, concurred.

Jackpot.

So we began dragging things in and without a second thought, began to pile our junk on the front lawn. The neighbor across the street began to pace back and forth, like a hyena waiting for a water buffalo to die. It's almost like watching the clock steadily approach high noon, diners waiting for cookie to ring the triangle. I left briefly to go throw away some boxes and other miscellaneous trash and when I returned, I saw people grabbing stuff from our yard and walking across the street, resembling ants taking food back to the colony. It was golden. This essentially saved me about 2 hours. I couldnt have been happier. Then I helped carry one load over...and I haven't really slept since. I got to hear more than I cared to about the inadequacies of her life, her trials that, according to her, had nothing to do with her specifically, but more TO her. Rough life being unemployed for 3 years. Really? 3 years? How is that? Are you injured? (no) I notice you have enough wherewithall to speed off in your Dodge Caravan for smokes every afternoon, so it isn't a mental defect (at least cognitively) or gross motor skill impairment (you do walk across the street daily for your mail). Seems to me that the choice to be unemployed is yours. Most people look forward to the spring weather for the activities, the fever we all get because winter is over. You look forward to it so the table and chair outside your front door has meaning....you sit in it and get cancer and yell at your kids for being born. Yes, Spring is here. How exciting. I now get to meet more people than I care to...as they park in front of my house....and buy your shit (and some of mine).

Buyer Beware

I have 3 lovely children. 66.67% of those children are girls. 50% of the girls are psycho. 100% of the psycho girls are 7-years old. 100% of the 7-year olds that live in this house that are psycho are NOT bleeding. The above equation says to me that within the next 36-60 months are going to be totally.....awesome....as I wait for the hormones to accentuate the psychosis that is my 7-year old.

I really should have seen this coming. Since birth, she has had a complaint for everything. "The sun is uppppppppppppppppppppppppppppppppp!!!!" Or, "WHY IS THEIR FOOD ON MY PLAAATTTEEEEEEEEEE???" My favorite to this day remains, when asked why she is crying hysterically, "I DON'T KNOWWWWWWWWWWWWWW!!!!!!" That lovely diddy came out of her mouth at 4. It was at the time that my once descended testicles went back home to the abdomen to rest.....forever. About the age of 5, while all her friends were wearing clothes from the Gap with matching accessories, she was wearing Walmart, garlic necklaces, a 18-pound crucifix and a Bible duct taped to her chest, in hopes that the demon within would be exorcised. It failed. As she has gotten older, her complaints, still without reason, are backed by her idea of reason and meaning, all of which are spoken 3 levels higher than the parental retort. In all reality, the trouble lies with Mom because the arguments are between her and Peyton. I should feel lucky that I am indirectly excluded from these episodes, but lately it has come to my attention that something needs to change or else she is gonna be at home longer than she needs to be come legal maturity.

I can see it now, at....let's say....15, she is going to want to get a tattoo. Jamie will say "HELL NO!" She will likely come to me. Of course, I will do the polite thing and say, "what did Mom say," knowing full well Mom said no because you can usually hear that from the next street over. I, however, will say "you bet, let's go!" My wife will inevitably freak out, attempt to stop us and I will tell her it will be fine and not to worry, not explaining how this will go down. Peyton and I will get in the car, her saying her friends have 3 or 4 but she only wants one and she can't BELIEVE she is going to be able to get a tattoo...wow....how cool she will be. We'll pull up to a tattoo parlor, and she will anxiously go find a tattoo book (I guess that's what happens) and check out butterflies, unicorns, Japanese symbols that, below the picture read "PEACE" or "STRENGTH" but actually mean "YOU ARE TOO DUMB TO KNOW THIS MEANS I HAVE A FAT ASS." Meanwhile, I will walk up to the counter and say that my 15-year old daughter wants to get a tattoo and since I was put on this Earth to be a "cool parent," I agreed and then am going to buy her wine coolers for her and her friends (never....ever....ever). The artist will say "great, what one does she want?" ike Christmas morning, she wil run over to the counter and throw the book down, stabbing her choice with her saber-like phalange and say "this one, Daddy. I want this one." I will look down and see a big, colorful Monarch butterfly carrying the genetic formula for the cure for cancer. "Honey that is SOOO pretty, but I have a better one. I have been dreaming for this day since you were 4-years old." I would then plop down the following picture, with the instructions that it can only be placed on the forehead.

That would take care of that....

Lessons Learned

I learned a lot this week. I started a couple IV's, I learned different techniques about patient interactionm, I studied more medical terminology and abbreviations than I care to regurgitate at the moment. That last part was just for WORK. I believe, however, that the most important lesson I learned is that there are no guarantees in life. Yes, I know. This is not an old lesson for me, but we often forget about this golden rule and will take it for granted until the realization hits you like a freight train.

About the only thing were are given in life are opportunities. What we do with those opportunities will define our success or our failure. There is no whining about failure. The saying goes "if you fail to prepare, then you prepare to fail." This is true with just about everything we are. It is more apparent in Nursing school. A lot of you wonder why I am absent at times, maybe not myself. When I made the decision to pursue Nursing as a career, I thought I was going to die, in a very literal sense. I might have cancer, I might not, your liver is failing, oh wait, no it isn't. You have a mass on your spleen and your kidney....and your newly diabetic. At this stage in my life I had not accomplished really anything. "But you have 3 beautiful kids." Sure...but what legacy would I leave behind? How would I impact them in such a way that if I died, they would always remember me? The realization hit me that, among other things, I had the power to impact someone's life forever. I had been underestimating my capabilities for far too long. I could do this and it became clear that my illness was a way for God to really open my eyes to what the definition of potential really was.

Being accepted into the Nursing program, pretty much anywhere, is really the easy part. Sure you have to go through many trials to get there. However, you can't stop when you are accepted. When I got accepted, I wasn't elated. There was no "sigh of relief." I got nervous. I got butterflies. For me, failure wasn't an option. This was going to be the rest of my life. I had finally found what I wanted to do, and I was not going to let anyone take it away from me. My acceptance was my opportunity for something better, for something fulfilling. I had no intentions of thowing it away.

The short of this story is this. I have had 6 fellow nursing students lose this opportunity, for one reason or another, and it pains me to see this happen. How is it that, when given the chance to pursue a passion in life, that you let this opportunity slip through your fingers? We ALL have things going on in our life. We have distractions. We have issues that can cause an impedence in our progress. Aside from death, what else is there that will stop your from moving forward? I don't quite understand it. Was it once a priority and then it wasn't? It is a lot of work. It is more work than I have ever experienced, at least scholastically, in my entire life. To me, it makes it that much more important to stay on top of things. It's like every other project you might be working on. If you get behind, it then makes it that much harder to catch up and keep going. You are more apt to quit, and use life as an excuse. Life is what got you where you are. Life got you the opportunity. Don't make excuses. Own the outcome. You will sure as hell own the reward. It DOES work both ways. Failure is a direct result of preparation, as is success. Where do you stand? Life is going to happen whether you are ready or not. Don't miss out on the chance to make a difference because you forgot tomorrow was coming.

There are no guarantees...even for tomorrow.

Taking Chance

It's not a typo.

God works in mysterious ways. I have always believed that. It seems about the time I wonder if God is paying any attention in my life, He points me in a direction I had no intention to go. I rented this movie. I had never heard of it before. No one had ever told me about it. I am not a semper fi, do or die type individual. I am insanely proud of our troops. This is not a partisan choice. I am proud of them, not because they are protecting our freedom, although that is part of it. I am proud, primarily, that they die for their brothers next to them. I am proud that they demonstrate a bond that cannot be replicated without a certain level of sacrifice that, unfortunately, most of us do not get to implement. I am honored to loudly and obnoxiously state GOD BLESS OUR TROOPS to anyone that would listen. I do not believe I am alone in this, but this movie made me really appreciate a side of our military that most outsiders are not familiar with.

The military escort for a fallen brother.

This process was so deliberately illustrated without saying a word. As a viewer, I could objectively see how marines form a bond beginning at recruitment, continuing through boot camp and the battlefield, and even in death. No man is left behind is not just a saying established in battle. It extends when a soldier is killed in the line of duty. It was an eye opening experience for me to see, not just what happens, but how, in this particular soldier's story, the public honoring a stranger. As a society, these deaths are just newsworthy for a brief moment and skipped over, not giving credence to the sacrifice given by the soldier and also the family. Sure, the soldier know what the consequences are for entering battle, but they do so without hesitation. They do so to protect their brothers, their family both in war and in peace. They do what outsiders may think is a worthless cause. Names of the fallen soldiers are attached to a presidency when in reality, politics is not what drives these men and women to do their duty. At least, not domestically. I'm sidetracked.

An escort will accompany the remains of a fallen soldier home, to a funeral director, and will pass on the personal effects to the family. The story was amazing. Any movie based on true events, and one without addition of un-Godly amounts of cinematic license, is one that will catch my attention. This was one of those movies. I watched it twice,back-to-back, because I wanted to see dedication defined. Without going into too much detail, it is a story of a stranger accompanying a stranger, to pass him on to strangers and everything in between. Watch a trailer. Read the story about it online. Then go rent it. It will change the way you view things. I guarantee that.