Another fabulous mini vacation...

A relic I felt worthy of posting now..
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Went on another great vacation while Noah is on a work hiatus. We had a wedding in Los Gatos on Saturday June 9th so we headed up a day early and stayed in San Jose. The drive was about 5 hours; we enjoyed our iPods through the car stereo and stopped at a rest stop and ate Framani salami, d'affinois soft cheese, and hunks of sourgdough bread. We switched back and forth on driving duties, laughing when Noah did a funny South Park imitation "They took our joobbs!", and telling each other in a funny voice, "We're havin' fuuunnnn!"
Our hotel was modern and cool and we headed straight to the pool for the afternoon, drinking the champagne of beers (Miller High Life), and diving in when we got too warm. We had reservations at a Michelin 2 star restaraunt and called a taxi to take us there at 7:30. They sat us at a wonderful corner table and we didn't leave until 12:30! We ordered the tasting menu paired with wine; the food was amazing, the wine was equally, and at the end of the meal we met the chef who had actually met Noah at a bookstore some time back. Go figure..

Another day, another dollar?

Just informed at work today that no one is receiving raises this year. What?! Is this legal? According to our CEO, because of the financial situation of the hospital, no one is getting a raise. Not just nurses, but, supposedly, all staff. I hate to say it, but I must confess, that I will not feel bad "padding" my hours. If I clock out at certain times I will suddenly be getting double time. The worst thing a hospital can do is hurt overall morale. That will not help the financial situation of the hospital. Please reassure me that other hospitals are going through strain...

So hard to keep up...

It's so hard to keep up on all that happens at work (as you all know). Tonight we had this poor guy who was in his bathroom at home and the (cheap) framed mirror he had on his bathroom wall broke and fell on his calf while he had his back turned. It basically sliced through skin, subcutaneous tissue, fascia, and muscle on its way down. It was on of the gnarliest lacerations (if you want to call it that) that I have ever seen. The ER doc spent one and half hours and over 80 stitches to put his calf back together again. The doc was kind and gave him a milligram of Dilaudid to help him through his ordeal as well as several shots of 2% lidocaine. Can you imagine having part of your calf muscle sheared off by a mirror??!! Does that trump the seven years bad luck rule??

God, what to say about our beautiful trip to New York? (Our new favorite city). Noah got fired (not so unexpectedly) on Tuesday night and as we sat up late night on Wednesday we realized we might not get another chance to take such a last minute trip since I conveniently had 5 days off in a row. We bought tickets on Travelocity at 2am for 3 nights at a modern, hip hotel in midtown Manhattan,. We flew from LAX on Friday morning and landed at JFK at 1 pm eastern time. We cabbed it to our hotel on 5th ave and 55th street. After a celebratory drink at our hotel lounge we took a cab to 5th ave and 9th street for 9pm dinner reservations at a restaurant Noah had read about called Cru. We have eaten at the top places in LA and this place blew them all out of the water. Food, service, ambience...it was all there. The maitre' de asked us where we wanted to eat while we visited and personally made us lunch reservations at Cafe Boulud for the next day. We flagged a cab (great thing about NYC, the minute you decide you want a cab, you wave your hand and there it is), and went back to our hotel. (Our cabby casually asked us in the quintessential NY accent 'You all seen Paris Hilton?').

The next morning we discovered the beauty of the subway system. All you need is a map and a $7 "fun pass" to get you anywhere on Manhattan all day long. We checked out the Union Square Farmers Market. The weather was beautiful, spring had sprung in New York and ramps, herbs, flowers, and people of all shades were out and about. We later headed to Central Park and took all sorts of pictures while saxophone players serenaded us and cherry blossoms drifted past. At 1:30 we walked to Cafe Boulud and ate an amazing ($150) lunch. The staff treated us VIP and Noah (typical!) knew the guy that was seated two tables away from us. Small world! We ate, for example, white asparagus veloute (soup) with vanilla oil and garganelle (a handmade pasta) with morels, snap peas, and english peas. Noah ordered sticky toffee pudding for dessert, I of course, didn't order any but they sent me three different types of house made ice cream. We walked off lunch checking out the neighborhood, then got ready for dinner. Dressed up and (of course) took the subway to the Madison Square Park area and had a cocktail at a place where Noah knew the chef. Then around the corner to A Voce for dinner, an new Italian place that is impossible to get last minute reservations but Noah "knew someone". Aaahh, the beauty of marrying a chef! I highly recommend it. After dinner we hit a rooftop bar that had an amazing view of the city...and then things got a little foggy. Way too much booze! We got the subway back to our hotel and at about 2am was eating hotdogs and schwarma at the nearest corner stand. Another great thing about New York...there is always something nearby that is open.

The next morning we headed up to the top of the Rockefeller Center "Top of the Rock" and was blown away by the incredible view. (See above photo.) We were to meet up with a great friend of mine that I hadn't seen in six years but she was driving in with her family from New Jersey and we weren't sure when she was going to make it in so we headed over to Greenwich Village to hang out. We got a call from my friend, Stacia, who said she had taken the subway in and on a whim got off in Greenwich Village. We hadn't told her where we were going and, wonderfully, we were 4 blocks away from each other. So we hooked up and had a picnic at a small neighborhood playground where her kids could play and we could catch up. Stacia is one of those one-of-a-kind friends that no matter how long you have been apart it feels like its only been a couple of weeks. So happy!!!

Still, the sun is shining in the city. I have blisters on my feet but don't care. We are spending way too much money but realize it's worth it. We fly out tomorrow and start to feel sad. We contemplate moving to NYC and then are realistic that all the beautiful things we see now would seem different if we weren't on vacation. It's such an incredible place with amazing things to see. The more we checked off our "to do list" we only added more. Go if you have the chance.

Patient's that are absolutely bonkers..

Oh boy! Ran into some serious wackos tonight...(yes, wackos is a medical term):

A guy came in with a complaint of "out of Valium". On his chart he had listed a long, long list of medications he says he regularly takes, including heavy duty narcotics. But reports he has no regular physician. I asked him, "Where do you get your medications?" He answers, "The pharmacy". Brilliant. "No," I said. "Who prescribes your medications?" He says various Emergency rooms he visits. He has insurance, people! He has no reason not to have a regular doctor to prescribe! Instead he racks up gigantic ER bills because he is too lazy (or too drug seeking) to get a regular doctor. And you wonder why insurance is so f*cking expensive?! Blame assholes like this, working the system. Guess what? We didn't give him shit except advice to see a regular doctor.

A woman came in because she just had genital warts frozen off. She said she wanted information about cervical cancer. The PA asked her "Didn't your doctor give you information?" She said, "My doctor told me I was going to die in 3 to 15 years from cervical cancer." Okay... So we gave her information after telling her that she must have misunderstood what her doctor meant. When I brought her discharge instructions she asked me if she could volunteer at the hospital. I said she would have to call the volunteer department. She asked if she could volunteer on the cancer ward. "I don't know how it works but you can ask," I responded. Then she said, (obviously this girl was only hearing what she wanted to hear) "I want to work on the cancer ward so that I can learn about cervical cancer." Whoah, whoah! "You cannot volunteer on a cancer ward and quiz patient's about cancer!! Look on the internet, go to your doctor, the local library, whatever! But do not volunteer with cancer patient's to get info!" I called the volunteer office and left them a message that this woman probably wouldn't be a good choice.

A woman came in after being "assaulted" by the police. Her daughter had been pulled over for a traffic violation and had somehow ended up in handcuffs. The mother had showed up on the scene and apparently charged the police officers. They grabbed her arm and pinned her against the hood of a police car. The cops let both of them go eventually but the mother ended up in our ER in hysterics. "I'm a teacher! They can't do that to ME!" (Common elitist view) In an ER we are required by law to report, to the police, any assaults. So a sargeant showed up to take a statement and of course this woman flipped. "I don't want this man in my room!", etc, etc. I felt bad for the poor sargeant because he was not involved in the incident and he was just trying to do his job. And I have to give him props for being polite even though she was verbally abusive toward him. She refused to give a statement to him but did agree to sign a medical report waiver so that the police station would receive a copy of her chart. The police asked me to accompany him to the car where he had the paperwork. I walked them out to the police cruiser and this women would not shut up about the "travesty" that had occured to her and her daughter. All the policeman wanted her to do was sign a peice of paper. But she couldn't stop bitching and complaining. So I took her by the shoulders, looked her in the eyes, and asked her, "What is your top priority right now?" She immediately responded, "My daughter." I said, "Sign the papers, go to your daughter, and deal with all this bullshit tomorrow!" She got my point and left 10 seconds after signing the paper. So the poor sargeant and I had a good laugh over what a freak she was. Now, don't get me wrong. I understand why she was so upset. But if you had been there to hear everything she said and did, you might be a little more cynical. I tried to explain to her that she is in LA and the cops don't know that her daughter who they pulled over is "a sweet, smart girl who goes to UCLA". They just know some girl who was just pulled over is now not obeying their commands and freaking out. And they also don't know that the mother is a 2nd grade teacher just trying to protect her "mentally unstable daughter". They just see two freaky ladies trying to fight with them. My name was involved in the police report because I witnessed her refusing to make a statement and that the sargeant was civil to her. Hopefully I won't ever get involved but in this in this sue happy society, you never know...

On the other side of the bed: nurse becomes patient

It's always weird for a nurse or other health professional to get sick and (gasp!) become a patient. Suddenly subjected to giving over your body and put your trust in people you don't even know, then having to make decisions about your health (usually while under the effects of narcotics). Much like bringing your car to the mechanic and having to trust that they know what they are talking about and trusting their recommendations. Here's what happened to me on Monday night...

Noah and I had been having a lazy, relaxing day after entertaining his family for Easter the day before. I admit, I was a little hungover, but had been taking care of myself during the day, drinking lots of water, and eating good. It was around ten o'clock and I was on the couch watching TV. Noah was working on laundry and went outside to check on the laundry. (our machines are at the back of the apartment building.) After he went outside, I decided to grab some cookies in the cupboard. I rarely crave sweets but they sounded good. I walked into the kitchen, reached into the cupboard, and suddenly my heart started to pound in my chest. At first I just thought I had gotten up too fast and maybe my blood pressure didn't have time to catch up to the sudden movement, then, as my heart beat harder, I thought that maybe I was having a panic attack. I hadn't had one in years but you never know. Granted, all this thought process happened in maybe 2 seconds. Then, I was having an odd dream. I opened my eyes and Noah was standing above me asking why I was on the floor. Cookies were scattered about the floor. I was very confused. "I don't know why I'm on the floor. What happened?" Noah helped me up and brought me to the couch. I was covered in sweat and very pale. Noah looked worried. I kept asking, "What happened?". As my mind cleared, I realized that my tongue was swollen, I had bit it! Now it started to sink in. "I think I fainted!" Then my head hurt and I put my hand up and that's when I felt a gigantic lump forming. "You have to take me to the hospital right now," I told Noah but he was already in action, grabbing me a jacket and his car keys.

My head started to clear a little as we drove and I started to realize what a surreal situation this was. What the hell had caused me to black out and how had it happened so fast, with hardly any warning. And worse, how hard and fast had my poor head hit the kitchen tile to cause this enourmous misshapen lump that was growing on the back of my head? I still felt unsteady as we walked into the doors of the ER, my ER, where I know everyone. The ambulance bay was packed and I knew, and felt guilty, that the ER was busy. I also knew that I needed a CAT scan to make sure I wasn't bleeding into my brain from the fall. They got me into a room right away and got to work. I had to appreciate the nurses as this point. Already anticipating what tests the doctor was going to do and doing them but at the same time being caring and attentive, trying to make me as comfortable as possible. Of course I knew everyone and they were all shocked I was now on....THE OTHER SIDE.

I hate to say it like that but it is true. You have to have compassion and empathy as a nurse but at the same time you have to keep a little bit of distance. If you completely empathized with every single patient, all the hurt, all the sad stories, you would basically be an emotional wreck, unable to get the job done. To a patient it may seem uncaring, but it is a defense mechanism that all medical workers have. Nurses walk a fine line; yes, we want to take care of our patient's emotionally as well as physically, but, we must also save energy for all the other patients that come through our doors, as well as saving some for ourselves and our families when we come home.

So, even though I was "one of them", I did feel the "clinicalness" of the nurses, that is to say, I felt the subtle but still palpable distance as they went about their jobs. And I understand why some patient's complain about their nurse not caring or their doctor not caring. So I watched the nurses start an IV in my arm and draw blood, get an EKG, take my blood pressure, and get my paperwork started. This was them caring about me. Getting things done quickly and efficiently, so that I may start to feel better, find out what's wrong (or not), and then letting me go home with my husband and putting all this behind me. Making sure I'm not in pain, I'm warm enough, I have ice for my head. They cannot stay in the room and hold my hand and stroke my hair. But they can show me that they care about me by getting the job done. I think that is a big misunderstanding in our society right now. The role of nurse has changed, they have bigger responsibilities than ever before. And while some patient's think it is important for the nurse to hold the straw to their mouth while they drink, the nurse must also be getting the labs, running the tests, starting the IV's, giving the meds...you get the picture.

I went for a CT scan and, phew!, no inner bleed just a subcutaneous hematoma from the fall. (We were jokingly calling it my "hematomato" because it was visible from across the room, practically). All my labs were normal. My blood pressure was normal. My EKG...well, that's where it got a little tricky. The doc asked me if I had ever been diagnosed with WPW, aka Wolf Parkinsons White syndrome. It's a heart condition that can cause arrythmias. Well, no I had never been diagnosed with it. He said that my EKG showed only one of the two hallmark signs for WPW so that he wasn't ruling it out. But, like I tell all my patients, this is an ER and I would have to take my health in my own hands and follow up with a cardiologist. I was hemodynamically stable, my BP was normal, I no longer had a pounding headache (after 8 mg of morphine and 1/2mg of Dilaudid), so I was free to go home. That is another thing that people don't understand about Emergency Rooms. We can't heal you, we can't always tell you exactly what is wrong. What we can do is make you stable and comfortable enough to go home and take care of it later or, if you are really sick, we will admit you to the hospital where a more appropriate doctor, a specialist, can take the time to figure out the problem. People expect to walk into the ER sick and walk out two hours later feeling "all better", but that is not a reality and people need to know that.

So, I have taken a few days off work to let my poor noggin shrink back to size. I admit, I had a little post traumatic stress syndrome. I kept imagining what the sound of my head hitting the tiles must have sounded like. And I kept getting nervous when I was in the kitchen or the bathroom, I'd think 'What if I passed out right now?'. But so far so good. I met with my doctor today who is internal medicine. I have an HMO so I am not "allowed" to go directly to a cardiologist until I see my primary doc. He was very nice but also annoying. Doctors have these big brains and they don't rule out anything so as he droned on about possible seizure activity or heart arrythmias or thryoid problems, I had to tune him out. No sense worrying about a thing until it is proved it is actually that thing. My diagnosis? After being a tad dehydrated, I jumped up from the couch a little too quickly and vasovagaled. It seemed more dramatic than it was because I happened to bite my tongue and bruise my skull. But, like a "responsible" adult (and like going to a mechanic), I let him take a few more tests and am currently wearing a Holter monitor which records the electrical activity of my heart for 24 hours. I will follow up with the cardiologist on Tuesday, as recommended. Meanwhile, I'm taking it easy and thanking god I didn't land face first!!

Sunday suppers

We went out to eat twice today. For lunch we went to one of our favorite bistros in West LA/Brentwood called Literati II. Noah had been offered a job there but declined for certain reasons. It has become one of our favorite places to eat, the food is always good and consistent. Farmer's market driven and simple. Since it was Sunday, they were serving brunch. Noah had grilled asparagus with burrata cheese, prosciutto, and a walnut vinagrette. I had a bacon and broccoli quiche. We snacked on pomme frites with aoli, first. Very relaxing Sunday, 2pm. And Noah, being the insanely sweet husband he is, accompanied me to a fabric store where I bought some beautiful apron making material. (See above photo for the awesome finished product! Thank you Amy Butler!)

For dinner, we traveled to West Hollywood (pretty much the mecca of all great LA restaurants), and a place we only go when we are seeking out said great restaurants. We went to a place called Celadon, Noah worked with the chef a couple of years ago. The chef is half Jewish, half Japanese; the food "asian fusion". The food had great clean flavors, was fun, and the kitchen sent us some special dishes on the house. But probably not a place I would go back to. The decor made me feel like I was in Pier One. The service was great though. I was having really bad menstrual cramps toward the end of the meal, you know the kind, feels like you are starting to have contractions. (I say that in theory, of course.) Needless to say, I wanted to cut the meal short and go home and get in my jammies but I also wanted to have dessert. I asked if I could get "The Lemon Trio" to go but, alas, the server informed me it was not possible. Oh well. We paid the bill and started to walk out, me half doubled over my contracting uterus, when the server called us back. The chef had sent us the lemon trio to eat before we left! So, we sat back down and ate gratefully, my cramps momentarily forgotten.

Noah and I never feel guilty for these overindulgent days. Yes, we're taking in far too many calories, and yes, we are spending way too much money. But who cares? We are enjoying our time in LA, the sights, the food, the weather. We are enjoying our years of fast metabolism, low cholesterol, and healthy livers. We will probably pay the price later but for now we are loving our lives, loving food, and, most importantly, loving each other.