morning question

"Will I be good to my neuronal terminals today?"

Suppose you ask yourself that question, and the answer is "no." Do not bother with the rest of that day. It will not be worth the effort.

One of the really lovely things about methamphetamine is the way it damages the terminals of neurons involved with dopamine and serotonin. It chainsaws them. Not a good thing, really, because dopamine is that most excellent neurotransmitter which gives you a feeling of reward when something you do goes well. It's the brain's way of giving itself a nice box of Godivas.

He was asleep when I got report from the nurse on the previous shift. Four-point leather restraints held each limb to the bedrails.

Smoking crystal meth causes the brain to flood with massive amounts of dopamine, initiating a brief intense rush.

It took several staff members and a host of security people to get him there. Somehow he had persuaded the night crew that he would be okay if taken out to smoke a cigarette. He ditched the staff member assigned to watch him and went to look for his soulmate among the bushes near the parking area, so I was told, and police were notified.

The dopamine peak soon subsides, the pleasant feelings ebb away gradually, and the user feels empty and cranky. Tweaking.

A previous incident with the police initiated his little stay with us to begin with. After a crystal binge he swore he saw his most honored loved one doing it in a car with someone else. (Hallucinations? Poor romantic choice? Both?) As she's the mother of his child, (so presumed,) this upset him greatly, and he got weird with a knife or something. The cops tasered him to no great effect, and he took a couple bean-bag-bullets to the chest, too, before he was subdued.

To dispel the emptiness, the user does more methamphetamine. And each time the drug is used, it further impairs the ability of the brain to produce and deploy dopamine in ways that make one feel pleasure naturally. Eventually the habitual user becomes completely devoid of the ability to experience pleasure, except in those meth-induced fitful respites.

He slept most of the morning. Then the calming effects of the medicines began to wear off. He yelled obscenities, struggled with the leathers, and alarmed the watcher at his bedside, who felt that the wrist leathers needed to be re-secured. When we did that he got an arm loose and everything went to hell for a bit.

So goes the downward spiral of methamphetamine addiction, taking with it the twisted and broken ends of the neuronal terminals that allow a person to feel good. Period.

We managed to hold down his arm while calls went out to other staff people and Security. After a couple hours of struggle, and the administration of some sedatives and anti-psychotics, he went to sleep again.

Almost all meth addicts relapse, since there is no other way for them to experience anything positively, really. Love, beauty, a fine meal, a happy ending... nope, nothing there. Banished. Gone like two Beatles.

Then the love of his life came to visit. We did not want her there, afraid that he would wake up, see her, and go off again. There she sat. There he did lay, tied to the bed with leather belts, medicated into submission.

"He really doesn't do drugs that much," she said.

How Can You Tell?

When I got him, he was still pretty messed up. Chest tubes, paraplegic, tracheotomy, and a decubitus ulcer on his butt that was covered by a dressing as big as Tom Delay's face, of which it seemed to remind me. But he was a really nice guy, soft-spoken and polite, and the family members I met were good citizens all. So, the initial story I heard about him didn't ring true to me.

At first I was handed some tale about a home-invasion robbery in which he took a bullet in the back. "Serves him right," some staffers said, going along with the notion that the frightened homeowner was of course justified in blasting this guy into a wheelchair for life.

Then another person, a staff supervisor who I trust implicitly, said that was not the case. Instead, the patient was outside the scene when struck by the bullet. Like an innocent bystander, tragically and randomly cut down by urban violence.

That story fit better with the patient's personality, from what I saw in him.

I never asked him. I did not feel that it was helpful, at that stage of his recovery, to discuss it. He's got the rest of his life to sort it out. I only had the few minutes that my work allows me to spend with each patient, so in that small amount of time, I did what I always do. I cared. We got him looking good for a visit from his children. He had not seen them in a month, due to his intense hospitalization.

Later when he left the hospital, I went to say good-bye and he remembered me by name, though I only worked with him for a few hours. I discussed these two stories with the discharging nurse, and she turned it back around again.

She spent a lot more time on him than I did, so I do not distrust her version, which placed him in the home as something of an accomplice to someone else who instigated the robbery. That still makes him an alleged felon, in a Roshomon kind of way.

It is even presumed that eventually he will be charged. Perhaps when he gets out of rehabilitation.

I would not want that. Paraplegia has a way of reforming even the most violent among us, and he didn't seem to be one of them, anyway.

really doing it

My precocious young one wants us to go to a sushi restaurant and insist that the waitperson bring us "chapsticks" instead of "chopsticks," just to get a funny reaction.

When the young one was 4 she already had "a favorite opera," Salome, so we have several recordings and a couple DVD versions of Strauss's notorious score. She loves it when Salome kisses the head. The head of John the Baptist, that is.

When Macy's had a cutlery sale, this not-yet-seven-year-old insisted that I get a cleaver. I just couldn't talk her out of it. Personally, I prefer a santoku. The salesperson wisely counselled the young one to "be careful with it."

I'll say.

While driving to Winslow one day a couple years ago, the radio was broadcasting a recording of the infamous final scene, which culminates in the head-kissing and then the crushing death of Salome herself. The young one said "Leonie Rysanek." I really couldn't tell, and I have a little bit of an ear for this stuff. On a car radio it sounded like maybe Leontyne Price to me, but the young one nailed it.

Commence walking now

We filled up last night for about $2.27 for the low-grade stuff. Personally, I have made a bet with many people that gas will hit $5 per gallon before Bush leaves office, but it was not the price which caused me alarm.

It was what the attendant said.

"We only have 87 octane," he told my spouse, who went to inspect the W.C. "That's what I'm getting anyways," I said. Then I realized that meant they had no higher octane fuel to sell.

Blagojevich

Under his emergency filing , this northern-state governor has decreed that pharmacies must dispense birth contol prescriptions despite the personal feelings or objections of the pharmacist. If he or she refuses to fill the scrip, then another pharmacist must be made available to do so, or arrangements must be made to have another pharmacy provide service.

This, in response to the recent spasm of fascist legislative attempts to allow pharmacists to apply their "moral" objections to their customers, and the blogosphere (or at least the part of it that is reality-based and of sensible humor,) is resounding with "what ifs." I have a few of my own.

For example: what if I have a Republican patient who suddenly requires defibrillation? Can I refuse to do so on moral grounds? For what, exactly, would be the point of jump-starting the so-called "heart" of a Republican?! It just doesn't make any sense to do so. Not just immoral, but stupid, really.

Isn't pulseless ventricular tachycardia a divine manifestation of God's will?

Other "what ifs" include possible refusals of service to men with Viagra prescriptions, refusals based on racial bigotry, refusals based on just plain laziness, etc.

Why would a pharmacist of firm moral standing dispense hemorrhoid-shrinking steroidal cream to a Republican, for wouldn't that be assisting suicide?!

Or vaginal lubricants? Isn't vaginal comfort just another fiendish Satanic ploy? Would you ask a pharmacist to do the devil's work?! No, I say. Good women hardly need such things. (Smirk here.)

If John Ashcroft were a PetSmart register jockey, would the shareholders support his moral "right" to refuse to sell kitty kibble to owners of calico cats?! In God's kingdom, hell yes!

I'm sick of it already.

Day of Bunnies

There was a period in my life, (there have actually been several,) when I was full of sloth and I would do such things as watch the television game show Wheel of Fortune. This was many years, even decades ago, by now.

As I recall (and after witnessing such, who could ever forget it?) a particular episode of the show featured as one of its contestants a clergyman of some sort. He wore a clerical collar. Several clue letters had already been turned by Vanna White, grand diva of wonderbread female gameshow assistants.

The board was showing this: TH_ ___ T_STAM__T.

It was the clergyman's turn. The wheel was lucky for him and he had a good sum to win. I suspected he would take the easy way and perhaps "buy an E" which would subtract $200 from his pot, but supply a determining clue.

He chose instead to solve the puzzle immediately, saying it's "The New Testament."

Someone else might have chosen "Old." And that would have lost.

A shrimplate moment.

How French is That?

There was a man outside the hospice where Terri Schiavo lay in her final repose (again) and he carried a sign reading "Honor Her Wishes." His name was given as Richard Avant, in the account I read online from Long Island Newsday (morning, 3/23/05.) A progressive fish in a pond of conservatives.

A shrimplate moment.

"Culturally or stylistically advanced" is what Merriam-Webster gives in definition of the word "avant," from the French. Ain't that a kicker, considering the abuse our conservative fellow Americans heaped upon all things Gallic not so long ago.

It is not conservative to honor the wishes of those who lay dying.

It is not conservative to be culturally or stylistically advanced.

It is not conservative to hold the French in honor, even though the freedoms unleashed in their Revolution reverberate, with our own, through history, to this day yet.

It is not conservative to prevent government from meddling in the most private and sacred of marital affairs.

Rather, it is progressive; it is "avant."

Genuine Appreciation

This was years ago: nurse G. quietly asked me to come help him and nurse K. with a patient.

We walked down the hall to the room to find the patient on the floor next to her specialty bed. That particular kind of bed had pretty low siderails, and when little nurse K. had rolled the patient over to clean up a mess of incontinent stool, the patient just kept rolling. Her own body weight (she was quite obese,) gave her the momentum to just go over the rails and K. couldn't stop her.

It took about five of us to get her flaccid and heavy (near 300 lbs.) body onto a rigid backboard to lift her back into bed.

Her urinary catheter got pulled out, and while K. reinserted it, G. and I each had to hold up a fat leg out of the way so K. could see where to insert the new one. How come they never show things like that on TV medical shows?

That particular patient was a controversial one. She was irreversibly vegetative. After suffering a heart attack, she stopped breathing long enough to have suffered immense brain damage. But the family members remained completely in denial about her condition, despite repeated demonstrations from the doctors that she was vegetative.

She stayed at that hospital for the better part of a year. Though there were times when she was able to maintain breathing on her own (such as when she fell out of that bed,) there were also weeks when she had to be put on a ventilator. The medical staff wanted to pull the plug, as did administrative staff. Family refused.

Family also refused to have her moved to a facility that cared for long-term ventilator-dependent patients, because that would be "too far away."

The patient was uninsured.

Anyways, we didn't want the whole place to know that the patient fell on the floor. Of course the proper incident form and doctor notifications were done, but we didn't shout it to the world. It seems safe to discuss it now, under anonymity. And the accident luckily caused no injury, not even a bruise.

There were weeks when I myself was assigned this woman. I never, ever saw a voluntary movement nor any indication at all that she was in the least aware of anything. Doll's eyes.

What blew my mind the most about the family would be when they trotted in the children to "talk to grandmaw." The adults would go on talking to one another about "how good she looks" doting on every flicker as a response to their chatter, while the kids looked at each other, and at me, like their parents were nuts.

The poor children were quite obviously totally creeped out, but the adults were in denial about that too, commenting on "how much the grandchildren like seeing their grandmaw at the hospital."

Yes, they did pronounce it "maw," to my ears.

Though she was brain dead, her bowels worked just fine, and tube-feedings can encourage rather loose movements. The adults saw this as an angelic sign of "life" and they would chuckle and congratulate her on "making a good one" as they hopped out of the room, leaving nursing staff to deal with the clean-up.

It was as if, without irony, they thought she crapped all over herself just to show them how much she genuinely appreciated them being there.

The kids looked particularly freaked about that. Scared and disgusted, but glad to be leaving the room.

Bedbaths would take several people, because nobody on nursing staff wanted to have to pick her up off the floor again, should she have rolled out of bed. And it was easier to clean her if somebody else was holding a heavy buttcheek up out of the way.

Eventually the woman was transferred, against family wishes, to a long-term-ventilator facility hours away in a different state; a state in which the facility could get reimbursement for her care.

The hospital itself went financially back into the black the following year.

When You Pull the Tube

Nothing much happens at first.

Situations I have seen usually involve provision of comfort measures, like a continuous intravenous morphine infusion, for the dying patient. I have not read anywhere that Terry has such a morphine drip going, but since these are common in Hospice situations, I might guess that the husband would have this made available to her if it appears she's in any pain.

Immediate-release oral morphine could also probably be administered to a patient such as her, avoiding the difficulties of maintaining intravenous access.

A morphine drip also can sometimes seem to speed up the dying process a little. I may be misinformed, but I do not believe that the parents have requested morphine, probably out of fear it will hasten her inevitable demise. I have heard families express that concern in similar situations.

Frist and the other Republican hammersacks that want to interfere with this have so far, to my knowledge, not come out in favor of thusly medicating this poor woman. And indeed, why would they? It's not like they really care about her.

Ironically their concern for her serves only to make an object out of her, for their own political gain. Real nice, that. And real stupid, too.

There's already enough suffering in the world, don't you think? Why make more?

Hopefully it will all be done and forgotten by the time anyone sees this, my first post.

3/19/05 dona eis requiem