Family: Ya Gotta Love 'Em

Monday

There was a time, early in our marriage that Doug would stash airplane-sized mini bottles of rum and/or vodka in anything from potted plants to laundry baskets throughout the house in preparation for a visit from his family. "In the Case of Emergency" he explained.

As if. Give me a break. I had worked in Emergency Departments for years without having to resort to alcohol in order to steady my nerves. I felt confident that I could handle the "in-laws" for a few hours. On their first formal visit, I lasted about 30 minutes. The rum was in the bathroom medicine cabinet.
Today I am introducing a "guest writer"...Daniel lives in New York and is on his way to becoming a Nurse Practioner. He's a warm and wonderful man who was a tech when we met in Baylor's ER several years ago. Recently, Daniel returned to Texas for a family visit and shared his following thoughts....
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Things I Have Learned While In Texas:

1) My father informed me that I must send him money while he is in prison (for committing a felony) because "the Bible" says that you should 'honor thy father and mother.' His interpretation of this was that I am supposed to support him financially while he is prison.

TRANSLATION: That's a crock of S*%$ if I ever heard it. I am supporting you... with my taxes. So, sit in there, learn your lesson, and be happy you have a meal every night unlike most of the world.

2) Never fly Southwest Airlines. Mostly because, whereas their flights are labeled as "direct," this simply means that they will take you directly to your location, AFTER stopping in EVERY MAJOR CITY along the way. Needless to say, you get what you pay for in choosing cheaper flight accommodations.

3) Never take a bunch of hillbillies (my family) to high-scale Japanese hibachi restaurant. Let me just highlight some of the comments made last night: (And remember to think of these with your best southern accent interpretation)

  • From my uncle," Do you guys have anything more than 8oz. of steak? I was thinking more like 30oz."

  • From my brother, "Why don't you have sweet tea?" Response from the sweet Japanese lady, " Because we have sugar packets."

  • From my brother, "Why would anyone drink sake when we have BudlLite?"

  • From my cousin, "I don't eat vegetables; I only eat medium RARE beef and starches."

  • From my brother after the waitress asked a question, "I didn't understand a word you just said to me...."

  • My mother told the hibachi chef that her onions never look like a volcano or say, "choo choo."

  • By far the best part of the night, was watching my grandfather's face while I sucked down an entire bottle of sake (with some help from my buddy Sonia) to help me prevent from strangling any of my hillbilly family.

  • watching my grandmother take a shot of sake! (Oh, that was the best!)

4) I also learned that my grandfather (one of the smartest members of my family) believes that our president Barack Obama is the Antichrist. That was an interesting conversation. Enough said there.... Needless to say, I admitted to him that the Bible is equivalent to me as Aesop’s Fables and I don't believe that Obama has the capacity to be the Antichrist.

5) My grandfather also firmly believes that he will die in precisely 2 years. This because he asked "the Lord" the let him live 10 more years while on his deathbed from pancreatitis. Sorry gramps.... that's doubtful.

6) My mother likes Puma socks because they feel like "hose."

7) My aunt Donna stays awake until midnight because her husband has severe sleep apnea. He believes that this is "just the way he breathes" and she needs to get over it. ha ha.... that was funny.

8) My grandparents believe that anything sugar free must be good for you! Umm, how about no...

9) You really never know who your true friends are until it comes time to just show up!....

10) My grandmother's cardiologist (whom also had a heart transplant himself.....no joke) believes her heart is "just fine!" Despite her NY Class III Heart Failure diagnosis.

11) My grandfather believes that he is a liberal democrat because he liked Bill Clinton while in office. This despite his hatred for Obama, strong conservative views, anti-gay marriage, anti-everything, and no interest in government sponsored assistance programs of any kind for the underserved populations.... because he came from poor and worked hard for everything he has.... (Me too, but still some people just need a little shove!)

12) Barodontalgia ["tooth squeeze" from changes in atmospheric pressure in airplanes] really happens! Ouchie!!!

13) I am SO GRATEFUL, that I did not acquire the southern accent. It makes you sound "special."

14) Channelview, Texas.... my hometown, has turned into the Mexican slums and I will never be able to return there.... well, legally at least after Mexico claims this land to be their own.....

15) Finally, I have determined that I am leaving Rochester, NY by the end of October next year before the bitter winter begins and the after the beautiful Fall commences. I will most likely be returning to Dallas for a few years until life points me back to the NICE part of Houston.

We will see what life holds.

Those are among other things, that I learned on my short 3 day trip to Texas. -Farewell Mexican slums, its back to Rochester, NY tomorrow, the city with the worst case of "little man syndrome" I have ever seen.

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Bless you Daniel. I guess my in-laws aren't so bad after all.

The Fluffiness Factor

Friday


Entering this world at a hefty 9 lbs 6 oz, I have always been chubby. Like so many of my generation, good behaviour, good grades, outstanding accomplishments and/or achievements were rewarded with food. Food was also used to treat a broken heart, a cut or scrape, hurt feelings and/or disappointments.

My parents were raised during The Great Depression and experienced the hardships of poverty that I have never known. Feeding their four children well was a responsibility they did not take lightly. We had never gone hungry and they took great pride in that. As children, we were not only encouraged to eat, but we were also celebrated for having good appetites. Portion control was never an issue and there was always more than enough food available.

Which brings me to what I will call “The Fluffiness Factor”. It has trailed me my whole life and without doubt, will continue to stalk me.

My ‘Battle of the Bulge’ began as a teenager when I learned that an effective way to lose weight was by not eating – at all. That didn’t last long.

As a young adult I became a walking reference guide on any diet you could name…Atkins, Weight Watchers, The Scarsdale Diet, The Cabbage Diet (not a crowd-pleaser), Protein Shake diets, The Grapefruit Diet, The Rice Diet and the list goes on…

Once, while attending a Weight Watcher’s meeting, in the 80’s, my friend Vicky and I settled into our chairs and waited for the leader to begin her lecture. We really didn't want to be there in the first place and meeting room was hot and crowded.

The leader began our class, dramatically… “LADIES, YOU are not chunky, YOU are not pleasantly plump, YOU are not chubby. FACE IT ladies, YOU are FAT.” With that, Vicky and I looked at one another, convulsed in a fit of uncontrollable laughter, headed out the door and directly to a nearby Hamburger joint where we managed to salve our feelings with a cheeseburger, fries and a coke.

Today, I have four different dress sizes hanging in my closet, diet books and plans continue to entice me (Body for Life, The Flat Belly Diet, You, on a Diet, The Fit or Fat Diet, Eat This, Not That, The Six Day Mini Makeover Diet) and I’ve joined and rejoined Weight Watchers so many times that I don’t need to attend the ‘orientation’ meeting any more.

Something has got to give. Is it time to “Embrace my Fat”?

Recently, my friend JoBeth has encouraged me to do the White Rock Marathon with her. Well, not really the 'whole' marathon, and not 'running' it. We'll be walking it and it will only be a 1/2 marathon but I think we get a T-shirt with registration. Cool.

Anyway... I'm in training.

Parkland 4: Psych

Wednesday

In the 80’s, Parkland’s “Psych Pit” included patients who were mentally ill, suffering from alcohol and/or drug dependency, the homeless, the hungry, and those involved in messy divorces.

Yes. Messy divorces. It was trendy back then that in order to “stick the knife in and twist it” you could have your estranged spouse served with a Mental Illness (MI) Warrant.

The procedure was a simple one…
  1. Complete the appropriate paperwork and attest that your spouse is a danger to themselves or others.
  2. Have the document signed, before a notary and sealed.
  3. Courier the affidavit to the Dallas County judge who would review your claims and then endorse the “MI Warrant” with his/her signature.
Dallas County Sheriff’s Deputies would then be dispatched to your estranged spouse’s home or place of business, handcuff them and take them to Parkland’s Psych Pit. At that time, Texas Law gave the state the right to hold the above-mentioned spouse for 72 hours in order to determine their competency.

Needless to say, we had some very pissed off estranged spouses.

Staffed with one Registered Nurse and one Psychiatric Intake worker – I had been warned by my peers that Psych was "each man for himself". The Psych Intake worker usually hid out in a small booth in the back of the Psych office - the ER Nurse managed the "Psych Pit" and was responsible for ...
  • Meeting and Greeting patients, police, sheriff’s, paramedics.
  • Crowd control
  • Searching pockets, removal of belts, boots, matches, guns, knives and/or anything that could be used for inflicting injury or used as a weapon.
  • Initial Psychiatric Nursing Assessment and Documentation
  • Medication Administration
  • Self Preservation
During my orientation, the topic of “self-preservation” was addressed by the more seasoned ER nurses at lunch…
  1. Buy a pack of cigarettes before starting your shift – it will make it easier on you (it was the eighties and smoking was allowed in hospitals).
  2. Make friends with your psych patients. They’ll help you out if somebody goes ‘nuts’ on you.
Oh God.

I soon learned that the cigarettes were not for me, but to be used as a way to entice the psychiatric patient into being my friend.

Manipulative? Yes.
What can I say? We did the best we could. We survived.

Parkland: Pedi ER - Part 1

Parkland 3: Triage

Thursday

There were many nights that as the sole triage nurse and with a gaggle of people lined up in front of me, I would hop off my chair, grab my clipboard and walk the line of sick and injured so that I could pull out those who looked ‘bad’ and triage them first.

“The Public” didn’t get it.

Derogatory remarks pointed in my direction were frequently heard from fit-looking '30-somethings' and exhausted moms. I learned early on that it was best not to respond to 'triage catcalls'. Explaining just how an abdominal stab wound 'trumps' a broken wrist would most likely fall on deaf ears and was a waste of time. You didn’t want to get into it.

Triage is an art. The effective Triage nurse is perceptive, knowledgable, communicative and decisive. An added 'skill' learned at Parkland was the trained ability to "never let them see you sweat".

On my first night alone at Triage, I was approached by a disheveled, diminutive man in a long trench coat. When I asked him how I could help him, he burst out into tears and sobbed – loudly. Heads turned. I paused and again asked him how I could help. He threw his head onto my desk, burying it in his arms. Wailing. There were several people waiting to be triaged and I’m afraid that I was a little less than therapeutic when I said in my most firm ‘Nurse Ratchit’ voice…“Sir. Tell me why you are here today.” With that, he lifted his head, looked me straight in the eye and with a disgusting amount of snot coming from his nose, said… “I have a gun in my pocket and I’m going to blow my head off”. Well then. Triage decision-making time.

- Do I become more sympathetic to the little fella? Yes.
- Do I ask for the gun? No. Could be problematic.
- Do I call for Police backup? Wanted to – Couldn’t do that without causing him alarm.
- Do I make him my friend? Definitely yes.
- Do I offer a tissue? Without a doubt.

So, asking his first name, I introduced myself and reassured him we were here to help him. Then I asked him if he wouldn’t mind if I took the gun from his pocket. Abruptly, and to my surprise and relief, he stood up and assumed the ‘frisking’ position against the wall. I took his lead and began searching him all the while looking back, all big-eyed and mouthing the words, “Help Me” repeatedly. I was trying to get anybody's attention. Nobody bit. Two Dallas Police Officers were having a conversation only about 20 feet away and were oblivious to my dilemma, the clerks at triage were busy entering data into their terminals and the patients in line were waiting their turn, people coming and going glanced in my direction but would just continue on. Not one person so much as raised an eyebrow. It was then that I gathered 'frisking' to be an added Triage nursing expectation.

Welcome to Parkland.

I never did find the weapon.

Parkland 4:Psych

Parkland 2: The Times

Tuesday

Dallas Morning News September 1985

The 80's to me, were a lot like the 60's to others.

An inner-city county E.R. Nurse who smoked like a freight train and rarely (if ever) wore a seat belt, I drove a 1979 Pinto, drank way too much alcohol and reserved glove use for sterile procedures and only for the most obvious body fluids. It was the 80's. It was also the time when a poorly understood, spooky new disease was killing young gay men left and right.

If someone had said I was on a path of self-destruction - I would have thought they were nuts.

Parkland Hospital was the only Level 1 Trauma Center in the Dallas area and as a young ER Nurse, I had a need to be there. I was warned that Parkland was 'no frills', the patients were poor and uneducated and that the nurses were 'tough' but I was looking forward to 'a walk on the wild side' and would not be deterred.

I worked the night shift, 11pm - 7am and soon learned that most of what they said was true. Many of my co-workers were in fact 'tough' but they were also compassionate and real.

Generally, my patients were very poor and uneducated but they also taught me more about humanity than they will ever know.

Although we worked hard, we played hard as well. Breakfast tacos and margaritas were commonplace at a Mexican Restaurant nearby named 'Rositas' or a "Grand Slam" breakfast and cocktail could be had at Denny's after work.

But when we wanted to dance on a Friday morning ...it was a dark little place on Northwest Highway where you would never attempt to frequent at night but who opened their doors at 6:30 am. With the lure of mixed drinks, flashing colored lights, strobes and a lit-up dance floor pulsating to the rhythm of the disco beat... cops, firefighters and various health care workers would fill the place. Closing time was 2pm and I can tell you that it was certainly a slap in the face to come outside and into the bright sunlight.

We were, young, single and indestructible. Sleep was for sissies.
Parkland 3: Triage
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Not surprisingly, as of 2008, the numbers are up. The most recent data that I can find is from cityrating.com... Be careful out there.
  • Murder = 226
  • Aggravated Assault = 8075
  • Rape= 601

Parkland 1: The Introduction

"WHEN YOU THINK YOU'VE SEEN IT ALL, WE CAN MAKE YOU THINK AGAIN..."

This was the ad campaign for Parkland Memorial Hospital, Dallas Texas circa 1984-1985. The slogan was on T-shirts and ball caps and included the following text “…we think you can do more, learn more in one shift at Parkland, than you can in a month at a lot of other hospitals. The experience is that intense, that demanding. Nursing at Parkland isn’t for everybody. It’s hard work and there are no guarantees. The Parkland nurse knows that. Instinctively. It’s nursing that tests every skill you have. And some you haven’t.”

I was hooked.

With a year of ER Nursing experience embedded in my stethoscope and despite the fact that I was advised to have my head examined, I was willing to ‘suck it up’ and be a Parkland ER nurse. OO-RAH!

My formal orientation to Parkland’s ER included six weeks of combined didactic and hands-on instruction. My ‘preceptor’ a seasoned ER nurse named Cathy C. was tougher than nails. Once, I thought saw her smile, but soon learned it was just a little gas bubble. Ahem. We were joined at the hip for three long months.

In 1984, Parkland’s ER was divided into five separate ‘pits’ or specialties, all under one roof. Each 'Pit' had a doctor in charge - he or she was referred to as "The Pit Boss" and was a senior resident of that specialty.
Upon reporting for duty, I would be assigned to any of the following specialties on any given shift. Each specialty was unique and had their own set of challenges, but that was why I signed up to be a Parkland nurse in the first place.

Triage: 1 RN + 3 clerks Determine level of acuity of every person and ambulance that hit the door, based on chief complaint, vital signs, gut instinct and/or simply vision. The triage process was simple back then: Chief complaint, name, birthdate (which was optional) and level of acuity – emergent, urgent, non-urgent.

Surgery: 3-4 RN's + 2 clerks + 1 Patient Care Assistant (PCA)
All surgical (or potentially surgical) cases including trauma and burns – considered ‘clean’

Pediatrics: 2 RN's + 1 PCA
All children excluding pediatric trauma (they were triaged to surgery)

OB-Gyn: 2 RN's +1 clerk
All women of child-bearing age with complaint of low abdominal pain, gynecologic issues, pregnant women, and female sexual assaults.

Psychiatry: 1 RN + 1 MHMR (psychiatric intake) worker
Enough said.

Medicine: 3-4 RN's + 1 PCA + 1 clerk
Anything that didn’t fit into any of the other specialties – considered ‘dirty’

And so begins my Parkland Experience…and the nurse with the "gas bubble"? I could only aspire to be as good an ER Nurse as she was.

Parkland 2: The Times

"Bubba"

Sunday

( This may not be "Bubba" but it looks an awful lot like him)

It was a beautiful Sunday morning and I was in my garden, pulling weeds. For those of you who know me, I think we can all agree that, me ‘pulling weeds’ is a rarity. A brown bird was sitting on my lawn, so I acknowledged it by saying “hello” and continued on with my work.

About ten minutes later, the bird had not moved, so I walked towards it, thinking it would surely fly away…but it just sat there. “Birdie, are you OK?” I asked. Upon closer examination, I couldn’t help but notice it’s beak was broken. The nurse in me immediately went back inside the house where I found a syringe and extension tubing (a small length of tubing that can fit on the end of a syringe) and filled it with water. When I returned outside, the bird remained frozen in the same spot on the lawn. I christened him “Bubba”. He would not (or could not) drink.

Remembering that there was a terrific Emergency Animal Clinic not far away, I called them and was told that “yes” they would treat wild animals and that there would be no charge (woo-hoo!). Finding a shoe box, I padded it with towels then placed Bubba in it for transportation to the clinic.

The trip to the Emergency Animal Clinic was uneventful except “Bubba” was not looking so good. He had been standing up in the box initially, but was now lying on his side. Hmmm. Bad sign. Anyway, when we arrived at the clinic, he was still breathing and in the typical fashion of the Emergency Animal Clinic, there were no questions asked, Bubba was immediately taken back to see the Vet.

Now, what do I do? Do I wait for the prognosis? I don’t really know Bubba. How can I just walk out of the clinic? It wouldn’t feel right. I took a seat in the lobby with all the other pet owners. Why? I’m not so sure.

A few minutes later, the Veterinarian and his assistant approached me with very somber looks on their faces…sitting on each side of me, and in a very therapeutic manner said, “We are so sorry but he didn’t make it.” What do you say to that when they looked so sad? “It’s OK, I didn’t really know him anyway?” That would have broken their hearts. So I looked sad right back at them and simply said “Thank you for all of your help” and walked out of the clinic empty handed.

Hello Cupcake!

Friday

After reading a cool blog that I follow (Life Lessons 101), I was reminded me that …
  • My birthday is tomorrow
  • Cupcakes are a good alternative to Birthday Cake
  • My brother-in-law gave me the recipe book, “Hello Cupcake!” last year
  • My first attempt at making artistic cupcakes should not prevent me from trying again
And then the memories came flooding back…

My “Hello Cupcake!” book featured a recipe and directions for making the cutest “March of the Penguins” cupcakes. From the picture, it wouldn’t require Julia Child to whip these puppies up. They’re cupcakes for pete's sake - What could be so difficult?

My plan was to take them over to K&B's that afternoon as their nephews were visiting from Colorado and I thought they might like a cupcake or two.

The penguin recipe included white frosting, chocolate frosting and black food coloring. That is when I really should have applied the brakes.

Finding black food color was a challenge but I was committed to this little project and eventually tracked some down.

A word of warning: Black food coloring is pervasive and disgusting. It gets on and into everything. After using it, my fingernails were dyed black/blue (not so appealing when you are in health care) so I ended my cupcake-cooking day soaking my hands in bleach.

Oh, by the way... if nothing else, I consider myself to be a 'trooper' and once committed to a project, I will see it through to its bitter end.

This project started at 8am and ended at 3pm.

Other items necessary but that were not so easy to find were, plain donut holes (for the little feller’s heads) – no luck. I compromised by using glazed donut holes.

Plain mini donuts were to be used as penguin tummies but again I had to choose an alternative – powdered sugared mini donuts were used. Have you ever eaten one of those? They are repulsive - but they were my only choice and by God – I was making the penguins if it was the last thing I ever did.

You would have thought that after traveling to multiple stores, all in the name of short, fat penguin cupcakes, I would have called it a day. Not this cupcake-baker.

Muddling on and several hours later, I had made a royal mess of the kitchen, myself and Duke, my yellow lab mix. Who knew he would snag a freshly frosted black penguin from the kitchen table when my back was turned? Not pretty.

FYI: Other penguin parts included marshmallows cut to create the white ‘apron’, "Beaks" were Starburst fruit chews. "Wings" were made of chocolate wafers/ "Eyes" were created using white frosting with mini chocolate chips.


My penguins were not quite marching - maybe it was the look in their eyes, but they looked drunk. It was time for their debut.

Carefully, I transported them to K&B's.

Proudly, walking up their driveway with my penguins neatly arranged on a tray I promptly tripped, leaving a few of the little guys headless, on the asphalt.

I was beyond caring.

Why 'Wake'?

Thursday















My Aunt, Marie Anderson was among the most wise and beautiful women I have ever known.

Whenever a friend or relative would pass away, Aunt Marie was the first to organize ‘the wake’. Aunt Marie’s wakes were referred to in the possessive …“Laura’s Wake” or “Uncle Hubert’s Wake” etc.

At seventeen, after the tragic loss of my 25 year-old sister-in-law, Susan, everyone congregated at Aunt Marie and Uncle Andy’s place for “Susan’s Wake”. It was held immediately after the funeral and consisted of laughing, drinking, eating and reminiscing. It was a ‘party’.

I didn’t get it. How could anyone be happy at a time like this?

Susan was an oncology nurse and I aspired to be like her and now she was gone forever. I was devastated by her loss and along with a few other mourners was somewhat miffed about this ‘wake’ business as we felt that the laughter and frivolity was disrespectful. So, I isolated myself from the group and cried. I cried for her loss, her youth and her love. I cried for my brother.

After sitting alone for a while, drowning in my tears of sorrow, Aunt Marie joined me. What she said to me changed the way I thought about ‘wakes’ from then on …”Joanie, I have wakes to help people get beyond their grief and this party gives everyone permission to laugh again. Life goes on and know that Susan will forever remain in your heart but it’s time to get back with the living.” With that said, she led me to her kitchen table - the 'party spot' for my family - where I listened to the older relatives telling stories, jokes and laughing. Before I knew it, I was laughing too. That incredible weight of grief I felt in the pit of my stomach was lifting and I sensed Susan was watching us all with approval, joy and mostly, relief.


This week, I and my E.R. colleagues, Jim, Cathy,Bobbie and Carin had the honor of organizing “Lou’s Wake.” It was held after his Memorial service and all seventy attendees contributed to the cause. We laughed, ate, drank and reminisced about our friend who will always remain in our hearts.

We laughed while being reminded of Lou's 'Magic Eight Ball' and it's helpfulness when all else failed in decision making, the value of the "Tooth to Tattoo Ratio' in determining one's I.Q. and told stories of Lou's impact on us throughout the time he was in our lives. I'll bet that if he was looking down on us, he would have approved.

Dr. Louis Portera meant so much to so many.

St Thomas Aquinas Catholic Church has a capacity of 800 people - every pew was occupied. Baby blue coloured ribbons were worn by the Emergency Department mourners to commemorate the signature colour of Dr Portera's scrubs. Nice touch - he would have liked that.
As we continue in life remembering Lou and all that he meant to us, I'm thinking that he might have wanted to leave us with these final, parting words of advice..."Do The Right Thing".
Thanks Lou.



Paranoid in South America

Anticipating travel to South America was both exciting and scary. Admittedly, reports of muggings, kidnappings and police corruption go...