Leo's story

government considers you able to work if you can give anything more than 0%

But hey, maybe she already knew. I never established the exact rules of her psychic abilities, just that she said that she had had them her entire life, as had her mother, as had her grandmother. She's friends with shamans. She did reiki on her pets. This is her billionth hospital stay in the last year, and the length of this current admission is well into the double digits, but she just got a few tubes pulled out and some very promising lab results. She might go home soon, although she joked that if she did, she'd probably be back in a week anyway. She told me the thing that had made this hospitalization better than previous ones was that she wasn't keeping her gifts to herself. "I've passed on important messages to a dozen people that work here," she said, with the kind of smug satisfaction you only get from helping (or thinking you're helping) someone else. It's a great feeling. Heady. I gotta be careful with it. In addition to encouraging a certain paternalism towards patients and a sanctimonious delight in huffing your own farts, the embarrassment it transforms into when you realize that you actually weren't helping anyone is absolutely brutal. But sometimes you do help people. I don't believe in psychic abilities, but I'm glad she said to me what she said. It was good food for thought, and it's a very pleasant thing to experience someone striving to be useful and kind to you in particular.

A few hours later I met a different patient. She was calling out for help as I passed by her open door. You never know what you're going to get when you go into an unknown patient's room. Sometimes it's someone who just wants you to turn their lights off. Sometimes it's someone having a panicked mental breakdown. Guess which one this case was. She'd been brought in for the most mundane horrible reason that independent elderly adults come to the hospital: fell down, couldn't get up, and didn't get found for a long, long time. The patient had admitted earlier that evening basically catatonic. Wasn't catatonic now. I go in and get blasted by a fire hose of trauma--she's bouncing back and forth between the recent and distant past. Like absolutely sobbing about the last few days and then mid-sentence talking about something that happened three decades ago. Then back to the present, then back to her childhood, then back to yesterday, then back to the 1980s.

I stuck around and helped out a bit with a listening ear and a swallow eval to see if we can give her anything to drink. After she had some water, she'd calmed down a little and almost shyly said the the first thing I'd heard her say without crying: a local food establishment is releasing a limited edition cranberry lemonade for summer, and she was hoping to try it. Me and the other nurse who has come to help out are like, "we can get you fifty percent of that." I drop off a cranberry juice in the room, which I assume from her reaction was perhaps the greatest cranberry juice of her life, then page the on-call chaplain who told me she'd come by once she was finished in critical care. There was an unsuccessful code; the patient died. Spiritual care likes to be around when stuff like that happens. While we're waiting, the other nurse gets the patient cleaned up. It's actually incredible how much better she looks by the time I bring the chaplain in.

Chaplain and patient were still talking two hours later when me and another nurse were doing our assigned shift turning the floor's bedbound patients. We went into a room with another entirely new patient I have no idea about. I figure out from the sign on the door that she's a end-of-life comfort patient, and from what I saw when I walked, she was moving quickly along through the process of transitioning from "will die probably soonish" to "is actively dying now." There's an enormous piece of gauze on one half of her head. The other nurse pointed to it and said, "be careful with that." We repositioned the patient, minutely, gently, made sure she wasn't wet, tried to figure out if she was in pain. I try to always talk to unresponsive patients, let them know what I'm doing and why. I'm especially doing it tonight. My first patient, the psychic, she was telling me all about her out of body experience the time she died. "You see and hear everything," she told me. "And trust me, it changes you. I'm not scared to die anymore and I'm not sad about it. I'm sad that I'm going to make everyone who loves me sad when I go."

I have no idea what my current patient's thoughts on dying are, but we fluffed up pillows and straightened out limbs until she looked comfortable--or at least, didn't look uncomfortable. I tucked her back in, then looked up to finally noticed the sign someone had stuck up above the bed: NO PRESSURE ON RIGHT SIDE OF HEAD. PATIENT HAS NO SKULL THERE. I suggested to the other nurse that this sign should be bigger.

Three patients, three women all within five years of each other on the same medical floor. I floated there last night because it's my job to go to whatever unit is short-staffed, so I go somewhere new every night. Even if I was assigned to that floor again, I'm not working for another couple days. At least one of those patients will be gone by then. Maybe even all three. It's overwhelmingly likely that I'll never see any of them again, and frankly if I hadn't written this post, it's also likely I would never have thought of them again. I've worked in the hospital for almost five years now, with a new patient load almost every night. The half-life of my memory of the average patient is like twelve hours. They're gone from me by the next night. A few stick with you, probably forever, but 99 percent rest fade into an amorphous blob of humanity that you hope you've helped more than you've hurt and has given you more than it's taken.

And y'know, sometimes I write stuff like this, then sit back and go, "This is exactly the fart huffing I was talking about." I struggle with posting about nursing because I don't want to boast and I don't want to self-flagellate. I don't want to sound like I think I'm the pinnacle of nursing, I don't want to sound like I have a delusional lack of self-esteem about my own abilities. I want to represent myself as I am, I want to represent my field accurately, I want people to enjoy reading the posts, I want people to like me, and God willing I want those things to happen at the same time from the same words. Which is. Occasionally hard.

Like okay here's some more stuff from last night: that first patient, the only one that was actually my patient, I didn't do her CHG bath even though she had a central line. I realized that at 0500 when I still had two hours to do it, and instead I was like, "that's a day shift problem." That was an irresponsible choice made for my own convenience that could have a very negative effect on the patient. Or another, I was too pushy encouraging a patient to pee on their own when I should have just straight cathed them. Realized that in retrospect after someone else had to straight cath my patient at shift change. At one point, one of my patient's call light went off, and I didn't want to answer it, so I frowned at my computer and started typing intensely like I was dealing with really serious problem to see if someone else would get it. Which they did. I've got plenty more dipshit maneuvers like that, some based on good faith clinical judgment that ended up being wrong, some based on me not wanting to stand up again after I sat down. I don't really want to write this paragraph. I don't really enjoy publicly enumerating ways I've been selfish, lazy, mean, incompetent, or otherwise fallen short. I feel varying degrees of bad about the stuff in it. I feel varying degrees of worse about the stuff I've left out. I worry about the occasionally brutal anons who engage with me as a representative of a healthcare system that has brutalized so many people, and I worry that acknowledging that worry overexaggerates the degree to which it happens. Almost everyone is nice to me, which makes me feel guilty. But it also makes me feel good, and then I feel guilty about feeling good because that's egoism, and then I feel good about feeling guilty because surely only a really, really good person would feel this bad. Right?

The point of this post got somewhat away from me. Guess I really have been thinking a lot about my psychic patient's shared revelation. I wanna go back to my patient and be like, "They aren't guilt trips if you should feel guilty," but partially so she'll dispute that thought for me. I do think you should feel some amount of guilt when you fall short of the person you want to be in a way that affects other people. Sometimes you just gotta sit with that, and think about why it happened, and whether it'll happen again. But I also think you go too far down that path and you're back in the med room, staring at 100 pills of Dilaudid and thinking, "What if?"

The year is 1519, and you are Hernán Cortés. You and all of your compatriots are stuck in the most effective way to make someone a bad person: put them in a situation where they must become incredibly wealthy and powerful incredibly fast or else they will die horribly. Transatlantic voyages are absurdly expensive. Anyone in the ‘New World’ who isn’t rich enough to afford their own army is deeply in debt, with no collateral but their own sword-arm. It is an environment that does not reward half-measures. It does not even reward full measures. It only rewards putting a brick on the gas pedal and crossing your fingers - if you kill one person then you’re a murderer, but if you kill hundreds of thousands of people then you're a paragon of glory and the Spanish crown will make statues of you.

The year is still 1519 and you are Moctezuma II, Huēyi Tlahtoāni (great ruler) of the ‘Aztec Empire,’ also known as the Triple Alliance, or the Mexica. You know a thing or two about half-measures not being rewarded, because you are in a process of rapidly expanding and consolidating a nascent Mesoamerican empire. You are quite good at your job - even before you ascended to the throne, you cultivated a reputation as a skilled warrior, a dedicated student, and a devout worshiper. Your name means something like ‘lord who frowns in anger.’ It’s a fitting name, because the process of ‘imperial expansion and consolidation’ generally involves killing lots of people. To make matters worse, some weird hairy white guys showed up out of nowhere and they keep demanding an audience with you. You try every trick in the diplomatic handbook - deferment, threats, flattery, bribes - but everything you do just seems to make them more single-mindedly focused on your destruction. Later, after you are dead, they will claim that you thought they were gods.

The year is 1545, and this whole ‘colonialism’ thing is starting to peter out. Trans-Atlantic voyages are still ruinously expensive, and the pickings are getting slimmer every day - it’s not like you can go loot Tenochtitlan a second time. You’re starting to wonder if it’s time for everyone to pack up, go home, and forget about… holy shit is that a mountain of silver? Is that an honest-to-god mountain with more silver in it than every other existing silver mine on the face of the earth combined? Yes. Some call it Potosí. Many will call it “the mountain that eats men.” In a single moment, colonialism goes from a plundering campaign for recently-unemployed soldiers to a permanent institution. The alchemists back in Prague and Vienna never learned how to turn lead into gold, but the mercenaries and taskmasters in Potosí found a much simpler equation to turn blood into silver.

The year is 1571, and the economy of the Ming dynasty doesn’t feel so good. Their experiment with paper money was a failure, to put it gently. The experiment with paper money failed horribly. It turns out when you try to have paper currency but you don’t have sophisticated counterfeit protections and there’s also a booming cottage industry of people making paper in their cottages, well, you can guess how that ends. So you’re trying to shift to a silver economy. But then you run into an even bigger problem: you don’t have enough silver. So if you start demanding taxes in silver, the price of silver will skyrocket, which means taxes will skyrocket when the economy is already ailing from the whole ‘paper money’ thing. Some hapless scholar-official in Guangdong is nervously watching a peasant sharpen his pitchfork when he gets word from a messenger: some gweilo just showed up at the part with literal shipfuls of silver and they want to buy silk, tea, spices, and porcelain at outrageous markups.

Within living memory, the world was still ‘medieval’ in many ways - slow, parochial, zero-sum, carefully arbitrated by tradition and precedent. Legible. And now Spanish sailors take Bolivian silver on ships guarded by West African mercenaries and Japanese ronin, sailing to their colony in the Philippines to rub shoulders with Chinese officials, Indian sultans, and Malay merchants. All because some dipshit from Genoa got his math wrong and wouldn’t shut up about it.

You’ve heard of woolly mammoths, but what about woolly tapirs? 🤔Also known as the mountain tapir (Tapirus pinchaque), this species can be found in the cloud forests of South America’s Andes Mountains. Adults can weigh up to 400 lbs (182 kg), and their thick fur coats help insulate them from the cold temperatures of their habitat. Unfortunately, this endangered species is threatened by human activity including hunting and deforestation. 

It didn’t work. It didn’t save her. But it’s so very possible that he spent his last moments alive trying to save someone else, one of his crew, and they probably both knew that it wouldn’t work, that there wasn’t a lot of hope in a blizzard on the lakes in November, but he tried … he tried anyway. Even if it did nothing but maybe make her body easier for her family to find.

You know that Mr Rogers thing of ‘look for the helpers’? How many times has someone, facing the end, done something tiny and fragile and maybe hopeless just to try and help someone else? Whether it works or not. How many people went to their graves at least trying?

That has to say something about us. As a people. As monstrous as we sometimes (perhaps often) are, so many times we were also …

Whoever saves one life, saves the whole world.

And sometimes you can’t save one life, sometimes it doesn’t work, sometimes there’s no getting out of this for anyone, but … try anyway. Because it matters anyway.

the strangest fandom hobby is plotty fanfiction, the kind that requires research, because engaging in this hobby makes no goddamned sense.

it doesn’t even give anybody masturbation material, which is at least a logical and admirable goal that contributes to the betterment of society, or at least society’s solitary orgasms.