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"[...]a vessel cleaving the dungeon of the waves[...]"
You're Love in the Time of Cholera!
by Gabriel Garcia Marquez
Like Odysseus in a work of Homer, you demonstrate undying loyalty by
sleeping with as many people as you possibly can. But in your heart you never give
consent! This creates a strange quandary of what love really means to you. On the
one hand, you've loved the same person your whole life, but on the other, your actions
barely speak to this fact. Whatever you do, stick to bottled water. The other stuff
could get you killed.
Take the Book Quiz
at the Blue Pyramid.
Never miss a word
You're Infinite Jest!
by David Foster Wallace
While you1 consider yourself2 to be clever,
there are those3 who think you're just full of yourself or, perhaps worse,
playing a joke4 on everyone around you, and yet you are pretty sure that
you really are that brilliant after all, since people would hardly take the time to
get to know you5 if they didn't care very deeply about what you had to
say to them, to wit, about their lives, their hopes, their dreams, their fears, their
drug habits, and of course what videos6 they prefer to watch, since,
after all, your impressive vocabulary and tendency to go on and on7 makes
you seem superior, able to educate them, and really drive a sense of something
ineffable into their measly little skulls while you are not above making a cheap
gag or really going after anyone or anything or telling them about incredible
futures involving tennis, geopolitics, and
1Meaning you personally, not someone like you or your own
personal daddy, for example.
2As well as you can see yourself, which, frankly, may not be that well.
3Though we wouldn't deign to be so peripatetic as to name them here, mind.
4Jokes, though not common in Victorian England, were known to originate
sometime in ancient history, perhaps as early as the time of Babylon, or even before.
It is thought that the history of the joke plays an integral role in the mindset of
the characters depicted here, though you may disagree at this point, in which case I
am facing quite the dilemma in relaying this narrative, no?
5It is rather time consuming, after all.
6Ha!
7and on and on and on...
Take the Book Quiz II
at the Blue Pyramid.
You're The Metamorphosis!
by Franz Kafka
Though you think you're in the midst of a dream, the fact of the
matter is that your life has become a nightmare. The nightmare at first seems
horrific to you, but you are slowly able to adjust to the facts of the matter
and settle down and make do with what you've been given. There are those that
would say you're pointless and absurd, but you're really just trying to
demonstrate that people can (and do) adapt to anything, no matter how absurd
it is. Not that this will really inspire them to change, because they probably
don't understand.
Take the Book Quiz II
at the Blue Pyramid.
About Me
- Σφιγξ
- possesses wholly unmerited academic pretensions; examines love as an entomologist; collects haunted dollshouses; notes the lunar phase as regularly as the temperature; peruses field guides; reads like a serial magazine subscriptionist; functions through coffee and "mood" music; draws to the very corners of the page; takes notes on unlined paper; reads poetry as prayer; observes textual authority with the incredulity of fiction; suppresses the smart-ass answer(s); adapts as well as anyone beseiged by her own bibelots; she is a sensation seeker in spite of all of this.
25 comments:
https://books.google.com/books?id=Qb1aDwAAQBAJ&lpg=PA346&dq=Marianne%20Moore%20%22A%20Grave%22&pg=PA346#v=onepage&q=Marianne%20Moore%20%22A%20Grave%22&f=false
http://www.raintaxi.com/literary-features/john-ashbery-created-spaces/john-ashbery-sings-a-song-of-thingness/
https://www.youtube.com/watch?v=O7TbkqBluzg
https://books.google.com/books?id=aqNVCgAAQBAJ&lpg=PP1&dq=Fredy%20Neptune%20%22steam%22&pg=PA3#v=onepage&q=Fredy%20Neptune%20%22steam%22&f=false
"Give an amp of calcium gluconate to stabilize the cardiac membranes."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4313592/
Hopefully, I will be moving back to this.
After November 23, I work on the Cardiovascular Intervention (CVI) unit, with CCU in the back. That, is the next step. It may not be an improvement on the current situation with regard to scheduling, at first.
Neptune square Sun: A confusing period according to Astrodienst
"Mid-April 2019 until beginning of February 2021: This can be a period of confusion and uncertainty in which your life direction becomes unclear. Even if you have previously felt that you knew what you were doing and why, now you may encounter circumstances that force you to question your assumptions. Your will may seem to be temporarily paralyzed, and you won't have your usual energy. In fact this influence can coincide with times of low physical vitality and low psychological energy. For this reason you should avoid unnecessary physical stress and follow good health habits to maintain strong overall resistance to illness.
But it is much more likely that this influence will result in disorientation, as alluded to above. You may experience disappointments in your work, career or even in your home life that make you feel defeated and dispirited. But you must not sit back and allow this reaction. Certainly you may suffer defeats during this time, but these defeats occur only when you do something that is not a true reflection of yourself. Because your total energy as a human being is not behind your actions, you don't push through with the vigor that would guarantee success: hence your failure.
You should avoid several types of activity during this time, because your insecurity about yourself will make them turn out badly. First, this is not a particularly good time to become involved in spiritual or mystical sects. Your sense of self needs nourishment and growth, not denial. You are not yet ready for that, and the teachings of such groups are likely to confuse you and retard your development as a human being. Similar warnings apply to the study of the occult in general.
Second, avoid risky or speculative ventures, because your sense of reality is too weak to appraise the risks accurately. If you are having trouble in your work, avoid the temptation to change jobs now. Later, when you understand your needs better, you may be able to make the change. Any new job you start now would not be an improvement over the present one."
Yes. I will not shift about searching for a better situation. I will finish school, and then I will have better options. I hate it when I already work over, and then I have to work on my days off. It makes me extremely upset, to be a stand in for poor planning.
Saturn sextile Saturn: Limited warranty according to Astrodienst
"1 January 2020 until 18 January 2020: This is a time of equilibrium and balance in your life, because now you have a pretty good idea of how to handle your own world. Events will run along more or less easily during this time. But it is important to note that it will not necessarily be an especially happy or peaceful time. Our lives are directed by our own demands much more than we realize, but very often those demands are unconscious. We would often be horrified if we knew what we are really trying to do. We try to protect ourselves and what we feel belongs to us from "threats" that often are not real threats according to adult criteria. Yet we structure our world according to them. This influence only guarantees that you will be successful in patterning your world. If you are very unhappy at this time, you had best get in touch with what you are really doing.
This can be a time when you are successfully approaching your main conscious goals in life. Or it can be a time when you are being run largely by unconscious "programs," as if you were a computer. Usually you will experience a little of both of these effects. However, in the long run the positive possibilities are more useful to know about. Concerning the negative side of this influence, suffice it to say that the difficult and unsatisfactory aspects of your life that you are experiencing now require you to look into yourself more closely.
At this time you are particularly good at working with other people. You are able to see your individuality and differentness in a way that makes it possible for you to work with others in a complementary way so that neither you nor they feel competitive. You can work just as well with people who are above you and with those at your own level.
You approach your own goals methodically and practically, for you are not particularly idealistic at this point. You are much more concerned about how to achieve what you want in concrete practical terms. Use this time well, for it gives you the opportunity to lay a foundation that will protect you in the future."
Strontium - 38 from Paul Parsons & Gail Dixon's The Periodic Table: A Visual Guide to the Elements (2013)
"Strontium is often associated with its radioactive isotope strontium-90, which was produced by above-ground nuclear explosions during the mid-20th century and became a major source of contamination. Strontium-90 is a particularly powerful emitter of harmful radiation and has a half-life of 29 years. A study of hundreds of thousands of teeth in the 1950s and 1960s showed that levels of strontium-90 were 50 times high in children born in 1963 than in those born in 1950, to above ground testing. These findings helped to convince President John F. Kennedy to sign the Partial Nuclear Test Ban Treaty with the United Kingdom and Russia, ending above-ground nuclear weapons testing. The Chernobyl disaster of 1986, when an explosion at a nuclear power plant in the Ukraine spread radioactive fallout over western Russia and most of Europe, contaminated a huge area with strontium-90."
The Owls of Athens from John Browne’s Seven Elements that Changed the World: An Adventure of Ingenuity and Discovery (2014)
“The Owls of Athens are thick and heavy silver coins stamped with the helmeted head of Athena on one side and her owl, the symbol of wisdom, on the reverse. First minted at the end of the sixth century BC in Athens, they soon spread far outside its walls. They were used as a tool of foreign trade and became a symbol of Athenian power. Other coins came and went; only the weight and form of the Owl remained constant for more than three centuries. And that consistency ensured that Athenian coins were accepted and trusted throughout the Mediterranean. Only the Venetian ducat of medieval Europe, which was minted for more than half a millennium, would rival the longevity and credibility of the Owl. […] But in 413 BC, Athens began to lose control of its silver when the Spartans captured a nearby town, creating a fortress from which to occupy the region. A general defected to the Spartans and told them how their occupation could cut Athens off from the silver mines of Laurium. The plan worked, the mines were closed and, in an act of desperation, the city melted down the gold objects on the Acropolis, including eight gold statues of Nike, the goddess of victory. In 404 BC, following a prolonged siege, Athens surrendered to the Spartans. Thucydides described the chronic shortage of silver as a principal cause of Athens’ defeat. The silver mines had supported the rise of a great civilization, but their absence hastened the fall.”
Semper Eadem from Anna Whitelock’s The Queen’s Bed: An Intimate History of Elizabeth’s Court (2013)
“Whilst Hilliard’s miniatures and full-size paintings had moved towards the creation of his standard face for images of the Queen, it was very likely an Italian [sic] Frederigo Zuccaro [Federigo Zuccari], who had come to England at Elizabeth’s request in 1576, that provided the master pattern that was to be adopted as the officially sanctioned image. In Zuccaro’s ‘Darnley’ portrait, Elizabeth’s face is unreal, like a mannequin’s, and she is pictured wearing a simple gown of white and gold brocade with fine lace ruff sleeves and a pearl necklace which is looped to form an oval across her right breast. In her right hand she holds a multi-coloured ostrich feather fan close to her body, and in her left a half-concealed small box. […] the natural, physical and sexual body of a woman and the royal body politic represented by the royal regalia positioned next to her.
Zuccaro’s blanched, mask-like face pattern was thereafter inserted on portraits of every size throughout the 1580s and early 1590s. The first of the so-called ‘sieve portraits’ adopted the Darnley face. No other face pattern of the Queen was to be so widely disseminated and this is testament to the government’s ability to control the royal image during this period. […] Elizabeth’s motto ‘Semper Eadem’ – ‘Always the Same’, became a necessary instruction.”
29. Any Unnatural Elements from Haruki Murakami’s Killing Commendatore (2017)
“I spent those two days gazing, back and forth, at the two paintings in my studio—Tomohiko Amada’s Killing Commendatore and my own painting of the man with the white Subaru Forester. Killing Commendatore was hanging now on the white wall of the studio. The Man with the White Subaru Forester was in a corner of the studio facing the wall (only when I wanted to look at it did I return it to the easel). Other than gaze at those paintings, I killed time reading books, listening to music, cooking, cleaning, weeding the garden, taking walks nearby. I didn’t feel like taking up my paintbrush. The Commendatore didn’t appear, and maintained his silence.
As I hiked the mountain roads nearby, I tried to find a place from which I could view Mariye Akikawa’s house. But I could never find it. When I saw it from Menshiki’s house, I gathered it wasn’t far from me, but the topography obstructed my view. As I hiked through woods I unconsciously was on the lookout for hornets.”
Prologue from Lewis C. Kaplan’s translation of Hella S. Haasse’s Het woud der verwachting (1949), In a Dark Wood Wandering (1989)
In one of the towers of the ducal wing was a small room to which few had access. Louis d’Orléans had turned this room over to his astrologers: two of them, Maître Darien and Ettore Salvia, could carry on their experiments here in privacy, working with the powders and liquids which they were attempting to transmute into gold. Other, stranger things undoubtedly took place in this murky chamber into which, on the brightest day, little light seemed to filter through the small greenish windowpanes.”
The only time I will stay over is if I get the guarantee that I am off the next day. I am afraid of working over 18 hours with the risks of dehydration contributing to hyperviscous blood clots and stroke.
While I am not excluding the full moon's part in this, I have never been in charge with as many adults threatening to walk out...hate the assignment, et cetera.
I thought of this, "give an amp of calcium to stabilize the cardiac membranes" when I intervened in some orders to give IV calcium chloride, which should not be given IV push except in a Code. We had the order modified to give in a diluted form in a 30-minute IV piggyback infusion without incident.
I had 10 mL of IV dextrose bleed out of an IV (extravasate) in the one good arm of a cancer patient on dialysis, with her daughter at the bedside, crying of burning(!) Steady, now drink a Sprite so your sugar won't drop (after a large dose of IV insulin), a cold compress and elevation...with good response.
"IV Calcium: IV calcium is indicated when the serum potassium is >6.5 mEq/L regardless of whether ECG changes are present.6 Given their poor sensitivity and specificity, ECG changes should not be used as diagnostic criteria for treatment of hyperkalemia.7 The immediate goal of acute management in hyperkalemia is the stabilization of the membrane potential, which is often done with IV calcium. Calcium antagonizes the effects of hyperkalemia through effects on the threshold potential and the speed of impulse propagation at the cellular level. IV calcium can be given as 10 mL of a 10% calcium gluconate solution over 2 to 3 minutes or as calcium chloride, which contains three times the amount of calcium per 10 mL dose. Calcium chloride is also irritating to the veins and must be given via central catheters. It is important to note that IV calcium is administered for myocardium membrane stabilization and does not promote the intracellular shift or elimination of potassium.6"
https://www.uspharmacist.com/article/updated-treatment-options-in-the-management-of-hyperkalemia
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185817/
I received a morbidly obese child who had a mediastinal mass and thymectomy excised with the placement of a steel plate. She had acute ST segment elevation without any anti-inflammatories like Motrin or colchicine for pericarditis. I have a bad feeling she will have a slow pericardial effusion precipitating tamponade...
https://journals.lww.com/jcardiovascularmedicine/Citation/2017/10000/Late_constrictive_pericarditis_after_surgical.25.aspx
I am at my best when I search for the corroborating evidence for my initial impressions.
https://www.google.com/books/edition/The_Book_of_Thoth_Egyptian_Tarot/hgmODwAAQBAJ?hl=en&gbpv=1&dq=thoth+queen+of+cups+reception&pg=PT144&printsec=frontcover
Yes, the thymectomy girl was readmitted with 500 mL drained from a pericardiocentesis.
https://www.ncbi.nlm.nih.gov/books/NBK441988/
"Finally, patients undergoing cardiac surgery that have a higher risk for developing DS are:
younger age
have a B negative blood type
prior history of pericarditis or treatment with prednisone
[...]
The exact cause of DS is unknown, though it is thought to be immune-mediated. Antimyocardial antibodies have been shown to be elevated in the blood of patients with DS, but it is unclear whether these antibodies are the cause or occur as a result of the syndrome. These antimyocardial antibodies are thought to target antigens that have become exposed through damage to the pericardium [11]."
I fault most of the practitioners in the specialty for their myopic urgency to get to the next customer, which is the fault of the doctoral saleslady, who might as well be selling luxury vehicles, pushing the scheduled cardiac cases through the unit and stepdown in a maximally efficient way. The valve replacements and other acute surgical interventions aside, the upsell to surgery for some wealthier, insured demographic groups is notable, but one wonders if the readmissions translate into net gains? Of course they do.
I will put Exercise 88 here.
I received my offer from work after midday coming in at 61,000 base with more money for nights and weekends, full benefits and 5% biweekly match into the TSP. My mother said this was a low ball offer, but I am going to take it. I will either start June 21st or July 5th.
Administratively, I am trained every day of the work week until further notice.
When I am on nights, starting the second week of August, I will work a 2-2-3 schedule with every other weekend free. The schedule will be made a year in advance with annual leave blocked. This means that I can look forward to a week of time off every couple of months.
I am on my new schedule, and I am transitioning well. I do not have to stay over, and I am discouraged from doing this. I am on a steady, mostly chronic ward, but now I am more independent and well-resourced with the on-call physician I knew from my other job.
At Carilion, a hospitalist is surprised that anyone calls about patients. The annual leave schedule will come up after I am not as new to system. It has been difficult to retain staff on this ward, so I get the impression that everyone is relieved that I come and go without complaints.
https://unusualplaces.org/the-singing-ringing-tree/
Due to a low patient census, I was sent to the surgical ICU to train this weekend. I worked with two PCU appropriate patients and one ICU patient with a ventral hernia repair with mesh, dehiscence, and washout with a wound vac, who was at risk of abdominal compartment syndrome. The patient is particularly at risk because he is a diabetic with high blood sugars infusing dextrose in his IV bags (!) Diabetics heal poorly.
This is the worst case scenario:
https://www.semanticscholar.org/paper/Management-of-a-Septic-Open-Abdomen-Patient-with-of-Yetisir-Sarer/14ddbdbbebc6c60bfedddb8ca320e82e89792599/figure/4
This was the book I was told to get:
https://www.google.com/books/edition/Marino_s_The_ICU_Book/yWAYAgAAQBAJ?hl=en&gbpv=1&dq=Marino+ICU+book&printsec=frontcover
I am not sure if I will be sent somewhere else based on staffing needs, but the team there who have worked at UVA, Durham, Walter Reed, etc., felt that I was worth teaching.
The closure of the Salem facility will come after five years. That is my prediction. I was right to leave.
I was asked this, today, why I am so comfortable working on PCU. Don't I want more for myself?
The truth is that I would like to grow intellectually, but I steer away from chronic, high-intensity conflict. I could routinely stretch the truth for the most generous outcome for both the surgeon and the patient, for that is why we are here, to make people feel better about what one possibly cannot change, to a point. Some of the old school providers are still amenable to this paternalism. Most young people are very competitive, undercutting, and never miss an opportunity for self promotion, regardless of the patient.
I will decide what to do.
https://journals.sagepub.com/doi/abs/10.1177/0969733016638144?journalCode=neja
https://youtu.be/UFGD5HHUJDI?si=XeDT0Ujqv0NIfcs7&t=773
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