Step by Step

(Note:  While I haven’t been blogging much in the past few years, every now and then I still write something for fun.  I think this was sometime last year. I just found it on the my laptop.  Enjoy.)

This past Friday I’m visiting with my son, and like always he hops into the car after school with nothing but his clothes, an oversize parka that would look good in North Korea, and a deck of Yu-Gi-Oh cards with a play mat, which is a really big $40.00 mouse pad distinguished the fact that it’s really big and costs $40.00.  Even though this has become routine, I am persistently surprised by it.  He is now in high school, and when I recall that when I would pick him up from middle school he would emerge with a backpack the size of the Canadian Maritimes full of homework, I am always confused by his lack of gear.  I know they give homework in high school, and I know my kid.  And I know he is not the one who dutifully does his homework at lunch, but waits until 10 PM the night before the paper is due, and then needs a pen with blue ink because black ink or typing it on the computer is NOT what the teacher wants. So it was with great aplomb that, while tossing his clothes in the washing machine, I noticed a neatly folded, and then crushed up, blue piece of paper as it fell out of his pants pocket.  Colored pieces of paper make me nervous, as they’re often associated with nothing good.  Pink slips.  Yellow triplicates.   Black toe tags.  And my anxiety was in no way alleviated when I unfolded it to find it was his birth control homework.

That’s right.  My kid, the one for whom the concept of effective and prolonged toothbrushing is still a puzzle, is taking Sex Ed.  This is the same offspring of whom I have said repeatedly can only entertain the concept of driving once he learns to pick his clothes up from the floor, and therefore for whom I forsee a lifetime of public transport, is now studying sex.  (In fairness to him, though, I should note that in the ER I’ve seen plenty of pregnant people, and pregnancy progenitors, who have had catastrophic issues with oral hygiene.  If a kiss is still a kiss, perhaps a gum is still a gum.) 

I don’t want to get into dealing with adolescent sexuality.  Let’s just say it was not a problem for me because I was a short unathletic dweeb, and while I knew what the bases were the chances of me making the team were fairly slim.  And with The Teen it’s still pretty easy for the moment, because I’m more worried about him actually talking to a girl about anything that’s not a video game than what he would do if he actually touched one.

This particular worksheet was of interest for several reasons.  I was initially struck by the chart where you fill in the non-prescription methods of birth control.  In one of the rows under the heading of “Method,” he filled in “Sexual abstinence.”  Fair enough.  Under “How Does it Work?” he had written “Choosing to not have sex.”  So far, so good.  But in the column entitled “Does it Protect Against STD/HIV?” he answered “No.”

That made no sense to me at all, and not just because I have a medical background.  This kid has known exactly how things happen since age six at which time he was proud to declare he knew about “setual innercurse,” although he wasn’t quite sure how the man and the woman got there in the first place.  His knowledge of these things has only continue to grow as he learned about that “When a man loves a woman, he gets a powerful urge” from Puss in Boots in Shrek 2, and because I once accidentally left my Clarence Carter CD in the car and had to explain what “Strokin’” was about and why he shouldn’t stroke anything until he was married or dead, since both are often the same thing.  So I asked him how in the world he could put down that saying no wouldn’t prevent and STD or AIDS.  I had clearly forgotten about    teenage logic, because the answer, while wrong, made literal sense.  “Words can’t block an infection.  If it could, we could tell a cold to go away and it would.”  Well…ummm…yeah?

(For the record, correction has been instituted, and we are now clear that the word “no” is the ultimate method of birth control.   But, in deference to teen logic, it only works if you actually listen to what anyone else says, which is nowhere in the job description of adolescent.)

Then there was the part where you are to list five key steps in using a condom correctly.  I looked at his answers, and while technically correct, I felt he left out a lot.  For example, Step One is not to check the date on the package, but to actually FIND A GIRL.  Step Two is not to open the package, but to TALK TO A GIRL.  Step Three?  Talk to a girl about ANYTHING except collectible trading card games or League of Legends.  Anything.  Anything at all, son.  PLEASE.  And while I would be happy to educate him on the steps following condom use…like being sure to call and send flowers the next day…I’m not going to push beyond these first three steps, because checking these off the Bucket List is a major accomplishment unto itself.  (Please recall that I’m dealing with a young man who has already concluded that his soulmate will be a “hot” girl who cosplays as Harley Quinn and acquits herself well in both Yu-Gi-Oh and Starcraft.  It’s gonna be a long wait for grandchildren.)

I was also surprised to learn that they did not actually make him put a sample condom on a model.  I think that was a grave error.  Without prior experience, the first use of the prophylactic will come in darkened environment where he’ll be lucky to open the package with the condom rather than the small rectangular pouch of Gray Poupon stashed in his pocket from the college cafeteria.  And I’m pretty sure that condiments are not on the list of nonprescription methods of birth control.

I can barely wait until they watch the pregnancy video and the miracle of birth.  That ought to take some explaining.

My Son, the Super-Hero

When I was in junior high school I was an avid collector of comic books.  My favorites were (and still are) those starring the Legion of Super-Heroes, a group of teens who banded together to fight interstellar villainy in the 30^th Century.  While I’ve been out of touch with the Legionaires since the first of Lord-only-knows how many reboots of the DC Universe in the 1980s. I can tell you anything you want about the Legion from their first story in Adventure Comics #247 (1958) until issue #300 of their own title in the early 1980’s.  Death of Ferro Lad?  Check.  Sir Prise and Miss Terious?  Um-hmm.  Why there’s a Proty 2?  Got that.  Princess Projectra and the pain plague?  Yep.  Radio Roy, whose ears could pick up any radio broadcast in history, with a chorus of “Three-Eyed Sam from the Planet Wham!” eminating from his head?  Sure, know that one too.  I was so into the Legion   that I can still remember lying in bed before sleep and pretending I was Wildfire, a creature of pure energy held together only by a protective suit, having giving up my life for the universe and being consoled as the raven-tressed Shrinking Violet and the winged Dawnstar proclaimed their love for me.  Nowadays Shrinking Violet is in a relationship with Light Lass, and as far as Dawnstar goes I never recognized that intimacy with a being of pure antimatter would probably result in horrific third degree burns at best, if the mixing of matter and anti-matter doesn’t first result in the complete annilhation of the known universe.  Not to mention that those wings have got to get in the way.  Granted, it’s kind of hot when your lover’s hair falls, soaked with the sweat of passion, in your face.  But feathers?  Choke, gasp, wheeze.

So it was with this background of great affection for super-teams that when I stumbled across a weathered copy of Issue #1 of the Jewish Superhero Corps while cleaning out boxes in the basement, I was captivated all over again.  The Corps were the work of  Alan Oirich, and as best I recall the story he was a mainstream comic book artist who returned to orthodoxy (the actual term is ba’al teshuva) and wanted to create heroes consistent with the values of the more traditional Jewish community.  Allow me to introduce you to the lineup.

Menorah Man:  An astronaut who ate a radioactive olive on Mercury, giving him the power to grow six additional arms for a total of eight and to shoot fire from all of them.  Has a talking pet monkey that does the same, just in case you need to fricassee eight bananas at once.

Kippah Kid:  Robin throwing trick yarmulkes instead of Batarangs.  No Speedos, though.  Probably for the best. 

Magen David:  Think Captain American with a shield shaped like a six-pointed Star of David.  Also the Patron Super-Hero of Kosher Wine.

Driedel Maidel:  The power of super-spinning, and probably of super-motion sickness and super-barfing.  No word on which hero holds her hair back.  My bet’s on Kippah Kid.  He’s that kind of nebbish.

Shabbos Queen:  Has a magic wand that can make anything mechanical rest for 25 hours.  The wand has to rest one day out of seven.  So invading Earth on a Saturday morning would be a smart move.

Matzah Woman:  Radioactive Matah gave her the powers of Supergirl.  Her kryptonite?  Being under water for 18 minutes, the time it takes for matzah dough to rise.  I think that’s also called drowning.

The Mysterious Minyan Man:  Can divide into ten six-foot-tall men, or grow to one sixty foot tall man.    (A minyan is a group of ten who form for prayer.)  So two really awkward basketball teams, or the best Jewish big man since Dolph Schayes.    

I should note that all members of the team are, in accordance with orthodox tradition, modestly dressed.  This means that unlike most superhero teams, you cannot be certain that every female has a truly heroic chest or a tight, well-formed…ummm…bagel.  Driedel Maidel spins so fast we’ll never know, and I suspect the blur is a way of hiding her shortcomings.  Since she’s Jewish, we know darn well that Shabbos Queen isn’t a natural blonde.  So that leaves Matzah Woman as the most likely candidate for bodaciousness, and she looks like the kind of girl who also makes a mean noodle kugel. 

You may think these sound silly, and they are.  But is it any worse than the genesis of my beloved Legionaires such as Lightning Lad, who received electrical powers when blasted by a lightning-shooting beast on the planet Korbal?  Shadow Lass, who can invoke pitch-black shades as a result of her encounter with a shadow beast on Talok VIII?  Ultra Boy, who gained his powers after his scout craft  was swallowed by a space whale? Do you see a recurrent theme?  (And for the record, Ultra Boy’s real name is Jo Nah.) 

Not all powers result from animal encounters.  On some planets, everyone’s got something.  Phantom Girl can dematerialize because she’s from the fourth-dimensional planet  Bgtzl.  Stone Boy’s people learned to turn to rock to avoid the six month nights on their home world.  Matter-Eater Lad is from the planet Bismoll, where everyone can literally eat everything without needing to stop for…well…it all goes somewhere.  Later, M-E Lad (he has no cool nickname) becomes President of Bismoll, presumably after an inorganic version of the Nathan’s Hot Dog Contest. Suddenly the Jewish Corps seems more plausible.

For the record, there really are super heroes who are Jewish.  Ben Grimm, also known as the Thing of the Fantastic Four.  (We won’t go into that whole Golem thing).  Kitty Pryde, Shadowcat of the X-Men.    Gim Allon, Colossal Boy of my own beloved Legion.  (His mother became President of Earth, but that was little comfort her boy dated a shiksa.)  And many of the most creative names in comic history were Jewish.  Jerry Siegel, Joe Shuster, Joe Simon, Jack Kirby, Will Eisner, and Stan Lee only top the list.  I’ve recently finished a book entitled “Superman is Jewish?” proposing that many of the comic book heroes are a reflection of the need for Jews to be seen as powerful forces rather than as the victims of history.  Maybe true, but I’m pretty sure Superman’s not Jewish.  I know this as one of the six Jews who live in Supe’s home state of Kansas, and while the Kents are fine people they really don’t drop by for Shabbat.

One of the things that I really liked about the Legion was that they were always having tryouts for new members.  I’d like to see that in future issues of the JSHC.  Because while the current membership is great, I think the Corps could use a little cultural-specific component.  Here are a few suggestions.

     Guilt Woman:  Interfaith sharing is not a new phenomena.  Both Catholics and Jews share a long legacy of guilt, but I would contend that because we don’t have either confession or a savior to take the guilt off our hands, we’ve got a worse time of it.  Guilt Woman’s power is to make you feel bad…not just bad, but rotten to the core…about whatever it is you are doing.  For example:

     Villian:  “I’m going to blow up the word with this hydrogen bomb!”

     Guilt Woman:  “And what would your mother say?  She’d be disappointed.  Imagine, her little        baby, all grown up acting like this?  When was the last time you called her?”

     Villain:  “I’m sorry.  Can I borrow your phone?”

Disaster averted.

Feeding Bubbe:  Patterned after my Great-Grandma Rosie who would give me a dollar to eat a bowl of Jell-O, Feeding Bubbe flings bowls of food at evil masterminds while shouting “EAT!  EAT!  YOU LOOK THIN!”  Compelled to do, the evildoers are then bloated and immobilized. 

(If only Grandma Rosie was alive when I was in college, I would have never had a student loan.  I should note that one of the prerequisites to the fiscal feed was that you had to sit and watch Lawrence Welk with her every Sunday night at 6.  Which is why I still think Anacani is a hot little number.)

Jewdar:  Able to determine with just a glance, or at the sound of a name, if someone is Jewish.  Spent twelve years in the Himalayan Yeshiva learning the skills of Six Degrees from Menachem Schneerson.  Not a particularly useful power, but able to pick out those who might be particularly susceptible to the abilities of Guilt Woman and Feeding Bubbe.

The WonderJap Twins, Melissa and David.  Like Zan and Jayna, their powers activate with a fist bump.  Melissa shouts “Shape of a Charge Card!” and is able to make unlimited purchases and put it on Daddy’s bill.  David yells “Form of an Inert Object!” and becomes a Jewish husband.

Tefillin Lad:  The Lubavitch Hasidim are the closest thing we have to missionairies, but they work only within The Tribe.  For the Lubavitch, wrapping tefillin is the starter mitzvah that leads a liberal Jew back to more traditional ways.   (Tefillin are straps attached to small boxes containing written prayers which the pious wrap around their arm and head while they pray.)  Tefillin Lad will brave aliens, dust storms, and even a herd of pigs to wrap tefillin around the head and arms of an enemy.  Then he will produce a pushkah (charity box) and ask for a donation for the State of Israel.

Hypochondria Girl:  Has to power to make everyone think they have a dread disease.  Kind of like when  you see a patient with scabies and suddenly everyone ER itches.

     Villian:  I’m going to take over the world as soon as I take a Tylenol for this headache.”

     Hypochondria Girl:  “You should see a doctah.  I might be a tumah.”

     Villian:  “You’re right.  I’ll put down the laser and go right now.”

Shiksa Kid:  Consistently drawn to WASPY blondes and petitie Asians, he is a skilled scout, stopping at nothing to track down his prey, shower her with gifts and affection, and marry her no matter what his mother might say.  As a result, he doesn’t get along well with Guilt Woman, and they usually have to kept at opposite ends of the Super Hero Clubhouse.  His best friend is another hero, Family Law Attorney Man. 

Gefilte Fish:  A non-human member, he lives in a jar and only comes out during Passover.  This oozing  gelatinous mass with an odor of adolescent gym socks is the ultimate deterrent.

Your suggestions are welcome.

**************************************

Speaking of interesting Jewish things, the other day I decided I would see what kind of Jewish game apps were out there.  There’s not a lot, and the few that are there are really not much fun.  It’s kind of like when you go to the toy section of the Christian bookstore and find the David and Jesus action figures.  There’s not a lot to do there.  I mean, what kids besides Rod and Tod Flanders want to play crucifixion?  “Look, Rod!  Let’s scourge Jesus with a stick!  Let’s have David kill some guy and sleep with his wife!”    Besides, they don’t come with accessories like water, wine, fishes, loaves, lepers, or Philistines, which clearly limits the play possibilities.  (Although I have seen a Moses action figure that comes complete with staff and tablets.)

I really only have two favorites within these meager pickings.  One is the Hebrew Lite Animal Cards, which comes (as most apps do) as a sample package of five cards until you shell out more money for the complete set.  As a result of careful study, I can now use the proper Hebrew words for bear and hippopotamus.  This is especially important because the bear and the hippopotamus are native animals to the windswept Israeli deserts.

The Teen and I did find another game which we still play.  It’s called “Mendy,” and it features a guy named Mendy (short for Mendel, if you must know) who wants to go to shul (a colloquial name for an orthodox house of worship).  The way Mendy gets there is to cross a bridge made up of ten moving segments, and you have to make Mendy jump between these segments without falling into the chasm below.  If you miss a jump, Mendy falls off and reappears back at the start.  We like to think that the moves you make to get Mendy across the bridge are an allegory for his journey of faith.  For example, when you have to move him backwards, we say that Mendy Runs From God. 

If you reach the shul, the screen flashes SUCCESS! That’s it.  No new levels, no pat on the back from an approving deity, not even a cents off coupon for the local haberdasher.  Nothing but spiritual rewards which, I suppose, is the point. 

Let me end with a personal plea for some good Jewish games.  Or at least add the Israelites to the Civilization series of games, so I can personally wipe the floor with the Germans and Arabs and Spanish and everyone else who has kicked us out and about for the past several thousand years.  I’ll play on the easiest setting so I can have tanks and jets and nukes while they still have sticks and rocks.  Kind of like the Israelis and Palestinians now.

...And We're Back!

Well, it's December and it's finally time to act upon that 2013 New Year's resolution to finish that book that I started during National Novel Writing Month.  And to blog again.  And to learn Pinterest.  And Twitter.  And to do P90X because I'm tired of having chest pain, because if I get in shape and stop having chest pain,  I don't have to have a stress test which might show ischemia, which might mean I get a cardiac cath, which might mean I get a stent, which definitely means there's no more corned beef hash bowel topped with three fried eggs and melted Velveeta at the Hanover Pancake House. 

So far my record is iffy.  I'm on Pinterest.  I have yet to Tweet or Twit or Twerp. I flunked the "Are You Ready for P90x?" fitness recommendations, so am working instead on Power 90, which includes such helpful advice as Tony Horton saying, "if we're going too fast, it's okay to hit the pause button."  You can hear him whispering "and go get another donut" under his breath.

Blogging and writing have been lagging behind.  Lots going on, but that's not really an excuse.  When things are happening, you should be writing rather than reaching high levels in iPad games like Catan and Great Little War Game and Bloons 4, getting stuck, and then buying another game so that 37 hours and four sleepless nights later you can get stuck again.  Not that I know anything about that.  Or about the Huffington Post Life After 50 pages.  With daily updates.

So, my friends, with your indulgence we'll try once again.  Some pieces may be a lot shorter than others, but we're gonna try to get something up at least every week.  And we will always attempt to address the key issues of the day.  Like what marital aids can be constructed with socks and electrical tape.  And if you say you feel only a little suicidal, what specific bit of you are you looking to hack off?  (See?  That's a shorter piece.)  And is yelling at teenagers to pick up their socks in advance of the actual cleaning moment an easy way to save time when you're going to have to yell at them anyway?

In the meantime, let me refer you to my son's most excellent blog, The Critical Frog (the criticalfrog.BlogSpot.com).  He does movie reviews, comments on video games and television, and occasionally throws a bone of disbelief at the latest antics of his father.  He's really good.  Please read and enjoy.  His blog is the one time in my Star Trek Universe that The Next Generation far and away betters The Original Series. 

Thanks for letting my back into your laptops.  Have your electrons call my electrons.  We'll talk.

The Teen’s sense of humor is literally in the toilet.  I don’t really mind too much, because that’s what 14 year old boys are all about and what 49 year old men have never outgrown.   Perhaps with age we have learned to hide our amusement until we are secreted by ourselves or amongst like-minded persons of similar age and gender, at which point we giggle uncontrollably like schoolgirls looking at a Seventeen magazine spread of Justin Bieber’s hair clippings.  But I thought my son, who is very creative and often makes up his own jokes and one-liners, had hit a new low when he started telling me about the Wonder Boner, the Wet Banana, and A Man, A Girl, and His Johnson.

I normally don’t put videos on the blog, mostly because before today I haven’t figured out how to do so. But I need to include these under the category of The Teen is Not Making This Up.

http://www.youtube.com/watch?v=eQ79pCJBcJ8

http://www.youtube.com/watch?v=GL2hYF2a2aY

http://www.youtube.com/watch?v=fxVH5sKUlPg

So please accept this entry as my official apology to The Teen.  Son, I stand corrected.  Or sit, depending on what it is I’m doing in there.  And above all, I’ll turn on the fan and light a candle.  Giggle.

 

 

Verbal orders in the ER are a source of never ending fun.  Health care pundits and poobahs would vehemently disagree and say that there is nothing fun about them.  They are easy to misinterpret, often inaccurate, not documented, an abusive manifestation of the physician-nurse relationship, and major sources of patient harm.  All of which I suppose are true to some extent, but it is equally true that in the hectic pace of the ER you simply can’t survive without them.

I think I like verbal order because unlike written ones, which are very much cut-and-dry, copy-and-paste sorts of things, virtually every verbal order is an exercise in negotiation.  There are many factors involved in the request, the issue, and the acceptance of verbal orders.  These include primarily the patient’s clinical condition, but also the nurse’s drive to get exactly what they want (know full well they can’t) and the physician’s impulse to prove they’re really in charge (knowing full well they’re not).  The wild card in the negotiation is something will call the General Annoyance Value of the patient.  The GAV is calculated by multiplying the subject’s  Chief Complaint (like “chest pain starting thirty minutes ago” or “painful rectal itch for three months”) by the Actual Clinical Severity of the patients.  This total is divided by the  number of times (factorial) the patient or an accompanying relative pushes the call button in a 20 minute period multiplied by the number of seconds it takes before the patient requests pain or anxiety medications upon arriving in the ER.  (The latter number is squared if a specific narcotic is requested by name).  The resulting equation looks something like this:

GAV = (CC)(ACS) / (BUTTON!)(Request)²

The reason patient volume (measured by volume in decibels times type and variety of profanity) is not included in this equation is that if you’re spending that much effort to yell out we know your airway is intact, you’re moving sufficient air past your vocal cords, and you’re getting enough blood flow to your brain to allow you to perform the higher functions of acting out.  In a general sense people who are really sick, who have problems with breathing and blood pressure, don’t do that.  So we can block you out and make the noise a non-factor, unlike the call button but which we are mandated, by administrative policy or State Law or religious duty or United Nations Mandate… keep getting those mixed up… obligated to respond. 

Once the AVS has been calculated, then the negotiation begins.  It’s kind of like “Name That Tune.”  You want to have the best chance of success with the least amount of drug, the lowest risk of respiratory depression, and the minimal amount of effort.  Here’s how it goes:

(For the uninitiated, Haldol is an antipsychotic drug and Ativan an anti-anxiety agent.  Both are used as sedatives in the ER.)

RN:  “The patient in Room 36 is acting up again.”

MD:  “I can snow that patient with 10 of IM Haldol.”

RN:  “I think we should use 5 mg of IV Haldol.”

MD:  “He’s too wild.  I don’t think you can get an IV.”

RN:  “I can if we give 2 mg of IM Ativan.”

MD:  “But if we give 2 mg of IM Ativan why not just give 10 mg of IM Haldol?

RN:  How about we give 5 mg IM Haldol, then start an IV to repeat if needed?

MD:  “Snow that patient.”

(Personally, I have come to the belief that once we get to this point, the health care system has failed the patient.  The actual solution to the problem is the Ativan lick.  Just like a salt lick, you put one of these in each patient room.  When the patient feels anxious, they take a lick.  If they don’t calm down, eventually they will take enough licks that they will fall peacefully to sleep, which stops them from taking any more meds into their system.  An alternative would be Ativan lollipops, but unfortunately the dose cannot be as well controlled, especially they’re treated like Tootsie Pops and no one can take more than three licks before biting through to the oh-so-relaxing center.)

Unlike most arguments in life, this really is a friendly exchange that can be win-win for all.  The patient feels better and becomes quiet, the call button does not get pushed, nobody stops breathing so there are no complications nor the accompanying paperwork, and we carry on in peace until the meds wear off or it’s time to play the Golden Medley.

 

Apparently the Customer Service Professionals have decided that nurses no longer know how to ask patients how they’re doing.  You know these people.  They’re the folks having lunch with the Vice President of Patient Care (who was, back in the day, the Head Nurse, and before that the Matron), the ones who do the mandatory Patient Satisfaction Inservice on your day off replete with squishy foam stars as party favors and day-old bagels in the back and a mandatory fifteen minute showing of the video of guys throwing fish in Seattle.  They’re the ones who always start their talk by going around the room and having everyone introduce themselves, the ones who pint to you and ask you to give an example of great customer service (“Leaving me alone so I can sleep in the back row” may be the correct answer, but not the right one), and who always remind you that they know what’s it’s like because they’re a nurse, too.

(Incidentally, when I went to Seattle, there were forty people standing around the fish stand waiting to watch a fish being thrown but nobody actually buying fish.  I did see one guy buy a live lobster, but that didn’t get thrown.  Probably something about hearing the lobster shriek as it flies through the air, claws open, antenna waving frantically, all ten legs spread out in terror.  The fish-tossing industry is nothing if not ethical.)

The origin for all these highly paid and mostly useless consultants is the advent of something called the Hospital Care Assurance Program (HCAP), where patient satisfaction scores become a factor in Medicare reimbursement.  It is another element in the general trend to regard health care in terms of subjective patient opinions rather than outcomes, despite recent studies showing that the “most satisfied” patients have higher morbidities and incur extra costs on the health care system.  The advent of these scores have given consultants yet another vehicle to sell their services to unsuspecting hospitals.  (If any of you highly paid and mostly useless consultants are out there and want to have a serious discussion about how HCAP scores are essentially flawed measurements, and how efforts to improve HCAP scores are often directed at lower level employees rather than established administrative systems, I’d be delighted to have that conversation.  For now, it’s my blog and I’ll say what I wanna.)

As I’ve said, these Men in Black and Women in Pastels have determined that one of the keys to customer service is that nurses need to see patients more often and ask them more focused questions about their needs.  The fact that nurses are overworked, overstressed, dealing with sicker patients with greater demands in an increasingly more complex clinical and administrative environment is apparently not the problem.  So the Customer Service Professionals have put together an “Hourly Rounding Log.”  It’s kind of like the sheet you see posted on the door of the restroom at Target, where someone named Randy initials that he has meticulously inspected the facility each hour and it has met his standards for cleanliness, the fact that Randy also has dog barf on his pants  from his last job at PetSmart notwithstanding. 

The Hourly Rounding Log is headed by a script that features the sequence of questions one is supposed to ask of the patient during your assessment.  It also implies that you should be asking these questions every sixty minutes, even in the wee hours of the morning, because there is nothing that gives patients the warm fuzzy feeling of care like being woken from a deep sleep every sixty minutes to ask if you’re okay.

The script is not a Tennessee Williams production.  (If it was, you’d expect one of the lines to be “Bedpan!  Bedpan!  BEDPAN!”).  Here are the five scripted sayings:

Is there anything you need?

I have time now to take you to the bathroom.

Is there anything else you need?

Let me be sure your call light is within reach.

Please call if you need anything, otherwise someone will be back in an hour to check on you.

Professionally, I was insulted by this on behalf of the many highly trained and experienced nurses I’ve worked with over the years.  Caring cannot be taught or scripted any more than clinical instinct can be, time is not a function of clocks and charts but of acuity and need,  and the “script” is yet another example of how health care systems try…and fail…to reduce healthcare to factory piecework.  Personally, I was offended by the fact that apparently the Hourly Rounding Log does not apply to me.  I am a doctor, after all…a nice Jewish Doctah, at that…and I passed Physician Egotistical Behavior 101 with honors. 

So I went and asked one of my nursing colleagues why no one was rounding on me.  I was told that since I’ve made it clear what I really need is a winning lottery ticket, a bathtub in my home big enough to drown a pig, and one-way bus fare to the Frustrated Writer’s School, there was no way I could be helped.  I was told they could take me to the bathroom if I wished, but I would have to know they would gossip about what they saw.  (One of every male ER doctor’s fear is that they will get in a horrible accident, need a urinary catheter, and expose their assets to those who really do understand that saying how long it is in centimeters rather than inches is just a dodge.)  And I was told that while they would  be back to check on me in an hour if I hadn’t moved any patients, and they would do so with the expectation of doing CPR.  Because if I’m not moving the meat, the only excuse is to be dead.  Preferably with a Do Not Resuscitate Order in my hand so I don’t take up a bed.

Last Spring I wrote about taking The Teen to a Yu-Gi-Oh tournament back home in Daytona ("The Yu-Gi-OH Blues, 2/11/11).  If you couldn’t guess by the tone of that piece, it was my fervent hope that his adoration of this collectible trading card game of infinite editions (translated as infinite new ways for parents to spend money) would fade, much like I’m sure the Osmonds wake up every day and say “Crazy Horses?  What were we thinking?”  I thought that maybe he would come to realize that there are more productive things to do with his time them play cards, things like standing outside the house to get some sunlight and breathe unfiltered oxygen and learning to use soap and shampoo on a regular basis.  (I mean, he’s now called The Teen for a reason.  Although even this facet of his development has been interesting because maybe it wasn’t just personality that kept the girls away until I hit college.  Maybe it was just the smell.)

Well, he’s still playing Yu-Gi-Oh, and he’s really gotten very good at it.  And because I have the car and hold the allowance, I’m still along for the ride.  So here is the 2012 update of what I’ve learned about Yu-Gi-Oh:

 

 

 

No, really, here’s what I’ve learned.

The Teen still wants me to learn to play.  He offers to construct beginner decks for me.  I appreciate that he still wants to have playtime with Dad, but I still can’t get my head around the game.  Plus this year I can’t see the writing on the cards even with my bifocals.

 

For the third year in a row The Teen and I attended GenCon, the largest gaming convention in the world.  I have come to the conclusion that My Own Flesh and Blood is actually the Crown Prince of Nerds, the hottest thing under 21 in the collectible trading card world.  Of course, as my father noted when he came to GenCon for a day, my mother would also be the hottest thing at the convention.  Mom is celebrating the 45^th anniversary of her 29^th birthday.

In larger card stores and gaming conventions, there is always a place called the Abandoned Parent’s Corner.  This is where parents, all fathers for some reason, sit pretending to do something…anything…for the interminable hours their kid is playing Yu-Gi-Oh.  It’s a quiet place, as everyone is too busy looking at their watches to talk.  The only motion is when someone gets up to go find a refreshing adult beverage and returns 20 minutes later belching is a most happy fashion, hoping their kid is still there so there will be no awkward explanations for later.

Total count of Yu-Gi-Oh players at Collector’s Cache in Lenexa, Kansas on September 1, 2012:  43.  Total number of females:  0.  Total amount of soap and soap products used that morning:  ¼ bar, unscented.   Bowls used for haircuts:  38.

The only way to get a family photos that includes The Teen is to get him to pose at the “Make Your Own Yu-Gi-Oh Card” booth at a gaming convention.

There are a lot of themed decks.  Many sound very ominous, like Anti-Meta Chaos” and “Skull Servants” and “Bain Capital.”  There is, however, a Rabbit Deck featuring cards such as “Resuce Rabbit” and “Mecha Bunny” and “Super-Nimble Mega Hamster.”  Apparently those playing with this deck get manhandled on a regular basis.  But it sounds so nice.  It makes me feel like Allen Sherman, who wanted his kids to avoid Crazy Downtown and it’s vices like The Frug, but instead stay home and do a nice dance like the Bunny Hop.  Allen lost that one, too.

I get to witness conversations of great import such as “You don’t know what Thunderking Rhino does?  You mean you haven’t played for two weeks and you’ve forgotten what Thunderking Rhino does?  That’s f…ing lame.”  I have also learned that while my generation’s conversational faux pas was “You know,” this generation’s is “sucks.” 

 

There is a guy named Billy Blades who invented an Insector Deck.  The Teen defeated him in a demo at GenCon this year.  He has not smiled that much since he watched a cat poop on my head.  It is also the only time outside of school that I have heard The Teen refer to any one as “Mister.”  Billy is a pretty nice guy.  He looks about twenty.  I’d probably have to buy his beer.

But in the end there is hope.  About three months ago The Teen asked me if I thought he should stop playing Yu-Gi-Oh, if it was too much of a little kid’s game.  My answer could have been that it’s not a little kids game because at least I can understand Candyland, and honestly I’d probably give it up for Princess Frostine.  But instead I took the parenting route, saying that I thought it was fine for now, but that as he grew older and learned more I thought he would find more things in the real world to be of interest.  Yu-Gi-Oh is fine for now, but if you’re still playing in Grad School we’ll need to talk.

What I didn’t say is that, having been a teen at one faraway time, Yu-Gi-Oh will end when girls truly begin.  So can I be faulted for encouraging him to seek out reruns of Baywatch?  Hmmmmm.  I think not.