Heavenly Whiskey & Jim Dandy Biscuits...

I was sitting on a mountain top, 3*

30,000 feet to drop, T*

Tied me on a runaway horse U*

Uh huh, that's right, of course J*

Jim Dandy to the rescue! G*

Go, Jim Dandy! Go, Jim Dandy! ("*

(*

("Jim Dandy", LaVern Baker & the Gliders) I *

I*

I *

I was in a blue funk all week long. I hate those moods... T*

T*

The weather was bad and I couldn't seem to get a damn thing accomplished. There were pitfalls and road-blocks, both literally and figuratively, in every aspect of my world. T*

T*

The weather was cold, wet, and unpredictable. We road nurses drove through pouring rain, blistering icey wind, and mucky quagmires of knee-deep mud that had been created by the all the rain. Sometimes there would be a periodic breakthrough by a bright and brave sun to tease us into thinking that there was a light at the end of the tunnel---but the rain would always return, again soaking the already drenched pastures and overflowing lakes. The crazy weather even confused the animals. They didn't know whether to stand up or lay down...

*

A*

Although my daily patient visit-load is considerably less now that I'm the Branch Manager, I still perform all of the official, RN-only, visits as required by Medicare regulations (for such things as admitting new patients to our services, 60-day reviews, and resumption-of-care visits after a hospitalization). And I also see any patient who develops a complicated problem which calls for an RN assessment or decision to be made. Thus, I still make almost as many patient visits as I did before my promotion. M* *

M*

My blue funk persisted all week, and I drove the endless miles in a lethargic melancholia. Although I "faked" a happy mood for the sake of my patients, I mostly spent the miles on the road staring morosely at the beautiful, Texan scenery, mile after mile, while contemplating the various problems I was facing.

*

T*

This week it seemed like all the patients were sicker than usual...and it seemed as if nothing we did for them helped. My cell phone rang all week with news of problems. T* H*

Here in Podunk, road nurses are sometimes considered part of the family. Patients and/or their family members will call us at any hour of the day or night to ask advice about how to decide on what to do about both medical or emotional issues. We sometimes get pretty closely involved with their lives, sharing both in their joys--- and their sorrows. And when their lives fall apart, we nurses feel as helpless as they do. M* M*

Most road nurses I know take illness and disease very personally---and they fight those two entities valiantly and fiercely, on a daily basis, using every skill they've got ---- but sometimes the enemy wins no matter how strong the warrior... I * I*

I am haunted by what happened to one of my favorite patients, Mrs. Vernon. Mr. and Mrs. Vernon live on a large ranch about 15 miles outside of the city limits. Mrs. Vernon has always been one of my favorite patients, and she frequently gives me little gifts. My favorite gift from her was a beautiful, red hand-crocheted coaster. B* B*

But Mrs. Vernon had a bad heart---and she was certain that the "heart doctor" could fix it. She saw our town's heart doctor but he did not recommend surgery. So she and her husband made the long trek to Dallas to see another doctor, a cardiac surgeon---and he also dashed her hopes by telling her that he did not recommend surgery. He told her that it would be best to manage her heart condition with medication. O* O*

One day I fought my way through the wind and rain to see her. I was going to draw blood to check the level of anticoagulant in her blood. As I was performing the procedure, she and her husband told me their new plan. Unbeknownst to her local doctor or the heart surgeon in Dallas, they had gone to get another opinion, from another heart surgeon, and this one had agreed to operate on her heart to correct a defective heart valve. "* "W*

"What?" I exclaimed in surprise, almost dropping the tube of blood I held in my hand. "You got another opinion? But...but I thought you had already gotten a second opinion from that Dallas guy---and he said he didn't want to do surgery..." "* "W*

"Well, we got a third opinion," Mr. Vernon stated matter-of-factly. "And this guy says that he can fix that bad valve. He's going to operate on her the day after tomorrow. We're leaving for Dallas in the morning." "* "Y*

"Yes, isn't it wonderful?!" Mrs. Vernon said brightly. "He's going to fix my heart!" W* W*

When I got back to the office, I frantically located Mrs. Vernon's chart and opened it with a foreboding. I wanted to read the report from the Dallas heart surgeon. As I scanned its contents, my own heart sank with a quiet dread. "What's wrong?" Geena-Lou asked. I explained what Mrs. Vernon was planning. "Well what's wrong with that?" she asked. "I* "I *

"I just have a bad feeling about it," I replied. "Two heart guys have already tried to discourage her from having surgery, and now she's gone and gotten somebody else to do it. But just look at this report from the Dallas guy---her heart is in bad shape. Her ejection fraction is crap and she's got more than one defective valve. I just wonder whether or not her poor little heart can tolerate surgery...." T* T*

The day of the surgery, I repeatedly called the hospital to get a report on Mrs. Vernon's status. I don't like calling "big city" hospitals---to them, I'm just another voice in the vast hordes, and I have to wade through their endless red tape to get even the slightest morsel of information. I*

It's not like that here in good ole Podunk, where I can simply call our tiny little hospital and say something to the operator like: "Hey, Myrna-Jean, it's me, Bohemian. I'm looking for my patient or else her doctor," and Myrna-Jean will reply something to the effect of: "Your patient is down at Radiology kicking up a fuss because they made her take the bobby pins out of her hair before a CT scan, and her doctor is down in the cafeteria because it's chicken & dumpling day." A* A*

Anyway, I called the "big city" hospital and finally got through to an ICU clerk. I explained who I was and told her that I was calling for a status report on our patient, who had just undergone cardiac surgery. But the clerk replied that she couldn't give me any information due to "privacy rules". I argued with her, telling her that I would be glad to fax her a copy of the "Information Consent" which Mrs. Vernon had signed to allow my Road Nurse Agency to exchange information with the hospital---but the impatient clerk interrupted me and said: "Let me just transfer you to her family. They're out in the surgical waiting room." S* S*

She transferred me to a waiting room somewhere---and I finally got ahold of Mr. Vernon. "How is she?" I asked him anxiously. "* "S*

"She....she didn't make it...." he replied in a quiet, shocked whisper. "She just....didn't make it. They had finished the surgery and sewed her up---but then something bad happened." His voice trailed off and I heard him hand the phone to somebody else. "* "H*

"Hello? Hello?" I cried out in anguish. A* A *

A female voice came on the line. It was one of Mrs. Vernon's daughters. "This is Mrs. Vernon's daughter," she stated. "I'm sorry to tell you this, nurse, but she died. The doctor said that something happened in her heart after the surgery---it suddenly filled up with blood or something. And she died while she was still on the table...."

N*

No no no no....... G* M*

Mr. Vernon then brought Mrs. Vernon's body home to her beloved Podunk to be buried. Geena-Lou and I attended the funeral, which was held a few days later. We both wore our best clothes---Geena-Lou wore her mother's pearls---and we gathered with Mrs. Vernon's family at the cemetery. It was raining hard and there were too many people to fit under the small canopy which had been set up for the grave-side service. When Geena-Lou and I walked towards the grave, I heard muted whisperings from the crowd. T* T*

There's the road nurses....let them through.....move over for the nurses.... B* B*

But Geena-Lou and I took places in the back of the crowd, in the open weather, in order to allow as many family and friends as possible to take the few seats under the canopy. Neither she nor I had brought umbrellas, and so we stood in the rain and wind, the stinging raindrops mingling with the tears on our cheeks as the funeral service was given---and the preacher's words echoed in my ears for the rest of the week... T* T*

The sun shall not smite thee by day, nor the moon by night.... T* T*

The week wore on, and it didn't get any better. Two more of our patients became ill and had to be hospitalized, one for pneumonia and the other because I lost my temper. I lost my temper because all my attempts to get a particular patient in to see her doctor were repeatedly thwarted by minor annoyances. W* W*

We had been doing wound care on Mrs. Westmoreland's right leg. Mrs. Westmoreland lives in a small retirement community in a neighboring farm hamlet, and she has very poor circulation in her legs. The wounds on her leg weren't healing very well and I also suspected that they were infected with a nasty, drug-resistant variety of staph bacteria called MRSA. And what was worse, her left leg was beginning to look reddened and inflammed as well. Although most of Podunk's doctors are usually willing to let road nurses decide on what type of wound care to perform for many types of wounds, I decided that in this case I would feel more comfortable if he would take a look at her legs himself. I wanted him to look closely at the status of her circulation, and I also believed that he would need to see the wounds for himself in order to decide whether antibiotics would be needed. A* A*

And so I instructed Jane-Anne to see to it that the patient went to the doctor. B* B*

But Jane-Anne is a very young nurse, timid, and not very aggressive. She returned from the retirement community and told me that she had instructed the staff nurse over there to make the doctor's appointment for the patient. "* "*

"Hell, Jane-Anne, the staff over there will just let your instructions go in one ear and out the other," I told her. "They're busy as bees and may forget to make the appointment. So you've got to be firm. You make the doctor's appointment YOURSELF--- and then you call the staff over there and notify them of what day and time they need to have the patient at the doctor's office." A* A *

A day or so later, Jane-Anne came to find me. "I made her the appointment but she missed it. She said the weather was too cold and rainy for her to go out---because it would ruin her hair. So I called and made another appointment for the next day but she missed that one, too. This time it was because the staff nurse at the retirement community said that she didn't have enough staff available for somebody to accompany Mrs. Westmoreland to the appointment." I * I *

I blew up and started blustering to the heavens, asking the cosmos if it was going to take "an Act of God" to get a simple thing accomplished like getting a patient in to see her doctor. And then Jane-Anne said something else. "* "And her left leg is looking a little worse. It's all puffy and red--and clear fluid is coming out of it. She made me wrap a roll-gauze around it so that her pant leg wouldn't get wet. I told the staff nurse about it but she said it was probably just the same cellulitis that's on her right leg." "* "O*

"Oh for God's sakes," I griped. "I guess I'm going to have to go do this myself. Dammit, I'll drag her butt to the doctor myself if I have to." A* A*

And so I drove over to the retirement community. W

* When I arrived, I strode through the large sitting-room area and headed straight to the patient's room. I could hear a couple of the center's staff members murmuring to themselves, something like "Uh oh, there's Bohemian. And she looks pissed off...." I * I *

I knocked and then entered my patient's room. She was sitting at a table, listening to an old-fashioned cassette tape recorder. "* "*

"Look what the Blind Society brought me!" she exclaimed excitedly. "Since my eyesight is so bad that I can't read the Bible anymore, they brought me some cassette tapes with the Books of The Bible on them---and now I can listen to the Bible!" "* "N*

"Neato!" I agreed, sitting down at the table next to her. "But I'm here to gripe at ya, sugar pie. You missed your doctor appointments this week. What are you trying to do--- give your poor nurses ulcers? And what's this about your other leg looking bad now?" "* "Y*

"Yes, nurse," she replied sheepishly. "I know I should have gone to the doctor--- but first the weather was bad, and then the staff here said that they didn't have anybody to drive me. Why are you so worried? Do you think the wound infection from the right leg is spreading to my left?" I* "*

"I do think the wounds are infected," I told her. "But I also think there might be something else is going on with your left leg. So let me take a look...."

I*

I*

I asked her to take off her slacks and I looked at her left leg. The calf had swollen to one and a half times the size of her right calf, and it was red and inflammed. The swelling was so bad that I could poke a finger in it and leave a dent about 1/4" deep. The skin was stretched so tight by the swelling that it was pulled taught, breaking in some areas--- allowing clear liquid fluid to "weep" out---and the fluid was running down her leg.

O*

Oh no no no no....

"*

"I'm going to bend your ankle, sweety," I told the patient. "And I want you to tell me what happens when I do that." I*

I took her left foot in my hands and "dorsiflexed" it---and she cried out in pain, her face contorting in a grimace. "It hurts in the back of my knee, nurse," she exclaimed. "And it hurts down there at the ankle, too..." C* C*

Cursing to myself, I went out into the halls of the retirement center to find the staff nurse. She was at the main desk--and she saw me coming. She pretended to hide her face behind a book to "avoid" me.

"*

"I know you don't want to hear me," I told her over the book. "But she's going to have to be seen by a doctor TODAY, dang it. Have you looked at that left leg? It's twice the size of the other one. You know she had a hip replacement on that side last year. And she's got a positive Homans' sign." T* T*

The staff nurse put the book down and faced me, a slight frown on her face. "Yeah, but her legs ALWAYS look like that. You know that she has crappy circulation. I'm telling you, it's just cellulitis. And how do you know it's a real Homans' sign, anyway? She's such a titty baby that she yells no matter WHERE you touch her. I don't have enough staff to send one to sit with her at the doctor's waiting room---because she fusses up a storm if we ask her to wait by herself." I * I*

I sighed. She was right, and I didn't want to piss her off any more than I had to. "* "Y*

"Y*

"You're right, but give me a break, okay? You know that I've got to call the doctor about it," I whined. "So I'll call you later and tell you what he wants to do." I* I *

I returned to the office to call the patient's doctor but I couldn't find him at his office. So I called the hospital. "* "*

"Myrna-Jean? This is Bohemian. Can you find Dr. Hemlstedler for me? Tell him I need to talk to him about Mrs. Westmoreland's legs." "* "O*

"*

"Okay, Bohemian." M* M*

M*

Moments later, the doctor called me back. I could hear him eating something as he talked with his mouth full. "What's going on, Bo?" he asked edgily. "I'm here at the hospital doing rounds while the movers are moving everything from my old office to my new one, and my nurse is bitching her head off at me---she thinks I'm doing early rounds at the hospital just to get out of helping with the heavy work." "* "W*

"W*

"Well...aren't you?" I replied saucily. "You usually do your rounds later than this. And what are you eating? Is it chicken & dumpling day in the cafeteria?" He laughed in response.

"*

"*

"Nope, it's just some jello salad I stole off one of my patients' meal trays," he replied. I*

I*

I told him about Mrs. Westmoreland's left leg. "It's cellulitis," he replied. But I argued with him. "Yeah, she does have cellulitis. But that left leg makes me nervous, doc....it's big and red, and she's got a positive Homans'....and that's the side she had the hip surgery on last year. I think somebody ought to look at it." "* "*

"Okay, Bo'," he replied. "Tell my nurse to sign my name on an order for a stat doppler on that leg. It'll give her something to concentrate on other than bitching at me. Does that make you happy?" I*

It did. I*

I*

I called Radiology and told them to expect the patient, and then I called the retirement center. And thus, they finally took the patient to have the necessary test performed. And the doppler study proved that my fears had been warranted afterall---the results were indicative of a very serious condition called deep vein thrombosis---and she was quickly admitted to the hospital to be placed on anticoagulant medication.

"* "S*

"So are you going to tell the retirement center nurse 'I told you so'?" Geena-Lou asked me later.

"*

"Nope," I replied. "Not her. But I'm sure as hell going to say it to Mrs. Westmoreland. I'm going to tell her that the NEXT DADBLAME TIME I tell her to get her butt to the doctor, she had jolly well BETTER GO, weather or no weather, hair or no hair." T* T*

Towards the end of the week, I was so bone-tired that I thought I could hardly drag myself up out of bed in the morning. Lately I've been developing the lazy habit of not setting my automatic coffee-maker up in the evenings, leaving me without coffee in the mornings. Which means that I have to buy coffee on the way to work. T* T*

The one thing that a road nurse needs for a successful day on the road---or in the office---is a big, giant car-cup filled with good coffee. Or at least HOT coffee.... A* A*

Although I've lived and worked as a road nurse in the "big city", where road nurses are able to get away with driving sedan-style Buicks or Toyotas, I have always hired myself out as a "rural specialist", which means that I am prepared to take my nursing skills out into the most isolated of ranch and farm areas in a suitable vehicle which can tolerate the rough terrain. H* B*

But here in the wildlands of Podunk, it's not only the road and weather that a road nurse must be comfortable with, but also farm animals and unfriendly ranch dogs. And she needs to be well-rounded in her nursing experience because the road nurse companies out here require their nurses to have a large repertoire of skills, not just in routine, "everyday" nursing tasks of assessing body systems, drawing blood and performing wound care---but they must also be able to perform more specialized tasks of managing wound-vaccuum machines, starting and running IV's, handling implanted "central line" IV's, changing out stomach feeding tubes, fiddling with colostomies or supra-pubic urinary catheters, and giving nebulizer machine breathing treatments. A* A*

Also, a road nurse out here must usually perform her duties without any help or any hope of help. It's not like when I use to work in the ER and could summon a co-worker for help in difficult circumstances. Out here, road nurse companies simply can't provide that kind of back-up both because of the shortage of available road nurses and also because the distances we travel are mostly too great to make multiple visits a practicality. Although we see many patients in local retirement communities, the vast majority of our patients are out in ranch country anywhere from 10 to 50 miles away from our office---many areas of which are not near towns, gas stations, or populated areas. R* A*

And for some reason, we don't make as much money as hospital nurses. Road nurse companies are very cagey about their money, and road nurse salaries are totally negotiable. Simply put, you are paid for how valuable you are to the company. The skills which "buy" the most dollars per hour are prior road nurse experience (because it takes years to train one), a good knowledge of Medicare home health documentation (again, because it takes years to learn), the ability to "assess" the human body quickly and accurately, and the ability to make decisions independently. A girl can garner extra money if she can do "extra" things like speak Spanish, operate every single IV pump known to man, teach colostomy care to a new colostomy patient, and is a good "stick" at drawing blood. Although road nurse companies are usually willing to try out "rookie" nurses with no prior road nurse experience (if she has the other necessary skills), they'll pay her less until she proves herself. Usually, on average, only about 2 out of 10 such "newbies" will stick with it for at least a year. A* A *

A girl can also command a little extra money if she is known for being a "gunner", a slang term meaning that she will "gun the accelerator" because she is fearless and will go anywhere to do anything with any type of difficult patient. It's a fairly dangerous job and many girls just don't want to deal with it. (Remember that hapless LVN I trained once, whose sleeve was ripped off by a the ranch dog?) S* S*

So each time I go on the road, I carefully check my vehicle and equipment. I make sure I've got enough of everything that I might possibly need in the various containers stored in the back of the Jeep. And then I make sure that I've got what I need for a road emergency on the chance that I experience vehicle trouble. Since I originally bought the Jeep specifically for this job, it is equipped with a separate electrical system to power the back windshield wipers, defrosting system, and heater during extreme weather. I have special tires and the Jeep can shift into two types of 4-wheel drive if the going gets rough. There are towing bars and hooks on both the front and back of the vehicle, as well as drains in the floorboards for water overflow. I keep ice-scrapers, gloves, flashlights, tools, and bags of gravely stuff in case I need "traction". I've also got an extra car-charger for the cell phone, extra blankets, and jackets in case I get stranded while the temperature is below freezing. F* F*

Friday morning I was still in the blue funk but I was scheduled to go out about 30 miles into ranch country. So I performed my usual checks on the Jeep. The weather was cold enough and bad enough that I wanted to make sure I was prepared.

*

*

I * I hadn't done laundry and so I didn't have any clean uniforms. So I threw on some camouflage jeans, a black sweatshirt, and some red cowgirl boots. I pre-filled my car-cup with french vanilla creamer and some Sweet & Lo (in preparation for some McDonald's coffee), crammed my cell phone into my pocket, jammed the iPod headphones over my ears---and I was on my way. I blasted the iPod into my ears and sang along with the music as I drove. And oldie was playing, a song by the Ozark Mountain Daredevils, "Jackie Blue".

O*

Oooo-hooo, Jackie Blue L*

Lives her life from inside of her room F* F*

F*

First off, I headed for McDonalds. I pulled through their drive-thru to get my coffee. After I ordered at the loudspeaker box, I pulled around to the window. A familiar hand was already dangling out the window holding a giant cup of coffee. "You ready for it, baby?" the window guy asked, laughing. "You know I am!" I replied, retrieving the coffee. I pulled over to the side of the parking lot for a minute to pour the coffee from the McDonald's cup into my own car-cup. I took a sip and immediately felt better. MMMMM....nothing like some good hot coffee to wake me up in the morning. Now I was REALLY on my way...

A*

As I drove towards the outskirts of town, I was amused to see a truck on the road that "matched" me in my camouflage gear. Soon I had left our little town behind and was in open country. I stared at the passing farms and animals with the persistant melancholia which had gripped me for most of the week. M*

M*

My first stop was a ranch about 25 miles out of town. I was going to perform wound care and a blood draw on a lady who has some diabetic ulcerations on her right lower leg. I got there without too much trouble, even though I had to leave the main road to plow my way through some county roads covered with mud slicks. Finally, I reached the ranch I was looking for, and I slipped and slid my way through several pasture gates and over a couple of cow-guards. As I blew into the grounds of the ranch's main area---frightening the hell out of some loose goats and a bunch of chickens---I shifted into 4-wheel drive to careen my way through the deep mud, past the barn and round-pen, to the main building. I parked fairly close to the back door of a neat frame house. I jumped out of the Jeep, right into a large mud puddle, causing mud to splatter all over the pack of stupid yard dogs which immediately surrounded me. I ignored them and slung my nurse bag over my shoulder. I then entered the home's back door. I shouted my hello's to the waiting family as I blew into their warm kitchen. "Hey y'all!" I greeted loudly. "I'm here to see my favorite patient!" M* M*

My patient, Miss Mady, and her husband were sitting at the kitchen table, finishing up breakfast. Two female neighbors were also sitting at the table. The patient's two adult sons were present, most likely to do daily chores for the aging couple, and were hanging around the living room, joking around as usual. "Mornin' glory!" everybody chorused. "She's been waiting for you. Would you like some breakfast?" "I* "*

"I wouldn't turn one of them biscuits down," I said, eyeing the large platter of homemade "rolled out" biscuits. I noticed that my patient and the two neighbor ladies had their Bibles opened on the table in front of them. "Hey, Miss Mady," I greeted, plopping myself down at the table. "So sweety--how's that leg? I've got to change the bandages on it. And I've got to draw some blood this time, too." "* "*

"Okay, nurse," Miss Mady replied dutifully, smiling as she closed her Bible. "First have yourself a biscuit and then we can go to the bedroom where all the bandaging supplies are."

"*

"What's everybody sitting around the table looking so serious about?" I asked. "Are y'all plotting something? Are y'all gonna take over Podunk?" Everybody laughed when I said that. M* M*

My patient's husband, a grizzled old man in worn overalls, set his coffee cup down and smiled broadly. "The womenfolk think we menfolk are sinners or something--they're reading us Bible Verses." "S* "S*

"Since Mady's missed church from having been so sick with her leg and all, we came over to do a morning Bible Reading," one of the neighbors explained. O* O*

One of the ladies handed me the platter of fluffy biscuits, and I greedily took a big one as she continued explaining. "We're reading about what Heaven is going to be like. I hope you like the biscuits--I made them from scratch." "T* "*

"Thank you ma'am," I said gratefully, looking at my beautiful white fluffy biscuit. It was the most perfect biscuit I'd ever seen, wonderfully round, gently browned on top, fresh from the oven with steam still rising out of it. "So tell me y'all, what's Heaven going to be like? Is it better than Texas?" "P* "*

"Ain't no place better'n Texas!" one of the patient's sons declared, smiling. "But Heaven's probably the next best place. Put some jelly on your biscuit, sugar---use some of that strawberry--it's homemade and delicious. It's so good it'll make you stand up and slap yer memaw!" E* E*

Everybody laughed as Miss Mady gently took my biscuit from me and used a butter knife to neatly slit it in two. She then generously loaded it with some creamery butter and strawberry jelly before handing it back to me. I took a bite of it---and thought I'd gone to Heaven myself. It was the best dang bisuit I'd had in a long time. "* "O*

"Oh my gosh, but these biscuits are purely glorious, ma'am," I said with my mouth full of biscuit. "In fact, I do believe that these are the best dang biscuits in Podunk." The biscuit-maker beamed proudly. "So you're reading about Heaven, eh? I'll bet there's plenty of biscuits up in Heaven!" "* "W*

"Why, the Bible says that Heaven's going to be beautiful!" a neighbor lady exclaimed.

"*

"Everything will be wonderful---no more sickness, no more death..." "* "*

"And the sidewalks will be paved with gold," one of the sons added, winking at me. "* "*

"And there'll be free whiskey a'flowing in the streets!" the other son laughed, snatching a biscuit for himself. "Yeehah!" A* At*

At that, everybody burst out laughing. "Oh, Jim Dandy! You're such a mess!" his mother exclaimed. "Jim Dandy to the Rescue, indeed---only Jim Dandy would come up with something crazy like free whiskey a'flowing in Heaven!" "* "*

"That's why they call me Jim Dandy," the son retorted. "Cuz I make everybody happy. The Bible says that there's a special part of Heaven just for Texans---and the Lord done put a whiskey fountain right smack in the middle of it!" O* O*

One of the neighbors looked a little confused and asked seriously: "Where in the Bible does it say that there's a whiskey fountain flowing in the streets of Heaven?" "* "N*

"Nowhere, Myrtle!" Miss Mady replied. "Jim Dandy is just pulling our leg, as usual!" "* "I*

"I ain't lyin'," Jim Dandy teased, talking with his mouth full of biscuit and jelly. "The Bible does so say that there's a Texan section in Heaven with a whiskey fountain--- I think it's in the Book of Deuteronomy somewheres..." I* I *

I finished my biscuit and my patient and I set off down the hall towards the bedroom, she hobbling along with her walker and me toting my nurse bag full of supplies. I could hear everybody still talking and laughing at the kitchen table. "* "*

"Hey, Jim Dandy," I heard one son say to the other in a conspiratorial whisper. "It ain't Heaven where there's free whiskey in the streets---it's down here on earth at the Indian Reservation casinos in Oklahoma!"

I*

I walked with my patient to her room, going slowly as she hobbled along with her walker. "* "*

"You walk faster than I can," she said with a sigh. "I can't walk so fast anymore..." "* "W*

"Well that's cuz I'm speedin' " I teased, pretending to signal a traffic turn with my arm. "But honey, you had better stay in the slow lane---and don't take that corner on two wheels, yuk yuk!" W( W*

We finally arrived at her room where I had her sit down in a chair so that I could perform the wound care on her leg. While I was cleaning and dressing her wounds I nagged her about how high her blood sugars had been lately. "You know you're supposed to follow that diabetic diet the doctor assigned to you," I stated. "Letting your blood sugars get out of control is rough on your whole body, ya know. I'm only nagging you cuz I love you." "I* "I *

"I know, nurse," she sighed. "Good food is about the only pleasure I have left. But I'll try to do better. I'm going to the doctor for a check-up next week. One of my sons is going to drive me in his pick-up truck. But sometimes I wonder why I bother going to the doctor at all. I think I'm getting so old and broken down that I might as well give it up and just die---and go on home to the Lord...." "D* "D*

"Don't talk that way, puddin'," I admonished. "I don't want you going anywhere. I'd miss ya too much if you left. Who else would feed me biscuits and jelly--- or tell me funny stories about free whiskey in Heaven? Heck, I'm looking forward to that---cuz you know that I cain't have it anymore while I'm down here on earth. And besides, if you went to Heaven you'd miss your morning Bible Readings with your girlfriends." "* "O*

"Oh nurse!" she laughed. "You're right. Maybe I'll stay around awhile, yet..." S* Sh*

She laughed some more and then I pulled my venipuncture kit out of my bag. I quickly drew her blood and labeled the tubes for the lab. Finally, I finished up, tidying up the table where we kept the wound care supplies. I loaded my bag, gave her a hug and then waved goodbye. She smiled as I left--- and I heard her chuckling to herself. "Free whiskey in Heaven, indeed...." I * I *

I strode back through the kitchen and managed to snag another biscuit, jamming it into my pocket for later. And then Jim Dandy called out to me from outside the back door. I went outside to see what he wanted. "* "*

"Lord have mercy, youngun--- you've gone and lost another gas cap," he stated, pointing to the Jeep.

I*

I hung my head in shame because it was true. I'd lost another one. I don't know what my problem is, but I'm constantly losing gas caps. The one I had lost had been given to me by another patient as a replacement for the one I'd lost before that one... "* "I *

"I know, I know," I said guiltily. "* "*

"Don't worry yourself, sugar. I'll put another one on there," he told me. He went into the barn for a few minutes and then returned with a gas cap. He screwed it into place on my Jeep, and stood back. "It doesn't match your Jeep's paint, but it'll do---and you need air in that front passenger tire," he said. "* "O*

"Okay--and thank you, Jim Dandy," I told him gratefully. "You truly are Jim Dandy To the Rescue!" I* A*

And then I was off again, tossing my nurse bag into the passenger seat as I jumped back into the Jeep....

H*

Hides a smile when she's wearin' a frown O*

Oooo, Jackie you're not so down

*

I * I *

I drove deeper and deeper into ranch country, to the next patient's home, feeling more relaxed with each mile of dirt that I left behind. For some reason I was feeling better, less blue... I started to feel that familiar feeling that road nurses live for---a sense of elation at being unfettered and free in a state which was made for those who are wild at heart.... Y* Y*

You like your life in a free-form style Y*

You'll take an inch but you'd love a mile... M* M*

My cell phone rang. It was Belinda. "B* "B*

"Bohemian-Lou," she stated sternly. "I know you're in that mood again. So I'm going to jerk you out of it. My husband is out of town so you and I are going to go to the movies tonight. There's no getting out of it--you're going and that's final!" A* I *

I told Belinda I'd go to the movies and then finished my patient visits. When I was driving home, I spotted another camouflaged vehicle on the edge of town, which cracked me up. This one had deer antlers mounted on its grill.

*

A* A*

And so that night I went to the tiny Podunk movie theater with Belinda and her little girl, where there were four choices of movies. We picked a silly movie called "Epic Movie" and spent a small fortune on movie popcorn, Coke, Reese's Peanut Butter Cups, and Jelly Bellies. And as I sat in the theater audience laughing at the movie with Belinda and her little girl, somehow I felt the blue funk lifting.... t* T*

There never seems to be quite enough f*

floating around to fill your lovin' cup, o*

Ooh-hoo, Jackie Blue, w*

what's a game, girl, if you never lose?...

The Fabled "White" Appears....

We sat down and wept by the waters O*

Of Babel, and thought of the day...

(Lord Byron)

I*

I'm in a blue funk.

Perhaps it's the weather.

Perhaps it is because I was the "on-call" nurse this past weekend--- and I'm fatigued after having had to slog my way for two days through the endless lakes of mud that the recent rain has created out in Podunk's ranch country.

Perhaps it is simply because the sun has been hiding too much lately.....

But in any event, I would like to share with you the most beautiful and precious photograph that I believe I've taken in years...

t*

Behold....

The fabled "white"....who only appears this close to the main road once in a blue moon.....

W*

Who knows why I was chosen.

I*

I'll be back in a bit....

*

Dang cold...

T* T* T*

The disastrous ice storm and arctic weather which hit a large portion of the middle of the country has arrived. And just about everything in the State of Texas is frozen.

And let me assure you, it is very COLD. D*

Dang cold.

I*

In fact, it is so dang cold... (* (*

(How dang cold is it, Bohemian?)

I*

It is so dang cold.... I*

It is so dang cold that I have to stand shivering in the wind every morning to pour tap water over the Jeep in an attempt to thaw it out from under a quarter-inch layer of solid ice--- as well as those annoying little icicles which are dangling from the side mirror (and who greatly interfere with my Sonic and Taco-Bell drive-thru ordering procedures) ....

I*

It is so dang cold that my windshield wipers won't even wipe because they're frozen into place on the Jeep's windshield...

*

I*

It is so dang cold that the trees, fences, and everything else in the pastures are covered with shimmering blobs of ice--and the cows are vowing NEVER to lay down again..... *

B*

But the good news?

The good news is this:

Mr. Tynedale went home from the hospital today. And although the weather man is predicting more freezing rain and arctic temperatures tonight, and Mr. Tynedale lives on a distant cattle ranch 35 miles away---and there are no paved roads out there which means that I'll have to plow my way through frozen mud and ice--- and the cell phone rarely works in that region so God Help Me if I get stuck in said frozen mud and ice...

I'm bound and determined to go see him. And so I'll be going out there bright and early in the morning come hell or high ice...

(I'll blog more when my fingers thaw out.....) (if I don't get stuck in the mud & ice out on the Tynedale Ranch...)

(Oh, and just one more little thing: Y'all keep your fingers crossed that Geena-Lou's kids win ribbons on the animals they've entered in the Ft. Worth Livestock & Rodeo this weekend. It rained on them all the way there but they made it safely---towing NINE ANIMALS in one trailer!! --and Geena-Lou said that her husband griped his head off about one thing or another all the way there...) *

Take This Rain...

*

Make this rain into your fortress...

IIt's alright, take this rain,

It's alright, take this rain,

It's alright, take this rain,

You're going to be free...

("*

("Take This Rain", Jackson Browne) A*

*

It all started out with some fog --- but then it changed...

*

A really bad arctic front with sleet and rain has moved into the area. Apparently this front has been causing horrible weather all across the mid-section of the country. It started out foggy and misty here in Podunk--but has progressed to intermittent bouts of miserable, cold rain. And the temperature has been dropping by the hour. With this dismal weather, the driving conditions are horrid. And the weather report says that things will only get worse.

I*

I should have known the weather was going to turn bad on Thursday when all the cows started laying down in their pastures. You know what they say---when the cows lay down, the weather's going to change. B* B*

But I didn't think anything of the cows at the time--- because the weather was beautiful that day and I just figured that maybe the silly cows were tired or lazy....or something. You never can tell with stupid cows, ya know? * * * ? ** * *

O*

But the tell-tale sign of the cows proved correct and the weather has gone to hell in a handbasket since then. Right now it's raining cats and dogs. Everything is drenched. The Interstate highway is drenched, the countryside is drenched, and the hospital building is drenched. Even the paramedics barracks, which are usually perpetually open, have closed their huge doors to block incoming water. * *

And one of our LVN's, Geena-Lou, is the "on-call" nurse this weekend. And it's fortunate for her that she has a huge Ford pick-up truck with four-wheel drive--- because she's going to need it to get through the mud. *

She's got a daily wound care visit to do on a patient who lives on a distant cattle ranch, and to get there you've got to drive by several paint-pony ranches, a deer lease, and two goat farms. The region has few paved roads. It's so far out in the country that cell phones will blink in and out of "roam" mode, sometimes not working at all. I*

I told Geena-Lou that if she needs anything to call me. But I always worry that she's the type who won't call me. Geena-Lou is one of my heroes in that she is a hard-working country girl who can handle just about anything. She rarely complains, she loves each and every patient with a fierce loyalty, and her Texan work ethic is evident in her steadfastly humble, calm, and efficient common-sense approach to the job of nursing. Nothing ruffles her. *

*

She is the nurse I have mentioned in the past who once encountered a patient in a locked room. The patient's son had locked the door to keep the confused patient from wandering around while he was out in the cow barn---and the patient had suddenly become too ill and weak to get out of bed and unlock the door when Geena arrived to see her---and so Geena-Lou simply found a screwdriver and took the door off of its hinges.

I*

In case you're wondering why everybody in Podunk has a "Lou" or "Lu" after their first name, it's kind of complicated. And that is because of several Texan quirks. First of all, "Lou" is a term of endearment in small, Texan towns, reserved for those people you are the most fondest of.

*

For example, I call Belinda "Belinda-Lou" and she calls me "Bohemian-Lou". A*

A*

And then also, "Lu" is an abbreviated nickname given to people who have any sort of an "L" in their first name (like Linda, Lesley, Lindsay, etc), which was the reason for Lu-Lu's nickname. A*

And finally, "Lou" also happens to be a popular Texan middle name--- and thus many girls are actually given it as their formal middle name on their birth certificates.

B*

In Geena-Lou's case, her name is actually just "Geena"---I call her "Geena-Lou" simply because I am fond of her---we're buddies. Geena-Lou and I have worked together since the old days in my former Road Nurse Company. We've been through thick and thin together, including the incidents leading up to the company owners' decision to fire our mutual friend, Lu-Lu, which hurt both of us terribly. A*

Anyway, the weather is horrible right now. Yesterday, we nurses took the step of advising all of our patients in outlying areas to go to the store and stock up on groceries in anticipation of hunkering down to wait out the bad weather. But we really didn't need to do that because our country patients are very experienced in this aspect of country life. By Friday afternoon, every farm and ranch family in the Greater Podunk area had seen to it that their pantries were well-stocked with food and their woodsheds stocked with big stacks of firewood.

I*

In fact, the patients were the ones warning us nurses to "stay off the roads"... T*

The company has two patients in the hospital right now, and it's touch-and-go for one of them. Whenever we have patients in the hospital, we call every day to check on their progress----or else I'll drive over there and go see them for myself. Our office and my apartment are both less than 2 blocks away from the hospital. *

After a cup of Hazelnut coffee this morning, I pulled on one of my old "biker chick" jackets and drove over to the hospital to check on our two ill patients. *

I *

I parked in the Emergency Room parking lot. But in my hurry, on my way up the lot's ramp, I almost ran over the main pilot of the hospital's Medical Helicopter when he unexpectedly emerged from the ambulance bay doors in a dash towards the helicopter's landing pad.

W*

When I alighted from the Jeep, he hollered over at me: "What the hell are you trying to do, kill me?"

I*

I hollered back at him: "No, dammit, but you shouldn't be flying in this awful weather anyway."

*

"We're not going to fly," he replied. "I just came out here to tie the dang thing down so that it doesn't blow off the roof in this rain."

A*

I trotted into the warm ER and headed towards the elevator banks where I could go up to the "floor". I passed through the ER waiting room and waved at the receptionist. She waved back, and then returned to listening to a patient telling her about his cough. I went to the floor and approached the nurse's station to find out which rooms my patients were in. I encountered one of my company's own employees, a home-health aide who provides bathing and hygiene for our home patients---she also works as a nursing assistant in the hospital. "*

"Hey Jenna," I called. "Where's Mr. Tynedale and Mrs. Brown?" "*

"*

"He's in 302," she replied. "And he don't look so good. Mrs. Brown is further down the hall, in 311. And why in the hell are you wearing that dang Harley Davidson jacket? You trying to scare all the patients into thinking that bikers are taking over the hospital? You look like you're ready to get into a knife fight or something. Jane-Anne's Uncle Dean would kick your butt if he saw you wearing that thing in here... " I *

I*

I went to room 302. My heart sank when I saw our patient. Mr. Tynedale was lying in bed looking pale and weak. He was on oxygen. His worried wife and family were sitting in chairs nearby, watching the town's Baptist preacher--- who was wearing a suit and tie with cowboy boots while standing over Mr. Tynedale. The Preacher was holding his Bible, reading a verse to Mr. Tynedale. I didn't say a word and stood quietly, allowing him to finish the reading. "*

"I will lift up mine eyes unto the hills, from whence cometh my help. My help cometh from the LORD, which made heaven and earth...." W*

When he was finished reading Psalm 121, he took the patient's hand and began talking quietly. I turned to the patient's family. His wife, son, daughters, and their kids were crammed into the few available seats, or else hovered nearby, many clutching their Bibles. A multitude of get-well cards and flower-filled vases were crammed onto any available flat spaces. "*

"How is he?" I asked Mrs. Tynedale. "H*

"H*

"He won't eat," she told me sadly. "His weight has dropped down so much that they're talking about putting a feeding tube in him--but he doesn't want it and told the doctor that they'd have to tie him down like a mule to do it. And they don't know why he's so anemic. They did an MRI...but now the doctor wants to do a colonoscopy to see if he's bleedin' in there somewheres..." She started to cry softly. I leaned over and hugged her tight for a few moments. "*

"P*

"Please don't cry, Mee-maw," one of her grandaughters said, handing her a Kleenex. But she had tears in her eyes, too. M*

My cell phone began ringing but I silenced it. W*

When the Preacher was finished talking to the patient, I stepped over to the bedside and peered through all the oxygen and IV tubing at Mr. Tynedale. The formerly strong Texan cattleman, who was usually clean-shaven and clad in jeans and cowboy boots, was now lying before me, a study in diseased weakness. He was unshaven and wearing a hospital gown. I sensed that he was uncomfortable with how he appeared to those of us present. As he tried to speak to me, I knew from his expression that his helpless disarray must be killing him....just as I knew that it was most likely some virulent form of cancer that was eating him alive from the inside.

H*

He forced a wan smile. "Hey nurse," he said, managing a roguish grin. "*

"H*

"Hey yourself," I replied, trying to look cheerful despite my growing dread. "I hear that you're not eating. What's the matter---don't ya like the tasty hospital food? How about I go across the street to McDonald's and get you something really good---like one of them big ole juicy Big Mac's you love so much? It won't take me five minutes. And I'll bring you some ketchup and french fries...." "N*

"N*

"Naw, honey, don't do that," he said, taking my hand tenderly in his. "The food here is alright. It's just that I ain't hungry. But I sure do wish I could get up outta this dang bed---it's uncomfortable, and I've got to feed the cattle."

"*

"D*

"Don't worry yourself, Daddy," his son interjected. "I've already done it. You jest git yourself to feelin' better. The ranch'll be fine till you come home." A*

A*

After I talked with the patient for awhile, I sat down and tried my best to comfort his frightened family, assuring them that we nurses would continue our prayers for them. Before leaving I gave the patient's wife my cell phone number and told her to call me anytime, for any reason. I*

I didn't want to cry in front of the patient and his family. I wanted to present a strong and confident manner to help them take courage. Be strong, be strong! I told myself. Don't fall to pieces in front of them---because that might cause them to lose their hope....

S*

S*

Struggling to compose myself, I continued my way down the hall to visit my next patient. She was in better shape. She had broken her hip in a disastrous fall at home, but she had undergone surgery to repair it. Now she had a serious urinary tract infection, but the doctor had prescribed antibiotics for it. Hopefully, in a day or so, she would soon feel strong enough to begin the "rehab" process whereby she would undergo rigorous physical therapy to build her strength and get her back on her feet again. When she returned home from the hospital, I would schedule one of our own physical therapists to continue the therapy in her home. A*

After I finished my visits, I returned to the nurse's station where I again found Jenna. I chatted with her for a few minutes--- and then suddenly all the lights went out. A collective moan went up from everybody---and then the emergency generator kicked in and some of the lights came back on. "*

"Don't take the elevator," Jenna warned. "The bad weather is screwing up the electrical system. The lights flickered a couple of hours ago and somebody said that the elevator got stuck between the floors for about 25 minutes." "*

"T*

"Thanks for the tip," I replied. "I'll take the dang stairs." *

B*

But Jenna couldn't resist throwing out one more comment. "Don't walk by the Security Office," she said, smirking. "The guard is liable to shoot you in that jacket."

*

"Hell, I ain't worried," I laughed. "Buster Johnson is on duty---and that yokel couldn't shoot the broad side of a barn. Hell, I doubt his gun is even loaded."

*

When I got back to the ER, I sat down on a free seat in the waiting room and looked at my cell phone. The previous call had been from Geena-Lou. I called her back. "*

"W*

"What's up?" I asked her. "*

"J*

"Just letting you know what's going on," she stated. "I'm out here at Mr. Daniel's place. He called to say that the weather's supposed to get worse soon---and it's supposed to freeze tonight. His hip is botherin' him real bad and so he wants me to help him feed the horses and get all his animals into the barn." "R*

"R*

"Right," I replied, glancing out the window at the torrential rain outside. I could hear thunder rumbling in the distance.

A*

And then I remembered that Geena-Lou's kids have been feverishly practicing their roping skills, and have been faithfully tending some of their prize cattle for an upcoming livestock show and rodeo event in Ft. Worth next week.

"*

"Hey," I exclaimed. "What are you going to do about keeping your own animals warm? Aren't y'all getting ready for the rodeo next week?" "*

"M*

"My husband's off work today and he's already put the show animals into the barn," she told me. "But the damn donkeys were already in there and got pissed off about having to share the space---one of the idiots ran out through the barn door and off into the back pasture. I told my husband that I'd go get the stupid thing when I get home later this afternoon." I*

I hate donkeys....

"*

"Hey, how's Mrs. Dimwell's foot?" I asked suddenly, referring to one of our diabetic patients who is in real danger of losing her foot, as she's already had a toe amputated but the amputation site has not healed and is, in fact, worsening. "*

"Not too good," she replied. "The wound center doctor debrided the wound yesterday to see if there was any circulation there, but it hardly bled at all. She's got an appointment in Dallas on Monday to see a vascular surgeon---if the roads don't freeze and her brother can drive her down there. She's really hoping that the surgeon can figure out some way to save her foot. But between you and me and the signpost, I don't think it looks too good."

H*

"How's her family taking it?" I asked.

"*

"You know her husband," Geena-Lou said ruefully. "He never takes anything serious. He was hollering the whole time I was there, wanting her to get up and fry him some bacon for breakfast. I told him that he needs to let her stay off her foot like the doctor said, but he's spoiled rotten and wants her to wait on him hand and foot. I guess he ain't gonna listen til she's flat on her back after having lost her whole dang foot." "O*

"O*

"Okay," I said. "I'm just leaving the hospital now and I'm going back home. If you need anything, call me." "*

"O*

"Okey dokey," she replied. "Keep warm yourself, Bohemian-Lou..."

I* O* On the way home, I stopped at Bubba's Jiffee-Mart and bought myself a banana Moon Pie and some Diet Sprite. I returned to my apartment and noted that, indeed, the temperature was getting colder. I adjusted the thermostat and heard the heater come on. I looked out my bedroom window at the Interstate, watching the trucks go by in the foggy, rainy mist. **

I*

I mouthed a silent prayer for all of my company's patients. I also said one in for Geena-Lou, who will be on the wet roads both today and Sunday.

A*

And the temperature is dropping---and the rain goes on.....

*