eric135

two cans of black spray paint

My personal productivity has really taken a downturn of late. I have not been able to do as much studying of the stock market, and haven't really done that much "entertainment" reading (I'm STILL working on Tami Hoag's Kill the Messenger, which is excellent and I should have finished reading it by now).

I think the hardest times for nurses are the months of February and March. I always tend to be really dissatisfied with things during this time, until the summer comes and our census and acuity goes down. The holiday season got us tired, and then the flu season usually hits in January and February (this year, well into March) and then it's just a slow crawl until the Arizona crucible-like heat slows everything down. If things go as usual, we'll be periodically shutting different units down due to low census, which while it brings about a lot of floating between units (never fun), it also reduces our staffing shortages, and folks that need to take time off can get it.

Conflict with the physicians continues. Over the past couple of weeks, the latest thing was that the main hospitalist group was claiming we were "making up" the daily weights of our patients (we weigh every patient on nights). I just got so god damn sick and tired of hearing about it, and having to interrogate the nurses and CNAs about the problem, that one night, I just decided to be present at every patient weight (51 in all). I would weigh myself before each weight to verify the accuracy of the scale. If a patient balked at their weight, I would tell them what my weight should be, and then I would get on the scale and let the patient read my weight (exactly as I predicted it would be), which made them realize the scales were precise from one use to another. If any patient grumbled about being awakened for a weight, I identified myself as the charge nurse for the unit and told them the weight would have to be done (and then I filled out a Press Ganey complaint form to pass along to administration to back up nursing's claim that daily weights in the dead of night pisses people off). I then turned the list of weights and a personal statement staking my professional reputation on the precision of the weights and turned it into my boss, with a demand that the allegations of falsifying the weights stop.

And they did. I've gotten administration's assurance the issue is now dropped.

But the whole process really ramped up my feelings of anger and aggression, which really just isn't suitable for my role as charge nurse.

So the next day, I was driving into our new parking deck, and saw that they had blocked all of the spaces on the first floor with red cones, and come to find out the spaces are being reserved for physicians (it's a seven-level deck, most of which is empty). They painted each space with white lettering on the black asphalt: Physician Parking Only. And I don't know why but it has royally pissed me off. I've just lost so much respect for our physicians that the idea of giving up spaces for them just galls me.

So I've gone to our local Home Depot...

and bought myself a couple of cans of black spray paint...

When to finally pull the trigger

I've been doing more reading (so I'm presently reading Kill the Messenger, mentioned in an earlier post, and these two new ones. I like reading more than one book at a time. I know lots of people that can only read one book at a time, but yet it is normal to watch a dozen TV shows. I don't see any difference.

I've mentioned Jim Cramer before. I used to watch him a lot when his new show, Mad Money, first came out on CNBC, and I still do watch it on those days I am sitting in my office in the mood to do stocks. I think Cramer has an excellent understanding of how markets work, and how you can make money by identifying inefficiencies in the market. He also displays (almost too overwhelmingly) the excitement and euphoria of trading. I guess the lesson I took from his show is that you have to have both sides of the equation -- you need to know the numbers (price, earnings, PE, etc.) but you also need to know who is excited by all of it. Who will become fearful. Who will become boastful and overconfident. I personally don't party like Cramer does when a trade goes well, but I try to cash in on emotional buyers and sellers that, due to their emotionalism, have made a transient inefficienty where I can make a profitable trade. I've only read the first few chapters, and I already like it. I like his personal stories, about how he and his wife would seal themselves off in "the steak room" where she heartlessly makes Jim state clearly why they still own a stock even if it's down (my parents have their own version of this room, and the conflict my parents go through is captured so vividly in Cramer's book).

In Heiserman's It's Earnings that Count, I am trying to find a more mathematical method to determine how good or bad a company's earnings report really is. I do read earnings reports (the 10-K and 10-Q reports that you can get a piece of on yahoo, and the summary financial tables on yahoo). But my analysis is extremely simplistic. Reading the table from year to year, I want to see the company making more money quarter after quarter, year after year. However, as a shareholder, I am more interested in the earnings per share (EPS), which is the total earnings divided by the total number of shares. I want EPS numbers to also grow year after year, quarter after quarter.

But I'm missing a lot. There are numbers on the reports which can make the report a more pessimistic view, or a more hopefull view, that is not warranted or deserved. I've read only the first 4 chapters, but the jist seems to be to take the earnings report, and break it up into two reports -- one a pessimistic view (prevention of loss of capital is the primary objective) and an optimistic view (to realize greater gains and profits). By comparing these two views, you have a better grasp of whether the company is growing or faltering. The trading strategy I use now is to identify stocks with good earnings reports (indicating growth ahead), that did not already get overpriced due to market excitement (often these will take a tumble immediately after the earnings announcement). A trigger for me is a company with good earnings, with positive guidance, and whose price has not doubled overnight due to over-anticipation.

Confidence really might be everything

I took a couple of days off. I have just hated going to work the past week or more and folks have started to notice so I switched with folks to give me two nights off. It's been nice. I spent a couple of days watching TV, reading and studying the stock market. I also have been sleeping a lot (the first day off I slept 16 hours straight, and got out of bed basically when my bladder was too full).

B was out of town for 11 days, and that has been the longest I have lived alone in more than 10 years. It was certainly not any fun. I got so sick and tired of getting up to check that all the doors and windows were locked (after every little bump) that I started sleeping with a chair stuffed under the doorknob to the front door. My fatigue undoubtedly was due to the fact that I was getting only a few hours of sleep a day. The sixteen-hour sleep-a-thon wa after he had just gotten home.

I've been reading blogs about the stock market, and read this article about how the market has changed from intra-day volatility to volatility over 2-3 days. The article includes an interesting chart showing intra-day prices generallly decline, and that uptrends in stock price are now happening overnight, or over a period of a couple days. I had thought as much almost a year ago, when I decided to change strategy to a more long-term view. My current system is based more on earnings than momentum, and I've done really well. When I read about measley 6% gains in 2005, I almost coughed up my food. I assumed everyone was doing well since I was doing well.

Which brings me to wonder... if traders/investers do well if they believe they should or will do well?

I mean, in a market I assume to be "bad", I set really tight stops to get me out of trades if the stock price dips even a little bit. But when I perceive that the market is "good", I set stops at the most recent intra-day low that happened on greater-than-average volume. And it's kept me in stocks during more turbulent price swings. Then the stock goes higher -- without dumping me out at the bottom.

Would I have done as well if I had perceived a more negative bear-ish market? I doubt it.

Singing in the Rain

It's raining here in Phoenix for the first time in months and months. We took turns to go outside and watch it rain. I'm not kidding. I am sure there were Phoenicians out driving their trucks in the washes, with the subsequent air evacs via helicopter we see so often on the news when it rains hard. For the life of me, I don't know what would possess anyone to drive their car in the ditches specifically designed to catch and divert flood water, and to do so specifically when it rains.

Last night, we were short a monitor tech, and I decided to sit at the monitors rather than take a nurse away from patient care to watch the monitors. Whenever this happens, I do a lot of angry posturing, firing off several flame emails, and lots of angry phone calls. I know that I should know better, but I feel that if I don't go through these gyrations, we will always have to go over our usual ratios. But we did take all of the patients from the ER, and I think the nurses decided they didn't have to get all upset since I already was. Yes I get angry, but I know those patients have to go somewhere, and I know they can't all just hang out in the ER. And I know it's all about the mulla (moola?).

It was strangely quiet the entire 12-hour shift. The patients were busy as usual, and the ER admissions filled all of our empty beds by morning. But there wasn't the usual "baseline" conflict that I usually run into. No patients were upset asking to speak to the charge nurse. No physicians were upset at being called in the middle of the night (partly because we didn't have to make that many calls). No fighting between staff members. No one in AFIB RVR. No codes. No bed alarms (indicating a confused patient had decided to make a run for it). Hell, I didn't even start a single IV.

I'm back tonight, and if it goes as well as last night, I'll work extra Sunday because we are short (and I can not stop myself).

I wish I was off tonight. I sleep so damn good when it rains like this...

Four Books and TV

I've been catching up on my reading.

Spin, by Robert Charles Wilson, was a new author I decided to try. The story is set in the near future, when suddenly the Earth is surrounded by a field which makes time pass incredibly slowly for the Earth compared to the rest of the universe. So for every day on earth, millions of years pass everywhere else. There are a lot of other story lines developed.

Cell, by Stephen King, is King's most recent book. Cell phones cause people to turn into zombies. I avoid zombie movies because they give me nightmares, but zombie books don't seem to bother me. And King does such a great job developing characters. After I bought the book, I noticed that the fifth installment of his Dark Tower series is out in paperback, which I'll have to read.

The Chronoliths, by Robert Charles Wilson. I picked this one up after I read Spin, but didn't want to read two books by the same author in a row. It's my current read. Set in the near future, these towering monuments appear out of nowhere all over the world, coming from the future.

Kill the Messenger, by Tami Hoag. I've already picked out my next book. This one's a thriller/suspense novel.

Last night, I watched 8 episodes of the TV series, Invasion. We had given up on it back before Thanksgiving because the story line was moving way too slowly. But watching all of those episodes in one sitting was very entertaining. I'm now caught up with the original weekly airings. And I can't decide if I'll start watching it weekly, or if I'll just let TiVo record a bunch and watch them in one night. I'm thinking of watching 24, We have about 6 episodes TiVo'd. I gotta check out who they will be torturing/taser'ing/electrocuting this season.

Two nights spent in La-Z-Boy chairs

I've spent the past two nights working with a bunch of really confused patients. One was a homeless man taken off the streets of Yuma brought to our facility by EMS. For two nights, I've spent most of the night sitting in one of those La-Z-Boy type chairs (usually used by families spending the night). For whatever reason, he is completely bat-shit crazy until I sit down by him, and then, after we have about an hour of an amicable (although completely unintelligible) discussion about the fact that we are in a hospital, he was not arrested, and the his insurance will cover the bill, he drifts off to a fitful sleep. He asks the same questions (I am filipino, I am not a cop, I am a nurse, no I am not married) night after night. At least once a night, I will help him wobble like a weeble into the bathroom, where we have the most gentlemanly (albeit unintelligible) discussion while he is seated on the toilet and I am sitting in a chair in the room. All I did was provide encouragement. I tend to say, "You are getting better every day," or "You are going to feel much better tomorrow, I am sure," or "You will think more clearly tomorrow." But I have no idea if that will happen. But the constant repetition of positive statements tends to make these patients calmer. They might not totally comprehend what you are saying, but they key in on the positive intonations of your voice. In an almost reflexive manner, they calm down. At least for a little while.

I listen to a lot of nurses interact with the (bat-shit crazy) demented patient, and when they are tired, or rushed, or frustrated, what comes out is a lengthy barrage of negative statements. I admit I do that as well, especially when the patient is really difficult to manage. I think nurses sometimes try to reason with the patient, and use if-then-else types of arguments to get them to make the rational decision to behave better. Of course, since they are bat-shit crazy, this approach is less than successful. The nurses that do bettter are the ones that can switch from the rational approach to a more instinctive nurturing approach. Tell them they will fell better tomorrow. Tell them they will be more with it tomorrow. Tell them they are improving. Give them something to build on, even if it's more based on hope and faith than medical science.

The other patient I sat with suffers from dementia. I got the feeling the dementia would clear up once the medical problems were taken care of (she has a urinary tract infection and pneumonia). As I sat by her bed, a Christian music channel came on. They broadcast hymns and spiritual music while showing these panoramic nature shots. She could not read the words, but got some comfort having someone watching the screen with her. We didn't talk hardly at all; we just sat there quietly watching, until she eventually dozed off. At first, I went in there to give the nurse a break, thinking I could work on the next shift's assignments. So I sat myself down and started pulling out my pencil, shuffling the papers containing all of the names for day shift. But she was so much more quiet and relaxed when I put everything aside, kicked back in that La-Z-Boy chair, and watched the screen with her. After a while, I found myself really reading the words. I found myself trying to really experience the program, as my patient was obviously experiencing it. After the 45 minutes, I really did get the feeling the sun would come out the next morning (on really bad nights, I sometimes wonder).

I am off one night, then back on for three. I plan on watching all of the episodes of Invasion at one sitting. We've got about 9 episodes Tivo'd that we stopped watching because I was getting frustrated that the story line was taking too long to develop. But I find that consuming entire seasons at one sitting moves that process right along (the notable exception is Lost, a story line that still is completely incomprehensible after two seasons.)

oh no, NOT the ice pack...

Yesterday I spent 6 hours in class getting recertified in ACLS. As you can see from the picture, we are about to start on the babies. At first these classes made me nervous but the tests are not nearly as comprehensive as the review materials, and the "mock code" test (where you have a CPR dummy connected to a monitor with a crash cart nearby while you tell everyone what to do based on the rhythm the instructor puts up on the monitor). I've done real ones so often I don't worry about them anymore.

The last night at work, I was called to insert a foley. The patient has a pretty good case of prostate hypertrophy, but I was able to "make the turn". I got the catheter inserted all the way up to the hub but no urine came out (we had scanned him and he had about 500cc in there). Suddenly, the patient care tech and I were being sprinkled by a fountain of urine. There must have been some blockage of the tube (or it was kinked or occluded in some way) and the urine squirted out of the urethra around the catheter. We were trying to stay clear of the line (arc) of fire. My hands were full, and I told the tech to cover the penis with anything at all. In the vacinity, I noticed several pillows, pillow cases, blankets, paper towels. Behind her, almost a full arms' length away, I spied an ice pack. The next thing I knew, that ice pack (full of ice) went right over the tip of his penis and both of my hands.

Women. Typical.

After the procedure, I had to get a set of hospital scrubs to replace my urine-sprinkled uniform.

It could have been worse. I have an eerily similar story involving a patient that was getting an enema. They were washing down the walls, doors, ceilings and a window for the next day.

And how much is that going to cost me

Our TV set died the other day. It's been trying to die for a while now. We could tell because, occasionally, a part of the picture would be bent and distorted. Lately, it would turn off by itself, or refuse to come on without hitting the power button multiple times. Then one morning, it just wouldn't turn on.

So then the debate started, if we should maybe get a bigger TV set (which would require the purchase of a new entertainment cabinet -- which, as you may be able to see from this picture, is sort of swaying off center and really could stand to be replaced).

We opted to just stick with the present entertainment center, and limit ourselves to the largest set that would fit in the same spot (that puts us at a 27" diagonal -- all of 3" more, diagonally, than our broken set, but far from the 54" behemoth desired by B). Other factors to be considered was that I was not willing to spend more than 200 bucks for a TV set, and it had to fit in our (itty bitty) car's back seat (with or without box).

I remember telling the teenager behind the counter at Target, that I was worried the TV would not fit in the car. He kiddingly told me that the TVs nowadays came requiring assembly, and that we'd have to use a saudering iron to put the TV set together.

The next thing I knew, I was asking how much a saudering iron would cost me.

After all the ha-ha's were over, we were able to get the TV into our back seat (we had to give up the box).

We're pretty happy with our purchase. It's not HDTV or plasma, and it's nowhere near 54 inches, but it suits our needs.