Cassie Alexander, ICU RN Profile picture
Bay Area ICU RN & genre author. SFWA, CW 07 alum, & Benevolent Dictator of Codex. Titanium snowflake. Quick to anger, quicker to laugh. Gardener. She/her.
14 Sep
okay, after my tweet last night, turns out y'all are into the gross stuff, apparently especially scrotal related gross stuff, so here goes -- I won't post any pictures, what y'all google is on y'alls souls.

Fournier's gangrene is a nec fasc that effects genitalia...

Nec fasc = necrotizing fasciitis = flesh eating bacteria.

Like those things you read sometimes -- "she jumped in the lake, and went to sleep, and when she woke up we'd had to amuputate three limbs"

only this time on men's junk.

I don't really know why it sometimes happens there, people say 'oh, they're unclean' or whatever, but honestly, the incidences I've seen of it seem to be usually attributable to 1) bad luck and 2) a general desire not to go into the hospital have have ppl inspect your stuff

Read 14 tweets
13 Sep
A really random thread (because I haven't written enough fiction today and still have words in me) about why working on a burn unit rocks and it's the best place in the hospital. Follow if interested.

First off, everyone thinks it's gory and horrible and you can do it and shit smells but fuck all that.

The true magic of the burn unit is this -- demographically, the ppl who get burned are most likely to survive.

It's pretty much all dumb 16-25 yr old boys doing dumb shit, and pedi patients with scalds.

Yes, there are sad outliers, etc, in large people admitted into burn units for care survive.

Read 19 tweets
13 Sep
A meta-thing in this week's What we Do in the Shadows, is them playing MUSE during the 'Twilight' kickball part, bc Stephanie Meyer is a huge MUSE fan and each of her movies got their own brand new MUSE song.

Also, that show continues to be the only good thing in this timeline.
This is the only level of fame that I aspire to, really.

Pay off my house, not have to work again, fine, but to be in a sitch where someone is, "Oh yes, to accommodate you, we'll pay Matt Goddamned Bellamy to write a song specifically for your proj."

I'd die and go to heaven.
A random thing about me, is when we did EMDR therapy for my PTSD, my therapist wanted me to come up with 3-4 deep veins of good memories to balance out the tragic covid work ones, and one of my good ones was going to @muse shows.
Read 4 tweets
13 Sep
This is the most followers I've ever gotten in a day.

I'm getting the irrational urge to say something stupid or do something dorky to scare you new people off.
I think the thing that I'm feeling here now is the awkwardness of this being a semi-professional and branded/ing 'author' space for me...but also where I whine about why the fuck hasn't Neelix died yet, I've been watching Voyager for 7 effing seasons, WHY.
I missed an episode with the girls this afternoon, and we all have a pact, if we miss the episode where he dies, everyone will either stop viewing immediately, or everyone has to rewatch it with you.
Read 6 tweets
11 Sep
Zomg, y'all are really getting the word out! Year of the Nurse is down to #108 on Amazon's free list & I've done 0 promo other than mention it here. I'mma do a Freeboosky on Tues, and my mailing list on Weds, but this is already super amazing!❤️❤️❤️…
I've also gotten my first 'well at least it was free' one star spite review, lol.

One of the reasons I didn't go free sooner was because by casting a wider net, you get readers who don't like your stuff and your rating # goes down.
This is just a Known Thing, in fiction land anyways, Kara warned me about it when we got our first big exposure on Dragon Called.

But I think I've got enough of a ratings buffer to handle it now 🤞
Read 5 tweets
24 Aug
Saw someone w/a fiction revising Q elsewhere and thought I'd answer it here bc I'm clearly not going to get any 'real' work done on a release day, lolsob ;)

So -- How Cassie Edited 400k of Fiction Last Year, here we go!

First off, I'm not going to lie, it helps if you've been doing this forever (I'm like 23 years in) so yeah, experience is a magic of it's own.

But if my experience can help you, all the better, the world needs more great books!

Assuming you've gotten to the end of your book, the #1 thing ppl tell you to do is 'wait' before heading back in, which yes, totally works...but it does cost you time.

Another hack for getting around that is to switch up the way you view/feel your book....

Read 52 tweets
24 Aug
If you ever what fiction I wrote last year to stay sane(ish?) and happy(some!) and alive(woohoo!) it was writing this book here: an opposites attract sexy paranormal romance and charming as hellllllll. :D…
Today is Wolf's Princess's release day! :D

And one of the things I'm most proud of in it is that it's alllllll about consent. (All of my stuff usually is, except for the things that are explicitly labeled not!)

But in this book I had the characters make a game of it...

Because they were literally too different to have a functional relationship without abundant rules and enthusiastic participation.

They both wanted to be there with the other person! But they came from, literally, worlds apart.

Read 7 tweets
13 Aug
Someone asked me earlier today what would happen if hospitals actually did start refusing anti-vaxers care for covid, and while that idea sounds great right now when we're angry (and may indeed kinda-sorta wind up happening via the 'magic' of private health insurance...)

we can't actually go down that slope, because that's partially what got us here -- those people, already not trusting the health care system.

If we start refusing them care directly, other than the burden they're already putting on themselves and their local EDs...

They'll assume the worst, or that they're getting subpar care (possibly true, depending on how bad their local hospital is getting crushed, but at least that's...'equally' subpar?) and these are the people who're already in denial about everything, remember?

Read 9 tweets
12 Aug
Hey all! I made this video for tiktok but it hates me, so I'm reposting here.

I'm getting anxious about not reaching enough nurses as things get worse so if you're a nurse or a HCW, respond w/your email and I'll send you a copy of Year of the Nurse.
Book contains: cussing. Political commentary. Profound disappointment in governmental oversight. Suicide warnings.

It's a heavy book, but it's good, and if you're a HCW with MH issues right now, you are not alone.
My other recent bonafides:…
Read 7 tweets
11 Aug
sitting here on the couch trying to figure out what this unwarranted panic attack is all about and there are too many options, lolsob.
It started after sidechannel work gossip revealed some of my favorite and strongest coworkers have left/are leaving my hospital, and segued into generalized publishing malaise because I am tired of pushing Year of the Nurse, and oh, then, *points at covid map of US*

It's really the fact that so many of my coworkers have left that's scaring me. (Now that I'm sidechanneling w/a work friend who knows what's up with me.) Going back to work after all this was going to be stressful enough. I don't wanna be going back like the new kid in class. :/
Read 6 tweets
15 Apr
While the venn diagram between hospital work & police work aren't 100%, they do share many similarities -- we're both forward facing to the public, we work with people from all walks of life, and we're both threatened with personal violence.

And, sometimes, sadly, people do lose their lives.

When you accidentally harm someone at the hospital, it's called an sentinel event.

Immediately afterwards a fleet of people step in and consider what happened, how to fix it, and how to stop it from ever happening again.

At my old hospital, we had a pediatric nurse float over to care for a pediatric burned patient.

She put oral oxycodone into an IV line.

Now, already, there's ways to prevent damage from taking place -- oral oxy is a vibrant pink-orange....

Read 16 tweets
15 Apr
Trying to stay vigilant about recognizing my PTSD-hypervigilance is going swimmingly, lolsob.
Anyways, here are some plants from today:
This one is my current best "feed me, Seymour" out of a tough field:
Read 8 tweets
13 Apr
After having worked in an ICU this past year, I would literally get any vaccine on the market shoved into my arm, while I (& possibly the person providing it) were blindfolded, even if I knew it was mixed with lead & arsenic (which I know they aren't.)

Like they could spin the wheel of goddamned theoretical contaminants, and I'd be all, 'You know, guinea worms don't sound so bad, by comparison, shoot one of those fuckers in there too.'

We've left the ppl of Flint, MI waiting this whole effing time to get their pipes cleaned up, you drink water out of plastic bottles in neon colors all day, you think Starbux is healthy, and everyone likes to feed their livers wine.

Read 4 tweets
28 Dec 20
My mom does have covid.

Explaining to her how to prone herself.

Texting my dad with quarantine instructions for himself and everyone in my brother's household and everyone they saw over Xmas.

While at work.

Taking care of covid patients.
My current pt, I asked our MD what the plan is, and he was all, "find more people to carry the coffin" -- by which he means involve a few more services, so we can get this family to understand that the patient won't make it.
My husband asked if I should come home.

I can't.

Can't change anything for my mom, she's 3 states away.

Can't bone over my coworkers. My patient is a 1:1, we're gonna be short at 11 as is.

Told him my plan was just to be a mess on twitter so here we are.

Brace yourselves.
Read 13 tweets
27 Dec 20
My elderly parents, who I, even as an ICU RN, could not talk out of making a cross country move and visiting all of their relatives along the way, are in Texas now.

My aunt and uncle who they saw in AZ are now covid positive and my mom is sick.

I just want to throw up and cry.
If my mom does have covid, which seems likely, seeing as they visited my aunt/uncle 2 days prior to their positive diagnosis -- they hung out with my brother's wife's whole family on Christmas, including her elderly parents as well.
I try and I try and I do nothing but try and for what?

What is even the point of all this trying?

I am breaking myself and for why or who or who the fuck cares?
Read 4 tweets
7 Dec 20
I'm seeing a lot of trash takes on ICU capacity today, so here goes me explaining things (before I very much log off to write):

Yes! We have flu seasons here! And yes, our hospitals can get full during those flu seasons!

But what armchair ICU managers aren't realizing is

that it is unheard of for ALL ICUS EVERYWHERE IN THE STATE to be under thread of running out of beds (or currently out of them!)

Usually regions of the state can help one another. There's a fire, a disaster, the ambulances run, everyone pitches in.

I used to be a burn RN

And I got to see this collaborative process several times, first hand.

When there was that big gas explosion in Nor Cal a few years ago, you'd better believe every burn center in the state was overstaffed just in case.

Same same for the fires when the Camp Fire occurred.

Read 34 tweets
20 Nov 20
It's really frustrating to not have the right words to explain all this covid/nursing as someone who writes professionally.
When you're a writer you're used to thinking, 'There's some perfect way to explain this experience. If I keep trying, I'll get it right, and people will understand me. I can make this experience universal. I can change lives.'
I keep trying, and there's just...not.

I feel like a whiner. We're merely full, but not slammed. But I can't help but see what's coming for us. And feel how disposable our lives and the candlewicks of our souls seem to be.
Read 8 tweets