Restive State

Yes folks, I have joined the digital camera revolution. Again. Hopefully this one doesn't die. Or get stolen.

World famous Powell's. You can spend an hour in there and still not do more than skim the surface. That and get yourself lost.

I bough myself a new pannier today. Been wanting to get my stuff off my back during the commute, hoping that in conjunction with PT and exercises, my back won't hurt so much. We'll see if it works. Thing is, these specialty packs are expen$ive. I'm not exactly flush, so dropping a lot on something that may or may not work is a dicey proposition.

I had to think about what I needed to carry to and from work. Besides scrubs and lunch, there isn't too much. Expedition sized bags need not apply for this. Most of the junk I need is in the locker at work. Besides, having a small bag encourages me not too take the kitchen sink along. Let me say right away that while nice, Ortlieb panniers were right out. Can't really drop $100+ at this time. Sure it's for a pair, but I only need one. I found my way though. Thanks to articles at Commute by Bike and my hero, Fat Cyclist, came upon Banjo Brothers. Ended up with their "Waterproof Pannier" which considering we're in September already, will be getting a work out soon enough (never mind that it is going to be the 90's this week!).

After getting a rack on the bike, I mock loaded the bag with what I normally take: set of scrubs, lunch, emergency bike kit, personal items like keys, wallet, cell phone, Palm and other minuscule necessities. And you know what? It fit. Perfectly. With room to spare. Sure it knocked my bike a little off-kilter, but I think it will be worth. Otherwise, it's craigslist for it.

Til later...

Spent the day in town today. Linda had to work so she had the car and I was on foot. Took the bus to PT, then bummed around downtown until it was time to head home. Walked past the Zoobomb "sculpture", so I had to take a pick. Spent most of the afternoon on the bricks at Pioneer Courthouse Square just people watching. That in itself is almost always entertaining and today was no let down. Started off with the guy playing pan flute on the corner of Broadway and Morrison. Then you add in the street kids for color. Add a dash of suburban emo kids, a little bit of office workers, tourists and the one lone security guard and you end up with a fun afternoon at the square.

'Til later...

Here's the map.

Sometimes you have to ask "what were you thinking?"

Here's the map.

Bike parking at the end of the ride. Bikes and spandex as far as the eye can see. Read my wrap up here.

The "Hottest Day of the Year Ride", 'cept it wasn't. Nice weather though.

This week's numbers:
Car: 242 miles (wife and I).
Bike: 18.5 miles (took a ride after work on Sunday morning).
MAX: 52 miles

Yeah, it was a heavy driving week. Both of us had Dr.'s appointments which are a ways out. Then my wife had PT twice, which too was far out. We car-pooled n Friday night though. She was going over to a friend's house and dropped me on the way.

Some weeks will better, some worse.

I know it has become cliche to be "green." Even the stars, like Leo among others, have gone green. Funny thing is, is that I've always felt this way. But unlike them, I'm actually trying to change my habits to reflect this better "greener" me. I figured as good of a place to start would be transportation. So as an experiment, I'm logging my mileage by different forms to transport, just to see what 1 person can do. There's 3 modes in my life right now...

The Totals this week:
Car: 52 miles...or close to that
MAX: 52 miles, as close as I can figure/map it.
Bike: 10 miles for work + another 12 for fun.

the end for the moment...

part 2...

Now figure that usually, if I drive each way to work, by Google Maps, it is 11.7 miles, round trip. That makes it 70.2 miles, just to commute to work. Now figure with an average of 28 mpg, that's the equivalent of 2.5 gallons. which at current prices works out to about $7.70. Or to figure it by the federal mileage rate of $0.44/mile, it's $30.89. The funny thing is, time is not that big of a deal. I used to leave for my 19:00 shift no later than 18:15, making it to work about 18:45, stressed out from the drive. Now, I leave at 17:50 and roll into work about an hour later, but no stress and feeling good from the ride. It's not a bad trade-off.

Now I know that 70 miles a week is nothing. We used to put on over 1,500 miles a month (more like 2,000) between my wife and I. We've dropped that to well under 1,000, probably into the 500-700 range. Now comes the fun part. Using figures for greenhouse gas emissions found in this paper, the average passenger car produces 5.5 metric tons of emissions a year. This is based on a weighted average for miles per gallon (22.1mpg) and miles driven (12,000/year). So based on these numbers, we were producing anywhere from 687 to 916 kg of GHG a month, which roughly works out to 8.2 to 11 metric tons a year. Now dropping to only 700 miles a month, reduces our emissions by approximately 4.4 metric tons of GHG a year. That's nearly the equivalent of 1 average passenger car, so in effect, we've taken 1 car off the road. And that's not even including other things that we have started to try to do. I know that the math is inexact, but I'm looking at ballpark here.

The point is, we're just one family. You don't have to make a huge sacrifice to change, you just have to try. So in honor of Earth Day, here's an article to help you get started: Ten First Steps Toward a lighter, more sustainable lifestyle. (via Lifehacker)


It's not much, but it's a start.

We'll see what next week brings.

Yeah, Spidey 3 is getting the hype, but I've always been a fan of John McClane.

Tom

The thought of driving today just was not appetizing. Luckily there is a MAX stop close.

No longer is this my work blog, just place to chat about life. No more nursing stories, no more work stories, just me, my thoughts and things I like to talk about.

'Til later...

Let me preface this post by saying folks need medical care regardless, even if demented and combative...access to health care should be a universal right. But shouldn't we question why at times?

Report read, "AMS, agitated, combative. O to self, swings, spits, calls out. From hospice. UTI? Comfort care?" Not a great way to start. That was pretty much the gist. Severe dementia, chronic subdural with midline shift and significant atrophy, recent history of fall. Ativan made her more agitated, and she was all mine, all night long. She was small, tiny in fact, swallowed up by the regular bed she was curled in a near fetal position in the middle of the bed. Sleeping. For now. Do the norm, vitals, assessment, make sure she wasn't wet or in pain (not an easy task that), all the time she was calling out, trying to tear her IV out, not a family member in sight.

I read the notes the doc had written, the records from the facility she came from (especially the one about history and difficulties with male caregivers) and could not understand why we had given up our last monitored bed. The family did not want anything done, she was there because why...? So I gave her scheduled meds, tucked her in to sleep the night away. Except for some moment of calling out, she slept. I began to think. If she was here because of a mental status change or a shift in her meds, couldn't the facility have handled this? Weren't they used to dealing with the degeneration that happens at the end of the life cycle? Or was it because the family was feeling guilty she had fallen at the facility they had left her at? I don't know and have no answers. A hospital is a place to get better (ideally) and she was not going to get better, or stabilized for that matter. For two reasons: first, her disease process was very advanced, no coming back from that. Second, family didn't want anything done. We had people in the ER that needed the bed, needed the lebel of care our floor provides, but there she was.

We got dumped on, plain and simple. No one wanted to deal with her, she was orphaned by the system and her family, left to the care of strangers. So I did what all good nurses do, the best I could do for her. Make sure she was comfortable and not in pain. Not thirsty. Not wet or dirty. Tried to comfort her when she called out, obviously freaked out by the strange environment and let her rest. Nothing else to do.

Perhaps it is a failing of the health care system. Or that the familial guilt was too overpowering. Maybe it was that overriding thought from the older generation that you go to the hospital to die, when passing surrounded by friends and family instead of semi-private cold sterility is a more human(e) way to go. Whatever it was, she was stuck in the middle of it and didn't even know. Trying to maintain mental and psychological clarity in this without reverting to cynicism is hard. Trying to care without attaching labels or comparisons is worse.

'Til later...

If I could be a supervillian...

Your results:
You are Mr. Freeze

Mr. Freeze 68% The Joker 57% Magneto 57% Dr. Doom 56% Apocalypse 55% Juggernaut 53% Lex Luthor 48% Venom 43% Green Goblin 41% Dark Phoenix 40% Poison Ivy 40% Catwoman 36% Kingpin 30% Riddler 29% Two-Face 21% Mystique 17%

You are cold and you think everyone else should be also, literally.

Click here to take the "Which Super Villain am I?" quiz...


Still Lost...

So yes, it is a new name. Same old thing, just a newer, better name.
Now for the writing...

No two courses in the hospital are the same. Cliche? Yes, but true. I had a pair of patients lately that showed that to me in such contrast that it became extremely clear, like the first light of the sun as it peeks over the clouds. It stuns you to think that even with throwing all the modern machinery of medicine at the two folks, two very different things happened.

Yes, their presentation were different. But they came to the hospital for the same reason: to get better. The first, Mrs. A, was older, and suffering from medical maladies. Things like acute respiratory and renal failure, with a side of diabetes thrown in to make the situation interesting. Mrs. B, was past the average for her gender, but she was already gone when she arrived. Severe and unrelenting dementia left her unable to process or live in the world she once knew. Placed by her family with the diagnosis of "failure to thrive", she was here to pass on. Mrs. A however, looked like she might go first. She was clutched by the hand of delirium, not dementia, brought on by the failings of her kidneys. In my book she was the odds on winner to go first.

I first met Mrs. A helping out a fellow nurse with her care. Sometimes you need more than one set of hands to clean someone up and get them settled for the night. She looked at me with uncomprehending eyes and passively let us go about our business. Fast forward 2 weeks. I walked in to her room that night and was met by a completely different person. After introducing myself she asked, "Have we met before?" I replied that we had, but a little while ago. To which she said, "A lot of you have said that, I sit here and wonder how I managed to lose a month and I'm still trying to piece together what happened to get me here." In no way was she the passive somnolent patient I remember. We had healed her. Between dialysis and other treatments, she had emerged from the delirium that had ruled her life in the hospital and emerged into a world where she had lost a month of her life, but was still alive to start piecing together what her life had become.. She was going home, just as soon as the necessary arrangements were made.

Fast forward a couple more weeks, to Mrs. B. She lay there, calling out to the TV when she wasn't playing with her own feces or sleeping. She wore me out, on more than just a physical level. She wouldn't eat, spat everything back in our faces. On occasion, she would have a moment of lucidity, talk a little clearer to us, even get excited when we told her we had applesauce for her. But then just as she would drop into lucidity, she would fade away into the shell of the person she once was, motivated only by the barest of primitive instincts that were still accessible in her mind. She was here to get better. We did what we could, trying every trick in the book to get her to eat. Trying medications to bring peace to her short-wired brain and get more moments of lucidity and clarity. Short of heroic measures like TPN or a feeding tube, which she would have torn out, there was nothing left to do. Modern medicine had failed her, succumbing to the pressures of advanced severe dementia. The last night I had with her, the night I learned Mrs. A was going home, I thought Mrs.B was not going to make it through the night. Early evening lucidity with her daughters had given way to the restlessness and thrashing of someone fighting the inevitable. Somehow she managed to stay alive through the night. You do what you can for folks like her, knowing it is not enough and hoping that just your presence next to them is comfort for them, a kind stranger in a strange world. I don't know what happened to Mrs. B, I 've had a bunch of days off since I last saw her. Hopefully she left our institution and was able to spend the rest of her days with her fairly large family. We didn't heal her. In a way, we gave up. In the face of overwhelming odds we counted our chances and said "enough is enough." But in another way, I think we healed her. If nothing, I look at the last evening I had her, seeing her lucid and normal with her family as the chance to be with them, in a normal way, before the inevitable arrived.
Two different course, two different outcomes, each heading towards the inevitable, one path branched towards healing, the other towards release.

'Til later...

It had been a whirlwind last couple of weeks. Not to mention the Holidays, which always seem to fly-by faster than a hummingbird hyped up on espresso, I've been orienting to a new job. And getting a paycheck.

The new job is amazing. While not as technically demanding as an ICU job, the intellectual, emotional, psychological and technical demands are intense. It is possible that 'cause I am new to nursing that I have yet to develop the distance that keeps floor nurses sane, that psychic armor that enables us to deal with life in this field, but it has been kicking my butt. Everyday I come home to the wife and realize how lucky I am and how wonderful it is to have a support system at home. I wouldn't be doing so hot without her.

Hell, I don't think we would have made it through the Holidays without each other. Something about this time of year tends to open old wounds, surface old memories and cause one to relive events of the last year in a harsher light than any other time. It was not a good start to the season. On Thanksgiving, my folks gave us the box they had received from the hospital where Mia was born containing her personal effects, the last remaining things we had left of her. Pictures, her beanie babies the gown she wore the day she passed on were all there along with all of the associated memories and feelings. Pain, anger, helplessness and hopelessness were all there, flooding back leaving us battered and beaten in their wake. It hurt even more to know that she should have been here with us. Thanksgiving was when she was supposed to have come home, or in the best case, when she was due. This obviously was not the plan. We leaned on each other and coped the best we could. We survived.

Christmas was better, in spite of being broke. We stayed with the folks and had a good Christmas. It was the first we had spent with them together and the first we had been there in four years. It was more for them than for us. I know that we made their year just by being there. Funny how just being there is just the thing that is needed.

Work has been both thrilling and downright scary at the same time. I'm realizing how much I know, and how much more I need to learn. You don't realize how much your past experiences color you view of the present. It is hard as a nurse to present the objective view vs. the subjective one, keeping your own emotions and beliefs out of the equation. You chafe under the constraints imposed on you because you want to tell a family member the reality of the situation their loved one is in, but can't as you're not a doctor. All you can do is steer them in the direction where you think and pray they will receive real and realistic options.

Case in point: Mr. S was an 87 y/o admitted to our floor for syncope. To this point was living an independent life in pretty good shape for being 87 years old. After examination by the doctors was shown to have fairly severe aortic stenosis (it was one heck of a murmur...). The treatment for this is an aortic valve repair surgery. They go in, crack the chest, and replace the natural deteriorated valve with a new prosthetic. Post-op, you're talking about 6-8 weeks at a minimum of rehab, immunosuppressant meds if it is a animal valve, anti-coagualtion therapy, not to mention the risk of infection and other complications of a major surgery. When you think about how huge of an insult that is to the body, you wonder if correcting the problem is really the right thing to do. I wanted to tell the patient and his family to not do it. Tell them to go home, enjoy the time they have left - which is probably years anyways, play some bingo and watch the grandkids grow. Don't subject yourself to the trauma that is open heart surgery and risk losing your quality of life in exchange for quantity. But as a nurse, I can't. I can direct them to the cardiologist and the PCP who knows him and tell them to sit down and get a realistic view of this, weigh the pros and cons and then decide. And then pray that the docs will do the right thing and not push for surgery and present the balanced view, showing the good, the bad and the ugly...

Next time, DNRs and advanced directives...maybe.

'Til later...