So it happened and now???

I have entered into the real world of being a PA- I have been accepted to WSU-and it's amazing. Of course, scared, nervous- am I up to it? I find myself spending hours scouring the iTunes store- looking for apps that can help- equipment for class and beyond? I know I want to get the most sensible- the best- so I have every advantage. What is this?

I have entered into a world that I have been in awe of- the knowledge that all is not as it seems sometimes. I know that I will also have to depend on my inner knowledge- that gut feeling that I know I have, and that is indeed what has lead me along this path. Yes, can I admit it? No, not likely. But there are those that have it, ones that know, and those are the ones that I admire.

Keeping the real nature of what I will be doing- I think it's a gift to help others in a way that they could not do. The advantage of training, I suppose. To be able to do it, not just as an emotional support, but as a real support, with tools and knowledge to back everything up? That is a real gift.

Here is what I hate

I hate feeling stupid- I hate allowing others to make me feel stupid. I hate the feeling of losing my control over my emotions. I hate this sort of despair that comes at this point in the semester. I hate being sad.

Taco is sold- even reading the earlier post made me cry. It's such a loss for me. But oh well- I know everything that we went thru. It was a lot. But, here i am...really none the better. Isn't that supposed to be the end result of things? But no, I am none the better.

Doc is with Kelly. Very exciting. He is doing great. And I think I may try and keep him- but question that. Wrainthur is in Tryon, recovering from surgery on his hock- caused by another horse kicking him.

I have an interview in Nov and Dec. I am so sad that this has happened yet. I have a friend that has an offer and she is thinking about not taking it! What the hell is she thinking????????? My God- just to get an interview is great- and then an offer? And then not to take it??

Of course I worry that I won't get in. But over all, I guess it's all okay-

Now to balance my accounts (cuz being sad seems like such a good idea....)

So there are parts of me that scream petty- sad, and miserable parts. I am so torn on quite a few things- including the Taco issue. Stacy is doing quite well with him, winning a lot, and getting amazing scores…. And I am not as happy as I should be about it. I love that horse-I should be over joyed, but instead I am filled with anxiety and depression.

I made him who he is. I found him, put up with his issues (bucking, bolting and overall terror of the world) nursed him thru- cyst in his sesimoid, knee infection, Stifle infection, bone infection re: splint, leg injury, uveitis. I spent hundred of hours and thousands of dollars on making better. Finally after all this, and spending hours on the ground, we made it. We advanced thru training, onto prelim. Once there, we attacked getting the best we could be, and Beth made that happen. Our second year out, he was just so impressive-quality rides every step of the way. This horse NEVER EVER HAD A XC STOP! He just trusted me so much, and was so good. I was the issue, never ever him if we faltered that year. BUT- it if were not for me, I know he would not have gone anywhere. I let him be himself, and therefore created his trust in people so that he was able to be the star that he is. We were moving on to I, and I really thought A was in our future.

Then, as the saying goes, life happened. The first (and most avoidable) was the injury he sustained with Amy. This created an incredible cascade of events-and cost well over 25K. I am sick over that. Sick still, sick then, sick forever. IF this had not happened, the rest would not be an issue. It stopped my riding. I had Doc and Skeeter, but they were never the same as Taco. But how to explain that? How to let anyone know? With Taco, I could do anything, and he could do anything, because he was my star- I had such respect for him. I did not want to change who or what he was ever- I worked inside of it, and allowed the wonder of Taco to come out. I respected him, treasured him, allowed him. And by doing that, I created a happy animal – one who went out with confidence and assurance knowing that he was the best there was. Because Taco is the best there is.

Back to life. Ah, the economic crisis- this tossed all that we know into the free fall, it became clear that my dream was ending with a bang. I was not totally able to see that things were totally ending, but clearly, with hindsight, things were. I needed to change- needed to go back to work, needed to stop doing the horses as I had been doing them. Okay- fine. Work? Got a job. Needed a career? Back to school,- career on track. Sell horses? Sold Skeeter And since I was not going to be able to continue to ride prelim, I decided to lease Taco. Problem is this- not so easy for me after all.

He has evolved into being an amazing horse- a schoolmaster, really- for Stacy. She loves him. He loves her. He has done so well- and I am very proud of both of them. But damn it, this is my horse- my baby, my creation. Together, we are what is good about eventing. Yet, he has gone onto be good even with out me. Okay, not at prelim, but at Nov- and probably Training. But, he would NEVER have done that if it weren’t for my trusting a horse that was pretty untrustable. I believed in Taco. And guess what-that is why he can do what he can do today. I don’t think anyone that knew Taco “then” would believe that it’s the same Taco now.

But that does not matter anymore. I am not a professional, and the losing of Taco is just…horrible. I want him back- but I can’t take him back from Stacy- she is having the ride of a lifetime on him. I do want someone to say…Hey Annika, he is what he is because of you—but we all know that won’t happen. Because, well, it’s just like that. I really cannot imagine taking credit for doing well on a horse that someone else has trained and created. (think Dolly*I won my first event on her but she was “borrowed”* ). But for them it’s what they have done together. For them, it’s good. For me, not so good. For me, actually, depressing. I would never want to go Nov again. So why do I care? And really, since I had ridden SO much the past 2 years (like not at all…) what makes me think I could get back to that level again?? But I know if Taco was here, I could be doing what we’d like. But I think I have removed that from possible. Because I know what Stacy is feeling. It’s where I was when the accident with Amy happened. And to take that away??? I know- it a word it’s simply

Devastating.

So, perhaps my P-nut butter lid needs adjusting. Perhaps. But, I am resisting that strongly. I never wanted these changes. I never would have allowed these changes. It is against everything I stand for. Plan practice, prepare- it’s what I do.

Taco was my first measurable success ever. I know that seems silly. But I have always placed my kids first and foremost. Then, Art. So, my measure of success has really been in others. I never finished college, as Jaz came along, and then Nick when I was trying again. I always had okay jobs, but not careers. No need, really. But when Art and I got married, none of that other stuff mattered- I was doing my dream. I got to RIDE! With Taco, I got us there- I did the sweat, the hard work and there we ended up- at a spot higher than anyone could have ever imagined on a 1000 horse that was banned from the track. It never would have happened without Art, and I know that, but as far as the sweat and tears? That was me. Totally me. I knew how to get us there- when to push, when to stop. And so…. Taco and I were an US. We were a team. I did not get a ribbon, HE got a ribbon. And really, Taco won, I did not. Taco was …Taco. The amazing, incredible Taco.

I think all of this is hard for people to understand-I certainly get blank stares or glances of pity when I try and talk about it. A one trick pony sort of situation. If I were better, I could recreate a Taco, couldn’t I? Maybe not. Maybe, but it’s not Taco.

There will never be another Taco. I am tempted to try with Tahoe- he has something special, but the thought of going thru ALL that again is- tough.

Yes, I am on a different path. But this is not a choice that I made, it was made for me. I did not make this happen. But I have to adapt, even as I don’t want to, I must. And I find that really really hard to deal with.

My life was defined by Taco- my dad first came to see me ride when it was Taco, I was respected as a rider once I had Taco, I became someone to trust with Taco, because there as no question that I care for and would do anything I could for him which is the sign of honor for an equestrian, isn’t it?

I have no idea what to do, and that is why I am asking you….

So, today is really hard. I am leaving Tryon, heading back to work. Leaving the baby, leaving Jasmin, leaving my dear DEAR friends. I am saddddddd. But, it'll be okay,

I have a lot on my mind. CASPA sent in which is good. BUt I need to cut down on everything. I have too much. Need to sell books, and stuff. I want nothing around me- esp as I have so much to do in the next several years. Well, just IM'd with Marjo and that was very nice.

Off to bath and bed. Need both in equal measure!

My desire to be a PA was born over 15 years ago. I first learned about PA’s when my son was born. While his birth was uneventful, the following four years were anything but. I worked in the health care field, but now, I was seeing the other side of medicine. During my hasty education in taking care of my sick child, with all the confusing equipment and long, frightning hours standing next to his crib, I realized that I needed to know more. While involved in patient care as a PCA was nice, I had always wanted to be more involved and part of the team that brought solutions to medical problems. In my searching, I found this profession, and like the piece of a puzzle that has been missing, it fit.

I embarked on learning everything I could about being a PA. I shadowed and read and every chance I got to speak to a PA, I grabbed. I started work on my prerequisites. Watching PA’s on our unit interact with patients and physicians as the bridge brought further understanding of the relationship between the PA and MD. I admired the competence and compassion that PA’s exhibited and appreciated the time they spent with patients. The more I learned about being a PA, the more committed I was to entering the field.

However, life happened. I found myself the single parent of two children. Leaving my children and devoting the amount of time that I knew PA school entailed would not be fair to them, the program, or myself.

So, 15 years later, older, but certainly wiser, I am back on my path. It’s as exciting now as it was then. Except this time, it’s actually going to happen. I can honestly say having the full support of my family and friends makes the journey even more poignant.

My recent shadowing experiences have solidified my commitment. I have enjoyed rounding, listening to discussions between the team. I am ever grateful to the PA’s that swept me under their wings so I could witness everything they do in their day. The medical teams accepted my presence without question and invited me to attend lectures and case reviews. Shadowing allowed me to see inside the life of a PA, and what it was like to work as a valuable part of the medical team.

While I have seen PA’s in a hospital setting, I admit being excited about the general care possibilities. Being a PA will allow me to reach out to those not as fortunate; I will finally have the skills to make a difference. I fully intend to explore those options once in, and when I graduate from, PA school. I appreciate that reaching out is part of the PA mission. At this point in my life, becoming a PA feels more like a lifestyle choice rather then a career. This feels very right.

Life always seems to take its correct path. While missing my chance years ago, I can now grant my full attention to PA school and my ensuing career. Much like parenting, it’s important to put my total being into whatever I do. Knowing I can fully commit to being a PA confirms that now is, indeed, the right time.

CASPA in!

Its been a long time, baby! I have been pretty busy, and while that's good in some ways, it does create a barrier to doing things like this- which I admit are helpful when looking back.

A few posts back I said that I posted just so I could say that things ended up being okay. And, they are. I am officially done. I have my BS- quite anti-climatic, but important for my next step...admission into PA school. Wayne is for sure my first choice. Then, Mercy. Then, Emery, Maine and...well, I don't know. I want to get into Wayne. Period. Can you imagine my saddness if I don't? Sheesh.

I aced pathoPhys this summer. But, again, feels like an impostor, as I am not sure I actually KNOW it. My GPA thanks me for those 16 quality points. I guess all in all my GPA is good enough. My Math GRE is not; I know this. Verbal? A-OK. Shadowing? Good to go. All is fitting into place. Now, the wait happens, and I stress that I am not good enough. (drop it, huh?)

In Tryon right now, seeing Jas and wee Annika. She is just a lovely baby- so very pretty and special. I love her, and look forward to spending a lot of time with her once i am thru all of this Cr*p of school. I miss having time. I would really love having some good time!

So, hopefully, I can get back to blogging a bit. It IS helpful to step back later and look how far I have come. I am going to post my PS here, too. Just cuz. :)

Certainly the question of morality comes up most often when considering life and how it ends. Our decisions impact not only ourselves, but those that we love around us. To consider the meaning of life the same for all people is unfair. Each of us has a different set of criteria we determine to be important for what is referred to as “quality of life”. As much as we would like to believe that life is fair, it is proven time and time again that fairness is not what matters, nor does is appear to exist. There are those that get sick that are healthy, active people, and those that survive despite bad life style habits. Nothing fair about it. The one thing that we can control, however, is how we die.

As they say, nothing is as sure as death and taxes. We are all going to die. Some of may die sooner then we might like due to unfortunate circumstances. In this case, our morality is questioned in perhaps no greater way. It is my great belief that, since we have the resources and skills to assist us, having as much control of ones ending that is possible is the morally correct thing to do. For some this distinction may be too difficult to deal with- for them, they may need help understanding, and may not wish to participate in the discussion and indeed prefer a different sort of route. In accordance with the same sort of belief system, allowing them this freedom to make that choice is important. By allowing someone to participate in decisions made about their life, we grant them dignity, and support the value of life and principal of goodness for our moral base.

The concept of allowing someone to die is hard for some to accept. We do have all of these amazing resources to keep someone alive. But is this the right thing to do? I can argue that it is not always in the patients best interest to delay the natural process. In many cases, the person’s quality of life is so diminished that what we would consider the person is gone, and what remains is a shell. It is selfish to hold onto this as the remaining person-unwilling for whatever reason to let the person “go.” Sometimes it’s the doctors that don’t want to admit that there is nothing left to help the person. Sometimes it’s the family that has issues that prevent them from making that hard decision. Take the person is in that middle state of persistent vegetative state, where the patient looks alive- their eyes are open, they are breathing but cannot interact with their environment. These people are kept alive with a variety of measures, any of which, if stopped, would lead to the person dying a natural death.

In our book, (pg 215) Thiroux points out that dialysis has saved the life of many people. But even for some, this, too, may violate their sense of a quality life. While for some, being connected to a machine would be okay, as their values differ from someone else’s values of life, some people may not mesh well with the dependence on a machine for survival. While this is tough, it’s a fair question- does this person have the right to say no to dialysis? If they do, it would lead fairly quickly to their condition being such that death would indeed be knocking on their door. For this situation, it’s a cross between mercy death and allowing someone to die. For this person, I also believe that it’s their decision. They must have the right to decide how they wish to end their life. The concept of mercy death is more complicated. By taking a direct action in ending another person’s life, by necessity another person is involved. There are certainly moral issues with this. A medical doctor takes an oath that states “do no harm” as a primary responsibility. Causing death could certainly be considered doing harm. Or is it? If the patient requests death, and indeed demands it, I again believe it’s a patients right to ask this of their health care provider. What I am questioning here is the morality of the person helping. It would take two of similar moral beliefs to make this happen for a person. Indeed, it would unethical for someone to request assistance in their passing of someone that was morally opposed to causing one’s death.

It is my greatest hope that one day things such as mercy killing would be considered mercy death and perhaps morph even further to calling it allowing someone to die. The important question of what someone considers a meaningful life would have been asked and documented long before someone entered such a state. In this, for example, I say that I don’t want to be hooked up to a ventilator for more then a couple weeks, and if my condition looks to be one that would rely on others to take care of me forever, I would rather die. In this case, I have asked, but asked before I was unable answer. So, in this case, if someone were to allow me to die, or perhaps overdose me with some lovely sedative, my passing would be peaceful. I find it ironic that we treat our animals better then we treat humans at the end of life. While it is difficult to consider, it is all important to discuss, while it may be sad, it may save many a great deal of sadness.

Ann Arbor is going to the birds. 

Ann Arbor City Council recently approved an ordnance that allows for the keeping of hens inside the city limits. The permit limits homeowners to four, and they must all be hens. Simply put, hens don’t crow. 

(Left( Beautiful Araucans, also known as Easter Egg Chickens. They lay eggs that vary from light brown to blue.)

.Lauren Fetzer, 23, admits- she has been bitten by the chicken bug.  “I am a bona-fide chicken farmer,” she says holding a large, mostly white hen named Mrs. Lakenvelder.

“I never thought I would enjoy this, but we really do enjoy our girls.”

There have only been 11 permits for chickens inside the city limits since June 2008. Given the growing trend towards keeping chickens as backyard pets, it seems likely that Ann Arbor will host more Chicken Farmers as spring approaches. 

Ann Arbor joins several other cities across the US that allows for the keeping of chickens. From New York City, to LA, the movement towards chicken farming has gained momentum in the past several years, with web sites devoted to the keeping of back yard hens gaining members every day.

 K.T. La Bubadie says her site, www.backyardchickens.com  gets 500 hits a day, and boasts over 55,000 hits their first year. They have even expanded to a BYC store- with shirts that have sayings such as “chillin’ with my peeps” or “My pet made me breakfast.”

Why has this movement caught on? Some call it the Martha Steward Phenomenon.  Some suspec

t the Martha Stamp has contributed to the interest in keeping chickens. She dedicated a show to keeping chickens, introducing a few of her favorite hens.

Others say it’s the movement back to using food that is organic, and locally grown. 

"All around, we benefit- and I like the fact that our kids will see where their food comes from." says Fetner. The chicks that the Fetner's ordered last year are now the ones that are producing the eggs in their small flock. On average, she collects 2 to 3 eggs a day, more then enough for her family and neighbors.

Helana Scappaticci of Plymouth says her eggs taste better then the ones she gets at the store. “They are fresher, taste so much better and are much better for you,” Scappaticci says.

“I send my son out to get eggs and we make them right then,” says Scappaticci. “They taste so good.”

Scappaticci and Fetzer agree that knowing what their chickens eat and how they live make them feel better about eating the eggs their chickens produce. 

“We feed the hens organic food,” Fetzer says. “I know my hens are organic and their eggs have no added hormones or anything. Plus, they eat my kitchen leftovers.”

According to Fetzer, Mrs. Lakenvelders favorite food is blueberries.

While chicken keeping is new to Ann Arborites, Michigan has more then it’s fair share of chicken keepers. At La Bubadies online chicken forum at www.backyardchickens.com , the Michigan thread has over 12000 comments.

Even the by-product of chickens, their manure, has its benefits. According to La Bubadie, their manure provides a great nitrogen-rich addition to any compost heap.  

It appears that many chicken farmers enjoy the entertainment their chickens provide. Nick Strayer, 15, has had chickens since he was 8. Each chicken has a name and he has no problem telling you who is nice and who is not so friendly. 

Most will eat from his hand, and sit on his shoulder while he does chores. According to Strayer, they are quite entertaining. (See photo right)

“I just enjoy watching them, they always are doing something,” says Strayer. 

Strayer who lives in Chelsea, Mich. has a mix of bantams and large chickens. “I think the bantams are funny and really active,” says Strayer. “But I want larger chickens next time.” 

Chickens are no match to predators; fox, opossums, racoons and dogs all consider chicken a good meal. “I lost 10 one weekend from a ‘possum. It was really bad,” says Strayer. 

Keeping chickens safe is the most important thing for urban chicken farmers to consider. While fox are not often seen in Ann Arbor,  dogs, opossums and racoons are. A safe coop must be built. 

Examples of Chicken Coops from simple to elaborate

Many sources of coops can be found on the internet. The site www.A2chickens.com has several local people who build coops. Coops range from simple to complex. No matter what they look like, as long as they protect the hens from predators, bad weather and cold breezes, they work.

Other then a good coop, feed with added calcium is needed as well as a source of clean water. In Southeastern Michigan, a heated waterer is needed in the winter. 

Tractor Supply in Whitmore Lake has supplies for chickens. They just got chicks in this past weekend. They are for sale, 6 at a time. “They are straight run, however.” says the store manager. 

“We’ll be out of chicks by this weekend I think,” she says. Straight run means that you take your chances- you can get males or females. This poses problems for Ann Arborites, who must only house hens.

Pullets, female chickens are in demand and often much harder to get then straight run chickens. Pullets range in price from about $2 to over $5 for a day old chick, whereas their male counterparts are often half that price. 

Kimberely Emmert raises chicks to sell. About an hour north of Ann Arbor in Linden, she hatches out several batches of chickens each spring. Every chick is sold by the first weekend she advertises and people still want more. “I just love my chickens,” says Emmert. “I guess everyone else does, too.”

Fetner and a few friends ordered their chicks from McMurrys Hatchery, one of the most popular hatcheries, and a source of "Mail order chickens".

As of April 20th, McMurrys had no pullets available. The first date pullets will be available is mid June. This does not surprise too many. According to Thomas Kriese who host Urban Chickens and has a Facebook page dedicated to keeping chickens, there is a shortage this year. 

There is one other problem with mail order chicks-the number that must be shipped in order to ensure a survival rate.

McMurrys ship a minimum of 25 chicks per order to ensure survival. Chicks are only a day old when shipped, and very fragile.

Tammy Fisher, a teacher in Ann Arbor has ordered chicks for her class to raise. For her last batch a few years ago, she had a bit of a surprise when the chicks arrived.

"On ordering the chicks the hatchery told us to expect 20 percent to die. So, we ordered the minimum 25. Since it was really cold that February, they sent us 32- thinking attrition might be greater then 20 percent," says Fisher.

"I guess we are good chicken farmers- only two died. So, we ended up with 30 chicks that needed homes." Fisher says she had quite a few chicks turned chickens living in her garage before she found homes for the rest. 

It is possible to buy hens that are already laying. Kids will often sell their chickens after the 4-H fair is finished in July. You can even find them on Craigslist. 

The A2citychicken , a web site dedicated to chicken farmers in the Arbor Area can direct you to many local sources for chickens that are already laying, coops and advice for keeping hens in the Ann Arbor area. 

If you want to learn more about urban chicken keeping, you might want to check out Keep Chickens- a comprehensive guide to keeping chickens in urban settings. 

Want to keep hens in Ann Arbor? Click here for a permit!

Strange as I head towards the end (and the beginning)

I feel less competent.

I did well enough this semester (better then last for sure...) but the startling thing is that I feel much further away from having the ability to transform into being a PA. It does worry me that so many have not gotten in- I know of at least...4 that I can name, and more that I have heard of, that just have not made the final cut at either school.

Looking at Nova- while that feels hard, it may be the correct thing to do. I am also applying to at least 5 schools- certainly would hope to get into Wayne, then Mercy, then out of state. I think Art would be fine with NOVA, but Maine, not so much. :-) "too cold!"

Been having serious missing my XC riding- want to be running XC on someone- want to go prelim- intermediate and feel okay at it. I miss being a part of that world. Maybe I will again, maybe I won't. I thought just doing the horses as a hobby or past time might be okay. I guess it's not. when I move to Tryon, I can certainly begin again. But boy, I am not sure I will ever have the courage....

Had a brief Marc run this past monday- as usual, intense, amazing and...well, it's such an interesting thing- its all on his terms, which is really frustrating. But, I still enjoy the time, still find the entire thing amazing.

Otherwise, things are okay- I am taking 10 credits- Yeah, um....nuts.

More later!

What we missed in ME (*for med ethics blog)

What we missed in ME
First, this class was amazing. I was challenged and provoked- my thinking, admittedly fixed, was shaken, and beliefs that I have had were changed- my thinking needed the shake up.Consistent thought. sometimes tough to realize you are not being consistent in your thoughts. It actually makes you slightly crazy to realize that you have been inconsistent!I think the one thing I would have liked to discuss is the development of drugs. We touched on it in a few areas, but not as a way to save money in the system.I know were going to talk about it in the last lecture- insofar as using people for research. Certainly better then animals, but questionable.Yes, drugs are really good here in the US- and the FDA has done a good job (I do think so- despite some of the major mishaps, I can only imagine there were hundreds of more possible) screening. In other countries, I am not sure if the screening is as thorough as it is here. The issue for me seems to be in the cost it takes for someone to get a drug out on the market.I know there are several things that have happened- no more drug give-aways, no more wooden pens ;-)- a kind of medical payola that added to the overall costs. But...why does it have to be so costly? and why do they advertise as much as they do? It seems as if this should stop.But I am not sure. Because I don't really know. So, my thoughts are it's expensive enough to develop a drug- and we need to cut that expense down. Advertising should not be allowed. I believe that drugs should hit the market in a way that those that are really sick can benefit by using the drugs- and be part of a clinical trial sooner then later. Somewhat like a limited release. But have this not be such an expensive process- at least I think it might not have to be.I also think discussing hospice in greater detail would have been good.

Could He have been saved?

http://www.easternecho.com/content/emu-student-collapses-basketball-court-pronounced-dead-hospital


Thomas Rayborn Hill III had no indication of how serious his condition was when he felt weak on March 10 during a basketball game at the REC IM at Eastern Michigan University.
According to those present at the REC IM that evening, Hill fell several times and reported feeling short of breath. Hill eventualy collapsed and was transported to St. Josephs hospital in Ypsilanti, MI where he was pronounced dead.

Could he have been saved?

The short, sad, answer is probably not. While autopsy results have not been released on Hall, sudden deaths are often caused by Hypertrophic obstructive cardiomyopathy (HOCM) . In many cases, first indication of the disease is sudden cardiac death.

While HOCM is seen in all age groups, the saddest cases are seen in young athletes. The American Heart Association reports that 36% of sudden deaths are due to hypertrophic cardiomyopathy. The AHA estimates that 50% of HOCM cases have no known cause. The other 50% seem to be inherited.

HOCM often has no warnings signs. If there are, they can mistaken for being tired, or worse yet, lazy. The primary warning signal is a heart arrhythmia- not seen, and often not felt by those afflicted.

Signs that should not be ignored: sudden weakness, shortness of breath, or dizziness. Most important for coaches,trainers and participants-any time an athlete faints, HOCM should be suspected and quick medical treatment initiated.

Once a patient has suffered cardiac arrest, there is a very small window of opportunity to provide life saving treatment. The only way to correct an arrhythmia is through defibrillation- an electric shock provided by a machine.

Once someone's heart has begun a fatal arrhythmia or heart attack, the window of survival is quite narrow. According the the American Heart Association brain death occurs within six to ten minutes. The availability of a Automatic External Defibrillation (AED) is essential.

AED’s are available to the public-but at a cost. An AED is often in excess of $1500. In the average gym, six or more are necessary for each area of the gym.

Of course, someone has to know how to use them. Classes are taught by Red Cross- and often part of a simple CPR class. Despite training being available, there needs to be someone present and willing to use the AED.

What could have been done?

“He needed to stop when he first felt something, and defiantly after he collapsed the first time, “ says Sara Wilchowsky, an exercise physiologist at Eastern Michigan University. “ “If he did not know enough stop himself, someone needed to get him to stop. It’s the only thing that could have saved him .”

There are ways to find out if you have HOCM. The AHA has come up with a 12 question list for screening student athletes. If any of the questions are answered “yes”, athlete should be further evaluated for cardiac issues.

Wilchowsky believes that every student athlete should have at the minimum an ECG-a electrical record of their heart beats, before beginning a sports program. This test can sometimes pick up subtle changes that indicate a heart issue.

“But, really, the best way to test for HOCM is with an echocardiogram,” says Wilchowsky.

Screening for student athletes


A echocardiogram is an ultrasound of the heart. Totally non-invasive and painless, it can pick up the thickening of the heart wall that indicates HOCM. The results are immediate. However, most insurances do not cover the test for sports physicals.

Like Wilcowsky, many sports physicians also believe this should be part of an initial screening for student athletes.

This past March, Chelsea Community Hospital offered cardiac screenings free of charge for student athletes. According to an article in the Ann Arbor News, http://blog.mlive.com/annarbornews/2008/03/free_heart_screenings_set_for.html these were provided as a service to the community.

These screenings provided an ECG as well as a simple cardiac echo. If any red flags appeared, they could return to their regular MD and undergo further screening.

In the A2 News article, Dr. Steven Yarows, chief of medicine at Chelsea Community Hospital said it was like “looking for a needle in a hay stack.”

Yarows, the father of two, felt it important enough to get his children echos before they began a sports program. 

The physician goes on to say in the Ann Arbor article “Why not do it for everyone else?"


According the the American Heart Association, 850 persons a day die from SCD. In a March 2007 study, about 1-20,000 deaths occur in student athletes of high school age a year..

Feeling the effects of the new meds

Ugh- so they change my meds which should make things better and I feel worse! Hot and unable to concentrate. I have only 2 real weeks left of school, which is nice, but good god there is a lot to do, Is this miserable or what? I pretty much hate estrogen right now. Honestly.

So many things are going on its amazing. My dad and Ross have both been in the hospital, which weighed heavy on me, I guess more then I thought. I also have Jazz coming into town, which will broadcast all my failures- while its nice to have a daughter that is so amazing, it does sometimes make me feel a bit like a lump.I know she says the same about me, but really we both have two very different strength systems, if that is such a thing. Nick is going to NOLA, which is great- I hope the trip is good and eye-opening for him. Art is still doing his thing- I am glad for him on that. VERY proud of him. There have been some rough patches, but overall, I think things will be fine,

So, my personal list of To-Do's- Paper for Med Ethics, Paper/project for PR (GAG), Nutrition thing for (yeah, I know) nutrition. Major article for Feature writing, plus the one I never did- she is letting me turn it in late- nice, yet, do I care after this past several weeks? Then, I so fucked up a micro exam today- like REALLY fucked it up. I am going to email him and ask if I can do anything about it. Ugh. I so thought I was doing okay. Guess not, huh? That makes me feel just horrible. I think part of my lack of energy has to do with that...oh, and I have had a headache for the past day.

Okay- well, so thats it. Just wanted to write this so i can look back and say- see, it turned out okay- really!

Assignment: Edit this short article. At the bottom, note what changes you made and why you made those changes.

A suspect who robbed an 84-year-old woman was captured with the help of an Ann Arbor Police dog named Czar and his partner, Officer Jeff Robinson.

Police said the woman was walking to her car at the Krogers on South Maple Road at about noon when the suspect came up from behind her, grabbed her purse, then ran off.

Czar and Robinson tracked the suspect and found the purse about 400 yards away. They continued tracking eastward ending in the 800 block of South Maple Road where witnesses told Robinson that the suspect ran into an apartment at the __________complex.

The suspect was found in the apartment of a releative and taken into custody.

The suspect is an 18-year-old Ann Arbor man. Pending arraignment on Sunday, he is being held at the Washtenaw Country on the count of unarmed robbery, a 15-year felony.

The Ann Arbor woman was uninjured and her personal property returned.

“It’s an excellent job by Officer Robinson and his dog,” said Ann Arbor Police Sgt. Pat Ouellette. “The dog was a key component to taking the suspect into custody and recovering the purse.”

Clinton Profile....

http://topics.nytimes.com/topics/reference/timestopics/people/c/hillary_rodham_clinton/index.html


http://usliberals.about.com/od/liberalpersonalprofiles/p/HillaryClinton.htm

For this entry, I am primarily referring to the TImes article, unless I mention USLiberals. I did this for the contrast, again, personal reasons.



I chose to find a profile story on Hillary Clinton. I admit this was for purely personal reasons, as she is someone I have found complex, and in all honesty, don’t think I would like her as a person if I met her. Ah, but I found out more, and this article made her seem much more "human" to me- a nice thing!

What I liked was the profile piece made her seem likable- in spite of being called “fierce” and using words such as “bitter’ in describing both her and her political campaign in the last election. While these words seem to point towards subjectivity, the writer has done well using their comments to not seem subjective, but rather descriptive- yes, close bedfellows, but important difference.

The profile piece never describes her in a physical manner- which makes me wonder if it had been a male, would the same standards apply? I sense a bit of “over correction” in this tendency. This article did make me move into other articles, and that was nice- I learned more. Perhaps a benefit of online news?

The article in the Times did not discuss her marriage, as the first one did USLiberals. I think that is okay, as it did mention (and perhaps needlessly so) her as the “FIrst Lady” and the fact she traveled to more then 80 countries. Perhaps this was in support of her being chosen as Sec. Of State? Not sure.

I do not pick up any sort of opinion in the Times article, but do in the USLiberals article. I think that is because the USLiberals article was written for, well, US Liberals.

In both cases, I did come away with a nice understanding of Ms. Clinton, and while she still would not have gotten my vote (Obama is just...Obama), I do think meeting her would be great. She is really an outstanding woman- and one that perhaps we should point our young woman toward emulating- Brittny, move aside!

A new week begins

So, it appears that I am further along then I thought on the app process for PA school- or rather, I can begin applying this summer, which is somewhat of a surprise, as I was fairly sure that I would not be ready until fall. My pre-reqs will be done, and have a good enough average to put me more at the top of the heap- I have over 5000 hrs of patient care/contact. I have people that are willing to write rec letters for me. I have initiated my calls to shadow- need to call Matt and also Elise C and see if I can shadow them during the next several months. I also am changing my work schedule to a rotating Mon night, Tues Night, then Tues night, Wed night- or it least it appears this way! Never say for sure on this unit- because it will for sure change!

Other then that, 4ish more weeks of school- heading down the final stretch, pretty happy about this, gotta say. Need to check into classes for this spring summer(Obvious that I can't take "normal" classes...my work schedule won't allow for that....)

So, honestly, it's happening- I AM on this road, I AM getting there, I AM going to be there and be done. I see the light above me, just have a couple more big tunnels to get thru and climb. But, its gonna happen!

As another note- I did get to ride this past week, rode Wrainther and actually sat on Reason. what a total THRILL that was! Just walked him down the aisle, but that was totally okay with me. I loved being able to sit on him- he has an amazing walk, and hints at other amazing gaits. He did it all with a "okay, this is fine, and what I expected" attitude. I am really thrilled for that. If I can just walk him for the next 3 years, he, when I get out of school, will be ready to go. Also exciting to think about that, too!

Crazy

crazyness right now.
Many reasons- pressing reasons- hard reasons-
Jas is 27. Cafe Express closed (finally, perhaps, an end to that part of my life? I still hold onto loving that, doing that, being that- even tho it was over 20 years ago...such a terrific thing it was, we were.

A2 news is also closing. That perhaps signifies the greatest change, or the greatest "ping!!!" to my daily life- if they leave, what is happening? The world is really changing quickly, and I am not sure i am keeping up, for the first time ever.

My dad is really sick- Marc is being great- as much as i miss him, am grateful for his help on this. It's hard. The process is what is scary for me- I sense

Ross is also very sick- perhaps depression also (like really...why would that be? Hmm? I guess you always think about "payback" but in this case, that seems quite unfair- he is really sick...!)

Art continues to be depressed and does things to "self fulfill" what he considers the world at this point. After telling him to "check the oil- when DID you get the oil changed last?? I know that oil pan is going to go bad..." for the past several weeks and him saying that he would get to it, he (of course) didn't and of course, the truck (My TRUUUUCCCKKKKKK!!!!!) died yesterday. Of course that means he might have to get the lexus fixed (It's been sitting in the garage for, oh, a month as he drives my truck back and forth to work...)

This is the stuff that makes my psycho-crazy. Like totally nuts. A small, yet concrete example of what is the issue is. At some point, it has to be addressed before I get too angry. This is not the time to make quick moves, or rash moves, it's the time for slow, careful thinking.

As Christy says, we have to take care of our resources. This is a resource. The cars and house are a resource. It's all resources.

Chicken query letter

Dear Midwest Living:

Who would have thought that keeping chickens could cause a debate in city council? In Ann Arbor, it has been come a hot topic during council meetings, sparking conversations on both sides of the fence.

In early 2009, the keeping of chickens within the city confines became legal in Ann Arbor. Ann Arbor has modeled their ordinance after a similar one that Madison, Wisc has in effect. As in Madison, certain restrictions apply- to protect both the hens and the nearby homeowners.

Only a small handful of permits have been applied for in Ann Arbor due to the timing of the legislation passing. However, it’s clear the movement is catching on across the midwest. It’s expected that this sping more permits will be issued in Ann Arbor. The sale of chicks has increased according to hatcherys; more homeowners are interested in taking up raising hens, both for the eggs as well as the entertainment chickens provide to their urban owners.

I think your readers would like to read about keeping chickens in their own back yards. There are numerous benefits- including answers to the most pressing question of all; Chickens provide outstanding fertilizer for gardens, with minimal smell. In addition, their eggs are more nutritious then store brought eggs. The hens do provide entertainment with minimal work once the coop is built. As people consider their food sources, people find knowing where their eggs come from is a benefit. And perhaps of greatest interest to readers- back yard chickens come in “Designer Hens” varieties! They can (and do) get hens to match their homes decor.

I think the time is here for an article outlining the purchasing and care of chickens in a urban envoinment. There are many possible side bars that can spring from this; a tie to your cooking section on the use of eggs, the benefits to gardens, and of course, the joys that chickens bring to their owners.

I look forward to hearing from you,


Annika Kramer
4109 Sylvan Road
Grass Lake, MI

J Q 6

Are embryonic and fetal stem cell research morally acceptable? Why orwhy not?

Totally. It seems to me clear in this case. I see no harm for anyone in this, and do not think we would head down the slippery slope that some seem to elude would happen.

This is one of the easiest questions for me to answer without too many "what if" thoughts attached. In both cases, the fetus and embryo alike would not be "alive" unless pregnancy would be continued or in the cases of embryonic even begun.

I think this has great potential for many things- I am not sure we should consider using this to correct genetic things- although I am aware that is one of the main things it's used for in cases of Parkinson's, and I know that many diseases might also be considered genetic. I don't so much mean those cases. I mean moving into the area of genetic modification via the stem cell avenue.

In the case of trauma, nothing seems clearer to me then the use of stem cell therapy. If this can work (ignoring the possible ethical results of such testing for now) then I am all for it. Again, mentioning our employee that went to China, he does have feeling in his legs, and can move them slightly. Before this, was totally unfeeling.

As far as getting the material, if there is no cost in obtaining the cells for use, then the possibility for abuse in this area seems unlikely- much the same as organ donation. While the thought was organ farms, and many a scary movie was created about this- I don't think it's happened just yet.

Thankfully!

Hi all. Here is your 5th journal question:

Linda Purdy argues that in situations of genetic risk, it is immoral to
conceive a child. Do you agree or disagree? Why?

That's a hard one- probably for a few reasons this would depend on whether the person knew before they got pregnant . For this journal entry, I will assume that this is known beforehand, and not discovered during pregnancy.

As a couple contemplates pregnancy, I think it does behoove them to consider the life their child might lead if they were predisposed to a genetic illness. I am not sure where that line needs to be drawn, however, as once consent has been given from the woman, is it okay to terminate a pregnancy?

In this case, I do not think it is okay to terminate. As I write this, it feels wrong. It is an emotional response to be sure, and one that is complex as the variety of cases that could occur as a result of such a finding. If you found out that your child was going to be born with a condition that was life threatening, and painful medical conditions would happen, then I would consider a heart wrenching decision that a couple would have to confront themselves.

Back to the original assertion- One knows with a high degree of certainty that their child is likely to be born with a condition that would be life threatening, life limiting, and debilitating in all available resources. Is this morally responsible behavior?

As horrifying as this is for me to say, I do NOT think it is responsible. If a child is to enter this world, a world that is difficult at best- to enter with such problems to start seems quite unfair to the unborn child.

I place faith, too, that anyone that takes the time to get genetic testing would have done so knowing that they did not want to risk having a child that might have issues that would prove difficult.


Ah! But here is the thing! I got into work tonight- and lo and behold- we have a woman who is 24, on her 4th pregnancy, and is vented with an isolette outside her room, as if she codes, a c-section will have to be performed. ( not common, nor a good idea to perform this sort of thing on a cardiac ICU...) This woman has a congenital heart defect. She knows- and was told that she should not have children. So, she has 4. Well, this baby, if born alive, will have been subjected to many medications, and will be born very early (she is currently 27 weeks along)

I don't know if this heart condition that will be passed along- what I do know is that these kids will not have mom that is capable of taking care of them- once one has gotten to this place, things are not going to be good.

Do I think feeling this way is "right"? Nope, I don't. I feel bad about this, seems judgemental- which I hate to think of my self being. But, this woman has done a disservice to herself and her children. For many reasons- I think this is wrong. Again, makes me feel like a heel.

Okay, and taking this one step further- education probably plays a role in this. Perhaps again not the way to feel or think. In looking at my first thought- if someone did have the knowledge, you'd hope they would think about the ramifications.

I just learned that ain't necessarily so.

Story Outline

I would like to look at the move towards eating locally, and the moves that people have made in our area because of this phoneme.

I want to interview Community Farm, a local farm that grows in community gardens. I also would go to the farmers market in various communities and interview the growers and merchants that take the time to sell their products there.

I would try and interview people at the markets, and ask why they have chosen to go to the Farmers Markets, or invest in Community Farm. In addition, I would look on the web to see if there are any other articles and ideas that I can get more ideas from.

I do not think I will focus on the economy, as I believe it might be more expensive to eat this way. But, I would as a few why they chose to spend more in order to support Community farm and the Farmers Market, since spending is a choice.

The other idea that I have is keeping Chickens. I know this is a hot topic in A2 right now- and think it's interesting.

I have looked at few web sites, and spoken to a few people- McMurrys sells chicks and has seen their sales soar in the past few years. A lot of classrooms are hatching chicks again- which is also kind of interesting.

I would like to interview people that have worked to get chicken keeping legal in A2, and also talk to some that are opposed. I would also go to the web and see what is needed to keep chickens in the city- and the cost per egg (chickens do not lay an egg a day, but rather 2 eggs for every 3 days on average- but not in the winter, where they go on strike...which I feel like doing!)

My lead would probably be simple and to the point. Why does Mr. so and so want Chickens in his small yard on Washtenaw? I need to work on my leads, as I tend to get my first sentence and then work from there.

I believe that working on the Chicken Story will probably be what I end up doing. I think it's timely, and interesting, and different from most things- and it's interesting to many, I would think. :)

Outlne of final story.

While there are no roosters crowing in the Smiths back yard, there are chickens. Thanks to a recent change to the laws in Ann Arbor, the Smiths can keep 4 hens- enough to keep their family, and their grateful next door neighbors in eggs for most of the year.



"The eggs are good but this is hardly a cost effective venture!" says Smith. She stands in front of their homemade coop holding Mrs. Lakenvelder, a large mostly white hen who seems very content in her arms.

It seems as if keeping chickens has more to do with keeping chickens as pets rather then the eggs they produce. A pet with benefits, according to Smith.

According to many, the eggs taste better then store brought eggs.  Mother Earth News magazine has an article discussing the differences, including a heathful  1/3rd reduction in chloresterol.

Grocery store eggs are often older then two weeks since they have been laid. Home eggs are often less then a couple hours old-and fresh eggs are certainly better then older eggs. The hens are allowed to be out, are fed food that the owner controls. 

Need to match your coop with your house? Designer eggs are even possible-the shells can be colorful in hues that are multicolored- brown, green or even a pinkish tinged eggs come from specialized hens bred to produce "easter eggs". It gives new meaning to Green Eggs and Ham- although once you crack the egg, they all look the same.

Turns out there are more benefits to keeping the hens then their eggs. They are quite entertaining. The term pecking order comes from hens and their social status within their group. Watching hens walk around, scratching for something under the surface, clucking at each other, occasional chicken tag, it's like watching water or fire- it's always changing. These are very busy girls.

Even the byproduct of keeping hens- manure- can be beneficial. Many chicken owners turn it into compost for the garden. Here is an article about making Chicken Manure tea. While not a topic of dinner conversation, knowing what might benefit your plants seems like a good idea. 

"All around, we benefit- and I like the fact that our kids will see where their food comes from." says Fetner. The chicks that the Fetner's ordered last year are now the ones that are producing the eggs in their small flock. On average, she collects 2 to 3 eggs a day, more then enough for her family and neighbors.

Fetner and a few friends ordered their chicks from McMurrys Hatchery, one of the most popular hatcheries, and an impessive source of "Mail order chickens".

To keep chickens inside the city limits, you have to order just hens. This is to cut down on the crowing that rooters are known for- while enjoyable to some, it does have it's opponents. 

McMurrys has solved this dilemma with orders of only female chicks available- more expensive then "straight run" where the chicks are not sexed before sending out.

Pullets, female young chickens are in demand and often much harder to get then straight run chickens. Pullets range in price from about $2 to over $5 for a day old chick, whereas their male counterparts are often half that price.

There is one other problem with mail order chicks-the number that must be shipped in order to ensure a survival rate.

"Our first order of chicks the hatchery told us to expect 20 percent to die. So, we ordered the minimum 25. Since it was really cold that February, they sent us 32- thinking attrition might be greater then 20 percent," says Tammy Fisher, a teacher at Honey Creek Community School who ordered chicks for her class to raise a few years ago.

"I guess we are good chicken farmers- only two died. So, we ended up with 30 chicks that needed homes." Fisher says she had quite a few chicks turned chickens living in her garage before she found homes for the hens. 

While Fetner ordered  day old chicks, many choose to get hens that are already laying. This also quickens the egg laying process- a hen does not lay eggs until she reaches the age of at least 15 weeks. You also can get 4 hens instead of 25 chicks.

A quick look on Craigslist provides a few chicken farms in the Ann Arbor area. The A2citychicken , a web site dedicated to chicken farmers in the Arbor Area can direct you to many local sources for chickens that are already laying, coops and advice for keeping hens in the Ann Arbor area. The price of a hen ready to lay is about $15. 

While there have only been 11 permits for chickens inside the city limits since June 2008, the numbers seem likely to increase since orders of chicks have increased for the SE Mich area.  According to the Facebook group, Urban Chickens, there is an anticipated shortage of chicks available this year.

 Chicken keeping is fun, and provides organic, free range eggs for your family to enjoy. It is becoming a serious hobby for many. Perhaps this is the Martha Stewart phenomena- she has touted the benefits of keeping chickens in her magazine and blog. When you have chickens in your back yard, you control what they eat and how they live. "It's all good."

If you want to learn more about urban chicken keeping, you might want to check out Keep Chickens- a comprehensive guide to keeping chickens in urban settings. 

Want to keep hens in Ann Arbor? Click here for a permit!

Left- Martha Stewarts Chicken Coop

Where Otis moves to step-down and eventually to OR.

Okay, O - as we now know he is called, is out of our unit. He is in step-down, and as of this AM, should have been in OR getting a valve. Whatever happened to get him from waiting to die to this, I don't care. The man is getting better, in spite of the dire predictions. So, he is a happy one.

I have enjoyed thinking about him and hoping for him and praying for him. I did make him the center of thoughts- and if that was anything that helped, then good for him.  I am glad he is getting out. I do think that he will be changed for the better when he leaves- he is talking, and more outgoing. I am glad. I hope I get to see him again.

Mrs. Reader did indeed die on Monday. I hope her passing was okay. Mr. W died this morning- I was with his wife as she said goodbye. She wanted to be alone when he passed, and she held his face, kissing him as he took his last labored breath. It was very peaceful- his pressure just kept dropping, and then asystole ... nothing dramatic, thank God, just quiet. She will be okay. And, she will see him soon.  

It's so very strange that we have so many patients on comfort care right now. I am not sure where this is coming from- but odd, and very atypical for us. We have two still there that are heading towards comfort care. I am not sure why we are keeping them- well actually, their 02 requirements are too high for hospice. So, we get them. It's okay, but I worry that we may miss a point where a patient that needs a bed does not get a bed.

Mr W continued to run into V-tach- I guess they had the same issue all weekend, too. I took a picture of him for his family and sent it to them- he looked great; this was before his horrific run of tach-flutter (!) and his at least 6 shocks- just last night. Talk about PTSS....  He was so grateful for that to occur- seems as if we should make computers available for patients in the hospital so they can stay in contact. His wife was just out of hip-replacement surgery and can not visit him. He heads to OR for LVD on Wed- I hope he makes it there. He is also on the list.  So praying for him, too.

So, here is the quote for the weekend. From Nikolas-  "Do not trust anyone who is wearing a bow tie in a code. Just don't".  Point taken. Patient did not even make it to us.... He was a bit pissed.... 

Break is here!

I am sure it will be over before I know it, and certainly have plans to do nothing. Is that possible??

Inertia is an impressive force. Its one that apparently  I generate. Because when I am at work, NOTHING happens. Nothing. A huge big fat ZERO.  When I got home this am, Art was still sitting at the table, just waiting for me to make coffee (not going to happen) and make some sort of breakfast. After all, I was coming home right? Not going to school? So, I can do the horses, right? I mean, I have only worked all night, and since I am there- why not?

I can think of more then a couple, actually.  So, my dad's plan might have to coming to effect. I might just have to stop doing. That is not something that comes naturally. Not at all. But overall, maybe I can start in that direction. If not, I am going to get pissed (which is easy after no sleep, so try and keep that thought, missy, and remember it so you don't get all hot and bothered. Count to Ten- or 100, if that works better...)

So I have mountains of laundry, and still am looking at all the shit that needs to get done around the house. Watch Art sleep (HOW can he sleep with me during the day and also sleep at night??? How can that be?????) and still stare at me when dinner time approaches? 

It's hitting critical mass. There is one thing for sure. You do not see fit, thin men in our unit. You see men that are not fit and overweight and have just overlooked the fact that they need to take care of their bodies. No matter, I can say it again and again, try all my ideas, and nothing comes to fruition. Kind of irritating.  Okay, new post, no vent, all done. :-)

There is something different about  Teresa Chambors, 29. Brown eyes behind glasses, blond hair and a mid-length pink dress and bright red shoes, it’s hard to pinpoint exactly what it is about the Eastern Michigan University student.

She moves a bit slower than other students. She opts to take the elevator whenever possible. Her hands often shake as she attempts to write. But Chamber still manages to hold onto her 3.7 GPA.

It's what you can't see that makes Chambors different.

 Chambors has someone else's heart beating in her chest. 

At the age of 12, Chambors entered a maze of doctors, EKG's, cardiac echos and heart catherizations. Dr. McDonald Dick, head of Pediatric Cardiology at the University of MIchigan Hospital delivered the devastating news.

Chambors had Polymorphic Ventricular Tachycardia. Her heart would begin to  beat too quickly, often as a result of anxiety. Unlike others hearts, hers could not stop its frantic pace- in many cases, it can lead to sudden cardiac death. 

Chambors also had developed Idiopathic Cardiomyopathy, a condition where the heart has sustained irreparable damage. Because hers had been working overtime, the damage was done and was permanent. 

Chambors said she spent the next 10 years taking drugs to help her ailing heart function.  The condition ruled her life with numerous hospitizations, doctors visit and tests to monitor her health.  Often only able to stay away for five or six hours a day, Chambors said her social life, the pinnacle of most high schoolers' experience, was non-existent.

"High School was hell," says Chambors. 

Eventually the drugs stopped working and Chambors said her heart was getting weaker. She developed blood clots that traveled to her kidneys,  destroying 35 percent of their function- a condition she still has today. Chambors said she was hardly able to get up four stairs without stopping to catch her breath. It was clear, she needed a new heart. 

In July  2001, Chambors was placed on the "list". She joined the other 2000 plus people waiting for hearts in the USA. Many die waiting for their chance at a new life.

On January 26,  2002, Chambors said she got the call from the University of Michigan- a heart that matched had just become available. After seven months and two days waiting, her tiring heart was removed and another placed in her chest.

Chambors was the 498th heart transplant done at the U-M. 

Much later, Chambors said she was told her heart would have probably only lasted another two weeks. 

Chambors would love to meet her donor family. She has sent several letters, thanking them for their gift of life; thus far, she has not heard from the family. 

Chambors says she  considers such people like Dr. David Dyke and the other doctors and nurses on the heart transplant team her friends. She spent more time in the hospital then she did at school for those 10 years and said she forged stronger bonds with them then fellow students.

Mark Brown, a nurse in the new Cardiovascular Center at the U- M remembers Chambors pre- transplant. 

“You get to know them if they are frequent flyers,” says Brown. 

Chambors certainly qualified for that status- unable to actually account for all her days hospitalized, Chambors recalls several stints longer then a month. 

"The worse experience of my life was being on a vent." says Chambors. "It's like feeling you can't breath and you have to suck air through a straw." 

Chambors was on a ventilator two times, eventually getting a tracheostomy.

Chambors considers herself lucky. She says her transplant was considered one of the top 10 matches ever done at the U-M. Her chance of rejection, always a concern, is low. According to Chambors, this also means she has to take less medications daily then if the match was not as good.

As it is, Chambors says her meds still run a staggering $400-$500 a month- with insurance. Without drug coverage, she estimates her costs would quadruple.

Chambors still lives with her parents in Canton, and her "very important dogs."  She loves to talk about her pets, her beading and her card making instead of talking about her health. 

But, there are things that remind her. The medications make her tired. She must get eight to nine hours of sleep a day to keep up her energy. She takes the elevator and walks slowly to conserve her strength. Chambors carries a water bottle all the time as she says she is always thirsty, another side effect of the medications she must take daily for the rest of her life.

Chambers qualifies for federal disability. But she chooses to go to school, which disqualifies her for assistance. That's just fine with her. She says she just wants to blend in with other students and experience college with as much normalcy as possible-something she missed earlier in life.

Chambors was hospitalized last month, missing two weeks of classes which put a damper on her winter semester.  She said she is grateful to her professors for working with her and assigning work over the internet.

Dr. Lisa Bank, her ecology professor at EMU says she is keeping up- better than some of the other students who don’t have the excuse of illness. 

“They (professors) were great- I had my laptop at the hospital and was able to keep up on assignments and emails,” says Chambors. " I think I might keep my A average.”

Contacts :  Teresa Chambors- Phone 330-232-2828

wow- just wow

That says it all!

Think of a moral dilemma you might face at your place of employment. Choose one theory of action morality and use it to determine the morally correct

Think of a moral dilemma you might face at your place of employment. Choose one theory of action morality and use it to determine the morally correct course of action. Discuss the dilemma and the applicaiton of the moral theory.

journal question #1- medical ethics

I admit this question stymied me- I am not sure about what action morality is, honestly.  

I work in a place where there are a lot of decisions made for patients who cannot speak for themselves.  I would say that each shift I work, there is always some question that floats around the unit- "Are we doing the right thing for this patient?" I never hear "Are we doing the right thing for the hospital" or "the bottom line" but since I am in a caring situation, those things will not confront us when we are at work- our goal is to save the patient. At times, this is against all odds, and one does wonder, is it against what the patient herself would want?

Quick one sentence situations- A very intelligent MD, at the end of his life, wanting to prolong it even though this involved shocking him numerous times- his wish was to shock. A 96 yo woman who keeps saying "I want to go home" and her kids don't/won't listen.  A non-compliant patient, although one that was learning how to take care of himself, getting left off the txp list in what can only be described as a personality conflict.  A man who was not quite homeless, but had defiantly taken a turn towards that, who had no family, but health insurance being kept alive because no one had the legal right to say let him go. 

So, I will take the last situation. It's interesting, as this patient was thought to have no health care when he came in. He was driving with a friend, and was able to get to his destination, and when his friend got out of the car, he was found slumped over the steering wheel, unresponsive. It took a fair amount of time for the EMTs to get there, and when they did, he had no rhythm . He was shocked and brought back into a sinus rhythm.  Estimated time down was 10-20 min, but since there was not a good person reporting, it was hard to know. 

He was brought to the U, placed in intercool, a balloon pump, and a vent. He had a swan placed, a picc and an a-line, in addition to peripheral lines. Upon admission, he was missing toes, and his feet were in a horrid state- indicating that his diabetes was out of control. Indeed, his first BGL was almost 800. 

He had no next of kin, we could not find him in our system as having health care, and his friend reported that he had not seen a Dr. in over 40 years.  We eventually found out that he had already paid for his cremation,  and while not having an advanced direction, seemed to accept that when his time to go was time- well, it was time to go. It was also discovered that he had good medical insurance, through Ford. 

Since he had been with us, he had shown no signs of meaningful life. He was heavily sedated to be sure, but even when he was not, there may have been indication he was sensitive to changes in light, but his pupils were fixed and dilated. 

One of the RN's reported that his care was upwards of 150k a day for the first few days. With the vent, and the balloon pump and intercool, those machines in themselves run about 15-20k a day. He was on at least 10 different drugs and subjected to many tests each day, including lab tests every hour to manage the insulin levels. It was mandatory that we continue treatment. 

So, the question is this: This man did not have family, he did not have the wherewithal to take care of his own needs; He had one tooth, no dentures, and uncontrolled diabetes. Since he had health insurance and could afford care, he choose to not take care of himself. He must have been in a fair amount of pain given the state of his feet. 

So, given this silique, one would suppose that Kant would support the decision of the hospital. This is in direct opposition to utilitarianism-where the support of well-being and to alleviate suffering seems to be in diametric view to Kant and in this case, moving to palliative care would have been the correct thing to do.

  Where I get confused is the issue of happiness...or supporting autonomy. It seem that Kant also supports the dignity of the person. This seems to be clearer to me- the gentleman here did not seem to be the type of person that would support this continued support. But we have no way to know.  But if we were to assume, Kant would also support not continuing "extreme measures" in this case, and this man was unwilling to take even the smallest measures he controlled himself to ensure his health. 

We'll never know in this case- this gentleman suffered extensive system breakdown after 2 weeks on our unit. In the end, there was no saving him. We knew this from the moment we got him on the floor, but nothing could be done.  

In this case, using utilitarianism (Mill) and Kantism seem to lead to the same path. I guess that's what made it all the more frustrating for us as health care people.

Friday the 13th was just that. had a lot of things happen that added up to making it a rough day. I admit, it was not rough for me as much as for others. I just carried it a bit too far! :)

So it appears that I might be back to looking at schools out of state. I am not 100% sure, but if things close down here, there is no reason to stay in MI. Tryon would be great, but no PA school close to there. If the farm sells, then I have the freedom to go where ever I want. This is nice to think about- yet also exhausting. Not sure what would happen with Nick- that remains an issue for me. GH is great for him, and would like for him to stay there, but also know that his dad is NOT the best influence on or for him. In addition, I am not at all ready to let him fly on his own at all. Nor is he ready to not have me breathing down his neck...I am sure that is how he sees it!

Off to Gaslab!

Just got a call...

...which was nice for the day from the husband of a patient that I had a few months ago. I gave them my phone number just in case they needed something. He called just to say that he had been carrying my number, and they were so glad that I had come into their lives- and just...such a nice thing to get.

This has been a really difficult day. Just tough. I am not sure what I can do about it- the issues are so varied. At times, it would be so much easier to just say- Okay, I am doing this alone- I cannot carry you and me and everything else. 

yet, I understand how it is. I really really am understanding now- 

I don't understand the whys- but, I am beginning to see that the importance of love is deeper then just the surface and that perhaps I need to take note. I have a connection that is so much deeper then anything that I could have ever thought possible.  I am very very much in love.  I am in love with a spirit, with a soul, with an etherial being- but a physical one, too- even though I  don't know that physical being. It is the type of love I feel for my children- inexplicable but very valid. It does cause a physical pain- which is so strange, as I can also say I have never been as happy as I am, too. What a coin....

What is your reaction to our discussions of assisted reproduction?

Timely, I think! :)  

I don't have an inherent negative  reaction to the idea of a surrogate being used in the case of many that we spoke of. I do, however, have an issue with people hiring someone to carry their baby because it's just too hard, or their job is too pressing. For those that consider pregnancy a burden, I have news for you. Parenthood takes a lot more out of you.

 I must add here that being a parent has been great for me. I love my kids, and am so proud of what and who they have become and are becoming. I did not have the parents that make me the ideal mom- indeed, I had my daughter when I was 20 and single- hardly ideal. But in our case, things went really well, she is a lovely 26 year old woman, and I am very proud of her. I took care of her needs myself, and we did a great job together. To this day, we are still very good friends- and yet, when she needs, I can still be her mom. 

So, I do differ from a few- Motherhood was important to me- perhaps not in the way that conjures up the biological clock- who has a biological clock at 19?? But for me, I think it was a way to right a wrong. I remember saying to myself at 10 that I would not do my parents had done.  And it meant a lot to me to create the magic and joy that I have always felt childhood could be. It's not always that, needless to say, but for the most part, my memories of these times with the kids when they were young are full of grace- it's the only word I can think of to describe what it felt like to me.

Okay, that being out of the way....

I DO think that there is a biological clock. I think it does get louder as you get older. Some don't have it, and I think that's great...and they probably get a lot more done with their lives then those that choose to have kids. But to deny that it exists is (imo) very unfair. I don't think that everyone can override this desire - after all, isn't it all about re-creation anyway? The main purpose of life is to create more life, at least from the biological standpoint. 

I know that we have free will, and it's possible to override desire, and indeed in many cases, it's imperative that we do so. But when it comes to the desire of a woman to have a child, this might just be beyond that, and to say that these women do not have the right to use some other method to try and have a child is something that I can't do.

But, I do not support it in all the ways that it appears to be happening. The most obvious example is of the woman in CA. First, I very much believe that the MD needs to be drawn and quartered. What he did in implanting those embryos is akin to abuse. In some ways, this case may actually be (oh...I sound Kantian here) the catalyst for the reform that the industry needs.  Industry seems like a harsh word for making babies, but I think it might just be that.

I have 2 very good friends that are MD's- both have had some sort of IF- the first, she and her husband had trouble on their own, and so, Evan was created in a test tube. He knows it and they are open about it. 

The 2nd is more difficult for me. This woman was single, and did not want a man involved so she could maintain control. Her baby was a sperm bank baby- unknown father- just a number. This one, even when she told me about it, still rings hollow- something about it does not feel "right" to me. Her daughter is lovely, and she is a good mom, (controlling- no surprise there...).

I guess it's okay- or rather, I can't see anything that I can pin on it that would be considered wrong.  But something about it seems strange, wrong and George Orwell-esque to me. 

I do believe that there needs to be regulation. Some board needs to oversee these practices- and set guidelines. I suppose in our society that might cause concern- it is a control, but since we have chosen (as a society) to regulate things such as abortion, assisted suicide and what we consider "life", it seems as if this falls into the same sort of perimeters.  Again, I think our current media attention of the case in California might just be the catalyst that we need to bring attention to a situation that has flown very happily, under the radar. 

Journal entry 2- ME, Winter 2009 

My reaction to Assisted Suicide:

I have always wondered about PAS, and what I would do if that situation faced me as a PA. I have  thought it the right thing to do- the kind thing to do if the end was indeed inevitable. What I had not considered were the feelings that would go along with actually carrying forth the intention.

I still believe it’s necessary, and  truly a valuable part of being a member of the medical community. In addition to thinking about what I might do in such a situation, the thought of what a patient might want, if I was in a different thought process, and how I would handle this request, had not been one I had fully considered.

I found that the articles, and the ensuing conversations opened up my eyes. Since it seemed so clear to me with my work with patients in the ICU who often linger on for so much longer then necessary. I feel they feel pain-(and indeed sometimes actually believe that I feel their pain in a physical way) so to watch them getting something so simple as getting bathed can be difficult as a caretaker.  

I am beginning to see why this is such a difficult decision for so many, and therefore, why it's such a tough thing to settle for the masses. We don’t live with anothers thoughts and experiences, and so for this (and I am beginning to glean for all of philosophy), we must somehow step outside of our own pre-conceived notions and memories and move into a different realm.

In our class, there is a girl that obviously has strong memories, and therefore her feelings on this issues are based on one certain situation rather then looking at the whole. In ME, we need to look at the whole, rather then focus on our smallish world. I do not set a judgement in how she sees things- she creates a very good argument against PAS. Her belief in God is so very strong, and therefore she feels very strongly that  he is the one that should make such decisions regarding life and death. This makes sense given her frame of reference. I believe more compelling for her is when her friend got pulled from life support before she felt that all hope was indeed gone. She felt this was the wrong decision, made for the wrong reasons, and cheapened life. For her, (as for myself, but for different reasons) life is a gift and one that must be preserved at all costs. I respect that- but am not sure that it is the right one when looking at the issue of PAS and what it means for the medical community.

In the end, I do believe it’s about resources- more human then types of medical intervention. It is true that in other countries, after the age of 65, there are certain things that would not occur that are considered normal medical practices here. No person over 65 would get placed on dialysis- it just would not happen. Yet, in the US, this is something that is “usual and customary” and the outcry if we denied this for a patient would be (rightfully) riotous.

But the reality is that human resources are limited. There is only so much that one person can do. Given our current economic state, it is unrealistic to think that we can have unlimited attention from one MD- or others.  The cost would be far too high to pay- yes, if the need is a crisis, any MD I know would do all that they could to help that person make it to another sunrise. However, if it's a situation where there is no hope of a meaningful life (and yes, that is a whole other discussion...) one might feel the need to move onto their next patient...if that patient would benefit from their attention.

I suppose we need to consider what a meaningful life is- and this is probably where the issue truly lies.  Even if this is the underlying issue, is this something that the MD is responsible for defining? I am not sure, and nor do I think it a fair question to ask of someone who's attention needs to be in preserving life...meaningful or not, as this is not a decision one should be thinking when treating a patient.

We do have advanced directives in this country- and I for one would tattoo DNR-DNI on my chest if it would ensure that I would not end up in a state where someone else had to take care of me. That is my criteria for life- I want to be able to take care of my own needs at all times. I would never want to linger in a hospital bed, nor would I be okay as a quad. It's just not something that I have the internal reserves for. It's a brave person that can live that way, and I am very sure I am not that brave. 

I understand that this may  not be what my children or husband would want- they may want me "there" no matter what state I would be in- but I know who I am is very much not what being tied to a machine would be. Yes, I value life, I love life, I treasure life, but life for me is the ability to breath, eat and move as I was put on this earth to do.

I do know, and I do appreciate that many do not feel this way, and that's okay. I do however, think that coming up with some sort of code as a community is imperative. It's obvious from the class discussions, however, that this is not going to be easy.