Foxview Farm

Online blogs, podcasts, and other really neat things to have at your disposal.

2012-02-06T13:51:00.000-05:00

I am blogging this, because there are a few places that are my GO TO places on the web.

So, First- Podcasts....

A Gobbet 'o pus Mark Crislip who would be the first to say the world needs a more of Mark Crislip... Mark is an ID doc, and he podcasts about 2 times a week. Great quick listening. The beginning ones have a lot of sound effects that he has removed from the most current ones. I liked the sound effects for the first 100 or so. Now, I appreciate just listening. He also has an app that I use a lot, as well as a QuackCast that I have not explored yet. Sure to be soon.

Emcrit- just spectacular. Always has a bevy of show notes that I refer to. This is geared to the ED /Critical care MD but I still find it great to listen to. Usually about 20 min long. Great Manny Rivers MD of Henry Ford Fame and his sepsis talk. Saved my butt a few times!

ERcast- another one that just is easy to listen to- lots of everyday, important info'

OOPS! Never finished this post...will do so later! But for now, enjoy what I have listed thus far!

Babies...

2012-01-07T14:33:00.000-05:00

This is not going to be an "in order" post, because I am really behind (and yes, I was taught do NOT start anything with an apology but I am starting this with one because clearly I didn't listen.)

I am with Dr. Mason. I was told (perhaps warned??) that I was going to love him. I do. It is one of the best rotations I have had, just because his patients adore him, he gives them every second they need, and he gives us every second WE need. How many people can do that? A lot to look up to and learn from.

First day? A lovely OP vaginal birth. Since it was my first birth that I was not...um...being the center stage of, it was interesting. And beautiful. And the baby was perfect. Hard birth (OP means, at least from what I a can tell thus far is that is it going to be hard, and pushing a face up baby is often REALLY hard.) But she did it with a lot of coaching. I am pretty sure I was more happy than she was at that point in time.

Monday brings a lot of scheduled births that are from high risk moms. Several were from clinic patients that we saw on Friday. I am very glad I get to see those births. I am really excited and I must say that being a part of bring life into the world is just...amazing.

There is a lot more to write, and I think I will be writing a bit more "personal" stuff soon, because a lot of personal stuff is happening. Not all of it's good (ah- a very atypical Annika Sentence!) so deserves a bit more explanation. But that will come next...

EP rotation

2011-12-22T22:48:00.002-05:00

I love hearts. All sorts of hearts. I use hearts a lot in my cards, I have lots of hearts on my jewelry, I love the shape of hearts. But…

I especially love human hearts. So, clearly, I love my current rotation. Yes, I may sound like a commercial. I guess I could be a commercial. I love the Heart Care Program at the UMMC.

Since I have now rotated thru several hospitals, I can safely say that I still feel like the U really does put Pt and families first. Of course, that may not always be seen, but for the most part, if you are looking for someone to care, usually you don’t have to look too far for someone to go above and beyond his or her job description to help you find something or someone or to hold a hand that is in need.

What I love most about human hearts, however, is what is not obvious. I have always said (and may be gleaned way back in the earlier days of my attempts at blogging) that there seems to be so much more than just the obvious electrical and muscle dance that the heart makes. Here’s the thing- those abnormalities are, plain and simple, not so obvious.

This rotation is in EP and is all about those abnormalities of electricity. What gets blocked where and when, and then, what can be done to fix the wiring. The PA I worked with, along with his attendings and fellows, can look at an ECG and decipher the rhythm and know from the tracings exactly where, and why something is happening and if it can be fixed.

Well, there is a lot that can be done to fix hearts these days. A lot. I got to see a bit of whats done, and it’s fascinating! I saw a pacer put in-and what an amazing thing that was!

(good GOD…who thought being a MD would entail doing video games that mattered? Because that is what it seemed like to me- how the hand can direct this waving wire and somehow make it get to it’s intended target…huh? Who ever thought of that…wow- they played a lot of Mario in their younger days.)

So, it’s amazing to me- what can/should and cannot/should not be done.

Cardiology is clean medicine for the most part. It felt clean to me when I was teching, and still feels so. Most patients, when they get to the point of discharge, will be able to make lifestyle changes that will help improve their quality of life. Not everything can be fixed, but there are several things that truly do make a difference. I am not sure what other medical specialty can honestly say that.

Here is another thing that really has changed since I started on 7C in…oh boy- 1995. (!) . Before, when a pt was on a VAD, they stayed in the hospital. It was a bridge to transplant. Now? Not so much. People LIVE with VAD’s and they are no longer the huge machines that are connected to power pretty much all the time. Nope, these are portable ones that you bring right along with you to Target and Kroeger. I’d say from an outward appearance, that seems to be one of the biggest changes to me. The business of cardiology is getting people back to the things in life that sustain the heart that is not beating, but

Right now there is an abundance of new medications that are game changing-soon, maybe will come the day when the frequent blood draws just don’t happen. There are several new meds that have come out in the past 6 months, and it’s my understanding there are several more on the horizon. Amazing.

So, I thank the Heart Care Program, I thank Eryn Smith, and I thank all the patients that let me into their lives for a brief moment. I really enjoyed this rotation. As my facebook update said "I know jack Sh** but it sure was fascinating!"

The LOL Surgical consult

2011-11-23T20:33:00.000-05:00

Call nights are long- often filled with incredibly boring periods, peppered by intense moments of trauma codes. This night was no different, we had more ER consults than trauma codes. A good thing for the people involved, but for us, at hour 19, well, a bit of trauma does the exhausted body good-caffeine? Ha! No need with a healthy dose of adrenaline- stabbing, gunshot or 3, housefire with a pregnant woman- that'll getcha going.

I got a consult on an older AA woman. She had an abscess- but it was not specified where. I have learned that getting in on the bread and butter cases, the ones that the interns and residents don't want, are the ones that I want. I can DO them- and learn from them.

I did my H & P. the history revealed no major medical issues. No surgeries or injuries save a broken tooth or so. 3 kids, all normal vaginal deliveries. +FM of the typical DM, CAD, HTN- but thus far, she had none of the above. Did not smoke, drink, do drugs. No waving red flags. Okay! I can DO this! So, her issuse seemed to be just isolated- painful and isolated.

This poor, tiny 78 year old woman had an abscess on her mons pubis. Big one. Denied waxing, was not sexually active. She was married, but her "man" had been living with another woman for the past 20 years. She was a-okay with this. No one else in her life-lived alone. She did call her husband when I was interviewing her to ask him what other meds she took- Vit e was pretty much it.

The PE revealed she had the worst...um...well, yeast infection that I had ever seen, and honestly, guys, hope never see again. It was..."impressive". Put that in your admission note and that'll catch someone's attention. As I said, she denied DM, however, just as I was beginning to ask all the questions, leading at least my differential that such an infection tends to come from in a woman who denied ever being sick, the RN pops her head in "Her BGL is 511". As I was being told this, she was grabbing her Big Oreo Pack out of her purse to munch on. I told her that Oreos are probably off the menu for a bit.

At least I had one answer to one of her problems.

Clearly, however, the other issue was going to be done in the OR. Poor thing. She had a red, hot, fluctuant mass, about 6cmX10cm. It did not go thru to bone from what we were able to assess in the ED.

Here is where it gets funny.

She had never been in the hospital. She wanted to take EVERYTHING home- the empty IV bags, the chucks, her phone was out-she was snapping pictures everywhere. I have one of her-she wanted to have one of both of us on my phone too so I'd never forget her. (Not like I could forget her...).

She was so cheerful, so optimistic, and upbeat. She was sitting up in the OR when we got in, talking to everyone a mile a minute. I am sure she was nervous, but none the less, a truly bright spot in the rotation for everyone who touched her that night.

Later, I found out she had been putting Icy-Hot on her "'fected part". I came into her room for her post op check and she had it out to apply it to the open drainage area. I can only imagine the pain that would have been. I had asked her on initial interview if she had done anything to make it feel better, I guess I needed to ask if she did anything to make it feel better that failed. That I would consider a fail to be sure. She then admitted to putting cabbage compresses on her "'fected part" too. Her post op went smoothly- her BGL were labile as would be expected, but medicine did their magic and they were eventually controlled.

And now, in all the ways that so many of the rotations went in Detroit, her story is so much deeper, sadder and still astounding to me.

Frankly, Sad.

Remember that phone? All those pictures? She had a chronicle of her life in pictures on her phone. If anyone ever got her phone, the things that they would see. She could hardly see her phone, but she took pictures still. When she was showing them to me, about 1/2 way back was a picture of a man in a casket.

I was taken aback...what in Gods name did she have that for? I asked of course (I always ask...just my nature). She knew him- he was her neighbor. He had been shot, in front of her, outside her apt. And yes, she had pictures of him on the sidewalk, dead. She knew who shot him. While telling me about this, she covered her mouth, asked if she was going to Hell because she had lied to the "Po-lease" because she knew that if she admitted she knew, she might be next. You don't live that long on the east side of D-Town if you're a dummy. She clearly is no dummy. If there is a God, this woman is certainly not going to Hell. She has been there- but her cheerfulness and joy in the world was bigger and greater than what surrounded her.

She said she had pictures of all the people she had seen at funerals. All her friends kids who had died. All the people in her building who had been shot and killed over the years.

She told me that she slept in front of the window now, watching to see if anyone was coming. I am a white girl from the country and I have one thought about guns besides ban 'em. I want FAR away from them- esp if someone I don't know is carrying them. Her thought was that if she saw who was coming, she could get away. She was scared but it is what she knew. Me? I'da picked a door. A solid door.

I don't remember her name, I have her picture still. I hope she is okay. She was discharged home after 2 days stay to get her glucose under control. I hope she followed up- and I hope that somehow she has found some peace and quiet in her life. Yes, I asked SW if they could somehow help, but no- nothing to do. She was A&OX3. Frankly, she was a great example of survivor, strong, beautiful, an optimist in the light of all that is so difficult about D-Town.

This happened well over 2 months ago. I am ending my stint of being in Detroit for rotations. Overall, I have gained such an appreciation of the deep recesses of humanity that exist downtown. Yes, it's a terrible place, but under the layer of grime and filth, there really is something very special about the city. The grit, the simple acts of survival that profoundly effected my rotations there. Certainly I learned something about medicine or at least I hope so, but I also learned a lot about people. I actually do believe that the city can be brought back.

There are a lot more stories- more blog posts to come. It's a lot of driving to get to and from- easy 2 1/2-3 hrs a day. I won't miss that! Makes for no time to write anything. A2 next month....

The entire patient

2011-09-17T10:51:00.001-04:00

is what we treat.

A pt came in to us. Seriously hurt because they had done something stupid when consuming a bit too much alcohol. Well, a lot too much, really. Lucky because no one else got killed. He hurt himself worst of all, but his companion will be feeling the pain for days. He ended up being surgical to fix some seriously broken bones in his face.

(you ortho-gods, bones, bone fragments, breaking bones, moving bones-def not for me.... I give you credit.)

As a good PA student, I researched his EMR thoroughly. It had been mentioned that he had an ID band on his wrist from our hospital when he came in. I asked him when he was alert enough if this was so, and it was indeed the case- he had been DC'd just a couple of weeks before. Shocking- admitted for another trauma that was associated with ETOH. And further back, in the past 6 months he had been in our ED over 6 times. Not always admits, but always trashed.

Each time for ETOH abuse/issues. Levels were all over 200. Each time. Some MUCH higher. And most of these incidents were involving a several thousand pound vehicle traveling at high rates of speed. Anyone seeing any red flags?? I was holding his hand, and thinking how much he had cost our system, how close he has come to killing people. According to his EMR, he would spit at MD's when angry. None of that right now, he was a scared kid.

He was younger than my daughter, older than my son. I talked to him about quitting. He said he wants to, but he tried and he couldn't do it alone. I told him this meant NEVER drinking. He said he knows. He said he wanted that. He wanted rehab.

I accompanied him down to the OR later. He was polite, we kind of knew each other at this point in time. I admit still being irritated with him, and feeling cynical- he was driving without a license, he was responsible for several other injuries we were treating that day. What made me think my simple little "You GOTTA stop drinking before you kill yourself or someone else" talk would make any sort of dent in his disease?

A family member was escorted into the room to see him. It was a woman, who right away went to his side and started to rub his back. I introduced myself and she told me she was his grandmother. She asked me a bit about his injuries, and what to expect. I reiterated to her some of what I knew, and what I had told him- his physical injuries were serious, but the most important thing was that he must stop drinking.

She looked right at me and said "He has to learn to love himself first, then the rest will be easy. I want him to get through this- he has a lot to deal with when he gets out of here. My only concern today is that he knows he is loved, and that he is loveable, and that I am here for him. That's my only concern today for him today. The rest will come."

She proceeded to tell him some of that, and I watched her bend over him, whisper to him, rub his back. While he was in and out of awareness, she told me a bit more about him. She was his dad's mom, that his mom was not a loving person, and that she had said to him after he had come into us that she wished he had died. Her son just had been getting help with an addiction to drugs. "He's stepping upto the plate- it's taken him a long time, but he's here." Her grandson had worked for the city but had gotten laid off with the latest cuts. When telling me the background, we both were teary. She then prayed over him-for his recovery, the surgeons hands and the calmness that is needed in the OR to make her grandson better. Her faith, despite mine being questionable, filled that cubicle. It was bigger than anything else in that hospital at that point.

His mom came, clearly inebriated. Grandma left then, so the rest of the family could come in.

During his post-op check, he was doing very well. He responded well, wounds looked great. I told him that his grandma had been there- and what a remarkable woman she was. He said he loved her.

I then told him this: To have someone love you so much is a gift. It's a gift very few have. It's provides more riches than most have. It may not put food on the table, but it puts something into your soul, your heart that is just not possible to reproduce. It's not something one should ever take lightly, and indeed it's a kind of responsibility to know that someone loves you that much.

For me, it was a reminder. A chuck under the chin to remember that the story is far more than the EMR might indicate. It's complex, sad, heartbreaking. But there are threads of golden woven through that glint thru the ugliness that permeates so many stories we see. Keep looking for the golden. You might find it.

I'm glad you're here....

2011-09-17T10:13:00.001-04:00

Yesterday I observed a surgery that was not performed by one of our surgeons, but one from another service. We had had this patient for as long as I have been there, and has been my patient since getting to our hospital. I asked the if I could observe the day before, and was told to page the attending to ask.

I don't do that. Call me chicken if you want. I'll take that rather than the wrath of an irate attending that is about to perform miracles in the OR on a patient I care about. I want that attending to be in a really good, balanced mood when they take that blade into their hand, not irritated with a student-much less a lowly PA student.

So, I went down to pre-op with the pt and waited for someone who knew something about anything. The resident showed up and I asked him when the attending might be there. He said..."I'm glad you're here. I already talked to him about it- he's cool with it."

I admit- I got a bit hot and bothered. In a good way. Those words made my day. Quite possibly my rotation. Not one other person has said that to me since starting rotations;I miss that feeling of being a valued part of the team. Even as a tech, the RN's would comment on my being there- that they were glad to be working with me that night. I know I make a point of telling people that their presence is a good thing- that I appreciate them caring if I see them do something above and beyond. When teching, I have even emailed a RID (Really Important Doc) and said how much I appreciate their care of a patient. That might have been a bit too "annika" but I don't really care.

So, thank you Dr. C, you made my week. I stayed late to watch the surgery, but instead got a boost of needed energy.

Surgery

2011-09-17T09:33:00.000-04:00

So, as I said in the previous post, I am in surgery. I am surprised to say that I love the ED part most of all. I mentioned before that I had considered a residency in ED- one focused on Rural medicine that is in NY. I kind of dropped the thought off of my local radar, just because A)money-I need to make some of that green stuff and the sooner the better! and B) thinking that not having the continuity of patient care might limit my enjoyment.

Nope. Not so. It's actually good- I can care, and deeply care, about getting the patient better enough to get them to the next step of their recovery and that is good. I love the intensity, the need to bring all aspects of my (limited) training to the forepart of my brain, balancing the medicine, surgical aspects in the resus bay. I of course am watching and learning right now. But, my head is swimming with thoughts.

So, the thought of the residency is back. Strongly. I think it might be great. I think I might like it. And since nothing else has really grabbed me yet during rotations, maybe this is it. Stay tuned.

I also admit feeling like I have not learned nearly enough thus far in my rotations. Not nearly enough. I also admit that I wanted to be at UMMC for many of my rotations. Thus far, I have gotten none of them. Zero. I miss the U, miss the environment that that place provides. There were endless opportunities to learn there- endless. I miss that a lot. I also miss the caring that the U seems to have at the center. I am not seeing that out in the "real" world, and I find that sad.

So help me GOD....If I see/hear of another person slamming a NG tube down someone, without lube, and hurricane spray--forgetting lido-jelly even for a moment as a possible assist-and then wonder why the patient was so miserable and refusing another NG tube, I wish the NG curse on them some day. Because when I asked, I was told "it takes too much time". Oh boy...If I were not a student, and somehow could mention what I really thought, they'd get an earful. Say whatever you want, it's the wrong thing to do.

I have seen several surgeries but none of the usual suspects...no appy, lapchole, bowel obs for me! Nope, was in on a massive lac to the back of the neck where the C-spine was...right... there...and the clot that had formed was as big as a small baby. I kid you not. I have seen orbit repair with screws, plates, mesh. I have seen more I and D's- seemingly the bread and butter of surgery-forget hernias! I have seen an exploration of an orbit from a possible self-inflicted GSW...I'll tell that story at another date.

I have learned a lot I admit. Most of what I have learned is this:

Who you work with is as important as what you're doing
Driving over an hour to work is plain and simple NOT for me
I need to be someplace where patient centered care is at the fore-front at all times
I need to be someplace where you're striving to always be better, so the patients get better
I need to always be able to learn, to push past what I get and enter into areas that I feel lost and need the compass of those wiser than me to survive and thrive
Saying I don't know is okay as long as you make sure you will know soon

Till later. I have a hot date with First Aid and Surgery Recall, never mind Casefiles!

The rotations keep rolling

2011-09-17T09:02:00.000-04:00

I am currently in my surgical rotation. Parts, I love. Parts I dislike. I have seen a lot of what I do not like in me coming out- dealing with one of the team members is quite challenging for me. I have 2 more weeks. I ~~can~~will be nice, and think good thoughts about this person and know at the end of it all, I would rather have me than that person taking care of my patients. And if you "know" me, that's saying a lot.

I finished psych. Outstanding preceptor, but horrible rotation. I am rotating in an area where despair is the norm, and the genetic pool is riddled with mutations. Psych is a hard one for me, because we can't fix it. Not one bit. Our meds might make a difference, but does it really change the illness? No, it'd be a fix, but not a change. In many ways, it's like a cancer, but a never-ending-never-changing sort of cancer. Lifelong CLL. But worse. I admit wanting to fix things, to make things better. Inpatient psych, esp as a consult service really can't do that, nor does it pretend to do this. Perhaps that's why there are so many tools and ways to pigeon hole the patients. A DX is essential, and knowing what their GAF is becomes important. How does axis III change axis II? I? Perhaps intellectualizing all this allows for the MP to keep some distance, and allows for better care. I don't know, and I know that I am not going into psych.

That's okay. I am ok with that- there are so many things I want to go into, ruling one out is in my best interest right now.

A rather nice week at the office

2011-07-16T09:02:00.002-04:00

On the "interesting cases" kind of note- Saw an honest to God spontaneous Pneumo ("Large" according to the radiologist...wish I could have seen the films, to correlate PE findings with visual understanding).

Yes, Tall, skinny kid. But No SOB, nor any other serious "OH DEAR GOD" signs. Just an amazing MD who caught it during (yup) a routine PE. I'd bet that the kid was kind of miserable and made the appt. He had not been in for 3 years. I did notice fairly pink (red?) cheeks, which I remember seeing in my CO2 pts before. No ABG or BG to see, I am sure they did that at the ED. I'd also like to have seen that, but honestly, I am hoping it's venous, as this kid was already scared enough. Just writing about it gives me the heeby-geebies. My biggest issue is knowing that he might be in for a world of pain. And, came into the office without family attached to his side. In his car.

Ugh. But nods to an amazing peds MD who A) Caught it, and B) called me in to hear it. Did not say "This is what this is" but let me listen, and think. What I heard was cracking, and "far away" sounds on auscultation. Only way I could describe it.

Mrs A

2011-07-11T18:42:00.002-04:00

I had not been back at the U for long, so had not acquired my ICU shoes all that well yet when a pt entered my life in a way that few patients ever will.

She was on "the list" and had been several times. Each time, you get to "stay on" for a certain amount of time, and then, get taken off, moved out of the ICU (usually at least), have another full work up, and get re-listed. This happens several times for some patients, and it, I am sure, is most frustrating. Our unit remains one of the few that have not been renovated to the degree that being in the 2010+ years seems that it should be- and whomever designed the rooms clearly had never taken care of a patient that was on precautions.

Mrs. A had done the List Dance several times by the time I had really gotten to know her and her family. She had a devoted husband who kept her laughing, and family that cared. She was lucky that way. What she was not so lucky in, however, is exactly how sick she was. Obviously, being on the list meant something was seriously wrong, but also she kept getting those little annoying nosocomial infections. Okay, that is a huge understatement; she never came down with one of the Big Ones (MRSA, VRSA, C-Diff) but the ones that take one off the list but aren't that terrible to actually have.

Her husband had left for the evening, and she called me into her room. I asked her what she wanted and she said "I don't want to be re-listed". It was more than that, really but the end result was she was done. She had had it, and just was tired. At this point, she thought she had been in the hospital for about 6 months. I called in our Fellow (after explaining that I was not the person who needed to know this, but someone that might be able to actually DO something about this needed to hear this from her.) We all cried but clearly, we all understood. One can only take so much. Her reason for staying the path thus far had been for her husband- as I remember it, she said she was really ready months earlier, but she knew he would not want her to make that decision. I was not there the day of the family meeting, but clearly, when one loves as deeply as they loved each other, the decision was made.

Problem was- she had to stay with us. Her meds were not ones that could be stopped quickly and she could not be D/C'd to hospice on the meds. So, weaning began. She did well, and things went as smoothly as can be.

Mrs. A comes back to me a lot during my thoughts of special patients. But this weekend I had a very special Mrs. A moment. Ann Arbor has a lovely thing called Top Of The Park where local musicians play. There is some serious talent in the area. A man named Levi Johnson and his band played this past weekend. As I am wont to do, I began to dance- his was a funky, motown sound that makes even the most tired of feet move. He began (as a black man) to sing "Play That Funky Music White Boy" which brought me back to the last time I saw Mrs. A.

I asked Mrs. A what she wanted most of all and her answer was some good music. Her husband was there- and I asked what that was exactly. I was thinking my Jack Johnson and Michael Fronti might not be it. I was right- They wanted some good soul or funk- 70's type music like- oh- "Play That Funky Music White Boy" So, thank you to iTunes, I downloaded a few songs, we closed the curtains and turned the iPhone up as loud as we could and danced. Well, she moved in her bed and her husband and I danced. I remember that moment, and knew then that this was to be one of those moments I'd never forget- a white woman, in scrubs, in a tiny ICU room, dancing with a black man, and his wife moving as best she could, to the sounds of Motown. I realized then and know now, how absolutely lucky I am to have known them, their love, their courage.

Mrs. A died a week or so later. Her husband was there as were a few of our nurses that went to stay with her at the end. Someone posted a picture of her before she got ill- and she was startling in her beauty. The thing was, I saw that beauty from the inside of her, and it remains one of the most beautiful things I have ever known. My memory of her lives to this day.

Pediatrics

2011-07-08T23:36:00.002-04:00

I am currently in the beginning of my peds rotation in Ann Arbor. I have an amazing preceptor, who loves to teach (there is so much to be said for that!) and the practice is far more varied than I expected in Ann Arbor.

He has been practicing for over 30 years. But, he stays young, and strong, and everyone loves him. They are not dependent, however, on him, and he is busy enough that having people call in, or only RV when needed is the norm. As I said he loves to teach, and takes a lot of moments to teach, which are great and welcome for me.

I've seen 2 mono's (one clear case of mono, and one not-so-clear but both spot tested +) and 2 cases of Pityriasis rosea. Mono, I expected, but pityriasis not so much. I always figured it would be a board question and that's that. But the herald patch was noted in one kid, and the other one not as clear a beginning, but the christmas tree pattern was clear. "Score!"

I think this is my last easy rotation, so I hope that I use the time well. Other than that, things are heading towards Nick leaving, and I am heading towards being an empty nester. Feels kind of good! At least today it does....

FP

2011-06-20T22:43:00.000-04:00

I am ending the rotation next week. It's been a great rotation for many reasons- FP is a nice sorta gig, as you can actually follow up and try to help a patient change their lifestyle so they might enjoy healthier living.

So, for the first week... My pt. (and this is the generic pt's- and believe me, there are a zillion just like this.) DM-Type 2, NID, HTN Stage 1, add a bit of elevated BMI, a bit 'o drinking on the weekend- and maybe the weekdays. Maybe they smoke. Um. and the cardio they have (and this counts to them) is walking from the car to the door of their office.

Me:
So, you know that smoking (fill in the rest of the blanks) causes X,Y Z.
Pt:
Yes, I do. I have tried many times to stop. I just can't.
Me:
That's great! Keep trying. You can do it! There are ways that we can help you...(fill in the blank)
Pt:
Yeah, I got that patch/Pill/Gum once before. I stopped for a month/3 months/6 months and then started again.
Me:
Okay, well, I think that's great! Now, the next step is to try again.
Pt:
That sounds good. Yeah, maybe I can do it.
Me:
Wow- that's great! So, comeon' back in 4 weeks, and we will talk again.

Fast forward 5 weeks:
Me:
So, how are you doing?
Pt:
Well, I tried x,y and z and I cut down to 19 instead of 20 a day.
Me:
Well, Good...now, what can we do to help that move along faster for you?
Pt;
Well, I am not sure.

So, reality is this: When they are motivated to change, they will. I hope that I motivated some one person to change their lifestyle just one smidge to make their lives healthier. But I am not sure. I admit my conversations now lean towards

Me:
Do you smoke?
Pt:
yes, about a pack a day
Me:
Okay, you know you're going to get the lecture. You know it's bad for you and I want you to know that when you decide to quit, we are here to help you in any way we can. Until you want to quit, there really is nothing I can do to help you.
Pt:
Thanks. I've heard it all before.

We all know that we shouldn't smoke. Should drink in moderation. Should exercise. Should not eat junk, but eat at home, healthy foods filling our diet. But we don't- okay, some do, and I admire them. But I know I don't always. This past year is a great example. I have been a sitting, unexercising, icecream eating slob. I swear that this will change- when?

When I am darn good and ready. But it's HARD and its internal. I know all the reasons to be good- including feeling better. But, other than that. it comes from an internal place that just don't have the ability to tap right now. So, developing the knowledge that it's hard- yet still mentioning it at each and every visit is essential. I also have to say I bring it up in my ED conversations (the joys of being a student- no clock on my head). I hope to make an impression to my patients with advice on healthy living- and I'll keep trying to be an example.

That road to hell is well paved

2011-06-20T19:45:00.001-04:00

Nick is officially a college Freshman, Jas has come and gone, and I have 2 more official FP days with Dr. B. Hard to imagine that I am almost 15% done with the year. Um...really?

I don't know enough. That is what I know the most. The rest is just mush in my brain, and I am hoping at some point in time it clicks. As for now, Thank God for Epocrites and my other iPhone programs. I use them a lot, and am ever grateful for the quick glance to make sure I "get" it- and hopefully get it right.

I had one day that I found difficult. A pt came into the UC facility that I was working with. He was young, and had 3 small children with him. There was no other family with him, and the kids were, well, kind to say, un-disciplined. Now, I give my kids (or rather gave...sniff. No more kids for me! One all grown and one ready to be an adult....) a fair amount of free rein. But, there were certain things that they knew crossed the line. And perhaps I might have flown off the handle a few times, who knows...(they might and I do), but overall, I was never horrified by them in public. Actually, I have to say they usually made me proud.

So, this situation was tough for me. These kids needed to behave- Dad was in pain, sick, and needed a bit of a "best not to go to soak in the lake after getting a huge 'tat on your arm...and if it looks hot and inflamed and has smelly stuff oozing out of it- might be a good idea to head to your friendly ED/UC without your kids, before you have a full-blown abscess or 3 in your arm" kind of talk that you give to all your patients that come in. Well, maybe not exactly that, but...you can imagine something like that might be said to a supposed pt that might be presenting to you some day. Just sayin'.

So, there was that line of pt needing my attention, and the kids demanding my attention. Kids won for a bit, only because I was afraid that they might end up needing a head CT from them bashing each others heads into the walls....

So, I left, and felt bad. My job was my patient- not the kids. My job was to take care of him, not his kids. My job was to treat him, not judge his parenting. For the first time, I felt that I learned something- from the patient, not a book. There is a great video...Every Person has a Story that says it better than I can- a training video from Chik-F-La. I have NO idea why that day I did not remember that important part of caring is...caring, but I am sure to remember from this point on. I have no idea what or how these kids got to be there, but surely they deserved more of me.

I would never have thought I'd have needed a lesson such as this- usually I am the one that points this out to others. But, in a very nice, yet direct way, someone showed me, and I appreciate it.

We learn more by being at the bedside than we learn from books. I am grateful...always.

What I say vs. What I do.

2011-05-29T12:25:00.002-04:00

So I did indeed say I wanted to write more in the blog. I have evidence that this is a good thing -The Academic Life in Emergency Medicine Blog- which has reference to blogging as being good for medical education and promoting self awareness, increasing compassion...which everyone needs more of, but I seem to have in abundance and actually gets in my way at times (how's that for a sentence!). The ED rotation work has shown me that I had best pick up the speed....but I care if they are anxious about their kids and their work and their...I digress again Argh!

Obviously I have not done this better blogging thing. But I have thought about it. That road to hell is indeed paved with good intentions. So, here I am. And I have over 100 pts to log, a garden to ready, and a week of grandkids, kids, graduation, parties, and...more. But the strange thing is I have been thinking about a few patients -a lot.

What has stuck is the patients that stick. Yeah, I know-terrible prose. But I have experienced a few patients with stories that have really stayed with me over the years-the ones that wake me and I think- what went wrong? Or right? or what could I have done now that might have made the outcome better? And so, I'll mention them again, maybe some for the first time but...and hopefully, when I have some time, I will expand on their stories as I remember them. But for now....

There was the man who came in the the unit late one night- he was youngish, 50's? Had a hx of cardiac issues. He came in with his with his family- all were scared. As the medics wheeled him past, he looked at me, and said...I am really scared I am going to die.

Anyone that knows and heard this statement knows it's not one that you want to hear. Especially in this sort of pt. You'd think he'd be fine- he should be fine. But that sense of forebearing makes me nervous- always evokes that "thump" in the pit of my stomach. I was hooking him up and looked him right in the eye and said "we are going to do everything we can to make sure that does not happen." Dangerous statement- because while we can do everything, some things can't get fixed.

So without details, he did indeed die. I, of course, felt I had let him down. But the strange thing was this: He was still there. I mean it. Still in the room, still felt totally alive. His heart pumped nothing, his lungs exchanged no O2, his brain had not one discernible electrical wave. I have wrapped many a body, and some I believe were long gone in spirit before we readied them for the family and the final visit. This man was very much there, as confused as the other humans in the room when the code was called. This is a man that was not ready to die. Wanted to live. Wanted to see his kids grow, marry, and carry his grandkids. He wanted to do what most get to do, and don't even appreciate. His body died long before his soul was ready.

Often when wrapping a body, there is light talk, and sometimes laughter- it's a horrible task, really. That last zip as we close them inside the bag- it is so horribly finite. So, laughter can ease the time and stress of the task. There are some realities that happen at the end of everyones life that have to be taken care of. Some are not so nice, and really rather smelly. So, yes, while it seems terrible, there are some very bad jokes told- some bad situations that we've gotten into that do cause giggles to escape when it seems quite wrong.

For this gentleman, there was no talk, just whispers, and then, a soft prayer-for the transition he so badly did not want to take to go smoothly, because he was kicking and fighting the entire way. I spoke to him when doing my work- and I admit, tears were there. Because I really had let him down- a promise made that I could not keep...medical science had let him down. But finally, it was his body that had really let him down- while there are some things that can be fixed, so many can't. He could not be fixed.

He I will never forget.

Combined three into one.

2011-05-15T12:44:00.001-04:00

So, I combined my blogs. No reason other than I already feel splintered, and having three blogs somehow made that feel even worse, and stymied any attempts to continue to chronicle things in my life.

Because what I know now, more than before, is that the things I value all meld together in some sort of pattern that is me. Sometimes, it feels disparate but overall, what is true is that all of the things that I value are all of the things I care to write about. So, hopefully they combined and it works. I'll try and tag correctly if I ever decide to go back and read something.

So a few things- First. I value and believe in HIPAA. So, if there is something that refers to a patient, I have TOLD and ASKED that patient if it's okay that I write about them. And yes, even a few pictures! They knew obviously. Probably from this point on, there won't be patient picturess, as I am no longer a tech, but something between knowing nothing, and knowing something. (I assure you that I am more on the Nothing end of the continuum still, and am becoming more and more aware as the days pass that I had best put something between my ears that might indicate I know something.) If I ever DO have pictures, well, then, I have asked at least once and probably more than once, called my psychiatrist, discussed with friends, co-workers (who won't give a damn) and called my lawyer. So, if anyone ever reads this and things- OMG! She's crossed the line- remember the above, and add a bit of knowledge that I live in a world of guilt and if I ever did anything like "that" (dadada da...) I'd off myself.

Then, have to add that these are MY thoughts, my feelings, my everything, inc. misspellings, and errors of all sorts. So, forgive me. I am sure I will cringe and squirm when I read them, but perfection is not the goal, but the aim.

Then, I am going to link to a few really REALLY good blogs. Okay, these are mostly medical. But if I link it's probably worth the click. Because there are a few out there that A) know their shit, and B) do a good job, be it ernest or humorous. And are really good storytellers and sharers of knowledge. So, click and I promise to not lead anyone astray.

And finally, I am not anti- health care reform. I DO believe we waste resources. I DO think we need to get some control. I DON'T think Medicaid works well. I DID vote for Obama, and will again. I DO know we don't have the right formula. But I think we are getting there. I realize this is quite unpopular. But, so be it. You can quit now. I believe that we have to choose for ourselves how to die, and therefore, how to live. You choose to smoke, over eat, sit too much? Well, uh, I don't know what to say. I'll take care of you, but you will hear about it. Because that is my belief. We need to take care of us.

And while we all make mistakes, it's what we do when we veer from our path that is what we really are. I believe this. So- I try very hard to not judge what someone has done when they make a mistake, but rather how they are dealing with it.

I am pro-choice because I am pro-life. A wanted life is a good life.

So, there you are. Disclaimers now that it's an all in one.

First rotation starting....

2011-04-30T22:59:00.000-04:00

And it's family practice with Doc B as he calls himself. I am looking forward to the experience, but also scared Si*tLeS* at the same time. I don't even know WHAT to study- and therefore am feeling a bit- um, well, scared that he might ask me some sort of question right off the bat like..."So, this patient has a CR of 2.3, and blahblahblah and so what do you think is the real problem." I'd answer something like" well, I guess he is in renal failure of some sort?" and know that I know there are several sorts of renal failure but...what kind am I thinking of?

I would have NO idea. None.

Sigh. Got a lotta learning going on, I tell ya. Lots.

Doc

2011-04-10T20:34:00.001-04:00

1Today, I was able to ride Doc...it's been forever, and I just am in heaven. AND...

LOGAN WAS FINALLY BORN! 8. 1 oz and 20.5 inches long. It's amazing. Its been an emotional day to be sure; tears thru huge smiles.

So, here is the video of Doc, at least I *think* so! He was an absolute ROCK STAR!!!

One thought!

2011-04-05T07:46:00.000-04:00

It's the end of 3rd semester....yes, yes, yes.

Need a blog post on The Adventures of the POPES- because if life wanted to make sure that we are made quite aware that we are NOT in control, I can point out POPES and my adventures.

Til then...

been too long

2011-03-09T12:52:00.000-05:00

but so be it. I am really glad I had this blog to look back at- loved seeing what happened earlier, and loved seeing what has happened because there has not been a lot of that in the past year.

I have not really seen the horses, not spent any time with them, but overall, still am kind of involved on a peripheral level with their day to day lives. Doc is back home, so I now have 4, which really is way too many. But that's okay, I guess, until something better comes along for Doc. I think that 3 is probably too many, but I think I can manage 3, and always have someone to keep the other one company. Seems kind of silly, but oh well. I do think the three boys are a good combo, and while Doc adds nothing negative to the group, it remains that these are one expensive hobby!

Rotations starting means that perhaps I can start riding again...depending on the rotation, I guess. I worry because I don't know if I can balance things well enough to "do it all" but want to try and figure it out. I need to add it in, because I have taken so much out it's kind of hard because there is not a lot of me left. lookin' for some me!

I also want to try and figure out the best way to work things overall. First, car issues, Trailer issues, care issues, barn issues, animal issues, house issues. The balance of all of these, while maintaining sanity. Working on that might be the most important thing I do in the coming year.

Well, Dumb and dumber on in class, and off we go to whatever comes on for the next class session. I've given up knowing, and frankly caring.

a thought

2011-03-09T12:25:00.000-05:00

when someone says "do something!" what they mean may not be even close to what you think they mean. I think this might be an important thing to realize as a practicer of medicine. Because we can't assume anything, but I bet we do!

So, third semester. yup- here I am. I am not sure exactly how, but that's okay. I look forward with both fear and joy towards rotations, and can't wait until I get my first assignment. I hope I get to ease in slowly- PLEASE no surgery as my first! :) Psych? Maybe. OB? Maybe. But I'd live to save surgery, IM, FP for much later, thank you very much.

Things are somewhat quieter at home. That is good. I have not enjoyed the process that we have gone thru at all.

second semester already?

2010-09-18T22:13:00.000-04:00

Yup. It is. 2nd semester of PA school and I am still here! Amazing.

It was a hellofa semester- partly because of PA school, partly because life reminded me that I am NOT in control and that I had better just hold on. So, I held, was exhausted, paid a physical price but made it in the end. No shining glory for me. A B kinda semester, which means passing, but...honestly, was horrid.

But I am here.

So, books- important. Very important. Mosbys? May be one of the worst books ever. So many edits that need to be done, it's just scary. I fixate on those, which, of course, does not help. I seem to also use the PA PANCE prep book a lot, which is great.

Anatomy has stuck more than I thought, but overall, not a terrific experience, although Dr. Tracy-Bee was amazing, the lab, which should have been even more amazing, was a crash and burn as we did not have a great lab instructor. I highly recommend Dr. B. She is worth it in the end.

Classes? Love Clin Med, and do love PE but I think I got off on the wrong foot. This semester seems to be better, but I have no idea until I actually get in there and do something. So, that is how it is. PathoPhys? Oh boy- hard to keep positive in that class. Dr. P is being to grow on me. And HCI, well, that is just a great class! Stephanie is doing a great job- and the best part of all is that it keeps us positive about becoming a PA as we are actually doing something that seems related.

I had a bad experience on my comprehensive exam. First, my mom was in the hospital in A-Fib and my patient had a total coughing attack in the middle. I think I failed, but oh well. Onto the next one (after I re-do this one...I would not have changed anything, in the end, at least. )

Hopefully I'll get better at this, as I do enjoy remembering what was....

I am going to post on the other blog, as my life

2010-09-18T21:58:00.000-04:00

is really about being in school. But, again, I am totally aware that horses are it for me. I adore them. I love being with them. I love smelling them.

Everything about them? I love. I sit in my wee office, trying to write and read, and I can look out and see them. I watch them eat and know what they are doing at all times, their activities, and the hierarchy of the herd. But the best thing about these boys is this: they get along. Really really well. They are good to each other (as much as horses can be) and they also love me. This may sound silly, but the nicker that Reason gives my car when I pull in the drive will often bring tears to my eyes. Both Tahoe and Wrainthur put their heads into my arms when I need it most, allowing me to cuddle them in a way a horse should not. I

I just...well, I adore them. I don't want fancy rings, or necklaces, or fancy cars. I want my boys to be happy, to look and feel outstanding and to always feel safe. That is what makes life ok for them- to feel safe.

I am so glad they are in my life....

Hallelujah Rendition: Emory PA Graduation

2010-06-08T11:13:00.000-04:00

2010-05-31T14:12:00.000-04:00

Wow- beginning week 4 already...

We have had 4 tests already- and I think I have passed them. I know I have passed 2 of them at least- and am fairly sure about the fourth. This week brings my first clinical- Card IM- at Grace Sinai. Please note: I have NO idea where this is. Where is my map, anyway?

Speaking of maps- I have decided that this is pretty much unchartered waters for me. I feel lost 90% of the time. I am aware that certain things are harder for me than for others- this is okay, but frustrating- clearly youth is helpful in the regard. I hope I will do well in clinicals. I am going to assume that my forte will be the time with patients. Clearly, anatomy and rote memorization are not my forte. There is one area where getting a B will suffice. :)

So, I have spent more money on books in the past month then in my entire life- even building my "horse" library. I can see how they will truly be important. I have lots more I should get, and even more that I'd like to get. I can see how Greys or the full-blown Netters would be quite nice.

I have great classmates- and a new husband in Anne Hall, seen above with her bright smile. Arts comment was we already look alike, which I will take as a compliment. She is bright, smart, sweet and quite funny. She also does tell it like it is, which I appreciate greatly. "Right??"

And, just as a last note- there is NO way that I could have prepared for this. Perhaps taken a "real" anatomy class, and maybe given a bit more of a damn in my sciences that I took. But for the overall picture- they said it would be hard, I believed them, but no way did I ever imagine it would be THIS hard. Today is an okay day, but then again, I spent hours working this weekend. I decided to update this blog so I have some sort of record and since type pretty quickly, it's time well spent just so I can remember. Because, forgetting might be the MO soon- not the information but the frustration of gaining all that information into my brain.

Hope that I will get better at updating things- but in the meantime, I shall believe what those that have gone before me have said- those that make it persevere at this point- it's not the brainy but the stubborn that will still be standing in 23 months. And that drinking from a firehose is tough, just don't try and get it all at once- you can't and might drown trying.

First day...done!

2010-05-11T07:25:00.000-04:00

I left to meet my car pool buddies when the sky was deep velvety blue and the moon was just a clear sliver of bright light. This, I suppose was the perfect symbolism for this journey- I can't see much but there is a light that I am directed towards, and this is good....

The first day was filled with learning that I probably need more books than I currently possess, and that I had best get cracking soon. The problem with that is this: I have NO idea what to get cracking on! We did not get a clear guide line of what we are to do, so I am somewhat going to punt. I think I read on the Forum that getting those diseases that we are responsible for (our A list) as well as the B and C list is best accomplished by setting them on cards with each section clearly delineated. I will try and find that reference soon!

Off to day 2, and more PE!

A thank you

2010-05-08T10:22:00.000-04:00

to all that were kind enough to mentor me during this process. I realize that this was an invasion of your work day, time away from getting your job done efficiently. I realize that with each patient that came in the door, you realized, as did I, that my being there was an invasion of their lives- their most private lives. In this, I must also that the patients that accepted me and allowed me to eavesdrop into their visit.

By allowing someone to shadow, to experience what the real word of being a PA, you have given a gift both to the future PA but also to the profession. It is not surprising that it's a requirement to shadow a PA for acceptance into most programs. The day to day life of each PA and their particular area of practice is vastly different from each other. By looking at each particular PA I shadowed and what their careers entailed, I was able to see the possibilities for my own career, and honestly, give me some "oomph" in the rather tedious process of pre-reqs.

I had wonderful PA's to shadow. I sat in on morning rounds, grand rounds, the weekly trauma meetings, and cardio-thoracic meetings. I was in the hospital, in clinics, in private offices and in the Student Health center. I saw a lot- stitches, a very interesting I & D, burns, a freshy pregnant woman, a first pelvic, numerous UTI's, skeletal issues, and things I just had never thought of- how does someone get something stuck in their ear? Especially if they are over the age of six?

So, thank you. Thank you for your time, your advice, your support. Thank you for offering an ear and saying "if you need anything, just drop on email!" Thanks for the tips on surviving school, for the copies of notes taken, for the books passed on. Thanks for taking your time, both for and with me, but for the profession itself.

One week from today I will really begin!

2010-05-02T08:30:00.000-04:00

I have started to put my office together and feel as if I am "nesting" and getting that space together. I want it to reflect me, yet also be very very organized. It's a mess right now (will post progress pictures). I got bookcases at Ikea and Art put doors on them which look amazing! So, now on to filling those cases and getting things done the best that I can.

I am planning on ordering the books that I really REALLY need tomorrow from Amazon. I have enough supplies and things to get the year started. I am very pleased that I have my live scribe pen. My laptop seems to be functioning okay enough, so it will be fine. Was planning on the iPad but don't think so just yet.

I have had a terrible time sleeping and being calm. Up this AM at 6:45, and will push that back 15 min each day until 5:30 is the normal time. Hoping to get to bed by 10ish and up at 5:30. This should work, but I am feeling very flexible in how I deal with everything. That's good, as the rest of my life feels VERY out of control!

I made it home!

2010-05-02T08:23:00.000-04:00

So, after a lot of - ahem- issues, we, meaning Reason, Tahoe, Izzy and myself, made it on the road back to MI. This is nothing to brag about, I assure you, but I had to do it, face reality, and get on with it.

Once back here, I realized that the horses, by necessity, will be taking a back seat in the overall picture. Doc is for sale, and perhaps even Tahoe if the right person comes along. Actually leasing Tahoe would be great, but I need to figure out his silly kidney issues right now. He sure has something that is NQR about him. I like him a lot, so if I don't sell him, that's fine. I'd love the Doc money, however, incl. the Brenderup money....ah, for 20K sitting in the horse-kitty....Nice! (let me state right here that I hate money more than anything else in the entire world...honestly. Well, except child abuse... which is probably often spurred by lack of money.)

So, the trip back was not easy. The truck stalled numerous times, after dying right before I left when I had Autumn pick me up and drive me back to DarkHorse where there was NO power. Yesyesyes. What a way to leave. So Nick P came on Sunday night, took me out for dinner, and I fell asleep knowing that in the AM Stotts would try and solve my truck issues. Well, the damn thing worked JUST fine for them. Once I got on the road Tuesday AM, it started stalling. Thankfully, never totally died. But, the process was miserable. I made it to MI in 11.5 hrs, and liked the actual drive time a lot- never went inside anywhere- just ate what I had in the truck and drovedrovedrove. (I am on 3's today...)

So, the truck got me home...and it's status turned to Golden Truck after it died right after I unhitched it. Thankfully Art also was able to see that it was dead, and in his way thinking that I was doing something wrong (as we all would) tried to start it himself. And it did not start. This turns out to be strangely good, as when Palmer got the truck (towed in of course), it started. Now, if Art had not seen and tried to start it, it would have confirmed to him that I am a total whack job. I may well be one, but damn it, this truck has personality and it did not want to leave Tryon any more than I did. Love it when inanimate objects mirror my emotions.

So, the chicks arrived, and 7 died. That has never happened to me and it made me VERY sad. So, I am now at 21 chicks (went and got several more and gave 6 to Trish- 26 + 8=34-6=28-7=21. See? Math skills intact. They are of course cute as chicks can be.

It's been the week of getting ready to get to PA school. I am trying to get the office in order, and have gotten Bookcases from Ikea which Art and I put together yesterday. I like it, and feel as if I am nesting for school. Its a process, but...oh well, getting there is more than half the battle- only one more week to get there! Sheesh! That 6 months went fast!

So, I started another blog as a PA-S, and will try to keep horse/family/animal/farm things here and more school and personal musings about being a PA on the other blog. I assume that I will cross my lines a lot, but know I am trying. Onto the other blog and the building of the office and Arts Trip to Ikea

Tryon pony times

2010-04-17T18:21:00.000-04:00

Here I am in Tryon, doing my last 20 days stint before school starts, riding ponies, playing with Annika and just overall having a super time. I just cannot think of a better word to describe it. Its the kind of time that makes you sigh with contentment, and thank god for such lovely times. I have not kept up with the blog, nor email contacts which makes me sad- however, this time is just what I needed. I will have these memories to hold me during the next several months.

Here is a link to my FB album with pics of the ponies....
My Tryon pony times. Hopefully this link will work.... if not, here are a few "hot shots..." I am so thankful to have these pictures.

This is Reason, who has taken to being a "real" horse is fine fashion!

And Wrainthur, showing his Canter off...

Here is

Tahoe, showing that soon, we will have a gallop....

So, all in all, good good times. Now I am heading to a great dinner made by Nick and Jazz, with sweet Annika talking in the background. It is indeed Carolina Time....

3 more weeks

2010-04-17T17:59:00.000-04:00

and I am still scared! I am hoping that somehow I gain brains and memory and the ability to grasp concepts that today seem impossible!

School actually begins in 3 weeks....

2010-04-10T10:05:00.000-04:00

and I am more scared then ever about beginning. I have to remind myself the good and the bad- about me, school, my family and then realize that the good outweighs the bad.

Clive'

2010-04-05T10:24:00.001-04:00

This is Clive', or CJ as his friends and family know him. CJ is one of those very special patients that will not be forgotten, and deserve serious mention.

He came to our unit (CICU) and is being worked up for a few issues. CJ is legally blind... and very VERY shy. He is 19 years old. To say that the past several years of his life have been hard would really be an understatement.

But look at this smile. That smile only peeked out a few times, but with this smile, CJ could move mountains. I really hope that he one day sees himself in the same sort of lovely light that we saw in him. He was very worried about pain, and felt scared. I was there when he got his PICC and thereby was able to see just what a lovely young man he is.

Yesterday was Easter. CJ had no family to visit him. I had some easter candy I was going to offer up for the night shift, I decided (knowing that I might be in trouble, but oh well...) to make him an Easter Basket. I was lucky enough to find a basket that suited in our cabinets, and proceeded to fill it with as many goodies as I could find. I carried it over to CVC and presented it to CJ. Now, imagine that smile with the light of lots of candy...chocolate...jelly beans....! That hug he gave me made up for all those exhausting nights working, those back to backs that made my head pound. Thank you CJ...for making my last day as a Tech one of my best days.

So, I will look at CJ's picture in the coming months, and this will help me remember why I am walking down my path. Because it's this smile that makes everything worth it.

Okay- that's me, but...she LOVED her hair!

and here are a few of the other patients that have touched my heart....

He wanted one last picture. He did not last the night. A Lovely man, who was glad to join his wife....

He eventually did not make it, but they fought the long fight- together. When this picture was taken, they had been married about 8 months.

Pretty sure this was the cutest most loving family ever. He spent a lot of time laughing...

Mr. M did make it home, or to rehab. This is his wife, Sheryl with him. She loves him SOOOO much....

I don't think anything needs to be said about Ryan. He is a star in every sense of the word. This is 8 days post heart transplant.

This is also another patient past txp. He was amazing and strong thru out everything. One of those who don't say much but then when they do say something, you realize exactly what a difference you can make. It also is a good reminder that vented patients can and do remember things sometimes.

And, for full disclosure, every one of these patients knew I was taking their picture and I sent them the pictures for them to have. They also knew that I might put them in my blog....

Joy with a great friend...

2010-03-30T10:44:00.000-04:00

I got a FB message from Jess today. She could come out. And she could ride. (If I said that I had one of those excited trills carouse thru my body, it would be quite true.)

It's been so long since she has been here that she had not met Poppi nor Izzy. Ummm serious time had passed. Jess is the best horse friend a person can have. She is fun (perhaps slightly crazy- does she feel pain??) and a fantastic instructor. I am ripe for instruction...and selfish in being very excited that Jess was going to be here. Plus, she is a busy grad student and gets the schedule thing. To say that Jess is busy is really quite the understatement.

Jess meeting the older Wrainthur

But back to instruction. Jess makes me work hard- and the horse work hard, too. Yet, somehow you finish feeling so...excited about everything. I always finish on the verge of tears. I realize that sounds silly, but I do- because I am so grateful. So, I put Jess on Tahoe and I rode Wrainthur. I really wanted to see Tahoe go, and I wanted to see what Wrainthur would do.

And above is Jess on Tahoe in the indoor. He was really good- not sure if you can see the smile on Jess' face, but it's there!

We finished up the day by riding the boys around the farm on the trails, and was lucky enough that Art wanted to play with his camera. The horses did not really want to oblige by keeping their ears up, but that's okay!

Jess meeting the older Reason

What I remembered is this: I love horses. I love them in the same way I did when I was 8 years old, galloping around on the end of a dog leash with some "trainer" asking me for a canter and pretending to buck. The same way I would play with my Golden and pretend she was an amazing jumper and train her in our yard to jump crazy things. The same way I tended to my breyer horses. It's the exact same love I had then as I do know. I love everything about them.

And what I know is this: They remain and will remain a part of my life forever. Because they are as much of me as I am of me.

Reason become a BIG BOY!! (and I continue thinking and my good luck continues)

2010-03-26T22:37:00.010-04:00

Well it happened! I blogged earlier about starting to work with Reason. Well, today I long lined him. And in the spirit of my earlier posts, one thing leads to another (this is how school girls get in trouble...not like I know anything about that... *blush*) and I took it a bit further. And for the love of all things equine, that darn little pony just walked right up to the plate and hit a home run.

Now, please know, I have no fucking clue how to long line. I mean I "get" it, but I don't know how to do what I get, if you know what I mean. So, it was kind of another Laurel and Hardy moment where I was untangling the lines, and trying to figure out how to run them thru the irons, and how to attach them, and why the hell are they so long???????? So, off we went. I wish I had pics, because I am sure there were moments that might have made the epic fail blog, of which (in my dreams) I am often the lead story.

Reason might have been the poster child for a well raised horse. Kind of like my daughter. Made me look good. He was...well, not just good but Tony-the-Tiger great. And then...as seems to be my way these days, I of course thought...

"hmmm, that went well. I had better get on him- just so he remembers his(eventual)job."

So I did. Outside. Using the Rock. With a PITA JRT underfoot.

I might not be the sharpest pencil in the box (mixing metaphors I know... but this thought deserves as many as possible.) at times. I guess, however, that I am lucky sometimes and with Reason that has indeed been the case.

So, on I go. And I say...Walk on! And he does. Remember 3 days ago when he only would back up, trying to get his head at my shoulder?? Well, that was not today! So I decided that since that went well, we might walk down the drive way. I don't know how to upload to youtube- but I have a link to my FB page where I have some of the video posted.

Hope that works!! If it does, here is another....

I actually got everyone ridden today... Tahoe was good, Wrainthur was good,

although we did take a rather unintended spin in the woods due to a strange

piece of something that he has seen at least 100 times.

Really.

So, hopefully more tomorrow!

what one does before becoming a PA-S

2010-03-26T08:26:00.000-04:00

It's clear, I am scared. Scared a lot scared. I have poured myself into making cards again, have ridden more this week than any other in past memory(i spoke of that earlier- nice nice nice!). I have finally moved past the Taco issue (had to put that one to bed once and for all, and thank God I think I might have!) I have walked into my "office" and thought about how I need to change it. Maybe I will start that today??
Maybe not. I keep feeling like I have something I am supposed to do today, and can't remember what it is!

Here are some of the cards. Some, I really like a lot...

This one made me want to do another...

and this one was that effort.

I like my first one better, I think...But a happy mistake is the pseudo face that appears in the bottom right....

I then decided that I would try this....

This worked out okay- I think. That is the fiber stuff that I am SO not good with, but this was a cool way to use it, I think. I used UTTE for the enameling.

I then used UTTE to make this. It was on paper (Not such a good idea,

as the actual image was non-existent once I fired it up...oops. Glad that I had outlined it first!

So, anyway, a few cards. I am now going out to feed...hope nothing "oops" greets me! Why is it with horses that so many "oops" happen?????

Where I continue my riding(and do a lot of "thinking")

2010-03-24T16:58:00.005-04:00

BHow sad is it that I am excited (and quite sore, truth be told) that I have ridden now 2 days in a row??? A total of 5 (count 'em) rides. Maybe 6 if I can move my ass from this chair. Not quite possible this moment.

So, today was the "Need to work Tahoe" day to ensure that we are on the right track recovering from his strange colic yesterday. So, out we came and work we did. I was not going to ride, but it was about 60 out, sunny, beautiful and so, well, seemed like a walk down the driveway was a good idea. Got to the end and seemed like a walk around the property was a good idea. Finished that and it seemed like a walk into the jump field was a good idea. Got in there and it seemed like trying to get him to walk over this log.was a good idea. (seeing the trend here?)

when you get closer, it appears a bit "stranger..."

but really, it's pretty small. But strange looking. Oh, and no natural or unnatural wings of any sort. That admittedly might pose a problem.. and I admit, it kind of did.

So, since my efforts on his back were a solid failure, I thought I'd lead him over. Another "OMG! These STUPID humans! But she has peppermints...better go, huh?" moment to be had by Tahoe. So, he did. A few times. Even jumped the bigger part, (kinda). So, I got on...outside, from the log (Big deal, you know- getting on an OTTB out in the open...Taco trained me well on this one- we never really did this safely.) Tahoe was good and stood while I clamored on. I headed towards the log again. He went once and then decided that he'd had enough of the human & pony show and decided that he might like to do something else instead. Pretty much anything else. Like pout. So, off I got again, and over we went again with me jumping with a great deal of excitement. I got back on (still good about that, thankfully) and went thru our dance routine (again.)

Then-his brain got clicking and he decided that perhaps jumping this damn log, where I wanted him to jump it, was a good idea. Much better then just standing there with me clucking and telling him that it is a good idea to go over the damn thing. And that was that. Simple, huh?

Despite the fact that there was some weak discussion about this (no spurs nor crop made it kind of difficult to discuss. We needed to reason...) I am really proud of him. He DID it- was brave, and pretty honest. I mean, that is a big field, and he is not straight, and I am not solid. Could have (and should have) made for a disaster. But, this did not happen. He was good! So, back to the barn, rinsed off, and given an extra bit 'o' grain (which thankfully he ate right on up...wheew.)

So, onto Reason. Out we went to lunge. Yesterday he was very good. Well... good enough for me at least. I had already decided that I was going to walk him over the log when we were done lunging. No dummy am I! I will show him early what XC might look like at the minnow level. So, today, well, the gas musta had a bit of water in it, as we were sputtering on the lunge. I was much more out of breath then Reason was (no dummy is HE!) at the end. He just did not have much of a game face. So I was not going to get on him and just walk him to the above log. But then, I reasoned, I had better at least sit on him so he got the clue that this is what a big horse does. So I did. TOday we found 1st gear. Kind of like 1st base for a teenager- not what it will be, but the act is the same. We went forward. Not very fast, nor with any semblance of straightness, but we did go from point A to B- just not as the crow flies. A drunk crow, maybe.

So, we got to the door. And .... I was going to get off, but it seemed like a good idea to see if he might walk up the hill. My reasoning was this: it was heading towards the barn. But, boy oh boy, it seemed very very far away.

We were brave and up the hill we walked. And yes, I was scared. Because all I had was a halter and a lead rope. Some times I wonder about my sanity.

So we got up to the barn and I lept off and handed Reason tons of peppermints and a big hug. He like both of those. We headed down to the jump field, and he followed me over those willingly enough. I then decided (I did a lot of that today, didn't I?) that perhaps I should see if he thought going up and down the stone wall was a good idea.

If you count

five stones over, that is where I aim for. Sweet Reason jumped right up that wall...and right on down!

What a good boy!

He took it all as I would expect from Reason- in stride, without fuss. Nice boy! Goooodddddd Boy!

We then went inside, when I remembered that Reason did not exactly like baths so, I thought it would be a good idea to bathe him. From this picture, I don't think he agrees!

All in all, another great horse day. The kind of day where you get to remember why you do all that you can do to keep them- and keep them happy, safe and sound. The kind of day where you sleep soundly at night, as both the mind and body are tired.

A glorious day and then Tahoe gets Nephrosplenic Entrapment- what????

2010-03-24T00:02:00.000-04:00

the hell is that?? I had no idea. So. here is Tahoe earlier today...

He looks to be very happy, as he should have been. That changed in a big fat hurry...but several hours later, really.

But prior to his Nephrosplenic Entrapment... (the good part of the story) we had the most lovely ride. He was perfect. I cantered him both ways (okay, this seems small, but this horse could buck me right on off should he choose- his canter is a bounding one, with great push from behind- all the better to buck with, m'dear!) Then, we ventured outside down the drive, thru the XC pasture, and played on our log. Okay, since I don't really jump when no one is here, I walked over it. We did have a few moments when he thought that trolls and tigers lived under the logs, but overall, was pretty good! THEN!

I took him over to our driveway stone wall. And without an issue, we began to circle and added in the wee drop to our circle and he was perfect again! I was, needless to say thrilled. They say we get what we need, and not what we want...I did not WANT another horse, but I think I may have needed Tahoe. I realize that is a bit backwards, but oh well, I'll take it. So, he was one of my rides today.

I have to say that the other boys were just superstars, too! Reason was such a grown up! I lunged him, and then, again, without fanfare, got on him. Now, forward is not understood, as he walked next to me, right? So in his Reason way, he kept backing up, as I was saying walk on. It took me a moment to figure out what he was doing. He was trying to figure out how to get next to me! Funny how I stayed the same distance the whole time- Silly Reason! And Wrainthur was just fantastic, too! He went right to work, with a smile, and did everything I asked of him willingly and cheerfully.

There are times in life where you pinch yourself and say..."I am the luckiest person I know!" and today was one of those days. Just perfect. I did not stress about dinner (and am snacking on Cap'n Crunch as I write this waiting for barn check." I had that kind of happy that just deserves to be talked about. I took lots of pictures of the horses in the sun, and it was just...beautiful. Despite the mud. Beautiful!

Wrainthur with Tahoe peeking out...

Bobbi above and Tahoe an hour before his issues...

Then, I fed after dinner. Tahoe came in- slower then normal, and did not dive into his slop. He then began to toss his head, and for all intents and purposes, appeared to be colicing. Yet- he was pooping and farting. Hmmm. Vitals were off, HR was high at over 50, resp btw 20-30 and he was banging into the stall walls. He then would wrap himself around me as if to say...MOM! HELP! The onset was quick enough that I was worried. So emergency call here we come!

So...what gives?

Nephrosplenic Entrapment most likely! The onset is very quick and violent. They almost look like a neuro case. Nothing touches the pain that I possess and I know that we were very lucky that A) Christy came out...and B) I noticed it right away. I knew that the onset was very quick, and I knew exactly what he eats and well, it ended (thus far) really really well! He got a lot of drugs (I can't remember...bad horse mom!) and rectal was abnormal. No gut sounds on the left to speak of. HR was 54, resp 26+, temp 99.3. So, the rectal was abnormal because his bladder was over distended. His spleen was away from the body wall. And, the manure that was there was very wet and soggy. He was tacky for his mucus membranes, however. When she tubed him he was (rightfully) not a great patient. So, he bled- almost a 1/2 bucket full of blood (gross). This, however, was good for his speen, as it shrunk it some. In addition, we took him down to the indoor and made him RUN! He was now pretty sure that his human had gone totally nuts. But, then, about 10 min into it, you could see his hind end freeing up and he really seemed happier. the acid test was putting him back into his stall, and lo an behold, his dinner suddenly looked good!

So, I am heading back down to check on him and hope that all will be good. God...I was really scared for a moment....

Reason- later on in the day.

2010-03-23T12:54:00.001-04:00

Reason...

2010-03-23T12:52:00.000-04:00

He only walked in small circles, but none the less...I got on him
alone, without fireworks! Gooooood boy Reason!

K- I'm over it.

2010-03-23T09:38:00.000-04:00

Feeling a bit sorry for myself I admit over the past few weeks. Done. Finished. Feeling okay.

So, I am heading out to the barn, but thought- hmmm, I'd update here. It's been over a week. I am entering my last week as an official non-student. It's been a semester, and guess what? I like it! Best change that way of thinking, huh?? We have a meeting with the entire class on Sunday for dinner. Then, on Monday, it's official. I am going to orientation. I will then become a PA-S.

Shit.

Worked a lot of hours the past several weeks, but I am not planning on picking any more up. Therefore, I have 4 more 12's to work. I am going to miss a few of my co-workers so much- Mary, Kerry, Laura, Lauren, Lori, Andrea are a few that come to mind. They are very unique. Wonderful nurses.

So, more later, but off I go to finish feeding!

Bliss...

2010-03-14T22:45:00.000-04:00

Okay now...

2010-03-14T22:35:00.003-04:00

So, I just went back thru the CoTH forums and looked for Taco threads. Of course, there are several. I did not read them all- maybe I will some day- but I read enough to be amazed at what that horse went thru. He is such an amazing critter.... Actually, critter is never a word that should be attached to Taco. He would be much more likely to call himself an equine. Or Equid. I am not sure that he would know what that meant, but he still would call himself that.

But what remains is that he truly is amazing in how he just made it. Despite everything. Now, I have to say that I might not have gone that route again. Very expensive and heart-breaking. But I did, and so, here it is. And it is a testament to his vets and his support crew that no one ever gave up on him. He does have that special "zing" that makes him somehow worthy. And Taco is worthy. No question about it.

So onto the search for names for Tahoe. I keep thinking it has to be iconic- but for what? I am not sure. Something about this change, and flow and difference. Something that says change is mixed- not all good, not all bad. Something that included water. But, not sure.

but for memory road---here are some of the CoTH threads... The one I'd Love to find is of the CCI where it was an almost no go. But I think those are lost for good...sad....

Here is one thread...
and another
and yet another

A Taco Day...

2010-03-12T22:40:00.001-05:00

A day filled with reading entries about Taco...reliving the past thru my words and actually feeling how difficult that time was with him. It was REALLY hard, and I can hardly imagine that I sold him.

So what is strange is that it was the right thing to do. I know that. He is in a much better place for him- and therefore, it was/is the right thing. Stacy is fantastic with him and even as it is hard to say, I know that Taco has become a team with Stacy and has moved on. So, I come back to my kind of difficult place of knowing that what I want is not best. And I want best at all times.

My post earlier said that I try and see the bright side at all times. I do...and I remain committed to that. So, I am not exactly going in the right direction when I am sitting here in my personal quandary. Because I am not exactly seeing the bright side. Trust me on this, I want to.

So, the bright side is this. Taco is being fantastic. His jumping is amazing, and his flatwork is right back where it was 3 years ago before he got hurt. He looks amazing, and is happy. He has been really healthy, and all those hours and months of rehab and work really paid off. He made it...thru hell AND high water, he made it. And he could not have a better person than Stacy- and her support team is just amazing. It's all so clear and simple. Amy has done great things for both of them. And I can really see the progress in Stacys riding. It's quite impressive! I sure would not want them in my class at any show!

My bright side is I got into PA school.

God, maybe I just need to get over it. I just can't seem to....

Water water everywhere...

2010-03-12T11:57:00.001-05:00

So I come outside today, and what do I find? I find that Tahoes stall is flooded with water. Like, maybe oh, 4" of water? I am NOT kidding. See pic at right. This is because his waterer got off balance- so it suffered the worst of waterer issues- the weight fell on the wrong side and never turned off. I knew the moment that I walked in to the barn and Tahoe was trying to find a dry spot to stand on....none to be found. He hightailed it outta that stall right way!

So, for today, I spent an hour throwing out bedding that was really fine- until it became saturated with water. Like, oh, 50$ worth of bedding. How annoying! But, now, I see the light. Because now I know that I will have a TOTALLY clean stall! TOTALLY clean! New bedding, corners clean, everything clean.

Now, that is good.

I always want to see the bright side- always. And I must say, that this is the only bright side of this mornings efforts. ;-)

Beautiful day here--if you like mud!

I emailed about my saddles. I want to ride badly- and the horses need it too. So, hopefully that can happen soon. I am planning on working this weekend for a few hours. Then, 7 more shifts. After that, for the month of April and beginning of May? Horses horses horses.

Sigh.

cats

2010-03-10T21:47:00.001-05:00

I always said I had to go to Cat School. I have had cats before, but in this case, with our cats I am out of my league. So, this summer we ended up having 3 orphan kittens arrive at the farm. About 9 days old, they needed milk and lots of feeding. So, one found a home, but we ended up with 2...called (by me) Hilda and Zoey (or by the boys, Orange cat, and calico cat). Now, I have a lot of experience with orphans. What I know is that a mom (and dad) is VERY important, as they teach the rules. Zoey has obviously decided that she is a JRT. She burrows under the covers, sleeps right between Art and myself at night, and overall, runs the roost. Here are a few kitty pics. What can I say? I like the kittens.

Then, we have LUCAS who deserves all caps as he is HUGE.

And then, Rocky, who deserves mention only because I am fairly convinced that nothing in the world loves me more then Rocky.

But then, there is Hilda- named for her crazy love of brooms. Here she is, at about 12 days wrapped in Nicks arms. Cute, huh?

Can I publish

2010-03-10T10:43:00.001-05:00

From my iPhone? Seriously! Wow
Sent from my iPhone

today is the day to be productive!

2010-03-10T10:06:00.004-05:00

So here are a few pics that I have taken of the Tack Room Cleaning In Process. Okay, yeah, this is the feed room- sorry, but...
The water heater broke and therefore, flooded the tack room. So, we had to take every thing out. EVERYTHING.
This gave me the opportunity to clean the pit that it had become. Here is phase one...

What I found in the tack room has some kind of sad moments. I found Tacos feed bucket from oh-so-long ago (reduced feed as he was on stall rest- see entries in Feb) Daves SmartPak container and I also found, complete with milk drops in it, some of Reasons milk buckets. Now, this had nostalgia attached to it, but also a certain amount of YUCK factor. Really? I am that bad? Gross.

So, after attempting to solve the Privacy vs, want people to see things, here I am! Heading back outside, trying to get things clean enough before the vet gets here....shots, coggins and more today! Chaching!

2010-03-10T09:30:00.003-05:00

here are some horse pics... pics of horses

Just so there is always a record...

2010-03-09T22:40:00.001-05:00

I have taken the blog posts from COMH and made them here- dated them Feb 1,2 and 3 2008- which is about the time frame the posts took place during. I have tagged some of them- Taco, Wrainthur, Reason. ;-)

2010-03-09T19:34:00.005-05:00

I am thinking about where I am today- where I was 2 years ago, and what will happen in 2 years. My God- the past 3 years have flown by. I just realized that Taco's injury (which defines time for me) happened 3 years ago. If I look back on the blogs, I bet that I can find posts from them. Or maybe on the COMH page? I'll look and post.

So- what is now... Off to PA school. I met Nick D today- what a great guy he is and will be a terrific class mate. I am meeting with Shannon and Anne on Thursday. So, I am happy about that, too.

And, 2 years from now I will be in Clinicals. And looking for a real job. And thinking about moving. And...and...and. So, that is that, really. 2 years ago I was somewhat blissfully unaware of things- and little did I know that the changes they were a comin' .

I am excited that I can carpool- and excited that I can still spend time with the horses. I can assume that this blog will then trend towards school, but hopefully will still have some of the horse stuff, too. Because now I know, no mistaking it, they remain as the most important thing other then family I have. So, with that, here are some pics of the boys that make me happy!

More later...

The eyes

2010-03-04T19:24:00.002-05:00

There is nothing as amazing to me as the eyes of someone that is vented- where you know that the person is there- ready to enter back into life and take over their own breathing. There are some patients that just grab you with their eyes, pulling you closer and asking the hardest question of all-why?
Those patients are the ones that I take with me when I leave. I have never been a person that things about prayer as a way, often resorting to the COTHism of jingles. For these patients, the ones that stay in my vision, these are the ones that I think about during my days off.
I think that being able to be an active part in these patients lives will be one of the best parts of being a PA....

So it happened and now???

2009-12-26T12:53:00.003-05:00

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

2009-10-22T11:32:00.003-04:00

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....)

2009-08-30T19:58:00.001-04:00

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….

2009-08-16T22:00:00.002-04:00

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!

2009-08-13T22:04:00.000-04:00

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!

2009-08-13T21:56:00.002-04:00

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. :)

2009-06-28T23:54:00.001-04:00

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.

2009-04-22T18:46:00.000-04:00

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!

2009-04-22T12:05:00.000-04:00

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

2009-04-19T03:11:00.002-04:00

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)

2009-04-18T22:24:00.006-04:00

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?

2009-04-18T13:57:00.000-04:00

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

2009-04-01T18:26:00.002-04:00

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.

2009-03-31T10:08:00.000-04:00

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....

2009-03-31T09:20:00.000-04:00

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

2009-03-29T01:35:00.003-04:00

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!

2009-03-24T12:32:00.001-04:00

Crazy

2009-03-24T09:03:00.002-04:00

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

2009-03-24T09:01:00.000-04:00

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

2009-03-21T23:34:00.002-04:00

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!

2009-03-21T18:03:00.001-04:00

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

2009-03-10T09:11:00.000-04:00

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.

2009-03-10T08:36:00.000-04:00

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.

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.

2009-02-23T18:53:00.003-05:00

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!

2009-02-23T18:37:00.003-05:00

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. :-)

2009-02-18T14:32:00.000-05:00

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

2009-02-16T17:59:00.000-05:00

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

2009-02-16T11:55:00.003-05:00

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.

2009-02-16T01:46:00.003-05:00

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...

2009-02-13T22:13:00.002-05:00

...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?

2009-02-13T21:34:00.003-05:00

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.

2009-02-12T08:47:00.004-05:00

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.

The lost post (why doesn't this surprise me?)

2009-02-11T21:19:00.003-05:00

I must be in some sort of strange vortex of something- as I KNOW I wrote this already, and I can be fairly assured that I wrote it better before. The joys of stream of consciousness writing... I just write!

So, my man, Mr. G. Got his story- in a nutshell, go to the dentist, and don't forget to take care of your teeth. :-) His story (and again, I might not have this all right) happened as he got a pacer, a lead got infected (from the tooth) which then spread to his spinal column. From there, it just got worse, and the cardiomyopathy built on everything else. He was being hit with the showers of bacteria, which (again might not have this right) was settling in his brain, as well as his abdominal cavity. Dentists removed 3 teeth this past week and there is hope that this might be something that allows him to live a bit longer.

(Oh, I did write about this, just further down- I am NOT crazy!)

Here is what we don't have right now. And I am grateful. As much as I am looking forward to doing my piece on this, it's one hell of a shit disease. Antiphospholipid disorder- have not seen any of that for the past few months. I admit to seeing enough to last me a life time, given the horror that it is. We also have not had a postpartum cardiomyopathy. Another one that is tough. I do think my theses will be on APS.

So, today was good otherwise. very nice emailing back and forth- sanguine to be sure. It makes me smile, and certainly filled with elan. I also had a very nice lab- practicals are done and onto the lab quiz midterm. Last exam went very well, (Thank God) and I am feeling slightly more in control with this. Other classes are going well, so, it's all good.

I have played the mother lion today- went after Nicks Alg. teacher to figure out what the hell her issue is.... just finished with Randolph on the phone- I think it went well. We will see. I will pull him out of GH as fast as I can if things do not improve. Too much stress to put up with this.

Must sleep...Argh! Married for 9 years in 3 days. That was quick....!

Story Angles

2009-02-11T20:40:00.000-05:00

I would like to use the Martin Bandyke story that just happened in Ann Arbor. Martin John was laid off from the local station 107one- as far as I know, the only station that is germane to A2, and very important to the area. It appears to be owned by a larger company- and that company appears to not be located in A2. From what I can tell, with the tiny amount of looking, it is a rather large conglomeration and therefore, as much as I perceived 107one as local, it really was not. Martin John brought that feeling to the station, which is valuable in itself

There are a few angles I would think about- I know I would probably choose the profile of Martin John, but could also look at a few other ideas.

First would be the profile- He has been in A2 for 3 years (or close to) and A2 radio really has been about this station, which features Martin on the weekdays, as well as a nice segment called Fine Tuning on Sundays. He also is very involved in the local music scene, and knows a lot about the areas talent. He did a lot of community service, and was involved in a lot of local fund raisers, inc the Humane Society of Huron Valley. All in all, an interesting guy, and one worth a nice profile.

My second idea would be to look at the A2 radio scene- and how it has evolved and why it's facing such pressures financially. This is a big change for the station, and certainly a big risk. Why is radio in trouble? Is this a nationwide trend? What has satellite radio done to the local markets?

I would also think about doing something like "the day of a DJ" I think it would be interesting to see what others do, as well as looking at what Martin John did.

I also think an article looking at the local music scene would be nice- Martin did a lot with locals, and it would be interesting to hear more about them, and how important someone like Martin is to their getting noticed. Even if he is still not on the radio, I would guess that he will continue to be involved and finding out from him what he thinks about local talent would be neat, too.

Leads and other important things....

2009-02-10T09:38:00.000-05:00

Ann Arbor seems like a quiet town. Next to its news noisy neighbor Detroit, what can happen in such a small town? Plenty, says Greg Stejskal, former FBI agent that was based out of Ann Arbor for over 25 years.

During his career Stejskal has been involved in the unibomber case, the Oklahoma City Bombing case, the first case of internet threat brought to the attention of media- just a few cases that had ties to the Ann Arbor area.

********************************************************************************

Imagine someone told you that the MLB knew about the use and abuse of steroids years before it became the cover of SI. Imagine you were the person that told the MLB commissioner that steroid abuse was a problem and no one did anything about it. Imagine your frustration when the public outcry was so riotous that it was the cover of every newspaper for weeks- ten years after your investigation. If your name was Greg Stejskal, there would be no need to wonder- you would know.

************************************************************************************

In his years at the helm of the Ann Arbor division of the FBI. Greg Stejskal has seen many criminals do stupid things. When a suspect jumped into a lake in _____township, surrounded by FBI SWAT team members with guns drawn, Stejskal knew this was the top of the list for his Darwin Awards given out during his career.

such a mess-

2009-02-10T08:54:00.007-05:00

in so many ways.

this past weekend was something of a cluster. All the stars aligned to make things insane. It was a lesson in how not to not to- run a code, transfer a patient, let someone die, keep someone alive, schedule. I hope to never see that sort of nightmare again- The "leaders and the best" with no light? And...no one to fix it? Really? Seriously? Last time I checked, ALS is not done like that- I think everyone was so freaked out they panicked, and that created even more of the nightmare. What I learned? If someone has been running low all damn day, you do not transfer them to the unit at 3:30 am. And you don't put them in a room with no overhead light. And you don't have a resident at the end of their 80 hrs swan them, nor try and start an a-line when the pt is 60/d. You get your lines established earlier, and be proactive. And it the pt says..."I'm dying..." believe them. They know.

I was asked twice on Sun pm to make sure that they made it thru the night. Both my 90 yo woman as well as my 50 yo code. If the patient asks you this, you have an amazing responsibility. I left at 7:30- they both were still alive- and then, I felt horrible my lol wanted me there when she died; I had to leave. My other woman is intubated, and a mess-I wonder how she is today?

Ms. A went home-I think- she was interesting, and came along as such an amazing time

Dirge without Music

Edna St. Vincent Millay

I am not resigned to the shutting away of loving hearts in the hard ground.
So it is, and so it will be, for so it has been, time out of mind:
Into the darkness they go, the wise and the lovely. Crowned
With lilies and with laurel they go; but I am not resigned.
Lovers and thinkers, into the earth with you.
Be one with the dull, the indiscriminate dust.
A fragment of what you felt, of what you knew,
A formula, a phrase remains, --- but the best is lost.

The answers quick & keen, the honest look, the laughter, the love,
They are gone. They have gone to feed the roses. Elegant and curled
Is the blossom. Fragrant is the blossom. I know. But I do not approve.
More precious was the light in your eyes than all the roses in the world.

Down, down, down into the darkness of the grave
Gently they go, the beautiful, the tender, the kind;
Quietly they go, the intelligent, the witty, the brave.
I know. But I do not approve. And I am not resigned.

Questions....

2009-02-09T19:53:00.000-05:00

These are questions I would ask.

I am hoping to garner an interview with the woman who has just secured (Not 100% sure about this- it's still kind of U of M gossip...but I have a very close contact. She is at a conference until Thursday...am planning on calling her on Friday) the biggest grant given for research on High Risk pregnancy and sleep apnea. This project has been in the works for YEARS and just in the past month, it has been determined that there is a tie between sleep apnea/deprivation and preeclampsia. And NO I am not sharing names just yet! :-)This is not going to be announced to the public for another couple of weeks as I understand it. Still trying to get more info....

Tell me a bit about your background?

Do you have children yourself?

Where did you do your schooling?

Where did you begin your research?

What led you to the U of M?

What decided this particular field of research?

Who is this grant from?

Why?

How did you gather your information?

Sample size?

What do you hope is the outcome of this research?

What do you see this research leading to next? (or depending on where things go, see if she is willing to share other things she is working on....the biggest issue with this is the "scoop" factor. If this grant is indeed as big as I am told, I million for a single person..., that's a lot of money esp. today.)

I do not understand

2009-02-09T02:54:00.001-05:00

so many things in life. Just don't.

Ironic...

2009-02-09T02:14:00.003-05:00

talk about too much giving! wow, I am exhausted right now--on almost every level.

Done bitching.... :-)

April is in labor, so of course I am having monstrous cramps, because that's just how I do things- we have always had this really strange bond- I found out I was pregnant with Nick the day she delivered Tiff. If she got her period, well, I was sure to follow. I have no sense of my own body- I just go with whomever means something to me right then. Since I am in NO danger of getting pregnant now, it's kind of nice. :-) She knows it's a girl, and has "passed" all the U/S's with flying colors- thank God for them. So I am waiting to hear.... She is here, and text'd me at 11ish- but had not started labor, but her water had broken. Lyric- nice name.

At work, its been kind of nuts. I do have this lovely woman who is 90. When someone tells you they love you and they are 90, it's all good with me. She knows that her end is near, and it is. I thought we were there, but she rebounded. I just held her- Kerry is her RN, and we sat with her and when she was having the most trouble, she just came up so I could hold her. She must weigh about 90 lbs. She had the sense she would not make it thru the night- even though her numbers are good. She kept saying Thank you, and was so kind. Her docs are okay- but what can you do? so, comfort care, and hopefully a kind, sweet end. She wants to see her husband, and her son (who was killed by a drunk driver on Dec 23rd, many years ago. He was 28.) Her husband died a few years ago, and I heard about her life with him, too. It was a very lovely and happy life. She was fairly dismayed at the lack of dignity she experienced in the ED- "Everyone saw Everything. I was so embarrassed!" and then she told me a bit more about her husband- they must have had a very nice life :-)!! She is ready as I have ever seen anyone. She only has 10cc's out thus far this evening- so, hopefully....

I got a bit more about my other, very quiet man from Kerry- his entire situation has been caused by...3...bad...teeth. Yup- and, pretty sure he is not going to make it. He is VRE, so, it's hard for me to spend a lot of time with him, but I have gone in and spoken to him a couple of times tonight. He has been very kind, and thankful for everything we have done. He also has spinal involvement now- from the pacer lead that got infected. So, he is one sick man. 36 years old. I guess there have been some interesting family dynamics that have occurred since I have been gone. From what I understand, wife number 2 is not actually his wife, but was signing his papers as his wife. Wife number 1 got offended.... oops!

So, I am very boring right now.... when I have so much happening-my reserves go elsewhere.

Take backs...

2009-02-04T10:15:00.003-05:00

Sometimes, I give, or rather, throw too much of me out there. Give so much that I have nothing left, and nothing to save for when I need the reservoir for myself. Its not something that anyone asks for, it just is something I do. It might very well be a mistake- since it leaves me rather empty when all is said and done. Do not like this at all, but cannot find my way out of it....

I think, perhaps, that I am in a situation that may be like that now- and I am not sure what to do about it. If I look, it's me that is pushing forward, and perhaps too much. I can do this, and actually am trying not to (hence, here...) bombard.

I am not sure why I do this, and could say why and make up reasons, but at the end of the day, the clues are there, and I am not listening. But for some reason, I can't seem to hear over my own- something. But I have said it so many times that it's getting ridiculous and I must not continue...yet I do. It is true- I understand time, and effort- I am lucky in my "work"right now is makes me pretty available and yet, this is also not such a good thing- because I am left wanting and waiting and that makes one nuts. This is one time that doing the horses makes things so much easier for me...both the physical and emotional side is so busy that I was okay...no thinking made it easier. :-)

I am owed nothing. I am totally okay on my own, and am strong- I do not need to be protected from potential emotion. Yes, I will tell you what I am feeling, because that is what and who I am, but you owe me nothing, except, perhaps honestly. I will always be who I am- but I don't need to express it, if that makes sense?

When I even begin to write this, it seems so silly- and if you were to actually look at it for what it is, it IS silly. How can I be in love, in attachment, with someone I can't even touch? (Despite what I feel, the reality is....) I want to be attached- but, why?

Reality is I can get played like the the most amazing instrument of all- I will bend, and sway and move in all sorts of ways. I have a basic trust (which is amazing after all I know of the world) that is total when I am like this. Reality is- I am not like this often at all. I am, strangely enough, when I am with patients- about as bare as I can get, and don't really have any reserves up, because that seems very right to me. And I am okay when I leave. yes, I write about it, because it makes it easier for me...but overall, I am totally okay when I leave. I take a part of them with me, and hopefully leave a part of me with them...a good part.

I guess that is my thought here. I want to be able to- well, I guess this thought is not formed, as I don't have anything further to put here....

So this is somewhat difficult to write....and so I won't

harder then I might like

2009-02-02T19:41:00.002-05:00

I wrote the other day about the man we had in the unit- Perhaps a racial issue, perhaps a big black man having an RN that was gay? Not sure. But whatever it was, this man was NOT clueing us in on what was going on with him. He was in obvious pain (and obvious cardiac issues- you don't get a room with us that easily....Viral- sucks, I think, of all the horrific things...3 months ago, fine- now? Waiting for a heart and getting worse.)

I gave him the Annika Pep Talk- one that I reserve for times when I know I am stepping over the line, know that it might not be in my best interests, but, doesn't matter. I am compelled. And so, in I go, sit right in front of him and give him "the" talk. The poor guy can hardly look at me- still in pain (did not help he had stepped on his cath, as he was trying to get up...MAJOR pain, there- and well, I can only imagine. Luckily, was able to deflate and push back and things appeared okay....)

"You MUST tell us what is going on. We cannot read your mind- and you are here to get better- and we want to help." He seemed to listen, and then right before I left, I said. "Look, I want you to get better, and I care that you get better, and your wife cares, and...well, just so you know." With this, he looked up and said "Thank you."

So, the thought was he had an abdominal bleed, or something. He was to be sent to CT- and of course, I went home.

When I came in, I talked to his wife and told her I gave him the what for. She asked why, and she listened, and said he does not communicate well- and she thanked me.

This is before we found out he is VRE, and...I am not sure about the actual details, but he is throwing clots into his brain, and they fear that he is just filled with pockets of infection. I don't know why, as it was busy when Kerry told me this, and I don't understand exactly what the deal is, but whatever it is, it's not good. Not good at all. And damn it. Damn it. I sit here crying- because it's just the most horrible thing- his kids came in, and could not face him, as he had changed so. And, he is not going to get out...just not going to. And none of it is his fault at all. Younger then I am....

Before I left this AM, I went in to say goodbye and told him I'd see him in 5 days. He was still in the same place he has been for the past 2 days- sitting on the edge of his bed, unable to lay back, as he begins to choke. I just rubbed his shoulder for a moment- and tried to give him something that would make the coming week easier....

He is going to be one of those that people forget- and I don't want that to happen- because...no one should ever be forgotten.

Then the Quad down the hall- dirty young man (41), and he is PROUD of it! I could understand him as I lip read, and he was filled with things to tell me. Funny guy, been a quad for 20 years- was hanging his head out of a car and hit a guardrail. Drinking- yet, this man, in his words, shitty to have happen, but he would probably have died if this hadn't happened...in some other way that would have been a lot worse. He was sweet in his own way, and knew that his being taken care of well depended on his being a nice person. He was very successful.

The KFC lady- has a husband that is a sloth, too and she is hyper. We had good stories to share!

Then, watching the SuperBowl with my lovely txp w/u lady- (but...not to be, but she doesn't know that yet. Pressures just too high.) She wanted the Cardinals- me, too, I always like the underdog.

Then, Mr. C, at 25, one eye (he is the one that says I have a big butt- in total jest, but it's really funny- the story is just great- but for another time...) and his family- wow.

One quick thing- Black family groups have it all over us. They are so committed to each other, so intact when they are a unit. It's impressive. Care is the primary thing. I think it's because they are a matriarchal society- so the female values of care/love/compassion with a certain amount of "attitude" are stressed above all others. Just an observation from the past years of taking care of people. It's amazing.

And it's very fun to talk about the cultural differences between white butts and black butts. Apparently we have it all wrong....

I think it's possible

2009-02-02T03:17:00.005-05:00

to feel something that you can't prove.

Because I have, so much like some post much earlier on, since we are as humans, (and I am certainly human,) essentially selfish beasts, since I have, it's proven. To me. (none of this makes any sense, but tonight, that does not surprise me at all.)

Which is fairly funny, as I just got told that I might be a good free-lance writer.(Right after that email, I removed this blog from search engines- and any links to the other blog that I am keeping for Feature writing) I guess my writing had better tidy up before that occurs. :-) Note to self- Do Not Write Anything Important When You Have Gone Visiting Instead of sleeping.

back to my point- (which was???) Ah, yes, feeling when it's not tangible. Yes, I have done this. I know it. I know it might be something close to prayer- not in that sense (altho it felt as strong as that feeling- but that is a whole other topic....) but in the wholeness of it.

I felt every breath, every touch, every movement. I think it's interesting that it was the back of my hand, not the front (even if that is what I wanted to do, it was not right) that I used, and my breath was as much of a touch as anything else. I did not want to disturb (it was late...) but wanted and needed the contact. I sensed another was there- or even more then one other. I missed...and it felt good.

So, was it real contact? How can I say it was? I really can't. But it was something, something lovely, something somthing.

at 98, you should win

2009-02-01T05:30:00.004-05:00

It seems, on every level, that at 98, you would be able to win if you say "no". No to Cpap, no to being in the hospital, and her only positive, yes, it's time to die.

You have to wonder WHY her kids, both men very much into adulthood, keep on pushing- and she keeps saying (in her own garbled, missing her teeth, obviously pissed off way) "I want to go home!" This is VERY clear. The only thing that seems clear to me in this scenario.

Each turn hurts, each move is excruciating for her. She is weeping everywhere, and has no control. Since we are trying to keep her alive, she has had no sleep, so the ICU psychosis is setting in. Starting an IV in someone this age? Well, it's one thing that no one wants to do. RT is annoyed at the decisions being made. RN's and MDs are just amazed. She is DNR, she is miserable, she is 98.... good God, what is the logic here?

Maybe I am just tired.

beginning to muse about profile...

2009-02-01T05:19:00.000-05:00

I have a couple of ideas-
One-
Just getting into the market. what would make someone decide NOW in this market, that they will change their jobs to do something that seems SO risky

Another -''Alexander Frey returns to UM for a concert"

2009-01-28T22:36:00.000-05:00

Living off the Grid- Families that have chosen to use alternative sources of energy and how they do it.

http://www.off-grid.net/

This is a web site for people that have chosen this sort of life style. It is very broad...and not centered in Mich, but I would look here for ideas on where to look further.

http://www.popularmechanics.com/science/earth/1820211.html

This is an article where a family in Vermont will experiment with 6 different energy sources.

http://www.ewashtenaw.org/government/departments/planning_environment/planning/wind_power/about.html

This is a site that is just dedicated to Washtenaw Co, energy plan, specifically a wind generator. I did not know WC was doing this!

http://www.hbawc.com/mr_builtgreen.cfm

This is a site that is just for WC also- I think this would be a personal interview possibility.

I would also call those people that are advertising on the billboards that are all over town, but strangely cannot find them on the net.

http://www.meadowlarkbuilders.com/green.asp

This is one site, but not sure if its the same as the ones on the billboards.

http://www.usatoday.com/tech/news/techinnovations/2006-04-12-off-the-grid_x.htm

As much as I dislike USA, I would also try and approach some of their sources.

Just found out that Behi was right

2009-01-28T11:48:00.003-05:00

We were sending a pt off to the OR, and Behi came up as transport was taking him down. He stopped them- and said..." I just don't feel it's safe right now...something is bothering me." He sat at that monitor for ever, staring at it, staring at the tapes. "It's sinus, but there is something." People were very irritated...this guy was a PITA, and his family worse. Very intense, very critical. Frankly, we wanted him gone. I spoke to B and said..."trust it, it's okay, don't worry about what people say. It is you that has to make the decision." He said back "I don't understand what is it, but he keeps popping in and out and something is just not right."

He is one of the "good ones" right now. I really like him a lot. When Mrs. X told me she wanted to withdraw, I called him in to her room. As she was telling both of us, we both began to cry. This woman had been fighting for so long and the only reason she was fighting was for her husband. She had been on the list for ever, but no heart came thru- she kept getting sicker and sicker. She touched so many lives with her strength. But she was done. It was past hard for her, and understandable. But the compassion that he showed....

So, I just found out that the patient died during the procedure. Behi was indeed right. That 6th sense is one to be listened to, isn't it?

I understand crazy

2009-01-28T10:54:00.002-05:00

Thankfully, I am not. But, I understand- it's a close thing- one where you almost decide that you just will allow it- allow the slipping into loss of control. Like some people who die, it's just the easier path, the easier way to go.

I get it.

I don't understand other things- like meanness or being critical. I understand snippy and bitchy. I don't understand constant lying. I understand not wanting to hurt someone. I understand loving so much that your heart almost breaks.

I do not understand why, though. I just understand it. I cannot explain it. But oh well. Is it mine to explain?

Today, a kid jumped off the bridge at Maple. How did they get to that state? I think that is why adolescent depression is so serious. It's hard enough to believe that tomorrow is coming, but when you are that young, the feeling of today being so miserable that there feels to be no tomorrow is just overpowering. I hope their parents love them, and took care of them, and treasures them. I hope that what's next is okay for them. They were alive at press time this AM (28th) and I know I will be looking for updates. The benefit of my Features Class. I am so sad for this.

Yesterday I had an instructor begin to cry in class- she just broke down. I had felt she was sick since the beginning of the semester, and indeed she is. Surgery tomorrow. CA. Miserable. I hope that it turns out okay for her. I am praying for her, as I really think that helps. She is constantly on my mind, and I hope she knows that. She was horrified... but she is a passionate person, and that just happens sometimes....

yesterday was so hard....I can hardly begin to explain it. I am stunned at the emotions that rushed thru me, and it did indeed bring up that horrible feeling of childhood and loss- Parents that left without further thought...dad who could not stay with anything for more the 7 years- be it a dog or person. Thats why we have Cocoa- he was 7 and they were going to give him away. I am grateful to Art for understanding why I had to take him It was some sort of karmic justice. I projected onto him what I felt. I love my dad now, but he was the worst father- the first person to offer me drugs. I can hardly imagine. Of course, he doesn't remember this- why would he? Forget what's bad. Forward NO matter what. I don't want to talk to him about then (I am sure I was horrid as well, but I was a kid.)

The love of a parent should be unconditional. My belief. This is not his. Oh well. Our relationship now is one I love and treasure. I do NOT want to bring up anything with him now. He is too smart and would change what I know to be true.

Then mom- ah, she would leave me with the kids for weekends at a time- first when I was 11- she went to mexico with a lover. Then, I just accepted it. Who knew different? I would rock in fear, terrified of what was being asked of me. Because i was born knowing how important things are, and knew from the instant I was born that I was the one that had to take care of things. To this day, it makes me sick to my stomach. I know it shouldn't. But it does.

I guess I look back to ensure my forward is as careful as possible.

Attraction, again

2009-01-26T01:32:00.003-05:00

I believe that attraction is deeper then what we know. In that there lies an attraction factor. I can't explain it better then that. Some people just "do it" for others, and others just look and don't get it at all. Obviously, you can take it farther then that....

I have the loveliest man as a patient tonight- he is 70ish, and well, one of those guys that is not the most lovely to look at- life has been hard, obviously, for the past several months. But, there is something about him- that kind of intangible feeling when you know that person is just good, lovely and their heart (yes, I know) is honest.

Yesterday evening he was sat'ing in the 80%'s. Couldn't get more O's into him. I was helping him eat his dinner (most interesting, thru a face mask, and my total lack of depth perception- but we got it done!) and we began to talk.

I found out about his kids, his wife, his jobs, his love of fishing. I guess that the real answer to his increasing sats was the fact he was taking deeper breaths to talk, but I also think there was more- a will to live that came back. He loves chickens and horses and told me about his farm- 80 acres, with a valley where the deer played. He was just so much more there then when I first met him. He then looked at me and said, "What about you, kid? What's your story?" He then said..."you made me feel so much better...thank you."

I told him I'd bring in hard boiled eggs for him to eat, since they were organic and from our chickens. (Not entirely true- our hens are on strike, however, the eggs I brought in are free range and organic... did it really matter at that point that they were not from my hens?) and he was just grateful.

They (after so many attempts it made me sick, as I swear I feel some peoples' physical pain) got a triple lumen in. Thank God.

Yes, I brought him eggs. And best of all, he was still on the unit to enjoy them. I think the prayers worked.

And we just got a call that he is VRE. :-(

Then, I must write about the man who said he died. Asked me repeatedly WHY he had not died (not why he was alive, but why he had not died. I think that is interesting.) He remembered that he had been shocked and when he were placing him for a turn, he was very scared. He remembered everything. Kept saying (and hard for him to talk as he is just off the vent) "Are you going to shock me?" I kept saying no, and he (thank you versed...) kept asking.

Bits and pieces keep coming back to him. He wanted his watch, glasses and necklace. He had his necklace, and did not believe me. When I took it off to show him, he held it as if he was getting to know it again. From what I gather, it was his dads.

For some reason, I really like that transition period. Now, this guy is young, bold, brash, funny and (obviously) single. He is coming back very quickly- and so its a fast forward version of what we usually see.

His comment about being shocked is...
"it sucked" but now he had angels.

I think that I need to be...

2009-01-26T00:22:00.002-05:00

more aware of what and who I am at the core. I need to remember that, and live within that which I know to be true about me. What is that saying? Write what you want on your tombstone, then live that way. Mine, I would hope would say, is that I am a kind, honest person who gave everything she could.

This is very hard in many ways, as I am sitting on a path, and I need to focus, concentrate and be aware every step of the way. Obviously, focusing is hard for me right now. But I must do it. Must.

Perhaps the hardest thing of all is realizing that sometimes, even when everything seems hard or harder, you must put your big girl panties on and deal with things. Face on. Because at the end of the day, it's only your face in the mirror that provides any real answers. At the end overall, can I look at myself and see someone that I am/was glad to be?

I have been in many situations where things might have gone awry. I have always been able to deal with things in a way that I can say was, in the end, the right thing to do. I am hoping that I can continue to do this- every step of the rest of my life.

I also cannot live in fear- no matter what the fear is, as it's too damn painful. I think that some of this stems from what I "expect" and perhaps someplace there is this Catholic Nun shaking a ruler over my head, providing me with some insane amount of guilt.

So before, I said I hated muddy waters. Add that I hate guilt. It's useful, however. It controls...and that is what I seem to need, some modicum of control. I have almost none right now- self control seems to have flown right out the proverbial window.

So, sad that I am not who I want to be, sad that I am fighting something within me. Sad that I even need to do it. Boy, is desire a powerful thing. Dangerous thing. Bigger then me, little old me. Wow