Random Musings

Cymbalta off

2011-05-31T17:33:00.000-04:00

So just to finish the thoughts, the off stage is really the worst. After i weaned to 0mg, i had an ok first week, except for consistent vertigo. Week 2 left me realizing why there is a claim that some titrate individual beads out of the capsules to wean the last few milligrams. Apparently this end stage is the worst, but i wasn't ready to take a step back from the plan. The worst i had was a day where i could barely move my head side to side without some crazy vertigo that made me stay home and just play video games with my brother. That week also had me in emotional mood swings so bad that i could only ask people to forgive me the bits of crazy that would overwhelm me and make me sad and weepy one second, frustrated and angry the next, then hopeless and crying. But this passed.
Week three of being off, the vertigo is much milder, but now the chronic pain symptoms are seeming to rear themselves. Add to this an odd exhaustion. I've been sleeping a lot and it's not mitigated by caffeine. So i believe these symptoms might be the last in the series, because the emotional lability has certainly evened out. I'm still exercising but randomly with this exhaustion. I'm eating, i'm motivated to do things, and am writing again, which is cool. This week brings me the imposed assessment of my ability to play well with others, and will hopefully give me some new tactics to be a better human being. I'm realizing that the labeling department of psychologists is overwhelming, but if i come out of all of this with some new tools to be a little slower, less impulsive to jump to conclusions or offer my opinions which may be crap, then i will have gained something. If i get back to school doing this, that would be even cooler.

Cymbalta on and off from a nurse's POV

2011-05-09T17:21:00.000-04:00

My reasons for deciding to seek professional help were a temporary state of depression that needed some therapy, and then ultimately, pharmaceutical help. I do not have a clinical diagnosis of long standing depression. As a health care provider in some of the most stressful environments, it was hard to even walk into a psychiatrist's office with my complaints. But in the long run, i feel that all that has happened to me in the last two years has taught me about myself, and given me more insight into something i knew so little about and about which i had a long time been predjudice.
I'm putting this medication information out there as personal information about the medication i was prescribed. I do not represent anyone or anything with this posting. While i was looking for advice on how to safely navigate symptoms of withdraw, i found many useful and not so useful sources. Some things to expect during weaning/cold turkey from my scanning:
GI complaints (IBS Symptoms, diarrhea, nausea, constipation, cramping, etc)
Nerve firings that feel like "brain zaps" or twitches of muscles
Vertigo
Headaches (some almost like migraines)
Mania (even if you didn't have it before)
Worsening anxiety
Return of depression
Listlessness
Lack of Energy
Nothing
Flu-like symptoms
unlikely suicidal completion (this last one is *very* subjective and i can't find source data).
For most the removal of the drug will have some minor complaints. Most should subside after a month being drug free. Please keep your doctor in the loop *especially* with neurological symptoms to avoid missing something and if you feel any desire to harm yourself or others.

The symptoms going on Cymbalta for me were in some ways similar to statistics. While 30mg did nearly nothing for me, i found a sweet spot at 60mg. Please allow me to explain that going on Cymbalta was a trade of one set of symptoms for another. It is by no means a "miracle drug" or an easy way out, nor is it easy to accept some of these symptoms. My doctor and i chatted and chose this because i was also having emotional chronic pain symptoms which i had evaluated and were unfounded by almost any physical and lab test you would do on a 30 something year old.
Not eating/Nausea:
Anorexia i had because of anxiety and stress worsened and also turned into a "central" (you'll see why i call it that in a minute) nausea: one that when i yawned caused me to want nothing to be in my mouth ever, ever, ever. This is way different from usual nausea where you want to vomit. That was never the problem. It was more just a desire to push everything out of my oral cavity, including my tongue, tonsils, uvula and teeth.
Dreams:
I also had some crazy dreams with dream sequences that were clearly the culmination of my anxiety for that day, week, month.
Sexual side effects:
Some sexual side effects were there, but hardly the kind that some people face. Just a dulling of any pleasure, or difficulty getting there. But the affection and sexual feelings never fully went away as they do for some.
Weight change:
I am second percentile for weight loss. Cymbalta is the only drug that causes measurable weightloss in patients, and the average initial loss is 10lbs which evens out and returns to an average of 2lbs over the course of treatment. By the time i had culminated the stress, the anxiety, (added bonus the lack of continuous large doses of estrogen and progestrone in favor of the Mirena¨tm), the anorexia and the medication, my total weighloss was 32lbs (150lbs --> 118lbs). This was something i couldn't even do while marathon training. The least i have weighed since middle school was 140lbs. So when i suddenly went from a size 10 to a size 4/6, you can imagine my surprise. I stopped getting on a scale at that point. I could mostly look in the mirror and know i hadn't gained anything or had lost more.
Was it all worth it:
In effect: yes
For the year or so i've taken it, i stopped crying all the time. I could motivate myself to do some work more than what was required to drag myself to work. I didn't reach my goal of being able to exercise daily, but i did manage to consistently ride my bike to and from work. My anxiety stuck around, but i wasn't having panicky moments where i couldn't get my chest to stop hurting or my heart to stop racing. I've not ever had a situation i couldn't handle till the instigating event that snapped my whole emotional state into a panic. The bigger picture does show a slow build to losing my usual coping skills, but because of the rapidity with which the symptoms presented, learning meditation and relaxation techniques while i was knee deep in anxiety wasn't going to work. Those are things that need to build, like muscle groups while lifting. So taking Cymbalta was a metaphorical set of crutches to get my foot healed so that i could go do my physical therapy (so to speak)
Now all the down sides of my weaning.
As i've gotten to the lowest doses of Cymbalta, my neurologic system has decided to mess with me. Without a lick of alcohol, i get some pretty wicked vertigo. I also wake up with a headache almost daily. It's not a demon drug. It's just got some trade-offs like almost every antidepressant the world over. It turns out that it will muddle around with your basic nerve function because it muddles around with two of your neurotransmitters. Norepinephrine, it turns out, is vital to a lot more than just your psychological well being. And serotonin, similarly, is vital to other processes (90% of its function and production is in the gut, which explains the GI complaints, and it also is something responsible for migraine headaches).
I'd just like to document how the last 6 weeks have been going. Up until last week GREAT!
I started my weaning process from my start of 60mg in 10mg increments per week, as i had been warned of the side effects of too fast a taper. These pills are worse than steroids (which also require a specific taper regime and also messed with my head-literally). When i tried weaning directly to 30mg, things were *bad*. I had headaches, muscle aches, flu like symptoms, and weird anxiety.
So up until last Sunday things were wonderful (i am now at 10mg/day). But when i felt like i had a stomach bug from eating crab cakes on a train (i know, it was one of the smartest decisions i have ever made about food), i also developed the vertigo: the kind that when you move to fast the world spins. One time, while shifting my glance to the right, i felt like my vision was in filmstrip form, but going side to side instead of up and down.
I also noticed my mania. I have been cleaning and organizing and reorganizing.
And i have bouts of unexplainable anxiety that comes on when i don't expect it.

But here are some bright spots:
Week 2 of running after not doing so for at least 2 years
Genuine happiness making freeze pops out of freshly juiced produce
I'm eating almost normal sized meals again and actually crave desserts again!
Getting lots of support in learning how to do relaxation techniques, and practicing meditation thanks to roryk's insightful bit
I'm not weepy or depressed
I'm actually excited about things in my future and i don't feel like i'm stuck in that crazy tunnel in Switzerland anymore.
If you have any questions, feel free to ping me. Friday starts my first no Cymbalta week, and i will be managing some hefty stress over the coming weeks and months. I believe i will be fine. And that is a pretty cool place to be.

Another nother cheese cheese burger burger please

2011-03-17T06:49:00.000-04:00

Patient is diagnosed with a significant Abdominal aortic aneurysm. So this usually entails a bulging off a major part of the aorta. All sorts of things can cause it, and you can usually medically treat it with some medication, making sure that enough blood is flowing down to your legs and it doesn't rip open (which is the big risk and usually will require surgery.
Here you can see them exposing and opening the aorta at the site of the aneurysm. In this very skinny man's case, his was the size of a soft ball.

Yes, almost everything that you see in that picture that isn't hands, tools or drapes is the site of the aneurysm.

Oh, the plot thickens. So the inside of your vessels absolutely should not look like this. All that browning cottage cheese stuff, it turns out....not so good. That is the accumulation underneath a plaque that the patient developed caused either by a trauma to the inside of the vessel, fat or mineral deposits, or some other genetic issue. What has happened is that a bunch of inflammatory mediators and platelets and all sorts of other junk gets stuck under a little area of the plaque causing it to expand and bulge. Eventually, when the blood vessels is stretched to its max, it will tear and as it tears create a smaller and smaller likelihood of survival.

This is the same sort of process involved in those "plaque" deposits in your heart. Except that eventually they tear off and that mass of stuff goes and blocks off a narrower portion of your arterial system.

Here you see the stuff they pulled out of the artery. These are all the pieces of gunk that had accumulated there, from different types of blood cells, cholesterol, etc.
Did i mention how it smelled?
Imagine an infectious wound that has been brewing for a few weeks under a bandage. It's about like that.

To repair such a thing, it's not like you can give up another vessel in your body to replace your giant aorta like you can with one of your tiny coronary arteries. That's where the miracle of plastic (i mean silicone) comes in. Medicine is full of interesting stuff and i love looking through the surgical cabinets to see what all can be replaced in the body from joints to valves to *blooooooood vessels!* So there are many different sizes of silicone replacement aorta you can get from the tiniest of tiny (like in a neonate that needs palliative care for a congenital problem) to enormous. This is the biggest i've ever seen. (Though i did once sit in an OR waiting for the right *length* of vessel because it wasn't standard stock and they come in different materials, diameters, coatings, etc). This last photo is of that tube. I would say it was at least 1/3 the length of his aorta when they were done.
The patient is happily discharged.

Theater Exile does The Lieutenant of Inishmore

2011-03-11T15:37:00.000-05:00

A really great theater group here called Theater Exile is willing to bring all the dark humor to Philadelphia that it thinks might be tolerable. Along with 1812 Productions (of All Wear Bowlers fame) they are one of my favorites. I read the Lieutenant of Inishmore when i was in college studying Irish literature and it stuck with me as one of the funniest and darkest plays i'd ever seen or read. Later i would find the Pillowman and All wear Bowlers, and David Sedaris and other plays that would invoke similar dark guffaws.
Set on Inishmore, an island to which i've been in Ireland, that is rough and rocky atop cliffs that are ravaged by the seas, it is about an INLA (Irish National Liberation Army) officers' return home after finding out there is something wrong with his beloved cat. It turns out "Wee Thomas" the cat is dead, and the young man, "Mad Padraic," is a raging lunatic with designs on creating a splinter group from the INLA splinter group from the IRA because it doesn't meet his needs for violence (but claiming it is because he needs to make Ireland free from all the evil of the world-your typical homicidal zealot). Hilarity and violence ensue.

Theater Exile did a really find job adding some interesting mashups of traditional irish folk songs with Hip Hop, rock, metal, and pop between scenes that added to the shows edgy nature. The staging is also amazing. The single set conveys all you need, and adds a gotchya humor, while keeping its most contentious actor under control until he's needed.
In the lead role, Paul Felder does a really good job at just comedic crazy. He's perfectly balanced as seemingly morally superior and vacuous at the same time, without an evil bone in him. He is both sympathetic and pathetic, and this is how i've always seen his character. Just batsh*t crazy.
Elena Bossler has some pretty big shoes to fill. Her role was actually vacant because of a terrible loss to the theater company. While unsure if it was time or youth, her acting seemed more melodramatic than calculated. However, she was supposed to be a crazy patriotic 16 year-old who wants more than anything to have a cause for which to fight and more importantly be noticed. Hers was one of the least engaging performances of the night. Perhaps this was because her flinging herself at Padraic seemed as though she needed to prepare for them, and often seemed impatient for her line or cue.

My favorite performances were delivered by William Zielinski (Christy) and especially Pearce Bunting who delivered a brilliantly believable drunken Donny midway through. Donny's lines were frequently delivered with such comedic precision, that one couldn't help but laugh at the speed of his speech, his timing and pauses. With the help of Robert DaPonte as Davey, their chemistry was really well received. In the final standoff scene, their roles shine. Even when all the actors are on the stage, they seem to steal the show with their interactions, eye contact, gestures, and slapstick.

Overall, i came out really happy i forced myself out into the rain to see the show, and look forward to these guys doing more of their Irish series. Pump Girl was pretty wonderful and dark as well, albeit a more modern piece that tries to be slightly more serious.
One can almost forget how serious this play was in its day. The critique of blind Irish nationalism and violence that was sometimes not quite about a free Ireland anymore might be lost on contemporary American audiences. However, it is important to remember in context to appreciate all its humor.

There are only a couple more days to see it, so get out there. Ends this Sunday.

Flower show

2011-03-11T14:30:00.001-05:00

So Philadelphia has this totally ridiculous flower show every year (by ridiculous i mean huge). Before this year, i had never gone. Ericka convinced me and thus educated me. They have several exhibits like this one: the "window box" competition. This was my favorite, and next to it was a "city porch" style competition that included a Caribbean porch full of beautiful tropical plants and the porch dressed like a tikibar. There were also competitions between various types of plants (succulents, orchids smaller than..., orchid any type, orchid hybrids, rooftop greenery, topiary, etc.). Really, i wanted to hate it a lot. It's pure excess in a time when we, as a global community, could use a much different boost than a show of opulence-especially in Philadelphia. Seeing the good in the use in the convention center, and the huge draw of the suburban tourists, I still went. I should do everything at least once. And have you seen some of these plants?
These guys are so awesome. Heather, a friend from school gave us one of these guys as a present one year on. It managed to bloom a second time (which for our household is so far unheard of for orchids).

She got it for us because it was affectionately called the "darth vader" orchid. Um. It looks nothing like Anakin Skywalker. Then there were a bunch of other lovelies. My very favorite orchid was the crazy lioness butterfly looking one.

Another, in the "tiny orchid" category (which is to say you could have bought your orchid the night before the competition, or didn't need to have grown it that long that it was enormous and full of flowers) used bark as the root base for the plant and then hung that bark from an upside-down flower pot.
It was such an imaginative way to handle a plant that lives off trees and put it into a horticultural exhibit with a bunch of pretentious snoots, that i'm glad that it got at least an "honorable mention" (which i notice happens to rebels in competitions on the east coast).
This thing suits my aesthetic sense for sure. I don't know why, but white sage style outcroppings, the contrast of the bark, the iddy biddy, mountain-top, edelweiss-like flower in the midst of all the roughage is just a beautiful sight. Among the pretense of the other flamboyant orchids, its quiet statement seems more beautiful.

There's also a bonzai exhibit which was surprisingly underrepresented, but i suppose with a minimum of 12 years needed to groom even a tiny tree to be the shape you want, that makes sense. This is one of the younger of the bunch. One was 60 years old. Others 40 and younger. It is hard for me to imagine the endurance and patience involved in grooming a bonzai. There is no instant gratification, and being able to see the long view in concept and then prune accordingly when it comes to plants seems daunting. The results, however, are something i really love to see. The trees came from India, China and Japan. Interesting mixes and breeds, some with pine tree like leaves, other like this, and others still with barely any leaves and fat chunky trunks and branches.

Lastly, there was the "shape your plant/s into something interesting." There were quite a few interesting pieces like planes and one that used my very favorite lilies in a vase and had them cascade down like a lopsided chandelier. It won top prize and it was probably justified for a successful modern interpretation of the classical flower layout without too much fluff and pomp. But one should note the amazing dragon duo. I believe they were made from seeds and bark instead of flowers and grass. That alone makes them rebellious, but wooooo!

Root canal

2011-03-11T13:09:00.001-05:00

It turns out root canal isn't so bad.
But i say that with the caveat: it's not that bad if you had excruciating pain prior to the root canal. The good thing is that i can sort of read xrays, and some symptoms led me to believe something was wrong but i thought it was something else because i'm neither a dentist nor an endodontist. (oh, and i was repeatedly told it was just sensitivity that won't ever go away and i would need to use sensitive toothpaste).
If you look at my xrays (this is post rubbery post placement with the clamp still on my tooth), you'll notice that around the bottom of the root it looks weird. This is fluid accumulation, usually a sign of infection. This went with my weird, unable to locate exact source, random, flare up aches that i would feel in that area periodically. So off to the endo i go. Three drillings and fillings with some rubber tubes in my roots later with medication added to prevent infection and some pretty bad aches that got me on antibiotics, and then also an antifungal (which is allegedly the a-bomb of mouth/tooth issues) i realized some things: i'm a wuss about my teeth (the doc had to give me some tough love to get me to stop calling about the pain), teeth are scary, i don't want the pain that usually brings one to a root canal, and that Dr. Vettraino is not only a lovely woman with a beautiful Italian accent, but she is patient and explanatory and wonderful.

What i thought was neat in all this was the process at the end. So the xray shows the rubber tips they place down into the four roots of the molar. They are specially treated and the tooth is rinsed out with chlorhexidine (the napalm of antibacterials). The stuff above it is the temporary filling material that will later be removed by my dentist for a permanent one, and a crown is slapped on top of the whole thing.

The other photo is me braving a photo of myself with a giant hole in my tooth. If you know me at all, you know i can't handle two things in medicine: bones and teeth.

aminos

2011-03-07T23:11:00.001-05:00

I'm excited to show off my necklace. Special thanks to Raven Hanna who owns Made with Molecules. Her work is pretty spectacular. You can find her on etsy at molecularmuse and she likes to make things that involve science!
If you know the letters that represent each of the amino acids, and can speak German, then you might be able to figure out what it says. ;)

Cherry Chocolate Chip Cookies

2011-03-05T17:56:00.000-05:00

So there are these cookies i adore from the local bakery made with dark chocolate and cherries with a little sea salt...and really, what i needed to do was finally make them. I added a little twist by soaking my cherries in Kirschwasser. It's a liquor from Germany that smells like cherried gasoline. I firmly recommend using unsulfured cherries with no oil in them, as the oil will take up some of the valuable space for the liquor.

I usually use the old recipe off the nestle's chocolate chip cookie package as a base from which to start because i memorized it, and have learned to manipulate it well enough that my cookies don't turn out disastrous. Some changes i made are that i used 1/2 tsp salt instead of the whole tsp. Next time i might add an egg, too. And i always use way more stuff in my cookies because, well, anyone can make cookie dough.

Once the dough was ready, i spread it out onto the sheets, this time thumbprinting the centers to get an even cooking area, and added the tiniest bit of coarse sea salt on the tops. Esther, a woman with whom i worked at Jefferson used to salt her grapefruits. Turns out that salt brings out a little extra sweet, so the tart of the cherries and alcohol are balance nicely with the intensified sweet.

10 minutes in the oven on parchment paper and they were done. I can't wait to give them away. =)

i would like to find gratitude

2011-02-25T00:42:00.000-05:00

To speak frankly, so many things are not ok. I'm remembering the desire to feel and to write passionately and to express the beauty of the world through words, but after 22 months of mostly suffering, wondering what i'm doing here, wondering if this is this is the life i really want, my school has seriously tried to steal away those 22 months, the 30 pounds, the lost sleep and dreams full of anxiety, the need to become a selfish inward entity that forgets birthdays, the huge financial cost, and the woman curled into a ball of overwhelmed fear that i might not graduate. And as each situation becomes more intensely focused on my failings as a human being, i grow more anxious, lose more self esteem and thus it becomes more difficult to wear the mantle of camoflage. I'm outspoken, loud, brash, direct, and impulsive. I'm in my 30's and wonder why i can't remind myself who i was before this program started. "i'm young and strong but i feel old and tired." I wish i could say that what i learned in the last months could be seen as *worth* the learning it at the edge of a knife every day. But i can't say that.

"I will not pretend
i will not say i'm alright for you when
All i wanted was to be good.
to do everything and true."

Martha Wainwright - lyrics

New Project

2011-01-20T01:24:00.001-05:00

I'm calling it my reminder to focus as much attention to the awesome in my life. I'm going to try to talk about something amazing or someone whom i would like to thank, or someone i think is rad. Please remember, i have so much to be thankful for, and there is no particular order, except for a sudden shot to the chest that makes me feel inclined to write an inspired line.
Goto: http://taoofgratitude.blogspot.com/

OMG! i'm not chained to the program another 3 months!

2010-12-06T20:18:00.000-05:00

By the way, to anyone who might care about my sanity and weight loss and ability to cope, i passed the exam that if i failed might have meant another 3 months of school for me. Having passed this exam, i feel ready to tackle at least the next few weeks, if not months to get to the end of this long slog. Thanks to my absolutely amazing husband who has stood by me, loved me, endured and suffered me, and has been my compass and strength in really hard times, and thanks to everyone else who believes in me. Sometimes i forget to do it for myself. Your visits, packages, notes, phone calls, well wishes, thinking about me, hugs, all of the things i'm not thinking about right this second, all have helped me stay reasonably sane-despite the pounds lost, the tears shed, the time lost, the missed moments....well you know.

(Hyakki Yako: heart-wish i owned this)

Entimology of "tito"

2010-11-21T12:56:00.000-05:00

As many know, calling someone retarded is rather uncouth, and seems cruel in certain company. But in some cases, someone does something so "ridiculous," that ridiculous doesn't cut it. "Special," "idiotic." "questionable," "dumb" and other less slanderous words are inadequate to describe how short the bus is on which a particular person is riding. And how could one use the favored Boston slang "wicked retahted." MMW is a teacher of the occasional disabled child and thus found "retarded" somewhat uncomfortable. In considering the word with a close counterpart, they decided the most suitable synomym that wouldn't cause gasps was to call such acts of foolishness "tito maneuvers."
"Where did this come from?" some lovers of the Oxford English Dictionary might ask. Let me explain from the source:
tito: (tee'-toe) from the common American English slang for retard. To behave in a way that is similar to that of a disabled person, or someone with a mental illness that leads to poor decision making in a particular situation. evolution: retard->tard-->tardo-->tito.

a life in memoriam

2010-11-17T23:41:00.001-05:00

In all the self-centered meness of being neck deep in quicksand and sometimes struggling to breathe through coffee stirrers, i was unable to express something i needed to, in the company of people who understood. I found solace in a musical place i knew Steven Michael Morton would appreciate as i did. There i made my peace with his memory in my mind and heart, but here, i'd like to share some of my greatest memories of him.
In order to find your way out of the woods in NJ, follow the stream-eventually it will lead to a road. When everyone is staring at you being the bad guy, Steve was the man who would stand beside you and tell you the truth. He taught me to find beaver dens, watch the sky at night again, and to listen for owls in the frickin' suburbs of NJ. A big bear of a man, gentle as the lapping shore of a great ocean. He is one of the few i can consider an equal in intensity, heart, passion for the world, sadness it wouldn't realize its own potential. He owned chihuahuas with his wife, and genuinely liked them.
I cherish the gifts he gave me: a zuni octopus, a jar of Jersey sand, his friendship without asking anything.
In all, i have so many wonderful memories of him. Sharing my entire life history, Orion, a love of spyderco knives, the peace of lights in the nighttime, doughnuts in the snow in medic vehicles, and listening to patients and his similarly rare intuition. But most of all, he was the best damned paramedic partner, colleague, and one of the best friends i have ever had. He was able to save me the tears of hopelessness, so that i could get a job done. He was the black to my white cloud, and when we worked together, it was a s**tshow well controlled by peaceful trust in the other to get shit done. I don't know that i will ever find that same rare place with anyone in the workplace again, and if i do i will feel blessed.
But Steven Michael Morton, my friend, my partner-i miss you. I've missed you a long time. I wish i could laugh with you at stupid nerdy jokes, try to sit down for dinner in fancy restaurants, eat grilled swiss on rye with extra crispy fries and regret it later, listen to "don't fear the reaper" racing to calls, watch star trek until late in the night while waiting for the next totally horrendous call we would face. I keep you close, and will never forget the things you taught me.

suicide watch

2010-07-31T20:05:00.001-04:00

So yesterday i had a most interesting experience. But perhaps some background first:
I started my rotation in Dover, DE for hearts, which was exciting to me, despite the horrible commute and long hours and being away from home so much and having a super difficult semester in which i'm just barely making it grade wise in most of my classes. So far, i haven't worked with the woman who is supposed to be the full-time preceptor, so i worked with one of the part time preceptors. She and i are not coalescing well, it turns out. Having noticed that i really pissed her off my first day, i started out the second day with a really conscientious "what do you expect of me, where should i be, what is my role?" I was told that in the general rooms, i am expected to be independent, but in the heart room i am expected to stand back and wait to be summoned (more or less). Our day went somewhat better (Albeit we had a different physician working with us, which may have helped all things). The third day we worked together (a general surgical case) we had a patient whose IV wasn't working and no one noticed it until her arm was full of the medication that wouldn't absorb for another 20 minutes. The physician seemed not to hear me when i explained she was still awake, and he insisted she was, and at the very least "amnestic" despite still blinking and talking through the mask. He was not clear about what he wanted me to do other than throw a tube into her trachea. I could not perform this task.
A new IV was started, that wasn't really working either. Another IV was started (i looked but didn't try). In all the haste, i was the only one who spoke to the patient. So in addition to working alongside people who weren't clear what they wanted and wouldn't listen to what i was trying to communicated, i also had to confront something that has always bothered me and against which i have struggled for a long time.
This is, of course, my perspective.
Part time heart preceptor will not work with me again (which is a big deal because there are only two heart peeps whom i can shadow).
Physician said not to worry about it.
Primary preceptor and i chatted about the incident and she was supportive, but guarded. She sends me home early.
The next day (yesterday) i go in for a practical exam to school. After this exam is over, i'm cornered by the assistant director "can i speak with you here in this really small office with an oval table" where i find the two directors of student services also sitting. I'm convinced that i am out of the program or am getting some sort of verbal warning for some misstep i allegedly made that was in gross violation of policy or something. Truly, i felt like i had shown up to my probation officer with a dirty urine sample, or after having stolen hairspray from the local wallmart.
Turns out that my preceptor (the primary who hasn't worked with me) reported me as a "suicide risk" to my faculty who then felt that cornering me by myself with people i barely know, and making me talk to a psychologist for 15 minutes to reassure him i wouldn't jump off a bridge would be a good plan. When all was through, i was told that i should feel welcome to talk to them. The preceptor seemed disappointed that i might feel a bit put off by the experience.
The thing i can't understand is why my director ignored that i had already come to her with my current situation and how things are. Maybe that made her choose the path of an intervention, who knows. But the point is that i didn't really feel "cared for" as they wanted me to. All i felt is that three people had to jump through some hoops to make sure that if i did, in fact, throw myself off a bridge, they weren't to blame.
Why do i feel this?
Well, because there was no follow through.
My director wasn't present. She sent me an email to tell her when she could call me yesterday but never really followed through there, either. They all let me perform that simulation lab without a thought. A whole weekend, no one checked on the poor suicidal girl.
Just weird.
Anyway, i found one nice thing.
That thing is the awesome necklace i got from BlackSpotBooks in Philadelphia. Turns out, they are really good for drawing tiny cephalopods in. And remembering amazing shit.
Tuesday night will determine whether i completely bomb this semester.
I'm excited to see.
There is a little piece of me wishing i would fail, just to stop the madness.
When people say you have to make sacrifices for this program, i knew that. I made financial ones, social ones, situational ones....i wasn't counting on the physical toll of losing 30 pounds, going on anti-depressants just to avoid crying every day, relying on celebrex to control my stupid neck's constant aches, taking an entire saturday, every saturday, to recover from the week, and relying so heavily on the strength of friendships and family to have me be absent from them for so long.
This is water.
This is water.
This is Water.

Mad Cow Disease

2010-07-02T10:35:00.000-04:00

This entry has nothing to do with mad cow disease, but i thought it was a funny suggestion when i moused into the title and received the options a MCD, SIDS (sudden infant death syndrome), and MD.
A funny thing happened to us last night at about 3:00 in the morning.
There is a "ding" much like a text messge that wakes us from sleep. "is that a text message for you?" i ask. "No, must be your phone," mjw replies. Turn over, return to sleep? Next comes a loud crash. I'm not sure i am hearing correctly. "Did you hear something?" I'm still discounting it as my paranoia, because occasionally even voices sound like they must be in the next room. mjw turns to me a little perked eared. Another crash, clearly very "local." We jump out of bed. mjw brandishes a staff he keeps near the bed. We exit the bedroom to hear another loud bang, this time much like someone with a battering ram at the door to our apartment. "Go get your phone," mjw says quietly. "Do you want me to call 911?" "yes." I unlock the phone, pause, listen. I am suddenly aware of the familiar sound of an emergency scene at which i've been waiting for the emergency to be over: loud trucks, water hoses, shouting, emergency radios. I look out the window (we have black out curtains).
"The apartment is on fire" i say as i look at the ladder headed up to our roof and another at our kitchen window, and a streak of fire engines, lights strobing and hoses spread across the street (and of course, the early morning paparazzi to the firemen). mjw heads downstairs as the banging continues to try to get the fire department to stop so we can open the door. Attempts to open the door now fail, having been torn apart. So now the fire department has to follow through, take out the lock and part of the door with it.
Nice man. Cute, comes in, says we'll smell smoke for a while after i go to the roof and confirm no fire upstairs.
I believe we slept through the entire extinguishing, the ladder, hoses and footsteps on the roof, and all the sirens. Only the doorbell, an unrecognizable "ding" of a text message woke us....
Apparently there might have been a barbacue on fire. Well, whatever it was, the entire front of the apartment next door is now open for the world to see. Living where we do, we must have fire proof walls and rooves, because there is no fire damage to either side of the burnt reckage.
However, we have a funny story to tell.
Everything is ok with us. But after the adrenalin left, i got a good dose of what my parasympathetic nervous system does: circulate my gastointestinal tract realllllllly well.

Psychadelic renaissance

2010-06-26T04:25:00.001-04:00

http://www.stevenkotler.com/node/120
Turns out, that before i left Philadelphia to move out to California, i met a young man through friendster that wanted to revolutionize the way most people thought about psychedelics and MDMA (at least in the medical and federal community). I can't even remember who he was or whether i could even recognize him again. However, on a long walk through the sure kill river park, he explained his motivations. He wanted to give people a glimpse into what death might be like by administering DMT to people who were afraid. Having three brain cells to rub together, i was skeptical about the ethical motivations to this man's plans. Mostly they focused around the complication of not being able to predict the themes of the thoughts through a hallucination. Angels could easily become demons, distracted thoughts to black nothingness, colors to nashing teeth. Mostly, i worried about the general feeling of discomfort that was possible with poor dosing, or bad product, or unpredictable results.
Fast forward to the present day.
I was in Rochester and sitting in a man-home bathroom, and on the top of the catharsis reading pile is a Playboy. Now, i'm not into chicks, but they are prettier in general than boys. Plus, i'm curious about what the current objects of desire are and where i measure up just like any girl. Funnily enough, Playboy does have some good articles, and i started reading the moment i read the above title.
If you don't have time to read it, a quick summary: woman dying of terminal colon cancer. She is young-young for cancer. Riddled with pain despite attempting multimodal therapy (but it didn't sound like ketamine coma was one of them, so i assume she doesn't live near Temple: http://www.rsds.org/3/treatment/ketamine.html), she turns to the only thing left. At the behest of her mother, she calls a man in to administer psychopharmaceuticals. She enjoys them once the doses are worked out, craving them for the peace of mind, or the storm of mind-depending on your particular view on the matter. Crashing from each treatment of LSD or psylocibin, MDMA or marijuana or some combination of them, she suffers tremors, amplified pain, and requires long recovery. However, in the end, she benefits from all of it with a "good death."
What do i mean by "good death?" She goes peacefully into the inevitable, stripped of fear. She feels loved, and oneness with the universe, holding both parents' hands as her mind leaves her diseased body. She arrived here pretty much illegally. To my knowledge, there are only two allowances (i don't think they have grants) to synthesize (?) and utilize MDMA in patients. Harvard and Duke are using MDMA to deal with post traumatic stress disorder, which has failed most modalities because it's usually not a chemical imbalance, it is the brain attempting to protect itself by blocking out the most difficult events of our lives and failing by allowing them to show up in nightmares, angered interactions with peers, and symptoms of depression and maladjustment. Harvard's study must have gone well, as they received a renewal to continue their research. One or both institutions are also studying LSD in the same population. Usually soldiers returning from the mortar shells and roadside bombs of the middle east. The hope is, in each of these groups, that soldiers will open themselves to their experiences, express them, feel their fear in a safe environment, while they feel loved and supported by the whole of the universe. It's worked for some, as this article alludes.
This past weekend, i listened to a talk given by a man working at John's Hopkins with hallucinogens to synthesize meditation conditions for people who have practiced some form of spirituality but never explored drugs before to assist their quest. Their studies found that people experienced some of their most powerful transcendent thoughts on psylocibin. Their hope is to move on to cancer patients to help them feel connected and one with the world, and ultimately less afraid of the inevitable.
The idea of certain drugs being illegal is, to me, a grey area. I personally don't want to pay your hospital bill when you are in heart failure after toxifying your heart with cocaine for years. Also, i personally don't want to support the children of those who become so addicted to any substance that they abuse them or neglect them, or become otherwise absent. i don't want to pay their disability.
However, there is a self autonomy that has been stolen from us when it comes to end of life decisions. If one is unable to get it done ones self, one is damned to suffer. Having a tool like this to cope with things at the scariest point in life might just be a good thing. The slippery slope of morphine is similar to what this young woman with bowel cancer allegedly experienced. On the one side, morphine helps deal with pain and eases shortness of breath. One or two milligrams more and breathing stops, or slows, allowing carbon dioxide to build, and the long sleep to conquer.
In American culture, we appear to have the most unhealthy relationship to death of any other, raging against it in all forms, believing we can somehow cheat the oldest plan on earth, grieving to the point of disability, and hiding it away from sight when it finally happens. Much of this has been created by the medical community, attempting the impossible every day, replacing failing organs, recirculating hearts, cutting off and diseased limbs and organs, poisoning the poison. But sometimes all the medical community does is prolong the emotional and physical suffering and support hopes that should be turning to nurturing and putting affairs in order.
With legalization and careful administration with all the risks described, perhaps preparing a person for death could be a good thing: for an individual, for all that surround that individual, maybe even for the entire community. However, having no experience, i can't speak to the visions that are had, only guess from other's accounts.
The other issue is that with a drug like MDMA that seems to splay out your entire heart and soul before you and asks you in a loving way to confront something that's grown like a cancer in there, and only you can stop it may be the only cure. Listen to the current studies happening all over the world:

http://www.maps.org/mdma/

Anyway, it all got my to thinking.
It's fascinating stuff, and i know none of it is benign. However, i'm all about learning.

the Intimacy of the Joke

2010-06-22T21:07:00.000-04:00

Last week i had a patient in for breast reconstruction. She and her companion spent most of their time in the preop holding area and the PACU giggling like little girls. They told me the story of how her friend had taken care of her after her mastectomy at 39, cleaning her up in the tub, changing her bandages ("gross," she said). They then told the story of their jokes. In bandages, nearly crying, facing each other, her friend said to her "turn around when i'm talking to you."
This dark humor with the background they shared, gave me hope.
I hope you can find it, too.

Insert Clever Title Here

2009-11-20T16:17:00.000-05:00

It's true.
This program i decided to enter sucks.
Well, maybe in a year and several months i will feel better about dedicating my life to something that makes me feel panicked and depressed on a daily basis, and has stripped me of what self confidence i had gained after getting my pilot's license (i can fly a f**king plane, damn it. this seems like it should go a little easier).
Really all i would need is a couple vacations, and stars at my door when i come home at night. One of my coping mechanisms has always been a drive into the stars, to just sit, listen to music that made me melancholy and morose, but somehow happier, and all would be well. That seems like an insurmountable task right now, because that time should be reserved for doing homework, reading up on my anesthesia chapters, and studying note card, memorizing drug doses and effects. So what do i do instead? drink a lot of wine, and do homework while watching bad television. This is hardly coping.
The hardest thing about being a rational human being is the part where you recognize that your way of thinking about the situation is definitely making the situation murky, but you can't seem to make that emotional crap go away-thereby fully internalizing heart and mind into separate boxes. They are so inexplicably intertwined and yet can't seem to communicate very well. They're like a couple going to marriage counseling that have been sleeping in separate beds but are still f**king. The dark task is spocking/dataing it, and understanding both heart and mind: the rational and irrational; and learning to get those two parts communicating to be stronger together is probably going to be my life's work.
But school.....i still don't like it.

Leaks in the system

2009-07-27T13:09:00.000-04:00

It is surprising to me that people still show indignation at the fact that human beings will avoid cost to themselves. Here’s yet another way to avoid buying costly improvements to your hospital, thereby compromising your anesthesia providers.

While anesthetic gases are not well studied enough to clinically prove harmful, there are anecdotal studies that show a larger number of spontaneous abortions among anesthesia providers. Additionally, full dose anesthetics are known to be teratogenic. There is still a question whether over the long term they are carcinogenic.

OSHA makes guidelines for the amount of anesthetic gas allowed to be in an OR throughout the day (2ppm of halogenated agents with 100% O2, 0.5ppm of halogenated agent with N2O and 25ppm of N2O alone all over an 8 hour period). Apparently, hospitals have found a sneaky way to avoid getting real numbers. They take samples from ORs not in use, or before the day starts or after all the cases are over. This is the time when the least escape gases are present.

drunken rambling

2009-06-08T22:32:00.000-04:00

School is taxing. So far only in anxiety. The first exam i took was as i expected actually. It was very practice based and structured like undergraduate NCLEX nursing exam full of absolutes and lacking all substance or clinical. ML and i spent a good hour discussing the disappointment with the "IL program." It turns out it's no different. But these are things i expected. Being in such a highly specialized field changes a lot of things you would expect. Though in defense, i have some really challenging classes. Pathophys, for instance, is over my head hard, which is rare these days in medical info.

Unfortunately (or fortunate for you) some of us care about knowing some of the finer points, and thus, want to read more. I take it with less intensity. ML really thinks that it's important. I love it for research, but know that we'll never see the say, the finer opiods...oh, i learned about one of those and i was amazed that there is a more potent opiod than Fentanyl.....that's mind boggling to me.

It's *extremely specialized* all of it. Some people will argue that this is crazy that you can prescribe meds without knowing all of them....but *who can?* The field of medicine is so vast, that the only choice anymore is to specialize in one tiny part of the bigger picture. I have an *enormous* amount of respect for primary and emergency providers, b/c they must weedle down the components to their "specialty" for referrals. Some people seem to think this is a cop out. Maybe in a broader picture, but to look at so many disciplines and appropriately choose the specialty is nothing short of amazing (if done correctly). Plus you have to deal with all the BS sniffles that make it a completely thankless job.....

Anesthesia, it turns out.....is *amazingly* specialized. But it's not new to me, who has chose n weird professions from the beginnning....full of nepotism, and favoritism and questionable legal status and all that it entails....i don't quite know why i'm drawn to these weird "border" professions. But i simply am.

Currently i am distracted by "purple screen" on the Star trek (the original) view screen. Turns out purple is as bad a color as red. Oh wait.....there's the red.....

Incidentally, i thought that the Van Pelt was my dream library....it turns out it is the fine arts library. It reminds me of the library in Dublin....full of beautiful caves and quiet and solemn.....full of stained glass and dreams of being full of mystery. I think i'll study there more often. It enforces a quiet that nowhere else on campus does. Houston Hall is cool, too...but in a loud fireplace and fun kind of way. I call it "Penn's Hunting Lodge...." without the dead animals on the walls.

Our A/C works.
I hope hell has A/C, too.

Oh! and i got to play 4 square in Rittenhouse tonight. I miss 4 Square and am *incredibly* glad it has stayed acitve in the 2 years i was gone. A line of 20 players! wooooooo!
Oh and favorite gelateria: Capogiro. Make sure that if you come visit i take you to have the most amazing cold food you've *ever* had.

Making ze first corn chowder

2009-03-24T16:35:00.000-04:00

Because i seem to rarely post, i decided that i would try just writing about *anything*, even the mundane, to get myself back to regular writing. Here goes....a recipe attempt, my discoveries and my decisions for future attempts.

(This conveniently also helps me remember things that i know that i won't write down and then i'll make the same mistakes again.....so it's more than just a little slf-serving.

I decided on a non-meat based version from William Sonoma. I find that WS’s recipe website is a good resource to use as a base but the frustrating thing is that WS expects either a good knowledge of the cooking craft, or use of their items (so advertising is a bore) or really high quality ingredients.
I used their white sweet corn chowder recipe as a start and eliminated the things that I didn’t have at that moment (I made a quick visit to the store prior to visiting the recipe site) being thyme and fresh chives. I also chose to use fresh corn, halved the recipe except for the butter (which I think adds a little something to just about any recipe).

I also added a ready made WS seasoning (the herbs de Provencal…..it has some fennel, a touch of lavender, thyme, and basil….
I also hate celery with a bloody passion, so I exchanged red bell pepper .

Cooking the fresh corn takes a little longer if you’re just light simmering. I doubled the time to get still very crunchy corn bits.

The Herbs de Provencal sounded like a good idea, and were to some degree….if that was what you wanted to taste. Better to just stick with the one note spice of thyme probably for the future. Also, it is easy to under pepper and under salt this dish. I compensated with table spicing and adding some delicious trader joe’s Mexican cheese blend.

Served best with a hard cider or a nice light citrusy white. (I ended up with two Cabernets, so I really believe you should drink what you want ;)

Original recipe:
White Corn Chowder

Ingredients:

4 to 6 ears of white corn, husks and silk
removed

4 Tbs. (1/2 stick) unsalted butter

1/2 large yellow onion, minced

1 large celery stalk, minced

1 lb. russet potatoes, peeled and cut into
1/2-inch cubes

2 cups chicken stock

1 cup water

1 1/2 tsp. minced fresh thyme

1 cup half-and-half

Salt and freshly ground pepper, to taste

3 Tbs. thinly sliced fresh chives
Directions:

Holding each ear of corn by its pointed end and steadying its stalk end on a cutting board, cut down along the ear with a sharp knife to strip off the kernels, turning the ear with each cut. Alternatively, remove the kernels with a kernel cutter. You will need 4 cups corn kernels. Set aside.

In a large saucepan over medium heat, melt the butter. Add the onion and celery and sauté until soft, about 10 minutes. Add the potatoes, stock, water and thyme and bring to a simmer. Cover, adjust the heat to maintain a gentle simmer and cook until the potatoes are almost tender, about 8 minutes. Add the corn, cover and continue to simmer gently until the corn is tender, 3 to 5 minutes more.

Transfer about 4 cups of the soup solids to a food processor along with enough of the cooking liquid to achieve a puree. Secure the lid and cover with a kitchen towel. Process until smooth and return to the pan. Stir in the half-and-half and season with salt and pepper.

Reheat the soup gently over medium-low heat. Ladle into warmed soup bowls and garnish with the chives, dividing evenly. Serve immediately. Serves 6.

Adapted from Williams-Sonoma New American Cooking Series, California, by Janet Fletcher (Time-Life Books, 2000).

Alterations:
No thyme, instead, WS Herbs de Provencal (mistake)
Sub one red bell pepper for the celery (delicious)
No chives (no obvious difference)
Add Trader Joe’s Mexican Cheese for garnish/addition at table (there is nothing that cannot be improved with cheese)
Cooking time for corn X2 (necessary for it to not be uncooked)
Added double butter (Yum!)

Photos to be entered into record in a bit.

Born Under Punches

2009-01-05T23:02:00.001-05:00

I feel it worthy of internet mention that i had an epiphany today about Born Under Punches by the Talking Heads. I was truly impressed today when i sat in the car singing the following lyrics and finally felt them in the deep heart of internalization:

All i want is to breathe
Won't you breathe with me
Find a little space
So we can move between
Keep one step ahead
Of Yourself.

Perhaps others have had this revelation earlier, and i've always kind of gotten it, but today its full meaning circulated, jostled my core and turned on the little light in my head.
Thanks Mr. Byrne.

Fitz Roy!

2008-09-29T09:43:00.000-04:00

It was worth every moment of struggle, all the evil, weirdly positioned blisters, and every ache i feel from shoulders to toes. Patagonia is, hands down, the most amazing place i have ever hiked. I believe that is because everything is som much bigger in this world. The unbroken skies lay splayed out for all to have a view. One can escape people easily. One is encouraged to stray from the trail to follow moonbeams or hearts or whatever. I am feeling a loss as i come to my last day here.....i don´t really want to give this place up.

In an attempt to make the most of my hiking time, i ended up hiking to the highest point newa the collusus without actually requiring climbing gear. It took 8 hours round trip, and that was hauling a bit at the end. I only stopped to eat a quick lunch and take some photos up top....Laguna de los tres is currently a snow covered ice skating rink (despite my history of stupidity in the wild, i didn´t run down to test the ice...).

I can´t help but think about strange things when i hike. For instance, i thought about damsel fish protecting their eggs in San Pedro, Belize and me able to fight with them with my finger (without really being an agressor that wanted to eat their babies). I suppose it´s a back door reminder that there are places in the world to which i would return in a heart beat. El Calafate ranks high on the list.....Actually, i´m ready to buy property here. But eventually, if its exponential growth continues, it will be as frustrating as any other vacation destination.

As of today, i have had more lamb than i have had in my lifetime before this, and i don´t want anymore salami and cheese sandwiches for a long time.

Last night i also made an amazing discovery: my hotel room has mirror defrosters so that when you shower, you don´t keep it steamy. Talk about awesome. Not to mention there is this awesome little bench that looks out over the lake with comfy pillows and a light by which to read.

Hertz rented me such an awesome car, the door handle broke on the driver side. Woo hoo! good thing i´m limber.

I still suck at Spanish.
I met another woodpecker, red eyed birds, little birds with long beaks plucking bugs out of stumps, ibisses, plovers, and a falcon attacking two little birds in flight. I heard this crazy whooshing sound and there they were above me. Still, there have been no tiny deer and no puma. =(

moreno glacier, asadors, new friends

2008-09-27T23:21:00.000-04:00

Hiking atop the Moreno glacier is otherworldly. Having hiked on top of a glacier (twice) i can tell you it´s not like hiking in either the US or in Austria. The longest glacier and that of Mount Ranier must move more slowly than those of Argentina and Chile. Today i sat and listened as the Moreno glacier moaned to itself and cleaved giant piece into its glacial lake in protest of the sun and the heat of the day. Whereas the glaciers i´ve seen before seem relatively stable and friendly, this glacier seems like it´s ready to throw anyone who might set foot in the wrong spot.

That´s not entirely fair to say of course. These glaciers seem less ready to open giant crevasses under you if you step carefully.

Doing the ¨big icë¨tour was fun. I met some awesome people, and saw some things i´ve never seen before. Giant lagoons in ice are just one. Then there were the holes that seemed to come from no where and lead to the caverns and floes below. Some dove 100 meters under the ice. Drinking glacial water could make me consider drinking water only forever. The mountains rose around us, and naming glaciers here is simple. There is a north branch, an east branch and a main branch of the moreno glacier, instead of the Kautz and the renauld and etc, for each little outcropping or part of a glacier.

I can´t get over the delay of sound. That and simply the enormity of the things. They are like nothing you will ever meet, unless you travel to Greenland or Anarctica. It is impossible to explain what it looks like as you approach, or sitting atop a cliff next to this monster.

I met some lovely people: Glyn, from Wales, overly tall and with a prize-winning beard, who can name the longest Welsh town visited by train. It´s so long that all i can remember is go go gough which means red cave...but there´s something about a saint and some colors other than red and some crazy war that led to the name i can´t remember. There is Lance who both has friends in Japanese prisons and who likes to create fishtank ecosystems in his spare time and who can tell unrivaled, captivating stories of people and places. And there´s Ella who charms with her confidence and presence and can make you laugh and feel honored to know her just by smiling at you.

Yesterday we attempted a view of Fitz Roy. That bloody mountain stayed veiled in cloud an sleeting rain for us all day, despite a persistence through rain and long walks. I´m determined to find him tomorrow.

At the end of yesterday we found an Asador which serves barbacued meat. We all ordered the Patagonian specialty of lamb. Was it just a long day of hiking, or is mountain lamb the best thing ever? It even made the Malbec taste nice. Sorry Marty, still can´t find a heart for the special grape that makes Argentina famous.

Tomorrow i promise myself some delicious beef, because truly there is nothing quite like Argentinian beef. Especially when it is raised here, in Patagonia, under the shadow of these mountains and hills, free to roam hundreds of miles before being led to slaughter.

I also managed to try M&M´s famous calafate berry ice cream. It was more wondrful than promised, but had nothing on the MYM. mmmmm. merengue, caramel/dulce de leche and cream. Who could ever resist. I will return to the owner who invited us for Mate and patient conversation.

Having seen the moreno glacier, i am glad i have come at a time before the big tourism starts. I found the old trails that led to views of the glacier when only 1000 visitors a year showed up here. It was beautiful and quiet, and unlike the metal framed walkways that brought the loud families that ceased to feel awe and wonder and talked through the moaning of the glacier as it moved and churned and threw ice around in protest. In two years time, the earliest before i can return, the feel will change and it will become like any other park: full of people hoping to win a lottery, and unsatisfied with the simple pleasure of seeing something so massive and strange that it makes their heads turn and their eyes fix on something other than television sets.

Simultaneously, i am thankful to those tourists for a paved road to El Chalten. It wouldn´t exist if the number of people hadn´t exponentially grown so dramatically. Tomorrow i shall drive again to see the great Fitz Roy and his friends. Maybe i´ll catch view of the glacier Viedma again, too. Everything here is so enormous and different. Even the sky is different. I still haven´t found the southern cross and familiar constellations are missing. The clouds promise something as i write postcards from my little sitting bench in the hotel room.

I feel good about myself for bailing out a pleasant local who had managed to flatten 2 tires trying to get the crazy green rock into El Calafate for some rich bastards who wouldn´t settle for anything less. He asked if i always pick up people on the side of the road. I said only when they look desperate. Turns out that in addition to relocating large rocks, he is also an announcer on the Upsala Glacier tour on which i went. He does the English translation. No one that i have met here is anything less than amicable.

We live in a beautiful world. Truth is, i miss you. If you´re reading this, you know who you are.

Fauna count: crazy chicken, falcon hunting in tall grass that let me watch him as i cruised the local ¨highway," geese that mate for life, three kind of rodent sparrow, a "woody woodpecker" woodpecker and its mate, hares, cows, sheep, guiaca, and giant condor. Still no llama, huepac, or ostrich.

Entering El Calafate

2008-09-26T09:56:00.000-04:00

The airport at the entrance to this part of Patagonia is about as small as that of Hayden near SBS. I mean, tiny.....thank goodness this place is full of people who speak English, because at one time, i´ll bet it was difficult to navigate this place with the microscopic command of Spanish i possess. The town is truly a mountain town in its own right--a south American village of Zermatt or Aspen, but with less pomp. The traffic here stops for pedestrians and there´s a policia control on the way in....they check to see that your lights are working and you don´t look like a drug smuggler. "where are you coming from?" and that sort of thing. Makes me wonder if El Calafate is in danger of being overrun by Banditos.

I have a hard time remembering i´m on the other side of the world, as i listen to U2 in concert and look out over the little town surrounded by some of the most beautiful landscape i can imagine.

I´ve made the best decision in three weeks for dinner: lamb ravioli. Yummmmmmy. In Pura Vida (recommended by the Moon Guide, but with no "moon" designation, the style is eclectic, santa cruz hippy: paper and star lanterns, dream catchers and local woven wear. The subdued lighting is cozy and understated and we´ve wandered into happy downtempo like Theivery Corp and others (like the French sultry sounds of the future which is right now). The ravioli is filled with a delicious tender chopped lamb and pumpkin (a popular addition to all the food here) with a bit of cheese in a handmade pasta shell. The onion and olive cream sauce compliments the larger than normal bits of genius. the pepper might have been a a little finer (whole peppercorns at times). But this is the first time i´ve seen pepper in two weeks!

They also have half bottles of wine that i didn´t see from the start. It´s a nice touch for those of us who eat alone, but would prefer to avoid drinking for those who are absent. All of the cheap wines i have had so far have been utterly drinkable. Here is the Postales del fin del Mundo cabernet. When i say it, i think of things wonderfully sweet, melancholic and pensive.

Upsala and Spaghetti

2008-09-25T23:10:00.000-04:00

Upsala glacier boating, it turns out, is pretty darned awesome, even with all the geriatrics on board (i met several lovely people, but longed to be on my feet wandering, and noticed some inconsiderate cigarrette disposal). The boat trip was about 6 hours from start to finish, and i braved the icy cold to watch mountainscapes arrive and recede from the front of the boat whenever possible. We even got to see the Spelatini (spaghetti) glacier throw some ice around and make a lot of noise. It´s amazing to watch the ice fall in and then realize it dove so far that when it returns to surface it is like a volcano eruption.

Along the way we met many icebergs...some iceberg poop (or baby icebergs, but they are at the end of their lives), and i kept imagining myself with a tall frosty beverage, full of ice, about to take a sip while singing Octopus´s Garden. Don´t ask me why....

It was also my first interacton with a giant S. A. condor, crazy flying carrion-bird-of-prey chickens, and wild cattle--one contemplating his own mortality at a cliff face overlooking the water.

Enroute to Patagonia

2008-09-25T22:57:00.000-04:00

Cuidad del Este was a stopping point on the way to Patagonia to see Iguazu Falls. It turned out to be a special adventure all it´s ownÑ both mind blowing and harrowing with parts comraderie and frustreation. Imagine Niagra Falls, only bigger--like really bigger. The falls stretch over a huge expanse of land and have one large section, called the devil´s throat or Gargantua del Diablo, over which an unfathomable amount of water falls. It´s mesmorizing and lovely and amazing and exquisite, and sobering and not so much of the ¨disneyland" i imagined. It was a bit more like a south American Zion National Park trying to preserve place without sacrificing awe.

There were 5 of us included on the journey, including myself. Lynn, full of vigor and excited to do everything, who is somehow able to understand and be understood by everyone, even though she communicates largely with just louder volume and ellaborate hand gestures; Kristi, a mormon who lives the word and is kind and adorable, carrying photos of her cleft lip as a child, having finally realized it is a source of kinship, not shame and has a fabulous looking palate; my mother, who has come for the first time on a journey with so many first degree strangers that i´m proud to know her; and Jeannie, proud of her new dead animal acquisition: a new armadilla purse and whose smile and giggles are contagious even when frustrating things are happening.

After a wild attempt to have ourselves deported and banned from both Praguay and Brazil as we passed through, in transit, in both directions (visa issues), we managed to get to Sao Paolo in Brazil with slightly less stress. The way involved a frantic call to my siter-in-law (the awesome Molly), who managed to translate for us with the taxi driver nervously making signs of the cross as well crossed the borders. My mangled present tense Spanish and minimal understanding was apparently mostly correct.

Now in an airport in Buenos Aires, waiting for my plane to el calafate and the beautiful dream i have had since i started hiking.....Having 6 hours unti lmy connection (which required not only a change of planes, but or airports as well), i decided to find a dark corner in which to have a quick nap. I must have slept a bit because when i woke a second time, i was surprised to find that my spot was popular among the young male commuter set. There were 8 of us when i decided to get to my flight, me tucked in the middle, insulated from the draft, finding a little quiet before our next stop.

They all have way less carry on items, and also much nicer footwear. I wonder where they are headed.

Paraguay!

2008-09-19T17:34:00.000-04:00

It´s been another busy 10 days in Asuncion Paraguay.
There are a lot of tourists in Paraguay, but i´m really unclear as to what they are here to see. There are lovely people, but really....there´s not much. The culture is sort of interesting....if you have money, apparently you spend your time between the mall, school and restaurants and country club like things. Kids play tennis and ride horses and have expensive rich kid hobbies here. And that is more of what we see than anything else. The mission has tried to hide the living conditions of other people from us, it seems. So we have a barbacue at the riding club on the military base, and have a party in the backyard of the director of the board of Operation Smile Paraguay. Not that i am unhappy with these awesome events, but part of me wants to know more about the native Guarani, and learn about their culture (not from the perspective of those who barely know one). It might help me relate better to the families who are part of that population who speak a language as foreign to the high school students we work as Italian is to me (though it is the language of Paraguay).

We had many cancellations this time for low hemoglobins and colds. Unfortunately we also had two very sick children come through. One was a little girl who might have been sick before and the intubation worsened the cold, and one who has some sort of syndrom (looked like downs) who came out of the OR with seesaw breathing, sternal retractions and breathing 90 times a minute.....Both went to the ICU and did well. Both are now home.

Going back to the early comments, one of these children is Guarani, and his mother speaks only Guarani. Apparently, she didn´t want to go to the hospital because she didn´t know how to use and elevator or read enough Spanish to find her way around the hospital. One of the military men here went with her and her husband to act as a translator and friend and stayed with them at the hospital overnight, having developed an attachment to them.

The people with whom i work are always fantastic in their way, but several who have stood out have been Jane, who introduced herself to me by asking me was i married to Ben W. She is charming and sweet and pleasant. Having spent some time with her, i realize that my immediately liking her was not foolish. She continues to charm me and is always smiling. Jeanie is similar, and is soft spoken, adventurous and has foolishly invited me to Anarctica.

Emmanuel gets special kudos for giving my poor mother an epidural for her back when she was suffering so badly. But not just for that=for being patient and open and honest when he was talking to two women who are newly committed and assertive and not entirely (but mostly) women by nature.

And Ana, with whom i would work on literally any mission. She is beautiful, social, and such a competent intensivist. Knowing when to assert herself on behalf of a patient and when to back down and let someone else make decisions.

There are others, too: Carly and Shannon, our students are adorable and friendly and i really hope that Shannon decides to study medicine. Umberto let me growl at him with a plastic dinosaur. Jorge let me chase him with a pen because he forgot to sign his paperwork on nearly every case. Kim, who suffered me in the OR with her, and came despite a terrible tragedy in her life. Lynn who is excited about everything, Claudia´s sister, Marta, who suffered me to speak Spanish with her (however limitedly), and who barely speaks english either. Kathia, whose patients all came back pleasant and peaceful. John who gave blocks to all his kids......

i am tired, though.
and i´m getting sick again.
so i will stop now.
On to Cuidad del Este and the huge waterfalls surrounded by disneyland-like tourism.....
woohoo!
photos:
http://picasaweb.google.com/operationsmileparaguay2008
utterly unedited by me....

Puerto Vallarta, Colima, etc

2008-06-06T19:43:00.000-04:00

The five days of surgery are over, and 91 kids (some very old kids) got their new faces. One was a 30 year old man that was our last patient. He had his nose refixed....I gave him a stuffed turtle. At first he said no thanks, but then i told him it was an extra. He smile, giggled, and accepted. It was heart warming.
No catastrophes. Minor complications....A great team and mission overall.
I decided i am going to likely leave my computer here at the hotel and return to this hotel before i fly out. 7:30 is too early for a 3 hour tour.....So, look for me on gchat if you're reading. If i don't return by the 14th, assume me missing somewhere on the coastal road from puerto to colima.....

last full day

2008-06-06T01:03:00.000-04:00

Tomorrow will be our last day of surgeries and i will be sad. I'm really learning a lot here, and really enjoy the people. Karl, who has been hanging out in the recovery area as the Johnson and Johnson rep, has done a little research for me. Apparently the Vulcan de Colima is at threat level yellow. I think this means i shouldn't take anything in my bags for strangers while hiking....
Also, he double checked with his cousin that my route to Colima from Puerto Vallarta along the coastal road will be safe. The claim is "yes-between 10am-4pm." Well, that's enough for me, i guess. I have been warned to lock the car at all times and to buy Mexican driver's insurance so i don't risk getting thrown in jail for not having it....
I have also learned that i might need to bribe corrupt police officers and wear blinders if i see any shady drug-like deals going down near me.
Tomorrow is "tacky scrubs day" which i have trouble interpretting....One of my ideas was tacky, but in an unprofessional way. I decided to go with the tried and true poop humor. It only requires some brown stained toilet tissue. It must have been something i ate....

day 3 of 5

2008-06-04T23:55:00.000-04:00

So three days of surgery are over....some minor issues, many difficult cases, but all the kids are well. Some of them are totally adorable....like Carlos, who got a bilateral cleft lip done and would cry, but only if you stopped making him bubbles....
Another was the cute fiery redhead, Kimberley. I truly thought she would be a crazy woman, but she was cute as ever, one pigtail still in....doing really well. One bad case requiring immediate attention, and one relatively bad case. I'm learning a lot from the anesthesiologists on site, and am learning about surgery procedures when it come to trying to reconstruct a normal lip. For instance: today i learned that you don't need to do anything about all that hard gum that poked out from a bilateral lip_you just sew the muscle over it properly and it will work itself out--growing into the place it should once the skin, mucosa and muscle start pulling it into place. Beth was also really nice and taught me about all the surgical tools, and Julie (anesthesiologist) taught me more than i could imagine in a short period of time: including the fact that i want a custom fitted pre-cordial stethoscope. Apparently she had to really special order one.....but it worked out for her.....(incidentally, this is a stethoscope you use with which you listen for the child's breath sounds and heart sounds....).

Only two days left (well 1 1/2...). We should finish them all relatively quickly. The mission hasn't been any 15 hour days....none 17....mostly just 12 hours for us (not including transport and wake ups....). I feel like i'm on vacation even doing this because it's so darned fun.

Karl (the drug rep for Johnson and Johnson) was kind enough to take me to a gellateria that has been around for 100 years today. I had the best darned coconut icecream and kiwi sorbet i have ever, ever had. The post-op team and i then shared salads and had a bottle of wine. Who could ask for a better end of a day? Friday is our last day...there's a dinner planned, then out to drinks with Karl (promised to return his favor and invite him for a beer with my roommate). We'll see if i hold up.

I found out that the road from Puerto Vallarta is relatively safe and that the volcano is currently at threat level yellow. Safe to climb, though i need some sneakers and a way to carry water. Should i tough it out and just carry up my timbuk2 should bag? Votes?

mmmm.....tequila

2008-06-04T00:58:00.000-04:00

A well-aged tequilla is apparently like a well-aged scotch....and just as delicious going down. Three toasts in the Jose Cuervo cellars, stinking like rubbing alcohol, high off the fumes alone, i realized that tequila isn't just for margaritas anymore. It was a beautiful team building day in a city that got to name a type of alcohol. mariachi, a father and his two sons with their horse doing rope tricks and more beverages than you can count....my favorite was the plain lima margarita.....They served us a beautiful lunch and performed dances and all in a beautiful backdrop. Apparently the factory used to be the grounds for the estate. The ovens are made of adobe. They reuse all the left over pieces of agave plant as fertilizer (like 98%) and the rest is organic compost. Apparently their advert speak is that they are the only "organic" tequila. It made me giggle a bit =)
The tour was entertaining. The most famous agave farmer practices his trade as a showman for them now....he was on the cover of GQ....

To bed now.

Entry to Guadalajara

2008-05-31T20:56:00.000-04:00

I think of all the missions to which i've been, Mexico is my favorite so far. It happens to be for many reasons: familiarity with the language, warmth of the people, and ART.

Unlike the other two missions on which i've been, this time i arrived at the airport with a co-worker and was taken to our hotel in a private car of a volunteer. I found my roommate lounging in our room. Joanne is a beautiful fiery redhead, soft-spoken with a bright personality that charms.

It's also been a rather light mission. We only screened 128 patients, and there are only 94 on the surgical schedule. The challenging part will be that most require complicated work, and thus might be difficult after their surgeries are done. The local nurses are really wonderful and it was an adventure (much like always) communicating our different things to each other. We had translators, but i managed to be able to get our brief medical history from the parents in Spanish by the last couple patients. WooHoo!

We are working at the Institute de Circua Reconstructiv (?) It's an unasuming building on the outside, but on the inside, is this:

a giant mural that takes up a stairwell. Like much of the art of Mexico, they're not afraid to add some demons....

The first day we were able to take a bit of a look at the city: two churches, and a large market full of both wares and food. The numbers of fruit, and veggies and all sorts of birds....oh wait, those were pets. Actually the market has entire petshops full of finches and mourning doves. I wasn't in my bargaining mood, so i didn't even look much, except to see a pair of antelope skulls sharing space in one of those warmer ovens with fried corn tortilla thingies. From there, we went to a building that was once an old orphanage, now a giant art gallery. Outside, was some of the coolest sculpture i think i've ever seen. Made of brass, these bits of furniture are people stretched. Alejandro Colunga (sp) was his name. I have yet to do more research.

Day 2 of tourism found me in Tlaquepaque, which is a 20 minutes cab ride south. It's a little town full of high class galleries and some restaurants. There, Joanne and i were personally serenaded outside by a Mariachi band while we had Margaritas that made our heads spin. Also it involved a hellado that was better than any i've had in a while. I shopped for laundry detergent and moisturizer.

Today i spent the afternoon finding and playing at the Parques Aqua de Azul, or the park of the Blue Water. Here is a park much like Central Park in NY. Within, there is an aviary (sad birds with pulled feathers, but also bird pairs that seemed to be helping each other get by. Beautiful Scarlet McCaws seemed like they were partners within the large aviary. What made me sad was seeing a large hawk and a raven in cages the size of an ottaman that seemed like they wanted to hunt. The hawk was fierce, eyes twitchy, seeking feed and sport.

The butterfly park was a large mesh dome --the centerpiece of the park. It was sadly locked, but i was able to walk the perimeter. The ones that i saw fluttering about made me feel sleepy and warm....Butterflies also fluttered around wild: beautiful monarchs, and hummingbirds!

I saw, not less, than 5 brides.

I am headachy, possibly dehydrated from the dry heat and walking all day....
Hooray for everything!

Smoother Landings

2008-05-15T05:22:00.000-04:00

I managed to start understanding little things like flaring and controlling speed this last week with Dave. It's truly a wonder to learn something so wholly different than that to which i am accustomed. There are way more controls on that dashboard than i sometimes know what to do with. At some point i know that it will become more simple instinct....but for now i feel clumsy, insecure and generally frightened sometimes. I manage this with a candy bar after i get down to ground....

I got back from a really great visit on the east coast last Thursday. It was really nice to see so many people who i have missed and wanted to spend time with the last time i visited, but as usual it all felt too short. I need to take many trips cross country if i'm going to live this far away from people i like. Poop. I like people all over. That makes things really hard.....I had a rad tequila soaked evening with Chris Rossi at El Vez. They have the most delicious blood orange margarita i have ever had/ And their Oaxaca Guac is to die for...full of delicious garlic and onions....

Going wedding venue shopping with Ericka was also a delight. She made me a little jealous by finding a beautiful B&B in New Hope-ish area. I am super glad to be invited, because otherwise i would just have to book a room here for the weekend.

I also met up with a friend i haven't seen in 10 years. Jason and i used to hang out at my house and wander through woods in Cherry Hill when i was just out of high school. That was a less toxic time, when i was more straight edged and uptight....We still have some things in common. We both want Tenori-ons. We both dig the electronic beats. We both were despondent when the Chegg was closed on a Tuesday and we had designs on the best chicken wings on LBI (actually anywhere really....).

Friday was super fun at one of Josh's barbecues. When Josh throws a barbecue, he's throwing a party. It's a lucky-to-find-a-utensil, dig-into-the-protein-with-your-hands kind of party. A party where you might only know one person other than Josh. He might be trying to set you up with someone. I got to spend some quality time with Susannah, too. That is always a pleasure. Staurday night, i got to see her comedy troupe perform. Not only were they funny, but apparently Susannah has funny friends. I won a prize to go see them again =) I will do so as soon as Susannah lets me watch *her* perform!

This year is becoming busier and busier. I have decided to do a second OpSmile trip. The next will be to Paraguay....one in which my mother will join me and i might actually get a chance to see Patagonia before i die...which is on the top 10 list of places to travel (ranking with such places as Japan, New Zealand, Thailand, Madagascar, Italy, Greece, the Galapagos, Alaska, and Tibet (just like every other hippie). It turns out that nature is a drug to me. I like being in it. I like looking at trees, and watching them twist their branches singing soliloquies to the wind. I love the vast terrain of mountains, climbing through snow and watching ice melt. I like to sit in grass and feel individual blades trounce across my skin..... Patagonia (and much of what i have seen in photos of the surrounding areas in Chile and Argentina) fill the bill for being simply epic in their presentation.

I am really selfish for wanting to go on Op Smile trips to places i want to travel. It's such a great way to meet the people and get a feel for the culture in the company of so many locals with whom you work, though. This is one of the pleasures of these trips. Don't get me wrong, the satisfaction of seeing kids come out with fully fixed cleft lips is amazing and uplifting, but there's something so awesome and unique about getting a bunch of strangers together and working for a week to set that up for 150 kids.

On a completely different note: i have been finding that being with a partner really changes how you feel things...Spinning out of control on one of my anxiety trips used to be such a personal isolated feeling. I would rummage around doing whatever my fingers needed to do to cure my anxiety and no one would notice. Living with someone who is so close makes me so much more conscious of that feeling. Then the added nudge of "hey, what's up with you?" makes me question something that has just become routine. Learning new habits, learning to see more from the outside is a big challenge. I am realizing that there is so much involved in this intimacy that i can put words to. (rather than feeling paralyzed by all the things i can't) It's very nice, and makes me feel even more part of a team.

In the next 6 months i will log over 35,000 commercial airline miles.

No wonder i feel overwhelmed. But someone once won my heart with the phrase: life is short.

learning to fly

2008-05-01T01:22:00.000-04:00

learning to land is hard.
we catalogued 9 landings: 3 my instructor did. 2 i [racticed slips.... 2 my instructor aborted in a bit of frenzy (ok, only frenzied when i tried to put the nose down because i was too high in a straight pattern), and 1 passable, one i did well.
So i am learning a bit more about the muscle memory involved in pulling opposite aeleron and rudder to keep a nose straight, but wish there was a lot more runway to palo alto.
I love Dave Fry. He might be a hard instructor to please in some respects, but when you do well, he lets you know it.
=)

little side note while i am distracted. University of Penn foolishly accepted me into the anesthesia program for 2009. We're moving east side in a year. Two years to graduate with a masters in putting people to sleep without pain!!! woo hoo!!!

May brings an op smile trip to Guadalajara! After that it's anybody's guess.

Carolina and TQ over for wine and cheese tonight. I love those guys. TQ was gone too long, and now, on an east coast visit, i feel far away as well. party up upon the return. Must use my last year here to make sure that people like her know they are awesome and special and will be incredibly absent if we are gone for too long away from them....

Astrid...Rob...must make dates.
alone if neccessary.
Mom Weaver sending more wedding paraphanalia....shame shame....
;)
babbling like a brook with a high concentration of ethanol leads one to curb further rambling.
cheers!!!

what does your internets say about you?

2008-03-04T15:12:00.001-05:00

Every so often, i think it's good and healthy to "google" yourself. I know there are many who disagree and believe this is a psychological malady that can only lead to long term psychosis or just simple vanity.

I realize that my life hasn't changed much on the internet. Though i will say that with the popularity of Amazon, and my one review that stuck with them seems to place me as second on the internet searches with my actual name. That's not too shabby, but what does this say about me as a person in the internet world?

Sophus, for example, with his rare name also shows up second. His entry is his real live journal account. I think that's something of which to be proud.

After the first of "my" entries fourth comes stuff I've written. Actually, this is how i found out that some of my poetry exercises from college ended up on other people's websites. Which is flattering, but also confusing. One i hadn't ever let loose on the digitalized world, which means one of my classmates took it and typed it up for all to see.

Seventh is what seems like it should be my Blogger profile. Until you actually link to the thing and realize it's all in Italian. Sharing a name with Italian boys is just weird.

When you consider what people reveal about themselves on the internet, it's an interesting mix choice. For instance, A randomly decides to write things in her live journal, but you have no idea what is happening in between floods and vacations. There are months between.

M has chosen an equally episodic style in both a journal and a home page. When something strikes his fancy, he'll add it to the mix. But there's little rhyme or reason to the listings. Even the explanations only make sense to people to whom he is close.

J takes random bits that he's found in real life or on the internet and has short sentence to paragraph observations about them. He's hilarious, and makes me giggle pretty regularly. But who the hell is he?

Sophus is about the only one who has a real life story of the people i considered. Which is easy when your 28inches tall and have someone to type for you while you dictate. (Well thank goodness--think of how hard it would be to hunt and peck with those little fingers!)

Typing in my full name (middle name and all) produces no results....which i guess counts for something. Like that i haven't been disciplined by anyone that would put my name on the internet nor has google made my medical records accessible to the world. That's a little comforting.

I realize people on the internet are like people that only self-report. They choose the parts that they think are interesting, and their motivations are different. Some people blather at the mouth like me, observing things and offering opinions or just opening up dialogue about them, and hoping that someone they know will care to read the information. Some people want to point out the absurdities of life. Some people want to show others how smart they are, some people want to be funny, some people are looking for fame by reviewing something like food or comics or books or razor phones hoping that they can achieve interwebs notoriety for the few brief clicks that a ADHD society can handle. They do this in all sorts of ways from Youtube videos to animations to just plain old good font.

What does this say about us?
Are we all lonely?
100 billion bottles washed up on the shore.

Zero Punctuation

2008-03-03T16:22:00.000-05:00

It turns out that video games are funny:
http://www.escapistmagazine.com/articles/view/editorials/zeropunctuation

I have a dress on order in which to get married.
My first shift back to work after my first official "surgery" is tomorrow night.
Flying is one of the coooooolest things i've ever done. Amazing. I got to see Palo Alto from 3500 feet and fly just below SFO airspace. My flight instructor, Dave Fry, is probably one of the best instructors for someone with minimal understanding of the art. He explained everything so well that he had me take off and do a couple turns on my first day. I look forward to many other lessons and eventually being confident enough to land the bugger.
Woo hoo!
Maybe more photos....someday.

My appendectomy scar is bigger than yours!

2008-02-14T06:28:00.000-05:00

Last Thursday, i decided to investigate a pain in the belly that could only be described as suspiciously "textbook." This visit was less about the previous fear of headache caused by an AVM (causes subarachnoid hemorrhages, or simply put: bleeding in the brain, and can kill people) and more that the consistent pain in my stomach that migrated to my right lower quadrant might be the sign of a pretty pissed appendix. Turns out my vestigial body part was going the way of my sixth fingers and tail fast, but more violently, and in less evolutionary steps.

Some things i learned from this experience:

Anyone who tells you that laparoscopic surgery is painless is not human.
The skin glue they claim will come off easily in the shower doesn't.
I can show you where they did my chlorhexidine prep!
Thrush comes free with my $1000 dose of broad spectrum IV antibiotics.
I feel sympathy for pregnant women after trying to sit in a bus seat.
I understand obsession with regularity and love stool softeners.
My resting heart rate on anesthetic agents is 45.
Relinquishing control is *really* hard.
Give me more fentanyl.

Having told the receptionist in the ER that i was an ICU nurse upstairs also helped in receiving the best care possible, including a "pop-in" visit by the director of the department (maybe the director of the residents?) that led to him being my primary for my stay in the ER once he saw the CT scan, prompt attention from the surgeons (and even a conversation with one-like really communicating, sending receiving, the whole nine yards!) and being able to cheat and look up my stellar lab reports and feel confident that i don't need a physical (though my operative reports are not accessible to me easily and i'll have to ask about the whole anesthesia process since i don't remember anything after recalling to the CRNA my not remembering anything with that other dose of Versed i had when my wisdom teeth came out (to non-medical people, this is a benzodiazepine--like Valium or Xanax that has such potent amnesic effects that you wouldn't remember if someone ate your cat's heart in front of you, but keeps you perfectly cooperative and able to interact if given in the right dose)).

I awoke to the startling attempts to make my heart beat faster than the low 40's that were unsuccessful. (lowest i ever saw for a resting rate was 35 in a marathon runner). It was soon after that my love relationship started with narcotics (Hate started at day 6 after surgery when i finally pooped rocks). They worked so well for my pain and at that point i was so high from the anesthetics, i didn't even know i was high anymore. I just knew when the pain started again. I also learned that fentanyl is a very effective pain reliever, and dilaudid is not, and that morphine is totally ineffective for me. Well, except for the freaky feeling that i might be dying the moment it first hits my nervous system. After a few seconds, that goes away, i'm still in pain, and my mood may or may not be better.

They let me eat a couple crackers and drink some juice about 4 hours after the surgery, but have you ever had so much air pumped into your abdomen that you look pregnant? I'm only just now, a week later, able to down a meal like i used to. But i don't want dessert. That's weird for me, right?

Now i just can't walk upright because it pulls at the navel insertion site, and have tenderness all around my belly that feel like a stitch in my side at multiple sites.

So i also found out that i am in competition with: my great uncle who died of complications from a ruptured appendix; Jinnah, who waited long enough that his appendix ruptured and he got the added bonus of losing some bowel; Dave, who also ruptured and was in the hospital for four days with drains and has a 5 inch surgical scar; my aunt who also got a drain but didn't rupture; and the latest only 3 days after me, was Sean who didn't rupture but is probably equally bemused by the claims i read by some status post laparoscopy patients that they were back to their usual schedule of running 4 days a week within 3 days.

The care i received was stellar and i'm not just bragging about my institution. It could, however, be slanted because i am an employee. Every single human being with whom i interacted was really considerate and had way more than a modicum of feeling for the human part of medicine. It was nice

Will evolution catch up already?

Icon: Murderhorn, bags and music

2007-12-20T06:42:00.000-05:00

Retunring home from 2 weeks in Europe, finally I'm home. And i susequently do 4 night shifts in a row to wecome myself. I got to see the Murderhorn! There he was, pretending he would hide behind clouds, but i needed to wake up to see it, from the bedroom window of our totally awesome hotel.....the iconic mountain of the Alps.....We cheated and took a gondola most of the way to the top. Altitude sickness made me climb back down the ladder to the highest elevator in the world right after watching a Frenchman propose to his wife. She said yes...

We drove long hard hours to make Bremen by 3:30 AM on Monday. My aunt and uncle had beautiful plans for us, including eating at my favorite restaurant near them, Ambiente. It is entirely covered with solar panels that power the place during hte summer and spring when the sun actually shines. They also serve the best hot chocolate with little biscuits. This would be our first of many lovely European breakfasts full of toast and eggs and jellies and nutella and meat and cheese. I will come to wish for roughage, opting for voll korn brot eventually.....

After being treated to a little dinner party in our honor before we left, we hit the road to Berlin (again, late and power drive according to the Germans....they do live in countries the size of states, and one state means another language and culture alltogether). Ther we bought records, bags and went to Icon, a club with no actual written sign, just lights in the street with their "icon" hardy har har.

Here's a little something i wrote while i was there which summed up the non-music part of the night. The rest of the time, i was too busy dancing by myself, or next to Jared with his arms folded with two beers in his hand, or near mjw, who seems to show me up on the dance floor when he gets his groove on....:

The internal dialogue presents in a bathroom in a berlin electro-club: sitting in a bathroom stall suddenly realizing seperateness involved when earplugs bar the way to noise filtering the raw music from the chaff. It finds me wondering whether I'm addicted to full throttle and haven't actively pursued it until I've become too old in the engine's half life.

Is intensity a constructed thing? Have I imagined the world at the wind's fingertips to be something artificial and intangible? Can I tell excess from satiation? Will I always seek the thing that remains clouded behind the curtain? Have I taken too much in with the comfort of proton pump inhibitors that facade the exterior with a care free life? I touch that space between these thoughts whistfully...occasionally... when I glance into the void in the bathroom's tiles that waxes and wanes with a blink. There is sudden grateful sadness in those mom.ents and a feeling of being overwhelmed...and regret mixed with thankful understanding retrospect.

The music gets louder. I don't hear the break for the clang of my own head for a moment beating with precision against what it believes, at that same moment, to be the noise. I'm simulataneously sad and happy full of tears at that moment that I missed a bonding moment- with sound and noise and the other. A moment of internal dialogue-needed at a moment when the island can only remain isolated uninterested and desperate to be found. It seems odd and appropriate to lose myself now in the clang of other people's heads now that I have relocated my own.

Anyway....i've decided to stay home for a bit....

Thanksgiving

2007-11-23T03:20:00.000-05:00

Thanks to everyone i know for being. =)

One thing i failed to share was that i am engaged. This is a little scary, as i never thought it would happen. But i also knew that if i could stay with someone for a year and then live with them for a year, i would have this whole life thing licked. But as things happen a young man who stole my heart has asked to make it official.

http://www.ice-nine.org/matt/pics/mjw/2007/10/26/index.html

Photos of the asking.

I'm meeting him in Zurich in a week and i can't wait. In the meantime, i'm at my brother's place that he shares with two roommates in San Diego for T-day. Mom's here, too. We overate as 90% of Americans do on this day after Chris and Liz cooked an awesome meal (along with side dishes from the peanut gallery). I've also been playing a bit of guitar hero and we played a riotous game of Trivial Pursuit. I still stink at that game. Guitar Hero for PS3 is crazy hard on hard and medium is a force with which to be reckoned.

Bargaining, and Politics

2007-11-23T03:08:00.000-05:00

After paying what was asked once to a ridiculous amount, and a second run to the silk market, i have become a ruthless bargainer. If anyone knows me well, they know that i have a look in the eye and smile for nearly anyone i meet (except on a really bad day). This is certain death in the silk market. It means you're interested in some sort of wares. It is at its worst in the handbag and luggage department on basement level one, where they will literally push purses into you with words like "want a Prada bag?" and" look sexy lady, Gucci" and the like. Again, anyone that knows me with my granola gear knows that despite a fetish for things that organize my stuff (including bags of various sizes that are never quite perfect), i don't like any of those labels. But i tolerate it for the experience....and to find some Tokidoki knock offs. Day three of shopping and i'm unstoppable. Ten dollars is ridiculous for that silk scarf! I won't give you more than 7! Rachel and i tag teamed it and got people to throw their calculators at us and yell that we were taking advantage of them, as though they were selling to us at a loss. It turns out that in some ways, it's just funny. In other ways, it's just not how i operate.

Politics in Beijing are less direct. I did not get the opportunity to get to know anyone for significant a time except to find out that whenever asked an open ended question, they engage in creative avoidance, and when asked a direct question, they just try to point out the positives.

Someone with whom i spoke about China who had been there for several months in college more concisely explained "they have patriotism." I think that there is certainly a pride in Chinese history and the country. I wonder how much they misunderstand the outside, however. For instance....are the great shows of food a belief that we are gluttonous, or are they showing friendliness with food?

It was really hard to get a sense of any of it, for me.

Echolocation in traffic

2007-11-22T16:40:00.000-05:00

So, in America, many people have difficulty understanding why Asians drive the way they do. I have the answer. Just take a trip to any major Asian city and you will see the art of echolocation driving. There are no real traffic rules except speed limits and lights. There is no road rage, but statistically, in order to get anywhere, you will have to butt in line. You will also have to avoid letting others know you plan to butt, so you can’t use your turn signals, and you have to really push through stubbornness by making extra lanes if necessary.

As a pedestrian, the same kinds of rules apply. But given that you are a smaller, less formidable enemy, you have to be sure to pack cross. When one person edges out, everyone needs to, so that drivers recognize that they are no match for more than one adult sized obstacle.

Through all of this is the echolocation….the gentle beep to let you know I’m here. This is not to be confused with the beep because you just butt in front of me and I don’t like it (the most venomous form of road rage you’ll find.

And somehow, it all works. I only saw one minor fender bender while I was there. And no one yells. It’s really amazing.

He who looks for trump finds only 9’s

2007-11-22T16:34:00.000-05:00

Vincent, Rachael and Scott are now seasoned Uker players, but surely Vince was the most fun to watch perform. He now plays like no other Uker player, having learned the art of Zen Uker. He has no idea what trump is half the time. But somehow, he and Lindsay manage to kick everyone's ass. He also wears the worst poker face and has amazing luck. The giggles between he and Lindsay were more entertainment than the game itself. I think he has probably been the most entertaining Uker buddy I’ve ever met, especially when he was in the barn. Lindsay had never heard of mooing and wearing card cow ears. Must be something i picked up at band camp.

Terracottaschmotta

2007-11-19T11:33:00.000-05:00

After a luxury stay at the Sheraton, we were off again for more sightseeing. I am beginning to realllllly internalize why I hate going on tours. We head to the Terracotta Warriors today.

After a stop to the local tourist trap, the terracotta warrior manufacturing plant. We band together as a team and buy nothing!

A day full of stuff, we started with the Banpo Village. Allegedly a matriarchal village (surmised) 3000 years old, women were typically buried with more “stuff.” Skeletons were tiny, and some showed signs of violent death, though little explanation as to why except “this person seems in a weird position.” The thing that really got me is that 3000 years ago people still had this weird relationship to death. They put their childrens’ corpses into pottery jars and buried them. The idea of a coffin starts with this….what drives people to this end. What did they believe about the dead body that required it be encased and ritually buried…..? It fascinates me how we developed our ideas about the rituals of death.

The fire pit was also the central feature in the huts, explaining so much about society at that time. That is what makes the ritualistic ideas about death even more strange. They had to worry about food and shelter, and still went about the confusion of contemplating death.

Outside this archeologic site was the amusement park version: the entrance through which one passes is a giant vagina. There are also enormous breasts throughout the park. Very strange indeed….it explains why they made such a big deal at the entrance of the real Banpo village site of it being a “matriarchal” village. It might also explain why it was a big deal to stick one’s hand on the hip bend of a giant statue of the Empress/concubine statue at Houtang Springs.

The springs were beautiful, but mostly just for pretty photographs, and the imagining that one could be pampered in private hot springs. I was far more curious about the military history of the place. Apparently it served as the headquarters of General Chiang who wanted to eliminate any communist uprising during the 50’s. He was eventually forced out of his desires for thwarting the popular politics at the time, but never really lost his rank. That is all I know, however….leaves more research for the US.

Back in the bus, we headed to the infamous Terracotta Warriors. The story for these guys is amazing. Yet another bankrupting project for the Chinese people, this site takes up a vast amount of space and celebrates the life of one Chinese Emperor, Tang. He was so fearful of being beaten militarily that he wanted to be buried with his entire personal army. Someone close to him convinced him the terracotta variety would be just as effective in afterworldly battle and he settled for over 7000 warriors carved out of clay.

The story is so impressive that I expect it to be this otherworldly experience….
It isn’t.
Most of the “artifacts” are admittedly imitations. Though the chariots are impressive, they are admitted reproductions. The three warriors they chose of the over 7000 different members of the army are fascinating, and beautiful, but only a smidgeon of the bigger picture. The vault of warriors that was open was duly impressive to some degree but not any different than what we see in the photographs….Overall, I have loved the traveling, but I have learned many lessons on this trip.

The overnight train back to Beijing was met with less exhaustion, and thus with less sleep for all of us. I tossed and turned, for the first time finding myself unable to get thoughts of mjw out of my head, having the first moment to think of anything but traveling, working and being present. No distractions worked…..eventually sleep took me, but only for a few hours, and now I must sleep for days.

Saying goodbye is bitter. Traveling together has made us feel a bit like family for a while, and their absence is felt, despite my need to rest and be alone and take in all that has happened. I had dessert with Liu Fang and got to know her even better. She is as awesome as I thought she was and more. Hopefully she develops the confidence to figure out what she wants and then relax into it…..she is beautiful, dynamic, engaged, and atypical compared to many of the other Chinese women I have met. She cares what others think, but not enough to compromise herself. That sounds really familiar.

Tonight at the Marriott, someone left me a card under my door. Apparently I can order a “service item.” On the business cards are featured two lovely women…..I wonder what services they offer. ;)

Tomorrow I head to San Diego for T-day with the US family. My mother will be arriving from her stay in Brazil with Operation Smile. World travelers meeting to say thanks for being. Hooray!

After that, I work three days and head to Zurich to meet up with mjw and jared will join us on Saturday. Then it is time for a more leisurely vacation, and I will be the tour guide without tourist trap stops. Except maybe the Weinachtsmarkt. There’s no getting away from it….i love Christmas in Germany even if it lacks its Christian meaning to me….

Notes on the blog itself

2007-11-17T11:18:00.001-05:00

If you are reading this currently, you will notice the blog is a bric-a-brac and looks rather....well, terrible. It is for this exciting reason: i cannot access my blog from China. Apparently i am a dissident or something, and the government doesn't like that i mentioned the squatters, or needing the right Chairman to get a Coke. Now, i'm in real trouble....i posted stuff about Tian'men Square.....

Anyway, I can post new entries, but not see what's been written, realize when i've been drunken posting, can't edit in my photos yet, etc.....Please come back soon and see that i care enough to make it look better. Incidentally, all the commands are in Chinese characters, too. This makes things harder....

Thanks for reading, and patience. Hope you're all well

Yet another lemming

2007-11-17T11:15:00.000-05:00

We parted ways with nearly the entirety of the mission teams. I joined a group that is all staying until the 20th. It is Donna, Debbie, Scott, Vince, Rachel (who went to Hangzough), Lindsay and I all on our way to Xian very soon. We started the day with a rickshaw tour through the old streets of Beijing. This was probably the most fun that we have had with the tour guide. We ate in someone’s home for lunch, saw some local color like a mocking bird and two love birds in cages outside, and crickets, all to drown out the unwanted noises. It was nice to see the back alleys and where some of the people really live.

During the tour, we stopped at a Kindergarten. It was so cute…they came out and sang songs for us. They asked us to sing back and we improved an acapella Row Row Row Your Boat and did the Hokey Pokey with them, and then I chased after them all around the courtyard of their school. Truly a fun time. Turns out they must do this a bunch of times a day, because a group came right after us and a new batch of children with a new routine and song came out. Dance for me monkey! Dance! Oh, and then contribute money to the Kindergarten.

Before I told you that the Forbidden City was just a tourist trap and lots of space that was seemingly unoccupied by life. The Empress’ garden, however, is currently being used as a public park (for a small fee). Many locals were spending time here, either flying kites, or playing various kinds of card games or singing to one’s self, playing the saxophone, or setting up an amplifier and doing some karaoke. Even cooler than this was an outdoor gym. Here one could do bench presses, running straight-legged, monkey type bars, the parallel bars, sit-ups, stretches….all sorts of cool things.

It is here that I met three cats: lurking cat (a grey tabby that was out stalking the birds), nesting cat (planted firmly in a sandy pit keeping her territory warm) and posing cat (gracefully raising her head at varying intervals to look around and then returning to posing in various positions of beauty). It seems the cats were localized to one small plot of land in the park. Maybe they get fed.

After this, we tried eating at Pizza Hut, but the que was too long, so we ended up (after much rushed walking) at a place that served sub-standard hospital lunch room pizza (mind you, I haven’t had pizza since I left the Jersey shore last). We were going to do take out, but they seated us at the last minute.

We had just enough time from there to get to the train station and get settled onto our sleeper car. This has been, by far, one of my cooler experiences traveling. I have traveled by train but never a sleeper car! I was very excited, even about playing Uker at the table in the dining car until we got kicked out. Turns out this is a popular past time, as there were a bunch of German kids playing cards and a bunch of old Russian men doing the same, with their ladies watching with glasses of white wine (it’s still terrible). At 11, they kicked us out, and I went back to the all male but me car. Thank goodness, no one snored. I slept pretty well considering my usual light sleeper habits….though that might have had something to do with the cocktail of beer, benzos and narcotics I took to sleep.

We woke to the train conductor collecting our headphones and then collected out own belongings.

Our day of touring today in X’ian was not that exciting, I’ll be honest. And I felt especially taken advantage of when they pulled this feng-shui animal stick and I fell for it….but only for a gift for my brother (I am still trying to rationalize my parting with my money for a gift even though it made me mad again, which then just makes me mad at me for letting myself A. get sucked in, or B. feeling bad because I feel stupid for having bought the thing with which they tried to suck me in. Anyway, it’s all about a Dragon Horse and meaning good luck with health and family, and Booger, you’ll see it when you get it and it comes with all sorts of emotional turmoil. I’ll have worked it out by then.

We saw the city wall and a place of intellectual study that has all these stone tablets on which some famous Chinese works. It was called the Forest of Steeles and was actually interesting from a calligraphy stand point. Each of the tablets showed its own character with the style of writing. Some in cursive, some in block print….one that really caught my eye was one calligrapher who made his engravings as though they were true brush strokes. I wish I knew the name of the calligrapher, but our tour guide has a minimalistic approach to information. When I tried to listen to the German tour guide, I was missing too much to get the gist because of the ambient volume. Perhaps some research for home.

The rest of the interest was in what was written and the sheer volume of the tablets. I couldn’t understand Chinese (thought now I know the characters for people, eight, two, three, seventy two, and China), and the two tablets that featured some Arabic (?) were also, sadly, unintelligible.

The city wall was impressive, but unremarkable for a girl who has seen three British walled cities, and I learned a bit about Feng-Shui. Dumpling dinner just had me realizing I do not want dumplings again for like…..2000 days. Maybe not even then. They were cool, however, because some were in neat shapes. They were ducks, chickens, walnuts, monkeys and cabbages. Pretty cool. Our tour guide tried to talk us into some cruise-ship like show. We graciously declined, saying we would like to check out something like the night market. I tried to explain that they sell things like souveniers like the terra cotta warriors and chopsticks and stuff, have food stands, that sort of thing. I meant this to be a description of what the market was, not what I wanted….she said, repeatedly, even after much explaining that we just wanted to check out the market, not necessarily shop, that we could get the terra cotta warriors tomorrow, at the place where she was taking us, and at the terra cotta warrior site.

I will never take a tour again, I think. Despite all the language differences and cultural differences, I think I’m ready to go it alone for some of my next trip in China. The mission helped me appreciate how to get things done, and now I understand a bit more of the ropes of travel. But this is still not my way to travel. I wanted to hike some mountains today, but ended up a minority. I should have just gone off on my own…..maybe next time, I will feel a bit more confident with my ability to get along on my own.

Never underestimate a good burger

2007-11-17T10:36:00.001-05:00

The past few days have been very eventful. After a relatively painless flight back from Linyi to Beijing, we all went to the Hard Rock Café. Never before have I been such a pretentious tourist type as this. I was all full of piss and vinegar about the food, and wanted something different, something familiar, but not pork, chicken feet and fermented tofu. A ginormous burger fit the bill. Even a vegetarian can appreciate the full on comfort of eating a familiar food after so much of the same. Imagine a good garden burger, smothered in cheddar cheese, or some vegetarian chili…..imagine so many combinations…..i long for the convenience of multiple ethnic foods within blocks of each other and the option to eat what I want when I want.

We “shake” as Francesco says and then head home (leaving a few stragglers to bar hop the night away). Next morning is a bright and early start to the Great Wall. Now really, I was not too into going to the over traveled tourist section, but went on the trip for ease. And really, it also included the Forbidden City and Tian’man Square. These are all sites one should see once. Should I return, I wouldn’t need to see the latter two again, and I would choose a less traveled section of the wall, overgrown and worn thin, treacherous and a little scary.

On the way to the Great Wall we stopped at a Jade factory, in which we learned how to tell good quality jade from shoddy jade and where different varieties come from. This was the first of many tourist herding sites….well, it will be the first of many obligatory traps that such tours force upon their clients.

The Great Wall hike was just fun, a nice time to exert one’s self and be reminded of it for three days after. It was an accomplishment not everyone shared, but those who did had a good time of it. It is amazing to think that this creation is as large as it is and bankrupted an entire nation for its grandiosity that had little useful function. To see it wind across the landscape, seemingly haphazardly is something to behold, and literally awesome in a way. There are still remnants of it all around the county side, though Beijing had to tear down the sections within the actual city to create a decent road network in modern times. There were periodic guard towers and having seen the uniforms of the soldiers, I know those dudes were tiny….some of those steps were daunting for an average white girl. I’m impressed. In armor they did that!

After we were done the hike, we needed ice cream of course. Scott is a big fan of the Magnum bars, and I must admit, they are pretty darned good. We had a lovely Cappucino Magnum and headed to our second lemming shopping trip of the day, the copper vase factory. Here one learned about the time an energy they put into a single vase, but for you, we give a special deal. While a beautiful and interesting art…..well, the lemming comment should sum up the details. At this factory, we also had a decent lunch and many people were nearly left behind when the bus was ready to leave.

We then headed to the Forbidden City. This is where we discovered why the Chinese are so thin. Our tour guide, who went by Andy, walked at a rabbit’s pace leaving people stretched at least a mile behind him. He was fun the whole time, but seemed very hasty. We nearly raced through the Forbidden City. The highlights of what I learned are: yellow is a royal color, only the Emperor could use it on his shingles. The royal family is represented by the dragon and the phoenix, dragon=power, phoenix=family. The courtyards were protected from would be assassins with the complete removal of plant life, and with floors that stretched 15 layers deep to prevent from a digging attack. There were also three bridges that only royalty could pass: five bridges, the middle has dragon posts and is obviously for the emperor. The two on his flanks were for the royal family and the outer bridges for diplomats.
Interesting too, is the idea of the concubines. Apparently the emperor had 1000 concubines. You can’t even sleep with that many women in a year, can you? The women who “chose” to be concubines of the emperor (and were subsequently chosen by him) would have their entire family move up in rank. You can imagine the trouble that ensued between the women when another wanted to take the place of first wife, the Empress.

It was an impressive structure, and I think Chairman Mao must have had tourism in mind when the revolution occurred, because most of the buildings are still very much intact with little happening within the gates. The end passed through the Tian’men gate or “gate of heavenly peace.” Here I asked a less than diplomatic question in a diplomatic way. Andy remembers this incident in 1989 as a group of students that then also incited the workers to a revolution and the government finally stepped in because they felt they were losing the power. For the people living in Beijing that night, the electricity went off for 20 minutes, then came back on, during which they “cleaned up the square.” I’m uncertain what this interpretation means….cleaned up the protestors or cleaning up their bodies. I didn’t delve any further. He admitted that he didn’t really know what happened because all the media was silent about it.

After a full day of site-seeing we headed to the Silk Market, famous for its infamous knock-off designer labels. Many people shopped to exhaustion. I got exhausted mid-haggle. The culture of haggling is so incredibly potent here that both sides make unreasonable demands for merchandise and try to stiff each other. Besides this, they are also desperate to sell quantity, so despite attempts to make it clear that I was not a Gucci or Prada kind of gal, I decided to bail on shopping for things all together. I walked out with (mjw would be so proud) a bag. Then I lost all steam watching poor Scott get involved in a rather sketchy credit card transaction. Even seeing Lui Fang try to haggle was painful. She only managed to get a watch down to the same price as Jimmy, even though he is as white as a lotus flower.

A second Peking duck was had with many of the Chinese mission team members. It was not as exciting as the first time. No duck brains, and no scorpions on the menu. I was a little disappointed, I must admit. But we ordered some terrible tasting Chinese white wine and the way they filled them, I must have had more than I thought, because I went home unable to do simple mathematics.

Karaoke and candles

2007-11-13T20:15:00.001-05:00

It was the last day of surgery tonight. Almost all the priorities 1, 2, and 3 were done except a couple that were promised work later in the week by the local surgeon. Jeff, the photographer, did an amazing slide show tracking a really dramatic fix, a bilateral cleft lip that looks like he is a new kid altogether. He will never really know what it is like to be pointed at for his looks. It’s really nice to see the results of your mission work. In other missions, it requires patience or the acceptance that things might never change. In the case of this simple surgery, the results are dramatic and nearly instantaneous.

I’ve stayed late at the hospital nearly every night now. My attempt to leave early tonight failed, but I am glad I didn’t leave the unit until it was really time. Two kids ended up back in the OR for bleeding, so we were extra careful in keeping them in recovery a bit longer. One little girl unfortunately, didn’t get her surgery because when they took a closer look, they realized the work would be far more extensive than anyone thought. She may never be normal if no one comes to do this surgery for her, or volunteers to help her in country.

My body is truly beyond exhausted. I think that it is waging a rebellion. The excruciating headache I got tonight from sinus pressure was an indicator that it was mad. I have never worked so hard as I have here. It feels good but overwhelming. I will sleep soon.

After a lovely feast put on by the hospital, I found out that western women are revered as super beauties. Isn’t it strange how we all like the other better…two nurses nearly made me break out into tears. Sara in the recovery room was expected, but another girl I mostly just passed in the hallway and with whom I worked taking photos and distracting children and weighing them the first two days took a particular liking to me….i’m not sure why, because the language leaves getting to know people difficult, but she had a hard time letting me go, too. It is really a refreshing thing to have people become so attached, but I wonder to what they are attached. But then again, I have found some people instantly likeable just watching how they behave.

The food has been really good. Some things are not really for me, like fermented tofu. But I find the vegetables and fish absolutely delicious. There are also other little delicacies. Among them, I am told silk worms are yummy, and I am anxious to try deep fried scorpions if I get the opportunity again.

The hospital officials gave us all a beautiful gift of a calligraphy china set. It has a picture of the father of Chinese calligraphy on one (the vessel for the ink) and a collection of his calligraphy on the brush holder. I’m not sure what the cup says….none of the Chinese doctors I asked were able to translate it for me other than three characters that seem to mean keeping a rhythm. I’ll keep trying.

Karaoke happened tonight, as promised. The Chinese contingent held up all the Americans, as we all can’t really sing. Liu Fong and Tzau Ji Yi both did some duets, as did Lui Ching. Their voices are amazing. Even Li Dong and Xue Hong Zu joined us. They all sang. Jimmy, for whom karaoke is a favorite, did a fine job encouraging all of us to sing with a glorious rendition of Kokomo, and even Vince managed to join some duets, including singing Like a Virgin with Baron. I think Francesco and Lindsay were the only ones who got away without belting out a few lines. Even Francesca graced us with White Christmas.

Tomorrow we leave to return to Beijing and we will go on a city tour and see the silk market. I hear it’s a hoot. Then it’s off to Xian to see the Terracotta Warriors and a little hiking. Then back to Beijing for one last afternoon in the city. I still find it utterly amusing that it’s yesterday in the US. It’s almost like I can see into the future. Or something.

Culture and Kindness

2007-11-12T10:58:00.001-05:00

Day Four

Everyone is feeling better that was feeling bad, and one is now newly sick. Unfortunately, it is contagious. Many of the kids have come down with similar symptoms. It is good that theirs is a simple surgery, but this complicates things like hydration on kids that already can’t really drink much at a time.

It also creates another challenge for an overstretched Post-op area. I appreciate the concerns there….I worked there last mission in Brazil….it’s a lot of work, and they stay all day until the last patient gets out of the OR. I helped tonight with a few others of our crew until 1am. When you get to the hospital at 8am….that’s a long day even for me.

Lui Fong is killing herself being the strongest translator in the OR area. Tonight we rode in the elevator with her after she had woken from one of her brief naps. She has been here, everyday, giving every bit of herself. I want to do something exceptional for her. I will have to think of something nice. She is obviously not the only one, but she is the one I see most right now. Between being the photographer in training and translating random things for people who can’t speak each others’ languages, I’m surprised she is still doing so well.

Our equipment arrived today, which is really nice. It was a palate heavy day, so it was good we had the extra palate packs with which to work. We are having classic problems like IV’s out and how to organize the post op area and only one kid really did poorly after surgery. A little swelling in his throat from the endotracheal tube caused him to wheeze and have a little stridor, but we kept him in recovery for several hours until he had gotten through the worst of it. He’s there in the post op ward tonight, sleeping quietly, and seems like he is in good shape. The local nurses are also extremely hard working and strong clinically. That helps quite a bit.

Unfortunately, if you are not part of Operation Smile, there is little that you can do “officially.” That means that on the superficial scale, many are under-appreciated. Their name appears on no paperwork. But for instance, it is an honor to have a Chinese doctor working with us in recovery, Ma Jian Bao. He helps us carry the heavy children to post-op, and monitored that child who was with us for many hours with us. Even the families are watching out for each other. Tonight when I helped the Post-op nurses give their Ibuprofen, the other family members made sure no one was overlooked, helped with charts and moving things….it was such a nice thing to see.

Another contrast to other situations I have seen is how invested both parents typically are in their child. And of course they usually just have one. Most are poor and cannot afford the tax on having an extra child.

Women, incidentally, keep their family name, but do not pass it on to their children. So when a Chinese couple marry, the woman keeps her name, and doesn’t change it. This was something I didn’t know. Interesting tradition.

sickly

2007-11-10T17:14:00.001-05:00

Day Three:

First day of surgery went surprisingly smoothly, but ran very late. As I sit here typing, my roommate is finishing up in the recovery room. They waited until 7:30 to start a cleft palate that would take at least 2 hours, but all the surgeries were taking longer than normal.

There are 4 sick folks on the team, all with similar symptoms. One had the good fortune of passing out in front of me when I went to check on him. He’s just very dehydrated and will be fine, but in the moment, it was concerning. One of the students is a little sicker, but with the same illness. Vomiting, diarrhea, and fever are not my idea of a good time. So far I am not affected. Knock on head.

Francesca, Genevieve and I made some rounds to the sickly, distributing various medications in three different languages and varying drug doses. We also sent some white rice and cold cokes, and wished everyone a good night of sleep. Poor Kathleen is up worrying about her charges, but is ok.

Francesca is a boxer from Rome. She was able to get open my jar of juice. I love her. I don’t know why I felt I needed to share this, but I do.

Working with Francesco is very interesting. He is Italian. Today he made a wonderful cup of espresso for us. Delicious even without sugar, which for me, as most people know, is amazing. He served it up with some sugarless dark chocolate, from Lindt. Bellisimo! He and I talked about Hyenas and about drug dosages and about Italian candy. He is a charming Italian who smiles a lot and is genuine and kind.

Geoff Randolph is an amazing plastic surgeon. I took care of one of his lips today. If I ever needed something done to my face he would be my first choice. Later, I will post the photo of a 5 month old with barely visible sutures. He is very impressive. The baby was also incredibly calm and didn’t have any problems with coming out of his anesthesia. Could be coincidence, but I think it might be a good team combination, too.

Mahmoud from Egypt is another charming plastic surgeon. Genuine and kind, with a smile for everyone, he came with gifts to give all the nurses in the hospital. Just little sentiments like eyeglass holders, a set of pyramids, necklaces and the like. He also brought a container of his wife’s cookies and they were lovely cardamon (?) butter cookies.

Yesterday, visiting the grocery store was an adventure. People stop to stare at the tall round eyed foreign devils. I was fortunate enough to find some dragon pearl tea loose. It was the sweetest smelling tea I have smelled in a long time. It turns out it is just as expensive here as it is at home. A box full of instant coffee packs is only a dollar, though. Why do the price differences amuse me? Probably for the same reason I find it amusing that only the foreigners are making coffee in an espresso maker plugged in next to the suction canisters on the floor of the recovery room. It’s a different world.

Hopes

2007-11-09T08:05:00.001-05:00

Today was day two and last day of screening. I’m not certain how many patients came to us, but I imagine it was about 170 total. Unfortunately, it seems that we have a few snags. The first is that our equipment will not arrive, despite hefty attempt to get it here. First it was taking a long time in customs, then they said it was too heavy to get on the domestic plane that flew us here, so we were shipping it with a truck….now it seems there is “something wrong with the receipts and there is a discrepancy,” so we may not get it at all. This means that we may have to use all the local equipment, medications and supplies. It is uncertain what the end verdict will be. I know that some of the surgeons will be uncomfortable with the idea of using foreign equipment, and the anesthesia machines are all set for a different gas for sedation than that to which we are accustomed.

It is a lesson in flexibility and the ability to improvise.

The people who are helping us here as translators and the like are amazing. They are also having the time of their lives. Yesterday at dinner, I think they were very “happy” in the Brazilian sense, loud, rambunctious and the life of the party. They also enjoyed torturing us with their real names (after using chosen English names the last two days) during the name game and laughing at our really awful pronunciations. Turns out, though, that even other Chinese have difficulty with some of the pronunciations. It made me feel a little better.

Two who are leaving a particular impression are Liu Fong and Liu Ching. The former is a photographer in training, but serving as an invaluable translator, since she speaks the strongest English. We worked together taking the childrens’ photographs all day these past few days. She is kind, social, engaged, interested, and interesting. Liu Ching is a physician, but is doing research for a project she has making 3D images of childrens’ faces on the computer from photos. Apparently Dr. Li developed the program here. She’s just a genuinely warm person and seems wholly invested in this.

So yesterday, I didn’t explain about the North Face comment. Turns out, the product that is so frequently made in China, is priced out of the Chinese middle class market. To buy a down vest, they would pay 1200 RMB…..the equivalent of $150. Given the economy here, where you can buy candy bars for 10 cents, I think that might be an excessive rip off. It made me a little angry on behalf of the people of China.

On a lighter note, any child that came miles to see us who is a candidate for surgery will be getting it. We have 146 cases on the schedule last I heard. It will be busy, but rewarding. Those who are not candidates (usually these are those that require large facial reconstruction, have illnesses we can’t treat in time, or ever, and those with severe comorbidities) will be referred to the hospital or other clinics. Medical care here isn’t free, but by American standards is cheap. Many will receive help from Operation Smile to go forward in the health care system. We had one woman who came with a severe birth defect. She appeared to be in her 50’s and had such a severe deformity that she had no nose, had a cleft lip and palate and a 2 cm opening for a mouth. She has lived so long this way, and will have to continue because to repair her lip might cause her to have difficulty breathing.

Babies arrive that seem to already have psychosocial problems, one started hitting himself in the head when he was exposed to too much stimulus….he will probably never be in an environment where he can thrive, just one in which he can get by. Another might be deaf, because she didn’t even respond to the loud clapping all around her….

Teenaged girls with their cleft lips and palates feel ugly, and are shy in front of the camera, believing so long that they are ugly. Some of them are beautiful, despite this simple, repairable thing….I wish I could tell them, and make them believe that they are not ugly. But it’s hard enough with a teenaged girl that isn’t suffering from a physical deformity…..

Final note at the end of the night….
Turns out that we will have four local OR tables running. It is a great amount of trust we give to the Chinese physicians, however. All the medications are written in Chinese, including concentrations. I am glad we are all on the same side. The language is overwhelming. The tones and pronunciations are all foreign. I find my memory is unable to retain some of the pronunciations because I can’t even recognize how they are formed with the mouth. And that is what I mean by foreign. My mouth has a problem even pronouncing some of the words, let alone understanding their meaning. It is a rich and complicated language. It is a rich and complicated culture.

I asked Dr. Li what people believed here as far as religion. He makes it sound as if this culture is largely areligious. Most believe in the tenants of Confucius. “he makes sense to many and is right way,” he says. Many are Buddhist, some Christian, some Muslim. But most are without. It will be interesting to engage in more conversations about how the Chinese people manage to deal with the questions that overwhelm others, like explanations about our role in the universe and where we go when we die. Maybe I will have the opportunity.

Squatters and why North Face sucks

2007-11-08T08:11:00.000-05:00

One cannot over-appreciate the concept of a flushing toilet with the option to hover or plant--let alone TP and soap. Mothers cannot over appreciate the idea of a safety pin that will close a baby's diaper. I also thank my lucky stars that the air isn't pea soup in the country in which i live. I have the most interesting colored things coming out of my lungs when i cough the thick air of smog that never seems to dissipate.

Today was the first day of screening. Exhausted, we saw 130 children today of all ages. The goal is to see at least 170 up to 200 and choose 150 for surgery. It is wonderful to see that these kids are relatively healthy, well fed, and happy. Most will be candidates, if not perfect, at least close to, and will likely get the surgery. The concerning thing time-wise is that many are cleft palates, which is a longer, more involved surgery. Usually we do more lips. This might be different. We'll see.

So far the bus has left me behind twice of the three times we have ridden it. I have not been the only one. Tonight, coming to the restaurant from the hospital, our mission coordinator joined twelve of us in an ambulance tailing buses that got the go ahead to leave. I look forward to a head count to make sure i am with the team, but it was quite a nice learning experience trying to navigate our way to a hospital whose name we didn't know in a language in which most of us know about two phrases.

Tomorrow is day two of screening and hopefully our equipment will be cleared through customs so that we can actually operate on Saturday. It will be a really exciting mission if we find we have none of our supplies.

The Chairman buys me a Fanta

2007-11-07T08:19:00.001-05:00

I am on my second volunteer mission with Operation smile to China this next two weeks (operationsmile.org). We are one of four groups here, and our site is Linyi. There are also teams in Hangzou, and two other cities. I thought i would arrive to a somewhat rural section of China, given that Googlemaps was unable to tell me much about the area around it. I arrived to a brightly lit city with people dancing (exercising) in a square near the hotel and find out from the brochures that Linyi is a "top tourist city of China." There is no mention of Linyi in my Rough Guide, China, btw. I feel that this is an important city they have overlooked given this new information i received. Comically, or no, i also found a propaganda pamphlet that made the police here look very sympathetic and exciting. The brochure is 20 pages long with ads for mobile service and suggestions on how to avoid being pickpocketed. It also had some amusing illustrations of people escaping fires screaming.

The path here started in San Francisco, with me packing on the way to the airport because the wash and fold didn't open on Sunday. There was also a little matter of not enough room in the duffel, so i had to reorganize. Turns out i have enough socks for 3 weeks, but only enough shirts for one.

After a 12 hour plane flight (which went surprisingly hitchless with me getting to the gate as the second to last passenger on the plane, and a very nice, unlikely gay couple going on a three week long tour of China. I say unlikely because superficially they didn't seem like they should be together--a short Hawaiian with a tall European--until you watched them interact. They were as affectionate as any old married couple, knowing what the other would want off their trays, sharing reading material and the like. You know...simple kindnesses of knowing.) I arrived in Beijing, and met up with the team. You wouldn't think that getting out of the airport should be so complicated until you try to do it with 45 people in a place where they speak a crazy moon language only a few understand. Once we were loaded, it was off to the Sinoswiss Hotel, a beautiful airport hotel. It had 5 restaurants. I managed to talk two of the other ladies in the group to go out into downtown Beijing for dinner, which was really exciting. The lights are blazing, people were out, and it was almost like Times Square. Slight less lights, but equally enormous television screens with advertisements. I found a surprising lack of Chairman presence here, until i went hunting for it specifically. One of the really entertaining bits was entering the side market separate from the main street of Wang Fu Jing Street. Here i managed to score an awesome Go board, for which i spent way too much money. It was a valuable lesson learned though, that everything can be negotiated to about 20% of it's beginning asking price. This Go board will later make me *very* popular with the Chinese contingent of the trip, making it priceless. Thank you Jeremiah!

After some Peking duck which included the head (i tried the brains....turns out it's just like chicken livers), and some rice wine (imagine really terrible Jaggermeister), we were all ready for bed. Some of us had also just spent all our Christmas money, and others of us felt bad because we hadn't bargained to our true ability.

Today we left early to take the plane to Linyi. Bright and early we left....We then proceeded to wait for the weather to turn to actually get our plane. We were delayed 5 hours, after arriving there 2 hours early. After finding this out, the group ordered takeout KFC, and we bought sodas from a very temperamental machine. It was very particular about which image of Mao it liked. Eventually there was a running joke about the people for whom the Chairman would buy a drink....

During this time i had the opportunity to meet many of the Chinese physicians and one of the nurses who will be working in the OR. It turns out that one of the doctors is *very* good at Go. He is the head of the group of Chinese plastic surgeons. Another seems to be well matched for me, but probably only because he was very aggressive and wanted to take pieces when his part of the board was already won or lost.....Jeremiah will be happy to know that i beat him for my first game. I also managed to teach one of the men from Vietnam who is working with the medical records (at home he works for a mobile phone gaming company). For four hours i learned a great deal about the game and the people with whom i will work. It turns out that Go is also a game that people like to watch like chess. We had a motley audience, including a young boy who would wince when Huang (the young Vietnamese man) made a poor move.

Our hotel in Linyi is sparkly and opulent. I am roomed with a woman who is quiet as a church mouse at night. I am really looking forward to working with everyone.

Hooray!

In my defense

2007-09-27T18:24:00.000-04:00

It turns out my "fibromyalgia" has now led to tingling and numbness in my forefinger and thumb that is positionally related and is sometimes associated with pain, sometimes not. I had to do all my own research and advocacy but still have to go through the bureaucracy of medicine. I have to go back to the good old primary care doctor and beg for an MRI and a CT scan to go any further. That, or i wait about 12 days to see an Orthopedic physician on the 9th to have them give me the blessing to go for the MRI/CT scan ride. In my research i have discovered it could be two things: either i have an irritated c5, c6 injury, or it could be some kind of not quite thoracic outlet syndrome (which i thought was really only vascular--which might be why the "not quite" falls into play). Here's hoping a bit of PT can get this horse back on the rider, or something.
Medicine sucks.

Doctors and Lawyers and such

2007-09-06T00:53:00.000-04:00

Why would you want your child to grow up as a doctor rather than a cowboy? I'd like a cowboy as a kid? I'd like the rodeo champion to be my kid....doctors and lawyers and business executives are boring, regardless of how much they make.

But that's not really why i decided to adverbage some descriptions of my first PCP (Primary Care Physician) experience in about 15 years (last time when i had pneumonia). It turns out that since i never use my PCP, that i just chose a physician at random from the list of available ones. So perhaps it wasn't totally random, since i chose by letter and then "name that sounded cool." I ended up with Dr. Bennett Zier, a not terrible man, who specializes (i found out in his office today) in geriatric medicine. The 15 minute office visit for my first ever experience with him and saying that i had actually sought the ER for severe pain that was debilitating and was a Critical Care nurse at his alma mater went something like this.

Reading from my one page patient profile: "So, Linda, what brings you in?"
"Actually my name is Andrea."
Looking again at his paper, "Oh, yes, you're right. Let me get some information about you."
He asks me a few demographic questions, where i work, if i have someone with whom i live, which i answer enthusiastically.
"So what can I do for you?"

I attempt a lenghty description of pain that starts under my left shoulder, that then got so bad that it radiated to my head giving me what we in the biz call a WHOL (worst headache of life--real lingo for pain associated with a subarachnoid hemmorhage which is bleeding in the brain, or as mjw calls it "narn" syndrome (taken from 6 feet under), which i didn't really believe i had, but on coaxing from mjw went to the ER to determine the nature of, even if it was migraines. "All this started 2 weeks ago and the pain hasn't really gotten much better. And sometimes it radiates to my elbow, and i've tried pain medications and muscle relaxants and rest, and heat... "

"So you're saying you have scapular pain?"
"Well yeah, under it."
"You have fibrosis."
He then prints out a short description of fibromyalgia, which for many healthcare providers is equated to Freud's hysteria or what i like to call "Crazy woman's complaint." Now as a disclaimer, i do not think people with a diagnosis of fibromyalgia are crazy, i believe their real problem hasn't been figured out and might never. This paperwork, pulled form the internet in 30 seconds and printed to the local host has about 2 paragraphs written for the general lay person, and a picture of a woman, front and back with several "origin" sites (one of them is my scapula!...kind of) for my new disorder.
He takes my blood pressure while offering the option to have my shoulder injected with Lidocaine and then cortisone (about both i'm unthrilled) and says "try heat alternating with ice, and get back to me by Monday if the pain's not better." There's a little discussion about this being common and shots are ok, and really not a big deal but how he understands my reluctance and how common aggravators are stress, and what kind of stress i've been having (he devotes 30 seconds to this lengthy question and offers me a superficially sympathetic 3 sentences on his end-of-life dilemmas in nursing homes.
He gives me a prescription for 90 muscle relaxants, 30 Vicodin, and sends me on my way.

So this experience taught me some things:
Some doctors have forgotten about the healing art.
Some people don't know how to talk to their audience.
Some people don't really care about your experiences of illness.
I made a physician 30 mninutes worth of money in 15.
I now have a stock pile of drugs.

Good Night and Good Luck

2007-03-24T20:56:00.000-04:00

Watched GNGL a few nights ago: Edward Murrow's fight against the irrational mass hysteria of 60's McCarthyism. George Clooney, as it turns out, is a wise film-maker. Choosing a genious visionary and smart dialogue, he creates a modern critique of an old theme. Frequently in conversation i say "i don't understand how people don't see. The "i don't understand" part is confusing. It's not that i don't understand. I know how people are. What i mean is that i wish that human beings would evolve. In over 40 years, the masses, the public, the mob, the hoard, the plebs, all still want entertainment. But more importantly, returning to the lowest common denominator, they want Maslow's heirarchy at the level to which they're accustomed, and thus, they settle for convenient false senses of safety.
When i look back at the McCarthy era, it comes across as absurd. I don't understand why people don't see it happening all over again. Do other people see that historical repetition? Or is it only a select minimal few with the ability to consider critically? I am advantaged, coming from a New England education, smart family and friends, and people willing to engage in dialogue, learn new things, enthusiastic about knowledge and information. So I don't know the larger subset that allows these things to proceed with either enthusiasm or complacency.

My grandmother once told me that during the second world war in Germany, the nearest concentration camp was over 50 km away. It was apparently veiled as a construction site. At the time, i forgave her for her ignorance of what was "really happening." But considering again, i realize that her ignorance was a conscious one, one held by many Germans, a denial of what was happening to the other. Whether out of fear of reprisal, or just that cozy feeling that things were better for them when they had more money that was stolen from an entire subset of people....My grandmother lived in a house occupied by German soldiers of the Wehrmacht. She knew. She just didn't want to *know* what was really happening enough to investigate further. This opiated acceptance of amorality is equally unconscionable.

In situations like this, i wonder about my own courage. There is still something in me that could hide from view, afraid to speak up against injustice. There is a larger part of me that wouldn't let the coward hold sway. i hope that i would have the courage to act. I hope as a species we evolve into a collective with the fortitude to act on behalf of each other. To think critically about what we're told, and to be bold, be bold.

First moments, return from Belize

2007-03-18T23:51:00.000-04:00

We just got back from Belize last week. Diving the Blue Hole, was once again, otherworldly. That place is like no other place I've ever been. When i say it's like 20,000 Leagues under the sea, i mean it is like tripping down a rabbit hole into darkness, as you step off the wall of the reef to black. One feels almost like falling as the light fades and then there's just barely enough to get close to the stalagtites that hang there with billions of tiny filter feeders. There are only minimal fish at the legal diving depth and i think because of the nature of the hole being a karst-eroded sea cave. It would house huge animals at that depth, but it's hard to get there. The sharks are a nice touch. Hollywood sharks" as the dive master at the White Sands called them. Reef sharks really do have a movie-quality that is unrivaled by the nurse sharks we otherwise encounter. Even the baracudas can't compare.

Another dive we did with Tony (#2) was relatively shallow, but swarming with life. I got to spar with damsel fish. If you don't know what this is like, imagine "fighting" with a fish the size of your two fingers. You stick your finger near it, and it will charge you. Show it your palm and, as Elbert puts it ,"he'll feel like he did a good job." Apparently two of them were protecting not only their territory (very territorial for such a small little fish), they were protecting some eggs. That same dive also produced a pregnant lobster carrying sacks of eggs on his butt, and a morey eel. Oh, and then there was that other spotted eel (perhaps another type of morey) that looked pretty angry that we were near him. I was fascinated by all the filter feeders that acted like sensitive plants. You would touch their long tendrils and they would quickly retreat into their houses if you even waved water at them. Pussies.

As i write this, i remember that two divers from NJ are still trapped (dead) in a wreck in the Florida Keys. Of four, only one made it from that spot. He was the one who didn't go in. Apparently it's a sunken wreck to create an artificial reef about 130 feet down. I haven't been wreck diving, yet, but look forward to it someday. This was a sobering reminder of dangers other than nitrogen bubbles killing me.

The weather was less than cooperative, and we'll see if the photos come out. I still have to get a changing bag for the film, or try to do it tonight in a closet. Of the 7 days we were there, about 4 were windy and the day of the blue hole trip it decided to rain. After riding on the top deck getting splashed during the open water crossings, not an ounce of sun and diving, we were both freezing. But we saw so much cool stuff. It was truly amazing. Sadly, the Nikonos decided it also didn't want to rewind. So one roll was sacrificed to the 35mm gods. Sometimes i think digital may just be the way to go. Actually i've thought that for a while. It's just a matter of making it affordable for me =\

So it's my first day at UCSF and the view from the 10th floor is something to behold. You look out over the Golden Gate, the park with the same name and the Haight where i now live is on the other side view.

It's interesting the socialization process of moving in with someone. You learn to share space, make small compromises that you blow entirely out of proportion, you miss your living companion when they're gone. A home shared seems ghostly, more lonely with their absence, as though in a contract. You learn more about each other as you unpack each other's things, realize they have a past of which you weren't a part and parts of a present of which you're not a part. There's mysteries solved and further mysteries that surface. You learn about the heart of each other more than anything, i think. And i'm tripping around boxes of my partner's heart.

It's interesting the idea of a partner. I have always felt awkward with the term "boyfriend/girlfriend" or wife/husband. Significant other feels cheap or like a contractual business like relationship. While partner seems to delineate a bit more of the influence of the gay/lesbian set, i think it's a great term for a relationship that involves two invested souls, working together to protect each other, build each other up, strengthen each other and eak out a place in the world as a team. I never really had a great template for a healthy happy relationship. Much like most people in the world, i come from divorced parents and am surrounded by divorced parents. I worked in places in which most people just complained about their relationships, they talked to them four or five times a day with annoyed tones, or artificially placating tones, or complaints about everything. It makes me wonder if these people talk to each other. Like really talk and listen and try for one another to understand.

Having had no real influence that i can use as an example for how to make a relationship work, i walk into this with some vague ideas about how i'd like it to go, how i can make that happen, what i can live with and compromise, and how to first be honest with me about how i'm feeling and then try to express that all to the person i care about. It's not always easy to admit weakness, and sometimes i have to admit that my emotions are being totally irrational because of lack of self-esteem, or that i haven't had any sweets for at least 2 hours, or just general moodiness. But when i can admit this, own the feelings and realize that no one else can make those feelings stop, and that i might just need to sulk in the corner by myself for a bit, and that no one is obliged to meet me there and pull me out of the slump, i think that i'm better able to then come back about and communicate the important bits that need to be discussed.

Someone recently argued that the failure of relationships is secondary to finances. That people today want everything their parents had over the course of their lifetimes *now.* I think it's a definite problem, but doesn't that go back to communication again? Communication and honesty seems to be the crux of so many difficulties in our lives. We fail to be either in so many important things. The honesty with one's self thing is probably my biggest weakness. For a long time i would just overlook people's real intentions for their behaviours, and subsequently my ignorance of their motives. You could call it optimism, but it was something deeper. Then there is also the just letting the moodiness get the better of me and govern my interactions with others. Often this would happen with my ma who would flip out at me and i would immediately respond the same way out of defensiveness. Or even vice-versa. Now i spend a lot of time after the fact disembowelling the problems that i have found with out interactions and trying to beat them to the punch of irrational raised voices.

Going to the irrational raised voices, there was recently a discussion about the way people go about dealing with one another. Two people in my life have adapted themselves to screaming at each other. Sometimes they all of a sudden just yell for no apparent reason, but it's all so much deeper than what they claim to each other and i think themselves. They claim the yelling is just superficial and about a simple argument, but really where it comes from is so much worse. It's a control issue, and the way we deal with things that make us feel vulnerable. For one, it's that they don't feel heard or respected, for another it's that nothing feels like it's ever good enough. For others it might be that someone is doing something of which they don't approve or don't understand. Frustration, aggravation, self-consciousness, feeling neglected, whatever the case may be, they never sit down and talk about the heart of it. Is it that they don't know themselves? The problem is that at some point they never learn how to really *talk* about it to each other later. And this yelling carries out to anyone close to them. As one moves closer, people feel more vulerable. And there in comes a cycle of inability to talk to people about the hard stuff: the important stuff.

I have a whole bunch more thoughts on this. But for now....Let's let that subject rest.

I fell down the stairs....

2007-02-23T14:09:00.000-05:00

I'm convinced that one (if not many or all) of Matt's family is trying to kill me. A weekend in Michigan with them led me to the following injuries: bruise left elbow, bruise right elbow, bruises bilateral thighs, chin to the shoulder with subsequent bruise, a coccyx that won't stop crying like a little baby requiring narcotics for sleep (tobagan injuries), bruise to right calf (ice hockey/shimmie injury)....

Of course, it doesn't help that i was only trying to prove my own testosterone (?) level by joining in things like the "vag cav stacker" and being the tail end of a tobagan ride without an old person's cushion thinking i could handle it and creating a jump that will "kill people" that i then felt i also had to try out because i made it. Amusing.
I've taken more narcotics in a week than i have in a lifetime, and made my liver hurt overdosing on ibuprofen....

On a lighter note, Matt and i survived Ikea. We, as their target demographic, got a sweet couch, bed and other apartment necessities that will allow us to have guests and seats for said guests, and sleeping quarters for said guests. It's very exciting. Let this be a warning to all of you: you are invited to the sweetest pad in San Francisco. It will be even cooler when i muscle out Matt's art with my own, using his "free-for-all-art on the wall" approach to start covering up his choices in a multiple wallpapering scheme. The sabotaging tactics in that apartment will start to be epic!

No more shopping

2007-02-07T09:34:00.000-05:00

Finally, we are given a reprieve from the apartment hunt. After meeting a delightful woman that has a mimeographed copy of a lease, and ended up not really caring about how much we paid for the apartment, we found a sweet pad in the Haight. It occurs to us she might be a grifter with the best racket yet.

so far so good

2007-01-23T20:24:00.000-05:00

So, as i understand it, i am not a child murderer and my licenses are still valid in California and Pennsylvania. I think that UCSF is still going to hire me into its (i'm coming to find out) exclusive ICC unit which is much like the unit in which i worked in Philadelphia at Jefferson, but both the surgical and medical cardiac patients are combined. It sounds like they might be just a hair more progressive, but not by much, and i hear the cohesiveness of the unit is spectacular. Allegedly i'll start mid-March after Sven gets his wings in Florida, i find a new place to live in the city (with company), and i try not to get swallowed by whale sharks migrating through Belize's blue hole.
*yay!*
Now, if i can only get my act together to study for the GRE's and start trotting again, in whatever form it comes.

riding

2007-01-21T18:33:00.000-05:00

Ericka came in with Jamie for a week of skiing (riding) in Tahoe. We had a swanky dinner the first night in Harrah's hotel in some steak house to appease the moo gods (or maybe it was Jamie?). I also got to try a new single malt (so i can also be at least versed in scotch). First day i nearly thought i should quit riding all together. In 11 degree weather with the winds whipping about my head, i was off balance and off kilter, and for my "getting my sea legs back" day, man, was i ready to sell the board, the boots and all my winter jackets. Freaking cold as the baby Jesus. I don't know what that means....

But the day redeemed itself towards the end, as the sun peeked out, and the lake came into view through winter California skiies on Heavenly. Spectacular views, for sure. But why do i have to either take the gondola down or take a bus back to the gondola? Silly mountain planning if you ask me. On top of that we kept getting lost! For some reason, it's nearly impossible to actually follow the map, or the signs. There's some sort of voodoo navigation involved in finding one's way to a lodge....Oh, and don't go there on a cold day expecting to get inside for some hot cocoa. There are only 2 small indoor cafeterias on the mountain. Steamboat still wins all points in comparison.

In retrospect, i really shouldn't complain. The next day, Europe got hit with hurricane force winds toppling things on top of small people and bringing rail traffic to a halt in Germany and leaving most of the Czech republic in darkness.

After an awesome dip in the neighboring hot tub which sounded like ghetto booty central with the local hip/hop station playing throughout the place for one listener (the Block is a motel geared towards a certain special set of clientel that also likes to gaze at crudly painted half naked lady models and superhero characters on the walls and have window stickers that looked like street tags), we went for a bit of dinner and a beer.

Day two left me with some bad goat cheese reminders and sleeping in the lodge being visited by Halloween past, present, and future. By the time E & J got back i was growing fangs and craving raw meat. They talked me into sushi (i wanted to eat all the fresh ginger in the house, and suck down tea and my sweet tooth (always in charge, even when nauseated) talked me into some dessert--a banana roll, deep fried, smothered in ice cream and "special sauce" that had a hint of apple and caramel).

Day three ended up being a half day at Squaw Valley. What a fine mountain. The base of this bohemoth is like something out of Alpine photos from Austria, and the whole mountain is "in bounds" at your own risk. Main trails were largely groomed, but you were welcome to try to kill yourself running off cliffs (marked "cliff" in most places) and braving tightly packed trees (or you could just bomb down saddles between the mountains).

By far the better mountain, this one also boasts and olympic sized skating ring at "high camp" and swimming pool. It was, afterall, the site of the 1964 olympics. It stays true to tradition.

wining

2007-01-21T18:24:00.000-05:00

Settling into a whole new life has been an uphill battle and i'm still at the base of the mountain, that, at times, seems impossibly high. Some days i keep my head wholly in the game. Last week i even managed to get on the treadmill to find out that my knee really hates running, despite my heart being ready to sing the Chariots of Fire theme.
But that aside, i had both good and bad this week in nearly equal measure. My grandfather (in Germany) just had a carotid endarterectomy (basically they scraped out his carotid). As a special treat, he ended up with the delightful complication of a hematoma (a blood pocket in the side of his neck where it was supposed to be draining). Essentially this was secondary to his accidentally pulling out the drain attached to the surgery site. There was some worry that things for him might go really sour, but he made it through well. He's got all the tubes out and is back to his both charming old man/irritating old facist self, apparently (depending upon his mood and who comes to his door). Just a bit weak with a persistent cough that is still persistent.
Last week i found out that an old family friend of ours had a similar problem with his carotid arteries, didn't get a chance to have this surgery and ended up with a stroke that left him paralyzed on one side and unable to talk or swallow right. And on top of that, my mother's cousin was unreachable for a week because she was busy having a heart attack and having 5 stents placed in the catheterization lab while no one was looking.
My mother is feeling the stress, and seems lonely when i talk to her on the telephone. I ask, again, for a matter transporter if anyone has one. I would pop in to hug her periodically. I think she needs it.

Good parts of the week went more like this: Napa Valley with Matt was most excellent. We didn't hesitate to make it a lazy couple days. Our destination turned out to be Calistoga, the northern end of Napa, which was a good choice. By chance, i found a B&B called the Chanric, run by two gentlemen who have created a beautiful space. I was sold on the stay with a review that stated something to the effect that the decor wasn't the traditional flowery patterns that populate most Napa B&B's. After a few hours of looking for placed to stay, i had begun to rule out places based on their comforters....
Rick (one of the proprietors and the Chef) was one of the most genuinely nice people i have ever met. This is a man who will look you in the eye and mean every word of what he says, kindly and patiently. Add to this his culinary skills and i'm charmed. Breakfast was lovingly prepared for hours each night (we walked in as he was preparing the first day's papaya soup with a hint of pepper, homemade banana walnut bread, and omelet with ratatouie and the second day he prepared an omelet with black truffle oil, scratch-made pecan scones and a fruit cup with coconut sauce), and the environment was chill and sophisticated without a single smattering of pretention. I actually liked not having a TV anywhere (though we watched Touch of Evil on Matt's laptop, admittedly), and sitting in the main room in the sun was heartening.

The first winery we visited was Clos Pegas, which was nice, but too "man on the hill" ish for my tastes. And while he and his wife had neat pieces of art, it seemed as though they were simply "collecting" for the sake of collecting. "hey, let's have all these Dionysis themed pieces of art" in the same way some people collect those ridiculous shoe sculptures, or Hummel figurines (or Sandman hardbound editions?). But when they ran out of space in the display cabinet they started putting them in the refridgerator next to the unidentifiable cheese. The prize possesion of their collection was this fountain from Turin. There was a great hubub made about it, but its placement showed little thought, and it was thrown amidst some adobe brickwork as though it were waiting for something better.

The only seemingly thought out, well placed piece of art was a sculpture of the Earth mother in the center of the entry open to ever direction but earth and was placed there for exposure to the elements.

While i liked the "hands-on enjoyment" factor, i thought there was a lot of misplaced pretentious aire that should have been spent on the wine, rather than the art. The wine, btw, was very good. I would *not* recommend this place for a busy time of year unless you like sidling up to the side of the wine bar between scores of other people. It seemed a relatively popular place that saw a lot of people when the season is in full swing.

The second winery we visited was Reverie. This was the type of wine experience i hoped for. I learned a lot from our B&B comrade Les (who successfully talked me into spitting) and our taste-tourer. We started with the whites (i'm not fond of whites, so please don't ask for an objective opinion) outside by the large steel vats in which they are aged. Much bubble was spewn about three varieties we tasted. I'm getting better at picking out some of the individual flavors, but still not great. We then walked over to a redwood tree circle. On the way we "found" a bottle of Barbera hiding behind a bush. Lovely. In the redwood circle we got to try the wine with the funny name A.S. Kiken, which is a blend of the grapes left over from dad's wine mix (the not-so-schwag for his son, the schwag for the "other" vintners) and the owner's Cab Franc. Both of the owner's wines were wonderful, the younger's just that, but also very drinkable.....

From there (keep in mind we've had 6 half glasses of wine....), we went into the caves to do the last of the tastings. There were three more to try (thank you Les). The first was their basic Cab, which was better than the Clos Pegas in some ways, but not as good as their reserve). Then the reserve which was better, but not by miles (both 2004's i believe).
The crowning acheivement of the tasting was the rare opportunity to have a "library" wine. The reason we got to do this is because we were preceeded by the Rosenbluths (?) who were invited to the winery to taste some wine made by the also owners of Butterfly Restaraunt in SF who invited them to be part of a monthly tasting there in February (Syrahs). As a result, we got to try a 1992 Petit Verdot. Apparently this is a sparse low yield small grape (small green) that was produced here until 1996 (?) as its own varietal but is largely used as a blending grape. It was brought back into production in 2003 (i got a bottle of this, and i'm excited to try it on the whole aging thing if i can wait that long). This was one of the best wines i have ever had, and i'm glad i saved myself to enjoy it to the end. It smelled unmistakeably like Jasmine and cherries, and was beautiful. I would have loved a pot of my chocolate creme brule to go with it.....Only 10 years to wait =)

The experience at Reverie was wonderful, and I can't sing the praises of the people that were on site there enough (not to mention Kirby the little dog who, though scared, was willing to let me pet him and hung out a bit with me....). But the scenery, too, was worth a trek. Sitting in the redwood circle just reminded me of being back in Jersey in the children's cemetary when everything was very quiet. For some things there are few words.

Getting to know Pleasanton / holidays

2007-01-04T01:21:00.000-05:00

So today i wandered out past the malls, the strip and the highways....oh, well not too far from the highway, to the Pleasanton Ridge. It turns out it's not a total drag in California after all. Though my little peace of the world was interrupted by the occasional brake check by the 18 wheelers....but yes, wandering through "wine country" or the olive groves, or what i imagine Tuscany is like.....
I have a hankering for my mountain bike. It's not the Wisahickon, but it's a nice facsimile of Gloucester college....and it's purty like no other place in the area. Meeting some cows on the path, i only wandered about for an hour (sickly and getting dark....). Also, i caught a quick look at three deer along the way, heard an owl and what i believe to be grackles. i know i'm not supposed to like them, but i think they make purty noises.

For Christmas, i went "home." It was a bit overwhelming trying to see people and spend quality time with everyone. My family was almost all together in one place. Anyone who knows me, knows that the contents of the family is about 7, and all were there except my grandfather who has been bailing every year because he doesn't want to take the trip across the ocean. The time was largely occupied with them. My brother was home, my cousin with her boyfriend, aunt, uncle from germany and my ma, of course. We had a really nice times, though some difficulties, as are faced when you're around the same person for too long....

I'm realizing that there is really no "home" of which to speak anymore. Whereas my brother has the remnants of his room at my mother's still intact, mine has been overhauled. So i leave some things there, and share space in my brother's room and save some things in the basement as storage. But somehow there is something about the place. The transition is interesting. I never went through the "away for school" phase being on commuter campuses for every phase of my schooling and it's all different as one gets older.

Then we have Pleasanton, which feels nothing like where i want to plant and take root.

To all of you whom i missed while i was in Philadelphia, i apologize. I tried to get it all to work out to see everyone, but sometimes it's just really hard and time does not cooperate.

For the new year i spent it with Denise and Dave going from swanky to trashed Philly in a short couple hours. Mojitoes at Alma de Cuba (one of the most fantastic lounges in which i have ever been), then beer and scotch at the Bards on Walnut (we got so involved in our conversation we missed the fireworks, if you can believe it). They gave out free drinks to celebrate....jello shots and some fruity vodka filled thing....and then....
Geno's steaks for post new years gorging. I remembered that i'm not that big a fan of cheesesteaks, but that it's all an experience that can't ever be eliminated at the heart of a visit to Philly.
(Speaking of which...if you really like cheesesteaks and live near Delran, you must eat a chicken cheese steak with honey mustard sauce from the Fresh Works on Route 130. I say god damn! Don't put the honey mustard on a regular cheesesteak, however. You'll regret it....stick to fried onions on those.....

All Wear Bowlers

2006-12-08T20:24:00.000-05:00

As for All Wear Bowlers, it's a clown production out of Philadelphia's 1812 Productions. Clowns? you query. Well, yes, they are a clown act, but so much more than that. It caught my eye when it was given a description similar to Donnie Darko. A selection of nonsequitors was used to describe the play as a mix between Laurel and Hardy, Charlie Chaplin and....Samuel Beckett? Wow. This, not unlike the Pillowman, is dark and thoughtful about "art." But where the Pillowman relied a lot on the dark violent overpinnings that seemed simply background for the ultimate story, All Wear Bowlers does not (besides which, the Pillowman discusses art in general more than the art of performance). The performance starts with a black and white film reel of the two players in the style of the old silent comedies and breaks out with them discovering a way into our world, and ending up suddenly trapped here. There is a good deal of comedic analysis of art within art, and they call humoured attention to the fact that they realize this almost overdone cliche when they pull two theater seats out of the audience onto the stage and watch the audience. "I don't get it." one of them proclaims, watching the audience as though we are the performers. "Avant Guard." replies the other. "Oh. So many layers...." They have made the cliche new, however.
Within the analysis of the art is also an analysis about existence and perception and how we establish our own ideas about ourselves and our place in the world, and that is what feels so new. At one point, each of the two players has an individual performance, and they somehow cease to be two dimensional characters and become something more three dimensional, real, characters with whom we can sympathize as human beings. In between the physical humor of spurting water at each other, a godzilla sequence in which no props are used, Adding a third "Magritte man" into their lunch who offers them eggs (particularly clever--again with minimal props--only themselves, an extra hat, a suitcase and the eggs....), and a ventriloquist act where one uses the presumed dead other as the "dummy" is interlaced some really important talk about the dark meaning of existence for the individual human being navigating the "void."
The what?
Oh nothing.

by request....cars and parties

2006-12-07T20:36:00.000-05:00

So i recieved a request for photos of the Google party. i found some websites that highlight with some nice photos. I am glad to oblige.
This lady liksa the fooda. They are some lovely photos, and the food was pretty spectacular:

http://passionateeater.blogspot.com/2006/12/entertaining-ideas-from-google-holiday.html

and this chick didn't feel like putting forth too much but did a nice collage of Nemo's captured aquaman suspended from the ceiling by wires, the Impala room (unfortunately not the cars) and some costumes:

http://niniane.blogspot.com/

I haven't found the photos of Hades. He rocked the coolest costume of all the groups. If any photos become available, maybe i'll edit this or set up something new.

I also found out that sticking a car on a truck is a lot more money than even repairing it, but the nice service guy at Strong VW in Salt Lake City (mormon or no) has been kind enough to rebuild, and not replace my CV joint, assuring me that it won't try to kill me again any time soon. The belief is that the only damage the car sustained in whatever its trauma was to the three items they found: CV joint (maybe during a tow) the storm shield that protects the delicate car underbelly and the oil pan (even i bottomed my car out once before....).
I might get my car by next Friday. How exciting.
The other exciting thing is that i have an interview with UCSF's CCU next Friday. I really want to do ER but also got a call from Stanford's hospital system to step up the ER application there. I'll see what happens.

Road Trip Needs

2006-12-04T10:13:00.000-05:00

Should you ever find yourself needing some things for the road, this place has positively everything. Even novelty handcuffs.

2006-12-04T06:55:00.000-05:00

Incidentally, I almost forgot to tell of *other* excitement.
I have already worked a bit of overtime (yay to the work-a-holic in me) overcame illness (uncomfortable stomach thingie) and went to a holiday party. Now i have no frame of reference because i have only been to one holiday party and that was when i was like 20 or something at Memorial Hospital when it still was called such a community oriented thing. But when i tell you i have never quite been to a holiday party that spanned what seemed like 6 warehouse rooms, i am not kidding. While it was supposed to be a greek theme, it was only loosely translated. There was a lot of non-sequitor happening. I liked some of the costumes (Hades was especially friendly, and had the swankiest costume i have ever seen, as did his little vixen minions). Food was everywhere and music was kind of neat. It had one room with two DJ's spinning some passable stuff filled with Chevy Impalas from the 50's and 60's tricked out. (not sure how that works into Greek theme....) Another room (Hades and Zeus' rooms) had dueling string instrument players on a rotating stage. One was playing a harp and one a middle eastern looking lute (?). Interesting stuff. I think at one point, one switched to a guitar that made horn sounds.
Many of the people to whom Matt has introduced me in the past were there. He is convinced that Megana (his best friend Jinnah's wife) and i getting along might be to his and Jinnah's detriment. This is incredibly fun to play out. We all looked smashing and it was entertaining to know that even Google parties run out of liquor. But bravo on an incredible show. Maybe i am becoming urban hipster.
poop.
I also had my first real take out tonight. I got to eat Thai at the local thai place. Great red curry! Awesome mango and sticky rice!

Kidnapped by Mormons?

2006-12-04T06:11:00.000-05:00

You'll have to forgive my "large format" way of communicating, but i realized that after i explained for the third time how Mormons in Utah kidnapped my car that this could all be more easily accomplished via an online service. Yay. Anyone who has chosen this format in the past will recognize its usefulness, as well as its lack of personal touch. But i will write everyone emails from time to time as well. But this will get through the big stuff about which everyone is interested.

So yes....I left the east on my little blue wagon train headed for gold country after a 12 hour night shift (the 6th in 7 days). I saw Christopher in Philadelphia for a cup of caffeine to get me through to Pittsburg, and he gave me two gloriously wonderful mixes. I have decided that i really like the Futureheads.

I met Matt in Pittsburg the next morning at the airport and got some reading done waiting for his delayed plane from NY. He was kind enough to drive most of the way to his family's in Chicago. Meeting the rest of his extended family was really a pleasure. I am, admittedly, a little jealous of his family get-togethers. Turns out that his family is as into playing games as I am. I am reasonably certain that even if there weren't so many kids around, they would still be having bag-o/cornhole tournaments for slinkies. Thanksgiving dinner was lovely, and i got to sample a myriad of different desserts. Apparently, after i returned a hat with which i fell asleep (along with my jacket and my scarf because i was so cold from lack of sleep and playing flashlight tag) that belonged to one of the infamous "Morgan boys," i managed to win at least a thumbs horizontal from the extended family. Yay me!

Friday after Thanksgiving, Matt stayed in Chicago to celebrate his grandmother's birthday, and I made my way further. It was a 14 hour drive to Cheyenne, Wyoming. Grueling as it might have been, i found one redeeming quality to Nebraska. It's full of stars. I actually pulled over at the border to Wyoming to step out of the car and stare out into the wide starry night. It was one of those moments when things feel right for a good 5 minutes. Like the world might be holding you safely in its hand. But then a bunch of trucks came by, and i found sleeping quarters.

My Saturday was supposed to be an easy driving day, and that it was. 6 hours to Park City, where i decided i wanted to bunk for the night because of the possibility that i might be able to put that snowboard strapped to my car to good use. Turns out that my car had other thoughts for me. That and Colonial Volkswagon that sold me a car for about $1,000 over value because it's a covetted diesel that had been in a wreck and then continue to lie to me about their knowledge of it ever, despite my sending it through a safety check prior to my leaving the state. The mormons got it. Coming through the turns entering Park City the car started to feel as though i was driving over rumble strips when i banked left. Then when i tried to park it at the hotel, it sounded like it burped large steel parts and ceased to go. I can put it into gear, but can't make that gear do a damned thing.

So I had a meltdown and Matt came to my rescue. Ok, so i had a brief meltdown, and Matt helped me come to my senses sooner, so i didn't do anything rash like start an unsafe campfire in a dry wooded environment or drink milk out of the the carton after i left the refridgerator door wide open. He flew into Salt Lake (orinigal plan) rented a car (not original plan), picked me up and got my car towed. So the mormons are subjecting my car to all sorts of religious rites in Salt Lake, while i had to keep driving west. I was, after all, due to start work on Monday at 7am for orientation.

Matt drove the entire route to Cali, except for a bit until we had to chain up the rental to go over Donner Pass. The "fascist nanny state" as Matt likes to call it, made us chain up for a whopping 2 inches of coverage. But whatever. It just meant we had to shop in hell (Wallmart) and eat Boston Chicken, and get in at 3am.

So now i'm here. I have to confess, it's nice to move into an apartment like a hotel room. Bed was made, table set, and a box of goodies at the door. Nice touches. The apartment is like living in the "low rent" section of a really nice neighborhood. But it's cozy and keeps me warm and sheltered. My recruiter for the travel job couldn't be more awesome.

I oriented to the departments sort of haphazardly, and maybe that would be deliterious for some people. But it's been pretty cool. It's a good environment for a first travel job. They are *extremely* nice, here. The two units are pleasant places to work, one brand spanking new where they take their newly started open hearts. They have dedicated staff for them, though. The otehr is mostly medical. The differences are sometimes subtle, sometimes really dramatic. Like recusitation is shorter, less invasive (or inventive). Obviously, being a community hospital, it's less aggressive. But care is good. Some modern stuff prevails, though they are still being governed by some older methods understood and accepted as things that work by doctors that have been here a *really* long time without being convinced modern research is right. No pharmacy overnight, and no doctors in house to deal with CCU issues (ER docs respond to the codes....). Here's the kicker: all paper charting. I thought i was double documenting at JEFF? It can't compare to a paper MAR. If i have my choice....never again.

I may have an interview soon at UCSF which would be the ideal job for me. Things are going really well with Matt, and i haven't grown too tired of him yet, so i think the prospect looks good. He's been amazingly supportive and nice, even when i had a little crazy irrational time with the car. So that's all working out. Maybe the job in SF is what i need. Pleasanton is pretty much South Jersey all over again. Strip malls as far as the eye can see. More people and traffic though. I'm still convinced i couldn't live here for very long. The traffic from the Trader Joes to home of 5 minutes is enough to put me in a terrible mood.

So working here has been interesting. Last night i met me at 85. A little old lady, spry and confused, first thing for which she asked was "sweets." Chocolate, ice cream, whatever.

I miss people, but it's been pretty busy here, so i have been sufficiently distracted. Thanks for all the nice send-offs and checking up on me. I have a comfortable couch if anyone feels like visiting, and there are places to stay across the big highway that are only 5 minutes away. Everyone is welcome. I'll keep writing here and there.

Hope you're all well.