group therapy

I finally had the pleasure of spending an evening with my fellow triage nurses on Monday at Melt (which has an all night happy hour most of the week) as a kind of goodbye/group bitch session. The evening was both enlightening and comforting, but in no manner does it bode well for the longevity of the staff.

One of my biggest problems with my job (of which there are many) is that there is little actual interaction with my peers. I spend, on the whole of the course of the day, less than 5 minutes of face time with either of them en total. It creates a rather odd work environment, where your colleagues are largely strangers to you. I am not stating that 'work' isn't the dominant priority of time spent in employ, but there has to be some socialization as well. I know a lot of rather arcane information about my pod mates, but did not know until I planned this evening that my co-worker/functional supervisor was a vegetarian. I, in point of fact, could not tell you she has any siblings, her likes in any form of entertainment, where she heralds from, nor her age.

So, it came as somewhat of a major surprise that she is also unhappy with working triage. This is something I only found out after putting in my notice and, instead of a 'sorry to see you go' she responded instead with something to the effect of 'Good for you! I am happy you made it out!' The newest triage nurse (we can call her S and the other one C) said much the same. In our HH meeting I found out that C isnt even sure she wants to be in health care much longer, let alone in triage. She does not sleep well at night. She hates the phone work and finds it as relentless as I do. She wants nothing more than to work part time. S is new to triage and came from a rather haphazard clinic, but she too is already wearing down and also wants to just do the job part time. All mirrored the same complaints I have detailed over the past few months. As enlightening, is that they too were promised something more with the position and were likewise duped by the beguiling story of multiple job duties and working closely with the doctors. Now both are struck with the same disappointment when the job failed to provide any differentiation is task. The term 'groundhog's day' was used by all involved to describe the unerring uniformity of each and every day.

So, while not a heartening overall picture of the profession of triage nurse, it is also nice to know that it isn't 'me' per se, but rather the job itself. Maybe they say misery loves company for that reason alone. It is nice to not think of yourself as a failure. Its the job that is a failure. And that, at least, is something to hang your hat upon.

I wish them the best and everyone in the clinic. I don't think many will last very long.

Tomorrow is my last day!

1 week and Christmas

The long weekend has come and gone and, as usual, I find myself wondering where on earth it went. I remember leaving work an hour early on Thursday at the behest of my supervisor, a few family gatherings, a movie, and now it is Sunday and quite dark. I think a major holiday came and went as well. Why can't Monday-Friday feel that way?

Speaking of Monday-Friday, this will be the last such that I spend doing triage (maybe not ever, but hopefully for the foreseeable future). Tia asked me today if I was excited about the new job. I was not really sure how to answer that. I am happy to be leaving a job that I do not like and that does not agree with me, but I cannot say I am excited for what is to come. I am more cautiously hopeful. I am no grizzled health care veteran, but I do know that what is promised is often not delivered. Even if it is delivered as promised, it has a tendency to change rapidly into something else entirely.

My old supervisor (lets call her J) worked in the IV dept for many years. Specifically in pediatrics. Anyway, the supervisor down at MP ran afoul of some of the higher ups and they needed a new supervisor. With some measure of reservation, she decided to do it. She then found she quite enjoyed it. Within a year she was replaced as the supervisor down there, and her hours and pay cut. Within another year she was squeezed out of a job. Now I am not going to suggest that J was the world's greatest supervisor or employee, but she was not nearly the worst in either regard. So, effectively J left something she professed to really enjoy to do something to help the department, ended up really liking it, and then ended up out of work entirely.

So, to get back to the point, am I excited to be the guinea pig for a newly created position after some significant retooling in the department? Well, not entirely. Will I be more excited to go to work next Monday than this coming one? Absolutely. And that, at least, is a step in the right direction (though truth be told I would much rather be a 'kept' man and just stay home and go back to school.........working on it :)

As to the above, it may be creeping closer to reality (not the staying home entirely aspect, but perhaps something less than full time plus school) as Tia continues to garner accolades and, it appears, significant interest from others to advance her position. The nature of how exactly she might get the promotion or even what that would exactly entail in regards to remuneration is murky, but it appears she is doing quite fabulously and they will be rewarding her. I am of course, thrilled for her. I am not ashamed to admit that she is a much much better employee than I am, with more dedication, drive, and general ability than I seem to be able to muster. It of course creates no minor conundrum: her career trajectory vs. my general disinclination to stay in rainy Portland. But that is nothing to directly be considered at the moment.

At the moment, we must consider another move it appears. A local one however. We have mutually determined that the ENSO is not what we had hoped it would be. The staff are gracious and accommodating and the location is superb, but the apartment building itself leaves much to be desired. As I have detailed before, it is largely about expectation vs. reality. We expect that the trash chute will not be clogged (now multiple occasions), that the facilities will be clean and in working order, and that we won't have water in our apartment windows nor share music or conversation through our walls with our neighbors. These are expectations that we would not necessarily have were we not paying a premium price. What makes it even less tolerable is that there are SO many other places about. So, the search will begin in short order. More to come as always.

Good news/Bad news for Portland (mostly bad)

Interesting write up in the Tribune about the rather precarious economic situation facing the Portland metro area. The highlights (lowlights?) of which were the following:
- regional wages are 4 percent below the national average
- the cost of living in the Portland region is higher than 84 percent of all other metropolitan areas
- Portland housing costs are 31.6 percent higher than the metropolitan average
- health care costs were 10.9 percent above average
- groceries were 4.9 percent higher than average

On the upside:
- the cost of utilities was the only major expense category where Portland was lower than the average U.S. city.
- Portland is still the least expensive major city on the West Coast (12.6% less than Seattle, though their wages are 17% higher)

Throw those numbers in a bowl and mix liberally with some of the highest unemployment in the country and you have a mess. But not to worry, the article does state that our leadership has a plan: community leaders agreed that creating more good-paying jobs is the key to making Portland more affordable to more people. Or perhaps it is just a general statement of the obvious like saying to a bunch of starving people "what we need here is some food, preferably good food." With no real way to make that happen, it is more like a wish or a dream than a plan per se.

It certainly will be interesting to see how it goes. Hopefully well, but Portland will be competing for those good-paying jobs with a lot of other cities. Well, at least we can drink to drown our sorrows........uh, "A heavy drinker might want to move from Oregon, where hard liquor is taxed at the rate of nearly $21 a gallon, to Maryland or Washington, D.C., which have the country's lowest liquor taxes, $1.50 a gallon." Damn! Foiled again!

stuck in my craw

I was getting the mail the other day and I got something from the University of Rochester where I most recently matriculated (I am guessing I move around too often for the people from Florida Atlantic to locate me). It touted some new incoming dean tangentially related to the nursing program, included pictures of students doing something nurse-like, and had some feature about some new and interesting (and likely expensive) piece of equipment that will help students further nursing in some nebulous manner. It also had an envelope and a plea for me to send them money. One would perhaps rightly assume that that was the point of the venture all along, with the articles serving as window dressing.

I do not now, nor shall I ever, understand this practice. A school, in my eye, is nothing if not a business. They are not performing acts of random kindness by educating the huddled masses as great personal expense. They are charging a fee for a service. In point of fact, they are charging many fees for many services. You are likely going to need to pay for books, lab fees, a parking permit, fees for transcripts, food cards, and on and on. Yet, they have the temerity to ask for more based on some warm fuzzy experience I had there.

I like eating out. Its one of my favorite things to do. Tia and I particularly like a restaurant called Belly, who serves incredible hamburgers, the likes of which I have rarely seen duplicated. When we go there, we have a good time, we order, eat, and then pay. They contact us if they are running specials or have a new menu item to tout. They do not, however, send us pictures of us eating in the restaurant, reminding us of our shared times there and then ask for additional monies because, 'my wasn't that quite fabulous!' In fact, I know of no business that operates like that and if they did, it is certainly a place you would not frequent again.

What makes me angrier about it is two, I think, very salient points:

1. I am still paying for school. In fact, I shall for some time and at personal sacrifice be paying for a number of years. As many as 20 are allotted me such is the magnitude of the sum I already paid for the privilege of learning there.

2. The endowment for the school is in excess of $1.3 billion dollars of approximately $380,000 per student. There are other schools that have more, but not many. By any accounts it is in the top 30 or so in the country in that regard. They could offer education for free......though of course they do not.

Ultimately, I just don't get it. Maybe I am missing some larger point, but mostly I just wonder incredulously how in the hell it works. Cause that is one sweet business model!

I haven't had a good bitch session in awhile. Thanks for indulging.

Second hand jobs

So, as promised, I will spend this post looking forward and not back. Although I did neglect to mention one especially important nugget of gossip/insider information about my current digs. Upon telling my functional supervisor/fellow triage nurse about my plans of imminent departure, she both congratulated me, wished me well, and said in no uncertain terms that she would be following shortly thereafter! Which will mean that the only RN remaining, until they replace me that is, will have exactly 2 months experience. I can only imagine what a flippin nightmare it would have been to hear my supervisor's news and then have to continue working there.

The new job is, well, somewhat like my old job..........only different. They have undergone a radical transformation in the IV dept over the past couple months. They had an outside group come in (much like the Bobs above from Office Space) and evaluate and make recommendations. A lot of meetings, consultations, and general realignment was discussed which ultimately led to EVERYONE in the department having to reapply for their positions and then go through a 4 question, 15 minute, interview in front of a panel that included two managers from the department and two people who were outside of it and could, presumably, be unbiased. They all scored the answers on the 4 questions and then totaled those scores and used that along with some multiplication of absentee rate and ranked everyone top to bottom. But, that is when it gets a little, well, iffy.

So, lets say that Position A has two openings and Position B has two openings and 4 people are applying, lets call them 1,2,3,4. People 1,2,3 all apply unknown to one another for Position A and Person 4 applies for position B. They do the interview and factor absentee rate and rank them exactly as they are numbered. So, in this scenario Position A is filled by people 1 and 2. Position B is filled with Person 4 and, presumably, person 3 would be offered the 2nd opening in Position B, right? Wrong. The way it actually worked was that Person 3 would get no job at all. The remaining position would be opened up to anyone who applied and didn't get their preferred position.

The process allowed for a couple things to happen, likely both intended. One, use collected data to make staffing changes based on actual usage and not on the desires of other departments to have people constantly at the ready just in case. And two, weed out some staff whom either were generally not reliable/effective or they just didn't want around anymore without needing to go through the often lengthy and complicated process of firing someone.

As for me, I did not apply to the initial wave of offerings as I did not wish to, in any way, take someone's job. I had/have a job and they would ostensibly no longer. I may lack huge reserves of empathy, but I have enough not to be a total asshole. Plus, these were people I at least peripherally knew, if not knew well. However, once the first wave of interviews were done and positions were granted, there were actually some jobs still available. At the time, I did not understand the process. I honestly did not even know that they were effectively downsizing, thinking they were more or less reassigning roles. I clearly did not read the fine print (or between the lines), and I applied.

The jobs were posted late Wednesday, I spoke to my old manager that evening and applied the following morning. I was interviewed by her and another gentleman, who was not part of our department but did the other interviews, that afternoon. I was offered the job that evening. Accepted Friday morning and turned in my notice late that same afternoon. I found out that same day that one of my closest friends in the department did not fare so well, despite 7+ years in the department. She was rejected from a total of 4 positions she applied for (2 in the first wave and 2 in the second), though none were thankfully the one I accepted. I do not know the fate as yet of many of my former MP co-workers. I certainly hope they found something.

The specifics on the new job are not much different than what I did before, and wildly different. I will be the EM clinic. Just me. I will have help if I need it and someone will cover my breaks, but otherwise it will be just me and the patients. It is M-F and the hours are very similar to the ones I work currently, though I will now be a 40hr/wk employee. I will also get inpatient pay again, which is about a 10% pay bump. Strictly financially, it should be about about $9K annually (before taxes of course). But, honestly, I would have taken the job for the same pay I have now or even somewhat less.

The hope is that this works out. I will have the opportunity to do the kind of patient focused clinic care I love, though I will be going it solo which is a little bit nerve-wracking on a few levels. I will be able to keep up IV skills and do some PICC work as well on the floor should things quiet down in the clinic for stretches. I will be, in many respects, my own boss provided I don't rock the ship too abruptly. But, perhaps as importantly, I will not be sitting on the phone 95% of my work day. That alone is cause of some minor celebration!

Time for some gym work. Got another, albeit shortened, week staring me dead in the face. However much I am not looking forward to it, there is a lot less dread when you know the end is nigh. No matter how tough a day is, you can check it off the the calendar as one less you have to go through instead of just one less day until the weekend. Let the countdown begin!

My how things change (I quit!)

Inertia is a difficult thing to overcome. It can feel like pushing a loaded down wheelbarrow up a steep incline. The thing is, once you hit the peak, things move rapidly. In this vein, I applied for, was interviewed for, was offered and accepted, a new job in the span of 48 hours. After dozens of resumes and applications were sent out to disparate places with frequently no response, it happened just that fast. Why? Well........

If you have been reading this blog at all you know I hate my job. I have had many jobs in my life and I can certainly not attest to loving any of them. They are now, and will likely always be, necessary evils. Things I do because I need to eat, pay rent, and so on. I know this about myself. I work to live, not remotely the other way around. I would also be more than willing to lower my standard of living if it meant a corresponding reduction in my need to work. But I digress.

That said, I don't frequently hate what I do. Would I rather be reading a book on a beach with a tropical drink firmly ensconced in my right paw? You betcha. Would I also rather be cleaning the house, grocery shopping, or wiping down the interior of the car? Also strongly on the side of affirmative. However, are the health care jobs I have held, present company included, better than, say, working at a care facility bathing the dementia patients who no longer have control over their bowels or emotional states? Abso-freakin-lutely! There are many darker holes to climb out of to be sure. I sat in a climate controlled office bathed in fluorescent lighting with a headset atop my cranium with eyes forward perpetually affixed to the CRT in front of me. Many a worse fate has befallen many a better person than I.

I tried to figure out why I hated what I did. Why it made me feel the way it did. I tried to figure it out with a counselor, with Tia, with friends and family and on the pages of this blog. I can say without reservation that it had nothing to do with the people I worked with. The only one I did not care for left (and made many people in the clinic quite happy) and of those that remained I can say, at worst, I was ambivalent about them and, at best, I considered them friends that I would be more than happy to see outside of the confines of our clinic. They were a stellar group of generally upbeat individuals doing work that, from the doctors on down, paid them less than they were worthy of. I will truly miss most of them and hope to stay in touch.

I can also not largely say it was the patients who call. For the most part they are gracious and eager to hear anything that might make them feel better. They are calling at a low point physically and, like all of us when we are feeling that way, just looking to feel better. Sure, there are confrontations, the avidly over-calling anxiety junkies, and the straight up pill poppers looking to dull the pain of living away.

What I like to think is that it is the relentlessness of it all. The fact that around every corner and over ever hill is another expanse the likes of which you just traversed, like an MC Escher painting. Or perhaps it more like the sublimely funny Bill Murray movie Groundhog's Day, where the same day keeps happening again and again. There was never a beginning and and end to anything other than what the clock and calendar displayed. Mondays are the same as Fridays and July is the same as December because the calls never stop and they often don't even vary in content.

I also blame the chasm between expectation and reality. I was told, and naively believed, that I would have the opportunity to work closely with the doctors and, in some sense that was true, but mainly it was misrepresented. I exchanged mostly emails (TENCs) with them about patients and frequently didn't see or talk to some of them for days at a time other than good morning and good night (I barely exchanged words with the other nurses there because we rarely saw one another during the day as well). They were just as busy seeing live patients and, when I told one doc I was leaving, Daniela, and she said that she understood re: the learning issue as the clinic is a poor place for even doctors doing their rotations to learn. There just isn't the time available to do so because the doctors themselves are always running to play catch-up.

All the metrics are set up for one thing and one thing only: make primary care, or health care in general, profitable. The only way to accomplish that is volume. We were recently told that we need to make hospital follow up calls and given a hand out about it with some rather elegant doublespeak about caring for patients and the rate of illness that occurs after hospitalization. However, what stuck out the most prominently was a graph on the last page that assigned a dollar figure to each of these hypothetical patients and how much money that those follow ups to their primary care doctors might generate. Cold reality on display.

So, will I miss it? Well, in some ways I think I will. I will write more about the new job in the next post, but lets just say it will be far less peopled. I will miss working with a team, though we often didn't work on the same projects. I will the banter, the laughs at our own and at the patients expense, and I will miss the common bond of fighting a battle you can never win. But will I miss the job? Well, if you think that you haven't been paying attention the last few months.

new opportunity?!?!?

More to come........tomorrow I hope.

Midweek

Today has been quite interesting.

- First, the magical imitrex that smothered my migraine (quite literally as it constricts blood vessels in your brain) also had me buzzing on what seemed to be a caffeinated high. Ended up not falling asleep until better than 3:30 in the morning. Accumulated only a handful of hours even then. Thankfully today was my half day and I switched from AM to PM and was able to go to my appointment and make it in to work. The latter was funny because NO ONE thought I was coming in evidently even though I called saying I was in the message. Not that it matters. My job is definitely the more the merrier. Helps you spread the shit around a little thinner and that is good for all involved.

- My counseling session was actually quite good and more productive than most have been. That said, it is 3 and done there and, ultimately, I am left wondering if it was really helpful. I liked her as a person, but felt the sessions lacked much direction and wanted for insight. I didn't expect a tidy summation, but I would have at least liked to see one or two plot points tied up. I basically learned that it can be helpful and I think I will pursue it anew in the coming year with new insurance (and probably new hoops to leap through).

- As an odd aside, I heard from my former manager, and they apparently are opening up a few positions after a major shakeup which left more than a few people out in the cold. It was indicated that I ought to apply for one closing tomorrow. I think I will. No guarantees, but worth looking into. More to come as events warrant.

- Tried out Little Big Burger in the Pearl today and it was quite good, if not exactly great. On par price wise with 5 Guys burgers, but I have to give the edge to the latter. They do however have some amazing truffled fries for the same price as you would find for a large fry at McDonalds and these win hands down! So good. Anyway, if you have $10 and are in the area, not a bad place to spend it (or the sushi place next door or Roccos.....come to think of it there are a lot of cheap eats around there).

- Heard from our place, ENSO, regarding our concerns. They actually addressed them very thoroughly in a letter. Much appreciated. Don't know if that will warrant us staying long term, but I applaud their professionalism.

- Tia found a possible alternative place that is nearby and significantly cheaper. We are going to take a peek at it in a week or so. God help us if we have to move yet again. I can at least promise it won't be with Thunder Movers.

Migraines. juxtipositions, and dilemmas

I ended up coming home early today due to a migraine. It was only an hour early, because there is always too much to do and the third nurse has her half day today, but early nonetheless. We had finally hit a point of relative calm (generally around 4, though not always on Friday) and that along with the relative failure of the over the counter ibuprofen I had taken (which was no longer even remotely mastering even the most peripheral of symptoms) I finally ran up a white flag and surrendered. This is not meant to draw sympathy, I hate my job and would have happily left for a hangnail were it not for the regard I hold my coworkers in, nor to lionize my efforts under duress (though it does stress my already limited reserves of empathy), but rather to emphasize that today kind of blew. Thankfully my doctor, who I will truly miss when I switch to Kaiser in a few weeks, called me back and provided some imitrex. That plus a nap equals almost good as new. As good as I have felt recently anyway.

Part of the fun of migraines for me is the mild nausea (for some it is much worse however). Hence, lunch consisted of 2 pretzels, a diet Dr. Pepper and 3 bites of a sandwich. Needless to say, I was a little hungry when I awoke. Having little inclination to cook, I heated up some creamed chipped beef and made some toast and called it good all while reading about a restaurant called Alinea in Chicago which has some of the most marvelous looking food I have ever seen. I don't know if you would eat it or just stare at it (though for $195 per person you might as well eat it). Evidently dinner consists of 23 courses of small bites and crazy combinations. Check it out, the pics are incredible looking: Alinea. This of course made my already minimally appealing dinner look as appetizing at it already sounds. Bummer.

I am unfortunately not dealing well with the winter doldrums again this year. For some reason I always think it will be better than the last year, and then it never is. I am trying though, but it feels almost physical in how it affects me. I just feel, well, flat. Two dimensional. And it seems unfair or unrealistic (though it is completely fair and realistic because everyone else does it just fine.....or some semblance therein) to just move on about the day as though everything is hunky dory. I feel more badly for Tia than myself though. She has to deal with something she just doesn't really understand. Something that you can't see. Not only that, but she as to go through the motions with me even though she feels completely unaffected by it. And I don't blame her that. I mean, you put a band-aid on a cut, you take an aspirin (or more) for a headache, but what do you take for melancholy? It has to wear on her as it does me. And, unfortunately, life stops for no one and her job is already taxing and her family is having its own set of health troubles which she is trying to help with.

On top of it all, I keep tugging at her to move. I need it because I can't tolerate another winter here, but I know it is not something she wants to do. And from her side of things, I truly understand it. Here is her family, her friends, her career. The life she knows. There (wherever that may be) is a huge question mark. I feel like Monty Hall and I am asking her to trade in her prize money for whats behind door #3. Though even I don't know whats behind the door. I am more willing to do it, because I have much less to lose (though still a considerable sum as I value the people in my life here). I feel torn because, well, what if its a booby prize and we both ultimately lose? Or, what if it means that I am happy and then she falls into the hole I feel I am in?

On the other hand, you can't win anything without risking something. You certainly aren't going to go in a casino and be awarded money for just walking in the door, you have got to be willing to put your money in the machine and pull the handle. And there are risks to staying as well. I am already holding up about as well as a cardboard house in a rainstorm and the winter has just begun. The job market most places is bad, but here it is worse than average (45th out of the 50 states) and based on the applicants that are applying for jobs with Kaiser that Tia is seeing, they are literally higher people at 2 or 3 job classes below their level of expertise. People with Master's degrees and 10+ years of experience clamoring over entry level positions. So, using the gambling analogy, my options for finding a good job are about the same as taking a poker hand with a pair of 2s.

Ultimately it comes down to compromise and sacrifice and setting targets for those things. More to come as always.

over promise and under deliver

A successful business slogan I have always remembered is under promise and over deliver. The principle does not always work to be sure, but it largely does. When you exceed even modest expectations, people are almost always pleased. When you fail that, the outcome is reversed. I also believe in expectations being modulated to the environ. I do not expect that a McDonald's cheeseburger will be comparable to a burger at a chophouse nor do I expect even a new Kia to outperform a 5 year old Porshe. However, I do expect a McDonald's experience be consistent to other McDonald's experiences and a new Kia to compare to other new cars in its class and price range. According to people I have worked with and dealt with, even this puts me in a high needs class, seemingly because I expect some standards at all.

What does the preceding paragraph have to do with anything? Well, mainly it relates to our apartment. When we moved in, they over promised and they are certainly under delivering. This may not be a big deal, but for a 'luxury' apartment that is charging prices congruent with that moniker, it is highly disappointing. Since we have moved in the laundry list of complaints is as follows:
- The garage door keeps being repaired. At each repair, it gets noisier and noisier. It now has the distinctly displeasing sound of rending steel every time it opens. And it opens a LOT. And we are far too near it to ignore each and every opening.
- The gym is supposed to be stocked at all times with towels and cold drinks. It is a 50/50 proposition generally. Fine if that wasn't one of the sell points, but it was.
- The one garbage chute per floor works fine mostly, except when it is stuffed and blocked. Fun. But the big common problem is one recycle bin for everything but glass and one for glass that is emptied weekly. Tia and I used to fill one of those up ourselves at least monthly. Now you are talking about 30+ apartments and one bin. Which means recycling everywhere in a small room that gets cleaned out once a week.
- Leaky windows that, honestly, they continue to not address. I don't know what is being done behind the scenes, but the communication is poor. In the meantime there is no way there wont be mold issues in due time. This is in a number of apartments and appears to be structural.
- Supposed free internet that really only works about 20 feet from the hot spot.
- A big screen TV in the common room but only an antenna hooked to it so it gets 8 channels. Kind of like buying a sports car and then putting bike tires on it.
- No entrance from the lobby to the stairs, meaning you have to wait a long time for an elevator to take you up one floor. It is comical and everyone in the building is frustrated by it.
- A new front load washer/dryer that seems to never dry things and vaguely washes them.

I am sure there is more, but I mainly mean to make the point that a LOT of these things would not be problems except that we are paying a premium price for them. My expectation is that the price affords premium accouterments and that they be maintained. However, that is not happening. And, as our complaints dont seem to resonate, we are left contemplating other options that are altogether unappealing like moving yet again. Bah!

On other topics:
- It won't stop raining, and raining hard no less. Missing warm sun.......or either one of those things.
- Work is crazy busy. Even with 3 RNs running the phones it is a scramble to keep up with volumes. They also want to add more to our agenda. I am thinking that might be a while in the coming at this rate or something will fall off the table and be forgotten. Still nothing else in the pipeline.
- Going to a wedding reception today. My recommendation, just elope and have a party after. It is cheaper, more fun for all involved, and you can use your 'special day' money you would have spent on overpriced catering and attire to have a truly memorable honeymoon.
- I just read that the US govt spends more on defense than the NEXT 20 NATIONS COMBINED! Some estimates put it as higher than all other nations combined. And yet they dicker over pennies on tax breaks and the like. What the hell!?!?!
- Only three more weeks until the new year. Hopefully that means new opportunities too.

Time to get back to trying to do things. Hard to get motivated when it seems perpetually dim outside.

the weather for the next week.......color me unimpressed

	Today Mostly cloudy. Highs 45 to 50. Northeast wind 10 to 20 mph... except east wind 15 to 25 mph with gusts to 35 mph near The Gorge and over higher terrain. » ZIP Code Detail
	Tonight Partly cloudy. Lows 35 to 40. East wind 10 to 20 mph...except east wind 20 to 30 mph with gusts to 45 mph near The Gorge and over higher terrain.
	Monday Mostly cloudy. Highs 45 to 50. East wind 10 to 15 mph with gusts to 25 mph near The Gorge and over higher terrain. . » ZIP Code Detail
	Monday Night Mostly cloudy with a chance of rain. Lows around 35. East wind 5 to 15 mph. Rainfall amounts less than a tenth of an inch.
	Tuesday Mostly cloudy with a chance of rain. Highs around 45. Southeast wind 5 to 15 mph. Rainfall amounts around a tenth of an inch. » ZIP Code Detail
	Tuesday Night Rain. Lows 35 to 40.
	Wednesday Rain. Highs around 45.
	Wednesday Night Rain likely. Lows around 40.
	Thursday Rain likely. Highs around 45.
	Thursday Night Rain likely. Lows around 40.
	Friday Rain likely. Highs around 45.
	Friday Night Rain likely. Lows around 40.
	Saturday Mostly cloudy with a chance of rain. Highs around 45.

Its beginning to look a lot like...........well, Portland in winter

I have been trying to be better about posting, but have been somewhat waylaid by illness this past week. It is really tough to blog when you are A. somewhat dopier than normal due to regular doses of cold medications and B. not producing much to write about when you are doped up on cold medication and your sojourns include work to home and couch to bed.....intermixed with copious amounts of slumber. Had I blogged, it would have been something like: Woke up. Took pills. Forgot to eat breakfast. Fell asleep on couch. Woke up again wondering why I was so hungry. Made some kind of 1 or 2 step food item. More TV/sleeping. Nyquil. Wash/rinse/repeat. Compelling I know.

I did manage to make it to work most of the time during the week.......mainly because I knew it would be hell and I felt terrible about leaving my coworkers to deal with it understaffed. I was unfortunately right on with my prediction. For every day the clinic is closed, the amount of calls doubles on the following Monday. A three day weekend in September led to the most brutal Monday we had had since I started. This was a four day break and the calls did not let up until Thursday really. We ran dry of appointments most days by 10am. On one occasion, the day prior. It finally petered out around Thursday afternoon and, by Friday, was no different than any other Friday. I hope next week is better.

So, today Tia came back from her east coast shenanigans (or conference) and we decided to get out and get moving today............of course that didn't happen until nearly 2:30 after we both kind of milled around for a few hours aimlessly and belatedly realized that we had just burned through 80% of our daylight hours (they are shockingly brief here in the winter). We took the streetcar downtown, briefly ventured into Nordstrom Rack (where Tia and I simultaneously remembered that I dislike shopping normally, and HATE it when they are packed to the gills with shoppers between turkey day and commerce day). If you haven't been to the Rack, it is an experience to behold. All the name brands from Nordstrom's (albeit many brands I am not even tangentally familiar with) at reduced prices. Though, I have to admit, even the discounted prices still puts most things there at uncomfortably high prices for my liking and everything is tightly packed together, giving it the impression of a high end rummage sale and making me feel incredibly claustrophobic. Thank god for online shopping!

From there, we shuffled off to a 4 o'clock Happy Hour at Hubers which, aside from watching them make their famous Spanish coffees, was rather disappointing. The service was slow and indifferent and the food was middling. At least it was cheap. So, at least they have that going for them.

After wandering back in the blisteringly cold wind that made it feel infinitely colder than it actually was, my body quickly reminded me that I am only 'getting better' and not yet 'recovered' as I honestly feel like I have run some sort of marathon rather than just walked up the street (less than 2 miles total). Did I mention how much I hate being sick and how much it is going to hurt to get back to working out? Not looking forward to that.

Thats all folks. As I said, not much going on when you are prone most of the week.

Touch the Kitty - Kahneeta

With a 4 day holiday in our grasp, we determined that seeking a change of pace from the steel gray drizzle that permeates this area in the Fall and steal away to Warm Springs. Neither of us had been there, and the expectations were modest. It lived up to what I had hoped it would be.

The first thing you notice about the place is the isolation. For about 15 miles around it, it is sparsely peopled. We actually saw wild horses and cows walking along, if not upon, the roadway. There is a certain alien beauty to the high dessert, even in the winter. Plants in muted khakis and greens, low slung scrub brush, and jutting rock formations the color of burnt umber that dapple the landscape. I think the high desert is amongst the most beautiful I have seen, you can argue amongst yourselves the merits of that assertion however.

As for Kahneeta, well, it had its roses and thorns.

Roses:
- The staff were extraordinarily friendly. When we complained of some boisterous neighbors, they not only moved us, but moved us to what the front desk person termed as his favorite room in the hotel.
- The restaurant (the only one open and on site) was generally quite good and moderately priced. Love Indian fry bread!
- The pools were nice and warm, fed from the hot springs.
- Met a fun and interesting Portland couple there who we hung out with on Friday night.
- Walked out with more than $175 in winnings and hours and hours of entertainment.
- The weird casino people and all their bizarre rituals ranging from touching all over the screen, talking to the machines, and a woman who encouraged me to 'pet the kitty' to a digital image of a cat on a bonus game on one of the slot machines.
- Free HBO........got to see some Flight of the Concords and a movie or two I hadn't seen before.

Thorns:
- Even the 'nice renovated room' we were switched to had a certain cheapness to it. The showers varied from a shower head that was installed for pygmies in the first room to one that can best be described as akin to a spray nozzle on a hose in the second room. Low end fixtures were quickly showing there lack of durability. Pool towels that were actually smaller than the room towels and less absorbent. Thermostats that controlled rattle-trap heating and cooling elements and had very non-specific temperature settings. I would not say the place was falling apart, but it was definitely showing it's age.
- The non-smoking part of the casino was actually quite ample compared to other casinos, however it was designed poorly. The upstairs was non-smoking and there was no barrier, physical or air, that prevented the smoke from wafting upwards to the second level. Our clothes reeked and my throat was raw, though we had not been within 50 feet of a cigarette the entire evening.
- The expensive spa. A lot of dough for spa services in the middle of nowhere. I will grant there is no competition, but it would seem to repel demand as well.
- $4 to go on the slides, even while staying at the hotel (they do comp you the charge for pool entry at least). We didn't use it because it was WAY too cold, but still very odd to nickel and dime for something like that.

I think that fairly covers it. It was cold, but brightly sunny. It was restful and fun. It was, all in all, a perfect getaway that could have only been made better had we won the car they were giving away (it went to an elderly couple instead).

Now to start dreading tomorrow..........I can only imagine what troubles people managed to get into, and not bother treating, over a 4 day weekend. I am already starting to twitch nervously.

If you think it, it is so

The crux of a lot of medicine and psuedo-medicine is, in part, based on how much you believe it will work, known as the placebo effect. There is a story, I believe from the second world war but don't quote me on it, where nurses had to use saline instead of morphine for soldiers when they ran out of the latter. The summation of the story is that the ruse, by and large, worked. The soldiers believed they were getting morphine and reacted as though they got morphine. This is not to say that placebos work as well as the morphine itself would have........but it worked a hell of a lot better than if they had informed the soldiers they were out of pain medication.

Unfortunately doctors cannot utilize the placebo effect. They are pinned to the wall of legality.......should they not pursue anything and everything to treat, they open themselves up to possible legal ramifications. So, the placebo effect lies largely in the hands of Naturopaths and analogs thereof. That isn't to say that none of their medications/treatments have proven effect, but it is to say that they do utilize in large part the belief that their treatments will cure to, well, cure.

Why do I mention this, well because I went to see a mental health professional today for stress and she used some rather, well, a little new age for my general tastes, techniques. I don't wish to cast dispersions on the practice because I know there are many fervent believers and a multiplicity of success stories. Much like religion, if you are a believer, everything sounds plausible, but if you aren't, it just all sounds a little crazy. However, I am going to try to suspend my disbelief for my three sessions and see. Maybe I will become a believer too.

Indulge me

So, as I was perusing the latest Costco e-mailer I noticed this product: Shelf Reliance Thrive. Tia has explained to me that this has something to do with the Mormon's and their belief in some not too distant dystopian future in which some plague, natural disaster, or what have you will require all of us to have on hand a full year's worth of food. A LOT of questions spring to mind not the least of which are 'where does one keep all this food?' and 'how will you be protected/safe from said apocalyptic events?' and 'Why just one year?' The mind boggles. In the meantime the question remains: is death better than subsisting on a year's worth of freeze dried veggies and TVP and then, ostensibly dying yourself (or whatever their version of future events is)? Ponder it, but please don't spend much time doing so.

Two funny calls today or as I like to call them 'young men are dumb'.

- First call: young guy "I got an ammonia (sp) shot the other day and my arm is totally numb" Me: (stifling a laugh because an ammonia shot would hurt like hell I imagine) "Are you a patient at our clinic, because I am not finding you in our system."
YG: "Uh yeah, I saw a doctor there..........years ago"
Me: "Do you remember the name, because if your not a patient here, I can't offer you any advice except go to Urgent care to see a doc."
YG: "I said it was years ago and I don't remember."
Me: "Years ago you would have been a pediatric patient and we don't see pediatric patients in our clinic."
YG: "Screw this man, this is bullshit!" and hangs up.

Question - how the hell did he even figure to call us the clinic in the first place?

Second call related to a young man who, upon contracting an STD that was thankfully curable with an antibiotic was given a 7 day course. This call was a week later and, in essence, the following dumb things occurred: he stopped the antibiotics early because the symptoms went away (1), he then had unprotected sex again with someone he suspected was a carrier for an STD (2), and finally he then took the remaining 3 days worth of antibiotics the next AM to prevent the STD again (3). This was a college student who clearly did not understand how STDs were transmitted nor how antibiotics worked. Scary.

thankfully only 2 more days of it............I guess its more interesting that cold/flu and diarrhea at least (the bulk of my calls).

And in other news

I thoroughly dislike the local news. Because of it, I admit to being fairly ignorant of local events and developments. To me it is a fair trade. Local news pushes too much negativity and fear mongering for my tastes. It paints an exaggerated picture of theft, avarice, and violent crime that I find revolting. But, despite this heightened sense of negative reality, they always manage to find some positive piece of puffery that they inevitably shoehorn in the last segment before they bid us adieu. Whether it be a piece about a local kid selling his comic collection to send presents to the troops, a portrait of someone who has worked to effect positive change in the community, or a water-skiing squirrel, they try to leave us with a bit of a mental palate cleaner after force feeding us trash for the previous 29 minutes. The proverbial mint after your turd sandwich. Considering the negativity of my past few posts, lets call this the mint.

I write a lot of negative things about work, and there are enough of them to be sure, but much like the local news, it does tend to distort things by exaggeration. Most of the calls I get are genuine concerns and most of the people I speak with are fairly pleasant a grateful for advice. My coworkers, MAs, RNs, and docs alike, are by and large really good people. We all share and commiserate and deal with the same burdens which makes us a lot closer than some other workplaces I have been in. We do, when we can, have a lot of fun together even if just sharing some gallows humor. It makes a tough job much much more bearable.

On top of that, our little group in Pod 1 has been garnering an unusual amount of accolades. One of our docs said it makes her happy to come to work because she works with us all, and another two (who have been there for better than 15 years) have told our manager that this was the 'best group they have worked with.' It is certainly nice to be part of those comments. Also, I get more personal accolades than anywhere I have worked previously (or at least that I recall). I am sure I don't make everyone happy, but by and large they seem to find me competent, good with patients and staff, and generally easy to get along with. All those things just make me wish that I enjoyed it more..........and I am truly trying, despite how my blog might read.

Back to my lazy weekend (partially because I have a nagging suspicion that I am fending off another minor outburst of cold symptoms that seem to be traveling through our clinic).

Rigidity

One of the longest tenured members of our clinic is being forced by a shoulder injury to call it a career on the 1st of December. She has been with the clinic for better than 8 years and seen her share of changes along the way. She is a wealth of information and a valuable resource who knows seemingly all the ins and outs of the clinic. So, why is it that with near unanimity people are more than happy to see her go?

Well, the simple answer is rigidity. She is as inflexible a person I have ever met. There is clearly one and only one right way to do things. For example, I walk to work, and though I always leave from the same place and arrive at the same place, I kind of decide on a whim how I will get there and what streets I will meander down, sometimes based on mood and sometimes in such a fugue state I honestly don't know why I go the way I do. However, I don't doubt that N (lets just call her that) would walk the exact same way day in and day out. This in itself would be fine except she is not content to just do that and call it an idiosyncrasy, she would also take pains to point out all the reasons why her path to work was in all ways superior and point out all the flaws in the method in which you decide to get to work. And she does this constantly and to everyone: doctors, staff, or peers.

Everyone has a story about her, and none are positive. Doctors roll their eyes. Staff swap stories about past conflicts. And I, and the new nurse, both asked to have our training with her cut short because we could not stand to be around her. Better to be ignorant and learn as we go than to be bullied and belittled as we learn. She doesn't teach, so much as lecture and scold. She is the kind of person that, when you talk about a rough patient or a bad day, does not empathize but rather talks incessantly about how much tougher a day she had or how much worse it was before. It is almost pathological.........and you wonder how none of this penetrates. How can one person be okay with being so universally disliked? I know I couldn't.

There is certainly a part of me that feels a bit badly for her, or would if she wasn't always so self-satisfied. But mostly, like everyone else, I just want to see her gone. I don't love my job and I have strong doubts that I ever will, but I do genuinely like my coworkers and I think we will all be much relieved to not have her standing behind us, ever critical.

So long N..........may the door hit you where the good lord split you.

Mistakes and McRibs

mis·take (m-stk)n.

1. An error or fault resulting from defective judgment, deficient knowledge, or carelessness.

Now that I have been at my new job for more than 4 months, I feel confident in calling the move an unmitigated mistake. An error. An eff up. I try not to blame myself too much for it because, of the possible definitions of the word mistake, deficient knowledge is assuredly the culprit and you can do little about that. I tried to perform due diligence and shadow, ask questions, and o/w do everything I could to try to understand what the job was, but it was too much to believe that I truly knew what it was I was getting into. I couldn't.

The only thing I can compare it to is test driving a car. You can get a feel for the car's performance and a general idea about its accessories..........but until you own it you can't know that the cupholders are not in the ideal spots or the seat is too hard on long trips or that certain things rattle and on and on. Only in this case, using the car analogy, I think I bought a lemon altogether. The cupholders may be annoying, but it is nothing compared to your engine perpetually catching fire.

I think the major issue is really that the actual job is so very different from what it was purported to be. I knew I would be sedentary and that it would be M-F and that I would largely spend my day staring at pixels on a screen with a headset strapped on. But what I didn't know (couldn't know) was that, while I do primarily triage, I also do a whole lot of customer service, serve as a mouthpiece for both good and ill news for the doctors (generally the latter), and deal with a lot of people who are pissed off about something or another related to their health care that I am obligated to placate when I really want to just tell them to go eff themselves. Oh yes, and filling out copious paperwork and typing extensive notes about all of it. It is exhausting mentally and emotionally. I feel worn and frail. I vacillate between anger and a kind of deep overwhelming sadness because, well, what the hell can I do about it anyway? I have quite literally painted myself into a corner and there is nowhere to go without making a mess of everything. Honestly though, I more and more question whether that would really be all that bad.

In the interim, I am putting out multiple applications a week and ever broadening my search parameters because, well, the more trapped I feel the more open I am to any means of escape. Like the movie 127 hours, the protagonist didn't start by deciding to sheer his own arm off, but he did it eventually because he had little other choice. I am definitely encroaching upon that proverbial point because I am finding the cost of my displeasure to be too high. I hate the way I feel in my hours away, that I am already dreading tomorrow, and that Tia has to deal with all of it. Physically I am chronically headache ridden, my stomach is an acidic mess, and I find myself leaning further and further towards accepting pharmacological solutions as a means to subsist. Updates to come as they warrant of course.

In other mistakes, after being bombarded by ads and recommendations from people I work with, I tried a McRib. I think I may have had one before, but it has been a decade or so. I have to say, it may take another 10 years for me to forget this experience as well. The texture was off putting and the taste was somehow worse. Just altogether unpleasant. I just don't understand the clamor.

We also got to try a Portland institution this week, Stanich's. It was actually quite good and pretty darned inexpensive. For 4 adults, we ate well with a beer and 2 sodas and the tab was a mere $30. Not a one of us left less than stuffed. The burgers themselves are fairly pedestrian, but the cheese and sauteed onions were sublime. The fries were winners too, and appeared to be freshly cut with skin on (always a bonus to me). Not the best burger I have had in Portland, but dollar for dollar, among them to be sure.

I think it is time for a Sunday nap. A rare but necessary guilt free pleasure.

Fierce chops and other stray observations

I suppose every city represents juxtapositions of some kind or another. Certainly Portland does. I live in a place called the Pearl......which is a fairly upscale part of the city proper. We don't live in the thick of it, but we live there. Much like saying you ONLY got the base level BMW, you are still driving a damn fine automobile. Despite this, we are surrounded by the homeless. It is a startling contrast seeing someone begging for change outside an establishment that has the temerity to sell 'couture' t-shirts for better than $75 apiece. But yesterday, well, that had to take the cake. On my way to work someone had literally pitched a tent on the sidewalk, parked their cart out front of it and said 'fuck it, I am sleeping here' and then proceeded to do so. The difference from anyplace else I lived to here is that no one thought twice about it, they just stepped around. Odd indeed.

Speaking of odd, you have to love the 'individuality' of our denizens, even if they often end up trying to look so different from the mainstream that they end up looking kind of the same as each other. I had to go to work earlier than normal last week and both days I walked past a gentlemen with the fiercest pair of mutton chops I had ever seen outside of civil war reenactments. He was otherwise young and moderately dressed, certainly not traits one would associate with such a bold facial hair accoutrement. One wonders what kind of work he does and how this choice came to be. I am not one to state that you cannot express yourself in any way you choose, but I also understand that you also self limit your career options by doing so. Even if you boast sterling credentials, it is unlikely your neck tattoo, grizzled neck beard, and affinity for cranial accessorizing will net you a position of much import. Individuality does not need to be nakedly displayed. It should, in fact, run deeper than that. So, to mutton chops, I salute you sir, but I also have to wonder what you do with your days.

On Friday we saw some friends we had not seen for seemingly ages. It happens that way as a grown up (adult............er, teenager x2.........whatever). You end up not seeing people for months and then, when you do, you question why it has taken that long. Before long it has been another three months and the cycle repeats. One of the bummers about getting older is that you now have the money to do the things you couldn't when you were younger, but now you don't have the time. Then, at the point you retire and have the time, you probably won't have the money. Rather than go down that treacherous path, great food (Foster Burger is quite good), good friends, and I forgot how much Scattergories can be.

Time changes in the NW suck btw. I like the idea of walking to work.........I like less the idea of walking home in the pitch dark while it is cold and wet and I have to tromp over a slick mess of rotted leaves. The good news is this should all be over in just a scant 4 months or so (sobbing quietly to myself).

Speaking of slogging off to work, I best put myself to the task of sleeping so I can do it again tomorrow.

updated..........er, sorta

I havent had a whole lot to blog about lately. Definitely would have a hard time were this a vocation and not just a place to post random thoughts. How do people come up with something daily?

Work has been, well, work. We are finally starting to train the new RN, which means we will finally be at full staff for the very first time since I started working there. What will it mean? Well, no more spending all of Tuesday afternoon on my own. As a funny aside, the on call doc of the day this past Tuesday came over to let me know he was leaving for the day and asked where the other RN was. When I said she was gone for the afternoon and that was what she always did he looked at me rather incredulously and said 'Really? So you take the calls for all the doctors in the entire clinic?" When I answered in the affirmative he responded 'good luck with that!' Not to say I am the only one, the other RN has to do the same for me on my half day as well. My point is that it is freaking bananas! Thank goodness we will finally have a full staff. I hope she ends up staying............at least until I can figure something else out for myself :) In the interim, maybe things will be far less shitty.

I am beyond thrilled that the elections are officially over. I consider myself a dem, but I honestly am developing (have developed) an aversion to all politicians. According to what I read, estimates are that expenditures for the midterm elections were between $3-4 Billion dollars. I know in Oregon, the governor's race accounted for more than $6 million for the incumbent and more than double that for the challenger. Though the data is a couple years old (2007) at that time the Governor of Oregon was paid less than $94K. Lets just guess it is closer to $100K now. Throw in free housing, etc lets generously add another $100K to the total. So, at BEST, we are talking about someone spending 30 times their annual salary (and I realize it isn't their money) to keep a job and someone spending 60-80x the possible salary to unseat that person. Oh yeah, and that is EVERY 4 years, not just a one time deal. How can that NOT lead to corruption and elected officials beholden to the special interests that support them? If Kitzhaber wins (the incumbent) he will owe the unions that kept him there. If Dudley wins, he will owe the wealthy contributors like Phil Knight. The whole thing is just horrible. We all just continue to lose when our leaders don't do whats best for the majority, but do rather whats best for themselves and the people who paid to get them there.

But, as an aside, yeah for no more political ads on the TV and my mailbox stuffed full of the same.

A couple more days to go until the weekend.........almost there. Then Foster Burger with some old friends. Looking forward to it!

frame of mind

I know I use the blog as a place to complain about my job...........and for good reason, as it is a large part of what I do and is depersonalized enough to be relate-able without stepping on anyone's feet. The funny thing about blogs is that, the more people you know who read them, the less you can really say. But, I digress.

I am not a great worker. I mean, I do work hard when I am there, work well with anyone I work alongside, cause little trouble, learn quickly, and generally do a good job. However, I also don't like the tedium of working, lose interest once I have learned my position, and generally fidget like a sugared up toddler at an all day insurance seminar once I realize that movement is only lateral not vertical. This has been a Brobignagian problem in nursing. Because, though there is much to learn, once it is learned, you are pretty much at a plateau until a series of unfortunate events claim those with more seniority. Unlike at my first clinical job where downtime allowed for additional education and there was a focus on a disease process (in that case asthma/allergy), now I kind of learn little bits here and there when there is time, but there is very seldom opportunity to work one-on-one with a doctor to pick their brain or even get to work alongside peers (the only other RN does the same job as I do and we spend, maybe, 5 minutes a day conversing about patient issues or socializing in the least). So, while I am certainly not working on an assembly line at a chicken processing factory, I am not content either. And I don't know how to get there, so I keep looking elsewhere without much success.

I have postulated this before, and I think it may be true, but my general ancy nature related to work may, by and large, be the reason why I revel in the opportunities to move to different cities/countries. Maybe the sense of exploration and wonder I don't get at work, I get by learning the nooks and crannies of new places.

The person I feel the worst for in this is Tia..........because I know she does not share my general ennui with all things Portland and has a job that, while often frustrating, seems to generally offer her variety, challenge, and opportunities. And Tia is a good worker. She really values it in a way that I don't, which is generally as a necessary evil. I can appreciate that and understand why she doesn't necessarily share my flights of fantasy about uprooting and going somewhere else. Instead she gets to listen to my general dissatisfaction, nod in the right places, and hope like hell that I don't bring it up again tomorrow. For my part, I do genuinely try not to.

Until something new happens, I will try to focus and try not to chew my nails to nubs and start habitually popping Xanax to soothe my psyche, even if I am all atwitter on the inside.

"leave me the fuck alone"

When I was walking to work today, I came across a vagrant as I frequently do (Portland is rife with them) and, without provocation she muttered aloud 'leave me the fuck alone.' I have to say, I wasn't even taken aback (crazy people say crazy things), but I did think it relatively apropos. Tia says I have been crabby lately.........but I think my feelings of late can best be summed up by the 5 words the crazy lady spewed forth this morning.

I realize more and more that, while I feel I am doing a good job, I just don't like my actual job. I have been trying to keep more positive about it. I only offer 'advice' so I try not to stress about it when I don't have an answer. However, the sheer unadulterated neediness gets to you after awhile. Call after call after call. Especially on days like today where they flood in like water from a ruptured dam. The only thing I enjoy are the people I work with..........and some days I interact with them so little, I might as well be cloistered off in a closet somewhere. So, I continue to try to find alternatives........and may need to expand that search. I don't like feeling this way and it bleeds to far into other areas of my life (much to Tia's chagrin I am sure). Unfortunately little else in life affords me any real relief from the anxiety I have at the start of each and every day........not because I am concerned about the mystery of what lies ahead, but rather because I know EXACTLY what lies ahead.

I need to eat.........and then go back again. only half a day left before 2 days off.........which I will spend looking for something else to do with my weekday time.

Taco Hell

I cannot say that the most affluent, cultured, or savvy customers regularly partake in dining experiences at Taco Bell, but there is a singular sort of bizarreness that transcends even your average greyhound terminal at the location on Burnside. Dear god in heaven is there ever!

We occasionally (quarterly) get a Taco Bell yen. The last time we did, we lived decidedly in the burbs. This time, the nearest locale was 21st and Burnside.........I am pretty sure it will be our last visit there. I struggle with how to even describe the patrons that accompanied us in this, one of Dante's levels of hell. There was a gentleman who clearly just left a gym........in 1984. Despite the temps in the low 50s, he could not be bothered to hide any of his not undistinguished beer gut behind the paper thin veneer of a white sleeveless muscle tee and some shorts that embodied the word 'short' and would not have looked appropriate on an Olympic runner, which this gentleman was assuredly not. But he, my dear readers, was not the most distinguishable character in this play. In and amongst the assorted white trash, homeless (or nearly so) and crazies (there was a women who appeared to not be having so much a conversation as an argument with herself. It remains unclear who won the argument for those curious enough to wonder about such things), the was a man so transfixing we could not avert our gazes throughout our brief meal.

This man was dressed in garb familiar with most of your urban street people here.......kind of a hodgepodge of reasonably fashionable attire. He entered the eatery, promptly fished a drinking vessel from the trash and filled it with soda. He then got in line and ordered something (unclear) and then proceeded to spend the next 10 minutes at the counter that held the various condiments and plastic ware and unloaded a litany of refuse and assorted hodgepodgery from his pockets and reloaded them with paper towels and what appeared to be every packet of sauce that they had. This was all done in front of the vacuous stare of the cashier whom, I am fairly certain, sees this kind of behavior far too regularly to note it any longer. As an interesting sidebar to this story, the gentleman in question placed his beverage on a table while he proceeded to restock his every nook and cranny and another young indigent (I am supposing) picked up the drink and drank heartily from it. This continued until the first guy came to claim it back, at which point it was handed over as if nothing at all was strange about this. It was, to someone averse to catching and spreading germs, rather repulsive.

I have to say that I think it was a healthy overall decision to go to Taco Bell this evening.......because I think my urge to go again, ever again, may well have been sated.

NoHo and assholes and assholes and lawsuits oh my

Tia and I decided to head out to NoHo's cafe last nite after neither one of us felt like doing much cooking. This was of course a Groupon outing (as are most of our outings of late). NoHos is a Hawaiian food eatery and, if you are unfamiliar with plate food, it is all pretty similar: pork/beef/chicken/fish (or a combination thereof) marinated in Korean or Japanese flavoring alongside 2 scoops of white sticky rice and 1 scoop of macaroni salad. Vegetables are decorative if they exist at all. Oh yeah, and the meat is usually served by the metric ton. NoHos does this as well as anyone I suppose, but no better. And, since they charge about 50% more than the place right up the street from us, it is unlikely we will be back. The only difference is the place by us is outdoor eating predominantly and looks like a converted gas station......only marginally less visually appealing than the interior of Nohos though, which has not taken any great pains. Overall, we left full, the flavors were good, and the meat was plentiful.......but it is no less or no more than I would have felt at any number of eateries serving the exact same fare.

As for assholes, that goes out to whoever in our building had the party that evidently necessitated an angry letter to all of us from ownership. Now, I can't say I even heard this party or had any experience dealing with the obnoxious behaviors listed in it, but really? I mean, I expect the kind of drunk dorm room behavior in the low rent places where 3 college guys are splitting an $800 rent payment between them, but it is weird to think the douchebags live among us (though I have seen them in the halls........they all wear the same clothes so they are easy to spot in the wild with backwards baseball caps, at least one if not both ears pierced, a silver chain, and cars with some kind of homemade looking aftermarket spoiler). Ah well, the good news is they did come down hard on them.........I suspect it won't be happening again anytime soon.

As for lawsuits.........well, none really. But, since Tia did break her ankle on the cruise ship, I can dream of a large lump cash settlement from the cruise line can't I? Ah, if only I was a sleazebag.

Work has been ramping up of late...........cold season is upon us. If I am not fielding calls about colds, it is reactions from the flu shots themselves (which I am 90% certain are psychosomatic). Had security in to escort another patient out yesterday. Will be a few crazies when you have 19K patients. Keeps it exciting!

Speaking of work, I probably should eat something and clean up a bit before I have to go there. Thank god for one short day a week. It is the tendril that helps loosely bind my sanity at this point.

Violetta

We love burgers in this country. Adore them. they have a prominent place on menus throughout the Portland area, from the pedestrian to the gourmet. It is the quintessential American food.....meat, dairy, lettuce, bread. Portable. Customizable. Delicious!

Saying you don't like hamburgers is like saying you don't like movies, or puppies or sunrises......unfathomable. They come is such a spectrum, from the mass marketed mealy but satisfying in a pinch burger chains to insanely wallet busting epicurean fantasies. So, with burgers in our hearts, we trekked to Violetta, one of the newer Portland burger spots.

The concept is pretty straightforward and similar to places like Burgerville and Five Guys, order at the counter off the big board and take a number to your table. The difference is supposed to be in the quality of the food..........and that was frankly hit and miss. The burgers are locally raised as are all the toppings and even the bun is baked here. Of course, that doesn't come cheaply. Even without table service, you can still rack up $25 for 2 burgers, an order of fries, and a couple of beverages (even of the non-adult variety). With price comes expectation. When I plop down $7-$8 for the same at Burgerville or $12 at Five guys for the same basic fare, I expect Violetta to be 2-3x as good.........but they are alas not. The burgers, though well cooked with intriguing toppings like sun dried tomatoes, extended little more than salt to the palate. Texturally it was satisfying, but someone in the back was far too free with the shaker. The sweet potato fires however, were worth every penny. Crunchy, sweet, and salty at once paired beautifully with their house made aoili. Truly decadent and all that I hoped they could be and more.

So, overall, I would take a pass on Violetta. For the same dollars, you can do much better heading down to five guys or hitting up a local happy hour and throwing a few beers on the tab to boot. But..........if you happen to be nearby seeing a movie and fries are your thing, don't hesitate, you won't regret it!

Otherwise, still nursing a cold/sore throat/generally mucky muck that won't go and won't settle in and run its course either. Its a bad houseguest all together. A true bummer when you deal in voice for a living.

My super smart wifey figured out some kind of tax thingy (something to do with points on our former abode) that will net us 800 bones in amended tax return........or more accurately help us take back some of what we paid. Yeah for unexpected money!

Tomorrow is my 1/4 turn at the new gig. Weird. Has it really been that long (or only that long). One day at a time.

Speaking of which, time to let the cold pills do their work. Sleepy time starts now.

On a boat

Well, the week of vacation, which seemed to take it's own sweet time getting here, evaporated far more rapidly than expected. Overall, any vacation is wonderful by comparison to the alternative, but there are of course the roses and thorns of even the most sublime experiences. So, without further ado:

Roses:
- The sheer size and sense of wonder that glaciers evoke. We had an excellent view of one and it was truly magnificent. Even got to see and hear the glacier calving (large chunks falling off into the water). Truly the highlight of the trip.

- The tour of the lesser traveled parts of Juneau was really pleasant and unexpected. It is nice being able to experience things via cruise ship because it is, relatively, inexpensive. However, ports all look pretty much the same no matter where you are. The same shops full of kitchy tourist crap, high end jewelry, and a smattering of 'local' goods packaged in a way that scarcely suggest regionality.......so it is a rare pleasantry to see more of where the locals live, eat, and what there is that draws them there. I can't say I hope to move there, but it was interesting.

- The food as always, was very good and occasionally excellent in the dining room. The experience in the Pinnacle Grill (the upscale restaurant on board), was uneven but reached higher apexes when it hit them. Best steak I have had in a long time.

Thorns:
- The entertainment on the boat (save the comedian who was the best I have ever seen on a cruise ship......not necessarily a high bar) was spartan and generally uninspired. It was almost like they weren't even trying. Frequently what things they did plan were at the exact same time leaving you to pick one of three activities and then having nothing else to do.

- Food in the Lido (the serve yourself buffet which is the only real alternative to the sit down meals) was inconsistent in quality and rarely achieved more than mediocrity.

- The weather while not expected to be spectacular, was ruinous on day 1. The swells were about 30 ft and forced us to the inside passage. This caused us to lose a day in Sitka and not actually disembark the boat until Tuesday morning. One day did include an hour plus at a glacier, but it did not include any time off the ship. When you are choosing to not entertain people, 3.5 days on a ship is a long time. It was, however, exceedingly pleasant in Victoria.

- The itinerary could not have been worse and then did so after the weather shifted our schedule around. They shortened our day in Juneau (8-3:30), we had barely 5 hours in Ketchikan (itself not really much of a town), and didn't get into Victoria until nearly 8 at night, leaving four hours later (and the ship parked 1.5 miles outside of town and required a long walk or a $7 each way trip by bus into town). All told, only about 16hrs ashore in the week. Weak!

Overall, the trip was worthwhile without a doubt. It has, however, sated my desire to ever visit Alaska again.....at least by ship. It also probably sated my need to ever sail with Holland America ever again. They can't control the weather, but they can control the entertainment, the food, and the amenities on the ship and they did so poorly. The redeeming qualities were the pleasantness of the staff, the spectacular library, and the covered pool. But they made little use of every other amenity on the ship.

Well, as with every vacation, it ends with laundry.......and lots of it. Best to get to it then.

34 cents

I have wanted to blog one last time before vaca, so here goes what will likely be a half-assed effort.

My co-worker who was on the fence about leaving finally decided to stay which is excellent news. the sad part was what a struggle that was. With the support of both the head of the clinic and the lead MD, they went to whomever it was who decides on such monetary things with the sole goal of getting him $1/hr more. $40 a week. After some calculations and what have you the financial person offered him..........34 cents. $13.60/week. But, they assured him, he could expect a similar bump in another year. I don't know enough expletives to serve this situation effectively. Anyway, the lead PCP made an impassioned plea which stated, among other things, that a doctor might leave due to the continued staff upheaval, and finally the dollar was granted. Does not exactly make me hopeful about my own raise, but I am thoroughly proud of all involved who fought to keep a solid employee around for what really cannot mean much in the operating costs of an entire clinic.

The only other thing of note was our attempt to broaden our horizons tonite by watching a documentary about a school built in Afghanistan and run by a doctor who works at KP. Well, after he was up on stage for about 30 minutes prior to said feature starting ranting and carrying on about everything from education to poppy production, we decided it wasn't worth our time to even bother sticking around any further. So the only expansion I felt was of the throbbing in my skull from a killer headache. Lovely. Note to guy trying to get donations to support what appeared to be a good cause: shut the hell up and let your movie do the talking!

Off to bury my head under a pillow and pray that tomorrow at work is quick and painless and that there is enough time in the day to get the dozens of things on my to-do list accomplished.

another week comes to pass

This past week has been remarkable only in its rather unremarkableness (I am fairly certain I just made that word up). It has been, by and large, like any other week. Work was stressful, especially Monday and Friday, the MA in my pod is still contemplating leaving (and leaning further that way as the days, and the bullshit he deals with from patients, pass). I will be very unhappy if that happens, but I certainly can't blame him. More money and the promise of a more tolerable position is pretty tempting, even at the cost of a further commute. Will be interested to see how it plays out obviously.

The weekend was spent in the hunt for my first IPOD touch. I have kind of wanted one for awhile, but have an Ipod already (though now a few years old) and couldn't justify it in my head. But, sometimes you just have to treat yourself :) Anyway, compared the newest model to the older ones and also briefly considered the Microsoft Zune (and discarded it after finding their apps.......well, spartan is a generous term) and ultimately ended up buying a used model (with warranty) from someone on Craigslist. Tia and I both are having a blast playing with all the free and cheap apps. It is much much more than a glorified ipod like I had originally thought. More like a do it all handheld tech toy. So much fun and time wasting potential. Now I just need to figure out how to sneak it to work :)

Spent most of the rainy weekend in relative slow motion. Met the in-laws for happy hour (and were pleasantly surprised with a wonderful room upgrade for the cruise, which is awesome!) on Friday, went to a local thai place on Saturday with a groupon, and wandered around downtown today after popping over to the library. Nice if only because it was relaxing......and I think we both felt like thats what this weekend called for.

4 more work days to go! Cannot wait for vacation.

6 guys

This was another hellacious week at work. Almost felt punished for having a 3-day weekend. The calls were brisk and the crazy quotient was extremely high. I don't know what the statistics are, but I would venture to guess that 10% of the patients probably take up 90% of my time (and that of everyone at the clinic). The mental illnesses often usurp any physical ailments. Then, on the other side, the MDs bitch if they aren't seeing enough patients and bitch if they have to see certain patients without enough time. It is a fine line that you end up crossing on occasion because you cannot help but do so. The high point of the week was one of our special patients (who, I am not being factitious, was told not to come to her phys therapy appts because she reeked of urine) came to the lobby and began a profanity laced tirade in front of staff and patients alike because they would not refill her narcotic. Lovely.

As to what to do about the whole job situation, the answer remains unclear. I am still planning on doing nothing until I return from vacation, but unlike before the vacation is actually nearing (finally). I am still welcome at my old position, but that position seems to be changing rapidly. They are 'rethinking' it due to budget.....which as you can imagine does not mean anything positive for the employee. On the table are 12hour shifts at the Park, eliminating weekend patients so they can keep no more than 1 staff there, and combining the two big location (GS and Eman) into one large IV team that will travel btwn them. Will be interesting to see how it all shakes out. Also, another former co-worker left as she had planned which means that the entirety of their under-40 staff for the Park is gone. So, going back (if a position even existed) might not mean even remotely the same job anymore.

The weekend has been pretty mellow. Spent Friday nite with the guy living off of Groupon, which is a fascinating concept. According to his site: The premise is simple: No cash. The Groupawn (customer chosen to Live Off Groupon) has nothing but a year’s supply of Groupons good for the best things to eat, do, see and buy across the country. From skydiving and upscale cuisine to body waxing and foreign language classes, Groupon deals will shape the Groupawn’s daily life. He will need to rely on the kindness of strangers for social niceties (like tax and tip) and basic human needs (like somewhere to sleep and a ride to any of Groupon’s 60 cities.)

So, it sounds like an intriguing concept and one that most of us would be hard pressed to actually do..........but he was jovial, garrulous, and massive (6'6") so I am sure he will fare better than most. Plus, with $100,000 at the end of the year, it is a worthy venture. We met our friend/former Realtor Joleen, the groupon guy, and about a half dozen other people at Miss Delta for dinner and to discuss his adventures. It was a fun gathering, though I was far less impressed with the service/food. Were everyone not hanging out, it would have been unbearable and I would have left. As it was, it took more than an hour from seating until our dinner came. The restaurant was full, but not huge. The food itself was not terrible, but neither would I highly recommend it. The flavor was lacking in most everything I ate (save for the sweet tea, which was quite delicious). Overall, there are better options for your dining dollar.

Made it out to 5 Guys on Saturday early evening for dinner (we were in the area). They win time after time in the 'best fast food burger' comparisons. Though, after eating there, it is a rather unfair comparison. A cheeseburger at McDonalds might run about a buck, same with Wendys, BK, etc. A cheeseburger here cost closer to $4 (single) and $5 (there normal double patty) and these are built to order. Overall, it was MUCH more like eating a restaurant quality burger. The hand cut fries were a particular high point. Definitely heavy food though. This isn't the kind of place you will want to go for a jog after (though you might wish to). Quite good, but something to put into the 'eat rarely' column.

Yeah for football being back! Going to go enjoy it (while secretly lamenting that it is Sunday). Hopefully this week will be better.

DINK(y)

I had heard the term dink before, but it is still funny to me and I was surprised when one of my coworkers mentioned it when he was asking where I was going on vacation he said, "of course you two can live in the Pearl and go on a cruise, you're a couple of dinks." Dink stands for dual income no kids (and if you add the 'y' it stands for yet). Not sure if kids are in the future or not, and despite where my opinions often lean, I realize there are benefits to having them, but for right now it is great not having a little bundle of responsibility.

Friday nite after work I was invited to a Happy Hour with coworkers (I did not make it there due to a rather involved story that centers largely around my own directional challenges), spent Saturday out trying the Pope House Bourbon Lounge (the mixed drinks and the bourbon ice cream were amazing) with some new acquaintances, Sunday volunteering at CAT giving away over 3 tons of food (my biannual 'do something nice for others' day :) and then going to a friends party, grilling and playing Rock Band with a wall projector (and in an incredible sound system........they clearly LOVE that game), and then today took a trip out to the Casino before holing up for the night. Stuff we couldn't do with a kid (hell, not with a dog really).

Back to it tomorrow. More food reviews soon. Have to write more about the Pope House (kick ass happy hour). Can't wait to see what kind of calamities the patients of the clinic got into over a 3 day weekend that they didn't think needed immediate attention at an urgent care center or a hospital. It is shocking.

Changes

Work drama, it is just inherent in any business I guess. Tia deals with it in spades (mostly related to her contact with outside vendors or different sites) and I deal with it in more of an immediate sense. Though I try not to be involved in it, it certainly affects me as it affects those around me. The biggest thing of the moment is the relative instability of staffing.

The way our clinic is set up, each doctor has one medical assistant. They really work in teams of 2......one doing rooming functions like setting up the rooms, getting vitals, taking patients back and doing any in-clinic tests required along with refill requests, and the other on the phone with call ins, doing prior authorizations, and arranging the various scans, blood tests, etc that the doctors order. The team has to be fairly symbiotic, as they both tackle issues relating to the same doctors, so it is hard when there is a weak link or, in this case, someone new who is learning on the job.

When I accepted the position, the pod I work in (there are 4 total pods, each with ostensibly 4 doctors/4 MAs/and 1 nurse) had 4 MAs with experience ranging from 17yrs to 7 months. No one, however, was remotely new. Overall it was evidently quite cohesive. I say 'was' because the day I started was evidently 1 day past one of the other MAs leaving. She was replaced by a float. Then, just a few short weeks later, another MA (who had been there for a few years), also left. They replaced her with a new hire and jettisoned the float. So, within the first month, we had lost 2 veteran staff. Now, the formerly newest MA got offered another position (almost all offers have gone thru Providence which is apparently renowned for paying more and providing better benefits) and is strongly considering it. So, in less than 2 months, I may go from the least experienced to the second most experienced in our pod of 5. Not very comforting I have to admit because, though I do not perform the same duties, I lean heavily on the MAs. Suffice to say I am not happy and my podmates are downright distressed. In addition to this, another new MA who was hired for our pod, was instead kept in another pod.

In news directed related to me, there were another 4 interviewees for the triage position and at least one of them will be offered a position. Now it is an issue of them accepting, making it through all the hoops associated with getting hired in (background checks, drug screens, etc) and then getting set up and trained. So, best case, probably a ready to go product by mid to late October. I hope hope hope by flu season. Somehow I imagine that is going to totally suck.

I still waffle frequently about my job, but I am not sure what else to really do at the moment. I still waffle in much the same way about school. A constant dance of should I or shouldn't I. Here is hoping for the clarity or at least some rest on the long weekend. Then back to god knows what.