The last post before Mexico

Why is it that the time prior to vacation at work is always exponentially busier than normal. Some kind of cosmic balancing act where you have to be run ragged so you can be allowed to enjoy time away. On one hand it makes you savor leisure time all the more. On the other, it certainly doesn't make work any more bearable (nor entice one to come back............oh yeah, except to pay for another vacation).

Speaking of work, well, eff! It is getting close to wound care moving on from my roommates to the nether regions of the bowels of the burn unit. It is bitter sweet. On one hand, I am pretty much screwed for help. On the other hand, the percentage of crazy, smelly, derelict patients just shifted in a very positive way. So, I guess I can call it a wash.

We had our meeting with the big fish after work today. It was remarkable on two accounts: 1. they clearly know we exist and 2. They just as clearly have a very limited understanding of what we do as a department and, most specifically, what I do in the outpatient world. Some things of particular note:

- CB (the head nurse cheese) thought that we maybe shouldn't have IV carts. Our IV carts hold all number of things that we might need throughout the day. They are not in any way able to be replaced with, say, a fanny pack or even an overlarge backpack. However, they could be kept on units vs. us pushing them from unit to unit all over the hospital, so that could theoretically work. Also, we just ordered 10 more, at over $1300/ea. So, there is that too.

- CB brought up how we should maybe not see patients from outside docs without full hospital rights. This is, approximately, 50-60% of the business at ALL our clinics and it is our policy to do so. She was not aware that we saw such patients. This is now a 'top of agenda' item that they will be looking into.

- I brought up the fact that my 2nd nurse would be no more and that, in order to justify help, I needed more patients.........patients I can't see if I don't have help. A circular argument that I have been spinning within since I started really. The 'initial' resolution was to contact the resource pool for CNA help. However, when tried yesterday, we were rebuffed because the resource pool CNA would have been in overtime. So, instead, I had a charge RN who is likely making more than $40/hr as my second nurse (or probably about $12-$15 more than the CNA with overtime factored in). I was told to log the number of patients we could not see because of this. Patients from MD offices that I am sure will be happy to know that, though I cannot see their patient, I will be happy to write that fact down whilst they send said patient and future ones elsewhere. I will now go back to beating my head against the wall so I can better explain my massive headache.

On the one HUGE plus side, somehow I got (unsure as to why other than a calendar year passed) a 3.75% raise.

Minus, late meeting today, early meeting to talk about Medicare benefits and coding issues with said patient tomorrow! Jealous much?

A new (family) car!

We finished up our car shopping this past weekend. Not necessarily on purpose, but it happened anyway. We start by looking at the Rav4, which we didn't like enough inside to actually test drive. Just up the street, we popped into Wentworth Chevrolet. We were both a little (or a lot) skeptical about American cars. It is kind of a disappointing thing really, but in our vehicle class there has not been much to consider. They were most notable for shoddy interior quality and a track record of poor reliability. Somehow in the last few years they figured out this wasn't a reliable business plan and started to improve matters.

Those improvements led us to test driving the Chevy Equinox. It was not as large as the CR-V, but somewhat nicer inside. Plus, it was a very quiet cabin with a lot of upmarket features. However, we weren't looking to buy anything.............which of course does little to explain how we ended up driving it home. It was, and remains, a hard thing to wrap my head around. Not the small SUV part, because I have always liked them, but buying an American made car. I wish it weren't the case, but they have often not even been on my radar and most professional automotive sites would agree. But, dammit, it was the best one we looked at and they trotted out a lease deal we couldn't refuse. Plus Tia got them to install heated seats as well.

Leasing will hopefully prove a wise decision, though I won't necessarily hold my breath. I have heard both horror stories and of people who have had no problems just dropping off their car after the lease was up and walked away. The lease price was less than half the monthly payment though, and didn't change our current out of pocket, which is something we were really focused on. Plus now we have room for the little bugger and whatever accouterments come along with.

One minor work update: Seems like we will finally be getting a meeting with the execs this coming week. They will, at least in theory, explain to us exactly who our boss is and what they see as far as the direction of our department moving forward. Should be enlightening. As for the clinic, not much clarity there. Lots of, "well, I don't know, maybe we can try just being open on alternate Tuesdays and Leap day" instead of the more practical, in my mind, just shutting it down or offering a modicum of resources to make it remotely workable. I feel like closing it almost entirely will accomplish the same thing anyway..........just much more slowly.

Speaking of work. I spent a lot of the past week at different sites. Gresham was relatively pleasant and, while I like the people at the Park, the patients they see are WILDLY inappropriate for an outpatient clinic. People should be able to ambulate in and out and to self toilet. Not a stringent set of requirements really, but one they tend to ignore in scheduling down there. Makes for a VERY fragile work environment and one that feels always on the precipice of being unsafe. Evidently this will not rectified so long as the person in charge there remains so. The bummer is I think I will be there more often now.

More to come as always.

On how I found myself looking at cotton diapers on a Saturday night

I have to admit that I would have laid impossibly long odds even a year ago that I would have found myself in the situation above. But there I found myself after a day spent shopping for maternity clothes and looking at compact SUVs, which will have more room than our current car, intently listening to a saleswoman explain in detail how each brand (and there were numerous) works and how to use them. We also learned about a bunch of classes including those about baby wearing and are planning on attending some at the same store. 2012 is going to be strange. Really really strange.

I should also say that on that same day we started at the gym, managed to test drive 4 cars, had pretty amazing thai food, and finished it with a visit to the spa. Even the diaper store was a happy accident. So, while strange, it was a pretty damn good day as well.

Speaking of cars: got to drive the Subaru Forester, Honda CRV (ex), Kia Sportage, and a slightly used 2011 VW Tiguan. Surprisingly, we liked the Forester least. It is a nice, solid car, lots of windows and a spectacular full length sun roof, but fell a bit short (in our opinion) of the others. The Kia was really nice, but had poor visibility and the highest sticker price. The CR-V felt the largest, but was very solid, nice enough interior and the most storage space in the class. The Tiguan I have to say would be the VERY top choice for me if it weren't so expensive and takes premium gas............but what a BLAST to drive. So fun and very 'upmarket' interior. The roof rack whistled annoyingly though. Still a few more to try (Hyndai, GMC Terrain, Rav4) and then we will probably just play the waiting game for the right time. Nicest salesperson ever though.

As for diapers, it is a pretty complex thing evidently including (but not limited to): disposables, disposable inserts, and all manner of cloth exteriors with velco or snaps, with sizes and one size fit all, and all manner of inserts including all in ones. They range for $10-$12 for a shell and a few dollars for the inserts (evidently you don't need many shells, but you need 12-24 liners) to $20/ea for the all-in-ones. Overall, it is evidently about a $400 up front cost and then you are good for the duration of diapering vs. about 4x that for disposables over the same time frame. Anyway, if I come up with any revelations I will post them here.

Last week for my boss then, well evidently, no one will be there. They are eliminating the position per my boss and that means a director will be over the department. How that will work site to site is beyond me just as I wonder who will approve our vacations and discuss the state of the department. Plus, with wound care leaving in March and with one less full time floor position at EM, we are going to be very very thin for the clinic. I still see that as something that will be ending, but hopefully not until November.

More to come as events warrant.

165 degrees

I was heating up a microwaved meal for lunch and the instructions on the back state: "be sure to heat up the product to an internal temperature of 165 degrees as measured by a food thermometer in several spots" Um, say what? Assuming that the bulk of these meals are eaten at lunch, away from home, how many people have readily on hand a food thermometer? And, assuming that this is truly a safety risk, what the hell is in my prefabricated micro meal of macaroni and cheese that could prove dangerous otherwise? Frankly, I am a little worried.

Speaking of worries, an impending baby creates whole new avenues to divert my love of researching and over-researching products. I am floored at both the wide spectrum and equally wide price range of crib mattresses alone. Do you want a one sided or dual sided? Innerspring, foam, or latex? What about a little of each? How waterproof do you want it to be and, if so, what material is okay for waterproofing? You might buy an 'eco friendly' mattress, but find that it is only slightly less, for lack of a better term, 'toxic' than one that is not. Some people will rave about the 'natural' qualities of a certain brand, while others will decry it for using an adhesive bonding agent somewhere in the manufacture that will, evidently, slowly poison and/or mentally impair your little one. If you don't care about any of these things, or consider them to be as made up as ghosts or moderate Republican presidential candidates, you can get a mattress for under $65. If you believe with a vigor generally reserved for a Tim Tebow prayer session that any contact with something treated with chemicals would lead your little one to remedial classes and a hopeless life of criminal behavior, you can spend well over $400. The gray area of course is the stuff that lies in between. How much constitutes a modicum of concern and what rates as extreme overkill. Considering that there are various other 'exposures' such as the materials used to build the crib, the carpet or hard woods in the floor, the substances the clothes and sheets are made out of, etc....does the mattress really matter at all if you aren't going to go all organic non-toxic with everything? One thing is for certain, no matter what you pick there will be some flaws and it will lead inexorably to the downfall of western civilization as we know it. You know, if you believe in that sort of thing.

Thankfully, there are only a few dozen (hundred) other items to research. Ugh.