Life turns on a dime

I was thinking about how quickly life changes again just the other night as I found myself at a consignment sale for baby stuff. As I wandered around with Tia through rows of strollers, clothing, and cloth diapers, I couldn't help but feel oddly engaged. As weird as it was, it felt somehow nice to be so involved in even the more minuscule processes. If nothing else, it does help clarify things and realign priorities. Somehow, work stuff seems well, less important.

Of course, there are always doubts. Though clarity sometimes feels significant, it often is ephemeral. I feel just as out of my depth at times as I do engaged in the process others. I think that is pretty normal though. For instance, as an illustration, we have been incredibly fortunate to have so many people giving us so many things for the baby, but sadly one of them, we'll call them S & M (no relation to the other meaning) are having a rough go. M stays home with the baby, and he has not been doing terribly well. He was a former member of a band (name unknown) and has been collecting royalties and not working since the mid 90s (like winning the lottery really). He states he pretty much would wake up around noon, gym at 1, then wait for S to get home from work. Perhaps coming from such a, well, relaxed situation makes the transition to being a stay at home dad more difficult. Perhaps it is just a personality issue. Or perhaps he just isn't cut out for that period. All I know is that he is clearly excited to have the kid, and just as clearly unable to cope with that reality. While it is disconcerting, it is heartening to know that good parenting skills aren't a given. It takes a lot of work and effort and a seemingly bottomless well of patience. (Thank goodness for Zoloft right? :) So, while I certainly hope to be good at it, I more hope that if I am not, I am willing to seek out the help I need or find other options that are best for all involved.

On other topics, my health is improving. I decided to try (in a rare bit of sun induced insanity) mowing our flat and not overly large lawn with the push mower. This is generally quite easy to do and, effort wise, I reasoned similar to pushing my IV cart all over the hospital. Well, if that is the case, the good news is that I finished the lawn. The bad news is that the lawn subsequently finished me as well. But, thanks to one of my remaining pain pills, all is well once again. Evidently waiting 2 weeks is a good idea after all. I am to see the doc on Wednesday. Wish me luck in returning to work on Thursday..........and then wish me luck in not wanting to gouge out my own eyes shortly thereafter.

What little I have followed with my job (I do try to check my work email daily just in case anything come up) is that chaos continues to be the symbol by which my department defines itself. Looks like a lot of sick calls and, because of that and because of a lack of trained personnel for the clinic, things have not been going terribly smoothly. I just got an email about a patient who had been getting too much of a certain medication because the patient's medication infusion plan was built incorrectly (by whom I am not certain). So, based on that incorrect infusion plan, the pharmacy mixed the dose. They have access to the original order as much as we do, but clearly did not check it against the infusion plan. Evidently it was caught on the last day of the infusion, but then a dose was mixed and not administered, which the hospital has to eat the cost of (and it is a dearly expensive medication), though thankfully the patient was unharmed despite getting 5 days dosing in 3.

This has been a concern that I have vocalized to anyone wanting (or not wanting) to listen since we started with the new system. The way it works is that an order is sent to the clinic, the RN (generally me, except when absent) scans the order into the computer system and then builds an infusion plan from that order. When the patient arrives and is verified, the infusion plan is released to the pharmacy who then, presumably, checks the infusion plan against the scanned order. What is clear is that this is not happening...and I always doubted that it ever did. So, if the person who entered the infusion plan did so incorrectly, an incorrect dose would be mixed and then administered unless the person who is administering the drug (likely the person who built the plan in the first place) checks the medication against the original order (which should probably be being done as well). My concern has long been that the only person checking my work is, well, me. And although I pride myself on being very thorough and anal retentive about all aspects of how I run the clinic, I am certainly far from infallible. Just imagining someone who is less accustomed to working in the clinic and less familiar with the medications attempting to do my job, the possibilities for error are exponentially higher. Hopefully this will lead to a repair to the system as a whole.

Saw the Hunger Games yesterday. Not sure how to rate it exactly, though I came away impressed. It definitely is a movie that I feel is very much augmented by reading the book prior to seeing it, because it builds on the personal relationships that are necessarily given short shrift by the film. I continue to have no idea how they will end up filming the third book without a hard 'R' rating though.

More to come as always.

Recovery

5 days post surgery and the recovery is going pretty well I think. The pain has largely abated and become more focused on the area of the actual procedure. For the first few days, the pain was worse up and down both legs (it was difficult to lift them in and out of chairs and go up or down stairs, let along ambulate about) and in my shoulders. Thankfully that pain almost miraculously resolved on Saturday. Now, I am able to minimize my pain medications (I still have some always in my system, but far lower dosage and frequency), and move around a whole lot easier.

My follow up is scheduled for the 9th of April, but that seems almost too far out at this point. My hope is to get it moved up closer to the 4th or so. But, it is nice to even be considering that at this point.

More as always as events warrant, but I wanted to at least post some kind of update.

One more vestigial organ down

Well, it would appear that sometimes abdominal pain is something more than it initially appears.

On Monday night, I got home from work feeling the barest hints of general unpleasantness in my abdomen. It wasn't until after dinner that I really started to feel more significant discomfort. I thought, of course, that dinner just didn't agree with me. I went to bed without the pain abating, but figuring I would be all right the next morning. I was not.

Tuesday my pain was worse. I tried some pepto and some chew-able antacids, still locked into the idea that this was just some passing unpleasantness. I even managed to drag myself into work to see my afternoon patients after calling out for the morning. Only, after I got there, I promptly threw up. But, I figured I would save my sick hours and drag myself through the 5 hours in the clinic that I was needed. And, dammit, I did manage at least that.

Once I got home, the pain started to intensify and shift from above the belly button to the right lower quadrant. After going back and forth about what to do, Tia suggested a call to the advice line. It took nearly 45 minutes to get through, but once I did I was quickly patched through to the on call doctor who suggested I head in to the ED to get looked at. Reluctantly we went in at about 8pm, though I was still fairly convinced that I would be heading home in a few hours with some Percoset and instructions to call in for an appointment with my primary doc if the pain didn't dissipate. After being taken quickly back, they did some blood work and a urinalysis and we waited......for little more than an hour in a tiny room with little to do. From there, it turns out that my tests were all within normal limits except for my white blood count, which was very elevated (they fight infection). It was at this point that worry started to finally creep in.

We were sent back to a more permanent ER room, where I was given an IV, fluids, anti-nausea medication, and pain medication and they debated whether or not to have me drink contrast (awful stuff that) and do a CT scan or just perform surgery. The surgeon arrived in the room at about 1115, and after a few quick prods to the abdomen and some cursory questions, the symptoms were clear cut enough to not need to bother with the scan. Evidently my appendix needed to go.

They wheeled me into surgery around 12:15 (as best as I can recall) and, the next thing I remember, I was coming to in the recovery room. I was wheeled into my overnight room immediately thereafter around 3am and Tia finally was able to go get some sleep (more than I can say for myself really with hourly vitals and a new roomate that arrived around 530 that morning). I spent the rest of the day hanging out, getting pain meds, and nodding off with the least provocation. My mom stopped by and Diane called and finally Tia came by after work. They decided that I could be discharged if I felt up for it........something I really wanted to do. That also took more than a few hours. But, considering everything, it was just a hair over 24 hours from my arrival to the ED to my heading back home, which is quite impressive. And, aside from vomiting on the drive home, I am doing all right (well, plus the incredible abdominal pain from the surgery which was complicated by the appendix being inflamed and hidden somewhat and the general aches and pains related to said surgery).

I don't know if there is a moral to this story..........but if a doc suggests you head into the ED, just go. I am certainly glad I did or the situation could have been much worse.

It's a.........

Meeting. Well, a meeting with the nurse executive at the hospital. It was incredibly heartening that she was willing to meet with one of the smallest departments in the hospital, with my clinic being an even smaller part of that, and all because I was honest when she asked how things were going in the department. There were no immediate answers, but at least things are being looked into. They are going to do a long term evaluation on the clinic's ability to make money. This could mean a few different things, from full time additional help to closing it part time. In the short term, it doesn't mean anything though.....other than that I can see patients and continue to operate it. In the long term, they are discussing sending out a survey to providers, centralizing scheduling, and possibly better defining the parameters of patients we see. So, ball rolling, just no idea where it will roll to.

We spent the majority of the week in a kind of a hungover state from the time change and trying to reaclimate to a normal schedule after vacation. Unfortunately, that meant a lot of running around this weekend because very little got done during the week. We ended up buying a bed frame for downstairs, the gear for planter boxes for out back, and collecting an amazing array of baby stuff from friends and family. This included a nearly new crib from Caprice and Fergal along with a bassinet and a bunch of swaddling cloths, bottles, and a wrap. Miles and Sam (Tia's co-worker) gave us a baby swing, a seat, a bunch of diaper shells, and a different kind of baby carrier. This on top of another crib that we were given by Michelle along with all sorts of clothing, books and washcloths from my in-laws, my sister, and my parents. We literally have only bought a mattress thus far and, while we still need quite a few more things, it has been incredible how generous everyone has been.

And, the biggest news this weekend was that we had our midpoint ultrasound. The pictures were pretty amazingly detailed. You could see every bone and the outlines of the fingers and toes. It still seems unreal, but seeing baby blob move around kind of helps hammer the concept home that this is indeed happening, and it is happening very rapidly. The good news is that we are right on target size wise and things are progressing along well. Hopefully they continue in that manner. Up next hospital tours, diapering classes, and birthing classes. Life is certainly changing.

Oh yeah, its a boy! Time to start brainstorming names.

Dreams (and moving up a bracket)

Sadly, Tia and I are now returned from Mexico. Nary a drop of rain and only the faintest hints of cloud cover marked our stay. Temperatures were never above the lower 80s and never below the low 70s. It was idyllic. Of course, we were welcomed back by a delayed flight and 45 degrees and rain. Ah, home sweet home.

Dreams Villamagna is an all inclusive resort in Puerto Vallarta, Mexico and our first experience with both that locale and type of resort. Overall, I think we wouldn't hesitate to do something like it again, though like all holidays, it had it's pros and cons.

The cons (to get them out of the way first):

- Evidently half of the economy of Mexico is built on time shares. They are a constant nuisance, but none more so than having to deal with them at our hotel. After a long wait to get into the country, we were funneled through 2 large rooms of people 'offering directions and assistance' that, fairly overtly, were trying to sell you excursions and time shares right at the airport. When you finally make it through, you go through another area where you are harassed for transport. Finally, once we got connected with our prearranged transport, we were shuttled off to the hotel. After check in, we were shuttled to get our 'spa certificates' which was an opportunity to try to get us interested in time shares (mind you, we had just traveled all day and had yet to so much as see the resort or our room). Once we finally freed ourselves of them, we made it to our room.......but they are situated next to the entrance of the only breakfast option, so you are asked EVERY day about the damn time shares. Annoying to say the least.

- The staff at the hotel were all degrees of good to excellent, with most every need met immediately. However, for reasons unclear, they offer no information about the resort, show you where nothing is, nor do they explain much of what is offered. Thankfully Tia is resourceful and we found out about bike/kayak rentals (free), the spa (beautiful), and the various restaurants, etc. But, strange that they wouldn't at least go over them, even tersely. I guess they are too busy hawking time shares.

- Towels: For some reason, for the first few days, we had to call and ask for additional towels. We weren't requesting anything odd mind you, but they only gave us one towel each of the first few days. It was strange. Then, later in the week, we often got more like 4. Odd.

Pros:

- All inclusive is nice. The food options were more than adequate for the week (though the quality was hit and miss) and the drinks were always available and the service from the bars was fast and friendly. It was surprising how varied and fairly upscale the dinners were as well. Though, nitpicking, it would have been nice if there was a little more 'authentic' Mexican food to be had. Again, nitpicking.

- The room was gorgeous (and we got a basic room) with a separate deep tub and a hot tub on the balcony. The room was incredibly spacious and, I thought, very clean. The only oddity being a separate toilet that had frosted glass 'walls' which became clear about 5 feet up and looked directly into both the shower and the room. So, if you aren't comfortable with whomever you are sharing the room with, it could be pretty awkward.

- The beach was pristine and, despite what we had read, very few vendors came up to you (and when they did, they were not pushy). Lush fine sand as far as the eye could see in either direction. The only downside (again with the nitpicking) was that it was one resort after another, with nothing else. So, if you wanted to say, shop or eat off site, you weren't going to be doing that there.

- The entertainment (always something nightly) was actually wonderfully varied and of good quality, especially the fire show and the circus (which we admittedly only saw a bit of).

- The spa was perhaps the most gorgeous I have ever seen with two warm pools, a hot and cold tub, a steam room, and all sorts of fun infused waters and snacks.

Other random things:

- Alaskan air will not be on my list of preferred airlines in the future. They were kind enough to hold a plane for 30 of us that would otherwise have missed our connection in San Fran, but only because the plane we were to depart on arrived so late into Puerto Vallarta. This plus unbelievably long check in lines both coming and leaving (nearly an hour each side). Just seems like they don't have it together.

- Despite the good food at the resort (the osso bucco being my highlight), it is still amazing how much incredible food you can get at the dumpiest places in Mexico. We had 4 tacos and a large bottled soda for $4 in downtown in a lovely little place tucked away from the main drag. Excellent. Have no idea why anyone would eat at the horrid places like Hard Rock or Senor Frogs instead.

- Taxis are like amusement park rides there. Holy crap they are insane. But, also incredibly cheap.

- Avocado and tequila ice cream = delicious!

- Hammocks are possibly the most amazing way to enjoy a tropical drink and the ocean breeze. So nice.

- Did you know that turning 35 moves you to an entirely different bracket on forms? Suck!

- I think we just found our newest pet-sitter. As much as we loved Reigning Pets (and we still do), Mo totally rocks! She took great care of our critters and house sat for us for barely any additional money and, to top it off, cleaned our whole place. It looks better than when we do it. There is something to be said to coming home to a clean house with new bedding etc. Can't say enough positive about her.

Well, back to reality. Time to start cooking our own food, wearing long pants and jackets, and getting up for work. Boo. More to come as always, especially after my meeting this Thursday with the nurse executive for the hospital. Should prove interesting.