Baby!

What a crazy night and completely and totally unexpected.  Tia's baby shower (which was amazing, we are truly fortunate to have so many wonderful friends and family) ended at about 5.  By 530, Tia was feeling nauseous.  By 6 she was vomiting.  By 8 we were on our way to the hospital for, presumably, hydration.  By 930, the baby was experiencing rapid decelerations (caused by stress from the lack of blood flow through the umbilical cord).  By 10 she was being wheeled in to an emergency C-section under general anesthesia.  At 1008, our baby came out into the world while I watched through a small window because I wasn't let into the surgical suite.  Everything gets fuzzy after that.

But, at the moment, Tia is recovering at Sunnyside, our son is at St. Vincent's hospital, and I am putting together an overnight bag and heading towards St. Vincent's.  Our son was transferred by ambulance at about 1am and Tia should be transferred (also by ambulance) at some point today once they have space for us.  Hopefully, at some point tonite, we will all be together.  For now, I am just happy everyone is okay.

5lbs 14ounces.  18.75" inches long.  Good APGAR score of 9/10.

So much for the baby classes/breathing exercises though.  Ah, the best laid plans.

One more month

Despite it seeming like it is taking a LONG time to arrive, the countdown to the kiddo is progressing along as it should.  It wasn’t without a bit of internal terror that I realized, OMG its July!  Tonight we have our antepenultimate baby class which culminates on the 9^th, and Tia has her personal and work baby showers over the course of the next week.  Then it is pretty much time to pack an overnight bag and wait for the kiddo to decide he is ready to come out and say hello. 

It is weird the things you think about/forget about with a baby coming.  For instance, the other day I thought that we really should plan our fall/winter vacation so we have something to look forward to when the winter comes and then, very shortly thereafter, I remembered that we would have a newborn and caring for him might preclude a sunny jaunt down to Mexico.  This will clearly take some getting used to.  

Not much else new to report since my last post.  Just plowing through the list of items we are hoping to have completed by the time baby comes if only because it seems unlikely we will have the time, energy, or mental capacity to undertake them once he arrives.  To that end, we finished up the stairwell painting (a pretty amazing feet considering the height of the wall above the stairs), got the garden and weeding mostly under control (the latter is a losing battle, but I continue to soldier on so our yard doesn’t look like, well, our neighbor’s yard honestly).   We have so far gotten a pretty good yield of salad greens, scallions, and zucchini, though our beets are not looking too hot, our carrots are mostly pretty miniature, and our tomatoes have grown gigantic but are not yet ripening.  This will be a good learning experience going into the next summer (like don’t plant zucchini near ANYTHING else…..it gets way too large) and it has proven pretty enjoyable/cathartic.  Plus, next year, I won’t have to haul back 100 wheelbarrow’s full of dirt!  

Just waiting on my last patient.  I won’t say anything about her (lest I violate HIPPA) but she is funded by the Oregon Health Plan.  I mention this because she was upset the other day about the Supreme Court saying that Obamacare (or whatever you want to call it) was legal and could move forward.  I don’t know the specific details of the plan, so I cannot say with any certainty that it going to be a panacea for the health care system or an albatross, but I believe it represents an important step forward.  I say this having seen so many people without health care come through the hospital who would have benefitted from access to preventative health care, but use the ER instead because they cannot be refused treatment (at that point, they are usually in a much worse position).  But, I find it ironic that someone who only has health care because of a publicly funded option (and in my opinion abuses it), is opposed to health care as a publicly funded option for everyone else.  I just really hope she can’t (or at least doesn’t) vote.  

Off to baby class.  

Choose another 'path'

Tia told me the other day that my blogs read kind of negatively.  I don’t see it that way, but evidently she does and, I assume, maybe others do as well.  It isn’t my intent and certainly not some condemnation of my life at present.  I just generally write about things I feel strongly about, whether they be extremely good or not so good.   The major gist is, this isn’t a painting of my life as a whole, but rather a series of snapshots.  Because honestly, who wants to hear about the generalities and mendacity that make up a stereotypical day? 

On to actual events, there is some seemingly exceedingly positive news; we have found a daycare.  We went to 3 in-home sites and found one that had the right combination of safety, location, price and mission.  The first place we visited was also very promising, but all things being equal we didn’t see anything that made it worth nearly 25% more per month.  It is still not ‘cheap’ but it is comparatively reasonable.  The only two high comedy watermarks came at the only center we visited (and walked quickly out of as it appeared to be run by the homeless and what appeared to be an amalgamation of every late middle aged woman you see on ‘Hoarders’) and at the last in-home care we saw. 

The last place had a wildly different POV on parenting, largely in their refusal to negate anything.  In our hour we saw the woman who runs the place’s daughter pick up an ink pen.  Her mother gave her the option (or ‘path’ in her speak) of putting the pen in her cubby or giving it to her mother.  She chose neither, opting instead to write on the wall.  The presented another series of ‘paths’ to redirect her from drawing on the wall and led to her drawing on her dress.  That failing, she was given 2 other paths and, you guessed it, chose to start drawing on her body.  Then we had to sit and talk about the place after our tour, and while other care centers introduced us to the kids, took us on a tour, and then brought us somewhere to discuss and ask questions, she chose the ‘path’ of having most of the kids climb on her like a jungle gym and interrupt her every sentence.  Meanwhile her assistant did nothing to ‘redirect’ them elsewhere.  I envisioned Tia and I having to spend every night trying to undo the learning each day.  Honest to god, it was like being on a bad blind date.  You show up and the other person launches into diatribe lifted from Fox news and you know instantly you need to extricate yourself, but end up sitting through dinner because you can’t figure out a polite way to do so.  It is an hour I will never get back, but at least it provided some interesting stories.  And for that, we thank you.

We also have finally finished our nursery.  Once we get a car seat, we will be ‘unofficially’ done buying stuff (or getting stuff as the case may be).  I am very pleased with how it came out.  Tia and I had to be creative to get it to work within budget and special thanks to everyone who sent us Dr. Seuss books, to Diane for the Cat in the Hat clock and lampshade, and to My mom’s friend Rhonda for the beautiful hand made Cat in the Hat blanket.   

As for work, well that just gets stickier and stickier and I am finding it difficult to remain above the morass.  They approved the position here and will be posting it “soon” per my supervisor.  However, the position at the Park remains murky.  If the charge there, KV, opts to cut back her schedule to 4 days a week (per her, she was just hoping to do every other Thursday), they may post the position there as a .8 instead of a .6.  This obviously could prove troublesome from a childcare perspective, though we could probably still make it work 3 days a week.  Honestly, my major concern is when the hell they are going to post it.  The only upside (and it isn’t a huge one) is I have not put my notice in in any shape or form, so they can’t just get rid of me until that occurs and if that were to happen I could collect unemployment at that point, possibly mitigating the need to have childcare initially.  But again, WTF!?!?  The next step is evidently KV contacting our actual supervisor, interim as she may be, instead of the nurse exec at her site who is not in fact her boss.  Then, once Janine gets that info, they can in theory move ahead in whichever manner they are deciding to.  I always have the option of on call, and may need to avail myself of it, but it is increasingly frustrating that they show me one thing (the part time job they have been talking about since at least February) and then continue to dangle it far out of reach.    

And so the story goes…….. 

Pendulum

Life is pendulous.  If you are lucky, it isn’t swinging like a metronome at 4 beats per and you get to spend more time in the calm center and not the furthest swings.  However, sometimes self induced and sometimes external, there are times when you spend a little too much time out on the periphery.  Great when you are on a high, less so when you are not.  Lately, I have not been. 

There are myriad reasons why this is so, and nary a one of them is cataclysmic.  I realize that I am very fortunate to have a job I can tolerate and sometimes even like, a loving wife, and a good relationship with friends and family.  It is the constant uncertainty that is undermining my general sense of wellbeing.  The damndest part of that is that there really is no end in sight. 

There is still no timeline on when they are going to post out for my current position and, therefore, no timeline on when they might post out for the position at the Park.  This is due in large part to there being no timeline for hiring a Director and, therefore, no timeline for that person to then hire a manager.  What there is a timeline for however, is the baby.  Whether or not they figure out any of the above, the baby is coming, and I am dead certain he isn’t interested in the politics at my job nor the difficulty in finding childcare that is willing to work around the notion that we will need 3 days a week, we just aren’t exactly sure what three days those will be (and evidently it isn’t illuminating to say ‘not Saturday and Sunday’). 

Of course, clarifying one issue might lead to a bevy of other ones.  Should I find myself down at the Park in due time, there is the question of having a vehicle.  While my in-laws have been nothing if not wonderful about providing us their little used second car, it is not something that Tia or I feel comfortable putting a baby seat into.  Plus there is the fact that it takes premium fuel and gets no better than 13 miles to the gallon on average.  Still, it would take a lot of fill ups to equal another ride and, until we get settled into some more permanent work situations, it is an amazing luxury to have for the time being.    

The only other issue going on at the moment (for me anyway) is my damned allergies.  I am now on enough medications that I can easily breathe out of my nose a majority of the time, but it is also enough that I feel perpetually exhausted and wrung out.  I am not sleeping so much as passing out evidently and am not sure what to do to fix it.  Plus, with the addition of the steroids, I have the added benefit of sweating like I just crossed the finish line at a 5K every time I move overmuch.  I am going to have to start wearing headbands like Lebron so I don’t drip on anyone if this keeps up.  But, again, I can breathe.  So, there is that. 

The upshot is that, eventually, it looks like I will get my wish to cut to part time; just the when and the where need to be figured.  And, eventually, we will get child care figured out, though again it might not put us in an ideal situation from the jump like we would prefer.  And, one would assume that eventually the allergies will have to recede back like the tide and I can go back to just a few antihistamines (a few daily anyway) and find some kind of stasis until the shots finally (hopefully) take effect. 

Until all of that happens though………ugh.  Wake me when its over.   

Kool-Aid

Sometimes life is just overwhelming.  You tend to lose perspective and get swallowed up inside of it.  Working in a hospital helps, because there is always someone in worse straits…generally in the very next room you go into (though, at my hospital, many of these situations are self imposed).  Still, it is hard not to let stress eat at you. 

Tia’s job seems to be, finally, settling in.  Nothing is 100%, but the odds are in her favor that she will be retained at 80%.  My job continues to be somewhat of a mystery, but it is looking more and more like the plan is to hire someone full time for the clinic, have me train them, and then me moving to a part time position at the Park.  This isn’t ideal, but it will work…you know, if it in fact happens.  Until I see a job posted and I apply and am accepted in, I take nothing as a guarantee.  I have seen enough working to know that everyone is expendable.  However, I do get the impression that they are TRYING to make it work for me, which is heartening.  Still, my stomach is doing backflips while I wait to see what actually happens. 

Tia’s pregnancy is still moving along just about how it should except for some edematous extremities, but thankfully it is just retention and not the dreaded preeclampsia.  Her reflux is under better control and she has been, though in fits and starts, sleeping a bit more than she was (though a lot less than she would prefer). 

The house remodel continues its somewhat lurching forward momentum.  Feels like 2 steps forward, 1 step back all the time.  We finally get the walls down, but it creates so much mess that it takes a full day to clear it.  Then we start painting and everything is a mess again.  And the list goes on and on and on.  If we aren’t trundling loads of dirt and rock by wheelbarrow, assembling poorly drilled out and vaguely directed pieces of Swedish furniture, or painting, digging, or pressure cleaning something…..well, it must be a weekday.  And while there is no ‘clock’ per se, we are kind of trying to finish it all before August when the kiddo will be making his entrance and anything unfinished will likely stay that way for the conceivable future. 

The newest new thing was seemingly simple and ultimately not at all.  We had to cut a piece of granite.  However, it wasn’t a straight cut….it had to be notched.  So, we bring it to have it cut with a template included.  Tia calls later that day to say that they cut the finished end and then had to re-finish it (it is bull nosed).  Then, I evidently wrote the wrong measurement (though the physical template was correct) and they cut it to my measure (my fault, but annoying they didn’t stop to ask why the template and the measurements didn’t match…and erred on the side of cutting too much rather than too little).  So, as I write this our contractor (who has been nothing if not spectacularly helpful and brutally efficient, truly exemplary) is trying to fix all the above to make it work while not looking like someone tried to fix it to make it work.  Should be interesting.  I will say this, if he can’t make it happen, I have a hard time envisioning someone else could. 

As a side bar this is the stated policy of the granite place. 

Tia: We need to get a piece of granite cut, can you do that?

GP (granite place): Yes, for $75.  But, if it isn’t our granite, we can’t promise you we won’t crack it/break it.

Tia: Um, so if that happens, do you replace it?

GP: No

Tia: Are we still expected to pay for it?

GP:  Yes, because we are charging you for our time to cut it. 

If you go to a restaurant, and they burn your medium rare filet, you would ask that either they give you a new one or not charge you anything.  You would be incredulous if they said something to the effect of, “too bad” and expected you to pay for the time they spent effing up your meal.  Suffice to say we would not have paid and they would have just inherited a now broken piece of granite. 

We also had an exterminator out recently to deal with what can only be called an ant infestation at this point.  We tried out some store bought spray, but to no avail.  Now, our bathtub looks like an ant version of Kool-Aid day at the Jim Jones cult every time we walk in the bathroom.  Kind of gross, but at least we know its working. 

The last bitching I will do is about Short Term Disability (STD).  Evidently, short term disability covers you after childbirth (just the birther of course).  Tia’s starts after 30 days @ 50% of her salary.  For a  vaginal birth you are eligible for 6 weeks and for a c-section 8.  Our thought was this: Days 1-30 we would use Tia’s sick and vacation time.  Then 6 weeks of 50% pay followed by 2 weeks of no pay.  What we found out is that the ‘clock’ for disability starts the day the kid is born.  So, she will get 4 weeks of sick/vacation pay (or whatever of that she has to cover with) followed by 2 weeks of STD (covering you from day 31-44) and then NADA/ZIP/ZERO for the last 6 weeks.  Damn it!  

As for the good things, well we are still employed.  We still have lots of friends and family who continue to be overwhelmingly generous with gifts for our kiddo.  We still have a house that we love and the three best cats you could want (even with the obvious drawback of a cat we refer to half-lovingly as the ‘vomit comet’).  And, through it all, we still have each other (and generally are pretty happy with that arrangement). 

Here is to a better week.  Until then……only 3 more childcare centers to visit. 

 Post Script:  Got home and damned if the granite didn't turn out pretty well.  Our contractor is good.  

If this ride doesn't stop soon, I think I am going to vomit

Ah work.  The perpetual miasma of indecision and misdirection.  I spoke
with one of my supervisors in the morning on Tuesday and she told me 'we
are probably going to look at closing the clinic in August when you go
on leave'.   She did not mean temporarily while I was out, she meant
permanently.  The demands of staffing it when I am gone, the fact that I
do not want to work full time when I get back, and the fact that we
hemorrhage money month to month coalesced into the perfect shit storm.
So, I called Tia to tell her the news.  My options, as they were, are to
see if MP ends up posting a part time gig (still possible, but still not
concrete) or working on-call.  The advantage of on call is the bump in
pay (and extra 10% hourly) and increased flexibility.  The disadvantages
are being the first ones flexed, having nothing guaranteed, and being
required to go to any number of sites to work.  So, not ideal really,
but passable.

Skipping ahead to later in the day, the script gets totally flipped.
Evidently the long awaited financial report finally came through and,
shockingly/mysteriously we actually are profitable.  In fact, per this
report (of which I have yet to see) we are VERY profitable, especially
when you consider the size of the operation.   So now the discussion
isn't how quickly we can close it, but whether or not we should be
posting the full time gig here and getting someone trained before I
leave the full time position in October and, by the way, maybe finally
adding an additional part time position 3 days a week (which may itself
become full time).  So, now I could possibly even stay here.

Of course the reality is no one has any idea what the plan is.  I have a
meeting with the nurse exec next week that will hopefully illuminate
that somewhat.  That is the hope anyway.  Since we still have no
director and the manager role won't be filled until the director is
hired, has time to settle in, and then post the position, interview the
candidates and select from amongst them....lets just say nothing is
imminent.  The big issue for me is that we seem to be so fixated on A or
B, without ever considering C.  Why not just open it part time and see
what happens?  Honestly, that isn't likely to prove disruptive to a vast
majority of our patients and they would not have to change anything at
the moment......and could reevaluate the clinic once whoever they put in
the management positions have time to evaluate it.

This of course not only affects our financial bottom line, but really
impairs our ability to determine a good plan for the kiddo.  How do we
reserve a spot anywhere when we can't say how often we will need the
care?  How to we figure out if we can manage with one car, or need a
second?  The whole thing is a GD mess.  I hope that things clear up by
next week.  If not, just close it and let me collect unemployment and
take care of the kiddo for awhile.  Then we can all be happy :)

Everybody working for the weekend

There is just something luxuriant about a long weekend.  So much so that Tia and I opted to extend it a little further by taking off Friday as well.  It was the first weekend in some time that I can remember really relaxing, in between all the projects and errands we lately find ourselves embroiled in.  Of course, we did some of those too. 

Friday was a spa day.  Started with some chouquettes (an eggy donut-like pastry topped withsugar) and chocolate croissants still soft from the oven from St. Honore.  We then ambled down to the spa, where we soaked our feet, drank tea, and had warm oil scalp massages…followed by 90 minute full  body massages.  It is a rare treat that we both expect to be rarer once the baby comes (both because of cost and time).  We finished up by dropping off some paint for recycling and lunching at Grand Central (who have the BEST cowboy cookies you can buy…second only to the ones Tia makes).  Of course, being us, we then managed to get outside and trim some hedges, mow the lawn, and otherwise work on house projects. 

The rest of the weekend followed a similar pattern, leisure and work.  Of accomplishments and down time.  We drove up to the casino (lost a sum total of less than $10 between the 2 of us), took in a happy hour at Trader Vics (the most amazing crispy coconut shrimp and some seriously potent Mai Tais), and made dinner for my in-laws.  Also, we pressure cleaned the driveway and walkways, trimmed every hedge, bush, and plant in the front yard, weeded, hung shelving, cleaned, registered at Target for baby stuff, put together a bed frame, bought a mattress and hauled it home, and ran a smattering of other errands.  We also faced off with my old arch enemy….mulch.

For some reason, mulch ALWAYS misleads me.  It seems like each bag should go so much further, should cover so much more ground.  I had guessed maybe 8 bags of it for the front in between all the plants (and mind you, it isn’t as though we live on a palatial plantation-like plot of land) and Tia went ahead and picked up 12, which should SURELY be enough.  Unsurprisingly, it wasn’t nearly enough.  So, we have one half a finished product and one half looking better than it did before, but rather less than impressive comparatively.  Damn you mulch!  

So, what’s left?  Well, as Tia reminds me always, the projects NEVER end when you own a home.  We still need to paint the stairway, mulch the other half of the yard, and finish up the back yard’s planting.  Plus, god knows how many other things I have forgotten.  The projects aren’t all fun, but they are rewarding and I am invested in the outcomes.  Still, it is nice to be able to step away now and again and just do something fun with no real goals or intentions.  Now if there were only a few more long weekends.  Preferably every weekend.  

Little Talks

It is a curious thing writing a blog.  It serves both as a window (however draped) into my life and my muddled thoughts and as a diary of sorts for me to look back on and remember more acutely and possibly more accurately, the events that have led to this point in time.  It can also be hard to come up with topics to discuss when life can at times prove fairly rote and, dare I say it, ordinary.  This isn’t a bad thing for the purposes of actual life, as no one really wants to whipsaw from crisis to crisis, but it can make it hard to document without a degree of tedium shrouding every word.  

While I think it fascinating that we have put together an actual garden with actual growing things in it, it doesn’t exactly lend itself to the written page.  While I feel accomplished every time I put together something that works well for our house (our new bench!) or fix things, it translates poorly here.  Hence, the general lack of new text appearing on this site.  

Speaking of tedium, work remains remarkably staid.  Still little to no help here in the clinic and, conversely, they seem to have little need of my assistance in the hospital.  So, when the load is light, I am left largely to myself.  Plus, now that wound care is no longer here, I am literally by myself.  I suppose I ought not complain about being paid for being available to work rather than actually working, I can’t help but feel like I would just as soon be sent home so that I can be productive doing something else.  That said, I suppose we need the money more now than we need the lawn looking especially well tended and, much as I would like to have them done, there are few things on the to-do list that can’t stand to wait another day or week or month.  Plus, these are the kind of days that make up for the ones that you barely get lunch and never get your breaks. 

The rumor mill continues to grind the grist of a dozen conjectures.  They are interviewing someone from Colorado!  They have hired someone already!  They have 3 viable candidates!  They have no viable candidates!  We will have a director soon!  They are going to hire a manager instead!  They are going to hire both!  And on and on they go.  As with all else, I will post when events warrant.  Until then, assume like I do that nothing is in the offing...and you will most likely be correct. 

Tia continues to have her sleep troubles.  It has got to be infuriating knowing that it is just the beginning of such occurrences.  Some people say it is the body preparing for the lack of sleep to come.  But, if I knew I was going to be fasting tomorrow, you can be sure I would eat as much as possible tonight.  I would think the body would do the same.  All I know is that I feel badly for her.  On little sleep, I am clumsy, grouchy, and overall brain addled.  It is like, well, like most Mondays really.  

Not much else to report upon, so I will leave you (and me) with my current go to song: http://www.youtube.com/watch?v=ghb6eDopW8I&ob=av3e

Fixing things

There is nothing quite like home ownership to teach you how to fix things.  Home ownership + the internet + hardware store = weekend.

This past weekend, we learned all that we could possibly want or need to know about fixing windows including new terms (to me anyway) like balances and sashes.  But, after a bit of searching, we fixed a window that had been broken since we moved in with about 10 minutes of work.  Then, while Tia was away, I 'Ikea hacked' some Besta furniture and made some custom benches for our former dining area.  With the application of some better structural supports and outdoor bench cushions, we now have an awesome window seat with great underneath storage that looks like a built in.  Now this weekend our dryer stopped working and, after some more searching, we took the whole damn thing apart and tested the door switch, the thermal fuse, and the starter....all of which of course worked upon testing.  Then I put it all back together and, somehow, it worked.  I don't know if this counts as 'fixing' it, but Tia's logic is that it didn't work before and it does now, so it counts.  At the very least I now know how to take a dryer apart.  

We also managed to divest ourselves of some garage clutter.  If you have some garage clutter, follow these simple steps: 1. Put item on CL under 'free'.  2. Await responses......lots of them.  3. Get rid of clutter.  Truly one person'a trash is another person's treasure (and in our case, most of said trash was left in the garage when we moved here).   Eventually, with a little luck, time, and effort we may have an organized garage space...a manicured back yard that cultivates actual food...a complete nursery...and a more usable kitchen.  Now if we could just find a little extra time to work on all these things.

No changes at work.  Some rumors circulating about a possible new director coming in from Colorado, but it is hard to say if there is any truth behind it.  Typically it is little more than talk and certainly there is nothing substantiating it.  We shall see.

Speaking of running around, perhaps some food would be a good idea.  Now if we could just find the time to make that happen.

May Day

These are the times that it is tough to blog.  There isn't much of particular note that has changed since my last post.  The garden is now actually growing (abetted by the copious Portland rains).  The yard is looking more and more like we want it to, instead of just cultivating weeds.  The nursery is nearly done (although it has remained nearly done for some time).  There are many projects to be done of course, but it is all happening.  

As for the baby front, we are now (per the app) about 100 days from sleep becoming a fond memory.  Tia continues well (despite the horrendous acid reflux) and things are progressing as they should.  We are learning that child care is something that you need to explore prior to even having one.  Terms like 'wait list' are omnipresent.  And good lord are they expensive.  For 5 days a week it looks to be between $1000-$1350/month and about 10-15% per day less.  Yikes.  

On the work front, little has changed.  We still have no boss.  The clinic still limps along with just me 4 of the 5 days a week.  There are still staffing problems.  There is no real forward momentum, though I guess stasis is better than continued deterioration.  On the upside, I am still left mostly to my own devices.  

I have had opportunity to meet with the COO of finance, though the meeting unfortunately was mostly spent trying to explain what it is we do and offer suggestions on how to best cull the data they are trying to collect.  So, in summation, 2 months after meeting with the nurse exec, we are still trying to find a way to collect the data that can begin to determine the financial viability of the clinic.  Meanwhile, I saw 3 uninsured and 1 marginally insured patient today.  Sigh.  I still hope that they will consider a way to keep me around part time come the fall.  We shall see (don't worry about what you cannot control).  I will post as events warrant.  

My $14K appendix

Okay, I haven't posted in awhile.  Largely because nothing major has happened since my surgery and subsequent return to work.  Work in fact, remains a curious balance of chaos and indecision and since the meeting between our charge nurses and our de facto (until they hire someone) boss yielded no new information and no leads, we are just kind of floating with the current.  I did get a spreadsheet regarding the clinic from my meeting with the nurse exec, but it was utterly incomprehensible and my response to it has yet to yield and reply.   They are, however, trying to work out '5 year projections' for all our clinics.  To which I have to ask, what about now?  What about 5 week or 5 month projections?  Sigh.

We got the bill for my surgery.  Just a shade under $14K.  Thankfully it only ended up costing us $116.  Yay for Tia's insurance!  Go KP!

I did another thing that I never in my life thought I would do this past few weeks.  I spent $272 on dirt and rocks.  Not a new tablet computer.  Not a weekend away.  Not a shopping spree at the mall.  Nope, dirt and rocks.  8 cubic yards of em.  Then, they all had to be hauled into the back yard, one wheelbarrow at a time.  Thankfully, it is starting to really shape up now.  After 2 weekends and some help from the moms, our backyard no longer has more weeds than grass.  In fact, it now has 5 planter boxes and rock pathways.  It has actual plants planted.  In a fit of over ebullience, we even managed to rip out all the grass/weeds from our divider and gussy that up with some new plants and gravel.  So, also, our backyard now houses a couple cubic yards of plant clippings and weedy sod.  Anyone need some compost?

We also have managed to just about finish up the kiddo's room.  Painting - check.  Furniture - check (chair, dresser/changing table, and crib with mattress).  Art/wall hangings - not so much.  But, it is coming along.  I am pretty sure Tia will post pics.

I am being required to get my WA license now or 'risk having my position terminated by June 1st'.  This has thus far involved a $30 fee to verify my current license, a $92 fee for my new license, a fingerprint card that I must find a place to roll my fingers across ($15), and then send those along with a check for $32.50 so they can pay to verify those.  So, about $170 for a license to work where we have a small hospital/clinic that I might go to 6 times a year......or get fired.  Then it is just $108 annually to keep it up.  Sigh again.

Well, as the day is startlingly flying, I probably ought to take advantage of the last few hours of light.  I have a big day involving me: fasting, doing a barium swallow study, and later fingerprinting and then work.  Oh yeah, and then a 2 hour meeting with our financial adviser.  Maybe I should just go to sleep now.  

Portland in the 'summer'

I know it isn't summer yet (or really even Spring despite the official designation of such since March 20th), but a few days of sun and, relative, warmth serves as a nice reminder of the things I really like about Portland.  Tia and I spent this afternoon on about a 90- minute stroll. In that time we stopped and picked up an iced coffee, wandered through a consignment shop, found a new coffee/pastry place that had just opened, walked past a new non-profit brew pub prepping to open, another one doing brisk business, a quaint little garden store (complete with chickens), and past the Firehouse Restaurant on our way to our new community garden plot which, incidently, sidles up to a great park.  This we achieved by walking less than a half mile semicircle from our house going south and west.  As much as I cannot stand the weather most of the year, I can't say I have ever lived in another city where I was so near to so much and still living in a residential area.  It will be a great summer....you know, if it ever arrives.

I finally got to feel the baby kick.  Was really neat, though I don't know how I would feel if it was kicking  around inside of me.  It is gradually becoming more and more concrete a concept to me now though.  4 more months.  

Speaking of 4 more months, I made it through 2 days of work.  I thankfully had help, which gave me plenty of time to catch up on paperwork and all the little niggling issues that tend to come up.   I was asked to put together a 'clinic survival guide' or sorts as well in case something should again come up that leaves everyone else scrambling (like maybe a baby being born).  I thought I would be able to knock it out in an hour or two.   But, after over 2 hours and 5+ pages, I am nowhere near finished (though closer than when I started!).  Every time I answer once question, it brings up a bevy of additional ones.  I am not saying my job is exceedingly difficult (or any more so than anyone's job), but having to break down what you do to accomplish the things that I do to make the clinic run is not easy.  You have to think of all the things you take for granted that you do just because that is what you do day in and day out.  But, how would I explain it to anyone else who rarely to never does my job?  Will be a long process.   Of course, this wouldn't be necessary if, at any point ever, my suggestions to train everyone to work in the clinic (a 2-3 day initial rotation and then 1 day a month to keep up skills) were implemented.  But, I am going to go ahead and guess that the guide I will end up typing up will probably be the way that people orient themselves.  Sigh.  

We have started the discussion on childcare though.  It is really quite startling just how much will be changing.  Determining how many days you want (or can afford) to put a child in daycare is a huge topic of conversation.  Do you go with a nanny?  What if I work part time?  Not at all?  What if Tia does either of those?  It involves a LOT of guesstimation at this point of course.  By August, I might not have a clinic to work at.  Or Tia may run out of funding?  Or we might win Powerball and retire?  But, assuming we don't win any money, we have to figure out how much we can afford to live on, how much the kid will 'cost' on a monthly basis, and where those 2 lines intersect.  I know I at least would like to try to be home more than I am at work.   I guess we shall see.  

Time to finish up dinner and try to push through that thin melancholy that also descends on Sunday evening when you know in your bones another work week is about to begin.  

returning

Well, it would appear that tomorrow is the day.  I got the go ahead from the doc and got the paperwork to our HR department.  Of course, as always, there were issues.  The doc put today's date for my return on the form instead of tomorrow's date.  Despite my explanation to HR. they needed a 'corrected' date prior to letting me come back.  The doctor, mind you, is out in Clackamas and I was back at work to fax it (about 12 miles away).  So, I had the option of: A. Driving back out to Clackamas, B. Trying to contact said doc on the phone, fax over the form and have them fax the form back to my HR department (and somehow impart that this needed to be done ASAP) or C. Fix it my damn self and re-fax it.  Hmmmm, wonder which choice I went with.

Looks like a busy return date as well with 7 patients on the board.  Should be a nice welcome back.  It will be good to try to get my legs back under me with 2 days on, then hitting the weekend, before returning for the full week.  I haven't heard anything about the future of said clinic at this point, so I will assume at this point that I will be operating it in the same manner as I have been.   Wish me luck.

More to come as always.

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.

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.