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.

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.

We have a decision! (just possibly/maybe not the final decision)

Much has been written here about the impending Layoffs 2012 here, largely because that has been dominating my own myopic professional landscape. I have heard from others outside the profession who still believe that nursing is as portable a profession as any and that there is a clamor for our services, but that is simply not true. Not here in Portland anyway. The market has shrunk for the coveted positions inside of hospital systems, primary/specialty care clinics generally hire nurses cheaply or, more frequently, not at all (not when a medical assistant can do 80-90% of the work of an RN in a primary clinic at 40% of the cost). So, what you are generally left with are the crumbs that few truly covet: long term care facilities and psychiatric facilities. Both pay far less than they should and both generally offer pretty poor levels of job satisfaction.

Additional to the dearth of positions, nursing as a whole is not so fluid as one would think, which is compounded by the fact that when your career is in it's nascency you aren't exactly faced with an embarrassment of options. When I accepted a position in my department I looked at it as a foot in the door, but really it might as well have been a foot in some quick drying cement. I am now an IV nurse and, whatever my thoughts are on the subject and however much they may wax and wane over the course of my career, I am not likely to get very far away from this. Had I started on a surgical floor or an oncology unit, I would be saying the same about that. It takes an effort of will and knowing some people in decision making positions to move into another field.

So, as you can see, the thought of losing my position in the hospital was not one that I particularly relished (though I did have brief joyous thoughts of being free of work). Thankfully, the initial wave has finally passed (with a thin possibility of more changes by the mid February deadline). We ended up losing a full position at my home hospital (our newest full time nurse was let go and another one lost a shift a week). Additionally, the wound care nurses whom I share the clinic with, will be moved to the basement in the chronic wound clinic by early March (they are also moving to 7 days a week, alternating weekends). So, what this means to me directly is that I will be losing my second nurse (something I am required to have to administer medications) and I will be needing to use our floor staff for that purpose, a floor staff that is now short one person. I am awaiting the ensuing problems that this will invariably cause.

The other news (well, more or less speculation than anything) is that my boss received a rather ominous phone call requiring a meeting with the head nursing honcho on Monday. She, of course, fears the worst. While I don't think she is an exemplary manager, she is at least pleasant and generally supportive. Of course, maybe it will turn out to be nothing (which I hope for her sake, as she is the sole support for 4 kids). I am sure she will be suffering from an inordinate amount of stress this weekend.

Switching topics, we finally ate at a local place called Frank's noodle house this past weekend where they make their own hand pulled noodles and it was flipping fantastic. I have mostly dismissed the concept thinking that, well, noodles are noodles. They couldn't be more different. Chewy, dense, and delicious. Oh, and pretty cheap to boot. Not much on atmosphere though.

Tia's pregnancy continues well. Some mild nausea (sporadic) and generalized fatigue still plague her, but no severely limiting symptoms of either. However, I think she would argue against the concept of pregnancy being even remotely 'magical'.

still waiting for a decision

As with all corporate decisions, the phrase 'hurry up and wait' seems to pretty much sum things up. They were going to make the decision about the layoffs in mid-January (and enact them by mid-February). Now I hear late January or, possibly, mid-February to make the determinations and who knows when they will be enacted. I think I, along with most others, just wants them to make what announcements they are planning to and just moving along with it. The waiting is far worse than knowing would be.

As for my specific position, at least it remains consistently inconsistent. I have spent the past couple weeks in a relative fugue state, bouncing between not working at all and working more hours than I am schedule to with no seeming rhyme or reason to either course. I don't blame anyone for this of course, I know that those running the show are trying to be equitable and not put an undue financial burden on anyone in particular..........but it is somewhat hard to bear just the same, mostly because it is seemingly so haphazard. I often don't know much in advance if I am working the whole day or part of it or where I will finish the day once it begins.

I spent the past two days at different sites with yesterday being the kind of ultimate in yo-yoing. They asked me to come in early to start on the floor. I did, and then spent the next few hours there until we needed to add someone at the clinic. I added them for 1, but then was told that I needed to go to the Park to help out by 1, so I had to call my 1pm patient and reschedule him for, well, immediately (which thankfully worked for him). So, I ran to the clinic, opened it up and set up the supplies, performed the procedure and then shut it all back down again, ran to lunch and then spent the rest of my day in Tualatin covering for a sick call there. I am trying to be 'flexible' and help out, but it is quite wearying. But, work is work and I guess in this beggar's market, being choosy isn't in the cards. At least, for the most part, I like what I do and I try to remember the good things like when a patient calls me 'their hero' for getting IV access that no one else seemed to be able to find. It is the nice thing about having a specific skill.

From the home front, things are going pretty well. Tia is feeling less tired in general and things are progressing quite well. I have been home more and doing more around the house when she cannot (plus, I genuinely enjoy house work, it is somehow almost zen like, like when I exercise. I can block out pretty much everything else in my head and just accomplish tasks). I don't know if I would want to completely excise out working, but I would certainly be more than content to spend more time on the house and, eventually, the garden and less time roaming around the hospital.

Speaking of hospital, I seemed to have picked up some kind of bug there. Time for my weekend nap and, hopefully, waking up feeling slightly less like a pile of dog crap. More to come as always.

Anything new?

Well, it is 99.9% official, looks like I am going to be a dad. It is, honestly, terrifying, exciting, surprising (some would stay astonishing considering my previous lack of interest in the concept) and terrifying again. The upshot is that we have a long time yet to acclimate to the concept. The truth is I think I will need every month of it. I suppose you can never truly be ready though nor accomplish all the things you hope to prior to having a child (more travel, less debt, etc.), but at least I am more ready than the dads on Tia's 'Teen Mom' show. Aim low.

Work remains mysterious at the moment. I am flexing a lot (about a full week of hours in the past 3 weeks) and there is no solid answer on who or how many will be jobless soon. I am trying to take a glass half full approach though and hope that by being flexible now, I will be employed later. I would gladly give up 100 hours this month if it meant I had a

job the next. I will update as I hear of course.

Went snowshoeing this weekend for the first time since my initial trip out at Mt. Bachelor with a group of 4 other people from Tia's work. Was a

hell of a lot of fun, incredibly sunny and warm too. It was nice to exercise outside for once. Plus, much more fun than running in place on a treadmill. The most bizarre part were the birds. Thinking that there was no way they would fly and take food from my hand, I held up a piece of cracker and one flew and took it from my hand.......then another and another. It was really bizarre and made me feel like I was on some kind of nature show.

Saw the movie Drive this weekend as well. All I can saw is that it was nothing like what I thought it would be. Scant dialogue and languid pacing in the first half, hyper violent the second. It wasn't bad, but I can't recommend it either. An experience for sure.

2012 (almost)

I guess we will find out if the Mayans and/or Roland Emmerich are right and the world will cease, but I am betting that maybe a culture that counted on human sacrifice to appease their gods was not terribly prescient, but I guess we will find out in December.

There is little to add to my work drama of late. They are still planning on laying off 400 people (or otherwise eliminating those positions by inducements to early retirement and hiring freezes) and there is still no clear answer as to how many of our team might be affected. You can worry about it, but it isn't going to change anything. So, in the interim, we are moving from 'no flexing no matter what' because we wanted to preserve the notion that every hour is necessary to 'get the eff out of here as soon as you can.' So, I ended up flexing out about 40% of this past week. Left early on Monday, cancelled on Tuesday, worked all day Wednesday and left a hair early the last 2 days. Thankfully Tia is not dealing with the same, so it isn't like we will be in the bread line anytime soon. Not sure how long the flexing will continue though.

Other than that, had a nice holiday weekend (bummer that there was no 'holiday' extended time off, but nothing can be done about it) and am looking forward to a, hopefully, fresh start with new adventures in the coming year. Until then, cross em that my neck doesn't hit the chopping block.

Happy New Year!