SNOW!

First snow of the year (and possibly the last) and in our house at that. The puppies haven't seen snow in quite awhile, Cubby didn't seem to mind, Wrigley wasn't sold on the idea (plus she managed to take off her sweater). We had fun running and playing outside. Snow in the valley means snow on the mountain. Ready for snowboard season! Oh and Happy 4th anniversary to us!

Hello dirty puppy, almost forgot your coat is white

Mt. Hood from the plane

4 amazing years of marriage

SNOW

Patients at work patients at home

What a strange health week for our family of 4.
Shawn's been itchy - it didn't start with a rash but he eventually did get a rash and it resolved on its own but he's still itchy, not sure why. Then Wrigley gets sick, vomiting, diarrhea the works. Just when she gets over that hump, after bathtime we find she has an ear infection. Doggy ear infections stink, literally.  I think we caught the infection early enough and prevented her from needing super antibiotics and a trip to the vet. (I'm so glad Shawn's the ear cleaning expert, she doesn't want me anywhere near her ears). Then a rash I've had is beginning to get bigger and spreading like wild fire. It started as a singular red scaly spot then the little oval patches started to form along my sides then spread to the arms and a few on the legs. It itched, quite a bit and I was looking like a mutation, I was hoping I would still have some normal skin left. After some thoughts I knew what my rash was (much to my relief I wasn't coming down with a hybrid rash from jail) and so the 6-8 week wait begins. And then the canine conjunctivitis. Cubby's eye is so darn goopy it actually made me a little queasy trying to clean him up. A piece of mulch probably scratched his eye (they've been spending a lot of time outdoors) but I really hope it's not bacterial and Wriggy ends up with it too. Good thing we've got a paramedic and a PA in the family.

CC Shawn

The wait is finally over and it's official - Shawn is the newest night G-shift Crew Chief! So very proud of such a wonderful accomplishment. I know he has a lot to learn and faces new challenges but I know he will succeed every step of the way. He makes me so proud, all of his hard work and dedication have paid off.

Looks like we're headed to IVF, unless for some reason this cycle of meds works, since it will take awhile to dive into that journey, I've taken on some new activities: Barre3 class - mix of pilates/ballet/yoga. I forgot I had some of those muscles. Tonight I did "something bigger, something better" took a cabaret hip hop class at Vega Dance Lab. It was awesome. I forgot how much I love dancing. I'll be playing that song on my ipod for awhile.

Random note: the new Axe commercial (the one that shows two ladies washing golf balls), the little fine print at the end that states:" use gently on sensitive areas" cracks me up.

Puppy Socks

Thought I'd get the puppies some socks to help keep their paws from tracking any missed dirt after the nightly sponge bath, maybe working them into being comfortable wearing little puppy rain boots for the rainy season. Good thought but in practice, not so much. Actually, I would consider them a total fail. The socks don't really stay on like you'd think they would/should.  Ssurprisingly neither of them tried to gnaw their own paw off nor did they chew on them.  Cubs did however walk like he had 4 injured paws for the first few minutes. Just not so sure they're functional after all, who knew?

Wriggy's birthday is Thursday - she's going to be 3! (21 puppy years) [ don't tell, but she's getting a new sweater and Cubby is getting one too] not sure what to make her for treats just yet but they will be good - only the best for my little piggy.

No go on the precepting spot for Shawn, but that's ok, there are bigger and better things awaiting him.

So moral of the story - puppies really don't need socks.

Reconnecting

I think we've been in a time warp lately - the time just keeps going by faster and faster and the "to do list" seems to be getting bigger and bigger.

We're almost settled, just as busy as always and now with the house there are a million and one more things to do - mowing the lawn is a necessity but 3 weeks in and we're still enjoying it. I'll be glad when the boxes are all unpacked in the garage.

Puppies have learned to be outdoor explorers and we have become master paw-wipers.

Mom and grandma are coming to visit in 10days, pretty excited for this adventure - hoping to show grandma around I think it's been 30 years since she was last here/

Shawn applied and interviewed to be a preceptor - we're thinking positive precepting thoughts. He would be so awesome in that position.

I've learned a couple useful tidbits from work like don't let a friend give you a tattoo in places you can't see or else the "monster" tattoo you were hoping to get becomes "molester" I've also seen about 25-30% of my former classmate's and professor's chart notes. It's kind of fun to hear patient's talk about their great PA and then turns out I know them.

Breaking news*** just learned I've been feeding an ant colony 25# of dog food. Way to go****

The addition to our family has not happened and may not be in our cards. We've been using science to help us and still no luck, apparently my "garden variety" unexplained infertility resembles a garden from the Lost City of Atlantis- unexplainable. We may be headed to Oregon Reproductive Medicine (ORM) in the very near future but there may not be a scientific intervention to solve my biological conundrum. So we've nearly come to terms that our lives may be going in a different direction and so a great deal of traveling may be in order.

That about sums it up from the PNW.

Shiny Bins

So the house is finished, we closed on 6/30, keys are in hand, but we haven't had a chance to actually move in yet... kind of crazy as we sit here on the couch in our apartment when it's 95 degrees outside knowing that we could be enjoying 70 degree comfort inside our house. All in good time I suppose but really, who doesn't move right away? Maybe because my car has been dying a slow agonizing death... it's 12 years old, 181,936 miles, the driver door handle broke off so have to role down the window to open the door, the engine light is on and it occasionally continues to run, making a high pitched screeching noise even when the car is in "off" position and keys out of the ignition. So I bought a new car today. Betsy has gone to greener pastures, and now I'm enjoying Goldie - named lovingly for the band "Goldfish" that sings the song to the car's commercial.
Now that the car isn't an issue I guess we don't have any excuse not to pack up and get the hell out of Dodge, before it burns down. (yeah, an apartment fire in our complex this week due to a faulty propane tank was also motivation).

When did we grow up?

Nearly 22 years ago we were playing soccer - in the same tournament in KS but of course we wouldn't meet until about 17 years later when I graduated from college. Not long after meeting we were engaged and then married. We've travel, we've worked, we've played, we've gone to school and moved (a lot)  and we've managed to raise two dogs in the process. We've grieved, we've celebrated and we've developed our relationship to an amazing combination of friendship and love. However, these amazing adventures and legs to our journey pale in comparison to recent happenings. We signed 35 pages of documents to acquire our new home - that was built just for us, on a lot we picked with color choices and extras that we could only dream about for a house. Just a year ago I was in Ecuador finishing up PA school - and now a year later here we are. Wow. Time goes by so fast, how did this happen? We are so very blessed and grateful for each and every day and every opportunity.

Pictures worth 1000 words

Shawn and his dad putting up the scratch coat - so grateful he could fly out for 48hrs to do this project.

My favorite part of our house is the fireplace. They worked so hard and did a phenomenal job, it is beautiful! The pictures don't do it justice. At least the house and our work will keep us distracted for awhile since we ran into a dead end on the path to family expansion. It appears 2 legged additions might not be in our cards even with science's miraculous help after all.

mini updates

-house is coming along - always surprises, like a 10k retaining wall that needs to go in now, great. Shawn will be stoning the fireplace with his dad the first of June, really excited. I love the stone we've picked out, it's going to look stunning - plus anything done by the Zupfer men will be amazing.

-my work - same old same old, increase in MRSA, strep and tonsilar abscess

-shawn's work - may be changing shifts at the end of the month - mums the word but fingers crossed, not headed to days yet, just moving up the night chain.

-babies - Zupfer babies will be made with a little help from science, hopefully we'll have updates in 3-6months on this journey - we are so blessed that there is a possibility to have children, just going to take a wee bit longer than we thought.

Love is in the air

I'm blessed, very blessed. Not everyone has what we have. We have love. We have so much it overflows. I wish we could take our excess and share it with others and the world might be a better place. This of course will never be the case but it's still great to dream. At 7:45 this morning I took muffins to work for Shawn and the other hard working EMSers. I baked them fresh and I didn't have to go to work today. I did it because I love to do little things that put a smile on his face. Shawn will go out of his way to make sure I eat when I get home for work or take me out to lunch when he's running errands, even if it means going 20min out of his way. Our favorite thing to do is sit on the couch and just be. He really is my best friend and love of my life - what an amazing combination.

So where did all this gooshyness come from? Let me provide a little background first. When I was in high school, I was forced to transfers schools for my senior year. The "Cheerio" girls took me in with open minds and hearts - it was amazing. We had some really great times together. I am so grateful for their friendships even though we have all gone our separate ways, through social networking I can reconnect in someways. Several of these gals have their own blog: the Becker Family, Suburbangranola and articulatethelimb. Jessica, the author of the last blog is in law school, she is also newly engaged. She is one of those brilliant minds, a force to be reckoned with, she is articulate, thoughtful and insightful. Her most recent post reflected her inner cheese of being in love - and just how wonderful it is and how it should be celebrated. I just had to second her in my not so articulate way. Cheers.

Completely random: pregnancy post menopause - not sure what my thoughts are for sure about that... Apparently Russia, Italy and India are the places to go if over the age of 58 and ready to conceive, in fact India believes that elderly parents are much better parents because unlike younger parents working 8-10 hours a day, elderly parents have nothing else to do except to care for the child. Huh, never thought of it like that...

whiff test

There are always strange smells at work - always. One week it smelled like Thanksgiving stuffing (yet not holiday time), another time like pears, a month ago mustard and ketchup a couple days. I don't usually investigate how or why it smells, I'm sure it would ruin a great many things for me to see work's version of chicken noodle soup or a hamburger. Sometimes it's not food, it's burning rubber or stale air (if you can even guess what that smells like). These smells vary between tolerable to stomach turning and if I'm really lucky Shawn can catch a whiff of it lingering on my scrubs. Thank goodness I wear scrubs everyday.
This week, I couldn't quite place my nose on the smells but I started having weird cravings based on these smells. Like a salivating urge to eat hot dogs and nacho cheese, I actually contemplated stopping at the store for these commodities. EWWW. The next day it was chicken in a spinach wrap that sounded good. Where did this come from? I never would eat that. Today it was salmon and cheddar cheese served quesidilla style with salsa. As nasty as this one sounds, it was actually pretty good, the compulsion was so strong I went for it, plus we had all the ingredients. Oddly enough with these weird food desires some foods have fallen out of favor and make my stomach turn just thinking of them - ice cream and fresh baked cupcakes to name a couple. Very disappointing when I made cupcakes tonight.

And no, I'm not pregnant, so don't even go there, and if you already went there come back. Between cravings and aversions I'm not sure what to think, it may be the progesterone but I couldn't find that as an ADR on the package insert.

A Star-lin is born!

A little story:

There once was a little boy from Cuba who loved to play baseball. He wasn't good, he was great. He ventured to the US at the ripe age of 19. He wore his pants up while he played short batting .326. He was a bit shy, but confident. (Hold this thought)

An adorable couple, big baseball fans, traveled to AZ to see their favorite team during spring training. Happen to stay in the same motel as the farm team of said favorite team. Also had an amazing opportunity to be up close and personal with two of the players- one who has played for the team, the other awaiting his call, his turn to shine, a blurry picture and a couple of signed baseballs commemorate this occasion. With confidence, when asked when to expect him in uniform he says about 3 weeks.


Pan to 5 weeks later, almost to the day. 7am. This now 20 year old AA player gets a phone call. Today is his day. 6 RBIs, 2 swings. One homer, one triple. That's one helluva debut, a record in fact. Welcome to Chicago Starlin!

Jet-Setting

1800 miles one way, less than 24 hours - Nothing like living in the Present Tense.

17.96 hours

that was my overtime from the last pay period. Crap - I thought I was doing better, but in retrospect... I'm just going to work earlier to leave earlier but it's getting better, my 98 hr pay period is not the norm - I'm actually back down around 90 hrs, that's tolerable.

Today I found my mind wandering while seeing patients - it's not the first time this has happened. I'm usually thinking about what else to look up or read about or mulling over treatment decisions I've made recently. However today was the first time I actually took a patients temp twice because I was so wrapped up in my thoughts. (I've done this before just to keep a patient's mouth shut, or set the thermometer to setting that counts by one tenth increments - oops, again internal filter, I meant I was double checking that my thermometer was accurate).

Medicine is such an evolution. There are really no right answers, but there is an answer that has more backing from research or more promotion and that's what used. And I'm not sure where all my patients went to "med school" or nursing school or where they managed to work as an EMT between their time away from the rock yet they all seem to think that their two week CNA course or the fact that they watch Dr. Oz on Oprah is better than any degree or knowledge I have and somedays it's frustrating, not to mention the threat to sue or contact the ACLU.

Some patients are breakthroughs, "why should I take all these meds?" (for DM, HTN, high cholesterol) "well, do you like your eyes, kidneys, brain, heart to function?" "Well, yeah. You mean I could die?" (Not to get all philosophical - but yeah we're all going to die) "No one has told me that before, guess I'll take the meds."

Mystery Zone

One year ago we seriously committed to 2 adventures: expanding our family and moving to a house (a detached, single family dwelling to be more specific). Timing is everything in these two matters, especially having just finished up school in August, student loans, Shawn's job shaking up the shifts and cutting out overtime, a new company at my work, our families living 1600 miles away, etc. Our work hours are crazy and we have to actually plan when we are going to see each other and we mark it on the calendar. I leave before he's off and he leaves before I get home - weekends have become sacred. But weekends aren't always convenient for everything that needs to be done... Despite these challenges, we've managed to get a lot done on those weekends and the fruits of our labor are coming to fruition!

In the words of spoon: "Make us a house, some far away town, where nobody will know us well"

We still have a long way to go in the whole "expanding our family" plan, what we thought would be a relatively quick endeavor has become a little more calculated then we planned, which now includes meeting with a fertility specialist. So one leg of the journey is started, another leg is rolling along slowly but all in all, life is fantastic... in the mystery zone!

trusted eggs

Being a trustee of any type doesn't make you automatically trustworthy, so how about not smuggling 6 hard boiled eggs in your socks - you know someone is bound to figure it out, either by missing eggs or the trail of crumbling yoke in your wake.

Stages of disease and why I hate specialists

Working with my special population I see a variety of diseases in various stages. I've even been privy to seeing things I only thought I'd read or see in a textbook. Some disease processes don't show any outward signs and others are easy to spot as the disease ravishes the body.
Hepatitis C (HCV) is something I see daily, complicated with cirrhosis or other diseases, or just good old Hep C. There's really nothing much to do about it while in my care, feel for liver enlargement and check for yellowing of the skin (jaundice) or the sclera (icterus), encourage refraining from using Tylenol and alcohol, and education on how to prevent spreading the disease. Most of the population I encounter are relatively healthy Hep C'ers.

Around when I first started working, I encounter a patient with increased fatigue, easy bruising, no known history of HCV (to me) and some long ago history of thrombocytopenia which ultimately wasn't worked up because although low, not low enough. So now, with a Lo PT/INR and again thrombocytopenia and anemic and leukopenic (around 2.2), a trip to the hematologist/oncologist was in store. Well long story short, a CT scan and more blood work turns out the advanced liver disease is complicated by the HCV onward to a hepatologist, meanwhile, increased bruising and pallor. And here is where the plot thickens.

Now in any normal population, regular clinic, one would think a referral by a specialist to a specialist would result in an appointment with that said specialist, unfortunately I have learned that some specialists aren't interested in helping my special population even to go so far to refuse to schedule an appointment for a patient, and even canceling an appointment saying "there's nothing we can do for that patient, that patient should just follow up with the OHSU transplant team whenever they get released". Unacceptable. After the administrative asst. went to bat for me, telling the specialist they in fact needed to see the patient just to tell the patient themselves, and sure enough patient shows up and phone call saying, patient doesn't have an appointment. Again - cutting to the chase, I make nice with the receptionist, apologize for any miscommunication, but our records indicate an appt to tell answer questions for the patient and break the bad news that the patient needs a new liver. "They are taking the patient back right now" Relieved, I go about my clinic day until... the patient returns and there are no orders, no recommendations and the specialist didn't even bother to take the patient's history and information sheets they required the patient to complete. A quick phone call to speak to the provider and figure out what was said so I can be in the loop to talk to my patient. 4 hours later I am on the phone with a spineless PA with no confidence telling me yes there's a referral been made to OHSU, but would have to check with the receptionist for sure because she makes the referrals - whoa, brakes! I ask, so the receptionist actually makes the referrals, after much mumbling and stuttering, the PA further goes on to tell me that they didn't even bother making a chart note, as it's not their responsibility as far as they are concerned at that office oh and by the way, turns out no referral to OHSU and also told the patient they need to go see another specialist. Gee, thanks a lot for basically avoiding our patient and passing the buck. I should check that they didn't charge us for the no-chart note, no doc talk to the patient in the supply room visit.

So now, this once relatively healthy Hep C'er is slowly dying, needing a new liver, if OHSU even approves that person. I have seen the jaundice set in, increased pallor, fatigue, petechiae, loss of appetite and now, the swelling, eyes so puffy they barely open. Although this patient has made life choices for which there are life threatening consequences, it's still my patient, someones child, sibling, friend, I put forth my time and effort, couldn't the specialist (who is assured to be paid by my tax dollars) have a little respect for the person too? And if I could replay the conversation with the PA - I was dissapointed, ashamed to call them my collegue. No compassion, no care. And I may not be concise in my writings, or articulate to explain my disgust but I truly believe that any of my classmates would be advocating for their patients too, whether they come from a small town, a large clinic or satelite facility.

Double E Day

It's Easter yes, but four years ago on 4/4/06, I said YES! to the biggest question I've ever been asked. And so here we are today, 4 years later - new state, new life, new dreams -same amazing love. Life is great!

Spring Training

Awesome! Yup that about sums it up! Perfect weather, Cubs went 1-1-1 (yes, ties in spring training), met Sam Fuld and Starlin Castro and enjoyed the warm sunshine. Even saw a preview of the Cubs vs Marlins at the beautiful Peoria stadium. Even helped set a Cactus league attendance records. Even starting to like a few other players with the loss of Johnson (still sad).

Cereal Science

There's a special science when it comes to constructing the perfect bowl of cereal. Precise calculation of cereal and milk is paramount in not having soggy cereal or left over milk or even the dreaded left over cereal from lack of sufficient milk. It sounds simple enough and I am sure there are many cereal masters out there, but there are none of these masters living in our household. I can usually come close using a traditional round bowl - with minimal leftover milk and no dry cereal but when it comes to using one of our square bowls well, it isn't pretty. The square bowl is good for soups and salads and such but not for cereal. It's even ok for ice cream and pie. It's slightly tapered down to the bottom of the bowl so it's difficult to judge how much milk is really needed when the cereal fills in the tapered bottom giving the illusion the bowl is larger than it truly is hence a significant waste of milk. Moral of the story - keep all the round bowls washed, not piled in the sink. Trivial I know but the most significant happening in this household this morning.

A bit of advice

My mother always told me to wear nice underwear and socks, just in case some series of unfortunate events happened and you might be seen in your britches (this advice reinforced when I was a paramedic - very peculiar what people wear on a daily basis), well this next bit of advice runs along those same lines - If you are going to do something a little wild and crazy, that potentially gets you arrested, make sure you are not wearing your swimming suit... or less. No matter when you might be released, after your stint in the county Hilton, whether it be summer, winter, or spring, you will be released in the same outfit you came in wearing... which could be very chilly or slightly embarrassing (because staying at the county lodging is not). See, I'm learning something new everyday at work.

Present Tense

It's light outside when I go to work and when I leave work - too bad that will change once we lose an hour of sleep this weekend. Funny, Shawn always has to work the "fall back" weekends but never the spring forward ones. Work is improving (long hours and transition with the new company). I almost took a very enticing job offer at another facility in Hillsboro but decided timing wasn't optimal. My doc is quirky - even finding ways to chat me up about my personal life without making me feel like he's uncomfortable. Shawn just went through shift bid and ended up in a float position - guaranteed hours just not a guaranteed car, so if all else fails - he sits around and gets paid until there's a spot for him to take over. Unfortunately with this new float position it is the end of OT.

We are moving in the fall (7 1/2 months to be exact) if all goes as planned. We are planning for the long term now which is really fun, although still living in the moment while we can (like when an amazing crazy idea popped in our heads today for May that we are going to follow through on, oh so very very pumped).

It's only 2 weeks until Arizona... the last weekend of spring training - we are so pumped! We are so in need of a little away time, I really feel we've earned it. Our "merchandise" arrived today for our trip - t-shirts, hats and shoulder backpacks all with the cubs logo spring training Arizona printed on them - I'm a nerd but I felt really cool, like part of some VIP club (that I totally paid to be a part of). I'm hoping it's a great experience so we take another trip through this company during regular season and get a private tour of Wrigley field. See, already thinking ahead.

Not a leap year

My mom's birthday is Feb 29... sounds cool in theory to have a birthday on a day that only occurs every 4 years but unfortunately it doesn't mean that time is standing still in those passing years, so she actually gets jipped - aging without a special day to celebrate although I say she should celebrate for the last half of the day of 2/28 and the first half of 3/1 or get two days to celebrate every year she doesn't actually have a birthday. When I was a kid, I thought it was kind of neat that we celebrated our 10th birthday in the same years, mind you we weren't both turning 10.

March is practically here and that means just 4 more weeks until Mesa AZ!! Can't wait!! Sunshine, vacation and most importantly, Cubs baseball - the last few games before the start of the regular season!

Return to Os

Did 2 paps today - a third one scheduled for tomorrow - only after I sheepishly told the MD that I (and 2 nurses) couldn't find the speculums yesterday (and the last provider told me we had none because we dono't do them) and he opens one drawer that I didn't even know existed and woot - there are 15 speculums - egg on my face, guess I will be apping my RLQ abdominal pain with a white count and some other random woman complaint. Hadn't done any since Ecuador - I was worried I had lost my skill and I was in a bit of dread knowing that sometimes personal hygiene is not on the top of my populations to do list. But all in all great success - all on my own with my cytobrush and spatula in hand I followed the yellow brick road to the land of Os - even managed to find a retroverted one. Yay!

The Boss

My supervising doc called me The Boss about a week ago and has proceeded to occasionally call me boss when I'm in clinic... I do for all intensive purposes run the clinic - with his guidance of course, but I am not the boss of the clinic. So perhaps good readers one can empathize with me in my frustration when I get over ruled to send someone to the ER for a possible ostemyelitis or septic ankle joint. Slightly elevated white count at 13, no osteomyelitis on the xray - just evidence of an old fracture, no abscess, and a couple pieces of hardware. The ankle is now warm, red, pt is afebrile, still weight bearing, and is no other medical concerns(transient HTN) but I know if I saw this person in clinic - I would send them straight to ER. But in my setting we do things a smidgen different - the object is not to send them out, do as much as we can in house as it poses a threat to the community, the hospital and officer safety for people to go from our facility to one in the "free world". I may sit on a chest pain until troponins are sent back and read elevated from a stat lab, despite not having any change on the ECG. I wait on a hyperkalemic patient until they are above 6.2 - even though at 6 they can have fatal ectopy, not sending someone with lower right abdominal pain with a fever until blood work is back and a KUB, which both turn out to be normal. It's a slippery slope and an awkward phone call to a seasoned professional to say doc, I think the pt needs to go, because I am uncomfortable and you have not seen the patient, the command staff is asking me to override you.

In light of the not 1 but 2 or 3 contorted articles in the paper about a particular facility, I cringe knowing there is a slippery slope being a PA, using my best judgement but working and consulting with a physician - someone who is seasoned to make the best decisions to present to the patient. This is the one and only time I have thought to myself, I wish I were the doc right now.

What's up homie?

I think my doc and I are bonding. He's calling my JZ (he thinks he's the first to call me this and I decided after telling him my former classmates now colleagues have been calling me that) but hey it's "cool" and now I call him Dr. G (out loud), so it's all good. Maybe I should start calling my nurse Snoop.

Random story - cultured some weird foot lesions that i thought were totally vascular in nature but honestly was stuck and had no clue what else to do, so cleaned it up and stuck the lesion with a 27g and cultured what came out of it - blood. There are multiple lesions on the feet only, following superficial veins and no Roth spots... Low and behold heavy bacteria growth. Still not sure what the heck it is but hoping 7 days of Clindamycin will kick it... or at least give the patient diarrhea - i know exactly what to do with this.


Made first loan payment - sigh... I feel lost in the world of loans. I owe so much money. To consolidate or not... that is the question. First third of my check to taxes, then the next third to loans... sad day. Learned my site doesn't qualify for loan repayment after all - need more high or medium security peeps.
Peace out!

Distance

Can be a good thing, or a bad thing, depends on what we're talking about. Example of distance being good: not buying a property next to an existing home with a shoddy barn with aluminum roof and siding used for playing with street raced cars - just not a good idea, guess I'm not a "let me hear your engine rev" kinda person (so goodbye lot 48 I think). Example of distance being bad: between us and our family and friends.

On Friday I found myself caught in the middle of good distance. I really care about my patients, I work hard to mange their health care even though many, if not most, work hard to undo my hard work both while in my care or out of my care doing their not so legal recreational activities. One patient in particular caught me off guard - history of heavy meth use, brittle insulin dependent diabetic. I've been revising insulin therapy daily, then on routine labs the A1C is down 3 points yay! but the potassium is high at about 6, chronic anemia not a huge deal, the kidney function crappy, creatinine over 2.4, ECG normal, looks no worse for wear than normal. Thinking these critical lab values are an error in part to shipping labs off to a place 3 hrs away, I redrew them the next morning and sent them stat to the local hospital - only to get a phone call with even higher values. Now off to the ER to get sorted out although most likely won't be returning to our facility and maybe not even back to life as apparently kidney function has continued to decline and critical electrolyte levels on the rise. I was upset and me being me I cried when I got home, I felt frustrated and took it personally that everything was out of whack although I know the chain of events wasn't all under my care. I have to find the balance of distancing myself with patient's care or I'm afraid I will burn out.

Shawn and I had our first mutual patient. Canine dog bite - he scooped 'em up and I took care of the patient the next morning at "the facility". Cool.

What's in a name?

Apparently my new nickname amongst my patient population (or code name if you will) is "peas and carrots". If you can name the movie it came from - gold star to you, I think it's much better than Bunny Ranch - the title a former PA held.

The firing has begun or to be more PC the " we're are hiring someone else to do your job and there's not another job opening for you" needless to say the last week has been tough, especially after the article in the Columbian last week that (and I am paraphrasing here, but same gist) ... we (clark county) weren't happy with the current company and they cost too much money for their services, there were also 10 custody officer jobs on the line, so we went with a company that came in $700,000 less that will replace RNs with CNAs to save costs and all ten officer jobs and the 100 beds were saved. Didn't sit to well with the nursing staff considering the new company told them they weren't cutting any ones job. So now it's anyone's guess to see who stays and who goes, although I've heard I am safe, our health service administrator was informed she won't be staying as of today. I'm very grateful to have a job, hope it's all true, I love what I am doing and I really enjoy the people I work with and the patients - it's never a dull moment (well sometimes reviewing 40+ charts daily gets a little monotonous).

The name of the new company is catchy... Conmed. Maybe us PAs can open our own outpatient clinic for followup care called Ex-con med? Just a thought.

And that's all I've got to say about that.

Welcome 2010!

It's already 2010! YAY! Not that 2009 was bad, because it was really pretty great with lots of new beginnings, a few endings and as always some great Zupfer adventures. We're excited to see what 2010 brings. There are lots of things to look forward to like Cubs vs Seattle in June, family visiting us, us visiting family, learning if Jenni keeps her job with the new company but the top three things on our list to do: find a house to move out of our apartment, car for Jenni and expanding our family by way of a two-legged addition (we're finding we may have to try harder than those who can look at the opposite sex and succeed). So happy New Year everyone wishing you peace, joy and happiness each and everyday of the year!