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.