Monday, January 6, 2014

warm and sunny in Ak compared to lower 48!!

 blossom, rio and i are not complaining.  we are quite fond of 30 degree weather. perfect temperature!! blew off my alarm apparently, but did get out of the house in time to hit the coastal refuge off of reef ave i think it is.  the sledding hill was hopping as we arrived.  should have just made a few runs myself...that sledding is a blast!!  did mange to run a few errands so that was good too.
 rio opted in.  i'm starting to believe she is quite happy walking anytime the temperature is over 30 degrees'.  wasn't sure this morning as she has been staying on her dog bed in the am and expecting her breakfast delivered.  is she not feeling well or have i been trained.  hard to tell. she also tried to get up and went skidding on the laminate...hmm.  she did fine out walking.  still wonder some days if she isn't getting some dementia or deafness.
 as you can see it was worth the drive and walk as it was a beautiful sunset this evening.  always so funny to me that at 3 in the afternoon the moon is way up in the sky and the sun almost gone.
 blossom, oblivious to the beauty of nature as always.  tennis ball, tennis ball!!
 3 days work behind me.  goes pretty fast.  worked the first two nights in the adult icu and the last in the ccu.  one of my patients from adult icu moved over with me so that was nice to know one of them.  it was a rough week in the icu, my assignments weren't bad just a lot of sadness, codes, deaths.  it comes with working in the icu's.  when you are a patient in an icu you only have two options, you get better or you don't.  i see quite a lot of death.
 of course, the subject of that brain dead girl came up.  i have some takers for joining forces on my make believe hospital for the dead.  in the wee hours the conversations can sometimes take a turn.  i know at one point we referred to those late hours and the conversations that seemed to turn up as the "sex and secretion" hour.  i also added "guns and gore" as that seems to be a theme at times as well.  if you have spent any time having discussions with anyone medical about what they actually do you will discover that they all have great stories if you can stomach them.
 we can be in appropriate and politically incorrect.  it's what we do to cope with the stuff that we deal with day in and day out.  these things just don't happen to people who work in regular offices.  it keeps life interesting, but i'm sure we all can come across as irreverent and horrible.  try not to judge us, we still manage to put that crass attitude aside and give our patients our full attention and compassion for the most part.  i feel i have  grown in my feelings of empathy over the years.
 anyway, in our discussion about this hospital we are imaginarily creating it was decided that perhaps we should just transform a cruise ship into a floating hospital.  we could then travel the world.  we would then be free of any restrictions.  since the patients would all be dead on ventilators care is minimal, no narcotics required (when you have no brain function you have no pain or anxiety).  we figured we could then offer burials at sea for ease of families when the hearts finally do give out.  of course, we'd have a plan in place in case payment was late.  5 days late on payment, then we remove the ventilator. signed and understood. we got even more irreverent but i will withhold that information to protect the innocent and misunderstood.  
 i do hope that this family can come to terms with this loss and that this doesn't continue but it's not looking that way.  it seems there are always those who are willing to come to the aid of people like this.  some who are trying to win landmark cases and make a ton of money, some who just don't understand what it means to be brain dead and others who probably mean well, but are not being helpful in the big picture.
 it could very well be that another definition of death is evolving.  there are always fine lines and we are all seeming to try and push these definitions of life and death.  it could be that soon brain death won't be accepted and that we will be required to breath for people who are no longer considered dead when their brains aren't functioning. that they will have to stay on machines until their hearts stop beating no matter what.  i have always found the ethical and moral issues fascinating.  in the end i guess there are no clear cut boundaries in some peoples minds.  time and court cases will tell.
 i believe the brain death definitions, derived  from physicians and the legal field, came about as  a way to be able to define death so that organ donations could occur without families being concerned that the medical field was harvesting organs from live people.
 brain death does seem pretty clear to me, but i'm in the medical field. to an outsider these things all seem pretty murky no doubt .
 on a lighter note as i walked rovers run the other day before starting my work run i was battling out the bike ruts.  i'm not anti biker but i did find it tough to just walk with all those single track ruts. either i was walking peg legged, or i was walking with my legs wider apart than my normal gait or another thing was that i'd find myself trying to walk in the rut with both feet which was also uncomfortable.  guess i haven't really noticed it before.  i know one friend who uses the trails a lot to ski has complained about the increased bikes and how they trash the trails for cross country skiing.
 bought a new pair of snow pants at the sports authority today.  was wanting just a black pair so that i don't always have to look funky in fun ski pants if i run errands after or meet someone right after a walk in the snow.  it is amazing how many snow clothes you seem to find yourself needing when you are outside all the time.  there is a total difference in temperatures in the -20's or the +20's and in between.  you really have to be prepared for all the variables in order to keep warm.
 i also bought a new gym bag, they were on sale and i want to be able to put clothes in there for lifting weights and for swimming . i really want to increase my game and get a more complete workout and a better, healthier body.
 then of course, a trip to pet co for the dogs.  they love to go sniffing.  they really don't care if i purchase anything obviously, but they love to get a good sniff of all the options out there.
 gotta get planning on this kayak trip for this summer.  it is over packed with just my regular people.  i know there are others who are hoping, but right now it doesn't look like i can add anyone else.  i wanted to be able to have a few ketchikan friends join so that decreases the numbers for other folks to join.  will have to speak to the guides and see what options we have.  also have to decide how many days we want to do.  i'm starting to think maybe a 4 day, 3 night will be enough.  then i can chill extra days in ketchikan and do some hiking around my old trails.  very excited to see the progress the trails committee has made.
 some great boardwalk trails out there.  the scenery is amazing down there, i do miss life in Ketchikan some days.  there are a lot of perks to living in the bigger city though.  the biggest being the cost of living is better which allows me the option to travel around other parts of alaska more.
 the sky is on fire, right?
 just a few shots from my day on rovers run the other day.
 then in between shifts i did get that tree over to the recycling center.  i took quintons advice and bungee corded it to the sled.  man was that!!  what a difference.  it was a lovely walk over to carrs and back.
 here i am walking with the dogs and the tree.  we did get a load of smiles and funny looks from the people in the cars that passed by.
 view today from my window that kick started me to get to the coastal refuge for the sunset.  it was going to be sweet...i could tell.
 one from the drive over
 at the top of the sledding hill...very crowded from what i usually have seen there. had to park a ways away and walk down to the park...that never happens.
 should be able to see the moon way up in the sky in a few of these.
 laundry, trash, bills, recycling..for me a busy afternoon.  was thinking of trying to cook but i'm seeing that it's a wee bit late.  bummer.  can i get up early and cook  was going to do a pink theme for tomorrow but don't see that happening.  haha.  should be another nice day out there for a monday walk. it 's been colder in the lower 48 from the facebook reports i've seen.
 my co-worker was getting report forever from a nurse with a patient in the village.  when she finally got off the phone i asked her if they were now facebook friends?  been nice working with a variety of folks and getting to know more people.  lots of nice people scattered all over the hospital.
 haven't even read the sunday paper yet....i started to but quickly dropped off to sleep.  i'm a wimp in the morning.
 my grumpy patient was made happy and then said to me that i was "the best".  he wanted to smoke.  i advised against it, was pretty blunt with him about it all but in the end patients are not prisoners.  we generally do not hold them against their will.  at least not when they are able to ambulate and not gorked on drugs and restrained to beds.  happy i  never took up that nasty habit.
 have never tried pot either.  never got into any of those types of things.  i think in many ways it took me quite a few years to settle in on what i believed and didn't believe and by then you are kinda too old to do silly things like smoke pot.  colorado just legalized it so it will be interesting to see how that goes there.  i will say i have never had patients admitted purely for issues related to pot use.  alcohol...yes...all the time, pot, never.  they may have incidently used pot but it never seems to be the cause of their medical emergency.
 proof that rio was out there walking.  she is often impossible to photograph.  she wants to be right on me and is worried she'll be left behind so if i take her off leash and try to get enough distance to take a photo she is immediately walking towards me.
 a little alpenglow on the mountains
 the trail at 3-3:30 moon way up high on the left, sun almost down on the right.
 and back to the sledding hill..much less busy when i returned.  very few cars left.
 the dogs settle in after their supper in front of the fire.  so relaxing.
i have rambled another hour of my life away.  haha.  be healthy and stay safe!!

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