Tuesday, July 25, 2017

choices...

 family photo by SH.  thanks...these are out at Reflections Lake.  still more leash training required.  hopefully next summer we will be excellent on leash.
 the pups are doing better and better off leash.  we have been working on having them "hold up" when they are moving out waiting for me to throw ball.  they stop at that.  then i request a "sit" from both and then i throw....or sometimes i make them "stay" and /or "come".  it's a work in progress but they are smart pups.
 just hit the dog park again today since it seemed like the best thing.  knee seems to be feeling much better than that first day. i have worn a brace both days and taking ibuprofen or aleve.  so far the longer i walk with the brace on the easier walking becomes.  so hoping this proves this was a healable soft tissue injury.
 interesting news...a UK child, Charlie will be removed from life support apparently.  he has a genetic disease that has no known cure.  there supposedly are some experimental treatments from one Dr in US.  that Dr can't really give as much hope as i think everyone was led to believe.
 death in these cases, especially with children is extremely difficult for families and societies to accept.  at some point we do need to be rational and kind.  we need to allow doctors to help us know when carrying on would be futile.  it is odd to me that the same people who at this time are fine denying medical care to so many feel that society should pay any amount of money to keep these children's bodies alive no matter how futile it becomes.  no matter what pain they may endure, no matter how poor the quality of life may turn out to be.
 i work with death, i work with children, therefor i work with death in children.  thankfully, i have not become too involved with cases like this and so far our unit hasn't had cases to this degree where parents absolutely refuse to accept the outcome as being dire. I'm saying to the point of taking the case to court to prevent removal of treatment. i think that in general people do not wish for their loved ones to be kept alive indefinitely.  i do recall one case that went on for over a month I'd guess before family agreed.
 when i first started as a nurse it seems like these were decisions made by the Doctors and accepted by the families.  now things have changed and it is now decisions seemingly made by the families and then guided by Dr's and Palliative care specialists and sometimes eventually risk management and others who must be called in to intervene.
 there can be good and bad in both scenario's.  i think involving family can be helpful in that you can help them cope with the loss. on the down side, there is quite a bit of that as well.  as gross as it sounds...it costs a great deal of money each day this decision is not made.  that is just a reality. i hear from people on the right that we do not have an endless supply of money to care for peoples health needs in the US, but as i said these same people would spend millions keeping children like this alive indefinitely on life support.
 most parents/patients are not medically trained and they are also in an emotionally fragile state.  maybe not the best place or the best ones to be making these decisions.  while parents may know best in many circumstances they may also be unable to separate their pain and anguish over the loss from the reality of the situation.  now we have courts and media involvement which just complicates things more and people who have really no clue about the case start weighing in.  the trolls are loose in our nation and around the world.  so many who believe they know better than all the Dr's who have actually laid eyes and hands on the patient.  they believe they know better than the people who have performed the tests and analyzed the exams.  it is just so odd.
 each case does need to be looked at individually.  in the end, i wish that we were better able to accept that death is a part of our lives.  i wish we could learn better how to help people accept loss and move through it.  we are not all meant to live to 200 and sadly, children do pass away.  we can do a great deal in medicine but we all want to ignore that the more we do in medicine the more we risk as well.
 we have fragile people in our hospitals, that makes them vulnerable to infections.  then we put all sorts of tubes and wires in them and guess what...sometimes people will get bad infections and even die from the treatment we are giving them.  our nation is now a fault nation.  nobody dies or gets injured unless someone else is at fault.  the word "accident" has become a nonexistent term.  nothing is an accident...someone is always at fault.
 that girl who had complications from a routine tonsillectomy in CA i believe, is still being kept alive by artificial means due to multiple court battles.  they say she is now moving her feet to commands.  hard to tell what is true there.  sometime there will be some random spontaneous tics.  there she lays a few years at least after the fact....really at this point she is some sort of experiment and will never be the child they brought in for surgery.  maybe she will prove that some level of life can exist even with brain death...even if she can move her toes we as a society need to really decide if we want to keep everyone thought to be brain dead on life support indefinitely?  can we even afford to do that?  insurance companies are not keen on paying out claims as it is.. there is no way they will want to pay to keep brain dead people on life support indefinitely.
 the right can donate money for these extreme cases now but will they be willing and able to donate money to keep every brain dead person on life support?  if we decide to stop accepting brain death as actual death than you will have to just accept the death of all those who now benefit from organ donations from brain dead patients.  so we become a society that watches one child die from heart disease because we refuse to accept the death of another that has been diagnosed with brain death.
 it's all a bit depressing.  where will medicine be in another 20 years. I've been a nurse for 24 years i think it is.  people really need to think this all through.
 loved the shooting stars by the dandelions.
 a wild rose below.
 30 days....one of the talks i was listening to on the podcast.  he was saying how he just decides to do this or that for 30 days or a month i guess.  often whatever it is becomes a habit or other times the guy said, forget it.  so he's done all sorts of things for 30 days.  he tried meditation but he said anyway he's attempted meditation has not really gone well for him.
 big vote tomorrow about health care.   make phone calls, but it's out of my control.
 these are from a day trip to Seward a few weeks back.
 pups at Lowell Point.
 today i got some weeding done in the back yard.  not sure anyone can tell.  i put some raspberry plants out front but forgot to put a sign on them.  thought maybe someone would want them.  no raspberries on them yet...the berries will be popping out pretty soon though.
 spoke to a contractor about the kitchen.  will be quite the project but it will be good for the place.  lots of pre-planning before any cabinets get ripped out.
 yesterday we chilled with the danes and mastiffs at the dog park.  today, walked part way with another friend.  it is funny. there are people at that dog park and on other trails that i met soon after i arrived in Anchorage.  I've been in Anchorage since 2001 so I've known these people over 16 years.
 the guy today is on his second lab since I've met him.  his second lab is now getting old.  we've all known each other through various dogs.
 dog people are my kind of people.
 i really need to do some paper shredding.  clutter is such a bother.  cleaned out one closet, will have to tackle more clean out projects. my office for sure needs some decluttering.  when i gut the kitchen i will have to clear the crap out of all the cabinets and do the keep/trash/donate thing.
 happy pups on the beach. they really do love it.
 have wanted to not go too crazy with my knee since I'm back to work tomorrow night. i think it will all be OK though.
 finished watching the "switched at birth".  guess that is all they wrote of that show.  it was actually kind of annoying.  just an amazing amount of drama.  i mean who has that much drama...most of it self induced drama.
 then they all lie...all the time!!  of course, none of them can keep secrets either so their lies always became known...and more drama.  thankfully, there wasn't that much drama in my family growing up.  we had our spats but we were pretty dull...i really doubt a reality tv show of the palfreyman clan would have been that much fun to watch.
 i did enjoy watching all the ASL (American Sign Language).  pretty cool.  put an ASL dictionary on my ipad. figured i could try and learn a sign a day for my first month...so August i will try to learn a sign a day.
 always was interested in learning it. not sure why.  can't remember ever being around people who sign unless they were patients.
 it's a whole other world....so that show was interesting that way.  it took me into that world a bit.  i know it's just a show so maybe their signing was pretty terrible, who knows.

 Tusker gets the ball.
 love them in their life vests.  doubt it will last too long.  they are already getting more confident in their swimming skills.
 did some hose time again these past few days...they love that hose time.  it cracks me up to watch them flying through the air chasing the water.  they are amazing jumpers!!
 i thought these next three shots looked so baywatch!!  that is my girl.

 she looks so cool in the waves.
 orange ball and orange life vest really works for her and for photo ops.
 these guys love to shake...and their coats hold a lot of water.
 was brushing them today.  Ivy Rose is for sure a shedder.  Tusker is more like Blossom and sheds very little.
 Tuskers Bay Watch shot.
 back in the water.
 we got lucky this day and seemed to miss the rain.  we hit the beach twice that day.
 trouble coming out of the water.
 these faces on Ivy Rose as she was shaking off the water cracked me up.
 what a look.  haha.
grateful for:  A.  decreasing pain B.  back yard play time, so fun  c.  ice cream on hot days.