time for more root beer!!

 local eating establishment bear tooth and moose's tooth have now opened a brewry...broken tooth. today after i walked down on the beach refuge of anchorage i stopped by mooses tooth for some tasty pineapple and tomato pizza and a jug of broken tooth homemade rootbeer.  i survived my three nights of work and deserved a treat!  i also bought a ceasars salad.
there were a few moose out at the refuge.  this one was resting off trail when i walked out the trail and was up grazing upon my return.  rio could smell the moose but was sniffing off in the wrong direction.  no incidences though you can see our presence was noted.

 just took some more ibuprofen.  not sure working three nights helped much but i got through it.  the area on my thigh had become more and more angry and red, swollen, hot.  i called the doctors office friday morning when i got off work and at 10 am my doctor called me back.  after working all night i'm sure i was less than coherent, but i do remember something about calling when i woke up and coming by to have my leg checked.
i think he found it concerning as well.  the area of swelling and redness/pain is at least 5 inches in diameter.  there is area's above and below that are raised and have whitish borders.  of course, bruising, but i expected that.
he says he has never had anyone have an infection post this procedure, but he ordered me antibiotics just to be sure.  it could also be a repeat of the thrombophlebitis that i had this summer on my calf but now on my thigh.  overall i'm moving better, have taken ibuprofen with less frequency and the redness is slightly improved..though i'm feeling it right now.  fingers crossed that this will just keep improving.

 i knew i'd better get to the doctor friday as with a medical background you begin to imagine the worst for yourself and if i hadn't stopped by i'm sure that by tomorrow i would have been sure i had a pulmonary emboli and any other horrible thing my little brain could come up with.
the doctor did seem to look at my thigh with concern and then returned to my room with a marking pen to mark the area.

 work went fine.  was slated to do peat all week.  i made it through one night. i think i had 4-5 phone calls.  rounded a few times. i'm starting to decide it seems silly to pay someone 40-50/hr just to answer a few phone calls.  we do have a critical care nurse in the e icu and it seems like it would make more sense for that nurse to field these calls.  they could purchase a roving camera like they now have in the cviu and put one on each unit so they could just camera in to the e icu..then they even have a doctor there to  step in and make decisions.the night peat nurse could then be free to assist with breaks and procedures and such.  i'm thinking one nurse on days to do computer diving and check in on new admits from er and acc would be sufficient.  seems more cost effective to me, but then i've generally found not many people are interested in making things run better in this world.  tried to make the best of it by kicking my leg up every chance i got.   those rounds took some time. one false code alarm got me scurrying though not as fast as usual.  turned out the patient thought he was turning up the heat in his room  when he pushed the code buttom.  oops!

 did get the chance to pass along a charting thing i'd noticed from the week before.  general education...very basic.  the heart rate on the vital signs had been left blank for the day with a note, "unable to obtain".  thankfully, the dude wasn't indeed dead, but i thought some teaching was in order...that really could look bad.  can't really chart dude had no pulse all day and that not be a problem.  dude did have a blood pressure and was breathing so i wasn't to worried, but it was kinda funny.

 the next two nights i again was pulled from peat.  this time to go to peds icu.  friday at about 11pm and then the entire shift last night.  i was again happy to be out of that role so clearly it's not really my cup of tea.  i can do it, but i just don't really feel that i'm helping anyone and i prefer to be able to feel like i make a difference. can't do that very well sitting at some desk pouring through charts.  the adult icu isn't too busy so the first night they were able to call in someone to take patients and a nurse took over my peat while i headed up to peds.  eventually she was pulled off peat for an in house code...that was really supposed to be a no code i guess, but often families change their minds at the last minute.  the bottom line, imho, is they need to hire more people dedicated to taking peat.  i noted that the current peat schedule shows each of the night shift staff taking at least one week off a month for the next many months.
i honestly just don't think it's fair to have the float staff, and only float staff that can float to the icu's pre-scheduled for peat for over 10 days/month. perhaps that is becoming more clear as i've only worked one full night in peat out of 4 i've been scheduled.  personally, i think patient care comes first and someone else can answer that phone.  i think nurses could use a roving in house resource at nights, but perhaps it just needs to be set up different.

 did talk to my supervisor the one morning i was there and let her know that peat was not really doing it for me.  i'll try to keep an open mind, but like i said, i just don't think the role is helping in the big picture....at least not as long as there aren't float staff to cover hospital float staff needs.  those should come first before a desk job to answer phones.  simply because the patients should be taken care of first.

 peds icu was busy. i asked for a change of assignments for last night.  happy i did. it worked out best anyway.  the girl they had assigned to the really sick patient i had last night was another float nurse that they seemed to assume works in the adult icu...i've never seen her there and no...she isn't comfortable with vents...she got one anyway.  it was a stable one though.  she would have been in way over her head with the vent and all the drips and stuff i had.
i actually asked for a change because the family in one of the patients rooms i had the night before used all sorts of aroma and herbal therapy in the room and i had started having a hell of a time  breathing and coughing my arse off.  luckily i had my inhalers on me.  my respiratory tract was still giving me fits as i attempted to sleep the next day.  had to get out of bed and use my inhalers again.  i've never had that happen before.  we're supposed to be a scent free hospital, but family centered care complete with fish oil remedies trumps everything i guess.  i wore a mask in that room the rest of the night just so i could breath and not go into coughing spasms.

 saturday i just slept and rested.  no walk.  friday i did manage to get the dogs out to the par course across from the carrs, but between dealing with a few perscription pick up/drop offs and getting to the doctor between shifts there wasn't much sleep.

 it did feel great to shower friday and sleep ted hose free!!  for the next two weeks i still have to wear the full teds while i'm out and about but i can sleep free!!

 i walked out to this point where there were some open mud flats starting to open up under the snow and i could hear water.  best not to chance it beyond this point. seemed to be the spot where everyone else was flipping around and heading back as well.

 sleeping lady in the background

 a few skiers on the beach.

 had a bit of a psychic moment last night.  i think tiffany was a bit freaked out.  i swear i heard someone say, "is betsy available to talk?".  so i popped out of my room to see who needed to speak to me.  well, this had been said but on the phone to tiffany.  the people right by her hadn't heard that end of the conversation so not sure how it came to me.
i also saw my patient reach towards his face on several occasions out of the corner of my eye and also sit up...not possible as my patient was on a drip of medications that causes paralysis.  i took it as a good sign that he will recover fine.

 i have had a few of these sorts of incidences.  i think most you just push out of your head.  a few larger ones i remember pretty clearly.  i knew my mother was going to pass before her surprise party.  i remember getting off the phone with her one day and it just was clear to me that she didn't have much time left.  as i drove to work that night i said a prayer....i do that when i drive to work.  on this day i remember saying in my prayer that though i wanted to see my mother again, i didn't want her to suffer and that if she was suffering i asked god to not keep her on this earth for my own selfish desire to see her once more.  the next week she was gone.

 the day my father passed away i  woke from a deep sleep with an overwhelming sensation that a code was happening or going to happen.  that i needed to prepare was what i thought.  i assumed that i would be running a code at work that night and i even got out of bed, got out some books with algorhythms on how to run various code scenarios.  it wasn't long before my brother tom called me to say my father had coded at home and was gone.
i think we all have those feelings that run through us, perhaps there are times or situations where some of us are just more attuned to them than others.  i know i often feel my way through a night at work more than think my way through.  maybe the patient is sending you cues and you are just open to receiving them.  there is a lot of training to medicine, but there is also a great deal of instinct to it.  i've worked with very sick people and animals for so long i can sense something is going to happen often before i can see changes on the monitor, or the lab work and what not.

 was out at campbell airstrip the day i started back to work.  the groomers were coming through.  always fun to be the first ones to stomp on the fresh groomed snow.  looked like good skiing out there.  not this week for me.  may be able to get a last ski in next week if this leg is feeling better.  not my best year for skiing.  will have to make a better effort next year.  need to get back to the swim and bike in the summer and swim and ski next winter.  get a few pounds off and trim up.  don't like having arm flab...i look in the mirror and wonder who's old ladies arms are on my body.

 blossom will tromp  it all up long before i will.

 i'd heard of ted talks before so i finally started watching a few after my friend anita mentioned it to me again at dinner last week.  it can be a bit addicting.  some are soso, but you can just turn them off.  i like that they are short lectures on all sorts of subjects.  some just tell stories of others lives, escapes from unsafe governments.  today one lady who was a brain scientist tells her story of having a stroke.  she was pretty funny in describing the going through stroke.  she was saying part of her brain was in lala land and then the other side would try to kick in and be telling her she needed to get help, then lala brain would come back.  took surgery and years to recover but she has.

 dang...just realized it's trash day tomorrow and recycling day as well.  i'll have to get that done before i hit the sack.

 anyway.  i think my favorite ted talk so far was by ken robinson.  he was talking about education and how it stifles our creative sides. he says that education became a means to fill jobs, part of industrialization.  so those subjects deemed useful for getting jobs are put to the top and the arts are brushed off as hobbies and not generally useful for career paths.

 it was just really interesting, he made some excellent points. we are trained that to make mistakes is bad.  in the begining kids aren't afraid to be wrong.  loved his quote..."if you never allow yourself to be wrong you never come up with anything original".  but we teach creativity out of kids.  it's true and sad.

 in the old days he says, we hadn't invented adhd yet.  kids were just hyper.  he told a story of a girl who couldn't keep her attention in class and was often in trouble.  in a family meeting a wise education left the kid in one room and turned on music and took the parents out to speak to them seperately.  the girl began to dance.  he instructed the parents that she wasn't learning disabled, she just loved to dance.  he encouraged them to enroll her in a school of arts. she thrived and became a famous ballerina and then went on to have prominent career in the theater.  the talks are funny, informative and thought provoking.  they come in every sort of topic.  if you haven't ever checked out tedtalks check it out.

 blossom on the trail.  she got her tennis ball time in.  now i get to organize my garbage. i always forget it's sunday.

 low tide was at 5 and it was pretty low.  looks like the tide hasn't really been up that high for a bit.  the waters edge changes all the time.  it won't be long til i can't make it out here til next freeze.  it becomes a big marshy mess.

 bubbling up from the mud.  always love bubbles.

 incoming tennis ball.

 i think rio had a good day out there.  sniffing stuff.

 my moose's tooth pictures loaded sideways, with no way to correct them that i've been able to find. hmm.

 the new logo for their new brewery.  kinda cool.

 these last pictures were taken from by bedroom window at like 1 am.  i'm like a kid when these snowplows come through. i always love watching them.  kept hoping they'd come during the day and i'd head out and get some cool  black and whites.  no such luck yet.  perhaps next winter i will get my chance.  this machine just moves the snow off the main part of road and amazingly tries not to make your driveway impossible to get out of.

 some came out kinda decent considering it's night time, it's snowing and i'm shooting through a window.

 there is another big truck that comes through and picks up snow that is shoved to center and then is followed  by yet another series of trucks that it dumps snow into and those trucks scurry back and forth to the snow dump area's to await melt.

 the snow dump area's become mountains of snow complete with snow roads to get to the top for further dumping.

 yes, this is how i pass my time.

well trash and then teds off.   freedom!!  it is nice to be showering again.  back to work on tuesday.  not much of a break but i'll take it.