some days you are powerless...

 you don't always know why people are the way they are....was it bad luck, poor decisions, some combination of all.  compassion doesn't ask the questions, it just takes care of the patient.  my patient the other morning suddenly was unable to breath effectively.  it happens and then a breathing tube is placed and you just move forward, no big deal.  occasionally though, you know that putting that breathing tube in is not going to be a quick fix, you know it's not what that patient really wants...

 but you are bound by the parameters that have been set up to do what you know in your heart is not in the best interest or desire of the patient. when you are debilitated you may have to hope the judgement of others follows what you would wish to have happen. sometimes families aren't in the same emotional place the patient is.

 maybe when you are near death you just know and can be more accepting than those who are not near death.  they want to "fix" your death problem.  sometimes the kindest and most compassionate thing is to let the powers that be in the heavens, or whatever divine or not divine entity you believe in, take action... let nature take it's course finally.

 it saddened me greatly but it was our only choice, really.  when the word "trach" came up the next night when i was in the room with the patient, that patient violently shook "no".  Hopefully, the DR's and palliative care can help the family members make kind choices.

 i'm more and more convinced that when folks get to those pearly gates they may be asked why they insisted on making family members suffer rather than allow a gentle death to take them.  we don't even realize we are being selfish in these moments but i really think these are moments where we are supposed to choose compassion for our loved ones in certain situations, that is the life lesson that is supposed to be learned with many of these modern ethical conundrums.  were we thinking of ourselves or were we thinking of our loved ones?

 so a sad morning for me knowing that we were prolonging a life and no doubt going against the will of the patient.  suffering extended...

 felt a bit relieved when the next night part way through the shift i was shifted down to the ER.  will think of this unfortunate patient many times over the next weeks and hope that it all works out for the patient.

 in the end, medicine can only keep death from happening for so long, eventually a body can only take so much before a heart stops beating and no amount of compressions, shocks or drugs will reverse it.

 ER was steady and a nice break.  again compassion doesn't take into account the stories of the past, compassion just takes care of the case/situation at hand. a jail patient thanked me for being kind.  i told him that to me the injury is all i see.  you are your disease to me.  i think i probably have learned to keep some distance emotionally from many things.  only allowing myself to walk that line.  it's better to not always know all the details of why in others lives.  it's easy in this work to get jaded and judgemental.  to fight it you really need to treat each patient with the same level of care and kindness.

 i do ask questions, i know people lie or are in their own denial. i'm not asking these personal questions to catch people in a lie or to get them in trouble with the law. i simply ask the questions so that we can get a better picture of the medical situation. if you are a drug addict or an alcoholic it helps us to know.  there are diseases and infections and such that can be directly related or your situation can be greatly worsened by you going through withdrawls.

 in my opinion, who cares really if you lie...if we really need to know we will send a bit of that urine off to the lab. we just ask for a urine sample....we generally know.  we aren't shocked by results.  you work in medicine ... you are aware that all sorts of people drink alcohol with great and damaging regularity.  that all sorts of folks smoke and are often willing to risk their lives to sneak out and light up.  we know what all those marks are on your body, they are needle marks.  still i ask.  easier if people are just honest and you'd be surprised how many are.

 of course, some are just not aware really, of the extent of their issues with drugs or alcohol.

 had one jolly patient awhile back...that guy was drunk, and very happy and flirtatious.  i had to watch those hands at all times.  it was funny though, i was asking  this patient standard questions we ask...how often do you drink.  his family was behind him laughing and silently refuting all of the guys responses.  the patients couple of beers a day was quite the underestimate.  we know that too in medicine.

 woke a bit early today in order to get my schedule put in the computer.  will have to look at it again tomorrow and make sure i didn't mess it up in my sleepy state.

 was a bit sleepy the rest of the day.  did get errands and stuff done so i was really happy with that.

 took the dogs to the dunes.  Blossom loves the dunes and she got to chase her tennis ball about so she was happy.

 of course, every time i'm out on the dunes it occurs to me that if there was one of those big Alaskan quakes those lovely dunes would open right up and swallow us all up, never to be found again.

 i go anyway.

 my friend, GT, gave me this totally cool walrus art piece so i finally got it in to be framed.  i have a few more pieces to get framed so i was happy to get this one in. will be a few weeks.

 wearing those hose at work and well, everywhere, is annoying.  i can tell a difference but add an occasionally hot flash and you really just  want to rip those suckers off.

 cute goats on the seward highway.

 we finally pinned down a time for the board to get together....:-)  we are due for a meeting and it will be good to brainstorm a bit and see what we can come up with to help get Round Island funded and staffed. at least i feel like the current fish and game people are more open to options, still wish they were offering up partial funding rather than hoping some other group just comes in with all the money.

 loved all the big pancake ice out on the water....so cool to watch.

 trash, litter boxes, dog poop pick up...that is what sundays often become.

 my bruises are starting to fade a bit.  takes a bit of time to know how well this procedure worked for my veins.  for the moment, it does feel better though.  so i'm hopeful.

 the knee is also improving.  i've been doing isolated exercises.  even when i'm standing or sitting i try to just tighten those little muscles.  i think it's helping.  i feel like i failed my final exam at PT and i'll need to call and make another appointment and hope that it will be the final that i pass.

 massage again tomorrow evening.  will have her work the knee but avoid the calf and thigh i think.

 such cuties..

 look at all that ice out there.

 warm out today.  a bit breeze at the dunes but overall warm by Alaska standards.  still wish we'd get more snow.  my brother lives in Boston and they have been buried in snow this winter....looks nuts!!such strange weather across the nation it seems.

 California has super low water supplies and back east has more snow than they can handle. here the Iditarod is being re-routed to avoid the trail disasters of last years low snow year.

 it's Presidents day tomorrow.  not sure if anyone will be showing up to the Monday walks.  this year has been kind of hit and miss.  hopefully, next year will be better...if not, well all good things come to an end.  the coffee has been a bigger hit this year.  it is good, that meeting with friends each week.

 i've been out a lot so that has made the difference.  if i don't walk, it seems like in general nobody does.

 i am seeing that it is 1:30 am at this point.  i really should crash for the night.  enjoy the shots of the sea ice.  i always think it's pretty amazing

 took the dogs to petco and they got to visit with the hoards of weekend shoppers.  they love all the love.  still worried about Rio's increased urine output/drinking. will call in the morning, not sure if Presidents day is a vet clinic holiday...i suspect not.

 sunlight on the water between ice

 back to Portage.

 and then more ice on the arm.

 overall a good week at work.  it's great to be in a job where the 12 hours you work can really have a positive impact.  doubt i'm the smartest nurse out there, but i think i do my job well and i do it with compassion, kindness and some laughter tossed in as well.

 my model walk is improving...nearly back to my baseline.

 watch out American's Next Top Model, over 50 version...Betsy is in training....haha.

 leaving you with the beautiful hues of sunset

 thankful fors....A.  a lack of debilitating chronic medical issues... B.  that i've become less jaded and judgemental over the years not more so C.  the sweetest fur family a girl can ask for.