Boom de ah da......

Okay, so maybe I forgot to grow up. I did, but I didn't. I really have grown up. And old, too. But those things I loved as a child still amuse me. And today, I'm thinking about camp.

Maybe it's because of my trip to the mountains last weekend. I drove past the road that leads to the camp I attended when I was young. And I sang about a zillion camp songs, as I drove along, too. It made me smile.

Or maybe it's because my granddaughter is coming to visit this weekend. We just like to spend time together but, this weekend, we have a purpose. A goal. We are going shopping. And not just shopping shopping.....we're going shopping for camp!

She will be spending her very first week away at camp later this month. A friend of hers asked her to go, and my daughter gave her the green light to go. Of course, the first thing I thought of was shopping......

There are certain things she must take to camp with her, and we have “THE LIST” from the camp. There are the usual things: jeans, tennis shoes, a jacket, jammies and a sleeping bag. We will find those things for her, and the “other” stuff, too.

In order to go to camp, you have to have a cool flashlight. Not just a flashlight; it has to be cool, too. I am not sure what she will think is “cool” but we will find it, I'm sure. And I know won't be black, or brown, or army green, either.

You also have to have a magazine. Something to read, zipped up in your sleeping bag, after “lights out”......and I don't know what magazine that will be, either. Maybe a paperback book would do....

And, something that lots of campers forget to take: a plain white sweatshirt. And marking pens. What better way to remember your friends from camp than to have them write their names and a note on your sweatshirt?

I had one. I had a crush on one of the camp counselors, so I wrote “I Like Mike” on the back. Then, all my friends wanted to write on it, too, and so, they did. I forgot all about the sweatshirt after camp, until one day when I went to see my mother.

I was grown, with children of my own, and there in the garden, pulling weeds, was my mother, wearing my “I Like Mike” sweatshirt! How insensitive can a mother be? My beloved sweatshirt, worn to pull weeds in the garden?

Oh well....

Besides getting what she needs to go to camp, I have to talk to my granddaughter about what happens at camp. I want her to know about campfires and 'Smores and ghost stories and singing camp songs. I want her to feel the joy and cherish the moments and make wonderful memories.

Boom de ah da, Boom de ah da, Boom de ah da, BOOM!

Sail Away....

For those of us who are still employed full time in healthcare, it's been a pretty rough ride for the past couple of years. Medicare regulations have changed. Medicare scrutiny has increased. Medicaid reimbursement has diminished.

It's harder and harder to be a nurse, or a physician, or any of the allied healthcare professionals. Day after day, we are bombarded with things we have to do, and day after day, there seem to be fewer of us to do them. We work with less: less equipment, less reimbursement, fewer supplies and fewer staff.

Once in awhile, we find a way to have fun. And fun is very important, especially if you belong to a profession that deals daily with life and death issues.

Yes, this week was the 20th Annual Rubber Ducky Derby at Podunk General.....

Northeast of the hospital, and one street north of Main Street, is a venerable old brick building. Currently, it is a church. In a previous life, it was an antiques' store. In the beginning, it was a planing mill.

Logs were trucked down from the mountains and turned into usable lumber at that planing mill. Underneath the mill, unseen and unheard, is a creek. It is aptly named Mill Creek. It winds southwest from the former planing mill, along Main Street, completely underground.

It surfaces, literally, next to the hospital. There is a length of creek, about fifty feet long, that meanders between buildings belonging to the hospital. On the west side, small decks have been build just off the walkway, so employees can sit and eat lunch, talk, or relax on break, listening to the gentle flow of the creek.

On Tuesday of this week, the Rubber Ducky Derby brought out lots of spectators, participants, and “boat crews.” The rules are rather simple: the boat had to be larger than 5 inches X 5 inches, and smaller than 12 inches X 12 inches. It had to be handmade—created from scratch—and they had to have a minimum of 3 different dimensional parts. (No floating a paper plate down the creek, sorry!)

Department members, and their vessel, had to be at the creek at 0830 for judging in three different categories: The Most Creative; The Best Department Theme; and Best Rubber Ducky Theme. A prize was awarded for the best overall time, too.

I didn't get to go this year: I had patients to see. But I did get to see our vessel. It was an inflatable raft sort of thing, with a piece of Styrofoam in it. Tongue blades (with our individual pictures glued to them) were standing in the Styrofoam....all two dozen, or more, of us! And an American flag waved proudly at the aft, just like any proud American vessel.

No, we didn't win the race. We didn't even win our heat. But that's okay. We had a lot of laughs with it and, from what I heard, there was a very large crowd of employees enjoying the festivities. And, I think we got something better out of it anyway....

You might say it was good for morale. You might think we got a sense of pride in our department. That is all very nice but, we got something even better:

Our vessel was voted The Most Creative.....and we get a pizza party for the whole department!

How cool is that?

Larger Than Life....

No Father's Day barbecue for me today, I'm working. My kids will honor their father today, as they should, and I will go off to work to take care of patients. I will celebrate the day in my own way, thinking about Daddy and carrying him, as always, in my heart.

I swear, that man knew everything. He was well read and well educated. He worked full time and put himself through Columbia University. After graduating, he signed on to sail on a merchant freighter so he could see Europe.

He met my mother when he got back to New York City and got a job. She was a secretary in the same building. They enjoyed their carefree, childless years as a couple for almost five years. Then the war broke out and my daddy wanted to enlist in the Marines. My mother was against it, but he did it anyway, leaving her with an infant and heading off for parts unknown to fight the war.

As a child, I thought we lived an idyllic life. Of course, we probably didn't but I didn't know any better. We weren't particularly rich, but we were happy. Most of the social experiences I had as a child were with my immediate family or with my church family. My daddy, my mother, and my two brothers and I did things together all the time.

Daddy wanted us kids to be exposed to the great classics of literature, so he read to us almost every night, after supper. We would sit, spellbound, as he played all the parts and peppered the stories with his melodramatic readings, at times. Other times, his soothing voice and rhythmic reading nearly lulled me into a gentle sleep.

When I was in high school, he was the one who helped me with my homework. Not only did he know how to do the math, but he had read everything that was ever written (or so I thought). And when I had to pull an all-nighter to finish an assignment for my Contemporary History class, Daddy stayed up with me, and kept me awake and typing!

He was there for me when I was a young mommy, too. And then, when I went to nursing school, he was my chief babysitter, picking my kids up after school and taking them to his office for the rest of his afternoon. The kids loved it and I think he did, too.

He was so sad and lonely after my mother died. I worried about him and went to see him almost every day, just to make sure he was all right. He grieved as he needed to, and then he moved on. He remarried a woman who also loved to travel and they set off to see the world together. I was glad that he found someone, and that he was happy, but I missed our time together.

He was tall and handsome and honest and kind. I thought he would live forever, just because I knew I would always need him. But then, he got ill, a dozen years ago. No longer looking larger than life, he was frail and pale and dying. I was distraught. I wanted him to be okay and he wasn't. Even though I am an RN, I fantasized about his having a complete recovery from the devastation of CHF that put him in the hospital.

But, it was not to be. He got worse and worse, and I could see that the end was coming. When his wife and her family left the hospital room for a few minutes, I bent over Daddy and whispered in his ear: "you can go, if you need to, Daddy, I will be all right."

An hour later, we "pulled the plug" and Daddy drifted off for one last sleep. Though he is gone from my sight, he still dwells in my heart. And furthermore, he is STILL larger than life!

Happy Father's Day, Daddy! I love you.

Of Chickens and Fish....

I have done a lot of thinking today. Thinking and driving, too.

I didn't have that many patients to see today, but they managed to live on the opposite sides of town from each other. It always amazes me to see the differences in the neighborhoods in Podunk. I was in one this morning that was quite affluent.

Mostly, I was in the neighborhood where people live who have immigrated here from other places. This morning, I saw a woman who is Sikh. And a woman who is from the Philippines. Different cultures, different ways of dealing with the economic downturn.

One thing they all had in common, this morning, was that the homes were occupied by extended families. Although all the homes qualified as “single family dwellings,” all were occupied by multigenerational families.

The home in the affluent neighborhood is occupied by four adult men; three brothers and one of their sons. They all contribute to the household expenses and the upkeep. The youngest, who is the son of the youngest of the three brothers, was out front watering the garden when I drove up.

He smiled and greeted me warmly. He has a friendly smile and a mohawk haircut. I have no idea what the purpose is for the mohawk, but he seems to like it....

Out the back slider in this fancy home is the swimming pool. It is filled with bright blue water and a pool sweep that spouts water at erratic intervals. And amuses the chickens. Yes, there are chickens in the backyard, pecking the ground, looking for food.

On the other side of town, in the less affluent neighborhood that is home to people from all over the globe, things were quiet this morning. I was surprised: I only saw one toddler, escaping from his grandmother and running down the driveway toward the street. She caught him before he made it to his objective.

As I was walking back to my car after the first visit, a truck pulled into the driveway across the street. A little dusty black Datsun, with the back full of fishing gear. Yes, I know that Datsun became Nissan many, many years ago, but this truly was a Datsun pickup.

The man got out of the truck's cab and looked in the bed of the pickup, smiling. He pulled out a red and white ice chest and looked into it. And then looked into it again. A woman came out the front door and greeted him with a smile. He motioned for her to look in the ice chest. She did, and then squealed with delight.

He didn't go up to the lake before dawn to enjoy a lazy day of sport fishing. He went to catch supper and, obviously, he did. I quite imagine that the backyard at his house is filled with a vegetable garden, and that something will be picked to compliment the fish he caught.

None of the houses I was in today was particularly well furnished. In fact, they were all rather sparsely furnished. Only the absolute necessities were there, covered in old sheets to protect the upholstery. The televisions were all old, and small. There were no big screen TVs, no surround sound, no DVD players, and no video games.

Life has been reduced to the lowest possible common denominator that will provide the bare necessities for each member of the household. Food growing in the backyard. Chickens pecking at the cool decking surrounding a pool. Nearly thirty-year-old Datsuns driven to the nearest place to fish for supper. Children wearing diapers and little else.

And yet, the neighborhood had a heartbeat. There is a rhythm and a pulse to it. The people there are doing the best they can in a difficult economic situation. They eat what they can find, or catch, or grow. They wear what they have already. They sit on whatever is available, and they take it all in stride.

I suppose many of them came to America with only what they could wear on their back and carry in a carry on bag. All the “treasures” they might have been able to gather in another country are still there, in that country. They have come here to start over. And starting over is hard.

So, the other thing that amazes me is their smiles. They all smiled, all the time, while I was visiting. And sharing. As hard as it is for them to put food on their own tables, they didn't hesitate to offer me food while I was there.

And, at the end of the day, after hunting and gathering and sharing it with their extended family, they go to bed happy.

They are in America.....

Heaven is only an hour away...

How close heaven is, sometimes.....

I went to the mountains yesterday to show them to a friend. They're fairly close to Podunk, about an hour away. Sometimes, they are visible to the east, rising above the valley floor. Mostly, they are shrouded in clouds, or more likely, smog.

The traffic wasn't heavy, which was surprising for a beautiful, sunny morning in early June. It was even more surprising when we found out, at the park entrance, that admission was free. In honor of the National Parks' Day celebration, admission to Sequoia/Kings Canyon National Park was free.

I have always enjoyed driving Park to Park, driving up from the southern end, through both parks and then down the northern end. It isn't really the northern end, either. The majority of Kings Canyon National Park is reached by backpacking on trails.

I wasn't expecting it to be so sunny and warm in the mountains. They have been shrouded in clouds all week. But the sun was shining and it was warm. Well, warm enough that the snow was melting at higher elevations and sending little waterfalls down the mountains to meet the water in the lake, behind the dam.

Boats and houseboats dotted the lake as we ascended to the park. One of the boat ramps was closed: it was under water. The hills have turned brown, but there are still wildflowers blooming.

The beauty of driving in the park is the switchbacks. Not only do you get a second chance to see what you have passed, but you can only go about 25 mph. I drove, so my friend could watch the scenery pass by.

Most of the drive was filled with stories. My telling of the stories of my adventures in those very mountains. And songs. I think I sang every camp song I could remember.....

We walked back in to see the General Sherman tree, which is NOT the tallest tree, or the widest tree, or the oldest tree, in the world. It is just the largest. How can that be? It is wider than some of the taller trees, and taller than some of the wider trees. And redwoods don't taper, so they are nearly as wide at the top as they are at the bottom.

That's a lot of tree....

We also saw the Senate and the House Group, and the President Tree. Spent hours on the trails, walking forward and looking UP, at the beauty. There was still snow on the ground, some of it fairly fresh, having fallen earlier this week. An occasional look DOWN was necessary, too.

By the time we had traveled from the southern end to the northern end of the paved road, it was nearly twilight. One last stop, for one last tree: the General Grant Tree. The Nation's Christmas Tree. I have seen it many, many times before but, not like this. Not at sunset.

As the trees stood tall and proud, and darkened by the impending night, the General Grant's canopy of green was highlighted by golden light from the setting sun. It was amazing to see!

Of course, I took a million photos of our adventures, hoping to save, and savor, the memories forever.

There were so many things I wanted to see and do, but there wasn't enough time. Some of the adventures I have planned will have to wait for another visit.

Heaven is only an hour away....

Paper....

Yup, another piece of paper. To fill out. To fret over. To forget. To overwhelm the patient and family. Another tree bites the dust.

Actually, it's been about two months since the new piece of paper was introduced. And, I have to admit that it really serves a purpose. A good purpose.

It's a calendar. A blank calendar printed on a piece of blue paper, both sides. We are supposed to fill it out and give it to the patient when we do the admission process. Why? So the patient and family will know who is coming to visit, and when.

Ideally, the family will contribute to the calendar, too, adding doctor visits and other pertinent information. And the other disciplines, too. Sure, we have a calendar for each patient in our laptops, and we are supposed to schedule all our visits there, but that doesn't help the patient.

And so, we have a blue calendar. I wish I could tell you that I always remember to fill it out, or make necessary changes, but I don't. It's another piece of paper for me to forget.

And that's too bad. It's a good communication tool. And worthy of remembering. Some patients already have calendars that they use to remember their appointments. If they do, we just have them mark our visits on that. No use in duplicating things.

Today, I made a discharge visit to a patient that I have been seeing for almost a month. She is doing quite well and doesn't need nursing services any longer. I did her wound care one last time, and took wound measurements one last time, and was giving instructions to the daughter, via the interpreter, when Junior came in the room.

I am ashamed to admit this, too: I don't even know Junior's name. He is three years old, with dark brown, dancing eyes and a ready smile. Starting with my first visit, he has developed the habit of showing me something each time I visit. It might be a new toy, or a DVD he likes to watch, or, like today, a “Toy Story” inflatable float for the pool. Oh, and his “light saber” too....

As I looked at him, showing me his treasures and telling me all about them in another language, I realized something: I didn't have the calendar. The blue paper. Junior is the one who has taken it off the fridge and brought it to me for every single visit. Except this one.

I guess he read my mind: he stopped talking and ran out of the room. In a couple of seconds, he was back with, you guessed it, the blue paper. And there, on the paper, on today's date, was my name and the word “discharge.”

At three, he can't read yet. He was so happy to have a “job” to do to help me, and I always thanked him profusely for his help. Today, his older sister, my interpreter, told him what it said on the calendar. His smile disappeared.

I finished the wound care, gave the discharge instructions, and prepared to leave. By now, his smile had returned and, as usual, he walked out to my car with me. “Bye!” “Bye, Junior” “Bye!” “Bye, Junior” over and over again, as always. One last wave as I drove off, and I was gone.

Bet I don't forget the blue paper again for a long time....

Adios, Junior!

Questions...

Where are the words I need? How can I express what I am feeling? Do I even need to? Is it not enough that I feel it?

What prompts me to share those feelings and thoughts? Why do I think anyone else would be interested? Or do I write for me? And only me?

Lives lost. Love found. Friends gathering to share time together. Children growing. Me, growing old. All are fodder for my writing.

Patients who are dying. Lives diminished by illness. Bodies ravaged by disease and racked with pain. Heroes who survive it all, one way or another. Such is the form my writing can take.

The glory of a sunset, the exquisite beauty of a flower. The joyous sounds of a summer night. A baby laughing, a child crying, screeching tires and even sobs of joy. All have found a voice in my writing.

And I have to wonder why? Why do I write such things? Why don't I write something timely and intelligent and worthy of reading? Something trendy. Something funny. Something with mass appeal.

Why not? Because I write what I think, what I see, and what I feel. I write what I know and I write from my heart. I breathe, therefore I blog? Not quite, but close.

Today, I am happy to report that nothing of any consequence has happened in my life. Well, I did figure out how to use the calendar feature on my new iPhone. I can even program an event to recur weekly, monthly or yearly. And I did it without looking at the instructions. How cool is that?

Just in case I think I'm all that and a bag of chips, I lost three out of four games of Trivial Pursuit. I do know a lot more trivia than I did this morning, though....

Oh, and I got a great recipe from Rachel Ray for cod cakes and spinach/mashed potatoes. Yummers, as she would say....

And I watered my garden, played with my dogs, and wrote a poem, too.

So, what am I feeling? Alive. Vibrant and alive and happy. All that and more, too. I had a birthday and I am older. Not necessarily wiser but definitely older.

And that's a good thing.

Irritable? Who, me?

I don't like being the patient. I am much more comfortable being the nurse. The comforter, the teacher, and the caregiver.

I raced out of a meeting this afternoon, so I could be on time for my appointment with my physician. Stephen. I have blogged about him before, when he saved my life.

Well, maybe not that dramatic. When he made me slow down and stop stressing over things I could not control. That's what he did. Well, that and some medications for hypertension. And now, over two years later, I am doing much better. I haven't even had lab work done since 2008.

As Theresa led me to the exam room, she asked when my last labs were done. Then she looked it up in my chart: November, 2008. “That's too long ago....” she said. I just shook my head in agreement.

I sat in the exam room, waiting for Stephen, for over half an hour. I could hear him, in the next room, talking to the woman about her diabetes. I had to smile. I don't mind waiting my turn if he is taking his time with his patients. After all, isn't that what we all want from our physician? His time? And answers to our questions?

I did wait in there for quite some time. In fact, I had time to play Sudoku on my iPhone for awhile. Then, when I got tired of that, I downloaded Facebook to my phone, went to my Home page, read what everybody was doing, and posted my own message on my “Wall”......Sitting in the doctor's office.....for more than half an hour! Glad I brought my iPhone!

Of course, he walked in just as I posted it, so I had to let him read it.

And so, we talked. For an hour. He was telling me about “the earliest medical record”......and then, the “arpanet”.....all the while, he was taking my blood pressure. “What did you get? For my blood pressure?” I would ask him. He looked on my chart. No, he didn't write it down. And he took it again.

When he finished listening to my pressure, he took off again on the subject we were discussing. Again, I asked what my blood pressure was, and again he frowned at me and picked up the cuff to take it again.

Finally, the third time he took it, he wrote it down. We both frowned: 150/80. That's high, for me. I smiled at him and told him it was because he kept taking my pressure and forgetting to write it down. He said “you're probably right.”

Finally, we got down to brass tacks. My back has been bothering me, for about a month. Not my spine, the muscles over my right flank. He asked what I have been doing and I told him: taking care of patients in low beds in their homes....I have had three patients with wound vacs, requiring about 45 minutes of bending over the patient in the bed, three times a week.

“Do you want some time off work to let it heal?” No

“Do you want an MRI?” No

“Do you want to try physical therapy?” No

“Okay, what DO you want?” Pills, Stephen, I want pills.

I don't want to miss work, or go on “light duty”, I just want my back to quit hurting. And, if I can break the pain cycle with a muscle relaxant, I think that will do it. Well, that and heat and massage, all of which I am already doing.

He gave me samples of a fairly commonly used muscle relaxant. I am supposed to take it four times a day. I told him I won't do that: I have to drive a car all day and I can't afford to be sleepy. So we agreed: I will take them at night only. For now.

I am hoping it works. Getting drowsy at night is fine, during the day, not so much. And the other common side effect is irritability. But that won't be a problem, I don't think. I never get IRRITABLE!

Oh, and labs, Stephen. Theresa and I agree: I need to have labs done!

Summertime....

Well, it's finally here, I think. Summer, that is. Not officially, of course. That happens on June 21st. But at least it is warming up again, after a long, unusually cool spring.

I hear people say that they don't like summer. Or more specifically, the hot weather. That's too bad, because it's here until at least the end of September. That's four months from now. And that's a long time to be unhappy, or miserable, or suffering.

There are those triple digit days, true, and they are hard. But, for the most part, I do like the warmer time of year. I don't have a swimming pool, but there's one at my gym. And there's always the sprinklers to run through....

Mostly, I like the longer days. When I get up in the morning, it is not dark. And more importantly, when I get home from work, it is not dark. In fact, it feels like there is still some day left, and I like that.

To me, the secret to summer is to look at the positives, and there are many. Longer days. Sunny skies. Travel. Swimming, fishing, boating. Rafting down the river. Barbeques with friends and family. Lazy, hot afternoons spent reading in a comfy chair, with a portable fan blasting away, nearby.

The simple fact is, wishing that it wasn't summer won't make it go away. Any more than wishing it wasn't winter made last winter go away. Acceptance. That's part of it, too. Accept the fact that it's going to be hot and deal with it.

I always enjoy the summer evenings around Podunk. For some reason, sound carries quite well in my neighborhood, so I hear lots of interesting things. Starting later this week, there will be high school and junior college graduations at the stadium just north of me. I will hear “Pomp and Circumstance” many times this week.

I like the time of the evening just as twilight happens. If it's very warm still, the crickets begin their chirping. The neighborhood settles in for another evening and things are still. On moonless nights, the stars look as if I can reach up and touch them. I wish I could.

I like to water my garden at nearly twilight, then sit in a lawn chair and enjoy the evening. It reminds me of childhood summer evenings spent listening to my daddy read the classics to us. Then, we would all lay on a blanket on the grass and learn about the constellations, and how sailors used them to navigate.

I remember lying there and wondering how my daddy knew so much....

Yes, it gets frightfully hot in the afternoons, here in Podunk. But, we learn to work around it. I do my housework in the early mornings, before I go to work. And I go in to work early and start seeing patients early. By early to mid-afternoon, I am through seeing patients, and I am at home doing my paperwork.

Now that I have a barbeque again, meals are a breeze to fix. And what doesn't taste special after being barbequed? Votive candles inside glass hurricanes, a red-checked tablecloth on the patio table, the patio ceiling fans gently moving the air, and the smell of gardenias wafting up from the back garden....

What more heavenly way to spend one-third of a year of my life?