Nursing Journal

For my May term course I have to keep a journal of daily events. It’s our first course that’s hands-on with patients. In the end we will qualify as CNAs. That’s the frame of reference for the journal, just so you don’t expect too much. Since I have to keep a journal, why not share it on my blog?

The day started with a seemingly unnecessary drive to the University of Maine, where attendance was taken, we were told where we would next meet, and at what time. There was then a drive to SJH, where I was able to get my badge before we began.

At St Joseph’s Hospital, we again took attendance and went over some general information. We were split up into two groups, half getting computer training and half going on a hospital tour. The computer training was unfortunately disorganized and ill prepared. We did receive some key information on where to find the parts of the patient chart we needed to access.

The hospital tour was helpful in orienting us to break rooms, bathrooms, computer stations, patient boards, and some information that is kept outside the patient rooms. For a tour, it was quite adequate.

With the two groups back together, we pored over our class packet and what is expected of us. It was helpful to know up front what the expectations and grades are based upon.

All in all, I am cautiously looking forward to tomorrow’s start with the patients. I don’t feel I can get everything done in the time allotted, though I will have no idea if that is true until it actually happens. I want to be able to perform my patient activities well from a grading standpoint AND from a patient perspective. I want to fill all my paperwork out completely and correctly. I really want to be able to help my classmates when they need assistance, but I’m not sure if that will happen if there isn’t enough time for me to get my requirements completed.

We’ll see how tomorrow goes.

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Christmas Loot 2012

One of the few recurring themes I have is my Christmas loot. This is the stuff my amazing wife got me.

Again, it was a ThinkGeek stocking. My Tigger stocking remained empty, as my wife got a free Bazinga! stocking with her geek points. Inside:
The Tick vs Season 2
Chocolate Gaming Dice Set
D20 Lollipop
Hammer of Thor Bottle Opener
Bowman Drew Brees Rookie Card
Serenity Keychain
Firefly decal
Bacon Candy
Bacon Band-Aids

Total Back & Shoulder Shiatsu Cushion
3 CDs from my neverending wish list
Firefly T-Shirt
Bacon T-shirt
Corduroy pants
Castle Ravenloft Board Game

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I don’t always take the time to make little connections with people.

I stopped at Taco Bell on the way home from Portland last night. My work partner and I had just dropped a patient off at a hospital in that area, and I was a little hungry.

I went inside, and almost immediately a slightly disheveled young lady with the tag “Shift Leader” came around to take my order. I asked “how’s it going,” and she proceeded to tell me how busy it had been a few hours earlier. I asked if there was anything special going on, thinking graduations or some such. She mentioned it was because of KFC’s latest special deal.

I looked the menu over and asked if I could have two crunchy tacos. The young lady paused for just a split-second and said “no”. It was a good kind of humor, and I appreciated it. She rung in my order and I handed her $5. She again joked, stating “I can’t take this.” To this I finally replied, “rough crowd!”

When she brought my tacos, I noticed the chocolate chip cookies beside the register. Knowing that my partner had a biscuit for me in the ambulance and I had nothing in trade, I told the young lady that I had to buy a cookie while hauling my wallet back out. She asked if I wanted just one. I said yes and she then said she would just give me one. When she was bagging it, she said “what the heck, I’ll give you two.” I left, telling the young lady she was my new favorite.

Since leaving her place of business, I have told my work partner and my wife about this exchange. Now I’m telling anyone who wants to read on the internet. I took just a few seconds to honestly ask about her day, and she provided excellent customer service (even if she hadn’t given me free cookies).

I know we’re used to thinking about fast-food workers as low people on the totem pole. I joke that way sometimes, too. However, I really feel that they are providing a great service and their jobs are important. Besides that, they are important as people. Each and every one of those workers has a life outside of that job. They have interesting personalities, and quite often see things in different ways than I do. I can learn a lot from engaging them and getting to know them, even if just for a couple of minutes.

There are many, many interesting people out there, and they show up everywhere. I continue to try not to overlook them.

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Vacation 2012 – Part 2

We knew we were going into the mountains, and that “civilization” was pretty much an hour away. When turning off the state route, we drove in between two buildings of a farm. The winding road led us up and around the mountains until we arrived at the resort in the valley.

We checked in and were sent to our room. The building outside was warn. It was stained wood, and the stain was faded. We were on the second floor and there was no elevator (not a big deal, but something to keep in mind for older users). The side wall of the stairs was missing wallpaper and had the stains of some sort of liquid.

We entered the room, and it looked like it hadn’t been updated since it was built. My wife estimated the 40s, but I think it could have been as recent as the 80s. The living room did not have a DVD, though this is 2012 and a DVD player was advertised on the website. The master bedroom had a TV on the wall beside the bed, not directly across from the bed, which would cause neck strain for anyone trying to watch. The second bedroom had an older style TV and a VCR player.

Also of note, the pool area, with multiple pools, some for children, some for adults, and some heated, was closed. For a resort area, which advertises the pool area on the website, and has heated pools, to have those pools closed…without advertising this information on the website, is ridiculous. (We checked the Pools part of the website and the Calendar. No notes.)

The resort is a small community set in the mountains. It advertises for family vacations, and it expecting people of all walks and all ages. However, the resort does not have sidewalks or footpaths for people to use. To walk anywhere on the resort, the guests have to walk on the side of the road…with little shoulder. Besides guest cars coming and going at all times, the resort has busses, vans, and work trucks constantly going from one location to another.

The resort has a hotel on the campus, which seems to be its own separate business. This hotel seems to have been renovated recently and looks rather impressive. The sporting area attached, however, has not been.

Considering the fact that the resort is at least an hour from other attractions, one would think that they would want the attractions on site to be…attractive. We looked at the bowling alley, the pool tables, the pool, the hot tub, and the pool showers. All these areas have been neglected upkeep for quite some time. We also looked at the racquetball courts, but have no basis for comparison of their appearance.

Our room had an ironing board, but no iron (the iron was eventually found, on the last night of our stay, when we took the strainer out from under the sink to dry hand-washed dishes). The DVD player was hooked up to the TV, but we couldn’t get it to work. There were no instructions in the room. We have used multiple types of DVD players before but couldn’t figure this one out.

There were hand typed signs stating that Villa Roma was “no longer” responsible for items in the fridge that weren’t kept cool enough, signs stating that there was a $75 dollar charge for dishes not being done before we left, and signs stating that there was a $100 charge for not checking out on time, no exceptions. These were all unprofessional notices handled with unprofessional signs.

The last particular disappointment of note for Sunday was the meal we had at the on-site restaurant. It was the only eatery open on-site Sunday night, so they kind of had the monopoly. Just like other monopolies, they didn’t seem to care about the quality of the product. My four piece fried chicken came out with pieces so small I thought perhaps they used chickadee instead of chicken. My wife found her ravioli unappetizing. After paying a not-so-moderate price for the poor meal, we went back to the room to wallow in the inadequacy of it all.

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Vacation 2012: Villa Roma, Part 1

I have to admit, I wasn’t really prepared for vacation this year. I worked through Friday, and we had a bunch of errands to run on Saturday. I didn’t take time in the weeks building up to vacation. I never looked up information on where we were going and what was around for entertainment. I figured it didn’t matter as long as I had a week off with my wife. I’m easy to please.

We rented a car, just for the fun of something different, and we were given an Infinity. It was great. The car drove really well, everything responds instantly, and there were plenty of features. The drive was great, especially for an 8 hour drive, plus stops.

The resort was a disappointment before we even arrived.

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Profession Update

I have some notes about the vacation we’re on, but yesterday I received an email from the state University accepting me into their nursing program. I have tried for years to get into a Physician’s Assistant program, with no luck. Instead, I’ll take this track. My life is about to get a lot harder.

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Tell Me A Story

Tell me a story. I don’t care if it’s happy or sad, comedy or tragedy, history, fiction, non-fiction, horror, sci-fi, or fantasy, though not fantasy like lots of other people might consider fantasy. I mean adventurers, knights, horses, unicorn, dragons, elves, dwarves, hobbits, fairies, princes, princesses, werewolves, zombies, vampires, but not vampires like sparkly, emo, love-sick vampires. I mean vampires that are afraid of garlic and running water, vampires that are burned by a shaft of sunlight and destroyed when fully exposed to the sun. Vampires that hunger and thirst and feed off people’s throats. Vampires that are pale until they feed, and then they have rosy, red cheeks and are quite affable. Tell me about vampires who have superhuman strength and extraordinary speed.

Tell me a story of love or of loss or of heroics or of nefarious deeds. Tell me a story that you won’t tell any other, and I will laugh or cry, be shocked or angered. I’ll oooh and ahhh and hang on your every word and love every second of it.

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Last night I awoke to a gentleman standing over the foot of my bed.

Now, I’m not surprised that I slept through someone entering the house, making his way to the bedroom, and hovering over the foot of my bed until I woke up. I mean, that’s what happens when one takes those sleeping pills the doctors prescribe. First one becomes all loopy, and then one stuffs a bunch of food in one’s face, all the while convinced of having sound mind and making acceptable decisions. Then one turns the light off and –boom- falls asleep.

So I wasn’t surprised that this man was able to get in unnoticed. I was bloody freaked out that there was a man staring at me when I left the wonderful world of dreams to return to the dull world of reality. Of course, this time reality wasn’t dull. Who calls reality dull when waking up to a stranger?

When I realized that something was out of place in my bedroom (and my heart started its marathon pace), the gentleman smiled and tipped his hat. His hat? Precisely. Maybe now I should explain why I call him a gentleman.

The person standing unexpectedly before me when I awoke was wearing a three-piece suit, brown and pinstriped like one might imagine Sherlock Holmes wore when he did his official detectiving. The man had a cane in his left hand and a top hat, as quaint as you can be. Not only was he out of place in my bedroom, but he seemed out of place in time.

This anachronistic gentleman tipped his hat, smiled, and extended his right arm in invitation. Now, it is not my habit to join trespassers in a stroll around town in the middle of the night, nor is it my habit to be dressed appropriately for such an event when I am sleeping in my own bed. However, since he looked rather non-threatening, and because my mind was still a little foggy from my nocturnal medications, I quickly slipped out of my bed and clothed myself.

It’s a strange feeling to consider oneself underdressed when one is, in fact, dressed appropriately for the time and the event, but this gentleman had a certain…panache that I believe would have left anyone feeling a bit inadequate in a similar circumstance. My wind pants and t-shirt may have been more utilitarian, but I certainly wasn’t going to look as good doing…whatever it is we were going to do…as the gentleman in the suit.

He led me to the front door where I was able to get my jacket, which had my house key. This was a good thing because I strongly suspect that I would not be as adept as breaking and entering into my own house as this odd nighttime visitor. Without further detainment, the gentleman led me out of my house and onto my front lawn, whereupon another oddity awaited me.

You may recall a week or so ago there was a strange shape on my back lawn which I imagined to be a large fox or small coyote or something equally sinister. It turns out that the creature on the lawn was a fox, and I am able to relate this as a certainty because I saw the same exact beast on my front lawn when the gentleman led me outside.

This animal gave me a start like one I hadn’t had since, well, since waking up to find a stranger in my bedroom. However, the animal looked at the man, and the man looked at the animal, and both had what I can only describe as a look of knowing understanding. The fox seemed to be quite docile, a mere observer of events, and the gentleman gave it another one of his charming smiles that had persuaded me out of bed.

The gentleman led me away from my house and into the trees. I noticed the fox watch our departure, but instead of following, it turned back to minding my house.

How long we walked through the forest, I can’t be sure. I had not donned my watch during my hasty dress. Familiar landscapes quickly became unfamiliar, and the sounds I am used to hearing at night in my neighborhood changed to foreign, if contemporary, noises. When we did emerge from the woods, we were standing directly in front of your residence.

We didn’t have to walk any further, for what the gentleman apparently wanted me to see was quite plain in the light of the moon. There, watching your home as diligently as one was watching mine, was a sizeable grey fox.

The animal turned to look at us. The gentleman remained silent, merely smiling again his enigmatic smile. We stepped back into the woods and allowed the creature to return to its nocturnal vigil.

After another indeterminable amount of time I was returned to my own premises and allowed back into my bed. The gentleman had left me at the front door, so I was not witness to his skills of entering a locked home. When he left, he left alone, and the fox remained in my yard, staring at the house.

Needless to say, I took some time getting back to sleep last night. I could not get the visitation out of my head, the oddity of the experience, and the sights I had witnessed. I thought long about the gentleman, but I thought even longer about the foxes.

As I lie there pondering these events, one thought, nay one certainty, allowed me to relax until I once more fell asleep. The foxes are no mere observers, my dear. They are guardians.

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Baby Changing Station

He was washing his hands when the stall door slowly creaked open. Nobody came out, which was odd, but he also noticed the plastic contraption affixed to the wall. It read “Baby Changing Station.” Suddenly he had a glorious idea.

The sign in front of the fast food restaurant boasted that it was open 24/7, but everyone in the area knew that the city was a ghost town after 2AM. When he came back at 2:30 that night, he parked his car by some others in the department store lot next door. There were people inside stocking the shelves overnight, so his car didn’t look out of place. He opened the back door and unstrapped the small bundle from the car seat.

He had needed to drive around town for over an hour before the bundle had stopped crying and finally fell asleep. Now it smelled like sour milk, and definitely needed a clean diaper, but there was no way he was going to chance waking it before getting inside. He walked in slow, swaying steps across the parking lot.

He peeked around the corner of the building. As expected, the interior of the fast food restaurant was devoid of customers. He slowly opened the door. The restaurant’s two employees could be heard talking in the back, over the sound of hip-hop music. He stepped in and guided the door gently closed behind him.

Inside the bathroom, the door to the stall was half open. He stepped forward, careful not to squeak his shoes on the tile. He stepped through the half open door, rather than chance the creaking noise he had heard last time it opened. Here was the baby changing station, folded into the wall just like he last saw it.

He took one final peek out the stall door to make sure no one else entered the bathroom. He turned back and lowered the table of the station.

He set the bundle down on the baby changing station, and the child opened its eyes. It squinted in the bright bathroom interior, frowned, and inhaled a lungful of air to continue the caterwauling it had left off before the car ride. The man lifted up the baby station table and closed it into the wall before the child could begin the scream. Silence.

He was afraid that an employee may have heard the station close but wasn’t sure how long he was supposed to wait before opening it again. He looked at his watch. He looked at the bathroom door. He looked back at his watch. He never realized time could pass so slowly.

When he could wait no longer, he again lowered the baby changing station table. On the table was a puppy. It had a smooth blue bow tied around its neck. The puppy started wagging its tail.

He picked up the puppy. It licked his face. He nuzzled the puppy and scratched it behind the ears. The puppy cocked its head and closed its eyes contentedly.

He walked out of the bathroom, puppy under his arm. He left the restaurant and walked back to his car with a huge grin on his face.

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The Musical Divide

I’m not sure why I have such a fondness for songs about relationship problems.

I’ve only broken up with people three times. One of them wasn’t a big deal, but the other two were heartbreakers. However, these breakups can’t be the reason for my attraction to breakup songs, as they all occurred after my attraction to the music.

Perhaps finding Bon Jovi’s Slippery When Wet cassette in the coat closet at school was the start of my fondness. A good number of the songs on the tape have to do with just those issues. Perhaps since I liked the music, I liked the subject matter.

This doesn’t always happen to me, especially now that I’m a more circumspect adult. I can appreciate the musical quality of a song while abhorring the lyrics and/or subject matter. Are the lyrics and/or subject matter of the relationship songs really that bad, though?

Take a look at Bryan Adams for an example. He’s one of the artists I really liked in my college years. His music is great, especially for easy-listening fans who have the radio on at work. Most of those fans would probably not have any problem with Bryan Adams’ subject matter as the songs played in the workplace. However, when you really listen to what he’s saying, you hear songs about fornication and infidelity. To me, those themes aren’t something we should be encouraging.

So now we have music that I am fond, regardless of whether I can relate to it or whether I approve of the subject matter.

What’s up with that?

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Is anyone else in this current geographical location hot?

Seriously. I’m sweating like Big Bird at a Popeye’s.

Mmm. Love those biscuits!

I just put this shirt on and it is now drenched. The computer monitor is fogging up like the cold winter windshield of a car filled with 5 teenage girls. I had to go to the garage to get a squeegee.

Before my overheated computer circuitry fries, sending a brain-scrambling pulse through the delicate sensor nerves of my baby-soft fingers, I want to take a step back and remember things how they were…before the “incident”…back when all my friends and acquaintances weren’t gibbering morons who hadn’t had their brains supercharged by errant electrical surges.

I will miss you and this time when life was simple and I wasn’t dissatisfied by your mere presence.

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Loot List 2011

While my wife’s Christmas stocking was filled with Pampered Chef goodies, my stocking was filled with ThinkGeek.

A Conan the Barbarian Sword Letter Opener
Star Wars Chop Sabers
Bacon Flavored Croutons
Bacon Dental Floss
Hematite Adventure Gaming Dice

Gifts included a wonderful assortment:
Kindle Keyboard (3G, WiFi)
Dwarven Dig! Adventure board game
Robo Rally boardgame
Despair, Inc 2012 Custom Calendar
7 inch digital picture frame
Littmann Stethoscope (Navy Blue)
Texas Roadhouse gift card

Now I’m trying to figure out what to do with my old letter opener. It came from Africa, so I don’t feel like throwing it away. The point is broken, though. I think I’ll just stick it in a pen jar and let the top look out at me while I open letters with the Conan sword.

I hope Christmas was wonderful to you and yours!

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Open Book Testing

I recently took a midterm exam for an online course. Online courses, of course, mean open book testing. I had to wait quite a while to get my exam score, and the teacher had hinted that grades weren’t very good. I got a little nervous, but not too bad after remembering back to my first open book test.

In fourth grade history class we were told that we would have a history test in a few days. Being the student I was, I took the book home and studied it along with whatever notes and handouts I had. When it came time for the test, I was ready. Before starting the test, the teacher said it would be open book. Everyone grabbed their textbooks and opened them up, reading for the test…everyone, that is, except me.

I figured that I had studied the subject matter enough. I remember thinking I didn’t need the book because I had this information down. I boldly accepted my test and started answering questions that I knew the answer to.

I don’t remember any point during the test where I wanted to bring my book out, though that surely would have still been an option. Instead, I dutifully finished the test and turned it in, proud of my studying skills. Now this was quite a while ago, so this is how I remember it now. I very well may have turned it in a little more nervous than usual, wishing I had used my book. I don’t at any point recall enough anxiety over the questions that I felt the need to retrieve my book.

When the tests were handed back a few days later, the teacher stated that “only one person was bold enough to fail this test.” I wasn’t worried about that person being me because I had studied and felt good about how I did on the test. Sure enough, when the tests were handed out, I had a failing grade on my paper (or really close to it). The grade was in the 60s…for an open book test.

I learned something on that day. I learned that no matter how comfortable I felt about the material presented, I was always going to use my book in an open book test. That life lesson has not failed me to this point.

When the scores were posted for this recent online midterm, my grade was an 89. I know for an open book test that’s not really overwhelmingly great. I blame the lower-than-desired grade on the fact that I cut one hour off my allowable testing time by scheduling an appointment earlier that day and then forgetting my appointment time when I started the test. I ended up only having two hours to take my three hour test.

There’s another lesson I don’t expect I’ll forget any time soon.

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Disappointing Everyone

I am pretty much a disappointment to everyone who cares/cared about and believes/believed in me.

I spent a good number of my formative years at my great-grandmother’s house. She helped raise me, including educating me, and grew to love me. Everyone knew I was her favorite grandchild and that she absolutely adored me. When I eventually moved back in with my mother, the visits to my great-grandmother slowly grew fewer and fewer. I would go many weekends, then I would go a few weekends, and then I would not really go at all. She grew older and had to move out of the trailer where I grew up. She was in the hospital for cancer and I managed to visit her once. She was in a nursing home as she slowly lost her cognitive functions. She always asked about me when visitors came and would hope for the day when I would come visit. I managed one visit in years. She died and I have no idea when I last saw her before that. She spent the second part of her life getting irrevocably attached to me and then losing me. I disappointed her greatly.

My mother always encouraged me and fed my growing intelligence. She told me how smart I was all the time through grade school and high school. She did what it took to provide for and nurture a budding intelligence. I was, at different times, enrolled in an engineering program and a pre-veterinarian program. I am neither an engineer nor a veterinarian. I am not a medical provider, though I grew up with medical professionals all around me. One college diploma later, I am an EMT (a one semester course) and a registration representative (requisite? a one semester course). Neither pays enough to live above basic needs. I have disappointed my mother.

My wife saw my potential and married a man who could be anything he put his mind to. She has lived through periods of marriage where we bought generic brand foods and didn’t buy new clothes. She has lived though periods of working an extra job on the weekends to pay the bills. She inherited thousands of dollars of debt when she married me and had to help me pay it off instead of starting her marriage ahead of the game. She has worked long shifts, she has worked extra shifts, and she had worked physically demanding jobs. She has skimped and sacrificed and taken the brunt of living a low income lifestyle. Instead of pushing myself to constantly better myself and our situation, she is burdened with a man who finds contentment for too long with too little. I have disappointed the very love of my life.

If you were to ask me, completely out of this, or any, context, the three people I love or have loved most in my entire life, I would list these three women. I have let them all down to varying degrees, from the excusable to the unforgivable. I have become deplorable, and when I verbalize it, it hurts.

Posted in Get To Know Roger | 4 Comments

How I Spent My Vacation, part 2

Part 1

Thursday, May 19th

We used our free tickets to go to a plantation. Granted, this plantation was the one preferred by the Charleston Visitor’s Center (the same place that messed up our tour times the previous day), but when we requested a plantation walk we were (again) thinking about sprawling gardens with flowers in every color of the rainbow. We got a walk through someone’s forested back yard. So-and-so played here and the pastor/owner penned many of his sermons from here…. However, the place was severely lacking in flowers.

After the plantation walk, we went shopping at a Tanger Outlet. I liked the setup of the outlet area. We didn’t end up buying too much, which is different for our shopping day. I got a belt.

Friday, May 20th

Happy birthday to my wife! This was our day to just bum around the resort and bask in the warmth of SC along the beach…which led to both of us getting sunburnt. The sun drained us so we took a nap and woke up sore. I figured I would just be uncomfortable from my sunburn, but it was very uncomfortable sleeping the next few nights. We went to dinner at the Edisto Pavilion, an overpriced restaurant on the beach. Krissy’s pasta had shrimp, which she was sick of by that point in the vacation. I had a small steak, which fulfilled my craving.

Saturday, May 21st

I’m fine sitting around doing nothing. That’s part of vacation for me. Krissy, however, wanted to go do something. We figured Beaufort wasn’t too far away, just the next peninsula over, so we’d go check it out. It was kind of a spontaneous decision with no expectations, so it couldn’t disappoint us. The drive was a little longer than we expected, and the city is small, but there are quite a few things packed into it. Krissy had her first experience at a Chick-fil-A. We stopped at a chocolate shop that she had scouted out and bought a bunch more candy. They had a pack of chocolates shaped for nurses and the instruments they use. Apparently the pack was in the sun on the way home because two of the instruments melted in the car.

Sunday, May 22nd

We checked out relatively early and drove through SC, VA, WV, MD, and into PA before stopping for the night. We stayed at a Fairfield by Marriott and they seemed overexcited to have us there. I got two emails and a small card in the mail all thanking us for choosing them.

Monday, May 23rd

We finally arrived home after another long day of driving. We went through the rest of PA, NY, CT, MA, NH and into Maine. The house hadn’t burned down, and nobody had stolen the copper out of the house while we were gone. I consider that a win.

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How I Spent My Vacation

How I Spent My Summer Vacation
How I Spent My Spring Vacation
How I Spent My Vacation

Saturday, May 14th

After 15 hours of driving through Maine, NH, Mass, Conn, NY, Penn, MD, WV, and VA, we stopped in Fredericksburg for the night. Highlights include fog in Pennsylvania so thick that I couldn’t see 10 yards in front of me. Also, it was torrentially down-pouring in Fredericksburg. All the hotels at our first stop were full due to weddings and graduations. We were told not to bother stopping at the next exit, either.

Sunday, May 15th

It was another long day of driving, but we made it to the resort. Along the way we stopped to eat at a very unimpressive Hardees. That night we ate at an Edisto Beach restaurant called McConkey’s Jungle Shack. The food was pretty good, and the ambiance of the screened in porch was great.

Monday, May 16th

I woke up before the SC sun. Apparently the sun gets up an hour later in SC than it does in Maine. Also, we went for an extremely long walk on Edisto Beach. We kept thinking a resort-owned rest/bathroom area was coming up just around the next bend in the beach. We took a lot of bends and never made it to the rest area. We wondered back through town instead of back via the beach and stumbled upon Whaley’s, a little hole-in-the-wall type restaurant and bar.

Tuesday, May 17th

We explored what I liked to call “the Strip” of the island. This included one long building with a pizzaria, a movie rental store (not open until 2PM), an administrative office, a candy store, and a nails/massage office. We had some pizza and bought a bunch of candy. The rest of the day was spent mostly relaxing and reading.

Wednesday, May 18th

We got up early for a trip to historic Charleston. We bought tickets to what we were told was a 90 min trip to Ft Sumter and then a 90 min historical Charleston bus tour. We double checked before getting on the first bus and found that the Ft Sumter tour was closer to 3 hours. We couldn’t do that and the bus tour because we had made an appointment to sit through a sales pitch later in the day in exchange for $92 worth of passes and gift cards. Unfortunately, we had put a (refundable) deposit down for the sales pitch or we would have skipped it. We only took the bus tour and were actually a little disappointed in Charleston. Sure, there are old, nice looking buildings with lots of history. However, real estate is at a premium so the houses are rather close together. We enjoyed hearing the historical facts and seeing the local architecture, but there were no wide boulevards or sprawling gardens like I was expecting.

To be continued…

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Top Five Vacation Mistakes

5 – Timeshare

We finally succumbed and bought into a timeshare type thing. We have enough points to vacation once a year, if we book within 30 days. That is sure to limit our choices, since the good places will probably be booked up by then. However, if we vacation once every two years, the options really open up. I list this as a mistake, but I’m hoping we can make the most of it. Time will tell.

4 – Bur

Walking barefoot on the beach is fun. Stepping on a bur is not. Neither is pulling the bur off your foot with your fingers and thereby jabbing your thumb and causing it to bleed.

3 – Wrong turn

I took a wrong turn onto I 90 West in Massachusetts instead of I 90 East. This caused us to go 15 miles out of our way, but it seemed like a lot further. Apparently there’s not a lot of call for exits on I 90 West after it’s merge with I 84. Sounds like an exciting place.

2 – Mystery foot injury

Somehow on Monday I hurt my left foot. The top felt like it was bruised, like something had fallen on it. Also, the arch is sore. I spent the rest of the week hobbling around our various activities. It has been over a week now and the foot is still sore.

1 – Sunburn

I told myself not to burn. I didn’t listen. I burned on Friday, making Friday, Saturday, and Sunday uncomfortable. It was painful; it was itchy. It was stupid.

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Loot List – Christmas 2010

A lot of items have come off my wish list this year, between finding the rare ones myself, my birthday, and Christmas. CDs seem to be the slowest moving item on the list. I should probably start rounding these up when I get a chance. This year, ThinkGeek provided many of my birthday and Christmas presents.

Sport coat with elbow patches – This one is brown corduroy with brown elbow patches. Check that off my wish list.

Sweater vest

Uncle Oinker’s Savory Bacon Mints – From ThinkGeek.

J&D’s BaconPop popcorn – From ThinkGeek.

Mr. Bacon’s Big Adventure – “It’s a mad dash through Meatland on your way to the frying pan! Join Mr Bacon on a mouth-watering mosey through Meatland! On your journey, you’ll have to navigate your way through the Mustard Marsh, cross the eerie expanse of the Wiener Wasteland and sail on the Sausage Sea. If you make it past the deceptive detour of Vegan Alley and avoid getting grounded in Gristle Grotto, you just might make it to the Great Frying Pan at the end of the trail. Good luck on your high cholesterol journey!” From ThinkGeek.

Strawberry ChapStick (x2)

Chewbacca noisemaker – From ThinkGeek

Critical Hit Flashing D20 – From ThinkGeek

iTunes gift card ($15)

Swedish Fish – Christmas colors, red and green

The Big Bang Theory Season 1 and 2

Kill A Watt – Electricity usage monitor – From ThinkGeek

T-Shirts: [Ba][Co][N], Bazinga, Capt. Hammer, and 42 – From ThinkGeek

Miniatures: Almaran the Gold, Black Legionnaire, Overladen Henchman, Loryn Stormblade, Bergun Sunblaze, Praying Paladin, Gronk Spliteyte, and Mash Half-Ogre.

Blurt – The Uproarious word race game.

WOW Worship—Red (2004)

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08/24/10 Family Medicine

Today was the first day I was able to shadow a PA. The PA I shadowed has been in the field for many years and at her current office between 5 and 10 years. She started out with a BS in Chemistry and then worked as an oncology tech along with working in a laboratory. She works as a PA directly underneath a physician who specializes in geriatrics. There are other MDs and mid-level providers in the office, however, and she can end up seeing anyone’s patients at any time for any reason.

Most of this morning’s patients were follow-up patients. Two were acute add-ons. Many of the patients see her regularly, but at least one was seeing her because she was the first provider available.

I knew the PA from previous working experience, so we were able to dispense with the introductions and get right to the job at hand. The first thing she showed me was the electronic medical record (EMR) upon which she had two charts open for patients she had seen the previous day. She reminded me that, though the patient leaves the office with his/her plan of care, the documentation isn’t finished quite as quickly. Some of the documentation is done in the room while talking to the patient, at least enough to remind you when you sit down to finish the chart later. The rest of the documentation is often done during lunch, after the last patient of the day, or the next morning.

She told me that a provider trains his/her mind to remember what happened in the visit when it is time to finish documentation.

She had her schedule printed out before the day began and gave it a cursory glance to see what the day’s patients were coming in for. She could then look up past visits, if necessary, to remind her of the patient’s history and where she had left off with them. For the most part, when she entered the room with the patient, she was able to let the patient know that she remembered the last visit and what direction they were heading in.

I noticed that the patients really trusted the PA and wanted to know her opinions about everything related to their healthcare. One patient was schedule to see two MD specialists, but wanted to come back and see the PA to get her opinion on the matter before following the specialists’ advice. Another patient kept expressing her anxiety and stress due to her work situation. This patient seemed to want to talk about that a little more than she was able to during the office visit. The advice of the PA was important to both of these patients.

A 16 year old patient came in with a rash that her mother thought may be an allergic reaction to antibiotics she was taking. As the facts were investigated, it was found that the patient had been on the same antibiotic relatively recently with no side effects, plus the rash didn’t fit the typical allergic skin reaction pattern. She had, however, been swimming multiple days in the row, reusing the same damp swimsuit. In the end, the PA didn’t unnecessarily diagnose the patient with an allergy to a medication she may need in the future when there wasn’t conclusive evidence to do so.

Another of the acute patients was someone that I thought could have been treated over the phone if the PA had known the extent of the problems at the time. The patient had been seen for a similar problem in the past, had somewhat of a history actually. The patient had all the medications prescribed to her earlier in the year for a skin irritation but hadn’t needed to use the entire prescription. The patient didn’t have a new problem or need a new treatment plan, but just needed confirmation from a provider that it was OK to use the medication for what seemed to her to be a different incident. The PA was able to recognize the symptoms from earlier visits and recognize the medications from the EMR and assure the patient that it was appropriate to use them.

The last patient of the day told me she liked the PA because the PA was thorough. Right away, the PA started asking questions that didn’t seem to have to do with the chief complaints at hand. Through further probing, it was found that the chest discomfort and weakness the 38 year old patient was feeling was probably due to a new onset of hyperthyroid rather than any kind of cardiac problem, which she had been worried about. That patient had been good natured and making jokes, but deep down she was worried that her unhealthy lifestyle might be catching up to her. The PA was able to calm the fears significantly before the patient left.

I noticed that for every medical decision the PA made, there was another consideration that had to be followed up. For instance, when prescribing one medication to a patient, the PA then had to make sure to follow up with blood work afterward to check the liver. She also had to follow up with the prescription to make sure it didn’t cause a cough, which is the most common side-effect. No medical decision is an island. Medicine is an interconnected discipline and has to be practiced in that manner. That is often a challenge for an urgent care or emergency facility treating a patient they don’t know. The patient can be on other medications, have other allergies, and have other diagnoses that are going to affect medical decision making, however the provider doesn’t always have access to this information. In this regard, family medicine can be a little harder – you have to keep up with the patient’s entire medical history – but also a little easier because you have the medical history available when making decisions.

I realized a couple things from the experience I had today that I hadn’t thought of before. First, family medicine gives you a wide range of patient care opportunities. I like the thought of a challenge, as in the situations that present in an emergency department when someone’s life has to be saved and you might not know that much about the life before having to save it. Family medicine hints at this challenge with acute visits in a multi-provider practice. A patient you are unfamiliar with comes in to be seen for a problem you haven’t been following.

On the other hand, I like the thought of following up with the patient and seeing where my medical decisions brought them. Is the patient better off in the long run because of how I handled his/her care? Am I able to make the slight alterations in the care plan in each successive visit that ultimately lead to a healthy, enjoyable life for my patient?

Secondly, I was told that a provider trains his/her mind to remember what happened in the visit when it is time to finish documentation. I believe I would have the ability to see a patient at one point and document the visit later if necessary. Even now, hours after I have left the office, I can remember what the patients were seen for and how the PA treated them. Beyond the chief complaint and main reason for the visit, I remember many of the secondary diagnoses and other medications the patients were on that we saw today.

There were also some things from my shadowing experience today that I have further questions about. First, I understand the wisdom of looking at the schedule to know what to expect during your workday, however I wonder about planning the encounter before entering the room and the prejudices that come with it. From what I experienced the facts the patient gives, as they give them, influence the provider, but assumptions the provider researches before the visit can influence medical decision making before even talking to the patient. The patterns we see in healthcare can become ruts if we think that every patient with problem X can be treated the same or every patient with insurance Y abuses the system. It seems like it might be wise to mentally prepare oneself but be open-minded enough to not miss anything out of the ordinary.

Also, I think it is important for a PA, or any practitioner, to know the EMR well enough to be able to glean all the useful information from it. Healthcare may have been around a lot longer than the computer, but the computer can help in so many ways…if you know how to use it. Knowing how to access all the documents you want, and need, is key.

Lastly I’m concerned that some of the repetitiveness of the job might cause a provider to not fully listen to everything the patient is saying…and suggesting. I’d like to think that a PA is following up with a patient’s explicit and implicit anxieties instead of just focusing on prescribing a medication. There is an enormous link between a person’s mental well being and his/her physical well being, and that link works in both directions. If one is down, it can bring the other down. If one is up, it can bolster the other. Hopefully the practitioners of medicine aren’t just skimming the words coming out of the patient’s mouth for key terms and phrases, but are truly listening and taking into account everything the patient communicates to them. From just one morning in a family medicine office, one morning of listening to patients talking to a PA, I believe in a holistic approach to practicing medicine. This entire body of ours is inter-connected and it seems like it should be treated appropriately.

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PA School Planning

Last week the wife and I drove down to the University of New England to go over my latest PA school application. There were many details discussed, and I took a lot of notes.

Requirement: Anatomy and Physiology needs to be 8 credits taken within the last 7 years. The anatomy I took was Comparative Anatomy in the fall of 1996. I needed to get a B or better, and I got a C+.

Plan: I am signed up for A&P I (4 credits) this coming semester. I will get an A. I will take A&P II (4 credits) next semester and also get an A.

Requirement: 250 hours of direct patient care (CNA, CMA, EMT, RN, etc.). I have zero hours of direct patient care, though many years of working in healthcare.

Plan: I am signed up for an EMT course. I will pass with a high grade and start working as an EMT. This line of work actually interests me and is not just something to pad my resume, so that helps. Incidentally, this class requires an up-to-date Basic Life Support (BLS) certification. I have signed up for the course on the 25th.

Requirement: My Biology-Chemistry-Physics (BCP) average needs to be over 3.0, with more competitive applications being closer to 3.2 or 3.5. Mine is currently a 2.75 (and that’s what you get for slacking off in college, my supposedly smart friends).

Plan: An A in both A&P semesters will bring this BCP average to a 2.9. I need to get an A in another BCP class next semester. If that’s not enough, I may need a summer class in the May term (a human-related biology was suggested…I have lots of animal classes). If 8 credits worth of A’s brings me to 2.9, another 8 credits worth should bring me to 3.05.

Strongly Required: Shadowing a PA to know exactly what a PA’s roles and responsibilities are. Now, I have worked with Pas for 9 years now but have never officially shadowed one.

Plan: I want to shadow as many PAs as possible between now and my next application. My employer has a shadowing program. I just need the approval of a department head to shadow within their department. I have sent off some emails and I already have one PA willing to let me shadow him. I plan on typing up a paragraph or two of each experience after I have done it.

Other Suggestions:

Work on my essay for the application. Let them know why I’d be a good choice.

Come to the spring open house. Meet the staff. Make myself known.

Explain in more depth on the application exactly what my healthcare experience is. I guess I was rather Spartan on the info, figuring they’d ask more, in-depth questions at the interview. Ooops. I didn’t get an interview.

I also feel I should look up the requirements of a few other PA schools around and make sure I meet their specific prerequisites. I can’t put all my hopes in one school; it has burned me twice (by my own fault, yes).

So, I have a plan and I’ve gotten right on top of signing up for things. Let’s see how it goes.

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