...about Google Reader, folks. It rocks! And if you already have a Blogger account, the two work together. No new login needed.
While I'm getting caught up (instead of writing a paper, naughty me!) on all your blogs, I was checking out Thinspiration's latest pics--girlfriend is over 100 lbs lost! And looking so fantastic. So I just wanted to give her a shout-out over here...
...and also to my friend, who had RNY about 4 years ago, and finally got her tummy tuck and looks like a million bucks. She was quite thin, but had extra skin that was making her feel bad, so she went out and did something about it for herself. Self-esteem is just as important an outcome of WLS as improved health is. I won't give you away here, but you know who you are. She looks so beautiful. Congrats to you, lady!
Thursday, November 6, 2008
We all need each other...
Observing the "brave new world" following Tuesday's election has been interesting. What is reported in the dreaded "MSM" is a previously unseen spirit of cooperation from the White House and in politics in general. This is mainly mandated by the Transition Act, which budgets and requires processes for a smooth transition in government. But it's obvious that folks in Washington have been anticipating this particular power shift prior to Nov 5. What isn't reported, of course, is what is probably REALLY happening. All in due time, I'm sure.
But I've been giving some thought to the filibuster-proof majority that didn't happen for the Democratic Party. That, plus listening/reading some of the chatter about Republican rebuilding. I am glad the Republican Party's reign of terror, er, power is over. But I am also glad that the supermajority did not happen in the Senate. The parties need each other. Absolute power corrupts absolutely, and all that.
Let me be clear here: I may be left-of-center, but I don't trust or like either of the parties. I'm not a loyal Democrat, but their ideals usually fit mine better than the Republican ones. Not always. I personally think that most politicians, when placed under just a little pressure, turn out to pretty much be the same. I realize that is a very cynical viewpoint, but I don't think I am alone. I hope we've just elected an exception to this rule.
What I WOULD like to see is a new focus on public service, as has been promised by Obama's campaign. I think we could do a lot in this country if we just organized people's natural desires to be involved in the community and the world. Our citizens are our greatest natural resource, and most of them have been alienated by politics and policies of the past 20 or so years, at least. That's the change I'd like to see.
How about this WLS stuff? Well, weight is still hanging in that same 3 lb range that it has been sitting in. After taking a few days off, I ran again today. I haven't felt up to it--a little depressed, maybe--but today I just got sick of my own laziness and excuses and got off my butt. It felt a lot better to do something good for myself.
We need each other in this WLS arena, too. I get a lot of inspiration reading all of your blogs about your own journeys, at all different points along the way. Some are newbies, some long-time bandsters, some are just starting the pre-op process. And some aren't having surgery at all. I haven't really been frequenting the boards lately--that really fell off my radar once my free time started to disappear. But reading my sistas' blogs--including Achieving Me (She Smiles), Laura (I'm a Pretty Girl Momma), losingjusme, Diz, Angie (Journey to a New Me), Love My Lap Band (Lori), killthefatman (Manatee--right, not a sista, sorry man), Lise the Loser, and Pasta Queen, and Thinspiration (I'm sure I'm forgetting someone here, sorry! see sidebar for all my peeps)--you guys keep me inspired and moving along. I'm starting to formulate a bit of a plan in my brain to lose the last 10 after this semester is over. I'll let you know if I come up with anything concrete, but I think I'll be in the thinking phase for a bit here. Thanks everyone, for keeping it real.
But I've been giving some thought to the filibuster-proof majority that didn't happen for the Democratic Party. That, plus listening/reading some of the chatter about Republican rebuilding. I am glad the Republican Party's reign of terror, er, power is over. But I am also glad that the supermajority did not happen in the Senate. The parties need each other. Absolute power corrupts absolutely, and all that.
Let me be clear here: I may be left-of-center, but I don't trust or like either of the parties. I'm not a loyal Democrat, but their ideals usually fit mine better than the Republican ones. Not always. I personally think that most politicians, when placed under just a little pressure, turn out to pretty much be the same. I realize that is a very cynical viewpoint, but I don't think I am alone. I hope we've just elected an exception to this rule.
What I WOULD like to see is a new focus on public service, as has been promised by Obama's campaign. I think we could do a lot in this country if we just organized people's natural desires to be involved in the community and the world. Our citizens are our greatest natural resource, and most of them have been alienated by politics and policies of the past 20 or so years, at least. That's the change I'd like to see.
How about this WLS stuff? Well, weight is still hanging in that same 3 lb range that it has been sitting in. After taking a few days off, I ran again today. I haven't felt up to it--a little depressed, maybe--but today I just got sick of my own laziness and excuses and got off my butt. It felt a lot better to do something good for myself.
We need each other in this WLS arena, too. I get a lot of inspiration reading all of your blogs about your own journeys, at all different points along the way. Some are newbies, some long-time bandsters, some are just starting the pre-op process. And some aren't having surgery at all. I haven't really been frequenting the boards lately--that really fell off my radar once my free time started to disappear. But reading my sistas' blogs--including Achieving Me (She Smiles), Laura (I'm a Pretty Girl Momma), losingjusme, Diz, Angie (Journey to a New Me), Love My Lap Band (Lori), killthefatman (Manatee--right, not a sista, sorry man), Lise the Loser, and Pasta Queen, and Thinspiration (I'm sure I'm forgetting someone here, sorry! see sidebar for all my peeps)--you guys keep me inspired and moving along. I'm starting to formulate a bit of a plan in my brain to lose the last 10 after this semester is over. I'll let you know if I come up with anything concrete, but I think I'll be in the thinking phase for a bit here. Thanks everyone, for keeping it real.
Wednesday, November 5, 2008
Evelyn 1919-2008
Yesterday was a strange mixture of sadness and joy for me. Sometime in the early morning hours, my grandmother died. I learned that she was near death on Sunday night, and my deliberations about whether to go see her or not settled themselves quickly. It was really too late to leave on Sunday, but I finished my second case in the OR on Monday and excused myself to make the 6 hour drive, hoping she would still be there when I arrived.
I arrived around 9 pm. She was not conscious, and her breathing was halting and irregular. I wanted to remove the oxygen that was still being delivered to her, to avoid prolonging the inevitable unnecessarily. But I knew that the facility she was in couldn't do that without the doctor's permission (or at least hospice's okay), and I didn't want to put them in a bad position by doing it myself--plus the rest of my family might not have seen it the same way I did. At any rate, I don't think it mattered much. I held her hand and sang to her a little bit, told her I loved her and told her it was okay to go when she was ready. I left around 10pm, and she died a few hours later, in the early hours of Election Day.
My grandmother was a staunch Republican, for whom even Sarah Palin was not conservative enough. Oregon is an exclusively vote-by-mail state, and she made sure to vote while she was still able. That remained important to her even as she knew she was dying. I'm actually not certain if her vote was legal if she died on Election Day, but I'm certain it was counted nonetheless. She was resigned to the fact that John McCain was not going to win the election, though.
But my politics were very different from both of my grandparents. I have nothing but tremendous hope and pride in my country for our historic participation in democracy, and in our ability to elect one I feel is a transformational leader, Barack Obama. The only way this could happen in America was for people who really believed they could make a difference to get out and vote, and for people to really consider the man and his arguments rather than his race. Here on the "Left Coast" I think people take for granted the kind of advancements that the country has made in the last 50 years, and in doing that I think we tend to believe that we have advanced further than a realistic look at race relations in all of America actually reveals. There is still a great deal of oppression, more covert than in years past, and we have taken one step forward in this election--even people who did not think Obama was the best candidate seem to recognize this achievement. And I for one was really touched by McCain's classy concession speech, which seemed like a return to the John McCain we knew before the campaign really got heated. (I understand that there are politics in play with any concession speech, but I felt he meant what he said.)
All in all, I was proud of this country yesterday, and today. I hope that we can all come together to face the challenges of today and tomorrow. I think my grandmother would have recognized this if she had lived to see it, even if the person she voted for didn't win. For all her conservative politics and fundamentalist Christian beliefs, she had many surprises for us all. I remember growing up believing that she and my grandfather were racist, and perhaps they were--but in the last 10 years they both proved to me that this was either untrue or that their views had changed. This is a remarkable thing to happen so late in life, by people who lived in an insular farming town where ethnic diversity was composed entirely of Mexican migrant workers showing up on their farm for day labor.
My grandmother had a long career as a special education teacher, in addition to raising 3 kids and being a farmer's wife, which is itself a full time job. She received her master's degree around the time that my aunt, her middle child, graduated high school, and contemplated pursuing her doctorate but decided against it--this was still very rare in the 1960s, much less in a rural farming town. She was educated in the natural sciences as well, and had a zeal for learning and for teaching that influenced everyone around her. Even this year, she was mentoring teenagers at her church who she felt had the promise and ability to go to college but no one to encourage them in their abilities. She was the kind of Christian woman who sought out the holy books of every religion and sect and read them to better understand what they all were about. Her bookshelf had her well-worn and annotated Bible sitting next to copies of the Torah and the Book of Mormon, and numerous other religious books that she read for the sake of education. This was also unusual for a farmer's wife, but my grandmother was an unusual woman. Her intense curiosity must have been part of the impetus for my grandparents' globetrotting--they visited almost every continent after their retirement, and travelled extensively within North America. (They decided to retire from international travel when my grandfather was 90--it was becoming too difficult to make connecting flights and navigate complex itineraries, and keep up with their tour groups.)
My grandmother also played a significant role in the rearing of every one of her eight grandchildren. Three of them grew up on the family farm, which my aunt and uncle farmed. Their house was across the driveway from the stately farmhouse that my great-grandfather built, where my grandfather was born and lived his entire 92-year life. Two others lived at least part of their childhoods with my grandparents, and the rest of us spent summers and weekends and holidays there. Grandma definitely helped raise us all. She also taught my cousins how to read, long before they started elementary school, and provided extensive pre-school education to them, because teaching was as natural to her as breathing. In addition to the eight grandchildren, they had nine great-grandchildren and one great-great-grandchild.
One remarkable thing about both of my grandparents was that they were not sentimental about old things or old times, and always strived for progress. My grandfather always sought out the latest and best methods and equipment to run his farm, which he took great pride in growing as a profitable business as well as a physically beautiful place. My grandmother was similarly minded about embracing progress, and not the least sentimental. She cleaned out the farmhouse of all but the most cherished antique things, and donated them to the county historical society, where she worked for many years in her retirement. She then redecorated and remodelled the place, and fought to keep the house off the historical register so that they wouldn't have to have every change they wanted to make to their home approved by the county. I would like to think that these ways of thinking contributed to their growing acceptance of the more diverse world as times changed, and that even though they feared rising taxes and other signs of impending liberalism, they would have seen the good in what happened in yesterday's election.
I arrived around 9 pm. She was not conscious, and her breathing was halting and irregular. I wanted to remove the oxygen that was still being delivered to her, to avoid prolonging the inevitable unnecessarily. But I knew that the facility she was in couldn't do that without the doctor's permission (or at least hospice's okay), and I didn't want to put them in a bad position by doing it myself--plus the rest of my family might not have seen it the same way I did. At any rate, I don't think it mattered much. I held her hand and sang to her a little bit, told her I loved her and told her it was okay to go when she was ready. I left around 10pm, and she died a few hours later, in the early hours of Election Day.
My grandmother was a staunch Republican, for whom even Sarah Palin was not conservative enough. Oregon is an exclusively vote-by-mail state, and she made sure to vote while she was still able. That remained important to her even as she knew she was dying. I'm actually not certain if her vote was legal if she died on Election Day, but I'm certain it was counted nonetheless. She was resigned to the fact that John McCain was not going to win the election, though.
But my politics were very different from both of my grandparents. I have nothing but tremendous hope and pride in my country for our historic participation in democracy, and in our ability to elect one I feel is a transformational leader, Barack Obama. The only way this could happen in America was for people who really believed they could make a difference to get out and vote, and for people to really consider the man and his arguments rather than his race. Here on the "Left Coast" I think people take for granted the kind of advancements that the country has made in the last 50 years, and in doing that I think we tend to believe that we have advanced further than a realistic look at race relations in all of America actually reveals. There is still a great deal of oppression, more covert than in years past, and we have taken one step forward in this election--even people who did not think Obama was the best candidate seem to recognize this achievement. And I for one was really touched by McCain's classy concession speech, which seemed like a return to the John McCain we knew before the campaign really got heated. (I understand that there are politics in play with any concession speech, but I felt he meant what he said.)
All in all, I was proud of this country yesterday, and today. I hope that we can all come together to face the challenges of today and tomorrow. I think my grandmother would have recognized this if she had lived to see it, even if the person she voted for didn't win. For all her conservative politics and fundamentalist Christian beliefs, she had many surprises for us all. I remember growing up believing that she and my grandfather were racist, and perhaps they were--but in the last 10 years they both proved to me that this was either untrue or that their views had changed. This is a remarkable thing to happen so late in life, by people who lived in an insular farming town where ethnic diversity was composed entirely of Mexican migrant workers showing up on their farm for day labor.
My grandmother had a long career as a special education teacher, in addition to raising 3 kids and being a farmer's wife, which is itself a full time job. She received her master's degree around the time that my aunt, her middle child, graduated high school, and contemplated pursuing her doctorate but decided against it--this was still very rare in the 1960s, much less in a rural farming town. She was educated in the natural sciences as well, and had a zeal for learning and for teaching that influenced everyone around her. Even this year, she was mentoring teenagers at her church who she felt had the promise and ability to go to college but no one to encourage them in their abilities. She was the kind of Christian woman who sought out the holy books of every religion and sect and read them to better understand what they all were about. Her bookshelf had her well-worn and annotated Bible sitting next to copies of the Torah and the Book of Mormon, and numerous other religious books that she read for the sake of education. This was also unusual for a farmer's wife, but my grandmother was an unusual woman. Her intense curiosity must have been part of the impetus for my grandparents' globetrotting--they visited almost every continent after their retirement, and travelled extensively within North America. (They decided to retire from international travel when my grandfather was 90--it was becoming too difficult to make connecting flights and navigate complex itineraries, and keep up with their tour groups.)
My grandmother also played a significant role in the rearing of every one of her eight grandchildren. Three of them grew up on the family farm, which my aunt and uncle farmed. Their house was across the driveway from the stately farmhouse that my great-grandfather built, where my grandfather was born and lived his entire 92-year life. Two others lived at least part of their childhoods with my grandparents, and the rest of us spent summers and weekends and holidays there. Grandma definitely helped raise us all. She also taught my cousins how to read, long before they started elementary school, and provided extensive pre-school education to them, because teaching was as natural to her as breathing. In addition to the eight grandchildren, they had nine great-grandchildren and one great-great-grandchild.
One remarkable thing about both of my grandparents was that they were not sentimental about old things or old times, and always strived for progress. My grandfather always sought out the latest and best methods and equipment to run his farm, which he took great pride in growing as a profitable business as well as a physically beautiful place. My grandmother was similarly minded about embracing progress, and not the least sentimental. She cleaned out the farmhouse of all but the most cherished antique things, and donated them to the county historical society, where she worked for many years in her retirement. She then redecorated and remodelled the place, and fought to keep the house off the historical register so that they wouldn't have to have every change they wanted to make to their home approved by the county. I would like to think that these ways of thinking contributed to their growing acceptance of the more diverse world as times changed, and that even though they feared rising taxes and other signs of impending liberalism, they would have seen the good in what happened in yesterday's election.
Sunday, November 2, 2008
November already
Halloween 2008 is now a distant memory. I went to a work party on Saturday...you all know how dangerous those can be. We didn't stay too long. I was Marilyn Monroe (one of 3 there!) and my hubby was a fantastic Elvis. I drank a bit...more than I had originally planned, but not enough to embarrass myself in front of the people who are my preceptors for the next 18 months, thankfully. But this year I was more bothered than I have been in the past by the costumes that are commercially available for women. Why are they all so slutty? It was very hard to find something that I thought was work-appropriate, yet still attractive. It turned out that many of the women there weren't that bothered by the notion of dressing like a skank in front of one's coworkers.
I decided today that if I plan on not becoming tremendously fat again soon, I ought to start cooking again. I've been sort of getting by on things I can throw together quickly, which don't tend to be the best for you, of course. So I pulled out some favorite cookbooks and got started. The first thing I made was a "hot dish" type of casserole that is traditionally laden with sour cream and cheese, but I made it healthier (and more protein) by using nonfat greek yogurt instead of sour cream, and adding Morningstar Farms fake ground beef for a little more protein. It's quite yummy and not as sinful as the original by far. Later I plan on making some Wasabi Mashed Sweet Potatoes. Doesn't that sound strange and yummy? Decent nutritional profile too, though I'll have to dream up a way to get some more protein in them.
My grandmother is doing worse than before, and I need to evaluate tomorrow whether I ought to come back to Salem to see her before she dies. Everything in me longs to just go see her now, but I at least need to get through clinicals tomorrow first, and I want to call my aunt and uncle to see if she is alert enough to know if I am there. But either way, I'm torn on what I should do. I feel like I should try to get as much school in as possible, since it's so easy to get behind and so hard to catch up. But this is my grandma, probably my favorite person in my whole family (maybe just my favorite person, besides my hubby). And it's hard for me to concentrate on my schoolwork when I know she is dying. It's so hard to make these kinds of decisions. If I was still working I wouldn't be able to take this much time off at all--but then, if I was still working I'd be in Portland, and I'd be able to see her within a 45 minute drive, and I never worked more than 3 days in a row as an ICU nurse so I probably would have been able to see her more even if I couldn't take much time off. Not that it matters. My grandma is just a wonderful person, and I'm so lucky that I've had her in my life for over 35 years. It's hard to let go.
I decided today that if I plan on not becoming tremendously fat again soon, I ought to start cooking again. I've been sort of getting by on things I can throw together quickly, which don't tend to be the best for you, of course. So I pulled out some favorite cookbooks and got started. The first thing I made was a "hot dish" type of casserole that is traditionally laden with sour cream and cheese, but I made it healthier (and more protein) by using nonfat greek yogurt instead of sour cream, and adding Morningstar Farms fake ground beef for a little more protein. It's quite yummy and not as sinful as the original by far. Later I plan on making some Wasabi Mashed Sweet Potatoes. Doesn't that sound strange and yummy? Decent nutritional profile too, though I'll have to dream up a way to get some more protein in them.
My grandmother is doing worse than before, and I need to evaluate tomorrow whether I ought to come back to Salem to see her before she dies. Everything in me longs to just go see her now, but I at least need to get through clinicals tomorrow first, and I want to call my aunt and uncle to see if she is alert enough to know if I am there. But either way, I'm torn on what I should do. I feel like I should try to get as much school in as possible, since it's so easy to get behind and so hard to catch up. But this is my grandma, probably my favorite person in my whole family (maybe just my favorite person, besides my hubby). And it's hard for me to concentrate on my schoolwork when I know she is dying. It's so hard to make these kinds of decisions. If I was still working I wouldn't be able to take this much time off at all--but then, if I was still working I'd be in Portland, and I'd be able to see her within a 45 minute drive, and I never worked more than 3 days in a row as an ICU nurse so I probably would have been able to see her more even if I couldn't take much time off. Not that it matters. My grandma is just a wonderful person, and I'm so lucky that I've had her in my life for over 35 years. It's hard to let go.
Monday, October 27, 2008
Top 10 Wishlist: Exports to Spokane
Top 10 Things I Would Like to Export from Portland to Spokane:
10. Portland's beautiful neighborhoods.
9. Customized, do-it-yourself bikes, and their wacky owners. And all the weird bike culture in Portland. And bike paths.
8. Trains that arrive and leave at reasonable hours.
7. Drinking fountains and public trash cans on the streets.
6. Mild winters that don't require snow tires.
5. Free public Wi-Fi clouds.
4. Coffee--a Stumptown would be heavenly. While we're dreaming, we could export my all-time favorite Portland coffee house, Albina Press.
3. Saburo's Sushi
2. My band surgeon, Emma Patterson.
1.My friends. Not just the ones from Portland, though. You know who you are!
10. Portland's beautiful neighborhoods.
9. Customized, do-it-yourself bikes, and their wacky owners. And all the weird bike culture in Portland. And bike paths.
8. Trains that arrive and leave at reasonable hours.
7. Drinking fountains and public trash cans on the streets.
6. Mild winters that don't require snow tires.
5. Free public Wi-Fi clouds.
4. Coffee--a Stumptown would be heavenly. While we're dreaming, we could export my all-time favorite Portland coffee house, Albina Press.
3. Saburo's Sushi
2. My band surgeon, Emma Patterson.
1.My friends. Not just the ones from Portland, though. You know who you are!
Sunday, October 26, 2008
Right or Left?
I listen to a lot of podcasts, mainly because I drive a lot between Spokane and Portland (a 400 mile trip) and like to have intellectually stimulating things to listen to. One podcast that I enjoy is Speaking of Faith, by Krista Tippet and American Public Media. I do not particularly consider myself a religious person, for many reasons. But I enjoy these podcasts, which Tippet describes as “public radio’s conversation about religion, meaning, ethics and ideas.” They cover a great variety of religions and personalities within the world of faith, and speak of them in a particularly informed, nuanced way.
On my trip back to Portland on Friday, I listened to Tippet’s two part exploration of the faith life of both the left and right wings of the American political system. Both parts were extremely interesting; in fact, I found myself identifying more with the conservative commentator (Rod Dreyer) than the liberal one (Amy Sullivan). Mainly I think this series illustrated to me the main reason that I have ceased identifying as a religious person, as well as my reluctance to declare my political stance to even myself, much less to the world. The conversation on Tippet’s program basically addressed all the people caught in the gray no man’s land in the midst of this country’s two party system: liberals who are evangelical Christians, for example, and conservatives who have values that have traditionally been held as “liberal” views, such as eating sustainably grown food. There was a lot of conversation about the modern American impasse when discussing abortion, and the need for a different kind of dialogue about it so that some sort of progress may be made. They also discussed, in both segments, the idea that Christianity is exclusively the realm of Republicans, and that Republicans are by default, evangelical Christians.
I guess the thing that really resonated for me was the reason that we have a two party political system in American: our thoughts in this country about issues of culture, policy and faith are black and white. The US has a history of trying with all of its might to erase the gray in all issues. Things are one way or another. One of the unfortunate results of this is that many Americans are alienated by this because we do not fit neatly into one of the two boxes. In fact, I would argue that MOST Americans do not fit into the boxes the way we are “supposed” to. And this perception is passed on to the rest of the world, because we perpetuate it. The world perceives us as either super-conservative, uneducated religious fanatics who are rude and self centered, or passive, bleeding-heart activists who are filled with self-loathing over our citizenship. There are very few people who actually fit into these gross stereotypes, of course, but we allow this perception to be perpetuated. Our political system aptly illustrates it, and is part of the machinery that foments anti-American sentiment.
I have said on this blog before that intellect is under attack these days in American politics. I think this is part of the loss of nuance in political discussions. I also think that the attempts of the Republican party to associate themselves in the minds of Americans with evangelical Christianity has driven many more liberal people away from Christianity. It certainly happened that way for me—I have to admit that despite knowing some loving Christian people who do believe in social justice and equality for humans, as a whole I shy away from that faith because of the history and the association that I make with conservative politics.
For those people who wish to see more in-depth discussion of all the aspects of the issues we care about, rather than the sound-bite parsing of the conversation that happens today (yes, I am speaking of the dreaded “MSM” but more of the convenient way that we allow this to occur in our daily lives), I recommend checking out this podcast. Go to www.speakingoffaith.org.
On my trip back to Portland on Friday, I listened to Tippet’s two part exploration of the faith life of both the left and right wings of the American political system. Both parts were extremely interesting; in fact, I found myself identifying more with the conservative commentator (Rod Dreyer) than the liberal one (Amy Sullivan). Mainly I think this series illustrated to me the main reason that I have ceased identifying as a religious person, as well as my reluctance to declare my political stance to even myself, much less to the world. The conversation on Tippet’s program basically addressed all the people caught in the gray no man’s land in the midst of this country’s two party system: liberals who are evangelical Christians, for example, and conservatives who have values that have traditionally been held as “liberal” views, such as eating sustainably grown food. There was a lot of conversation about the modern American impasse when discussing abortion, and the need for a different kind of dialogue about it so that some sort of progress may be made. They also discussed, in both segments, the idea that Christianity is exclusively the realm of Republicans, and that Republicans are by default, evangelical Christians.
I guess the thing that really resonated for me was the reason that we have a two party political system in American: our thoughts in this country about issues of culture, policy and faith are black and white. The US has a history of trying with all of its might to erase the gray in all issues. Things are one way or another. One of the unfortunate results of this is that many Americans are alienated by this because we do not fit neatly into one of the two boxes. In fact, I would argue that MOST Americans do not fit into the boxes the way we are “supposed” to. And this perception is passed on to the rest of the world, because we perpetuate it. The world perceives us as either super-conservative, uneducated religious fanatics who are rude and self centered, or passive, bleeding-heart activists who are filled with self-loathing over our citizenship. There are very few people who actually fit into these gross stereotypes, of course, but we allow this perception to be perpetuated. Our political system aptly illustrates it, and is part of the machinery that foments anti-American sentiment.
I have said on this blog before that intellect is under attack these days in American politics. I think this is part of the loss of nuance in political discussions. I also think that the attempts of the Republican party to associate themselves in the minds of Americans with evangelical Christianity has driven many more liberal people away from Christianity. It certainly happened that way for me—I have to admit that despite knowing some loving Christian people who do believe in social justice and equality for humans, as a whole I shy away from that faith because of the history and the association that I make with conservative politics.
For those people who wish to see more in-depth discussion of all the aspects of the issues we care about, rather than the sound-bite parsing of the conversation that happens today (yes, I am speaking of the dreaded “MSM” but more of the convenient way that we allow this to occur in our daily lives), I recommend checking out this podcast. Go to www.speakingoffaith.org.
Wednesday, October 22, 2008
Kenneth 1915-2008
My grandfather spent about one week in the ICU. After a few days, they placed a tracheostomy and a feeding tube, in hopes that he would be able to communicate better and would be more comfortable. It was very difficult to tell if he was mentally intact or not, but he was answering questions appropriately and asking some of his own, mainly about my grandmother and asking to be shaved. However, despite being completely paralyzed from the neck down and remaining in bed on a ventilator for many days, with a cervical collar on, he appeared comfortable until Saturday.
I think on Saturday we realized that two things were happening: one, his memory was fading and his mental status was decreasing, and he was beginning to become uncomfortable with the immobility and being on a ventilator. At the same time, perhaps paradoxically, he was starting to realize that he wasn't going to get better or go home. For my grandfather, who was born in the house that he lived in his entire life, and who farmed the same land--with one arm--that entire time, this was unacceptable. The staff were beginning to talk about placing him in a nursing home. After all, his heart was starting to become irritable, but he was showing no signs of dying imminently. The only nursing home that could manage a paralyzed patient on a ventilator was in Vancouver, WA, which is about an hour from the nearest family members. We all realized that this was not a viable option for him.
So Saturday night we were all thinking about the same thing: my grandfather was not able to make his own decisions reliably any more, and continuing treatment would only delay the inevitable. No one wanted to have to decide to withdraw support, though (turn off the ventilator). Sunday morning, the neurosurgeon had a talk with my grandfather, and he told her that he wanted the ventilator turned off.
We all gathered at the hospital--his 3 kids, 4 of his 8 grandchildren, and all the spouses, plus a great-grandson. My grandmother couldn't be there, as she was still pretty ill and at another hospital. We met with the neurosurgeon and the trauma surgeon and went over what he had said and what the situation looked like for Grandpa. They told us how withdrawal of support would occur--he would be medicated with enough morphine that he was asleep, and then the ventilator would be disconnected from the trach. Everyone was comfortable enough with this to proceed.
As an ICU RN, I have withdrawn support on more patients than I can count. It is surprisingly frequent that we reach a point in our advanced medical treatment that continuing treatment only prolongs the inevitable. I have come to see this as a loving choice that families can make to end their loved ones' suffering, without actually causing death. (It is very different from euthanasia, although both are aimed at ending the suffering. Withdrawing support just means that the artificial interventions, or "life support", that are the only way the patient is not dying a natural death, are removed. This is called "comfort care" sometimes because medications are used to help the patient be as comfortable as possible.) I've always considered it a great honor to be present at this time in a patient's life. As a family member, I was actually prepared for this step when I first learned the nature of my grandfather's injury. I knew that 92 year old men do not live long as C1 quadriplegics, even with the most advanced treatment available. I also knew that his advance directive stated he did not want to be maintained on life support.
What happened next was really beautiful. We all gathered in his room by his bed, and one by one we told him that we loved him and that the family would be okay. He got to talk to us a bit as well, although it was hard to read his lips and he couldn't really "talk" with the trach. Then he got some IV morphine, and went to sleep. The ventilator was taken off, and he took some very tiny breaths, but couldn't do much because of how high his spinal cord injury was. I stroked his forehead as he had fewer breaths and turned a little dusky. Within 4 minutes he was gone.
My grandfather was a great man. He was well known and loved in his community. He lived his whole life in a farming town with a population of about 60. He lost his left arm in a farming accident when he was 18, but you never met a harder working man, and no one who knew him ever thought of him as handicapped by his injury. With little exception, he didn't sit still for long, which was why at 92 he still only looked about 70. He raised 3 kids and helped raise most of his grandkids as well. He had 9 great-grandchildren, and lived to become a great-great-grandfather, as well. He loved little kids, who were invariably fascinated by his hook instead of a hand. He had a special weakness for his granddaughters and great-granddaughters, and this would exasperate my grandmother at times. But he taught us all the value of honesty and hard work.
My grandmother won't be able to make his funeral this weekend. She is too weakend by her severe, end-stage heart disease and her injuries from the accident. She was just discharged yesterday to a home where she will be on hospice; she couldn't return to their home, either, because she can't go up any steps without severe chest pain, and needs assistance to even get to the restroom. We don't know how much longer we will have her with us, so I'm trying to see her as much as I can.
I came back to school yesterday, but it's hard for me to concentrate or get back into the swing of things. I have a lot of studying to do, but don't seem to be able to stay on task for very long. I did get a nice 5 mile run in today; running has been sporadic these past 2 weeks. And I am so sick of fast food, after grabbing whatever I can get between one hospital and the other. I have gone up and down a couple pounds, but have basically stayed about where I was when this all began. But all of this will sort itself out with time, I'm sure.
At 92 and 88 years old, my grandparents were prepared for death. They had advance directives and powers of attorney, wills and trusts all drawn up, and prepaid and prearranged their funerals. It was all neatly laid out in well-labeled file folders where my aunt could easily find everything. They didn't want to live forever. And I didn't want them to, either; as much as I've seen of life and death as a nurse, I know there are worse things than dying after a long, happy, healthy life. But this is not the end that I ever wanted or envisioned for them. At that age, you should get to die in your sleep, not deal with this kind of pain and suffering. And as much as they tried to prevent us from having to make difficult decisions about them, with their advance directive, the paperwork didn't really cover this sort of situation, so we were left with shades of gray to navigate. Trying to decide the right thing to do is not easy in a situation like this--and what one family member thinks is right might not be what another one is comfortable with.
I'm just grateful for the time I was able to spend with my family, and especially with my grandparents. I'm glad I was able to help my family navigate the health care system somewhat, and understand a bit more about the injuries they sustained. Being on the other end of the trauma system--the family end, instead of the provider end--is not something I recommend for anyone. But I am grateful that both of my grandparents received excellent nursing and medical care.
I think on Saturday we realized that two things were happening: one, his memory was fading and his mental status was decreasing, and he was beginning to become uncomfortable with the immobility and being on a ventilator. At the same time, perhaps paradoxically, he was starting to realize that he wasn't going to get better or go home. For my grandfather, who was born in the house that he lived in his entire life, and who farmed the same land--with one arm--that entire time, this was unacceptable. The staff were beginning to talk about placing him in a nursing home. After all, his heart was starting to become irritable, but he was showing no signs of dying imminently. The only nursing home that could manage a paralyzed patient on a ventilator was in Vancouver, WA, which is about an hour from the nearest family members. We all realized that this was not a viable option for him.
So Saturday night we were all thinking about the same thing: my grandfather was not able to make his own decisions reliably any more, and continuing treatment would only delay the inevitable. No one wanted to have to decide to withdraw support, though (turn off the ventilator). Sunday morning, the neurosurgeon had a talk with my grandfather, and he told her that he wanted the ventilator turned off.
We all gathered at the hospital--his 3 kids, 4 of his 8 grandchildren, and all the spouses, plus a great-grandson. My grandmother couldn't be there, as she was still pretty ill and at another hospital. We met with the neurosurgeon and the trauma surgeon and went over what he had said and what the situation looked like for Grandpa. They told us how withdrawal of support would occur--he would be medicated with enough morphine that he was asleep, and then the ventilator would be disconnected from the trach. Everyone was comfortable enough with this to proceed.
As an ICU RN, I have withdrawn support on more patients than I can count. It is surprisingly frequent that we reach a point in our advanced medical treatment that continuing treatment only prolongs the inevitable. I have come to see this as a loving choice that families can make to end their loved ones' suffering, without actually causing death. (It is very different from euthanasia, although both are aimed at ending the suffering. Withdrawing support just means that the artificial interventions, or "life support", that are the only way the patient is not dying a natural death, are removed. This is called "comfort care" sometimes because medications are used to help the patient be as comfortable as possible.) I've always considered it a great honor to be present at this time in a patient's life. As a family member, I was actually prepared for this step when I first learned the nature of my grandfather's injury. I knew that 92 year old men do not live long as C1 quadriplegics, even with the most advanced treatment available. I also knew that his advance directive stated he did not want to be maintained on life support.
What happened next was really beautiful. We all gathered in his room by his bed, and one by one we told him that we loved him and that the family would be okay. He got to talk to us a bit as well, although it was hard to read his lips and he couldn't really "talk" with the trach. Then he got some IV morphine, and went to sleep. The ventilator was taken off, and he took some very tiny breaths, but couldn't do much because of how high his spinal cord injury was. I stroked his forehead as he had fewer breaths and turned a little dusky. Within 4 minutes he was gone.
My grandfather was a great man. He was well known and loved in his community. He lived his whole life in a farming town with a population of about 60. He lost his left arm in a farming accident when he was 18, but you never met a harder working man, and no one who knew him ever thought of him as handicapped by his injury. With little exception, he didn't sit still for long, which was why at 92 he still only looked about 70. He raised 3 kids and helped raise most of his grandkids as well. He had 9 great-grandchildren, and lived to become a great-great-grandfather, as well. He loved little kids, who were invariably fascinated by his hook instead of a hand. He had a special weakness for his granddaughters and great-granddaughters, and this would exasperate my grandmother at times. But he taught us all the value of honesty and hard work.
My grandmother won't be able to make his funeral this weekend. She is too weakend by her severe, end-stage heart disease and her injuries from the accident. She was just discharged yesterday to a home where she will be on hospice; she couldn't return to their home, either, because she can't go up any steps without severe chest pain, and needs assistance to even get to the restroom. We don't know how much longer we will have her with us, so I'm trying to see her as much as I can.
I came back to school yesterday, but it's hard for me to concentrate or get back into the swing of things. I have a lot of studying to do, but don't seem to be able to stay on task for very long. I did get a nice 5 mile run in today; running has been sporadic these past 2 weeks. And I am so sick of fast food, after grabbing whatever I can get between one hospital and the other. I have gone up and down a couple pounds, but have basically stayed about where I was when this all began. But all of this will sort itself out with time, I'm sure.
At 92 and 88 years old, my grandparents were prepared for death. They had advance directives and powers of attorney, wills and trusts all drawn up, and prepaid and prearranged their funerals. It was all neatly laid out in well-labeled file folders where my aunt could easily find everything. They didn't want to live forever. And I didn't want them to, either; as much as I've seen of life and death as a nurse, I know there are worse things than dying after a long, happy, healthy life. But this is not the end that I ever wanted or envisioned for them. At that age, you should get to die in your sleep, not deal with this kind of pain and suffering. And as much as they tried to prevent us from having to make difficult decisions about them, with their advance directive, the paperwork didn't really cover this sort of situation, so we were left with shades of gray to navigate. Trying to decide the right thing to do is not easy in a situation like this--and what one family member thinks is right might not be what another one is comfortable with.
I'm just grateful for the time I was able to spend with my family, and especially with my grandparents. I'm glad I was able to help my family navigate the health care system somewhat, and understand a bit more about the injuries they sustained. Being on the other end of the trauma system--the family end, instead of the provider end--is not something I recommend for anyone. But I am grateful that both of my grandparents received excellent nursing and medical care.
Thursday, October 16, 2008
Google Reader
I have not kept up on my sistas' blogs. First it was school, now it's family...I feel so behind. But today I set up a Google Reader page and put all my blogs on it. It's so easy, and they're all in one place so I can hunker down and get all caught up. I don't have a TV in Spokane but this is just as good.
Go to www.google.com/reader and set yours up! I know there are other feed readers and whatnot but this is just so simple and easy to use, I love it.
Go to www.google.com/reader and set yours up! I know there are other feed readers and whatnot but this is just so simple and easy to use, I love it.
Article: Why Food Is Addictive For Some Women
I'm posting this now because I think it's relevent and interesting, and because reading it gave me something to think about other than what is happening with my grandparents.
I don't think this idea applies just to women. We had an interesting discussion the other day while waiting to talk to my grandmother's cardiologist at the hospital. It turns out every one of my grandparents' kids has a profound sweet tooth--their sons maybe even more than their daughter. It's been passed on to many, but not all of us grandkids. How much is genetic vs. learned behavior is hard to say.
The Pleasure Factor
Using milkshakes and brain scans, researchers find that some women are genetically predisposed to get less enjoyment from eating and may overeat to compensate.
By Sarah Kliff NEWSWEEK
Published Oct 16, 2008
It was a difficult question for obesity researchers: do some people overeat because they find eating more pleasurable or gratifying than others? Logically, that makes a lot of sense—it's a time-tested principle of psychology: if a behavior feels good, we'll keep doing it. But a new study published today in the journal Science adds to a growing body of research suggesting the opposite: that women who derive less pleasure from eating may eat more to compensate, putting them at higher risk for weight gain and obesity. The research also discovered a particular genetic trait that, when present, is associated with an even stronger relationship between low sense of reward and overeating.
"If you ask overweight individuals if they crave food, I really think they are legitimately thinking it's more rewarding," says study author Eric Stice, a senior scientist at the Oregon Research Institute. "They'll say they're really sensitive to the rewards. But when you look at the brain scans you get a different picture."
Previous brain imaging studies have looked at what happens when we look at pictures of food. In those cases, obese individuals tend to anticipate a higher level of satisfaction of eating the pictured food than lean individuals do, supporting the idea that the people who overeat are the ones who find it more rewarding. But the Science study was the first to do those same fMRI scans while participants were actually eating—or, in this case, drinking a chocolate milkshake.
"Nobody had ever administered food to people in a brain scanner and looked at what happens in the brain while you're eating," says Stice. "Now we have evidence that, when you give an obese individual a chocolate milkshake, there's less of a response going on."
What they found had a lot to do with dopamine, a neurotransmitter typically released in response to a pleasurable experience. Using an fMRI machine, the researchers measured the activity in an area of the brain that tends to be a hub for dopamine, called the dorsal striatum, when women had either a pleasurable food (the chocolate milkshake) or a control food (a tasteless solution). Obese women showed less activity in that region of the brain when they drank the milkshake compared to their leaner counterparts. And when researchers followed up with their participants a year later, they found those with decreased activity were also more likely to have gained weight. The more an individual overeats, the less potent the rewards from eating become and that creates a pattern of overeating. "The new bit is that once you start down that obesity track, it's hard to get back off," says Stice.
That risk was particularly pronounced among individuals with a particular genetic variation known as the Taq1A1 allele, suggesting a genetic disposition for weight gain—what other researchers call the most significant finding of this study. "What this research does to move things forward is identify a genetic component to brain functioning in obese people," says Gene-Jack Wang, a scientist with the Brookhaven National Laboratory. "This is a gene that can go any direction and these people are potentially more vulnerable [to having lower levels of dopamine]."
The study results reinforce the notion of obesity as similar to drug addiction, a comparison that researchers have been toying around with for the past few years. Dopamine has played a critical role in addiction research, where researchers have seen a similar pattern. "This research follows what we have seen in addictive people," says Nora Volkow, director of the National Institute on Drug Abuse. "At first we thought they were more sensitive to pleasurable responses. But research has shown exactly the opposite, that they have a blunted response to drugs and release much less dopamine. With obesity, it took everyone by surprise."
Researchers know that these findings of a genetic basis for low-reward overeating are important, but there's still a lingering question: how this research can best translate into obesity-prevention efforts. "A lot of things come out of this, a lot about future applications, possible drug treatments," says Wang. "It provides answers, but is also a bit of another Pandora's box." Wang and others know genetics is definitely not everything—rates of obesity have skyrocketed in the past century, far too quickly to be attributable to genetic variation alone—and that our nutritional environment plays an extremely significant role.
Still, if doctors can pinpoint genetic risk factors for obesity, it could reshape treatment: by, for example, identifying high-risk individuals early on or using pharmacologic interventions that could counterbalance low dopamine levels. Stice says he's not an advocate of genotyping, which he says would be "infeasible." Instead, he sees the main message of his study as a public-health warning, a strong reminder of why it's important to avoid overeating in the first place. "The more you eat, the less reward you get and the worse the problem is going to get," says Stice. Talk about a no-win situation.
© 2008
I don't think this idea applies just to women. We had an interesting discussion the other day while waiting to talk to my grandmother's cardiologist at the hospital. It turns out every one of my grandparents' kids has a profound sweet tooth--their sons maybe even more than their daughter. It's been passed on to many, but not all of us grandkids. How much is genetic vs. learned behavior is hard to say.
The Pleasure Factor
Using milkshakes and brain scans, researchers find that some women are genetically predisposed to get less enjoyment from eating and may overeat to compensate.
By Sarah Kliff NEWSWEEK
Published Oct 16, 2008
It was a difficult question for obesity researchers: do some people overeat because they find eating more pleasurable or gratifying than others? Logically, that makes a lot of sense—it's a time-tested principle of psychology: if a behavior feels good, we'll keep doing it. But a new study published today in the journal Science adds to a growing body of research suggesting the opposite: that women who derive less pleasure from eating may eat more to compensate, putting them at higher risk for weight gain and obesity. The research also discovered a particular genetic trait that, when present, is associated with an even stronger relationship between low sense of reward and overeating.
"If you ask overweight individuals if they crave food, I really think they are legitimately thinking it's more rewarding," says study author Eric Stice, a senior scientist at the Oregon Research Institute. "They'll say they're really sensitive to the rewards. But when you look at the brain scans you get a different picture."
Previous brain imaging studies have looked at what happens when we look at pictures of food. In those cases, obese individuals tend to anticipate a higher level of satisfaction of eating the pictured food than lean individuals do, supporting the idea that the people who overeat are the ones who find it more rewarding. But the Science study was the first to do those same fMRI scans while participants were actually eating—or, in this case, drinking a chocolate milkshake.
"Nobody had ever administered food to people in a brain scanner and looked at what happens in the brain while you're eating," says Stice. "Now we have evidence that, when you give an obese individual a chocolate milkshake, there's less of a response going on."
What they found had a lot to do with dopamine, a neurotransmitter typically released in response to a pleasurable experience. Using an fMRI machine, the researchers measured the activity in an area of the brain that tends to be a hub for dopamine, called the dorsal striatum, when women had either a pleasurable food (the chocolate milkshake) or a control food (a tasteless solution). Obese women showed less activity in that region of the brain when they drank the milkshake compared to their leaner counterparts. And when researchers followed up with their participants a year later, they found those with decreased activity were also more likely to have gained weight. The more an individual overeats, the less potent the rewards from eating become and that creates a pattern of overeating. "The new bit is that once you start down that obesity track, it's hard to get back off," says Stice.
That risk was particularly pronounced among individuals with a particular genetic variation known as the Taq1A1 allele, suggesting a genetic disposition for weight gain—what other researchers call the most significant finding of this study. "What this research does to move things forward is identify a genetic component to brain functioning in obese people," says Gene-Jack Wang, a scientist with the Brookhaven National Laboratory. "This is a gene that can go any direction and these people are potentially more vulnerable [to having lower levels of dopamine]."
The study results reinforce the notion of obesity as similar to drug addiction, a comparison that researchers have been toying around with for the past few years. Dopamine has played a critical role in addiction research, where researchers have seen a similar pattern. "This research follows what we have seen in addictive people," says Nora Volkow, director of the National Institute on Drug Abuse. "At first we thought they were more sensitive to pleasurable responses. But research has shown exactly the opposite, that they have a blunted response to drugs and release much less dopamine. With obesity, it took everyone by surprise."
Researchers know that these findings of a genetic basis for low-reward overeating are important, but there's still a lingering question: how this research can best translate into obesity-prevention efforts. "A lot of things come out of this, a lot about future applications, possible drug treatments," says Wang. "It provides answers, but is also a bit of another Pandora's box." Wang and others know genetics is definitely not everything—rates of obesity have skyrocketed in the past century, far too quickly to be attributable to genetic variation alone—and that our nutritional environment plays an extremely significant role.
Still, if doctors can pinpoint genetic risk factors for obesity, it could reshape treatment: by, for example, identifying high-risk individuals early on or using pharmacologic interventions that could counterbalance low dopamine levels. Stice says he's not an advocate of genotyping, which he says would be "infeasible." Instead, he sees the main message of his study as a public-health warning, a strong reminder of why it's important to avoid overeating in the first place. "The more you eat, the less reward you get and the worse the problem is going to get," says Stice. Talk about a no-win situation.
© 2008
Hiatus: Bad Week
This past weekend was supposed to be all about networking: I planned to go back to Portland for OHSU's Anesthesia Conference, where I would have a chance to meet Oregon CRNAs and scope out the job market.
Before that was able to happen, I had a day and a half of clinicals. On Thursday I was scheduled to provide anesthesia for a patient undergoing an aortic stent-graft, which was supposed to treat his aortic aneurysm. It is inserted through a large artery in the leg. The patient looked fairly ill, with fairly severe vascular, lung, and kidney disease. He had had some teeth removed a few months before to prepare for this surgery, and during that case he had dropped his blood pressure to an extremely low level, requiring more than one medication to keep it up. So we knew that it would be a risky procedure for this patient, and we prepared all the medications we thought we might need, and planned to do it with him deeply sedated rather than as a general anesthetic. (It's not unusual to do this procedure under deep sedation, but more common to do a GA.)
As we were preparing the patient in the OR, we gave him a tiny bit of sedation and a tiny bit of pain medicine. As I went around to place an arterial line in his wrist, my preceptor gave him a tiny bit more medicine because what I had given hadn't affected him yet. Then the patient complained of feeling "funny", turned purple and stopped breathing. We checked for a pulse and found none--started CPR. The code continued for about an hour and a half until we were finally able to transfer him to the ICU.
That was Thursday.
Friday I had a half day of clinicals so I could start driving to Portland early and get there in time for the networking reception downtown. While I was at the reception, my father called and left the same message he always leaves me when he calls: "It's Dad. Call me." I got the message around 8, and planned on calling him the next morning.
Saturday I went to the conference, which was very good. I turned off my ringer out of courtesy to the speakers, but towards the end of the day heard a few calls vibrating on my phone. On my way out of the auditorium, I listened to the voicemails, one from Dad and one from my brother. Just seeing that they had both called, I knew something was wrong. It turns out that my grandparents were in a bad car accident on Friday evening. My grandfather, who is 92, was driving my 88 year old grandmother somewhere. There's a 2 lane highway near their small farming town in Oregon, and my grandfather was trying to cross the highway and was hit by another car. Both of them were taken to different hospitals about 40 miles apart. The occupants of the other car had minor injuries.
(I'll interject here that our family has been trying to get Grandpa to stop driving for years. It is nearly impossible to get an independent, elderly adult to stop driving in this country, despite all the evidence in the world that the driver is no longer safe. Ironically he had actually tried to get his own mother to stop driving when she was in her 90s, and was unsuccessful, but that didn't help him see that he shouldn't be driving, either. Grandma used to drive instead until her heart attack last year, and now she can't. Not that she should be, either. But she would have been safer.)
My grandmother has bruising on her lungs and heart, and a broken rib. In a healthy person this would be a relatively minor injury and would heal without any problems. But my grandmother has bad cardiovascular disease, and has been intolerant of exercise since she had a heart attack about a year ago. Now, she was having constant chest pain and signs on her EKG that her heart was not getting enough oxygen--which is what causes heart attacks, ultimately. The accident was on Friday, she was in the ICU until Sunday and they moved her to the step down unit. She was still having severe chest pain the whole time, and they decided to do an angiogram to see if there was something they could treat to relieve the pain--even though they knew her heart disease was severe, and she was not a candidate for bypass surgery. What they found was that her heart disease is even worse than they thought, that she had had another heart attack, that all of her major vessels are blocked, and that she is expected to live no more than a few weeks. The plan is to discharge her from the hospital to hospice once her chest pain is under better control.
My grandfather was brought to another hospital about 40 miles south. He was not breathing initially, and his heart stopped a few times between the accident and the hospital. The reason he wasn't breathing is because he sustained a very high spinal cord injury in the accident--essentially the same injury Christopher Reeve had. He is unable to move his arms or legs, or breathe without a ventilator. For the first 24 hours, he was unresponsive. The family gathered and brought in their advance directive, which said basically that he didn't want artificial life support. Then, he woke up. A few more days were spent examining his situation and determining that he can actually respond by blinking and sticking out his tongue to yes/no questions, and that he seems to understand what is explained to him. Because of this, his advance directive is not effective until he is no longer responsive, and he has indicated that he wants to continue treatment. But remember, he is 92 years old. A healthy young person with this injury has a life expectancy of 2-5 years. Christopher Reeve survived 9 years with the best care money could buy--and he still died from complications related to his immobility. Even if my grandfather wishes to be sent to a nursing home on a ventilator, and despite his excellent health for a 92 year old man, he will not live long this way.
So this is why I haven't been blogging. I am taking a temporary leave from school while we deal with all of this. I don't know how long any of this is going to last. Both of my grandparents remain alert and able to interact; my grandmother is just as funny and smart as ever, but she knows that both of their conditions are grave. It is unlikely that they will see each other before they die. They are the hub of our family; they have been farming the family farm their whole lives, living in the house in which my grandfather was born. They now have a 5 generation family--they became great-great grandparents 2 years ago. I remained in Oregon until yesterday, when I finally had to get back to Spokane since I was only packed for 2 days, and I hadn't planned on anyone looking in on my cat. I'll head back either today or tomorrow morning and see what the weekend brings.
Before that was able to happen, I had a day and a half of clinicals. On Thursday I was scheduled to provide anesthesia for a patient undergoing an aortic stent-graft, which was supposed to treat his aortic aneurysm. It is inserted through a large artery in the leg. The patient looked fairly ill, with fairly severe vascular, lung, and kidney disease. He had had some teeth removed a few months before to prepare for this surgery, and during that case he had dropped his blood pressure to an extremely low level, requiring more than one medication to keep it up. So we knew that it would be a risky procedure for this patient, and we prepared all the medications we thought we might need, and planned to do it with him deeply sedated rather than as a general anesthetic. (It's not unusual to do this procedure under deep sedation, but more common to do a GA.)
As we were preparing the patient in the OR, we gave him a tiny bit of sedation and a tiny bit of pain medicine. As I went around to place an arterial line in his wrist, my preceptor gave him a tiny bit more medicine because what I had given hadn't affected him yet. Then the patient complained of feeling "funny", turned purple and stopped breathing. We checked for a pulse and found none--started CPR. The code continued for about an hour and a half until we were finally able to transfer him to the ICU.
That was Thursday.
Friday I had a half day of clinicals so I could start driving to Portland early and get there in time for the networking reception downtown. While I was at the reception, my father called and left the same message he always leaves me when he calls: "It's Dad. Call me." I got the message around 8, and planned on calling him the next morning.
Saturday I went to the conference, which was very good. I turned off my ringer out of courtesy to the speakers, but towards the end of the day heard a few calls vibrating on my phone. On my way out of the auditorium, I listened to the voicemails, one from Dad and one from my brother. Just seeing that they had both called, I knew something was wrong. It turns out that my grandparents were in a bad car accident on Friday evening. My grandfather, who is 92, was driving my 88 year old grandmother somewhere. There's a 2 lane highway near their small farming town in Oregon, and my grandfather was trying to cross the highway and was hit by another car. Both of them were taken to different hospitals about 40 miles apart. The occupants of the other car had minor injuries.
(I'll interject here that our family has been trying to get Grandpa to stop driving for years. It is nearly impossible to get an independent, elderly adult to stop driving in this country, despite all the evidence in the world that the driver is no longer safe. Ironically he had actually tried to get his own mother to stop driving when she was in her 90s, and was unsuccessful, but that didn't help him see that he shouldn't be driving, either. Grandma used to drive instead until her heart attack last year, and now she can't. Not that she should be, either. But she would have been safer.)
My grandmother has bruising on her lungs and heart, and a broken rib. In a healthy person this would be a relatively minor injury and would heal without any problems. But my grandmother has bad cardiovascular disease, and has been intolerant of exercise since she had a heart attack about a year ago. Now, she was having constant chest pain and signs on her EKG that her heart was not getting enough oxygen--which is what causes heart attacks, ultimately. The accident was on Friday, she was in the ICU until Sunday and they moved her to the step down unit. She was still having severe chest pain the whole time, and they decided to do an angiogram to see if there was something they could treat to relieve the pain--even though they knew her heart disease was severe, and she was not a candidate for bypass surgery. What they found was that her heart disease is even worse than they thought, that she had had another heart attack, that all of her major vessels are blocked, and that she is expected to live no more than a few weeks. The plan is to discharge her from the hospital to hospice once her chest pain is under better control.
My grandfather was brought to another hospital about 40 miles south. He was not breathing initially, and his heart stopped a few times between the accident and the hospital. The reason he wasn't breathing is because he sustained a very high spinal cord injury in the accident--essentially the same injury Christopher Reeve had. He is unable to move his arms or legs, or breathe without a ventilator. For the first 24 hours, he was unresponsive. The family gathered and brought in their advance directive, which said basically that he didn't want artificial life support. Then, he woke up. A few more days were spent examining his situation and determining that he can actually respond by blinking and sticking out his tongue to yes/no questions, and that he seems to understand what is explained to him. Because of this, his advance directive is not effective until he is no longer responsive, and he has indicated that he wants to continue treatment. But remember, he is 92 years old. A healthy young person with this injury has a life expectancy of 2-5 years. Christopher Reeve survived 9 years with the best care money could buy--and he still died from complications related to his immobility. Even if my grandfather wishes to be sent to a nursing home on a ventilator, and despite his excellent health for a 92 year old man, he will not live long this way.
So this is why I haven't been blogging. I am taking a temporary leave from school while we deal with all of this. I don't know how long any of this is going to last. Both of my grandparents remain alert and able to interact; my grandmother is just as funny and smart as ever, but she knows that both of their conditions are grave. It is unlikely that they will see each other before they die. They are the hub of our family; they have been farming the family farm their whole lives, living in the house in which my grandfather was born. They now have a 5 generation family--they became great-great grandparents 2 years ago. I remained in Oregon until yesterday, when I finally had to get back to Spokane since I was only packed for 2 days, and I hadn't planned on anyone looking in on my cat. I'll head back either today or tomorrow morning and see what the weekend brings.
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