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Wednesday, November 25, 2015

The Elements of a Great Nurse

One of the things that I feel completely ambivalent about is the patient's evaluation of their hospital experience.  On the one hand, it is critical that health care as we move forward be transparent and inclusive of the patient and what is important to them.  On the other hand, asking very sick people to evaluate the care they got in the hospital can invite some very harsh words that are often undeserved.

That said, I feel compelled to write about the incredible people I have had care for me at the bedside this past couple of months.  I have had two prolongs hospitalizations and several shorter ones, and while I have been frustrated at times, most of it has to do with the inpatient pharmacy and the speed with which relief offering medications come.

The things that have been inspirational for me as a health care provider is the gentle balance that nurses have to strike between being educators, cheerleaders, disciplinarians, and dispensers of empathy and compassion.  Many a nurse has shared a personal or family story in order to help me get through a difficult decision or attitude adjustment.  In mental health, we use this judiciously but effectively, and I saw nurses on non-mental health floors using this technique routinely.  I was also impressed with the timing of the help I received.  One of the crucial aspects of sharing experiences is that it has to be done when the patient is ready to hear it, and many a therapist  struggles with this.  The right message at the wrong time is essentially the wrong message.  Nurses caring for me have done this deftly.  Which is not to say that I am happy to need this help, I am not, but I am definitely comforted by it.

Tuesday, November 24, 2015

Inside Out (2015)

Into each life a little rain must fall.  That is the take home message of this very different Pixar movie that focuses on the complex emotions that run people's lives.  Which is taking off a pretty big bite for an animated movie aimed at the under four foot tall set.  But it works, and the adults in the crowd will be able to relate as well.
Riley is a happy well adjusted eleven year old girl whose parents have moved her from a comfortable Minnesota town where there is little stress in family life to a marginal lifestyle in San Francisco where almost nothing goes right.  The father's job is on the rocks, the housing is substandard and the furniture fails to arrive.  The way we know how Riley is feeling about all of this is through the five emotions that control her brain: Joy, Sadness, Disgust, Fear, and Anger.  This is a implication, of course, but much like the simplification of the elements of taste into salty, sweet, bitter, and sour,  it works.  The story unfolds, Riley's emotions play their roles, there is an adventure, and in the end, lessons are learned.  A very fine movie indeed.

Monday, November 23, 2015

Ginger Beef Stir Fry

I have been working hard while I have been getting chemotherapy and recovering from my abdominal surgery to keep enough protein in my diet to avoid losing muscle mass and enough red meat to avoid needing a blood transfusion, neither of which endeavors has been an unmitigated success, mind you, but those are my food related goals.  I am also trying to enjoy what I am eating, by and large, and every one in my immediate circle of fellow diners has been working towards these goals with me.  My eldest son came over to assemble this wonderful dish, which has the added bonus of having lots of ginger to combat nausea.

  • 2 Tbsp unseasoned rice vinegar
  • 5 Tbsp soy sauce
  • 1 Tbsp honey
  • 1 Tbsp grated ginger
  • 1 teaspoon chile pepper flakes
  • 1 teaspoon ground cumin
Beef and stir-fry
  • 1 1 1/4 to 1 1/2 lb top sirloin steak
  • 1 Tbsp cornstarch
  • 2 Tbsp vegetable oil (preferably peanut)
  • 1 Tbsp sesame oil (optional)
  • 3-4 green onions, cut on a diagonal, 1/2-inch apart, including the greens
  • 2 cloves garlic, thinly sliced
  • 2-3 hot chiles, preferably red serranos, seeded, sliced
  • 1-inch nob of ginger, cut into matchstick shapes
  • 1/2 cup loosely packed, chopped cilantro
1 Chill the steak in the freezer for 30 minutes before you slice it, this will make it easier to cut in thin slices. Slice the steak first crosswise in 1/2-inch thick slices. The cut each slice lengthwise into strips.
2 In a medium bowl, whisk together the marinade ingredients; the soy sauce, vinegar, grated ginger, honey, red chile flakes, and cumin. Mix the beef in with the marinade to coat and let it sit for at least 30 minutes, and up to 4 hours, in the fridge.
3 In a small bowl, mix the cornstarch with 2 tablespoons of cold water to make a slurry.
4 Heat the oil in a wok, or a large sauté pan, over high heat until it is nearly smoking. As the oil is heating up, pat the beef dry and separate it into small batches no larger than what can fit into the palm of your hand. Working in batches, sauté beef until just brown outside but rare inside, no more than 1 minute. Transfer beef to a bowl.
5 When all of the beef is cooked, put the chiles and garlic into the pan and stir-fry 30-45 seconds. Add the julienned ginger and cook for 30-45 seconds more. Add the beef back to the pan. Add the cornstarch slurry. Add the scallions and mix everything together. Cook for 1 minute.
Turn the heat off and mix in the cilantro. Serve at once with steamed white rice.

Sunday, November 22, 2015

So We Are Putting a Big Scary Needle In You

I recently had a bad infection and one of the ways to keep people afloat when that happens is to give them a lot of fluid.  Their blood pressure can be very low, and part of that might relate to what the infection is doing, and part of it is because they are dehydrated.  In any case, the prioritu to to keep blood flowing to all the vital organs and keep the kidneys working.
I had such a fluid resuscitation and was left with a lot of extra fluid in my abdomen which did not seem to want to go anywhere and was causing me a lot of discomfort.  The solution?  Put a needle in and take it out, a procedure called abdominal paracentesis.
Simple enough.  I was assured this would be no big deal, but when one thinks about big scary needles sometimes additional reassurance is indicated.  I had a very good experience for my paracentesis, in part of course because it was successful and painless, but I think part of that is being well informed and prepared for what is going to happen and what it will feel like.  The technologist and the physician both explained to me in plain language what the procedure would entail, the sensations that I would have, and just how much time it would all take.  It was easier than getting an IV in some senses because of all the care that was taken in getting me ready, both in my head and in my body.

Saturday, November 21, 2015

Suspicion (1941)

Yet another installment in our Hitchcock mini-marathon of films that he made after he came to the United States.  He was still developing his sense of the perfect blend of mystery and romance, how to blend the two so effectively that while the movies of his later day were clearly suspenseful, they still contained an element of relationships between men and women.  In this one the relationship outweighs the suspense, but is well worth seeing.  Joan Fontaine won an Academy Award for her portrayal of the wife married to a cad.
Lina is a shy and bookish woman from a well to do family who impulsively marries a cad, Johnny, a man known for womanizing and never holding any sort of employment.  His sources of income are gambling, mooching, borrowing, and perhaps on occasion a little theft.  It is not a match made in heaven, but to Johnny's credit, he does seem to love Lina and she is besotted with him.  So much so that she allows him to install her in a house they cannot afford while he manages to get himself into a jam he really cannot get out of.  Lina's suspicions grow, and Hitchcock's use of meaningful looks and long shot angles to convey the growing suspense are very much on display here.  All's well that ends more or less well in this early Hitchcock tale.

Friday, November 20, 2015

Cathedral Saint Demetrius, Vladimir, Russia

This is a UNESCO World Heritage site, and it is truly spectacular to see.  Sadly I have not managed to capture much of that with my photos, but let me tell you more about the church.
The hardest thing about looking at it is that it is white on white, and very tall.  A telephoto lens on a camera or some very good binoculars would be useful, because it has a fascinating carved surface that should definitely be savored rather than looked at from on far.

cathedral's carvingsWhy was the church built in the first place?   None of the chronicles mention exactly when this royal church was built. However, there are many reports that in 1197 the icon of St. Demetrius of Salonica was brought here from Byzantium, so it is assumed that it was around this date that the cathedral was constructed.
The next mystery involves the cathedral itself. Numerous relief images of lions, centaurs, snow leopards and exotic ornaments--over a thousand--are carved on the white-stone walls. The sculptural decor also incorporates subjects from the Bible as well as Classical mythology. In the central parts of the facades the image of King David is repeated. In medieval times he was associated with the celebration of beauty and harmony in the world. Though all these carved images may seem to be only mere decorations, they are also meant to inspire.  At the time, the influence of myths must have held equal sway with the people, because Hercules, and other traditional Greek mythological tales are also displayed intertwined.  Why?  There is no definitive answer to this question. Each of us are free to contemplate the possibilities.

Thursday, November 19, 2015

Chemotherapy and Hair

One of the realities of having a really bad cancer is that you are almost certainly going to lose your hair in an attempt not to lose your life.  That seemed like an acceptable cost, and when I learned that 90% of women who get my chemotherapy regimen lose their hair in the first cycle of chemotherapy, I got ready.  I went on line and ordered some scarves that I could see myself wearing.  I looked up a wig shop in town and went in and picked out the one I could live with and ordered it.  Then I went to get my hair cut to look like the wig so that I could get used to it.  And I didn't consider doing any sort of hair sparing therapy.

Then I went through my first round of chemotherapy.
I lost about half my hair, and I got to thinking about it.  I have never done anything to my hair.  I barely brush it.  How was I going to pull off a wig, no matter how much people told me they loved theirs, when I had never given my hair a second thought?  And while I was pretty sure that I could rock the scarf look at home and socially, but at work I would almost certainly need a wig.  Could I really pull that off?  Would I be more comfortable with just my thin hair?  So I borrowed a cold cap system to keep your hair.  You have these caps on dry ice (meaning unbelievably cold) and you switch them out every 30-60 minutes while you are getting chemotherapy so that your hair follicles freeze and don't get exposed to the chemotherapy.  It seems to work and is done often in Europe.  I was at a disadvantage, in that my chemotherapy was infused over 24 hours, which is an awfully long time, but that ultimately didn't matter because I could not tolerate the cold for an hour.  It was excruciatingly painful, and while I was trying to contemplate another day of this pain, then repeating it again, I completely got my head wrapped around what I would have to do about hair loss, because I could not manage what it would take to keep it!

Wednesday, November 18, 2015

Red Army (2015)

This is an odd documentary about the Red Army hockey system, and a group of players who were stars for them in that system for years.  They then all went to play for hockey teams in the the United States, where it largely did not work out as they had hoped that it would, and many of them returned to work in the Russian hockey system today.

The film is at it's best juxtaposing the well orchestrated, almost ballet like skating of the Russian team of that era.  They were superb athletes who were highly trained as a team and they were a vision to watch.  But then there was the darker side of that story.  They were all taken from their families as children, they were more or less forbidden from having personal lives, and one of their coaches had sadistic tendencies, all of which juxtaposed against the beauty and artistry  is food for thought.  The other thing I really liked about this is that it demonstrated that hockey does not have to be a stick high, board bashing game,  It can be much like soccer on ice, with a little bit of that, but not enough to draw a lot of blood or make it really ugly.  This is uneven but worth watching.

Tuesday, November 17, 2015

Matryoshka Nesting Dolls

I know, it is kind of silly, but I find these nesting dolls to be fascinating.  And even though they came to Russia via Japan, they are everywhere to be found in Russia, and so many sorts to choose from.  So yes, I did have to spend an inordinate time on my summer trip to Russia immersed in the culture that surrounds these nesting dolls.
I am not a big fan of the extravagantly numbered dolls nesting.  I rather like the sets that are five, which is definitely on the diminutive size, although looking into shop windows and seeing these gigantic dolls that go on to birth thirty two ever diminishingly small versions of the original is something to behold, it was not something that fascinated me.  The variety of painting styles, especially in the particularly finely made versions, was something that I loved.  The faces are what hold the attraction for many, but for me it is the stomach design and the babushka.  The most common abdominal adornment is flowers, but my two favorites were the iconic onion domes building paintings, and best of all, the fairy tales.  The two that I brought home had a different component of a Russian fairy tales painted on each doll, bringing in a part of Russia's past that reaches farther back than the Matryoshka doll.  And of course they had beautiful head scarves as well.

Monday, November 16, 2015

The Alarming Rate of Deconditioning

I had been sailing along the rim of deconditioning for about a month, able to avoid acknowledging it's existence because I was able to keep physically active each day on the treadmill or by taking walks and because I was eating just enough protein to keep myself out of a serious deficit.
Then I got a systemic infection, where my blood pressure was so low they would not allow me out of bed without assistance, I was getting fluids at a rate that literally gushed into my veins, and I had enough little bags of antibiotics hanging from my IV pole that I would be hard pressed to ague that I was doing well.  Fortunately, the antibiotics did the trick, I got enough fluid to hydrate two or three people, and my blood pressure came up to a level that reassured my doctor that I did not need to go to the intensive care unit.  But what suffered in all of this was my appetite.  All the extra fluid accumulated in my abdomen, which made food extremely unappealing and pretty hard to keep down.  So for several days I went with little protein and suddenly I can barely move.  Stairs?  Are you joking?  Even going from sitting to standing can seem like a chore.  I had to break out the whey and make ultra protein smoothies in an attempt to regain my baseline level of function, and after only a few days of debilitation.  I am on the road back to strength and vitality, but now I know, it can vanish in an instant.