Right. After a terrific backrub/massage courtesy of an angel, and an unusually good night's sleep (many who know of my battle with light sleeping and insomnia will realize how novel a deep sleep is for me), I found myself up at 6:45 this morning. I can't even get myself up that early during the week, due to said sleep problems, so to be up that early on a Saturday, and by choice, is unheard of.
I was sitting at the window next to my desk, gulping the first tea of the day, and watching the early morning sun slide across the rooftops of the townhouses opposite my building, and I noticed quite a few birds up and about, and they all seemed rather busy. I must here profess my ignorance as to bird types, so my descriptions will be based on what they look like. A black and white one was pecking at tree sap, a tiny yellow and gray one was flitting around the trunk of the tree with a piece of leaf in its beak as though looking for a hiding place, and a blue and white one was observing the goings on, and this is all in the same tree, mind you. Then a big mottled brown and white one with a red-orange head, and some sort of nut (or possibly a berry) in its beak, lands on the corner of the wall just outside my window and proceeds to make its way up to where the wall joins the roof overhang. It then pokes the nut (or berry) into a little crevice in the roof overhang, and once it decides the nut (or berry) is secure, it flies off. About ten minutes later, it returns with another nut (or berry), repeats the wall-climbing/treasure-stashing routine, and flies off again. In the space of an hour, the bird came back three times.
As I'm watching all the activity outside my window, I get the sudden urge to do something productive, which is often the effect early, chilly autumn mornings have on me (or it could be the tea, I suppose). There is shopping to be done, laundry to be washed, soup to be made, Persuasion to be read, Firefly episodes to be watched (courtesy of the same angel), journal entries to be written, an owl needlework project to be finished for a blue-eyebrowed darling great aunt who has a thing for owls, space heaters to be dug out of the closet and situated in rooms, and a half-finished watercolor painting to be considered for improvements or quietly turned over to begin again. Only two days to do it all.
But more tea and window-watching first. I want to see if the nut (berry) bird comes back.
Saturday, September 30, 2006
Tuesday, September 19, 2006
pain is the fifth vital sign
Some background: I'm working on an account for a morphine formulation that is given epidurally and provides up to something like 24- to 48-hour pain relief depending on dose, which is better than morphine given IV (only 4 hours or so of pain relief per dose). This new drug formulation has been studied in patients who have had hip, back, and caesarian surgeries. The only drawback to it, so far as I can tell, is that, as with any kind of morphine use, overdosing can cause severely decreased respiration, which ironically was exactly the situation my grandmother was in before she died recently. So of course, it's recommended to give the lowest dose possible while still providing pain relief.
As I'm researching the drug and the studies and the whole concept of pain management, I've come across several interesting things, and I'm only thinking about them because I'm weird that way. Vital signs (pulse, blood pressure, core temperature, and respiration) are easily and objectively measured. Pain, however, can't be measured objectively. It's usually assessed as "on a scale of 1 to 10, with 10 being excruciating, rate your pain." People have varied tolerances for pain, so their rating is usually based on previous experience (ie, compared to the most physically painful thing they've ever felt - broken bone, heart attack, giving birth, a severe burn, endometriosis, appendicitis, having teeth pulled, etc.), and the rating changes as people experience physical pain throughout their lives.
Mind you, one can observe a person's response to pain based on vital signs, but to measure pain itself, you really need the patient to describe it to you. And of course, there's the problem of interpretation. The caregiver may be inclined to interpret the pain rating based on their own experience with pain, and they may have to dig a little and ask more questions to clarify the patient's rating. Quite the conundrum.
There is a strong movement now to include pain assessment as part of a standard check of vitals, and though the objectivity mentioned above presents a challenge, I think it will become an important part of health care. Here's why: precisely because of its subjectivity, pain assessment forces caregivers to think of patients as other than objects to be poked, prodded, assessed, and mended on an assembly line. Pain is a human perception that requires dialogue between patient and caregiver for comprehension, evaluation, and treatment, which changes the dynamic of care to one of easing suffering (and by the way, possibly improving vital signs - and no, that's not coincidence), not just fixing what is broken and forgetting that patients, amazingly, are people too. "Whol"istic medicine, here we come!
As I'm researching the drug and the studies and the whole concept of pain management, I've come across several interesting things, and I'm only thinking about them because I'm weird that way. Vital signs (pulse, blood pressure, core temperature, and respiration) are easily and objectively measured. Pain, however, can't be measured objectively. It's usually assessed as "on a scale of 1 to 10, with 10 being excruciating, rate your pain." People have varied tolerances for pain, so their rating is usually based on previous experience (ie, compared to the most physically painful thing they've ever felt - broken bone, heart attack, giving birth, a severe burn, endometriosis, appendicitis, having teeth pulled, etc.), and the rating changes as people experience physical pain throughout their lives.
Mind you, one can observe a person's response to pain based on vital signs, but to measure pain itself, you really need the patient to describe it to you. And of course, there's the problem of interpretation. The caregiver may be inclined to interpret the pain rating based on their own experience with pain, and they may have to dig a little and ask more questions to clarify the patient's rating. Quite the conundrum.
There is a strong movement now to include pain assessment as part of a standard check of vitals, and though the objectivity mentioned above presents a challenge, I think it will become an important part of health care. Here's why: precisely because of its subjectivity, pain assessment forces caregivers to think of patients as other than objects to be poked, prodded, assessed, and mended on an assembly line. Pain is a human perception that requires dialogue between patient and caregiver for comprehension, evaluation, and treatment, which changes the dynamic of care to one of easing suffering (and by the way, possibly improving vital signs - and no, that's not coincidence), not just fixing what is broken and forgetting that patients, amazingly, are people too. "Whol"istic medicine, here we come!
Friday, September 15, 2006
this is what I saw today...
...during a 45-minute walk around a lake:
- a strong flowing waterfall, due to all the recent rain. Geese were lined up at the top of it, having an afternoon snooze; a blue heron was at the bottom of it, possibly looking for a snack in the water. Amazing that the heron could remain so still and upright with all that water coming at it, given its spindly legs
- two little girls feeding a crowd of ducks and geese, while their moms were talking and paying no attention at all. The girls would squeal and laugh whenever the ducks or geese would quack or eat whatever the girls had just thrown at them. One of the girls was dressed in a too-cute pink ballet costume and had blond hair messily pulled up into a ponytail.
- turtles poking their heads out of the water, and quickly pulling them back in again
- a hedgehog munching on grass on one side of the walking path
- a lone swan out on the water some distance away
- a large black and yellow butterfly on the grass near a trash can
- a HUGE bee on the ground. It sounded very angry, maybe it was lost
- dogs everywhere, walking their owners
- hibiscus, wide open and showing off
- a blanket of roses and leaves clinging to the side of a high fence
Awesome.
- a strong flowing waterfall, due to all the recent rain. Geese were lined up at the top of it, having an afternoon snooze; a blue heron was at the bottom of it, possibly looking for a snack in the water. Amazing that the heron could remain so still and upright with all that water coming at it, given its spindly legs
- two little girls feeding a crowd of ducks and geese, while their moms were talking and paying no attention at all. The girls would squeal and laugh whenever the ducks or geese would quack or eat whatever the girls had just thrown at them. One of the girls was dressed in a too-cute pink ballet costume and had blond hair messily pulled up into a ponytail.
- turtles poking their heads out of the water, and quickly pulling them back in again
- a hedgehog munching on grass on one side of the walking path
- a lone swan out on the water some distance away
- a large black and yellow butterfly on the grass near a trash can
- a HUGE bee on the ground. It sounded very angry, maybe it was lost
- dogs everywhere, walking their owners
- hibiscus, wide open and showing off
- a blanket of roses and leaves clinging to the side of a high fence
Awesome.
Tuesday, September 12, 2006
Keith Olbermann speaks
I read this wide-eyed with admiration for the thought and feeling that is written in it.
That is what I like about writing. That is what I like about blogging. People who think blogging is stupid just don't get the point. People are writing. They are writing out their ideas, and their days' highlights and lowlights, and their feelings, and their questions. Maybe some of it sounds ordinary and uninteresting and small, but it is important to whoever wrote it, and it helped them to process any number of things from confusion to musing to a whole range of emotions to just noting that the day was there and the writer had a place in it. Writing is always a good idea. No one will ever convince me otherwise.
That is what I like about writing. That is what I like about blogging. People who think blogging is stupid just don't get the point. People are writing. They are writing out their ideas, and their days' highlights and lowlights, and their feelings, and their questions. Maybe some of it sounds ordinary and uninteresting and small, but it is important to whoever wrote it, and it helped them to process any number of things from confusion to musing to a whole range of emotions to just noting that the day was there and the writer had a place in it. Writing is always a good idea. No one will ever convince me otherwise.
Monday, September 11, 2006
on this day
I've attempted not to watch or listen to much news today, but it hasn't worked. I've been trying to cope with the fact that it's been five years since the world stopped and the country burned. This is one of those memories that doesn't seem to get fuzzy with time. I remember too much too clearly from that day.
I was at work, and someone walked past my office and said "Did you hear? A plane hit the World Trade Center in New York." I briefly thought that it was a private plane or something and that it was an accident. Then a few minutes later, someone else walked past my office and said, "Did you hear? A second plane hit the other tower." And then I knew it wasn't an accident.
I started to go a bit numb, and then a third person walked past my office and said, "Did you hear? A plane has hit the Pentagon." People started leaving to pick up their kids from school because the school systems had decided to shut down. Then I started to panic, as my mind went through the following conversation - "Pentagon, government building, close to here, Dad works at NSA, also a government building, close to here, where is Dad?" So I called him at work, and he wasn't there, so on the off-chance, I called him at home, and he picked up. He was sick with a cold or something and hadn't gone to work that day. Sigh of relief, and then pang of guilt. I know where all of my family are - not so for people in NY and DC. Not so for Laura, who walked past me in tears because she had just heard that the fourth plane had gone down in Pennsylvania, and her brother lived in Pennsylvania, and she couldn't get him on the phone.
Someone brought a TV into the lunchroom, and people drifted in to watch. I went in there for water once, because my mouth had gone dry, and that's when the towers fell and people leaned closer to the TV and stood up and put their hands out as if they could keep the buildings from falling, and I watched the TV and my co-workers, and the water overflowed from my cup. Others had radios in their offices, and little groups would gather to listen and hear the same reports over and over again hoping for and dreading new information. The office had gone uncomfortably quiet, and it unnerved me, so I kept working. Panic has taught me that rather than just sit there and shake and let your mind have nightmares, go do something. I got some nasty looks and comments that day - "how can you just sit there and work?!" Because I have to. Because I need to. Because I had flown to Minnesota and back just two weeks earlier, and all this could have happened on that day instead of this one.
Driving home was creepy. It was 5:15 pm, and yet there was no traffic. I didn't see one car on the road during my drive home. I had the radio on for company, and "Bridge Over Troubled Water" came on. I've always liked the song, I think it's beautiful and poetic, and on any other day, it would have put me in a contemplative and meditative mood, but on that particular day, on that creepy drive home, it just made me cry, and I had to pull over to the side of the road for a few minutes until I could see clearly enough to drive again.
That night, I gave in to watching the news all evening and well into the night. One particular image I remember - the firefighters wincing as they saw people jump from the towers to their deaths. It reminded me of reading about the Triangle Shirtwaist Company fire. A bunch of seamstresses were locked into a firetrap of a room at the factory. A fire broke out, and the women couldn't get out because no one came to unlock the door. Several of the women chose to jump, supposedly because they wanted to have some measure of control over their deaths, they couldn't handle the idea of doing nothing. What a choice to make - to knowingly decide the manner of your death and willingly walk toward it. Other, more philosophical, reading tells me that when you are about to die, a part of the brain that is normally dormant suddenly becomes active, and you see and feel things that lead you through the transition, and the one thing you do not feel is fear. Rather, you feel an overwhelming urge to go toward whatever it is that you see - a glimpse of heaven, perhaps. Or a place seen vaguely in your dreams and longed for. Or long-dead loved ones reaching out to you.
I received a number of calls that night - Mom, grandmother, aunts and uncles, college friends. They just wanted or needed to know that I was there and okay, and I guess I needed to know too, as I felt strangely distant and out-of-sync with the day.
Yesterday, I was happily roaming around Renn Fest, meeting the "king," sitting in the hot sun to watch jousting and some bawdy (but hilarious) magic/swordfighting/comedy routines and the end of a rendition of A Midsummer Night's Dream, poking my head into shops and buying a watercolor print of a fairy. And today? Reality returned, and it rained and was chilly, and I went to work and spent all day on one project, and despite my best efforts, I got sucked into the news and commentary about the day's rememberances and ceremonies being politically motivated and the world being more unsafe than it was five years ago, and the bombings that happened in Spain and in London and in other places, and the changing reasons for the war, and Heather called and asked me to lunch tomorrow, and I've forgotten to buy dog treats, but I did remember to give Louise her meds, and five years nudges me and whispers a reminder not to forget any of it, not the mundane, nor the terrible, because it all matters. All of it.
I was at work, and someone walked past my office and said "Did you hear? A plane hit the World Trade Center in New York." I briefly thought that it was a private plane or something and that it was an accident. Then a few minutes later, someone else walked past my office and said, "Did you hear? A second plane hit the other tower." And then I knew it wasn't an accident.
I started to go a bit numb, and then a third person walked past my office and said, "Did you hear? A plane has hit the Pentagon." People started leaving to pick up their kids from school because the school systems had decided to shut down. Then I started to panic, as my mind went through the following conversation - "Pentagon, government building, close to here, Dad works at NSA, also a government building, close to here, where is Dad?" So I called him at work, and he wasn't there, so on the off-chance, I called him at home, and he picked up. He was sick with a cold or something and hadn't gone to work that day. Sigh of relief, and then pang of guilt. I know where all of my family are - not so for people in NY and DC. Not so for Laura, who walked past me in tears because she had just heard that the fourth plane had gone down in Pennsylvania, and her brother lived in Pennsylvania, and she couldn't get him on the phone.
Someone brought a TV into the lunchroom, and people drifted in to watch. I went in there for water once, because my mouth had gone dry, and that's when the towers fell and people leaned closer to the TV and stood up and put their hands out as if they could keep the buildings from falling, and I watched the TV and my co-workers, and the water overflowed from my cup. Others had radios in their offices, and little groups would gather to listen and hear the same reports over and over again hoping for and dreading new information. The office had gone uncomfortably quiet, and it unnerved me, so I kept working. Panic has taught me that rather than just sit there and shake and let your mind have nightmares, go do something. I got some nasty looks and comments that day - "how can you just sit there and work?!" Because I have to. Because I need to. Because I had flown to Minnesota and back just two weeks earlier, and all this could have happened on that day instead of this one.
Driving home was creepy. It was 5:15 pm, and yet there was no traffic. I didn't see one car on the road during my drive home. I had the radio on for company, and "Bridge Over Troubled Water" came on. I've always liked the song, I think it's beautiful and poetic, and on any other day, it would have put me in a contemplative and meditative mood, but on that particular day, on that creepy drive home, it just made me cry, and I had to pull over to the side of the road for a few minutes until I could see clearly enough to drive again.
That night, I gave in to watching the news all evening and well into the night. One particular image I remember - the firefighters wincing as they saw people jump from the towers to their deaths. It reminded me of reading about the Triangle Shirtwaist Company fire. A bunch of seamstresses were locked into a firetrap of a room at the factory. A fire broke out, and the women couldn't get out because no one came to unlock the door. Several of the women chose to jump, supposedly because they wanted to have some measure of control over their deaths, they couldn't handle the idea of doing nothing. What a choice to make - to knowingly decide the manner of your death and willingly walk toward it. Other, more philosophical, reading tells me that when you are about to die, a part of the brain that is normally dormant suddenly becomes active, and you see and feel things that lead you through the transition, and the one thing you do not feel is fear. Rather, you feel an overwhelming urge to go toward whatever it is that you see - a glimpse of heaven, perhaps. Or a place seen vaguely in your dreams and longed for. Or long-dead loved ones reaching out to you.
I received a number of calls that night - Mom, grandmother, aunts and uncles, college friends. They just wanted or needed to know that I was there and okay, and I guess I needed to know too, as I felt strangely distant and out-of-sync with the day.
Yesterday, I was happily roaming around Renn Fest, meeting the "king," sitting in the hot sun to watch jousting and some bawdy (but hilarious) magic/swordfighting/comedy routines and the end of a rendition of A Midsummer Night's Dream, poking my head into shops and buying a watercolor print of a fairy. And today? Reality returned, and it rained and was chilly, and I went to work and spent all day on one project, and despite my best efforts, I got sucked into the news and commentary about the day's rememberances and ceremonies being politically motivated and the world being more unsafe than it was five years ago, and the bombings that happened in Spain and in London and in other places, and the changing reasons for the war, and Heather called and asked me to lunch tomorrow, and I've forgotten to buy dog treats, but I did remember to give Louise her meds, and five years nudges me and whispers a reminder not to forget any of it, not the mundane, nor the terrible, because it all matters. All of it.
Friday, September 8, 2006
job update
Many people have asked me how my job search is going (thanks for asking), so I thought I'd give an update:
I've applied for four jobs: Science Writer at JHU APL, Medical Writer at ICON, Medical Writer at NIH in the complementary alternative medicine division, and writer for the Chesapeake Bay Foundation.
ICON is the only one that's called me back. I had a good conversation with their HR person. She thought my resume looked good, though she did say that the one snag was that I had no experience writing clinical protocols. She said she'd send my resume on to the Medical Director anyway. Haven't heard from them since.
Haven't heard from any of the others yet. Fingers crossed though. Hopefully, someone somewhere wants me to write for them.
I've applied for four jobs: Science Writer at JHU APL, Medical Writer at ICON, Medical Writer at NIH in the complementary alternative medicine division, and writer for the Chesapeake Bay Foundation.
ICON is the only one that's called me back. I had a good conversation with their HR person. She thought my resume looked good, though she did say that the one snag was that I had no experience writing clinical protocols. She said she'd send my resume on to the Medical Director anyway. Haven't heard from them since.
Haven't heard from any of the others yet. Fingers crossed though. Hopefully, someone somewhere wants me to write for them.
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