SLC Day 2

Up for a kiddie hike. Bean2 was ready and dressed in the car, while Bean1 was crying that he wanted to wear the blue pants. Yes, the ones that he'd outgrown, and that bean2 was actually wearing at the time. Such are the trials of youth. Bork eventually managed to wrangle the little stinker into some pants and into his car seat, and we all were off to Cottonwood Canyon. However, having gotten a late start, we missed Cheryl and the group. So, we muddled around the entrance to the canyon for a bit, walked up a bit from the parking lot, before ascertaining that indeed, we'd need to drive up a bit more before hikable terrain was obtainable.



Ended up driving up to the next parking lot, which had a nice trainhead to a little lake, and fortuitously got a parking space of someone just leaving. Genie and I lagged a bit, as the train was a bit steep, and the boys of the family were off ... arguing about who got to be first. Bork tried to settle it by having Bean1 lead on the way up, and Bean2 lead on the way down. When the going got really steep, Genie and I stopped to take a rest while the boys foraged on for more adventure.

~~~~~
For dinner, we were all splitting ways. Dad was taking the Beans to McDonalds ... a favorite treat. Bork and Genie were going out for some couple time. And JLITh and I were staying home for Korean BBQ with Scout. The original plan was to get the Havasupai-ers out to dinner, but Portenia couldn't make it, and JLITH wanted to cook, and who was I to gainsay her? Kalbi, chapchae, veggies, and chocolate dipped stawberries. Mmm Mmm good!

4th city in a month's time

Flew to SLC today for some time with JLITH and the Dragon family. Again my car was updated from economy to a PT-cruiser-esque, shiny black, Chevy thing. Good thing gas prices are on the sinking side.

Big and Little Bean are as exuberant as ever. So verbal and much more interesting. Genie says they take turns being naughty, which I guess is a relief. Genie is also getting bigger with the 3rd bean, so maybe I'd better start renaming them Bean!, Bean2, etc.

Bean1 is a perfectionist. He doesn't like to perform anything unless he feels very confortable with the performance value of it. He tends to be a little wiley. Loves Spiderman, trucks, dinosaurs, and his Little Blue Dog (of which his mother does not have a spare, so LBD has to stay at home where he's safe). Likes to drink water. Loves to ask, "Whacha doin', Dowa?" Bean1 cheerfully mugs for the camera.

Bean2 is an explorer. He'll try almost anything and doesn't care who's watching. He's also a bit of whiner, and has no trouble with wailing, especially when he's tired. Loves Superman, trains, elephants and his "Sheep" and "Baa baa Sheep" (one of which his mother has a spare for laundry days and if he gets lost). Still prefers milk. Bean2 is often in motion and rather shuns the camera. Bean2 has also started running with an almost athletic posture, something Genie says he started in the last few weeks.

Both Beans are taking tae kwon do lessons, although Bean2 lacks the discipline and coordination to do well. Both love to get thrown around and up in the air, which gives me a decidedly cool factor in their eyes.

Genie and Bork are doing well. Still not sure where they are going to end up this next summer. Bork has been going on interviews in NY, CO and CA for summer internships which should lead to job offers.

JLITH is still working like a demon. It seems as if her program is not as organized and cohesive as it should be. Lots of politicizing and upper echelon laziness that translates into more work for the peons.

Anyway, Dad also flew in tonight, and everyone except JLITH went up to Bountiful for a Korean Cultural show. Fan dancing, tae kwon do exhibits, and some really time warped performances by a group of aged missionaries and the Tender Apples. It almost felt like an old Brady Bunch show.

Gotta Dance

Worked today. Seems like I've been blogging a lot about work lately, but it's just been really interesting of late.

Today I started off with one of those chronic kids ... fully accessorized with a trach, gastrostomy tube, etc. However, the real excitement was that ML was coming in to get transitioned from flolan to remodulin ... our first ever case! AgreeableJ was the transplant specialist on. And when she and the transplant coordinators came with the calcs, I was ready to roll. We had the remodulin all primed and ready, with the drip sheet set for her initial weight (when she started flolan therapy so many years ago), a one liter bag of saline primed, oxygen via a face mask, and all the other monitoring stuff all set up. We went over everything, and rehearsed, and then we were ready to go. First, through her PIV, we gave 100cc of NS over 15 minutes, then another 250cc over 45 minutes. We started the face mask at eight liters of flow. Then, we removed her flolan drip, wasted 4cc of blood, flushed her broviac with 30cc of NS, then connected the remodulin and started it at twice the desired end rate. This took about 45 seconds. Then we waited for 0.5cc of the remodulin to infuse, which was the volume of the catheter. This took about 10 minutes. An agonizing 10 minutes, as ML started getting symptomatic ... decreased and erratic heart rate, decreased blood pressure, and abdominal pain. After the catheter volume had infused, we changed the rate to half of the initial rate. It took about an hour and a half for ML to feel better, and for her heart rate and blood pressure to stabilize out. By 1700, ML was eating like a champ, was on only two liters oxygen via a nasal cannula, and feeling back to normal.

I was done with report by 1930, and getting ready to leave when MM started to code. TallB started squeezing in NS, LL started priming the rapid infuser with saline, and I called the blood ban to hurry up with the rbc's, FFP and platelets. Some other nurses got the code cart out and started drawing up meds, and another called the mother from the parent room. We got the bagged blood products, primed some lines, and started infusing. By 2000, there was such a crowd in the room that I took at step back. By 2010 I was out of the unit.

Changed in the hall bathroom, and drove up to Pasadena for some dancing therapy. It'd been so long since I'd been to LG that I guess lots of people missed me. Danced all night. Loved it. It's such a release ... a way to utilize my pent up energy to create something beautiful (or at least fun), and connect with another person, if only for the duration of a song.

Stayed longer than I shold have, especially since I haven't packed for my trip to SLC. Oh well, I can sleep on the plane ...

A day without email

Soon, I hope to blog about the PICU conference I went to in Denver. But not tonight.

Today I came to work thinking that it would be a pretty easy day. Due to the crazy day T (who I precepted because her regular preceptor is off on medical leave) and I had had yesterday, I'd already arranged with the charge nurse to have a stable patient so that we could focus on charting and navigating the various computer systems we use. And the first ten minutes of report were going just swimmingly, when I got pulled to be in charge. Long story about specific precepting needs of a particular new hire. And we had two hemofiltration cases, one of which needed to have the circuit changed. Etc etc.

Crazy day. Three booked surgeries, two of which came to us. And two other surgeries that weren't booked for us, but that came anyway. One transfer out. Again, lucky that Tan Shaggy and NineYards (our new PICU medical director) were on.

Staffing the night shift was going to be tight. TL had already called a couple of nurses to see if they could switch off of Wednesday night to come in tonight. We had one taker, which was a relief. Then, AB, who was going to be in charge, called in sick. Not great news, but I wasn't about to argue with her, because she was clearly sick.

Finally had arranged everything. Had one patient that was trying to transfer in, but after consulting with Tan Shaggy, he recommended the patient to another facility. Lucky thing, because about 1745, the trauma pager went off. Bad news. Failure to fly (ICU code for fell out of a two story or higher window) toddler was coming in with bad neuro signs. The RT and I went down to the trauma room in the ED, and as soon as the kid rolled in, we knew he'd be coming up to our unit. I stayed to draw up intubation, code and sedation meds. When the kid was stabilized, the ED team took him over to CT, while I returned to the PICU and started getting things ready for his admission.

Again, lucky that MR was okay to take the patient. We gave RC her post-op, and started pulling things for the admission. Started prepping lines for art and CVP. ICP insertion and monitoring set-up. Ventilator. Miami J collar to change for the C-collar placed in the field. Primed lines of saline. Kid came up from CT, and we had trouble ventilating. Had to bag, with a fair amount of resistance. Pneumothorax. Chest tube set-up. And on and on.

I finally was able to step out and give the on-coming charge nurse report. Luckily LT had been team leader the night before, so she had an idea about most of the patients. By the time we'd finished, MR had finished up her part in the patient's care ... had gotten all emergent things done and given report to the on-coming nurse, and was finally charting all the fine details that hadn't been called out previously. When I went over to see how she was, she smiled up at me and said, "See what I'll do to get out of a boring spinal fusion?" I returned the smile and patted her on the back, and I was out of there.

The night air felt cool on my cheeks as I stepped out of the hospital gates. I felt jumpy as I waited for the traffic light to change. On busy days like this, it takes a while for the adrenaline to settle down. Finally, the pedestrian sign changed. As I was crossing the street, I suddenly remembered that I hadn't checked email once today. How incredibly bizarre.

I really hate psych/soc issues in nursing

Precepted T today, because TSO called in sick due to a pulled gluteus maximus (yes, that means butt) muscle.

It should have been an easy day. Our patient was supposed to transfer out in the morning, and we were going to get a cardiac admit in the afternoon. Little did we know that our morning patient wasn't going to get transferred until the late afternoon, and that her mother was crazy. At least that is what I would call a woman who wanted to breastfeed her 9 year old daughter in order to give her maternal antibodies ... and this woman was 48, if a day! Let's just say that we were mutually decided on not liking the other. Good thing that T is almost ready to go on her own, and did most of the care.

Our cardiac kid arrived around 1400. Sicker than our docs had anticipated. The charge nurse ended up helping T transfer our am patient, while I focused on the admit. Crazy. By the time we'd given report on both of them, it was past 2000, and we put off T's eval until tomorrow (the first time I've ever done this!), when we would have a calmer day.

Going topless and a star sighting

Left the Perky home early in the morning. Drove through Estes Park, up to Rocky Mountain National Park. After a quick stop at the visitor's center, and a chat with a friendly ranger, I drove out to take a look at Bear Lake. The scenery was so beautiful that I pulled on all the available layers of warm clothes, laid my pashmina over my lap, donned my cap and gloves, and took the convertible top down (HA! Not what you were hoping for?) and drove topless throughout the park. It was gorgeous. Blue blue sky. Tall evergreens. Autumning trees. Elk in the meadow. THe only bad point was getting stuck behind a black behemoth SUV that spouted black smoke at me, and refused to let me pass. It was a relief when he pulled off. Also took the scenic route out toward Sheep Lakes, and then it was time to scurry out to the airport.

Drove very fast all the way out to the airport, as I'd spent more time than I should have in the mountains. Thank heaven for traffic-free toll roads. Must admit that it was fun to have the top down the entire way. Got to the airport in good time, and the flight back to LAX was uneventful.

Took the bus back to Sepulveda and Santa Monica. Was going to wait for the transfer to get me nearer the apartment, but the weather was fine, and I had my super-roller carry-on, so I decided to walk. Glad I did. Because, at Westwood and Santa Monica, as I was waiting for the light to change, I saw a short, stocky asian man with a queer haircut walking towards me. It was too good to pass up, so I addressed him and said, "Excuse me, aren't you the gentleman from So You Think You Can Dance?" So sad that I couldn't remember that his name was Hawk. Anyway, it was him, and we exchanged pleasantries before the light changed again, and we separated. How's that for an LA homecoming?

PCC Conference Day 3 (edited)

Today was supposed to be a half day. However, I was incredibly bored, and left around 1030-ish, to explore greener (or redder, as the case may be) territories.

First off, I went to the Molly Brown Museum. Margaret Tobin Brown was never "Molly" in her lifetime. The nickname came about with the musical, "The Unsinkable Molly Brown." The daughter of poor Irish immigrants, she married JJ Brown for love despite having earlier deciding to marry for money. From the photos available, she does not appear to be a physically beautiful woman (at least to my 21st century sensibilities), but she was a good and strong women, one worth looking up to. And indeed, in a time when the average height for women hovered around 5 feet, she was a distinguished 5'8".

Mrs. Brown was a strong advocate for women's righs. She studied at the Carnegie Institute and became fluent in German, French and Russian. During the miners' strikes, she set up soup kitchens for the miners. She helped establish the country's first juvenile court. She ran for Congress twice. When the Titanic sunk, she shared the extra furs, blankets and stockings she'd thought to bring, and marshalled the women in the life boat to row for their lives. Once the survivors were aboard the Carpathia, she utilized her language skills to prepare survivor lists, and started raising money for the survivors. She was not allowed to testify before Congress, and published her accounts in the newspapers. During World War I, she was involved in relief and rebuilding efforts in France. She also enrolled at the Sorbonne in Paris for acting classes, following in the footsteps of Sarah Benrhardt.

I then jumped in the car to drive down to Royal Gorge. The idea of walking the world's highest suspension bridge, and riding the world's steepest inclined railway was too appealing to resist. And so I did. However, if I were to do it over again, I would come when it was warm, and also do some white water rafting as well. As it was, I had a very short time period in which to explore, and it was very cold. Ahhh, well ...

Stopped at Garden of the Gods on the way back. Spent most of the time driving through, although I did step out at a couple of spots. The rock formations look like red-hued stegasaurus plates sticking up out of the earth. At any moment, I expected the leviathan to rear its gigantic head.

On being an unknown quantity

After eating dinner and hanging around 16th Street some more, I headed over to the Denver Turnverein for some swing dancing. Had a little trouble finding it, and stopped to ask a bearded dennizen if he could direct me to the address. He gruffly asked why I was goign there, and I replied that it was for swing dancing, of course. At which point he broke into a large smile and welcomed me into the parking lot. Bearded parking guardian. I liked the idea.

The Turnverein is exactly the type of place I like. Casual, good floor, all ages (teens through retirees), lots of different types of swing music, low key refreshments available for a low price, and very friendly people.

When I got in, it was the same story with any new place where I go dancing. Invariably, I'm first asked to dance by some older gentleman ... generally in their sixties. Sometimes they're intermediate, more often than not they're solid beginner's (because the really newbie beginner's generally aren't courageous enough to ask a new person to dance, unless they're really overly confident). A1 was of the intermediate persuasion. A2 was of the very beginner persuasion. And then the flood gates were opened. Rather a lot of leads to dance with. It wasn't until B asked me to dance that I started to have fun. B also got me into the birthday/visitor dance, for which I was very appreciative.

The birthday/visitor dance is really fun. Mostly because it's a steal dance, meaning that people line up to steal the dance from other "competitors." And it's mostly the intermediate or advanced dancers that like to steal and show off their moves. So it was that I got to dance with a lot of the guys I'd been eyeing up to this point. Definitely made the night much more appealing. Talked with a few, and also met Christy and Kara. Best dance upstairs was with Steve, who was amazing at improvising and musicality. He asked me if I'd ever done contact improv. I'd actually never heard of it before, but it looks like something I might get involved in (although dancing without music seems odd).

When the hour got late, the dancers moved downstairs for blues dancing, over which I was terribly excited. I came down a little late, and watched the lesson, which was taught by John and Christy. The first dance I can remember was with the owner (who's name I can't remember, I'd recognize him on sight), who told me who I should dance with, and who encouraged me to be bold. Ended up[ dancing with John, Oleg, and Ponytail Man, some more with mike (not Mike), and a few others who I felt particularly like asking to dance with. Fantastic night. I just love dancing.

PCC Conference, Day 2

Late this morning as well. Bad, since I'm generally a very prompt, and usually early person!

First concurrent session was Surgical and ICU Management of Head and Spinal Trauma. This was an interesting presentation. Things learned: Hypertonic saline (anything > 0.9%) doesn't dehydrate like mannitol, but shuts down the pulmonary cilia, leaving pt more vulnerable to pneumonias; in decompressive craniotomies: remove bone flap and implant in abdomen (keeps bone sterile, alive, and it won't get lost like inevitably happens in a freezer); Putting in two ICP drains ... first in ventricles, second in lumbar area to drain from both top and bottom; brain dialysis to monitor lactate levels (?); Prevention in Buffalo/Pennsylvania: reduced incidence of head trauma secondary to child abuse by having mothers watch a video on hazardous effects of shaken baby syndrome, and sign that they've watched said video and understand it (cuts down on boyfriend abuse of mother's children).

In the second session, I met up with Z. After a stint with One Legacy (federal transplant donor agency), she's now a manager at a facility in Phoenix. She says she still misses us, and that she now appreciates more than ever what a great hospital my place is. Also met up with S, who's working in Denver, and echoed Z's assessment. And really, I'd have to concur ... my hospital is pretty fan-dam-tastic (as Superman is so fond of saying).

The second session was a little out of my area. It was titled Pediatric Arhythmias: Recognition and Management from the normal newborn to the CICU. However, it dealt mostly with congenital cardiac problems, which we don't see in my PICU, since we have all the cardiac kids go to the Cardio-Thoracic ICU.

For the third session, I chose Dr. Banner's Sedation and Analgesia presentation. The take home lesson is one I've always believed ... critically ill kids deserve drugs. Things learned: using Elamax for circumcisions (not that we do this in the ICU, but for prospective parents) and suture removal, using fentanyl (instead of morphine, due to itching) for burn patients; nalbuphine as a partial agonist; some hospitals taking demerol off of their formulary due to metabolite bioaccumulation, and risk of seizures; PCA literature doesn't show that basal rate alleviates pain, and takes five half lives to reach steady state; buffering lido 9:1 with bicarb (much less painful!).

The fourth session was rather a wash for me. I started at the Going Beyong Conventional Mechanical Ventilation Modes, but there wasn't any new material, and the presenter was so dead-pan that I found myself falling asleep.

For the last session of the day, I chose to go to Hazinski's Rapid Assessment and Initial Stabilization of the Critically Ill or Injured Child. This session was mis-labelled, as it was basically a course on the differenced between the pediatric and adult critical patient, but as none of the other sessions really interested me, I stayed. It was a good review, but not a lot of new material. One thing that I learned was that generally one can prevent shivering (as in the head trauma patient) by keeping the front of the tibias warm. Sounds like an old wives' tale, but I'll try it the next time I have a hypothermic patient ... along with other things like layering blankets, and baer huggers, etc.

PCC Conference Day 1

Arrived late this morning ... late start plus exceptionally bad traffic are a bad combo when one is new to a city and having someplace to be.

Walked in late to Mary Fran Hazinsky's prsentation on the new Pediatric BLS and PALS Guidelines. I'd recertified in PALS earlier this year, and will be recert-ing in BLS next month. Really sweeping changes. Codes need to be more coordinated to give continuous compressions after med administration, with fewer rhythm checks. After I'd heard her lecture, I wished I had signed up for the simulator mannikin sessions. However, it was too late, as they'd had a cap on 25 participants per session, so I'll have to push for more hands-on training back at the hospital.

Next came a lecture on Cerebral Oximetry and BIS monitoring. Didn't seem worth the effort for the results that were described.

A lecture on Pulmonary Arterial Hypertension followed. I honestly can't remember much of the lecturer, but I found the material very applicable. It brought to mind one patient we were going to get back from the cath lab, wherein they were going to do he cath, insert a broviac, start on flolan, then transition to remodulin. They were able to do everything but the transition. Anyway, it was very exciting. I wish we could transition all of our patients on flolan to remodulin. Remodulin is so low maintenance when compared to flolan, and since the half-life is four hours instead of two to five minutes, it gives a considerable window of safety to get to a hospital, should something happen to the infusion. I thought of ML and hoped that it would happen for her sometime soon. Things learned in this session: When using nistric oxide, NO and O2 lines need to be purged prior to use, MetHg accumulate faster in native American Indians; and Iloprost is an inhaled prostonoid that may figure strongly in the future (although it can't be given with ventilator therapy).

Dr. William Banner, Jr. was probably my favorite presenter of the conference. From the south, he has an ironic sense of humor, and a lazy drawling voice that made his pressentations seem less like a lecture, than an interesting discussion. His first presentation was on Street and Recreational Drugs: Overdoses and Management in the PICU. Talking with teens to assess intent ... both as parents and health care providers. Alcohol, MJ, SSRI's, Cocaine (involved in 26% of fatal injuries in NYC from ages 15-44, and to give benzo's), Rope, GHB, meth (increased use, easy to make, lasts 8-24 hours), XTC, and resversing narcotics, but not benzo's because of seizure potential .. plus, it's just nice to keep these patients sedated.

Next was a study on XIGRIS and severe pediatric sepsis. Xigris is recombinant activated Protein C, and the mechanisms of action are: promote fibrinolysis, ionhibit thrombosis, and decrease inflammation. The presenter (who is a pharmacist) ran through a bunch of studies that had somewhat ambivalent results. The end shot is that it can be used, but only under very special circumstances.

Laura M. Criddle next presented on blood transfusions: history (first blood bank in Russia in the 1930's), blood typing, blood products, giving transfusions, etc. Interesting historical presentation, but not much new info.

Hung out around 16th Street, then out to the airport to pick up Perky. Put down the top at the park and call area. Very cold that last half mile. Got her back home, then went to the Mercury Cafe for dancing sponsored by 23 Skidoo. Hmmm ... it was okay. A few very good dancers, very tango-inspired, who were not very friendly. Danced with an intermediate, puppy-dog friendly kid, and a couple of really beginner guys. Then Mike came. We've danced together before, but disagree on where. He thinks it was at Camp Hollywood, I think it was in Golden Gate Park in San Francisco. Anyway, it was fantastic to dance with him again. And then some other intermediate-type guys asked me to dance. The same old story. More on this for tomorrow.

The Mile High City

Went out to Denver, Colorado for the Contemporary Forums Pediatric Critical Care Conference. I generally try to make it every other year ... especially when they have it at a location other than the west coast.

I'd planned on staying in a hostel, and using my money for renting a car to get around. However, Perky's family lives just outside Denver, and I was invited to stay! Even luckier, Perky was in town for her high school reunion, which made it a little smoother.

Denver airport is a large affair, with a subway-ish train that transports people between terminals. By the time I'd gotten to the rental car shuttle stop, I'd resigned myself to having to report for my flight earlier than I wanted. However, I had a nice little surprise waiting for me at Payless Rental ... a free upgrade to a sexy PT Cruiser convertible! Of course I didn't have a hat to shield off the sun, and it was going to be too prohibitively cold to have the top down, but I felt an immediate gloss of cool come over me when I slipped into the driver's seat.

Driving out to Perky's on the backroads was so picturesgue that I often forgot to read the directions, and had to turnabout several times. Farmhouses, lots of sunflowers, and a good deal of sunshine. When I finally made it to Perky's home, her mother ML made me feel very welcome. Got my stuff settled in and made my way to the city to figure out where everything was. I'm just the kind of girl that needs a little prep time.

Got off of the freeway and coasted past Coors stadium. Must confess that It threw me a little to have the beer brand so prominently displayed. Made my way into the heart of downtown and navigated through the one-way street that are one of my many personal trials. Found the Marriot and nearby parking, ate dinner at a little Vietnamese Grill, and wandered around 16th Street. Sought solace at the Barnes and Noble, where I found my dinner companion for the next few days ... The Bookseller of Kabul.

And that's how I aged five years in 20 minutes

Today was my scheduled ECMO day. Lately it feels rather ridiculous to be on the team, since we hardly ever do ECMO in the PICU, there haven’t been many cases this year (when we’re first call) where we’re able to get in our hours on the NICU or CTICU, and our PICU ECMO team now consists of two RN’s on days, and two RN’s on nights. Realistically, if we ever did get a case, we wouldn’t have the staff to have a PICU ECMO RN for each shift.

Anyway, I walked in, and saw that I was assigned to Patient A. Which was fine. Except when I asked SS, she said that there actually was an ECMO patient on the CTICU, but that they’d decided to orient one of their own RN’s who’d recently completed the training. Which made the situation not fine. When I told SS that it had been months since I’d had any ECMO hours, she called over to the CTICU to try and swap out. However, they had another story of why it was impossible. Which left me with no ECMO hours. HG (the other ECMO day RN) commiserated with me, as she hadn’t done ECMO in three months. TL was also there, and hopefully as one of our managers, she will see to it that the first call ECMO RN’s get first priority to get our required hours on the pump.

The next (as if one wasn’t enough) challenge was to find an appropriate assignment for SB, who was precepting a new hire. SS eventually ended up switching my assignment for SB’s since her initial assignment was much too difficult for a first day of precepting on the unit.

So it was that I took report on Patient B. Who really was sick. Which was quite ironic, since I’d gotten half a report on her a couple days ago, until DD and I realized that it made more sense to switch assignments because he knew Patient B, and I knew his patient. Obviously, there was no way I was going to escape Patient B. The nurse giving me report started out by saying that Patient B had been on a trip to Mexico. And her tone told me all I needed to know. Turns out that Patient B had salmonella sepsis. And besides all the regular things that tend to happen with sepsis, her toes were totally necrosed, hands and feet cyanotic, and her kidneys were down, which was why she was on hemofiltration. Blistering all over her body, and an angry red rash over her trunk. Dopamine, epi, fentanyl and versed drips. TPN and IL. She needed an insulin drip, but there was no where to put it … as it wasn’t compatible with the drugs in her other lumens. Had to change the replacement fluid on the hemofiltration a few times because of labile electrolytes.

And then, I did it. Changing the dressing on her CVP line (which was right next to the Art-line, since her accessible sites were so limited), I was having trouble removing the tegaderm and steristrip dressing … steristripped supposedly because the line was already a little leaky. Although, both lines were sutured, making steristrips unnecessary. Anyway, I ended up cutting through one steristrip, and was able to extricate the intricate dressing. At first I saw a little blood, and I didn’t realize where it was coming from. A quick survey revealed that I had cut one of the three CVP lumens … the one with her pressors. A flash of panic, then I pinched it off and calmly (as best I could) called out for a helping hand. CW came in and handed me the clamp I needed, after which I transferred the pressors over to lumen 1 and got a doctor. Luckily (for me AND the patient), Dr. Metro was the only one on the unit, all the residents and fellows being in conference.

Dr. Metro calmly assessed the situation and said, “No problem.” Really, he is my favorite attending to work with. Besides being incredibly affable and knowledgeable and a good communicator, and having a dry wit, he also has a wife who on occasion sends baked goods to us on the weekends he’s on-call. We upped the epi a touch and changed the hemofiltration removal to zero, Easily enough, he popped in a 22g PIV into the left antecubital. I say easily because he actually comes to us from the anesthesia department. He then commented that this was an almost welcome diversion because it gave him something to do, and went to get supplies to rewire a line. We then upped the epi a little more, and when the pressure was sufficiently high, we switched the pressors to the LAC, and held the TPN, IL, fentanyl and versed. He rewired a new triple lumen CVP, and we switched everything back. Anxious titrating to maintain pressures. Withdrew a couple cc’s of waste from the LAC, and heplocked it. Redressed the CVP and art-line (no steristrips this time), and it was over. Returned the hemofiltration back to the original removal rate. I think I aged five years. The upside to this, is now she had a place to put the insulin drip, even if we didn’t know how long the line would last.

And so, there it is. The worst thing I ever did as a nurse. It really scared me. I’m so glad that it was Dr. Metro on, and that he was the only one actually on the unit … I would have hated to deal with any of the fellows, as much as I generally like most of them. And you can bet that I am going to be very very VERY careful with lines from now on. Steristrips only on unsutured lines. And keep those scissors away!!!

Carrying On

Bought a carry-on suitcase today. Had planned on getting a snazzy little Salomon number, but it still took me visits to a couple stores, and serious deliberations in REI. And then, when I did purchase said snazzy number, I didn’t even make it to my car before I realized that I’d made a mistake. Quickly returned to the store and got the Victorinox number with the swivel handle that makes walking and pulling so easy. I love it. Small enough to carry-on, but expandable 3 inches. Bright red and easy to spot. And the joy of the swivel handle. Watch out world, here I come!

Miscellania

Finally, a year later, went to Langer's Deli with Wry-an and Hubbs. Georgia Peach completed the party, making us an even foursome. Langer’s, supposedly the best Jewish deli in all of LA, is located across the street from Echo Park. Whenever I see it, I’m reminded of Grandpa Lee’s death. Not that I was very sad for him when he died … he was old and had been cranky with life (and infirmity) for years. However, as a teenager, I did feel a lingering guilt that I had been at a party the night he died.

Anyway, as the three of us walked to meet Hubbs, it was like being in a different world. Shady guys offering to sell fake driver’s licenses (and being none too discriminate … because it’s been a long time since I’ve looked underage), saints’ candles, painted religious figures, and underwear for sale.

Some fries and pastrami later, and we were all stuffed. I’d tried to order onion rings, but to my great disappointment, there were none to be had. The fries were rather a disappointment … crinkle-cut, frozen things that had none of the freshness I’ve come to expect since my first In-N-Out order of fries. The best thing about the place was our waitress. Didn’t ever catch her name, but she must have been at least sixty, had the most delicious Scottish burr, and a smile as wide as the Atlantic, unselfconsciously displaying teeth that I’ve come to associate with a great lack of regular dental care. Honestly, she was charming.

~~~~~~~~~~~~~~~

That night Wonder Woman, Precious, Superman and I headed over to Universal City Walk to see the So You Think You Can Dance stage show … an early Christmas present from WW and Precious. Absolutely loved it. Many of my favorite dances from the season. Two new duets choreographed by the dancers themselves. And several dances reworked for more dancers than originally choreographed. It was fabulous. Loved it!

MESG: Jill M. Derr on Eliza R. Snow

After recovering from my horrendous night, I dragged myself out of bed, showered, and headed back to Irvine for the Miller-Eccles lecture. Generally I try to go to the one in Los Angeles, but plans tomorrow night (and a great desire to hear about Snow) enticed me south for the second time this week.

Dined with some of the group at Mimi's Cafe ahead of time. Got to meet Professor Derr and her husband. Also there were ArM, RuM, Mr. Critical Thinking, Poetess, Madwoman, Economan, VR and wife, JB and wife, and a few others who I'm not acquainted with. Talked a bit about our respective careers, but what I seem to remember most was the conversation about feminism and mormonism.

Carpooled out to the lecture location out in Anaheim. Drove with VR and Co in his Prius hybrid. I like it, a lot. And if I'd have had the funds to buy one earlier this year, I would have. Sooner or later, we will have to wean ourselves off of oil/gasoline consumption and work towards more sustainable means. Of course it will be painful, and politically and financially charged. But it must happen.

Greatly enjoyed Professor Derr's talk. Eliza R. Snow. Secretary in Emma Smith's Relief Society Presidency. Plural wife of first Joseph Smith then Brigham Young. Never had children. Strong advocate for women's rights AND polygamy. Poetess ... she penned the lyrics of the hymn "O, My Father," which contains one of the few references to Heavenly Mother still evident in the LDS sphere. Crossed the plains. The second Relief Society President in the history of the church. Brigham Young's right-hand person. The part that fascinated me the most was the discussion of female venues of power within the early church, and how she ended up taking the Smith name.

Apparently Snow enjoyed a fair amount of influence as one of BY's wives, and as RS president. She had an active hand in fashioning the lives of the saints, especially the women and children, in the Salt Lake Valley. However, when the general presidencies of the auxiliaries were set up, it seems as if defining the authority therein had a paradoxical limiting effect. Yes, she was defined as the top woman, but with a more limited scope of influence. Also interesting that she took the name Smith after BY died. Maybe because the BY marriage was not consummated, but one of powerful convenience? Maybe because she always thought of JS as her one (ironically) true love? Maybe as a bid for power as her influence diminished after BY died?

After the lecture ended, VR and Co were anxious to leave, and I was not opposed. It got me out to Atomic Ballroom that much quicker, for some long awaited dancing. Atomic is okay. Not fantastic like LG, but okay. Met and danced a bit with Slim Jim. Saw Buddy Schwimmer (self-proclaimed?) King of Swing out, but did not see him dancing. Danced with a couple new faces. If I were ever in Irvine on a Friday night, I'd go again.

Twenty hours

Woke up this morning prepared for a good day. The plan was to put in 12 hours at work, then head up to Lindy Groove for some much missed dancing. And then it all went wrong.

At work, found that I was given the most difficult assignment. I've learned to handle this type of news with equanimity. The tough assignments all rather go around (except to a few to whom they do NOT got to), and I rather feel like it's a good vote of confidence from whomever was in charge the night before. And honestly, it's generally better than being in charge myself, so why waste time complaining? Toddler with (questionable familial) cardiomyopathy with an as yet undiagnosed metabolic disorder; intubated (of course); on a couple pressors, an insulin drip and sedatives; poor perfusion; dropping H/H/platelets; and acidotic. My morning was thrashed. Gave blood products. Ensured she was adequately sedated. Checked blood glucoses every hour and titrated insulin drip. Arterial blood gases as needed, and with vent changes. Administering paralytic meds (and concommittant additional sedation and analgesia) to manage her respiratory status. Titrated lasix drip. Started and titrated nipride drip to increase peripheral circulation. Also some pysch/soc issues that are better left undiscussed. I think every single molecule of Degree I had applied that morning had vanished by 1000.

Somewhere in the afternoon, things got better. A lot better. ABG's were looking really good. ABP's were still a little low, but given her cardiac status, were acceptable. Her perfusion was dramatically improved thanks to the nipride. Her In's and Out's were even, and urine output was sufficient thanks to the lasix. And so it was that when SC came around asking if anyone wanted to do a triple shift, I started considering. I could go dancing tomorrow night down in Irvine, and the Morocco trip is coming up fast, I'd really like to see how this patient does, and the last couple times I volunteered to do a double, they'd found someone to do a triple. Plus, our team was Dr. Metro for attending, and Tan Shaggy for fellow. And as these are the physicians I like working with best (very intelligent, affable, and communicative). So, I agreed to do a triple. And then things got worse.

Potassium on an ABG was low. So I gave a KCl bolus. After the bolus, rechecked it with a routine ABG. And found out that she was very acidotic. Gave sodium bicarb and adjusted the vent. Repeat gases. In the meantime, her extremities started looking flame-red. Yes, she was perfusing very well, but her blood pressure was also starting to be affected more than was comfortable. Ended up stopping the nipride and having to bolus with more saline.

By the time 0300 rolled around, I was shot. Absolutely worked over. Ready to crawl into bed and disappear for a day. Gave report and got out of Dodge. Next time, I'll try to be a little more strategic and stay over when I have a more stable patient!

And, to give credit where credit is due, I must say that all of this was done in close consultation with Dr. Metro, Tan Shaggy, occassionally the resident, Dan-the-Man RT, various consulting physicians, and all the other ancillary staff (lab, blood bank, social work, house keeping) without whom my career would be impossible.

Ch-ch-changes

Worked on my exponent post until it was in fairly reasonable shape. Did NOT immediately post it like I did two weeks ago, and thus did NOT mistakenly post on AmyB’s day.

Drove down to Irvine. Stopped at Trader Joe’s for dinner fixings, and then on the Pilgrim Girl and Nichan’s place. And waited. And waited some more. Sometime around 1730, just after calling into the apartment to make sure they hadn’t slipped in past me, I get a call from PG. Running late, Harry had trouble at the orthodontist’s.

Dinner with Pilgrim Girl and the two kids (Nichan is taking Wed night classes this semester) was on me tonight. Caprese salad (fresh mozzarella, chopped basil, mini red and golden tomatoes, pine nuts, balsamic vinegar and olive oil), garlic bread and mushroom risotto. Not a whole lot of cooking, but oh so tasty. PG also had some garlic spread that we used liberally, which I intend to get some of at ... you guessed it, Trader Joe's.

VR was leading tonight's discussion on the religiosity of college-aged students. Apparently he had been involved in a study that conducted surveys on daily religious involvement of college freshmen around the country. The data he shared with us had two subsets: LDS (at non-church sponsored schools, interestingly enough) and all other students. Questions asked about daily practices, political beliefs, social justice, spirituality, etc. The LDS students seemed much more willing to identify experiences as spiritual, and much less willing to do anything with regards to social justice.

As usual, the discussion was lively and engrossing. And as I looked around the group, I was sudden;y struck at how quickly it is changing. Tall Spaniard already left. Mr. Critical Thinking and Poetess will be leaving in the summer, and who knows about all the rest. Contemplating the changes made me sad. This interlude has been so idyllic ... having this unique space in which to discuss and examine difficult theological (and cultural) principles has been a such a relief and a period of growth in spiritual and intellectual knowledge, that I am very reluctant to have it change at all. And yet, I do hope that it will be sustainable. That as the failiar crowd moves on (hopefully becoming professors around the country and starting their own Outhouse Intellectual groups), new faces will join in and enliven the discussion even further. I can think of a couple of new people that I'm very interested to get acquainted with. So, change is in the air. We shall see what it brings.

Recovery

Ouch. Ouch. Ouch. I feel (and hobble around) like a very old woman. My body is so incredibly sore. Attended the preceptor committee meeting at work, then off for a sports massage. It was good, although I think I may have yelped a time or two when the masseuese was working on my calves. Anyway, now that all the camping stuff has been cleaned, aired and put away, I only have to wait for the soreness to dissipate, while I languish in vaporous clouds of menthol.

Havasuapi: Getting on Out

After a intermittently sleepless night, I finally managed to get to sleep. Only to awakened by JLITH's alarm at 0500, then my own at 0600. Havasuapi must have been sad to lose us, because she was weeping ... rain pelting down on our tents. Scout ended up joining Portnenia and Highland Hiker. Finally, I got up and dressed and started packing, eventhough the rain was still going ... there was no way that I was going to miss getting my backpack on the muletrain and having to carry it out! Stuffing the wet tent back into the bag and pack was not ideal, but it had to be done. We did finish and managed to get up to the paddock a little after the appointed time. Lucky thing, as the Indian mule train driver was rather on time. In the end, he got all of our packs (JLITH had consolidated her pared down pack with the rest of our stuff) onto one mule. Hallelujah!

Rain continued to spit, and the prospect of sticking around until the afternoon was ever less appealing. In the end, we left the camp around 0930. We passed by Zlot's campsite on the way out, but there was no sigh of life, eventhough he'd said that he would pack out at 0700.

Stopped over at Najavo Falls for a bit. I was rather disinclined to take off my hiking boots and get wet, so I relaxed a bit at the bottom, then moved to the top of the trail to bask in the sun. Meanwhile, Scout, Portenia and Highland Hiker scampered in and out of the bridal veil-ish falls.

As we were getting ready to make for the village, who should join us at this juncture, but Zlot! What timing. Unfortunately, he was carrying his entire pack, as the helicopters were supposedly not running on Saturday. The hike to the village was slow. Not difficult,just slow. JLITH and I took the rear, and soon the others were out of sight. I took JLITH to task for moving so slowly that even I was restless. Apparently she had a pulled muscle in her leg, but stiffened her upper lip and soon we caught up with the others.

Breakfast at the village cafe. What we all really wanted was lunch, but it was too early. Anyway, almost anything was better than the short rations we'd been on the past few days, and we dug into our breakfast burritos with relish. The patio was nice and cool. It afforded us a nice view of the towering red rock, farms, and busy helicopter landing field. No flights on Saturday? Lies, all lies. JLITH gazed longingly at each helicopter as it left. After the second one, I told her that she'd better do something about it next time. Accordingly, when the next helicopter arrived, I saw her approach it. As the propeller was still beating, I was not surprised when she boarded it ... to talk to the pilot, no doubt. All of a sudden she was waving, and the copter was lifting up. I was so astonished, and the laughter just bubbled out uncontrollably.

The hike out was long and hot. Except when it was not. Scout was often times far infront. He's so fit that even when he's just sauntering, he moves much faster than the rest of us. Highland Hiker, Zlot and I brought up the rear. Now that we were past all the water fun, HH was dealing with her too small boots again. Zlot was carrying his full pack. And me? My only excuse is that I was slow, and very sore. Stopped for a minute at the tadpole pool. I pointed it out, and got enough ooh's and aah's to ennable me to catch a brief respite. Zlot also shared some of his liquid gold ... ie: Gatorade!

Passed by this intriguing rock display. The "mounting" is a huge boulder, maybe 12 feet high, with numerous, shallow "mini-caves" into which passing hikers have placed pebbles. The result is a Museum of Rock, which vaguely resembles a thimble or spoon collection that one would expect to see in a senior citizen's home.

It did end up raining on us. Quite decidedly so, to the tune of everyone else getting out raingear to put over their backpacks small or large. Me? I took off my outer shirt and gloried in the shade and coolness. The showers didn't last for long, but they cooled us off, and made the dust more complacent. We had a few more showers, which was rather disconcerting, as the sun was shining when it occurred, but the rest of the way was mostly dry.

At one rest spot ... and everyone was resting, except for Scout, who was leagues ahead ... Zlot said that we should alter the hiking line-up. He suggested that the slowest person (me, of course) should be the frontrunner, setting the pace so that one could carry on a conversation, and not get too winded. Also said that it would be best so that no one would go into anaerobic metabolism. I didn't like the idea of slowing everyone else down, but since I knew that HH was moving a little slower beause of her feet, and that Zlot was dealing with carrying a full pack, I acquiesced. And so we continued with me in the lead, until we reached the base of the ascending portion.

We all took a long break at the base. We drank and ate up. Portenia, instead of giving me a bite of her Cliff Protein Bar, gave me the whole thing. It was good ... tasty, without the mealiness of your run of the mill protein bar, and less carbs.





On the long trek up, Scout soon outdistanced us. Portenia soon followed suit. However, I was kept in good company with HH and Zlot. We took our time. Zlot even gently urged us forward with the promise of a series of benches, "just around the corner." After another brief respite, we continued climbing up the awful switchbacks. We spotted JLITH waving from the top, and then soon saw Scout coming down the mountain. He offered sips of gatorade, and to carry stuff. I, being the weak one, happily took him up on the offer. about two switchbacks down, JLITH also joined our group, with cool gatorades for each of us! Good girl. We all made it to the top in short order, and started getting ready to drive back to civilization. Goodbyes were said to Zlot, and the rest of us headed out to Kingman for the all the comforts that In-N-Out could provide ... food, drink, flush toilets and running water to clean up in! The drive was long, but much better made in daylight than in the dark.

When we finally arrived in Kingman, it was almost dark. I opened my car door, swung out my legs, and realized afresh how painful is was to move. We all hobbled into the joint and made a beeline for the restroom. Fifteen minutes later, freshened up and coated with Portenia's menthol gel, I emerged to gain my just reward. And at about 0130 in the morning, I reached home. Showered. And fell into the creature comfort of my own bed. Heaven.

Havasupai: Mooney/Beaver Falls and a new friend

Sore. Very sore. The thing is, my bed at home is so supremely comfortable, that anything else … the bed at JLITH’s, hotel rooms, and most certainly a meager camping mat and sleeping bag on hard earth … is a definite step down.

We breakfasted on Cliff Bars, then headed out for Mooney and Beaver Falls. Mooney Falls is my favorite part of Havasupai. Descending through the cavern and steep areas is a little scary and very exhilarating. Plus, the views of the water and falls are so majestic, the pool at the bottom like a shimmering piece of turquoise petrified wood.




At the bottom, we decided to plug on to Beaver Falls, and enjoy the sights on our way back. On the way, we ran into Zlot (not his real name, of course, but how I mispronounced it the first time). He was hiking around, getting lost by the myriad fake trail offshoots. He joined in the caravan, much to our delight.

Finally, after traversing the endless wild grapevine section (for which I’d advised everyone to wear longer pants, remembering the lashing my legs took the year before), we arrived at the rope climb. JLITH quickly scrambled up, and Portenia also made it up. Then Zlot. I confess that I balked. After having lost a watch and a camera, plus taking a battering plunge at this site last year, I was not overly eager to sacrifice any more to the Supai totems. I’d already decided that taking it easy at the lagoon would be sufficiently relaxing and entertaining while I waited for the group to return. However, Scout was very convincing, and coaxed me (with the help of his strong shoulder) up the rope climb, and suddenly there I was at the top! Highland Hiker came quickly up next, and Scout brought up the rear.

The trail from this point on was very hot and dry. The vegetation is scrubby, and there’s very little shade. Lots of scrambling made the way interesting. It was such a relief to reach Beaver Falls, even though the climb down was a little hairy. Beaver Falls is actually quite beautiful, which I hadn’t appreciated last year, since we’d taken a different approach, and stayed much higher. It looks like a series of azure pools that a clan of beavers might have made to retain all the family close by. We refreshed ourselves in the pool for a while, and then it was time to return. Zlot, who had been conversing with Portenia, was to return with us. Fortuitous when a lone hiker finds congenial company. I know I felt so much relief hiking the Narrows back with the boy scouts. Comforting to know that someone is available to go on ahead for help in case of an injury.

As we scrambled up the rocky and sandy cliff to regain the trail, I managed to do what I’d avoided so far … scrape myself. No pretty legs for me for a while. I just hope it doesn’t scar as badly as the one from last year, which scar had just faded after my infamous peeling-like-an-onion incident.


Retraversing the grapevines, I was sucker-punched by an errant trekking pole. There I was, hurrying along. In my mind I vaguely remembered the few vine-camouflaged potholes that hid by the side of the trail. All of a sudden, I stepped through one and down I went. I saw the cork end of my trekking pole heading for my right eye, but was powerless to stop it. Pow. Ouch. I might have said an unladylike word or two. I was concerned to say the least. After JLITH and Zlot reassured me that there was no bleeding in the ocular orbit or gross abnormality, I turned my attention to my vision. Of course my eye was watering like I had just watched Love Story again, but was worried me more was the blurred circular area of vision. I assume it was my prosthetic lens, a little budged out of place. Zlot took a good look, said that I had a small abrasion to the lower eyelid, and a bit of a hematoma above, but that he had betadine to clean, and triple antibiotics to salve my wound.

After a couple minutes, as the vision was quickly normalizing, I pronounced myself fit to continue. We plugged on until we reached the rope swing. Scout and Zlot had the time of their lives, and even JLITH and HH joined in the fun. Stopped also at the base of Mooney for a photo op. Then the long climb up … 200 feet. Very tired and thirsty at this point, as water had run out before descending the rope climb. Near the top of Mooney, we took a break. My last push ended at the spring, where I refilled my water, drank deeply, then refilled. Zlot kindly asked me where our camp was, so that he could dress my injury.




Zlot came back to our camp shortly after. Apparently he’d left the betadine in another pack, but came to us prepared with the rest of his supplies. I wisely refrained from stating that I also had some stuff, and let him take care of my eye. Sometimes it’s very nice not to have to be the caregiver all the time, and I wanted him to stay and chat. It got a little later, and Zlot excused himself for dinner. Like a dolt, I didn’t reflect much on it.

I took a quick wash In the river, and changed into the comfort of my PJ’s. Scout started boiling water for dinner. And then we all realized that Zlot would be eating alone, and thumped our heads at not having invited him to eat with us. I walked up to his campsite to invite him. I found it easily enough, bright yellow tent and large tree felled over the picnic table, but Zlot was nowhere to be found. I waited a couple minutes just in case he had gone to the restroom, and fretted that I had nothing to leave a note with. Scout happened past, and scratched a note in the dust. We tried to stake a twig in front of it, but the ground was too hard, so we ended up leaving a couple twigs crossed right in front of it.

Back at out campsite, Scout continued to boil water for all of our meals, and I tried out the hammock, which was a vast deal more comfortable than my air mattress. High approval ratings on the hammock. I would even contemplate getting one myself, it if wasn’t for the exposed-to-insects factor.

Since JLITH was so opposed to the beef enchilada of the night before, Scout let us use the lasagne that a roommate had left before moving out. It was okay. Not great, but better than the beef enchilada, and pretty decent when it came to dehydrated food. As we were finishing our meals, I wondered if Zlot had gone to Havasupai or Navajo Falls? Then Portenia said that she’d seen him on her way back from cleaning up at Havasuapi Falls. She’d done the gracious thing that we’d all forgotten to do (ie: invite him to dinner), but that he’d declined since we hadn’t said anything earlier. Immediate remorse. So I walked up to his campsite to invite him to share some conversation and dessert (JLITH’s snickers bars). I found him finishing up his own dinner. We both laughed ruefully as I showed him our dust-note, which he’d not noticed. And so I brought our Hungarian friend back and we all ended the night with talk of politics, President Bush, and science fiction, with the full moon benevolently looking on.

At some point we did all go to sleep. And at many points I tossed and turned and tried to sleep some more. I woke up around 0200. Tossed fitfully for 45 minutes before I finally caved and got out my travel notebook and started jotting down notes from the last few days. Also dressed my leg scrape and took more advil. And I successfully resumed my bid for sleep.

Havasuapi: Hiking In

Woke up early. To an unpleasant sound. No, not the mosquito, although the four bites on Highland Hiker's leg witnessed his continued activity. No, it was the sound of rain on the roof of my car. Not generally an unpleasant sound, but very grating to my ears as I contemplated a wet trek and camp down in Supai. I fell asleep again, swatting at Mr. Squeeter, hoping the heavy rain would let up.

Finally around 0900, the rain seemed to be light enough that hiking wouldn't be absolutely miserable. Got out of the car, and Lo And Behold! Scout, Portenia (so named because she's from Buenos Aires) and JLITH (an old ATP joker name) were a couple cars down, getting their packs ready. Some quick introductions, and we tried to hurry our way down. HH was a little slow on the upswing, but I should have been so careful.


My pack was heavy. Tent, sleeping bag, mat, mess kit, camel back, camera and case, and a whole lot of other things made it feel lik dead weight on my hips and shoulders. Even before we started descending into the canyon, I was glad that we'd all decided to let the mules carry out packs out. HH and I definitely brought up the rear. I'd like to blame it on my heavy pack, but it's really no excuse. I was the D student of the class. However, it was between being a D student of the Fit group, or the A student of an Unfit group that actually didn't go to places like these. Maybe I should hang out with really unfit people to appear more fit? HH had a legitimate excuse ... too small (and new) hiking boots. We (or at least I) watched enviously as JLITH, Scout and Portenia skipped along the path.

Eight miles later, we reached the convenience store, where snacks and gatorade were purchased from one of the friendly locals. HH bought some water socks, and I was about to buy some Gatorade when I came to the horrible realization that in my haste to leave the top, I had indeed left my baggie of money (and the adjacent one with toilet paper) in the car ... a dismal 8 miles away. I was about to sorrowfully replace the cold (and vibrant red) Gatorade, when JLITH volunteered some of her funds.


Thankfully, Scout was also well prepared in the monetary way, and covered HH and I for the fees ... $57 to camp for two nights, and a jointly-rented mule to pack our things out. After relaxing on the grass, while pretending to play with the friendly cat and dog who sought our caressing hands, we made a quick stop at the cafe, then trudged the remaining 2.2 miles to the campsite. Again, HH and I dawdled. And again, we justified the break with a mini-spate of picture taking.

We caught up with JLITH near the top of Havasu Falls. The water is just so blue. The only thing I've ever seen like it were the waters of the Rio Celeste in Costa Rica. In Havasupai, the waer owes its beauty to lime deposits. The sign says that it’s travertine, which is the same stuff that the Coloseum and the Getty Museum are made of.


After a “break for mini-spate-ing,” we started down the path again. Before we got too far, Scout came bounding up, and offered to take my pack the rest of the way, as he and Portenia had already found a pack and started setting up. Never one to look a gift horse in the mouth, I quickly took him up on his offer. I also might have wanted to slug him when he laughed at how light my pack felt, but restrained myself somewhat admirably. Eventually, we set up camp, and trooped back to Havasu Falls to refresh and clean outselves.


We were in the water by 1615. And yes, it was cold. However, the desire to smell not as bad as we actually did got Portenia and I into the act of lathering up with some of Scout’s biodegradable soap, and plunging into the beautiful water. After a while I got too chilled, but Scout and JLITH made it over to behind the waterfall and took this marvelous photo.

When we finally made it back to the camp, we were all a little chilled. JLITH and DW worked a bit on HH’s camp stove, but the untamable flame (or maybe it was the leaking pipe) became too scary, and we all ended up using Scout’s superiorly designed and simple stove to boil the water for our dehydrated meals. My deal with JLITH was that I would buy the food (and the tent) if she would carry it down (as I would the tent). Imagine my delight when I found a whole line of dehydrated meals on sale for 30% off at REI. We only ended up eating one of the three I brought down. But I don’t think JLITH gave the chicken enchilada and the spicy Thai chicken much of a chance after the beef enchilada. It wasn’t really that bad. Really.

At this point, I think it advisable to mention the animals were are not our friends. This includes all sundry squirrels with giant teeth (THIS BIG, as JLITH would say, that can cut through a backpack strap in alarmingly fast time), scurrying little cute mice who nonetheless are probably carrying diseases, and bats that flit about in the most alarming way. However, of the three, I must say that my most cordial feelings were to the bats, in the hope that they would make the mosquitoes in the area DIE!

Early to bed, since we were all tired. Portenia in Scout’s tent. Scout in his hammock. HH, JLITH and I in my tent. We were all snug as a bug in a rug when it started spitting rain. Groans all around. However, as I tossed and turned for most of the night, I am in a firm position to be able to say that it did not rain hard or long.

Havasuapi: Getting to the Hilltop

We got a late start out of LA. Which was very unfortunate, given the awful traffic that plagued us until we were well past Pomona. And what do two girlish women (or women-ish girls) talk about when they have hours upon hours of road ahead of them? Well, I’ll leave that to your imagination. I vastly enjoy road trips with congenial company. Maybe it’s the camaraderie, the air of excitement, or maybe just the captive audience … because honestly, where can she run to?

When the sun had cast its last fiery farewells to the moon, thick darkness fell all around. That is, until it was shorn to tatters by the brilliant and jagged lightening rods that Zeus threw down from his heaven to light the way. Lightening storms followed us all the way to Hualapai Hilltop. No rain or thunder, just brief seconds wherein portions of sky tried to trick us into believing it was the middle of a sunny day. Eerie, and yet not. I actually really dislike driving long distances in unlighted areas, and at least the lightening illuminated the sky to the point that I knew that vast mountain ranges were not closing in on me, as they seemed to do driving down to Arches from SLC.

We stopped outside of Barstow for gas. It was selling for an outrageous $3.24/gallon … absolutely ridiculous given that gas in LA was selling for $2.97 that same day. At least we know now where not to stop on the return trip.

We stopped again in Seligman, where the gas was a much more accommodating $2.79. Quick stop over at a Dairy Queen for dinner. Had to order the onion rings to further my search for the best onion rings in the nation. The DQ version stood up pretty well … sliced a good thickness (not too wide or thin), fried up extra crispy, and eaten hot. The cafeteria at my work also does a pretty good job, although I hate it when the rings stick together in the oil, making for some soggy rings. However, the best onion rings have to be the ones at the Greek place in Westwood Village. The name escapes me just now, but it’s a fantastic place for lunch, and I think I will start taking friends there.

Got to Highway 18, and I ran out of steam about 40 miles in. At which point Highland Hiker kindly offered to take over the wheel. How thankful was I!

When we finally arrived, we tried to get comfortable for a final night’s sleep on upholstered surfaces. I was almost out, when I heard the distinctive high-pitch whine of one of my most hated enemies … a mosquito! Just the thought of it flying around in my car, was enough to keep me “awaker than a guilty conscience.” HH tried to lure it with her headlamp and smash it with her hands of death, but to no avail. In vain I chanted, “Die! Die! Die!” but the little bugger eluded us with much skill.

The teachings of (bizarre) men, mingled with scripture

Argh! I was just adding some fun youtube links on to the end of a fascinating post about the freakish conference White Boy and I attended down in San Diego, when it got killed by a misguided key stroke! I really don't have the energy to rewrite it, so you'll have to ask me or WB about it sometime. One hint: the speaker talked about this for the hour after sacrament meeting. You tell me if you think saying "dolphin" through the water, then freezing it, made the crystal so pretty.

Now, to get back to the really important stuff. Youtube clips to amuse and delight:
OkGo-Here It Goes Again
Kevin and Carla at Barswingona
Love Me or Leave Me
Doug and Emily
West Coast Swing and Lindy
Hop, Swing and A Jump: Traffic Jam
Swiss Drum Corp

The good, the bad, and the funny ...

The Good
Dancing ... three nights in a row. Lindy Groove Thursday. Fabulous night. White Stretch J even asked me to dance. Friday at Paseo Colorado. Live music, professional dance floor, white lights and twinkling stars overhead, and plenty of people to dance with. A fantastic venue, and I'm so sad that this was the last one this summer. PBDA on Saturday. Jumpin Joz on the bandstand, lots of dances, and some old familiar faces: Shane (all cleaned up) and Carmen (oh those fabulous Suzy Q nights).

Hiking the Corral Canyon Trail, then having lunch at Malibu Seafood. The refreshing breeze, bright sun, and sparkling ocean were just the ticket to start getting ready for Havasupai.

Dinner with Wry-an on Saturday night. Who knew he liked sushi? There are some people I like in big groups, and some I like in very small groups. Wry belongs in the latter, and it's good to have face time every once in a while.

The Bad
Being in charge on Wed. Awful day at work. So awful that the only thing to do was laugh and plug on with it. Six planned surgeries. Five of which actually came. An unplanned post-op. And an unplanned ED admission. Blessings to DG who bought a package of Hershey kisses to ease the craziness.

Work on Thursday. Started as team leader and hoped for no patient load so that I could go to the presentation on Emma Smith. However, I had to take over a patient at 1730. Then, French MD had to come in and examine because of complications. Funny to hear him use my name several times (a first, although we see each other all the time). In fact, it's rare for me to call the docs by their names unless I especially like or admire them. Actually, since we have so many attendings, fellows and residents, it's rare for me to actually make the effort to remember their names unless they are a resident who has become a fellow, or an attending that I deal with on a regular basis.

The Funny
Mini-hulk introducing me to a friend, and discovering that we both used to attend Ren Faire at Glen Saint Helen, and both love _Ender's Game._

Realizing how lame I can be. After chatting with Jim2 in the cafeteria, then seeing him in the deserted eating area (practically parked right in front of the cash register, all by himself), I just couldn't make myself sit down at the same table and have brunch. Of course I really wanted to. Really. But I just couldn't do it. I contented myself with flashing him a cute (I hope) grin as I walked past, and went upstairs to the lonely nurses' lounge. And if you believe me when I say that I contented myself, I have some beach front property you should look at.

The Sushi Nazi

Being that it was FGITW's birthday today, and being that we were both free, I was finally able to take her out to lunch at Sushi Nozawa. I've been wanting to share this find with her for a while, but could never find a time when she, I and Nozawa were all free. And frankly, Nozawa was the most problematic one.

Sushi Nozawa. Little dive place in Studio City. Only open two hours for lunch, four and a half hours for dinner, and only during the week. Only one sushi chef. Rather pricey. No take-out. And yet, it's the best sashimi I've eaten in the US. So fresh and tasty. My favorite is the chisai maguro (or little tuna): exquisite slices of fish served with scallions and ponzu sauce. Sugoku oishi desuyo!

Anyway, we sat at the bar, which is an experience in and of itself. At the bar, one can only eat Omakase style. Which basically means that you eat whatever Nozawa puts in front of you. The sushi rice is warm (hence the no take-out rule), and the nori (when he uses it) is crisp. And the sashimi ... heavenly.

At the bar, FGITW talked about Allen Say, boys and men, and cabbages and kings. And then she charmed Nozawa with her flawless Japanese, blonde hair, and winning ways. At one point he gestured to a patron behind us and shouted, "No phone! No phone in here!" And then muttered to us about the abominable manners of American people who talk on cell phones. FGITW quietly reached in her purse and put her phone (which she is never without) on vibrate. I wanted to turn around and see the lady with the abominable manners, but was too chicken that he'd bust me for staring.

Anyway, it was a great way to spend the day. Scrumptious sashimi and some good soul talk with my Japanese sister.

Meet the ... uhm ... older sister archetype?

So, Wry-an has been wanting me to meet Georgia Peach. Actually, I'd already met her, and liked her, and been impressed before I ever knew he knew her. But I got the impression that he wanted me to like her more than just as a girl who's excited to learn about swing/blues dancing. So I offered to take them out to dinner. And a couple of weeks later, we finally got our schedules insync enough to get together.

Went to Pizzicotto in Brentwood. My favorite Italian eatery. Il cibo e' tanto delizioso (that sounds about right, although my Italian is so corrupted by the broken Spanish I use at work, that I don't half trust myself). We ate outside, a first. Mixed green salad, risotto di terra (my favorite), grilled salmon with veggies, and pumpkin gnocchi. Meraviglioso!

Lots of talk. The Emma Smith bio I have on my to-read list. Sunstone symposium. Georgia and the southern wave. Travel for fun. Travel for work. GP's clinic work in Africa. Good times.

Anyway, they have my approval. Not that they need it. But I am rooting for them. I want them to be happy.

And really, I would like to see all of my friends happy. It makes me sad when good friends are unhappy, or I see friends doing things that I can't see leading to happiness. But then again, I'm a friend, and not their mom. And I think they will be vastly happy. And really, no one needs my approval. Not even my youngest brother (who is one year younger than Wry-an), although I hope he doesn't ever hook up with THAT GIRL again.

Eeek!

As someone who's being linked to on other blogs in the 'nacle, I should be more descriptive. However, when I found myself linked to on one of Eve's posts over at Zelophelad's Daughters, that was my exact response.

Some other recent posts that have really gotten me thinking ...
Polyandry
Feminism I Can Embrace
LDS Modesty
Rationales for womens' priesthood
“Whores” and Scriptures: Epithets, perceptions of women, and divine texts

The healing

Went to work today. Intended to have one of the fellows look at my toe and prescribe more some antibiotics. However, it was the B-team on today, and I decided that it would be better to go to UCLA ED afterhours and get this thing in the system in case I needed referrals later on. Ended up taking some supplies, into a bathroom and removing the offending and detached toenail off and dressing it with some xeroform to dry it out.

After work, drove home, changed, and went over to UCLA ED. How bad could it be? The first (and last) time I was there was New Year's Eve, and it was pretty deserted. How bad indeed. First, there was no parking in the ED lot. The parking girl said that it would be $8 to park in the other lot, and I was squeezed for cash this week. Tried to park on the street, but that was impossible. After about 20 minutes total, I pulled up to a separate kiosk. The guy told me that the $8 was refundable (!), but that the kiosk closed at 2200. Anyway, in I went. Got registered (coincidentally right after a girl who also had a toe injury that looked to be gettin infected), and hurried to get my parking reimbursed before the deadline.

Back in the waiting room, I parked myself on a chair against a wall and snoozed a little. The Other Toe Girl (hereafter TOTG) and I were called back together, and placed in a large room with curtains that separated each gurney. After the initial assessment by the nurse, TOTG pulled back the curtain, and we compared our undressed wounds. She got off with a pair of crutches, but I won with a prescription for Keflex, which look so pretty with their scarlet capsules.

I actually miss my toenail, but even more I miss all the dancing I was to do in SLC, and the dancing at Paladino's amd LG that I am missing out on now. My one consolation is the hope that I'll be healed enough to go to Havasupai next month.

Real Food and Catan

Wonder Woman decided to cook tonight. Wonderful veggies from the Farmer's Market, fish and pork medallions. Scrumptious. Precious, Superman, TheDot, Ballerina, FGITW, Improv-er, Gadget Boy, Lovely Lady, Perky, Charming, Mr. Baritone and Wry-an stopped by for a little bit, and even Rico and Rica came by for some food and gaming.

The Catanning was rough. In two out of three games, I had a metropolis stolen. Oh, the pain and anguish of it all. Improv-er was the big winner ... I think three games.

And, WW, Precious and Superman are taking me to the touring show of So You Think You Can Dance for an early Christmas present. How fantastic is that?

Then again, maybe driving's not so bad ...

Up at an ungodly hour to fly back to LA. However, also first day in five when I haven’t felt obligated to put on makeup. Hurray!

Don’t know how, but I missed the turnoff for the 80W and drove right past. I mean, aren’t there huge signs everywhere? Anyway, I had to turn off at Redwood and backtrack.

The big news is the new airport security measures. Apparently British Intelligence uncovered an Islamic extremist plot to construct bombs onboard flights with the use of a Casio watch, a battery and some special gel. Thus, the new restrictions state that no liquids of gels are allowed in the boarding areas, or on board. So far, breastmilk and medications like insulin are still allowed.

Interesting, because as I was trying to make my way to check in, I saw three middle-eastern men, with substantial beards and flowing linen robes walking in the other direction. I wondered about them. What brought them to Utah? Did they feel ostracized? Had people been more rude and prejudicial since the plots were discovered, or had it not made a difference? I had almost made up my mind to walk on the other side of the escalator, when I silently denounced myself and passed right by them. Good thing, since the other side of the escalator was barricaded off to block pedestrian traffic.

Of course, the new restrictions made the SLC airport chaotic and crowded, which one wouldn’t expect before 0600. One bad thing about Southwest in SLC is that it is the stepchild of the airport. The check-in counter is on the extreme left, and if one is coming from the parking lot, one has to walk by luggage carousel (of which I have distinctly repulsive memories), and a myriad other ticket counters before one can check in. And then, they have the e-ticket counter on the far left of the Southwest area. As if anyone actually buys regular tickets anymore.

After I was finally checked in (which was rather a killjoy, since I would have been able to carry aboard my bag if not for the liquid/gel prohibitions), had to scurry (since I couldn’t actually run because of my toe, not that I would have run anyway, as I really hate running) to the security line, which stretched back past the luggage carousel (again!). The line actually moved rather fast … I only wasted 30 minutes of my life. Then again, I could have had 6-9 fantastic dances in that time. Oh, the regret.

Did some more scurrying to make it to the boarding gate. Again with the step-childedness of SW … their boarding areas are just about as far away from the security area as one can get while still remaining indoors. I passed an old guy waiting in a go-cart, but my impatience told me that he might drive slower that I was able to scurry.

Finally made it to gate B-17, and was the 3rd to last person to board the plane. And as fortune would have it, a seat was waiting right in the front row, with room in the overhead bin for my laptop case. How unexpectedly serendipitous. Of course, the seat was next to a couple with a toddler on the mom’s lap, making the bulky dad shift his burly arm into my personal space … at first I shifted away, but then it got uncomfortable, so I decided a little arm contact wouldn’t kill me. And when the mom moved the child onto her other arm, the proper distribution of arm space was wonderfully restored.

Now, if only I could have one of the burritos that the captain had so lackadaisically placed on the center divider controls (I even saw the little containers of salsa right next to it), I would be perfectly happy.

Next time, maybe I’ll drive …