Nothing quite like a cone on a Saturday afternoon to make the world a bit sweeter...

Life

“When you arise in the morning think of what a privilege it is to be alive, to think, to enjoy, to love …” ― Marcus Aurelius, Meditations

 

Life gets to you at times, doesn't it? I don't often write about work. I think it's because I have desensitized myself to a lot of the human emotion I deal with on a daily basis, purely on a survival mode. I have probably interacted with 50 different patients today, performing surgical procedures, helping them with their pain, sometimes the worst pain of their life, other times talking them and guiding them through their recovery, sometimes successful, other times not so successful. I think if I actually processed all that human emotion, actually thought about each individual person and what they carried home based on their current issue, be it their gallbladder, their gangrenous toes, their occluded aorta, their metastatic cancer, or maybe just their painful clotted varicose vein, or even their incidental cosmetically bothersome spider vein, (oh yes, it happens,) I would become an anxious crazy mess. 

And then I write, or start to process these thoughts and I do think about all this STUFF, for lack of a better word. It's not often. I guess I seek solace in knowing that most of the time, heck I hope all of the time, I at least make a good attempt and TRY to make things better for people.

Until that doesn't happen.

Today started off a bit hairier than most, but not entirely out of the ordinary for Katie the PA-C. We've had a run on gangrene lately. I think I started my morning with three different patients, among 15, fathers, grandfathers, husbands, friends.....who had gangrenous toes, feet, etc. One recovering from a vascular surgery, the other suffering from diabetes and renal failure. Both not having much sensation thus being able to withstand in office debridement.

So there I find myself, sniping, excising, swabing, placing pressure, and repeating, dead flesh, dead toes, dead tendon, dead, dead, dead. Until blood flow is reached, healthy pink tissue, having a fighting chance. We stop. We've chatted though the whole thing, one patient teary eyed, visibally disturbed at the awful site of his own foot, another rather cofused and somnolent, another very calm and collected while his distressed 6 year old grandson looks on, myself trying to focus on the task at hand, trying desperately to ignore the nauseating smell that I've become accustomed to, trying to find life in their limb, trying to distract the child, trying to calm my mind in wondering WHY this child has to witness this, why is their parent letting them witness this sight.

This is all rather common place. Pus, blood, dead tissue, alive tissue. I work with it, configure the appropriate treatment using surgery, fancy dressings, wound vacs, antibiotics, and move on, expecting success, planning for failure. Death is apparent, but in small pieces. Dead tissue, a dead occluded artery, a ischemic dead portion of the brain, infected dead bone, etc. A small piece dead, but the person as a whole is still very much alive.

Until cancer.

Today I had to tell a dear 60 year old Mom, Aunt, Niece, Sister, Partner, Friend, Patient that her pancreatic cancer had spread, quickly, and was now causing common bile duct obstruction. 

This really isn't news. Except she had just had surgery, a huge surgery, weeks ago, for palliative measures, to help prevent this very thing, or at least give her more time. To prevent her extreme yellow glow, her vomiting bile, her unrelenting pain.

She had been CONVINCED of surgery. This Friend, Mom, Aunt, Niece was not immediately a fan of surgery. She would rather not know of the cancer and die that way, she told me in her own words. I'm not sure if it was her family or her that made the final push to have the surgery, but it happened. As well as a filter to catch the venous clot, it happened too, placed in her vena cava, to catch that inevitable clot that would become a pulmonary embolus and kill her. Kill her QUICKLY. Where now she is dying, leaving this world, rather slowly, quite yellow, quite uncomfortable. 

My brain can get the best of me in situations like these. I explain the CT results. Tell her of her growing cancer pushing on the very bile duct bypass that was created to bypass the original cancer. Listen as she tells me this is it. No more procedures. Listen as she tells me she wishes her filter wasn't in, as she wouldn't have to suffer, as the CT shows a big clot the filter has caught...saving her life...for what? She asks. 

I get on the phone to hospice, which she has not wanted until now. Too tough, too thrifty, "too much money", "I'm not bad enough" was what she said before.

Now she says, please, soon, NOW! I'm ready now.

I can't get them to her soon enough, is what I feel. I should have gotten them there last week, last month, last year....

"At first do no harm"

 

Half a Decade Ago...

Roughly...give or take a few days...I was making pizza. LOTS and lots of pizza. Or so I thought. I was deep in that nesting stage, overdue, and wanting to do something, ANYTHING, to prepare for our first kiddo.
It's like jumping off a cliff, isn't it?
Or so people liked to say.
It is a club of it's own kind, this having kids thing.
5 years ago tomorrow Forrest made me a Mama. 5 YEARS! Wow!

 

Happy of Happiest Birthday to my wonderful, dynamic, spirited, intelligent, caring oldest son.


If you happen to be in our neck of the woods on Sunday, come on by to celebrate!

The Tour of California

Last week I had a planned week off of work and the boys and I rented a nice SUV, (lust worthy for moi, and no need to worry about putting 1700 miles on my Subaru...1700 miles!!! Ahhhh!) and took off down the coast for a nice tour of Coastal CA! We stayed with my parents the majority of the time, but also hit Pismo Beach, Santa Barbara, Sacramento, and Napa in between for some fun. The boys were great travelers actually. I timed the drives well I think to help our cause as I was traveling solo, and didn't want to get in over my head. I also borrowed an idea from old college friend Alison with special gifts or treats every hour or two on the first day to keep the monkeys happy...and happy they were! Playdoh, new books, glow i the dark worms for night time, you name it, we probably had it. We only watched one car movie the whole ride and they were super excited and stoked to be in a new cool car and visit family. MUCH better than flying I'll say!!! A bit is left off here, including a momentous birthday party for my Dad and a visit to the fire station for the boys...they will come up later, I promise!

Enjoy the pictures...in no particular order...

Talin enjoys some book reading with Grampa...

Forrest and Talin loved the Kidspace Museum in Pasadena. The thing they liked the most...the artificial river!!!

Believe it or not this is Forrest's first real experience at trike racing. Concrete is rare where we live. He rides his off road trike around plenty but just getting the thing to move is a chore. Racing, yea right! He had a blast getting better and better at following the arrows, getting the hang of merging with other trike riders, and having the occasional collision or two ;-) This was also at the Kidspace Museum in Pasadena.

Finishing off their ice cream treats at Kidspace Museum.

Enjoying some sweet reading time with Granny!

Bike ride with Grandpa! This was Forrest's longest ride yet. 14 miles on the kiddie tandem hook up we have. This was a stream runoff that the kids had fun playing in.

Cogswell Cyn bike ride, lunch stop. Leave it to my Dad to find the most beautiful spots in LA county.

Playing with the Panorama...Wait...two Talins?

That Forrest can push on my last nerve!!! ;-)

14 miles finished!

Visit to Granny's T-K classroom. This is her last year teaching. So glad my boys got to see her classroom. They love that their Granny is a Kindergarten Teacher!

We started and ended the trip enjoying Santa Barbara. The kids had SO MUCH FUN building sand castles, joining in on other kids projects of digging holes, jumping in the waves, etc. We were blessed with beautiful weather on our trip and made the most of it!

Proud

Proud of the hospital I work at, and my fellow colleagues...nurses, PA's, physicians, surgeons, lab techs, CNA's, all of them! My mother in law, Gloria, has had a tough week. Actually a down right rotten week really. Within 2 days she learned she was a severe insulin dependant diabetic, and that she had broken her hip. The fall was completely unrelated to the diabetes. She had been moving a branch off her driveway and in the tug of war match, well, the branch won and she went flying, breaking her femur. She actually didn't see a doctor, was walking on it with the help of a walker, and saying it was feeling better when she saw her PA for the diabetes news. Her PA on examining her hip promptly ordered an xray and Voila, a broken hip had occured.
Through great PA friends who work with our orthopedics group we quickly had a pending ORIF scheduled of the right hip, as well as Diabetes management as her sugars were pretty out of control. I was doing my best to check her blood sugars before and after work, and be sure she got her insulin , but it was all very overwhelming to her, and for good reason! We took one day at a time this last week until today...and today it happened! She is a hospital virgin, I would call it. No prior surgeries, and other than the recent diabetes no other medical diagnoses. She was a nervous Nelly but she had a wonderful spinal anesthesia, a short nap, and her hip will now, (hopefully) heal, and she will learn how to manage her Diabetes, give her self insulin, and be non-weightbearing for 6 weeks.
My hospital did fabulous. She was one impressed patient! I loved being able to chat with my friends who were also the amazing professional people who were giveing her great care. I think this really put her at ease, giving her faith in the medical community.
For myself, being on the other side, seeing the whole system come together as family of a patient, rather than a PA in the hospital, I was impressed as well. I speak to nursing staff on the phone all the time, work in the OR all the time, but to see their interactions, high level of skill, and awesome compassion, well it made me proud of our big little hospital here in the redwoods.
She will be in for another 2 -3 days, where hopefully we can get a great care plan ironed out. I'm sure there is still a lot of struggles with her weeks events left to play out, but at least now we are on the road to recovery. This is an individual who is NOT overweight, has never smoked, is very active, but well, SH$% happens you know! A pancreas can  poop out, falls happen, and you can get better and overcome it all. Looking forward to healthier weeks ahead :-)

A Jumpin' Janurary for Forrest and the whole family....

Quite a busy month this last one was...in no particular order it brought...

 Swimming Lessons For Forrest!

Putting his ears underwater was a big fear, as you see in this picture, that he conquered by the end of the month. Go Forrest!

Forrest and his 3 Tiny Swimmers pals, practicing their moves out of the water

Burnt Ranch Preschool for BOTH boys!!!

Not the greatest picture, but Forrest is trying the trike out in the red helmet. Burnt Ranch Preschool is a morning, parent involved school three days a week. We are going Monday mornings. All kids 1-5 are invited so little brother Talin has joined us as well. Being a kindergarten readiness based program it is helping Forrest, along with his other preschool, get prepared for the big start of K this fall! So far we love it. I have most Mondays off, so we are able to go to "school in the canyon" as Forrest says, just 15 minutes away from our home. ANNNDDD meet other parents and kids who will eventually be in K next year :-)

 

 

 

 

 

Finding ways to fill the LONG WINTER NIGHTS.....(besides beer for the parents ;-) and goodness those nights sometimes can be LOOONG!

like drumming on the kitchen floor to Rusted Root and Dave Matthews Band, of course :-)

Forrest gets a real haircut!!!

Handsome Boy!

 Dad has a mishap with a box cutter and Forrest learns about stitches...

yea, I know, a scary picture. Forrest was very enthralled in how the whole "stitches" deal worked though. His Dad, lets say, is not the biggest brave guy when it comes to blood, stitches, you get the picture. Forrest's job  was supposed to be to rub his head while I did the deed, but he was too curious about how I was going to get his hand back together so he wasn't much help. "Wow Mom why are you putting that needle RIGHT in Dad's bloody oweee?" Yea, I probably wouldn't have liked that much either. Hence the shot. All healed up now though....

Cold weather means a LOT of wood cutting going on...

Quite clear Forrest loves doing a job, especially with big equipment. Here he is splitting wood with Dad, working the handle for the splitter that controls the machine. He did a great job. A brave Dad took the chance :-)

 

 

 Watering our neighbors cute greenhouse plants and enjoying their great view...

a great day to break up our weekends for the next month

And Mom just may have added a glass of wine to this picture :-)

And....We have eggs! 8-10 a day!!! You say, okay, that's great, I guess. But we LOVE eggs, and we LOVE LOVE the days getting longer which is why the chickens are laying again. Whipeeee :-)!!!!!

Carpe Diem

When you have a bunch of sunny and cold days, eventually those sunny frigid days turn a bit warmer and THIS happens!!!!

Alex in 2014

...is fully in a fish frenzy if I ever saw one....
...is currently awaiting THIS coveted water vehicle so he can chase after the prize in previously untouched waters...
...has recently healed from his first good laceration that required his wifey's suturing skills. Enjoyed the week without dish duty, and somehow still managed some fishing in that week as well, (as you see from the above picture...because fishing in river water/fish slime/etc is much more hygenic than dishes....now you know...;-)
...have to add that he managed to also cut another few cords of wood, deliver a few more cords, all with stitches in his hand, (in his defense...)
...currently loves hard cider, Breaking Bad, and, of course, fishing every spare second he can manage....
...currently feels angst about crazy little boy energy, the lack of rain this winter (summer fires, water issues, fishery downward spiral?), and how he's going to get any work done around here with a record number of beautiful steelhead in the river currently...
I love you honey! Forever and ever....(PS---fishing trips for you = bike rides for me, right???)

Talin in 2014...

Will be THREE in May :-)
Is a lover boy at his best...until his brother gets involved...or his parents won't give him his 'nacks...then it's "GO 'WAY MAMA! 'EEVE ME 'LONE!!!!!" stomping, hands on hips, it's really a crack up actually.
Won't shut up (no better way to say this...)
His talking is EXPLODING! (okay, I guess there was a better way to say it;-)
Still loves his pacificier....won't consider sending it to other new babies so tough love is coming soon folks...
Is a complete polar opposite of Forrest in some ways...but in crazy little boy energy they are a good match!
Is FINALLY sleeping better at night, and later! As in just started getting better this last month. Wowzers little Talin that took awhile! And you slept in till 745 yesterday! Amazing!
Is the LOVE of his daycare. The absolute favorite. Or so they tell me. Which is very nice to hear.
Is a super picky eater at the moment.
His hugs can melt me. "I wuv you SO much Ma!"
Loves big kid Legos but is no where developmentally near ready for them. Destructo mode is T-man at the moment!
Loves jackets and being bundled up outside, (who woooda thought!!!???)
Doesn't quite have the patience or attention span for books or movies...very different that Forrest.
Hasn't even started potty training yet...maybe this summer? (Or this should be the PARENTS are not into potty training yet, summer with warm days here we come!)
Is doing quite well in his two days a week of pre-school with big brother...until they start body slamming each other, then it's not so great, (with Talin sometime the instigator in a big way I hear...uhh ohhh)
Has yet to have, or really need, a hair cut...EVER! Awww, little infant hair still on his head?(oh yea, he was a bald one wasn't he!)
And the thing that is for certain, he is a sweet, humorous, 2 1/2 year old that I feel SO incredibly lucky to call my son. We love you Talin!

Forrest in 2014...

Will be 5.....(WHAT, when did that happen!!!)
Is still a firecracker;
Is a smart smart cookie who impresses his parents daily;
Can beat his parents in his Memory and matching game hands down, (I swear folks, crazy memory on this kid!) and can be quite obsessive about it as well, ("I'll trade you 4 matching games for a 20 minute walk outside....)
Is driving his parents crazy over his Winter Break....(ooooh boy Pre-School can't restart soon enough!)
Is quickly teaching his parents through indirect means, (can we say agression, fits, hyperactive running around the house 20 times in two minutes?) that we MUST keep this kid busy.
Loves, loves, LOVES his Legos
Is so, so SO frustrated by his Legos and his little brother constantly dismantling them
Is obsessed with his little brother...in not the greatest way, (luckly little brother is a tough cookie and a smart one at that but the honeymoon period in brotherdom is OVER.....)
Is so physically talented...frisbee, catch, in the water, out of the water, jog two miles with Mom, hike 4 miles with Dad...you name it, he can do it----IF it's his OWN idea!
Still hates clothes...(which, makes the Winter very hard yet again this year)
Is an awesome eater....and a healthy one at that. Eats his salad every night like a champ, though admittedly his "favorite noodles" are top-a-ramen and he's definitely got a thing for hot dogs...
Is a lover, not a fighter....until he's a fighter...then he's got to sleep...we think....

and we're still figuring him out! But the hands down best thing is that life will never be boring with this kid. ANNND he starts Kindergarten in 8 short months....whattttttt!