Compression stockings, who knew?

It's been another good week here.  Spring has taken off and it is colorful!  Tulips, daffodils, grape hyacinth forsythia bushes and small violet pansies are everywhere.  Even the yellow dandelions are a welcome sight.  The trees are in bud and bloom; bud colors vary from green to yellow to red and blooms from white to fuschia to powder pink.  If you have never seen a Magnolia in bloom (i.e. myself), I highly recommend it.  They blooms start out as a bright pink, then unfurl to become a beautiful, large, pink blossom.  If this color palette is fore-shadowing for the fall, I can tell you I am very much looking forward to experiencing that.  Last weekend, I didn't take the time to describe the country side I was horse-back riding in.  Central Pennsylvania has gently rolling, yet large, hills.  You may have gotten that sense after the recount of my harrowing ride from several weekends ago.  What I haven't discussed is how vividly green and inviting the farmland is.  Driving through the country side here, brings to mind the scenery of English period pieces.  I half expect to see an old English manor in the distance, or perhaps Mr. Darcy riding to Longbourn to declare his love to Elizabeth Bennett (a Jane Austen reference, if I just lost ya).  Add to that picture an Amish horse and buggy (I have seen several already) and you've got yourself an idyllic setting.

I mentioned in a previous posting that I have to wake up early in the morning for work.  Well, I've already had a few days when I hit snooze too often and ended waking up 30 minutes late (not good when you've allotted 45 min to get ready for work.)  In order to combat this bad habit, I have decided to exploit one of my cat's habits.  She has an automatic feeder that goes off at 5 o'clock in the morning.  If it goes off and there is no feed in that slot, she comes and lets me know in no uncertain terms that she is hungry and would like to be fed.  Normally I keep it stocked so that I don't get woken up prematurely.  Now however, I have found it helpful to have a reliable alarm clock that physically wakes me up while purring, and who needs to be fed in order to turn off.  Since employing this behavior, I have woken up on time, everyday.

I do a lot of standing and walking at my job.  So much so, that I have purchased two pairs of compression stockings in the hopes of staving off future dysfunctional leg veins.  I bought a light weight compression, as I don't have current problems, and man, do they make a difference!  My legs and the bottoms of my feet aren't nearly as tired at the end of the day.  I can tell that my overall energy is better too.  I wore them every day last week except Wednesday, and I couldn't believe how tired I felt at the end of the day compared with the other four.  They also keep me warm, which is nice since I'm in a cool, air conditioned environment all day.

I received a lovely complement this past week from one of the circulating nurses (the circulating nurse stays in the operating room during an operation, and runs the non-sterile side of the operation; a scrub nurse is "scrubbed in" meaning they are wearing sterile gown and gloves and managing the sterile instruments and field).  We had been positioning a patient for the operation and she showed me a trick with one fo the pieces of bedding equipment.  For the next case, I happened to use that piece of equipment again, this time using her trick.  She looked at me and said, "Wow, you're a good learner."  She was genuinely surprised at how quickly I caught on to, and used the information she had supplied me not just a few hours earlier.  I had never thought about myself in those terms, I've always thought of myself as a "good student,"  but being in school for so many years, I developed a penchant and skill for learning.  Speaking of learning, both surgeons are consistently letting me open and close for the cases.  Opening entails making the initial incision, dissection down to the ribs, and opening into the chest cavity, while closing entails using different types of suture material and appropriate stitch/knot to close the multiple layers of muscle and skin.  I'm getting more comfortable with the daily routine, am feeling like more of a professional and less like a student and am taking on more of the daily responsibilities like taking the call pager.  I'm also writing notes and orders on patients, and so far I must say the "paperwork" part of my job (the one aspect I knew would be my least favorite) is quite manageable.

We look at a lot of chest x-rays and chest CT (aka CAT) scans everyday.  Our patients are generally very sick, with either pneumonia, pleural effusions, emphysema or multiple problems, that I'm beginning to forget what a "normal" chest x-ray should look like.  This has lead me to fully realize, you don't want the opportunity to be consulted by our service.  The doctor's are very friendly, compassionate, empathetic and very good at what they do, but if you are sent to us, that means you're pretty sick.  Which is my segue into a public service announcement about smoking: DON'T DO IT!  I've never been a fan of smoking, but seeing first-hand the complications that arise from it (I'm not just talking about cancer), and treating those complications, makes me dislike it even more.  I understand that it's thoroughly addictive (both chemically and behaviorally)  and there is often a culture surrounding it, but wow, the quality of life that smoking leads to, is just...bad.  I have patients who have more years in their pack-year smoking history than they are years-old, i.e. they've smoked more than one pack per day, for multiple years (such as a 54 year old with a 70 pack-year smoking history).  Now, that's not the norm, but a pack a day is very normal for the patients I see.  Their skin is dull and weathered, their teeth are yellow, they have raspy voices and nasty coughs, the whites of their eyes are grey and more often than not, they are dependent on oxygen in order to walk a single flight of steps or walk the hall to the bathroom.  Those are just some of the "cosmetic" complications because usually smoking has also given them heart disease, lung disease, vascular disease (the blood vessels), and a myriad of other problems.  Plus, it makes other chronic diseases (such as Type 2 diabetes) worse and harder to treat.  Eighty five to 90% of lung cancer is caused by smoking and/or a known environmental carcinogen (i.e. second-hand smoke, asbestos).  Not only that, it is the No. 1 cancer killer of both men and women in the United States.  It kills more people in the U.S. every year than colon, breast, ovarian and prostate cancers combined.  Yet, there are few fund raising events to raise awareness and money to research it.  We don't need to do extensive research, we know why lung cancer occurs in the U.S.: it's smoking!  For many of my patients, the experience of a complication from smoking is enough to make them (and sometimes their adult children) quit; there is a small handful who don't.  Yet, even knowing what can happen, young people will take up the habit and smoke throughout their lifetime.  To me that's a reflection of how addictive tobacco truly is (and how influential an environment is on a young person).  Until someone has a life-altering experience, or simply becomes determined to quit for themselves once and for all, nicotine will hold it's grip on a them, no matter the amount of education and scare tactics used.  So, the short of the long of it is, don't start; and if you do, try to find something in your life that is meaningful enough to motivate you to quit.  Because trust me, a burst emphysema bleb, subsequent collapsed lung and prolonged air leak (leading to the prolonged use of a chest tube), is excruciatingly painful and not something you want to experience.  Thanks for sticking through that with me.  I've said my piece, preached to the choir and hope that my opinions haven't offended anyone.

Danville's Old Forge Brewery

Danville may be a small, sleepy town, but thankfully it has a microbrew pub in it.  Not only that, but said establishment is a 2 minute walk from my front door.  The Old Forge Brewery is a nice place to relax, have a brew or two, eat some fresh, local grub and catch live music on Thursday evenings.  Warren and I first went to OFB when we were here in November for my interview trip.  Between the welcoming atmosphere and smooth, tasty beers, I knew that I could happily live in Danville, PA for a few years.  We went back to the brewery during our house-hunting trip over Valentine's day of this year.  Again, Old Forge delivered (complete with seasonal chocolate brew), plus we got to enter into their Valentine's Day gift basket drawings.  I got a call from OFB a few days after we had returned to Denver, letting me know that I had won one of the drawings.  It was for the nail salon gift basket.  I picked up the basket a month later.  Luckily, the pair of beer glasses, gift certificate, beer cozies and Valentine sweet treats hadn't expired.  I've redeemed my gift certificate.  The pedicure was fine, though nothing to write home about...literally (hehe).

I took my mom there during the week she helped me move in.  This was just after St. Patrick's day.  They had a delicious Irish Draught on nitro.  It was smooth and creamy without being heavy.  I ordered one at lunch, and after sampling it, my mom had to order one too.  What a treat for us!  They don't sell nitro beers in growlers, so that's forced me to try some of their perennial beers.  They have a nice blonde, red and porter (and IPA for "hop heads").  Thus far, Warren and I have brought home three of their growlers.  For those of you who are familiar with the microbrew scene in Colorado, I would say Old Forge's beer style is a mix between Oskar Blues and O'Dell, with a food style (and come to think of it, beer too) reminiscent of Mountain Sun.

So far, I've only talked about beer.  They also make three homemade sodas: birch beer, root beer and cherry.  I've only had the birch beer (tastes a lot like sarsaparilla), but based on how delectable it was, my guess is the others are just as good.  There is also a bar tender there who now recognizes myself and Warren.  Her boyfriend is an emergency medicine resident at Geisinger.  They're originally from Oregon, he did his medical schooling at CU (same school as me) and they've been in Danville for two years.  It was nice to have commonalities to bond over.  Needless to say, it's great to have a quality, friendly place to walk to when we don't feel like cooking, or just want to relax and drink a cold beer.

At least the barber wasn't named Sweeney Todd...

Warren decided to get his hair cut this past weekend at the barber shop here in town.  It's an old fashioned place, complete with spinning pole and old timers waiting in their chairs for the next customer.  Warren asked for a small trim and "clean-up around the neck and ears."  What he received was a buzz cut, ala the military... and a missing right eyebrow.  Wait, what?!  That's right folks, the old timer who cut Warren's hair, attempted to "clean up" his eyebrows, with comically disastrous results.  Now, I don't want to be dramatic, his entire right eyebrow isn't missing, just the middle 2/3 aka most of it.  And his left eyebrow didn't make it out unscathed either, it's just not nearly as, how do I put this? absent looking.  Needless to say, he won't be seeing that guy again.  Oh the trials of moving somewhere entirely new.

-Kristen

That bled like stink!

Happy Sunday All,

I've gotten some great feedback this week about update preferences.  I will continue sending out email updates (probably weekly) and I've set up a blog.  The blog link is: http://kristenfrey.blogspot.com/ .  This week was another good week of learning and getting comfortable with my job.  I'm spending a lot of time in the OR to get familiar with the procedures and to practice surgical techniques (e.g. suturing, opening dissection, placing chest tubes).  Rather than going into a verbose and lengthy narrative of my weeks at work, I'm going to highlight one case each week (though that too may end up being verbose and lengthy...hmm).

The case of the week goes to a lady with lung cancer in the middle lobe of her right lung.  She is fortunate in that she was able to just have that lobe removed, rather than the entire lung.  What makes her the case of the week is that during her surgery, one of the branches that comes off the right pulmonary artery tore 2/3 of the way through surgery (it was going to be taken anyway, but it prematurely came loose from the main line).  "Oh boy that can't be good", you may be thinking... And you would be right.  Before I continue with my story I want us to all be on the same page.  The pulmonary vascular system is special: it's tubing and contents are opposite to that of the rest of the body.  Normally arteries have thick walls and carry oxygen rich (red) blood to the body.  While veins have thin walls and bring oxygen poor (blue) blood back to the heart and lungs.  Since the pulmonary system is opposite of that it means, the pulmonary arteries are thin and contain blue blood (to go into the lungs and get fresh oxygen), while the pulmonary veins are thicker and contain red blood (to go to the heart and get pumped to the rest of the body).  Why is that so important you may ask?  It means that the pulmonary arteries are flimsy and prone to tearing, but carry a very large volume of blood in them.  You know that saying from "Finding Nemo," that "all drains lead to the ocean"?  Well, all veins lead to the heart, and then lungs...  So if there is an unintentional, uncontrolled tear in a pulmonary vessel, someone can bleed to death very quickly.  Ok, back to the story.  Her operation was video assisted up to this point.  When the small vessel partially tore, it was like the dam had broken loose.  I've never seen that much blood come out of such a small hole before.  Dr. Facktor and Luiz (the resident on our service this month), were calm as they found the leak and controlled it with gauze clamped in the end of an instrument.  Dr. Facktor had the staff page Dr. Friscia to the OR stat! as Luiz enlarged the small VATS incision to become an open thoracotomy incision.  The two surgeons then worked together to repair the hole as quickly and carefully as possible.  It took them just a few minutes to repair.  In that time however, even with good control, the patient lost about 900mL of blood, which is just under 1/4 of her total blood volume.  She didn't require an intra-operative blood transfusion, though I think she got one afterward in her hospital room.

Geisinger is very much on the "healthy living to prevent diseases" bandwagon.  As such, they provide free pedometers to employees who request one.  I walk all over the hospital every day and curiosity has gotten the better of me.  I received my pedometer last week and have logged a few days already.  So far, I've walked 4-5 miles a day at work!  That does include my walk to and from work, but the vast majority of it comes from walking the hospital.  Add that with the hours spent standing during surgeries, plus the Calories burned for thinking/learning.  That all means I get voraciously hungry for lunch and dinner.  In order to prevent myself from being featured on one of those Snickers commercials, I've taken almonds and granola bars to work to hold me over if I feel myself getting too hungry.  Maybe I should just buy a Snickers instead...

I went horse-back riding again yesterday.  The horses are up to pasture at Laurie's brother's.  So rather than having a harrowing adventure up an old logging road, we did a mellow 1.5 hour loop on rural dirt roads.  It was a lot of fun, and I'm not nearly as sore as I was after the last ride.  I'm going to end here for tonight because I need to get to bed.  I will blog about Warren's barbershop experience and the Old Forge Brewery this week.  So stay tuned to that link :-)

I hope you are all doing well,

Kristen

Hand in a chest cavity?

Sixth email, sent April 14, 2013:

"In last weeks email I believe I mentioned that I was going horse-back riding again with Laurie.  We went for another ride across the creek and up the hill to the old logging roads.  This time however, Laurie took me up the steeper terrain.  And she wasn't kidding; there were a few moments I was quite nervous that my horse wouldn't make it up (or down) the hill successfully on all four legs (for anyone who has seen "The Man from Snowy River," there were moments I felt like the main character on his trusty steed, though I didn't have as much trust in my steed).  We also got lost a couple of times. On several occasions we came across fallen trees on the trail, this required harrowing 3-4 foot detours.  Harrowing, because the terrain was damp-ish leaves on top of loose dirt and slate rock with brambly bushes and tree branches.  At one such juncture, there was a thick tree top occluding the trail, i.e no trunk to contend with.  My horse, having had quite enough of detours, decided he was just going to plow through the downed tree.  During that moment I found a new use for riding helmets: wrecking ball.  I ducked my chin to my chest and let him bowl us through the tree branches.  We made it through without a scratch (though Laurie did warn me to look for ticks after that.)  On our way back down, my left leg got caught on a tree trunk as we went through a narrow gap.  I am still rocking a sizable bruise from that.  What an adventure!  I had fun, but I'm not sure I want to go up grade that steep again.

I have completed my first week in the trenches, as they say.  I must admit, I am physically and mentally exhausted, and overwhelmed by the onslaught of information.  Before I started, I knew I would be bombarded by information and my expectations have definitely been met.  I wake up around 5:15 change, eat breakfast and walk to the hospital to be in the locker room by 6:25.  That's so I can change into my scrubs and be in the office by 6:30.  It's then time to round on patients (check-up on hospitalized patients) before 7 o'clock conferences, meetings or OR cases.  The rest of the day is a mixed bag: time is spent in the OR, outpatient clinic or other parts of the hospital.  We act as consultants for the rest of the hospital (7-7, M-F), so even on a day without previously scheduled surgical cases, someone may need to go to the OR or have a bedside procedure.  

Some basic terminology to help you through the next part of this email (and subsequent emails...): Chest Tube = a drain tube placed into the chest cavity to drain air or fluid; Pneumothorax = air around the lungs; Pleural Effusion = serosanguinous (clear, pinkish/red colored) fluid around the lungs; Hemothorax = blood around the lungs; Empyema = pus (i.e. infection) around the lungs; Thoracotomy = opening made through the chest wall, with spreading of the ribs, to get a clear view of inner structures; Lobectomy = removing one of the five lobes of the lung (3 are on the right, 2 on the left); Pneumonectomy = removal of an entire lung, either right or left side; Pulmonary Embolism (PE) = blood clot within a vessel of the lung; Deep Vein Thrombosis (DVT) = blood clot in one of the deep veins of the thigh.

I got to see some interesting cases this week, including two patients who needed a pneumonectomy performed through thoracotomy.  Pneumonectomies are relatively uncommon procedures.  For these two gentlemen however, their cancer tumors were located such that a lobectomy would be inadequate to remove the entire tumor.  Fortunately for these two gentlemen, their tumors were on the left side.  Right-sided pneumonectomy patients have much worse outcomes, than patients with left-sided pneumonectomy.  This is a well documented phenomenon and nobody is entirely sure why that is.  I think a thoracotomy pneumonectomy is the most extreme procedure I will see.  It is uses sparingly because of the difficult road to recovery.  Not only is lung function greatly diminished, but every breath hurts due to the fact that the ribs are spread apart and an inch long chunk is taken out of one rib.  Pain control is of the utmost importance.  Patients who are in too much pain to breath deeply, cough or walk about are at high risk for pneumonia, DVT and PE.  From there it can be a rapid downward spiral of multiple severe complications and death.  The advent of technology has allowed for video assisted thoracic surgery (VATS), aka endoscopic surgery.  By using small incisions and not spreading open the ribs, this helps decrease pain and healing time after surgery.  As such, I think I will see more VATS lobectomies than its much riskier predecessor.

I have the sense that placing chest tubes will be a large part of my job.  Just this week I saw patients draining every fluid I can think of, including a malignant pleural effusion (cancer cells present in the fluid).  I've already assisted in several placements; the ones I did myself were in the OR during thoracotomy cases (there are several reasons to do a thoracotomy, they're not just for pneumonectomy) when you can stick one hand inside the chest cavity in order to feel the ribs from the inside.  This makes for extra assurance that you're not going to puncture something important.  It's definitely surreal to have your hand in such an important space (I was really creeped out the first time I felt a beating heart hitting the back of my hand).

That's a taste of what my job will entail.  I did get to work-up two new patients during a clinic day.  It was refreshing to have a task that I actually felt comfortable and mostly competent doing.  I hope to have more of those this week.

Warren and I were invited to a pig roast yesterday by his new branch manager.  It was about 20 minutes away, in the woods.  There was a shelter, bathrooms and "crick" running behind the woods.  We had a good time with great tasting pork, sides, beer and bonfire.  There was a range of ages in attendance.  I now have a new facebook friend, potential local hair stylist and a gal who really (emphasis on really, I suspect she was pretty drunk at that point) wants to get together to drink wine (her circle of friends sticks with light beer and shots).  Warren and I agree that there is an accent here in PA, it's a mix of New Jersey and Canadian with a hint of Southern (or maybe it's just "hick").  All in all we had a great time.

That's it for now.  I've heard from several of you about liking my emails.  Thanks for the feed back!  If any of you would prefer to be taken off the list, please let me know.  Also, I'm thinking about getting a blog so I can update more frequently with smaller amounts to read in one sitting.  Please let me know if that appeals to you.  I'll let you know the verdict next week :-)

Have a great week!

Kristen"

First week on the job

Fifth email, sent April 6, 2013:

"Well, I survived my first week on the job.  That's probably because it was very nearly all orientation.  I am now oriented to a lot of things (our health sciences library is great!), though navigating the hospital building itself, not as much.  Part of the problem with navigating, besides the fact that it's a large structure, is the fact that various parts of the building were built at different times.  Floors don't always match-up, hallways take unexpected turns and some elevators have "G" as the main level while others have "1" as the main level.  Plus, the whole thing is on a hill, so a basement/lower level may in fact be above ground at the outside doors.  Not to mention, artwork is sparse; artwork serves as a Hansel & Gretel-like breadcrumb navigation system for me...recognize the artwork and I'm probably on the right track.  The other day I walked in to a part of the building (a new entry point to me) at ground level.  I assumed I was entering on level 1.  As I walked further on to try and find the area I thought I should emerge, I passed an elevator bank that said I was in fact on the second floor.  Hunh, I was not expecting that.  Fortunately, fire safety being what it is, there was a stairwell nearby.  I went down a level and emerged at the place I wanted to be.  Needless to say, I've snagged a map of the hospital from the patient information desk; it's no google maps but it helps.

Through all this orientation, I've come to realize I am fortunate to be part of the Geisinger employee force.  This is one hospital system and health plan that is obsessed with being the best.  Abigail Geisinger (an 85 y/o widow) founded the hospital in 1915.  She hired Mayo-trained surgeon (he literally trained under the Mayo brothers), Dr. Harold Foss, to be her chief of staff and charged him to, "make my hospital right...make it the best."  After her death, he stayed on as superintendent and chief of staff until 1958.  The saying, "Make it the Best," is literally printed on every employee's I.D. badge.  At every managerial level of the hospital, there is a physician-business administrator team.  They hold the same amount of responsibility and accountability for their department/region, no matter if it's on the medical or administrative side.  This business-medical partnership started with the Geisinger-Foss team, and is one of several aspects of the Geisinger Health System that makes it unique among hospitals today.  GHS is a non-profit that is doing so well they are hiring about 1200 new employees each year, and buying up failing hospitals in the region just so the competition won't be able to.  There are multiple quality measures for GHS.  Included on this list are: using up to date, evidence based medicine to deliver quality health care, patient satisfaction, family satisfaction, employee satisfaction, and accountability to patients, community and Abigail's request to "make it the best" (I'm telling you, that's a big deal quote around here). Financial stability/profit is included in their quality measures, but it is not the primary goal (i.e. patient's are not dollar signs and bonuses, they are people and should be treated as such).  The people delivering my orientation classes and appointments, readily admitted GHS is far from perfect.  I think that in striving to "make it the best," while accepting that humans are imperfect, some of the humanity has been preserved in this corporation.

I finally got to really see my department on Friday.  I'd had lunch with the PA I'll be working with, Nevin, on Tuesday, and had a meeting with my supervisor, Susan, on Thursday.  But I hadn't had a tour and in-depth look until Friday morning.  Karen, the RN who works exclusively for Thoracic Surgery, gave me a tour and overview of the clinic.  I then got to round on an inpatient being discharged and observe in the OR on a quick, straightforward case (resection of a 3cm x 2cm x 2cm chest wall mass laying just below the skin; like a cyst or lipoma, but his had a lot of blood vessels.)  The mass probably could have been resected in an office setting, but this 67 y/o male had transposition of the great arteries at birth (a condition where the aorta comes off the right side of the heart instead of the left and the pulmonary artery comes off the left instead of the right; so deoxygenated blood goes to the body, while oxygenated blood goes right back to the lungs) and a heart transplant within the last 5 years (he will be on immunosuppressing drugs for the rest of his life.)  With such a history, they deemed it better to do this procedure under sterile OR conditions, rather than mostly sterile exam room conditions.  After the procedure, Nevin and I went to lunch and he started to teach me about the chest-tube vacuum machines they use for lobectomy patients (aka had a lobe of lung removed).  I can tell there's going to be a good amount of pressure/volume Physics involved in this position...

Warren left Denver Thursday morning and arrived here late last night (2:30 am).  I am so glad he is here safely and without incident.  I'm excited to show him around and point out the new things I've learned.  For today though, he's sleeping and unpacking.  The weather here is sunny and warmish (should get into the low 50s), so I'm going to go help Laurie plant the fruit trees she bought last week (two apple, two peach and one pear) and go for a ride.

I hope you're all doing well!

Kristen

p.s. Geisinger provides free pedometers to their employees.  I'm going to get one so I can see just how far I walk each day.  I walk to campus, then all the way across the hospital and up to the 5th floor, just to get to my office.  The locker room and OR is on the 3rd floor.  The brand new cafeteria is on the lower level (it's a walk-out basement, with two-story windows in the eating area.)"

Settling and nesting, how appropriate for Easter Time

Email numero quatro, sent March 30, 2013

"The settling in and nestling phases are in full swing.  I left off by telling you we arrived safely at our destination late Tuesday night (this is a week ago Tuesday now.)  Our host for the next several days was Laurie, who I was introduced to through a thoroughly circuitous route.  Laurie is the mother of a med student (Maria, pronounced "Mariah") at the Rocky Vista osteopathic medicine program in Colorado.  My Dad met Maria in January when his mom was in the hospital (Grammy is ok.)  Grammy's dinner was several hours late; when my dad went to find someone to ask what was going on, he ran into Maria in the hallway.  She wasn't working on Grammy's case, but offered to help track down the missing dinner anyway.  They got to chatting, my dad mentioned I got a job at Geisinger and Maria told him her mom (the aforementioned Laurie) lived close by.  Her mom is fixing up her 1860s farm house to become a bed and breakfast, and welcomes visitors to her home.  Not only that, but her mom has two horses and would love to have another person to ride with!  What a great happenstance this has turned out to be.

My mom and I stayed with Laurie for four nights.  She was a wonderful host.  She not only provided warm beds and breakfast, but homemade dinner too!  It was great to have a home to go to (Laurie's) at the end of our long days of cleaning, moving and organizing a chaotic house (mine.)  What a great welcome to a new state.

I mentioned in one of my previous emails about needing a queen-sized split box springs.  Before moving here, I had never heard of such a thing.  Evidently they are very common here.  The two gentlemen at the mattress store knew exactly what I was asking for.  One of them even commented that the house must have been built before 1890 (evidently there was a staircase growth-spurt at the turn of the last century.)  As it turns out, the main part of the house I'm renting was built in the 1850s; the garage and master suite were added about 5 years ago.  Anyway, I was able to pick up a pair of box springs and take them home that day.  They were so easy to manage, my mom took both of them upstairs while I was busy doing something else.  

My mom has been such a great help to me with this move. From driving to cleaning to manual labor, it would have been too overwhelming to do alone.  We got the majority of the house in order before she went home last Sunday.  I was very sad to see her go.  It felt like pulling up that last safety line from the shore, before a boat leaves the harbor.  Thank goodness for phones, I think we've talked everyday since.  She left me with a beautiful, King-sized bed quilt.  We picked out the pattern and fabric at the beginning of February; she finished the last stitches on the way to the airport.  It's full of love and warmth, I'll cherish it from here on out.

Other things I've learned about the area I've moved to include: a crew team rows the Susquehanna river on Sunday mornings, there are opossums here (based on the road kill I've seen) and wild turkey (I saw these alive and, well, gobbling), the state tree is the Pennsylvania Hemlock (a fur tree) and Tastykake chocolate cupcakes are really tasty...cakes.  Oh, and the church bell across the street rings on the hour, every hour of the day and night.  One ring per hour of time; thank goodness it's not on military time otherwise it would ring 23 times at 11 p.m.

Over the last week since my mom went back to CO, I have been nesting.  I've cooked meals here, taken two baths in the jacuzzi tub, am doing my first loads of laundry and finally got WiFi (I was beginning to have internet withdrawals.)  I've had to buy extra furniture, not only to fill our larger space, but because we have a lot of books, binders and other items requiring shelving, eg. towels and linens (narrow staircases and no linen closets in these old 1850's houses.)  The office is really the last room to get unpacked.  Most of those boxes belong to Warren, so I've been leaving that room alone.  I have taken over the future guest room as my stretching/yoga/pilates/fitness-y room.  There is no furniture in there yet so it's perfect for the yoga mat and foam roller (a corner bookcase will soon be joining them.)  It has two windows in it, which makes it bright and inviting even on cloudy days.  It's a great space to just sit and be.

Laurie and I took the horses out for a 2.5 hour long trail ride today.  It was a windless, bluebird sunny day in the 50's, free of bugs.  Perfect conditions for a long, leisurely ride.  Laurie has extensive property that goes up to the side of a mountain.  To give you an idea of how much land, there is a highway and large creek (I'm not sure the term "creek" gives it justice, but "river" is a bit of an exaggeration) running through it, with multiple fields large enough to cultivate feeder corn.  All leading up to the base of a mountain.  A friend of hers owns the lower half of the mountain, while a Mennonite community owns the top half.  Neither one minds if Laurie rides her horses onto their respective properties.  We took the horses across the highway and creek (low, at about a foot deep this time of year), into the woods and up the mountain.  We followed an old train bed at the mountain's base to get to the old logging roads that criss-cross the mountain side.  We followed one of the logging roads until it petered out, then headed home (we were getting sore and the horses were tired; they're fat from winter's hay and lack of exercise.)  Signs of spring were readily apparent in the woods: buds are forming on the trees (you see them up close when they whack you in the face), the fiddle-head ferns are cropping up, and you have to be on the lookout for black bears again.  Needless to say, I thoroughly enjoyed myself.  Afterward, we had dinner together and Laurie invited me to join her family for Easter dinner tomorrow.  I think I've found a surrogate home in Pennsylvania. :-D

Monday marks the start of my employment with Geisinger.  I'm super excited for it.  I begin with a week of orientation (with a smattering of clinical hours), then jump right into the fray.  I will keep you posted.  Thanks for sticking with me through this long email.  And thank you also for your support.  This is a big journey for me and it is made easier knowing I have the encouragement and love of family and friends. :-)

Cheers,

Kristen

p.s. I have photos to show you, but iPhoto is not cooperating at the moment.  I'll send them by themselves later."

Journey: The Details, Part 2

Email 3, sent March 23, 2013

"When we last left our plucky road-trippers, they had left Trenton, IL in good spirits, amazed at their luck (thanks Officer Bojangles), and with a good story to tell.  As night crept onward we approached the Indiana state line and our hotel for the night, The Drury Inn.  By this point, the speed limit on I-70 kept changing between 65 and 70, so my cruise was set to 70.  As we came down a hill, I noticed a pair of headlights, which originated from the median, shining perpendicular to the road.  At this point I was going 5mph over the speed limit, and wanting to avoid any additional trouble (one police encounter is plenty for me for the day thank you very much), I turned off my cruise control and went back to 65.  Some of you may know from riding in my car, that smooth shifting is not its strong suit.  This is especially true when slowing down at a high rate of speed as my vehicle is more than willing to go slower than you would like.  The result is a noticeable deceleration of the car... even in the dark.  That, coupled with my out-of-state-from-a-state-that-recently-legalized-marijuana license plate, meant that the squad car followed me the last mile of Illinois and across the Indiana state line.  As soon as we crossed that border, "WOOP, WOOP."  

All I could think was, "Are you shitting me?"  I mean, REALLY!? 5mph over is not that much, people had been passing me all evening!  "WTF reason is this guy gonna give for having pulled me over (can you tell I was upset?)"  Officer Napoleon and his side-kick DEA-jacket came to the passenger side window.  Officer Napoleon, "Good evening.  Well it's a pretty minor reason I pulled you over.  It's because your license plate light is burnt out.  That's illegal in the state of Indiana.  I'm gonna have to write you a warning."  Me, "[Uhhh] Ok. I'm glad to know it's burnt out."  When, after the mental jaw-drop and forehead slap, all I really wanted to say was "Seriously?!!!"  He then asked what our destination was, both for the night (Terre Haute) and ultimately (Danville, PA).  "Well, I'm going to need you to come to the squad car while I write it up." A brief pause (SERIOUSLY!!??), then I said, "Ookaayy."  All I could think was, "Say WHAAAA'?" and "[insert Sir Alec Guinness' voice here] This is not the car you're looking for... no really, the closest thing to anything contraband is remnants of catnip on a scratching post."  As I walked to the squad car, I wished I'd had the number for Indiana state troopers just to make sure these two guys were legit (turns out they were, I have the lame-o  warning to prove it.)  

Thank goodness Officer Napoleon had his side-kick sit in the back seat, so I could sit in the passenger seat (to put me at ease I'm sure), while they asked questions and wrote out a warning.  Questions included: "Why are you moving to Pennsylvania?" (for a job, I'll be operating on people's chest cavities as a PA) "How old are you anyway?" (this ringer came from DEA-jacket, apparently he hadn't seen my driver's license; I'm 30) "Whoa! I thought you were 21!" (really dude? really?) "No, I've got two Masters degrees and I've decided it's time to get a job and pay back some loans"  They didn't quite know how to handle this, but by this point in the questioning they could both tell they had a dud of a car on their hands anyway.  After chatting with them for a few minutes (DEA-jacket was a regular chatty Cathy), Officer Napoleon ended with, "What do you think about Colorado's recent legalization of pot?"  "Aha!" I thought, "now you've fully revealed what you're after."  I answered in a way any politician would be proud of, non-committal and vague with an air of confidence to confuse the masses (in this case just the two state officers).  "Well, I think it's going to be tough to regulate given that it's still illegal under federal law.  I know a lot of people are happy about it.  But I can tell you, I do not envy Governor Hickenlooper's job."  Satisfied that they had no reason to search my car, they sent me back to the car with my carbon copy.  Within moments, we were back on the road.  While they were questioning me, my mom had gotten out of the car to "stretch" and "look at the stars," but mostly to make sure that the two strange men weren't driving off with me as a hostage.

We made it to the hotel where, according to the desk clerk, we learned that this kind of traffic stop is pretty routine along that stretch of I-70.  Oh, and there is a super max federal prison a few miles down the road where several famous serial killers have stayed (made me feel much safer to know that...)  Needless to say we got a new license plate light the very next morning.  The guy at the shop furthered our knowledge by telling us that, according to the police officers he knows, they pull people over for minor things in the hopes of finding drug traffickers.  Basically, driving the speed limit, with a burnt out license plate light and Colorado plates in Indiana, painted a giant target on our backs.  Ugh.

Day 3 was uneventful.  There were a lot of state troopers in Ohio, we did our best not to get acquainted with them.  We made it to our final destination late Tuesday night, tired and grateful to have made it safely.  Thus ended the journey for us.  Moving in and nesting are the next steps.

Good night,

Kristen"

Journey: The Details, Part 1

Installment 2, sent March 22, 2013:

"Day one started out uneventfully, we drove across Eastern Colorado on I-70 and into Kansas.  It was flat, brown and WINDY!!!!  There was a steady, stiff crosswind and my little Rover found it difficult to maintain the speed limit of 75mph.  Around mid-day, Warren called to let me know he saw fresh-looking oil on the ground below where I had parked the night before.  He suspected the oil filter may have been loose (I just had the oil changed, and it's happened before when the service guys haven't tightened the cap enough.)  I checked the oil a few times at gas stops and rest areas.  At our stop in Junction City, KS, I thought the oil looked a little bit lower on the dip stick, so I decided to take the car to Walmart next door to have them take a look.  After waiting 30-45 min, they informed me that everything looked fine; the oil tank was full, the filter was tight and there were no detectible leaks.  There was no charge for this inspection.  If you find yourself at the auto service department of Walmart in Junction City, I hope Sabine is working.  She's helpful, nice, pleasant to talk to, and will make you glad you stopped.  Day one ended with us staying at the Courtyard by Marriott in Blue Springs, MO (just east of Kansas City.)

We had two plans for the second day of our journey: see the Gateway arch in St. Louis and visit Trenton, IL (the town my mom lived in during Junior high.)  The weather was cloudy cool and breezy, but without the relentless wind we'd encountered in Kansas.  We got a late start from the hotel and made it to the arch and "Jefferson National Expansion Memorial" museum around lunch time.  The arch was conceived of in 1933, construction started February 1963 and was completed October 1965.  It was built as a memorial to the Westward expansion of the United States, both through the Louis and Clark expedition and the Louisiana purchase.  There is an extensive museum, two theaters and an innovative tram system that goes up into the arch to an observation deck at the top.  We opted to keep our visit short (and free) and didn't go into the arch or watch one of the films.  Even so, we were there for an hour.  

We headed to Trenton, IL, population 2007.  As we got into town on the one-lane main drag (Broadway St/Old Hwy 50), the lady in front of us stopped to wait for oncoming traffic in order to complete her left turn.  As I normally do, I looked to make sure the intersection was clear (no peds, no turning cars) and went around her on the right hand side.  A couple blocks down was the left we needed to take to find the house my mom had lived in (416 Main St.), so I took the turn.  You can imagine my surprise when I looked in my rearview mirror and saw a squad car behind me with his lights flashing.  Several thoughts ran into each other in my mind.  They went something like this: "Is that for me?" "EEP!!" "I've never been pulled over before," "I've never had a ticket before," "I know I wasn't speeding. What is he pulling me over for?" "Pull over and put the car into park."  Officer Bojangles (not his real name, his last name was long with a 'j' in it somewhere) approached my car, introduced himself and informed me that passing on the right is illegal, both in IL and CO (which I doubt), and lectured me on the potential dangers of right-handed passing.  When he asked what we were doing in Trenton anyway, we told him about my mom growing up as an Air Force brat in a house down the block.  Boy did he brighten up.  Suddenly, he turned into a tour guide and representative for the town.  He was talking to my mom about all the things that had changed in the last 48 years (not much as it turns out.) They had a lengthy and lovely conversation (with the guilty party, me, sitting awkwardly in the driver seat between them).  He wrote me a warning and let us go.  We approached 416 and stopped.  Officer Bojangles drove up next to us and rolled the window down.  "Would you like to go inside?" he called.  "[Uhhh] Sure," we said.  "I'm good friends with the Jenkins'.  They should be home.  Let me give them a call and I'm sure they'll let you go inside."  He whips out his personal cell, calls up Rick, explains the situation and 10 minutes later we find ourselves inside the entryway of this beautiful old home.  Thanks for pulling me over Officer Bojangles!  We spent an hour or more chatting and taking a tour of the home.  Memories were recalled and email addresses were exchanged.  Some things just happen for a reason :-)

I will detail the rest of the journey this evening.  For now I have to get ready to go back to the house (more unpacking and cleaning), and hit up the mattress store (turns out modern-day, queen-sized box springs DO NOT fit up the tight staircases or windows of a 19th century house).

Cheers,

Kristen"

Journey and Unpacking

Below is the first of my emails letting people know how my move from Colorado to Pennsylvania was going.  It was sent March 21, 2013:

"I wanted to send a quick update of my move.  As most of you know, my mom and I drove out to Pennsylvania together.  It took us three days, but we made it safely to our destination late Tuesday night (we're staying with a lady in Orangeville, which is near Danville).  We were able to get into the rental house Wednesday and immediately started to clean (though the landlords had supposedly cleaned, there is still a lot of grime to be wiped from surfaces).  My household goods arrived this morning and the truck was unloaded in 3 hours.  So far, the only casualty of the shipment is to a metal trashcan lid; there is a giant dent in the top where there used to be no blemish.  We have put in long days since we left Colorado on Sunday.  I will tell you more stories from our road trip in future emails, they include being pulled over twice in the same day (different states), a long trip down memory lane (for my mom) and having the car in the shop, twice, despite there being nothing mechanically wrong.  I hope you are all doing well!

Good night from PA,

Kristen"