No news is good news, but so to is good news, good news

I received welcome and good news this last week in the form of an offer letter of employment.  I have accepted a position with Kaiser Permanente in Lafayette, CO in the orthopedics department.  My last day with Geisinger will be May 16.  We'll move, take a brief vacation, and find a place to live, before starting work on June 9.  Warren and I are super duper excited!

Spring into the season

We had our first absolutely beautiful weekend of the season this past weekend.  Warren and I took full advantage despite the fact that I had to round Saturday and Sunday mornings.  We spent Saturday out in the fields practicing our archery skills.  I'm no Katniss Everdeen, but it sure has been a fun sport to take up.  Saturday evening we went over to a friends for a BBQ. There was a good turnout of people and we had a nice time eating, drinking and chatting with friends.

Sunday we went to Rickett's Glenn State Park for the first hike of the season.  The weather couldn't have been more beautiful: early 80's, sunny, low humidity and with only the slightest of breezes.  It was wonderful.  The trail we took was technically closed due to a remaining coat of ice on the trails.  We, and many other groups, decided to chance it anyway.  We encountered only a little bit of ice as we made our way to the top of the trail; it was by no means impassible.  We did not however make all the way to the top.  We were nearly there when on the trail ahead we saw a pair of girls who had disgruntled looks upon their faces, waiting for a park ranger to finish writing something down.  I may have mis-read the situation, but it struck me as a scene of ticket writing for hiking a closed path.  Warren and I didn't stick around to test those waters.  We made it down without incident and rounded out a lovely weekend with burgers and a shake at May's drive-in.

No news is good news

The last few days, I've been reading the blogs from several of my friends.  They sound happy and busy with their extra-curricular activities.  And so, I was inspired to write my own update; despite the fact that there isn't much of an update here in central PA.  The weather continues to be lousy, work is steady and we're hooked on "Breaking Bad".

Being a young working professional at Geisinger, means I have become friends with other young working professionals, primarily residents.  This is both good and bad.  The good is meeting like-minded individuals of varied backgrounds and home origins.  The bad means that the majority of them will eventually move away :-(  The first of these friends moved away one week ago.  Joanna is a PA surgical resident from Salt Lake City, UT.  She and I got along very well: we had similar tastes (drinks, food, clothes), ideas and goofy voices (amongst other shenanigans.)  I will miss having her here.  The next round of residents graduating and moving on to bigger and better things, comes up in June.  A couple we have been on a few double dates with, will be moving to Toronto (sigh).

Warren had his wisdom teeth out this past week.  Everything went well, and I must say, having seen him recover from anesthesia a couple of times now, he is a funny guy.  And inquisitive.  Anesthesia brings out his inner 5 year old, "what about this?" "why that?" "how did this go?"  It's a good thing I was there to hear the answers, because he forgot the responses shortly after the surgeon gave them.

The weather, part II: return of the frozen pipes

So, the bathroom pipes froze on Friday.  They were thawed, nothing burst and the faucets were left flowing.  Sunday morning we awoke to a frozen (again!) hot water pipe to the master bath.  Turns out that BOTH hot and cold water need to be left on in order to keep pipes from freezing.  Easy enough in our guest bath because there's one knob to control the faucet.  The master bath, however, has separate controls for hot and cold.  Getting a low flow mixture to produce tepid water, is not very easy at it turns out. 

In addition, both pipes to the washing machine in our laundry room froze (no where near the bathroom pipes, but another interior wall).  This room was added to the main house sometime in the last 50 years (a guesstimate).  But was poorly constructed with no insulation; and the radiator that was installed doesn't work.  With sub-zero temps that room is just straight up cold.  After double checking the pipes in our cellar/basement/crawl space area, we determined the freeze wasn't down there, but near the tap.  Utilizing our multi-purpose thawing tool, my hair dryer, we got the washing machine up and running.  Only to discover during the rinse cycle, that there was an obstruction in the drain pipe (seriously?!), as soapy, dirty laundry water was spewing into the air.  There was some cursing, pausing of the washer in mid-cycle and scrambling to find large, utility towels to mop of the mess.  It's a good thing we had a hot water load of wash in there, because without any intervention on our part (save time and stopping the machine), whatever was clogging the drain (I think it was an ice-chunk) resolved itself.  We have now invested in a space heater for that room.

The weather: It's cold!

Much like a large portion of the country, we are experiencing extremely low temperatures here in central PA.  As I mentioned in my previous blog we've had to deal with frozen pipes.  We got them successfully thawed and nothing burst, but now we have to have a continuous flow of water streaming from both bathroom sinks (ugh, what a waste!).  Both faucets are on interior walls, so logic would dictate that they wouldn't freeze.  Alas, the main part of the house was built somewhere around 1850, with horizontal stones as the foundation for the exterior walls.  A garage/2nd floor master suite addition was constructed just a few years ago on the North side of the house.  Well, the main hot and cold lines for both bathrooms run through the wall that is the interface between the two generations of construction.  Logic would dictate that this area would have some modern updates for efficiency.  Alas, it is an area where you can clearly see the old stones, can readily feel any draft or breeze, and there is absolutely zero insulation (which explains why the master bath has anti-radiantly heated floors, i.e. they're frigid).  The only difference is that the new pipes are PVC while the old pipes are copper.  So, yeah... I'm glad that A) we do not pay the water bill and B) don't have to pay the money it will take to properly insulate the pipes and addition.  The plus side of dealing with this is that Warren and I know what plumbing access panels look like and we've become handy with a hair dryer... for non-styling purposes.

p.s. 'freezing' has no business preceding 'rain'.  I do not like this weather phenomenon.  It's not common to CO, and it just feels like a step's been skipped, i.e. snow (which I realize is also solid water, but in a more fluffy, less disruptive form.)

Snow in Central PA

I have been assured by many people, that it rarely snows here in the winter time.  If it does, there's very little that falls and it melts quickly.  This news comes from both natives and people who moved here from colder climes (namely Minnesota and Maine).  I believed them, for a while anyway...

The first "snow" we had was maybe an inch: roads were moist and grass blades could still be seen through the dusting.  People here FREAKED out!  They really couldn't handle it.  Drivers crept along the roads, and Danville schools were put on a two-hour snow delay.  Many of my native co-workers were aghast that school wasn't cancelled altogether.  A school bus (from a non-Danville district) did take a turn too fast that morning and slid off the road.  All passengers were taken to the hospital: some had minor injuries, most had no injuries, two were hospitalized overnight.  So, with fears confirmed, people around here officially became chionophobic.

Temperatures remained in the 30's for the next week and we got rain (which did indeed melt the snow). Then another "snow" storm was predicted.  This time school was cancelled the night before the storm hit.  People were braced for the 2 inches that were predicted.  The next morning dawned cold and cloudy.  Every now and then a flake could be seen.  The day went by and nothing happened.  By afternoon the clouds were lifting.  There was no snow.  Karen (my nurse co-worker from Maine) and I were shaking our heads over how fanatical people around here get when it comes to "snow".  I mean really?  What if it actually snowed around here?  Would the world as they know it, end?  I was soon to find out...

December began with mild temps, rain and a day so warm and humid that it felt like a summer's afternoon.  This balmy weather was soon to be squelched by the real deal.  An actual snow storm.  The predictions called for a few inches of snow here, 4 at the most.  We ended up with 6 whole inches of snow!  People did indeed freak out.  School was closed and some shops were too, but as it turns out, the city's infrastructure held up.  Roads were appropriately cleared and the apocalypse did not occur, which, like the rest of the folks around here, was a major concern of mine.  What a relief!

Since then, a few more snow storms have hit.  Warren and I flew in from CO January 2 to a storm in the area that brought frigid temps, wind and another 4-5" of snow.  With all that, I think folks around here are acclimating to the concept of snow in winter time.  Shops are open, streets are clear and drivers are able to navigate at regular speeds.  Although, with this latest storm school was cancelled for two days.  And our bathroom pipes froze.  But other than that, life is fairly status quo around here.

It's the Holiday Season!

Well, true to my journaling track record, I experienced a steep decline in posts starting in August.  And by steep, I mean that I haven’t posted anything since August.  As you may have guessed a lot has happened in that time.  Summer turned into fall, which rapidly turned into winter.  I’ve taken up archery, Warren’s gotten a new job and we’ve both gotten into our routines/grooves.  We’ve gone through Labor Day, the Bloomsburg Fair (it’s a holiday out here), Halloween, Thanksgiving, Christmas and began a new year!  Let’s explore some of these unfamiliar events in more detail, shall we?

Archery

                My friend, Joanne, and I decided we would take up archery together.  We’ve both always thought it would be fun, and given that it’s quite popular around here, we decided there was no time like the present.  We each bought a re-curve bow (think “Katnis Everdeen” from ‘The Hunger Games’) and three arrows, from a shop in Middleburg, PA.  The shop owners, a husband and wife, have some of the best customer service skills of any retail shop I’ve been to.  They not only take the time to help with your current retail wants, but they will have your name and needs memorized from that point forward.  It may not sound like a big deal, but how many stores do you go into on a regular basis, see the same clerk and it takes months before you feel like they know you by name (let alone what you’re in there for)?  Joanne and I made one visit, and promptly ordered bows and arrows.  When I went to pick up the orders, Judy (who had originally helped me and Joanne) was busy with another customer, but with just a glance toward me and the freshly closed front door, she was able to tell her husband, “Kristen is here to pick up both her re-curve and Joanne’s.”  I thought maybe it was a fluke, because two non-camo wearing, females without male companionship in an archery shop is quite a unique sight.  However, every time I've been in since, I’ve observed Keith and Judy greet their other customers in this manner too.

                I'm ok with the bow, I generally manage to hit the target Warren got from Wally-Mart.  But, it is very difficult to aim with a traditional bow.  It's not so much aiming as it is getting a feel for the bow and hoping it hits near where you'd like.  There are no sights, it's just repetition.  To the point that you have to breath the same with every draw and release.  It's not a sport you can excel at if you're not able to get calm and focused.  Good thing a yoga studio opened up in town around the same time I took up the bow and arrow ;-)

The Bloomsburg Fair

                This is an annual, state-fair style event that is coveted by both the locals and carney folk, alike.  People drive from several states away, just to experience this fair.  There are carnival rides and boardwalk games, agricultural competitions (giant produce, anyone?), concerts, rodeo performances, trinket vendors and of course, copious amounts of food; primarily of the fried variety.  Most stands offer your typical deep-fried fare (potatoes, random veggies, oreos, twinkies, etc).  Some have more exotic offerings such as deep-fried, bacon-wrapped, Snicker’s bars.  There’s even a stand that will deep-fry any food-item you bring to them.  So, chances are that if it’s edible and been deep fried before (say at the Texas state fair), someone will offer it at the Bloomsburg Fair too.  And this, the sheer selection of (fried, junk) food, is the main draw to the fair.  Every year there is a heart attack or two on the grounds, and this year was no different.  Although, I think someone has yet to die at the fair from their heart attack.  My cardiology office-mates like to joke that they need to have a Geisinger cardiology stand at the fair, just in case someone needs a coronary cathed or stented emergently.

                The Bloomsburg fair has its own permanent grounds, located at the west end of the town of Bloomsburg (normally a cute, quiet college town.)  Throughout the year, various small events can rent out space on the grounds, but otherwise it’s deserted most of the year.  However, for the week of the fair, the whole area turns into a place of grid-lock and pandemonium.  The local schools get the week off, people set up parking lots in their yards (apparently a very lucrative endeavor), and some (who are dis-enchanted by the whole thing) just leave town until the fair has cleared out.  Hundreds of thousands of people attend annually.

View from the sky ride.  

A people mover to easily get from one end of the fair to another.

Luiz and Joanne

I'm on the left.  

We spent Thanksgiving here in Pennsylvania with Luiz, Joanne and another couple Jared and Amy (he's a urology resident).  We had a wonderful holiday with them, and learned a delicious new way to cook turkey.  Warren and I even managed to get through our Kale salads; the dressing was very yummy!

Christmas and New Year were spent in Colorado.  It was Warren's first trip back home since moving out here in April! (I'd made it home in late August for a few days) We both had a wonderful time, and were sad to leave the bluebird skies of CO for the freezing temps and whipping snows of PA.

And if you're still with me on this post, you'll (hopefully) be as delighted as I am, to hear that Warren and I got engaged on New Year's Eve.  We'll technically very early on 1/1/14, but you get what I'm saying.  We have no date, venue or any details really, but we do know it will be in Colorado.  Probably the mountains.  Probably this year.

You know your patient's constipated when...

You know your patient's constipated when...
Their abdominal pain is trumping their surgical pain

You know your patient's constipated when...
The usual Colace, Senokot and Dulcolax haven't even addressed the problem,
neither has the Dulcolax suppository

You know your patient's constipated when...
They've received a Fleet's enema, followed by two soap suds enemas, with no results

You know your patient's constipated when...
They've received the aforementioned within a 24-hour period, plus a half dose of the bowel prep regimen used for people undergoing colonoscopy, with zero results

And finally, you know your patient's constipated when...
The pharmacy voluntarily pages you, in order to inform you that your patient has been pre-approved for an 8mg, subcutaneous dose of an anti-constipation medication so potent, that results typically occur within seconds of administration.  A medication so potent, and coveted, that it is ordinarily reserved for palliative care patients only.  A medication that is so coveted, and secret, that neither I nor my supervising Physicians have even heard of it, let alone ordered it.

Subsequently order it, I did.  And sure as shit, it worked within seconds...

"Working for the Weekend"

I think I can officially say that Warren and I are "working for the weekend."  Each weekend we seem to find something new to do or just enjoy time hanging out with Joanne and Luiz.  Here are the highlights of our weekends in July:

1) Kayaking the West branch of the Susquehanna river.  A nice wide, smooth flowing river, I got the hang of it pretty quickly.  And with 4 hours on the river complete with snacks, water fights and conversations with good friends, who wouldn't enjoy themselves?

Me and Joanne

Warren

Luiz

2) A long weekend with family.  See my previous post about my sister and dad being in town.  Great memories

3) Archery shopping with Joanne.  Joanne and I decided we'd like to learn how to use a bow and arrow.  Not to hunt anything, but for target practice, especially on those days when you need to release a little tension.  We took a few practice shots with different bow types (recurve vs. compound).  We both like the wooden bows more than the modern ones (like they use in the olympics).  In fact, we ended up ordering the same bow.  No date yet as to when it's supposed to arrive, I'll keep you posted...

4) A brand new yoga studio has opened in town, studioB (www.studiobyogacenter.com).  It is owned by a young lady, Becky, who moved here from NYC, because her sister is starting residency at Geisinger in Ob/Gyn.  She said that she was planning to open a studio soon in Long Island anyway, and when her sister was accepted here, she decided to relocate too.  If nothing else, but to have an opportunity to thrive in a place where there isn't a yoga studio on every corner (I'm sure the rent's cheaper here too.)  I took my first class there today.  It's a great space, very open and inviting with a positive energy.  I was amazed at how much my body/spirit was craving a good yoga class.  I will definitely be back there.

Family Visit

Two weekends ago, I was very happy to welcome my dad and sister to Danville, PA.  They arrived late Thursday night after flying directly from Denver to the Harrisburg airport.  We'd been experiencing a heat wave that whole week prior, and I was concerned that there wouldn't be enough AC in the house to keep us all from melting (or choking on the humid air).  Luckily, the heat wave broke on Friday and we were able to enjoy outdoor activities without too much discomfort.

On Friday, we went to Rickett's Glenn for a hike touring the famous waterfalls.  Rickett's Glenn, as I may have mentioned before, is a recreational state park complete with lake, cabins, camping grounds and hiking trails.  The park is 13,050 acres at the top of a "peak," measuring 2449 feet above sea level.  The most famous of the hiking trails is the aptly named "Falls" trail.  This trail takes you down the hillside through old growth timber on a tour of waterfalls.  There are 22 waterfalls in all, with varying heights up to 94 feet.  The scenery is gorgeous, hike is moderately difficult, and the best part is that there are areas to wade into the water to cool off from the humidity of the area.  We had eaten a picnic lunch before our hike, and rounded out the afternoon with ice cream cones from snack shop after our hike.

Saturday Warren was able to joins for the day's activities (he'd had to work Friday.)  We all went to the gym (Warren and I belong to Anytime Fitness) and got in a great work out.  We then headed to downtown Danville to see what was going on at the Iron Heritage Festival and find a place to eat a late breakfast/early lunch snack.  We ended up at a place called "Pappas."  Warren and I had never tried it before, probably due to low expectations and very limited hours of operation.  It ended up being an experience to remember.  The short of the long of it is:

• They didn't have half the items listed on the menu (it may have been closer to 2/3, I'm not kidding)
• They stopped serving breakfast promptly at 11am (it was 11:04 and we were made well aware that there were no more eggs, toasts, sausage or bacon)
• but if you really wanted something breakfast-like, you could order the lunch-time egg and bacon sandwich (choice of toasted bread, including English muffin), if it was ok that the eggs had an essence of hamburger flavor (the apparent difference between breakfast eggs and lunch eggs)
• Oh, and cash only to pay thank you very much (phew, good thing that's all we had on us)

It reminded me of the "Olympia Restaurant" sketch from the early days of SNL (click here to navigate to the Hulu page, then scroll down to find said sketch: www.hulu.com/best-of-snl )  We hung out in Danville the rest of the day, had an early dinner, then drank wine and played Scattegories at the house until late.  The night was rounded out by a nice fireworks display that we could view from our porch, courtesy of the Iron Heritage Festival.

Sunday morning we met at the Pine Barn Inn (the hotel where my dad was staying) for breakfast, then headed out to Lewisburg for the morning.  Lewisburg is a cute university town about 20 minutes NW of Danville.  It is home to Bucknell, a private liberal arts university with Bucky the Bison as a mascot. We wandered the main street which has some cute boutique shops (most of which are closed Sundays, as is the norm in these parts).  When then had a nice dinner from the grill at home.  Complete with a grilled brussels sprout dish Katrina made.  Dinner was delicious.  We then played Jenga on the patio well into the night, with fireflies and a fire-pit fire in the background.

Monday morning the clock struck midnight, and Katrina and my dad had to leave for home.  I was sad to see them go, but treasure the weekend we spent together.  It made me that much more excited for my trip home at the end of August.

Fall at Rickett's Glenn

Danville as viewed from across the river in Riverside

Candid shot of Katrina and Dad

Overdue Update: the synopsis of the June mini-holidays

It has been well over a month since I last published.  A lot has happened in that time, and the time somehow managed to fly by.
Highlights from June include:

1) Long weekend in NYC with my very dear friend Lucy B and 5 German tourists (I feel the name of a band coming on... And no, they were not all random German tourists, we knew one of them before hand.)

2) Long weekend of "camping" in the woods near Pittsburgh with my dear friends Megan and Ron (the quotes are because they take this trip every year and Ron has tricked out their campsite with potable, filtered, running cold and hot water. Yes, there is a tarp shower stall in camp.)

3) Long weekend in Las Vegas for the wedding of one of Warren's very good friends, and

4) Birthday weekend in Vegas (we killed two birds with one stone that weekend)!!!!

Plus, there was fourth of July, though neither Warren nor I got a long weekend for that (we both had to work Friday and Saturday afterward).  We did however, get to watch the Bloomsburg fireworks show. The display was punctuated by the dancing fireflies in the yard we were sitting in (I'll have to gush about those later.)

Last Sunday we took a rare full day off and decided to check out some of what Pennsylvania's outdoor recreation has to offer.  We went to a state park called Rickett's Glenn to hike the famous water fall trails. The park is heavily wooded/forested and located at the tallest point in PA, over 2400ft!  The creek that runs down the hill (mountain really) has been dammed up toward the top and a reservoir has been created.  There are canoes, kayaks and a beach, plus a snack shack with plenty of fried food and ice cream.  The park also features camp sites and cabins for rent.  We however did not know any of that before going, we just wanted to check out the water falls. And check them out we did, along with a lot of other people.  This put a damper on the tranquility of the place.  Fortunately, we were too sweaty and hot from the sheer humidity of the climate that we wouldn't have been able to take in the tranquility of the place anyway.  Despite our glistening discomfort, we enjoyed the hike.  And by the end, we were very grateful to know that we could purchase an ice cream to help cool us down a bit.

This coming weekend we are planning to go kayaking with our friends Luiz and Joanne (Luiz is the general surgery resident I've mentioned; Joanne is his wife, she and I get along very well.)  They're a great couple and I am so glad we've met them.  There is a company out here called Canoe Susquehanna and they offer private guided trips of the river as well as planned group events.  We'll be participating in one of the planned group events.  It should be fun!

Enough with the words, on to the pictures!!

Me and Lucy at dinner.  This restaurant/bar turned out to be very nice, we even became "regulars" for the few nights we were in town.  Though we have a sneaking suspicion we may have eaten pigeon being passed off as chicken (Lucy's suspicion more so than mine.)

We took a helicopter tour of Manhattan

The WTC memorial as seen from the air

Weekend of camping.  Photography was not high on my priority list.  As such, I only have a few pics, more so to get a feel of things than to capture any one thing in great detail.  Soooo, this is not a great example, but the white tents in the background are Megan and Ron's campsite.

VEGAS!  The night of Jarret and Marisa's wedding, the groomsman all wore black suits and purple ties, and it was hot at night easily in the upper 90's (I was overheating in a sleeveless dress)

Birthday dinner at Nobu (in Caesar's Palace)

There are 22 waterfalls at Rickett's Glenn, they are all named.  I don't know what the name of this one is (cause I didn't bother to remember it...)  But it's a high/tall water fall (see the person in the lower right corner for reference)

Another named, yet unknown name, water fall

This one has a large tree that fell into it.

It's very green here 

(and have I mentioned the humidity? Shvitzing, it's the story of my life right now!)

And to wrap things up, here are a few pictures of the cutest kids in the world (though perhaps I'm biased... then again, maybe not) enjoying Tastykake chocolate cupcakes all the way from PA to CO.

Sage (well posed for the camera little man) and Willow (I hope she gets her last bite in before it's smashed)

Daddy and Brooke (she is super excited!)

Urban Poison Ivy

I mentioned in my last post ("the humidity cometh") that the poison ivy out here grows to epic proportions.  Little did I know at the time, that it also thrives in urban settings.  No sooner had I finished that post, than I was standing at my kitchen window, staring at a plant that looked suspiciously like poison ivy in my back patio.  Now, something you should know about my back patio is that it is made entirely of pavers.  There is no lawn, there is no garden, there are no flower beds, it is comprised solely of gray paving stone.  Of course there are weeds, but I'm plucking them out like a teenager pops their pimples: aggressively and knowing the darned things are just gonna sprout back up.  Anyway, between my patio "wall" and my neighbor's yard (which is elevated above mine, so they have a wall too) is a gap.  Occupying this gap is an assortment of weeds, included in this assortment, much to my chagrin, is poison ivy.  How in the h-e-double hockey stick did it get there? And how is it thriving?  My weed "garden" offers very little shade and in fact the poison ivy is located such that it gets direct sunlight all afternoon.  Those not versed in poison ivy lore may be saying "so?".  Poison ivy is a plant that thrives in shaded, cool, damp locations.  It has innocuous looking, bright green, leaf-shaped leaves (think of a leaf that a 4-year-old would draw).  They are broad with smooth edges, some larger ones have scalloping along the edge, and a mild sheen on the top surface (though most things around here have a mild sheen, thanks to the humidity).  The hallmark of poison ivy, and what tipped me off in this case, is that the leaves grow in clusters of 3 on a single stalk.  We have poison ivy in Colorado, it is most commonly seen growing on the shaded slopes of  mountains.  There it grows as a ground covering, which has always made me wonder why it's called poison IVY.  Well, now I know.  The plant in my back patio did not originate from the soil between the walls, it's a tendril that has creeped its way down the wall from under a bush my neighbor's yard.  Which simultaneously solves the mystery of why this piece of poison ivy is in a sunny-ish location instead of the favored shaded, damp, cool location: the majority of the plant is in the latter-mentioned locale.  Which brings me to the next problem of, how am I going to get rid of it?  I can't very well just rip it out (I don't want to test the waters of that itchy, red, rash) and Round-Up isn't going to target the root very well.  As my sister said when the diagnosis of 'poison ivy' was confirmed, "have fun with that. :-)"

The Humidity Cometh

A few weeks ago, I got a glimpse of what the summer heat and humidity may bring.  Since then, it has turned cool and decidedly less humid.  Today, however, I fear may be a pivotal change from glimpse to prolonged heat and humidity.  "It must be hot there today," you may be thinking.  No, no it's actually cloudy, cold and rainy.  The reason I suspect today may be a turning point, and not say tomorrow (when the heat is actually supposed to rise), is because rain fuels the foliage around here.  Foliage that reaches woodland proportions: the poison ivy is so large as to be confused with a large bush or tree, the poison oak reaches hundreds of feet into the air on the tree that it climbs.  Not to mention the myriad of ferns, moss and thousands of plant species I never even knew existed.  While it makes for a beautiful, lush, green landscape, it also makes for a transpirationally* dense landscape, i.e. HUMIDITY.  We're talking smack-you-in-the-face, knock-the-breath-right-outta-ya, humidity.  Not to mention the fact that there is a large-ish river running through the valley, evaporation occurring at every square inch.  Oh yeah, that's the other part, we're in a landlocked valley.  The air doesn't have a high-peaked, mountain range or tidaling, ocean to compel it to move.  That can add up to stationary, hot, humid air; ugh.  As I said earlier, I caught a glimpse of this when it was upper 80's with 80%+ humidity; apparently that's nothing compared to the middle of summer.  Great.

*Transpiration is the process by which plants take water from the soil, use it, then "exhale" it into the atomosphere.

The top 10 reasons I like my job

Good Evening All!

Much like the frequency with which my car gets driven these days, it's been two weeks since I sent out an update.  Work has been good, I feel like I'm starting to get into the groove and flow of things.  My learning curve is still steep, but navigating the hospital is no longer a huge obstacle.  Don't get me wrong, I still get lost several times a week, but hallways and routes are becoming more familiar (both through sight and smell...)  Last weekend was my first weekend of solo rounding.  It's not totally solo, cause I discuss the patients with the Doc who's on-call that weekend,  but it does mean that I see every patient we have in the hospital myself, write notes and make the orders for them.  During the work week the inpatients are split between myself and Nevin (the other PA), plus the resident if we have one on service that month.  So going in by myself over the weekend was a bit intimidating.  My time management skills were definitely put to the test.  Fortunately, it seems to have gone well because none of our patients declined, or died, over the weekend.  I consider it to be a small victory.  On that note, I would like to share the top 10 list of reasons why I like my job. Here it goes:

10) I get to follow patients progress from their initial visit with us, through surgery and months after surgery; aka continuity of care and relationship building.

9) I walk a lot during my working hours. No being chained to a desk for me.

8) I get to do inpatient, surgery and outpatient duties all in the same day.  After all, variety is the spice of life!

7) Geisinger has a great reputation, nationally and internationally.  I've set myself up for great future opportunities.

6) I'm learning how to assist with some pretty major procedures. (see my previous posting about my hand in a chest cavity, if you need a refresher ;-)

5) My team is great!

4) I get to wear exercise clothes TO work. No need to change for the gym after work

3) I get to wear scrubs and a lab coat AT work, which means very few dry cleaning expenses.

2) I don't have to deal with people's private parts.  See them, yes; deal with the medical side, no. Though we do get the occasional "code brown" (yes, people sometimes lose control of their bowels while undergoing surgery.  However it gets cleaned up by the OR nurses before the patient is moved back to their bed, so it's like it never happend...)

1) I get to sew the, sometimes gaping, wounds closed at the end of cases!

I'm going to end there for tonight.  I have more topics to write about, but they'll take me too much time right now (I had a late day today and I'm exhausted).  I hope you are all doing well.

Love,

Kristen

p.s. If you haven't already, head over to my blog (http://kristenfrey.blogspot.com) to read about the robots that roam the hospital halls.  Turns out there are at least 3 of them, not just 2 (I saw MADDIE the other day)...

TUG and ROXIE, the creepy hall roaming robots

Geisinger is on the cutting edge of health care.  Evidently this includes ways in which to distribute supplies.  I've been in several hospitals that have tube systems to deliver specimens from inpatient floors to the laboratories below (think the drive-up teller at a bank), but I've never seen automatic hall roaming robots.  Geisinger has two of these robots.  From what I understand, they deliver supplies from a central location to floors all over the hospital.  Both robots are large rectangular boxes on wheels with two large round buttons on top; one button encircled in red, one encircled in green (stop and go perhaps?).  The "oldest" of the two robots is TUG, it "rides elevators alone."  I'm serious, it literally has red tape around the top of it on all sides that says, "TUG rides elevators alone."  I have yet to test and see what happens if you try to ride an elevator with TUG.  The other is named ROXIE, it/she has no red tape, so can apparently commingle in an elevator.  The robots remind me of one of the dysfunctional, rectangular robots on the space ship from 'WALL-E.'

"How innovative," you may think; "creepy," I say.  I initially thought they were innovative, now I also feel creeped out by them.  I've pin-pointed this feeling as a combination of three sources: 1) personal interaction with the robots, 2) observation of the robots and 3) Hollywood films (specifically 'WALL-E' and the 'Terminator' films, both of which ultimately portray human kind as being controlled by machines).  For the most part interactions with either 'bot involves a person seeing them cruise down a hallway from afar, and stepping out of the way to let the 'bot pass without incident.  But sometimes, and this has happened to me more than once, an unsuspecting person will be standing in a hallway, involved in an engrossing conversation, and BAM! out of nowhere comes a loud "beep-blooping" sound followed by a disgruntled, automated female voice saying, "hallway blocked, must re-route."  Now I assume this is the robot "thinking" out loud to itself so it doesn't accidentally get backed into by an unsuspecting human, but part of me thinks that the robot is really saying, "Yo!  Stop loitering and get outta the way!  I'm on a mission people."  It's a nice warning system really, but the skeptic in me wonders how it knows there's a blockage to it's route and how far that blockage-searching technology reaches.  I've happened upon both robots as they've exiting elevators alone and opened badge-secured double doors, since we were going in the same direction I've followed behind them.  The way the 'bots move is, for lack of a better term, robotic.  Cold, calculating and "seeing" in 360 degrees.  Not to mention the "open sesame!" way in which they can get through locked doors.

They say people fear the unknown.  Since I don't know much about these robots perhaps that's the "creepiness" I feel.  Here is a sampling of the litany of questions I have: What happens if I accidentally touch/back into the robot?  Does it have a force field?  Does it have a shock probe ala R2D2?  What is it really carrying in those locked drawers?  How much does it "know" about its surroundings?  How the heck can it navigate the convoluted hallways and wings that are Geisinger Medical Center (the navigation must be as sophisticated as Google Maps)?  Can the navigation technology be turned into an app for new employees to use in order to navigate this place  (I learned today that "Abigail Geisinger Pavilion" and "Geisinger Pavilion" are in fact different, one is not short for the other)?  Perhaps I'll never know (though I do plan on trying to ride an elevator with TUG by accident, just to see).

Photo curtesy of: http://images4.fanpop.com/image/photos/18200000/WALL-E-wall-e-18247125-1772-1249.jpg

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"