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