Wednesday, January 28, 2009

How do you spell committment?

I'm coming up on 7 months of employment at El Centro. My application for the National Health Service Corp loan repayment for service is due at the end of the week. Its a two year obligation for paying of about 50% of my student loan debt. This is a good thing, something to be especially grateful for in rocky economic times. Why am I freaking out about it?

It would mean that if I decided to leave my job for any reason before my service obligation was complete I would have to repay the amount dispersed plus 150% interest. The government is pretty serious about this stuff. It means I'm here. I'm committed. I'm nervous.

This should not be making me uncomfortable, but it is. I have itchy feet, mid-winter restlessness. The bloom is off the rose. Everything would be fabulous if I could move to another city, preferably somewhere warmer/cooler/closer to family/farther from family/higher in the mountains/more urban. What do you mean the geographic cure is a placebo?

I've decided not to buy a house. I just don't know if I want to stay here after my service agreement is up. I'm apprehensive about potential relationships; what if something gets serious and they are unwilling to consider relocating? What if that person has a small child (as has been the case with a few men I've dated recently)? Katie will be 18 in three and a half years, and legally I don't need to stick around and hopefully she will fly the nest and be off to college (though I'll still help out financially if I can). Do I really want to spend another 8-10 years helping to raise another child?

Most likely there is too much analysis going on here. I have contradictory needs for consistency and plenty of room to change my mind. What would Buddha do? He'd just sit with the feeling of restlessness, see the fear that it comes from, acknowledge it and let it pass. Let's see if I can do that.

Thursday, January 22, 2009

Interesting Measures of Success

So, the last couple of Thursday afternoons I've been going to the nursing home in Las Vegas to look after a few of the residents. The environment is pretty depressing and some of the patients, I think, would be better off without a lot of the "life-saving" measures we give them. What life is it exactly we're saving?

One of the residents, Mr. A., has been creating a fuss at the home. He's been aggressive with the staff, a few visitors, and apparently the chaplain. Usually if an elderly person has a sudden change in behavior it means that they have a urinary tract infection. Its a simple matter of getting the patient to pee in a cup (or emptying their catheter bag), dipping a stick in it, and giving them some antibiotics and, voila'!, instant behavior correction!

I gave an order for a urinalysis. This was complicated by Mr. A. swinging his walker at the nurses aid sent in with the specimen cup. When I got there this afternoon, the nurses station was abuzz with tales of Mr. A.'s attitude problem. I asked about the urine sample that was requested a week ago. Never got it. Mr. A was headed straight for a psych eval and sedation.

Suddenly, or at least as suddenly as a guy who's had a stroke and uses a walker can go, he was standing in front of the desk. I grabbed my specimen cup and followed him down the hall. It was time to use my advanced clinical skills.

"Mr. A., how are you today". I gave him my biggest smile. He smiled and babbled back.

"Do you remember me?" More smiling on both sides.

"Can you give me a urine sample?" Smiling, babbling, walking towards the bathroom.

"I have a cup right here, will you fill it up for me?" Smiling, nodding, babbling.

He handed me a cup. Half-empty, half-full, didn't matter. It took two minutes to get a urine sample from dangerous geezer. I capped the cup, thanked him sincerely, helped him tuck his shirt into his pants and took my prize down the hall.

The charge nurse on duty saw me coming with the cup wrapped in a paper towel.

"You're kidding!"

"Nope, got some test strips?"

Two minutes later we had a positive test strip for a bladder infection. Mr. A. cruised down the hall and said hello with a big grin on his face. There were no walkers thrown, not even a cross word spoken.

There a couple things to be learned here. If you smile, say please and thank you, and treat people with respect, you'll generally get what you want. This is especially true with people who have lost a good portion of their dignity and freedom.

The other lesson is that old guys love me. I am far more successfull with the 80 and over crowd than I am with men in my own demographic.

Tuesday, January 20, 2009

At Last

At Joe's Ringside Bar here in Las Vegas the Rio Gallinas School held an inauguration ball. The students of the 2nd grade to 8th grade school dressed up and crowded the dance floor while footage of the actual inauguration ball in Washington DC place on the big screen.

Barak and Michelle danced to Beyonce singing the Etta James classic "At Last", which happens to be one of my favorite songs. It is longing relieved, prayers answered, romance and sweetness. It was the perfect song for a couple that seem so in love with each other and the perfect song for a nation looking for a hero. I got a little verklempt.

Give the dogs a bone till tomorrow. Tonight is all magic.

Monday, January 19, 2009

Back From the Not So Frozen North

All I can say is: Thank goodness for the Montezuma Hot Springs. After a 5 hour drive, getting the kinks out was priority #2 after greeting Wanda the Wonder Shepherd.

My visit with my brother and sister in law was great. They really went out of their way to make us comfortable, well-fed and slightly tipsy on great wines. My brother Aaron is a bit of an oenophile and is passionate about finding unusual wines that are quite delicious. My favorite from the weekend is "Plungerhead" zinfandel. I'm not usually one for zins but this was super tasty and worth stocking up. Here's a review:

Katie and I had a wonderful time. I don't think I've been that relaxed for an age. We wandered around, saw the Celestial Seasonings plant in Boulder, listened to music on the Pearl Street mall, and saw "Marley and Me". We bawled our heads off at that one. In the ladies room after the movie we saw one woman after another with running mascara and sniffles.

Even with all the strange new of the weekend (there's more that I can't really write about at this time), it was a wonderful time to bond with Katie and Aaron. I'm looking forward to the next trip in March.

Sunday, January 18, 2009

Save the Last Dance for Me

This New Years Eve I went to the historic Plaza Hotel with two freinds for dancing and champagne. This years resolution is to dance more. And boy, did I. A man named Micheal Esquivel twirled me around the dance floor till the band packed up. He looked eerily like Jim Belushi, had played semi-pro rugby in New Zealand and had moved back to Las Vegas to be near his elderly parents.

Dancing with Mike made my New Years. It was joyous, graceful, spontaneous and altogether wonderful.

Today while I was in Boulder with Katie, I got a call from Francis, a friend from work. Mike had been killed in an accident with a train. The man who, two weeks ago, was dancing with me and ringing in the new year with balloons and champagne is just gone.

I'm so grateful to have danced with him. It was joyful and life-affirming. That will be my memory of our brief acquaintance. I hope it was a happy memory for him too.

Thursday, January 15, 2009

Keeping the Heart Open

Today I received the pathology report on a woman diagnosed with a particularly aggressive variety of breast cancer. When I called her, she didn't cry or fuss or any of the things I would have done. She thanked me for the pain relievers I'd given her earlier today and said she was just glad to know what was happening to her. After we finished speaking I went to the office of a colleague, a woman with many more years of experience than me who had helped me with the case. I sat down and cried.

I suppose after enough time in medicine this sort of thing will stop being so painful. But I hope that I don't stop feeling. Pema Chodron's book "The Places That Scare You" says that its easy to shut our hearts down in the face of discomfort (dis-ease), become hardened and cut off from the source of love. The more difficult path, and more rewarding, is to sit with dis-ease, observe it, and allow it to move through us and past us on its own. She talks about the boddhichittra, having a tender place like an open wound where compassion originates. Gratitude for the experience.

I'm grateful that most of my work is not so emotionally wrenching. It's wonderful to live in a state, for all its shortcomings, that provides healthcare for women with cancer. I'm happy that my patient still has options. I'm grateful for the support of my colleagues and for the grace with which my patient is moving forward.

Wednesday, January 14, 2009

decisions, decisions

Once again, I'm considering purchasing a house. I love my current place. Its out in the country next to the river. There are hawks and owls and kingfishers that hunt in my backyard. Its peaceful and the stars are beautiful. The rent is also fairly high (especially for a single girl). The wonderful 18 foot ceilings and wall of windows make heating the place expensive and my landlords have made it fairly clear they don't appreciate me asking for repairs on the house. I've spent some wonderful mornings drinking coffee on the porch in my pajamas watching the birds and listening to the quiet.

Right now there are two real estate possibilities. One is a little 1940's bungalow in town. It needs a new roof and probably could use double-paned windows but has a fabulous interior and is really convenient to work. The other place is a little farther outside town from where I'm at now. Its passive solar, has a great view of the valley but is a bit small and has a smallish lot. Both of them are in the right price range for me and with a few improvements will most likely have a good resale value.

It really gets into my committment issues, which is a bit ridiculous. One of the reasons I'm in Las Vegas is so that I can get the National Health Service Corps loan repayment for rural health care providers. That's a committment of at least 3-4 years. Basically, I'm an indentured servant. If I walk away before the contract is up I'll have to pay something like 150% interest on the monies paid by the government. Buying a house should be a financial decision, not emotional. But I don't have a tattoo for the same reason... What if I hate it, what if I change my mind, what if the floor sags?

A friend from work is looking at houses right now. I'm going to call his real estate agent and see what comes up.

Monday, January 12, 2009

Woohoo, Jazzfest

I have booked the big trip for the year. I'm headed off to Jazz fest in New Orleans with my freind Julie and maybe, just maybe, Amy too (we're working on her resistance, she's trying to be all fiscally responsible on us). The three of us havent done a girls weekend for almost 2 years. We're renting a little carriage house that's only 5 minutes from the fairgrounds and about 15 minutes from the quarter. Its absolutely wonderful, has a kitchen and a clawfoot tub. This is going to be a ridiculous amount of fun. Girlfreinds, Aretha Franklin, oysters and New Orleans the muse; it doesn't get much better.

Short post. Here's a picture of the blizzard the day before Christmas Eve.

Sunday, January 11, 2009

my pretty flowers

Katie and I picked up an orchid at Trader Joe's before she left. It seems to be very happy here. I've always been reluctant to get an orchid plant, because I thought they were high maintenance. Not true at all.

Saturday, January 10, 2009

Duke Ellington and All That Jazz

I'm not sure where the day went, but it sure left in a hurry. Now its the end, lots of things got done and I'm working on making space. Not the "cleaning the closet" sort of space but the "cleaning out the head" sort of space.

One of my mentors, way back in the day, told me that there is fertility in emptyness, that until there is a void, creativity is stifled. When he told me this I was seventeen years old. I thought I understood what he meant. That was before I acquired emotional baggage and furniture and a file cabinet full of check stubs and tax returns from the last seven years.

Being single after a couple of decades of serial monogamy is a scary proposition. It means sitting still and not chasing the wind. Its learning to sooth that anxious feeling that comes up from the pit of the stomach when it would feel so much better to call someone, anyone, to feel some sort of connection with another human being. It means walking through the dark alley of longing and regret without panicking about the boogy monster (who is me anyway).

Buddhism teaches that suffering is caused by desire for anything other than what we are or what we have in this moment. Now is perfect, it is as it is. I have always had some difficulty with this idea. Isn't suffering also caused by circumstances outside our control? If we didn't have desires, how would we educate ourselves, feed ourselves, take care of our loved ones, or create art? Those things stem from desire. They are all good things.

I think the difference is this: does the desire cause unhappiness or joy? Does the desire come from a place of compassion or fear? Compassionate desire can save the world. Desire that comes from fear has nearly destroyed it.

By no means have I got this all figured out. I get angry, petulant, resentful, depressed and a host of other negative emotions. I feel sorry for myself sometimes. But I'm working on it.

Wednesday, January 7, 2009

Another reason to be grateful for good health

In the rural medicine rule book, section a part 2, we read that patients with heart complaints may not present to the clinic until 30-45 minutes before the close of business. This ensures that any plan that the health care provider, nurse, or office manager may have had at the end of the day are thoroughly smashed.

Part 3 of the same section states that the amount of time that the 911 dispatcher needs to decide where the patient should be taken is directly proportional to the amount of oxygen that the patient requires to decrease his shortness of breath.

It must also take 30 minutes for the EMT's to establish an IV in a hypotensive patient with chest pain.

Emergency vehicles will be in violation of said rule book if they follow the route to the hospital that they took to the clinic, thus making their total time from dispatch to hospital less than 3 hours.

Did I mention that I do a lot of praying these days?

Monday, January 5, 2009

Big Ball o Crud

I stayed home sick today. My sinus passages are loaded with mucus, I have a barking cough that is reminiscent of the mating call of a leopard seal. I'm alternating between sweating through my clothes and shaking chills. Sounds like fun, huh?

I caught up on my daytime tv including the Anthony Bourdain marathon. Love that guy, there's something about a tall, neurotic, intelligent man who can cook that just turns my crank. Lots of risk taking behavior and a smart ass attitude. That's more testosterone than you can shake a stick at. It's not the healthiest archetype, but it sure is fun.

It would be great to say that I spent the day soul searching and considering my new years resolutions but that would be dishonest. I spent the day stoned on nyquil, dozing in and out of consciousness, eating soup and leftovers. I'm going to pop a few more of those bad boys before bed and hopefully be well enough tomorrow to hit the ground running.

Sunday, January 4, 2009

A Dr. Zhivago kind of day

Its snowing again. There's 2-3 inches on my porch, no wind and I'm trying to decide if I should head off to the store now or take the chance that its going to clear up later. Braving the weather might keep the melancholy at bay for a bit longer.

Katie went home yesterday. We had such a wonderful visit and I always hate taking her back. It leaves a void that I can't fill. There have been shifts in my relationships that need accomodating and a great, aching need for healing. Moving up here has given me the chance to rest from the chaos of PA school and my divorce. Now I think its time for the rehabilitation.

One of my goals for this year is to go deeper into meditation and yoga, hopefully to become less susceptible to the emotional winds that push me off balance. I'll have to cultivate some discipline or at least unpack it from that PA school box that I put away. I don't have any problem creating structure in my life but there are so many distractions and no sense of urgency. I suppose that sense of urgency will have to be created as well.

Right. Off to the store with me.