Where did I put my summer?

I've been out of the blog-o-sphere for the last two and a half months. Katie came for the summer and it seemed like every waking minute was packed. We went white water rafting, she had friends come to visit, and we spend a few days in Pagosa Springs. Katie got some babysitting gigs and took art lessons. I got a new bike, a fabulous Bianchi Volpe that I ride all the time. I rode in two charity events in Albuquerque; one for the American Diabetes Association and the other for NM AIDS Services. In September I'm planning to ride the century in the Durango Fall Blaze and Celebration. Hopefull, 'll be up for the mileage and the crazy climbs!

My twenty year high school reunion was last month. Whoah! That was a little weird. There were a few folks with whom I was glad to reconnect, most I already had via the magic of Facebook, but others I didn't remember. It was like one of those strange dreams where you are supposed to be taking a test, but it's in a language you never studied.

Anyway, the activity isn't looking like it's going to slow down. I'll get some pictures up pretty soon and try and keep the blog interesting for the three of you who read it.

New Mexico has some of the best weather in the United States. Over 300 days of sunshine, relatively mild winters at the lower elevations and, north of Albuquerque at least, summers that aren't painfully hot. Consequently we are weather wimps. We don't know how to drive with anything wet or white on the road. Most of us have dry rot on our windsheild wipers and umbrellas are something we buy when we get ready to go out of town.

Yes, we have our summer monsoon season; those lovely afternoon thunderstorms in the summer that cool things off and keep things green (as green as it gets in most of the state). But at most those storms last for about an hour. We consider them more like mood swings than real weather trends.

For the last few days, it has been cloudy and rainy here in Las Vegas. This is great because our moisture has been pretty sporadic since January and we were looking at a nasty fire season. A collective sigh of relief has gone up across Northern New Mexico. That sigh lasted until this morning when we looked out side and said "What the hell? Why is it still raining? When is it going to stop? Are we going to have to build an arc?"

The forecast calls for thunderstorms through the weekend and 80% chance of showers daily through next weekend.

WHAT?

My Stars

This is my friend Lillian. Lillian is one of the most wonderful, formidable women I know. She's a single parent to a gorgeous, talented, athletic daughter. She's the second generation operator of a 1200 acre ranch east of Las Vegas. I'm not sure how many cattle she has but she tends them diligently. Her little cabin was a stone barn that she and her daughter restored, plastered, and expanded by hand. It has no electricity and no running water, just a cistern, a wood burning stove, and a lantern. The two of them created roadways on the ranch with a pick and a shovel. Whenever she and I get together we laugh like little kids. She was my first friend here in Las Vegas.


One of the interesting things about Lillian, but certainly not her defining feature, is that she has Multiple Sclerosis. However, she doesn't define herself by her illness. To her, it's a reason to creatively adapt.

Because she know's she won't be able to manage the strenuous responsibilities of ranching forever, she's created a plan. She's opened her ranch as a photographer's retreat and gives tours for other people as well. So far, besides the photographers, she's hosted botanists, hikers, and archeologists.



She's also restoring a one room schoolhouse on her property to serve as a bed and breakfast so that guests can stay for a while.

One of the things I love about Lillian is her cheerfullness. She always has a positive attitude, even when she's out of energy for the day. I think this is what has kept her mobile despite her illness.

So, if you're out our way, see if you can book a little tour with Lillian.

More Love Lessons from La Loma

Mrs. R. came in today for an exam and a mammogram referral. She's been in to see me quite a few times for other things and we have a nice, relaxed rapport. The exam was "unremarkable" (though no woman wants to hear that her breasts are "unremarkable", even at 67). We joked a little bit and she made a comment about being a nun. It turns out that her husband of 48 years had a massive heart attack a few years ago and that was the end of physical intimacy.

Now, at this point I was running a bit behind on a very busy morning. So busy that I spent lunchtime working on charts and finishing prescriptions. But Mrs. R. kept talking and I kept listening. She told me about the love she and her husband had for each other. How they still make each other laugh after almost 50 years together. How they occasionally bicker about stupid things and annoy each other. But that's what you have to put up with for that kind of longevity and those kinds of rewards.

I've been doing a bit of reading and thinking about being single and being in relationship. An article I read this morning about the tendencies of Gen X-er's to marry late or not at all said that we lacked the ability to commit, we're always looking for the end of the rainbow. If you've ever looked for the end of the rainbow, you know that it's elusive. So elusive that it doesn't exist. We're searching for a perfection in another person or a situation or a job that we do not have in ourselves. We have little tolerance for frustration. Ergo, we may have even less success at relationships that our parents, the baby-boomers. Hard to believe, I know.

So, committment means is standing still with an open heart. Not standing with one foot out the door, ready to run at the first sign of trouble. It's taking the laughter and the fear and the mess and the joy altogether.

Gearing up

Sundays are sort of the abyss of the week. The weekdays are full up with work and preparing for work. Saturday is full of errands and social engagements. Sundays are different. There may be something going on in the morning, a walk or sunday pancakes or catching up with laundry. Towards the end of the day, though, it gets very quiet especially if your domestic partner is a dog. Thoughts of work start to creep into your head.

Last week was particularly rough, work-wise. We're out of cold and allergy season and people are actually coming in because they have real problems. Very real, very complicated problems. They are sick and scared and have been asking questions so difficult that I don't even know where to begin. On top of that, sometimes I feel that my grasp of basic medicine is not very firm.

Friday night I went salsa dancing with some friends in Albuquerque. It was a benefit for the American Association of Minorities in Medicine. We met up with a few other friends; Seema, who is rounding the corner of her first year in Physician Assistant school at UNM, and Jose, who was set to graduate the very next day. Seema is in the stressed out, ready to fall apart portion of PA school where the end seems so far away that you can't even imagine what it will be like when you don't spend every waking moment studying or worrying. Jose is in a rosier place than that. He's done with the worst part. Now all he has to do is prepare for the certification exam, pass it, get his license and then a job. No problem.

Then its the job. The first year of working as a PA you know a little bit off the top of your head and know where to look up the rest of it. A full year after my own graduation I know I love what I do, but sometimes I don't know if I know what I'm doing. My mentors, who've been practicing for 20 and 30 years, tell me this is a normal thing. Sometimes, after all these years, they still don't know what they're doing.

So, the trick with Sunday nights, and maybe with all of the nights is to stay in the moment and not worry to much about what's going to walk through the door the next day.

Like Ginger Rogers sang in "Swing Time"; Pick yourself up, dust yourself off, and start all over again.

The Dead Horse I'm Kicking

Today was busy. At the La Loma clinic I saw twice as many patients as I usually do. This is a good thing. Our organization has been a little short on numbers for the last few months and there has been some whispers about being unable to keep the outlying clinic open if the trend continued. Rumors are worth the air they're spoken with but still... Its hard to believe that a clinic that makes its living from medicare/medicaid, state childrens health insurance programs (SCHIP), and sliding scale payments would find the number of visits slipping.

Several patients have told me that they can't get the medications I prescribed because their insurance will only cover a small portion or won't cover the cost at all. Even with the discounted medications at Walmart and Walgreens and our prescription assistance program we can't cover everything.

My freind and colleague A told me about his bout with malaria while he was in Kenya as a student. His stay in the hospital and medications came to a grand total of $90. He felt his care was a good as any he'd recieved in the United States. The same hospital stay here would cost thousands of dollars.

I'm not sure what is the best solution for health care in our country but we can't keep doing the same things and expect the situation to improve.

the single girl and the geographic cure

I went to Colorado/Wyoming over the weekend to visit the Katie and my other crazy relatives. Wanda the wonder-shepherd rode shotgun and didn't vomit once! We got a homeopathic remedy for last fall that seems to have rid Wanda of motion-sickness and has radically changed the way we travel. She can now ride in the car longer than an hour without nausea and actually napped in the back seat!

Another milestone on this trip: my little red subie turned over 100,000 just south of Cheyenne. On the ride back through snowy Raton Pass I decided that I would drive the ruby-subie for another 100k then get a new one. Maybe by then there will be hybrid impreza's! That all-wheel drive is pretty handy on bad roads.

The first thing Katie and I noticed about Cheyenne, besides the wind of course, was the smell of the refinery. I must say I prefer the cow manure smell of western Nebraska to the gas refinery smell of southern Wyoming. However it did make for cheap fuel; $1.79/gallon. That's a full thirty cents cheaper than it is here in the other Las Vegas.

I have no pictures of this trip as I was depending on my mother's excellent communication skills and sense of timing and left my camera in my backpack which I left at her place. Oh well.

Katie and I had a nice, mellow time and she survived her nearly terminal boredom. We saw the family including my brother Aaron and his family. Funny how having kids will make you want to spend time with the rest of your family. I also got a travel buddy for Jazzfest! My uncle's girlfriend, Ruth, is going to go with me. Woohoo! I have a feeling she and I could get into a little trouble together...

ACK

The wind commenced blowing one day in February and has not stopped. The juniper started blooming around the same time. So, besides the pollen which has saturated everything i own including the pillows where I rest my weary head, the wind has blown in piles of fine dust and has prevented any serious biking or hiking, or walking that one would normally do when the temperatures rise and the sun comes out. If I want to continue to eat pasta at this rate, then I will have to break down and go to the gym for the next few weeks until spring rage passes.

Here's the grand pronouncement of the day: I'm going to ride in the Santa Fe Century, a 100 mile bike ride in north central NM. No, I'm not going to ride the whole thing, probably the 25 or 50 mile loop. We'll see how the gym thing goes.

Just like any hobby there is a wide variety of very expensive bike accessories and gadgets. Since I'm really just getting into cycling I don't want to spend a lot of money to keep up with the cool kids. Sure, I'd like to have the super comfy harlot-wear padded, non spandex shorts and some izumi shoes and a nice camelback hydration pack but I'm also not going to drop several hundred bucks all at once. A few weeks ago, when I declared my midlife crisis on facebook, a friend recommended a red Buell bike instead of a MGB convertible. Wise advice.

Notes on Houston

Mockingbirds in the spreading branches of the Live Oaks. Their ever changing song competes with the tropical notes of the grackles. There are layers of sound in the fog. I have strong coffee and watch the sparks tumble down the concrete from the construction site across the street. Later, I learn that coffee protects the liver from cirrhosis. This is good.

1927 recording of Gershwin playing the piano for Rhapsody in Blue while I write this in my hotel room. More longing in the opening clarinet notes than I've ever heard. It would be a good soundtrack for the exhibition hall; the medical people being wooed by the sales reps.

First dinner on the patio this year; humid breeze, cigarette smoke, happy hour beer. We toasted Erika's engagement and our first meeting in a year.

If ya can't get love, have pasta and red wine

and jazz.

I'm off to Houston on Wednesday for continuing education. I haven't actually put my suitcase away from the last trip. Don't call it laziness, call it efficiency. All I have to do is throw some underwear and an iron into the bag. And my other stuff...

Wanda is going to be upset with me, but I think traveling is going to save my sanity this year. It such a great thing to be able to move freely about the country. This is the first time in my life that I've had the income to be able to travel without giving anything else up, like eating and paying rent.

I'll be meeting up with my lovely friends from PA school Alicia and Erika. That's going to be fabulous. I haven't seen Alicia since graduation and Erika since late summer (even though we work for the same company).

Shakin' the Groove Thang

Salsa dance classes started a couple of days ago! Hooray for Adam, my dear friend and dance in structor and his very non-white-guy-from-Vermont hip shakin'. Seriously though, it's really good to get out of the house in the evenings, be with other humans, and move my body. I was starting to talk to myself and pretend that Wanda the wonder-shepherd was talking back. Not good.

The interesting thing about dance class is that there is one man; the intrepid Vince, a friend from PA school and now work. Why are men apprehensive about dancing and/or learning
to dance? There is nothing sexier than a man who knows how to lead on the dance floor. That sort of confidence and intimacy leads to other types of confidence and intimacy. If you know what I mean. Most women love dancing and are willing to look silly to learn how to salsa, ballroom, electric slide (well, maybe..) or two step.

I think men get impatient with learning and intimidated because it can look complicated. It's really not. Like most things, if broken down into the basics, dancing is not difficult. It does require surrender, though. Surrender to music, rhythm and a certain level of emotional intimacy. This can be scary. See "Dating Rule #2.

To me, skiing is scary. Riding a porch swing without a seat belt high up over a bunch of ice and snow followed by hurtling down a steep hill at high speeds while balanced on two waxed sticks. Um, right. Even while wearing heels, the odds of an injury more serious than a mashed toe are pretty low. However, I know some pretty athletic and graceful men who ski on a regular basis and are very good at it who are terrified of the hardwood. And by that I mean the dance floor. Get your mind out of the gutter.

Men have no idea how many romance points they get for knowing how to dance. Even making the effort and being able to laugh at yourself for missing a step will make your girl happy. And if the girl is happy...

Happy Trails

Tuesday I attended the funeral of my father's older brother, David "Dutch" Baumeister in Paxton, Nebraska. He died last week at home, surrounded by his wife, children, and brothers. His wife, Joanne, did everything in her power to make his passing easy and painless. I wish I had some photos of him to share.

My Dad is the extrovert of the three brothers who grew up on that northern prairie. He's always cut his own path, tilted windmills, and talked a blue streak. Uncle Dave was darn close to silent. He kept his thoughts close and didn't like being the center of attention. But he was the bass player in a band and restored classic cars. He and my father exchanged pictures and sculptures of birds; Dad likes ducks and Dave collected eagles. All over the house that he and Joanne shared were eagles, soaring over rivers, mountains, and trees. He was a quiet romantic.

David was diagnosed with pancreatic cancer a month ago. He carefully considered his funeral arrangements. His meticulously restored cars were to be in the procession from the church to the cemetary. The music he chose was singular; "Ghost Riders in the Sky", "Ring of Fire", "Kalijah", "Islands in the Stream". All his favorites.

The church was packed with family. There aren't many Baumeister's left but my grandmothers family, the Emme cousins, were all present. My youngest brother Aaron was a pallbearer. Its so strange to see him as an adult; father, husband, and man. I brought Katie along. She hadn't met that side of the family before. My father drove Dave's pickup and his son in law drove the chevy convertible down the main street of Paxton to the cemetary. The American Legion Honor Guard gave a 21 gun salute that startled us all.

The next few hours we spent in the basement of the Lutheran church. The Ladies auxiliary had prepared a midwestern spread of ham, scalloped potatoes and green jello salad with plenty of iced tea. No Lutheran luncheon is complete without green jello salad and iced tea.

A funeral is as good as a family reunion. Cousins and family freinds who hadn't seen each other in years were telling stories and catching up. Katie played with my nephew, EJ. Both of them were gorgeous and charming. My stepmother, Kay was gracious and definitely out of her element. It was just so much fun to watch.

So thanks, Dave, for bringing us all back together on a grey Tuesday. I think it was exactly the party you would have wanted.

Back From the Frozen North

Holy cow, Chicago is cold. I had such a great time with Amy. In our limited time together she showed me her city, introduced me to her friends and took care of me when the nasty bronchitis hit.

I'm really not sure how to move all the photo's around to make this a coherent story, so enjoy it anyway.

Angela's Dating Tip #3: Lap(top) Dancing

Ah, online dating. Those of us who rely on the electronic cupid admit it a bit sheepishly. Who wants to admit that they're fishing in a barrel? With dynamite? Ok, just with big firecrackers, but still...

The bait for the hook is the profile. The profile needs to have an attractive picture showing the quarry in its natural habitat. It should make the prey look approachable, with healthy plumage and a nice nest. Remember, the point of the display is to attract a mate.

Some members get this. Their profile photos are pleasant, they smile, there are flattering shots of them in exotic locations. Sometimes they include their dog's or cats to show their sensitivity. Kittens, especially are a nice touch. They have also proof-read their profile text, checking for spelling errors and NEVER writing their profiles in all-caps or in text-speak.

There are also those that seem a little confused about the purpose of the profile. The photos look like mug-shots, with scowls and furrowed brows. One profiler that I saw even flashed a gang sign. Gentlemen, these things are not attractive. They are scary.

You attract more flies with honey than vinegar. Show those pearly whites. Use that spell-check if you really want to snag a smart girl. Think of a profile as a resume, first impressions count.

Conversations in Hot Water

Going up to the Montezuma hot springs is one of my weekend routines. Get up in the morning, have a cup of coffee, check emails, go soak. I'm a lucky girl. Usually I go early enough that I'm there alone to listen to the river and the bird songs and watch the vapor rise off the water undisturbed.

Sometimes, though, I meet people. Interestingly enough, its never been the same person twice. I've met professionals, carpenters, hippy travelers, neurotic 20-something couples, obnoxious teenagers, eccentric locals, and people in transition. The first timers are easy to spot; nervously going from pool to pool, looking for the right spot, checking out the vibe.

The hot springs have their own rules of ettiquette. If a pool is empty, its fair game. If someone is in it, you always go to another pool. If they are full, you ask if you can share. In general, noise is to be kept to a minimum and conversation is entered into with an almost ritualistic respect.

Today I struck up a conversation with a very interesting man. We talked about the nature of relationships and love. We discussed the difficulties of independent people who value their space entering into romantic relationships and what has to be done to keep a relationship going.

"What if" he proposed, "you could find someone that didn't expect you to change, even subconsciously, who you are, who wanted the best from you and you felt the same. Someone who encouraged your eccentricities and you did the same. What would you do then?"

"That would be great" I said. "But the difficulty is getting past expectations."

"Expectation minus reality equals disappointment" he returned. "And in the end if we are open to possibilities we are always changed by our encounters with others."

Then I went home and made pancakes.

Clean up on aisle 5

Thursday afternoon is my time to clean up after Uncle Sam. That's when I see veterans. Most of the time this is Geezer patrol, my favorite demographic. The WWII guys are generally a lot of fun, they've had time to deal with the horror of their experiences and we're dealing with their cholesterol, diabetes, and arthritis just like the rest of my geezers. The vietnam era guys are usually in some sort of substance abuse recovery, are starting to deal with some of the geezer issues of old age and generally have some sort of chronic pain.

Then there are the folks coming back from Iraq/Afghanistan. These people can't sleep at night between the physical pain and the nightmares. Some of them can't hold a job because the PTSD symptoms of anxiety, irritability, and hypervigilance get in the way. Looking into their eyes is looking into anguish.

When one signs on with the military, one is "guaranteed" health care for the duration of their service. If a service person is injured while in the military, they are guaranteed healthcare for the rest of their lives. The staff of VA hospitals and clinics are quite good and quite committed to their patients, as committed as those found in civilian clinics and hospitals. The problem is the beaurocracy and the lack of forethought on the part of the government when the current wars were budgeted.

Here is an example from today. A 30 year old man came to my clinic for back pain related to a service injury. He also suffers from depression, insomnia, and anxiety. He has scars on his face and neck from burns. He is able to go to physical therapy once a month at the VA hospital in Albuquerque, two hours away. He would like to go to counseling for PTSD. This referral will take approximately 3 months to complete. I requested that he be able to go to a local provider for weekly PT in Las Vegas. It is highly unlikely this will be approved.

The next man was a 45 year old man. He'd had rods inserted into his spine, one of which had slipped and was moving up his back. He told me that since the psychiatrist had given him the right meds, he didn't have to retreat to the woods behind his house to work out his nightmares. He could now manage a long grocery line and a traffic snarl. The surgical referrals I wrote today were for the "Invasive Spinal" clinic, orthopedics for a carpal tunnel release as well as a dermatology referral for laser therapy.

These guys were perfectly healthy, sane, and productive young men before their national guard units were called up. They are the victims, along with the civilians in Iraq and Afghanistan, of the hubris of W, Dickie, and Rummy. Its a picture of waste and half-baked schemes. If you weren't already against the war, an afternoon in my clinic will change your mind. And I don't see the worst of it. We'll be paying for this one for a very long time.

Angela's Dating Rule #2 and Other Minutiae

Pre-date nervousness is natural and, if managed correctly, can even be endearing. There's bound to be awkward moments, butterflies, and sweaty palms. It's ok. If you don't allow the jitters to be overwhelming they can show your date that you are vulnerable. Vulnerability = attractiveness, especially if you are a man. Chicks dig vulnerable guys.

What is not ok is telling your date that you are intimidated by them. If you are out with someone that intimidates you it's time to do a check-in;

Do you think your date is out of your league? Then thank your lucky stars they asked you out/agreed to go out with you! And for crying out loud, don't admit it! That's just saying "I really don't have a whit of self-confidence". Sexy.

Are they doing something that makes you uncomfortable? Its probably time to cut things short and move on to greener pastures. Life is too short to voluntarily be around people that are weird or judgemental or smell bad. Go home, open your favorite beverage, turn on some Sinatra and give yourself a pedicure, even if you are a man. Nice toes are sexy.

Update: My mother is home from the hospital and doing ok. She left with a lot of hardware, 4 cardiac stents, and will have one more placed in a few weeks. I dealt with my mini-breakdown by taking a deep breath and reminding myself that no one was actually dead yet.

I'd really rather write about the fact that George Gershwin was 38 years old when he died but had already made an indelible mark on American music. I'd rather write about the SCHIP (State Children's Health Insurance Plan) bill that President Obama just signed. The wonders of modern antibiotics, the color of the sunset tonight, the white cows that escaped into the dun colored pasture across the river (I followed their hoofprints tonight in the half-light of dusk).

My mother, who is 58, had two cardiac stents placed this afternoon. She'd gone to the emergency room late last night after two days with chest pain. There are a total of 4 partial blockages in her arteries. Tomorrow the cardiologist will decide whether 2 more stents will need to be placed. Given the possibilities for disaster, this is really pretty good news. I just didn't expect the collision with heart disease to happen so soon. However, if she takes her cardiac rehab seriously she should have many relatively healthy years ahead of her.

My relationship with my mother has always been difficult. I don't think I've ever left that adolescent same-sex separation stage. My mother has never had anything but unconditional love for all of her children and grandchildren, really for just about everyone around her (except my father, but that's a totally different story). I, on the other hand, love my mother but often wish she was a different person. A more responsible, more energetic, more together mother. I'm sure I seem to her odd, and cold, and hard. But she loves me anyway for being her odd, cold child. Our arguments haven't begun because she was pushing me. They happened because I was pushing her. Now I'm faced with the fact of her mortality. I don't care for that idea at all.

I called a friend tonight to talk about all of this. Her mother has recently moved back in with her at age 87 with all the mother-daughter baggage. My friend has been practicing buddhism for many years and reminded me of the impermanence of everything, including those we love. I'm pushing back hard against that pillar. This, I suppose, is a natural reaction. We think that by holding on tighter to the things we care for that we'll get to keep them. We're greedy. The more we kick and scream, well we just kick and scream. It doesn't change impermanence. I don't like that either.

Hallucinating

While I was sick in bed yesterday, nursing a ridiculous fever and bellyache, I was tossing around blog ideas. I probably should have been resting my little fevered brain rather than hallucinating about the blog but at least I wasn't hallucinating about little green monsters nibbling my toes. On the flip side, I could have conjured up images of Liam Neeson bringing me soup and cool washcloths for my hot forehead and telling me that even with the sweaty chills and morning breath I was still gorgeous. Then maybe he could have nibbled my toes. Apparently I have to be in a state of reasonably good health to come up with that one. Damn. That could have given me hours of enjoyment.

I've been doing a bit of dating over the last few months, both the online and offline varieties. I have learned a few things about what makes for a good date and what I look for in a dating site profile. You, my lucky readers, are going to reap the rewards of my experience, the good, the mediocre, and the ugly.

This is how its going to work; I'm going to continue to write about the things I usually write about. This would be the stuff about work, about family, time with the dog, etc. Interspersed with the regularly scheduled programming will be Angela's Rules for Dating. You can also send me your dating rules and tell me why they are important to you.

Here comes rule number one.

On the first date it is acceptable to mention, in passing only, the previous relationship/marriage. It is date DEATH to spend 20-30 minutes discussing the reason the above mentioned relationship/marriage failed. Save that for later. There will be a time when you will want to work through issues that may have cropped up before. The first date is not that time. The first date is for investigating issues such as intellectual and physical chemistry, for discovering you both have a passion for the hokey-pokey or that his love of neopolitan ice cream turns your stomach. Giving too much information too soon does two things: 1) shows that perhaps you aren't as over that last person as you thought you might have been, and 2) makes the person sitting across the table from you feel a little uncomfortable and/or bored. Don't bore your date.

You know that job interview question "where do you see yourself in five years"? Its a good question. It asks about long range planning and the ability to set goals. These thought processes are important to organizations. Planning and goal setting allow them to improve productivity, create new products and services, and maintain a budget and staff.

But right now if you asked me about my five year plan I'd have to say I have no idea. I know I want to keep practicing medicine but where that will be or what form it will take is a mystery. Community health is intensely rewarding but I'm finding myself very good at women's health (which I never thought I'd like). I'd like to be in a position to travel more, learn more, dance more.

I keep saying that I don't know where I'll be in 5 years because I would never have put "live alone and work in Las Vegas, NM" on the plan. I thought I'd be happily married, Katie would be living with us, and I'd have a orthopedic surgery job with a big practice, and we'd be either putting an addition on the house or moving into something with a little more space, maybe in the North Valley.

PA school was the big goal, it was Mount Everest. I got down with just a little frostbite but with all my fingers and toes intact and now my mountain climbing predilections are temporarily quenched. Whats a goal oriented, hyperfocused girl to do? I guess its time to enjoy the warm tent and the abiltiy to breathe without an oxygen tank.

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.

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.

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.

http://www.msnbc.msn.com/id/28760822/displaymode/1107/s/2/framenumber/1/

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

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: http://webmarin.com/blog/2006/05/plungerhead-dry-creek-old-vine.html

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.

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.

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.

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.

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.

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.

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.

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?

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.

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.