Jet Lagged

Luckily, I was able to squeeze in a quick visit to my parents' home this past week. Originally, I had planned on leaving after my shift on Sunday night. I raced to get all of my dictations done and sprinted out to the parking lot in the snow. The usual 20-minute drive to the airport took over 45 minutes, and sadly my flight was canceled due to the current storm, which ultimately resulted in 13 more inches to the already established impenetrable wall of white fluffy stuff on my lawn.

ALL of Monday was spent in various airports and my new route included an extra layover and routing through O'Hare, where 200+ flights were canceled. So, I arrived in Phoenix late Monday night, over 22 hours later than planned.

The visit home was brief, but great. It was good to spend time with my quirky brothers and sister-in-law. We helped make gingerbread cookies on Christmas Eve. For reasons unknown, my mother had acquired a lobster-shaped cookie cutter, so many a ginger lobster was born. Being the reclusive group we are, we skipped the hometown Santa parade and gathering of the masses in the town plaza, and headed off to our traditional candlelit church service. The failing octogenarian organist played at 1/3 the correct tempo, and appeared to have a dissociative fugue during the 4th verse of "Joy to the World" as she suddenly began playing a different song with her left hand, while somehow continuing on with her right. It was very strange.

Many a homemade tamale was scarfed down by yours truly. The javelina are again on the rampage, and gobbled up mom's poinsettias by the front door. I hope they get a tummyache.

My parents loved the GPS unit that my brothers and I pitched in on. (It's always more fun to me to watch other people open the gifts I picked out than opening my own.) The MRE's sent by AG were a big laugh, although having arrived later than planned, there wasn't a good time for us to make a meal of them together.

Christmas Day there was prime rib, mashed potatoes, green bean casserole, homemade rolls, Yorkshire pudding, cranberry jelly, and cranberry relish. Sister-in-law outdid herself again with a chocolate cream pie and blackberry/raspberry cheesecake in addition to the assortment of holiday cookies. AG was able to call and is doing well. Apparently, there's a surplus of lobster and steak at the current base he is at, poor guy!

The flight home was uneventful. Half of the snow had melted away in my absence. No sooner had I made it in the door, when I got a call asking if I could work the overnight shift as someone had called out sick. I already had the early shift today, so that wasn't possible, but I got up extra early in the morning and called in to make sure they weren't in overwhelmed mode.

Today was the usual list of suspects: headache, nonspecific abdominal pain, chest pain, acute exacerbation of chronic back pain, neck strain, suicidal ideation, scabies, vaginal bleeding, et al. Guess it's back to the grindstone!

Santa's Knee

It has been snowing a lot here lately. The snowblower has piled snow up past the the height of the doors of my car on each side. I have a narrow driveway, so there's barely room anymore to drive down between the walls of snow.

The other night I was working in the Pediatric ED, when I happened to glance over at the adult side. There, in room 19, was a man in his 60s wearing a t-shirt that tugged at his beer belly, red suspenders, and blue jeans. His long white hair snaked past his shoulders and he had a full scruffy beard. Both hands were bandaged with gauze and were obviously now reduced to bloody meat as blood was ominously spreading across the dressing. As it turned out, he'd stuck not one, but both hands into his snowblower.

For only a brief second, I thought about grabbing the closest screaming tot and plopping him/her down on Santa's lap. Perhaps AG and I should start with a dog...

Drats

Last week we wrapped up the first arm of our rat study. The study was time consuming, in that I had to drive into work 2-3 times per day to check on them and do testing. It was also interesting in that we learned to develop our protocol along the way. For example, one of the symptoms that we were looking for was renal failure, so we were monitoring urine output. At first, we were going to base this on cage weights, but that seemed too variable. Then we decided to line the cages with an absorbant pad that we could easily glance at for urine output. The rats responded in kind by chewing up the pad to make nesting material. Finally, we had to resort to wire cages with pads below to collect specimens. This, of course, required more paperwork.

This was the control arm of the study, so we were giving the rats a known chemical compound, and then treating them with placebo (saline). The next arm of the study would be administering the same weight-based dose of chemical to a new group of rats, only this time administering a likely antidote with the expectation that there would be less behavioral changes and less cellular damage.

Our dose of toxin was based on an "established" LD50 from other people's research (Being a child of the 80's I'm going to call this O.P.R.). LD50 is short for lethal-dose 50, and means that 50% of subjects receiving that dose should die. This is somewhat variable given that nothing in medicine is exact. From OPR, death or at least renal failure was expected to develop in 3-5 days. Our control arm was 10 days long.

Unfortunately, we ran into a huge problem: NONE of the rats died. There was some weakness noticed with behavior testing and at least one of the rats was doing some odd drunken head-bobbing, but that was about all that we noticed.

Being the suspicious women that we are, we had ordered extra rats in case some of them failed the baseline neuro testing, so we had a few extra rats to work with. On day 6, we gave those extra rats double the LD50 and....

NONE of them died, either!

So now there's a huge problem with our study in that if our chemical compound is not actually toxic at the dose we gave, we can't really proceed with the antidote arm. We have contacted the people behind OPR, and not really gotten anything other than, "hmm, that should have worked." Currently, our tissue samples are with the pathologist, so hopefully there will be some sort of changes at the cellular level, otherwise we have to either ditch the remainder of the study or do another study to first determine the proper LD50.

In trying to figure out what went wrong we've thought of:

1. Maybe our chemical isn't what the label says it is (and it didn't have an expiration date), so we have sent samples to an outside lab for analysis.

2. Maybe by administering saline we prolonged the renal failure and study wasn't long enough to reach our endpoints of renal failure/death.

3. Maybe our math was wrong, but it's been quadruple-checked.

4. OPR was wrong, and we need to do a separate LD50 study.

So there has been a lot of learning with this project. Either way, I have something to present for my required academic project, but I really wanted this to work. There have been a few accidental contaminations in consumer products with this compound, and it would have been cool to be part of the research behind developing a protocol for treating an ingestion. There are still blood tests pending as well, so for now, I am crossing my fingers and trying to be patient.

12-Month Countdown

525,600 minutes, 525,000 moments so dear.

525,600 minutes - how do you measure, measure a year?

In daylights, in sunsets, in midnights, in cups of coffee.

In inches, in miles, in laughter, in strife.

In 525,600 minutes - how do you measure a year in the life?

How about love? How about love? How about love?

Measure in love. Seasons of love.

"Seasons of Love" - RENT

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I hate goodbyes. Yesterday, when we left to take AG to the base it was still dark outside. The moon was full, and it was frigid, with the thermometer reading below zero. This was the moment I had been dreading for several months. I hate getting emotional, and worse than that, I hate being emotional in front of people.

The past week, his parents and I helped him pack, and clean out his apartment. I now have an attic with a great big pile of army duffel bags and Rubbermaid storage containers. Being on an elective block, I was fortunate to be able to spend a lot of time with him this past week, but somehow it is never enough. His parents were a huge help, if they hadn't been there I would probably still be cleaning and packing today.

Family and friends no longer say their goodbyes at the airport, so we dropped him off and watched him pile into a van. He still had several hours of waiting to go before his flight. When we drove away, the sun was rising, and because of the weather, there was a strangely bright beacon of light that appeared to be shooting up from the sun.

In a way, it is easier now that he is gone, in that now it is just a year-long wait before he comes back. The dreaded goodbye is over, and the waiting is out of my control. Due to his position, he should have occasional Internet access and phone usage, and compared to the places that the other battalions are going, he's going to probably one of the safest areas. I am fortunate in that I have a supportive family, friends, and a busy work schedule to distract me.

New Vocabulary

Well, it's official: AG and I are engaged. We exchanged Christmas gifts early as he is leaving for Afghanistan later this week. I thought we were done when he suddenly pulled a ring box out of his pocket, dropped to one knee, and asked me to marry him.

Of course I said, "Yes!"

We have talked a lot about the future over the past few months, and although we had talked about marriage, I didn't think that he was going to propose before he left because there's been just too much other stuff going on. Being a traditionalist, he made what must have been a very anxiety-provoking phone call to my father to ask for his permission.

Now I just have to get used to saying the word fiance.

Strung Out

I just finished putting up more Christmas lights. Last year, I was working in the ICU up until the week of Christmas, so I just didn't bother. The year before, I was disappointed to see that the strand of lights that I had bought didn't span the width of the house. When I went to buy more lights, I was disappointed that the store was sold out of the weird snowflake-style icicle lights that I had bought.

This year, I saw that Lowe's was carrying the right kind of lights, so I quickly bought another strand. I put up the lights last weekend and was agitated that I now only had enough lights to span just over half the width of the house (it's really not a big house, so this was puzzling). Today, I put up two more strands of lights, and now they wrap around to the side.

Putting up lights is somewhat of an adventure. It requires balancing a ladder in the mulch of my unevenly surfaced flower beds. While I was on the ladder, the snow flurries started. An elderly woman stopped on the sidewalk and complimented me on how she likes looking out the front of her house and seeing all of the lights. This was nice to hear as I tried to balance towards the house in anticipation of a failing ladder.

As I got around to the side, I realized that I could no longer use the more stable inverted V-shaped option of the ladder because the slope on the side of the house is too steep. So, I resorted to propping the ladder against the side of the house. While reaching up and somewhat backwards to reach the nails, I was reminded of a news report that I heard a few years ago. It was something about how the risk-taking center of one's brain typically matures at age 25. For me, this is definitely true. (Apparently this has never happened for "The Phoenix" in regards to her driving!)

Like my father and his mother, I am a true worrier. Last week, I screamed as we slowly went down a hill on the four-wheeler. Maybe it's occupation-related. After reducing ankle fractures from four-wheeler and ladder injuries, not to mention toe amputations from lawn mowers, I guess it's somewhat of a miracle that I don't wear full football gear every time I leave the house or operate machinery.

The good thing about being precariously perched against the side of my house on a slope was that if I fell backwards, I could shorten my fall by landing on my neighbor's suburban. Perhaps they had OnStar? Maybe it would automatically call for help when I hit the roof?

To my dismay, I ran out of nails for the lights about 10 feet along the side of the house. So now I have a clump of lights hanging down. Oh well, I'm not getting back on that ladder for a few weeks...

Stuffing

My holiday weekend got off to an unusual start last Wednesday. AG and I had planned for an early start, however at the last minute, I found out that the meeting I had been waiting for the past week to occur was going to happen at last that morning.

My rat study is finally becoming an actuality. However, to make it happen we had to have one more day of animal training. Bits of white fur went flying as we learned to do saphenous vein draws, gavage feedings and how to sedate the little beasties. At one point it was somewhat festive as the lab expert showed us how to deftly guide a rat into a cylindrical bag with an opening at the end to make the feedings easier. As she guided the rat into the bag further, with it scurrying towards the opening and tail hanging out, I couldn't help but think of how this was similar to squeezing frosting out of a tube when cake decorating! Our test subjects gave the ultimate sacrifice in the interest of training us for autopsies, and I wondered if there was anyone else on the planet thankful at that moment that rat dissections are relatively straightforward.

Meetings when you are in a rush never seem to end, and I quickly raced home to help load up the cooler with snacks and AG and I were off, an hour and a half later than planned. It was a long drive, prolonged by Lake Effect snow that hurled at the windshield and increased the weight of our eyelids. We were on our way to his aunt's house out in West Virginia. Along the way, signs read "Buckle up for next one million miles" and I knew I was far from home when an Amish buggy, complete with horse, crossed over an overpass.

Finally, we made it. His parents soon joined us, and we all settled in for the night. The next morning, visitors progressively arrived, until we had 30+ people situated at three different tables. (AG's family is like mine in that neither of us will ever make it to the adult table.) I don't know how his aunt did it all, but she was able to orchestrate plenty of room for everyone, and somehow managed to have the dinner dishes washed and stacked while the rest of us nibbled at an incredible selection of pies.

Thanksgiving morning, AG and I went for a bit of a ride four-wheeling, followed by target shooting out in the backyard. I had never fired a gun before (I always refused to go out with my father and brothers, being the petulant teenager that I was), and took turns at two different rifles and two different handguns. I actually did pretty well with an older bolt-action style rifle than with the other ones which had fancy magnification scopes and laser-sites. Something about just lining up the iron sites and watching casings flip out of the rifle each time I cocked it amused me. I did alright with the 0.22's, but when I switched to a 0.40 caliber handgun, is when I took a beating. For the next two days my arms were sore, just from lifting the weapons, and bracing myself when I fired them.

After Thanksgiving, we drove back to AG's parents' home. Over the weekend, we met up with several of his friends and family, and did an early Christmas gift exchange. I think that you can tell a lot about a person by their friends and relatives, and it's neat to see him in that kind of environment. The weekend went by all too fast, with lots of hurried goodbyes before he leaves for deployment, but I was happy to see that he has such a strong, supportive network.