Sort of a Day Off

I had today off, but it wasn't very relaxing. My realtor met with me and did a walk-through of the house. I have a few more things to finish up and then a lot of de-cluttering to do. My plan is similar to what I do when my parents come to visit. I just throw a bunch of crap in boxes and shove it in the attic. I'll post some before/after pictures soon.


It snowed again today. Just a little bit of flurries, but it made me glad that the other day when we had "unusually warm weather" I slapped a fresh coat of paint on the deck outside to cover up all of the peeling spots. I would have liked my realtor to have been a little more optimistic today, but I guess I'll just have to see how it goes. I still think the house will show better in May when everything's green and blooming, but I would like to at least get people looking at it now.


Last night's shift was really busy. I typically average around two patients an hour, but I was at almost three per hour, and that was even with precepting an intern, which slows me up a little. I got so backlogged on dictations that I was there two hours past my shift discharging patients, slapping together splints, and stabbing at pockets of pus in the hallway and I still had to go in for an hour of catch-up work today.


The rest of the time was spent running errands... picking up empty boxes, grocery shopping, buying a shop vac to vacuum up all the cobwebs and spiders that have been breeding in the basement the past 3 years, etc.


Next week I head off on my "international medicine" rotation. Two weeks of sun, and working with limited resources. It sounds like fun... especially the nearby beach and hiking part. I can hardly wait. I'm really looking forward to lounging and reading a book in the sun.

The Steamer

In my line of work, it is important to get along with one's coworkers. Doing shift-work means that we don't stay until the patient is dispositioned. Often a patient gets seen and examined, labs and imaging studies are ordered, and then their care is transferred over to the new doctor when it is time for the original provider to go home. In regards to patient care, this can be the most dangerous time for the patient as the incoming doc typically doesn't have time to fully re-evaluate the patient.

As you can imagine, everyone has their own level of comfort in decision making. After you get to know the other doctors in the group, you can typically figure out who is going to have more patients to sign-out because they tend to order more tests than everyone else, who is going to do very minimal work-ups, and who is going to intentionally order a CT scan fifteen minutes before the end of their shift so that they don't have to make the decision about what to do about the patient during their time in the department.

Like every other job, it's frustrating to get additional work handed over to you by people who seem to be determined to get by doing the bare minimum. It also stinks to come in to a full waiting room and patients who have been in rooms for hours, not seen by anyone, and the previous staff heads home seemingly carefree on-time.

At my place, we've come to refer to bad sign-outs as steamers, because the messes left behind are reminiscent of steaming piles of... well, you get it. Sometimes it's unintentional, but sometimes someone who's billed as "stable" suddenly deteriorates after shift change and it seems to be more a factor of a shoddy exam or workup because someone was in too much of a hurry. Extreme examples of this would be the patient signed out as "possible pneumonia" ending up needing a pelvic exam because their "rib pain" turns out to actually be belly pain, or in one really bad example, a "stable" patient coding in the CT scanner.

After being in a hospital for a while, you get to know how your night's going to start depending on who the previous shift was, and steamers definitely happen at both the attending and the resident level. I think that all of us ultimately want to do right by our patients and co-workers, but when there are so many interruptions in care throughout the shift, it becomes easily to get distracted, especially by the thought of it being past time to go home. It does get old after a while, and I can't imagine what it's like to be in the same place, taking bad sign-outs from the same co-workers over and over, year after year. While the names and faces will be changing out in a few months when I leave, I am sure the situation will be the same.

Eat Your Greens

I was talking with my mother the other day and she was telling me about some new sort of lettuce-type plant that she was growing in her garden. She couldn't remember the name of it, me- something or other. Jokingly, I asked her if it was mescaline, which she thought it might be, but clearly that is not it. Although that would make it more interesting when the javelina raided her garden.

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As for working the overnight after St. Patrick's day, it wasn't too bad. I was expecting all sorts of drunks and injuries, but surprisingly, there wasn't a whole lot. We were busy all night long, and I had some very sick patients, and for some reason there were people who in the waiting room all night for little things like rashes and sore throats, but it wasn't the drunkfest I was expecting.

Silence

My attitude has been in the toilet lately. I'm not sure what did it: maybe working too much, maybe not taking the time to do anything fun/relaxing, or maybe I just need a change in pace. My vacation time is all used up, so that is not an option. Fortunately, I have an elective block coming up where I will be spending two weeks with some of my co-workers staffing a small emergency department in the Caribbean. Yes, there's work involved, but there's also a nearby beach, and plenty of sunshine.

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I deal with violence on a daily basis at work: shootings, stabbings, and plain old assaults. To be able to handle it, you have to be able to separate yourself emotionally from your patient. Too much time spent imagining the pain of a steak knife entering your gut doesn't do anyone a whole lot of good; sympathy and empathy don't mix. Desensitization is a much-needed coping skill.

Recently, all of us were shocked by the death of a co-worker. She was shot by her ex-husband in front of their children. He later shot himself during a standoff with police. Both of them were brought in to the ED, and I was extremely thankful that I wasn't there when either one happened. She was someone that I knew, although not personally. I can't imagine the pain that those who worked side by side with her over the years are dealing with it, especially those that were involved in her care.

As expected, it is taking some time for people to go back to working the way they were before. It is somehow quieter, and more orders seem to be falling through the cracks, but people are piecing themselves back together, and reforming that protective shell that keeps them going.

Sweetheart

Should I be creeped out that a teenage patient of mine called me "sweetheart" the other night? He's a manipulating emancipated teen that mainly comes in for med refills and to be fed a meal every now and then. I'm sure he has a lot of great relationships in his future.

Um, Spring?

Ok, so it's not my favorite sign that Spring is on its way, but last night as I was driving in to work, I caught an unmistakable whiff of skunk. Hey, I'll take it if that means we are almost done with this winter!

We got dumped on with snow again this week, but it has almost all melted away the past two days. I'm actually getting a good view of my lawn for the first time in months. The crocus are on their way, but nowhere near blooming yet.

There's Always One

It seems that no matter how small or large the workspace, there's always one: the wackadoo. You know who I'm talking about, that special guy or girl who is prone to sudden outbursts and unpredictability. Sometimes they mark themselves with crazy hair colors or head scarves (or both!), and sometimes it's a little less obvious than that.

I think that we have more than our alotted wackadoos at my workplace, but there is one in particular that stands out. You would think that if you were a doctor or a nurse, that perhaps you wouldn't call out sick for stupid things, but you would be wrong. It is annoying when people call out sick, but most people are very apologetic and just say they don't feel well, or whatever.

Well, this particular person at my workplace likes to invent crazy stories that really don't make any sense at all. Since I've known them, they've missed multiple days at work for deaths of cats, neighbors, had three separate cancer scares, and various bizarre diagnoses that never really get confirmed. The highlight last year was when she called out saying that she had fainted, fell down the stairs, and dislocated her jaw. Supposedly, she had to put it back in herself by punching herself in the face. (Jaw dislocations take a lot of force to reduce, and not only can you probably not hit yourself hard enough, but an uppercut is not the right direction of force.) It was a really busy day, so since her jaw was supposedly back in, we asked her to come in anyway, but then she said she had lost her vision-- yet she declined an ambulance. Oddly enough, she was back to her usual state of health the next morning.

Every now and then there seem to be flare-ups in Wackadoo-land, prompting another bizarre illness. The other day, it was "I'm vomiting so hard that it's coming out my ear." While I guess the pharyngotympanic tube does connect to the nasopharynx, it is blocked by the eardrum, and it seems pretty unlikely that you could retrograde vomit out your ear. Most people open their mouths when they vomit, so it doesn't seem possible to force it back in the other direction and you'd have to perforate your tympanic membrane in the process. Nose? Yes. Ear? No.

I was talking with AG on the phone about it, and he said, "How come somebody just doesn't call 'Bullshit' on her?" To which my answer is, that it's typically easier to just work through the shift with one less person than have to deal with her antics and whining at work. At least she's creative, although it is annoying to those of us who just show up day after day and don't call out sick.

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Silk's comment on my last post made me realize I probably haven't mentioned my upcoming move. I'm graduating from residency this summer and have signed with a hospital just far enough away that I don't want to commute. It's not a position that I plan on keeping long-term, but one that will be more convenient for up until AG and I decide to relocate (hopefully somewhere warmer).

So, the house is going up on the market soon, and I'm scurrying to get a lot of things done beforehand. This week's project was painting my bedroom. There were several holes and cracks in the wall and a kind of half-ass faux finish done by the previous homeowners, so it needed to be done. Unfortunately, I didn't have somewhere convenient to stash the furniture in my room while I worked, so I resorted to shoving it around in Tetris-like fashion while I sanded, taped, and painted. I'm planning on contacting my realtor next week to come out and help me choose which projects to complete.

Housework

I celebrated Valentine's Day with a phone call from AG and we were able to exchange gifts in the mail. That morning a plumber came to the house and installed a brand new garbage disposal for me (I didn't trust myself around water AND electricity) as part of my getting-ready-to-put-the-house-up-for-sale project.


This weekend I worked a couple of shifts where we were actually overstaffed, so we all just kind of sat around. I am on the pediatric side right now, so I spent a good couple of hours sedating the Incredible Hulk the other night. He was a toddler in superhero pajamas who came in after having his 3rd seizure, so we went ahead and ran him through the MRI machine. The problem with MRI's is that they take FOREVER. A CT scan is pretty quick, but getting a small child to lie perfectly still for 30 minutes for an MRI is darn-near impossible.


This kiddo took dose after dose after dose of ketamine like a champ. He was really cute though, and came out of the machine all wide-eyed and yelling, "Whoa!" Luckily, there weren't any bad things like tumors on his scan.


Today I was off, so I spent the day finishing up painting along the stairwell, and started patching some holes and cracks in my bedroom. I really wish I had gotten this stuff done early for me to enjoy a freshly-painted house, but I think I should be able to get everything done in time, provided I can find a responsible contractor to do some cement work.

Wintry Mix

Yesterday it was 50 and sunny-- or so I'm told. I slept the day away after working the overnight shift. Today I'm off and it's now alternating between raining horizontally, frozen rain, and big wet flakes. Argh.

Avoidance

I haven't been doing much writing around here lately. Work in the PICU the past several weeks was somewhat monotonous. See the sick babies, write progress notes, round, check the babies labs, round again, blah, blah... in to work in the dark, home from work in the dark.

Sick babies depress me.

The unit was actually slow while I was there. Given the time of year, I had expected a lot of nasty respiratory illnesses, but most of our kids were post-op kids. Tiny runts on ventilators working with half a heart, or trying to breathe through little buds instead of lungs. Tubes in mouths, stomachs, chests, bladder catheters... little plastic octopi plugged into walls. And the beeping machines... yuck.

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On weekends I have been working at my other job. The extra money will be nice when it comes in, but it probably hasn't helped my attitude. Some days are good and I walk out of there confident and ready to start my upcoming new job, and some days are not so good. One of the other residents and I were on together the other day, and although I was in the room helping her for almost an entire hour, the patient ended up dying anyway. We have talked the case over and over since, and even though everyone has told us over and over that we did everything right, there's still that feeling of failure.

I don't know why I take it personally when patients die, but I do. If anything, we probably overworked the code-- shocking, giving every medication, and doing compressions so vigorously our joints hurt the next day. Obviously there will always be some that are too sick to save, but it just aggravates me when people die in front of me.

Up until that shift, I was thinking that I was ready to start doing single-coverage (working without another physician on in the department), but now I'm hesitant to do so. On the one hand, I think it will be a good while before I have a case that emotionally draining again. We were lucky in that both of us were able to devote our attention to the one patient, and because I was there, I was able to go back to seeing new patients and cleaning up the rest of the rooms while she spent the rest of the evening dealing with the family and other stuff. I can't imagine what the would have been like if I had been there by myself, especially as I soon got wrapped up in stabilizing a patient having a heart attack and getting him shipped out as quickly as possible. I haven't had the wonderful experience of having to run in between two or more unstable patients yet, and am not looking forward to it.

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Things are starting to normalize around here. I have umpteen projects to do before I put my house on the market in the next few months, and kept myself busy this past weekend taping and painting the hallway along the stairs.

AG is safe and doing well, although frustrated by his minimal trips "outside the wire".

I did my taxes already, now I'm just stalling on paying them until April.

I'm back in the department starting tonight, so at least I'll be around my people more the next few weeks.

More Winter

Phil is now on my hit list. I don't want another six weeks of winter! On the plus side, it now doesn't get dark here until 5:30 pm, so spring must be on its way, although not fast enough!

Superbowl

Ate too much and didn't think about work. I thought that this commercial was the best.

The Greatest Gift

She was already dead when I came in to work. Blunt head trauma sustained during a common winter activity. Not breathing, and intubated on scene by paramedics. Despite two emergent neurosurgeries, there were no signs of improvement. The day before she had failed neurologic and apnea testing.

For some reason, the weekend team did not want to declare her brain dead the day before, so we waited, as a re-evaluation by neurosurgery had been promised. When I first examined the patient that morning, her family members were yelling at her nurse for not supporting their hopes that she would wake up. I just quietly listened to the patient, and did a quick neuro exam and let them be.

When we rounded as a team, the child's father told us that they were waiting for a miracle. He said that he believed in the Bible and there were cases where people had been brought back from the dead. He didn't believe that God would allow his daughter to survive the accident only to die now. My attending said that he believes in miracles, but that from his exam, the child was clinically brain dead. He apologized to her father, but said that in his opinion, their daughter did not survive the accident. He told them that they should talk to only the loved ones whose opinions they valued. They would have some decisions to make, including possible organ donation, if the child was confirmed brain dead by neurosurgery later as he suspected.

Neurosurgery finally came back to the bedside and the same tests from the day before were repeated. Again, there were no signs of brainstem functioning or breathing. Time of death was declared, and the family was given time to talk with their pastor and social workers.

It was an awkward situation for us to walk into that morning, having not met the family beforehand, but I think that my attending handled it pretty well. I believe in miracles, too. I would have also added that miracles and unexpected outcomes happen in spite of what we do. As a physician, there is nothing that I can do to stop one of God's miracles from happening. Some people recover in spite of showing up late in their disease, while others seek treatment immediately, get treated aggressively, and still die. Life is unpredictable. While I have not seen anyone declared brain dead recover, I have seen a patient recover from removal of life support when it was expected to be a terminal wean. Maybe that's how I rationalize dealing with my own values though, when sometimes families and powers of attorney make different decisions than what I would do. However, at the same time, I think that saying something like that also helps the family to move through their grief. To the family members, there is never going to be an acceptable time to remove life support. They will wait, day in and day out for weeks, and even months. It's horrible to watch families camp out in hospitals, losing sleep and sometimes risking their jobs to be at the bedside of a loved one non-stop, especially when there is not expected to be any recovery.

In the end, the patient's family decided to donate her organs. An organ transplant service was contacted, and they set out immediately looking for matches across the country. Things got a little hairy while we waited as the patient developed renal failure, had great swings in blood pressure and glucose levels, and lost the ability to concentrate her urine (likely due to pituitary infarction). It took about 36 hours of constant work to arrange, but three separate surgical teams were flown in and coordinated to harvest her heart, lungs, kidneys, pancreas, small intestine, corneas, bone, and skin. In the end, she helped about 50 people, a significant number of which were probably children.

I think that this child was part of a miracle, it just wasn't one for her family. It was amazing that she was able to help so many others, and that her family was able to make the decision to donate in spite of the shock of an unexpected death.

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For the last couple of weeks, "Grey's Anatomy" has been focused on a small boy needing organ donation. However, in their scenario, the surgeons are running all over the hospital testing critically ill patients to look for a match, and pressuring their family members to donate. In reality, this is prevented by the use of independent organ donation teams. Once we find a donor (typically emergency and ICU patients), the procurement team is contacted and they come in and run the show as far as looking for matches on the national database.

While it makes for good drama on TV, there are obvious ethical concerns about having the same doctor caring for a potential donor and a potential recipient. We can't randomly test people for matching a recipient without their knowledge, and have no control in regards to what order on a recipient list a patient is. So get it together, TV writers, that was just ridiculous-- I'm not running a chop shop here!

2008 Reading List

Continuing in my quest to read less and less each year:

The Kite Runner - Khaled Hosseini

This book was pretty engaging, an interesting account of the author's life in Afghanistan.

Animal, Vegetable, Miracle - Barbara Kingsolver

An account of a year's worth of sustaining a family by only buying locally, growing fruits/vegetables, and harvesting poultry. Is this really possible? Probably not for your average working family, although it did make me think more about supporting my local economy.

Bringing Down the House - Ben Mezrich

This one had been in my reading pile for a long time, but I had to read it before going to see "21". Still can't seem to win at poker.

I am America (And So Can You!) -Stephen Colbert

If 1,000 monkeys typing on 1,000 typewriters can randomly peck out "War and Peace", this is what 10 crackpots armed with macbooks and endless coffee can do. Ridiculously goofy.

Not So Funny When it Happened - Tim Cahill

I don't remember this one too well, but I think that it did make me smile.

Intern, A Doctor's Initiation - Sandeep Jauhar

My mother sent me this one. It's the story of one guy's progression through residency. He struggles to find balance between family life and work. A lot more sunny perspective than "House of God".

The World Without Us - Alan Weisman

If you suffer from insomnia, this one's for you. There were some interesting points along the way, but so slow and painful.

Into the Wild - Jon Krakauer

Haven't seen the movie. I read this soon after returning from Alaska. Kind of a bizarre story, and tragic to die so close to aid under the delusion of a wilderness adventure. Wondered if the guy wasn't an undiagnosed schizophrenic.

Love in the Time of Cholera - Gabriel Garcia Marquez

Joined a book club, read the book, then missed the meeting (oops). I have another book of his sitting on my shelf, but this one was kind of weird. I think I missed the romance behind the protagonist's delusion that if he could seduce one widow, he was fated to wait out the marriage of his one true love and get the girl in the end. Also, enemas? Not an intimacy to be shared between lovers! Ugh.

You Don't Know D _ _ _

The PICU is running at about half-capacity this week. As a result, we had the Inauguration coverage playing live on the television in Room 1. There were about a half a dozen of us clustered together in there at one point, when suddenly--

"Who's the guy in the wheelchair?" a lone voice questioned.

"That's Dick Cheney, he strained his back packing, or something." I said.

"Who's Dick Cheney?" she asked.

"Only the current Vice President, who's been in office for eight years." scoffed my attending.

"Dick Cheney, you know the guy who shot some guy in the face while he was out turkey hunting," a nurse chimed in. (Well, at least she was sort of right.)

"Oh yeah, that guy... Huh, I guess I've never seen him before," she said, defensively.

There was kind of a long, awkward pause and then people started guessing who Nancy Pelosi was. To their credit, they did recognize Steven Spielburg...

Brr

-11F is really just too silly to go outside.

New Low

The other day I confronted a woman who was seeking pain meds. The medical student saw her first and there were a few things during her presentation that just screamed that this lady was going to be trouble:

1. Abdominal pain x 1 year

2. Recent month-long admission with no diagnosis

3. Multiple abdominal surgeries

4. Allergic to morphine, "Only Dilaudid works"

5. "I need a PICC line, no one can ever get an IV on me."

At first I felt mildy guilty for being cynical, but as the case unfolded, it turned out she had lied to us during the interview. When I had asked if she could be pregnant, she said, "No." When I told her that she was, she said, "Oh yeah, the hospital yesterday said that, too." Her pain had been coming and going for about a year, so there wasn't anything to do emergently besides some basic labs and physical exam.


We got ready to discharge her and she asked for pain meds. As it turned out, she already had a prescription for narcotics from another hospital, but it wasn't very pregnancy-friendly. I don't like talking down to people, but in this case I told her that the only way I would give her a prescription for a pain medicine was if she gave me her other one to destroy. So we traded prescriptions. Let's just hope she doesn't call the other hospital up saying she "lost" their prescription. In the meantime, I've sent a nasty-gram to her primary physician. I will still probably end up with a letter from the Board of Health in a few months letting me know she got multiple prescriptions from different providers, but at least she left my department with a prescription for a safer drug.

Just before discharge, I looked her up in our computer system, and the only thing listed was a previous admission for what turned out to be pseudoseizures and there was a mention of "drug-seeking behavior". When we confronted her, she didn't deny seeking pain meds, but now I wonder if I didn't miss the real diagnosis.

Sigh

I have been meaning to post more, but it's been a busy week with lots of minor headaches.

A couple of weeks ago, I signed up for direct deposit at my moonlighting job. Last week, I got the paystub, but somehow no $ showed up in my bank account. I gave it a few extra days becuase of the holiday, but nothing came of it. So, I went into the bank. I showed them the pay stub, it had the right account number on it, and several phone calls later, the bank manager had it figured out. For some reason, the hospital, despite being given a voided check, put a New Jersey routing number on the account instead of my actual routing number.

So, I called the hospital.

I explained that the wrong routing number had "somehow" been put on the account, the bank was returning the check, and could they please put the right routing number on it to fix future checks. Apparently, this was too much to take in, so I had to wait until the payroll person could get back to me.

The next day, the payroll person calls back. She says that she can't understand why the check didn't go into the account, that she looked up the routing number for Bank of America by my zip code (not New Jersey, btw) and it should have worked. At this point, I tell her that the routing number doesn't have to do with my physical address, it has to do with where the account was opened, and it matches the account number, not the bank branch I visit.

This is where it gets more stupid.

I tell her that the bank account was opened in Arizona, and she says that she's "not authorized to send paychecks to Arizona." I try to explain that when you do your banking with a major company, you don't have to change your account numbers when you move across the country, they stay the original number and routing number as when they were opened. I halfheartedly try to explain how things work electronically and there is no actual paycheck that goes to Arizona and then back here, and that the bottom line is that I just need the right routing number that matches my check put on the account.

At this point, she says that she has to talk with corporate to see how she can get my check out to some bank in Arizona. I tell her that it's not "some bank", it's just Bank of America, with a different routing number than the local one. I mention how at my main hospital, I have direct deposit, and there was no issue with getting it set up. However, she is unwilling to type in the routing number on my check and is hung up on putting in a number by my current address.

At this point, I decide it would be more convenient to just deposit the check in person every two weeks rather than spending more time on this. So, finally she agrees to just continue mailing me my checks. Before she hangs up she says, "And it will be much quicker for me to just mail the check to you, rather than me mailing it to Arizona and them having to mail it back to you to be signed." ARGH!

I have a sinking feeling this income is going to be on both my 2008 and my 2009 W-2's, but I think I'd just rather take the tax hit twice than talk to her again.

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Then there's been the argumentative not-sick people fake coughing/wheezing and not understanding why I can't admit stable bronchitis, the people demanding IV antibiotics when they aren't appropriate based on their culture results, and of course, the "my doctor sent me here for an MRI" crowd.

I'm back to doing floor medicine for the next four weeks. I'm sure I'll be stir-crazy and wishing I was back in the ED by the end of it, but for now I'm looking forward to getting out of the department.

Happy New Year!

Happy New Year! I decided to finish off 2008 by breaking my right pinkie toe. It was stupid-- I was putting away laundry and just managed to stub it hard on the corner of the bed. I've iced it, buddy-taped it, and have been taking ibuprofen when I can remember to. Most of the time, it's fine, but it has caused me to hobble around and try to heel walk on that side at work the last two nights.

Behold, the unhappy piggy (ignore the sad state of my toenail polish):

All in all, 2008 has been a great year: I fell in love, ran a half marathon, had a great Alaskan adventure, and have signed a contract for my first "real" job. My family and friends are doing well, and I really can't complain. Overall, I feel happy and confident, and can't remember the last time that I have had so many things to look forward to.

2009 however, is off to a violent start. I worked the overnight shift, and despite starting out with an empty ED, it was crazy. At midnight we wore party hats and toasted each other with sparkling cider. We potlucked, and waited for the chaos. It finally started at about 1:30. Multiple patients with multiple stabbings, several overdoses, too many head lacerations to count, and every kind of skull fracture/head bleed combo imaginable: depressed fractures, non-depressed fractures, subarachnoid bleeds, subdural bleeds, intraventricular bleeds with impending herniation. That last one is going to turn into the first homicide of the year... our charge nurse was joking at the beginning of the shift that there should be a door prize for the first homicide of the year like there is for the first baby born in a local hospital (yes, we are a dark-humored group).

I spoke with AG this morning, and he sounded in good spirits (although getting tired of lobster, poor boy!).

So here's to 2009: Bring it on!

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!