Saturday, April 30, 2011

Royal Hats

Do you watch the royals on Friday?

Messed Up

This morning I fall into a 7 day on-call rotation for the hospital service. Dread. Exhaustion. Seemingly endless issues which have no permanent fix. Nothing I do is like taking out an inflamed appendix in an otherwise healthy person and meeting up with a cure. Nothing.

I'm strangling.

All I can do is give my best self to this job, come home and vegetate, sleep,  get up and go at it again. Over and over.

There is no energy left over for blogging, gardening, nurturing relationships, exercising.

Triathlon?  Out the window.

My depression is overpowering me. Again. Never ever does it go away forever despite my hopes and creative pharmacology.

For weeks I've felt this way. Can't shake it.

And so, I cut back, eliminate, and ruminate. My life is WORK and my DAD in that order. And, downtime....on the couch watching TV, eating, reading, trying to regain some energy to start it all up the next day.

For now, blogging is on hold until I can get out of this mess. Again.

Sunday, April 17, 2011


Well, I did it.

Rather, Denny did it. He ordered me a Kindle.

I've been talking about a Kindle for some time. Early on I could never imagine reading a book, magazine article or newspaper on a hand held, light weight device and scrolling through page after page. "I prefer holding my reading material the old fashioned way.", I'd say.

What made me change my mind was a bit of time and the opportunity to play around with one of these fascinating word storage machines outside of a high pressure sales environment. Thanks, Brenda.

This is a very cool device.

I've been practicing my reading and now it feels almost normal (but still novel; no pun intended).

There's a definite role for old time books with pages turned by hand. The Kindle will never be a permanent substitute. I love holding a book, its weight in my hands, the cover, the subtle scent of the pages.....ahhhh.

The benefits of a Kindle?
-- a great way to tote a lot of books on a trip on a device weighing 8.5 ounces
-- a fine solution to overflowing bookshelves (although I do like the look of overflowing bookshelves)
-- great deals on books; less expensive than "hard copy"
-- satisfies the "gotta have it now" syndrome
-- extremely portable; fits in a purse, always ready to go
-- font size flexible; I can (occasionally) get by with no reading glasses!
-- rapid downloads, huge inventory of books, long battery life
-- cool option to read a sample before purchasing

The drawbacks of a Kindle?
-- no old school, familiar feel and look of a book, no bookshelf with all those favorites
-- tough to share a good book; e books can't be transferred to anyone else
-- if it gets stolen, you've lost more than a book

As you can see, the benefits win out. Can't wait to take my Kindle to Hawaii and in the meantime, I'm reading A Visit from the Goon Squad and have two other good reads in the queue. I'm happy.

Saturday, April 16, 2011


My kids rode this bus to and from King's School ten years ago. I took this picture several days ago as I trailed the bus and braked my car to let a student disembark. He was young, had a heavy backpack, and a hoodie.

Time keeps moving on.

Friday, April 15, 2011

Still Beautiful

These yellow tulips were lovely when fresh and a week later still charming. Fresh flowers bring so much joy. I buy some for Dad and another bunch for me.

Spring is here even if the rain, wind, and chill won't leave.

Monday, April 11, 2011

Does Dad Know?

Tomorrow is April 12. Last year on this day we celebrated my parent's 69th wedding anniversary at their adult family home. It was a happy occasion with local family gathered together to honor a man and woman in their 90's whose long marriage was a story of great love punctuated by the the ebb and flow of life; joy and loss, struggle, adventure, family, friends, and accomplishments.  Looking back, I'm so glad we partied in grand style in that off year. We made much of their 50th and 60th Anniversaries and would have done the same for their 70th had that been in the cards. 69 years as a married couple was their legacy together. They were blessed.
Dad's been talking about Mom a lot in recent weeks. He'll focus on her picture hanging on the wall of his room and comment about what a beautiful woman she was or he'll remark about her many talents and how so many cherished and admired her. Indeed. She was an amazing woman. I believe with all my heart that he loved her deeply.

Dad has also asked about the date of Mom's death. He couldn't recall for sure and when I told him we were coming up on the 6 month mark, he was surprised. I know he misses her terribly. In later years, they rarely left each others company. For better or worse, I would think as Mom's mental and physical health deteriorated. Day in and out it was Doris and Dean. Dean and Doris. 

April 12, 2010

A week or two ago, Dad, in a contemplative moment advised me that in his view " the biggest question in the universe" is "where do we go when we die?". Dad will come up with heavy stuff like this every now and then. He allowed that the choices were "nowhere, Heaven, or Hell". Several days later he mentioned that he was fine with cremation, that what lasts when we die is our spirit and that "there wouldn't be room for all those bodies in an afterlife".  He's obviously thinking about death and dying. I feel honored to be a part of his musings. These are things I think about too.

What I don't know is if Dad has figured out that tomorrow is not only his 70th Wedding Anniversary but the 6 month mark to the day (also a Tuesday) that he awoke, ate his breakfast, and waited in a living room chair until I arrived at the house. I'd been summoned urgently by a loving caregiver at the home with news that my Mom was close to death. I tried to make the car trip in time to be there at the end but didn't make it.  I arrived in time to meet Dad at the door to Mom's room and tell him she was gone. I will never forget his face. It's not that he didn't know this was coming; we all did and we'd made peace with the inevitable as we sat vigil by her bedside for the several days prior to her death. But, we all left at night to sleep and rest up for the next day. I wish I'd stayed that last night. She died around 8 AM on that lovely fall morning in October. Dad mentions regularly that one of his favorite caregivers was "with Mom at the end" and he's glad of that. Likewise.

I'll visit Dad tomorrow and I'll probably remind him that it's April 12th. It may make him sad. It makes me sad. But I suspect we can comfort each other because that's what we do.

Sunday, April 10, 2011

Wet or Dry?

You'd think distinguishing wet from dry would be straightforward. All you need do is open your eyes and take in the view. The extremes of wet and dry paint unmistakable pictures in our brains. Even less dramatic images than these provide a fairly accurate interpretation of what is and what isn't wet or dry.

Did you know (medical types will agree with me; I hope) that distinguishing wet from dry in medical practice is likely the most challenging day to day dilemma we face?  After over 30 years of  "doctoring" and sub specializing in a field where making this distinction between wet and/or dry is of critical importance, I'm eternally humbled. Seems I get it wrong way more than I think I should. Sometimes in the midst of emotional exhaustion after a week on call, I consider my decades of experience with thousands of patients worth very little when it comes to making the call regarding the fundamental question: wet or dry?.

Why is this seemingly straightforward diagnostic decision so difficult?

I'll take a stab at it answering this question. I certainly had my head buried in the problem all week as the hospital consultant for the Nephrology service.

The problem is:

1. Too much fluid (wet) and too little fluid (dry) is relative.

2. What is too much for Peter may be too little for Paul. What is too little for Mary Kate may be too much for Ashley.

3. The physical exam gets you only so far; someone can be "swimming" (as I like to say) in water but be dry where it counts (perfusion of critical internal organs). The flips side is a physical exam with relatively normal findings with regard to fluid but meanwhile the wet is insidiously attacking the one organ that can tolerate it the least, the lungs. Wet lungs are never a good thing.

4. A little wet can turn deadly wet just because. A little dry can turn deadly dry just because.

5. Treating dry with fluids can easily turn sour. Treating wet with drying agents (diuretics, dialysis or other physical removal of fluid) can easily turn sour. Why? Just because.

6. Wet may be just what the doctor ordered to fix the problem. Dry may be just what the doctor ordered to fix the problem. Sometimes it's best not to intervene at all but let the wet or the dry just be and wait it out. But, all too often we try to fix the wet or the dry and that leads to issues that further compound the problem.

Last evening, after a long 7 day on-call stretch, I had had it up to my eyeballs in this morass of fluid, slogging my way through the wet and dry fields and making decisions based on gut feelings, experience, and a small dose of science. I get it wrong as often as I get it right, I thought at which point I lamented to my husband that I really don't have what it takes to do this kind of work.

His comment?

"Who do you know that gets this wet/dry stuff right? Anyone?"

The answer is that no one gets it right all the time or even most of the time. We all try. We genuinely try our best but the pathophysiology of each situation; the time, place and person, the unique moment creates a minefield waiting for a misstep.

I'm glad the week is almost over.

Saturday, April 9, 2011

Tough Week

Dead and fallen branches, hard and slippery rocks close to a stream. This was my week on call. The end is in sight.

Sunday, April 3, 2011

Home From Vegas II

A week ago today, Pate and I toured a different side of Las Vegas; namely the surrounding desert to the west of the city, better known as the Mojave. I've always wondered where the Mojave Desert was. Did you know that this desert is home to the species yucca bevifolia, otherwise called the Joshua tree? These spiky dudes were everywhere, punctuating the open vistas and 'big sky' views. Apparently 19th century Mormon settlers named these hardy desert survivors after biblical Joshua because their uplifted spines recalled the vision of Joshua with his hands uplifted in prayer.

We visited Red Rock Canyon which is barely thirty minutes from the glitter and lights of the Vegas strip and oh, so out there in rugged and breathtaking nature. We took an easy hike to a waterfall after walking through the visitor's center where we learned all about Mohave flora and fauna. We both remarked on how little we learned about snakes of the Mojave. I don't think they wanted to scare visitors into avoiding the hikes. We knew they were out there and kept our eyes and ears open.  No encounters of  the slithering kind. I don't think snakes like people very much.

Red Rock Canyon was spectacular and in some ways reminded me of the red rock of Aruba. These pictures don't do justice to the variegated rock faces with golden hues interspersed with burnt orange.

After the desert experience, we headed back to the Oasis (RV park) to get ready for our night on the town. Contrast the open air and natural beauty of Red Rock Canyon with the Las Vegas Strip. The green is unnaturally green, cultivated and showy. The music and throngs of people, the whirling barrels of zillions of slot machines and the captivating Cirque du Soleil Mystere performance finished off the day.

Except for the last hours of the day spent around a kitchen table at the Oasis sipping on these....

Till later.

Home from Vegas, Part I

The trip to Vegas last week was too short but resplendent with good memories. On the way home I ended up checking my carry on size bag because it was so heavy with all my slot machine winnings.....not; but that's beside the point. My third trip to Vegas was not about the Strip at all even though I did drop some bills into a few machines in a several casinos over my three days. Didn't win a damn thing and I should know better. But...

The trip was about reconnecting with Pate, my girlfriend of 25 years; one I consider near and dear to my heart but with whom I've rarely telephoned in the 20 years we've lived so far apart.We write letters and emails and now we text. This is all because of my quirks, not hers. She puts up with me.

After a few years working together in Houston, she moved to Tampa and I moved to Seattle. We lived about as far from each other as you could get, on the diagonal, and still live in the southern 48 states. Through the years there have been visits every few years but never enough. Once we met in Albuquerque for a gal's weekend adventure to Santa Fe. Another time we met in Huntsville (Alabama, not Texas), dropped my son Chris off at Space Camp and took off on a car trip with our then two younger kids through through Tennessee. The last two visits have not been visits at all since they involved weddings of my oldest and then her oldest child.  It's impossible to count those quick weekends as quality time spent in each others company  since it's all about getting our kids down the aisle.

Pate moved to Vegas last fall and calls a silver Airstream trailer her home. She knows it's likely not permanent although she did allow that downsizing and living in an RV full time is not necessarily an outrageous thought. She and her husband, who's still in Florida getting ready to move West, just might. I spent three great days and nights calling the Oasis RV Resort home. Pate's trailer was a dwarf compared to the "big rigs" on either side. But inside, we had all the amenities. If there's a toilet and a refrigerator, I'm in heaven.

Pate knows her neighbors; I was surprised to learn that a large percentage of the folks staying at  the Oasis are semi-permanently parked there with their huge class A RVs, pets, and small cars in tow for trips about town. For those not savvy with the terminology, the class A is a motor-home, all in one and some look like large buses. They were everywhere at the Oasis.

Pate (and Ed's) Airstream in Vegas
Pate's neighbors are great folk. Everyone is (or seems) so happy, chilled out, laid back and in a good mood. I've always loved that about the RV life. It may be a total facade but I don't think so. Every time we journeyed out in our humble, little tent trailer and pulled into a place with hook-ups (that's a good), we knew we'd landed in friendly territory.  I met Russ with his 150 pound Great Dane who gave me slobbery kisses. I sat outside on a glorious, sunny and warm day with Pate, Chet, and Steve enjoying chocolate mousse vegan style. Amazing.

An interesting trailer. Aruba?

"Brutus" watches Animal Planet when not catching some fresh air

The secret vegan ingredient in chocolate mousse? Shh. Avocado.Delicious

Pate and I enjoyed great food, drink, and conversation inside the Airstream as well. Life is sweet.

Staples; plus lime and ice

Outfitted with Internet

Goes well with rum and coke
More later. Part II  is another post.

Saturday, April 2, 2011

April Comes, Ready or Not

I posted a mere 7 times in March 2011; the fewest number of blog entries since the inception of Ahead of the Wave.  Yikes, what's happening to me?  More time spent at my day job is the reason. Now we're into the second day of April; she comes whether we are ready or not. I'm not. Where did March go?

I've much to blog about; my inspirations come to me when I'm out there doing my best to run/walk on the Couch to 5 K routine. Today the sun was shining, a real treat after endless Seattle rain. I dragged my aching knees back on the pavement after a week off and did fairly well although a dose of Aleve was appreciated after the workout.  I'm determined to press on and hope I'm not doing damage to the medial meniscus of my right knee, the one that started talking to me shortly after the sprint Triathlon in 2007 and which ultimately ended up under the knife 3 years ago.

Pate's legs look like this.
Speaking of knees, my friend Pate suffers from creaky and temperamental knee joints as well.  I'll be writing more about my recent trip to visit girlfriend Pate (I call her by her last name); the three day jaunt that involved a city called Las Vegas, a trailer park, and rum-cokes. For now, however, I'm talking about knees. Pate and I have a tradition of sorts; when we're together we often buy something identical. This is some form of bonding I suppose but it is kind of sweet. I'll look down at my wallet or, more recently my toe ring and think: Oh, yes, Pate has one just like this. This time, though we bought identical knee supports at a local drugstore in Vegas. Good God, I thought as we stood in line to pay for our purchases. We're really getting on in years if we're buying supplies to support our aging joints. Geezer-hood is coming.

Anyway, troublesome knees or bust! I'm pressing on with plans for the Danskin sprint Tri. If I end up walking the 5 K instead of running, so be it. For now, I'll down those aleve, glucosamine-chondroitin, and wear my knee support faithfully whilst listening to Beyonce, Lady Gaga, and Rihanna. These gals propel me forward like none other.

Today, I felt my Mom close by. Again, she whispered to me, "Go!"