Welcome to 2009

Interestingly, it has been almost a year since my last post.  Much has changed, and some things not so much.

Anyway - I wanted to give a cyber shout out (can you still do that?) to the 300+ girls who graduated from Stern College this last week.

 I was just so proud of them all....

Maybe this one in particular.

Thank you for that moment of nachas... now

 I have to go assemble and install my new ceiling fan.

A Balabusta's work is never done.

The second 100-year rain

June 21, 1997 was the 100 year rain that brought a lot of flooding to Milwaukee.

This last week has been the second 100 year rain.

Anyone know where I can rent an ark?

Scenes from the hallway

I have been working in the echo lab, which is a very interesting job in and of itself. One day I will tell you more about it. What I have to tell you about today is the hallway.

Across the hallway from the clinic is the cath lab. Not a great setup, but a cath lab has a great deal of inertia, and once planted doesn't move for at least 20 years. Some days I get to work and there is already a gurney outside in the hallway. There is a light above the main entrance to the lab that says "Room in Use" and a sign on the door that says "Don't use this door when light is on".

Some days I get to work and the gurney is already there and the light is already on. I like those days. Other days it isn't, which means the case hasn't started yet. Eventually you hear the commotion of the gurney and assorted rolling stands coming down the hallway, kids, parents. The woosh of the doors, the staff comes out with big smiles to greet the pt and family. Sometimes the pt is a baby and the gurney is just a crib.

Last week it was a full gurney with a girl, maybe 7-8 sitting up. They got to the doors. I heard the woosh and turned around. I saw this girl hugging her father and then she reached across the other side to hug her mother. "Mommy come with me!" the girl said. "It's okay, just don't touch anything," the staff said.
"Okay, Mommy's coming...."
Then woosh. The light goes on. About five minutes later mother comes back out and hugs father who is still standing in the hallway. Then they walk away. I go back to work.

With sleeping pts, you spend a lot of time in dark, quiet rooms, so you hear the hallway pretty well. I am very intuitive about voices and tones.
"Where's T.? They need her in the cath lab."
"I thought D. was in there."
"She is, they need T too."
"She's in back, I'll get her."
Then later I hear T's voice..."I don't get know, get 3 more units."

I recover my patient and go to eat lunch in the breakroom. T's got half a yogurt on her desk. My next patient comes, and goes and I notice the gurney is gone. T is back at her desk eating and taking messages off her phone. The crew is in the lab with the big carts. I don't know if I want to ask how it went, how it turned out, or if I would rather keep my doubts.

I decided I would rather keep my doubts.

Then another nurse came in and asked how it turned out. The girls was on the ropes for a while, but she came out okay.

I go home. Park in the garage. It's cold, the air is still, very quiet. Quiet in a way no one in New York has even imagined. Mentally and physically I walk from one world to another and back again. Still, I carry these things with me always.

It does well to remember that we are very fragile, intricate, beautiful beings and that tomorrow is promised to no one.

Tomorrow there will be another gurney in the hallway.

Shipping a box to Israel ? - Think Again!

Since my visit to Israel last summer I have been accummulating things in a box that I wanted to send to my cousins, such as: My favorite coffee, jelly beans, a computer program for the kids, and lots of Hershey Chocolate Kisses, which I know they like.

First you have to find a box, it should be something sturdy. I found a box from a case of wine. That was just about the right size, maybe a little too big, but definitely sturdy.

After months of collecting and planning, I was ready to ship. I had to call Israel to get the address, but today was going to be the day, of that I was determined. Bought shipping tape last night, labeled the box and all ready to go.

I took the box to a UPS store. I remembered it as a Mailboxs place, but whatever, they have a scale, they can ship. First thing they told me is that you can't ship anything in a box from wine. Ever. I had two options, one was to buy a box from them, the other was to wrap the box in brown paper. I chose to wrap my sturdy box in brown paper, but when they found out the box was going to Israel, they dissuaded me from that because they said the paper "wouldn't make it that far." So, I bought a smaller box from them for $3.50.

We opened the box, repacked everything. Fit nicely. Now how much does it cost to ship this box. Weight 12 lbs. Well via UPS it would cost either $236 or $136 dollars, depending on if I wanted it there tomorrow or not. If I took it to the post office I could ship it Priority Mail for $76. Well, I decided not to ship UPS and take my chances with US Parcel Post, which I knew was cheaper.

So we drove down the street to the post office and I already had the customs form from the UPS store. I get up to the front of the line and I am told that as of May 14, 2007 there is no more parcel post and the cheapest (and only) way to ship anything to Israel is Priority mail, which will cost $76. However, the lady says, we have a small box that is flat fee. This means whatever you can fit in it, you can ship for $37. Everything these days goes by air, no boats or ships involved.

Well, I decided to go for the small box. I took the box back to my car, opened the purchased UPS box and repacked most of the things into the smaller US Priority mail box and returned to the post office, where the box now weighed 9 lbs. I filled out about 7 forms and showed ID and paid the lady and my box was on it's way. Should be there in 6-10 days - approximately.

Anyway, here's the zen question of the day - "Why is it called SHIPPING, if you can't ever put it on a SHIP?"

Patient Centered Care

I step out of my Mrs. Balabusta role for the following post, and speak, for a change, and a nurse and more directly, as a member of the sentient human race.

Having said that, it has come to my attention in the last week of clinics that I have been sadly overestimating the intellectual capacity of many people, mostly patients. In short, Thinking is Very Overrated.

I now move to the realm of nursing theory. My lay readers may follow along at their own Peril:

Nursing, in common with many other professions, loves key catch phrases, especially if you are writing a paper, or a grant, or say, for example, both. Two of my favorite catch phrases are Evidenced Based Practice and Patient Centered Care. I could write an entire post about Evidence Based Practice, or I could sum it up like this: "Let's try this and see if it works - if it does, we'll write a paper!"

But I digress, because this post is about Patient Centered Care. This affects me and my family on a very personal level because the institution in which my grandfather (aka The Man of Steel) resides has become all about Patient Centered Care. If I had to sum of the theory of Patient Centered Care in a nutshell it would go like this - "We should care more about the patient than the institution itself." Radical, I know, but they do have evidence to back up this theory. The evidence runs something like a lot of surveys that say patients like their care providers to, get this, make the patient their first priority, especially in institutions they are likely to reside in for several years and to which they will be leaving their entire life savings.

But I digress again. One example at my grandfather's institution of Patient Centered Care is that they now serve breakfast anytime between 7 and 10 a.m. to accommodate those habitual late risers. My grampa however points out rather succinctly that although he is an early riser and likes to eat breakfast no later than 8, the staff didn't ask him what time he liked to wash or get dressed. The aforementioned Man of Steel, who is by the way classified as the "old old" only requires clean towels, help with his AFO and tying his shoes. Still, he likes to have his shoes tied before breakfast, so his idea for Patient Centered Care would be if they would ask him what time he likes to get dressed and washed instead of offering him breakfast until 10.

Also they offer him a bedtime snack. They take a cart around and bring him graham crackers. Every night, graham crackers. This is exactly what makes institutions institutional and exactly the kind of thing Patient Centered Care was supposed to make extinct. So Grampa, being sick of graham crackers, asked for a banana before bed. He was told that the graham crackers already had his sticker on them, so he had to take them, and anyways the bananas will be served with his breakfast. "Well, I will take the graham crackers if I have to. But if the bananas are handy, could I have my banana now instead of in the morning?" Surprisingly, this request was granted and Grampa considered it a major victory, stroke of unusual luck, or a mere fluke. But if you ask him what's nu - he has a story to tell about how he scored a banana for bedtime snack.

So you would think the above stories mean that if the institution really wants to center their care around the patient, they would logically.....ask the patient what they want? I admit that would be the direct approach - it's almost too easy. In fact, it's just what they'd be expecting us to do. So obviously, that's not what they did.

In fact, the institution mailed a form to my father about my grandfather that was about 8 double sided pages long. It came with a cover letter stating that the more we know about our patients the better care we can offer them, and that is why we are asking you the family members to fill out this questionairre titled "My Life Story". My father decided he didn't have all the information he needed to answer some of the questions so he brought the questionairre to Thanksgiving Dinner so after the Packer game was over (We BEAT the Lions) he would ask Grampa the necessary information.

Now some of the questions were in fact, centered around better care for the patient. Information like religious preference and marital status, number of children and grandchildren (my father attached a spreadsheet here). However, some of the questions were irrelevent, bordering on ridiculous and made for some very humerous exchanges that in retrospect, we should have videotaped. I will however, from memory give you some examples of the questions and Grampa's answers.

Personality inventory: Check the box if you think this adjective applies to you. Grampa, just answer yes or no if you want to check the box.
Active? - Yes.
Passive? - Yes.
Angry? - Why? What did you do?
Depressed? - Every time the social worker meets with me they ask me that. Do I look depressed? Anyway, I just say no.
Cheerful? - Sure, why not?
Insightful? - Okay.
Introspective? - What does that mean?
Hopeful? - Hopeful? I'm 93! What exactly am I supposed to be hoping for?
Athletic? - Sure, I can walk to the bathroom by myself.
Demanding? - Eh, why knock your head against the wall? It would be nice if they could serve the coffee -HOT- with the dessert, otherwise the coffee gets cold while they are passing around the dessert. Is that too much to ask? Is that demanding?
Content? - Content or continent? Okay.

As amusing as that exchange was, it only got better from there.

Where is your favorite place to go on vacation? -Vegas? Why?
What is your favorite book? - I don't like books.
What is your favority movie? - I don't care for the pictures.
What is your favorite movie actor? - They're all bums.
What about actress? - Elizabeth Taylor, she was pretty good.
What's your favorite sport? (This is after the game which we parked at the end of the dining room table for the Thanksgiving Dinner) - Football, I guess.
What do you do to relax? - Relax? I relax when I'm asleep don't I?
Do these things help you to relax:
Prayer? - No, usually he goes pretty fast.
Synagogue? Isn't that the same as prayer?
Temple? Isn't that the same as Synagogue? Who wrote these questions?
Meditation? Never.
Purposeful breathing? Everytime I breath its on purpose.
Sports? You mean watching sports or playing?
Reading? No.
Music? Yes.
Tai Chi? Gezuhntieit.

Then we go to the really obscene stuff. I admit, these next few questions made me lose my patience and go off like... like... like a ...wait a minute, you tell me.

What is your favorite color? - Why you painting the room?
What is your favorite day? - Is today Thursday? That sounds pretty good.
What is your favorite dream? - None of your business.
What is your favorite plant? - Huh? Plant? Like flowers? Elm trees are nice. You know the poem, roses are red, violets are blue -

That's it. Right there. I want someone to tell me for the love of everything holy what instrument these administrators lifted from which study and how knowing your favorite PLANT is going to impact patient care as much as a stupid question like - WHAT DO YOU LIKE TO EAT BEFORE BED, IF ANYTHING?

The Point and Shoot Club

Today Mrs. Balabusta did not go to the hospital. Instead, I packed my rolling duffel and headed out to cubicle-land, where anxious computer programmers anxiously awaited my arrival. They lined up for a block, while I was interviewed and fingerprinted (it was a high security area).

And then I stuck them with sharp objects - and they thanked me.

Seriously 129 flu shots in 4 hours, not too shabby.

I must say my record is 191 flu shots in 5 hours, but this was a brisk pace anyway. You have to have rhythm, that's where it's at.

So two posts in one week, sort of breaking all expectations I know. Try to curb your enthusiasm.

Mrs. Balabusta has a slow day

Mrs. Balabusta has been running around lately like a chicken without a head, but much better looking.

However, since we are having a slow day, relatively speaking, I have the chance to update on the Life and Times of Mrs. Balabusta. I know many of you are wondering how Mrs. Balabusta manages to fill the hours of her day and week and still breathe, eat and -occasionally- pee, (in that order) I will below summerize the list of paying jobs I have:

1. Float Nurse, Ambulatory Clinics, Famous Pediatric Tertiary Institution.
2. Staff Nurse, Flu shot clinics, dispatched from national industrial health company.
3. CPR Instructor, other tertiary care institution in the same city.
4. Substitute teacher, primary yeshiva school on days when I am not otherwise engaged.
5. Aerobics Instructor, 4 evenings a week lately for girls and women (technically, I make no money doing this, but it decreases my annual obligation, so I count it here.)

And the PT wants to know why I don't blog more often. Some of us have to go to work to pay the bills, and others of us can just sit back, blog and play XBox for whole minutes at a time.

But seriously, the minutes that I am not being paid to do something are few and there is still shopping, cooking and other family-home based needs that, you know, need to be met now and again. Usually I do a pretty good job keeping up with demands, but now and again something somewhere slips and the PT is left scrounging for milk for his Cheerios.

Actually, I like being busy. But since I do have some free time I would like everyone to speak up and tell me what they had for lunch today. I had a really fantastic salad with apple and cheddar cheese chunks. My theory is that most people hunt down lunch and shoot it rather than having an actual plan. I know some of the things the PT eats should be shot first.

You will get extra points if you supply pictures.