Kinetic energy

for those of you who don't remember chemistry, is defined as the energy an object possesses due to its motion.  I think this is how I survived for months prior to our move.  For so long I was in school, raising a family, working 2 and sometimes 3 jobs... and just when school finished it was time to look for a job in a new state, pack, move.... I had energy just because I was in constant motion.  However, I must admit that somewhere near to the actual moving date the kinetic energy became frenetic energy.  Frenetic energy is wildly excited or frantic energy.  Now that the move is over and life has settled into a real routine (something I have not had for a few years now) I find myself faced with an alarming amount of free time on my hands, and no energy.  I think I have no energy because I am not in motion.   I am also facing what countless generations of mothers before me have... children leaving home.  I would think that for most moms they get to watch children go out the door one by one with a little space in between.  I had one son leave and then 3 months later I left my daughter and her family.  Kind of a double whammy.  There is one kid left at home and he is kind enough to give up a day now and then to spend with his mom and dad.  Good thing too because I don't think I could take being left by all three kids at one time!

I have pretty much kept up my resolve to walk the dogs on a daily basis.  The weather has cooperated by staying above 15 degrees, but when I come home by cheeks are stinging from the cold and the skin on my thighs is pink and cold even under the lined jeans.  I have started to vary my routes a little and by doing so found a couple of house for sale on the next street over.  This is not a prestigous area, but the asking price of the houses is about 360,000.  That's a whole lot of money for a very moderate amount of house.

Today Steve joined me on a walk.  We went down and walked on the lake.  When I had passed there the other night, I could hear kids playing ice hockey on a patch of ice by someones beach.  They must have made a skate rink on the ice because the lake ice is covered with snow and is not at all suitable for skating.  There were some folks out ice fishing and a few cross country skiers.  That's a sport I would like to give a try, but not quite yet.  On the way back we saw a couple of moose.  It seems I can't go anywhere in this neighborhood without running into them.  They pretty much ignored us as they were chomping down on some saplings by the shore, but we gave them a wide berth and I was quite happy that Rosey did not pick up on the fact that they were there. 

Another thing we did this weekend was to head over the the Univ of Alaska - Anchorage (UAA) for the final weekend of the folk festival.  On Saturday we caught the final 5 minutes of a banjo contest and then a couple of local performers before heading over to a guitar workshop.  Jake plays and Steve used to play so watching the workshop and the performers was really all the incentive we needed to head over to the music store.  At the store Steve bought himself a new acoustic and I got one too!  Hopefully it will help to energize me and help restore some of that kinetic energy.  So Sue - I know you are reading this - here's the challenge - pick up your guitar and practice and maybe in the summer we can play together! 

On the way out of the store Steve said - maybe we will become the new Partridge family.  And Jake asked, with all the innocence of youth - Who are they?

I don't have a lot of pictures for you this week.  But here is what I have -

Normally you hear about Seattle and how all the folks in Seattle like their coffee.  Well, apparently they like coffee in Anchorage too because you can find these little booths in parking lots all over the city

coffee to go - Alaska Style

For my biking friends - here are a couple more shots.  Notice how fat the tires are and the mittens that appear to be attached to the handlebars

There appears to be a lot of pride in the Native Alaskan heritage, and much of that is expressed in public art.  This sculpture is around the corner from where I work, not too far from downtown.  I can't wait to see it when there is no snow on the ground so I can get the full effect.



Having troubles figuring out what this is - think about a fish that swims upstream and is famous all over Alaska



Downtown Anchorage is very tiny and there are few high-rise buildings.  Here is one that is kind of all by it's lonesome



I guess there is two in this shot, but not exactly what you would call a skyline!  This isn't all of downtown, but still it is the city of Anchorage

 And what would a post be without a picture of the mountains?  It is about 10:30 AM in this shot.  The sun has actually been out for about an hour, another reflection that our days are getting longer.  In fact, at 0800 when I was coming home from the grocery store I noticed some tiny tendrils of light stretching out into the dark.  However, the most dramatic change can be told in the evening, or at least that is how it seems to me.  If I leave the office late, it is still light and stays that way until about 5:30 PM.  That's about an hour later than it was when I first started working two months ago.

Here is your weekly dose.

Until next week!



Rapidly

my heart is beating.  My hands are shaking and I am having trouble typing.  Such a scare I just had.  It is 7:50 AM and still dark outside.  I was just checking emails and decided to warm up the car before I left for work.  This is a routine I do every morning.  We don't have a garage in this little house, so the cars are parked right outside the front door.  The front door has a wooden platform in front of it with two steps.  It isn't really big enough to be considered a deck, and I don't think you could even fit a chair by the door.  Maybe a pot of flowers in the spring.

This morning, I flung open the door like I do every day and there staring at me was a moose standing at the bottom step.  No more than a foot away.  I'm not sure which of us ran away faster, although I did make sure I closed the front door before I ran.  As I ran away, I could see the moose turning tail and leaping away, rather cat-like, from me.  From my front window I watched him saunter up the driveway, so I think he wasn't a shook up as I was.

Today's lesson:  Look out front window prior to opening front door.

Whew - coast is clear.  Now I am going to try this again....

Withers

is the word to describe an anatomical spot on a horse.  It is where the base of the neck meets the shoulders.  I believe most 4-legged animals have a withers, I'm just most familar with horses from all the years of riding lessons.  I am going to guess that a moose would also have withers, but since I am not about to saddle one up, I don't have to worry about keeping my hands even and light on the reins, and centered over the withers.  The only reason I am talking about withers is to try and give perspective on how truly large these animals are.  I realize that every week I ramble on about the moose, but I am fascniated by them.  So to give perspective is the withers and ears of a moose peaking over the 6 foot privacy fence in my backyard...



The withers are to the left of the bunny rabbit looking ears, right below the window frame.  He isn't even holding his head up, but rather low as he looks for more nibbles.

 This was not the first moose of my day.  Earlier, Rosey and company had been barking like crazy out the front window.  When I went and looked I saw this



Hard to imagine something so large can hide in plain view

 I was watching this mooses ears to see how it would react to the barking dogs.  Truthfully, they swiveled all over and I couldn't tell what the moose was thinking.  I was thinking I was gald to be inside the house and didn't have to determine if the moose would give me a head start if he decided to chase me.  After a few minutes I think the moose got tired of listening to barking dogs and headed down the street.


Later in the afternoon the dogs were outside and Rosey was going crazy.  That's when I saw the aforementioned withers and ears peaking over the fence.  I was very surprised to see the moose there because I thought the neighbors yard was completely fenced in, but I guess they are only fenced on three sides and the moose found a way to wander into the backyard.  So, disregarding all the advice I had read on avoiding a moose outside, I ran out with my camera to try and get some shots.



Rosey, the Mighty Moose Hunter



I got these shots by standing behind the 6 foot fence and holding the camera over my head pointing in the general direction of the moose.  The Mighty Rosey continued to yap, but the moose ignored her.  However, I started to look around and realized that the fence I was standing behind was old and rather derilect.  I decided it was not strong enough to hold back a large and pissed off moose, so I gathered the dogs and went back inside the house where I could watch the withers and the ears of the moose bob up and down until he wandered back out of the yard.

Here is a picture of packaging.  This is how Wal-Mart sells butter and milk.  So far I have only seen them packaged like this in WalMart.

Sorry they are sideways, I can't figure out how to fix that.  Anyway, I bet someone out there made a lot of money to figure out they could ship more and spend less by changing the shape of a gallon of milk and a pound of butter. 

This week at work I met a gentleman from Barrow.  Barrow is way the heck up on the northern edge of Alaska and has the honor of being the northern most city in the US.  It is cold and dry, surrounded by the Arctic Ocean on three sides, and it can snow any month of the year.  This gentleman is Native Alaskan and told me that he spoke only Inupiat at home until he went to school.  The teachers would hit him and his siblings on the back of the hand with a ruler if they didn't speak English.  And this was only in the 1960's. He told me that his father had been the captain of his whaling ship, which is a big honor. Many of the Inupiat in the region still hunt bowhead whales. 

I drove out to the Mat-Su valley this past week.  Apparently this is a big farming region.  After the devastion caused by the dustbowl and the depression the WPA resettled 200+ Norwegian/Scandinavian farming families from Minnesota and other cold-weather states into the area.  Apparently the thought was they were all ready used to cold, harsh weather and would stand a better chance than say a farmer from Florida.  Many of the families left, but several stayed and the area remains important to farming. Along the way I passed a sign for a reindeer farm.  Think we may have to go visit when it gets a little warmer... But it really wasn't the type of farm I expected to see. When I reached my destination they told me there was a whale in the strait, but I didn't see it.  I understand the strait, or Cook Inlet is a good place to see Beluga whales in the summer.  Another outing that will have to be undertaken...

For my cycler friends, I got another photo -



It's a balmy 24 on this day.  That's the Alaska range in the background.  I am heading east and going toward them.

Notice the No U turn sign in the photo.  Here you can make a U-turn at many of the intersections. I find it a little weird.

Everyday we settle a little more into routine. I have now figured out where the grocery store is, the bank and I found a decent place for a haircut.  I got a Costco membership (Alaska's grocery store they told me).  While I was there I saw folks loading up with 100+ lbs of items like rice and flour and lots and lots of toilet paper.  Those are the folks who live "off the grid", or off the road system.  "Out in the bush" is another phrase.  I also heard that an Alaskan pick-up line is "Hey, I've got running water..." 

Here's hoping your water continues to flow. We have heated water in our toilet tanks to prevent feeze-up!

Until next week....

Being Homeless

is not a laughing matter or a topic to be dealt with in an off-hand way, and I certainly don't want to sound like that.  And this is not the forum to address the societal and economic issues of the homeless.  However, I am completely taken aback by the number of homeless individuals there are in Anchorage.  They stand outside of shopping centers with hand-lettered cardboard signs.  There are men and women, wrapped from head to toe to protect them from the environment.  I can't tell what their signs say, the signs are small, the lettering is smaller.  I am just amazed that they are here.  Apparently, there are enclaves of tent cities throughout communities in Alaska.  The vast wooded areas within the cities not only provide some shelter from the environment but also some handy hiding areas. One group to whom I have donated a few dollars here and there are some dedicated men who stand outside of the shopping areas and collect money for the homeless vets.  It's easy to distinguish these guys.  They have matching jackets and real signs.  They seem to work in unified groups. I don't know where the money goes or how they utilize it.  All I know is when I am done in the grocery store it just seems to be the right thing to pass them a couple of dollars to help some men and women who served our country.  Having said that, I would be lying if part of me wasn't going "Dude - homeless in Alaska?!  Really!? Isn't there a better place to be homeless?" 

Of course, watching the way the lower 48 has been hit with snow and rain, I think I have been having the better weather.  There has been a wicked little glint in the eyes of the forecasters up here when they report another snowstorm is sweeping the midwest and up the east coast.  Kind of a "ha ha ha - your turn suckers" type of thing.  But that has changed over the course of the last few days as our weather once again dipped below zero.  Last week I gave back my borrowed car and got a rental. I was scared to death to take the borrowed car anywhere, but with the rental I feel a sense of freedom and have had the opportunity to finally do a little exploring on my own.



Loaner on the left, Rental on the right


One of the first things I did was go and get my 4th set of fingerprints done for my Alaska RN license.  The tally so far is 2 sets rejected by the board of nursing and one set rejected by the FBI.  I returned this fourth set with a nice note reminding them that it was the fourth set of prints I had turned into them, but I would be happy to keep re-submitting my prints.  My hope is that at some point they will just do a background check on my name only and not my prints.  I have a year for them to sort it out.

This weekend, Jake and I set out to do a little shopping.  I wanted to go to Kohl's which is on the northeast side of town while we live on the southwest side.  Driving around Anchorage is pretty easy.  Most of the main streets are 4 lanes and they either run north-south or east-west.  However, since I haven't been driving anywhere but to work, I really don't know what street goes where and the ones I thought were north-south are really east-west, so I need to reorient my mental compass.  There is also a highway that runs through town, but I opted not to take it because I wanted to explore.  So Jake and I set out about 11 AM on Saturday - the sun was out and the sky was brilliant blue.  The temperature was a balmy -2.  We were doing just fine, but somewhere we missed a turn.  No big deal but the road we were on started to climb the mountain.  These aren't really high mountains, but they do climb pretty fast from sea level and there is only one road up and over.  I don't know how far over it goes, and I don't think there is any more town on the other side of the mountain. Anyway, by the time we found a spot to turn around, the temperature was -7. And that was in the sunlight.  I had Jake snap this picture while we were driving.



Biking in Anchorage on a -5 below 0 day.


 The only thing that bothers me about the cold is I finally made the decision to walk the dogs every night.  The first night we went out it was 13 degrees.  We only made it up and down the block, but it was a start.  It was also as far as we got because every night since that has been colder and colder and I really just can't go out in -4 degree temps to walk the dogs.  They will just have to wait until the temperature climbs over 15.  I can't believe I just committed to that.


Clinical updates for this week.  I had a referral for a patient with an art line and it caused quite the stir.  Apparently, not all the ICU RN's were familiar with art lines. I haven't worked the unit, although I was asked again if I would (give me 90 days to learn this job before I start learning another one, please, I asked) so I have no comment as to how the unit operates, I was just surprised that art lines were such a surprise.

Here is a discharge challenge that I never experienced before - we couldn't discharge a patient due to high winds.  Honestly, the patient was flying to Valdez where the winds were gusting up to 70 miles per hour, to much for the little planes to take off and land, so the discharge had to be held over for another day.  Do you think his insurance will pay for that extra day?

And a lift team!!  Here there are dedicated members of the health care team who come and assist you in moving your patients into and out of bed.  They help with - get this - lifting!! and moving!! They actually consider a back a precious commodity and don't want anyone to hurt themselves by turning, lifting, moving, transferring, etc. patients without help.  It is truly a wonderful thing.

This past week the paper had a supplement full of community oriented classes.  There was everything from swimming at the local pools, to ski classes, pottery, etc etc etc.  I know Burlington publishes the same type of community class calendar, but this brochure also offered some handy tips that I had never seen before, and I quote: "pay attention to moose body language."  I am not sure I want to get close enough to worry about their body language, but the sage wisdom continued with the comforting knowledge that a moose whose ears are up is curious, but a moose whose ears are laid back is stressed.  Apparently, a stressed moose is not a happy moose and should be avoided at all costs.  However, if the moose cannot be avoided and he chases you, it is ok to hide behind a tree.  Or, you can run away if you have a head start.  How do you know if you have a head start?  Does the moose stop and count?  Then I heard the story of someone who was chased by a moose in a strand of saplings.  They hid behind the fattest little tree they found and the moose charged and banged its head on the tree.  The impact was enough to daze the moose and give the guy a head start.  I'm not sure that every moose would be as accomodating and smack its head against a tree just to give you the opportunity to run away (I'm thinking Monty Python here - Run Away, Run Away!).  The advice continues with, if a moose knocks you down... and at this point I am vowing to never walk outside again... curl into a ball, protect your head and lie still until the moose retreats.  Above this sage advice is a picture of smiling little children playing on a hillside, unaware that they should be surveying their surroundings for moose and trying to interpret their body language.  But moose are everywhere.  We see one at least once a week and I still cannot get over how large they are and how much they don't care that you are where you are.  So I composed myself, and continued to read the rest of the activities until I came to the next little insert that read in large letters "BEAR AWARE?"  Anchorage is Bear country (oh crap) and April is when bears begin to emerge from their dens (double crap).  I looked at the dogs who were blissfully unaware that it was -7 outside and we were in danger of being chased by mooses or bears.  They were also unaware of my resolve to start taking them on daily walks. Maybe I won't walk them when it warms up past 15.  The Anchorage Zoo is promoting a Bear Aware day on Mother's Day - so guess where I am making my family take me?

This weeks photo op is courtesy of Steve.  He went to Kodiak Island, about an hour and a half flight from here.  From all accounts, Kodiak is beautiful and full of wildlife viewing opportunities.  I knew there were bears (Kodiak bears of course!), in fact, right after we moved here there was a story of a hunter who had his butt bit off by a bear in Kodiak (he survived).  Apparently, there are also herds of caribou and cows.  Yes, cows.  Wild cows roaming Kodiak island. Don't ask me why, I really don't know.  So enjoy the pictures - and remember when you see a moose, check out what it's ears are doing to determine if you need a head start or not.

Until next week....



See the ice in the ocean?




See the snow on the shore?




See the surfboard that actually gets used in winter?



See the surfer off to the left?  I hope he has a warm suit under his dry suit.




Eagle tree




Heeeeere fishie fishie fishie







Chinook

is not a word I ever really heard as a child growing up on the east coast, or as an adult in the midwest. However, when I stopped to get gas at the start of the New Year, the man behind the counter asked me what I thought about the Chinook.  I didn't have an answer for him, because as I previously stated, I am not really familiar with the whole idea of a Chinook.  In fact, it sounds vaguely like something that should be in the western movies that Steve likes to watch on AMC on Saturday mornings.  Actually, the whole gas station confused me.  The name is Tesoro and sits on the corner down the block from work.  There are the pull up pumps with a little hut in the middle about the size of a Fotomat hut (I know, I am really dating myself here).  I got out of the car with my credit card in hand and stared at the pump.  It caught me quite off guard to realize that there was no way to pay at the pump.  I actually had to go into the little hut and talk to the attendant. Imagine that, huh, real human contact! The inside of the Tesoro hut has enough room for 1 1/2 customers to stand in it, and a teeny little counter where the attendant stands.  The inside of the walls were covered from floor to ceiling with photos. Color photos, faded black/white photos.  Photos of kids, dogs, birthday parties, Christmases, family picnics...  It was overwhelming and I didn't know where to look.  I think in the corner there were some small, bright, colorful dresses that looked like they were childsize and maybe came from Mexico, but my senses were reeling in this tiny little hut.  It was 7:30 in the morning and pitch black outside, the weather had finally hit above the 30 degree mark, but inside this hut it was a fiesta for the eyes.  And than the gentleman behind the counter asked me what I thought about the Chinook winds.  I don't know, I confessed, I'm from Wisconsin.

Back at the pump I was once again feeling like an idiot because I couldn't figure out how to pump the gas.  It took a few moments before the synapses fired in my brain and I realized I had to flip the handle on the pump to turn it on.  No push button start on these pumps, no pay-at-the-pump.  Wow, it felt like a time warp.  Anyway, back to the Chinook.  I did what anyone does these days when they don't know what something is.  I googled it.  According to Wikipedia - a Chinook wind is a warming wind from the ocean into the Pacific Northwest, or in this case, Alaska.  And a warm wind it was.  We had a days of above freezing weather, and even rain.  Not enough to melt the snow, but enough to lower some of the snowbanks so I can almost see over them when I try and pullout into the street.  The warm weather lasted for the majority of the week, but over the last couple of days it has drifted back below the freezing mark and today the temperature never reached 20.  I guess the January thaw is over and the Chinook has blown itself out.

One other weather thing I noted was the difference in weather reporting.  Early in the week the weatherman reported a chance of snowshowers overnight, and would than move on with his report.  Back in Wisconsin, any snow forecast was also accompanied by predictions of accumulation, be it 0.5 inches or 5 inches, the weatherman told you what to expect.  So when I heard snowshowers and there was no accumulation mentioned, I did not give a second thought to amounts.  And every morning I woke up and swept two inches of snow off the car.  The lesson learned - Alaskans don't seem to worry about accumulation unless it is more than 4 inches.  At least in Anchorage anyway.  However, as I said, we had this warm up, and even the snow showers have stopped.  The air is dry and for the most part very clear. 

I have noticed that my days appear to be getting longer.  I googled some information and discovered that on average the sun rises here about 3 hours later than it does in Wisconsin, although the sun sets at the same time.  However, on my daily drive home it appeared that the sky was staying lighter a little longer each day.  On average we are gaining over 3 minutes of daylight every day and you in the Midwest are gaining over a minute.  I had guessed that the gain in sunlight had to be huge since in the summer we have only a few hours of night.  Or so I have been told.  Actually, that answers one of the questions I had last week about are there fireworks on the 4th of July.  And the answer?  No - no fireworks on the 4th of July because no one would be able to see them.

Yesterday I was working for a few hours and got a text msg from Tara that someone had found Riley.  So I called home and discovered that Riley had squeezed through the fence. He was home and safe, but the dogs no longer have the run of the yard and the doggie door has been closed off.  And poor Rosey had just figured out how to use the darn thing.  Also tops on the list of chores for this week - get them tags with this address and phone number. 

This morning I took the dogs for a nice walk.  The weather was a balmy 13 degrees, and the sun had just begun to come up, but there was no wind.  The last two days have produced a lot of fog around town.  Driving in it on the way to work is ghostly since it is also dark.  But then the moisture freezes on everything coating it in a layer of hoar frost, so this is how things looked when I walked around.


view to the left



the rising sun and the frosted trees

the view up Sand Lake Rd. This is a plowed pedestrian path.  They are all over town.  Makes it easier for all the bicycles I guess



an intrepid chickadee.  I read an article in Alaska magazine that said Alaskan chickadees were the smartest due to the harsh weather conditions they had to face.  The only other birds I have seen are Ravens which are everywhere, and magpies which are more elusive



The view down Raspberry St.  I live off this street

back on to Terry Street!

Home Sweet Home.  Notice how the fireplug is protected.  I'm thinking there have been problems with plows in the past.

The only other thought I have to share this week is about personal space.  One summer day on a visit to WI from NY, my sister mentioned how aware midwesterners were of personal space.  In the crowds of the city people often invade your personal space.  Whether that is from necessity or because they aren't as aware of personal boundaries, I really can't say.  But I do know that when we lived in WI people would move to get out of each others way.  There is certain level of politeness to it - perhaps a recognition of personal boundaries and a desire to not want to invade someone else's space, but also a desire not to have someone in your space.  With all the available space in Alaska you would think that maybe people would be more cognizant of personal space, but that's just not the case.  Maybe it's the cold and dark that makes people squeeze together.  The crowd at WalMart is like Filene's Basement on Bargain days.  Makes me miss the Wallyworld in WI with its wide open aisles and people who give each other space. 

Keep warm and enjoy the lengthening of the days.

Until next week!

Happy New Year!

The old year went out with a bang, and the New Year came in with a bang. Actually, it was a lot of bangs, and pops and whistles and pretty colors.  Fireworks were legal in the city of Anchorage until 1 AM.  We could hear, and occasionally see, them being shot off all around us. Apparently this is the first time in quite some time that fireworks were allowed in Anchorage for New Years Eve, but they have been allowed in some surrounding communities.  I wonder if they are allowed for the 4th of July?

The weather warmed up yesterday, it was actually 39 degrees.  In fact, as I was driving through town I noticed some houses had their windows open. When I saw the first open window I thought it was an isolated incident, but then there were two more open windows on the same block.  Maybe this is an indication of how warm it gets here in the spring/winter....  Of course, the weather dropped back below freezing after the sun went down so I was glad to be home listening/watching the fireworks all around us.  Okay, I admit, I was actually sleeping on the couch for a while before going to bed - but I could still hear/see the fireworks when I was awake.  The three of us went to a restaurant called the Mooses Tooth for pizza.  The pizza was very good, and appropriately enough, we saw another moose nonchalantly standing by the side of a six lane road while we were on our way to dinner.   Have you ever heard of gyro pizza before?  Neither had I, but it was surprisingly tasty and I am glad there are leftovers in the fridge.

Before I go much further, I have to include some hospital/clinical stuff that I have observed.  I have not oriented to the floor, and I don't think I will until February.  I think I need 90 days at this job before I go and try and learn another. So whatever I say here is based only on observation.

Charting - everyone uses primarily paper except one hospital.  Another hospital does do some online charting, but not all of it.  PAMC is apparently moving to computer charting this year.  They will also be using Epic, which I believe is what Aurora is replacing Cerner with.  The expectation is that my hospital will probably switch to Epic about a year after PAMC does.

Tele techs - I think EVERYONE has them.  Monitors are not left unattended.  In fact, I overheard a discussion in one hospital where they were short a teletech one night and they were going to have an RN come in and pick up the shift to make sure there was coverage.  She would not have pts, just watch the monitors.  And I think there were only 3 people on the monitor.

Hospitals - I have been to all 4 of the players in town now.  Not that I can navigate my way through them very easily.  Especially the big ones. PAMC is probably like the mothership - there are multiple floors and multiple units.  Renal Acute Care. Adult Acute Critical, etc etc.  I don't even know what all the letters on some of them mean.  I have been in a couple of the acute care units now.  They appear to be set up more like a horseshoe than an L-shaped pattern like MHOB.  Some rooms are bigger, some are about the same.  Like so many things, it probably depends on the age of the facility.  The newer facilities or units are larger with the beds positioned in the middle of the room so you can actually get to both sides of the pt easily without moving things out of the room, and the vents seem to fit in the room, they aren't just one more thing that is in your way.  I have seen some IV pumps that look more like flat rectangular boxes then anything I am used to.  Staffing ratios appears to be about the same in the acute care settings, and acuity based staffing seems to be something I hear a lot of buzz about.

Restraints - my facility does not like to use them.  We utilize 1:1 sitters instead of restraints whenever possible. I don't know how many of our vented/trach'd pts require sedation as many of them come for vent weaning, but I do know that the facility preference is not to restrain them.  There have been some accidental extubations, but they just reintubate them in needed or put the trach back in if someone decanulates themself.  I do not know where the underlying philosophy for this came from, and since I haven't worked the floor I don't know how well it all comes together, but I think the idea itself is great.

So, I am learing more about what the discharge planners and the UR folks do.  Things are supposed to flow in a pattern, but as always, there are obstacles that interrupt the flow of things.  The biggest obstacle has to be insurance companies.  Oh my, am I learning about insurance companies.  See, once we get a referral, it becomes part of my job to not only make sure the pt is appropriate for our facility, but also to get their insurance company to give prior authorization for the transfer to our hospital. If the pt has medicare, there are standard criteria that if the pt meets them, they can transfer.  But with private insurance, it can get very very interesting. We have to give explanations as to why the pt should come to us, how they would benefit, maybe send a letter, provide medical necessity... and then we may get approval for a week.  After that, it becomes the job of someone else to contact the insurance company.  And I'm not sure if that is case mgm't or UR.  So the case mgm't dept has to worry from the time the pt is referred about where will the pt discharge to.  This is a very real challenge here because the options are so limited. If the local snf (skilled nursing facility/nursing home) is full, you can't just look to the next town because there is a very real chance that the next town does not have a SNF.  Or you can only reach the next town by plane, and they still don't have a SNF. It's a challenge.  And I have never heard the word medevac so much in my life as I have heard in the last month.  Pts up here are medevac'd all the time.  They are put in a plane from one facility and flown here.  Or, we even medevac people to the "lower 48".  That's a term you hear all the time.  Frequently combined with "it's different here from the ...."  One hospital here is located next to Merrill Airport and there is a runway right next to the hospital.  The plane can just about taxi right up to the doors of the hospital.  Imagine doing that anywhere else where you have worked.  I can't.  I still can't imagine it and I see it a couple of times a week!

Ok - enough of medical stuff and on to other things.  Last weekend was Christmas.  It was a little melancholy as there was only one child at home and I did not have any of my decorations.  But it was still a lovely day and I had the opportunity to touch base with all of my family.

a little Christmas cheer

The day after Christmas was bright and beautiful. At 10 AM the sun was finally up, here is the sky at sunrise

so I decided to go for a walk with the dogs.  Now one dog weighs 14 lbs and the other weighs 85 lbs, so walking the two of them together in good weather is challenging.  Walking them both on icy roads is a little interesting.  So we headed out to the lake in 9 degree weather.  There are no sidewalks on my street, but the snow was packed down and I guess Rosey was able to tolerate it without difficulty this time.  The crossroad by the lake is a main street with a sidewalk, and as we were going down the sidewalk I noticed this



moose print



I tried to get my dog or my shoe or something in the picture to try and show you how large this footprint is, but really.  Imagine this... I am wearing my lined jeans I bought off ebay 2 years ago on a whim, and hardly ever wore (but now wear every weekend), coat, hat (yes I broke down and bought a hat), winter ski gloves (had to buy those too), hiking boots with heavy socks and I am walking the canine equivilent of Mutt and Jeff. So visualize this and than maybe you can appreciate why I couldn't get anything else into the pciture. Ha!

So the dogs and I snuck through the chained gate on the little park to walk out onto the lake.  There was a large group of folks cross-country skiing on the ice.  In fact, there is a path worn in the ice around the lake.  From walkers, skiers, snow mobiles (they call them snow machines here), I don't know, but is was well used.  I walked with the dogs onto the ice.  They were so excited.  Riley was pulling and if I had been wearing skis he would have pulled me around the lake.  Even Rosey was ignoring all the little snowballs packed in her fur.  I rounded my first corner on this little lake and this is what I saw:

I really was very surprised at seeing a floatplane or seaplane or whatever the call them parked along the beach in someones backyard.  So, being the tourist that I am I had to take a picture.

Like many lakes, the lakefront property homes appeared to be beautiful.  I walked a little farther with the dogs when I noticed this:

Can you see the planes?  On closer look around the lake I saw there were several more planes parked around the lake, but I managed to not take pictures of all of them.  I was afraid someone would think I was a stalker or something.  So the dogs and I walked a little, but it was cold so I turned around to head home and this is the scenery those poor folks with the lake front property have to look at:

Pretty tough, huh?  So by now it was almost noon and I think in this next shot you can see how far the sun rises, as you can tell, it doesn't reach directly overhead -

That shiny thing way off to the right is the sun.

The dogs and I headed home where we warmed up, eventually.

It was a work week for Steve and I, but Jake is still off from school.  One day he calls me to tell me there is a moose peeking through the window at him. Apparently, they were browsing the foundation plantings.  Then they bedded down behind the neighbors RV and were still there when I came home from work.  They were hard so see, even though they were so large.  Two moose, a mom and baby I think, curled up together.  Very cute if you can imagine something that can weigh over 1000 lbs as cute. I tried to get a picture, but it was too dark and I wasn't going to get close enough for my flash to work.  Steve said we should feed them carrots, but I'm still not going to try and handfeed them.  Actually, someone told Steve to feed them pumpkins and bananas.  Apparently, they love bananas.  However, I am still hesitant to create a moose feeding station in my front yard.  I mean, these things are huge!  How would I get out of my car and into the house if there was one in my driveway?  I could be stuck in the car for a long time.  In fact, last night we had a talk with Jake about what he should do if he comes home from school and there is a moose in the yard.  How many of you parents have had to have that discussion with your teenager??

Last night, New Year's Eve, I snapped a few photos before we went to dinner.  The sunset (at about 4:30 PM) was absolutely beautiful.  Once again, the mountains were reflecting the pink sunset.  I think you can see it a little in these pictures. Oh, we had to stop at Home Depot before we went to dinner.  Sometimes when we drive through town I spend more time looking at the scenery than where I am going.  Good thing I am not the driver!!

Wishing everyone the best of everything for this new year.

Until next week!