H-one-N-one-big-pain-in-the-derriere

I got my arm injected with the new stuff this week. We received about 200 doses and between our staff and our pregnant patients we just about used it up. No, I didn't get the shot in the butt, and it didn't hurt any more than the seasonal flu shot (which it shouldn't, since it's made in the same way and given in the same way). But I'm on call this weekend, and the phone never stops ringing for long. Taking calls from worried parents with sick kids doesn't bother me much; that is why I get paid the medium bucks. What troubles me is that this bug seems to be changing the rules that we've worked so hard to adhere to, and that our patients have come to accept, that is, the rules about confirming a diagnosis to some extent before throwing medicine at it, and being conservative about using that medicine, to avoid teaching the bugs how to resist it.

The CDC wants us to strongly consider prescribing Tamiflu or Relenza to patients "at increased risk of complications" without examining them if they have fever and respiratory symptoms. That risk group includes all pregnant women, children before age 2, and people with common chronic health problems (think asthma, diabetes, heart disease) that make suffering through the flu more dangerous. I am prescribing according to those recommendations, because I think it'll save lives this year, but wonder what this practice will do to the long-term usefulness of the very few anti-virals that work for flu. Already Tamiflu no longer works on seasonal ("regular") flu. But we weigh this against the slow output of vaccine, and the value of keeping sick people out of waiting rooms and emergency departments, which are full of people who shouldn't be exposed to coughing/sneezing flu victims, and the danger of this illness to some young people, and this is where we are, treating people with a phone call.

For the record, I've been exposed to lots of this crud, and I'm fine, as are all my fellow providers. I think this is one wonderful case where being old is a good thing. (If any of you reading this can think of other such cases, I'm always looking for things to be thankful for.) Also, if you are one of the many who thinks animation and viruses are a natural match, check out http://www.npr.org/health and scroll down to "Flu Attack! How a Virus Invades Your Body". It is creepy but cool.

Birthday

It is odd what can make a birthday good. I expected little of this one. No one at work knew, as far as I knew. I wasn't sure my husband would remember, and I was tempted to test him on that by not saying anything. When that thought occurred to me, I realized how wicked that would be and reminded him just so I couldn't play that little game. This morning, facing the usual grueling day at work, I told myself that I would not dare the world to neglect me and then be mad at the world for it, but would just try to practice my gratitude.

That is not why it was a good day. There were just lots of little gifts in it. Merlin made me a hot breakfast. A tough little patient who has always cried whenever I came near her decided I was not that bad today. A patient who really needed to go the the crisis center didn't fight me on the point. I took a lunch break (yeah, really!) with a friend. A patient on my (very behind) schedule who looked like she was having a stroke wasn't, and her own nurse practitioner recognized what was going on stepped in and calmed the situation. I got to sing with friends at the end of the day. Granted that the singing was preparation for a memorial service for someone I wish weren't gone, it was still a privilege to be asked to do it, and a joy to do it. And then, another hot meal at 10 p.m., wrapped up with apple cake fresh out of the oven with lemon sauce.

And eight or ten friends from all different corners of my life, if a life can have eight or ten corners, wished me a happy birthday on facebook. I know that's paltry by some standards, but I feel pretty rich right now.

Heaven

I've had two friends go there in the last month, and it's made me think about that kingdom differently. It is easy to think of heaven as where old people we love sit around having tea and cookies and wait for us to show up. Today I remembered that my ninety-something in-laws and aunts who crossed over in the past few years aren't old anymore. Hard to know what they are like now, but not old, I bet.

It all occurred to me as some fallen walnuts crunched under my feet as I walked down the street in the rain. The crunch of nuts on the sidewalk is one of the fine pleasures of living in this world in this season. I wondered if our young friend Grant who just died suddenly four days ago would miss that feeling or look back on it as nothing compared to the pleasures of the kingdom we were made for. Probably neither, exactly. I suspect that the pleasures of life on earth will be seen in a new and brighter light and will actually be greater in the remembering of them than they were in the experience of them. Maybe. Of course, I think that in heaven if we want to crunch nuts under our feet, we'll get to. Please, this is not being flip. It just becomes more necessary to think about the next phase as more people I know move into it.

Fly-by-night blogger tries again

I cannot multi-task. A friend--was it you, Susan?--told me about someone who cannot read without something on TV to watch at the same time. That's nuts. I am trying to listen to Pandora (right now, the Decemberists are on the Neko Case station; I don't think I'll ever learn to like Mr. Meloy's voice, but I like his songs) and write this at the same time, and can barely do it. Music is not really background to anything that takes up cortex for me. And music is for singing along with, or at least for humming a harmony to. Or escaping inside of.

I can sometimes sign prescription refills while on hold (that's right, being on hold is a task for me, maybe because there is music to sing along with). I can listen to NPR and do dishes. I can sort of drive and drink coffee, although that's iffy. But talk on the phone and check facebook? Give advice and take notes? Sing and blog? Not so much.

Of some comfort is research that shows no one is really good at multi-tasking. Most people just don't know it.

NPR 50 Great Voices

Not that anyone is reading this, but if you do, there is one week left to nominate the best voice you've ever heard, or several of them, on the NPR website. I only nominated two (Alison Kraus and Ray Charles), but it made me think of other voices that have taken me away over the years.

As a little kid, I loved Doris Day. (That's right, and I'm not embarrassed about it.) I loved, and still love, Ella Fitzgerald. My mom let me have her vinyl Ella albums, Ella sings Gershwin, and Ella Sings the Rodgers (Rogers?) and Hart Songbook. My mom's record collection, by the way, is why I know a lot of songs you don't--we were not wealthy, but that is where the fun money went. She was very eclectic.

I liked what everyone else liked in high school. In college, James Taylor, Elton John, and Neil Young. I could sing just like Neil, probably still can, as his range is my range and he's very imitable. Now, Natalie Mains and Alison are the voices I'm guilty of envying. And anyone who sings in Portuguese.

A man cried on the phone with me today. I called to give him a little good news, and he said he just couldn't care, because his child had cut off his contact with his grandchildren. He apologized for breaking down, but what else could he do? What worse thing can you do to anyone than to take away, by any means, all contact with someone they love? There isn't anything sadder.

A woman called me last month just to say she was stumped over what to do with her husband who is drinking himself into an early grave while her son is deployed in that other hemisphere. She had to know I wouldn't know what to do, but just wanted to tell me. Two of the three great loves of her life are in peril, and each far from her in one way or the other.

My brother-in-law's wife took their children to another country and has kept them there for 10 years. He's seen them twice in that time. He hasn't grown to love them less. He hasn't grown used to it. I don't know how he stands up under it. God has made him amazingly tough, but he's always in crisis.

Guess I think we should take every chance to love the ones we love, and be the best friends we can be to those bereft because of war, craziness, meanness, booze, or the plain old mortality that parts us all in time.

I renew my license along with the other credentials attached to it every two years in October. You have to present a list of all the education you have acquired in the intervening two years (which must total at least 100 hours, which seems eminently reasonable to me), but it seems that every two years they add something that you didn't have to do the last time. So that every two years, no matter how many hours I have racked up, I am in suspense as to whether they will find me wanting, and come down on me with their wrath, and strip me of my only way to make a living. No matter that I've done this five times now, and they have always just said, "Yes, fine, here's your license," I still expect to have the board of nursing show up on my doorstep and say, "Ma'am, we need to speak to you about this alleged course in bio-identical hormones, and by the way, are you sure you gave an honest answer to this question about any mental health conditions that might affect your ability to practice?" It came in the mail Saturday, along with that same familiar sense of relief.

Gratitude

No one at work is out to get me. My friends are not catty. My husband makes supper for us most worknights. He is healthy. So are my kids. They support themselves, and when they come for the weekend it is a good weekend. Both sides of our family love us. I can hear. My bifocals work. The only pain I have I can avoid by not lying on my right shoulder. I have a very cute car but not a very cool car, so I never worry about it getting stolen. I get out of work after dark 6+ months of the year to a deserted parking lot, and haven't been mugged once. I don't like running (after the first 4 blocks), but I can do it, and I can make myself do it even though I don't like it. I have a fortunate metabolism. I go to a very kind-hearted Mennonite church where they help me keep believing, as do lots of other people. No one I love seems to be addicted to anything. God looks after my patients. I still have a mom. I am just so grateful, and not nearly grateful enough.

Those Blasted Curly Lightbulbs

I actually hope someone will set me straight on this. I hate energy-saving lightbulbs, and I was thrilled to find that the one over our staircase had finally burned out. My theory about them has been that they don't ever burn out. They are like that imaginary trip across the street where each step is half as long as the last, and so you never arrive. The bulbs simply burn more and more dimly with each passing year and never really get to the place where you can say it's burnt out and throw it away. Which is good for the environment, because, as far as I know, those bulbs are very toxic and have to be disposed of like nuclear waste, in a sealed bag, at a secret site in a city you don't live in. Am I wrong? I read about this as recently as a couple of years ago when we were getting Consumer Reports. Nevertheless, the upside of having one burn out is that you get to replace it with one with decent candlepower.

And then my personal handyman went to replace it, and it turns out to have been the fixture, not the bulb. So my theory is intact, and the thrill is gone.

Is This Thing Working?

Tonight we are going to a potluck. We are lazy potluckers, or, in my case, maybe too egotistical to want to trot out my best stuff only to be obscured or eclipsed by other people's best stuff, or maybe even by their less-than-best. So we always take brownies, with something extra thrown in, like chocolate chips, mint chips, raspberries or cherries from the yard, etc. Today I am thinking of going down to the hardware store and buying a variety of local apples from the vendors in the parking lot and just taking the beautiful apples (with the brownies, but not in the brownies). Lazy, see?

I am happy about Rio de Janeiro being chosen for the 2016 Olympics, my being a fan of the Obamas notwithstanding. I really do think the president wasted his international capital on this one. Not sure if Rio is really deserving; it is pretty weird and crime-ridden, although, as God really does love and look after fools, we suffered no victimization there on our brief sojourn last year. But it is Rio, and exotic, and loveable in its way; I really hope the poor of the city benefit and don't suffer in the rush to be Olympian. And I will watch as much of the games as I can (though I will be really, really old then), hoping to see something of the streets we wandered through on my one and only visit to Brazil. Obrigada, IOOC!