“We are all in the gutter, but some of us are looking at the stars.”

What is hope? I have had three big HUGE conversations with three separate friends about this very topic in the last week. It seems to be a theme right now. But more than just a theme, its a root nerve that runs through life.

I can live with a lot of things, I can survive a lot of things, but having no hope is not one of them. Hope keeps me alive. It makes the sun rise and makes each day a new fight that is worth fighting. There are volumes of stories that speak of hope, lord of the rings, Shawshank, the list goes on and on. But what is this thing of hope?

I think it is this. It is the spark of life. It is what keeps us going when life sucks and the shit of the world around us threatens to drown us. People tend to insulate themselves from the pain of life by whatever means they can find. TV, food, drugs, sex, religion, whatever fires them up for a few moments in time. But they are hiding because they fear to hope. Hope can hurt you so much, it can kill you. Hope is a drug that can bring you bliss, or crush you in one fell swoop.

I am no expert on hope. But I do hope. I hope for things that I have no right to hope for. My life is burning with hope for not just myself, but for my friends. Beyond my friends I have hope for mankind. Granted, its hard to see it some days when I get buried in the foul smelling cesspool that is normal life. But I still hope. I will always hope. I will hope for love, life, and peace. I hope for my friends to be touched by the fire of hope and pick it up and run with this thing. I hope for people to taste life.

I hope.

All I have to say about that is "asphinctersayswhat". ~ Wayne

"Peanut butter cups here I come"

This from the man who until 4 days ago was on insulin and dialysis. Now he has someone else's kidney and pancreas. This frees him up to eat peanut buttercups. Weird. I would think that being forced into mechanical means of prolonging your life would make you think something along the line of "Perhaps I should care for this gift that just a few hours ago was someone else's body". No, first thought is about peanut buttercups.

I am in a place to observe free healthcare. I see what happens on a daily basis in my ecosystem. When I was a student, I saw people who didn't check their blood sugar because they didn't have the money to buy enough strips. Thats not a "barrier" to care where I work. You want strips, BAM, done, pick them up at the pharmacy. Oh, your meter is not accurate, hell, let me put that in and BAM, you get a brand new one. No co-pay, nothing other than the inconvenience of having to wait in a line.

So in a system where you get free medical care, free medical supplies, and a nice air conditioned room to wait in. Your diabetes should be in top shape right?

Incorrect sir.

Why am I pleading with you to take your insulin? Why am I pleading with you to check your sugar? I refuse to get lost in your self destructive behavior. Go home, eat your spam, smoke your "couple packs a day", dont check your blood sugar because it hurt your finger, its your life.

No, I am not bitter already. Just frustrated. Frustrated that I can spend so much time on this and it wont make a difference a few weeks from now.

Lidocaine acts on the NA channel after the cell is fired.

I have not hated the holidays for a few years now. But I am feeling the start of hating this one. I may just become a bit bah-humbug this year. I don’t feel happy about it. I feel insulated from the world.

I feel bad. I remember when I had a good friend end her years of college and become very sad about her leaving that time behind. I did not openly mock her, but the tone was one of mocking.I did not understand.

There is a newfound drive in life, but it scares me. I get up every morning and I run through all my ACLS cards. I see them in my head. I see the patients that we have coded at work in my mind. Its no shit time. Its 1147 at night and I am studying from The Schnob’s text book. I want to know the mechanism of how lidocaine stops arrhythmias. I am sure that was taught to me, and I even remember drawing out the diagrams of it back on a white board somewhere. I even have notes and highlighter marks in my text book proving that at some point in my past I even looked at this page.

Perhaps a little gin will make it all better. One can only hope.

MS

Fiction is obliged to stick to possibilities. Truth isn't. ~ Twain

There was a disturbance in the force last night. I was at work and had a person comes in wearing a hoodie with the hood up. Sick person. Anyone wearing a hood here is defiantly sick. We get them all plugged in, they are in a wheel chair, cant use their legs from a MVA a couple years ago. They have a home health who comes to visit them. My first gut reaction is that this person is really really no kidding sick.

I take a history and find that they were in the hospital a few months ago for a wound check. So we roll them over to look at the wounds. I a very infected stage 3 DU on the L hip. There is also a dressing on the sacrum, so I take that down. It’s the worst DU that I have ever seen in my life. 11CM by 12 CM that tunnels another 8 CM around the R side. The sacrum is completely exposed as well as L1, and a good part of the pelvis.

Both heals are eaten down completely to the bone and smell gangrenous. I would not be surprised if the R foot has to come off.

The next person to arrive via EMS is another young person about the same age, who was playing football and ran into another player. But now cant feel anything from mid shin down, and can no longer move the ankle, or foot, or toes. The loss of sensation crosses 4 dermatomes and 3 levels of spinal inervation. Anatomically I don’t believe that there is a way to make this happen. I check the reflexes and at first I note that there are no reflexes on the affected side. But when I go back and check again a little closer I note that the muscle is activated for the reflex, but he is tensing the rest of his foot to hold down his foot. My spidy sense says malingering.

I am sitting out in my area looking at these two rooms with two very different people. One who will never walk again, one who wont walk. I feel like there is something that the force is trying to tell me, I just don’t understand it.

What to say?

I dont know what to say. I found this when I was in the shower and realized that I was not alone, that there was a HUGE F-ING spider that wanted to eat my face.

"Education is what survives when what has been learned has been forgotten." ~ Skinner

I realize that I have been delinquent in updating this. I apologize.

Anyhoo. I finished up the wonderful joy that is officer development school in Rhode Island, which by the way turned out to be a lot harder than I had planed on it being. I think mostly because I was really unprepared to deal with a bunch of just baby snobs. So, my thought process went something like this: It was the first week and they were asking for volunteers for the jobs, now my first plan had been to do the safe thing that I did when I went through basic training and that is just hide in the middle and never volunteer for anything ever. But this was different this time, I chose to take it all on head on. Grab it by the horns if you will. So why not vol for the student leader guy right? I mean whats the worst thing that could happen? This is not really that tough compared to what I have been doing lately. So I was the only guy who volunteered for it, so I will be damned if I did not actually get it.

It was not that bad at all as far as just the job, but dealing with all the other students was the biggest problem for me. There were about 10 prior enlisted and its not really all that hard, but the senior chiefs screwed with us a lot in stupid little ways, all the normal fun and games. I think the weirdest thing that I can remember is that the first three times I pissed one of my classmates off the very first FIRST reason out of their mouth why I should respect them was that they have a PHD. Its odd, here are a bunch of the smartest people in the world and asking them to clean the floor or take out the trash is so far below them. Its sad almost. They are 30 something and have never been outside the bubble of education. Smartest dumb people ever. But I got fired after the first week so that was fine with me. Then I could just hide for the rest of the time, I had done my duty.

So, step forward to arriving at my first Navy duty station. Naval Hospital Guam. I get here late night and my sponsor meets me at the airport and he happens to look like an extra from Miami Vice. Purple silk shirt with a couple too many buttons unbuttoned and his chest hair and gold bling popping out. But he takes me to lodging in his Jag so thats nice of him. He is a nurse from the ward so does not know much of anything about where or what, so I get plugged into fam med the next day and wonder around in my dress blues sweating my ass off. I get about two days into the check in and someone stops the check in because my bilit number that is on my orders is not in fam med, but in the ER, so I have to go talk to the CO (commanding officer) and XO (executive officer) and DFA (Director for Administration) and a bunch of other three letter people. But the bottom line is that I ended up working in the ER, not fam med.

Its FANTASTIC! The ER has been PA-less for 6 months so they are super happy to have me there. The ER is booked for two PAs and one GMO (general medical officer aka an intern) but have had none of the above for the last year and change. So, I am doing my best to not suck it up too much, but damn, its been a while since I was in a real good clinic setting. That was my biggest fear about going to the ER, I told them outright that I am new, I suck, you have to be patient and hold my hand and pull me along. But the docs here are so freaking good about that. The department head doc is a really awesome guy and was talking with me last night and he was really excited about something because I had asked him a question. He said: Oh, its great, we have not had anyone here in a long time to teach so its nice to be able to have someone to teach that wants to learn.

God, its fun. I love this stuff.

So, now that I am an old salt and have a dozen shifts in the ER under my belt as a naval PA and am getting ready for another shift today I decided that I should at least update you as far as what I have been doing and where the adventure has taken me so far.

M@

"hope is a dangerous thing" Shawshank

I feel an unfortunately large amount of alone tonight. I have been “alone” for a month or so now. At first it was such a change from being in officer school where I was packed in very small space for 5 weeks and ate, slept, shit and shared about everything with a group of people. Its different here. Here, there is a big insulation layer between me and others.

I sit on my porch and drink my gin and watch, I watch as the world spins by me. But part of me does not want to be here. It’s the first time since arriving that I have really felt it. It’s a geographic isolation. I feel alone.

Perhaps I have just been running at full speed and not noticing much else. I am sure that it will pass, that I will sleep tonight and that it will all be better in the morning. That’s the beauty of me. I have been in some crappy places, but life just seems better in the morning.

Perhaps it is the tease of making contact with people, yet not really connecting with them. I guard my “electronic” connections because it feels like that is such an important thing, but in truth perhaps that is a cause. It gives me a false sense of being near people. I crave the contact of my herd that I left back in the states. It just hit me today that I don’t get to see them. That this is truly a level of isolation. It’s a lot of talk, but I wont be back in the states for a very long time. None of them are coming here. I kept thinking that I would see them again and soon. But not so. Its dangerous to hope too much. But how do you balance the hopes of daily life with living life with hope of greater things? I don’t want to just sit here and “hope” that I get a good breakfast tomorrow. I want to hope big, but the big hope hurts when you don’t get it. How do I hope big, but hope realistic? There must be a balance in the mix.

Life is just one day at a time.