I was just asked today to "post some more cool medical stuff on your blog". I have intended to do this for a while, but tonight offers me the chance to do it. I am staying up late tonight in order to prepare for tomorrow's night shift. I was told that I should try to stay up late tonight, get up early in the morning, then take a long afternoon nap before my night shift. It was one of a couple of different suggestions, and I'm excited about it, because I love afternoon naps. Maybe this night thing will work out for me.
I need to set something straight. I completely messed up on graft vs host disease when I mentioned it earlier. I said that the body launches an attack against the graft. That's not true. It's the other way around, and I can't believe I missed this obvious thing. Stinking faulty memory.
Anyway, the transplant attacks the body. There's a couple of different ways to do bone marrow transplants. Autologous means that the patient donates his own bone marrow. It is freezed. His own bone marrow is destroyed through chemo treatments, and then his preserved bone marrow is re-introduced into his body. This type of transplant poses no risk for graft vs. host disease (GVHD), because the cells in the transplant are already accustomed to the cells in the patient's body. In fact, they are the cells from the patient's body. Allogeneic transplant means that someone else donated their bone marrow for the patient. Often, the donor is a close relative. This type of transplant involves the possibility of developing graft vs. host disease.
I met a woman last week who had just begun to develop GVHD. Instead of having a completely red body from head to toe, she only had slightly reddened fingertips. The soles of her feet were also red. She had not yet complained of any itching or other related complications. The nurses still seemed to react more sympathetically to this sign than the patient could understand. I think it's because the nurses know too well the path down which these symptoms suggest this patient will go.
Also, that one patient that was yellow...they did some liver function tests. His bilirubin was, indeed high, as manifested by yellowish skin. Also, his liver function was at less than optimal which explains his jaundice. I felt pretty good about this predictive observation. My nursing assessment skills are slowly coming around.
I also came across a rare skin disorder called calciphylaxis. It seems as though the process of this disease is poorly understood, but it involves the calcification of the skin. In this patient, as is typical, her condition presented with late stage renal failure, probably related to the kidneys' inability to filter out excess calcium. The significant thing about this disease is the necrosis of the skin. "Νεκρος" is Grecian for "dead". When cells die, that's usually not a good thing. In body tissues, necrotic tissue turns black. This patient had 3-4 inch patches of black tissue on the surface of her skin. This is an ominous sign, because it represents the beginning of calcification on her skin. Spots that had started that way have now progressed to 1-2 inch deep wounds five inches in diameter all around her trunk. I was amazed to find that she had only begun to recognize signs of this disease about a month ago. It has already progressed to form significant necrotic craters on her body. These wounds refuse to heal and will eventually cause her death. The patient was experiencing enormous amounts of pain due to her abundant open sores. Somewhere I read that she has a 45% chance of making it for a year and 35% chance of making it five years.
Treatment: pain medications, dressing changes and wound care, dialysis (which is basically a huge kidney; a patient's blood is filtered through a machine).
If you are grossed out easily (Allison), don't read this paragraph. Her wounds are treated with dressings saturated in acetic acid. That's the stuff that makes vinegar smell bad. Another option for treatment of this condition involves maggots - yes, maggots. The maggot larvae eat up all the bad stuff in a wound and leave the living tissue. This patient wasn't undergoing that treatment, which I was glad about.
This patient was, however, being transported to a "hyperbaric chamber" which involves exposure to oxygen at a high pressure, a much more appetizing treatment. I thought at first that "hyperbaric" related to a high amount of fat. "Baryophobia" is a relatively newly defined eating disorder type condition in which a patient is afraid of becoming heavy. Also "bariatric" relates to obese patients. However, the root is Greek again, "βαρο-": weight. It relates more accurately to pressure. So, hyperbaric oxygen therapy relates to exposure to pressurized oxygen.
I had my first reporting off experience sometime last week. At the shift's change, each nurse records significant information on each of her patients for the nurse who will take them. Hearing report everyday is a continual reminder that each profession has its own language. There are so many acronyms on these reports. I've heard a lot of people refer to this phenomenon as B language, but it reminds me of the military. There are also random numbers thrown around like confetti. However, even with my limited knowledge, I'm able to decipher what most things are, and my unlimited M resources help me with the rest.
RMG - something metered glucose, aka: blood sugar
UCI'd - urinary catheter indwelling, aka: patient has a foley
During these reports, I kept hearing the nurses say "rie-ghers". I knew that it was something that happened during a neutropenic fever by context (neutropenic fever is when a patient who is low in neutrophils, a type of white blood cells, gets a fever. This is a big deal, because it is a sign of an infection which the patient is ill-equipped to fight), but other than that, I was a bit puzzled. "Rie-ghers" is spelled rigors. "Oh! 'rhig-ers!" I exclaimed to my nurse. I know what those are - the shake that accompanies a chill.
In other news:
I went to the dentist. They took an x-ray and told me, "Yeah, you definitely have an abscess in there." So I'll need a root canal. I'm scheduled for next Thursday.
I got paid today. Woot.
I signed up for that healthy living place. I did a couple of aerobics type classes. One was called Zumba and I followed an African American trainer in some crazy dance movies. At one point, she said, "Now show me your shimmy. You just move your shoulders and let your accessories follow."
I am self-proclaimed "less than dumb" nowadays at getting around this place I call a city.
I found out that I have some camp friends that live here. I'll probably meet up with them sometime this week.
Tuesday, June 17, 2008
Frederick M. Lehman: The Love of God
- The love of God is greater far
Than tongue or pen can ever tell;
It goes beyond the highest star,
And reaches to the lowest hell;
The guilty pair, bowed down with care,
God gave His Son to win;
His erring child He reconciled,And pardoned from his sin.- Refrain:
Oh, love of God, how rich and pure!
How measureless and strong!
It shall forevermore endure—
The saints’ and angels’ song.
- Refrain:
- When hoary time shall pass away,
And earthly thrones and kingdoms fall,
When men who here refuse to pray,
On rocks and hills and mountains call,
God’s love so sure, shall still endure,
All measureless and strong;
Redeeming grace to Adam’s race—
The saints’ and angels’ song. - Could we with ink the ocean fill,
And were the skies of parchment made,
Were every stalk on earth a quill,
And every man a scribe by trade;
To write the love of God above
Would drain the ocean dry;
Nor could the scroll contain the whole,
Though stretched from sky to sky.
Some more CS
"Not that I am in much danger of ceasing to believe in God. The real danger is of coming to believe such dreadful things about Him." -A Grief Observed
He is certainly different from what I thought He was, but the reality of Him makes me love Him more. He's real and tragic and He's not so cut and dried.
Dynamic. This word kept occurring when I first started in nursing. Everything seemed to be described as dynamic.
dy·nam·ic
He's dynamic. Ever personal. And that's important, because we're persons. And as persons, time is constantly changing us. and so while He is unchanging Himself, His goings about with us are ever changing:
He is disciplining Father. He is tender abiding presence. He is articulate and clear. He is a voice waiting in silence. He is ever ready for the moment at hand. He is strong and displays that He doesn't have to be present, that we might be melted that He is. He is the lion and He is the lamb.
He is certainly different from what I thought He was, but the reality of Him makes me love Him more. He's real and tragic and He's not so cut and dried.
Dynamic. This word kept occurring when I first started in nursing. Everything seemed to be described as dynamic.
dy·nam·ic
adj. also dy·nam·i·cal (-ĭ-kəl)
|
He is disciplining Father. He is tender abiding presence. He is articulate and clear. He is a voice waiting in silence. He is ever ready for the moment at hand. He is strong and displays that He doesn't have to be present, that we might be melted that He is. He is the lion and He is the lamb.
"dontcha be doin that cheerch hop"
A little bit ago, I wrote this:
This weekend I went to a couple of church services. One was bad news. But the Saturday night service was beautiful. C. John Steer, a British man from the Spurgeon Seminary in Great Britain spoke at a Saturday night, college-oriented service. He spoke on the end of John 12. Verses 20-36.
"We would see Jesus." - gutsy Greeks requested...to which Jesus responded by speaking about His death and the agony thereof. His sermon touched my heart in a tender place. Jesus let them see Him, but He showed them a specific part of Himself. He showed them His agony and death.
Do you see, O little one? Do you see what the cross is? Do you see the bitter agony of separation? This is the cross. I have shown you the cross. Do you see? Do you see Me? You want to see me, but do you see Me? This agony, this terror, this difficulty of soul - do you see? This is My story of beauty. There is nothing so beautiful - this terrible story.
This man presented another thing - something about faith. He claimed that the people that lived then didn't hear God's voice for one reason: they were not expecting it. He said, 'If you don't believe something happens, you have to have an explanation for it when it does happen,' and 'God speaks and we miss it.' I have thought about this so many times. Whenever somebody articulates something I have been thinking about for a long time, I feel a deep sense of relief that somebody else is on the same page, that somebody else thinks those thoughts.
I keep thinking about this verse in Matthew. 13:58 "And he did not do many miracles there because of their lack of faith." This verse, and a few like it seem to be proof that the people's lack of faith have a direct role in the amount of miracles Jesus performs.
The second sermon seemed almost to be a perfect rebuttal of this british man's eloquent, faith-filled words. Sunday morning, I walked into a big church - lots of full pews. My particular pew was packed, and I wished for a little more elbow room. The music started and was upbeat and cheesy and had too much treble. There must be a place for this, but it's not my personal preference. I couldn't help but laugh out loud while thinking about the synchronicity of this music, Kathy Trocolli, and my friend Zach Backstrom from camp's clapping dance. We even sang a song we did for closing ceremony at camp. Classical.
Then the preacher came out and began his discourse on prayer. His point was that it's difficult to pray, because we think it doesn't really matter - God's going to do what He wants anyway. And when we pray, we don't get what we want. Then he went on to define and explain six reasons we should pray anyway. I don't think he really believed most of them - not deep down - and it came through in his preaching.
I found myself watching random screenplays in my mind: I punched this man's medium sized belly, and he puked out all his unbelief. I threw tomatoes at him, and upon impact, they exploded all over him. I went through a vast array of options for ammunition that would allow for "splat". Pumpkin guts were my personal favorite. I think I should become a millionaire by inventing a super soaker that spews out pumpkin gutbombs. I could call it Gut Pumper. Or Putt Gumper.
I wanted to give him a good talking to, and my finger would shake at him, and I would whip out my best black talk, "Boy, you gotta believe! You gotta have faith! And you gotta get out of spoiled America!"
He told a story of obvious miraculous healing. Actually, I think it was a situation in which a missionary in a foreign country brought another missionary (who just happened to be dead) back to life. His response was, "I don't know what to do with that. I certainly never expect to ever hear a story like that in my life again."
And perhaps that is the very reason he won't.
This weekend I went to a couple of church services. One was bad news. But the Saturday night service was beautiful. C. John Steer, a British man from the Spurgeon Seminary in Great Britain spoke at a Saturday night, college-oriented service. He spoke on the end of John 12. Verses 20-36.
"We would see Jesus." - gutsy Greeks requested...to which Jesus responded by speaking about His death and the agony thereof. His sermon touched my heart in a tender place. Jesus let them see Him, but He showed them a specific part of Himself. He showed them His agony and death.
Do you see, O little one? Do you see what the cross is? Do you see the bitter agony of separation? This is the cross. I have shown you the cross. Do you see? Do you see Me? You want to see me, but do you see Me? This agony, this terror, this difficulty of soul - do you see? This is My story of beauty. There is nothing so beautiful - this terrible story.
This man presented another thing - something about faith. He claimed that the people that lived then didn't hear God's voice for one reason: they were not expecting it. He said, 'If you don't believe something happens, you have to have an explanation for it when it does happen,' and 'God speaks and we miss it.' I have thought about this so many times. Whenever somebody articulates something I have been thinking about for a long time, I feel a deep sense of relief that somebody else is on the same page, that somebody else thinks those thoughts.
I keep thinking about this verse in Matthew. 13:58 "And he did not do many miracles there because of their lack of faith." This verse, and a few like it seem to be proof that the people's lack of faith have a direct role in the amount of miracles Jesus performs.
The second sermon seemed almost to be a perfect rebuttal of this british man's eloquent, faith-filled words. Sunday morning, I walked into a big church - lots of full pews. My particular pew was packed, and I wished for a little more elbow room. The music started and was upbeat and cheesy and had too much treble. There must be a place for this, but it's not my personal preference. I couldn't help but laugh out loud while thinking about the synchronicity of this music, Kathy Trocolli, and my friend Zach Backstrom from camp's clapping dance. We even sang a song we did for closing ceremony at camp. Classical.
Then the preacher came out and began his discourse on prayer. His point was that it's difficult to pray, because we think it doesn't really matter - God's going to do what He wants anyway. And when we pray, we don't get what we want. Then he went on to define and explain six reasons we should pray anyway. I don't think he really believed most of them - not deep down - and it came through in his preaching.
I found myself watching random screenplays in my mind: I punched this man's medium sized belly, and he puked out all his unbelief. I threw tomatoes at him, and upon impact, they exploded all over him. I went through a vast array of options for ammunition that would allow for "splat". Pumpkin guts were my personal favorite. I think I should become a millionaire by inventing a super soaker that spews out pumpkin gutbombs. I could call it Gut Pumper. Or Putt Gumper.
I wanted to give him a good talking to, and my finger would shake at him, and I would whip out my best black talk, "Boy, you gotta believe! You gotta have faith! And you gotta get out of spoiled America!"
He told a story of obvious miraculous healing. Actually, I think it was a situation in which a missionary in a foreign country brought another missionary (who just happened to be dead) back to life. His response was, "I don't know what to do with that. I certainly never expect to ever hear a story like that in my life again."
And perhaps that is the very reason he won't.
Monday, June 16, 2008
from Cosmos
I'm reading Cosmos by Carl Sagan. It's pretty sweet.
Kepler, this guy that lived a while ago, decided to try to figure out the orbits before anyone knew that they existed. He sought out to answer, in essence the questions about the movement of the planets. How do they go? And in order to find the answer to this question, he made all of these calculations assuming that the orbits were circular and was 8 minutes off in the end. He writes that all of his findings amounted to "only a single cartful of dung" because of these stinking eight minutes. Then he figured out that the orbits weren't perfect. Why should they be perfect? Nothing on earth is perfect. The orbit of Mars wasn't a perfect circle, rather, an ellipse. "Ah, what a foolish bird I have been!"
So when the planets are close to the sun, they are moving really fast, because the gravity of the sun is stronger there. When they're far away, they move slower. And this is described in Sagan's book with the words "forever falling toward, but never reaching, the Sun."
Kepler discovered that the heavens function in a manner that science could touch. "Astronomy is part of physics."
Check this out: "Kepler believed that the speed of each planet corresponds to certain notes in the Latinate musical popular in his day - do, re, mi, fa, so, la, ti do. He claimed that in the harmony of the spheres, the tones of Earth are fa and mi, that the Earth is forever humming fa and mi, and that they stand in a straightforward way for the Latin word for famine. He argued, not unsuccessfully, that the Earth was best described by that single doleful word."
Another quote by Kepler: "Do not sentence me completely to the treadmill of mathematical calculations - lave me time for philosophical speculations, my sole delight."
Kepler, this guy that lived a while ago, decided to try to figure out the orbits before anyone knew that they existed. He sought out to answer, in essence the questions about the movement of the planets. How do they go? And in order to find the answer to this question, he made all of these calculations assuming that the orbits were circular and was 8 minutes off in the end. He writes that all of his findings amounted to "only a single cartful of dung" because of these stinking eight minutes. Then he figured out that the orbits weren't perfect. Why should they be perfect? Nothing on earth is perfect. The orbit of Mars wasn't a perfect circle, rather, an ellipse. "Ah, what a foolish bird I have been!"
So when the planets are close to the sun, they are moving really fast, because the gravity of the sun is stronger there. When they're far away, they move slower. And this is described in Sagan's book with the words "forever falling toward, but never reaching, the Sun."
Kepler discovered that the heavens function in a manner that science could touch. "Astronomy is part of physics."
Check this out: "Kepler believed that the speed of each planet corresponds to certain notes in the Latinate musical popular in his day - do, re, mi, fa, so, la, ti do. He claimed that in the harmony of the spheres, the tones of Earth are fa and mi, that the Earth is forever humming fa and mi, and that they stand in a straightforward way for the Latin word for famine. He argued, not unsuccessfully, that the Earth was best described by that single doleful word."
Another quote by Kepler: "Do not sentence me completely to the treadmill of mathematical calculations - lave me time for philosophical speculations, my sole delight."
Saturday, June 14, 2008
beached
It's been a perfect day here, the kind that makes me want to go jump in the lake. So my roomie and I scoped out a county park with sand and sun and water. it was perfect. and while I was mulling over Elizabeth Elliot's words about her early missionary experiences with the Colorado indians, I heard a strange thing a few yards away. A big hispanic man in a hawaiian button-up put some plugs in his ears and began to serenade his beer at a picnic table. Intermittently, he would let out an elated, whiny sort of chuckle.
"I can't get through a page." My roomie had a tough time letting our live music remain in the background when a man fully decked out in a black wet suit with a huge white scorpion on his significant belly came into our view saying to his woo-ee, "Anytime I see water, I just want to get all decked out in a wet suit and jump in." Throughout our stay, he continued to woo his special friend with replaying of his latest video game victories. He laid on his side with his head propped up on one hand - feet in the water, head out, wooing her.
It was very Napoleon.
"I keep thinking of deer." My roomie was referring to our latest encounter with the security guard here at Evanston who told us that we need to drive really slowly right by the speed bump, because deer like to run out of the woods, "And if one of those hits your car, boy, yoo knoh, it's totaled." He sort of looks like a worn-out version of Nicolas Cage. He's got his hip shades. I think they're stolen from the fresh prince of Bel-Air himself.
Oh, the people.
"I can't get through a page." My roomie had a tough time letting our live music remain in the background when a man fully decked out in a black wet suit with a huge white scorpion on his significant belly came into our view saying to his woo-ee, "Anytime I see water, I just want to get all decked out in a wet suit and jump in." Throughout our stay, he continued to woo his special friend with replaying of his latest video game victories. He laid on his side with his head propped up on one hand - feet in the water, head out, wooing her.
It was very Napoleon.
"I keep thinking of deer." My roomie was referring to our latest encounter with the security guard here at Evanston who told us that we need to drive really slowly right by the speed bump, because deer like to run out of the woods, "And if one of those hits your car, boy, yoo knoh, it's totaled." He sort of looks like a worn-out version of Nicolas Cage. He's got his hip shades. I think they're stolen from the fresh prince of Bel-Air himself.
Oh, the people.
Saturday, June 07, 2008
excerpts of thought
"Reality, looked at steadily, is unbearable."
-C.S. Lewis; A Grief Observed
I'm so glad Lewis said that, because it's an exact articulation at what I've been thinking about a lot lately - the idea that true idealists have no chance of being happy unless they set their hope on Someday.
I find myself staring at the women doctors here. There's this one that is extremely gorgeous. Foreign, and has the most beautiful accent. The medical terminology just sort of rumbles beautifully out of her. I'd like to stare at her a lot. And then become her.
But I don't know about this doctor thing. Intellect doesn't usually work out so well for me. It gets me all screwed up. It seems like when I try to use it primarily, I just end up with more questions. No answers. And instead of finding out answers to answerable questions, I try to find answers to the questions that can't be answered intellectually.
I have been thinking lately about timelessness. That has a lot of significance, especially in the realm of the whole predestination/election thing. the absence of causality has huge significance. I just think there's no way we can comprehend fully not being bound by time...things not causing each other...there not being an existence of "before that, this." There is no before. There only is. and not even that, because our comprehension of is, means it's not was or will be. Even more baffling than timelessness is the concept of timelessness and timeness intermingling with one another. How can this be? So maybe it's not that God chooses us, and then we follow Him, and it's not that we respond to Him and then He presents Himself to us, maybe there's much more of a timelessness factor in the whole thing, even in our responses, that we can't understand, because we can't know how our actions and lives are judged and recorded in a world with no time. who are we really? well, in a world of no time, we are all that we ever were, all that we are, and all that we ever will be all at the same time. and we are doing all that we ever did, all that we are doing, and all that we will ever do all at the same time.
This changes my ideas drastically about election and predestination. it makes the debate obsolete in my mind. Does God elect people? And if He does, on what basis?
I can't know. But it has something to do with the enigma of "fair" and "timeless", two things that don't exist in our realm of understanding.
I've also been thinking about the relativity of adjectives. In my world of nursing students at PC, I'm pretty smart. But here, I feel dumb because I am dumb. All these words are relative. Size. Dumb, smart, knowledgeable, rich... How can words like that even exist alone? They don't mean anything by themselves. How the unseen powers must jeer at our evidence of pride by semantics. We know nothing of rich.
And how experiences define words. You thought someone was smart, but then you experienced someone smarter, and you look back, and you think the first person wasn't actually smart. You just thought they were smart. But now that you have a clearer picture of what smart is, the first person and "smart" don't mix.
This is why we have comparatives and superlatives.
-C.S. Lewis; A Grief Observed
I'm so glad Lewis said that, because it's an exact articulation at what I've been thinking about a lot lately - the idea that true idealists have no chance of being happy unless they set their hope on Someday.
I find myself staring at the women doctors here. There's this one that is extremely gorgeous. Foreign, and has the most beautiful accent. The medical terminology just sort of rumbles beautifully out of her. I'd like to stare at her a lot. And then become her.
But I don't know about this doctor thing. Intellect doesn't usually work out so well for me. It gets me all screwed up. It seems like when I try to use it primarily, I just end up with more questions. No answers. And instead of finding out answers to answerable questions, I try to find answers to the questions that can't be answered intellectually.
I have been thinking lately about timelessness. That has a lot of significance, especially in the realm of the whole predestination/election thing. the absence of causality has huge significance. I just think there's no way we can comprehend fully not being bound by time...things not causing each other...there not being an existence of "before that, this." There is no before. There only is. and not even that, because our comprehension of is, means it's not was or will be. Even more baffling than timelessness is the concept of timelessness and timeness intermingling with one another. How can this be? So maybe it's not that God chooses us, and then we follow Him, and it's not that we respond to Him and then He presents Himself to us, maybe there's much more of a timelessness factor in the whole thing, even in our responses, that we can't understand, because we can't know how our actions and lives are judged and recorded in a world with no time. who are we really? well, in a world of no time, we are all that we ever were, all that we are, and all that we ever will be all at the same time. and we are doing all that we ever did, all that we are doing, and all that we will ever do all at the same time.
This changes my ideas drastically about election and predestination. it makes the debate obsolete in my mind. Does God elect people? And if He does, on what basis?
I can't know. But it has something to do with the enigma of "fair" and "timeless", two things that don't exist in our realm of understanding.
I've also been thinking about the relativity of adjectives. In my world of nursing students at PC, I'm pretty smart. But here, I feel dumb because I am dumb. All these words are relative. Size. Dumb, smart, knowledgeable, rich... How can words like that even exist alone? They don't mean anything by themselves. How the unseen powers must jeer at our evidence of pride by semantics. We know nothing of rich.
And how experiences define words. You thought someone was smart, but then you experienced someone smarter, and you look back, and you think the first person wasn't actually smart. You just thought they were smart. But now that you have a clearer picture of what smart is, the first person and "smart" don't mix.
This is why we have comparatives and superlatives.
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