How To Use and Elevator

How to use an elevator:
1. Push the up or down arrow ONCE...repeatedly pushing the button does not make the elevator come faster. It also does not help to push an already lit up button.
2. Wait patiently
3. Move to the side an allow people from inside the elevator to exit
4. Calmly walk into the elevator and push the button for your floor ONCE
5. Stand quietly and wait for your floor
6. Repushing your floor number at each stop does not make the process faster
7. Exit the elevator onto your floor

Common elevator courtesies:
1. If you can walk and the stairs are next to the elevator and you are just going up or down one floor, you should probably take the stairs.
2. Smoking before entering the elevator makes asthmatics wheeze and others want to vomit
3. Perfume gives everyone a headache
4. Control you kids
5. Do not hold the elevator for your family that is still unloading from the car. Just wait.

The elevator is the cause of so many daily frustrations. It makes me angry.

Life Changes

Life can change in the blink of an eye. This isn't a new thought but it has never meant as much to me as it does now. While 2011 hasn't been terrible, it certainly hasn't been smooth sailing. I have learned a lot about human behavior and response to difficulty. I have responded to situations in far different ways than I would have ever expected. I have been inspired by the way other people have responded to their own trials. Throughout my life I have found comfort in the words my parents used to alleviate my childhood anxiety, "God doesn't give you things you can't handle". I'm sure those weren't the exact words but you get the point. So, of course I believed that I was safe from serious illness or trauma..."NO way could I handle cancer or major surgery..." But then again I was pretty sure that I would slip into a very deep depression, necessitating a feeding tube for nutritional needs, when Paisley died. I somehow managed to grieve the loss of my soul dog while maintaining my adult duties, which included eating.

Now I will likely be faced with  the subjects of my worst nightmares. Since learning of the hole in my heart I have done what any dedicated nurse practitioner and knowledge seeker would do. I have read EVERYTHING about congenital heart defects. That right there is a shocking thing by itself. I have a congenital heart defect...it sounds strange. I know all about the 3 types of ASDs and the associated defects. I know why people aren't always diagnosed in childhood. I know the difference between PFOs and PDAs and VSDs and ToF and PS and PVR and Mustard procedures and OHS etc. I know that there are only 2 ACHD clinics in AZ. I know that ACHD stands for adult congenital heart defect. I know about shunts and pressures.  I am also beginning to believe that I might not have any idea what "normal" is related to cardiac health. Things that I thought were totally normal or possibly related to high anxiety are actually more likely caused by this damn hole in my heart. Seriously, it is not normal to feel your heart beating ALL of the time?!

Unfortunately, it is the things that I don't yet know keeping me awake at night. Wednesday can't come soon enough! I can't wait to have a moderately invasive and highly uncomfortable (if I am not properly sedated) test completed so that my cardiologist can tell me exactly what kind of hole I have, how big it is, where it is located, and how it will need to be fixed.  No matter what, I just want it fixed NOW. I want to move past this detour in my life and recover. I am excited and full of optimism that if I no longer have a hole in my heart I just might turn into a VERY active person. With 6 pack abs and the ability to run a half marathon even though I hate running! Maybe I will develop a love for pounding the pavement. How cool would it be if I were able to hike without fear of quitting early or embarrassing myself with a slow pace? I have just accepted in life that I wasn't blessed with amazing athletic ability. For the most part I have payed attention to my fitness throughout life but was always perplexed with the disconnect between my effort put forth and objective measures of physical fitness. So the constant "what if I need open heart surgery to repair my heart" question that is circling in my head is tempered with my hopes of becoming an amazing sheet of muscle!

ASD PFO VSD BBC

I have a tendency to obsess! My mind can get stuck, moving in rapid circles trying to analyze and conceptualize one subject. This is especially true for health related topics. My job plays into this weakness, or possibly strength I have been given. Give me an obscure clinical picture and I will not only look for possible zebras but also for the unicorns. Horses are boring. More all-consuming and detrimental to my overall well-being is my own health, or rather threats of health decline. Basically, I have a hole in my heart. It has been years, actually more than a decade, since I have had vague cardiac symptoms. Cardiac workups were all relatively normal and it was all blamed on anxiety. "You are just sensitive to catecholamines." Great! I have since accepted that and lived with it. Normal for me is fast heart rate, awareness of every heart beat, shortness of breath with minimal activity and a general sense of being more tired than others. But I have done a good job of ignoring and compensating and living. But now I have learned that there really is a problem...a congenital heart defect...a hole...I don't know exactly what kind or how big this hole is yet. I need another test first. I have earned the most amazing opportunity to have a long probe shoved down my esophagus to get a good look at my heart. I am sure this will feel awesome! (sarcasm) Actually, I really shouldn't feel anything or be aware of anything with the right mix of sedatives. The looming question is, "How will it need to be repaired?" I have found peace with a cath lab repair but am a bit leery of an open heart repair. So I am hoping, praying, and crossing my fingers for cath lab repair. Open heart will take an influx of strength, trust and faith...and probably some daily anxiolytics prior to surgery. My mom and Hez will probably need some too! So hope for a PFO, accept the liklihood of an ASD but hope for ostium secondum asd, doubt the vsd and come on BBC-Your show, "Luther", is way too short! 10 episodes in 2 seasons? You have sucked me in and I am obsessed. Now you make me wait for season 3. mean.

How do I communicate "moron"?

I recently dicussed communication styles with friends over Postino's bruchetta and wine. The managers in the group have taken classes on identifying how different employees communicate. Apparently this ensures that everything runs smoothly by providing every employee with an effective voice. BUT, my question was, "How do I communicate moron"? I understand that some people are assertive while others are passive. Some people like to analyze data and some like to create. But what about the rest of the population (I'd say about 98% of adults) who do not have the brain capacity to even entertain such high level communicaton skills? It is possible that I have a skewed sample, thus believe that most people are idiots. It scares me. IS America becoming dumber? Less able to interact in the real-life, non-virtual world? I am impressed at the number of blank stares I get in the course of one day. At times I feel self-conscious and doubtful of my abilities to effectively communicate. How can so many people have difficulty understanding simple instructions and/or explanations. Why do I walk around with the same song in my head everyday? "Only stupid people are breeding..." Is the stupidy a result of poor education, language barriers, apathy or legitimately low IQs? Whatever the cause, I need to develop a better coping mechanism to deal with the morons of the world. It is stupid that stupid people have enough power to make me so angry in my day to day life.

Entitlement and the Decline of America

Entitlement is to blame for the rapid decline of the Great US of A. Entitled people expect and demand privileges. The have a delusional belief that they are superior to others. They enjoy manipulation and controlling people and situations. We are a nation where narcissism extends far beyond the DSM and into the core of our infrastructure. What happened to reciprocity? The Golden Rule? If you come to my aid I will repay you in some way or at a minimum I will thank you over and over. With entitlement there is demise of reciprocity. There is no sense of repayment, rather entitled people simply expect others to meet their needs. In health care, it is evident that entitlement and narcissism control the system.

"I am very busy. I am in the emergency department because I am very sick. I demand to be treated immediately. And I expect the Cadillac of all work-ups. Yes, I want a stat MRI of my back. Yes, my pain has been present for 2 years, that's why I must have a stat MRI. You won't order an MRI? I need to speak to the hospital manager. The hospital president. I will call my lawyer. I will absolutely not wait overnight for the MRI. I am leaving. You will be sorry."

This is not a far-fetched situation. It happens every day. In health care alone, Americans are demanding more and more. The health care industry enables this behavior. Heaven forbid a patient leave unhappy. Enter in the customer service push in emergency medicine. You wonder why the use of percocet and other opioid pain killers has increased exponentially over the past 10 years. Everyone wants them and providers dare not say no, because management will be notified that the patient is not adequately being treated. It's a losing battle. We have developed a system that cannot sustain itself, which is obvious.

There are so many social realms in which entitlement has taken the throne. It is all the same. Without reciprocity our society will crumble. We will lose.

Anarchy

I loathe the word "commentary". The definition can be either positive or negative, but I almost always associate this word with the negative. Criticism or Critique. My patients typically do not enjoy the "running commentary" on their thoughts provided by exasperating auditory hallucinations. I do not appreciate commentary regarding my commentary.

I also do not take well to being told, "You shouldn't..." First, and most obvious is the fact that I do not like being told what to or not to do. Ask my parents! They will confirm this. I don't view this as a completely faulty personality trait. I think it has actually gotten me to where I am now, both personally and professionally. I also just find it condescending. It's not really worth your breathe to tell me that I shouldn't do something because I can probably rattle on forever about everything I do that I shouldn't.

I shouldn't:
1. Cuss: I do. A lot. I try to censor when necessary.
2. Sleep In: I hate mornings. I hate my alarm clock. I am not naturally set to rise early. I like the night.
3. Hate Myself: I don't actually hate myself, but I certainly find it hard to love myself. I am "should" love my body, but I don't. I am embarrassed by the shape it has taken.
4. Eat Processed Sugar: I try not to, but I do. I can justify it by mixing sugary goods like peanut butter cups with frozen yogurt. The yogurt is "healthy".
5. Judge: I silently judge everyone. It's not always bad.
6. Lie: Sometimes I do. I'm not a good "big" liar, but a little white lie here and there doesn't seem problematic to me.
7. Break Rules: I LOVE to break rules! I believe in the philosophy that one should not ask for permission, rather ask for forgiveness. Rule breakers make history and create revolutions.
8. Be Late: No matter how hard I try to be on time I am usually a few minutes late. Unless my life or some other life depends on my timeliness I will likely be a bit late.
9. Hold Grudges: I have a hard time forgetting. I might bring up prior lapses in judgment, stupidity, or thoughtlessness from years ago, if we fight again.
10. Put "Real" Trash in the Recycle Bin: I'm sorry! Sometimes, I don't want to exert the energy to mentally sort out what can and cannot go in the blue bin.

I could go on, but I should stop.

Paisley

She is breathing noisily on my arm. I can feel her breathe; hot and wet. It is faster than it has been in the prior 7 years. It keeps me awake. Worried. On edge. But when it slows and becomes more quiet I am also awake. I have joked in the past that I must have some form of autism, because I really do like my dogs better than most people! I'm pretty sure I have always been a bit extreme on dog spoiling...she has a car seat! But, I always assumed that Paisley Star would live her full life span of 18+ years. I have gained acceptance of the fact that I will never have a rug in my home until I am approximately 40 something years old. That is just one of many sacrifices I have made out of love for my dog. Now, I am just hoping for one day more and then another and another etc. I come home each day with a slight pang in my chest for fear that she won't be alive. She has this way of looking at me that makes me believe that I am the most important person in the world. She depends on me entirely and in return she gives me all the love that her 11 pound body can give. I have to credit her with getting me through some of the toughest times in my life. She listens without passing judgment. She never gives advise when advise is not needed (well, actually she never does). She never interrupts and never interjects her opinions. She just cuddles and gives a few licks here and there. I can't stand the thought of losing her to a terrible disease. I have done everything to give her the absolute best chance at survival and nothing seems to be working. I'm not giving up hope!! But, I'm also not naive to the facts. If love itself can cure, Paisley should be making a full recovery soon. I love love love this dog. (some of you may think I am crazy, but that is OK)