Fa-la-la-la-la....

Nathan and I are stuck in town for work, so we decided to have some friends over for Christmas Eve dinner.  We were six in total, which is the largest group for which I've done a holiday meal.  I usually make more than what is needed in one meal by default (good at proportions of ingredients to one another, not so good at overall proportions to the size and number of bellies present at a meal), so this time I purposely shot big so that we'd have leftovers after all the effort. 

I forgot to get a shot of the appetizers.  Black eyed pea salsa (homemade), tortilla chips, hummus, chana (dry roasted chickpeas), black pepper cashews, and banana chips.

Dinner included a chickpea tart with cranberry sauce; apple, sage and walnut stuffing; roasted rosemary red c and sweet potatoes; and kale slaw with fennel, carrot, raisin and almond curry dressing.  Hazzah.

I had asked for a new, full sized food processor since my current one was only 4 cups and would over heat with a few minutes, so when I saw the size of a box sent by my parents I decided to open it early yesterday morning.  Used it to make the crust for the tart, the tart filling, and the slaw dressing.  And from visiting Nathan's grandparents last week we acquired the white Corningware, two large serving spoons, and a couple bowls that I used for the salsa and whatnot.  That means dinner's success was thanks to a few generous people.  Nathan and I did not register for our wedding, nor have we ever contemplated a china set before, but luckily we had enough to make a rustic set of six without having to seek out extras.  And, luckily, it all fit on my little table without feeling crowded.

From left, clockwise: Laura, Davis, Brian, Molly, and Nathan

Laura and Davis brought fixings for lightly fried banana and chocolate wontons with ice cream, and Molly and Brian brought a pumpkin pie and big fruit salad.  Laura also brought Prosecco, which I - the constant lightweight of gatherings - left to the others.

I'm loving the fact that the work involved with entertaining means 1) our apartment is the cleanest it has been in at least a year, 2) we have lots of food ready to go for today, and 3) the commute home and to bed was a mere ten steps. 

Today's plan is much more chill.  Morning run, check on the cats I'm kitty-sitting, movie (likely Hyde Park on Hudson), and yummy leftovers.  I'm going to pull out Charlie Brown's Christmas cd, and we'll probably also watch some more Antiques Roadshow. 

To bid you all a humor filled holiday, here is Nathan managing to stop laughing just long enough to mimic my Gramma's holiday card.  Between the card and our own silliness we were rolling for a good ten minutes....

Making it up the stairs

Last Friday was a long day, with a caseload including two extra patients and thus flying from one session to the next by the seat of my pants.  If there ever is a dull moment in a hospital it will surely be made up for with massive chaos soon thereafter.  As I laid down to sleep one particular encounter replayed in tandem with memories from the Montauk Century three (four?) years ago.

Over lunch I got a call from the nursing care coordinator that my patient had been accepted to two different subacute rehab facilities, the first of which is apparently one of the best in the city, but the patient was refusing to go and was adamant about going home.  By the history given by the patient and obtained in the social worker's notes I had assumed the originating nursing facility was his home.  Turns out he was there for the last eleven months, having entered for subacute rehab but was never released for reasons we don't know (safety, being fully informed of a change in living situation, the facility reaping money from insurance...?).

"He won't listen to us.  They have a bed waiting, and it only needs his agreement.  Can you see him today?  Talk to him, something?"  I agreed to do what I could.

Mr. Y had been fun to see for the last two weeks.  He is the hero of all patients in nursing facilities - many facilities neglect patients and leave them soiled in bed for half the day, and occasionally a jaded PT comes around for "therapy" consisting of hip flexion (no functional value those who have difficulty standing up, i.e. weak hip extension), knee extension, ankle pumps, and a return to a soiled bed.  Many facilities don't encourage ambulating when it is difficult because they see it as "unsafe," thus leaving patients in bed or in wheelchairs and allowing them to become even more deconditioned over time.  Not Mr. Y.  His post-stroke mental faculties are relatively intact despite difficulty with expressing himself verbally and weakness/increased muscle tone in his left arm and leg.  He is a fighter.  I have seen inspired patients, but never the likes of this.  He is a man determined to never let a nursing facility limit him.  Instead of allowing physical regression and depression, he will argue for however long it takes until you let him do what he knows he can do.  His survival in a sub-par nursing facility is guaranteed.  But his survival at home, in a third floor walk-up apartment with no family or social support aside from a 70 year old neighbor who can open a can of food occasionally, and with the need to leave home three days a week for dialysis, is not guaranteed.   He would at a home health aid and was borderline for requiring 24/7 care.  The farthest he walked with me previously (and I had seen him five days per week, mind you) was 60 feet, and he hadn't performed stairs in a year if not more.  And yet he refused to go anywhere else but home.

We met at 5:30 a.m. with intentions to head out by 6:00.  Goal: 130 miles from New York City's Penn Station to Montauk, NY on the eastern tip of Long Island.  Our rag tag group was having trouble hitting the road.  One person went for a bagel.  They came back 10 minutes later.  Another said that looked good, and they went off for a bagel.  Five minutes later a third member wanted to use the bathroom. Once back ten minutes later First decided they also needed the bathroom.  Third waited five minutes before saying that maybe a bagel was a good idea.  Yup, that kind of group, and that kind of morning.  I'm trying to not play mom to the group and nag, but we need to leave soon because the day will take longer than others assume.  I look at my watch, trying to be patient: 6:15, 6:28, 6:40.  Finally everyone is ready to go.  

First looks over at Youngin' (fourth person), says "Dude, where's your helmet?"

"Helmet?  What helmet?  Iyyy... aaaahh... errraaahh...  We don't really need a helmet, do we?"  

Fifth (for those counting, including me makes six) glares in response.  After a bit of debate, we determine that his home is along the way to the Brooklyn Bridge and so we will make a pit stop.  We ride down, pull over to the street's edge, take a few pictures and chuckle about previous rides.  Ten minutes later Youngin and Dan (formerly referred to as Second) come back helmetless.  His house keys went with his bag to the finish, and he is too nervous to ring up and possibly upset his father (Youngin' is 20 at this point).  Dan offers his wife's helmet at home, and they take off to get it.  First decides to make a stop around the corner for batteries while we wait.  She and Third take off.  Fifth and I wait another fifteen minutes, pondering what exactly we got ourselves into.  Finally they arrive, the white helmet with hippie flowers works well with Youngin's skin tones, we take off to meet the battery search crew, and finally the day begins.  

I have an aid with me, because I know Mr. Y will want to prove that he can walk.  Just the day before he wanted to show that he used to walk without a walker, and after five solid minutes of arguing I gave in and agreed to a trial so long as we switch to the walker if he needs his hands on something.  He needed to palm the wall or grab my hand, not to mention I had to give him minimum to moderate assistance for balance.  We only made it ten feet out he still refused to use the walker on the way back, so the aid and I grabbed each hand to stabilize his return trip.  So is the persistence of Mr. Y, bless his intrepid heart.  It's hard when you want to maximize a patient's independence but their persistence, regardless if from baseline personality or from altered perception secondary to their condition, hinders their performance. 

So today the aid and I enter, and I begin the conversation about where he may go.  I want him focused, so that he knows that x, y and z must be achieved if he's able to go home.  Two home care groups have declined him, saying they cannot offer 24 hour care and they find him unsafe as per the notes from the last week and a half.  (I agreed and had been recommending even a short rehab stay.)  Home care groups laugh at the notion of getting even 12 hour care.  I tell him anyone who goes home must be able to walk up and down the hall twice, go up and down as many stairs as they have at home, and do it all without any of my help (all this is true, with fluctuating values according to their home setup).  I describe his current need for assistance, and that with his progression and motivation if he got rehab then within a couple week's he'd be okay (which I also believe is true).

"No.  You cannot push me.  They all push me.  Those places just want your money."  He's already sitting up to show he could walk, with large gestures and pointing in our faces.  "I kept asking to go home before and they kept telling me no because they wanted my money.  They did not take care of me.  They just took my money and ignored me.  I'm going home.  You cannot push me." 

You can tell he retains the notion of safety and retains awareness of his abilities, because otherwise he would have been attempting to walk out of the hospital days ago and would have ended up with one-to-one supervision and been labelled as "impulsive."  But instead he has waited for me, even with his anger and huge motivation building ever more.  I try explaining that we have a different facility lined up, one that has very good feedback in terms of rehab and their outcomes overall.  These people will help you get stronger.  He hears nothing of it.  It only makes him angrier.

Talking has hit a wall, so I switch to a plan.  "Here's what we have to do."  I give him parameters, same as before.  I reinforce that at home he won't have us to help, so he's gotta do it on his own.  He agrees, pops up, and refuses to use the walker.  I'm guarding him while trying to persuade otherwise, and his level of assistance and balance are like before.  We get to the door, eight feet out.  He's still refusing to use the walker, but he has stalled, I think because he realizes how much he needs support. 

"You can walk farther if you use the walker.  It will help.  You can go home with a walker.  I need you to walk a long way with the walker so we can show the social worker what you can do."  That finally gets through.  He takes the walker without even looking down, starts marching down the hall with the aid and I flanking him, hands hovering six inches off his shoulders and hips, not knowing if or when he might go down, not knowing his endurance or his mental clarity once fatigued. 

Fast forward through many hours of riding.  Light rain.  Youngin' takes a skid witnessed only by Fifth, comes out unscathed but a little hurt in his ego.  Panda Portraits.  Then pouring rain.  Flat tire (me).  Mercifully a sponsoring bike shop come along with a tube since there's no chance of vulcanizing fluid drying in this downpour.  Multiple aid stations later, we are not the only ones who are seemingly "behind."  More riding.  The rain stops, but our socks are soaked and we've lost body heat.  My feet are completely numb.  

Next aid station I pull off my socks to wring out extra water.  We've come about 70 miles, just over half way.  Fifth uses a winter hiking trick and puts my foot on his abdomen.  Wowza does that work well.  While I recover and stuff my face, Dan decides to take off early so we can catch up in a short bit.  We grab a bunch of food to stuff our faces while riding on, only to be intercepted by a race volunteer who reports that we have been cut off and must decide whether to continue on, without knowing if aid stations will still be open, or if we want to get on the sweep bus to be taken to the finish.  My heart sinks, my face heats up, and I go completely stoic and cold to First, Youngin' and Third who don't seem to care either way "since we got a good ride in regardless."  Completing a task is deeply imbedded in my genetics.  

"Dan is out there.  We need to decide and call him ASAP."  My voice comes out hard and, unintentionally, with disdain.  

One attempt fails, then another.  Different cell carriers make no difference.  Fifth turns to Youngin' and, since Youngin' didn't just have frozen feet, tells him to go pick up Dan and bring him back, but Youngin' hasn't moved an inch because their still talking about something.  I'm was so angry I wasn't even hearing what their banter was about.

I should explain Dan a little more.  You can tell he grew up an athlete.  Pitcher, quarterback, and a history of acting (his current and now long term passion).  But he also has epilepsy, the type that encompasses the entire brain in a way that is inoperable.  In his daily life it manifests something like attention deficit disorder.  But the man is pure teddy bear, and is wildly successful at everything he's done.  You should see the way he glides through traffic.  It's like watching a bicycling version of Stevie Wonder.  You swear he's gonna die, and get in perfect, poetic fluidity he never even has to so much as flinch.  But if you could boil down the human race to perhaps five souls whose heart, actions and life could make us seem actually redeemable to a hostile alien invasion and change their minds - he'd be on the top of the list.  He holds nothing back, he hides nothing, and with more heart and positive joy than most others I know he can accomplish literally anything.  He is so endearing that I am defensive of him and care deeply for his success.  He learned from our two previous rag tag centuries that if he takes less time at aid stations and starts ahead, he can go at an appropriate pace and avoid over-stressing himself, and we'll eventually catch up.  But there's a catch to that.  Yes, we will catch up to him.  But it takes a half hour to catch up to him at our normal pace when he only left five minutes before us.  

They are still discussing something when I hastily don all my gear and helmet.  

"While you all keep f***ing chatting Dan is getting farther away than you think.  Don't f***ing underestimate him.  He's going to be hard to catch.  You DO NOT f*** with Dan."  

And before anyone is able to respond I tear down the ramp and around the corner.  Fifth yells for me to call once I've got him.  I'm worried we won't make it back in time to catch the bus and our out-and-back jaunt will have been for naught while simultaneously wasting more time needed to get to the finish in time for the last train back to the city.    

Mr. Y makes it fifty feet down the hall.  The turn is a little sloppy, but we're trying to place hands on as little as possible. 

"See?  I can do it.  The only thing stopping me before was being dizzy."  Are you dizzy now?  "Only a little dizzy.  I can do it." 

He makes it the fifty feet back, so I bring up the notion of stairs.  Mr. Y's room is near the nurses' station, which is also next to the small lounge that has a mock four-step stairwell.  As we turn to head in, I see the care coordinator and the social worker watching with their heads propped on their hands, in disbelief and with no clue what to do next.  We get to the stairs, get his hands on the rails and move the walker out of the way.  One foot on, second foot on, and both knees immediately buckle.  The aid and I are still hovering, so we catch him and move even closer.  Moderate assistance for the stairs.  On the way down the aid spots from behind while I spot in front.  Stairs remain a no go, a big red stamp on his chart marking unable to go home, but Mr. Y doesn't register this.  Once safely back with the walker I ask his opinion of his performance.  He asserts that he can do it, that he'll get stronger quickly and it won't be an issue.  I point out that was only four steps and that he'd have to do closer to thirty at once. 

He still shakes his head.  "I can do it." 

We swing down a second hallway.  At this point the stairs already indicated that he's not safe to go home, but we're going to use the opportunity to go big.  If he can't go home, I want him on paper to be seen as ambulatory so he does not get stuck for another 11 months at the new rehab/nursing facility.  [For those who don't know, subacute rehab is usually offered by nursing facilities rather than as a stand alone entity or as part of a hospital.  Distinguishing between short rehab stay, long term rehab stay, and simply requiring 24 nursing care are big differences.]  The care coordinator and social worker alternate between shaking their heads and laughing thanks to the difficulty of the situation.  How to persuade him otherwise when he is so determined to have his way?  I cannot speak for others of the team, but I don't want to condemn him to a nursing facility the rest of his life.  And yet I know he's just not quite ready.  We cannot force him to go.  He is still in charge of his care.  But we cannot in good conscience let him sign a paper saying he understands the risks of declining our recommendation of rehab, only to then be readmitted 4 hours later from a fall on the stairs his first day home.  And I wish we could have teased out this performance much earlier so that we could have made stairs into a goal.  Sure, maybe he still would have needed rehab.  But with what we currently have as his performance limitations I want him safe.

I've been peddling in as high a gear as I can tolerate, whipping around corners, hoping with each turn to see any semblance of him.  So many turns.  I think they are all reasonably marked, but if you look around to watch the view you could easily miss one.  I see someone up ahead, scream his name and sigh relief, only to roll up on a different lone rider I don't know.  Crap.  Lone Rider probably thinks I'm crazy by the way I pass like a frantic bat out of hell.  I keep trying to call Dan's phone, keep failing.  

It takes ten minutes of sprinting to catch him, steady as ever.  

"DAN!"  

"Bucky!  Where's everyone else?"  I slow to a stop, Dan stopping in suit.

"The sweep wagon caught us.  The group is waiting back at the last aid station.  We have to turn around."

"What?!?  You're serious?"
 
"Yea dude.  We gotta go before they leave without us."

We take off, maintaining the fastest speed Dan is capable of.  My phone rings.  It's Fifth.  "Where are you [static] ...trying [static] leave [static] ...fast..."  

I scream into my phone.  "Three minutes.  Give us three minutes.  Stall."  The call drops.  I mutter obscenities.  

Dan looks over, worried.  "Is this because of me?  Because of my epilepsy?  Damnit.  I knew it would hold us back.  I'm so sorry.  Damnit."

"NO.  It is NOT because of you.  You've been one of the steadiest riders today.  It's because people kept screwing off, wasting time, and because of Youngin's helmet shenanigans that we've run out of time.  It has NOTHING to do with you.  Those a**holes put YOU in a predicament."  

I get another call, again with lots of static.  "Two more turns and we're there.  Thirty seconds!"  We race into the lot, all waiting on the bus except Fifth, who has loaded his bike onto the truck but has refused to get on the bus and let it pull away.  We throw our bikes on top of the pile, and as I walk onto the bus out of breath I don't dare look at First, Youngin' or Third, who are relaxing like its a party.  My hands are shaking I am so angry.  They try to re-enact Fifth's manipulation of their rule, how funny it was to hear the bus driver yelling at him to board and yet have him taunt by standing 100 feet away and make the walk to the bus last for minutes, repeating "Yes I am getting on the bus.  I'm walking there now."  

I'm fighting back tears.  You joke around for an hour and a half, THEN admit to forgetting a helmet, then pull some I'm-afraid-of-my-dad crap (wouldn't he be glad you wanted to be safer with a helmet??), then put Dan at a HUGE risk.  And you find the situation laughable.  My response?  "That's nice," without even pretending to take my eyes away from the window.  Dan's response?  He sits next to Youngin', and plays thumb war with him.  Dan doesn't take things personally, nor does he hold grudges.  I take note, try to breath, try to stop the waves of anger pouring from the throbbing veins on my forehead.  Third sits next to me.  I stay facing the window.  The bus pulls out.  I close my eyes.  

One hundred fifty feet.  Two hundred feet.  We pass by the nurse's station yet again.  By the time he gets back to his room and into bed he has walked 250 feet with contact guard.  Time to talk reality again.

"We need you to be safe.  I know you will get stronger soon, but for now you need help because of the stairs."  Mr. Y is nodding.  Maybe the opportunity to prove something has made him more agreeable to compromise?

I tell him my recommendation, that he only way he can go home is if he has a walker and, more importantly, he has an aid.  "You HAVE to have an aid.  If we cannot get you an aid, then its too dangerous and you need to go to rehab for a SHORT stay."  He nods after each statement.  "I want you to be safe.  No falls!" 

He smiles as I say no falls.  He understands.  I think he just wants as much independence as he can get.  And I can absolutely respect that.  He shakes and verbally repeats that he must have an aid to go home or else rehab is okay.  I leave his room exhausted, and find another home care rep and the social worker in the hall outside the room.  I describe what he just did, and my assessment of needing help for stairs. 

The home care rep repeats that even twelve-hour care would be near impossible to get, and brings up the issue of how he will perform self care.  Cooking, bathing, dressing.  I sigh and inform her that while I can infer such things, they are properly assessed by occupational therapy; that I can only assess and recommend for gross physical activities.  The social worker brings up the need for stairs three days a week for dialysis, at which I repeat that he'd need an aid.  My official recommendations will be: home PT with 24/7 home health aid for safety and assistance with stairs, otherwise patient will require short term stay at subacute rehab.  Beyond that, from what he's given me to work with today, I can say no more.

We all sigh and nod the unspoken understanding that it all boils down to what Mr. Y wishes.  I trudge off to find a computer so they have the note to fax to whoever.  If more home care companies deny him, then that will be presented by the social worker to help reinforce the need for rehab.  We shall see. 

After a while of watching the horizon swell and fall, the clouds roll past in gray lines, I start to calm down.  I glimpse over at Third, who has brown dots all over her face.  I hadn't noticed before.  I asked if she had been drafting.  The head wind was taking its toll, so Fifth offered to pull her ("pull" meaning take the heat and shield the person behind).  It was her first draft experience.  

"Did it help?"  

"Yea, but it was hard to breath and hard to see where I was going what with all the dirt thrown in my face."  I hadn't the heart to tell her that the draft is pretty wide behind a guy his size, and that he could have fixed his rear fender alignment.  

We chatted a bit longer until the bus pulled up to another aid station.  Turns out this one was 30 miles from the finish, and any able rider was instructed to complete the rest of the route.  We hit the port-a-potties (much more efficiently than this morning), and upon regrouping realized that by the end of the ride we would have accumulated a full century, one hundred miles.  Seems the day was salvageable after all.  I was the first to the ride's finish, collecting and greeting the others as they rolled in.  Dan's face was just as much of a big smile as the other two centuries we'd done before.  I've said it before and I'll say it again.  Never.  Doubt.  Dan.  Dan the Century Man.

At work Saturday I pulled up my patient list for some logistical documentation stuff, and saw the Mr. Y was discharged.  A quick peek into the social worker's notes revealed that Mr. Y agreed to rehab.  They left him all sorts of information, lots of people he could talk to himself.  Even after he agreed, they left information on how he could appeal the decision should he change his mind.  Mr. Y then stated he would not appeal, that he was okay with a short rehabilitation stay.  I found myself smiling. 

Whether he had to prove it to himself or to the rest of us, the man was going to illustrate the full depth of his independence, both physically and cognitively.  I think he needed to know that we were not ignoring him or looking down at him, that we were on his side yet albeit overly controlled with his safety.  I only hope that from the moment he landed at the new subacute facility that he verbalized his game plan of working on stairs, lots of stairs, and, oh yes, more stairs so that he could go home.  And hopefully they have some good occupational therapy there too, to get his activities of daily living bumped up a notch too.  He remains in my mind someone who, despite all odds, will never let life take away his ability to try. 

Bad cats

Merus has been eating like a fiend lately.  She is served oversized meals, and yet that doesn't seem enough.  She scavenges around the kitchen for about an hour after eating in hopes of finding something.  *Sigh*

Last night she decided that the dry food bags on top of the fridge, which have lived there since the cats and I moved in with Nathan, were suddenly fair game:

The bag now has a new home inside a drawer.  Not much later I heard metal scraping.  Turned around to see, and couldn't grab my camera fast enough:

Now, the kittens are nothing if not competitive.  This morning I found the rubber basting brush on the kitchen floor.  I left it in the sink after using it to spread olive oil on bread last night.  Sadie's rubber fetish struck again:

No evidence of any chewed off ends, no pile of orange dotted puke either.  *Sigh*

The half-aero ears indicate plotting.

A modest domestic party

Our good friend (and vicar) John is working hard to upstart a new business, the website of which will go live next week.  Nathan and I intended to hold court at our place, but when John realized he needed to continue working on Thanksgiving we decided to move our cooking party to John's place to as to blend with his sewing party.  The result was a calm and pleasant day.  I was particularly proud of my pie, which was the first time I've made the entire thing, crust included, from scratch.  Hazzah!

I made:
- kale chips (eaten as an appetizer, not pictured)
- Red Red (spicy bean stew of sorts)
- roasted potatoes with rosemary
- nom nom nom pumpkin pie (from scratch, including my first crust)

Brant made:
- green bean casserole
- bacon
- supplied giant smoked turkey wings

Kevin made:
- stuffing
- cranberry sauce
- rolls (warming in the oven, not pictured)
- pecan and chocolate chip pie

John made:
- torch-finished the smoked turkey wings

Nathan made:
- an excellent supervisor ("Can I eat it yet?  How 'bout now?  Um, and now?")

Seems more appropriate to celebrate with my face stuffed: Wowwrrah!

Train karma and a double taper -- Philadelphia Marathon race report

I needed to leave work on Saturday by 3pm to make my 4:05 train to Philly.  Biggest reason: I needed to get to the convention center before it closed at 7pm to get my bib, since no race day pickup exists.  Any later train would have put me into Philly's 30th St Station at 6:30, so I needed the 4:05-5:30 train.  It has also been a work week where a minimum number of patients per day is now mandated ongoing for numerous reasons (reasons for which I will not get into) so I really needed to squeeze in one last treatment for the patient who had declined earlier.  I left their room at 3:05, ran up to the office, speed-typed a note and plugged in my stats etc, found myself uber thankful for outsmarting myself and doing certain clerical items the day before, changed out of my scrubs, and flew out the door by 3:15.  Usually an arrest-stat is the only time running through a hospital is warranted.  With my duffel slung over my back I ran down 7 flights of stairs, the block and a half via the overpass to the train, and nearly felt like I was back in the 800m start from high school what with trying to elbow my way through weekend mullers to get to the A train.  Time: 3:20.

Mechanical voice announcement, next Brooklyn bound A train is 2 stations away; time: 3:23.  I'm at 168th St, and need to go 5 express stops to Penn Station/34th St.  It's gonna be close.  Update: 1 station away; time: 3:26.  I'm rocked back and forth between feet and trying my best to not be one of those futilely annoying people who look up the tracks for an incoming train as though putting on such a display will make it arrive faster.  Eons later (3:28) it arrives.  It's pretty full, but it rolls.  And for all my jittering I am able to make myself read so as to not check my watch every minute while we get through the windy and slow sections between 168th to 145th to 125th.  Miraculously we arrive at 34th at 3:50.  I speed walk to the Amtrak platform, and I end up with 5 minutes to spare before the track assignment is announced.  The mob forms, we all make it on the train, I even have an open seat next to me, and we take off on time.  No traffic to deal with, no slow and cautious driver who rides the break.  We arrive at all stops, including Philly, on time.  I get to calmly walk to the expo past some amazing buildings like City Hall, and I arrive with one hour left of the expo.

I definitely call that a good start, particularly since my participation in the Philly Marathon is all last minute.  I received notice of having a lottery spot for for displaced NYC Marathoners only 9 days prior, and took a chance on my being allowed to come in at 7am the Saturday of travel in order to leave on time.  Since I don't really do phase training aside from the ebb and flow of long runs according to my next race, I hadn't stopped running following the cancellation of NYC the way many others had.  I treated the extended taper by feel, trying to re-establish better leg turnover with moderate distances and yet not get sucked into over-training at the last minute.  The course is flatter than I'm used to running, and I didn't anticipate needing to train for flat and speedy until late winter for Boston.  Lots of unknowns.

The feel of the Philly M is quite nice.  It's a big marathon what with over 20,000 runners, and yet is nowhere near the headache to get to the start as it is for something like NYC.  They said to get into corrals by 6am in prep for a 7am start.  Really you could get in five minutes before starting and you'd still be okay.  From negotiating an unknown city and unknown start area I got there at 6:15.  There were a few schmucks waxing negative about NYC not giving refunds (helloooo, just because the event was not held does not mean the equipment wasn't already rented for multiple weeks and that all items like shirts, bibs, post-race heat sheets/fleece blankets weren't already paid for and received), but on the whole people were relaxed and happy to be there.  The feel was much more like the NYC Half.  And that was fine by me.

NYC runners were given two separate corrals that fed in parallel to the original six corrals.  Their waves take place every 3-4 minutes (NYC was going to have 4 waves this year filled with some 30 corrals each).  We didn't realize this.  At 7am the elites took off.  I had doffed my giant trash bag in prep to start, and the small shivers turned into big full body shivers while we stood there watching the time clock roll and waiting.  The first age-group corral lets loose.  We waited.  We were maybe 50 feet from the start line with an open expanse ahead, and yet we couldn't go yet.  Four minutes go by.  Full body shivers become full body spasms.  The second age-group corral lets loose.  We still wait.  We get to 7 minutes of waiting.  My hip abductors are starting to cramp from all the shivering.  The volunteers are mistakenly told to let us forward, and before an organizer can correct them we've all started pushing through the breach on one side.  Note to Phillians: you cannot stop an impatient NYC mob.  It's not that we can't listen or can't follow directions.  It's that the directions seem somewhat counterintuitive as to what we judge for ourselves, so we will do as we wish.  Thanks in advance.

And so, some 8 minutes after the gun, we are off.  I hadn't realized my feet were numb until then.  No matter.  By a mile into the race I was feeling much better.  By 4 miles in I had removed my arm warmers.  Philly is relatively flat, plus it has narrow streets what with being an older city, so it makes you feel really fast.  Each corral is quite varied in terms of ability, so the faster crew from NYC played Frogger for the first 6 miles.  I ran on the sidewalks a lot.  I think the other issue was that even though we may have been ahead of many slower marathon corrals, all half marathon corrals had already been released so you had to get through all run-walkers and those who prefer to run in groups of four though do so in side-by-side fashion.  But because Philly was that much more chill than NYC there was plenty of space and opportunity to jump on the sidewalk during the first few miles if needed without clobbering pedestrians.

I had 6 salt pills with me, and I was glad I had them.  In my freezing frenzy I started faster than advised, averaging ~7:10 miles.  By the time we hit half way I was already feeling heavy in my legs. So I upped my intake from 1 pill per hour (based on the amount I was sweating) to 1 pill every 30 minutes.  Yet another time when Traprock memories loomed.  I had two gels with me, one intended for mile 20 since it has a mega caffeine boost.  I downed a gel every 5 miles, and luckily Clif was the gel sponsor and I was able to pick up two gels mid-race for use at mile 10 and 15.  My pace was slowly decreasing with each 10k, and I had to keep redefining my cruising speed to avoid imploding.  I had enough rest stamina-wise thanks to the double taper, but my legs felt like they were two weeks overdue from a break from the roads.  So from the halfway point to the end was all about hamstring mitigation.  I kept doing the math, and I wasn't so sure I could hold pace enough to equal last year's 3:21 pace.  Pre-Sandy I had hoped for 3:15.

This is when the 50 mile experiences really helped.  You still have your mind intact, and you've experienced something way more painful than the current predicament.  By mile 20 I had to force myself to relax into a short though normal stride, but I was able to minimize the peg leg bad form that was starting to wreak havoc on my left leg (the side with more chronic patellofemoral and ITB stuff) and my right hip flexor out of compensation.  Math check: If I could hold 8 minute miles, then I could just maybe get within reach of 3:15.  Four miles to go, and my stride is getting smaller and smaller.  Solution: arms!  This will sound judgemental when I'm not meaning to be, but those who think you don't run with your arms have never really run before.  This point during NYC 2011 was when tunnel vision started setting in.  Thanks to the salt pills this year was just dying legs.  The 8 minute miles were holding somehow.  It sure as hell wasn't easy.

Other memories came back from the NYC Half, which was total complete desperation at the chance to finish under 1:30.  With so much stiffness and fatigue you can't suddenly unleash a manic beast, but with one mile to go I probably looked like I fist pumping my way to the finish line in my penguin waddle-sprint.  But, miraculously, my body complied.  I was able to pass those who had passed me four miles earlier and were now paying for it.  And I managed to squeak in under 3:15.  I couldn't straighten my right hip for another half hour while baby stepping through the finish festival, but I was very, very happy at being able to revive the end of this year's race season into a personal best.  It also means I get to up my seed at Boston in the spring.

Eventually I picked up my bag and changed clothes, which was a 15 minute ordeal.  Some NYC runners were meeting a restaurant/bar north of the finish line, so I slowly meandered north to keep myself moving and hopefully get warm again.  I got there an hour before the room was reserved, so I sat at the bar and watched football while sipping warm coffee and eating a treat of french toast (which I realized I hadn't had in years).  In the end the other runners were much later in getting there, and I had to leave for my train before they even started to head over.  But it was a nice little place with good food, and I actually enjoyed the quiet of sitting with myself in reflection of the last year as a whole.  And when I got back to the train station my train was on time, people actually line up for trains in Philly (Did you read that correctly?  They LINE UP.  I almost fainted...), and when I got back to Penn Station 10 minutes early an A train arrived exactly when I hit the subway platform.

Everything went smoothly for Philly, and the race was a surprising personal success.  It was a nice way to end the year with a bang, and a good solid effort to make me want (and thus comply) with a few weeks worth of yearly off-season. 

Longest taper ever.

Numerous marathons throughout November and December opened their doors to those left race-less by NYC's cancellation.  I am one of 3000 lucky enough to be selected via lottery for the Philadelphia Marathon this coming Sunday. 

NYC's cancellation was not that big of a loss to me since my big race for the year was Virgil Crest in September, plus that was by far the more appropriate decision under the circumstances.  But I realized that after a taper period I will be too antsy to allow myself a genuine rest period unless I have a race to exhaust myself.  I may have knees twice my age nicknamed the Old Ladies.  I may be early to bed and early to rise in total opposition to all others my age, and I may scoff at going out if it means leaving home after 7pm.   But, for better or worse, I am still the annoyingly energized puppy that needs lengthy, daily constructed play time so that I don't chew up an entire closet's worth of shoes.  Or in Sadie's case, yoga blocks and shoe laces and foam rollers and the box spring and power cords and.... 

So be it.  Philly, here I come.  Who knows what result will come from the double-taper, but it will let me finally take my off season before the slow build up Boston.

Hurricane Sandy - the day after

Hamilton Heights may not be the classiest of places, but because it is on a hill (something like 120 feet above sea level) we were safe.  We also retained electricity, hot water and internet access the entire time aside from a few light flickers.  Occasionally we felt a subtle building shimmy, and a few times I wondered if a bedroom window was going to stay in place while we were asleep.  That was the worst of it.  We are lucky. 

The New York Times posted a particularly interesting time-lapse video from the 51st floor of their building on 42nd street.  

I had Monday off work as a regular part of my Tuesday-Saturday schedule.  Nathan's work closed because the trains were shut down Sunday evening.  I didn't know what to expect during Tuesday's walk to work.  With such a foul weather lead up I had assumed it would take just as long to die down.  In the end I got patches of sun and only occasional wind.  Nathan returned to work today (Wednesday) via foot.  Tomorrow the subways are returning with partial service, meaning operating on one train per track in those area unaffected by water damage or power outages.  The A train runs local from 168th by my hospital to 42nd street by Nathan's store.  Again, we are lucky. 

Here you'll find photos of the damage found uptown.  Fell trees, an occasional broken car window, mild flooding in an area where common even with normal rain, tattered deli signs.  The crux of the clean up is sweeping away all the leaves.

It's a downright boring story for us, really.

(All photos taken Tuesday 10/30/2012.)

South bound west side highway, closed with boggy ankle-deep water.  Workers had to find and manually unclog drains one at a time.

Along the bike path/west side highway, view of Jersey across the Hudson.

Subways were closed. This station still is.

A cemetery on 155th St at Broadway.

A downsized staff working to maintain full operations.

12th Ave, ~136th St, mere feet above the Hudson River, which is on the other side of the building.  Over the retaining wall starts Hamilton Heights, our neighborhood.

Another view for perspective.

Same retaining wall.

Riverside Drive at 165th St, next to the dog run and NYPresbyterian.

Same trees, view of their remaining trunk.

Downed sign on Broadway ~160th St.

One of numerous exits from Riverside Park, ~104th St (?).  Trunk sections were over a foot in diameter.

In the area where we were almost hit by a falling branch while out being curious idiots.  The van was not so lucky.

Hurricane Sandy [updated]

7:15 a.m.: Hudson River, from Riverside and 135th St

9:15 a.m.: Hudson River, from the bike path ~ 150th St

Midday update:

12:30 p.m.: Again from the bike path, now with spittle rain and an increase in waves.  And ducks.

Evening update:

5:20 p.m.: Felled tree, Riverside at 147th Street

6:00 p.m.: Hudson River in the southern shadow of the George Washington Bridge

6:15 p.m.: Trees previously intact on our way out to the Hudson were down on our return trip.  This one missed us by about ten feet.

Yea, we're those jackasses out wandering in the pre-storm with cameras.  But we are safely indoors now that the real post-tropical cyclone >50mph winds and rain are in full stride.  Our building, which directly adheres to neighboring buildings, has shook a few times.  And our bedroom window seems a little sketch.  Not as in leaky, but as in the whole window shimmies.  Merus has been laying on someone's lap quite literally 95% of the day.  Sadie only got freaked out an hour ago when the real stuff started and our phones started chirping with emergency alert texts.  Earlier, though, they were like this:

The curse is broken

For the last couple years, foul weather capable of temporarily incapacitating a city has only struck when I was traveling to/from the midwest.  There was the blizzard of December 2010, the east coast earthquake that shook the Financial District in August 2011, hurricane Irene one week later in August 2011.... 

I've credited Nathan with breaking the curse, as the two times I've flown to Missouri have been without incident since he accompanied me to Sam and Kristin's wedding a year ago. 

The difference?  Now I get to experience the natural disasters myself.

Cue hurricane Sandy. 

And oddly enough this one has decent timing for me, all things considered.  Hurricane Irene blew through on the day of the Bronx Half.  The Bronx was my favorite, since it ends up slightly smaller in size and with the most hills of all the borough half marathons.  I spent much more time than necessary choosing between a mid-August visit to KC and a return for the Bronx Half, or a late-August visit and the TNF KC 50k.  I ended up choosing the 50k, and I got lucky.

Since I'm running the marathon again this year, I've been eyeing the storm (ba dum dum... dumb...) so that if it hits NYC it will hit mid-week rather than marathon Sunday (November 4th).  So far so good.  At the same time, it does not interfere with my last long run, nor does it interfere with my last shake-out run (i.e. hill repeats) prior to the big day.  It also should not interfere with the expo that starts on Thursday.

The biggest difference is that I work at a hospital.  Hospitals do not close during such pesky things as hurricanes.  We are given extra time to get to work, but we are still expected to show up to work on Tuesday.  I am also still in my probationary period, so I do not get days off.  I usually walk the 1.2 miles to work, which equates to 2 subway stops.  The subways will likely shut down Sunday night at 7pm.  Yet another time I wish I had invested in waterproof pants, the main piece of gear I always find theoretically practical yet talk myself out of, only to tsk tsk myself at times like these.

On the plus side, I may be able to get some video (carefully, of course!) of the hurricane as I trudge through it.  Wouldn't that be cool?  Me getting side swept by all the piles of garbage that so decorate this city while crawling at 0.5mph towards the big NewYork-Presbyterian banner declaring "Great things happen here." 


Great may be a relative term in this case.  And no patient gets to argue against "I trudged a mile through a hurricane just so that you could walk today.  Now move!"   

And, since the route to NYP dips down and reascends regardless of your chosen route, I will have the pleasure of telling my future grandchildren that it was uphill both ways.  Hazzah.

11 days

Eleven days until the 40,000+ sized flash mob that is the marathon.  Mission for the next week and a half: keep calm and carry on.

A coworker says I cannot go by "Ms." once married.  Apparently I have to go by "Mrs."  Why?  Because Mrs. means you are nice, while Ms. means you are not nice.  I make pointless arguments about wanting my "title" *ahem* to reflect me as an individual rather than "Mrs. [Husband's first and last name]."  And since she cannot remember Nathan's last name, her attempts always end up rhyming with my last name.  The hyphened version ends up being "Buckles-Ruckles."  I actually think its cute.  New nickname, it seems. 

Merus had her two-week checkup with the new vet.  She responded very well to the antibiotics, the infection is gone, her gums are the closest to a normal pink since who knows when, and she has voraciously eaten her way back to a realistic (albeit still somewhat light) weight.  Plan: symptom management if/when they arise in the future.  Gingivitis, when chronic like her's, tends to be chronic regardless, so that's the best thing to do since amputating their entire mouth is not an option.  So far so good.  Last night she tried to steal away with homemade chickpea-lentil-curry crackers.  Crackers.  Seriously.

October has brought much of the rain we could have used over the summer.  And we've had genuine autumn weather for more than the usual two weeks.  Love it :)  But when it isn't raining, the moisture in the air has produced some lovely sunrises and sunsets, like this (worth it in full size):

Not back for the camera on my phone, right?

We've created a monster

Merus's gingivitis came back with a fury.  The previous vet (Dr. O), who did her extractions in June, was either unable or unwilling to figure out why the screams and food sensitivity and weight loss secondary to not eating were occurring again.  So she's seeing a new vet (Dr. P).

The difference is significant.

Instead of limiting the evaluation to a 2 second glimpse in her mouth that sends her screaming off into the corner in pain, Dr. P sedated her to get an actual and thorough look at the entirety of her mouth.  Findings: continued raging gingivitis and some ulcer-like lesions on her gums secondary to infection, weight had dropped to 6.8 pounds (she was 9 pounds when first adopted in June 2011, 7.5 pounds after her extractions in June 2012), and significant dehydration (skin tenting! gah!).  She got an IV while she was out to rehydrate.  Instead of a pain med via oral liquid 2 to 3 times per day (buprenex, which makes her live in an opioid fog, not to mention is time sensitive and thus lapses with pain breakthrough because of being gone at work and/or from her hiding where I couldn't find her - can you tell I wasn't a fan?) on top of an oral antibiotic, we now have a long lasting pain shot performed in office and a once daily oral antibiotic.

I never knew a 30-day lasting pain shot existed.  I would have laughed in your face if you had claimed such before this.  But it works.  Magnificently.  It's not meant to be a human convenience.  Rather, it makes SO much more sense in terms of maintaining good pain control for an animal.  They don't understand the idea of a medication schedule, or the importance of consuming the entire therapeutic dose.  Now instead of 4 or 5 oral affronts per day to allow her to eat, Merus has only one antibiotic dosage per day.  BIG difference when their mouths are the source of pain and the method of medication administration. 

The other difference is Dr. P's office recommended using baby food so that it is super smooth.  I'd been mashing wet food to smithereens with water added to try to make it easy to lap up, but with mixed results.  Baby food is ridiculously smooth.  And our cheap-and-crusty-but-nearby grocery stores carry a few meat in meat gravy purees varieties.

The combination of everything has worked so well, in fact, that it has created a monster.  Sadie will start meowing for food within an hour or so of feeding time.  Now Merus will meow all day long.  Walk by the kitchen area?  Mrrrowww.  Stand up from the bed (the farthest away you can be in this apartment from the kitchen)?  Mrrrowww.  Change out laundry loads from the washer?  Mrrrowww.

Look up from your computer?  Mrrrowww.  

Phone rings?  Mrrrowww.

Pick up your soup spoon while eating lunch at work 1.2 miles away?  Mrrrowww.

Turn over in your sleep?  Mrrrowww.

Her meals are ~150 calories per meal since she is underweight.  For reference, an 8 lbs cat needs ~115 per meal to maintain weight.  And yet no matter the calories or the volume consumed she is friggin' insatiable.  The litter box is all kinds of extra stinky these days.

After dinner last night I heard glass clinking while in the bedroom.  Investigation found this:

Nathan has pulled her out of the bin not five minutes later.  Cute that he thought placing a towel over the top would deter her.  

We are just starting the second week of the two-week antibiotic course.  We go in for a check up on Monday so see how things have progressed and to decide what the next course should be.  My guess is significant interventions will be needed, because while she was sedated at the first visit Dr. P did the blood work necessary prior to surgery.  But that will be determined in time.

For now I just have to deal with having two Bad Cats....

The Party.

I walked into a calm room, my patient asleep, roommate and roommate's husband quiet.  I gently wake the patient and take my time navigating the patient into our ambulation session.  Due to personalities of the morning that had to be seen due to impending discharge, I was not able to get to her room at the late morning hour which had previously worked well.  People with Alzheimer's do better with consistency, and they do better in the morning due to what is called a sundowning effect.  I was pushing my luck with 1:30pm, so I strove to make the transition as calm and easy as possible.  The orientation phase going smoothly as previous days, a good sign.

A PT popped his head in to the room.  "Are you seeing the other patient in this room?"  I respond a simple no. 

I again work towards re-orienting my patient to the fact that she is in the hospital, and that it why her room seems different and messy.  That the footsteps she hears outside are other nurses and doctors.  That we don't need a coat because we will be staying inside.  I have to lean in to speak close to her ear so that she hears and understands everything.

An OT comes in to see the roommate, who is on the other side of the dividing curtain.  She has a brassy voice in the first place, but the roommate is also partially hard of hearing.  Loud discussion between the roommate, OT and husband ensue. 

"Who is that?  Who is there?" 

"It is the OT to see your roommate." 

"Someone should tell them that this is not an appropriate time to have a party." 

I re-orient to being in a hospital.  She mentions the coat again.  I re-orient to our staying inside. 

The roommate's nurse enters.  Apparently there is some question that is now involving multiple opinions.  Four voices go back to being three, then the PT comes in again to consult, then two doctors pause within five feet of the door to discuss something from down the hall.  My patient has a hard time hearing me over the others, but we are able to get up to start our walk. 

But once vertical, the visual of an unrecognizable room meets the audio of unrecognized voices.  She begins to get frustrated about the clutter in her room.  The noise has surpassed her threshold, and I can tell that this won't end well, nor will the path run smooth.  At this point we have not walked, only stood, but for the sake of her safety I will run with whatever direction she gives be it a walk or a return to bed or something else entirely. 

I offer a handhold assist, which we have used successfully for the last two days. 

"No.  I don't need it.  I take my privacy seriously.  No one let's you have your privacy anymore.  I can't move when you hold me back." 

"I'm only here to make sure you stay safe." 

"Oh, good.  Thank you." 

"You're very welcome." 

"Oh, sure, [mocking tone] you're very welcome."  She sticks her tongue out at me.  Bad sign. 

"Would you like to go back to bed and get comfortable?"

"I can't get comfortable.  I don't want give up that easily."  She starts to walk toward the door, so I follow and guard, cautious that yesterday she was minimum assistance for balance but today rejects any offer of assistance. 

We come within two feet of the door, and the nurse practitioner walks up.  "It's good to see you up."

"What?"

"It's good to see you up."

"Oh, okay."  She fiddles with her hospital bracelet on the left arm, and with the wound dressing on her right arm.  Both arms and legs show signs of slight edema, just enough that her socks and bracelet and all other apparatuses fit tightly, so she fiddles with them out of noticing their presence but not understanding what it is.  The NP notices, takes her hand.

"This looks a little tight, does it feel okay?"

"Does what feel okay?  This room is a mess."

The NP quickly realizes that she added too much on top of the activity at hand.  But instead of a gentle apology and exit she attempts to explain herself.  I keep my sigh to myself, waiting, still guarding.  After a full minute of bumbling discussion that does nothing to soothe the patient, the NP goes to check on the situation with the roommate.  Five voices.  A joke, followed by laughter.  My patient takes one step to the right diagonal.  Pauses.  Turns and takes a step to the left.  Pauses.  She doesn't know where to go, or what to make of the scene.  I'm dying to get her back to her bed.  She doesn't deserve to be bed bound, but the usually succinct OT session is obviously not going to end any time soon.  To have her ambulatory while riled up could become dangerous if she doesn't allow me to continue guarding.  Last thing I want is for her to become so upset or so fearful that she falls. 

"There's just too much.  Too much people.  People with their parties."  I offer to go back to her bed.  I try to emphasize that there is something home-like about it to draw her interest.  She has none of it.

One of the nurses who was already one of my favorites looked up from a nursing cart.  The nurse has had my patient before.  She gives a knowing face of the difficulty when the patient is confused.  I motion for help, saying that it's too loud to get her back to her room safely.  We are a mere 15 feet away from her bed. 

The nurse takes her hand, begins anew with re-orienting the patient.  It takes a dozen exchanges and a full minute for each step, but this nurse understands the safety issue and is very patient with keeping the patient on board with the return to bed.  At this point I let the nurse guide verbally.  Because of the time that has now passed in an agitated state, I have become associated with the offending noise and privacy invasion.  I don't fight it.  I'm only glad the nurse is able freshly re-achieve a voice of calm separate from the rest of the chaos, despite having been another addition on top of everything else.  You use what works. 

Slowly, eventually, we get to standing next to her bed.  The "party" is down to three voices, but it is still loud enough.  I move myself to standing behind my patient where she cannot see me, because having the nurse in front is enough to keep her upset about sharing a small space.  We re-orient her to the fact that this is her bed, that this is a hospital.  Eventually she sits on the side of the bed.  I am still there in case she needs assistance with sit-to-supine, since I'm not sure if/how her function changes when agitated. 

The OT calls over to me, asking if I have the roommate on my caseload. 

"No," I say softly.

OT.  "Is everything okay?"

Nurse.  "It's the party.  It's a little too noisy."

OT.  "Party?  Hah!  What party?!"  Still brassy and loud.  They are walking toward the door, passing by the foot of my patient's bed.

Nurse.  "The noise is too much for her.  We'd like to keep it quieter, if we could."

OT.  "Okay."  Still brassy.  They pause as a group, all within view of my patient, all looking.  "I just wanted to see if Laura has this patient on her list." 

I shake my head.  "No, sorry." 

OT.  "Okay.  Thanks."  They continue walking out, continue talking.  Pretty sure they failed to realize that the noise was an issue.

Patient.  "Why does she have to be here?"  Pointing at me.

I can take the hint.  "I'll leave you with your nurse."  The nurse nods that she's okay.  I take my leave.

Forty minutes.  That's how long it took to orient the patient, by happen chance get her agreeable to stand, have things go south, and then the time required to return the patient to safety.  You cannot predict, but it still weighs heavy on my heart to have contributed to the exact opposite of what this patient needed.  Would she have become agitated by the "party" had I not woken her, had I not added physical activity to the list of offending overstimulation?  Logic says possibly.  My heart says probably not. 

PT fail.

Tomorrow she goes early, come hell or high water.  The other patients can simply wait their turn.