So for my work in the hematology lab, I have to get 12 hours of education on pertinent topics every year. I get most of my opportunities from speakers the hospital hosts, live or by video. Today I watched one online about changes in healthcare as the affordable care act goes into effect. Changes include focus on ACOs and ‘medical homes’. ACO stands for Accountable Care Organization and they are like networks of different medical professionals. A medical home is a primary care location/doctor. The dual focus is supposed to provide lower cost. ACOs make medical records easier to share and specialized services easier to find. Having a medical home means patients have a single doctor who oversees their results and hopefully can compare it all for best care. Another area of focus needs to be patient involvement. With so much information available it only makes sense to have patients paying attention to their own results. I’ve already seen some of this in my own care. Rather than a “you’re fine” I actually got a list of my chemistry panel and complete blood count.
So long story longer, a really big thing that stood out to me was a mention of patients choosing to utilize the emergency department as their primary medical home. Hospitals want to discourage this because the care in an emergency room setting is more expensive to provide than at a primary doctor office. I was curious as to why anyone would use the ER this way. ER visits can be all day events. I did a quick google search and found a great article describing a study on just this question.

Here is a link to the study I found:
ER is better

Basically there were lots of reasons for choosing the ER
1) Appointment making- it’s actually quicker to walk into an ER and wait rather than trying a walk-in at some primary care locations. And it’s more convenient to go to the ER for same-day treatment versus trying to fit in a primary care schedule that is already packed. Some offices do not have immediate openings and you wait for an opening with potentially very little notice.
2) Transportation- through Medicaid rides are arranged 72 hrs in advance. An ambulance will come right away if you say you need one.
3) Late hours- primary doctors often close at or near 5pm. ER is around the clock.
4) Cost- all kinds of specialists are available in a hospital and one has to pay only once versus multiple specialists with multiple copays.

I think this info is super interesting and could be of use to fixing the problem of ER care in non-emergent situations. There are clearly some obstacles to tackle before alternatives can become more attractive than ER care.

My life is complex. Ok, all life is complex.

They used to have very little idea how viruses worked. There is a textbook in my lab from the 1950’s that mentions some scientists believing the chicken pox virus (then called varicella) was related somehow to the shingles virus (then called zoster). Today we know they are the same exact virus and we call it varicella-zoster.

Happy Birthday (the song) is considered some group’s property and is rarely sung on TV or in a movie because of the royalties. WTH?

And did you know when Pastel colors were developed pink was allocated for boys and blue for girls? Boys were to wear pink as a diminutive of red. Girls would wear blue which was seen as more dainty. Later the colors shifted, and now they’ve become imperatives in some people’s minds to the point where boys in pink are harassed. I’d just tell people I’m a time traveler.

Beliefs change once you are exposed to different ones. Once you see another view it all seems so different. Getting in someone else’s shoes is hard and even harder to guess about. My life is different than it used to be. I don’t know where it’s going. I can’t guess. I have been guessing wrong. Did I get bored and boring? I care about more stuff and maybe that makes me a better person. But seeing pain I’m trying to fix makes me sad and sadness can sometimes immobilize me. Am I just waiting for the next adventure to sweep me up again?

My niece recently told me the following story:

I’m drawing this picture of a monster. He lives in the woods, but he knows how to find his way to this house. He has a map his mommy gave him. He also has a song taught to him by his mommy when he was little in case he ever loses the map. So he’ll know how to get here without the map. He’s being chased by creditors. He’s hiding a goose with a golden egg. The egg hatched into a golden crocodile with golden teeth. It sleeps in my bed with me. If the monster tries to get me the crocodile will bite him. And I can kick him in the butt too. Or I can throw up on him so he doesn’t get me.

On vacation we spotted a sign that read: Fluffys Roast Beef. It looked like a casual, summer-type restaurant. The name struck me as odd. Even weirder though was the fact that across the street was an animal hospital. So does the ‘Fluffys’ actually describe the source of their ‘roast beef’? Sorry kids, Fluffy is in heaven now. On the bright side, they’re having a sale on roast beef sandwiches across the street! Poor Fluffy.

Hanging around with nephew at the Great Escape theme park, some of the adults were discussing season passes. One of us mused that perhaps a separate, shorter line was available for pass holders. Nephew pipes up angrily in an insistent voice, “Tha’s a BAD WORD!” All the other adults looked at each other confused, trying to figure out the source of the problem. Not me. I said, “No sweetie he said pass. holders.” That does sound almost uncomfortably close to a rude word for part of one’s butt.

I got some more interesting stories from my dad’s mother.

Grandma was a war bride from WWII who came over to be with my grandpa, who she’d married in England. The Catholic church she attended did not recognize the marriage. They informed her that she was “living in sin” and her children were “bastards”. Finally, to appease them, she got married to my grandpa again with the required Catholic ceremony.

In passing my grandmother and parents remarked that they remember a time when a road now called the Atwood Rd was instead called Nigger Hill Rd. When asked for more details my dad said, “Well it was probably some black guys living on a hill.”

My grandmother talks about my grandpa and his temper. I guess he had a tendency to get in fist fights. He owned a shop which sold gas and he also fixed cars. Some guy came in and asked grandpa to fix his headlight. Grandpa said, “No! I don’t do electrical work and I can’t fix it.” The guy began to insist until finally, grandpa threw him out- physically like they do in Westerns, by the collar and seat of the pants. The guy charged back in a punched grandpa. Grandpa came right back with punch that took this customer to the ground, then he kept punching. Grandma saw from the house (next door to the shop) what was happening and sent my dad, who was about 14 years old, out there to stop him. My dad ran outside and found grandpa kneeling over the man punching him repeatedly, so he shouted at grandpa, “Dad, stop!” Then after all this grandpa fixed the man’s headlight!

Remind me when I ask: there are really no great restaurants in Plattsburgh.

A while ago I made corn pone for one of my projects. It doesn’t have very many ingredients if you go old school. My recipe called for cornmeal, baking soda and powder, and buttermilk. I forgot to pick up buttermilk. So I learned how to make it from cream, which I happened to have. It turns out if you beat cream a long time it will become butter and buttermilk. Here’s how it went:

I put the cream in a tupperware container with an extra awesome top that seals really well. I shook it like a polaroid picture for a long time but only managed to make slightly stiff cream. Next I put the cream in a blender and hit go. It got frothy like a frappe. Then the cream got thick enough to form soft peaks. Then nothing changed. Then still nothing. Then I noticed little round dots of yellow like fat globs sticking to the inside of the blender. Then there were a few more. Then the whole blender was filled with milky liquid and whitish solid bits like cooked milk scum. That was my butter. It was so much tastier than it looked. I strained the contents, reserving the liquid in a measuring cup. So I had a measuring cup full of buttermilk. And a strainer full of fresh butter. Following advice from the internet, I washed the butter. Under ice water, the butter actually sticks together like dough. You wash it by squishing and working the butter underwater as if it’s clay. After a couple rinses, the water stays mostly clear and you can stop. Drain the water, work the butter just a tad to remove pockets of water, and refrigerate.

The corn pone was far less spectacular. It was dry and crumbly and tasted kinda like sand. So much for that recipe!

Then today I made bread and decided to try butter again too. The bread came out incredibly nice for my first try. The butter I did a larger batch. It turns out that sometimes a blender isn’t great for butter making when the frothy cream sticks to itself and makes an air pocket around the chopper part. I switched to a hand mixer halfway through and then things went as before. So I guess the key to great butter is to use at least two devices to make it.

Homemade bread with homemade butter is my new fave!

I am not convinced that knowing is half the battle. Plus if it was true, there’s this whole other half that no one talks about. Clearly it is time to rethink the battle so, Dan and I did. After much discussion we decided the battle breaks down roughly in thirds as follows:

part 1- knowing

part 2- perspiration

part 3- relativity

We don’t know what we are fighting yet, but we are ready.

 

When you think about it, it seems really strange that Christians say they eat the body of Christ and drink his blood. Are we vampires? Or was Jesus a gingerbread man with grape juice for blood? I should totally write another book for the bible explaining Jesus’ post-risen gingerbread transformation. So, that’s why no one recognized him when he came back!

 

My niece is cute but weird. (wonder where she gets that from?) When she was a baby I’d often make up songs for her about whatever was on my mind at the time. Twice now I’ve been around as she made up songs to sing her baby brother. Both times the lyrics included a description of the baby accidentally falling in the toilet and subsequently being saved.

Example:

           Hush little baby don’t you cry, I’m gonna bring you a blankey

           And if you fall in the toilet, I will go and take you out

           And mom and dad will help me, so you don’t have to drown

All perfectly true of course. She really loves him. If he ever managed to fall into a toilet, she would totally take him out.

Snake venom, bat wing, bits of rotting moss that cling!

Green wood! Broom straws! Harshness from an old crow’s caw!

When the word now fills the air, take us from here to there!

NOW!

That is a spell cast by Sidney the witch from the television series Blizzard Island. It is a transport spell. Now, I know none of you has any idea what I’m talking about because although my sister and I absolutely loved this show, it is hopelessly obscure. But you can find episodes on you tube in sections. The puppeteering is excellent and the (puppet) character asides are delightful. I rarely love puppet stuff that doesn’t come from Henson, but I sure love this.

 

It still hasn’t really snowed here. It dusted a few flakes late in 2011, but none of those stuck around more than an afternoon. A couple days ago we finally got some snow that stuck, but it was more like little pebbles of snow than a nice blanket. I imagine snowy pebbles might make a cold and tastly cereal for anyone that likes…um, water. And the Flintstones would advertise it.

BARNEY! Come back with my Snowy Pebbles!

 

My niece is gonna be a big sis. She went to a big brother/big sister class to learn a little bit about what that means. I asked her about it:

me: What did you learn in your class today?

her: ’bout holdin a baby

me: (skeptical) Oh? You’re going to hold the new baby when it comes?

her: (pause) NO! I’m going to get a GROWNUP to help!

me: (impressed) That’s…exactly right.

thechurchproject.yeahmyfoot.com

I am newly interested in a show called Phineas and Ferb. It follows the summer vacation of two brothers who enjoy inventing complex devices and achieving implausible goals- goals like finding Atlantis and making ice cream on the moon. Their sister Candace often tries to reveal their exploits to their mother, always failing to get her attention before the resulting machinery is swept away by a random event. Other characters include the boys’ friends Baljeet, Buford, and Isabella. Sometimes Isabella is followed around by a group similar to a scout troop. Phineas and Ferb have a pet platypus named Perry who leads a secret double life as Agent P. Agent P belongs to an organization whose purpose is unclear, however, each episode sees Perry checking up on the activities of Dr Doofenshmirtz, who claims to be an evil scientist/inventor. The boys constitute the A story, while Perry and Dr D follow a separate B line.

There are several things I like about this series. The story is often formulaic, but at the same time it takes advantage of that fact with call backs to their repeated actions (boy if I had a nickel for every time THAT happened!) and jokes when someone steps out of pattern (Candace why aren’t you out trying to bust your brothers?). I’m impressed by the fact that even with the formula and the fact that it’s a cartoon, there are no flat characters. Candace is constantly trying to get the boys ‘busted’ but she isn’t simply a mean older sister. She has her own life, a love interest, is community minded (she volunteers at a built site) and actually cares about the well being of her younger brothers when you get right down to it. There is a complex love-hate relationship between Buford and Baljeet; although Buford is more the bully-type and Baljeet the nerd, they often collaborate without complaint to help Phineas and Ferb with projects. Isabella is sweet and helpful, but also spunky and inventive when the need arises. Of the two brothers, Ferb is the strong silent type. Outwardly he often appears stoic, but his actions prove that he enjoys all his adventures with his step-brother Phineas and I suspect there’s a lot more going on in his mind than he expresses out loud. Phineas is happy, optimistic, adventurous- there’s just no stopping him. He’s the one at the very center of all the schemes. I liken him to Jim Henson. He, almost magically, is able to gather a group of the most talented and diverse friends and bring out the best in all of them.

Without a doubt my favorite relationship is that of Perry and Dr Doofenshmirtz. On the surface they are good vs. evil, with Dr D playing the bumbling bad guy and Perry getting the upper hand in the end. But they are well-matched. And Doofenshmirtz has a complex character with a long backstory of childhood woes leading to his deciding to become evil and trying to rule the tri-state area. He seems to struggle with this at times and it can be difficult for him to be as evil as he’d like. He constantly expects Perry to show up and thwart him and even seems to miss it when Perry is detained or late. There are hints that he actually considers Perry his closest friend. Perry is concerned mainly with his mission to check up on Doofenshmirtz and stop any negative consequences he sets in motion, however Perry also seems concerned with Dr D himself, particularly when he imperils his own life/well-being. Perry gets Dr Doofenshmirtz out of danger on occasion and has even helped with situations in which Dr D was merely sick, incapacitated, or short of money. I consider the treatment of the Dr Doofenshmirtz and Perry the Platypus characters extremely well-done and congratulate the creators. I often find myself rebelling at the concept of pure good vs. pure evil, when reality is so much more complicated than that. It’s nice to find something that reflects this, and especially nice to find it in a medium that is usually so shallow.