Trying to get home

Not too long ago I was in the position of trying to figure out how to get my elderly parents from the Four Corners area of New Mexico to Oregon.
Other recent issues have come up that brought this back to mind, and I decided to do some comparison shopping.

The scenario I posed: Someone is sick or dying and you have to get home, tomorrow. You can't drive and must take public transit to get there. What does it cost and how long does it take?

First, I used major metropolitan cities because the sad fact is that if you live in a lot of the US, especially the western half you are just shit outta luck. There are no trains or buses, and there may or may not be a regional airport that can get you to a major airport to fly from. Generally for a significant cash outlay - because they are the only game in town. So if you happen to live where my parents did, you either find someone to drive you or pay for a 4 hour taxi ride to Albuquerque. There IS a private shuttle service that runs once a week to the airport, sometimes. And this is representative, not exceptional.

Next: My criteria was round trip tickets leaving May 3 and returning one week later on May 10. The exception here wound up being Amtrak, which has a mudslide on the tracks on the Seattle to LA run. So for Amtrak I moved the dates to June 7-14 for both routes to give a fair comparison.
Travel times listed are one-way but prices are for round trip.

The purpose here is to provide some concrete numbers to demonstrate the cost of travel for those with the fewest number of options.
Note here also that the bus option is Greyhound because they have a monopoly on national bus services in the US. The train service is Amtrak because they are the for-profit but tax supported monopoly holder on passenger train travel in the US.

Prices listed are all the lowest prices available and are generally restricted as far as baggage limits, non-refundable and cannot be changed. Accommodations are the cheapest the service offers - a seat.

First route: Seattle to Los Angeles

Greyhound         $164.00      avg 28 hours one-way

Amtrak               $121.00      35.5 hours one-way

Airline*              $143.04      2.5 - ? hours one-way

*This is a Travelocity 'secret fare' so no info on airline or transit time until ticket is booked, but in this scenario it would be the cheapest choice.

Second route: Dallas to Albuquerque

Greyhound         $118           13.5 -17.5 hours one-way

Amtrak              $132*          35 hours

Southwest         $670             2.5 hours

*This fare does not include the "self-transfer" required in El Paso - i.e. taxi fare or city bus from one station to another.


As for availability for everywhere else, here are some maps of the two monopolies - Amtrak and Greyhound. Yes, I am aware that Greyhound has competition in some very limited markets, mostly on the Eastern half of the US. But for the vast majority of places it is the ONLY bus service, if available at all.

Albuquerque Greyhound Depot

 Searching for photos of Los Angeles, Dallas and Seattle Greyhound stations points out another big problem with bus travel - the terminals tend to be in seedy, rundown and frankly frightening neighborhoods. In addition to the pure discomfort and inconvenience of hours upon hours in a bus, to arrive in a frightening, dark neighborhood where nothing is opened in a huge city in the middle of the night is going to be a huge issue for vulnerable people. Bus travel has always been marketed as cheap travel for poor folks or for minorities who were at risk traveling by car in much of the south. 

Greyhound route map of the US and Canada

Coast Starlight - hard to fault the view!

Southwest Limited in Albuquerque

Amtrak's advertising in the west has tended to center on a theme of "you could drive, but why?" Marketing to families, seniors, vacationers, etc. Their market has generally not been competing with bus travel, but with car travel. The selling points are the convenience of not having to drive and being able to take in the sights, as well as amenities accessible right there on the train without having to stop.

Amtrak route map of the US *

*Note here that the routes marked in green are connected by bus. So imagine trying to get to Salt Lake City from San Diego or Portland...

Something for comparison - and this map is on their website, not hidden in a pdf!

RailEurope Map

Air travel is the most popular way of getting from one place to the other in the US. Because again, US is BIG - and anything else takes a lot of time. And currently most airline travel in the US is comparable in comfort and amenities to a bus, rather than a train. The incentive is that you spend many fewer hours on the plane. Usually...

And again - the biggest issue here is that despite the fact that we have essentially nationalized rail travel, and have allowed a monopoly on bus travel, huge areas of the US are completely unserved by either. People who cannot drive are literally stranded where they are with no options.

I also find it fascinating how much art created in the past to show what life will be like in the far future of post 2000, how much prominently features some form of mass transit. *sigh*

The Future of Public Schooling(TI)

Travel with me now to the near future of Public Education!

 

Betsy DeVos Vocational and Technical High School

Here at BDVTech, we pride ourselves in a public school curriculum that is designed by experts – the BEST experts, everyone knows they are the best, experts in the career preparation that young people are going to need in the coming decades. Well, not ALL young people. But you know, THESE young people. The public school young people, some of whom I have met personally. Lovely people, they love me, you know? Anyway, welcome to all the incoming students.

Introduction to agriculture:

This is the first class in the agriculture track, that introduces students to the exciting opportunities available working as a seasonal farm laborer. An opportunity to work in the great outdoors and travel the country while contributing to the well-being of all those who depend on our great agricultural industry.

Introduction to Customer Service:

Learn about the exciting opportunities that exist in the customer service industry. Customer service skills can take you from the exciting world of retail fashion, to electronics sales, and even into online and telephone support! If you love working with the public, and remember to SMILE you will go far.

Introduction to Food Service (TI)

You have probably never noticed them, but when you go out to dinner somewhere...well maybe not YOU but when I go out to dinner somewhere there are a whole lot of people doing stuff, working hard to make sure that our food is what we asked for and is really good. If they want a damn tip they do, right? Anyway…

This class introduces students to the amazing world of food service. From the front of the house to the back of the house – and let's be honest, the back of the house is where most of you are gonna end up- you will learn the language, the rules, and how to survive in the world of food service.

**Please note** This is part of our 'tipped industries' (TI) program, with a focus on allowing students to learn to maximize their earnings without costing their employers any more money.

Introduction to Alcohol Service (TI)

This track is separated out from Food Service due to significant differences in the range of skills and variety of applications. Young women on either the Food Service(TI) or Adult Entertainment(TI) tracks are encouraged to take their electives in this track – these skills will help keep those tips up. They also give you a fallback once those looks start to fade. Currently we are discouraging males from Alcohol Service (TI) at the vocational level. Most Bartender jobs are currently being filled by Psych majors.

Happy Holidays!

 It is that wonderful time of year! A season of Peace, as season of Giving. And a season of kvetching about how commercial Christmas has become, yadda yadda yadda.

I don't need to point out that this year is pretty scary for lots of folks too. Seems like Peace on Earth is farther away than ever in some places.

So here's a thought to take with you as go through our varied winter holidays.

Santa Claus. That jolly old elf. You know the guy, the one who lives at the North Pole and spends all year making toys (or getting them on Amazon these days most likely!)
Once a year he gets in his sleigh and rides across the globe delivering gifts to all the (good) children of the world.

 Hrmph, you say? I outgrew that belief YEARS ago thankyouverymuch. Bunch of nonsense. Not possible. Ridiculous.
 So I say....AHA! But your argument is simply one of logistics. Nobody argues that the idea of someone DOING what Santa does is impossible or ridiculous. We have known of people in our lifetimes for whom doing good for as many as possible was simply a logistics problem.

Stop and think about that.

If the technology existed tomorrow to make Santa's Christmas Eve ride possible, would someone do it? Absolutely. People already do within the limits of their technology.

THAT is the world we live in. A world where Santa absolutely exists, many times over, generation to generation. And perhaps someday children will laugh at the silly people who believed that he wasn't real!

Peace.

Pearl-clutching Primate Politics

ALL THE TROPES!

Just read yet another article busily deconstructing the methods that the liberal left is utilizing to communicate with 'middle america' and assessing the effectiveness of various strategies in convincing those poor deluded folk that they are WRONG. Hence the pearl-clutching reference...

To be crystal clear here - I am a spittle-flinging lefty socialist from way back. So I am just as appalled as everyone else by the direction our nation has seemingly suddenly rotated, and suffering the same amount of disorientation and grief.

BUT

I also have a very good understanding that we are all pretty much just primates with cars and designer clothes who are not that far removed from the campfires and caves of our evolutionarily recent ancestors.
And when you strip away all the loaded language and the rationalizations what you see is pretty simple and clear. Divide and conquer is a very old and effective strategy. And our primate brains are very, very susceptible to that sort of manipulation because it goes along with how we see and interact with the world.
Using phrases like 'how we are wired' causes pain to those whose jobs involve both neurophysics and anthropology, but it is an easy shorthand to discuss the ways we classify and learn about the world and our place in it, based on how our brains have evolved over time. And our cultures reflect both the ways we are wired to think, and the strategies we have come up with to overcome a lot of those instincts in order to make living in large and often congested groups possible.

Part of that wiring is differentiating 'self' from 'other'. Most of us of a certain age can still sing the song 'One of these things is not like the other'. We classify and name things reflexively. We draw maps so that we can create imaginary lines to separate 'mine' from 'theirs'.
Using that to solidify your own position at the top of the tree by getting those below you fighting with each other to maintain their current position rather than eyeballing yours is a pretty basic and simple strategy.
And getting primates focused on easily identified differences in appearance to facilitate that unrest is not exactly rocket science either.
Which also explains why folks are willing to vote against their own apparent best interest.
Because they can always see someone down below them who they are higher than on the tree. And it is pretty easy to convince people that kicking the folks below them down if they try to climb up will ensure their place in the pecking order. Because the alternative of offering a hand up to those below is seen as a threat to the place at the top.
So you convince white men that they are threatened by everyone 'below' them. You convince white women that they are threatened by people of colour.
You convince people of colour that they are threatened by 'illegals' who shouldn't even BE here - so long as those illegals are brown-skinned of course.
And you convince everyone that they are threatened by 'Muslim terrorists' identified most easily as women in head scarves...
Most importantly, you convince everyone that they are far better off keeping the guys below them off their current branches and fighting to maintain their current position so everybody doesn't suddenly realize how much nicer the view would be way up on top.
In essence, you get the primates so busy fighting with each other that they fail to notice you packing up the silver and looting the vault.

So rather than wringing our hands about how we convince the other guy that they are WRONG, SO WRONG - how about we just point out that we should all be watching both Trump's hands and counting the spoons? And if we give each other a hand up, we can ensure there will be enough for everyone and not just the fat orange primate decorating the top of the tree?

Exceptionalism vs Inclusiveness

Being exposed to some very racist family members from an early age, I have had the opportunity to observe this sort of thinking in its natural environment, surrounded by others who either explicitly or tacitly supported it. Fortunately my parents saw this as an opportunity for education and discussion with us about why it was wrong, and I am grateful.

It wasn't just racism either. It was a deep-seated fear and distrust of anyone who fit into that huge box marked 'other'. Hippies were another huge bugaboo.

What I observed was fascinating. Because they had friends, neighbors, acquaintances, and later family members who fell into groups that inhabited that box. But the dissonance was solved by making exceptions. And it is a pattern I have seen my whole life when exposed to people who have internalized stereotypes for those they see as 'other'.

"Well my friend Bill is black, but he is different because he...

...has a good job and works hard."

...is from here and talks like educated people."

...has a white parent so he isn't REALLY black."

...isn't, you know, URBAN."

...wears khakis and oxford shirts."

...has a degree and owns his home."

...is married and his kids go to school with my kids."

"My sister is on disability but she is REALLY sick and isn't just faking it so she doesn't have to work. I mean, she has diseases x, y and z. And the doctors even say it is so much worse with her than anyone they have seen before."

"My nephew is in rehab right now. He isn't a junkie or anything! He got addicted to prescription pills. We need to do something about pharmaceutical companies that make those things"

"Bob's son is schizophrenic and living in the park right now. It is absolutely criminal the way all that money is spent on lazy homeless people who won't work when there are people who really NEED help and can't get it!"

"She is a woman but she is REALLY good. Thinks just like a man!"

"Maria from work is different because she...

...is Mexican but she was BORN here.

...isn't Mexican, she is from Central America. Or South America...anyway.

...was born in Mexico but she is actually here legally.

...speaks perfect English. You can't even tell she is Mexican!

...is from Mexico or South America somewhere down there. But she has green eyes and blonde hair! She doesn't look Mexican at all.

...is Mexican but she only has one kid. And her husband is Mexican and he has a really good job too. 

"My daughter's friend is Native American. But he doesn't drink alcohol at all."

"My friend Joe is gay. But you can't TELL. He doesn't act like a fairy or anything."


You have heard it. You have probably said something like it about someone, somewhere sometime. You have definitely done it about yourself. We do it to rationalize our own behaviour all the time.

The reverse of this is inclusiveness. The realization that if this is happening to me or mine, friends and family, acquaintances, people I know...then it is may very well apply to others in the same boat.
We see it when the vocal opponent of marriage rights does an about-face when their child comes out as gay. Or the person who never had an interest in social activism becomes radicalized by the personal experience of someone close to them, or a personal issue.

Being aware of things like confirmation bias is very helpful here too. Realize that we will always file away the rare validation of or our prejudices, even in the face of a really impressive amount of evidence to the contrary.

This line of thought can also be applied to those of us reeling from the recent elections. Statistically, a lot of us know people who voted for the winning side. And we made exceptions for them, rather than considering they might represent a much larger group. Because they did not fit our stereotype.

I'll leave you with some photos of kids on Spring Break:

An Internet Quiz for You!

An Internet Quiz

In the scenarios below, what is the FIRST intervention required?

A person tells you they are hungry and have no food.

a) Assess for qualification for agency assistance programs.
b) Determine causes of current crisis, and assess for probable compliance with available programs.
c) Assess for resources available to hungry person.
d) Feed the hungry person.
e) Determine if the person is a danger to the public.
f) Sign the hungry person up for fishing lessons.

A person tells you they are cold and have no shelter.

a) Assess for qualification for agency assistance programs.
b) Determine causes of current crisis, and assess for probable compliance with available programs.
c) Assess for resources available to homeless person.
d) Shelter the homeless person.
e) Determine if the person is a danger to the public.
f) Sign the homeless person up for fishing lessons.

A person is in pain and/or medical distress.

a) Assess for qualification for agency assistance programs.
b) Determine causes of current crisis, and assess for probable compliance with available programs.
c) Assess for resources available to ill person.
d) Provide medical assistance to the ill person.
e) Determine if the person is a danger to the public.
f) Sign the ill person up for fishing lessons.


It's getting cold outside. Make sure you have your priorities in the right order.

Are Dead-Tree Books once again a measure of wealth?

Just to be clear, NOT where I grew up.

I grew up in a house full of books.
As an avid reader, this just seemed like a reasonable thing to me. As I grew to adulthood, I occasionally encountered houses that had few books - both my grandparent's homes were like that. It seemed odd, but since I was rarely staying long and usually travelled with my own stash, the lack never really impacted me much.

Not here either!

My house has always been full of bookcases overflowing, books piled on tables, next to the bed, even stacked on the back of the toilet.

Fast forward to the present. Just moved my mom in with us after my dad died in early September. We were in process of moving them both when he passed away pretty suddenly. He and Momma had been in the process of trying to sort through a lifetime of books to decide what was moved and what was donated. I now have a bedroom in this house filled to the ceiling with boxes, and a good number of those boxes are full of books. We moved four bookcases as well. Looking at the number of books and bookcases I am struck by the staggering amount of square footage that is consumed by printed books. Even in tall bookcases, it requires yard after yard of wallspace. Creatively arranging furnishings away from the walls into islands in the middle of the room to allow access to all those books.

Most places I have lived in recent years were far from the top of the list in price per square foot for housing, but it certainly is not near the bottom. If you live in a place with a healthy economy, chances are good you are dedicating a significant percentage of your income to floorspace to house you and your stuff. If you are like me, and on a limited income, then that floorspace becomes even more dear since there is less of it.

Just substitute the kids for dogs...

The advent of e-books have been a huge boon to bibliophiles like myself, they tend to be cheaper than dead-tree versions and they take up no floorspace! They lack the tactile satisfaction of a physical tome, and are generally pretty problematic for sharing, but you can keep your entire library on a pocket computer (They really should not be called smart phones since their telephonic function is generally a poorly executed afterthought. They are better at taking photos than at voice transmission.)

I suspect we are entering a time very soon when once again the library full of physical books will be a conspicuous luxury reserved for the wealthy and/or the eccentric. In the meantime, you will be able to find me buried under boxes of books trying to figure out where the heck to put them all!

The good news here is that libraries become even more relevant as we transition from buildings full of books to electronic archives of knowledge that will need to be curated, sorted, and maintained. And having a central repository that can be accessed remotely without the need for filling one's own electronic floorspace will also be in demand. Having those sorts of repositories that are not privately owned will be essential to ensure the continued free access to knowledge for everyone. Would love to hear from my librarian friends on whether I am completely off the beam here or not.

Is 2016 taking all our heroes?

It has been a tough year. It started early, and it seems every time we turn around another beloved public figure has passed away.
Baby boomers are at an age where a lot more of our idols are passing, and the modern world has produced a whole lot more beloved public figures as well.

All that said, every time I see another post of "screw you 2016" lamenting the accumulation of deaths I am reminded of a time when I was the beneficiary of some real perspective.

I started my first job as a hospice nurse on Sept 14, 2001. The management staff of the agency I had been hired at was stranded in another state due to the lockdown of all civilian air traffic. The remaining staff were in shock, trying to deal with everything that was going on while ensuring that patients were being seen and getting the support they needed.

My initial orientation involved going along on visits with various members of the team, and the chaplain was my first week. All anybody was talking about was the national trauma we were experiencing, including our chaplain. As we went on home visits, he was preparing himself to help families traumatized by the attacks on our country, in addition to their own loved one who was dying.

What we found was something that affected me profoundly, and informed how I approached my job ever after. When we entered a home, all that was happening and the only thing that was real in that home was the tragedy unfolding there. The immediate and real loss of a loved one. The events that were completely changing the world as we knew it outside those houses were background noise. People knew they should be concerned, but time and space work differently when you are in the liminal space created by the dying. 

In that space, the process of losing a loved one, the personal tragedy that is unfolding is all there is. Going through that door is entering an airlock, and on the inside there is a single focus. Other stuff exists, and has to be dealt with, but doesn't feel real. And as those who enter that space, we have to recognize and accept that THIS death, THIS loss overshadows anything else going on outside. And even if we have a connection to that person, it is not OUR loss.

So when I see yet another person who I admired has died, rather than adding them to some list of grievances I prefer to contemplate and grieve for those who are right now in that liminal space between the life that included that person and the life ahead
without them. And wish them peace and comfort going forward.

Who the Heck are You? A quick guide to medical care providers.

 
A visit to the doctor, to a clinic, nursing facility or hospital means talking to a dizzying number of people about medical issues. People ask for history, check your blood pressure and vital signs, take your blood, give you injections...who the heck are all these people?

Here is a quick guide to many of those letters you will see on the badges of the people you talk with.

MA or CMA - this is a medical assistant, most often seen in an outpatient clinic working with providers there. They work under the supervision of doctors and nurses. Their scope of practice in most states where they are regulated include clerical tasks, taking history, vital signs, assisting the provider during exams, taking specimens, and may be trained in phlebotomy (taking blood). Some states allow them to do additional simple procedures and operate equipment under the supervision of a physician, but they are never allowed to interpret results. What is a medical assistant?  They are usually the liaison between patients and their primary care providers, and may be mistakenly referred to as "nurse". Note that it is illegal for an MA or CNA to present themselves in such a manner. Calling yourself a nurse is a crime.

CNA - this is a Certified Nursing Assistant, most often seen in home health or inpatient facilities such as nursing homes or hospitals. CNAs work under the supervision and delegation of an RN, and provide hands-on bedside care such as taking vital signs, bathing and cleaning the patient, transferring the patient and assisting them with movement and self-care tasks like toileting and shaving. They also have the important responsibility of tracking bowel movements and skin condition in severely impaired patients, alerting the RN when changes are noted before much larger problems occur. They may also do dressing changes and daily wound care in some states. Both of the above require similar education, the primary difference is the location of their work and the tasks that are delegated to them. Both have differences in regulation and licensure (if any) varying by state. Differences between CNAs and MAs

LPN or LVN - this is a Licensed Practical Nurse or Licensed Vocational Nurse, terminology varies by state. An LPN *is* a nurse. They are licensed to provide nursing care, and are found in most places you will find doctors and nurses. They work under the supervision of a physician or RN and may have duties delegated by an RN. Limitations on practice by LPNs vs RNs are in areas that require clinical judgement, and in more advanced care settings. Many states limit the role of LPNs and do not allow them to administer IV medications or narcotics.  Working as an LPN .  LPNs are used to help keep healthcare costs down because it is much less expensive to have a group of LPNs working under the supervision of one RN than to employ RNs only.


RN - Registered Nurse. This is a nurse who has completed either an associates/certificate program or a bachelors degree in nursing, and passed the national licensure exam (NCLEX) as well. They perform all nursing tasks, supervise and may delegate to LPNS, MAs or CNAs, and may obtain advanced specialty training to increase their scope of practice in particular areas. While an RN has the broadest scope of practice of all the above listed, they also have the highest level of responsibility. The RN is responsible for not only their own scope, but they accept the responsibility of tasks that are delegated to them by physicians. An RN is responsible for ensuring the appropriateness of treatments, medications, etc that they have been ordered to give and is accountable along with the prescriber if the are wrong. Scope of practice is determined on a state-by-state basis, and requirements for continuing education vary. My specialty is Hospice and Palliative Care (CHPN). Some states allow me to pronounce a patient dead, some states require that I contact a physician to get that pronouncement, some states require the coroner to be notified, etc as an example of variations on scope of practice. As far as the other letters you will see after RN on a nurse's badge, they will generally designate their specialty certifications and may also include their education (MSN - masters of science in nursing, etc).

 APRN - Advanced practice RNs. These are RNs who have continued their education to a master's or doctorate in a particular specialty area and by doing so have increased their legal scope of practice. APRN  These providers practice medicine under their own licenses, and in most states do not require supervision of a physician to practice. The financial advantages of having a DNP versus an MD in roles that do not require the scope of practice of a physician are the same as those for hiring an LPN versus an RN. In the past, a Master's degree was the minimal educational requirement in most states for a Nurse Practitioner (APRN). Many states have changed that requirement to a doctorate, and there has been a push to make this a national requirement. So the Nurse Practitioner who sees you at the clinic may well be Doctor Nurse! http://www.nursepractitionerschools.com/faq/dnp-requirement-for-np This is similar to the change in requirements for pharmacists, who are now required to have a doctorate as well.

PA - Physician Assistant. PAs are masters degree trained medical providers who attend a specialized Physician Assistant program. http://www.nursepractitionerschools.com/faq/np-vs-physician-assistant PAs work under the supervision of a physician, and are frequently found in the same settings that you would find Nurse Practitioners. The primary difference between the two is that an NP can diagnose and treat without the supervision of a physician.

 DO - Doctor of Osteopathy. A Doctor of Osteopathy is a physician who has received their degree in medicine from a School of Osteopathic Medicine. They are licensed in each state as physicians and have the same scope of practice as MDs. DOs primarily see their practice as different from traditional medicine in the emphasis on a holistic patient-centered, versus disease-centered focus. An example: Oregon License Definitions Note that the scope of practice in Oregon is identical to that of an MD, with the addition of musculoskeletal manipulation.

MD - A licensed Doctor of Medicine, graduate of an accredited medical program and licensed by the state to practice medicine. May be found anywhere medicine is practiced. There are a vast number of specialties of medicine. A couple that regularly confuse people are Internist (a doctor with advanced training in Internal Medicine) and Intern (a medical doctor who is doing their clinical training for their licensure). Hospitalist - this is a fairly new specialty, physicians who specialize in treating patients who are hospitalized, coordinating all the specialties involved and ensuring that the patient is followed appropriately after discharge. Note that it is also illegal to impersonate a physician!




***Disclaimer: The above are the opinions and research of myself, a retired nurse. None of the above constitutes medical advice or definitive anything, is representative of the US, et cetera ad nauseum. Consult your local state medical board or nursing board for definitions, limitations, requirements and scope of practice.

NOT Nurse

NURSE

New Drug Alert - Epidemic declared!*

Today we have become aware of a new, terrifying drug trend sweeping the nation. Teenagers are combining ED medications with Minoxidil for a fast, crazy high lasting well over four hours. Kids refer to this combination as "Drug X". 

Teens everywhere are succumbing to the siren call of Drug X, and health officials are declaring a new drug epidemic as it sweeps the boulevards and gated communities of our nation. 
Most worryingly, this drug is easily manufactured by simply combining the two drugs, which are often easily obtained at home. Parents may not realize there is a problem until "date night" when they discover the missing ingredient.

DrugX and Addiction*

Doctors say compounds like DrugX are highly effective for treating ED. And patients are much less likely to get addicted if they use these drugs in just the dosage necessary to treat their ED.
But when a person starts taking compounds when they are not in ED, or in doses beyond what is required to treat their ED, doctors say the drugs have a different metabolic impact on the brain. In those situations, addiction is highly likely.
Many teens crush up DrugX pills and snort them to get high, getting a hefty dose of drug all at once when they are not having ED to begin with. This form of taking in the drug is much more likely to lead to addiction.

 A Pricey Habit*
DrugX is very expensive on the street: $80 for one pill. To pay for his habit, Ryan says he cashed $7,000 in savings bonds his aunts had given him on birthdays. He sold his PlayStation, leather jackets, cell phone — everything he had — just to stay high and keep from getting sick. He finally broke down and asked his parents for help.
Looking back on it, Ryan says he didn't think using DrugX would be that dangerous because it was a prescription pill — that made it seem safe. Many different kids at his high school were playing around with it, he says: "People from every sort of group — the burnouts, athletic kids, the geniuses and, like, girls playing wicked-good softball [who were] offered scholarships to places — they would be using it."
That sentiment is echoed by 18-year-old Mike, a recovering DrugX addict in Winthrop, Mass. Mike says he was always an athlete and played football. Until his sophomore year in high school, he attended a prep school with wealthier students; he later transferred to the local public school. He says that, if anything, he saw more DrugX at the prep school.
"All the popular kids — that was the cool thing to do," Mike says. "It seemed like it was cool because it was so expensive, this big rich drug. And a lot of rich kids were doing it because the poor kids couldn't afford it."
DrugX is so expensive that many teens turn to stealing to support their habit.
"I stole so much money from my parents," says Katie, 18, who is also a recovering DrugX habit. She says she and a friend both stole their parents' ATM cards to support their habits. "I stole $5,000 from my parents in two months."
Katie also wrote checks from her mother's checkbook. Katie's parents say she and her friends stole cameras and jewelry from their house. Somebody stole her father's wedding ring out of his top drawer.
"It's like someone just punched you in the stomach," Katie's father said in an interview with NPR. "You know you're never going to get it back. And what did it get used for? The addiction." 

In the face of such a monumental problem, Congressmen are being called upon to offer some solutions. After consultation with many experts and industry representatives, millions of healthcare dollars are being earmarked for education and treatment programs to address the issue. Congressman
Richard Priap responded to questions at a press conference yesterday:

Obviously, any sort of ban on the drugs being used illicitly to create this compound is impractical and does not address the root problems. Denying millions access to these needed and useful drugs solves nothing and simply creates a more profitable market for smuggling rings to fill. Law abiding citizens will be denied needed treatments while criminals continue to have access, which is always counterproductive. Prohibition simply does not work, as we have demonstrated again and again.

*SATIRE ALERT*SATIRE ALERT*SATIRE ALERT*
 Obviously the above is satire. Please note that the paragraphs colored yellow are taken from an NPR story on OxyContin that can be found in its whole and unaltered state HERE .
 As a hospice nurse, I have seen how the panics over OxyContin abuse have negatively affected patients who NEED these drugs for severe pain, with little impact on overall narcotic abuse nationwide. I watch huge numbers of people suffering the effects of bans on psuedoepinephrine based drugs in an attempt to address methamphetamine abuse, again with less effect on drug manufacturing than it has on law-abiding allergy and virus sufferers.
I picked on NPR for the *protected* satire above because the article for me highlights the reporting that goes along with issues that affect the wealthy white and educated demographic. It is an emergency, an epidemic, requires immediate action. I mean these kids are moving on to HEROIN for heavens sake! Poor people use heroin. 

So I wondered - what would happen if Richie Rich started getting high from a combination of Dad's hair restorer and impotence meds?


 Please note - this is not a real thing and if you try this then you are stupid and deserve whatever horrific mutation results. 

Nurse's musings on weight issues

Several recent Plurk conversations are gelling in my head so I am gonna think aloud here for a bit.
WALL OF TEXT WARNING
Discussions of the fallacy of the "average" discussions of challenges with healthcare and another discussion about the horrors of flying when obese. And I think I sometimes I come off as judgemental or unsympathetic because of the limitations of the medium. So here goes!
First, medicine (in the US) as it is currently practiced is a high volume business that makes its money via tests, imaging, labs, surgery and other interventions. All those things pay the bills, which is why so may practices do those in-house now. Providers are required to see a minimum number of patients a day, carry a large census of patients they are responsible for, and as a result visit times are brief. Medicine is essentially practiced as a game of averages. This test result usually means diagnostic code xxx, which is treated with treatment regimen y. So everyone with a blood pressure over a predetermined norm get drug A, then if that doesn't work drug B. etc. And if 900 of your 1000 patients benefit from your treatments then that is a great success rate. Unless you happen to be one of those 100.
The other side of the coin is patient expectations. We spent a lot of years selling the idea of the miracles of modern medicine. Add popular culture on television and movies to that and you wind up with expectations for healthcare and interventions that are WAY off. The ER team on TV does some chest compressions and the patient is well! Johnny wakes up from his three year coma in perfect health. If the brilliant but curmudgeonly doctor puts his mind to it they can diagnose you by the end of the 30min episode. And cure whatever it is just in the nick of time. Dying is especially elegant in popular media. Great lighting, makeup, fully conscious until you say something profound and slip away. RL is so much messier than that.
Patients often expect that if the doctor would only do ALL the tests, they could find out everything that is wrong with you RIGHT NOW (and sometimes even in the future) and fix it all today. And it doesn't actually work like that. At all.
Human beings and human bodies vary a lot in many parameters, and the idea that there is a "healthy" perfect state is a fallacy. Weights vary quite a bit, as do blood pressure, blood sugar, pain tolerance, and on and on.
Genetics plays a big role - you can have the textbook perfect weight, exercise, eat an ideal balanced diet, go to church every Sunday and still drop dead at 40 of a heart attack. Or get colon cancer at 50, or MS at 35...
Weight is an issue for a number of reasons - heart disease is a combination of genetics and damage from blood pressure, plaque buildup, high blood sugars, etc. Diabetes is the biggest risk of long term obesity, in the insulin resistant form. Genetics play a smaller role in that type. Diabetes leads to blindness, multiple organ failure, amputations, and was a very frequent end stage diagnosis I saw in hospice, usually from kidney failure (dialysis only works for so long).
Most universal issue with weight is one I personally deal with and that is joints. Joints are engineered in humans to work within a certain weight range, with body type and sex playing a role. But your joints WILL wear out eventually at any weight. What excess weight does is speeds up that process. And obviously the more weight you carry the faster it happens.
So back to provider and patient expectations. Providers need a different approach. Currently the attitude is that I am going to educate you on what you need to do in order to improve the health profiles that are outside the norm. Your goals and limitations are not even on the table in most cases.
What needs to happen is a discussion that starts where we are right now. What is it that keeps you from doing what you need and want to do? What does the provider see as a big issue or concern? What is available to help you as a patient meet your goals, if your goals are unreasonable then WHY are they and what would be reasonable goals? And there should ALWAYS be a nurse CM or a social worker available if needed who can direct patients to resources in the community.
As a patient, understand that everything is not fixable. And that anything that stresses your body's ability to maintain balances or does long term damage is going to have consequences no matter WHY that is. Some people CAN'T lose weight, but those people are also going to have to deal with the consequences of that. And the best way to approach that conversation is not to pass judgement. It is to acknowledge that these are the challenges we face and make plans on how we can mitigate the inevitable damage and give some really good quality of life.
Because ultimately sitting down to a nice steak or having an ice cream cone should be a delight, not a prelude to shame.

The Scourge of Adblocking software

Back in the day, visiting a website often involved being exposed to some random advertising in a banner across the top of the page.

Something like this.

Over time, online ads began to creep down pages, filling first the left margin and then the right.

I know that article I'm looking for is in here SOMEWHERE

Of course, we had been able to ignore the banner ads after a time, and eventually were able to ignore all the kibble surrounding the content we sought. So the advertisers escalated their pitches. Ads flashed, jiggled, popped up in middle of your screen, marched around over the page. Much harder to ignore, and should you break down and click on one of them it did not make them stop on your future visits. If you bought every single item being advertised there, you would still be facing that mess on every visit.

Then came the video ads. These are sneaky because they may not be there when you open the page. But the advertising feed on that page will serve them up randomly, and they play immediately. Some arsehole just woke the baby, scared the shit out of you, and froze your computer squawking about paper towels.

If that wasn't enough to drive you into the arms of your nearest adblocker, this did. Doing research, surfing, shopping, looking at newsfeeds or working on the web only to suddenly have every page you visit covered with ads related to what you have been looking at. Now conventional wisdom says that targeted advertising is much  better than just random products, and we are all pretty much aware that our web usage is tracked and reported. But having your nose rubbed in it is creepy as hell.

And do NOT get me started on commercial shopping sites that have obnoxious ads flashing and popping up all over the place WHILE I AM TRYING TO BUY YOUR DAMN STUFF.

So - THAT is why my lazy butt took the time and trouble to find and install an adblocker. Because the escalating war for my attention was actually becoming nauseating. And since webpages I have contacted about it disavow any control over their ads, I am going to have to just skip them.

Can we go back to this? This was nice.

Dreams and cogitations

As a child, she was surprised and wounded by the first rock that struck her. But she picked it up and put it in her pocket, and contemplated it later.

As the years passed, the rocks became more frequent and her collection grew. She was no longer surprised by them, but still dreaded each one. Her collection grew into a little wall that she could shelter behind when she needed it.

Over time, her wall grew into cottage where she could go for safety, a place to breathe and just be.

Decades passed and the rocks sometimes became less frequent, but were often larger. Her cottage began to take on the aspects of a Manor. There was not just room for herself there, but offer safety and comfort for those she loved as well.

By the time she was old, she had created a Castle. Within its walls she could provide shelter, compassion, and safety for any who required healing. The giant stone fireplace contained a roaring fire where she could tell stories and share wisdom. Children play in the gardens of that castle, and it is a rare stone that makes it over the wall.

Worlds and stories and songs, the strata of all that we have been and all that we believed of ourselves layered and overlapping. Pangaea, Laurasia, Gondwana, Panthalassa. Primeval forests teeming with life. Vast plains of flora and fauna competing, breeding and dying.

Dark World below Blue World below Yellow World below White World. Shambala, Eden, floodplains and mountain valleys. Deep caves with ashes from countless fires and energetic shapes dancing across the walls in their flickering light.

Vast kingdoms spreading across plateaus, blood soaked battlegrounds and rivers running red with blood. Troy, Ur, Atlantis, Pompeii, Alexandria, Timbuktu, Giza, Babylon, Teotihuacan, Cairo, Carthage.

Each layer covers the one below, and yet those beneath are sometimes incorporated into those above. A pyramid pierces them all, thrusting up into today, still reaching towards the sun. Some things are lost, and some things break out at unexpected times and places.

The strata of all that has come before sits below the plane of now.

And the World Tree, in whose shadow and branches and roots we make our way, has a taproot that extends down through every layer.

Some New Year's Makeover hints for 2016

We are fast approaching the new year, 2016. Twelve months bursting with potential and promise stretching out ahead of us. In the spirit of the New Year's Resolution tradition, I offer some suggestions for some easy tweaks to beautify your world and your lighten your soul.

Weight loss is easily accomplished by dumping all the baggage currently hauled around intended to weigh and judge whether those in need are deserving of help.
By dumping the requirement that people have "earned" compassion, the ability to reach out and help everyone who needs help is achieved. Feeding people because they are hungry, comforting those who are in pain, offering healing to the sick, and a roof to the homeless. Without worrying about anything besides identifying the needs.



Work out more by exercising your right to vote in every election. Strengthen our democracy by making your voice heard on every issue that is important to you. Email your legislators, petition your government and make your representatives accountable to you.
Get your heart rate up by doing things that scare you, that make you feel uncomfortable and that push your boundaries. 




Increase your vocabulary by having conversations with people who are different than you are. People with different interests, different backgrounds, different beliefs. Speak up about your values, and discover how enlightening assuming the best of people's intentions can become. Add the words "why not?" and use them frequently to follow any statement that contains the words "of course we can't"...



Meditate on the awesome smallness of specks of stardust, and the hugeness of the universe. Open yourself to infinite possibility. Wrap yourself in the patchwork quilt of humanity, in all its beautiful variations.



And in the words of the great philosopher Wil Wheaton: Don't be a dick.

Another shout into the void

*Disclaimer: I do not identify as religious, but I am very spiritual. I belong to no organized religious group, and prefer to choose my teachers based on their teachings rather than on their sect. I live in a culture that identifies predominantly as white, western and Judeo/Christian. I also write this stuff primarily to organize my thoughts and make them easily accessible, not to advise others on how to relate to the ineffable.*

Religion does not cause violence. So many folks believe this to be the case, make art and write songs about how getting rid of religion would make a peaceful world. Sorry.

We create religions as a means of sorting "us" from "them". Because as trooping primates, that is what we do. Identifying who we fuck versus who we fight.

National borders are there to mark where our troop has staked a claim on the local resources. If those resources start to get low, we go to war with someone who has more of the resources we need. It is more obvious when we were fighting with rocks and clubs - but it is still what we are doing. We create political constructs to explain why our region of resources is vastly superior to the other guy's. And it makes a handy excuse when we need to go "liberate" his resources for the use of our own.

When any of these groups get too big, whether they are religious or secular, schisms have to occur to allow smaller subgroups to form that are viable units to maintain what has been termed the "monkeysphere" Dunbar's Number.

We will use religion, or political systems, or historic grudges, or assumed territorial violations to rationalize war against the "other". But ultimately it is always just some variation on a resource grab.
Even the seemingly stateless terrorists we see today are quick to declare a "state" and to start attempting to move into and take over regions to acquire their resources. They recruit women to populate those regions with their offspring. Same old story whether it is chimps, Visigoths, or Exxon.

We have evolved socially and culturally quite rapidly, and now with technology our culture is evolving even faster. Our bodies and brains are on a MUCH longer timeline. So no small number of our impulses, coping mechanisms, instincts, etc were developed in a vastly different environment.

And our drive to name, to categorize, to sort is a product of this need to identify what constitutes a threat versus what is "us".

Survival as a species is going to require us to understand and accept this, and to utilize that knowledge using the beautiful large frontal lobes we now possess to guide us going forward. Maybe there are just too many of us and we are not ready for a monkeysphere that encompasses the entire planet. It could be that we will wind up decimating our populations via war-related disease and famine back down to a size that has enough space to keep the current model.

If you assume you are in a group likely to survive, it probably doesn't sound so bad. And hey, maybe it won't happen in your lifetime.

Right?