Rabbit Hole Survival Strategies

Mr. Blitch is working an early morning bookkeeping shift for 7 straight days. Up at o3:OO, out of the house by o3:30, into the vault by o4:OO.
Yesterday (Saturday), I woke up when he left the house. Once awake, the hamster wheel that resides in my brain sprang to life.
There must be some residual from my 12-hour noc shift nursing days that enables me to snap from peaceful slumber to stone-cold awake & alert. And once there, not so easy to return.
I decided to make the most of it, and get in some Oncology Nursing Certification studying. Quiet house, deadlines always looming: seize the moment.

unnamed-1

Half the day passed by. I ventured into the kitchen, down to the laundry area to stretch my legs and throw in a towel load. I became acutely, uncomfortably, twitchily, aware of the dog hair swirling around my feet. Our kitchen, the Bane of My Fucking Existence, had dirty dishes piled up over every minimal square inch of counter space.
An irrational, yet too-familiar, rage started creeping up from deep within.
Did I mention I’m on steroids? Crohn’s? No. Well, not directly.
I’ve had an earache for about 2 months. I’ve been to see my PCP twice now for it. We’ve tried antibiotics, nasal sprays, allergy medicine, the gamut. Now we’re trying steroids. It’s not helping. I even have *real* Sudafed. (Sudafed is only available by prescription in the state of Oregon. Thank you very much, Central Oregon Meth Labs. Way to ruin Over-the-counter decongestants for the rest of us.)
A fun fact about Crohn’s disease, is that some of us can develop Ear-Nose-Throat manifestations in tandem with our usual GI inflammation.
Ear pain, steroids, fatigue, stress. It can become a fairly speedy road to rage.

Text to my friend, M:  “Do you ever have thoughts about moving out of your home? (Asking For A Friend)”

M, back to me:  “I think maybe you’ve been studying too long and need a break. Why don’t you come over and we’ll go for a walk?”

Still in the possession of a modicum of sense, I was able to recognize M’s offer as a Beacon of Sanity, and drove straight to her home.
On the short drive, my mind started cycling again with unfinished blog fodder.
I dictated the following to my phone, and the phone actually got it mostly right:

unnamed

 

 

Easter Sunday & Mohs Surgery Monday

Bob King Dairies; 4.16.2o17 to 4.17.2o17

Bob tells everyone he doesn’t have much of an appetite, and he doesn’t give a hoot about any kind of holiday. Yet somehow, he never passes up an opportunity to eat some of Mr. Blitch’s cooking.
He says little to nothing to his grandson. Nor to his son-in-law of 19 years, for that matter.
But he will grudgingly follow his daughter out to the hen house for a visit to Marigold. It’s the small price he must pay for his supper, and he knows it. Humor the Urban Chicken Whisperer, and you will be rewarded with a meal.

Bob and his daughter; Bend, Oregon, August 2oOO, and Portland, April 2o17:


SCD Easter meal:
~ Grilled Chicken
~ Roasted Beet Salad
~ Salad greens
~ Homemade Blueberry*Apple*Ginger jello
~ Apple-Rhubard grain-free crumble


Life: Celebrate that Goodness every-flippin-day!!

At this point in the Blapplegate Family home, any single day when no one is ill, and no one is working, is a day to celebrate togetherness and Life. Just simply being alive, being upright, being bipedal, and being somewhat functional.
This year, a special guest made the appreciation for Capital-L-Life rise even more to the surface: a dear family friend who had recently completed many long months of treatment for breast cancer was at the table. Just a few days prior, she had gone in for her first mammogram after treatment. The news was all clear and all good, and there was much to celebrate.

 Deuxième partie: Mohs

I wasn’t sure how to tell Bob that the pathology had come back from his latest skin biopsy with unfavorable results. (Unfavorable = cancer, in this case)
Again. His 4th skin cancer in left last few months.
It wasn’t even so much the news of yet another cancer; he’s grown accustomed to it by now. Born a true redhead in 1933, growing up on farms in Nebraska and then Oregon’s Willamette River valley, his skin was somewhat doomed.
It’s more the anticipation of an appointment: he doesn’t sleep well for several days prior, his terror of simply being outside is renewed. If I mark an appointment too far in advance on his wall calendar, it swallows his focus.
This time, I took a chance… I waited until I was driving him back home after the Easter meal at our house. I mentioned it casually: “Dad, the derm office contacted me… they didn’t like what they saw on that last biopsy. They want to whack that little spot off your cheek. They had an opening for tomorrow, so I took it.”
He was in good spirits, and he took the news surprisingly well. To his way of thinking, he got a twofer. Two days with me, literally the only person he allows into his world any longer.
What Bob doesn’t know is what a huge fucking deal it was for me to obtain this particular day off from my work as an Oncology Nurse Navigator. I had in fact made the appointment 5 weeks ago. Our dermatology clinic only performs Mohs procedures on Mondays. Mondays only, and only mid-day, right when I have the responsibility of setting up and taking notes for a weekly Cancer Conference. Presence of a Nurse Navigator is required, and getting coverage involves requesting another Nurse Navigator to drive from our main hospital campus 18 miles away. In short, it’s damn near impossible.

Anyway, things have improved since last year, when I had to literally travel from Bob’s hospital room at that other hospital 18 miles away and drive to fulfill my Monday obligation at the more remote hospital where I usually work. The support of a new manager has made it possible for me to occasionally request, and get, coverage.
(And oh yes, it’s also the law. It’s the Fucking law: https://www.dol.gov/general/topic/benefits-leave/fmla
Just saying. But I digress…)

So, MOHS!

uch_028549-2
(Image cred: Terese Winslow, Medical & Scientific Illustrator)

I made a change in my time management strategy as Bob’s caregiver last month: I bought a laptop, so that when I’m idling away the hours at medical appointments with Bob, I can multitask and study for my ever-looming Oncology Nursing Certification exam.

Mohs procedures are done in stages. The visible lesion is removed, and sent to an on-site lab for a peek under a microscope. The surgeon will keep removing only small slices of skin until they are confident there are clear margins (‘clear’ meaning the tissue is free of cancer cells).

If a patient is fortunate, they may obtain the clear surgical margin in just one or two slices. However, the appointments are made with the understanding that they may have to do multiple incisions, and the process may take 2 hours or longer.

I was feeling optimistic today: I had snacks for myself and Bob, I had my fancy new laptop, I had the day off work. We checked in early, and headed to the downstairs surgery suite. I stayed in the room with Bob to review the consent, and keep him company while they numbed him up.

They booted me out when it came time for the actual cutting. I cheerfully headed back to the waiting area, and pulled out my laptop. Ready to …. ready to realize that I could get no online service in the basement of this building.

Silly me, I don’t know how I never noticed this before, but this Derm clinic is located in a historic NE Portland building. It was originally a private mortuary. Later, it was purchased by Multnomah County, and became the county’s morgue.

So there I am, seated in the bowels of the former county morgue, with no way to access my study content. Did I bring any of my books or flashcards? Hell no, I had finally let go of my Luddite-with-slightly-Amish-tendencies ways, and stepped into the Modern Era.

And this was my reward.

So I sat, and became the new BFF of an elderly Veteran who was waiting for his wife. It was sweet. It was not how I needed to be spending my time, but it was sweet.

Bob came out in between slices. We shared a banana. I made him a coffee in the waiting room lounge. Free Coffee!! He was, I believe, in heaven. The doctor and nurses are incredibly kind, they dote appropriately on him.

He was done in about 2 hours. He had missed his lunch at the care home where he resides. Snacks are one thing, but it was 1:30 in the afternoon. One-half a banana and a couple handfuls of peanuts can only carry a person so far.

Me (starving): “Dad, can I take you out for Chinese food (his favorite)…?”
Bob: “Oh, no, I don’t think so. They saved some clam chowder for me back at the place.”

Off we go. I deliver him, with his pressure bandage covering half his face, and leave him to his chowder. (There is also a small plate on the side with a Bob-size treat: 5 crackers, a small cluster of grapes, and 3 Oreos.)

“Thank you” he says, as I depart. “Thank you for… caring for me.” You are welcome, dad. You are very most welcome.

 

 

 

 

If You Don’t Gnome Me By Now

All Good Things Must…
My week off is nearing its end. The work nightmares and peri-menopausal hobgoblins are re-emerging.
So today, I blow the dust off my inner tool kit, and pause to reflect on a few of the many things that I am graced with. Fighting bitter tendencies with blessings.

My Traveling Companions: 
Mr. Blitch, and my Book Gnome. They both remind me to put worry aside and enjoy my travels.
I’ve often been accused of being too serious. Fun and frolic were things relatively unknown in my home of origin. I’m taking strides to change my ways.

Mid-week, we headed north. I packed my little buddy in for safe transport from Rockaway to Cannon Beach.
We got in a little trainspotting on the way:

IMG_3363

Viewing Through the Lens of Another:
Mr. Blitch grew up fishing on the rivers of northern Florida and the salt water flats of the  Florida Gulf Coast. He was in his mid-twenties when he came to Oregon for art school and got his first glimpse of the PNW coastline.

Now, 20+ years later, his eyes still pop a little every time he sees the Pacific Ocean.
Salmon and steelhead fishing have become my Florida boy’s greatest passions.
When I travel the PNW with Mr. Blitch, the view is entirely different.

I see familiar rocky cliffs with Douglas firs, Sitka spruce, prehistoric ferns and moss.
When I ask him what he sees, he says “Mountains that fall into the ocean.”
One difference I notice between the two of us… I’m always looking down; his gaze is always up and outward. (Note to self.)


Learning is fun!
I am under tremendous pressure to study for, and eventually obtain my Oncology Nursing Certification. It’s been a crap year, trying to work full time while providing care for my father.
My studying had gone completely by the wayside.
But this week, I’ve given myself a Do-Over.
I said goodbye to unfinished and expired testing modules. I purchased a test-specific online study program that will in theory, both provide me with continuing ed credits, and prepare me for my fucking certification exam.
Normally, I’m a paper and pencil kind of gal. But in this case, I opted for the online version. Instead of having testing booklets scattered between home, office, and auto, I have it all at my fingertips.
And much as this Luddite with Amish tendencies hates to admit it, I’ve been enjoying my studying this week.
Granted, my study-buddy and the quiet of a remote coastal motel room have been instrumental in setting the mood. But I am hopeful that I will return to Portland tomorrow refreshed, and on the right track.

IMG_3358

Expectation Management: Further Thoughts

Oregon Coast Study & Wellness Week: Day 3

IMG_3322

I was awakened around O430 this morning by the song of howling winds. Kind of a firm, yet gentle nudging from Mother Nature to get my ass out of bed and start the day off right with some stretching and some early morning studying.

I see from the the weather report, that today will feel like 46° ~~ which is a nice improvement from much of yesterday which felt like 43°.

A note about Oregon Coast beaches: the signs and warnings? They’re there for a reason. I went for a late afternoon beach walk while my husband was napping the other day, and noted that the beach was absolutely empty. Not a soul in site.

It was also high tide, and this particular area is known for Sneaker Waves. I walked along the narrow strip between the boulder embankment and the incoming shoreline, with raindrops pelting my face. Thinking enviously of my friends who are vacationing in Hawaii this week, I came to my senses and realized where I was, like or or not, and that perhaps a walk through the semi-deserted Spring Break coastal town was a safer & wiser option.

IMG_3313

That’s a wool poncho I’m wearing in the photo. I purchased it up in Vancouver, B.C. this last winter. I wear this on the beach here in Oregon, rather than a swimsuit, and you are all welcome.

I will save the bathing suit frolicking photo for the time, if & when, I ever make it to Hawaii.

So, it’s going well. I’m studying. I’m eating healthy, I’m getting some (brisk) walks in each day.
I’m rationing out a few hours here and there for my long-neglected, ever-patient, and supportive spouse.

Yesterday we took a back country drive along the Kilchis River. My husband is an avid fly fisherman, sadly here for a few days sans casting rod. He wanted to at least see some parts of the area he’s not fished before.

Soundtrack provided by yours truly.
#LizPhair
#lettersandsodas

IMG_3321

 

The Awkward Inner Unicorn

Sometimes we have to face the hard truths.
I decided to take my Inner Unicorn for an outing, and realized that even she, like me, is a super-award being.

IMG_3304

She and Mr. Blitch are trying to have a go at something resembling a vacation.
It’s unpaid, as all the Bob King FMLA days have wiped out Nurse Apple’s paid vacation bank.
It’s 47° degrees and storming on the Oregon coast. (A redundancy, I realized as I typed.)

Yet, it is still time away from Portland. It is a day without illness, without eldercare responsibilities, without a set timetable of tasks to be done.

That said, my Awkward Inner Unicorn apparently does not know how to relax.
Awake at o500, there was some stretching, some coffee consumption, and then the focus shifted to the studying that needs to be done.

Something shitty happened recently. I was given a 2 year timeline to accomplish completion of an Oncology Certification. There was a 2 year timeline: from the time of hire at my new job as an Oncology Nurse Navigator.
Study guides were enthusiastically purchased, all best attempts were made to both learn a new professional role, take care of an elderly parent, and raise a teenage son, and be some kind of spouse, and study. Study on the sidelines.

Several Continuing Education self paced courses were purchased: Lung Cancer, Chemotherapy & Management of side effects, Skin Cancer, Women’s Cancer, Pain and Palliative Care.

I’ve been chipping away at these. In hindsight, not a good strategy. It would have been better to take one at a time, and designate time for study. Instead, there was one in my office, one in my car, one in my purse… when I had a moment, I’d grab a highlighter and read a bit. Here and there. It was what I could do.

One night recently, I decided to just finish one of the damn things. I stayed up until midnight, and finished the reading, and filled out the quiz.

The next morning, I faxed the quiz off to the testing company. I knew it was close. I had had 1 year from the time of purchase to complete and submit. But life hasn’t been gentle or kind to me or my family this year, and. And.

The test was denied: it had expired.
It wasn’t just a little expired, it was 3 months expired. 15 months had blown by, with me clinging to a fantasy that I could somehow control my Crohn’s disease, my schedule, my care taking of my parent…
I give myself A for effort. 

It’s now o600. Day 1 of Oregon Coast Study Vacation. Here I go again.

Wish me luck.

IMG_3303 2

 

 

This was not in the job description.

I am experiencing an Alternate Universe week, where my Oncology Nursing job feels not so much like nursing, and my caregiver role for my father feels way too much like nursing.

16681875_10155192796723469_2867887446635447538_n

Our Oncology Nurse Navigation team has been tasked with presenting a Survivorship Care Plan template to our IT support specialists. We have a plan in our computer charting system, but it needs to be updated and streamlined, with the goal of meeting national cancer accreditation standards, and presenting survivorship care plans to 100% of our breast cancer patients who were diagnosed in 2016 or after…
It’s a thing. A big, fucking, thing.

16864730_10155194011908469_1372045003327754088_n

However, having recently been accused by my new manager of being a perfectionist, and having “extremely high” expectations of myself and others… I suppose it is, in a way, my cup of tea.

Meanwhile, there is my #eldercare role. This was from this morning:

Bob King Diaries; o2.23.2o17. 
Today is Bob’s son’s birthday. Also the anniversary of Bob’s son’s maternal grandmother’s death.
Historically, not always a great day for the Applegate-King people.
Round 2 with skin cancer lesion removal.
All handicapped parking spots at the clinic were full this morning. 
Bob appeared confused by directions to remove both overshirt and undershirt for suture removal on chest, and surgical procedure on his back.
Nurse Apple noticed that his pupils were unevenly dilated… wondering how things will go later in the afternoon, when she takes Bob in for an eye exam.
She stays in the room for the surgical prep; Bob looks to her each time the doctor or nurse asks him a direct question. It’s unclear if he is not hearing them, or not understanding their words.
He winces as the nurse places a cold grounding pad on his side. “This,” she explains, “is so you don’t get shocked when we cauterize the incision.”
“No,” Bob says, “I wouldn’t want that!”

16938905_10155195557153469_8928403149818594340_n