Back at home and feeling pretty good. Thought I’d just pass on the following paragraphe juste from my bro:
This year, both Groundhog Day and the State of the Union Address fall in the same week. It is an ironic juxtaposition: one involves a meaningless ritual in which we look to a creature of little intelligence for prognostication, and the other involves a groundhog….
One more round of chemo due this evening and then I’m done, apart from my Neulasta shot Saturday evening, which is a recovery shot – i.e. an injection to help my recover from the chemo induced neutroprenia. I had a last intrathecal injection of methotrexate this morning from Dan Zuckerman, the oncology fellow. The intrathecal is the injection through the dura of the spinal cord into the cauda equina, so named because the jumble of nerves supposedly look like a horse’s mane. I should be going home Sunday morning, all being well. Folks here are confident that I am on the road to recovery. I had the option of going home Saturday evening but I feel happier to be spending one more night here. It’s going to be sad to say goodbye to all the nurses and PCAs and doctors who have been looking after me over the last few months.
I will probably not update the blog so frequently when I’m home recovering. There’s not not going to be so much to write about, but I will try to update it weekly until I’m back to work.
Rough night. The Cytarabine is not agreeing with my digestive system and I ran a temperature last night. Still, only a few more days to go, so I can take it.
Yesterday evening I did something that I think I’ve never done before – I watched a whole state of the union address on TV. Readers of this blog will already know I’m no fan of the shrub, but I felt I owed it to myself to hear what he had to say on healthcare; as it turned out, not a lot that we didn’t already know – he’s pushing HSAs and more tax breaks, and cutting back on Medicare, as the baby-boomers retire. For all his talk of bipartisan government, it seems as if this administration has already decided what the solution is. This one’s going the way of the social security reforms last year.
I loved some of the cutaway shots that they had for the state of the union. One in particular of Hilary looking smug, and ever so slightly shaking her head in obvious disagreement with something the shrub had said. I also felt bad for Samuel Alito; there were a couple of times where the camera caught him looking totally lost, gazing around the chamber, as if to say, “who are all these people and what have I gotten myself into?” Also, who was the guy dressed as Dr. Who in the back? All the men were dressed in standard tailored dark suits, varying only slightly in shades of grayness and color of tie, except for this one guy who had on a brown jacket and a striped scarf wrapped around his neck.
Last night was Miranda’s band concert and Mo tells me it went well. The scheme of listening in on it via cell phone did not go so well, however. Even though Maureen was sitting near the front of the auditorium, the microphone of a cell phone is not designed to pick up sounds from more than a few inches away. From my end it sounded like the sound was coming through a very cheap short wave radio that someone kept tuning in and out. In the end, I had to hang up. I hope I can catch the concert later this month on the Comcast local channel.
[later]
I hear that there is still no word on the Volpe Center contract award, and that it may not come for another month. This is just another area of uncertainty to deal with in the coming months. If I return to work and my old bosses are no longer there, then I can’t just slide back into my old job. I probably can’t do that anyway. I have no idea at this time when I’ll feel fit and energetic enough to get back to work, maybe April, likely later. I’ll have to play it by ear, I suppose with the advice of my doctors. I’m not sure that I want to work part time as a way of slipping back into work; this may be difficult to do anyway and still retain my disability benefits. Also, Parkinson’s Law (work expands to fill time available) would almost certainly mean that I’d end up working more than I planned. It’ll be strange getting back to work, but I expect that after a few days it’ll feel like I’ve never been away. I miss you guys at work!
Counting down the days and the remaining chemo infusions until I’m all done. I met with the physiotherapist today and he checked out my neuropathy and strength and balance. He showed my some exercises that I can do to help me get back to normal, or at least accommodate my condition. My balance is a little bit off but it’s good enough that I won’t need a cane. I must admit that the last thing I want to do at the moment is exercise – napping is more where I’m at – but I suppose I must discipline myself.
Coincidentally, the room that I’m in is exactly the same room that I started out in, ward 5B, room 35. It’s very small, but this does give the advantage that I can reach the bathroom while I’m still attached to the IV pole. The ward is in the shape of a three-quarter circle; consequently all the rooms are wedge shaped, since they are on the circumference. The nurse’s station occupies the center of the circle; the next ring is the corridor, often littered with extra chairs and equipment, with terminals and storage closets on the edges; the outer ring has the patient rooms. There are 10 patient rooms in the ward, of which about half are double. For most of my visits here I have had a private room.
I have been reading more of “The Patient from Hell.” The author, Stephen Schneider, is a climatologist working in the field of global warming. He makes distinction between two types of knowledge that I think is important to grasp if we are to understand system safety. The one type of knowledge is the knowledge that is backed up by empirical facts; the other type of knowledge is the knowledge that comes from understanding how a process works. For the first type of knowledge, we can design processes to reduce error. For example, if a doctor submits a chemo order for a patient that is outside of what is considered the generally accepted range, the system can flag it. For the second type of knowledge, even if we don’t have objectively observed data, we can still engage in a hazard analysis and risk assessment, and design controls to try to mitigate the risks. There are difficulties, however with doing this:
What this means for system safety is that you should never for a moment think that you have all the risks covered. You don’t. Accidents will still happen. Having skilled practitioners in the front line, versed in process knowledge, is needed to catch proto-accidents that did not get caught by the processes. In the medical arena, the folks in the front line are not the specialists or even the attending doctors, but the nurses, who are carrying out the processes. Minor incidents happen all the time and do not get reported. For example, this morning I was given medication meant for the patient in the next room – it was only when I questioned why I was receiving this medication that the nurse realized her mistake. I wonder how many times that patient has received my medication?
