Feeling much better. Spent a couple of hours last night relearning Cribbage and playing it on the computer. I think it would go so much better with a couple of pints though!

My appetite is coming back. Made a good attempt at a new year’s lunch of turkey, cornbread stuffing, potatoes, and peas and onions. Not the way Mo and would have cooked it, and I regret that I wasn’t able to palate Xmas dinner when I was back home. I also miss Miranda’s shakes and smoothies. They don’t seem to understand what it means to make a “malted shake” here (duh – you make it with malted milk!).

Got myself disconnected from the infernal infusion device for a few hours today and walked around the ward, and also around the wards one floor down. I’m on the sixth floor and have a bit of a view of another hospital – Mass Baptist I think it is. I’m curious where Choate’s sanatorium, one of the Boston locations mentioned in POB’s Surgeon’s Mate was located. Given POB’s attention to detail I would guess that it was based on a real sanatorium. From the description in the book, it had a view of the harbor and was located on a hill. The harbor in 1815, I fancy, was bigger than it is today, but Aubrey was able to see far out to where the British blockade lay, so the location should still have a view of the harbor. The name of the owner, Choate, I assume is also based on a real person. There was a Choate-Symes hospital around the corner when Mo and I lived on Lawrence Street in Woburn.

Talked with Martin this afternoon and am looking forward to his visit a week on Monday. Not sure what I’ll be doing then, but I assume some sort of outpatient visits for the CODOX regimen, so he’ll be able to relieve Mo of some taxi duty for a coupe of days. It’ll also be nice for him to get to know Mo and Miranda better.

I have a CT scan schedule for this afternoon to image my left leg. I’ve been having muscle pain down there, and it’s possible that it’s abscessed. Watch this space! (i.e., stay tuned!)

One important difference between medical and aviation safety systems, that I’m not sure I have adequately addressed yet, has to do with short-staffing. In aviation, if the crew doesn’t show up the plane doesn’t fly. The customer is inconvenienced, but, except in rare cases, not put in any danger. In medicine, if the staff is not available, the work still needs to be done, and has to be shared with other staff, and the customer *is* put at risk. Here, at DFBWCC, in the oncology ward that I’m in, the nurse:patient ratio is 1:3. Also, there are PCAs (Patient Care Assistants) that support the nurses by taking vital signs and responding to non-medical patient requests, and alerting nurses in case a situation needs to be escalated. Some PCAs are student nurses and can perform other tasks, such as disconnecting patients from their IVs.

At DFBWCC, I gather from the literature that staffing ratios were significantly improved following the Betsy Lehman accident, but obviously, the ratio is still subject to perturbations. I gather that in certain units, such as an ICU, they can call up extra staff if they are short, but in other units, and particularly around this time of year, with the holidays and increased likelihood of bad weather and resultant travel delays, there remains the possibility of short staffing. Yesterday, for example, I had no PCA. A very minor impact obviously, but still one that increased the nurse’s workload.

An obvious performance measure to track is the actual staffing level vs. the planned staffing level. There are controls in place to avoid inadequate staffing levels; for example, a nurse may have to work a double shift if his/her replacement is not available. How often those controls are invoked, and measuring staffing levels that do not invoke controls, could help tell what pressures are acting on minimum standards.

One of my nurses tells me that a friend of hers works at another hospital where the nurse:patient ratio is 1:6. She thinks this is too low, but I suspect it is not uncommon.