Category Archives: Medical

Not Paint

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I think we are all familiar with an expression that relates an activity as about “as thrilling as watching paint dry.” Well, there is a hospital equivalent – about as entertaining as watching IVs drip. Unlike the days when many of us trained – nurses and docs no longer have to be able to calculate concentrations, count drops, or manage flow rates. Instead, they program electronic pumps that manage it all for them. And as far as concentrations? The pharmacy sends every thing up premixed so that task is taken out of busy hands; instead being performed by someone who is mindnumbingly bored by repetitive mixing under a hood.

Frankly, garter stitch is more of an intellectual challenge.

The garter stitch comment is a result of my digging out some skeins of fingering yarn and turning them into scarves. Knitting back and forth is soothing. Not having to keep track of anything more than a two row pattern is soothing. And, when my brain feels completely numb, I switch over to a complicated lace pattern for one repeat, curing me for hours of being stupid.

Back to the IVs. There is blood. And platelets. And antibiotics of several kinds along with maintenance, calcium, magnesium, potassium. And rejection inhibitors of which I know either chemical names, or brand names, but not both – nor, frankly do I care. Just that there maybe up to four little electronic boxes, each with their own tubing, doing their own measuring after being carefully programed.

And they drip, drip, drip…..

Needles and Rays

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which in this case has absolutely nothing to do with trees or baseball.

Rather, it has to do with stem cell stimulation shots into College Guy which lead to him spending the day @ the infusion center hooked up to the pharesis machine so that his stem cells could be collected.

At the same time, George had the fun of having to hold still for a 30 minute session before turning over like a pancake to bake on the other side. TBI = total body irradiation in this case rather than traumatic brain injury.

Tonight the Bone Marrow Transplant lab will do their thing and the transplant is scheduled for sometime tomorrow.  Meanwhile, Noah, tired and with slightly sore arms from having to hold them straight all day was glad for the ride back to our side of the Bay.

 

No trees

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Right outside George’s window to vanish and reappear with the fog. His room this time (and the room he started in the last time) has a north facing window through which I can see that the construction of this spring is just about complete. All that remains is the shrouding and scaffolding at the end of the building section directly across. Gazing toward the east, portions of downtown San Francisco are visible. Provided, of course, that one enjoys gazing at those places which are off limits for the foreseeable future.

I will just mention, beyond some of the most fantastic nurses I have ever met, that one never gets much sleep in a hospital. Between frequent vital signs, beeps from the IVs which run continuously and traffic in the ward corridor, there isn’t much opportunity for rest. So catching short naps (i.e. drifting off) during the day is about the only option.

The protocol this time adds whole body radiation to the chemo regiment in order to essentially completely wipe out his immune system. It doesn’t look to be a whole lot more fun than the last time; so far he has been spared the nausea, but I suspect his hard won hair return will shortly depart.

On the positive side, when you don’t have any white blood cells of your own, you are at high risk for infection and are spared from having to share a room. No one to argue about the TV remote and the hospital Wifi means access to one’s daily dose of news programs.

Another day, another drive

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Instead of driving to Parnassus (UCSF) this morning we had to head to UCSF Mission Bay. No biggie, right? Wrong. We were given an arrival time of 0715 which meant absolutely zero chance of adding a passenger to make use of the HOV lane. Instead, we wound up in that mess called “the Maze” where I-80, I-580 and other assorted freeway entrance ramps combine to approach the Bay Bridge Toll Plaza. Twelve minutes to get from home to the Maze (including the coffee stop). 35 minutes to get through the Maze and Toll Plaza, less than 15 after that to get to Mission Bay including getting off an exit too early.

As it turns out, the CV Center in Mission Bay doesn’t even open till 0730 so I have no clue as to why we were instructed to be there so early. The only advantage that I found was that lovely on street FREE parking spot about a block away. Of course, the meters don’t operate till 0900, but still. Free parking in SF? Totally amazing. I had never driven into Mission Bay before. I don’t get it. Two tiny bridges across the estuary. Tons of new buildings, densely packed. UCSF, Warriors Stadium, inadequate public transportation. Not an area which I would willingly visit or work in.

Tests went fine and we were home right about 0900 including a stop at Acme Bread for fresh Peach Puff Pastries. Yum. I spent most of the rest of the day with brain in idle. Watched part of the As manage to sneak past the Astro’s in Houston before they head to Arlington tomorrow. For the moment, they are actually ½ a game up in the Wild Card race.  Shana kindly volunteered to pick up Noah from the airport late tonight. Home for a day before we head to San Diego to get him set before school….

Too many appointments

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A long time ago – oh let us say May – I made a couple of appointments for myself. Figured that George would be well past the time that he needed to go to UCSF twice a week, and besides, his appointment days were Monday and Thursday. So here I am, end of August and needing to be at the VA at the same time he needs to be at UCSF. He did agree to be dropped off early so that I wouldn’t be late.

Imagine my surprise to find that there was essentially no traffic at all heading to SF over the Bay Bridge. I mean, zero back up at the Toll Plaza at 0815 on a Friday morning. There is normally more traffic that that at 1400 in the afternoon or 0200 at night. Dropped him off at UCSF, went to the VA.

In case you are wondering why we didn’t do it in the other order (besides the fact that I don’t really want him driving right now) it is simple. UCSF charges $4/hr for parking. Parking at the VA is free….

I finished with my appointments just about the time that the infusion center released him from transfusions

it is not ghee

(and a bone marrow biopsy).

traffic back was unusually light for a Friday afternoon.

Then we watched the As defeat the Yankees for the fourth time in a row (three in Oakland and now the first game in the Bronx).

Pussy Cat where have you been?

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Well, it certainly has not been to London, nor visiting a queen. This is as close to a queen as I have come

from a shop window

where she does the wave which I am sure is solar powered. The dogs (corgis?) wag their tails.

Most of the month it seems, I have been treading water – house hold chores, baseball, a bit of sewing, reading, a few puzzles, procrastinating (i.e. those papers are about at the 50% complete stage) and keeping an eye on George.

Unfortunately, starting last Thursday – that has turned into close to a full time job. We knew that his stem cell transplant had produced white cells, but not as many platelets or red cells as would have been expected to this point. An attempt to back down on the immune suppression didn’t help. His hemoglobin was way down and there was hardly a platelet to be found. That last is concerning, since platelets are ½ of the bodies clotting system. Clotting factors can do only so much without platelets to sort of plug up holes.

So Thursday he received necessary but unexpected transfusions and a request for a return visit on Saturday and Monday. Thursday evening he received a request to come back in on Friday which we managed. Then there was Saturday. And a request to come back on Sunday. (Dani pulled the Sat & Sunday drive). We did Monday, then Tues, then Wednesday which leads us to today. It has been platelets every day, plus more blood on both Saturday and yesterday.

The summary of which will be confirmed with a bone marrow biopsy tomorrow – but everyone is pretty sure that the stem cell transplant failed. Probably because he had a few white cells left which have managed to kill off the transplant. It could be that it just didn’t take. In any case, a couple of new donors have been potentially identified and are being screened.

Obviously, George is not thrilled and this drive is getting really, really old. Much harder on him than me since, instead of seeing restrictions lifted as we get close to the magic 100 days post transplant he has more treatment in the future.

 

What? No Platelets

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This morning, getting George’s lab results provided a nasty surprise. We knew that his red cells and platelets hadn’t come back the way that his oncologist was hoping. But being severely anemic again and essentially having no platelets circulating was not on the planned list of results.

The brief, short visit turned into hours as he received both platelets and packed, irradiated red blood cells.

And, if I haven’t said it before – my sincere thanks to all of you who are regular blood donors. It isn’t just the military, traffic accident victims and those caught in mass shootings who benefit from a healthy and robust blood supply. It is also those who are older, or under treatment for various malignancies who are kept alive during the course of treatment by the generosity of total strangers.

and we will have to be back tomorrow. Probably Saturday and Sunday as well.

Oh, joy.

Less than an hour

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My skin normally starts to crawl when I even think of facing the traffic into San Francisco from my side of the Bay. Since this is Thursday, George has an appointment at UCSF.

Taking a deep breath, I made an early run to fill the gas tank. Trust me, the very last thing I want to do is run out of fuel on the Bay Bridge and become “one of those idiots” who impact traffic with their rudeness. I think you understand. So, full tank of gas (petrol) followed by a coffee stop at Peet’s for human trip fuel before heading back to the house to grab my passengers. Since Alex had to make a run into the city today, I had the three of us–the magic number for the HOV lane. Rather than committing myself to having to get off at the Fremont Exit, I skipped picking up a fourth passenger at the North Berkeley Ride Share and just headed out.

My least favorite part of the trip, if one could say that any portion of the trip was all right, is having to work my way across five lanes of traffic to get to the HOV lane from the University Avenue entrance. Three of those lanes are Oakland bound and they are by far denser than the right lanes. And, hello – this is California where a turn-signal doesn’t seem to mean much of anything. I can actually be appreciative of large trucks, they never ride the bumper of the vehicle in front of them so there is usually space that I can squeeze into.

Once we hit the HOV lane, it was clear sailing all the way to the San Francisco side of the Bay Bridge. Even the traffic up Olivia wasn’t that bad. All in all, we were at UCSF in less than an hour from leaving home, an unheard of fast trip for rush hour. George is stable, getting a bit stronger everyday. It would be really nice if his red blood cells and platelets were recovering as fast as his white cells, but I guess we don’t get to have everything. He has been shifted to weekly visits from twice a week, so that is excellent from my point of view.

After we returned home, I spent the afternoon organizing my studio a bit more and machine embroidering lace doilies, just because I could. And, they are pretty mindless with few, if any, color changes.

large and small

Driving in a bubble

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The time was 0930 in the morning and we had left the house on the way to UCSF. The HOV lanes were still active so after making a kamikaze series of four lane changes to the left, we sailed along to the left sided flyover headed toward the Bay Bridge. There isn’t all that much traffic in the left lane, made even less by those single drivers smart enough to get out of the HOV lane before the cameras documents their law breaking activity. From there the flyover lane crosses to the right side and meets up with the HOV lane coming from the Oakland direction. Sailing through the toll plaza, we entered the main portion of the traffic just past the metering lights. To our left, and ahead of us was a small, reddish Fiat. There was no one around the Fiat by 10 meters or so in any direction. In a location where traffic was almost bumper to bumper, there was this bubble of “no drive” around the Fiat.

From there, all the way across the bridge, no matter the speed for the rest of the traffic, this Fiat seemed to travel at a slow and constant speed with everyone avoiding it. Traffic going 40? The Fiat is going 30 and everyone passes it. Traffic going 20? The Fiat continues to sail along with everyone avoiding it. Admittedly, I didn’t see much with it traveling faster than everyone around it. More like it turtling along with every single last car, truck and motorcycle avoiding getting anywhere near the Fiat.

When last seen, it was puttering south on the freeway, its bubble space still intact.

Arriving at UCSF early, George had his labs drawn and his follow up appointment. From there it didn’t run as smoothly as I would have liked. Because his feet hurt, someone hadn’t been drinking enough fluids. Not drinking fluids puts one’s kidneys at risk. Instead of heading home, we wound up spending almost an additional  four hours while someone (fill in the name yourself) received a significant amount of IV hydration.

The drive home was painful as the afternoon rush traffic had already started. My afternoon errands had been completely and totally taken over by hanging out at UCSF while someone’s IV went drip, drip, drip. Taking a deep breath here and releasing the last of the pent up anger, frustration and general disgust….

But the next time someone doesn’t drink enough on his own – he can Lyft or Uber home….

enough to gag a horse

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just in case

you were thinking that the medication fun stopped when he was released from the hospital – the pill progression continues. Technically there are 5-6 times a day that something on the scheduled kicks in. The first thing we did after returning home was to take an extremely good look at that schedule.

Of note – the reason that there are 0600 medications in a hospital is that shift change is at 0700. This allows the nurse to make sure that all meds are administered and computer logged prior to the end of the shift. In the bin are those which are once a day, those which are q12 hrs, one which is three x a day, one which is twice a day. Not being completely stupid – I started from the end of the day and worked backwards. My night owl is going to be up past 2100 in the evening, especially with naps during the day. So 2200 is more sensible for “bedtime” meds than 2100. That means that the q12 hours are 10 & 10 and while I am at it, twice a day can follow the same pattern. 3x a day can be distributed between 0700->2200. Those that have to be taken with meals are assigned to breakfast, lunch and dinner and the rest in the morning. (on the basis of that old adage about doing the worst thing first and getting it over with – something about a frog?).

did I mention that there is also a few hundred cc’s of IV magnesium every day?

thought not.

And all of it needs to be balanced around those really essential things in life – naps, meals, news programs, baseball….

Not Vanished

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A quick summary:

Contrary to public opinion, none of us have up and vanished. Life has just been a bit of a slog, more so probably for George than the rest of us, but still, the days have sort of blended together in an unending cycle of up, meds, meals, more meds, naps, work around the sleeping dude, more meals, meds and attempting to have enough energy to do all those basic life functions that involve laundry, grocery stores and cooking (hello? I made a deal 40+ years ago that my life did not include kitchens or bathrooms. Something is seriously wrong here….)

Between 2x weekly trips through insane traffic to SF and running various and assorted errands around here, the last week and a half have sort of slipped by in a blur. Life has been defined in 5 x day medications, sore feet (George), taking out trash & kitchen clean-up (Noah), filling our freezer with tasty goodies (Shana), dog visits (Gwen) and attempting to straighten out the amount of “stuff” that is trying to take over our lives

other than that – the Minnesota Twins are in town for a three day series over the 4th. Tonights game was a bit of a slug fest (3 home runs on each side). For the Twins – Jason Castro is local to the Bay Area. He had a huge number of family and friends present. If someone wThere as going to hit two home runs for the Twins, I am glad it was him. If someone was going to hit a grand slam – it was terrific that it was our brand new catcher in his first game in the majors.

And believe it or not – there are some rude Twins fans. LA and Houston fans have come to understand that there is always sound coming from the Coliseum Right and Left Field Bleachers; it is not worth complaining about. Especially if one attempts to do it a al D Trump on Twitter. Hello? There is no such thing as “too much Cow Bell…..” Oh – final score? 8:6 As

Monday morning traffic

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Sucks at the best of times. This morning was not one of those. In the future, I think there are two choices – either get on the interstate at University Avenue, work my way over to the left hand HOV lane and drive faster than a crawl. Or.. take the frontage road all the way on the Bay side to Powell Street and get on the freeway there which is just at the start of the maze and just short of where the HOV lane dumps in from the northbound branch of 580. I did the worst – got on in between University and Powell which meant there was no chance at all of getting safely across 5 lanes of traffic and having to spend more than 20 minutes crawling along between two freeway entrances.

The only good thing was that once we were past the start of the congestion we were able to access the right hand HOV lane and literally flew along the right fly-over looking down with sneers at all of those sitting in stopped traffic. HOV here is 3 people in the car which should explain why I had Noah up and about much earlier than his normal routine. Him getting sleep was much less relevant to me than shortening our car ride by an hour or more. Once past the toll plaza, the traffic wasn’t all that great but moving is much better than creeping or standing still.

I have finally figured out UCSF’s parking ramp. Having also appropriated Alex’s old wheelchair from its (final-not) resting place in the garage where it was stored just in case anyone would need it again, we made fast work of getting from the garage to the clinic. Yes, George can walk but he still is having significant foot pain so why would we make him hobble?

Appointment went well. Number of meds is not going to decrease anytime in the near future. OTOH, it is obvious that the stem cell transplant has taken hold.

I managed to finish embroidering the last of the little girls onto the quilt top.=

color gamp 3×6 embroidered

now it is just a matter of the backing, quilting and tossing it over to Shana for the finishing.

 

A walk in the park

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From where I am staying in outer Sunset, it is just a short hike across Golden Gate Park to the SFVA. Of course, I can just ignore the fact that the portion of the stroll from the park to the VA is straight up 42nd.

at the top of the map

 

you can see the location of the VA. and at the bottom you can see the small upside-down “V” where the cross-road park road connects to the streets on the north side of the park. Please count them, five blocks straight up hill, a definite challenge on a cool and foggy morning.

It was dental day for me. Like many others of our generation, I have a significant amount of dental work. Due to the care and diligence of Army (and Air Force) dentistry over the years, I still have all of my teeth (except for wisdom which exited when I was in med school thanks to the U of MN Oral Surgery Residency Program. $25, thank you very much). In fact, I have had one crown for a significant number of years, enough that I actually have worn through the crown. Today’s mission impossible for my poor dentist whom I have gotten to know rather well over the last two years, was to see if it could be patched with the alternative facing me of a new crown. Much as I really appreciate the SFVA dental staff, I don’t need to devote another several ½ days to the dental clinic. A successful patch later, I was about to go out the door. Only one dental issue left in my future – replacement of crown that will involve a visit to the periodontist. Since the previous dentist retired, there is only a part-timer on contract. His tech stopped in – would I be able to trade my August appointment for returning this afternoon?

Of course!

It was only a matter of taking the shuttle over to UCSF and hang out with George for about three hours and taking the shuttle back. Nice guy (family Ukraine -> Israel -> to California) which means, of course, his practice is in Menlo Park (altho he denies living in Sunnyvale). His tech’s family came from China when she was young. My dentist’s family came from India. The nurses and cleaning staff are equally reflective of who takes care of our veterans–it is the new immigrants and their children. The ones that feel that they are contributing to the U.S. by taking care of those who serve. And often, they are also first to volunteer should the country need them and at a much higher rate than those who are two generations or more in the U.S..

(off soap box).

After being told to expect pain, I breezed through the pharmacy and ran for the shuttle, getting back to UCSF by 1600. I spent the afternoon just hanging out with George, then we watched the first three quarters of the Warrior-Raptors game before I headed to the N-Judah. He still has squat for white cells or platelets; I figure another week in this place. He is bored, he is tired. If you want to email him directly – georgeDOTrehmATicloudDOTcom with substituting the appropriate punctuation  It would be a lot more appreciated by him than me playing momma monkey and plucking loose hair.

 

CISTM-Saturday

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rather than continue to confuse myself and everyone else around me with trying to determine which day it is. Yes, Saturday. As apposed to either the third or fourth day of the conference depending on whether or not one actually counts Wednesday.

Of course, it was this morning that I discovered that the DC Metro doesn’t open till 0700 on Saturdays. What is worse, the station nearest my hotel, like the rest of the Metro doesn’t open till 0800 on Sundays. Once again, a system which is designed for white collar office workers on a Mon-Fri schedule and discounts everyone who works shifts and needs to present at 0700 on a weekend or holiday.

The lectures and symposiums ranged over all age groups and types of travels with, still, an emphasis infectious disease. Probably the highlight of the morning was the presentation by the Smithsonian on their “Outbreak” exhibit (which is on epidemics in a connected world).

they fed us lunch – (who says there is no such thing as a free lunch)

excellent veg option

And for those medical types – ABCs of resuscitation? Airway, Breathing….camera….

After attending the business meeting, I skipped the reception to get back to my hotel before it became dark. My congrats to any Texans–the As just didn’t have it and lost both games of the double header.

George is holding his own – minus platelets and white cells.

 

 

CISTM19-D3

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This is a 7000 series train. Followed by where it is going and the next station. Of course, not all seven thousand series trains are created equal on the Washington DC regional Metro. Some have internal electronic signage. Some don’t. The trains are all shiny silver without any of the advertising wraps that are now becoming much more common on the BART system. The insides –

shiny inside as well

some of interior design is the same as BART. But there is a noticeable difference; both are there sidewalls which create compartments, but also blocks free movement of passengers. I also noted the complete lack of space for bicycles. Apparently, no one in the DC Metro area uses a bike for commuting.

outside the NOMA-GALLAUDET U METRO STATION

where my hotel is located. There are various bits and pieces of that particular leaf (Oak?) around the station.

That was just the getting to and from the conference portion of my day. Otherwise, I went to a number of excellent presentations and a couple in which I was all too easily distracted. On me, maybe. Our military related symposium went extremely well as did our working group meeting. Surprisingly, the Canadian contingent outnumbered the US. Otherwise, we had representatives from Austria, Australia, India, Taiwan, UK,  France, and a few who never said anything,.

I had a chance to FaceTime with George who is getting extremely bored (watching the eucalyptus sway and paint dry). Otherwise, there is news on the TV which is not necessarily thrilling. And of course, there is baseball and on some nights, basketball. (The As almost managed to toss away their win against the Rangers.)

D-Day

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the day (June 6, 1944) in World War II on which Allied forces invaded northern France by means of beach landings in Normandy. Today is the 75th Anniversary. All who served in that war, no matter which side, are now in their 90s. Our memories are short; the further we get from that conflict the easier it is to revise history. To discount the burden on those involved at the time, respect for all those who died, and the impact of post war on the future of more than just the countries directly involved with fighting on their lands. It isn’t just the Holocaust survivors of whom I speak, it is all who underestimate the impact on our politics today. That war, and the follow on Korean Conflict (War) had a huge impact on all of my generation as we grew up in the aftermath with the Cold War. The influence on our parents in turn affected us. And a large number of “us” are today’s politicians.

I headed back to the hotel early last night. Exhausted would have been a polite way of describing my staggering in the door and landing face down on the bed. At 0700 I was back at the hotel, meeting with the rest of the leadership of our working group. (ISTM provided breakfast, so there was a reward for being at a meeting when my body was clearly sure it was 0400). End result, we have a fairly good plan for the next meeting and a potential for joint symposium with a couple of the other special interest working groups. If any of can make a commitment to the regional meetings in 2020, there is a possibility (ick, how German can I get in sentence construction translated into English) of symposium at those meetings as well.

Our Coin

(and a thanks to Miriam. Her logo for our working group has been turned into a very nice coin. Military are all about coins.)

There were a number of absolutely excellent presentations today covering a range of topics from the expected malaria presentation through the handling of emergencies. I should have stayed for some of the evening meetings. Instead, I went back to the Courtyard Marriott to sleep.

(Word from George is that he is stable. Bored out of his mind, but stable).

CISTM16-P

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Ok, title coding first. This is the Conference, International Society of Travel Medicine, #16. This afternoon was dedicated to the pre-conference workshops. Those included to take examinations could have spent the morning on the Certification Exam. I decided that I didn’t want to do years ago. I enjoy the meetings and I have a network now of fabulous people. But another exam? Done with those, thank you very much. And if I had, had even the smallest temptation, UCHastings and legal exams have thoroughly cured me.

I successfully made it from the airport to the Metro to the meeting hotel. I am still contemplating whether it is better to walk 4 blocks up hill from Dupont Circle, or 8 blocks downhill from Woodley Park. Such hard decisions are the bedrock of life.

The pre-course, mostly organized by my French colleague ran smoothly, so that is one critical item checked off my list. After thinking carefully, I bagged the opening ceremonies and reception in favor of heading to my hotel (the cheaper one a few stops up the Red Line Train to ….

 

D+5, Robo

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At this point, it is waiting and consumes about as much energy as watching paint dry.

Seriously, it is nap, hang out, watch for side effects, complications, or infections (and hopefully none of the above).

So I thought I would talk to you about Robo.

Some bright person somewhere in the hospital, who if they are sensible, will never, EVER, admit that this was their idea, decided that robots could deliver certain items more safely and securely than people. And it was not a one time purchase.

entering an elevator

They do not share space. There is a robotic voice feature that basically says “get out of my way.” If you are already on an elevator, it may tell you to leave. If you are both at the elevator, it will tell you that you can not ride with it. Note – TELL, not ask,. I have the suspicion that the robots are disruptive enough that they do not allow them on the utility elevators which means that they are restricted to interrupting visitors and staff, rather than patients being transported between hospital locations.

stuck

It took several of us to free up this particular bit of idiotic machinery, as it was stuck. There was a bed in the way, there was a chair in the way. Oh, horrors! And this is one of the new models. It has flashing lights, the same robotic voice. If you have a real desire to learn more – there is an article about Tug in 2017 on Wired. Or its home page on Aethon. Note – there are no prices on the website. Frankly, I don’t see it as a money saving measure – given initial investment, maintenance, and the requirement for people on both ends of the supply run, which means that it doesn’t really improve patient safety in delivery of medications, blood products or surgical instruments. There is the issue of contamination as it rolls in and out of public spaces. And finally,  they get stuck. The end result of which means that it is not what you want for anything that is an emergency. It probably is cheaper than replacing a pneumatic tube system in an older facility, but there is something seriously to be said about investment in people.

I am now at USO at SFO. Taking the red-eye from here to DC. The ISTM meeting starts on Thursday morning. As an every two year meeting, I try not to miss. I would make the exception this year except for the fact that I am the co-chair of one of the working/interest groups and made the commitment to be there for the meeting last fall (before any of the current challenges materialized). Even so, I might have bailed had not two other committee members done (including the local organizer) so leaving it down to my co-chair (French) and the sec/treasure (Canada).

The two eldest will be checking on George, I will be making extensive use of FaceTime. And I paid for trip insurance in case I have to head home early.

D+2

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totally amazed this morning – I had to wait for the outbound N-Judah to clear before proceeding to the tram stop. The drive of the inbound waited for me! Perhaps I am just having great luck right now with transportation drivers. Yesterday I had an appointment at the SFVA. My choice was to take the N-Judah in to Powell, then catch the 38R out Geary spending almost 90 minutes under way or .. walk across Golden Gate Park. I chose the latter. 40th->41st. Across the park on pleasant paths which come out at 42nd. Stagger up the hill for a few blocks (about four?) and there I am at the VA. Distance well under 3k, time less than 30 minutes. Coffee my reward on arrival.

Last night seemed to be another of those “not getting enough sleep” for George so he slept most of the morning. I wound up going back to the Outer Sunset for a few hours of sleep myself. Met Alex at the ballpark to collect the “unicorn rainbow fanny pack” give away and watch the As lose another to Houston.

Headed to Berkeley for the night to do home laundry, repack some clothes and otherwise take a short break.

D+1

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(easy to see where we are, right? No need for now for me to come up with any interesting headings, titles or anything that requires even basic imagination. Especially helpful when I am running more than a bit tired.)

Mostly today was sleep. There is nothing like running a bit of fever during the night added into the extremely frequent checks to insure that you don’t get much sleep. KQED is running in the background (I forgot to bring my headphones – something that I will correct on Saturday night when I head back to the East Bay for a few hours.)

From here on in, it is going to be mostly watchful waiting. Plus medications. Remember from a couple of years ago when I was complaining about having to take a handful of pills in the morning? My meds have nothing on the double handful George gets to swallow multiple times a day. There are anti-infection for both virus and bacteria, kidney support, liver support, Calcium, VitD (sunshine now one’s enemy), immune suppressors and a few others. Thinking about counting them. Then again, why would that make either of us feel any better? Still several meds running through the I.V. which will be our friend for days yet. My main job right now is quiet support and laundry.

Rest assured, I am passing along everyone’s well wishes.

The As had it, then they blew it. I am headed to the game tomorrow. I don’t think my presence or absence will make a difference. If you tune into the game on TV, we are the crew with the drums right behind the banners in the right field bleachers.