awake, again

i got maybe 4 hours of sleep last night. i slept from 9 to 12 and at 12 i had to get up and go to the bathroom. after that i lay in bed for about 4 hours, thinking. i don't know what changed in my head during those 3 hours of sleep, as i'd fallen asleep fairly easily at 9, but something did. i have noticed over the last several nights, in which i slept well, that as i relax into sleep i see images on the insides of my lids when i close my eyes. i follow those images and am soon asleep. but after midnight last night when i closed my eyes all i saw was blackness. i thought about my job and what else i might want to do, a train of thought that is beginning to become irritating to me but of which i could not let go. before 12 i had a dream in which people were scaling the glass facade of a barn using hand-held suction cups. then they skated down the sloping top edge of the plate glass to the ground. yellow joined me on the bed for a while, on and off, lying on my chest or my back, depending (of course) on how i was positioned. i might have slept a bit between 4 and 5 this morning. kara is down with a cold, almost completely unable to breathe through her nose, and she got more rest last night than i did.

vented

my weekend's over - i start working again in half an hour. another week of medical transcription. but i'm almost glad, glad to have something to fill the day, despite that fact that my job feels dead-end and i don't know what else to do for a living. i feel better this morning than i have for the last few days. i did a fair amount of reading over the weekend, a fair amount for me anyway, about 70 pages of dickens, mostly in the mandolin. kara and i watched 2 decent movies, rendition and michael clayton, neither of which was very cheery but both of which were good - we like mr gyllenhaal and mr clooney. our dryer - our clothes dryer - might be on the fritz; the heating element might be lost and i think we need to have it looked at, sometime this week, somehow. and i dreamed all through last night, it seemed, of shotgun blasts, graphic informational videos of how such blasts punch holes in people, dent them, mangle them, blow them inside-out - vivid, terrible, bloody dreams. and yet now i feel almost chipper. perhaps i have been vented.

lower

i guess i've been feeling kind of low the past couple of days, without direction. i'm off today, i don't have to work at all, there's nothing i really have to accomplish. but i want to do something. but i don't know what. i'll probably end up driving around a bit. i don't know.

but here's a snap of eliot interrupting my workday yesterday. and there's yellow curled atop the monitor.

i'm 213/861 (roughly 24.74%) of the way through bleak house. i like it, i do, but sometimes i do wish for a faster pace. i'm going ahead with it, though. no stopping now.

i haven't done any writing for a while; that probably adds to my current bleak outlook. i should write today but i don't know if i want to. it's more that i want to want to do something than i actually want to do something.

i had another quarter of my mouth professionally cleaned yesterday. i like my hygienist, and anesthesia is certainly a good thing. the remaining half gets cleaned 2 weeks from today in one appointment, and my surgery is 4 weeks from today. i'm trying to tease some facial hair from my cheeks to cover the bruises that will result, which is rather a ridiculous notion. i've never been able to grow a full beard.

even 20

it's been a while since i've done this sort of thing, but i guess i'm in the mood now. here's a taste of the 20 medical reports i transcribed yesterday. as per usual, they remind me of how lucky kara and i are, healthwise. kara's finger still hurts a little bit sometimes and my widsom teeth come out on march 21, but otherwise we're doing very well. but check out the poor bastards described in these reports.

1. interim summary for an 8-month-old boy with influenza b pneumonia, dehydration, and hypoxia, 4 days into his hospital stay.
2. operative report for a 49-year-old woman with migraine headaches. she underwent placement of a new nerve stimulator and replacement of the stimulator's generator's battery by a neurosurgeon.
3. preoperative history & physical examination for a 71-year-old male with a cerebral metastatic tumor. he was about to undergo a craniotomy for resection of the tumor.
4. social work note for a 41-year-old male alcoholic who was seeking detox. he has behavior issues and local detox centers won't accept him. he awaits an open bed somewhere.
5. emergency department note for a 33-year-old man with lyme disease and seizure disorder. he said he was active military and didn't want the physician to contact his primary care provider because he didn't want to be medically discharged from the military.
6. social work note for a 14-year-old boy who ran away from home secondary to truancy issues. he was found at his sister's boyfriend's mother's house after 4 days on the run. his sister's boyfriend's mother was allegedly giving him alcohol, pot, and ecstasy. the patient has a court date regarding his truancy later this week. cps was called.
7. discharge summary for a 67-year-old man with syncope. he was given intravenous fluids and medications. he was discharged after a 3-day stay.
8. inpatient cardiology consultation for an 18-year-old girl with abdominal discomfort and an abnormal ecg. she had gastroparesis and a possible mitral valve prolapse.
9. emergency department note for an 18-year-old boy with perirectal pain. he had cellulitis but no abscess on a ct scan. he got antibiotics.
10. admission history & physical examination for a 63-year-old man with shoulder pain, lethargy, and a uti. he will be given antibiotics and observed.
11. discharge summary for a 26-year-old woman with diabetic ketoacidosis, diabetes mellitus, and a possible ectopic pregnancy. her diabetes was managed and she will follow up with a gynecologist.
12. discharge summary for a 28-year-old man with obstructive sleep apnea. he underwent a tonsillectomy and an adenoidectomy. postoperatively, due to iatrogenic water intoxication, he suffered a hyponatremic seizure. he was sent to to the icu and given sodium. his levels normalized after a 3-day stay.
13. inpatient gastroenterology consultation for a 32-year-old woman with right lower quadrant abdominal pain. a ct scan showed fluid in her abdomen and inflammatory changes of her cecum and ascending colon. possible diagnoses included diverticulitis, infectious colitis, appendicitis, and crohn colitis. she will be continued on antibiotics.
14. discharge summary for an 8-month-old boy with fevers, upper respiratory symptoms, diarrhea, and emesis. he was given antibiotics and discharged after 6 days.
15. operative note for a 5-year-old boy with an arachnoid cyst on his thoracic vertebrae, from t3 to t6, causing compression of his spinal cord. the spinal cord was decompressed and the cyst was removed.
16. history & physical examination for a 5-month-old boy with chronic lung disease. he was transferred from the nicu to the picu in respiratory failure and impending cardiovascular failure. he was on mechanical ventilation and antibiotics. a tracheostomy was being considered and an echocardiogram is planned for the coming week.
17. emergency department note for a 4-month-old boy with vomiting. he was given antibiotics and discharged.
18. operative note for a 60-year-old female with right ovarian papillary serous cystadenocarcinoma. she underwent an exploratory laparotomy, total abdominal hysterectomy, bilateral salpingooophorectomy, and excision of the ovarian mass.
19. long-term video inpatient eeg monitoring of a 65-year-old woman who has a history of seizures. no seizures occurred during the 4-day monitoring session and the study was nondiagnostic.
20. operative note for a 14-year-old boy with appendicitis. he underwent an appendectomy without complications.

so? jolly good fun, huh? interesting, yes, or not so much? regardless, these are the things i get to think about all day, though from a professional distance of course. still, sometimes a report gets to me. i thought a bit about that boy running away from home, and also about the cancer patients, because cancer scares me.

today happens to be presidents' day so kara and i aren't working. no new medical reports today. she's going to be doing some school stuff and i think i'll do a bit of cleaning. i might go to the store if it turns out we need anything. otherwise i'm relaxing. oh, i might put some more spackle on the area of the wall in the front room that the dogs have been chewing. goddamn those dogs.

ashbery again

oh, and here's a pbs interview with john ashbery, still one of my favorite writers. give a listen, if you like. it doesn't hurt.

plumbing, again

we got a new kitchen faucet yesterday, after about 36 hours of being without one that didn't spray water everywhere when turned on. it's nicer to have a fully functioning kitchen sink, in my view, than not. i appreciate things like that. the faucet itself is perhaps not what kara would have chosen in an ideal world, aesthetically speaking, yet i believe it will serve. (note that the sink itself, the backsplash, and the nozzle on the faucet remain old.)

the plumber was just a boy, of i believe ukrainian descent (i really like ukrainians for some reason, the accent, the bone structure), 10 or 15 years younger than i. and he was friendly, if a little reserved at first. he worked quickly. so maybe i should become one. a plumber, not a ukrainian.

but i went to college, didn't i? indeed, i graduated from a small, new england, liberal arts college with a fine english program, nestled in woodsy maine, no less. why am i thinking of working a trade?

i was brought up (intentionally or not) to look down on the trades, on those whose careers depended on vocational school rather than a 4-plus-year academic education. (of course, a 1-year program in a vocational school prepared me for the job i'm working currently - is that why i look down on myself? - but i do work with words, and concepts of medicine, so maybe that elevates what i do? or not?)

i had not much in the way of ambition when i entered college, and less when i left it. my goal at graduation was to get a job (of some sort) that would support me as i wrote fiction. so, as i currently do have a job and do occasionally write fiction (though i've been between attempts for a few weeks now), i suppose i'm living my dream.

and yet i am unsatisfied. not always, to be sure, but sometimes. i do worry that advances in transcription software will eventually put me out of a job. i'm afraid of 20 years passing with me doing this same job. i wouldn't mind being our department's qa manager, working toward that; however, our current qa manager was just hired within the past year and if she doesn't do anything profoundly stupid then she's virtually guaranteed that job as long as she wants it, and she's younger and fitter than i. (and, as i learned a few weeks ago, our in-house transcription department is a rare thing in this world of outsourcing; a qa job elsewhere would likely be hard to come by.)

so why am i unsatisfied with my current job? (does this beg the question - isn't everyone at least intermittently unsatisfied with her or his job? who exactly am i to be looking for more?) what do i want to be doing instead? what did my parents have in mind for me when they shipped me off to college, and how relevant is that anyway? why did i not go into plumbing - or become an electrician or go into construction - immediately after high school? (though i don't for a moment regret college; i do value my education) (that last question can probably at least in part be answered thus: i was and am rather a girly boy and such jobs frightened me. plus they were deemed beneath me, which seems to make much less sense now than it did then.)

anyway. behold our new kitchen faucet, while i dream, undoubtedly fleetingly, of an apprenticeship; as we were told yesterday by that ukrainian boy, all plumbing fails eventually.

kinda cute, kinda annoying

since i rearranged the furniture up here in my office, eliot has started enjoying sitting on my desk immediately in front of the monitor. i peer over and around him to work. sometimes he lies down and i can look over him without difficulty, but sometimes he plays with the cord for my headphones or tries to bat the cursor on the screen.

yellow, in contrast, likes to sprawl on top of the monitor while i work; i think he likes the warmth.

attempt at massive chuck d

i have set before myself a formidable challenge: reading bleak house. the only other dickens i've read is great expectations, and that was when i was in high school. i liked it, actually, rather a lot. and i very much want to see the alec guinness film again (i saw that somewhere during high school too, i think). anyway. so bleak house is of course over 800 pages and the print is very small. i love the idea of diving into it and being immersed. i hope this happens. right now i'm on page 7 i think, so i guess we'll just see. wish me luck, eh?

otherwise, i've not much in the way of news. i had a quarter of my mouth cleaned professionally yesterday, the upper left, and with the anesthesia it was almost a pleasant experience. though afterwards of course my cheek felt three times its normal size, bloated and ugly.

dental surgery

that has a rather jolly ring to it, doesn't it? yes, yes. and it is in my future.

abject confession: prior to yesterday afternoon, it had been 15 years since i've sat in a dentist's chair. i know, i know. deplorable, irresponsible. still, it's very easy to not go to the dentist if you put your mind to it. i haven't had any tooth pain over the years, and once the first year or two had gone by it became more and more difficult to summon the stones to make an appointment. but i did it, i made that appointment, and i went.

and it wasn't bad. the dentist and all his techs and hygienists were very kind, friendly, and goodlooking. more than a dozen x-rays were taken and then the dentist did his examination. he was gentle. then he was very thorough in his explanation of his findings. for not having had a professional dental cleaning since 1993, he said, my teeth are in remarkably good shape. there is some tartar and there are some cavities, but i still have good bone surrounding each tooth. (evidently i have good genes, dentalwise.) oh, and i need to have my wisdom teeth removed.

heck - i didn't even know i had wisdom teeth. the way he explained the reason for the need for the extractions was so nonchalant and friendly that it wasn't until i got home and talked to kara - hey honey guess what? - that it struck me that this could be a very unpleasant procedure. teeth 1, 16, 17, and 32 will be history, and in their place will be inflammation, pain, and - oh yes - pain. (but - perhaps i will get percocet!) so i made an appointment with an oral & maxillofacial surgeon for feb 14 - valentine's day - for a consult. and i go back to the same dentist this afternoon for stage 1 (of as many as 4 stages) of dental cleaning.

still, the dentist told me that it looked like, after the professional cleaning, the surgery, and the filling of my cavities, i should be a low-maintenance dental patient. after 15 years, i'm sure it could be a heck of a lot worse. and i don't even floss!

all over again

we went to deja vu again last night - the one here in tacoma. it was kara and i and a friend - a woman friend. it was all right, but significantly less enjoyable than when kara and i went in seattle a few weeks ago. there was more of a crowd - it was saturday night - and some of those guys were acting like dicks, throwing fistfulls of dollars into the air. some of the guys were plain creepy, sitting and staring, lengthwise-folded dollar bills jutting from between their teeth. and most of the dancers were boring, actually, doing the same routines over and again. some of them i liked, though, or aspects of some of them i liked, i should say. and they - the dancers - seemed more confrontational than in seattle, so it wasn't really relaxing for any of us. there was a constant threat of a naked or nearly-naked woman suddenly doing a somersault into your lap. i suppose it was disappointing at the end of the day. but it was fun hanging out with our friend - we had dinner in a restaurant beforehand and she got hit on by a guy at the bar - he had a drink sent over - flattering and embarrassing - and, at the club, well, we all seem to like to watch, so it's not as if it was a wasted evening. there were more female patrons there than i had expected - my showing up with 2 women wasn't exactly groundbreaking. the club itself was a disappointment, is all. still, there are others.

magnolia day

twas 8 years ago today that kara & i had our first date: we went to see magnolia in downtown seattle. (though she probably wouldn't have paid me much mind in the first place if i hadn't mentioned a john sayles movie to her a week or two earlier. so the writers and directors paul thomas anderson and mr sayles ought to take a bit of responsibility here.) afterwards we went to the neighborhood of wallingford and had drinks in a bar called murphy's with alex & jeff and carla & nate. those couples are no longer together, though perhaps that's for the best.

we haven't seen magnolia all the way through in quite some time. we might try and make time to watch it this weekend, though, despite tom cruise.