The wind is severely cold.
It makes a cocoon of noise that forces me to huddle.
Why not be uncommon and bold?
Lift my face to the rain – not stare into a puddle.
Mine, Your love for the taking,
But there is always a fight for something dear.
What chains can I be breaking?
Only when I search Your voice does it seem clear.
Fix the gate or train the dog.
You chose to free me, not lean on my heart.
But life here is such a fog.
I wonder what attraction is next to keep us apart.
You chase – I sense no relent.
What is the source of this great desire to save me?
Your grace I recklessly spent,
So my soul denies life together can actually be.
You come and show me your face.
I forget what that cost or what it means.
Early this morn I look where?
And discover that there is only void – save your great dare.
Sunday, December 28, 2008
Wednesday, December 10, 2008
Its OK . . .just hold your breath for the next 5 hours
The institute of Medicine, Department of Health and Human services and others have brilliantly come to the aid of your future doctors. Residents all over the country are looking forward to a reprieve from the oppressive schedules that have characterized post-graduate training in the United States for decades. The new "proposals" will limit their shifts to 16 hours with a mandatory 5 hours of uninterrupted sleep before any return to duty. In a week the total hours on-duty will be limited to 50. Of course that means that there are 8 hours that are left for someone else to work each day and a total of 118 hours per week.
The obvious question is who will care for the patients those other hours? In the past some surgery residencies split the 168 hours "evenly" at 100 hours for each resident. The complaint was the famous, "I miss half of the good cases" - when sharing with another.
Now that same work requires 4 surgery residents to cover the hours.
The problem: There are no extra doctors coming through the system to fill the required slots. So, where might a qualified provider be found? What hours will these new residents work once they finish their training? Most practicing physicians learned the ability to work long and hard during those training years. Where will the new doctors, the ones that are far fewer in number than the population will require, learn to work at 03:00?
One answer is the teaching staff of the institutions wherein the residents learn. Of course those older, less resilient doctors are even less capable of functioning deep in the dark hours of a night. And teaching after being up all night? Intellectual functioning for teaching is an early victim of sleep deprivation. So, the now fresher, "safer" residents get less oversight and instruction.
Perhaps physician extenders, or independent nurse practitioners can fill the bill. I think that the 6 years of post-high school diploma training required to become a nurse practitioner may lack some of the finer points of medical training that are part of the 13 years post high school training a surgeon must endure.
So, as we all age, it is interesting to think who might be at our bedsides at 03:00 in an emergency. Will we be alone, holding our breath until the doctor finishes the 5 hour nap?
The obvious question is who will care for the patients those other hours? In the past some surgery residencies split the 168 hours "evenly" at 100 hours for each resident. The complaint was the famous, "I miss half of the good cases" - when sharing with another.
Now that same work requires 4 surgery residents to cover the hours.
The problem: There are no extra doctors coming through the system to fill the required slots. So, where might a qualified provider be found? What hours will these new residents work once they finish their training? Most practicing physicians learned the ability to work long and hard during those training years. Where will the new doctors, the ones that are far fewer in number than the population will require, learn to work at 03:00?
One answer is the teaching staff of the institutions wherein the residents learn. Of course those older, less resilient doctors are even less capable of functioning deep in the dark hours of a night. And teaching after being up all night? Intellectual functioning for teaching is an early victim of sleep deprivation. So, the now fresher, "safer" residents get less oversight and instruction.
Perhaps physician extenders, or independent nurse practitioners can fill the bill. I think that the 6 years of post-high school diploma training required to become a nurse practitioner may lack some of the finer points of medical training that are part of the 13 years post high school training a surgeon must endure.
So, as we all age, it is interesting to think who might be at our bedsides at 03:00 in an emergency. Will we be alone, holding our breath until the doctor finishes the 5 hour nap?
I missed the message
It seems that when Mr. Obama was campaigning, I did not listen long enough. I heard him say, "Change." I missed the second part of the message, as did most of the voting public. It was, "back."
As evidenced by his cabinet appointments, Mr. Obama did not intend to change to something new, only to, "Change back." Back to the Clinton leadership and ideas that led to many of the failed policies that we had to endure with the Democrat-led congress. The deregulation of the banking system that Clinton (Bill) put into place that allowed the subprime, Fannie Mae etc. melt down.
Now we change back to FDR's public works policies to save us from the economic disaster, so we can hand the profits over to the holders of our creditors - the Chinese.
I have been learning the wrong languages. I thought Spanish and English would help me communicate with my fellow citizens. Chinese would be a better language - the language of the new management.
As evidenced by his cabinet appointments, Mr. Obama did not intend to change to something new, only to, "Change back." Back to the Clinton leadership and ideas that led to many of the failed policies that we had to endure with the Democrat-led congress. The deregulation of the banking system that Clinton (Bill) put into place that allowed the subprime, Fannie Mae etc. melt down.
Now we change back to FDR's public works policies to save us from the economic disaster, so we can hand the profits over to the holders of our creditors - the Chinese.
I have been learning the wrong languages. I thought Spanish and English would help me communicate with my fellow citizens. Chinese would be a better language - the language of the new management.
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