CONTACTS 

SUBJECTS
Birthday with Daughter Plan See Movie Water for Elephants Nurse Diff

0603 -
0603 -    ..
0604 - Summary/Objective
0605 -
060501 - Follow up ref SDS 11 0000, ref SDS 10 0000.
060502 -
060503 -
060504 -
060505 -
060506 -
060508 -  ..
0606 -
0607 -
0608 - Progress
0609 -
060901 - Kathy got the message yesterday wishing her happy birthday, called
060902 - from Lafayette Reservoir.
060904 -  ..
060905 - She enjoyed doing errands today, and having lunch with Amy, and later
060906 - dinner with Amy Michael, Mia and Simone.  Amy was off work, so she
060907 - spent the entire day visiting her mom, starting with taking the car in
060908 - for service.
060910 -  ..
060911 - They planned to see the movie...
060912 -
060913 -                    Water for Elephants
060914 -
060915 -              http://www.boxofficeprophets.com/column/index.cfm?columnID=13882
060916 -
060917 - ...based on a book that chronicles life in a traveling circus during
060918 - depression times of the 1930s.  The story centers on a love triangle
060919 - of a vetinarian caring for the animals, and the wife of an animal
060920 - trainer.  One analyst commends detail presented by the author, but
060921 - says the writing lacks passion or soul.  This seems conflicting with
060922 - the book becoming a best seller, giving rise to a movie.
060924 -  ..
060925 - Kathy liked the book.  She feels Reese Witherspoon may not be right
060926 - for the lead character's persona.  Since Amy had too many errands
060927 - today, they set a date to see the movie on Sunday.  Will be
060928 - interesting to hear Kathy's verdict after seeing the movie.
060930 -  ..
060931 - Asked Kathy about taking the car in for service before the "target"
060932 - mileage is reached?  Mentioned checking the oil, and it does not seem
060933 - terribly low, about mid-way between half and full marks, which seems
060934 - like 75% full.  Not sure if this is a quart low?  Kathy takes her car
060935 - in every 3 or 4 months to get all fluids checked, even if mileage has
060936 - not been reached.
060938 -  ..
060939 - At work yesterday Kathy had a problem setting an IV for a patient
060940 - similar to work last week at the VA, reported on 110429 1230.
060941 - ref SDS 11 UN6K  Kathy explained that needle punctures must follow the
060942 - path of veins in order for IVs to get adequate blood flow.  Many
060943 - factors complicate alignment because veins naurally bend and weave
060944 - through human tissue.   Well muscled patients, dehydration, and
060945 - overweight patients all make finding veins and positioning the needle
060946 - difficult for setting IVs.
060948 -  ..
060949 - Kathy asked about quality control surveys on health care at Kaiser for
060950 - Millie or through the VA?  She related that patients complain most
060951 - about painful IV procedures from multiple needle punctures.  The
060952 - patient yesterday getting maternity care reported a prior difficult
060953 - encounter that took 8 tries to set an IV.  Expectant moms are
060954 - typically overweight from the pregnancy process, and this woman
060955 - weighed over 300 pounds.  After the first miss, Kathy wisely requested
060956 - assistance from the Anesthesia Department to help the patient as much
060957 - as possible, avoid starting her journey having a new baby with another
060958 - painful IV needle experience.  The anesthesia nurse was successful
060959 - with one try, which minimized pain and trauma to the patient, and
060960 - maintained good feelings among the team for delivering the baby, and
060961 - post-procedure recovery.
060963 -  ..
060964 - Patient comfort and emotional frame are obviously important.  In
060965 - Millie's cas, we tried to avoid trauma for providers, as well.  An
060966 - example is Mil's visit to the ER on 090720 1437. ref SDS 5 RW43
060968 -  ..
060969 - During the call today, we considered case study on 110429, showing
060970 - anesthesia "experts" had difficulty setting IVs for heart surgery in
060971 - October 2009. ref SDS 11 UO3G  This underscores that needle punctures
060972 - combine skill, art, and luck.   Doctor Brzezinki's paper on this
060973 - subject at UCSF, and cited during heart surgery prep on 091022,
060974 - ref SDS 6 LN88, did not prove useful, reported a few months later on
060975 - 091219. ref SDS 7 0O4R
060977 -  ..
060978 - Millie received quality care surveys from Kaiser.  One of the more
060979 - interesting quality reports was congratulatory notice that her
060980 - mamogram test 2 weeks earlier was negative.  This was received in the
060981 - mail on returning from surgery to remove a tumor in Millie's left
060982 - breast, reported on 020312 0930. ref SDS 2 YV3O
060984 -  ..
060985 - No matter how difficult problems became, we always commended the
060986 - quality of care Millie received, illustrated by her letter to the
060987 - doctor on 080428 2343. ref SDS 4 1H6Y  The medical team was routinely
060988 - notified of problems to solve with guidance in the record on work
060989 - plans, shown by case study on 040416 1045. ref SDS 3 GN7J
060991 -  ..
060992 - Today, Kathy reminded that drinking water is not a good solution to
060993 - set IV catheters for anesthesia, cited in the record on 110429 1230.
060994 - ref SDS 11 QF62  While it helps the nurse find a vein with strong blood
060995 - flow, drinking a lot of water conflicts with NPO protocol for
060996 - anesthesia.  She also said that a well muscled body has more natural
060997 - "breaks" in the veins, which further complicates setting an IV
060998 - catheter.  Marry commented on this "muscle" issue, reported, 110429
060999 - 1230, ref SDS 11 QF5M
061001 -  ..
061002 - Kathy mentioned a radio broadcast talking about accuracy in writing,
061003 - possibly related to a movie or book.  The radio host noted challenges
061004 - of human memory.  Kathy was reminded of focus on the fragility of
061005 - memory that SDS strives to solve, explained in in POIMS....
061006 -
061007 -         Accurate undrstanding relying on............. ref OF 7 Y36K
061009 -          ..
061010 -         Time and complexity degrade and
061011 -         confuse human memory......................... ref OF 7 PR7G
061013 -  ..
061014 - Andy Grove, former CEO of Intel, concisely describes problems from
061015 - taking important action based solely on tenuous human memory, see his
061016 - book "Only the Paranoid Survive," reviewed on 980307 1614. ref SDS 1
061017 - 3668
061019 -  ..
061020 - Mentioned the 1964 movie "Outrage."  Paul Newman offers a comedic
061021 - touch playing a slow-witted outlaw.  Comedy takes the edge off a very
061022 - serious problem of people remembering common experiences in very
061023 - different and conflicting ways according to personal interests.  Kathy
061024 - hasn't seen the movie.
061026 -  ..
061027 - "Outrage" is listed among movies reviewed in the record on 100908
061028 - 1633. ref SDS 8 BQ5G
061030 -  ..
061031 - Kathy asked about swallowing after VA EGD and dilation on 110429 1230.
061032 - ref SDS 11 SR6K
061034 -  ..
061035 - Explained difficulty on 110504, but likely due to eating too fast,
061036 - noted in case study on 101010 0744. ref SDS 9 SY8F
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0611 -