April, 2006 Archive

August 30, 2016, 3:51 pm

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Generic cialis roundish.jpgShe was born ten days late.

Generic cialis Nearly two feet long and almost nine pounds.

Generic cialis In retrospect, generic cialis I’m sorta glad she was a C-section!

Generic cialis And she was perfect.

Generic cialis Except that she looked like an orangutan, generic cialis according to her grandmother.

Generic cialis Her soft blond hair stood straight up until she was eleven months old.

Generic cialis Good thing afros were the style back then, generic cialis because I think she was the only white baby I’ve ever seen with one.

Generic cialis She walked at nine months.

Generic cialis She could point out the individual Bee Gees by name at 18 months (hey, generic cialis I have my parental priorities!).

Generic cialis Healthy, generic cialis beautiful (don’t believe what her grandmother said) and the smartest baby in the world. Generic cialis Not that I was partial or anything.

Generic cialis My daughter, generic cialis Lillian, generic cialis is now 25 years old.My regular readers will remember her as the child who presented me with my dermoid cyst grandchildren, generic cialis Barry and Bridget a few months ago.She is tall, generic cialis blond, generic cialis model-thin and gorgeous (I’m still not biased, generic cialis as you can see.) She works in public relations for the city of Portland, generic cialis Oregon.

Generic cialis She works with the public everyday, generic cialis talking on the telephone, generic cialis greeting office visitors, generic cialis arranging sales, generic cialis working with her managers.

Generic cialis She even interviewed for a job that would mean coordinating conventions and meetings for the city, generic cialis providing even more opportunities for working with the public.

Generic cialis And she has stuttered continually since she was two-and-a-half years old.

Generic cialis Stuttering, generic cialis or dysfluency as it is also known, generic cialis is rare in females. Generic cialis The ratio of males to females is 4:1. Generic cialis There is no known causation (although theories abound) and there is no cure.

Generic cialis Water.That was the first word.When Lillian would say it, generic cialis it came out as “wa-wa-water”.

Generic cialis No biggie. Generic cialis It isn’t unusual for toddlers to go through a period of what appears to be stuttering when they first learn to talk. Generic cialis It’s harmless. Generic cialis It’s transient.

Generic cialis For Lillian, generic cialis it never stopped.

Generic cialis “Oh, generic cialis she’ll grow out of it”, generic cialis her pediatrician told me. Generic cialis Visit after visit. Generic cialis Year after year. Generic cialis “She’ll grow out of it.” Grandparents expressed concern. Generic cialis Aunts and uncles expressed concern. Generic cialis “Oh, generic cialis she’ll grow out of it, generic cialis that’s what the doctor said!”, generic cialis I reassured them.

Generic cialis She still stutters.

Generic cialis She has lived with taunts and laughter, generic cialis like when we were on a cruise and she tried to order a hamburger. Generic cialis The waiters laughed at her and mocked her speech. Generic cialis When she answers the phone, generic cialis it sometimes takes her 10-15 seconds to say a single word. Generic cialis People would hang up thinking there was no one on the line. Generic cialis She could not say her name without going through facial contortions and repetitive syllables.

Generic cialis Speaking in front of the class was torture. Generic cialis And this was in a supportive, generic cialis Catholic grammar school and high school with kids who had known her since she was five and where ridicule was not tolerated under any circumstances.

Generic cialis Public school would have eaten her alive.

Generic cialis When evaluated at the age of seven at the Speech and Learning Center of the Children’s Hospital, generic cialis Oakland, generic cialis they asked her to draw a picture of herself.

Generic cialis She drew a crying clown. Generic cialis At the age of seven her self image was already taking the brunt of the stuttering backlash.

Generic cialis Oh, generic cialis we did speech therapy, generic cialis off and on. Generic cialis Lillian hated it and hard a hard time complying with the exercises. Generic cialis All speech therapy can do is give you tools to use and she felt even the tools made her talk differently.

Generic cialis All she wanted was to be able to talk.

Generic cialis Normally.

Generic cialis She has used the new earpiece device that gives feedback as you speak (actually works with the developer of the device), generic cialis which helps with fluency. Generic cialis It’s better, generic cialis but not a cure.

Generic cialis Lillian gave me permission to blog about her experiences with stuttering.

Generic cialis I wish I could have asked her to “guest blog” how debilitating this was and is for her. Generic cialis I’m feel I’m not getting across how the inability to communicate normally can be so devastating to a life and a person’s self esteem.

Generic cialis Like it was when she was seven, generic cialis externally Lillian seems like she has a charmed life. Generic cialis She graduated from college (with honors), generic cialis has never had a dearth of boyfriends (who never seemed to mind the stuttering), generic cialis and ironically, generic cialis works as intimately with the public as you can!

Generic cialis But she never knows if she loses a job interview, generic cialis if it was her speech that held her back. Generic cialis If she’ll be fluent or not each time she answers the phone.

Generic cialis Every time she opens her mouth to speak, generic cialis she doesn’t know.

Generic cialis And it hurts.

Generic cialis Badly.

Generic cialis Lillian has a speech disability.It’s not visible.She doesn’t need special equipment to walk or move. Generic cialis Or a disabled placard.

Generic cialis But it is a disability just the same.

Generic cialis She says no one really understands how disabiling stuttering is, generic cialis despite her high-profile job.

Generic cialis I understand.

Generic cialis Who knows if she has even experienced discrimination, generic cialis no one tells you they aren’t hiring you because you stutter. Generic cialis She could have easily taken a job in a back corner and hidden herself from the world and the need to communicate.

Generic cialis Instead, generic cialis she has tackled life head-on and puts herself out in public every day. Generic cialis Stuggling with what the rest of us take for granted: communication.

Generic cialis Does that make her a hero?

Generic cialis You’re damned right.

Generic cialis People with diabilities do it everyday of their lives.

Generic cialis She is an inspiration.

Generic cialis And I am extremely proud of her.

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1:11 pm

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Crestor 10mg pills $160.00 It looks like they had three-dimensional chest x-rays back then!

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Crestor 10mg pills $160.00 That “specific criteria” usually means one of two things:

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Crestor 10mg pills $160.00 Lack of staff and/or lack of critical care beds are not, crestor 10mg pills $160.00 for example, crestor 10mg pills $160.00 criteria for diverting ambulance traffic.

Crestor 10mg pills $160.00 The status of any particular ED is visible on a county-wide monitoring system; a computer resides in each ED.

Crestor 10mg pills $160.00 (You can also signal the county if your CT scanner is down: patients with head injuries and possible strokes will automatically be diverted.)

Crestor 10mg pills $160.00 Some counties have restrictions on how many hours you are allowed to be on divert in a 24 hour period, crestor 10mg pills $160.00 some have limits on how many consecutive hours are allowed.

Crestor 10mg pills $160.00 Others have no restrictions, crestor 10mg pills $160.00 but keep track of the different hospitals and evaluate how much time they spend on diversion.

Crestor 10mg pills $160.00 Too much time on diversion is a no-no.

Crestor 10mg pills $160.00 But what exactly does it accomplish?

  • Well, crestor 10mg pills $160.00 it might keep elderly, crestor 10mg pills $160.00 altered and septic patients from nursing homes from arriving by ambulance.
  • It will keep the ambulance-for-the-stubbed-toe folks from arriving.

Crestor 10mg pills $160.00 And that is about it.

  • If you are in cardiac arrest, crestor 10mg pills $160.00 you go to the nearest hospital, crestor 10mg pills $160.00 period! Diversion means nothing at this point. Crestor 10mg pills $160.00 Even if you don’t have a monitor and have to perform resuscitation in the hallway, crestor 10mg pills $160.00 that patient is coming and you will find the means to deal with it.
  • If the paramedics are going Code 3 (red lights and siren) they will come to your hospital. Crestor 10mg pills $160.00 You don’t question the medic’s decision – it is their call. Crestor 10mg pills $160.00 And it should be. Crestor 10mg pills $160.00 You must accept Code 3 traffic at all times. Crestor 10mg pills $160.00 It means the patient is critical.
  • On both sides of the San Francisco Bay, crestor 10mg pills $160.00 there are hospitals 5-15 minutes apart all down the highways. Crestor 10mg pills $160.00 If two hospitals in a row are on diversion, crestor 10mg pills $160.00 then neither of them are on diversion, crestor 10mg pills $160.00 because it would mean passing up two hospitals for care.
  • Diversion does not stop:
    • the walk in MIs
    • the patients with pulmonary edema
    • the decompensating asthmatics
    • the suicidal overdoses
    • the trauma patients laying in the back of their friend’s truck
    • the patient with the CVA whose family managed to get them into the car despite the paralysis of their entire left side.

Crestor 10mg pills $160.00 You get the picture. Crestor 10mg pills $160.00 In addition:

  • Patients who have an HMO plan and are transported to non-HMO hospitals because of diversion have to deal with extra paperwork to make sure their hospitalization is covered or have to deal with the extra trauma of being transferred for admission to the hospital that was diverting at the time of their call to EMS.
  • Some hospitals in our area are well known for certain specialties and patients often request facilities for that reason; requests that cannot be accomodated if the facility is on divert.
  • A patient may be diverted to a facility where their regular doctor does not have admitting privledges, crestor 10mg pills $160.00 especially distressing if the doctor was planning on meeting the patient at their usual hosptial.

Crestor 10mg pills $160.00 Some of my worst shifts have resulted not from ambulance traffic, crestor 10mg pills $160.00 but by the acuity and number of walk-in patients to the department.

Crestor 10mg pills $160.00 So while it may be psychologically comforting (and it is) to think that you will not be receiving ambulance traffic, crestor 10mg pills $160.00 diversion can cause distress to patients, crestor 10mg pills $160.00 put pressure on the medics in the field and you can never really be sure that the Code 3 ring-down isn’t just a second away.

Crestor 10mg pills $160.00 Ambulance diversion just gives the illusion of control, crestor 10mg pills $160.00 something that you never get in emergency departments.

Crestor 10mg pills $160.00 It’s the nature of the beast.

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August 30, 2016, 3:34 pm

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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