Berkeley for a night

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Since my friend, at who’s house I have been staying, arrived back in town, I am freed from cat sitting duties. Not that the cat was willing to be “sat.” This particular cat is high on complaining from under the bed, scolding me, and evening whining. But not being willing to come out for a visit. So I was perfectly happy to leave her lording it over me (she thinks she won because her person is back and now I can just shove off – thank you very much) and head to my own bed for a night.

What was also on the agenda for the day was a stop at UCHastings for an afternoon seminar on current California legislation (in the Trump era). The time was well spent, informative, and reflective of the fact that California, by itself, is about the world’s fifth or sixth largest economy. Scary that. Which explains why a certain regime is so unhappy with the state’s willingness to maintain all the rules which have been applicable for the last 30-40 years. (and no, I won’t go any further down that soapbox or rabbit hole). Not that many people showed up, which means there was a lot of food left over. Cannelloni, yum.

North Berkeley BART to 29 Sushi to home. And laundry, and house clean up. and sorting stuff out.

Nothing exciting there…

words in my head

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don’t do me anywhere near as much good as words on paper (which, in today’s world translates to words in an electronic document). I have come to acknowledge that putting off finishing the requirements for the two outstanding incompletes from grad school is not doing me any good. In fact, it more resembles the garbage left too long under the sink. The longer it sits, the more it smells. The more it smells, the less you want to deal with it. At some point, the nose is held (clothespin optional) and the stinking container is emptied, washed, and put back with all good intentions to avoid this cycle in the future.

Then the future rolls around again.

Please understand – I don’t give a flip about grades, all I want it is “met enough work to warrant a pass.” Having said that – it is hard to imagine putting in hours of work researching and writing for no good reason if the end results could possibly be of benefit.

It is the old Tikkun olam. Build the world a better place.

So… the background to today’s public health challenges include the following:

  1. San Francisco is an extremely expensive place to live
  2. The tech boom has resulted in an increase of 100k jobs over the last decade and the loss of 30k in housing in just the last few years
  3. The weather in California is not as bad as many of the other parts of the country
  4. changing demographics have resulted in marginalization of portions of the population.
  5. San Francisco became the mecca for a number of lifestyles starting in the 1960s

 

Now, back tracking to 2008-2009, there were several medical publications that discussed Hepatitis A infections and risks in homeless populations. Those discussions centered, of course due to the standard medical tunnel visions, on immunizing everyone to avoid disease.

So why was everyone in both city governments and public health circles so stunned when an epidemic of Hepatitis A started sweeping through homeless & IV drug user communities (and yes, there can be an overlap between the two). I fail to understand why anyone was surprised. Or, even more stunned to be in a situation where a normally mild disease most often seen in childhood in most of the developing world, various institutions was causing hospitalizations and death. This epidemic was recognized, not because of the obvious failure of the city, the infrastructure and public health to recognize the failure to provide for a vulnerable population but that hospitalization costs were skyrocketing.

The solution? According to the CDC – we should adopt the 2009 recommendations (hello, this is now 2017….) to add homelessness, IV drug use or MSM* to the list of peoples needing HepA immunization.

For those of you who don’t remember the history of Hepatitis A – this was the food/water borne version of hepatitis for which you (as a citizen of a developed country) received a large shot of gamma globulin in a major muscle group (usually gluteus maximus). 5cc is a significant volume, trust me. In 1995, the first versions of HepA vaccine became available. Every military member with a brain in his/her head was more than willing to get immunized. One shot with maybe a booster vs large/painful shot every 3-6 months while deployed? Other than the military, most of the other developed world citizens at risk of HepA were tourists indulging in street food while visiting developing countries. With the usual transmission being the fecal-oral route, it was obvious to everyone concerned that sanitation was as important to breaking the infection cycle as immunization.

We seem to have forgotten that bit of intelligence. It doesn’t matter if you immunize the whole world against a disease. That is one disease. As anyone who has every had noro-virus, salmonella food poisoning or one of the hundreds of other possibilities, the key to not getting diarrheal disease is availability of toilet facilities accompanied by strict adherence to hand washing. Which takes us to a city where there are no 24 hour public toilets, hand washing facilities are limited, no one wants homeless encampments, there is not enough shelter space for those who need it, and serious money is spent on a daily basis on power washing human excrement off the sidewalks.

Yes, we can immunize everyone. But it is not going to solve the sanitation issue.

I am making some basic assumptions. The first is that most people do not chose to be homeless. That they don’t set out to be vulnerable, dirty, and hungry. That, if they had the money to have food and shelter, they would. But San Francisco has teachers in their schools living in cars because they can’t afford a place to live.  I also make the assumption that mental health, substance abuse issues, and physical health issues impact lives to the point where many become homeless. And those problems don’t become better by being without a home.

<two hour break in which I spent digging through PubMed. Surprise, surprise, all the public health people, when discussing issues related to the HepA outbreak mentioned and repeatedly mentioned that sanitation was a serious issue and one of the most difficult to resolve. Having said that – it is no where in any of the CDC guidance. Just immunizations. Go figure>

I finished off the draft memo – sent it on its way, and spent sometime working on a Hitchhiker variation in a lovely yarn color called – magic unicorn.

 

*MSM= men who have sex with men…

 

Yogurt

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There are serious limits on George’s diet right now. Processed foods are fine, prepackaged complete with preservatives and fixatives. But nothing fresh, nothing from outside that doesn’t fit into the above categories, and certainly nothing home made.

UCSF runs an a la carte menu for patients. Rather than trying to come up with multiple daily menus, balanced meals and pap that no one would possibly want to eat – they actually treat patients as adults and let them order anything they are allowed to have off the menu. Up to six times a day. The only limits actually being the times of day that the kitchen is open.

But they have breakfast all day, soups, snacks, pizza and entrees after 1100. There are options from more than just the standard middle America fare, the ice cream (available in vanilla or chocolate) is Hagen Das, the vegan shake option smells horrible.

Last spring, the pudding option became one of George’s favorite and I had to find a local source for the first couple of months home before the novelty wore off. The yogurt wasn’t to his liking. A couple of days ago, I noticed that the Peet’s I have been stopping at on the way in morning carries smallish containers of his favorite brand of yogurt. It is prepared. It comes in a sealed container. He is allowed to have it, along with canned vanilla lattes.

It is a nice change from bananas, crackers, and peanut butter in single serving containers.

 

Strider

a sneakily simple knitting pattern from Martina Behm – takes one skein of sock yarn and is all garter stitch.

Strider

Oct 2017

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As I was looking over posts from Oct 2017 – I realized that lack of cheap internet access on the NCL Sun meant that I never got around to posting pictures from Fleet Week, the Blue Angels, the Bridges, San Francisco, or the SF Bay. Since I finally found the old photos on a back up hard drive (and yes, sorting by year, month, date is the only way to go), I decided to share. It is not like otherwise there is a lot of thrill in seeing garter stitch scarves or listening to me whine about lack of progress on those papers still hanging over my head.

Fleet Week

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is just starting in San Francisco. In the back of my head, I sort of had filed the information away along with all the other local events that are interesting but don’t elicit any personal interest in participation.

Then I noted some rather low flying, fast, expensive aircraft buzzing the Golden Gate Bridge.

Right – Fleet Week – when Navies get together and show off – their ships, their abilities, and, in the case of the US Navy – the Blue Angels.

I don’t remember where I was or what I was doing last year – but I remember 5 Oct 2017. I was headed round trip through the Panama Canal on the NCL Sun in the company of good friends from Australia. We were due to pull out from San Francisco at a reasonable time of the afternoon. And then the fun started. It was a Friday afternoon. The tannoy announcement informed us that we were going to be delayed secondary to the Blue Angels rehearsing. Along with dozens of others, I went and staked out my territory on the upper deck. Up at the bow with a good camera and excellent lens. I checked the old post to discover that I hadn’t uploaded pictures at the time. And since I have changed laptops since then, I have to find the connector, pull out the backup drive, and find the photos.

Right.

Anyway. It is Friday. And what started out this whole train of thought was seeing what I thought was a low flying aircraft out of the corner of my eye. George’s window mostly faces another section of the Long Building. I can see toward downtown (East) if I look out and too the right between the two wings of the building. Huh? Walking to the lounge at the end of the hall, I had a clear view of the stretch of Bay which separates San Francisco from Marin and includes the Golden Gate. Contrails slowly dissipating. Oh – ok, Fleet Week, Blue Angels.

Back to my audio books and knitting.

Thursday already

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Kind of like time flying? Actually more like creeping along the ground a la inch worm. There isn’t much to distinguish days of the week for a hospital inpatient. The nurses here are on 12 hour shifts of which they work three in a row. So every three days there is a new nurse. Occasionally, George even sees one of them again. Since the nurses rotate between this floor (12Long) and 11 Long the total number of faces on the staff board is on the high side of 150.

Meanwhile, we wait. The routine seems to be fairly set on 1) visits by the oncologist; the hospitalist (who never come in together and I am not sure that they really communicate with each other) 2) the nurses 3) all the misc personnel from cleaning staff to laundry to trash emptying to food delivery 4) medications 5) various IVs from platelets to blood to antibiotics to electrolytes.

Making a round of the station (since walking off the station falls into the NO box) can be the highlight of the day since it is a different set of walls to stare at.

All of this makes me tired, just writing it. I am contemplating sleeping here tonight as I am just to tired to want to deal with the N-Judah….

Not my brightest move

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It was after sundown and I was contemplating food and drink. As part of this thought, I decided it was time to head toward sleep. That and there was this bag of laundry. As I reached to put on my quilted vest, the light bulb went on. I didn’t have the vest. In fact, I had left it on the bed at home. No big deal, except for the fact that the keys were in the right hand pocket. No way to get into my friend’s house.

Checked in with Dani who checked, found the vest and verified that the missing keys were exactly where I thought they were. She agreed to pick me up at NB. Originally my plan was to just stay at home. But that would have involved getting up at really dark:30 to be dropped back at BART. And either staying up tonight or getting up even earlier to deal with laundry.

In stead, she very kindly brought me the vest (complete with keys) and headed back home. I dashed back into NB station in time to just miss the outbound train. 18 minutes later, I boarded the Warm Springs bound train (the only one at this time of night headed in approximately the correct direction. Implied was a train change at MacArthur. No problem, only a few minutes wait. and wait. Then, apparently, we were also the connector train for SF bound passengers from Dublin/Pleasanton/Fremont/Warm Spring. So there we sat at 12th Street for 15-20 minutes waiting.

At this point, I am trying to decide if I am going to make it to Outer Sunset tonight, or sometime in the wee hours of the morning. We finally board the TWO connecting passengers and roll slowly to West Oakland, crawl through the tunnel and creak to a stop at Embarcadero. After dashing up the stairs, out the gate, through the turnstile to Muni – I see the N-Judah just closing its doors as I hit the platform.

Ok, why should I worry about another 18 minutes of delay. It is not like being stressed is going to make the trains arrive any sooner. Finally the time is up and I board. Oh, wonderful, this is one of the older trains without working signage. I know the route fairly well, but trying to figure out where we are once we leave the more densely packed stores is a bit of a challenge. The lights are just being turned out at the corner store (39th & Judah) which is my landmark for the 40th street stop.

Jessica’s cat, of course, was not at all grateful that I had made the effort to get back to her. Clean water, clean box, fresh food? None of it counted as she whined and grumbled at me from her favorite hiding place beneath the bed. After all, she was expecting service long before 2300. Tossing the clothes in the washing machine, I remembered to take out the trash bins before collapsing.

Drip, Drip, Drip

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(reprise)

Actually, when I think about it, watching paint dry might just provide a bit more satisfaction than watching IVs. When the paint is dry, that bit of the renovation is complete and you can move on to a new room. In the case of IVs – one is simply replaced by the next in line, and the next, and the one after that. Whether it is blood, platelets, calcium, magnesium, potassium, immune suppression drugs, antibiotics or solution-du-jour – the little boxes attached to the IV pole modulate the flow and seem to announce a change rather loudly. That change, completion or “air-in-the-line” of course is most likely to happen in the few minutes between interruptions that might possibly have been intended for a nap.

Otherwise – this is D+11. Things are proceeding. At least we think they are. No signs of rejection in either direction, but no real sign of some of those millions of stem cells settling in and setting up housekeeping either.
There is NPR, and the baseball playoffs (such that they are) and the occasional phone call/email to keep George entertained. I think he is beyond the worst of lousy feeling secondary to both the chemo and radiation. No clue how much longer he will be here as an inpatient, all depends on when those stem cells settle in and start producing.

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…..

Oh, yah, blogs

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What is probably fairly obvious at this point is that I have both a lot on my mind and a limited ability to accomplish anything worth while.

Worthwhile being rather liberally defined as a few rows of knitting, some laundry, CME, a phone call or three, a hour out of an audio book. I am not making any claims about being efficient about the use of my time or being particularly inclined to communications.

And I can most sincerely confirm what all of us, if we don’t know it from personal experience have long presumed – hospitals are not a place to get any rest, nor are they a location from where anyone, patient or family, can expect to accomplish much of anything during a fairly long day. Interruptions, I swear, are timed so that it is impossible to maintain any kind of task focus.

The nurses, well that one is obvious, as are the various doctors (can’t have just one – no – it needs to be several from different services). But then there are the dietician staff, the nutrition staff, the pharmacy staff, laundry staff, cleaning staff, waste basket emptying staff, sharps container changing staff….. you get the idea.

I am exhausted just writing out the list. But, over all, George is stable. So it now it is just a waiting game.

Slipping past

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Most years I tell everyone to completely blow off my birthday. This year, with everything else going on – I didn’t even have to bother going that far. The very basics of spending hours at UCSF, deciding if I am going to get off Muni at the Peets located at Carl & Cole followed by a hike up a rather large hill (this is San Francisco – there is ALWAYS a hill) vs. just bail off at UCSF and buy my latte at the hospital coffee shop. They also serve Peet’s, but it isn’t in the app network. Small, measly little point, but occasionally getting a free beverage from my favorite coffee shop seems like a nice reward.

Otherwise – right now I don’t see 69 as being any different than 68. There are more important things in my life than worrying (or celebrating) a few more grey hairs or a date that is relevant only to the DMV and passport office.

Yes, there are times in our lives when the whole world changes, tilts, spins off its axis in a fraction of a second to a new course that could be wonderful but more often devastating, creating a new reality. I will take this year instead hoping for small increments and nothing more than I can handle that hour.

In spite of themselves

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Clearing off the baseball stuff first. Thanks to the records of other teams – the As will host the American League Wild Card game on Wednesday. Which is good considering that they lost the last two games of the season to the Mariners. Especially watching them today, I am not sure that their heads were really in the game. Best I can say is that they weren’t shut out.

Now, due to the fact that Tampa Bay is from the East Coast, the start time needed to be modified so that all those poor Floridians don’t have to stay up too much past their bedtimes. Rather that our usual 1905 first pitch, the game will start at 1700 PDT. That is right – 5 0’clock in the afternoon. Seriously. Not an afternoon game, not an evening game but a weird time in between. Personally, I think it has to do with sales of ads on the TV broadcasts, but what do I know?

Looking at Stub Hub, the only quantity of tickets are either on Mount Davis (upper deck in outfield) or plaza deck in outfield. But there are people who seem to think that their tickets are worth multiple hundreds of $$$. I wish them luck. Especially since you can buy tickets for Mt Davis directly from the As for less than ½ the Stub Hub asks..

In more important news, George is stable. Absolutely exhausted but holding his own.

My plans to take Alex (son-in-law) out for brunch on his birthday were partly thwarted by PG&E (Pacific Gas & Electric) which treated us to a power outage this morning. Affecting a goodly portion of Berkeley, Albany, San Pablo Avenue, El Cerrito, Kensington etc, all the places we enjoy going to for breakfast were without power. = no coffee….

We wound up in Emeryville as the nearest location that had power.

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.

Fantastic First Inning

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Arranging to meet Noah at the Coliseum BART station from his flight from San Diego – I dragged him to the As game before releasing him to take a break.

It was a good game, with the As scoring an amazing number of runs in the first inning (7) and a final score of 12:3 over the Texas Rangers.

An up day is always good.

Admission

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and another day that seems to drag on forever. To get admitted to the hospital (in this case, UCSF) one has to first show up at the clinic where blood is checked, vital signs are taken, a provider is seen. Then over to the actual hospital where the admission paperwork is completed. Then the idiots wanted, apparently, another chest x-ray. I am not sure what they expect to find considering that he had a CT last week.

And then waiting for a room. At least with a different view than before.  Looking north toward Marin, east toward downtown, down to Parnassus Avenue busy with traffic, buses and pedestrians.

The plan is for a second attempt at a bone marrow transplant. College Guy (aka Noah) will be back in town tomorrow. Sunday he checks in at the clinic and to begin a series of bone marrow/stem cell stimulating shots. If everything goes as planned, he will head back to San Diego next Saturday.

Walking on to the ward in the early afternoon, I am not sure if it is a good thing or not to recognize a fair number of the nursing staff. The good thing for me is avoiding the mind numbing drive to San Francisco and back on what was rapidly becoming a daily basis. Starting this coming week (due to the generosity of a friend) I will be camped out again in a guest room in the outer Sunset district and traveling back and forth on the N-Judah.

KC? Really

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I mean. Seriously.

I returned the rental car this morning at San Diego Airport. Picked up a physical boarding pass from Southwest Airlines and worked my way through the usual disorder of TSA. Of note is that the USO is at Terminal 2 (which makes sense as the “International Terminal). I decided it just wasn’t worth the hike over and back. My flight was on time and I arrived in Oakland with more than enough time that I could have gone home.

But since there was about 3 hours to this evening’s game; the final homestand of the 2019 season it just didn’t seem worth the effort. Instead, I hung out in the terminal long enough to make sure that my phone was charged before heading on the mono-rail to the Coliseum BART station and the overpass to the Stadium with plenty of time to locate both food and drink.

I lasted till about 2100 when it was obvious that this game was going to take forever. Two hours in and we were not even out of the 5th inning. Managing to miss the Richmond train by seconds (I just love people who block stairs, escalators with their intense conversations or cell-phone huddles) so had to wait 25 minutes for the next train.

I was home in time to watch the 9th inning. To watch the As lose to the Royals, perhaps the second worst team in the league. In good news – the Twins won. If the A’s can get it together, they actually may hang on to their wild card slot.

And tomorrow is another day. Another drive to UCSF.

Box Stores

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Costco, IKEA, Target.

Probably three of the most frequently visited stores by parents of those setting up life at school or job in a new area of the country. We started with Target for some kitchen/bathroom needs, then moved on to Costco for anything that required volume (or discount). My son is practical. He can live without furniture but really wanted a decent vacuum cleaner. Our final stop on the run was IKEA (where we also found the second Costco which means that we did more driving than was absolutely necessary).

He now has a bed, some food in the kitchen, a kettle, a french press, cutting boards, knives, and a temporary desk so that he can get his computer set up.

Still on his list are tackling the rental agency about the cleaning that wasn’t done, getting his internet access, dropping off paperwork at school, grabbing his textbooks end of the week and otherwise settling in.

His location is good – 15 min walk from school. From the looks of the complex, there are a number in his age group. I am betting as well the tenants include house staff from the near by Jacobs Medical Center. Being across the street from a decent shopping center affords fast food and three grocery stores within reasonable walk (Vons, Ralph’s, Whole Foods). Oh, yes, Trader Joe’s as well.

We grabbed an early supper. I was more than interested in another nap. I am headed back to the Bay Area tomorrow, Noah flies back on Saturday for a week.

La Jolla

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as it turns out is home to University of California, San Diego, Go figure. Anyway – not San Diego State University which is a completely different institution.

We arrived on site in the early afternoon. Dealing with traffic on I-5 has seriously moved up on my list of “things that never need to be repeated in this life time.” The portion around San Diego isn’t that bad, but we had to get past L.A. and its sprawl before being able to relax at all. The only positive thing I can say about LA freeways is that they define HOV as 2 people in a vehicle.

20 minutes worth of frustration and fussing around finally liberated Noah’s apartment keys from the lock box. The one which was neither on the end of the row, nor marked with red tape. And, even better, there was an elevator from the garage up to the third level where he will be living. Helping with the first load or so, I proceeded to take a short nap while he finished unloading the car.

Not being up for much more (something about 4 hours total of sleep in the last 36+, we elected to find food and call it an early night.

Two places at once

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And it was back to UCSF this morning, followed by getting organized this afternoon. Probably the only thing at all easy about the day was the fact that the As are still out of town.

Otherwise, picked up a renta-beast (vehicle large enough to haul College Guy’s stuff including his desk chair) in preparation for tomorrow’s drive to San Diego. I left the packing to him, I went and took a nap. My first inclination had been to leave late this evening and stop somewhere along the drive. Reconsidering, I have elected to leave early in the morning and just drive through.

Early = about 0300 in the morning figuring that there isn’t going to be all the much traffic for the first 3-4 hours of the drive but having full daylight for the ugly portion (being LA and environs). Wisely, I had talked myself out of driving both ways, instead opting for the car and a flight back on Monday.