Double
Dosage of
Fluorescent tags
Measure the distance, a newly-formed mold.
Two points a ten day gap lights in blacklight.
A gaze, growth
Sequestered
Where it
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"[...]a vessel cleaving the dungeon of the waves[...]"
You're Love in the Time of Cholera!
by Gabriel Garcia Marquez
Like Odysseus in a work of Homer, you demonstrate undying loyalty by
sleeping with as many people as you possibly can. But in your heart you never give
consent! This creates a strange quandary of what love really means to you. On the
one hand, you've loved the same person your whole life, but on the other, your actions
barely speak to this fact. Whatever you do, stick to bottled water. The other stuff
could get you killed.
Take the Book Quiz
at the Blue Pyramid.
Never miss a word
You're Infinite Jest!
by David Foster Wallace
While you1 consider yourself2 to be clever,
there are those3 who think you're just full of yourself or, perhaps worse,
playing a joke4 on everyone around you, and yet you are pretty sure that
you really are that brilliant after all, since people would hardly take the time to
get to know you5 if they didn't care very deeply about what you had to
say to them, to wit, about their lives, their hopes, their dreams, their fears, their
drug habits, and of course what videos6 they prefer to watch, since,
after all, your impressive vocabulary and tendency to go on and on7 makes
you seem superior, able to educate them, and really drive a sense of something
ineffable into their measly little skulls while you are not above making a cheap
gag or really going after anyone or anything or telling them about incredible
futures involving tennis, geopolitics, and
1Meaning you personally, not someone like you or your own
personal daddy, for example.
2As well as you can see yourself, which, frankly, may not be that well.
3Though we wouldn't deign to be so peripatetic as to name them here, mind.
4Jokes, though not common in Victorian England, were known to originate
sometime in ancient history, perhaps as early as the time of Babylon, or even before.
It is thought that the history of the joke plays an integral role in the mindset of
the characters depicted here, though you may disagree at this point, in which case I
am facing quite the dilemma in relaying this narrative, no?
5It is rather time consuming, after all.
6Ha!
7and on and on and on...
Take the Book Quiz II
at the Blue Pyramid.
You're The Metamorphosis!
by Franz Kafka
Though you think you're in the midst of a dream, the fact of the
matter is that your life has become a nightmare. The nightmare at first seems
horrific to you, but you are slowly able to adjust to the facts of the matter
and settle down and make do with what you've been given. There are those that
would say you're pointless and absurd, but you're really just trying to
demonstrate that people can (and do) adapt to anything, no matter how absurd
it is. Not that this will really inspire them to change, because they probably
don't understand.
Take the Book Quiz II
at the Blue Pyramid.
About Me
- Σφιγξ
- possesses wholly unmerited academic pretensions; examines love as an entomologist; collects haunted dollshouses; notes the lunar phase as regularly as the temperature; peruses field guides; reads like a serial magazine subscriptionist; functions through coffee and "mood" music; draws to the very corners of the page; takes notes on unlined paper; reads poetry as prayer; observes textual authority with the incredulity of fiction; suppresses the smart-ass answer(s); adapts as well as anyone beseiged by her own bibelots; she is a sensation seeker in spite of all of this.
55 comments:
https://books.google.com/books?id=gTk9Ol9_MjYC&lpg=PA18&dq=pythagoras%20tetractys&pg=PA18#v=onepage&q=pythagoras%20tetractys&f=false
http://www.openculture.com/2014/09/the-guggenheim-puts-109-free-modern-art-books-online.html
https://books.google.com/books?id=8sBaCAAAQBAJ&lpg=PT124&dq=Tarot%20XX%20Aeon&pg=PT125#v=onepage&q=Tarot%20XX%20Aeon&f=false
Yes. The Chigi Pyramids, in context, point out the arrangement of the letters of the Tetragrammaton (72) in a Pythagorean tetratcys; Ayin (VI) is one of the names. You and I would have to be very conscious in bringing a double tetractys to term. I am glad we realized it, such gifts, near your birthday.
http://www.independent.co.uk/travel/the-10-most-surreal-landscapes-in-the-world-10207604.html
http://www.archdaily.com/438992/ad-classics-la-sagrada-familia-antoni-gaudi/
http://www.domusweb.it/it/notizie/2015/05/01/the_italian_alchemy.html
http://www.smh.com.au/entertainment/art-and-design/legendary-architect-and-designer-le-corbusier-celebrated-at-frances-centre-pompidou-20150423-1mrjfh.html
https://books.google.com/books?id=7gde2t9ta4QC&lpg=PA455&dq=Lyra%20Summer%20Triangle&pg=PA455#v=onepage&q=Lyra%20Summer%20Triangle&f=false
Yes, I will put Exercise 81 here, too. Thank you, for reminding me.
The fish hook, the Emperor, and the exponential four from the last Card lead to tetracyclines in the late Sixties.
https://books.google.com/books?id=CJfuCAAAQBAJ&lpg=PA172&ots=smF-XuMIZW&dq=tetracycline%20fused%20tetracyclic%20nucleus&pg=PA173#v=onepage&q=tetracycline%20fused%20tetracyclic%20nucleus&f=false
Yes, Metapontum, on the Gulf of Tarentum, produced Leucippus, the teacher of Democritus. Archytas, Lysis, and Cleinias (not in chronological order) taught in the Pythagorean school there.
https://books.google.com/books?id=PeQTDAAAQBAJ&lpg=PA105&dq=syphilis%20Metapontum&pg=PA105#v=onepage&q=syphilis%20Metapontum&f=false
https://books.google.com/books?id=T1_oCAAAQBAJ&lpg=PA59&dq=Archytas%20of%20Tarentum%20doubling%20the%20cube&pg=PA59#v=onepage&q=Archytas%20of%20Tarentum%20doubling%20the%20cube&f=false
Future project(s)*
https://drive.google.com/file/d/0B3DfyJRIT4jyVTVzTF9jeG1YMUk/view?usp=sharing
https://www.moma.org/collection/works/6356
https://www.youtube.com/watch?v=zj-cv40BPIc
Jean-Michel Folon, for Olivetti, too.
http://typicaltyping.blogspot.com/2015/11/olivetti-poster-of-day-jean-michel.html
Late entry: https://1drv.ms/i/s!AsA4BY25Ql_1jSBk9E09KNZTDGRz
I will find this, too. Exercise 82 will go here.
https://1drv.ms/u/s!AsA4BY25Ql_1jjl91F2ZWm1pODZU
The quantified self accents my neuroses, yet I will get my labs drawn yearly now; if I can be spared a prod in an office, via mail order. It is very important that I keep my sugar consumption low with the possibility of increased glucose uptake by the localized tumor on my foot. 5.3 A1C is too high. If I remember, the fructosamine likely reflected the two chocolate croissants from the day before. I do not take a gram of niacin daily, either. I flush once or twice a week, now.
https://1drv.ms/b/s!AsA4BY25Ql_1jmi1K3CUoT6OWo8U
https://books.google.com/books?id=eScbBQAAQBAJ&lpg=PA227&dq=high%20ast%20alt%20niacin&pg=PA227#v=onepage&q=high%20ast%20alt%20niacin&f=false
https://books.google.com/books?id=4d7wHD428MwC&lpg=PA65&dq=the%20half-life%20for%20albumin%20is%2019%20days%2C%20the%20measurement%20of%20fructosamine%20gives%20an%20estimation%20of%20average%20glycaemic%20control%20over%20the%20previous%202-3%20weeks&pg=PA65#v=onepage&q=the%20half-life%20for%20albumin%20is%2019%20days,%20the%20measurement%20of%20fructosamine%20gives%20an%20estimation%20of%20average%20glycaemic%20control%20over%20the%20previous%202-3%20weeks&f=false
https://www.sciencedirect.com/science/article/pii/S2452336417300420
"If oxygen is present, the two pyruvates, with help from the pyruvate dehydrogenase enzyme complex, is converted to two Acetyl-CoA molecules. The acetyl-CoAs enter the mitochondrion where it fuels the citric acid cycle. Each acetyl-CoA molecule goes through the citric acid cycle. Therefore, from one glucose, the yield is 6 NADH molecules, two FADH2 molecules, and two ATP molecules. The 6 NADH +2 FADH, plus the NADH produced in glycolysis and at the PDH complex, now enter the 'electron transport system' (ETS). This is where the efficient production of ATP occurs: The ETS is a multi-stage process, called oxidative phosphorylation or cellular respiration, which, with the help of ATP synthase has the following yield: This summary gives a theoretical yield of 40 ATP per glucose. 32–38 ATPs are generated depending on the enzymes an individual's DNA codes for. Cancer cells typically 'switch' from 'cellular respiration' to the very inefficient glycolysis for their ATP needs, a phenomenon described by Otto Warburg in 1924. The amazing thing is that tumors, which are highly energy demanding tissues, switch to a very inefficient energy producing pathway. They make up for this energy demand by going through glycolysis faster than necessary in normal cells."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5933890/
Sugar-free Red Bull when I work.*
The lesion on my foot was benign, and the biopsy site did not reveal any irregular margin or pigmentation. Putting imminent metastasis to the brain down, for now.
A neurologist that assessed my patient called me over, "so that I can be taught something" and mentioned that reference from Hamlet (I.iii.50) about "the primrose path" of debauchery resulting in the full display of the triad of Korsakoff syndrome: altered mental status, ophathalmoplegia, and ataxia.
http://flipper.diff.org/apprulesaccount/items/info/6616
https://books.google.com/books?id=-kCCDwAAQBAJ&lpg=PA102&dq=Hamlet%20%22the%20primrose%20path%22&pg=PA102#v=onepage&q=Hamlet%20%22the%20primrose%20path%22&f=false
*Ophthalmoplegia (CNS II, IV, VI)
https://academic.oup.com/ps/article/94/8/1979/1530907
Please, please remind me that I am off dessert. I have not felt a reactive hypoglycemia in a while, which is weakness from excess insulin production from simple carbohydrate. In this case, it was a slice of carrot cake. No more.
https://www.nature.com/articles/d41586-019-00398-1#ref-CR3
https://www.first-nature.com/fungi/clathrus-ruber.php
La fenêtre treillisée.
The same neurologist mentioned ...Lewy Body dementia...but may benefit from a probiotic.* She has been in practice over 45 years, and I always read her notes in comic sans.
https://clinicaltrials.gov/ct2/show/NCT03847714
https://m.youtube.com/watch?v=zRYjVFFsi38
I am not afraid of neurodegenerative conditions. What I like about Della Christine is that she will routinely draw a B12 level among a plethora of less-used labs prior to her consult to correct metabolic derangements. She is on a mission to ban haloperidol sedation in delirious inpatients...it increases confusion and falls.
My patient had a frontotemporal focus on eeg, which is the region most responsive to B12 repletion according to this small sample study.
http://www.jneuropsychiatry.org/peer-review/vitamin-b12-deficiency-cognitive-impairment-and-neuroimaging-correlates.html
https://academic.oup.com/advances/article/10/suppl_1/S31/5307224
I am not sure that I can drink sugar free beverages with this knowledge...substrates that cause pro-inflammatory shifts in the gut microbiome. The stimulant delivery system in the afternoons may just be a crutch I should kick away. Or, drink more coffee.
Yes, I will put Exercise 86 here. The elucidating pattern will be the tetractys in the nettles.
Evenings are tiring at times because the neglected things soon come back to bite some. It is always a bad sign when the attending refuses to change his or her name on the database from the emergency room provider; running off on Saturday morning to avoid doing a heart catheterization, what could be best done on Monday, while the last dose of Coumadin runs out and the comes down INR <2. No notes, or communication about this by the attending cardiologist. Perhaps, he knew that this was not a priority?
The cardiac biomarkers are trending up, reported and charted as such, and then the evening comes around, and it is my fault that the NSTEMI patient sat on a heparin drip with an INR of 2.4. There are no ekg changes, no chest pain, no shortness of breath (supplemental oxygen is routinely added for increased demands of a coronary syndrome in progress). In hindsight, a best case scenario would be to have made a case for giving Vitamin K, bring down the INR, and cath that evening. He will be catheterized Sunday morning. No one lays in a hospital bed with a suspected MI and waits until the workweek for intervention, but maybe it was not warranted.
INR is an index of a different coagulation pathway than aPTT, which is used to monitor the anticoagulation of heparin. What frequently happens when bridging a patient off heparin to their home dose of Coumadin after hospitalization is that the INR is slow to reflect the titrated dose; therefore, heparin does not significantly prolong INR bleeding time.
Anyhow, three cardiologists and the NP read a ekg at 1800 last night and tried to see ST-segment elevation, but failed. If we tort this, there isn't a progress note from a single cardiologist except the admitting ED physician, and my notes about calling, with the uptrending troponins in a results grid, until late evening. Game on. My prediction is that his catheterization will not find any obstructions.
It was good the patient was heparinized with a history of stroke, where thrombi can break off and trigger such events, and I consulted with pharmacy about this. The elevated troponins were caused by something other than an acute coronary syndrome, and I will be interested to see how this plays out. I put this here, not as a defense, but to remind myself.
"Based on our investigation and others on this topic, non‐ACS troponin elevation is a common, high‐risk clinical scenario. In our cohort, non‐ACS troponin elevation is about twice as frequent as ACS, and the problem is likely to grow dramatically within the next few years as ultrasensitive troponin assays are eventually approved for use in the United States. These assays are much more sensitive than the current assays, and may make it challenging to distinguish between someone with an acute supply/demand mismatch from someone with an elevated troponin due to chronic, but stable, illness such as CAD, heart failure, or diabetes. Non‐ACS troponin elevation remains poorly understood, with no viable treatment options other than addressing the pathophysiology resulting in the troponin elevation. Due to the heterogeneity of the diagnoses and pathophysiological conditions that result in elevated troponin, a unifying treatment is not likely feasible."
https://www.journalofhospitalmedicine.com/jhospmed/article/127998/mortality-due-elevated-troponin#jhm2619-bib-0003
Still working on the Exercise.
"Acute coronary syndromes (ACS) are a major cause of morbidity and mortality. Despite the use of optimal medical therapy and revascularisation there remains a significant risk of vascular events. Registry data indicates a persistent risk even in patients who are event free in the first year following ACS, with as many as 1 in 5 patients suffering a vascular event in the subsequent 3 years.[1]
The central process underlying ACS is the development of a thrombus overlying a ruptured or eroded plaque, leading to various degrees of acute vessel occlusion and myocardial ischaemia.[2] A thrombus that originates following plaque rupture consists largely of platelets; in addition, coagulation pathways are also triggered by plaque rupture and platelet aggregation.[3]"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5980649/
"Cardiac troponin (cTn) is the standard blood-based test to confirm the diagnosis of acute myocardial infarction. (See 'Diagnosis of acute myocardial infarction', section on 'Definitions'.)
However, troponin is not specific for acute thrombotic occlusion of a coronary artery, the most common precursor to acute myocardial infarction. Increased blood concentrations of cTn can also be seen in a variety of other diseases, such as sepsis, atrial fibrillation, heart failure, pulmonary embolism, myocarditis, myocardial contusion, and renal failure. In addition, stable chronic elevation of cardiac troponin may be detectable with high-sensitivity assays in patients with underlying structural (muscle) heart disease. Analytical false positives or false positives due to injury of skeletal muscle are very rare."
https://www.uptodate.com/contents/elevated-cardiac-troponin-concentration-in-the-absence-of-an-acute-coronary-syndrome
https://www.amjmed.com/article/S0002-9343(08)00572-X/abstract
On the fronts of other crises, I found an energy source, high in caffeine, low in sugar, and no artificial sugars at risk of altering the microbiome. I have tested it for two weeks now. Relief. Ecuadorian rainforest slash and burn agriculture for guayusa plantations?
https://runa.com/
With 30-35% left ejection fraction on echocardiogram and multi-vessel disease post-cath, the referral for bypass grafting revascularization was made, and the NSTEMI diagnosis over the weekend, with the argue to expedite care, did not change the resulting conclusion.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4269543/?report=classic
*argument
Tetractys,the Decad of Intelligence...it keeps coming up in gentle reminders:
http://zeroequalstwo.net/decad-of-intelligence-exquisite-artmagical-publi cation-from-fulgur/
This patient I mentioned with the STEMI-ish issue is still here, a cachexic wraith walking the hallways. You can visualize the bones in his face. The NP that roasted me apologized.
https://onedrive.live.com/?cid=f55f42b98d0538c0&id=F55F42B98D0538C0%212586&ithint=file,pdf&authkey=!AMbCZVr12NvssIA
"A number of studies have also shown that cardiac cachexia is linked to raised plasma levels of inflammatory cytokines, such as tumor necrosis factor alpha."
https://www.ncbi.nlm.nih.gov/pubmed/12163209
*Indigo, according to Ithell Colquhoun, is earth. I think of you and indigo often.
https://www.youtube.com/watch?v=XEiZNUM9nNQ
https://fulgur.co.uk/books/ithell-colquhoun/taro-as-colour/?v=7516fd43adaa
https://1drv.ms/u/s!AsA4BY25Ql_1lBviWxrd_bDXRrxA
When I have such exhausting, but mostly successful days with patients, and then I have to sit down to chart, I do not know if I could do narrative notes on inpatients...30, 40 consults. I get the impression that many are on autopilot.
There are many that work 60 hours a week, and this productivity and focus gives one an edge over others, I know. I will get to the point when I am less sensitive to the emotional backlog that creates drag on my work.
https://www.nationalreview.com/2020/09/the-immovable-raphael/amp/
https://www.wga.hu/html_m/r/raphael/5roma/4a/
Yes, I do notice the sale of Taro as Colour.
I have eliminated the crutch of any energy drinks with more hydration.
As a catalogued inner thought, I refer to the neurologist by her first name without disrespect: Della Christine consulted on unresponsiveness in a quadriplegic...who was found presumably post-ictal with no arousal to sternal rub (no kidding), who was referred for an EEG subsequently demonstrating an absence of interictal epileptiform discharges (IEDs). To remember: generally, IEDs can be distinguished by duration with spikes < 70 ms and sharps are between 70- 120 ms. He was put on infusions of thiamine and levetiracetam prophylaxis, the latter which causes drowsiness, and he could not be more drowsy.
Does she use Comic Sans for its dyslexic readability? There are few repeated letters in Vincent Connare's typeface (1995), but it has saturated in the culture for use in lampoons and consciously inappropriate news. Red, blue and green text colors for the electronic medical record? Is it overt contempt for the job? One day, I will ask her. I get the impression that she was once same-sex oriented in a prior life, and she refers to a husband whom she took off a ventilator (not being selfish like the rest of these people), but that it hardly matters now that one's heart is a desert and one is past the point of seeking partners.
https://www.frontiersin.org/articles/10.3389/fpsyt.2019.00207/full
I am orienting a former mayor's son, who is not a physician, like his father; and therefore, a failure, and who was married last year and photographed by a wedding photographer, who formerly spent time with my brother. They would pass out in the basement in the early aughts before awaking at noon to go wait tables for more money for heroin. This photographer borrowed my keys off the hook one night, and totaled my car and four cars on the block in 2009. Ha! The orientee's wife, who is a nurse leader in adolescent inpatient psychiatry, came up to keep him; as if I was interested, though they have been married for less than a year, or long enough for the wedding photos to come down from social media. Another chick at work is pulling equity out of her house for IVF to get a baby, though she has been married and a householder for less than a year. These millennials are insane.
https://www.newyorker.com/magazine/2010/01/04/what-do-you-call-it
https://condenaststore.com/featured/new-shades-2020-roz-chast.html
I love the delicacy of the marble chain, and the subject of Francesco Queirolo's Il Disinganno (1754), which I take to mean disillusion in a broader sense, which is the freedom from the deception of form:
https://www.flickr.com/photos/dalianera/28436193417/in/photolist-XP7kW4-KhVR92-6nLPao-bnpD5H-Ti62TA-KjNVAR-T64V5q-Ti63dd-3TVScg-7L4VbS-7Z4qr4-5nkqxo-4ShUFR-4Sn75N-4ShUNr-4Sn6Wf-e6aTkp-e6aTpp-e6gwM9-e6gwQ3-6ce272-e6gwHu-cavV57-ziN1BC-7zU554-2duf8zt-JFzu3T-e6aTjn-FCW9By-zWzo18-tWvSh8-e6gtbq-e6gtao
https://www.youtube.com/watch?v=mdMmGvOlHzw
https://www.youtube.com/watch?v=QSsA8vB103c
https://amp.ft.com/content/f57f3c31-e622-425e-9aee-5261803cb275
To segue here with the lesson of Asimov's Solaria, which resisted immigration and replacement of its establishment-holders who feared a loss of standard of living, and reversion to the managed caves of steel of Earth.
I am not for clearing the slate of student debt, but for eliminating the interest after a certain number of on-time payments. The entire trajectory of my late younger life has been tacking the desired course to the remunerative career that will pay my obligation. It is difficult for people before my generation to understand this.
https://nypost.com/2021/08/07/why-student-loan-debt-is-trapping-more-americans-than-ever/amp/
The system is reckless and just getting by...I came for four hours for my RMH PRN requirement. In addition to my paced dual valve replacement, Aquinoxed COPD patient who could not maintain his sat, an a fresh cardiac cath with an hs-troponin of 104,699 ng/L, I received a Down's syndrome patient post-covid, trached on a vent, with a heart rate below 40 bpm at shift change. I called the resident who wrote an order to place pacing pads and atropine at the bedside. My question was why is it if we are going to resort to ACLS protocols at the bedside, we don't transfer back to the unit for a 1:2 ratio? She had her trach downsized that day, and my suspicion was that she was slowly getting hypercapnic with the narrowed airway with the resultant respiratory acidosis depressing contractility with drop in heart rate.
I had to straight cath her, which was awful, but prior to leaving, I made a note with her blood gas at 1930 with the ph 7.53 and PaCO2 48 noted with the aggregate VS in the 40s-50s. The resident updated the mother on the phone because I would not.
https://www.uptodate.com/contents/ventilator-management-strategies-for-adults-with-acute-respiratory-distress-syndrome/print
I have no fear of traveling because the routine mismanagement and status quo requires me to be this way, everywhere. The compensation will help, but the Zeitgeist is recklessness and that nothing is stable anymore.
And then the NP, who questioned whether I knew the updated hs-tropinin lab values, who I reminded that hs-trops >20 ng/L were reportable labs, had the nerve to shill her essential oil business at the nurse's station. She did not ask me if I was interested.
I found Aimee Mann's Lost in Space (2002), again. It made me think of the generosity of a person, a NICU traveler in Anchorage, Alaska, who had mailed it to me when I was at boarding school. My older self wishes that I had been more generous and maintained our friendship before she suddenly died on New Year's Eve in 2009. She introduced me to Woman in the Dunes (1964) and Imamura's The Eel (1997), which tied with Kiarostami's Taste of Cherry (1997) at Cannes.
The lonely night shift hours were passed talking to me on a pay phone for my junior year of high school.
https://www.youtube.com/watch?v=JbhtBVrFr-4
https://www.youtube.com/watch?v=zyEl-goAEqk
http://www.midnighteye.com/reviews/the-eel/
I remember Lisa from this film:
https://www.youtube.com/watch?v=vFhCjpH2dAU
https://www.uptodate.com/contents/treatment-of-metabolic-alkalosis
ph 7.53 in the settling of pitting edema
I am not suggesting that I am leaving and looking beyond what happens with you. You are half of my memory now, for better or worse.
I will put Exercise 89 here.
I want to explore a Card from the perspective of the deceased being botched with a carmelizing resin treatment and the preparations of seventy days, including the self-serving loved ones among pretenders to the throne. Maybe interspersed with lines from the texts that were not painted on the wall. XIII. La vie reprend son cours
https://m.youtube.com/watch?v=cIwyeXdOUPA&t=537s
https://youtu.be/qFPMPLELTZU
https://1drv.ms/u/s!AsA4BY25Ql_1mXr1Fm17KsV3pCiR
Thank you, for reminding me.
To be read, sometime:
https://www.fantasticfiction.com/w/mika-waltari/egyptian.htm
Exercise 90.
I had a dream last night about shopping with my maternal grandmother, my mother, Christine, and deciding which amaryllis bulbs to try based on the hemisphere of origin. One of strongest positive associations of the holidays that I had with her were the many plants. We stopped the car, and I got out, then. She did seem to be sick as she walked with me.
https://youtu.be/HU_FMAc7Q9c
Rate-limiting uptake of various things to promote a low tumorigenic environment aside, I do not want to think about this anymore. I was upset a few days ago after taking niacin, and the histamine flush was not the usual pleasant heat, but a massive reaction where my hands, head, and feet turned red, but everywhere else was this white, dermatographic braille that took hours to settle. The itch was unbearable, and then I went to mow the foot-high grass, and after lunch, I collapsed in exhaustion, not able to get up otherwise than hydrate.
Further up, one takes into account the Aeon, or the Judgment with the triad popping out of their coffins. I still see potential for this, to marry, and have at least one child, but I have to clarify our goals, and work best within limitations.
I need to believe this is still possible.
I transferred a patient on our floor to the oncology unit. He was referred for a VATS with mediastinal lymphadenectomy, which was cancelled due to the discovery of chronic lymphocytic leukemia invading his thoracic cage. He was very nice, and his family left all the flower arrangements since they could go on the cancer ward. I had this shock of seeing Trish Gaither, who is one of the best nurses in the hospital, and my mentor as a student there, when I mentioned walking someone to the bathroom, and entire leiomyomatic uterus falling out on the floor...Anyway, I felt that it was full circle, one of the death closets with the sedate pictures and no window views.
There is no accounting for how anyone will go. One must make the best time of now.
https://m.youtube.com/watch?v=IuKcQKRpKQM
I will put Exercise 90 here.
https://pubmed.ncbi.nlm.nih.gov/36286254/
Exercise 90. Thank you for reminding me.
https://1drv.ms/i/s!AsA4BY25Ql_1mx1h6W8Y91QaAAL7
The stroke coordinator came to our interdisciplinary rounds with an MRI image of a severe posterior ischemic stroke with possible brainstem herniation. The attending after a lower limb bypass did not upgrade the patient, the neurointensivist consulted did not order neurochecks, and there was nothing in the chart, even in a progress note, to document anything was done for the patient. I remember asking the NP if we needed to call a stroke alert, to expedite CT and upgrade, but it was dismissed. The last tort on our floor was from 2018 with exact conditions like this, the coordinator said. Surgery patients off anticoagulation are at elevated risk for stroke.
I asked her how am I to override the team? Call a rapid response. What I should done, even if this was not my patient, bur I was charge, was to put a note in chart with the assessment and who I told. The circumstances are complicated by the fact that the 55 year old was a heavy alcoholic in withdrawal so the gait defects and finger pointing was not cleat. He is in ICU now, and thrombolytics may not have been given either way, but the failure is that nothing was done.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8065750/
"It is important to emphasize that the face arm speech test (FAST), a prehospital stroke screening tool, is less sensitive in posterior circulation infarctions and may be one cause of delay on the diagnosis.1"
https://radiopaedia.org/articles/posterior-circulation-infarction?lang=us#nav_clinical-presentation
"The classic clinical presentations for PCCI are the '5 Ds'; dysphagia, diplopia, dysarthria, dizziness, and dystaxia. The cerebrovascular anatomy of the posterior circulation can lead to highly specific signs in PCCI."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10511775/#:~:text=The%20classic%20clinical%20presentations%20for,highly%20specific%20signs%20in%20PCCI.
I found the following compact discs: an unopened compilation album by Jacques Brel (1998), Aznavour 2000, The National's Trouble Will Find Me (2013), and Barbra Streisand's Superman (1977).
The Maxims (1667):
https://www.gutenberg.org/files/9105/9105-h/9105-h.htm
An unopened puzzle to work with Elevendy on the living room end table:
https://images.app.goo.gl/GVK3x6VV6ZA515Gj6
https://shop.adventurewithkeen.com/product/birds-of-the-carolinas-field-guide/
https://www.aba.org/store/american-birding-association-field-guide-to-birds-of-the-carolinas/
This shop had Lladros, a dozen espresso machines, Staub cookware, humidifiers, golf bags; all the modern archeology, but not my taste.
Opportunity acquisitions. I know I have other projects to finish first.
I despaired that the drought kept the hummingbirds away this season, but the rain arrived in September. This morning, a female ruby throat appeared on the Mexican sunflowers. I made up some nectar for her in the feeder as she and other pass through on migration.
https://www.fws.gov/story/2024-08/august-2024-bird-month-ruby-throated-hummingbird
https://jackziegler.com/product-category/love-and-marriage/page/2/
https://www.pealim.com/dict/3706-etzem/
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