Sunday, April 11, 2010

Sourcing Miracles & Keeping Dreams

Kaiser is seeking short stories for possible publication. Here is mine.

EIGHT!!! The subject line of my email streaked out across the Internet through Lotus Notes, screaming at my friends, Kaiser nurses and physicians all. My eighth patient was off insulin.

I recently queried those patients, many of whom lived with diabetes long before working with me. “Why did you do it?” I asked, “What made the difference?”

To which they replied, “No one ever said it was possible and no one ever gave me the steps to make it happen.”

The book Three Law of Performance would call that a change in their occurring world.

In 2008, I joined the Chronic Conditions Department in diabetes care management and invited patients to take-on their disease by learning to count and restrict carbohydrates and get off their insulin. Eight of them did.

“Number Eight (I’ll call her Annie) is an obese, 56 year-old female and a Kaiser Permanente employee,” my email read. “She has been in and out of my care management program twice. When I run at lunch, I pass her walking and we high-five as I yell words of encouragement.”

I encourage patients to get help and seek support.

"You are not reliable to eat for good glucose control and weight loss. If you were, you would have done it. There are many programs available in and out of Kaiser. Pick one and take your cook along. What appeals to you? Do something; do anything." 

Annie did, she attended the Kaiser's Diabetes and Nutrition Class, learning to count and restrict carbohydrates. The impact was startling, stunning, immediate and we regularly and rapidly decreased bedtime insulin in response to hypoglycemia and fasting blood sugars at the low end of the target zone.

Annie was happy with that result and it carried her through the holidays. In January of 2010 she joined Over Eater's Anonymous. Within days we decreased Glipizide due to recurrent hypoglycemia.

On day thirty-seven of her Over Eater’s Anonymous program, she reported a twenty-six pound weight loss and we stopped all glycemic agents but Metformin.

“I can see my toes!” she looked down and pointed. “The aching in my hands and feet is gone,” she stood in the doorway of my office flexing her hands. “I always felt like I had the flu, kind of achy all over; that’s gone. I had no idea how bad I felt.” She hugged me and said, “I love you.”


Annie’s new goal is to run a marathon in her 60th year. I will coach her through lunchtime runs and at least one section of that marathon.

Since then, Patient #9 is off all glycemic agents excepting Metformin and my meager pipeline is working, counting, keeping meticulous records and gunning for their insulin.

I have come to know that I provide an empowering context for these patients; that I am the keeper of this dream. Dreams and goals disappear, they fade in the frenetic pace of every day, they are beaten from us or we abandon them as unattainable. I meet my patients wherever they lie along the continuum of health, acknowledging what they have done. Together we explore small, attainable steps from which they choose.

“I want you to be successful so lets choose something that you know you can stick with. Can you do two five-minute walks every day?”

Most often I direct them into well-established Kaiser or community resources. I never recreate the wheel and it is always our first goal to achieve glycemic control with or without additional medications.

As healthcare providers, when we extend the invitation and provide a pathway toward health, some patients will play for and with their lives.

“In life there are many games we can play,” my email concluded. “We play health and wellness games at Kaiser Permanente. I love and play this game - it brings me to tears and fulfills me in every way. You are the first to know excepting my fabulous pod leader Dr. Huang - who provides a supportive, nurturing environment in which patients and employees can flourish and thrive, including moi’.

BE well and dare I say... THRIVE!”

Lorin Bacon is an Acute Care Nurse Practitioner with Kaiser Permanente in Sacramento, California.

Sunday, April 4, 2010

A Birthday in Yosemite-Part 3

The weather broke on Sunday to clear and sunny skies. The forecast was for more of the same gray soup that had settled over California like tule fog. But Mother Nature is not wont to follow the forecasts of man; the day was unpredictably clear and clear means cold.

I rolled over to peek at the clock and everything about me hurt,

e-v-e-r-y-t-h-i-n-g! Auwe! Plagued with chronic low back pain from a career of hauling patients, I always stretch before leaving my warm cocoon… but this was more than back pain. My quads ached so I pulled my heels up next to my hips and laid my knees on the bed to stretch. Try that bilaterally and simultaneously, that’s a feat! I rolled to my tummy for daily yoga favorites: child, cat, camel and rolled out of bed for warriors one and two. My calves strenuously protested the reach for my toes. My shoulder sockets, jack hammered forward in repeated backward tumbles onto outstretched arms, ached and would ache for weeks.

I dressed and headed for my morning cuppa joe. Deep ruts in the heretofore, muddy service road through camp, were frozen solid. Pea-sized, ice-gravel crunched noisily beneath my boots. The air bit and I coughed with temperatures below freezing. Overhead, snow capped Half Dome shined against an azure sky. A great plume of smoke rose beyond Mother Curry’s Bungalow and the smell of coffee permeated camp, pulling me along like a like a moth to light.

In the lobby, I bumped into the young Russians with whom I’d exchanged cameras at the confluence of trails and trail signs deeply buried in snow. We queued for coffee and chatted of our climb and afternoon departures.

Coffee at the Coffee Corner is self-serve. I purchased a large and filled my insulated Starbuck’s cup that would keep warm for hours. Retracing my steps, I stopped outside Mother Curry’s Bungalow. In her day, the cabins of Camp Curry were called bungalows, those at the Ahwahnee – cottages, while those in Tuolumne Meadows were called cabins. They have not upheld that tradition as all signage and maps currently say: cabins. Too bad, some traditions are quaint and sweet; they honor the Ancients and deserve preservation.

Starting again from outside Mother Curry’s Bungalow, I suddenly remembered it was my birthday. I stopped in my tracks and looked about with new and liquid eyes. The valley pocket remained in shadows, the sun insufficiently high to peer over its shoulders. Overhead, granite gleamed in sunshine, promising a warmer day.

I smiled and sang: Happy Birthday to me. Happy Birthday to me. Happy Birthday dear Lorin. Happy Birthday to me. Why am I going home? I could make spending birthdays in Yosemite a tradition. Yes, I just may do that.

I opened the curtains to watch the sky lighten and plopped onto the bed with my laptop. I’d read and write before packing and checking out. At 11:30 I’d be in the main dining room of the Ahwahnee Hotel for Sunday Brunch, my birthday brunch.

My morning was non-descript. I packed my auto after moving it to warm in the sun. As I ferried satchels to my SUV, Cliff peaked through the window. Cliff was my housekeeper, a resident of Merced who had never visited Yosemite until job loss forced him to seek work far from home. He lived in resident housing and worked four days straight before returning to Merced.

“Waaooww!” I said, imagining how yummy Yosemite living could be, “I’d never want to go home.”

Cliff glared, “It ain’t that great here,” he snarled, “You’d wanna go home, trust me.”

Remember my departing email? “Methinks a winter trip to Yosemite is a good sieve. I will meet people like me. I'll probably LIKE THEM!” Remember that? Exclude Cliff. How one can reside one’s entire snuff-chewin’, teeth losin’ life in the shadow of Half Dome and never visit or appreciate is … oh never mind.

I stopped by the Lodge to retrieve and send a few emails. A fire sputtered and spit in the fireplace though it was 10 a.m. I sank deeply into the same log chair I had occupied twelve-hours prior. I fiddled and figured out how to post to facebook from my iPhone, posting my picture at Columbia Rock, shglicked by George. At the registration desk I checked-out, surrendering the oversized, brass key to my cabin. I arrived at the Ahwahnee ahead of schedule and browsed through their gift shop.

The Ahwahnee Hotel is a stunning amalgam of rustic rock and timber, art deco designs, arts and craft styling, and native Indian motifs. The hotel occupies the meadow beneath the Royal Arches rock formation and the former village site of native Miwok Indians – who called themselves Ahwahneechee.

Designed by architect Gilbert Stanley Underwood, who designed the lodges at Zion, Bryce Canyon and the Grand Canyon’s North Rim, it is in retrospect, his crowning achievement. The site was chosen for maximal sun exposure and its iconic Yosemite Valley views: Glacier Point, Yosemite Falls and Half Dome.

As seen from Glacier Point, the lodge is Y-shaped. It was constructed from 5,000 tons of rough-cut granite, 1,000 tons of steel, and 30,000 feet of timber. Its exterior wood and structural timbers are actually stained concrete poured into wood simulating molds. Construction lasted eleven months and totaled USD 1,225,000 upon completion in July 1927.

Its grand public spaces are rich with tapestries, hand-stenciled timber beams and floors, massive stone hearths, log-beamed ceilings that soar to 30-feet, stone patios and expansive lawns. I’ve sat on those lawns in late summer and watched deer feed. Even in winter, buried beneath snow, the south lawn beckoned.

The dining room is notably Five-Star and dinner is a formal affair, by reservation only. Sunday brunch is casual. I checked-in with the maître d'.

“Ah, yes Ms. Bacon, we have your reservation for,” he paused to reconfirm before looking up, “One?”

“Yes,” I smiled reassuringly. I received many an odd look those three days in Yosemite. You have a reservation for… one? A look of puzzlement shadowed their faces momentarily; we are so unaccustomed to women traveling solo.

The maître d' checked himself and smiled broadly, “Welcome,” he parroted, back on auto-pilot, “We are glad you could dine with us.”

Me too buddy; you have no idea. “Thank you.”

Carol stood at his elbow ready to usher me inside. She was a delightful woman in her forties with an eggplant figure topped and coiffed in pageboy. She wore the black pants and white, long-sleeved, button-down shirt customary in food service. The busboys were similarly clad with an additional long, white, Bistro apron. My busboy was Sally, a decidedly masculine young woman with multiple facial piercings and the never-ending pitcher of fresh-squeezed orange juice – which made her decidedly popular as well.

I was seated in the west-facing alcove originally designed as the porte cochère. Yosemite Falls fell, framed in floor to ceiling glass. At my right elbow, towering over my table, The Royal Arches.

I wandered through the buffet area replete with sushi and egg chefs. A skilled pianist tapped ebony and ivory on the periphery. He looked up from his keys; I smiled and nodded as I passed, pondering a song request. That thought disappeared in the myriad of morsels, trays of truffles, dishes of desserts, bushels of breads and cheese, displays of fruits and vegetables, a panoply of epicurean delights Ahwahneechee-style.

As one whose diet is nearly devoid of meat, a buffet line offers multitudinous opportunities to indulge without discarding all but three of an eight-ounce steak. I conned the prime-rib guy out of two-bites. It’s easily been two years since I last tasted prime rib. YUM!

I ladled up cheese, bacon and collard green grits and three-bites of Cajun catfish. Veeery tasty but too-too salty – my persistent complaint of food prepared by others. I salivated at the sushi station where a chef rolled nori-maki sushi on request. I settled for one rolled disk each of seared-ahi and spicy tuna sushi.

The dining room’s entire south wall is glass, six by twelve foot panes edged by six-foot sliders, and all that completely surrounded by craftsman style windowpanes. Incandescent candelabras stood along the walls, their warm glow pallid against sunlight and snow reflection off the south lawn. On gray days I remembered, the cavernous dining hall could be dark and dreary.

I jotted notes in my journal and listened to the conversations around me. The couple against the west-facing window had broken their carb-free diet for her 61st birthday brunch. The four-top next to me also included a portly and pony-tailed birthday boy. I volunteered that it too was my birthday and that started the patrons of three tables talking.

“What do I have to do to get to the top of that?” Birthday-girl Karen pointed west to Yosemite Falls.

“Walk,” I said.

“That’s my downfall,” she said, “I don’t like to exercise.”

“Do you own an iPod?” They did but were unsure how to load their favorite books into it.

“Have your grandkids help you,” I offered, “They’ll do it in under ten minutes.” They laughed, knowing it was true.

“Then start waking, even if it’s two five-minute walks a day. When you get to two ten-minute walks, combine them into one fifteen-minute walk and increase that by one-minute each day until you are walking forty-five-minutes a day.”

“We’ve both lost forty pounds,” she disclosed, “We’ve got about another fifty to go and we’re gonna do it! We’re back on our diet tomorrow.”

What is it? What always has me at the center of these conversations; as if my forehead blinks neon: Healthy NOW, ask me how! I acknowledged them genuinely and profusely; they beamed slathered in my praise.

Before leaving everyone hugged: the patrons of three-tables-talking, our waitress Carol, our busboy Sally, and promised to attend birthday brunch at the Ahwahnee the following year. Before leaving, EVERYONE HUGGED and I hugged strangers who share my birthday. Do you know how extraordinary that is? For moi’? Curmudgeon-me who does not like to be touched?

“We’ll be a lot thinner,” Karen smiled, waggling a finger between she and her husband.

I wandered to the south patio, to sit in the sun and drink in the Ahwahnee before my departure from the valley. Snow outlined small ridges normally invisible from the ground. My eyes wandered and I imagined the Ancients watching me scour the cliffs in search of their visage – watching me watching them. Clouds rolled in from the west and a cool wind began to blow. I closed my eyes to feel Ahwahneechee and sent a silent prayer of thanks to Heaven (which from Yosemite – is not so far). Climbing into my SUV I meandered through the valley, following the Merced River, stopping at every whim and fancy.

A wolf or coyote protected kill near the roadway. I doubled back for a picture but it ducked before I could center my photo. The Merced flowed low and slow, seeking the riparian trough, exposing alluvial beaches that would disappear with both the thaw and throngs. I shglicked a pic. With nary a ripple and barely a current, tree and beast and rock and sky were eye to eye on its glassy surface. I parked and walked into the meadow - to imbibe its vibe.

Lastly, I returned to the Tunnel View lookout along CA Hwy 41. A brisk wind bit as I marched across the parking lot, mesmerized again by the view that captivated the cavalry two centuries ago. Many photographers littered the sidewalk. Bridal’s Veil fluttered in the wind and dark clouds threatened.

Quietly joyful at my return, I stayed to drink in Yosemite and let her steep, suffusing my cells and etching my memory in her unassuming tea… for later, for me and to honor the Ancients. I watched the gathering gloam until my ears ached and skies cried tears from Heaven (which from Yosemite – is not so far). Only then did I begin the journey home.

E ha’ina ‘ia mai ana kapuana la: This is the end of my story: A Birthday in Yosemite. It was memorable and nurturing in its many moments. It’s valuable methinks, to create moments and memories to treasure.

Mahalo for your readership. This muse was penned merely as a practice and to capture my tale, to be relished, relived and remembered as an Ancient.

May you steep in life's glory, make memorable moments playing in my Heaven and paint on Her canvas. Aloha