Tuesday, December 13, 2011

Falling for Portland - Thrice

My conference began Friday evening, leaving the entire day to poke about Portland. The Rose Garden had been recommended.
“You’re a week late,” the concierge reported, “They dead-headed the Rose Garden last week; it’s nothing but stalks now.” 
Plan B: The Columbia River Gorge is of great interest – but I didn’t have a car (yes - I could have rented) or companion. I thought the Columbia River Gorge should be shared… so I saved it for someone. I may never see it - and I didn’t want to see it alone.
Plan C: I dressed for winter – wind-block, fleece jacket and scarf – and left in search of a Chinese congee breakfast. Congee is the ubiquitous rice porridge of Asia, the equivalent of oatmeal in the West. Cantonese call it juk (pronounced jook). 
A Chinese dragon slithering down a wall stopped me in my tracks 30-paces beyond its perch. I retraced my steps and entered. The DragonfisH serves dim sum during lunch but an American breakfast. Bummer! I had their Asian, vegetarian omelet with Shitake-shrooms, green onions, tofu and stiff coffee while scouring the map and planning my day.
Portland’s is located at the confluence of the Willamette and Columbia rivers. The mighty Columbia divides Oregon and Washington states. Portland’s downtown is divided into five sections: Southeast, Southwest, Northwest, North, and Northeast. The Willamette, a tributary of the Columbia, divides Portland into its east and west sections. Burnside Street provides the north/south dissection.
Buddy Keoki knows I am an avid reader. I usually (and currently) read three books simultaneously. 
“You have to go to Powell’s bookstore,” he recommended, “You’ll LOVE Powell’s bookstore.”
I located Powell’s Books on the north side of Burnside Street and circled it’s picture on the map. Columbia, the outdoor apparel and product company, located one of only three stores nationwide near my hotel in the SW sector. Mountain Hardware - a favorite gear brands - is next door. Sooo excited! I circled them both. Northface, REI, and Keen are located in the NW sector.  All, by the way, are located along Fareless Square, that free-zone encompassed by MAX, Portland’s light rail and bus line. I planned to walk but knew if the hour got late, I could hop MAX to the Hilton.
I began with an after breakfast stroll through half of South Park Blocks, a nine-block park located at the southern end of the SW sector. It was cool, a nearby digital display flashed 48•. Old trees bent gracefully, their leaves beginning the annual trek across the color-wheel from green to yellow, orange, peach or red. Bronze statues of the famous and fallen dotted the park: Martin Luther King, Abe Lincoln, Bobby Kennedy.  Their loss felt weighty and all the more oppressive under gray skies.
My first foray was into the Columbia store where I spent 90-minutes, learning about new fabrics and ways to keep warm in winter. The great thing about company stores like this is their salespeople - who are schooled and knowledgable in the product line. It’s like buying an Apple product at the Apple Store versus big box. Big difference! Back to keeping warm in winter: Omni-Heat® Thermal Reflective helps regulate your temperature by reflecting and retaining warmth your body generates. Columbia’s new fabric Onmi-Heat® looks to be lined in tinfoil - titanium actually. It provides warmth without bulk. No more Michelin Man fashions!
“It’s all engineering,” Fred said the previous night. “These new fabrics; it’s all engineering.”
I am always in the hunt for the ideal travel shoe. My constant traveling complaint is packing more shoes than clothing: running shoes, sport sandals, dress sandals, pumps, and slippers (flip-flops) - the flowered, Aloha ones when island bound. 
At Columbia I found a sporty, low profile, approach shoe: a light-hiker good for trail runs and limited street running. A new heel-cup design allows for the low profile while the sole is stiff, sticky rubber for schmearing rock - and they’re ooh-la-la chic. Ka-ching! Score! I learned the latest in trail-running-shoe technology and sprung for a new pair as my Salomon’s have holes. 
“Is that an Arcteryx pack?” I carry a small backpack when traveling. It fits nicely beneath an airplane seat and usually holds my laptop. I purchased it on clearance at REI in Seattle - the best place in the world to buy packs. I’m just sayin’.
“Uh-huh,” I nodded.
“Nice pack,” he said.
Eventually I meandered next door to Mountain Hardware where I learned that both Mountain Hardware and Sorel are subsidiaries of Columbia. I didn’t know that; did you? (I apologize to the non-gear-heads amongst you.) 
“Is that an Arcteryx pack?” Okay - I have NEVER been stopped for my Arcteryx pack - EVER. 
“Uh-huh,” I nodded.
“Good gear,” he said. He was a long and lean, Japanese man - over six-feet tall. Peering from behind John Lennon glasses; his smooth, black hair was pulled, Samurai-style, into a spiky top-knot. He was willowy and striking with an engaging smile filled with piano-key teeth. What a handsome kid!
“You oughta know,” I said, “You guys make the best gear.”
“That’s very kind of you,” he said, almost blushing. We fell into conversation and he was complimentary of Sacramento, having visited once.
Just then the lead in my favorite mechanical pencil exsanguinated and expired. I consider this a minor disaster and referenced the map for a store of genus-CVS. Eventually deciding my pen would suffice, I tarried forth though not without pencil-perseveration and angst.
I made my way to SW 10th Ave. and walked north to Powell’s Books, three-stories of new and used books. Y’all know I LOVE used bookstores. My heaven will be a used bookstore with Starbucks attached, the fragrance of roasted beans mingling with the musty scent of old and cherished pulp.
In a recent conversation about Steven Covey’s book, The Seven Habits... I was critical. “I think we can all agree with his premise but he gives you no access to change. He gives you lists but no access. One of the real strengths of Landmark is it gives you access to real and lasting change by providing insights into beliefs and behavior normally hidden from your view.”
“Have you read Pema Chödrön?” Keoki inquired, “The Buddhist nun?”
“I’ve heard that name but no, I haven’t read her.”
“Pick up one of her books,” he said, “You’ll like her and she gives you access.”
Seeking Pema, I climbed the broad, wooden stairwell to Powell’s third floor. Steeped in the smell of books - a stranger finds comfort in a strange land. I purchased a small book, Practicing Peace in Times of War. It is excellent and Keoki was right, Pema provides access. 

With great effort, I pried myself from Powell's and hoofed it cross-town to visit REI, North Face, and Keen, finally turning toward my hotel at 4pm. Daylight waned, temperatures dropped, and trees brightened with strings of white lights. It was so very festive with the feel of Christmas in the air.
I strolled along North Park Blocks, a six-block park in the NW sector of town before making my way back to SW 10th Ave.
A beautiful, brick edifice consumes the city block at 12th and Burnside: HW Weinhard Ice & Power Plant. I remember drinking Henry Weinhard’s Private Reserve  while living in Alaska. 
The backfill: It all started in 1856 when Henry Weinhard, a German brewer, arrived in the Pacific Northwest. His brewery prospered, diversifying into root beer to survive Prohibition. Today Henry Weinhard’s is owned by Miller Brewing Company and Brewery Blocks, occupying five city blocks at Burnside, still houses Henry’s Tavern. 
There was a hint of sadness in the soot stained, red-brick smokestack against an evening sky, a silhouette that harkens to an era past. It tugged and gave me pause. Masonry and brickwork are virtually lost arts though we are seeing a resurgence in newer freeway walls. I leaned against the building across the street, stopped in thoughtful appreciation.
I passed through the old, industrial area of the city, cobbled streets turned niche boutique. Old loading docks hold tables and chairs for outdoor eateries and she-she boutiques fly banners from abandoned hoists. A computer school and its 40 cycling students found its home inside an old warehouse. A Cadillac drove by with the smacking, sticky sound of studded tires against cobble. Snow season must be upon Portland.  
I walked leisurely and reminisced on the cities I have explored solo: Hong Kong, Denver, Seattle, Cleveland, Chicago, New York, Santa Fe, Portland, and probably a few others I’ve forgotten. While I welcome company, my full day foray into outdoor-gear shops would have been intolerable to all but a very few of my friends. 
I returned to my hotel to freshen up for my dinner meeting.
Ya know how I always seem to land in the right place at the right time? Remember my recent Chicago diabetes conference when happenstance had the conference moderator, a highly respected and beloved endocrinologist from UC San Diego, join my lunch table? Not one to miss an opportunity, I spoke with Dr. Edelman about disease reversal. 
“Well obviously, we have to do it,” he said. He shared successes and failures. “Run it for five-months. When you’re trying to change habits as ingrained as eating, you’ll have better results with a longer program. My best results came from a program that we ran for five-months.”
Upon my return I called an endocrinologist to share his information.
“I had lunch with Dr. Steve Edelman.”
“Oooooh.” Yeah, like I said, respected and beloved.
Back to the right place at the right time. This was a small conference of thought leaders: pharmacists, endocrinologists, primary care, NP’s, PA’s, and one RN. Me? A thought leader in diabetes? (It’s inconsistent with my picture of self.) I spent the day sitting next to the gentleman who co-chaired the Chicago meeting; Dr. Polonsky of the Behavioral Diabetes Institute in San Diego. We discussed disease reversal. Of course! How could I not? His presentation essentially encompassed successful strategies for enrolling patients in increased self-care. Disease reversal in diabetes does not occur without patient empowerment and complete responsibility for increased self-care.
We got the sneak preview of a glucometer awaiting FDA approval as-we-speak.  About the size of my little finger, it docks to an iPhone. It is black glass with stainless steel trim and a single round button - very iPhone-ish, very sexy, very user-friendly. It will run off an App and will graph blood sugar trends, individual blood sugar readings, food logs, weight, exercise, and allow for emailing that information from the iPhone. 
That launched a long discussion called “we’re not ready for this amount of data and how do you deal with email?”
Kaiser Permanente is one of the few healthcare organizations that actually has a system in place to effectively and securely manage patient email. I shared my workflow using email as a provider at KP. People were incredulous and clearly saw themselves as waaay behind the power curve.
The proposed App was insufficient in that it was not linked to a food database and thereby unable to produce food logs. Nor did it include a place to log weight and exercise - integral parts of self-care. It will now. 
Why iPhone? “We realize it’s a niche market but it is also a tech-savvy market and for this to work, it has to get into the hands of techies.”
The key will be the cost of test-strips. For patients in managed care, notorious late-adapters not known to embrace new technologies for a small, nouveau niche, the barrier for patients will be the cost of strips, which will be independently borne. Strips are expensive, approximately $1 apiece.
Conference complete, I was shuttled to the airport, home by 9 pm, and in the hospital the next morning at 0700. I emailed my manager on Monday, sharing Dr. Polonsky’s ideas for behavioral change. I am on the departmental meeting agenda in January to share that with my colleagues.
One of our endocrinologists is running her second disease reversal program. The first was wildly successful albeit a brief eight-weeks. I have not shared Dr. Polonsky’s conversations, insights, and research - but I will. She is forging a new path at KP and I am head cheerleader.
The purpose of my trip was to attend a diabetes conference. All the rest - Fred and Tina, exploring Portland, chic approach shoes - is cake. Writing it is cream cheese frosting and being alive twice. Mahalo for the opportunity to practice this craft called writing. Mahalo for living in my present and in my being-alive-twice moments as well.
Mele Kalikimaka to all e Hauoli Makahiki Hou!

Thursday, December 8, 2011

Falling for Portland - Twice

Why do I write? Many centuries ago, a Chinese poet noticed that to recreate something in words is like being alive twice. I so get this! 
When I write, I recapture those fleeting thoughts and subtleties sidelined by the persistent present. Writing encapsulates the moment and enlivens it yet again for my future. I am going to love reading and reminiscing when I am very old - holding my loves, my family and friends, my adventures to quickened pulse - once again.
I’d asked for a quieter room, away from the elevator. Sounding like a country bumpkin, I pleaded my case during check-in. 
“I don’t sleep well in cities.” It’s true. The sirens, the traffic, the gunfire – I don’t sleep for long anyway – normally six hours. If I’m awakened? Fohgahdit! 
She gave me a corner room at the end of the hall, on the sixteenth floor. I opened all the drapes, exposing twenty-five feet of glass, sat in the corner window seat to watch daylight dissolve and Portland’s skyline come alive in lights. City streets below teemed with commuters - cyclists and cars jockeying for asphalt.
Portland is known to be the most cycle-friendly city in the country. The leading 20-feet of major intersections is painted in the familiar and universal bicycle icon. You know – the green square with the centered white bicycle? That icon – painted on the roadway. No kidding! When traffic is stopped, cyclists wend their way to the front of the intersection and cluster upon the icon. The green light sends a surge of flesh and metal charging into the intersection with the right of way. 
The theme song from I Dream of Jeannie filled the room and I reached for my cell phone at the end of the bed. As an aside, I Dream of Jeannie is a constant reminder for me to come out to play, make merry, and grant wishes. It’s about being A YES to life and its numerous invitations. As ee cummings so aptly wrote: yes is a world and in this world of yes live (skillfully curled) all worlds
As an aside to the aside, I have never seen this quote without parentheses though we KNOW ee cummings never used any letter or symbol requiring the use of the shift key. Hence, his writing is sans capitals and punctuation. He would NEVER use parentheses (though they add clarity) in this phrase (of which I am quite fond). Ha! But I digress, twice in two paragraphs even. My apologies.
To repeat: The theme song from I Dream of Jeannie filled the room and I reached for my cell phone at the end of the bed.
“We’re in the lobby,” Fred said. Funny how a voice from so long ago can seem so familiar. I wonder if time is kind to our vocal cords, his voice sounded exactly the same. That voice on the other end of this call? I’d know that voice anywhere… and he was no longer the young man I knew. 
We reconnected this year on facebook when Fred sought high school classmates. He subscribed to my blog in an effort to learn who I had become. During the intervening years, Fred had married and raised a family. His adult children and wife interact on facebook with hilarity, kindness, and affection. In my vernacular, love is present. That single assessment filled me with admiration for the life he had made for himself. 
Upon learning I would travel to Portland for a diabetes conference, I sent Fred and Tina an invitation to meet for coffee, drinks, or dinner. They collected me at the Hilton for a dinner that was representative of Portland. 
      We drove to Jake’s Grill, established in 1892 and apparently resuscitated from near-death by McCormick & Schmick in 1994. Their menu “features an incredible selection of seasonal Pacific Northwest foods, hand-built and hand-mixed cocktails in one of Portland’s liveliest bars.” Dere’s no doubt dat joint was jumpin’.
We sat on old, wooden, high-back benches, the style early settlers placed before the hearth to trap heat and warm its occupants. They also work to keep conversations at the table - and restaurants quieter. 
Have you noticed that newer establishments are as noisy as Chinese restaurants? Voices and clattering dinnerware, the sounds of dining float unimpeded across the eatery. Notice the bare floors and walls? Nothing to absorb sound and bring decibels down. Establishments like P.F. Changs and the Yard House believe noise creates energy and draws customers. I find competing with the din to speak with my companions, annoying. I dunno, perhaps it’s a sign of age or early hearing impairment or senile irritability or all of the above. I must be getting old.
Fred bears a striking, almost eerie resemblance to his Dad. Tina is model-esque. You know: statuesque and svelte - the kind of figure that flatters every stitch of cloth. Their children are handsome and when I said so, they agreed, confessing their surprise.
“We don’t know where their good looks came from,” they laughed.
Our three-hour dining extravaganza began with a local Riesling followed by Crab Louie for me. Ya know - I’m no wine connoisseur but I do live near Napa and by virtue of proximity, have become a vino snobbare! The Klamath Riesling was fair though, now that I think of it, infinitely better than the Georgian Chardo-vi-nnay-gar prompting a reflexive spew some years ago.
We reviewed the last thirty years: parents, siblings, children, nieces, nephews, classmates, the significant highlights. Fred is a mechanical engineer. I suddenly remembered his interest in drafting classes, the hours spent on a single drawing. I think we were high school seniors that year but it might have been the year previous. That he is now an engineer is consistent with the young man I knew. Guess it’s true; we really don’t change. 
Fred built their home. That too is consistent with the guy I knew, always tinkering with cars and fixing things. A lot of our time together was spent fixing his latest wreck on wheels. I remember a Corvair with a hole clear through the backseat floor! He sold that for a VW Bug and upgraded Bugs for years.   
      Bug-bitten, I bought a 1979, convertible, Super Beetle - Danube blue. It has been my longstanding favorite car until my most recent acquisition, Z Jet, a Mercedes convertible, SLK 350.
“Do you know you are the last guy I ever dated who could fix anything?” It was more accusation than question, one leaving me instantly unsatisfied with the majority of the men in my life. “My Dad could fix anything and it’s such a valuable skill. I’ve never had another man who was handy. I’m that man!” I stabbed my chest repeatedly to their chuckles. “I’m the one with the tools. And there are things I don’t know how to do." I scowled, It’s so annoying.”
Tina is a writer. Her avocation is writing and she has several pieces published in the Chicken Soup book series. Fred thought writing would give us common ground on which to build a friendship. I’m guessing he eliminated self as that commonality?
“I have one rule,” he announced sternly, “I’m off limits. You cannot write about me.” Oh how he doth flatter himself! 
Tina laughed, “Honey I write about you all the time!” Laughter ruled and we agreed that Fred was off limits. So he rubber-stamped me not writing about him here. They dropped me at the Hilton; we hugged and promised to keep in touch. Tina invited me to stay with them upon my return. I wonder if she cleared that with Fred?

Thursday, November 24, 2011

Falling for Portland

These are the event of November 3, 2011.

Terminal-B at Sacramento’s International Airport is open?! This is hardly news for most Sacramentans but as one who survives sans TV, I miss those nationally inconsequential details overlooked by CNN.com. I received the Terminal-B tidbit via signage aboard the bus from Economy Parking... and flustered travelers racing to re-board, anxious about their departing flight. The two airlines I most frequent, Hawaiian and Southwest, are newly relocated to Terminal-B.
Terminal-B is three floors of open-beamed glass and girders with an arched, wooden ceiling paragliding seventy-feet overhead. Baggage Claim is on ground, natch. Ticketing on two. “All Gates” on three. I could find no ascending escalator – only descending (not kidding) - so reluctantly resorted to the glass tube: elevator and chute.

A long loop of cabling drops, gracefully preceding the elevator. It bears a startling resemblance to Alien dropping silently from above and I recognize this view as a new view of an elevator.
The third floor to “All Gates” is nothing more than a way station, a light-rail terminus and overlook for the ginormous red rabbit diving through a central hole toward baggage on ground. A red rabbit, not white, which in my humble opinion, is historically more apropos for chasing toward adventure. One pill makes you larger and one pill makes you small. White however, would disappear in the natural light pouring through all that glass.
I am interested to experience Terminal-B when Sacramento is in its infamous throes of triple-digit temperatures. All that solar heat trapped beneath glass – like a solarium. No doubt brighter minds than mine have pondered this scenario – haven’t they?

The distal half of Terminal-B is out next to the runways. The Link, a three-car monorail, delivered me to the security checkpoint complete with two full-body scanners. Security screening was remarkably quick and light-years more efficient than the previous, notorious, and terminally constipated check-point B.
Between security and runway lies a long line of gates, shops, and restaurants - and I do mean restaurants – establishments serving real and healthy food like Dos Coyotes and Jack’s Urban Eats. Notably, distal Terminal-B is sans the ubiquitous stench of Cinnabons. ‘Tis a breath of fresh air.

I queued for boarding. The passengers behind me began discussing the American Bubble as we pressed tightly, five to a Southwest-Air-seating-section.
“What’s our in-flight movie?” I asked crossing the jet’s threshold. Our flight attendant smiled, “It’s an old re-run; me.” We chuckled.
I stowed my roller-bag overhead and chose a seat just ahead of the mid-plane exit row. The young, svelte couple behind me read aloud from the placard outlining occupant requirements for exit row seating. “Passengers requiring a seatbelt extender may not occupy the exit row.” My attention jerked, ears perked and rotated posteriorly, a trick I learned from my wayward cat.
“Wow! I heard that,” I said, poking my head round the edge of my seat. “I wonder if that’s new? It points to fitness.” They nodded.
Our flight attendant addressed exit row occupants. “The door weighs fifty-pounds. In case of evacuation, push that lever in the direction of the arrow, slide your hands into those slots, and grab onto the handles inside. Pull the door into the plane, rotate it, and throw it out. Then you are responsible for staying here to guide passengers out. Is everyone able to perform those duties?” She paused. “Does anyone want to relocate?” No one moved so she thanked them for accepting the mantle of duty and moved on.

My mind wandered. The obese desire exit row seating because excess butt and back fat moves them forward in the seats and on airplanes, jams their knees into the seatback ahead. The extra legroom of Emergency Exit Seating (EES) mitigates the knees-into-forward-seatback problem. And now; now they are excluded from exit row seating.

I reached for the placard of information. Here’s the short of it. A passenger seated in an exit seat must have sufficient mobility, strength, and to:
• push, shove, pull or otherwise open Emergency Exit
• lift, hold, deposit on nearby seats, maneuver - over the seatbacks to the next row or out the opening - objects/obstructions the size and weight of over-wing window exits… etcetera, etcetera, etcetera. [Said only in my best Yul Brynner. I command you, as the king would, to re-read it as Yul Brynner would. Precise, crisp enunciation: Et-ceterra (roll the R’s), et-ceterra (flick your hand dismissively), et-ceterra! (stamp your foot)] Excellent! Mahalo for your indulgence.
And a passenger seated in an exit seat must NOT:
• require a seatbelt extension to fasten his seatbelt.

Bottom line: ya gotta hoist a 50-pound door and fit within the seatbelt. I consider myself very fit and in the past, routinely hoisted 40-pound sacks of dog food over my shoulder. But a fifty-pound door? Out in front? Hoisted over the seatbacks into the next row? I seriously doubt I could lift that door, pull it in, rotate it, and throw it out. It’s a shocking and disappointing realization for me… about myself and my physical abilities – or lack thereof.  …No more exit row seating for me. Waaah!

I expanded my seatbelt out fully. Just how big is this really? I guesstimated I could sit atop myself and just fasten the belt.
“How big is this?” I asked our passing flight attendant.
“Jackie Gleason but not John Candy?”
Talk about old re-runs. "That’s big,” I laughed.

Southwest Air made short work of an eighty-minute flight to Portland and we were on the ground in sixty. I peered out the window as we descended through thick cloud cover. Rain was forecast for my entire trip and clouds that had stippled our flight path coalesced densely over Portland.
The day was gray with low cloud cover – so typical of the Pacific Northwest. We followed the Columbia River past hillsides colored a deep forest green, punctuated in gold. An occasional flare of bright orange drew my eye to a single tree in spectacular fall flame.
I remember flying into Seattle to a similar scene. Two years ago? Descending over water, thickly thatched hillsides displaying the best the west can muster in fall foliage. This reminds me of Seattle.

My mind back-flipped. This reminds me of Seattle. In that moment, I saw my affinity for hanging current, present-moment experiences on the memory of something similar. The cabling of the elevator reminded me of Alien. The scene from the airplane over Portland reminded me of descending into Seattle.
Familiarity brings a certain sense of safety and at our most elemental, we seek safety for survival. I wonder how often my reminiscing to create relationships present to past, distract me from real, present-moment experiences.

On the ground, I rode MAX, Portland’s light-rail into the city. The ticket cost a whopping $2.40. MAX is interesting in that there is a “free-zone” within the city proper.  One can jump on and off the train, moving about the city without paying a toll. It’s good for business, making the downtown veeery user friendly.
A group of Goth(ic) teenagers hustled by and jumped off the train. Their hair dyed jet-black, their clothing, footwear, caps - black, all black. Chains hung from their belts, exposed skin sported gruesome tattoos.
“Is it still Halloween?” an old man asked through a thick Spanish accent.
“Only in Portland.”

 The stop labeled Old Town / Chinatown propelled me unexpectedly from the train. I meandered through Old Town still under redevelopment. Not much to it.
Chinatown is comprised of a very few, dingy streets. I passed many dark, shabby doorways: so & so’s Restaurant & Lounge. Small groups of men loitered. Why are Chinatowns universally seedy, sleazy, and squalid?

It was 1pm; I was hungry. Hong Kong style dim-sum; the sign invited me in. The large, well-lit restaurant was nearly vacant. I was directed to a table against the wall.
Nearby, a daughter chastised her mother for failing to calendar her doctor appointments accurately. The missed appointment had been rescheduled and duly entered into her appointment book stuffed with annotated paper scraps and corralled by a large, thick rubber band. They collected her walker and shuffled out.
“Dim sum and hot tea,” I answered her query.
Two men seemed to conduct business two tables away. Their voices echoed off the lifting, green, linoleum floor tiles and Formica tabletops.

My waitress returned, teapot in hand, pushing the dim sum cart with its collection of steaming bamboo bowls. I chose a dish of fahn noodles with shrimp and my favorite – deep-fried mochi balls rolled in sesame seeds, containing azuki (sweet, red) bean paste. Actually, my favorite mochi balls contain shredded coconut but azuki beans will suffice.
Cheung fahn is a Hong Kong street-vendor snack. Rice noodle dough is rolled into flat, thin sheets served with sweetened shoyu (soy sauce). Shrimp fahn has shrimp rolled up inside like a crepe. I gasped when she poured shoyu, overfilling and overflowing the dish before I could utter a word of protest. OMG! She left without sopping up the soy that inched its way across my table.
I looked about. Garish, red tasseled, Chinese kitsch hung from the ceiling and banister climbing to the second floor. The walls were papered in Ting Tsao beer posters. Shoyu inched its way across my table. Lovely.

It is my opinion that as a culture, we Chinese appreciate functionality, efficiency, and value, often to the exclusion of aesthetics. Meals are seldom presented with attention to color, proportion, and placement on the platter. The measure of a good Chinese restaurant is good food - lots of it.
I looked at my plate of fahn drenched in shoyu and the puddle on the table. I don’t like salt, don’t want the salt, and sampled with caution. It was a delicious mix of shoyu, oil, and sugar water. Not too salty and oh-so hou-hou! (Cantonese for very good.) The mochi-balls were delicious; I stowed two in my pack.
A section of the hallway was missing linoleum floor tiles altogether; the exposed concrete was worn smooth. Paint peeled from the stall door. A bucket caught dripping water beneath the sink. Corner floor tiles were blackened from repeated sloshing by a filthy mop, left to dry. Function over aesthetics.
A scampering cockroach or mouse was all that was needed to complete the picture, and were I a Portland resident, I would patronize this restaurant for its hou-hou sung (literally: good, good food).

I stepped outside and located myself in GoogleMaps on my iPhone. I pointed myself in the right direction and started walking, dragging my roller-bag behind me. It wasn’t long before I happened upon the financial district and “Occupy” encampment. All was quiet at Occupy, no chanting, no picketing. People were hunkered beneath tarps and in tents, sharing quiet conversations. Starbuck’s paper cups and plastic lids overflowed the garbage though the sidewalk was clean, the campground tidy.

I arrived at the Hilton with an hour to spare before meeting high-school beau Fred and Tina, his lovely wife of thirty-years.

Monday, October 31, 2011

Facebook Ninja

Alright! I’ll admit it! I’m a Facebook Ninja. I sneak about and spy on my family and friends. I occasionally download their photos for my own. (I have been known to avatar-ize their picture and return – to peals of laughter – I might add.) Less frequently, I’ll leave a comment. I never participate in games or send seeds for the farm. I have no interest or time for pretend-worlds. My real world provides plenty. But I do like birthday reminders, graduation photos, wedding dances, and my great-nephew Kiko, Ninja-ing it up.

I’ll admit to spying on myself as well - on Google Maps. I’ve peered at our family home in Kaneohe – ever on the lookout for changes. I zoom in from space to my home in Folsom, California. In the five years I’ve lived on Gardner Court, Google Maps has updated the photo thrice.

I zoomed-in on Thursday morning and notice a new picture. In the aerial view, my sycamore tree is fully leafed, the grasses in the greenbelt out back, scorched. My lawn bears patches hinting of brown and dry – typical August. Were my backpack hanging from the back fence drying after a bath and new waterproofing, I could affix the photo to September 2010. So I scour the photo for cues. It must be Thursday afternoon, my green-waste-recycle-bin is at the curb. A smudge of maroon in the backyard is the Japanese maple, zen garden completed in June 2011.

A search for self on the property was unsuccessful. That might feel a little odd – like Henry DeTamble in Time Traveler’s Wife, meeting himself in different times.

The close-ups shifts to a pedestrian view: my sycamore is bare and front door screams Chinese-red at the street. Christmas lights hang from the eaves. My SUV is parked on the driveway, the license plate electronically smudged, making it unreadable. Interesting. The lawn is green and coiffed. The front corner of bare dirt is nearly filled in now, after poisoning by 50% Roundup that killed most of the Bermuda grass and everything else.
Three oil spots on the drive remind me of the truck that was loaded with construction materials: French doors removed from the condos in Truckee, a sliding glass door from Granite Bay, white interior doors that were replaced in Gardner Ct, an oak hutch, bathroom light fixtures, towel bars, faucets, and the like – all donated to Habitat for Humanity. I thought we made that run in spring though my Christmas lights, with me the last holdout of the court, came down late January.

I remembered the hummingbird’s nest in a low-lying branch of the sycamore. I’d climbed a ladder with camera and ruler to capture its image. It floated to the ground during a blustery spring storm and I have it still, enraptured in its micro-detail.
I zoomed Google Maps closer… and closer… and closer still. And there in the crux of small branches, is the nest. I am flabbergasted and astounded. Low orbiting satellites take pictures from 300-500 miles above earth. That’s hi-def!

I am fascinated and uncomfortable with the transparency of modern life and the permeability of Facebook. While I love dropping in Ninja-style, the thought that I too am Ninja'd is unnerving. My friend’s Pastor Paul cautioned, “Be mindful; you never know who’s watching.” Too true and never more so.

Sunday, September 25, 2011

Unions: A Double Edged Sword

Union membership comes with the job at Kaiser Permanente. And while I labor under a brand-spanking-new contract that arguable makes me one of the highest paid nurses on the planet, I often find myself at odds with the advice and tactics of CNA (the California Nurse’s Association).
The work stoppage of September 22nd is a good example. Twenty-two days into a newly minted, CNA negotiated, and extremely generous contract, nurses were asked, by CNA, to honor a one-day work stoppage with workers negotiating their first contract between NUHW (National Union of Healthcare Workers) and Kaiser. I personally found the request shocking and divisive.

Most Kaiser North Valley (greater Sacramento) nurses were surprised to learn that 34 hospitals and 23,000 nurses throughout the Central Valley and northern state were affected by the CNA call-to-action. Clearly this was a CNA flex of muscle and show of power. “The nation’s largest-ever strike by nurses,” CNA reported.
“When I learned that Sutter’s and Children’s nurses were out I thought good, I’m supporting them too,” one colleague said. That’s certainly one way to look at it.  

I’ll assert that few Kaiser nurses had knowledge of a larger, coordinated, and politicized call-to-action by CNA. Why was that information withheld? Why were Kaiser nurses asked to participate while local Sutter nurses did not support the Sutter Bay Area work stoppage?

In my book, withholding information is tantamount to lying. I want “to know”, not “find out” on the evening news. In other arenas it’s called a sucker punch. Shame on you CNA!
Full disclosure and informed choice may not have changed the outcome of the day but that does not negate their obligation, nay duty, to fully disclose. I do have the option to divert my union dues to charity. When my shiner and fat lip heal, I may investigate that option.
Fool me once, shame on you – fool me twice, shame on me.

NOTE: I am debating on sending this to the Sacramento Bee – Letters to the Editor. The problem is two fold. First, it is written as if I unknowingly went out on strike. I did not. I chose to report for work on my day off to support Kaiser through this day. Second… retribution. Kaiser is a CNA stronghold, the issue is polarizing, and … as you learned in my last episode with the robot, I CLUCK, cluck, cluck, cluck, cluck.

Saturday, September 3, 2011

It IS Silicon Valley after all…

I ate in the car and drove into the night. I had a general idea of direction and roads though the connector between I-680 and I-880 was not broadcast and signed many miles upstream – as is both customary and expected on California’s interstates. I exited 680 two miles too soon, pulled into a Chevron to check Google Maps on my iPhone, and backtracked to the interstate to proceed yet again, in a southerly direction. 
Maybe I’m getting to old for this, I thought. I felt intimidated if not a little lonely, pressing on in darkness to an unfamiliar city. My destination was El Camino Hospital of Silicon Valley. I would train nurses working the night shift, get a few hours of shut-eye, and return for a full eight-hour day and two-plus-hour drive home.
One more wrong turn, one more U-turn, and I parked parallel on the street fronting the hospital. Expansive lawns glowed beneath an iridescent moon - their edge an eerie blend of blackness and dappled moon-glow.

El Camino occupies a large, wooded campus with tree-lined drives. The night was clear; stars peeked through the canopy overhead, branches swayed in the bayside breeze. Voices floated, carried on the gentle wind, punctuated by a woman’s laughter. 
I hoisted my bag and felt more alone than ever. My soles scratched against the concrete walk leading to the front entrance. Glass panels revealed a lobby dimly backlit for slumber. The automatic doors were locked shut. A sign pointed toward the Emergency Department (ED) and the secured, nocturnal entrance.

As I turned to go a housekeeper opened the doors, allowing entrée into the silent lobby. I thanked him and followed directions to the ED, to sign-in with Security. I traversed the spacious public section of the main floor. My footsteps echoed against polished tiles and down deserted corridors. 

I paused at the Labyrinth inset into the floor with contrasting tiles. It was beautiful in the pale light, the silent night.
A labyrinth is an ancient symbol that relates to wholeness. Labyrinths have historically been used as meditation and prayer tools. The journey toward the center cleanses the dirt of the road, the weighty cares of life. The journey out is one of rebirth, to consciously dwell in the flesh made holy and whole by the infinite center. Not unfitting, I thought, this commanding labyrinth occupying, nay, consuming the central lobby.

Knee-level, wall sconces cast small, golden puddles of light reflecting off travertine tiles. I moved from puddle to puddle, crossing the hall like a pond - from lily pad to lily pad.
I would later learn that hospital staff travels in a parallel pond – parallel halls and elevators that keep patients, gurneys, and scrubs from the grand and pristine public places. 

Glass doors slid soundlessly, opening ahead of me. The ED glared and blared with a flood of lights and activity, a jarring contrast to the muted spaces behind.
 I looked about. No guard holstering a firearm loitered in the corner. I passed through no metal detectors seeking hidden weapons. 
The young man behind the security desk signed me in and relinquished the binder containing my assignment – those units requiring my in-service. He included a map and general directions before I headed back from whence I came, into the delicious, quiet corridors, to find the fourth floor.

Seeking the elevator, I turned down a long and empty hallway illuminated indistinctly by the soft glow of sconces. I stopped to consult the map and something moved. My head snapped up to peer down the dim passage. A brown, narrow box - approximately three feet tall - approached silently. 
“What the … ,” I muttered soto voce’, blinked, and stared hard. It moved along the railing on which I leaned. I retreated to the junction of the main corridor. It advanced. I fled to a safe distance as it reached the junction. “Crossing hallway,” it announced, and cross it did, before proceeding to the elevator to wait for a lift.

The housekeeper approached from behind, laughing.
“What is it?” I asked, eyes as big as saucers.
“A robot,” he said nonchalantly, as if they were commonplace… for they were. “We have many robots here.”
“What do they do?”
“Mostly, they deliver medicine, linens, and pick up the garbage.”
I thought about that during my drive home the next day. While robots are assuredly pricey, they do not acquire injuries hoisting soiled, wet linens and trash – sources of frequent employee injury.

“Where are you trying to go?” he asked.
“To the fourth floor, to the ICU and CCU.”
“Use that elevator,” he pointed to the space where the robot too had waited.
“Thank you,” I said, secretly relieved the robot was gone. I would not have shared that elevator with the robot. Call me chicken… CL-U-U-U-U-U-CK, cluck, cluck, cluck, cluck.

I worked just a few hours and returned before dawn the following morning. We start in the hospital at 0400 and work for several hours catching stragglers on the nightshift. That is followed by a two-hour break during shift change at 0630, when nurses get report, then round on and assess their patients. Time for a cuppa joe and bitta breakfast. A player piano plinked at the base of the grand stairwell leading from the mezzanine lobby to the café and cafeteria below.

While on break I ducked inside the ICU waiting room, to check it out. Soft couches and over-stuffed chairs were arranged in conversational clusters. Tables, telephones, phone books, a work counter, I was instantly impressed. 
The attached kitchenette was fully appointed with sink and counter space for meal preparation, a refrigerator and microwave, table and chairs, and a brightly colored kids table with chairs carved in animal shapes.

When I remember how families camp in hospitals during a loved one’s critical illness – such a waiting area can really support family health on many levels – and trust me, supporting the family supports the patient. In a world that presses for shorter hospital stays, supporting families to indirectly support patients makes sense - monetary and otherwise. 
These inviting waiting rooms sharply contrasted the beautifully aloof lobby whose long, linear, modernistic couches were better suited to airports and waiting than hospitals and communicating.

I had the opportunity to watch many more robots on task, gliding silently through the hospital. 
“Your medications have arrived,” one brown box robot - looking not unlike a steamer trunk - announced upon landing in the nurses station. It waited patiently: no drumming fingers, no rolling eyes, no deep sighs or throat clearing, no playing with its phone, no texting or sexting to another. After one-minute it announced again and without irritation, “Your medications have arrived.” 
This particular robot provides refrigeration and is used to transport newly prescribed medicines requiring immediate administration. Prior to robot delivery, some medicines could be “tubed” in the pneumatic transport system. That or someone had to fetch the drug from the pharmacy. Now, at least in Silicon Valley, a robot makes the delivery announcing politely, “Your medications have arrived.” 
As an aside, routine medications are stored in a locked dispenser whose computer delivers the drug, and only that drug, at the proper time. Pain medications are doled out judiciously. The computer flags unusual activity i.e. a pill ordered for a toddler (toddlers take liquids, not pills), a nurse who removes a particular narcotic at twice the rate of her coworkers. Often, it’s an ordering error; sometimes it’s not. These pharmaceutical computers have made habitual drug theft and abuse by medical personnel much more difficult. Not impossible but more difficult.

On the third-floor, I passed an Asian garden of rock and bamboo. It seemed an odd shade of blue-gray but in the dimness of dawn, it was difficult to discern what color wizardry was at work, if any. After sunrise I clearly saw that the raked “pebbles” of the garden were pieces of blue sea-glass – thousands of them. It was so… curious, surreal, and at the same time, calming.

Speaking of communication – each staff member wears a Vocera  on a lanyard around their neck – a small voice communicator called a “badge”.  
“The Vocera solution enables communication at critical hospital speed, driving better outcomes for the patient and caregiver. … hands-free, voice-controlled, wireless voice communication.”

Hospital staff: physicians, nurses, techs, transporters, housekeepers, 
e-v-e-r-y-o-n-e logs into the communication program when they don their badge.
“Computer,” Capt. Kirk commanded, “Find Mr. Sulu.”
The Vocera is more like than unlike the communicators of Star Trek. No flip phone, it is a single unit about four inches long, two inches wide, and one inch thick. It can receive outside calls and texts, it can page, and all commands are voice activated. 
Vocera works like this: Bones presses the button, “Call Lorin Bacon.” On the other end of that call Vocera ask, “Can you take a call from Dr. (Bones) McCoy, ship surgeon of the Starship Enterprise?” A “yes” response routes the call through. A “no” response rolls the call into voicemail. (Where Bones is likely to leave a dramatic message. “Good God woman, I’m a surgeon not a phone operator! I need help in the OR. Get here before my patient dies!”) See, that’s the thing about Bones: drama, drama, drama! I want a man without drama! But I digress -  :-D 
If a call is placed to one who is not logged into the system, the caller is notified and given an option to leave voicemail. Vocera claims to reduce hospital-wide, overhead pages by greater than 80%. 
On another note, it forces one to learn the names of one’s coworkers – including those that are often invisible: environmental services (the housekeepers and refuse guys), the linen guys, the pacemaker techs, the dietary techs…
It’s slick; Beam me up Scotty!

Typically, I set-up at the nurses station for my 10-minute in-service. Several nurses gather, I deliver my schpeel, answer questions, and wait for the next group. I had more than a few occasions to observe robots in the line of duty.
“Your linens have arrived.” Emergency linens? I’m unsure any linens should be delivered by robot. That forces a $50/hour nurse to stop and deal with linens. I’d rather they come up the good-old-fashioned-way, via the $20/hour guy with the big linen cart who restocks the entire floor for an entire 24-hour period.
Still, I’ll concede there may be benefit to robot delivered linens, though in my chronic and terminal myopia, I fail to see it.

As I waited at the counter of the nurse’s station, I felt a presence at my right elbow and turned. I was startled by a robot (a tall, brown box) nearly six-foot tall! 
(Pause in think: you KNOW I like em brown, long, and lean. It occurs to me that this robot actually meets my basic physical criteria. He was kinda square though.) My apologies – I digress yet again for a bitta humor.
Apparently, I stood in the glide path. “Don’t move,” the nurse sitting before me advised, “It will recalculate and move around you.” All four wheels beneath the robot must articulate 180-degrees and independently for it paused briefly, then moved sideways and proceeded once again, returning to the glide path along the railing once it was able. Brown-long-and-lean was a garbage robot, come to deliver a large, empty blue bin and retrieve the full one. Each garbage bin station is assigned a digital locator. On command, robots exchange blue bins. 
Earlier I overheard a robot commanding, “Clear the halls.” This one made no such declaration and moved without a sound. It stopped within arm’s reach without a peep. These were not personable robots with manners and command of language. They did not engender the desire to fraternize in trash compactors (ala Star Wars) or spend time making their acquaintance. They made no endearing noises, possessed no British sensibilities. Not like R2D2, even less like C3PO.

Our team had been inside El Camino for four consecutive days. Few nurses had missed our “refresher.” My colleague Kris would follow on the evening shift, the final shift. We were done.
We were there to teach nurses the care, feeding, and maintenance of central lines, those large bore IV’s that extend into the central circulation (the superior or inferior vena cava). In the medical environment of decreasing reimbursements and the ever-present threat of litigation, keeping central venous access devices patent (unobstructed) and de-bulked of bio-matrix (blood clots) prevents infection, insures timely therapy, and cuts costs. A win-win. 
In the world of diminishing education budgets, the pharmaceutical company imbedded our highly skilled team to train nurses.

I have participated in these blitzes for many years and even traveled as far away as Seattle. It takes a large team to cover a hospital sixteen hours each day, for the better part of a week. As busy as nurses are, I find them eager and apt students. They want to understand, do it better, and get it right. They want the best for their patients.

I used to say I like perfection – that as a group, nurses are perfectionists – and we are. But I have come to realize it is not perfection but excellence that I like. I seek excellence and am inspired by those who pursue it in care delivery and patient outcomes. 
I am also inspired by beauty and utilitarian art. Beauty can touch me without notice or fanfare and alter my experience of the now. Beauty pulls me out of myself, beyond my smallness, connecting me to others and the infinite. Utilitarian art brings beauty to every day objects like lobby floors and third floor gardens… and I am tugged at every turn.
One definition of integrity is workability, something could be said to possess integrity when it works. I witnessed a high degree of workability at El Camino, from Vocera communicators, to numerous and comfortable family waiting areas, to vegetarian menus, to robots that do the heavy lifting.

What is there to say of an organization that recognizes the nature and nurture of humans, then provides the tools and stimulus for humans to succeed, exceed, and excel? Whoa! 
I intend to follow El Camino Hospital of Silicon Valley with interest. Methinks their eye is not just on the ball, but on the stitch of ball, and they are swinging for an intergalactic home run.