AirPods review

I freaking love these little things. As with most things Apple, I initially said there was zero chance of my spending $160 on something that small, and then within a few weeks I was pissed that I had to wait 6 weeks for them to ship.

They ARE small. The case does look like a dental floss container. I’m pleased and amazed to report that I have lost neither an AirPod nor the case (yet), probably largely because I bought a cover that clips on to my bag. The wirelessness that makes the AirPods easy to lose also makes them easier to use—you won’t find me embittered over not having to untangle headphone wires.

They DO look stupid. “Where are the wires?” people ask me. Or “do you have horns growing out of your head?” Or I just get strange looks. More often than not, though, , before the interaction is over, the people ribbing me are asking me where they can get a pair. I intensify the stupid look by often wearing just the right Pod. Hey, it works for me.

Apple has thought of everything! They magically connect to the things I want them to connect to, and they don’t drop the connection. It’s easy to check the battery status. To charge them, you just put them in the case.

Speaking of battery status, I haven’t run any tests, but I my impression is that the battery life is pretty good. Without the charging case, I wouldn’t say that, but it’s so easy to charge them back up that it seems very painless.

I probably should have discussed sound first, but I’m not an audiophile. That being said, I think they sound really good. I notice myself putting them in to listen to things even when I’m not around other people and could just use my speakers, because they sound so good. I definitely prefer them for making phone calls (my primary use for them).

Are they worth $160? As with all things Apple, apparently so, because people are buying them. I wouldn’t scrimp and save for them. They’re not life-changing. But I would recommend them for people who talk on the phone a lot or get peevish about tangled headphone wires. If I exercised, I’d probably recommend them for that too…they sit solidly in my ears and show no inclination to slide out.

In summary, AirPods are really small, look really stupid, sound really good, and are so handy I’d feel bereft if I suddenly didn’t have them.

Weighing in: can the iPad replace a Mac?

It seems as if everyone and their dog is making YouTube videos and writing blog posts about whether or not the new iPad Pros can replace a desktop system, and despite myself, I keep consuming the posts. Even though I have my own answer (no).

I want the iPad to be able to replace my Mac: I mean, fewer things to charge, maintain, and sync, right? I have a new 10.5-inch Pro running the public iOS 11 beta, and I love it. Even on my last iPad, I rarely opened my MacBook Pro. I’d like to say that now I just never need it and won’t be replacing it, but I can’t.

For probably 95% of the stuff I would do on a laptop, the iPad is as good as or better than a laptop for me. I say better because of portability and availability. Just as the best camera is the one you have, the best computing device is the one you have. I’m never going to haul around a computer everywhere I go, but the iPad is small enough to put into my bag.

For the other 5%, I just can’t make it work. I’ve geeked out with Workflow and tried day-wasting workarounds just to see if it could, but alas, I end up scuttling back to my laptop. This complicated 5% includes

  • iTunes,
  • Hazel,
  • Macros,
  • Blogging, and
  • Scanning.

iTunes exists on iOS, of course, but it’s really limited. I have Apple Music and a bunch of smart playlists, and I like to monkey with my music based on play counts, skips, and other strangeness that you just can’t access on iOS.

Hazel, macros, and scanning go together. I try to put everything through my ScanSnap and do away with having towering piles of paper everywhere, and I use TextExpander and Hazel to keep everything organized so I can find it later. This involves scanning the thing, renaming it with my own conventions, and letting Hazel work her magic.

You can scan stuff over the air with a ScanSnap now, but I’ve found the implementation rickety. By the time I fiddle with it and get it to work (again), I could have just opened my laptop and gotten four times as much work done.

You can rename PDFs in iOS and put them in other places. Manually. I’d rather let Hazel do the heavy lifting. The new Files app may help with this, but there will still be an efficiency issue.

You can implement Workflows to do the work of a bunch of automated tasks that a laptop would handle, but I have a few that I’ve given up trying to transfer over. These are mainly monthly maintenance tasks, so I don’t need the laptop very often for them, but I do need it.

You can blog on an iPad, and I’m writing this post right now on mine. If I didn’t use SquareSpace, I might be able to exclusively use my iPad for blogging; however, I do, and SquareSpace is like the Hotel California. You can check in, but you can never leave. But that is a rant for another day. They have an iOS app, Blog, which I’ll probably use to post this. It does the job if you’re posting text and maybe one image that can float at the bottom of your post. Otherwise, forget it. Back to the laptop for the complicated Web interface, which chokes and dies on even my slick new Pro powerhouse.

So there you have it. I won’t be getting rid of my MacBook Pro anytime soon. I will, however, most likely keep it until it dies rather than replacing it when it gets a little slow. I don’t need a super-slick machine for the stuff I use it for now. The iPad has totally become my primary computing device: it just can’t be my only device.

NotePlan review (iOS)

I’m a calendar junkie. I love finding new ways to potentially organize myself, because I need all the help I can get. For a few years I’ve been using paper organizers (for the planner girls out there, my latest setup was an A5 Gillio Appunto with disc-bound system that had 3/4” Levenger aluminum discs and a bunch of inserts I designed myself. It. Was. Pretty.) because I couldn’t quite get the digital ones to work, meaning I’d forget stuff and tasks would somehow just fall off my horizon. And they worked pretty well, and I liked doodling in the margins and using stickers and washi tape. (I did. Don’t judge me.)

Why digital again, before I start on NotePlan? It’s relevant to why this app works for me. Mainly because my paper system was getting too complicated. It had too many charts, cross-outs, write-ins, and cross-references for the stuff I have to keep track of. I spent a lot of time rewriting tasks and redoing lists because my life is a moving target.

One system that worked well for me for a while was bullet journaling (see the creator’s site here). The idea is to have a trusted brain-dump system that can quickly be processed and gotten through. Few people are bullet journal purists because it doesn’t easily allow for forward planning, so for a few million ideas on how to do that check Pinterest. That’s what got me. If I have a dentist appointment in 6 months, it does me no good to write it on my daily bullet journal page. I will lose it.

So like most people, I developed hybrid systems where I drew out the months in regular grids and then bullet-journaled on a daily basis but still had my year to refer to. This is more or less the system I used for a few years in my paper books. I’d have monthly layouts, weekly layouts, a separate section to collect all my to-do’s, and then a daily page where I brought everything together to focus on that day. And it worked great. I didn’t lose or forget stuff. It just got fairly labor intensive to copy things from daily page to daily page that I hadn’t gotten done; it stopped being fun and became a major drag.

I also, as a side note, have a ton of stuff to keep track of for work, because in addition to being a nurse, I also have to actually case-manage. That stuff, it turns out, is much more easily corralled in a Numbers file. Therefore, I found myself hauling around an iPad AND an A5 notebook and felt a little overwhelmed.

I transferred all my appointments to iCal calendars in Fantastical and bought Things 3 for both my Mac and iOS, and that system worked OK. Things 3 does combine calendar events and to-do’s in a Today bin. So does Fantastical, for that matter, if you want to use Reminders. I won’t review Things 3 because a lot of people have already done that: just Google it.

Then I saw a brief mention of NotePlan and read Brett Terpstra’s review, and after deliberating for a day or so I downloaded the iOS version (it has a Mac version as well, but given that I open my laptop about twice a month at best, I haven’t sprung for it).

It’s pretty polished for a new app. It probably has a niche audience: you have to like or at least tolerate Markdown. Which likely means you are a geek. If you ever used and liked TaskPaper, you are in this group. I also think that a bullet journaling background helps.

NotePlan is how I integrate all my electronic Things into daily pages like I had in my Gillio, only I can easily add and move and reschedule stuff. It has a calendar section and a notes section, and everything uses plain text, so you can use whatever tagging system you want (@tag, #tag, etc.).

You can use Markdown links to link to notes or tasks, which leads to fabulousness for me like making a to-do item in my calendar that links to my “monthly tasks” note, which in itself contains a list of tasks. I reschedule that one (linked) task from day to day and not the entire list until everything is checked off.

NotePlan-1.png

There’s a monthly calendar view which isn’t very helpful because it uses a system of colored dots to show you what’s on each day; I still refer to another calendar app regularly to see my events listed out. But it’s handy for jumping around from daily page to daily page. Tap on a day and the magic starts happening.

You get a list of your calendar events at the top and then a blank page at the bottom for whatever your little heart desires. You can dash off Markdown lists which are really tasks that can be completed, cancelled, or rescheduled just by tapping buttons (you don’t have to actually type in much Markdown at all unless you want to). In between you can write notes or whatever you want.

There are shortcuts to archive processed tasks and to deal with any remaining open tasks, so you can quickly clean up the detritus of your day and start anew the following day.

I LOVE THIS. It’s got all the advantages of bullet journaling but does all the copying and scheduling for you.

As I mentioned before, there is a notes section which can be linked back and forth to the calendar. It’s all plain text, which can either be a pro or a con (I wish the system Notes app would allow plain text!). I mainly like using the notes to create task lists that I don’t want to appear every single day. They’re easy to link to the relevant day.

NotePlan allows repeating tasks, although the implementation is a bit dodgy and basic. If you want something to repeat every 2 weeks, for example, you’re out of luck. It’s NOT a full-featured task manager. Then again, that isn’t the purpose of it. Those already exist.

Of course, there are drawbacks, although there are surprisingly few for a new app. The developer must rock.

My main quibble is that search doesn’t work across notes and calendar. This severely restricts tagging utility, because if I have @work tasks in my calendar and in notes, they don’t all show up together. You also can’t do ninja searches like you can in TaskPaper and other plain text systems for, eg, tasks tagged @work that are @done. A related weirdness is that you’re supposed to use hash tags to tag your notes, and using hash tags to tag stuff that already has Markdown in it looks yucky to me. If it worked across calendars and notes, I’d do it, though.

The other thing on my wish list is to be able to interact with calendar events somehow. They’re read-only right now. I’m not suggesting that NotePlan become a plain-text Fantastical, but it would be nice to be able to tap on an event and be bounced over to the calendar app of my choice.

Hydration and the dying process

I got an e-mail asking whether giving dying people water can keep them comfortable and/or aid in the dying process.

This is a frequently asked question, actually; it seems natural to attempt to hydrate someone who has stopped drinking. Family members often ask, “should we start IV fluids?” Or even “what about a feeding tube?” Approached without context, of course it seems cruel to avoid giving someone water. But there is a context.

My boss has been a hospice nurse for like 100 years or so, and one of the first things she said to me (after “when you’ve been doing this for a year, you MAY have some idea what you’re doing”) was that ultimately, our patients all die of dehydration. Which I thought was idiotic. She has a point, though. I’ve watched a lot of people die by now, and it does seem directly related to volume status.

That’s kind of the sticking point, though, isn’t it? If giving your loved one fluids will keep them from dying, why wouldn’t you do that?

Here’s why.

When a body shuts down, muscles stop working, even the little involuntary ones in the GI tract. If you put stuff down there and nothing is happening, it causes fullness and nausea. Think about how you feel when you have gastroenteritis (the “stomach flu”)...you feel like “oh God, please, I don’t want anything in there!” The dying person seems to naturally reach a similar place where they just don’t feel like eating or drinking anymore, probably because to do so causes discomfort.

What about IV hydration? It works for a while, but ultimately if the body is shutting down, it is shutting down, and it will stop being able to do anything with those fluids. They will seep out of the vasculature into the tissues and cause swelling, which by all accounts is uncomfortable (who enjoys being bloated?). At that point you are left at the same point as above, except now you have a lot more fluid to get rid of before death occurs.

Another way to think about it is like a car with a radiator. The car will run, at least kind of, as long as there is enough fluid in the radiator. The body is the same. Until the fluid runs out it can keep going and going and going and....

My concrete answer is this. As long as the person is thirsty, the body is probably able to use the water, and they should be offered fluids as usual. But when they stop being thirsty, it’s probably because the fluid is going to cause more harm than benefit, and that’s the time to stop fluid intake and change to moistening the mouth and lips only. But without question, fluids prolong the dying process, and that can be beneficial or not.

How to Assess a Dying Patient

A nursing assessment of someone who is about to die is a special one that nobody really teaches you how to do; it's as if nursing instructors think you should just...KNOW. So I thought I'd write up a little post about it.

Keep a few things in mind. First, dying people don't like noise. They're mostly pretty tuckered out and seem to be concentrating on the task at hand, so keep your voice low and avoid your Perky Nurse Tone or chatting them up. Second, they may be unable to participate in your assessment at all. It can be similar to an assessment of a plain old unconscious person. Third, "normal" has to be skewed. Crazy vital signs and deranged assessments become the norm. What you find cannot be construed as abnormal.

Neuro: The person will go through decreasing levels of consciousness until they may be totally unresponsive. Don't go pressing their nail beds to assess this. It's mean. They may be progressively confused, talking to people you can't see. They typically sleep almost all the time (as I've said [before], it's called actively dying for a reason).

Vital signs: These get funky. As the process really gets under way, typically the heart rate will go up and blood pressure will decrease. A fever is common. Respirations will be all over the map (more on that below), and the oxygen saturation will drop no matter how much oxygen is flying through the nose hose. Don't be surprised if you get these vital signs: 102.2, 130, 28, 78/32, 82%.

Respiratory: Lots of weirdness here. Changes in breathing are important to notice. There is the infamous death rattle to contend with, and if you hear it, you'll know that you're probably looking at 72 hours or less. The lungs will sound like a swimming pool housing a woodwind section. Accessory muscles will be used, particularly diaphragmatic breathing: the patient may start doing a two-part breath, using the diaphragm to kind of squeeze the last of a breath out. Start looking for apeneic spells, and count how long they are. They may be combined with very fast respirations as well. The very last breaths you may see are agonal breaths, and these may be nothing more than the person opening and closing their jaw a few times.

Skin: Google “mottling images” if you haven’t seen mottling before. It can happen anywhere, including the nose and ears, but mostly it starts on the bottoms of the feet, around the knees, or on the lower legs. The skin may be very cool or very hot, if the patient has a fever. The patient may be pale, flushed, cyanotic, sallow, or even downright yellow. All are normal.

Output: People usually quit eating and drinking a few days before death. If someone is very edematous, it takes longer to eliminate those fluids, but at some point urination will stop. Track what’s going in and out.

This is just a short bit on the basics, and they apply to someone dying a natural death. All bets are off when you start contending with ventilators and intravenous fluids and medicines. I have much more to say about all of this so I may write more in-depth posts at some point: leave comments or send me an e-mail if there’s something you all want to know about.

The value of leaving things alone

I've noticed lately that a lot of things get better when you don't do anything about it. I'm talking about medical things, but also about just life things. What's up with that? In critical care, we fix everything RFN (right frigging now). In hospice, we don't take action about a lot of things. And you know what? Most of them resolve anyway. It makes me wonder how many unnecessary procedures go on all the time.

I've seen the following things just get better with no intervention whatsoever: atrial fibrillation with rapid ventricular response, extreme bradycardia (low 30's), multiple multiple infections of all kinds, wounds that I felt absolutely needed sutures, and a lot of alarming situations where I've thought, "in the ER, I'd have a doctor over here immediately." They just...get better.

Same with life situations. The older I get and the less likely I am to react and start frenetically trying to fix things, the fewer things I have to fix because the problem often disappears or fixes itself.

It's hard to do nothing, though, on both accounts. What nurse wants to just not do anything for a patient? I've now had to stand by a dozen times by someone I'm pretty sure is in some deadly cardiac rhythm and do nothing because we don't code people in hospice. It's a weird feeling. But as I say, now I wonder how many codes would have resolved themselves anyway that I've been in. I mean, maybe the successful codes would have resolved anyway, and the unsuccessful ones would never have had a chance to matter what. I'm growing decidedly anti-code.

Just to be clear: I am NOT anti-treatment. If someone has an infection that is causing pain or distress, by all means I want to treat it, if that's what the patient wants (sometimes they don't!). If some situation in my life is causing ME pain or distress, I want to remove the source of distress sooner rather than later.

But it's food for thought. Is it absolutely necessary to DO something about this situation?

Can I eat low carb as a vegetarian?

Operation kick-ass 2017 is in progress. I'm still doing my Miracle Mornings, astonishingly enough. In fact, I get up early even when I don't have to because I just wake up and feel like getting up. That is a miracle for sure.

Exercise is a big challenge for me, but at least I've discovered that I actually enjoy yoga. I'm stiff as a board and probably look like a total idiot, but it's the first physical activity I've found in a long time that I don't actively dread. That's an important first step.

Exercise aside, my main focus right now is on my diet. I went spelunking on the Internet and various books for ideas for why, despite doing everything I previously thought would solve the problem, my weight refuses to budge. I'm swayed by research and data indicating that sugar and white flour are Really Bad, so I've cut those out. So far I've read The Case Against Sugar and The Vegetarian Low-Carb Diet. I'm halfway through Why We Get Fat. The ideas are so hard to grasp; they make my brain hurt. But the arguments are very compelling.

I'm a vegetarian and will remain one. Nonviolence is one of my Values, with a capital V. It is however difficult to eat anything at all if you don't eat meat and seek a low-carb existence. I'm at the beginning of my journey and find that this switch is daunting to say the least. My diet has always been based squarely on bread, pasta, and rice (to say nothing of loads and loads of chocolate!), because I was raised on the low-fat high-carb idea. I have mountains of mouth-watering recipes that I no longer want to default to.

Thank heavens for Pinterest. And Paprika.

The sugar withdrawal is HORRIBLE. Horrible. The only way I'm getting through it is that it's so horrible I don't want to have to do it again. I'm exhausted in a special, "I can't keep my eyelids open" way. My entire body aches. I'm dizzy and nauseated. I'm starving as soon as I eat. My stomach is upset and I'm gassy and bloated. It's really truly unpleasant, yet all these symptoms are apparently to be expected. And I'm still eating carbs! I'm eating way FEWER carbs, but I am including whole grains and beans in my diet because (a) I have to eat something and (b) I'm not as swayed by thoughts that these carbs are harmful as sugar and white flour are. I imagine it would be a lot worse if I really did a carb cleanse.

In some ways this isn't changing my diet all that much, because I can switch white flour for some whole grains once in a while. Beans are a staple of my diet and I remain 80% convinced that their benefits outweigh their possible drawbacks. Veggies are my go-to. I'm eating a lot more leafy greens, though, because the easiest way I've found to throw a meal together is to house the rest of my food on a salad instead of on rice or pasta.

The change isn't so much what I'm adding as what I've taken out. I was shocked and appalled to discover exactly how much sugar and white flour I was eating every day, starting from my ab-fab caramel Keurig coffee every morning and continuing on to my pile of chocolate in the evenings. I've always thought sugar really wasn't that bad compared with fat so I've never restricted it. And I definitely never made any effort to restrict white flour. I ate a ton of bread, chips, tortillas, and pita/naan. My body is clearly asking me what exactly I'm doing to it right now. I can FEEL my blood sugar jumping around and trying to find a new normal!

My One Task for today is to figure out and prepare some foods I can have available when I get starvingly hungry, because I want to reach for my old foods and then feel cranky and deprived when I remind myself that these foods are not healthy for me. I have a selection of organic nuts and seeds to munch on and am tempted to buy some of the low-carb snack bars, but I really want to get away from processed food.

I am excited to see how this change affects me. I'm committed to see it through for a while until I am pretty sure I'm through the awful adjustment period, because I can see how it would be easy to mistake growing pains for possible negative effects of the lower-carb eating style. If it doesn't work for me, I will try something else, but I will not add back sugar and white flour. Those are out.

Why I have a Kindle and an iPad

My Kindle Paperwhite turned up with a giant scratch on the screen. It was actually like a huge gouge in the screen, and I have no idea how it happened because I don't typically drive over my Kindle or use it for tennis practice.

I thought I could read around it, but no. Then I thought I could just use my iPad (a baby Pro) to read on, but no. This weekend I schlepped to Best Buy and forked over the money for a new Paperwhite (and then gave Amazon $15 for a case, which I've never bothered with on a Kindle). Five minutes after I got home, the twin Kindle was up and running just like the old one, and I breathed a sigh of relief.

But I feel somehow guilty about having a duplicate gadget. How many tablet-like items does one person reasonably need (David Sparks, I'm looking at you!)? At least I bought a several-generations-old Kindle and didn't spend $300 for the Oasis, I guess. I'm writing this post to justify why I am engaging in anti–clutter reduction.

Reasons to have a Kindle even if you have an iPad:

  • Size. I don't realize I'm holding a Kindle. The Paperwhite is itty-bitty. It slips easily into my purse and doesn't drag down my shoulder, and I can hold it up to read in bed without my hands going to sleep and without needing to prop it up with a pillow. If I fall asleep while I'm reading, I can drop it on my head without risking waking up or sustaining a concussion.
  • Screen. Kindle screens don't give me a headache. I don't think they look as sharp and snappy as Amazon claims; I'd much rather stare at my crystal-clear iPad, in theory, but in practice I haven't yet experienced a headache or eye strain with a Kindle, and I read a lot, lot. iPads start making me want to take a break after an hour or so despite what I try with the brightness and so on.
  • Battery. The Kindle batteries really do last weeks. iPad batteries are no slouches, for what they're powering, but I can run down my iPad to nearly nothing on a weekend when I'm plowing through some reading, in a single day. And THEN how am I going to check Facebook?
  • Single tasking. Which brings up my next point. The only thing I can do on a Kindle is read, whereas with my iPad, despite my best intentions, I respond to those banner notifications sliding across the top of the screen. I CAN'T HELP MYSELF. Then an hour later I'm still watching guilty dog videos on YouTube. Reading on a Kindle is more relaxing for me because it gives me a break from constant connection.

I used to like the Kindle Owner's Lending Library benefit, which let Kindle owners borrow a book a month for free. Amazon seems to have replaced that with Prime Reading Eligible books, which lets Amazon Prime members read eligible books for free. So now you no longer have to own an actual Kindle to read books for free (the iOS and Android apps will work), but you do have to be a Prime member, which I am.

Amazon isn't what I'd call transparent with all these benefits. They kind of introduce them and switch them around in confusing ways. They also have the Kindle Unlimited program, because no company can live with itself nowadays without having Yet Another Subscription Program. With this subscription you pay $9.99 per month and get all-you-can-read Kindle books, as long as the books are Kindle Unlimited eligible. And there's the rub. If I want to read a book, it's a specific book that I have to hope is eligible. If I were a reader who could happily browse known Kindle Unlimited books and be happy with those, it would be a great deal for me.

Anyway, none of that is tied to owning an actual Kindle anymore, like it used to be. This is good and bad. Before, if you didn't own a Kindle device, the Lending Library was not available to you. Now, if you don't have Amazon Prime, Prime Reading isn't. Either way you had to buy an Amazon device or service, I guess.

I do read some stuff on my iPad, of course. iBooks, obviously. PDFs. Web clippings. RSS feeds (yes, they still exist, and so do people who read them). eBook formats that don't work on Kindle. If you aren't in the Amazon ecosystem, a Kindle is useless, but I've been buying Kindle books for like a decade now and have a zillion of them.

It works for me. I guess I'll keep on living in an extraneous-device household. Anyone else out there sporting another tablet and a Kindle? Why?

I'll just do it myself: Independence in home health

Scenario: your patient has an SpO2 of 48% at rest and on oxygen. Scenario: your patient's wound is suddenly giant and bleeding. Scenario: your patient is so agitated that she is trying to pull her own fingers off.

Those kinds of things sound bad. You'd go get a coworker to help you, right? You can't do that in hospice.

Independence and responsibility are things I idiotically overlooked when I started case managing for hospice, but they are at the forefront of challenges (and satisfaction) with the job.

In my job, I am frequently the only health care provider who sees the patient. That means if I miss something, it's not going to be caught by anyone else. I'm the only one who intimately knows all the medications the patient takes and knows every square inch of their skin and every crackle and wheeze in their lungs.

What's in my car is all I've got to handle anything that happens. What would you put in your car to deal with any imaginable circumstance? Sometimes I physically long for a hospital room with oxygen and suction right there on the wall, along with toys like otoscopes; a cabinet filled with bandages, Kerlix, and gauze; gloves on demand; a clean sink (with running water); and other nurses who can hold stuff for me. (Ever tried putting a Foley in a woman who can't get out of her recliner? By yourself? While staying sterile?)

In hospice, I don't have any of that. If I've done my job right, I'll have an oxygen concentrator to work with and a box of gloves in the house, but otherwise I either can't control what I'll need (e.g., running water) or it's just not feasible (e.g., I can't possibly foresee what types of dressings I'll need for any possible wound). Running to the office for supplies is almost always also not feasible. I work in rural Kansas, and it is not infrequent for me to find myself an hour away from the office (and from anything else).

This is scary. It didn't scare me at first because for some reason I didn't realize how alone I'd be. It took a succession of "oh, crap" incidents to scare me, those ones where you think, "Well, this looks bad. We should call someone." And then realize that you are the someone who's been called.

Now that I have realized how scary things can get at any moment—because forget the Emergency Department: hospice is hands down THE MOST unpredictable environment I've ever worked in—I have found a sense of challenge and achievement in the unpredictability and reliance on my own skills and experience. I have become very good at walking into impossible situations and having good assurance that I will end up figuring something out. That's pretty cool.

It's not just patients who rely on me, either. Physicians do. I often think it must be nerve-wracking for them. Here they are tasked with providing end-of-life care to people they will never even meet, and they have to rely on me, often ONLY me, to pass along accurate assessments and recommendations. If a patient is having trouble breathing, is it likely pneumonia? Or could it be their CHF? I have to decide what to assess and pass along, and I don't get to use toys like labs and X-rays to figure it out. I'm usually also the one who has to negotiate whether the patient and family will want to treat the problem in the first place, because in hospice we walk a thin gray line between treatment that increases comfort and treatment that unnecessarily prolongs life.

I negotiate a lot of what I call "curiosity treatments." These are things that would be interesting to know but in the end will not change what we actually DO for the patient: things like X-rays, chemistries, and even UAs. Getting a UA on a patient with signs of a UTI would be a slam dunk in the hospital, but in a home hospice patient, is it worth the hassle and trauma to the patient to do a straight cath? Will I even be able to get the sample to the lab in a reasonable amount of time? We often just presumptively treat that stuff because it's more timely for the patient and the results of the lab tests end up being relatively unimportant. Physicians rely on me to figure this stuff out.

Somehow this all works, I think largely because of teamwork. Perhaps ironically, the more indepently you work, the more important having a good backup team becomes. Without one I'd be truly alone.

Miracle Morning, Miracle Me: That Pesky E

I started religiously doing the Miracle Morning 16 days ago. I blogged about it on Medium already and thought I'd start blogging regularly about my adventures. I'm thinking hard on what to do with my blogging future, by the way; I don't think being a nurse blogger is my thing anymore. Anyway.

You're supposed to give yourself a full 30 days to acclimate to the systemic shock that occurs when you start getting up early and doing healthy stuff, so I'm about halfway through. I told myself I wouldn't edit the system until I'd tried it exactly as written for long enough to tell if it's doing anything.

I've changed around the amounts of time I spend on each SAVERS, but otherwise I've been a purist, and there's no proscription against changing how much time you spend on each thing anyway.

Getting up early and doing SAVRS has caused relatively little friction for me, which shocks me because I was a night owl for so long. The E (exercise) I am having more trouble with in the morning. When the weather has been nice, which in Kansas means not too far below freezing and without a whistling wind, I've had surprisingly little difficulty getting out the door for a (very slow) walk/jog to start out my fitness journey. Today it's like 3F, so that isn't going to happen.

I've supplied myself with Ways to Exercise at Home so I have T25 DVDs and a yoga app on my iPad/Apple TV. Problem is, the boyfriend and I live in the tiniest of houses, and he's working second shift right now, so there is nowhere and no way I can do much of anything except creep around in the mornings to avoid waking him up. The gym? Is 15 minutes away. With my work schedule I do not have the wherewithal to spend 30 minutes a morning just driving. That's several hours a week I could be doing something, well, something else. I drive enough during working hours.

Furthermore, I feel totally worn out starting around late morning and am starting to wonder if "exercise in the morning" is too one size fits all. Hands down I am more likely to do it I I can cross it off my list first thing. I'm not debating that. Still, at least with current circumstances being what they are, I've decided to break with my resolve and try exercising after work. I'll let you know how that goes.