Back where it's beautiful

Don't get me wrong.  We saw some beautiful areas around the Yakima Valley.  We saw some beautiful scenery around Mt. Rainier.  But, when the chips are in the middle, I say that the Columbia River Gorge is one of the most beautiful places on earth.  I can think of a very small number of places that might match it, but I don't think anything beats it.

We were going to stay last night in Cascade Locks because it was closer to the scenic gorge area, but that park didn't have sewer hook ups and showering after a day of adventure is nice.  So we pressed on and eventually ended up staying in Gresham, OR at the very park where we first stayed for the Vancouver contract.  Great for an overnight.

This morning we woke up to somewhat dense fog.  This isn't ideal for viewing the gorge, but it is still pretty awesome in the fog.  We headed out.  On I-84 the fog stayed with us so we decided to try to climb out of it and headed up toward the Vista House at Crown Point.  Sure enough, as we made it up to the rim ridge of the gorge, the sun broke out.  We passed by the Lewis and Clark lookout and saw what we came for.

Yeah, wow. I'm not even gonna caption that one.

And that wasn't the only one.  Once up above the fog, the view was spectacular in any direction.

This one though, totally gets a caption.

Vista House looked so good we just had to go see it.  The view from there was nice too.

Michael was totally ignoring the view and hunting for mushrooms.

He has his Trader Joe's mushroom collection can.

He can put it down to be goofy.

But, of course the other big draw of the gorge is waterfalls.  And right near here is probably my favorite waterfall of all, Latourell Falls.

Loving this leaf.

Revisiting of an old favorite.

Wait for it...

Max had to climb up to perch on some rocks

The falls, finally in sight

Wait for iiiit...

Waiiit for iiiittt...

BANG, long exposure.  You know I'm nothing if not consistent.

We followed the trail back down the creek looking for a different way out, but turned back. We learned our lesson about unplanned hikes last time we were this way.

Bridges are cool

Bridges and fall colors are awesome. 

The hunter and his prey

Right here is a great place to toss up some leaves and make it rain.

Then it was time to head out to the next destination.  We decided to skip Multnomah and the crowds.  Instead we stopped at Horsetail Falls for a quick photo.

Oh yeah, you know it's coming.

Anatomy of a picture

So I put up a picture yesterday on Facebook and Google +.  It was a good picture and got a fair bit of response.  Most of the commentary talked about how peaceful the scene was and how much fun it would be to take a quiet walk there.

It is amazing what framing will do for you. There are many instances of this online, this one is mine.  Let me walk you through the origin of the shot.  I think it serves as a wonderful lesson on the power an image can have in your mind when the reality is nothing like the image.

Here is the original picture.

Not bad, right?  I was fairly proud of it.  The only thing I did really was open in GIMP and change the color curves a little to punch it up.  I'm not good enough at photo manipulation programs to do them with any real subtlety.  I'm quite ham handed.  Here is the original photo.

See, not really much of a difference.
It was a cloudy day and I waited around for about thirty minutes for a sunbeam to come light things up for me.  It took a while.  I was bored while I waited and took some shots in case the light never came.  You can tell what a difference that light made when it did finally show. 

So, back to the beginning.  I had the opportunity to pass by this place again this morning, probably for the last time. Such is the life for a full time traveler.   I took the opportunity to snap a couple of pictures that tell more of the story of the picture.  Also, I got a chance to see what a difference full light from the opposite direction had on the picture.  I passed by in the morning instead of the evening.

So, it all started like this.

I was driving home with the kids and saw that.  I really thought it might turn into a good image and planned on getting back as soon as I could.  We were leaving the next day and I thought I would never get another chance at it.  Later in the day I snuck out and stood there waiting for the light to change.  Peaceful?

Only if two lanes of highway traffic and passing fruit trucks are peaceful.  I had to be ever mindful backing up that there was no real barrier between myself and the highway.  Two steps further back and you were in traffic.  And yes, that van was there yesterday too.

I thought the light today would be a bit better, but I am not so sure.  I may have just gotten lucky.

I think in the end it boils down to this.  Beauty isn't always in the world, just in how you see it. 

So, that was the story.   On the way home I pulled of to the side of the road for another shot at this house with Mt. Adams in the background that I like so much.  I think this one will take a better photographer than I to do it justice though.

Diagnosis

(This is part one of what I expect to be a three part series.)

3:30 in the morning.

Max walks in and wakes us up, telling us that his tummy hurt and he was sick. He threw up in his bed. 

For the past week, he had been sick with what appeared to be hand foot and mouth disease. That day he had finally seemed to be over it and was eating again. Sarah gets up to go look and sure enough, he threw up all over his bed. I ask if I can help clean it up, but she says she has it. It is a top bunk against the wall. As unpleasant as it may be, it really is a one person job. Meanwhile, I am in bed comforting Max. Something isn't right.

I know he is sick, but something is wrong, really wrong and it takes me a moment to wake up enough to realize what that is. He smells like nail polish remover.

I'm an ER nurse. I know what that smell is and what it means, but...no way. Max isn't diabetic. No one related to us is diabetic. Can't be.

And yet I look down and see a groggy little boy breathing fast and deep. My hand against his chest can feel his heart pounding away like mad. Maybe he has a fever. I get (or more probably it was Sarah, I don't really remember) the thermometer and check. No fever.

What could it be? No, what else could it be.

After lying there for a minute thinking about dehydration and ketones and the danger of acidosis, I take Max into the living room and sit with him on the couch. How long until Walgreen's opens and I can get a glucose meter. Hell, we should have one of those around anyway. No way that he has diabetes, but I would sleep better knowing that for sure.

By this time, sleep is out of the question. Walgreen's doesn't open until 9am here. That is hours away. If he is diabetic and in DKA, I shouldn't wait. All in all it took nearly three hours for me to shed the denial, realize the situation, and get moving. I'm a little ashamed of that, but there is a special dread ER workers have about taking themselves or their families in to be seen in an ER. That takes something pretty big to overcome.

I told Sarah I was going to my ER to get his blood sugar checked and she got ready to wake Michael and get them dressed. I told her to stay home, don't wake Michael. I'll call if something is wrong. Hadn't quite shaken all of that denial off yet, really and there wasn't anything she could do there other than wait and worry. There would be plenty of time for that later.

We drove to my ER and checked his sugar. It was 469. DKA (Diabetic KetoAcidosis). My co worker whispered, “Shit. I'm so sorry” and I walked out front to check in to the ER.

I snuggled up against him on the bed while they started the IV and drew blood. I knew the script and let Max know what was coming. He was sick, but he understood. There wasn't much fight in him at the moment. They started the process for a transfer. The hospital where I work doesn't have pediatric services. Dr. Monick, the ER physician on duty that morning knew a pediatrician she recommended to us who just happened to be on call that morning.

I snuggled up in bed with Max trusting my co workers to do what I had seen them do so many times before. I let go of the burden on having to be on guard and just held Max. I started to grieve. I didn't know what was next, but I had a good idea. I have seen enough diabetic complications. I could see the bare outline of the struggle coming up and didn't want it. I grieved the loss of perfection in my little boy. I wanted so bad for all the best for him and now this. As a parent. I had an idealized version of my kids growing up. It never included diabetes.

Then I stopped, as much as I could anyway, because it wasn't about me. I wasn't the one who would deal with a lifetime of extra burden. This was about Max. And the best way for me to help him was to stop thinking about what was lost and start figuring out the best way to deal with the new reality that was in front of me.

I still had to call Sarah.

She sounded as confused as I was when I first realized what was happening. News of that magnitude takes a little while to process and she was coming in to all of this a little late. She made it to the hospital just in time to see us loaded up in an ambulance for the drive across town.

Next: Hospital stay.

Every once in a while

I don't talk much about work here.  Heck, I don't talk much about work anywhere but at work usually because people just don't understand.  There are things you see and do working in an emergency room that just don't translate well to 'normal' people.  Or, well... anyone else really.  Don't get me started.

I know this blog space is usually filled with long exposure pictures of waterfalls, kids, passing street signs and other things not appropriate for long exposure photography, but it is a blog about a travel nurse and family.  Every once in a while nursing will creep in.

We in the ER do some pretty heinous stuff on a regular basis.  I have scraped archeological  layers of feces of people that haven't unbuttoned their pants in a month. Think about that for a second.  I have been yelled at, spit on, cursed at (OK, that one can get amusing at times).  I have seen more blood, guts, death and sorrow than I care to recall to anyone who can't share the experience.  Honestly, most shifts I am happy if nobody died and I didn't get fired.  I don't always meet my goals. 

Every once in a while though, circumstances coalesce into an opportunity to personally help someone.  I help people all the time as part of a team.  I do my part and start IV's, assess and monitor patients, give medications and so on.  I help people often that way.  But to do so personally, that isn't so frequent. 

This time it happened.  It was a pretty routine situation.  The person, and their family who accompanies them, comes in and tells of a chronic problem that is worsening.  They have been dealing with it for a long time and no one has been able to explain to them why this thing is happening.  It is somewhat obvious to me what is likely going on, but some problems are sensitive.  Some problems carry with them a stigma and a judgement from the patient and the public that prevents you from just walking in and going, "Yeah, you probably have X, but it isn't an emergency." I could tell from the history and what they reported their doctor telling them that even the primary doctor was tiptoeing around the diagnosis. 

Normally I am so busy that all I can do is rush in, draw the blood, administer the medication and do my normal routine stuff and get out.  I would love to sit down and talk to you long enough to figure out how you communicate so I can try to figure out the best way to convince you of what you are dealing with and what you need to do, but that would take 30 minutes and I barely have 5 because I have three other patients, one kid who can't breathe, one who has a kidney stone and a 90 year old who has been throwing up all day and is losing their blood pressure. Normally.

This time it was slow.  I had some time.  Instead of sitting on my butt at the nursing station or getting a bite to eat or any of the other things I could have done, I decided to go into the room and talk.  It took a while, but I think I explained something important.  Something about how a small decision made in reaction to something that happened long ago can snowball into something later.  How even dysfunction can become normal when you do it long enough.  There is no judgement.  There is only a lack of understanding.  I feel, whether it is true or not I will never know, but I feel like I explained something to this patient and their family that will make a real positive difference in their lives. 

That feels good. 

I don't know if I would say it makes up for the crap, abuse and sadness that often accompanies this job, but it helps.