Archive for October, 2013

First sunrise

Thursday, October 24th, 2013

It was still dark, just barely, when the girls and I woke from an uncharacteristically uninterrupted long night’s sleep. Bill is in Atlanta this week for a professional pricing conference, and I’m grateful that last night went well.

Looking out the window, I noticed that the sky was shifting from dark to lighter blue, and asked if they would like to see the sun come up before breakfast. They exclaimed “si!” and raced off to collect shoes.

We donned fleece pants and jackets against the cool morning and walked to the end of our street, where we could see the eastern sky brightening from pink to orange. Then… POW! the first blinding rays of sun cleared distant treetops on the horizon to paint our faces golden and light our street.

On our way home, we greeted dogs, collected loose flowers, spotted the moon, watched birds and airplanes, hugged a pumpkin, and ran into one of my colleagues. We also saw a front loader, a dump truck, two school buses, and several Metro buses, too. Good and lovely morning!

Sights of summer: New brain buckets for girls!

Sunday, October 6th, 2013

When my colleague, Carol, unexpectedly gave us her bike trailer in late July, we were unprepared with helmets. I nearly ordered some cute ones to come quickly from Amazon, but then remembered that Consumer Reports rates that kind of essential safety gear.

Armed with comparative data, we elected to suck it up and order a pair of top-rated youth bike helmets from Bontrager. Unfortunately, they were both expensive ($45 ea) and back-ordered. But they finally arrived a few weeks later and both Cate and Sam are delighted to have their own helmets! (As always, click for larger.)


Newly helmeted trailer girls


Sam


Cate


Trailer girls


Cate exclaims


Sam in sunshine

*Astute readers will notice that neither of these helmets is sufficiently well-adjusted yet. We’re working on that, and in the meantime, they’ll fit right in around here!

Sights of summer: popsicles on the porch!

Sunday, October 6th, 2013

A “cold” front brought cool weather to Houston this morning, including temps in the 60s. Quick before we get to winter, here are some more photos from our summer.

We have an “ice tube” mold that I found at Ikea. During our last gut bug, it occurred to me to use it to make popsicles out of lime Gatorade. They don’t have any sticks/handles, but once I wrap the end with a bit of paper towel and secure it with a rubberband, they’re easy enough to hold on to. (As always, click for larger.)


Sam, Cate, and Nane


Sam


Cate

Adventias: Grateful for local family…

Saturday, October 5th, 2013

I don’t remember exactly, but I began accompanying Sarah to all routine physician visits sometime eight or nine years ago. At some point, I began taking notes on my laptop instead of on paper, and that Word doc goes back to July 2006.

Along the way, I shepherded Sarah through the emergency room on several occasions. While I am impressed by the breathtaking array of diagnostic tools and tests that modern medicine presents, I am more convinced than ever that no one should ever go to hospital alone.

Having someone to hold a patient’s hand and offer reassurance is nice. But having someone to pay attention, take notes, and make sure that the care received over time remains consistent and appropriate seems essential.

The 11 days I spent in hospital when our girls arrived did little to disabuse me of this view.

Physicians and nurses both vary by day and time. Continuity of care in a hospital setting relies on written notes in patient charts, and oral summaries passed along at each shift change. The longer one is in hospital, the more cursory the hand-offs seem to be. Many times, I have served as third party glue holding Sarah’s treatment on course.

With that in mind, I am immensely grateful to our family for being there for Sarah when I cannot. In particular, huge thanks to our cousin Sharon who, again, dropped everything to be the first family member on the scene when Sarah arrived at the Methodist ER. In addition, Sharon stopped by to check on Sarah and query her nurses every morning on her way into work, at a time when I had to be home tending to toddlers. Thank you, thank you, thank you!


Sharon

Thanks also to my Mom for covering Sarah two days so that I could go into Central Houston and concentrate on my shiny new job. I don’t have any photos of your visits, but I’m glad you were there. Finally, thanks to my brother, Chris, and his family for coming to visit Sarah, too.


Chris with Sierra


Shawnacy with Alles


Izzy with Alles


Chris and Bob

Adventias: Well, that was unexpected… part II

Saturday, October 5th, 2013

In June 2013, Sarah fell and hit her head. The ER attending physician wrote an order to transition to hospice care.

Sarah did not yet meet Medicare eligibility requirements for dementia, but qualified under “failure to thrive.” At just 85 pounds, Sarah had become a tiny slip of a thing.

The hospice physician recommended, and we agreed, to discontinuing all vitamins and mineral supplements. It made me sad to concede that long-term risk of malnutrition is no longer a meaningful concern for Gran’mom.

But then, a funny thing happened. When we stopped filling Sarah’s belly every morning with tiny rocks of calcium, vitamin C, and other supplements, her appetite increased. She ate more food, and she gained back a few pounds. Weight gain is not consistent with end-of-life behavior, and the hospice physician determined that, under Medicare’s rules, Sarah was no longer eligible for hospice care.

So at least temporarily, she “graduated” from hospice on Tuesday, Sept 24, 2013… the same morning that a Belmont nurse found Sarah on the floor by her bed with a fractured hip.

* * *
By all accounts, any hip fracture is a serious injury. Several months ago, our Gran’mere in Ohio fell and cracked her pubis. She was “lucky” to be able to begin PT immediately, without surgery.

In contrast, our Gran’mom has osteoporois. The Methodist Hospital ER physician said the x-ray revealed that when she fell, the neck of Sarah’s right femur was “crushed like a Coke can.” In a young, healthy individual — say, a cyclist or snowboarder — the probability of successfully repairing this injury surgically is around 30-50%, and the risks of complications are significant. In the elderly, treatment almost always requires surgical replacement, followed by months of physical therapy (PT).

However, the purpose of physical therapy is partly to strengthen and primarily to teach someone how to adapt to their new physical (dis)abilities. Because of her dementia, Sarah is not a good candidate for PT. She’s incredibly unlikely to learn how to move without causing herself tremendous pain. In fact, a week later, she is still surprised every time someone informs her that her hip is fractured, which is why she’s hurting.

* * *
After ruling out surgery, Sarah’s prognosis is grim. She will never walk again. Unable to sit up well, she requires someone to feed her and offer her water. Within days of becoming bedbound, her ancient and fragile skin is already breaking down, on its way toward developing painful sores and potentially, infection. The fracture will never heal, so she will endure chronic pain, and require opiates for pain relief. As her body acclimates to the opiates, she will require larger doses for less benefit. The morphine will suppress her appetite and her respiration.

Dr. L, the wonderful internal medicine doctor who has supervised Sarah’s care at Methodist Hospital, says that he is unsure how quickly Sarah will decline, but he does not expect her to “bounce back” or even plateau. He’s clear on the direction of her trajectory, if not the slope.

After spending six nights at Methodist Hospital, Sarah was transferred to nearby Houston Hospice. There is a small potential that Sarah will stabilize, continue to eat, and require transfer to a long-term skilled nursing facility. But our current expectation is for Sarah’s care to focus on attempting to keep her comfortable while she winds down to a gentle end.


Dr. L listening to Sarah’s erratic heart rhythm


Sarah gazing up at her niece, Sharon

Well, that was unexpected… part I

Tuesday, October 1st, 2013

In December 2010, I helped organize and execute one of CTC’s educational freight rail tours for members of Central Houston Inc., a nonprofit that advocates for sustainable redevelopment of Downtown Houston and the central city. A month later, they called me to announce that they were creating a new part-time Director of Transportation Planning position, and ask if I would be interested in the job.

At the time, I had already started the fertility treatment cycle that led to the arrival of Sam and Cate. With much optimism, I cheerfully told them that I was honored to be asked, but not in a position to start a new job.

When they asked if I could recommend someone else for the role, I told them that I knew exactly who they should go after, and pointed them to my colleague Emily (our future Auntie Em). As an experienced director and trained urban planner, Em was perfect for the job, and Central Houston hired her a week or two later.

* * *
In early August 2013, I read an article from the New York Times Magazine about women who opted out of professional work in the late 1990s in order to be full-time mothers, and subsequently wanted back in: “The Opt-Out Generation Wants Back In”.

As a professional-turned-full-time-parent, I was curious. At some point in the not-too-distant future, it behooves me to find a job and contribute income to our household. I figured that about the time we finish building our new house — in mid-2014 — it would be time to get the girls into preschool and get me a good job.

But I had no specific plans. Heck, I last revised my résumé in 2004 (114 kb pdf), *nine* years ago.

* * *
Also in August 2013, Auntie Em married her once-and-future sweetheart, Royce Henderson. He and Em are both from Linden, in far northeast Texas (near Texarkana), and Em’s mom and stepdad are there, too.

Then, on August 27th, Emily texted me with news of another big change: her consulting employer invited Emily to go run their Tyler office. Tyler, Texas, is just 75 miles from Linden, Royce, and Em’s aging parents. Em, understandably, jumped at the opportunity. She plans to move before the end of the year.

Then a moment later, a text inquiry, “Could you think about 1 or 2 half days a week starting the 2nd or 3rd week in October?????”

My reply: “Ummm…. Probably yes?”

* * *
Emily strategically invited me to participate on the technical review committee for Central Houston’s 2013 Downtown Commute Survey. The three-hour meeting was just the opportunity I needed to dust off my transportation skills and convey my availability.

During the meeting introductions, when Emily announced her upcoming departure, one of the researcher participants (Carol Lewis) asked unbidden whether I was available to fill in. Afterward, Bob Eury, Central Houston’s president, took me aside and asked if I would like to come work for them. I agreed.

While Bob offered me a permanent part-time staff position, I elected to start as a contractor. I may miss out on a benefit or two, but for now, I like the simplicity of getting paid when I work and not when I don’t, with the understanding that there may be times when I am unavailable to work.

The Times Magazine piece goes on:

“The 22 women I interviewed, for the most part, told me that the perils of leaving the work force were counterbalanced by the pleasures of being able to experience motherhood on their own terms. A certain number of these women — the superelite, you might say, the most well-off, with the highest-value name-brand educational credentials and powerful and well-connected social networks — found jobs easily after extended periods at home.

Pamela Stone, a professor of sociology at Hunter College and the author of the 2007 book “Opting Out? Why Women Really Quit Careers and Head Home,” heard many similarly glowing stories. In the early 2000s, she spent considerable time interviewing 54 well-off married mothers drawn primarily from the alumnae networks of several highly selective colleges and universities “who had navigated elite environments with competitive entry requirements,” as she described them in her book. Now she’s updating her research and has reached about 60 percent of her interviewees, two-thirds of whom have returned to work — their decisions sometimes prompted by their husbands’ somewhat reduced earnings, post-recession. “What I heard repeatedly was ‘The job found me’ or ‘The job fell into my lap,’ ” she told me.

Well, yes. That.

I have mixed feelings about being away from Sam and Cate. But my departure nearly always coincides with naptime, and they seem to have accepted that, “Mama go work.” and “Mama come home!” Our wonderful nanny, Claudia, has been exactly the anchor and source of daytime continuity that the girls and I need to sort out our new schedule.

That being said, I am LOVING getting back into transportation work. And I can scarcely imagine a professional job that more perfectly plays to my strengths and lifestyle aspirations. I look forward to work before I get there and I enjoy thinking about it on the way home. I am thrilled to be working with these people.

So if I haven’t said it lately: thanks, Em.