Monday, April 30, 2018

Books read in April 2018

New:

1. Rogues edited by George R. R. Martin and Gardner Dozois
2. An Honest Woman by Jónína Kirton 
3. From a Certain Point of View (Star Wars anthology)
4. The Water Walker by Joanne Robertson

Reread:

1. Celebrity in Death
2. Delusion in Death

Monday, April 23, 2018

"What if I never get better?" is a valid question

Frustrated with the persistence of some of my post head-injury symptoms, I googled what if I never get better.

The first page of results was all pages about depression, reassuring depression patients that it will get better at some point and that if life feels hopeless, that's just the depression talking.


If the first page of Google results represents the zeitgeist, this is a problem.

The full scope of human experience includes situations where you never get better. Sometimes you might spend years or even decades not getting better.  It's not necessarily depression talking, sometimes not getting better is simply an objective reality, and people need to figure out how to live with that, not to be patted on the head and told they're depressed.

This would also make me reluctant to mention to a medical professional when I'm afraid I'll never get better. I'd be concerned they'd get distracted from the thing that's causing me despair and instead start treating me for depression - confusing things by introducing new medications and such, when what I actually need is a timeline and a flowchart and a series of possible outcomes and perhaps to be informed of the existence of assistive devices or palliative options.

***

This is all the more important because, since I started writing this post, I've seen an optometrist (given that my remaining symptoms are visual) and it looks like there's a decent possibility that my problems can be solved with different glasses, and/or vision therapy (which I didn't even know was a thing, but is kind-of-but-not-entirely like physiotherapy for the eyes).

I don't want to fall into the trap of getting overoptimistic, but this is the first time since I hit my head that there seems to be even a remote possibility of just maybe being happy or comfortable at some point in the nonspecific future!  I'm still waiting for the glasses to be made, so keep your fingers crossed!

And this is all significant because it comes from treating me like I'm never going to get better.

I didn't approach the optometrist with "what if I never get better?" - I approached him from the point of view of "this is what I'm experiencing, can we diagnose and/or rule stuff out?" But a productive "what if I never get better?" conversation would have had the same outcome:

Me: "What if I never get better? What if focusing on the computer screen is hard work every single moment of every single day for the rest of my life?"
Doctor: "We'll see exactly what your eyes are doing, and then look into making you glasses to adjust. If you never get better, you'll wear different glasses that do some of the work for you. In parallel, we can also give you some exercises for your eyes, so you can work proactively on making this specific symptom better."
Isn't that a better outcome?  And more hopeful than platitudes and/or psychological treatment that don't address the underlying issue?

Monday, April 16, 2018

Disappointed with Fresh's latest menu update

I've finally had a chance to try every new item on Fresh's menu, and I'm not impressed. All of the new items are less yummy than the items they removed. The only new item that makes me go "Yay!" is the essential greens, but that's an appetizer-sized dish at an entree-sized price. Meanwhile, several of my favourites are gone. (holiday wrap! mega life salad! jerusalem bowl!)

Also, there are now fewer wellness choices on Ritual (which is significant because that's the only nutritional indicators we have), and the only new item that's a wellness choice is the dragon broccoli, which is too spicy for my refluxy self.

Fresh has been a favourite since they moved to my neighbourhood, so it's disappointing that this latest update made it meet my needs less well than before.

Friday, April 13, 2018

Things They DID Invent: shut up and pregnancy test

Something I'm sure I've blogged about before but can't find the post: when I was younger, many of my peers and I had the experience of medical professionals interrogating us about whether we were pregnant.  They'd start with "Is there any possibility that you're pregnant?" and then, when you said no, they'd say "How do you know?" They'd ask about the details of your menstruation and the choreography of you personal life and basically it was a whole gauntlet - which is particularly upsetting when you're a teenager (especially a teenager who feels too young to have sex), if your parents are present, etc.

Because of this, I've long advocated for simply doing a blood or urine test for pregnancy without belabouring the point, rather than interrogating the patient at length if you aren't going to take her word for not being pregnant.

I'm pleased to announce that when I was in the hospital with my head injury, they did just that. They did a number of blood tests to rule out heart attack, do a blood count, test for nutritional deficiencies, etc., and one of the tests they did was a pregnancy test.  They didn't even mention this to me - I didn't even see it until I was handed my printed-out blood work results.

Obviously pregnancy needs to be ruled out when a female patient of child-bearing age faints, probably on a more solid basis than recent menstruation or lack of reported recent exposure to sperm. So instead of interrogating me, they simply did the test that they would have had to do anyway.

I'm very glad they did it this way, and I hope they do the same on minors and other more vulnerable patients.

Thursday, April 12, 2018

Things They Should Invent: use fruitless library catalogue searches to feed the library's acquisitions list

I heard about an upcoming book that sounds interesting, so I searched for it in the library catalogue. Unfortunately, it wasn't there yet.  But, instead of going to the trouble of putting in a request for them to acquire the book, I just figured I'd search again closer to the publication date, then wandered off to do something else.

I'm sure I'm not the only one who does this. Asking the library to acquire a specific book is A Whole Big Thing, and it may well already be ordered but not in the catalogue, or get ordered through whatever their normal channels are by the time the release date arrives.

But what if simply searching for a book and finding it isn't present in the catalogue could automatically inform the library that someone wants the book?

The library already knows what people are searching for.

The technology already exists to determine when a user arrives at a webpage and doesn't click on any of the outlinks (which, in this case, would be the books listed in the search results) and to generate a list of pages where this occurs - the free stat counter I use on my blog even has this functionality! This list could then be sorted in by frequency, to identify what multiple people are searching for but not finding.

Then the frequently-fruitless search terms would need to be compared with a list of current and forthcoming books. Does such a thing exist? I know Books In Print is a thing, I don't know if there's also a "Books Soon To Be In Print".  (Although even if there isn't, comparing frequently-fruitless searches with Books In Print could be useful in and of itself.)  I also don't know if it has some method to allow you to write your own program to search its database.  Google Books has an API, which might be a starting point (although I certainly can't rule out the possibility of there being better starting points that I haven't thought of.)

But comparing terms on List A with terms on List B is totally something a computer can do.  And once it's done, you've got a list of frequent fruitless searches that are also titles of books.  Which is most likely a list of book titles that people are searching the catalogue for but not finding.

Which seems like useful information to have when deciding which books to buy.

Saturday, April 07, 2018

How to treat your adult child like an adult

Imagine you wanted to prove that you are an excellent parent.  Think about all your child's characteristics or accomplishments that you'd cite as supporting evidence.

Assemble all these characteristics and accomplishments into a mental file, and whenever you talk to or behave in a way that affects your adult child, make sure your words and actions are fully informed by everything in that mental file.

For example, suppose you feel like a good parent because your child successfully launched and has a lucrative career that makes them happy.  Make sure that in your every dealing with your child, you treat them like someone who successfully launched and has a lucrative career that makes them happy.

Or suppose you feel like a good parent because you child is kind and caring.  Make sure that in every dealing with your child, you treat them like someone who is kind and caring.

This strategy can also be used on children who are not yet adults, to treat them with the amount of respect and consideration they deserve.

Wednesday, April 04, 2018

Half-formed idea for how to warn prospective tenants of bad neighbours

From The Ethicist:

I have a rental property, and the neighbors next door are extremely racist. We didn’t know this when we bought the house. We have had both white and Hispanic people as renters. The next-door neighbors harassed the Hispanics until they left. The white family had no issues getting along but did hear their racist rants. I cannot legally do anything about this behavior. Am I obligated to tell any prospective renters about this problem? I don’t want people to move in without knowing of it. If I do tell them, how do I phrase it so that I’m not perceived as discriminatory?

I know what to do to solve this problem, but I don't know how to get it done.

What you need is online reviews that turn up on the first page of Google results for the address, accurately describing the quality of the property and of your services as landlord, and accurately describing the neighbours' behaviour.  Then anyone who's interested can be warned about the neighbours and make decisions accordingly, but it won't come across as the landlord trying to dissuade tenants of certain ethnicities.

The problem, of course, is making online reviews happen. Working hard to convince former tenants to leave online reviews is bad form, and leaving them yourself as a landlord is outright inethical.

Nevertheless, the best medium for communicating this message is the voice of former tenants.

Monday, April 02, 2018

My emergency room experience

When I fainted and hit my head, I went to the emergency room at Sunnybrook.

Upon arriving at the emergency room, you swipe your health card in an automated kiosk, select a category into which your complaint falls, and describe it in a few words. The kiosk then issues you a number.

You sit down in the waiting room chairs, and the numbers come up on these big screens above small glassed-off offices. When your number comes up, you go talk to a triage nurse. It took less than 10 minutes (and perhaps even less than 5) for my number to come up.

The triage nurse listens to your problem, asks questions, takes your vitals, takes down all the information, takes your vital signs, and enters everything into the computer so you can be appropriately triaged.  Then I was sent back to the waiting room. Some other patients were sent into the other "zones", which have different waiting rooms, and I don't know what happens to them after that. (You can google Sunnybrook emergency room zones for more information - no point in me trying to explain it here when I don't have any information that hasn't already been put on the internet from more reliable sources.)

Soon after speaking to the triage nurse (maybe 5-10 minutes, definitely under half an hour), the receptionist calls your name, and you check in. They scan your health card, take your information, emergency contact, name of primary care physician, and issue you a wristband.  Then it's back to the waiting room.

What happens next depends on the particulars of the patient's condition. For me, another nurse called my name, and took me into a room (two examining tables/beds divided by a curtain) where he took my blood and took an EKG. This was about an hour after I arrived.  Then I was sent back to the waiting room for the longest wait of the day.  I later learned that this blood work was the primary diagnostic tool in my case, so even though I was sitting around for four hours, my blood work was at the lab.

After four more hours of waiting, they finally called my name and brought me into the "orange zone", where I was seated in another small waiting area. This made me nervous, because a lot of the patients in this area were in beds with machines and/or IVs hooked up to them. I could overhear that one patient had had a stroke, and another patient's family members were crying. It turned out this was a kind of mixed-use area - the people in beds were ER patients who were going to be staying in the hospital overnight, waiting for a bed to open up in the appropriate ward. They were also using this zone for patients who didn't need actual treatment, which is why I was there.

After sitting around in the orange zone waiting area for a bit, a nurse talked to me, asked me to tell my story again, re-took my vitals, and told me that my tests had come back normal so I just had to talk to the doctor and then I'd be discharged.  Then he sent me back to the orange zone waiting area.

After some more time waiting, the doctor called me and took me to a stretcher in the hallway that could be curtained off.  He asked for my story again, asked me questions, talked to me about my test results, did some non-invasive clothed physical exams (including stroke screening and palpating my abdomen). Then he gave me discharge instructions about how to take care of the bump on my head and what signs to seek further medical attention for, answered my questions, and sent me home.

My total time in the orange zone was 1-2 hours, my total time in the ER was about 6 hours. This was on the Saturday afternoon of a long weekend.

***

A bit about the physical environment:

The Sunnybrook ER is on the ground floor. The main entrance is on the first floor (which is one storey higher than the ground floor), so you have to go down a storey if you come in the main entrance. I don't know whether there was another easier way to access the ER.

The waiting room chairs are padded (with a vinyl-like upholstery that appears to be easy to clean) and have high backs. I can't tell you if they're comfortable to lean back on because I had an enormous bump on the back of my head. They were more comfortable than classroom chairs, church pews, or the chairs in my doctor's waiting room. I've previously blogged that ER waiting rooms should be sleepable, so I was surprised to notice that there was one (but only one) recliner-style chair that appeared to be sleepable. I'm not sure if it was there intentionally for sleepability or it was just an extra chair that they put there for more seating. In any case, I didn't try it out since other patients needed it more than me, and I couldn't lean my head back anyway.

The waiting room was very crowded (on the Saturday afternoon of a long weekend), and some patients' family members were sitting on the floor, or standing. I suspect some patients took those wheelchairs by the entrance so they'd have somewhere to sit, and after a while uncomfortable-looking folding chairs started materializing from somewhere.

There are washrooms right in the ER waiting room - two accessible family-style washrooms (i.e. with the toilet and sink behind the same door). They weren't always perfectly clean - sometimes there were puddles of water or bits of paper towel on the floor - but they were always well-stocked with toilet paper, soap, paper towels, sanitizer, etc. so our washroom experience could be as hygienic as possible. Despite the crowded waiting room, I never noticed a line for the washrooms. There is also sanitizer available in the waiting area.

There are vending machines selling water, juice and pop (just inside the doors of the ambulance entrance, by the security booth). I didn't notice anywhere where you could get food within the immediate vicinity of the ER waiting room, but I didn't ask either. There is a food court on the main floor between the main entrance and the elevators, and Google suggests that there are other sources of food elsewhere in the hospital, although I didn't investigate. Some patients' family members went and fetched food from the food court, and I suspect one person somehow had food delivered.

There are multiple password-protected wifi networks with "Sunnybrook" in the name, and no open networks. I didn't inquire about whether we were allowed to use any of them, or try to guess any of the passwords. I googled around the idea after the fact and the internet suggests that one is intended for patients and visitors, but I have no firsthand information.

There are a few wall outlets in the waiting room, but the waiting room was not designed with the assumption that everyone will have a device to charge.

I saw the triage nurses give a basin-like thing to one patient who thought he might vomit, and a blanket to another patient who was shivering, so it's possible other items for the patient's comfort might be available upon request.  No one gave me ice for my head bump, but I didn't ask either.

***

The best thing about this ER visit is that every single person I dealt with had outstanding bedside manner.

The triage nurse, young enough to see me as non-young, who squeezed my hand reassuringly when I confided that I had never been in a hospital before and was frightened, even though she's in a hospital every day and, I'm sure, sees hundreds of people with more cause to be frightened than I have.

The nurse who did my blood work and EKG, diligently requiring me to remove only the minimum clothing necessary and exposing only the minimum skin necessary (and covering exposed skin up as soon as the procedure permitted, even when the body part in question was just my calf), despite the fact that we were behind a curtain and my style of dress makes it apparent that I don't come from a more-modest-than-average cultural tradition.

The orange zone nurse, who patiently answered all my questions about what test result numbers mean even though they were normal and I didn't have to worry about them, and took the time to explain to me why I was in this section with stroke patients and people on tubes and machines.

The doctor, who sat down with me, looked me in the eye as though I had his full attention, and patiently answered every single question about what might have happened and what do I do next and how fainting works and how head lumps work and what they tested for and how they ruled out certain things, even though he was also in charge of all the stroke patients and people on tubes and machines - and even took the time to reassure me that I had done the right thing by coming to the hospital and when I should go to the hospital under similar circumstances, even though we could both see that I was the least important patient he was treating that day.

Even the security guards, who were kindly and patiently giving people directions and answering questions about where you can get food and drink and bathrooms and how the sign-in kiosks work, in between actual security guard emergencies.

Several years ago, I fell down an internet rabbit hole of reading ER nurse blogs, and I found that some of them were kind of . . . contemptuous, I suppose, of their patients. On their blogs, they dissed patients for being frightened when their condition wasn't serious, or for coming to the ER for something that isn't an emergency, or for bringing their mother even though they're a grown-ass adult. As someone who met these criteria (I didn't bring my mother, but I was considering calling her because sometimes I want my mommy when things are scary), I was kind of worried about how I might be treated in the ER. So I am quite pleased that every single person I dealt with at Sunnybrook was outstandingly kind and caring. This makes me feel far safer and more confident for next time I need hospital care.

And I sincerely hope there isn't ever a next time.