North to Alaska

I had multiple people ask me for detailed information on our Alaskan cruise, so I decided to take notes and turn it into a blog post. 

We cruised out of Seattle and stayed the night prior in downtown Seattle near the space needle. With several hours to explore before boarding, we walked around downtown, explored the area outside of the Museum of Pop Culture. Fun fact: their 5 year run of a Pearl Jam exhibit ended exactly one month before we arrived.

Now, on to the cruise details. We sailed on the Carnival Luminosa. Boarding in Seattle was the easiest boarding ever. We were on board within 10 minutes of getting dropped off by the shuttle bus. Once on board, we had several hours to wait around before we could go to our room so we toured the ship. It's a typical Carnival cruise ship with some slight variations. The buffet areas are spread out more and staff serve you at each buffet station. Throughout the week, we noted delayed and inconsistent meal times in the dining room, which I theorized was a systems issue with Carnival not accounting for the increased staff required for these buffet areas taking staff away from the dining rooms. 

Day two was a sailing day. This day felt disconnected from the rest of the trip, either due to Carnival treating it like the rest of its cruises or due to the expectation of being in Alaska sooner. I will say, the tropical themed approach to Alaska doesn't fit. Tiki bars and sunbathing doesn't exactly scream Alaska. There was a naturalist on board, but her role seemed very minimal.

 

Juneau, day three. Our shore excursion of hiking near Mendenhall glacier got canceled last minute. We were notified by a note slipped under our door approximately two hours before we were supposed to get off the ship. Not only did this mess up our plans, it made alternative planning very difficult. I rushed down to the line to get a debarking ticket for each of us. These were required this stop due to having to use the ships life boats as shuttles to the dock. When they started calling numbers and we realized we were going to be one of the last ones off the ship, I made a quick stop by the customer service desk. The representative was very understanding and got us moved to the front of the line for debarking. This day was the first of many rainy days for us, which we had anticipated and planned for. We considered it an authentic Alaskan experience. With our excursion canceled, we shifted gears, took a bus to Mendenhall glacier for $45 a person, hiked to Nugget falls and had a great experience. 

Once done with the hike and a quick stop at the visitors center, we rode back to the downtown area to experience Juneau. We snacked at a food truck court- rockfish taco for me and Nutella crepe for Andrea. We did some window shopping and some actual shopping there as well. We finished out our time there with crab legs at Tracy's Crab Shack. Despite the difficult start to the day, we had an amazing time and I'd highly recommend doing it yourself like we did in Juneau over spending the money on an excursion.

Skagway, day four. We had an early boarding time for the white Pass & Yukon Route railway. The railway is a must do at this stop. The railway provided amazing views from the comfort of your railcar. You could also walk out onto a small viewing deck, which I did more than most. It was cold on the deck, but well worth it. The pictures from this ride tell the story much better than I can. The train ride was interpretive, so a guide gave cues to all passengers along the way. 

After the railway, we had a good lunch at Skagway Fish Company followed by a second excursion of the day:Triple adventure-biking, hiking, and rafting. I categorized this excursion as a good experience with more exposure to wider range of the area. It was good to get some physical activity in for the day and our guides were all very helpful, but this experience was one I could take or leave. Carnivals instructions for this day missed the mark once again. We were discouraged from purchasing the second excursion due to potentially not making it back from the first excursion, despite a clear hour plus break between the two. Also, a letter was delivered the night before encouraging us to use the shuttle 50 minutes prior to our excursion due to anticipated crowds. We left an hour early and were at the end of the pier in 5 minutes, leaving us with almost an hour to wait and nothing to do but stand in the rain.

Tracy Arm Fjord, day five. We booked the early glacier explorer excursion, which may have been the highlight of the trip. Our small vessel captain navigated us to within 1/4 mile of Sawyer glacier. We had breathtaking views of the glacier. We saw more harbor seals than one could count. We were back on board the cruise ship by 10 am with nothing else on the itinerary for the day. Later in the day, while exiting the fjord, the onboard naturalist announced humpback whales had been spotted on the port side of the ship, which just so happened to be our side. We struggled to locate signs of whales for a few minutes, then decided to head to a more populated area to seek assistance. After talking to a few people, a gentleman announced "spouts" and pointed in a general direction. We quickly located the spouts and, after retracing our steps to share information with other travelers, made our way back to our balcony to watch for the whales from there. All in all a wonderful experience!

Ketchikan, day six. I think Ketchikan is Inuit for "a whole lotta rain". With no excursion booked and only five hours in port, we walked to Creek Street and checked out some totem poles in town. With some shopping completed and another Nutella crepe from Alaska crepe Co in Andrea's belly, we headed back to the ship. Knowing we'd be back on board early this day, we had a reservation at the on board steak house this night. While seated at our window table on the starboard side of the 10th deck, we noticed an oddly placed buoy approximately half a mile out. As we stared at the buoy, a whale jumped, full breach, right between the buoy and us! The meal was excellent, but the whale spotting was the highlight of the day!

Victoria, day seven. This day was essentially another sailing day with a late, short stop. After breakfast and some small talk with others seated nearby, we realized there was a lot of whale activity. We went back to our room and spent a couple of hours whale watching from our balcony. Our balcony neighbors had a long lens camera and were attempting to catch some shots of whales out of water. We quickly started working together, calling out sightings to each other to share the experience. During this time, we saw another full breach from a humpback whale, countless whale 'spouts', a pod of orcas, and several groups of dolphins swimming near the ship. 

As for the Victoria off-boat experience, that can be described in one word: rushed. We were scheduled to be off the boat at 8:00 pm and back on board at 11:30 pm. We didn't get the 'all clear' to get off the ship until 8:30. Accounting for lines and walk time to downtown, that gave us little time to do anything and made for a stressful evening.

Debarkment day: we changed flights earlier in the week due to a letter we received letting us know that we would be one of the last groups off the ship due to us carrying off our luggage. When we docked and the announcements were made, we were actually the very first group called to exit the ship. Once off the ship, the process was very quick. A glance at our passports and into a cab headed for the airport.

In summary: I highly recommend this experience, just not with Carnival. You might have already noticed, but there were multiple issues the throughout the trip that could have put a damper on our experience. We made the best of the trip and had an unforgettable experience, despite Carnival attempting to derail us multiple times. In fact, I'm finishing up this post as we wait on a delayed flight. A flight that we wouldn't even be on if carnival had given us correct information during the cruise. 

One last personal nitpick on Carnival: you cruise out of Seattle, you've got to at least include a nod to the area being the birthplace of grunge! All of the musical opportunities during a cruise and not a single song with Seattle roots! Monday was even memorial day. Rooster was right there, sitting on a tee for you!! 

These Are But Dreams

Mark Anthony Duncan died by suicide June 19th, 2021. I have no idea what kind of man he was. In fact, my last conversation with him was almost 20 years ago. I ran into him in a checkout lane at Walmart. Apparently he was working a local concert event called "Bonestock". He invited me out and I politely declined.

You see, Mark and I were very close friends in elementary school. We were always playing basketball or kickball or whatever game was popular at recess together. Then, somewhere around middle school things started to become complicated between us. 

Without going into too much detail, basically some of the more 'popular' kids began to manipulate our relationship. Instead of playing together, we found ourselves always pitted against each other. We had several small fights/skirmishes, with a memorable one coming in 8th grade when we were playing kickball at recess. Just as recess was ending, I hit Mark with the ball to get him out sliding into 2nd base. If memory serves correctly, I believe the ball may have hit him in the groin and he took that as intentional. He was ready to to fight, but I wanted nothing of it. 

Coach Adams was tasked with punishing us in PE right after recess. He did so by making us run laps around the baseball field. Interestingly enough, later that year Coach Adams would award us both with the PE award for the year based on us always pestering him and pulling shenanigans on him during class. You see, in the presence of attentive adults, the manipulation was much less possible. 

On January 15th of this year, Eddie Vedder released "Brother The Cloud" the, in my mind at least, long anticipated tribute to his friend Chris Cornell, who was lost to suicide in 2017. I made it about 10 seconds into the song and began to weep. "I had a brother, but now my brother is gone."

I attended Mark's memorial service at a park in Dexter. I still have his memorial card, which I use as a bookmark. I pull it out and quickly study the adult that used to be my close friend. "I search the sky for a glimpse of his blue eyes and there I find his image in the clouds." 

There were maybe half a dozen people that I knew at the memorial, including his widow and my former classmate Krystal. I remember bits and pieces of their budding romance from high school, but no real specific details, for you see, "rising rivers in the dark erodes the shores til our shores were far apart."

During the memorial service, Krystal brought one of their daughters over to the group of people I was mingling with in hopes that some of us could share stories of her father's childhood. I was the one most equipped to provide these, and I think I shared a story from high school when my truck broke down near Mark's house causing me and the two guys that I had with me to seek refuge at his house, but his mom wouldn't let us come in.

I've spent a lot of time thinking of my long lost friend and what might have been had our shores not eroded so far apart. The suicide prevention coordinator at work tells me that the average suicide directly impacts up to 135 people. That number is likely low. I hadn't spoken to this man in almost 20 years and can barely make it through one of my now favorite songs without welling up with tears.

If you are having suicidal thoughts, please contact national suicide prevention at (800) 273-8255. If you are worried that you may have suicidal thoughts, please program this number in your phone. Or reach out to me. I'll gladly listen and support you.

"Should you ever leave this earth before me, I doubt this highly, do for me what I'd do for you. Put your arms around my friend and say for me: fuck you." 

Ten Years of Memories

In June Andrea and I celebrated our tenth wedding anniversary.  We celebrated by taking a trip to Aruba for a week. We had a blast creating memories. We met other couples from Los Angeles and Chicago while we were there and just generally had a good time.  We took a four wheeling adventure with a crazy tour guide named Ralph through the undeveloped northern coast of Aruba.  Doing 60 KM an hour on some of the sorriest excuses of roads you've ever seen.  Bouncing and laughing the whole way. We drank a coconut milk based drink that was mixed for us by a local affectionately known as 'Doctor Coco'. We snorkeled in the open ocean over a wrecked ship. We dined at the finest dining places imaginable in an island setting. Fresh seafood and steak. We generally had a blast.






Rewind a few years. November 11, 2011. It was set to be the happiest day of our lives. We went in to start the process of having our daughter on November 10. If we'd known then what we know now, we would have understood why she ended up waiting until 1:41 in the morning on November 12th. Our daughter wanted to come out facing this world head on. Anyone that knows her can understand why. But, because of her stubbornness, a C-section was required. The anesthesiologist had difficulty getting Andrea completely numb, so she made the choice to be put under. Since Andrea had to go under, I wasn't allowed to be in the operating room. As soon as Madelyn was in the recovery room, I was brought in. Big, beautiful brown eyes and bottom lip poked out. I was ecstatic. I was terrified. I could see Andrea through the window as they were closing her up. The lasting image I have from that moment was my wife laying there with tape holding her eyes shut. I was terrified because Andrea is the planner. She had the plan laid out for how everything would happen once Maddie was here and in that moment I realized that Andrea wasn't there. I would be responsible for taking care of this tiny baby by myself until my wife made it through recovery. Which, of course she did, and quickly too. We were allowed to take Maddie into the recovery room to meet Andrea. It was a joyous moment. One that I'll never forget.


Exactly two years later, along comes little brother. Gabriel was a scheduled C-Section, so there were no surprises with him. Well, other than him being a him. Andrea had chosen not to have the sex of our second child revealed. She wanted that surprise. She's like that. Impulsive. Fun loving. Anyway, back to Gabe. Our big man came into the world without a name.  We had a couple of names that we had picked out, but were still not sure what we wanted to name him. After we got back to our room and were able to have visitors, we brought Maddie back first to be the first to meet her little brother. She was smitten. Soon, we brought back our parents and other visitors. We still hadn't chosen a name. We presented the options to Madelyn and she chose Gabriel. So, that's what we went with and I couldn't be happier.


Somewhere during all that, we had trips to the smoky mountains a few times, our second trip to the Bahamas, Destin, and to see our friends in South Carolina. We had innumerable fun times, including our first encounter with a bear on an auto trail in Gatlinburg and Andrea yelling at me 'DON'T GET OUT OF THE TRUCK!' because I slammed on the brakes to stop when I saw the tiny 20 pound cub right beside the road.   We thoroughly enjoyed Cades Cove and all the wildlife we spotted during our trips there. As with all of our trips, we also enjoyed some of the best food imaginable.


Destin was a different trip. It was our kids' first time seeing the ocean. We also brought along Montanna Ford to help wrangle them. Once again, we made life long memories playing on the beach, digging in the sand, and running in the gulf.


The scariest moment of my life happened on December 11, 2012.  I've previously written about that day. I wrote about it from the waiting area as we waited to hear how my wife would pull through invasive brain surgery. She pulled through just fine. She is a warrior.


We had a wonderful split level home outside of Advance that we realized wasn't meeting our needs, so we sold it and moved to a beautiful piece of property with a single wide trailer on it. Not the best living conditions, but definitely not the worst. The end goal there was to build a home with more practical space on that property.  That home will be complete in two weeks. We hand picked every detail about that home. Part of hand picking those details meant many trips to Menards, Lowes, Home Depot, and trips to St. Louis to shop at Cabinets To Go and Lumber Liquidators.  During one of those trips, which we were fortunate enough to get some alone time on, we made a stop in Clayton at Pastaria. Highly recommended. We sat on the sidewalk, eating and talking and watching some construction workers use a crane to position a large beam. Then we watched some oblivious teenagers walk right through the middle of the construction.  You should have seen the looks they got from the workers. Not that they noticed. They were too busy looking at their phones.


One of my favorite memories of our new house will be this: during the Perseid meteor shower this summer, our basement had just been poured. Madelyn had never seen a shooting star. So, we took her up, laid on blankets and watched shooting stars from our basement floor. A memory etched forever into our minds.


I say all of that to say this: My wife is very important to me. She completes me. I've taken advantage of her being our planner, our organizer, our engine and not taken the time to publicly or privately acknowledge her for what she does for our little family. I've not taken time out of routine to plan things for her, to show her how much she means to me and how much I need her. For that, I'm sorry.

Family First

I typically avoid talking about my professional life online, simply because I'm not that interested in talking about work when I'm already putting 50+ hours a week into it.  But a recent comment to a colleague and friend on twitter (twitfriend?) sparked an, IMO, unhealthy discussion where I felt like I was chided for not devoting my personal time to evidence based practice.  So, I'm going to share my professional responsibilities and time requirements with you.  Since 140 characters on Twitter wasn't enough space, here we go!

First, I'd like to tell you a little about my professional life.  I work for a VA Medical Center as the only full time physical therapist.  We have another part time therapist that works three days a week and we've been in the process of hiring another full time PT for about a year now. I took the position of the only full time therapist on staff almost four years ago.  At the time, they had a contract PT and a tech.  The PT came in and did about 12 evals a day, two days a week and the tech 'treated' somewhere north of 40 patients every day.  I straightened that out in the first week. I put together an equipment list and had all of our outdated or nonexistant equipment replaced with things you would typically see in an outpatient setting. 

Now we roll 15 patients per day, 30 minute time slots, with 3 new patients every day, along with working in any 'priority' patients. We also cover inpatient evaluations and short term rehab evaluations, as well as issuing canes, walkers, TENS units, etc. I'm also the chair of an amputation prevention committee and host a tele-clinic to decrease driving strain on our amputees.

We serve an area basically the size of South Carolina, roughly 10,000 square miles if I measured correctly on the map.  Just the two of us. Time management is crucial in the office, as I alluded to in the twitter discussion with Jerry. Simply put, we do not have time in the clinic to devote to evidence.  As I suggested, someone/something that provided a synopsis of good evidence would be of great benefit to us, as well as many other rural PTs. 

I work 40 hours a week, plus 30 minutes for lunch and an hour drive each way.  So my work day is about 10.5 hours and busy with something to be done at all times.  I like it that way.  Sitting around makes for a long day. As you can see, I do not have large openings in my schedule to devote to literature.

All of the above information is why I suggested that access to evidence needs to be simpler and more readily available.   One person apparently took offense to my suggestion, telling me that such an idea would cut down my critical thinking skills and make me a lazy thinker.  I don't expect that I will agree with that person much.  Apparently we are from very different generations and different backgrounds.  I can break down and apply information quickly and easily, if I have the information.  Apparently, from her opinion, it takes her longer; that's okay, we're all different.  Just don't hold me to her standard as it may hold me back.

Now, dear person I do not know,  you know who you are judging when you start to have your little twitter chat with me as the central focus. As one of your responders said, I work to live, not the other way around. My career is not my life.  My life is my life and I wouldn't have it any other way.  You frequently stated, both on Saturday and in your discussion that I had identified family as a hindrance to EBP.  That is incorrect; you assumed that I felt they were a hindrance.  They are a priority. I'd hope that your family would be the same to you.  And while I'm addressing your asinine claims, I have no sense of guilt about time spent with family.  I feel like I have an excellent balance on family time and work time. I merely made a suggestion for making access to evidence better.

I put in my time, do a good job, and do my best to stay current.  That best includes staying in touch with courteous, respectful colleagues through various social media avenues to have access to their knowledge and taking on students, who bring in fresh knowledge from the academic relm.

Let me make this explicitly clear: I do not feel an obligation to give up any of the time that I have each day that is not already devoted to working, driving, sleeping, eating, changing diapers, or cooking. I'll be damned if I'm going to spend that 'free' time on work.

So, while you're sitting around, talking about #SolvePT on social media, I'll be happily enjoying my family and solving patient problems, one veteran at a time, while I'm at work. 

Oh, and there is a reason that I do not get involved in these silly, self-important twitter discussions:

To-morrow, and to-morrow, and to-morrow,
Creeps in this petty pace from day to day,
To the last syllable of recorded time;
And all our yesterdays have lighted fools
The way to dusty death. Out, out, brief candle!
Life's but a walking shadow, a poor player,
That struts and frets his hour upon the stage,
And then is heard no more. It is a tale
Told by an idiot, full of sound and fury,
Signifying nothing.

And Now, We Wait

I'm sitting in the waiting room as a surgical team pokes around inside my wife's brain. Let that sink in for a bit. My 26 year old wife. Brain surgery.
This is all such a surreal experience. My wife is the picture of health. She is physically fit. She has only complained of focal headaches, which are more than likely unrelated to the  aneurysm the surgeon is currently working to eliminate. Yet here I sit, surrounded by family, friends, and plenty of strangers waiting to hear word on their loved ones.
This surgery is much riskier than the previous non-invasive procedure she went through just a couple weeks ago. This surgery will eliminate the risk of the aneurysm rupturing. But, the associated risks with this procedure are much worse. Her biggest fear is that she will be permanently changed to the point that, somehow, I will no longer be able to love her. That's not going to happen.
It's funny, in a way, to say that. You see, you probably don't know this, but there was a time a few short years ago where we had reached the end of our respective ropes with one another. We separated and were talking about filing divorce papers. We each had our plans and were working those plans. But God's plan was bigger than our plans. He changed our hearts and lives to see what He had in store for us. I, we, are forever grateful.
In a few long hours, my loving wife will come out of surgery. She will have a large swath of hair missing on the left side of her head, a long incision across her scalp, and yet to be determined side effects. I will love her all the same.

A Humbling Experience

I completed my second 5K today. Well, first really, since the first one I ran was a 6K. It was a truly humbling experience. My wife, Andrea, used my first run as a motivating factor for her to get into running. So, she got together with our pastor and came up with a plan: we would start a bible study/run group with our church and run twice a week to train for a monthly 5K.

It just so happens that the first 5K we were planning to run was the first annual Sarah White: Scare Your Fear Memorial Scholarship 5K.  Sarah was a local teacher that valiantly fought cancer, only to come up short about a year ago.  I did not know Sarah or her husband Brian, but had heard bits and pieces of their story, mainly through Facebook. If you believe in such a thing, you might say that it was quite the coincidence that we chose this run as our first run. As for me, I'm not much on coincidence; I choose to believe in God's perfect plan.

Have I mentioned that Andrea has an aneurysm in her brain? She has been blogging about it and trying to keep all of our friends and family up to date. If you want her side of the story, go over to her blog and check it out.  Here are the details: an aneurysm is basically a weakened spot in a vessel that is susceptible to rupturing. She has a significant family history of this happening, and the result is frequently death. So, we have been getting many tests and her neurosurgeon is on the verge of recommending surgery. Brain surgery. That's scary. Looking at the statistics on aneurysm repairs makes it even more scary. Depending on where you look, around 40% of people that have an aneurysm rupture die. Around 4% of people die in the operating room getting their aneurysm clipped and 12% come away with significant side effects. Weighing these numbers and the options for treatment have been, well, scary.

The outpouring of support through advice, thoughts, and prayers to our family during this time has been amazing. Friends, family, and acquaintances have reached out to offer their support and we really appreciate it. I'd like to share part of an exchange with one of my "internet friends" that has touched my heart. After sharing Andrea's latest blog post, I received a direct message on twitter from this person that read, "You normally don't love people you've never met, but my wife and I love you, Andrea, and Maddie. The Grace of God does some pretty amazing things."

Back to today: Maddie is sick. She woke up with an eye almost swollen shut. She's had a productive cough for a few days and ran a low grade fever off and on over that time. So, we called the Pediatrician's office this morning and were told to go to urgent care so that she could be prescribed antibiotics to help fight off the infection. After 2+ hours in urgent care and eating lunch, we were on a very tight time schedule to make it to the 5K.  But, by the Grace of God, we made it. This run was very important to Andrea. She wanted to show that, despite the adversity she is facing, she isn't going to let it get her down.

Neither of us placed today, FWIW. I finished 26th overall and just missed the top three for my age group. My time would have been top for the 20-29 age group. Andrea finished 54th overall.  Pretty respectable for her first competitive run and first time running that far.

The most important part of today, for me, happened well after the race had ended and after the awards had been handed out.  Brian White spoke to the runners and shared some personal stories about Sarah.  I cannot tell you what he said, and it didn't matter. It mattered that he said anything at all. I was deeply touched simply by his presence standing in front of the crowd and speaking. Brian, my friend and brother in Christ, I do not know you, but I want you to know that I love you. The Grace of God indeed does some pretty amazing things.

To Grandma's House I'll Go

I grew up in the country. I mean, down multiple gravel and/or dirt roads to get home 'in the country'. Fortunately, my Granny Arnold lived about a quarter of a mile down the road from us.  My brother and I spent many of our free days with granny and built a very special bond with her over the years.

So, when my mom was on an important phone call one day and too busy to stop and tie my shoe, it was an easy decision for my five year old mind what I would do.  I would make the quarter mile trek to granny's house.  I'd never made the trip on my own, but I knew granny would be more than happy to tie my shoe.

Granny lived in a decent sized mobile home surrounded by 40 acres of farm land that my uncle farmed.  She had a large garden in the front and a chicken house in the back.  A sandy driveway stretched about 100 yards off the main road down to granny's house.

So, I hopped on my little black and yellow bike and started pedaling. I don't remember any details from that trip over to grandma's.  I seem to remember an old truck rolling slowly past at one point, but I think that is a detail my brain has added over the years to make the story more sensational.

When I finally made it up granny's long driveway, I saw granny coming around the corner of the house. She had just been out checking the chicken house when she noticed me.  The look of surprise on her face would only be matched by the look of fear on mine when my mom realized I was gone and figured out that I had made the trip alone.  I knew better and she would remind me that I knew better!

Grandma tied my shoe and we went inside and waited for my mom to show up. This is the end of my recollection of this event.  Legend has it that mom swatted my butt the whole quarter mile trip back home. I sent her a text today to fact check the story and here is one of her responses: "I'll bet your butt still hurts.  My hand does!"

Being a parent myself now, I can imagine the fear that gripped my mom in that moment; the horrific realization that your child is gone and you have no idea where they are.  I'd probably respond the same way she did.  I can tell you this much: I learned my lesson and never made the same mistake again!

Granny passed away during my first year of PT school. She had battled with dementia and was on Coumadin. Family helped to monitor her medication at home. She had recently spent a few nights in the hospital and had her Coumadin dosage altered, if I recall correctly. Somehow her levels got off and she was found unresponsive and passed away shortly thereafter.   

I place no blame for her passing; neither on family or her physician. I was and continue to be disappointed that she didn't receive further services when released from the hospital. There are so many home health companies that would have been more than happy to make the trip to Granny's house. But, God's timing is perfect, whether we understand it or not.  I draw comfort from Isaiah 57:1-2:

The righteous perish, and no one takes it to heart; the devout are taken away,and no one understands that the righteous are taken away to be spared from evil.  Those who walk uprightly enter into peace; they find rest as they lie in death.

At the time, it was painful not being able to be there for her as she had been there for me when I needed help.  I'm frequently reminded of my granny when I go out into the country to see an elderly woman living alone. These patient's hold a special place in my heart and take me back to riding down that sandy lane and seeing the comforting sight of my granny there to make everything alright.