Turn and face the strange

I wrote a little while ago about potential changes and hoping to take a vacation from the blog after the election this Fall. Well, the time schedule has changed a little. In fact it'll only be a few weeks.

For those long-time readers you may remember my posts about the reboot, retraining to be a radiological technologist. It went better than expected, and I entered another career which fortunately I happen to like a lot. For the past five and-a-half years I've been working PRN, which means "as needed." As needed has turned out to be 2 to 3 weekday evenings and most weekends. In the past almost six years I've added CT (formerly known as CAT) scan to my general x-ray registry and worked hard to develop as good a reputation as I have in graphic design.

My reputation has garnered me several offers of part-time and full-time positions. I've left the management of the hospital radiology department disappointed many times. But this time I couldn't say no.

Okay, here we go. I certainly hope there's enough material to build wings out of on the way down. As many of you may know, I've been down this economic rabbit hole 4 times before in my life. All 4 times it ended up with me losing my job and being unemployed for 8, 1, and 6 months. All because I chose to ride it out. So, I have the opportunity to change that. So I am.

If I choose correctly I will have saved us (spouse and I) from economic devastation and our life will be different. If I choose poorly I will dive right into that economic devastation. But I've chosen. I'm going to do what I normally do on a small scale, but the opposite of what I do on the macro scale. I'm running into the flames and will be starting full time at the hospital just as we predict the height of the COVID-19 pandemic hits Ohio. Hopefully I can work PT at what is the current day thing.

If this works out the way I hope, this is going to be hard. I'm going to push myself to the edge. But hopefully this time I won't lose a job and income. I'll keep health insurance. And I'll have a guaranteed minimum income. There are hundreds of smaller trade offs.

I will not be as income secure (if nothing would change with the day job) as I have been. But I don't see the economy "roaring back", and business will be very different. But the hospital is (mostly) steady work. The hours aren't great, but fit well with PTing the day thing.

But with all that, I doubt there will be much time to continue to blog regularly. I've been somewhat proud that I've been able to get out a linke-poo fairly regularly these past five plus years. But I doubt we're going to be able to keep it up. In fact I doubt there will be time for much of anything extra.

The timing can't be helped. And believe me it bothers me that I won't be able to help much in the coming months.

RT (R)(CT)

Well, yesterday I took my CT registry exam. I know I haven't said too much on the blog about it (more so on Facebook and twitter), but I was pretty concerned. For the practice exams I was fairly well stuck at 80 (while it is a percentage, they don't call it a percentage). That was better than the 64 I had when I first took a practice exam. But it's a lot less than I'm used to getting. So yesterday as the test started I was pretty nervous. I do well on standardized tests, always have. And I was fairly certain I would pass. The question was by how much. You need at least a 75. There are about 180+ questions (for our test you have to answer all the questions or let time run out, this is compared to the nursing registry where once you achieve a 75 they stop asking questions). So, after an hour and 15 minutes (we have 3 hours), I scored a 93. Booyeah! Which is slightly less than the 96 I got on the X-ray test, but I'll take it.

So, for now I'm done. In the future I may look at getting MRI (their pay is pretty good, but it's also a much different pace and a lot more actively controlling the scan). I would love sonography, however the limitations of a man going through the program are a little high (there are some highly invasive scans, for my practice/job I would need to have a female tech with me during those scans, a little cost prohibitive on the employment side). So it's an RT(R)(CT) for me. Reboot is done for now.

Which means it's only the CE credits (24 every two-years), hospital education (there is A LOT of that), and recertifications of the licenses I hold (which is also a pain). No more evening/Saturday classes, clinical time (internship), and stupid student hoops to jump through. Just the regular employee hoops.

Not that it frees up that much time, however it does free up some head space (I had to do all of those things before, and go through school and study for the registry, etc).

I don't want to jinx it, but I might be able to have a life again.

Now, as to the writing… I've had discussion about how day jobs affect and inform the writing. Working in health care is doubly so. I have experience working in a factory, working as a pro designer, working as a politician, with various levels and responsibilities in those, you'd think I'd have a lot more. But it's my experiences working at the hospital that I think have added to my ability to tell a story. It might be because those other areas were so well entrenched in my head by the time I decided to get serious about writing and that health care has all been upfront and new. I don't think that's all of it, though. Time (and the words) will tell.

Thing I've learned in the reboot, part 4

"Why do you need to hurt me?" Well, that's not the actual question we get, it more like, "Ow! F#$kers, why did you do that?" or "I can't move that way."

Let me just say to that last one, yea, you probably can. I've seen people all stiff and immovable while on the table. Then once I say we're done, suddenly get all flexible and lose while they walk out of the room (yes, we call you names after you leave). I should also point out there are patients I try not to move at all (especially if I can see that they have a broken hip/femur before I even x-ray them). But mostly people can do what we ask.

By why do I need to move you, touch you, get you at just the right angle? Because I need to demonstrate your anatomy in the proper position with the proper relationships of parts so the Radiologist can diagnose you correctly.

Okay, first there's such a thing as anatomical position. Everything relates to anatomical positions. Why, when your hip is hurting, why do I need you to go pigeon-toed? Because the neck and head of your femur are at specific angles entering the acetabulum and I need you to be in that correct anatomical position for the x-ray. Is it important? Well, if say your hip is broken (I can tell by how your foot is laying on the table, even if I can't see a clear dislocation in the leg) I won't make you (warning FEMORAL ARTERY!), but for everything else, yea, I need you to do that.

In general, we will probably take at least two x-rays of you (with some notable exceptions). And we may take up to six for any one study (like a cervical spine). If you have multiple studies that number can really add up. For one patient I had to do C-Spine, T-Spine, and L-Spine (that's at least 12 x-rays, if not more for repeats or to get specific cone down views). For everything we x-ray we need at least two views to determine exact location of anything that might show up. Also, not all problems show up in all views. Even broken bones. You'd be surprised how many breaks we see in one x-ray in a study and don't see in any of the others. For any bone we need two views, hopefully at 90° to each other. For any joint we need three views (sometimes only two, but that's depending on if you just have pain or if there was a recent injury). Your bones (and soft tissues) are complex. Nobody is exactly the same. I've taken AP (straight on views, beam enters Anteriorly, exits Posteriorly) views of forearms that look like Laterals (side view, typically lateral to medial sides). It's freaky. Then there's your spine. Sure, you may think it's just a bone, but we have to show the intervertebral joint spaces (either an oblique or lateral depending on where we are in your spine, these are where your nerves exit the spinal column) and the zygapophyseal joints (this is where the vertebra articulate against each other, either the oblique or lateral, not the same plane as for the intervertebral spaces). I need to show all of those, hence the numerous x-rays for what you think is a simple pain.

Why don't I focus in on exactly where your pain is? Well, I need certain studies for the doctors to diagnose you correctly, and where you think the pain is may not be where the problem is. Also I need to show the x-rays in specific order to the doctor. Every x-ray has distortion in it. This is because the x-rays come from a point source (5mm) and angle outward from there. I need to show the x-ray with the distortion the doctor has come to expect. If, however, I'm x-raying the wrong side, let me know (you wouldn't believe just how often doctors put the wrong side on their orders - heck, even we get it wrong because we're thinking about the last order we did, or mix up our anatomic positioning). Also, if we're x-raying the "wrong part", ask about it. I've had to (have the full tech) call the doctor's office to get them to change the order. For example, PT had obvious forearm fracture, doctor ordered a wrist thinking it would also show where the fracture was. Um, no. Would you like a forearm instead?

Why can't I just do the wrist and get the forearm (or vice versa)? Okay, one a wrist is typically 4 views for injury, and a forearm is always just 2 views. With a wrist I will get the distal quarter of your radius and ulna (the bones that make up your forearm), but I'm demonstrating the spaces between your carpels (wrist bones), so the radius and ulna will be distorted. While the forearm shows the elbow and wrist, because I'm centering on the forearm, those joint spaces won't be open. One is not the other (even if the doctor asks us to cheat - which we won't do).

And because of how your anatomy is put together I need to get you at specific angles to demonstrate the proper anatomy. Take your shoulder. For an injury we will get a view called a Grashey (named after the doctor who specified it). This is typically an AP (your back against the plate) and rotating the patient by about 45° (again, everybody is slightly different) onto the injured side (especially if you're lying on the table, this can be quite painful). I need to get this view to show the Glenoid Fossa (this is the "socket" on the scapula where the head of your humorous articulates) in profile (it's a cup, but I need it as flat as possible) and the humeral head and the space in-between them. There are a lot of injuries that can only be diagnosed with this view, and it needs to be done properly. So, yes, even if you're in real pain, I need you to do this. I may be able to get away without the Lawrence/Superior-Inferior Axillary (your armpit), for an injury (and that's the only time we take it) it's a very difficult position to hold. But I can't argue away not having the Grashey.

So, yes, I know you think we should only need one x-ray to see what's going on. But we need more. And we need you to hold in exact, specific positions. I know it's painful to hold your legs pigeon-toed on the table (yes, we have to do it ourselves for training) or to rotate your hand palm up and then palm down (AP and internal rotation for elbow and shoulder routines), but the doctor needs to see the bones and tissues in the relationship they're expecting. And know if I'm too far off, I get written up. So not only is it your health on the line, it's my ass and job on the line too.

Also, we will ask you if you've had a recent injury and exactly where the pain is. Be honest with us. If you've had an injury that may mean I need to get different views and your really don't want us calling you back to redo the study (yes, it's happened more than once). If you have a question, like "why are you x-raying my right shoulder when it's my left knee I twisted" ask away. I want to get the right study done (because I don't want to ask you back for another study) and the doctor may have ordered the wrong study (or I may think I'm x-raying someone else, this is why we always ask you to say your name and birthdate). Also, I should be able to explain why I'm doing all those x-rays or why I'm looking at your C-spine instead of your hand where you have the pain (probably looking for pinched nerves). It's your right to know.

But if you ask me not to do something because of the pain, I may be able to take the same image a different way, but I may need you to be at a certain angle, holding you hand a certain way, leaning on the bad side because I need that exact view to show the Radiologist so they can diagnose you properly.

Thing I've learned in the reboot, part 3

"I've had so many x-rays I'll probably glow in the dark now."

"X-rays don't work that way."

I told the truth, and I lied. X-rays don't deposit radiation that way, it's not like you accumulate radioactive materials and then become an emitter (that's a different type of radiation). So I told the truth for what it was worth. But while the beam is on, you emit x-rays through scattering. So I lied.

Some quick notes. X-rays are high speed photons. So far, we haven't been able to detect matter in the beam (like we can with visible light). X-rays can't be reflected. They can't be focused. They travel in straight lines. You can think of them as very fast bundles of energy. They lose that energy quickly. We no longer think of x-rays and gamma rays as being different, it only depends on the source and a little bit of the energy levels.

Here's how we create x-rays. There's this tube, think of it like a large arc light. On one side we accumulate electrons (mA) and for a (usually) small amount of time (s, mA * s = mAs, this is how many x-rays we're going to make). Then we hit that filament with a high voltage charge (kV, this is how energetic and penetrative the x-rays will be) forcing those electrons across the gap to the anode. Then several things happen, but mostly we make a hellalotta heat and a little bit of x-rays (something like 98+% to less than 2%). See, there's a lot of friction when the electrons slam into the Tungsten (used for general diagnostic x-rays, mammogram machines use molybdenum - the metal is chosen for the specific binding energy of the K-shell/inner shell electrons and the ruling energy profile of the beam and their ability to handle high heat). Most of that friction is transferred to heat.

Here's where the fun part begins.

The x-ray beam is heterogeneous in energy. Remember kV? Okay, energies of the x-ray will start around 10 kV and go up to the maximum kV we selected (most machines can go up to 120 kV). A small percentage of electrons, however, either are slowed down by the nucleus of the target material and that energy loss is transferred into creating an x-ray photon (this is called Bremsstrahlung or "braking"). These x-rays are typically of the higher energy levels. The electron could knock an outer shell electron out of it's orbit. This will create an x-ray of the same energy as the binding energy of the electron (lower in outer shells) and propel the electron with the force of the remaining energy. These are typically around 10 kV or so and aren't useful for diagnostic x-rays (sometime called Grenz Rays). The original x-rays could knock a K-shell (the innermost shell) electron out of orbit. For tungsten this creates an x-ray in the 50-70 kV range (what we use for most diagnostic imaging). Then, as electrons cascade down the shells we create even more x-rays at lower energy levels.

Okay, so we now have a whole bunch of heat (which will be handled by the tube vacuum, the oil the tube sits in, the rotation of the anode, etc., but this is also important, it is possible to overload the tube this way and then Bad Things Maynerd™) and a heterogenous bunch of x-rays heading out in all directions. Now, the tube case handles much of the x-rays heading in directions we don't want them to (lead lined, although there is an allowable "leakage"). There's a window at the bottom of the tube which lets the x-rays out in the direction we want. We then have aluminum shielding to remove all the lower energy rays (10 to 50 kV). These can't give us anything diagnostic so if we let them in you would be receiving a high skin dosage of radiation without any benefit (here we talk about half value layers, and you don't want to know). After this filtering we now have collimation (best thing ever) which helps us "cone down" the beam to where we need it. That is, no need to expose a full 8"x10"cassette if we're just x-raying your finger. We "cone down" to the finger and that's the area where the x-rays are (mostly, we'll get to that in a moment).

The x-rays now enter your skin and start doing a whole bunch of other interactions. As you change the beam, this is called "attenuation" and it's what gives us the image. Most x-rays will pass right through you without interacting. Your body can do a number of things with the x-ray that don't pass right though. They can absorb the entire x-ray photon (photoelectric effect). This then can produce scattering. It's basically the same results as creating x-rays. Some will "break", some will eject k-shell electrons, some will raise electrons to higher energy states. And here is where I lied. These interactions can also create new x-rays which typically travel within a 15° cone of the original x-ray path (classical scattering), but others (depending on energy levels and interaction states) can travel back the way the original x-ray came (back scatter) or head off in new directions (Compton scattering, this is the most dangerous for the x-ray techs and why we can't be in the room with you or we have to wear lead shielding). The ones that continue through then hit the cassette or digital imaging plate (CS, direct, and indirect). And here's the thing, most of the x-rays will pass through that without interacting as well. But some of them will hit luminescing crystals (indirect digital and film screen - for these types of devices 90% of the exposure will be from this photoluminescence and 10% from direct x-ray exposure) or the PSP (CS, or digital cassettes, this raises electrons to higher energy states which we read to make the image) or direct digital receptors. After that we have lead backgrounds in the cassettes or in the floors or somewhere and the x-rays (most of them) are exhausted.

For those x-rays that continue (and scatter) they conform to the Inverse Square Law. That is, the intensity of the beam diminishes by the inverse square of the distance. Or, in the space it takes the x-ray to travel from 2' to 4' the beam is 1/4 the intensity than it was at 2'. At a distance of 6' the beam is pretty weak.

Still with me? Okay, so we mentioned scatter. This is why we do all our protection schemes. This is why we'll use lead shields when we can. It's also why we need to leave the room if we can. Not because of the central ray (the main beam), but the scatter from the patient. This is where the majority of our occupational exposure comes from.

And you aren't the only thing that produces scatter. Air is not a vacuum. Air between the tube and the patient will produce a small amount of scatter. You need to think in volumes here. The table will produce scatter. Anything that is lighter than lead will produce scatter.

Lead is used for shielding because of it's high atomic weight (x-rays are absorbed by the photoelectric effect without producing scatter) and it's pretty dense. Note, there are regulations on the thickness of lead that is needed, blah blah blah. It's also cheap. There are newer materials (plastics and nano materials), but they're pretty expensive. There's even a cream that's being tested to see if it'll protect doctor's hands.

But, when the beam is not on, there is no radiation (normally, there's leakage things, blah blah, so small it doesn't matter). There is no scatter.

So, does that explain it? X-rays will not make you radioactive, but you will actually produce other x-rays while the beam is on. Once the beam ceases, no more radiation.

Of course, this is the high level overview (and I think I got all my terms correct).

Things I've learned for the reboot (part 1 of I don't know how many)

X-ray radiation is nothing to be trifled with. In the past x-rays have been used for everything from killing off children's enlarged thymuses (important to your immune system, and normally enlarged in children compared to adults), as a treatment for acne, and to properly fit shoes. And there is no excuse for these issued. Clarence Dally died from his exposure to x-rays in 1904 (he was Thomas Edison's friend and glass-blower, he also was the subject of Edison's demonstration of fluoroscopy at the National Electric Light Association exhibition in 1896 and sat for 8-hours each day under the fluoroscope). X-ray radiation damage profile is mapped in what's called a Linear, Non-threshold chart which means there is no exposure level which doesn't have some risk.

We don't use much radiation in x-ray these days. With digital we use a little more than the last film technology (90s), but much less than the 70s and 80s (and you don't want to know about before that). Fluoroscopy uses a little more. If you need fluoro, be careful, ask questions, and ask if they can put the machine on "pulse". Most radiologists will only do intermittent fluoro-ing (not have the beam on all the time). CT (or CAT) scan gives you a much higher dose. If you've had recent CT scans (in the past year or two) and the doctor is asking for more, let that doctor know (especially if they hadn't ordered the earlier scans). Understand that there is no official top limit to the dose you can receive for diagnostic and therapeutic x-rays (CT included), but you should limit it as much as you can. We are happy to make copies of your scans for you if you ask. If it's a personal copy there will be a small charge, but just tell us its for your doctor (wink) or have them put it on the order. If your scan was done at an allied health care provider (in Cleveland we have University Hospitals and Cleveland Clinic) if you stay within one system, the doctors should be able to see your previous scans). Let them know one was done. Unless something has changed, they may be able to use your prior scans.

This next point is very rare, but worth noting. It is uncommon for you to have "reddening" of the skin after x-ray treatment. If after a CT scan or fluoroscopic procedure (especially catheterization or arteriorgrams) you have red skin (like a sunburn) or an ulceration, even if you think it's not where you were x-rayed, see a doctor immediately (if they weren't involved in the procedure, let them know about it). Erythema is a direct cause of 300 rem of exposure. Three-hundred rem (Roentgen equivalent man) is also the LD 50/60 number which means that of a population that experiences a 300 rem full-body dose, 50% will be dead in 60 days. With treatment, you can survive. Like I said, these days this is very, very rare, but still can occur. Immediate diagnosis and treatment is the key to surviving this. If you're having standard x-rays, even for complicated procedures (like a bone survey (not the same as "bone density" or DEXA scan) or having an l-spine/t-spine/c-spine series) you won't get anywhere near this dose unless the machine explodes over you, and even then more than likely not.

If you're under 21 keep a record of all the x-rays you've had. Go to imagegently.org, they have some helpful publications.

X-rays interact at the atomic level. We actually are concerned with which electron (well, actually their shell) we knock out of its orbit. This is also how x-rays are produced, but we'll probably cover that later. This is also what makes them dangerous, because we're changing the electrical charge on the atom (ionization). That can disrupt your organic chemistry. We're also creating a lot of free radicals (which can cause damage). Fortunately the most common effect of these, even for "direct strikes" (when we hit your DNA) is either no appreciable damage or cell sterilization (it's unable to successfully divide again).

The human body is an amazingly beautiful, complex and robust system that can handle a lot of injury and still remain functioning. Contrarily, the human body is a disgustingly smelly, simple and fragile system that the tiniest of disruptions can cause catastrophic chain-reaction failures.

Things that you might think are just annoyances, or aren't important are, in fact, exceedingly important to correct diagnosis and treatment. Say, having a shellfish or seafood allergy for instance. Yea, if you have one, never forget to tell your healthcare worker (because you're most likely actually allergic to iodine, which is in a lot of things). That pain in your toe just might be related to that pain in your back or rear you've been having. If you might have a pinched nerve in your neck your doctor will do ask you to do things you might think aren't related, like rolling your eyes around, but are actually important to the diagnosis.

Oh, and while I'm thinking of it, if you have neuropathy, it is vitally important to visually check where you have a lack of sensation. Every. Single. Day. No, you don't what to know why, just trust me on this one. Okay, well, I've seen enough necrotic toes on diabetics. You don't want to have to deal with that (and I really don't want to x-ray them, yes, your x-ray department should have spray to help clear that smell, but sometimes it doesn't work so well).

Oh, and try and keep your toenails clipped and your feet clean. I know your Mom told you to wear clean underwear, but seriously, clean feet are way, way more important to me. Okay, let's just say clean everything. Make sure you're clean. Because, damn.

X-rays don't just show your bones. We see everything. Fat. Edema. Some muscles. Major organs. So you may be x-rayed to show some of these soft-tissues (and it's a part of our protocol to show them clearly to make sure we have a good exposure). For hands and fingers, we should even see your fingernails.

We will ask you very personal questions (especially if you're female). We don't do this to embarrass you, we're trying to protect you. If you may be pregnant, you really need to say so. If it's been more than 28-30 days since your last cycle, we may ask for a pregnancy test. If you are female, you're x-ray technologist (the person who takes the x-ray) should ask you directly about this unless you're coming from the ER/ED and had a pregnancy test already, or you're older than 50 or so (everybody's department has a different cut-off, if you're older than 45 I'll ask if you've gone through menopause).

If you know you have something in you, or you have situs inversus, or had things removed, let your technologist know. Don't leave it as a surprise for us, we get enough presents as it is. Fortunately one patient did let me know he had his patella removed before I took a sunrise (without a patella, there's no need for a sunrise view).

And while we're at it, try and keep track of your prothesis, okay? No, really, if I ask if you've had a hip replacement or surgery, you think you'd remember that. You'd be wrong about it, too. If you have permanent metal in you limbs, back, neck, or head, let us know. We have to show all of it on the x-ray and if you don't tell us you have a 12 inch plate along your distal ulna, we may need to retake 3 of the 4 views of your wrist to include it. Let us know. We're here to help.

No, x-rays won't bother your phone, but it has to be out of the x-ray (so don't leave it in your pocket). I have funny stories about these, but I can't share them here. Let's just say some of you have your phone in weird places, okay.

If you have a doctor's order to limit your movement (say, like a recent pacemaker implantation), let us know that as well. With HIPAA we don't see all of your history, only the doctor's order and their diagnosis to support that order. Also, your doctor (or their assistant) may have lied to us (or the insurance) or not told us the full story, so you gotta let us know. For example, with that pacemaker, you shouldn't be raising your left arm above your shoulder, but your doctor is doing a 2 view chest x-ray to check for pneumonia. All the order says is "pneumonia", not "possible complication from surgery to implant pacemaker". And if it's been long enough that you're no longer in the sling, I may ask you to raise that arm up to take the lateral. You shouldn't do that. Let me know and let me know why (not just, "it's stiff").

And that's a wrap

So, took the ARRT registry today. And the result is… (this is the point in most reality TV shows where they take a fake pause to heighten tension and splice in footage of both sides of the decision making process that were very obviously taken at other times during the show by the goofy look on everyone's faces, but they needed to add footage here because there really wasn't any pause in real life) … 96%. Booyea!

I can haz RT(R) now?

RT(T) means I can work as a regular radiological technologist taking x-rays of patients.

So that's what it's all been leading to. Well, actually there's a lot more work to come (finishing up the licensing process with ARRT, getting the final blessing, getting the Ohio State licensure - which is an automatic with ARRT certification, but still requires paperwork). And then this Fall we start on getting the RT(CT) (computed tomography, which the natives call CAT Scan). While there are more comps to do for CT than for R, there's a lot less coursework. And CTs are often scheduled procedures which makes it easier to schedule in to get those comps (for the regular RT, you kinda take them as they come).

I might do another post on just how insane this whole thing has been (I have an app to keep track on when I was working where, and it's mostly been registering on the 74-80 hours per week since January, with a break between Spring and Summer semesters - that's before I add in mandatory lunch time, commute time, and coursework/study time).

How shall we fill the empty spaces?

I know I'll do some posts on what all I've learned. These won't be technical (I don't think), but more along the lines of my post "I'm sorry, dear."

Would I do it all again? I'm not sure. This has nearly killed me more than once. But I've done some good work, I'm met some cool people, I've grown tremendously. But it's a hellalotta time, energy, and money. I think if I were a few years older I wouldn't have made it. On the other hand, I think I've found something I like as much as design. It's not the same love, but I think it could become similar. The plus side is that except for seeing stupid things on TV shows (seriously, producers, gets some consultants) it doesn't interfere too much in real life (for those of you who have sat through my discourses on design in the wild, you know what I'm talking about).

So, at least for this one, all that's left is the party and filling out paperwork. Did I mention the 24 hrs of CEU every two years?

Now if you all will excuse me, I'm going to go collapse in a corner.

Random thoughts on the reboot - I'm sorry, dear

(Inspired by a conversation with a friend)

The small cuts are the ones that hurt the worst. I've seen people with bones sticking out of their skin, people whose bones have been shattered, missing limbs and digits that only recently gone missing, and while some of them have screamed as we positioned them for x-rays, the ones who scream the loudest and most often have been the ones with lacerations, abrasions and hematomas.

I can't blame them. When I shattered my fibula, I thought it was the worst pain in the world. Until I had a 6mm kidney stone. Yea, you don't want one of those. Trust me.

But it's also true in the reverse.

And then there are those who think we're unfeeling bastards because we make them hold their ankle at a certain angle, or we don't react when they tell us the most horrible thing they've experienced. Probably something that happened in the past two hours. Because we will make you move that hand that hurts so much you're thinking of just cutting it off and being done with it. When a nurse or other professional uses endearment terms, understand we are not belittling you. We are identifying (and in some small way, trying to protect ourselves). I used to hate it when other techs would call the patients "honey". But two years in I find myself following their example and saying, "I'm sorry, dear. I'm so very sorry."

There are times we just accept we can't get a certain view. "DUE TO PAIN AND PT CONDITION, UNABLE TO OBTAIN VIEW. BEST POSSIBLE FILMS." Most often this is for the axillary (shoulder) view, which is only performed on those who have injured their shoulder (hold your arm straight out, or up at an angle, while turning your head opposite of the injured shoulder, lean out to the side you're holding up, now imagine doing this when the humeral head is +1" out of position).

I'm sorry, dear. I'm so very sorry you are in pain or that I have to cause this pain. I'll try to go fast/slow.

We know some positions aren't comfortable. We know our tables aren't comfortable. But we also know we need to get the correct views on the x-rays so the doctors can correctly diagnose you. We'll give you the encouragement you need, show you the confidence you need to see, give you as much energy as we can to lean forward as we lift you up by the sheet. We won't wince when you wince. And not give you any sign that yes, you do smell rancid (I know you apologized for that, but damn). No, I've seen fingers bleed worse than that.

Haven't showered for a week? No problem. Three inch long, crusty, yellow toe-nails? No problem. The auto-sphygmomanometer reads 200/120 and you ask me if that's high? No problem. Not in front of the patient. Never in front of the patient.

Back in the workroom? Oh, yea, we talk about it. We cuss, we exclaim, we wonder just WTF these people were thinking (3 days before you came to the ER, have you seen your ankle, did you notice the blood in your urine, just how many times have you fallen and hit your head?). And we cry as parts of us die because we can't help our patient.

Everybody's pain level is different. Everybody's life journey is different.

There's an exam called the osseous survey. It's about 14 images and we see almost everything from your knees and elbows up at least in one view (thoracic and lumbar spine we get a lateral view as well). There's a few things that will cause a doctor to order one. The most common, though, is checking metastatic cancer. Most patients I've done this on have been late sixties and older. Some have been in their 50s.

And then there was the teenager. Fourteen images is a lot of x-rays. These days we don't use very many actual x-rays to take an image (in fact, we're approaching the threshold where we could go lower in dosage, but the resulting film would be full of quantum mottle/noise and not very good for diagnosing anything). We measure our doses in the ones and tens of millirems/microsieverts (as a comparison, it takes 300 rem for your skin to redden, radiation sickness syndromes start above 600 rem). And an osseous survey (I think) is still less than most CT scans. But we're still giving a high chance (comparatively) for cancer. So as I'm positioning this teen for the left humerus, image number 11, I'm thinking, "Geez, I'm giving them cancer." But when we're done I wheel them down the hallway for their infusion. They already have it. And another part of you dies as you smile at them and mumble some encouragement when you leave.

A part of you dies when you see friends in the waiting room and they tell you their spouses are in nuclear medicine getting staged for lung cancer.

And a part of you dies when you hear the doctors mention the patients you just x-rayed probably won't last out the week.

And a part of you dies as you think the patient you just worked on will never have the opportunity to legally have a drink or the option of declining it.

Do you want to see that pain as I x-ray your wrist because it's sore after you twisted it falling into a chair? Do you deserve to see it as I move your leg which I can already tell isn't broken and you just have a bad bruise? Do you deserve to see it as I hold your elbow and wrist so your ulna and radius don't go further out of alignment as another tech positions the film below because I can already tell your arm is broken in two places? Do you need to see it as you tell me that I'll see some spots on your lungs from the TB you had as a kid and you're afraid it might be back?

No, no you really don't want to see that. So I put on a smile and say, "Thanks for telling me that, now take in a deep breath and hold it"; "I'm not a doctor, I'm not allowed to diagnose you"; "You need to ask the doctor if that bp reading is high."

There are patients who are so skin and bone it hurts them to lie on the table. There are patients who aren't all there and can't tell you why they are getting an x-ray. There are patients who are scared at what an x-ray might show but even more frightened by not knowing. There are patients who are so used to doctors appointments they'll start undressing right in front of you because they have no embarrassment left in them. There are the patients you're on a first name basis with because you've seen them so often. You ask how their kids are doing. I still have to ask you your full name and date of birth, though. There are patients who are in so much pain, even after morphine shots, they can only nod or shake their head. And there's the little girl lying broken on your table because some fucker couldn't wait or couldn't be bothered to watch where they were going and clipped her with their mirror.

I'm sorry, dear. I'm so very sorry.

Reboot Update - Partial Spring 2014

First grades are in. Clinicals are a 97%, so that's 1) huge improvement over previous semesters, and 2) an A. Also took first final today in Radiation Protection and prof has posted final grades. Over all I have 210.4 out of 204. Booyeah. So for the last class where it would be possible to get over 100%, I got over 100%. So 2 out of 3 are A's. Now it's the last final on Thursday in Pathology. Prof isn't using blackboard, so I won't know grade until posted on my transcript (could be next week).

Summer is going to be crazy busy. I'm glad I only have a few things to accomplish in clinicals (although 2 of them are very intense an dI was hoping to get both of them done at the other site where things were less pressure-cookery). Summer is also cramming for our national registry. There are tons of things that are "by the book" (ie. on the registry) that aren't the way we do things in actual practice. There is also whole sections of information that I have the knowledge of, but haven't had reinforcement in clinical settings (such as the use of film). Starting to feel tense about it.

Hey, it's only my future career on the line.

Confusion

So, I'm here at Confusion. It's Saturday night and the batteries have been exhausted to the point where I can't shut down. That sometimes can happen. Last night, it's widely accepted, we acted as if it were Saturday night. So tonight found a lot of us wondering what was going on. Or at least our bodies felt that way.

Which is why at 11 o'clock I came back to the room to crash. I'm feeling my age in a bad way. Also, apparently my brain has been working on things I didn't think were a problem, and I don't think they are. But with various issues at the day thing, the reboot, and here on the intranets I've been thinking about these challenges. So I have a feeling I brought some people down, for which I apologize. I obviously haven't had time to process these thoughts and I feel comfortable around you all, so it's leaking out in ways I didn't expect.

But I wanted to talk about cons in general. See, Confusion is the con I've gone to the longest and continuously (I've missed one year since I started coming). A lot of people I know here I consider friends. I've broken bread with them and drunk their mead as it were. The con has grown and changed, as these things do. I find I miss some of charm of the smaller con (I don't miss the drum circle disrupting our bar con at midnight, though), but I'm happy for my friends who put this con on that it has grown as successful as it has. I've seen their hard work, blood, sweat and tears and it's a tribute to them that Confusion is the celebration it has become.

Cons have their own lives and when you go to one you have a variety of experiences. I've found every year is a different relationship. Some years it's a joyous hecktishness, some years it's a struggle to go to everything you want, some times I haven't gone to any programming, sometimes I've partied, most years it's been bar-con. Some years the programming it hot and some years I'm indifferent to it. There are expensive years, years I eat most meals in the con suite, years I drink too much, years I hardly drink at all. There are years I'm outgoing all weekend and kind of drive home in a shocked silence. One year I hit extrovert overload Friday night and had to spend a lot of Saturday in my room. Some years I want to meet everybody new, and some years I just want to spend with the people I'm closest to.

I think it's probably the same with any con you might attend.

I don't have any real point here, I think. But for the last few years I've wanted to write a post like this. There are people who say that cons are the best things ever, and some say they're a waste of time. I guess what I'm saying is that if you go to a convention and you find it to not be to your taste it may just be that year for that convention.

My friends are here. I really love that I get to see and hang out with smart people here. I love the people I know here, and even the people I don't know, but have seen often enough we say hi to each other. I love catching up with everyone's lives. There have been years that I didn't know if I'd come back, but I'm glad I have. This year I'm grateful I've been able to come. I think part of me really needed this... whatever this feeling is; friendship, contentment, belonging, comfortableness.

It's also reminded how much I need to write, which is the part of me that has suffered from being ignored the most during this reboot. Today, while listening to programming I've put down about a thousand words of a short story I've been wanting to rewrite. And I think they're good words. Writing them was exercising a muscle I haven't used consistently in a long while.

There are plans afoot with the reboot that would take more time away from the writing. I now have to rethink them. I don't know that I want to go on for another year or three before I can get back to the words in a more consistent way. And maybe that is my take away this year.

I am a writer. While I may let those coals of that particular fire die down to embers, it won't completely burn out. And I can't afford to let them if only to protect my sanity. And being here has reminded me of this.

So, that was… something

So ends my two weeks away from work and school. Just for the record, I spent 12 hours working for the day thing and 16 hours in clinicals. So, not so much a real vacation (also add in family obligations, etc).

But I hate having all these plans for my time off. I barely got any writing done (less than 200 words or so). Didn't get t-shirts designed (well, I did get one design and then got turned off by setting up the store). Didn't get my study materials ready for the registry.

I do have my books ready for next semester. I found a few freelance accounts that hadn't settled and sent out second notices. Started bringing in the holiday decorations (since it's going to be below 0 for the next few nights I didn't want to fill up the garage to dry the decorations out and have my car freeze up outside).

With the day thing it's stressed me out so much that I've been overeating. I started having the Sunday night blahs on Friday.

I just realized I never let you all know how last semester sorted out. On all my classes I got As (for that 8 hours at 4.0). Two of those were by the skin of my teeth. Clinicals was a B (3 hours at 3.0). I missed an A there by 2 points. Anyway, so for the semester it was a 3.7, and that brings my over all GPA to 3.9. Somewhat disappointing, but I'll take it. This fall was the toughest semester (3 classes, 23 comps). Next semester has 24 comps, but only 2 classes, but there are complications with clinicals (6 weeks in an outpatient facility, and 2 weeks in CT… so that lowers opportunity to get comps). Did I mention I also helped my class make $800 for our graduation (because of our last Summer classes, we don't graduate with the rest of the students so have to float our own ceremony)?

So, that was something. For the next 7 to 8 months it's going to be crazy schedule. Hope we all survive.

The Lamentable State of the Business Today

Or why I'm doing the reboot.

Why the design market sucks. here's one example from Monster. Looking for a Graphic Designer/Assistant Manager to handle co-managing a team plus be responsible for 100+ "multiple page" publications within 4 months (4x4x5=80 days, which means 1+ large publications per day). Plus communications with their 100+ customer base. And what are they willing to pay? $13-15 an hour (or $27,040 to $31200 a year). "Company confidential"? Why, so we won't egg your place? Dear company confidential, same you pal, and the horses you rode in on. Seriously? The sad part is they're probably swamped with resumes. More fodder for the reboot.

I guess it could be worse. You could be applying for "This position is your opportunity to join a respected organization that is redefining media advertising in Northeast Ohio by offering an extensive portfolio of digital and print media solutions." :: rolls-eyes :: The small print, "Northeast Ohio Media Group is a new, digitally focused company…" So, a brand new company that's respected and redefining advertising. That's some shit slinging right there. Oh yea, the title is "Part-time", but the description is "full-time". That's redefining all right.

Last but not least is this designer position who is basically responsible for everything. I mean everything. Writing, layout, proof-reading, and all their social media out reach (that's 3 full-time jobs right there). Plus, "Possess strong graphic design skills." Oh yea, there's also the "Demonstrate strong computer skills including proficiency in Microsoft Office Applications…" (meaning they want you to design print ads using Powerpoint). And what education do they want? "Associates or Bachelor’s degree from an accredited college or university preferably in English, Marketing, or Business Administration." Uh, yea, Bob.

It's my party and I'll cry if I want to

For those long time readers, you know I often refer to October as Writetober. October is chock full of writing experiences and this is the time of year my writer brain kicks into fourth (not much to do outside, so time starts freeing up, however many years of living on a school calendar, it's my favorite time of year, etc).

This week is the start of the next Viable Paradise workshop. Four years after my own experience and a lot of my class mates have made break throughs. I'm still on the mailing lists so I get to see all the hope and excitement of the new class and the well wishes of those of us who have been through it. Thursday night on the island and you'll never be the same.

Next weekend is also a writers' retreat with a bunch of friends, the first of which I won't be able to attend since I started to be invited (it's not the first retreat I've had to say no to, but this is the retreat I was first invited to and I worked hard to go to all of them, including one when I was out of work and it's not an entirely inexpensive experience). I already miss everybody that will be there. And I miss the 10,000 words or so I normally get out during the weekend. There is this feeling of homesickness when I linger on not being able to go.

This summer when I was looking into MBA programs, another course of action I was seriously considering was to drop this reboot thing all together and throw myself deeper into writing. The unfortunate thing about that, and what keep coming up, is that while I've had minor successes, no money has flowed in from my writing. And this reboot is about keeping money (and benefits) flowing. Our lives weren't supposed to be like this. We actually planned for my wife's job to provide most of the income and security which left me to be able to take the risks I would need to grow my career. When life decided to kick us down I had to shift to a more safe path (well, I didn't have to, but facing low probabilities of success and lower-income made those risker propositions even riskier).

Writing is my risky proposition. There is a low chance of success, and (at least at the beginning) the high possibility of low returns even if there is success. But it was something I could attempt and find some success. And I miss it. I miss it terribly.

MBAs and Reputations

Oh Great Internet Brain,

Since I've dealt with many an MBA in my day, but never really considered one myself, I'm at a loss to answer these questions. If the Great Internet Brain could be of assistance, that would be fabulous.

I know that some business school MBAs are highly sought after (Harvard, Weatherhead (Case), U of Chicago, etc), but those are probably out of reach for me (both distance and cost). Are there sub-tiers of acceptance? Would a State U MBA be worth more than a smaller college MBA? And where does an MBA from someplace like the University of Phoenix fit in? Are there places and programs I should run away from (other than the diploma mills)?

I'm sure it's also dependent on the focus of the program. While I think accountancy would be cool, that really requires a BA in Accountancy. So this would be for either Management, Marketing, or Communications. But is there a focus that is more preferred than others? A for instance would be could be a marketing manager, but having a Marketing MBA isn't as preferable to a Business Management MBA for the position.

Any information you have, articles I should read, magazines I should get, websites to read, etc, would be greatly appreciated in this manner. Mostly what I'm seeing in my searches are sales pitches for specific programs, not so much the hard data of why I would want to go there (other than, "don't you really want to have this (name) behind your degree" or "we'll work with you" etc). And none of the information that would say, "sure, you can get a great MBA education there, but nobody is going to hire you" or vice versa.

TIA

School Work

Since I mentioned it in my post about school being out (for Summer!), here is a photo of my presentation board.

Click to embiggen.

And End of Summer

Session that is. My 8 weeks of classes and clinicals are over. So now I get to do all the normal, living things in the next 6 weeks, when Fall starts.

I have the preliminary grade for our "Seminar" class (1 credit). It's an A. The instructor would like to submit the presentation board I did to the OSRT (the Ohio Society of Radiologic Technologists). So I think I did good there. Not sure how I did on clinicals, though. My guess is the best I'll get is a B. Might be a C. I failed a lot of competencies (doing the actual procedures perfectly). Mostly on minor things (not like I x-rayed the wrong part or anything).

But the schedule for Fall is just as crazy as this summer. More so, actually. In fact, I have no idea how I'm going to accommodate classes and work. And that leads me to the difficulty. I might not be able to both continue classes and work at the day thing. So I need to figure out how to juggle both or figure out an alternative plan.

So far my logic flows in this direction: I need to the job to keep going to classes, I don't need the classes to keep going to work. It's going to suck either way.

What is past is past, what is the future we cannot say

Grades are finally in for the last semester. I had a lot of troubles these past 5 months. I'm not sure how much I've shared here, but I struggled a lot to juggle the classes and 16 hours of clinical time with a 40 hour (at least) work week.

Clinicals are set up to test our knowledge and get us prepared for our new jobs. they can also be seen as a two-year job interview where you work on actual, living people, many of whom either don't want to be there or are in pain. There's a lot more variance there, but those are the main categories. Part of our clinical time is spent studying, a very little part of the time. Most of the time we are watching the other techs, assisting, and as we gain skills and "competencies", do the actual work.

Competencies, as a quick explanation, are a way to test our skills. There are a number of "procedures", and we need to show our ability to do them at a specific rate during the semester. We do things like "chest, pa and lateral", "wrist pa, lateral, oblique, navicular", things like that (every bone has at least 2 views, every joint at least 3). First we have to be exposed to the procedure in class, then we can watch/assist a tech doing it, then we "pre-comp" (where the tech can help us), and then finally we "comp" which means from beginning the patient, taking their history, positioning, setting technique (just how much radiation we're going to use), process, escort, hang the "films", and close the patient we do it all ourselves. The only time a tech is allowed to interfere is if we're about to make a major mistake, or if we need to repeat an image (both are automatic failures). Once we comp (for the most part) we can do the procedures ourselves without a tech (although a tech needs to approve all radiographs).

So, starting out I was doing good. This past Spring we needed 12 comps, 3 re-tests (redo a comp from the group of comps, like one out of the lower extremities), and 3 film critiques (where we discuss our radiographs, prove our knowledge, and critique ourselves for quality). Not to mention employment like reviews. In the first 4 weeks I knocked out 6 comps and I forget how many pre-comps. And then I couldn't find the crest of anyone's pelvis (the top of your hip) to save my life. So I was shooting high, and shooting low. And I started failing comps. So I took a few weeks off the pace I had set (class, first time I see procedure I attempted a pre-comp, and then right after I'd attempt the comp) and just worked on my basic skills. But I never got back to the pace I had set earlier (while the other 1st year with me continued to rack up comps, next to him I look like a slacker). And I Was failing with "little things" (relative term), not for my rapport with patients, or basic positioning, or setting technique, but small stuff (many of my fails were scored >90%).

I know why (because our actual classroom experience leaves out those "little things" and every tech has their own pace, patter, and positioning tricks). But it's not that much of an excuse. There was also a personality issue, but I think that one got tamped down by the end.

Then there were the two classes. For the one, it dealt most with computer and math stuff this semester, so it wasn't that hard. I was pretty confident I would get an A and I did. The other was positioning class, which was what I had scrapped by with an A last semester (94%). This semester I was sure I would get a B (was hitting right along the 94% with my tests, made the mistake of not double-checking a lab exercise the whole lab did together - 87%, and my lab practical which was an 87%). But somehow I managed to pull an A out of the air (probably 93.6% or something). For clinicals I got a B. Fortunately, clinicals was only a 2 credit hour course, and the other two added up to 7 hours. I think that gives me a 3.7 for the semester. Which brings me to 3.95 over all. So I won't get that "graduate with a 4.0" feeling (some part of me is disappointed, but not a lot).

In another week we start Summer. That's 8 weeks of 1 class and 32 hours of clinical time for the first 5 weeks, then 40 hours the last 3 weeks (class only runs 5 weeks). Plus, you know, my 40 hour a week day thing. I have my schedule worked out on paper, and it's a killer. Basically 16 and 18 hour days Monday through Saturday (hopefully I'll have my Sundays to collapse in a gelatinous mass and get the lawn mowing done). But in that 8 weeks I need 14 comps. The good news on that front is that I start with 4 in the box already. But with juggling schedules, I have a lot of evenings at the hospital, not our major productive time, also not a lot of chances for surgery, fluoro, and bone study cases. My Clinical Instructor, regular instructor, and myself believe that this will be a big disadvantage come this fall (which, BTW, has 9 hours of classwork and 24 hours of clinicals, plus the aforementioned 40 hours of work).

So, one, giving you advanced notice that I won't be posting much during those 8 weeks (watch me post every single day now). And two, I may not be alive at the end of it.If this blog goes dark by July 12th, you'll know what happened.

Random thoughts

So, last night I had several intense dreaming sessions. This is unusual for me as I don't often remember my dreams. Last night there were three dreams about writing. Not of me actually writing, or stories I would like to write, or hitting the lottery as a semi-famous writer, but three dreams about carving out time to write and constantly being thwarted. I have had a few hours here and there where I could write. Mostly I stared at the screen and tinkered around the edges of things.

Friday was the first time I messed up on the schedule. I forgot to bring home the hard drive with all my work on it. Fortunately there was enough work in email to complete the week with 40 hours.

The reboot is stumbling a little. For one class I'm pretty sure I'll get an A without too many issued. The positioning class I'm again struggling right at the border line between B and A. And I think for clinicals I'm smack in the mille of a B. Clinicals is where I'm really struggling. About a month ago I had a talk with one of the tech about how I was doing. And from that talk I stepped back a little from the course I was on (see the technique, pre-comp, and then try for comp) and worked on the basics, getting a rhythm, and just tightening up my skills. For the past week and a half I've tried to get back into finishing up comps (this summer's schedule is going to make it tough, and I want to start with a few in the bag). It didn't go well. But last Thursday was actually very good. Hopefully the next few weeks will see breakthrough.

For some reason this year is a banner year for freelancing. I have two new clients, one of which is a recurring customer (I've already completed two jobs for them since the beginning of the year, and I have a feeling there's a lot more being lined up). Both of these came through word of mouth from other clients. And now that I've knocked those projects out, there's two more in the wings from my existing customer base (recurring projects on schedules).

Still trying to figure out how I'm going to get yard work done during the early summer.

Troubles in paradise

And the strikes keep coming. The Reboot is in trouble and we're not sure how it's going to shake out. Mostly because there are lots of things up in the air.

In the main I'm doing good, although I feel like I'm stumbling around like the three blind mice. The coursework is still running in the A category, although for clinicals I might end up with a B. This weekend I need to be studying for the mid-term in positioning (delayed because of scheduling conflicts).

I do like the work. And I think I'm pretty good with the patients. I have a decent rapport with them (those I deal with directly). And while most times we're just dealing with pain, last week we had several severe injuries, bleeding, thumb sliced off, and a shattered ankle… the kind that elicits involuntary wincing when you see it in the x-rays. But all of which I could deal with. And surgery is actually sort of fun (although I have a limited experience, and the doctors I have been with are very cool, from what I understand there are plenty who aren't). There's been a few stumbles, but from what I understand that's normal. Several of the tech have shared their stories, include one of the techs I put in the category of "I want to learn from them" who said they did worse than I am doing for their clinicals. It wasn't until 2 years of being a tech that it clicked.

I've tried to figure out why I keep making small mistakes. Looking for where things are going wrong. For all of it I come to one answer. I'm blindingly tired. The day thing I can do in my sleep, and I think that's what I have been doing. My initiative levels are quite low. The only thing that keeps driving me is my damn work ethic.

But were about to head into the section of coursework that requires even more time. So that problem isn't going to get any better. So the question to myself is, is this a level I can work at or am I going to be so tired that I end up making a big mess of something (myself, the coursework, the day job, or the worst of the worse and my biggest fear, a patient). This summer requires 40 hours of clinical for 8 weeks. Right now between classes, work, clinicals and freelance I'm running at around 72 hours (before all the commutes, lunches, etc). How am I going to be able handle 80 hours? And how am I going to juggle that load with the day thing? There's also a few other things happening at the same time, all of which is going to be a drag on continuing the reboot.

So right now I have no answers. Next week we do a mini-review and we start selecting hours for the Summer. If I can't swing a schedule that allows me to keep my day job, I'm not sure how I can keep in school. I need the benefits that the full time job brings to stay in class (not to mention to pay for it). But I don't necessarily need the classes to keep the job.

But then what do I do next? Do I find another avenue for rebooting? Suckj it up buttercup and find a way to keep going? Is this the "time to focus on writing" moment/event? If I can't make the Summer work, should I finish the semester or just stop now and cut my loses?I don't know. Like I said, right now I've got no answers.

Reboot Progress

I keep psyching myself out. So far this year we've had several "quizzes" (the tests being mid-term and final). And I'm not doing so well. It's a combination of things. Like having 3 different classes, the higher standards (94% is the cut off for an A), the schedule, and the aforementioned psych-out. So I've been scoring a high B on most of the quizzes (91-93%). But understand that this means one or two questions missed.

Today we had another one, and I psyched myself out for not thinking volvulus is a twisting of the intestine (I thought it was where one portion of intestine slides inside another, which I believe is intussusception, which I knew, but got mixed up). The other is a 50/50 call for making sure that the lower-margin of the abdomen is on the x-ray you should palpate the greater trochanter instead of the iliac spine. Well, the iliac spine is what you palpate to center your x-ray beam, but the greater trochanter equates to the synthesis pubis, which is the lower-margin of your abdomen. So I spent 3 minutes thinking it over and eventually selected the greater trochanter which, IMHO, is correct (as it "makes sure" you get what you're looking for), but most of my fellow students put the iliac crest. Damn.

On the positive side I did score the clinical site I wanted. That is the Geauga Hospital. So if you're getting an x-ray there on a Friday starting October 26th, you may see me there. And if you wait until Thanksgiving and need a PA chest x-ray to make sure you just over ate, chances are I might be your tech (PA chests are very common and will probably be the first thing I comp on). And, it will be the second shortest commute I've had in my life at only 20-30 minutes.

Now the good news is for Patient Care (which is the pre-clinical class), I think I'm getting an A. However, it's only 2 credits. Radiologic Principles, which is where we learn how to position the patient to get the x-ray projection we want, I'm getting a high B (depends on how badly I screwed this quiz up). Now there are other assignments and evaluations of labs, but I don't know any of those grades, yet. I'm hoping with the test being longer and worth more (but they're comprehensive) to pull over a 94% (I'll be at 91-93% depending on today's quiz). In Intro to Radiographic Technology, I'm doing the same on the quizzes, but I know my scores on the other parts. For the points awarded so far I'm in the 97% range. Although for all these classes the "exams" will be the majority of our grade.

Now, a little about the schedule. I typically leave by 7am for either work or class. And then I return home somewhere around 9pm Monday through Friday. And then that's when I eat dinner. Saturdays and Sundays, so far, are mine to study. Give the schedule of quizzes, exams, and assignments I'm pretty much studying all weekend. There's a little bit of free time, and I do sleep in. But to give you a sense of the time I have, my TV watching time this weekend was all used up while the Cleveland Browns were winning, and I missed the beginning of that game. I did get some Halloween decorations out, but I didn't go full bore this year.

The day thing has gotten used to the adjusted schedule (I think)… just in time for clinicals to muss it up. There has been lots of talk and debate about getting me a laptop so I can "work from home" (read as the time between class and lab, which would add an extra 4 hours to the week, and reduce my total commute time by an hour or more depending). With last week's exam I was able to go to work between class and lab on Wednesday (which I normally don't get to do) which added 2 hours to the total. And it made a huge difference to the week. You might not think it, but wow, I could feel it. So, maybe, if they can't pull it off with the laptop, I just might do it myself. It would seriously help once clinicals would start, and if they allow me to put the corporate licensed software on my personal laptop, I could swing the rest for less than $500. Maybe $600 with a large monitor for here at the house. Believe me it would be worth it. Even for just working on Saturday to stay home and put in 8 hours.

So, that's where we are. I've already had my first day of forgetting the schedule (actually, I forgot Bette's schedule and slept and extra 10 minutes which cut into her getting ready on her early days). And I am getting very worn out, and I think that contributed to part of my performance today. I don't know. I hope I have it in me to do this.

And now that it's Write-tober I'm feeling very antsy for not having written much lately. I've got stuff on cards and I've been feeding Scrivener a little of all three projects (four, but I haven't done much for the fourth). Another VP class is being forged and I'm feeling the time slipping away. I'm really hoping to do a close to NaNoWriMo level of work come the December break. Maybe with the more structured work day of the clinicals I might be able to get some done during lunch hour, if I can find a place to secure the laptop while I'm working. It feels like that part of my dream is withering on the vine and I struggle to keep my brain form sabotaging my aspirations. I feel at loose ends with the writing right now. I'll need to do something to feed that need soon.

Bad writer, no biscuit

Okay, I'm going to say this here as a way of publicly shaming myself so maybe I'll not do this again.

You may remember a long time ago me posting about finally buying Neverwinter Nights II and it not working on my wife's iMac (at the time the most advanced platform in the house) because of the graphics card. Well, on a lark Sunday I downloaded it into the new machine (which reminds me, I should do a post about how, after 12 years or so I finally upgraded my personal laptop a few weeks ago). Anyway, it's been working great the past two nights as I've sunk about 7.5 hours into the game and stayed up way past my bedtime to do so.

Argh!

That time would have been better spent writing. Hell, I've got the gorram notes to key in if nothing else (a nice stack of scraps of paper). But instead I've put my head down and escaped.

I would blame Saladin Ahmed for sharing that link about Baldur's Gate being rereleased, but that's a cop out. I know how I am with these games, which is why I don't normally seek them out. I let myself get sucked in. The first few minutes are free, to paraphrase. The rest suck your life away.

And the worst part is I should have been reading and studying for classes. The first test is tomorrow for Grue's sake. I can't let this suck away my school like Bard's Tale tried to do. Put down the mouse and get back to work, damnit.

So, what do you think, self? You've dubbed up good by putting that software on your machine. Bad writer, no biscuit. Just don't let it suck up so much time again. Set a timer, or better yet, do it after you've done the writing/studying.