I just got in from a party at which I was the only American. There were Koreans, Philipinos, Germans, French (who brought the champagne and did the cooking, thank God), Peruvians, Indians, Egyptians, and me. Very interesting evening for me, we turned on the TV at 23:58 and watched the ball drop, and then turned it back off and kept aruguing about films, politics, educations, sex, books, and art. The food was great.

These people from other countries, they think we should stop using oil so much. They have a point.

So, Happy New Year to my slashdot circle, I think I should probably go to bed, turn off the lights and use less oil.

No, not the meme. That one didn't appeal to me. This is in response to SW's plea for words. I can't leave Bethanie out there all be herself to maintain the verbiage, even though she is more than up to the task.

This time last year I was struggling with a weight-loss plateau that still vexes me. So, some time in mid-year I just stopped struggling. I have not achived all of my weight loss goals, but I have achieved a number of them, so I just turned my attention to other things until the urge to recommit to the effort arises naturally. I sense inklings of just such a re-emergence, particularly recently.

As I think back to last year at this time, I was working at a job that was doomed to end (it was a temp position) on a project that was doomed to fail (executive leadership was not committed to it). This year, I find myself employed in a job that I love, a permanent position that will be there as long as I want it, doing something that I am not only good at but would do for free if my circumstances permitted it. So, thumbs up on the career front. I could stand to be making more money, but I'm making a lot more than a lot of people, and considering my expensive environment (which makes my effective income a bit less), I'm doing okay given the twists and turns I went through to find my way here.

Personally, I have also made leaps and bounds. I am much happier with myself. When I come into intimate enough contact with other people to know their existential pain, I find that I have quite a bit less of it in comparison these days. I have spent a lot of money on psychotherapy, more than was spent on my college education, and I do not regret a penny of it. On the contrary, I feel incredibly fortunate to have found my therapist and to have had the means to pay her for her work.

I have some significant challenges at work, my leggy Buddhist supermodel of a job has turned out to have an eating disorder, high credit card debt and a penchant for not communicating well, but she still has plenty of charm to make rolling up my sleeves and working out our relationship well worth the effort.

When I first moved to NYC, one problem I had was friends. I didn't have any. That problem was persisting even as late as last year, but in the last year I have had an explosion of friends in my life, so much so that I now have problems giving them all the attention they deserve. I also have the luxury of letting friendships that are less than rewarding pass away naturally. I had a half dozen New Year's Eve party invitations this year, this will be the first New Year's Eve in many years that I won't spend alone.

I made one New Year's Resolution last year: to completely abstain from the intentional ingestion of High Fructose Corn Syrup. I did it. All I really missed was using ketchup when eating out. Not a penny of my food dollars went to companies that put their own profits ahead of the consumer's well-being with regard to choice of sweeteners. That feels good.

That's what a New Year's Resolution should be, something achievable, a small change that has a big effect, something that it might take a year to see the benefits of.

It has also been a good year for my Buddhist practice. My deliberate efforts at cultivating compassion and loving-kindness (through regular Buddhist practice) have paid rich dividends in both my personal and professional life. My employer tells me they've never received so many positive family letters written about a nurse in so short a time. I'm also pleased that I have enough perspective on life to not let that go to my head. Compassion and empathy are energies that one can be a channel for, but not the source. That is, its not something I do, its something I allow. It takes effort to learn how to be truly compassionate, that is, to make a connection to another human as an equal and peer, not shouldering their suffering, but being present with them, knowing it could be you, or might be you some day, and just connecting upon the axis of shared humanity. It's not a doing, it's a being.

So, as I sit here in a Starbucks on Broadway and 112th, amongst Columbia students, four different languages being spoken in earshot (English, Japanese, Spanish and French), sipping a caffe americano, it is with no small amount of personal satisfaction that I get ready to turn the page on 2005. Things are good.

So, what would I like to be looking back on in a year? That's simple. A relationship with a suitable candidate for a life partner.

Cheers.

rdewald is just west of Boston for Christnas Day. I went to a party in Amesbury last night in observance of the Swedish traditions, attended by a variety of Americans of Scandanavian heritage. There were Swedish meatballs, meat pie, this and that kind of traditional bread. It was the same party I attended on Christmas eve last year. There's a family that runs a farm in New Hampshire that attends, the host family is the head of an Episcopal church, I met a guy that makes glass harmonicas. Candles in the all the windows, it was a real Yankee Chrstmas.

It's nice. There's snow on the ground, but not in the way, the weather's been unusually warm. New England at Christmas is beautiful. Be well.

Kinky Friedman for Governor (of Texas)!

Why the Hell Not?

Actually, my favorite campaign slogan of his is "How hard can it be?"

Damn right.

Kinky, when he was Richard Friedman, and a freshman at the University of Texas in the Plan II program, had a chance to be my friend. He did not avail himself of that opportunity, but we did enter the same class at our alma mater. He's a couple of years older than I, but he went to the Peace Corps before college.

He looked more like a young Bob Dylan back then.... I kept up with his musical career, his band, The Texas JewBoys, his comedy, his detective novels (they're great!), a number of runs for political office, and I shall NEVER forget one very interesting evening with Kinky, Hunter S. Thompson, a bottle or two or three of Jack Daniel's, and an intimate group of about 1500 friends at the Austin Opry House. It was a MOMENT in time.

My favorite Kinky Friedman song?

"They ain't making Jews like Jesus any more."

Offended? We all hope so. Tell your momma I said Hi.

Kinky's the real thing, a true Texan, in the tradition of LBJ, Frank Dobie, and Willie Nelson.

I'm going to miss the quiet of a NYC sans buses. Apparently, they make a lot of noise.

Well, it's over. The buses are going to go back online as soon as people show up to prep and drive them. The subways will take some time to get up, just as they did after the blackout.

Today was a lot of walking, a nice sense of having the City to one's self, and a widespread sense that they were going to get this thing settled before the TWU head honchos got hauled off the jail, which was due this afternoon. I'm pretty sure they would have not had much choice but to slap them in jail, just as the congress is not going to have much choice but to impeach George Bush.

Judges, however, are still known to have some spine, as evidenced by the Padilla case decision this week. Congress? Well, we'll see. They haven't shown much interest in doing their jobs for a while, so GWBush may just get away with admitting to an impeachable offense publicly.

"I'm George Bush and I approve of this lawbreaking."

On the plus side, it is a lot easier to get a table at a restaurant or get waited on in a store right now. There simply aren't as many people around and the ones who are around are neighborhood regulars who know how to cooperate for efficiency and pleasure in these transactions. No "what the hell is a macchiatto?" questions in line at Starbucks, no yokels waiting until their number comes up at a deli counter or for a bartender to get around to them before deciding what they want.

I shared a cab with a very lovely woman (who resembled Lisa Kudrow), who might have otherwise not given me the time of day. much less the seat next to her, if it weren't for the transit strike. We chatted it up quite a bit, I almost asked her for her number (she was too young). I slept very, very soundly last night (probably because I walked about five more miles yesterday than I normally do). My caseload at work is a bit down, it's quite possible I would have either been pulled into the office or to another area to do some extra work were it not for the strike.

On the minus side, I had two patient crises yesterday which I had to resolve over the phone (I would have much preferred to been in the home) and I spent $20 on a shared cab ride that would have been no more than $12 (and solo) sans strike. Also, it's cold, the only break I have from it is in my patient's homes, I'm otherwise in the friggin' cold all the time. Also, a *BIG HUGE* minus is that I left my cell phone charger at the office yesterday, a must have for my practice, so now I am faced with the decision about a $30 outlay or a 7 mile round-trip excursion, either by foot or cab, to pick it up. EFF!

People are coping for the most part by not coming to work or by car-pooling. Right now, we're still in the first couple of days and a lot of people are just putting things off. If this stretches out a few days more it's going to really start to hurt some people who have trouble getting around under the best of circumstances.

A few of my patients have had to do without their home health aides who can't make it into the City, another had to deal with an ambulance service that was overbooked. I'm sure we're going to learn in days to come about deaths and other suffering that can be blamed on the strike, I'll bet a few of these just have yet to be discovered.

The weather has been nice, if cold, which has been a great blessing. It's dry, there's no snow on the ground of any consequence, the winds are mild, the sun is bright.

One thing that's been sort of unusual is that I am being asked by almost everyone "They're going to settle this thing today, aren't they?" I'm the kind of guy that likes to know the names of the clerks, cooks, doormen, and cops that I see routinely, so I talk to people a lot, and recently there's been a great deal of interest in my opinion about the state of the strike.

Heck, I dunno. I tend to not pay a lot of attention to things I can't control, so I'm not very informed about the issues. I just find it a measure of people's general distress that this question is coming up so much. It's as if everyone feels like they can out up with this for a day or two, but if it drags out, well, things are gonna break.

That's the report for now, it's a first and only draft, sorry for the choppy prose and typos. I gotta drink this Grande Americano and walk 22 blocks uptown, there's a little old lady that needs her medicine....

The Transit Worker's Union is striking against the Metropolitan Transportation Authority in New York City. No buses, no subways. I live near Columbia University, at about 116th street on the upper upper west side of Manhattan. I have to be in a meeting on Tuesday mornings which is held at 57th and Broadway.

I walked. It took about an hour and a half (including a couple of stops in Starbucks on the way). Google maps tells me it is about three and a half miles.

Uphill.

In the snow.

No, not really. One thing that was quite fortunate is that it was a dry and clear twenty degress for my morning constitutional, and mostly level.

Above 96th street there are no traffic restrictions. At 7am there was a ten block back-up on Columbus Avenue above 96th. Below 96th, where one must have four passengers in the car and no commercial vehicles are allowed, it was as if it was very early on a sleepy non-holiday Sunday morning. Cars were zipping down empty north-south avenues, there was practically no cross-street traffic at all.

There was a number of people walking, about as it is during a busy Saturday afternoon. Once I got to mid-town the morning pedestrian traffic was actually a little light.

I'll keep posting here as much as I can to let those of you with an interest (which I imagine is going to be mostly my NYC readers) what it's like for me.

"You can't count on the system to be good. People have to be good."

The words were spoken to me just a few years by a friend of mine who is a Catholic nun. She taught at my high school and distinguished herself as one of a handful of adults (my parents were not among them) who both really *saw* me as a kid/teenager and was brave enough to speak up about it. I was difficult to see as a kid, I hid behind a wall of lies and roles, all defenses against the reality of my life as a child and adolescent. The reality of my life was neglect and abuse, the consequences of which survive to the very day, though I'm closer to putting it behind me now than I ever have been.

But, I digress.

Sister Mary Brian uttered the above quote in the garden of the old MoMA, where we met a few years back to visit when she was in town to visit a friend of hers. We were discussing the Catholic Church itself and the scandals and mismanagement which was emerging at the time. But, the utterance has stuck with me, it has so many applications, particularly to political life here in the US right now.

I just came in from a day in the City. Christmas here is very special, the City really puts a show on, and there's multiple opportunities here to really have very nice experiences during the winter holidays.

There's also very little awkwardness around the coincidence of the religious holidays here. A number of Jews I know have Christmas trees in their homes. Religion-inclusive greetings such as "Happy Holidays" and "Seansons Greetings" are seen as evidence of a proud generosity of spirit, not of exclusion or co-opting of some group's traditional territory.

In group therapy we've been talking about and working on what we call "roles." The term refers to patterns of behavior and thought which take our attention away from feelings and our present experience. Included in this work is recognition of "frames" and "framing," which provides the mental entrance into a role.

Roles come with a price. A high price. We lose ourselves in them, we get further away from who we really are, as do those around us. The payoff is they are familiar and temporarily comfortable. They shield us from the pains of life: (1) isolation, (2) responsibility, (3) uncertainty, and (4) impermanence.

I can give you what I think is an excellent example of this in a short exchange from the group. Pauline in a very beautiful and warm member of group whose defenses and roles have kept her from knowing her own beauty and warmth well into her 30's.

Pauline: My boyfriend left me last Friday.

Therapist: Pauline, that's a frame. Tell us what really happened.

Pauline: My boyfriend told me he wanted to end our realtionship last Friday.

Therapist: Note how you're feeling now, Pauline, what'e the difference?

Pauline: I'm not feeling so much like a victim.

Victimhood is a powerful role for many people, myself included. It gives you a warm cuddly blanket to wrap yourself in to protect yourself from the pains of (1) bad things happen, (2) we are each free to chose how to react to them, (3) there's no way to know what's going to happen next, and (4) every relationship and everyone dies.

I can tell when I am going into a role when I notice that I am going off-alignment with another human being. I can take a superior or an inferior role, which I refer to as "one-up" and "one-down." One-up is when I decide that someone else is not as wise, evolved, kind, or (insert ettribute here) as myself and therefore I can dismiss my interaction with them as being beneath my authenic consideration. One-down is when I decide that someone else is simply more (insert attribute here) than I am and I can't have an authentic transaction with them because we are not peers. They sound like opposites, and they are in the way that North is opposite South, but both are directions and share many more attributes than distinguish them.

What is the inevitable result of the entrance into a role is the loss of my authenticity as a human being. Roles go according to scripts, patterns that are worked out beforehand, that are repeated every performance, which resemble real life in only the most superficial of contexts. That is, words are exchanged, agreemments are sometimes entered into, and feelings are swept safely under rugs, no longer present in the room.

Authentic transactions involve the exchange of words, agreements are sometimes entered into, and feelings are felt, which results in them no longer being present in the room. But its not safe, not in the sense of avoiding the awareness of isolation, responsibility, uncertainty and impermanence. What happens in authentic transations is the participants are left with a sense of shared humanity, no matter what the resolution, each participant in an authentic transaction knows their own isolation, responsibility, uncertainty and impermanence. Compassion and empathy can bridge the details, connecting people who are experiencing all this as doing so together. That's community.

Those who wrote about Jesus hundreds of years after his death relate that this was central to his message. That's what Christmas means to me and it seems to me to be the kernel of wisdom around gift-giving. Here, beloved, be alone, responsible, uncertain and dying, here together with me.

So much of political life in this country has devolved into roles, in fact, we really only have two: Conservative and Liberal. Everyone and every issue has to be reduced to one role or the other, and then everyone can fall into line behind their role of choice. Conservatives are completely robbed of authentic interaction with Liberals, and vice versa. The payoff for the roles are group membership, demonization of the opposition, certainty, and solidarity with a long history of related positions which stand the test of time, such as assertions about what the founding fathers really wanted, or whatever.

Liberals shield themseves with the notion that since both Presidential elections were fradulent they aren't *really* responsible for the government we have now. They'd be different if we weren't the victims of election/campaign fraud. Conservatives shield themselves with the notion that the terrorists force our hand on this or the other discontinuation of our political culture and values, so they aren't really responsible for the government we have now. They'd be different, all for freedom and privacy and peace, if it weren't for being victims of terrorism.

Both sides seek to shrink from the horror of the government we have now. They each use their own defenses. They are much more alike than different.

Taking a page from Rove's frame that religious organizations have been discriminated against by the government by an abusive misapplication of the First Amendment, we are now told that Liberals are taking the Christ out of Christmas by advocating for inclusive and generous holiday greetings. The utter ironic absurdity of this should be as transparent as the notion that Pauline's boyfriend abandoned her by being authentic about a change in his feelings for her. But, the roles blind us.

No one can take the Christ out of anything. There's no there there. The presense or absence of Love in any situation is in the eye of the beholder. No one can put it there, no one can take it away. We see what we choose to see.

Just a few words on my mind now. I don't get to post as often because my life is filled with my work, which I dearly love. I read, though, and I'm glad each of you is along with me on this ride.

Om Mani Padme Hum. Be well, be happy.

Well, as I'm sure most expected, Gov Schwarzenegger decided to do the politically expedient thing and step aside from his opportunity to spare Tookie. One thing is clear, Arnold's not finished with running for office.

It's also pretty clear that he is not made of the kind of stuff it would take to make a stand for morality against the mob sadism of those who believe we should kill people to show that killing people is wrong.

Some number of employees of the State of California will commit the coldest, most premeditated, most senseless form of murder there is. They will knowingly kill someone they don't know, for reasons that make no moral, logical, rational, or philosophical sense. The killing will accomplish nothing, make no one safer, right no wrong, bring no one back, accomplish no gain for the killers, nor for those for whom they kill. No lives will be saved, nothing of value will come of it. It is just sadistic senseless brutal violence. Mankind at it's worst. No one will be at risk when it happens, no threats will have been issued, there will be no emotional crisis to mitigate the savage coldness of the murder, no advantage will be gained, it is utterly and completely senseless.

Go on, Arnold. This is how you get votes in this country, and it is shameful and tragic. Tookie's pain will be over soon, the rest of us will have to live with his blood on our hands.

It's on the front page right now. Coca-Cola has decided to market a coffee-coke blend soda, first in France, but also here in the US.

Here at the Center of the Known Universe, we have had a similar product available for four generations, Manhattan Special, which is, like so many NYC legends, misnamed because it is made in Brooklyn (similar to the Lexington Avenue Egg Cream, which has no egg, no cream, and can't be obtained on Lexington Avenue, or Herald Square, which is a triangle, or Madison Square Garden, which is not on Madison, is not square, and does not contain a garden).

I even know a place in Cobble Hill, a neighborhood in Brookln, that has Manhattan Special on tap, as it were, i.e., dispensed from a fountain soda dispenser.

Manhattan Special is great, and they use cane sugar, so it is one of the few non-diet carbonated cold drinks I still consume. I would try the new coke product, but I'm certain they will still be putting profits ahead of their customers' health; using HFCS. If they put out a diet version, I may give that a try.

But, if you can find Manhattan Special where you live (try your specialty grocers), I assure you, a carbonated coffee drink is not a bad thing. I give Coca-Cola credit for thinking a bit outside their box.

JOBS

Domino's Pizza Delivery Driver
Security Guard at Clothing Optional Apartment Complex
Stock Boy at Men's Clothing Store
Hospice Nurse

REPEAT-WATCH MOVIES

South Park: Bigger and Uncut
Blazing Saddles
Gandhi
Young Frankenstein

FOUR CITIES OF RESIDENCE

New York, NY
Denver, CO
Austin, TX
Pecos, NM

FOUR BELOVED TX SHOWS

Washington Week in Review
South Park
The Simpson's
M*A*S*H

FOUR VACATION DESTINATIONS

New York, NY
Austin, TX
Pecos, NM
Amsterdam, NL

FOUR WEBSITES VISITED DAILY

Hospice Pharmacia
Weather Underground
Wonkette
Life Hacker

FOUR FAVORITE FOODS

NYC Pizza
Central Texas BBQ
New Mexican Green Chili
Dutch Chocolate

FOUR PLACES I'D RATHER BE RIGHT NOW

Here is the only place there is.

I'm mad about Christmas. People are getting it all wrong. Why should they impose their views on us! So, I'm declaring The War on the War on the War on the War on Christmas (tm).

We really don't have to put up with this. We can make it right. We have the power, every rational person agrees, we just need to make our voices heard!

If you can figure out what waging The War on the War on the War on the War on Christmas (tm) means, let me know. I'm not sure what to do about a tree.

rim shot

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I got a letter from a family. It was nice. It helps.

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There is considerable tumult at work. Be careful what you ask for, folks. I wanted a job that was important, where I do something that matters. I have it. I'm breaking out into a rash. I'm pretty sure its stress.

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If you haven't yet had the honor and privilege of reading my current sig line....Give Jesus a break, observe a Buy Nothing Christmas. Canadian Mennonites. Go figure. I'm into it. I'm not *buying* gifts this year (I'm still giving gifts). It feels right for me, and it's a lot more fun than shopping. I'm baking, burning CD's, coding up HTML and writing letters. I'll be doing something almost every evening from now until Christmas, something thoughtful for a friend or two or ten.

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I've been watching the Christmas advertising with interest this year (as opposed to doing everything possible to avoid it, which has been my traditional observance of the Season). I've learned to find it interesting to identify the appetites targeted, and I notice that it is a sort of generous and sympathetic joy derived from the act of giving that is the most common target. Apparently people respond to that message (advertisers know what they are doing) which is a hopeful sign, Clarence.

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The University of North Carolina Tarheels are going to surprise the NCAA Men's Basketball world this year. They lost 7 players from last year's Championship Team, the real stars of the Matt Doughtery recruiting classes are gone now....it's Roy Williams team, which is to say it's a return to Carolina basketball of the Dean Smith era in many ways, which is what I really like about college basketball.

The Illinois loss was a lot closer than anyone expected and the Heels beat a very tough Kentucky team last weekend on the road. They're ranked now.

Will they repeat? Of course not, but Roy Williams has demonstrated once again that he can make things happen for a college basketball program. They will be better than .500 in the ACC, which is no small thing. It is going to as enjoyable as a rebuilding year can be for UNC fans.

I stepped on my ear-buds that came with my iPod while taking my cup of coffee from the bar over to the sugar/milk area in Starbucks last week. I usually toss them over my shoulder during my brief interactions with the outside world (like ordering a Venti Americano with room), they fell off, I had a computer in my other hand, I wasn't paying attention and I discovered that Apple did not engineer these for being stepped on by 370 lb men, no matter how good-looking they may be.

My other set of headphones got run over by a NYC bus, no joke. I was exiting the rear door of one of those mammoth double-length crosstown buses, which stopped right up against a parked car, so I had to squeeze past the door to close it, the headphones came off, fell in the path of the rear wheels of the bus, and I discovered these cheapo around-the-back-of-the-head personal audio monitors were *also* not engineered for being run over by massive City buses.

Engineering failures. Damn them.

Anyway, I need new personal audio monitors and before I go down to the Apple store and pay a lot for earbuds that were okay, but not great, I thought I would ask you friendly people for suggestions.

Thanks in advance.

Heh, heh, Reality is all Cool and stuff.

Replaces Buddha as my desktop wallpaper.

If medicine is about treating sickness, then nursing is about helping people cope with being sick.

In hospice, as a nurse, I am out from under the prime directive of life extention / death avoidance. This is somewhat liberating intellectually, but it takes a long time to get used to it. My habits were honed over the years to always avoid death. Death was the flunking grade. Sometimes you faced it, but you could only be comfortable if you had literally exhausted every way you knew to prevent it, including all of your wild guesses.

In hospice, death is the goal line. You don't know when it is going to arrive, but you invite it in for tea when it comes. A few nights ago I sat vigil at the bedside of a patient who I believed was going to die at any moment. I was wrong. I sat there for four hours learning I was wrong, holding her hand, watching for the emergence of symptoms I could medicate or otherwise ease. She was exhibiting Cheyne-Stokes respiratory patterns, mottling, unresponsiveness. I reflected on the fact that in another context I have been in, as an ICU nurse, the emergence of any one of a number of symptoms I was seeing would be the cause to hit the panic button, to summon a small army of people from all over the place, to whip out dozens of tools and medications, basically to turn the scene into a flurry of activity.

Instead, I sat holding her hand, noting that her grip was getting weaker over time, scribbling notes on a note pad, and listening to the low, mournful howl of the late autumn wind whipping around the window frame. It was very peaceful and still, a deeply profound and moving moment of quiet compassion.

I called her family in from out of town, they came, but death didn't. I felt a bit like a failure for the misjudgement.

Of course, you're always eventually right. Everyone dies.

It can be a difficult decision for patients and their families to choose hospice care, sometimes its the only thing to do.

The world of the hospice nurse is about respecting autonomy and symptom control. I like to say to patients that I am going to work to do two main things: (1) keep them out of pain and (2) keep them in control of their circumstances. It's not really that simple, but that it a principle I return to in my thought processes very frequently.

The hardest thing I have been dealing with lately is the fact that sometimes the things I do to make the patient comfortable make the family uncomfortable.

A good example of this is the administration of morphine in the patient who is dying in respiratory distress. Morphine has a bad reputation among the lay public, it is seen as a drug of abuse, a drug of desparation, given only in hopeless situations to try to dent intractable pain.

That is sometimes true, of course, but this is a bit like characterizing the brakes in a car as a desparate measure, used only to avoid fatal accidents.

Morphine actually eases breathing, it is a good drug to relieve respiratory distress, particularly when titrated from relatively low doses. Usually hospice patients who die in respiratory distress have a long history of treating the underlying disease process and having their distress relieved by those treatments. In hospice, we're past that point. Their disease is no longer responding to treatment, so we're treating the *symptom* of respiratory distress, which means we do things like turn up the oxygen and administer low-dose opioids to people not complaining of pain. Death is on the way, we're just making a soft place for it to land.

For the family, whose only previous contact with morphine is in desparate situations, it sometimes is interpreted as if we are acting to hasten death, trying to just put someone to sleep, like a pet. There's acually no evidence that morphine (or other opioids), given in the way that we do it in hospice, either hasten death or prolong life. It simply eases respiratory distress, sometimes accompanied by a sense of mild euphoria and it also sometimes eases anxiety.

Think about it, what do you do when anxiety has been relieved and euphoria introduced? You lie back, close your eyes and relax. Picture that in your head. Picture every death scene you've witnessed in the movies or TV. See the association emerging?

So, I've just made the patient comfortable and the family uncomfortable. Welcome to hospice care.

There's a lot more to it. You get the usual assignments in people's minds we all do in our daily interactions, but the volume gets turned up on mine a little more. I have some patients and families who regard me as virtually beatified, a saint walking this ordinary earth. I no more deserve that than the creepy disgust with which I am regarded by those that associate me with the grim reaper, scythe in hand. The gamut runs between.

I can't predict it. Some patients I expect to like me don't, others that I expect not to, do. Some families like me while the patient doesn't, and vice versa. I regularly piss people off. I regularly disappoint them. I regularly am the only person they can turn to and ask about dying. Sometimes I am the only person to whom they have admitted they know they are dying.

Things have to get done. When someone needs something, I can't wait until it's convenient to get it done, I may run out of time. I sometimes do. I've found I'm better than I expect at predicting imminent death, but I am nothing near perfect at it. In some ways, the hardest thing is dealing with accepting my mistakes and shortcomings. That's really hard. Sometimes I'm wrong. Sometimes I don't know. Sometimes I miss things, signs, clues, harbingers of problems, which I really want to see every time.

Its hard. I love this job, but it's hard.

It helps to write about it. More later.