Bye Summer '09- you've been good to me.

Today is a rainy SoCal day, it feels like fall has actually arrived here in Los Angeles, and I am ready to embrace a new season. However, this transition of seasons has me looking back over the past season and shaking my head a little because the Summer 2009 might be one for the LK record book.  Really all of 2009 has been pretty good to me. Certainly there were rough times, but as I begin to think about all of the year ending festivities that approach I am awed at what a summer (year) it has been.  

 Summer 2009 dawned with me in a minor state of flux, focussed on training for my triathlon, but worried about things I couldn't control.  I gave up controlling the uncontrollable and just went with things.  The results have pretty much been good.  A few bumps on the way, but forward progress nonetheless.  Then there was the tri...  As July waned, my exercise complusion grew.  I approached the triathlon with excitement and trepidation.  When the day finally came, I was well trained and met almost all of my goals.  Afterwards, I surrounded myself with friends and basked in the glow of completing the race and finishing in the top 1/3 of my age group.  People said I glowed, maybe I did, but I was certainly on a post race high for at least a week.  Then the reality that my Asia trip was fast approaching set in and my focus switched to planning for that.  A few short weeks later I hurtled through time and space,  and I found myself in the admazing adventure that was my trip to Mongolia.   After an amazing week of trying to help the people of Mongolia I set off to relax in Bali.  Bali was unlike any place I have ever been. It was beautiful, it was relaxing, it was centering. And then I came home, and life picked up where I left it.  Again I find myself trying to just go with it, enjoying the journey as it passes.

Whew what a summer it has been, as I think about moving into fall, I fear that this sort of post crazy multi event high might be leading to an emotional crash.  That wouldn't shock me.  What goes up usually comes down, but I feel like my life is on a forward trajectory and my outlook is amazing. Thanks Summer 2009, I'll remember you!

Dear Owner of the dog who attacked Sadie

Thank you so much for your kind note and apology for this weeks incident between our dogs.  It was very kind of you to replace my shirt that your dog ripped even though it was a very old t-shirt.  While it was cute of you to sign it from your pit bull, I truly feel that it is you the irresponsible owner that owed me and Sadie the apology, not your dog.  I have absolutely nothing against pit bulls, some friends of mine have a pit bull who is one of the sweetest dogs ever.  When I am at their house tomorrow, her head while likely be in my lap while I scratch her tummy. However, her owners know she is dog aggressive and have her well trained and don't let her run around the street off leash.  That is the difference

Your dog did what pit bulls were bread to do, attack a dog that crosses their home territory and to desist when the humans get involved.  The fact that I literally yanked Sadie by her leash away from your dog and then hoisted her to my shoulders is why she is unharmed.  The fact that the incident happened at all is because your dog was off leash in public.  That is on you, an irresponsible dog owner.

I take exception to you signing the note from your dog because it really isn't your dog's fault, you just need to realize that you have a dog aggressive dog and not let him run around loose in front of your house.  Bad things can follow...

Thank you very much,

Lisa

This incident occurred during Sadie's and my regular evening walk along our regular path on Monday evening.  I haven't walked back by the house yet, but I know that neighbor and have seen her dog running the streets off leash when he has gotten out before.  We just happened to be in the street in front of their house when he got out this time.  However, aside from us both being upset we are fine.  Sadie is back to normal.  Me not quite, but we're fine.

Wash your hands, please!

In 1845, Dr Semmelweiss in Austria investigated why women were dying of postpartum infections at an alarming rate, ~15%.  He instituted a policy of handwashing after discovering that interns and residents were sometimes proceeding straight from performing autopsies to delivering babies. After instituting the hand washing policy the rate of infection fell to the baseline for the era. Slowly his discovery that hand washing was an important tool to prevent spread of infections gained support.  It is now accepted as gospel truth that dirty hands can spread infection and that hand washing, as simple as it may sound, is one of (if not the) most important weapon against preventing the spread of nosocomial infections.

When I was in Mongolia, I was aghast at the lack of facilities for appropriate hand hygeine.  The staff restrooms often doubled as storage closets.  There was no way to dry your hands.  They did have alcohol gel avialable to use before touching patients, but not at every bedside to be sure.  When the neonatologist there broached the subject of their infection rate, Monica and I immediately launched into a discussion of careful attention to hand hygeine and appropriate patient skin prep and care of central lines.  At first they were resistent, but with gentle support they could appreciate the impact something so simple could have.  Of course, the barriers to hand hygeine in an emerging country are huge.

However, it would be very narcissistic and first world-centric of me to say that the barriers only exist in such circumstances as those I saw in Mongolia, when everyday in my unit we are still working to achieve 100% compliance of all health care practitioners to hand hygeine.  For something so fundamental, I do not think that 100% compliance is an unrealistic goal and fortunately, I have the support of my hospital to try to get there.

Thanks Dr. Semmelweis.  I hope your contributions to medicine will no longer have to be talked about soon.