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Richard J. Riehl is a Carlsbad, California resident, retired university administrator, and award-winning columnist for the former daily newspaper, the North County Times. Contact him at richard_riehl@yahoo.com

Friday, July 24, 2015

The "Palomar Hilton" Medical Center: A Room with a View and Dream Team Nurses

As my wife was wheeled into her hospital room at midnight last Monday, a paramedic politely questioned her, testing to see if the UTI diagnosed earlier in the Encinitas emergency room had affected her mental state.

"What's your name?"
"Karen Riehl."
"Do you know where you are?"
"I'm in a wonderful hotel!" She made a grand gesture around the room.

It was her sense of humor, of course. The ambulance crew discovered it during their drive from Encinitas to Escondido's Palomar Medical Center. But when I joined her later, I discovered it was no joke. The place truly resembled a well-appointed hotel room with a hospital bed. When Karen learned she would be admitted to a hospital overnight, we pictured a small, double room with minimal necessities, beds separated by a translucent curtain, sleepless nights, and the usual assembly-line patient care.

What we found instead was a spacious single room with a large window framing a splendid view of the rolling hills of Escondido. The remote device used to call the nurse and to operate the TV also controlled the window shade. Below the window was a sofa that folded into a bed, my sleeping quarters. The room's thermostat hung on the wall next to the sofa. Karen had it set to 74°.

 A smaller window, near the door, allowed a nurse to keep watch on a patient without entering the room. A 45-inch flat screen TV hung on the wall opposite the bed. Below it, a narrow counter, large enough for personal effects, towels, coffee cups, etc. ran most of the length of the room.

A Patient Resource Guide stood on one end of the counter, just like a fine hotel's Guest Services guide. It had answers to every patient's questions: a description of each feature of the room, how to adjust the bed, what to do with your personal belongings, encouragement to speak up for your needs, a list of your privacy rights, how to pay your hospital bill, and what happens on your going home day.

A menu for room service was placed next to the resource guide. The meals were delicious. In her three days Karen enjoyed grilled salmon, pizza, granola, hot dogs, fruit, and chocolate ice cream.

A whiteboard on the wall in the corner of the room facing the bed contained vital patient information, beginning with the individual's preferred name. The room number was listed, as well as its telephone number, today's date, and the name and call numbers for all caregivers. The board was updated daily.

But what impressed us most about Karen's stay was the incredible teamwork among the staff. Each time there was a change in nurses the one leaving joined the one coming on to introduce the new one to Karen and assure that she did not have to retell her story about symptoms and personal needs with each change of nurse. Each nurse was exceptionally kind and knowledgeable. Nurse Kurt had a fine straight-faced sense of humor, warning us that he was known as the hospital's hyperactive nurse, once harboring aspirations to be a standup comic before picturing himself standing in front of an audience with nothing to say. He handed Karen off to Nurse Ferdie, who took the time to explain, in layman's terms, what the various medications and treatments did to help Karen recover from the bacterial infection she battled. Nurse Haley had a sparkling sense of humor and an intuitive understanding of Karen's frustrations with being tethered to an IV machine for hours each day. 

The day of Karen's discharge five individuals with supervisory responsibilities for patient care joined Nurse Haley in Karen's room. They wanted face-to-face feedback on her stay. No hospital had ever given us that opportunity. As my wife's sleepover roommate, all I could add to my satisfaction with this hotel was being jolted awake one night by the silence. Had we been left behind in an evacuation? Nope. It was just a priority for this hospital to keep it quiet at night, recognizing the healing power of a good night's sleep.

Tuesday, June 30, 2015


My afternoon nap was disturbed last Thursday by the sound of a man's cheery voice from behind the screen at my open front door.

"Hello, hello!"

Awakening from a sound sleep, I shuffled to the door to find a man standing there, holding a clipboard. He didn't introduce himself, just explained, "We're gathering signatures to save the strawberry fields." I didn't recognize him, but his easy way led me to believe he was a fellow resident of our 40-unit condo community.

Despite full knowledge of our HOA ban on door-to-door solicitation and my own vow never to sign a petition without knowing the details of what it meant and who was pushing it, I allowed the phrase, "save our strawberry fields" to cloud my better judgment. When Karen called from another room to ask who was at the door I told her it was someone who wanted to save the strawberry fields. She gladly added her name to mine for the apparent do-gooder at the door.

The following day, as I awaited my prescription in the pharmacy, I picked up the June 12 edition of The Coast News. The headline, "Nordstrom Signs On to Strawberry Fields Shopping Center," of Ellen Wright's article told me we had happily signed up to clear the way for a two-story shopping mall next to I-5, hiding from public view the bucolic farming scene we've treasured through the years.

Reading further I discovered the developer, Caruso Affiliated, has launched a "citizen-led" initiative campaign to bypass the usual approval process. The city council will be able to approve the project outright, or put it on the ballot. If 15% of registered voters signatures are gathered (8,900 signatures of 59,000 voters) and the council chooses a ballot measure, a special election will be held.

I soon discovered another news article about the project. This one in the San Diego Reader, "More Shopping, Less Strawberry Picking in Carlsbad's Strawberry Fields?" By Ken Harrison on May 29. Harrison opines, "Some say the initiative tactic used by big developers is a ploy to sway a generally uninformed electorate, or, in some cases, hoodwink them with slick or misleading campaigns."

I also learned Caruso Affiliated's citizen-led initiative campaign is headed up by a former planning commissioner, a member of the Lagoon foundation, and a former Carlsbad Chamber of Commerce CEO, hardly a cross-section of community interests.

A few days later, Karen and I came upon another signature gatherer lurking outside the door of our local grocery store. His appearance was a far cry from the well-dressed neatly coiffed gentlemen at our front door. I asked him who he worked for. Visibly taken aback, he asked why I wanted to know. I told him we want to know who paid him to gather signatures. (I, too, was a far cry from the sleepy old man who shuffled to his front door last week.) He finally told us he had a card. I asked him if I could have it. He handed it to me. I discovered he worked for Voter Contact Services, Inc. in Oceanside offering services for Petition Drives, Door-To-Door, and GOTV, For Issues and Candidates. On the reverse side were instructions for turning in signatures for payment.

Here was the classic example of how citizen-led petition drives have been perverted by big money. I remember the days when signature gatherers had a personal interest in the issue and not in $1 to $3 to get my autograph.

Although I blame myself for giving away my name so readily, I also blame the lack of a local daily newspaper. If a developer calling himself "Papa" had not purchased the North County Times to kill it, Carlsbad residents would have been able to gain a far better understanding of the issues and be less vulnerable to developer spin. Full disclosure: for 9 years, as a freelancer, I wrote op-ed community opinion columns for the newspaper.

In case you haven't heard, a Sacramento County judge ruled an initiative campaign for a new law titled Sodomite Suppression Act was "patently unconstitutional," since it calls for the killing of gays. http://tinyurl.com/ntkw635. State Atty. Gen. Kamala Harris had to ask for the ruling because she had no power to keep it off the ballot.

It makes you wonder how the author of that initiative would have spun the new law for his signature gathering campaign. Maybe something like, "Save Our Children, the Right Way."

Is it any wonder the Caruso Affiliated campaign for the strawberry fields shopping mall chose the title "Preserving Carlsbad Open Space" in bold type, followed by "The Right Way" in smaller, gray type.  That means one more shopping center, rather than a new venue for the arts and entertainment, a place that would attract visitors for what makes Carlsbad unique, rather than just another parking place to shop, dine and catch a movie. Like L.A.

Tuesday, June 23, 2015

Top Ten Reasons To Be Grateful The Day After My Hernia Operation

10. Obamacare, for my free annual checkup that led to the diagnosis.

9. The wealth of information online about Inguinal Hernia Repair. I got sidetracked surfing the web, coming upon a long list of surgeon slang words. "Virgin abdomens" define first-timers like me, doing nothing to reduce my fear of being cut open by a stranger. But I liked the inter-active decision-maker at another website. It helped me understand my personal priorities: balancing fear of the knife vs. fixing a problem that won't fix itself. Painful daily reminders by My Little Buddy, throbbing in my groin, tipped the balance.

8. Sharon, a family friend who'd had the operation, promising me it was "no big deal." That only called to mind what Vice-President Biden had whispered into President Obama's ear just before he began his speech on the enactment of The Affordable Care Act. Were Biden's words prophetic about the pain I'd feel in repairing my hernia? That it would, in fact, be "a big F-ing deal"? It turned out that they were both right, his words about taming My Little Buddy, and hers about the pain of the procedure.    

7. Kaiser Permanente, for their computerized medical records. A written report was emailed to me within an hour of the meeting with my surgeon a few days before the operation.

6. Nurse Cheryl, who skillfully and discretely shaved the site of my operation. Putting me at ease with her sense of humor, she chuckled, "Now you know what women have to go through." I stifled the impulse to reply, "Be careful down there, Nurse Cheryl. Don't nick me, bro'."  

5. Nurse Mari, who cheerfully wheeled me down to the operating room. She was the third nurse, as well as my surgeon, to ask me what I was there for and what side of my groin would be cut. I knew it was just their way of gaining my confidence there would be no accidental slices in the operating room.

4. Anesthesiology, for making my three-hour, out-patient surgery entirely pain-free. Entering the operating room was the scariest part of my adventure that morning, but the anesthesiologist was expert at making me more comfortable mentally and physically. After affixing a plastic mask over my nose and mouth, she asked me to inhale deeply three times, by my third breath, Elvis had left the building.

3. Modern medicine. It wasn't that long ago, measured by this septuagenarian's sense of time, that living with an unrepaired hernia was a life sentence. I'd have had to make a life with My Little Buddy.

2. Dr. Elliot. I wasn't there to see him, but lying naked on the gurney with my arms outstretched, I pictured a masked man in whom I'd placed all my trust, younger than my children, leaning over me with a knife. I thanked God, Allah, or whatever other power of the universe there is, for his expertise.

1. My life-partner, Karen, who has filled my prescription for health and happiness with her daily dose of love and laughter for 29 years. 

Next month I'll be scheduling a return to the same operating room for two cataract operations. Which reminds me of how grateful I am for being able to do all of this without worrying about cost, thanks to the generous insurance benefits enjoyed by California State University retirees. The Affordable Care Act has brought health care through insurance coverage to many who have had to go without. But too many continue to be left out while politicians wrangle about whether health care is a right or a privilege.          

Wednesday, June 17, 2015

Bart and Gilda

We adopted our two-year-old twins six months ago. Bart adapted quickly to his new home, but Gilda continues to be an unhappy camper. She bit Karen's finger when she tried to feed her last week.

Although they look a lot alike, they aren't really twins. They both have four-inch shells. But Bart's an Eastern painted turtle and Gilda a red-eared slider. We named them after Bart Simpson and the late Gilda Radner. Bart and Gilda are aquatic turtles, so we needed to buy an aquarium, water heater and filter, basking platforms and turtle food.

We adopted the two to compensate for the loss of our beloved toy poodle, Olivia. She'd been a puppy mill mother for ten years before we got her from a shelter offering free "seniors-for-seniors" pets. She'd been traumatized by her years in a cage. She'd also been debarked. Because she refused the leash, we got her a stroller for small dogs that had a sign on its side reading, "Outward Hound." As she rode along with us on our daily walks the looks we got from passersby ranged from smiles to sneers. She remained our faithful companion and silent partner for eight years.

Bart and Gilda are no louder than Olivia, but are not quite as much fun. They can't be cuddled on the couch. But they are entertaining in their own way. Although they have two basking platforms, they prefer snuggling together on one. Bart likes to climb up on top of Gilda's shell, remaining motionless until one of us appears, when the two of them skitter off into the water. Their behavior inspired us to do some research on turtle mating. The graphic YouTube videos suggest it ain't only Bart's carapace that's horny.

I also discovered Bart's love of ukulele music. When I play his favorite, "Salty Dog," he races around underwater, raising his head occasionally to savor the moment. Gilda just hides until it's over.

Our collection of canine companions through the years has entertained us with a variety of personalities. Brandy, a cockapoo, was Karen's loyal companion throughout her single mom years and a casualty of our move from Washington to Indiana. While we were busy moving into our new home she quietly left by the back door, getting lost in the snowy woods nearby. She was probably searching for the home she knew.

Brandy's passing brought us a beagle we named Phydough, who loved to join me in song when I played the guitar. He was also fond of running off whenever the front door was left open. One evening we were certain he was gone forever when a stranger appeared at our front door, holding Phydough's collar. His run for freedom had carried our wandering beagle about a mile and a half away.

Then there was Wilson, a miniature schnauzer with a wonderful sense of humor and an arrogant attitude that prompted him to strike a regal pose whenever he spotted us with a camera. He loved to race out the front door but remain within sight so he could tease us, dancing away upon our approach. We had to give him up when we moved across town to our tiny condo, where he would have been miserable.

I had a succession of three pets as a kid. King was a collie standing taller than I. After he disappeared one day my parents explained he had to be taken out to the country, where he would be happier. I now suspect "the country" meant the hereafter.

Pitch, a black cat, was my best friend and confidante in grade school. But when we moved to the country, he wandered off, back to the city, I  presume.

After Pitch's departure a family friend gifted us with a beautiful and well-behaved Doberman. We lost Fritz in a tragic accident. Mom found his body next to the railroad tracks. A passing train had decapitated him after his collar had become entangled in the tracks.

After the loss of all my childhood pets, I was reluctant ever to give my heart to another. Until I met Karen, who told me how Brandy had kept her spirits up during some very hard years. I now understand the joy of caring for a pet, even though their loss will inevitably break your heart. Even when your pets look like helmets with legs, like our Bart and Gilda.  

Thursday, June 4, 2015

The Joy of Aging

Yesterday I got an email message from my newly retired brother Jim. He attached a photo of my niece setting a school record in the high jump. As a school record holder a half century ago in the pole vault, I envied her youthful ability to defy gravity. Several years ago I realized I could no longer leave the ground under my own power without injury.

The last time my body took flight against my will, I was literally swept off my feet by a South Dakota dust devil. My wife Karen and I were on an Elderhostel trip in the Black Hills. One blustery afternoon, while walking along a gravel road, we encountered the tiny tornado. It lifted the two of us into the air and dropped us in a roadside ditch. She landed first. I tried to  avoid falling on her, keeping my arms outstretched in my descent. She later called my midair gyrations a vision of Superman in flight. We didn't reach the height of our niece's record-setting leap, but I like to think we captured some of the thrill she must have felt in clearing the bar.    

We recently returned from a trip to Iowa to see the couple we met in Elderhostel. Our visit with them was fun, but the travel was a bummer, beginning with our arrival in Denver for our connecting flight to Des Moines. Our flight from San Diego was late, so we had to race from Denver's Gate B24 to Gate B86 within about 20 minutes. In our younger days this would have been an exciting challenge. But the joy of aging has curbed our enthusiasm for physical challenges.   

Upon our attempt to board the swift moving sidewalk, our only hope of getting to Gate B86 on time to board our next flight, Karen fell, performing a ballet-like semi-splits on her way down. A young male flight attendant passing by lifted her to her feet and summoned a wheelchair. I couldn't help lift her because of my hernia, another joy of aging.

After pushing Karen's chair along the moving sidewalk, reaching an estimated speed of 20 mph, we arrived at Gate 86 in time to learn the plane to Des Moines had been delayed an hour.

The return flight home went smoothly, aside from several hours of panic that I'd left the car keys in our Des Moines hotel room, hoping we'd find them in our checked bag upon our arrival home in San Diego. We found them, and after breathing a sigh of relief, vowed to stay away from air travel for awhile, maybe forever. 

This week I'm scheduling surgery to repair my Little Buddy, the name I've given the irritating bulge that found a home beneath my unmentionables. Then I'll schedule the cataract surgery.

The good news about the joy of aging is the wealth of opportunities for personal development, set aside or remaining undiscovered amid the distractions of youth.

I've discovered a passion that came as a complete surprise: a quest to conquer calculus. After skipping 5th grade and getting lost in fractions, I concluded I hated math. But now, through online instruction in the free Kahn Academy, I've achieved mastery in Algebra and am navigating my way, with baby steps, through geometry and trig. I work at this about three hours a day, while Karen is writing her next novel in another room. After her eBooks are published on Kindle, Nook, iPad and iBooks, I get to be her publicist---which is a somewhat related to my earlier career in university recruitment and enrollment management.

About an hour each day I play one of my four instruments: guitar, ukulele, banjo, and mandolin, singing my favorite folksongs and golden oldies, picturing an adoring audience of septuagenarians raising their glowing cell phones in appreciation. Karen got me a balalaika for my birthday, so I've begun learning finger positions on that strange, three-string Russian instrument.

Next week Karen and I begin a six-week class on San Diego History, offered through Cal State San Marcos extended learning.    

So, despite the relentless march toward physical incapacity, there can be joy in aging. If you're lucky enough to do it with someone you love.