January 17, 2012

Transplant seminar #3

Since being accepted as a pre-transplant patient at Columbia, I've had to start attending educational seminars, designed to equip with patients and their caregivers with as much information about transplant as possible without resorting to throwing encyclopedias at us.  Each seminar is two talks, usually, and focus on one corner of the transplant world.

The first I attended was actually rather nice, as it was a panel discussion of post-tx patients.  (They generally have their own support meetings, so it is not common to meet post-tx people.)  It was great hearing their stories, seeing how healthy they've become, and listening to the complaints of their caregivers, who seem to have become accustomed to being bound to a *sick* person, rather than just a *person*.

The second set I attended had to do with the ex-vivo project.  Columbia is in a group of five transplant centers doing the very first ex-vivo lung transplants, using a machine that can keep lungs viable outside the body much longer and allow for treatment of those organs before implanting into the recipient.  Fascinating stuff.  So far, they've done two.  The study needs 42 before the FDA will consider it an approved method.

Today's session was a two-parter covering the donors themselves and pre-transplant testing.  I found it odd that Carmen Saunders was covering that topic (and she needs practice!) considering that every patient in that room had already gone through these tests.  But that's an assumption. And perhaps the caregivers aren't up to speed.  Or maybe we need a reminder why some tests get repeated so often.  I personally didn't find any of the tests too onerous, despite the gloom-and-doom rhetoric from other patients, except perhaps for the bicycle test, which I see the importance of and am glad to repeat anytime they want it.

The topic of "who are the donors" was new area for me, certainly.  I was shocked to find out that not every donor is an accident victim.  Or rather, that there are circumstances under which a person is considered a viable donor but is NOT DEAD YET.  Cadaveric donors were not covered, as they're pretty much no longer used for whole organ transplant, only certain tissues.  Of the remaining donors, where heartbeat and breathing has been maintained through brain death in one fashion or another, here's the breakdown:

1)  traditional brain death - typically an accident victim.  someone who is found still alive but who dies en route to the hospital, or is killed in a way that poses no trauma to the thoracic cavity, but damages the head AND life support begins immediately.  This is the ideal case and the one I certainly think of when pondering how I'll end up with lungs (if that should so happen).

2) DCD or Donation after Cardiac Death.  This is a NHBD Category III donor, who is still alive, but will die if life-support is withdrawn.  There are strictly controlled standards against which patients are judged.  The injuries must be fatal, the patient has no hope of recovery, and continued life-support or treatment is only prolonging the inevitable.  Etc.  (This would have been my dad.  He donated his corneas; and the transplant surgeons can be ready, but after his pulmonary embolism, it became only a waiting game.  Dad's fate was sealed at that point.  Unfortunately, since his lungs are what killed him, his other tissues were too damaged from poor oxygenation to be useful.)  ANYWAY.... this is a less-common category for donors.

3)  extended criteria donor.  This is the healthy old guy out mowing his lawn who takes a rock to the head and never wakes up again.  If you're over 65, you don't meet donation criteria.  But exceptions can be made.  I'll take a 65-year-old marathon runners lungs any day over a 20 year old basement-dwellers'.

4)  Finally, we learned about CDC high-risk donors.  These includes people who have been incarcerated, have a drug history, history of risky sexual behaviour, etc.  Not entirely off the eligible donor list, but a person would receive their organs only if in dire, dire need.

I also learned today that if there's a multiple organ transplant, it's the condition of the lungs that is the primary determiner of viability, as opposed to liver or heart.

And what exactly goes into a patient's LAS in the UNOS system?  PFTs, arterial blood gas results, and the number of feet walked during the 6-minute test.  There may be more, but those were mentioned.

I find these seminars mentally exhausting.  Not to mention my personal discomfort being in the same room with other people who may have bugs I might pick up or who might get my bugs.

January 15, 2012

Coffee obsession

I have a problem: I can't seem to stop collecting coffees. Or maybe the problem is that I'm too delighted in all the variety out there. The obsession isn't actually about coffee: it's about CHOICE.

I have a Keurig brewer, which was a gift two (three?) years ago from my mom. It is, in fact, the only coffee maker I've ever loved. It's just so EASY. And it makes switching from one variety of coffee to another - or even to tea or hot chocolate or chai - as simple as getting a sampler pack or a 12- or 18-count box at the local grocery. On a weekend, I may have three different kinds of coffee in a day. Or tea. Or hot chocolate. It's great!

These aren't the K-cups you're looking for.
My problem is that I don't quite finish a box before stocking up on a couple more. So at present I have six varieties of coffee in my pantry, another half-dozen represented by stragglers in the little revolving carousel, and two varieties of K-cup tea.

They're like merit badges!

Not that the long-rooted tea obsession has gone away either! In teabag form, I have three different kinds and in loose-leaf form another four. And as long as we're on the topic of pre-packaged hot drinks, I'll admit that I also recently got a box of Trader Joe's instant coffee (pre-sugared, pre-creamered) just to try it. At 10 cents per serving, I'm not risking much.

And it doesn't suck, believe it or not.
But is all this variety too much? Sure, I love offering my guests a large choice, from regular to hi-test to half-caff to decaf and even herbal teas. But I'm the first to look at a restaurant menu and point out that I could make a decision a lot easier if there were fewer choices!

LESS choice is a discipline and is probably a good one. For instance - let's look at the lines formed at two different establishments for getting your morning cuppa on the way to work. On the one hand, you have Starbucks - highly glossy, awful coffee, very expensive - I have to wonder why people ever go there. Ah, but they have CHOICE. So they flock to the counter, debate for a while, give their complicated "coffee" orders, which take the baristas five minutes to make, and the whole trip takes 10 or 15 minutes.

If you get tennis neck from reading the menu, it's too big.
But on the other side of the street, there's the local deli or small diner. They make one kind of coffee - and it isn't decaf. It's made by the gallon (or two or three) at a time. They have some choices for cream and sugar or their substitutes, but those are limited. And if you have them do the cream and sugar, they do it one way and that's it. Guess how long their lines are? They have none! Not for lack of customers, but because they have a high turnover rate on each order. A good sidewalk coffee/donut guy can pump out 180-200 cups of coffee an hour.

Order some breakfast in your head.  See how easy that was?
So if less choice is clearly the better way to go, why am I so obsessed with collecting coffees and teas? If I'm honest with myself, I could be happy with a single roast for the rest of my life. (Note: that roast is currently Eclipse, but any of the extra-bolds will do.) I don't get bored with a coffee so much as distracted by shiny new ones. If I weren't such a braincase, perhaps I could have some mental discipline and narrow my coffee selection to something more reasonable. Perhaps I can focus if I have just one more cup of coffee...

January 11, 2012

Holiday Windows 2011

Now that the Christmas window season is wrapped up and behind us, I want to record a few thoughts. First, I'm not entirely on board with the entire concept of Christmas, as it has become in modern times. I could do an entire blog post on THAT, but I won't. Suffice it to say that my skepticism about what's genuinely GOOD about the holidays guides my evaluation of my own work as well as others.

I had a hand in multiple retailers' windows and I'm quite pleased with how things turned out. Note that I'm NOT posting pictures here or anywhere else of windows I was involved with. I'm not refraining because I feel bound by non-existent stipulations in a contract I never signed, but rather that the web is saturated with these images. I also never brought a camera along on my many trips to the windows, other than my iPhone, and never got great shots. Que sera sera.

I was responsible for the initial design phases of Lord & Taylor, under the aegis of Spaeth Design as production company, and guided/directed by the client's dreams and wishes. They bring to us the central idea and we flesh it out. Then we build. In Lord & Taylor's case - build and rebuild and rebuild. Though the product we installed was true to the central concept and looked very good, with continuous thumbs up across the internet, the process to get to that was more convoluted than it should be. There must always be time for reflection, evaluation, and necessary modifications as the design is being brought to life, but I'd say that that has been taken to an unhealthy extreme in L&T's case. On the commercial side, I don't see how it can possibly be a sustainable business model for the production company. But that's their fight to take to the client, not mine.

Spaeth has my final color models of the windows on display at their offices, which horrifies me. Models are not the product and are certainly not art. There's a certain archival value to them, but these are not meant to be seen by non-L&T clients. But whatever. I don't own them, Spaeth does. And there's plenty of artifacts floating around those offices that I *am* proud are on display.

Macy's is a riddle in a puzzle in an enigma blah blah blah. Along about May, I was tasked with taking the initial sketches of the Macy's Herald Square designs and converting them to tell the same story in Macy's on State in Chicago. There wasn't much time to do this and much of the drafting was supposed to hinge on what was planned for New York. But much of THAT didn't exist - and so I made up fresh designs to explore the concept and the client, the production company, and I boldly stepped forward into building. Of the pictures I've seen, I like the results. Fun and unusual. Really liked the puppets. We have separate motion and costume designers and I have to give them credit for doing a great job.

I had nothing to do with Macy's Herald Square's scenery, beyond what was copied out of Chicago drafting for use in Herald Square - a few gear shapes, some lettering. My job in New York was lighting, which was an enormous undertaking. I was able to talk the production electrician I used in 2009 into coming back on the promise that there were fewer lights to deal with - less cable to run in advance, maybe 60% of the number of lighting units, and some miscellaneous practicals to power. I didn't LIE, but....well, I knew it wouldn't be as simple as all that. Yes, there were less units to put on the ceiling - but more on the floor. And there was an enormous amount of LED lighting to power. I did any LED installation myself, if it wasn't already dealt with at the shop, but poor Shu ran a lot of 12v power this season. If this style of lighting continues as a trend, I am wondering if dedicated 12V lines, powered from a main transformer, wouldn't be a better idea.

Anyway, the actual total count of lighting units runs to about 325 to 350. Conventional lighting planned for about 160 units, and LED lighting doubled that. For counting purposes, I define a unit as any piece of lighting powered by it's own connection. So each LED is not counted, but a group of them in one housing that then connects to a breakout or a transformer is counted as one unit.

What was shocking to me and a major obstacle to overcome, was Spaeth's reluctance to put money into the lighting. They had contracted to DO the lighting, but hadn't considered the actual costs. I had to get fairly blunt with them and explain what it really takes to light Christmas windows, labor costs, etc. They conceded on labor and also purchased all the LEDs needed. I got the client to purchase other needed items, including some units we can reuse for several years and some color. All told, though, the total lighting expenditure had to have run pretty close to what it did in 2009.

I am pleased to note that the LEDs held up extremely well. Only two units actually died the entire season. Maintenance was reduced (one of my goals), though the store employee responsible for changing burnouts really didn't like the birdies. :)

So how do other retailers' windows compare? Well, I thought Bergdorff-Goodman's Carnival of the Animals was awesome, though not especially Christmasy. Tiffany's got more accolades than I thought it deserved, but they were well-executed. I loved Van Cleef & Arpels small windows. I was disappointed with Saks. And while everybody was talking about Barney's GaGa windows, I was just puzzled. Wrong time of year. But whatever.

January 1, 2012

Happy New Year all

A few tribulations with my Apple computers lately. Had many things to fix and had to put it off until my FIT class was done. But finally, I had the Christmas break to deal with it all.

First I went to TekServe and after extensive queries and waiting, a manager managed to dig up a MacCuff in the basement. Apparently, these things are generally sold in bulk to institutions, not individually to people who want to get the Mini under the desk, rather than on top of it. (My desk has 7 square feet of space.) The MacCuff is a very nicely engineered piece of steel, I have to say. Easy to mount with a variety of options, all ports accessible, and the fit is snug but smooth. I guess that's what surprised me most - how well the thing fits a Mini. I'm now trying to find a similar mount for my connected external drive.

The Seagate hard drive I've been using as my Archive drive is borked. In early December, I was doing a TimeMachine backup when it fell off the desk. This damaged it enough that DriveSavers couldn't recover any data. So...19 years or more of work - gone. I'm still discovering things that are gone forever, but surprisingly, I'm not terribly upset. It feels like freedom, in a way. but I will shortly have to start a new Archive drive and will BACK THAT UP along with backing up the main computer harddrive. So frustrating.

Within the last three weeks, I've had to get service for all of my expensive Apple toys - some of it long overdue. The Mini needed a new optical drive. (The mist from my breathing treatments eventually buggers the optical sensor, I believe, as this isn't the first optical drive to quite working and the techs ALWAYS note a "white, salt-like substance" on the computer's vents and fans. (As a matter of fact, hypertonic saline is one of my meds.) For similar reasons, the 23" Cinema Display also needed service. They did about $600 worth of work, replacing the glass and LCD screen inside completely.

What AppleCare didn't cover, however, was the liquid damage to my MacBook Air. Scotch is not good for a laptop. And though the niece and nephew indirectly caused the accident, it was, I admit, primarily my own fault. Let's just say NORAD Santa Tracker is now the target of my enmity. The upside is, the repairs were cheaper at Apple than at TekServe and I now, basically, have a new early-2010 MacBook Air, given the number of internal components that got replaced.

iCloud: Upgrading to Lion has gone smoothly, mostly due to good advice from a stagecraft forum. Moving to iCloud went smoothly until syncing the Air last night. Instead of disabling the calendars on MobileMe, I deleted them - which had the effect of deleting them on iCloud and everywhere else. Undos only brought back the calendars, but not the events! Fortunately, I'd backed up the calendars before installing Lion on my first machine, so I restored my calendars and events fairly quickly. Still, I have a lot to learn about Lion.

When you upgrade to Lion, your user Library is hidden by default. It IS available as a shortcut from the Go menu with the command key held down. To get regular visibility back, type this command into terminal: chflags nohidden ~/Library.

And so my annual "deal with the hardware" is over, for now. I am ready to deal with taxes.