“You’re safe with me”

 People ask me: what does your “you’re safe with me” that I wear pin mean.

For Ralph and I it represents a promise of trust and protection. It assures you that we are promising to protect you from harm, assuring you that your secrets, your well-being, and your dignity are secure with us. You can be completely free to be yourself without fear of judgement, betrayal, or hidden agendas.

We have many close friends from a variety of lifestyles, cultures, genders, and so many variations. We do not judge and we are not afraid to call them our friends.

T & Ralph

 As Ralph and I wake up this morning, we want to wish ALL mothers and mothers to be a very special “HAPPY MOTHER’S DAY!”

On that note, we want to subtly remind all you “children” to acknowledge the observance of this special day by:

Visiting your mother and thanking her for being your mom.

While you are visiting, give mom a big hug. 

If you can’t go visit, give her a call, if you can’t call send her a happy text.

Send her a special gift: a card, flowers, a keep sake, etc.

Most of all, let her know you love and appreciate her.

T and Ralph

 I don't usually make long posts but this morning I need to tell you the story of my journey.

When I was diagnosed with rectal cancer in November 2022 I was definitely surprised and in shock. No family history of cancer, no personal "high risk factors", and no previous symptoms. 

After breaking the news to Kat and Seth I immediately began aggressive treatment. Fortunately, over the years in clinical practice I have had the privilege of working with some of the best Oncology Specialists in the Memphis area. Kat and I chose my care team and the journey began. After my initial treatment of 12 cycles of bi-weekly chemo and 30 cycles of radiation that ended at the end of March 2023 the tumor was destroyed and all that was left was scar tissue. 

Since that time, I have had monitoring, scoping, imaging, and close follow up with oncology, GI, and oncology surgery. In January of this year, a second tumor was found. The treatment for this tumor involved surgically removing the tumor and a section of my rectum which created the need for an ileostomy.

I am a firm believer that "everything" happens for a reason. While we may discover the reason, many times we never figure out the reason(s).

For me, this journey has been a multitude of emotions:

Humbled that I had a disease the may end my life.

Wondering "why me".

Experiencing the side effects of chemo personally that I had explained to patients over the years personally.

Realizing that the cancer was not just a "physical" problem, but had created  mental, emotional, psychological, family, and life issues as well.

I am blessed with an awesome support system. Family, friends, students (former and current), colleagues, patients (former and current), many others and even strangers.

those of you that know me, know that I have named that "voice inside my head" Ralph. Ralph and I have very intense "discussions" about many things. After diagnosis, we realized that I had to treat not only the cancer, but my psychological well being as well. 

I have been involved in public safety with fire and EMS since I became a volunteer firefighter and first responder in 1978 and remain involved today. During that time I have been assaulted by patients and family members, shot at, stabbed, and verbally abused. Ralph and I decided that if we were going to let cancer win this battle it was going to need to "up it's game". Developing this mental attitude led me to adapt a slogan: #nottodayreaper. I initially had a few t-shirts made with the slogan on them for Seth, Kat and myself. Once the word got out about the shirts, I started getting requests from folks for one of the t-shirts. As of today there are 120 of these shirts throughout the United States including Alaska and Hawaii. It was not a money making project, it was a mental health project.

So, what has this journey taught Ralph and I?

I have had the opportunity to speak to several cancer support groups, individual cancer patient's and their family members, and the general public about cancer from both a provider standpoint as well as a patient standpoint. 

I have been contacted by friends and acquaintances asking if I could speak with their "friend" who has cancer. (I am always willing to speak to them)

I have realized that I truly am "one of the lucky ones with cancer" with minimal symptoms.

And so many other things.

I get asked frequently about what I tell people with cancer when I talk to them. 

I will share a letter that I wrote to one of my "cancer friends" that I have been speaking with since shortly after my diagnosis. Please keep in your mind, that this lady had stage 4 lung cancer and continued to text and call me throughout my treatment program. 

February 14, 2025

Dear (I am not sharing her name),

I hope this letter finds you well. I’ve been reflecting on the impact you’ve had on my life, and I wanted to take a moment to express my heartfelt gratitude.

I want to sincerely thank you for sharing your hopes and fears with me. I hope that our talks have helped you understand your disease process. Your kindness, support, and presence in my life have meant more than I can express. I remember when I was diagnosed and the phone call you made to me. That moment showed me that no matter what is cast upon us there is a reason. Although we may never truly know all of the reasons, one of the reasons was that you and I could connect and support each other.

You’re questioning and openly sharing your fears and hopes encouraged me to share my medical knowledge as well as my personal experience with cancer truly inspired me. Because of you, I have had the honor and privilege to meet and talk with literally hundreds of cancer patients and hopefully in some way made their journey a little easier.

I just want you to know that your actions and presence are deeply appreciated, and I am truly grateful to have you in my life. Thank you for being an amazing friend.

With gratitude and appreciation,

Thomas “Tommy" Cooper

Now to close the circle of our relationship, the day I rang the bell at the Radiation Center she called me on the phone to make sure I "rang the bell loud and long". We talked for about 10 minutes and yes many tears were shed.

4 days after this call, I received a letter, which I thought was from my friend by the return address. However, when i opened it it was from her husband. Unknown to me, she had called me from her Hospice bed and left this earthly world shortly after she hung up with me. Her husband told me she had made her peace with her death and had told him when she hung up the phone from our call that "everything was good now, Tommy has completed radiation".

Now many of you are asking "why" I have chosen to share the story of my journey. I share this to let you know that you are NEVER alone in your battles. I am always available by text, email, or phone if you need to ask questions, scream, cry, holler at someone, need someone to listen, or need a hug.

Respectfully Tommy and Ralph

#nottodayreaper

Stuck in Dutch Harbor and eating lunch

 Ralph and I made it to Dutch Harbor and looks like all flights this evening are going to be cancelled. All checked in to the Grand Aleutian Hotel.

We are sitting in the resturant and our neighboting table is the Sig Hansen (from the F/V Northwestern and Deadliest Catch) family and some boat crew members. 

But guess what folks, they are doing the same things you and I do at a family lunch. Eating, laughing, joking, and enjoying each other. They all are cordial and friendly and deep down just people.

As professional courtesy I introduced myself, I thought introducing Ralph might be a stretch. I told him who I was and what I was doing in Dutch. Since he is currently filming for Deadliest Catch, we wanted him to see what we were going to post to verify we would not be doing anything contrary to his contractual obligations. He approved the text and offered to get a family member to take our picture.

Ralph and I are sharing this to remind all of ya’ll that they are “just folks”.

Special thanks to the Hansen family and crew.

Follow them on Deadliest Catch!

Remember, take care of yourself and each other.

T and Ralph

Continuing to learn about different cultures everyday

 Good morning!

Ralph and I are nearing the end of this evolution in Alaska. You have read, and hopefully learned, about our interaction with a multitude of cultures as we work in rural and remote places. Each day is a welcomed cultural learning opportunity for us. At our current assignment, we are blessed to be learning and interacting with plant staff from 15 different cultures and backgrounds. This morning Ralph and I had blintz for breakfast. We heard some of you say: "a what?". So let's take this opportunity to learn about cultural things. 

First off, what is a blintz and where do they come from. Well, blintz are a large component in the Jewish culture. A cheese blintz (Hebrew: חֲבִיתִית; Yiddish: בלינצע) is a rolled filled pancake in Ashkenazi Jewish cuisine, in essence a wrap based on a crepe or Russian blini. Traditional blintzes are filled with sweetened cheese, sometimes with the addition of raisins, or fruit preserves and then slightly sautéed.  Blintzes represent foods that are now considered typically Jewish, and exemplify the changes in foods that Jews adopted from their Christian neighbors. If the blintzes are served at Passover, matzo meal is used instead of flour.

While we are at it, do any of the non Jewish readers know the major Jewish holidays? Most Jewish holidays are religious holidays observed in Judaism based on the biblical mitzvot and rabbinic mandates. The major Jewish holidays in order from the start of the Hebrew calendar are:

• Rosh Hashanah
• Yom Kippur
• Sukkot
• Shemini Atzeret
• Simchat Torah
• Chanukah (Hanukkah)
• Purim
• Pesach
• Shavuot
• Tish-a B’Av

For the Jewish people around the world, these are 10 of the most important Jewish holidays. Shabbat, which is a day of rest celebrated on the seventh day of the week, is also given the status of a holiday. Rosh Chodesh is a minor observance, occurring on the first day of  each month of the Jewish calendar.

Link to explanation of the Jewish calendar.

Ralph and I get asked all the time: "how do you get so much information about so many things?" The answer to that is simple: we interact with individuals and groups from all over the world, we are naturally curious, we actually talk to people and ask questions, and we definitely are not bashful.

We hope ya'll have a very blessed day.

Till next blog,

T and Ralph

Imaging Decisions

This is for informational purposes only. This is not to be interpreted as “medical advice”.

Ralph and I get asked quite frequently how do we treat patients without imaging capabilities. For those working ER in facilities with imaging capabilities, obtaining x-rays/CT Scans/etc is not an issue. However, when you work in rural or frontier areas imaging may not be obtainable without involving enormous transportation costs. So, today we are sharing some guidelines for determining the necessity and/or urgency of obtaining imaging for certain injuries.

Canadian C-Spine Rule

The "2 and 6 rule" in the context of C-spine fractures refers to the Canadian C-Spine Rule, which uses a system where if a patient meets two high-risk criteria OR a single high-risk criterion with six low-risk criteria then cervical spine imaging is recommended to check for potential fractures; essentially indicating a need for further investigation to rule out a C-spine injury. 

Key points about the Canadian C-Spine Rule:

High-risk factors (mandate imaging):

·         Age greater than 65 years 

·         Dangerous mechanism of injury (e.g., significant fall, high-impact collision) 

·         Numbness or tingling in extremities (paresthesia) 

·         Low-risk factors (allow for clinical assessment without imaging):

·         Simple rear-end collision. 

·         Sitting position in the emergency department.

·         Able to walk at any time since the injury. 

·         Delayed onset of neck pain.

·         Absence of midline cervical spine tenderness.

NEXUS Criteria

What is the Nexus criteria?

NEXUS (National Emergency X-Radiography Utilization Study) is a set of validated criteria used to decide which trauma patients do not require cervical spine imaging. Trauma patients who do not require cervical spine imaging require all of the following: alert and stable. no focal neurologic deficit.

NEXUS Criteria for C-Spine Imaging

Clears patients from cervical spine fracture clinically, without imaging.

Focal neurologic deficit present

No0

Yes+1

Midline spinal tenderness present

No0

Yes+1

Altered level of consciousness present

No0

Yes+1

Intoxication present

No0

Yes+1

Distracting injury present

No0

Yes+1

If none of the above criteria are present, the C-Spine can be cleared clinically by these criteria. Imaging is not required.

These are just two of the guidelines for C-spine imaging, there are several others. Know and learn the guidelines used in your clinical setting.

This is for informational purposes only. This is not to be interpreted as “medical advice”.

Have a great day!

T and Ralph

How does your culture celebrate the New Year?

 With our travels over the years, Ralph and I have been fortunate to meet and become friends with individuals and groups from many countries and cultures. The ways of celebrating events varies greatly from family to family, region to region, culture to culture, and country to country. We are going to list the way some of our friends celebrate the New Year:

 Italy

Eat 12 spoonful's of lentils, one with each chime of the clock at midnight.

• Rosh Hashanah

  The Jewish New Year, which is celebrated on the first and second days of the Hebrew lunar month of Tishrei. It's a time for reflection, atonement, and forgiveness. 

Sinhalese New Year

Marks the end of the harvest season and begins at a time determined by astrological calculations.

Islamic New Year

Starts on the first day of Muharram, the first month of the lunar Hijri calendar.

China

Celebrate Lunar New Year, which marks the beginning of spring and a new year on the lunisolar calendar.

Denmark

Smash old plates and glasses against friends and family's doors to banish bad spirits.

Colombia

Walk around the block with an empty suitcase to wish for a year of travel and adventure.

Spain

Eat 12 grapes, one for each chime of the clock at midnight, for good luck and happiness in the coming year.

Finland

In Finland, people predict the coming year by casting molten tin into a container of water, then interpreting the shape the metal takes after hardening. A heart or ring means a wedding, while a ship predicts travel and a pig declares there will be plenty of food.

Panama

To drive off evil spirits for a fresh New Year’s start, it is tradition to burn effigies (muñecos) of well-known people such as television characters and political figures in Panama. The effigies are meant to represent the old year.

Brazil

In Brazil, as well as other Central and South America countries like Ecuador, Bolivia, and Venezuela, it is thought to be lucky to wear special underwear on New Year’s Eve. The most popular colors are red, thought to bring love in the New Year, and yellow, thought to bring money.

Greece

An onion is traditionally hung on the front door of homes on New Year’s Even in Greece as a symbol of rebirth in the New Year. On New Year’s Day, parents wake their children by tapping them on the head with the onion.

And ya'll think Ralph and I are weird...... 

Thank you for over 36,000 views!

 Thank you all for supporting our blogging. We have officially received over 36,000 views. While this doesn't seem like a large number when compared to many other blogs, to us it gives validity to our efforts. 

Whether you read the blogs because you are considering doing locums assignments, need a good laugh, or just scratch your head and think "wtf" Ralph and I are very appreciative.

We try to inform, occasionally educate, and attempt to give you a small dose of stress relief. But we always want you to remember that we get as much or more from you than we can ever hope top give back to you.

Forever humble,

T and Ralph

Celebrating Two Christmas' in Alaska

 

Ralph and I hope Santa brought you everything you asked for (or at least what you truly needed).

From the title of this posting some of you are already scratching your heads because you "know" there is only one Christmas. Well for all you knowledgeable Christmas scholars we have earth shattering news for you. There are actually two Christmas' celebrated in Alaska. There are six principal calendars in current use around the world. These are the Gregorian, Jewish, Islamic, Indian, Chinese, and Julian calendars.

There is the traditional United States Christmas celebrated on December 25th each year. This is determined because the United States, and most parts of the world, use the Gregorian calendar. Pope Gregory XIII introduced the Gregorian calendar in 1582. This replaced the Julian calendar, which had been the most common calendar in Europe up until this time.

So, why the need to change the calendar? The Gregorian calendar was designed to accurately represent the Earth's solar year and seasons. Scholars of the time used astronomical observations and complex mathematical calculations to create it. The Gregorian calendar has a year length of about 365.24 days. Most years have 365 days, but every fourth year is a leap year, with the exception of years that are divisible by 100 but not 400. For example, 2000 was a leap year, but 2100 and 2200 are not. The Gregorian calendar is used by the United States and the rest of the Western Hemisphere.

So why is one Christmas not enough? With Alaska's close proximity to Russia one can presume (correctly) that as people from across the Bearing Sea migrated to North America (Alaska was the closest point of land) they brought their religion with them. Orthodox communities in Europe, Africa and the Middle East - which make up more than 12% of all Christians - celebrate Christmas Day weeks after most of the Western world. It's because they use a different calendar, called the Julian calendar (developed by Julius Caesar), to work out what day Christmas should be. On the Julian calendar December 25 corresponds to January 7 on the Gregorian calendar. Additionally, they celebrate Advent, which is 40 days long and begins on November 28.

Ralph and I will be celebrating "Second Christmas" with our Alaska friends on Jan 7, 2025. So, what does that entail?

Russian Orthodox Christmas takes place on January 7 and the celebration lasts for six days. 

In the Orthodox tradition nothing is eaten or drunk on Christmas Eve until the first star appears in the sky. The star is symbolic of the great star that led the Magi to the newly born Christ. Once the first star has appeared in the sky, the festivities begin with a Lenten meal - meaning meat or dairy products (including chocolates) are excluded. This Christmas Eve meal is "The Holy Supper" . The family gathers around the table to honor the coming Christ Child. A white tablecloth is used to symbolize Christ's swaddling clothes and hay is displayed as a reminder of the poverty of the place where Jesus was born. A tall white candle is placed in the center of the Table, to symbolize Christ - the "Light of the World." A large round loaf of "pagach", a special Lenten bread, is placed beside the candle to symbolize Christ - the "Bread of Life".

The father begins the Christmas meal by leading the family in the Lord's Prayer, a prayer of thanksgiving for the blessings of the past year and for the good things to come in the new year. The head of the family greets those present with "Christ is Born!" - the traditional Russian Christmas greeting - and the family responds with "Glorify Him!" The Mother then draws a cross with honey on each person's forehead, saying a blessing - "In the Name of the Father and of the Son and of the Holy Spirit, may you have sweetness and many good things in life and in the new year." The Lenten bread (Pagach) is then broken and shared. The bread is dipped first in honey to symbolize the sweetness of life and then in chopped garlic to symbolize life's bitterness. The "Holy Supper" is then eaten. After dinner, no dishes are washed and the Christmas presents are opened. The family goes to church for the Christmas Mass which lasts until after midnight.

Traditionally, the "Holy Supper" consists of 12 different foods, symbolic of the 12 Apostles. Although there was also some variation in the foods from place to place and village to village, the following is a good summary of what is typically served.

1) Mushroom soup with zaprashka (or Sauerkraut soup)
2) Lenten bread ("pagach")
3) Chopped garlic
4) Honey
5) Baked fish
6) Fresh Oranges, Figs and Dates
7) Nuts
8) Kidney beans (cooked slowly all day) seasoned with shredded potatoes, lots of garlic, salt and pepper to taste
9) Peas
10) Parsley Potatoes (boiled new potatoes with chopped parsley and margarine)
11) Bobal'ki (small biscuits combined with sauerkraut or poppy seed with honey)
12) Red Wine

On Christmas morning the family returns to church for the Christmas day Liturgy. After church the family gathers together to exchange gifts and share a special Christmas meal. Children go from door to door caroling the song "Thy Nativity".

"C Rodzhestvom Kristovom"(srod-zshest-vum krist-o-vum) is a common Russian Christmas greeting, meaning "with the Birth of Christ!"

Ralph has a thought for ya'll to ponder:

No matter what your religious beliefs or not beliefs, it is always appropriate to care for one another. If you think yo have little to give or share, think again. We are going to use an example that many of you will either be ready to scrap over or believe it is like comparing apples to raisins. Either way, we are expressing our personal beliefs. 

When I was a preteen, I attended a large Baptist church. Every Wednesday and Sunday (twice) the pastor basically begged for money from the parishioners. Emphasizing that each member should be tithing 10% of their income to this church, "regardless". There was a family with very little financial resources. They were obviously struggling to keep food on the table and a roof over their kids heads. The mother volunteered to clean the church every week since their family had no extra money and they literally were scraping by. In open service the pastor scolded this family for not tithing. He actually made the statement: "we just need you to tithe, we pay a janitorial service to keep this place clean."

To this day Ralph and I do not understand this logic. At the awesome age of 11 I asked the pastor, in front of my parents: "wouldn't it be more money if you didn't pay the janitors?". The pastor explained to my parents that they needed to go home and pray for their "troubled son". Since my only sibling was female, I deduced that he was referring to me. Needless to say this experience made a very lasting impression on me.

You say you have nothing to give. Ralph and I disagree. We all have a few minutes of time we can share with someone. We can always have an open ear to listen, without opinion or judgement. If you have an apple, you can share. It will amaze you the positive impact human touch can have during someone's time of trouble. Each of us has a multitude of gifts to give and share. 

As Ralph and I get down off our soap box, we hope each of you have a Merry Christmas and a blessed New Year in 2025.

We now will go back to our regular programing.

Happy Christmas Eve

 As many are preparing for the arrival this evening of Santa, do you actually know how this tradition came about? Santa is someone who remains in children’s hearts forever. He’s the imaginary make-believe man who magically brings gifts and toys to kids at Christmas. To the “grown-ups”, Santa Claus is the wonderful idea of selfless giving and goodwill.

Santa also has some other names too. Among the common ones are Saint Nicholas and Santa Claus. Both of these names came from the Dutch legend of Sinterklass brought long ago by settlers who arrived in New York. The Dutch long had a legend that Saint Nikolaas brought presents to children. The Dutch honored this kind saint with the annual festival celebrated on December 6th. English-speaking settlers to the new world and who lived nearby took advantage of this enjoyable Dutch festival. They, in turn, brought Sinterklass and the gift-giving custom into their own ritual celebration for Christmas.

World wide there are at least 124 names for the one we call Santa:

1. Aba Chaghaloo (Afghanistan) 
2. Aghios Vassilis (Greece)
3. Ash Man (Germany)
4. Aya Nicola (Turkish)
5. Babadimri, Albania 
6. Baba Noel, Iraq 
7. Babbo Natale (Italy)
8. Baboushka (Russia)
9. Befana (Italy)
10. Bellsnickle (Old American)
11. Bozic Bata (Serbo-Croatian)
12. Bozicek (Slovenia)
13. Christkind (Austria)
14. Christkindl (Switzerland)
15. Christkindle (Germany)
16. Daidina Nollag, Ireland 
17. Ded Moroz “Grandfather Frost” (Russia)
18. Deda Mraz (Bosnia /Serbia/Yugoslavia/Macedonia)
19. Diado Coleda (Bulgaria)
20. Dun Che Lao Ren “Christmas Old Man”(China)
21. Dyado Koleda, Bulgaria
22. Dyed Moroz (Russia)
23. El Niiiito Dios (Mexico) 
24. El Nino Jesus (Central America)
25. Father Christmas (Jamaica/England/N.Z.)
26. Feliz Navidad (Uruguay)
27. Gaghant Baba (Armenia)
28. Ganesha (India)
29. Grandfather Frost/Father Frost (Russia)
30. Gwiazdor (Poland)
31. Hagios Nikolaos (Greece)
32. Hoteiosho “a god or priest who bears gifts” (Japan)
33. Hoteisho (Japan)
34. Ilwyd (Wales)
35. Jizo (Japan)
36. Jolasveinn (Iceland)
37. Joulupukki (Finland)
38. Julemanden (Denmark)
39. Julenissen “Christmas gnome” (Norway)
40. Julgubben (Finland)
41. Jultomten “Christmas brownie” (Sweden)
42. Kaledu Senis (Lithuania)
43. Kanakaloka (Hawaii)
44. Karacsony Apo (Hungary)
45. Kerstman (Belgium/Netherlands)
46. Klees’chen (Luxembourgish)
47. Kolyada (Russia)
48. Korvatunturl (Lapland)
49. Kris Kringle (Aus./Can./U.S.)
50. Los Reys Magos (Spain)
51. Mar Nkoula (Arabic)
52. Menino Jesus (Central America)
53. Mikulas (Hungary)
54. Moss Craciun (Romania)
55. Nicolo (Austria) 
56. Pa Norsk (Norway)
57. Pai Natal (Portugal)
58. Papa Noel (Egypt/Spain)
59. Papai Noel (Brazil)
60. Papal Noel (Spain, Latin America) 
61. Pelznickel (Dutch/Netherlands/Germany)
62. Pere Noel (France/Belgium/Canada)
63. Püha Nikolai (Estonian)
64. Queen Mab, Canada
65. Rauklas (Germany)
66. San Nicola (Italian)
67. San Nicolò (Italian)
68. San Niccolò (Italian)
69. San Niklaw (Malta) 
70. San Nikolas (Basque)
71. San Nikola (Maltese) 
72. San Nicolás (Spanish)
73. Saint Basil (America/England/Greek)
74. Saint Nicholas (Aus./Can./U.S.)
75. Saint Nick (Aus./Can./U.S.
76. Saint Nicolas (French)
77. Saint Nikolaas (Netherlands)
78. Samichlaus (Switzerland)
79. Sanctus Nicolaus (Latin)
80. Sankt Nicolai (German)
81. Sankt Niklaus (German)
82. Sankt Nikolai (Norwegian/Swedish)
83. Sankt Nikolaus (Swedish/German)
84. Sant Nicolau (Catalan)
85. Santa Claus (Aus./Can./U.S.)
86. Santa Dan Short (Oklahoma City)
87. Santa Kurohsu (Japan)
88. Santy (Ireland)
89. São Nicolau (Portuguese) 
90. Sfântul Nicolae (Romanian)
91. Shaggy Goat (eastern Germany)
92. Shakhta Babah (Azerbaijan)
93. Shën Koli (Albanian)
94. Shën Kolli (Albanian)
95. Shën Kollit (Albanian)
96. Shën Nikollië (Albanian)
97. Sing Dan Lo Ian (Hong Kong)
98. Sint Nikolaas (Dutch/Netherlands) 
99. Sint Nicolaas (Dutch/Netherlands) 
100. Sint Sinterklaas (Dutch/Netherlands)
101. Sinterklas (Indonesia)
102. Sinterklass (Colonial Dutch)
103. Sontgaclau Romansch:
104. Sunnercla (Germany)
105. Svätý Mikuláš (Slovakian) 
106. Svatý Mikkuláš (Czech)
107. Svaty Miklas (Czechoslovakia)
108. Svetnik Miklavz (Slovenian) 
109. Sveti Mikalojus (Lithuanian)
110. Sveti Nickola (Serbo-Croatian)
111. Sveti Nikola (Macedonian/Croatian/Bulgarian) 
112. Sviatyij Mykolai (Ukrainian)
113. Sweti Mikolaj (Poland) 
114. Swiety Mikolaj (Poland)
115. Svyatoy Nikolay(Russian)
116. Svyatoy Nikolskay (Russian)
117. Svyatoy Nikolsky (Russian)
118. Szent Miklós (Hungarian)
119. Szent Mikulás (Hungarian)
120. Tsminda Nikolozi (Georgian)
121. Vader Kersfees (South Africa) 
122. Viejo Pascuero “Old Man Christmas”(Chile)
123. Volvo Indo (Brazil)
124. Weihnachtsmann “Christmas Man”(Germany)

The reality is the spirit of Christmas is a mood or attitude that is appropriate for the Christmas season. It is often characterized by spending time with family and friends, feelings of goodwill, a willingness to enjoy oneself, and benevolence.  For many it also refers to the biblical meaning which is celebrating the gift of God's love through his Son. The spirit of Christmas can also be a reminder of childhood innocence and a reminder of our real destination in life.

Ralph and I had a long pondering and discussion about Christmas in the early hours of this morning. Regardless of your religious or spiritual beliefs, here are some things you can do  that will allow you to experience the true spirit of Christmas:

Giving gifts with eternal value: understanding, compassion, service, friendship, gentleness, and kindness.

Sharing kindness: expressing gratitude and offering forgiveness.

Being selfless: Thinking about others, forgiving, and taking stock of what is truly important.

Being aware of our blessings: acknowledge the good in our lives, sharing what we have with those that have not, and letting those that you care about and are important in your lives know your feelings.

Those of you that read our ramblings are truly appreciated. Your presence allows Ralph and I to survey the world from perspectives that differ from our own. You reinforce the fact that we are blessed in so many ways. For this and your ongoing support we are truly humbled.

MERRY CHRISTMAS EVERYONE FROM TRIDENT AKUTAN, AK!

Ralph and T

What do I have to work with here and what are some of the challenges?

 I am truly humbled, over 100 folks have read our blog since the previous posting. And some of you have asked some excellent questions. Some serious and some that made us smile. We will start with a few of the serious ones to begin.

Someone asked what I had to work with here on Akutan island. Here are a few pics of the clinic. I have a Bell Ranger on site for Medevac, Ralph is my nurse, the Safety Team is trained in first aid and CPR and they have been trained in clinic documentation during “emergencies”.

We are 760 air miles from Anchorage where there are two Level II trauma adult centers and a Level II pediatric trauma center. There are no Level I trauma centers in Alaska because there are no trauma research and teaching facilities in the state.

The closest Level I trauma center is Harbor View Medical Center in Seattle, Washington. This facility is only 1,975 airmiles from Akutan however there are no aircraft closer than Anchorage with flight capabilities to Seattle. BTW, Seattle is only 1,434.59 air miles from Anchorage. 

So if Ralph and I can get them stable enough to send to Anchorage (760 air miles and "if everything is timed perfectly" the patient will be in the Trauma Center in Anchorage in about 3 hours).

These assignments are NOT something for every provider to consider undertaking. You have to remember,  I started in EMS in 1978 as a "driver". Like everything else I have ever undertaken Ralph and I went the long way up the hill. Became a Georgia EMT-B 13353, then Georgia Cardiac Technician 1469, then progressed to Georgia Paramedic 3161. We eventually went to an Community College ADN-RN program, then a RN to BSN program, a MSN FNP program and ultimately a DNP ACNP program. I have worked in third world settings, responded to multiple disasters, rural EMS, Grady EMS in Atlanta, worked the 1916 Olympic Park Bombing and specialize in rural and frontier medicine. When I am at home I work in ER, Critical Care , and Hospitalist.

But if you feel you are up for the challenge, let Ralph and I know. There are plenty of needs all over.

 

If ya'll keep asking, Ralph and I will answer honestly to the best of our ability.
 

And the other question I was asked: “is there anything you are afraid of?”

Well actually there is one thing: Kat 😜

Where have I been?

The last few years have been full of challenges and obstacles. We dealt with COVID and the resulting psychological trauma. We were attempting to treat patients that had "something" that we knew little if anything about other than it was killing our patients and despite the healthcare team doing everything they could, there was not a damn thing we could do to help the multitude of patients we could not save. 

If we admit it, additional psychological trauma developed because our patients were dyeing alone. If they were extremely fortunate, they may have had the opportunity to see their families and their families see them on an I-pad or some video device. So many did not have that opportunity. Our patients did not have the benefit of human touch due to our PPE use. Even after death many facilities would not allow the family to even see the patient after their death. 

Ralph and I are very vocal about believing that "no one should die alone". Many of you, just as we have, have been the only person to hold our patient's hand as they took their last breath. Ralph and I look at that simple act as one of honor. While we can not stop the reaper from reaping, we know in our hearts and minds that the patient was not alone. During COVID neither the patient and nor we as care givers had that opportunity.

Then in 2022 I was diagnosed with rectal cancer. Now before you clutch your pearls, after 12 rounds of chemo and 30 cycles of radiation I am currently cancer free. I will continue to be scoped, poked, prodded, imaged and a few other "things" for the next 4 years but as of this writing I am cancer free. Those of you that know Ralph and I understand that we believe there is a reason for everything. Hang around and we will share "why" we believe: we developed rectal cancer, we never developed any symptoms from the cancer (we will talk about how we were diagnosed in another post), and the opportunities that the experience provided us. 

 Ralph and I continue to teach in the CBU BSN program and have started back doing some locums. Currently, we are in Akutan, AK which is in the Aleutian Chain. We are covering the holidays at the Trident Akutan Plant Clinic. 

For those of you that have kept in contact, we are back. If this posting is the first you have read, please go back in the archives and catch up. It will explain quite a bit about my relationship with Ralph and oour outlook on life.

Tommy and Ralph

Where will this road go?

Ralph and I have embarked on a journey.
When I was in 8th grade I was 6’0” and weighed a solid 240 lbs. I played both sides of the ball all through high school and was, if I do say so, “solid”.
This year on February 1st I weighed 306 lbs (on our bathroom scale).
We chose to work on our weight. Not by dieting per say, but by making better choices. We have decreased the portions we eat. Try really hard to resist temptation in regard to impulse eating. We pack our lunch for work... rather than ordering pizza or eating in the hospital cafeteria.
When we weighed earlier today the scale stopped at 267.8 lbs.
Well as of 2 minutes ago the world is still turning. There has not been a Zombie Apocalypse, and Kat still tolerates us. We still suck down coffee and diet Coke like there is no tomorrow and have not been hungry or miserable.
The only issue is it looks like a family of gypsys moved out of our clothes.

It's been a while

Well, it has been a little over one year since Ralph and I have taken the time to blog. Life has been full and very busy, to say the least. Two years ago I took over as Head Administrative Coach for the Christian Brothers High School Brothers in Arms Trap and Skeet Team. We have had some challenges and always find opportunities for improvement, but the athletes (yes I said athletes) have done an outstanding job.  Ralph and I need to clarify something for some of regarding the term athlete.  You are thinking: "shooting at clay targets is not athletic".
Think about this instead:
The average trap gun weighs around 9 lbs. A round of trap is 100 targets. This means that an athlete has to raise and mount their 9 lb gun 100 times. Using old school math, that means in a period of around 45 minutes, each athletes lifts and lowers around 900 lbs. They do this in the heat, cold, rain, snow, and wind. Try it some time :-)
For the past two summers I have had the enjoyable task of traveling around the county with my son as he pursues his love of competitive shotgun sports. Actually, I get to drive the truck and write checks. He gets to shoot and bring home the bling, and he has gotten a lot of it.
Ralph and I are still traveling around the country working locum assignments, speaking, and teaching. In fact, we will be in Columbus, MT next weekend on a locum assignment.
I had the honor of presenting two topics at the 2019 Annual Tennessee Nurse Practitioner Conference last weekend in Memphis, TN. I presented a 4 hour pre-conference hands on workshop on Incision and Drainage. Sunday morning I presented from the main stage "Bugs, Spiders, and Other Yucky Things".


I am still teaching 4-5 Joint Injection Courses each year with Advanced Education  Services  ( www.injectioncourses.com ). I will be teaching in Phoenix, AZ October 12th.


My wife, KAT and I both are working with our friend and colleague, Brett Snodgrass MSN, FNP and her company: BBS Health Education ( www.bbshealtheducation.com ). We are providing regional CEU educational conferences for practicing clinicians on a multitude of topics. We will be doing:
BBS Knoxville Pain Management Boot Camp - September 13, 2019 8am-4pm        
BBS Knoxville Pharmacology CE Conference - September 14, 2019 8am-4pm with OPTIONAL SUTURE COURSE
BBS Jonesboro Pharmacology CE Conference - October 12, 2019 8am-4pm with OPTIONAL SUTURE COURSE


In February I took a hospitalist position at a local Memphis hospital. It is a 7 on - 7 off schedule which allows for plenty of time for Ralph and I to observe the world...........


Although Ralph and I have not taken the time to blog, we have been diligently making notes about our observations of life. We will get to work on some more blog postings.
As always, our goal is to educate, entertain, and let you know it is ok to laugh at yourself. It must be because we do it quite frequently.

Are you a REAL nurse? Or are you just someone who was able to pass NCLEX?

As Ralph and I travel across the country, I have the opportunity to work with some of the best healthcare workers in the world. Their level of skill and compassion is second to none. Unfortunately I have to opportunity to work with some of the biggest slackers in the world as well.
One might ask what is the difference, or how can you tell. The most recent example we will illustrate below:
Scenario 1: 30 minutes before staff shift change we are called to the ER because EMS is inbound with a possible stroke. In preparation for their arrival, I ask lab to come to the ER and Xray to warm up the CT scanner. I tell the ER RN that if the patient is stable on arrival they will go straight to the scanner (which they will pass by on the way from the ambulance to the ER) and then to the ER. The reply from the "RN" was "they need to come to the ER first so I can triage them and get their history in the computer". Needless to say at this point Ralph woke up!
I met the EMS crew at the door, did a rapid assessment and to the scanner we went. When we exited the scanner and arrived in the ER the "RN" was nowhere to be found. The patient was in the ER with 3 members of the BLS EMS crew, a CNA and Ralph and I. Over the next few minutes an appropriate history was obtained, NIH Stroke Scale of 6 documented twice, a 12 lead EKG was obtained,  I started 2 large bore IVs, hI had reviewed the head CT and identified a subdural hematoma, and was talking to the tertiary hospital neurologist on the phone when the "RN" wandered back into the room. Her first words were "why didn't you come get me, I was just having a cup of coffee". I asked her to call the on call RN to assist us because we were going to fly the patient to a neurosurgeon. Her response was "night shift will be here in a few minutes, I don't want to bother the on call RN".
Well at this point it was all I could do to keep Ralph from "splainin" the facts of life to this supposed "RN". But, professionalism prevailed and I was able to keep him muzzled.
The night shift staff arrived and the day shift "RN" informed us that ******* is here I am outa here.
Scenario 2: A few weeks later, Ralph and I were called to the ER for a chest pain patient that had walked in. The ER nurse for the day was the night shift RN from the previous case. When I walked into the ER about 6 minutes after I was called I was handed a 12 lead EKG, the patient had 1 large bore IV and a second was being started, the patient had been given 325 mg aspirin that he chewed, and labs were drawn and in process. This patient eventually also flown to the above mentioned tertiary hospital with a diagnosis of Non STEMI MI, had been started on thrombolitics in our ER and, by EKG and symptoms, his infarct was resolving. The evolution of this case also overlapped shift change, and the oncoming night shift "RN" was, you guessed it, the day shift "RN" from the previous case. The day shift RN did not leave the ER until almost 3 hours after her shift had ended and she had seen the patient roll out the ER door with the flight crew, because this was HER patient.
Now the difference between the 2 scenarios, in mine and Ralph's opinion, is one of the above is a Registered Nurse, and one is someone who was able to pass NCLEX.
Ralph and I will let you debate which is which, and even more importantly, which you choose to be like.
Happy New Year!

Happy Christmas Morning!

As Ralph and I sit here, away from home on a frigid ( 0 degrees F ) Christmas Morning watching the wind and snow through the window, we realize how much we have to be thankful for. We are warm and dry, have more food than we can eat, are healthy, and have a family at home that loves us.

Unfortunately, many of our acquaintances, friends, and neighbors can't say that:

My wife was out before 5 am this morning helping feed the homeless in Memphis, yet I have more than enough to eat.

Many people need warm clothes, yet I have dry boots, gloves, a hat,  and a warm winter coat.

There is someone, somewhere at this very second fighting for their last breath, yet I am healthy.

There are fire and EMS workers, at this very minute, exposed to the elements as they care for others. Yet I have a nice warm emergency room to practice my trade in.

There are emergency workers spending the day away from home with their "second family", yet I have the ability to FaceTime with mine.

Somewhere there is a soldier sitting in the sand, or maybe a wet ditch, standing constant vigil so I may enjoy the things I do and provide for my family. Yet so many things I seem to take for granted.

Somewhere there is a person that has no family, they may be in a strange land with no friends, yet Ralph and I have been befriended by many here and have several invites to visit this afternoon so we "won't be alone on Christmas".

As a christian, today is my celebration of the birth of Christ. Yet somewhere, someone is being persecuted because of their religious beliefs. And even more unfortunate, we may only have to look across the street to see it taking place.

So how do we change things, how do we make the world a better place? We do it just like we do everything else, one breath, one step at a time, and one smile at a time. But most importantly, we do it everyday and we don't just talk about it, we take action.

As we approach the new year, the time for resounding resolutions, let's focus on one thing:
Let's try to make everyday like Christmas. Be thankful for what we have, help those that have not, and most of all, "Let's be good to each other".

Merry Christmas from Scobey, MT

T and Ralph

Good morning from frigid Scobey, MT!

Ralph and I are back on the road, healing the sick and observing life!

It has been two years since Ralph and I have shared with you, but life has a way of both getting in the way and changing your perspective on life. In my last posting, my plan was to blog more as I settled into an academic life. I was not going to work locums so I could be home with a blossoming teenage son.

Well, you guessed it, life sent in a 100 mph fast ball that totally changed both my plans and our family life. BG (our son) suffered a severe closed head injury 2 years ago and has suffered from post concussion syndrome since. Initially, he had a continuous debilitating headache that was uncontrollable with multiple medication therapies. Additionally, he had severe spatial vertigo so he was unable to walk without assistance. And if he attempted to read, after one to two minutes his headache became so severe he would vomit. We obviously could not leave him alone, so our family became home bound. Either Kat or myself stayed with BG continually, he was never alone. There was "no quick trip to get a gallon of milk". Kat and I rearranged our lives so we could care for BG.

This period was the most depressing, frustrating, maddening, and horrendous time in my life. Imagine your teenage son vibrant and active one day, and the next he is afraid to try and walk because he is afraid he will fall down. He doesn't want to go outside because his vertigo gets worse. He learns to compensate for the vertigo by crawling on the floor and sitting down to go up or down steps. He has a totally flat affect, he never laughs or smiles and he has no interest in doing things because he is afraid it will make his head hurt worse. Heck, a teenage boy that won't play video games? I am a healthcare provider, I take care of people, I "fix" people, yet I could not make my son better. Both Kat and I know people, we are respected in our local healthcare community, but we could not get appropriate help for our son.

There is a sports concussion program at one of the neurology groups in town. This program deals with concussions and the residual effects, BUT only if they occur during a "sporting event". It seems that the program is funded by research money, and BG didn't fit their research inclusion criteria. Now being the realist that I am, I know you can not truly imagine the emotions that that information produces, but try. What if that was your child? Well, I think you are getting the picture. The 6 ft 275 pound "papa bear's" redneck-country boy  personality moved expeditiously to the forefront! What do you mean "he doesn't meet your research criteria"? He is sick, you have the knowledge, information, and resources to potentially make him better, FIX HIM! Fortunately, this is one time Ralph's logic prevailed and I was neither arrested nor sued for inflicting severe bodily harm to the concussion program folks, even though I think it would have improved my state of mind (at least for a few minutes).

We finally found a program and facility in Atlanta, GA that provided information, resources, and support. Almost one year later BG's symptoms had improved enough for him to return to school, by the way, did I mention that he lost his entire freshman year of high school? He still has a continuous headache, that he rates daily as a 2-3/10. He occasionally has an increase in his headache that will put him in bed for a day or two, but he has learned to compensate and adapt remarkably well.

BG has returned to school and has made the honor roll his last two semesters. He has resumed most normal activities that teenagers participate in, including back to shooting competitive trap. He smiles, he laughs, and we have our BG back. We will help him deal with his headaches and pray that one day his head won't hurt (there is still that possibility).

Now that he is better, I have left the academic world and am back to doing what I love. Providing healthcare in rural and frontier areas!

Until next time,
Me and Ralph