Nikon D5200 to reach US photographers in late January for $900

Americans wanting to leap into DSLRs with a Nikon D5200 have had no choice but to sit on pins and needles waiting for a release date. As of CES, we know that they'll have a more comfortable seat very soon: the company has committed to bringing the advanced amateur camera to the US in late January for $900 with an 18-55mm lens in the box. Some of the D5200's companion accessories should be available at the same time, including the $95 WR-T10 and $278 WR-10 wireless remotes, the $127 WR-R10 remote transceiver and the $75 WR-A10 wireless remote adapter. The D5200 isn't the cheapest route into interchangeable lens cameras in the wake of these prices, but it potentially hits a sweet spot for those whose love of photography is just slightly more than a casual fling.

Continue reading Nikon D5200 to reach US photographers in late January for $900

Filed under: Cameras, Nikon

Comments

Source: Nikon

Source: http://www.engadget.com/2013/01/07/nikon-d5200-to-reach-us-photographers-in-late-january-for-900/

hostess brands nh primary david crowder band natalie wood van halen annalynne mccord billy the kid

Obama sends military one of its own as DOD chief

WASHINGTON (AP) ? President Barack Obama said he was sending the U.S. military "one of its own" Monday as he selected decorated Vietnam combat veteran Chuck Hagel to lead the Pentagon as it scales back spending and winds down a decade of war.

A former Republican senator from Nebraska, Hagel would be the first enlisted military member to become secretary of defense, and Obama called him "the leader our troops deserve."

"In Chuck Hagel our troops see a decorated combat veteran of character and strength," Obama said as he introduced Hagel at a White House news conference. "They see one of their own," who will champion veterans and military families.

An Army infantry sergeant who risked his life to pull his younger brother to safety while both were serving in Vietnam, Hagel would bring to the job a gritty view of war and the independent temperament to express those views.

He is known as a contrarian Republican moderate who was a fierce critic of the Bush administration's war policies and he is likely to support a more rapid withdrawal of U.S. troops from Afghanistan.

Long the frontrunner for the Pentagon job, Hagel, 66, forged a strong personal relationship with Obama in the Senate, including overseas trips they took together. And he carved out a reputation as an independent thinker and blunt speaker.

"In the Senate, I came to admire his courage and his judgment, his willingness to speak his mind, even if it wasn't popular, even if it defied the conventional wisdom," said Obama. "And that's exactly the spirit I want on my national security team, a recognition that when it comes to the defense of our country, we are not Democrats or Republicans, we are Americans."

Hagel has also suggested he won't be shy in disagreeing with the commander-in-chief and his outspoken nature has already given some senators, who will confirm his nomination, pause.

"I do think Obama's done a good job overall. There are a lot of things I don't agree with him on; he knows it," Hagel told the foreign policy website Al-Monitor last March.

Wounded during the Vietnam War, Hagel initially backed the invasion of Iraq, but later became a credible critic of the wars, making routine trips to Iraq and Afghanistan. He opposed President George W. Bush's plan to send an additional 30,000 troops into Iraq ? a move that has been credited with stabilizing the chaotic country ? as "the most dangerous foreign policy blunder in this country since Vietnam, if it's carried out."

While Hagel supported the Afghanistan war resolution, over time he has become more critical of the decade-plus conflict, with its complex nation-building effort.

Often seeing the Afghan war through the lens of his service in Vietnam, Hagel has declared that militaries are "built to fight and win wars, not bind together failing nations." In a radio interview this year, he spoke broadly of the need for greater diplomacy as the appropriate path in Afghanistan, noting that "the American people want out" of the war.

In an October interview with the online Vietnam Magazine, Hagel said he remembers telling himself in 1968 in Vietnam, "If I ever get out of this and I'm ever in a position to influence policy, I will do everything I can to avoid needless, senseless war."

If confirmed by the Senate, Hagel would succeed Defense Secretary Leon Panetta. Panetta has long made it clear he intended to leave the job early this year, after serving in the post for about 18 months.

To political and defense insiders, Obama's preference for Hagel makes sense.

The former senator shares many of the same ideals of Obama's first Pentagon leader, Republican Robert Gates. When Obama became president in 2009, he asked Gates to remain as defense secretary. Both Hagel and Gates talk of the need for global answers to regional conflicts and an emphasis on so-called soft power, including economic and political aid, to bolster weak nations.

"A Hagel nomination signals an interest in, and a commitment to continuing a bipartisan approach to national security," said David Berteau, senior vice president at the Center for Strategic and International Studies.

He said Hagel's two terms in the Senate, before he retired in 2009, spanned the latter years of the post-Cold War military drawdown and the post-Sept. 11 buildup. "From a budget point of view he has seen both ends of the spectrum and that gives him a good perspective to start from."

Hagel's possible selection has been met with mixed reviews. Senate Armed Services Committee chairman, Sen. Carl Levin, D-Mich., said Hagel would be "terrific."

But Republicans have said he faces tough questions, with South Carolina Sen. Lindsey Graham declaring Hagel would be "the most antagonistic secretary of defense towards the state of Israel in our nation's history."

Hagel has criticized discussion of a military strike by either the U.S. or Israel against Iran and spoken of the influence of the "Jewish lobby" on Congress. He also has backed efforts to bring Iran to the table for talks on future peace in Afghanistan.

"The appointment of Chuck Hagel would be a slap in the face for every American who is concerned about the safety of Israel," said Matt Brooks, executive director of the Republican Jewish Coalition.

In comments to the Lincoln (Neb.) Journal Star, Hagel said critics have "completely distorted" his record, insisting he has backed sanctions against Iran and demonstrated total support for Israel.

The National Jewish Democratic Council issued a statement Monday saying it trusts that Hagel "will follow the president's lead of providing unrivaled support for Israel," including "leading the world against Iran's nuclear program."

Hagel often straddled party lines and had some high-profile dustups with his Republican colleagues.

In 2008, he criticized GOP vice presidential candidate Sarah Palin, saying she lacked foreign policy credentials and that it would be "a stretch" to consider her qualified to become president. His wife, Lilibet Hagel, endorsed Obama in his first run for president. Hagel also was mentioned as a possible candidate for Pentagon chief when Obama was first elected.

As defense secretary, Hagel would preside over the withdrawal of combat troops from Afghanistan and the waning days of the war, and would direct some of the steepest cuts in Pentagon spending in years. His task would be to restructure a pared down military that can step away from the grinding wars of the past 11 years and refocus on a swath of regional challenges from Syria, Iran and North Korea to terrorism in Africa and the defense buildup in the Pacific.

His experience and his allies on Capitol Hill will work to his benefit.

"Certainly his name coming forward is one I'm very open to," said Sen. Bob Corker, R-Tenn., who served with Hagel on the Senate Foreign Relations Committee. "I had good relations with him while he was in the Senate. Certainly (he's) a veteran and someone who also spent a lot of time around the world understanding the relations other countries have with the U.S. and vice versa."

Defense analyst Loren Thompson, of the Virginia-based Lexington Institute think tank, said Hagel knows the political system and is known for thinking outside the box, which would help as budget cuts move forward.

"He's a veteran who understands how Congress works and has stayed plugged in to developments in defense policy," Thompson said. "He is not tied to the status quo and will think creatively about how to manage America's military forces."

___

Associated Press writer Donna Cassata contributed to this report.

___

Lolita C. Baldor can be followed on Twitter at http://twitter.com/lbaldor

Source: http://news.yahoo.com/obama-sends-military-one-own-dod-chief-201953243--politics.html

katt williams greg mcelroy new york post kate middleton bob costas bowl projections Jovan Belcher

Infusionsoft Raises $54M From Goldman Sachs To Scale Sales And ...

Infusionsoft has raised $54 million from Goldman Sachs for its small business sales and marketing automation platform. The investment pushes Infusionsoft?s total venture funding to $71 million. The company raised $9 million in 2007 from Mohr Davidow Ventures and another $8 million from vSpring Capital in 2008, with Mohr Davidow participating.

Infusionsoft will use the capital to build out the business and potentially do an IPO if it makes sense in the next few years.

?This is a decision by the board saying let?s go for it,? Founder and CEO Clate Mask told me last week. ?We are building a big, independent company to be around for?decades?to come. We want to be the Inuit for the sales and marketing business of a company.?

The Infusionsoft SaaS platform caters to small businesses that earn more than $100,000 in sales and have fewer than 25 employees.?It helps these companies automate the often disparate sales and marketing platforms that they use to make it one single process. For instance, it automates marketing tasks, such as using SMS to get leads, and then sends emails to those leads on a scheduled basis.?Often, small businesses may use Salesforce.com and an email marketing service, such as Constant Contact.?Infusionsoft replaces those platforms to become a company?s system of record.

Infusionsoft competes with marketing automation companies, such as Marketo and Eloqua, which Oracle acquired last month.

Infusionsoft is an all-in-one sales and marketing software for small businesses. They provide CRM, email marketing, marketing automation and e-commerce. Infusionsoft benefits small businesses by helping them solve for lead generation, customer nurturing and saving time. They currently service 12,000 small businesses representing 44,000 users. Their offering starts at $199 monthly plus a one-time coaching and consulting fee. They don?t require contracts and provide free customer support.

? Learn more

vSpring is a traditional early-stage venture capital firm with over $350 million of committed capital under management. Specifically, they target information technology and life sciences companies headquartered in the Intermountain West region. They look for companies with the potential to transform their markets and create lasting value. Their primary areas of focus include enterprise software, networking and communications, security software, Internet, mobile computing, drug discovery, drug delivery, diagnostics, and medical devices, all markets where the firm has deep experience. Their...

? Learn more

Source: http://techcrunch.com/2013/01/07/infusionsoft-raises-54m-from-goldman-sachs-to-scale-sales-and-marketing-automation-platform-for-small-business/

march madness bracket south by southwest i want to know what love is courtney mercury retrograde bath salts heart shaped box

Neil McCarthy: Bonfire of Insanity

About a generation ago, Gerald R. Ford arguably lost the the 1976 presidential election by refusing to let the federal government lend New York City any money to finance its ballooning debt. In the face of a near bankruptcy that would have sent the nation's then largest metropolis -- along with its seven million inhabitants and the lucrative national franchise known as Wall Street -- into a death spiral, Ford chose to troll for votes everywhere else.

This prompted one of the city's two remaining tabloids, the Daily News, to run a headline that became iconic -- "Ford to City: Drop Dead."

It seems that some political parties never learn.

John Boehner -- Ohio Republican, Speaker of the House, ostensible deficit hawk but really one of the myriad defenders of a new Gilded Age where a 39.6 percent marginal tax rate is just too much for your average billionaire -- refused Tuesday to allow the House of Representatives to vote on the $60 billion dollar aid package for Hurricane Sandy's victims. The Senate had already passed the bill. And the House stayed in session until near midnight to make sure the rest of the country, including all those red staters, were not forced to suffer a New Year's day tax increase.

But Boehner wouldn't let them vote on the Sandy aid package.

I guess they were too tired.

This has created what amounts to a political meltdown among New York, New Jersey and Connecticut Republicans -- yes, Virginia, they do exist.

The Jersey Shore, New York City's Rockaways, the South Shore of Long Island and large parts of Connecticut's Sound Shore can double these days as accurate movie sets for remakes of Saving Private Ryan's opening scenes from World War II's Normandy beaches. Thousands of homes lay in ruins in the wake of Sandy. Thousands more are partially or wholly uninhabitable. My wife's cousin in Monmouth Beach, NJ lost her whole first floor -- furniture and all -- to the Atlantic Ocean, and has been living for the last two months in a friend's condo. Another cousin in Belle Harbor, a section of NYC's Rockaways, needs $100k to make his house once again a suitable home. Still other relatives across Jamaica Bay in Canarsie lost three cars parked in the street when flood waters turned that Brooklyn neighborhood into a lake.

And these were the lucky people.

Breezy Point, on the far eastern end of the Rockaways, literally went up in smoke as flooded but live electrical connections ignited a bonfire that quickly consumed more than eighty sardine-packed homes on what locals affectionately call the Irish Riviera. Even if sufficient numbers of first responders could have crossed the Gil Hodges Bridge that connects Breezy to Brooklyn -- and they couldn't given the high winds -- New York's bravest still would have been stopped by flooding that made it impossible for the trucks to get to the flames.

So, in one fell swoop, the dreams of hundreds of very middle income families were destroyed by Sandy. None of these denizens of an outer-borough, as they are known in Manhattan, showed up in Bonfire of the Vanities, Tom Wolfe's 1987 punch at this Gilded Age's traders and financiers who always seem to have first call on the nation's resources. And none of them park their assets on Wall Street or manage their portfolios from their beach houses.

Their little spit of summer sunshine on the Irish Riviera was their principal asset.

For many, it was their only asset.

NJ Gov. Chris Christie is mad. So are Rep. Peter King, Rep. Michael Grimm and Staten Island's Borough President James Molinaro. They are all Republicans, and right about now they are in the mood to assert their own Second Amendment rights and storm what is left of the dysfunctional GOP caucus in Washington, DC. During the height of the Sandy crisis, President Obama was calling Christie at midnight to offer federal help; Boehner wouldn't even take Christie's first four phone calls as the governor tried to get the speaker to schedule a vote in the House.

Memo to Chris -- when the other guy calls at midnight and your own guy won't even pick up the phone, maybe it's time to choose a new side.

Rep. King had perhaps the best take on this latest GOP meltdown. "These people have no problem finding New York when it comes to raising money. They only have a problem when it comes to allocating," said King. He then added that anyone from the tri-state area who donates campaign money to Republicans "should have his head examined." Molinaro was a bit more succinct -- "They're a bunch of idiots."

The "idiots," as is their wont, blamed everyone but themselves. Rep. Darrell Issa said the Senate bill was pork, laden with "non-essential" funding. If it was, there couldn't have been much. The bill allocated $60 billion to the three states, a mere drop in the bucket for anyone worried about the deficit (which won't be helped much if the Jersey Shore is closed for business this summer) and small potatoes given the scope of the disaster.

In a move that was all profile and no courage, Boehner's office responded to the onslaught of criticism by announcing there will be a vote on Friday, apparently when the new Congress, which is to be sworn in that day, assembles. Peter King, however, is not convinced. As he noted, most of the Republicans do not support the Sandy Relief Bill. Boehner, who already had problems with his caucus before yesterday, arguably did not improve his position by voting in favor of not falling off the fiscal cliff, which a majority of GOP members also opposed, and can't be eager to make them walk another plank.

Nonetheless, the 112th Congress is now gone. It will vote no more.

Maybe the new one will do better.

It clearly cannot do any worse.

?

"; var coords = [-5, -72]; // display fb-bubble FloatingPrompt.embed(this, html, undefined, 'top', {fp_intersects:1, timeout_remove:2000,ignore_arrow: true, width:236, add_xy:coords, class_name: 'clear-overlay'}); });

Source: http://www.huffingtonpost.com/neil-mccarthy/john-boehner-sandy-aid_b_2398861.html

yahoo.com/mail baylor april 9 albatross louis oosthuizen phil mickelson 10 year old gives birth

American Airlines entering key period in restructuring

(Reuters) - As American Airlines' board meets next week, expectations are high that it will give more concrete shape to the airline's plans to either merge with US Airways or stay independent.

The directors of parent AMR Corp plan to review a tie-up with its smaller rival against an alternative plan to exit bankruptcy as a standalone company, several people familiar with the matter said.

But the people close to the talks told Reuters they do not expect the AMR board to formally choose one option over the other next week, as detailed terms of a deal, such as price and the new management team, have yet to be hammered out. There are currently no plans for an announcement after the meeting.

The meeting that starts Wednesday could still provide clues about whether American is finding merit in the idea of merging with US Airways while it is still restructuring in bankruptcy.

AMR Chief Executive Tom Horton rebuffed an aggressive takeover push from US Airways early in the bankruptcy process, saying American preferred to exit court protection on its own and consider a deal later.

Now, after several months of talks with US Airways and AMR's creditors, Horton has softened his approach at the insistence of the creditors' committee and agreed to consider all options.

In a message to employees on Thursday, Horton said there's no specific deadline for the evaluation to end, but the company expects to "bring this to a conclusion within a matter of weeks."

"I can assure you we are conducting a collaborative, fact-based analysis to determine the best path forward for American," he said.

US Airways, which has pursued the merger for more than a year, is hoping that AMR's board recognizes the benefits of a combination and will choose to move quickly to negotiate final terms of a deal as soon as this month, the people said.

US Airways declined to comment for this story.

A deal in bankruptcy remains uncertain and could still founder on price or other issues. The pilots union for US Airways must still vote on how to integrate labor contracts, but the process got a boost late on Friday with a recommendation by the board of the US Airline Pilots Association. Other unions also are reviewing the details.

The equity split also remains at issue. US Airways' formal merger proposal in November suggested that AMR's creditors would own 70 percent of the merged entity, and the US Airways shareholders the remainder. AMR has said its creditors deserve closer to 80 percent.

Still, Horton's new tone and other recent events suggest the combination long championed by US Airways and by pilot unions at both airlines will get a serious review by AMR's board.

With one major obstacle - labor integration - appearing closer to resolution, AMR board members will be faced with a merger scenario that is becoming more specific.

The board of the Airline Pilots Association, the union representing AMR pilots, last week approved a memorandum of understanding laying the groundwork for how it would integrate its workforce with that of US Airways.

The board of the US Airline Pilots Association voted on Friday to recommend its member ratify that MOU. The move sent a "pretty strong message" of support, a pilot at US Airways said.

Voting is likely to take several weeks. If the union's 5,000 members ratify it, the deal would mark a major step toward ensuring relative labor peace between the unions, something many tie-ups in the airline sector have historically lacked.

AMR leaders had previously warned that labor integration challenges could render any benefits of a merger smaller than what US Airways has said.

American is the last of the three major U.S. airlines to restructure through bankruptcy. AMR declared bankruptcy in November 2011 citing high labor costs, and eventually reached new, cost-saving contracts with its three primary unions, including its pilots, after bitter negotiations.

A BIGGER AMERICAN?

A lot is riding on AMR's choice. A tie-up with US Airways would give American Airlines the scale to match bigger rivals that are upgrading service and expanding international routes. Yet going it alone could spare the company the operational headaches associated with mergers, preserve existing management and give it more control over its destiny.

A combined American-US Airways would have revenue of $37.03 billion based on 2011 figures, on par with the $37.11 billion delivered by United Continental Holdings , which became the world's biggest carrier when it was formed in 2010. The new American would have 118,000 employees, compared with some 88,000 at United.

The new carrier would have a solid presence on the important U.S. East and West coasts and on North Atlantic routes, given American's revenue-sharing joint venture with British Airways and Iberia . American currently has East Coast hubs in Miami and New York, while US Airways has key operations in Philadelphia and Charlotte, North Carolina.

The East Coast operations could be structured in a way to make a combined American-US Airways more competitive against Delta Air Lines , which operates out of Atlanta and New York, and United Continental, which has a major hub in Newark, New Jersey. Delta and United are both the products of mergers.

A merged American "could potentially become the dominant player on the East Coast," said John Wensveen, head of airline advisory services at Radixx International, which provides distribution systems and management consulting.

He said American already faces the prospect of greater competition for corporate clients on the lucrative New York-to-London Heathrow route now that Delta is buying a stake in Virgin Atlantic and plans to apply for a joint venture that would allow revenue-sharing.

Still, analysts say a combined carrier would have challenges such as integrating its workforce.

George Hamlin, an aviation consultant in Fairfax, Virginia, said US Airways staff working under bankruptcy-era contracts could expect to be brought up to the same pay level as American Airlines employees, likely raising costs of the combined entity.

"You need to sit down and carefully look at how all the pieces go together," Hamlin said. "This would have an impact on the cost structure of American."

American Airlines doesn't have to take the merger path. Reported results since the carrier filed for Chapter 11 bankruptcy protection last year suggest the leaner company would be profitable when it emerges.

In the third quarter, American produced a profit of 33 cents a share, excluding one-time items. Earnings before interest, tax, depreciation, amortization and restructuring costs (EBITDAR) came to $1.61 billion.

With cost and revenue benefits from the bankruptcy filing included, AMR projects that EBITDAR figure could nearly double to $2.95 billion by the third quarter of 2013, according to data from the carrier.

But Helane Becker, an airline analyst with Dahlman Rose, said an independent American and US Airways would both face challenges of how to grow to compete effectively longer term.

"United and Delta would start to leapfrog them," Becker said. "From American's point of view as they are emerging from Chapter 11, they have to ask the question how do they go from $25 billion in revenue to $35 billion in revenue to compete with United and Delta."

The case is In re AMR Corp et al, U.S. Bankruptcy Court, Southern District of New York, No. 11-15463.

(Reporting By Nick Brown and Soyoung Kim in New York, Karen Jacobs in Atlanta; Editing by Alwyn Scott and Tim Dobbyn)

Source: http://news.yahoo.com/american-airlines-entering-key-period-restructuring-000501974--finance.html

free pancakes at ihop martina navratilova high school shooting daytona 500 national pancake day ohio school shooting sean young arrested

Video: Opposition demands truth about Chavez?s health

Sorry, Readability was unable to parse this page for content.

Source: http://video.msnbc.msn.com/nbc-news/50361881/

sanctum the notebook duke basketball miranda july joe paterno near death joepa sc primary

Thoughts on Death and Dying (or Life Goes On) ? Kens Take on the ...

Thoughts on Death and Dying (or Life Goes?On) January 2, 2013, 4:11 am
Filed under: Uncategorized | Tags: AIDS, death, dying, grief, grieving, healthcare, healthcare worker, Hepatitis B, HIV, hope, infectious diseases, Kubler-Ross, Marines, Navy, research, research paper, surgical technology

Introduction

Each year, I have my new students write a paper on the topic of death and dying.? There are a couple of reasons for this.? First, the previous instructor of this introductory course to Surgical Technology had this as an assignment for her classes.? As I was new to teaching this course, it was easier not to change the syllabus up and so it remained.? Second, many of the students are relatively young, in their late-teens or early-20?s, a life stage, they learn is, referred to as early adulthood.? As a result of their relative youth and life experiences, many have not had an opportunity to witness dying or death very closely.? As these are folks, a number of whom are entering the healthcare professions for the first time, I believe it is important for them to have an understanding and to develop empathy for those facing critical challenges in their lives.? As these learners develop professionally, they will be tasked to interact with patients and family members coping with serious, life-altering, news regarding illness, traumatic injury, or other infirmity that may well lead to their death.? This will always be challenging.? Many of us may believe that it is easier to see someone die when they are elderly and have had a full life and find that it is extremely stressful and disheartening to witness the dying or the death of a young person.? It is important to remember that each of our patients is a unique individual with personal needs and desires and as healthcare professionals, we must strive, wherever possible, to meet these needs with compassion.

The original text assigned for this project was the book, ?On Death and Dying? by Elisabeth Kubler-Ross.? It was written in 1969 and served as the preeminent resource on the topic for a number of years.? The book, based on interviews with a number of patients facing a terminal illness, their family members, and healthcare workers caring for these people established a method by which individuals cope with a terminal diagnosis.? This became known as the grieving process and described steps that an individual went through when faced with a terminal diagnosis.? It was a five-step process that Kubler-Ross defined based on her experiences with the individuals she interviewed.? As my students have well described her observations, I will simply state that, according to Dr. Kubler-Ross, the grieving process begins with a stage of denial, progresses into anger, and through bargaining and a period of depression; the patient reaches a stage of acceptance.? I first read this book in the 1980?s and re-read it the first year this topic was assigned by me in 2003.? This second reading had particular relevance to me as I will discuss later.

It should be noted that I am not an English or literature professor and I inform my students each year that I am not looking for a book report or a critique of the literary merits of the book they select to use as a reference.? Rather, I instruct them that after they read the book they will take an event from their own lives, one that may have nothing to do with death and dying, per se, but one that caused them stress and emotional turmoil, and to describe how they experienced grief and loss during that time.

Over the past decade, I have read some other books and other references regarding dying and death, including Kubler-Ross? follow-up to ?On Death and Dying? titled, ?On Grief and Grieving? which followed family members and care givers who provided care for one who was dying, or who had died.? A newer book, ?Final Gifts? by Hospice Nurses, Maggie Callanan and Patricia Kelley introduces us to the concept of ?Nearing Death Awareness? and discusses how patients who may seem to be delirious or illogical are actually attempting to communicate with those around them things they are experiencing.? These references, and others, are now on the list of approved readings for students preparing to research material for this project.

Seeing Death

I have worked in healthcare since I was 16 years old.? I was a student in the Nurses? Aide Co-op program while in high school.? At that point I was unfamiliar with the concept of death other than it was something old people endured.? The only family member I recall who had died up to this point was my great-grandfather, Big Dziadz, if you?re Polish, and I was quite young when he died.? One of the memories I have was of pushing him in an old wheelchair at the nursing home where he was at when my Mom and Grandma would visit him.? The floors were marble and there were wooden benches in the visiting area.? It reminded me of a church, cold and hushed.? Not very much like home at all.? As a Nurse?s Aide, or Orderly as males were sometimes called, I did not experience the death of any patient.? There were a couple of patients who were clearly dying and one of these was a sweet elderly lady whose face always brightened on the days that I was there.? Whatever her disease process was, I cannot recall, however it left her bones very fragile and she was on the orthopedic ward that I was assigned to.? She was very patient and did not complain.? Her family was always in attendance and she always gave me candy or baked goods that her family had brought in for her with a wink saying I was too skinny!!? One day she was no longer there when I came in and that was that.? Life went on.? For me.

At 17, I joined the US Navy to become a Hopsitalcorpsman.? As a kid, my dream was to become a firefighter/paramedic and this was a good way to get some of that training.? While in Hospitalcorps School, I learned about Surgical Technology and jumped at the opportunity.? I figured that you could not perform surgery on board a ship and I would be assigned to a land-based hospital and be able to attend college classes so when I left the Navy, I?d be able to land a firefighting job right away.? I quickly learned there are some ships that are large enough to provide a surgical platform and every guy in my class was assigned to one of these large ships!? I was assigned to the USS Saipan, a helicopter-amphibious assault ship.? On deployment in the Arctic Circle in August of 1986, one of our helicopters carrying 21 US Marines and crew, hit the side of our ship and landed in the frigid Arctic waters.? I ended up on the Search-and-Rescue crew in a 36? patrol boat that night as the only medic in our crew of six.? That night, I saw death, up close and personal.? The first victim brought out of the water was not breathing.? I cleared his airway, inserted an oropharyngeal tube and prepared to perform mouth-to-mouth, when he started coughing.? At this point the second crash victim had been brought aboard our boat and he, too, was not breathing.? I repeated the same process of clearing the airway and positioning the oropharyngeal airway.? As he began to weakly cough I pulled the tube out and noticed the first Marine had stopped breathing, I went back to him and got him breathing.? In the meantime the other, less seriously injured survivors were being brought aboard and being sheltered in the tiny cabin below-decks.? By this point the second Marine had also stopped breathing and I had to make the decision to focus on the first Marine to make sure he continued to breath.? It was a decision an 18 year-old should not have to make, but I do not regret the decision.? Life went on.

A week later, I was on the trauma team that received a medevac patient who had been run over by a large tracked (as opposed to wheeled) vehicle.? We brought him into our trauma room and even before we had cut all of his clothes off, we identified several fatal injuries and ceased our efforts.? I did not have another patient die in my care for several years.? Life went on.

A Wake-Up Call

By 2002, I had worked in the Operating Room for almost 18 years.? I had been teaching Surgical Technology for over three years.? Life was good.? Much had happened since that evening in the Arctic Ocean.? Most of it was good.? Some of it had provided me with challenges, and subsequently, the strength to face the future and become better for it.? About nine months after the helicopter rescue, I was discharged from the Navy for being gay following a witch-hunt aboard the ship.? While working in surgery one day in 1988, I was accidentally stabbed with an 11 blade and contracted Hepatitis B.? Ironically, I had just recently received the first dose of the vaccine, but that was apparently insufficient to prevent infection.

In January of 2002, I went in for a routine Human Immunodeficiency Virus (HIV) test.? I had first tested negative in 1986 during the blast of testing that was mandated for all US service members once a reliable test became available.? I then tested annually until about 1995 and then tested every other year.? I should have had my routine test in 2001, but somehow, with my work and personal schedule, did not get it done.? While I had been feeling rundown and had had bronchitis late in the prior year, I was not overly concerned.? During the weeklong wait for the results I became ill and was admitted to the hospital with pneumonia.? My oxygen-saturation on admission was 87% with supplemental oxygen and dropped to 86%!? The doctors were interested in putting me on a ventilator and moving me into the Intensive Care Unit (ICU).? I was not that interested in this option and elected a 12 hour wait-and-see approach.? Because I worked at the hospital, and because I was already awaiting test results, my Doctor did not order an HIV test.? Instead he ordered surrogate tests of the immune system.? One of the markers of immune function is the CD4 count.? Also referred to as T-helper cells, they muster immune responses to infection.? Normal values for CD4?s are 500 to 1,500 cells/mm.? I had 26!? By clinical definition, I had Acquired Immunodeficiency Syndrome (AIDS)!

Those who know me know that I enjoy research and reading and learning new things.? After discharge from the hospital I began to do research on HIV and AIDS.? I went to the testing center and received my official HIV test result.? I did not experience denial in the way a number of the people interviewed by Kubler-Ross did.? In fact, I don?t recall experiencing any of the stages described in her work.? Considering that I considered myself fairly knowledgeable about HIV and AIDS, I did think that my diagnosis was pretty much a terminal sentence with, perhaps, a life expectancy of a couple of years.? I immediately began to research treatment options and prepared for my meeting with the Infectious Disease (ID) specialist.? I learned that AIDS may not quite be the death sentence that I was anticipating, although I was starting the game down several runs in the eighth inning with two batters out.? While doing this, I prepared my Durable Power of Attorney for Health Care, or Health Care Proxy.? Life went on!

My parents, family and friends were all very supportive and continue to be very important to me today.? I have an independent streak and tend to look at things like this as challenges to overcome instead of reasons to whine and complain!!? My ID doctor is an incredible guy and when I had my first appointment with him about a month after getting out of the hospital was surprised I was not already on anti-retroviral therapy (ART).? After explaining that my primary care physician did not want to start something that he (my ID guy) may not have wanted, we agreed to begin a specific regimen that I suggested.? My HIV viral load dropped dramatically and my CD4?s bounced back to near-normal levels.? Life went on!

Side effects from the medication and occasional bouts of illness over the years have left me frustrated and I was able to change to a new regimen which greatly reduced the side effects.? For the next several years, my health was relatively stable.

Setbacks

In 2010, I developed sudden, terrible, headaches and neck pain that led me to contact my ID doctor.? He sent me to the ER and I was admitted after a lumbar puncture (LP) to determine if I had meningitis.? I did.? Cryptococcal meningitis to be specific.? The reader may recall that around this time a number of people were dying of a cryptococcal meningitis strain in the Pacific Northwest and even though it was a slightly different strain, my folks were quite worried and afraid of this development.? I had a percutaneous intravascular central-line catheter (PICC) placed and for the next two weeks had to go into the hospital each day to receive infusions of amphotericin B.? In addition, I had to take additional antifungal medications daily for a period of time yet to be determined.? The oral medication, fluconazole (Diflucan?) is generally pretty effective at treating this when used with amphotericin.

For several months, things were pretty good and in mid-February of 2012, the headaches returned with a vengeance along with neck pain and stiffness.? My friend, crypto, had returned.? Another round of LP, PICC insertion and amphotericin was in order.? About a month and a half after completing this round of treatment, the headaches began to return.? My third round of daily hospital visits in less than a year.? It was discovered on cultures of my spinal fluid (CSF) that this strain of organism was resistant to the fluconazole and I was switched over to another drug, voriconazole (Vfend?) which had a lower resistance profile. Because voriconazole interacts with one of my HIV meds, I had to change from my single-pill combination to a regimen that is two pills.? In addition, the amphotericin is very toxic to the kidneys and the liver and so I had to have blood drawn every other day, and in some cases every day, to check for renal and hepatic function.? I was placed on magnesium and potassium supplements as both of these were lowered.? My potassium actually dropped low enough that they considered admitting me to the coronary care unit.

My third round of treatment was extended to four weeks, then to six weeks and finally to eight weeks.? Each day I was on the unit receiving my infusions I saw many other patients, a majority of whom were receiving chemotherapy for various malignancies or blood transfusions to replace volume or cells.? I often times walked the halls, as I was there for eight to ten hours a day, and say ?Hello!? to them or ask how they were doing.? The nurses all laughed as when I would check in, they would send me into a room and I would get all the lines ready and sometimes have my vital signs done before they even got there!? They would say that I was taking their jobs away!? My last treatment was on August 4, 2011 and I have not had a relapse since then.? This is good, because, I am not certain I can tolerate another round of treatment like that.? My kidney function has returned to normal levels and although my liver function is currently normal, Hepatitis B has taken a toll on my liver.

A Cold Chill

In early December of 2011, I had a routine abdominal ultrasound (U/S) for evaluation of the liver.? We (my ID doctor and I) had not made sure we did this more frequently and it had been a few years since the last U/S showed no abnormalities.? I was not overly concerned with the results of this one as I lay on the stretcher while the technician squirted some warm conducting gel onto my abdomen and began the examination, pausing occasionally to capture images for the radiologist to review.? I reminded the technician that I needed the results sent to my doctor who was part of another health system from where I had the exam performed.? I had to have the exam performed at the facility approved by my employer in order for it to be covered by insurance.? The joys of our medical insurance industry.? I made sure she had the telephone and fax numbers for the doctor?s office and went on with my life.

I heard nothing from my doctor, which was not unusual because we never bother each other for routine issues, however, my Mom pressed me to contact his office to see what the results were.? When I contacted him in mid-January, he said he had not received the results yet.? I told him that I would personally obtain and deliver the results to his office.? Based on this timeline, you may sense that I tend to procrastinate and you would be correct.? About a week went by before I actually went to the radiology department and obtained a CD-ROM of the imaging study and a written report from the radiologist.

I read the report first as it was only one page and thought, ?Oh crap!?? The report identified numerous lesions on the liver that were, ?suspicious for metastatic disease.?? I looked at the disc with images and although U/S is not an imaging modality I have much experience interpreting, it was obvious what the report was referring to.? I shot an email off to my doctor explaining the findings and informing him I would be dropping the report and CD-ROM off at his office in the morning.? I did a search through the medical literature for diagnosis and treatments for hepatocellular carcinoma (HCC).? What I found was not promising.? Not promising at all.

The next day before lunchtime my doctor called to express his thoughts and he appeared as surprised as I did.? We had an appointment already set for a few days later and discussed some options.? That appointment stood out for me as it was the first time it was in his office instead of an examination room.? Even though this was a planned visit, he did not examine me that day.? He informed me that he had spoken with one of the liver transplant specialists who recommended Magnetic Resonance Imaging (MRI) of the entire abdomen to determine if this was a primary HCC or if it was metastasized from elsewhere.? I left the office that day thinking, ?Cancer staging.?? Wonderful.? I updated my Healthcare Proxy and drafted a Living Will.

I scheduled the MRI that day and they were able to slot me in for a couple of days later.? I now understand why some patients experience a sense of claustrophobia when having this type of exam.? It is also associated with annoying and loud noises.? The very next day I went to the radiology department to get a CD-ROM of the imaging and a copy of the report.? For some reason they said I had to go to medical records to get a copy of the report, but they printed me the disc of images.? I went to medical records and filled out the form to obtain a copy of the radiologist?s report which the clerk provided to me.? I went to the hallway and sat down on one of the benches to look at the report.? I mumbled to myself as I sat down that I should have brought some tissues.? I pulled the report out of the envelope and began to read: ??nodules appear to be cirrhotic in nature.? No evidence of primary malignancy in the abdomen or pelvis.?? Whew!!!

This past fall, I met with a new liver specialist, down the hall from my ID doctor.? I am still trying to determine if I like him.? We had a nice conversation and he asked a number of questions but only performed a cursory physical exam.? He and I are in agreement that we need to perform imaging every six months.? I will also be making sure we have tumor markers checked every six months as well.? As it was near the six-month time frame, he ordered an abdominal U/S which he really wanted performed at that hospital instead of the one where I worked.? He seemed resigned to the fact that I needed to have it done at the hospital where I work.? I had the U/S performed and obtained the disc and report and hand delivered them to the liver doctor?s office.? I received a call a few days later that based on the results he wanted to order an MRI.? To my interpretation of the report, and imaging, no significant new findings are present.? He, through his staff, again wants the MRI performed at hospital A and I inform his staff that I will need to have it performed at hospital B because that is where I work.? I have the MRI done, obtain the report and the disc and deliver them to the liver doctor?s office.? That was on Thursday and he may be out of town for the holidays.? I have an appointment scheduled with him at the end of January.? The radiology report on the MRI recommends a liver biopsy as the MRI cannot rule out the presence of HCC.? And, life goes on.

Final Thoughts

As healthcare workers, we are in a unique position to provide comfort and specialized care of a patient who is facing death.? Even an Environmental Services employee or Dietary Aide can help improve the quality of life for a dying patient.? A simple smile or a warm ?Hello!? can make a difference in some patient?s day.? For those of us with specialized training, we may, too often, evaluate laboratory results and attempt to manage symptoms, always hoping for a cure.? In the majority of cases, there is a cure, or at least some therapy or procedure that may be performed to provide some quality of life for the patient and his or her loved ones.? In the end, regardless of our level of knowledge or our professional title, we are each human and in need of human contact and interaction.? Holding someone?s hand for a moment, pausing to really listen to the needs of our patient, speaking with the patient in a way that the patient can comprehend, and with honesty and empathy.? These are things that our patient?s need and deserve.? I have heard it reported that patient?s enter a healthcare facility with the expectation that all of the staff members are technically qualified and that the reason they come into a particular facility is not that the staff members are greater technical experts but, rather, that the caregivers at the particular place are compassionate and empathetic.? In ?Final Gifts,? Callanan and Kelley, make a strong case that those who are dying are very aware of their own impending death.? They need to be comforted but not pitied.? They need to be respected.? They seek to be understood.? As healthcare workers, we need to be attuned to the communications of our dying patient?s as they may share something that would otherwise be missed or dismissed as delusional rantings.

As a healthcare worker, who has been a patient, and likely will be a patient again, I have recognized that there are hundreds of little things that sometimes get missed by the trained professionals tasked with providing effective and efficient care.? One thing I must say is that all of the nurses and doctors and lab technicians and radiology technicians and ultrasound technicians and housekeepers and dietary staff that provided care for me have not missed one important thing when caring for me, and that is that I am an individual, and that I have greatly appreciated their empathy and compassion as much as their technical skill and expertise.

Like this:

Be the first to like this.

Leave a Comment so far
Leave a comment

Source: http://kenwcst.wordpress.com/2013/01/02/thoughts-on-death-and-dying-or-life-goes-on/

mario manningham williams syndrome hoya casa de mi padre corned beef and cabbage diners drive ins and dives jeff who lives at home

Source: http://frankierich35.typepad.com/blog/2013/01/thoughts-on-death-and-dying-or-life-goes-on-kens-take-on-the.html

qnexa kingdom of heaven national enquirer whitney houston arizona republican debate arizona debate enquirer national inquirer