Wednesday, July 23, 2014

Why Can't We Make It Easy?

I've become a believer in the idea of "make it easy to do it right." Which means that when I want to do something, say, for example, keep my dining room tidy, then I should make it as easy as possible. That could mean getting rid of a few items to reduce clutter, or it could mean organizing my storage areas so that it is easy to put things away, or it could mean diverting my pathway into the house so I don't automatically dump my bag on the dining room table as I walk in. It's not that there is a particular right way, but that overall the path of least resistance tends toward a tidy dining room. I harness my own laziness by setting up good default options.

I've heard this idea at work as well, that the best road to safe and high quality patient care leads through this territory of creating systems that default to actions and choices with the best evidence behind them, and then improve on those systems in iterative fashion based on outcomes so that the defaults become better and better. It's a great idea but I don't think my job actually believes in it.

I sat through a meeting today with about thirty other people. The goal of the meeting was to educate us about a particular problem that preventing our senior leaders from accurately measuring how much work we are doing. This is a big deal in these days of minimal resources, so we want to try to fix this problem so that we can hang on to our manpower and space. The meeting took over an hour of time. From my perspective the only bright spot was that the speaker seemed genuinely enthusiastic about her work in extracting information from a huge database and making it useful. She was beaming as she talked to us and seemed close to bouncing with delight a few times. It's not the kind of task that I personally enjoy but it was cute to see how happy it made her to have created this tracking tool and to share it with us.

I'm glad there was one bright spot because I found the content of the meeting discouraging. The gist of what I took from the meeting is that the biggest source of the problem is our electronic medical record, which causes providers to mislabel their work with outdated numerical codes instead of using the new mandatory codes. Apparently at times it even switches out the providers' entry of the new codes for the old codes, without notifying the provider. These codes are a way for medical work to be measured, and they have to be correct to go into the large database that leadership uses to evaluate work. So every patient visit with an incorrect code is lost from the perspective of counting work. Thanks to our goofy computer system we apparently have hundreds of hours of work that just don't count.

This just seems really silly to me. Ideally, an electronic medical record system would help providers be more accurate with tasks like assigning the correct codes to a particular kind of work. I'm not a computer person and I don't know much about systems or programming. From my naive end user perspective though, it would make sense to me to only put correct options into the system in the first place. If you only offer correct options then you are making it easy for health care providers to complete the task correctly. The default answers will be the right ones. It makes no sense at all to have a system that offers wrong and outdated codes as the default options months and months after the change has taken place. It is really foolish to have a system that swaps out correct codes for wrong ones. It's the exact opposite of making it easy to do it right.

Really, it's very discouraging.

Saturday, July 19, 2014

Canning Comedy

Blackberry Jam!
True to my intentions last weekend (Blueberries, Blackberries and Decoupage), we did actually make and can blackberry jam this week. I'm not going to tell you the technical details, the whys and the how-to's of the canning process, because there are much better instructions available online (National Center for Home Food Preservation) then I could give you. Not to mention that our jam making was a bit of a comedy, so you probably don't want my advice anyway. 

First of all, you should start with a good recipe for jam. Unfortunately I don't have one to give you. If you have one, please let me know, because the one we used was distinctly mediocre. It probably should have been intuitively obvious, but a ratio of 6 cups of sugar to 5 cups of blackberries yields a jam that is much, much too sweet. It did gel nicely, thanks to all that sugar and the pectin we added. Unfortunately the pectin also has a strange citrus-y smell that I'm not crazy about. The jam is not bad, but it's nothing to write home about. It's edible, and it's ok on peanut butter and jelly sandwiches, but it just doesn't have much flavor other than sweet.

Second, make sure you and your jam making team are on the same page. My husband and I just aren't a great team in the kitchen. There's a reason that we generally consider the kitchen his and I stay out of the way, and it's not only because he is a good cook and I don't enjoy food preparation all that much. It's also because we have completely different attitudes towards cooking. He is a very creative chef with a tendency to figure things out on the fly and alter recipes as he pleases. I like to read the directions at least once and maybe twice before beginning, have all my materials prepared and ready and execute each step precisely. It's not really a great combination in practice. Especially when trying a completely new technique that has lengthy instructions that threaten dire food poisoning if you mess up. We got through with a lot of patience and courtesy for each other and the occasional gritting of teeth, but let's just say it didn't flow.

Third, it's hard to work with boiling water and boiling sugary jam with an almost four year old daughter underfoot. I had dreadful visions of parents tripping, hot sticky liquids splashing, and widespread third degree burns. We ended up chasing her out of the kitchen to go draw pictures of us making the jam. Which she did, but it wasn't the wholesome family project we were hoping for. She did help me affix the labels to the jars once they were cooled the next day but I think she felt left out. She won't eat the jam, either.

All in all, it goes to show you there's a learning curve for everything. All in all, I would consider our first efforts at canning a reasonable success, despite the comedy. We did actually make jam. We did manage to preserve it in glass jars which we sterilized and sealed in a boiling water bath as instructed. All the lids "popped" and became concave as the instructions described, which means we correctly drove the air out of the jars creating a vacuum that (along with the sugar and acid in the jam itself) will prevent the growth of bacteria. The 8 pounds of blackberries we picked are no longer in danger of spoiling. We have many half-pint jars of blackberry jam sitting in the pantry now and they look very pretty. I estimate that it will probably take us about a year to eat our way through it, which I suppose will take us right up to next year's blackberry harvest so that we can try again. You know, I can't wait!

Sunday, July 13, 2014

Blueberries, Blackberries and Decoupage

We're having a very domestic kind of weekend around here. It started Saturday morning when we woke up and got moving early so that we could pick blueberries at Homestead Farms in Maryland. A few months ago, back in the winter that would not end, my family made a list of things we wanted to do this summer. We put it up on the refrigerator and since the end of May we've been using it to guide our weekend plans. One of the items I added was picking blueberries, and I realized this week that we'd better get to it before blueberry season was over.

8 pounds of blueberries
Saturday morning found us in a field of blueberries, listening to the buzz of insects and the grumble of a tractor as we plucked berries and reminded our almost four year old over and over again to only pick the blue ones. We picked about 8 pounds before she got bored and then we decided to move on to blackberries and gathered about 8 pounds of those as well. Then we had a snack at their country kitchen stand; a strawberry smoothie that was unremarkable and one of the best pieces of cherry pie that I've ever eaten. Then we watched the chickens for a while and fed clover to the goats before it was time to head for home. The farm itself was great; incredibly well organized, very friendly and the entire morning was a ton of fun. Before we left our daughter was asking if we could come again tomorrow. I told her no, not tomorrow, but that we would definitely be back for apple picking in the fall.


Blueberry Scones (with red sprinkles)
When you've come home with 16 pounds of fruit you have the pleasing problem of coming up with good uses for it. So far we've frozen several bags of blueberries for use later in the year. We've made blackberry peach cobbler using the peaches my husband and daughter have been buying each week at our local farmer's market. We made blueberry pancakes and blueberry scones using a modification of a cranberry scone recipe. I think later in the week we will try our hands at making and canning some preserves.

I remember my mother spending a summer canning tomatoes one year when our neighbor had an unexpected bumper crop and was giving out grocery sacks full of tomatoes each week to everyone. I think I was about seven then and we ate those canned tomatoes for years after that. Every time my mom made spaghetti sauce she'd open up another jar of preserved tomatoes. She canned tuna that year too, because my grandfather took my dad and my uncle on a fishing trip and they came back with a driveway full of huge silver fish. We couldn't hope to eat before it spoiled so my mom preserved jar after jar of it. I think after that she must have been sick of the whole process because she never canned anything again that I remember. My husband and I haven't ever tried canning before ourselves, but we have the materials and good instructions and some tasty looking jam recipes.


Our tray!
My daughter and I also made a tray this weekend to carry our food to the deck when we are cooking out. I realized a few weeks ago that a tray would be helpful, after my husband and I made about four trips each to carry out the plates, cups, silverware, napkins, condiments and food for our dinner and then another four trips each carrying everything back. I didn't want to buy something though. I looked around for something we could repurpose but then I found a craft project in the book A Homemade Year by Jerusalem Jackson Greer that sounded perfect; decorating a baking sheet with a collage sealed and held in place by decoupage glue. My husband didn't care to sacrifice any of his baking sheets to the cause but at the Arts and Crafts store my daughter and I found an unfinished wooden tray. We painted it and then we pasted pictures clipped from Smithsonian magazines and covered them with several coats of dishwasher safe decoupage glue. It looks about like you'd expect a collaboration with a three year old to turn out, which makes it wonderfully us. It probably would have been cheaper to just buy a tray after the cost of the supplies and time is added up but this way was a great deal of fun in addition to being practical.

I like living in the 21st century. There are plenty of problems but I am a huge fan of sanitation and hygiene, easy travel, instant communication, and electricity. I am hopeful that in the coming decades we will make further progress on human rights and freedom, equality and education and opportunity for all, and our care of the environment and our fellow creatures. At least these things are on our radar now, discussed and proclaimed as shared values. So I'm not someone who yearns to go back to a simpler time. I just like making things. I like picking my own fruit on a hot summer morning and working with my family to turn it into delicious food. I like getting my hands messy and creating good memories while we make something useful. I want to hang on to the good parts of the past while we keep moving forward.

Thursday, July 10, 2014

Vulnerable

I want to blame them so I'll feel safe, and that's always suspect.

It's a thought I had a couple times today, working through a tough situation at work. I hear so many painful stories and stand witness to so much suffering that sometimes I find myself wanting to distance myself by blaming. I catch myself thinking "this is your fault because you did/didn't...." and I know I'm just trying to feel less vulnerable. I'm trying to believe that I'm different, I'm safe, that whatever terrible thing is going on could never happen to me.

Here's the thing, though. It's a lie. It's untrue. Oh, sure, there are common sense things you can and should do to avoid basic hazards. Wear seatbelts. Don't drink and drive. Things like that. But the reality is that life is messy, life is dangerous, life is brutal. Really bad things happen for no good reason and no one is safe. And in the end, no one gets out alive.

It's not my favorite thing to think about. I'd rather think about the beautiful parts of life, or at least the parts that leave me feeling in control. Let's talk about holidays and family gardens, about crafts with my daughter and knitting projects. Or let me wax philosophical about resting, or meeting challenges at work, or about religious topics. That's much more fun. It's much safer and less painful. It's not that those things aren't true. It's just that they aren't the whole truth.

I find the feeling of vulnerability horribly painful. Knowing all the bad things that can happen, being honest enough to admit that I am not safe, that no right action and right choice of mine will keep me safe, is dreadful. I have no magic power to keep myself and those I love safe from harm. It stirs anxiety in my heart and I want to crawl under the covers and never come out.

Except. Even hiding under the blankets, I am still going to get hurt. Dramatic things could happen. My bed could collapse or my house could fall in. More realistically, I would end up with bed sores and pneumonia and urinary infections, because that's what happens when you can't get up and move around. Worst of all, I'd have the pain of loneliness. I'd have the pain of missing all the good stuff that is the other half of life's story. I would suffer anyway and not even have any joy to balance out the pain.

Safety is just an illusion. I can't skip pain as a part of life; it's not an optional portion of the curriculum. All I can do is find my way through. I can live in a way that is rich and vibrant, so that when pain hits I have good memories and good ideas and most of all good friends to carry me through. I can engage suffering with compassion instead of blame. When I catch myself clinging to that illusion I can choose to wake up, to be honest and kind and brave. I can stay open to love and joy. It isn't easy. It's just the only answer I've found so far.

Saturday, July 5, 2014

Independence Day

4th of July pinwheel!
Photo by Rose Anne Karesh, 2014.
Last year on the 4th of July my husband and I were unpacking everything in our house after moving. Our daughter was up with my husband's mother for a few days so we could work without her "help" and so we spent the holiday frantically laboring, trying to get everything done before we went and picked her up. In one of our rare pauses I watched a few local fireworks from our back deck, the ones that were close enough and high enough to see, and thought wistfully about my childhood 4th of July celebrations. Next year, I vowed.

I grew up in the Historic Triangle area of Virginia; the area defined by Williamsburg, Jamestown, and Yorktown Battlefield, where the American Revolution was won. Each year for the 4th of July we would take a picnic dinner over to the base of the victory monument at Yorktown. Sometimes we'd invite friends and other times it would be just our little family, but no matter what else was happening in our life we went every year that I can remember until I left for college. We would wander around the fields and woods and the beach of the York River and then eat our dinner. Then we'd lay down on the blanket and listen to the Air Force band play their concert of patriotic songs while we waited for it to get dark enough for fireworks. Once night truly fell the whistles and booms and bright colored stars would dazzle while we oohed and aahed. At the end we'd pack up our belongings and head back to the car and then wait in the jam to get out of the park, usually arriving home after 11pm.

This was the experience I wanted to recreate, a year ago on my back deck. I wanted to bring my daughter and my husband and my mom (and I would have liked to bring my sister, had her busy schedule permitted it) to Yorktown and feast on fried chicken and watermelon and my mom's potato salad which is the best I've ever had. I wanted to walk on the beach and up and down hills and see if the bamboo thickets were still growing strong. I wanted to listen to the 1812 Overture and watch fireworks with my daughter for the first time.

Unfortunately, things don't always work out as planned. We drove down to my Mom's house this weekend, despite the hurricane off the east coast, trusting the National Hurricane center's predictions that it would be far enough into the ocean for safety. The 4th of July started out rainy but cleared up by late morning and we thought all would be well. The plan for the day was to take my daughter out to a favorite local museum to tire her out and then put her down for a nap so she could stay up late. Then off to Yorktown in the afternoon for our picnic, explorations and fireworks.

My husband and I executed our part of the plan, but of course my daughter somehow missed the memo. She absolutely, categorically refused to nap. We tried for two hours. We played her regular sleep time music. We read stories. We took turns watching over her and even laying down with her. We even told her - no nap, no fireworks, since there was no way she could stay up and out so late. Alas, it was to no avail. Our darling daughter would not be quiet, would not lay still, would not close her eyes, and above all would not sleep.

So we changed plans. We've learned that our daughter is a terror when she hasn't slept enough. If she stays up late she will not sleep in the next day; she wakes up at her usual time but in a terrible mood. All the sweetness and fun that usually balances out the strong-willed aspects of her personality evaporates and she is angry, demanding and impossible to please. Worse, she gets so keyed up that she has trouble sleeping, which just prolongs the pain for all of us. This can go on for two or three days, until she finally manages to catch up. My husband and I had some anxiety about taking her to fireworks even with a nap, but we reassured each other that a solid afternoon nap the days before and after the big event would head off enough of the unpleasantness to make the evening worthwhile. Without a nap, we decided that discretion would be the better part of valor. We changed our plans.

We packed up the car with our picnic and headed to a different and quieter local park. My daughter wore the adorable 4th of July outfit my mother bought for her, with a lacy red white and blue skirt. We talked about our country and what freedom means and why we were celebrating. We ate our fried chicken and potato salad and watermelon and topped it off with brownies for desert. We blew bubbles that the breeze grabbed and wafted far out onto the nearby reservoir. We picked weeds to pop at each other and played on the playground and were home by 7:30 pm. Our daughter went to sleep at her usual bedtime and woke up cheerful and pleasant this morning.

I would be lying if I said I wasn't disappointed. I was, and am. I grumbled to my husband and I whined to my sister on the phone a little. The irony that today, when we have no particular evening plans, she is soundly asleep for an afternoon nap is not lost on me. Still, I think it is a marker of some of the growing I have done that I didn't have my own temper tantrum and spoil the whole evening with bitterness and sulks. I was able to shift and enjoy the outing we did have, even though it wasn't the one I had wanted. Perhaps that's another kind of independence.

Sunday, June 29, 2014

Work In Progress

I'm knitting a sweater for myself. Usually when I knit I knit blankets and toys, gifts for my child and the children of my friends. These are fun projects; they move along quickly, they make me feel clever, and at the end they make other people smile. Recently when I was in a stressful situation I knit stress balls for the people around me; the knitting relieved my stress as I hope the squishy, springy balls relieved theirs. But I don't knit for myself very often. It's just not as motivating.

Sweaters aren't my favorite thing to knit, either. I've made a few but they haven't come out quite right. I have one I can wear to work but the others ended up being too large and too ill fitting for anything other than goofing around, which is a shame for something I spent so much effort to make. The problem is, sweaters have to be done correctly in order to fit. You have to count stitches per inch and rows per inch and pattern rows. There is a lot of measuring and checking involved at each step of shaping the garment and it's easy to get the details wrong. Small mistakes can have big consequences. Handknitting sweaters also take a very long time. It usually takes me months and sometimes a year to finish a sweater. The knitting process gets pretty dull in sections when you are just turning out row after row of basic stitches to form the fabric. Which probably explains why they take me so long to finish; I get bored and start doing something else.

I really love this yarn I found, though. It's a soft wool and nylon blend which I know will feel good when the weather gets cold again. The yarn is fine and even which I hope will give the sweater a smooth and polished appearance when I'm done. The colors shift from deep red wine to purple to lavender to a rich, bright pink. Growing up I thought I couldn't wear colors like pink and red because I have red hair, but I've learned they actually look quite flattering on me. I want a sweater made out of this yarn, and the only way I'm going to get it is to knit it myself. I found a simple pattern that lets me knit the entire sweater in the round, which is a faster (although dull) way to knit because you aren't constantly turning the garment back and forth. I am not sure that the ease of knitting will balance out the tedium of the pattern but I'll see how it goes and how long it takes.

When I'm feeling very ambitious I think I would like to make enough sweaters that I could wear a handmade sweater to work every day without repeating my clothes more than once every couple weeks. At my current pace it would take me until past the time I could retire to accomplish this. Then again, each stitch is one stitch closer. I suppose that what I'm hoping is that if I keep knitting sweaters it will get easier. Like anything else I've done, with practice my skill will improve and the sweaters I make will look better and I'll get them done faster. In knitting people talk about their WIP; their work in progress (knitters also KIP - knit in public). I like to think my knitting, like so much in my life, is a WIP.

Sunday, June 15, 2014

Afternoon At The Creek

I am a child of the suburbs. Growing up I fed my love of nature through books, reading with a kind of hunger the descriptions of a more pastoral life in the work of L.M. Montgomery, Laura Ingalls Wilder, and Madeleine L'Engle. I lived on a cul-de-sac surrounded by other houses and shopping centers, and my explorations on foot only ever took my to other neighborhoods with different looking houses. A lonely child, I drew pictures of the fantastic house I would have some day and I always situated it on a vast property with a stream running through it. Of course it included stables, as would the house of any sixth grade girl.

My family wasn't particularly outdoorsy and we weren't well off either, so we didn't go hiking or camping or on trips to National Parks.When I was very young I had an uncle who would take my sister and I to one of the local parks and we would walk the trails together, but that stopped after my parents divorced. In retrospect I think he was trying to give them time alone to work things out and couldn't think of anything else to do with two little kids. After that our exposure to the great outdoors was mostly limited to the occasional trip to a 4H camp sponsored by a school. Even the summer camp my sister and I attended was focused on music and drama; it was located in a forest but we spent our camp time indoors rehearsing.

I still live in the suburbs today. My townhouse stands in the middle of a row of other town-homes off one of the busy main routes through my overdeveloped and overcrowded county. I love my house. It's the right size for us, it's easy to take care of, and it's very convenient to my job, but it's definitely not the dream home of my childhood. Mostly, that's okay. I have new dreams as an adult and this house fits them better. But I was happy today, while out with my family, to find an easy walking route that dropped us down onto a county trail system near my home. The system actually encompasses the entire county, following green spaces along streams with protected woods to either side that limit storm run off.

We wandered down the trail about a mile and a half enjoying the sound of the creek next to us. The trail criss-crossed the shallow stream in a few places and most of them weren't bridged. Maybe the stream is usually low enough that the crossings are dry, but it's been raining quite a bit lately and so today we found 6 to 12 inches of water at each intersection of stream and trail. This turned into a minor adventure as our daughter and I held hands and hopped across the on low round concrete pillars that seem to be placed there for that very purpose. My husband strode behind us carrying the stroller. It all worked well until our daughter missed a step and got her feet wet. Then it worked even better because she and my husband just waded across the crossings together. I stuck with the pillar hopping since I dislike walking in wet sneakers. Next time I'm bringing my water sandals and we'll leave the stroller at home. Our daughter was game for walking the entire distance and had much more fun that way, picking dandelions and daisies and finding pinecones and sticks to show us along the way. Before we went home we found a shallow gravel area where she and my husband could build little dams and splash rocks while I sat on the bank on a comfortable rock and soaked it all in. We scouted out areas we can bring friends for a picnic play date later in the summer.

It's not the idyllic, unspoiled farm country of my childhood books, to be sure. The road is never far away and we still live bounded by houses, shopping centers and terrible traffic. It's nice though, to sit on a creek bank in the midst of all that and give my daughter a little taste of a place where wet and muddy feet are all part of the fun. It's nice to see nothing but trees and water and rocks and hear nothing but a rushing stream and my child's laugh.