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Sunday, February 20, 2011

What's in a Recipe?

Last week I talked about things I did to prepare for Randori.  Basic strategies, exercises to acquire new skills that might be helpful.  It completely didn't resonate with Katie.

If you know me, you know I never really follow recipes.  I make scribbles in the margin of some of my cookbooks now because I regret losing my happiest accidents.  I do follow the basic structure, as I have sad memories of many, many unhappy accidents in the kitchen.  I hounded Mom for my favourite childhood recipes, and now I mess with all the amounts.  I always add more spices to the gingerbread house dough because I want it to be more fragrant.  I get the recipes, then I never follow them.  Even my own recipes.

Katie never needs an alarm clock.  She wakes up at the same time each day.  She sits, stretches, and eats the same breakfast.  The SAME breakfast.  It used to be that she alternated porridge with bacon and eggs.  Now, every day is just bacon and eggs.  She goes to bed around the same time, and no matter if she has work to do or not she watches TV at the same time.  And, only a handful of shows.

I am chaos.  I get into a project or a book and I forget to sleep.  I might sleep for 16 hours straight, or be awake for over 20.  I'll be awake to go to work at 5:30pm or 5:30am and all bets are off if it is my day off.  My favourite breakfast foods are pizza, pasta and burritos.  There's nothing like an extra serving of hot garlic and tuna pasta first thing in the morning.  The first time my family doctor wanted to know what I ate for breakfast, that particular day I'd been eating Reese's Peanut Butter Cup ice cream and pork Keilbasa.  Yes, I teach all my patients about the importance of good nutrition.

Katie puts the fan on just from the smell of my food.  She is terrified to leave the house for fear I'll make a mess (not justified). 

At work, I could be teaching or doing acute care or researching.  A good day has me doing all the above.  I get told protocols all the time, and I violate many of them.  Admittedly, so many people follow protocols by the  time I come along the protocol has given the patient all the benefit that it can.  I don't "think outside the box" so much as I never like to be in a box.  I don't understand boxes.  I get uncomfortable in a box.  I rebel.

It was a huge revelation for me to take a clinic in cross country skiing.  I'd done many marathon events with no technique at all.  Suddenly, a way to aim my poles meant I could push harder.  Video was used to show me that I was driving my shoulders back too high on a double pole plant.  I was shown the physics of the movement, and I could immediately see there was only a certain distance that I could push and everything else just got me more tired.

Dad and I have gone canoeing many times, and we always push our luck.  Mom brought home a video of how to read rapids and how to do different strokes and why.  I watched it 50 times, totally fascinated.  When Dad and I worked together, we could run the worst rapids on the Nahanni River with no problem.  We took Figure 8 rapid better than the professional guides on the river with us because we learned to Ferry.

Dad is a lawyer, and is often deep in legal texts and looking at the fine print.  He leaves work behind, and he is chaos incarnant.  Stephanie and I joke that he is a dog obedience school cult deprogrammer - the best behaved dog is a hellion after he's looked after them for a few days.  He knows how to be more structured than anyone I know in the right environment, and he discards it when he wants to.

At work, certain drugs go together.  Certain drugs don't.  There is an order to draw blood tubes, and a very good reason for it (cultures need to take the waste blood, coags won't fill up fully if a butterfly is used, etc.) 

A good handwashing sink is high and wide enough that the water runs towards your elbows and not your fingertips.  You use the foot pedals or knee taps rather than using your hands so that you don't touch the dirty tap and recontaminate your hands.  Alternatively, you use the towel paper to turn a tap off.  You wash your forearms so that your sweat or your patient's blood doesn't carry bacteria to your hands.  Alcohol foam is only useful if your hands aren't visibly contaminated, and while it kills VRE and MRSA more effectively than soap and water, Alcohol has no sporicidal action and won't kill C.Diff.  There is a huge amount written on handwashing technique.  Silly little thing, but many priniciples and ways to do it and rationales for every option.

In a code, a board needs to be put under a patient so that chest compressions will work (the air bed will absorb the compression, not the patient's chest.)  The patient needs to be flat, or the angle changes and you're not pushing on a heart.  People go to ACLS classes to be taught how to talk - specific phrases are to be used for basic tasks so that everyone knows what you are doing.  Clear has a meaning, and everyone needs to learn that meaning.  You need to call for help, or you are there all by yourself.  There is a right way that will help you, and a wrong way that puts you and your patients at risk.  Research is carried on all the time over how long a port should be scrubbed, and how big should the alcohol pad be and so on.

I read a Taiji book many years ago when I was first starting to learn the Chen Man Ching form.  The author referred to making coffee.  What steps do you need to go through?  Do you actually know them all?  What is the most efficient number of steps.  What takes the least time and least effort to make the best coffee?  He went on to say if you already knew, then you were a Taiji master already.  I was very interested, and I saw elements of what I had learned in skiing and canoeing.

Dad lives in a world that is very organized and very heavy with rules and protocols.  Legal trials depend on it, or justice can't be served.  Katie makes a living correcting sentence structure, spelling and punctuation to make someone else's communication more clear.

I have no problem looking at how to make my approach more logical, because I know I have absolutely no problems discarding any semblance of logic when I want to.  Structure and "the best approach" can fascinate me, but I go back to constant flux very easily.  Using structure is actually very difficult for me, and I rebel against it constantly.  I have seen the consequences of a lack of structure in my own life far too often, and I can see the benefits I get from exploring and using structure.  For Katie and for my Dad, time off is a chance to let the restrictions completely go, but they can fall back on the structure of their lives immediately.

When the freestyle classes start, this will be a chance to really see which world, structure or chaos, most of the students live in.

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