Soft Shell Crabs at Yantze Gourmet

Over the Memorial Day holiday, Mr. Scholar and I tried a few new restaurants and visited a few old favorites. Yantze Gourmet restaurant in Lansdale is a little gem located in a strip mall, as most things are these days. But that's no reason to turn your nose up. Good food can be found anywhere if you are willing to look and be adventurous.

One of the nice touches at Yantze is that the owner comes to every table, welcomes you and tells you what the specials are. On this day, the special was soft shell crabs in a spicy brown sauce served with fried rice and steamed vegetables. “Soft shell crabs are not for everyone and they are only in season for a short time,” she said. “But if you like soft shell crabs, you will like ours.”

Usually I order off the menu just because everything they serve is wonderful. But today, I wanted something novel. Soft shell crabs, I thought to myself. They remind me of spring weekends in Connecticut with my parents on one of my father's boat hunting expeditions. I am accustomed to crabs that are sauteed and served on toast points or deep fried and slapped on some kind of roll. I had not eaten crab in years, mostly because of a squeamishness developed over the last few years. (Who can say why?) But if I could actually get over the notion of eating moulting crab, I was willing to trust my palate to the chef at Yantze.

The crabs were lovely. I was rewarded with slightly crunchy, sweet, tangy, spicy taste. Every few bites or so, I would remind myself that I was eating crabs in their most vulnerable state and I would wonder if I was going to be able to finish the dinner. But prevail I did. The vegetables that accompanied the crabs were not exotic, but they were perfectly steamed and provided a nice foil to they spicy main dish. Alas, I was too full for the fried rice. It was yet another lovely meal.

Review: The Nursing Spectrum Networking and Educational Event

On Tuesday April 7, 2009 Nursing Spectrum hosted a networking and educational event at Dave and Buster's in Philadelphia, PA. As providence would have it, I was able to attend my first “dog and pony show” as a nurse. I've attended other such professional events in my previous incarnation. What surprised me was how small this event was, given the location and the time of year. I'll elaborate...

For all its faults, Philadelphia is a major university town. With Penn, Drexel, and Temple all within blocks of each other, there are three nursing programs right there. Jefferson hospital, CCP, Frankford-Torresdale, and Northeast hospital each have programs. Just within the city limits, that adds up to a lot of newly minted nurses. There were very few hospitals advertising positions, and the ones that had vacancies were looking for specialty nurses with years of experience. Only two hospitals were seeking graduate nurses, one southern hospital and one regional hospital in a less than desirable city west of Philadelphia. No aspersions on the hospital itself, it's just that the city has been struggling with a depressed economy and rising crime rate for over a generation.

Another trend I noted was a disproportionate number of home care agencies. I think home care is a vital part of nursing and I believe that many facility-acquired infections can be avoided by allowing patients who can go home to receive treatment at home. But it seems that home care nursing is one of those areas where people look at you and wonder “why aren't you working in a hospital?” Also, how many graduate nurses could find jobs in home care? A new nurse needs to be around other nurses and I know when I first started, the last thing I wanted was be alone with a patient. I also noticed that the “grandmomma” of home care nursing, the Visiting Nurse Association, was absent.

The good news is that creative thinking and technology are expanding the profile of patients who can stay home. I spoke to a rep from a home infusion company who told me that her patients received total parenteral nutrition and chemotherapy at home in addition to traditional intravenous therapies. The only therapy they don't support is blood transfusion. I was truly overjoyed to learn that patients could now receive chemo and TPN at home. I've met many patients on chemotherapy who wanted only to be in their own home. I'm definitely following up with them.

As far as the “networking” part of it, many attendees traveled in pairs. I think traveling in pairs to a networking event is a defensive strategy against meeting new people. I also noticed that some people, you know who you are, took the lists of open positions from unmanned booths. Shame on you! Those lists were not for taking. You know you are stealing it when you shark an unattended booth a couple of times before you slip the list into your bag, all casual like.

I did not participate in the educational part of the session for three reasons. First, the continuing education credits I would earn will expire with my license this fall. Second was that the topic “business etiquette” didn't grab me. I've been jobbing for over 20 years. I don't need to be told that it's shabby practice to talk on your cell phone while caring for a patient. Third, I had to pick up the cat from the vet.

Impressions: there are shockingly few jobs for new and recent grads in Philadelphia and budgets for marketing schwag must be in the negative number territory as I didn't even score a “Nursing Spectrum” tote bag. But I am glad I attended because it generated some new ideas for career direction. I look forward to the next event.

Grids

When you're in nursing school, part of your clinical training is to fill out all the paperwork that is required in the care and keeping of a patient under your. There are admission forms, daily flow sheets, physicians' orders, incident reports, medication forms, transfer forms, consultation forms, discharge forms...I'm sure other nurses could list more forms. These are just the ones that I use almost daily. The one I find most disturbing are what we affectionately call “The Skin Sheet”.

When you are admitted to our facility, we strip you naked and inspect your skin from head to toe. Any bruises, moles, scars or potential for skin injury is documented on a form. But if you have an injury that moves into the realm of “wound” (think bedsores), we fill out the Skin Sheet. The Skin Sheet is a grid on which we record the date we found the wound, stage of the wound, the size of the wound, if it's draining, if it is tunneling, if it smells, and if it hurts. It's meant to be an objective tool that tells us how to treat the wound and allows us to monitor the progression of the wound. What the Skin Sheet doesn't explain is how the wound got there, what kind of neglect this patient experienced before admission to our facility, or how anyone who claims they are in health care could allow this to happen?

I often disagree with much of what goes on where I work but there are some things I think we do particularly well and that is prevent and heal wounds. If a patient comes in with a clean bottom, it stays that way while they are with us. If they come in with a wound, we do everything we can to improve it or heal it. But when a patient comes into the facility with wounds that are so large and so invasive, it becomes clear that somewhere down the line, the patient was the victim of neglect.

The Skin Sheet I fill out every week on this patient only tells me if these wounds are getting bigger or smaller. They don't explain why this person sat in his own filth for so long that his skin started dissolving to the bone. The boxes on the Skin Sheet only allow me to what kind of drainage is coming out of the wound. There is nowhere on the grid where I can document how fast the room was spinning the first time I stripped off the old, soiled dressing and saw what was there. I can document on the Skin Sheet if I think the wound causes pain for the patient. But there is nowhere on the Skin Sheet where I can document my rage that whoever was responsible for what happened to this man (who cannot speak or move of his own volition). There is no place on the grid for me to document how useless my emotional reaction is to this man. Every time I initial the sheet, I bear witness to what I believe is neglect that has caused harm.

Into the fray...

It is a universally accepted notion that any person in possession of an opinion will wish to share it... mostly. So here I am, many years late, diving into the fray. This diary of sorts is meant primarily for friends and family, however anyone is welcome to join the conversation. The opinions expressed here are mine alone and may range from evaluations of local restaurants to essays on health care.

It was dismaying to me that our local Olive Garden won “Best Italian Restaurant” when there are so many locally owned Italian restaurants that serve delicious meals and where there is no danger of running out of pre-fabricated chicken parmesan. Don't get me wrong, I like a good bread stick as well as the next person. But food is a way of getting to know other cultures...everyone eats. So why not try that local French-Thai place by the train station?

It is alarming to me when I hear that health care reform will mean health care rationing. If you think there is no rationing in our current system, talk to a patient with low hemoglobin whose insurance will not cover a simple weekly injection of darbepoetin alfa, but will cover a blood transfusion . I currently work in the health care industry, but I have worked in pharmaceuticals, IT and education. I have stories to share about all of them.

It is gratifying to know that the Internet allows us to connect with people from all over the world and stay in contact with the people who mean the most to us. That is the hope and purpose of this blog. Welcome to it.