Retreat to safer waters

The new rotation started this week and it’s largely been orientation and training nonsense so far. It’s not fun getting up at 6:30 every day when, for the last 6 weeks, I got to wake up at 7 and lounge around in bed until 9 before I had to get ready for work where I got paid human money. But c’est la vie. Part of my responsibilities over the next 6 weeks will be warfarin counseling for 4 days. Warfarin is an anticoagulant, and also a vitamin K antagonist. It’s an ancient and neat drug that people take to thin their blood after something like a limb replacement, stroke, DVT, or pulmonary embolism. It’s also a drug that interacts with every other known drug in the universe, as well as vitamin K containing foods (e.g. spinach, kale, etc.) Since it thins the blood, it inhibits the body’s ability to clot and can cause bleeding if the blood is too thin.  As a result, patients need to be counseled on how to take it, how to recognize signs of bleeding, diet, etc.

Fun fact: warfarin was actually used as rat poison back in the day. Rats would literally hemorrhage to death.

In other news, winter decided to pay us a visit this morning with a decidedly frigid day, much to my consternation.
A short story from my latest Vonnegut book had a beautiful and very weather appropriate bit of imagery:

“Autumn winds, experimenting with the idea of a hard winter, made little twists of soot and paper, made the plastic propellers over the used car lot go frrrrrrrrrrrrrrrrrrrrrrrrrr.

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