Socrates, Myers-Briggs, and Dog-Training: Languages I Speak

Socrates, Myers-Briggs, and Dog-Training: Languages I Speak

via Daily Prompt: Translate

Over the years I’ve significantly improved my relating abilities.  Whether or not you give credence to the Myers-Briggs Personality Types, it has been my Rosetta stone.  INTP.  Probably one of the more misunderstood personalities, in a woman it has much more brutal implications.  Unfeeling, aloof, blunt, overly analytical, indecisive.  It’s not all that bad, most of the time, and especially since I’ve unlocked the mysteries surrounding my affect and those around me.  After several conversations and with enough information, the four letters of my acquaintance beg me to label them.  I’m not a savant, just a studier.   

When I “rescued” a puppy from the farm several years ago, as a studier I immersed myself in all things Dog.  Puppy training classes, dog parks, clicker commands, Animal Planet, socialization, polite introductions, enzymatic urine cleaner, and so on.  All of this training was actually for me, not my dog.  As a human, I had to learn to interpret and relate to my dog.  To anticipate her behavior in certain situations and to use her psychology to our mutual benefit (“sit”, click, treat) was a skill I didn’t realize I desperately needed.  Even the simplest of gestures and one that makes me most proud as a dog mother (ick, hate that term), is when she goes to the back door when she needs to do her business.  She also goes to the door for about 13 other reasons that infuriate me, but at least she doesn’t relieve herself indoors.  Raising and training my dog, my protector, created a new facet in my comprehension of the world.  It made me more human and bilingual.


Make that trilingual.  I studied Spanish for a few years in high school.  It was enough for me to test out of my college credit requirements.  While most people forget the languages they learn, I think the reason I held on to much of Spanish is because English was always intuitive.  A second language is inherently more difficult and requires logic, at least for me, the INTP.  A few times in my career I’ve attempted some translation at the bedside of a Spanish-speaking patient, but I never advertised.  Completely rusty and insecure in my overall ability to speak it, my attempts are generally feeble.  A resident physician turned to me in a patient room, indicating I spoke Spanish.  I never told him this, so, I really think he jumped to a conclusion in an attempt to deflect attention from him not securing an interpreter before rounds.  “Tiene usted dolor?” I asked.  A confused furrow of the brow and darting eyes from me to the resident confirmed my fear that I should practice more, or at least not try to be the hero anymore.

At times conversing across disciplines requires overcoming a language barrier as well.  Words typed into a chart may hide true intent, feelings, or conclusions and instead provide only facts and clearly defined outcomes.  Although electronic medical records improve the quantity of communication, I argue that the quality lacks, especially for third parties like me who scour the pages like forensic scientists trying to piece together a mystery.  Adding a complication, pharmacists are precise when it comes to pharmacology, especially when communicating with physicians.  Prophylaxis and prevention on the surface connote similar meanings, but guidelines use them differently in specific scenarios.  Patients admitted to the hospital usually receive some sort of DVT (deep venous thrombosis) prophylaxis, and it’s often enoxaparin or heparin at prophylactic doses, not therapeutic anticoagulation doses.  A patient who’s had a blood clot in the leg (a DVT) in the past may continue on long-term anticoagulation for DVT prevention.  This is not the same as DVT prophylaxis.  A prophylactic dose is much lower and ineffective for anticoagulation.  This is the language of pharmacology that prevents misinterpretation, but not everyone speaks it.  Not everyone realizes the breach exists.  So, when I hear from someone that a patient is on DVT prophylaxis but are taking a therapeutic anticoagulation dose, I first have to translate for myself the intent of treatment so I can then evaluate therapy (and on the down-low, suggest alternative verbiage).

Resting somewhere among the pillars of interpreting behaviors, words, and intent, is the practice of effective teaching.  I lecture pharmacy students in the classroom several times a year, but I mostly teach, instruct, and guide them in a clinical setting during their last year of school.  Real, live patients are the case studies, self-directed research is the lecture, and patient presentations are the exams.  Translating classroom knowledge into clinical practice in the hospital presents some level of difficulty for students.  I question the students to assess foundational knowledge, ability to evaluate known and potential factors affecting pharmacotherapy, and critical thinking.  I explain concepts to reinforce or to correct deficiencies in knowledge.  Sometimes I ask questions that yield left-field answers that I have to admit my students would have to be clairvoyant to answer correctly.  (I’m working on my Socratic method.)  Frustration strikes when a student commits the same errors over and over.  Either I am not conveying information in a way they grasp, or they are drowning in a sea of unfamiliarity.  In the case of the latter, my INTP-lack of compassion kicks in.  (How did they make it to their 4th year of pharmacy school?)  But if it’s my inability to uncover the disconnect, to focus the blurry lens, then I have to find alternative inroads.  I study my students, their behaviors and reactions, to identify the cause and whether the fix should be my responsibility or theirs.  Ultimately, I can’t force a student to learn (clicker-treats are not appropriate in this scenario), but I do my due diligence to bridge the language barrier.

Interestingly, INTPs often become professors…of the absent-minded variety.  I wish.

 

 

Translate I’m not a savant, just a studier

On Food and Dying: Upping the Meatballs

On Food and Dying: Upping the Meatballs

The diet order, whether it’s for the patients to select for themselves or one that is most prudent and forced upon them, is often the smallest afterthought, but it frequently becomes the spark-less plug in the discharge engine.

To eat or not to eat:

  • The patient can’t eat because of a procedure scheduled for tomorrow, but, oh, wait!  They ordered food today and had a patty of sausage.  The surgeon isn’t going to be happy.  Or sometimes the patient is resuming a diet that had been held for whatever reason, but it must start with “clears” to see if they can tolerate it before moving on to soft, mechanical and then regular food.  If the diet progresses too quickly, the patient may choke or get nauseated and the process starts over.

What to eat:

  • The type of diet we’ve learned will lead to a healthier and simpler life.  It may decrease the number of necessary prescriptions or effectively eliminate a disease.  Or in the case of kidney disease, liver disease, diabetes, or hypertension, a diet low in phosphate or protein or carbs or sodium will help prevent further complications and make the management of the disease so much easier.  Frankly, though, these diets are not easy or pleasant, and some patients rather starve than force bland fish down.

Diets are like medications, and they can sometimes do the same job as atorvastatin or metoprolol.  Many people struggle for years adhering to a special diet.  It’s in those last few months of life, however, when benefits bestowed by healthy habits lose their impact.  The cost-to-benefit ratio is high.  To be dying…as all of us are, I think we’d rather go down enjoying ourselves with milkshakes, french fries, and meatballs.

In my career I’ve worked in acute care, hospice, outpatient clinics, and even a while in a retail  pharmacy.  As a student intern working in a chain pharmacy, I encountered a patient dying to eat.  Every month this thin man with a long, white beard walked up to the window and silently handed over a prescription for two bottles of viscous lidocaine compounded with some other ingredients.  Sometimes he was by himself and sometimes with his son, but I never heard his voice.  The lidocaine he bought numbed the pain caused by esophageal cancer and its treatment so that he could bear to swallow, whether it be a soft hamburger or a few sips of water.  I can’t remember who stopped going to that pharmacy first, me or him, but I know I never saw him again after that summer.

My first clinical job after residency was at a large hospital with well-trained internal medicine physicians.  One of my attendings was a pathologist turned geriatrician.  She could see both the minute and the broad, the little things that could turn into big things.  On rounds one day, a pleasant gentleman with dementia and no teeth widened his mouth with smiling eyes when we walked into his room.  Our attending spotted a mild abnormality–a dried, white film coating the inside of his mouth.  People with dementia often lose awareness and capability of performing self-care.  Wetting his dry mouth had become someone else’s task.  Our attending took a latex glove and pinched the film beginning at the roof of his mouth and removed it.  I rarely get queasy in the hospital, but this did it, just a touch.  The patient was happy with the result.  He was always happy, it seemed.  The man didn’t eat or drink much, but when he could communicate with family he asked for a McDonald’s vanilla milkshake and fries.  At this point, the hospital’s cardiac diet was doing more damage to this amiable man’s spirit than good for his heart.  “He can have whatever he wants,” declared our attending.  The next day on our visit, a warm, salty, greasy smell hovered as we approached.  He was there, smiling and sitting up in bed, with fries sticking out of his mouth.  What else could he want.

There are occasionally those patients who we think are in denial.  They have a very serious disease, cancer, that has brought them to the hospital.  He had stomach pain and impatience.  His wife sat in the window banquette, unamused by her husband’s grousing.  She audibly hushed him as the team of white coats entered his room.  Earlier before rounds, we discussed this gentleman.  His first meal in two days had been a disaster.  He hadn’t been able to eat before because of several tests we needed to perform.  When he ordered spaghetti, he was disappointed by the  meatballs, specifically the number of meatballs.  There wasn’t much more we could medically do for this patient.  His disease path was set, and intervention would be fruitless.  “Sir, we are going to keep an eye on you today and hopefully send you home in the morning,” the resident stated in a bright manner.  Sensing the annoyed demeanor of the patient, he followed up with, “and we’re going to up the meatballs.  Doctor’s orders.”  That’s all he needed to hear.  Again he was able to live his curtailed life.

Today, the biscuits & gravy and bacon & eggs were on the menu for many.  Patients who were admitted due to small bowel obstructions, electrolyte abnormalities, decreased appetites and depression, from whom we withheld feeding by mouth, were once again hungry and allowed to have a diet.  Our team joked at the irony of fixing the mind and bowels only to wreck their arteries.  Oh well, treating the soul is more important right now.  Sometimes that’s the only treatment that works.

Poop Queen

Poop Queen

I didn’t see it coming , but poop has become a frequent focus in my career…and life.  Gastroenterologists and parents who change poopy diapers probably think the same thing or scoff at my confession, but I’ve unwittingly assumed it as a soapbox matter because there’s a hole in our understanding.

It probably all started back in residency when I rounded with a particular group of young doctors in the hospital.  The physicians in their first and second year of residency created a hazing-type of award called the “Golden Finger”.  A chart drawn on the white board outlined every intern’s name next to a series of columns that denoted certain procedures they regularly performed on patients.  They marked every procedure they squeezed out, but only one column resulted in a trophy, the digital rectal exam (DRE).  Also used for prostate exams, the DRE can be used to manually disimpact the poop chute of a constipated patient.  I doubt it’s pleasant for either patient or doctor.

On the other end of the pooping spectrum is diarrhea, and it can be bad.  In hospitals especially, the spread of Clostridium difficile (C. dif) is as feared as the plague or an impending ice storm, although an ice storm would smell better.  As a resident I presented an educational session over lunch to hospital staff about C. dif.  Antibiotics and stomach acid suppressants can sometimes be just as harmful as they are helpful and lead to outbreaks of C. dif colitis.  The poop is watery and it is frequent.  Washing hands with soap and water and bleaching surfaces are the best preventative measures against its spread.  The best treatment?  Fecal transplants.  It’s a thing.

There’s a fluffier side, albeit just as informative.  A little show called Scrubs immortalized the importance of poop in a song.  It’s not just the fact that the bowel moves or not, but it’s the condition and contents of the poop that expose your darkest secrets.

Runners talk a lot about poop.  There are port-a-potties available on running routes for that very reason.  While urination may be the primary goal for some—some runners just let that go—poop can’t be freely and inconspicuously dropped.  One needs privacy and a pot, or at least a hole.  One time I ate fettuccine alfredo the night before a long run.  I thought carb-loading would be beneficial.  What I didn’t count on was the effect of the deliciously creamy fat in my meal.  After my 8 miles the next morning, I almost did not clear the 15-minute drive home to release my belly angst.

Now it seems that much of my job as a clinical pharmacist is to teach the importance, methods, and mechanisms of keeping things flowing.  Here are a words of wisdom I float to young doctors and those wishing to become more proficient in the cathartic arts:

  • Drug-induced constipation is predictable, therefore, mostly preventable or at least manageable (i.e. if you prescribe a med that causes constipation, you should also prescribe a stool softener and/or laxative, lifestyle modifications/exercise, fiber, and water).
  • Constipation is much easier and less expensive to prevent than it is to treat (i.e. once constipation is present, you’ve already lost the battle; time to bring out the big, unpleasant guns).
  • If constipation has been going on for days, the best route to treat is from underneath (i.e. suppository or enema).
  • If you consult a gastroenterologist for constipation, they will almost always choose the most expensive (albeit, sometimes the most effective) treatment (i.e. potential wasted resources).
  • There are no real evidence-based guidelines for constipation. The patient population and causes of constipation are so heterogeneous (i.e. varied) that a one-size-fits-all approach (or saying one type of treatment is “ineffective”) does not work.
  • Common sense and experience go a long way. Start with your least expensive agents first.  Match the cause of the constipation with the mechanism of action of the bowel regimen.  Maximize doses, routes, and frequencies.  Then, move up the cost ladder.  Then, consult gastroenterology.

Many days my recommendations for bowel regimens pass like this:

“Mr. A is on Norco® PRN [as needed], but he’s taking it 3-4 times a day and has nothing ordered for his bowels.  Can we add docusate scheduled once daily at least?  And maybe senna PRN?  If our attending [physician] prefers Miralax, that’s okay, too.  Just need something scheduled.”

“I was checking Ms. B’s recorded bowel movements, and she’s had none for 5 days.  We started her on diltiazem for her a. fib, and that is known to cause constipation.  She’s also been taking TUMs.  Can we add some scheduled docusate and a one-time bisacodyl suppository?”

Although these seem like rather immaterial propositions and for a seemingly an innocuous illness like constipation, you wouldn’t want to wait until the patient gets a small bowel obstruction and has to be decompressed with a nasogastric tube or until we have to give a $150 one-time injection in hopes to get things moving…or better yet, put in for a gastroenterology consult.

Recommending bowel regimens is akin to a mother reminding a child to flush the toilet after use.  It seems like a minor thing in the hospital, especially when a patient is there for severe pneumonia or a myocardial infarction, but it’s a necessary thing.  Bowels don’t shut off just because there are more life-threatening matters at hand.

I have acquiesced to the fact that this will just be part of my job.  I review medications and look for missing pieces, offending pieces, interacting pieces, and so on.  Who better than me to be on the lookout?  They (the young doctors) know it, too, and I have been crowned the Poop Queen.  I will preside over my kingdom from my throne, if I must.

The Personality of a Hospital

The Personality of a Hospital

The first hospital I worked in after residency was an academic medical center.  It was a hospital located just outside the city limits of a major metropolis that held at least 10 large hospitals, ranging from community to research-oriented, teaching and non-teaching, university-affiliated and non-university affiliated.  There were other hospitals, too, small and medium, specialty, for veterans or native people, etc, etc.  The reason I make all of these distinctions?  They all have different feels, different personalities.  
Now, an academic (or university-affiliated) hospital typically employs a lot of teachers, researchers, and learners.  They teem with teams that are about the size of a junior varsity basketball team, many times clogging the hallways outside of patient rooms or crowded around a computer at the nurses’ station.  All are clamoring for understanding and knowledge of not only diseases and medicine but also of approaches and behaviors.  

I grew up in a small, rural town (population ~ 10,000) and never really knew if I would leave it, but as I progressed through my education, the collective ambition of my encouragers propelled me to see more than what my small town or state could offer.  Away I went to one of America’s 5 largest cities.  Of course there were cultural, economic, and atmospheric differences, but I was up to the challenge.  What does “up to the challenge” even mean, anyways?  Must one be successful at the challenge or just blissfully ignorant of the difficulties that lie ahead?

Aside from the personality of a city, I was excited for the bustling nature of a self-contained powerhouse that makes up an academic medical center.  I generally expected to be intimidated just by being there—not many people with an education have an inferiority complex, but I did.  I do.  There were commanding people, knowledgeable people, good teachers, condescending professionals, good attitudes, and bad attitudes.  This is everywhere though.  

My naiveté, that I would be embraced and utilized to the very limits of my professional knowledge, training, and expertise was quickly injured.  I didn’t give up, though.  I was told I’d have to prove myself, make myself an asset that they would soon see they could not live without.  The thing about academic medical centers, knowledge and expertise are commonplace.  I was commonplace.  I was disposable.  I was also young and not as experienced.  It showed, I’m sure.  The truth was that what I offered wasn’t appreciated, to put it politely. 

Perhaps I could win on a social level.  I learned and begrudgingly accepted that it’s not really what you know; it’s who you know.  And it’s not what you say, it’s how you say it.  I chose to say it with donut holes.  That worked for the few hours we were in rounds and maybe for a few precious minutes when I had to page the resident later to give a recommendation on a patient, but it was fleeting.

Every day when I ventured across the hospital to a meeting, to the cafeteria for lunch, or to the coffee stand for an afternoon break, I’d cross paths with the physicians I’d rounded with that morning.  My hopeful eyes would search for contact, I’d prepare my smile and turn my head slightly in their direction…but nothing.  No acknowledgement.  We’d be the only two people in the hallway for 40 or 50 feet, and their eyes that were once straight ahead, searched the floor.  I clearly had done something wrong, I hadn’t charmed them, hadn’t impressed them with my expertise.  My clothes weren’t fancy enough, my sense of humor wasn’t funny enough, I wasn’t pretty enough. 

It took me a long time to figure it out.  Some of my colleagues were more successful at crossing the invisible line.  They had traits that were deemed more attractive or at least local.  I was an alien.  I didn’t belong.  I began to accept it.  At some point I became more confident in my professional abilities and started not to care as much.  I had surpassed the limits of knowledge and had gained experience that none of the residents and many of the attending physicians had.  I vacillated between bitterness and graciousness when considering their snubbing of me.      

Alas, the time had come for me to move on.  Things always have a way of working out for me at the right time, after a lesson has been learned or the next situation has been readied.  After a small, but very meaningful pit stop, my home started calling.  A job back in my home state, the only position I would have accepted, came open.  It was time for a new personality.

The new hospital I went to had a simple rule for its employees:  Make eye contact and say ‘hello’.  I was no longer an alien.  Everyone smiles and is helpful.  It’s not a large, academic medical center, but it is a teaching hospital.  I don’t have to bribe people with sugar anymore.  In fact the food I brought in the early days didn’t impress anyone, but I didn’t need it to attain a level of respect and acceptance.  Acceptance both as a professional and as a person came simply because I was there, doing my job.  I won’t discount my earlier job because it did teach me.  It provided me an invaluable experience.      

Comparing and contrasting the two hospitals is a ready-made tale of the golden rule and loving your neighbor.  Both hospitals are affiliated with the same religious order—both have a motto that implores its professionals to heal and to treat others, both their body and spirit, as Jesus did.  I laugh at the torture I endured, tearing myself apart and doubting my abilities, my personality, and my looks, when it wasn’t my personality that needed inspection.  

The personality of a hospital has many influencers–the people, the administration, the culture of the surrounding people.  My personality was influenced by the first hospital, and my life suffered.  I had to learn to be myself again and what God intended for me, and eventually, the right hospital found me.    

White Coat Nuttiness & Dental Care

White Coat Nuttiness & Dental Care

When I was in pharmacy school, we learned and were subsequently certified to take blood pressure–the precise way to take blood pressure.  It’s a two-fold method, where you have to pump up the cuff two different times and noting when the pulse disappears and reappears on the first go.  Really, it’s long and complicated, and there are shortcuts, but this was a) school and b) pharmacy school, where we’re taught to check, recheck, and be as accurate as possible by adhering to systematic processes at the outset.  It’s no wonder I border on obsessive precision disorder.

When I settled into a new town at about 10 years into my career, I decided to establish care with a physician.  I was relatively young and didn’t have any major problems, but it’s still a good idea.  The nurse checking me in took my blood pressure.  It was elevated above the point where you need to treat it.  For me though, it was way higher than it had ever been.  In school when we practiced taking each other’s blood pressure, mine was typically around 100/70.  How could it be so high now?  Sure, I had gained weight since then and had just left a very stressful job in search for a more balanced existence, but I had also started running, losing weight, and eating better.  My physician and I agreed to just keep an eye on it and get a home blood pressure monitor.  Okay, check.  Follow-up in 6 months….  Umm, we’ll see.  I’m not a good follower-upper where my own health is concerned.

Several months later I went to the dentist. With adults I guess they take more precautions.  I admit it had been about 7 years since my last dental appointment.  They took my blood pressure.  It was high!  More than a little high.  Almost stroke range high.  Seriously?  I had been checking at home, and it was what I expected–120s/80s and lower especially right after a cardio workout.  The answer had been confirmed for me.  Yes, I had White Coat Hypertension.1

Well, the dentist, a seemingly caring man about my age, asked me about my life, stresses, hobbies, etc.  I thought he was just trying to get to know me and calm me down, but, no.  He was gearing up to give me advice on my blood pressure because he would not be able to work on me with it that high.  Yes, stress can do a lot of bad things, but he proceeds to tell me a good way to handle stress is exercise.  Did he not just hear me tell him that I ran a half-marathon a few months ago?!  I exercise.  Furthermore, I know these things. I’m in the healthcare biz.

I followed up with my physician a few weeks later to tell him the saga.  I brought my home machine and showed him my numbers, including the one I took right after the dental visit because my blood pressure had stayed elevated for 2 hours afterward.  Typical for WCH. We agreed, yes, it’s White Coat Hypertension (read: you get really, really anxious at dr’s offices, and your adrenaline starts pumping), and perhaps something should be done.  At work I spend my entire day around white coats.  I work in a hospital.  With physicians, nurses, pharmacists, mid-level practitioners, etc.  How could I have this White Coat Nuttiness?

It’s simple.  I’m human.  I’m afraid of being judged, evaluated, criticized.  I had done all the right things by changing my job, my lifestyle, my diet, my weight.  I’m still afraid of someone discovering a disease, uncovering an ugly truth, shining a light on something inside that I don’t want to know.

Well, the result?  I got a prescription for a blood pressure pill.  Regardless of the cause of my hard-pounding vessels, that trauma to my vasculature and vital organs will eventually lead to badness.  Treatment. Prevention.   …but I have yet to return to the dentist.  Bad patient.

  1. Shimbo D, Abdalla M ,Falzon L, Townsend R, Muntner P. Role of Ambulatory and Home Blood Pressure Monitoring in Clinical Practice: A Narrative Review. Ann Intern Med. 163(9):691-700.

Welcome to Puppygeddon

Welcome to Puppygeddon

A text then a ringing doorbell did not send me into panic as it normally does.  The house and my self were a mess.  Technically, I was clean. I did shower and brush my teeth that day, but the absence of makeup and a frizzy topknot contradicted any attempt to impress.  This was in contrast to my house.  The floor hadn’t been swept in nearly 2 months. Dust accumulated everywhere.  Even worse, though, was just the clutter.  Remnants of dog toys and shed fur blanketed the carpet.   Fur would line my socks if I chose not to wear shoes while walking through the house.  When my guests walked in, I saw their eyes widen and jaw slightly drop.  “Welcome to Puppygeddon!” I said sarcastically, to set the mood and their expectations for comfort.  “You should see the backyard.”

Oh, puppies.  This was my second but the first one in my own house.  New carpet. Mortgage. Nice furniture. You get the picture.  My first beast, A, is 5 & ½ years old, and I raised her from 9 weeks old in a third-floor apartment.  Imagine carrying that now 90-lb creature as a 3-month old puppy up and down 3 flights of stairs 5 or 6 times a day, only to have her poop on the carpet despite just having roamed the miniature lawn at the foot of the stairs.  This puppy, W, is 6 or 7 months old, and I’ve only had him a month.  He’s house-trained for bowel purposes, and he is much smarter than A ever was…but he is still a puppy.

The world is his playground, and he explores it with his mouth.  When A was a puppy, she did this too, but the carpet was old, the furniture was to be donated at the next move, and the digs were rented.  She taught me a lot about what to expect, but Puppy W is a disrupter.  I had to recalibrate and puppy-proof the house.  His propensity toward tv remotes and electrical wires was one I had not encountered before, but his fascination with shoes and stinky socks and underthings, I should have anticipated.  I had to close doors, place hard plastic things above the level of the coffee table (and his eyes), and be ever aware of new or absent puppy noises.  Both signal destruction.

The backyard was another new experience for me.  Dog A never had a backyard as a puppy.  She is now a more mature, wandering dog.  Sure, the yard is a minefield of poop (as the guy who mows my lawn likes to remind me), but I didn’t have to worry about freshly dug holes and plants being ripped out of the earth.  Now, Puppy W had a reputation of digging holes when he arrived, but as I expected Puppy W plus Dog A equals endless wrestling and chasing.  No time for holes.  Sort of.  There had been black weed cloth to cover a flower bed I never used.  It was well-buried and immovable from my perspective, but W had his way.  Now there are little shredded black pieces of cloth as well as double the amount of landmines lining the yard from fence to fence.  At least it’ll be well-fertilized.

Puppy W is cute.  His personality is that of a charmer.  He knows when it’s time to go to his crate for the night, and lies limp on the floor in the corner, daring me and knowing that I will strain my back to pick him up or at least get him started in the right direction.  Dog A is cute, beautiful even, but she is definitely not a charmer.  She is my protector and much like me.  Her personality is so deeply rooted in what she is, what she does, that the social easiness required of a charmer in seemingly unproductive situations eludes her.  She’s an introvert.  She has a job, she knows what it is, she can do it, but it’s also all or nothing.  It’s either turned on or turned off.  As for her barking and growling at passersby, it’s mostly turned on.  And it’s loud.

The disruption of an extroverted, lovely puppy and all the exuberance that comes with puppyness, has taken its toll on us, A and me.  But it’s good.  A definitely needs to learn that other animals can share our space without assault.  I suppose it’s always good for a singleton to invite more living beings into one’s sphere, but I truly believe A took up enough space that I didn’t need more.  Oh well, I’m a sucker.  It’s a lesson and a friend for A and a distraction and destruction of expectation and routine for me.  So, the other day when another friend came over and gasped at the strings extruded from rope knots, cotton stuffing strewn about, and dismembered toys all over the floor, she immediately began cleaning my puppygeddon.  I just laughed at how normal it had become.  I also know that puppygeddon will soon end.  I can clean my house then.