Relaxation

The view from our 18th floor hotel room at the Caribe Hilton, San Juan

We have been in Puerto Rico these last 10 days or so. I have never needed a vacation like as badly as I did when we came. Can't remember when I've slept so much or so hard, and have been able to do anything or nothing. As I sit here on the balcony of the Rincon Beach Resort and Hotel, I am looking out onto a turquoise ocean, white sand, and beautiful palm trees lazily moving with the ocean breeze. There is an infinity pool, several cabanas, and acres of abandoned beaches stretching in either direction.

We spent six days with Sam's family over on the East side of the island, then three days at the Caribe Hilton in San Juan. I have never enjoyed a place like that hotel and Old San Juan. If you would like to see pictures of our trip, go to http://picasaweb.google.com/HernandezHouse08/PuertoRico2010# and double click on the first picture. You can look through and see where we've been and some of the sights so far. I am just far too lazy just now to try to upload these pictures here.

El Morro sentry tower at the gate of Puerto Rico, Old San Juan

I think that I'm even getting a hint of color in my cheeks and arms. It is rare to find someone more white than I am, so this is gratifying. When I left work at the last day before vacation, the Chair of my department intoned, "You need to be outside more, Barbara." Then Sam's auntie told me the same thing. Of course, the girls have always thought that I'm hilariously pasty-faced, so being outside in the sun may give me an advantage in more ways than I ever considered!
I think we're going kayaking in the ocean today, around the bends and over the backs of fish. The ocean is so clean here that one can look down about 4 feet and see fish swimming around, stones, shells, etc. It is truly beautiful.

One of the things that Sam told me when we bought our house is that he'd love to have it decorated like a Puerto Rican house. I had no idea of what that meant until I got here. But once here, and into several homes and lots of buildings, I am thinking of what would work with our space and belongings...the painting and redesign will really be fun for me. The observation tower in the Rain Forest Preserve

We will be leaving Rincon on Sunday morning, heading back to Levitown to have one last family bash before flying out on Monday morning from San Juan. We are getting weary of life away from the predictability of our own home environment, but it is doing us a world of good to be here. I will truly feel sad as I leave this magical place. We have helped the economy here considerably, and I feel as though I am leaving a pint of blood here--in the stomachs of mosquitoes and no-seeums that have fallen down my shirt and tortured my extremities since I've been here. There is just no lady-like way to rake at a patch of six bites over my "angel bone" on my back!

Porta Coeli, ca. 1609. Oldest church in the Western Hemisphere

The next few months will not be as vexing and stressful as the last few have been, so I hope to be more visible here after next week. Thanks for standing by.

A Sabbath day photo shoot

Here are some pictures that I took last week while I was out meandering about with Mother. I hope you enjoy the sights.

This is our city hall, framed by these lovely orange daisies, with Mount St. Bernardino in the background.

This calla lily is in my front garden, just outside the front door walkway.

These ranunculus were delicate and gorgeous, as are the following--all in one huge flowerbed outside our university athletic center.

Here is Mother looking up as she felt the first drops of rain that almost drowned us a few moments later.

Iceland poppies

These palms are famous in the Inland Valley region where I live. They were planted originally (probably a good 90 years ago) on the outside edges of orange groves, just to identify the end of one person's acerage and the beginning of another's. There are many of these rows of silent gians in our area--always aresting to look at, especially against the stormy sky.

Outside Mission Asistencia--one of the old California Missions.

The old mission.

It was a wonderful meander. I hope to go again soon.

Grand Rounds

I have been building a training program for marriage and family therapists who work with people in medical settings. There is a national trend to include mental health providers alongside physicians in clinics, hospitals, and follow up areas where medical patients are seen. This type of collaboration is still fairly new, but research shows that it pays for itself in reduction of unnecessary physician visits and waste of healthcare dollars. At a time when healthcare is a huge debate, it seems important to try to find ways to stretch these monies. Medical family therapy is one such way.

There are now at least four universities nationwide who teach medical family therapy, one offering a doctoral degree in it. In 2001, the former chair of the department called me in Minnesota and asked if I would be willing to come to this university and head up a new medical family therapy program. In fact, I'd never been trained in it and was unprepared to do that, so I declined. My dissertation wasn't yet completed--another reason not to come out to California.

Little did I know that in 2008 I would be placed in the role to fill a vacancy of the woman hired to do this job. Over time this program has grown and through the grace of God, I have been able to set up a sexual dysfunction clinic (physician, physical therapist and medical family therapy intern). I have placed three students in the hospital where they work alongside the psychiatry residents, doing bedside individual, couple, and family therapy, and also with rehab patients. They negotiate issues between volatile couples whose children are dying, assist contentious family members come to decisions about whether or not to withdraw life support, and work with those who are depressed, anxious, or otherwise emotionally compromised.

I have two interns seeing liver/pancreas and kidney transplant candidates as they wait for organs and either get very sick, get an organ, or die. The stories they tell me each week are amazing--I do not know a more needed resource than family therapy for these folks. The stress on their families is beyond anything that I hope I will ever be called on to endure.

I've placed a student in the perinatal palliative care unit, working with high risk moms who recognize that when they give birth, their babies will die due to a number of pregnancy problems. This intern will also be making follow up home visits to try to help the parents negotiate and manage their (typically) very different grieving styles and needs.

Two interns are in our outreach primary care clinic, providing mental health services in exam rooms for the underserved in our region.

Last but not least, one student is now placed in the medical school simulation lab, working with medical students, residents, and specialty fellows, coaching them on death notification and general attending and communication skills.

All of these folks are practicing under the umbrella of my license and supervision (I pray a lot!)

It seems that my program is on the cusp of really taking off. Students are clamoring to get into it (it's just for doctoral students in our department), and physicians are now taking notice of how much improved their patients are after seeing our interns.

One of the things I've been doing is holding medical family therapy grand rounds once per month. Since my interns are largely from non-medical backgrounds, any exposure to medical equipment, language, or phenomena, are much appreciated. Last week we had a sort of medical tube petting zoo for my students. You can see here, that they really enjoyed working on the manikins in the simulation lab.

After they watched me insert a catheter in this manikin who supposedly had an abdominal incision ("eeeouw" all around), I asked them to get him up on a bedpan. It took the whole group several minutes to figure out how to accomplish this for the 250 lb. patient. It was a major production. Good thing it wasn't a real person trying to hold out!

What a lark! I am having more fun than I thought possible. But it has been all-consuming. This is why I haven't been online for almost a month. Thought you'd like to see what has been happening in my world.