CONGRATULATIONS!!!

I realize that I may be celebrating a tad early, but in order to earn my blog makeover (okay, I already did it - so much for delayed gratification) I have to post today rather than waiting until tomorrow. In any case, I am celebrating the fact that tomorrow is the LAST DAY OF CLASS for Tom in his first semester back to school. Whew!!! I can't believe he (we) made it.

I was going to a post a photo of the man, but he was concerned it would compromise the protection of his identity, and thus the mission, in this world of technosavvy teenagers. You know, can't have too much information out there on the world wide web.

I freely admit that we are crazy (insane), but right before Christmas, completely out of the blue, my husband decided to go back to school...full time...16.5 credit hours full time. That on top of his full time job, job as a scout master, and did I mention he's a joyful dad of nine? (Maybe joyful isn't the word he would use, but in any case...) We survived!

The semester was complicated by the fact that he was unable to get time off in order to go to class. He carefully arranged his schedule to go to whichever classes he could fit in on his lunch hour. David and I took turns picking him up from work, driving him to class (so he wouldn't have to find a place to park), picking him up, and driving him back to work. Some of his classes he couldn't get to, so I went in his place, took notes, turned in papers (that he wrote - just wanted to clarify), etc. His professors were extra accommodating and good to work with. One even came to our home twice to go over things with him and offer excellent suggestions.

Aside from Tom's studying and David's driving, this has truly been a family project. All of our kids have taken on the responsibility for most of the meals. Carmen took on Chamane's laundry, and Kirk did his share of extra little boys' loads. They've all pitched in by getting (sort of) their work done without being asked (as much).

All and all, it's been a great semester, full of all kinds of blessings. After finals, we will have a few silly days of celebration (cleaning our house and doing more jobs) before we start over. The best thing is that now we know we can do it. We know if we all work together, we can pull off a miracle in order to help our dad fulfill his dreams and goals. That's a pretty great family project!

Sound Familiar??

Sorry, but I couldn't resist.

1. Abolition of property in land and application of all rents of land to public purposes.

2. A heavy progressive or graduated income tax.

3. Abolition of all right of inheritance.

4. Confiscation of the property of all emigrants and rebels.

5. Centralization of credit in the hands of the State, by means of a national bank with State capital and an exclusive monopoly.

6. Centralization of the means of communication and transport in the hands of the State.

7. Extension of factories and instruments of production owned by the State; the bringing into cultivation of wastelands, and the improvement of the soil generally in accordance with a common plan.

8. Equal liability of all to labour. Establishment of industrial armies, especially for agriculture.

9. Combination of agriculture with manufacturing industries; gradual abolition of the distinction between town and country, by a more equable distribution of the population over the country.

10. Free education for all children in public schools. Abolition of children's factory labour in its present form. Combination of education with industrial production, etc., etc.

-- The Communist Manifesto -- Marx

Josh's History and Physical Examination

CHIEF COMPLAINT
1. Subungual hematoma of the 1st finger, left hand.
2. Status post dyspilectomy and clipping. See link for details.

HISTORY OF PRESENT ILLNESS
The patient is a 6-year-old white male who was brought in by his mother and seen in consultation for ecchymotic discoloration and mild tenderness of the subungual region of the distal phalanx of the 1st finger, left hand, secondary to blunt trauma. There is an area of subcutaneous bleeding in the proximal portion of the nail that measures approximately 4.5 x 4 cm. Patient is no longer experiencing any significant pain at rest. His mother states that she has no idea what caused the bleeding. Patient himself states "I'm just not that good with a hammer."

PAST MEDICAL HISTORY
Past medical history is positive for head injury with epidermal sutures.

SOCIAL HISTORY
Mother's ambivalence is probably due to the fact that the patient lives with his parents, 6 brothers and 2 sisters. He does not drink or smoke. He does however work, vacuuming the floor in his family's home.

MEDICATIONS
None.

ALLERGIES
None.

PHYSICAL EXAMINATION
GENERAL: Patient is a well-nourished, well-developed white male in no acute distress.
HEENT: Pupils are round and reactive to light. Extraocular muscles are intact. Sclarae are clear, nonicteric. Tympanic membranes intact. Nares patent. Oropharynx clear.
NECK: Supple, without adenopathy. No carotid bruits are heard.
LUNGS: Lungs clear to auscultation. No rhonchi, rales, or wheezing.
CHEST: Heart is regular rate and rhythm, without murmur.
ABDOMEN: Slightly distended secondary to lunch x2.
EXTREMITIES: Extremities without edema. Regular pulses bilaterally. There is an ecchymotic discoloration over the dorsum of the base of the distal phalynx just above the lunula, measuring approximately 4.5 x 5 cm. No onycholysis is noted. No apparent avulsion of extensor tendon.
RECTAL: Deferred.

ASSESSMENT
1. Subungual hematoma of the left distal phalynx of the 1st finger of the left hand, with good hemostasis.
2. Status post dyspilectomy and clipping.

PLAN
Recommend treating the patient with Children's Tylenol 80 mg 1 tablet p.o. t.i.d. p.r.n. pain. It is felt that since there is no longer any significant pain, trephination at the base of the nail is not recommended at this time. Mother will bring him back if there is any further indication of infection or swelling. Otherwise, followup in my office in 2 weeks' time.