Finally Coming Home

Today was our last day at Momoko's dad's house. We returned home finally, after spending over a month visiting. First we headed for the hospital to see Momoko's mom. En route, we saw a motorcyclist on the ground. He was far from his bike. The accident must have just happened.

Grandma was awake. She was also talkative, but could only communicate by moving her lips. No sounds came out. Spent around twenty minutes talking with her. Had to wash out hands before and after the visit. Wore a gown plus gloves in her room.

Then we put gas into the rental Cadillac XTS. I dropped Momoko off in front of the airline terminal. I then proceeded to the rental car rental center. Took a while for someone to check my car. Almost forgot my book in the back seat. Just missed the shuttle going to the airport.

We tried to eat at Cinnabon. They did not have breakfast sandwiches available, contrary to their posted menu. Instead we went to Moe's. Got sausage breakfast burritos which were spicy. Filled up on soft drinks at the Schlotzsky's dispenser. Our plane arrived on time.

All seats on the flight had be sold. However we somehow got lucky and there was an empty seat between Momoko and I. This was the last day for SouthWest Airlines to serve peanuts on their flights. Little Kat was waiting for us when we touched down. Stopped at McDonald's for a snack.

Short Trip to Neighboring Big City

Momoko and I decided to take a short trip this weekend. We headed two hours northeast of her dad's house. Momoko booked us a room at a hotel for one night. There was a long turnpike that led us there. After checking into the hotel, we headed out for some lunch.


I wanted to go to Fatty's pub. It was across the street from FatBurger. Momoko did not want to go. Then I thought we could go to this Mongolian BBQ. Momoko did not want that either. We ended up going to some Italian place. Yelp told me to order the pepperoni bread. So we did. I also skipped the fries and got a salad with bacon and boiled egg as my side.


That night we caught an early evening showing of Skyscraper, the latest movie starring Dwayne Johnson. The next day we got a continental breakfast and decided to drive downtown. Many of the street were blocked and had detours. There were a number of homeless people. Not much to see really. Therefore we headed home.


On the way home, there was a Nissan Titan overfilled with belongings behind me. I decided I had to stay in front of that disaster waiting to happen. The car went down to half a tank of gas. Stopped at the plaza in the middle of the highway. All the non-diesel pumps were jam packed with people. So I decided to head back to Momoko's dad's house and fill up there.

The Art of Medical Ventilation

We visited grandma on the weekend. There was a new nurse there. She looked at the ventilator and exclaimed that the reading was 55, so grandma was doing good. I quizzed her on what 55 meant. Did not get much info. I talked to the respiratory therapist. She had a lot to say. But I still could not grasp what 55 meant in the big scheme of things.


So I decided to do some research. The ventilator we are talking about is a medical ventilator. In the old days, it was called a respirator. It blows air with extra oxygen into the patient. The air is heated and humidified as well. The ventilator also monitors things such as the air pressure, volume, and rate of flow into the patient.


An invasive use of the ventilator requires a breathing tube to be inserted in the patient. The tube inserted into the patient is called a trach tube during a process called intubation. The tube goes ito the patient's windpipe. The tube can have a cuff, making it a cuffed tube. The cuff holds the tube in place and prevent leaks. Non-invasive use of a ventilator means air is blown into the nose/mouth.


The ventilator is a life critical system. The goal is to wean the patient off the ventilator. A respiratory therapist tunes the settings of the ventilator. There are some risks to using a ventilator such as pneumonia and/or damage to the vocal chords. The ventilator also makes it hard to cough.


There are different techniques a ventilator can control the flow of air into a patient. It can keep up a certain pressure of air. It can also ensure a specific volume of air enters the patient. It could also concentrate on delivering air at certain time periods. Or it can use a combination of pressure, volume, and timing.


There are different modes that a ventilator can be set to run under. AC mode is when the ventilator kicks in to assist each time a patient breathes. SIMV will also kick in when the patient breathes, but only do so for a certain amount of breathes per minutes (the extra breaths are unassisted). The PSV mode is when the ventilator ensures a certain amount of pressure is present when the patient breathes. And finally the ARPV mode provides a constant pressure of air.


There are many readings on the ventilator to control its usage. The respirator rate is how many breathes per minute are delivered. The tidal volume is how much air is sent in per breath. The flow is how fast the air gets delivered to the lungs. The waveform is how the amount of pressure varies over the duration of one breath. And finally there is the oxygen concentration, which I discuss below.


Oxygen concentration is also known as FiO2, or fraction of inspired oxygen. It is expressed as a percentage. It tells you how much oxygen is in the air delivered to the patient. Oxygen in the tank is 100% oxygen. Air is 21% oxygen, but mostly consists of nitrogen. The ventilator artificially adds more oxygen to the air given to the patient.


Patients might initially be given 100% oxygen for a very short amount of time. They will be getting more than 21% oxygen if they are using a ventilator. The percentage could be lower than 40% for some patients. Above 60% oxygen for sustained periods is considered toxic. If you are on 60+% oxygen for more than 12 to 24 hours, you risk damage to the patient. Most of the time, the oxygen concentration will be set to below 50% to prevent toxicity/damage to the patient.

Princess Mononoke Revisited

Momoko and I decided to go see a special feature at the movie theater. They were bringing back Princess Mononoke. This is an animation from 20 years ago. Miyazaki directed it. Studio Ghibli did the animation. Momoko thought she saw it before. However it had been a long time.


While driving up to the theater, we found the parking lot to be full. I went behind the theater. Also full. I drove around the main lot a couple times. Eventually somebody came out and left. We took their space.


I had eaten lunch. So I opted out of popcorn and soft drink. Before the show started the Front & Center pre-show was just some music. A dude in the second row started dancing and then left the theater after a couple minutes.


During the second action sequence in the movie, I realized that I too had seen this movie before. But I forgot almost everything about it. Half way through the show I got hungry. I thought it would be okay as Momoko only eats half her popcorn at each show. This time she got hungry and finished the bag.


On the way out, I got a popcorn for the road. Grandma pre-purchased around 75 medium popcorns for the year. So I got it for no further charge. Sprinkled some cheddar cheese flavoring on it and I was good to go.

Taking a Trip

I wanted to take a day trip with Momoko. She thought we could head to the Northeast. I said we should go South. Turns out Momoko used to like two hours south of her dad's house. So off we went. Momoko thought one day was not enough time. Therefore she rented us a room.


It was strange to see so little civilization as we travelled south. Just a bunch of wide open space and a lot of farm land. I did see that we passed some big government base. However we did not see much until we descended upon our destination.


We got lunch at a pub. It was strangely similar to the one we ate at during our last visit to her parents' house. Checked into the hotel. It has a large full kitchen. I took a nap. Then we went out to see Momoko's middle school. Also found where her mom previously worked.


Tried to eat dinner at this grill. But they place was packed. Could hardly get a parking spot. We instead went to an all you can eat Chinese buffet by our hotel. The next morning we started out with the hotel continental breakfast. Then we were off.


I gassed the car up. Momoko went into the store and got a Sprite. Time to "go home" to Momoko's dad's house.

Getting Greek Food Abroad

Momoko and I have been going out to eat frequently. She asked if we should visit some new café the other day. I thought we should go somewhere else. Her sister had previously recommended a local Greek place for take out.


We got to the Greek place. There seemed to be nobody there except for one employee. I liked that there was a $5.99 special posted on the door. Gyro, fries, and drink for $5.99. When I tried to order it, the employee with a raspy voice said there were two gyro specials. I said I wanted the one that was on the door for $5.99.


The drinks were in cans and were warm. We were provided cups with ice. Some weird children's television show was playing far in the back on an old style TV. We got out meals. The gyro seemed to be lacking the sauce. However, once I got deeper in the pita, I found plenty of sauce.


Momoko got a more expensive salad version of the gyro. I finished up her diet Coke and we took off. A couple other people wandered in after us. The place had a lot of room, contrary to what Momoko's sister said about the establishment. We may return with Little Kat to let him try the special too.